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- Villa, Luisa L., et al.
(författare)
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Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions
- 2007
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Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 356:19, s. 1915-1927
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Human papillomavirus types 16 (HPV-16) and 18 (HPV-18) cause approximately 70% of cervical cancers worldwide. A phase 3 trial was conducted to evaluate a quadrivalent vaccine against HPV types 6, 11, 16, and 18 (HPV-6/11/16/18) for the prevention of high-grade cervical lesions associated with HPV-16 and HPV-18. METHODS: In this randomized, double-blind trial, we assigned 12,167 women between the ages of 15 and 26 years to receive three doses of either HPV-6/11/16/18 vaccine or placebo, administered at day 1, month 2, and month 6. The primary analysis was performed for a per-protocol susceptible population that included 5305 women in the vaccine group and 5260 in the placebo group who had no virologic evidence of infection with HPV-16 or HPV-18 through 1 month after the third dose (month 7). The primary composite end point was cervical intraepithelial neoplasia grade 2 or 3, adenocarcinoma in situ, or cervical cancer related to HPV-16 or HPV-18. RESULTS: Subjects were followed for an average of 3 years after receiving the first dose of vaccine or placebo. Vaccine efficacy for the prevention of the primary composite end point was 98% (95.89% confidence interval [CI], 86 to 100) in the per-protocol susceptible population and 44% (95% CI, 26 to 58) in an intention-to-treat population of all women who had undergone randomization (those with or without previous infection). The estimated vaccine efficacy against all high-grade cervical lesions, regardless of causal HPV type, in this intention-to-treat population was 17% (95% CI, 1 to 31). CONCLUSIONS: In young women who had not been previously infected with HPV-16 or HPV-18, those in the vaccine group had a significantly lower occurrence of high-grade cervical intraepithelial neoplasia related to HPV-16 or HPV-18 than did those in the placebo group.
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| 5. |
- Plos, M., et al.
(författare)
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Non-Linear Analysis and Remaining Fatigue Life of Reinforced Concrete Bridges
- 2007
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Rapport (refereegranskat)abstract
- The work provides methods for non-linear structural analysis and fatigue safety evaluation in assessment of existing railway bridges. The use of non-linear analysis leads to higher load carrying capacities, but also to improved understanding of the structural response, forming a better basis for decisions in the assessment. The methods for fatigue assessment lead to increased remaining service life of reinforced concrete railway bridges.The achievements of the work are:• Models for assessment of concrete bridges by non-linear analysis are described, and examples and general recommendations for practical application of the methods aregiven.• An overview of the effect of corrosion on the bond properties has been developed through non-linear analyses and tests found in literature. Recommendations for practical assessment of anchorage capacity in corroded railway concrete bridges are presented.• The determination of reliable in-situ material properties in old concrete bridges is described,including properties for fully probabilistic analysis. A particular aim was to develop better methods to describe development of concrete properties with age and degree of hydration.• Recommendations are given regarding re-distribution of sectional forces and moments, obtained through linear structural analysis (with FEM). In a case study, a typical slab bridge was designed using different methods, and its response evaluated through nonlinearanalyses.• A good understanding of the load-carrying mechanisms in combined bending-shear-torsion gives a possibility to make more accurate assessments than with standard code methods. Methods and examples are presented.• A state-of-the-art review of fatigue behaviour of reinforced concrete railway bridges is presented and a methodology to assess the remaining fatigue life of existing reinforced concrete bridges subjected to railway traffic is developed.
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| 6. |
- Plos, Mario, et al.
(författare)
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Structural assessment of railway concrete bridges : non-linear analysis and remaining fatigue life
- 2006
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Ingår i: Bridge Maintenance, Safety, Management, Life-Cycle Performance and Cost. - London : Taylor and Francis Group. - 0415403154 ; , s. 271-
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Konferensbidrag (refereegranskat)abstract
- For a sustainable development in Europe, there is a need to at least double the railway transports in the coming 20 years. In order to reach this, the residual service lives of existing concrete bridges need to be extended at the same time as they are subjected to higher axle loads, higher railway speeds and heavier traffic intensity. Today, many concrete bridges are replaced or strengthened because their reliability cannot be guaranteed based on the structural assessments made. The aim of the work presented here is to provide enhanced assessment methods that are able to prove higher load carrying capacities and longer fatigue lives for existing concrete railway bridges. One main objective is to facilitate the use of non-linear analysis for structural assessment. In addition to higher load carrying capacities, the methods give improved understanding of the structural response, forming a better basis for decisions in the assessment. Another main objective is to improve knowledge about the fatigue behaviour of concrete bridges and to develop realistic methods for the evaluation of remaining fatigue life of existing bridges. The emphasis here is on short-span bridges and secondary elements. The work presented is a part of the ongoing EU-project Sustainable Bridges. The results will be implemented in the Guideline for Load and Resistance Assessment of existing European Railway Bridges that is being developed
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| 8. |
- Airell, A, et al.
(författare)
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Chlamydia trachomatis PCR (Cobas Amplicor) in women: endocervical specimen transported in a specimen of urine versus endocervical and urethral specimens in 2-SP medium versus urine specimen only
- 2000
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Ingår i: International journal of STD & AIDS. - : SAGE Publications. - 0956-4624 .- 1758-1052. ; 11:10, s. 651-658
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Tidskriftsartikel (refereegranskat)abstract
- The sensitivity of Roche Cobas Amplicor Chlamydia trachomatis polymerase chain reaction (PCR) including the internal control (IC) programme to identify inhibition, was investigated on 3 different samples from women: (1) swab samples from the urethra and the cervix pooled in 2-SP transport medium, (2) swab sample from the cervix transported in a urine sample from the same patient, and (3) urine sample alone. Out of the 2412 patients, 193 (8.0%) were chlamydia positive and in 14 of these the results showed discrepancies between sampling methods. The sensitivity of PCR on urethra/cervix, urine/cervix and urine was 98.4% (190/193), 97.9% (189/193) and 93.3% (180/193) respectively. The higher sensitivity of PCR on urethra/cervix and urine/cervix as compared with urine alone was statistically significant. Without the IC, the sensitivity of PCR on urethra/ cervix, urine/cervix and urine would have been 95.9% (185/193), 94.8% (183/193) and 90.7% (175/193) respectively. Factors influencing the rate of inhibition were also studied.
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| 9. |
- Andersson, S, et al.
(författare)
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A comparison of the human papillomavirus test and Papanicolaou smear as a second screening method for women with minor cytological abnormalities
- 2005
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 84:10, s. 996-1000
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Tidskriftsartikel (refereegranskat)abstract
- Background. Of the estimated one million Papanicolaou (pap) smears performed annually in Sweden, about 4% show any degree of abnormality. Approximately, 1% of these cases contain moderate or severe atypia (high-grade squamous intraepithelial lesions) and the rest contain low-grade atypia. Recommendations for the management of minor abnormalities vary in various parts of Sweden. Generally, a second Pap smear is obtained 4-6 months after the first one showing low-grade atypia. The aim of this study is to compare the sensitivity of human papilloma virus (HPV)-DNA testing for the detection of cervical intraepithelial neoplasia (CIN) 2-3 with that of a second Pap smear in women, who had low-grade atypia in their first Pap smear. Methods. Women with low-grade atypia in the Stockholm area, detected at a population-based cytology screening, were enrolled. A repeat Pap smear, HPV test, and colposcopically directed biopsies were obtained. For the detection of HPV, Hybrid Capture II (HC II) was used. Results. The HPV-DNA test was positive in 66% of the 177 participating women. The sensitivity of the second Pap smear and HPV-DNA test to detect CIN 2-3 was 61 (95% CI = 45-74) and 82% (95% CI = 67-91), respectively. The positive and negative predictive values of HPV testing were 27 (95% CI = 18-35) and 89% (95% CI = 80-97), respectively. Conclusions. In Sweden, a second Pap smear is often obtained for the follow-up of women with low-grade atypia. The results of our study show that compared to the second Pap smear, HPV testing with HC II is a more sensitive method for detecting high-grade lesions.
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| 10. |
- Carlander, C., et al.
(författare)
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Assessing cervical intraepithelial neoplasia as an indicator disease for HIV in a low endemic setting: a population-based register study
- 2017
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Ingår i: Bjog-an International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 124:11, s. 1680-1687
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To analyse whether the prevalence of undiagnosed HIV among (1) all women in Sweden and (2) migrant women, diagnosed with cervical intraepithelial neoplasia grade 2 or worse CIN2+ reaches the threshold of 0.1%, which has been suggested to be cost-effective for HIV testing. Design Population-based register study. Setting Counties of Stockholm and Gothenburg, Sweden, 1990-2014. Population All women, born between 1940 and 1990, with at least one cervical cytology or histology registered in the Swedish National Cervical Screening Register (NKCx). Methods Data were collected from the NKCx and the Swedish National HIV register. The proportion of women with undiagnosed HIV among women with CIN2+ compared with women with a normal/mildly abnormal cytology/histology was assessed. Results The proportion of undiagnosed HIV was higher among all women with CIN2+ than among those without CIN2+: 0.06% (95% CI 0.04-0.08) versus 0.04% (95% CI 0.04-0.04); P = 0.017). Among migrant women, the proportion of undiagnosed HIV was higher among those with CIN2+ than among those without [0.30% (95% CI 0.20-0.43) versus 0.08% (95% CI 0.07-0.10); P < 0.001] and exceeded 0.1%, suggesting the cost-effectiveness of HIV testing. Women with undiagnosed HIV at the time of CIN2+ had a significantly lower nadir CD4+ T-cell count, as a measure of immunosuppression, compared with women without CIN2+ before HIV diagnosis ( median nadir CD4, 95 cells/mm(3) versus 210 cells/mm(3); P < 0.01). Conclusions HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN2+.
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