Human papillomavirus type specific risk of progression and remission during long‐term follow‐up of equivocal and low‐grade HPV‐positive cervical smears

The prevalence of clinically relevant HPV types and their specific risk for progression and regression in women with atypical squamous cells of uncertain significance (ASCUS) and low‐grade squamous intraepithelial lesions (LSIL) were studied in a routine screening population. A 4‐year cohort of women (n = 820) with ASCUS/LSIL and a positive HPV test in triage were followed for 6–9 years. The progression risks for CIN2+/CIN3+ were determined for single (71.2%) and multiple HPV infections (28.8%). The CIN2+ progression risk for all HPV 16, all HPV 35, single HPV 16 and single HPV 35 infections were 65.3% (95% CI: 59.6–71.0), 64.4% (95% CI: 50.4–78.4), 63.8% (95% CI: 56.2–71.4) and 73.7% (95% CI: 53.9–93.5), respectively. Based on CIN2+ progression risks four main groups were defined; the HPV 16 group, the HPV 31/33/35 group, the HPV 18/45/51/52 group and the HPV 39/56/58/59/66/68 group with progression risks of 65.3% (95% CI: 59.6–71.0), 62.1% (95% CI: 54.8–69.4), 52.6 (95% CI: 45.9–59.3) and 39.5 (95% CI: 33.0–46.0), respectively. In multivariate analyses, women in the age group 40–49 years had an increased risk of CIN2+ progression. As for CIN3+, HPV 16 had a higher progression risk than other HPV risk groups (p < 0.05). In multiple infections only HPV 16 had a significant additive CIN3+ progression risk (p < 0.05) as compared to other HPV risk groups. In summary, HPV types 16 and 35, including the HPV risk group 31/33/35, had a similar CIN2+ progression risk, but only HPV 16 had a higher risk for CIN3+ progression.     

Revised PROPELLER for T2-weighted imaging of the prostate at 3 Tesla: impact on lesion detection and PI-RADS classification

Purpose

To evaluate revised PROPELLER (RevPROP) for T2-weighted imaging (T2WI) of the prostate as a substitute for turbo spin echo (TSE).

Materials and methods

Three-Tesla MR images of 50 patients with 55 cancer-suspicious lesions were prospectively evaluated. Findings were correlated with histopathology after MRI-guided biopsy. T2 RevPROP, T2 TSE, diffusion-weighted imaging, dynamic contrast enhancement, and MR-spectroscopy were acquired. RevPROP was compared to TSE concerning PI-RADS scores, lesion size, lesion signal-intensity, lesion contrast, artefacts, and image quality.

Results

There were 41 carcinomas in 55 cancer-suspicious lesions. RevPROP detected 41 of 41 carcinomas (100%) and 54 of 55 lesions (98.2%). TSE detected 39 of 41 carcinomas (95.1%) and 51 of 55 lesions (92.7%). RevPROP showed fewer artefacts and higher image quality (each p?<?0.001). No differences were observed between single and overall PI-RADS scores based on RevPROP or TSE (p?=?0.106 and p?=?0.107). Lesion size was not different (p?=?0.105). T2-signal intensity of lesions was higher and T2-contrast of lesions was lower on RevPROP (each p?<?0.001).

Conclusion

For prostate cancer detection RevPROP is superior to TSE with respect to motion robustness, image quality and detection rates of lesions. Therefore, RevPROP might be used as a substitute for T2WI.

Key points

? Revised PROPELLER can be used as a substitute for T2-weighted prostate imaging.? Revised PROPELLER detected more carcinomas and more suspicious lesions than TSE.? Revised PROPELLER showed fewer artefacts and better image quality compared to TSE.? There were no significant differences in PI-RADS scores between revised PROPELLER and TSE.? The lower T2-contrast of revised PROPELLER did not impair its diagnostic quality.

     

The new Epstein gleason score classification significantly reduces upgrading in prostate cancer patients

Purpose

To evaluate the differences between the old and the new Gleason score classification systems in upgrading and downgrading rates.

Severe prosthetic valve-related endocarditis following dental scaling: a case report.

There is a well-known correlation between surgical dental procedures and the risk of bacterial endocarditis in patients with prosthetic cardiac valves. A 43-year-old patient with prosthetic aortic and mitral valves, which already have been removed twice because of endocarditis, suffered from a prosthetic valve-related endocarditis following dental scaling, which was performed without any antibiotic prophylaxis. Invasive medical procedures in patients with prosthetic heart valves may lead to endocarditis. Antibiotic prophylaxis is recommended even for dental procedures considered to be "harmless," such as dental scaling.     

Lack of a clinically significant pharmacokinetic drug interaction between tiagabine and valproate

This single-center, open-label study examined the safety and potential effect of tiagabine on valproate pharmacokinetics under steady-state conditions. Twelve adult patients with seizures controlled by an individualized fixed dosage of valproate participated in the study. On day 1, the pharmacokinetics of valproic acid were determined. On days 2 through 14, tiagabine was titrated from 8 to 24 mg/d (or the maximum tolerated dose up to 24 mg/d), and the patients continued to take their usual fixed dosage of valproate. Valproic acid pharmacokinetics were assessed again on day 14. The mean maximum plasma concentration (Cmax ) and area under the plasma concentration-time curve from time zero to the end of the dosing interval (AUC0-tau ) for valproic acid were reduced approximately 10% and 12%, respectively (p < or = 0.05), when valproate and tiagabine were administered concomitantly, compared with the mean values when valproate was administered alone. The concomitant administration of these drugs was generally well tolerated. Ten patients reported treatment-emergent adverse events during the study, the most common of which was dizziness(n = 8). Only one patient experienced events that were considered to be severe. There were no clinically important effects on laboratory values, vital signs, or physical exam findings. The small decreases in mean valproic acid Cmax and AUC0-tau observed during the concomitant administration of tiagabine and valproate are probably of limited clinical importance, given the broad therapeutic range of valproate (50-100 microg/mL).     

Cutane Thermoreceptoren mit marklosen afferenten Fasern

Ohne Zusammenfassung     

Strong antigenic selection shaping the immunoglobulin heavy chain repertoire of B-1a lymphocytes in lambda 2(315) transgenic mice

The B lymphocyte compartment of the recombinant mouse line L2 consists predominantly of CD5(+) B-1 cells that exclusively express the transgenic (Tg) lambda 2 L chain of the plasmacytoma MOPC315. Using such Tg mice as a simplified model to study positive selection processes, we show that restriction to a single L chain results in a strongly oligoclonal IgH chain repertoire in fetal and neonatal liver-derived B cells, as well as in peritoneal CD5(+) B-1 lymphocytes from adult mice. In contrast, in vitro differentiated fetal liver Pro/PreB-I cells from L2 embryos show a clear increase of complementarity determining region three (CDR3) diversity. These data suggest that the antibody repertoire of B-1a cells is strongly selected by antigen during fetal as well as adult peritoneal phase.     

An association between cutaneous sensitivity to histamine and HLA phenotype

Four hundred and twenty randomly chosen subjects from a normal population were HLA typed and tested for cutaneous sensitivity to histamine by prick testing with 5 concentrations of histamine (10⁻³, 10⁻², 10⁻¹, 1, 10 mg ± ml⁻¹). Positive responses to 10⁻¹ mg ± ml⁻¹ histamine occurred in 41% of the subjects, and particularly those with HLA-B7 (55%) (p < 0.005). It is concluded that genes within the major histocomptability complex influence cutaneous responses to histamine.     

Impulse aus unspezifischen cutanen Receptoren der Katze bei Druck,Erwärmung und Abkühlung

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