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BACKGROUND: Utilization of active surveillance (AS) for prostate cancer is increasing. Optimal selection criteria for this approach are undefined and questions remain on how best to expand inclusion beyond typical men with very low- or low-risk disease. We sought to review the current experience with AS for men with intermediate-risk featuresMethods:PubMed was queried for all relevant original publications describing outcomes for men with prostate cancer managed with AS. Outcomes for patients with intermediate-risk features as defined by the primary investigators were studied when available and compared with similar risk men undergoing immediate treatment. RESULTS: Cancer-specific survival for men managed initially with AS is similar to results published with immediate radical intervention. A total of five published AS series describe some outcomes for men with intermediate-risk features. Definitions of intermediate risk vary between studies. Men with Gleason 7 disease experience higher rates of clinical progression and are more likely to undergo treatment over time. Intermediate-risk men with Gleason 6 disease have similar outcomes to low-risk men. Men with Gleason 7 disease appear at higher risk for metastatic disease. Novel technologies including imaging and biomarkers may assist with patient selection and disease surveillance. CONCLUSIONS: The contemporary experiences of AS for men with intermediate-risk features suggest that although these men are at higher risk for eventual prostate-directed treatment, some are not significantly compromising chances for longer-term cure. Men with more than minimal Gleason pattern 4, however, must be carefully selected and surveyed for early signs of progression and may be at increased risk of metastases. Incorporating information from advanced imaging and biomarker technology will likely individualize future treatment decisions while improving overall surveillance strategies.

Introduction: Recent discoveries in cell therapy research present new opportunities for cellular products to be used to treat severe, and as yet incurable, diseases. It is therefore essential to implement a quality control programme in order to ensure that safe cells and tissues are provided., Methods: In a preliminary phase of the setting up of a the cellfactory, monitoring was carried out monthly over a 6-month period in one out of three cell therapy laboratories and filter rooms in order to evaluate the microbial contamination of air and surfaces and the presence of airborne particulates., Results: The mean total bacterial and fungal loads measured in the air in the centre of the filter room were 20.7 +/1 28.9 colony-forming units (cfu)/m3 and 9.2 +/- 15.4 cfu/m3, respectively, and 5.2 +/- 4.1 cfu/m3 and 6.8 +/- 13.4 cfu/m3, respectively, in the laboratory. The mean fungal load values recorded on the surfaces sampled in the laboratory were in 6 out of 18 cases higher than the reference values (5 cfu/plate). As to the results of particulate monitoring, with regard to the 0.5 microm particles, about 83% of the samples revealed values below the limit of 350.000 particles per cubic metre., Conclusions: In this set-up phase, monitoring was able to pick out structural and organisational flaws acceptable in a laboratory compliant with Good Manufacturing Practices class C (Annex 1), but not in a class B facility. Thanks to this preliminary monitoring phase, and by correcting these flaws, the clean room facility could achieve compliance to class B.

Introduction: In dentistry, as in surgery, there is a risk of cross-infection for both patients and staff The aim of this research was to evaluate procedures and behaviors enacted by dental staff which might engender a risk for themselves and their patients., Methods: A questionnaire was administered to 106 dental workers in Genoa (Italy), both public and private. Whenever personal interviews were conducted, the facilities involved were also inspected and the activities of the dental staff were observed directly., Results: This research highlighted some critical points in both structural and organizational features and in the management of infective hazards in the sample considered. In some cases, inadequacies were noted with regard to the prevention of cross-infections, such as the lack of disinfection of work surfaces and the handles of chair-set accessories., Discussion and Conclusions: The particular nature of dental work, in which aerosols of blood and saliva may be produced by rotating instruments, engenders a risk of infection. Application of the various preventive measures available can significantly reduce microbial contamination and the risk of occupational infection and cross-infections. Furthermore, improvement in the structural and organizational features of dental surgeries and the continuing education of health-care workers is indispensable to the control and prevention of infectious diseases.

Introduction: The study assessed the efficacy of a system of nebulization of a hydrogen peroxide-based solution for surface disinfection., Methods: Different concentrations (1, 2 and 4 ml/m3) of the same disinfectant solution (active principle: hydrogen peroxide) were nebulized inside a 50 m3 experimental environment. Sampling was carried out on both horizontal and vertical surfaces, and the total bacterial load at 37 degrees C was determined by means of direct contact with Rodac plates. The disinfection efficacy of the system was evaluated by comparing the total bacterial load measured on the surfaces before and after treatment. Statistical analysis was performed by means of Stata/SE9 software., Results: The percentage reduction in the mean bacterial load on horizontal surfaces as a result of treatment at concentrations of 1, 2 and 4 ml/m3 proved to be 54.9%, 70.9% and 86.9%, respectively. With regard to vertical surfaces, the percentage reduction was 100% in all experimental conditions., Discussion and Conclusions: The system tested proved to be efficacious in disinfecting surfaces inside environments of 50 m3 in volume. It could therefore be used to disinfect surfaces in hospital and community settings. In healthcare facilities, disinfection by means of nebulization systems could help to reduce the risk of spreading nosocomial infections.

Background: Many dental procedures produce extensive aerosols and splatters that are routinely contaminated with microorganisms., Methods: Air containing blood-bearing aerosols and surfaces contaminated by sedimenting blood particulate was sampled in 5 different dental cubicles. To assess contamination by blood particulate, the concentration of hemoglobin (Hb) in the air and on the sedimentation surfaces was determined., Results: The mean concentration of Hb in the air aspirated in the 5 cubicles was 0.14 +/- 0.23 microg/m(3), corresponding to a blood volume of 8.7 x 10(-4) microL/m(3). Similarly, the mean concentration of blood particulate sedimented on surfaces was calculated and found to be 1.56 microL/m(2). In 80% of the cubicles monitored, 100% positivity to the Hb determination test was recorded in all of the surface samples., Conclusions: The results obtained revealed contamination of both air and surfaces by blood particulate. Moreover, with the exception of those obtained in 1 cubicle, all of the samples of sedimenting particulate analyzed were positive for the presence of Hb.

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.

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.

Introduction: As occupational exposure to anaesthetic gases is one of the main risks for operating theatre staff an environmental monitoring campaign was conducted in order to evaluate the degree of pollution by nitrous oxide (N2O) in the operating theatres of some hospital facilities in Liguria., Methods: Any leaks (systemic and/or managerial) of anaesthetic gas and the number of efficacious air exchanges per hour supplied by air-conditioning systems were evaluated by means of an IR spectrometer, which was wired to a computer for data collection and analysis. The concentration of nitrous oxide in the centre of each operating theatre was measured by means of chemo-adsorbent cartridges analysed by gas chromatography., Results: In 76.0% of the operating theatres examined a mean environmental concentration of N2O below the legal limits was recorded. The highest mean concentrations were generally associated with the presence of systemic leaks. Supplying an adequate number of efficacious air exchanges per hour enabled environmental concentrations of anaesthetic gas to be kept within acceptable levels., Discussion and Conclusions: Training personnel in the correct management of the operating theatre and of anaesthesia equipment, and ensuring the availability of an adequate air-conditioning system enable the risk of exposure to nitrous oxide to be minimised. This can be achieved through a concerted effort on the part of all involved, in accordance with the concept of ongoing improvement in healthcare services.

Although formaldehyde has recently been classified by the IARC as "carcinogenic in humans" (class 1), it is still widely used in pathology departments for the fixing and conservation of biological tissues. Its use therefore raises the question of occupational exposure. The present paper reports the results of an environmental monitoring campaign to evaluate pollution by formaldehyde in various areas of three pathology departments. Chemi-adsorbent cartridges able to adsorb airborne formaldehyde were used to detect the substance. Quantitative determination of the formaldehyde was carried out by means of liquid chromatography (HPLC). The concentrations of airborne formaldehyde in the areas monitored were fairly modest, being below the limits of indoor concentration proposed by the OSHA. In one of the three departments, however these limits were exceeded in 40% of the samples taken in the room used for the storage of containers. As yet, in spite of the recent class 1 classification by the IARC, no provisions have been made to ban the use of formaldehyde. It is therefore essential to draw up environmental monitoring programmes in order to evaluate occupational exposure and to assess the efficacy of any preventive measures adopted.

A total of 1,030 microbiological samples were taken in 3 hospital wards with different air-conditioning features: no conditioning system (ward A), a conditioning system equipped with minimum efficiency reporting value (MERV) filters (ward B), and a conditioning system thoroughly maintained and equipped with high-efficiency particulate air (HEPA) filters (absolute) (ward C). The air in each ward was sampled, and the bacterial and fungal concentrations were determined by active and passive methods. The concentration of fungi on surfaces was also determined. Active sampling showed positive samples in wards A and B only, with average values of 0.50 colony-forming units (CFU)/m(3) (95% CI, 0.30 to 0.70) in A and 0.16 CFU/m(3) (95% CI, 0.13 to 0.20) in B. Passive sampling was positive only in ward A (mean, 0.14 CFU/cm(2)/h; 95% CI, 0.13 to 0.15). Aspergillus was found in 27% and 22% of sampled surfaces in wards A and B, respectively, but in no samples from ward C. The most commonly found species was A. fumigatus (76% of cases in A and 34% of cases in B). The results show that the use of air-conditioning systems markedly reduces the concentration of aspergilli in the environment. Proper maintenance of these systems is clearly fundamental if their efficacy is to be ensured.