Infected hip prosthesis in patient with suspected Covid-19 infection.

BACKGROUND: Infections following arthroplasty are one of the major risks during this type of surgery. Moreover, the outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus Disease 2), has developed into an unprecedented pandemic, posing enormous pressure on health-care providers around the world. CASE PRESENTATION: Four and half years after right hip arthroplasty, the patient came back to our attention with pain at the same hip. The instrumental examinations showed signs of cup detachment. After carefully analyzing the case, we decided to perform a sterile aspiration of the hip in the operating room under C-arm fluoroscopy. Microbiological examinations showed positivity for E. coli. The patient underwent surgery by which the prosthesis was removed and a spacer was implanted. A therapy with Cefotaxim 2 g three times a day for 6 weeks was then set, and then a total arthroplasty was performed. During this period, the COVID-19 pandemic occurred and therefore the patient received nasal-throat swabbing two times, and both yielded negative results. However, 1 week after the final surgery, his respiratory conditions deteriorated and chest X-ray and CT scan showed images of ground-glass opacification patterns (GGO). Due to the clinical symptoms and the characteristic images of the instrumental examinations, the patient was transferred to an observation ward. Thereafter, two more swab tests gave negative results. The patient was then transferred to the ward for patients with typical symptoms of COVID-19 but with negative swab tests for 2 weeks and was subsequently discharged home. CONCLUSION: The purpose of this case report was to point out the correct treatment of a PJI after the outbreak of COVID-19. Despite the ongoing COVID-19 pandemic, the guidelines in the case of periprosthetic hip infection further confirmed the correct management of the patient.

Effects of ultrasound and selenium on human neurons in vitro.

As the effects of ultrasound on human brain functions might bear therapeutic potential, in this study, we examined the effects of diagnostic, i.e. non-thermal, ultrasound, on morphology, networking, and metabolic activity of SH- SY5Y human neurons in culture, as well as on the expression of GAP-43, Hsp90 and VEGF proteins, with and without selenium in the culture medium. The rationale for studying selenium lays in the observation that selenium improves functional neurologic outcome in traumatic brain injury and, therefore, analysis of the interactions between ultrasound and selenium may be of clinical interest. In the presence of selenium, ultrasound increased the overall number and length of elongations arising from the neuron bodies, thus reflecting an increase in the complexity of neuronal networks and circuits. The expression of GAP-43, Hsp90 and VEGF and metabolic activity of SH-SY5Y neurons, studied as markers of cell damage, were not affected by ultrasound or selenium. This study suggests that ultrasound may modulate neuronal networking in vitro without inducing cellular or molecular damage and highlights the potential role of selenium in the ultrasound-elicited cellular responses.

JNCC guidelines for minimising the risk of injury and disturbance to marine mammals from seismic surveys: We can do better.

The U.K.'s Joint Nature Conservation Committee 1998 guidelines for minimising acoustic impacts from seismic surveys on marine mammals were the first of their kind. Covering both planning and operations, they included various measures for reducing the potential for damaging hearing - an appropriate focus at the time. Since introduction, the guidelines have been criticised for, among other things: the arbitrarily-sized safety zones; the lack of shut-down provisions; the use of mitigation measures that introduce more noise into the environment (e.g., soft-starts); inadequate observer training; and the lack of standardised data collection protocols. Despite the concerns, the guidelines have remained largely unchanged. Moreover, increasing scientific recognition of the scope and magnitude of non-injurious impacts of sound on marine life has become much more widespread since the last revisions in 2010. Accordingly, here we present feasible and realistic recommendations for such improvements, in light of the current state of knowledge.

Morphological analysis of neurons: Automatic identification of elongations.

Our study is focused on the development of a new method for the automatic analysis of cell images. We focused on neurons (cells line SH-SY5Y) treated/untreated with ultrasound and stained with Haematoxylin-Eosin. The aim of the algorithm is the automatic detection of the cell body as well as the determination of the number and the length of neuron elongations. Starting point of the algorithm was the convolution of an image with a bank of rotating Gaussian kernels and the construction of a module map. Then several strategies were implemented to detect cell bodies and to detect and extract data about cell elongations. We have also realized a graphical user interface allowing the loading, saving and processing of images. Results show that this method is able to properly and efficiently detect cell contours and elongations. The automated evaluation is in strong agreement with manual evaluation performed by an expert operator, with an average error of 11% with most parameter combinations. This tool constitutes an important support in biological research activities, where operators need to analyze a large number of images to investigate about cell morphology before and after a treatment.

Obstetric implications of fetal inherited thrombophilia in thrombophilic women.

OBJECTIVES: The relationship between fetal thrombophilic polymorphism and adverse pregnancy outcomes is still unclear. The aim of this study is to evaluate if fetal thrombophilia may affect obstetric and perinatal outcomes in thrombophilic women. STUDY DESIGN: From 2007 to 2011 all patients with a known inherited thrombophilic mutation consecutively admitted to our labor ward at ⩾25weeks of gestation with a singleton viable pregnancy were considered eligible for the purpose of the study. At the age of 1year, the infants were tested for inherited thrombophilic mutations. Patients were then divided into two groups according to the presence or absence of any neonatal mutation. MAIN OUTCOME MEASURES: The following outcome variables were then compared between the two groups: gestational age at delivery, birth weight, incidence of hypertensive disorders of pregnancy and SGA neonates. RESULTS: Overall, 67 pregnancies of 49 women were studied. Among them, the G20210A Prothrombin (32/67 or 47.7%) mutation and the Factor V Leiden mutation (31/67 or 46.3%) were the commonest findings, with a single patient presenting both. A thrombophilic mutation was found in 38 mother-infant pairs. The risk of all maternal and perinatal events including the incidence of hypertensive disorders disorders (5/29 or 17.2% vs 6/38 or 15.7% p=1.00) and of SGA neonates (3/29 or 10.3% vs 7/38 or 18.4%, p=0.49) was comparable between the two groups irrespective of the associated fetal thrombophilia. CONCLUSIONS: Our data suggest that women with inherited thrombophilia carrying a thrombophilic fetus are not at increased risk of adverse pregnancy outcomes.

Applicability of a new robotic walking aid in a patient with cerebral palsy. Case report.

BACKGROUND: Gait training with the help of assistive technological devices is an innovative field of research in neurological rehabilitation. Most of the available gait training devices do not allow free movement in the environment, which would be the most suitable natural and motivating condition for training children with neurological gait impairment. AIM: To evaluate the potential applicability of a new robotic walking aid as a tool for gait training in non-ambulatory children with Cerebral Palsy. DESIGN: Single case study SETTING: Outpatient regimen POPULATION: A 11-years-old child unable to stand and walk independently as a result of spastic tetraplegic cerebral palsy (CP). METHODS: The experimental device was a newly actuated version of a dynamic combined walking and standing aid (NF-Walker®) available in the market which was modified by means of two pneumatic artificial muscles driven by a foot-switch inserted in the shoes. The child was tested at baseline (while maintaining the standing position aided by the non-actuated NF-Walker®) and in the experimental condition (while using the actuated robotic aid). The outcome measures were: 2-minute walking test, 10-metre walking test, respiratory and heart parameters, energy cost of locomotion. RESULTS: At baseline, the child was unable to perform any autonomous form of locomotion. When assisted by the actuated aid (i.e. during the experimental condition), the child was successful in moving around in his environment. His performance was 19.63 m in the 2-minute walking test and 64 s in the 10-metre walking test. Respiratory and heart parameters were higher than healthy age-matched children both at baseline and in the experimental condition. The energy cost of gait, which was not valuable in the baseline condition, was significantly higher than normality during the experimental condition. CONCLUSION: The new robotic walking aid may help children suffering from CP with severe impairment of gait to move around in their environment. CLINICAL REHABILITATION IMPACT: This new robotic walking device may have a potential impact in stimulating the development and in training of gait in children with neurological gait impairment. Future studies are warranted in order to test this hypothesis.

The new potential invader Linopherus canariensis (Polychaeta: Amphinomidae) in a Mediterranean coastal lake: colonization dynamics and morphological remarks.

The newly introduced polychaete Linopherus canariensis Langerhans, 1881 was found in the Lake of Faro (NE Sicily), during a study comparing the macrobenthos in artificial modules with a neighboring sandy bottom assemblage. Of a total of 4465 specimens, almost 6% showed morphological variation related to branchial turfs and mean body size. The sandy bottom exhibited an average density of 41.86 ind L⁻¹ and a wet biomass of 30.35 mg L⁻¹, whereas the artificial substratum reached levels of 205.29 ind L⁻¹ and 318.44 mg L⁻¹. The highest estimated immigration rate was 3.7 ind L⁻¹d⁻¹ (5.8 mg L⁻¹ d⁻¹). In the artificial microhabitat, 0.4% of the population showed mid-anterior fragmentation, with anterior- (2%), mid- (< 1%) and posterior- (1%) regenerating lineages, which contributed significantly to the dispersion ability of this species. L. canariensis was a selective micro-deposit feeder, even under conditions of reduced sediments. Linopherus was found to be a new potential invader of stressed environments that is probably tied to the import of oysters.

Expression of SPANX proteins in normal prostatic tissue and in prostate cancer.

The sperm protein associated with the nucleus in the X chromosome (SPANX) gene family encode for proteins that are not only expressed in germ cells, but also in a number of tumors. In addition, SPANX genes map in an interval of the X chromosome (namely, Xq27), which has been found to be associated with familial prostate cancer by linkage analysis. The aim of this study was therefore to evaluate SPANX protein expression in normal prostate tissues and in prostate carcinoma. For this purpose, formalin-fixed and paraffin-embedded sections obtained from 15 normal (at autopsy) donors and 12 men with prostate cancer were analyzed by immunohistochemistry. About 40% of both normal and tumor prostate samples resulted SPANX positive. Signals were exclusively with the nucleus in normal prostate cells, whereas both nuclear and cytoplasmic positivity was observed in tumor cells. In conclusion, these findings showed that SPANX genes are expressed in both normal and tumor prostate gland, but the latter showed a peculiar cytoplasmic staining positivity. This suggests a possible association between SPANX over expression and prostate cancer development. Additional studies are needed to corroborate this hypothesis.

Neutron back scattering for the search of the Battle of Anghiari.

The 'Battle of Anghiari' is a wall painting made by Leonardo Da Vinci around 1505. Its present day location is unknown but some indications suggest that the mural might be concealed behind a brick wall. Test measurements are presented demonstrating that neutron back scattering (NBS) can be used to search through the wall for the painting. NBS is a non-destructive technique to establish the presence of the hydrogen contained in the painting materials that were probably used by Da Vinci.

A modified constraint-induced movement therapy (CIT) program improves paretic arm use and function in children with cerebral palsy.

AIM: Constraint-induced movement therapy (CIT) is a rehabilitation intervention put forward by Taub and colleagues for sensorimotor disorders in children with hemiparesis, comprising consisting of the restraint of the unaffected arm and concurrent intensive training of the affected arm for six hours/day for two weeks. The aim of this study was to evaluate the effectiveness of a modified CIT program (mCIT) characterized by restraining the unaffected hand with a cotton mitten during daily activities and a reduced intensity training program for two h/week for five weeks. METHODS: Ten children (age: 1-9 years) with hemiparetic cerebral palsy were enrolled in a randomized, cross-over study in which the effects of a mCIT and a conventional physiotherapy program were compared. The amount of use and the functional performance of the affected arm were evaluated by means of two specifically devised tests (Use and Function Test). A further test evaluated functional performance during bimanual tasks. These measures showed a good inter-rater and inter-session reliability. All tests were administered before, at the end and four weeks after treatment. RESULTS: Significant differences between the two therapeutic approaches were evidenced in both affected arm use (P=0.008) and function (P=0.018). These improvements maintained at the follow-up (Use Test P=0.07; paretic arm function P=0.012). Bimanual function performance showed a trend towards improvement in both post-treatment and follow-up testing. The conventional physiotherapy group did not show any improvement in any outcome measure. CONCLUSIONS: The mCIT program proposed in the present study showed to be a promising rehabilitative procedure in children with congenital arm paresis after cerebral palsy.

Evaluación de un programa integral de tratamiento de obesidad y sobrepeso en niños escolares y adolescentes en Santiago de Chile (1999-2006) / Assessment of a multidisciplinary program for the treatment of obesity in children

Background: Medical treatment of obesity requires a multidisciplinary approach including dietary, exercise and behavioral interventions. Aim: To report the results of a multidisciplinary program for the treatment of obesity in children. Patients and Methods: Three hundred twenty four children (155 males), aged between 5 and 18 year, were treated with diet, exercise and behavioral modification, between 1999 and 2006. At baseline and at the end of follow up, weight, height, z score for body mass index (BMI), blood pressure and features of the metabolic syndrome were assessed. Results: z scores for IMC decreased by 0.28 points (95 percent confidence intervals: -0.31 to -0.25). Sixty percent of patients achieved a weight reduction of 5 percent of more of their initial weight. In a multiple linear regression model, weight loss was directly associated with the follow up time and inversely associated with the initial waist circumference. Patients had a reduction of 0.05 z score points of BMI per month (95 percent confidence intervals –0.07 to –0.025; p < 0.001), while adhering to the program. The overall compliance with the three months treatment period was 59 percent. Conclusions: In children and teenagers, a multidisciplinary management of obesity achieves a sustained weight loss, that ifs proportional to the lapse of adherence to the program.

Rehabilitation of limb apraxia improves daily life activities in patients with stroke.

We randomly assigned 33 patients with left hemisphere stroke, limb apraxia, and aphasia to an apraxia or a control (aphasia) treatment group. Before and after each treatment, patients underwent a comprehensive neuropsychological testing battery and a caregiver evaluation of patient's activities of daily life (ADL) independence. Apraxia severity was related with ADL independence. Control (aphasia) treatment improved patients' language and intelligence performance. Apraxia treatment specifically improved praxic function and ADL.

Male and female rural probationers: HIV risk behaviors and knowledge.

Individuals involved in the criminal justice system are at substantial risk for HIV infection and have elevated rates of AIDS. Offenders under community supervision, such as probationers, have substantially more opportunities to engage in high-risk behaviors than prisoners. Furthermore, probationers in rural areas are at risk because rural areas may be slower to adopt HIV risk-reduction approaches. Consequently, the primary goal of this study is to describe the HIV risk behaviors and level of HIV knowledge of 800 rural felony probationers. Bivariate results indicate that males have substantially greater criminal histories and engage in more substance use risk behaviors than females. Overall, there was minimal and inconsistent use of condoms, but there were no significant differences by gender. Gender differences prevailed in perceived HIV knowledge, with females reporting high levels of perceived HIV knowledge. Multivariate models did not support the hypothesis that perceived knowledge would be a more robust correlate of scores on the HIV Risk Behavior Knowledge Test for males than females. Results suggest that rural residents are not protected from engaging in HIV risk behaviors and future studies should examine gender discrepancies between perceived and actual HIV knowledge among offenders under community supervision.

Early and delayed orthotic treatment in congenital metatarsus varus: effectiveness of two types of orthoses.

AIM: The aim of this study was to evaluate the effectiveness of early or delayed orthotic treatment of congenital metatarsus varus and evaluate the efficacy of static vs dynamic anti-varus orthosis. METHODS: Twenty-five children (14 males, 11 females), of 81.3 days of age (range 1-189) (41 feet affected) were selected among 88 patients referred to our rehabilitation department for foot deformity. Children were assigned to 1 of 2 groups (dynamic or static orthosis) according to a simple randomization scheme. Patients were evaluated at diagnosis (T1), at the end of treatment (T2) and at a follow-up performed at least 2 years after the end of treatment (T3). Primary outcome was measured using the Bleck scale. The IOWA functional rating system questionnaire was performed at follow up evaluation. RESULTS: The Bleck scale showed that both static and dynamic orthoses were effective and that the best results were achieved with early treatment. The IOWA questionnaire showed that no child had residual deformities that interfered with daily activities. Nonetheless, the dynamic orthosis group had better scores in 4 sub-items related to parental satisfaction, foot function, heel position, and foot passive motion. CONCLUSIONS: Both static and dynamic orthoses are useful for correction of congenital metatarsus varus. Optimal results are achieved with early treatment.

Association of MHC Class I chain-related A (MIC-A) gene polymorphism with Type I diabetes.

AIMS/HYPOTHESIS: A distinct family of MHC genes has been identified in the class III region and denominated MHC Class I chain-related genes (MIC). The MIC-A gene is located between the TNFA and the HLA-B genes. The aim of our study was to test the association of the polymorphism of the MIC-A gene with Type I (insulin-dependent) diabetes mellitus and evaluate the interaction between MIC-A and TNFA, HLA-B, HLA-DR and HLA-DQ gene polymorphism. METHODS: Type I diabetic (n =95) and healthy (n = 98) Italian subjects were typed for exon 5 of MIC-A and for HLA-DRB1, HLA-DQA1, HLA-DQB1 and TNFA alleles. All subjects were also typed for the presence of HLA-B8 or HLA-B15. RESULTS: The frequency of MIC-A5 was increased in diabetic subjects (53 % vs 15 %) (OR = 6.1) (corrected p, p(c) < 0.0005). Among HLA class II haplotypes, both HLA-DRB1*03-DQA1*0501-DQB1*0201 (DR3-DQ2) and DRB1*04-DQA1*0301-DQB1*0302 (DR4-DQ8) ("at-risk class II haplotypes") were positively associated with diabetes (OR = 6.7 and 6.0, respectively) (p(c) < 0.003). Also HLA-B8 was more frequent among Type I diabetic subjects than among healthy control subjects (OR = 2.8, p = 0.01). None of the TNFA alleles were statistically significantly associated with Type I diabetes. The MIC-A5 exon was negatively associated with age at clinical onset of diabetes (p = 0.012). Thus, 68 % diabetic subjects younger than 25 years and 29 % older than 25 years were carrying this allele. Both MIC-A5 and the at-risk class II haplotypes were independently associated with Type I diabetes and the combined association of the two markers had the highest relative risk (OR = 172). In subjects younger than 25 years, the OR of MIC-A5 was as high as 21.7 and was more than twofold that of at-risk class II haplotypes (OR = 9.5). The MIC-A5 exon was not in linkage disequilibrium with any of the HLA-class I, class II or TNFA alleles studied. CONCLUSIONS/INTERPRETATION: The MIC-A gene polymorphism is associated with genetic risk for Type I diabetes and the combination of MIC-A5 and at-risk class II haplotypes is now to be seen as the strongest genetic marker for this disease.

Determination of enteroviruses, hepatitis A virus, bacteriophages and Escherichia coli in Adriatic Sea mussels.

The aim of the present study was to evaluate the incidence of enteric viruses in mussels and to verify the possibility of using phages as indirect indicators of mussel viral contamination. Mussels (36 samples) collected from three different areas of the Adriatic Sea were analysed to determine the following parameters: Escherichia coli, somatic coliphage (T6 phage), F-Plus (MS2 phage), B40-8 (phage of Bacteroides fragilis), enteroviruses and hepatitis A virus. Most of the results of the bacteriological analysis (most probable number (MPN) ml-1) were in accordance with the bacteriological limits established by European law, with the exception of seven samples. The bacteriophage analyses were always negative for F-Plus and B40-8, with the exception of a few samples, whereas the somatic coliphages were generally between 0 and 20 MPN g-1, with the exception of two samples (110 MPN g-1). The virological analysis showed five samples positive for the presence of enteroviruses and 13 for the presence of hepatitis A virus (in three samples both viruses were present). Most of these samples presented acceptable bacteriological parameters and the bacteriophages were absent or their value was generally very low. The results show that the detection of E. coli and phages does not seem to be a good indicator of viral contamination.

Autoantibodies against recombinant human steroidogenic enzymes 21-hydroxylase, side-chain cleavage and 17alpha-hydroxylase in Addison's disease and autoimmune polyendocrine syndrome type III.

OBJECTIVE: To evaluate the frequency of autoantibodies (Ab) against 21 hydroxylase (21OH), side-chain cleavage (SCC) and 17alpha-hydroxylase (17OH), in Addison's disease (AD) and autoimmune polyendocrine syndrome type III (APSIII). DESIGN AND METHODS: We used radiobinding assays and in vitro translated recombinant human (35)S-21OH, (35)S-SCC or (35)S-17OH and studied serum samples from 29 AD (18 idiopathic, 11 granulomatous) and 18 APSIII (autoimmune thyroid disease plus type 1 diabetes mellitus, without AD) patients. Results were compared with those of adrenocortical autoantibodies obtained with indirect immunofluorescence (ACA-IIF). RESULTS: ACA-IIF were detected in 15/18 (83%) idiopathic and in 1/11 (9%) granulomatous AD subjects. 21OHAb were found in 14/18 (78%) idiopathic and in the same (9%) granulomatous AD subject. A significant positive correlation was shown between ACA-IIF and 21OHAb levels (r(2)=0.56, P<0.02). The concordance rate between the two assays was 83% (24/29) in AD patients. SCCAb were found in 5/18 (28%) idiopathic (4 of whom were also positive for 21OHAb) and in the same (9%) granulomatous AD subject. 17OHAb were found in only 2/18 (11%) idiopathic and none of the granulomatous AD patients. Two APSIII patients were positive for ACA-IIF, but only one was positive for 21OHAb and SCCAb. 17OHAb were found in another two APSIII patients. CONCLUSIONS: Measurement of 21OHAb should be the first step in immune assessment of patients with AD and individuals at risk for adrenal autoimmunity, in addition to ACA-IIF. Due to their low prevalence in AD, measurement of SCCAb and 17OHAb should be indicated only for 21OHAb negative patients and/or for those with premature ovarian failure, regardless of ACA-IIF results.

Autoantibody recognition of COOH-terminal epitopes of GAD65 marks the risk for insulin requirement in adult-onset diabetes mellitus.

Some type 2 diabetic subjects develop secondary failure to sulphonylurea treatment and require insulin therapy. To test the diagnostic sensitivity and specificity of epitopes of GAD65 autoantibodies (GAD65Ab) for insulin requirement, in patients with latent autoimmune diabetes of the adult, we studied 569 adult subjects with a clinical diagnosis of type 2 diabetes mellitus. All the patients had been initially treated with hypoglycemic agents and/or diet for at least 1 yr. The presence of GAD65Ab (61/569, 10.7%) depended on insulin therapy (P<0.0001), low BMI (P<0.0001), and low basal C-peptide (P = 0.01). The majority of GAD65Ab-positive subjects (47/61, 77%) had antibodies directed to both middle (GAD65-MAb) and COOH-terminal (GAD65-CAb) epitopes. However, GAD65-CAb were more frequent in insulin-treated subjects (92% of GAD65Ab+ individuals) than in subjects treated with hypoglycemic agents and/or diet (18.2% of GAD65Ab+ individuals), while the exclusive presence of GAD65-MAb was more frequent in subjects treated with hypoglycemic agents and/or diet (81.8% vs. 8%) (P<0.0001). The presence of GAD65-CAb had a diagnostic specificity for insulin requirement as high as 99.4% (compared with 96.9% of GAD65Ab as measured in the traditional radiobinding assay) and identified a subgroup of patients with low BMI, low basal C-peptide values, and a need for insulin therapy. Subjects carrying only GAD65-MAb were phenotypically indistinguishable from GAD65Ab-negative patients. Patients positive for GAD65-M+CAb, but not those positive for GAD65-MAb only, showed an increased risk for thyroid autoimmunity, as revealed by the presence of thyroid peroxidase autoantibodies. Our study demonstrates that the use of epitope-specific antibody assays improves the diagnostic specificity of GAD65Ab, and that the presence of GAD65Ab binding to COOH-terminal epitopes is strongly associated with a need for insulin requirement.

[An interlaboratory study of the use of PapNet in the quality control of cervico-vaginal cytology]. / Uno studio interlaboratorio sull'impiego di PapNet nel controllo di qualità della citologia cervico/vaginale.

In this feasibility study of the utilization of the PapNet System (Neuromedical Systems, Suffern, NY) for computer-assisted cervical/vaginal cytology diagnosis, a random sample of 329 negative smears and a series of 68 positive smears reported as such by the Caltagirone laboratory, underwent PapNet review at the Imola laboratory. False-positive (FP) cases (smears originally classified as ASCUS, LGSIL, AGUS, e HGSIL and interpreted as negative on PapNet) and false-negative (FN) cases (reverse discrepancies) were further and conventionally re-evaluated by the staff of the originating laboratory. On PapNet review, there were 16/68 FP cases (23.5%) e 20/329 FN cases (6.1%) with a FP:FN rate ratio of 3.8 (95% confidence interval, 2.2-6.3). At final re-examination of these diagnostic errors, most FP cases (14/16) were confirmed as such whereas the FN cases significantly decreased from 20 to 9, with a final rate of 2.7%. As a consequence, the ratio of the FP rate (14/68) to the FN rate (9/329) rose to 7.5 (4.1-12.6). The study suggests one potential approach to the preliminary utilization of PapNet by those laboratories that are interested in this technology. The results are in accordance with those of the previous PapNet review studies which have generally shown a greater frequency of FP cases compared with FN cases.