Risk of recurrent disease following conization of cervical intraepithelial neoplasia grade 3 according to post-conization HPV status and surgical margins.

OBJECTIVE: To examine the absolute risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) following conization according to post-conization HPV status and surgical margins. METHODS: A total of 11,006 women with CIN3 on the cone were followed for up to 14 years using nationwide registries. We estimated absolute risks of recurrent CIN2+ and sensitivity and specificity of HPV testing and margin status in predicting CIN2+ 4 years after conization. RESULTS: Altogether, 2537 women were HPV positive and 8469 were HPV negative. During follow-up, 306 and 140 women were diagnosed with CIN2+ among HPV positive and negative women, respectively. HPV positive women had higher absolute risk of CIN2+ compared to HPV negative women. Specifically, the 8-year absolute risk of CIN2+ was 12.5% (95% CI: 11.2-13.9) for HPV positive women and 1.8% (95%CI: 1.5-2.1) for HPV negative women. Among HPV negative women, the 8-year absolute risk was 2.7% (95%CI: 2.1-3.5) and 1.3% (95%CI: 1.0-1.7) for women with positive and negative margins, respectively. The same pattern was seen among HPV positive women. Combined testing with HPV and margins had a higher sensitivity but lower specificity than HPV testing alone. CONCLUSION: Our results add knowledge on long-term risk assessment of women treated with conization as taking both HPV and margin status into account added further stratification of the risk of recurrent disease compared to HPV status alone. Additionally, combined testing with HPV and margin status had higher sensitivity than HPV testing alone, which is important in high-risk populations, however, the specificity was lower.

[Nationwide survey of postgraduate medical training in clinical neurology]. / Deutschlandweite Evaluation der ärztlichen Weiterbildung in der klinischen Neurologie.

BACKGROUND: Currently, no data are available, which reflect the situation of medical doctors specializing in neurology in German hospitals. In order to secure the high standard of neurological patient care it is essential to evaluate the working conditions and the specialty training in neurology. OBJECTIVE: This nationwide survey was conducted throughout Germany with the aim to address problems and to give suggestions for improvements in neurological training curricula. MATERIAL AND METHODS: The survey was online from February to May 2017 and 953 neurologists undergoing further training participated. RESULTS: More than half of the young neurologists were satisfied with their medical training. One of the main problems that complicates clinical training is the workload. In addition, organizational obstacles within the clinic, such as poor structure of education or a lack of mentors, lead to dissatisfaction among participants. The size or type of the department, as well as the prevailing service system, exert only a minor influence on the quality of specialist training, although there were differences especially in the self-assessment of the participants in connection with the type of department (university hospital versus public or private hospital). CONCLUSION: Specialist training in neurology can be improved by simple arrangements, e. g., the introduction of a binding rotation scheme, internal mentoring and structured feedback. In addition, it will be necessary to relieve medical staff of administrative duties in order to create time for training and the learning of competencies.

Comparison between the yeast flora of Middle Eastern and Western European soft drinks.

Samples of a carbonated orange drink, raw materials, and intermediate products originating from 6 Iraqi bottling plants were examined. 69 drinks, 4 flavoured syrups and 19 simple syrups contained yeasts, whereas all samples from one plant and all samples of beverage base were free from viable yeasts. From the orange drink 2 species were isolated viz. Saccharomyces montanus and Torulopsis stellata. The following species were present in simple syrup: Hansenula anomala, Sacch. bisporus var. mellis, T. candida and T. stellata. Sacch. bisporus var. mellis was also isolated from favoured syrup. Representative strains were submitted to routine growth tests at reduced oxygen tension, at reduced water activity and on solid soft-drink media containing various amounts of anti-microbially active benzoic acid at pH 3.0. The results are discussed and compared to those obtained in European soft drinks.