European consensus statement on expert colposcopy.

BACKGROUND: Following the publication of the European consensus statement on standards for essential colposcopy in 2020, the need for standards relating to more complex and challenging colposcopy practice was recognised. These standards relate to colposcopy undertaken in patients identified through cervical screening and tertiary referrals from colposcopists who undertake standard colposcopy only. This set of recommendations provides a review of the current literature and agreement on care for recognised complex cases. With good uptake of human papillomavirus (HPV) immunisation, we anticipate a marked reduction in cervical disease over the next decade. Still, the expert colposcopist will continue to be vital in managing complex cases, including previous cervical intraepithelial neoplasia (CIN)/complex screening histories and multi-zonal disease. AIMS: To provide expert guidance on complex colposcopy cases through published evidence and expert consensus. MATERIAL & METHODS: Members of the EFC and ESGO formed a working group to identify topics considered to be the remit of the expert rather than the standard colposcopy service. These were presented at the EFC satellite meeting, Helsinki 2021, for broader discussion and finalisation of the topics. RESULTS & DISCUSSION: The agreed standards included colposcopy in pregnancy and post-menopause, investigation and management of glandular abnormalities, persistent high-risk HPV+ with normal/low-grade cytology, colposcopy management of type 3 transformation zones (TZ), high-grade cytology and normal colposcopy, colposcopy adjuncts, follow-up after treatment with CIN next to TZ margins and follow-up after treatment with CIN with persistent HPV+, and more. These standards are under review to create a final paper of consensus standards for dissemination to all EFC and ESGO members.

Preparing railway stakeholders against CBRNe threats through better cooperation with security practitioners.

This paper presents partial results from the Horizon2020 PROACTIVE project, following a set of literature reviews and surveys conducted with first responder organisations and rail security experts. Qualitative and quantitative data from two surveys are being presented. The results provide an overview of the CBRNe (Chemical, Biological, Radiological, Nuclear and explosive) preparedness and response capabilities of railway stakeholders and how these relate to a wider context represented by CBRNe first responders. The results highlight a set of challenges as well as five core skills that railway staff need to develop or improve: 1) understand the specific characteristics of the CBRNe threat, 2) develop basic response measures, 3) cooperate with authorities and train with specialised first responders, 4) improve public awareness about this threat, and 5) optimise crisis communication. In line with these, project PROACTIVE will further help update rail crisis management plans with practical recommendations concerning the CBRNe threat.

Are Medical Students from Across the World Aware of Cervical Cancer, HPV Infection and Vaccination? A Cross-Sectional Comparative Study.

This study aims to understand and compare the level of knowledge, the attitude and the awareness of cervical cancer, HPV infection and vaccination among medical students from across the globe. It was conducted by sharing a questionnaire on medical students' Facebook groups. We successfully analysed 736 responses, of which 74.3% were females and 25.7% males. Their mean age was 23.14. As regards to the respondents' knowledge of the risk factors for cervical cancer, 28.8% of the participants identified HPV, 23.5% chose "Having many sexual partners", 15.4% identified "Starting the sexual life at a young age", 14.7% chose HIV and 13.3% answered smoking. Regarding the knowledge of the Pap test, 92.4% of the students stated that they knew what it is, although 98.5% of these respondents chose the correct answer. Concerning the knowledge of early warning signs of cervical cancer, 34.4% recognised vaginal bleeding. According to our research, American, Eastern and Western European students had more knowledge regarding the risk factors, early signs of cervical cancer and Pap test than African and Asian students. A total of 50% of the sexually active females had gone at least once to be screened by the means of a Pap test. A total of 39.8% of the participants stated that they had received the HPV vaccine. The findings of our research highlight the need for additional education measures to improve knowledge and awareness regarding HPV infection, especially among medical students, since they will be future healthcare providers.

European consensus statement on essential colposcopy.

This European consensus statement on essential colposcopy provides standards for the general colposcopist seeing women referred for colposcopy with an abnormal cervical screening test (including cytology and HPV tests) or with a clinically suspicious cervix. The article gives guidance regarding the aims and conduct of colposcopy. Recommendations are provided on colposcopy technique, the management of common colposcopy issues, treatment and follow-up of after treatment of CIN or early stage cervical. Colposcopists should make an informed decision on the management of each individual that is referred and organize appropriate follow-up. Cervical cancer is still a major health issue and the quality of care can only improve if there is a structured guidance for women with an abnormal smear or suspicious cervix.

Collecting evidence from distributed sources to evaluate railway suicide and trespass prevention measures.

It can be difficult to select from available safety preventative measures, especially where there is limited evidence of effectiveness in different contexts. This paper describes application of a method to identify and evaluate wide-ranging preventative measures for rail suicide and trespass fatalities. Evidence from literature and industry sources was collated and reviewed in a two stage process to achieve consensus among experts on the likely effects of the measures and factors influencing their implementation. Multiple evaluation criteria were used to examine the measures from different perspectives. Fencing, awareness campaigns and different types of organisational initiatives were recommended for further testing. This is the first time evidence has been collected internationally across such a range of preventative measures. Commentary is provided on using this type of approach to select safety measures from a pool of prevention options, including how re-framing the scope of the exercise could identify alternative options for prevention. Practitioner summary: The findings give insight to how different measures work in different ways and how industry can consider this in strategic initiatives. The method could be used in future studies with different frames of reference (e.g. different timescales, level of ambition and safety context e.g. railway crossings or highway fatalities). Abbreviation: RESTRAIL: REduction of Suicides and Trespasses on RAILway property.

The iris signal: blue periphery, tan collaret and freckles pattern - strong indicators for epidermal skin cancer in South-Eastern Europe.

BACKGROUND: Eye and skin share the embryological origin. Both are established risk factors in epidermal skin cancer. There are few reports using iris colour classification scales, most of them analyse colour in general or are too complex to use in daily practice. OBJECTIVES: To investigate which iris colour pattern is associated with epidermal skin cancer in a S-E European Caucasian population. METHODS: A case-control study was conducted on 480 patients: 229 skin cancers patients and 251 controls (dermatological patients free of skin cancers) admitted in two medical clinics of Dermatology in Bucharest, between October 2011 and May 2014. High-resolution iris photographs were taken for each patient. Three parameters of the iris were analysed individually and in association patterns for each patient: periphery, collaret and freckles. RESULTS: The most frequent iris colour pattern associated with epidermal skin cancer was blue periphery with light brown collaret and freckles present. In terms of individual parameters, the strongest indicators for skin cancer patients were blue periphery and blue collaret. CONCLUSIONS: The results of this study sustain the hypothesis that blue periphery with light brown collaret and freckles iris pattern is a reliable phenotypic marker for epidermal skin cancer. The results of this study differ from previous reports in which skin cancer risk was associated with a homogeneous blue iris. We account these differences in the characteristics of the recruited patients (S-E European, skin type II and III). The assessment of iris colour patterns is an easy and inexpensive detection tool in skin cancer risk assessment.

Optimizing suicide and trespass prevention on railways: a problem-solving model from the RESTRAIL project.

Suicides and trespassing accidents result in more than 3800 fatalities in Europe, representing 88% of all fatalities occurring within the EU railway system. This paper presents a problem-solving model, which consists of a multistep approach structuring the analysis of a suicide or trespass-related problem on the railways. First, we present the method used to design, evaluate and improve the problem-solving model. Then we describe the model in detail: it comprises six steps with several subsequent actions, and each action is approached through a checklist of prompting questions and possible answers. At the end, we discuss the added value of this model for decision makers and its usability in the selection of optimal prevention measures.

A systematic review of the literature on safety measures to prevent railway suicides and trespassing accidents.

This review covers a central aspect in railway safety which is the prevention of suicides and trespassing accidents. The paper attempts to answer the following research question: 'What measures are available to reduce railway suicide and trespass, and what is the evidence for their effectiveness?' The review is based on 139 relevant publications, ranging from 1978 to 2014. The analysis aimed to identify the past and current trend in the prevention practice by looking both quantitatively and qualitatively at the recommended measures. According to the results, there has been a constant focus on suicide prevention, and only relatively recent interest in trespass countermeasures. The content analysis revealed 19 main preventative categories which include more than 100 specific measures. We identified 16 common categories against railway suicide and trespass, and 3 categories of specific measures to prevent suicide. There are only 22 studies which provide empirical support for the effectiveness of measures. Actual combinations of measures are barely evaluated, but several challenges emerge from the literature. The discussion focuses on the need for a unified approach to suicide and trespass prevention, and on the importance to consider the effect mechanism of the measures in order to design better interventions.

Heterologous type of malignant mixed Müllerian tumor of the uterus presenting as a vulvar mass.

Carcinosarcoma is a rare, extremely aggressive tumor of the uterus with a poor prognosis. The authors describe a case of a 78-year-old woman who presented with a giant mass protruding through the cervix, vagina, and vulva. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The histopathological examination of the surgical specimen revealed a malignant mixed Müllerian tumor. The clinical and pathological features, molecular data, and prognosis of this aggressive neoplasm are discussed. Although uterine carcinosarcomas are extremely rare, when a postmenopausal woman with a vulvar mass is admitted to the gynecology clinic, the physician should consider that the mass may be a carcinosarcoma.

Early diagnosis of limb body wall complex: a case report.

Limb body wall complex (LBWC) is a rare polymalformative syndrome. The majority of cases presented in the literature have been diagnosed in the second or third trimester of pregnancy. The authors present a case of LBWC diagnosed in the first trimester of pregnancy. The combination of two- and three-dimensional ultrasounds proved to be useful for establishing the diagnosis and differentiating from other abdominal wall defects. The diagnosis was followed by therapeutic abortion at 14 weeks' gestation, and the pathological report confirmed the diagnosis.

[Cervugid ovules in cervico-vaginal infections and cervix uteri precancerous conditions treatment]. / Tratamentul infectiilor cervico-vaginale si a starilor precanceroase ale colului uterin cu Cervugid-ovule.

UNLABELLED: This medicine was authorized by the National Drug Agency (ANM, Bucuresti) in 2001. PURPOSE: To evaluate the effectiveness and the tolerance to Cervugid-ovules, a preparation that combines the polyvalent local antiinflammatory action of chloramphenicol, metronidazole and nystatin with the effect of hydrocortisone acetate, an unspecific anti-inflammatory agent; they all are embedded in a Lipex-403, semisynthetic fat. MATERIALS AND METHODS: The evaluation of 500 patients ages between 15 and 85 years with genital infections, registered in the files of "Cl. II Obst. and Gynecology" of the Cuza-Voda Hospital from Iasi has been studied. We studied the subjective manifestations (local discomfort and pelvic pains, local burning and dryness,vulvovaginal itching and dyspareunia) and objective manifestations (vaginal and cervical secretion, the cytotest performed and colored though the Papanicolaou method and reported in the Bethesda system). RESULTS AND DISCUSSION: Healing of the subjective symptoms in 98%, healing of the leukorrhea--as a main objective symptom--in 95%; The Bethesda system cytotest was one of the inflammatory type in the most of the cases and there wew found in 85 cases: 6 ASCUS, 41 LSIL, and 37 HSIL. The use of Cervugid had a healing response in most of the cases when used in acute and chronic cervico-vaginal inflammatory processes. Cervugid may be considered as an important agent in the treatment of the precancerous affections af the cervix uteri on the following reasons: zhe cure of the infections caused by chlamydia, involved in the etiology of cervical neoplasms, the cure of the HPV infection under episome form, classified in the Bethesda system within the ASCUS, AGUS or LSIL classes. When the cytotest was in the HSIL class, a conization in the LLETZ method was performed. CONCLUSIONS: Cervugid is conceived for those three main categories of pathogenic factors related to the etiology of cervico-vaginitis: microbia germs, protozoa and mycosis. In addition, it is active on chlamydia and mycoplasms, always sensitive to chloramphenicol therapy. That is why Cervugid with in local administration is indicated in the microbial, trichomoniasis and mycotic vaginitis caused by one category of pathogenic agents or by associated forms, in cervicitis, in the pelvic inflammatory processes (pelvic congestion, metritis, adnexitis, and inflammatory processes associated with benign or malignant tumors of the genital apparatus). The results obtained proved that Cervugid is highly effective medicine.

The role of heat shock proteins in reproduction.

Heat shock proteins (hsp) were first discovered in cells exposed to elevated temperature. They are preferentially expressed in response to an array of insults, including hyperthermia, free oxygen radicals, heavy metals, inflammation and infection. In addition hsp are involved in several processes essential for cellular function under physiological conditions. Heat shock proteins are expressed during oogenesis and spermatogenesis. In the early stages of the pregnancy they are expressed both in embryo and maternal decidua. Antibodies to bacterial and human hsp are present at high titers in serum of many patients undergoing in vitro fertilization. Several studies provided evidence that immune sensitization to hsp is associated with unsuccessful embryo development and implantation failure in in-vitro-fertilization (IVF) patients.

[Phenytoin influence on human metanephros]. / Influenta fenitoinei asupra metanefrosului uman.

The influence of Phenytoin on the human embryo is knowing to produce the fetal hydantoin syndrome. Even this syndrome is knowing to produce microcephaly, mental retardation, eyelid ptosis etc it is not mentioned the influence of Phenytoin on the human metanephros. This is the reason of our study, made on human embryos. Their mothers received during pregnancy Phenytoin. In one studied embryo we have remarked a malformation in the metanephros. Even we can not make a strong correlation between the malformation and the Phenytoin we consider that pregnant women should not use Phenytoin during pregnancy.

The influence of some prostaglandin analogous on the female rat ovary and uterine tube epithelium.

The synthetic analogous of the prostaglandins are utilized in the obstetrical and gynecological therapy for multiple purposes. 4 lots with 12 nonpregnant female rats were use: the Ist received 25 g/kg/day isopropyl ester PGF2; the IInd lot received 50 g/kg/day isopropyl ester PGF2; the IIIrd lot received 50 g/kg/day optic active cloprostenol; the IVth lot was the witness lot. The medication was intraperitoneally (i.p.) administrated in a unique daily dose. Prostaglandin F2 analogous at small doses (25 micrograms/kg/day) induce vasodilating effects on the ovary blood vessels and functional luteolysis rather than structural luteolysis. Both of the prostaglandins analogous at doses of 50 micrograms/kg/day present obvious vasodilating and luteolytic effects, although the intensity of the phenomenon is not the same, cloprostenol is more active, inducing a more obvious vasodilatation and luteolysis.

Sexual reinforcement in the female rat.

Sexual reinforcement in the female rat was studied in a preparation that allowed continuous operant responding for access to a male rat leading to intromission. Experiment 1 used a high operant level nose-poke response to test the possible reinforcing effects of some components of access to a male. A simple tone stimulus used as a conditioned reinforcer and two odor stimuli, target male bedding and emulsified preputial gland, were tested. None of these contingent events altered responding above or below operant level. Access to the male, which was always accompanied by intromission, immediately increased response rate when it was made contingent upon the nose-poke response. Performance on fixed-ratio schedules was erratic, and response rate was low in comparison to typical food-reinforced responding. An interresponse-time analysis indicated, however, that some effect of the ratio contingency may have been present. In Experiment 2, several modifications of the procedure were tested with the objective of creating a more tractable preparation for behavior analysis. Response type and the hormone delivery method were changed, and 2 target males were used instead of 1. The latter tripled the average number of reinforcers earned in a single session. Differences between sexual and other reinforcers are discussed in terms of procedural, quantitative, and motivational aspects of the sexual reinforcement procedure.

[Heterotopic cloacogenic carcinoma of the lower lip]. / Carcinome cloacogénique hétérotopique de la lèvre inférieure.

Cloacogenic carcinoma is a tumour which develops from cylindric epithelial cells at the anorectal junction. Besides this usual localization, other sites have been described including the vagina, urethra, sigmoid colon, vulva and perianal skin. We observed a labial localization in a 50-year-old woman. A 15 mm tumorous formation developed rapidly after initial excision without skin or mucosal changes. The clinical diagnosis was epidermoid carcinoma but histological examination revealed an aspect comparable to cloacogenic carcinoma with nodules of basaloid tumour cells showing atypical mitosis within the nodules and the uniformly eosinophilic masses. We considered that this particular histological aspect eliminated the diagnosis of basocellular or epidermoid carcinoma and suggest that the carcinoma developed from embryon reliquats of cloacoanal transition cells in a heterotopic localization.