EFFICACIA DEL CARBOSSIMETILGLUCANO NELLA REGRESSIONE DELLE ALTERAZIONI CITOLOGICHE CERVICALI DI BASSO GRADO HPV CORRELATE

Lo studio si propone di valutare l’efficacia del carbossimetil?glucano (Colpofix®) in pazienti con citologia anormale includendo pazienti che allo screening presentano citologia deponente per ASCUS-LSIL, suddivise poi in pazienti con referto citologico di ASCUS o LSIL e colposcopia negativa e pazienti con citologia anormale, colposcopia positiva ed esame istologico deponente per HPV-CIN1, le quali, avendo prospettato loro la possibilità di scelta tra trattamento fisico distruttivo e follow-up, decidono per il follow-up. Metodi. Presso l’ambulatorio di Laserchirurgia e Patologia Cervico-Vaginale dell’ Istituto di Scienze Ginecologiche , Perinatologia e Puericultura dell’Università degli Studi “La Sapienza” di Roma, sede Policlinico Umberto I , nel periodo compreso tra settembre 2007 e dicembre 2008 sono state reclutate un totale di 60 pazienti che allo screening presentavano citologia deponente per ASCUS-LSIL suddivise in due sottogruppi: pazienti con referto citologico di ASCUS o LSIL e colposcopia negativa e pazienti con citologia anormale, colposcopia positiva ed esame istologico deponente per HPV-CIN1, le quali, avendo prospettato loro la possibilità di scelta tra trattamento fisico distruttivo e follow-up, hanno deciso per il follow-up. Il trattamento prevede la somministrazione di carbossimetil?glucano gel nebulizzante in ragione di una applicazione al giorno (5 erogazioni) per 20 giorni, seguiti da 10 giorni di pausa ed un ulteriore ciclo di 20 giorni. Le pazienti sono state valutate con controllo colpo-citologico a 3, 6 e 12 mesi dalla fine della terapia. Risultati. Nel gruppo di pazienti con citologia positiva e colposcopia negativa, su un totale di 30, 10 (33%) presentavano diagnosi di ASCUS, 20 (67%) di LSIL. Al primo controllo colpo-citologico a 3 mesi 8 su 10 pazienti (80%) con diagnosi iniziale di ASCUS sono risultate negative, 7 su 20 pazienti (35%) con diagnosi iniziale di LSIL sono risultate negative; al controllo colpo-citologico a 6 mesi 10 su10 pazienti (100%) con diagnosi iniziale di ASCUS sono risultate negative, 14 su 20 pazienti (70%) con diagnosi iniziale di LSIL sono risultate negative; al controllo a 12 mesi 17 su 20 pazienti (85%) con diagnosi iniziale di LSIL sono risultate negative mentre 3 pazienti (15%) sono andate perse al follow-up. Delle 30 pazienti che presentavano allo screening citologia anormale, colposcopia positiva ed esame istologico deponente per HPV-CIN1 al primo controllo colpo-citologico a 3 mesi 6 su 30 pazienti (20%) sono risultate negative, al controllo colpo-citologico a 6 mesi 18 su 30 pazienti (60%) sono risultate negative , al controllo colpo-citologico a 12 mesi 24 su 30 pazienti (80%) sono risultate negative. La persistenza di CIN1-HPV, confermata istologicamente, è stata riscontrata in 4 su 30 pazienti (13%), per le quali è stata scelta la terapia fisico distruttiva come trattamento finale, mentre 2 su 30 pazienti (6%) sono andate perse al follow-up. Conclusioni. Il nostro studio ha evidenziato, con un follow-up semestrale di 12 mesi, in donne che hanno fatto regolare uso secondo lo schema proposto del carbissimetilbetaglucano, la totale regressione delle lesioni citologiche di LSIL, con colposcopia negativa, dell’85%, e la totale regressione delle lesioni istologiche di CIN1-HPV dell’80%, rappresentando quindi una valida alternativa al trattamento fisico distruttivo immediato e al semplice “wait and see”, in quanto provvista di una buona tollerabilità al farmaco, basso costo, alta adesione delle pazienti e netto miglioramento dell’indice di regressione delle lesioni a 12 mesi

Laser vaporization in the management of CIN

To evaluate the effectiveness of laser CO2 vaporization in high-grade cervical intraepithelial neoplasias and to assess the diagnostic reliability of cytology, colposcopy, microbiology and HPV tests in predicting recurrence in a long-term outcome. Forty-four patients affectd by high-grade cervical intraepithelial neoplasia (HG-CIN) were submitted to laser CO2 vaporization and followed-up a minimum of five years. Vaginal smears for microbiological examination were detected. HPV testing was performed by polymerase chain reaction (PCR). The average age of the patients was 19.5 years (range 15-24). The cure rate after a single treatment was 95%. Two cases (5%) revealed HG-CIN persistence after three months. The five year follow-up of all cases submitted to a second laser procedure revealed negative cytologic and colposcopic findings. A higher degree of expertise and experience from the colposcopist and long-term follow-up proves the effectiveness of laser vaporization in the management of CIN in young women. It has been suggested that HPV infection alone may not be sufficient to promote carcinogenesis and that other cofactors could be involved. Microbiological tests are important to identify and treat any inflammation which might represent a cofactor of HPV infection in the pathogenesis of cervical dysplasia. Cytocolposcopic long-term follow-up, microbiological and HPV tests can improve regression of disease.Aims: To evaluate the effectiveness of laser CO(2) vaporization in high-grade cervical intraepithelial neoplasias and to assess the diagnostic reliability of cytology, colposcopy, microbiology and HPV tests in predicting recurrence in a long-term outcome. Methods: Forty-four patients affectd by high-grade cervical intraepithelial neoplasia (HG-CIN) were submitted to laser CO(2) vaporization and followed-up a minimum of five years. Vaginal smears for microbiological examination were detected. HPV testing was performed by polymerase chain reaction (PCR). Results: The average age of the patients was 19.5 years (range 15-24). The cure rate after a single treatment was 95%. Two cases (5%) revealed HG-CIN persistence after three months. The five year follow-up of all cases submitted to a second laser procedure revealed negative cytologic and colposcopic findings. Conclusions: A higher degree of expertise and experience from the colposcopist and long-term follow-up proves the effectiveness o

Design and Integration of Automation Systems with Manual Operation: Small and Medium Enterprises Issues

Today it is more and more mandatory for all commercial companies to comply with the principles and methodologies of Industry 4.0 and to achieve the related capabilities protecting their competitiveness and taking a leading-edge position on market as regards technologies. Specifically, the whole production and sale system must achieve the fundamental characteristics of Industry 4.0 approach, but specially the manufacturing companies must also change and update their management procedures, internal organization, resource training, assets and all production process to keep safe their current business capacities. This evolution process is even more critical for Small and Medium Enterprises (SME), that traditionally tend to be conservative and to protect their way of operation, usually characterized by a low level of automation. The work presented focuses on the design and integration of a semi-automatic welding cell of train bolster in a SME which is currently realizing a project aimed to the acquisition of Industry 4.0 capabilities, with special focus on manufacturing processes. Among them, one of the most important is the production of welded-steel critical structures, that the Company supplies to prime manufacturer of railway rolling stock systems. The experience gained during the activity, the criticalities due to the integration processes and the adopted design methodologies are here described. The work has been carried out consistently with the Systems Engineering principles, starting from the requirements elicitation and analysis to the systematic approach for the design and integration activities

Oral contraceptives and clinical recurrence of human papillomavirus lesions and cervical intraepithelial neoplasia following treatment

Objective: To evaluate the effect of oral contraceptive use on the recurrence rate of human papillomavirus (HPV) lesions and cervical intraepithelial neoplasia (CIN) following ablative or excisional procedures in a long-term follow-up. Method: The study was conducted with 650 oral contraceptive users presenting with HPV lesions and/or CIN, and 670 women who had these lesions but did not use oral contraceptives acted as controls. The participants underwent cytologic evaluations, colposcopy, and direct biopsy, followed by either ablative treatment by laser carbon dioxide vaporization or excision by a loop electrosurgical excision procedure or cold knife conization. They were then followed up for a minimum of 5 years. Results: The recurrence rates did not differ statistically between the case and control groups. Conclusion: Oral contraceptive use was not found to increase the recurrence rate of HPV lesions and/or CIN after ablative or surgical treatment. © 2007 International Federation of Gynecology and Obstetrics

Conservative approach to preneoplastic cervical lesions in postmenopause

Aim: To evaluate the recurrence rate of high-grade squamous intraepithelial lesions in postmenopausal women previously submitted to laser CO2 conization and the role of persistent oncogenic HPV types. Patients and Methods: Fifty-five patients with a cytological diagnosis of high-grade squamous intraepithelial lesions were triaged with a standard colposcopy. Hormonal replacement therapy was considered as significative in influencing cervical trophism. Vaginal smears for microbiological examination were obtained. H-R HPV test was performed by PCR. The follow-up checks including cytology, colposcopy and HVP test were performed for a minimum of 5 years. Results: Histological analysis revealed 19 CIN2 (cervical intraepithelial lesions) and 36 CIN3 lesions. The cumulative failure rate at first treatment was 14%. HPV test was positive for HPV 16 type in all patients. Forty-two patients during the follow up checks resulted negative to cytology, colposcopy and HR HPV test. At the one-year follow-up check, 7 patients revealed normal cytological and abnormal colposcopical findings and persistent positive HR HPV test. At the five-year follow-up check, 14 patients with a normal cytological smear had a recurrence of CIN2/3 and positive HR HPV test. Conclusion: In postmenopause, the correct management of H-R squamous intraepithelial lesions is still debated. However, a satisfactory follow-up is the main requirement for the conservative management. HPV typing in the follow-up is important to detect persistent types to identify women at risk of developing cervical abnormalities. The incidence of cervical neoplasia does not decrease with increasing age. Since HPV positivity predicted subsequent infection, testing postmenopausal patients for the virus may be a cost-effective method of disease prevention

A homozygous MED11 C-terminal variant causes a lethal neurodegenerative disease

The mediator (MED) multisubunit-complex modulates the activity of the transcriptional machinery, and genetic defects in different MED subunits (17, 20, 27) have been implicated in neurologic diseases. In this study, we identified a recurrent homozygous variant in MED11 (c.325C>T; p.Arg109Ter) in 7 affected individuals from 5 unrelated families