Oral 111-Indium-DTPA colonic scintigraphy was used to assess segmental transit in 23 patients with slow transit constipation (STC) and 13 controls. The transit time did not differ between patients and controls in the right colon, whereas the patients had a consistent delay from the transverse colon and distally (P<0.05–0.001). Two individual patients had a delay in the right colon. Twenty-eight patients underwent a left- (n=26) or a right (n=2) hemicolectomy for STC, after evaluation including colonic scintigraphy. Twenty-three patients (80%) were satisfied with the outcome after a median of 50 months. The median stool frequency increased from one to seven per week (P<0.001). The number of patients with bloating, excessive straining and painful defecation decreased (P<0.05). The laxative use decreased (P<0.01) and faecal continence was unchanged. A blunted rectal sensation correlated to a poor outcome. Fifty constipated patients with slow colonic transit and 28 controls were investigated with anorectal manovolumetry. Anal resting pressure was lower (P<0.05), and squeeze pressure tended to be lower (P=0.09) in patients. Rectal sensation was not different between groups, although ten patients had a threshold for filling sensation above the 95th percentile of controls. The rectal compliance was increased in patients (P<0.05–0.01). Total and segmental colonic transit was assessed with radio-opaque marker study and scintigraphy in 35 constipated patients, and related to normal values. Twenty-seven of 31 female patients had a prolonged total transit time on marker study, and 26 on scintigraphy. Of those 31 patients, 29 had prolonged segmental transit only in one or two segments on marker study. The two methods gave a similar result, except in the descending colon (P<0.05). However, the results varied considerably for individual patients. In conclusion, patients with STC often benefit from a segmental colonic resection, following assessment including scintigraphy. Anorectal physiology testing may predict surgical results.

Colonic ischaemia (CI), Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are devastating complications after abdominal aortic aneurysm (AAA) surgery. The aims of this thesis were to study the incidence and clinical consequences of IAH/ACS and the association between CI and intra-abdominal pressure (IAP) among patients undergoing OR for ruptured AAA (rAAA), to compare extraluminal pHi monitoring, with standard intra-luminal monitoring among patients operated on for AAA, and to study the frequency and clinical consequences of IAH/ACS after endovascular repair (EVAR) for rAAA. The incidence of ACS was 26% in a retrospective study of 27 patients undergoing OR for rAAA. Consensus definitions on IAH/ACS were appropriate for patients after OR for rAAA: 78% (7/9) of patients with IAH grade III or IV developed organ failure and all patients who developed CI had some degree of IAH. Active fluid resuscitation treating hypovolaemia to avoid CI may partly cause IAH. The association between CI and IAP was investigated in a prospective study on 29 patients operated on for rAAA, 86% (25/29) were treated for hypovolaemia and ten (34%) had both IAH and CI. Since monitoring colonic perfusion is very important and there is no ideal method, a new technique, extraluminal colonic tonometry to detect colonic perfusion was compared with standard intraluminal tonometry. Although, this new method was not able to determine the severity of ischaemia it may serve as a screening test. EVAR of rAAA is feasible and patients may benefit from this less invasive procedure. Of 29 patients treated with this technique, 10% developed ACS, and all patients except one with preoperative shock developed some degree of IAH. In conclusion, IAP/ACS is common after both OR and EVAR for rAAA, and is associated with adverse outcome. Monitoring IAP and colonic perfusion with timely intervention may improve outcome.

Orientador: José Ricardo de Arruda Miranda / Resumo: Inflammatory bowel disease (IBD) is an idiopathic gastrintestinal tract disease that affects a large part of the world population and has its symptoms related to changes in colon motility. However, the evolution of these changes is not completely understood, and may be related to symptoms that appear in stages when the disease is apparently controlled. The objective of this work was to perform a long-term evaluation of the mechanical and electrical aspects of colonic contractility during the model of inflammation induced by trinitrobenzene sulfonic acid (TNBS) in rats. This work applied an efficient and low invasive methodology associating mechanical, electrical, chemical and histological information. The contractility and inflammatory parameters were acquired in the same animal at six different times: before induction of TNBS (control) and at 2, 5, 8, 11 and 14 days thereafter. The mechanical activities were acquired by Alternating Current Biosusceptometry (ACB) and subdivided in Rhythmic Propagation Ripples (RPR) and Rhythmic Propulsive Motor Complex (RPMC). We recorded the electrical activity by electromyography (EMG) and evaluated the inflammation processes determining the myeloperoxidase activity (MPO) in the feces. Additionally, we compared the thickness of colon layers throughout the inflammation by histopathological analyzes. Our results showed transient changes in MPO activity levels and frequency of RPMC contraction, while RPR and electrical activity underwent perma... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

A doença diverticular dos cólons (DDC) é relacionada à civilização, industrialização e à dieta. Estudos fisiológicos demonstraram que uma pressão intraluminal elevada, bem como alterações estruturais adquiridas da parede intestinal parecem ser fator decisivo, que se intensificam com o envelhecimento. Estas alterações podem ser causadas por alterações no tecido muscular e tecido conjuntivo relacionados ao metabolismo do colágeno e elastina, que presumivelmente pode ser geneticamente determinada. Sabe-se que pacientes com desordens genéticas do gene da elastina (ELN), como a estenose aórtica supravalvar e a cutis laxa, podem manifestar hérnia, diverticulose e disfunção urinária. Recentemente, foi demonstrado mutação pontual no exon 20 do ELN em pacientes com hérnia inguinal. No presente estudo investigamos o polimorfismo do exon 20 do ELN em 14 pacientes com DDC e 26 controles. A presença de mutação foi verificada por eletroforese conformacional de fita simples e sequenciamento automático. Demonstramos bandas anormais em alguns pacientes, que representaram uma mutação não conservativa: substituição de um nucleotídeo (AGT->GGT) no códon 422 do gene da ELN em cinco pacientes com DDC. Nenhum indivíduo controle estudado apresentou este tipo de mutação. Observamos uma associação significante (P=0,003) desta mutação com o desenvolvimento da DDC e risco relativo 3,89 vezes maior (intervalo de confiança de 95%: 2,21-6,83) dos indivíduos com esta mutação desenvolver DDC. Esta mutação troca Serina, um aminoácido não polar, por glicina, um aminoácido neutro, alterando a estrutura hidrofóbica da elastina e secundariamente a estrutura da fibra elástica. Esta alteração pode promover perda da complacência da parede intestinal e o desenvolvimento de divertículo / Colonic diverticular disease (CDD) is related to civilization, industrialization and diet. Physiological studies demonstrated that increased intraluminal pressures as well as acquired structural changes of the intestinal wall seem to be decisive factors, which intensify during ageing. These changes may be due to alterations of the musculare and connective tissues and are related to collagen and elastin metabolism, which presumably can be genetically determined. It is known that patients with genetic disorders of elastin gene (ELN), such as supravalvular aortic stenosis and cutis laxa, may also manifest hernias, diverticulosis and bladder dysfunction. Recently, punctual mutations were demonstrated in ELN exon 20 of inguinal hernia patients. In the the present study, the polymorphism ELN exon 20 was tested in 14 patients with CDD and in 26 controls. Mutations were sought by singlestrand conformation polymorphism and by automatical sequence. An abnormal band was demonstrated in some patients, representing a missense mutation: a single nucleotide substitution (AGT->GGT) was detected in codon 422 in five patients with CDD. There is a substituion of serine, a nonpolar amino acid, by glycine, na uncharged one. No controls showed this punctual mutation(P=0,003), and the odds ratio for development of CDD was 3.33 (95% confidence interval:1,98-5,62). As a consequence of this substitution, the hydrophobic structure of elastin and of elastic fiber may promote a loss of compliance of the intestinal wall and development of diverticula

Colorectal cancer (CRC) remains the second deadliest cancer in the United States, despite steady reduction in mortality rate over the last three decades. Colonoscopy is the gold-standard screening modality with high sensitivity and specificity to mature polyps. However, the miss rate for small (<5 mm) lesions is estimated to be as high as 26%. Because the five-year survival rate for CRC detected at the local stage is 90%, there is a clear need for a screening procedure that is sensitive to these small lesions. Optical coherence tomography (OCT) has become a major biomedical imaging modality since its invention in 1991. As the optical analog to ultrasound, OCT provides information in both lateral and depth dimensions with resolution < 10 µm and an imaging depth of about 1.5 mm in scattering tissue. In this dissertation, I describe my efforts to develop new uses of OCT for improved early detection of adenoma in the azoxymethane mouse model of CRC. In recent years, commercial OCT systems have reached imaging speeds sufficiently high for in vivo volumeric imaging while laterally sampling the tissue at the Nyquist limit. First, I describe the design of a miniature endoscope and the integration of this probe with a commercial OCT system. Then I describe the development of two OCT imaging methods, one structural and one functional, that could be used for future work in diagnostic or therapeutic studies. The structural method produces en face images of the colon surface showing the colonic crypts, the first such demonstration of crypt visualization in the mouse. Changes in the crypt pattern are correlated with adenoma and are one of the earliest morphological changes. The functional method uses a Doppler OCT algorithm and image processing to detect the colon microvasculature. This technique can be used for vessel counting and blood flow measurements. Angiogenesis occurs at the beginning of tumorigenesis, and the tumor-originated arterioles are incapable of regular vasodilation. This Doppler OCT technique could potentially detect tumors at the earliest stages by measuring the change in local blood flow velocity in response to vasodilatory stimuli.

O Orlistat é um membro de uma classe de drogas usadas como tratamento para obesidade. No entanto, a segurança de seu uso em longo prazo ainda não é conhecida. O Orlistat exerce sua atividade no lúmen do trato gastrintestinal inibindo a enzima lipase pancreática, responsável pela hidrólise dos triacilglicerídeos normalmente ingeridos com a dieta. Esse medicamento, quimicamente sintetizado, é um derivado da lipstatina, inibidora natural da lipase produzida pelo Streptomyces toxytricini. Assim, a excreção de gordura fecal fica significativamente aumentada com o uso do Orlistat. Estudos epidemiológicos e em modelos experimentais, sugerem que o aumento das dietas hipergordurosas tem efeito promotor para o câncer colorretal. Tal efeito deve ser relacionado, pelo menos parcialmente, às mudanças intra-colônicas causadas pela ação direta da gordura nas células da mucosa do cólon, os colonócitos. O estudo atual tem como objetivo verificar os efeitos do Orlistat na formação colônica de focos de criptas aberrantes (FCA) e na proliferação celular epitelial da mucosa gastrintestinal. Ratos Wistar machos receberam dieta padrão ou dieta com aumento de gordura, suplementada ou não com Orlistat (200 mg/kg), e duas doses semanais do carcinógeno químico Dimetilhidrazina (DMH) (25 mg/kg). Após 30 dias, nos animais tratados com DMH, o Orlistat foi associado a um aumento significativo no número de FCAs colônicos e na proliferação celular epitelial da mucosa do cólon, independentemente da dieta. Os achados obtidos neste trabalho permitem concluir que o aumento do teor de gordura na luz do cólon distal, em decorrência da ação do Orlistat, pode potencializar a ação da DMH na formação de FCAs e no aumento da proliferação celular epitelial da mucosa colônica. / Orlistat is a member of a drug class used as obesity treatment. However, the security of its use in a long period of time is not known yet. Orlistat has its activity in the lumen of the gastrointestinal tract inhibiting the pancreatic lipase enzyme responsible for the hydrolyze of the triglycerides that usually are swallowed with the diet. This drug chemically synthesized, is a derived from lipstatina, that inhibit naturally the lipase produced by Streptomyces Toxytricini. So, the excretion of fat excrement stays significantly increased with the use of Orlistat. Epidemiologic studies and in experimental pattern, suggest that the increase of the high-fat diets facilitate the appearance of the colorectal cancer. Such effect must be related, at least partially to the changes intracolonic caused by the direct action of the fat in the cells of the colon mucous, the colonocytes. The current study has as objective to check the effects of the Orlistat on the formation of rat colonic aberrant crypt foci (ACF) and in the epithelial cell proliferation of the gastrointestinal mucous. Male Wistar rats received either a standard diet or a high fat diet (HFD), supplemented or not with Orlistat (200 mg/kg chow) and two doses of the carcinogen dimethyl-hydrazine (25 mg/Kg). After 30 days, Orlistat was associated to a significant increase in the number of colonic ACFs and cell proliferation in DMH-treated animals, independently of the HFD. The find got in this study permit to conclude that the increase in the level of adiposity inside the distal colon, due to Orlistat action, can potencializar the DMH action in the formation of ACFs and in the increase of epithelial cell proliferation of the colônica mucous.

Introdução e Justificativa: O câncer colorretal é a 3ª neoplasia maligna mais incidente no mundo, e apresenta comportamento bastante heterogêneo aos tratamentos instituídos. Conseguir diferenciar os pacientes de acordo com seu prognóstico e comportamento tumoral é um desafio. A biologia molecular, através dos microRNA (miRNA), pode contribuir na identificação do perfil tumoral e ajudar a predizer os desfechos clínicos. Objetivos: Comparar a expressão tecidual de miRNA-92a, miRNA-133a e miRNA-145 de pacientes com câncer de cólon, correlacionando o perfil de expressão de miRNA com aspectos clínicopatológico e prognóstico. Casuística e Métodos: Quantificação de miRNA-92a, miRNA-133a e miRNA-145 pela técnica de reação em cadeia de polimerase em tempo real (RTPCR) em amostras de tecido tumoral em pacientes com câncer esporádico de cólon (grupo de estudo) operados entre janeiro de 2010 a dezembro de 2011 e em amostras de tecido colônico sadio de pacientes saudáveis (grupo controle) submetidos à colonoscopia de rotina para rastreio de câncer colorretal. Os resultados das dosagens de miRNA foram correlacionados ao valor do antígeno cárcinoembrionário (CEA), idade, estadiamento, invasão linfovascular, sobrevida livre de doença e sobrevida global. Resultados: A idade média dos pacientes foi de 66 anos e 60% eram do sexo masculino. No momento do diagnóstico inicial 22% apresentavam metástase à distância, e em 80% dos pacientes foi atingida ressecção R0. A sobrevida global foi de 46 meses e a sobrevida livre de doença foi de 32 meses. Apenas o miRNA-133a esteve hiopoexpresso no grupo de estudo (p=0,0007). Ao se correlacionar os perfis de expressão dos miRNA às variáveis clínico-patológica e prognóstica, a hiperexpressão do miRNA-92a esteve associada a maior sobrevida global (p= 0,044). Discussão: O tempo de espera entre o encaminhamento para hospitais terciários e o início do tratamento oncológico pode contribuir para o elevado índice de pacientes com doença metastática ao diagnóstico. Melhores desfechos têm sido associados a hospitais de maior volume, aparentemente devido à maior expertise de que esses hospitais possuem. O miRNA-133a, um supressor tumoral, tem sido hipoexpresso em amostras tumorais quando comparadas a tecidos sadios. Por sua vez, a hiperexpressão do promotor tumoral miRNA-92a que esteve associada a melhor prognóstico, pode ser explicada por uma desregulação dos genes alvo desse miRNA ou por diferenças geográficas na expressão dos miRNA. Conclusão: o miRNA-133a encontra-se hipoexpresso em amostras tumorais, enquanto que a hiperexpressão do miRNA-92a esteve associada a melhor sobrevida global. / Introduction: Colorectal cancer is the 3rd most common malignancy in the world, and their incidence has been increase in the last decades. Although patients diagnosed with early stage tumors have more than 65% of overall survival, behavior of colorectal tumors and their response to established treatments is quite heterogeneous. Gap: In this context, becomes interesting differentiate patients according to their prognosis and tumor behavior. Molecular biology through the miRNA quantification can improve the identification of tumor profile and predict clinical outcomes. Propose: Evaluate tumor profile tissue expression of miRNA- 92a, miRNA- 133a and miRNA-145 in patients with non-hereditary colon cancer, correlating with clinicopathological variables and oncological outcomes. Assessing the ability of the expression of these miRNA predict the prognosis. Methods: A dosage of miRNA-92a, miRNA-133a and miRNA-145 was performed in tumor tissue samples from patients with colon cancer (called study group) and non-tumoral colonic tissue samples from healthy patients (called the control group) by real-time polymerase chain reaction. The results of miRNA levels were correlated with clinicopathological data and oncological outcomes. Results: Mean age was 66 years and 60% was male. At initial diagnosis, 22% of lesions had distant metastasis. R0 resection was achieved in 80% of patients. Disease-free survival was 32 months, and overall survival was 46 months. The MiRNA-133a showed higher values in the control group when compared to the study group (p = 0.0007), and miRNA-92a was associated with higher overall survival (p = 0.044). Discussion: Better outcomes in highly specialized centers could be explained by advances in surgical technique and perioperative care. MiRNA-133a was underexpressed in colonic tumoral tissue, likely others tumors. MiRNA-92a overexpression was associated with improve overall survival. It could be explained through deregulation of target genes or geographic patterns of miRNA expression. Conclusion: MiRNA-133a was underexpressed in study group, and over expression of miRNA-92a was associated with better overall survival.

Colon cancer, a disease in which malignant tumors form in the tissues of colon, is the first commonest cancer and the second leading cause of cancer-related deaths in Hong Kong. The standard treatment options for colon cancer include surgery and chemotherapy. However, multidrug resistance (MDR) develops in nearly all patients with colon cancer. In fact, most of the cancer-related deaths are due to chemotherapy failure caused by MDR, which occurs during the course of cancer progression and chemotherapy. Thus, the reversal of MDR plays an important role in the successful chemotherapy for colon cancer. This study investigated such a pharmacological action in reversing MDR in colon cancer cells by tanshinones, targeting the two common mechanisms responsible for MDR, i.e. overexpression of ATP-binding cassette (ABC) transporters and suppression of apoptosis. / Overexpression of P-glycoprotein (P-gp), one of the most important ABC transporters, can mediate the efflux of drugs out of cancer cells, leading to MDR and chemotherapy failure. The reversal of P-gp-mediated MDR by five tanshinones including tanshinone I, tanshinone IIA, cryptotanshinone, dihydrotanshinone and miltirone was evaluated in colon cancer cells. Bi-directional transport assay showed that only cryptotanshinone and dihydrotanshinone decreased the P-gp-mediated digoxin efflux in Caco-2 cells. The two tanshinones potentiated the cytotoxicities of doxorubicin and irinotecan in P-gp overexpressing colon cancer SW620 Ad300 cells. Moreover, these two tanshinones also increased intracellular accumulation of P-gp substrate in SW620 Ad300 cells, presumably by down-regulating P-gp mRNA and protein levels, as well as inhibiting P-gp ATPase activity. / Suppression of apoptosis can lead to MDR in cancer cells to anticancer agents with pro-apoptotic property. Hence, this study also investigated the circumvention of resistance to apoptosis in drug resistant colon cancer cells by cryptotanshinone and dihydrotanshinone, two potential MDR-reversing tanshinones. The drug resistant SW620 Ad300 cells were still sensitive to both cryptotanshinone and dihydrotanshinone in the promotion of cell death. When compared with the parental SW620 cells, the two tanshinones induced less apoptosis but more autophagy in the drug resistant cells. Further studies showed that cell viability was increased after inhibition of autophagy by siRNA interference or autophagy inhibitor. Thus, autophagy induced by the two tanshinones was pro-cell death in SW620 Ad300 cells, which could overcome resistance to apoptosis. / In addition, suppression of apoptosis can be caused by p53 defects/mutations, which were found in more than 50% of all human cancers. Our results also showed that apoptosis and autophagy induced by cryptotanshinone and dihydrotanshinone were independent of the status of p53 in colon cancer cells. The p53-independent cytotoxic actions of the two tanshinones could be useful in overcoming resistance to apoptosis in cancer cells caused by p53 defects/mutations. / Taken together, the current findings indicate a great potential of cryptotanshinone and dihydrotanshinone in the reversal of MDR caused by P-gp overexpression and suppression of apoptosis. They are promising candidates to be further developed as therapeutic agents in the adjuvant therapy for colon cancer, especially for the multidrug resistant cancer types. / 結腸癌是指形成在結腸組織的惡性腫瘤，在香港常見的癌症中排第一位，亦是香港排第二位的致死癌症。結腸癌的標準治療方案主要包括手術和化療。然而，多藥耐藥是結腸癌成功化療的一個障礙。事實上，大多數癌症引起的死亡都和在癌症的發展和化療的過程中產生的多藥耐藥有關。因此，多藥耐藥的逆轉對於結腸癌的成功化療非常重要。本研究旨在通過針對多藥耐藥兩種常見的機制ABC跨膜蛋白的過表達和抑制的細胞凋亡來探討丹參酮對結腸癌細胞多藥耐藥的逆轉。 / P-gp的過表達可介導藥物排出癌細胞，從而導致多藥耐藥和化療失敗。本研究評價了tanshinone I，tanshinone IIA，cryptotanshinone，dihydrotanshinone和miltirone對P-gp介導的結腸癌細胞多藥耐藥的逆轉。雙向轉運實驗表明，只有cryptotanshinone和dihydrotanshinone可以減少P-gp介導的digoxin外排。這兩個丹參酮可以增加doxorubicin和irinotecan在P-gp過表達的結腸癌SW620 Ad300細胞中的毒性。此外，這兩個丹參酮也增加P-gp底物在SW620 Ad300細胞內的積累，推測是通過下調P-gp的mRNA和蛋白水平，以及抑制P-gp的ATP酶活性。 / 抑制的細胞凋亡可導致腫瘤細胞對促凋亡的抗癌藥物产生多藥耐藥。因此，本研究也探討了cryptotanshinone和dihydrotanshinone能否克服結腸癌細胞的凋亡耐受。結果表明cryptotanshinone和dihydrotanshinone仍然能够杀死耐藥的SW620 Ad300細胞。當與SW620細胞相比，這兩個丹參酮在耐藥細胞中誘導的細胞凋亡較少，但自噬增多。進一步研究表明，這兩個丹參酮誘導的自噬是促進細胞死亡的，從而可以克服細胞的凋亡耐受。 / 此外，p53的缺陷/突變存在於50%以上的人類癌症中，并可以抑制細胞產生凋亡。結果表明，cryptotanshinone和dihydrotanshinone誘導的凋亡和自噬與p53在結腸癌細胞中的表達無關。這兩個丹參酮不依賴於p53的細胞毒性可以用於克服p53缺陷/突變引起的凋亡耐受。 / 綜上所述，本研究結果表明cryptotanshinone和dihydrotanshinone在逆轉P-gp的過表達和抑制的細胞凋亡引起的多藥耐藥中具有巨大潛力。它們可以進一步發展為有前途的治療劑并用於結腸癌的輔助治療，尤其是用於多藥耐藥的結腸癌。 / Hu, Tao. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 163-182). / Abstracts also in Chinese. / Title from PDF title page (viewed on 06, December, 2016). / Hu, Tao. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

Introdução e Justificativa: O câncer colorretal é a 3ª neoplasia maligna mais incidente no mundo, e apresenta comportamento bastante heterogêneo aos tratamentos instituídos. Conseguir diferenciar os pacientes de acordo com seu prognóstico e comportamento tumoral é um desafio. A biologia molecular, através dos microRNA (miRNA), pode contribuir na identificação do perfil tumoral e ajudar a predizer os desfechos clínicos. Objetivos: Comparar a expressão tecidual de miRNA-92a, miRNA-133a e miRNA-145 de pacientes com câncer de cólon, correlacionando o perfil de expressão de miRNA com aspectos clínicopatológico e prognóstico. Casuística e Métodos: Quantificação de miRNA-92a, miRNA-133a e miRNA-145 pela técnica de reação em cadeia de polimerase em tempo real (RTPCR) em amostras de tecido tumoral em pacientes com câncer esporádico de cólon (grupo de estudo) operados entre janeiro de 2010 a dezembro de 2011 e em amostras de tecido colônico sadio de pacientes saudáveis (grupo controle) submetidos à colonoscopia de rotina para rastreio de câncer colorretal. Os resultados das dosagens de miRNA foram correlacionados ao valor do antígeno cárcinoembrionário (CEA), idade, estadiamento, invasão linfovascular, sobrevida livre de doença e sobrevida global. Resultados: A idade média dos pacientes foi de 66 anos e 60% eram do sexo masculino. No momento do diagnóstico inicial 22% apresentavam metástase à distância, e em 80% dos pacientes foi atingida ressecção R0. A sobrevida global foi de 46 meses e a sobrevida livre de doença foi de 32 meses. Apenas o miRNA-133a esteve hiopoexpresso no grupo de estudo (p=0,0007). Ao se correlacionar os perfis de expressão dos miRNA às variáveis clínico-patológica e prognóstica, a hiperexpressão do miRNA-92a esteve associada a maior sobrevida global (p= 0,044). Discussão: O tempo de espera entre o encaminhamento para hospitais terciários e o início do tratamento oncológico pode contribuir para o elevado índice de pacientes com doença metastática ao diagnóstico. Melhores desfechos têm sido associados a hospitais de maior volume, aparentemente devido à maior expertise de que esses hospitais possuem. O miRNA-133a, um supressor tumoral, tem sido hipoexpresso em amostras tumorais quando comparadas a tecidos sadios. Por sua vez, a hiperexpressão do promotor tumoral miRNA-92a que esteve associada a melhor prognóstico, pode ser explicada por uma desregulação dos genes alvo desse miRNA ou por diferenças geográficas na expressão dos miRNA. Conclusão: o miRNA-133a encontra-se hipoexpresso em amostras tumorais, enquanto que a hiperexpressão do miRNA-92a esteve associada a melhor sobrevida global. / Introduction: Colorectal cancer is the 3rd most common malignancy in the world, and their incidence has been increase in the last decades. Although patients diagnosed with early stage tumors have more than 65% of overall survival, behavior of colorectal tumors and their response to established treatments is quite heterogeneous. Gap: In this context, becomes interesting differentiate patients according to their prognosis and tumor behavior. Molecular biology through the miRNA quantification can improve the identification of tumor profile and predict clinical outcomes. Propose: Evaluate tumor profile tissue expression of miRNA- 92a, miRNA- 133a and miRNA-145 in patients with non-hereditary colon cancer, correlating with clinicopathological variables and oncological outcomes. Assessing the ability of the expression of these miRNA predict the prognosis. Methods: A dosage of miRNA-92a, miRNA-133a and miRNA-145 was performed in tumor tissue samples from patients with colon cancer (called study group) and non-tumoral colonic tissue samples from healthy patients (called the control group) by real-time polymerase chain reaction. The results of miRNA levels were correlated with clinicopathological data and oncological outcomes. Results: Mean age was 66 years and 60% was male. At initial diagnosis, 22% of lesions had distant metastasis. R0 resection was achieved in 80% of patients. Disease-free survival was 32 months, and overall survival was 46 months. The MiRNA-133a showed higher values in the control group when compared to the study group (p = 0.0007), and miRNA-92a was associated with higher overall survival (p = 0.044). Discussion: Better outcomes in highly specialized centers could be explained by advances in surgical technique and perioperative care. MiRNA-133a was underexpressed in colonic tumoral tissue, likely others tumors. MiRNA-92a overexpression was associated with improve overall survival. It could be explained through deregulation of target genes or geographic patterns of miRNA expression. Conclusion: MiRNA-133a was underexpressed in study group, and over expression of miRNA-92a was associated with better overall survival.

O presente estudo objetivou avaliar os efeitos da inflamação e das expressões de metalotioneínas (MTs) e ciclooxigenase-2 (COX-2) na desnervação associada à carcinogênese experimental colônica, através da avaliação de imunoexpressão de COX-2, mieloperoxidase (MPO), neutrophil elastase (NE) e cluster de diferenciação 68 (CD68). Ainda, para analisar a presença de mutações e de danos ao material genético, realizou-se a técnica de imunoistoquímica para identificação de células imunomarcadas para MTs e histonas gamma-H2AX (H2AX). 52 ratos machos Wistar foram divididos em seus respectivos grupos: C (controle), B (controle dos animais desnervados), D (aplicação de DMH 30 mg/Kg ou 125 mg/Kg), BD (Cloreto de benzalcônio 0,3% na serosa intestinal, com posterior aplicação de DMH) e DB (aplicação de DMH, com posterior administração de BAC), sendo subdivididos de acordo com o tempo em que foram mortos, sendo: 24 horas, 72 horas (para avaliação da fase de iniciação) e 20 dias (para avaliação da fase de promoção). Como resultado, a desnervação foi capaz de proteger as células colônicas contra os efeitos desse carcinógeno, o que pode ser observado através da diminuição significativa da imunomarcação de MTs e de H2AX nos grupos desnervados. Ainda, através do aumento do número de células positivamente marcadas para MPO, NE e CD68, neutrófilos, macrófagos e/ou monócitos podem estar estritamente relacionados ao papel protetor da desnervação contra o câncer em um período de 20 dias após administração do DMH, uma vez que os animais desnervados apresentaram uma significativa diminuição desses marcadores. A desnervação aumentou o número de células imunomarcadas para MTs em animais que receberam apenas a aplicação do DMH e foram mortos após 20 dias - o que possivelmente diminuiu a expressão de COX-2 encontrada nesse estudo. Assim, sugere-se que os possíveis mecanismos protetores desempenhados pela desnervação contra o câncer sejam: (i) o aumento de MTs - conhecidamente protetoras à célula, e (ii) atuação da desnervação sobre o processo inflamatório, mais especificamente sobre neutrófilos e macrófagos e/ou monócitos. / This study evaluated the effects of inflammation and expression of metallothionein (MTs) and cyclooxygenase-2 (COX-2) on denervation associated to colonic experimental carcinogenesis by immunohistochemical evaluation of COX-2, myeloperoxidase (MPO), neutrophil elastase (NE) and cluster of differentiation 68 (CD68). Also, to analyze the presence of mutations and damage to DNA, was performed the immunohistochemical technique to identify positive immunostained cells for MTs and histone gamma-H2AX (H2AX). 52 male Wistar rats were divided into their respective groups: C (control), CB (control related to denervated animals), D (application of DMH 30 mg/Kg or 125 mg/kg), BD (0.3% benzalkhonium chloride administration in the intestinal serosa, and subsequent application of DMH) and DB (application of DMH with subsequent administration of BAC, in serous). The animals were subdivided according to euthanasia time: 24 hours, 72 hours (for evaluation of the initiation phase of the carcinogenesis process) and 20 days (for assessment of promoting phase). As result, the denervation process was able to protect colonic cells against the carcinogen effects, which can be seen through the significant decrease in immunostained cells for MTs and H2AX. Moreover, through the increased expression of MPO, NE and CD68, we found that neutrophils, macrophages and/or monocytes are closely related to inflammation on development of early colonic experimental carcinogenesis (20 days groups) - which was reverted by denervation. The denervation increased the number of immunostained cells for MTs in denervated animals that received application of DMH - what could possibly decreased COX-2 expression found in this study. Thus, it is suggested that the possible protective mechanisms performed by denervation against cancer are: (i) increased MTs - known to be protective to the cell, and (ii) actuation on inflammatory process, more specifically on neutrophils and macrophages and/or monocytes.