Toward improvements in HIV epidemiology

Considerable efforts are expended for prevention of HIV infections and for treatment of HIV-positive individuals, and it is widely agreed that improvements in both areas would be highly desirable. Observing and understanding the epidemiology of HIV are centrally necessary for the design of strategies for both prevention and for treatment. The way to improvement is to focus not on successes but on gaps to be filled or missteps to be corrected, so we discuss weaknesses of current practices and conundrums, why expected successes have not materialized. The fundamental uncertainty stems from the lack of a gold-standard HIV test. As a result, one cannot accurately compare HIV data from different global regions that use different testing protocols, for example, varying criteria for what constitutes a positive Western Blot or the availability or non availability of PCR or culture tests, or drawing inferences about HIV infection based on the Bangui definition of AIDS. In addition to uncertainty in cross-country comparisons, lack of the gold standard entails a fundamental inability to detect, analyze, and correct for false-negative and false-positive test-results by direct means rather than indirect inferences. Therefore, considerable effort would seem to be warranted to prepare pure samples of HIV for establishment of a true gold-standard HIV test. The weaknesses in testing practices may well account for at least some of the troubling conundrums and mutually contradictory data that seem inexplicable. These troubling conundrums include: conflicting estimates of HIV infections and of HIV-disease deaths from equally authoritative sources; apparently drastically different primary modes of transmission in different geographic regions (primarily among drug injectors in Russia and Eastern Europe, primarily among married couples in sub-Saharan Africa, primarily among gay men and drug addicts in the United States and Western Europe); extreme racial disparities in HIV infection, with Asians and Asian Americans consistently less affected, by about one-third, than white Americans, while black Americans are affected by as much as an order of magnitude more than white Americans. Testing uncertainties doubtless also contribute to the confusion as to whether certain conditions (e.g. lipodystrophy or nephropathy) should be described as HIV-associated or as AIDS-associated. Although it is the time honoured practice in science that such anomalies or conundrums are quarantined in the expectation that progress will eventually resolve them without research focused directly at the anomalies, it would seem in the case of HIV/AIDS that specific efforts would be worth pursuing to resolve at least some of these conundrums, because a better understanding would improve epidemiological data and understanding and help toward the design of better strategies for prevention and treatment

Thyroid-like follicular carcinoma of the kidney: report of two cases with detailed immunohistochemical profile and literature review.

Thyroid-like follicular carcinoma of the kidney (TLFC) is an unusual histological variant of renal cell carcinoma not included in the current WHO classification of renal tumors. Its morphological features resemble a large spectrum of benign and malignant renal and extra-renal conditions which should be ruled out in the diagnostic process. Because TLFC outcome is different from the other variants of renal cell carcinoma, the exploration for disease-specific markers is mandatory. The aim of the present paper is to illustrate the histological characteristics and immunohistochemical profile of two new cases along with a brief review of the literature

DILLo: an Italian lexical database for speech-language pathologists

A novel lexical resource for treating speech impairments from childhood to senility: DILLo—Database Italiano del Lessico per Logopedisti (i.e., Italian Database for Speech-Language Pathologists) is presented. DILLo is a free online web application that allows extraction of filtered wordlists for flexible rehabilitative purposes. Its major aim is to provide Italian speech-language pathologists (SLPs) with a resource that takes advantage of Information and Communication Technologies for language in a healthcare setting. DILLo’s design adopts an integrated approach that envisages fruitful cooperation between clinical and linguistic professionals. The 7690 Italian words in the database have been selected based on phonological, phonotactic, and morphological properties, and their frequency of use. These linguistic features are encoded in the tool, which includes the orthographic and phonological transcriptions, and the phonotactic structure of each word. Moreover, most of the entries are associated with their respective ARASAAC pictogram, providing an additional and inclusive tool for treating speech impairments. The user-friendly interface is structured to allow for different and adaptable search options. DILLo allows Speech-Language Pathologists (SLPs) to obtain a rich, tailored, and varied selection of suitable linguistic stimuli. It can be used to customize the treatment of many impairments, e.g., Speech Sound Disorders, Childhood Apraxia of Speech, Specific Learning Disabilities, aphasia, dysarthria, dysphonia, and the auditory training that follows cochlear implantations

DILLo: an Italian lexical database for speech-language pathologists

A novel lexical resource for treating speech impairments from childhood to senility: DILLo—Database Italiano del Lessico per Logopedisti (i.e., Italian Database for Speech-Language Pathologists) is presented. DILLo is a free online web application that allows extraction of filtered wordlists for flexible rehabilitative purposes. Its major aim is to provide Italian speech-language pathologists (SLPs) with a resource that takes advantage of Information and Communication Technologies for language in a healthcare setting. DILLo’s design adopts an integrated approach that envisages fruitful cooperation between clinical and linguistic professionals. The 7690 Italian words in the database have been selected based on phonological, phonotactic, and morphological properties, and their frequency of use. These linguistic features are encoded in the tool, which includes the orthographic and phonological transcriptions, and the phonotactic structure of each word. Moreover, most of the entries are associated with their respective ARASAAC pictogram, providing an additional and inclusive tool for treating speech impairments. The user-friendly interface is structured to allow for different and adaptable search options. DILLo allows Speech-Language Pathologists (SLPs) to obtain a rich, tailored, and varied selection of suitable linguistic stimuli. It can be used to customize the treatment of many impairments, e.g., Speech Sound Disorders, Childhood Apraxia of Speech, Specific Learning Disabilities, aphasia, dysarthria, dysphonia, and the auditory training that follows cochlear implantations

Non solo a Milano: arte, cultura, spettacolo. Tomo secondo

The local marketing with a participatory bottom-up logic begins with the active teaching of geography and applied aims recognition, cataloging, description and enhancement of our cultural heritage

Effect of complete androgen blockade on pathologic stage and resection margin status of prostate cancer: Progress pathology report of the Italian PROSIT study

OBJECTIVES: To compare the pathologic stage and surgical margin status in patients undergoing either immediate radical prostatectomy or surgery preceded by 3 or 6 months of neoadjuvant hormonal treatment (NHT) in a prospective, randomized study. METHODS: Four hundred thirty-one men with prostate cancer were enrolled in the Italian randomized prospective PROSIT study. The whole-mount sectioning technique was used. By May 1999, the reviewing pathologist had evaluated 303 specimens. One hundred seven patients were untreated before radical prostatectomy was performed, and 114 and 82 patients had been treated for 3 and 6 months, respectively, with complete androgen blockade. RESULTS: Pathologic organ-confined disease was found in 63.1% of patients with clinical Stage B disease treated with 6 months of NHT versus 61.0% after 3 months of NHT and 37.5% after immediate surgery. Among patients with clinical Stage C tumors, pathologic staging found organ-confined disease in 62.5%, 32.1%, and 11.1% of patients after 6 months of NHT, 3 months of NHT, and immediate surgery, respectively. Three months of NHT produced a significant increase in negative margins both in patients with clinical Stage B and C disease, but the addition of another 3 months of treatment did not significantly improve this result. A lower degree of benefit was observed in patients with clinical Stage C tumors. CONCLUSIONS: This study shows that complete androgen blockade before surgery is beneficial in men with clinical Stage B disease. The effects are more pronounced after 6 months of NHT than after 3 months

Effect of complete androgen blockade on pathologic stage and resection margin status of prostate cancer: progress pathology report of the Italian PROSIT study.

OBJECTIVES: To compare the pathologic stage and surgical margin status in patients undergoing either immediate radical prostatectomy or surgery preceded by 3 or 6 months of neoadjuvant hormonal treatment (NHT) in a prospective, randomized study. METHODS: Four hundred thirty-one men with prostate cancer were enrolled in the Italian randomized prospective PROSIT study. The whole-mount sectioning technique was used. By May 1999, the reviewing pathologist had evaluated 303 specimens. One hundred seven patients were untreated before radical prostatectomy was performed, and 114 and 82 patients had been treated for 3 and 6 months, respectively, with complete androgen blockade. RESULTS: Pathologic organ-confined disease was found in 63.1% of patients with clinical Stage B disease treated with 6 months of NHT versus 61.0% after 3 months of NHT and 37.5% after immediate surgery. Among patients with clinical Stage C tumors, pathologic staging found organ-confined disease in 62.5%, 32.1%, and 11.1% of patients after 6 months of NHT, 3 months of NHT, and immediate surgery, respectively. Three months of NHT produced a significant increase in negative margins both in patients with clinical Stage B and C disease, but the addition of another 3 months of treatment did not significantly improve this result. A lower degree of benefit was observed in patients with clinical Stage C tumors. CONCLUSIONS: This study shows that complete androgen blockade before surgery is beneficial in men with clinical Stage B disease. The effects are more pronounced after 6 months of NHT than after 3 months