<p>Karcinom dojke predstavlja najče&scaron;ću malignu neoplazmu među ženskom populacijom, a po&scaron;tedna terapija dojke, preferirani je model lečenja bolesnica u ranom stadijumu bolesti. Smatra se da je optimalna hirur&scaron;ka resekciona margina 2 mm. Opisano je mnogo metoda koje služe za intraoperativnu proveru suficijentnosti resekcione hirur&scaron;ke margine i sve one imaju svoje prednosti i mane. Ciljevi ove studije bili su da se utvrdi, da li postoji statistički značajna razlika u određivanju &scaron;irine negativne resekcione hirur&scaron;ke margine izražene u milimetrima pri operacijama karcinoma dojke upotrebom palpatorne metode i intraoperativne mobilne radiografije, poređenjem nalaza merenja hiruga sa većim i manjim iskustvom u hirurgiji karcinoma dojke kao i nalaza radiologa u odnosu na patohistolo&scaron;ku ex tempore analizu. Istraživanje je sprovedeno kao retrospektivno&ndash;prospektivna studija na Klinici za operativnu onkologiju, Instituta za onkologiju Vojvodine i obuhvatilo je 150 bolesnica kod kojih je preoperativno dijagnostikovan karcinom dojke. Kriterijum za uključenje u studiju bilo je izvođenje po&scaron;tedne operacije dojke sa ili bez disekcije ipsilaterale aksile, dok su iz studije isključene bolesnice kod kojih nije bilo moguće izvesti po&scaron;tednu operaciju dojke, one sa radiolo&scaron;ki potvrđenom diseminovanom bole&scaron;ću, kao i bolesnice koje su ranije operisane zbog karcinoma iste dojke. Kod svih 150 ekstirpiranih karcinoma dojke urađena je procena &scaron;irine resekcione hirur&scaron;ke margine intraoperativno palpatornom metodom, zatim na aparatu za mobilnu digitalnu radiografiju, te radiogram analiziran od strane iskusnog i manje iskusnog hiruga u hirurgiji karcinoma dojke, kao i radiologa te upoređen sa nalazom ex tempore patohistolo&scaron;ke analize. Definitivna &scaron;irina resekcione hirur&scaron;ke margine potvrđena je na parafinskim patohistolo&scaron;kim preparatima. Srednja vrednost praćenja bolesnica, postoperativno, iznosila je 100,97 nedelja. Najveći broj bolesnica pripadao je starijoj životnoj dobi (56,67%). Preoperativna lokalizacija klinički nepalpabilnih tumora u dojci urađena je kod 52 (34,67%) bolesnice. Najče&scaron;će se tumor prezentovao kao solitarni fokus sa okolnim ognji&scaron;tima in situ karcinoma (72, 48%), dok je najče&scaron;ći histolo&scaron;ki subtip bio duktalni invazivni karcinom dojke (112 (74,67%)). Najveći broj operacija dojke okarakterisan je kao kvadrantektomija (85 (56,67)), dok je najučestalija operacija aksile bilo određivanje limfnog čvora stražara (119 (79,33%). Analizom rada aparata za mobilnu digitalnu radiografiju do&scaron;li smo do saznanja da nema statistički značajne razlike u oceni kvaliteta radiograma i &scaron;irine resekcione hirur&scaron;ke margine merene na aparatu za mobilnu digitalnu radiografiju između iskusnog hirurga i radiologa. Statistički značajna razlika nije uočena ni pri merenju &scaron;irine resekcione hirur&scaron;ke margine izražene u milimetrima na aparatu za mobilnu digitalnu radiografiju od strane iskusnog hirurga i radiologa u odnosu na ex tempore patohistolo&scaron;ku analizu, dok je ista uočena nakon definitivne patohistolo&scaron;ke analize. &Scaron;ansa doresekcije tkiva dojke nakon merenja na aparatu za mobilnu digitalnu radiografiju je 1,4 puta veća nego nakon patohistolo&scaron;ke ex tempore analize. Lokalni recidiv javio se kod jedne pacijentkinje tokom perioda praćenja. Ne postoji statistički značajna razlika u određivanju &scaron;irine resekcione hirur&scaron;ke margine izražene u milimetrima upotrebom aparata za mobilnu digitalnu radiografiju od strane iskusnog hirurga i radiologa u odnosu na patohistolo&scaron;ku ex tempore analizu, dok ista postoji nakon analize radiograma od strane manje iskusnog hirurga. Palpatorna metoda se ne može smatrati sigurnom metodom u određivanju &scaron;irine hirur&scaron;ke resekcione margine. Ne postoji statistički značajna razlika u broju doresekcije tkiva dojke između hirurga sa različitim hirur&scaron;kim iskustvom.</p> / <p>Breast cancer is the most common malignant neoplasm in the female population, and conservative breast therapy is the preferred treatment model for patients in early stages of the disease. The optimal surgical resection margin, from healthy breast tissue around the primary tumor is 2 mm. Many methods have been described that serve to check the resection margin during breast conservative surgery and all of them have their advantages and disadvantages. The aim of this study was to determine whether there was a statistically significant difference in the determination of the width of the negative resection margin expressed in millimeters in breast cancer surgery using palpatory method and intraoperative mobile specimen radiography, comparing the findings of measuring of surgeons with greater and lesser experience in breast cancer surgery as well as the findings of the radiologist in relation to histopathological ex tempore and definitive histopathological analysis. The study was conducted as a retrospective - prospective study at the Clinic for Operative Oncology, Oncology Institute of Vojvodina and included 150 patients who were preoperatively diagnosed with breast cancer. The criterion for inclusion in the study was the opportunity to perform breast conservative surgery with or without complete axillary lymph node dissection. Patients that were treated with breast amputation, those with radiological confirmed disseminated disease, as well as patients previously operated from cancer were excluded from the study. For all 150 extirpated breast cancers, an estimate of the width of the resection surgical margin was performed intraoperatively with a palpatory method, followed by measuring on device for mobile specimen digital radiography, and a radiogram was analyzed by an experienced and less experienced surgeon in breast cancer surgery, as well as by a radiologist and compared with an ex tempore histopathological analysis. The definitive width of the resection surgical margin was confirmed on histopathological preparations. The mean follow-up, postoperatively, was 100.97 weeks. The majority of patients belonged to the elderly age (56.67%). Preoperative localization of clinically impalpable breast tumors was performed in 52 (34.67%) patients. Most often the tumor was presented as a solitary focus with surrounding foci of in situ cancer (72, 48%), while the most common histological subtype was invasive ductal breast cancer (112 (74.67%)). The majority of breast operations were characterized like quadrantectomy (85 (56.67)), while the most frequent axillary surgery was the determination of the sentinel lymph node (119 (79.33%). No significant difference was observed in the evaluation of radiography quality and the width of the resection surgical margin measured on the mobile digital radiography device between the experienced surgeon and the radiologist. No statistically significant difference was observed in the measurement of the width of the resection surgical margin expressed in millimeters on the mobile digital radiography device by the experienced surgeon and radiologist versus ex tempore histopathological analysis, while the statistical difference was observed after definite histopathological analysis. The chance of breast tissue reexcision after measurement on a mobile digital radiography device is 1.4 times higher than after histopathological ex tempore analysis. Local relapse occurred in one patient during the follow-up period. There is no statistically significant difference in the determination of the width of the resection surgical margin expressed in millimeters using a mobile digital radiography device by an experienced surgeon in breast cancer surgery and radiologist with respect to histopathological ex tempore analysis. However, the statistical difference exists after radiogram analysis by a less experienced surgeon. The palpatory method cannot be considered as a safe method in determining the width of a surgical resection margin. There is no statistically significant difference in the number of breast tissue additional resections between surgeons with different surgical experience.</p>

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Within the context of the assessment of laryngeal function, acoustic analysis has an important place because the speech signal may be recorded non-invasively and it forms the base on which the perceptual assessment of voice is founded. Given the limitations of perceptual ratings, one has investigated vocal cues of disordered voices that are clinically relevant, summarize properties of speech signals and report on a speaker's phonation in general and voice in particular. Ideally, the acoustic descriptors should also be correlates of auditory-perceptual ratings of voice. Generally speaking, the goal of acoustic analysis is to document quantitatively the degree of severity of a voice disorder and monitor the evolution of the voice of dysphonic speakers.<p><p><p>The first part of this thesis is devoted to the analysis of disordered connected speech. The aim is to investigate vocal cues that are clinically relevant and correlated with auditory-perceptual ratings. Two approaches are investigated. The variogram-based method in the temporal domain is addressed first. The second approach is in the cepstral domain. In particular, the first rahmonic amplitude is used as an acoustic cue to describe voice quality. A multi-dimensional approach combining temporal and spectral aspects is also investigated. The goal is to check whether acoustic cues in both domains report complementary information when predicting perceptual scores.<p><p><p>Both methods are tested first on a corpus of synthetic sound stimuli that has been obtained by means of a synthesizer of disordered voices. The purpose is to learn about the link between the signal properties (fixed by the synthesis parameters) and acoustic cues.<p>In this study, we had the opportunity to use two large natural speech corpora. One of them has been perceptually rated. <p><p><p>The final part of the text is devoted to the automatic classification of voice with regard to perceived voice quality. Many studies have proposed a binary (normal/pathological) classification of voice samples. An automatic categorization according to perceived degrees of hoarseness appears, however, to be more attractive to both clinicians and technologists and more likely to be clinically relevant. Indeed, one way to reduce inter-rater variability of an auditory-perceptual evaluation is to ask several experts to participate and then to average the perceptual scores. However, auditory-perceptual evaluation of a corpus by several judges is a very laborious, time-consuming and costly task. Making this perceptual evaluation task automatic is therefore desirable. <p>The aim of this study is to exploit the support vector machine classifier that has become, over the last years, a popular tool for classification, to carry out categorization of voices according to perceived degrees of hoarseness. / Doctorat en Sciences de l'ingénieur / info:eu-repo/semantics/nonPublished

Broadband Dielectric Spectroscopy (BDS) in combination with a nanostructured electrode arrangement – which circumvents the conventional need to evaporate metal electrodes onto soft matter – is used to study the molecular dynamics of several glass forming materials confined in nanometric (> 5 nm) layers. Other complementary experimental tools employed in this work include spectroscopic vis-Ellipsometry (SE), AC-chip calorimetry (ACC), X-ray reflectrometry (XRR), Differential Scanning Calorimetry (DSC) and Atomic Force Microscopy (AFM). The latter is used to characterize the topography of the samples and to determine their thicknesses. Under the conditions of annealing samples (Tg + 50K) in high oil-free vacuum (10E-6 mbars) for at least 12 h and carrying out measurements in inert (dry nitrogen or argon) atmosphere, it is found for all studied thin layers that the structural relaxation, and hence the dynamic glass transition – in its mean relaxation times – remains within a margin ±3 K from the respective bulk behaviour. It is revealed, inter alia, that the one-dimensional confinement of thin films introduces restrictions on other (slower) molecular relaxation processes which manifest, depending on the specific system under investigation, as (i) an interruption of the end-to-end (normal mode) fluctuation of the chains, or (ii) a slowing down of the delta-relaxation when the system is cooled towards glass-formation. Furthermore, (iii) evidence is provided to show that the dimensionality of confinement plays a significant role in determining the resulting dynamics. A molecular understanding of these findings is given, and the discussion presented with respect to the on-going international debate about dynamics in confinement.:1. Introduction 2. The glass transition and chain dynamics 2.1 The phenomenology of the glass transition 2.2 Theories of the glass transition 2.2.1 Free volume theories 2.2.2 Cooperative concepts 2.2.3 Mode-coupling theory 2.3 Dynamics of polymer chains in melt 2.4 The dynamic glass transition in confinement 2.4.1 Experiments: state-of-the-art 2.4.2 Theoretical attempts at explaining dynamics in confinement 3. Sample preparation and experimental techniques 3.1 Thin-film preparation by spin-coating 3.1.1 Films on glass slides 3.1.2 Films on silicon wafers 3.1.3 Reproducibility of sample preparation 3.1.4 Stability of thin film samples 3.1.5 Film thickness determination 3.1.6 Sample annealing experiments 3.2 Use of nanostructured electrodes – a novel approach 3.3 Poly(cis-1,4-isoprene) (PI) in porous media 3.4 Experimental techniques 3.4.1 Broadband Dielectric Spectroscopy (BDS) 3.4.1.1 Polarization 3.4.1.2 Dielectric relaxation 3.4.1.3 Debye relaxation 3.4.1.4 Non-Debye relaxation 3.4.1.5 Dielectric data in the time domain 3.4.1.6 Conductivity contribution 3.4.1.7 The distribution of relaxation times 3.4.1.8 BDS – summary 3.4.2 Spectroscopic Ellipsometry (SE) 3.4.3 AC-chip calorimetry (ACC) 4. Results and Discussion 4.1 Effect of sample geometry on measured dynamics 4.1.1 Introduction 4.1.2 Experimental details 4.1.3 Results and discussion 4.1.4 Summary 4.2 Dynamics of polystyrene in a wide range of molecular weights 4.2.1 Introduction 4.2.2 Experimental details 4.2.3 Results and discussion 4.2.4 Summary 4.3 Molecular dynamics of itraconazole confined in thin supported layers 4.3.1 Introduction 4.3.2 Experimental details 4.3.3 Results and discussion 4.3.4 Summary 4.4 Segmental and chain dynamics in nanometric layers of poly(cis-1,4-isoprene) 4.4.1 Introduction 4.4.2 Experimental details and data analysis 4.4.2.1 Sample preparation 4.4.2.2 Data analysis 4.4.3 Results and discussion 4.4.3.1 1- versus 2-D confinement of poly(cis-1,4-isoprene) 4.4.4 Summary 5 Conclusions 5.1 Dynamics in confinement – a wider perspective

Volume overload is a common feature in patients on haemodialysis (HD). This contributes significantly to the cardiovascular disease burden seen in these patients. Clinical assessments of the volume state are often inaccurate. Techniques such as interdialytic blood pressure, relative blood volume monitoring, bioimpedance are available to improve clinical effectives. However all these techniques exhibit significant shortcomings in their accuracy, reliability and applicability at the bed side. We evaluated the usefulness of a dual compartment monitoring technique using Continuous Segmental Bioimpedance Spectroscopy (CSBIS) and Relative Blood Volume (RBV) as a tool to assess hydration status and determine dry weight. We also sought to evaluate the role of Atrial Natriuretic Peptide (ANP) and B-type Natriuretic Peptide (BNP) as a volume marker in dialysis patients. The Retrospective analysis of a historical cohort (n = 376, 55 Diabetic) showed a significant reduction in post-dialysis weights in the first three months of dialysis (72.5 to 70kg, p<0.027) with a non-significant increase in weight between months 6-12. The use of anti-hypertensive agents reduced insignificantly in the first 3 months, increased marginally between months 3-6 and significantly increased over the subsequent 6 months. The residual urea clearance (KRU) fell and dialysis times increased. The cohort was very different to that dialysing at Tassin and showed a dissociation between weight reduction and BP control. This may relate to occult volume overload. CSBIS-RBV monitoring in 9 patients with pulse ultrafiltration (pulse UF) showed distinct reproducible patterns relating to extra cellular fluid (ECF) and RBV rebound. An empirical Refill Ratio was then used to define the patterns of change and this was related to the state of their hydration. A value closer to unity was consistent with the attainment of best achievable target weight. The refill ratio fell significantly between the first (earlier) and third (last) rebound phase (1.97 ± 0.92 vs 1.32 ± 0.2). CSBIS monitoring was then carried out in 31 subjects, whilst varying dialysate composition, temperature and patient posture to analyse the effects of these changes on the ECF trace and to ascertain whether any of these interventions can trigger a change in the slope of the ECF trace distinct to that caused by UF. Only, isovolemic HD caused a change in both RBV and ECF in some patients that was explained by volume re-distribution due to gravitational shifts, poor vascular reactivity, sodium gradient between plasma and dialysate and the use of vasodilating antihypertensive agents. This has not been described previously. These will need to be explored further. The study did demonstrate a significant lack of comparability of absolute values of RECF between dialysis sessions even in the same patient. This too has not been described previously. This is likely to be due to subtle changes in fluid distribution between compartments. Therefore a relative changes must be studied. This sensitivity to subtle changes may increase the usefulness of the technique for ECF tracking through dialysis. The potential of dual compartment monitoring to track volume changes in real time was further explored in 29 patients of whom 21 achieved weight reductions and were able to be restudied. The Refill Ratio decreased significantly in the 21 patients who had their dry weights reduced by 0.95 ± 1.13 kg (1.41 ± 0.25 vs 1.25 ± 0.31). Blood pressure changes did not reach statistical significance. The technique was then used to examine differences in vascular refill between a 36oC and isothermic dialysis session in 20 stable prevalent patients. Pulse UF was carried out in both these sessions. There were no significant differences in Refill Ratios, energy removed and blood pressure response between the two sessions. The core temperature (CT) of these patients was close to 36oC and administering isothermic HD did not confer any additional benefit. Mean BNP levels in 12 patients during isovolemic HD and HD with UF did not relate to volume changes. ANP concentrations fell during a dialysis session in 11 patients from a mean 249 ± 143 pg/ml (mean ± SD) at the start of dialysis to 77 ± 65 pg/ml at the end of the session (p<0.001). During isolated UF levels did not change but fell in the ensuing sham phase indicating a time lag between volume loss and decreased generation. (136±99 pg/ml to 101±77.2 pg/ml; p<0.02) In a subsequent study ANP concentrations were measured throughout dialysis and in the post-HD period for 2 hours. A rebound in ANP concentration was observed occurring at around 90 min post-HD. The degree of this rebound may reflect the prevailing fluid state and merit further study. We have shown the utility of dual compartment monitoring with CSBIS-RBV technique and its potential in assessing volume changes in real time in haemodialysis patients. We have also shown the potential of ANP as an independent marker of volume status in the same setting. Both these techniques merit further study.

The dissertation examines mainly segmental assimilatory processes of Xhosa phonology within the dependency framework. This model is a multi-faceted approach which involves hierarchical organisation of features into larger constituents known as gestures. The analysis includes an elementary historical background to the development of phonological theory with emphasis on the shift from traditional linear approaches to modern non-linear models, as well as a shift from derivational theories to representational frameworks. An exploration of the phonetics/phonology interface through the application of gestures is considered an advantage of using the dependency framework over other theories of phonology. The focus of the dissertation is the description of phonetically-motivated and morphologically-motivated Xhosa phonological processes. A brief exposition of the use of the dependency framework in non-assimilatory Xhosa phonological processes is given as a possible recommendation in the conclusion of the dissertation. / Language Education, Arts and Culture / M.A. (African Languages)

Objetivo: Verificar a eficácia da associação do alongamento do tronco com exercícios de estabilização segmentar em pacientes com dor lombar crônica inespecífica (LCI). Métodos: Trinta e quatro indivíduos com diagnóstico de lombalgia crônica inespecífica de ambos os sexos, com idade entre 18 e 65 anos, foram randomizados em dois grupos: Grupo Alongamento Placebo + Estabilização Segmental (GAPES) e Grupo Alongamento + Estabilização Segmentar (GAES). Cada grupo realizou 12 sessões de tratamento de uma hora, duas vezes por semana. Os desfechos primários foram: intensidade da dor (Escala Numérica de Dor-END); avaliação qualitativa da dor (Questionário McGill-QMG); e incapacidade funcional (Questionário de Incapacidade de Rolland e Morris-QRM). Os desfechos secundários foram: percepção do efeito global (PEG); estado emocional (Inventário de Depressão de Beck-IDB e Escala Visual Analógica para Ansiedade-EVA-A); sinais e sintomas adversos; e satisfação do paciente (MedRisk). Cada sujeito foi avaliado no início e no fim do tratamento (seis semanas) e seguido três e seis meses após a intervenção. O nível de significância definido em alfa é igual a 0,05. Resultados: Não houve diferença significativa entre os dois grupos de tratamento na redução da intensidade e na qualidade da dor, na incapacidade funcional, na ansiedade e nos índices emocionais após o término do tratamento e durante o follow up. Conclusão: As duas propostas são efetivas no tratamento de LCI, com resultados estatisticamente significantes nos desfechos estudados. No entanto, a associação de exercícios de alongamento de tronco com os de estabilização segmentar não foi mais efetiva do que o uso isolado de estabilização segmentar lombar (ESL) / Objective: To verify the effectiveness of the association of trunk stretching with segmental stabilization exercises in patients with non-specific chronic low back pain (LCI) Methods: Thirty-four individuals with a diagnosis of non-specific chronic low back pain of both sexes, aged between 18 and 65 years. They were randomized into two groups: Group Stretching Placebo + Segmental Stabilization (GSPSS) and Group Stretching + Segmental Stabilization (GSSS), each group received 12 sessions of one hour, twice a week. The primary outcomes were pain intensity (Numerical Rating Scale-NRS); qualitative pain assessment (McGill Questionnaire); functional disability (Rolland and Morris Questionnaire-RMQ). The secondary outcomes were perception of the overall effect Global Effect; emotional state (Beck Depression Inventory-BDI and Analog Visual Scale for Anxiety-VAS-A); adverse signs and symptoms; and patient satisfaction (MedRisk). Each subject was assessed at the baseline and in the end of treatment (six weeks) and followed up three and six months post-intervention. The significance level set at Alpha = 0.05. Results: There was no significant difference between the two treatment groups in reducing intensity and quality of pain, functional disability, anxiety and emotional indexes after the end of the treatment and during follow up. Conclusion: The two treatment proposals are effective in the treatment of LCI, with statistically significant results in the outcomes studied, but the association of trunk elongation exercises with those of segmental stabilization was not more effective than the isolated use of ESL