Hot flashes are one of the most bothersome symptoms experienced by women who have undergone breast cancer treatment-induced menopause. This vasomotor symptom has been hypothesized to be responsible for decreased sleep quality. This study further investigated the relationship between hot flashes and sleep quality in this population. The convenience sample consisted of 30 women being seen at an outpatient clinic in a comprehensive cancer center in southwest Florida. All participants were between the ages of 36-65, had a diagnosis of breast cancer and were currently taking a selective estrogen receptor modulator for at least six weeks. The participants completed the Hot Flash Diary, Hot Flash Questionnaire, Hot Flash Related Daily Interference Scale, Pittsburgh Sleep Quality Index and a demographic form. The mean sleep score of the sample was 9.33 (SD= 4.4). Global sleep scores above five are indicative of poor sleep quality, and global sleep scores of eight or more have been linked to cancer-related fatigue. Sleep was strongly correlated with hot flash distress (r = .754, p. = .000) and hot flash severity (r = .718, p. = .000) and moderately correlated with hot flash interference (r = .507, p. = .004) and hot flash frequency while asleep (r = .680, p. = .000). The small sample size was a study limitation. However, study results do support findings from previous studies. This study addresses a symptom management problem that may give nurses better understanding of the experiences of their patients. These findings also may assist patients in helping their providers to understand the frustration they are experiencing with regard to their decreased sleep quality.

Während der letzten Jahre stellten GnRH-II-Antagonisten einen Interessenschwerpunkt bei der endokrinen Therapie gynäkologischer und auch anderer Karzinome wie des Prostatakarzinoms dar. Es konnte dargestellt werden, dass GnRH-II-Antagonisten schon in nanomolaren Konzentrationen in vitro und in vivo zu Apoptose von Mamma- Endometriums- und Ovarialkarzinomen führen. In dieser Studie sollte untersucht werden, ob eine Wirkungssteigerung des Antitumoreffekts durch die Kombination des GnRH-II-Antagonisten [(AcD-2-Nal1), (D-4Cpa2), (D-3Pal3), (D-3Pal6), (D-Leu8), (D-Ala10)] mit dem selektiven Estrogenrezeptormodulator (SERM) Tamoxifen beziehungsweise mit dem selektiven Estrogenrezeptordestabilisator (SERD) Fulvestrant erzielt werden kann. Hierzu wurden das Proliferationsverhalten der Ovarialkarzinomzelllinien OVCAR-3, SKOV-3, EFO-21 und EFO-27 sowie Veränderungen der Rezeptorexpression des ER-α, ER-β, GPR-30 und des GnRH-II-Rezeptors bei Behandlung der Zellen mit den einzelnen Substanzen und der Kombination von Tamoxifen und GnRH-II-Antagonist untersucht. Auch die Apoptosewege wurden anhand des Nachweises der Phosphorylierung von p38 und JNK und der Spaltung von Caspase-3 bei Behandlung mit der Kombination von Tamoxifen und GnRH-II-Antagonist untersucht. Die Behandlung der Zelllinien mit der Kombination von Tamoxifen beziehungsweise Fulvestrant und GnRH-II-Antagonist führte bei drei von vier Zelllinien zu einer stärkeren Verminderung der Zellzahl als die Behandlung der Zellen mit den einzelnen Substanzen. Auch auf Rezeptorbasis zeigte die Kombinationstherapie Vorteile gegenüber der Monotherapie mit Tamoxifen und GnRH-II-Antagonist. Apoptose fand bei den untersuchten Zelllinien SKOV-3 und EFO-27 vor allem durch den Weg der Phosphorylierung von JNK statt. Die Phosphorylierung von JNK erfolgte bei der Kombinationstherapie in kürzerer Zeit und fiel intensiver aus als bei einzelner Anwendung der Substanzen Tamoxifen und GnRH-II-Antagonist. Insgesamt konnte gezeigt werden, dass die Kombinationstherapie von Tamoxifen und GnRH-II-Antagonist sowohl bezüglich der Zellproliferation als auch der Rezeptorexpression und der Induktion von Apoptose einer Monotherapie mit den Substanzen überlegen war.

Skeletal fragility is characterized by low bone mass, negative changes in bone microarchitecture, and compromised tissue matrix properties, including accumulation of microdamage. Microdamage accumulates in vivo from daily physiological loading and is targeted for repair through a normal remodeling process, thus preventing microcrack growth and potential fracture. However, impaired remodeling is associated with aging and osteoporosis, resulting in an increased accumulation of microdamage which contributes to reduced bone mechanical properties. The current clinical method for assessing increased risk of fracture involves measuring bone mineral density (BMD) of the hip and spine, locations of trabecular bone where high rates of remodeling occur. The bisphosphonate alendronate (ALN) reduces clinical risk for fracture by significantly increasing BMD, but studies have shown a concomitant reduction in intrinsic properties that may be the underlying cause for recent reports of spontaneous fractures with long-term alendronate use. Another anti-resorptive agent called raloxifene (RAL) is a selective estrogen receptor modulator (SERM) and has been shown to modestly improve BMD while decreasing fracture risk to a similar degree as alendronate. The combination of RAL and ALN as a treatment for osteoporosis may provide the benefits of each drug without the negative effects of ALN. Therefore, the overall goal of this thesis was to address the effects of aging and anti-resorptive agents on the properties of bone through the formation of microdamage. Assessment of age-related effects on bone was conducted through quantification of microdamage progression. It was found that old bone results in greater incidences of microdamage progression, reflecting a compromised tissue matrix with reduced resistance to crack growth. Effects of combination treatment with RAL and ALN were evaluated through biomechanical testing, micro-CT imaging, and microdamage quantification. Results showed improved trabecular bone volume and ultimate load with positive effects on trabecular architecture. Combination treatment reduced the proportion of microdamage that may lead to catastrophic fracture, indicating an improvement in the local tissue matrix properties.