辅助生殖技术助孕宫颈妊娠合并结核复发一例

目的：报道一例辅助生殖技术（ART）助孕后的宫颈妊娠合并结核复发，讨论其相关病因、诊断及治疗方法。方法：通过病例报道和相关文献复习，对宫颈妊娠的病因、诊断、治疗、结核复发以及与ART的关系进行分析。结果：宫颈妊娠合并结核发生率极低，一旦发生不良结果，对患者影响巨大，早期诊断和及时治疗尤为重要。结论：ART过程中对可疑结核复发患者要及时诊断、及早处理。     

一种新型病证相结合肝阳上亢证颈性眩晕大鼠模型的制备方法

目的：建立一种简单、可靠的符合肝阳上亢证的颈性眩晕大鼠模型，同时建立一种简便可行的反应动物眩晕程度的评价方法。方法：选用SPF级雄性SD大鼠24只，8周龄，体重280~320 g，随机进行分组（每组6只），使用局部注射聚桂醇注射液（硬化剂）与附子汤灌胃相结合的方法制备肝阳上亢证颈性眩晕大鼠模型（联合造模组），与单用局部注射硬化剂的大鼠（硬化剂组）、单用附子汤灌胃的大鼠（附子汤组）、空白对照组进行对照，以大鼠通过一段玻璃管的时间（跑管时间）反应大鼠的眩晕程度，分别于造模前、造模后第2周、造模后第3周进行观测。结果：附子汤组与空白对照组跑管时间比较差异无统计学意义；联合造模组与硬化剂组跑管时间比较差异无统计学意义；硬化剂组与联合造模组跑管时间延长，不仅与对照组差异有统计学意义（P<0.05），且与附子汤组的差异有统计学意义（P<0.01）。造模后的跑管时间较造模前相比，差异具有统计学意义（P<0.05）；比较造模后2、3周的跑管时间，差异无统计学意义（P>0.05）。结论：该造模方法能有效制成肝阳上亢证颈性眩晕大鼠模型，且跑管时间能在一定程度上反映大鼠的眩晕程度，为今后颈性眩晕的动物研究提供了一种简便可行的动物模型与眩晕的检测方法。     

Validation of the Functional Assessment of Cancer Therapy with Cervical Cancer Subscale (FACT-CX) for Quality of Life in Thai Patients Prior to Chemoradiotherapy

Objective: Cervical cancer is the second most common cancer in Thailand. For cervical cancer, there is no cancer specific quality of life questionnaire. This study aims to develop and validate Thai FACT-CX. Methods: The cross-sectional study included all women aged ≥18 years with stage IB2-IIIB who planned to undergo chemoradiotherapy. Those who did not understand Thai language, had other cancers (except for skin cancer), were diagnosed with impaired cognition and/or overt psychosis, and major depression were excluded. The FACT-CX comprises 42 items with 5 domains and a score range of 0-168. The WHOQOL-BREF comprises 26 items with 4 domains and a score range of 26-130. The participants were interviewed about demographic and clinical data. Both questionnaires were self-completed.  Factor analysis was used to compare our data with the previous structure. The reliability used Cronbach’s alpha. Spearman’s correlation determined relationship between the domains of the modified FACT-CX and WHOQOL-BREF. Both questionnaires were compared with socioeconomic and clinical variables using the Ranksum test and Kruskal-Wallis test. P-value > 0.05 considered significant. Results: The 245 participants included. Expletory factor analysis revealed an accumulative variance of 0.42 with 4 factors. The internal consistency was 0.84, 0.81, 0.78, 0.77 and 0.90 for perception of self, suffering symptoms, family support, life resilience and total questions. There was correlation between the domains of the modified FACT-CX and WHOQOL-BREF.  Both the modified FACT-CX and WHOQOL-BREF could identify differences between the groups of patients. Conclusion: Finally, the Thai modified FACT-CX was found to be reliable and valid for measuring quality of life among untreated cervical cancer patients.     

Endostar,an Antiangiogenesis Inhibitor,Combined With Chemoradiotherapy for Locally Advanced Cervical Cancer

This phase II randomized clinical trial aimed to assess the efficacy and toxicity of Endostar, an antiangiogenesis inhibitor, combined with concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC). Patients with LACC were randomly assigned to either CCRT plus Endostar (CCRT+E arm) or CCRT alone (CCRT arm). All patients received pelvic intensity-modulated radiation therapy (IMRT) and brachytherapy. Weekly cisplatin was administered concurrently with IMRT. Patients in the CCRT+E arm also received concurrent Endostar every 3 weeks for two cycles. The primary endpoint was progression-free survival (PFS) and acute toxicities. The exploratory endpoint was the impact of vascular endothelial growth factor receptor-2 (VEGFR2) expression on long-term survival. A total of 116 patients were enrolled. Patients in the CCRT+E arm and in the CCRT arm had similar acute and late toxicity profile. The 1- and 2-year PFS were 91.4% versus 82.1% and 80.8% versus 63.5% (p=0.091), respectively. The 1- and 2-year distance metastasis-free survival (DMFS) were 92.7% versus 81.1% and 86.0% versus 65.1% (p=0.031), respectively. Patients with positive VEGFR2 expression had significant longer PFS and overall survival (OS) compared with those with negative VEGFR2 expression. Patients in the CCRT+E arm had significantly longer PFS, OS, and DMFS than those in the CCRT arm when VEGFR2 expression was positive. In conclusion, CCRT plus Endostar significantly improved DMFS but not PFS over CCRT alone. The addition of Endostar could significantly improve survival for patients with positive VEGFR2 expression.     

22234例子宫颈高危型HPV感染及亚型分布研究

目的:分析17种型别的高危型人乳头瘤病毒(HPV)在22234例子宫颈癌筛查中的感染率及亚型分布特点。方法:回顾性分析2018年1月1日至2019年1月1日22234例于华中科技大学同济医学院附属协和医院行子宫颈癌筛查患者高危型HPV感染率及感染亚型。结果:22234例接受子宫颈癌筛查患者中,一种或以上高危型HPV阳性者3574例(16.1%),其中HPV16或(和)HPV18阳性者703例(3.2%)。在3574例高危型HPV阳性女性中,最常见的高危HPV感染是HPV52(24.4%),其次为HPV58(16.5%)、HPV16(14.0%)、HPV53(12.6%)和HPV39(8.6%)。与HPV16阴性患者相比,在HPV16阳性的患者中,除HPV31、HPV35、HPV45、HPV26和HPV82以外的12种高危型HPV的感染风险均显著降低约2~5倍(OR 0.169~0.530,P<0.05);与HPV18阴性患者相比,HPV18阳性的患者中HPV16、HPV33、HPV39、HPV51、HPV52、HPV58和HPV53的感染风险均显著下降(P<0.05)。结论:女性高危型HPV感染率较高,最常见的高危型HPV是HPV52和HPV58感染,并且HPV16、18感染对多个其他型别高危型HPV感染有保护作用。     

Outcome factors in surgically treated patients for cervical spondylotic myelopathy

Context/Objective: To investigate prospectively preoperative parameters that might be related to the outcome of surgically treated patients for cervical spondylotic myelopathy (CSM).

Design: Prospective study.

Setting: Single Center in Ioannina, Greece.

Participants: Thirty-six patients were included in the study. There were 21 males and 15 females, mean age 50.8 years, range 39–70 years. The mean BMI was 27.3.

Outcome measures: From each patient, we recorded age, sex, BMI, symptoms, duration of symptoms, comorbidities, lifestyle, myelopathy grade based on MRI and levels of compression. All patients completed the modified JOA (mJOA) and NPE questionnaires preoperatively and at 1, 3, 12 months and 5-years postoperatively.

Results: The mean mJOA score significant improved from 10.8?±?1.9 points preoperatively to 16.6?±?2.2 points at 12 months postoperatively. The mean mJOA score at 5-years postoperatively was 15.5?±?3 points. The difference was still highly significant. The mean NPE score significant improved from 59.8?±?12.2 points preoperatively to 28.2?±?8.5 points at 1 month, to 35.8?±?8.1 points at 3 month and to 28.2?±?8.8 points at 12 months postoperatively. Younger patients had significant higher baseline mJOA scores and significant higher mJOA scores 5-year postoperatively. No correlation was found between sex, BMI, symptom duration, baseline mJOA or myelopathy grade and outcome at 12 months or 5-year postoperatively.

Conclusion: Age was highly predictive factor of outcome for patients undergoing surgical treatment of CSM.     

杭州市适龄女性接种宫颈癌疫苗意愿及影响因素调查

目的了解杭州适龄女性对宫颈癌疫苗的认知度,接种意愿及其影响因素。方法2018年1月至3月,通过实地调查的形式,抽样调查在杭州市内生活的适龄女性对接种宫颈癌疫苗的意愿及影响因素,采用统计描述、χ2检验、二分类logistic回归分析接种意愿的影响因素。结果共计获得384份调查问卷,其中有效问卷384份。77.86%的被调查者在接受调查之前听说过宫颈癌疫苗,52.34%的被调查者愿意接种宫颈癌疫苗,90.36%的女性对宫颈癌疫苗的推广表示支持。年龄、学历、对宫颈癌疫苗的了解程度、医生推荐、亲朋好友有接种经历是影响适龄女性接种宫颈癌疫苗意愿的主要因素。结论杭州市适龄女性对宫颈癌疫苗的知晓率高,但接种意愿不高。需积极开展预防宫颈癌相关知识的健康教育,提高适龄女性对宫颈癌疫苗的认知度及接种意愿,从而推进宫颈癌的防控。     

针刀治疗神经根型颈椎病研究概述

神经根型颈椎病在颈部疾患中发病率高,常表现为颈、肩、上肢运动感觉功能障碍,致使中老年人饱受疾患折磨,且该病随着生活、工作方式改变有年轻化发病趋势。西医非手术治疗该病常采取消炎镇痛、缓解神经根水肿等办法,不能有效解除压迫及高应力状态,症状易反复,难以达到患者期望值。而手术治疗风险较大、术后恢复慢且经济负担重,患者接受程度普遍较低。自朱汉章教授1976年创造针刀伊始神经根型颈椎病便是针刀治疗的优势病种。针刀治疗神经根型颈椎病作用机制复杂,在病理生理、临床试验等层面已得到部分阐释。临床操作各有千秋,常表现为进针点定位选择之别。除单纯针刀疗法外,针刀搭配其他治疗方式而衍生出的一系列综合疗法如手法、药物、神经阻滞、针灸等为治疗该病提供了更多选项。经40余年的针刀医学实践阐明,针刀治疗神经根型颈椎病具有独特优势。该文检索中国知网、万方网等数据库有关文献,总结了针刀治疗该病的最新研究进展。现从机理研究、操作方法、方案选择三个方面加以概述,便于为临床提供参考,促进针刀医学的基层推广。     

侧块螺钉固定术后不同颈椎曲度与脊髓后移的关系及其对手术疗效的影响

目的探讨全椎板减压侧块螺钉固定术后颈椎曲度大小与脊髓后移距离的关系及其对手术疗效的影响。方法回顾性分析2016年10月至2017年12月邯郸市中心医院行全椎板减压侧块螺钉固定术的85例脊髓型颈椎病患者的临床资料,其中有78例患者获得完整随访,术后根据Harrison方法测量颈椎曲度将患者分为A组(43例,0°≤颈椎角≤16.5°)和B组(35例,颈椎角>16.5°)。观察两组患者术后脊髓后移距离、神经恢复效果、轴性症状及C5神经麻痹发生情况。结果A组患者术后颈椎角为(8.5°±3.8°),B组为(19.6°±3.0°),两组比较差异有统计学意义(t=14.071,P<0.001);A组患者椎板切除宽度为(22.1±1.7)mm,B组为(21.8±1.5)mm,两组比较差异无统计学意义(P>0.05);A组患者脊髓后移距离为(1.7±0.4)mm,B组为(3.2±0.7)mm,两组比较差异有统计学意义(t=11.879,P<0.001)。术后两组患者神经功能均有显著恢复,至术后1年时,两组神经功能改善率分别为(63.3±13.1)%和(65.1±13.9)%,组间比较差异无统计学意义(t=0.587,P=0.559)。A组术后1周时VAS评分为(5.2±1.3)分,术后1个月时为(3.5±0.6)分;B组分别为(3.8±0.8)、(2.4±0.4)分,组间不同时间点比较差异均有统计学意义(t=5.567,P<0.001;t=9.289,P<0.001);A组患者C5神经麻痹发生率为7.0%(3/43),B组为11.4%(4/35),两组比较差异无统计学意义(P>0.05)。结论术后颈椎曲度越大脊髓后移越充分,术后颈椎曲度的丢失与轴性症状的发生有关,颈椎曲度与神经功能的恢复及C5神经麻痹的发生无关。