No description available.

It seemed desirable to investigate further the possible role of complement and its components in the protective action of serum against transplanted neoplasms. It is the purpose of this thesis to present data which suggest that the C'4 component plays an active part in this process though the mechanism is not disclosed.

Lorsque l'hépatite chronique C a occasionné une cirrhose et que, du fait de ses complications, le pronostic vital est en jeu au terme de quelques mois, la transplantation hépatique (TH) représente l'unique traitement efficace,. Malheureusement, la récidive quasi-systématique de la cirrhose C, après la transplantation hépatique, est la principale barrière à la survie du greffon. De nombreux facteurs ont été associés à la sévérité des récidives, et une implication des lymphocytes T régulateurs CD4+CD25+ (Treg) et de certains immunosuppresseurs a été suggérée. Par ailleurs, le patient transplanté peut également être confronté au problème du rejet aigu d’allogreffe, qui est partiellement contrôlé par les Treg et par une thérapie immunosuppressive rigoureuse. Paradoxalement, plusieurs études ont suggéré que certains immunosuppresseurs sont moins efficaces que d’autres dans la prophylaxie du rejet d’allogreffe et peuvent même être associés à des épisodes de rejet plus fréquents. Il existait donc un besoin urgent d’évaluer le rôle joué par les immunosuppresseurs sur les Treg dans la récidive de la fibrose C et dans le rejet du greffon. Dans un premier temps, nous avons confirmé l’implication des Treg dans la progression de la récidive de l’hépatite C. En effet, les marqueurs associés à cette population sont surexprimés dans le foie et dans le sérum de patients, 1 an et 5 ans après la TH, et ce proportionnellement à la sévérité de la récidive. Dans un deuxième temps, nous avons évalué l’effet d’immunosuppresseurs utilisés après la TH (cyclosporine A (CsA), tacrolimus, rapamycine et mycophénolate mofétif) sur l’activité des Treg. Nous avons ainsi montré que seule la CsA a une action inhibitrice sur l’activité des Treg, et ce, uniquement aux doses thérapeutiques de 20 et 40 ng/mL (doses administrées au long terme, 5 ans après la TH). Cette inhibition de l’activité des Treg par la CsA ne modifie pas leur phénotype (expression protéique ou génique), mais conduit à la sécrétion d’IL-2 et d’IFN-γ par les Treg, cytokines de la voie Th1. Le mécanisme immunosuppresseur de la CsA étant d’inhiber la transcription de l’IL-2, via la voie calcineurine/N-FAT, nous avons tenté d’identifier si elle agissait sur les Treg par cette voie ou par une voie indépendante de la calcineurine. Deux observations ont renforcé l’hypothèse d’un mode d’action calcineurine/N-FAT - indépendant : (i) le fait que le tacrolimus, qui a le même mécanisme immunosuppresseur que la CsA, n’inhibe pas l’activité des Treg et (ii) le fait que NIM811, un analogue de la CsA n’agissant pas sur la voie de la calcineurine, inhibe l’activité des Treg aux mêmes doses que la CsA. Cette hypothèse a par ailleurs été directement confirmée par l’absence de modification du profil de déphosphorylation du facteur de transcription N-FAT, en présence de CsA. Enfin, bien que les corticoïdes soient connus pour préserver l’activité des Treg et induisent leur prolifération in vitro, ils sont incapables de reverser l’effet inhibiteur de la CsA sur les Treg. Nos résultats suggèrent donc qu’une dose thérapeutique de CsA inhiberait l’activité des Treg CD4+CD25+. Les cellules T régulatrices jouent un rôle important dans la tolérance du greffon et dans la sévérité des récidives après la TH, leur inhibition par la CsA pourrait alors favoriser le rejet du greffon et diminuer la sévérité des récidives. Ces résultats sont importants dans la mesure où la transplantation hépatique est à l’heure actuelle la seule alternative de survie au stade du carcinome hépatocellulaire, et qu’il n’existe aucun traitement efficace contre le rejet du greffon ou la récidive de l’hépatite C. Le traitement immunosuppresseur idéal n’existe pas, cependant il ne devrait pas augmenter l’activité suppressive des Treg, au risque de favoriser la récidive de l’hépatite C, ni inhiber cette activité, au risque de favoriser le rejet du greffon. / Liver transplantation (LT) remains the only effective therapeutic approach for cirrhosis related HCC patients. Inevitable hepatitis C virus (HCV) recurrence after liver transplantation is a major barrier to the survival of a transplanted liver. It may be promoted by immunosuppression and the emergence of CD4+CD25+ regulatory T cells (Treg). Transplanted patients are also been confronted to allograft rejection, which is partially controlled by Treg cells and the administration of an immunosuppressive therapy. However, some immunosuppressive drugs have been associated with more frequent graft rejection. In this context, it was important to assess the effect of immunosuppressive drugs on regulatory T cells, both in HCV recurrence and graft rejection. We have first confirmed the implication of Treg cells in hepatitis C recurrence progression. Indeed, regulatory T cells markers are over-expressed, 1 and 5 years after LT, both in the liver and in periphery and proportionally of the recurrence severity. In a second time, we have analysed the effect of immunosuppressive drugs used after LT (cyclosporine A (CsA), tacrolimus, rapamycine and mycophenolate mofetil) on regulatory T cell activity. We have shown that only low concentrations of CsA (20 and 40 ng/mL) inhibit regulatory T cell activity (these doses are used 5 years after LT). It seems that CsA does not affect regulatory T cell phenotype (protein and gene expression) but lead to a secretion of Th1 cytokines in Treg cells : IL-2 and IFN-γ. As CsA, is known to inhibit IL-2 transcription through the calcineurin/N-FAT pathway, we have tried to identify if CsA inhibits Treg cells via this pathway or via a calcineurin -independent pathway. Two observations have confirmed the hypothesis of a calcineurin -independent pathway : (i) tacrolimus, which have the same immunosuppressive mechanism as CsA, could not inhibit Treg activity, and (ii) NIM811, a calcineurin - independent CsA analog, inhibits regulatory T cell activity at the same concentrations than CsA. Moreover, this hypothesis has been directly confirmed by the absence of of modification of the N-FAT dephosphorylation profile. Lastly, corticoids, known to preserve Treg activity, could induce Treg cell proliferation in vitro. However, they could not reverse the inhibitory effect of CsA on Treg cells. Our results suggest that a therapeutical dose of CsA could inhibit CD4+CD25+ regulatory T cell activity. Treg cells play an important role in graft tolerance and hepatitis C recurrence after LT, so their inhibition by CsA could favour graft rejection and decrease recurrence severity. These results are important, as liver transplantation iscurrently the only survival alternative for HCC related patients. The ideal immunosuppressive therapy does not exist, but it would not increase Treg activity, which may promote hepatitis C recurrence, neither abrogate this activity due to the risk of graft rejection.

Purpose The purpose of this research is an assessment of whether the noninvasive method of computed tomography angiography of liver preoperatively before liver transplantation does provide sufficient details for the surgeons. At the same time, by comparing the images reconstructed from scanners equipped with and without 64 slices, we can appreciate the limits of each scanner and set up an acceptable standard for each scanner. Methods In a retrospective study from May, 2005 to March, 2007, 52 patients receiving liver transplantation underwent 104 computed tomography studies for evaluation of intra-hepatic arterial anatomy provided by the radiology department in a southern medical center. The reconstructed CT angiograms were compared to see if they were compatible to the conventional digital subtracted angiograms for the demonstration of the anatomy details. The CT images exported from different mutislice count scanner¡]MSCT¡^were reevaluated for the limits and variance of the quality. Results Multi-slices CT with its obvious advantage of the faster speed and thinner scan slices, can distinguish 100¢M(104/104) of the 3rd grade of arteries of liver (segmental branches ), 61.5¢M(64/104) for 4th grade of arteries (sub-segmental branches ), 100¢M (104/104) of the portal vein and 93¢M(97/104) of hepatic vein. The images of the 52 patients provide sufficient quality of intra-hepatic arterial details for liver transplantation.

No description available.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

350 f. / Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2013-03-08T14:21:39Z No. of bitstreams: 3 Tese Alice Lumi Satomi parte 2.pdf: 5262814 bytes, checksum: fb37044dde85413f1222ec9913d5645f (MD5) Tese Alice Lumi Satomi parte 3.pdf: 3707093 bytes, checksum: 18f7631c7e4cfa01384786a7d8e8499a (MD5) Tese Alice Lumi Satomi parte 1.pdf: 6268095 bytes, checksum: 52d351d8e4183636e8e242669d585078 (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-03-22T14:39:44Z (GMT) No. of bitstreams: 3 Tese Alice Lumi Satomi parte 2.pdf: 5262814 bytes, checksum: fb37044dde85413f1222ec9913d5645f (MD5) Tese Alice Lumi Satomi parte 3.pdf: 3707093 bytes, checksum: 18f7631c7e4cfa01384786a7d8e8499a (MD5) Tese Alice Lumi Satomi parte 1.pdf: 6268095 bytes, checksum: 52d351d8e4183636e8e242669d585078 (MD5) / Made available in DSpace on 2013-03-22T14:39:44Z (GMT). No. of bitstreams: 3 Tese Alice Lumi Satomi parte 2.pdf: 5262814 bytes, checksum: fb37044dde85413f1222ec9913d5645f (MD5) Tese Alice Lumi Satomi parte 3.pdf: 3707093 bytes, checksum: 18f7631c7e4cfa01384786a7d8e8499a (MD5) Tese Alice Lumi Satomi parte 1.pdf: 6268095 bytes, checksum: 52d351d8e4183636e8e242669d585078 (MD5) Previous issue date: 2004 / O presente estudo de caso examina a dinâmica da continuidade da ‘música para koto’, sōkyoku, no Brasil, a partir de grupos inicialmente observados por Dale Olsen (1983a), em 1981. A temática “música transterritorializada” ou “repertório dos imigrantes”, sob perspectiva etnomusicológica, busca contribuir para os estudos de antropologia urbana em discussões sobre “minorias étnicas”, especificamente, sobre “comunidade nikkei”, ou “nipobrasileiros”. O primeiro capítulo esclarece sobre a natureza do estudo situando o tema, as bases teórico-metodológicas, as intenções, as descobertas e questões iniciais da pesquisa. “Dados Musicais Imigrados”, parte I, aproxima-se da abordagem “pré-partida” (Schramm 1990) e fornece as bases organológicas apreendidas da literatura musicológica e com os co-autores dos grupos observados. O capítulo 2, “Dragão Deitado na Areia Confabula com as Ondas”, situa o instrumento e a diacronia das escolas sōkyoku. O capítulo 3 esboça um tutorial sobre a “Notação Musical e os Recursos Sonoros” do koto, para iniciados em notação ocidental. O capítulo 4 agrega uma “Introdução à Análise do Repertório para Koto”, focalizando “Rokudan no Shirabe”, peça representativa das escolas. As partes II e III seguem a linha de abordagem “surgimento, manutenção e adaptação” (Satomi 1998), uma aproximação de “construção histórica, manutenção social e criação individual da música” (Rice 1987). As duas partes indicam as circunstâncias históricas e sócio-culturais, os principais agentes dos grupos e as atitudes e conceitos em torno do ensino, aprendizagem e performance. A pesquisa de campo, iniciada em 1996, envolve três entidades sociais sediadas na cidade de São Paulo: a AOKB – Associação Okinawa Kenjin do Brasil, o grupo Miwa-Kai e a ABMCJ – Associação Brasileira de Música Clássica Japonesa. Estes três casos dividem-se de acordo com o comportamento observado durante a pesquisa. Nas duas filiais das sōkyoku de Ryūkyū, da AOKB, e no grupo Miwa-Kai, simpatizante do estilo Ikutaryū, prevalecem atitudes coletivistas peculiares ao imigrante pré-guerra. A análise desses dois grupos consta nos capítulos 5 e 6, que compõem a parte II intitulada “Surgimento e Continuidade de Atitudes Pré-Guerra.” A parte III, “Implantação da Mentalidade Pós-Guerra”, composta pelos capítulos 7 e 8, discorre sobre a ABMCJ. Esta entidade congrega uma exprofessora do estilo Yamada-ryū, e os grupos Miyagi-kai e Seiha Brasil de Koto, adeptos de ramificações da Ikuta-ryū. No interior desses grupos convivem a conduta rural pré-guerra e a mentalidade urbana “moderna” ou “ocidentalizada” do pós-guerra. A “Conclusão” justifica que as atitudes culturais de etnicidade, herança ou ideologia podem ser consideradas tanto como manutenção de valores da terra emigrada, quanto como adaptação aos valores da terra de acolhimento. Especulando as razões dessa resistência cultural, detectou-se que praticar a música clássica de minoria étnica em uma megalópole como São Paulo pode ser um eficaz “mecanismo de defesa” ou de “elaboração do conflito” (Hashimoto 1995). Os imigrantes reconstroem a terra perdida, no espaço ou no tempo, e os descendentes, internos e externos à comunidade, um mundo “idealizado” livre de contaminações. / Salvador

Made available in DSpace on 2014-12-17T14:16:28Z (GMT). No. of bitstreams: 1 MarianaGD_DISSERT.pdf: 1350118 bytes, checksum: 5e25fd552ff8be29e71b6c0ae2fa383c (MD5) Previous issue date: 2011-02-25 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Despite Candida species are often human commensals isolated from various oral sites such as: tongue, cheek and palatal mucosa plus subgingival region, there are some properties linked to the organism commonly known as virulence factors which confer them the ability to produce disease. Oral candidiasis is one of the main oral manifestations reported in literature related to kidney transplant patients. The objectives of the present study were to identify and investigate virulence factors of yeasts isolated from the oral cavity of kidney transplant recipients admitted at the Hospital Universit?rio Onofre Lopes, in Natal RN. Seventy Candida species isolated from 111 kidney transplant recipients were investigated in this study. Identification of the isolates was performed by using the evidence of germ tube formation, hypertonic broth, tolerance to grow at 42?C, micromorphology and biochemical profiles. We observed a high rate of isolation of yeasts from the oral cavity of kidney transplant recipients (63.1%) being C. albicans was the most prevalent species. Oral candidiasis was diagnosed in 14.4% of transplant recipients. We evaluated virulence properties of the isolates regarding to: biofilm formation on polystyrene microplates as well as XTT reduction, adherence to acrylic resin and human buccal epithelial cells and proteinase activity. Most isolates were able to form biofilm by the method of adhesion to polystyrene. All isolates of Candida spp. remained viable during biofilm formation when analyzed by the method of XTT reduction. The number of CFU attached to the acrylic resin suggested high adherence for C. parapsilosis. C. albicans isolates showed higher median adherence to human buccal epithelial cells than non-C. albicans Candida isolates. Nevertheless, this difference was not statistically significant. C. dubliniensis showed low ability to adhere to plastic and epithelial cells and biofilm formation. Proteolytic activity was observed for all the isolates investigated, including the unique isolate of C. dubliniensis. There was a statistically significant association between proteinase production and the presence of oral candidiasis. Studies related to oral candidiasis in renal transplant recipients are limited to clinical and epidemiological data, but investigations concerning Candida spp. virulence factor for this group of individuals are still scarce. We emphasize the importance of studies related to virulence factors of yeasts isolated from this population to contribute to the knowledge of microbiological aspects of oral candidiasis / Apesar das leveduras do g?nero Candida serem frequentemente comensais humanos, isoladas de diferentes s?tios orais, incluindo l?ngua, mucosa jugal, mucosa palatal e regi?o subgengival, existem algumas propriedades ligadas a Candida spp., comumente denominadas fatores de virul?ncia, que lhes conferem a capacidade de produzir doen?a. Candid?ase bucal ? uma das principais manifesta??es orais citadas na literatura em rela??o aos pacientes transplantados renais. O objetivo deste estudo foi realizar identifica??o e avaliar os fatores de virul?ncia de leveduras isoladas da cavidade bucal de receptores de transplante renal que s?o acompanhados no Hospital Universit?rio Onofre Lopes, na cidade do Natal RN. Foram utilizadas 70 leveduras do g?nero Candida isoladas de 111 receptores de transplante renal. A identifica??o dos isolados foi realizada atrav?s das provas de forma??o de tubo germinativo, caldo hipert?nico, toler?ncia ? temperatura de 42?C, an?lise da micromorfologia e perfil bioqu?mico das leveduras. Observamos elevado ?ndice de isolamento de leveduras na cavidade bucal dos receptores de transplante renal (63,1%), havendo predom?nio de C. albicans. Candid?ase bucal foi diagnosticada em 14,4% dos transplantados. Avaliou-se o potencial de virul?ncia das leveduras atrav?s da forma??o de biofilme pelo m?todo de ader?ncia a microplaca de poliestireno, redu??o do XTT, habilidade de ader?ncia a corpos de prova de resina acr?lica e a c?lulas epiteliais bucais, bem como atividade de proteinase. A maioria dos isolados foi capaz de produzir biofilme pelo m?todo de ader?ncia ao poliestireno, determinada atrav?s de leitura em espectrofot?metro. Todos os isolados de Candida spp. permaneceram vi?veis durante a forma??o do biofilme pelo m?todo da redu??o do XTT. A contagem do n?mero de UFC aderidas ao corpo de prova demonstrou alta capacidade de ader?ncia de C. parapsilosis. Os isolados de C. albicans apresentaram maior mediana de ades?o ? c?lula epitelial bucal humana do que os isolados de C. n?o-C. albicans, contudo essa diferen?a n?o foi estatisticamente significativa. C. dubliniensis apresentou baixa capacidade de ader?ncia ao pl?stico e c?lulas epiteliais e forma??o do biofilme. Observamos atividade proteol?tica em todos os isolados pesquisados, inclusive o isolado de C. dubliniensis, e associa??o estatisticamente significativa entre a produ??o de proteinase e a presen?a de candid?ase bucal. Estudos relacionados ? candid?ase bucal em receptores de transplante renal limitam-se ? investiga??o de aspectos cl?nicos e epidemiol?gicos, n?o havendo dados concernentes a fatores de virul?ncia. Ressaltamos a import?ncia da realiza??o de estudos relacionados aos fatores de virul?ncia de leveduras isoladas nessa popula??o, a fim de que se aprofunde o conhecimento dos aspectos microbiol?gicos da candid?ase bucal / 2020-01-01

Bakgrund: Fler än 6000 människor i Sverige lever med en transplanterad njure på grund av försämrad eller utebliven njurfunktion. Att leva med en transplanterad njure innebär ett nytt liv med en livslång läkemedelsbehandling, risker för komplikationer och en påverkad livskvalitet. Dessa faktorer kan leda till ett ökat lidande hos patienten, vilket sjuksköterskan har ett stort ansvar i att förebygga genom att bland annat arbeta utifrån personcentreradvård. Syfte: Syftet var att belysa patienters erfarenheter av att leva med en transplanterad njure. Metod: En integrerande översikt av kvalitativ forskning, inspirerad av metasyntes som är baserad på nio kvalitativa artiklar. Resultat: Efter att ha analyserat de utvalda artiklarna framkom tre teman och sju subteman. Studiens tre teman är: känslor och tankar efter en njurtransplantation, stöd av omgivningen och ökad livskvalitet. Konklusion: Stödet från sjuksköterskan och anhöriga var avgörande faktorer för att främja patienters välbefinnande och livskvalitet. Sjuksköterskans omvårdnadsarbete var bristande inom ämnet, vilket resulterade i ett lidande hos patienterna som hade kunnat förebyggas genom ökad förståelse av vårdpersonalen. Däremot upplevde många patienter att deras livskvalitet förbättrades avsevärt efter transplantationen. / Background: More than 6000 people in Sweden live with a transplanted kidney due to impaired or absent kidney function. Living with a transplanted kidney means a new life with lifelong drug treatment, risks of complications and an affected quality of life. These factors can lead to increased suffering of the patient, which the nurse has a responsibility to prevent by, among other things, working from a person-centered approach. Aim: The aim was to illustrate patients´ experiences of living with a transplanted kidney. Method: An integrative review of qualitative research, inspired by meta synthesis based on nine qualitative articles. Findings: After analyzing the nine selected articles, three themes and seven sub themes emerged. The study´s three themes are: feelings and thoughts after a kidney transplant, support from the environment and increased quality of life.  Conclusion: The support from the nurse and relatives were crucial factors in promoting patients’ well-being and quality of life. The nurse´s nursing work was deficient in the area, which resulted in a suffering of the patients that could have been prevented through increased understanding from the healthcare professionals. However, many patients also experienced a significant improvement in their quality of life after the transplant.