子宫颈上皮内瘤变或原位腺癌的处理(2006年版)

2006年9月18—19日，146名代表29个组织和专业学会的专家在Bethesda聚会，修改制订了有关如何处理宫颈癌筛查异常结果妇女的以循证医学为依据的共识指南。有关低度宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）的处理，变化较大。以往，需要根据阴道镜检查结果是否满意进行处理，对所有的CIN1妇女均可以采用破坏或者切除疗法。在新的指南中，不论阴道镜检查满意与否，对因低度宫颈细胞学结果转诊而明确的CIN1，细胞学随访是唯一的处理建议。     

宫颈鳞状上皮肿瘤的病理诊断价值探讨

目的探讨宫颈鳞状上皮肿瘤的病理诊断价值。方法对193例妇女进行宫颈液基细胞学涂片及宫颈活组织病理检查,回顾性分析准确率。结果宫颈液基细胞学检查结果正常及炎症9例,ASCUS45例,LSIL36例,HSIL103例,病理学检查结果CINI39例;CINII50例;CINIII49例,和病理学结果比较,细胞学的假阴性率为3.11%。结论宫颈鳞状上皮内病变临床误诊情况多见,建议应用细胞学与组织学联合诊断,以有效提高正确诊断率。     

2001年宫颈细胞学异常妇女处理的共识指南

目的：为宫颈细胞学异常和宫颈癌前病变妇女提供以证据为基础的处理指南。参加者：由美国阴道镜及宫颈病理学会(American Society for Colposcopy and Cervi-cal Pathology，ASCCP)主办的研讨会共邀请121位宫颈癌前病变诊断和治疗专家，共有来自29个专业组织、联邦机构、全国和国际性卫生保健机构的代表参加。证据及共识过程：宫颈细胞学异常妇女的处理指南是通过多步骤过程而形成的。于会议前6个月开始，工作组根据1988～2001年正式发表的英文文献综述并应用互联网公告栏广泛采纳专业协会的意见，形成处理指南草案。2001年9月6～8日，ASCCP共识会议在马里兰州的Bethesda举行。会上报告了指南的支持性证据，并进行了讨论、修订和投票。结论：非典型鳞状细胞(atypical squnmous cells，ASC)妇女的处理取决于巴氏检查结果是否进一步分类为未明确诊断意义的(undetermined significance，US)非典型鳞状上皮(ASC—US)或是不能排除高度鳞状上皮内病变(high-grade squamous intraepithelial lesion，HSlL)(ASC-H)。ASC-US妇女应接受的治疗计划是2次重复细胞学检查，即刻阴道镜检查，或人乳头瘤病毒(human papillomavirus，HPV)高危型的DNA检测。在采用液基细胞学筛检时，首选建议做HPV DNA检测。大多数情况下，患有ASC-H、低度鳞状上皮内病变(low-grade squamous intraepithelial lesion，LSIL)、HSIL和非典型腺细胞的妇女都应该立即做阴道镜检查。     

门头沟区宫颈癌筛查302例宫颈不典型鳞状上皮病变结果分析

目的：总结门头沟地区妇女宫颈癌筛查宫颈不典型鳞状上皮病变的发生率与年龄的关系,并分析阴道镜检查下的病理结果。方法回顾性分析35～59岁行宫颈癌筛查巴氏涂片结果ASCUS的妇女,在阴道镜定位下多点活检的组织病理学检查。结果302例宫颈细胞学诊断为ASCUS患者,45～49岁年龄组宫颈上皮内瘤变CINI～I I的发生率（25.53%）高于其他年龄组,差异有统计学意义（P＜0.05）。40～44岁年龄组CINI～I I的发生率（16.67%）高于35～39组、50～54组、55～59组CINI～I I的发生率,差异有统计学意义（P＜0.05）。302例ASCUS患者中,阴道镜诊断的≥LSIL 119例（39.40%）,阴道镜指导下组织活检,病理学诊断109例（36.09%）,病理学和阴道镜诊断阳性符合率为91.59%。结论40～49岁ASCUS患者直接做阴道镜引导下多点取活检,其他年龄组ASCUS患者阴道镜检查若未发现病变,6个月后复查细胞学检查;阴道镜检查以及阴道镜下取活检对ASCUS的处理具有较高的临床价值。     

DNA倍体分析和HPV检测在宫颈ASCUS诊断中的意义

目的对宫颈液基细胞检查考虑为非典型鳞状上皮细胞(ASCUS)而活检诊断宫颈高级别鳞状上皮内上皮病变(HSIL)的病例进行联合检测DNA倍体和HR-HPV,研究DNA倍体分析和HR-HPV检测对ASCUS病例诊断和临床处理的意义。方法选取1 087例经活检确诊的ASCUS病例分别进行DNA倍体分析和HR-HPV检测,出现非整倍体、多倍体以及细胞DNA含量>9c的病例均视为倍体异常。结果在液基细胞学诊断ASCUS而活检诊断为HSIL的病例中89.5%(68/76)的病例检测出DNA倍体异常,HR-HPV感染为84.2%(64/76)。HR-HPV感染和/或DNA倍体异常与宫颈HSIL之间差异有统计学意义(Ρ=0.001,0.001和0.001)。细胞核DNA含量>9c与宫颈HSIL之间差异有统计学意义(Ρ=.001)。结论宫颈液基细胞学标本出现HR-HPV阳性和DNA倍体异常,特别是出现细胞核DNA含量>9c,预示很可能存在宫颈HSIL或者具有进展为宫颈HSIL的可能,联合检测HR-HPV和DNA倍体改变有助于宫颈HSIL早期筛查。     

沈阳地区人乳头瘤病毒感染与宫颈疾病关系的研究

目的 了解沈阳地区人乳头状瘤病毒(HPV)感染在宫颈病变患者中的型别分布情况,探讨不同亚型HPV感染在宫颈病变中的作用.方法 应用HybriMax技术,对1 001例门诊就诊妇女的宫颈脱落细胞进行21种亚型的HPV感染检测.结果 在946例宫颈细胞学检测异常妇女中,479例HPV检测阳性,阳性率为50.63%.细胞学检测异常组妇女HPV感染率与细胞学检测正常组妇女比较,差异有统计学意义(P＜0.01);在29例宫颈癌患者中HPV全部阳性.在HPV感染者中,除43型外,其余20种HPV亚型均被检出.感染率最高的亚型是HPV-16,阳性率为23.15%,感染率高的其他亚型依次为58、52、CP8304、33、53型.HPV的多型感染率随宫颈病变程度加重而升高,细胞学正常组HPV的多型感染率与宫颈癌组妇女比较,差异有统计学意义(P＜0.01).结论 沈阳地区HPV在可疑就诊妇女宫颈脱落细胞中的感染率为50.63%,常见HPV亚型依次为16、58、52、CP8304、33、53型.HPV的多型感染可能促进宫颈癌的发生.     

子宫颈息肉的鳞状上皮内病变24例病理分析

目的探讨发生于子宫颈息肉的鳞状上皮内病变（SIL）的临床病理学及细胞学特征。方法收集24例子宫颈息肉的SIL,复习病理切片、细胞学检查及第二代杂交捕获法HPV-DNA（HC2HPV-DNA）情况,同时对其进行免疫组化检测。结果发生低级别SIL（LSIL）10例,发生高级别SIL（HSIL）14例。10例LSIL中,4例合并非息肉子宫颈的LSIL,其中3例细胞学为LSIL,1例为意义不明的不典型鳞状细胞（ASCUS）;另外6例仅子宫颈息肉有LSIL的病例中,1例细胞学为LSIL,其余5例细胞学阴性。14例HSIL中,1例合并非息肉子宫颈的LSIL,细胞学为LSIL,3例合并非息肉子宫颈的HSIL,细胞学为HSIL。其余10例仅子宫颈息肉有HSIL的病例中,2例细胞学为HSIL,1例为倾向高级别病变的不典型鳞状细胞（ASC-H）,7例细胞学阴性。HC2HPV-DNA检测,3例LSIL及3例HSIL阴性,其余18例均阳性。结论子宫颈息肉的SIL少见,可合并或不合并非息肉子宫颈的SIL。单纯子宫颈息肉的SIL可能被细胞学检查漏诊。     

457例宫颈鳞状上皮细胞病变的病理学研究

目的探讨组织病理学诊断对宫颈不典型鳞状上皮（ASC）病变的价值。方法对457例宫颈液基细胞学检查结果为ASC患者，做5％醋酸宫颈染色肉眼观察，阴道镜检查及宫颈多点活检行组织学检查。细胞学诊断采用TBS（2001）分级报告系统，阳性诊断包括意义不明的不典型鳞状细胞（ASC-US）及以上病变与组织病理学诊断结果对照分析。结果457例宫颈液基细胞学与组织病理学结果显示：ASC-US组CINII以上者34例，占8．15％；ASC-H组CINⅡ以上者14例，占35％；2组之间差异有统计学意义（X^2=59．17，P〈0．01）。结论重视液基细胞学检查不典型鳞状上皮细胞及以上病变患者准确掌握TBS分级诊断标准，提高宫颈早期病变的检出率。     

青海省海南藏族自治州地区4865例宫颈癌筛查结果分析

目的：探讨海南州地区妇女宫颈病变的现状及临床意义,为宫颈癌的防治提供依据。方法：查阅2009年9月—2013年12月我地区4 865例（20～70）岁因各种妇科疾病就诊于我院妇科门诊行宫颈液基细胞学检查（TCT）的妇女,采用妇科常规检查、TCT检查进行宫颈癌筛查,用TBS-2001诊断系统进行分析,做出诊断。对细胞学异常患者,行阴道镜下取活检。结果：宫颈细胞学异常者408例,检出率为8.39%。各年龄组患病情况之间有差异。上皮内病变高发年龄组为（30～39）岁。高级别CIN高发年龄组为（40～49）岁,宫颈癌的高发年龄组为（50～70）岁。上皮内病变（CIN）检出率25.90‰,宫颈癌检出率3.49‰。经组织学活检确诊为CIN者109例,宫颈鳞癌20例。CIN检出率22.40‰,宫颈癌检出率4.11‰。结论：在宫颈癌筛查中应用TCT检查,能够大幅度提高宫颈疾病检出的阳性率,提早发现癌前病变,早期治疗,以降低宫颈癌的发生。     

基层医院推广宫颈病变筛查新技术

由于传统巴氏人工阅片会出现较高的假阴性率(文献报道为2%~50%)或假阳性率,目前国外已停止使用巴氏人工阅片法,取而代之的是宫颈细胞学检测新技术及TBS分类法。①薄层细胞学检测系统(TCT):对异常细胞诊断率提高13%,对低度以上鳞状上皮病变的检出率提高65%,但该设备1次只能处理1     

Sperm DNA Fragmentation may Influence IUI Outcome but could be Treated by ICSI： Evidence from Human Sperm Bank

Objective To determine the correlation between semen parameters, sperm DNA damage, progressive motility （PR）, morphology and intrauterine insemination （IUI）/ intracyto- plasmic sperm injection （ICSI） outcomes. Methods All the donors providing the samples in this study were recruited by Shang- hai Human Sperm Bank. For IUI, 122 donors were divided into group A （n=60） and group B （n=62）. Group A had a higher pregnancy rate while group B had a lower pregnancy rate （3.86 ± 1.50% vs 0.18 ± 0.52%）. For ICSI, 45 donors were divided into group C with a higher pregnancy rate （77. 78 ± 17.21%, n=23）, group D with a lower pregnancy rate （40. 73 ± 19.19%, n=22） and group E with an average preg- nancy rate in the sperm bank （48.96 ± 12.08%, n=23）. Semen analysis, morphology and DNA damage were assessed on samples retained in the sperm bank. Fresh semen samples were also collected and corresponding semen analyses data was included along with the pregnancy rates. Results No significant difference was found in the population characteristics between groups A and B, while there was a significant difference in sperm DNA fragmetation index （DFI） and morphology between the two groups （P〈0.05）, but not in other semen parameters （P〉0.05）. There was no significant difference in population characteristics between groups C, D and E while the DFI of group D was significant higher than groups C and E （P〈0.01）, but there was no significant difference in other semen parameters （P〉0.05）.Conclusion DFI might be a good predictor for IUI outcomes. Infertile couples with a high DFI should choose ICSI treatment instead of IUI. DFI should be a routine screening marker used to screen for sperm donors.     

Comparison of Fresh Blood Cell Nature Immune Reaction of Children Patients with SLE or RA

To research the erythrocytes of condition of innate immunity in the children patients with RA and SLE, comparing with changes of activity of CD35 （CR1） on the erythrocyte between these two kinds of diseases, and further discuss the pathogenesis of these two kinds of diseases in children. The reaction of innate immunity of erythrocytes, lymphocytes and neutrophils which isolated from fresh blood of patients with RA and SLE to tumor cells was measured, and then the levels of expression of CD35 by using flow cytometry （FCM） were measured. The rosette rate of erythrocyte, lymphocytes and granulocytes adhering to cancer cell in the children patients with RA were higher than counterparts of normal controls （P〈0.001） respectively; the rosette rate of erythrocyte, lymphocytes and granulocytes adhering to tumor cells in the children patients with SLE were lower than counterparts of normal controls （P〈0.001） respectively. The rosette rate of these to tumor cells of children patients with RA, showed the highest figure change during different phases, including progression phase〉stationary phase 〉 extinction phase. And the rosette rates in these three groups were significantly higher than ones of that in normal controls. The expression of CD35 on the erythrocyte of children patients with RA was significantly higher than that of normal controls （P〈0.001）, while that of patients with SLE was significantly lower than that of normal controls （P〈0.001）. The CD35 on the red cells showed significantly positive correlation （γ=0.804, P〈0.01） with adhering erythrocytes and positively correlation with the rate of lymphocytes （P〈0.05）. The native immune function of children patients with SLE or RA was out of balance, and perhaps its changes have a relation with activity of diseases. It was suggested that the erythrocyte immunity function may be a new indicator to the condition of children patients with RA or SLE to judge the development and prognosis.     

Electroacupuncture at Feishu （BL13） and Zusanli （ST36） down-regulates the expression of orexins and their receptors in rats with chronic obstructive pulmonary disease

Inflammation and lung function decline are the main pathophysiological features of chronic obstructive pulmonary disease （COPD）. Acupuncture can improve lung function in patients with COPD, but the underlying mechanisms are not well understood. Orexins （OXs）, which are found in peripheral plasma, are neuropeptides that regulate respiration and their levels are related to COPD. Therefore, we hypothesized that acupuncture might alter OXs, reduce lung inflammation and improve lung function in COPD. METHODS： COPD was induced in rats by exposure to cigarette smoke for 8 weeks and injecting with lipopolysaccharide twice. Electroacupuncture （EA） was performed at Feishu （BL13） and Zusanli （ST36） for 30 min/d for 2 weeks. Rat lung function and morphology were assessed after EA. The levels of tumor necrosis factor-α （TNF-a） and intedeukin-1β （IL-16） in bronchoalveolar lavage fluid （BALF） and orexin A and B levels in the lung tissue were detected by enzyme-linked immunosorbent assay. OX receptor mRNA levels and immunopositive cells were assessed with real-time polymerase chain reaction and immunohistochemical methods, respectively. The relationships among lung function, cell factors, and OX levels were analyzed by Pearson correlation analyses. RESULTS： Compared with the control group, lung function was significantly decreased in the rats with COPD （P〈0.05）. There were obvious increases in TNF-α and IL-1β levels in BALF （P〈0.05 and P〈0.01, respectively）, orexin A level in lung tissue （P〈0.01; but not orexin B） and mRNA expressions of OX 1 type receptor （OXR1） and OX 2 type receptor （OXR2） in lung tissue （P〈0.05 and P〈0.01, respectively）; the integrative optical densities （IODs） of both receptors were greater in the COPD group （P〈0.05）. For rats with COPD subjected to EA, lung function was improved （P〈0.05）. There were notable decreases in TNF-a and IL-1β levels （P〈0.05 and 〈0.01, respectively） in BALF. Orexin A, but not orexi     

Successful Pregnancy and Birth in A FET Cycle Following the Triggering of Oocyte Maturation with 800 IU of Human Chorionic Gonadotropin

Objective To describe two clinical cases involving patients who were administered 800 IU of hCG to trigger oocyte maturation and who underwent a frozen-thawed embryo transfer （FET） cycle. Methods Two infertile patients with high ovarian response undergoing stimulation for IVF,, in which 800 IU of hCG was injected by mistake. IVF patients treated under a short protocol with 800 IU of hCG triggering ovulation. Live birth, clinical pregnancy outcomes and ovarian hyperstimulation syndrome （OHSS） were observed. Results Neither cycle of the two patients was canceled for oocyte retrieval failure and no OHSS was observed. Both patients gave birth to live twins after FET. Conclusion Triggering oocyte maturation in two hyper-responders by employing 800 IU of hCG could produce a good quantity of good-quality oocytes and an excellent clinical pregnancy and retain the opportunity for conception and live birth. Broader studies are needed.     

Effect of Timing and Number of Intrauterine Insemination （IUI） on the Cycle Clinical Outcome

Objective To study the effect of timing and number of intrauterine insemination （IUI） per cycle on the outcome of artificial insemination by husband （AIH）. Methods A total of 195 infertile couples underwent 379 cycles of lUI with husband＇s sperm. They were divided into 4 groups according to the ovulation and the number of IUIs per cycle： single IUI was performed 24 h after hCG injection, including single IUI before ovulation （group A） and single IUI after ovulation （group B）; double IUI was performed 24 h and 48 h after hCG injection, including double IUI before and after ovulation （group C） and double IUI before ovulation （group D）. The relation-ship between IUI pregnancy rate and the factors like processed total motile sperm （PTMS）, timing and number of lUIs per cycle was analyzed. Results When PTMS〈5 × 10^6, only one case in group B got pregnant, while no pregnancy was observed in other groups. When PTMS ≥ 5 × 10^6, pregnancy rates in all group were improved significantly. The pregnancy rate in group B reached 32.22%, which was significantly higher than that in group A （14.12%）, group C （20.00%） and group D （17.39%）, respectively （P〈0.05）. Conclusion IUI treatment is recommended to be performed when PTMS ≥ 5 × 10^6. An ideal pregnancy rate can be achieved by single IUI which is performed 24 h after hCG injection, and double IUI performed without ovulation could not result in significant improvement of cycle pregnancy rate.     

Selective Short-term Fertilization Combined with Early Rescue ICSh An Optimal Strategy for Patients at High Risk for Fertilization Failure

Objective To investigate clinical outcomes in patients who were at more precise criteria risks for fertilization failure and were treated with selective, short-term fertilization （oocytes and sperm co-incubated for 4 h） and early rescue intracytoplasmic sperm injection （ICSI）. Methods A retrospective analysis was performed on 2023 women undergoing assisted reproductive technology （ART）. They were assigned to 4 groups： short-term in vitro fertilization （short-term IVF,, group A, n=217）, regular IVF （oocytes and sperm coincubated overnight, group B, n=1475）, short-term IVF and early rescue ICSI （shortterm ICSI, group C, n=94）, and regular ICSI （group D, n=237）. Results In group A, 69.8% （217/311） achieved normal fertilization rates, and the complete fertilization failure rate （fertilization rate was 0%） was 12.9% （40/311）. But all of the fertilization failure oocytes got rescue ICSI. In group B, the complete fertilization failure rate was 1.1% （19/1 692）. The fertilization rate, 2 PN （pronucleus） rate, and i PN rate were significantly lower in group A than those in group B （70.9% vs 80.8%, 57.8% vs 66.3%, and 3.5% vs 6.2%, respectively）. No significant differences were observed in clinical pregnancy rates and birth defect rates between groups A and B. The fertilization rates in groups C and D did not significantly differ （77.9% vs 76.2%）, which was also true for birth defect rates. The clinical pregnancy rate of group C was higher than that of group D （51.2% vs 42.3%）, but this difference was not significant （P〉0. 05）.Conclusion These results suggested that selective, short-term fertilization can result in effective outcomes for patients who were at high risk for fertilization failure.     

Application of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis

Background Airway management is crucial in clinical anesthesia.Many complications associated with airway management result from unexpected difficult airway,but predicting a difficult airway is a major challenge.We investigated the efficacy of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis,a population with a high incidence of difficult airway.Methods We randomly enrolled 303 patients scheduled for elective surgery for cervical spondylosis at Peking University Third Hospital between August 2012 and March 2013.Preoperatively,patients were evaluated for difficult airway according to a clinical index and parameters on lateral cervical radiographs and magnetic resonance images.Difficult airway was defined as Cormack-Lehane grades Ⅲ-Ⅳ.Logistic regression was used to identify a combined （clinical and radiological） model for difficult airway.A receiver operating characteristic （ROC） curve was used to describe the effectiveness of prediction.Results We identified three clinical predictive factors using the ROC curve：mouth opening,stemomental distance,and neck mobility.We created a clinical model using three factors：gender,age,and mouth opening,with odds ratios （OR） of 0.370,1.034,and 0.358,respectively.Using the clinical and radiological parameters,we formulated a combined model with five risk factors：gender,mouth opening,atlanto-occipital gap,the angle from the second to sixth cervical vertebraes in the neutral position,and the angle difference of δ （the angle between the laryngeal axis and the epiglottic axis） from the neutral position to extension （OR：0.107,0.355,0.846,1.057,and 0.952,respectively）.The sensitivity and specificity of the combined model were 80.0％ and 65.7％,respectively,and the ROC curve confirmed that the combined model was better than any single clinical predictor and the clinical model.Conclusion The efficacy of the combined model including both clinical and radiological ind     

中医药治疗颈性眩晕的Meta分析

目的分析中医药治疗颈性眩晕的临床疗效。方法通过在维普资讯中文科技期刊数据库及CNKI中国期刊全文数据库中检索,纳入以颈性眩晕患者为研究对象,比较中医药与西医治疗效果的随机对照试验,评价纳入研究的质量。采用Jadad量表记分法,并用RevMan4．2．7软件进行Meta分析。结果中医药治疗颈性眩晕患者总体疗效优于西药,其汇总[OR（95％CI）：5．25（3．61,7．65）,P〈0．00001]。结论中医药治疗颈性眩晕的总体疗效显示出比西药治疗支加有效的倾向。尚需更多高质量研究以增加证据的强度。     

Treatments for primary aneurysmal bone cysts of the cervical spine: experience of 14 cases

Background Aneurysmal bone cyst （ABC） is a benign lesion with the potential to be locally aggressive.The optimal treatment of cervical spine lesions remains controversial.This retrospective study was designed to evaluate the different treatments for primary ABCs of the cervical spine.Methods This series included eight men and six women diagnosed between 2002 and 2012.A retrospective review of the hospital charts,operating room reports,office charts,and radiographs was performed.The data collected included patient age,sex,radiological features,pathology,treatment method,outcomes,and complications from biopsies and treatments.The mean age at diagnosis was 17.5 years old with a range of 6-35 years.All patients had experienced local pain for a mean of 7.3 months （range,0.5-18.0 months）,and three patients had neurological deficits （one with radiculopathy and two with myelopathy）.The Frankel classification before treatment was E in 12 cases,D in one case,and C in one case.Results Four patients received radiotherapy alone.Ten patients underwent surgery,including five total spondyiectomies,two local resections,and three curettages.Three patients received preoperative selective arterial embolization,and four received adjuvant radiotherapy.The mean follow-up time was 44.5 months （range 12-96 months）,and no recurrence was identified.Three patients with neurological deficits achieved complete recovery,as noted at the final follow-up examination.One patient received radiotherapy without appropriate immobilization as prescribed and developed C1-C2 subluxation with severe spinal cord compression but without myelopathy.He refused further treatment.Conclusions The results can be achieved by different treatments （surgical resection/curettage,selective arterial embolization,and radiotherapy） for ABC of the cervical spine.Reconstruction of stability is also important for the treatment of cervical ABC.