The efficacy of therapeutic modalities for non-Hodgkin’s lymphoma have been tested and improved throughout the 19th century through various series of drug trials aimed at eliminating cellular malignancies, first through chemotherapy treatment, and more recently through immunotherapy. While to an extent successful in eliminating cancerous lesions and affected cells, chemotherapy treatments have shown to influence the induction of new malignancies, through genetic mutation, as well as unwanted toxic effects of systemic poisoning. The purpose of this thesis is to compare treatment methods in terms of their biomolecular activity, precision of intended results, and possible drawbacks, as well as their application to specific populations of Non-Hodgkin lymphoma diagnoses, including Follicular and Diffuse Large B-Cell lymphomas. In the following sections on contributing factors specific to Diffuse Large B-Cell lymphomas and Follicular lymphoma, elements of disease prognosis will be analyzed from a molecular and clinical point of view. This includes a focus on the impact of genetic mutation, the immunohistochemical evidence these changes present, as well as the variances in immune cell functionality, and finally a description of symptoms with direction to specific underlying causes. An analysis of standard of care chemotherapy, and monoclonal antibody treatments will then be provided for each occurrence. The second segment will discuss novel techniques being developed for the treatment of lymphoma including but not limited to new monoclonal antibodies, synthetic lethality modulation, inhibition of selected chemokine receptors, DNA vector immunization for production of internal host antibodies, concepts of cell mediated bispecific antibody induced destruction, and new generations of Immunomodulatory drugs. With the recent development of cost effective sequencing technology, included is a discussion of the shift towards personalized medicine treatments, targeting appropriate phenotypic specific populations for optimal results, as it relates to therapies for Diffuse Large B-Cell lymphoma and Follicular lymphoma.

Bakgrund: Periodisering av träning kan vara av intresse för tränande kvinnor och deras coacher då hormonerna fluktuerar under menscykelns faser. Mycket forskning om styrketräning är gjorda på män. Att studera ökning av muskelstyrka hos kvinnor är komplext då deras hormoner fluktuerar månadsvis och anses kunna påverka studieresultat under menstruationscykeln. Syftet med litteraturstudien var att sammanställa studierna som finns inom ämnet och därefter dra nytta av kvinnors hormoner för att optimera muskelstyrka och att undvika risken för nya skador eller drabbas av de risker styrketräning kan minska. Syfte: Att granska och sammanställa studier gällande eventuella skillnader i muskelstyrka under menscykelns olika faser samt gällande eventuell effekt av periodiserad träning på muskelstyrkan i menscykeln faser.  Metod: En systematisk översiktsstudie med både interventionsstudier och observationsstudier inkluderade. En första sökning gjordes på PubMed och fem studier valdes ut och kvalitetsgranskades enligt PEDro scale. Därefter utökades sökningen för observationsstudier vilket gjordes på Google scholar. Där framkom ytterligare fyra studier och dessa granskades enligt SBU:s granskningsmall för observationsstudier.  Resultat: Resultatet tyder på att det inte finns någon tydlig skillnad mellan faserna då resultatet skiljde sig mellan de olika studierna. Forskningen inom ämnet är för bristfällig för att komma till någon adekvat slutsats gällande resultatet.  Konklusion: Vidare forskning, samt fler studier med samma utfallsmått behövs för att kunna dra slutsatser utifrån frågeställningarna. / Background: To periodize training can be of interest for athletic females and their coaches because the hormones fluctuate during the menstrual cycle. A large part of the research in strength training has been done on men. To study an increase in muscle strength in women is complex because their hormones fluctuate monthly and are considered to be able to influence study results during the menstrual cycle. The purpose of this literature study was to compile the studies available in the subject and then take advantage of women's hormones to optimize muscle strength and to avoid the risk of new injuries or suffer from the risks strength training can reduce.  Objective: The aim of this study was to review and to compile studies regarding the possible differences in muscle strength during the menstrual cycle and the possible effect of periodized training applied to the different phases of the menstrual cycle.  Method: A systematic review study included observational studies and intervention studies. The search was done on PubMed and five studies were included, then quality reviewed according to PEDro scale. The search for observational studies were made on Google scholar and four studies were selected, then reviewed according to the SBU’s review template for observational studies.  Results: The results indicated that there is no evident difference between the phases as the results were different between the different studies. The research on the subject is too insufficient to make an adequate conclusion. Conclusion: Further research, as well as more studies with the same outcome measure, are needed to be able to come to a conclusion based on the issues.

No description available.

No description available.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Résumé : Le syndrome des ovaires polykystiques (SOPK) affecte 6-10% des femmes en âge de procréer et est la principale cause d’infertilité anovulatoire. Cette condition est principalement caractérisée par une hyperandrogénie provenant des ovaires et des glandes surrénales. De plus en plus d’études, à la fois in vivo et in vitro, indiquent qu’une surexposition ovarienne en gras, de même que les mécanismes lipotoxiques subséquents pourraient causer l’hyperandrogénie chez ces femmes. Ainsi, cette étude vise à 1) évaluer l’implication des gras et de l’inflammation folliculaire dans la production des androgènes ovariens par une étude de corrélation; et 2) comparer les niveaux folliculaires de gras, métabolites lipidiques et marqueurs inflammatoires entre les femmes SOPK et non-SOPK. Cette étude transversale a recruté 80 femmes en cours de fécondation in vitro. Treize étaient SOPK, 58 étaient non-SOPK et 9 avaient un diagnostic incertain. Les participantes au projet avaient un âge moyen de 33 ± 4 ans. Tout groupe confondus, les niveaux folliculaires de testostérone corrélaient avec les gras (r=0,381; P=0,001; indépendamment de l’IL-6), les acylcarnitines (r≥0,255; tout P=0,008; non indépendamment des gras) et l’IL-6 (r=0,300; P=0,009; indépendamment des gras). De plus, les niveaux folliculaires de gras corrélaient avec les acylcarnitines (r≥0,594; tout P<0,001). Lorsque comparées aux femmes non-SOPK, les femmes SOPK étaient plus obèses (BMI: 31,2 vs. 25,1 kg/m2; P=0,009) et avaient des niveaux folliculaires plus élevés de testostérone (12,9 vs. 0,29 nM; P=0,001), de gras (P=0,001), d’acylcarnitines (tout P=0,001) et du marqueur inflammatoire IL-6 (13,0 vs. 8.6 pg/mL; P=0,018), le tout indépendamment de l’IMC. Les résultats suggèrent qu’une exposition intra-ovarienne en gras pourrait contribuer à une augmentation de la production des androgènes. Les mécanismes pourraient inclure une β-oxydation insuffisante, illustré par des acylcarnitines élevés, menant à l’accumulation de métabolites lipidiques toxiques, et une inflammation ovarienne, possiblement suite à une infiltration de macrophages. Ces deux mécanismes semblent être indépendants. De plus, l’environnement ovarien des femmes SOPK est caractérisé par une élévation des gras, de métabolites lipidiques et de marqueurs inflammatoires. Il peut donc être proposer que l’hyperandrogénie caractéristique du SOPK soit causée en partie par la lipotoxicité. // Abstract : Polycystic ovary syndrome (PCOS) affects 6-10% of the women of childbearing age and is the main cause of anovulatory infertility. It is mainly characterised by hyperandrogenism that can originate from the adrenal gland and the ovaries. A growing number of evidences, either in vivo or in vitro, points toward an overexposition to fat and lipotoxic mechanisms (lipid induced cellular toxicity) as the cause of PCOS hyperandrogenesis. Therefore, we aimed to: 1) evaluate the implication of follicular fluid (FF) levels of fat and inflammation markers in the ovarian production of androgens through a correlation analysis; and 2) compare FF levels of lipids, lipid metabolite levels and inflammation markers between PCOS and non-PCOS women. This cross-sectional controlled study was performed with 80 women undergoing an IVF procedure. Among them, 13 were PCOS, 58 were non-PCOS and 9 had an uncertain diagnosis. Participants were aged 33 ± 4 years old and had an average body mass index (BMI) of 25.7 ± 6.2. When analysing all women, follicular levels of testosterone correlated significantly with fat (NEFA + triglycerides) (r=0.381; P=0.001; independently of l’IL-6), acylcarnitines (r≥0.255; all P=0.008; not independently of fat) and l’IL-6 (r=0.300; P=0.009; independently of fat). Moreover, follicular levels of fat significantly correlated with acylcarnitines (r≥0.594; all P<0.001). When compared to non-PCOS women, PCOS women were significantly more obese (BMI: 31.2 vs. 25.1 kg/m2, P=0.009) and had significantly higher follicular levels of testosterone (12.9 vs. 0.29 nM, P=0.001), fat (P=0.001), acylcarnitines (all P=0.001) and inflammatory marker IL-6 (13.0 vs. 8.6 pg/mL, P=0.018), everything independently of BMI. Our results suggest that intra-ovarian exposure to fat may be responsible for the increased production of androgens. Mechanisms are likely to include an insufficient β-oxidation, leading to the accumulation of toxic lipid metabolites, and ovarian inflammation, possibly through macrophage infiltration. Both these mechanisms seem independent of one another. Also, intra-ovarian environment of PCOS women are characterized by increased levels of fat, acylcarnitines and inflammatory marker. It can thus be proposed that lipotoxic mechanisms are responsible for the increased production of androgen that is characteristic of PCOS women.

Treatment decision making (TDM) in oncology is complex. Understanding treatment information is essential for shared TDM. Research suggests many patients have low numeracy. This mixed methods study explored numeracy and experience with numbers in a sample of individuals diagnosed with follicular lymphoma. Participants completed questionnaires (N = 32) and interviews (N = 20) assessing numeracy, decisional conflict and regret, and number preference. Results suggest that mean objective numeracy was relatively high, and most reported high confidence in numerical ability. Most participants preferred to receive numbers during the TDM process. There was no relationship between numeracy and decision outcomes. Future research should investigate the use of numeracy measures in practice and the impact of patient preferences and beliefs on shared TDM.

Follicular lymphoma (FL) is the second most common non-Hodgkin lymphoma (NHL). FL is clinically designated as an indolent disease with a long median survival of 8-10 years. However, the clinical and biological behavior of FL shows considerable variability, with some patients showing aggressive disease progression and very short survival. Because defects in the regulation of apoptotic cell death are fundamental in FL pathogenesis, we hypothesized that deregulated expression of components of the pRb signaling pathway may promote cell proliferation, thereby complementing antecedent anti-apoptotic mutations and producing more aggressive disease. In the present study we undertook an immunohistochemical (IHC) evaluation of expression of key cell-cycle regulatory proteins in diagnostic biopsies from 127 cases of FL using formalin-fixed, paraffin-embedded tissues (FFPE) in tissue microarray (TMA) sections immunostained for p53, pRb, p16INK4A and cyclin D3. Data analysis revealed that increased abundance of p53 or p16INK4A is associated with reduced overall survival (OS) (p=0.005 and p=0.014 respectively), and with conventional pathological markers of tumour aggressiveness including high histologic grade. Encouraged by this remarkable finding of a counterintuitive association between p16INK4A expression and clinical outcome, we analyzed CDKN2A gene deletion and methylation, as these are the most frequent mechanisms of the CDKN2A gene inactivation in NHL including FL. We determined the deletion and methylation status of CDKN2A in 105 FL cases. Laser-capture microdissection was used to enrich the samples for lymphoma cells. CDKN2A was deleted in 9 cases and methylated in 22 cases. The 29 cases (28%) with CDKN2A deletion or methylation had decreased overall survival (OS) (p=0.046) in all cases and in cases treated with rituximab (p<0.001). Our findings indicate that deleterious alterations of CDKN2A are relatively prevalent in FL at diagnosis and can predict poor clinical outcome. In summary, our data reveal novel insights into the pathogenesis of FL and suggest a relationship between increased p16INK4A expression and CDKN2A deletion or methylation and unfavorable clinical outcome in FL. We hope that the work presented herein will provide a useful prognostic tool for predicting the prognosis and choosing optimal treatment approaches to help patients suffering from FL. / Thesis (Ph.D, Pathology & Molecular Medicine) -- Queen's University, 2013-03-12 23:49:44.541

Transmissible spongiform encephalopathies (TSEs), such as scrapie and variant Creutzfeldt-Jakob disease are infectious, fatal, neurodegenerative diseases. Following peripheral infection TSE agents usually accumulate in lymhoid tissues before spreading to the central nervous system. In mice, follicular dendritic cells (FDCs) expressing the host prion protein (PrPC) are essential for scrapie agent accumulation in lymphoid tissues. The accumulation of the scrapie agent on FDCs is critical for the efficient spread of infection to the brain. However, it is unknown whether FDCs themselves actively replicate the scrapie agent, or simply accumulate it following production by other cells types such as neurones, lymphocytes or other stromal cell populations. To definitively address this issue a transgenic mouse model was created in which PrPC is switched on or off exclusively on FDCs. Expression of cre-recombinase (Cre) under the action of cell-specific gene promoters can be used to induce or delete the expression of a target gene in specific cell populations. In this model, Cre expression is driven by the complement receptor type 2 gene (Cr2/CD21) which is expressed by FDCs and mature B lymphocytes. Characterisation of the CD21-cre mouse line was achieved by crossing with a ROSA26 reporter strain. The CD21-cre mouse line was subsequently crossed with floxed-PrP mouse lines to produce compound transgenic mouse lines in which PrPC expression was switched on or off, only in FDCs. Cre expression by B lymphocytes was eliminated by γ-irradiation and grafting recipient mice with Cre-deficient bone marrow. Immunohistochemical analysis confirmed the expression PrPC had been switched on or off exclusively on FDCs. Subsequently, the mice were challenged with scrapie by intra-peritoneal injection to determine the precise role of FDCs in the accumulation of scrapie in lymphoid tissues. Switching off PrPC expression exclusively on FDCs prevented the accumulation of TSE agent specific disease-associated PrPSc in the spleen after i.p inoculation. Conversely, in mice in which PrPC was expressed only on FDC, successful replication of the agent occurred on the FDC network in the spleen. Taken together, these data show PrPC-expressing FDCs alone are sufficient to support the accumulation of the scrapie agent within lymphoid tissues. Furthermore, these data suggest FDC replicate the TSE agent and do not simply accumulate it following synthesis by other cell types.

The Transmissible Spongiform Encephalopathies (TSEs) or “prion” diseases are a group of fatal neurodegenerative diseases the aetiology of which is not fully understood. These diseases are characterised by a number of pathological changes in the central nervous system (CNS) including; vacuolation of the neuropil, gliosis and deposition of PrPSc; the abnormal form of the host glycoprotein PrP. Although the major pathology in these diseases is associated with the CNS the immune system is central to the pathogenesis of many natural and experimental TSEs including natural scrapie in sheep, chronic wasting disease in free ranging and captive deer and variant CJD (vCJD) in humans. Unlike many infectious diseases where deficiencies in immune function are opportunistic for the invading pathogen a competent immune system is required for efficient TSE infection via peripheral routes. As infection of the lymphoid tissues in many TSEs can occur many months before the detection of infectivity in the CNS, the determination of those cells in the lymphoid system has been the focus of much research and a number of studies now point towards the importance of the follicular dendritic cell (FDC), a long-lived radio resistant cell, in TSE pathogenesis. The involvement of FDCs in peripheral TSE pathogenesis relates to the inability of ionising radiation to influence pathogenesis, the association of PrP protein with FDCs in both uninfected and infected lymphoid tissues, and the demonstration that TSE pathogenesis is severely impaired in mice devoid of these cells. The aims of this thesis were to further understand the role of FDCs in the pathogenesis of a range of mouse-adapted experimental TSE strains and to determine if peripherally acquired TSE infections are influenced by host age or by stimulation of the immune system. Using chimaeric mouse models where a mismatch in the expression of PrP protein between FDCs and lymphoid/myeloid cells was produced, further evidence for a critical role for in the pathogenesis of the ME7 TSE strain was produced. Although these findings produced strong evidence that FDCs were important for the ME7 strain the possibility that different TSE strains may target different cell types in the peripheral lymphoid system was explored using a range of mice with specific immunological defects. Infection of these mice with several experimental TSE strains showed that the presence of mature FDCs was also important for the pathogenesis of the strains tested. Clinical cases of vCJD have been confined almost exclusively to young adults, although the reasons behind this apparent age-related susceptibility are not fully understood. The capacity of the immune system to mediate immune responses to pathogens declines with age as a result of impaired lymphocyte and FDC function. As FDCs are critically involved in the pathogenesis of many TSEs, including vCJD, it was hypothesised that an aging immune system may impair disease pathogenesis. Peripheral infection of senescent mice failed to produce clinical disease during lifespan, although evidence of disease transmission, was detected in a proportion of aged mice. These findings demonstrate that this inefficient disease transmission, as a consequence of age, may lead to considerable levels of sub-clinical disease within the population. Finally the influence of immune system stimulation, by the generation of a humoral immune response, on peripheral TSE pathogenesis was investigated. These findings demonstrated that immunisation can influence pathogenesis, but only during the early stages of infection prior to spread to the CNS. These data imply that modulation of the immune system does not alter TSE pathogenesis once disease has been initiated in the CNS. Finally, these studies have found some preliminary evidence that TSE infection may induce FDC activation suggesting that TSE infection may influence the immune response. Together, these data show that a functional immune system and specifically, the presence of mature FDCs, are central to the pathogenesis of peripherally acquired TSE infections.