Prognostic value of serial blood S100B determinations in stage IIB-III melanoma patients: a corollary study to EORTC trial 18952.

S100B is a prognostic factor for melanoma as elevated levels correlate with disease progression and poor outcome. We determined its prognostic value based on updated information using serial determinations in stage IIb/III melanoma patients. 211 Patients who participated in the EORTC 18952 trial, evaluating efficacy of adjuvant intermediate doses of interferon α2b (IFN) versus observation, entered a corollary study. Over a period of 36 months, 918 serum samples were collected. The Cox time-dependent model was used to assess prognostic value of the latest (most recent) S100B determination. At first measurement, 178 patients had S100B values <0.2 μg/l and 33 ≥ 0.2 μg/l. Within the first group, 61 patients had, later on, an increased value of S100B (≥ 0.2 μg/l). An initial increased value of S100B, or during follow-up, was associated with worse distant metastasis-free survival (DMFS); hazard ratio (HR) of S100B ≥ 0.2 versus S100B < 0.2 was 5.57 (95% confidence interval (CI) 3.81-8.16), P < 0.0001, after adjustment for stage, number of lymph nodes and sex. In stage IIb patients, the HR adjusted for sex was 2.14 (95% CI 0.71, 6.42), whereas in stage III, the HR adjusted for stage, number of lymph nodes and sex was 6.76 (95% CI 4.50-10.16). Similar results were observed regarding overall survival (OS). Serial determination of S100B in stage IIb-III melanoma is a strong independent prognostic marker, even stronger compared to stage and number of positive lymph nodes. The prognostic impact of S100B ≥ 0.2 μg/l is more pronounced in stage III disease compared with stage IIb.

Cellular and molecular mechanisms underlying the effects of sleep loss on hippocampal synaptic plasticity

SUMMARY : The function of sleep for the organism is one of the most persistent and perplexing questions in biology. Current findings lead to the conclusion that sleep is primarily for the brain. In particular, a role for sleep in cognitive aspects of brain function is supported by behavioral evidence both in humans and animals. However, in spite of remarkable advancement in the understanding of the mechanisms underlying sleep generation and regulation, it has been proven difficult to determine the neurobiological mechanisms underlying the beneficial effect of sleep, and the detrimental impact of sleep loss, on learning and memory processes. In my thesis, I present results that lead to several critical steps forward in the link between sleep and cognitive function. My major result is the molecular identification and physiological analysis of a protein, the NR2A subunit of NMDA receptor (NMDAR), that confers sensitivity to sleep loss to the hippocampus, a brain structure classically involved in mnemonic processes. Specifically, I used a novel behavioral approach to achieve sleep deprivation in adult C57BL6/J mice, yet minimizing the impact of secondary factors associated with the procedure,.such as stress. By using in vitro electrophysiological analysis, I show, for the first time, that sleep loss dramatically affects bidirectional plasticity at CA3 to CA1 synapses in the hippocampus, a well established cellular model of learning and memory. 4-6 hours of sleep loss elevate the modification threshold for bidirectional synaptic plasticity (MT), thereby promoting long-term depression of CA3 to CA 1 synaptic strength after stimulation in the theta frequency range (5 Hz), and rendering long-term potentiation induction.more difficult. Remarkably, 3 hours of recovery sleep, after the deprivation, reset the MT at control values, thus re-establishing the normal proneness of synapses to undergo long-term plastic changes. At the molecular level, these functional changes are paralleled by a change in the NMDAR subunit composition. In particular, the expression of the NR2A subunit protein of NMDAR at CA3 to CA1 synapses is selectively and rapidly increased by sleep deprivation, whereas recovery sleep reset NR2A synaptic content to control levels. By using an array of genetic, pharmacological and computational approaches, I demonstrate here an obligatory role for NR2A-containing NMDARs in conveying the effect of sleep loss on CA3 to CAl MT. Moreover, I show that a genetic deletion of the NR2A subunit fully preserves hippocampal plasticity from the impact of sleep loss, whereas it does not alter sleepwake behavior and homeostatic response to sleep deprivation. As to the mechanism underlying the effects of the NR2A subunit on hippocampal synaptic plasticity, I show that the increased NR2A expression after sleep loss distinctly affects the contribution of synaptic and more slowly recruited NMDAR pools activated during plasticity-induction protocols. This study represents a major step forward in understanding the mechanistic basis underlying sleep's role for the brain. By showing that sleep and sleep loss affect neuronal plasticity by regulating the expression and function of a synaptic neurotransmitter receptor, I propose that an important aspect of sleep function could consist in maintaining and regulating protein redistribution and ion channel trafficking at central synapses. These findings provide a novel starting point for investigations into the connections between sleep and learning, and they may open novel ways for pharmacological control over hippocampal .function during periods of sleep restriction. RÉSUMÉ DU PROJET La fonction du sommeil pour l'organisme est une des questions les plus persistantes et difficiles dans la biologie. Les découvertes actuelles mènent à la conclusion que le sommeil est essentiel pour le cerveau. En particulier, le rôle du sommeil dans les aspects cognitifs est soutenu par des études comportementales tant chez les humains que chez les animaux. Cependant, malgré l'avancement remarquable dans la compréhension des mécanismes sous-tendant la génération et la régulation du sommeil, les mécanismes neurobiologiques qui pourraient expliquer l'effet favorable du sommeil sur l'apprentissage et la mémoire ne sont pas encore clairs. Dans ma thèse, je présente des résultats qui aident à clarifier le lien entre le sommeil et la fonction cognitive. Mon résultat le plus significatif est l'identification moléculaire et l'analyse physiologique d'une protéine, la sous-unité NR2A du récepteur NMDA, qui rend l'hippocampe sensible à la perte de sommeil. Dans cette étude, nous avons utilisé une nouvelle approche expérimentale qui nous a permis d'induire une privation de sommeil chez les souris C57BL6/J adultes, en minimisant l'impact de facteurs confondants comme, par exemple, le stress. En utilisant les techniques de l'électrophysiologie in vitro, j'ai démontré, pour la première fois, que la perte de sommeil est responsable d'affecter radicalement la plasticité bidirectionnelle au niveau des synapses CA3-CA1 de l'hippocampe. Cela correspond à un mécanisme cellulaire de l'apprentissage et de la mémoire bien établi. En particulier, 4-6 heures de privation de sommeil élèvent le seuil de modification pour la plasticité synaptique bidirectionnelle (SM). Comme conséquence, la dépression à long terme de la transmission synaptique est induite par la stimulation des fibres afférentes dans la bande de fréquences thêta (5 Hz), alors que la potentialisation à long terme devient plus difficile. D'autre part, 3 heures de sommeil de récupération sont suffisant pour rétablir le SM aux valeurs contrôles. Au niveau moléculaire, les changements de la plasticité synaptiques sont associés à une altération de la composition du récepteur NMDA. En particulier, l'expression synaptique de la protéine NR2A du récepteur NMDA est rapidement augmentée de manière sélective par la privation de sommeil, alors que le sommeil de récupération rétablit l'expression de la protéine au niveau contrôle. En utilisant des approches génétiques, pharmacologiques et computationnelles, j'ai démontré que les récepteurs NMDA qui expriment la sous-unité NR2A sont responsables de l'effet de la privation de sommeil sur le SM. De plus, nous avons prouvé qu'une délétion génétique de la sous-unité NR2A préserve complètement la plasticité synaptique hippocampale de l'impact de la perte de sommeil, alors que cette manipulation ne change pas les mécanismes de régulation homéostatique du sommeil. En ce qui concerne les mécanismes, j'ai .découvert que l'augmentation de l'expression de la sous-unité NR2A au niveau synaptique modifie les propriétés de la réponse du récepteur NMDA aux protocoles de stimulations utilisés pour induire la plasticité. Cette étude représente un pas en avant important dans la compréhension de la base mécaniste sous-tendant le rôle du sommeil pour le cerveau. En montrant que le sommeil et la perte de sommeil affectent la plasticité neuronale en régulant l'expression et la fonction d'un récepteur de la neurotransmission, je propose qu'un aspect important de la fonction du sommeil puisse être finalisé au règlement de la redistribution des protéines et du tracking des récepteurs aux synapses centraux. Ces découvertes fournissent un point de départ pour mieux comprendre les liens entre le sommeil et l'apprentissage, et d'ailleurs, ils peuvent ouvrir des voies pour des traitements pharmacologiques dans le .but de préserver la fonction hippocampale pendant les périodes de restriction de sommeil.

Inverse association between circulating vitamin D and mortality-dependent on sex and cause of death?

BACKGROUND AND AIMS: In various populations, vitamin D deficiency is associated with chronic diseases and mortality. We examined the association between concentration of circulating 25-hydroxyvitamin D [25(OH)D], a marker of vitamin D status, and all-cause as well as cause-specific mortality. METHODS AND RESULTS: The study included 3404 participants of the general adult Swiss population, who were recruited between November 1988 and June 1989 and followed-up until the end of 2008. Circulating 25(OH)D was measured by protein-bound assay. Cox proportional hazards regression was used to examine the association between 25(OH)D concentration and all-cause and cause-specific mortality adjusting for sex, age, season, diet, nationality, blood pressure, and smoking status. Per 10 ng/mL increase in 25(OH)D concentration, all-cause mortality decreased by 20% (HR = 0.83; 95% CI 0.74-0.92). 25(OH)D concentration was inversely associated with cardiovascular mortality in women (HR = 0.68, 95% CI 0.46-1.00 per 10 ng/mL increase), but not in men (HR = 0.97; 95% CI 0.77-1.23). In contrast, 25(OH)D concentration was inversely associated with cancer mortality in men (HR = 0.72, 95% CI 0.57-0.91 per 10 ng/mL increase), but not in women (HR = 1.14, 95% CI 0.93-1.39). Multivariate adjustment only slightly modified the 25(OH)D-mortality association. CONCLUSION: 25(OH)D was similarly inversely related to all-cause mortality in men and women. However, we observed opposite effects in women and men with respect to cardiovascular and cancer mortality.

Dietary vitamin D and cancers of the oral cavity and esophagus.

BACKGROUND: Data on the association between vitamin D and upper digestive tract neoplasms are limited. METHODS: In two case-control studies in Italy, we examined the relation between dietary vitamin D intake and squamous cell carcinoma of the esophagus (SCCE; 304 cases) and oral/pharyngeal cancer (804 cases). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by multiple logistic regression. RESULTS: Adjusted ORs for SCCE and oral/pharyngeal cancer were 0.58 (95% CI 0.39-0.86) and 0.76 (95% CI 0.60-0.94), respectively, for the highest tertile of vitamin D intake. Using a reference group of those in the highest tertile of vitamin D who were never/former smokers, ORs were 8.7 (95% CI 4.1-18.7) for SCCE and 10.4 (95% CI 6.9-15.5) for oral/pharyngeal cancer among heavy smokers in the lowest vitamin D tertile; similarly, compared with those in the highest tertile of vitamin D who drank <3 alcoholic drinks/day, corresponding ORs were 41.9 (95% CI 13.7-128.6) for SCCE and 8.5 (95% CI 5.7-12.5) for oral/pharyngeal cancer, among heavy alcohol drinkers in the lowest vitamin D tertile. CONCLUSION: We observed inverse associations between dietary vitamin D intake and risk of SCCE and, perhaps, oral/pharyngeal cancer, which were most pronounced among heavy current smokers and heavy consumers of alcohol.

Chemical labelling of oyster shells used for time-calibrated high-resolution Mg/Ca ratios: A tool for estimation of past seasonal temperature variations

The geochemical compositions of biogenic carbonates are increasingly used for palaeoenvironmental reconstructions. The skeletal delta O-18 temperature relationship is dependent on water salinity, so many recent studies have focused on the Mg/Ca and Sr/Ca ratios because those ratios in water do not change significantly on short time scales. Thus, those elemental ratios are considered to be good palaeotemperature proxies in many biominerals, although their use remains ambiguous in bivalve shells. Here, we present the high-resolution Mg/Ca ratios of two modern species of juvenile and adult oyster shells, Crassostrea gigas and Ostrea edulis. These specimens were grown in controlled conditions for over one year in two different locations. In situ monthly Mn-marking of the shells has been used for day calibration. The daily Mg/Ca.ratios in the shell have been measured with an electron microprobe. The high frequency Mg/Ca variation of all specimens displays good synchronism with lunar cycles, suggesting that tides strongly influence the incorporation of Mg/Ca into the shells. Highly significant correlation coefficients (0.70<R<0.83, p<0.0001) between the Mg/Ca ratios and the seawater temperature are obtained only for juvenile C. gigas samples, while metabolic control of Mg/Ca incorporation and lower shell growth rates preclude the use of the Mg/Ca ratio in adult shells as a palaeothermometer. Data from three juvenile C. gigas shells from the two study sites are selected to establish a relationship: T = 3.77Mg/Ca + 1.88, where T is in degrees C and Mg/Ca in mmol/mol. (c) 2012 Elsevier B.V. All rights reserved.

Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts.

BACKGROUND: Obesity is associated with vitamin D deficiency, and both are areas of active public health concern. We explored the causality and direction of the relationship between body mass index (BMI) and 25-hydroxyvitamin D [25(OH)D] using genetic markers as instrumental variables (IVs) in bi-directional Mendelian randomization (MR) analysis. METHODS AND FINDINGS: We used information from 21 adult cohorts (up to 42,024 participants) with 12 BMI-related SNPs (combined in an allelic score) to produce an instrument for BMI and four SNPs associated with 25(OH)D (combined in two allelic scores, separately for genes encoding its synthesis or metabolism) as an instrument for vitamin D. Regression estimates for the IVs (allele scores) were generated within-study and pooled by meta-analysis to generate summary effects. Associations between vitamin D scores and BMI were confirmed in the Genetic Investigation of Anthropometric Traits (GIANT) consortium (n = 123,864). Each 1 kg/m(2) higher BMI was associated with 1.15% lower 25(OH)D (p = 6.52×10⁻²⁷). The BMI allele score was associated both with BMI (p = 6.30×10⁻⁶²) and 25(OH)D (-0.06% [95% CI -0.10 to -0.02], p = 0.004) in the cohorts that underwent meta-analysis. The two vitamin D allele scores were strongly associated with 25(OH)D (p≤8.07×10⁻⁵⁷ for both scores) but not with BMI (synthesis score, p = 0.88; metabolism score, p = 0.08) in the meta-analysis. A 10% higher genetically instrumented BMI was associated with 4.2% lower 25(OH)D concentrations (IV ratio: -4.2 [95% CI -7.1 to -1.3], p = 0.005). No association was seen for genetically instrumented 25(OH)D with BMI, a finding that was confirmed using data from the GIANT consortium (p≥0.57 for both vitamin D scores). CONCLUSIONS: On the basis of a bi-directional genetic approach that limits confounding, our study suggests that a higher BMI leads to lower 25(OH)D, while any effects of lower 25(OH)D increasing BMI are likely to be small. Population level interventions to reduce BMI are expected to decrease the prevalence of vitamin D deficiency.

Influence of nutrition on urinary oxalate and calcium in preterm and term infants.

Few data for normal urinary oxalate (Ox) and calcium (Ca) excretion related both to gestational age and nutritional factors have been reported in preterm or term infants. We therefore determined the molar Ox and Ca to creatinine (Cr) ratios in spot urines from 64 preterm and 37 term infants aged 1-60 days, either fed formula or human milk (HM). Only vitamin D was supplemented; renal or metabolic diseases were excluded. Urinary Ox/Cr ratio was higher in preterm than in term infants, both when formula fed (1st month 253 vs. 180 mmol/mol and 2nd month 306 vs. 212 mmol/mol; P&lt;0.05) or HM fed (206 vs. 169 mmol/ mol and 283* vs. 232 mmol/mol; *P&lt;0.05). Ox/Cr was also higher in formula- than HM-fed preterm infants. The ratio increased during the first 2 months of life irrespective of nutrition. Urinary Ca/Cr ratio was comparable in all groups during the 1st month of life, except for a lower (P &lt; 0.05) value in term infants fed HM (0.10 mol/mol). It increased in all groups during the 2nd month of life, being highest in HM-fed preterm infants (1.86 mol/mol). In conclusion, urinary Ox and Ca excretion is influenced by both gestational age and nutrient intake in preterm and term infants.

High prevalence of severe vitamin D deficiency in combined antiretroviral therapy-naive and successfully treated Swiss HIV patients.

OBJECTIVES: To evaluate the prevalence of 25-hydroxyvitamin D [25(OH)D] deficiency in HIV-positive patients, a population at risk for osteoporosis. DESIGN: Retrospective assessment of vitamin D levels by season and initiation of combined antiretroviral therapy (cART). METHODS: 25(OH)D was measured in 211 HIV-positive patients: samples were taken before initiation of cART from February to April or from August to October as well as 12 (same season) and 18 months (alternate season) after starting cART. 1,25-Dihydroxyvitamin D [1,25(OH)2D] was measured in a subset of 74 patients. Multivariable analyses included season, sex, age, ethnicity, BMI, intravenous drug use (IDU), renal function, time since HIV diagnosis, previous AIDS, CD4 cell count and cART, in particular nonnucleoside reverse transcriptase inhibitor (NNRTI) and tenofovir (TDF) use. RESULTS: At baseline, median 25(OH)D levels were 37 (interquartile range 20-49) nmol/l in spring and 57 (39-74) nmol/l in the fall; 25(OH)D deficiency less than 30 nmol/l was more prevalent in spring (42%) than in fall (14%), but remained unchanged regardless of cART exposure. In multivariable analysis, 25(OH)D levels were higher in white patients and those with a longer time since HIV diagnosis and lower in springtime measurements and in those with active IDU and NNRTI use. 1-Hydroxylation rates were significantly higher in patients with low 25(OH)D. Hepatitis C seropositivity, previous AIDS and higher CD4 cell counts correlated with lower 1,25(OH)2D levels, whereas BMI and TDF use were associated with higher levels. In TDF-treated patients, higher 1,25(OH)2D correlated with increases in serum alkaline phosphatase. CONCLUSION: Based on the high rate of vitamin D deficiency in HIV-positive patients, systematic screening with consideration of seasonality is warranted. The impact of NNRTIs on 25(OH)D and TDF on 1,25(OH)2D needs further attention.

Marqueurs biologiques des statuts vitaminiques B12 et D: aspects analytiques d'importance clinique [Biological markers for the status of vitamins B12 and D: the importance of some analytical aspects in relation to clinical interpretation of results].

Biological markers for the status of vitamins B12 and D: the importance of some analytical aspects in relation to clinical interpretation of results When vitamin B12 deficiency is expressed clinically, the diagnostic performance of total cobalamin is identical to that of holotranscobalamin II. In subclinical B12 deficiency, the two aforementioned markers perform less well. Additional analysis of a second, functional marker (methylmalonate or homocysteine) is recommended. Different analytical approaches for 25-hydroxyvitamin D quantification, the marker of vitamin D deficiency, are not yet standardized. Measurement biases of up to +/- 20% compared with the original method used to establish threshold values are still observed.

Reliability of methods used for the risk assessment of mixture of micropollutants in aquatic enviromments : from theoretical concepts to field observations

Ces dernières années, de nombreuses recherches ont mis en évidence les effets toxiques des micropolluants organiques pour les espèces de nos lacs et rivières. Cependant, la plupart de ces études se sont focalisées sur la toxicité des substances individuelles, alors que les organismes sont exposés tous les jours à des milliers de substances en mélange. Or les effets de ces cocktails ne sont pas négligeables. Cette thèse de doctorat s'est ainsi intéressée aux modèles permettant de prédire le risque environnemental de ces cocktails pour le milieu aquatique. Le principal objectif a été d'évaluer le risque écologique des mélanges de substances chimiques mesurées dans le Léman, mais aussi d'apporter un regard critique sur les méthodologies utilisées afin de proposer certaines adaptations pour une meilleure estimation du risque. Dans la première partie de ce travail, le risque des mélanges de pesticides et médicaments pour le Rhône et pour le Léman a été établi en utilisant des approches envisagées notamment dans la législation européenne. Il s'agit d'approches de « screening », c'est-à-dire permettant une évaluation générale du risque des mélanges. Une telle approche permet de mettre en évidence les substances les plus problématiques, c'est-à-dire contribuant le plus à la toxicité du mélange. Dans notre cas, il s'agit essentiellement de 4 pesticides. L'étude met également en évidence que toutes les substances, même en trace infime, contribuent à l'effet du mélange. Cette constatation a des implications en terme de gestion de l'environnement. En effet, ceci implique qu'il faut réduire toutes les sources de polluants, et pas seulement les plus problématiques. Mais l'approche proposée présente également un biais important au niveau conceptuel, ce qui rend son utilisation discutable, en dehors d'un screening, et nécessiterait une adaptation au niveau des facteurs de sécurité employés. Dans une deuxième partie, l'étude s'est portée sur l'utilisation des modèles de mélanges dans le calcul de risque environnemental. En effet, les modèles de mélanges ont été développés et validés espèce par espèce, et non pour une évaluation sur l'écosystème en entier. Leur utilisation devrait donc passer par un calcul par espèce, ce qui est rarement fait dû au manque de données écotoxicologiques à disposition. Le but a été donc de comparer, avec des valeurs générées aléatoirement, le calcul de risque effectué selon une méthode rigoureuse, espèce par espèce, avec celui effectué classiquement où les modèles sont appliqués sur l'ensemble de la communauté sans tenir compte des variations inter-espèces. Les résultats sont dans la majorité des cas similaires, ce qui valide l'approche utilisée traditionnellement. En revanche, ce travail a permis de déterminer certains cas où l'application classique peut conduire à une sous- ou sur-estimation du risque. Enfin, une dernière partie de cette thèse s'est intéressée à l'influence que les cocktails de micropolluants ont pu avoir sur les communautés in situ. Pour ce faire, une approche en deux temps a été adoptée. Tout d'abord la toxicité de quatorze herbicides détectés dans le Léman a été déterminée. Sur la période étudiée, de 2004 à 2009, cette toxicité due aux herbicides a diminué, passant de 4% d'espèces affectées à moins de 1%. Ensuite, la question était de savoir si cette diminution de toxicité avait un impact sur le développement de certaines espèces au sein de la communauté des algues. Pour ce faire, l'utilisation statistique a permis d'isoler d'autres facteurs pouvant avoir une influence sur la flore, comme la température de l'eau ou la présence de phosphates, et ainsi de constater quelles espèces se sont révélées avoir été influencées, positivement ou négativement, par la diminution de la toxicité dans le lac au fil du temps. Fait intéressant, une partie d'entre-elles avait déjà montré des comportements similaires dans des études en mésocosmes. En conclusion, ce travail montre qu'il existe des modèles robustes pour prédire le risque des mélanges de micropolluants sur les espèces aquatiques, et qu'ils peuvent être utilisés pour expliquer le rôle des substances dans le fonctionnement des écosystèmes. Toutefois, ces modèles ont bien sûr des limites et des hypothèses sous-jacentes qu'il est important de considérer lors de leur application. - Depuis plusieurs années, les risques que posent les micropolluants organiques pour le milieu aquatique préoccupent grandement les scientifiques ainsi que notre société. En effet, de nombreuses recherches ont mis en évidence les effets toxiques que peuvent avoir ces substances chimiques sur les espèces de nos lacs et rivières, quand elles se retrouvent exposées à des concentrations aiguës ou chroniques. Cependant, la plupart de ces études se sont focalisées sur la toxicité des substances individuelles, c'est à dire considérées séparément. Actuellement, il en est de même dans les procédures de régulation européennes, concernant la partie évaluation du risque pour l'environnement d'une substance. Or, les organismes sont exposés tous les jours à des milliers de substances en mélange, et les effets de ces "cocktails" ne sont pas négligeables. L'évaluation du risque écologique que pose ces mélanges de substances doit donc être abordé par de la manière la plus appropriée et la plus fiable possible. Dans la première partie de cette thèse, nous nous sommes intéressés aux méthodes actuellement envisagées à être intégrées dans les législations européennes pour l'évaluation du risque des mélanges pour le milieu aquatique. Ces méthodes sont basées sur le modèle d'addition des concentrations, avec l'utilisation des valeurs de concentrations des substances estimées sans effet dans le milieu (PNEC), ou à partir des valeurs des concentrations d'effet (CE50) sur certaines espèces d'un niveau trophique avec la prise en compte de facteurs de sécurité. Nous avons appliqué ces méthodes à deux cas spécifiques, le lac Léman et le Rhône situés en Suisse, et discuté les résultats de ces applications. Ces premières étapes d'évaluation ont montré que le risque des mélanges pour ces cas d'étude atteint rapidement une valeur au dessus d'un seuil critique. Cette valeur atteinte est généralement due à deux ou trois substances principales. Les procédures proposées permettent donc d'identifier les substances les plus problématiques pour lesquelles des mesures de gestion, telles que la réduction de leur entrée dans le milieu aquatique, devraient être envisagées. Cependant, nous avons également constaté que le niveau de risque associé à ces mélanges de substances n'est pas négligeable, même sans tenir compte de ces substances principales. En effet, l'accumulation des substances, même en traces infimes, atteint un seuil critique, ce qui devient plus difficile en terme de gestion du risque. En outre, nous avons souligné un manque de fiabilité dans ces procédures, qui peuvent conduire à des résultats contradictoires en terme de risque. Ceci est lié à l'incompatibilité des facteurs de sécurité utilisés dans les différentes méthodes. Dans la deuxième partie de la thèse, nous avons étudié la fiabilité de méthodes plus avancées dans la prédiction de l'effet des mélanges pour les communautés évoluant dans le système aquatique. Ces méthodes reposent sur le modèle d'addition des concentrations (CA) ou d'addition des réponses (RA) appliqués sur les courbes de distribution de la sensibilité des espèces (SSD) aux substances. En effet, les modèles de mélanges ont été développés et validés pour être appliqués espèce par espèce, et non pas sur plusieurs espèces agrégées simultanément dans les courbes SSD. Nous avons ainsi proposé une procédure plus rigoureuse, pour l'évaluation du risque d'un mélange, qui serait d'appliquer d'abord les modèles CA ou RA à chaque espèce séparément, et, dans une deuxième étape, combiner les résultats afin d'établir une courbe SSD du mélange. Malheureusement, cette méthode n'est pas applicable dans la plupart des cas, car elle nécessite trop de données généralement indisponibles. Par conséquent, nous avons comparé, avec des valeurs générées aléatoirement, le calcul de risque effectué selon cette méthode plus rigoureuse, avec celle effectuée traditionnellement, afin de caractériser la robustesse de cette approche qui consiste à appliquer les modèles de mélange sur les courbes SSD. Nos résultats ont montré que l'utilisation de CA directement sur les SSDs peut conduire à une sous-estimation de la concentration du mélange affectant 5 % ou 50% des espèces, en particulier lorsque les substances présentent un grand écart- type dans leur distribution de la sensibilité des espèces. L'application du modèle RA peut quant à lui conduire à une sur- ou sous-estimations, principalement en fonction de la pente des courbes dose- réponse de chaque espèce composant les SSDs. La sous-estimation avec RA devient potentiellement importante lorsque le rapport entre la EC50 et la EC10 de la courbe dose-réponse des espèces est plus petit que 100. Toutefois, la plupart des substances, selon des cas réels, présentent des données d' écotoxicité qui font que le risque du mélange calculé par la méthode des modèles appliqués directement sur les SSDs reste cohérent et surestimerait plutôt légèrement le risque. Ces résultats valident ainsi l'approche utilisée traditionnellement. Néanmoins, il faut garder à l'esprit cette source d'erreur lorsqu'on procède à une évaluation du risque d'un mélange avec cette méthode traditionnelle, en particulier quand les SSD présentent une distribution des données en dehors des limites déterminées dans cette étude. Enfin, dans la dernière partie de cette thèse, nous avons confronté des prédictions de l'effet de mélange avec des changements biologiques observés dans l'environnement. Dans cette étude, nous avons utilisé des données venant d'un suivi à long terme d'un grand lac européen, le lac Léman, ce qui offrait la possibilité d'évaluer dans quelle mesure la prédiction de la toxicité des mélanges d'herbicide expliquait les changements dans la composition de la communauté phytoplanctonique. Ceci à côté d'autres paramètres classiques de limnologie tels que les nutriments. Pour atteindre cet objectif, nous avons déterminé la toxicité des mélanges sur plusieurs années de 14 herbicides régulièrement détectés dans le lac, en utilisant les modèles CA et RA avec les courbes de distribution de la sensibilité des espèces. Un gradient temporel de toxicité décroissant a pu être constaté de 2004 à 2009. Une analyse de redondance et de redondance partielle, a montré que ce gradient explique une partie significative de la variation de la composition de la communauté phytoplanctonique, même après avoir enlevé l'effet de toutes les autres co-variables. De plus, certaines espèces révélées pour avoir été influencées, positivement ou négativement, par la diminution de la toxicité dans le lac au fil du temps, ont montré des comportements similaires dans des études en mésocosmes. On peut en conclure que la toxicité du mélange herbicide est l'un des paramètres clés pour expliquer les changements de phytoplancton dans le lac Léman. En conclusion, il existe diverses méthodes pour prédire le risque des mélanges de micropolluants sur les espèces aquatiques et celui-ci peut jouer un rôle dans le fonctionnement des écosystèmes. Toutefois, ces modèles ont bien sûr des limites et des hypothèses sous-jacentes qu'il est important de considérer lors de leur application, avant d'utiliser leurs résultats pour la gestion des risques environnementaux. - For several years now, the scientists as well as the society is concerned by the aquatic risk organic micropollutants may pose. Indeed, several researches have shown the toxic effects these substances may induce on organisms living in our lakes or rivers, especially when they are exposed to acute or chronic concentrations. However, most of the studies focused on the toxicity of single compounds, i.e. considered individually. The same also goes in the current European regulations concerning the risk assessment procedures for the environment of these substances. But aquatic organisms are typically exposed every day simultaneously to thousands of organic compounds. The toxic effects resulting of these "cocktails" cannot be neglected. The ecological risk assessment of mixtures of such compounds has therefore to be addressed by scientists in the most reliable and appropriate way. In the first part of this thesis, the procedures currently envisioned for the aquatic mixture risk assessment in European legislations are described. These methodologies are based on the mixture model of concentration addition and the use of the predicted no effect concentrations (PNEC) or effect concentrations (EC50) with assessment factors. These principal approaches were applied to two specific case studies, Lake Geneva and the River Rhône in Switzerland, including a discussion of the outcomes of such applications. These first level assessments showed that the mixture risks for these studied cases exceeded rapidly the critical value. This exceeding is generally due to two or three main substances. The proposed procedures allow therefore the identification of the most problematic substances for which management measures, such as a reduction of the entrance to the aquatic environment, should be envisioned. However, it was also showed that the risk levels associated with mixtures of compounds are not negligible, even without considering these main substances. Indeed, it is the sum of the substances that is problematic, which is more challenging in term of risk management. Moreover, a lack of reliability in the procedures was highlighted, which can lead to contradictory results in terms of risk. This result is linked to the inconsistency in the assessment factors applied in the different methods. In the second part of the thesis, the reliability of the more advanced procedures to predict the mixture effect to communities in the aquatic system were investigated. These established methodologies combine the model of concentration addition (CA) or response addition (RA) with species sensitivity distribution curves (SSD). Indeed, the mixture effect predictions were shown to be consistent only when the mixture models are applied on a single species, and not on several species simultaneously aggregated to SSDs. Hence, A more stringent procedure for mixture risk assessment is proposed, that would be to apply first the CA or RA models to each species separately and, in a second step, to combine the results to build an SSD for a mixture. Unfortunately, this methodology is not applicable in most cases, because it requires large data sets usually not available. Therefore, the differences between the two methodologies were studied with datasets created artificially to characterize the robustness of the traditional approach applying models on species sensitivity distribution. The results showed that the use of CA on SSD directly might lead to underestimations of the mixture concentration affecting 5% or 50% of species, especially when substances present a large standard deviation of the distribution from the sensitivity of the species. The application of RA can lead to over- or underestimates, depending mainly on the slope of the dose-response curves of the individual species. The potential underestimation with RA becomes important when the ratio between the EC50 and the EC10 for the dose-response curve of the species composing the SSD are smaller than 100. However, considering common real cases of ecotoxicity data for substances, the mixture risk calculated by the methodology applying mixture models directly on SSDs remains consistent and would rather slightly overestimate the risk. These results can be used as a theoretical validation of the currently applied methodology. Nevertheless, when assessing the risk of mixtures, one has to keep in mind this source of error with this classical methodology, especially when SSDs present a distribution of the data outside the range determined in this study Finally, in the last part of this thesis, we confronted the mixture effect predictions with biological changes observed in the environment. In this study, long-term monitoring of a European great lake, Lake Geneva, provides the opportunity to assess to what extent the predicted toxicity of herbicide mixtures explains the changes in the composition of the phytoplankton community next to other classical limnology parameters such as nutrients. To reach this goal, the gradient of the mixture toxicity of 14 herbicides regularly detected in the lake was calculated, using concentration addition and response addition models. A decreasing temporal gradient of toxicity was observed from 2004 to 2009. Redundancy analysis and partial redundancy analysis showed that this gradient explains a significant portion of the variation in phytoplankton community composition, even when having removed the effect of all other co-variables. Moreover, some species that were revealed to be influenced positively or negatively, by the decrease of toxicity in the lake over time, showed similar behaviors in mesocosms studies. It could be concluded that the herbicide mixture toxicity is one of the key parameters to explain phytoplankton changes in Lake Geneva. To conclude, different methods exist to predict the risk of mixture in the ecosystems. But their reliability varies depending on the underlying hypotheses. One should therefore carefully consider these hypotheses, as well as the limits of the approaches, before using the results for environmental risk management

Effect of long-term climbing training on cerebellar ataxia: a case series.

Background. Efficient therapy for both limb and gait ataxia is required. Climbing, a complex task for the whole motor system involving balance, body stabilization, and the simultaneous coordination of all 4 limbs, may have therapeutic potential. Objective. To investigate whether long-term climbing training improves motor function in patients with cerebellar ataxia. Methods. Four patients suffering from limb and gait ataxia underwent a 6-week climbing training. Its effect on ataxia was evaluated with validated clinical balance and manual dexterity tests and with a kinematic analysis of multijoint arm and leg pointing movements. Results. The patients increased their movement velocity and achieved a more symmetric movement speed profile in both arm and leg pointing movements. Furthermore, the 2 patients who suffered the most from gait ataxia improved their balance and 2 of the 4 patients improved manual dexterity. Conclusion. Climbing training has the potential to serve as a new rehabilitation method for patients with upper and lower limb ataxia.

Le facteur D du complément: toxine urémique [Factor D of complement: Uremic toxin?].

Factor D is an essential enzyme of the alternative pathway of complement. Its catabolism is mainly renal. The concentration of factor D increases with renal failure, and is approximately 10-fold higher in patients with end-stage renal disease. The accumulation of factor D is responsible for an enhancement of alternative pathway activation. Whether this excess of factor D has pathophysiological consequences remains to be determined, however, complement activation might participate in adverse effects during hemodialysis and in the progression of renal injury.

Examination of Heterogeneous Crossing Sequences Between Toner and Rollerball Pen Strokes by Digital Microscopy and 3-D Laser Profilometry

The determination of line crossing sequences between rollerball pens and laser printers presents difficulties that may not be overcome using traditional techniques. This research aimed to study the potential of digital microscopy and 3-D laser profilometry to determine line crossing sequences between a toner and an aqueous ink line. Different paper types, rollerball pens, and writing pressure were tested. Correct opinions of the sequence were given for all case scenarios, using both techniques. When the toner was printed before the ink, a light reflection was observed in all crossing specimens, while this was never observed in the other sequence types. The 3-D laser profilometry, more time-consuming, presented the main advantage of providing quantitative results. The findings confirm the potential of the 3-D laser profilometry and demonstrate the efficiency of digital microscopy as a new technique for determining the sequence of line crossings involving rollerball pen ink and toner. With the mass marketing of laser printers and the popularity of rollerball pens, the determination of line crossing sequences between such instruments is encountered by forensic document examiners. This type of crossing presents difficulties with optical microscopic line crossing techniques involving ballpoint pens or gel pens and toner (1-4). Indeed, the rollerball's aqueous ink penetrates through the toner and is absorbed by the fibers of the paper, leaving the examiner with the impression that the toner is above the ink even when it is not (5). Novotny and Westwood (3) investigated the possibility of determining aqueous ink and toner crossing sequences by microscopic observation of the intersection before and after toner removal. A major disadvantage of their study resides in destruction of the sample by scraping off the toner line to see what was underneath. The aim of this research was to investigate the ways to overcome these difficulties through digital microscopy and three-dimensional (3-D) laser profilometry. The former was used as a technique for the determination of sequences between gel pen and toner printing strokes, but provided less conclusive results than that of an optical stereomicroscope (4). 3-D laser profilometry, which allows one to observe and measure the topography of a surface, has been the subject of a number of recent studies in this area. Berx and De Kinder (6) and Schirripa Spagnolo (7,8) have tested the application of laser profilometry to determine the sequence of intersections of several lines. The results obtained in these studies overcome disadvantages of other methods applied in this area, such as scanning electron microscope or the atomic force microscope. The main advantages of 3-D laser profilometry include the ease of implementation of the technique and its nondestructive nature, which does not require sample preparation (8-10). Moreover, the technique is reproducible and presents a high degree of freedom in the vertical axes (up to 1000 μm). However, when the paper surface presents a given roughness, if the pen impressions alter the paper with a depth similar to the roughness of medium, the results are not always conclusive (8). It becomes difficult in this case to distinguish which characteristics can be imputed to the pen impressions or the quality of the paper surface. This important limitation is assessed by testing different types of paper of variable quality (of different grammage and finishing) and the writing pressure. The authors will therefore assess the limits of 3-D laser profilometry technique and determine whether the method can overcome such constraints. Second, the authors will investigate the use of digital microscopy because it presents a number of advantages: it is efficient, user-friendly, and provides an objective evaluation and interpretation.

Vitamin D deficiency: A forgotten treatable cause of motor delay and proximal myopathy.

We report a four-year-old African boy referred for proximal muscle weakness, fatigability and episodic limb pain. Classical causes of structural and metabolic myopathy were initially considered before clinical and biological features of vitamin D deficiency rickets were identified. Prompt treatment with vitamin D and calcium supplementation led to a complete reversal of the muscle symptoms. Rickets-associated myopathy should be included in the differential diagnosis of proximal myopathy, especially in at-risk individuals. Vitamin D deficiency and its prevention remain important health issues in industrialized countries.

Changes in D-serine levels and localization during postnatal development of the rat vestibular nuclei.

The patterns of development of the vestibular nuclei (VN) and their main connections involving glutamate neurotransmission offer a good model for studying the function of the glial-derived neuromodulator D-serine in synaptic plasticity. In this study we show that D-serine is present in the VN and we analyzed its distribution and the levels of expression of serine racemase and D-amino acid oxidase (D-AAO) at different stages of postnatal (P) development. From birth to P21, high levels of D-serine were detected in glial cells and processes in all parts of the VN. This period corresponded to high expression of serine racemase and low expression of D-AAO. On the other hand, in the mature VN D-serine displayed very low levels and was mainly localized in neuronal cell bodies and dendrites. This drop of D-serine in adult stages corresponded to an increasing expression of D-AAO at mature stages. High levels of glial D-serine during the first 3 weeks of postnatal development correspond to an intense period of plasticity and synaptogenesis and maturation of VN afferents, suggesting that D-serine could be involved in these phenomena. These results demonstrate for the first time that changes in D-serine levels and distribution occur during postnatal development in the central nervous system. The strong decrease of D-serine levels and the glial-to-neuronal switch suggests that D-serine may have distinct functional roles depending on the developmental stage of the vestibular network.