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311	Avaliação dos biomarcadores urinários no controle do tratamento de estenose de junção ureteropélvica em adultos / The role of urinary biomarkers in the assessment of ureteropelvic junction obstruction in adults Eduardo de Paula Miranda 04 March 2016 (has links) INTRODUÇÃO E OBJETIVO: A estenose de junção ureteropélvica (EJUP) é importante causa de obstrução do trato urinário e pode levar a deterioração progressiva da função renal. Há espaço para o aprimoramento de novos métodos diagnósticos capazes de discriminar hidronefrose e uropatia obstrutiva. Acredita-se que os biomarcadores urinários podem fornecer indícios de lesão renal precoce na obstrução urinária. Neste contexto, KIM-1 pode elevar-se na urina por lesão tubular proximal, NGAL por lesão no túbulo proximal, distal ou alça de Henle, CA19-9 por produção excessiva no túbulo obstruído e ?2-microglobulina (beta2M) por injúria ao glomérulo ou ao túbulo proximal. O objetivo do presente estudo foi avaliar as propriedades diagnósticas dos biomarcadores urinários citados em adultos com EJUP, sendo o primeiro estudo na literatura a avaliar tais moléculas nesta população. MÉTODOS: Foram estudados de modo prospectivo pacientes consecutivos acima de 18 anos com diagnóstico de EJUP submetidos a pieloplastia videolaparoscópica de dezembro de 2013 a fevereiro de 2015. Foram excluídos do estudo pacientes com EJUP bilateral, rim contralateral patológico, EJUP em rim único, antecedentes de tratamento cirúrgico para estenose de JUP ou taxa de filtração glomerular inferior a 60 ml/min/1,73m2. Cada paciente forneceu quatro amostras de urina para medição de biomarcadores, uma no pré-operatório e outras com 1, 3 e 6 meses de seguimento pós-operatório. O grupo controle foi constituído por voluntários saudáveis sem hidronefrose à ultrassonografia. RESULTADOS: Foram incluídos 47 pacientes com idade média de 38,6 ± 12,7 anos (intervalo 19 a 64 anos), sendo 17 (36,2%) do sexo masculino e 30 (62,8%) do sexo feminino. O grupo controle foi composto por 40 indivíduos semelhantes ao grupo com EJUP no que concerne idade (p = 0,95) e sexo (p = 0,82). KIM-1 foi o marcador com melhores propriedades diagnósticas, apresentando área sob a curva (AUC) de 0,79 (95% CI 0,70 a 0,89). O NGAL, por sua vez, teve AUC de 0,71 (95% CI 0,61 a 0,83), CA19- 9 teve AUC de 0,70 (95% CI 0,60 a 0,81) e (beta2M) apresentou AUC de 0,61 (95% CI 0,50 a 0,73), sendo o único biomarcador com propriedades inadequadas neste cenário. O KIM-1 foi o marcador mais sensível com o ponto de corte 170,4 pg/mg de creatinina (sensibilidade 91,4%, especificidade 59,1%) e o CA 19-9 o mais específico para o ponto de corte de 51,3 U/mg de creatinina (sensibilidade 48,9%, especificidade 88,0%), enquanto o NGAL foi o que apresentou maior queda após desobstrução, com 90,0% dos pacientes apresentando clareamento superior a 50%. CONCLUSÕES: A avaliação dos biomarcadores urinários é útil no diagnóstico de obstrução em adultos com EJUP submetidos a pieloplastia videolaparoscópica. O KIM-1 foi o marcador mais sensível e o CA 19-9 o mais específico, enquanto o NGAL foi o que apresentou maior que com a desobstrução. Houve queda das concentrações dos marcadores após pieloplastia no período estudado. O papel exato dos biomarcadores urinários no cenário de obstrução em adultos deve ser mais amplamente investigado / INTRODUCTION AND OBJECTIVE: Ureteropelvic junction obstruction (UPJO) is an important cause of urinary tract obstruction and can lead to progressive deterioration of renal function. Thus the development of novel non-invasive methods capable of discriminating obstruction and hydronephrosis may be useful. Elevation of urinary biomarkers may provide early evidence of kidney damage in urinary obstruction. In this scenario, urinary concentrations of KIM-1 may be elevated following proximal tubular injury, while NGAL may increase as result of injury to proximal or distal tubule as well as to loop of Henle, CA19-9 after overproduction in the obstructed tubule and ?2 microglobulin (beta2M) after injury to the glomerulus or the proximal tubule. The aim of this study was to evaluate the diagnostic properties of these urinary biomarkers in adults with UPJO. METHODS: We prospectively studied consecutive patients older than 18 years diagnosed with UPJO undergoing laparoscopic pyeloplasty from December 2013 to February 2015 in our institution. Exclusion criteria included patients with bilateral UPJO, unilateral UPJO with contralateral pathologic kidney, solitary kidney, history of previous surgical treatment for UPJO or glomerular filtration rate below 60 ml/min/1,73m2. Each patient provided four voided urine samples for biomarker measurement, one at preoperative consultation and the others at 1, 3 and 6 months of postoperative follow-up. Healthy individuals with no hydronephrosis on ultrasound evaluation constituted our control group. RESULTS: We included 47 patients with a mean age of 38.6 ± 12.7 years (range 19-64 years), from which 17 (36.2%) were males and 30 (62.8%) were females. The control group consisted of 40 subjects with no statistical difference to the study group regarding age (p = 0.95) and gender (p = 0.82). KIM-1 had an area under the curve (AUC) of 0.79 (95% CI 0.70 to 0.89) and was the biomarker with the best diagnostic properties. CA19-9 had an AUC of 0.70 (95% CI 0.60 to 0.81), NGAL had an AUC of 0.71 (95% CI 0.61 to 0.83) and beta2M had an AUC of 0.61 (95% CI 0.50 to 0.73). KIM-1 was the most sensitive marker with a cutoff of 170.4 pg/mg creatinine (sensitivity 91.4%, specificity 59.1%) whereas CA 19-9 as the most specific one, displaying a cutoff of 51.3 U/mg creatinine (sensitivity 48.9%, specificity 88.0%). NGAL showed the greatest decrease in urinary concentrations after pyeloplasty, in which 90.0% of patients had a clearance greater than 50% in comparison to preoperative values. CONCLUSIONS: The evaluation of urinary biomarkers is useful in the assessment of UPJO in adults undergoing laparoscopic pyeloplasty. Urinary concentrations of CA 19-9, NGAL and KIM-1 were elevated in patients with UPJO and significantly decreased after pyeloplasty. The exact role of those biomarkers in the setting of obstruction in adults should be further evaluated Adulto Antígeno CA-19- 9 Curva ROC Diagnóstico Hidronefrose Lipocalinas Marcadores biológicos Microglobulina-2 beta Molécula de lesão renal tipo 1 Obstrução ureteral Adult Beta 2-microglobulin Biological markers CA-19-9 antigen Diagnosis Hydronephrosis Kidney injury molecule-1 Lipocalins ROC curve Ureteral obstruction
312	O efeito do laser de baixa intensidade na fibrose intersticial renal Oliveira, Fabiana Aparecida Mayrink de 24 February 2011 (has links) Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-07-18T17:29:53Z No. of bitstreams: 1 fabianaaparecidamayrinkdeoliveira.pdf: 602450 bytes, checksum: 44abccc7edd994e7c93876d1aac063dd (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-22T15:11:02Z (GMT) No. of bitstreams: 1 fabianaaparecidamayrinkdeoliveira.pdf: 602450 bytes, checksum: 44abccc7edd994e7c93876d1aac063dd (MD5) / Made available in DSpace on 2016-07-22T15:11:02Z (GMT). No. of bitstreams: 1 fabianaaparecidamayrinkdeoliveira.pdf: 602450 bytes, checksum: 44abccc7edd994e7c93876d1aac063dd (MD5) Previous issue date: 2011-02-24 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / Justificativa e Objetivo: Independente da etiologia, a doença renal crônica (DRC) envolve fibrose generalizada e progressiva do tecido, atrofia tubular e a perda da função renal. Atualmente, as terapias eficazes para esta condição são escassas. Neste estudo, foram investigados os efeitos da terapia laser de baixa intensidade (LLLT) sobre a fibrose intersticial, que ocorre após obstrução ureteral unilateral (OUU) em ratos, um modelo experimental de doença renal crônica. Materiais e Métodos: Foram utilizados 32 ratos Wistar, 8 em cada grupo, machos, com 250 a 300g de peso aproximadamente e 8 semanas de idade. O rim obstruído de metade dos ratos, submetidos à OUU receberam dose única intra-operatória do LLLT (AlGaAs laser, 780 nm, 22,5 J / cm ², 30 mW, 30 segundos em cada um dos nove pontos). Após 14 dias, a fibrose renal foi avaliada pela coloração por picrosírius e medição da área transversal sob luz polarizada. Análise imunohistoquímica quantificou células do tecido renal que expressam marcadores de fibroblastos (FSP-1) e miofibroblastos (α-SMA). RT-PCR foi realizado para determinar a expressão de mRNA de genes chaves relacionados com a fibrose: TGF-β1, Smad3 e colágeno I (Col I). Resultados: No grupo OUU e tratado pelo LLLT os animais apresentaram menos fibrose renal do que os animais obstruídos (OUU). α-SMA, TGF-β1 e Smad3 foram aumentados no interstício renal de ratos OUU. LLLT reduziu a expressão de todas essas moléculas. LLLT não parece ter um efeito significativo no Col I ou FSP-1, que também foram induzidos por OUU. Conclusão: Pela primeira vez, nós mostramos que LLLT tem um efeito protetor em relação à fibrose intersticial renal. Entende-se que, atenuando a inflamação, a laserterapia pode impedir a ativação tubular e transdiferenciação, que são os dois processos principais que formam a fibrose renal no modelo OUU. / Background and Objective: Regardless of the etiology, chronic kidney disease (CKD) involves progressive widespread tissue fibrosis, tubular atrophy and loss of kidney function. At present, effective therapies to this condition are lacking. We investigated the effects of low level laser therapy (LLLT) on the interstitial fibrosis that occurs after unilateral ureteral obstruction (UUO) in rats, an experimental model of CKD. Study Design/Materials and Methods: We used 32 Wistar rats, 8 in each group, males, 250 to 300g weight and 8 weeks old. The occluded kidney of half of the Wistar rats that underwent UUO received a single intraoperative dose of LLLT (AlGaAs laser, 780 nm, 22.5 J/cm², 30 mW, 30 seconds on each of nine points). After 14 days, renal fibrosis was assessed by Sirius red staining and measurement of the cross-sectional area under polarized light. Immunohistochemical analyses quantitated the renal tissue cells that expressed fibroblast (FSP-1) and myofibroblast (α-SMA) markers. RT-PCR was performed to determine the mRNA expression of key fibrosis-related genes, namely TGF-β1, Smad3 and collagen I (Col I). Results: The UUO-LLLT animals had less severe renal fibrosis than OUU animals. α- SMA, TGF-β1 and Smad3 were increased in the renal interstitium of UUO rats. LLLT reduced the expression of all of these molecules. LLLT did not appear to have a significant effect on Col I or FSP-1, which were also induced by UUO. Conclusion: For the first time, we showed LLLT had a protective effect regarding renal interstitial fibrosis. It is conceivable that by attenuating inflammation, LLLT can prevent tubular activation and transdifferentiation, which are the two processes that mainly drive the renal fibrosis of the UUO model. CNPQ::CIENCIAS DA SAUDE Terapia de laser de baixa intensidade Obstrução ureteral Fibrose renal Doença renal crônica Fator transformador de crescimento beta Proteínas smad Alfa-actina de músculo liso Low-level laser therapy Ureteral obstruction Renal fibrosis Chronic kidney failure Transforming growth factor beta Smad proteins Alfa-smooth muscle actin
313	Clinical and clinicopathological studies in healthy horses and horses with colic Gomaa, Naglaa Abdel Megid 22 March 2011 (has links) In order to investigate the effect of food restriction on fat mobilization in horses with impaction in left ventral colon during treatment, serum triglycerides, NEFA and total bilirubine (TB) were measured before and after treatment. On another side, the determination of alcohol dehydrogenase (ADH) activity in serum could facilitate the distinguishing of the non-strangulating intestinal obstruction from the potential fatal strangulation obstruction and could submit a new prognostic biochemical parameter for intestinal strangulation. With the intention of giving a highlight over the analgesic effect of Buscopan® compositum in horses with colic, it was attempted to investigate the effect of Buscopan® compositum on the intestinal motility of healthy conscious horses in different regions of intestine. A significant elevation of NEFA and TB was observed in horses with impaction in left ventral colon at admission. By relieving the impaction, there was a significant elevation of triglycerides in comparison to its level at admission. There was a significant increase in ADH activity in all horses with acute intestinal obstruction. ADH activity was significantly higher in horses with strangulation in comparison to non-strangulation obstruction. There was only a significant correlation between ADH and lactate in horses with non-strangulation obstruction and colon torsion. Only AST and GLDH were significantly increased in horses with colon torsion. ADH activity > 20 U/l had 80.56% specificity and 80.49% sensitivity for discriminating horses with intestinal strangulation from non-strangulation obstruction. ADH activity < 80 U/l had 94.44% specificity and 66.67% sensitivity for survival. Buscopan® compositum had an immediate, rapid and significant (p< 0.05) reduction of duodenal, cecal and left ventral colon contractions after application. Cecal and left ventral colon contractions restored rapidly their normal contractions after 30 min, while duodenal contractions returned to the normal rate after 120 min of Buscopan® compositum administration. The horses with impaction in left ventral colon are susceptible to fat mobilization during the period of treatment as a result of food restriction. It was characterized by a revisable hypertri-glyceridemia and hyperbililrubinemia. Serum ADH activity could have a useful clinical value in detecting the intestinal strangulation and predicting the prognosis in horses with intestinal strangulation. Buscopan® compositum at its therapeutic dosage has an immediate, potent, short-lived reductive effect on cecum and left ventral colon contractions but a minor, longer effect on the duodenal contractions. Therefore, it is thought to be more effective in treatment of spasmodic colic than in large colon impaction.:Contents I List of Abbreviations II 1 Introduction and Literature 1 2 Results 4 2.1 Publication 1: Triglyceride, free fatty acids and total bilirubin in horses with left ventral large colon impaction 4 2.2 Publication 2: Clinical evaluation of serum alcohol dehydrogenase activity in horses with acute intestinal obstruction 9 2.3 Publication 3: Effect of Buscopan® compositum on the motility of the duodenum, cecum and left ventral colon in healthy conscious horses 43 3 Discussion 60 4 Summary 68 5 Zusammenfassung 70 6 References 72 7 Acknowledgement 81 / Um den Effekt der Nahrungskarenz auf die Fettmobilisation bei Pferden mit Verstopfung der linken ventralen Längslagen des Kolons während der Behandlung zu untersuchen, wurden Triglyceride (TG), freie Fettsäuren (FFS) und Gesamtbilirubin (GB) bestimmt. Andererseits ermöglicht die Bestimmung der Aktivität der Alkoholdehydrogenase (ADH) im Serum die Unterscheidung zwischen einer nichtstrangulierenden intestinalen Obstruktion und einer potentiell tödlichen Strangulation. ADH kann somit als ein neuer prognostischer biochemischer Parameter für die intestinale Strangulation eingesetzt werden. Um den spasmolytischen Effekt von Buscopan compositum bei Pferden mit Kolik zu untersuchen, wurde der Effekt von Buscopan compositum auf die intestinale Kontraktion von gesunden Pferden in verschiedenen Regionen des Darmes getestet. Eine signifikante Erhöhung der FFS und des GB wurde bei Aufnahme von Pferden mit einer Verstopfung in der linken ventralen Längslagen festgestellt. Nach der Behandlung der Verstopfung konnte eine signifikante Erhöhung der Konzentration von TG, bezogen auf die TG Konzentration bei Aufnahme in die Klinik, festgestellt werden. Bei Pferden mit akuter intestinaler Obstruktion wurde eine signifikante Erhöhung der Aktivität der ADH beobachtet. Die Aktivität der ADH war bei Pferden mit einer Strangulation signifikant höher als bei Pferden, die eine nichtstrangulierende Obstruktion des Darmes hatten. Bei Pferden mit einer nichtstrangulierenden Obstruktion oder einer Kolontorsion wurde eine positive Korrelation zwischen der ADH-Aktivität und der Laktatkonzentration im Serum festgestellt. Nur bei Pferden mit Kolontorsion waren die Aktivitäten von AST und GLDH signifikant erhöht. Für die Unterscheidung zwischen Pferden mit einer intestinalen Strangulation oder einer nichtstrangulierenden Obstruktion wurde für die ADH- Aktivität größer als 20 U/l eine Spezifität von 80,56% und eine Sensitivität von 80,49% ermittelt. Eine ADH-Aktivität kleiner 80 U/l zeigt, mit einer Spezifität von 94,44% und einer Sensitivität von 66,67%, eine günstige Prognose für das Überleben des Pferdes an. Nach Gabe von Buscopan® compositum trat eine sofortige schnelle und signifikante (p<0,05) Reduktion der Kontraktionen im Duodenum, Zäkum und den linken ventralen Längslagen ein. Die Kontraktionen des Zäkums und der linken ventralen Längslagen normalisierten sich schnell innerhalb von 30 min, wogegen die Kontraktionen des Duodenums erst 120 min nach der Applikation von Buscopan® compositum den Normalzustand erreichten. Pferde mit einer Verstopfung in der linken ventralen Längslagen des Kolons sind während der medizinischen Behandlung anfällig für Fettmobilisation aufgrund der reduzierten Futter-aufnahme. Dies ist gekennzeichnet durch eine reversible Hypertriglyceridämie und eine Hyperbilirubinämie. Die Aktivität von ADH im Serum kann ein nützlicher klinischer Parameter sein, um eine intestinale Strangulation zu identifizieren und bietet sich auch als prognostischer Marker bei intestinaler Strangulation an. Die Applikation von Buscopan® compositum in der therapeutischen Dosierung hat eine sofortige, potente und kurzzeitige Reduktion der Kontraktionen des Zäkums und der linken ventralen Längslage aber einen geringen und länger anhaltenden Effekt auf die duodenalen Kontraktionen zur Folge. Daraus folgt, dass Buscopan® compositum bei der Behandlung von Krampfkoliken effektiver ist als bei Verstopfungen des großen Kolons.:Contents I List of Abbreviations II 1 Introduction and Literature 1 2 Results 4 2.1 Publication 1: Triglyceride, free fatty acids and total bilirubin in horses with left ventral large colon impaction 4 2.2 Publication 2: Clinical evaluation of serum alcohol dehydrogenase activity in horses with acute intestinal obstruction 9 2.3 Publication 3: Effect of Buscopan® compositum on the motility of the duodenum, cecum and left ventral colon in healthy conscious horses 43 3 Discussion 60 4 Summary 68 5 Zusammenfassung 70 6 References 72 7 Acknowledgement 81 info:eu-repo/classification/ddc/636.089 ddc:636.089
314	Criminalisation and obstruction of civil SAR activities : The impact of Decree-Law No. 1 of January 2, 2023, and the distant port policy on civil SAR activities in the Central Mediterranean Sea Schrezenmeier, Stephen January 2023 (has links) In January 2023, the newly elected right-wing government led by Giorgio Meloni approved Decree-Law No. 1/2023 which restricts the work of civil Search and Rescue (SAR) organizations, with the aim to reduce the flow of people reaching the country's shores. Simultaneously, SAR organizations claimed that the Italian government started to deploy a policy of allocating distant ports to the NGO ships for the disembarkation of survivors. This thesis aims to analyse this new twofold approach towards civil sea rescue activities in the Central Mediterranean to answer the question of how it impacts the work of civil SAR organizations. For this purpose, a mixed-methods approach that joins quantitative and qualitative methods is deployed. The quantitative analysis of this thesis draws upon rescue data provided by SAR NGOs, as well as on press reports to understand the impact of the new approach on the disembarkation of survivors and movements of ships. To gain a deeper understanding of the impact on the rescue dynamics in the Mediterranean Sea, the qualitative analysis draws upon the results of semi-structured interviews conducted with staff of civil SAR organizations. In the course of this thesis, I argue that the new Italian approach falls into a larger trend of obstructing the work of SAR NGOs, deployed by the Italian government since the start of the de-governmentalisation of SAR activities in the Central Mediterranean in 2014. While the distant port policy leads to obstruction of SAR activities by delaying the disembarkation of survivors, Decree-Law No. 1/2023 falls into a wider strategy of criminalisation of civil SAR activities. I furthermore argue, that it is the interplay of the two newly introduced policies mentioned above that leads to severe obstruction of civil SAR activities. Finally, I engage theories about humanitarian space to describe the obstruction of civil SAR activities as the shrinking of the humanitarian space in the Mediterranean Sea. Civil search and rescue Central Mediterranean Sea obstruction criminalisation humanitarian space Social Sciences Interdisciplinary Globalisation Studies Globaliseringsstudier Human Geography Kulturgeografi
315	Análise da expressão das metaloproteinases e seus inibidores teciduais no músculo detrusor de pacientes com obstrução infravesical por hiperplasia prostática benigna / Expression of metalloproteinases and their tissue inhibitors in the detrusor muscle of patients with bladder outlet obstruction due to benign prostatic hyperplasia Ferreira, Yuri Afonso 03 October 2014 (has links) Introdução: A obstrução infravesical (OIV) de longo prazo secundária a hiperplasia prostática benigna (HPB) pode causar alterações funcionais e morfológicas na bexiga. Um dos principais eventos consiste no aumento da deposição de colágeno e perda de complacência vesical, levando a alteração de armazenamento e esvaziamento urinário. O aumento da deposição de colágeno na matriz extracelular (MEC) da musculatura detrusora é a principal razão para a diminuição da complacência vesical. Na bexiga, assim como em outros órgãos, este fenômeno depende da atividade equilibrada de enzimas proteolíticas, incluindo as metaloproteinases (MMP) e os seus inibidores endógenos (inibidores teciduais de metaloproteinases-TIMPs). Como estes fenômenos são desconhecidos na bexiga obstruída, o objetivo deste estudo foi avaliar a expressão gênica de colágeno, MMPs e seus inibidores na bexiga de pacientes com obstrução infravesical. Material e Métodos: Foi realizada uma análise prospectiva e controlada de 43 pacientes com OIV devido a HPB, que foram submetidos à ressecção transuretral da próstata (RTUP) entre 2011 e 2012. Como grupo controle foram selecionados espécimes de músculo detrusor de 10 pacientes que foram submetidos a prostatectomia radical retropúbica devido adenocarcinoma de próstata. Todos estes pacientes tinham idade menor que 60 anos, tamanho de próstata menor que 30 gramas ao ultra-som e escore internacional de sintomas prostáticos (IPSS) menor que 7. Todos os pacientes foram submetidos a estudo urodinâmico pré e pós operatório (após 6 meses). A biópsia de fragmento de músculo da bexiga foi realizada ao final da RTUP e colocada em solução estabilizadora de RNA para quantificação da expressão de colágenos I e III, metaloproteinases de matriz 1, 2 e 9, e inibidores de MMPs (TIMP1, TIMP2 e RECK) na bexiga de pacientes com HPB. Os genes descritos foram avaliados através da técnica de reação em cadeia da polimerase quantitativa em tempo real (qRT-PCR). Resultados: Todos os pacientes com HPB tinham confirmado OIV, através da análise do estudo urodinâmico (média de pressão detrusora no fluxo máximo de 78,5 cmH2O e fluxo urinário máximo de 7,7 ml / s). O gene MMP1 mostrou-se superexpresso em pacientes com HPB (mediana = 1,87). MMP9, TIMP1 e RECK estavam subexpressos na maioria dos casos, enquanto TIMP2, colágeno I e III foram superexpressos (1,5, 4,4 e 1,9 vezes, respectivamente). No que diz respeito às características clínicas e urodinâmicas encontramos que MMP2 foi mais expresso entre pacientes com um baixo IPSS global (0,005) e sem urgência (p=0,035). Colágeno III foi mais expresso em pacientes com contrações vesicais não inibidas (p = 0,049). Os outros genes não mostraram nenhuma correlação estatística com quaisquer características clínicas ou urodinâmicas. Após 6 meses de RTU, pacientes que possuíam expressão aumentada de duas ou mais MMPs, apresentaram resolução da CNI em 66,6% dos casos, contra 14,0% quando apenas uma ou nenhuma MMP estava aumentada (p=0,038) Conclusões: Encontramos um perfil de superexpressão de MMP1, TIMP2, colágenos I e III, e expressão baixa de MMP9, TIMP1 e RECK nos pacientes com OIV. Considerando o escore de sintomas prostáticos e a urgência miccional, encontramos curiosamente uma maior expressão de MMP2 em pacientes menos sintomáticos e sem urgência miccional. Encontramos uma associação entre a maior expressão de colágeno III com HD. A expressão aumentada de duas ou mais MMPs está relacionada à maiores taxas de resolução das CNIs. / Introduction: Long-term Bladder outlet obstruction (BOO) secondary to Benign prostatic Hyperplasia (BPH) can cause functional and morphological abnormalities in the bladder, such as increased collagen deposition and loss of compliance, leading to urinary storage and voiding symptoms. A decrease in bladder compliance is known to be correlated with deterioration of renal function. Increased deposition of collagen in the extracellular matrix (ECM) is the primary reason for a decreased compliance. In the bladder, as in other organs, this phenomenon is dependent on the balanced activity of proteolytic enzymes, including matrix metalloproteinases (MMPs) and their endogenous inhibitors, tissue inhibitors of metalloproteinases (TIMPs). The imbalance between MMPs and TIMPs is a key regulator in ECM turnover. Since these mechanisms are unknown in the obstructed bladder, the objective of this study was to evaluate gene expression of collagen, MMPs and their inhibitors in patients with bladder outlet obstruction due to BPH. Material and Methods: We performed a prospective and controlled analysis of 43 patients with BOO due to BPH who underwent transurethral resection of the prostate (TURP) from 2011 to 2012. The control group was comprised of 10 bladder specimens from patients with < 60 years who underwent radical prostatectomy with an International Prostatic Symptom Score (IPSS) < 8 and prostate volume < 30 grams. All patients underwent urodynamic analysis pre and post operatively after 6 months. A biopsy of the bladder muscle was performed at the end of TURP for analysis of collagen, metalloproteinases and TIMPs gene expressions. For this purpose we used the quantitative real time polymerase chain reaction method (qRT-PCR). Results: All patients with BPH had confirmed BOO confirmed through urodynamic analysis (mean detrusor pressure at maximun flow 78.5 cmH2O and mean maximun flow 7.7 ml/s). MMP1 gene showed an important an overexpression in patients with BPH (median = 1.87). A similar phenomenon occurred in a lesser extent to MMP2, to which 13 of 23 subjects had under-expression (mean = 1.2). MMP9, TIMP1 and RECK were under-expressed in the majority of cases, while TIMP2, colagen I and III were over-expressed (1.5, 4.4 and 1.9x respectively) (figure). With regard to clinical and urodynamic characteristics we found that MMP2 was more over-expressed among patients with a low global IPSS (0.005) and without urgency (p=0.035). Colagen III was more over-expressed in patients with non-inhibited bladder contractions (p=0.049), RECK was more over-expressed in patients with a decreased complacence (p=0.049). The other genes showed no statistical correlation with any clinical or urodynamic characteristics. After 6 months of TURP, patients with non-inhibited bladder contractions showed resolution in 66.6% of cases, when had increased expression of two or more (> 02) MMPs in patients compared with 14.0% when only 01 MMP was increased (p = 0.038) Conclusions: BOO is related with an over-expression of MMP1, TIMP2, colagens I and III, and with an under-expression of MMP9, TIMP1 and RECK. Detrusor overactivity is related with higher collagen III expression, this fact may be due to a lower MMP1 expression. A lower global IPSS and no urgency were related to a higher expression of MMP2, sugesting that this gene may be inhibiting collagen deposition in the bladder. The increased expression of two or more MMPs isrelated to greater rates of resolution of non-inhibited bladder contractions Benign prostatic hyperplasia Bladder outlet obstruction Colágeno tipo I Colágeno tipo III Collagen type I Collagen type III Detrusor overactivity Endoscopic resection of the prostate Enurese noturna Estudos prospectivos Expressão gênica Gene expression Hiperatividade detrusora Hiperplasia prostática Metalloproteinases Metaloproteinas matrix-2 Metaloproteinase da matriz P-1 Metaloproteinase da matriz-2 Metaloproteinase da matriz-9 Metaloproteinase matrix-1 Metaloproteinase matrix-9 Metaloproteinases Obstrução infravesical Prospectives studies Ressecção endoscópica da próstata Tissue inhibitors of metalloproteinases Urinary urgency Urodinâmica Urodinamics
316	Análise da expressão das metaloproteinases e seus inibidores teciduais no músculo detrusor de pacientes com obstrução infravesical por hiperplasia prostática benigna / Expression of metalloproteinases and their tissue inhibitors in the detrusor muscle of patients with bladder outlet obstruction due to benign prostatic hyperplasia Yuri Afonso Ferreira 03 October 2014 (has links) Introdução: A obstrução infravesical (OIV) de longo prazo secundária a hiperplasia prostática benigna (HPB) pode causar alterações funcionais e morfológicas na bexiga. Um dos principais eventos consiste no aumento da deposição de colágeno e perda de complacência vesical, levando a alteração de armazenamento e esvaziamento urinário. O aumento da deposição de colágeno na matriz extracelular (MEC) da musculatura detrusora é a principal razão para a diminuição da complacência vesical. Na bexiga, assim como em outros órgãos, este fenômeno depende da atividade equilibrada de enzimas proteolíticas, incluindo as metaloproteinases (MMP) e os seus inibidores endógenos (inibidores teciduais de metaloproteinases-TIMPs). Como estes fenômenos são desconhecidos na bexiga obstruída, o objetivo deste estudo foi avaliar a expressão gênica de colágeno, MMPs e seus inibidores na bexiga de pacientes com obstrução infravesical. Material e Métodos: Foi realizada uma análise prospectiva e controlada de 43 pacientes com OIV devido a HPB, que foram submetidos à ressecção transuretral da próstata (RTUP) entre 2011 e 2012. Como grupo controle foram selecionados espécimes de músculo detrusor de 10 pacientes que foram submetidos a prostatectomia radical retropúbica devido adenocarcinoma de próstata. Todos estes pacientes tinham idade menor que 60 anos, tamanho de próstata menor que 30 gramas ao ultra-som e escore internacional de sintomas prostáticos (IPSS) menor que 7. Todos os pacientes foram submetidos a estudo urodinâmico pré e pós operatório (após 6 meses). A biópsia de fragmento de músculo da bexiga foi realizada ao final da RTUP e colocada em solução estabilizadora de RNA para quantificação da expressão de colágenos I e III, metaloproteinases de matriz 1, 2 e 9, e inibidores de MMPs (TIMP1, TIMP2 e RECK) na bexiga de pacientes com HPB. Os genes descritos foram avaliados através da técnica de reação em cadeia da polimerase quantitativa em tempo real (qRT-PCR). Resultados: Todos os pacientes com HPB tinham confirmado OIV, através da análise do estudo urodinâmico (média de pressão detrusora no fluxo máximo de 78,5 cmH2O e fluxo urinário máximo de 7,7 ml / s). O gene MMP1 mostrou-se superexpresso em pacientes com HPB (mediana = 1,87). MMP9, TIMP1 e RECK estavam subexpressos na maioria dos casos, enquanto TIMP2, colágeno I e III foram superexpressos (1,5, 4,4 e 1,9 vezes, respectivamente). No que diz respeito às características clínicas e urodinâmicas encontramos que MMP2 foi mais expresso entre pacientes com um baixo IPSS global (0,005) e sem urgência (p=0,035). Colágeno III foi mais expresso em pacientes com contrações vesicais não inibidas (p = 0,049). Os outros genes não mostraram nenhuma correlação estatística com quaisquer características clínicas ou urodinâmicas. Após 6 meses de RTU, pacientes que possuíam expressão aumentada de duas ou mais MMPs, apresentaram resolução da CNI em 66,6% dos casos, contra 14,0% quando apenas uma ou nenhuma MMP estava aumentada (p=0,038) Conclusões: Encontramos um perfil de superexpressão de MMP1, TIMP2, colágenos I e III, e expressão baixa de MMP9, TIMP1 e RECK nos pacientes com OIV. Considerando o escore de sintomas prostáticos e a urgência miccional, encontramos curiosamente uma maior expressão de MMP2 em pacientes menos sintomáticos e sem urgência miccional. Encontramos uma associação entre a maior expressão de colágeno III com HD. A expressão aumentada de duas ou mais MMPs está relacionada à maiores taxas de resolução das CNIs. / Introduction: Long-term Bladder outlet obstruction (BOO) secondary to Benign prostatic Hyperplasia (BPH) can cause functional and morphological abnormalities in the bladder, such as increased collagen deposition and loss of compliance, leading to urinary storage and voiding symptoms. A decrease in bladder compliance is known to be correlated with deterioration of renal function. Increased deposition of collagen in the extracellular matrix (ECM) is the primary reason for a decreased compliance. In the bladder, as in other organs, this phenomenon is dependent on the balanced activity of proteolytic enzymes, including matrix metalloproteinases (MMPs) and their endogenous inhibitors, tissue inhibitors of metalloproteinases (TIMPs). The imbalance between MMPs and TIMPs is a key regulator in ECM turnover. Since these mechanisms are unknown in the obstructed bladder, the objective of this study was to evaluate gene expression of collagen, MMPs and their inhibitors in patients with bladder outlet obstruction due to BPH. Material and Methods: We performed a prospective and controlled analysis of 43 patients with BOO due to BPH who underwent transurethral resection of the prostate (TURP) from 2011 to 2012. The control group was comprised of 10 bladder specimens from patients with < 60 years who underwent radical prostatectomy with an International Prostatic Symptom Score (IPSS) < 8 and prostate volume < 30 grams. All patients underwent urodynamic analysis pre and post operatively after 6 months. A biopsy of the bladder muscle was performed at the end of TURP for analysis of collagen, metalloproteinases and TIMPs gene expressions. For this purpose we used the quantitative real time polymerase chain reaction method (qRT-PCR). Results: All patients with BPH had confirmed BOO confirmed through urodynamic analysis (mean detrusor pressure at maximun flow 78.5 cmH2O and mean maximun flow 7.7 ml/s). MMP1 gene showed an important an overexpression in patients with BPH (median = 1.87). A similar phenomenon occurred in a lesser extent to MMP2, to which 13 of 23 subjects had under-expression (mean = 1.2). MMP9, TIMP1 and RECK were under-expressed in the majority of cases, while TIMP2, colagen I and III were over-expressed (1.5, 4.4 and 1.9x respectively) (figure). With regard to clinical and urodynamic characteristics we found that MMP2 was more over-expressed among patients with a low global IPSS (0.005) and without urgency (p=0.035). Colagen III was more over-expressed in patients with non-inhibited bladder contractions (p=0.049), RECK was more over-expressed in patients with a decreased complacence (p=0.049). The other genes showed no statistical correlation with any clinical or urodynamic characteristics. After 6 months of TURP, patients with non-inhibited bladder contractions showed resolution in 66.6% of cases, when had increased expression of two or more (> 02) MMPs in patients compared with 14.0% when only 01 MMP was increased (p = 0.038) Conclusions: BOO is related with an over-expression of MMP1, TIMP2, colagens I and III, and with an under-expression of MMP9, TIMP1 and RECK. Detrusor overactivity is related with higher collagen III expression, this fact may be due to a lower MMP1 expression. A lower global IPSS and no urgency were related to a higher expression of MMP2, sugesting that this gene may be inhibiting collagen deposition in the bladder. The increased expression of two or more MMPs isrelated to greater rates of resolution of non-inhibited bladder contractions Colágeno tipo I Colágeno tipo III Enurese noturna Estudos prospectivos Expressão gênica Hiperatividade detrusora Hiperplasia prostática Metaloproteinase da matriz P-1 Metaloproteinase da matriz-2 Metaloproteinase da matriz-9 Metaloproteinases Obstrução infravesical Ressecção endoscópica da próstata Urodinâmica Benign prostatic hyperplasia Bladder outlet obstruction Collagen type I Collagen type III Detrusor overactivity Endoscopic resection of the prostate Gene expression Metalloproteinases Metaloproteinas matrix-2 Metaloproteinase matrix-1 Metaloproteinase matrix-9 Prospectives studies Tissue inhibitors of metalloproteinases Urinary urgency Urodinamics
317	Study of genetic factors in treatment-related complications in patients with childhood acute lymphoblastic leukemia and post transplantation of hematopoietic stem cells Petrykey, Kateryna 12 1900 (has links) La leucémie lymphoblastique aiguë (LLA) est le cancer le plus fréquent chez les enfants. Malgré le fait que plus de 80% des enfants atteints de LLA sont aujourd'hui guéris de leur maladie, ce succès a toutefois un prix élevé, car l’exposition aux médicaments cytotoxique et/ou à l’irradiation pendant une période vulnérable du développement de l’enfant peut entraîner des conséquences à long terme. En effet, environ 60% des enfants ayant survécu à une LLA devront vivre avec des problèmes de santé liés au traitement, également appelés effets indésirables tardifs (late-adverse effects, LAEs). Parmi ces derniers, on notera des problèmes métaboliques, l’ostéoporose, une altération des fonctions cognitives ou cardiaques, ainsi que la dépression et l’anxiété. Si certains survivants ne présentent aucune de ces complications, d'autres peuvent en avoir plusieurs. Différents facteurs peuvent contribuer à cette variabilité, notamment le traitement reçu, les caractéristiques de la maladie, les habitudes de vie et, surtout, la constitution génétique du patient. Ce projet s'est concentré sur les biomarqueurs génétiques permettant d'identifier les individus les plus susceptibles de souffrir de LAEs. Récemment, une étude exhaustive (évaluations cliniques, psychosociales et biochimiques) s’est déroulée au CHU Sainte-Justine pour caractériser chacune de ces morbidités chez 250 survivants de la LLA de l'enfant (cohorte PETALE). De plus, on a obtenu le profil génétique de chaque participant. Nous avons utilisé cet ensemble de données et des outils statistiques et bio-informatiques pour réaliser des études d'association comparant la fréquence des variants génétiques chez les survivants ayant développé ou non des LAEs; en particulier, les complications cardiovasculaires et neurocognitives, ainsi que les troubles de l'humeur tels que l'anxiété et la dépression. D'autres facteurs de risque tels que les caractéristiques de traitement et/ou de la leucémie ont été pris en compte lors de l'analyse pour dériver les meilleurs prédicteurs génétiques. Ainsi, en utilisant l'approche des gènes candidats, nous avons identifié les variants communs des gènes MTR, PPARA, ABCC3, CALML5, CACNB2 et PCDHB10 qui étaient associés à des déficits de performance des tests neurocognitifs, tandis que les variants des gènes SLCO1B1 et EPHA5 étaient associés à l'anxiété et à la dépression. Deux variants, rs1805087 dans le gène MTR et rs58225473 dans le gène CACNB2 sont particulièrement intéressants, car ces associations ont été validées dans la cohorte de réplication SJLIFE (St. Jude Children's Research Hospital, Memphis, USA). Les analyses d'association ont été complémentées par une étude d'association à l'échelle de l'exome, qui a identifié plusieurs gènes supplémentaires comme des modulateurs potentiels du risque de développer des complications neurocognitives liées au traitement (gènes AK8 et ZNF382), ainsi que l'anxiété et la dépression (gènes PTPRZ1, MUC16, TNRC6C-AS1, APOL2, C6orf165, EXO5, CYP2W1 et PCMTD1). Le variant rs61732180 du gène ZNF382 a ensuite été validé dans la cohorte de réplication SJLIFE. Également, nous avons effectué des analyses d’association concernant les complications cardiaques liées au traitement qui ont identifié plusieurs nouveaux marqueurs associés à ces complications dans les gènes TTN, NOS1, ABCG2, CBR1, ABCC5, AKR1C3, NOD2 et ZNF267. De plus, nous avons résumé les connaissances actuelles sur les marqueurs pharmacogénomiques qui ont été associés aux effets de cardiotoxicités, induites par les anthracyclines, qui affectent les patients atteints de cancer pédiatrique. Nous avons également inclus un aperçu de l'applicabilité des résultats rapportés, notamment ceux qui ont été validés dans la cohorte PETALE. Par ailleurs, nous nous sommes intéressés aux complications qui surviennent après une greffe de cellules souches hématopoïétiques. Nous avons appliqué des approches bio-informatiques et statistiques similaires pour obtenir un profil plus complet de la composante génétique derrière ces complications potentiellement mortelles. Ainsi, une étude d'association à l'échelle de l'exome a été réalisée dans une cohorte de patients pédiatriques subissant une greffe de cellules souches hématopoïétiques après un régime de conditionnement contenant du busulfan. Nous avons identifié de nouvelles variations génétiques conférant un risque plus élevé de syndrome d'obstruction sinusoïdale (notamment dans les gènes UGT2B10, BHLHE22, et KIAA1715) et de maladie aiguë du greffon contre l'hôte (dans les gènes ERC1, PLEK, NOP9 et SPRED1), qui pourraient être utiles pour des stratégies personnalisées de prévention et de traitement. Ces travaux contribuent à la compréhension de l'influence des facteurs génétiques sur le risque de développer des complications liées au traitement, tant au cours du traitement qu'à long terme. De plus, les marqueurs génétiques signalés ainsi que d'autres facteurs de risque connus peuvent conduire à des modèles de prédiction identifiant les patients à risque accru de ces complications. / Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Even though more than 80% of children with ALL are now cured of their disease, this success comes at a high price as exposure to cytotoxic drugs and/or radiation during a vulnerable period of child development may have long-term consequences. In fact, approximately 60% of children who survive ALL will have to live with treatment-related health problems, also called late-adverse effects (LAEs). These include metabolic problems, osteoporosis, impaired cardiac or cognitive functions, as well as depression and anxiety. While some survivors do not have any of these complications, others may have more than one. Different factors can contribute to this variability, in particular, the treatment received, the characteristics of the disease, the lifestyle, and, above all, the genetic makeup of the patient. This project focused on genetic biomarkers capable of identifying the individuals most likely to suffer from LAEs. Recently, an exhaustive study (clinical, psychosocial, and biochemical evaluations) took place at Sainte-Justine University Health Center (Montreal, Canada), with the goal to characterize each of these morbidities in 250 survivors of childhood ALL (PETALE cohort). In addition, the genetic profile of each participant was obtained, and we used statistical and bioinformatics tools to perform association studies on this dataset in order to compare the frequency of genetic variants in survivors with or without LAEs. We evaluated cardiovascular and neurocognitive complications, as well as mood disorders such as anxiety and depression. Other risk factors, such as treatment and/or leukemia characteristics were also considered during the analysis to derive the best genetic predictors. Thus, using the candidate gene approach, we identified common variants in the MTR, PPARA, ABCC3, CALML5, CACNB2, and PCDHB10 genes that were associated with deficits in neurocognitive tests performance, whereas variants in the SLCO1B1 and EPHA5 genes were associated with anxiety and depression. Two variants, rs1805087 in the MTR gene and rs58225473 in the CACNB2 gene, are of particular interest since these associations were validated in an independent SJLIFE replication cohort (St. Jude Children's Research Hospital, Memphis, USA). The association analyses were complemented by an exome-wide association study, which identified several additional genes as potential modulators of the risk of developing treatment-related neurocognitive complications (genes AK8 and ZNF382), as well as anxiety and depression (genes PTPRZ1, MUC16, TNRC6C-AS1, APOL2, C6orf165, EXO5, CYP2W1, and PCMTD1). Variant rs61732180 in the ZNF382 gene was further validated in the replication SJLIFE cohort. To a great extent, we performed association analyses regarding treatment-related cardiac complications which identified several novel markers associated with these toxicities in the TTN, NOS1, ABCG2, CBR1, ABCC5, AKR1C3, NOD2, and ZNF267 genes in survivors of childhood ALL. In addition, we summarized the current knowledge on pharmacogenomic markers related to anthracycline-induced cardiotoxicity affecting pediatric cancer patients. We also included a brief overview of the applicability of reported findings to the PETALE cohort, validating several of them. Besides, we were interested in the complications that arise after a hematopoietic stem cell transplantation. We applied similar bioinformatics and statistical approaches to gain a more complete insight into the genetic component behind these life-threatening complications. Thus, an exome-wide association study was performed in a cohort of pediatric patients undergoing hematopoietic stem cell transplantation following a conditioning regimen containing busulfan. Our results identified new genetic variations conferring a higher risk of sinusoidal obstruction syndrome (notably in the UGT2B10, BHLHE22, and KIAA1715 genes) and acute graft-versus-host disease (ERC1, PLEK, NOP9, and SPRED1 genes), which could be useful for personalized prevention and treatment strategies. This work contributes to the understanding of the influence of genetic factors on the risk of developing treatment-related complications, both during treatment and in the long term. Furthermore, the reported genetic markers along with other known risk factors can lead to prediction models identifying patients at increased risk for these complications. survivants du cancer cancer infantile effets indésirables tardifs complications neurocognitives anxiété dépression performances cognitives troubles de l'humeur doxorubicine maladie aiguë du greffon contre l'hôte busulfan facteurs génétiques étude d'association séquençage de l'exome entier Childhood acute lymphoblastic leukemia cancer survivors childhood cancer late adverse effects neurocognitive complications anxiety cognitive performance mood disorders anthracycline-induced cardiotoxicity doxorubicin sinusoidal obstruction syndrome acute graft versus host disease hematopoietic stem cell transplantation genetic factors exome-wide association study whole-exome sequencing Genetics / Génétique (UMI : 0369)
318	Žiju tarot / I Live Tarot Oplatková, Hana January 2012 (has links) Private deck of cards created during six-month survey and documentation of daily experiences. The package contains 49 cards and it is inspired by a set of 78 tarot cards. Text content - reverse side of the card was created using diary notes. Face side of the card was chosen as a representation of processes taking place usually in days when the card was read.
319	Action in Chronic Fatigue Syndrome: an Enactive Psycho-phenomenological and Semiotic Analysis of Thirty New Zealand Women's Experiences of Suffering and Recovery Hart, M J Alexandra January 2010 (has links) This research into Chronic Fatigue Syndrome (CFS) presents the results of 60 first-person psycho-phenomenological interviews with 30 New Zealand women. The participants were recruited from the Canterbury and Wellington regions, 10 had recovered. Taking a non-dual, non-reductive embodied approach, the phenomenological data was analysed semiotically, using a graph-theoretical cluster analysis to elucidate the large number of resulting categories, and interpreted through the enactive approach to cognitive science. The initial result of the analysis is a comprehensive exploration of the experience of CFS which develops subject-specific categories of experience and explores the relation of the illness to universal categories of experience, including self, ‘energy’, action, and being-able-to-do. Transformations of the self surrounding being-able-to-do and not-being-able-to-do were shown to elucidate the illness process. It is proposed that the concept ‘energy’ in the participants’ discourse is equivalent to the Mahayana Buddhist concept of ‘contact’. This characterises CFS as a breakdown of contact. Narrative content from the recovered interviewees reflects a reestablishment of contact. The hypothesis that CFS is a disorder of action is investigated in detail. A general model for the phenomenology and functional architecture of action is proposed. This model is a recursive loop involving felt meaning, contact, action, and perception and appears to be phenomenologically supported. It is proposed that the CFS illness process is a dynamical decompensation of the subject’s action loop caused by a breakdown in the process of contact. On this basis, a new interpretation of neurological findings in relation to CFS becomes possible. A neurological phenomenon that correlates with the illness and involves a brain region that has a similar structure to the action model’s recursive loop is identified in previous research results and compared with the action model and the results of this research. This correspondence may identify the brain regions involved in the illness process, which may provide an objective diagnostic test for the condition and approaches to treatment. The implications of this model for cognitive science and CFS should be investigated through neurophenomenological research since the model stands to shed considerable light on the nature of consciousness, contact and agency. Phenomenologically based treatments are proposed, along with suggestions for future research on CFS. The research may clarify the diagnostic criteria for CFS and guide management and treatment programmes, particularly multidimensional and interdisciplinary approaches. Category theory is proposed as a foundation for a mathematisation of phenomenology. action Chronic Fatigue Syndrome Myalgic Encephalomyelitis Chronic Immune Deficiency Syndrome enaction social enaction social enactivism enactive psycho-phenomenological psychophenomenological vipassana groundlessness mind-body korper leib co-generative Focusing co-creative environment Antonio Damasio reciprocal constraints Pierre Vermersch Claire Petitmengin Antione Lutz narrative discourse phenomenal invariants Evan Thompson Merleau-Ponty Algirdis Julien Greimas Husserl first-person Fransisco Varela modelling invariants Natalie Depraz isotope John Boyd OODA loop Jonathan Shear Shaun Gallagher Arthur Kleinman Humberto Maturana second-person Alva Noe Dan Zahavi stages Embodied Mind Canterbury Wellington New Zealand non-dual non-reductive embodied phenomenological third-person graph-theoretical cluster analysis cognitive science experience solution subject-specific categories universal categories universal categories self energy illness process intersubjectivity Mahayana Buddhism contact narrative recovered making sense recursive loop perception dynamical decompensation neurology diagnosis empathy treatment management neurophenomenological neurophenomenology consciousness veracity agency multidimensional interdisciplinary category theory enculturation mathematisation of phenomenology interview nomenclature diagnostic criteria incidence prevalence coping strategy etiology epidemiology psychosomatic medicine meaning women girl female anthropology sociology cognitive behavioral therapy exercise therapy recovery mindful awareness suffering symbolisation Prasangika no-self aggregates wheel of karma cognition basic element analysis mental factors operational closure stereotypes enactive ontologically fragile self grief process-knowledge epoche phenomenal invariants textual invariants compound meaning saturation formalisation cluster analysis inter-session review inter-individual validation explicitation interview intricacy confidence psychophenomenology self-esteem sanction self dis-integration permanence continuity ego-self emotion surrender semiotic square meditation empathy semiotic compassion existential feelings goal obstruction movement transformation change somatic Giovanna Colombetti agoraphobia panic anxiety psychotherapy sleep rest pain weakness strength stamina Diego Cosmelli heaviness food chemicals allergy recovering despair frustration helplessness fear efference valence afference as-if-body-loop consciousness representation attention recovery intention sustainable sustainability neurasthenia existential feelings asthenia hysteria mononucleosis samatha-vispasnya prajna vijnana Eugene Gendlin Abhidharma dukkha shamatha interdependence vipashyana
320	A case for memory enhancement : ethical, social, legal, and policy implications for enhancing the memory Muriithi, Paul Mutuanyingi January 2014 (has links) The desire to enhance and make ourselves better is not a new one and it has continued to intrigue throughout the ages. Individuals have continued to seek ways to improve and enhance their well-being for example through nutrition, physical exercise, education and so on. Crucial to this improvement of their well-being is improving their ability to remember. Hence, people interested in improving their well-being, are often interested in memory as well. The rationale being that memory is crucial to our well-being. The desire to improve one’s memory then is almost certainly as old as the desire to improve one’s well-being. Traditionally, people have used different means in an attempt to enhance their memories: for example in learning through storytelling, studying, and apprenticeship. In remembering through practices like mnemonics, repetition, singing, and drumming. In retaining, storing and consolidating memories through nutrition and stimulants like coffee to help keep awake; and by external aids like notepads and computers. In forgetting through rituals and rites. Recent scientific advances in biotechnology, nanotechnology, molecular biology, neuroscience, and information technologies, present a wide variety of technologies to enhance many different aspects of human functioning. Thus, some commentators have identified human enhancement as central and one of the most fascinating subject in bioethics in the last two decades. Within, this period, most of the commentators have addressed the Ethical, Social, Legal and Policy (ESLP) issues in human enhancements as a whole as opposed to specific enhancements. However, this is problematic and recently various commentators have found this to be deficient and called for a contextualized case-by-case analysis to human enhancements for example genetic enhancement, moral enhancement, and in my case memory enhancement (ME). The rationale being that the reasons for accepting/rejecting a particular enhancement vary depending on the enhancement itself. Given this enormous variation, moral and legal generalizations about all enhancement processes and technologies are unwise and they should instead be evaluated individually. Taking this as a point of departure, this research will focus specifically on making a case for ME and in doing so assessing the ESLP implications arising from ME. My analysis will draw on the already existing literature for and against enhancement, especially in part two of this thesis; but it will be novel in providing a much more in-depth analysis of ME. From this perspective, I will contribute to the ME debate through two reviews that address the question how we enhance the memory, and through four original papers discussed in part three of this thesis, where I examine and evaluate critically specific ESLP issues that arise with the use of ME. In the conclusion, I will amalgamate all my contribution to the ME debate and suggest the future direction for the ME debate. 174

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