Includes bibliographical references (leaves 142-168) / x, 168 leaves : ill. (chiefly col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Aim was the purification and identification of the early primitive ectoderm-like (EPL) cell induction signals within the medium conditioned by the human hepatocellular carcinoma cell line HepG2 and the localisation of the signals that induce EPL cell and primitive ectoderm formation. / Thesis (Ph.D.)--University of Adelaide, Dept. of Molecular Biosciences (Biochemistry), 2001

This research focuses towards the development of a clinical decision support system (CDSS) based on cellular and tissue image analysis and classification system that improves consistency and facilitates the clinical decision making process. In a typical cancer examination, pathologists make diagnosis by manually reading morphological features in patient biopsy images, in which cancer biomarkers are highlighted by using different staining techniques. This process is subjected to pathologist's training and experience, especially when the same cancer has several subtypes (i.e. benign tumor subtype vs. malignant subtype) and the same cancer tissue biopsy contains heterogeneous morphologies in different locations. The variability in pathologist's manual reading may result in varying cancer diagnosis and treatment. This Ph.D. research aims to reduce the subjectivity and variation existing in traditional histo-pathological reading of patient tissue biopsy slides through Computer-Aided Diagnosis (CAD). Using the CAD, quantitative molecular profiling of cancer biomarkers of stained biopsy images are obtained by extracting and analyzing texture and cellular structure features. In addition, cancer sub-type classification and a semi-automatic grade scoring (i.e. clinical decision making) for improved consistency over a large number of cancer subtype images can be performed. The CAD tools do have their own limitations and in certain cases the clinicians, however, prefer systems which are flexible and take into account their individuality when necessary by providing some control rather than fully automated system. Therefore, to be able to introduce CDSS in health care, we need to understand users' perspectives and preferences on the new information technology. This forms as the basis for this research where we target to present the quantitative information acquired through the image analysis, annotate the images and provide suitable visualization which can facilitate the process of decision making in a clinical setting.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Pathology / Doctoral / Doctor of Philosophy

There are a number of existing staging systems for patients with hepatocellular carcinoma (HCC). Yet, Barcelona Clinic Liver Cancer (BCLC) staging classification is the only one which suggests treatment guidance. Although BCLC staging is widely used in Western countries, it may not fit in the management of HCC patients in Hong Kong as they mostly have different etiologies and have more aggressive treatment strategy when compared with their counterparts in Western countries. It is aimed in this thesis to develop a new prognostic staging system in conjunction with treatment guidelines for HCC patients in Hong Kong. Three thousand eight hundred and fifty six adult HCC patients presented to the Department of Surgery, Queen Mary Hospital between January 1995 and December 2008 were included. The patient data were randomly separated into a training set and a test set for scheme development and performance assessment respectively. Four established prognostic factors which have determinative roles in treatment, namely Eastern Cooperative Oncology Group performance status, Child-Pugh grade, tumor status, and presence of extrahepatic vascular invasion/metastasis, were selected in building the scheme. Cox proportional hazards regression on overall survival was used to derive a relative coefficient for each category of these four factors. Clinical knowledge in addition to the relative coefficients was involved in the proposal of the prognostic stages. Then a classification and regression tree analysis was performed to elicit a set of simple clinical decision rules given the factors. This tree-structured classifier was adjusted with clinical judgment and reconciled with the proposed prognostic staging system for treatment guidelines. This Hong Kong Combined Liver Cancer (HKCLC) prognostic classification scheme stratifies patients to stages I to V with distinct overall survival outcomes. Its performance was compared to BCLC scheme for their discriminatory ability as staging systems and effectiveness of treatment guidelines. The former used receiver operating characteristics (ROC) analysis and concordance index as measures of the ability to distinguish patients with different prognosis for overall survival. HKCLC staging had significantly larger 1-year, 3-year and 5-year area under ROC curve values and higher concordance index vis-a-vis BCLC staging. The latter compared the overall survival of patients who received different treatments. The overall survival of patients with the same BCLC stage and the same HKCLC stage but received HKCLC recommended treatments were compared with those received BCLC recommended treatments by Kaplan-Meier plots and log-rank test. HKCLC treatment guidelines had wider indications for more aggressive treatments than the BCLC treatment schedule, and demonstrated significant survival benefit in our patients. / published_or_final_version / Surgery / Master / Master of Philosophy

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