[The use of distal occlusion correctors during treatment on an individual lingual bracket system in adult patients]. / Primenenie korrektorov distal'noi okklyuzii pri lechenii s ispol'zovaniem individual'noi lingval'noi breket-sistemy u vzroslykh patsientov.

A case of treatment of a 35-year-old patient with a retroposition of the lower jaw, distal occlusion of the posterior teeth, deep incisal overlap, narrowing of the deformity of the dentoalveolar arches, protrusion of the lower incisors, crowded position of the teeth, mismatch between the incisor lines, absence due to extraction of tooth 3.6, with impacted dystopic tooth 3.8 is presented. Fixed individual orthodontic appliances of the WIN («DW Lingual Systems GmbH¼ Germany) were used. It was found that the use of the Herbst apparatus in combination with the WIN lingual bracket system in adult patients helps to achieve optimal functional and aesthetic results. The use of a distal bite correction device is an additional support for the mesialization of the molars of the lower jaw.

[The mesialization of molars of the lower jaw after performance surgical manipulation with using miniscrew anchorage approach]. / Mezializatsiia moliarov s pomoshch'iu breket-sistemy posle provedeniia p'ezokortikotomii.

Process of the mesialization of molars in the lower jaw is long-time, moreover the molars are not frequently bodily translation. Conduction of the corticotomy reduce to regional acceleration phenomen that permit to accelerate the tooth movement avoiding negative inclination. PURPOSE: To improve the effectiveness of the treatment using piezocorticotomy and miniscrew anchorage approach in cases of third and second molar mesialization when first molar is missing. MATERIAL AND METHODS: 24 patients (10 men/14 women) aged 25-40 years with a fixed vestibular braces and the absence of molars on the lower jaw. Cone-beam computed tomography was performed before and after orthodontic treatment, as well as immediately after the piezokortikotomy (79 Cone-beam computed tomography). Miniscrews was placed in the area between roots of the first and second premolars (27 miniscrews) and surgical manipulations was performed using device VarioSurg (NSK, Japan). Depending on width of the alveolar ridge piezocorticotomy was performed (16 piezocorticotomies) or splitting using piezosurgery approach (11 splitting). RESULTS: Mesialization speed of molars in patients with support of piezocorticotomy is equal to 1.1±0.1 mm/mo that is higher than in patients without surgery only with miniscrew approach (0.33±0.006 mm/mo Roberts et al, 1996). Mesialization speed of molars in patients with support of splitting is equal to 1.6±0.15 mm/mo. However, we observed that after corticotomies surgery, the speed was increased only within the first 4.5 months, after splitting, the speed was increased only withing 2.5 months, after that period the speed gradually decreases. Bone density after surgery decreased, but at the end of treatment gradually restored. CONCLUSION: Piezo surgery with corticotomies is an effective method to accelerate the mesialization of molars in the lower jaw, that conduce to reduction duration the treatement and to allow to almost bodily translation of the molars.

Longitudinal outcomes of high-risk human papillomavirus (HPV) infections as competing-risks events following cervical HPV test at baseline visit in the NIS-LAMS cohort.

BACKGROUND: The complex natural history of human papillomavirus (HPV) infections following a single HPV test can be modeled as competing-risks events (i.e., no-, transient- or persistent infection) in a longitudinal setting. The covariates associated with these competing events have not been previously assessed using competing-risks regression models. OBJECTIVES: To gain further insights in the outcomes of cervical HPV infections, we used univariate- and multivariate competing-risks regression models to assess the covariates associated with these competing events. STUDY DESIGN AND METHODS: Covariates associated with three competing outcomes (no-, transient- or persistent HR-HPV infection) were analysed in a sub-cohort of 1,865 women prospectively followed-up in the NIS (n = 3,187) and LAMS Study (n = 12,114). RESULTS: In multivariate competing-risks models (with two other outcomes as competing events), permanently HR-HPV negative outcome was significantly predicted only by the clearance ofASCUS+ Pap during FU, while three independent covariates predicted transient HR-HPV infections: i) number of recent (< 12 months) sexual partners (risk increased), ii) previous Pap screening history (protective), and history of previous CIN (increased risk). The two most powerful predictors of persistent HR-HPV infections were persistent ASCUS+ Pap (risk increased), and previous Pap screening history (protective). In pair-wise comparisons, number of recent sexual partners and previous CIN history increase the probability of transient HR-HPV infection against the HR-HPV negative competing event, while previous Pap screening history is protective. Persistent ASCUS+ Pap during FU and no previous Pap screening history are significantly associated with the persistent HR-HPV outcome (compared both with i) always negative, and ii) transient events), whereas multiparity is protective. CONCLUSIONS: Different covariates are associated with the three main outcomes of cervical HPV infections. The most significant covariates of each competing events are probably distinct enough to enable constructing of a risk-profile for each main outcome.

Covariates of high-risk human papillomavirus (HPV) infections are distinct for incident CIN1, CIN2 and CIN3 as disclosed by competing-risks regression models.

BACKGROUND: In addition to the oncogenic human papillomavirus (HPV), several cofactors are needed in cervical carcinogenesis, but whether the HPV covariates associated with incident (i) CIN1 are different from those of incident (ii) CIN2 and (iii) CIN3 needs further assessment. OBJECTIVES: To gain further insights into the true biological differences between CIN1, CIN2 and CIN3, we assessed HPV covariates associated with incident CIN1, CIN2, and CIN3. STUDY DESIGN AND METHODS: HPV covariates associated with progression to CIN1, CIN2 and CIN3 were analysed in the combined cohort of the NIS (n = 3187) and LAMS study (n = 12,114), using competing-risks regression models (in panel data) for baseline HR-HPV-positive women (n = 1105), who represent a sub-cohort of all 1865 women prospectively followed-up in these two studies. RESULTS: Altogether, 90 (4.8%), 39 (2.1%) and 14 (1.4%) cases progressed to CIN1, CIN2, and CIN3, respectively. Among these baseline HR-HPV-positive women, the risk profiles of incident CIN1, CIN2 and CIN3 were unique in that completely different HPV covariates were associated with progression to CIN1, CIN2 and CIN3, irrespective which categories (non-progression, CIN1, CIN2, CIN3 or all) were used as competing-risks events in univariate and multivariate models. CONCLUSIONS: These data confirm our previous analysis based on multinomial regression models implicating that distinct covariates of HR-HPV are associated with progression to CIN1, CIN2 and CIN3. This emphasises true biological differences between the three grades of CIN, which revisits the concept of combining CIN2 with CIN3 or with CIN1 in histological classification or used as a common endpoint, e.g., in HPV vaccine trials.

Epidemiological, clinical and viral determinants of the increased prevalence of high-risk human papillomavirus (HPV) infections in elderly women.

BACKGROUND: Population-based studies have reported a second peak of human papillomavirus (HPV) prevalence among women > 55 years, but reasons for this U-shaped HPV prevalence curve are poorly understood. OBJECTIVES: To analyse determinants of high-risk HPV (HR-HPV) infections among postmenopausal women. STUDY DESIGN AND METHODS: A cohort of 3,187 women was stratified into three age categories: i) youngest age group < 25 years (n = 1.103); ii) women between 26-55 years (n = 2.004), and iii) women > 55 years (n = 80), analysed for epidemiological, clinical and virological determinants of their HR-HPV infections. Real-time PCR was used for HPV genotyping, analysis of viral loads for HPV16, 18/45, 31, 33/52/58, 35 and 39, and load of integrated HPV16. RESULTS: Age-standardised prevalence of HR-HPV infections showed a second peak among women > 55 years, with a perfect U-shaped curve (R2 = 0.966). The factors explaining this increased HR-HPV prevalence among older women include: i) cohort effect, ii) higher viral loads for HR-HPV types with cubic model curve (R2 = 0.714) for HPV 16, iii) distinct shift (p = 0.0001) from multiple-type infections to single HR-HPV types, iv) transition from episomal to integrated HPV16 (p = 0.009), v) higher load of integrated HPV16 (p = 0.009), and, vi) higher proportion of incident infections, higher rate of viral persistence, and lower rate of HR-HPV clearance. CONCLUSIONS: These data suggest that in women who fail to eradicate their HR-HPV infection until menopause, selection of integrated viral clone has taken place, driving the process towards progressing disease. Consequent to this, most of the HR-HPV infections in women > 55 years were associated with high-grade CIN or invasive carcinoma.

Clearance of high-risk human papillomavirus (HPV) DNA and PAP smear abnormalities in a cohort of women subjected to HPV screening in the New Independent States of the former Soviet Union (the NIS cohort study).

BACKGROUND: We analysed the temporal relationships of the clearance of human papillomavirus (HPV) DNA and cytological abnormalities in women participating in a screening study in three NIS countries. METHODS: The 274 patients included in this analysis were prospectively followed-up for 21.6 months (range: 0.5-42.9). All 274 women had abnormal PAP test (ASC-US or higher) and high-risk HPV-positive test (HCII) at baseline. Two groups were compared: 132 women who cleared both tests (Group 1), and 142 women who cleared either HPV or abnormal PAP test (Group 2). The first clearance during the follow-up, and the last visit clearance were modeled using life-table techniques, and the predictive factors were analysed using univariate (Kaplan-Meier) and multivariate (Cox) survival analysis. RESULTS: There was no difference in the mean clearance time for the abnormal PAP test (14.4 months; 0.7-40.5 and 12.6 months; 0.5-35.0) and high-risk HPV DNA (12.67 months; 0.6-33.5 and 10.8 months; 0.7-33.4) in Group 1 and Group 2 (Mann-Whitney: P = 0.107 and P = 0.082, respectively). Clearance times for HPV DNA and abnormal PAP test did not deviate from each other in either groups (Wilcoxon: P = 0.063 and P = 0.088). The monthly clearance rates for the abnormal PAP test are 1.32 and 1.38%, and those for the HPV DNA 1.62 and 1.61%, in Groups 1 and 2, respectively. Of the factors predicting the last visit clearance, the issues related to smoking are of particular interest. CONCLUSIONS: The clearance of high-risk HPV type and abnormal PAP test shows a close temporal relationship, the former preceding the latter, however, by an interval of 1.0-2.0 months.

Factors predicting persistence of high-risk human papillomavirus (HPV) infections in women prospectively followed-up in three New Independent States (NIS) of the former Soviet Union.

BACKGROUND: We completed an analysis of the factors predicting the persistence of high risk (HR) HPV infections in women participating in a multicenter screening trial in three NIS countries. METHODS: The 543 baseline HR HPV-positive women included in this analysis are derived from a sub-cohort of 887 women who were prospectively followed-up for a mean of 21.6 months (range: 0.5-42.9) as a part of a multi-center screening study in three NIS countries (the NIS cohort study; n = 3,187 women). Of these 543 women, 273 showed persistent HR-HPV in serial Hybrid Capture II (HCII) testing during the follow-up (Group 1), whereas 270 women cleared their infection (Group 2). These two groups were compared with their epidemiological, clinical, and virological data (HCII, PCR) to disclose the factors predicting persistent HR-HPV infection. RESULTS: Women with persistent HR-HPV infections were significantly younger (27.3 yrs) than those who cleared their infection (29.1 yrs) (p = 0.006), and their follow-up time was shorter; 14.1 and 21 months, respectively (p = 0.0001). Both variables were treated as confounders in the multivariate analyses. Of the 66 recorded epidemiological variables, only being a current smoker proved to be an independent predictor (OR 1.693; 95% CI 1.114-2.573; p=0.014). Baseline colposcopy, biopsy or Pap smear did not predict HPV persistence, whereas an incident or persistent abnormal Pap during the follow-up were independent predictors in a multivariate model (p = 0.005), together with the high viral load (HCII RLU/CO at 100 pg/ml cut-off), and HR HPV positive PCR test (p = 0.0001). When all significant variables were entered in the regression model, only the follow-up time (OR 0.950, 95% CI 0.924-0.976; p = 0.0001) and HR-HPV positive PCR (OR 4.169, 95% CI 1.741-9.987; p = 0.001), remained independent predictors. CONCLUSIONS: While several factors were related to HR-HPV persistence in univariate analysis and when adjusted for age and follow-up time as confounders, the only independent predictors in the multivariate regression model were follow-up time and HR-HPV positive PCR. Clearly more data are needed on type-specific persistence and HPV integration as its predictors.

Mutagenic effects of dimethyl terephthalate on mouse somatic cells in vivo.

The mutagenic activity of dimethyl terephthalate (DMtP) was evaluated in the micronucleus test in mice. A clear clastogenic effect was obtained at all concentrations studied (0.2-1.0 mmole/kg body weight). The maximum number of micronuclei occurred 24 h after a single intraperitoneal (i.p.) injection. The time-course for the DMtP-induced micronuclei was in agreement with the available data on the rapid excretion of phthalates from the mammalian body. The dose-effect response was best described by a linear equation with a logarithmic component. The emergence of the latter term was related to the toxic effects of DMtP at higher concentrations on bone marrow erythropoietic function. A comparison of the effects induced by DMtP and by methyl nitrosourea indicated that DMtP cannot be considered a strong mutagenic compound. We have compared the sensitivity of the mouse micronucleus test and that of Drosophila dominant-lethal test by contrasting the effects obtained at similar exposure doses. This comparison leads to the conclusion that the micronucleus test is capable of responding to far lower phthalate concentrations than the Drosophila dominant-lethal mutation test. Our results testify to the ability of dimethyl terephthalate to cause genotoxic damages in vivo in both somatic and germinal cells of higher organisms. Thus, the chemical in question may be of potential genetic hazard to man.

Influence of metastases on the prognosis of adenocarcinoma of uterine cervix.

95 cases of adenocarcinoma of the uterine cervix were analysed for the influence of metastasis on the prognosis. When there was penetration of cervical stroma, < 10 mm or > 10 mm, spread of the tumour to the uterine corpus, metastasis in the ovaries and no detection of metastasis in patients the differences in survival rates were not statistically significant. Local spread of adenocarcinoma to the uterine corpus, penetration of cervical stroma > 10 mm and metastasis to ovaries may not adversely influence the patients survival.

[Characteristics of mutagenesis induced by nitrosomethylurea in a mammalian multilocus system in vitro]. / Osobennosti mutageneza, indutsiruemogo nitrozometilmochevinoi v mnogolokusnoi sisteme in vitro u mlekopitaiushchikh.

The mutagenic effect of short- and long-term MNU exposition causing alkylation and that combined with carbamoylation, correspondingly, at the four specific gene loci of the CHO-AT3-2 Chinese hamster line was studied. The increase both in MNU mutagenic effects and in the range of induced changes resulted from intensification of carbamoylating processes. True point mutations occurred mainly on alkylation. When carbamoylation is increased, the quantity and variety of mutations change towards accumulation of the number of other genetic lesions, for example, frameshift mutations and deletions.

[Arsenic trioxide inhibition of the thiophosphamide induction of mutations in mouse germ and somatic cells]. / Ingibirovanie trioksidom mysh'iaka induktsii mutatsii tiofosfamidom v polovykh i somaticheskikh kletkakh myshi.

After single i. p. injection of arsenic trioxide, at the dosage range of 1/4 to 1/40 LD50 into hybrid mice (CBA X C57B1/6J)F1, no induction of dominant lethals in male germ cells was observed. However, it led to an increase in the number of micronuclei in the erythrocytes of bone marrow. Treatment with the effective dose of thioTEPA, causing an increase in the number of dominant lethals in male germ cells and in the number of micronuclei in the erythrocytes of bone marrow, followed by injection of arsenic trioxide, resulted in inhibition of the mutagenic activity of thioTEPA. This inhibition increased proportionally with the dose of arsenic trioxide.

[Mutagenic action of the dimethyl ester of terephthalic acid on murine somatic cells in vivo]. / Mutagennoe deistvie dimetilovogo éfira tereftalevoi kisloty na somaticheskie kletki myshi in vivo.

Mutagenic activity of dimethyl terephthalate (DMtP) was evaluated using the bone marrow micronucleus test in mice. Clear clastogenic effect with the highest response in 24 h after a single i.p. injection was obtained at all concentrations used (0.2-1.0 mM/kg). The time-course for the micronuclei induced by DMtP was in agreement with the literature data on fast excretion of phthalates from mammal body. The dose-response curve for DMtP-induced micronuclei was linear in form with the logarithmic component. The emergence of the latter was related to the elevation of the chemical's concentration to the level at which DMtP starts to exert toxic influence on bone marrow erythropoietic function. The comparison of the effect induced by DMtP with that of methyl nitrosourea indicated that DMtP could not be considered as a strong mutagenic compound. Susceptibility of the micronucleus test was compared with that of Drosophila dominant lethal test in terms of the concentrations at which equal clastogenic effect was seen. This comparison made it possible to conclude that the micronucleus test in mice was able to respond to much lower phthalate concentrations, as compared with the test in Drosophila. The results provided the evidence of capacity of dimethyl terephthalate to cause alterations of genetical structures in both somatic and germinal cells of two highly organized species in vivo.

[Role of pathological dedifferentiation in the level of exfoliation of elements of the multilayer epithelium of the uterine cervix]. / Rol' patologicheskoi disdifferentsirovki v urovne éksfoliatsii élementov mnogosloinogo épiteliia sheiki matki.

In cervical dysplasias, dissociation of intercellular junctions occurs to a degree that depends directly on the severity of the dysplastic process which involves the entire epithelium from the basement membrane to the surface layer. The present cytologic studies have demonstrated that as the severity of dysplasia increases, smears taken from exfoliative cells of the stratified squamous epithelium show proportional decreases in the number of cells from the upper epithelial layers and increases in that of cells from the lower levels. The findings obtained indicate that morphologic characterization of exfoliative cellular material may help in the early cytologic diagnosis of cervical disorders.

[Role of surgical interventions in the treatment of patients with trophoblastic tumor resistant to chemotherapy]. / Rol' khirurgicheskogo vmeshatel'stva pri lechenii bol'nykh trofoblasticheskoi opukhol'iu, rezistentnoi k khimioterapii.

A retrospective evaluation of 85 case histories of chemotherapy-resistant trophoblastic disease treated at the Center's clinic (1975-1996) was carried out. Both therapy efficacy and survival rates were lower in patients operated on prior to chemotherapy and during medication. However, excision of resistant foci of trophoblastic tumor contributed to the effectiveness of chemotherapy.

[Monoclonal antibodies in the radioimmunological diagnosis of malignant tumors of the gastrointestinal tract and ovaries]. / Monoklonal'nye antitela v radioimmunologicheskoi diagnostike zlokachestvennykh opukholei zheludochno-kishechnogo trakta i iaichnikov.

The report deals with the clinical significance of application of two procedures of radioimmunologic assay of levels of monoclonal CA-19-9 and CA-125 antigens in diagnosing gastrointestinal and ovarian malignancies. The CA-19-9 antigen test appeared to be ineffective at the early stages of development of malignant tumors of the stomach, rectum and colon. The level of the antigen showed an increase in 37% of cases of hepatic metastases only. However, the test may be instrumental in differentiating between inflammatory processes and malignancies in the pancreatohepatoduodenal area. CA-125 antigen serves as a discriminating marker for tumor involvement of the ovaries. However, its specificity in differentiating between benign and malignant tumors of this organ is under 63%.

[Diagnosis and treatment of trophoblastic uterine tumors]. / Diagnostika i lechenie trofoblasticheskikh opukholei matki.

An evaluation of 801 cases of different forms of uterine trophoblastic tumors treated at the Center in 1960-1981 is given. Chorionepithelioma was confirmed histologically in 488 cases. Modern means of diagnosis of uterine trophoblastic tumors are discussed. A retrospective analysis of treatment of patients is presented. The result of up-to-date combination chemotherapy of patients with uterine chorionepithelioma are reported. The role of surgery in the treatment of trophoblastic tumors is discussed.

[Malignancy of hormonally active ovarian tumors]. / K voprosu o zlokachestvennosti gormon-aktivnykh opukholei iaichnika.

401 cases of hormone-producing tumors of the ovary were studied (190 theca-cell, 169--granulose cell, 25--mixed thecagranulosa cell and 17--virilising tumors). Histological diagnosis, clinical stage and end results of their treatment were compared. Theca-granulosa cell tumor is considered to be the most malignant form of these neoplasms. Pure theca-cell tumor proved to be benign in most cases. Of special interest is a high percentage of patients being cured at stage 1 (FIGO classification) of neoplastic process, that stands, in the authors' opinion, in close relationship with comparatively good results obtained in these patients.

[Clinical evaluation of different methods of treatment in patients with endometrial stromal sarcoma of the uterus]. / Klinicheskaia otsenka razlichnykh metodov lecheniia bol'nykh éndometrial'noi stromal'noi sarkomoi matki.

The data on treatment of 50 patients with endometrial stromal sarcoma (Ess) are discussed. Mean age-46.5 years. The group included 28 patients with stage I tumor, 7-stage II, 8-stage III and 7-stage IV. The end results of surgical, combined and complex treatment were followed up in 45 cases. Surgery was given to 24 and combined and complex therapy-to 21 patients. Five- and ten-year survival was 55.6 and 26.7, respectively, whatever mode of therapy and stage.

[Clinical importance of determining steroid hormone receptors in endometrial adenocarcinomas]. / Klinicheskoe znachenie opredeleniia retseptorov steroidnykh gormonov v adenokartsinomakh éndometriia.

Estradiol receptor (ER) and progesterone receptor (PR) levels were measured in 216 endometrial adenocarcinomas. Tumors containing more than 10 fmol/mg protein (for ER) and 20 fmol/mg (for PR) were considered receptor-positive. Tumors were both ER- and PR-positive in 75%. In stage I and II tumors, ER and PR levels were significantly higher than in stages III and IV. A similar relationship was established for minor (not deeper than 0.5 cm) and considerable involvement (deeper than 0.5 cm). There was an inverse correlation between ER and PR levels and ER- and PR-positive tumors incidence, on the one hand, and anaplasia, on the other. Adjuvant progestin therapy proved ineffective in tumors with a PR level under 100 mol/mg protein.

[Surgical treatment of patients with borderline serous tumors of the ovary]. / Khirurgicheskoe lechenie bol'nykh seroznymi pogranichnymi opukholiami iaichnikov.

The paper deals with the data on treatment of 63 patients with serous borderline tumors of the ovary (SBTO). Mean age was 40.2 years. The study included 30 patients (47.6%) with stage IA tumor, 15 (23.8%)--IB, 4 (6.3%)--II and 14 (22.2%)--stage III. Relapse frequency was 14.3%, irrespective of stage and method of therapy. Surgery was given to 18 patients (28.6%), combined therapy--by 45 (71.4%). Recurrent tumor was recorded after surgery in 2 (3.2%) and in 7 (14.8%) after combined therapy. Generally, surgery is the main treatment received by patients with SBTO. Adjuvant chemotherapy was not followed by decrease in relapse rates.