A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / To systematically review all studies examining HPV vaccination acceptability among immigrant and ethnic minority parents and eligible individuals for cervical cancer prevention in the Unites states. MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane database searches were conducted searching for English language, US‐based studies to examine immigrant and ethnic minority population’s acceptability of HPV vaccination. Thirteen of more than 3,098 potentially relevant articles were included in the final analysis. Results. Latinos were statistically more likely to accept vaccination for both their daughters and sons. Foreign‐born adult Latinas were more accepting of the vaccine than U.S.‐born Latinas after controlling for other variables. Overall African American and Asian American parents were less likely to accept HPV vaccination for their daughters than Hispanic and White parents. Of the African American parents who intended to vaccinate their children the majority were significantly non‐Baptist and had higher levels of education. The majority of Haitian immigrants intended to vaccinate daughters and the rest agreed that they would most likely have their daughters vaccinated if their daughters’ physicians recommended it. More research is needed, particularly in the context of health care provider HPV vaccination recommendation to immigrant and ethnic‐minority populations. Acceptance figures so far suggest that the vaccine is generally well received among Hispanic/Latin and Haitian immigrants, but details of ethnic variations among these groups and a qualitative understanding of lower rates of acceptability among African American and Asian American communities are still being awaited. Despite advances in cervical cancer screening rates in the US, cervical cancer remains disproportionately high among low‐income immigrant and minority women, making this subgroup particularly vulnerable to disparities in screening and its detection. The purpose of this study is to examine the qualitative aspects of institutional and community level interventions of Cervical Intraepithelial Neoplasia (CIN) within the immigrant and refugee populations and the use of HPV vaccination as a prevention method. Combinations of the following keywords/phrases will be used: CIN‐ Cervical Intraepithelial Neoplasia, Cervical diseases, Cervical dysplasia, Refugees, Pap smear, Cervical Cancer Screening, HPV‐ Human Papillomavirus, HPV vaccination, Ethnic minorities, Immigrants. Independent reviews of each article will be conducted to assess the study quality and confirm the accuracy, completeness, and consistency of the abstracted data.

Le but de ce travail est d’améliorer les techniques de mesure cinématique tridimensionnelle (3D) afin d’étudier les schémas cinématiques du complexe de l’épaule et du rachis cervical chez des sujets sains et pathologiques. La première partie de ce travail propose un rappel d’anatomie fonctionnelle, une revue de la littérature de la cinématique du complexe scapulo-huméral et une mise au point sur les techniques de mesure de ces deux complexes articulaires. La deuxième partie de ce travail a pour objectif d’évaluer à partir d’études cliniques originales : - la reproductibilité des techniques de mesure des rotations des complexes scapulo-huméral et cervical et d’en proposer une amélioration par une analyse simultanée des translations du barycentre de la scapula ainsi que par la mesure couplée des deux complexes articulaire. - les schémas cinématiques de la scapula dans différents modèles de pathologies ostéo-articulaires au cours de gestes analytiques et fonctionnels. En conclusion, ce travail de thèse met en évidence : une variabilité intra-individuelle dans la capacité à reproduire un mouvement à l’identique avec le membre supérieur et à conserver la même précision dans le repositionnement de la tête. - des mouvements de translation 3D de la scapula, dont certains de grande amplitude, associés aux rotations des mouvements de faible amplitude du rachis cervical associés aux mouvements du membre supérieur en faveur de son rôle proprioceptif. - des schémas cinématiques scapulaires spécifiques : - de la lésion neurologique en cas de scapula alata dynamique. - de la nature fonctionnelle de la tâche en cas de pathologies ostéo-articulaires communes / The aim of this work was to improve the methods of kinematic assessment of the shoulder complex and of the cervical spine in order to improve understanding of scapular and cervical spine kinematics in asymptomatic and symptomatic subjects. The first part of this work provides a reminder of functional anatomy, a literature review of the 3D kinematics of the shoulder complex and issues relating to measurement techniques of both articular complexes. The second part is based on original clinical studies assessing: - the reliability of the measurement techniques of the rotations of both articular complexes and their enhancement by addition of scapular translations and the coupled mobility of the cervical spine and shoulder complexes. - the patterns of scapular kinematic in different ostéo-articular pathologies In conclusion, this work highlights: - intra-individual variability in the ability to reproduce a movement with the upper arm and in the accuracy of repositioning the head . -3D scapular translations (some with large ranges) associated with scapular rotations. - small movements of the cervical spine associated with upper limb movements relating to the proprioceptive role of the cervical. - spine specific scapular kinematic patterns depending on: - neurological lesions in the case of dynamic scapula alata, - the type of movement in common osteo articular pathologies

M.Tech. (Chiropractic) / Purpose: The effectiveness of cervical spine adjustments for improving spinal function and relieving pain has been well established. However, the mechanisms responsible for these changes after spinal adjustments are still being researched. Further scientific evidence regarding the neurological and physiological effects following spinal adjustments is warranted. Evidence suggesting that spinal dysfunction has an effect on central neural processing is growing. A number of palpation from the first to the sixth visit. The seventh visit consisted of gathering data only. Results: Clinical and statistical improvements in the entire group were shown over the course of the treatment with regards to cervical spine range of motion, touch pressure threshold and neck pain and disability. Conclusion: The results show that lower cervical spine adjustments do have an effect on touch pressure threshold, cervical spine range of motion and neck pain and disability in patients with chronic cervical facet syndrome. Touch pressure threshold returned to optimal function, cervical spine range of motion increased and neck pain and disability decreased in all participants over time. authors have suggested that spinal dysfunction may lead to altered sensory input to the central nervous system (Murphy and Taylor, 2008). Aim: The aim of this study was to determine the effect of C6, C7 and T1 spinal adjustment therapy on those individuals with posterior neck pain due to chronic cervical facet syndrome and its influence on touch pressure threshold, neck pain and disability as well as cervical spine range of motion. Method: This study consisted of a single group of thirty participants between the ages of eighteen and fourty-five. The potential participants were examined and accepted according to the inclusion and exclusion criteria. The only method of treatment administered to each participant was cervical spine adjustments delivered to restricted C6, C7 and Tl segments in the lower cervical spine. Subjective and objective findings followed. Procedure: Treatment consisted of seven visits. Subjective and objective data was taken at the first, fourth and seventh visit. Objective data consisted of cervical spine range of motion readings taken using a Cervical Range of Motion measuring instrument (CROM), and touch pressure threshold results obtained via the Semmes Weinstein monofilaments. Subjective data was taken in the form of a Vernon Mior Neck Pain and Disability Index. Cervical spine adjustments were applied to restricted segments in the lower cervical spine (C6, C7, Tl), identified through motion

M.Tech. / Purpose: The cervical facet joints have attracted relatively little attention as possible sources of neck pain and referred pain. Multiple authors have described the management of cervical facet joint pain but not the cause (Manchikanti et al., 2002). Method: This study consisted of one group of 100 participants. The participants were between the ages of 18 and 40 years. Potential participants were examined and accepted based on the inclusion and exclusion criteria. All the participants received a cervical spine adjustment. Objective and subjective readings were taken. Procedure: The participants were seen only once. The Visual Analogue Scale was completed by each participant before treatment. Algometer readings were taken over the most restricted cervical spine facet joint and cervical spine range of motion (CROM) machine readings were taken measuring the ranges of motion of the cervical spine. The participants received an adjustment to the most restricted cervical spine facet joint as determined by motion palpation. The CROM machine and algometer readings were taken again immediately after the adjustment and the algometer readings were taken again 10 minutes later. Results: In terms of subjective measurements based on the Visual Analogue Scale, all participants experienced clinically significant pain before starting the trial.In terms of objective measurements based on algometer readings, a clinically significant difference was found as the pressure pain threshold increases over a period of time. In terms of the CROM machine readings there was a clinical improvement from the pretreatment ranges of motion to the post-treatment ranges of motion. The algometer and CROM readings were statistically incomparable to begin with. Conclusion: The results proved that there was a statistical significant noted immediately after the adjustment and 10 minutes later, however, this does not mean much as thegroups were not comparable to begin with. A statistically significant difference was noted for all ranges of cervical spine motion (flexion, extension, right and left lateral flexion and rotation), thus showing that the cervical spine adjustment was successfully delivered to the restricted segments.

O tratamento cirúrgico das afecções que acometem a coluna cervical alta colocam em risco estruturas neurovasculares, como a artéria vertebral e a medula espinhal, durante a colocação de parafusos transarticulares em C1-C2 e parafusos de massa lateral em C1. O presente estudo visa determinar os parâmetros anatômicos do atlas (C1) em uma amostra da população brasileira, compará-los aos resultados já apresentados na literatura para outras populações e, assim, identificar e alterar as indicações dos implantes utilizados no tratamento das afecções da coluna cervical alta. Foi realizado um estudo observacional retrospectivo de um banco de dados prospectivo, incluindo 100 pacientes atendidos em um hospital terciário, entre janeiro de 2012 a dezembro de 2013. Foram utilizados cortes axiais e sagitais de tomografias computadorizadas. Os parâmetros estudados foram, no corte axial: o ponto de entrada do parafuso (DTPPE), o ângulo de segurança (ADSPA), o tamanho ideal do parafuso (TPA) e o tamanho da massa lateral entre os forames vertebral e transverso (DCVFT); no corte sagital foi medido o tamanho ideal do parafuso (TPS), o ângulo de segurança (ADSPS) e a espessura do arco posterior (EAP). Todos os parâmetros foram divididos de acordo com a idade, sexo e o lado esquerdo e direito. Resultados: O ponto de entrada dado pelo DTPPE foi 21,86 ± 1,5 mm a esquerda e 22,7 ± 1,44 mm a direita no sexo masculino; e 20 ± 1,4 mm a esquerda e 20,24 ± 1,34 mm a direita no sexo feminino. A zona de segurança (ADSPA) foi 23,68 ± 6,12º a esquerda e 24,0 ± 5,82º a direita no sexo masculino e 18,09 ± 5,46º a esquerda e 18,57 ± 5,34º a direita no sexo feminino. A espessura do arco posterior (EAP) encontrada no sexo masculino foi 8,95 ±1,75 mm a esquerda e 8,92 ± 2,22 mm a direita, no sexo feminino encontramos uma espessura menor de 7,21 ± 1,53 mm a esquerda e 7,41 ± 1,58 a direita. Por meio de uma técnica original e reprodutível de avaliação de exames de tomografia computadorizada, os parâmetros anatômicos do Atlas encontrados na amostra da população estudada em nosso estudo foram semelhantes aos apresentados previamente na literatura. No entanto, foram observadas diferenças entre os sexos. Assim, recomendamos a utilização do exame de tomografia computadorizada como método de avaliação pré-operatória quando a fixação da massa lateral pelo arco posterior do Atlas for empregada. / The surgical treatment of conditions affecting the high cervical spine puts at risk neurovascular structures, such as the vertebral artery and the spinal cord, during the placement of transarticular screws in C1-C2 and lateral mass screws in C1. The present study aims to determine the anatomical parameters of the atlas (C1) in a sample of the brazilian population, to compare them with the results already presented in the literature for other populations and thus to identify and change the indications of the implants used in the treatment of spinal affections cervical high. A retrospective observational study of a prospective database including 100 patients treated at a tertiary hospital between January 2012 and December 2013 was performed. Axial and sagittal sections of computed tomography were used. The parameters studied were, in the axial section: the screw entry point (DTPPE), the safety angle (ADSPA), the ideal screw size (TPA) and the lateral mass size between the vertebral and transverse foramina (DCVFT) ; in the sagittal cut, the ideal screw size (TPS), the safety angle (ADSPS) and the posterior arch thickness (EAP) were measured. All parameters were divided according to age, sex and left and right side. The entry point given by the DTPPE was 21.86 ± 1.5 mm on the left and 22.7 ± 1.44 mm on the right in the male; and 20 ± 1.4 mm on the left and 20.24 ± 1.34 mm on the right in the female. The safety zone (ADSPA) was 23.68 ± 6.12 ° on the left and 24.0 ± 5.82 ° on the right in the male sex and 18.09 ± 5.46 ° on the left and 18.57 ± 5.34 ° on the right in females. The posterior arch thickness (EAP) found in males was 8.95 ± 1.75 mm on the left and 8.92 ± 2.22 mm on the right, in females we found a thickness less than 7.21 ± 1.53 mm on the left and 7.41 ± 1.58 on the right. Using an original and reproducible technique for the evaluation of CT scans, the Atlas anatomical parameters found in the sample of the population studied in our study were similar to those previously reported in the literature. However, differences between the sexes were observed. Thus, we recommend the use of computed tomography (CT) examination as a preoperative evaluation method when lateral mass fixation by the posterior arch of the Atlas is used.

Os tumores da cérvice-uterina, que representam uma das principais doenças ginecológicas em mulheres na idade reprodutiva em todo o mundo, estão etiologicamente associados com a infecção pelo papilomavírus humano (HPV). A progressão de uma lesão intraepitelial escamosa de baixo-grau (LSIL) a um carcinoma invasivo de cérvix uterina está acompanhada da degradação da matriz extracelular (MEC) devido à ação progressiva das metaloproteinases de matriz (MMP-2, MMP-9 e MMP-14) no processo de invasão e metástase. Entretanto, o balanço entre as MMPs e seus reguladores como RECK e TIMPs é necessário para controlar esta invasão. O objetivo deste projeto consiste em avaliar a atividade e a expressão das metaloproteinases 2, 9, e 14, e caracterizar a expressão do gene supressor de metástase RECK e do inibidor tecidual de metaloproteinases (TIMP-2), em modelo de queratinócitos humanos infectados com retrovírus recombinantes que expressam os oncogenes E6 e/ou E7 de HPV 16, em culturas cultivadas em monocamada e organotípicas. Para isso, utilizamos ensaios de real-time PCR, zimografia, western blot, imunocitoquímica, ensaio de ELISA e imunohistoquímica. Em culturas em monocamada observamos que as células que expressam as oncoproteínas E6E7 de HPV16 apresentaram menores níveis protéicos de RECK e TIMP-2 em relação ao controle pXLSN. Quando analisamos as culturas organotípicas, também observamos esta diminuição dos níveis de RNAm e protéicos de RECK em rafts que expressam E6E7, acompanhado pelo aumento da atividade de MMP-9, em relação ao controle. Também observamos que o tratamento das culturas com a citocina TNF aumenta a expressão gênica, protéica e atividade de MMP-9 em todas as linhagens analisadas. Além disso, os oncogenes E6 e/ou E7 não afetam a expressão e/ou atividade de MMP-2, MT1-MMP. Nossos dados demonstraram que a expressão das oncoproteínas E6E7 de HPV16 estão relacionadas com o desequilíbrio entre MMPS e seus inibidores, sugerindo que em uma fase pré-invasiva do carcinoma cervical, não somente as MMPs, mas, principalmente seus inibidores são críticos para início da progressão tumoral. / Cervical cancer is etiologically associated with to high-risk human papillomavirus (HPV) infection. It has been observed that matrix metalloproteinases (MMPs) -2, -9, and MT1-MMP are required for basement membrane degradation during cervical carcinoma progression. Moreover, a counterbalancing among MMPs and their regulators, such as TIMPs and RECK, is necessary to modulate invasion. In order to study the effect of HPV oncogenes on MMPs expression, primary human keratinocytes (PHKs) were infected with recombinant retroviruses expressing wild-type HPV16 E6 and/or E7 oncogenes and were used to seed monolayers and organotypic cultures. Quantitative real-time PCR (Q-PCR), western blot, zimography, immunocitochemistry, ELISA assay and immunohistochemistry were used to determine the expression level and activity of MMP-2, MMP-9, MT1-MMP and their inhibitors RECK and TIMP-2. We observed that cultures expressing E6E7 presented lower RECK and TIMP-2 protein levels than control keratinocytes. In addition, rafts cultures presented the same lower RECK levels additionally presenting higher MMP-9 activity than control. Furthermore, we observed that expression of E6 and/or E7 proteins do not affect MMP-2 and MT1-MMP protein levels and/or activity. We also observed that TNF treatment enhance the MMP-9 gene and protein expression and activity in all studied cell lines. Taken together, our results demonstrate that HPV16E6E7 expression is related with the unbalance between MMPs and their inhibitors, suggesting that in the initial steps of HPV-related cervical disease, not only MMPs but also RECK and TIMP-2 are critical for tumor progression.

Embora se aceite que as lesões cervicais não cariosas tenham uma etiologia multifatorial, as contribuições relativas dos vários agentes etiológicos permanecem obscuras. O presente estudo propõe um modelo que simula a formação de lesões não cariosas em laboratório e estuda a influência específica de cada tipo de tensão no dano provocado ao esmalte e/ou à dentina. A face vestibular de incisivos bovinos foi cortada em forma de palito com 18 mm x 3 mm x 3 mm. Cada palito recebeu um entalhe na região cervical da parede voltada para a polpa, com o objetivo de direcionar a concentração de tensões para a junção esmalte-dentina. Os corpos de prova (n=108) protegidos com verniz ácido resistente, exceto numa faixa de 1,5 x 18 mm da superfície vestibular, foram divididos em dois grupos, um imerso em solução de ácido acético pH 4,5 e o outro imerso em água destilada. Cada grupo foi dividido em três subgrupos (n=18), dos quais, dois deles sofreram carregamento estático de 800gf em dobramento, um para provocar tração e outro para compressão na região da junção esmalte-cemento, e o terceiro não foi submetido a carregamento. Após 72h de ensaio os palitos foram lavados, desidratados e embebidos em resina acrílica. Em cada grupo de 18 espécimes, 06 foram cortados no sentido longitudinal e 12 no sentido transversal do palito, obtendo-se lamelas de 0,05 mm. As lamelas foram fotografadas em microscópio de luz, e foi medida a profundidade de perda e/ou desmineralização de dentina e esmalte. Os dados obtidos foram submetidos à análise de variância ANOVA, seguida pelo teste de Tukey com 5% de significância. Para comparações entre diferentes regiões do mesmo corpo de prova, foi utilizado o teste t pareado. Foi avaliada também a ocorrência de trincas e fraturas. Não foram encontrados danos nas lamelas dos palitos imersos em água destilada. Nos espécimes seccionados transversalmente a profundidade de desmineralização do esmalte sob tração foi de 158±18m, significativamente maior que a dos demais grupos (138±21m para sem carga e 129±16m para compressão). A profundidade de desmineralização e perda de dentina nos palitos submetidos à tração foi 186±23m, seguidos de 160±20m nos palitos sem carga e 140±27m nos palitos sob compressão. Nos cortes longitudinais foram realizadas medidas da profundidade de desmineralização do esmalte em três pontos: na junção esmalte-dentina (E1), a 3,5 mm (E2) e a 7,0 mm (E3) desta junção. A profundidade de desmineralização do esmalte nos espécimes sob tração foi significativamente maior na região cervical (E1) que nas demais regiões. Para os corpos de prova que sofreram compressão, as regiões E1 e E2 não apresentaram diferença significativa entre si, porém a região E3 teve desmineralização significantemente menor às outras. Nos corpos de prova sem tensão só houve diferença significativa entre os dois extremos (E1 e E3). Foram observadas trincas e fraturas no esmalte cervical apenas nos espécimes submetidos à tração. Parece lícito concluir que a tensão influi na ação do ácido sobre os tecidos dentários, sendo que a tração aumenta significativamente os danos e a compressão tende a reduzi-los. / Although it is accepted that non-carious cervical lesions have a multifactorial etiology, the relative contributions of several etiological agents remain unclear. This study proposes a model which simulates the formation of non-carious lesions in laboratory and studies the specific influence of each kind of tension in the damage caused to the enamel and/or the dentin. The buccal surface of bovine incisor was cut in the stick form measuring 18mm x 3mm x 3mm. Each stick received a groove in the cervical region of the wall facing the pulp aiming to guide the tension concentration to the dentin-enamel junction. The specimens (n=108) protected with resistant acid varnish, except in a 1.5mm x 18mm labial surface range, were divided into two groups, one immersed in acetic acid solution pH 4.5 and the other in distilled water. Each group was divided into three subgroups (n = 18), in which, two of them suffered 800gf static load on folding, one for tensile and the other for compression in the enamel-cement junction region, and the third did not suffer loading. 72h after the trial, the sticks were washed, dehydrated and embedded in acrylic resin. In each group of 18 specimens, 06 were cut in the longitudinal direction and 12 in the transversal one of the stick, getting 0.05mm lamellae. The lamellae were photographed in light microscope, and the depth of loss and/or demineralization of enamel and dentin was measured. Te data were analyzed by ANOVA variance, followed by the Tukey test with 5% significance. For comparisons between different regions of the same specimen, the paired t test was used. It was also evaluated the occurrence of cracks and fractures. No damages were found in the lamellae sticks immersed in distilled water. In specimens cut transversely, the depth of enamel demineralization under tensile was 158±18m, significantly higher than the other groups (138±21m for unloaded and 129±16m for compression). The depth of demineralization and dentin loss in sticks submitted for tensile was 186±23m, followed by 160±20m for the unloaded sticks and 140±27m for the sticks under compression. In the longitudinal cut, measures of the enamel demineralization depth were made in three points: the enamel-dentin junction (E1), 3.5 mm (E2) and 7.0 mm (E3) of this junction. The enamel demineralization depth in specimens under tensile was significantly higher in the cervical region (E1) than in other regions. For the specimens that suffered compression, the regions E1 and E2 did not show significant difference between themselves, but the E3 region showed demineralization significantly lower than the others. In specimens without tension, there was only significant difference between the two extremes (E1 and E3). Cracks and fractures in the cervical enamel were observed specimens only in the specimens under tensile. It seems reasonable to conclude that tension influences in the acid action on the dental tissues, and that tensile increases significantly the damage and compression tends to reduce them.

A infecção genital pelo papilomavírus humano (HPV) corresponde a uma das doenças sexualmente transmissíveis mais frequentes no mundo. Uma preocupação dos pacientes que apresentam HPV na região anogenital diz respeito à possibilidade de disseminação desse vírus para outras partes do corpo. O objetivo geral desse estudo foi avaliar a possível correlação existente entre infecções pelo HPV na mucosa oral e no colo uterino em mulheres com sorologias positiva e negativa para o HIV. Pretendeu-se, também, identificar variáveis clínicas, demográficas e laboratoriais associadas à infecção oral pelo HPV. A amostra foi constituída por 200 pacientes do gênero feminino, sendo 100 com sorologia positiva para HIV (grupo 1) e 100 com sorologia negativa para HIV (grupo 2). As pacientes foram incluídas consecutivamente no Centro de Referência e Treinamento em DST-AIDS entre abril de 2008 a maio de 2009. Todas as pacientes assinaram um Termo de Consentimento Livre e Esclarecido e responderam a uma ficha com questionamentos sobre hábitos e comportamento sexual. Além disso, tiveram as cavidades oral e ginecológica examinadas, sendo que células superficiais de ambos os locais foram coletadas e avaliadas pela captura híbrida 2 e pela citologia em base líquida. Para comparação de variáveis qualitativas, como freqüências e proporções, foi utilizado o teste de qui-quadrado ou exato de Fisher, se necessário. Para comparação de dados quantitativos, foram utilizados os testes de Mann-Whitney ou t de Student. A análise multivariada foi executada utilizando-se o teste de regressão logística, sendo que o valor de significância estatística estabelecido foi de 5% (p<0,05). O DNA do HPV foi detectado nas amostras cervicais de 41 (41%) pacientes HIV+ e de 45 (45%) HIV- (p=0.67). Nas amostras da cavidade oral, o DNA do HPV foi observado em 11 mulheres do G1 (HIV+) e em 2 mulheres do G2 (HIV-) (OR=6,06; 95%IC=1,31-28,07; p=0,02). Os subtipos oncogênicos foram prevalentes em ambos os grupos, sendo que não foi observada diferença entre os grupos (p=0.87). Nenhuma paciente apresentou lesão macroscópica oral relacionada ao HPV, sendo que 15 (15%) mulheres do G1 (HIV+) e 17 (17%) do G2 (HIV-) apresentaram lesão macroscópica na região genital (p=0.2129). Com os resultados obtidos pôde-se concluir que nesta população não houve correlação entre a infecção pelo HPV nas mucosas oral e cervical. Além disso, as pacientes HIV+ apresentaram maior prevalência de infecção pelo DNA-HPV na boca em comparação às pacientes HIV-. / Human papillomavirus (HPV) is one of the most prevalent sexually transmitted viruses worldwide with both oral and genital manifestations. The high prevalence of HPV infection among HIV + individuals provides an opportunity to elucidate the relationship between oral and cervical HPV-infection in this group of subjects. The aim of this study is to evaluate the possible association between oral and cervical infections in HIV-positive and negative patients. One hundred HIV+ (group 1) and 100 HIV- (group 2) women were recruited consecutively from a gynecologic clinic between April 2008 and May 2009. All subjects were given a cervical and oral examination. Cytological samples were evaluated by the hybrid capture 2 technique from oral and cervical scrapings. Statistical analysis was performed using chi-square test and p values < 0.05 were considered significant. HPV-DNA was detected in cervical scrapings from 41 (41%) HIV-positive subjects and from 45 (45%) HIVnegative subjects (p=0.67). In oral samples, HPV-DNA was observed in 11 subjects from group 1 and in 2 subjects from group 2 (p=0.02). High-risk HPV subtypes were prevalent in both groups and no difference between the groups was detected (p=0.87). No subject showed macroscopic oral HPV-related lesion, whereas 15 (15.00%) from group 1, and 17 (17.00%) from group 2, presented with macroscopic genital lesion (p=0.2129). HPV-DNA was more frequent in oral mucosa of HIV+ patients than HIV- (p=0,018). There was no association between oral and cervical HPV infection in HIV+ and HIV- patients. Presence of cervical lesion was not associated with oral lesion.

O Papilomavírus Humano (HPV), da família Papilomaviridae, são vírus epiteliotrópicos que provocam lesões de pele ou mucosa. O carcinoma do colo uterino é uma das principais causas de morte de mulheres em todo o mundo, sendo a infecção pelo HPV o principal fator de risco para o desenvolvimento do carcinoma cervical. Durante o processo maligno, a migração descontrolada de células neoplásicas, é uma característica fundamental da invasão tumoral, sendo que as metaloproteinases de matriz (MMPs) participam largamente deste processo pois são responsáveis pela clivagem de proteínas da matriz extracelular. O projeto propôs investigar a expressão de MMP-9 total em amostras cérvico-vaginais com inflamação, lesão e tumor. Foram coletadas duas amostras cérvico-vaginais como esfregaços para diagnóstico citológico e imunocitoquímica. A coleta foi realizada em 630 pacientes da Penitenciária Feminina de Sant´ana, no período de agosto de 2009 a agosto de 2010. As lâminas foram submetidas à imunocitoquímica para detecção da expressão de MMP-9. Os resultados indicaram um aumento da expressão de MMP-9 total diretamente proporcional com o aumento do grau das lesões nos esfregaços, corroborando com dados de histologia da literatura. Portanto, tal método de correlação de MMP-9 total com esfregaços cérvico-vaginais poderá auxíliar o prognóstico em esfregaços. / The Human Papillomavirus (HPV) are epitheliotropic viruses from family Papillomaviridae, which cause skin or mucous lesions. Carcinoma of the cervix is a major cause of death in women worldwide, and HPV infection a major risk factor for development of cervical carcinoma. During the malignant process, cell migration is a fundamental characteristic of tumor invasion, and the matrix metalloproteinases (MMPs) are responsible for the cleavage of extracellular matrix proteins. This project aims to investigate the expression of MMP-9 in different degrees of injury in the smear. We collected two cervical smears for cytological diagnosis and immunocytochemistry. Data collection was conducted in 630 women of the Sant´ana Women\'s Penitentiary, during the period August 2009 to August 2010. The slides were submitted to immunocytochemistry to detect the expression of MMP-9 and noticed an increase in protein expression in parallel with the increased lesions grade, which corroborates the histology of the literature and could be a method prognostic aid in vaginal smears.

A proposta desse estudo in vitro foi avaliar a influência do pré-alargamento cervical no desgaste apical de canais simulados curvos preparados com instrumentos rotatórios de níquel-titânio. Foram confeccionados 30 blocos de resina com canais simulados de 20 graus de curvatura que foram divididos aleatoriamente em três grupos distintos (n=10) de acordo com o tipo de alargamento cervical realizado: Grupo I - sem alargamento cervical; Grupo II - alargamento cervical realizado com brocas CP Drill®; Grupo III - alargamento cervical realizado com brocas LA Axxess®. Previamente ao alargamento cervical os canais foram preenchidos com tinta nanquim em toda sua extensão e realizaram-se as fotografias iniciais com auxílio de máquina digital posicionada em estativa. Para o preparo apical utilizaram-se instrumentos rotatórios K3® na seqüência de 20.02 até 45.02, sendo que, entre o intervalo do uso de cada instrumento o canal foi preenchido, novamente, com tinta nanquim e realizada a fotografia final para cada instrumento. As fotografias pré e pós-operatórias foram sobrepostas e procedeu-se a mensuração do desgaste linear da parede interna e externa do canal simulado no ápice da curvatura e no ápice do canal proporcionado por cada instrumento, com auxílio do software Image Tool. A diferença entre esses valores, de acordo com cada área do canal avaliada, foi submetida à análise estatística. O teste de Regressão Linear permitiu estabelecer uma correlação entre o calibre do instrumento e o desgaste do canal, que pode ser traduzida em uma equação matemática, indicando que é diretamente proporcional. O teste de Kruskal-Wallis (complementado com pós-teste de Dunn) permitiu a comparação do desgaste entre os diferentes grupos experimentais. Por meio desses testes pode-se observar que grupo onde não foi realizado o pré-alargamento cervical apresentou padrões de desgastes diferentes daqueles onde o preparo foi executado. O grupo sem pré-alargamento provocou o desgaste acentuado do lado externo da curvatura, enquanto os grupos preparados com CP Drill® e LA Axxess® mostraram padrões de desgaste semelhantes, denotando a maior centralização do instrumento no canal em ambas as regiões analisadas (ápice da curva e ápice do canal). Pode-se concluir que o pré-alargamento cervical influenciou de forma positiva no preparo da região apical de canais simulados curvos, proporcionando preparos mais centralizados dessa região. / The purpose of this in vitro study was to evaluate the influence of cervical preflaring on prepared canal shape in simulated curved root canals prepared with nickel-titanium rotary systems. Thirty resin blocks with simulated canals with 20º curvature were fabricated and randomly assigned to three groups (n=10) according to the type of cervical preflaring: Group I - no cervical preflaring; Group II - cervical preflaring with CP Drill® burs; Group III - cervical preflaring with LA Axxess® burs. Previously cervical preflaring, the canals were thoroughly filled with India ink and the initial photographs were taken using a digital camera fixed in a static position. Right after, apical preparation was performed using 20.02 to 45.02 K3® rotary instruments. At each change of file, the canals were refilled with India ink and the final photographs were taken for each instrument. The initial and final photographs were superimposed and linear dentin removal produced by each type of rotary instrument was measured with specific software at the internal and external portions of the curvature apex and at the canal apex. The difference between the initial and final values was analyzed statistically, according to each canal region. Statistical analysis by linear regression established a correlation between instrument size and canal transportation, which can be expressed by a mathematical equation. This correlation is directly proportional, which means that the greater instrument, the more accentuated the canal transportation. Additionally, Kruskal- Wallis test (complemented by the Dunn\' post-test) allowed comparing dentin removal among the different experimental groups. These tests revealed that the non-flared group presented different dentin removal patterns, as compared to the groups where cervical preflaring was undertaken. The group without preflaring presented a significantly greater dentin removal on the external side of curvature, while the groups preflared with CP Drill® and LA Axxess® exhibited similar dentin removal patterns, demonstrating a greater centralization of the instrument inside the canal, for both analyzed regions (curvature apex and canal apex). It may be concluded that cervical preflaring influenced positively the apical preparation of simulated curved canals, producing more centralized preparations in this region.