INTRODUÇÃO: Picos de pressão inspiratória excessivos e elevados volumes correntes (VT) durante a ventilação manual podem iniciar a resposta inflamatória no pulmão do prematuro. A manobra de insuflação pulmonar sustentada (IPS) tem sido estudada como um procedimento para melhorar a aeração pulmonar imediatamente após o nascimento. OBJETIVO: Avaliar a influência do ventilador manual em T (peça T) e do balão autoinflável (BAI) nas variáveis de mecânica respiratória durante a ventilação manual e a manobra de IPS, além da influência do treinamento como instrutor do Programa de Reanimação Neonatal da Sociedade Brasileira de Pediatria (PRN-SBP), na qualidade da ventilação. MÉTODOS: Em um estudo experimental, prospectivo e randomizado, 114 indivíduos, entre instrutores e não instrutores do PRN-SBP, ventilaram um manequim neonatal intubado, equivalente a um recém-nascido de 2500 gramas, por períodos de três minutos, utilizando um BAI e a peça T. A escolha do primeiro equipamento foi feita por randomização e os operadores não tinham acesso aos dados de mecânica respiratória durante a gravação. Ao final da ventilação manual, foi solicitado que cada indivíduo realizasse uma manobra de IPS durante 10 segundos, a uma pressão de 20 cmH2O. Para cada parâmetro de mecânica respiratória obtido durante a ventilação manual e a IPS, foi realizada uma comparação direta entre os equipamentos, considerando a formação e o treinamento dos participantes. Os dados foram obtidos por um sistema informatizado que permitiu a análise posterior. RESULTADOS: Em relação à ventilação manual, foi encontrada uma diferença nos valores do VT e do TI entre os equipamentos. Com o uso do BAI o VT foi de 28,5 (12,6) mL, mediana (amplitude interquartil) no grupo instrutores e 31,6 (14,0) mL no grupo não instrutores, enquanto que com a peça T foi de 20,1 (8,4) mL e 22,3 (8,8) mL, respectivamente. O TI encontrado com o uso do BAI foi de 0,5 (0,2) segundos, mediana (amplitude interquartil), tanto para instrutores como para não instrutores, enquanto que com a peça T foi de 1,0 (0,6) segundos e 1,1 (0,9) segundos, respectivamente. Em ambos os parâmetros não foram observadas diferenças entre os grupos de profissionais. A capacidade do operador de manter uma pressão alvo de 20 cmH2O durante os 10 segundos de IPS foi avaliada através da área sob a curva de pressão (ASC), que foi 1,7 vezes maior com o uso da peça T em relação ao BAI (p < 0,05). A pressão inspiratória máxima aplicada para a realização da IPS foi maior com o uso do BAI, enquanto que a pressão média das vias aéreas, avaliada entre o início e o final dos 10 segundos de procedimento, foi maior com o uso da peça T. Novamente não foram observadas diferenças entre os grupos de profissionais. CONCLUSÃO: A peça T resultou em menores valores de VT e maiores valores de TI independente do treinamento como instrutor do PRNSBP. A peça T permitiu uma maior eficácia na realização da manobra de IPS, representada pela manutenção da pressão alvo pelo período desejado e por uma maior pressão média nas vias aéreas em relação ao BAI / INTRODUCTION: During manual resuscitation of neonates, excessive peak inspiratory pressure (PI) and high tidal volume (VT) may trigger an inflammatory response in the lungs. The sustained lung inflation (SLI) maneuver has been studied as a procedure to improve pulmonary aeration immediately after birth. OBJECTIVE: To assess the influence of a T-piece manual resuscitator versus a self-inflating bag (SIB) on respiratory mechanics during manual ventilation and the SLI maneuver and the influence of training as a Brazilian Society of Pediatrics Neonatal Resuscitation Program instructor on the quality of ventilation. METHODS: In this experimental, prospective, randomized trial, 114 operators, including Brazilian Society of Pediatrics Neonatal Resuscitation Program instructors and non-instructors, ventilated an intubated neonatal resuscitation trainer (equivalent to a 2500g neonate) for 3-minute periods using an SIB or a Tpiece device. The choice of first device was random, and operators had no access to respiratory mechanics data during recording. At the end of the manual ventilation period, each operator was asked to perform an SLI maneuver for 10 seconds at 20 cmH2O. For each respiratory mechanics parameter obtained during manual ventilation and SLI, a direct comparison between devices was performed, taking operator training into account. Data were obtained through a computerized system for later analysis. RESULTS: During manual ventilation, differences in VT and TI were found between the two devices. The SIB was associated with a median (interquartile range) VT of 28.5 (12.6) mL in the instructor group and 31.6 (14.0) mL in the noninstructor group, whereas the T-piece was associated with a VT of 20.1 (8.4) mL in the instructor group and 22.3 (8.8) mL in the non-instructor group. Regarding TI, the SIB was associated with a median (interquartile range) value of 0.5 (0.2) seconds in instructors and non-instructors alike, whereas the T-piece was associated with a value of 1.0 (0.6) seconds in the instructor group and 1.1 (0.9) seconds in the non-instructor group. No differences between the operator groups were found in either parameter. Operator ability to maintain a 20-cmH2O pressure during the 10-second SLI maneuver was assessed by the area under the pressure curve (AUC), which was 1.7 times greater with the T-piece device than with the SIB (p < 0.05). Peak PI during the SLI maneuver was higher with the SIB, whereas mean airway pressure, assessed between start and end of the 10-second maneuver, was higher with the T-piece. Again, there were no differences between the operator groups. CONCLUSION: The T-piece was associated with lower VT and higher TI values regardless of training as a Brazilian Society of Pediatrics Neonatal Resuscitation Program instructor. The T-piece provided greater efficacy in performing the SLI maneuver, as represented by maintenance of target pressure throughout the desired period and by a higher mean airway pressure as compared with SIB use

O câncer de mucosa oral é um problema de saúde pública, com maior incidência em homens acima de 50 anos. Uma das manifestações clínicas mais precoces do câncer da mucosa oral são as lesões leucoqueratósica. O aspecto clínico não homogêneo e o tamanho maior de 200mm2, em mucosa não queratinizada como a do assoalho da boca e ventre da língua, são aspectos que implicam na possibilidade de evolução da lesão. A dificuldade do diagnóstico das lesões precoces está na seleção do local a ser biopsiado principalmente frente a lesões extensas e heterogêneas. O objetivo desta pesquisa é avaliar se a utilização do exame clínico juntamente com os métodos auxiliares de diagnóstico das lesões leucoqueratósica da mucosa oral (VELscope®, Azul de toluidina e Solução de lugol) contribui para uma maior precisão do diagnóstico de displasias nestas lesões quando comparado ao histopatológico. E, identificar os padrões morfológicos destas lesões quando avaliadas por meio da microscopia confocal reflectante. Foram selecionados 30 pacientes, maiores de 18 anos, portadores de lesão clínica compatível com leucoplasia oral triados no ambulatório da disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo e que precisavam ser submetidos à biópsia para o estabelecimento do diagnóstico final. Foram realizados os testes de Azul de Toluidina, Solução de Lugol, VELscope®, microscopia confocal reflectante e posteriormente, a biópsia incisional para obtenção do diagnóstico final. Os pacientes incluídos possuíam média de idade 60,66 anos, sendo 70% (21/30) do gênero feminino e 30% (9/30) do gênero masculino. O tabagismo foi relatado por 16,7% (5/30) dos pacientes, sendo 60% (3/5) homens. A associação do tabagismo e etilismo foi relatada em 10% (3/30) dos pacientes, o tabagismo isoladamente por 6,6% (2/30) e o de etilismo por 3,3%(1/30). A associação dos hábitos e o etilismo isolado foram relatados somente por homens. Enquanto que o hábito de tabagismo isolado foi relatado somente por mulheres. Com o uso do VELscope® todas as lesões apresentaram perda da fluorescência tecidual sendo, portanto todas positivas para este método. Com a Solução de Lugol, 100% das lesões não coraram, sendo portanto positivas para este método. O exame histopatológico permitiu o diagnóstico de 30% (9/30) casos de carcinoma epidermoide, 10% (3/30) de neoplasia intraepitelial, 20% (6/30) de líquen plano oral e 40% (12/30) de líquen simple crônico oral. Para o uso do VELscope® e do Lugol foi observada uma sensibilidade de 100% e uma especificidade de 50%.Para o Azul de Toluidina foi observada uma sensibilidade de 63,15%- 66,66% e especificidade de 75,67%-82,35%.Na Microscopia Confocal Reflectante foram definidos padrões para os quatro diferentes diagnósticos observados. Os métodos auxiliares de diagnóstico por cromoscopia e fluorescência de mucosa se mostraram eficientes no auxílio da delimitação da extensão da lesão e a Microscopia Confocal Reflectante permitiu a visualização de padrões morfológicos das lesões brancas de forma não invasiva. A utilização da Microscopia Confocal Reflectante permitiu também a determinação de padrões morfológicos para o carcinoma epidermoide, a neoplasia intraepitelial, o líquen plano oral e o líquen simples crônico oral e se mostrou eficiente quando comparada ao exame histopatológico. / Cancer of the oral mucosa is a public health problem, with higher incidence in men above 50 years. One of the earliest manifestations of cancer of the oral mucosa lesions are leukokeratosis. The inhomogeneous clinical aspect and the larger size of 200mm2 in non-keratinized mucosa as the floor of the mouth and constipation of the tongue, are aspects that imply the possibility of evolution of the lesion. The difficulty of diagnosis of early lesions is in the selection of the site to be biopsied primarily against large and heterogeneous lesions. The objective of this research is to evaluate the use of clinical examination along with diagnostic aids leucoqueratósica of oral lesions (VELscope ®, Toluidine blue and Lugol solution) methods contributes to greater accuracy of diagnosis of dysplasia in these lesions when compared the histopathological. And identify the morphological patterns of these lesions when evaluated by reflectance confocal microscopy. 30 patients older than 18 years, with clinical lesion compatible with oral leukoplakia screened in the outpatient discipline of Clinical Dentistry, Faculty of Dentistry, University of São Paulo and that needed to be biopsied to establish the final diagnosis were selected. Tests toluidine blue, Lugol\'s solution, VELscope ®, reflectance confocal microscopy (RCM) and subsequently, incisional biopsy to obtain the final diagnosis were performed. Patients enrolled had a mean age 60.66 years, 70% (21/30) were female and 30% (9/30) were male. Smoking was reported by 16.7% (5/30) of patients, 60% (3/5) homens.A association of smoking and alcohol use was reported in 10% (3/30) of patients, smoking alone by 6.6% (2/30) and of alcoholism by 3.3% (1/30). The association of habits and alcoholism alone were reported by men only. While the habit of smoking alone was reported by women only. Using the VELscope ® all lesions showed loss of tissue fluorescence, so being all positive for this method. With Lugol\'s solution, 100% of the lesions did not stain, thus being positive for this method. Histopathological examination allowed the diagnosis of 30% (9/30) cases of squamous cell carcinoma, 10% (3/30) of intraepithelial neoplasia, 20% (6/30) of oral lichen planus and 40% (12/30) chronic oral lichen simple. For the use of Lugol VELscope ® and a sensitivity of 100% and a specificity of 50% was observed for the toluidine blue a sensitivity of 63.15%- 66.66% was observed and a specificity of 75.67% - 82.35%. Confocal Microscopy In reflective patterns observed for the four different diagnoses were defined. Auxiliary diagnostic methods chromoscopy and fluorescence mucosa were effective in aiding the delimitation of the extent of injury and Reflectance Confocal Microscopy allowed the visualization of morphological patterns of white lesions noninvasively. Use the Reflectance Confocal Microscopy also allowed the determination of morphological patterns to epidermoid carcinoma, intraepithelial neoplasia, oral lichen planus and lichen simplex chronic oral and proved efficient when compared to histopathology.

O estudo das células-tronco cancerígenas (CTCs) durante o processo de malignização e no carcinoma epidermóide intra-bucal já instalado é essencial para um melhor entendimento de como essas células participam da formação e manutenção de uma neoplasia. Atualmente, a identificação de células com características de células tronco se dá principalmente através da expressão de marcadores celulares como o ALDH1 e o CD44. A proteína ALDH1 é responsável pela oxidação de aldeídos intracelulares e vem sendo utilizada para o isolamento de CTCs em inúmeros canceres incluindo casos de cabeça e pescoço. A proteína CD44 é uma glicoproteína envolvida na adesão e migração celular, também participa do processo de metástase e já foi associada às CTCs. Nesse trabalho, a expressão dessas proteínas foi analisada em 45 casos de displasias epiteliais e 13 casos de carcinomas epidermóide intra-bucais. As lesões displásicas foram classificadas em casos leves (19), moderados (18) e intensos (8) e foram também divididas em casos de baixo risco (22) e alto risco de transformação maligna (23). A expressão imunohistoquímica para a ALDH1 foi encontrada predominantemente na camada basal em 16 casos de displasias epiteliais e em 7 carcinomas epidermóides, com a marcação difusa pela epitélio neoplásico. A expressão imunohistoquímica de CD44 foi encontrada em 42 displasias epiteliais e em 12 carcinomas epidermóides, sendo que nas displasias, a expressão ocorreu predominantemente na camada basal do epitélio e no carcinoma epidermóide a expressão foi disseminada. Ambos marcadores exibiram aumento de expressão com a evolução do grau das displasias. / The study of cancer stem cells (CTCs) in the process of malignant transformation and intra-oral squamous cell carcinoma already installed is essential for a better understanding of how these cells participate in the formation and maintenance of a neoplasm. Currently, identification of cells with characteristics of stem cells is primarily through the expression of cell markers such as CD44 and ALDH1. The ALDH1 protein is responsible for the oxidation of intracellular aldehydes and has been used for the isolation of CTCs in numerous cancers including head and neck cases. The CD44 protein is a glycoprotein involved in cell adhesion and migration, also participates in the process of metastasis and has been associated with CTCs. In this work, the expression of these proteins was analyzed in 45 cases of epithelial dysplasia and 13 cases of intraoral squamous cell carcinomas. The dysplastic lesions were classified as mild (19), moderate (18) and intense (8) cases and were also divided into low-risk cases (22) and high risk of malignant transformation (23). The immunohistochemical expression for ALDH1 was found predominantly in the basal layer in 16 cases of epithelial dysplasia and squamous cell carcinoma in 7, with diffuse labeling by neoplastic epithelium. Immunohistochemical expression of CD44 was found in 42 epithelial dysplasias and 12 squamous cell carcinomas, and in dysplasias, the expression occurred predominantly in the basal layer of the epithelium and in squamous cell carcinoma expression was widespread. Both markers showed increased expression with the evolution of the degree of dysplasia.

Objetivo: Avaliar a citologia cérvico-vaginal em adolescentes com lúpus eritematoso sistêmico juvenil (LESJ) e comparar com controles. Material e métodos: Cinqüenta e duas adolescentes com LESJ (critérios do American College of Rheumatology) foram comparadas com 52 controles saudáveis. Todos os esfregaços de Papanicolaou foram avaliados por uma mesma citopatologista, que desconhecia o exame ginecológico, e foram classificados de acordo com o Sistema de Bethesda, 2001. Resultados: As médias das idades das pacientes com LESJ e controles foram similares (16,17 ± 1,94 versus 16,13 ± 2,16 anos, p=0,92). A citologia cérvico-vaginal foi similar em ambos os grupos, embora as relações sexuais no último mês tenham sido menos freqüentes nas pacientes com LESJ em relação aos controles (23% versus 59,6%, p=0,0003). Apenas uma paciente (2%) com LESJ e duas controles (4%) tinham displasia cervical (LIE-BG) e papilomavírus humano (HPV) (p=1,0). Citologia cérvico-vaginal inflamatória foi observada em 21 (60%) das pacientes com SLEDAI maior ou igual a 4 e em apenas 4 (23%) daqueles com SLEDAI < 4 (p=0,001). Assim como, uma maior freqüência de achados inflamatórios também foi observada em adolescentes virgens com LESJ (57% versus 8%, p=0,005). Vaginite por Candida spp foi observada em 7 pacientes com LESJ (14%) e em nenhuma dos controles (p=0,012), e foi associada com uso de drogas imunossupressoras (p=0,01) e dose alta de prednisona (p=0,002). Conclusão: Nossos achados indicam que o trato genital feminino é um órgão alvo no LESJ, pois inflamação cérvico-vaginal está associada com atividade da doença independentemente da atividade sexual. / Objective: To evaluate cervicovaginal cytology in adolescents with juvenile systemic lupus erythematosus (JSLE) and to compare them to controls. Material and methods: Fifty-two female adolescents with JSLE (American College of Rheumatology criteria) were compared to 52 age-matched healthy controls. All Pap smears were evaluated by the same cytopathologist blinded to gynecology examination, and performed according to the Bethesda Classification System 2001. Results: The mean age of JSLE patients and controls were similar (16.17 ± 1.94 vs. 16.13 ± 2.16 years, p=0.92). The cervicovaginal cytology was found to be similar in both groups, although sexual intercourses in the last month were less frequent in JSLE than controls (23% vs. 59.6%, p=0.0003). Only one patient (2%) with JSLE versus two controls (4%) had cervical dysplasia (LGSIL) and human papilomavirus (p=1.0). Inflammatory cervicovaginal cytology was observed in 21 (60%) of patients with SLEDAI ? 4 and only 4(23%) of those with SLEDAI<4 (p=0.001). Likewise, a higher frequency of inflammatory changes were also observed in virgin JSLE (57% vs. 8%, p=0.005). Candida spp vaginitis was observed in 7 JSLE (14%) versus none in controls (p=0.012) and was associated to immunosuppressive drugs (p=0.01) and high dose of prednisone (p=0.002). Conclusion: Our findings supports the notion that female genital tract is a target organ in SLE since cervical inflammation is associated to disease activity independently of sexual activity.

A displasia cortical focal (DCF) é uma das causas mais frequentes de epilepsia refratária. Na clínica, diferentes informações são usadas para localizar o foco epileptogênico, mas nenhum método é autossuficiente para evidenciar o local original das crises, associado com a presença da DCF. Embora haja relatos na literatura indicando alterações no padrão de distribuição de tons de cinza e morfologia dos voxels decorrentes da DCF, algumas limitações dos métodos desenvolvidos ainda impedem a utilização clínica. Nossa proposta foi investigar a capacidade de identificar DCF através de análises de espessura cortical e padrões de textura em imagens estruturais de Ressonância Magnética (RM), validando os métodos desenvolvidos a partir uma base de imagens retrospectiva, cujo tecido epileptogênico já havia sido ressecado e a DCF confirmada em análise histológica. A caracterização das DCF foi feita a partir da segmentação automática de tecido cortical saudável em conjunto com a segmentação manual da DCF feita por um especialista, e consiste na geração de mapas de característica e extração de valores de distribuições para comparação em análise estatística. Investigamos também a eficácia da detecção de DCF através do uso de algoritmos de aprendizado de máquina para classificação automática. Obtivemos precisão 0,81 e sensitividade 0,87, colocando o método desenvolvido em par com outros métodos presentes na literatura. Entretanto, foi identificada uma grande dependência do desempenho de métodos de pré-processamento, como corregistro e segmentação automática. / Focal Cortical Dysplasia (FCD) is one of the most frequent causes of refractory epilepsy. In clinical procedures, the information gathered from different techniques is used in order to locate the epileptogenic focus, associated with the presence of FCD. However, there is no self sufficient method to evidence the presence and location of such lesions and especially its extension. Although there are reports indicating change in gray scale intensity patterns and voxel morphology in the presence of DCF, limitations in developed methods still prevent their clinical use. Our proposal was to investigate the capability of identifying FCD through cortical thickness and texture patter analysis in structural MRI images, validating developed methods by utilizing a retrospective base of images from patients that were subjected to surgery, with the FCD being confirmed in histological analysis. Characterization of FCD was achieved from automatic segmentation of healthy cortex and manual segmentation of FCD tissue made by an specialist, and consists in the generation of texture or structural feature maps and comparison of distribution values in healthy or FCD tissue with statistical analysis. We also investigate the efficiency of FCD detection with Machine Learning automatic classification, obtaining precision of 0,81 and sensitivity of 0,87, placing our method on par with other methods in the literature. However, there is a major performance dependency of proposed method with pre-processing steps, like registration and automatic segmentation.

Developmental dysplasia of the hip is a congenital condition of the musculoskeletar system which occurs during childhood. Incidents of congenital hip dysplasia are diagnosed in approximately 3 % of newborns. This defect is 5 times more prevalent in girls than in boys. The theoretical part of this thesis deals with the congenital defect itself, the use of orthopedic aids and the education of parents, as well as children's tolerance towards orthopedic appliances. Two goals were set for this thesis: to determine mothers' awareness of congenital hip dysplasia and to map the importance of educating medical staff in this field of care. The empirical part of this thesis was devised through quantitative research carried out using semi-closed questionnaire techniques. The research sample was mothers of children diagnosed with hip dysplasia. The results showed that during their first pregnancies, in most cases, women are not aware of hip dysplasia; more awareness was reported in mothers who underwent orthopedic examinations with their first children. The highest awareness was shown in mothers who were diagnosed with hip dysplasia themselves. The results further indicate that education in the field of the care and handling of children with hip dysplasia is vital. It is necessary for general or pediatric nurses to educate parents, mainly concerning proper hygiene of their children. The results of this thesis can be used by medical staff to broaden their general knowledge of treating hip dysplasia, and for general or pediatric nurses who deal with affected children. The theoretical background and research results may also be helpful for parents of children who have been diagnosed with hip dysplasia. For parents of these patients, this diagnosis causes stressful situations for them to deal with. This thesis will explain how this condition arises, explain treatment options, and provide education on caring for children with hip dysplasia.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2006. / Includes bibliographical references (leaves 100-107).

Einleitung: Die Ellbogengelenkdysplasie (ED) stellt eine der häufigsten Lahmheitsursachen bei jungen Hunden mittelgroßer und großer Rassen dar. Dabei wird der radioulnaren Inkongruenz eine maßgebliche Rolle in der Pathogenese zugesprochen. GUILLOU und Mitarbeiter (2011) konnten zeigen, dass eine axiale radioulnare Translation von bis zu 1 mm in gesunden kaninen Ellbogengelenken in vivo auftritt. Auf dieser Basis entstand die Hypothese einer vermehrten radioulnaren Beweglichkeit in dysplastischen Gelenken, die zu einer dynamischen Inkongruenz führen könnte, da ca. 40 % der Patienten keine messbare Stufe aufweisen. Ziele der Untersuchungen: Ziel der Studie war der Vergleich der dynamischen radioulnaren Inkongruenz bei orthopädisch gesunden und dysplastischen Hunden in vivo. Material und Methoden: Sieben dysplastische Ellbogengelenke von sechs Hunden und sechs orthopädisch gesunde Ellbogengelenke von fünf Hunden sind in die Studie eingegangen. Alle Probanden der ED Gruppe zeigten einen fragmentierten Processus coronoideus medialis ulnae. Nach Implantation von jeweils mindestens drei Markern in Humerus, Radius und Ulna erfolgte die biplanare, fluoroskopische Untersuchung der Gelenke, während die Hunde im Schritt auf einem Laufband geführt wurden. Die gewonnenen Röntgenvideoaufnahmen wurden aufgearbeitet und die gemessene Bewegung der Marker auf rekonstruierte dreidimensionale Knochenmodelle jedes Probanden übertragen. Alle Animationen wurden visuell beurteilt und anschließend die relative radioulnare und humeroulnare Bewegung an den animierten Knochenmodellen gemessen und als Translation in Millimeter und Rotation in Grad angegeben. Weiterhin wurden die Kontaktflächenmuster für die ulnare Gelenkfläche in dysplastischen und gesunden Gelenken bestimmt und gegeneinander visuell verglichen. Ergebnisse: Für die relative radioulnare Translation konnten in der Kontrollgruppe 0,7 mm und in der ED Gruppe 0,5 mm gemessen werden. Beide Werte unterschieden sich nicht signifikant voneinander (P= 0,2092; Konfidenzintervall -0,6 – 0,2). Die relative humeroulnare Rotation lag in der Kontrollgruppe bei 2,9 Grad und in der ED Gruppe bei 5,3 Grad. Damit lag ein signifikanter Unterschied zwischen beiden Gruppen vor (P= 0,0229; Konfidenzintervall 0,4 – 4,4). Die Kontaktflächenmuster zeigten in der Kontrollgruppe, während der dargestellten Fußungsphase, eine homogene Verteilung des Kontaktes über das gesamte mediale Koronoid. Hingegen konnte in dysplastischen Gelenken eine Reduktion des Kontaktes im kraniolateralen Anteil des Koronoids beobachtet werden. Schlussfolgerung: Die radioulnare Bewegung zeigt zwischen gesunden und dysplastischen Gelenken keinen signifikanten Unterschied auf. Die Hypothese einer ausgeprägten Translation zwischen Radius und Ulna in Gelenken erkrankter Hunde, die während der Bewegung zu einer dynamischen RUI führt kann damit widerlegt werden. Allerdings zeigt der Humerus in dysplastischen Gelenken eine vermehrte Rotationsbewegung, die zu einer Verlagerung der Trochlea humeri gegen den medialen Kronfortsatz führt. Dieser visuell und quantitativ erfasste Effekt spiegelt sich auch in den Kontaktflächenmustern wieder. Da Pathologien im Sinne des FPC typischerweise im Bereich des dargestellten, konzentrierten Kontaktes auftreten, ist davon auszugehen, dass es durch die humerale Rotation zu einer vermehrten Belastung des Koronoids kommt, welche zur Fragmentation des Kronfortsatzes führen kann. Die Ursache dieser vermehrten Bewegung ist derzeit nicht bekannt. Möglicherweise spielen Weichteilpathologien eine Rolle, ähnlich der Pathogenese der Hüftgelenksdysplasie. Neben der bereits bekannten und beschriebenen statischen RUI scheint die Rotationsinstabilität des Humerus eine entscheidende Rolle in der Pathogenese der ED zu spielen, insbesondere in kongruent erscheinenden Gelenken. / Introduction: Elbow dysplasia (ED) is one of the most frequent reasons for forelimb lameness especially in young large breed dogs. Radio-ulnar incongruence is discussed to be one of the main factors in the pathogenesis of ED. GUILLOU et al. (2011) described an axial translation between the radius and the ulna up to 1 mm in sound canine elbow joints in vivo. Based on this study we developed the hypothesis that pronounced radio-ulnar movement in dysplastic joints leads to a dynamic radio-ulnar incongruence. This dynamic incongruence might explain why 40 % of dysplastic dogs show no measurable step formation. Objective: The aim of the study was to compare the dynamic radio-ulnar incongruence in sound and dysplastic dogs in vivo. Material and Methods: Seven dysplastic joints in six dogs and six sound joints in five dogs were evaluated. All dysplastic joints showed a fragmented coronoid process and a radio-ulnar incongruence and cartilage lesions on the ulnar and humeral joint surface in a varying degree. A minimum of three Tantalum markers were implanted into the Humerus, Radius and Ulna each. Afterwards biplanar fluoroscopic gait analysis was performed while the dogs were walking on a treadmill. Gained marker movement was transferred onto reconstructed three dimensional CT bone models of each dog. The 3D animations were visually assessed and relative movement between the radius and ulna as well as between the humerus and ulna was measured and expressed as translation (millimeter) and rotation (degree). Further the joint contact patterns of the ulnar joint surface were determined for all dysplastic and sound joints and visually compared to each other. Results: Relative radio-ulnar translation was 0.7 mm in sound joints and 0.5 mm in dysplastic joints. There was no significant difference between these two groups (P= 0.2092; convidence interval -0.6 to 0.2). A significant difference between the dysplastic and the sound group was present in the relative humeral rotation (P= 0.0229; convidence interval 0.4 to 4.4). Humeral rotation relative to the ulna was 2.9 degree in sound and 5.3 degree in dysplastic joints. Humero-ulnar contact at the medial coronoid process was evenly distributed over the medial coronoid process in control elbows, while contact area in dysplastic elbows was reduced and shifted to the lateral aspect of the medial coronoid process Conclusion: Radio-ulnar movement is not significantly different between dysplastic and sound elbow joints. So the hypothesis of a pronounced axial translation between the radius and the ulna in dysplastic joints, leading to dynamic RUI can be neglected. However the humerus shows a significantly pronounced rotational movement in dysplastic joints compared to sound elbows. The trochlea humeri moves towards cranio-lateral and hits the medial coronoid process at its cranio-lateral aspect. The effect of this rotational movement can be shown in the joint contact patterns of the ulnar joint surface. Contact is shifted towards the tip and the lateral aspect of the coronoid process. In that area fragmentation of the medial coronoid process is typically observed. It seems that rotation of the humerus relative to the ulna leads to reduced contact and mechanical overload of the coronoid process. The cause of this increased rotational movement remains unknown. Maybe the documented movement could be interpreted as joint instability similar to the pathogenesis of hip dysplasia in which soft tissue laxity results in joint instability and degenerative joint disease. Besides the already described static radio-ulnar incongruence humeral rotational instability seems to play a role in the pathogenesis of elbow dysplasia, especially in congruent joints.

Les papillomavirus humains (VPHs) sont reconnus comme les agents étiologiques du cancer du col de l’utérus. Notre étude a pour but de décrire le polymorphisme de la région régulatrice virale (LCR) et du gène E6 du VPH52 chez 216 femmes canadiennes avec différents grades de lésion du col et d’établir s’il existe une association entre les variantes décrites et la présence de lésions intraépithéliales de haut-grade (CIN2,3) du col de l’utérus ou de cancer invasif. L’âge (OR 1.1, 95% CI 1.02-1.17, p=0.005) fut significativement associé à la présence de cancer invasif. Une variante de la région régulatrice virale, MTL-52-LCR-02, présentant une substitution nucléotidique au niveau du nucléotide 7436, fut aussi associée à la présence de cancer du col de l’utérus (p=0.015). Dans une analyse multivariée, après ajustement pour l’âge, l’ethnicité et le site de recrutement, une délétion au niveau du nucléotide 7695 (OR 5.7, 95% CI 1.2-27.9) ainsi qu’une substitution au niveau du nucléotide 7744 (OR 8.3, 95% CI 1.1-61.0) du LCR, et la variante K93R de la protéine E6 (OR 9.5, 95% CI 1.3-68.9) furent associées de façon significative avec la présence de CIN2,3. Ainsi, le polymorphisme du LCR et du gène E6 du VPH52 est associé avec la présence de CIN2,3 et probablement avec celle d’un cancer invasif. / Human papillomaviruses (HPVs) are the main etiological agents of cervical cancer. Our study aims to describe HPV52 polymorphism in the long control region (LCR) and in the E6 gene, and to investigate the association between LCR and E6 polymorphism and high-grade cervical intraepithelial neoplasia (CIN2,3) or invasive cervical cancer in 216 canadian women with various grades of cervical disease. Age was significantly associated with cervical cancer (OR 1.1, 95% CI 1.02-1.17, p=0.005). The MTL-52-LCR-02 variant, with a nucleotide substitution in the LCR at position 7436, was also associated with cervical cancer. MTL-52-LCR-02 has been identified in 28.6% of women with cervical cancer and in 0.0% of women without cervical cancer or CIN2,3 (p=0.015). In a multivariate analysis, after adjusting for age, ethnicity, detection of HPV16 or 18, and study site, a deletion at nucleotide position 7695 (OR 5.7, 95% CI 1.2-27.9), a variation at nucleotide position 7744 (OR 8.3, 95% CI 1.-61.0) in the LCR and the K93R variant of the protein E6 (OR 9.5, 95% CI 1.3-68.9) were associated with CIN2,3. This study confirms that HPV52 polymorphism in the LCR and in the E6 gene is associated with risk of development of CIN2,3 and possibly invasive cancer of the uterine cervix.

Introduction: Le supplément d’oxygène et la nutrition parentérale (NP) sont les deux sources majeures de stress oxydant chez le nouveau-né. Lors de la détoxification des oxydants, le potentiel redox du glutathion s’oxyde. Notre hypothèse est que le supplément d’oxygène et la durée de la NP sont associés à un potentiel redox plus oxydé et à une augmentation de la sévérité de la dysplasie bronchopulmonaire (DBP). Patients et Méthodes: Une étude observationnelle prospective incluant des enfants de moins de 29 semaines d’âge gestationnel. Les concentrations sanguines de GSH et GSSG à jour 6-7 et à 36 semaines d’âge corrigé étaient mesurées par électrophorèse capillaire et le potentiel redox était calculé selon l’équation de Nernst. La sévérité de la DBP correspondait à la définition du NICHD. Résultats: Une FiO2≥ 25% au 7ième jour de vie ainsi que plus de 14 jours de NP sont significativement associés à un potentiel redox plus oxydé et à une DBP plus sévère. Ces relations sont indépendantes de l’âge de gestation et de la gravité de la maladie initiale. La corrélation entre le potentiel redox et la sévérité de la DBP n’est pas significative. La durée de la NP était responsable de 15% de la variation du potentiel redox ainsi que de 42% de la variation de la sévérité de la DPB. Conclusion: Ces résultats suggèrent que l’oxygène et la NP induisent un stress oxydant et que les stratégies visant une utilisation plus judicieuse de l’oxygène et de la NP devraient diminuer la sévérité de la DBP. / Introduction: oxygen supplementation and total parenteral solution (TPN) are two main clinical practices that sustain oxidative stress. Glutathione is a key molecule that detoxifies peroxides resulting in a more oxidized redox potential. We hypothesize that O2 supplementation and longer TPN duration are associated with both more oxidized redox potential and more severe bronchopulmonary dysplasia (BPD). Patients and methods: A prospective observational study including infants of less than 29 weeks gestational age. GSH and GSSG from whole blood sampled on day 6-7 and at 36 weeks of corrected age (CA) were measured by capillary electrophoresis and redox potential was calculated using Nernst equation. BPD was classified according to NICHD guidelines. Results: There was a significant association between FiO2 ≥ 25% on day 7 of life and TPN duration longer than 14 days and both more oxidized redox potential and more severe BPD. TPN duration explained both 15 % of total variation observed in redox potential and 42 % of total variation in BPD severity. These associations remained significant after adjustment for gestational age and illness severity. The relation between the severity of BPD and the redox potential in blood was not significant. The statistic power (1-β) to show an effect of redox potential on severity of BPD was 52%. Conclusion: Both redox potential of glutathione and BPD severity are both associated with early O2 supplement and TPN. Strategies targeting judicious use of O2 supplement and either decreasing the duration or using safer formulation of TPN are expected to help reducing BPD.