Quantificação dos isômeros ácido L-ascórbico e ácido D-iso-ascórbico em geleias de frutas por cromatografia líquida de alta eficiência

Ascorbic acid has important nutritional characteristics such as high antioxidant potential, preventing diverse damage and diseases in the tissues and the process of aging. Different isomeric forms of the ascorbic acid can be found in nature and each one have different potential antioxidant and different activity pro-vitamin C. This work examined a method to detect and quantify the isomers L-ascorbic acid (LAA) and D-iso-ascorbic acid (DIAA) in jelly fruit. The method showed acceptable selectivity, linearity, repeatability and recovery. DIAA was not found in the analyzed samples, but LAA was found up to 605 mg in 100 g of sample.

ARSÊNIO E ARROZ: TOXICIDADE, METABOLISMO E SEGURANÇA ALIMENTAR

Arsenic is considered a semimetal, and its wide distribution in the Earth's crust in different chemical forms, including organic and inorganic species, has a great deal of influence on the mechanisms of toxicity. Exposure to arsenic can be either through occupational practice (use of pesticides) or by the consumption of water and food containing the element. Rice is considered a fundamental constituent of the basic diet of Brazilians and is usually cultivated in flooded conditions. Such a plantation system results in an increased amount of As in the soil and hence a greater accumulation of As in the plant, which is highlighted by the inorganic species' classification as highly toxic. Besides the use of mitigation techniques to reduce the toxicological risk, monitoring the concentration of As and its chemical species in rice and rice products is required through the establishment of legislation in the area. Thus, some world organizations are conducting improved research to determine and establish acceptable concentrations of As and its chemical species in rice, e. g., in 2012, FDA researchers described a chemical speciation methodology for As in rice and rice products. Hence, the application of existing chemical speciation methods and the establishment of parameters for ensuring food security and exposure risk assessment deserve particular consideration.

Cyanobacteria from the Baltic Sea and Finnish lakes as an energy source and modulators of bioenergetic pathways

Cyanobacteria are a diverse group of oxygenic photosynthetic bacteria that inhabit in a wide range of environments. They are versatile and multifaceted organisms with great possibilities for different biotechnological applications. For example, cyanobacteria produce molecular hydrogen (H2), which is one of the most important alternatives for clean and sustainable energy. Apart from being beneficial, cyanobacteria also possess harmful characteristics and may become a source of threat to human health and other living organisms, as they are able to form surface blooms that are producing a variety of toxic or bioactive compounds. The University of Helsinki Culture Collection (UHCC) maintains around 1,000 cyanobacterial strains representing a large number of genera and species isolated from the Baltic Sea and Finnish lakes. The culture collection covers different life forms such as unicellular and filamentous, N2-fixing and non-N2-fixing strains, and planktonic and benthic cyanobacteria. In this thesis, the UHCC has been screened to identify potential strains for sustainable biohydrogen production and also for strains that produce compounds modifying the bioenergetic pathways of other cyanobacteria or terrestrial plants. Among the 400 cyanobacterial strains screened so far, ten were identified as high H2-producing strains. The enzyme systems involved in H2 metabolism of cyanobacteria were analyzed using the Southern hybridization approach. This revealed the presence of the enzyme nitrogenase in all strains tested, while none of them are likely to have contained alternative nitrogenases. All the strains tested, except for two Calothrix strains, XSPORK 36C and XSPORK 11A, were suggested to contain both uptake and bidirectional hydrogenases. Moreover, 55 methanol extracts of various cyanobacterial strains were screened to identify potent bioactive compounds affecting the photosynthetic apparatus of the model cyanobacterium, Synechocystis PCC 6803. The extract from Nostoc XPORK 14A was the only one that modified the photosynthetic machinery and dark respiration. The compound responsible for this effect was identified, purified, and named M22. M22 demonstrated a dual-action mechanism: production of reactive oxygen species (ROS) under illumination and an unknown mechanism that also prevailed in the dark. During summer, the Baltic Sea is occupied by toxic blooms of Nodularia spumigena (hereafter referred to as N. spumigena), which produces a hepatotoxin called nodularin. Long-term exposure of the terrestrial plant spinach to nodularin was studied. Such treatment resulted in inhibition of growth and chlorosis of the leaves. Moreover, the activity and amount of mitochondrial electron transfer complexes increased in the leaves exposed to nodularin-containing extract, indicating upregulation of respiratory reactions, whereas no marked changes were detected in the structure or function of the photosynthetic machinery. Nodularin-exposed plants suffered from oxidative stress, evidenced by oxidative modifications of various proteins. Plants initiated strategies to combat the stress by increasing the levels of alpha-tocopherol, mitochondrial alternative oxidase (AOX), and mitochondrial ascorbate peroxidase (mAPX).

Co-infection by porcine circovirus type 2 and porcine parvovirus in aborted fetuses and stillborn piglets in southern Brazil

Porcine circovirus types 1 and 2 (PCV1, PCV2) and porcine parvovirus (PPV) are widespread in pig populations around the world. Nevertheless, only PCV2 has been associated with different clinical syndromes, thus representing a major problem to the pig industry. The association of cases of swine abortions and stillborns with PCV1 and PCV2 and PPV was studied retrospectively (2005-2007). Additional pathogens were also investigated in lesioned fetuses. The studied litters included stillborn piglets and several mummified fetuses of varied sizes. Ventricular dilatation, myocardial pale areas, and mesocolic edema were the gross lesions. Escherichia coli was detected as co-infecting with PCV2 the cases in which mesocolic edema was seen. Microscopic lesions included non-suppurative myocarditis, myocardial necrosis and fibrosis, mineralization foci and intranuclear inclusion bodies in cardiomyocytes, and interstitial mononuclear pneumonia. Samples from 7 (5.78 per cent) of 121 aborted fetuses and stillborn piglets had lesions consistent with a viral cause and showed both positive anti-PCV2 immunostaining as well as PCV2-PCR. In samples from 3 (2.47 per cent) of these 7 fetuses, co-infection with PPV was confirmed by Nested-PCR. Both viruses were detected in fetuses at different stages of gestation. Viral antigens of PCV2 were detected by immunohistochemistry mainly in macrophages and myocytes. PCV1 individually was not detected in any of these affected fetuses, but it was associated with PCV2 and/or PPV in some of them. These findings indicate that PCV2 alone or in association with PPV should be kept in mind when investigating causes of infectious abortion in pigs in Brazil.

Technological development of 40mg furosemide tablets: equivalence and bioavaibility study in dogs

Furosemide (40mg) was administered to 20 street dogs, 10 males and 10 females, in two different pharmaceutical forms: (1) compressed furosemide 40mg formulated at the Federal University of Pernambuco (UFPE-tablet), and (2) a commercial formulation with equal bioequivalence produced by the Laboratory for Pharmaceutical Technology of Pernambuco State (LAFEPE), the LAFEPE-furosemide. The study aimed to evaluate the kinetics of dissolution of the UFPE-tablet in order to analyze the behavior of bioavailability of the best formulation for veterinary use. The plasmatic concentrations of furosemide for the determination of parameters of pharmacological kinetics were analyzed by high-performance liquid chromatographic method (HPLC). The in vitro study accomplished through physiochemical analyses demonstrated that the formulas of the furosemide tablets attained the pharmaceutical requirements in agreement with USP 23 and the Brazilian Pharmacopoeia. The evaluation accomplished in dogs with UFPE-tablets given in only dose demonstrated uniformity in blood levels indicating stability in maintenance of the pharmaceutical formulation and efficiency in absorption of the active compound. These values are not significantly different in relation to the 5% confidence limit. Regarding maximum concentration (Tmax) time and global bioavaibility assessed by AUC means, there were no considerable differences as well. UFPE-furosemide displayed 743.492µg/mL.h as AUC average value whereas LAFEPE-furosemide had an average of 537.284µg/mL.h.

Muutos kuntaorganisaatiossa - tapaustutkimus erään kunnan teknisestä toimialasta

Kuntaorganisaatioiden muutokset ovat tulleet Suomessa runsaan parinkymmenen vuoden aikana yhä välttämättömämmiksi sekä globaalien että kansallisten toimintaympäristöjen muuttumisen vuoksi. Niitä tehtäessä on kuitenkin kohdattu suuria vaikeuksia jo muutosprosessien alussa, suunnittelu- ja päätöksentekovaiheessa. Keskityttäessä organisaatiomuutosten tavoitteisiin ja lopputulokseen ovat keinot niihin pääsemiseksi jääneet vaille riittävää huomiota. Tämän väitöskirjatutkimuksen päätavoite on selvittää syitä, jotka edistävät ja haittaavat kuntaorganisaation muutosprosessia. Sekundäärisenä tavoitteena on tarkastella motivaation, toimintakulttuurin, poliittisten ja ideologisten eroavaisuuksien sekä arvojen ja asenteiden vaikutusta muutosprosessiin sen eri vaiheissa sekä erilaisissa olosuhteissa. Tutkimuksessa käytetään kvalitatiivista tutkimusmenetelmää, joka tukeutuu erään kunnan teknisen toimialan muutosprosessiin. Tutkimuksen kohteena olevana ajanjaksona sekä vakaassa että muuttuvassa toimintaympäristössä ovat tuon kunnan teknisen toimialan organisaatiomuotoina olleet virasto, liikelaitos, osakeyhtiö ja toimintojen ulkoistaminen. Empiirisen aineiston sekä niin kansallisten kuin kansainvälisten tutkimusten perusteella pyritään löytämään muutosprosessia vaikeuttavia tekijöitä sekä keinoja vaikuttaa prosessin onnistumiseen. Tapaustutkimuksen aineistona ovat tarkastellun kunnan organisaatiomuutoksia koskevat dokumentit. Niitä on täydennetty haastattelemalla henkilöitä, jotka ovat joko suoraan vaikuttaneet muutokseen tai ainakin olleet siinä kiinteästi mukana. Muutosprosessiin liittyviä haasteita lähestytään prosessitutkimuksen avulla pyrkien selvittämään erilaiset kriittiset tapahtumat ja käännekohdat, syy-yhteydet sekä mahdolliset muutoksia suuntaavat mallit. Vaikka muutoksiin vaikuttavat tekijät ovat tämän tutkimuksen tulosten perusteella pääosin samat kuin mitä on havaittu kansainvälisissä tutkimuksissa, liittyy niihin kuitenkin tutkimuksen tapauskohteessa kansallisia ja osittain paikallisiakin erityispiirteitä. On havaittavissa sekä kansallisten ominaispiirteiden että pohjoismaisen hyvinvointiyhteiskunnan ihanteen vaikutusta ihmisten suhtautumisessa muutosprosessiin sekä käyttäytymiseen sen aikana. Tämän tutkimuksen valossa avoimuus ja oikeudenmukaisuus ovat vahvimmin vaikuttavia tekijöitä kuntaorganisaation muutoksessa. Tämän tutkimuksen teoriatarkastelu pohjautuu tutkimuksiin, jotka ovat kohdistuneet muutosprosesseihin yleensä niin julkishallinnon kuin yksityissektorin organisaatioissa. Vaikka tämän väitöskirjan tutkimuksen fokus on kuntasektorilla, ovat sen tulokset suurelta osin sovellettavissa myös yksityissektorille.

CO2:n adsorptio Loviisan voimalaitoksen päästöilmasta 14C-päästöjen määrittämiseksi

Tämän kandidaatintyön tavoitteena oli selvittää mahdollisuuksia 14C:n kemiallisten muotojen eriyttämiseen käyttäen Loviisan voimalaitoksella olemassa olevaa näytteenkeräyslaitteistoa. Lisäksi tarkoituksena oli selvittää parhaiten tähän käyttötarkoitukseen soveltuva zeoliittityyppiä tyypeistä 4A, 5A ja 13X. Työn kirjallisessa osassa käsitellään ydinvoimalaitoksen C14-päästöjä keskittyen pääosin Loviisan VVER-laitokseen. Adsorption osalta esitellään kaupallisesti käytettyjä adsorptiomateriaaleja ja paneudutaan adsorptioon fysikaalisena ja kemiallisena ilmiönä. Lisäksi esitellään kahden desorptiomenetelmän perusperiaatteet. Kirjallisen osan lopussa kootaan tutkimukseen vaikuttavia tekijöitä ja esitellään aiemmin käytössä ollut näytteenkeräyslaitteisto. Kokeellisessa osassa esitellään työssä käytetyt laitteistot. Lisäksi on kuvattu mittausten suoritus nestetuikelaskurilla. Tämän jälkeen työssä esitellään mittaustuloksien käsittely ja näin saadut tulokset.

Absence of linkage between MHC and a gene involved in susceptibility to human schistosomiasis

Six hundred million people are at risk of infection by Schistosoma mansoni. MHC haplotypes have been reported to segregate with susceptibility to schistosomiasis in murine models. In humans, a major gene related to susceptibility/resistance to infection by S. mansoni (SM1) and displaying the mean fecal egg count as phenotype was detected by segregation analysis. This gene displayed a codominant mode of inheritance with an estimated frequency of 0.20-0.25 for the deleterious allele and accounted for more than 50% of the variance of infection levels. To determine if the SM1 gene segregates with the human MHC chromosomal region, we performed a linkage study by the lod score method. We typed for HLA-A, B, C, DR and DQ antigens in 11 informative families from an endemic area for schistosomiasis in Bahia, Brazil, by the microlymphocytotoxicity technique. HLA-DR typing by the polymerase chain reaction with sequence-specific primers (PCR-SSP) and HLA-DQ were confirmed by PCR-sequence-specific oligonucleotide probes (PCR-SSOP). The lod scores for the different q values obtained clearly indicate that there is no physical linkage between HLA and SM1 genes. Thus, susceptibility or resistance to schistosomiasis, as defined by mean fecal egg count, is not primarily dependent on the host's HLA profile. However, if the HLA molecule plays an important role in specific immune responses to S. mansoni, this may involve the development of the different clinical aspects of the disease such as granuloma formation and development of hepatosplenomegaly.

Diversity of genomic electropherotypes of naturally occurring equine herpesvirus 1 isolates in Argentina

The genomes of 10 equine herpesvirus 1 (EHV-1) strains isolated in Argentina from 1979 to 1991, and a Japanese HH1 reference strain were compared by restriction endonuclease analysis. Two restriction enzymes, BamHI and BglII, were used and analysis of the electropherotypes did not show significant differences among isolates obtained from horses with different clinical signs. This suggests that the EHV-1 isolates studied, which circulated in Argentina for more than 10 years, belong to a single genotype.

Prognostic Factors In Breast Cancer. With Special Reference to Cyclins A, B1, D1 and E, MMP-1 and Decorin

Breast cancer is a highly heterogenous malignancy, which despite of the similar histological type shows different clinical behaviour and response to therapy. Prognostic factors are used to estimate the risk for recurrence and the likelihood of treatment effectiveness. Because breast cancer is one of the most common causes of cancer death in women worldwide, identification of new prognostic markers are needed to develop more specific and targeted therapies. Cancer is caused by uncontrolled cell proliferation. The cell cycle is controlled by specific proteins, which are known as cyclins. They function at important checkpoints by activating cyclin-dependent kinase enzymes. Overexpression of different cyclins has been linked to several cancer types and altered expression of cyclins A, B1, D1 and E has been associated with poor survival. Little is known about the combined expression of cyclins in relation to the tumour grade, breast cancer subtype and other known prognostic factors. In this study cyclins A, B1 and E were shown to correlate with histological grade, Ki-67 and HER2 expression. Overexpression of cyclin D1 correlated with receptor status and non-basal breast cancer suggesting that cyclin D1 might be a marker of good prognosis. Proteolysis in the surrounding tumour stroma is increased during cancer development. Matrix metalloproteinases (MMPs) are proteolytic enzymes that are capable of degrading extracellular matrix proteins. Increased expression and activation of several MMPs have been found in many cancers and MMPs appear to be important regulators of invasion and metastasis. In this study MMP-1 expression was analysed in breast cancer epithelial cells and in cancer associated stromal cells. MMP-1 expression by breast cancer epithelial cells was found to carry an independent prognostic value as did Ki-67 and bcl-2. The results suggest that in addition to stromal cells MMP-1 expression in tumour cells control breast cancer progression. Decorin is a small proteoglycan and an important component of the extracellular matrix. Decorin has been shown to inhibit growth of tumour cells and reduced decorin expression is associated with a poor prognosis in several cancer types. There has been some suspicion wheather different cancer cells express decorin. In this study decorin expression was shown to localize only in the cells of the original stroma, while breast cancer epithelial cells were negative for decorin expression. However, transduction of decorin in decorin-negative human breast cancer cells markedly modulated the growth pattern of these cells. This study provides evidence that targeted decorin transduction to breast cancer cells could be used as a novel adjuvant therapy in breast malignancies.

FANCD2 Western blot as a diagnostic tool for Brazilian patients with Fanconi anemia

Fanconi anemia is a rare hereditary disease showing genetic heterogeneity due to a variety of mutations in genes involved in DNA repair pathways, which may lead to different clinical manifestations. Phenotypic variability makes diagnosis difficult based only on clinical manifestations, therefore laboratory tests are necessary. New advances in molecular pathogenesis of this disease led researchers to develop a diagnostic test based on Western blot for FANCD2. The objective of the present study was to determine the efficacy of this method for the diagnosis of 84 Brazilian patients with Fanconi anemia, all of whom tested positive for the diepoxybutane test, and 98 healthy controls. The FANCD2 monoubiquitinated isoform (FANCDS+/FANCD2L-) was not detected in 77 patients (91.7%). In 2 patients (2.4%), there was an absence of both the monoubiquitinated and the non-ubiquitinated proteins (FANCD2S-/FANCD2L-) and 5 patients (5.9%) had both isoforms (FANCD2S+/FANCD2L+). This last phenotype suggests downstream subtypes or mosaicism. All controls were diepoxybutane negative and were also negative on the FANCD2 Western blot. The Western blot for FANCD2 presented a sensitivity of 94% (79/84) and specificity of 100% (98/98). This method was confirmed as an efficient approach to screen Brazilian patients with deleterious mutations on FANCD2 (FANCD2S-/FANCD2L-) or other upstream genes of the FA/BRCA pathway (FANCDS+/FANCD2L-), to confirm the chromosome breakage test and to classify patients according to the level of FA/BRCA pathway defects. However, patients showing both FANCD2 isoforms (FANCD2S+/FANCD2L+) require additional studies to confirm mutations on downstream Fanconi anemia genes or the presence of mosaicism.

Food webs in the era of molecular revolution – Like resolving the Gordian knot with a tricorder

Living nature consists of countless organisms, which are classified into millions of species. These species interact in many ways; for example predators when foraging on their prey, insect larvae consuming plants, and pathogenic bacteria drifting into humans. In addition, abiotic nature has a great initiative impact on life through many factors (including sunlight, ambient temperature, and water. In my thesis, I have studied interactions among different life forms in multifaceted ways. The webs of these interactions are commonly referred to as food webs, describing feeding relationships between species or energy transfer from one trophic level to another. These ecological interactions – whether they occur between species, between individuals, or between microorganisms within an individual – are among the greatest forces affecting natural communities. Relationships are tightly related to biological diversity, that is, species richness and abundances. A species is called a node in food web vocabulary, and its interactions to other species are called links. Generally, Artic food webs are considered to be loosely linked, simple structures. This conception roots into early modern food webs, where insects and other arthropods, for example, were clumped under one node. However, it has been shown that arthropods form the greatest part of diversity and biomass both in the tropics and in Arctic areas. Earlier challenges of revealing the role of insects and microorganisms in interactions webs have become possible with the help of recent advances in molecular techniques. In the first chapter, I studied the prey diversity of a common bat, Myotis daubentonii, in southwestern Finland. My results proved M. daubentonii being a versatile predator whose diet mainly consists of aquatic insects, such as chironomid midges. In the second chapter, I expanded the view to changes in seasonal and individual-based variation in the diet of M. daubentonii including the relationship between available and observed prey. I found out that chironomids remain the major prey group even though their abundance decreases in proportion to other insect groups. Diet varied a lot between individuals, although the differences were not statistically significant. The third chapter took the study to a large network in Greenland. I showed that Artic food webs are very complex when arthropods are taken into account. In the fourth chapter, I examined the bacterial flora of M. daubentonii and surveyed the zoonotic potential of these bacteria. I found Bartonella bacteria, of which one was described as a new species named after the locality of discovery. I have shown in my thesis that Myotis daubentonii as a predator links many insect species as well as terrestrial and aquatic environments. Moreover, I have exposed that Arctic food webs are complex structures comprising of many densely linked species. Finally, I demonstrated that the bacterial flora of bats includes several previously unknown species, some of which could possibly turn in to zoonosis. To summarize, molecular methods have untied several knots in biological research. I hope that this kind of increasing knowledge of the surrounding nature makes us further value all the life forms on earth.

Detection, Identification and Molecular Variation of Human Enteroviruses

Picornaviruses are the most common human viruses and the identification of the picornaviruses is nowadays based on molecular techniques, for example, reverse transcriptase polymerase chain reaction (RT-PCR). One aim of this thesis was to improve the identification of picornaviruses, especially rhino- and enteroviruses, with a real-time assay format and, also, to improve the differentiation of the viruses with genus-specific locked nucleic acid (LNA) probes. Another aim was to identify and study the causative agent of the enterovirus epidemics that appeared in Finland during seasons 2008-2010. In this thesis, the first version of picornavirus qRT-PCR with a melting curve analysis was used in a study of rhinovirus transmission within families with a rhinovirus positive index child where rhinovirus infection was monitored in all family members. In conclusion, rhinoviruses spread effectively within families causing mostly symptomatic infections in children and asymptomatic infections in adults. To improve the differentiation between rhino- and enterovirus the picornavirus qRT-PCR was modified with LNA-incorporated probes. The LNA probes were validated with picornavirus prototypes and different clinical specimen types. The LNA probe-based picornavirus qRT-PCR was able to differentiate all rhino- and enteroviruses correctly, which makes it suitable for diagnostic use. Moreover, in this thesis enterovirus outbreaks were studied with a well-observed method to create a strain-specific qRT-PCR from the typing region VP1 protein. In a hand-foot-and-mouth-disease (HFMD) outbreak in 2008, the causative agent was identified as CV-A6 and when the molecular evolution of the new HFMD CV-A6 strain was studied it was found that CV-A6 was the emerging agent for HFMD and onychomadesis. Furthermore, unusual E-30 meningitis epidemics that apeared during seasons 2009 and 2010 were studied with strain-specific qRT-PCR. The E-30 affected mostly adolescents and was probably spread in sports teams.

Profil de pratique des médecins omnipraticiens en santé mentale au Québec

Au Québec, face à la prévalence élevée des problèmes de santé mentale et à la pénurie de médecins psychiatres, le médecin omnipraticien (MO) occupe une place primordiale dans la prise en charge et le suivi des soins de santé mentale. Dans le contexte de réforme du système de santé mentale axée sur un renforcement de la collaboration entre les MO, les psychiatres et les équipes de santé mentale, notre étude vise à mieux comprendre la pratique clinique et la pratique collaborative développée par les MO, leur appréciation des outils de travail et de la qualité des services de santé mentale, dans le but d’améliorer la complémentarité des soins au niveau primaire. Cette étude transversale impliquait 1415 MO de neuf territoires de centre de santé et de services sociaux (CSSS) du Québec. L’échantillon final était constitué de 398 MO représentatifs de lieux de pratique diversifiés et le taux de réponse était de 41%. Nos résultats mettent en évidence que la pratique clinique et la pratique collaborative des MO diffère selon le degré de gravité des problèmes de santé mentale des patients rencontrés, c’est à dire, trouble transitoire/modéré de santé mentale (TTM.SM) ou trouble grave de santé mentale (TG.SM), et que les MO sont favorables au fait de travailler en collaboration avec les autres professionnels de la santé mentale. Ainsi, il apparaît important de renforcer l’accessibilité des MO aux professionnels de la santé mentale, particulièrement les psychiatres, et de les informer de l’existence des autres acteurs en santé mentale sur leur territoire, pour renforcer la collaboration et la qualité des soins primaires de santé mentale.

Dépistage prénatal de la trisomie 21 et autres aneuploïdies au premier trimestre

La présente thèse par articles aborde différentes facettes du dépistage prénatal de certaines aneuploïdies au premier trimestre de la grossesse. L’introduction retrace l’historique du dépistage prénatal et énonce les différents marqueurs biochimiques et échographiques associés aux aneuploïdies. La première publication démontre que le tabagisme maternel abaisse significativement les niveaux sanguins maternels de PAPP-A et de la fraction libre de la β-hCG et augmente significativement la clarté nucale, confirmant la nécessité de contrôler cette co-variable dans le calcul de risque final, du moins pour la trisomie 18. Le deuxième article identifie des seuils de clarté nucale au-delà desquels la biochimie génétique n’apporte aucune valeur additionnelle au dépistage prénatal de la trisomie 21 et de la trisomie 18. Pour les fœtus avec clarté nucale supérieure aux seuils établis, un diagnostic prénatal intrusif devrait être offert sans délai. Le troisième et dernier article porte sur la première détermination des niveaux plasmatiques maternels de la protéine FLRG (follistatin-related gene) au premier trimestre de grossesse et sur son rôle potentiel à titre de marqueur biochimique dans le dépistage prénatal de la trisomie 21. Bien que détectables, les niveaux plasmatiques maternels de FLRG ne sont pas significativement altérés en présence de fœtus avec syndrome de Down. Dans la discussion générale, les trois articles sont abordés sous un angle plus spécifique au Québec. Des données complémentaires et originales y sont présentées. Une discussion sur l’évolution future du dépistage prénatal est entamée et des axes de recherche sont proposés.