Prevalence of human papillomavirus in young Italian women with normal cytology: how should we adapt the national vaccination policy?

Background: Human Papillomavirus (HPV) is the most common sexually transmitted infection. In Italy, HPV vaccination is now offered free of charge to 12-year-old females. However, some regional health authorities have extended free vaccination to other age-groups, especially to girls under 18 years of age. We conducted a multicentre epidemiological study to ascertain the prevalence of different genotypes of HPV in young Italian women with normal cytology, with the aim of evaluating the possibility of extending vaccination to older females.Methods: The study was performed in 2010. Women aged 16-26 years with normal cytology were studied. Cervical samples were analyzed to identify the presence of HPV by PCR amplification of a segment of ORF L1 (450 bp). All positive HPV-DNA samples underwent viral genotype analysis by means of a restriction fragment length polymorphism assay.Results: Positivity for at least one HPV genotype was found in 18.2% of the 566 women recruited: 48.1% in the 16-17 age-class, 15.4 in the 18-20 age-class, 21.9% in the 21-23 age-class, and 15.5% in the 24-26 age-class; 10.1% of women were infected by at least one high-risk HPV genotype. HPV-16 was the most prevalent genotype. Only 4 (0.7%), 4 (0.7%) and 3 (0.5%) women were infected by HPV-18, HPV-6 and HPV-11, respectively. Of the HPV-DNA-positive women, 64.1% presented only one viral genotype, while 24.3% had multiple infections. The HPV genotypes most often involved in multiple infections were high-risk. A high prevalence was noted in the first years of sexual activity (48.1% of HPV-DNA-positive women aged 16-17 years); HPV prevalence subsequently declined and stabilized.The estimate of cumulative proportions of young women free from any HPV infection at each age was evaluated; 93.3% and 97.1% of 26 year-old women proved free from HPV-16 and/or HPV-18 and from HPV-6 and/or HPV-11, respectively.Conclusions: Our findings confirm the crucial importance of conducting studies on women without cytological damage, in order to optimise and up-date preventive interventions against HPV infection, and suggest that vaccinating 26-year-old females at the time of their first pap-test is to be recommend, though this issue should be further explored

Rome consensus conference-statement: human papilloma virus diseases in males

Human Papillomavirus (HPV) is a very resistant, ubiquitous virus that can survive in the environment without a host. The decision to analyse HPV-related diseases in males was due to the broad dissemination of the virus, and, above all, by the need to stress the importance of primary and secondary prevention measures (currently available for women exclusively). The objective of the Consensus Conference was to make evidence-based recommendations that were designed to facilitate the adoption of a standard approach in clinical practice in Italy. METHODS: The Sponsoring Panel put a series of questions to the members of the Scientific Committee who prepared a summary of the currently available information, relevant for each question, after the review and grading of the existing scientific literature. The summaries were presented to a Jury, also called multidisciplinary Consensus Panel, who drafted a series of recommendations. RESULTS: The prevalence of HPV in males ranges between 1.3-72.9%;. The prevalence curve in males is much higher than that in females and does not tend to decline with age. Women appear to have a higher probability of acquiring HPV genotypes associated with a high oncogenic risk, whereas in males the probability of acquiring low- or high-risk genotypes is similar. The HPV-related diseases that affect males are anogenital warts and cancers of the penis, anus and oropharynx. The quadrivalent vaccine against HPV has proved to be effective in preventing external genital lesions in males aged 16-26 years in 90.4%; (95%; CI: 69.2-98.1) of cases. It has also proved to be effective in preventing precancerous anal lesions in 77.5%; (95%; CI: 39.6-93.3) of cases in a per-protocol analysis and in 91.7%; (95%; CI: 44.6-99.8) of cases in a post-hoc analysis. Early ecological studies demonstrate reduction of genital warts in vaccinated females and some herd immunity in males when vaccine coverage is high, although males who have sex with males gained no benefit at all. Males with an immunodeficiency disease are at greater risk of developing disease. Infertility seems to be caused by HPV in some cases. Studies demonstrate vaccination to both genders can be more efficacious and social equity matters are to be taken into consideration. CONCLUSIONS: The Jury made Recommendations based on the scientific evidence presented by the Scientific Committee. Accordingly, for prevention purposes and social fairness and equality, as both sexes are affected by the disease, the vaccination of 12-year-old males against HPV should be recommended in order to guaranty protection to everyone. Aspects related to healthcare policy and economic sustainability, are to be discussed by respective public system representatives. More campaigns to raise awareness through all institutional channels are needed, not only regarding anogenital warts, but for HPV-related diseases in general in males in accordance to new scientific evidences

Advantages of cone beam computed tomography (CBCT) in the orthodontic treatment planning of cleidocranial dysplasia patients: a case report

Our aim was to discuss, by presenting a case, the possibilities connected to the use of a CBCT exam in the dental evaluation of patients with Cleidocranial Dysplasia (CCD), an autosomal dominant skeletal dysplasia with delayed exfoliation of deciduous and eruption of permanent teeth and multiple supernumeraries, often impacted. We think that CBCT in this patient was adequate to accurately evaluate impacted teeth position and anatomy, resulting thus useful both in the diagnostic process and in the treatment planning, with an important reduction in the radiation dose absorbed by the patient

The Australia Telescope 20GHz Survey: Hardware, Observing Strategy, and Scanning Survey Catalog

The Australia Telescope 20GHz (AT20G) survey is a large area (2{\pi} sr), sensitive (40mJy), high frequency (20GHz) survey of the southern sky. The survey was conducted in two parts: an initial fast scanning survey, and a series of more accurate follow-up observations. The follow-up survey catalog has been presented by Murphy et al. 2010. In this paper we discuss the hardware setup and scanning survey strategy as well as the production of the scanning survey catalog.Comment: 32 pages, 20 figures, accepted for publication in experimental astronom

Health burden and economic impact of measles-related hospitalizations in Italy in 2002–2003

Background: A large measles outbreak occurred in Italy in 2002 - 2003. This study evaluates the health burden and economic impact of measles- related hospitalizations in Italy during the specified period. Methods: Hospital discharge abstract data for measles hospitalizations in Italy during 2002 - 2003 were analysed to obtain information regarding number and rates of measles hospitalizations by geographical area and age group, length of hospital stay, and complications. Hospitalization costs were estimated on the basis of Diagnosis- Related Groups. Results: A total of 5,154 hospitalizations were identified, 3,478 ( 67%) of which occurred in children < 15 years of age. Most hospitalizations occurred in southern Italy ( 71 %) and children below 1 year of age presented the greatest hospitalization rates ( 46.2/ 100,000 and 19.0/ 100,000, respectively in 2002 and 2003). Pneumonia was diagnosed in 594 cases ( 11.5%) and encephalitis in 138 cases ( 2.7%). Total hospital charges were approximately (sic) 8.8 million. Conclusion: The nationwide health burden associated with measles during the 2002 - 2003 outbreak was substantial and a high cost was incurred by the Italian National Health Service for the thousands of measles- related hospitalizations which occurred. By assuming that hospital costs represent 40 - 50% of the direct costs of measles cases, direct costs of measles for the two years combined were estimated to be between (sic)17.6 - 22.0 million, which equates to the vaccination of 1.5 - 1.9 million children ( 3 - 4 birth cohorts) with one dose of MMR. The high cost of measles and the severity of its complications fully justify the commitment required to reach measles elimination

Evolution of active galactic nuclei

[Abriged] Supermassive black holes (SMBH) lurk in the nuclei of most massive galaxies, perhaps in all of them. The tight observed scaling relations between SMBH masses and structural properties of their host spheroids likely indicate that the processes fostering the growth of both components are physically linked, despite the many orders of magnitude difference in their physical size. This chapter discusses how we constrain the evolution of SMBH, probed by their actively growing phases, when they shine as active galactic nuclei (AGN) with luminosities often in excess of that of the entire stellar population of their host galaxies. Following loosely the chronological developments of the field, we begin by discussing early evolutionary studies, when AGN represented beacons of light probing the most distant reaches of the universe and were used as tracers of the large scale structure. This early study turned into AGN "Demography", once it was realized that the strong evolution (in luminosity, number density) of the AGN population hindered any attempt to derive cosmological parameters from AGN observations directly. Following a discussion of the state of the art in the study of AGN luminosity functions, we move on to discuss the "modern" view of AGN evolution, one in which a bigger emphasis is given to the physical relationships between the population of growing black holes and their environment. This includes observational and theoretical efforts aimed at constraining and understanding the evolution of scaling relations, as well as the resulting limits on the evolution of the SMBH mass function. Physical models of AGN feedback and the ongoing efforts to isolate them observationally are discussed next. Finally, we touch upon the problem of when and how the first black holes formed and the role of black holes in the high-redshift universe.Comment: 75 pages, 35 figures. Modified version of the chapter accepted to appear in "Planets, Stars and Stellar Systems", vol 6, ed W. Keel (www.springer.com/astronomy/book/978-90-481-8818-5). The number of references is limited upon request of the editors. Original submission to Springer: June 201