HPV16/18和端粒酶在宫颈上皮内瘤变和宫颈癌中的表达及临床意义

目的 探讨宫颈上皮内瘤变(CIN)和宫颈癌(CC)中人乳头瘤病毒(HPV)16和18以及人端粒酶基因(hTERC)的表达及其临床意义.方法 随机选择2010年1月至2012年1月该院收治的CIN和CC患者各30例,并随机选择同时期在本院门诊就诊的宫颈正常30例病理标本作为对照.分别采用PCR和TRAP-PCR技术,对所有样本宫颈组织中hTERC和HPV16/18的感染和表达情况进行检测.利用SPSS17.0软件,运用Logistic分析各组HPV 16/18和hTERC的感染和表达与宫颈病变的关联性.结果 ICC和CIN组HPV-16/18和hTERC阳性率显著高于正常宫颈组(P＜0.05),而ICC组HPV16/18和hTERC阳性感染率显著高于CIN组(P＜0.05);CINⅢHPV16/18和hTERC阳性感染率极显著高于CINⅡ和CINⅠ组(P＜0.05),CINⅡHPV16/18和hTERC阳性感染率极显著高于CIN Ⅰ组(P＜0.05);ICC和CINⅢ与HPV16/18和hTERC阳性存在显著正相关(P＜0.05),正常宫颈组织与HPV16/18和hTERC阳性不存在关联性(P＞0.05).结论 HPV16/18感染和hTERC的表达在CC发生发展中起重要作用,与CC宫颈组织病变有密切的关联性,两者联合检测是宫颈CIN早期筛查的理想手段之一.     

人乳头瘤病毒检测在宫颈癌前病变及宫颈癌筛查中的应用

目的探讨人乳头瘤病毒（HPV）检测在宫颈癌前病变及宫颈癌筛查中的应用价值。方法对363例患者进行薄层液基细胞学检查、人乳头瘤病毒检测及阴道镜检查。结果 363例标本中,HPV感染阳性191例,占52.6%。宫颈炎组HPV感染率为27.2%,宫颈上皮内瘤变（CIN）Ⅰ级为66.2%,CINⅡ级为71.0%,CINⅢ级为86.0%,宫颈癌组感染率为100%,HPV感染阳性率随宫颈病变程度加重而明显升高（P=0.000）。在191例感染者中,HPV的主要基因型依次为HPV-16、HPV-58、HPV-33、HPV-18、HPV-31和HPV-11。CIN组的多重感染率明显高于宫颈炎组（P=0.001）。结论 HPV感染及多重HPV感染与宫颈病变的严重程度密切相关,HPV检测在宫颈癌前病变及宫颈癌的筛查中有重要的临床价值。     

人子宫颈癌组织PD-L1表达及其与HPV16E6/E7的相关性

目的探讨PD-L1在宫颈癌发生、发展中的作用。方法采用免疫组化SABC法及RT-PCR法分别检测40份宫颈癌组织(宫颈癌组)、25份宫颈上皮内瘤变(CIN)Ⅱ、Ⅲ级组织(CIN组)、8份正常宫颈组织(正常组)中程序性死亡配体1(PD-L1)、HPV16E6/E7(人乳头瘤病毒16型E6/E7)表达并分析二者的相关性。结果宫颈癌组、CIN组均有PD-L1、HPV16E6/E7表达,宫颈癌组表达明显高于CIN组(P<0.01);PD-L1与HPV16E6/E7表达呈正相关,r=0.531,P<0.01。正常组未见二者表达。结论 PD-L1在人子宫颈癌中发生、发展中起促进作用。     

宫颈上皮内瘤变Ⅲ级患者宫颈锥切术后人乳头瘤病毒感染的诊断及治疗

目的探讨宫颈上皮内瘤变(CIN)Ⅲ级患者宫颈锥切术后人乳头瘤病毒(HPV)感染的临床诊断及治疗。方法选取69例CINⅢ级宫颈锥切术后HPV感染患者,对其临床症状、治疗方法等进行回顾性分析。结果术后HPV感染一般无典型临床症状,实验室检查仅在临床期才可明确,HPV转阴率为95.65%,治疗前后二代杂交捕获(HC2)值、阴道镜Reid评分差异显著(P<0.05)。结论 CINⅢ级患者宫颈锥切术后HPV感染无明显临床症状,积极治疗后预后较好。     

宫颈LEEP术对阴道病原体感染的疗效观察

目的探讨LEEP术对宫颈上皮内瘤变(CIN)患者阴道病原微生物的疗效及术后高危型人乳头瘤病毒(HPV)持续感染与解脲支原体(UU)及沙眼衣原体(CT)相关性。方法选取CINⅡ～Ⅲ级患者178例,术前取宫颈分泌物检测HPV、UU、CT,术后每半年随访一次检测HPV、UU、CT,并行宫颈细胞学检查。结果 LEEP术后高危型HPV检出率与术前比较,P<0.01;UU、CT检出率有所下降,但无统计学差异(P>0.05);LEEP术后高危型HPV持续感染患者的UU和CT阳性率与转阴组比较,P均<0.05,沙眼衣原体检出率与转阴组比较,P均<0.05。结论宫颈LEEP术可以有效去除HPV感染,对支原体、衣原体感染效果不明显,需要辅助抗生素治疗;UU、CT感染可能增加高危型HPV持续感染的机会。     

血小板在中老年宫颈癌患者发展过程中的变化及对预后的影响

目的研究血小板数量在中老年宫颈癌患者发生发展过程中的变化,探讨其在宫颈癌进展中的作用,研究其与宫颈癌临床参数的相关性。方法选择进行宫颈癌筛查和治疗的女性361例,年龄45~73岁,中位年龄62岁。根据是否感染高危人乳头瘤病毒(HPV)分为HPV阴性组和HPV阳性组,比较两组血小板数量是否有显著差异。根据病理检查结果分为宫颈慢性炎症组、宫颈上皮内瘤样病变(CIN)Ⅰ级或Ⅱ级组,CINⅢ级组,浸润性宫颈癌组,比较各组血小板数量是否有显著差异。在浸润性宫颈癌患者中,分析不同的组织分化程度、组织病理类型、肿瘤间质浸润深度、肿瘤体积大小、淋巴结转移情况、国际妇产科联盟(FIGO)分期、5年生存率与血小板数量是否相关。结果 HPV感染与否对血小板数量具有显著影响(P=0.000),其均值分别为HPV阳性组(250±55)×10~9/L,HPV阴性组(274±62)×10~9/L。以血小板数量判断是否感染HPV,其ROC曲线下面积为0.621,以253×10~9/L为判断标准,敏感性为67%,特异性为56%。宫颈慢性炎症组、CINⅠ级或Ⅱ级组、CINⅢ级组和浸润性宫颈癌组血小板数量无显著差异(P=0.456)。在浸润性宫颈癌组中,治疗前血小板数量与肿瘤体积(P=0.003)、是否有淋巴结转移(P=0.000)、5年生存率(P=0.032)明显相关。血小板数量与FIGO临床分期(P=0.463)、宫颈癌的组织病理类型(P=0.782)、细胞分化程度(P=0.522)、宫颈间质浸润深度(P=0.176)无关。结论血小板数量可作为是否感染HPV的辅助诊断指标。     

黄石市620例女性宫颈病变与宫颈HPV亚型分布关系分析

目的分析黄石市620例女性宫颈病变与宫颈人乳头瘤病毒(HPV)亚型的关系,为宫颈癌防治及宫颈HPV疫苗研制提供数据支持。方法选取2015-01~2015-12在黄石市妇幼保健院进行宫颈癌筛查女性6 500例,结合液基薄层细胞(TCT)、阴道镜和宫颈活检结果进行分组研究。结果 HPV感染阳性率为25.23%;根据病检结果:慢性宫颈炎、宫颈上皮内瘤样病变(CIN)Ⅰ级、CINⅡ/Ⅲ级、宫颈癌HPV感染率分别为37.50%、60.00%、83.33%、100.00%。其中高危型HPV16(33.87%)、高危型HPV52(14.52%)、低危型HPV43(6.45%)、低危型HPV42(6.45%)所占比率最高,而单一感染占79.55%,≤30岁感染率为40.28%。结论黄石地区最多见的感染宫颈HPV亚型为高危型HPV16、HPV52及低危型HPV43、HPV42,且随着宫颈病变程度的增加,宫颈HPV的阳性率也随之增加,以单一感染为主。宫颈HPV感染有年轻化的趋势。     

贵州地区宫颈上皮内瘤变和宫颈浸润癌患者HPV感染状态及其亚型分布

目的观察贵州地区宫颈上皮内瘤变（CIN）和宫颈浸润癌患者人乳头状瘤病毒（HPV）的感染状态及其亚型分布。方法采用导流杂交技术对30例CIN（CIN组）、33例宫颈浸润癌患者（宫颈癌组）、60例自愿接受宫颈HPV感染筛查的妇女（对照组）进行HPV分型检测,所有受检者均来自贵州地区。结果 CIN组HPV阳性13例（43.33%）,宫颈癌组19例（57.58%）,对照组5例（8.33%）。CIN组、宫颈癌组与对照组比较,P均〈0.01。CIN组共检出7种亚型HPV,均为高危型（HR-HPV）,无多型HPV感染（M-HPV）。其中HPV16 7例,HPV31、52各2例,HPV18、33、53、58各1例。宫颈癌组检出5种亚型,亦均为HR-HPV,M-HPV3例。其中HPV16 11例,HPV534例,HPV58 3例,HPV18、59各1例。对照组检出7种亚型,HR-HPV中的HPV16、18、31、39、53、58和低危型HPV的HPV6各1例;M-HPV 1例。CIN组、宫颈癌组HPV16感染率明显高于对照组,P均〈0.05。HR-HPV感染与CIN（OR=8.412,95%CI为2.62~26.99）和宫颈浸润癌（OR=14.929,95%CI为4.74~46.98）紧密相关,且主要与HPV16感染有关（CIN：OR=17.957,95%CI为2.09~154.15;宫颈浸润癌：OR=29.500,95%CI为3.60~242.07）,P均〈0.05。结论贵州地区CIN和宫颈浸润癌与HR-HPV感染密切相关,HPV16为主要感染亚型。     

HPV16感染与宫颈病变组织HDAC1和P21waf表达的关系

目的 探讨不同病理类型的宫颈病变中组蛋白去乙酰化酶1(HDAC1)、细胞周期调控抑癌基因P21waf蛋白的表达及其与人乳头瘤病毒(HPV) 16感染的关系.方法 选择宫颈病变病理蜡块标本110例,其中包括慢性宫颈炎20例(慢性宫颈炎组)、宫颈上皮内瘤样病变(CIN)Ⅰ 22例(CIN Ⅰ组)、CINⅡ24例(CINⅡ组)、CINⅢ24例(CINⅢ组)、宫颈癌20例(宫颈癌组).应用免疫组化SP法检测各组宫颈组织中HDAC1、P21waf的表达,应用PCR法检测HPV16 DNA.统计各组宫颈组织中HPV16 DNA、HDAC1与P21waf的阳性率,比较HDAC1、P21waf与病理级别的相关性.结果 慢性宫颈炎组、CIN Ⅰ组、CINⅡ组、CINⅢ组及宫颈癌组HPV16感染阳性率逐渐增加、HDAC1表达逐渐增强(P均＜0.05).HDAC1表达强度与病理级别及HPV16感染呈正相关(r=0.510,P＜0.01),P21waf表达强度与病理级别及HPV16感染呈负相关(r=-0.468,P＜0.01).HDAC1与P21waf的表达呈负相关(r=-0.349,P＜0.05).结论HDAC1可能促进宫颈癌的发生、发展,P21waf可能参与阻止宫颈癌病变过程.HPV16能提高HDAC1的表达及降低P21waf的表达,从而促进宫颈癌的发生发展.     

老年宫颈病变与人乳头瘤病毒感染的相关性

目的探讨老年宫颈病变与人乳头瘤病毒(HPV)感染的相关性。方法选择我院2008年10月至2011年6月,在我院妇科门诊就诊的891例老年妇女作为研究对象。按照病理组织检查结果分为炎症或者正常组、低度鳞状上皮细胞内瘤变组及宫颈癌或高度鳞状上皮细胞内瘤变组。比较三组就诊者的HPV感染情况,探讨HPV感染和老年宫颈病变之间的相关性。结果 891例老年妇女中HPV感染者共计412例(46.24%);经液基细胞学检测及阴道镜检测宫颈病变患者368例,病变率为41.3%。炎症或正常组为579例,其中HPV感染者145例(25.04%),宫颈癌或高度鳞状上皮细胞内瘤变组127例,感染110例(86.61%);低度鳞状上皮细胞内瘤变组185例,感染140例,感染率为75.67%;三组比较,两组宫颈病变患者的总感染率明显高于正常或炎症组,组间比较差异显著(P<0.05)。宫颈鳞癌及高度鳞状上皮内瘤变组感染HPV-H率为92.3%,宫颈鳞癌及高度鳞状上皮内瘤变组、低度宫颈上皮内瘤样病变组、炎症或者正常组的HPV双重与多重感染率分别为:45.40%、28.34%和12.26%,正常或炎症组明显低于另外两组(均P<0.05)。结论老年宫颈病变与HPV感染密切相关,且随着宫颈病变程度的加重,HPV二重或多重感染的概率亦增加。     

高危型人乳头瘤病毒感染率及亚型分布与宫颈病变程度的相关性分析

目的 探讨妇女高危型人乳头瘤病毒(HR-HPV)感染率及亚型分布与宫颈病变程度的相关性.方法 回顾性分析2018年1月至2019年12月绍兴市3 307例妇女细胞学检查和HPV筛查结果.细胞学检查采用液基薄层细胞检测(TCT),HPV筛查采用聚合酶链式反应(PCR)-反向点杂交法,采用SPSS 18.0软件进行统计学分...     

Clinical control study of traditional Chinese medicine hot compress combined with traction in the treatment of cervical spondylotic radiculopathy: Study protocol

Cervical spondylotic radiculopathy (CSR) is the most common type of cervical spondylosis, accounting for about 60% of the incidence of cervical spondylosis. Both cervical traction and traditional Chinese medicine hot compress are common and effective treatment for CSR. This study will be performed to investigate the effect of a combination of cervical traction and traditional Chinese medicine hot compress on CSR. In this non-blinded, randomized controlled trial, 100 eligible patients will be randomly divided into a treatment group (intermittent cervical traction combines with traditional Chinese medicine hot compress) and a control group (intermittent cervical traction combined with hot compresses). Before and after the intervention, the Visual Analog Scale score, Neck Disability Index score, and 20-score scale of symptoms will be evaluated at baseline and at 7, 14, 21, and 28 days. During the treatment period, any signs of acute adverse events, such as paralysis of aggravated pain, nausea, dizzy, and even syncope, will be recorded at each visit. Although intermittent cervical traction and traditional Chinese medicine hot compress have been used in the treatment of CSR in China for many years, there is no consensus on its effectiveness of combination therapy. This experiment will provide convincing evidence of the efficacy of intermittent cervical traction combined with traditional Chinese medicine hot compress in the treatment of CSR.     

The significance of m6A RNA methylation modification in prognosis and tumor microenvironment immune infiltration of cervical cancer

Recent studies have highlighted that N6-methyladenosine (m6A) plays a significant role in tumorigenicity and progression. However, the mechanism of m6A modifications in the tumor microenvironment (TME) immune cell infiltration in cervical cancer (CC) remains unclear.Clinical and RNA sequencing data of 25 m6A RNA methylation regulators were acquired from the Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) database. LASSO Cox regression analysis was used to generate a prognostic risk signature. m6A modification patterns were identified based on the expression of 25 m6A regulators, and their correlation with TME immune cell-infiltrating characterization was analyzed. Principal component analysis was used to construct an m6A-scoring signature (m6A score) to evaluate the m6A modification patterns of individual CC samples and guide the selection of more effective immunotherapeutic strategies.Genetic and expression alterations of 25 m6A regulators were highly heterogeneous between CC and normal tissues. METTL14 and IGF2BP1 were selected to conduct the prognostic risk signature. Three m6A modification patterns were identified in 659 CC samples, which were associated with distinct clinical outcomes and biological pathways. The TME immune cell-infiltrating characterization of the three m6A modification patterns was highly consistent with 3 tumor immune phenotypes, including immune-excluded, immune-inflamed, and immune-desert phenotypes. Due to the heterogeneity of m6A modification patterns, an m6A scoring signature was established to evaluate the m6A modification patterns of individual CC samples. Univariate and multivariate Cox regression analyses revealed that the m6A score is a robust and independent prognostic biomarker for assessing the prognosis of CC patients. A low m6A score, characterized by higher somatic mutation and higher expression of proliferation-related and DNA repair-related genes, indicated poor overall survival. Activation of immune infiltration was exhibited by the high m6A score, which was likely to have a good response and clinical benefits to antiPD-1/L1 immunotherapy.This study highlights the prognostic value of 25 m6A regulators in CC. The m6A modification is related to immune regulation and the formation of TME heterogeneity and complexity. An m6A scoring signature to clarify the individual m6A modification pattern could enhance our understanding of TME immune cell-infiltrating characterization and guide immunotherapy strategies.     

Albert-Lembert versus hybrid-layered suture in hand sewn end-to-end cervical esophagogastric anastomosis after esophageal squamous cell carcinoma resection

Background

Hand sewn cervical esophagogastric anastomosis (CEGA) is regarded as preferred technique by surgeons after esophagectomy. However, considering the anastomotic leakage and stricture, the optimal technique for performing this anastomosis is still under debate.

Methods

Between November 2010 and September 2012, 230 patients who underwent esophagectomy with hand sewn end-to-end (ETE) CEGA for esophageal squamous cell carcinoma (ESCC) were analyzed retrospectively, including 111 patients underwent Albert-Lembert suture anastomosis and 119 patients underwent hybrid-layered suture anastomosis. Anastomosis construction time was recorded during operation. Anastomotic leakage was recorded through upper gastrointestinal water-soluble contrast examination. Anastomotic stricture was recorded during follow up.

Results

The hybrid-layered suture was faster than Albert-Lembert suture (29.40±1.24 min vs. 33.83±1.41 min, P=0.02). The overall anastomotic leak rate was 7.82%, the leak rate in hybrid-layered suture group was significantly lower than that in Albert-Lembert suture group (3.36% vs. 12.61%, P=0.01). The overall anastomotic stricture rate was 9.13%, the stricture rate in hybrid-layered suture group was significantly lower than that in Albert-Lembert suture group (5.04% vs. 13.51%, P=0.04).

Conclusions

Hand sewn ETE CEGA with hybrid-layered suture is associated with lower anastomotic leakage and stricture rate compared to hand sewn ETE CEGA with Albert-Lembert suture.     

Evaluation of cervical length and optimal timing for pregnancy after cervical conization in patients with cervical intraepithelial neoplasia: A retrospective study

To evaluate the change of cervical length and the best timing for pregnancy after cervical conization in patients with cervical intraepithelial neoplasia (CIN).This was a retrospective study including patients under 40 years with fertility desire treated by cervical conization for CIN. To assess the cervical length, the patients were divided into 2 groups according to different surgery procedure: loop electrosurgical excision procedure (LEEP) and cold knife conisation (CKC). Patients with cervical length < 2.5 cm in CKC group were divided into 2 groups according to whether receiving cervical cerclage. Trans-vaginal ultrasound examination was used to measure cervical length by fixed professional sonographers.In LEEP group, the cervical length preoperative was significantly longer than 3 months postoperatively (3.03 ± 0.45 cm vs 2.84 ± 0.44 cm, P = .000). In CKC group, the cervical length preoperative was significantly longer than 3 and 6 months postoperatively (2.90 ± 0.41 cm vs 2.43 ± 0.43 cm and 2.68 ± 0.41 cm, respectively, P = .000). Cervical length was significantly longer at 12 and 9 months after cerclage compared to that without cerclage. Eighteen patients got pregnant in LEEP group, among which one was pregnant at 5 months postoperatively and had premature delivery. There was 1 inevitable abortion and 1 preterm birth among 39 pregnant patients from CKC group.Patients who have fertility desire with CIN were recommended for pregnancy at 6 and 9 months after LEEP and CKC, respectively. Cerclage effectively prolonged cervical length in patents with that less than 2.5 cm to prevent cervical incompetence.     

Cervical balance and clinical outcomes in cervical spondylotic myelopathy treated by three-level anterior cervical discectomy and fusion and hybrid cervical surgery: A CONSORT-compliant study with minimum follow-up period of 5 years

As the technology of combining with fusion and nonfusion procedure, cervical hybrid surgery (HS) is an efficacious alternative for treatment with cervical spondylotic myelopathy. While studies on cervical alignment between 3-level HS and anterior cervical discectomy and fusion (ACDF) were seldom reported. The effects of cervical imbalance on its related clinical outcomes are yet undetermined as well.Patients with cervical spondylotic myelopathy, who underwent 3-level ACDF or HS, were included to compare cervical alignment parameters after surgery and then explore the relationship between cervical balance and clinical outcomes.Forty-one patients with HS (HS group) and 32 patients who with ACDF (ACDF group) were reviewed from February 2007 to September 2013 with the mean follow-up of 90.3 ± 25.5 (m) and 86.3 ± 28.9 (m), respectively. Cervical alignments parameters including the C2 to C7 cervical lordosis (CL), C2 to C7 sagittal vertical axis, T1 slope. and T1SCL (T1 slope minus CL), and the clinical outcomes like neck disability index (NDI) and Japanese Orthopedic Association (JOA) score were measured and recorded preoperatively (PreOP), intraoperatively, and on the first preoperative day and the last follow-up (FFU). The balance and imbalance groupings were sorted based on the T1SCL: T1SCL≤20°,balance; T1SCL > 20°, imbalance.We found significant improvements (P < .001) in NDI and JOA at intraoperatively and FFU after ACDF and HS, and no difference on cervical alignment and clinical outcomes between the 2 procedures on the basis of intergroup comparisons. By between-subgroups comparisons, however, we found significant differences in CL and T1SCL at PreOP (P < .05). Nonetheless, there was no significant difference on the clinical outcomes between balance and imbalance subgroups at FFU at PreOP (P > .05), indicating that the change of T1SCL was not correlated to NDI and JOA at FFU.Both HS and ACDF groups showed significant clinical improvements after surgery. There was no correlation between cervical balance and clinical symptoms.     

颈性眩晕

颈性眩晕通常与颈椎病有关, 但不一定完全由颈椎病所致。与颈性眩晕有关的主要是椎动脉型和交感型颈椎病。由椎间盘侧突压迫导致的椎动脉供血不足非常罕见, 由椎体不稳引起的交感型颈椎病较多, 但后者也有其严格的诊断标准。治疗以保守治疗为主。     

Prognostic value of cervical ligamentum flavum thickness as a morphological parameter to predict cervical stenosis

One of major causes of cervical central stenosis (CCS) is thickened change of cervical ligament flavum (CLF). The association of a morphological parameter called cervical ligament flavum thickness (CLFT) with CCS has not been reported yet. Thus, the purpose of this research was to investigate the relationship between CCS and CFJT.Data were obtained from 88 patients with CCS. A total of 87 normal controls also underwent cervical spine magnetic resonance imaging (CSMRI). All subjects underwent axial T2-weighted CSMRI. Using our picture archiving and communications system, thickness of ligament flavum of the cervical spine at C6/7 level was analyzed.The mean CLFT was 1.41 ± 0.24 mm in normal subjects and 2.09 ± 0.39 mm in patients with CCS. The CCS group was found to have significantly (P < .001) higher rate of CLFT than normal subjects. ROC curves were used to assess the usefulness of CLFT as a predictor of CCS. In the CCS group, the best practical cut off-point of CLFT was 1.71 mm (sensitivity = 90.9%; specificity = 90.8%), with AUC of 0.94 (95% confidence interval: 0.90--0.98).Greater CLFT values were associated with greater possibility of CCS. Thus, treating physician should carefully examine CLFT, as it can help diagnose CCS.