VALUTAZIONE DELLA COMPRESENZA DEL PAPILLOMAVIRUS (HPV) IN SEDE ORALE E GENITALE IN DONNE CON CITOLOGIA CERVICALE POSITIVA E NEI RISPETTIVI PARTNER

Introduction/Objective The human papilloma viruses (HPVs) are DNA viruses associated with benign and malignant lesions. For gynaecologists, the carcinogenic potential and the necessity of HPV presence for the development of cancer has been understood for decades in relation to the cervix uteri, and for a large portion of other anogenital tumours. The HPVs have been studied in last decades also by many other different specialist due to its role in association with numerous different cancers in several tissues including Head and neck squamous cell cancer (HNSCC) and Oral Squamous Cell Carcinoma (OSCC). HNSCC accounts for more than 7 % of all human cancer types. Despite the development of new surgical techniques and the introduction of multidisciplinary treatments still almost half of the patients decease. For a long time period smoking and alcohol were the main risk factors contributing to HNSCC. Even if a decline in smoking has been registered from '70s till now, the incidence of OSCC is still rising. This might be explained by an increasing of HPV positive tumors. For this reason the women\u2019s HPV-positive cervix is discussed to act as a virus reservoir. However, until today it remains unclear if the women\u2019s HPV-positive cervix uteri really serves as a virus reservoir and if certain sexual practices are the cause for HPV transmission to the oropharynx. Data on genotype-specific concordance of oral-oral and genital-oral HPV infections among heterosexual couples are key to understand HPV transmission between partners. This study aimed at assessing the concurrence of oropharyngeal HPV infection, with relative genotyping, in women with cervical lesions and in their current stable sexual partners in an Italian population. Material and methods 105 female subjects with a positive PAP test were enrolled in this study. Complete datas, cervical brush, oral swab, oral rinse and urine (only male) samples were collected from 44 women and 28 men. Demographic and behavior data were obtained through a structured questionnaire. HPV-DNA amplification was performed by polymerase chain reaction assay (PCR) using both primers MY09/MY11 and FAP59/64. HPV genotyping has been performed with Sanger technique and each sequence compared with the Finch software and "The PapillomaVirus Episteme" (PaVE) database. Positive samples have been analyzed also with the Inno-Lipa Genotyping Extra kit in order to have an higher accuracy in case of multiple genotype infections. Different variables were considered for the statistical analyses: gender, age, number of partners, oral sex, alcohol consumption per week, lesions etc. The effect of the variables on the HPV infection status was assessed, by fitting a generalized model, using the GLM (General Linear Model) function in R software. The family \u201cbinomial\u201d was used for the description of the error distribution and link function. The function fisher test was used to perform Fisher\u2019s exact test as a verification test. The model was tested using the maximum likelihood to evaluate the effect of the inclusion of each parameter to the model. As a supplementary analysis, the correlations were calculated between all parameters. Results 86% of cervical samples were HPV-positive. Different genotypes have been isolated (i.g. 6, 66, 39, 16, 31, 56, 42, 58, 114, 59, 61, 68, 45, 35, 33 e 53, 89, 114). 20% of the oral samples were positive in the female group and 25% in the male one. Only one sample of urine was positive and the same HPV genotype has been found in the cervical brush of his female partner. No other specific genotype concordance has been found between female and male couples. The regression of the variables against the total infection status highlighted three significant factors: gender, oral sex and alcohol (p value: 0,000224, 0.0119 and 0.0362 respectively). This finding shows that males and females are different in what concerns the HPV infection; the oral sex is associated with HPV infection and third that alcohol consumption seems to have a negative effect on HPV infection status. Other variables such as the number of partners, number of sexual rapports, age or use of bird controls pills do not seems to be significant. The regression of the variables against the oral infection status shows that gender is a significant factor (p value 0.04517) but not oral sex and alcohol. Age and smoking although not significant show a trend close to significance (p value 0.0885 and 0.0901 respectively). Moreover, the analyses highlighted that oral sex and alcohol are significant factors for the cervical infections (p value 0.0492 and 0.0229 respectively). The number of partners, the use of bird control pills, smoking and age seem do not to have an effect on cervical infections. As a second step, we divided the data into males samples and females samples. Subsequently, we did two regressions using the two datasets subsets. We found that oral sex is highly significant in women but only suggestively significant in men for HPV infection. In our study oral sex was about three times more common in men than in women. Moreover, in men the number of the partners and the number of sexual rapport seem to have an effect on oral HPV infection (p value 0,0514 and 0,08 with a trend close to significance respectively). As the sample size is relatively low we checked and confirmed the significance of the oral sex and alcohol association using the Fisher exact test. We calculated also the correlations between all the parameters which gives some important biological considerations. Correlation between oral sex and cervical infection was significant (p value 0.04001). Conclusions The limited data suggest that among sexual partners in Italy, HPV transmission to the oropharynx by oral\u2013genital sex or by autoinoculation is a rare event with low HPV concordance. An interesting result is that an asymptomatic HPV infection was common in both spouses while genotype-specific concordance was low. The presence of the virus in both male and female oral mucosa was detected in over 20% of the subjects suggesting an important presence of the virus even if the direct correlation with the cervical infection is still not clear. The presence of the virus in the urine of the male partners was detected only in one case suggesting a low transmission of the virus from the cervical site to the male genital mucosa. Alcohol consumption, oral sex practice and higher number of sexual partners seems to be associated with the presence of the virus

VALUTAZIONE DELLA COMPRESENZA DEL PAPILLOMAVIRUS (HPV) IN SEDE ORALE E GENITALE IN DONNE CON CITOLOGIA CERVICALE POSITIVA E NEI RISPETTIVI PARTNER

Introduction/Objective The human papilloma viruses (HPVs) are DNA viruses associated with benign and malignant lesions. For gynaecologists, the carcinogenic potential and the necessity of HPV presence for the development of cancer has been understood for decades in relation to the cervix uteri, and for a large portion of other anogenital tumours. The HPVs have been studied in last decades also by many other different specialist due to its role in association with numerous different cancers in several tissues including Head and neck squamous cell cancer (HNSCC) and Oral Squamous Cell Carcinoma (OSCC). HNSCC accounts for more than 7 % of all human cancer types. Despite the development of new surgical techniques and the introduction of multidisciplinary treatments still almost half of the patients decease. For a long time period smoking and alcohol were the main risk factors contributing to HNSCC. Even if a decline in smoking has been registered from '70s till now, the incidence of OSCC is still rising. This might be explained by an increasing of HPV positive tumors. For this reason the women’s HPV-positive cervix is discussed to act as a virus reservoir. However, until today it remains unclear if the women’s HPV-positive cervix uteri really serves as a virus reservoir and if certain sexual practices are the cause for HPV transmission to the oropharynx. Data on genotype-specific concordance of oral-oral and genital-oral HPV infections among heterosexual couples are key to understand HPV transmission between partners. This study aimed at assessing the concurrence of oropharyngeal HPV infection, with relative genotyping, in women with cervical lesions and in their current stable sexual partners in an Italian population. Material and methods 105 female subjects with a positive PAP test were enrolled in this study. Complete datas, cervical brush, oral swab, oral rinse and urine (only male) samples were collected from 44 women and 28 men. Demographic and behavior data were obtained through a structured questionnaire. HPV-DNA amplification was performed by polymerase chain reaction assay (PCR) using both primers MY09/MY11 and FAP59/64. HPV genotyping has been performed with Sanger technique and each sequence compared with the Finch software and "The PapillomaVirus Episteme" (PaVE) database. Positive samples have been analyzed also with the Inno-Lipa Genotyping Extra kit in order to have an higher accuracy in case of multiple genotype infections. Different variables were considered for the statistical analyses: gender, age, number of partners, oral sex, alcohol consumption per week, lesions etc. The effect of the variables on the HPV infection status was assessed, by fitting a generalized model, using the GLM (General Linear Model) function in R software. The family “binomial” was used for the description of the error distribution and link function. The function fisher test was used to perform Fisher’s exact test as a verification test. The model was tested using the maximum likelihood to evaluate the effect of the inclusion of each parameter to the model. As a supplementary analysis, the correlations were calculated between all parameters. Results 86% of cervical samples were HPV-positive. Different genotypes have been isolated (i.g. 6, 66, 39, 16, 31, 56, 42, 58, 114, 59, 61, 68, 45, 35, 33 e 53, 89, 114). 20% of the oral samples were positive in the female group and 25% in the male one. Only one sample of urine was positive and the same HPV genotype has been found in the cervical brush of his female partner. No other specific genotype concordance has been found between female and male couples. The regression of the variables against the total infection status highlighted three significant factors: gender, oral sex and alcohol (p value: 0,000224, 0.0119 and 0.0362 respectively). This finding shows that males and females are different in what concerns the HPV infection; the oral sex is associated with HPV infection and third that alcohol consumption seems to have a negative effect on HPV infection status. Other variables such as the number of partners, number of sexual rapports, age or use of bird controls pills do not seems to be significant. The regression of the variables against the oral infection status shows that gender is a significant factor (p value 0.04517) but not oral sex and alcohol. Age and smoking although not significant show a trend close to significance (p value 0.0885 and 0.0901 respectively). Moreover, the analyses highlighted that oral sex and alcohol are significant factors for the cervical infections (p value 0.0492 and 0.0229 respectively). The number of partners, the use of bird control pills, smoking and age seem do not to have an effect on cervical infections. As a second step, we divided the data into males samples and females samples. Subsequently, we did two regressions using the two datasets subsets. We found that oral sex is highly significant in women but only suggestively significant in men for HPV infection. In our study oral sex was about three times more common in men than in women. Moreover, in men the number of the partners and the number of sexual rapport seem to have an effect on oral HPV infection (p value 0,0514 and 0,08 with a trend close to significance respectively). As the sample size is relatively low we checked and confirmed the significance of the oral sex and alcohol association using the Fisher exact test. We calculated also the correlations between all the parameters which gives some important biological considerations. Correlation between oral sex and cervical infection was significant (p value 0.04001). Conclusions The limited data suggest that among sexual partners in Italy, HPV transmission to the oropharynx by oral–genital sex or by autoinoculation is a rare event with low HPV concordance. An interesting result is that an asymptomatic HPV infection was common in both spouses while genotype-specific concordance was low. The presence of the virus in both male and female oral mucosa was detected in over 20% of the subjects suggesting an important presence of the virus even if the direct correlation with the cervical infection is still not clear. The presence of the virus in the urine of the male partners was detected only in one case suggesting a low transmission of the virus from the cervical site to the male genital mucosa. Alcohol consumption, oral sex practice and higher number of sexual partners seems to be associated with the presence of the virus

Metodología y productos para la formación a distancia

GDT es una compañía de servicios empresariales que, en el ámbito de la formación continua y ocupacional, ha apostado por un modelo innovador y tecnológicamente avanzado. La teleformación consiste en el empleo intensivo de los recursos puestos a disposición por las nuevas tecnologías de la información y de la comunicación: Internet, CD-ROM, tutorías a distancia, seguimiento en tiempo real. En este sentido, GDT ha realizado una serie de productos formativos, como son diversos cursos en soporte CD-ROM integrados en un gran proyecto de Centro de Teleformación, abierto al conjunto de empresarios y de trabajadores de toda Andalucía.GDT is an enterprise services company that, in the field of professional training, works with a innovative and advanced technological model. Distant training is based on the intensive use of new information and communication technologies: the Internet, CD-ROM, distant tutoring, real-time follow up. GDT has created different products, such as CD-ROM courses integrated in a wide-scale project: a Distant Learning Centre, open to all employers and workers of Andalusia

Three-dimensional evaluation of rapid maxillary expansion anchored to primary molars: Direct effects on maxillary arch and spontaneous mandibular response

Aim The purpose of this study was to evaluate the effects of rapid maxillary expansion (RME) on maxillary and mandibular arch in the mixed dentition. Methods Forty-four consecutive patients with transverse maxillary deficiency were recruited. Test group: 21 patients (10 male, 11 female; 7.4 \ub1 1.2 years) who underwent RME (Haas type) therapy banded on the primary second molars. Control group: 17 patients (10 male, 7 female; 7.3 \ub1 1.1 years old) who did not receive any orthodontic treatment. Dental casts obtained pre-treatment and after appliance removal (11 months) were processed by means of a three-dimensional scanner (3Shape D250 laser, DK). Digital landmarks were traced using the VAM software (Canfield Scientific Inc., Fairfield-NJ, USA). Arch Length, interdental width and torque differences were measured before and after the removal of the appliance. The t-test (P < 0.05) for paired data was applied to evaluate the measurements values before and after treatment. The linear regression model was employed to assess the correlations between treatment effects. Results The efficacy of the RME was confirmed both on maxillary and mandibular arch. Mandibular intermolar width (+2.02 mm) together with primary intermolar (+1.39 mm), intercanine width (+0.95mm) and torque variations significantly increased. The untreated control group showed no significant statistical differences between T0 and T1. The linear regression between maxillary and mandibular data showed correlations between the torque of the teeth 16/46 and 65/85 (P < 0.05). Conclusions RME anchored on primary molars is an effective treatment option to correct tranverse maxillary deficiencies. All the measurements increased significantly confirming the indirect effect of RME on the mandibular arch

Laser-assisted treatment of dentinal hypersensitivity : a literature review

The purpose of this literature review was to evalu- ate the effectiveness of the laser-assisted treat- ment of dentinal hypersensitivity. A review with inclusion and exclusion criteria was performed from January 2009 to December 2014 with elec- tronic data-bases: MedLine via PubMed, Science Direct and Cochrane Library. Research of paper magazines by hand was not considered. Forty- three articles were selected between literature re- views, in vitro studies, clinical trials, pilot and preliminary studies. The items were divided into laser-used groups for an accurate description, and then the reading of results into various ty- pologies. Laser-assisted treatment reduces denti- nal hypersensitivity-related pain, but also a psy- chosomatic component must be considered, so further studies and more suitable follow-ups are necessary

Timing considerations on the shear bond strength of orthodontic brackets after topical fluoride varnish applications

OBJECTIVES: To assess the best temporal association between the application of a fluoride varnish on enamel and bonding procedures. MATERIALS AND METHODS: Eighty mandibular bovine incisors were used. Teeth were divided into 4 groups (20 per group); Groups 1-3 were treated with fluoride varnish (Fluor Protector, Ivoclar Vivadent, Schaan, Liechtenstein), and Group 4 served as control with no pretreatment. Tooth were stored in deionized water (37\ub0C) and subjected to thermal cycling for 400 (Group 1), 800 (Group 2), and 2500 (Group 3) cycles corresponding, respectively, to 15, 30, and 90 days in order to simulate the three different timing of bracket bonding. Shear bond strength (SBS) was measured using an Instron Universal Testing machine. Tooth surfaces were examined under a stereomicroscope at 10 7 magnification to assess the amount of adhesive remnant index (ARI). One-way analysis of variance (ANOVA) and Tukey's honestly significant difference post-hoc test were used for the comparison of SBS values between groups (P < 0.05). The Chi-square test was used to examine differences among ARI scores. (P < 0.05). RESULTS: One-way ANOVA and Tukey post-hoc test showed that the SBS of different groups were significantly different and was impacted by different timing of bonding (P < 0.05). The main differences were between the control group (17.02 \ub1 6.38 MPa) and Group 1 (6.93 \ub1 4.3 MPa). The ARI scores showed that there were no significant differences between the four tested groups. CONCLUSIONS: The SBS of the brackets bonded 15 days after the application of the fluoride was set back to an optimal value

Evaluation of the difference in caries experience in diabetic and non-diabetic children : a case control study

AIM: To evaluate the caries prevalence and related variables in Type 1 diabetic and non-diabetic children and among the diabetic children according to their metabolic status. METHODS: Sixty-eight diabetic and 136 non-diabetic children, matching by gender and age (4-14 years) were enrolled. The diabetic children were divided: a) 20 children in good metabolic control (Hb1ac 647.5) and b) 48 children in bad metabolic control (Hb1ac>7.5). Dietary and oral hygiene habits were investigated. Caries status was registered using the International Caries Detection and Assessment System. Oral microflora was analysed using the checkerboard DNA-DNA hybridisation method. Plaque acidogenicity was recorded after a sucrose rinse. RESULTS: Sugared beverage and snack intake was higher in diabetic group compared to non-diabetic group (p = 0.03 and p = 0.04, respectively) and in subjects in bad metabolic control (p = 0.03 and p<0.01, respectively). Oral hygiene habits were similar, except for the use of fluoridated adjuvants, higher in non-diabetic children (p = 0.04). No statistically significant differences were observed regarding caries figures, but a higher number of caries free subjects was found in diabetic subjects in good metabolic control (p<0.01). Significant difference for the main cariogenic bacteria was found between diabetic and non-diabetic subjects (p<0.05). The pH values showed statistically significant differences between diabetic and non-diabetic subjects and between diabetic subjects in good and bad metabolic control (p<0.01). CONCLUSIONS: Diabetic children in good metabolic control might even be considered at low caries risk, while those in bad metabolic control showed an oral environment prone to a high caries risk

Presence of Legionella spp. in human dental plaque

Aims. The aim of this research is to verify the presence of Legionella in human dental plaque. Methods. 65 adult patients not treated with systemic or local antibiotics at least 2 months before the time of sample collection were enrolled for plaque collection between September 2015 and December 2016. A brief questionnaire about lifestyle and health risks was administered. Legionella spp. detection has been executed by semi- nested PCR. Results. 8 out of 65 plaque samples (12.3%) were positive for Legionella spp. As regards health risks and lifestyle aspects, no relevant difference was observed between patients involved in our study, except for two positive patients who have reported a COPD ongoing and a pneumonia in the past. Conclusions. This study represents a step forward in the knowledge of reservoirs of the microorganism and richness of oral microbiot

Sphenofrontal distance on three-dimensional ultrasound in euploid and trisomy-21 fetuses at 16-24 weeks&apos; gestation

Objective: To compare the distance between the sphenoid and frontal bones on three-dimensional (3D) ultrasound in euploid and trisomy-21 fetuses at 16-24 weeks' gestation. Methods: We acquired 3D volumes of the fetal profile from 80 normal and 30 trisomy-21 fetuses at 16-24 weeks' gestation. We used the multiplanar mode to obtain the mid-sagittal plane and measured the sphenofrontal distance as the shortest distance between the most anterior edge of the sphenoid bone and the lowest edge of the frontal bone. Results: In normal fetuses, the sphenofrontal distance increased linearly with gestational age, from 15.1mm at 16 weeks to 18.2mm at 24 weeks. In fetuses with trisomy 21, the mean sphenofrontal distance delta value was significantly smaller than in normal cases (-3.447mm (95% CI, -5.684 to -1.211mm); P<0.01). The sphenofrontal distance was below the 5th and 1st percentiles of the normal range in 29 (96.7%) and 27 (90.0%) trisomy-21 fetuses, respectively. Conclusions: The sphenofrontal distance is shorter at 16-24 weeks' gestation in fetuses with trisomy 21 than in normal fetuses. A reduction in the growth of the anterior cranial base contributes to the mid-facial hypoplasia observed in fetuses with trisomy 21