高危型人乳头瘤病毒DNA检测在宫颈癌筛查中的作用

目的:探讨高危型人乳头瘤病毒(HPV)DNA检测在宫颈癌筛查中的作用。方法:2005年4月~2006年4月在我院妇科门诊就诊2 340名妇女进行宫颈癌前病变筛查,采用第2代杂交捕获试验(HC-Ⅱ)检测高危型HPV DNA联合薄层液基细胞学检查,同时进行阴道镜检查,并以宫颈活检的组织病理学为确诊标准。结果:筛查并经病理诊断为HPV感染365例,宫颈上皮内瘤变(C IN)Ⅰ级71例,C INⅡ48例,C INⅢ55例,宫颈浸润癌31例。以组织病理学为确诊标准,高危型HPV DNA检测C INⅡ、C INⅢ的敏感度是91.33%,特异度是74.51%,阳性预测值是5.21%,阴性预测值是99.79%。宫颈细胞学筛查C INⅡ、C INⅢ,以未明确诊断意义的不典型鳞状上皮细胞(ASCUS)为分界点的敏感度、特异度、阳性预测值、阴性预测值分别是90.80%、80.45%、12.30%、99.50%;以高度鳞状上皮内病变(HSIL)为分界点的敏感度、特异度、阳性预测值、阴性预测值分别是98.90%、73.98%、4.90%、100.00%。高危型HPV DNA在不同宫颈病变中的阳性率分别是:宫颈癌88.57%(31/35),C INⅢ91.67%(66/72),C INⅡ87.50%(56/64),C INⅠ42.00%(21/50)。结论:高危型人乳头瘤病毒DNA检测在宫颈癌前病变的筛查中有很高的敏感度和阴性预测值,高危型HPV DNA联合细胞学检查可使敏感度和阴性预测值有提高,但特异度未能提高。     

4799例妇女病普查结果分析

目的:掌握和了解十堰市妇女常见病、多发病患病率,制定干预措施。方法:于2004年1~12月对十堰市4 799名妇女进行了妇科病、乳腺病普查。结果:4 799人中患各种妇科病1 885人,患病率为39.28%。妇科疾病前3位是阴道炎、宫颈糜烂、附件炎或附件包块,4 799例中患乳腺疾病者570人,患病率为11.88%,乳腺疾病以乳腺增生为主,其次是纤维瘤。结论:应广泛宣传妇女常见病、多发病的防治知识及乳腺自检方法,以降低生殖道感染发生率。     

Sickle cell disease in pregnancy

With advances in management, many women with sickle cell disease now survive to have children. The high risk of fetal and maternal sequelae mandates multidisciplinary management involving an obstetrician, a haematologist, an anaesthetist and a haemoglobinopathy specialist nurse. Hydroxyurea, a new treatment for sickle cell disease, is contraindicated in pregnancy. Exchange transfusion may be indicated in women with a serious obstetric or haematological complications. In those with sickle cell disease, the entire pregnancy is a high-risk period that warrants close monitoring. It is thus important for every obstetrician to be familiar with the condition.     

Ontogeny of aromatase and tyrosine hydroxylase activity and of aromatase-immunoreactive cells in the preoptic area of male and female Japanese quail

The aromatization of testosterone into oestrogens plays a key role in the control of many behavioural and physiological aspects of reproduction. In the quail preoptic area (POA), aromatase activity and the number of aromatase-immunoreactive (ARO-ir) cells are sexually differentiated (males > females). This sex difference is implicated in the control of the sexually dimorphic behavioural response of quail to testosterone. We analysed the ontogenetic development of this sex difference by measuring aromatase activity and counting ARO-ir cells in the POA of males and females from day 1 post hatch to sexual maturity. We investigated in parallel another enzyme: tyrosine hydroxylase, the rate limiting step in catecholamine synthesis. Between hatching and 4 weeks of age, aromatase activity levels were low and equal in males and females. Aromatase activity then markedly increased in both sexes when subjects initiated their sexual maturation but this increase was more pronounced in males so that a marked difference in aromatase activity was present in 6 and 8 week-old subjects. Tyrosine hydroxylase activity progressively increased with age starting immediately after hatching and there was no abrupt modification in the slope of this increase when birds became sexually mature. No sex difference was detected in the activity of this enzyme. The number of ARO-ir cells in the POA progressively increased with age starting at hatching. No sex difference in ARO-ir cell numbers could be detected before subjects reached full sexual maturity. The analysis of the three-dimensional organization of ARO-ir cells in the POA revealed that, with increasing ages, ARO-ir cells acquire a progressively more lateral position: they are largely periventricular in young birds but they are found at higher density in the lateral part of the medial preoptic nucleus in adults. These data indicate that aromatase activity differentiates sexually when birds reach sexual maturity presumably under the activating effects of the increased testosterone levels in males. The number of ARO-ir cells, however, begins to increase in a non sexually differentiated manner before the rise in plasma testosterone in parallel with the increased tyrosine hydroxylase activity. Whether this temporal coincidence results from a general ontogenetic pattern or from more direct causal links remains to be established.     

适宜农村地区子宫颈癌筛查方法的研究

目的探索适合宫颈癌高发且经济欠发达地区子宫颈癌及其癌前病变的筛查方法,以最终降低子宫颈癌的发病率和死亡率。方法以山西省襄垣县下良乡35￣55岁的妇女作为对象,进行以人群为基础的宫颈癌筛查。对符合条件的妇女进行危险因素、癌症及子宫颈癌认知情况的问卷调查,用醋酸染色后肉眼观察(VIA)和碘染色后肉眼观察(VILI)进行宫颈检查,结果异常者进行阴道镜下活组织检查并得到最终的病理学诊断。将该次筛查对不同级别病变的检出率与历年来的襄垣地区的筛查结果进行比较。结果该次筛查人群参与率为74.8%。患宫颈糜烂和滴虫感染的妇女分别占受检人群的48.3%和14.8%。最终经活检病理确诊的CINⅠ的现患率为0.8%(10例)、CINⅡ0.7%(9例)、CINⅢ1.1%(13例)、子宫颈癌0.2%(3例)。该次单纯肉眼观察对CINⅡ和对≥CINⅢ病变的检出率略低于已往当地普查项目,但差别无统计学意义。结论在资源有限,经济不发达的农村地区,由经过培训的医生进行肉眼观察的宫颈癌筛查是可行的,单纯肉眼观察是一种经济有效的筛查方法,建议进一步在农村地区进行推广。     

Practical applications of snake venom toxins in haemostasis

Snake venom toxins affecting haemostasis have facilitated extensively the routine assays of haemostatic parameters in the coagulation laboratory. Snake venom thrombin-like enzymes (SVTLE) are used for fibrinogen/fibrinogen breakdown product assay and for the detection of fibrinogen dysfunction. SVTLE are not inhibited by heparin and can thus can be used for assaying antithrombin III and other haemostatic variables in heparin-containing samples. Snake venoms are a rich source of prothrombin activators and these are utilised in prothrombin assays, for studying dysprothrombinaemias and for preparing meizothrombin and non-enzymic forms of prothrombin. Russell's viper (Daboia russelli) venom (RVV) contains toxins which have been used to assay blood clotting factors V, VII, X, platelet factor 3 and, importantly, lupus anticoagulants (LA). Other prothrombin activators (from the taipan, Australian brown snake and saw-scaled viper) have now been used to assay LA. Protein C and activated protein C resistance can be measured by means of RVV and Protac^®, a fast acting inhibitor from Southern copperhead snake venom and von Willebrand factor can be studied with botrocetin^® from Bothrops jararaca venom. The disintegrins, a large family of Arg-Gly-Asp (RGD)-containing snake venom proteins, show potential for studying platelet glycoprotein receptors, notably, GPIIb/IIIa and Ib. Snake venom toxins affecting haemostasis are also used in the therapeutic setting: Ancrod (from the Malayan pit viper, Calloselasma rhodostoma), in particular, has been used as an anticoagulant to achieve ‘therapeutic defibrination’. Other snake venom proteins show promise in the treatment of a range of haemostatic disorders.     

γ干扰素释放试验诊断儿童潜伏结核菌感染的Meta分析

目的以结核菌素皮肤试验(TST)为参考试验,评价QuantiFERON-TB Gold test(QFT)和T-SPOT.TB两种IFN-γ释放试验诊断儿童潜伏结核菌感染的准确性。方法计算机检索EMBASE、PubMed、Cochrane图书馆、中文科技期刊全文数据库、中国期刊全文数据库和万方数字化期刊群等数据库,检索时间均为建库至2010年3月。全面检索IFN-γ释放试验诊断儿童潜伏结核菌感染的文献,按照诊断试验的纳入标准筛选文献,提取纳入文献的特征信息(研究背景、设计信息和诊断参数信息)。根据QUADAS质量评价标准评价纳入文献的质量。采用Meta-Disc1.4软件进行Meta分析,检验异质性,并根据异质性结果选择相应的效应模型。对纳入文献予以加权定量合并,计算汇总敏感度、特异度、阳性似然比、阴性似然比和诊断优势比及其95%CI,绘制汇总受试者工作特征(SROC)曲线,并计算曲线下面积(AUC)。结果共检出相关文献285篇,按照文献纳入标准,最终纳入13篇文献(英文文献12篇和中文文献1篇)。10篇文献报道了QFT试验对儿童潜伏结核菌感染的诊断价值,汇总敏感度为0.40(95%CI:0.37~0.44)、汇总特异度为0.87(95%CI:0.85~0.88)、汇总阳性似然比为6.21(95%CI:3.07~12.54)、汇总阴性似然比为0.46(95%CI:0.31~0.68)、汇总诊断优势比为15.58(95%CI:7.47~32.48),SROC AUC为0.8931。4篇文献报道了T-SPOT.TB试验对儿童潜伏结核菌感染的诊断价值,汇总敏感度为0.74(95%CI:0.68~0.79)、汇总特异度为0.84(95%CI:0.81~0.87)、汇总阳性似然比为4.66(95%CI:1.27~17.12)、汇总阴性似然比为0.42(95%CI:0.18~0.99)、汇总诊断优势比为13.71(95%CI:3.71~50.72),SROCAUC为0.8306。结论 IFN-γ释放试验适用于进一步鉴别诊断儿童是否处于潜伏结核菌感染,不适合儿童潜伏结核菌感染的筛查。     

子宫内膜癌及癌前病变危险因素的调查研究

目的:研究子宫内膜癌(EC)及癌前病变的流行病学特征及其发病的高危因素,为明确EC筛查的适宜人群提供依据.方法:选取2009年3月到2010年7月在北京大学第一医院妇产科行宫腔镜检查+分段诊刮术且同时行子宫内膜细胞学检查的540例患者.比较组织病理学诊断与子宫内膜细胞学筛查的结果.采用SPSS1O.0软件二分类非条件Logistic回归分析对影响组织病理学与子宫内膜细胞学结果的高危因素进行分析.结果:组织病理学结果为EC/非典型增生的相关危险因素:BMI≥25kg/m2、年龄≥40岁、糖尿病、高血压、绝经、恶性肿瘤家族史和毒物放射线接触史;独立危险因素:BMI≥25kg/m2、年龄≥40岁、糖尿病和恶性肿瘤家族史.子宫内膜细胞学报告为非典型腺细胞以上的相关危险因素:BMI≥23 kg/m2、年龄≥40岁、糖尿病、高血压、绝经和恶性肿瘤家族史;独立危险因素:BMI≥23 kg/m2和年龄≥40岁.结论:建议对年龄≥40岁或恶性肿瘤家族史的患者中进行EC的筛查;对肥胖、糖尿病的患者加强子宫内膜状况的监测.子宫内膜细胞学报告与病理学诊断的高危因素谱基本相同.     

上海地区人群中部分稀有血型筛选

目的了解上海地区人群中部分稀有血型的频率和分布情况,用于解决临床上稀有血型的用血问题。方法利用稀有单克隆、多克隆抗血清,对Kell血型系统的K0,Miltenberger血型系统的Mur＋,Duffy血型系统的Fya-,高频率抗原中的Lan-、Vel-进行筛选;用2 mol/L尿素进行Kidd血型系统的Jk（a-b-）表型筛选。筛选方法包括试管法间接抗人球蛋白试验（IAT）,U型96孔微量板IAT和U型96孔微量板盐水直接离心法试验。结果从24 093名献血者中发现1例K0表型;在2 970名献血者中检出15例Mur＋;从200名献血中,检出1例Fya-;从6 153名献血者中发现2例Vel-;在300名献血者中发现了1例Lan-;在102 760名献血者中,成功检出4例Jk（a-b-）。结论Mur＋、Lan-、Jk（a-b-）表型频率明显高于白种人;Fya-表型频率低于白种人。     

结核感染T细胞斑点试验在手、腕部腱鞘结核诊断中的应用评价

目的 探讨结核感染T细胞斑点试验(T-cell spot of Tuberculosis,T-SPOT.TB)在手、腕部腱鞘结核诊断中的临床应用价值.方法 通过对2012年1月至2018年1月我院收集64例怀疑手、腕部腱鞘结核临床资料进行回顾性分析,根据病理诊断及临床表现判断有无结核分枝杆菌感染;全部病例均经过T-SP...