Atrioventricular septal defects among infants in Europe: a population-based study of prevalence, associated anomalies, and survival.

OBJECTIVE: To describe the epidemiology of chromosomal and non-chromosomal cases of atrioventricular septal defects in Europe. METHODS: Data were obtained from EUROCAT, a European network of population-based registries collecting data on congenital anomalies. Data from 13 registries for the period 2000-2008 were included. RESULTS: There was a total of 993 cases of atrioventricular septal defects, with a total prevalence of 5.3 per 10,000 births (95% confidence interval 4.1 to 6.5). Of the total cases, 250 were isolated cardiac lesions, 583 were chromosomal cases, 79 had multiple anomalies, 58 had heterotaxia sequence, and 23 had a monogenic syndrome. The total prevalence of chromosomal cases was 3.1 per 10,000 (95% confidence interval 1.9 to 4.3), with a large variation between registers. Of the 993 cases, 639 cases were live births, 45 were stillbirths, and 309 were terminations of pregnancy owing to foetal anomaly. Among the groups, additional associated cardiac anomalies were most frequent in heterotaxia cases (38%) and least frequent in chromosomal cases (8%). Coarctation of the aorta was the most common associated cardiac defect. The 1-week survival rate for live births was 94%. CONCLUSION: Of all cases, three-quarters were associated with other anomalies, both chromosomal and non-chromosomal. For infants with atrioventricular septal defects and no chromosomal anomalies, cardiac defects were often more complex compared with infants with atrioventricular septal defects and a chromosomal anomaly. Clinical outcomes for atrioventricular septal defects varied between regions. The proportion of termination of pregnancy for foetal anomaly was higher for cases with multiple anomalies, chromosomal anomalies, and heterotaxia sequence.

MALT1 and Caspase-10 : two cysteine proteases controlling lymphocyte activation

Τ cell activation via the Τ cell receptor (TCR) through antigen recognition is one of the key steps to initiate the adaptive immune response. The mechanisms controlling TCR-induced signaling pathways are the subject of intense research, since deregulated signaling in lymphocytes can lead to immunodeficiency, autoimmunity or lymphomas. In Τ lymphocytes a complex composed of CARMA1, BCL10 and MALT1 has been identified to receive signals from TCR proximal events and to induce further signals crucial for Τ cell activation. MALT1 is scaffold protein and a cysteine protease and both functions have been shown, among other effects, to be crucial to initiate the activation of the transcription factors of the nuclear factor κΒ (NF-κΒ) family after TCR-stimulation. Several proteolytic targets have been described recently and all of them play roles in modulating NF-κΒ activation or other aspects of Τ cell activation. In this study, we describe a novel target of MALT1, Caspase-10. Two isoforms of Caspase-10 are cleaved by MALTI in Τ and Β cells after antigen receptor stimulation. Caspases are a family of cysteine proteases that are known for their roles in cell death and certain immune functions. Caspase-10 has so far only been reported to be involved in the induction of apoptosis. However it is very closely related to the well-characterized Caspase-8 that has been reported to be involved in Τ cell activation. In the present study, we describe a crucial role for Caspase-10, but not Caspase-8, in Τ cell activation after TCR stimulation. Jurkat Τ cells silenced for Caspase-10 expression exhibit a dramatic reduction in IL-2 production following stimulation. The data obtained revealed that this is due to severely reduced activation of activator protein-1 (AP-1), another transcription factor family with key functions in the process of Τ cell activation. We observed strongly reduced expression levels of the AP-1 family member c-Fos after Τ cell stimulation. This transcription factor is expressed upon TCR stimulation and is a crucial component of AP-1 transcription factor dimers required for Τ cell activation. In further analysis, it was shown that this defect is not based on reduced transcription, as the c-Fos mRNA levels are not altered, but rather seems to be caused by a defect in translation or protein stability in the absence of Caspase-10. Furthermore, we report a potential interaction of the c-Fos protein and Caspsae-10. This role of Caspase-10 in AP-1 activation however is independent of its cleavage by MALT1, leaving the role of Caspase-10 cleavage in activated lymphocytes unclear. Taken together, these results give new insights into the complex matter of lymphocyte activation whose understanding is crucial for the development of new drugs modulating the immune response or inhibiting lymphoma progression.

Prediction of 18-month survival in patients with primary myelodysplastic syndrome. A regression model and scoring system based on the combination of chromosome findings and the Bournemouth score.

The predictive potential of six selected factors was assessed in 72 patients with primary myelodysplastic syndrome using univariate and multivariate logistic regression analysis of survival at 18 months. Factors were age (above median of 69 years), dysplastic features in the three myeloid bone marrow cell lineages, presence of chromosome defects, all metaphases abnormal, double or complex chromosome defects (C23), and a Bournemouth score of 2, 3, or 4 (B234). In the multivariate approach, B234 and C23 proved to be significantly associated with a reduction in the survival probability. The similarity of the regression coefficients associated with these two factors means that they have about the same weight. Consequently, the model was simplified by counting the number of factors (0, 1, or 2) present in each patient, thus generating a scoring system called the Lausanne-Bournemouth score (LB score). The LB score combines the well-recognized and easy-to-use Bournemouth score (B score) with the chromosome defect complexity, C23 constituting an additional indicator of patient outcome. The predicted risk of death within 18 months calculated from the model is as follows: 7.1% (confidence interval: 1.7-24.8) for patients with an LB score of 0, 60.1% (44.7-73.8) for an LB score of 1, and 96.8% (84.5-99.4) for an LB score of 2. The scoring system presented here has several interesting features. The LB score may improve the predictive value of the B score, as it is able to recognize two prognostic groups in the intermediate risk category of patients with B scores of 2 or 3. It has also the ability to identify two distinct prognostic subclasses among RAEB and possibly CMML patients. In addition to its above-described usefulness in the prognostic evaluation, the LB score may bring new insights into the understanding of evolution patterns in MDS. We used the combination of the B score and chromosome complexity to define four classes which may be considered four possible states of myelodysplasia and which describe two distinct evolutional pathways.

A receptor-like kinase mutant with absent endodermal diffusion barrier displays selective nutrient homeostasis defects.

The endodermis represents the main barrier to extracellular diffusion in plant roots, and it is central to current models of plant nutrient uptake. Despite this, little is known about the genes setting up this endodermal barrier. In this study, we report the identification and characterization of a strong barrier mutant, schengen3 (sgn3). We observe a surprising ability of the mutant to maintain nutrient homeostasis, but demonstrate a major defect in maintaining sufficient levels of the macronutrient potassium. We show that SGN3/GASSHO1 is a receptor-like kinase that is necessary for localizing CASPARIAN STRIP DOMAIN PROTEINS (CASPs)--major players of endodermal differentiation--into an uninterrupted, ring-like domain. SGN3 appears to localize into a broader band, embedding growing CASP microdomains. The discovery of SGN3 strongly advances our ability to interrogate mechanisms of plant nutrient homeostasis and provides a novel actor for localized microdomain formation at the endodermal plasma membrane.

Regulation of insulin secretion by phosphatidylinositol-4,5-bisphosphate.

The role of PIP(2) in pancreatic beta cell function was examined here using the beta cell line MIN6B1. Blocking PIP(2) with PH-PLC-GFP or PIP5KIgamma RNAi did not impact on glucose-stimulated secretion although susceptibility to apoptosis was increased. Over-expression of PIP5KIgamma improved cell survival and inhibited secretion with accumulation of endocytic vacuoles containing F-actin, PIP(2), transferrin receptor, caveolin 1, Arf6 and the insulin granule membrane protein phogrin but not insulin. Expression of constitutively active Arf6 Q67L also resulted in vacuole formation and inhibition of secretion, which was reversed by PH-PLC-GFP co-expression. PIP(2) co-localized with gelsolin and F-actin, and gelsolin co-expression partially reversed the secretory defect of PIP5KIgamma-over-expressing cells. RhoA/ROCK inhibition increased actin depolymerization and secretion, which was prevented by over-expressing PIP5KIgamma, while blocking PIP(2) reduced constitutively active RhoA V14-induced F-actin polymerization. In conclusion, although PIP(2) plays a pro-survival role in MIN6B1 cells, excessive PIP(2) production because of PIP5KIgamma over-expression inhibits secretion because of both a defective Arf6/PIP5KIgamma-dependent endocytic recycling of secretory membrane and secretory membrane components such as phogrin and the RhoA/ROCK/PIP5KIgamma-dependent perturbation of F-actin cytoskeleton remodelling.

Novel role of a family of major facilitator transporters in biofilm development and virulence of Candida albicans.

The QDR (quinidine drug resistance) family of genes encodes transporters belonging to the MFS (major facilitator superfamily) of proteins. We show that QDR transporters, which are localized to the plasma membrane, do not play a role in drug transport. Hence, null mutants of QDR1, QDR2 and QDR3 display no alterations in susceptibility to azoles, polyenes, echinocandins, polyamines or quinolines, or to cell wall inhibitors and many other stresses. However, the deletion of QDR genes, individually or collectively, led to defects in biofilm architecture and thickness. Interestingly, QDR-lacking strains also displayed attenuated virulence, but the strongest effect was observed with qdr2∆, qdr3∆ and in qdr1/2/3∆ strains. Notably, the attenuated virulence and biofilm defects could be reversed upon reintegration of QDR genes. Transcripts profiling confirmed differential expression of many biofilm and virulence-related genes in the deletion strains as compared with wild-type Candida albicans cells. Furthermore, lipidomic analysis of QDR-deletion mutants suggests massive remodelling of lipids, which may affect cell signalling, leading to the defect in biofilm development and attenuation of virulence. In summary, the results of the present study show that QDR paralogues encoding MFS antiporters do not display conserved functional linkage as drug transporters and perform functions that significantly affect the virulence of C. albicans.

Defecto en la homeostasis del oxido nítrico. Mecanismo común subyacente de la insulino-resistencia, la hiperactividad simpática y la morbi-mortalidad cardiovascular [Defective nitric oxide homeostasis. Common underlying mechanism between insulin resistance, sympathetic overactivity and cardiovascular morbidity and mortality]

Obesity, insulin resistance and associated cardiovascular complications are reaching epidemic proportions worldwide and represent a major public health problem. Over the past decade, evidence has accumulated indicating that insulin administration, in addition to its metabolic effects, also has important cardiovascular actions. The sympathetic nervous system and the L-arginine-nitric oxide pathway are the central players in the mediation of insulin's cardiovascular actions. Based on recent animal and human research, we demonstrate that both defective and augmented NO synthesis represent a central defect triggering many of the metabolic, vascular and sympathetic abnormalities characteristic of insulin-resistant states. These observations provide the rationale for the use of pharmaceutical drugs releasing small and physiological amounts of NO and/or inhibitors of NO overproduction as a future treatment for insulin resistance and associated comorbidities.

Endoscopic Approach and Management of Parasellar Lesions

The parasellar region is the location of a wide variety of inflammatory and benign or malignant lesions. A pathological diagnostic strategy may be difficult to establish relying solely on imaging data. Percutaneous biopsy through the foramen ovale using the Hartel technique has been developed for decision-making process. It is an accurate diagnostic tool allowing pathological diagnosis to determine the best treatment strategy. However, in some cases, this procedure may fail or may be inappropriate particularly for anterior parasellar lesions. Over these past decades, endoscopy has been widely developed and promoted in many indications. It represents an interesting alternative approach to parasellar lesions with low morbidity when compared to the classic microscopic sub-temporal extradural approach with or without orbito-zygomatic removal. In this chapter, we describe our experience with the endoscopic approach to parasellar lesions. We propose a complete overview of surgical anatomy and describe methods and results of the technique. We also suggest a model of a decision-making tree for the diagnosis and treatment of parasellar lesions.

CD47 knockout mice exhibit improved recovery from spinal cord injury.

Recent data have implicated thrombospondin-1 (TSP-1) signaling in the acute neuropathological events that occur in microvascular endothelial cells (ECs) following spinal cord injury (SCI) (Benton et al., 2008b). We hypothesized that deletion of TSP-1 or its receptor CD47 would reduce these pathological events following SCI. CD47 is expressed in a variety of tissues, including vascular ECs and neutrophils. CD47 binds to TSP-1 and inhibits angiogenesis. CD47 also binds to the signal regulatory protein (SIRP)α and facilitates neutrophil diapedesis across ECs to sites of injury. After contusive SCI, TSP-1(-/-) mice did not show functional improvement compared to wildtype (WT) mice. CD47(-/-) mice, however, exhibited functional locomotor improvements and greater white matter sparing. Whereas targeted deletion of either CD47 or TSP-1 improved acute epicenter vascularity in contused mice, only CD47 deletion reduced neutrophil diapedesis and increased microvascular perfusion. An ex vivo model of the CNS microvasculature revealed that CD47(-/-)-derived microvessels (MVs) prominently exhibit adherent WT or CD47(-/-) neutrophils on the endothelial lumen, whereas WT-derived MVs do not. This implicates a defect in diapedesis mediated by the loss of CD47 expression on ECs. In vitro transmigration assays confirmed the role of SIRPα in neutrophil diapedesis through EC monolayers. We conclude that CD47 deletion modestly, but significantly, improves functional recovery from SCI via an increase in vascular patency and a reduction of SIRPα-mediated neutrophil diapedesis, rather than the abrogation of TSP-1-mediated anti-angiogenic signaling.

Role of Notch signaling in epidermis and appendages

Résumé Dans la peau, il a été montré que Notch1 induit l'arrêt de la prolifération et la différentiation des keratinocytes. L'inactivation de Notch1 cause une hyperplasie de l'épiderme et la formation de carcinomes basaux cellulaires. Notre groupe a principalement identifié deux voies de signalisations, la voie Shh et la voie Wnt, qui sont dérégulées en conséquence de l'inactivation de Notch1 dans la peau. Nous avons démontré l'habilité de Notch1 à réprimer la voie Wnt induite par ß-catenin dans les keratinocytes primaires ainsi que dans d'autres types de cellules épithéliales humaines. De plus, nous avons pu déterminer que Notch1 régule cette voie, probablement en favorisant la phosphorylation de ß-catenin par le complexe axin/APC/GSK-3ß. La protéine faisant partie de la voie Wnt, ou la protéine affectant la voie Wnt, qui est régulée par Notch1 est sujette à de plus amples investigations. Un autre but de cette étude a été l'identification de potentiels gènes cibles de Notch1 autres que ceux faisant partie des voies de signalisation Shh et Wnt précédemment évoquées. Ce projet fut abordé par l'analyse de puces à ADN (ISREC et Affymetrix) qui ont été utilisées pour des expériences de gain et de perte de fonction de Notch1 dans des keratinocytes prúmaires. En plus de l'hyperplasie épidermale, les souris Notch1 déficiente ont une perte importante de poils. Nous avons montré que Notch1 est nécessaire pour le développement et l'homéostasie des follicules pileux. En effet, l'inactivation du gène Notch1 mediée par l'activation des kératines 5 ou 14 dans l'épiderme, cause des défauts du cycle ainsi que de la structure des poils. De plus, d'autres appendices de la peau, comme les glandes sudoripares et de Meibomius, ont une structure anormale et sont non fonctionnelles dans les souris Notch1 déficiente. Finalement, nous avons observé que la déficience de Notch1 dans l'épithélium cornéen mène à la formation d'une plaque épidermale opaque sur la cornée. Basé sur l'hypothèse que le défaut des glandes de Meibomius des souris Notch1 déficientes cause des lésions de la surface oculaire, nous avons montré que Notch1 est essentiel pour la cicatrisation de la cornée. Lorsque Notch1 est absent, les cellules souches de l'épithélium cornéen ne sont plus capables de se différentier en cellules cornéennes, mais réparent la blessure en se différentiant en épiderme. Ce résultat indique que Notch1 est essentiel pour la différentiation de cellules souches de la cornée qui sont spécifiquement impliquées dans la réparation de la cornée. De plus, nous avons montré que l'expression de CRBP1 dans l'épithélium cornéen est diminuée en l'absence de Notch1, ceci étant possiblement à l'origine de la formation de la plaque épidermale. Abstract: In the skin, Notch1 has been shown to trigger cell growth arrest and differentiation of keratinocytes. Notch1 inactivation results in epidermal hyperplasia and subsequent formation of basal cell carcinoma-like (BCC-like) tumors. So far our group has identified two main pathways, the Shh and the Wnt pathway, that are deregulated as a consequence of Notch1 inactivation in the skin. We showed the ability of Notch1 to represses ß-catenin-mediated Wnt signaling in primary keratinocytes as well as in other types of human epithelial cells. In addition we were able to determine that Notch1 regulates this pathway possibly by enhancing ß-catenin phosphorylation by the axin/APC/GSK-3ß complex. The exact target protein of the Wnt pathway or target protein that affects the Wnt pathway, and that is regulated by Notch1, is subject of current investigation. Another aim of this study was the identification of possible Notch1 target genes in addition to those of the Shh and Wnt signaling pathways. This was addressed by gene chip analysis using ISREC as well as Affymetrix microarrays for gain and loss of function of Notch1 in mouse primary keratinocytes. In addition to epidermal hyperplasia, Notch1 deficient mice show an important hair loss. We showed that Notch1 is required for postnatal development and homeostasis of hair follicles. Indeed, keratin5 or keratinl4-driven Cre recombinase-mediated inactivation of the Notch1 gene in the epidermis causes perturbations of the hair cycle and structural defects of the hair follicle. Moreover, other skin appendages, like the sweat and Meibomian glands show abnormal morphology and are not functional in the Notch 1 deficient mice. Finally, we observed that Notch1 deficiency in the corneal epithelium leads to the formation of an epidermal corneal plaque. Based on the hypothesis that the Meiboinian gland defect in the Notch1 deficient mice results in lesions of the eye surface, we showed that Notch1 is essential for wound-healing of the cornea. In absence of Notch1 the stem cells of the corneal epithelium are no longer able to differentiate in the corneal fate but instead repair the wound by differentiating into skin-like epidermis. This result indicated that Notch1 is essential for the differentiation of corneal stem cells specifically implicated in corneal wound-healing. Moreover, we showed that CRBP1 expression in the corneal epithelium was lost in the absence of Notch1, possibly being at the origin of plaque formation.

Emergence of secretion-defective sublines of Pseudomonas aeruginosa PAO1 resulting from spontaneous mutations in the vfr global regulatory gene.

Pseudomonas aeruginosa undergoes spontaneous mutation that impairs secretion of several extracellular enzymes during extended cultivation in vitro in rich media, as well as during long-term colonization of the cystic fibrosis lung. A frequent type of strong secretion deficiency is caused by inactivation of the quorum-sensing regulatory gene lasR. Here we analyzed a spontaneously emerging subline of strain PAO1 that exhibited moderate secretion deficiency and partial loss of quorum-sensing control. Using generalized transduction, we mapped the secretion defect to the vfr gene, which is known to control positively the expression of the lasR gene and type II secretion of several proteases. We confirmed this secretion defect by sequencing and complementation of the vfr mutation. In a reconstruction experiment conducted with a 1:1 mixture of wild-type strain PAO1 and a vfr mutant of PAO1, we observed that the vfr mutant had a selective advantage over the wild type after growth in static culture for 4 days. Under these conditions, spontaneous vfr emerged in a strain PAO1 population after four growth cycles, and these mutants accounted for more than 40% of the population after seven cycles. These results suggest that partial or complete loss of quorum sensing and secretion can be beneficial to P. aeruginosa under certain environmental conditions.

Deviant trajectories of cortical maturation in 22q11.2 deletion syndrome (22q11DS): a cross-sectional and longitudinal study.

22q11.2 deletion syndrome (22q11DS) is associated with an increased susceptibility to develop schizophrenia. Despite a large body of literature documenting abnormal brain structure in 22q11DS, cerebral changes associated with brain maturation in 22q11DS remained largely unexplored. To map cortical maturation from childhood to adulthood in 22q11.2 deletion syndrome, we used cerebral MRI from 59 patients with 22q11DS, aged 6 to 40, and 80 typically developing controls; three year follow-up assessments were also available for 32 patients and 31 matched controls. Cross-sectional cortical thickness trajectories during childhood and adolescence were approximated in age bins. Repeated-measures were also conducted with the longitudinal data. Within the group of patients with 22q11DS, exploratory measures of cortical thickness differences related to COMT polymorphism, IQ, and schizophrenia were also conducted. We observed deviant trajectories of cortical thickness changes with age in patients with 22q11DS. In affected preadolescents, larger prefrontal thickness was observed compared to age-matched controls. Afterward, we observed greater cortical loss in 22q11DS with a convergence of cortical thickness values by the end of adolescence. No compelling evidence for an effect of COMT polymorphism on cortical maturation was observed. Within 22q11DS, significant differences in cortical thickness were related to cognitive level in children and adolescents, and to schizophrenia in adults. Deviant trajectories of cortical thickness from childhood to adulthood provide strong in vivo cues for a defect in the programmed synaptic elimination, which in turn may explain the susceptibility of patients with 22q11DS to develop psychosis.

Evaluation of the immune response to infection with metastatic and non-metastatic "Leishmania guyanensis" parasites

ABSTRACT : Les infections par le parasite Leishmania guyanensis se caractérisent par une dissémination depuis le site initial d'infection jusqu'aux tissus naso-pharyngés, responsable de la Leishmaniose à lésions secondaires muco-cutanées (LMC). Les lésions des patients atteints de LMC montrent une massive infiltration de cellules immunitaires, une réponse immunitaire élevée et la présence de parasites (bien qu'en très faible quantité). La LMC engendre une augmentation de l'expression de TNFa ainsi qu'un défaut dans le contrôle de la réponse immunitaire caractérisé par une absence de réponse à l'IL 10. La réponse immunitaire de l'hôte ainsi que la virulence du parasite sont deux facteurs reconnus pour le contrôle de l'infection. Le mécanisme de la pathogenèse de la LMC restent grandement incompris, surtout le mécanisme de dissémination de l'infection du site d'inoculation jusqu'aux sites secondaires d'infection (métastases) ainsi que les détails de la réponse de l'hôte contre le pathogène. Dans un modèle d'infection d' hamsters avec des parasites du Nouveau Monde, la classification des parasites Leishmania se fait en fonction de leur capacité à développer des métastases. Ce modéle d'infection a permis de caractériser différentes souches de parasites selon la classification de l'Organisation Mondiale de la Sante (OMS) tel que la souche de référence W>É-II/BR/78/M5313 qui est reconnue comme hautement métastatique alors que ces clones dérivés de M5313 montrent de grandes variations quand a leur capacité à créer des métastases. Les clones 13 et 21 sont métastatiques (M+) alors que les clones 3 et 17 sont nonmétastatiques (NI-). Les objectifs de cette thèse ont été d'étudier le rôle de la réponse immunitaire innée des macrophages après infection in vitro avec différents clones métastatiques et non-métastatiques du parasite L. guyanensis, ainsi que d'étudier la réponse immunitaire générée suite à une infection in vivo par les clones M+ et M- de L. guyanensis dans un modèle marin. L'analyse de la .réponse immunitaire des macrophages in vitro montrent qu'il y aune augmentation significative de leur statut d'activation après infection par des parasites M+ indiquée par la modulation des marqueurs d'activation de surface CD80, CD86 et CD40, ainsi que une augmentation significative de CXCL 10, CCLS, IL6 et TNFa au niveau transcription de l'ARNm et au niveau de la protéine. Cette phénomène d'activation a été observée chez les deux souches de souris C57BL/6 et BALB/c. L'utilisation d'un inhibiteur d'entrée des parasites (Cytochalsin D) ou d'un inhibiteur des fonctions endosomales (Chloroquine) diminue de manière significative la réponse des macrophages aux parasites M+. L'utilisation de macrophages déficients en TLR, MyD88, et TRIF a démontré que la réponse générée après infection par les parasites M+ était dépendante de la voie de signalisation de TRIF et TLR3. Lors d'infection in vivo par des parasites M5313, au moins 50% des souris BALB/c présentent un phénotype sensible caractérisé par des lésions non-nécrotiques qui ne guérissent pas, persistent plus de 13 semaines après infection et contiennent un nombre considérable de parasites. Ces souris développent une réponse immunitaire de type T helper 2 (Th2) avec un niveau élevé d'IL-4 et d'IL-10. Les autres souris ont un phénotype non-sensible, les souris développant peu ou pas de lésion, avec peu de parasites et une réponse immunitaire diminuée, caractérisée par un niveau faible d'IFNy, d'IL4 et d'IL10. De plus, les souris BALB/c infectées par un parasite L. guyanensis isolé à partir des lésions muco-cutanées d'un patient humain atteint de LMC ont démontrés un phénotype similaire aux souris infectées par la souche M5313 avec 50% des souris développant des lésions persistantes, alors qu'un parasite dérivé des lésions cutanées humains n'a montré qu'une faible sensibilité avec une lésion transitoire qui finit par guérir. Nous avons montré que la sensibilité de ces souris BALB/c dépend de l'IL-4 et de l'IL-10 car les souris IL-10-/sur fond génétique BALB/c ainsi que les souris BALB/c traitée avec de l'anti-IL4 étaient capables de contrôler l'infection par M5313. Les souris C57BL/6 sont résistantes à l'infection par le parasite M5313. Elles développent une lésion transitoire qui guérit 9 semaines après infection. Ces souris résistantes ont un très faible taux de parasites au site d'infection et développent une réponse immunitaire de type Thl avec un niveau élevé d'IFNr et peu d'IL4 et d'IL10. Les infections in vivo de souris déficientes en MyD88, TRIF, TLR3 ou TLR9 (sur fond génétique C57BL/6) ont indiqué que MyD88 et TLR9 étaient impliqués dans la résistance à l'infection par L. guyanensi, et que TRIF et TLR3 avaient un rôle important dans la sensibilité. Ce travail met en évidence le fait que la réponse immunitaire de l'hôte est modulée par le parasite selon leur caractérisation d'être soit M+ ou M-. Nous avons démontré également que plusieurs gènes et voies de signalisations étaient impliqués dans cette réponse favorisant le développement d'une LMC. ABSTRACT : Leishmania guyanensis parasites are able to disseminate from the initial site of cutaneous skin infection to the nasopharyngeal tissues resulting in destructive secondary lesions and the disease Mucocutaneous Leishmaniasis (MCL). The secondary lesions in patients have intense immune cell infiltration, elevated immune responses and the presence (albeit at low levels) of parasites. More specifically, MCL patients produce higher levels of TNFa and display impairment in their ability to control the immune response due to a defect in their ability to respond to IL10. Little is known about the pathogenesis of MCL, especially about the dissemination of the infection from the site of inoculation to secondary sites (metastasis) and the response of the host to the pathogen. The hamster model of L. guyanensis infection has previously characterized the WHO reference strain, L. guyanensis WHI/BR/78/M5313, as being highly metastatic. Clones of parasites derived from this reference strain show a differential ability to metastasize. This thesis studied the differential immune response generated by macrophages in vitro, or by mice in vivo, following infection with L. guyanensis parasites. A significant increase in the activation status of macrophages derived from C57BL/6 or BALB/c mice was observed after in vitro infection with L. guyanensis parasites when compared to non-metastatic parasites. This change in status was evidenced by the increased expression of surface activation markers, together with the chemokines, CXCL 10, CCLS, and cytokines, IL6 and TNFa. Furthermore, in vitro infection of macrophages isolated from mice deficient in either a specific Toll Like Receptor (TLR) or the adaptor molecules MyD88 or TRIF, indicated that the immune response generated following L. guyanensis metastatic parasite infection was reliant on the TRIF dependent TLR3 signalling pathway. In vivo footpad infection of BALB/c mice with the L. guyanensis M5313 parasites showed a reproducible susceptible phenotype, whereby at least 50% of infected mice developed non-healing, nonnecrosing lesions with high parasitemia that persisted over 13 weeks post infection. This phenotype was characterized by a Th2 type cytokine immune response with increased levels of IL4 and IL10 detected in the draining lymph nodes. IL 10 deficient mice on a BALB/c background, or BALB/c mice treated with anti-IL4 were able to control infection with L. guyanensis M5313 parasites, thereby proving that these cytokines were indeed implicated in the susceptibility to infection. Moreover, infection of BALB/c mice with patient isolated L. guyanensis parasites confirmed that MCL derived parasites were able to induce a susceptibility phenotype similar to that of L. guyanensis M5313. C57BL/6 mice, on the other hand, were highly resistant to infection with L. guyanensis M5313 parasites and produced transient footpad swelling that healed by week 9 post infection, together with low degrees of footpad parasitemia and a Thl polarized immune response. Infection of mice deficient in MyD88, TRIF, TLR3, and TLR9 (on a C57BL/6 background), indicated that MyD88 and TLR9 were involved in the resistance of these mice to infection, and that TRIF and TLR3 were involved in the susceptibility. This study has shown that the host response can be differentially modulated depending on the infecting parasite with several genes and pathways being identified that could be involved in promoting the development of MCL.

Arterial hypertension after surgical closure of omphalocele and gastroschisis.

Arterial hypertension has been reported as a complication of surgical closure of an abdominal wall defect. No report studying the incidence, the characteristics and the clinical significance of hypertension after surgical correction of an omphalocele or gastroschisis has been published so far. The medical records of all newborns with surgically corrected gastroschisis or omphalocele identified in two centers were retrospectively evaluated. Arterial hypertension was defined as a mean daily systolic and/or diastolic blood pressure value higher than the 95 percentile for age and/or weight, according to literature data. The timing of surgery, weight gain, plasma creatinine and the use of diuretics or vasoactive drugs were compared between the groups with and without hypertension. Seventy-two patients were identified and included in the study, 29 with omphalocele and 43 with gastroschisis. Those with omphalocele were born at a mean age of 37.3+/-2.6 weeks with a mean birth weight of 2,971+/-715 g, and those with gastroschisis were born at 36.1+/-2.0 weeks with a mean birth weight of 2,527+/-498 g. Blood pressure values of 66 patients were available for analysis. Of the omphalocele patients, 46.2% (12/26) developed systolic hypertension, compared to 17.5% (7/40) of the patients with gastroschisis (P =0.024). Hypertension was always transient, lasting an average of 4 and 1 day in the omphalocele and gastroschisis groups, respectively. Two patients with omphalocele were given anti-hypertensive therapy. There was no difference between patients with or without hypertension regarding weight gain, use of vasoactive drugs or diuretics, mean weekly creatinine values or the timing of surgery. Newborns with an abdominal wall defect frequently present with transient arterial hypertension. Hypertension occurs significantly more often, is more severe and lasts longer in patients with omphalocele than in patients with gastroschisis. In both groups, hypertension is transient and rarely requires therapy. The cause of hypertension remains unclear.

Frecuencias de trepanación en la Edad del Bronce

En un estudio osteológico de los restos humanos de la Edad del Bronce de Cataluña se ha puesto de manifiesto la existencia, en esta época, de un suave y gradual proceso de difusión racial a lo largo del litoral noroeste del Mediterráneo, así como las influencias que éste ha tenido en el área catalana, donde aparece un elemento foráneo, de origen centroeuropeo, minoritario, localizado fundamentalmente en Solsona y de modo particular en tres yacimientos muy cercanos entre sí: los megalitos de El Collet, Clara y la cueva sepulcral de AigüesVives (fig. 1). Este aporte foráneo, relacionado sin duda con las prospecciones de metal y objetos de origen transpirenaico como la cerámica de apéndice de botón, aparece asentado en la zona reutilizando los sepulcros y mezclado con la población indígena, según muestran las abundantes formas de tránsito (Turbón, 1977, págs. 132, 340, 418 Y 326).