Association between bacterial vaginosis and cervical intraepithelial neoplasia: systematic review and meta-analysis

Objective: Bacterial vaginosis (BV), the most common vaginal disorder among women of reproductive age, has been suggested as co-factor in the development of cervical cancer. Previous studies examining the relationship between BV and cervical intra-epithelial neoplasia (CIN) provided inconsistent and conflicting results. The aim of this study is to clarify the association between these two conditions. Methods: A systematic review and meta-analysis were conducted to summarize published literature on the association between BV and cervical pre-cancerous lesions. An extensive search of electronic databases Medline (Pubmed) and Web of Science was performed. The key words 'bacterial vaginosis' and 'bacterial infections and vaginitis' were used in combination with 'cervical intraepithelial neoplasia', 'squamous intraepithelial lesions', 'cervical lesions', 'cervical dysplasia', and 'cervical screening'. Eligible studies required a clear description of diagnostic methods used for detecting both BV and cervical precancerous lesions. Publications were included if they either reported odds ratios (OR) and corresponding 95% confidence intervals (CI) representing the magnitude of association between these two conditions, or presented data that allowed calculation of the OR. Results: Out of 329 articles, 17 cross-sectional and 2 incidence studies were selected. In addition, two studies conducted in The Netherlands, using the national KOPAC system, were retained. After testing for heterogeneity and publication bias, meta-analysis and meta-regression were performed, using a random effects model. Although heterogeneity among studies was high (chi(2) = 164.7, p < 0.01, I-2 = 88.5), a positive association between BV and cervical pre-cancerous lesions was found, with an overall estimated odds ratio of 1.51 (95% CI, 1.24-1.83). Meta-regression analysis could not detect a significant difference between studies based on BV diagnosis, CIN diagnosis or study population. Conclusions: Although most studies were cross-sectional and heterogeneity was high, this meta-analysis confirms a connection between BV and CIN

Visualisation Method Toolkit: a shared vocabulary to face complexity

With companies, universities, individuals or entire departments, promoting open dialogue, constant interdisciplinary collaboration is a challenge that still meets some resistance. Learning to deal with complexity, with the coexistence of different points of view, learning to work in more heterogeneous teams, in relation to know-how combined in new, sometimes original and challenging formulations, brings particular needs. From the importance of language and a shared vocabulary to the ever-increasing need to work on tools and not just applications, from the constant promotion of collaboration and contamination between different backgrounds and disciplines to the guarantee of a continuous training process through laboratory activities and workshop, this contribution - through the Visualisation Method Toolkit project and its experimentation - investigates the potential of data visualization as a medium to bring design closer to a company's core business as well as support students, institutions and other organizations in communication, both in the analysis and/or scenario phase and in support of dissemination actions towards a more informed quanti/qualitative collective decision making with the aim of enabling new innovative and sustainable good practices

Aspects of human papillomavirus (HPV) disease in human immunodeficiency virus (HIV) infection

Cutaneous and genital human papillomavirus (HPV) infection in HIV patients, on suppressive anti-retroviral therapy (ART), poses under-investigated clinical challenges. HPV in HIV may represent a form of immune reconstitution associated disease (IRAD). HPV disease and IRADs have been separately correlated with human leucocyte antigen (HLA) genotype. HLA might also influence HPV in HIV. Comprehensive HPV typing of persistent warts obtained from HIV infected and healthy subjects was performed. Cutaneous HPV types were detected using nested PCR/sequencing and newly developed (Luminex based) HSLPCR/ MPG; genital and beta HPV types were identified using a reverse hybridisation line probe assay. Real time PCR was employed to determine HPV DNA viral loads. HLA alleles were defined in HIV infected and healthy patients by Luminex-based molecular typing using DNA derived from blood. The HPV profile of cutaneous and genital HIV warts differs significantly from warts from healthy individuals. In HIV, HPV 7 has been confirmed to be an important HPV type in cutaneous warts (p=0.001). In genital warts in HIV, HPV 11 is the predominant HPV type (p=0.15) and HPV 6 is less common (p=0.002), contrasting with the usual finding that HPV 6 is the principal type in the general population. Cross-over of HPV types between cutaneous and genital sites suggests that HPV tropism is less important than previously thought. An excess of beta HPV types, predominantly as mixed infections, is seen in cutaneous warts in HIV (p<0.0005). The HLA class I allele group HLA-B*44 (as the allele HLA-B*44:02 and the haplotype HLA-B*44, -C*05) has been identified more frequently in HIV than in controls (p=0.004, allele group; p=0.0006, allele; p=0.001, haplotype). The class II allele HLA-DQB1*06 may also be of interest (p=0.03). However, the differences are reduced after correction for multiple testing. Further work is required to ascertain if these HPV types and alleles are of importance