INTRODUÇÃO: Estudos observacionais e pré-clinicos sugerem o efeito antitumoral da metformina em tumores sólidos, incluindo o câncer colorretal. Entretanto, os efeitos da metformina no câncer colorretal ainda não foram testados em estudos prospectivos. PACIENTES E MÉTODOS: Este foi um estudo de fase II, unicêntrico, braço único de pacientes com câncer colorretal metastático em progressão e previamente tratados com 5-FU, irinotecano, oxaliplatina e anti-EGFR, se RAS selvagem. Os pacientes receberam metformina 850 mg VO duas vezes por dia e 5-FU 425 mg/m2 e leucovorin 50 mg IV semanal até progressão de doença, toxicidade inaceitável ou retirada de consentimento. O desfecho primário foi controle de doença em 8 semanas. RESULTADOS: Dos 50 pacientes incluídos, 11 (22%) alcançaram o desfecho primário. Para toda coorte, a SLP foi de 1,8 meses e a SG mediana de 7,9 meses. Quando avaliamos somente os 11 pacientes que alcançaram controle de doença na semana 8, a SLP foi de 5,6 meses e a SG foi de 16,2 meses. Houve tendência a maior sobrevida entre os obesos (12,4 vs 5,8 meses de acordo com IMC maior ou menor que 30) e aqueles que tiveram maior intervalo livre de 5FU antes de entrar no estudo. O tratamento foi bem tolerado e os principais efeitos colaterais de qualquer grau foram diarreia, náusea, vômito e mielotoxicidade. CONCLUSÃO: Neste estudo de fase II, a metformina combinada ao 5FU apresentou atividade modesta na população geral de pacientes com câncer colorretal metastático refratário. Em análise de subgrupo, obesos e maior intervalo livre de 5FU foram associados a controle de doença prolongado. Estudos prospectivos randomizados com metformina em câncer colorretal devem ser realizados / BACKGROUND: Observational and pre-clinical studies have suggested that metformin has antitumor effects in solid tumors, including colorectal cancer. However the effects of metformin in colorectal cancer have not been tested in clinical trials. PATIENTS AND METHODS: This was a single center, single-arm phase II clinical trial where histologically confirmed colorectal cancer patients with measurable and progressing metastatic disease previously treated with 5-FU, irinotecan, oxaliplatin and an anti-EGFR, if the tumor was RAS wild type, were enrolled to receive metformin 850 mg orally bid continuously plus 5-FU 425 mg/m2 and leucovorin 50 mg IV weekly until disease progression, unacceptable toxicity or consent withdrawn. The primary endpoint was disease control rate at 8 weeks. RESULTS: Among 50 patients included, 11 (22%) met the primary endpoint. The median progression free survival was 1.8 months and the median overall survival was 7.9 months. Analyzing only those 11 patients who achieved disease control rate at 8 weeks, their median progression-free survival was 5.6 months and their median overall survival was 16.2 months. There was a trend for prolonged median survival for obese patients (12.4 vs 5.8 months) and those longer off 5FU. The treatment was well tolerated and the main side effects were diarrhea, nausea, vomiting and myelotoxicity. CONCLUSION: Metformin and 5FU showed an overall modest but intriguing activity in refractory colorectal cancer patients in this phase II study. Some patients presented long-term disease control. Further trials are needed to confirm these results, particularly in obese patients with colorectal cancer

During the several years in which this therapy has been developed and evaluated, as standard dermatological preparation has not been available. The objective of the present work was to study the release of 5-FU from various ointment bases and to attempt to determine the type of base which would release the compound most satisfactorily. The methods chosen were designed to determine the release and penetration of 5-FU both by in vitro and in vivo methods. A modified agar plate method was chosen as the in vitro test for measuring release and subsequent diffusion into the agar. The penetration of the compound from various bases was determined by applying the medicated bases to the skin of guinea pigs and subsequently analyzing a biopsy of the inuncted skin, using quantitative spectrophotometry.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19597号 / 医博第4104号 / 新制||医||1014(附属図書館) / 32633 / 京都大学大学院医学研究科医学専攻 / (主査)教授 松田 道行, 教授 野田 亮, 教授 山田 泰広 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Colorectal cancer is the third most common cancer in the United States and there is currently a lot of research going into new antitumor agents to kill the cancer. One method for replicating the tumor response to a drug in vivo is by creating an in vitro drug testing model to replicate the in vivo condition. This research project was conducted to determine the efficacy of testing tumor cultures in a microfluidic device as a way to provide accurate drug responses in vitro instead of using in vivo subjects in clinical trials. A total of four experiments were conducted with each experiment increasing the complexity of the culture model. The first experiment was a 2-dimensional tumor culture that was seeded in a well plate to study how 5-fluorouracil treatments affected the tumor cell viability. The second experiment was a 2-dimensional tumor culture that was seeded on top of a fibrin extracellular matrix (ECM) gel to determine how the tumor cells would respond to the 5-luorouracil treatments while growing on the fibrin. The third experiment was to create a 3-dimensional tumor culture that was seeded inside the fibrin ECM gel. This experiment was conducted to determine if tumor cells cultured within the fibrin gel could receive nutrients from the medium diffusing through the gel. Once the tumors responded as expected in the fibrin gel, the gel could be injected into a microfluidic device for the fourth experiment. The fourth experiment was a proof of concept to determine if the tumor cells could survive in the microfluidic device and be properly treated with 5-fluorouracil. The experiment with the cells seeded in the well plates showed that an increase in 5-fluorouracil concentration caused a significant decrease in cell viability. Both fibrin gel experiments showed that the average tumor size, total tumor area, and tumor count decreased as the 5-fluorouracil concentration increased. The tumor cells were successfully able to be cultured in the microfluidic device and the average tumor size decreased significantly when the culture was exposed to the 5-fluorouracil treatment.

Despite therapeutic advances, colorectal cancer still has a 45% mortality rate, and one of the most crucial problems is the development of acquired resistance to treatment with anticancer drugs. Thus the aims of this project are to develop drug-resistant colon cancer cell lines in order to identify mechanisms of resistance for the most commonly drugs used in colorectal cancer: 5-fluorouracil, oxaliplatin, and irinotecan. Following evaluation of drug sensitivity to these agents in an initial panel of eight colorectal cancer cell lines, 3 lines (DLD-1, KM-12 and HT-29) were selected for the development of 5-FU (3 lines), oxaliplatin (2) and irinotecan (1) resistant sublines by continuous drug exposure, with resistance confirmed using the MTT assay. Consistently resistant sublines were subject to a „stable isotope labelling with amino acids in cell culture‟ (SILAC) approach and a MudPIT proteomics strategy, employing 2D LC and Orbitrap Fusion mass spectrometric analysis, to identify novel predictive biomarkers for resistance. An average of 3622 proteins was quantified for each resistant and parent cell line pair, with on average 60-70 proteins up-regulated and 60-70 down-regulated in the drug resistant sublines. The validity of this approach was further confirmed using immunodetection techniques. These studies have provided candidate proteins which can be assessed for their value as predictive biomarkers, or as therapeutic targets for the modulation of acquired drug resistance in colorectal cancer.

No description available.

Chemotherapy related neurotoxicity is the decrease in cognitive function observed in patients receiving chemotherapy for breast cancer. For cancers with higher survival rates such as breast cancer, quality of life for patients after treatment cessation is a major concern. In studies performed in our laboratory, we reported cognitive deficiencies in male Swiss-Webster mice on administering 75 mg/kg 5-FU with 3.2 mg/kg MTX and these deficits were significantly greater than groups receiving either drug alone or in another higher dose combination. The probable mechanisms for the reported drug-drug interaction (DDI) between 5-FU and MTX could be either pharmacokinetic (PK) or pharmacological. Since the reported study consists of a combination of two drugs, it is imperative to determine if the PK of either drug was altered. On performing the PK based study we established the nature of the DDI to be PK based. We observed statistically significant changes for PK parameters clearance and apparent volume of distribution. Since, 5-FU and MTX are high clearance drugs, uptake transporters responsible for presenting the drugs to the clearing organs are the limiting factors for their clearance. Therefore, for any PK based interactions observed between 5-FU and MTX in the different dose groups a highly probable mechanism would be interactions at the site of uptake transporters. Based on the physicochemical properties of 5-FU and MTX and the results observed form the PK study, we hypothesized transporter-based interactions to be a probable mechanism for the observed DDI. From the transporter based studies we hypothesized 5-FU probably inhibited the uptake of MTX's transport across the blood brain barrier (BBB). To date the transport of MTX and other similar folates has not been characterized extensively. However, MTX is a very close analogue for reduced folates and therefore shares the transporter reduced folate carrier-1 (Rfc-1) expressed abundantly at the BBB, with endogenous reduced folates. Hence we hypothesized the decreased exposure of MTX in the presence of 5-FU would most probably be as a result of inhibition of uptake transporters such as Rfc-1. Finally, we developed a mathematical PK model for MTX to predict appropriately drug concentrations in the plasma and the brain tissue. The utility of the model was to support the hypothesized interactions responsible for the observed PK data. This models utility is to provide the PK component for the future PK-pharmacodynamic models, which would narrow the gap between the reported cognitive deficits and the PK results reported in this dissertation. / Pharmaceutical Sciences

Introdução: O carcinoma de células escamosas (CEC) do canal anal é uma neoplasia pouco frequente, correspondendo a 1-5% dos tumores intestinais. Entretanto, o risco de CEC do canal anal vem crescendo. O tratamento padrão do CEC de canal anal nos estádios II-III consiste em 5-fluorouracil infusional associado a mitomicina-C e radioterapia, desde 1974. Estudos clínicos com o objetivo de identificar novos esquemas terapêuticos mais convenientes para câncer do canal anal devem continuar. Métodos: Pacientes com CEC de canal anal T2-4N0M0 ou T (qualquer) N1-3M0, com bom performance clínico, função renal e hematológica normais foram tratados com capecitabina 825 mg/m2 12/12 horas durante a radioterapia associada a dose única de mitomicina-C 15 mg/m2 no Dia 1. O objetivo primário do estudo foi determinar a taxa de controle local em 6 meses da associação de capecitabina, mitomicina-C e radioterapia em pacientes com câncer do canal anal. Os objetivos secundários foram determinar a taxa de toxicidade aguda graus 3-4, conforme os critérios da CTCaev4.0, taxa de resposta completa 6 semanas após término da quimio-radioterapia, sobrevida global e livre de progressão e taxa de colostomia em 1 ano. O tamanho da amostra foi calculado usando a ferramenta \"estágio único de Fleming\". Considerando 85% de eventos esperados (taxa de controle local em 6 meses), 1 desvio padrão e 5% de erro alfa, o tamanho ideal da amostra foi de 51 pacientes. Resultados: De novembro/2010 a fevereiro/2014, 51 pacientes foram incluídos, sendo avaliados 43 pacientes. Dezessete pacientes (39,5%) tinham estádio II, 11 (25,6%) estádio IIIA e 15 (34,9%) estádio IIIB. O seguimento mediano foi de 23,1 meses. Entre os pacientes que foram avaliados em 6 meses, 3 (7%) apresentaram resposta clínica parcial, 37 (86%) tiveram resposta clínica completa e 3 (7%) apresentaram progressão de doença. O controle loco-regional em 6 meses foi de 86%. Em relação às toxicidades graus 3-4, observaram-se diarreia grau 3, em 4,6% dos pacientes, radiodermite grau 3, em 23,2%, vômitos grau 3, em 2,3%, plaquetopenia graus 3-4, em 6,9%, leucopenia grau 3, em 6,9%, e linfopenia grau 3, em 11,6%. Um paciente HIV positivo (2,3%) apresentou choque séptico grau 4, pneumonia grau 4, meningoencefalite herpética grau 4 e síndrome de ativação macrofágica grau 4. A taxa de colostomia foi de 18,6%. Conclusão: Capecitabina e mitomicina-C são um tratamento bem tolerado em pacientes com carcinoma de canal anal, com controle loco-regional em 6 meses em 86% dos pacientes. Palavras-chave: carcinoma de células escamosas, câncer anal, capecitabina, radioterapia, mitomicina-c / Background: Squamous cell carcinoma (SCC) of the anal canal is an uncommon malignancy accounting for 1-5% of intestinal tumors; however, its incidence has been increasing. Treatment for stage II and III anal canal SCC is infusional 5-fluorouracil associated with mitomycin and radiotherapy, since 1974. More convenient treatments for patients are needed. Methods: Patients with SCC of anal cancer T2-4N0M0 or T (any) N1-3M0, with good performance status, normal blood, and renal function were treated with capecitabine 825 mg/m2 bid during radiotherapy associated with a single dose of mitomycin 15 mg/m2 on day 1. Primary objective was local control rate at 6 months determined by clinical examination and radiological assessment. Sample size was calculated using Fleming single stage design. Results: From november/2010 to february/2014 51 patients were initially included, however 43 patients were assessed. Seventeen patients (39.5%) were stage II, 11 patients (25.6%) stage IIIA, and 15 patients (34.9%) stage IIIB. Four patients (9.3%) were HIV-positive, while 39 (90.7%) were HIV-negative. Median follow-up was 23.1 months. Among patients who finished the treatment and were reevaluated at 6 months 3 patients (7%) presented partial response, 37 patients (86%) had complete response, and 3 patients developed progression of the disease (7%). Regarding grade 3-4 toxicities, 10 patients (23.2%) had grade 3 radiodermitis, 3 patients (6.9%) had grade 3-4 thrombocytopenia, 5 (11.6%) had grade 3 lymphopenia, 1 patient (2.3%) had grade 3 vomiting, 2 patients (4.6%) had grade 3 diarrhea and 3 patients (6.9%) had grade 3 leukopenia. One HIV+ patient had septic shock, pneumonia, herpetic encephalitis and macrophage activation syndrome. Colostomy rate was 18.6%. Conclusions: Capecitabine and mitomycin with radiotherapy seem to be a safe treatment for SCC of the anal cancer, with a complete response rate in 6 months of 86%

Wong, Wai Ki Vicky. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 105-131). / Abstracts in English and Chinese. / Abstract --- p.ii / 摘要 --- p.iv / Acknowledgements --- p.vi / Table of contents --- p.vii / List of tables --- p.xii / List of figures --- p.xiii / List of abbreviations --- p.xiv / Chapter Chapter 1: --- Introduction --- p.1 / Chapter Chapter 2: --- Colorectal cancer / Chapter 2.1 --- Literature Review / Chapter 2.1.1 --- Colorectal cancer --- p.8 / Chapter 2.1.2 --- Incident rate of colorectal cancer --- p.8 / Chapter 2.1.3 --- Hereditary colorectal cancer --- p.9 / Chapter 2.1.4 --- Sporadic colorectal cancer and Wnt signaling pathway --- p.10 / Chapter 2.1.5 --- Chemotherapy treatment of colorectal cancer --- p.11 / Chapter 2.1.5.1 --- 5-Fluorouracil --- p.12 / Chapter 2.1.5.2 --- Oxaliplatin --- p.14 / Chapter 2.1.5.3 --- Irinotecan --- p.14 / Chapter 2.1.6 --- Biomarkers for colorectal cancer --- p.15 / Chapter 2.1.6.1 --- Thymidylate synthase --- p.15 / Chapter 2.1.6.2 --- Dihydropyrimidine dehydrogenase --- p.16 / Chapter 2.1.6.3 --- Thymidine phosphorylase --- p.16 / Chapter 2.1.6.4 --- Microsatellite-instability status --- p.16 / Chapter 2.1.6.5 --- Clinical uses of biomarkers for colorectal cancer --- p.17 / Chapter 2.1.7 --- Choice of cell line as colorectal cancer model --- p.17 / Chapter 2.1.8 --- Aims of study --- p.17 / Chapter 2.2 --- Materials and Methods / Chapter 2.2.1 --- Verification of SW480 as a nuclear β-catenin positive cell line / Chapter 2.2.1.1 --- Maintenance of cell lines --- p.21 / Chapter 2.2.1.2 --- Antibody --- p.21 / Chapter 2.2.1.3 --- Agar block preparation for SW480 and CCD-18C0 cells --- p.22 / Chapter 2.2.1.4 --- Immunocytochemical staining --- p.22 / Chapter 2.2.2 --- Effect of anti-cancer drugs on cell viability / Chapter 2.2.2.1 --- Maintenance of cell lines --- p.22 / Chapter 2.2.2.2 --- MTT cell viability assay --- p.23 / Chapter 2.3 --- Results / Chapter 2.3.1 --- SW480 is a β-catenin positive cell line --- p.24 / Chapter 2.3.2 --- Antiproliferative effects of cytotoxic drugs in SW480 cells / Chapter 2.3.2.1 --- 5-Fluorouracil --- p.26 / Chapter 2.3.2.2 --- Oxaliplatin --- p.29 / Chapter 2.3.2.3 --- Irinotecan --- p.31 / Chapter 2.4 --- Discussion / Chapter 2.4.1 --- SW480 as a nuclear β-catenin positive cell line --- p.33 / Chapter 2.4.2 --- Antiproliferative effects of 5-fluorouracil in SW480 cells --- p.33 / Chapter 2.4.3 --- Summary --- p.34 / Chapter Chapter 3: --- Effect of 5-fluorouracil on mRNA expression in SW480 cells / Chapter 3.1 --- Literature Review / Chapter 3.1.1 --- Application of quantitative real-time polymerase chain reaction in cancer research / Chapter 3.1.1.1 --- Principles of quantitative real-time polymerase chain reaction --- p.36 / Chapter 3.1.1.2 --- Advantages of quantitative real-time polymerase chain reaction over conventional polymerase chain reaction --- p.39 / Chapter 3.1.1.3 --- Determination of colorectal cancer biomarkers by quantitative real-time polymerase chain reaction --- p.39 / Chapter 3.2 --- Materials and Methods / Chapter 3.2.1 --- Determination of the effect of 5-fluorouracil on mRNA expression in SW480 cells / Chapter 3.2.1.1 --- Treatment of cells --- p.40 / Chapter 3.2.1.2 --- Extraction of total RNA from SW480 cells --- p.40 / Chapter 3.2.1.3 --- Removal of genomic DNA --- p.41 / Chapter 3.2.1.4 --- Determination of the efficiency of genomic DNA removal --- p.42 / Chapter 3.2.1.5 --- Determination of the purity and concentration of RNA --- p.42 / Chapter 3.2.1.6 --- Determination of the integrity of RNA --- p.43 / Chapter 3.2.1.7 --- First strand cDNA synthesis --- p.44 / Chapter 3.2.1.8 --- Real-time polymerase chain reaction using human Wnt signaling pathway RT2 ProfileŕёØ PCR array --- p.44 / Chapter 3.2.1.9 --- Calculation of the fold-change in genes expression between the 5-FU treated and control SW480 cells --- p.45 / Chapter 3.3 --- Results / Chapter 3.3.1 --- The quality and quantity of RNA --- p.46 / Chapter 3.3.2 --- Effects of 5-fluorouracil on genes expression in SW480 cells --- p.48 / Chapter 3.4 --- Discussion / Chapter 3.4.1 --- Alterations in mRNA expression in 5-fluorouracil treated SW480 cells --- p.55 / Chapter 3.4.1.1 --- Extracellular signaling molecules --- p.55 / Chapter 3.4.1.2 --- Canonical Wnt signaling pathway --- p.56 / Chapter 3.4.1.3 --- Regulators of cell cycle --- p.57 / Chapter 3.4.1.4 --- Regulators of growth and proliferation --- p.58 / Chapter 3.4.1.5 --- Regulators of transcription --- p.58 / Chapter 3.4.1.6 --- Regulators of Wnt receptor signaling pathway --- p.60 / Chapter 3.4.1.7 --- Other genes involved in Wnt signaling --- p.61 / Chapter 3.4.2 --- Limitations of Q-RT-PCR --- p.61 / Chapter 3.4.3 --- Summary --- p.62 / Chapter Chapter 4: --- Effect of 5-fluorouracil on proteins expression in SW480 cells / Chapter 4.1 --- Literature Review / Chapter 4.1.1 --- From mRNA to proteins --- p.63 / Chapter 4.1.2 --- Application of proteomics in cancer research --- p.63 / Chapter 4.1.3 --- Two-dimensional gel electrophoresis --- p.64 / Chapter 4.1.4 --- Principles of MALDI TOF mass spectrometry --- p.64 / Chapter 4.1.5 --- Peptide mass fingerprinting --- p.65 / Chapter 4.1.6 --- Drug response proteins detected by proteomics in colorectal cancer cell lines --- p.65 / Chapter 4.1.7 --- Detection of biomarker in colorectal cancer formation using proteomics --- p.66 / Chapter 4.2 --- Materials and Methods / Chapter 4.2.1 --- Determination of the effect of 5-fluorouracil on proteins expression in SW480 cells / Chapter 4.2.1.1 --- Treatment of cells --- p.67 / Chapter 4.2.1.2 --- Cell lysis --- p.67 / Chapter 4.2.1.3 --- Protein quantitation of cell lysate --- p.67 / Chapter 4.2.1.4 --- Sample preparation for two-dimensional electrophoresis --- p.68 / Chapter 4.2.1.5 --- Two-dimensional electrophoresis --- p.69 / Chapter 4.2.1.6 --- Silver staining --- p.69 / Chapter 4.2.1.7 --- Image analysis --- p.70 / Chapter 4.2.1.8 --- In-gel protein digestion --- p.70 / Chapter 4.2.1.9 --- Peptide mass fingerprinting using mass spectrometry --- p.71 / Chapter 4.3 --- Results / Chapter 4.3.1 --- Protein expression patterns of 5-fluorouracil treated and untreated SW480 cells by 2-dimensional electrophoresis --- p.72 / Chapter 4.3.2 --- Identification of the differentially expressed proteins after 5-fluorouracil treatment in SW480 cells --- p.75 / Chapter 4.4 --- Discussion / Chapter 4.4.1 --- Effects of 5-fluorouracil on protein expression in SW480 cells --- p.82 / Chapter 4.4.1.1 --- Identified upregulated proteins after 5-fluorouracil treatment in SW480 cells / Chapter 4.4.1.1.1 --- Cyclophilin A --- p.83 / Chapter 4.4.1.1.2 --- Cytokeratin 19 --- p.83 / Chapter 4.4.1.1.3 --- Cytokeratin 8 --- p.84 / Chapter 4.4.1.1.4 --- RAN --- p.84 / Chapter 4.4.1.1.5 --- Heat shock protein 27 --- p.84 / Chapter 4.4.1.1.6 --- Peroxiredoxin 6 --- p.85 / Chapter 4.4.1.2 --- Identified dowiiregulated proteins after 5-fluorouracil treatment in SW480 cells / Chapter 4.4.1.2.1 --- Heat shock protein 60 --- p.86 / Chapter 4.4.1.2.2 --- Cytokeratin 18 --- p.86 / Chapter 4.4.1.2.3 --- Cytokeratin 9 --- p.86 / Chapter 4.4.1.2.4 --- Carbamoylphosphate synthetase I --- p.87 / Chapter 4.4.1.2.5 --- a-Enolase --- p.87 / Chapter 4.4.1.2.6 --- Heat shock protein 70 --- p.87 / Chapter 4.4.1.2.7 --- nm23 --- p.88 / Chapter 4.4.1.2.8 --- β-actin --- p.88 / Chapter 4.4.2 --- Limitations of proteomics profiling --- p.89 / Chapter 4.4.3 --- Summary --- p.90 / Chapter Chapter 5: --- Verification of proteinśة identities by immunocytochemical staining / Chapter 5.1 --- Materials and Methods / Chapter 5.1.1 --- Antibodies --- p.91 / Chapter 5.1.2 --- Treatment of cells --- p.91 / Chapter 5.1.3 --- Agar block preparation of SW480 cells --- p.92 / Chapter 5.1.4 --- Immunocytochemical staining and evaluation --- p.92 / Chapter 5.1.5 --- Polymer-based immunohistochemical detection system --- p.93 / Chapter 5.1.6 --- Statistical analyses --- p.93 / Chapter 5.2 --- Results / Chapter 5.2.1 --- Confirmation of proteomic findings using immunocytochemical stainings in paraffin-embedded sections of 5-fluorouracil treated and untreated SW480 cells --- p.94 / Chapter 5.3 --- Discussion / Chapter 5.3.1 --- Immunocytochemical staining to verify proteomics findings of 5-fluorouracil treated and untreated SW480 cells --- p.99 / Chapter 5.3.2 --- Limitations of ICC staining --- p.100 / Chapter 5.3.3 --- Summary --- p.100 / Chapter Chapter 6: --- Conclusions and future perspectives / Chapter 6.1 --- Significance of study --- p.101 / Chapter 6.2 --- Future perspectives --- p.102 / References --- p.105