<p>Colorectal cancer is one of the most common malignancies in Sweden, with more than 5000 new cases annually. Median age at time of diagnosis is approximately 75 years. Owing to the ageing population, the incidence of colorectal cancer is increasing. The improvement in surgical technique and the introduction of adjuvant radio- and chemotherapy increased the 5-year survival rate from approximately 30-40% in the early 1960s to almost 60% in the late 1990s. The cost of public health care has risen considerably, and case-costing systems are increasingly demanded. Linked to clinical guidelines and quality registers, such control systems form a proper basis for quality assurance projects and improvement. The aim of this thesis is to describe the efficiency and cost effectiveness of colorectal cancer treatment in a defined Swedish population. Emergency surgery for colon cancer, constituting 25% of the cases, increased both mortality and cost. Among emergency cases there was not only an increase in postoperative mortality but also a stage specific decrease in long-term survival rate. Correct staging is decisive for further treatment of patients after colon cancer surgery and influences long-term survival. The number of lymph nodes examined varied between different pathology departments and could be used as a quality measurement. The proportion of tumour stage III increased the more nodes examined. A prognostic estimation of stage III cases that is less sensitive to the number of nodes examined is proposed. A case-control study aimed at identifying risk factors for anastomotic leakage after rectal cancer surgery confirmed previously known risk factors but failed to identify further steps during the perioperative course that were amenable to improvement. This research has confirmed that population-based quality and case-costing registers, linked to clinical guidelines, constitute a proper source for projects of quality improvement and decisions about distribution of resources in health care.</p>

A diagnosis of coeliac disease (CD) in adults relies on the presence of a structurally abnormal intestinal mucosa, followed by a clear clinical remission on a gluten-free diet. There is a clear need for a rapid, simple, safe and sensitive method to determine the type and intensity of inflammation in the gut mucosa in clinical practice. The overall aims of our studies were to develop and evaluate a new technique, “the mucosal patch technique”, to characterize rectal local inflammatory process after rectal food challenge in patients with CD<b>. In study 1</b> we evaluated the potential of the new technique. The technique was well tolerated and easily applied. Pronounced neutrophil and eosinophil involvement in ulcerative colitis (UC) was demonstrated. With the high sensitivity of the technique, low-degree mucosal neutrophil activation could also be quantified in patients with collagen colitis,UC in clinical remission and in patients with irritable bowel syndrome. <b>In study 2 and 3</b> the aim was to elucidate the dynamics of the rectal inflammatory response and nitric oxide (NO) production after rectal gluten challenge. We found a pronounced neutrophil activation in coeliac patients after rectal gluten challenge. This activation was apparent 4 hours after challenge and remains for at least 48 hours. A more modest eosinophil activation started 1-2 hours later and remained at least for 48 hours. The biphasic pattern of neutrophil and eosinonphil activation after challenge suggests a biphasic inflammatory reaction. The activation of neutrophils and eosinophils precedes a pronounced enhancement of mucosal NO production. Some of our coeliac patients displayed signs of an inflammatory reaction after rectal corn gluten challenge. <b>In study 4</b> the aim was to investigate the local inflammatory reaction to gluten and cow’s milk protein in CD patients in remission. The findings indicate that not only gluten sensitivity but also cow’s milk (CM) protein sensitivity is common in CD. The data support the hypothesis that CM sensitivity may contribute to persistent symptoms in coeliac patients on gluten-free diet.

Colorectal cancer is one of the most common malignancies in Sweden, with more than 5000 new cases annually. Median age at time of diagnosis is approximately 75 years. Owing to the ageing population, the incidence of colorectal cancer is increasing. The improvement in surgical technique and the introduction of adjuvant radio- and chemotherapy increased the 5-year survival rate from approximately 30-40% in the early 1960s to almost 60% in the late 1990s. The cost of public health care has risen considerably, and case-costing systems are increasingly demanded. Linked to clinical guidelines and quality registers, such control systems form a proper basis for quality assurance projects and improvement. The aim of this thesis is to describe the efficiency and cost effectiveness of colorectal cancer treatment in a defined Swedish population. Emergency surgery for colon cancer, constituting 25% of the cases, increased both mortality and cost. Among emergency cases there was not only an increase in postoperative mortality but also a stage specific decrease in long-term survival rate. Correct staging is decisive for further treatment of patients after colon cancer surgery and influences long-term survival. The number of lymph nodes examined varied between different pathology departments and could be used as a quality measurement. The proportion of tumour stage III increased the more nodes examined. A prognostic estimation of stage III cases that is less sensitive to the number of nodes examined is proposed. A case-control study aimed at identifying risk factors for anastomotic leakage after rectal cancer surgery confirmed previously known risk factors but failed to identify further steps during the perioperative course that were amenable to improvement. This research has confirmed that population-based quality and case-costing registers, linked to clinical guidelines, constitute a proper source for projects of quality improvement and decisions about distribution of resources in health care.

No description available.

Si les connaissances anatomiques supportent l'élaboration des techniqueschirurgicales, peu d'informations étaient disponibles sur l'anatomie et la physiologie del'innervation pelvi-périnéale. La détermination précise de l'origine, du trajet péri-viscéral, desrapports anatomiques avec les organes et les vaisseaux de voisinage et de la terminaison deces nerfs au niveau d'organes dont ils commandent la fonction était jusqu'alors peu accessibleaux techniques anatomiques classiques de dissection macroscopique sur sujet cadavérique.Dans le domaine de la chirurgie pelvienne pour cancer, l'amélioration de la qualité de vie desmalades passe par la préservation de ces structures nerveuses, la dimension fonctionnelle étantdésormais indissociable des impératifs carcinologiques. En effet, l'intégrité de ces nerfs estindispensable aux fonctions de continence sphinctérienne et de sexualité. Par ailleurs, lamajorité des travaux s'intéressant aux séquelles fonctionnelles postopératoires sont réaliséschez l'homme et très peu de travaux concernent exclusivement les femmes dont les troublessexuels sont plus difficiles à identifier. La réduction de ces troubles fonctionnelspostopératoires passe donc par une meilleure compréhension de l'anatomie nerveuse pelvipérinéale,qui peut être éclaircie par de nouvelles techniques d'étude

Serial prostate-specific antigen (PSA) measurements (PSA velocity) as an additional instrument to detect prostatic cancer was introduced in 1992. It has previously been reported that PSA increase per year differed in the last 5 years prior to diagnosis in patients with benign prostatic hyperplasia (0.18 ng/ml/year), locally confined (0.75 ng/ml/year) and metastasized (4.4 ng/ml/year) cancer of the prostate (CaP) in contrast to healthy men (0.04 ng/ml/year). The ability of PSA velocity to detect organ-confined CaP in patients with intermediate PSA serum values depends therefore on a reliable and reproducible PSA result. The present study comprised 85 men with PSA values between 3 and 8 ng/ml (Abbott IMx). PSA measurements were repeated with Abbott IMx (n = 85 patients) and Hybritech Tandem-E (n = 59 patients) assays. The PSA serum values differed from one examination to the other from 0.02 to 2.74 ng/ml with the Abbott IMx. Standard deviation amounted to 0.35 ng/ml with the Abbott IMx PSA assay. Using the Hybritech Tandem-E assay, mean standard deviation was 1.15 ng/ml and therefore higher than with the Abbott IMx assay. The difference from one test to the other ranged from 0.05 to 4.05 ng/ml with the Hybritech Tandem-E. Using the Abbott IMx assay, 10.6% of all repeat measurements exceeded 1 ng/ml whereas in the Hybritech Tandem-E assay 62.7% of the second measurements differed >1 ng/ml from the first PSA result. An increase in PSA serum values may therefore be due to intratest variation, physiological day-to-day variation as well as prostatic disease. It is important to notice that the intra-assay variation may be greater than the PSA increase per year in a patient with CaP. Therefore, PSA velocity seems to be of limited value. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-04-25T14:57:15Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) lais_matos_oliveira.pdf: 1897599 bytes, checksum: f8cca6f71386c22ad68bc755f7803402 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-05-16T19:49:29Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) lais_matos_oliveira.pdf: 1897599 bytes, checksum: f8cca6f71386c22ad68bc755f7803402 (MD5) / Made available in DSpace on 2017-05-16T19:49:29Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) lais_matos_oliveira.pdf: 1897599 bytes, checksum: f8cca6f71386c22ad68bc755f7803402 (MD5) Previous issue date: 2016 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / Objetivou-se com este estudo avaliar as caracter?sticas fisiol?gicas de diferentes grupos gen?ticos mantidos no cerrado. Foram avaliados 48 bovinos de corte criados em sistema precoce para abate aos 24 meses, sendo seis machos e seis f?meas de cada grupo gen?tico (Nelore, ? Nelore x ?Caracu, ? Caracu x ? Nelore, ? Angus x ? Nelore x ?Caracu). Os par?metros fisiol?gicos taxa de suda??o (TS), frequ?ncia card?aca (FC), frequ?ncia respirat?ria (FR), temperatura retal (TR), temperatura da superf?cie corporal (TSC) foram obtidos entre 07:00 e 12:00h. Foram avaliados o comprimento, n?mero de pelos por unidade de ?rea, densidade de massa dos pelos e di?metro m?dio dos pelos. A colora??o do pelo e pele foram avaliadas por meio da Tabela Padr?o e do color?metro MniScan XE Plus. O delineamento experimental foi o inteiramente casualizado em esquema fatorial com seis repeti??es. Foi utilizado o procedimento GLM do SAS, adotando-se para compara??o de m?dias o teste t com n?vel de signific?ncia de 5%. O NEL apresentou maior FR seguido pelo ?NCAR. A FC foi maior no ver?o. A TS foi maior no ver?o em rela??o ao outono. A TR foi maior no ?NCAR, seguido pelo ?CAR, sendo a menor TR observada no NEL e TRI. Houve correla??o positiva entre a temperatura do olho e a temperatura retal. Os pelos do dorso e garupa foram mais compridos no outono, e, em rela??o ao sexo, maiores nas f?meas. O comprimento dos pelos na garupa foi maior no TRI, seguido pelo ?CAR, NEL e ?NCAR. O di?metro dos pelo do dorso foi maior para o ?NCAR, seguido pelo ?CAR, TRI e NEL. O n?mero de pelos na garupa foi maior n?mero no ver?o. Os pelos do dorso foram mais inclinados no ?NCAR, seguidos pelo ?CAR, NEL e TRI. No ver?o, os pelos do dorso permaneceram mais inclinados, e, em rela??o ao sexo, os machos tiveram maior inclina??o no dorso e garupa. A densidade dos pelos no dorso e garupa foi maior no outono. Os pelos da garupa foram mais densos no ?NCAR, seguidos do ?CAR, TRI e NEL. A EC no dorso foi maior no TRI, seguida pelo NEL, ?CAR e ?NCAR. Entre os sexos a EC foi maior nas f?meas. A EC na garupa foi maior no TRI, seguida pelo ?CAR, NEL e ?NCAR. Os pelos tanto do dorso quanto da garupa foram mais claros no NEL. Os pelos mais escuros no dorso foram observados no TRI e na garupa no ?CAR. O grupo gen?tico que demonstrou maior adapta??o ? cria??o no Cerrado foi o NEL seguido do ?NCAR. / Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Zootecnia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / The objective with this study was to evaluate the physiological characteristics of different genetic groups maintained in the savannah. Thirty-eight beef cattle raised in a system to be slaughter at 24 months of age were evaluated, with six males and six females of each genetic group (Nellore; ? Nellore x ? Caracu; ? Caracu x ? Nellore; and ? Angus x ? Nellore x ? Caracu). Sweating rate (SR), heart rate (HR), respiratory rate (RR), rectal temperature (RT) and body surface temperature (BST) were obtained between 07:00 and 12:00. Length, number of furs per unit area, mass density of the fur, and the average furs diameter were assessed. Fur and skin coloring were evaluated using the Standard Table and the MniScan XE Plus colorimeter. The experimental design was the completely randomized in a factorial scheme with six replicates. The GLM procedure of SAS was used, adopting the t test for mean comparison with significance level of 5%. The NEL presented higher RR followed by ? NCAR. The HR was higher in the summer. The SR was greater in the summer compared with the autumn. The RT was higher in the ?NCAR, followed by ?CAR, with the lower RT observed in NEL and TRI. There was a positive correlation between eye temperature and rectal temperature. The furs of the dorsum and rump were longer in the autumn, and, in relation to sex, larger in females. The fur length on the rump was longer in TRI, followed by ?CAR, NEL and ?NCAR. The fur diameter on the dorsum was larger for ?NCAR, followed by ?CAR, TRI and NEL. The number of furs on the rump was higher in the summer. The furs on the dorsum were more inclined in ?NCAR, followed by ?CAR, NEL, and TRI. In the summer, the furs on the dorsum remained more leaned, and, in relation to sex, the males have a higher inclination on the dorsum and rump. Fur density on the dorsum and rump was higher in autumn. The furs of the rump were denser in ?NCAR, followed by ?CAR, TRI, and NEL. The EC on the dorsum was higher in TRI, followed by NEL, ? CAR, and ?NCAR. Among the sexes, the EC was higher in females. The EC on the rump was higher in TRI, followed by ? CAR, NEL and ?NCAR. The furs on both dorsum and rump were clearer in the NEL. The darker furs on the dorsum were observed on TRI and on the rump on ? CAR. The genetic group that demonstrated the greatest adaptation to the raising in the savannah was NEL followed by ?NCAR.

Fundação de Apoio a Pesquisa e à Inovação Tecnológica do Estado de Sergipe - FAPITEC/SE / The present dissertation aimed to investigate beliefs and other constructs of the Theory of Planned Behavior (TPB), to developing a model able to identifying the main predictors of the intention to perform Digital Rectal Exam (DRE). For this, we did three studies. In the Study 1, a theoretical chapter on TAP and its applicability to human health behaviors was carried out, with emphasis on the behavior of the ETR. The Studies 2 and 3 were empirical, men between 40 and 70 years old participated, dividing them into two groups: the men that did the DRE x the men that didn’t do the DRE. In the Study 2, we aimed to identify the main beliefs of men about DRE, comparing the responses pattern by group. Here, a questionnaire with sociodemographic and clinical questions and the free word evocation technique were used. We found that men who had already done DRE tended to evoke more terms for the susceptibility and severity of prostate cancer, while men who had never done emphasized the susceptibility to cancer and also the benefits of doing the DRE. These data showed how each group looks at the DRE, allowing for occasional interventions. The Study 3 investigated the predictive model of TPB (attitudes, norms and perception of control), aiming to identify the main predictors of the intention to doing the DRE. A scale with TPB constructs was used, as well as sociodemographic and clinical issues. In short, the results revealed that the attitude is better to predict the intent of men who had never done the DRE, while the norms are better to predict the intention of men who had already done so. And the perception of control seemed to work with the male audience whatever if they did or not the exam. Finally, we understood that TPB and the study of beliefs can help social and health researchers to understand the single factors that induce a person to engage in the behavior of interest, in this case, to understand how men engage in the DRE. / A presente dissertação buscou investigar crenças e os demais construtos da Teoria da Ação Planejada (TAP), visando desenvolver um modelo capaz de identificar os principais preditores da intenção de realizar o Exame do Toque Retal (ETR). Para isto, realizou-se três estudos. No Estudo 1 foi realizado um capítulo teórico sobre a TAP e sua aplicabilidade a comportamentos de saúde do homem, com ênfase no comportamento de realização do ETR. Já os estudos 2 e 3 foram empíricos, realizados com homens entre 40 e 70 anos de idade, dividindo-os em dois grupos: Fez o ETR x Não fez o ETR. No Estudo 2, procurou-se identificar as principais crenças de homens acerca do ETR, comparando padrão de respostas por grupo. Aqui, utilizou-se um questionário com questões sociodemográficas e clínicas, além da técnica de evocação livre de palavras. Constatou-se que os homens que já fizeram o ETR costumaram evocar mais termos voltados à suscetibilidade e gravidade do câncer de próstata, enquanto que os homens que não o fizeram destacou a suscetibilidade ao câncer e, também, os benefícios de realizar o ETR. Tais dados mostraram como cada grupo vê o ETR, possibilitando intervenções pontuais. Já o Estudo 3 investigou o modelo preditivo da TAP (atitudes, normas e percepção de controle), visando identificar os principais preditores da intenção de realizar o ETR. Foi utilizada uma escala com os construtos da TAP, além de questões sociodemográficas e clínicas. Em suma, os resultados revelaram que a atitude prevê melhor a intenção de homens que nunca fizeram o ETR, enquanto as normas preveem melhor a intenção de homens que já o realizaram. Já a percepção de controle pareceu funcionar junto ao público masculino independentemente de ter feito ou não o exame. Enfim, entende-se que a TAP e o estudo das crenças podem auxiliar os pesquisadores sociais e da saúde a entender os fatores únicos que induzem uma pessoa a engajar-se no comportamento de interesse, neste caso, entender como homens se engajam na realização do ETR.

Primeiramente objetivou-se neste estudo examinar dentre os principais índices de estresse térmico qual melhor reflete o potencial impacto das condições meteorológicas sobre a homeostase térmica de novilhas leiteiras mestiças. Oito animais foram expostos ao sol das 9h00 às 13h00 em novembro e dezembro de 2016, janeiro e fevereiro de 2017, em Uberlândia, MG, Brasil. Após, foram medidas a frequência respiratória e a temperatura retal. Simultaneamente, foram quantificadas as temperaturas de bulbo seco e bulbo úmido, temperatura do globo negro e velocidade do vento. Em seguida, foram calculados a radiação solar, a umidade relativa, a temperatura radiante média e dez índices de estresse térmico. Os mesmos foram correlacionados com as variáveis fisiológicas e o Índice de Temperatura Equivalente apresentou as maiores correlações, seguido pelo Índice de Estresse Térmico para Vacas e pelo Índice de Estresse Ambiental. Na segunda pesquisa, determinaram-se os valores de temperatura do ar, umidade relativa e Índice de Temperatura e Umidade (ITU) de uma propriedade rural de produção de leite a pasto e da estação meteorológica oficial mais próxima, confrontando-os. Na fazenda, as leituras dos dados foram registradas por uma estação meteorológica automática, a cada cinco minutos, de fevereiro de 2015 a setembro de 2016. Depois, calcularam-se a média por hora e o ITU horário. Selecionaram-se os valores diários mínimo, médio e máximo. O mesmo foi feito com os dados da estação meteorológica oficial, que foram horários. A temperatura mínima e média na estação meteorológica foram maiores que na fazenda, respectivamente, durante todo período experimental e em 16 meses. A temperatura máxima da propriedade rural foi maior que a da estação em seis meses. Já a umidade relativa mínima, média e máxima da estação meteorológica foram inferiores às da fazenda. O ITU mínimo foi maior na estação oficial e o ITU máximo superior na fazenda em todos os meses. Por fim, o número de dias com um ITU máximo igual ou superior ao ITU crítico foi maior na fazenda. Assim, dados da estação meteorológica oficial subestimam o efeito do estresse por calor. / Firstly, the objective of this study was to examine among the main heat stress indexes which ones best reflect the potential impact of meteorological conditions on the thermal homeostasis of half-blood dairy heifers bred. Eight animals were exposed to direct sunlight from 9h00 to 13h00 in November and December of 2016 and January and February of 2017, in Uberlândia, MG, Brazil. After, the respiratory rate and the rectal temperature were measured. Simultaneously, the temperatures of dry bulb and wet bulb, as well as that of black globe, were quantified, as was the wind speed. Afterwards, the solar radiation, the relative humidity, the mean radiant temperature and ten stress indexes were calculated. They were correlated with the physiological variables and the Equivalent Temperature Index presented the highest amount of meaningful correlations, followed by the Cattle Heat Stress Index and the Environmental Stress Index. In a second research, the values of air temperature, relative humidity and Temperature Humidity Index (THI) of one rural property with milk production at pasture and those from the nearest official weather station were determined, confronting them. At the farm, data readings were recorded by an automatic weather station, every five minutes, from February 2015 to September 2016. Then, the hourly average and hourly THI were calculated. The minimum, average and maximum daily values were selected. The same was done with data from the official weather station, which were times. The minimum and mean temperature in the meteorological station were higher than on the farm, respectively, throughout the experimental period and in 16 months. The maximum temperature of the rural property was greater than that of the station in six months. Meanwhile, the minimum, average and maximum relative humidity of the meteorological station were lower than those of the farm. The minimum THI was higher at the official station and the maximum THI higher at the farm in every month. Finally, the number of days with a maximum THI equal to or greater than the critical THI was higher on the farm. Thus, data from the official weather station underestimate the effect of heat stress. / Dissertação (Mestrado)

Les cancers sont l’une des causes majeures de mortalité dans le monde. Les mécanismes en jeu dans la croissance tumorale sont qualitativement connus, mais on se sait pas à l’heure actuelle prédire précisément quel sera le développement d’une tumeur donnée, ni estimer de façon certaine le protocole thérapeutique optimal pour chaque patient. Il est entendu que la modélisation mathématique pourrait apporter des éléments de réponse à ces questions. Durant cette thèse on s'est alors intéressé à la construction de formalismes mathématiques pour décrire la croissance tumorale et l’action de traitement anti-cancéreux. En particulier, on s'est intéressé à la prise en compte des mécanismes aussi bien moléculaires que cellulaires et tissulaires, par la construction d’un modèle continu, multi-échelles, de croissance de tumeur solide et d’angiogenèse. A partir de ce modèle, nous a pu envisager de façon qualitative un protocole optimal de combinaison entre un anti-angiogénique et une chimiothérapie.Le modèle multi-échelles inclut une représentation mathématique des voies de signalisation du VEGF dont on détaille la construction.Dans une autre approche, on a considéré un modèle discret, cellule-centré, reproduisant le développement de sphéroïdes de cellules épithéliales mammaires telles qu’observées lorsque ces cellules sont cultivées in vitro. On a pu mettre en évidence les différents mécanismes cellulaires impliqués dans la morphogenèse de structures composées de cellules saines, et celles composées de cellules mutées.Ces contributions montrent l’intérêt du formalisme multi-échelles adopté pour intégrer les connaissances et données sous-jacentes à l’étude du traitement des tumeurs. / Cancer is one of the leading causes of death in Europe. The mechanisms involved in tumour growth are qualitatively known, but we are still unable to precisely predict how a given tumour will evolve, nor estimate with certainty the optimal therapeutic protocol for each patient.It is well understood that mathematical modelling could give part of the answer to these questions. That is why during this thesis we considered the building of mathematical formalisms to describe tumour growth and the action of anti-cancer treatments. In particular, we investigated the molecular to tissular mechanisms of cancer development and angiogenesis through the building of a continuous multi-scale model. We were able to reproduce the effect of anti- angiogenesis treatments on tumour growth, and qualitatively study an optimal therapeutic protocol of anti-angiogenic combined with cytotoxic drugs. This multi-scale model integrates a mathematical representation of the signalling pathways of VEGF (Vascular Endothelial Growth Factor). We detail the development of this model which is based solely on information available in the literature and dedicated databases. In another approach, we considered a discrete, cell-based model to reproduce the development of spheroid structures of mammary epithelial cells. This model considers the behaviour of these cells when observed while grown in vitro in an appropriate medium. We were able to highlight the different mechanisms involved in the morphogenesis of wild and mutated cells structures.This work shows the importance of the multi-scale formalism we used to integrate the knowledge and data related to the study of cancer treatment.