Pilocytic astrocytoma (PA) is the most common brain tumor in children. This tumor is usually benign and has a good prognosis. Total resection is the treatment of choice and will cure the majority of patients. However, often only partial resection is possible due to the location of the tumor. In that case, spontaneous regression, regrowth, or progression to a more aggressive form have been observed. The dependency between the residual tumor size and spontaneous regression is not understood yet. Therefore, the prognosis is largely unpredictable and there is controversy regarding the management of patients for whom complete resection cannot be achieved. Strategies span from pure observation (wait and see) to combinations of surgery, adjuvant chemotherapy, and radiotherapy. Here, we introduce a mathematical model to investigate the growth and progression behavior of PA. In particular, we propose a Markov chain model incorporating cell proliferation and death as well as mutations. Our model analysis shows that the tumor behavior after partial resection is essentially determined by a risk coefficient γ, which can be deduced from epidemiological data about PA. Our results quantitatively predict the regression probability of a partially resected benign PA given the residual tumor size and lead to the hypothesis that this dependency is linear, implying that removing any amount of tumor mass will improve prognosis. This finding stands in contrast to diffuse malignant glioma where an extent of resection threshold has been experimentally shown, below which no benefit for survival is expected. These results have important implications for future therapeutic studies in PA that should include residual tumor volume as a prognostic factor.

Thesis (MSc)--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: Introduction: The ability of different polyunsaturated fatty acids (PUFAs), especially n-3 PUFAs, to prevent the development of cancer has been under intense investigation the past three decades. Numerous studies have shown that these fatty acids can kill cancer cells in vitro as well as in vivo whilst normal cells remain unaffected. Unfortunately, the cellular and molecular mechanisms responsible for this phenomenon are still poorly understood. This study investigated the signalling pathways modulated by docosahexaenoic acid (DHA) in an adenocarcinoma cell line, in order to shed some light on these unknown mechanisms. Materials & Methods: NCM460 (normal colon epithelial) and CaCo2 (colon adenocarcinoma) cells were cultured and treated with low doses of palmitic acid (PMA), oleic acid (OA), arachidonic acid (AA), and DHA. The effects of these fatty acids on the proliferation of the cells were measured with the MTT assay. The composition of membrane phospholipids of CaCo2 cells was determined after 48h supplementation with different fatty acids by gas chromatography. Also, CaCo2 cells were treated with DHA (10 μM) only and proteins were harvested at fixed time points ranging from 2 minutes to 48 hours. The protein inhibitors wortmannin (PI3 kinase inhibitor), PD 98059 (MEK inhibitor) and SB 203580 (p38 inhibitor) and also RNA interference (RNAi) of the p38 MAPK protein were used to investigate cross-talk between signalling pathways. ERK, p38 MAP kinase, Akt, and p53 were then analysed by Western blotting using phospho-specific and total antibodies. The cleavage of the apoptotic proteins, caspase-3 and PARP were also analysed. Results and discussion: MTT assays revealed that none of the fatty acids were toxic to normal cells. In addition, DHA was shown to be most effective to kill CaCo2 cells whilst protecting NCM460 cells and a subsequent dose response experiment revealed that lower concentrations are most suitable for this purpose. DHA was also shown to be readily incorporated into phospholipids, along with AA. This is associated with increased membrane fluidity, which could affect the localisation, and downstream effects, of various signalling proteins within the membrane. Western blot analysis revealed a rapid increase in activity in most proteins under investigation, especially ERK and Akt (Ser473). Long-term DHA supplementation suppressed the full activation of Akt. This down regulation of survival signalling could lead to cell death in CaCo2 cells. In addition, it was shown that after 48h, DHA induced the cleavage of caspase-3 and PARP, which is indicative of apoptosis. RNAi experiments suggested a possible role for p38 MAPK in the phosphorylation of p53 at Ser15, a site which is associated with DNA damage. Conclusion: DHA exerts its effects by means of cellular signal transduction pathways, particularly by suppression of the important survival-related kinase, Akt. This could have implications for future therapeutic interventions in cancer patients, as fatty acids are safe to use and do not interfere with the functionality of normal tissue. / AFRIKAANSE OPSOMMING: Inleiding: Die vermoë van verskillende poli-onversadigde vetsure (POVSe), veral n-3 POVSe, om die ontstaan van kanker te voorkom, is intens nagevors die afgelope drie dekades. Menigte studies het aangevoer dat hierdie vetsure kankerselle in vitro asook in vivo kan doodmaak, terwyl normale selle nie daardeur beïnvloed word nie. Ongelukkig word die sellulêre and molekulêre meganismes onderliggend tot hierdie verskynsel nie goed begryp nie. Hierdie studie het verskeie seintransduksie-paaie wat deur dokosaheksaenoësuur (DHS) in ‘n adenokarsinoom sellyn gemoduleer word, ondersoek. Materiale & Metodes: NCM460 (normale kolonepiteel) en CaCo2 (kolon adenokarsinoom) selle is onderhou in ‘n selkultuur-laboratorium en behandel met lae dosisse palmitiensuur (PMS), oleïensuur (OS), aragidoonsuur (AS), en DHS. Die invloed van hierdie vetsure op die proliferasie van die selle is d.m.v. die MTT toets bepaal. The samestelling van membraan-fosfolipiede van CaCo2 selle is na 48h behandeling met die verskillende vetsure bepaal deur middel van gaschromatografie. Die CaCo2 selle is ook met DHA (10 μM) alleenlik behandel en teen vaste tydpunte wat wissel van 2 minute tot 48h, waarna proteïene geëkstraeer is. Die proteïen-inhibitore wortmannin (PI3 kinase inhibitor), PD 98059 (MEK inhibitor), en SB 203580 (p38 inhibitor) asook RNAinterferensie (RNAi) teen die p38 MAPK proteïen is ingespan om oorvleueling tussen seintransduksie–weë te ondersoek. ERK, p38 MAPK, Akt, en p53 is geanaliseer deur middel van die Western–klad metode met fosfo–spesifieke en totale antiliggame. Die kliewing van die apoptotiese proteïene caspase-3 en PARP is ook bepaal. Resultate en bespreking: MTT toetse het ontul dat geen vetsure toksies was vir die normale selle nie. Daar is ook gevind dat DHS die mees effektiewe vetsuur was om CaCo2 selle te dood, terwyl NCM460 selle beskerm word. Gevolglik het ‘n dosis-respons eksperiment getoon dat laer konsentrasies die beste geskik is vir hierdie doel. Daar is ook gevind dat DHA maklik in fosfolipiede geïnkorporeer word, tesame met AS. Dit word geassosieer met verhoogde membraan-vloeibaarheid, wat die ligging, en ook stroom-af werking, van verskeie seintransduksie proteïene in die membraan, kan beïnvloed. Westernklad analises het ‘n vinnige verhoging in die aktiwiteite van die meeste proteïene onder die soeklig, getoon, veral ERK en Akt (Ser473). Langdurige DHS behandeling het die maksimale aktiwiteit van Akt onderdruk. Hierdie afname van oorlewing-gerigte seine kan lei tot seldood in CaCo2 selle. Daar is boonop geving dat DHS die kliewing van caspase-3 en PARP geïnduseer het na 48, wat dui op apoptose. Uit die RNAi eksperiment kon daar ook ‘n moontlike rol vir p38 MAPK in die fosforilering van p53 by Ser15, wat geassosieer word met DNS-skade, getoon word. Gevolgtrekking: DHS beoefen sy effekte deur middel van seintransduksie paaie, veral deur die oorlewing-geassosieerde kinase, Akt, te onderdruk. Dit kan implikasies hê vir toekomende terapeutiese ingrypings in kankerpasiënte, aangesien vetsure veilig is om te gebruik en nie skadelik is vir normale weefsel nie.

Introduction This thesis describes a research study designed to examine the consequences of disability arising out of spinal cord compression secondary to cancer, and to examine the rehabilitation services available to patients. Research aims and questions The study was intended to achieve the following: 1. To ascertain what might constitute effective rehabilitation interventions for patients with metastatic spinal cord compression. 2. To identify the conditions in which these intervention might be delivered. 3. To ground proposals in spinal cord compression patients’ experience of disability. The following research questions were posed: 1. What are the consequences of disability for patients with metastatic spinal cord compression? 2. What strategies do patients themselves use to manage disability? 3. What do health care staff, particularly rehabilitation professionals, understand to be the consequences of disability for this patient group, and correspondingly, what are their views on the significance and provision of rehabilitation? 4. To what extent is rehabilitation being provided to these patients, and with what effect? 5. Where rehabilitation is not being provided, why is this the case? Study design The study had two components: • A series of nine in-depth interview-based case studies, which involved talking to patients about their experiences of living with spinal cord compression, as well as gaining the perspectives of family members and the health professionals who provided care and services. • A retrospective audit of the medical records of 73 spinal cord compression patients admitted to a radiotherapy in-patient unit (the Frank Ellis Unit at the Churchill Hospital in Oxford) over a two year period (July 2003 – June 2005), identifying disability-related problems and the measures taken to address them. This was a Phase I modelling study in terms of the Medical Research Council’s framework for evaluating complex interventions, with Pawson and Tilley’s (1997) Context-Mechanism-Outcome configuration adopted as a conceptual basis for data collection. Within-case analysis was informed by George and Bennett’s (2004) account of process tracing, and between-case analysis was modelled on the constant comparative method of Glaser and Strauss (1967) with an analysis of narrative as a variation on that theme. Results Disability is a serious problem for patients with spinal cord compression, but it is one problem among many others, not the least of which are the physical and emotional consequences of life-threatening illness. In response to disability, patients ‘twin-track’ their attitudes to it, acknowledging but also resisting the idea of themselves as disabled, and adopting a series of psychological devices to manage the tension. In effect, patients recognise that something significant has changed and that, as a consequence, new self-management skills must be learned, functional boundaries must be explored, useful information must be sought. At the same time, they display a determination to hold on to an established identity, associated with a sense of normality. This identity embraces the idea of competence and resourcefulness, the events, activities and pleasures that one looks forward to, and the wish to avoid burdening others. It is not a ‘disabled’ identity. To some extent, these two attitudes are in tension, as one acknowledges disability while the other, implicitly or explicitly, resists it. Consequently, patients try to find ways of resolving this tension, by ‘revising downwards’ their expectations, by constantly deferring the anticipated pleasures, and by avoiding situations in which their abilities might be put to the test, or the sense of normality be disconfirmed. Health care professionals are likely to construe the patient’s response as indicative of a certain type of character – ‘realistic’ on one hand, and ‘unrealistic’ on the other. They do not see ‘acknowledging / not acknowledging’ as twin facets of a complex response to circumstances, or as something which every patient engages in to one degree or another. Patients are motivated not to recognise rehabilitation as something they need, a view which is confirmed by the cursory form of rehabilitation experienced in hospital, and by the marginal significance attributed to it by nursing and medical staff. On discharge, hospital staff assume that rehabilitation needs will be identified in the community, although the way in which community rehabilitation services are organised virtually guarantees that this will not happen, unless a specific referral is made (as it is in only 5% of cases). The patient, meanwhile, remains unaware of the potential value of rehabilitation, and has no incentive to request rehabilitation if no-one offers it. They are consequently unprepared for life post-discharge, and assume that they (and their families) must manage on their own. Conclusions Like the patients, health care professionals may have to ‘twin-track’ if they are to provide rehabilitation in a way that is acceptable to patients with metastatic spinal cord compression. Instead of categorising patients as ‘realistic’ or ‘unrealistic’, they should work towards sustaining patients’ ‘positive illusions’, while at the same time taking whatever opportunities arise to enhance the patient’s day-to-day ability to function in a ‘safe’ space. This entails revising some deeply entrenched ideas about working with patients who have a disability: patient-centredness, the importance of goal setting, and the need for adjustment.

Le cancer du poumon a une incidence et une létalité parmi les plus hautes de tous les cancers diagnostiqués au Canada. En considérant la gravité du pronostic et des symptômes de la maladie, l’accès au traitement dans les plus brefs de délais est essentiel. Malgré l’engagement du gouvernement fédéral et les gouvernements provinciaux de réduire les délais de temps d’attente, des balises pour les temps d’attente pour le traitement d’un cancer ne sont toujours pas établis. En outre, le compte-rendu des indicateurs des temps d’attente n’est pas uniforme à travers les provinces. Une des solutions proposées pour la réduction des temps d’attente pour le traitement du cancer est les équipes interdisciplinaires. J’ai complété un audit du programme interdisciplinaire traitant le cancer du poumon à l’Hôpital général juif (l’HGJ) de 2004 à 2007. Les objectifs primaires de l’étude étaient : (1) de faire un audit de la performance de l’équipe interdisciplinaire à l’HGJ en ce qui concerne les temps d’attente pour les intervalles critiques et les sous-groupes de patients ; (2) de comparer les temps d’attente dans la trajectoire clinique des patients traités à l’HGJ avec les balises qui existent ; (3) de déterminer les facteurs associés aux délais plus longs dans cette population. Un objectif secondaire de l’étude était de suggérer des mesures visant à réduire les temps d’attente. Le service clinique à l’HGJ a été évalué selon les balises proposées par le British Thoracic Society, Cancer Care Ontario, et la balise pan-canadienne pour la radiothérapie. Les patients de l’HGJ ont subi un délai médian de 9 jours pour l’intervalle «Ready to treat to first treatment», et un délai médian de 30 jours pour l’intervalle entre le premier contact avec l’hôpital et le premier traitement. Les patients âgés de plus de 65 ans, les patients avec une capacité physique diminuée, et les patients avec un stade de tumeur limité étaient plus à risque d’échouer les balises pour les temps d’attente. / Lung cancer is among the most lethal and the most diagnosed cancers in Canada. Given the poor prognosis and symptom burden of the disease, timely access to treatment and quality care are essential. In spite of government commitments to reduce waiting times in cancer care, national clinical benchmarks for cancer care have yet to be established, and waiting time reporting by provinces is inconsistent. One of the proposed strategies for reducing waiting times in cancer care is the use of interdisciplinary teams. I undertook an audit of the interdisciplinary pulmonary oncology program at the Jewish General Hospital from 2004 to 2007. The primary objectives of this study were: (1) to audit the performance of the interdisciplinary pulmonary oncology service at the Jewish General Hospital with respect to waiting times for key intervals and subgroups of patients; (2) to compare waiting times in the clinical trajectory of lung cancer patients seen at the Jewish General Hospital with existing waiting time guidelines; (3) to determine those factors associated with longer waiting times in this population. A secondary objective was to suggest measures to be considered in order to reduce waiting times. The JGH’s lung cancer service was compared against benchmarks developed by the British Thoracic Society, Cancer Care Ontario, and the pan-Canadian waiting time benchmarks for radiation oncology. Patients waited a median of 9 days from the time they were ready to treat until their first treatment, and a median of 30 days from their first contact with the pulmonary service until their first treatment. Patients over age 65, those with early-stage disease and those with good performance status were less likely to meet the recommended guidelines.

No Brasil, o Sistema de Saúde é Universalista, com o tratamento integral gratuito ao paciente com câncer, cujo direito é assegurado por Lei e regulamentado pelo Ministério da Saúde / Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), por meio de Decreto Presidencial e Portarias. A habilitação e credenciamento de Hospitais em Unidades ou Centros de Alta Complexidade em Oncologia segue critérios rígidos, que determina como sendo obrigatória a presença do Cirurgião-Dentista na equipe multiprofissional e multidisciplinar na oncoterapia. O tratamento odontológico é compulsório e imprescindível na terapia antineoplásica, para prevenir e tratar as complicações orais: hemorragia, infecção, mucosite oral, xerostomia, cárie de radiação, trismo, alterações periodontais, osteonecrose avascular, osteorradionecrose; que podem levar à interrupção da oncoterapia, acarretando um aumento considerável nos custos da terapia implementada, a piora da qualidade de vida, e em alguns casos, podendo levar o paciente a óbito. O protocolo de cuidados orais na oncoterapia é normatizado e padronizado pelo INCA. Desta forma, foi realizado estudo do tratamento odontológico em pacientes com diagnóstico de câncer atendidos no Serviço de Odontologia Oncológica do UNACON do Hospital Geral de Palmas/Tocantins, no período de abril de 2011 a dezembro de 2016. Os dados foram obtidos de forma individualizada e estruturados segundo Variáveis Demográficas (VD), Procedimento Odontológico (PO), Procedimento Odontológico por Dente (POD) e Outras Variáveis de Interesse (OVI). O impacto financeiro de PO e POD foi avaliado pela comparação entre a tabela SIGTAP do Sistema Único de Saúde (SUS) e a tabela VRPO/SOESP (Valores Referenciais para Procedimentos Odontológicos/Sindicato dos Odontologistas do Estado de São Paulo). A maior incidência de pacientes foi observada na 5ª década de vida, com tendência à proporção homem/mulher de 1:1. Foram realizados 910 procedimentos preventivos/profilaxia/atividade educativa; 1826 raspagens supra e subgengival e aplicação tópica de flúor por hemiarcada; 932 restaurações de uma e duas faces com resina fotopolimerizável; 909 exodontias; 2746 sessões de laserterapia de baixa potência. O impacto financeiro mostrou uma defasagem significativa da Tabela SIGTAP/SUS. O estudo realizado revela a importância de uma base de dados estruturada para o registro do tratamento odontológico realizado em pacientes com diagnóstico de câncer atendidos no Sistema Único de Saúde; para que com isso seja possível fomentar, nos Sistemas de Saúde no Mundo, a elaboração e padronização de protocolo de cuidados orais na terapia antineoplásica, e o planejamento dos recursos humanos e financeiros destinados ao tratamento odontológico nos pacientes oncológicos. / In Brazil, the Health System is Universalist, with free comprehensive treatment for the cancer patient, whose right is guaranteed by Law and regulated by the Ministry of Health / National Cancer Institute José Alencar Gomes da Silva (INCA), through a Presidential Decree and Ordinances. The accreditation of Hospitals in Units or Centers of High Complexity in Oncology follows rigid criteria, which determines as mandatory the presence of the Dentist in the multiprofessional and multidisciplinary team in oncotherapy. Dental treatment is compulsory and essential in antineoplastic therapy to prevent and treat oral complications: hemorrhage, infection, oral mucositis, xerostomia, radiation caries, trismus, periodontal changes, avascular osteonecrosis, osteorradionecrosis; which can lead to interruption of oncotherapy, leading to a considerable increase in the costs of the therapy implemented, worsening of quality of life, and in some cases, leading to death. The protocol of oral care in oncotherapy is standardized by INCA. In this way, a study of the dental treatment was carried out in patients diagnosed with cancer attended at the UNACON Oncological Dentistry Service of the General Hospital of Palmas / Tocantins, from april 2011 to december 2016. Data were obtained individually and structured according to Demographics Variables (VD), Dental Procedure (PO), Dental Procedure by Tooth (POD) and Other Variables of Interest (OVI). The financial impact of PO and POD was evaluated by comparing the SIGTAP table of the Unified Health System (SUS) and the VRPO / SOESP table (Reference Values for Dental Procedures / Union of Dental Practitioners of the State of São Paulo). The highest incidence of patients was observed in the 5th decade of life, with a tendency to male to female ratios of 1: 1. Nine hundred and ten (910) preventive procedures / prophylaxis / educational activity were carried out; 1826 supra and subgingival scaling and topical application of fluoride by hemiarcate; 932 single and double sided restorations with photopolymerizable resin; 909 exodontia; 2746 sessions of low power laser therapy. The financial impact showed a significant lag in the SIGTAP / SUS Table. The study reveals the importance of a structured database for the registry of dental treatment performed in patients diagnosed with cancer treated in the Unified Health System; so that it is possible to promote, in the World Health Systems, the elaboration and standardization of oral care protocol in antineoplastic therapy, and the planning of human and financial resources for dental treatment in cancer patients.

Prostatacancer är den sjätte mest förekommande cancertypen i världen, och den tredje vanligaste cancertypen bland män. De olika typer av behandlingar som finns idag botar oftast inte sjukdomen. Det är därför viktigt att utveckla bättre behandlingsmetoder. Det är sedan tidigare känt att mangan kan orsaka apoptos i olika celltyper. Det ger en möjlighet att använda mangan för att hämma cancer och det är därför viktigt att veta vilka apoptotiska markörer som är involverade. Syftet med projektet var att undersöka om de sker en ökning av de apoptotiska markörerna kluven Kaspas-3 och kluven PARP efter manganbehandling av prostatacancerceller. Därefter kunna avgöra om manganbehandlingen har orsakat celldöd genom att inducera apoptos. Under projektet odlades prostatacancerceller (PC3) som sedan behandlades med 200 µM mangan under 6, 24 och 48 timmar. Därefter mättes mängden av proteinerna kluven Kaspas-3 och kluven PARP med hjälp av ett sandwich-ELISA kit. En tydlig stegvis ökning av apoptosmarkörerna med inkuberingstid hade förväntats. Det förväntade resultatet erhölls inte, för kluven Kaspase-3 ledde manganbehandlingen t.o.m. till en sänkning av koncentrationen. Det kan ha uppstått problem vid analysen som t.ex dålig lysering av cellerna eller ojämn tillväxt av dem. Det behövs fler studier för att utreda detta och för att undersöka andar potentiella apoptosmarkörer. / Prostate cancer is the sixth most common cancer type in the world, and the third most common cancer type among men. The different types of treatments that are available today do not usually cure the disease. It is therefore important to develop better treatment methods. It has previously been stated that manganese can cause apoptosis in different cell types. It provides an opportunity to use manganese to inhibit cancer and it is therefore important to know which apoptotic markers that are involved. The purpose of the project was to investigate whether an increase in the apoptotic markers cleaved Kaspas-3 and cleaved PARP after manganese treatment of prostate cancer cells. Thereafter, it can determine whether manganese treatment has caused cell death by inducing apoptosis. During the project prostate cancer cells (PC3-cells) were cultivated, then treated with 200 µM manganese for 6, 24 and 48 hours. The amount of the proteins cleaved Kaspas-3 and cleaved PARP was measured by using a sandwich ELISA kit. A clear gradual increase of apoptotic markers with incubation time was expected. The expected result was not obtained, for cleaved Kaspase-3 manganese treatment even decreased the concentrations. There may have been problems with the performance of the analysis such as poor lysis of the cells or uneven growth of the cells. More studies are required to investigate this and other potential apoptotic markers.

Made available in DSpace on 2016-04-28T20:40:05Z (GMT). No. of bitstreams: 1 Patricia Lima de Almeida.pdf: 592141 bytes, checksum: e0059767af759d3757df1759eeca4622 (MD5) Previous issue date: 2009-05-28 / Breast cancer renders a number of morbidity significant. Mastectomy is considerate the principal form of affectation of the image body. Whereas the disease achieved the image body and that the alterations into the scheme body affect the femininity, investigating - if how the snapshot body from woman was affected at cancer treatment of breast and the repercussions from the alterations of the scheme body in its femininity. By used the illustration by one wed clinical, The instruments of collection of information was, scales of Image body, depth interviews and the application by one draw - stoic. Result, the perception of the scheme body changed no implicating necessarily on a (des)configuration of the image body, provided that may be structure and coherent; and that the femininity can be maintain, when the design of woman transcends the question anatomical and confers the ability to used many the social`s class female. Femininity may be favored or retrieves via the utilization of resources creative, offer by culture. Wed studied apresented integration psychic because the capacity of elaboration from results of all the treatment of the cancer, beyond of aging, what current during the treatment. Both, disease and aging are periods what they confer (re)configuration of the image body. Finally, the treatment of cancer renders a font of pain and suffering for to affect the body (scheme and image body), the standpoint of woman & the femininity because all of the methods of treatment from disease (surgery, chemotherapy, radiotherapy and hormoniotherapy), with peculiarity. The meeting of data and information of study contributory about to the searches about cancer treatment, image body and femininity, and for to attending and treatment psychological of women what suffers alterations in its scheme body, independent of being cancer or breast cancer, but any disease what the alternation may be modification into the scheme body or that crossed the femininity from woman / O câncer de mama representa um número de morbidade significativo. A mastectomia é considerada a principal forma de afetação da imagem corporal. Considerando que a doença afeta a imagem corporal para além da perda derivada da cirurgia, e que as alterações no esquema corporal afetam a feminilidade, investigou-se como a imagem corporal da mulher foi afetada pelo tratamento de câncer de mama e as repercussões das alterações do esquema corporal na sua feminilidade. A partir da ilustração de um caso clínico, utilizando-se como instrumentos de coleta de dados, escalas de Imagem corporal, entrevistas em profundidade e a aplicação de um Desenho-estória, obteve-se como resultado que a percepção do esquema corporal alterado não implica necessariamente numa desconfiguração da imagem corporal, desde que esta seja estruturada e coerente; e que a feminilidade pode manter-se quando a concepção de mulher transcende a questão anatômica e ainda, confere a capacidade de redimensionar os papeis sociais do gênero feminino. Notou-se que a feminilidade pode ser favorecida e/ou resgatada, através da utilização de recursos criativos, ofertados pela cultura. Verificou-se ainda, a integração psíquica do caso estudado, em função da capacidade de elaboração das seqüelas e conseqüências de toda a propedêutica do câncer, além do processo de envelhecimento, que decorrida durante o tratamento. Ambos, doença e envelhecimento, são períodos que conferem reconfigurações da imagem corporal. Concluiu-se que o tratamento de câncer representa uma fonte de dor e sofrimento por afetar, dentre outros, o corpo (esquema e imagem corporal), a posição de mulher e a feminilidade, a partir de todos os métodos de tratamento da doença (cirurgia, quimioterapia, radioterapia e hormonioterapia), com peculiaridades. A reunião de dados e informações possibilitados pelo estudo contribui para as pesquisas sobre tratamento de câncer, imagem corporal e feminilidade e ainda, no processo de atendimento e tratamento psicológico de mulheres que sofrem alterações no seu esquema corporal, independente de ser câncer ou câncer de mama, mas qualquer doença em que a alternativa seja uma mudança no esquema corporal e que atravesse a feminilidade da mulher

L'intérêt croissant susciter par les applications biomédicales des plasmas non thermiques, inspire le développement de nouvelles sources plasmas. Les décharges à barrière diélectrique (DBD) ou les décharges couronne générées dans l'air ambiant ou dans le flux de gaz rare sont généralement utilisées. Production des plasmas directement dans un liquide a un grand potentiel pour les processus de stérilisation des substances liquides et pour le traitement extracorporel du sang. Les mécanismes physiques de formation d’une décharge électrique dans un milieu liquide ne sont toujours pas entièrement compris .La première partie de cette thèse examine le sujet de l'initiation et le développement de décharge nanoseconde dans les diélectriques liquides (eau déminéralisée, éthanol et n-pentane). La visualisation ombroscopique résolue en temps, la spectroscopie optique d'émission et les mesures électrique sont appliqués à l’étude d’une décharge électrique initiée sur une électrode à pointe positive.Nous avons montré que, selon l'amplitude de tension trois scénarios différents peuvent se produire dans des diélectriques polaires, notamment, la cavitation d'une bulle, le développement de décharge dans une cavité gazeuse (le mode ‘buisson’) et l'initiation de la décharge filamentaire (le mode ‘arborescent’) se propageant directement dans le liquide. La différence dans la formation et la propagation de deux modes de la décharge (‘buisson’ et ‘arbre’) révèle les mécanismes physiques étant très distincts.Dans la deuxième partie de ce travail, nous abordons la question d’interaction entre les plasmas froids atmosphériques avec les cellules vivantes in vitro et in vivo. L’étude porte sur le mécanisme de la mort cellulaire induite par le plasma. Cytométrie de flux avec deux marqueurs AnnexinV (AV) et de l'iodure de propidium (PI) a été appliquée pour l’analyse de la viabilité cellulaire. On montre l’induction de l' apoptose dans les cellules de T lymphocyte humain (Jurkat) et dans les cellules épithéliales (HMEC) traités par le plasma de DBD nanoseconde. Dans les souris nudes l'induction de l'apoptose et de la nécrose en fonction de la dose est observé par la microscopie électronique dans les coupes de l'épiderme. L'analyse histologique montre l’apparition des lésions importantes dans l'épiderme , derme, hypoderme et les muscles en fonction de la durée du traitement. Production de peroxyde d'hydrogène dans le milieu de culture (PBS) exposé au plasma de DBD est mesurée à l’aide d’une sonde fluorescente sélective (Amplex® Red). La viabilité des cellules de la thyroïde humaines ( HTori -3) et des cellules de mélanome (1205Lu) cellules démontre la dépendance nonmonotone de la concentration de H2O2. Le rôle majeur du peroxyde d'hydrogène produit par plasma et du champ électrique de la DBD est suggéré. / Growing interest in biomedical applications of nonthermal plasmas inspires the development of new plasmas sources. Dielectric barrier (DBD) and corona discharges produced in ambient air or in noble gas flow are typically applied. Direct production of plasma in liquids has a great potential for sterilization of liquid substances and extracorporeal blood treatment. The physical mechanisms of discharge formation in liquid medium are not fully understood.The first part of this thesis deals with the initiation and development of the nanosecond discharge in liquid dielectrics (deionized water, ethanol and n-pentane). Time-resolved shadowgraph visualization, optical emission spectroscopy and electrical diagnostics are applied to investigate the discharge formation on point anode.We have shown that depending on the applied voltage amplitude three different scenario can occur in the polar dielectric, namely, cavitation of a bubble, discharge development in the gaseous cavity (bush-like mode) and initiation of the filamentary discharge (tree-like mode) propagating in bulk liquid. Formation of the bush-like and the tree-like discharges is governed by distinct physical mechanisms, resulting in strongly different plasma parameters.In the second part of this work we address the question of how cold atmospheric plasma interacts with living cells in-vitro and in-vivo, and what is the mechanism of plasma induced cell death. Flowcytometry based cell viability assay with two markers AnnexinV (AV) and Propidium iodide (PI), demonstrates a dose dependent induction of the apoptosis for human T lymphocyte (Jurkat) and epithelial (HMEC) cells treated with DBD plasma. In nude mice model, induction of apoptosis and necrosis in dose dependant manner is observed by electron microscopy in thin epidermis sections. Histological analysis shows significant lesions appeared in epidermis, dermis, hypodermis and muscle as a function of treatment duration. Production of hydrogen peroxide in culture medium (PBS) exposed to DBD plasma is measured using selective fluorescent probe (Amplex® Red). Cell viability of human thyroid epithelial (HTori-3) and melanoma (1205Lu) cells demonstrates nonmonotonous dependence on H2O2 concentration. The major role of plasma produced hydrogen peroxide and DBD electric field is suggested.

Yu, Wai Lam. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 79-88). / Abstracts in English and Chinese. / Acknowledgements --- p.IV / Abstract --- p.V / 論文摘要 --- p.VII / Table of Contents --- p.IX / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Cancer --- p.1 / Chapter 1.2 --- Hepatocellular Carcinoma (HCC) --- p.2 / Chapter 1.2.1 --- Risk factors causing HCC --- p.3 / Chapter 1.2.2 --- Molecular mechanism of HCC --- p.7 / Chapter 1.2.3 --- Treatment of HCC --- p.8 / Chapter 1.3 --- Tetrandrine (Tet) - A Natural Compound Derived from Traditional Chinese Medicine (TCM) --- p.10 / Chapter 1.3.1 --- Traditional Chinese Medicine (TCM) --- p.10 / Chapter 1.3.2 --- Tetrandrine (Tet) --- p.12 / Chapter 1.4 --- Molecular View of Apoptosis --- p.14 / Chapter 1.4.1 --- Overview of apoptosis --- p.14 / Chapter 1.4.2 --- Caspase cascade --- p.15 / Chapter 1.4.3 --- Bcl-2 protein family --- p.18 / Chapter 1.4.4 --- The role of mitochondria in apoptosis --- p.20 / Chapter 1.5 --- Anti-cancer Agents Inducing Apoptosis Are New Targets --- p.22 / Chapter 1.6 --- Aim of Study --- p.26 / Chapter Chapter 2 --- Materials and Methods --- p.27 / Chapter 2.1 --- Cell Culture And Treatment --- p.27 / Chapter 2.1.1 --- Cell lines used --- p.27 / Chapter 2.1.2 --- Tetrandrine (Tet) --- p.28 / Chapter 2.1.3 --- Chemicals and reagents 2 --- p.83 / Chapter 2.1.4 --- Solution preparation --- p.29 / Chapter 2.1.5 --- Procedures --- p.30 / Chapter 2.2 --- Cell viability --- p.32 / Chapter 2.2.1 --- Chemicals and reagents . --- p.32 / Chapter 2.2.2 --- Solution preparation --- p.32 / Chapter 2.2.3 --- Procedures --- p.32 / Chapter 2.3 --- Apoptosis detection --- p.34 / Chapter 2.3.1 --- Chemicals and reagents --- p.34 / Chapter 2.3.2 --- Solution preparation --- p.35 / Chapter 2.3.3 --- Procedures --- p.36 / Chapter 2.4 --- Gene expression in tet-induced apoptotic cells --- p.39 / Chapter 2.4.1 --- Chemicals and reagents --- p.39 / Chapter 2.4.2 --- Solution preparation --- p.40 / Chapter 2.4.3 --- Procedures --- p.40 / Chapter 2.5 --- Protein expression in tet-induced apoptotic cells --- p.44 / Chapter 2.5.1 --- Chemicals and reagents --- p.44 / Chapter 2.5.2 --- Solution preparation --- p.45 / Chapter 2.5.3 --- Procedures --- p.48 / Chapter 2.6 --- Cell cycle analysis of tet-treated cells --- p.54 / Chapter 2.5.1 --- Chemicals and reagents --- p.54 / Chapter 2.5.2 --- Solution preparation --- p.54 / Chapter 2.5.3 --- Procedures --- p.54 / Chapter Chapter 3 --- Result --- p.56 / Chapter Chapter 4 --- Discussion --- p.70 / Chapter 4.1 --- Dose- and Time- Dependent Inhibitory Effects of Tet were found on HuH-7 And JHH-4 Cell Lines --- p.70 / Chapter 4.2 --- Tet Is More Selective Towards Liver Cancer Cells --- p.71 / Chapter 4.3 --- The Cell Death in HuH-7 Cells Induced by Tet is Mediated Through Apoptosis --- p.72 / Chapter 4.4 --- Hepatocellular Carcinoma (HCC)Tet Induces G1 Phase Cell Cycle Arrest as Part of Its Mechanism in Inducing Apoptosis in HuH-7 Cells --- p.73 / Chapter 4.5 --- Tet Could Probably Induce G1 Phase Cell Cycle Arrest in JHH-4 Cells --- p.75 / Chapter 4.6 --- "Tet-induced Apoptosis Involves the Intrinsic, Caspase-Dependent Pathway in Both the HuH-7 and JHH-4 Cell Lines" --- p.75 / Chapter 4.7 --- Proteins in Bcl-2 Family are Involved in the Inhibitory Mechanism of Tet --- p.77 / Reference --- p.79

Eighty-two patients with breast cancer, twenty-seven patients with nasopharyngeal carcinoma and sixty-five patients with rheumatoid arthritis in this study were selected based on voluntary, randomization and double blind grouping criteria. / In nasopharyngeal carcinoma patients, the decrease in percentage and the absolute count of T lymphocytes in the TCM group was significantly lower than those in the placebo group. Besides, the decrease of the absolute count of T helper and T suppressor in the TCM group was significantly lower than that in the placebo group (all p < 0.05). The decrease may be due to radiotherapy. However, there was no significant difference in plasma sIL-2R and soluble tumor necrosis factor receptor 2 (sTNFR2) between the TCM group and the placebo group. / In rheumatoid arthritis patients, there was no significant difference in plasma. C-reactive protein (CRP), in the percentage, absolute count, and the ratio of CD4+/CD8+/NK/B lymphocytes between the TCM group and the placebo group. / Results showed that the absolute count of T helper lymphocytes (CD4+), the ratio of T helper lymphocytes (CD4+)/T suppressor and cytotoxic lymphocytes (CD8+), and the percentage and the absolute count of B lymphocytes were significantly elevated in the patients with breast cancer after taking Yunzhi-Danshen capsules, while plasma soluble interleukin-2 receptor (sIL-2R) concentration was significantly decreased (all p < 0.05). / This study shows that the selected traditional Chinese medicine have determinable immunomodulatory effects in patients with cancer and rheumatoid arthritis. (Abstract shortened by UMI.) / Traditional Chinese medicine (TCM) has been used to treat chronic diseases and tumor allegedly by immunomodulatory mechanisms. Breast cancer and nasopharyngeal cancer are prevalent carcinoma diseases in Hong Kong. The immune system of such patients could be adversely affected during the course of conventional chemotherapy or radiotherapy. Rheumatoid arthritis is an inflammatory autoimmune disease of the joints. The aim of this study was to assess the immunomodulatory effects of TCM Yunzhi-Danshen in auxiliary treatment of both kinds of cancer patients, and Lingzhi (Ganoderma Lucidum)-San Miao San ( Atractylodes lancea, Phellodendron amurense and Achyranthes bidentata B1) in supplementation treatment of patients with rheumatoid arthritis. / by Bao Yixi. / "July 2005." / Adviser: Wai-Kei Lam. / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0166. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 150-167). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.