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

published_or_final_version / Anatomy / Master / Master of Philosophy

Han, Li. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 132-140). / Abstract and appendixes also in Chinese. / Chapter 1.1 --- BACKGROUND & SIGNIFICANCE OF THE STUDY --- p.1 / Chapter 1.2 --- STRUCTURE OF THE THESIS --- p.4 / Chapter 2.1 --- BPH --- p.6 / Chapter 2.1.1 --- PREVALENCE OF BPH --- p.6 / Chapter 2.1.2 --- IMPACT OF BPH SYMPTOMS ON PATIENTS --- p.9 / Chapter 2.1.2.1 --- CLINICAL SYMPTOMS OF BPH --- p.9 / Chapter 2.1.2.2 --- IMPACT OF CLINICAL SYMPTOMS ON QUALITY OF LIFE --- p.10 / Chapter 2.1.3 --- IMPACT OF BPH MEDICAL MANAGEMENT ON PATIENTS --- p.11 / Chapter 2.1.3.1 --- MEDICAL MANAGEMENT OF BPH --- p.11 / Chapter 2.1.3.2 --- SIDE EFFECTS OF PHARMACOLOGICAL AND SURGICAL THERAPIES --- p.15 / Chapter 2.1.4 --- USE OF COMPLEMENTARY AND ALTERNATIVE THERAPY AMONG BPH PATIENTS --- p.19 / Chapter 2.1.4.1 --- PREVALENCE --- p.19 / Chapter 2.1.4.2 --- REASONS FOR TURNING TO CAM --- p.20 / Chapter 2.2 --- ISOFLAVONES --- p.43 / Chapter 2.2.1 --- ISOFLAVONES FUNCTION --- p.43 / Chapter 2.2.1.1 --- STRUCTURE --- p.43 / Chapter 2.2.1.2 --- FOOD SOURCES --- p.45 / Chapter 2.2.2 --- APPLICATION OF ISOFLAVONES IN BPH --- p.46 / Chapter 2.2.2.1 --- DOCUMENTED MECHANISM OF BPH --- p.46 / Chapter 2.2.2.2 --- STUDIES IN VITRO --- p.47 / Chapter 2.2.2.3 --- STUDIES IN VIVO --- p.48 / Chapter 2.2.2.4 --- EPIDEMIOLOGIC EVIDENCE --- p.49 / Chapter 2.3. --- RESEARCH GAP IN HUMAN STUDY --- p.50 / Chapter 3.1 --- STUDY DESIGN --- p.51 / Chapter 3.2 --- AIM --- p.51 / Chapter 3.3 --- STUDY POPULATION --- p.52 / Chapter 3.3.1 --- INCLUSION CRITERIA --- p.52 / Chapter 3.3.2 --- EXCLUSION CRITERIA --- p.52 / Chapter 3.3.3 --- SAMPLE SIZE ESTIMATION --- p.53 / Chapter 3.4 --- RANDOMIZATION --- p.54 / Chapter 3.4.1 --- GENERATION THE RANDOM ALLOCATION SEQUENCE AND DETAILS OF RESTRICTION OF RANDOMIZATION --- p.54 / Chapter 3.4.2 --- IMPLEMENTATION OF RANDOMIZATION --- p.54 / Chapter 3.5 --- BLINDING --- p.55 / Chapter 3.5.1 --- WHO WERE BLINDED --- p.55 / Chapter 3.6 --- INTERVENTION --- p.55 / Chapter 3.6.1 --- STUDY MEDICATIONS AND DOSAGE --- p.55 / Chapter 3.6.2 --- STUDY REGIMEN --- p.56 / Chapter 3.7 --- DATA COLLECTION --- p.56 / Chapter 3.8 --- OUTCOME MEASUREMENTS --- p.58 / Chapter 3.8.1 --- PRIMARY OUTCOME --- p.58 / Chapter 3.8.1.1 --- UROFLOWMETRY： PEAK URINE FLOW RATE (QMAX) --- p.58 / Chapter 3.8.2 --- SECONDARY OUTCOMES --- p.59 / Chapter 3.8.2.1 --- BLADDER SCAN： POST-VOIDING RESIDUAL VOLUME (PVR) --- p.59 / Chapter 3.8.2.2 --- SYMPTOMS SCORE (IPSS) --- p.60 / Chapter 3.8.2.3 --- QUALIFY OF LIFE --- p.61 / Chapter 3.8.2.4 --- SERUM PSA LEVEL --- p.62 / Chapter 3.8.2.5 --- URINALYSIS TEST --- p.62 / Chapter 3.8.3 --- AE/SAE --- p.63 / Chapter 3.8.3.1 --- SELF REPORTED AE/SAE --- p.63 / Chapter 3.8.3.2 --- SEXUAL HORMONE LEVEL --- p.64 / Chapter 3.8.3.3 --- SEXUAL RELATED QUALITY OF LIFE --- p.64 / Chapter 3.9 --- STATISTICAL ANALYSIS --- p.65 / Chapter 3.9.1 --- DESCRIPTIVE ANALYSIS --- p.65 / Chapter 3.9.2 --- COMPARATIVE ANALYSIS --- p.65 / Chapter 4.1 --- PARTICIPANTS FLOW --- p.67 / Chapter 4.2 --- DEMOGRAPHICS --- p.69 / Chapter 4.3 --- BASELINE CHARACTERISTICS COMPARISON --- p.70 / Chapter 4.3.1 --- IPSS --- p.72 / Chapter 4.3.2 --- QMAX AND PRV --- p.73 / Chapter 4.3.3 --- QUALITY OF LIFE --- p.73 / Chapter 4.3.4 --- SERUM PSA LEVEL --- p.74 / Chapter 4.4 --- EFFICACY OUTCOMES --- p.74 / Chapter 4.4.1 --- QMAX AND PVR --- p.74 / Chapter 4.4.1.1 --- QMAX --- p.74 / Chapter 4.4.1.2 --- PVR --- p.75 / Chapter 4.4.2 --- IPSS --- p.79 / Chapter 4.4.2.1 --- TOTAL IPSS --- p.79 / Chapter 4.4.2.2 --- IPSS SUB SCORE 1_ INCOMPLETE EMPTYING --- p.79 / Chapter 4.4.2.3 --- IPSS SUB SCORE 2_ FREQUENCY --- p.80 / Chapter 4.4.2.4 --- IPSS SUB SCORE 3_INTERMITTENCY --- p.81 / Chapter 4.4.2.5 --- IPSS SUB SCORE 4_ URGENCY --- p.82 / Chapter 4.4.2.6 --- IPSS SUB SCORE 5_ WEAK STREAM --- p.82 / Chapter 4.4.2.7 --- IPSS SUB SCORE 6_ STRAINING --- p.83 / Chapter 4.4.2.8 --- IPSS SUB SCORE 7_ NOCTURIA --- p.84 / Chapter 4.4.3 --- QOL --- p.90 / Chapter 4.4.3.1 --- QOL IN IPSS Q8_QOL_URINATION --- p.90 / Chapter 4.4.3.2 --- QOL IN SF-36 --- p.91 / Chapter 4.4.3.2.1 --- PHYSICAL FUNCTIONING --- p.91 / Chapter 4.4.3.2.2 --- ROLE-PHYSICAL --- p.92 / Chapter 4.4.3.2.3 --- BODY PAIN --- p.92 / Chapter 4.4.3.2.4 --- GENERAL HEALTH --- p.93 / Chapter 4.4.3.2.5 --- VITALITY --- p.94 / Chapter 4.4.3.2.6 --- SOCIAL FUNCTIONING --- p.95 / Chapter 4.4.3.2.7 --- ROLE-EMOTIONAL --- p.95 / Chapter 4.4.3.2.8 --- MENTAL HEALTH --- p.96 / Chapter 4.4.4 --- SERUM PSA LEVEL --- p.103 / Chapter 4.4.5 --- SUBGROUP ANALYSIS --- p.106 / Chapter 4.4.6 --- SELF-PREFERENCE EFFECT ANALYSIS --- p.107 / Chapter 4.4.7 --- DIARY ANALYSIS --- p.109 / Chapter 4.5 --- ADVERSE EVENTS --- p.113 / Chapter 4.5.1 --- SELF-REPORTED AE/SAE --- p.113 / Chapter 4.5.2 --- SEXUAL HORMONE LEVEL --- p.114 / Chapter 4.5.3 --- SEXUAL RELATED QUALITY OF LIFE --- p.114 / Chapter 4.5.3.1 --- SEXUAL LIFE UNSATISFACTORY --- p.114 / Chapter 4.5.3.2 --- LIBIDO DECREASE --- p.115 / Chapter 5.1 --- PRINCIPAL FINDINGS --- p.116 / Chapter 5.1.1 --- EFFICACY --- p.116 / Chapter 5.1.2 --- SAFETY --- p.117 / Chapter 5.2 --- STRENGH AND LIMITATIOINS --- p.117 / Chapter 5.2.1 --- STRENGTH --- p.117 / Chapter 5.2.1.1 --- BLINDING IS EFFECTIVE --- p.117 / Chapter 5.2.1.2 --- COMPLIANCE IS GOOD --- p.118 / Chapter 5.2.1.3 --- LONG TREATMENT PERIOD --- p.119 / Chapter 5.2.1.4 --- STUDY OUTCOMES INCLUDE BOTH OBJECTIVE OUTCOMES AND SUBJECTIVE OUTCOMES --- p.121 / Chapter 5.2.2 --- LIMITATIONS --- p.121 / Chapter 5.2.2.1 --- INSUFFICIENT SAMPLE SIZE --- p.122 / Chapter 5.2.2.2 --- POSSIBLY LOW DOSE --- p.122 / Chapter 5.2.2.3 --- LACK OF BASELINE DATA ON QUALITY OF SEXUAL LIFE --- p.123 / Chapter 5.2.2.4 --- "LACK OF DATA ON LIFESTY FACTORES INCLUDING DIETARY HABIT, PHYSICAL ACTIVITY, SMOKING STATUS AND ACOHOL CONSUMPTION" --- p.123 / Chapter 5.3 --- INTERPRETATIONS OF THE RESUTLS --- p.124 / Chapter 5.3.1 --- TWO POSIVE RESULTS IN EMPTYING FUNCTION AND QUALITY OF LIFE --- p.124 / Chapter 5.3.2 --- ONE NEGATIVE RESULT IN PEAK URINARY FLOW RATE --- p.127 / Chapter 5.3.3 --- QUALITY OF SEXUAL LIFE --- p.129 / Chapter 6.1 --- CONCLUSIONS --- p.130 / Chapter 6.2 --- IMPLICATIONS --- p.131

5α-reductases (5αRs) catalyse reduction of 4-pregnene steroids, most notably the androgen testosterone to its more potent metabolite dihydrotestosterone (DHT). Well-characterised isozymes of 5αR are designated 5αR1 and 5αR2. Inhibitors of 5αR, finasteride (a 5αR2 inhibitor) and dutasteride (a dual 5αR1 and 5αR2 inhibitor), are utilised in conditions where a reduction in androgen action is desired, including benign prostatic hyperplasia. Although 5αR2 is predominantly expressed in reproductive tissues, both isozymes, but particularly 5αR1, are expressed in metabolic tissues including liver and adipose and both metabolise glucocorticoids as well as androgens; therefore inhibition of 5αR may have consequences for metabolic health. This thesis addresses the hypotheses that 5αR1 inhibition with dutasteride decreases insulin sensitivity and causes dysregulation of the HPA axis in humans. Metabolism and the HPA axis were studied in men prior to and following 3 months of dutasteride (0.5 mg daily; n=16), finasteride (5 mg daily; n=16) or control (tamsulosin MR; 0.4 mg daily; n=14). Glucose disposal during hyperinsulinaemia was the primary endpoint, measured during a hyperinsulinaemic euglycaemic clamp, with d2-glucose and d5-glycerol tracers. Peripheral insulin sensitivity for both glucose uptake and NEFA suppression decreased with dutasteride versus both finasteride and control, while hepatic insulin sensitivity was preserved. Body fat increased with dutasteride, though was not accompanied by changes in metabolic or inflammatory gene transcript abundance in subcutaneous adipose biopsies, nor any differences in abdominal adipose depots on post-treatment MRI. Subtle dysregulation of the HPA axis was evident with both 5αR inhibitors, though to a greater degree with dutasteride and changes were largely compensated for. In support of this study, this thesis also describes the development, validation and application of two novel liquid chromatography tandem mass spectrometry assays; establishing compliance by measuring serum drug levels, and demonstrating effects of 5αR inhibitors on androgen metabolism and adrenal steroidogenesis by measurement of testosterone, DHT and androstenedione. In conclusion, 5αR1 inhibition with dutasteride, but not finasteride, induces peripheral insulin resistance and increases body fat. Findings presented may have important implications for patients prescribed dutasteride for benign prostatic hyperplasia.

Orientador: Flávia de Rezende Eugênio / Banca: Renée Laufer Amorin / Banca: Maria Cecília Rui Luvizotto / Resumo: Ahiperplasiaprostática benigna(HPB) é a afecção mais comum da próstata canina, porém, a comparação dos diferentes métodos diagnósticos como o exame de palpação retal, citologia, histologia e imunoistoquímica é pouco estudada nesta espécie, diferentemente do que ocorre no homem. Este trabalho teve por objetivo estudar, em vinte cães idosos, as alterações cito e histológicas com emprego de imunomarcadores, na glândula prostática. Em todas as glândulas observou-se HPB cística, associada ou não à hiperplasia glandular ou estromal. A imunomarcação com citoqueratina (CK) AE1/AE3 foi relevante em ácinos com epitélio achatado ou com proliferação acentuada. A Vimentina (VIM) V9 teve expressão moderada em áreas com hiperplasia estromal acentuada. O toque retal e o lavado prostático mostraram ser métodos de auxílio no diagnóstico das prostatopatias, sendo indispensável o uso da histopatologia para um diagnóstico definitivo. O emprego de imunomarcadores teciduais prostáticos infere que próstatas com HPB demonstram alterações metabólicas que respondem à imunomarcação em células hiperplásicas. / Abstract: Benign Prostatic Hyperplasia (BPH) is the most common affection of the canine prostate, however, the comparison of different diagnostic methods for BPH through, digital rectal examination, cytology, histology and immunohistochemistry has a few studies in this specie, unlike man. The purpose of this study was understood, in twenty old dogs, cytology, histology alterations using immunomarkers in the prostate gland. All the glands showed the presence of cystic BPH, associated or not with glandular or stromal hyperplasia. The immunomarking with AE1/AE3 cytokeratine was relevant in alveoli with flat epytelium or with a strong proliferation. V9 Vimentine showed to be moderate in areas with a deep stromal hyperplasia. Rectal palpation and the prostatic washing product compose auxiliary diagnostic methods for prostatic diseases, being undismissable the use of histopathology for a conclusive diagnosis. Prostatic tissue immunomarkers employment to conclude that the prostate with HPB demonstrate metabolic changes which react with immunomarking in hyperplasic cells. / Mestre

In recent years, domestic medicine companies limited by total value pay system can be regarded as depressing business. While some of medicine companies have been gradually losing their advantages, they, in addition to moving the production base to other countries, hope to find the suitable management system which completely subvert the way of thinking and traditional management skills as well for the purpose of improving the performance and competitiveness of company. Balanced Score Card (BSC) was proposed in 1990 by Kaplan & Norton. This set of management systems is to establish company's vision and mission. According to the survey, BSC has already been introduced by a lot of listed companies or non-listed companies to enhance the business performance. Therefore, we can know that BSC has deeply influenced the operation of Taiwan's companies of. BSC breaks through the traditional limitation to measure the performance in financial views , constructs four major aspects to inspect operation of companies in terms of financials, customers, business internal process and organization learning to grow, and gives consideration to balance between financial performance and non financial performance, balance between long-term goal and short-term goal, balance between internal and external of company, linkage between performance measurement and operation objective, improving management performance measurement system. Application of BSC would convert the organization vision into concrete goal, link the goal with cause-effect relationship, guide the behavior of staff and organization by the performance measurement and incentives, and combine personal goal with company goal. High ranking managers can not only easily communicate with staffs, but also trace back the effectiveness of company operation. However, It is still unable to find out whether the domestic medicine companies selling benign prostatic hyperplasia drugs could use BSC to improve its company performances or not. So, this research selects domestic medicine companies selling benign prostatic hyperplasia drugs as research object and investigates the effect of four major aspects such as financials, customers, business internal process and organization learning to grow, and influences of BSC on company's performance. Also, through qusetionaires and surveys, it would help domestic medicine companies selling benign prostatic hyperplasia drugs to set up the effective BSC system to raise company performance. The result of study can be offered to domestic medicine companies selling benign prostatic hyperplasia drugs as reference in the future.

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Thesis (Ph. D.)--West Virginia University, 1999. / Title from document title page. Document formatted into pages; contains vi, 125 p. : ill. Vita. Includes abstract. Includes bibliographical references (p. 107-122).

Thesis (Ph.D.)--Michigan State University. Dept. of Anthropology, 2008. / Title from PDF t.p. (viewed on July 7, 2009) Includes bibliographical references (p. 127-135). Also issued in print.

Purpose: Ultrasonically measured intravesical prostatic protrusion may be a promising noninvasive method of assessing bladder outlet obstruction. Previous investigations of this technique focused on patients with acute urinary retention and symptomatic men identified in urology clinics, which may not reflect the distribution of intravesical prostatic protrusion in community dwelling men. Materials and Methods: In 2006 a total of 322 white men residing in Olmsted County, Minnesota underwent transrectal ultrasound examination which permitted direct measurement of intravesical prostatic protrusion. Cross-sectional associations between lower urinary tract symptoms/benign prostatic enlargement and intravesical prostatic protrusion were measured. Rapid increases in lower urinary tract symptoms/benign prostatic enlargement measures as predictors of severe intravesical prostatic protrusion were also assessed. Results: Overall 10% of these men had an intravesical prostatic protrusion of 10 mm or greater. Greater intravesical prostatic protrusion was weakly correlated with greater prostate volume (rs = 0.28), higher obstructive symptoms (rs = 0.18) and lower peak urinary flow rate (rs = -0.18). Men with the most rapidly growing prostate before intravesical prostatic protrusion measurement were 3 times more likely to have an intravesical prostatic protrusion of 10 mm or greater. Men with an intravesical prostatic protrusion of 10 mm or greater were more likely to use medications for lower urinary tract symptoms/benign prostatic enlargement compared to those with an intravesical prostatic protrusion less than 10 mm (adjusted OR 2.95, 95% CI 1.23-7.06). Conclusions: These population based data provide reference ranges for future studies of intravesical prostatic protrusion as a predictor of adverse urological outcomes. Intravesical prostatic protrusion is significantly correlated with greater prostate volume, higher obstructive symptoms and lower peak urinary flow rate, suggesting that it may have clinical usefulness in predicting the need for treatment.