Multicentric data analysis of the learning curve for laparoscopic Shull's repair of pelvic floor defects.

Introduction: Pelvic organs prolapse remains a significant health concern affecting millions of women worldwide. The use of native tissues to suspend the apex has acquired relevance in urogynecologic surgery. One of the most commonly used procedures performed without mesh is the technique described by Shull, consisting of suturing the vaginal apex to the uterosacral ligaments. The objective of the study is to evaluate the learning curve of laparoscopic Shull's repair for the correction of pelvic floor defects, including the surgery time and surgical outcomes. Materials and methods: This is a retrospective study conducted at the Policlinico G. Martino, University of Messina, Messina, Italy, and Policlinico Vanvitelli, Vanvitelli University, Naples, Italy. All patients affected by grade I-IV POP, consisting of apical prolapse with or without cystocele, and who underwent laparoscopic Shull's technique for prolapse correction were enrolled. The endpoints to estimate the learning curve for the procedure were the percentage of laparoscopic procedures completed, operative time, and the early complication rate. Results: A total of 31 laparoscopic Shull repairs were collected for the study. To evaluate the learning curve of the technique, we divided the 31 cases into three different groups: Procedures 0-10; 11-20; 21-31. The parameter for evaluating technique learning was the operative time. Group 21-31 demonstrated an operative time of 97 min (SD 20), compared with 121 min (SD 23) in group 0-10 and 120 min (SD 13) in group 11-20. A comparison of these means through ANOVA showed a p-value of 0.01 for the entire system, and 0.95 for the comparison between 0 and 10 and 11-20, 0.04 for 0-10 vs. 21-31, and 0.02 between 11 and 20 and 21-31. Conclusions: The rate of surgical improvement in terms of time became effective after an average of 20 procedures. However, the improvement seems to be effective case by case for surgeons skilled in basic endoscopy.

Fetal aortic isthmus Doppler assessment to predict the adverse perinatal outcomes associated with fetal growth restriction: systematic review and meta-analysis.

PURPOSE: Fetal growth restriction (FGR) management and delivery planning is based on a multimodal approach. This meta-analysis aimed to evaluate the prognostic accuracies of the aortic isthmus Doppler to predict adverse perinatal outcomes in singleton pregnancies with FGR. METHODS: PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov and Google scholar were searched from inception to May 2021, for studies on the prognostic accuracy of anterograde aortic isthmus flow compared with retrograde aortic isthmus flow in singleton pregnancy with FGR. The meta-analysis was registered on PROSPERO and was assessed according to PRISMA and Newcastle-Ottawa Scale. DerSimonian and Laird's random-effect model was used for relative risks, Freeman-Tukey Double Arcsine for pooled estimates and exact method to stabilize variances and CIs. Heterogeneity was quantified using I2 statistics. RESULTS: A total of 2933 articles were identified through the electronic search, of which 6 studies (involving 240 women) were included. The quality evaluation of studies revealed an overall acceptable score for study group selection and comparability and substantial heterogeneity. The risk of perinatal death was significantly greater in fetuses with retrograde Aortic Isthmus blood flow, with a RR of 5.17 (p value 0.00001). Similarly, the stillbirth rate was found to have a RR of 5.39 (p value 0.00001). Respiratory distress syndrome had a RR of 2.64 (p value = 0.03) in the group of fetuses with retrograde Aortic Isthmus blood flow. CONCLUSION: Aortic Isthmus Doppler study may add information for FGR management. However, additional clinical trial are required to assess its applicability in clinical practice.

First report on natural infection with Leishmania infantum in a domestic ferret (Mustela putorius furo) in Spain.

A pet domestic ferret (Mustela putorius furo) with a papular lesion involving the right pinna was diagnosed with chronic pyogranulomatous dermatitis by histopathologic examination. Intralesional, intracytoplasmic oval microorganisms compatible with Leishmania spp. or Histoplasma spp. were observed in macrophages and multinucleate giant cells. Leishmania infantum (L. infantum) infection was diagnosed by PCR, culture in Novy-MacNeal-Nicolle medium, and immunohistochemistry. Abnormal clinicopathological results included increased alanine transferase, alkaline phosphatase, serum gamma glutamyl transferase and polyclonal gammpathy. Anti-Leishmania antibodies were detected by enzyme-linked immunosorbent assay, immunofluorescence antibody test and western blot using L. infantum antigen. Immunoreactivity against the 16 kDa specific L. infantum antigen fraction was observed by western blot. PCR performed in blood samples obtained from this patient after positive parasite isolation detected L. infantum DNA. To the authors' knowledge, this is the first diagnosis and isolation of L. infantum in a domestic ferret naturally infected in an endemic region (Spain) where canine and feline leishmaniosis is frequently detected. According to these findings, ferrets should be included as potential reservoir hosts of L. infantum. Future investigations should analyze the epidemiological role of ferrets in L. infantum infection including the prevalence of infection.

Approaching the transit time limit for high-precision spectroscopy on metastable CO around 6 µm.

As molecular spectroscopy makes its comeback to the limelight of fundamental sciences, scientists need ever better coherent light sources and diagnostic methods. Of particular importance for molecular spectroscopy is the mid infrared spectral region, where strong and narrow ro-vibrational excitations have their fundamental transition frequencies. Unfortunately, much technology in some portions of this spectral region is still rather pioneering. Here we present a high-resolution spectroscopy experiment, based on a molecular beam setup, which pushes the measured linewidth close to the transit time limit, on the order of 100 kHz. Moreover, we discuss the issue of frequency-noise characterization and the linewidth measurement of the ultrastable infrared laser used in the experiment.

Healthcare-associated Clostridium difficile infection: role of correct hand hygiene in cross-infection control.

INTRODUCTION: Clostridium difficile (CD) is the most common cause of health-care-associated infectious diarrhea with increasing incidence and severity in recent years. The main cause of hospital's acquired cross infections can be attributed to incorrect hand hygiene. We described the epidemiology of CD infection (CDI) in a teaching hospital in Southern Italy during a two years surveillance period and evaluated the health-care workers compliance to hand hygiene. METHODS: CDI Incidence rates were calculated as the number of patients with positive C. difficile toxin assay per 10,000 patient-days. Compliance with hand hygiene was the ratio of the number of performed actions to the number of opportunities observed. Approximately 400 Hand Hygiene (HH) opportunities/year /ward were observed. We finally checked out if any correlation could be found. RESULTS: From January 2015 to December 2016 a total number of 854 CD determinations were performed in patients with clinical symptoms of diarrhea. The search for toxins A and B was positive in 175 cases (21,2%), confirming the diagnosis of CDI. Compliance to hand hygiene was significantly inversely associated with the number of CDIs: the lower the compliance of health-care workers with hand hygiene the higher was the number of cases of CDIs (p = 0.003). CONCLUSIONS: According to our results proper handwashing of health-care workers appears to be a key intervention in interrupting CD cross infections regardless of age and type of department in which the patient is admitted.

Clinical and haemodynamic risk factors associated with discrepancies in lower limb length with capillary malformations: data from the national paediatric French cohort CONAPE.

BACKGROUND: Genetics discoveries have allowed for a better understanding of capillary malformations (CMs) associated with overgrowth syndrome. However, molecular analyses are still not easy to perform or interpret. Other analytical methods are needed. OBJECTIVES: To identify clinical and haemodynamic factors associated with leg length discrepancy (LLD) in children with CMs of the lower limbs. METHODS: Data were obtained from the multicentre French national cohort CONAPE (COhorte Nationale d'enfants atteints d'Angiome Plan de membrE inférieur), from children aged 2-12 years old with CMs of the lower limbs. Clinical characteristics were prospectively collected. Haemodynamic factors were measured by an sonographer who calculated the arterial blood flow (ABF) in both lower limbs. An ABF difference ≥ 50% between the two lower limbs was considered relevant. LLD ≥ 2% was determined by the same radiologist on centralized radiographs. RESULTS: We analysed data at baseline for 96 children. The mean ± SD age was 5·6 ± 3·1 years; 49 (51%) were male; and 14 (15%) showed LLD. In total, 32 patients (33%) had venous anomalies, 13 (14%) lymphatic anomalies and in one child a diagnosis of Parkes Weber syndrome was made. Only an increased circumference above the knee was more frequent with than without LLD (43% vs. 13%, P = 0·02). In all, 10/79 patients (13%) showed a difference in ABF ≥ 50%: four had LLD. The frequency of differences in ABF ≥ 50% was greater with than without LLD [33% (n = 4/12) vs. 9% (n = 6/67), P = 0·04]. CONCLUSIONS: ABF measured by Duplex ultrasonography is a simple, low-cost and noninvasive complementary examination for help in detecting LLD, with a difference of ≥ 50% possibly associated.

Immune cell profile of dental pulp tissue treated with zoledronic acid.

AIM: To characterize the pulp immune cell profile in the teeth of rats treated with zoledronic acid (ZA). METHODOLOGY: Male Wistar rats (n = 6 per group) received four intravenous infusions of ZA at doses of 0.04, 0.20 or 1.00 mg kg-1 ZA or saline (control). On the 70th experimental day, they were euthanized. The first right molar was examined microscopically and submitted to toluidine blue reaction and immunohistochemical for CD68, tumour necrosis Factor (TNF)-α, interleukin (IL)-1ß, inducible nitric oxide synthase (iNOS), nuclear factor kappa B (NF-kB) and IL-18 binding protein (IL-18 bp). The presence of ectasic/dilated vessels and inflammatory cells was analysed, and mast cells and mononuclear CD68-positive cells were counted along with the intensity of immunostaining (0-3) for inflammatory markers in odontoblasts and nonodontoblasts pulp cells. The Kruskal-Wallis/Dunn's test (scores or quantitative data) and the chi-squared test (categorical data) were used (GraphPad Prism 5.0, P < 0.05). RESULTS: There was no differences in the number of animals exhibiting dilated/ectasic blood vessels (P = 0.242) and inflammatory cells (P = 0.489) or in the number of mast cells (P = 1.000). However, there was an increase in mononuclear CD68-positive cells (P = 0.026), immunostaining of TNF-α (P = 0.020), IL-1ß (P = 0.027) and iNOS (P = 0.001) in odontoblasts, and IL-1ß (P = 0.013) in nonodontoblast pulp cells dose-dependently. NFkB (nucleus and cytoplasm) and IL-18 bp did not differ between groups. CONCLUSION: ZA modified the immune cell profile in the dental pulp, increasing the number of macrophages and expression of pro-inflammatory markers independent of NFkB.

Ventilación mecánica invasiva como tratamiento de la insuficiencia respiratoria aguda en pacientes infectados por el virus de la inmunodeficiencia humana / Invasive mechanical ventilation as a treatment of Severe respiratory insufficiency in patients infected by the immunodeficiency virus human

Objetivo: Conocer la prevalencia y las características epidemiológicas de los pacientes infectados por el virus de la inmunodeficiencia humana que requirieron ventilación mecánica invasiva más de 12 horas para tratar la insuficiencia respiratoria aguda en la Unidad de Cuidados Intensivos de un Hospital General de Agudos. Asimismo, se realizó un análisis comparativo entre los pacientes con el virus de la inmunodeficiencia humana y aquellos sin el virus. Materiales y Métodos: Estudio descriptivo, prospectivo y longitudinal llevado a cabo entre el 1 de agosto de 2012 y el 31 de julio de 2014. Se incluyeron adultos con ventilación mecánica invasiva por más de 12 horas debido a insuficiencia respiratoria aguda. Se realizó un análisis multivariado de regresión logística para identificar la asociación entre muerte en la Unidad de Cuidados Intensivos y virus de la inmunodeficiencia humana. Resultados: Ingresaron 344 pacientes en la Unidad, el 46,80% requirió ventilación mecánica invasiva por insuficiencia respiratoria aguda, con una prevalencia del virus de la inmunodeficiencia humana del 12,42%. Los pacientes infectados tenían una media de la edad de 39.42 ± 11.58 vs. 49.37 ± 20.54. En un análisis multivariado, se observó que los pacientes infectados corrían un mayor de riesgo de morir en la Unidad de Cuidados Intensivos que los no infectados (OR: 5,125; IC95% 1,725-15,226; p = 0,003). Conclusión: Los pacientes con el virus de la inmunodeficiencia humana que recibieron ventilación mecánica invasiva más de 12 horas para tratar la insuficiencia respiratoria aguda tuvieron un riesgo cinco veces más alto de morir en la Unidad de Cuidados Intensivos que los no infectados. (AU)

Objective: To know the prevalence and epidemiological characteristics of patients infected with human immunodeficiency virus requiring invasive mechanical ventilation for more than 12 hours as a treatment for acute respiratory failure at the Intensive Care Unit of a General Acute Care Hospital in Buenos Aires City. A comparative analysis was also performed between subjects with human immunodeficiency virus and those not infected. Materials and Methods: Descriptive, prospective and longitudinal study conducted between August 1st, 2012 and July 31st, 2014. Adults with invasive mechanical ventilation for more than 12 hours due to acute respiratory failure were included. A multivariate logistic regression analysis was performed to identify the association between mortality in the Intensive Care Unit and human immunodeficiency virus. Results: A total of 344 patients were admitted to the Intensive Care Unit, 46.80% of them required invasive mechanical ventilation for acute respiratory failure, with a prevalence of human immunodeficiency virus of 12.42%. The average age of infected patients was 39.42 ± 11.58 vs. 49.37 ± 20.54. In a multivariate analysis it was observed that patients with human immunodeficiency virus had more risk of death in the Intensive Care Unit than those not infected (OR: 5.12%, CI95% 1.72-15.22; P=0.003). Conclusion: The risk of death of subjects with human immunodeficiency virus who received invasive mechanical ventilation for more than 12 hours as a treatment for acute respiratory failure was five-fold higher than that of those uninfected patients.(AU)

[Erythema palmare hereditarium (Lane's disease): Report of a paediatric case]. / Érythème palmaire héréditaire (maladie de Lane) : observation chez un enfant.

BACKGROUND: Palmar erythema may be either congenital or acquired, hereditary or non-hereditary. Its diagnosis and management differs according to whether or not it is acquired, hereditary or associated with symptoms. Herein, we report the case of a child with hereditary palmoplantar erythema (Lane's disease). OBSERVATION: A 2½-year-old girl consulted for palmar erythema, present since birth, predominantly on the thenar and hypothenar eminences and on the palmar aspect of her fingers. She also presented mild diffuse erythema on the soles of her feet. Both her mother and grandmother had similar signs. The girl had neither impairment nor pain linked to this erythema, and she had no associated symptoms. Physical examination was otherwise normal, as were the results of standard laboratory tests. DISCUSSION: We diagnosed Lane's disease based on the girl's hereditary erythema with autosomal dominant transmission, and the congenital and asymptomatic nature of her palmoplantar erythema. Nine publications have reported cases of Lane's disease, but this condition is probably highly under-reported.

Ongoing spread of colistin-resistant Klebsiella pneumoniae in different wards of an acute general hospital, Italy, June to December 2011.

We describe polyclonal spread of colistin-resistant Klebsiella pneumoniae in an acute general hospital in Italy. Between June and December 2011, 58 colistin-resistant K. pneumoniae isolates were recovered from 28 patients admitted to different wards, but mainly in the intensive care units. All isolates were tested for drug susceptibility and the presence of beta-lactamase (bla) genes. Clonality was investigated by repetitive extragenic palindromic (rep)-PCR and multilocus sequence typing (MLST). Fifty-two isolates had minimum inhibitory concentrations (MICs) for colistin of 6-128 mg/L, carried bla(KPC3) and were attributed to sequence type ST258. The remaining six isolates were susceptible to carbapenems, exhibited MICs for colistin of 3-32 mg/L, and belonged to two different types, ST15 and ST273. Rep-PCR included all isolates in three clusters, one containing all ST258 KPC-3-producing isolates and two containing ST15 and ST273 isolates.Cross-transmission containment measures and intensification of staff and environmental hygiene could not stop the outbreak. Selective pressure and horizontal transmission probably contributed to emergence and spread of three different strains of colistin-resistant K. pneumoniae in the hospital. Strict implementation of the above measures and a wider awareness of the antimicrobial resistance threat are crucial to preserve the last therapeutic options of the multidrug-resistant Gram-negative infections.

Electrophoretic deposition of transparent ZnO thin films from highly stabilized colloidal suspensions.

The parameters that control the stability of ZnO-nanoparticles suspensions and their deposition by electrophoretic deposition were studied, so as to organize the assembly and compaction of nanoparticles. The addition of cationic polyelectrolyte - Polyethylenimine (PEI) - with different molecular weights was investigated, in order to study their effectiveness and the influence of the molecular weight of the organic chain on suspensions dispersion. It was found that PEI with the highest molecular weight provided better dispersion conditions. Cathodic EPD was performed under previously optimized suspensions conditions and over electropolished stainless steel substrates. Experimental results showed that the EPD process in these conditions allows obtaining dense transparent ZnO thin films. Deposition times and intensities were optimized by analyzing the resulting thin films characteristics. Finally, the deposits were characterized by FE-SEM, AFM, and different spectroscopic techniques.

Drosophila male courtship behavior is modulated by ecdysteroids.

Temperature-dependent induction of ecdysteroid deficiency in the ecdysoneless mutant ecd(1) adult Drosophila melanogaster results in altered courtship behavior in males. Ecdysteroid deficiency brings about significantly elevated male-male courtship behavior including song production resembling that directed toward females. Supplementation with dietary 20-hydroxyecdysone reduces male-male attraction, but does not change motor activity, courtship patterns or attraction to females. These observations support the hypothesis that reduced levels of ecdysteroids increase the probability that male fruit flies will display courtship behaviors to male stimuli.

Effect of addition of soybean trypsin inhibitor to colostrum on immunological status in goat kids.

The aim of the study was to evaluate the influence of soybean trypsin inhibitor (TI) on immunoglobulin G (IgG) serum levels and growth in neonatal goat kids. Twenty-four newborn kids were fed with natural colostrum (group A), and 24 kids received the same colostrum with 1 g of TI per litre (group B). Blood samples were obtained at birth and on days 1, 2 and 4 of life to analyze serum proteins, IgG and haematological parameters. There were no clinical signs of disease and no significant differences in body weight between the groups. Haematological parameters were not affected by treatment. The peak of serum IgG was reached at 24 h of life, but no effects of soybean TI was observed on serum IgG levels. The apparent efficiency of absorption of IgG was similar in both groups (group A 24.5% vs. group B 25.2%, p > 0.05). The addition of TI to colostrum did not change the concentration of serum proteins and their fractions in goat kids. The correlation between serum IgG and gamma-globulin was positive and significant (p < 0.01, r = 0.64) in group A, but not in group B (p > 0.05, r = 0.08), suggesting a negative influence of soybean TI on gamma-globulin absorption. These results show that addition of soybean TI to colostrum did not improve the performance or immunological status in goat kids.

[Pneumotorax and cannabis]. / Pneumotorace e cannabis.

AIM: After having read the articles by Treasure and Beshay about the particular incidence of spontaneous pneumothorax (SP) in patients with daily consumption of Cannabis the authors took a strictly control of these subjects reviewing their personal experience in the treatment of this condition. In particular, the prevalence of SP has been evaluated through genomic assay of monocorial twins. The strong impact of the inflammatory phenomena that have always supported the emphysema burning is 10 time higher among worldwide population and patients with SP. METHODS: In order to determine the real incidence of spontaneous pneumothorax in patients with proved daily assumption of Cannabis a retrospective analysis of patients with history of Cannabis drug abuse has been performed. In the period from January 2002 and June 2007,12 consecutive patients with SP and history of Cannabis abuse were enrolled. Selection criteria were: 1) age <16 years; 2) single-sided spontaneous pneumothorax; 3) history of daily Cannabis assumption. Patients with previous thoracic surgery/trauma and positive anamnesis for other drug assumption (ODA), snorkelling or work exposition to pollutions were excluded. In order to avoid the clinical overlapping of pathology and clinical symptoms due to other factors, patients with pleural effusion and documented similar episodes were excluded. This series focused on particular on twins. In all the patients an endopleuric drainage tube was inserted, and 3 patients underwent toracostomy. RESULTS: No operatory mortality and/or complications were observed. CONCLUSIONS: The role of the thoracic surgeon is important to sensitize on the problem of the circulation of light drugs among young people and their effects on the lung activity.

Pigment dispersing hormone generates a circadian response to light in the crayfish, Procambarus clarkii.

Photoreceptor cells have been identified as important structures in the organization of the circadian system responsible for the generation and expression of the electroretinogram (ERG) circadian rhythm. They are the structures where the circadian periodicity is expressed (effectors) and which transform information from external light signals to be conducted to the pacemaker in order to induce adjustments of the rhythm (synchronizers). After isolation, eyestalks perfused in a pigment dispersing hormone (PDH) solution, show significant changes in receptor potential (RP) amplitude and duration. Exogenous PDH injected into intact crayfish induces a migration of retinal shielding pigments to a light-adapted state. A single dose of PDH produces advances or delays in the circadian rhythm of response to light of visual photoreceptors. All these effects depend on the circadian phase of PDH application. Consequently, the determination of the action of exogenous PDH on photoreceptor cells proved to be very helpful in understanding some mechanisms underlying the circadian organization of crayfish.

Influence of colostrum treated by heat on immunity function in goat kids.

The aim was to evaluate the influence of goat colostrum treated by heat on immune function in kids. Thirteen newborn kids were fed untreated colostrum (group A) and 13 kids were fed colostrum treated by heat (56 degrees C, 30 min) (group B). Blood samples were obtained at eight time points between the ages of 0 h to 28 days. Serum protein fractions, IgG levels and phagocytic activity of neutrophils were determined. A delayed type hypersensitivity (DTH) test was used, clinical status and body weight was recorded. There were no clinical signs of disease and no differences (P>0.05) on body weight between groups were noted. Kids from group B had less total protein levels and gamma-globulins than kids from group A (P<0.05). A decrease in serum IgG levels (P<0.05) was observed in kids from group B during all experiment. DTH response in kids from group B was lower (P<0.01) than group A, suggesting alteration on cellular immune system. No effects on phagocytic activity of the neutrophils were observed when both groups were compared (P>0.05). These results showed that colostrum treated by heat impaired some immunological parameters in kids, but these changes did not affect on clinical status or performance.

[Differences in variables representative of cardiovascular disease or repercussion between subjects with high cardiovascular risk with and without any family history of early cardiovascular events]. / Diferencias en variables representativas de enfermedad o repercusión cardiovascular entre sujetos de alto riesgo cardiovascular con y sin antecedentes familiares de eventos cardiovasculares precoces.

UNLABELLED: INTRODUCTION, BASES AND AIMS: Study the possible associations between any family history of early heart disease and variables expressive of heart disease, lesion or repercussion in subjects of high cardiovascular risk. MATERIAL AND METHODS: Nationwide cross-sectional study with 2264 consecutive patients in the Outpatient Clinic of Internal Medicine 18 years of age or older and with high or extremely high cardiovascular risk taken from the CIFARC (Integral Control of High Risk Cardiovascular Factors) study run by the SEMI (Spanish Internal Medicine Association) cardiovascular Risk Group. We have studied the relationship between the presence or lack of same in family histories of early heart disease (AFP-Family History of early heart disease, hereafter FH) and different variables in the factors concerning cardiovascular risk and target organ lesion. The statistical treatment (Chi-2, ANOVA and Pearson s linear regression) was performed using the STATISTIX programme. RESULTS AND DISCUSSION: We observed a significative increase (p<0.05) in the group with FH with a percentage of the following variables: Total cholesterol>250 mg/dl, HDL<40 mg/dl, LDL>130 mg/dl, LVH (left ventricular hypertrophy), creatinine 1.2-2mg/dl, retinopathy I-II, serious retinopathy, smoking, proteinuria>300 mg/dl, kidney insufficiency and peripheral vascular disease. This significative increase in the variables under study appeared in males of over 55 years of age and in females of over 65 years of age; nevertheless, this increase in the incidence rate is becoming more common as of age 50 in males, with a maximum in both sexes after the age of 70. No significative differences were noted with regard to sex, BMI (Body Mass Index), atheromatosis, ischemic cardiopathy and cerebrovascular disease. On the whole, subjects of both sexes of the FH group have come to the clinic 3 years earlier than those of the group without FH. CONCLUSIONS: Patients with FH show a greater incidence of certain factors concerning heart risk and target organ lesion.

Regression of papilloma high-grade lesions (CIN 2 and CIN 3) is stimulated by therapeutic vaccination with MVA E2 recombinant vaccine.

Human papillomavirus (HPV) is the etiologic agent for cervical cancer. In Mexico, a women dies every 2 h, and since 1990 the statistics have shown that the numbers of deaths are increasing. We conducted a phase II clinical trial to evaluate the potential use of the MVA E2 recombinant vaccinia virus in treating high-grade lesions (CIN 2 and CIN 3) associated with oncogenic papillomavirus. Fifty-four female patients with high degree lesions were treated either with an MVA E2 therapeutic vaccine or with conization. Thirty-four women received the therapeutic vaccine, at a total of 10(7) virus particles per dose injected directly into the uterus once every week over a 6-week period. Twenty control patients were treated with conization. By colposcopy, 19 patients out of 34 showed no lesion, in three patients the lesions were reduced by 85-90%, in eight other lesions had reduced by 60%, and in four more patients, they were reduced by 25%. Histological analysis showed total elimination of high-grade lesions in 20 out of 34 patients after treatment with MVA E2. Eleven patients had a 50% reduction in lesion size. In two other patients, the lesion was reduced to CIN 2 and in one more patient the lesion was reduced to low grade (CIN 1). All patients developed antibodies against the MVA E2 vaccine, and generated a specific cytotoxic response against papilloma-transformed cells. DNA viral load was significantly reduced in MVA E2-treated patients. Conization eliminated the lesions in 80% of the patients, but patients did not develop cytotoxic activity specific against cancer cells and did not eliminate the papillomavirus. In addition, three patients treated with conization had recurrence of lesions 1 year later. These results show that therapeutic vaccination with MVA E2 proved to be very effective in stimulating the immune system against papillomavirus, and in generating regression of high-grade lesion.