Efficacy of HPV Vaccination Regarding Vulvar and Vaginal Recurrences in Previously Treated Women: The Need for Further Evidence.

Vulvar and vaginal cancers are relatively rare cancers, but their incidence is increasing worldwide. Overall, 78% of vaginal cancers and 25% of vulvar cancers are associated with Human papillomavirus (HPV) infection. Immunization could be an option for the management of these cases. We researched and assessed the evidence on the efficacy of HPV vaccination administered to women previously treated with surgery, radiotherapy, or chemotherapy with respect to the recurrence of vulvovaginal disease. From 2006 to November 2022, only one study evaluated the efficacy of HPV vaccination with respect to preventing vulvovaginal recurrences in treated women and showed that a quadrivalent HPV vaccine administered after the surgical treatment of vulvar high-grade squamous intraepithelial lesion (HSIL) can reduce vulvar recurrence of the disease. Therefore, the efficacy of HPV vaccination with respect to vulvovaginal recurrence is still an unexplored field. Further studies are needed to produce stronger evidence in order to appropriately support interventions to protect women's health.

Interfering with the Tumor-Immune Interface: Making Way for Triazine-Based Small Molecules as Novel PD-L1 Inhibitors.

The inhibition of the PD-1/PD-L1 axis by monoclonal antibodies has achieved remarkable success in treating a growing number of cancers. However, a novel class of small organic molecules, with BMS-202 (1) as the lead, is emerging as direct PD-L1 inhibitors. Herein, we report a series of 2,4,6-tri- and 2,4-disubstituted 1,3,5-triazines, which were synthesized and assayed for their PD-L1 binding by NMR and homogeneous time-resolved fluorescence. Among them, compound 10 demonstrated to strongly bind with the PD-L1 protein and challenged it in a co-culture of PD-L1 expressing cancer cells (PC9 and HCC827 cells) and peripheral blood mononuclear cells enhanced antitumor immune activity of the latter. Compound 10 significantly increased interferon γ release and apoptotic induction of cancer cells, with low cytotoxicity in healthy cells when compared to 1, thus paving the way for subsequent preclinical optimization and medical applications.

The impact of aerators on water contamination by emerging gram-negative opportunists in at-risk hospital departments.

OBJECTIVE: Our aim was to evaluate the impact of aerators on water microbiological contamination in at-risk hospital departments, with a view to quantifying the possible risk of patient exposure to waterborne microorganisms. DESIGN: We analyzed the microbiological and chemical-physical characteristics of hot and cold water in some critical hospital departments. SETTING: Two hospitals in northern Italy. METHODS: We took 304 water samples over a 1-year period, at 3-month intervals, from taps used by healthcare personnel for handwashing, surgical washing, and the washing of medical equipment. We analyzed heterotrophic plate counts (HPCs) at 36°C and 22°C, nonfastidious gram-negative bacteria (GNB-NE), and Legionella pneumophila. RESULTS: The percentages of positivity and mean values of HPCs at 22°C, HPCs at 36°C, and GNB-NE loads were significantly higher at outlet points than in the plumbing system. In particular, GNB-NE positivity was higher at outlet points than in the plumbing system in both the cold water (31.58% vs 6.58% of samples were positive) and hot water (21.05% vs 3.95%) supplies. Our results also revealed contamination by L. pneumophila both in the plumbing system and at outlet points, with percentages of positive samples varying according to the serogroup examined (serogroups 1 and 2-14). The mean concentrations displayed statistically significant (P < .001) differences between the outlet points (27,382.89 ± 42,245.33 colony-forming units [cfu]/L) and the plumbing system (19,461.84 ± 29,982.11 cfu/L). CONCLUSIONS: These results reveal a high level of contamination of aerators by various species of gram-negative opportunists that are potentially very dangerous for immunocompromised patients and, therefore, the need to improve the management of these devices.

Can particulate air sampling predict microbial load in operating theatres for arthroplasty?

Several studies have proposed that the microbiological quality of the air in operating theatres be indirectly evaluated by means of particle counting, a technique derived from industrial clean-room technology standards, using airborne particle concentration as an index of microbial contamination. However, the relationship between particle counting and microbiological sampling has rarely been evaluated and demonstrated in operating theatres. The aim of the present study was to determine whether particle counting could predict microbiological contamination of the air in an operating theatre during 95 surgical arthroplasty procedures. This investigation was carried out over a period of three months in 2010 in an orthopedic operating theatre devoted exclusively to prosthetic surgery. During each procedure, the bacterial contamination of the air was determined by means of active sampling; at the same time, airborne particulate contamination was assessed throughout the entire procedure. On considering the total number of surgical operations, the mean value of the total bacterial load in the center of the operating theatre proved to be 35 CFU/m(3); the mean particle count was 4,194,569 no./m(3) for particles of diameter ≥0.5 µm and 13,519 no./m(3) for particles of diameter ≥5 µm. No significant differences emerged between the median values of the airborne microbial load recorded during the two types of procedure monitored. Particulates with a diameter of ≥0.5 µm were detected in statistically higher concentrations (p<0.001) during knee-replacement procedures. By contrast, particulates with a diameter of ≥5 µm displayed a statistically higher concentration during hip-replacement procedures (p<0.05). The results did not reveal any statistically significant correlation between microbial loads and particle counts for either of the particle diameters considered (≥0.5 µm and ≥5 µm). Consequently, microbiological monitoring remains the most suitable method of evaluating the quality of air in operating theatres.

Spread of multidrug carbapenem-resistant Acinetobacter baumannii in different wards of an Italian hospital.

BACKGROUND: Multidrug-resistant Acinetobacter baumannii (MDRAB) is an important cause of hospital acquired infection. We describe a 7-month outbreak of a MDRAB infection involving various wards of an Italian hospital and an investigation of the possible source of the infection was conducted. METHODS: A baumannii was isolated from various biological samples from 22 colonized or infected patients, and was identified and characterized for its antibiotic sensitivity. Typing of A baumannii was performed by multilocus sequence typing (MLST). Investigation of the outbreak involved extensive microbiological sampling of the environment. RESULTS: In 50% of cases the infection occurred in the ICU. Invasive procedures were performed in 63.6% of patients. The strain isolated proved to be resistant to all the antibiotics tested, including carbapenems, and displayed the same allelic profile in all patients. None of the 141 samples taken during environmental monitoring showed positivity for A baumannii. CONCLUSION: The results of the present study reveal the importance of strict adherence to control measures by all health care personnel and highlight the fact that regular staff training and frequent revision of control measures are essential to the successful management of an outbreak.

Evaluation of environmental contamination by glutaraldehyde in an outpatient facility for digestive endoscopy in an Italian hospital.

The potential harmful effects of glutaraldehyde on human health are well known, and in recent years various new substitutes for this compound have been proposed for the disinfection and thorough sterilization of medical instruments. Nevertheless, glutaraldehyde is still widely used in hospital environments. In order to evaluate environmental contamination by glutaraldehyde vapours, the rooms of a hospital out-patient department of digestive endoscopy were monitored in 2005; a total of 52 samples were taken. The mean environmental concentration of glutaraldehyde was 3.7+/-7.4 microg/m(3). The number of efficacious air exchanges per hour was 6.3 v/h in all of the environments monitored. The study revealed that, in a hospital setting, adequate structural and functional planning, combined with responsible management on the part of the personnel and constant careful checking of the results obtained can minimize the risk of occupational exposure to glutaraldehyde.

A new microbiological problem in intensive care units: environmental contamination by MRSA with reduced susceptibility to glycopeptides.

The present study evaluated the percentage of methicillin-resistant Staphylococcus aureus strains with reduced susceptibility to glycopeptides in four intensive care units (ICU) by means of environmental sampling of air and representative surfaces. The total bacterial count was taken and possible S. aureus strains were subsequently isolated. To assess methicillin resistance, an antibiogram was performed on the colonies that were positive to the coagulase test. A standard E-test was then carried out on the colonies that developed, in order to evaluate glycopeptide resistance, and any heterogeneous resistance was confirmed by means of a macromethod E-test. The antibiogram performed on the colonies of S. aureus revealed that 85.7% of all air samples were positive for MRSA, and that 64.3% of all the samples proved to be heterogeneously resistant to glycopeptides. Methicillin resistance was recorded in 41.0% of surface samples, and 32.5% of all samples proved positive for hGISA.

Urinary hydroxyproline as a biomarker of effect after exposure to nitrogen dioxide.

A cross-sectional study was carried out on two groups of subjects differently exposed to nitrogen dioxide in order to test the urinary hydroxyproline ratio (UHP/mg/24 h/m(2)) as a biomarker of effect after exposure to this pollutant. UHP was determined in samples of 58 subjects divided into two groups comparable to as lifestyle and training. The first group was composed of 29 subjects who used to do jogging in urban areas polluted by nitrogen dioxide. The second group was made up of 29 subjects who used to do jogging in non-polluted countryside areas. The mean concentration of UHP of urban joggers was 25.02+/-9.21 mg/24 h/m(2), whereas in those training in the countryside it was 13.78+/-6.68 mg/24 h/m(2). Thus, UHP was higher in subjects training in areas polluted by nitrogen dioxide than in the subjects training in non-polluted areas.