Objective: To quantify and compare histopathological differences regarding atherosclerosis and granular media calcinosis (GMC) of ascending aortic aneurysms (AAA), which are associated with aortic stenosis (AS) or aortic regurgitation (AR). Additionally, a subanalysis of patients with bicuspid or tricuspid aortic valve (BAV or TAV), which were contained within the AS and AR group, was conducted. Patients and Methods: From 01/2012 till 12/2015 84 ascending aortic tissue samples were obtained and divided into their convex and concave half during aortic surgery. Aortic surgery was indicated due to AAA in association to AS (AS-AAA group: n = 43) or AR (AR-AAA group: n = 41). Both groups contained 19 patients with TAV. Convex and concave halves of all samples were stained with three different histologic dyes: hematoxylin-eosin (HE) was used as general stain for atherosclerosis, von-Kossa (vKossa) stain and alizarin-red (Ared) stain were used as calcinosis specific dyes. HE stained samples were analyzed using a semi-quantitative score, while calcinosis quantification was carried out by a binary, pixel guided contrast analysis via computer software. Results: In the AR-AAA group, atherosclerosis was two and a half times more often detectable in the concave halves of the tissue samples as in the AS-AAA group (AR-AAA concave: 15 (36%) vs. AS-AAA concave: 6 (13%), p ≤ 0,01). Regarding GMC, tissue samples from AS-AAAs showed a 4,2-4,5% higher mean GMC deposit than their AR-AAA counterparts (p ≤ 0,001). Furthermore, BAV patients within the AS-AAA group showed a 2,1-2,4% higher mean deposit of GMC than their TAV peers (p ≤ 0,002). These finding of higher GMC deposition was consistent for BAV patients contained in the AAA-AR group. Conclusion: AR-AAA are, in comparison with AS-AAA, more prone to develop atherosclerosis. Atherosclerosis will most likely present at the concave curvature of the ascending aorta. AS-AAAs present significant higher mean GMC deposits than AR-AAAs. Combined with a bicuspid morphology of the aortic valve, GMC deposition in AAAs is elevated in comparison to AAAs with TAV morphology. Therefore AS-AAAs with BAV have the highest tendency to develop heavy GMC deposition, compromising the biomechanical structure of the aortic wall.

La poursuite du rythme d’augmentation de l’espérance de vie des générations issue du baby-boom dans les pays développés serait souvent accompagnée de limitations fonctionnelles, d’incapacité, de plus en plus observées dans la population gériatrique. L'objectif général de cette thèse était de contribuer à la connaissance de l’évolution de l’autonomie fonctionnelle des personnes âgées dans une population hétérogène. Il s’agissait dans un premier temps d'identifier des groupes homogènes dans une population hétérogène de personnes âgées suivant la même trajectoire d'autonomie fonctionnelle sur une période de deux ans, ainsi que des facteurs prédictifs potentiels. Dans un second temps, d’analyser les conséquences cliniques des trajectoires et la survie des patients sur la même période d’observation. Le SMAF (Système de Mesure de l’Autonomie Fonctionnelle) et les échelles ADL (Activities of Daily Living) ont été employés comme indicateurs d’évaluation de l’autonomie. Dans ce contexte, des données de 221 patients issues de la cohorte UPSAV (Unité de Prévention, de Suivi et d’Analyse du Vieillissement) ont été exploitées. Nous avons employé trois méthodes d’analyse de trajectoires dont le GBTM (Group-Based Trajectory Modeling), k-means et classification ascendante hiérarchique. Les résultats ont révélé trois trajectoires distinctes d’autonomie fonctionnelle : stable, stable pendant un temps puis détériorée, continuellement altérée. Les facteurs prédictifs des trajectoires obtenus à l’aide de la régression logistique sont des critères socio-démographiques, médicaux et biologiques. Les personnes âgées affectées à la trajectoire de perte d’autonomie (trajectoire continuellement altérée) ont montré de fortes proportions de chutes dommageables. A partir d’un modèle de Cox, les troubles neurocognitifs, l’insuffisance cardiaque, la perte de poids involontaire et l’alcool ont été révélés comme facteurs prédictifs de la survenue du décès. On conclut de ces travaux que l’analyse longitudinale sur deux ans de suivi a permis de trouver des sous-groupes homogènes de personnes âgées en termes d’évolution de l’indépendance fonctionnelle. Quel que soit le niveau d’autonomie, la prévention de l’UPSAV devient utile même si le niveau d’utilité n’est pas le même. La prévention et le dépistage de la perte d’autonomie de la personne âgée suivie sur son lieu de vie doivent être anticipés afin de retarder la dégradation et maintenir l’autonomie à domicile. Des analyses ultérieures devraient s’intéresser à l’exploration de plus larges cohortes de personnes âgées pour confirmer et généraliser notre travail. / The increase in life expectancy of baby boom generations in developed countries would often be accompanied by functional limitations, disability, increasingly observed in the geriatric population. The general objective of this thesis was to contribute to the knowledge of the evolution of the functional independence of older people in a heterogeneous population. First, it was to identify homogeneous groups in a heterogeneous population of elderly people following the same functional independence trajectory over a two-year period, and potential predictive factors. Second, it was to analyze the clinical consequences of trajectories and patient survival over the same observation period. The SMAF (Système de Mesure de l'Autonomie Fonctionnelle) and ADL (Activities of Daily Living) scales were used as indicators for measuring independence. Analysis were performed from a sample of 221 patients of UPSAV (Unit for Prevention, Monitoring and Analysis of Aging) cohort. We used three methods including trajectory analysis including GBTM (Group-Based Trajectory Modeling), k-means and ascending hierarchical classification. The results suggest three distinct trajectories of functional independence: stable, stable then decline, continuously decline. The predictors of trajectories obtained using logistic regression are socio-demographic, medical and biological criteria. Patients assigned to the loss of independence trajectory (continuously altered trajectory) reported high proportions of injurious falls. Based on a Cox model, neurocognitive disorders, heart failure, involuntary weight loss and alcohol were revealed as predictors of death. We conclude from this work that the two-year longitudinal analysis identified homogeneous subgroups of elderly people in terms of changes in functional independence. The prevention of UPSAV becomes a useful even if the utility level is not the same. Prevention and screening of the loss of independence of the elderly person followed at home must be anticipated in order to delay the deterioration and to maintaining the autonomy. Future analyses should focus on exploring large cohorts of older people to confirm and generalize our research.

Die bikuspide Aortenklappe gilt als Risikofaktor für das frühzeitige und häufige Auftreten von Aortenklappenvitien, Aneurysmen und Dissektionen. Das Ziel dieser Arbeit ist es, ein begründetes chirurgisches Therapiekonzept für Patienten mit bikuspider Aortenklappe und Dilatation der Aorta ascendens zu entwickeln. Wir analysierten die Daten von 555 Patienten mit bikuspider und 2015 Patienten mit trikuspider Aortenklappe, die sich in unserer Einrichtung einer Operation an der Aortenklappe und/ oder einem Eingriff im Bereich der Aorta ascendens unterzogen. Die Aorta ascendens wurde angiographisch, echokardiographisch und mittels CT auf ihre Konfiguration analysiert und histologisch und histomorphometrisch beschrieben. Auch wurden die Langzeitergebnisse nach Aorta ascendens Reduktionsplastik erfasst. Bei Patienten mit bikuspider Aortenklappe sind mit zunehmendem Durchmesser der Aorta ascendens häufiger die histologischen Zeichen einer Dilatation zu finden. Schwerere strukturelle Veränderungen, insbesondere eine höhergradige zystische Medianekrose, sind nicht zu beobachten. Die Aorta Ascendens Reduktionsplastik zeigt bei Patienten mit bikuspider Aortenklappe und Dilatation der Aorta ascendens gute Langzeitergebnisse. Nur bei Patienten mit nicht optimaler Durchmesser-Reduktion bei der Operation kommt es zu einer späteren Redilatation. / The bicuspid aortic valve is a known risk factor for the early and frequent occurrence of aortic valve defects, aneurysms and dissections. This study aims to develop an appropriate surgical therapy concept for patients with bicuspid aortic valve and dilatation of the ascending aorta. The data of 555 patients with bicuspid and 2015 patients with tricuspid aortic valve who underwent surgical treatment of the aortic valve and/or of the ascending aorta at our institution were evaluated. We analyzed the configuration of the ascending aorta by angiography, echocardiography and CT and described the aortic wall by histological and histomorphometric examination. We also analyzed the long-term results after reduction aortoplasty of the ascending aorta. Histological examination of the aortic wall specimens showed that patients with bicuspid aortic valve with increased diameter of the ascending aorta more often have histological signs of dilatation. More severe histological changes such as cystic media necrosis did not occur. Reduction aortoplasty of the ascending aorta shows good long-term results in patients with bicuspid aortic valve and dilatation of the ascending aorta. Only in patients in whom surgical reduction is less than optimal does redilatation occur later.

To investigate the roles of different dorsal spinal pathways in controlling movements in rats, I performed lesions of specific spinal pathways and measured the behaviour abilities of rats using different sensorimotor behavioural tests. The first experiment was designed to understand the contribution of sensory pathways traveling in the dorsal funiculus during locomotion and skilled movements using sensitive behavioural tests. I demonstrated that ascending sensory fibers play an important role during overground locomotion and contribute to skilled forelimb movements. The second experiment compared the differences in sensorimotor abilities caused by dorsal funicular lesions performed at two different levels of rat spinal cord. My results showed that the pathways present in the cervical and thoracic dorsal funiculus exert different functional effects over control of limb movement during locomotion. The third experiment investigated the compensatory potential of dorsal funicular pathways after dorsolateral funicular injuries in rats. My results showed that dorsal funicular pathways do not compensate for loss of dorsolateral pathways during the execution of locomotor tasks, though there is indirect evidence that rats with dorsolateral funicular lesions might rely more on ascending sensory pathways in the dorsolateral funiculus during skilled forelimb movements. Finally, the fourth experiment was designed to investigate the compensation from dorsolateral funicular pathways after injuries to pyramidal tract in rats. I demonstrated that pathways running in the spinal dorsolateral funiculus do provide compensatory input to spinal circuitry to maintain skilled reaching abilities after lesions of the pyramidal tract but these same pathways do not appear to compensate during either overground locomotion or skilled locomotion. Thus, this compensatory response is task-specific. These results highlight the fact that behavioural context determines the nature of compensation from spared pathways after spinal cord injuries.

To investigate the roles of different dorsal spinal pathways in controlling movements in rats, I performed lesions of specific spinal pathways and measured the behaviour abilities of rats using different sensorimotor behavioural tests. The first experiment was designed to understand the contribution of sensory pathways traveling in the dorsal funiculus during locomotion and skilled movements using sensitive behavioural tests. I demonstrated that ascending sensory fibers play an important role during overground locomotion and contribute to skilled forelimb movements. The second experiment compared the differences in sensorimotor abilities caused by dorsal funicular lesions performed at two different levels of rat spinal cord. My results showed that the pathways present in the cervical and thoracic dorsal funiculus exert different functional effects over control of limb movement during locomotion. The third experiment investigated the compensatory potential of dorsal funicular pathways after dorsolateral funicular injuries in rats. My results showed that dorsal funicular pathways do not compensate for loss of dorsolateral pathways during the execution of locomotor tasks, though there is indirect evidence that rats with dorsolateral funicular lesions might rely more on ascending sensory pathways in the dorsolateral funiculus during skilled forelimb movements. Finally, the fourth experiment was designed to investigate the compensation from dorsolateral funicular pathways after injuries to pyramidal tract in rats. I demonstrated that pathways running in the spinal dorsolateral funiculus do provide compensatory input to spinal circuitry to maintain skilled reaching abilities after lesions of the pyramidal tract but these same pathways do not appear to compensate during either overground locomotion or skilled locomotion. Thus, this compensatory response is task-specific. These results highlight the fact that behavioural context determines the nature of compensation from spared pathways after spinal cord injuries.

Magnetic resonance images (MRI) are acquired by sampling the current of induced electromotiveforce (EMF). EMF is induced due to flux of the net magnetic field from coherent nuclear spins with intrinsic magnetic dipole moments. The spins are excited by (non-ionizing) radio frequency electromagnetic radiation in conjunction with stationary and gradient magnetic fields. These images reveal detailed internal morphological structures as well as enable functional assessment of the body that can help diagnose a wide range of medical conditions. The aim of this project was to unwrap phase contrast cine magnetic resonance images, targeting the great vessels. The maximum encoded velocity (venc) is limited to the angular phase range [-π, π] radians. This may result in aliasing if the venc is set too low by the MRI personnel. Aliased images yield inaccurate cardiac stroke volume measurements and therefore require acquisition retakes. The retakes might be avoided if the images could be unwrapped in post-processing instead. Using computer vision, the angular phase of flow measurements as well as the angular phase of retrospectively wrapped image sets were unwrapped. The performances of three algorithms were assessed, Laplacian algorithm, sequential tree-reweighted message passing and iterative graph cuts. The associated energy formulation was also evaluated. Iterative graph cuts was shown to be the most robust with respect to the number of wraps and the energies correlated with the errors. This thesis shows that there is potential to reduce the number of acquisition retakes, although the MRI personnel still need to verify that the unwrapping performances are satisfactory. Given the promising results of iterative graph cuts, next it would be valuable to investigate the performance of a globally optimal surface estimation algorithm.