Clinical Validation of the Vitro HPV Screening Assay for Its Use in Primary Cervical Cancer Screening

Many scientific societies have issued guidelines to introduce population-based cervical cancer screening with HPV testing. The Vitro HPV Screening assay is a fully automatic multiplex real-time PCR test targeting the L1 GP5+/GP6+ region of HPV genome. The assay detects 14 high risk (HR) HPV genotypes, identifying individual HPV16 and HPV18 genotypes, and the HPV-positive samples for the other 12 HR HPV types are subsequently genotyped with the HPV Direct Flow Chip test. Following international guidelines, the aim of this study was to validate the clinical accuracy of the Vitro HPV Screening test on ThinPrep-collected samples for its use as primary cervical cancer screening, using as comparator the validated cobas® 4800 HPV test. The non-inferiority analysis showed that the clinical sensitivity and specificity of the Vitro HPV Screening assay for a diagnosis of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) were not inferior to those of cobas® 4800 HPV (p = 0.0049 and p < 0.001 respectively). The assay has demonstrated a high intra- and inter-laboratory reproducibility, also among the individual genotypes. The Vitro HPV Screening assay is valid for cervical cancer screening and it provides genotyping information on HPV-positive samples without further sample processing in a fully automated workflow.

HPV self-sampling among cervical cancer screening users in Spain: A randomized clinical trial of on-site training to increase the acceptability

A randomized clinical trial was conducted to compare the impact of two different instructions on vaginal self-sampling in its acceptability and willingness for future screening rounds among women attending cervical cancer screening (CCS). From November 2018 to May 2021, women aged 30-65 living in Spain attending CCS were randomized 1:1 in two arms. In the "On-site training arm (TRA)", women took a self-sample at the primary health care centre following provider's instructions. In the "No on-site training arm (NO-TRA)" women only received instructions to take self-sample at home. All women had to return a new sample collected at home one month after the baseline visit and an acceptability questionnaire. The proportion of self-samples returned, and acceptability was computed by the study arm. A total of 1158 women underwent randomization, 579 women per arm. At follow-up, women in TRA were more likely to return the home sample than women in the NO-TRA (82.4% and 75.5% respectively; p = 0.005). Over 87% of all participants favoured home-based self-sampling approach for future CCS, similar by arm. Over 80% of women in both arms chose to collect and return the self-sample at a health centre or pharmacy. Home-based self-sampling was a highly accepted strategy for CCS in Spain. Trying it first with prior on-site training at the health centre significantly increased the sample's return suggesting that a provider's supervision raised confidence and adherence. It is an option to consider when moving to self-sampling in established CCS. Preferred delivery sites most likely contextual. Registration on ClinicalTrials.gov: NCT05314907.

Modeling of lactic acid rejection from lactose in acidified cheese whey by nanofiltration

The continuously increasing demand of lactic acid opens a window for the integration of membrane technology in the dairy industry, improving the sustainability by avoiding the use of large amounts of chemicals and waste generation. Lactic acid recovery from fermentation broth without precipitation has been studied by numerous processes. In this work, a commercial membrane with high lactose rejection and a moderate lactic acid rejection, enabling a permselectivity up to 40%, is sought to perform the simultaneous removal of lactic acid and lactose separation from the acidified sweet whey from mozzarella cheese production in a single stage. The AFC30 membrane of the thin film composite nanofiltration (NF) type was selected because of its high negative charge, low isoelectric point, and divalent ion rejection, as well as a lactose rejection higher than 98% and a lactic acid rejection lower than 37%, at pH 3.5, to minimize the need of additional separation steps. The experimental lactic acid rejection was evaluated at varying feed concentration, pressure, temperature, and flow rate. As the dissociation degree of lactic acid is negligible in industrially simulated conditions, the performance of this NF membrane was validated by the irreversible thermodynamic Kedem-Katchalsky and Spiegler-Kedem models, with the best prediction in the latter case, with the parameter values: L_p = 3.24 ± 0.87 L × m^-2 × h^-1 × bar^-1 and = 15.06 ± 3.17 L × m^-2 × h^-1, and σ = 0.45 ± 0.03. The results obtained in this work open the way for the up-scaling of membrane technology on the valorization of dairy effluents by simplifying the operation process and the model prediction and the choice of the membrane.

Everything causes cancer? Beliefs and attitudes towards cancer prevention among anti-vaxxers, flat earthers, and reptilian conspiracists: online cross sectional survey

OBJECTIVE

To evaluate, using an online non-probability sample, the beliefs about and attitudes towards cancer prevention of people professing vaccination scepticism or conspiracy theories.

DESIGN

Cross sectional survey.

SETTING

Data collected mainly from ForoCoches (a well known Spanish forum) and other platforms, including Reddit (English), 4Chan (English), HispaChan (Spanish), and a Spanish language website for cancer prevention (mejorsincancer.org) from January to March 2022.

PARTICIPANTS

Among 1494 responders, 209 were unvaccinated against covid-19, 112 preferred alternative rather than conventional medicine, and 62 reported flat earth or reptilian beliefs.

MAIN OUTCOME MEASURES

Cancer beliefs assessed using the Cancer Awareness Measure (CAM) and Cancer Awareness Measure Mythical Causes Scale (CAM-MYCS) (both validated tools).

RESULTS

Awareness of the actual causes of cancer was greater (median CAM score 63.6%) than that of mythical causes (41.7%). The most endorsed mythical causes of cancer were eating food containing additives or sweeteners, feeling stressed, and eating genetically modified food. Awareness of the actual and mythical causes of cancer among the unvaccinated, alternative medicine, and conspiracy groups was lower than among their counterparts. A median of 54.5% of the actual causes was accurately identified among each of the unvaccinated, alternative medicine, and conspiracy groups, and a median of 63.6% was identified in each of the three corresponding counterparts (P=0.13, 0.04, and 0.003, respectively). For mythical causes, medians of 25.0%, 16.7%, and 16.7% were accurately identified in the unvaccinated, alternative medicine, and conspiracy groups, respectively; a median of 41.7% was identified in each of the three corresponding counterparts (P<0.001 in adjusted models for all comparisons). In total, 673 (45.0%) participants agreed with the statement "It seems like everything causes cancer." No significant differences were observed among the unvaccinated (44.0%), conspiracist (41.9%), or alternative medicine groups (35.7%), compared with their counterparts (45.2%, 45.7%, and 45.8%, respectively).

CONCLUSIONS

Almost half of the participants agreed that "It seems like everything causes cancer," which highlights the difficulty that society encounters in differentiating actual and mythical causes owing to mass information. People who believed in conspiracies, rejected the covid-19 vaccine, or preferred alternative medicine were more likely to endorse the mythical causes of cancer than their counterparts but were less likely to endorse the actual causes of cancer. These results suggest a direct connection between digital misinformation and consequent erroneous health decisions, which may represent a further preventable fraction of cancer.

Intensified fish farming. Performance of electrochemical remediation of marine RAS waters

Aquaculture has been the fastest growing agricultural sector in the past few decades and currently supplies about half of the fish market. A range of environmental and management concerns including limited land and water availability have led to intensifying fish production by recirculating aquaculture systems (RAS). Fish's diet contains 30-60 % protein and about 4-10 % nitrogen (N). As fish assimilate only 20-30 % of the feed to produce body mass, the unassimilated N is released in the form of toxic ammonium that deteriorates water quality and compels its degradation. Widely extended biological nitrification is not efficient in the removal of nitrites nor other chemicals and pharmaceuticals used during fish culture. Electrochemical oxidation, a less developed alternative, reports several advantages such as, i) simultaneous degradation of ammonia‑nitrogen (TAN) and water disinfection in the same step with considerable simplification of the whole process, ii) easy adaptability to different production scales and periods of fish growth, and iii) no generation of harmful by-products and no use of chemicals, among others. Besides, in the case of marine aquaculture, the technology benefits from the high conductivity of seawater; thus, electrochemical oxidation is positioned in a very good place to satisfy the water treatment needs of the increasing production rate of marine aquaculture fish. Here, we report the analysis of the performance of a RAS demonstration plant aimed at farming gilthead sea bream (Sparus aurata) and sea bass (Dicentrarchus labrax) and provided with electrochemical remediation of culture water. The performance of the plant, with 20 m³ of seawater operating at a recirculation rate of 0.9-1.4 h^-1, has been analysed in terms of TAN removal, water disinfection, make-up water intake and energy consumption and compared to data of conventional RAS provided with biofilters. The benefits and advantages of the innovative electrochemical remediation of RAS water are highlighted.

Worldwide use of HPV self-sampling for cervical cancer screening

An increasing body of evidence supports the validity of self-sampling as an alternative to clinician collection for primary Human Papillomavirus (HPV) screening. Self-sampling effectively reaches underscreened women and can be a powerful strategy in low- and high-resource settings for all target ages. This work aims to summarize the current use of HPV self-sampling worldwide. It is part of a larger project that describes cervical cancer screening programmes and produces standardized coverage estimates worldwide. A systematic review of the literature and official documents supplemented with a formal World Health Organisation country consultation was conducted. Findings show that the global use of HPV self-sampling is still limited. Only 17 (12%) of countries with identified screening programs recommend its use, nine as the primary collection method, and eight to reach underscreened populations. We identified 10 pilots evaluating the switch to self-sampling in well-established screening programs. The global use of self-sampling is likely to increase in the coming years. COVID-19's pandemic has prompted efforts to accelerate HPV self-sampling introduction globally, and it is now considered a key element in scaling up screening coverage. The information generated by the early experiences can be beneficial for decision-making in both new and existing programs.

Sensitivity of cervical cytology in endometrial cancer detection in a tertiary hospital in Spain

Introduction

Cervical cytology is a well‐stablished cervical cancer screening method. However, due to the anatomical continuity of the genital tract, it can also detect signs of endometrial disease. Our aim was to estimate the sensitivity of cervical cytology in endometrial cancer detection and prognosis in a large population over a 30‐year period in a large academic tertiary hospital in Spain.

Methodology

We performed a search for women diagnosed with endometrial cancer from 1990 to 2020, who were surgically treated and had a previous cervical cytology result. Information Technologies Department databases from Bellvitge University Hospital and the Screenwide case–control study's database were used. Cervical cytology results were classified as abnormal when squamous lesions, glandular atypia or malignant cells were identified.

Results

Overall, we evaluated 371 women with endometrial cancer and a documented cervical cytology performed within 3 years previous to surgical treatment. Overall, the sensitivity of cervical cytology for endometrial cancer detection was 25.6%. Several clinico‐pathological characteristics, such as non‐endometrioid histology and a higher stage, were correlated with higher sensitivity.

Discussion

We observed a low sensitivity of cervical cytology to effectively diagnose endometrial cancer. However, recent technological advances using genomics and epigenomics may offer a promising perspective to detect endometrial cancer with high sensitivity in these cervical specimens.

Comparative cost analysis of cervical cancer screening programme based on molecular detection of HPV in Spain

Background

HPV cervical cancer screening (CCS) must use validated HPV tests based on the molecular detection of either viral mRNA (Aptima HPV Assay—AHPV) or DNA. AHPV has demonstrated the same cross-sectional and longitudinal sensitivity for the detection of HSIL/CIN2+ lesions but with greater specificity than HPV-DNA tests. The study aimed to estimate the total costs of a CCS with a primary HPV test based on the detection of mRNA compared to DNA in women aged 35–65 years for the National Health System.

Methods

A decision-tree-based model to estimate the cost of the CCS until the first colposcopy was designed based on Spanish CCS guidelines. The total cost (€, 2019) for CCS with AHPV or DNA tests (HC2 and Cobas) was calculated, including HPV test, liquid-based cytology (LBC) and colposcopy, for a population of 7,263,529 women aged 35–65 years (assuming 70% coverage). Clinical inputs derived from a literature review were validated by a multidisciplinary expert panel. Data from head-to-head studies between different HPV tests were selected.

Results

The use of AHPV showed reduction of 290,541 (− 35%) and 355,913 (− 40%) LBC compared to HC2 or Cobas, respectively. Furthermore, AHPV avoided 151,699 (− 47%) colposcopies versus HC2 and 151,165 (− 47%) versus Cobas. The total cost of CCS was € 282,747,877 with AHPV, € 322,587,588 with HC2 and € 324,614,490 with Cobas. Therefore, AHPV savings € − 39,839,711 versus HC2 and € − 41,866,613 versus Cobas.

Conclusions

Assuming that 70% of women from 35 to 65 years attend the CCS programme, the cost of screening up to the first colposcopy using AHPV would provide cost savings of up to € 41.9 million versus DNA tests in Spain.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01310-8.

Long-term protection of HPV test in women at risk of cervical cancer

Objective

To evaluate the 9-year incidence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and cumulative adherence to perform a next test in a cohort of women aged 40+ years with no cervical screening cytology within a window of 5 years (underscreened women), after baseline cervical cytology and HPV tests.

Methods

In Catalonia, Spain, co-testing with cytology and HPV test has been recommended in the Public Health system since 2006 for underscreened women. In 2007, 1,594 women with underscreened criteria were identified and followed through medical records form Pathological Department. 9-year cumulative incidence of histologically confirmed CIN2+ and cumulative adherence to perform a next test were estimated using Kaplan-Meier statistics.

Results

Follow-up was available for 1,009 women (63.3%) resulting in 23 women with. CIN2+ (2.3%). Of them, 4 women (17%) had both tests negative at baseline (3CIN2 and 1CIN3) with cumulative incidence of CIN2+ of 0.4% (95% CI: 0.1–1.4) at 5-years and 1.3% (95% CI: 0.4–3.7) at 9-years. During the first year, the prevalence among women with both tests positive was 27.0% (95% CI: 13.0–50.6) for CIN2+. Lost to follow-up was higher among women with both tests negative compared to those with both positive tests (38.7% vs 4.2%, p-value <0.001). 40.5% of the women HPV-/cyto- had a re-screening test during the 4 years following the baseline, increasing until 53.5% during the 6 years of follow-up.

Conclusions

HPV detection shows a high longitudinal predictive value at 9-year to identify women at risk to develop CIN2+. The data validate a safe extension of the 3-year screening intervals (current screening interval) to 5-year intervals in underscreened women that had negative HPV result at baseline. It is necessary to establish mechanisms to ensure screening participation and adequate follow-up for these women.

Sensitivity of cervico-vaginal cytology in endometrial carcinoma: A systematic review and meta-analysis

Cervico-vaginal cytology is primarily a cervical cancer screening test. The anatomical continuity of the uterine cavity with the cervix makes the Papanicolaou (Pap) test accessible to evaluate signs of disease shed from the endometrium. Our aim was to determine the sensitivity of routine Pap test in endometrial carcinoma detection and its relationship with clinico-pathologic factors. We performed a systematic review of studies reporting Pap test results prior to diagnosis of or surgery for endometrial carcinoma between 1990 and 2018 in PubMed or Web of Science. Two independent reviewers extracted data and assessed study quality using an adapted Newcastle-Ottawa Quality Assessment Scale and Quality Assessment of Diagnostic Accuracy Studies tool. We identified 45 studies including a total of 6599 women with endometrial cancer. Abnormal Pap test results prior to diagnosis of or surgery for endometrial carcinoma were observed in 45% (95% CI, 40%-50%) of study participants. This percentage was significantly higher among those of non-endometrioid histology compared with endometrioid subtypes (77% [95% CI, 66%-87%] vs 44% [95% CI, 34%-53%], respectively; P heterogeneity <.001). Several clinico-pathologic factors were related to a higher percentage of abnormal Pap test results, including high-stage, myometrial invasion >50%, high histological grade, positive peritoneal cytology, presence of lymph node metastasis, cervical involvement, and lymphovascular invasion (P heterogeneity <.05 for all variables). Routine cervical cytology can detect endometrial cancer in almost half of patients, whereas sensitivity is higher among individuals with non-endometrioid histology or more advanced cancers. This review summarizes the current clinical and prognostic value of cervical cytology in endometrial carcinoma. Recent technological developments using molecular biomarkers may improve accuracy for early cancer detection.

Moving towards an organized cervical cancer screening: costs and impact

Background

HPV screening has been shown to be more cost-effective than cytology screening under most scenarios. Furthermore, it should be offered only in organized programmes with good quality assurance mechanisms. This study analyses the comparative cost of the current policy of opportunistic cytology screening vs. a hypothetical organized programme based on primary HPV screening.

Methods

Total cervical cancer expenditure was defined as the sum of three cost elements: (i) direct (medical and non-medical) costs, obtained from a calibrated Markov model of the natural history of HPV and cervical cancer; (ii) programmatic costs, estimated based on other organized screening programmes; and (iii) indirect costs, extrapolated from previously published data.

Results

Organized HPV screening at 5-year intervals costs consistently less across all coverage levels than opportunistic cytology screening at 3-year intervals. The current annual direct medical cost to the public health system of the opportunistic cytology at 40% coverage is estimated at €33.2 per woman screened aged 25-64. Under an organized programme of primary HPV screening at 70% coverage, the cost is estimated to be €18.4 per woman screened aged 25-64.

Conclusion

Our study concludes that the economic resources currently devoted to providing opportunistic cytology screening to 40% of the target population at 3-year intervals could be more effectively used to screen 70% of the target population at 5-year intervals by switching to an organized programme based on primary HPV screening. This finding is of relevance to other European countries or regions with similar screening policies and health infrastructures.

[Evaluation of mortality after the analysis of the screening history in women diagnosed with infiltrating cervical cancer]

Objetivo

Evaluar el impacto de la ausencia de cribado en la incidencia de cáncer de cuello uterino durante el periodo 2000-2010 en el Principado de Asturias.

Diseño

Estudio retrospectivo.

Emplazamiento

Todos los hospitales públicos de Asturias.

Mediciones principales

Fueron revisadas 374 historias clínicas de mujeres diagnosticadas de cáncer de cuello uterino. La información clínica, el estadio FIGO y los datos de las citologías previas fueron obtenidos de las historias clínicas e informes de anatomía patológica. Se realizó análisis bivariante utilizando el test de chi-cuadrado de Pearson y regresión logística para el cálculo de odds ratio e intervalos de confianza al 95%.

Resultados

El 65,6% de las mujeres diagnosticadas de cáncer de cérvix entre los 25 y los 70 años no habían realizado una citología en al menos los 5 años y medio anteriores al diagnóstico. Este porcentaje se relacionó con la mayor edad al diagnóstico, la presencia de síntomas asociados y con un estadio tumoral avanzado en el momento del diagnóstico. En las mujeres diagnosticadas con una edad mayor de 70 años se objetivó que el 83,3% no habían realizado ninguna citología con anterioridad al momento del diagnóstico.

Conclusión

La implantación de un buen programa de cribado de cáncer cervicouterino y una calidad óptima del sistema en cada uno de los procedimientos que lo integran contribuiría a disminuir la incidencia y la mortalidad por cáncer de cuello uterino en Asturias.

Screening of cervical cancer in Catalonia 2006-2012

The early detection of intraepithelial lesions of the cervix, through the periodic examination of cervical cells, has been fundamental for the prevention of invasive cervical cancer and its related mortality. In this report, we summarise the cervical cancer screening activities carried out in Catalonia, Spain, within the National Health System during 2008-2011. The study population covers over two million women resident in the area. The evaluation includes 758,690 cervical cytologies performed on a total of 595,868 women. The three-year coverage of cervical cytology among women aged between 25 and 65 years was 40.8%. About 50% of first screened women with negative results had not returned to the second screening round. The introduction of high-risk human papillomavirus DNA (HPV) detection, as a primary screening cotest with cytology among women over age 40 with a poor screening history, significantly improved the detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+), being far superior to cytology alone. Cotesting did not improve the detection of CIN2+. The use of the HPV test for the triage of atypical squamous cell undetermined significance (ASC-US) improved the selection of women at high risk of CIN2+. Sampling (both cytology and HPV test) was largely performed by midwives (66.7%), followed by obstetricians (23.8%) and nurses (7%). Over half of the centres (54.8%) had full use of online medical records. During the study period, educational activities for professionals and for women were carried out periodically. The organisation of screening as a population activity in which women are actively called to the screening visit and the introduction of HPV testing as a primary screening tool are strongly recommended to ensure the maximum population impact in the reduction of the cervical cancer burden.

Assessment of soil pollution based on total petroleum hydrocarbons and individual oil substances

Different oil products like gasoline, diesel or heavy oils can cause soil contamination. The assessment of soils exposed to oil products can be conducted through the comparison between a measured concentration and an intervention value (IV). Several national policies include the IV based on the so called total petroleum hydrocarbons (TPH) measure. However, the TPH assessment does not indicate the individual substances that may produce contamination. The soil quality assessment can be improved by including common hazardous compounds as polycyclic aromatic hydrocarbons (PAHs) and aromatic volatile hydrocarbons like benzene, toluene, ethylbenzene and xylenes (BTEX). This study, focused on 62 samples collected from different sites throughout The Netherlands, evaluates TPH, PAH and BTEX concentrations in soils. Several indices of pollution are defined for the assessment of individual variables (TPH, PAH, B, T, E, and X) and multivariables (MV, BTEX), allowing us to group the pollutants and simplify the methodology. TPH and PAH concentrations above the IV are mainly found in medium and heavy oil products such as diesel and heavy oil. On the other hand, unacceptable BTEX concentrations are reached in soils contaminated with gasoline and kerosene. The TPH assessment suggests the need for further action to include lighter products. The application of multivariable indices allows us to include these products in the soil quality assessment without changing the IV for TPH. This work provides useful information about the soil quality assessment methodology of oil products in soils, focussing the analysis into the substances that mainly cause the risk.

[Coverage of cervical cancer screening in Catalonia, Spain (2008-2011)]

OBJECTIVE

To estimate cervical cytology coverage for the period 2008-2011 by age groups and health regions from data recorded in the medical records of women attending centers within the Catalan national health system.

METHODS

The data used to estimate coverage were obtained from the primary care information system. This information was anonymous and included age, center, date, and the results of cytological smears for a total of 2,292,564 women aged 15 years or more.

RESULTS

A total of 758,690 smears were performed in 595,868 women. Among women aged 25-65 years, the estimated coverage was 32.4% of the assigned population and was 40.8% in the population attended. Geographical variation was observed, with higher coverage among health regions closer to Barcelona. Abnormal Pap smears increased slightly from 2008 to 2011 (from 3% to 3.5%, respectively, p <0.001). In women with a negative first smear, the mean interval until the second smear was 2.4 years, but only 50% of women with a negative first smear in 2008 attended a second round during the study period.

CONCLUSIONS

Cervical screening coverage in the National Health Service of Catalonia includes one in three women. Second round participation was poor. Existing computer systems in primary care centers can ensure monitoring of population-based screening programs for cervical cancer. These systems could be used to plan an organized screening program to ensure wider coverage and better follow-up.

State of the art and review on the treatment technologies of water reverse osmosis concentrates

The growing demand for fresh water is partially satisfied by desalination plants that increasingly use membrane technologies and among them reverse osmosis to produce purified water. Operating with water recoveries from 35% to 85% RO plants generate huge volumes of concentrates containing all the retained compounds that are commonly discharged to water bodies and constitute a potentially serious threat to marine ecosystems; therefore there is an urgent need for environmentally friendly management options of RO brines. This paper gives an overview on the potential treatments to overcome the environmental problems associated to the direct discharge of RO concentrates. The treatment options have been classified according to the source of RO concentrates and the maturity of the technologies. For the sake of clarity three different sources of RO concentrates are differentiated i) desalination plants, ii) tertiary processes in WWTP, and iii) mining industries. Starting with traditional treatments such as evaporation and crystallization other technologies that have emerged in last years to reduce the volume of the concentrate before disposal and with the objective of achieving zero liquid discharge and recovery of valuable compounds from these effluents are also reviewed. Most of these emerging technologies have been developed at laboratory or pilot plant scale (see Table 1). With regard to RO concentrates from WWTP, the manuscript addresses recent studies that are mainly focused on reducing the organic pollutant load through the application of innovative advanced oxidation technologies. Finally, works that report the treatment of RO concentrates from industrial sources are analyzed as well.

Prediction of cervical intraepithelial neoplasia grade 2+ (CIN2+) using HPV DNA testing after a diagnosis of atypical squamous cell of undetermined significance (ASC-US) in Catalonia, Spain

Background

A protocol for cervical cancer screening among sexually active women 25 to 65 years of age was introduced in 2006 in Catalonia, Spain to increase coverage and to recommend a 3-year-interval between screening cytology. In addition, Human Papillomavirus (HPV) was offered as a triage test for women with a diagnosis of atypical squamous cells of undetermined significance (ASC-US). HPV testing was recommended within 3 months of ASC-US diagnosis. According to protocol, HPV negative women were referred to regular screening including a cytological exam every 3 years while HPV positive women were referred to colposcopy and closer follow-up. We evaluated the implementation of the protocol and the prediction of HPV testing as a triage tool for cervical intraepithelial lesions grade two or worse (CIN2+) in women with a cytological diagnosis of ASC-US.

Methods

During 2007-08 a total of 611 women from five reference laboratories in Catalonia with a novel diagnosis of ASC-US were referred for high risk HPV (hrHPV) triage using high risk Hybrid Capture version 2. Using routine record linkage data, women were followed for 3 years to evaluate hrHPV testing efficacy for predicting CIN2+ cases. Logistic regression analysis was used to estimate the odds ratio for CIN2 +.

Results

Among the 611 women diagnosed with ASC-US, 493 (80.7%) had at least one follow-up visit during the study period. hrHPV was detected in 48.3% of the women at study entry (mean age 35.2 years). hrHPV positivity decreased with increasing age from 72.6% among women younger than 25 years to 31.6% in women older than 54 years (p < 0.01).

At the end of the 3 years follow-up period, 37 women with a diagnosis of CIN2+ (18 CIN2, 16 CIN3, 2 cancers, and 1 with high squamous intraepithelial lesions -HSIL) were identified and all but one had a hrHPV positive test at study entry. Sensitivity to detect CIN2+ of hrHPV was 97.2% (95%confidence interval (CI) = 85.5-99.9) and specificity was 68.3% (95%CI = 63.1-73.2). The odds ratio for CIN2+ was 45.3 (95% CI: 6.2-333.0), when among ASC-US hrHPV positive women were compared to ASC-US hrHPV negative women.

Conclusions

Triage of ASC-US with hrHPV testing showed a high sensitivity for the detection of CIN2+ and a high negative predictive value after 3 years of follow-up. The results of this study are in line with the current guidelines for triage of women with ASC-US in the target age range of 25-65. Non adherence to guidelines will lead to unnecessary medical interventions. Further investigation is needed to improve specificity of ASC-US triage.

Kinetics of electro-oxidation of ammonia-N, nitrites and COD from a recirculating aquaculture saline water system using BDD anodes

The viability of the electro-oxidation technology provided with boron doped diamond (BDD) electrodes for the treatment and reuse of the seawater used in a Recirculating Aquaculture System (RAS) was evaluated in this work. The influence of the applied current density (5-50 A m(-2)) in the removal of Total Ammonia Nitrogen (TAN), nitrite and chemical oxygen demand (COD) was analyzed observing that complete TAN removal together with important reductions of the other considered contaminants could be achieved, thus meeting the requirements for reuse of seawater in RAS systems. TAN removal, mainly due to an indirect oxidation mechanism was described by a second order kinetics while COD and nitrite removal followed zero-th order kinetics. The values of the kinetic constants for the anodic oxidation of each compound were obtained as a function of the applied current density (k(TAN) = 7.86 × 10(-5) · exp(6.30 × 10(-2) J); kNO2 = 3.43 × 10(-2) J; k(COD) = 1.35 × 10(-2) J). The formation of free chlorine and oxidation by-products, i.e., trihalomethanes (THMs) was followed along the electro-oxidation process. Although a maximum concentration of 1.7 mg l(-1) of total trihalomethanes was detected an integrated process combining electrochemical oxidation in order to eliminate TAN, nitrite and COD and adsorption onto activated carbon to remove the residual chlorine and THMs is proposed, as an efficient alternative to treat and reuse the seawater in fish culture systems. Finally, the energy consumption of the treatment has been evaluated.

Aromatic DNA adducts and polymorphisms in metabolic genes in healthy adults: findings from the EPIC-Spain cohort

Aromatic compounds such as polycyclic aromatic hydrocarbons, arylamines and heterocyclic amines require metabolic activation to form metabolites able to bind to DNA, a process mediated by polymorphic enzymes. We measured aromatic DNA adducts in white blood cells by the (32)P-post-labelling assay in a sample of 296 healthy adults (147 men and 149 women) from five regions of Spain. We also analyzed functional polymorphisms in the metabolic genes CYP1A1, CYP1A2, EPHX1, GSTM1, GSTT1, NAT2 and SULT1A1. A significant increased level of DNA aromatic adducts was found related to the fast oxidation-hydrolysis phenotype defined by the polymorphism I462V in CYP1A1, the allele A in IVS1-154C>A of CYP1A2 and the combination Tyrosine-Arginine for Y113H and H139R of EPHX1. Geometric means (adducts per 10(-9) normal nucleotides) were 2.17, 4.04 and 6.30 for slow, normal and fast phenotypes, respectively (P-trend = 0.01). Slow acetylation by NAT2 was associated with a significant decrease in adduct level; subjects with slow alleles *5A and *7A/B had in average 1.56 x 10(-9)adducts, as compared with 5.60 for those with normal NAT2 activity (P-value = 0.01). No association was seen with polymorphisms of other metabolic genes such as GSTM1, GSTT1 or SULT1A1. We concluded that the metabolic pathways of oxidation, hydrolysis and acetylation are relevant to the formation of bulky DNA adducts. This could suggest a potential involvement of aromatic compounds in the formation of such adducts; however, given lack of specificity of the post-labeling assay, a firm conclusion cannot be drawn.

Subacute hemicorporal parkinsonism in 5 patients with infarcts of the basal ganglia

In 1929, Critchley introduced the term "vascular parkinsonism" (VP), which has been the subject of considerable controversy in neurology. Parkinsonism does not appear to be a frequent consequence of striatal infarcts, although unilateral parkinsonism has been reported as an acute or subacute onset syndrome following strategic infarcts in the striatum. Previous 123-I ioflupane SPECT (DaTSCAN) studies involving radioisotope labeling of the dopamine transporter protein at presynaptic level in patients with IPD (idiopathic Parkinson's disease) have found this technique to be highly sensitive in exploring the nigrostriatal pathway. Previous studies of VP with DatSCAN have been inconclusive. The present study correlates clinical data (unilateral parkinsonism following contralateral lenticular infarction), and radiological (CT/MRI) and functional neuroimaging findings (DatSCAN) in 5 patients with CT/MRI criteria for striatal infarcts. Finally, in 2 of these patients a diagnosis of IPD was made because of the follow-up of clinical signs and pathological DaTSCAN findings not concordant with the size and location of the vascular lesion.

Consumption of cruciferous vegetables and glucosinolates in a Spanish adult population

OBJECTIVE

To assess the intake of glucosinolates and cruciferous vegetables among Spanish adults.

DESIGN

Cross-sectional analysis of a prospective cohort study.

SETTING

The Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC).

SUBJECTS

We analysed data from 40 684 men and women aged 35-64 years from the EPIC-Spain cohort. The usual diet was assessed by means of the dietary history method, and glucosinolate intake was calculated using a published food composition database.

RESULTS

The average intake of cruciferous vegetables was 11.3 g/day, accounting for about 5% of total vegetable consumption, whereas the daily intake of total glucosinolates was 6.5 mg, among which 35% were of indole type. The absolute intake of glucosinolates was in average higher in men than in women (6.8 vs 6.2 mg/day), whereas glucosinolate density per energy unit was higher in women's diet (3.4 vs 2.7 mg/4200 kJ). Northern regions consumed in average 36% more glucosinolates than Southern regions (7.3 vs 5.4 mg/day). There was a positive association of glucosinolate intake with body mass index, physical activity, educational level and an inverse relationship with alcohol consumption.

CONCLUSIONS

Contrary to the pattern seen for total vegetable intake, our estimate of consumption of cruciferous vegetables, and hence of glucosinolates, is relatively low within Europe, which in turn is lower than in North America and several Asian populations.

Intake and food sources of nitrites and N-nitrosodimethylamine in Spain

OBJECTIVE

To conduct a comprehensive assessment of dietary intakes of nitrites and N-nitrosodimethylamine (NDMA).

SUBJECTS AND SETTING

A study was conducted within the Spanish cohort of the European Prospective Investigation in Cancer and Nutrition (EPIC) to assess the intake and food sources of these compounds in Spanish adults. The study included 41,446 health volunteers, aged 29-69 years, from Northern and Southern regions. Usual food intake was estimated by in-person interviews using a computerised dietary questionnaire.

RESULTS

The estimated geometric mean was 0.994 mg day(-1) for nitrites and 0.114 microg day(-1) for NDMA. For both compounds a positive trend in consumption with increasing energy intake was observed. Dietary NDMA was related to age and sex after energy adjustment, while nitrite consumption increased with higher intakes of vitamin C (P < 0.001). The food groups that contributed most to intakes were meat products, cereals, vegetables and fruits for nitrites, and processed meat, beer, cheese and broiled fish for NDMA. Current and past smokers, who had high levels of NDMA from tobacco exposure, were also identified as the highest consumers of dietary NDMA. Furthermore, smokers had low intakes of vitamin C (an inhibitor of endogenous nitrosation).

CONCLUSIONS

Intake levels of NDMA and nitrites in a Mediterranean cohort are currently relatively lower than those previously reported, although processed meat, beer and cured cheese still are the most important contributors to NDMA intake.

[Study of presynaptic nigrostriatal pathway by 123-I-FD-CIT-SPECT (DatSCAN SPECT) in primary orthostatic tremor]

INTRODUCTION

Primary orthostatic tremor (OT) is defined as a clinical syndrome with high frequency (13-18 Hz) tremor when standing predominantly involving legs and trunk. OT is thought to be driven by an unique supraspinal tremor generator. Previous studies suggest that the nigrostriatal dopaminergic transmission is impaired in patients with OT.

CLINICAL CASE

All three patients at an age of 56, 45 and 72 years fulfilled the diagnosis criteria of primary OT. The duration of illness amounted to 4, 3 and 1 year, respectively. The three patients had single-photon emission computed tomography (SPECT) using 123-I-FP-CIT as dopamine transporter tracer (DatSCAN).

RESULTS

DatSCAN was normal in every patient.

CONCLUSIONS

OT is considered to be caused by a central oscillator because high-frequency tremor bursts are time locked in arm, leg, trunk, and even facial muscles and peripheral stimulation does not reset the tremor. Some reports suggest that the central generator may be located in the posterior fossa. In our patients presynaptic nigrostriatal pathway was normal.

[SPECT with 123I-IBZM: utility in differential diagnosis of degenerative Parkinsonisms and establishment of quantification method]

OBJECTIVES

To assess utility of SPECT with 123I-Iolopride ( 123I-IBZM) in the differential diagnosis of patients with Parkinsonian symptoms and try to establish an adequate quantification method.

MATERIAL AND METHOD

We analyzed a total of 34 patients who underwent a study with 123I-IBZM SPECT. Studies were analyzed qualitatively (visually) and quantitatively, using different quantification methods. We used different sums of slices (2, 3, 4, and 7 slices) with different cortical regions as a reference (frontal and occipital regions). Results were analyzed statistically. The final diagnosis of patients was established by two neurologists, specialized in movement disorders.

RESULTS

Studies were visually assessed as normal in 24 cases and as pathologic in the other 10 cases. Scintigraphic studies had an adequate diagnostic correlation in 33 of the 34 patients. Four of the 8 methods used in the quantification were statistically significant in the differentation between normal and pathological. The use of different cortical brain regions as reference did not improve differentation between normal and pathologic studies. Global quantitative assessment of the studies showed that normal studies had higher values than pathological ones, with important overlapping between both categories.

CONCLUSIONS

123I-IBZM SPECT is an effective diagnostic tool in the establishment of the differential diagnosis in patients with Parkinson's disease and Parkinson-Plus. Quantification of these studies had limited utility since the overlapping of index values between normal and pathological restricts their use in individual cases.

Dietary intake of polycyclic aromatic hydrocarbons in a Spanish population

The objective of the present study was to estimate the dietary intake of polycyclic aromatic hydrocarbons (PAHs), particularly benzo[a]pyrene (B[a]P), as well as to identify the principal dietary sources of such compounds in the Spanish adult population. The study included 40,690 subjects aged 35 to 64 years from five regions of Spain that were included in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Spain cohort. Usual food intake was estimated by personal interview through a computerized version of a dietary history questionnaire. The estimations of B[a]P and total PAHs were made, taking into account the country where the determinations of content of these compounds in the foods came from and the year of publication. The mean intake of B[a]P in the population was 0.14 microg/day, and the mean intake of total PAHs was 8.57 microg/day. Both for B[a]P and total PAHs, women had a significantly lower mean intake than men, and older people consumed lesser amounts than younger people. Furthermore, the intake was higher in the northern regions. There were no significant differences by smoking status. The food groups of meat and meat products, cereals, and oils and fats contribute 55.5% to the total B[a]P intake, while cereals and meat and meat products contribute 61% to the total PAH consumption. Our estimations of B[a]P intake were lower than in the United Kingdom and The Netherlands, were similar to those found in other studies from Spain and Italy, and were higher than those in the United States and Norway.

[DaT-SCAN SPECT in the differential diagnosis of dementia with Lewy bodies and Alzheimer's disease]

INTRODUCTION

Dementia with Lewy bodies (DLB) is one of the main differential diagnosis of Alzheimer's disease (AD). In DLB there is 40-70% loss of striatal dopamine and the loss of dopaminergic cell is accompanied by loss of the dopamine transporter. The loss of dopaminergic neurons in DLB can be confirmed in vivo with I-FP-CIT (DaT-SCAN), a pre-synaptic dopamine transporter marker. There are no changes in DaT-scan in AD compared with controls. AIM. The use of DaT-SCAN for the differential diagnosis between AD and DLB.

CASE REPORTS

We use the DaT-SCAN to study the nigrostriatal pathway in 6 patients with dementia and moderate parkinsonism. The Mini-Mental Test and the Unified Parkinson's Disease Rating Scale, motor part only (UPDRS), were performed. A SPECT scan was carried out 3 to 4 hours after administration of 185 MBq FP-CIT (ioflupane) a dopaminergic presynaptic ligand. With occipital cortex used as a radioactivity uptake reference, ratios for the caudate nucleus and the anterior and posterior putamen of both hemispheres were calculated. All scans were also rated by a simple visual method. All patients had dementia with moderate fluctuations in cognitive function, parkinsonian syndrome and hallucinations. DaT-SCAN was normal in 2 patients and pathological in 4.

CONCLUSION

The sensitivity and specificity of the DLB criteria vary markedly. FP-CIT SPECT may be a new tool in the differential diagnosis between DLB and AD.

Reliability of bulky DNA adducts measurement by the nuclease P1 32P-post-labelling technique

The aim was to assess the reliability of bulky DNA adducts measurement by means of the 32P-post-labelling assay. The research design consisted of an intramethod reliability study. Buffy coats from 41 subjects were used to obtain two aliquots of 1-5 microg DNA for each subject; bulky DNA adducts were measured using the nuclease P1 32P-post-labelling technique. The reliability of the measurement was assessed by means of the intraclass correlation coefficient (ICC), the distribution of the differences between the two measurements and the limits of agreement. The estimated ICC was 0.977, with a 95% confidence interval between 0.921 and 0.977. The limits of agreement were +/- 0.44 (DNA adducts per 10(8) nucleotides). Only three subjects had differences lying out of such limits. Bulky DNA adduct levels measured by the 32P-post-labelling technique showed good reliability. Only one measurement is needed to use DNA adducts as a biomarker of exposure and, possibly, cancer risk. Besides, as a validation analysis, 32P-post-labelling measurements can be repeated in only 20-30% of samples.

Development of a food database of nitrosamines, heterocyclic amines, and polycyclic aromatic hydrocarbons

Some nitrosocompounds that are formed during food preservation, as well as polycyclic aromatic hydrocarbons (PAH) and heterocyclic amines (HA) formed during cooking, may have carcinogenic activity. An accurate assessment of dietary intake of such compounds is difficult, mainly because they are not naturally present in foods, and they are not included in standard food composition tables. Our objective was to develop a food composition database of nitrates, nitrites, nitrosamines, HA, and PAH. We conducted a literature search on the food content of these compounds using the Medline and EMBASE databases. We gathered the following information: 1) Food information: name, cooking methods, preservation methods, cooking doneness, temperature, and time; 2) compound information: type, quantity, value type, analytic method, and sampling methods; and 3) publication information: year, author, and country. We developed a table that includes 207 food items with information concerning the concentration of nitrites, nitrates, and nitrosamines, 297 food items with information about HA concentration and 313 food items with information about PAH. The database is based on 139 references from 23 different countries. It is arranged according to compounds and food groups to facilitate its practical use. The potential limitations are due to the quality of the information we could obtain through Medline and EMBASE databases. This database will allow investigators to quantify dietary exposure to several potential carcinogens, and to analyze their relation to the risk of cancer.

[Study of the pre and post-synaptic dopaminergic system by DaTSCAN/IBZM SPECT in the differential diagnosis of parkinsonism in 75 patients]

INTRODUCTION

Essential tremor (ET) may be misdiagnosed as idiopathic Parkinson's disease (PD). In neurodegenerative diseases, structural imaging, such as CT or MRI, is of limited value for differentiating parkinsonian syndromes since structural changes are often only evident by the time the disease is far advanced. Most cases of symptomatic parkinsonism are vascular parkinsonism, but PD may coexist. The differential diagnosis between Alzheimer's disease (AD) and dementia with Lewy bodies (LBD) is often difficult.

OBJECTIVE

To define the utility of functional neuroimaging test to establish differential diagnosis between PD and ET, drug induced parkinsonism, multiple system atrophy and vascular parkinsonism, and between AD and LBD, when clinical presentation, evolution or treatment response are atypical.

PATIENTS AND METHODS

A group of 75 patients with parkinsonism was examined by clinical assessment and DaTSCAN (123I-FP-CTI, dopamine transporter protein marker) and/or IBZM SPECT (D2 receptor marker). The patients were recruited from our outpatient clinic.

RESULTS

Correlation between initial clinical diagnosis and functional imaging studies (DaTSCAN and/or IBZM SPECT) in our patients did not reach that described (more than 90 %) for these techniques in previously published studies. Conclusions. According to sensitivity and sensibility reported in previous imaging studies of the pre and/or postsynaptic dopaminergic system using DaTSCAN and/ or IBZM, SPECT may be a new tool in the diagnosis of parkinsonian patients with difficult clinical diagnosis.

[Fluctuations and dyskinesias as early L-dopa-induced motor complications in severe Parkinsonian's patients]

Daily fluctuations of motor performance and dyskinesias in patients with Parkinson's disease (PD) treated with levodopa represent a difficult challenge to our understanding. We report 10 patients diagnosed of severe PD (Hoehn and Yahr: III-IV/V) treated with levodopa (range of dose: 750-900 mg/day) in single drug therapy since their diagnosis (mean time of levodopatherapy: 4.8 2.4 months, range: 3-6 months). All patients developed motor complications within weeks to months after initiating L-dopatherapy. Two patients received an intravenous apomorphine infusion (mean dose: 8.5 mg/day) during a mean time of 7.5 hours, but motor complications persisted during the infusion in spite of continuous dopaminergic stimulus. The degree of nigrostriatal damage (disease severity) seems to be a very important risk factor for the development of treatment-related motor complications.

[Bone mineral density measurement techniques]

Different techniques for measuring bone mass density developed in the last years are revised. Single and dual fotonic absorciometry are now outdated by the use of single and dual x-ray absorciometry which don't need an isotope source. The most widely used technique now is the dual energy x-ray asbsorciometry, specially the ones who analyse lumbar spine and hip. It is an accurate and precise tool and has proved to be a good predictor of fractures. Nevertherless, peripheral densitometers based on dual energy x-ray or on broadband ultrasonic attenuation, have also proved to be of utility. Quantitative computed tomography is the only three-dimensional densitometer available, capable to selectively measure cortical or trabecular bone. It has the inconvenient of the high radiation and cost. We argue about advantages and disadvantages of the different techniques of bone mass measurements.Lastly, we revise the indications of densitometry. There are not unanimous criteria about this question, but different organisms and scientific societies have elaborated recommendations based on risk factors of osteoporosis and fracture, that could be of utility in clinical practice.