Extending Human Papillomavirus (HPV) vaccination beyond female adolescents and after treatment for high grade CIN: the Italian HPV Study Group (IHSG) review and position paper.

OBJECTIVE: Human PapillomaVirus (HPV) vaccination has been introduced in recent years in clinical practice as the most effective primary prevention strategy for cervical cancer and HPV-induced lesions, either pre-malignant or benign. Since its introduction, HPV vaccination has been progressively demonstrated as extremely effective in preventing extra-genital and male diseases also; furthermore, non only adolescents but adult subjects have been investigated and reported as positively responding to vaccine immunostimulation. More recently, effectiveness of post-treatment vaccine administration has been preliminarily investigated with very promising results in terms of decreased recurrences. On this basis, we report an Italian-focused picture of the state of the art and take a position in favour of the extension of HPV vaccination to male adolescents, to older age groups and to already treated subjects.

Thin vulvar melanoma: a challenging diagnosis. Dermoscopic features of a case series.

BACKGROUND: Vulvar melanoma (VM) is rare and is often diagnosed late. Dermoscopy may aid in its recognition, differentiating VM from other more common vulvar lesions, such as melanosis and naevi. However, little is known about the dermoscopic features of thin VM. AIM: To retrospectively analyse a series of histopathologically diagnosed thin VMs and to highlight their most suggestive dermoscopic features. METHODS: A multicentre, retrospective study was conducted, including histopathologically proven thin VMs, either intraepidermal or with Breslow thickness ≤ 0.5 mm, diagnosed during the period 2016-2018. We particularly focused on their dermoscopic characteristics to highlight the most suggestive dermoscopic diagnostic clues. RESULTS: In total, 14 cases of early-stage VM were included, in women with a mean age at diagnosis of 64.86 years. The most frequently affected sites were the labia minora. Of these, 11 cases were unifocal. Dermoscopy most often revealed structureless areas, grey globules and areas, irregular black-brown dots, blue and white structures, and red areas. CONCLUSIONS: In our experience, early-stage VM often exhibits dermoscopic features that are more typical of thicker cutaneous melanomas. Dermoscopy may provide useful clues for the prompt diagnosis of thin VM.

[Perinatal transmission of HIV]. / Infezione perinatale da HIV.

Paediatric HIV infection is still the most important pandemic, despite the substantial reductions of mother to child transmission achieved in North America and Europe. The total number of people living with the human immunodeficiency virus (HIV) rose in 2004 to reach its highest level ever: an estimated 39.4 million people are living with the virus. This number has been rising in every region, compared with two years ago, with the steepest increases occurring in East Asia, in Eastern Europe and central Asia. Sub-Saharan Africa remains by far the worst-affected region, with 25,4 million people living with HIV at the end of 2004. The AIDS epidemic is affecting women and girls in increasing number in Africa; them make up almost 57% of all people infected with HIV, but became a striking 76% in Sub-Saharan area. This review will focus on the current knowledge available regarding the timing of HIV transmission and the subsequent implications for its prevention. Mother to child transmission can take place during pregnancy, labour, delivery and post-partum, through breastfeeding. Different factors may influence HIV transmission during each of these time periods, and hence interventions to reduce transmission during each of these periods may also require different preventive strategies. The risk of mother to child transmission of HIV infection can be substantially reduced from 15-20% without interventions to less than 2% with the use of antiretroviral therapy during pregnancy, during labour and in the neonatal period, with an elective caesarean section delivery and refraining from breastfeeding. Factors associated with an increased risk of perinatal HIV transmission include advanced maternal blood, prolonged duration of ruptured membranes, and increased quantity of HIV in maternal blood at delivery.

Rates of neonatal death and cerebral palsy associated with fetal growth restriction among very low birthweight infants. A temporal analysis.

OBJECTIVE: To assess whether changes over time in neonatal survival and infants' neurodevelopmental outcome among very low birthweight (VLBW) infants was correlated with the obstetric aetiology of VLBW. DESIGN: A cohort study of 773 VLBW infants. SETTING: A University hospital in Northern Italy. POPULATION: All the VLBW infants born over a 20-year period (1983-2002) at a single institution. METHODS: Evaluation of neonatal mortality and neurodevelopmental outcome of the surviving infants at 2 years of corrected age. Logistic regression analysis was used to compare the improvements of neonatal outcome associated with obstetric risk factors over time. MAIN OUTCOME MEASURES: The risk reduction of neonatal death or cerebral palsy associated with each obstetric category responsible for VLBW over time. RESULTS: The overall rates of neonatal mortality and cerebral palsy were 38.7% (43/111) and 17% (9/53) in the period 1983-87 and 13.7% (34/24) and 6.3% (13/205) in the period 1998-2002, respectively. The adjusted decrement per 5-year period was 33.1% (95% CI = 7.9-51.4) for neonatal death and 29.1% (95% CI = 25.3-32.7) for cerebral palsy, respectively. The adjusted rise in the rate of intact survival at 2 years of corrected age was 7.6% (95% CI = 3.1-12.3) per quinquennium. In logistic models with neonatal death or cerebral palsy as a combined outcome variable, and gestational age, corticosteroid use, surfactant use, and time of birth as explanatory variables, fetal growth restriction (P < 0.001) and pre-eclampsia (P= 0.011) interacted significantly with period of birth. The adjusted decrement in the rate of neonatal death or cerebral palsy as a combined variable was 27.5% per 5 years (95% CI = 13-39.6) in the overall population, 54.5% per 5 years (95% CI = 46.8-61.2) (P < 0.001 compared with overall population) among growth-restricted infants and 50.3% per 5 years (95% CI = 42.5-57.1) (P= 0.003 compared with overall population) in infants born to mothers with pre-eclampsia. CONCLUSIONS: Over a period of 20 years, the decrement in the rate of neonatal death or cerebral palsy was higher in growth-restricted fetuses than in other VLBW infants. This reduction was not obtained at the expense of an increased rate of neurodevelopmental impairments in surviving infants.

Localization of polypeptides in frog virus 3 by radioiodination technique.

Frog virus 3 is an amphibian icosahedral deoxyribovirus which replicates in the cytoplasm of infected cells. The radioiodination of purified virions using the enzyme lactoperoxidase has shown that the major component of the structural proteins is only partially exposed through the lipoprotein membrane that constitutes the outer layer of the icosahedral capsid.