TBS诊断系统在宫颈病变中的应用研究

目的：对642例查体病人的宫颈涂片进行分析，研究宫颈良性病变和癌前病变及癌变在正常人群中的的发病率。方法：应用TBS系统对兰州市某大型商场30～51岁妇女642例行子宫颈涂片，显微镜下阅片，作出诊断，并对SIL以上的病例行阴道镜下活检术，进行病理检查。结果：正常582例，异常60剜，全部病例中仅1例漏诊。结论：TBS诊断系统与病理和临床诊断趋于一致，具有很高的准确性和适用性。     

Associations in breast and colon cancer screening behavior in women

RATIONALE AND OBJECTIVES: Gender-based psychosocial factors appear to influence colorectal cancer (CRC) screening adherence. Given its near-universal acceptance by the public, screening mammography represents a potential "teachable moment" for educating patients about the risk of CRC. Accordingly, to better understand screening behaviors among women, data from the Behavioral Risk Factors Surveillance Survey (BRFSS) were analyzed to identify potential relationships that would allow interventions to enhance CRC screening. MATERIALS AND METHODS: Women 50 years and older who participated in the BRFSS 2001 survey were included in the analysis. Colorectal, breast, and cervical cancer screening adherence with American Cancer Society guidelines was determined. We identified the association between breast and cervical cancer screening adherence and general health and demographic characteristics with CRC screening adherence. RESULTS: After adjustment for sociodemographic factors in a multivariate analysis, women 60-69 years old (adjusted odds ratio [OR], 1.50; P < .01) and 70-79 years old (adjusted OR, 1.39; P < .01), having achieved at least some high school (adjusted OR, 1.62; P < .01) or college (adjusted OR, 2.11; P < .01) education, having health coverage (adjusted OR, 1.67; P < .01) or a personal physician (adjusted OR, 1.60; P < .01), and adherence to screening mammography (adjusted OR, 2.42; P < .01) and Pap smear (adjusted OR, 1.70; P < .01) were independently associated with an increased likelihood CRC screening adherence. Women in self-reported good general health were less likely to have adhered to CRC screening guidelines (adjusted OR, 0.79; P < .01). Current smokers were also less likely to have adhered to CRC screening guidelines than were women who never smoked or formerly smoked (adjusted OR, 0.76; P < .01). Participants who adhered to both mammography and Pap smear guidelines were significantly more likely to adhere to CRC screening (51.5% CRC screening adherence) compared with women who adhered to neither screening test (8.2% CRC screening adherence), with an adjusted OR of 5.67 (P < .001). Participants who adhered to both mammography and Pap smear guidelines were significantly more likely to adhere to CRC screening than were women who adhered to either screening test (38.0% CRC screening adherence) with an adjusted OR of 1.94 (P < .001). CONCLUSION: Women with up-to-date mammography and cervical cancer screening were more likely to be up-to-date with CRC screening. Regardless of the increased association between non-CRC-related cancer screening and CRC screening, rates of CRC screening utilization remained low in these otherwise compliant populations.     

Management of cervical cancer detected during pregnancy: role of magnetic resonance imaging

ObjectiveThe aims of the present study were to assess the role of magnetic resonance imaging (MRI) in the staging and follow-up of uterine cervical cancers discovered during pregnancy and to evaluate the role of MRI in decision making regarding treatment options for patients with uterine cervical cancer during pregnancy.MethodTwelve pregnant women with cervical cancer were included. Two populations of patients were distinguished: localized cervical cancer discovered on the Pap smear during the first trimester of pregnancy, at an early stage (n=5), and invasive cervical cancer revealed later, during the second or third trimester (n=7). Abdominal and pelvic MRI sequences were acquired with a phased-array coil. Magnetic resonance results were correlated with the physical examination, Pap smear, and pathology.ResultsIn the first population, MRI was normal or detected a small lesion (stage IB1), and pregnancies were allowed to continue. In the second population, MRI detected a lesion in every case (mean size, 62 mm; 30–110 mm), and positive lymph nodes were depicted in 2 cases. The pregnancy was interrupted in four patients: one interruption in localized cervical cancer group and three in invasive cervical group). In all other cases, a cesarean section was done after the 30th week. In one case, MRI assessed response after chemotherapy administered during pregnancy.ConclusionMRI is an essential examination for planning the treatment of cervical cancers diagnosed during pregnancy.     

EA50染液pH值变化对宫颈脱落细胞染色的影响

目的探讨EA50染液pH值变化对宫颈脱落细胞染色的影响,寻求提高巴氏染色质量的方法。方法用1 mol/L Na2CO3和1 mol/L HAC分别处理EA50染液,测定其pH值,观察宫颈脱落细胞在不同pH值EA50染液中染色的效果。结果宫颈脱落细胞在低pH值染液中着色不鲜艳,细胞质染色异常,表现为红染严重,红、黄、绿着色对比不清晰;宫颈脱落细胞在高pH值染液中着色不鲜艳,细胞质染色异常,表现为绿染严重,红、黄、绿着色对比不清晰;宫颈脱落细胞在pH值4.0左右染液中细胞着色鲜艳,细胞质染色正常,红、黄、绿着色对比清晰。结论 EA50染液pH值变化对巴氏染色效果有明显影响,稳定染液的pH值在4.0左右可显著提高巴氏染色质量。     

CT导引细针吸取细胞学检查诊断肺周及胸膜病变

目的：对影像学检查所发现的肺周、纵隔及胸膜病变进行在ＣＴ导引下的细胞学检查，以期获得对该部位病变定性诊断和分类的经验。材料和方法：采用ＣＴ（ＳＣＴ－２０００Ｔ－１１型，日本岛津）对２２例患者的肺周、纵隔及胸膜病变扫描定位，７号腰椎穿刺针穿刺取材涂片，Ｐａｐ染色和光镜观察。结果：２２例中除１例因患者配合不佳而致针吸失败外，２１例获得准确和基本准确诊断，由于采用了细针，还减少或避免了出血、气胸等并发症。结论：肺周及胸膜病变的ＣＴ导引细针吸取细胞学检查是一种有效、简便和准确性高的诊断方法。     

Evaluation of whole-body cancer screening using <Superscript>18</Superscript>F-2-deoxy-2-fluoro-<Emphasis Type="SmallCaps">d</Emphasis>-glucose positron emission tomography: a preliminary report

OBJECTIVE: (18)F-2-deoxy-2-fluoro-D-glucose positron emission tomography (FDG-PET) is a promising screening modality targeting whole body. However, the validity of PET cancer screening remains to be assessed. Even the screening accuracy for whole-body screening using FDG-PET has not been evaluated. In this study, we investigated the screening accuracy of PET cancer screening. METHODS: A total of 2911 asymptomatic participants (1629 men and 1282 women, mean age 59.79 years) underwent both FDG-PET and other thorough examinations for multiple organs (gastrofiberscopy, total colonofiberscopy or barium enema, low-dose thin section computed tomography and sputum cytology, abdominal ultrasonography, an assay of prostate-specific antigen, mammography, mammary ultrasonography, Pap smear for the uterine cervix, and magnetic resonance imaging for the endometrium and ovaries) between February 2004 and January 2005, and followed sufficiently. The detection rate, sensitivity, specificity, and positive predictive value of FDG-PET were calculated using cancer data obtained from all examinations along with a 1 year follow-up. RESULTS: From among 2911 participants FDG-PET found 28 cancers, 129 cancers were PET negative. PET-positive cancers comprised seven colorectal cancers, four lung cancers, four thyroid cancers, three breast cancers, two gastric cancers, two prostate cancers, two small intestinal sarcomas (gastrointestinal stromal tumors), one malignant lymphoma, one head and neck malignancy (nasopharyngeal carcinoid tumor), one thymoma, and one hepatocellular carcinoma. PET-negative cancers included 22 gastric cancers and 20 prostate cancers that were essentially difficult to detect using FDG-PET. The overall detection rate, sensitivity, specificity, and positive predictive value were estimated to be 0.96%, 17.83%, 95.15%, and 11.20%, respectively. CONCLUSIONS: FDG-PET can detect a variety of cancers at an early stage as part of a whole-body screening modality. The detection rate of PET cancer screening was higher than that of other screening modalities, which had already shown evidence of efficacy. However, the sensitivity of PET cancer screening was lower than that of other thorough examinations performed at our institute. FDG-PET has some limitations, and cancer screening using only FDG-PET is likely to miss some cancers.     

Women in sports: the Naval Academy experience

Women were first admitted to the United States Naval Academy with the Class of 1980. The physical performance of 63 women in that class along with 69 in the Class of 1981 and 78 in the Class of 1982 is compared to the performance of a random sample of male midshipmen in the same Classes. The Department of Physical Education made some adjustments in the fitness program for women but did not change the objectives. The number of hours of physical education was the same for the men and women. Performance tests show that the women have scored better than had been anticipated and that the scores have improved with each Class. The women have averaged three times as many visits to the orthopaedic clinic for stress-related injuries than the men, but as the women have become acclimated to a more active life, they have sought medical attention for these problems less often. The women in these three Classes have had no trauma-related orthopaedic surgery. It is anticipated that when women midshipmen begin to participate in the same vigorous sports as men, e.g., soccer, lacrosse, and others, that injuries will increase. We conclude that physical fitness requirements for women will become increasingly similar to the men's requirements. At this time, the performance of women is often a result of society's conditioning rather than apparent physiologic differences between the sexes.     

Celebrating 40 years of the achievements of the American Association for Women Radiologists

For the past 40 years the American Association for Women in Radiology (AAWR) has continued to support efforts to achieve its founding goals of improving the visibility of women in radiology, advancing the professional and academic standing of women in radiology, and identifying and addressing issues faced by women in radiology. In the past 5 years, the AAWR has made great strides to support women in radiology through amplifying the voices of women heard at the American College of Radiology (ACR) Annual Meeting, initiating the AAWR Research & Education Capital Campaign, establishing the fellows of the AAWR, and advocating for practicing radiologists and trainee parental leave. The many accomplishments of the AAWR over the past 40 years and the committed future work of the AAWR ensure the voices of women in radiology are heard and the needs of women in radiology are recognized.     

Gender and the Radiology Workforce: Results of the 2014 ACR Workforce Survey

PurposeAs part of the 2014 ACR Human Resources Commission Workforce Survey, an assessment of the gender of the U.S. radiologist workforce was undertaken. Radiologist gender in relation to type of practice, work location, leadership roles, and full- versus part-time employment have not previously been assessed by this survey.MethodsThe survey was completed by group leaders in radiology identified through the Practice of Radiology Environment Database.ResultsThe response rate to the survey was 22%, representing 35% of all practicing radiologists. The survey found that 78% of the radiology workforce is male, and 22% female. Among the men, 58% work in private practice, and 18% in the academic/university environment; among women, percentages were 43% and 31%, respectively. Of all physician leads, 85% are men, 15% women. Of the full-time radiologists, 15% of men are practice leaders compared with 11% of women.ConclusionsFewer women than men are in private practice. More women than men practice in academic/university environments. Among part-time radiologists, there are more men than women, but significantly more women work part time than men. Women are in the minority among practice leaders.     

MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer

OBJECTIVE: The purpose of this study was to review MR imaging findings in the ipsilateral breast in women with percutaneously proven breast cancer. MATERIALS AND METHODS: Retrospective review was performed of records of 70 consecutive women with percutaneously proven unilateral breast cancer who were considered candidates for breast conservation surgery and who had preoperative MR imaging of the ipsilateral breast. MR images and medical records were reviewed. RESULTS: MR imaging identified mammographically and clinically occult cancer other than the index lesion in the ipsilateral breast in 19 women (27%), including infiltrating cancer in 11 women (16%) and ductal carcinoma in situ in eight women (11%). These additional sites of cancer were in the same quadrant as the index cancer in 14 women (20%), in a different quadrant in three women (4%), and in both the same and different quadrants in two women (3%). Additional sites of cancer were more likely in women with, rather than in those without, a family history of breast cancer (42% vs 14%, p < 0.02) and in women whose index cancer was infiltrating lobular rather than other histologies (55% vs 22%, p < 0.06). In 17 women (24%), MR imaging detected ipsilateral lesions that were benign. Changes due to prior percutaneous biopsy were infrequently observed on MR images and included a clip in 12 women (17%) and a small hematoma in two women (3%). CONCLUSION: MR imaging identified additional sites of ipsilateral cancer in 27% of women with percutaneously proven breast cancer. The yield was highest in women with a family history of breast cancer or infiltrating lobular histology in the index cancer. Change after biopsy was infrequent and did not interfere with the MR imaging interpretation.     

Stress and coping in male and female health care providers during the Persian Gulf War: the USNS Comfort hospital ship

The development of the USNS Comfort hospital ship during the Persian Gulf War provided an opportunity to examine the relationship of gender to stress and coping in health care providers exposed to wartime stressors. Just before the outbreak of Operation Desert Storm, medical personnel (N = 250) rated the stressfulness of current wartime experiences and the helpfulness of stress-reducing resources onboard ship in a combat theater. The responses of men and women were compared; to identify the dimensions of these responses, a principal factor analysis (orthogonal rotation) was performed. Generally, men and women ranked stressors and stress reducers similarly; women scored higher on the stress ratings. Two factors, similar for men and women, were identified in the stress ratings: fear of injury and trauma-related work demands. The dimensions of the stress reducers, however, were different for men and women. The findings support retrospective studies and suggest that different mechanisms of stress reduction may be operative even though men and women are performing the same activity.     

Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound

AIM: The aim of this study was to evaluate the contribution of bilateral whole-breast ultrasound (BBUS) to the diagnosis and management of women with newly diagnosed breast cancer. METHODS: Over a period of 6 months, 102 women presenting with breast cancer underwent BBUS. Data were collected on clinical findings, radiology, histology and surgical outcome. These women were compared with a control group of 124 women presenting over a similar 6-month period 1 year previously, who had undergone targeted breast ultrasound. RESULTS: Multicentric/multifocal tumours were demonstrated in 35 (34%) of the 102 participants and in 18 (15%) of the 124 controls, a statistically significant difference (Fisher's exact test, p = 0.001). Multiple tumours were diagnosed preoperatively in 18% of the study population compared with 8% of the controls, and BBUS identified invasive multifocal/multicentric tumours in significantly more women in the study population (11 versus 1 control) (Fisher's exact test, p = 0.019). Contralateral cancer was diagnosed in 4 women in the study population and none in the control population (Fisher's exact test, p = 0.040). Surgical review showed that the surgical management changed significantly in 8% (95% confidence interval 4 to 14%) of cases in the study population following BBUS. The increase in the number of women undergoing benign biopsies in the study population (10 versus 5 controls) was not statistically significant (Fisher's exact test, p = 0.11). CONCLUSION: BBUS increased the preoperative diagnosis of multiple tumours in women presenting with primary breast cancer, resulting in a management change in 8% of cases.     

打鼾对妊娠晚期孕妇睡眠质量的影响

 目的 探讨打鼾对妊娠晚期孕妇睡眠质量的影响。方法 对126例妊娠晚期孕妇进行问卷调查,分为非打鼾组85例和打鼾组41例。分析打鼾对孕晚期妇女睡眠质量的影响。结果 本研究中共有41例孕晚期妇女存在打鼾,占调查孕妇总数的32.5%;打鼾组夜间睡眠时间短于非打鼾组,日间睡眠时间、入睡时间及夜间小便次数高于非打鼾组(P <0.05)。打鼾组Epworth嗜睡量表评分高于非打鼾组(P<0.01)。打鼾组孕妇发生夜间憋醒、用口呼吸和睡眠多汗的比例高于非打鼾组(P<0.05)。打鼾组夜间入睡困难比例高于非打鼾组(P<0.01)。打鼾组孕妇Epworth嗜睡量表评分≥9分的比例高于非打鼾组(P<0.01)。 结论 打鼾在孕晚期妇女中较常见,打鼾组孕妇的睡眠质量明显不如非打鼾组。     

宫颈液基薄层细胞学检查在女飞行员宫颈病变筛查中的作用

目的：探讨宫颈液基薄层细胞学检查在女飞行员妇科体检中的作用。方法：回顾性分析2007-01～2008-12间运用宫颈液基薄层细胞学检测（TCT）及传统巴氏涂片方法,均采用TBS分类,对40名女飞行员进行宫颈病变的筛查。不典型鳞状上皮细胞（ASC-US）以上列为阳性病例,比较两种细胞学诊断结果与阴道镜下活检宫颈组织病理学结果间的关系。结果：TCT细胞学阳性病例5例,阳性率为12.5%（5/40）,组织病理学阳性3例,均为人类乳头瘤状病毒感染,阳性60%（3/5）;而传统细胞学的阳性检出率仅为5%（2/40）,组织病理阳性率为0。结论：宫颈TCT检测能明显提高细胞学诊断的阳性率,女飞行员HPV感染现象值得关注。     

宫内节育器异常的X线分析

目的　探讨宫内节育器异常的X线表现。方法　对我院门诊 6 2 4例放置节育器妇女进行立位透视检查 ,测量节育器位置 ,观察其形态。结果　 6 2 4例宫内放置节育器的妇女中 ,位置异常 75例 ,其中节育器经子宫颈脱落 32例 ,节育器变形 12例 ,节育器断裂 10例 ,带环妊娠 8例 ,放置两个节育器 10例 ,节育器嵌入子宫肌层 2例 ,节育器游离腹腔 1例。结论　定期对放环妇女进行X线检查十分必要。     

MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer

OBJECTIVE: The purpose of this study was to determine the frequency and positive predictive value of biopsy performed on the basis of MR imaging findings in the contralateral breast in women with recently diagnosed breast cancer. MATERIALS AND METHODS: We performed a retrospective review of records of 1336 consecutive breast MR imaging examinations over a 2-year period. Of these examinations, 223 imaged the asymptomatic, mammographically normal contralateral breast in women whose breast cancer was diagnosed within 6 months preceding MR imaging. Records of these 223 examinations were reviewed to determine the frequency of recommending contralateral breast biopsy and the biopsy results. RESULTS: Contralateral breast biopsy was recommended in 72 (32%) of 223 women and performed in 61 women. Cancer occult to mammography and physical examination was detected by MR imaging in 12 women, constituting 20% (12/61) of women who underwent contralateral biopsy and 5% (12/223) of women who underwent contralateral breast MR imaging. Among these 12 cancers, six (50%) were ductal carcinoma in situ (DCIS) and six (50%) were infiltrating carcinoma. The median size of infiltrating carcinoma was 0.5 cm (range, 0.1-1.0 cm). Contralateral biopsy revealed benign (n = 31) or high-risk (n = 18) lesions in 49 women, constituting 80% (49/61) of women who underwent contralateral biopsy and 22% (49/223) of women who underwent contralateral MR imaging. CONCLUSION: In women with recently diagnosed breast cancer, MR imaging of the contralateral breast led to a biopsy recommendation in 32%. Cancer was found in 20% of women who underwent contralateral breast biopsy and in 5% of women who underwent contralateral breast MR imaging.     

Correlates of physical activity among pregnant women in the United States

INTRODUCTION: Physical activity recommendations for pregnant and nonpregnant women have been issued, but little data exist to compare the extent that these women are meeting the recommendation levels. METHODS: A population-based, cross-sectional study using data from the 1994, 1996, 1998, and 2000 Behavioral Risk Factor Surveillance System evaluated the physical activity recommendations met by pregnant and nonpregnant women. The study population included women who were 18-44 yr of age. Random digit dialing, telephone surveys were used to assess all information. Pregnant and nonpregnant women were categorized into five mutually exclusive groups based upon their level of physical activity in the past month: vigorous activity (meeting guidelines) moderate activity (meeting guidelines), moderate or vigorous activity (not meeting guidelines), irregular activity, or no physical activity. RESULTS: Nonpregnant women were more likely than pregnant women to meet the vigorous or moderate physical activity recommendations. Walking was the most common activity among pregnant and nonpregnant women (52 and 45%, respectively). Pregnant women meeting the moderate or vigorous physical activity recommendations were more likely to be younger, nonhispanic white, more educated, not married, nonsmokers, and to have higher incomes. CONCLUSION: Many pregnant women do not appear to be meeting the physical activity recommendations. Healthcare providers should further encourage the promotion of physical activity during uncomplicated pregnancies.     

Screening women at high risk of breast cancer on the basis of evidence

Geneticists are able to identify the risk of breast cancer. Strategies on offer include prevention, early diagnosis by screening, and prophylactic surgery. This paper analyses the evidence for offering screening. The radiation dose of mammography has been measured, but the risk is not fully known. Mammography screening of women of 40–50 years in the normal population has known effect. Little evidence is available for women under 40 years or for women with genetic susceptibility to breast cancer. Dense parenchymal pattern is associated with high grade cancers, and is both a risk factor and a reason for impaired screening sensitivity. Whether this applies to younger women or women at high risk is speculative. The pathological features of the cancers in gene carriers show differences from those occurring in normal women. This work should be correlated with imaging features. There is no literature to support the use of newer imaging methods in these women. Ultrasound and MRI avoid radiation and may be useful in dense breasts. SestaMIBI and PET scanning are not yet mature enough for screening, and may never have such a role. Any newer modality must be subjected to a formal randomised trial before being offered to screen women at high risk.     

Why don’t female medical students choose diagnostic radiology? A review of the current literature

While the number of women entering medical schools is approaching 50% nationally, women continue to be underrepresented in a number of specialties including diagnostic radiology. While diagnostic radiology has many characteristics that might be desirable to women, such as reasonable call hours, flexible scheduling, and high salaries, women still do not choose diagnostic radiology as a career. This article examines the literature to discern possible reasons for why women are entering diagnostic radiology at a lower rate. We address trends among women in academic medicine, which resemble trends among women in diagnostic radiology, and examine the effects of gender and socialization in medical school on specialty choices among women. The current literature suggests a constellation of factors may be responsible for the gender differences in diagnostic radiology. We suggest that further research is needed to elucidate why women do not seem to be choosing diagnostic radiology as frequently as one might predict based on the lifestyle of diagnostic radiologists and the numbers of women currently entering medical school. Once these reasons are made clear, it will be possible for residency program directors and medical schools to ensure that women are making informed specialty choices, whatever those choices may be.