Are Medical Students from Across the World Aware of Cervical Cancer, HPV Infection and Vaccination? A Cross-Sectional Comparative Study.

This study aims to understand and compare the level of knowledge, the attitude and the awareness of cervical cancer, HPV infection and vaccination among medical students from across the globe. It was conducted by sharing a questionnaire on medical students' Facebook groups. We successfully analysed 736 responses, of which 74.3% were females and 25.7% males. Their mean age was 23.14. As regards to the respondents' knowledge of the risk factors for cervical cancer, 28.8% of the participants identified HPV, 23.5% chose "Having many sexual partners", 15.4% identified "Starting the sexual life at a young age", 14.7% chose HIV and 13.3% answered smoking. Regarding the knowledge of the Pap test, 92.4% of the students stated that they knew what it is, although 98.5% of these respondents chose the correct answer. Concerning the knowledge of early warning signs of cervical cancer, 34.4% recognised vaginal bleeding. According to our research, American, Eastern and Western European students had more knowledge regarding the risk factors, early signs of cervical cancer and Pap test than African and Asian students. A total of 50% of the sexually active females had gone at least once to be screened by the means of a Pap test. A total of 39.8% of the participants stated that they had received the HPV vaccine. The findings of our research highlight the need for additional education measures to improve knowledge and awareness regarding HPV infection, especially among medical students, since they will be future healthcare providers.

Effect of a variable hepatic insulin clearance on the postprandial insulin profile: insights from a model simulation study.

The liver plays a pivotal role in determining postprandial insulin levels because it is responsible for the extraction of a large (approximately 50%) fraction of the newly secreted insulin by the pancreas. Evidence exists that hepatic insulin extraction is not constant during a meal, but is inhibited because of saturable receptor-mediated mechanisms and/or increase in hepatic blood flow. The aim of the present study was to exploit the ability of mathematical model simulation to shed light on the role of a variable hepatic insulin extraction during a meal. Mathematical models of insulin secretion and kinetics were coupled to provide predictions for the concentration of insulin in plasma following a meal under the assumptions of either a constant or a time-varying hepatic insulin clearance. Our results indicate that a 20% inhibition in hepatic clearance is able to remarkably enhance the plasma insulin level following a meal. These results emphasise the need for simple and accurate methods to measure the time course of hepatic insulin extraction under nonsteady-state conditions.

Natural occurrence of the diamond hexagonal structure in silicon nanowires grown by a plasma-assisted vapour-liquid-solid method.

Silicon nanowires have been grown by a plasma-assisted vapour-liquid-solid method using tin as the catalyst. Transmission electron microscopy in the [12[combining macron]10] zone axis shows that the diamond hexagonal (P63/mmc) crystal structure is present in several nanowires. This is the first unambiguous proof of the natural occurrence of this metastable phase to our knowledge.

Synthesis engineering of iron oxide raspberry-shaped nanostructures.

Magnetic porous nanostructures consisting of oriented aggregates of iron oxide nanocrystals display very interesting properties such as a lower oxidation state of magnetite, and enhanced saturation magnetization in comparison with individual nanoparticles of similar sizes and porosity. However, the formation mechanism of these promising nanostructures is not well understood, which hampers the fine tuning of their magnetic properties, for instance by doping them with other elements. Therefore the formation mechanism of porous raspberry shaped nanostructures (RSNs) synthesized by a one-pot polyol solvothermal method has been investigated in detail from the early stages by using a wide panel of characterization techniques, and especially by performing original in situ HR-TEM studies in temperature. A time-resolved study showed the intermediate formation of an amorphous iron alkoxide phase with a plate-like lamellar structure (PLS). Then, the fine investigation of PLS transformation upon heating up to 500 °C confirmed that the synthesis of RSNs involves two iron precursors: the starting one (hydrated iron chlorides) and the in situ formed iron alkoxide precursor which decomposes with time and heating and contributes to the growth step of nanostructures. Such an understanding of the formation mechanism of RSNs is necessary to envision efficient and rational enhancement of their magnetic properties.

A comparative study of the efficacy of long-term treatment with escitalopram and paroxetine in severely depressed patients.

OBJECTIVE: This randomised, double-blind, fixed-dose study evaluated the efficacy of escitalopram and paroxetine in the long-term treatment of severely depressed patients with major depressive disorder (MDD). RESEARCH DESIGN AND METHODS: Patients with a primary diagnosis of MDD and baseline Montgomery-Asberg Depression Rating Scale (MADRS) >or= 30 were randomised to 24 weeks of double-blind treatment with fixed doses of either escitalopram (20 mg) (n = 232) or paroxetine (40 mg) (n = 227). The primary analysis of efficacy was an analysis of covariance (ANCOVA) of change from baseline to endpoint (Week 24) in MADRS total score (last observation carried forward, LOCF). MAIN OUTCOME MEASURES; RESULTS: At endpoint (24 weeks), the mean change from baseline in MADRS total score was -25.2 for patients treated with escitalopram (n = 228) and -23.1 for patients with paroxetine (n = 223), resulting in a difference of 2.1 points (p < 0.05). The difference in the change in the MADRS total score (LOCF) was significantly in favour of escitalopram from Week 8 onwards. The proportion of remitters (MADRS or= 35), there was a difference of 3.4 points at endpoint in the MADRS total score in favour of escitalopram (p < 0.05). The overall withdrawal rate for patients treated with escitalopram (19%) was significantly lower than with paroxetine (32%) (p < 0.01). The withdrawal rate due to adverse events was significantly lower for escitalopram (8%) compared to paroxetine (16%) (p < 0.05). There were no significant differences in the incidence of individual adverse events during treatment. CONCLUSION: Escitalopram is significantly more effective than paroxetine in the long-term treatment of severely depressed patients.

Clinical and Pathological Analysis of Two Cases of Cutaneous Malignant Melanoma.

The purpose of this study was the clinical and histo-immunohistochemical analysis of two cases: a cutaneous pigmented facial malignant melanoma and a lumbar congenital nevus with malignant transformation. A series of clinical elements raised the suspicion of some malignant melanocytic lesions and the histopathological analysis through the paraffin embedding technique confirmed the clinical suspicion. The immunohistochemical analysis using the streptavidin-biotin-peroxydase method of the facial malignant melanoma showed: S100 protein intense and diffuse positive, Tyrosinase diffuse positive, HMB45 strong and focal positive, Cyclin D1 positive in approximately 40% and Ki-67 positive in almost 70% of the tumor cells. The malignant melanoma developed on the nevocellular nevus displayed: S100 protein intense and diffuse positive, both in the nevus cells and in the malignant melanocytes as well, Tyrosinase intense and diffuse positive in the malignant melanocytes, poor and focal positive in the nevus cells and HMB45 intense and focal positive in the malignant cells and positive in the isolated nevus cells. Cyclin D1 was positive in about 70% of the malignant cells, but negative in the nevus area and Ki-67 was found positive in relatively 30% of the malignant melanocytes, also in less than 1% of the nevus cells. The pattern and the intensity of the Tyrosinase and HMB45 immunoexpression are important in the differentiation of the nevus cells from the malignant melanocytic cells. The immunoexpression of Cyclin D1 does not correlate directly with the proliferating activity of the malignant melanocytic cells in all types of malignant melanomas.

[Therapeutic options in locally advanced breast cancers]. / Optiuni terapeutice în cancerele mamare avansate local.

The authors are showing their experience on 394 locally advanced breast cancer in the last 10 years. In this trial were included the tumours larger than 5 cm, multiple tumours, tumours invading the skin or the thoracic wall with invaded or fixed axillary or supraclavicular nodes and acute carcinomatous mastitis. The optional therapeutic schedule was modified upon the stage. It consisted in pre- or postoperative radiotherapy, polychemotherapy or polychemo- or radiotherapy alone, associated with nonspecific immunotherapy and hormonotherapy. In patients with complex treatment the survival rate was 45.4% at 5 years and 12.3% at 10 years. The authors highlight the importance of the surgical treatment which offer a big potential in the context of the complex treatment.

[Therapeutic strategy in breast cancer]. / Strategia terapeutica în cancerul mamar.

The authors present the actual concepts of the therapeutic strategy for the breast cancer. The choice of the optimal protocol treatment is based on a complete and correct pretherapeutic evaluation. This implies the staging using TNM/ UICC/ 1987 system (explained in the text) and the definition of the prognostic factors: axillary lymph node involvement, other pathological patterns, the situation of the hormonal receptors and the cell proliferation index. For the stages I-II the strategy of the treatment include: modified radical mastectomy, postoperative irradiation in well defined cases and the adjuvant systemic treatment using chemotherapy and hormonal therapy. The laparoscopic ovariectomy is a safe and simple technique. For the local advanced cancer (IIIA and IIIB) the treatment begins with a systemic aggressive approach, the surgery being applied following the tumoral regression. In the stage IV the complex palliative treatment is indicated.

[Strategy and tactic in the treatment of local advanced rectal cancer]. / Strategie si tactica în tratamentul cancerului rectal local avansat.

In local advanced rectal cancer (LARC) was defined at the work group in rectal cancer as a tumour what invade the serosa or neighbouring organs, associated with invaded perirectal or mezorectal nodes, with internal fistulae, peritoneal carcinomatosis and locoregional recidives. On a trial of 97 patients, the authors present personal experience, in comparison with literature data regarding therapeutic strategy and tactic of parameters: operability and the moment of operation, indication of preoperative radiotherapy, the type of operation, excision of the metastasis, adjuvant therapy and attitude of locoregional recidives. The survival of the patients was 21.6% at 3 years and 15.4% at 5 years.

[Vulvar cancer. The therapeutic aspects]. / Cancerul vulvar. aspecte terapeutice.

Even though it has a low frequency (4 - 5%) compared to genital cancers, it has certain biological features represented by the possibility of multicentric localisation what performs on the dystrophic lesions, the presence of the inguinal nodes, the sensibility of the irradiation of the cancer and nodes and the efficacity of the treatment of the treatment of the bleomicine which request many therapeutical problems. Between 1985-1994, in Coltea Surgery Clinic there were operated 13 vulvar carcinoma, in women between 45-69 years old, in stages II (6), III (4) and IV b (3). Primary lesion was on labia major (11), labia minor (1) and posterior fourchette (1). Preoperative radiotherapy was made in 9 patients. At 3 patients, valvar lesion represents the second cancer--in all cases were syndrome neoplasia, after cervix neoplasia (2) or ano-rectal neoplasia (1) which were operated. At histopathological exam all cancers were spinocellular epithelium keratosis in 10, non-keratosis in 2 or trabecular in 1. The surgical treatment was selective and consisted in total vulvectomy (9), vulvectomy with inguinal lymphadenectomy (3) and left colostomy (1) after ano-rectal invasions and intestinal obstruction. The postoperative mortality and complications were zero. Postoperative treatment consisted in radiotherapy in association with chemotherapy 93) or only chemotherapy (8). The survival rates at 3 years (2), 5 years (30, 7 years) (3) and 10 years (2), justify the complex treatment. In conclusion, vulvectomy represents the specific treatment associated with inguinal lymphadenectomy in case of lymph nodes metastasis. Postoperative radiotherapy and postoperative chemotherapy seem to increase the survival rate.

[The therapeutical strategy for locally advanced breast cancer]. / Strategia terapeutica în cancerul mamar local avansat (C.M.L.A.).

As for the other cancers, the strategy of therapy of breast cancers is going to a unitary standardization. In our department between 1984-1999 we are operated 1040 patients with breast cancers, which means 25.3% of all cancers treated. 688 (64.3%) were CMLA, 646 (96.7%) of them were in patients women and 22 (3.3%) men. The mean age was 52.4 years (3-84 years). All patients were divided into two trials and analyzed: retrospectively (A) 312 (46.7%) and prospectively (B) 356 (53.3%) patients, 51.2% of patients was in III and IV TNM stage. The patients from trial B were treated concerning with specific therapeutically protocol, adapted by age, anatomopathological form, volume of tumor, skin or thoracic wall invasion, inflammatory lesions, lymph node invasion and physiological period. The results were: the increase of number of radical surgical interventions, the decrease of the morbidity, the increase of survival and a better quality of life.

[Considerations on 988 breast cancers]. / Consideratii pe 988 cancere de sân.

AIM: Therapy schedule improvement. MATERIAL & METHOD: The study includes 988 patients (which 16 men) with breast cancer who underwent surgery between 1984-1998. Out of them 63.2% were in advanced stages. The patients were divided in 2 homogenous groups: trial A = 520 patients treated between 1984-1991 (in stade: I = 2, II = 240, III = 246, IV = 32) studied retrospectively, and trial B = 468 patients treated between 1992-1998 (in stade I = 3, II = 212, III = 235, IV = 18) studied prospectively. In trial B the complex therapy schedule was improved according to disease's stade, local breast aspect and patient's biological status, straining on neoadjuvant therapy. To the entire group 945 radical mastectomies (95.6%) were performed. Only 628 (63.5%) could be properly followed up. RESULTS: Global 5 years survival rate was 72% (improved from 69% in trial A to 72% in trial B). The survival rate varied according the stage from 100% (stade I), 88% (stade II), to 22% (stade III) and 2% (stade IV). In the advanced states, the local recurrencies at 5 years were of 22% and the methastases of 17%. CONCLUSIONS: The neoadjuvant therapy, selectively applied upon stade and patient improves the 5 year survival rate. Every patient with an advanced breast cancer can benefit of a complex, differentiated and well guided treatment. The adequate operation earn the important role in powering the neoadjuvant and adjuvant therapies. Further results improvement requires restarting the collectivities and high risk persons screening.

A 3D insight on the catalytic nanostructuration of few-layer graphene.

The catalytic cutting of few-layer graphene is nowadays a hot topic in materials research due to its potential applications in the catalysis field and the graphene nanoribbons fabrication. We show here a 3D analysis of the nanostructuration of few-layer graphene by iron-based nanoparticles under hydrogen flow. The nanoparticles located at the edges or attached to the steps on the FLG sheets create trenches and tunnels with orientations, lengths and morphologies defined by the crystallography and the topography of the carbon substrate. The cross-sectional analysis of the 3D volumes highlights the role of the active nanoparticle identity on the trench size and shape, with emphasis on the topographical stability of the basal planes within the resulting trenches and channels, no matter the obstacle encountered. The actual study gives a deep insight on the impact of nanoparticles morphology and support topography on the 3D character of nanostructures built up by catalytic cutting.

Structural transitions at the nanoscale: the example of palladium phosphides synthesized from white phosphorus.

Stoichiometric reactions of Pd(0) nanoparticles with various amounts of white phosphorus (P4) are an efficient route to convert them into the corresponding Pd phosphides Pd(x)P(y). Formation of crystallized palladium phosphide nanoparticles is a two-step process, which allows exploring in detail the phase transitions of the Pd(x)P(y) system, from amorphous Pd-P nanoparticles (formed in a first step at moderate temperature) to crystallization (at higher temperature). The second temperature was found to be strongly dependent on the Pd/P ratio: PdP2, Pd5P2 and Pd3P stoichiometries form the amorphous phases, but only PdP2 and Pd5P2 could be further crystallized from them. Although it exists as a bulk crystalline material, Pd3P could only be crystallized by starting from the more Pd-rich Pd6P composition. Phase-to-phase transformations from P-poor phosphides (Pd3P and Pd5P2) to the P-rich PdP2 were also demonstrated, and a first Pd-P phase diagram at the nanoscale was tentatively produced.

A comparative study of the efficacy of acute and continuation treatment with escitalopram versus duloxetine in patients with major depressive disorder.

OBJECTIVE: This study evaluated the efficacy and tolerability of escitalopram and duloxetine in the treatment of major depressive disorder (MDD). RESEARCH DESIGN AND METHODS: Patients were randomised to 24 weeks of double-blind treatment with fixed doses of escitalopram (20 mg) (n = 143) or duloxetine (60 mg) (n = 151). The primary analysis of efficacy was an analysis of covariance (ANCOVA) of change from baseline to endpoint (week 24) in MADRS total score (last observation carried forward). MAIN OUTCOME MEASURES; RESULTS: At week 8, the mean change from baseline in total MADRS score was -19.5 for patients treated with escitalopram (n = 141) and -17.4 for patients treated with duloxetine (n = 146), a difference of 2.1 points (p < 0.05). At week 8, the proportion of responders (> or = 50% decrease in MADRS) was 69% (escitalopram) and 58% (duloxetine) (p < 0.05) and remission (MADRS < or = 12) rates were 56% (escitalopram) and 48% (duloxetine) (NS). For the primary endpoint, the mean change from baseline in total MADRS score at week 24 was -23.4 for patients treated with escitalopram and -21.7 for patients treated with duloxetine, a difference of 1.7 points (p = 0.055, one-sided). The difference in mean change from baseline in MADRS total score favoured escitalopram at weeks 1, 2, 4, 8, 12 and 16 (p < 0.05). The overall withdrawal rates were 22% (escitalopram) and 25% (duloxetine) (NS). The withdrawal rate due to adverse events was lower for escitalopram (9%) compared to duloxetine (17%) (p < 0.05) and significantly more patients treated with duloxetine reported insomnia (12.6% vs. 4.9%) and constipation (8.6% vs. 2.8%). CONCLUSION: Escitalopram was superior to duloxetine in acute treatment and at least as efficacious and better tolerated in long-term treatment of MDD.

[Adult onset Still's disease with normal level of serum ferritin]. / Boala Still a adultului cu manifestari aterosclerotice sistemice severe.

We present a case of an adult onset Still's disease: a 51 year old men presented with one month history of high spiking fever, asymmetric migratory polyarthritis and a previous history of pharyngitis. The diagnostic was based upon clinical criteria and laboratory findings, and necessitated the exclusion of infectious, neoplastic, and other "autoimmune" disease. The systemic involvement in our case induced us to comment therapy with corticosteroid. Patients with systemic disease have a favorable prognosis, with only rare serious complications from the disease (pericarditis, tamponade, diffuse intravascular coagulation, amyloidosis, hepatic disease, and respiratory failure) or the treatment (infections, gastrointestinal bleeding etc.).

Growth hormone release by glycine injected intravenously in 22 healthy sexually immature children.

A solution of 10% glycine (250 mg/kg of body weight) was injected in within 5-10 minutes in 22 healthy, sexually immature children who were previously tested for insulin-induced hypoglycemia. Blood specimens were collected before, 10, 30, 60 and 120 minutes after injection for glucose, HGH and total alpha-amino nitrogen determination. The mean peak post-glycine level of serum HGH was 11.47 +/- 1.558 ng/ml (+/- SEM) and did not differ significantly from the corresponding post-insulin mean value (15.63 +/- 0.247 ng/ml). The highest post-stimulatory mean value (8.88 +/- 1.694 ng/ml) was observed 30 minutes after the end of the injection of glycine. Glycine is a reliable GH stimulating agent, which may be tentatively used for detection of hyposomatotropism in children.

Mild stimulation of serum immunoreactive insulin (IRI) release following large doses of intravenously given glycine to children of normal pituitary function.

In healthy, sexually immature children of both sexes serum IRI levels rose more than expected from random inter-individual variation (i.e. more than 3 standard deviations of the basal level) in 10 out of 21 subjects loaded by glycine. The IRI release by glycine though moderate and not constant is, however, unquestionable. The growth hormone (GH) secretory response to glycine did not change according to the occurrence and/or magnitude of IRI release. It was concluded that GH and IRI stimulatory properties of glycine given intravenously in large doses are completely unrelated.

Release of growth hormone, prolactin, LH, FSH and IRI in serum through orally administered 1-proline in high dosage.

Orally given 1-proline in high dosage (500 mg/kg b.w.) resulted in growth hormone (GH) release in 9 healthy, sexually immature children investigated (5 boys and 4 girls). A slight, unsignificant decrease of the mean prolactin level was also noted. Serum immunoreactive insulin (IRI), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) concentrations in serum were not influenced. The possible use of proline loading in high dosage for the detection of GH deficiency especially in small children and in infants is suggested.