INTRODUÇÃO: O mixofibrossarcoma (MFS) é um dos mais frequentes sarcomas de partes moles (SPM) em idosos que afeta principalmente as extremidades. Historicamente, é um grupo de tumores heterogêneos. Clinicamente está caracterizado por apresentar uma alta incidência de recorrência local (RL) e um conhecimento limitado sobre a sua capacidade de metástase. O índice de RL após a ressecção cirúrgica é relativamente maior quando comparado com outros SPM. Não existe um consenso em como identificar os pacientes com maior risco. O objetivo deste estudo foi analisar os fatores de prognóstico dos pacientes diagnosticados com MFS em uma instituição única. MÉTODOS: Foram analisados retrospectivamente os prontuários de 75 pacientes com diagnóstico confirmado de MFS nas extremidades, que foram submetidos a tratamento cirúrgico, nos últimos 25 anos. Comparamos idade, sexo, tamanho e localização do tumor, grau histológico segundo a Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) e o estádio segundo a American Joint Committee on Cancer (AJCC). A média de idade foi 49,7 anos. A localização foi: membro superior (25,4%), membro inferior (66,6%) e pelve (8%). Os pacientes apresentaram baixo, intermediário e alto grau, em: 29,3%, 24% e 46,7% dos tumores, respectivamente. Pelo tamanho foram categorizados em: =/< 5 cm (13,3%), > 5 e <10 cm (42,7%), > 10 e <15 cm (9%) e =/> 15 cm (18,7%). Em total, 26,7% receberam radioterapia pós-operatória. As margens foram livres em 76% e comprometidas em 24%. A análise da regressão de Cox bivariada foi utilizada para determinar as associações entre os fatores clínicos e de tratamento com a RL. RESULTADOS: O tempo médio de seguimento foi 30.7 meses. O 26,7% dos pacientes apresentaram RL. Metástase foi reportada em 27 (36%) pacientes. O local mais comum de metástase foi: pulmão (92,6%) e gânglios linfáticos (18,5%). O tempo médio de sobrevida dos pacientes com metástase foi 21,2 meses. Os fatores preditivos para RL foram: margens comprometidas (hazard ratio 5.47, 95% intervalo de confiança, 2.23-13.40, P < 0.001) e metástase (hazard ratio 10.24, 95% intervalo de confiança, 3.53-26.68, P < 0.001). Os fatores preditivos da sobrevida livre de RL foram: grau histológico, margens comprometidas (hazard ratio 3.18, 95% intervalo de confiança, 1.51-6.70, P =0.001), e metástase (hazard ratio 15.23, 95% intervalo de confiança, 5.57-41.61, P= 0.001). Os fatores preditivos de sobrevida em geral foram: RL (hazard ratio 5.13, 95% intervalo de confiança, 2.15-12.24, P < 0.001), e metástase (hazard ratio 540.97, 95% intervalo de confiança, 5.04-58112.03, P < 0.001). CONCLUSÃO: As margens cirúrgicas comprometidas e a metástase estão diretamente associadas com a RL. O grau histológico do tumor, as margens comprometidas, a RL e a metástase, são fatores de pior prognóstico no MFS / BACKGROUND AND AIMS: Myxofibrosarcoma (MFS) is one of the most common soft tissue sarcomas (STS) in elderly patients and it primarily affects the extremities. They are a historically heterogeneous group of tumors. The clinical course of MFS is characterized by a high incidence of local recurrences (LR), but knowledge about distant metastasis is sparse. MFS is reported to have a higher risk of LR following definitive surgical excision relative to other STS. There is no agreement on how to identify patients at major risk. The objectives of this study were to analyze the prognostic factors and outcomes of patients with MFS treated at a single institution. METHODS: We retrospectively reviewed the records of 75 patients with pathologically confirmed MFS of the extremities who underwent surgery in the last 25 years. We compared the age, sex, tumor size and location, Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade and the American Joint Committee on Cancer (AJCC) stage. Median age was 49.7 years (range, 1 to 88 y). Site of disease was: upper extremity (25.4%), lower extremity (66.6%) and pelvic (8%). Patients had low, intermediate and high-grade, in: 29.3%, 24% and 46.7% of tumors, respectively. Tumors were categorized as =/< 5 cm (13.3%), > 5 and < 10 cm (42.7%), > 10 and < 15 cm (9%) and =/> 15 cm (18.7%). In total, 26.7% received postoperative radiotherapy. All patients underwent surgery. Margins were negative in 76% and positive in 24%. Bivariate Cox regression analysis was utilized to determine associations between clinical and treatment factors with LR. RESULTS: Median follow-up time was 30.7 months (range, 1.8 to 383.8 m). We found a 26.7% of LR. Distant metastasis was reported in 27 (36%) patients. The most common sites of metastasis were: lung (92.6%) and lymph nodes (18.5%). The overall survival rate in patients with metastasis was 21.2 months (range, 4.8 to 114.8 m). Predictors of LR were: positive margins (hazard ratio 5.47, 95% confidence interval, 2.23-13.40, P < 0.001) and distant metastasis (hazard ratio 10.24, 95% confidence interval, 3.53-26.68, P < 0.001). Predictors of overall survival free of LR were: grade, positive margins (hazard ratio 3.18, 95% confidence interval, 1.51-6.70, P =0.001), and distant metastasis (hazard ratio 15.23, 95% confidence interval, 5.57-41.61, P= 0.001). Predictors of overall survival were grade, LR (hazard ratio 5.13, 95% confidence interval, 2.15-12.24, P < 0.001), and distant metastasis (hazard ratio 540.97, 95% confidence interval, 5.04-58112.03, P < 0.001). CONCLUSION: In this institutional series of MFS, positive margins and distant metastasis were significantly associated with a higher risk of LR. Tumor grade, LR, positive margins and distant metastases were significant predictors of overall survival poor prognosis

On choisit un groupe algébrique G, un sous-groupe algébrique H de G ; on choisit une mesure de probabilité borélienne μ sur G. On considère alors la chaîne de Markov sur l’espace homogène X = G/H de probabilité de transition Px = μ * δx pour x ε X. Dans cette thèse, on étudie les propriétés de récurrence de ces marches aléatoires.On s’intéresse à deux types de récurrence : la récurrence presque-sûre (toute trajectoire revient presque-sûrement infiniment souvent dans un compact) et la récurrence en loi (il existe une mesure de probabilité μ stationnaire sur X .On s’intéresse également aux éventuelles propriétés de transience presque-sûre (toute trajectoire quitte presque-sûrement définitivement tout compact).On construira d’abord un exemple où on n’a ni récurrence presque-sûre en tout point, ni transience presque-sûre en tout point. On montrera ensuite un critère de récurrence presque-sûre dans le cas où G est un groupe de Lie semi-simple ; on a en fait dans ce cas une dichotomie : soit tous les points sont récurrents,soit tous les points sont transients.Dans le cas où G est le groupe affine GL(d,ℝ) α ℝd,on donnera un critère de récurrence en loi sur les Grassmanniennes affines, et, dans un dernier chapitre, on donnera quelques résultats partiels d'un projet en cours,permettant de donner des résultats pour le groupe SO(p, p+1) α ℝ2p+1. / Choose an algebraic group G, and an algebraic subgroup H. Choose a Borel probability measure μ on G. Consider the Markov chain on the G-space X = G/H with transition probability Px = μ * δx for x ε X.The point of this dissertation is the study of the recurrence properties of such a random walk.We consider two types of recurrence : almost-certain recurrence (i.e. almost-every trajectory enters some compact set infinitely often) and the associated almost-certain transience (where almost-every trajectory eventually leaves every compact set) and recurrence in law (i.e. there exists a μ stationary probability measure on X).First, we show that, in general, there is no dichotomy between almost-certain recurrence and transience by constructing an example with both almost-certainly recurrent and almost-certainly transient points.We then prove a criterion for almost-certain recurrence when G is a semi-simple Lie group and X is a G-space. In fact, in this case, we have a dichotomy where either every point of X is almost-certainly recurrent, or every point of X is almost certainly transient.When G is the affine group GL(d,ℝ) α ℝd, we give a criterion for recurrence in law on the affine Grassmannians.In the final chapter, we give some partial results from an ongoing project,which give a criterion for recurrence in law the group SO(p,p+1)α ℝ2p+1.

Orientador: Antônio José Maria Cataneo / Resumo: Introdução: No melanoma primário, a aplicabilidade da biópsia de linfonodo sentinela (BLS), seguida ou não de esvazimento linfonodal (EL) é conhecida. Na recidiva locorregional (RL) de melanoma, alguns serviços tendem a indicá-la, buscando estadiamento mais acurado para embasar condutas individualizadas aos pacientes, ainda que as evidências sejam insuficientes. Objetivo: Avaliar o sucesso da BLS no encontro do linfonodo sentinela (LNS) e sua positividade na RL. Comparar a sobrevida entre os pacientes com LNS positivo e negativo. Verificar diferença na sobrevida pós EL. Métodos: Revisão sistemática, através das bases MEDLINE via PUBMED, LILACS, SCOPUS, EMBASE e CENTRAL, buscando estudos experimentais e observacionais sobre BLS na RL de melanoma. Desfechos avaliados: sucesso na BLS pelo encontro do LNS, positividade para melanoma no LNS; sobrevida no subgrupo LNS positivo comparado com o negativo; sobrevida livre de doença no subgrupo LNS positivo comparada com o negativo; sobrevida dos pacientes submetidos ao EL. Para metanálises, utilizaram-se RevMan 5.3 e StatsDirect 3.0.121. Resultados: Foram identificados 1872 estudos, destes, seis estudos observacionais foram incluídos, totalizando 449 pacientes. O LNS foi encontrado em 98% das BLS (IC 95-100%, I2=53,7% - seis estudos). LNS com 32% de positividade para melanoma (IC 19-47%, I2= 84,6% - seis estudos). A chance de sobrevida global em cinco anos foi 2,49 vezes maior no subgrupo com LNS negativo (IC 95% 1,41-4,38, I2=0% - qua... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: In primary melanoma, the applicability of sentinel lymph node biopsy (SLB), followed or not by complete lymph node dissection (CLND) is known. In locoregional recurrence (LR) of melanoma, some groups may indicate it for more accurate staging to support individualized management, even with scarce evidence. Objective: To evaluate success in SLB and its positivity in LR. Compare survival between patients with positive and negative sentinel lymph node (SLN). Check for survival modification after CLND. Methods: Systematic review through databases such as MEDLINE via PUBMED, LILACS, SCOPUS, EMBASE and CENTRAL, searching for experimental and observational studies on SLB in melanoma LR. Outcomes assessed: success in SLB by finding the SLN, positivity for melanoma in the SLN; survival in the positive SLN subgroup compared to the negative one; disease-free survival in the positive versus negative SLN subgroup; survival of patients undergoing CLND. For meta-analyzes, RevMan 5.3 and StatsDirect 3.0.121 were used. Results: The total number of patients in six observational studies was 449, over 1872 studies indentified. The SNL was found in 98% of SLB (95-100% CI, I2 = 53.7%, 6 studies). SLB detected 32% positivity for melanoma on SNL (CI 19-47%, I2 = 84.6%, 6 studies). The chance of five year overall survival was 2,49 higher in the negative SNL subgroup (95% CI 1.41-4.38, I2 = 0%, 4 studies). Meta-analyzes were not performed due to lack of objective data for disease-free survi... (Complete abstract click electronic access below) / Doutor

This licentiate consists of two papers treating polynomial sequences defined by linear recurrences. In paper I, we establish necessary and sufficient conditions for the reality of all the zeros in a polynomial sequence {P_i} generated by a three-term recurrence relation P_i(x)+ Q_1(x)P_{i-1}(x) +Q_2(x) P_{i-2}(x)=0 with the standard initial conditions P_{0}(x)=1, P_{-1}(x)=0, where Q_1(x) and Q_2(x) are arbitrary real polynomials. In paper II, we study the root distribution of a sequence of polynomials {P_n(z)} with the rational generating function \sum_{n=0}^{\infty} P_n(z)t^n= \frac{1}{1+ B(z)t^\ell +A(z)t^k} for (k,\ell)=(3,2) and (4,3) where A(z) and B(z) are arbitrary polynomials in z with complex coefficients. We show that the roots of P_n(z) which satisfy A(z)B(z)\neq 0 lie on a real algebraic curve which we describe explicitly.

Bakgrund: Cancer är en sjukdom som 61000 individer drabbas av i Sverige varje år. Antalet överlevande är större tack vare tidigare upptäckt av cancer. Att drabbas av cancer kan upplevas traumatisk varför flera efter friskförklarande upplever rädsla för canceråterfall. Syfte: Syftet med denna litteraturöversikt var att utforska upplevelser av att leva med rädsla för canceråterfall. Metod: En litteraturöversikt över nio vetenskapliga artiklar enligt Fribergs metod. Artiklarna till resultatet hämtades från Academic Search Complete, Cinahl Complete och Nursing &amp; Allied Health Database. Resultat: Rädsla för canceråterfall kan ses som ett fenomen som orsakar lidande hos den drabbade, och påverkar fler områden i livet negativt, fysiska, psykologiska samt psykosociala. Litteraturöversikten presenteras i två teman. Det första temat är Utlösande fenomen som behandlar fenomen som ökar rädslans intensitet. Det andra temat är Hantering av rädslan för canceråterfall som behandlar hur det drabbade påverkas psykosocialt och hur de hanterar livet. Diskussion: Canceröverlevare befinner sig i en ny livssituation efter cancerbehandlingen är klar, detta kan innebära svårigheter att hantera livet efter cancersjukdom. Sjuksköterskan behöver vara uppmärksam på att dessa patienter inte enbart dyker upp i onkologisk kontext utan också i öppenvården. Litteraturöversiktens fynd har diskuterats utifrån Roys adaptionsmodell. / Background: Cancer is a disease that 61,000 individuals suffer in Sweden each year. The number of survivors is greater due to early cancer detection. Being affected by cancer can be perceived as traumatic, which is why several people whom survived cancer, experience fear of cancer recurrence. Aim: The aim of this literature review was to explore experiences of living with fear of cancer recurrence. Method: A literature review of nine scientific articles according to the Friberg method. The results articles were taken from Academic Search Complete, Cinahl Complete and Nursing &amp; Allied Health Database. Results: Fear of cancer recurrence can be seen as a phenomenon that causes suffering in the affected person, and affects areas of life negatively, physically, psychological and psychosocially. The literature review is presented in two themes. The first theme is Triggering Phenomena which deals with phenomena that increase fear. The second theme is Managing the Fear of Cancer Recurrence, which addresses how the fear affect the affected psychosocially and how the affected deal with life. Discussion: Cancer survivors are in a new life situation after the cancer treatment is complete, this can mean difficulties in managing life after cancer. The nurse needs to be aware that these patients not only appear in the oncological context but also in outpatient care. The findings of the literature review have been discussed on the basis of Roy's adaptation model

The crime of theft according to section 205 of Czech Criminal Code This diploma thesis focuses on crime of theft according to section 205 of the Act No. 40/2009 Coll. Criminal code. Crime of theft is the most committed crime out of them all. It is therefore possible to think that one of the causes of such a high frequency may be its inadequate regulation in the Criminal Code. For this reason, the aim of thesis was to describe and evaluate its development and propose possible changes. Thesis also includes a comparison with the foreign regulation and extensive work with the judicial case law, which significantly contributed to the completion of the individual qualified crime elements Thesis is divided into five chapters and many subchapters. The introductory chapter is devoted to the inclusion of theft into the system of property crimes. In the following section are mentioned earlier opinions on the protection of property as such and how ownership is protected today. The second chapter describes, evaluates and compares the historical development of the legal regulation of the theft with the current regulation, especially in the Czech territory. This chapter discusses how different the perception of the property protection was and over the period has been. Also, next part in this chapter is devoted to...

Purpose: Meningiomas are common intracranial tumors, often well controlled with surgical resection alone. While the efficacy of radiation therapy in improving local control and progression-free survival is well documented, prognostic data substantiate factors that are predictive of poor local control following definitive radiation therapy. PCNA is a DNA polymerase expressed at the highest levels in the S-phase, the most resistant portion of the cell cycle to ionizing radiation in vitro. We investigated the possible correlation between the levels of PCNA expression and the clinical outcome of patients treated with definitive radiation therapy. Methods and Materials: Archival tissue was collected from 33 cases of meningioma treated at our institution for definitive radiation therapy between 1970 and 1990. Age-matched normal meningeal tissue and asymptomatic meningiomas removed at autopsy served as tissue controls. A standard ABC immumoperoxidase technique employing antibodies to PCNA, PC-10 (Dako, California) was used to stain specimen slides for PCNA. PCNA index was defined as the number of positive nuclei per 10 high-power fields at 400x magnification. Two independent observers scored the slides without prior knowledge of the cases at hand. Results: Patients with high PCNA index were less likely to be controlled by therapeutic radiation (p < 0.001, Kaplan- Meier). All patients with a PCNA index greater that 25 failed radiation therapy. Using multivariate analyses, malignant (but not atypical), histology and PCNA index were significant predictors of progression following radiation therapy (p < 0.05, log rank). Conclusion: PCNA index may be a useful adjunct to more standard histopathologic criteria in the determination of meningioma local control and progression-free survival following therapeutic irradiation. Data on a more expanded population evaluated on a prospective basis will be needed before such criteria are routinely employed in the clinical setting.

Background: The number of cancer survivors across North America is increasing, with estimates indicating that this population will grow to nearly 19 million individuals by the end of 2020. This increase can be attributed, in part, due to improvements in cancer treatments, of which radiation therapy is most commonly used. Unfortunately, exposure to radiation also increases the risk of secondary cancer development long-term. Moreover, obesity and physical inactivity are prevalent, modifiable, risk factors among cancer survivors, with both factors being linked to decrements in quality of life, increased cancer risk, and greater mortality risk. To date, there has been promising epidemiological and clinical data highlighting the role of exercise as a way to mitigate cancer risk and improve survival; however, longitudinal studies are lacking and the effects of radiation in these studies have been largely ignored. Therefore, there is a major clinical need to directly evaluate the combinatory long-term effects of radiation, exercise, and/or obesity to reveal their implications on healthspan, cancer incidence, and survival. Recent pre-clinical work from our group has shown that after being exposed to radiation, endurance exercise prevented several negative alterations to hematopoietic stem cells and their niche caused by high-fat diet (HFD)-induced obesity. We also showed that leukemic blast viability in vitro was greater when cultured in bone marrow supernatant from mice with HFD-induced obesity compared to bone marrow supernatant from mice without HFD-induced obesity. It is unknown, however, whether these findings extend to alterations in cancer risk across the lifespan. As such, the purpose of this study was to evaluate the effects of lifelong exercise and diet-induced obesity on healthspan, cancer incidence, and survival in an established mouse model of radiation-induced cancer. Methods: Male CBA mice (n=80) were randomly divided into either a control diet (CTRL; n=40) of 45% high-fat diet (HFD; n=40) and then further divided into either a sedentary group (SED; n=20) or exercise-trained group (EX; n=20). At age 13 weeks, all mice were exposed to a cancer inducing dose of whole-body ionizing radiation (3 Gy). A healthspan index score and endpoint monitoring were conducted throughout the study by blinded investigators. Results: When normalized to CTRL/SED, the highest healthspan score was in the CTRL/EX (score = +2.5), followed by HFD/EX (score = +1) and lastly HFD/SED (score = -0.5). Cancer incidence was significantly higher in the HFD/SED group when compared to the CTRL/EX group (p<0.05) and a trend for higher cancer incidence for HFD/SED was observed when compared to the CTRL/SED group (p=0.079). There was no significant difference between the HFD/SED and HFD/EX group in cancer incidence (p>0.05). Overall survival was significantly higher in the HFD/SED group compared to CTRL/SED group (p<0.05); however, risk of cancer-related mortality was 1.6-times higher in the HFD/SED group compared to the CTRL/SED group (RR=1.60; 95% CI, 1.00-2.56; p=0.0495) and 1.68-times that of the CTRL/EX group (RR=1.68; 95% CI, 1.02-2.78; p=0.0415). Conclusion: Our findings show that lifelong exercise training resulted in higher healthspan index, lower cancer incidence, and lower risk of cancer-related mortality following radiation exposure, with these effects being largely reversed by HFD-induced obesity. This study provides the rationale for future studies to uncover cellular and molecular mechanisms that could be underlying these results. Moreover, this study presents a proof of concept for the consideration of clinical studies in cancer survivors examining exercise as an intervention to reduce the long-term effects of radiation.

Localized geodetic deformation of an approximately arctangent shape around locked strike-slip faults is widely reported, but there are also important exceptions showing distributed interseismic deformation. Understanding the controlling mechanism is important to the interpretation of geodetic observations for hazard assessment and geodynamic analysis. In this thesis, I use simple finite element models to separately study the two major contributors to the deformation: far-field loading and previous earthquakes. The models feature a vertical strike-slip fault in an elastic layer overlying a viscoelastic substrate of Maxwell or Burgers rheology, with or without weaknesses representing extensions of the fault either along strike or to greater depth. If the locked fault is loaded only from the far field without the effects of previous earthquakes, localized deformation occurs only if local mechanical weaknesses below the fault and/or somewhere along strike are introduced. I first show that the effects of far-field loading are rather limited even in the presence of extreme weaknesses. Then I use idealized earthquake cycle models to investigate the effects of past seismic events in a viscoelastic Earth. I demonstrate that, after a phase of fast postseismic deformation just after the earthquake, the localization of interseismic deformation is controlled mainly by the recurrence interval of past earthquakes. Given viscosity, shorter recurrence leads to greater interseismic localization, regardless of the rheological model used. The presence of a low-viscosity deep fault zone does not change this conclusion, although it tends to lessen localization by promoting faster postseismic stress relaxation. Distributed interseismic deformation, although less reported in the literature, is a natural consequence of very long recurrence and in theory should be as common as localized deformation. The apparent propensity of the latter is likely associated with the much greater quantity and better quality of geodetic observations from higher-rate and shorter-recurrence faults. Using viscoelastic earthquake-cycle models, I also explore the role of nearby earthquakes and creeping segments along the same fault. For faults of relatively short recurrence, frequent ruptures of nearby segments, modelled using a migrating rupture sequence with or without temporal clustering, further enhance localization. For faults of very long recurrence, faster near-fault deformation induced by a recent earthquake may give a false impression of localized interseismic deformation. / Graduate

Improvements in the medical field have given many cancer patients and survivors better odds of long-term survival. As more patients become survivors, the demand for psychological treatment becomes greater. The most prevalent concern of survivors is getting help with a psychosocial condition known as fear of recurrence (FOR). Prior to this study, few researchers had explored how having a more aggressive cancer influences the development of FOR. The purpose of this quantitative study was to determine whether cancer stage and type (a measurement of severity) are predictive of FOR development in the high-risk cancer groups lung and bronchus and female breast. The theoretical framework guiding this research was based on Mishel's theory of uncertainty in illness, which states that uncertainties about illness recurrence can cause survivors to experience breakdown in their lives (whether psychological and/or physical). The fear of cancer recurrence inventory (FCRI) survey was administered to 97 lung and bronchus and female breast cancer survivors; the survivors were asked to rate their level of discomfort about the possibility of a cancer recurrence. Data were analyzed using multiple linear regression. The results indicated that cancer type and severity both impacted the development and severity of FOR in lung and bronchus and female breast cancer survivors. Furthermore, regardless of the cancer type, stage of cancer, age of the survivor, or years in remission, survivors reported clinical levels of FOR in all areas of concern. Practitioners can use the current findings to work towards developing better intervention and treatment programs that promote quality survivorship and reduce the risk and rate of FOR in high risk cancer populations.