Background: Neck pain is a major public health with great effects on both the individual and society. Cervical radiculopathy is a relatively common form of neck pain with neurological symptoms. Physical therapy is often the first treatment but there is paucity in literature reviews investigating the effects of physical therapy. Objective: To assess the effects of physical therapy for cervical radiculopathy. Methods: A literature search was conducted in PubMed, CINAHL, PEDro and Web of Science. A total of 12 RCT articles were included in the study. The articles were reviewed based on the aims of the study and the PEDro scale. Results: Eight studies of moderate quality and four high quality. Most studies used the same outcome measures. Most common interventions were traction and manual therapy. Outcomes were varied with some reporting positive effects and others no change. Treatment periods, number of sessions and follow-up varied. In most cases, the positive results wore off at follow-up and differences between groups less pronounced. Conclusions: The quality of RCTs investigating cervical radiculopathy is variable. There is limited evidence suggesting that physical therapy treatment can have a measurable and significant long-term effect on cervical radiculopathy. / Bakgrund: Nacksmärta är ett allvarligt folkhälsoproblem med stor effekt på både den enskilde och samhället. Cervikal radikulopati är en relativt vanlig form av nacksmärta med neurologiska symtom. Fysioterapi är ofta den första behandlingen för detta tillstånd men det är brist på litteraturstudier som undersöker fysioterapins effekter. Syfte: Att undersöka effekterna av fysioterapi för cervikal radikulopati. Metod: Litteratursökningar gjordes i PubMed, CINAHL, PEDro och Web of Science. Totalt inkluderades 12 RCT artiklar i studien. Artiklarna granskades utifrån studiens frågeställningar samt PEDro kvalitetsgranskningsmall. Resultat: Åtta studier var av måttlig kvalitet och fyra hög kvalitet. De flesta studier använde samma utfallsmått och alla uppmätte smärta, funktionshinder och funktion. De två vanligaste behandlingarna var traktion och manuell terapi. Resultaten av insatserna varierade då vissa rapporterade positiva effekter och andra ingen förändring. Behandlingsperioder, antal sessioner samt uppföljning varierade. I de flesta fall, så avtog de positiva resultaten vid uppföljning och skillnaden mellan grupperna blev mindre uppenbara. Konklusion: Denna litteraturöversikt påvisade att kvaliteten på de RCT studier som undersöker cervikal radikulopati varierar. Resultaten visar att det finns begränsad evidens som tyder på att fysioterapi kan ha en mätbar och betydande inverkan på cervikal radikulopati i längden.

Cervical cancer is the forth most commonly diagnosed cancer among women worldwide. It is caused by persistent infection with an oncogenic type of Human Papillomavirus (HPV). The HPV is a necessary but not sufficient cause of cervical cancer. Environmental factors such as smoking, high parity and long-term use of oral contraceptives increases the risk of cervical cancer. Genetic factors also affect the risk of developing the disease. The aim of this thesis is to search for and evaluate genetic risk factors for cervical cancer using both a candidate gene approach and a genome-wide association study (GWAS). Paper I examined the association of genetic variation in three Fanconi Anemia (FA) genes (FANCA, FANCC and FANCL), involved in DNA repair, with cervical cancer susceptibility in the Swedish population. No association was observed. Paper II evaluated the association of genetic variation in the TMC6 and TMC8 genes with susceptibility to cervical cancer in the Swedish population and an association of two SNPs (rs2290907 and rs16970849) with cervical cancer was observed.  In paper III the first GWAS performed in cervical cancer was reported. Three independent loci in the major histocompatibility complex (MHC) region at 6p21.3 were found to affect the susceptibility to cervical cancer. Paper IV examined the sequence variation in the TMC6 and TMC8 region and its association with cervical cancer. A highly polymorphic 21 bp sequence was identified and found to be repeated 5 to 42 times in both cases and controls. Lack of this repeat was associated with increased risk of cervical cancer. An intronic SNP (rs2926778) located in between the TNRC6C and TMC6 genes was also found to be associated with cervical cancer. The thesis provides evidence for the importance of genes in the immune system for cervical cancer susceptibility. The genetic risk factors identified explain only a part of the genetic susceptibility, implying that other risk factors remains to be identified

I dagsläget finns effektiv behandling för cervixcancer med en god överlevnadsstatistik i Sverige och delar av västvärlden. All typ av behandling för cervixcancer kan medföra olika konsekvenser som kan leda till sexuell dysfunktion och en påverkad kroppsbild. SYFTE: Att identifiera vilka faktorer som bidrar till sexuell dysfunktion och en negativt påverkad kroppsbild hos kvinnor som behandlats för cervixcancer. METOD: Polit och Beck (2012) niostegsmodell följdes för att systematiskt utföra denna litteraturstudie. CINAHL och PubMed användes som databaser för att hitta relevanta artiklar. Artiklarna granskades och resulterade i totalt 14 stycken som användes i resultatet. Tre olika huvudteman urskildes i artiklarna och dessa var: Kroppsbild efter behandling, Sexuell dysfunktion efter behandling samt Behandlingsspecifika samband. RESULTAT: Resultatet visade att sexuell dysfunktion och kroppsbild påverkades negativt av både fysiska och psykiska faktorer så som dysparenui, minskad lust, blödningar och flytningar från vagina, rädsla att samlag skulle skada vagina efter behandling, förminskad och trång vagina. Behandlingsmetoden hade en stor betydelse för hur allvarliga dessa faktorer blev . SLUTSATS: Det är av stor vikt att som sjuksköterska och vårdpersonal uppmärksamma de problem och komplikationer som uppstår efter behandling av cervixcancer för att kunna bemöta patienterna och främja deras hälsa.

Cervical cancer is the second most common cancer, with about 500 000 new cases per year among women worldwide. With a well-organized screening programme the number of cases can be reduced by more than 50%. In spite of having such a screening programme there are still around 450 new cases yearly in Sweden. The majority of these cases occur in non-attendees. There is thus a need to improve the Swedish cervical cancer screening programme in order to further reduce the number of cases of cervical cancer. Cervical cancer and high-grade cervical dysplasia are caused by sexually transferred high-risk human papillomaviruses (HR-HPVs). In cases of persistent HR-HPV infection there is a risk of development of dysplasia and in some cases subsequent progress to cervical cancer. HR-HPV testing shows high sensitivity as regards the detection of cervical dysplasia. Self-sampling of vaginal fluid for the analysis of HR-HPV has many advantages, since a woman can perform the sampling herself in a private setting, whenever suitable, without the need to travel to a clinic. Our studies have shown that sensitivity in the detection of precancerous lesions is about twice as great with the HR-HPV self-test compared with cytology-based tests.  If a woman was HR-HPV-positive in two consecutive tests, the specificity of the HR-HPV test increased to about 98%. Among women with short-term persistent HR-HPV infection, the prevalence of CIN 2+ was over 40%. There was good concordance in sensitivity as regards the detection of CIN 2+ between self-obtained and physician-obtained samples, although self-sampling was associated with slightly lower specificity. The prevalence of HR-HPV from day to day in premenopausal women was not influenced by hormonal changes during the menstrual cycle. Neither were there significant day-to-day changes in postmenopausal women. A single self-test thus provides reliable information on whether or not a woman has an HR-HPV infection. In conclusion, self-sampling combined with the analysis of HR-HPV appears to be a powerful alternative as a primary screening method for the prevention of cervical cancer. Self-sampling for HR-HPV testing is a suitable, safe and accepted strategy for cervical cancer prevention among women.

Cervical cancer is a disease that annually claims the lives of over a quarter of a million women. A substantial number of these deaths could be prevented if population wide cancer screening, based on the Papanicolaou test, were globally available. The Papanicolaou test involves a visual review of cellular material obtained from the uterine cervix. While being relatively inexpensive from a material standpoint, the test requires highly trained cytology specialists to conduct the analysis. There is a great shortage of such specialists in developing countries, causing these to be grossly overrepresented in the mortality statistics. For the last 60 years, numerous attempts at constructing an automated system, able to perform the screening, have been made. Unfortunately, a cost-effective, automated system has yet to be produced. In this thesis, a set of methods, aimed to be used in the development of an automated screening system, are presented. These have been produced as part of an international cooperative effort to create a low-cost cervical cancer screening system. The contributions are linked to a number of key problems associated with the screening: Deciding which areas of a specimen that warrant analysis, delineating cervical cell nuclei, rejecting artefacts to make sure that only cells of diagnostic value are included when drawing conclusions regarding the final diagnosis of the specimen. Also, to facilitate efficient method development, two methods for creating synthetic images that mimic images acquired from specimen are described.

Cervical cancer is the third most common cancer among women worldwide, and the fourth leading cause of cancer mortality. Despite significant declines in the incidence and mortality rates of cervical cancer in Canada, it remains the 4th most common cancer in women aged 20-29 years. In order to gain novel insights into cervical cancer tumourigenesis and clinical outcome, we investigated and characterized the alterations in microRNA (miRNA) expression in this disease. Firstly, we performed global miRNA expression profiling of cervical cancer cell lines (n=3), and patient specimens (n=79). From this analysis, we identified miR-196b to be significantly down-regulated in cervical cancer, and characterized its role in regulating the HOXB7~VEGF axis. The global miRNA expression data also led to the development of a candidate 9-miRNA signature that was prognostic for disease-free survival in patients with cervical cancer, although we were unable to validate this signature in an independent cohort. This report describes important considerations concerning the development and validation of microRNA signatures for cervical cancer. Our investigations also led us to a comparison of three methods for measuring miRNA abundance: the TaqMan Low Density Array, the NanoString nCounter assay, and single-well quantitative real-time PCR. Our findings demonstrated limited concordance between the TLDA and NanoString platforms, although each platform correlated well with PCR, which is considered the gold standard for nucleic acid quantification. Furthermore, we examined biases created by amplification protocols for microarray studies. Our analysis demonstrated that performing a correction using the LTR-method (linear transformation of replicates) could help mitigate, but not completely eliminate such biases. Overall, this report presents insights into the role of miRNAs in cervical cancer, as well as an evaluation of technical considerations concerning miRNA and mRNA expression profiling studies.

Ziel dieser Arbeit ist die retrospektive Auswertung der operativ mit ventraler Dekompression und intersomatischer Fusion (ACDF) durch stand alone Cage versorgten Patienten und die Diskussion, ob eine postoperative Sinterung Einfluss auf das Outcome hat. Material und Methoden: Es wurden 33 Segmente operativ durch ACDF mit standalone-Cage bei 17 Patienten (11 Frauen und 6 Männer) Durchschnittsalter 56 Jahre (33 bis 82 Jahre) versorgt und nach durchschnittlich jeweils 8 und 26 Monaten klinisch, radiologisch und durch Scoreerhebung nachuntersucht. Ergebnisse: 70,6 % der Patienten (12/17) und 50,5% der Segmente (18/33) zeigten eine Sinterung. 36,3% der Sinterungen (12/33) bereits zur 1. NU nach 8 Monaten. Zur 2. NU nach 26 Monaten fand sich bei 100% eine Fusion ohne Pseudarthrose. Zusammenfassung: Die Sinterung des Cages hat keinen negativen Einfluss auf das Outcome. Wesentlich für das Outcome sind das Ausmaß und die Dauer der vorbestehenden Symptome. Es sollte besonders bei festgestellter Myelopathie frühzeitig eine operative Intervention erfolgen.

Bakgrund: Antalet drabbade kvinnor av livmoderhalscancer i Sverige är cirka 450 per år. Cirka en tredjedel av kvinnorna är under 40 år. I Sverige har insjuknandet av livmoderhalscancer minskat, troligen efter att regelbunden populations screening infördes på 1960-talet. Symtomen är få och diffusa och är därför svåra att upptäcka. Screening är en viktig undersökning för att upptäcka cancern tidigt. Tidigare forskning visade att kvinnor med livmoderhalscancer förändrade värderingar och synen på livet. Den begränsade forskningen inom området gör det relevant att studera kvinnors upplevelser av att leva med livmoderhalscancer. I studien användes livsvärldsteorin för att ge perspektiv på kvinnors upplevelser av att leva med livmoderhalscancer. Syfte: Är att analysera och beskriva kvinnors upplevelser av att leva med livmoderhalscancer. Metod: Studien har en kvalitativ ansats och en kvalitativ innehållsanalys används för att analysera bloggarna. Datamaterialet består av fem bloggar publicerade på internet. Resultat: Presenteras under kategorier, Förändrad identitet, En ständig kamp och Yttre påverkande faktorer. Slutsats:Livmoderhalscancer medför många psykiska och fysiska förändringar hos kvinnorna. Vilket bidrar till kvinnornas svårigheter att bevara sin identitet och självkänsla. / Background: The number of suffering women of cervical cancer in Sweden is approximately 450 per year. About a third of the women are under 40 years. In Sweden has the onset of cervical cancer reduced, probably after that regular population screening was introduced in the 1960s. The symptoms are few and diffuse and therefore difficult to detect. Screening is an important survey to detect the cancer early. Previous research showed that women with cervical cancer changing values and views on life. The limited research in this area makes it relevant to study women's experiences of living with cervical cancer. The study used the life-world theory to provide perspective on women's experiences of living with cervical cancer. Aim: The study aims are to describe the women´s experiences of living with cervical cancer. Method: the study has a qualitative approach and a qualitative analysis is used to analyze blogs. Data involve five blogs published on the Internet. Results: Presented in categories, Changed identity, a constant struggle and External influencing factors. Conclusion: Cervical cancer causes many physical and psychological changes in women. This contributes to women’s difficulties to preserve their identity and self-esteem.

Injury to the human neck is a frequent consequence of automobile accidents and has been a significant public health problem for many years. The term `whiplash' has been used to describe these injuries in which the sudden differential movement between the head and torso leads to abnormal motions within the neck causing damage to its soft tissue components. Although many different theories have been proposed, no definitive answer on the cause of `whiplash' injury has yet been established and the exact mechanisms of injury remain unclear. Biomechanical research is ongoing in the field of impact analysis with many different experimental and computational methods being used to try and determine the mechanisms of injury. Experimental research and mathematically based computer modelling are continually used to study the behaviour of the head and neck, particularly its response to trauma during automobile impacts. The rationale behind the research described in this thesis is that a computational model of the human head and neck, capable of simulating the dynamic response to automobile impacts, could help explain neck injury mechanisms. The objective of the research has been to develop a model that_,, can accurately predict the resulting head-neck motion in response to acceleration impacts of various directions and severities. This thesis presents the development and validation of a three-dimensional computational model of the human head and cervical spine. The novelty of the work is in the detailed representation of the various components of the neck. The model comprises nine rigid bodies with detailed geometry representing the head, seven vertebrae of the neck and the first thoracic vertebra. The rigid bodies are interconnected by spring and damper constraints representing the soft-tissues of the neck. 19 muscle groups are included in the model with the ability to curve around the cervical vertebrae during neck bending. Muscle mechanics are handled by an external application providing both passive and active muscle behaviour. The major findings of the research are: From the analysis of frontal and lateral impacts it is shown that the inclusion of active muscle behaviour is essential in predicting the head-neck response to impact. With passive properties the response of the head-neck model is analogous to the response of cadaveric specimens where the influence of active musculature is absent. Analysis of the local loads in the soft-tissue components of the model during the frontal impact with active musculature revealed a clear peak in force in the majority of ligaments and in the intervertebral discs very early in the impact before any forward rotation of the head had occurred. For the case of rear-end impact simulations it has been shown for the first time that the inclusion of active musculature has little effect on the rotation of the head and neck but significantly alters the internal loading of the soft-tissue components of the neck.

The cervical spine must provide structural support for the head, allow large range of motion and protect both the spinal cord and branching nerves. There are two types of spinal joints: the intervertebral discs which are flexible connections and the facets, which are articulating synovial joints. Both types degenerate with age. Current surgical treatments include spinal fusion and articulating disc replacement implants. If both disc and facet joints are degenerated, fusion is the only option. In spinal fusion, the disc is removed and the adjacent vertebrae are fused which causes abnormally high stress levels in adjacent discs. In disc replacement, an articulating device is inserted to restore intervertebral motion and mimic healthy spinal kinematics. Disc arthroplasty does not significantly increase adjacent level stress but the lack of rotational constraint causes increased facet contact pressures. Thus, there is a need for a cervical total level arthroplasty system (CTLAS) that has a disc implant specifically designed to preserve the facet joints and implants for facet arthroplasty that can act independently or in-unison with the disc replacement. The conceptual design of a CTLAS implant system was proposed that would replace the disc and the facet joints. To facilitate medical imaging, PEEK (polyetheretherkeytone) was selected as the structural and bearing material. In the present thesis, multi-station pin-on-plate wear testing was initiated for pairs of unfilled (OPT) and carbon-fiber-reinforced (CFR) PEEK. Wear is important in arthroplasty implant design because wear particles can cause osteolysis leading to loosening. A variety of experiments were performed to investigate the effects of load, contact geometry and lubricant composition on wear. CFR PEEK was found to have much lower and more predictable wear than OPT PEEK in the present experiments. The wear of OPT PEEK pairs showed sensitivity to lubricant protein concentration. The coefficient of friction during testing was found to be quite high (up to 0.5), which might have clinical implications. Also, some subsurface fatigue was found, exposing carbon fibers of CFR PEEK. This remains a concern for its long-term application. Further wear testing is recommended using actual implants in a spine wear simulator.