Background: The twisting motion of the left ventricle (LV), with clockwise rotation at the base and counter clockwise rotation at the apex during systole, is a vital part of LV function. Even though LV rotation has been studied for decades, the rotation pattern has not been described in detail. By the introduction of speckle tracking echocardiography measuring rotation has become easy of access. However, the axis around which the LV rotates has never before been assessed. The aims of this thesis were to describe the rotation pattern of the LV in detail (study I), to assess RV apical rotation (study II), develop a method to assess the rotation axis (study III) and finally to study the effect of regional ischemia to the rotation pattern of the LV (study IV). Methods: Healthy humans were examined in study I-III and the final study populations were 40 (60±14 years), 14 (62±11 years) and 39 (57±16 years) subjects, respectively. In study IV six young pigs (32-40kg) were studied. Standard echocardiographic examinations were performed. In study IV the images were recorded before and 4 minutes after occlusion of left anterior descending coronary artery (LAD). Rotation was measured in short axis images by using a speckle tracking software. By development of custom software, the rotation axis of the LV was calculated at different levels in every image frame throughout the cardiac cycle. Results: Study I showed significant difference in rotation between basal and apical rotations, as well as significant differences between segments at basal and mid ventricular levels. The rotation pattern of the LV was associated with different phases of the cardiac cycle. Study II found significant difference in rotation between the LV and the RV. RV rotation was heterogeneous and bi-directional, creating a ´tightening belt action´ to reduce it circumference. Study III indicated that the new method could assess the rotation axis of the LV. The motion of the rotation axes in healthy humans displayed a physiological and consistent pattern. Study IV found a significant difference in the rotation pattern, between baseline and after LAD occlusion, by measuring the rotation axes, but not by conventional measurements of rotation. AV-plane displacement and wall motion score (WMS) were also significantly changed after inducing regional ischemia. Conclusion: There are normally large regional differences in LV rotation, which can be associated anatomy, activation pattern and cardiac phases, indicating its importance to LV function. In difference to the LV, the RV did not show any functional rotation. However, its heterogeneous circumferential motion could still be of importance to RV function and may in part be the result of ventricular interaction. The rotation axis of the LV can now be assessed by development of a new method, which gives a unique view of the rotation pattern. The quality measurements and results in healthy humans indicate that it has a potential clinical implication in identifying pathological rotation. This was supported by the experimental study showing that the rotation axis was more sensitive than traditional measurements of rotation and as sensitive as AV-plane displacement and WMS in detecting regional myocardial dysfunction.

There are several reasons to research the effects of axial twist exposures and the resulting loading on the spine. The lack of consensus from the limited work that has previously examined the role of axial twist moments and motions in the development of spine injuries or generation of low back pain is the primary reason. From recently published works, axial twist moments appear to represent an increased risk for injury development when it acts in concert with loading about other physiological axes (i.e. flexion, extension, and compression). However, there is a large body of epidemiologic data identifying axial twist moments and/or motion as risk factors for low back disorders and pain, demonstrating the need for this series of investigations. It is likely that these combined exposures increase risk through altering the spine’s load distribution (passive resistance) by modifying the mechanics, but this deduction and related causal mechanism need to be researched. The global objective of this research was focused on determining whether there is evidence to support altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist moments (when added in combination with one and two axes of additional loading). Also included was whether these modes of loading can modify spine mechanics and contribute and/or alter the development of damage and pain. This objective was addressed through one in-vivo (Drake and Callaghan, 2008a– Chapter #2) and three in-vitro (Drake et al., 2008– Chapter #4; Drake and Callaghan, 2008b– Chapter #5; Drake and Callaghan, 2008c– Chapter #6) studies that: (1) Quantified the amount of passive twist motion in the lumbar spine when coupled with various flexion-extension postures; (2) Documented the effects of flexion-extension postures and loading history on the distance between the facet articular surfaces; (3) Evaluated the result of axial twist rotation rates on acute failure of the spine in a neutral flexion posture; and (4) Explored whether repetitive combined loading has the ability to cause enough deformation to the spine to generate pain. Through the combination of findings previously reported in the literature and the outcomes of Drake and Callaghan (2008a– Chapter #2) and Drake et al. (2008– Chapter #4), a postural mediated mechanism was hypothesized to be responsible for governing the load distribution between the facet joints and other structures of the spine (i.e. disc, ligaments). Increased flexed postures were found to decrease the rotational stiffness by resulting in larger twist angles for the same applied twist moment in-vivo relative to a neutral flexion posture (Drake and Callaghan, 2008a– Chapter #2). This suggested there might be an increased load on the disc due to a change in facet coupling in these combined postures. Similarly, increased angles were observed in flexed and twisted postures for in-vitro specimens relative to a neutral flexion posture. These observed differences were found to correspond with altered facet joint mechanics. Specifically that flexed twisted postures increased the inter-facet spacing relative to the initial state of facet articulation (Drake et al., 2008– Chapter #4). These finding supported the postulated postural mechanism. Therefore, in a neutral posture the facet joints likely resisted the majority of any applied twist moment based on the limited range of motion and higher axial rotational stiffness responses observed. It was suspected that the changes in mechanics would likely cause a change in the load distribution however the magnitude of change in load distribution remains to be quantified. Further support for this postulated postural mechanism comes from the mode of failure for specimens that were exposed to 10,000 cycles of 5° axial twist rotation while in a static flexed posture (Drake and Callaghan, 2008c– Chapter #6), and neutrally flexed specimens exposed to 1.5° of rotation for 10,000 cycles reported in the literature. Without flexion, the failure patterns were reported to occur in the endplates, facets, laminae and capsular ligaments, but not the disc. However, with flexion the repetitive axial twist rotational displacements caused damage primarily to the disc. If the load distribution was unchanged, the higher axial rotation angle should have caused the specimen to fail in less cycles of loading, and the failure pattern should not have changed. Modulators of this hypothesized mechanism include the velocity of the applied twist moment and the effects these have on the failure parameters and injury outcomes. The three physiologic loading rates investigated in this work were not shown to affect the ultimate axial twist rotational failure angle or moment in a neutral flexion/extension posture, but were shown to modify flexion-extension stiffness (Drake and Callaghan, 2008b– Chapter #5). All of the flexion-extension stiffness values post failure, from a one-time axial twist exposure, was less than those from a repetitive combined loading exposure that has been established to damage the intervertebral disc but not the facets. Therefore, it is likely that the facet joint provides the primary resistance to acute axial twist moments when the spine is in a neutral flexion posture, but there appears to be a redistribution of the applied load from the facets to the disc in repetitive exposures. The aforementioned studies determined there are changes in load distribution and load response caused by altered mechanics resulting from twist loading, but whether the exposures could possibly produce pain needed to be addressed. Previous research has determined that the disc has relatively low innervation in comparison to the richly innervated facet capsule and vertebra, with only the outer regions being innervated. Likewise, it is assumed that pain could be directly generated as the nucleus pulposus disrupted the innervated outer annular fibres in the process of herniation. Also, direct compression of the spinal cord or nerve roots has been shown to occur from the extruded nucleus and result in the generation of pain responses. Additionally, the nucleus pulposus has been shown to be a noxious stimulus that damages the function and structure of nerves on contact. The other source of nerve root compression commonly recognized is a decrease in intervertebral foramina space, which was previously believed to only be caused through losses in disc height. However, decreased intervertebral foramina space due to repetitive motions appears to be a viable pain generating pathway that may not directly correspond to simply a loss of specimen or disc height (Drake and Callaghan, 2008c– Chapter #6). This is new evidence for combined loading to generate pain through spinal deformation. The objective of many traditional treatments for nerve root compression focus on restoring lost disc height to remove the nerve root compression. Unfortunately, nerve root compression caused by repetitive loading may not be alleviated through this approach. This collection of studies was focused on determining whether altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist loading (when added in combination with one and two axes of additional loading) was occurring, and examining how these modes of loading can contribute and/or alter the development of injury and pain. Therefore, findings generated from this thesis may have important implications for clinicians, researchers, and ergonomists.

There are several reasons to research the effects of axial twist exposures and the resulting loading on the spine. The lack of consensus from the limited work that has previously examined the role of axial twist moments and motions in the development of spine injuries or generation of low back pain is the primary reason. From recently published works, axial twist moments appear to represent an increased risk for injury development when it acts in concert with loading about other physiological axes (i.e. flexion, extension, and compression). However, there is a large body of epidemiologic data identifying axial twist moments and/or motion as risk factors for low back disorders and pain, demonstrating the need for this series of investigations. It is likely that these combined exposures increase risk through altering the spine’s load distribution (passive resistance) by modifying the mechanics, but this deduction and related causal mechanism need to be researched. The global objective of this research was focused on determining whether there is evidence to support altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist moments (when added in combination with one and two axes of additional loading). Also included was whether these modes of loading can modify spine mechanics and contribute and/or alter the development of damage and pain. This objective was addressed through one in-vivo (Drake and Callaghan, 2008a– Chapter #2) and three in-vitro (Drake et al., 2008– Chapter #4; Drake and Callaghan, 2008b– Chapter #5; Drake and Callaghan, 2008c– Chapter #6) studies that: (1) Quantified the amount of passive twist motion in the lumbar spine when coupled with various flexion-extension postures; (2) Documented the effects of flexion-extension postures and loading history on the distance between the facet articular surfaces; (3) Evaluated the result of axial twist rotation rates on acute failure of the spine in a neutral flexion posture; and (4) Explored whether repetitive combined loading has the ability to cause enough deformation to the spine to generate pain. Through the combination of findings previously reported in the literature and the outcomes of Drake and Callaghan (2008a– Chapter #2) and Drake et al. (2008– Chapter #4), a postural mediated mechanism was hypothesized to be responsible for governing the load distribution between the facet joints and other structures of the spine (i.e. disc, ligaments). Increased flexed postures were found to decrease the rotational stiffness by resulting in larger twist angles for the same applied twist moment in-vivo relative to a neutral flexion posture (Drake and Callaghan, 2008a– Chapter #2). This suggested there might be an increased load on the disc due to a change in facet coupling in these combined postures. Similarly, increased angles were observed in flexed and twisted postures for in-vitro specimens relative to a neutral flexion posture. These observed differences were found to correspond with altered facet joint mechanics. Specifically that flexed twisted postures increased the inter-facet spacing relative to the initial state of facet articulation (Drake et al., 2008– Chapter #4). These finding supported the postulated postural mechanism. Therefore, in a neutral posture the facet joints likely resisted the majority of any applied twist moment based on the limited range of motion and higher axial rotational stiffness responses observed. It was suspected that the changes in mechanics would likely cause a change in the load distribution however the magnitude of change in load distribution remains to be quantified. Further support for this postulated postural mechanism comes from the mode of failure for specimens that were exposed to 10,000 cycles of 5° axial twist rotation while in a static flexed posture (Drake and Callaghan, 2008c– Chapter #6), and neutrally flexed specimens exposed to 1.5° of rotation for 10,000 cycles reported in the literature. Without flexion, the failure patterns were reported to occur in the endplates, facets, laminae and capsular ligaments, but not the disc. However, with flexion the repetitive axial twist rotational displacements caused damage primarily to the disc. If the load distribution was unchanged, the higher axial rotation angle should have caused the specimen to fail in less cycles of loading, and the failure pattern should not have changed. Modulators of this hypothesized mechanism include the velocity of the applied twist moment and the effects these have on the failure parameters and injury outcomes. The three physiologic loading rates investigated in this work were not shown to affect the ultimate axial twist rotational failure angle or moment in a neutral flexion/extension posture, but were shown to modify flexion-extension stiffness (Drake and Callaghan, 2008b– Chapter #5). All of the flexion-extension stiffness values post failure, from a one-time axial twist exposure, was less than those from a repetitive combined loading exposure that has been established to damage the intervertebral disc but not the facets. Therefore, it is likely that the facet joint provides the primary resistance to acute axial twist moments when the spine is in a neutral flexion posture, but there appears to be a redistribution of the applied load from the facets to the disc in repetitive exposures. The aforementioned studies determined there are changes in load distribution and load response caused by altered mechanics resulting from twist loading, but whether the exposures could possibly produce pain needed to be addressed. Previous research has determined that the disc has relatively low innervation in comparison to the richly innervated facet capsule and vertebra, with only the outer regions being innervated. Likewise, it is assumed that pain could be directly generated as the nucleus pulposus disrupted the innervated outer annular fibres in the process of herniation. Also, direct compression of the spinal cord or nerve roots has been shown to occur from the extruded nucleus and result in the generation of pain responses. Additionally, the nucleus pulposus has been shown to be a noxious stimulus that damages the function and structure of nerves on contact. The other source of nerve root compression commonly recognized is a decrease in intervertebral foramina space, which was previously believed to only be caused through losses in disc height. However, decreased intervertebral foramina space due to repetitive motions appears to be a viable pain generating pathway that may not directly correspond to simply a loss of specimen or disc height (Drake and Callaghan, 2008c– Chapter #6). This is new evidence for combined loading to generate pain through spinal deformation. The objective of many traditional treatments for nerve root compression focus on restoring lost disc height to remove the nerve root compression. Unfortunately, nerve root compression caused by repetitive loading may not be alleviated through this approach. This collection of studies was focused on determining whether altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist loading (when added in combination with one and two axes of additional loading) was occurring, and examining how these modes of loading can contribute and/or alter the development of injury and pain. Therefore, findings generated from this thesis may have important implications for clinicians, researchers, and ergonomists.

This dissertation explores the ways in which Charles Dickens writes Nancy in Oliver Twist, Anthony Trollope writes Carry Brattle in The Vicar of Bullhampton, and Elizabeth Gaskell writes Esther in Mary Barton to represent and examine some very personal and painful anxiety. About Dickens and Trollope, I contend that they turn their experiences of shame into their prostitute's shame. For Gaskell, I assert that the experience she projects onto her prostitute is that of her own maternal grief in isolation. Further, I argue that these authors self-consciously create biographical parallels between themselves and their prostitutes with an eye to drawing conclusions about the results of their anxieties, both for their prostitutes and, by proxy, for themselves. In Chapter II, I assert that in Nancy, Dickens writes himself and his sense of shame at his degradation and exploitation in Warren's Blacking Factory. This shame resulted in a Dickens divided, split between his successful, public persona and his secret, mortifying shame. Both shame and its divisiveness he represents in a number of ways in Nancy. In Chapter III, I contend that Trollope laces Carry Brattle with some of his own biographical details from his early adult years in London. These parallels signify Carry's personal importance to her author, and reveal her silences and her subordinate role in the text as representative of Trollope's own understanding and fear of shame and its consequences: its silencing and paralyzing nature, and its inescapability. In Chapter IV, I posit that Gaskell identifies herself with Esther, and that through her, Gaskell explores three personal things: her sorrow over the loss of not one but three of her seven children, her possible guilt over these deaths, and her emotional isolation in her marriage as she grieved alone. In her creation of Esther, Gaskell creates a way both to isolate her grief and to forge a close companion to share it, thus enabling her to examine and work through grief. In Chapter V, I examine the preface of each novel and find that these, too, reflect each author's identification with and investment of anxiety in his or her particular prostitute.

Background: Aortic stenosis (AS) is the most common heart valve disease in Europe and North America. Age-related calcification of the valve is the commonest cause of acquired AS, especially in patients older than 70 years.Conventional surgical aortic valve replacement (SAVR) and the novel, minimally invasive transcatheter aortic valve implantation (TAVI), effectively preserve left ventricular (LV) function, relieve symptoms and improve survival in patients with severe symptomatic AS. However, patients with impaired LV function may carry significant operative risk, and long recovery time. In addition, such patients might have other comorbidities, and hence adding another challenge. Thus evaluation of ventricular function before and after AVR, as well as critical evaluation of TAVI patients should contribute to better clinical outcome. Methods: We studied LV function by conventional echocardiography before and after SAVR in the following groups; (I) 86 patients (aged 71±10 years) with severe AS and LV dysfunction; (II) 112 consecutive elderly AS patients (aged 77±2 years) and compared them with 72 younger patients (aged 60±1 years); (III)66 patients (age 70±2 years, 53 male) who underwent AVR for severe AS with concurrent LV dysfunction; (IV) 89 consecutive patients with symptomatic severeAS who underwent successful TAVI, 45 of whom received trans-apical TAVI (TA)(age 80.8±4.9 year, 26 male) and 44 trans-femoral TAVI (TF) (age 82.9±5.8 year,22 male).The conventional echocardiographic measurements were made according to the guidelines. Severe AS was identified by aortic valve mean pressure gradient >40mmHg or valve area <1.0 cm2. LV systolic dysfunction was identified as ejection fraction (EF) <50%. LV long-axis function was presented by mitral annular plane systolic excursion ( MAPSE ) at lateral wall and septal wall, which were measured from apical four-chamber view. Also from the same view, LV septal and lateral wall deformation using STE as well as global longitudinal systolic strain. The LV systolic twist as the net difference between apical rotation and basal rotation was measured from the parasternal apical and basal short-axis views in the TAVI patients. Results: Study I: In the low flow and high gradient group, operative (30-day) mortality was 10%, and peri-operative mortality was associated with lower mean LVEF, higher mitral E:A ratio, peak systolic pulmonary artery pressure (PSPAP), and higher serum creatinine (all p<0.001), NYHA class III–IV, concomitant coronary artery bypass graft (CABG), urgent surgery, and longer bypass-time (all p< 0.05). Mortality at 4 years was 17%. Univariate predictors of 4-year mortality were: lower EF (p<0.001), presence of restrictive LV filling (p<0.001), raised PSPAP (p<0.001) and CABG (p=0.037). However, only EF<40 % (p=0.03), the presence of restrictive LV filling (p=0.033) and raised PSPAP (p<0.01)independently predicted mortality in this group.Study II: Elderly patients had higher NYHA class, more frequent atrial fibrillation (AF), coronary artery disease (CAD), emergency operation and use of bioprosthetic valves. They also had shorter E-wave deceleration time (DT) and larger left atria (LA) (p<0.05 for all). 30-day mortality was 12% vs 4 % (Log Rank x2=3.02, p=0.08) and long term mortality was 18% vs 7% (Log Rank x2=4.38,p=0.04) in the two groups, respectively. Age was not related to mortality after adjustment for other variables. Among all variables, anemia (OR 4.20, CI:1.02–6.86, p=0.04), cardiopulmonary bypass (CPB) time (OR 1.02, CI 1.01–1.04,p<0.01), significant patient prosthesis mismatch (PPM) (OR 5.43, CI 1.04–18.40,p<0.05) were associated with 30-day mortality in elderly patients. Their long-term mortality was related to CBP time (OR 1.02, CI 1.00–1.05, p=0.04),PPM (OR 4.64, CI 1.33–16.11, p=0.02) and raised LA pressure: DT (OR 0.94, CI0.84–0.99, p=0.03) and pulmonary artery systolic pressure (PASP) (OR 1.12, CI1.03–1.19, p<0.001).STUDY III: Following SAVR peak aortic pressure gradient (AOPG) decreased and indexed valve area increased (64±3 to 19±1 mmHg and 0.30±0.01 to 0.89±0.03 cm2/m2, p<0.001 for both). LVEF increased (from 45±1 to 54±2%;p<0.001), LV end diastolic and end-systolic dimensions fell (LVEDD index: from 33±1 to 30±1 mm/m2; and LVESD index: from 27±1 to 20±1 mm/m2; (p<0.01 forboth). LV diastolic dysfunction improved as evidenced by the fall in E/A ratio (from 2.6±0.2 to 1.9±0.4) and prolongation of total filling time; (from 29.2±0.6 to31.4±0.5 s/min, p=0.01 for both). Among all echocardiographic variables, LV dimensions (LVEDD index, OR 0.70, CI 0.52–0.97, p<0.05; LVESD index, OR 0.57, CI 0.40–0.85, p=0.005) were the two independent predictors of post-operative LV functional recovery on multivariate analysis. A cut-off value ofpre-operative LVESD index<=27.5 mm/m2 was 85% sensitive and 72% specific inpredicting intermediate-term recovery of LV function after AVR (AUC, 0.72, p=0.002). STUDY IV: Before TAVI, there was no difference between the two patient groups in gender, age, body surface area (BSA) and baseline LV function. However, left ventricular mass index (LVMi), left atrial volume index (LAVi) and tricuspid regurgitation pressure drop (TRPdrop) were increased in the TA group (p<0.05).One week after TAVI, aortic pressure gradient (AOPG) markedly dropped in thetwo groups (both p<0.001), LVEDD index and LVESD index fell but EF andmyocardial strain remained unchanged. Overall cavity twist reduced (p<0.048).Significant LVESD index reduction was only seen in TF group (p=0.02) with a slight increase in LVEF (p=0.04). Lateral MAPSE increased only in the TF group(p=0.02). LV longitudinal systolic strain remained unchanged in TA patients while apical lateral strain increased in TF group. LV apical rotation fell in the two groups but basal rotation increased only in the TA patients (p=0.02). LAVi reduced in bothgroups and to a greater extent in TF TAVI (p=0.006), as did TRPdrop (p<0.001). Conclusion: SAVR and TAVI are two effective treatments for severe AS patients.The severity of pre-operative systolic and diastolic LV dysfunction is the major predictor of mortality following SAVR for low-flow and high gradient AS.Peri-operative AVR survival is encouraging in the elderly. Long term mortality in the elderly is related to PPM, LV diastolic dysfunction and secondary pulmonary hypertension. LV functional recovery was evident in most patients with LV dysfunction after SAVR. A lower prevalence of LV functional recovery in patients with large pre-operative LVESD index might signify the loss of contractile reserveand thus predict post-operative functional recovery. TAVI results in significant early improvement of segmental and overall ventricular function, particularly in patients receiving the trans-femoral approach. The delayed recovery of the trans-apical TAVI group, we studied, might reflect worse pre-procedural diastolic cavity function.

Objective: To determine the effects of head position and of different postural control demands on head tremor measures in participants with essential tremor. Methods: Seventeen participants with essential tremor (ET) of the head and 17 control participants took part. Individuals held their heads in varying degrees of rotation, flexion, and extension. Subsequently, individuals sat and stood in different postures, incorporating different foot placements (feet apart and together), surfaces (solid and foam), and vision conditions (eyes open and closed). Neck muscle activity was recorded from three muscles bilaterally (trapezius, sternocleidomastoid, splenius capitis). Three-dimensional head and thorax positions were recorded using an Optotrak system, and head angular velocity with respect to thorax was calculated by differentiating tilt-twist angles. Fourier analysis was used to determine tremor power. Results: ET participants showed sharp peaks at their tremor frequency in spectral plots of kinematic data, whereas CN participants did not. Electromyography data was too noisy for frequency analysis. ET participants displayed increased tremor power in head positions 25° from neutral compared to neutral and positions 50° from neutral. Tremor power increased with increasing difficulty of posture for both participant groups. Removal of vision resulted in decreased tremor power in ET participants; power was significantly decreased in the easier postures, and progressively less so with increasing difficulty of posture. Interestingly, tremor direction was inconsistent in both groups, and two ET participants displayed multiple tremor peaks. Conclusions: The tilt-twist method is a feasible way of measuring head kinematics. Changing stiffness of the neck likely mediates the effect of head position on head tremor power, with the resultant interplay of the central driver and the mechanical resonance driving the amplitude changes. Decreasing stability of posture increases head tremor, likely due to the associated increase in postural sway and stress on the postural control system. Vision appears to exacerbate head tremor through the addition of tremor-related visual noise and an implicit task to stabilize vision; this is possible evidence of a visuomotor deficit. However, stabilizing vision becomes less important with increasing difficulty of posture, resulting in a narrowing gap in tremor power between vision and no vision conditions. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2011-03-31 18:16:59.927

Previous studies on wood instability have identified some wood basic properties which influence the timber distortion and shape changes while the wood is losing or gaining moisture. These properties include wood anisotropic shrinkage, equilibrium moisture content (EMC) in both desorption and adsorption, fibre saturation point (FSP) and water diffusion coefficient. This study investigated the stability related wood properties and their variations within the stems of the New Zealand grown radiata pine trees. The basic density, EMC and shrinkage for the earlywood and the latewood were also experimentally determined. In taking into account these properties and their variations, an analytical model was developed to simulate the wood distortion. The equilibrium moisture content was determined at 30°C and humidity range from 27% to 90%. It was found that the EMC difference between the earlywood and the latewood was negligible. The experimental results also show that the EMC decreases from pith towards the bark over the disc cross section and the trend is most obvious at high humidities (70-90%). Along the tree height, the EMC decreases from ground towards the top of the stem. The tangential shrinkage results were highly variable but, in general, the latewood has higher values than the earlywood. The opposite trend was found for the longitudinal shrinkage, higher values for the earlywood than the latewood. In the tree height direction, the tangential shrinkage was found to decrease with the tree height. This follows the same trend as the microfibril angle which in general also decreases with the tree height. The fibre saturation point (FSP) was determined from the tangential shrinkage values at different equilibrium moisture contents. These were taken as the intersection point of the tangential shrinkage line with the moisture content axis. The experimental results have revealed a trend that the FSP decreases from the pith towards the bark and also decreases with the tree height. Similar behaviour was found for the tangential and longitudinal swelling during the adsorption. The moisture transport within radiata pine was investigated based on the diffusion theory under transient and isothermal condition of 30°C. The moisture dependant diffusion coefficient was derived from the experimental data using the inverse analysis method. The surface emission coefficient was determined by taking into account the variable surface moisture content, wood density and the ambient conditions. In the experiments, 138 samples in total (46 samples for each XIV of the longitudinal, tangential and radial directions) were used and their diffusion coefficients were determined for both the adsorption and the desorption with moisture content ranging from 6% to 22%. The derived diffusion coefficients are comparable with the reported data in the literature. Further investigation of the wood type influence on the diffusion coefficient revealed that compression wood has the lowest diffusion coefficients in the three directions (longitudinal, tangential and radial) both in the desorption and in the adsorption. In addition, the moisture content has the least influence on the diffusion coefficient in the compression wood. Investigation on the effects of the wood density has shown that in general, the diffusion coefficient decreases with increasing wood density although the correlations are only significant for the longitudinal direction in desorption. An analytical model for the simulation of the wood twist was developed which is based on the geometry and geometrical changes of the grains aligning non parallel to the pith. A board consists of numerous such grains which change the length and shape with moisture content change. The model predictions confirm that the grain angle, the tangential and longitudinal shrinkage and the conical angle all affect the development of the board twist. However, the discrepancies between the model prediction and the experimental data are significant, partly due to the experimental uncertainties and partly due to the model errors. In this study, sound velocity in the longitudinal direction was measured for the test samples used in the shrinkage experiments. The results revealed that the correlations between the sound velocity and the volumetric shrinkage at oven dry are significant. Based on this finding, the relationship between the tangential shrinkage and the radial shrinkage, the tangential shrinkage can be predicted from the sound velocity measurements. As the tangential shrinkage has significant influence on the wood distortion, this method can be used to segregate logs which may be prone to wood distortion.

Background：Aortic stenosis (AS) is the commonest valve disease in the West. Aortic valve replacement (AVR) remains the only available management for AS and results in improved symptoms and recovery of ventricular functions. In addition, it is well known that AVR results in disruption of LV function mainly in the form of reversal of septal motion as well as depression of right ventricular (RV) systolic function. The aim of this thesis was to study, in detail, the early and mid-term response of ventricular function to AVR procedures (surgical and TAVI) as well as post operative patients’ exercise capacity. Methods：We studied LV and RV function by Doppler echocardiography and speckle tracking echocardiography (STE) in the following 4 groups; (1) 30 severe AS patients (age 62±11 years, 19 male) with normal LV ejection fraction (EF) who underwent AVR, (2) 20 severe AS patients (age 79±6 years, 14 male) who underwent TAVI, (3) 30 healthy controls (age 63±11 years, 16 male), (4) 21 healthy controls (age 57±9 years, 14 male) who underwent exercise echocardiography. Results: After one week of TAVI, the septal radial motion and RV tricuspid annulus peak systolic excursion (TAPSE) were not different from before, while surgical AVR had significantly reversed septal radial motion and TAPSE dropped by 70% compared to before. The extent of the reversed septal motion correlated with that of TAPSE (r=0.78, p<0.001) in the patients as a whole after AVR and TAVI (Study I). Compared with controls, the LV twist function was increased in AS patients before and normalized after 6 months of surgical AVR. In controls, the LV twist correlated with LV fractional shortening (r=0.81, p<0.001), a relationship which became weak in patients before (r=0.52, p<0.01) and after AVR (r=0.34, p=ns) (Study II). After 6 months of surgical AVR, the reversed septal radial motion was still significantly lower than before. The septal peak displacement also decreased and its time became prolonged. In contrast, the LV lateral wall peak displacement increased and the time to peak displacement was early. The accentuated lateral wall peak displacement correlated with the septal peak displacement time delay (r=0.60, p<0.001) and septal-lateral time delay (r=0.64, p<0.001) (Study III). In 21 surgical AVR patients who performed exercise echocardiography, the LV function was normal at rest but different from controls with exercise. At peak exercise, oxygen consumption (pVO2) was lower in patients than controls. Although patients could achieve cardiac output (CO) and heart rate (HR) similar to controls at peak exercise, the LV systolic and early diastolic myocardial velocities and strain rate as well as their delta changes were significantly lower than controls. pVO2 correlated with peak exercise LV myocardial function in the patients group only, and the systolic global longitudinal strain rate (GLSRs) at peak exercise was the only independent predictor of pVO2 in multivariate regression analysis (p=0.03) (Study IV). Conclusion: Surgical AVR is an effective treatment for AS patients, but results in reversed septal radial motion and reduced TAPSE. The newly developed TAVI procedure maintains RV function which results in preservation of septal radial motion. In AS, the LV twist function is exaggerated, normalizes after AVR but loses its relationship with basal LV function. While the reversed septal motion results in decreased and delayed septal longitudinal displacement which is compensated for by the accentuated lateral wall displacement and the time early. These patients remain suffering from limited exercise capacity years after AVR.

Submitted by Automação e Estatística (sst@bczm.ufrn.br) on 2018-06-05T21:48:08Z No. of bitstreams: 1 LarissaSantosAmaralRolim_DISSERT.pdf: 2305138 bytes, checksum: 14b3b617e544762c66ebb1f48bfcb9de (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-06-11T19:21:02Z (GMT) No. of bitstreams: 1 LarissaSantosAmaralRolim_DISSERT.pdf: 2305138 bytes, checksum: 14b3b617e544762c66ebb1f48bfcb9de (MD5) / Made available in DSpace on 2018-06-11T19:21:02Z (GMT). No. of bitstreams: 1 LarissaSantosAmaralRolim_DISSERT.pdf: 2305138 bytes, checksum: 14b3b617e544762c66ebb1f48bfcb9de (MD5) Previous issue date: 2018-02-23 / Introdução: O Carcinoma de Células Escamosas Oral (CCEO) é um grande problema de saúde pública em todo o mundo. Acredita-se que o mecanismo responsável pela progressão tumoral seja baseado na invasão coletiva ou de células individuais, chamado de Transição Epitelial-Mesenquimal (TEM), onde ocorre uma diminuição da expressão de biomarcadores epiteliais e aumento da expressão de biomarcadores mesenquimais, como Twist. A Podoplanina (PDPN), uma glicoproteína transmembranar, está envolvida na motilidade das células neoplásicas que estão passando pela TEM para orientar o complexo celular durante a invasão. Objetivo: Realizar uma análise comparativa entre a imunoexpressão da PDPN e do Twist em 40 casos de CCEs de lábio inferior (CCELI) e 36 casos de língua oral (CCELO), para analisar possíveis associações com parâmetros clínicos-patológicos (tamanho do tumor primário, metástase linfonodal regional e à distância, estadiamento clínico, grau histológico de malignidade e padrão histológico de invasão). Métodos: Para avaliação do grau histopatológico de malignidade, utilizou-se o sistema proposto por Brandwein-Gensler et al (2005). Para os dois marcadores, quatro tipos de análises imuno-histoquímica foram realizados: análise do front de invasão, das áreas compressivas do tumor, das grandes ilhas tumorais (>15 células neoplásicas) e dos ninhos/células dissociadas (<15 células neoplásicas). Para a análise das relações entre os parâmetros clínicos e histopatológicos e as imunoexpressões de PDPN e Twist, foi utilizado o teste não paramétrico de Mann-Whitney. Para verificar possíveis correlações entre as imunoexpressões de PDPN e Twist, foi realizado o teste de correlação de Spearman (r). Para todos os testes estatísticos, foi estabelecido um nível de significância de 5% (p < 0,05). Resultados: Não foram encontradas diferenças estatisticamente significativas na imunoexpressão de PDPN e Twist em relação ao tamanho do tumor, metástase e estadiamento clínico de CCELI (p > 0,05). Porém foram encontradas diferenças estatisticamente significativas na imunoexpressão citoplasmástica de PDPN em relação aos padrões de invasão tipo 4 e 5 (p = 0,032) de Brandwein-Gensler et al. (2005). Também não foram observadas diferenças estatisticamente significativas na imunoexpressão de PDPN e Twist em relação ao tamanho do tumor, metástase e estadiamento clínico de CCELO (p > 0,05). Observou-se diferenças estatisticamente significativas entre a expressão citoplasmática (p = 0,006), membranar (p = 0,030) e geral (p = 0,025) de PDPN nos CCELO com os padrões de invasão tipo 4 e 5 de Brandwein-Gensler et al. (2005). Além disso, foram observadas correlações negativas estatisticamente significativas entre a expressão membranar da PDPN e as expressões geral (r = -0,356; p = 0,024) e citoplasmática do Twist (r = -0,336; p = 0,034) nos CCELI. Conclusões: A expressão da PDPN está inversamente relacionada com o Twist em CCELI, além de demonstrar que ambas proteínas estão associadas com um pior padrão de invasão nos CCELI e CCELO. Também, levantou-se a hipótese de que a relação da PDPN com o Twist em CCELI e CCELO possa estar mais envolvida com uma transição parcial do fenótipo epitelial para o mesenquimal do que uma transição completa coordenada pela PDPN. / Introduction: Oral Squamous Cell Carcinoma (OSCC) is a major public health problem worldwide. It is believed that the mechanism responsible for tumor progression is based on collective invasion of cell groups or individual cells, called Epithelial-Mesenchymal Transition (EMT), where there is a decrease in the expression of epithelial biomarkers and increased expression of mesenchymal biomarkers as Twist. Podoplanin (PDPN), a transmembrane glycoprotein, is assumed to be involved in the motility of neoplastic cells that are undergoing through EMT to guide the cell complex during an invasion. Objective: To perform a comparative analysis of the immunoexpression of PDPN and Twist among 40 cases of lower lip CCEs and 36 cases of oral tongue, (primary tumor size, regional and distal lymph node metastasis, clinical staging, histological grade of malignancy and histological pattern of invasion). Methods: To evaluate the histopathological grade of malignancy, the system proposed by Brandwein-Gensler et al. (2005) was used. For the two markers, four types of immunohistochemical analysis were performed: analysis of the invasion front, tumor compressive areas, large tumor islands (> 15 neoplastic cells) and nests/dissociated cells (<15 neoplastic cells). The non-parametric Mann-Whitney test was used for the analysis of the relationships between the clinical and histopathological parameters and the PDPN and Twist immunoexpressions. To verify possible correlations between the PDPN and Twist immunoexpressions, the Spearman (r) correlation test was performed. For all statistical tests, a significance level of 5% (p <0.05) was established. Results: No statistically significant differences were found between PDPN and Twist immunoexpression and tumor size, metastasis, and clinical staging on lower lip SCC (p > 0.05). However, statistically significant differences were found between the cytoplasmic immunoexpression of PDPN and the invasion patterns type 4 and 5 (p = 0.032) of Brandwein-Gensler et al. (2005). Also, no statistically significant differences were found between PDPN and Twist immunoexpression and tumor size, metastasis and clinical staging on oral tongue SCC (p > 0.05). Statistically significant differences were observed between the cytoplasmic (p = 0.006), membrane (p = 0.030) and general (p = 0.025) PDPN expression in oral tongue SCC with the invasion patterns type 4 and 5 of Brandwein-Gensler et al. (2005). In addition, the Spearman correlation test demonstrated statistically significant negative correlations between PDPN membrane expression and Twist general expression (r = -0.356, p = 0.024) and Twist cytoplasmic expression (r = -0.336; p = 0.034) in the lower lip SCCs. Conclusions: PDPN expression is inversely related to Twist in lower lip SCC, it was demonstrated that both proteins are associatved with a worse invasion pattern in SCC. It has also been hypothesized that the relationship of PDPN with Twist in OSCC may be more involved with a partial transition from the epithelial to the mesenchymal phenotype than a complete transition coordinated by PDPN.

This diploma thesis deals with the portrayal of child heroes in English and American literature, in works of Charles Dickens and Mark Twain. The chosen novels are Oliver Twist, David Copperfield, The Adventures of Tom Sawyer and The Adventures of Huckleberry Finn. These novels are analysed in the themes of child labour and poverty, racism, religion, the view of the world by children in contrast to the adult perspective, upbringing and education. The last chapter deals with the humour of both novelists. Thus the emphasis is put on the social aspect of the literary output of Dickens and Twain. The main aim of the thesis is to depict these child heroes and their acting in the literature of the 19th century, and to reflect the life experience of both authors.