Bakgrund Patienter med neurologiska sjukdomar är ofta i behov av rehabiliterande insatser för att kunna bibehålla kroppsliga funktioner och klara av dagliga aktiviteter. I vissa fall får dessa patienter möjlighet att delta i rehabiliteringsperioder i ett varmt klimat (klimatvård). En rehabiliteringsperiod pågår oftast i 3-4 veckor och inkluderar multidisciplinär vård med bland annat fysioterapi. Det finns en begränsad kännedom gällande upplevelser av fysioterapeutiska insatser vid klimatvård och dess effekter. Syfte Syftet med denna intervjustudie var att undersöka och beskriva erfarenheter och upplevelser av fysioterapeutiska insatser vid klimatvård bland patienter med neurologiska sjukdomar. Design och metod Studien var kvalitativ med en explorativ design där data inhämtades genom fem semistrukturerade intervjuer. Vid databearbetning användes kvalitativ innehållsanalys med induktiv ansats. Resultat Studiens resultat tyder på att den fysioterapeutiska behandlingen var central och att individanpassad intensivträning upplevdes som fördelaktigt av studiens deltagare. Ett patientcentrerat arbetssätt framkom som viktigt för rehabiliteringens resultat. Andra faktorer som beskrevs som värdefulla och påverkade den totala rehabiliteringen var det varma klimatet, det sociala utbytet med andra deltagare samt att komma ifrån sin vardagliga kontext. Ökad motivation till fysisk aktivitet framkom som en viktig effekt av att få klimatvård. Konklusion Socialt stöd, det varma klimatet och lyhörd rehabiliteringspersonal bidrog till en positiv upplevelse av de fysioterapeutiska insatserna vid klimatvård. Upplevelser av ökad motivation till fysisk aktivitet och fler positiva hälsoeffekter innebär att klimatvård skulle kunna betraktas som ett värdefullt komplement till rehabiliterande vård. / Background Patients with neurological diseases are often in need of rehabilitative medical care in order to sustain body-function and manage activities in daily life. In some cases, rehabilitation in a warm climate is offered to patients within this group. The rehabilitation period often includes multidisciplinary medical care and will go on for 3-4 weeks. Physiotherapy is commonly a central part of the period. There is limited knowledge in regard to the experiences of receiving physiotherapy during a rehabilitation period in a warm climate and its effects. Purpose/Aim of the study The aim of the present study was to explore and describe experiences of receiving physiotherapy during a rehabilitation stay in a warm climate among patients with neurological diseases. Design & Method This study had a qualitative and exploratory design were data was collected through five semi-structured interviews. To analyze the data a qualitative, inductive approach was used. Result The result of this study suggest that physiotherapy was a central part of the rehabilitation stay and that intensive and individually designed exercise programs were beneficial. Patient-centered care was described as important to the result of the stay. Factors such as the warm climate, social support and being away from one’s daily environment were reported to be crucial in regard to the total rehabilitation experience. An enhanced level of motivation to physical activity was described as an important effect of receiving medical care in a warm climate. Conclusion Social support, a warm climate and responsive health care professionals contributed to a positive experience of receiving physiotherapy as a part of a rehabilitation stay. Experiences of enhanced motivation towards physical activity and more positive health outcomes suggest that a rehabilitation stay in a warm climate could be considered as a medical care complement.

This diploma thesis deals with the topic of nutritional support in patients with neurological diseases (stroke, craniocerebral trauma, critical-illness-polyneuropathy. The aim of this thesis is to find out, how implemented unified system of nutritional support affects the well-being of patients at neuro-rehabilitation clinic Asklepios Schlossberg Klinikum in Bad König. There were observed 58 patients (33 men and 25 women) during 8 weeks. The theoretical part of this thesis describes basic components of nutrition, energy expenditure and needs, selected neurological diseases, dysphagia, malnutrition and nutrition in intensive neurological care. The practical part of the thesis analyses data obtained by the observation. There are observed changes of body weight, BMI and laboratory values of total protein and albumin in serum. These data are divided by sex, age and type of disease. Based on the results, it was found that although patients due to uniform tube feeding do not have sufficient protein intake, serum total protein and albumin levels increased. This can be caused by eating a uniform diet that contains good quality protein in patients, which suffered from hypoalbunemia at the outset of observation, also by reducing the effect of stress reactions with gradual improvement of the state and...

京都大学 / 新制・課程博士 / 博士(工学) / 甲第24812号 / 工博第5155号 / 新制||工||1985(附属図書館) / 京都大学大学院工学研究科マイクロエンジニアリング専攻 / (主査)教授 横川 隆司, 教授 安達 泰治, 教授 永樂 元次 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DGAM

A mutação espontânea tremor (tr) , autossômica recessiva, foi identificada na colônia de camundongos Swiss no Biotério do Departamento de Patologia da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo. Os mutantes apresentaram como principais características fenotípicas tremores, ataxia e convulsões tônicas audiogênicas. Por meio de dez retrocruzamentos essa mutação foi transferida para a linhagem congênica C57BL/6 (N10). O mapeamento genético com marcadores microssatélites distribuídos pelo genoma do camundongo indicou que a mutação tr encontra-se no cromossomo 14, na região entre 33,21 e 38,21 cM, tendo como possível candidato o gene Egr3 (Early Growth Response 3). O presente estudo teve como objetivo caracterizar o fenótipo comportamental do camundongo mutante tremor. A caracterização do fenótipo dos camundongos mutantes Swiss foi realizada a partir do nascimento até a idade adulta. Os parâmetros do desenvolvimento físico analisados foram: desdobramento das orelhas, erupção dos dentes incisivos, abertura dos olhos, surgimento da pelagem completa, ganho de peso e comprimento dos filhotes e desenvolvimento sexual. No desenvolvimento reflexológico foram analisados: preensão palmar, geotaxia negativa, endireitamento de postura e sobressalto. No 21&ordem; dia de vida foi realizado o teste de campo aberto para analisar a atividade geral dos animais, e no 60&ordem; dia esse teste foi repetido, juntamente com testes para analisar parâmetros comportamentais. Os testes realizados em campo aberto foram ordenados por parâmetro avaliado; 1) atividade geral dos animais e sistema sensorial: frêmito vocal, irritabilidade, reflexo auricular, aperto de cauda, reflexo corneal e resposta ao toque; 2) testes psicomotores: trem posterior, reflexo de endireitamento, tônus corporal e força de agarrar; 3) avaliação do sistema nervoso central: tremores, cauda em pé, micção e defecação. Demais testes realizados analisaram: comportamento em labirinto em cruz elevada, coordenação motora em trave elevada, memória espacial no labirinto em T, e respostas comportamentais nos testes de natação forçada e de suspensão pela cauda. Exceto pelo menor peso no desmame, os parâmetros de desenvolvimento analisados não apresentaram diferenças significativas entre os mutantes e controles, o que confirmou a hipótese de que as alterações fenotípicas somente são perceptíveis a partir de 3 semanas de vida. A caracterização comportamental do fenótipo também foi realizada nos mutantes em fundo genético C57BL/6, de ambos os sexos, com 8 semanas de idade. Em relação aos camundongos controle, nos mutantes houve aumento da presença de cauda em pé, da ataxia e do tremor; menor frequência de levantar e de limpeza do corpo (grooming); redução da coordenação motora, indicando evidente prejuízo motor. Também foram observadas respostas negativas à ansiedade e hiperatividade, mas não houve alteração na memória espacial dos mutantes. Os resultados indicaram que o mutante tremor apresentou prejuízos de origem no sistema nervoso central; demostraram também que o fenótipo observado coincide com as alterações descritas na literatura, sugerindo o gene Egr3 como possível candidato para a mutação. A caracterização fenotípica desse animal é importante no entendimento das alterações causadas pela mutação e se essa apresenta potencial como modelo para doenças neurológicas. / The autosomal recessive spontaneous mutation tremor (tr) was identified in the Swiss mice colony of the laboratory animal facility of the Department of Pathology, from Faculdade de Medicina Veterinária e Zootecnia - Universidade de São Paulo. The mutants presented tremors, ataxia and audiogenic tonic convulsions as the main expressive characteristics. This mutation was moved from Swiss onto C57BL/6 by ten backcrosses (N10). Genetic mapping with microsatellite markers distributed through the mouse genome showed that the mutation is on 14 chromosome, between 33.21 and 38.21 cM, making Egr3 (Early Growth Response 3) a candidate gene. This study aimed to characterize the behavior phenotype of the tremor mice. Phenotypic characterization of the Swiss mutant mice was performed from birth to adulthood. The physical development points analyzed were: unfolding of the ears, eruption of the incisor teeth, opening the eyes, complete fur, weight gain and length, and sexual development. The reflexology development ones were: palmar grip, negative geotaxia, posture straightening and reaction to sound. On the 21day-old the open field test was performed to analyze the activity of the animals, and on the 60-day-old this task was repeated along with tests to analyze behavioral parameters. The tests performed in the open field were evaluated by parameters; 1) general activity and sensory system: vocalization, irritability, auricular reflex, tail flick, corneal reflex and response to touch; 2) psychomotor tests: hindquarter fall, surface-rightingreflex, body tone and grasping strength; 3) evaluation of the central nervous system: tremors, straub tail, micturitionand defecation. Other tests analyzed: behavior in elevated plus maze, motor coordination in balance beam test, spatial memory in T maze alternation test, and behavioral responses in forced swing and tail suspension tests. Except for the lower weight at weaning, the development parameters analyzed did not show significant differences between the mutants and controls, which confirmed the hypothesis that phenotypic changes are only perceptible after 3weeks-old. The behavioral characterization of the phenotype was also performed on 8-week-old C57BL/6 mutants of both sexes. In comparison to the control mice, in the mutants there were an increase in the presence of straub tail, ataxia and tremor; less frequent rearing and grooming; less motor coordination, indicating evident motor impairment. Negative responses to anxiety and hyperactivity were also observed, but there was no change in the spatial memory of the mutants. The results indicated that the tremor mutant presented damages in the central nervous system; also showed that the phenotype coincides with the changes described in the literature, suggesting the Egr3 gene as a possible candidate for the mutation. The phenotypic characterization of this animal is important to clarify impairments caused by the genetic mutation, and also identify if this potential model could be useful to study neurological diseases.

Neste trabalho utilizamos diferentes abordagens para o estudo de genes associados com desenvolvimento e funcionamento do SNC assim como com doenças neurológicas: 1) uma das abordagens consistiu na identificação do alelo associado a uma forma de retardo mental sindrômico com herança recessiva ligada ao cromossomo X, síndrome de Snyder-Robinson, em uma família Brasileira. Utilizando as estratégias de estudo de ligação genética e análise de genes candidatos, identificamos a segunda mutação patogênica no gene SMS (que codifica a enzima espermina sintase) associada à síndrome de Snyder-Robinson. A identificação dessa mutação contribuiu para: delinear e expandir o espectro clínico da síndrome, evidenciar domínios importantes para o funcionamento da proteína espermina sintase, comprovar a importância dessa proteína nos processos cognitivos, e também possibilitar um aconselhamento genético preciso para membros da família; 2) outra abordagem consistiu em analisar (triar mutação) o gene codificador da proteína colibistina (ARHGEF9), a qual está envolvida em sinaptogênese inibitória, em pacientes Brasileiros portadores de hiperecplexia (6 pacientes) e em pacientes portadores de retardo mental associado com epilepsia (22 pacientes). Não identificamos nenhuma alteração patogênica no gene ARHGEF nos 28 pacientes estudados; contudo, o número de pacientes analisados foi muito pequeno. Julgamos que a análise de um número maior de pacientes com essas doenças neurológicas pode vir a revelar novas mutações deletérias em ARHGEF9; 3) a última abordagem consistiu no estudo funcional da proteína colibistina. Com o objetivo de identificar outras proteínas que interagem com a colibistina humana utilizamos o sistema de duplo-híbrido em leveduras e experimentos de co-imunoprecipitação in vitro e in vivo. Identificamos a proteína eIF3-p40 interagindo com a proteína colibistina e também com a proteína gefirina (a qual, por sua vez, também interage com colibistina e está envolvida com funcionamento de sinapses inibitórias). A proteína eIF3-p40 é uma das subunidades do complexo do fator 3 de iniciação de tradução protéica em eucariotos (eIF3). Essas interações ligam as proteínas colibistina e a gefirina à maquinaria de tradução protéica, revelando uma provável nova função dessas proteínas no controle da tradução em sítios pós-sinápticos inibitórios. / In this work we have used different approaches to the study of genes associated with CNS development and function as well as with neurological diseases: 1) one study involved the identification of the allele associated with an X-linked recessive sindromic form of mental retardation, Snyder-Robinson syndrome, in a Brazilian family. Using genetic linkage analysis and candidate gene strategy, we identified the second pathogenic mutation in the SMS gene (that encodes the spermine synthase enzyme) associated with the Snyder-Robinson syndrome. The identification of this mutation contributed to: the delineation and expansion of the clinical spectrum of the syndrome, highlight important domains for spermine synthase protein functioning, demonstrate the importance of this protein in cognitive processes, and also a precise genetic counseling for family members; 2) a second study involved the mutation screening of ARHGEF9, gene encoding the collybistin protein, which is involved in inhibitory synaptogenesis, in Brazilian patients with hyperekplexia (6 patients) and in patients with mental retardation associated with epilepsy (22 patients). We did not identify any pathogenic alteration in the ARHGEF9, gene in the 28 studied patients, but the number of patients analysed was very small. However, the possibility remains that additional mutations in ARHGEF9, may contribute to other cases of hyperekplexia and mental retardation associated with epilepsy; 3) the last study involved the functional analysis of collybistin protein. In order to identify other proteins that interact with human collybistin, we used the yeast two-hybrid system and in vitro e in vivo co-immunoprecipitation experiments. We identified the eIF3-p40 protein as collybistin and gephyrin (another protein involved in the function of inhibitory synapses that also interacts with collybistin) binding partner. The eIF3-p40 protein is one of the subunits of the eukaryotic initiation factor 3 complex (eIF3). These interactions link the collybistin and gephyrin proteins to the protein translation machinery, revealing a putative new role of these proteins in the translation control at inhibitory postsynaptic sites.

A mutação espontânea tremor (tr) , autossômica recessiva, foi identificada na colônia de camundongos Swiss no Biotério do Departamento de Patologia da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo. Os mutantes apresentaram como principais características fenotípicas tremores, ataxia e convulsões tônicas audiogênicas. Por meio de dez retrocruzamentos essa mutação foi transferida para a linhagem congênica C57BL/6 (N10). O mapeamento genético com marcadores microssatélites distribuídos pelo genoma do camundongo indicou que a mutação tr encontra-se no cromossomo 14, na região entre 33,21 e 38,21 cM, tendo como possível candidato o gene Egr3 (Early Growth Response 3). O presente estudo teve como objetivo caracterizar o fenótipo comportamental do camundongo mutante tremor. A caracterização do fenótipo dos camundongos mutantes Swiss foi realizada a partir do nascimento até a idade adulta. Os parâmetros do desenvolvimento físico analisados foram: desdobramento das orelhas, erupção dos dentes incisivos, abertura dos olhos, surgimento da pelagem completa, ganho de peso e comprimento dos filhotes e desenvolvimento sexual. No desenvolvimento reflexológico foram analisados: preensão palmar, geotaxia negativa, endireitamento de postura e sobressalto. No 21&ordem; dia de vida foi realizado o teste de campo aberto para analisar a atividade geral dos animais, e no 60&ordem; dia esse teste foi repetido, juntamente com testes para analisar parâmetros comportamentais. Os testes realizados em campo aberto foram ordenados por parâmetro avaliado; 1) atividade geral dos animais e sistema sensorial: frêmito vocal, irritabilidade, reflexo auricular, aperto de cauda, reflexo corneal e resposta ao toque; 2) testes psicomotores: trem posterior, reflexo de endireitamento, tônus corporal e força de agarrar; 3) avaliação do sistema nervoso central: tremores, cauda em pé, micção e defecação. Demais testes realizados analisaram: comportamento em labirinto em cruz elevada, coordenação motora em trave elevada, memória espacial no labirinto em T, e respostas comportamentais nos testes de natação forçada e de suspensão pela cauda. Exceto pelo menor peso no desmame, os parâmetros de desenvolvimento analisados não apresentaram diferenças significativas entre os mutantes e controles, o que confirmou a hipótese de que as alterações fenotípicas somente são perceptíveis a partir de 3 semanas de vida. A caracterização comportamental do fenótipo também foi realizada nos mutantes em fundo genético C57BL/6, de ambos os sexos, com 8 semanas de idade. Em relação aos camundongos controle, nos mutantes houve aumento da presença de cauda em pé, da ataxia e do tremor; menor frequência de levantar e de limpeza do corpo (grooming); redução da coordenação motora, indicando evidente prejuízo motor. Também foram observadas respostas negativas à ansiedade e hiperatividade, mas não houve alteração na memória espacial dos mutantes. Os resultados indicaram que o mutante tremor apresentou prejuízos de origem no sistema nervoso central; demostraram também que o fenótipo observado coincide com as alterações descritas na literatura, sugerindo o gene Egr3 como possível candidato para a mutação. A caracterização fenotípica desse animal é importante no entendimento das alterações causadas pela mutação e se essa apresenta potencial como modelo para doenças neurológicas. / The autosomal recessive spontaneous mutation tremor (tr) was identified in the Swiss mice colony of the laboratory animal facility of the Department of Pathology, from Faculdade de Medicina Veterinária e Zootecnia - Universidade de São Paulo. The mutants presented tremors, ataxia and audiogenic tonic convulsions as the main expressive characteristics. This mutation was moved from Swiss onto C57BL/6 by ten backcrosses (N10). Genetic mapping with microsatellite markers distributed through the mouse genome showed that the mutation is on 14 chromosome, between 33.21 and 38.21 cM, making Egr3 (Early Growth Response 3) a candidate gene. This study aimed to characterize the behavior phenotype of the tremor mice. Phenotypic characterization of the Swiss mutant mice was performed from birth to adulthood. The physical development points analyzed were: unfolding of the ears, eruption of the incisor teeth, opening the eyes, complete fur, weight gain and length, and sexual development. The reflexology development ones were: palmar grip, negative geotaxia, posture straightening and reaction to sound. On the 21day-old the open field test was performed to analyze the activity of the animals, and on the 60-day-old this task was repeated along with tests to analyze behavioral parameters. The tests performed in the open field were evaluated by parameters; 1) general activity and sensory system: vocalization, irritability, auricular reflex, tail flick, corneal reflex and response to touch; 2) psychomotor tests: hindquarter fall, surface-rightingreflex, body tone and grasping strength; 3) evaluation of the central nervous system: tremors, straub tail, micturitionand defecation. Other tests analyzed: behavior in elevated plus maze, motor coordination in balance beam test, spatial memory in T maze alternation test, and behavioral responses in forced swing and tail suspension tests. Except for the lower weight at weaning, the development parameters analyzed did not show significant differences between the mutants and controls, which confirmed the hypothesis that phenotypic changes are only perceptible after 3weeks-old. The behavioral characterization of the phenotype was also performed on 8-week-old C57BL/6 mutants of both sexes. In comparison to the control mice, in the mutants there were an increase in the presence of straub tail, ataxia and tremor; less frequent rearing and grooming; less motor coordination, indicating evident motor impairment. Negative responses to anxiety and hyperactivity were also observed, but there was no change in the spatial memory of the mutants. The results indicated that the tremor mutant presented damages in the central nervous system; also showed that the phenotype coincides with the changes described in the literature, suggesting the Egr3 gene as a possible candidate for the mutation. The phenotypic characterization of this animal is important to clarify impairments caused by the genetic mutation, and also identify if this potential model could be useful to study neurological diseases.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A retrospective study including dogs with neurological disease was conducted at the Service of Neurology (SN) of the Veterinary Teaching Hospital, Universidade Federal de Santa Maria (UFSM) between 2006 and 2013, with the objective to identify and characterize the age, breed and sex, neurological diseases and classify them according to the anatomical region and DINAMIT-V acronym. Were evaluated 1.277 neurological records of dogs and obtained the information for inclusion in the study in 1.184 of them being the etiological diagnosis in 525 (44,4%) and presumptive in 659 dogs (55,6%). The most common breeds were dachshunds (27,5%), followed by mixed breed. The most common sites were the spinal cord between T3-L3 (40,9%) and thalamus-cortex (17,5%). Most dogs were diagnosed with degenerative disorders (49%), being disc disease intervertebral more observed, followed inflammatory/infectious disease (16,6%). It can be concluded that the higher prevalence of neurological disorders in dogs involve the spinal cord and thalamus-cortex, with the most frequent being degenerative and the data obtained may assist future studies associated with frequency and distribution of the main neurological diseases in dogs. / Foi realizado um estudo retrospectivo de cães atendidos no Serviço de Neurologia (SN) do Hospital Veterinário Universitário (HVU) da Universidade Federal de Santa Maria (UFSM), entre 2006 e 2013, com o objetivo de identificar e caracterizar a idade, raça e sexo, as doenças neurológicas e classificá-las de acordo com a região anatômica e acrônimo DINAMIT-V. Foram avaliadas 1.277 fichas neurológicas de cães e obtidas as informações para inclusão no estudo em 1.184 delas, sendo o diagnóstico etiológico confirmado em 525 cães (44,4%) e presuntivo em 659 (55,6%). As raças mais frequentes foram dachshunds (29,2%), seguido das sem raça definida. Os locais mais comuns foram a medula espinhal entre T3-L3 (40,9%) e tálamo-córtex (17,5%). A maioria dos cães foram diagnosticados com doenças degenerativas (49%) , sendo a doença do disco intervertebral a mais observada, seguido das doenças inflamatórias/infecciosas (16,6%). Pode-se concluir que a maior prevalência das doenças neurológicas de cães envolvem a medula espinhal e tálamo-cortex, sendo as degenerativas as mais frequentes e os dados obtidos poderão auxiliar em futuros estudos sobre a frequência e distribuição das principais doenças neurológicas em cães.

Neste trabalho utilizamos diferentes abordagens para o estudo de genes associados com desenvolvimento e funcionamento do SNC assim como com doenças neurológicas: 1) uma das abordagens consistiu na identificação do alelo associado a uma forma de retardo mental sindrômico com herança recessiva ligada ao cromossomo X, síndrome de Snyder-Robinson, em uma família Brasileira. Utilizando as estratégias de estudo de ligação genética e análise de genes candidatos, identificamos a segunda mutação patogênica no gene SMS (que codifica a enzima espermina sintase) associada à síndrome de Snyder-Robinson. A identificação dessa mutação contribuiu para: delinear e expandir o espectro clínico da síndrome, evidenciar domínios importantes para o funcionamento da proteína espermina sintase, comprovar a importância dessa proteína nos processos cognitivos, e também possibilitar um aconselhamento genético preciso para membros da família; 2) outra abordagem consistiu em analisar (triar mutação) o gene codificador da proteína colibistina (ARHGEF9), a qual está envolvida em sinaptogênese inibitória, em pacientes Brasileiros portadores de hiperecplexia (6 pacientes) e em pacientes portadores de retardo mental associado com epilepsia (22 pacientes). Não identificamos nenhuma alteração patogênica no gene ARHGEF nos 28 pacientes estudados; contudo, o número de pacientes analisados foi muito pequeno. Julgamos que a análise de um número maior de pacientes com essas doenças neurológicas pode vir a revelar novas mutações deletérias em ARHGEF9; 3) a última abordagem consistiu no estudo funcional da proteína colibistina. Com o objetivo de identificar outras proteínas que interagem com a colibistina humana utilizamos o sistema de duplo-híbrido em leveduras e experimentos de co-imunoprecipitação in vitro e in vivo. Identificamos a proteína eIF3-p40 interagindo com a proteína colibistina e também com a proteína gefirina (a qual, por sua vez, também interage com colibistina e está envolvida com funcionamento de sinapses inibitórias). A proteína eIF3-p40 é uma das subunidades do complexo do fator 3 de iniciação de tradução protéica em eucariotos (eIF3). Essas interações ligam as proteínas colibistina e a gefirina à maquinaria de tradução protéica, revelando uma provável nova função dessas proteínas no controle da tradução em sítios pós-sinápticos inibitórios. / In this work we have used different approaches to the study of genes associated with CNS development and function as well as with neurological diseases: 1) one study involved the identification of the allele associated with an X-linked recessive sindromic form of mental retardation, Snyder-Robinson syndrome, in a Brazilian family. Using genetic linkage analysis and candidate gene strategy, we identified the second pathogenic mutation in the SMS gene (that encodes the spermine synthase enzyme) associated with the Snyder-Robinson syndrome. The identification of this mutation contributed to: the delineation and expansion of the clinical spectrum of the syndrome, highlight important domains for spermine synthase protein functioning, demonstrate the importance of this protein in cognitive processes, and also a precise genetic counseling for family members; 2) a second study involved the mutation screening of ARHGEF9, gene encoding the collybistin protein, which is involved in inhibitory synaptogenesis, in Brazilian patients with hyperekplexia (6 patients) and in patients with mental retardation associated with epilepsy (22 patients). We did not identify any pathogenic alteration in the ARHGEF9, gene in the 28 studied patients, but the number of patients analysed was very small. However, the possibility remains that additional mutations in ARHGEF9, may contribute to other cases of hyperekplexia and mental retardation associated with epilepsy; 3) the last study involved the functional analysis of collybistin protein. In order to identify other proteins that interact with human collybistin, we used the yeast two-hybrid system and in vitro e in vivo co-immunoprecipitation experiments. We identified the eIF3-p40 protein as collybistin and gephyrin (another protein involved in the function of inhibitory synapses that also interacts with collybistin) binding partner. The eIF3-p40 protein is one of the subunits of the eukaryotic initiation factor 3 complex (eIF3). These interactions link the collybistin and gephyrin proteins to the protein translation machinery, revealing a putative new role of these proteins in the translation control at inhibitory postsynaptic sites.

The sciatic nerve is the largest nerve in the human body giving both motor and sensory innervations to the lower limb. It can be affected in chronic diseases, such as diabetes, or compressed anatomically by structures such as piriformis and aneurysms leading to sciatica or paralysis of the lower limb. The current study therefore focuses on the arterial supply of the sciatic nerve as well as its course. Embryologically, the sciatic nerve is supplied via the axial artery during the first trimester. As the axial artery regresses, the iliac system develops. A failure of sciatic artery regression leads to several variations of pelvic and femoral arteries, with a risk of iatrogenic injury/trauma for those patients undergoing pelvic, gluteal and thigh surgical procedures. An understanding of the variability of the pelvic arteries in relation to a coexistent sciatic artery will provide an appropriate background for clinicians. The present study proposes a new theory of sciatic artery development and persistence, as well as new theories for the superior and inferior gluteal, internal pudendal and obturator arteries. The thesis is in two parts: first an anatomical study on the dissection of 171 cadavers including the pelvic, gluteal and thigh regions to observe (i) the patterns of the arteries these regions, and (ii) the course of the sciatic nerve. With variable course of sciatic nerve, there is a variability of its blood supply. Moreover, it includes a new classification of sciatic nerve with respect to clinical implications. The thesis clarifies the origins of the sciatic artery and its course. The second part is a literature review of sciatic artery aneurysm cases in 171 patients, which clarifies the risk of aneurysm, together with its incidence with respect to pathologic finding and associated disorders. Radiologists have to be aware of the internal iliac artery classifications to be able to alert general surgeons, orthopaedic surgeons, obstetricians, gynecologists, and urologists so that they can improve patient management.

La détection de la protéine prion anormale dans les tissus lymphoïdes de patients britanniques suggère qu’après exposition à l’agent de la variante de la maladie de Creutzfeldt-Jakob (vMCJ) plus de 99% des contaminations pourraient demeurer cliniquement silencieuses. Ces données soulignent un risque de transmission secondaire par transfusion sanguine ce qui nous a conduit à une étude expérimentale. En parallèle des formes classiques de vMCJ, nos modèles murins et simiens de retransmission ont mis en evidence des phenotypes atypiques. Ces phénotypes échappent actuellement aux critères de diagnostic puisqu’aucune protéine prion anormale (PrPres) n’est détectée.Nos travaux ont eu pour but principal d’évaluer expérimentalement le risque sanguin au travers d’études de retransmission et de caractérisation de la replication des souches classiques et atypiques aux niveaux périphérique et central.Nous observons une très forte hétérogénéité dans la réplication de la PrP anormale dans les différents tissus lymphoïdes des macaques transfusés développant une vMCJ. Le niveau de contamination des tissus lymphoïdes apparait proportionnel à l’infectiosité sanguine de ces animaux et au risque de transmission de la maladie in vivo. Concernant les formes atypiques, la majorité des macaques transfusés n’ont pas de réplication dans les tissus lymphoïdes bien que ces phénotypes soient transmissibles expérimentalement à des modèles murins. Des transmissions à des souris immunodéficientes révèlent que les souches atypiques sont transmissibles par voie périphérique en l’absence d’un système immunitaire fonctionnel.Une alternative à l’expérimentation animale a été réalisée grâce aux « mini-brains » mimant la complexité du cerveau humain. Ces organoïdes cultivés en trois dimensions sont sensibles à au moins un isolat de prion associé aux formes sporadiques humaines. Les mini-brains pourraient ainsi constituer un nouvel outil d’étude des maladies à prions et permettre à termes la caractérisation des souches atypiques. / The detection of abnormal prion protein in the lymphoid tissues of UK patients suggests that after exposure to the agent of variant Creutzfeldt-Jakob disease (vCJD), more than 99% of contaminations may remain clinically silent. These data highlight a risk of secondary transmission through blood transfusion. In parallel to the classical vCJD forms, our experimental models in mice and macaques revealed another group which avoids the current diagnostic criteria, including the absence of abnormal prion protein (PrPres).The main goal of our work was to experimentally assess the risk of blood through retransmission studies and characterization of the abnormal replication of classical and atypical strains examined at peripheral and central levels.We observed a high heterogeneity of the distribution of the abnormal PrP in the lymphoid tissues of vCJD transfused macaques. The global level of contamination in lymphoid tissues seems proportional to the blood infectivity in these animals and to the risk of in vivo transmission of the disease. Regarding atypical forms, despite an absence of replication in lymphoid tissues, these phenotypes are experimentally transmissible. Transmissions to immunodeficient mice reveal that atypical strains are transmissible through peripheral routes in the absence of functional immune system.An alternative to animal testing has been achieved using to "mini-brains" mimicking the complexity of the human nervous system. These organoids cultured in three dimensions are sensitive to at least one prion isolate associated with human sporadic forms. Thus, mini-brains could constitute a new tool for studying prion diseases and improve the characterization of atypical strains.