Purpose: The management of head and neck squamous cell carcinoma (HNSCC) is complex and often involves multimodality treatment. Currently, most management decisions are based on clinical parameters with little appreciation of patient differences in underlying tumour biology. The identification of biomarkers that predict response to radiotherapy would be clinically useful in determining optimal management. The purpose of the thesis was to investigate potential biomarkers that might predict radiotherapy outcome in patients with HNSCC. Aims: 1) To investigate the hypoxia-associated biomarkers carbonic anhydrase 9 (CA9) and hypoxia-inducible factor -1α (HIF-1α) in patients with early glottis cancer who underwent radiotherapy as their primary mode of treatment, furthermore to investigate the role of accelerated hypofractionated radiotherapy in the management of T2 glottic cancer. 2) To investigate markers of hypoxia (CA9 and HIF-1α) and viral infection in oropharyngeal cancer, and in particular to test for an association between hypoxia markers and viral infection. 3) To investigate HIF-1 and CA9 in a series of patients undergoing surgery as their primary mode of treatment to explore whether they are associated specifically with radioresponsiveness or a general poor prognosis. Results: 1) Adverse prognostic factors for locoregional control were low pre-treatment haemoglobin (Hb; p = 0.010), advancing T stage (p = 0.001) and high CA9 expression (p = 0.032). Low Hb and high CA9 expression were independent factors on multivariate analysis; and combined predicted locoregional recurrence with an odds ratio of 8.0 (95% CI: 2.7-23.9), or either/or with an odds ratio of 3.3 (95% CI 1.5-7.1). In the subset of T2 patients, five-year locoregional control following radiotherapy was 82% and cancer specific survival was 90%. Serious morbidity occurred in 1.8% of patients. T stage subdivided by vocal cord movement was significant for local control. 2) Features associated with a poor locoregional control were older age (p=0.002), tongue base subsite (p=0.002), heavy alcohol use (p=0.004), heavy smoker (p=0.0002), low Hb level (p=0.001), advancing T (p=<0.0001), N (p=0.001) and AJC (p=0.001) stage, high CA9 expression (p=0.020) and high HIF-1α expression (p<0.0001). In multivariate analysis T stage (p=0.003) and high HIF-1α expression (p=0.001) remained significant. 3) Extracapsular spread was significantly associated with poor cancer specific survival (p=0.022). No other patient variables were associated with outcome. HIF-1α expression was significantly associated with poorly differentiated tumour (p=0.019) and the tumour having a cohesive front (p=0.026). Conclusion: 1) Hb and CA9 have potential to be used together as a biomarker to identify glottis cancer patients with a high probability of a poor outcome following radiotherapy, furthermore, vocal cord movement should be taken into consideration when managing glottis cancer. 2) As it does not appear to be influenced by HPV status, HIF-1α warrants further investigation as a biomarker in oropharyngeal patients treated with primary radiotherapy. 3) As HIF-1α and CA9 had no prognostic significance in patients undergoing surgery, they should be explored further as markers to help guide management decisions in patients with HNSCC.

A dissertation presented in partial fulfilment of the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 1997. / The purpose of this investigation was to compare the effectiveness of chiropractic manipulation alone to the use of chiropractic manipulation together with therapeutic exercise in the management of chronic mechanical cervical spine conditions. Measurements in terms of objective and subjective clinical findings, were to be used to substantiate or refute the use of auxiliary therapeutic exercise in these conditions. It was hypothesised that therapeutic exercise would be a valuable adjunct to the chiropractic management of chronic mechanical cervical spine conditions in terms of objective (flexibility) and subjective (pain and disability) clinical findings. Thirty consecutive subjects suffering from chronic neck pain were obtained from local advertising (radio and newspapers) and randomly placed into two groups for comparison. The 0. age group of subjects accepted ranged from 16 to 60 and included both sexes from any race, who had suffered from neck pain for six weeks or longer. Subjects were assessed to determine whether there were any contra-indications to manipulation or exercise. Treatment commenced for a month with both groups receiving spinal manipulative therapy and one group doing daily therapeutic exercises. The eROM goniometer, McGill Pain Questionnaire, Numerical Pain Rating Scale - 101 Questionnaire and the CMee Neck Disability Index were / M

Dissertation submitted in the partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1996. / There have been few substantiated studies done to investigate the efficacy of spinal manipulative therapy for cervical syndromes [Vernon et.al. (1990: 13), Sloop et.al. (1982: 532) and Cassidy 1\ et. al. (1992: 495)]. Therefore, more conclusive evidence is needed to verify the success of manipulation, especially in terms of chiropractic treatment methods. The purpose of this investigation was to evaluate cervical spine manipulation and combined cervical and thoracic spine manipulation, according to subjective and objective clinical findings, in order to determine the efficacy of each approach in the management of mechanical neck pain. It was hypothesized that cervical spine manipulation, and combined cervical and thoracic spine manipulation would both be effective in the treatment of mechanical neck pain. However, it was proposed that combined cervical and thoracic spine manipulation would be more effective than just cervical spine manipulation, in terms of subjective and objective clinical findings. This study consisted of a controlled trial of a sample population diagnosed with joint dysfunction (cervical and thoracic facet syndrome) . Thirty subjects were randomly divided into two groups: the control group and the experimental group. The control group was treated with cervical adjustments only and the experimental group received combined cervical and thoracic adjusfments. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2002. / The purpose of this study was to determine the efficacy of muscle energy technique in the treatment of chronic mechanical neck pain. This was a randomized placebo controlled study. Two groups of thirty subjects from Durban and the surrounding areas were selected to participate in the study, which was carried out at the Technikon Natal Chiropractic Day Clinic. Subjects were diagnosed with the condition by the researcher. Each subject received six treatments within a period of three weeks. Group A received muscle energy technique and de-tuned laser therapy applied to joint fixations. Group B received de-tuned laser therapy applied to the fixated areas. Subjective assessment was by means of the Short-Form McGill Pain Questionnaire and the Numerical Pain Rating Scale-101. Objective assessment was by means of the digital algometer (The Commander\x99 Algometer by Jtech Medical Industries) and the Cervical Range of Motion Device. Both the subjective and objective readings were taken prior to the first treatment and a day following the final (sixth) treatment. / M

M.Tech.

A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirement for the degree of Master of Science in Physiotherapy Johannesburg, 2017 / Background: The cognitive elements of fear avoidance and pain catastrophising in individuals suffering from chronic pain, including chronic low back pain and chronic musculoskeletal conditions, have been found to be significant impediments to recovery. However, little is known about the influence of fear avoidance and pain catastrophising on chronic non-specific neck pain, especially in the context of a South African population. The purpose of this study was to determine the prevalence of fear avoidance and pain catastrophising in patients suffering from chronic neck pain of three or more months’ duration who were attending physiotherapy in private clinics in Johannesburg, South Africa. The objectives of this study were to establish the prevalence of fear avoidance, the prevalence of pain catastrophising, and to establish the association between demographic variables and fear avoidance and pain catastrophising respectively. Methods: In order to fulfil the objectives, a cross-sectional design was used on the basis of the validated Tampa Scale for Kinesiophobia-11 (TSK-11) and the Pain Catastrophising Scale (PCS) questionnaires to determine the prevalence of fear avoidance and pain catastrophising respectively in patients suffering with chronic neck pain. The patients were sampled sequentially from randomly selected private practices in Johannesburg, South Africa, with the particular focus being on musculoskeletal conditions. The demographic data included gender, age, pain intensity, marital status, highest level of education attained, employment status, duration of neck pain, and whether or not the participant had had to reduce his/her work load as a result of the pain experienced. These factors were tested in terms of their association between fear avoidance and pain catastrophising respectively, and of the association between fear avoidance and pain catastrophising itself. A total of 106 participants were interviewed. The data from the questionnaires and the demographic questionnaires were analysed using Statistica, version 12. The results were considered significant when p-values of 0.05 were attained. Results: A total of 106 participants with a mean age of 48.7 years (SD=14.8; range 20-80 years) were drawn sequentially from a randomly selected total of 25 private practices. Female participants constituted 81.1% (n=86) of the total participants and 76.4% had some form of tertiary education. The majority (76.4%) were working and most (79.2%) had not reduced their work load as a result of their pain. Many participants were in a relationship (67.9%) and the pain intensity showed a mean of 4.4 on the VAS (SD=2.2; range 0.3-8.7), with the median pain duration being 96 months (8 years) (IQR=30-180 months) (2.5-15 years); range 3-756 months (0.25-63 years)). The TSK-11–Total showed a mean score of 22.9 and 25.5% of the participants (n=106) presented with significant fear avoidance measured on theTSK-11-Total scale. The prevalence was based on a cut-off equivalent to the midpoint scale. The median score for the PCS-Total was 12. The prevalence of clinically relevant scores for the PCS-Total was 15.1% (n=106) of the population studied, based on a cut-off score of =30. There was a significant, positive correlation between the TSK-Total and the PCS-Total and its subscales; and between the TSK-SF and the PCS-Total and its subscales. Significant association was found between the highest level of education and the TSK-11-Total score. The mean TSK-11 score for those with secondary education (26.0 ± 3.4) was higher than that for patients with a tertiary education (21.9 ± 1.5), indicating that those with a secondary education were more likely to be fear avoidant than those with a tertiary education. There was a significant, positive correlation between pain intensity and the TSK-Total score, and a significant positive correlation between pain intensity and the PCS-Total score. No significant association was found for fear avoidance and pain catastrophising in respect of any of the other demographic variables. Conclusion: This prevalence study established that of the sample of adults attending physiotherapy for chronic non-specific neck pain, 25.5% suffer from fear avoidance and 15.1% suffer from pain catastrophising. An association was found between the total scores for fear avoidance and pain catastrophising. Furthermore, an association was also found between fear avoidance and its subscale, somatic focus, and between pain catastrophising and all its subscales, namely rumination, magnification and helplessness. Yet another positive association was found between secondary education and fear avoidance, and a positive correlation between pain intensity and both fear avoidance and pain catastrophising respectively. / MT2018

Thesis (M.Sc.)--Boston University, Henry M. Goldman School of Graduate Dentistry, 1977 (Dental Public Health). / Includes bibliographical references: (leaves 6,13).

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No description available.

The role of the anterior neck muscles in cervical dysfunction has become an area of interest in the physiotherapy literature, resulting in the development of new methods for assessing and treating dysfunction of these muscles. However, these methods are based primarily on electromyographic (EMG) and various imaging studies, and lack a detailed anatomical or biomechanical foundation. The purpose of this work was to examine the morphology and basic biomechanics of the sternocleidomastoid (SCM); scalenus anterior, medius, and posterior; longus capitis and colli; rectus capitis anterior and lateralis muscles with a view to better understanding the capabilities of these muscles. This will contribute to our understanding of the mechanisms of cervical disorders and inform more evidence based approaches to treatment. This research was completed in three stages: dissection of the fascicular anatomy of the anterior neck muscles in embalmed cadavers; magnetic resonance imaging (MRI) of these muscles in young volunteers; and biomechanical modelling. Descriptive and morphological data from both the dissection and MRI studies were recorded, and cross-referenced for input into the biomechanical model. The biomechanical study involved calculating the peak force capabilities of each fascicle, and deriving the orientation and distribution of these forces across the cervical motion segments using CT scans. The result was a detailed breakdown of the peak torque, compression and shear forces generated by the anterior neck muscles at a fascicular level, calculated with reference to each cervical motion segment. The dissection study revealed several interesting findings regarding the structure of these muscles, adding considerable detail to anatomical textbook descriptions. Findings are described for each individual muscle. The MRI study found substantially larger muscle volumes than found in the dissection study, due to changes both with age and embalming. Biomechanical modelling demonstrated that in the neutral position the anterior neck muscles are not capable of exerting large forces, and do not act equally on all the cervical motion segments. Moment generating capacity into flexion was dominated by the SCM, and increased at lower levels in the cervical spine. All muscles were capable of producing compression, and total compression capacity remained relatively even at different cervical levels. Shear capacity was minimal, and was only potentially produced by the SCM in the lower cervical spine. The anterior neck muscles are complex and interesting muscles for which textbook descriptions tend to be simplified. These muscles act closely on the cervical motion segments, producing largely compressive forces. The more deeply placed longus and scalene muscles demonstrated a limited capacity for producing flexion moments, especially compared to the SCM. At C2-3 the SCM produced a net extension moment, suggesting that at this level (and above) the longus capitis and colli may proportionally play a greater role in cervical flexion. However, the force capabilities of these muscles remain very small and may be insufficient to produce actions attributed to these muscles in the clinical literature. This research presents data fundamental to understanding the function of these muscles, and which has the potential to contribute towards many different biomechanical applications in future research.