Ricerca di HPV-DNA e tipizzazione virale nella diagnostica di prevenzione del carcinoma della cervice uterina

Papillomaviruses are relatively ubiquitous and have been described as causative agents for epithelial lesions in a wide variety of animals as well as in humans. Approximately 30 HPV types have been isolated from anogenital epithelium (cervix, vagina, vulva, rectum and penis). HPVs induce a variety of proliferative lesions, but only the “high-risk” types are associated with anogenital cancers. “Low-risk” viral types include HPV-6 and HPV-11; “high-risk” types include HPV-16, 18, 31 and 56. HPVs “high-risk” types are more strongly associated with high-grade lesions (HSIL) than they are with low-grade lesions (LSIL). The traditional process for cervical cancer screening programs (PAP test) is vulnerable to air drying artifacts and has limits to sensitivity, since as many as 90 percent of collectet cells can be discarted with collection device. The present study was undertaken to assess the screening performance of HPV-DNA typing in a sample of 142 women drawn from a routine screening for the prevention of cervical cancer. The results indicate that HPV-DNA screening and typing, used together with PAP test, can improve the detection of patients with cervical disease and can serve as a quality assurance indicator in cervical cancer screening programs

Tuberculosis in Kindergarten and Primary School, Italy, 2008–2009

An outbreak of tuberculosis (TB) in Italy involved 19 schoolchildren with active TB and 43 with latent infection. The source of the outbreak was a school assistant born in Italy who had a family history of TB. This outbreak highlights the need for maintaining clinical and public health expertise in countries with low TB incidence

Detection of E6/E7 HPV oncogene transcripts as biomarker of cervical intaepithelial displasia

It is widely accepted that only persistent infection with high risk types of Human Papillomavirus (HPV HR) is a significant risk factor for the development of an invasive squamous cervical cancer. The overexpression of viral oncogenes E6/E7 of HPV is considered a necessary process for incurring in a malignant phenotype.A HPV infection can be identified by detection of HPV DNA in biological samples, but the DNAbased tests cannot delineate between transient or persistent and potentially transforming infection. Instead there is many evidence to suggest that detection of HPV gene expression may constitute a more specific approach to highlight a clinically significant infection. Especially seems that the detection of E6/E7 transcripts can be usefully used for identify the women with a persistent HPV infection that will can induce a future cervical cancer. The aim of our study is to investigate if the detection of oncogenic viral gene activity by detecting transcripts of the E6 and E7 genes can be most usefull of HPV-DNA test in the triage of ASCUS or low grade cervical lesions. Our results confirm that HPV E6/E7 mRNA test can be considered a promising method to stratify HPV positive women for risk of future high-grade cervical lesions or cervical intaepithelial neoplasia

Valutazione del ruolo dell’HPV-DNA test nei programmi di prevenzione del cancro cervicale

Human Papillomavirus (HPV) infection is the main cause of cervical cancer and cervical intraepithelial neoplasia (CIN) worldwide. Consequently, it would be useful to evaluate HPV testing to screen for cervical cancer. Recently several molecular biological tests able to detect different HPV types and to divide into high and lowrisk group have been developed. In this study we examined HPV prevalence and genotype distribution in a group of 446 women and evaluated the role of HPV-DNA testing in cervical screening programs. HPV detection and genotyping were done using a polymerase chain reaction based assay (HPV Typing test). One hundred and fiftythree of those women had HPV infection (34.5% of the patients); 23 (15%) had low cancerrisk HPV DNA (LR); 116 (75.8%) had hight-risk HPV types (HR) and 14 (9%) from both groups. 130 women (85%) in this HPV-infected group had at least one high risk HPV type, and were therefore considered to be at high risk for cancer. PCR results were not completely comparable with cytological diagnosis. We conclude that a combination of HPV DNA and cytologic testing has almost 100% sensitivity and negative predictive value. The specificity of the combined test is slightly lower than the specificity of the Pap-test alone but this decrease could potentially be offset by a greater protection from neoplastic progression and cost savings available by extended screening intervals

Idiopathic intracranial hypertension without papilledema in refractory chronic daily headache

A diagnosis of idiopathic intracranial hypertension with- out papilledema (IIHWOP) should be considered in unresponsive chronic daily headache (CDH) patients [1]. A CSF opening pressure (OP) above 200 mm H2O has been detected in chronic migraine patients with conflict-ing result, ranging from 10% to 86% of patients [1,2]. Moreover, controversies ex ist regarding the OP cut-off value greater than 200 or 250 mm H2O and the role of transverse sinus stenosis (TSS) [3,4]

Inhibition of c-Jun N-terminal kinase decreases cardiomyocyte apoptosis and infarct size after myocardial ischemia and reperfusion in anaesthetized rats

1. Myocardial ischemia/reperfusion is associated with inflammation, apoptosis and necrosis. During this process, c-jun N-terminal kinase is activated in cardiac myocytes resulting in apoptosis. 2. This study investigates the effects of AS601245, a nonpeptide ATP competitive JNK inhibitor, on infarct size caused by myocardial ischemia/reperfusion in anaesthetized rats. The left descending coronary artery of anaesthetized rats was occluded for 30 min and then reperfused for 3 h. AS601245 was administered 5 min before the end of the ischemia period as an i.v. bolus (1.5, 4.5 or 15 mg kg(−1) i.v.) followed by continuous i.v. infusion (18, 55 and 183 μg kg(−1) min(−1), respectively) during reperfusion. Controls received saline only. 3-Aminobenzamide, a poly(ADP-ribose) polymerase inhibitor, was used as reference compound at 10 mg kg(−1) i.v. bolus plus 0.17 mg kg(−1) min(−1) continuous infusion. 3. AS601245 significantly reduced infarct size at 4.5 mg kg(−1) (−44%; P<0.001) and 15 mg kg(−1) i.v. (−40.3%; P<0.001) similarly to 3-aminobenzamide (−44.2%; P<0.001). This protective effect was obtained without affecting hemodinamics or reducing ST-segment displacement. 4. The beneficial effects on infarct size correlated well with the reduction of c-jun phosphorylation (−85%; P<0.001 versus control) and of TUNEL-positive cells (−82.1%; P<0.001) in post-ischemic cardiomyocytes. No change in the phosphorylation state of p38 MAPK and ERK in post-ischemic heart was observed in the presence of AS601245 in comparison to the vehicle-treated group. 5. These results demonstrate that blocking the JNK pathway may represent a novel therapeutic approach for treating myocardial ischemia/reperfusion-induced cardiomyocyte death

Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries : The Italian Registry of Endovascular Treatment in Acute Stroke

I Purpose: Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion. Methods: A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated. Results: Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P &lt; 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P &lt; 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P &lt; 0.001) as the best independent predictors of outcome. Conclusion: Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcom

European Multicenter Study of ET-COVID-19

International audienceBackground and Purpose: Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19. Methods: Multicenter, European, cohort study involving 34 stroke centers in France, Italy, Spain, and Belgium. Data were collected between March 1, 2020 and May 5, 2020. Consecutive laboratory-confirmed COVID-19 cases with large vessel occlusion, who were treated with MT, were included. Primary investigated outcome: 30-day mortality. Secondary outcomes: early neurological improvement (National Institutes of Health Stroke Scale improvement ≥8 points or 24 hours National Institutes of Health Stroke Scale 0–1), successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2b), and symptomatic intracranial hemorrhage. Results: We evaluated 93 patients with COVID-19 with large vessel occlusion who underwent MT (median age, 71 years [interquartile range, 59–79]; 63 men [67.7%]). Median pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were 17 (interquartile range, 11–21) and 8 (interquartile range, 7–9), respectively. Anterior circulation acute ischemic stroke represented 93.5% of cases. The rate modified Thrombolysis in Cerebral Infarction 2b to 3 was 79.6% (74 patients [95% CI, 71.3–87.8]). Thirty-day mortality was 29% (27 patients [95% CI, 20–39.4]). Early neurological improvement was 19.5% (17 patients [95% CI, 11.8–29.5]), and symptomatic intracranial hemorrhage was 5.4% (5 patients [95% CI, 1.7–12.1]). Patients who died at 30 days exhibited significantly lower lymphocyte count, higher levels of aspartate, and LDH (lactate dehydrogenase). After adjustment for age, initial National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and successful reperfusion, these biological markers remained associated with increased odds of 30-day mortality (adjusted odds ratio of 2.70 [95% CI, 1.21–5.98] per SD-log decrease in lymphocyte count, 2.66 [95% CI, 1.22–5.77] per SD-log increase in aspartate, and 4.30 [95% CI, 1.43–12.91] per SD-log increase in LDH). Conclusions: The 29% rate of 30-day mortality after MT among patients with COVID-19 is not negligible. Abnormalities of lymphocyte count, LDH and aspartate may depict a patient’s profiles with poorer outcomes after MT. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04406090