[Development of a second generation prophylactic vaccine against human papillomavirus]. / Desarrollo de una vacuna profiláctica de segunda generación contra el papilomavirus humano.

Human papillomaviruses (HPV) are the etiologic agent for cervical cancer (CC), the second cause of cancer death in women worldwide. It is estimated that half a million new cases are diagnosed each year, mostly in developing countries due to the lack of massive programs for early detection of the virus. Recently, two prophylactic vaccines against the main oncogenic HPV types 16 and 18 (responsible for 80% of CC) have been introduced into market. Both of these vaccines, obtained as recombinants, have been shown to be safe and effective; however, their high cost works against its immediate impact in the incidence of HPV infection in developing and low-income countries. There is a need to have in hand second generation, low cost vaccines of massive use that will decrease CC cases in a large extent. With this in mind, we have developed a recombinant expression platform that allows us to obtain virus-like particles (VLPs) to formulate both effective and accessible vaccines against HPV infection.

Desarrollo de una vacuna profiláctica de segunda generación contra el papilomavirus humano / Development of a second generation prophylactic vaccine against human papillomavirus

Los papilomavirus humanos (HPV) son el agente etiológico del cáncer cervical (CC), la segunda causa de muerte por cáncer en mujeres. Se estima que medio millón de nuevos cánceres se diagnostica cada año, ocurriendo la mayoría de ellos en países en vías de desarrollo debido a la ausencia o ineficiencia de los programas masivos de detección temprana. Recientemente se han introducido en el mercado dos vacunas profilácticas contra las principales cepas oncogénicas de HPV, la cepa 16 y 18, responsables por el 80% de todos los CC. Estas vacunas se obtienen en forma recombinante y han demostrado ser extremadamente seguras y eficaces. Sin embargo, su impacto inmediato en la incidencia de la infección por HPV en países en vías de desarrollo será mínimo, debido principalmente al alto costo de las mismas. Existe la necesidad de contar con vacunas de segunda generación, de bajo costo y de aplicación masiva que permitan disminuir sensiblemente el número de CC en la población. Con este objetivo hemos desarrollado una plataforma de expresión recombinante que permite obtener partículas tipo virus (VLPs) con las cuales es posible formular vacunas efectivas y accesibles contra la infección por HPV.

Human papillomaviruses (HPV) are the etiologic agent for cervical cancer (CC), the second cause of cancer death in women worldwide. It is estimated that half a million new cases are diagnosed each year, mostly in developing countries due to the lack of massive programs for early detection of the virus. Recently, two prophylactic vaccines against the main oncogenic HPV types 16 and 18 (responsible for 80% of CC) have been introduced into market. Both of these vaccines, obtained as recombinants, have been shown to be safe and effective; however, their high cost works against its immediate impact in the incidence of HPV infection in developing and low-income countries. There is a need to have in hand second generation, low cost vaccines of massive use that will decrease CC cases in a large extent. With this in mind, we have developed a recombinant expression platform that allows us to obtain virus-like particles (VLPs) to formulate both effective and accessible vaccines against HPV infection.

Reconstrução cirúrgica de fratura fronto-naso-órbito-etmoidal / Surgical reconstruction of a frontonasal orbital-etmoidal fracture

As fraturas do seio frontal são originadas a partir de acidentes de grande intensidade, que incluem acidentes automobilísticos, agressões físicas, acidentes esportivos e quedas. Normalmente, estão associadas com fraturas do terço médio da face, incluindo fraturas maxilares, naso-órbito-etmoidais e zigomáticas. Várias modalidades de tratamento têm sido propostas para reconstrução das fraturas fronto-naso-órbito-etmoidais, incluindo fixação dos fragmentos ósseos com placas e parafusos, reconstrução com enxertos ósseos e implante de malhas de titânio. No caso ora apresentado, utilizou-se do acesso bicoronal para reconstrução da parede anterior do seio frontal e restabelecimento do contorno fronto-naso-órbito-etmoidal, sendo utilizado enxerto ósseo de calota craniana para esse fim. Verificou-se a integridade do ducto fronto-nasal, não havendo necessidade de canulização deste. Esse procedimento é importante diretriz no plano de tratamento, uma vez que determina a obliteração ou canulização do ducto. Nenhuma complicação ou sequela foi observada na proservação de aproximadamente um ano. A proservação por longos períodos pós-operatórios é importante para avaliação de possíveis complicações.

Frontal sinus fractures are originated from high intensity accidents, including automobile accidents, altercations, sports accidents and falls. Normally, they are associated with fractures of the middle third of the face, including maxillary, nasal-orbital-etmoidal and zygomatic fractures. Several treatment modalities have been proposed to reconstruct fronto-nasal-orbital-etmoidal fractures, including fixation of bone fragments with plates and screws, reconstruction with bone grafts and titanium mesh implants. In the case here presented, bicoronal access was used to reconstruct the anterior wall of the frontal sinus and to reestablish the fronto-nasal-orbital-etmoidal contour, using a bone graft from the cranial cap for this purpose. The integrity of fronto-nasal duct was verified, and there was no need to canalize it. This procedure is an important guideline in the treatment plan, since it determines obliteration or canalization of the duct. After one year of follow-up, no complication or sequela was observed. Long periods of post-operative follow up are very important to evaluate possible complications.