Salvia officinalis (Lamiaceae), conhecida popularmente como sálvia, tem sido muito utilizada no sul do Brasil como condimento nos alimentos, tintura hidroalcoólica e chá para o tratamento de vários distúrbios de saúde. As propriedades dessa planta são estudadas por apontar possíveis mecanismos de ação antioxidante e antitumoral. Neste trabalho, o extrato hidroalcoólico e aquoso de sálvia foram analisados quimicamente por meio de cromatografia gasosa acoplada a espectrômetro de massas (GC-MS) e electrospray de alta resolução acoplada a espectrômetro de massas (ESI-QTOF MS/MS) em modo negativo. A identificação química mostrou a presença de ácidos como caféico, rosmarínico, málico, succínico, tartárico, cítrico, ursólico e compostos como luteolina-7-O-glucoronide, eucaliptol, β-tujona, β-cariofileno, α-cariofileno, α- tujona, cânfora viridiflorol, mannol, rosmanol e seus isômeros metilcarnosato e ácido 12-metoxicarnosinico. Os extratos apresentaram compostos polifenólicos com capacidade de varrer os radicais 2,2-difenil-1-picrilhidrazil (DPPH•) e 2,2’- azino-bis(3-etilbenzotiazolina-6-ácido sulfônico) (ABTS•+), além de atividade catalase (CATlike) e superóxido dismutase (SOD-like). Ambos os extratos apresentaram menor citotoxicidade em linhagens não tumorais (HeK-293 e MRC-5) e seletividade para linhagens tumorais (Hep-2, HeLa, A-549, HT-29, A-375 e HepG2). Além disso, verificou-se que o aumento do tempo de exposição ao extrato hidroalcoólico diminuiu a viabilidade em linhagens tumorais. Foram observadas alterações morfológicas por coloração de Giemsa e a avaliação da apoptose com anexina V e iodeto de propídeo mostraram a maioria das células tumorais em estágios finais do processo de apoptose e necrose após 24h de tratamento em ambos os extratos. Sugere-se que o extrato de Salvia officinalis (L.) possui atividade biológica em células tumorais, podendo ser objetivo de mais estudos com a finalidade de comprovar sua eficácia como possível agente para o tratamento do câncer. / Submitted by Ana Guimarães Pereira (agpereir@ucs.br) on 2015-02-12T12:00:17Z No. of bitstreams: 1 Dissertacao Charlene Silvestrin Celi Garcia.pdf: 2151872 bytes, checksum: 7bfd73bdf5fd152982466e3f75044d21 (MD5) / Made available in DSpace on 2015-02-12T12:00:17Z (GMT). No. of bitstreams: 1 Dissertacao Charlene Silvestrin Celi Garcia.pdf: 2151872 bytes, checksum: 7bfd73bdf5fd152982466e3f75044d21 (MD5) / Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul, FAPERGS / Salvia officinalis (Lamiaceae), popularly known as sage, has been used in south of Brazil as a condiment in foods, as tincture and tea for the treatment various health disorders. The properties of this plant have been studied and suggest possible mechanisms of antioxidant and antitumor action. Here, the sage hydroalcoholic and aqueous extract were chemically analyzed by gas chromatography-mass spectrometry (GC-MS) and by high-resolution electrospray ionization mass spectrometry (ESI-HRMS) in negative mode. The chemical identification showed the presence of acids as caffeic, rosmarinic, malic, succinic, tartaric, citric, ursolic and compouns like luteolin-7-O-glucoronide, eucalyptol, β-thujone, β-caryophyllene, α-caryophyllenen and α-thujone, camphor, viridiflorol, mannol, rosmanol and its isomers methylcarnosate and 12-methoxycarnosinic acid. The extracts showed the content of polyphenolic compounds, ability to scavenge the free radical 2,2-diphenyl-1-picrylhydrazyl (DPPH•) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS•+), moreover catalase (CAT-like) and superoxide dismutase (SOD-like) activity. Both extracts showed lower cytotoxicity in non-tumor lines (HEK-293 and MRC-5) and selectivity for tumor cell lines (Hep-2, HeLa, A-549, HT-29, A-375 e HepG2). Furthermore, it was found that increasing the treatment exposure time of the hydroalcoholic extract decreases the tumor cell viability. Morphological changes by giemsa were observed and staining for annexin V and propidium iodide showed majority of tumor cells at late stages of the apoptotic process and necrosis after 24h treatment with both extracts. The results of this study suggest that the extract of Salvia officinalis (L.) has biological activity against tumor cell and may be the objective of further studies in order to prove its effectiveness as a possible agent for the treatment of cancer.

Orientador: Agnaldo Lopes da Silva Filho / Coorientador: Andréa Teixeira de Carvalho / Resumo: O câncer epitelial de ovário representa um desafio para Oncologia Ginecológica, devido à sua natureza insidiosa e alta mortalidade. Há também uma compreensão limitada da etiologia da doença ao nível molecular, o que continua a dificultar o desenvolvimento de alvos terapêuticos. Estudos recentes de morfologia, imuno-histoquímica e de genética molecular têm levado ao desenvolvimento de um novo paradigma para a patogênese e a origem do câncer epitelial de ovário, baseado em um modelo dualista de carcinogênese que divide o câncer epitelial de ovário (CEO) em duas grandes categorias chamadas de tipos I e II. O objetivo deste estudo foi avaliar o padrão das citocinas e quimiocinas encontradas no tecido ovariano de mulheres saudáveis e mulheres com CEO tipo I e tipo II. Além disso, descrever a associação desses biomarcadores com os dados clínico-patológicos. Foram analisadas amostras de tecido ovariano e ascite obtidas de mulheres com CEO (n=26) e amostras de tecido ovariano e lavado peritoneal de mulheres sem evidências de malignidade (n=16 - grupo de controle). Nas amostras de tecido, a expressão gênica foi avaliada utilizando a metodologia de PCR quantitativo em tempo real (qPCR) para os genes IFNG, IL-10, TGFB1, CCL2, CCL3, CCL5, CXCL8, CXCL9 e CXCL10. A detecção dos níveis de citoquinas/quimioquinas nos fluidos peritoneais foi realizada através do método Cytometric Bead Array (CBA) os marcadores IL-12p70, TNF, IL-10, IL-6, IL-1--8, IL-17A, IFN-IL-4, IL-2, CCL2, CCL5, CXCL-9 e CXCL-10. No grupo das pacientes com CEO, 10 (38,5%) apresentavam estágios I/II e 16 (61,5%) estágios III/IV. Com relação ao tipo de tumor, de acordo com a nova classificação, 8 (30,8%) eram do tipo I e 18 (69,2 %) do tipo II. A citorredução ótima foi obtida em 15 (57,7%) das mulheres com CEO. Mulheres com CEO tipo II apresentaram maiores níveis séricos do marcador CA-125 quando comparado às do tipo I. Não houve óbito no grupo... / Abstract: The epithelial ovarian cancer represents a challenge to Gynecologic Oncology due to its insidious nature and high mortality. There is also a limited understanding of disease etiology at the molecular level, which continues to hamper targeted therapeutic development. Recent morphological, immunohistochemical, and molecular genetic studies have led to the development of a new paradigm for the pathogenesis and origin of epithelial ovarian cancer based on a dualistic model of carcinogenesis that divides epithelial ovarian cancer into 2 broad categories designated types I and II. The aim of this study was to evaluate the cytokines and chemokines pattern in ovarian tissue from healthy women and women with EOC type I and type II. Also, we described the association of these biomarkers with the clinicopathological data. Samples of ovarian tissue and ascite obtained from women with EOC (n=26), samples of ovarian tissue and peritoneal wash from women with no evidence of malignancy were analyzed (n=16 - control group). In the tissue samples, gene expression were evaluated by quantitative real time PCR (qPCR) IFNG, IL-10, TGFB1, CCL2, CCL3, CCL5, CXCL8, CXCL9 and CXCL10. The detection of cytokine/chemokine levels in peritoneal fluids was measured by cytometric bead array immunoassay (CBA), IL-12p70, TNF, IL-10, IL-6, IL-1--8, IL-17A, IFN--4, IL-2, CCL2, CCL5, CXCL-9 and CXCL-10. In the group of women with EOC, 10 (38.5 %) had stage I/II and 16 (61.5 %) were stage III/IV . Concerning tumor type, according to the new classification, 8 (30.8 %) were type I and type II were 18 ( 69.2 % ) . Optimal cytoreduction was achieved in 15 (57.7 %) women with EOC. The CA-125 showed higher serum levels in patients with EOC type II compared to type I. There were no deaths in women with type I tumor while 6 (33.3 %) of patients with type II tumor died . Increased expression of IL-10, CXCL8 and CXCL9 genes in the group of women / Doutor

Salvia officinalis (Lamiaceae), conhecida popularmente como sálvia, tem sido muito utilizada no sul do Brasil como condimento nos alimentos, tintura hidroalcoólica e chá para o tratamento de vários distúrbios de saúde. As propriedades dessa planta são estudadas por apontar possíveis mecanismos de ação antioxidante e antitumoral. Neste trabalho, o extrato hidroalcoólico e aquoso de sálvia foram analisados quimicamente por meio de cromatografia gasosa acoplada a espectrômetro de massas (GC-MS) e electrospray de alta resolução acoplada a espectrômetro de massas (ESI-QTOF MS/MS) em modo negativo. A identificação química mostrou a presença de ácidos como caféico, rosmarínico, málico, succínico, tartárico, cítrico, ursólico e compostos como luteolina-7-O-glucoronide, eucaliptol, β-tujona, β-cariofileno, α-cariofileno, α- tujona, cânfora viridiflorol, mannol, rosmanol e seus isômeros metilcarnosato e ácido 12-metoxicarnosinico. Os extratos apresentaram compostos polifenólicos com capacidade de varrer os radicais 2,2-difenil-1-picrilhidrazil (DPPH•) e 2,2’- azino-bis(3-etilbenzotiazolina-6-ácido sulfônico) (ABTS•+), além de atividade catalase (CATlike) e superóxido dismutase (SOD-like). Ambos os extratos apresentaram menor citotoxicidade em linhagens não tumorais (HeK-293 e MRC-5) e seletividade para linhagens tumorais (Hep-2, HeLa, A-549, HT-29, A-375 e HepG2). Além disso, verificou-se que o aumento do tempo de exposição ao extrato hidroalcoólico diminuiu a viabilidade em linhagens tumorais. Foram observadas alterações morfológicas por coloração de Giemsa e a avaliação da apoptose com anexina V e iodeto de propídeo mostraram a maioria das células tumorais em estágios finais do processo de apoptose e necrose após 24h de tratamento em ambos os extratos. Sugere-se que o extrato de Salvia officinalis (L.) possui atividade biológica em células tumorais, podendo ser objetivo de mais estudos com a finalidade de comprovar sua eficácia como possível agente para o tratamento do câncer. / Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul, FAPERGS / Salvia officinalis (Lamiaceae), popularly known as sage, has been used in south of Brazil as a condiment in foods, as tincture and tea for the treatment various health disorders. The properties of this plant have been studied and suggest possible mechanisms of antioxidant and antitumor action. Here, the sage hydroalcoholic and aqueous extract were chemically analyzed by gas chromatography-mass spectrometry (GC-MS) and by high-resolution electrospray ionization mass spectrometry (ESI-HRMS) in negative mode. The chemical identification showed the presence of acids as caffeic, rosmarinic, malic, succinic, tartaric, citric, ursolic and compouns like luteolin-7-O-glucoronide, eucalyptol, β-thujone, β-caryophyllene, α-caryophyllenen and α-thujone, camphor, viridiflorol, mannol, rosmanol and its isomers methylcarnosate and 12-methoxycarnosinic acid. The extracts showed the content of polyphenolic compounds, ability to scavenge the free radical 2,2-diphenyl-1-picrylhydrazyl (DPPH•) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS•+), moreover catalase (CAT-like) and superoxide dismutase (SOD-like) activity. Both extracts showed lower cytotoxicity in non-tumor lines (HEK-293 and MRC-5) and selectivity for tumor cell lines (Hep-2, HeLa, A-549, HT-29, A-375 e HepG2). Furthermore, it was found that increasing the treatment exposure time of the hydroalcoholic extract decreases the tumor cell viability. Morphological changes by giemsa were observed and staining for annexin V and propidium iodide showed majority of tumor cells at late stages of the apoptotic process and necrosis after 24h treatment with both extracts. The results of this study suggest that the extract of Salvia officinalis (L.) has biological activity against tumor cell and may be the objective of further studies in order to prove its effectiveness as a possible agent for the treatment of cancer.

Introdução: Além do catabolismo protéico acentuado, o paciente com câncer apresenta alterações no metabolismo lipídico. Objetivo: o objetivo do estudo foi avaliar as concentrações séricas de ácidos graxos (AG) antes, durante e após o tratamento oncológico de pacientes com neoplasia de estômago ou de esôfago. Casuística: O estudo prospectivo longitudinal foi conduzido com 14 pacientes com neoplasia de estômago ou de esôfago [62,1 anos (IC95% 55,6-68,6)], sob tratamento oncológico em unidade especializada. O estudo incluiu também 15 voluntários saudáveis [61,0 anos (IC95% 57,1-65,0)]. Métodos: Foram aplicados os questionários de ingestão alimentar (Recordatórios de 24h) e inquéritos relacionados com efeitos adversos e de toxicidade (CTCAE) que potencialmente interferem na ingestão alimentar e no estado nutricional. Foram feitas as medidas antropométricas, a impedância bioelétrica e coleta de sangue para os exames laboratoriais. Os AG foram determinados por cromatografia gasosa e expressos como porcentagem da área total. No Grupo Câncer, os procedimentos foram feitos antes do início, na metade e ao término do tratamento oncológico; o Grupo Controle foi submetido às mesmas avaliações em apenas uma ocasião. A análise estatística foi feita por meio do software Statistica 8.0, usando testes estatísticos não paramétricos. Resultados: As reações adversas relacionadas ao tratamento oncológico foram redução da ingestão de alimentos, saliva espessa com alteração no paladar e náuseas. Antes do início do tratamento, os pacientes com câncer já haviam perdido 17% do peso em relação ao usual; o peso corporal e o IMC reduziram entre a primeira e a terceira avaliação, mas não houve alteração na composição de massa corporal magra e gorda, na ingestão energética e da maioria dos macronutrientes no decorrer do estudo. Em relação ao Grupo Controle, o ácido nervônico foi maior enquanto que os ácidos gama-linolênico e alfalinolênico foram menores no Grupo Câncer. Na avaliação longitudinal, o ácido lignocérico reduziu durante o tratamento oncológico. Conclusão: os pacientes com câncer de esôfago e de estômago apresentam alteração discreta na concentração dos AG séricos em relação aos controles e o tratamento oncológico teve pouco impacto no perfil de AG circulantes / Introduction: In addition to enhanced protein catabolism, the cancer patient has alterations in lipid metabolism. Objective: The objective of the study was to evaluate serum concentrations of fatty acids (FA) before, during and after cancer treatment of patients with gastric or esophageal cancer. Subjects: The prospective longitudinal study was conducted with 14 patients with gastric or esophageal cancer [62.1 years (95% CI 55.6 to 68.6)], under cancer treatment in a specialized unit. The study also included 15 healthy volunteers [61.0 years (95% CI 57.1 to 65.0)]. Methods: The food intake questionnaires were applied (24-hour Dietary Recall) and inquiries related adverse effects and toxicity (CTCAE) that potentially interfere with food intake and nutritional status. Anthropometric measurements were made, the bioelectrical impedance and blood collection for laboratory tests. Gas chromatography determined the FA that was expressed as a percentage of the total area. In Cancer Group, the procedures were done before the start, the middle and at the end of cancer treatment; the control group underwent the same evaluations on only one occasion. Statistical analysis was performed using Statistica 8.0 software, using non-parametric statistical tests. Results: Adverse reactions related to cancer treatment have been reduced food intake, thick saliva with altered taste and nausea. Before the treatment, the patients with cancer had already lost 17% of weight with respect to the usual. Body weight and BMI reduced between the first and the third evaluation, but there was no change in the composition of lean and fat mass, energy intake and macronutrient most during the study. Compared to the control group, the nervonic acid was higher while the gamma-linolenic and alpha-linolenic acids were lower in the cancer group. In the longitudinal evaluation, the lignoceric acid reduced during cancer treatment. Conclusion: Patients with esophageal and stomach cancer have a mild change in the concentration of serum FA compared to controls and cancer treatment had little impact on the current FA profile

M.A. (Social Work) / Cancer is a common condition and is becoming an important issue in South Africa. During their lifetime people may develop different forms of cancer such as lung -, throat -, skin -, colon -, and breast cancer. Cancer affects people of different age groups from small children up to older people. It cuts across different racial groups and different socio economic levels. The patient with cancer faces one of the greatest stress situations known to man. Cancer is frequently a chronic disease. Acute periods of illness or intensive therapy may interrupt periods of normality for months or years. Treatment may necessitate major alterations in lifestyle or normal body functions. The diagnosis of cancer is seen by many as synonymous with death. (Kellogg & Sullivan : 1978) Kellogg (1978) believes that the fear of loss of self determination, of being dependent and non - productive, can be more stressful than the prospect of death itself. The patient may also fear that the disease, the results of treatment, or the changes he presumes will result, will cause others to isolate or abandon him...

Ph.D. / Ligands bis(pyrazolyl)acetic acid (L1) and bis(3,5-dimethylpyrazolyl)acetic acid (L2) were synthesised by reacting pyrazoles and dibromoacetic acid under phase transfer conditions, by using benzyltriethylammonium chloride as the catalyst. Ligands L1 and L2 were characterised by a combination of 1H, 13C{1H} NMR, IR spectroscopy and microanalysis. Esterification of L1 and L2 led to formation of bis(pyrazolyl)ethyl acetate (L3) and bis(3,5-dimethylpyrazolyl)ethyl acetate (L4). Ligands L3 and L4 were also characterised by a combination of 1H, 13C{1H} NMR, IR spectroscopy and microanalysis. Subsequently, new pyrazolyl palladium(II) and platinum(II) compounds, [PdCl2(L1)] (1), [PdCl2(L2)] (2), [PtCl2(L1)] (3a) and [PtCl2(L2)] (4) were prepared by reacting bis(pyrazolyl)acetic acid ligands (L1-L2) with K2[PdCl4] or K2[PtCl4] respectively. The structures of complex 1 and 2 reveal distorted square planar geometries. The bond angles of N-Pd-N, N-Pd-Cl, N-Pd-Cl, for 1 and 2 are between 85.8(3)o and 90.81(4)o). The platinum compound, K2[Pt4Cl8(L1)2(deprotonated-L1)2].2H2O (3b), crystallised from aqueous solutions containing 3a when such solutions were left to stand overnight. Each platinum coordination environment consists of two cis-Cl ligands and one K2-N^N(L1) unit (L1 = bis(pyrazolyl)acetic acid), with two ligand moieties in 3b that are deprotonated with two K+ counter ions. Reaction of bis(pyrazolyl)acetic acid ligands (L1-L2) with [HAuCl4].4H2O gave gold(III) complexes [AuCl2(L1)]Cl (5a) and [AuCl2(L2)]Cl (6a). The spectroscopic, mass spectroscopy and microanalysis data were used to confirm the formation of the desired complexes. However, attempts to crystallise 5a and 6a led to formation of [AuCl2(pz)(pzH)] (5b) and [AuCl2(3,5-Me2pz)(3,5-Me2pzH)] (6b). This was confirmed by the structural characterisation of 5b, which has a distorted square-planar geometry. When complexes 1-6a were screened for their anti-tumour activity against CHO-22 cells, they showed no appreciable biological activities against CHO-22 cells. Substitution reactions of complexes 1-6a with L-cysteine performed to probe any relationship between the observed antitumour activities and the rates of ligand substitution of these complexes were inconclusive. Dithiocarbamate ligands L5-L8 were synthesised as potassium salts by introducing a CS2 group in positions 1 of pyrazole, 3,5-dimethylpyrazole, indazole and imidazole. The reaction of L5-L8 with [AuCl(PPh3)], [Au2Cl2(dppe)], [Au2Cl2(dppp)] and [Au2Cl2(dpph)], led to isolation of complexes [Au(L)(PPh3)] (13-16), [Au2(L)2(dppe)] (17a-19), [Au2(L)2(dppp)] (20-22) and [Au2(L)2(dpph)] (23-25) (dppe = bis(diphenylphosphino)ethane, dppp = bis(diphenylphosphino)propane, dpph = bis(diphenylphosphino)hexane; L = anions of L5-L8). The mononuclear molecular structure of 15 features a near linear geometry with a P(1)-Au(1)-S(1) angle of 175.36(2) o. The binuclear gold(I) complexes 20-22 and 23-25 have two P-Au-S moieties as evident in the solid state structure of 25. Attempts to crystallise complex 17a led to the formation of a gold(I) cluster complex [Au18S8(dppe)6]2+ (17b) as confirmed by X-ray crystallography. Cluster 17b features weak Au···Au interactions (2.9263(7)-3.1395(7) Å). Complexes 13-16 and 20-25 were tested in vitro for anticancer activity on HeLa cells. The activities of gold(I) complexes 13-16 were comparable to that of cisplatin. Dinuclear gold(I) complexes 20-25 also showed appreciable antitumour activity against HeLa cells. However, the dpph gold(I) compounds (23-25) were highly active, with 24 showing the highest activity against HeLa cells (IC50 = 0.1 μM). The tumour specificity (TS) factors for 23 and 24 were 31.0 and 70.5, respectively.

The present study was undertaken to determine the effects and possible mechanism of action of cimetidine in cancer and Alzheimer’s disease (AD). Throughout this study emphasis is placed on free radical levels since the magnitude of the relationship between diseases and the levels of free radicals vary from one disease to another. Studies were carried out to examine the effect of cimetidine on free radical levels using superoxide formation and lipid peroxidation as indicators of free radical levels. The experiments revealed that addition of cimetidine, especially in high concentrations (0.5 and 1.0 x10-6 M) significantly inhibited WHCO6 cancer cell growth rather than cancer cell growth, as no normal control was available. Free radical formation as well as hydroxyl radical formation were reduced in the deoxyribose assay. In addition, cimetidine exhibits properties of binding to metals such as copper and iron. To maintain consistency in the experiments, a WHCO6 (Wits Human Carcinoma of the Oesophagus) cell line was used to investigate the effect of cimetidine in cancer. Neurodegeneration was induced in the rat brain using neurotoxins such as cyanide to investigate the relationship between cimetidine in AD. A decrease in cancer cell growth was accompanied by a concomitant decrease in the levels of free radicals and lipid peroxidation, suggesting that the growth-inhibitory effects of cimetidine on WHCO6 cancer cells in vitro may be due to free radical scavenging properties. This proposal was further strengthened by determination of free radical levels in the rat brain. After treatment with neurotoxins to induce neurodegeneration, the levels of free radicals in the rat brain suggest that addition of cimetidine reduces free radical levels in the rat brain in a dosedependent manner. Further experiments were done in an attempt to uncover the underlying mechanism by which cimetidine exhibits free radical scavenging properties. Metal binding studies were done using electrochemical, HPLC and UV/Vis studies. The results show that cimetidine binds iron and copper. These metals have been implicated in free radical production via the Fenton reaction. By binding with cimetidine the metals become unavailable to produce free radicals and hence cimetidine indirectly reduces the formation of free radicals. The final experiment was the determination of cimetidine as a hydroxyl radical scavenger in the deoxyribose assay. Cimetidine was shown to act as a potent hydroxyl radical scavenger, thereby confirming its activity as a free radical scavenger. In addition, cimetidine protects against damage to the deoxyribose sugar, a component of DNA. Whilst there are many theories that explain the therapeutic role of cimetidine in degenerative disease, the actual mechanism of the role of cimetidine is emphasized as a free radical scavenger. Regardless of the mechanism of action, cimetidine does inhibit tumour growth according to this study and also reduce free radical levels in neurodegeneration, which suggests a role for cimetidine as a possible additive in treatment of patients with such disease states. These findings have important clinical implications, and needs to be investigated further.

Bakgrund: Cancer ökar bland befolkningen och det i sin tur kan leda till ökade komplikationer av behandling och cancersjukdomen i sig såsom långvarig smärta. Patientens upplevelse är inte alltid att vårdpersonalen ser smärtproblematiken som kan uppstå. Sjuksköterskan ska arbeta för att lindra lidande, vilket smärta är del av. Lidande en unik upplevelse som ser olika ut för varje individ. Då lidande kan komma av den totala livssituationen behöver sjuksköterskan en ökad förståelse för att kunna uppfylla sitt ansvar. Syfte: Syftet med litteraturöversikten var att sammanställa forskning om långvarig smärta efter cancerbehandling. Metod: En integrativ litteraturöversikt med 11 artiklar. Resultat: Två huvudteman identifierades, dagligt liv och livskvalitet, samt sex underteman om hur långvarig smärta inverkar på följande; fysiska aktiviteter, dagliga aktiviteter, arbetslivet, läkemedelsanvändning, generell hälsa och sexlivet. Slutsats: Många patienter upplevde en negativ påverkan på det dagliga livet med både psykiska, fysiska och sociala dimensioner. Patienterna upplevde att arbete, fysisk aktivitet samt att dagliga sysslor blev begränsade på grund av den långvariga smärtan. Hur stor påverkan patienterna fick på de olika dimensionerna tycks ha en koppling till vilken cancerform och behandling patienterna fick. / Background: Cancer is increasing among the population, which can lead to an increased number of complications as chronic pain, not only from the cancer treatment but from the disease itself. Patients have also been found to feel that their pain problems are not taken seriously by the healthcare professionals. The nurses should work to relieve any suffering which is caused by pain. Suffering is a unique experience that is different for everyone. As suffering may be due to the overall life situation, the nurses need a greater understanding of the situation in order to fulfill their responsibilities. Aim: The aim of this literature review was to compile research on chronic pain after cancer treatment. Method: An integrative literature review with 11 included articles. Result: Two main themes were identified; daily life and quality of life, and six subthemes regarding how the chronic pain influences and impacts the following; physical activities, daily activities, the professional life, drug use, general wellbeing, and sex life. Conclusion: Many patients experienced a negative impact on their daily life in both mental, physical and social dimensions. Patients felt that work, physical activity and daily tasks were limited due to the chronic pain. This varied in all aspects depending on the type of cancer and which treatment the patients received.

[pt] Este trabalho teve como objetivo principal avaliar as representações sociais, elaboradas por mulheres que tiveram câncer de mama, sobre a doença, sua etiologia e tratamento. Desenvolvemos teoricamente o tema a partir de quatro perspectivas: biológica, psicossomática, psicossocial e multifatorial. Realizamos uma pesquisa de campo, de natureza qualitativa, estudando 10 casos de mulheres que tiveram câncer de mama com idades entre 35 e 50 anos, que se submeteram à mastectomia, podendo ter feito ou não a reconstrução mamária, e que participavam como membros de uma associação de apoio a mulheres com câncer de mama da cidade de Niterói, Rio de Janeiro. Como instrumento desta pesquisa, utilizamos um questionário identificador e entrevistas semidirigidas, aplicados a tais mulheres individualmente e, depois, a seus familiares, com base em roteiro pré-elaborado. Para avaliação dos dados obtidos, empregamos a análise de discurso intra-sujeito e intersujeito. Na primeira, buscamos identificar, em cada caso, a percepção das entrevistadas sobre a doença, sua etiologia e as repercussões do tratamento oncológico em sua identidade feminina. Na segunda, construímos 10 categorias de análise. Os resultados revelaram que o câncer é apreendido pelas mulheres como um risco e ameaça à vida, que a retirada da mama afeta, majoritariamente, a identidade corporal e feminina, e que o adoecimento provoca muitas mudanças em suas vidas. / [en] The prime purpose of this paper is to assess the social representations created by women who have had breast cancer, and to discuss the disease, its etiology and treatment. We developed the theme theoretically, based on four perspectives: biological, psychosomatic, psychosocial and multi-factorial. We performed field research of a qualitative nature, studying ten cases of women who had breast cancer in the 35 to 50 age group and had undergone a mastectomy, could have done mammary reconstruction or not, and who participated as members of a support association to women with breast cancer in Niterói city, Rio de Janeiro State. As an instrument of this research, we used an identifying questionnaire and semi-focused interviews with those women individually and later with their relatives, based on a previously prepared script. In order to assess the obtained data, we used intra-subject and inter-subject discourse analysis. In the former, in each case we looked to identify the interviewee s perception of the disease, its etiology and the repercussions of cancer treatment on her female identity. In the latter, we created ten analytical categories. The results showed that women are apprehensive of cancer as life threatening and a risk, that breast removal in most cases affects the corporal and female identity, and that contracting the disease causes many changes in their lives.

The development of checkpoint immunotherapy has been a paradigm shift in the treatment of cancer, leading to dramatic improvement in treatment outcomes across a broad range of tumor types. Nevertheless, our current understanding of the tumor immune microenvironment and mediators of resistance to therapy are limited. The recent development of high-throughput single-cell RNA-Sequencing (scRNA-Seq) technology has opened up an unprecedented window into the transcriptional states of distinct tumor-infiltrating immune and stromal cells. However, even this technology has its biological limitations, with very high levels of data dropout induced by low total mRNA molecules and capture efficiency. This thesis explores the application of a transcriptional regulatory protein activity inference approach to single-cell data in order to resolve gene dropout and more deeply characterize upstream drivers of cell state within the micro-environment of several distinct tumor types. To this end, algorithms for inference of protein activity, drug sensitivity, and cell-cell interaction have been adapted to scRNA-Seq data, along with an approach for querying enrichment of single-cell-derived population marker gene sets patient-by-patient in larger bulk-RNA-Seq cohorts. By applying these tools systematically, we have identified distinct cellular sub-populations associated with clinical outcome in different tumor types, including a novel population of C1Q+/TREM2+/APOE+ macrophages associated with post-surgical tumor recurrence in clear cell renal carcinoma, a sub-population of fibroblasts associated with improved response to immunotherapy in head and neck squamous cell carcinoma, tumor cell subpopulations with distinct inferred drug sensitivities in cholangiocarcinoma and prostate cancer, as well as tumor-specific regulatory T-cells (Tregs), active as a mechanism of immunotherapy resistance across a range of tumor types. In ongoing clinical trials from both primary and metastatic prostate cancer as well as clear cell renal carcinoma, we are able to assess which of these populations are enriched in non-responders to checkpoint immunotherapy. The proteomic master regulators of each of these single-cell types have direct utility as potential biomarkers for treatment response, but they may also be therapeutically modulated as novel targets for combination immunotherapy, potentially improving treatment response rates and treatment outcomes in future clinical trials. Finally, this thesis also presents a discovery-to-validation platform to accelerate micro-environment-directed drug repurposing in the context of immunotherapy resistance and rapid CRISPRko validation of novel therapeutic targets. This platform has been developed specifically to validate newly identified master regulators of tumor-specific immunosuppressive regulatory T-cells (Tregs), resulting in discovery of low-dose gemcitabine as a tumor-specific Treg-modulating drug synergistic with anti-PD1 checkpoint immunotherapy and TRPS1 as a proteomic master regulator with clinically significant effect on tumor Treg-infiltrating and tumor growth rate. However, the platform itself may be readily extended in future work to prioritize agents against immunosuppressive macrophage and fibroblast populations for clinical development and trials. As we have discovered, different cancers have different populations of cells driving therapy response and resistance. Taken together, the analytical and validation tools presented in this thesis represent an opportunity to tailor future immuno-therapies at the single-cell level to particular tumor types and to individual patients.