Thesis (M.F.A.)--Rochester Institute of Technology, 2004. / Typescript. Includes bibliographical references (leaves 92-96).

PURPOSE: To determine the accuracy of prostate biopsy Gleason score (GS) compared to prostatectomy GS. To determine whether a biopsy is a satisfactory diagnostic procedure to offer active surveillance for patients with low-grade prostate cancer. METHODS: This study was conducted in Tuft Medical Center as retrospective cohort study over the period from 2007-2010. The study included 83 patients for whom biopsy and prostatectomy GS were available. MEASUREMENTS: Gleason scores of 6, 7, and 8-10 were assigned to low, moderate, and high-grades, respectively. The kappa statistic was calculated to assess the degree of agreement between biopsy and prostatectomy. The ROC curve was used to evaluate the sensitivity and specificity of prostate biopsy for different Gleason grades. Also, compared whether the use of specific criteria for active surveillance (Johns Hopkins and UCSF) may decrease the level of up-grading in patient with low-grade prostate cancer using Chi-square test. RESULTS: The distribution of low, moderate, and high-grade cancer in biopsy (52%, 32%, 16%) and prostatectomy specimen (33%, 55%, 12%) showed fair agreement with weighted kappa 0.35. The prostate biopsy accurately predicted GS in 46%, up-graded in 38%, and down-graded in 16%. The patients with low-grade cancer and potentially eligible for active surveillance showed up-grading in 50% of cases. This up-grading reduced to 40% with the use of Johns Hopkins criteria and to 41% with the use of UCSF criteria. CONCLUSIONS: The accuracy of biopsy GS in predicting prostatectomy GS is severely limited and therefore biopsy is not enough diagnostic procedure to offer active surveillance.

The effects of temperature, defoliation, light, and certain fall cultural practices on rest and hardiness of Gleason Elberta peach buds were studied. The influence of these factors on abscisic acid concentration in peach buds and a possible role of ABA in rest and hardiness of peach buds were also investigated. Peach leaf buds enter rest in early fall, reach a rest intensity peak in early winter, then break rest as a chilling requirement is met. Complete defoliation before rest has begun will cause some leaf and flower buds to grow, while defoliation after rest has begun will not cause visible bud growth. Effective chill-unit accumulation in the fall apparently did not begin until after a certain amount of leaf abscission had occurred. A GA3 application on August 15, 1974, delayed leaf abscission, and also caused an extension of the rest period. Early fall defoliation was correlated with a reduction in rest intensity and a reduction in the rest period of leaf buds. A result of this study indicates the possibility of the existence of a rest promoting substance that was apparently translocated from a side of a tree exposed to ambient temperatures to a warm greenhouse covered side. Decreasing temperatures caused an increase in flower bud hardiness, however, other factors also had effects on hardiness. An extended day-length treatment caused flower buds to acclimate more slowly than those on untreated trees during the early fall period. The light affect was not evident as colder temperatures prevailed. Buds on trees that were kept warm, acclimated to the same level as buds on trees kept at cooler but non freezing temperatures. However, it took the warm buds approximately four months longer to acclimate. Buds on trees that were exposed to below freezing temperatures acclimated to a much lower level than those on trees not exposed to freezing temperatures. Fall pruning and heavy fertilization with ammonium nitrate did not reduce cold hardiness enough to be measured. However, buds on vigorous, large diameter twigs were more hardy during the early winter period than buds on twigs of smaller diameter. The August 15 and September 19 GA3 treated trees and the early defoliated trees had a delay in acclimation during the fall period, although they did eventually acclimate to the same level as the untreated buds. Abscisic acid concentration in peach leaf and flower buds was low before rest began, increased sharply during the rest inception period, and decreased in concentration before the end of rest. ABA may be a controlling factor in the inception of rest in peach. There was no apparent relationship between ABA concentration and cold hardiness of Gleason Elberta peach flower buds.

El cáncer de próstata es la segunda neoplasia más común en la población masculina del mundo. El comportamiento clínico del cáncer de próstata localizado es muy variable; mientras que algunos casos tienen un tipo agresivo de cáncer que resulta en metástasis y muerte del paciente, otros tendrán un tipo indolente que se puede curar con terapias o monitorear cuidadosamente. Existen múltiples sistemas de estratificación de riesgo de mortalidad que usan parámetros clínicos, como los niveles de PSA y la Puntuación de Gleason. No obstante, estos criterios no pueden predecir adecuadamente el riesgo de recurrencia bioquímica. Los pacientes con cáncer de próstata no pueden ser dicotomizados con precisión en grupos de recurrencia bioquímica de bajo o alto riesgo mediante el uso de parámetros clínicos. Por este motivo se integró información genómica y clínica con el objetivo de identificar potenciales biomarcadores predictivos y generar firmas pronóstico que permitan una dicotomía más acertada de los pacientes. Se empleó una metodología de análisis estadístico predictivo de la recurrencia bioquímica utilizando genes relacionados con la regeneración de células madre de relevancia para la recurrencia bioquímica de cánceres, como la vía de señalización Wnt y la pluripotencia de células madre; y la contribución del parámetro clínico de la Puntuación de Gleason, de manera que se generó un firma pronóstico integrada. La firma integrada fue validada en cohortes independientes de pacientes disponibles en repositorios internacionales para ser dicotomizados en grupos de riesgo que puedan asociarse con un pronóstico bueno o malo. De esta manera, se tendrá un mejor pronóstico de los pacientes y la asignación adecuada de terapias para su tratamiento. Queda claro que el desarrollo y validación de nuevos biomarcadores para evaluar el pronóstico de recurrencia en cáncer de próstata contribuiría a mejorar la salud en la mayoría de los países independientemente de sus características sociales, económicas, culturales y epidemiológicas.

Submitted by Leonardo Cavalcante (leo.ocavalcante@gmail.com) on 2018-04-23T20:47:31Z No. of bitstreams: 1 Arquivototal.pdf: 1433584 bytes, checksum: fb8978802ac3b768c50f569bc4124e5e (MD5) / Made available in DSpace on 2018-04-23T20:47:31Z (GMT). No. of bitstreams: 1 Arquivototal.pdf: 1433584 bytes, checksum: fb8978802ac3b768c50f569bc4124e5e (MD5) Previous issue date: 2014-03-20 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / In this dissertation we develop a rst contact with the theory of Banach Algebras and C*-algebras. As usual of a rst contact, we build the Spectral Theory in Banach algebras with unit. We present the characterization theorems of C *-algebras of Gelfand-Naimark and Gelfand-Naimark-Segal, including the GNS construction. Moreover, we prove a theorem which characterizes all complex homomorphisms in the C*-algebra C(X), as point-evaluation homomorphisms. We also present, as a curiosity, a proof of the Fundamental Theorem of Algebra using the Gelfand-Mazur Theorem. As a prerequisite to the Gelfand-Naimark-Segal's characterization of C *-algebras, we further develop, in the background, the theory of the direct sum of any family of Hilbert spaces. . / Nesta dissertação desenvolveremos um primeiro contato com a Teoria de Álgebras de Banach e C*-álgebras. Como tópico de um primeiro contato, construiremos a Teoria Espectral em Álgebras de Banach com unidade. Apresentaremos os Teoremas de Caracterização de C*-álgebras de Gelfand-Naimark, e Gelfand-Naimark-Segal, incluindo a constru c~ao GNS. Al em disso, provamos um teorema que caracteriza todos os homomor smos complexos na C*-álgebra C(X) como sendo homomor smos de avaliação. Apresentaremos também, como curiosidade, uma prova do Teorema Fundamental da Álgebra a partir do Teorema de Gelfand-Mazur. Como um pré requisito a Caracterização de Gelfand-Naimark-Segal de C*-álgebras, desenvolvemos ainda, em segundo plano, a teoria da soma direta de uma familia qualquer de espaços de Hilbert.

Purpose: To evaluate the validity of the Gleason score after neoadjuvant hormonal treatment as predictor of diseasespecific mortality after radical prostatectomy. Patients and Methods: A total of 2,880 patients with a complete data set and a mean follow-up of 10.3 years were studied; 425 of them (15%) had a history of hormonal treatment prior to surgery. The cumulative incidence of deaths from prostate cancer was determined by univariate and multivariate competing risk analysis. Cox proportional hazard models for competing risks were used to study combined effects of the variables on prostate cancer-specific mortality. Results: A higher portion of specimens with a history of neoadjuvant hormonal treatment were assigned Gleason scores of 8–10 (28 vs. 17%, p < 0.0001). The mortality curves in the Gleason score strata <8 vs. 8–10 were at large congruent in patients with and without neoadjuvant hormonal treatment. In patients with neoadjuvant hormonal treatment, a Gleason score of 8–10 was an independent predictor of prostate cancer-specific mortality; the hazard ratio was, however, somewhat lower than in patients without neoadjuvant hormonal treatment. Conclusion: This study suggests that the prognostic value of the post-radical prostatectomy Gleason score is not meaningfully jeopardized by heterogeneous neoadjuvant hormonal treatment in a routine clinical setting.

<p>We investigate the spectrum of certain Banach algebras. Properties</p><p>like generators of maximal ideals and generalized Shilov boundaries are studied. In particular we show that if the ∂-equation has solutions in the algebra of bounded functions or continuous functions up to the boundary of a domain D ⊂⊂ Cⁿ then every maximal ideal over D is generated by the coordinate functions. This implies that the fibres over D in the spectrum are trivial and that the projection on Cn of the n − 1 order generalized Shilov boundary is contained in the boundary of D.</p><p>For a domain D ⊂⊂ Cⁿ where the boundary of the Nebenhülle coincide</p><p>with the smooth strictly pseudoconvex boundary points of D we show that there always exist points p ∈ D such that D has the Gleason property at p.</p><p>If the boundary of an open set U is smooth we show that there exist points in</p><p>U such that the maximal ideals over those points are generated by the coordinate functions.</p><p>An example is given of a Riemann domain, Ω, spread over Cⁿ where the fibers over a point p ∈ Ω consist of m > n elements but the maximal ideal over p is generated by n functions.</p>

We investigate the spectrum of certain Banach algebras. Properties like generators of maximal ideals and generalized Shilov boundaries are studied. In particular we show that if the ∂-equation has solutions in the algebra of bounded functions or continuous functions up to the boundary of a domain D ⊂⊂ Cn then every maximal ideal over D is generated by the coordinate functions. This implies that the fibres over D in the spectrum are trivial and that the projection on Cn of the n − 1 order generalized Shilov boundary is contained in the boundary of D. For a domain D ⊂⊂ Cn where the boundary of the Nebenhülle coincide with the smooth strictly pseudoconvex boundary points of D we show that there always exist points p ∈ D such that D has the Gleason property at p. If the boundary of an open set U is smooth we show that there exist points in U such that the maximal ideals over those points are generated by the coordinate functions. An example is given of a Riemann domain, Ω, spread over Cn where the fibers over a point p ∈ Ω consist of m &gt; n elements but the maximal ideal over p is generated by n functions.

The thesis is carried out in order to improve the transfer case in trucks with all-wheel-drive. When the truck loses traction at the rear wheels, due to slippery surfaces, wheel-spin occurs. If the driver engages the all-wheel-drive at a point where traction already has been lost, a relative rotational speed in the dog clutch will occur. If this relative speed is too high the dog clutch bounces of itself before coupling or it does not couple at all. To avoid this problem, the geometry of the teeth is modified. FE simulations are done for the existing model as well as for all the new models in order to find out which of them can handle the highest relative rotational speed. The results show that the original model is not the best one. Simple modifications of the teeth’s chamfer distance and chamfer angle shows that the dog clutch can handle up to 120 rpm of relative rotational speed whereas the original model only handles 50 rpm. / Examensarbetet är utfört för att försöka förbättra inkopplingen av allhjulsdrift på lastbilar. När en lastbil kör på halt eller löst väglag kan hjulspinn uppstå vid bakhjulen. Om föraren kopplar in allhjulsdriften när hjulen börjat slira uppstår en relativ rotationshastighet mellan halvorna i klokopplingen. Om denna relativa rotationshastighet är för hög kommer halvorna i kopplingen studsa mot varandra innan de kopplas ihop eller inte koppla ihop alls. För att undvika detta problem har klokopplingens tandgeometri modifierats. FE simuleringar är gjorda på den ursprungliga modellen samt alla nya modeller för att ta reda på vilken som kopplar vid högst relativa rotationshastighet. Resultaten visar att förbättringar kan göras. Enkla modifieringar på avfasningarnas avstånd och vinklar visar att klokopplingen kan klara upp till 120 rpm i relativ rotationshastighet jämfört med den ursprungliga modellen som endast klarar 50 rpm.

Der Gleason-Score ist ein wichtiges Kriterium für die prognostische Einteilung des Prostatakarzinoms und sollte auch am positiven Resektionsrand bestimmt werden. Es wurden 1 836 Prostatakarzinomfälle aus den Jahren 2006-2010 analysiert. Dabei wurden Anzahl sowie Lokalisation der R1-Resektionen; der Gleason-Score und die Länge (mm) des positiven Resektionsrand bestimmt. Danach wurden Unterschiede zwischen R0- und R1-resezierten Patienten; Unterschiede innerhalb der R1-Kohorte und die Länge des positiven Resektionsrands ausgewertet. Es erfolgte eine statistisch-explorative Analyse der Überlebenszeit der R1-Kohorte und der Einfluss der klinisch-pathologischen Variablen (Alter, PSA, pT-, pN-Kategorie, EPE, Gleason-Score im Tumor, Gleason-Score am Resektionsrand, Länge des Resektionsrand, Operationsmodus) auf die Prognose des Prostatakarzinoms. Alle Einteilungen wurden anhand der TNM-Klassifikation 7. Auflage, (UICC), Gleason-Grading-System Revision 2015 (ISUP) und dem prognostischen Gruppierungssystem der ISUP 2015 vorgenommen. Nach radikaler Prostatektomie zeigten 242 (13,2 %) Patienten eine R1-Resektion und 166 (9 %) ein biochemisches Rezidiv. Es zeigte sich, dass in der R1-Kohorte gegenüber der R0-Kohorte mehr pT3-/pT3b-/pT4-Kategorien, mehr positive Lymphknoten, Infiltrationen der Perineuralscheiden und Venen, EPE und Samenblaseninfiltrationen auftraten ( p <0,001). In der R0-Kohorte häuften sich die Gleason-Scores 6 und 7a (25,4 % | 47,5 %), in der R1-Kohorte dagegen die Werte 8 und 9-10 (28,5 % | 17,8 %). Von 242 positiven Resektionsrändern unterschieden sich 147 (60,74 %) in ihrem Gleason-Score vom Gleason-Score des Tumors, 103 (42,56 %) hatten einen niedrigeren und 44 (18,18 %) einen höheren Gleason-Score am Resektionsrand. Die Analyse der R1-Kohorte mittels der ISUP-Grade zeigte, dass in Präparaten mit Gleason-Score von 6 und 7a mehr pT2c- und pT3a-Kategorien vorhanden waren, dagegen in solchen mit Gleason-Score 7b, 8 und 9-10 ein Anstieg von pT3b- und pT4-Kategorien zu verzeichnen war. Mit steigendem ISUP-Grad kam es zum Anstieg der pN-Kategorie, der EPE und der Infiltrationen der Samenblase sowie der Anzahl und medianen Länge der positiven Resektionsränder. Nach Kaplan-Meier wurde der Einfluss der o.g. Variablen auf die Überlebenszeit bis zum biochemischen Rezidiv überprüft. Die roboterassistierten Prostatektomien zeigten mit (82 Mon. | CI 70-96) im Vergleich mit den retropubischen (72 Mon. | CI 68–76) und laparoskopischen (53 Mon. | CI 39–67) die höchste Überlebensrate. Nach 85 Mon. hatten 70 % der R1-Resezierten ein Rezidiv vs. 30 % R0-Resezierter. Überraschend ergab sich innerhalb der R1-Kohorte eine prognostisch „gute“ Gruppe aus Gleason-Score 6 und 7a mit Überlebenszeiten von (72 Mon. | (CI 50–95) || 49 Mon.|(CI 30–69)). Die prognostisch „schlechte“ Gruppe bildeten Gleason-Score 7b, 8, 9-10 (27 Mon. | (CI 16–38), 25 Mon. | (CI 14–36) & 24 Mon. | (CI 11–36)). Patienten mit Gleason-Score ≤6 und 7a am Resektionsrand zeigten (53 bzw. 51 Mon. | CI 50–95) im Vergleich zu Gleason-Score 7b, 8 und 9-10 (25; 24 bzw. 26 Mon.|CI 15–36) rezidivfreies Überleben. Patienten mit Gleason-Score 6 zeigten bei R0- (82 Mon. | CI 78–98) und R1-Resektion (72 Mon | CI 51–94) nur einen geringen Unterschied. Positive Resektionsränder ≤3mm vs. ≥3mm zeigten wie nur ein positiver Resektionsrand vs. multiple positive Resektionsränder ein längeres Überleben. Mittels Cox-Regression wurden die o.g. Variablen auf ihr Risiko für die Entstehung eines biochemischen Rezidivs überprüft. In der univariaten Analyse ergaben sich hohe Risiken für die Gleason-Scores 7b, 8 & 9-10 am positiven Resektionsrand (HR 2,5 bis HR 2,3) und für multiple positive Resektionsränder (HR 2,1). Die multivariate Cox-Regression mit Basis pT-Kategorie ergab eine Steigerung des Risikos für ein Rezidiv durch die Gleason-Scores am Resektionsrand 7b und 8 (HR 1,8) sowie für den positiven Resektionsrand ≥3mm (HR 1,4). Wurde der Gleason-Score des Tumors als Basis genutzt, so erhöhte sich das Risiko für ein Rezidiv durch den Gleason-Score des Resektionsrands 9-10 (HR 1,8), den positiven Resektionsrand ≥3mm (HR 1,4) und multiple positive Resektionsränder (HR 1,4). Auf Basis dieser Ergebnisse ist die Bestimmung des Gleason-Scores am Resektionsrand sowie der Länge und Anzahl der positiven Resektionsränder nach R1-Resektionen erforderlich, um eine bessere Risikostratifizierung durchführen und so die angemessene Therapie auswählen zu können.:Inhaltsverzeichnis Abkürzungsverzeichnis Tabellenverzeichnis Abbildungsverzeichnis 1. Einführung 1.1 Klassifikation 1.1.1 TNM-Klassifikation 1.1.2 Gleason-Score 1.2 Forschungsstand zu positiven Resektionsrändern 1.2.1 Forschungsstand zum Gleason-Score am Resektionsrand 1.2.2 Forschungsstand zur Länge des positiven Resektionsrand 2. Ziele der Arbeit 3. Materialien und Methoden 3.1 Studienpopulation 3.2 Vorgehen der Erhebung 3.2.1 Bestimmung des Gleason-Scores am Resektionsrand 3.2.2 Bestimmung der Länge des positiven Resektionsrands 3.3 Pathologische Klassifikationen 3.4 Geräte 3.5 Statistische Methoden 4. Ergebnisse 4.1 Analyse der klinisch-pathologischen Kriterien für Grundgesamtheit, R1- und R0-Kohorte 4.1.1 Subgruppenanalyse der R1-Kohorte nach ISUP-Graden 4.2 Korrelationsanalyse von Gleason-Score und Länge des positiven Resektionsrandes 4.3 Überlebenszeitanalyse der Grundgesamtheit 4.3.1 Überlebenszeitanalyse der R1-Kohorte unter Gruppierung klinisch-pathologischer Variable 4.4 Hazard Ratios der klinisch-pathologischen Variablen 5. Diskussion 5.1 Limitationen 6. Zusammenfassung 7. Literaturverzeichnis Anhang Lebenslauf Danksagung Eigenständigkeitserklärung