Notre groupe a montré que l’hypoxie sévère (0.1% O2) induit un arrêt du cycle cellulaire en G0 des cellules humaines CD34+ et des cellules murines FDCP mix. Peu d’études ont exploré l’existence de Cellules Initiatrices de Leucémie (CIL) dans les LAL et leur rôle dans les rechutes. Notre projet s’est focalisé sur l’effet de l’hypoxie sévère sur la quiescence des CIL dans les LAL, qui pourrait être responsable d’un pourcentage de rechutes. En effet dans la niche hématopoïétique, ou sont localisées les Cellules souches hématopoïétiques et probablement les CIL, la concentration d’oxygène avoisinerait 0,1%.Nous avons utilisé la lignée de LAL NALM6 pour explorer les effets de l’hypoxie sévère sur leur survie, leur cycle cellulaire et leur chimiorésistance. Nos résultats ont mis en évidence qu’une culture à 0.1% O2 durant 7 jours de la lignée NALM6: - inhibe leur prolifération sans surmortalité, - révèle une population restreinte de CIL quiescentes et chimiorésistantes capables d’induire une leucémie dans des souris. Nous avons recherché les relations entre l’hypoxie sévère et quelques caractéristiques des cellules primaires de patients atteints de LAL : existence et rôle de CIL résistantes à l’hypoxie et aux agents thérapeutiques conventionnels des LAL ; localisation de ces cellules résiduelles dans la moelle osseuse des souris xénogreffées. Nos résultats suggèrent que certaines rechutes de LAL pourraient être dues à la persistance à long terme de « quiescent/dormant » CIL dans les niches hypoxiques de la moelle osseuse. Ce modèle est intéressant pour explorer les mécanismes in vitro et in vivo de chimiorésistance dans les LAL et le rôle de l’environnement dans ce phénomène. / Our group showed that severe hypoxia (0.1% O2) induces G0 cell-cycle-arrest of human CD34+ cells and of murine FDCP-mix Cells. Few studies explored the existence of quiescent Leukemia Initiating Cells (LIC) in ALL and their role in primary chemoresistance and relapses. Our project is focused on the effect of very low O2 concentrations in the maintenance of quiescent LIC in ALL, that could be responsible of a percentage of relapses. Indeed in bone marrow niches, where hematopoietic stem cells and probably LIC are located, the O2 concentrations are below 0.1%.In the present study we used the NALM-6 ALL cell line to explore the effects of culture at 0.1% O2 on their survival, cell cycle and chemoresistance. Our results evidence that a 7 days culture of NALM-6 cells at 0.1% O2: - inhibits their proliferation without major cell death; - reveals a restricted LIC population of quiescent and chemoresistant LIC; - maintains quiescent chemoresistant LIC that induce leukemia when injected in immunodeficient mice. We investigated the relationships between severe hypoxia and some characteristics of ALL primary cells obtained from patients: existence and role of quiescent chemoresistant LICs in ALL relapses; location of these residual cells inside the bone marrow of engrafted mice. Our results suggest that some ALL relapses could be due to the long term persistence of “quiescent / dormant” LIC in hypoxic bone marrow niches. This model is of interest for exploring the in vitro and in vivo (xenograft) mechanisms of chemoresistance in ALL and the role of the bone marrow environment in this phenomenon.

Aim: Through this review we aim to investigate if there is an alternative orthotic treatment for paediatric patients with idiopathic congenital talipes equinovarus showing the same maintenance of correction as the benchmark treatment but with higher adherence. Methods: A literature search was performed in the data bases MEDLINE, CINAHL and Scopus. Predetermined eligibility criteria were used to include and exclude articles. Critical appraisal was performed for the included articles. Relevant data was extracted, analyzed and presented to aid in answering the research question. Results: Of the 204 articles found in databases, seven were included in the final review. Adherence rate and relapse rate was extracted from the seven orthotic interventions. Most of the orthoses presented both better adherence and maintenance of correction than the benchmark treatment. The majority were case series, not including a comparison group and with short-term follow-up. Conclusion: The results indicate that there are orthotic designs that may be preferred over the traditional Denis Browne bar. However, the lack of high-quality evidence and standardization to detect and define a relapse and measure adherence makes it difficult to recommend an alternative orthosis with the present evidence. Factors other than the orthotic design also influence the adherence.

The diploma thesis deals with anorexia nervosa as one of the basic forms of eating disorders, with emphasis on the very common chronic progression of this serious psychiatric illness. This thesis is based on the scientific fact, that conspicuous eating habits, constant control of thinking and behavior, as well as self-perception disorders, are observed in most cases, even in already cured patients. Long-term stress in common with a prone personality, can result in the acute phase of anorexia nervosa. The diploma thesis is qualitatively focused. The chosen methods of data collection are a questionnaire survey and a following semi-structured interview. The condition for participation in the research is the past experience with anorexia nervosa, without the current presence of the acute phase of this disease. The main goal of the diploma thesis is to map the burning issues of individuals who have gone through the acute phase of anorexia nervosa in the past, their current feelings and needs. The output of the diploma thesis are the specific recommendations, coming from the results of research survey, which would help to reduce the probability of relapse of the acute phase of mental anorexia in stressful situations. KEYWORDS Anorexia nervosa, eating disorders, chronicity, relapse prevention, addictive...

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The word addiction is almost immediately associated with notions of drug dependency and alcoholism, and drug addiction is often referred to as a pandemic that affects individuals, families, communities and society at large. Aetiological approaches to understanding and treating addiction have changed dramatically throughout history, and currently the most contemporary approach is that of the disease model which views addiction as an illness rather than as a ‘badness’. While the underpinnings of Narcotics Anonymous’ 12 step philosophy employs non-specific drug language as it views all drugs as having the capacity to become addictive, and while it does not distinguish between the capacity for substances and certain behaviours to become addictive, activities such as overeating, having sex and gambling are yet to be classified as legitimate addictions by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). As a result, it appears as if some confusion exists as to whether these behaviours should be classified as impulse control disorders or as genuine addictions due to the various similarities they share in common with substance based disorders. The research conducted explored how people recovering from addiction, as well as how people working with addiction understand addiction and multiple dependency, together with the factors that contribute to relapse and the ability to abstain. Various 12 Step meetings from a variety of 12 Step Fellowships were attended and members were invited to participate in the study. Ultimately seventy eight participants completed a self developed questionnaire which was utilised to assess how people recovering from addiction understood addiction and multiple dependency and the factors that contribute to relapse and the ability to abstain. Quantitative data were analysed via descriptive and inferential statistics. Furthermore twenty participants working with addiction were interviewed with the use of a semi structured interview schedule in order to explore their perceptions around addiction and the factors that contribute to relapse and sobriety. Qualitative data were analysed using thematic content analysis. Results indicated that the majority of recovering addicts and professionals working with addiction understand addiction as a disease. However, discrepancy was apparent with regards to whether or not all recovering addicts have the same disease and subsequently whether all addictions can be treated in the same manner. The above result suggested that there was no standardised, uniform way in which the disease model is understood and interpreted. Factors such as cross addiction, resistance to change and issues relating to the maintenance of change were identified as issues that contribute to relapse, while factors such as aftercare, following the 12 step programme and support were identified as the main aspects that contribute to sobriety. No statistical significance was noted between participants who had relapsed as opposed to those who had not for variables of sensation seeking, impulsivity and perceived stress (which may have been as a result of small sample size). Deeper understanding of the disease model together with broader application of it, and a focus on appropriate training and more comprehensive assessment could perhaps see a reduction in high rates of relapse and recidivism more commonly known as the ‘revolving door syndrome’.

The aim of the current study is to study characteristics of high-risk cancer cells within the childhood disease neuroblastoma (NB) by mapping regrowth after treatment with the chemotherapy doxorubicin (doxo). The cell-line SK-N-BE(2)-C (BE(2)-C) was used as a model. Results from a previous study by Hultman et al., (2018) have indicated that while a majority of BE(2)-C cells could be shown resilient to a 1 μM dose of doxorubicin (doxo), only a very small fractions had the capacity for immediate replication following a single or double treatment of doxo (“remaining replicating cells”; RRC). The current study aims to investigate if RRC are responsible for regrowth. Cultured BE(2)-C cells were exposed to doxo and labelled with the nucleoside analogues EdU (5-ethynyl-2’-deoxyuridine) and BrdU (5-bromo-2-deoxyuridine). The results from the current study indicated that the RRC subpopulation might not be responsible for regrowth since the nucleoside labelling was not shown to be present in the cells of the regrowing colonies. However, technical challenges, e.g. the settings of thresholds for EdU and BrdU detection, in combination with the dilution of DNA markers in replication, call for further studies using additional methods, e.g. isotope markers, in order to firmly conclude that other subpopulation(s) than the RRC population are responsible for regrowth. Apart from studying cell populations responsible for regrowth, a pilot study was performed including another combination of treatment using an ATM-inhibitor (KU-60019) together with the chemotherapy doxo. There were some measurement points missing, but the current results indicate that regrowth is postponed when the ATM-inhibitor is added in combination with single or double treatment of doxo. The research procedures and processes involved in this thesis, are similar to those included in the syllabi for the natural science subjects for the upper secondary school. This underlines the importance of studying inquiry and laboratory work. A literature review was performed, analysing current research on open-and closed ended laboratory work. Ten research articles were collected and characterized by natural science subject, type of laboratory style (open or closed) and student learning competences. Findings from the current study indicate that open-ended laboratory work promotes student interest in the subject. The learning competences problem-solving ability and procedure ability are most commonly studied in laboratory work based on the results from the current study. / Syftet med studien är att studera hög-risk cancerceller inom barncancersjukdomen neuroblastom (NB), genom att kartlägga återväxt efter kemoterapi-behandling med doxorubicin (doxo). En multiresistent neuroblastom cell-linje med hög-risk egenskaper, SK-N-BE(2)-C( BE[2]-C), användes som modell. Enligt en tidigare studie på BE(2)-C celler, utförd av Hultman et al., (2018), kan efter en enkel eller dubbelbehandling med doxo majoriteten av cellerna överleva, men endast en mycket liten andel kan också omedelbart fortsätta dela sig. Dessa celler benämndes som ”kvarvarande replikerande celler” (RRC). I denna studie undersöktes hypotesen att RRC är ansvariga för återväxt efter doxo-terapi, hypotetiskt återspeglande situationen vid återfall hos patienten. BE(2)-C celler odlades in vitro i petriskålar, behandlades med doxo, och analyserades sedan i mikroskop genom att använda två kemiska markörer för cell-delning; EdU (5-etynyl-2’-deoxyuridin) och BrdU (5-bromo-2-deoxyuridin). Intressant nog, men något oväntat, indikerar resultaten att RRC troligen inte är ansvariga för återväxt. Detta skulle då tyda på att återväxten orsakas av andra cellpopulationer, utan förmåga att omedelbart efter kemoterapin fortsätta dela sig. Dock förekom tekniska utmaningar med valda metoder, t.ex. gränsvärdena för EdU- och BrdU-detektering, i kombination med utspädningen av DNA-markörer vid replikation. Därför krävs ytterligare studier med användning av andra metoder, t.ex. isotopmarkörer, för att fastställa vilka subpopulationer som är ansvariga för återväxt. Utöver att studera cellpopulationer ansvariga för återväxt så genomfördes även en pilotstudie med en kombination av doxo och annan typ av kemoterapi riktad mot cellens förmåga att reparera DNA skador; en ATM-inhibitor (KU-60019). Pilotstudien indikerar att återväxten av BE(2)-C förskjuts vid närvaro av KU-60019, både i kombination med enkel eller dubbelbehandling av kemoterapin doxo. Det naturvetenskapliga arbetssättet i denna studie, vilket inkluderas i ämnesplanerna för de naturvetenskapliga ämnena för gymnasieskolan, understryker betydelsen av att studera laborativt arbete. En litteraturstudie genomfördes med fokus på öppna och slutna laborationer. Tio forskningsartiklar analyserades och karaktäriserades; typ av laborationsstil (öppen eller sluten) och elevers lärandekompetenser. Resultatet från denna studie indikerar att öppna laborationer bidrar till att öka elevers intresse. Vidare visar resultatet att laborativt arbete i skolan inkluderar utvecklingen av främst problemlösningsförmågan och procedurförmågan. Forskningsprocedurer och processer involverade i detta examensarbete diskuteras.

Introduction: Multiple sclerosis (MS) is an autoimmune disorder of the CNS that typically affects young women of childbearing age. Due to the international published data, safety for pregnant women with MS can be assumed. However, no study has been published in the Czech Republic to address the effect of MS on pregnancy and perinatal outcomes. Objective: Analysis of the clinical course of patients with MS during and after pregnancy, and perinatal outcomes in comparison with healthy pregnant women. Methods: A single centre prospective observational study in the period 2006-2015 was conducted. Complete data from 68 patients with MS were analyzed (85 deliveries) and were compared with a control cohort of 68 age- and parity - matched healthy pregnancies. Results: The comparison between relapse rate and EDSS before, during and after delivery showed no statistically significant difference (relapse in 7.4% and 9.5%, EDSS 1.27 and 1.49). Perinatal outcomes were comparable in both cohorts. The weight of newborns differed by 159 g, (p = 0.295), complications in pregnancy were represented in 16.2% in the group with MS and in 27.9% in controls (p = 0.295), caesarean section was performed in 16.2% in patients with MS and in 23.5% of controls (p = 0.629), 79.4% of patients with MS were breast-feeding. In the MS...

Indiana University-Purdue University Indianapolis (IUPUI) / Stress has been shown to contribute to alcohol drinking; however, inconsistencies in both the clinical and pre-clinical literature speak to the need for better paradigms to study this interaction. The present experiments compared animal models of the propensity to consume ethanol, the selectively bred alcohol-preferring (P) and high-alcohol-drinking (HAD) rat lines, in their response to yohimbine on ethanol seeking and self-administration and anxiety-like behavior. The P and HAD lines consume similar amounts of ethanol, yet differ in apparent motivation to drink ethanol, in anxiety-like behavior, and response to stress in alcohol drinking. Therefore, it was of interest to determine whether stress may differentially affect ethanol-motivated behaviors between the P and HAD lines. Acute administration of yohimbine, an α-2 adrenoreceptor antagonist that increases anxiety and activate stress systems, increased operant ethanol self-administration and reinstatement of ethanol seeking in P rats, and free-choice ethanol drinking in both P and HAD rats. However, acute yohimbine administration decreased ethanol drinking when given limited access in the home cage, an effect that was diminished by extending the pre-treatment interval or increasing the number of ethanol exposure sessions. Yohimbine did not alter appetitive responding during a non-reinforced trial, nor did yohimbine alter the acquisition of free-choice ethanol drinking. Exposure to alcohol deprivation resulted in modest increases in ethanol intake, but yohimbine did not potentiate this effect. While acute yohimbine administration increased anxiety-like behavior, prior experience with repeated yohimbine exposures or with repeated deprivation periods did not. P rats were shown to be more active and less anxious and to display greater responding during a non-reinforced trial than HAD rats. Taken together, the results of these experiments demonstrate that the timing of yohimbine exposure relative to ethanol access is a critical component to determining its effects on ethanol seeking and self-administration and anxiety-like behavior. Further investigation into the parameters under which stress alters the motivation to seek and consume ethanol between these selectively bred lines is warranted, and future work that incorporates therapeutic agents aimed at reducing stress reactivity and alcohol drinking could elucidate effective strategies in the treatment of alcoholism.

Les cellules cancéreuses du sein se disséminent du site primaire aux organes secondaires, où elles restent dormantes pendant des mois, voire des années. Cette période de dormance se traduit par une latence clinique entre la résection chirurgicale des tumeurs mammaires primitives et le diagnostic d'une rechute métastatique chez environ 30 % des patientes atteintes d'un cancer du sein. Les mécanismes de survie et de croissance ultérieure de ces cellules tumorales disséminées (CTD) dormantes restent largement inconnus, ce qui entrave la prise en charge clinique des patientes concernés. Des facteurs intrinsèques et extrinsèques dictent le destin et le comportement des DTC dans les organes secondaires. Notre travail dans les chapitres deux et trois visait à révéler les gènes et les voies de signalisation contribuant au devenir du DTC en ce qui concerne les deux catégories de facteurs. Dans le chapitre deux, nous avons exploité les sous-lignées de cancer du sein murin 4T07 et 4T1 qui modélisent les deux destins de rester dormant ou de se transformer en métastases visibles, respectivement, après dissémination spontanée à partir de la tumeur mammaire primaire. Nous avons appliqué un pipeline de criblage CRISPR à l'échelle du génome pour explorer les dépendances génétiques différentielles des deux lignées, c’est à dire leur réseau de signalisation intrinsèquement différent. En comparaison avec les cellules sujettes à la dormance, les cellules métastatiques démontrent une activité PI3K de classe I élevée. Contre-intuitivement, les cellules sujettes à la dormance affichent une activité mTORC1 plus élevée qui pourrait être attribuée à un positionnement lysosomal périphérique constant. Le blocage de ce positionnement périphérique a réduit la charge des DTC dans les poumons et l'incidence des métastases visibles, ce qui suggère qu'il pourrait s'agir d'un mécanisme de survie médicamenteux pour les DTC du sein. Dans le chapitre trois, nous avons effectué un criblage CRISPR in vivo à l'échelle du génome dans des cellules sujettes à la dormance, ce qui a mené à l’identification du gène non caractérisé Mob3c comme un régulateur potentiel de la dormance. Le niveau d'expression de Mob3c dans les modèles de dormance par rapport à ses homologues prolifératifs a soutenu la prédiction du criblage selon laquelle Mob3c pourrait être un suppresseur de métastases. Des cribles basés sur la protéomique et des tests d'interactions protéine-protéine ont suggéré que MOB3C interagit avec le complexe endonucléase RNase P, qui catalyse différentes fonctions cellulaires essentielles, y compris la maturation de l'ARNt. Les analyses cliniques axées sur les rechutes métastatiques (c'est-à-dire la survie sans métastases à distance et sans progression) chez les patientes atteintes d'un cancer du sein ont validé les résultats précliniques décrits dans les deux chapitres, soutenant une signification et un impact potentiels des connaissances moléculaires révélées. / Breast cancer cells disseminate from the primary site to secondary organs, where they remain dormant for months to years. This dormancy period is reflected in a clinical latency between the surgical resection of the primary breast tumors and diagnosing a metastatic relapse in about 30% of breast cancer patients. Mechanisms of survival and subsequent outgrowth of these dormant disseminated tumor cells (DTCs) remain largely unknown, hence hindering clinical management of affected patients. Intrinsic and extrinsic factors dictate the fate and behavior of DTCs in secondary organs. Our work in chapters two and three aimed at revealing genes and pathways contributing to the DTC fate with respect to the two categories of factors. In chapter two, we leveraged the 4T07 and 4T1 murine breast cancer sublines that model the two fates of either remaining dormant or outgrowing into visible metastases, respectively, after spontaneous dissemination from the primary mammary tumor. We applied a genome wide CRISPR screening pipeline to explore the differential genetic dependencies of the two lines, hence their intrinsically different signaling wiring. In comparison to the dormancy-prone cells, metastatic cells display high class I PI3K activity. Counterintuitively, dormancy-prone cells display higher mTORC1 activity that could be attributed to a constant peripheral lysosomal positioning. Blocking this peripheral positioning reduced the DTC burden in the lungs and the incidence of visible metastases, suggesting that this might be a druggable survival mechanism for breast DTCs. In chapter three, we carried out an in vivo genome-wide knockout CRISPR screen in dormancy-prone cells, that put forward the uncharacterized gene, Mob3c, as a potential pro-dormancy gene. Mob3c expression level in models of dormancy in comparison with proliferative counterparts, supported the screen prediction of Mob3c potentially being a metastasis suppressor. Proteomics-based screens and protein-protein interaction assays suggested that MOB3C interacts with the endonuclease RNase P complex, that catalyzes different essential cellular functions including tRNA maturation. Metastatic relapse-focused clinical analyses (i.e., distant metastasis- and progression-free survival) in breast cancer patients validated the outlined preclinical findings in the two chapters, supporting a potential significance and impact of the revealed molecular insights.

Allogeneic hematopoietic stem cell transplantation (alloHCT) represents the only potentially curative treatment in high-risk AML patients, but up to 40% of patients suffer from relapse after alloHCT. Treatment of overt relapse poses a major therapeutic challenge and long-term disease control is achieved only in a minority of patients. In order to avoid post-allograft relapse, maintenance as well as pre-emptive therapy strategies based on MRD-detection have been used. A prerequisite for the implementation of pre-emptive therapy is the accurate identification of patients at risk for imminent relapse. Detection of measurable residual disease (MRD) represents an effective tool for early relapse prediction in the post-transplant setting. However, using established MRD methods such as multicolor flow cytometry or quantitative PCR, sensitive MRD monitoring is only applicable in about half of the patients with AML and advanced MDS undergoing alloHCT. Donor chimerism analysis, in particular when performed on enriched leukemic stem and progenitor cells, e.g. CD34+ cells, is a sensitive method and has emerged as an alternative option in the post alloHCT setting. In this review, we will focus on the current strategies for lineage specific chimerism analysis, results of pre-emptive treatment using this technology as well as future developments in this field.