应用液相基因芯片技术筛查山东地区高危人群人乳头瘤病毒基因型

目的 评价Luminex XMAP系统的液相芯片技术在女性生殖道人乳头状瘤病毒（HPV）感染检测中的临床价值,调查山东地区女性生殖道HPV感染情况及最常见的基因型。方法 取妇科门诊就诊者宫颈脱落细胞2925例,采用液相芯片技术进行HPV基因型检测,96孔板操作,26种亚型1次呈现。639例患者同时做病理诊断,按组织病理学分为细胞学正常组、炎症组、宫颈上皮内瘤变（CIN）Ⅰ组、CINⅠ-Ⅱ组、CINⅡ组、CINⅢ组和宫颈癌组。通过HPV DNA亚型分布结合病理诊断,分析山东地区HPV感染基因型与宫颈病变程度的关系。结果 HPV总感染率36．0% （1054/2925）,26种基因型检出23种,按感染率从高到低依次为HPV-16（26．75%）,HPV-52 （25．75%）,HPV-58（10．47%）,HPV-18（8．87%）和HPV-11（6．94%）。其中高危型感染占87．32%,低危型13．68%;单一型感染698例（66．22%）,多重感染356例（33．78%）,低危亚型11、6多与高危型多重感染。1054例HPV阳性患者中,261例（24．8%）为21～25岁女性,随年龄增大阳性例数减少, 52例（4．9％）为51～67岁女性。各病理组HPV阳性率及多重感染率依次为正常组23．37％、4．89％，炎症组33．08％、7．14％，CINI组54．54％、18．18％，CINⅠ-Ⅱ组57．14％、28．57％，CIN Ⅱ组82．61％、41．30％，CINⅢ组91．30％、43．37％，宫颈癌组100％、38．46％。以组织病理学为确诊标准，液相芯片HPVDNA检测CINⅡ、Ⅲ和宫颈癌的灵敏度、特异度、阳性预测值、阴性预测值依次为88．57％、76．63％、68.89％和92．16％。结论 所选山东地区高危人群HPV感染的常见基因型是16、52、58、18、11、6、56、31。随宫颈病变程度加重，HPV感染率及多重感染有增加趋势，HPV阳性以年轻女性多见。液相芯片HPVDNA检测在宫颈病变临床诊断及大规模筛查中有重要价值。     

上海地区女性宫颈人乳头状瘤病毒型别分布的 Meta分析

目的：分析人乳头状瘤病毒（ HPV）在我国上海地区女性中的感染情况及型别分布,为地区宫颈癌防治提供依据。方法检索The Cochrane Library（2016年第3期）、PubMed、Ovid、EMbase、中国生物医学文献数据库、万方数据库和中国知网,查找有关上海地区女性宫颈HPV感染的文献,检索时限为2000年1月至2015年12月。由两位评价者根据纳入与排除标准独立筛选文献、提取资料和评价纳入研究后,采用Stata 12．0软件进行Meta分析。结果纳入的研究对象共165432例,总HPV感染率为32．5％（95％CI：0．289～0．361）。高危HPV感染中居前六位的是HPV 16、52、58、53、33、18,感染率分别为9．0％、4．5％、4．0％、2．1％、2．0％、1．7％;低危型HPV感染中居前三位的是HPV81、11、6,感染率分别为2．0％、1．8％、1．5％。有明确宫颈组织病理学结果的研究对象共21587例,总HPV感染率为41．9％（95％CI：0．276～0．562）,宫颈HPV的感染率在低级别宫颈病变组居前五位的是HPV16、58、52、18、33;在高级别宫颈病变组感染率居前五位的是HPV16、58、33、18、52。其中HPV16、18、31、33、58在高级别宫颈病变组的感染率高于低级别宫颈病变组。结论 HPV16、52、58、53、33、18是上海地区女性宫颈HPV感染的优势型别,HPV型别分布在不同级别宫颈病变组之间存在差异。     

人乳头瘤病毒感染与宫颈病变的关系研究

目的 探究人乳头瘤病毒(HPV)感染与宫颈病变的关联,为本地HPV感染防治和疫苗研制提供证据。方法 选择本地妇女2338例作为研究对象,严格按照宫颈疾病诊断三阶段筛查方案筛查宫颈病变,对本地区HPV感染型别进行统计分析。结果 HPV-52是人群HPV感染最流行的亚型,其次为HPV-16,HPV-18,HPV-33和HPV-53;宫颈癌组、CINⅡ/Ⅲ组、CINⅠ组患者HPV阳性率显著高于无宫颈病变组,宫颈癌组、CINⅡ/Ⅲ组HPV阳性率显著高于CINⅠ组,差异均有统计学意义（P<0.05）;CINⅠ常见的感染亚型依次为：HPV-52,HPV-16和HPV-CP8304;CINⅡ/Ⅲ常见的感染亚型依次为：HPV-16,HPV-33以及HPV-52;宫颈癌常见的感染亚型依次为：HPV-16,HPV-18以及HPV-33。结论 HPV的致癌潜能与基因型有关,而与多重感染无明显相关,宫颈细胞学病变级别越高HPV感染率越高。     

子宫颈分泌物中人乳头瘤病毒感染的调查研究

目的：研究人乳头瘤病毒（humanpapillomavirus，HPV）与宫颈癌的病因关系。方法：采用聚合酶链反应（PolymeraseChainReaction，PCR）检测不同宫颈粘液标本137份，其中正常宫颈37例、宫颈炎53例、宫颈癌47例。结果：上述三种标本中，HPV－16DNA的检出率分别为18．9％、43．4％和72．3％。宫颈癌标本中HPV－16检出率显著高于宫颈正常组（P＜0．01），宫颈癌组与宫颈炎组中HPV－16检出率比较，两者差异无显著意义（P＞0．05）。结论：宫颈癌发病与HPV感染有密切关系。     

P16蛋白和TCT及HPV基因分型联合检测在宫颈病变筛查中的应用

目的探讨P16蛋白、液基薄层细胞学检测（TCT）和人类乳头状瘤病毒（HPV）基因分型联合检测在宫颈病变筛查中的应用价值。方法选取2632例宫颈疾病患者进行TCT榆查，采用免疫组化Elivision法检测P16蛋白的表达，用核酸分子快速导流杂交技术检测HPV基因分型。结果HPV感染总阳性率为26．94％，21种基因亚型均被检出；阳性率居前5位的基因亚型为HPV16型（13．16％）、HPV52型（12．84％）、HPVep8304型（11．00％）、HPV58型（10．46％）和HPV18型（8．31％），基因亚型以高危型为主，占74．76％；单～和二重感染分别占67．98％和24．26％；细胞学分类诊断为正常＋炎症、ASCUS、LSIL和HSIL的对象中，HPV感染的阳性率分别为20．98％、38．99％、61．33％和75．51％；正常＋炎症、ASCUS、LSIL和HSIL中P16蛋白表达率分别为0．00％、22．02％、44．44％和79．59％；不同宫颈细胞学诊断级别间HPV感染率及P16蛋白表达率差异均有统计学意义（P〈0．01）。结论宫颈疾患人群中，HPV感染率较高，且以高危型、单一和二重感染居多；随着宫颈病变程度加重，HPV的感染率和P16蛋白表达率逐渐升高。     

成都地区妇女HPV感染的流行病学特征及与宫颈病变的关系

目的：探讨成都地区妇女宫颈人乳头状瘤病毒（human papillomavirus,HPV）感染的分子流行病学特征及其与宫颈癌前病变的关系。方法：收集四川省人民医院2015年1月-2017年1月在妇科门诊就诊并进行HPV分型检测的患者8 204例,其中4 390例患者同时行宫颈液基细胞学检查,229例患者同时行病理学检查。结果：HPV感染率为23.28%,其中高危型HPV感染占58.53%。HPV感染以单一感染（72.88%）为主,HPV52、58、16型最常见,而在多重感染中,62.13%为二重感染,以52型合并其他高危型（58、16、53型）感染最常见。不同年龄组的HPV感染率差异有统计学意义（P＜0.001）,其中≤20岁年龄组HPV感染率（61.76%）最高。高危型HPV感染率随着细胞学诊断级别的升高而升高,且高危型HPV感染率在细胞学异常人群中显著高于细胞学正常人群（P=0.025）。高危型HPV感染可存在于各级CIN及宫颈癌病变,而低危型HPV感染只存在于CINⅠ。结论：HPV基因型的分布具有明显的年龄和区域分布特异性,且HPV感染率与宫颈病变严重程度呈正相关。研究结果对研制适合成都地区妇女的特异性HPV疫苗,以及宫颈癌的筛查与防治具有参考价值。     

高危型HPV在宫颈癌发生中的作用

本文利用PCR技术检测了44例宫颈癌患者和15例慢性宫颈炎患者病变组织中高危型HPV（16，18，31，33）的感染率，发现44例宫颈癌患者高危型HPV的阳性率高达91％（40／44），其中HPV16型感染率54．55％（24／44），HPV18型感染率18．2％（8／44），HPV31型感染率13．6％（6／44），HPV33型感染率4．55％（2／44）；15例慢性宫颈炎患者有2例感染HPV16型。结果提示HPV16型是宫颈癌发生最常见的基因型，其次为HPV18型和HPV31型，故对育龄妇女定期进行高危型HPV感染的普查，在早期预防宫颈癌的发生具有十分重要的意义；联合采用分子生物学和宫颈脱落细胞学技术进行即定期普查，既能提高阳性率，又能对感染高危型HPV的慢性宫颈炎患者进行早期的有效预防。     

江西地区宫颈癌及宫颈癌前病变妇女HPV感染型别研究

目的探讨江西地区女性宫颈癌前病变及宫颈癌患者人乳头瘤病毒(HPV)主要感染型别。方法选取2015年1-12月该院肿瘤科住院患者为研究对象。采用导流杂交技术对宫颈癌前病变患者667例和宫颈癌患者394例进行HPV感染型别检测,并对不同级别的癌前病变及不同病理类型宫颈癌型别感染情况进行分析。结果宫颈癌前病变及宫颈癌中以单一HPV感染为主。宫颈癌前病变组织中总HPV感染率为90.4%,主要感染型别依次为HPV16、58、52、33、31和51;宫颈癌组织中总HPV感染率为97.5%,主要感染型别依次为HPV16、18、52和58。不同级别的宫颈癌前病变HPV感染率比较差异无统计学意义(χ~2=4.574,P=0.102),但随着级别升高,HPV16、18型感染也升高(χ~2=42.700,P=0.000)。不同病理类型的宫颈癌HPV感染率比较差异有统计学意义(χ~2=8.799,P=0.012)结论江西地区中HPV16、58、52、33、31、51型别为宫颈癌前病变中的主导型别,HPV16、18、52、58型别为宫颈癌中主导型别,HPV16、18型感染提示宫颈癌变高风险存在。     

宫颈病变组织中p16蛋白表达及其与人乳头瘤病毒感染的关系

目的探讨宫颈癌（cervicalcancer）及其癌前病变组织中p16蛋白表达及其与人乳头瘤病毒（humanpapillomavirus,HPV）感染的关系。方法采用免疫组化（immunohistochemistry,IHC）SP法检测40例宫颈浸润癌（invasivecarcinomaofcervix,ICC）标本（ICC组）、20例低度宫颈上皮内瘤样病变（cervicalintraepithelialneoplasiaI,CINI）标本（CINI组）、30例高度宫颈上皮内瘤样病变（CINⅡ～Ⅲ）（CINⅡ～Ⅲ组）标本和20例正常宫颈组织标本（对照组）的p16蛋白表达;用导流杂交基因芯片技术（HybriMax）测定上述标本的人乳头瘤病毒分型。结果P16蛋白在正常宫颈上皮（对照组）无表达,在宫颈癌及癌前病变组织呈现过表达（ICC组,CINI组,CINⅡ～Ⅲ组）;在CINI,CINII～HI,ICC组过表达率分别为35．0％,83．3％和100．0％。P16蛋白表达随宫颈病变级别进展而增加（P〈O．001）。高危人乳头状瘤病毒在正常宫颈上皮（对照组）的感染率为0,CINI,CINⅡ～Ⅲ,ICC组分别为55．0％,80．0％和92．5％。HPV一16和（或）一18亚型是宫颈癌及癌前病变最常见感染亚型。P16蛋白过表达在高危型人乳头瘤病毒（highriskhumanpapillomavirus,HR—HPV）感染宫颈组织明显高于HPV呈阴性或低危型人乳头瘤病毒（low—risk human papillomavirus,LRHPV）感染宫颈组织（P〈0．05）。结论P16蛋白过表达,可用于区分正常宫颈和宫颈癌前病变及宫颈浸润癌组织。P16蛋白过表达与高危型人乳头瘤病毒感染有关。     

沈阳市妇女人乳头瘤病毒感染型别分布的研究

目的探讨沈阳市妇女人乳头瘤病毒（HPV）感染的型别分布。方法在沈阳市某社区抽取年龄为15～59岁的1000名妇女进行子宫颈癌危险因素的流行病学问卷调查，对已婚未孕妇女采集子宫颈细胞标本，用PCR分析和酶联免疫实验进行HPV检测分型，用薄层液基细胞学、醋酸染色后肉眼观察试验、碘试验和电子阴道镜进行子宫颈癌和癌前病变筛查。结果在纳入研究的702例妇女中，总的HPV感染率为17．0％。HPV感染在细胞学异常者中占64．1％，细胞学正常者中占11．1％，差异有统计学意义（P〈0．05）。人群中高危型HPV感染率为11．9％，低危型为6．5％。高危型及低危型HPV在细胞学异常人群中的感染均明显高于细胞学正常的人群。共有32个型别的HPV被鉴定。感染最多的类型为HPVl6（3．4％），52（2．4％）和58型（1．9％）。总HPV感染率、高危型及低危型在各年龄组间的分布差异均无统计学意义（P〉0．05）。但是高危型HPV感染在45岁以下年龄组中占主导地位，即高危型及低危型感染的差异有统计学意义（P〈0．05）；在45岁以上年龄组，高危型及低危型感染的差异无统计学意义（P〉0．05）。结论沈阳市妇女HPV感染在细胞学异常人群中明显高于细胞学正常的人群。主要感染型别是16、52和58型。     

Factors associated with changes in satisfaction with care

OBJECTIVE: Satisfaction with care is an important outcome for evaluating the effectiveness of medical care. Many factors can influence satisfaction, including disease state, healthcare utilization, and health-status changes. However, few studies have investigated the association between these factors and changes in satisfaction. DESIGN: This study examined the influence of personal characteristics, type of health plan, disease states, and healthcare utilization on changes in satisfaction with care in a prospective cohort over a 12-month period through two surveys, baseline and follow-up. PARTICIPANTS: Enrollees in one of three different commercial health plans: point-of-service product, an unrestricted fee-for-service product, and a preferred-provider organization product. MEASUREMENTS AND MAIN RESULTS: Two multivariate logistic regression models were constructed. The first model evaluated factors that predicted increased satisfaction with care between the two surveys. Compared with respondents who reported no change in health status, both those with improved health status (odds ratio [OR], 1.29, 95% confidence interval [CI95], 1.03-1.61) and those with declines in health (OR, 1.29, CI95, 1.03-1.61) were significantly more likely to report an increase in satisfaction with care. Those with a history of hospitalization were also more likely to report an increase in satisfaction with care (OR, 1.27, CI95, 1.01-1.59). The second multivariate logit model evaluated factors that predicted decreases in satisfaction with care from the baseline survey. Those with reported declines in health status were more likely to report decreases in satisfaction with medical care (OR, 1.43, CI95, 1.13-1.79). Neither age, gender, race, type of health plan, disease state, nor doctor's office visits were related to observed changes in satisfaction with medical care. CONCLUSION: Changes in satisfaction with care appear to be related to changes in health status. However, the relation between these two attributes is not intuitively apparent.     

Soy isoflavones in conjunction with radiation therapy in patients with prostate cancer

Soy isoflavones sensitize prostate cancer cells to radiation therapy by inhibiting cell survival pathways activated by radiation. At the same time, soy isoflavones have significant antioxidant and anti-inflammatory activity, which may help prevent the side effects of radiation. Therefore, we hypothesized that soy isoflavones could be useful when given in conjunction with curative radiation therapy in patients with localized prostate cancer. In addition to enhancing the efficacy of radiation therapy, soy isoflavones could prevent the adverse effects of radiation. We conducted a pilot study to investigate the effects of soy isoflavone supplementation on acute and subacute toxicity (≤6 mo) of external beam radiation therapy in patients with localized prostate cancer. Forty-two patients with prostate cancer were randomly assigned to receive 200 mg soy isoflavone (Group 1) or placebo (Group 2) daily for 6 mo beginning with the first day of radiation therapy, which was administered in 1.8 to 2.5 Gy fractions for a total of 73.8 to 77.5 Gy. Adverse effects of radiation therapy on bladder, bowel, and sexual function were assessed by a self-administered quality of life questionnaire at 3 and 6 mo. Only 26 and 27 patients returned completed questionnaires at 3 and 6 mo, respectively. At each time point, urinary, bowel, and sexual adverse symptoms induced by radiation therapy were decreased in the soy isoflavone group compared to placebo group. At 3 mo, soy-treated patients had less urinary incontinence, less urgency, and better erectile function as compared to the placebo group. At 6 mo, the symptoms in soy-treated patients were further improved as compared to the placebo group. These patients had less dripping/leakage of urine (7.7% in Group 1 vs. 28.4% in Group 2), less rectal cramping/diarrhea (7.7% vs. 21.4%), and less pain with bowel movements (0% vs. 14.8%) than placebo-treated patients. There was also a higher overall ability to have erections (77% vs. 57.1%). The results suggest that soy isoflavones taken in conjunction with radiation therapy could reduce the urinary, intestinal, and sexual adverse effects in patients with prostate cancer.     

Falling in love with romantic ideals: women in relationships with child molesters

Drawing on data from a larger research study, this paper explores intersecting and competing social relations that influenced the romantic desires of women who became intimately involved with men who molested children. Through a feminist poststructuralist lens, women’s narratives were analysed with the use of feminist interpretations of Foucauldian discourse theory. Analysis informed of a discursive power over participants that made the attainment of romantic desires an imperative for ensuring social respect, worth and credibility as women. When all was not ideal, these same romantic desires compelled women to fix and hold onto their relationships – even when with men that attract damning societal responses towards them. Even upon acknowledgement of their partners’ sexual transgressions, the fear of relationship breakdown meant that romantic desires again featured as imperatives for the women. The imagined pleasure of achieving romantic desires is discursive; so powerful that it outweighed women’s fears and dangers of precarious intimate life with men who commit abhorrent acts.     

Factors Associated with Sarcopenia in Patients with Colorectal Cancer

Introduction; Sarcopenia are frequently observed in cancer patients and was associated with poor prognosis. Objectives; to determine the association of nutritional status, body composition, and clinic parameters with sarcopenia in patients with colorectal cancer (CRC). Methods; We conducted a cross-sectional study of 197 patients with CRC. The sarcopenia elements, including lumbar skeletal muscle index (SMI), handgrip strength, and gait speed were measured. The SMI was assessed by computed tomography at third lumbar vertebra. Phase angle (PA), serum albumin (SAlb), muscle attenuation (MA), and the scored patient-generated subjective global assessment (PG-SGA) were also evaluated. Univariate and multivariate analysis of factors associated with sarcopenia were performed. Results; Sarcopenia was present in 29 of 195 patients (15%) and was significantly correlated with advance age, lower body mass index (BMI), SAlb, PA, MA, higher PG-SGA score, and malnutrition (PG-SGA B). In univariate analysis, age, BMI, SAlb, PA, MA, PG-SGA score, and malnutrition (PG-SGA B) were associated with sarcopenia. Multivariable analysis revealed that BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia. Conclusion; BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia in patients with CRC.