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1.
Cancers (Basel) ; 14(9)2022 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-35565224

RESUMO

(1) Background: This population-based study aimed at identifying the factors associated with the likelihood of detection of stage IA cervical carcinoma-versus the detection of stage IB through IV cervical carcinoma-and the patterns of surgical treatment. (2) Methods: Between 1995-2016, 3750 patients living in the Emilia-Romagna Region (northern Italy) were registered with cervical carcinoma, including 2942 eligible patients (median age, 53). Multivariate analysis was performed using binary logistic regression models. (3) Results: The likelihood of stage IA cervical carcinoma (n = 876, 29.8%) did not change over time, decreased with increasing patient age, and was lower for patients with adenocarcinoma and grade 3-4 disease. Three hundred and fifty (40.0%) patients had a conservative treatment, 317 (36.2%) had hysterectomy, 197 (22.5%) had hysterectomy with lymph node dissection (LND), and 12 (1.4%) had a conservative treatment with LND. The proportion of hysterectomy decreased from 70.6% in 1995-1999 to 46.9% in 2011-2016. The likelihood of hysterectomy increased above the age of 40. Among screening-aged (25-64 years) patients, the likelihood of hysterectomy did not differ between screen-detected and non-screen-detected ones. Hysterectomy was increasingly combined with LND. High tumour grade was the strongest determinant of LND during hysterectomy. (4) Conclusions: This study provided a multifaceted overview of stage IA cervical carcinoma over the last decades.

2.
Minerva Ginecol ; 71(6): 442-459, 2019 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-31741364

RESUMO

HPV vaccination has been introduced in clinical practice in recent years and represents the most effective strategy of primary prevention of cervical carcinoma and of female genital preneoplastic conditions. One of the major issues of the subject is represented by vaccination coverage of the target population. Since its introduction, HPV vaccine efficacy has been progressively demonstrated also towards extragenital HPV-correlated conditions and in males too. Moreover, even subjects of older age groups or subjects who already had HPV infections have been demonstrated to received benefits from vaccination, due to improvements of their immunological response. Recently, vaccine efficacy has also been investigated in terms of adjuvant administration after treatments of preneoplastic or benign conditions of the female lower genital tract caused by HPVs; preliminary results indicate an interesting and promising field of application. On this basis, in this article an analysis of the state of the art has been performed, with specific regard to the Italian scenario and with the focus of future perspectives of implementation of the HPV vaccination policy. From the available evidences, the Italian HPV Study Group recommends the extension of systematic HPV vaccination to males too, to adult subjects and also after conservative treatment of genital HPV correlated conditions.


Assuntos
Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Vacinação/métodos , Adolescente , Adulto , Fatores Etários , Feminino , Humanos , Itália , Masculino , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia
4.
Pesqui. vet. bras ; 36(12): 1145-1154, Dec. 2016. tab, graf, mapas
Artigo em Português | LILACS, VETINDEX | ID: biblio-842032

RESUMO

Realizou-se estudo epidemiológico descritivo da raiva dos herbívoros no estado do Paraná entre os anos de 1977 e 2012. Os casos confirmados de raiva e o total de amostras de encéfalo encaminhadas para o diagnóstico foram distribuídos por espécie, por ano, por meses, por mesorregião geográfica e por municípios, aplicando-se o teste de Qui-quadrado para verificar se havia associação com esses fatores. Modelo probabilístico foi ajustado à série histórica para verificação de padrões cíclico ou sazonal. Comprovou-se que a raiva é uma doença endêmica no PR, com ocorrência variável entre os anos, sem padrão sazonal e com ciclicidade aparente a cada 18 anos, acometendo, sobretudo, bovinos (86,9%) e equídeos (11,3%). Verificou-se grande difusão no estado (47,6% dos municípios), e a maior expansão geográfica aconteceu na última década. As áreas de ocorrência maior foram as mesorregiões Centro Oriental e de Curitiba, seguidas por Norte Pioneiro e Oeste. O número de casos de raiva por município se correlacionou, ainda que fracamente, com o número de abrigos de Desmodus rotundus (r=0,469; p<0,0001). Sugere-se que a imunização anual de bovinos e equídeos passe a ser adotada nas áreas de maior ocorrência (mesorregiões Centro Oriental e de Curitiba) e encorajada nas de ocorrência intermediária (mesorregiões Norte Pioneiro e Oeste).(AU)


A descriptive epidemiological survey of rabies in herbivorous reared in the state of Parana, Brazil, was carried out from 1977 to 2012. The positive cases and the total number of brain samples processed for diagnostic purposes were distributed according to species, year, month, geographical region and municipality. Chi-square test was used to verify if rabies was associated to these factors. Probabilistic model was applied to historical series in order to verify cyclic and seasonal patterns. In Parana, rabies is an endemic disease with variable yearly occurrence, without seasonal pattern and with a possible cyclic pattern every 18 years. Cattle (86.9%) and equides (11.3%) were mainly affected. Rabies was registered in 47.6% of all municipalities, indicating a great spread of this disease in Parana, mainly during the last decade. Middlewest and Curitiba regions, followed by Pioneer North and West regions, were the areas of most occurrence. The number of cases per municipality was weakly correlated with the number of shelters for Desmodus rotundus (r=0.469; p<0.0001). Therefore, we suggest that annual immunization of cattle and equides should be applied in the high occurrence areas (Middlewest and Curitiba regions) and encouraged in intermediate occurrence areas (Pioneer North and West regions).(AU)


Assuntos
Animais , Bovinos , Encefalite/epidemiologia , Doenças Endêmicas/veterinária , Equidae , Lyssavirus , Infecções por Rhabdoviridae/epidemiologia , Vacinação em Massa/veterinária
5.
Eur J Obstet Gynecol Reprod Biol ; 206: 64-69, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27639133

RESUMO

OBJECTIVE: An innovative web-based colposcopy quality assurance programme was implemented in population-based cervical screening services in three north-eastern Italian administrative regions with different colposcopists' training background. In this study, the levels of intra- and interregional intercolposcopist diagnostic agreement were evaluated. STUDY DESIGN: Of the 158 registered colposcopists, 125 accessed the website of the programme, logged-in, viewed a posted set of 50 digital colpophotographs selected by an expert steering committee, and classified them for the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy. Anonymous data were downloaded and analysed using the crude, or observed, proportion of agreement and the kappa coefficient. RESULTS: There were 113 eligible colposcopists. Overall, crude agreement on the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy was 0.72, 0.72, and 0.87, with kappa values of 0.60, 0.36, and 0.69, respectively. The homologous kappa values were 0.61, 0.41, and 0.69 in one region, 0.57, 0.36, and 0.69 in another, and 0.66, 0.38, and 0.74 in the third. Total intra- and interregional agreement were nearly identical, with kappa values of 0.59 and 0.60 for the colposcopic impression, 0.38 and 0.35 for the visibility of the squamocolumnar junction, and 0.69 and 0.69 for the need for biopsy. The width of 95% confidence intervals around the above kappa values was ≤0.01. CONCLUSIONS: The levels of agreement varied between moderate and substantial both within and between regions. Regional differences in training background had minor effects. The interpretation of colposcopy is potentially well-reproducible.


Assuntos
Colposcopia/normas , Detecção Precoce de Câncer/métodos , Garantia da Qualidade dos Cuidados de Saúde , Telepatologia/normas , Neoplasias do Colo do Útero/diagnóstico , Feminino , Humanos , Itália , Programas de Rastreamento , Neoplasias do Colo do Útero/patologia
6.
Diagn Microbiol Infect Dis ; 86(3): 270-272, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27601381

RESUMO

Two-thirds of 152 patients treated for high-grade cervical disease, free of persistence/recurrence, and followed-up both with human papillomavirus (HPV) DNA testing and HPV genotyping cleared their high-risk HPV infection within 1year. Viral clearance continued at diminishing rates during the second and the third year, at the end of which it was virtually complete.


Assuntos
Carcinoma/tratamento farmacológico , Carcinoma/virologia , Papillomaviridae/isolamento & purificação , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/virologia , Adulto , Tratamento Conservador/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
J Cancer ; 7(1): 107-14, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26722366

RESUMO

Persistent positivity of HPV-DNA testing is considered a prognostic index of recurrent disease in patients treated for CIN2+. HPV detection, and particularly genotyping, has an adequate high rate of sensitivity and specificity (along with an optimal reproducibility), for accurately predicting treatment failure, allowing for an intensified monitoring activity. Conversely, women with a negative HPV-test 6 months after therapy have a very low risk for residual/recurrent disease, which leads to a more individualized follow-up schedule, allowing for a gradual return to the normal screening scheme. HPV testing should be routinely included (with or without cytology) in post-treatment follow-up of CIN2+ patients for early detection of recurrence and cancer progression. HPV genotyping methods, as a biological indicator of persistent disease, could be more suitable for a predictive role and risk stratification (particularly in the case of HPV 16/18 persistence) than pooled HPV-based testing. However, it is necessary to be aware of the performance of the system, adhering to strict standardization of the process and quality assurance criteria.

8.
Pesqui. bras. odontopediatria clín. integr ; 16(1): 411-424, jan.-dez. 2016. tab
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-912892

RESUMO

Objective: To perform cross-cultural adaptation of the Dental Environment Stress (DES), to test its construct validity and reliability, and to identify the sources of stress among Brazilian dental students. Material and Methods: The DES was transculturally adapted to Portuguese using translation/back-translation, review by an expert bilingual committee and consensus building. The first version was tested in a sample of 42 dental students to check the understanding level of the alternatives. The final version was applied to all the students enrolled in a Brazilian Public Dental School. Construct validity was assessed through factor analysis, performed by principal components analysis and Varimax rotation and reliability by internal Cronbach's alpha coefficient (95% CI). Wilcoxon rank sum was conducted to test for gender and Kruskall-Wallis for year comparison. Multivariate analysis relied on ordinal logistic regression modeling. Results: Factor analysis revealed five factors that possessed eigenvalues greater than 1.5 and together explained 46.88% of the total variance. Internal consistency of each factor was adequate, with Cronbach's alpha ranging from 0.65 to 0.84. 'Examinations and grades' (82.80%) was the highest scored item. Females presented higher rates, as well as second's and fifth's years students. The entering students were generally concerned with factors related to "Academic Performance", whereas clinical year students with "Insecurity Concerning their Professional Future". Conclusion: The Portuguese version of the DES presented good results, thus it could be a valid instrument to assess the factors of perceived stress in Lusophone countries, subsidizing the development of strategies to minimize the stress and optimize school performance.


Assuntos
Humanos , Masculino , Feminino , Adulto , Brasil , Análise do Estresse Dentário , Estudantes de Odontologia , Tradução , Análise Multivariada , Estatísticas não Paramétricas , Inquéritos e Questionários
9.
J Lab Autom ; 21(3): 432-8, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25673634

RESUMO

Cervical specimens collected in liquid-based cytology (LBC) media are the most common sample type used for high-risk human papillomavirus (HPV) testing. Since preanalytic steps such as vortexing and decapping vials, liquid transfer to a sample input tube with matching unique identifier, and recapping the original vials are required for processing LBC samples prior to running the Abbott RealTime High Risk HPV assay (Abbott, Wiesbaden, Germany), a full manual execution can be complicated, especially in high-throughput diagnostic contexts. Here, a custom-configured worktable setup for the Tecan Freedom EVO (Tecan, Männedorf, Switzerland) designed to automate and control preanalytic steps for ThinPrep (Hologic, Marlborough, MA) samples was used to evaluate the impact of automated versus manual preanalytics. Archival results for manual processing of 226 samples were compared with those obtained with the Tecan protocol, observing a very good overall concordance for final assay interpretation (95.6%). High overall agreement (100%) resulted also from retesting 99 samples by both the preanalytical protocols. High reproducibility was observed analyzing 23 randomly selected samples by automated preprocessing in triplicate. Hence, the new configuration of the Tecan platform translates the manual steps required to process ThinPrep specimens into automated operations, controls sample identification, and allows for saving hands-on time, while maintaining assay reproducibility and ensuring reliability of results, making it suitable for screening settings.


Assuntos
Automação Laboratorial/métodos , Técnicas de Genotipagem/métodos , Papillomaviridae/classificação , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Manejo de Espécimes/métodos , Colo do Útero/virologia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Papillomaviridae/isolamento & purificação , Reprodutibilidade dos Testes
10.
Value Health ; 18(8): 956-68, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26686779

RESUMO

BACKGROUND: Human papillomavirus (HPV) plays a role in the development of benign and malign neoplasms in both sexes. The Italian recommendations for HPV vaccines consider only females. The BEST II study (Bayesian modelling to assess the Effectiveness of a vaccination Strategy to prevent HPV-related diseases) evaluates 1) the cost-effectiveness of immunization strategies targeting universal vaccination compared with cervical cancer screening and female-only vaccination and 2) the economic impact of immunization on various HPV-induced diseases. OBJECTIVE: The objective of this study was to evaluate whether female-only vaccination or universal vaccination is the most cost-effective intervention against HPV. METHODS: We present a dynamic Bayesian Markov model to investigate transmission dynamics in cohorts of females and males in a follow-up period of 55 years. We assumed that quadrivalent vaccination (against HPV 16, 18, 6, and 11) is available for 12-year-old individuals. The model accounts for the progression of subjects across HPV-induced health states (cervical, vaginal, vulvar, anal, penile, and head/neck cancer as well as anogenital warts). The sexual mixing is modeled on the basis of age-, sex-, and sexual behavioral-specific matrices to obtain the dynamic force of infection. RESULTS: In comparison to cervical cancer screening, universal vaccination results in an incremental cost-effectiveness ratio of €1,500. When universal immunization is compared with female-only vaccination, it is cost-effective with an incremental cost-effectiveness ratio of €11,600. Probabilistic sensitivity analysis shows a relatively large amount of parameter uncertainty, which interestingly has, however, no substantial impact on the decision-making process. The intervention being assessed seems to be associated with an attractive cost-effectiveness profile. CONCLUSIONS: Universal HPV vaccination is found to be a cost-effective choice when compared with either cervical cancer screening or female-only vaccination within the Italian context.


Assuntos
Detecção Precoce de Câncer/economia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Vacinas contra Papillomavirus/economia , Neoplasias do Colo do Útero/diagnóstico , Fatores Etários , Teorema de Bayes , Criança , Análise Custo-Benefício , Feminino , Doenças dos Genitais Femininos/economia , Doenças dos Genitais Femininos/prevenção & controle , Doenças dos Genitais Masculinos/economia , Doenças dos Genitais Masculinos/prevenção & controle , Neoplasias de Cabeça e Pescoço/economia , Neoplasias de Cabeça e Pescoço/prevenção & controle , Humanos , Programas de Imunização/economia , Itália , Masculino , Cadeias de Markov , Modelos Econométricos , Infecções por Papillomavirus/transmissão , Anos de Vida Ajustados por Qualidade de Vida , Fatores Sexuais , Comportamento Sexual , Neoplasias do Colo do Útero/economia
11.
Braz. j. oral sci ; 14(3): 199-203, July-Sept. 2015. tab, graf
Artigo em Inglês | LILACS, BBO - Odontologia | ID: lil-770537

RESUMO

Abstract Aim: To evaluate if gypsum mixed with different water types, with their different compositions influence the dimensional change, surface roughness and compressive strength of type IV and V gypsum specimens. Methods: Sixty specimens were fabricated from metal matrices and divided into six groups (n=10) according to the used type of gypsum and water: G1, G2 and G3 - type IV gypsum and tap, mineral and distilled water, respectively; G4, G5 and G6 - type V gypsum and tap, mineral and distilled water, respectively. Water/powder ratio followed the manufacturer's recommendations (19 mL/100 g) in all groups. The same specimens were used for all tests. A micrometer dial evaluated the dimensional change. The surface roughness of three random points was determined with a rugosimeter; a universal testing machine performed the compressive strength test. The data were subjected to analysis of variance (ANOVA). Results: There was no statistically significant difference (p>0.05) between the three types of water in the studied variables. There was statistically significant difference (p<0.05) between the gypsum mixes for the dimensional change variable. Conclusions: The different water types, with their different compositions, did not influence the analyzed physical and mechanical properties.


Assuntos
Sulfato de Cálcio , Água , Prótese Dentária , Força Compressiva
12.
J Clin Virol ; 70: 53-57, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26305820

RESUMO

BACKGROUND: Although it is hypothesised that human papillomavirus (HPV) testing may have a role in surveillance of patients conservatively treated for stage IA squamous cell cervical carcinoma, research on this topic has been minimal. OBJECTIVES: To determine: (1) the changes in HPV test result from treatment onward; (2) the time to viral clearance; and (3) the negative predictive value (NPV) and positive predictive value (PPV) of HPV test result for the detection of CIN2 or worse (CIN2+) during follow-up. STUDY DESIGN: In a multicentre retrospective follow-up study of a consecutive series (1997-2009) of 91 patients, longitudinal outcome measures were estimated as cumulative probabilities using the Kaplan-Meier method. RESULTS: For patients testing HPV-positive at the first follow-up visit (n=44), the probability of change to negative rose from 0 to 0.78 between 7 and 21 months after treatment. For HPV-negative patients (n=47), the probability of change to positive rose to 0.13 between 9 and 26 months. After a median follow-up of 50 months (range, 2-80), the NPV for CIN2+ was 1.00. The PPV was 0.60 (95% confidence interval, 0.43-0.77) after 26 months. The median time to detection was 5 months. CONCLUSIONS: If adequately confirmed, these findings would indicate that HPV testing is capable to identify the patients who have had their lesions fully removed, and would make it possible to focus follow-up efforts on a subset of patients at high risk of residual or progressive disease.


Assuntos
Carcinoma de Células Escamosas/epidemiologia , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/terapia , Feminino , Seguimentos , Genótipo , Técnicas de Genotipagem , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de Saúde , Papillomaviridae/classificação , Infecções por Papillomavirus/complicações , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase/normas , Valor Preditivo dos Testes , Estudos Retrospectivos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etiologia , Neoplasias do Colo do Útero/terapia
13.
Biomed Res Int ; 2015: 614035, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26180805

RESUMO

PURPOSE: To report the accuracy of colposcopically directed biopsy in an internet-based colposcopy quality assurance programme in northern Italy. METHODS: A web application was made accessible on the website of the regional Administration. Fifty-nine colposcopists out of the registered 65 logged in, viewed a posted set of 50 digital colpophotographs, classified them for colposcopic impression and need for biopsy, and indicated the most appropriate site for biopsy with a left-button mouse click on the image. RESULTS: Total biopsy failure rate, comprising both nonbiopsy and incorrect selection of biopsy site, was 0.20 in CIN1, 0.11 in CIN2, 0.09 in CIN3, and 0.02 in carcinoma. Errors in the selection of biopsy site were stable between 0.08 and 0.09 in the three grades of CIN while decreasing to 0.01 in carcinoma. In multivariate analysis, the risk of incorrect selection of biopsy site was 1.97 for CIN2, 2.52 for CIN3, and 0.29 for carcinoma versus CIN1. CONCLUSIONS: Although total biopsy failure rate decreased regularly with increasing severity of histological diagnosis, the rate of incorrect selection of biopsy site was stable up to CIN3. In multivariate analysis, CIN2 and CIN3 had an independently increased risk of incorrect selection of biopsy site.


Assuntos
Colposcopia/métodos , Processamento de Imagem Assistida por Computador , Internet , Garantia da Qualidade dos Cuidados de Saúde , Neoplasias do Colo do Útero/patologia , Adulto , Animais , Biópsia , Feminino , Humanos , Itália/epidemiologia , Camundongos , Pessoa de Meia-Idade , Fatores de Risco , Neoplasias do Colo do Útero/epidemiologia
14.
Ecancermedicalscience ; 9: 533, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26015802

RESUMO

Since the introduction of biomolecular testing for the identification of high-risk human papillomavirus DNA (hrHPV-DNA) in cervical cancer preventive strategies, many interesting aspects have emerged in this field; firstly, HPV-DNA testing has been demonstrated to have better sensitivity than conventional cytology in several settings: screening, triage of ASC-US and in follow-up after treatment. Despite this, some limitations of these new technologies have also been underlined: the major issue is the low specificity of the tests, which cannot discriminate between regressive and progressive infections. Thus, recent research has moved the attention towards novel markers of progression that could more precisely detect cases at real risk of cancer development. In view of the fact that progression to cancer is dependable of the E6/E7 proteins integration and transforming action, the overexpression of E6/E7 transcripts has been seen as a valuable marker of this risk. This review aims to summarise the literature data on this topic and to provide a clear view of the emerging perspectives.

15.
Ecancermedicalscience ; 9: 528, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25987897

RESUMO

BACKGROUND: Over the last two decades it has become clear that distinct types of human papillomavirus (HPV), the so-called high-risk types (hrHPV), are the major cause of cervical cancer. The hrHPV-DNA testing has shown excellent performance in several clinical applications from screening to the follow-up of conservatively treated patients. METHODS: We conducted a systematic review of the recent literature on the performance of HPV DNA testing in follow-up after treatment of high-grade cervical lesions, adenocarcinoma in situ, and microinvasive carcinoma compared to Pap smear cytology. RESULTS: Observational studies have demonstrated that the high risk hrHPV-DNA test is significantly more sensitive (95%) compared to follow-up cytology(70%) in detecting post-treatment squamous intraepithelial high-grade lesions. Moreover, in patients treated conservatively for cervical adenocarcinoma in situ, the hrHPV-DNA test is the most significant independent predictor of recurrent disease or progression to invasive cancer, and the combination of viral DNA testing and cytology reaches 90% sensitivity in detecting persistent lesions at the first follow-up visit and 100% at the second follow-up visit. The cause of microinvasive squamous cervical carcinoma is increasingly treated with conservative therapies in order to preserve fertility, and an effective strategy allowing early detection of residual or progressive disease has become more and more important in post-treatment follow-up. Primary results seem to indicate that the median time for viral clearance is relatively longer compared with patients treated for CIN and suggest a prolonged surveillance for these patients. However, the potential clinical value of HPV-DNA testing in this clinical setting needs to be confirmed by further observations. CONCLUSIONS: The excellent sensitivity, negative predictive value, and optimal reproducibility of the hrHPV DNA testing, currently is considered a powerful tool in the clinicians' hands to better manage post-treatment follow-up either in cervical squamous lesion or in situ adenocarcinoma.

16.
Ecancermedicalscience ; 9: 531, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25987900

RESUMO

Usual vulvar intraepithelial neoplasia (uVIN) is the most common VIN type, generally related to a human papillomavirus (HPV) infection, predominantly type 16. The incidence of uVIN has been increasing over the last decades, and a bimodal peak is observed at the age of 40-44 and over 55 years. Almost 40% of patients with uVIN have a past, concomitant or future HPV-associated lesion of the lower genital tract. HPV-related malignancies are associated with a persistent HPV infection. The host immune response is of crucial importance in determining clearance or persistence of both HPV infections and HPV-related VIN. About 60% of the patients present with symptoms. Clinical features of uVIN vary in site, number, size, shape, colour, and thickness of lesions. Multicentric disease is often present. Most uVIN lesions are positive at immunohistochemistry to p16(ink4a) and p14(arf), but negative to p53. Irrespective of surgical treatment used, uVIN recurrence rates are high. Positive margins do not predict the development of invasive disease and the need to re-excide the tissue around the scare remains to be demonstrated. Therefore, considering the low progression rate of uVIN and psycosexual sequelae, treatments should be as conservative as possible. Medical treatments available are mainly based on immunotherapy to induce normalisation of immune cell count in uVIN. None are approved by the food and drug administration (FDA) for the treatment of uVIN. If medical treatment is performed, adequate biopsies are required to reduce the risk of unrecognised invasive disease. Some studies suggest that failure to respond to immunotherapy might be related to a local immunosuppressive microenvironment, but knowledge of the uVIN microenvironment is limited. Moreover, our knowledge of the potential mechanisms involved in the escape of HPV-induced lesions from the immune system has many gaps. HPV vaccines have been demonstrated to be effective in preventing uVIN, with 94.9% efficacy in the HPV-naive population, while studies on therapeutic vaccines are limited. The low incidence of VIN requires large multicentre studies to determine the best way to manage affected patients and to investigate the immunological characteristics of the 'vulvar microenviroment' which leads to the persistence of HPV.

17.
J Low Genit Tract Dis ; 18(4): 309-13, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24886869

RESUMO

OBJECTIVE: To report the results of an Internet-based colposcopy quality assurance program from a population-based cervical screening service in a large region of northern Italy. METHODS: In 2010 to 2011, a Web application was made accessible on the Web site of the regional administration. Fifty-nine colposcopists of the registered 65 participated. They logged-in, viewed a posted set of 50 high-quality digital colpophotographs selected by an expert committee, and rated them for colposcopic impression using a 4-tier classification (Negative; abnormal, grade 1 [G1]; abnormal, grade 2 [G2]; suspected invasive cancer [Cancer]) derived from the International Federation for Cervical Pathology and Colposcopy 2002 classification. kappa (κ) coefficients for intercolposcopist agreement and colposcopist-committee agreement were calculated. RESULTS: Colposcopist-committee agreement was greater than intercolposcopist agreement (overall κ 0.69 vs 0.60, p<.001). The κ values for colposcopist-committee agreement were 0.83 on Negative, 0.53 on G1, 0.66 on G2, and 0.80 on Cancer (all p values for pairwise comparisons<.001, except for Negative vs Cancer [p=.078]). There was no systematic tendency for colposcopists to underestimate or overestimate the colposcopic findings (2-tailed sign test, p=.13). Overall colposcopist-committee agreement was greater among patients 35 years or older (p<.001) and for colposcopists with previous quality assurance experiences (p<.01). Only 0.2% of Negative impressions were formulated for a cervical intraepithelial neoplasia grade 2 or worse. As a parallel finding, the impression of Cancer predicted cervical intraepithelial neoplasia grade 2 or less in 0.5% of cases. The histologic substrates of G1 were dispersed over a large spectrum. CONCLUSIONS: The reproducibility of colposcopic impression, when classified by trained colposcopists examining high-quality images, is higher than is generally thought.


Assuntos
Colposcopia/métodos , Colposcopia/normas , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Internet , Garantia da Qualidade dos Cuidados de Saúde/métodos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Feminino , Humanos , Itália , Pessoa de Meia-Idade , Competência Profissional/normas , Adulto Jovem
18.
Dent Traumatol ; 30(2): 112-7, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23829469

RESUMO

BACKGROUND/AIM: The present research evaluated the induction of ankylosis and the eruption rate in rat incisors, with the aim of achieving stable anchorage for orthodontic tooth movement (OTM) of the molars. MATERIAL AND METHODS: Fifteen male Wistar rats were used. In the Experimental group, the right superior incisor of each animal was extracted, denuded of the PDL and the dental papilla, and reimplanted. The Control group was the left superior incisors. The eruption rate was measured at 7, 10, 12, 14, and 16 days after replantation. NiTi closed springs with a 50cN release force were installed for additional 9 days, and the eruption rate was determined. Then, the rats were sacrificed, and ankylosis was examined by microscopic analysis. Differences with P < 0.01 were defined as statistically significant. RESULTS: The eruption rates were 0 and 0.39 mm day(-1) in the Experimental group and Control group, respectively. All incisors of the Experimental group showed ankylosis according to histological analysis. CONCLUSIONS: The methodology used to induce ankylosis in this study was effective for anchoring the incisors during the OTM of rat molars, eliminating the undesirable effects consequent to continuous eruption.


Assuntos
Ortodontia , Anquilose Dental , Técnicas de Movimentação Dentária/instrumentação , Animais , Incisivo , Masculino , Ratos , Ratos Wistar , Erupção Dentária/fisiologia
19.
Int J Gynecol Cancer ; 23(9): 1663-9, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24172101

RESUMO

OBJECTIVE: The p16 (p16(Ink4a)) tumor-suppressor protein is a biomarker for activated expression of human papillomavirus oncogenes. However, data are insufficient to determine whether p16 overexpression predicts the risk for progression of low-grade cervical intraepithelial neoplasia (CIN). This study was aimed at evaluating the risk for progression to CIN2 or worse during a 3-year follow-up of an unselected series of 739 patients with CIN1 biopsy specimens tested for p16 expression. METHODS: Positivity of p16 was defined as a diffuse overexpression in the basal/parabasal cell layers. Selection biases were ruled out using a control group of 523 patients with CIN1 biopsies not tested for p16 expression. Analysis was based on the ratio of progression rates. RESULTS: In the first year of follow-up, the 216 patients (29%) with p16-positive CIN1 had a higher progression rate (12.3%) than did the 523 patients with p16-negative CIN1 (2.2%) (rate ratio, 5.5; 95% confidence interval [CI], 2.59-11.71). In the second and third years, differences were smaller (rate ratio, 1.32 and 1.14, respectively) and not significant. The patients with p16-positive CIN1 also had a lower risk for regression to normal in the first year of follow-up (rate ratio, 0.55; 95% confidence interval, 0.42-0.71) and nonsignificant changes in the second and third years (rate ratio, 0.81 and 0.84, respectively). CONCLUSIONS: The patients with p16-positive CIN1 had an increased risk for progression that was concentrated in the first year of follow-up. Immunostaining of p16 could have a role in short-term surveillance of patients with CIN1. Further research should focus on midterm/long-term outcomes of p16-positive CIN1.


Assuntos
Genes p16 , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/genética , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/genética , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Progressão da Doença , Feminino , Seguimentos , Regulação Neoplásica da Expressão Gênica , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Prognóstico , Neoplasias do Colo do Útero/patologia , Adulto Jovem , Displasia do Colo do Útero/patologia
20.
BMC Health Serv Res ; 13: 237, 2013 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-23809615

RESUMO

BACKGROUND: Colposcopy, the key step in the management of women with abnormal Pap smear results, is a visual technique prone to observer variation, which implies the need for prolonged apprenticeship, continuous training, and quality assurance (QA) measures. Colposcopy QA programmes vary in level of responsibility of organizing subjects, geographic coverage, scope, model, and type of actions. The programmes addressing the clinical standards of colposcopy (quality of examination and appropriateness of clinical decisions) are more limited in space and less sustainable over time than those focused on the provision of the service (resources, accessibility, etc.). This article reports on the protocol of a QA programme targeting the clinical quality of colposcopy in a population-based cervical screening service in an administrative region of northern Italy. METHODS/DESIGN: After a situation analysis of local colposcopy audit practices and previous QA initiatives, a permanent web-based QA programme was developed. The design places more emphasis on providing education and feedback to participants than on testing them. The technical core is a log-in web application accessible on the website of the regional Administration. The primary objectives are to provide (1) a practical opportunity for retraining of screening colposcopists, and (2) a platform for them to interact with colposcopists from other settings and regions through exchange and discussion of digital colposcopic images. The retraining function is based on repeated QA sessions in which the registered colposcopists log-in, classify a posted set of colpophotographs, and receive on line a set of personal feedback data. Each session ends with a plenary seminar featuring the presentation of overall results and an interactive review of the test set of colpophotographs. This is meant to be a forum for an open exchange of views that may lead to more knowledge and more diagnostic homogeneity. The protocol includes the criteria for selection of colpophotographs and the rationale for colposcopic gold standards. DISCUSSION: This programme is an ongoing initiative open to further developments, in particular in the area of basic training. It uses the infrastructure of the internet to give a novel solution to technical problems affecting colposcopy QA in population-based screening services.


Assuntos
Colposcopia/normas , Programas de Rastreamento/métodos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Auditoria Clínica , Continuidade da Assistência ao Paciente , Feminino , Humanos , Itália , Pessoa de Meia-Idade , Sistemas On-Line , Teste de Papanicolaou , Vigilância da População , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Esfregaço Vaginal
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