The objective of this study is to address some important questions associated with stomach cancer patients using the data from the Surveillance Epidemiology and End Results (SEER) program of the United States. To better understand the behavior of stomach cancer, we first perform parametric analysis for each patient group (white male, white female, African American male, African American female, other male and female) to identify the probability distribution function which can best characterize the behavior of the malignant stomach tumor sizes. We evaluate the effects of patients’ age, gender and race on the malignant stomach tumor sizes by developing quantile regression models, which gives us a better understanding of the behavior of the malignant stomach tumors. We also proposed statistical models with respect to patients’ malignant stomach tumor size as a function of age for different races and gender group, respectively. The proposed models were evaluated to attest their prediction quality. Furthermore, we have identified the rate of change of the malignant tumor size as a function of age, for gender and race. We evaluated the routine treatment of stomach cancer using parametric and nonparametric survival analysis. We have found that stomach cancer patients who receive surgery with radiation together have a better survival probability than the patients who receive only radiation. We performed decision tree analysis to assist the physician in recommending to his patients the most effective treatment that is a function of their characteristics.

Na mucosa gástrica, cinco tipos compõe o epitélio gástrico: mucosas superficiais, parietais (CP), mucosas do colo (CMC), endócrinas e zimogênicas (CZ). As CMC originam as células CZ por transdiferenciação e a população de CP é importante para que o processo ocorra.Durante a transdiferenciação observamos células com características de CMCs e CZs, denominadas células em transição (CT) que ocupam o segmento entre o colo e a base da glândula. Essa transição entre células e a presença de CP são essenciais para a homeostase da base da glândula. Porém, estudos mostram que alterações no padrão alimentar influenciam a organização do epitélio gástrico de ratos, e o desmame precoce (DP) modifica a dinâmica de proliferação, migração e maturação das células. Nosso objetivo foi avaliar os efeitos imediatos do DP sobre as populações de CMC, CZ, CT e CP, e investigar se tais efeitos são mantidos até a vida adulta. Para isso, ratos Wistar (CEUA ICB USP 18/2015) foram divididos em dois grupos: amamentado controle (A) (permaneceram com a mãe até 21 dias), e DP (separados das mães aos 15 dias). O estômago foi coletado aos 18, 30 e 60 dias de vida pósnatal. Em cortes histológicos, verificamos que o índice de CP não foi alterado pelo DP, porém a distribuição dessa célula na glândula foi modificada aos 18 e 30 dias. Sob microscopia de fluorescência e confocal, observamos que o DP aumentou a população de CMC (GSIIFITC+) aos 18 dias (A vs DP; P<0,01), e de CZ (Mist1-Cy3+) aos 18 e 60 dias (A vs DP; P<0,05). O número de CT/campo (GSII-FITC+Mist1-Cy3) não se alterou após o DP, evidenciando que o segmento de transição entre o colo e a base da glândula representa um importante controle de tamanho populacional. Para avaliar o comportamento de CT em relação ao seu destino (CZ) e sua origem (CMC), analisamos o índice de CT sobre essas populações. Sobre o destino, devido à ausência de resposta no número de CT/campo e ao aumento de CZ nos animais DP, o índice CT/CZs variou aos 18 e 30 dias. No entanto, o índice de CT/CMC (origem) não foi alterado pelos tratamentos nas diferentes idades. Sob microscopia eletrônica de transmissão, avaliamos as características ultraestruturais das CMC, CT e CZ aos 18 dias, e observamos principalmente as organelas envolvidas na reorganização das células durante a transdiferenciação. Nosso estudo mostrou que o desmame precoce acelera a diferenciação celular e muda a distribuição de células mucosas do colo e zimogênicas na glândula gástrica, porém esse processo ocorre com preservação do tamanho compartimento de transição e do número de células parietais. Assim, podemos sugerir que o desmame precoce aumenta a população de células zimogênicas por meio de uma passagem mais rápida entre a região do colo e da base, na presença de células parietais, e esse mecanismo seria acionado logo após a transição da dieta, podendo manter-se ativo até a vida adulta. / Five epithelial cell types are found in the gastric mucosa: surface mucous, parietal (PC), mucous neck (MNC), endocrine, and zymogenic (ZC). The MNC originates ZC through transdifferentiation, and the presence of PC is important for the process. During transdifferentiation, we observe cells that present characteristics from MNC and ZC that are identified as transition cells (TC). They occupy the area between the neck and base of the gastric gland. The transition between these cells and the presence PC are essential for homeostasis at the base of the gland. However, studies show that changes in dietary pattern influence the organization of rat gastric epithelium, and early weaning (EW) modifies the proliferation, migration and maturation dynamics of these cells. Our aim was to evaluate the immediate effects of EW on the populations of MNC, ZC, TC and PC, and to investigate if such effects are maintained until adult life. To that, Wistar rats (CEUA ICB USP 18/2015) were divided into two groups: suckling control (S) (pups remained with the mother until 21 days), and EW (pups were separated from mother at 15 days). The stomach was collected at 18, 30 and 60 postnatal days. After analyses of histological sections, we verified that PC indices were not altered by EW, but the distribution of this cell was modified at the 18 and 30 days. By fluorescence and confocal microscopy, we determined that EW increased MNC population at 18 days (A vs PD, P <0.01), and ZC at 18 and 60 day (A vs DP; P <0.05). TC number/field did not change after EW, indicating that the transition between neck and gland base is under an important population control. In order to evaluate the behavior of TC regarding its final differentiation (ZC) and origin (MNC), we calculated TC index on these populations. In relation to ZC, we found a variation in TC index at 18 and 30 days, specially because TC number did not change, whereas ZC population increased. However, the TC index on GSII + cells (origin) was not altered by treatments throughout growth and ageing. Finally, under electron microscopy, we studied the ultra structure of MNC, TC and ZC and observed the reorganization of secretory apparatus during transdifferentiation at 18 days. Thus, we can suggest that EW increases ZC population through a rapid traffic through transition compartment between neck and base, in the presence of parietal cells, and such mechanism would be triggered soon after dietary transition and be kept activated until adult life.

Delayed gastric emptying, that manifests clinically as intolerance to enteral feeding, occurs in over 50% of critically ill patients and has a major impact on patient morbidity and mortality. Despite the recognition that the proximal stomach has a major role in gastric emptying of liquids, only the motor activity of the antro-pyloro-duodenal region has been evaluated in detail. In addition, many of the proposed risk factors for the gastric dysmotility, particularly a prior history of diabetes mellitus, have not been evaluated formally but have been extrapolated from data from non-critically ill patients. The currently available prokinetic drugs, erythromycin and metoclopramide, are considered to be the first line treatment for feed intolerance. However, neither data comparing the effectiveness of these agents nor the data on the effects of combination of therapy in the treatment of feed intolerance are available. The aims of this thesis were, therefore, to examine: (i) proximal gastric motor activity and the association between proximal and distal motility; (ii) the relationship between entero-gastric humoral responses to nutrients, gastric emptying and feed intolerance; (iii) the impact of admission diagnoses, choice of sedations, timing of initiation of feeding, and pre-existing history of diabetes mellitus on gastric emptying and feed intolerance; and (iv) the efficacy of erythromycin, metoclopramide and combination of these drugs in treatment of feed intolerance in critically ill patients. The current thesis indicates that motor activity is impaired in multiple regions of the stomach in the critically ill. When compared to healthy humans, proximal gastric relaxation was prolonged and fundic wave activity was educed during small intestinal nutrient infusion in critically ill patients. In addition, simultaneous assessment of proximal and distal gastric motility demonstrated a possible disruption of the motor integration between the proximal and distal stomach. In light of the recent data that suggested a significantly greater proportion of meal distributed proximally in critically ill patients with delayed gastric emptying (Nguyen, et al. 2006), the disruption of the gastric motor integration and the prolonged gastric relaxation in response to duodenal nutrients may play a significant role in the pathogenesis of slow gastric emptying during critical illness, especially as liquid formulae. The entero-gastric hormonal feedback responses were also disturbed during critical illness. Both fasting and duodenal nutrient-stimulated plasma CCK and PYY concentrations were significantly higher in critically ill patients, particularly those who did not tolerated gastric feeds. The rate of gastric emptying of a liquid meal was inversely related to both fasting and postprandial plasma CCK and PYY concentrations, supporting the potential role of plasma CCK and PYY in the pathogenesis of gastric dysmotility in critically ill patients. Admission diagnosis, choice of sedative drug and blood glucose control but not the timing of enteral feeds were important factors for delayed gastric emptying and feed intolerance in these patients. In particular, delaying enteral feeding by 4 days had no impact on the rate of gastric emptying, intra-gastric meal distribution, or plasma CCK and PYY concentrations. Contrary to traditional belief, critically ill patients with a pre-existing diagnosis of type 2 DM have only a minor disturbance to the proximal stomach, a relatively normal gastric emptying and are at no higher risk of feed intolerance than those without DM, suggesting the presence of pre-existing DM 2 in critically ill patients should not influence the standard practice of gastric feeding. Therapeutically, short-term treatment with low dose erythromycin was more effective than metoclopramide, but the effectiveness decreased rapidly overtime at similar rate as observed with metoclopramide. In patients who failed to response to either agent, treatment with both agents was highly effective in re-establishing feeding success. The use of combination therapy as the initial treatment for feed intolerance was also more effective than erythromycin alone and had less tachyphylaxis. Treatment with erythromycin and metoclopramide, either as a single agent or in combination did not associated with major cardiovascular adverse side effects. Although diarrhoea was a common side effect and was highest with combination therapy, it was not associated with Clostridium difficile infection and settled quickly after the cessation of the prokinetic therapy. In summary, the work performed in the current thesis has provided substantial insights into the understanding of the nature, risk factors, pathogenesis and treatment of disturbed gastric motor function in critically ill patients. Not only do these findings stimulate further research into the mechanisms responsible for gastric dysmotility in critical illness, they also lead to the development of new strategies for optimizing the management of feed intolerance. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1320667 / Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2008

Decapitated Vs. Stomach buried – A study of decapitated people and stomach placed people in Iron Age in Sweden and Denmark. This essay is about decapitated persons in graves and those buried on their stomach in the Iron Age in Sweden and Denmark. The analysis is to compare these graves by six perspectives; location of the grave, construction of the grave, grave goods, sex, age and interpretations of the grave. Out of this I found out if there are any different patterns of these graves, except that they are decapitated and places on their stomach. I compare between fifteen graves located on their stomach, nine decapitated graves, four graves that involve both and eight graves that do not contain any of it.

The stomachs of 183 bigeye tuna (Thunnus obesus) were collected from three Taiwanese longline vessels operating in the western Indian Ocean during the period from April to December 2006. Their fork lengths ranged from 89 cm to 198 cm. Distinguishable prey species, belonging to 28 families, consisted mostly of fishes, crustaceans, and cephalopods. Fourteen prey items were newly recorded, among them, five families (Anoplogastridae, Bothidae, Grammicolepididae, Pinguipedidae, and Sciaenidae) were firstly recorded as the diet of bigeye tuna. Two special dietary species were found for the first time. Oplophorus gracilirostris, the dominant numerical dietary species, had not been previously recorded; however, O. typus had been recorded in the past. The other special prey species found, Macrurocyttus acanthopodus (Grammicolepididae), was not only the first record in the stomach of bigeye tuna but also the first record in the Indian Ocean. The largest body length among prey species was 655 mm for an Alepisaurus ferox. The number of prey species appeared to decrease with the increasing size of the bigeye tuna, and larger Indian bigeye tuna tended to feed on larger prey species. In the stomachs of the bigeye tuna, Oplophorus gracilirostris was the most frequently found prey species (56.8%). The three numerical most dominant prey species were Oplophorus gracilirostris (38.2%), Charybdis smithii (8.8%), and Alepisaurus ferox (3.6%). In addition, the fish prey item, Alepisaurus ferox, had the highest percentage of prey weight. The total percentage of prey weight for prey fishes is similar to that reported in previous research, but the average weight of Alepisaurus ferox is heavier than the previous report. Additionally, the percentage of prey weight for Paralepididae is lower than the results of previous studies. Moreover, the occurrence and percentage of the number of Oplophorus gracilirostris are distinctly higher than the results of previous studies. These findings indicate that the percentage of mean preys number exist seasonal effect. Alepisaurus ferox was the most numerous prey in May to July; Oplophorus gracilirostris was the most numerous prey at 200 m depth in August to October 45¢XE to east; Charybdis smithii was the most numerous prey at 50 m depth in August to October 45¢XE to west. A possible reason to explain this phenomenon is that there are strong feeding migratory behavior in bigeye tuna.

Thesis (M.N.(Clinical))--Victoria University of Wellington, 2009. / Includes bibliographical references.

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

No description available.