Introducció: Els protocols de preservació d'òrgan s'han instaurat com el tractament d'elecció en molts carcinomes escatosos de cap i coll amb el doble objectiu d'eliminar la patologia oncològica i d'evitar l'exèresi quirúrgica de l'òrgan afectat.Actualment existeix una manca d'acord en el maneig de les àrees ganglionars cervicals després de tractament de preservació d'òrgan en els pacients amb metàstasis regionals avançades al diagnòstic inicial.Objectius: Es va realitzar un treball amb dos objectius principals. El primer va ser valorar el millor tractament per a aquests pacients. El segon objectiu va ser l'avaluació de la existència d'una relació entre la resposta ganglionar al tractament i el control local de la malaltia.Material i mètodes: Per al primer objectiu es va dur a terme una revisió en 657 malalts amb carcinoma escatós de cap i coll i adenopaties al diagnòstic inicial sotmesos a tractament conservador d'òrgan entre 1985 i 2005.Per al segon objectiu del treball es van revisar 134 pacients amb càncer de cap i coll amb metàstasis cervicals en el moment del diagnòstic sotmesos a seqüència terapèutica de preservació d'òrgan que va incloure buidament cervical i amb resposta completa a nivell local a la fi del tractament.Resultats: La supervivència lliure de malaltia regional als 5 anys pels pacients tractats únicament amb radioteràpia va ser del 63.1% i pels pacients que van seguir tractament ganglionar amb cirurgia i radioteràpia del 69.1%, tot i que aquest últim grup inicialment presenta un pitjor pronòstic. La presència de metàstasis regionals avançades al diagnòstic, la no resposta completa a la quimioteràpia d'inducció, i la no inclusió de cirurgia en el protocol de tractament van actuar com a factors de risc independents per a la recidiva regional de la malaltia.La presència de restes tumorals en el buidament cervical post tractament conservador es va mostrar com a factor de risc per a la presència de recidiva local, i va donar un empitjorament en la supervivència als 5 anys.Conclusions: En els malalts amb metàstasis regionals avançades el tractament amb millors resultats en el control regional inclou la realització de cirurgia ganglionar. La presència de restes tumorals a nivell regional influeix en el control local de la malaltia. / Introduction: Organ preservation protocols for the treatment of many head and neck cancers have two main objectives: to treat the disease and to avoid surgical excision of the affected organ. However, there is no consensus concerning management of cervical node metastases following conservative treatment in patients with advanced regional metastases at diagnosis.Objectives: The present study had two main objectives. The first was to evaluate the best treatment for these patients, and the second was to determine the relationship between response to treatment and local control of the pathology.Methods: For the first objective we reviewed 657 head and neck cancer patients who had cervical metastases at time of diagnosis and were treated with an organ preservation protocol between 1985 and 2005.For the second objective we reviewed 134 head and neck cancer patients with cervical metastases at time of diagnosis who were treated with an organ preservation protocol and had complete local response and neck disection after the non-surgical treatment.Results: Regional relapse-free survival at 5 years for radiotherapy only patients was 63.1%, and for the radiotherapy plus surgery patients it was 69. 1. The second group was diagnosed with more advanced regional pathology, so their initial prognosis was worse than in the first group. Advanced regional metastases, non-complete chemotherapy response and no neck dissection were independent risk factors for regional relapse. The finding of cancer cells in the neck dissection analysis was a risk factor for local relapse. These patients had a worse 5-year survival than patients without cancer cells in the neck nodes.Conclusions: Patients with advanced regional metastases had better regional control with neck dissection plus radiotherapy than patients with radiotherapy alone. Cancer cells in the neck dissection after preservation protocol influenced local control of head and neck cancers.

The F-box protein Skp2 (S-phase kinase associated protein 2) positively regulates the G1-S transition by controlling the cell cycle inhibitor p27Kip1. The p42/p44 mitogen-activated protein (MAP) kinase activation is also necessary for the cell cycle progression. p27Kip1 acts as a negative regulator of the cell cycle by inhibiting the activity of cyclin/cdk complexes during G0 and G1. RT-PCR, Western blotting and immunohistochemical staining were used to assay their relationship with cervical lesion development. In RT-PCR and western blotting, Skp2 mRNA and protein were expressed mostly in carcinoma tissues. At Fisher¡¦s exact test showed that Skp2, p27Kip1 and p42/p44 MAP Kinase are strongly associated with disease progession respectively (P < 0.0001, P < 0.0001, P = 0.0043). We also found a postive correlation between the expression of Skp2 and p42/p44 MAP Kinase (P = 0.0097).

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Health communication has become a popular way for health promotion. Public service advertisements of disease prevention construct the understanding of disease and actions toward caution and healing. However, the health messages provided by mass media are not neutral and value-free information; instead, they imply with domestic cultural values, moral regulation, and social order by framing people who affect a disease as lack of self-control, self-surveillance, and negligent behavior. A series of cervical cancer preventing advertisements long-term sponsored by P&G is selected for studying samples. The aims of this research are to discover the power, ideology and dominant discourse about women's health in advertisements. Semiotic theory is adopt as analyzing methodology in exploring mainstream discourse about women's health and body regulation in Taiwan, through voice-over, story, and images in advertising. This research finds that information for preventing cervical cancer appeared through media is full of patriarchy ideology. The perception of "healthy" women body is shaped to fit social expectations in female characters, as well-controlled, fragile and protection needed, as well as capability for giving birth of a child. The advertising represents social construction of illness, and defines women's health problems as individual and private responsibility. The importance of national health policy and the force of social control are absent and ignore. Thus, to disclose how patriarchy, dominant ideologies which undermines women's health are implemented in health communication is the main purpose of this paper.

The purpose of this study is to quantify the dynamic mechanical properties of human cervical ligaments following whiplash. Cervical ligaments function to provide spinal stability, propioception, and protection during traumatic events to the spine. The function of cervical ligaments is largely dependant on their dynamic biomechanical properties, which include force and energy resistance, elongation capability, and stiffness. Whiplash has been shown to injure human cervical spine ligaments, and ligamental injury has been shown to alter their dynamic properties, with potential clinical consequences such as joint degeneration and pain. In this study we quantified the dynamic properties of human lower cervical ligaments following whiplash and compared their properties to those of intact ligaments. Whiplash simulation was performed using biofidelic whole cervical spine with muscle force replication (WCS-MFR) models. Next, ligaments were elongated to failure at a fast elongation rate and peak force, peak elongation, peak energy, and stiffness values were calculated from non-linear force-elongation curves. Peak force was highest in the ligamentum flavum (LF) and lowest in the intraspinous and supraspinous ligaments (ISL+SSL). Elongation was smallest in middle-third disc (MTD) and greatest in ISL+SSL. Highest peak energy was found in capsular ligament (CL) and lowest in MTD. LF was the stiffest ligament and ISL+SSL least stiff. These findings were similar to those found in intact ligaments. When directly comparing ligaments following whiplash to intact ligaments in a prior study it was found that the anterior longitudinal ligament (ALL) and CL had altered dynamic properties that were statistically significant, suggesting that whiplash may alter the dynamic properties of cervical ligaments. These findings may contribute to the understanding of whiplash injuries and the development of mathematical models simulating spinal injury.

Cervical Spondylotic Myelopathy (CSM) is a common type of spinal cord dysfunction in the elderly. The natural history of CSM is associated with disc degeneration and spondylosis, leading to the static and dynamic compression of the spinal cord, tissue ischemia, tissue damage, and ultimately neurological function deficit. However, the severity of the spinal cord compression does not necessarily correlate with the signs and symptoms of CSM in patients. Until now, the pathomechanism of CSM was not well understood. Establishing an evaluation technique is, therefore, criticalfor the pathophysiological investigation of CSM. Magnetic resonance imaging (MRI) has been widely used for evaluating the spinal cord parenchyma. However, conventional MRI is limited in detecting macroscopic changes, e.g. spinal cord compression, edema or hemorrhage etc. Recently, there has been increasing interest in diffusion tensor imaging (DTI), which permitting detects tissue water molecule diffusion at the microscopic level. The conventional DTI analysis for CSM relies on hand-drawn regions of interest (ROIs), so called ROI-based measurements. The ROIs are drawn on the sagittal image or on the axial image to cover the whole cord, which are insufficient to describe the precise diffusion pattern. In particular, the deformation and degeneration of the myelopathic cord poses a big challenge for the ROI-based analysis. The most commonly used parameter, fractional anisotropy (FA) has difficulty in determining the level diagnosis due to its relatively large variance along the cord. Furthermore, the functional activation following microstructural damage remains underexplored. In this dissertation, several novel methods for region-specific analysis were proposed for the investigation of microstructural changes in the CSM. In Chapter 2, ROI-based analysis was employed to detect the regional diffusion characteristics in CSM. In Chapter 3, an auto-template was developed that segments the cord and measures the DTI parameters automatically. We found that our auto-template outperforms hand-drawn ROI-based methods in terms of efficiency and reproducibility. In Chapter 4, entropy-based analysis was proposed to characterize the loss of complexity of microstructure in the myelopathic cord. It was demonstrated that FA entropy was an objective and quantitative evaluation parameter that was superior to conventional methods for separating CSM patients from healthy subjects. In Chapter 5, orientation entropy was used to detect the disordered orientational distribution of the nerve tracts in CSM, which could be used as a good index for the pathogenic level estimation. In Chapter 6, a diffusion tensor tractography-based method was proposed to overcome the difficulties in column-specific ROI drawing on the deformed and degenerated spinal cords. In Chapter 7, the structure-function relationship in the cervical spinal cord was explored by a combination of DTI and functional MRI. A significant correlation was found between enhanced functional responses and the loss of microstructural integrity in CSM. In this study, several novel post-processing methods were proposed and demonstrated, which were shown to have extraordinary capabilitiesfor the investigation and assessment of CSM. It is expected that these methods can be used as valuable tools for clinical diagnosis and for the selection of the most appropriate treatment strategy for CSM. / published_or_final_version / Orthopaedics and Traumatology / Doctoral / Doctor of Philosophy

Introduction: Human papillomavirus (HPV) is the sexually transmitted etiologic agent of cervical cancer. While HPV infects both men and women, little is known about HPV infection in men. Specifically, knowledge of the prevalence of type-specific HPV infection and the distribution of these infections by anogenital anatomic site in men is incomplete. Evaluation of factors associated with HPV infection based on complete anogenital sampling and with HPV-16 antibody detection may lead to a better understanding of HPV transmission and prevention.Methods: A total of 493 asymptomatic men ages 18 to 40 years old were recruited in Tucson, Arizona, and Tampa, Florida, from 2003 to 2006. Eligibility requirements included having had sex with a woman within the past year and having no history of genital warts. Testing for HPV from anogenital swabs from six anatomic sites and semen was conducted by PCR and reverse line blot genotyping for 37 HPV types. Serum antibodies for HPV-16 were detected by ELISA. Self-administered demographic, health, and sexual history/behavior questionnaires were collected. HPV prevalence and type distributions by anatomic site were calculated, as was seroprevalence of HPV-16 antibodies. Multivariate logistic regression was used to identify independent risk factors for HPV infection at any anatomic site and for having HPV-16 antibodies.Results: HPV was detected in at least one sample for 303 (65.4%) men, with 29.2% of men having an oncogenic infection and 36.3% having a non-oncogenic infection. Multiple HPV types were detected in 27.2% of men. Factors associated with infection were a greater lifetime number of female sexual partners, currently smoking 10 or more cigarettes per day, lack of condom use, and more sexual partners in the past three months. HPV-16 antibodies were detected in the serum of 63 (12.8%) men, and detection was associated with increasing age and concurrent detection of HPV DNA in perianal or anal canal samples.Discussion: The combination of more complete anogenital sampling and sensitive HPV detection for 37 HPV types resulted in a higher HPV prevalence in asymptomatic men than previously reported. Smoking and condom use were the most important modifiable risk factors for HPV in men. These results have implications for research of HPV transmission.

Multi-echo T2 relaxation measurements of the human spinal cord (SC) reveal a short T2 pool of water believed to arise from water trapped between myelin bilayers, where the proportion of this water to the total water signal is called the myelin water fraction (MWF). In the present study, MWF were measured in the healthy human cervical spine at the C4-C6 vertebral levels in vivo using a 3D modified 32 echo CPMG sequence to acquire axial slices perpendicular to the cord. Volunteers were recruited in two age ranges, under 30 years old and over 50 years old, and a subset of both groups were scanned twice to test reproducibility. Mean MWF in the dorsal and lateral column WM of the group under 30 years of age was 0.29 (0.01) (mean(SE)), which agrees with previously reported MWF values in the cervical spine. The mean absolute difference between two scans was 0.06 or 26%. A negative correlation between WM MWF and age was hinted at in these findings, however more subjects are required to improve statistical power. This study paves the way for the use of 3D myelin water imaging in the cervical spine at 3.0T for the assessment of SC WM pathology.

Orthopaedic reconstruction often involves the surgical introduction of structural implants that provide for rigid fixation, skeletal stabilization, and bone integration. The high stresses incurred by these implanted devices have historically limited material choices to metallic and select polymeric formulations. While mechanical requirements are achieved, these non-degradable materials do not participate actively in the remodeling of the skeleton and present the possibility of long-term failure or rejection. This is particularly relevant in cervical fusion, an orthopaedic procedure to treat damaged, degenerative or diseased intervertebral discs. A significant improvement on the available synthetic bone replacement/regeneration options for implants to treat these conditions in the cervical spine may be achieved with the development of primarily mineral biocomposites comprised of a bioactive ceramic matrix reinforced with a biodegradable polymer. Such a biocomposite may be engineered to possess the clinically required mechanical properties of a particular application, while maintaining the ability to be remodeled completely by the body. A biocomposite of Si-doped calcium phosphate (Si-CaP) and poly(ε-caprolactone) (PCL) was developed for application as such a synthetic bone material for potential use as a fusion device in the cervical spine. In this thesis, a method by which high mineral content Si-CaP/PCL biocomposites with interpenetrating matrices of mineral and polymer phases may be prepared will be demonstrated, in addition to the effects of the various preparation parameters on the biocomposite density, porosity and mechanical properties. This new technique by which dense, primarily ceramic Si-CaP/PCL biocomposites were prepared, allowed for the incorporation of mineral contents ranging between 45-97vol%. Polymer infiltration, accomplished solely by passive capillary uptake over several days, was found to be capable of fully infiltrating the microporosity of the sintered calcium phosphate ceramic. After infiltration, these biocomposite materials demonstrated an increase in compressive strength, flexural strength and Young’s modulus with increasing ceramic content and met design targets for use as a cervical fusion prosthesis. The biocomposite was amenable to shaping and drilling and was found to maintain its strength after 30 days immersion in Earle’s Balanced Salt. / Thesis (Ph.D, Mechanical and Materials Engineering) -- Queen's University, 2009-11-24 16:18:16.461

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