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.     

细菌素产生菌的筛选及其细菌素的分离纯化

从香肠中分离得到一株产细菌素的乳酸片球菌，其发酵液经硫酸铵沉淀，CM—Sephadex C50阳离子交换柱层析后，得到的细菌素样品通过SDS—PAGE证明是一条带，分子量约20．83ku，该细菌素对热及酸碱稳定，易被酶降解而失去活性，对许多革兰氏阳性茵有较强的抑制作用，而对革兰氏阴性茵、酵母和霉没有作用。     

HR-HPV在农村宫颈癌前病变高危年龄妇女中的感染状况调查

目的:探讨高危型人乳头瘤病毒(High risk-human papilloma virus,HR-HPV)在中国农村宫颈癌前病变高危年龄妇女中的感染状况,为宫颈癌前病变的防治及宫颈癌筛查方案的制定提供客观依据。方法:对宫颈癌高发区江西修水县人桥乡2499例年龄为30~49岁农村已婚妇女进行以人群为基础的宫颈癌及癌前病变筛查的横断面研究。采用了目前被普遍认可的多种筛查技术的联合筛查:包括宫颈薄层液基细胞学检查(TCT)、宫颈脱落细胞HPV DNA检查、醋酸染色肉眼观察(VIA)、碘染色肉眼观察(VILI)以及阴道镜检查等方法。不同方法间遵循独立、双盲原则。对其中任何一项检查异常的妇女进行宫颈活组织病理检查,以宫颈活组织病理检查作为诊断金标准。HPV DNA检测采用第二代杂交捕获实验(Hybrid capture-2,HC-Ⅱ)对受检妇女宫颈脱落细胞行HPV DNA半定量检测。观察农村宫颈癌前病变高危年龄妇女病变程度与HR-HPV感染的关系以及HR-HPV在宫颈癌前病变高危年龄妇女人群中的感染状况。结果:2499例受检妇女中,352例妇女因HPV DNA缺失被排除,其余2147例妇女纳入本研究,共检出无宫颈病变1966例、宫颈鳞状细胞化生81例、慢性宫颈炎271例、CINⅠ82例,CINⅡ37例、CINⅢ59例、宫颈癌3例。HR-HPV在不同程度宫颈病变的感染率分别为5.1%、54.9%、66.9%、80.5%、94.1%、98.1%、100.0%。HR-HPV检出妇女中总阳性率为20.63%,在30~34岁、35~39岁、40~44岁、45~49岁各年龄组的阳性率分别为21.07%、19.66%、21.29%及20.54%。宫颈癌前病变妇女HR-HPV感染率与慢性宫颈炎妇女比较,差异有统计学意义(P<0.05)。宫颈癌前病变高危年龄妇女不同年龄组HPV感染率无统计学差异(P>0.05)。结论:HR-HPV感染与宫颈病变程度呈正相关,与年龄无明显相关性。     

广东省早产儿视网膜病筛查阳性率调查分析

目的:了解广东省早产儿视网膜病(Retinopathy of prematurity,ROP)的发病率,为规范开展早产儿ROP筛查奠定基础。方法:通过信函、现场和电子邮件的方式对广东省设有新生儿ICU的医院进行ROP筛查情况调查,调查内容包括2002年1月～2006年12月ROP筛查例数和阳性病例数。结果:筛查阳性率一级医院为零,二级医院为1.05%,三级医院为3.85%,广东省ROP筛查总阳性率为2.11%,随着医院级别的升高,ROP筛查阳性率不断增高;广州市ROP筛查阳性率明显高于省内其他地区的平均水平;二级医院中,综合医院和妇幼保健院ROP筛查阳性率分别为1.23%和0.98%,两者比较差异无显著性(P>0.05);而三级医院中,综合医院和妇幼保健院ROP筛查阳性率分别为3.62%和4.54%,差异无显著性(P>0.05)。结论:广东省ROP筛查阳性率较低,各级医院ROP筛查情况差异较大,以行政干预手段促进和规范ROP筛查防治工作势在必行,建议建立以三级医院为依托的覆盖基层医院的ROP筛查防治模式,提高ROP的整体防治质量。     

DryEyeRhythm: A reliable and valid smartphone application for the diagnosis assistance of dry eye

PurposeUndiagnosed or inadequately treated dry eye disease (DED) decreases the quality of life. We aimed to investigate the reliability, validity, and feasibility of the DryEyeRhythm smartphone application (app) for the diagnosis assistance of DED.MethodsThis prospective, cross-sectional, observational, single-center study recruited 82 participants (42 with DED) aged ≥20 years (July 2020–May 2021). Patients with a history of eyelid disorder, ptosis, mental disease, Parkinson's disease, or any other disease affecting blinking were excluded. Participants underwent DED examinations, including the Japanese version of the Ocular Surface Disease Index (J-OSDI) and maximum blink interval (MBI). We analyzed their app-based J-OSDI and MBI results. Internal consistency reliability and concurrent validity were evaluated using Cronbach's alpha coefficients and Pearson's test, respectively. The discriminant validity of the app-based DED diagnosis was assessed by comparing the results of the clinical-based J-OSDI and MBI. The app feasibility and screening performance were evaluated using the precision rate and receiver operating characteristic curve analysis.ResultsThe app-based J-OSDI showed good internal consistency (Cronbach's α = 0.874). The app-based J-OSDI and MBI were positively correlated with their clinical-based counterparts (r = 0.891 and r = 0.329, respectively). Discriminant validity of the app-based J-OSDI and MBI yielded significantly higher total scores for the DED cohort (8.6 ± 9.3 vs. 28.4 ± 14.9, P < 0.001; 19.0 ± 11.1 vs. 13.2 ± 9.3, P < 0.001). The app's positive and negative predictive values were 91.3% and 69.1%, respectively. The area under the curve (95% confidence interval) was 0.910 (0.846–0.973) with concurrent use of the app-based J-OSDI and MBI.ConclusionsDryEyeRhythm app is a novel, non-invasive, reliable, and valid instrument for assessing DED.     

Study Protocol for the Most Effective Recall Method in a Cervical Cancer Screening Program in Klang,Malaysia

Background: Cervical cancer is the second most common cancer among Malaysian women with an ASR of17.9 and a mortality rate of 5.6 per 100,000 population in 2008 (GLOBOCAN, 2008). The 5 year prevalence wasestimated to be 14.5 per 100,000 population. As the second most common cancer affecting productive females,cervical cancer imposes an impact to the socioeconomic aspect of the country. However, the poor uptake ofcervical cancer screening is a major problem in detecting early pre-cancerous lesions and thus, delay in initiatingtreatment for cervical cancer. Realizing the urgency to increase the uptake of PAP smear, besides enhancing thepromotion of PAP smear screening for women above 35 years old, the call-recall system for pap smear screeninghad been piloted in one of the suburban districts which aimed to improve regular participation of women forcervical and breast cancer screening. This is of public health importance as identifying the best feasible optionto increase patient’s respond to participate in the screening program effectively in our setting will be helpfulin implementing an organized regular population based screening program tailored to our setting. The pilotprogram of cervical cancer screening in Klang was an opportunity to assess different options in recalling patientsfor a repeat pap smear to increase their participation and adherence to the program. Methods and Results: Thiswas a population based randomized control trial. Women aged 20-65 years in the population that matched theinclusion and exclusion criteria were re-called for a repeat smear. There are four different intervention groups;letter, registered letters, short messages services (SMS) and phone calls where 250 subjects were recruited intoeach group. Samples were generated randomly from the same population in Klang into four different groups.The first group received a recall letter for a repeat smear similar to the one that has been given during the firstinvitation. The intervention groups were either be given a registered letter, an SMS or a phone call to re-callthem. The socio-demographic data of the patients who came for uptake were collected for further analysis. Allthe groups were followed up after 8 weeks to assess their compliance to the recall. Conclusions: The study willprovide recommendations about the most effective methods for recall in a population based pap smear screeningprogram on two outcomes: i) patients response; ii) uptake for repeat pap smear.     

The National Cancer Screening Program for Breast Cancerin the Republic of Korea: Is it Cost-Effective?

This goal of this research was to evaluate the cost-effectiveness of the National Cancer ScreeningProgram (NCSP) for breast cancer in the Republic of Korea from a government expenditure perspective. In2002-2003 (baseline), a total of 8,724,860 women aged 40 years or over were invited to attend breast cancerscreening by the NCSP. Those who attended were identified using the NCSP database, and women weredivided into two groups, women who attended screening at baseline (screened group) and those who did not(non-screened group). Breast cancer diagnosis in both groups at baseline, and during 5-year follow-up wasidentified using the Korean Central Cancer Registry. The effectiveness of the NCSP for breast cancer wasestimated by comparing 5-year survival and life years saved (LYS) between the screened and the unscreenedgroups, measured using mortality data from the Korean National Health Insurance Corporation and theNational Health Statistical Office. Direct screening costs, indirect screening costs, and productivity costs wereconsidered in different combinations in the model. When all three of these costs were considered together,the incremental cost to save one life year of a breast cancer patient was 42,305,000 Korean Won (KW)(1 USD=1,088 KW) for the screened group compared to the non-screened group. In sensitivity analyses,reducing the false-positive rate of the screening program by half was the most cost-effective (incrementalcost-effectiveness ratio, ICER=30,110,852 KW/LYS) strategy. When the upper age limit for screening wasset at 70 years, it became more cost-effective (ICER=39,641,823 KW/LYS) than when no upper age limitwas set. The NCSP for breast cancer in Korea seems to be accepted as cost-effective as ICER estimates werearound the Gross Domestic Product. However, cost-effectiveness could be further improved by increasingthe sensitivity of breast cancer screening and by setting appropriate age limits.     

Effects of Age,Breast Density and Volume on Breast Cancer Diagnosis: A Retrospective Comparison of Sensitivity of Mammography and Ultrasonography in China’s Rural Areas

Purpose: Mammography has been confirmed as the only effective mode to improve the prognosis of patientswith breast cancer in Western developed countries, but might not be a good choice in other areas of the world.One of the major challenges in China is to determine an optimal imaging modality for breast cancer screening.This study was designed to clarify the sensitivity of ultrasonography compared with that of mammography inrural China. Methods: We retrospectively studied the sensitivity of mammography and ultrasonography basedon 306 breast cancer patients detected by the program of “screening for cervical cancer and breast cancer”performed in Chinese rural areas between January 2009 and December 2011, and analyzed the effects of age,breast density and volume on the sensitivity. Results: Stratified analysis showed that the sensitivity of breastultrasonography was significantly higher than that of mammography in premenopausal patients (81.4% vs.61.1%, p=0.02), in women ≤ 55 years of age (82.2% vs. 63.4%, p<0.01), in the high breast density group (AmericanCollege of Radiology [ACR] levels 3-4) (85.9% vs. 60.6%, p<0.01) and in the small breast volume group (≤400ml) (87.1% vs. 66.7%, p<0.01). Age had a significant effect on sensitivity of mammography (breast density andvolume-adjusted odds ratio, 6.39; 95% confidence interval, 2.8-14.4 in age group > 55 compared to age group≤ 45), but not that of ultrasonography. Neither breast density nor volume had significant effect on sensitivityof mammography or ultrasonography. Conclusions: Ultrasonography is more sensitive than mammography indetecting breast cancer in women under 55 year-old Chinese, especially in those with high-density and relativelysmall breasts.     

Application of Human Papillomavirus in Screening for Cervical Cancer and Precancerous Lesions

Cervical cancer is a commonly-encountered malignant tumor in women. Cervical screening is particularlyimportant due to early symptoms being deficient in specificity. The main purpose of the study is to assess theapplication value of cervical thinprep cytologic test (TCT) and human papillomavirus (HPV) detection in screeningfor cervical cancer and precancerous lesions. In the study, cervical TCT and HPV detection were simultaneouslyperformed on 12,500 patients selected in a gynecological clinic. Three hundred patients with positive resultsdemonstrated by cervical TCT and/or HPV detection underwent cervical tissue biopsy under colposcopy, andpathological results were considered as the gold standard. The results revealed that 200 out of 12,500 patientswere abnormal by TCT, in which 30 cases pertained to equivocal atypical squamous cells (ASCUS), 80 casesto low squamous intraepithelial lesion (LSIL), 70 cases to high squamous intraepithelial lesion (HSIL) and 20cases to squamous cell carcinoma (SCC). With increasing pathological grade of cervical biopsy, however, TCTpositive rates did not rise. Two hundred and eighty out of 12,500 patients were detected as positive for HPVinfection, in which 50 cases were chronic cervicitis and squamous metaplasia, 70 cases cervical intraepithelialneoplasia (CIN) Ⅰ, 60 cases CIN Ⅱ, 70 cases CIN Ⅲ and 30 cases invasive cervical carcinoma. Two hundred andthirty patients with high-risk HPV infection were detected. With increase in pathological grade, the positive rateof high-risk HPV also rose. The detection rates of HPV detection to CIN Ⅲ and invasive cervical carcinoma aswell as the total detection rate of lesions were significantly higher than that of TCT. Hence, HPV detection is abetter method for screening of cervical cancer at present.     

A Novel,Low-Cost Method of Enrolling Infants at Risk for Retinopathy of Prematurity in Centers with No Screening Program: The REDROP Study

Purpose: To report the first-year results of the Red Card for Retinopathy of Prematurity (REDROP) study, a low-cost interim strategy to enroll infants into retinopathy of prematurity (ROP) screening where limited expertise exists, piloted at a multi-specialty general hospital.

Methods: Red “warning” cards were placed alongside green “congratulations” cards above the weighing scale in the neonatal unit. Staff weighing the newborn were instructed to give either one of the cards to each mother depending on the weight of the child (≤ 2000 g, red, and > 2000 g, green). Red cards contained information (tri-lingual) about ROP and the venue of screening. Green cards contained general pediatric eye education and recipients were not called. A portion of the red card with the infant’s birth date and mother’s contact number was retained and collected weekly by volunteers. Mothers were reminded on the mobile phone to come for ROP screening. Screening and treatment were performed free.

Results: During the study period, 224 of 805 (27.8%) infants were born ≤ 2000 g. Of these, 169 (75.4%) survived and were eligible for the red card; 91 (53.8%) received it. Of these, 43 (47.3%) infants completed ROP screening, 14 (32.6%) had some stage ROP, and three (6.9%) required laser treatment. The main reason for the lower turnout for screening was the inability to contact mothers on their provided phone numbers.

Conclusions: REDROP demonstrates the feasibility of this low-cost method of enrolling unscreened infants into a ROP program. The cost of enrolling each infant was less than 5 rupees (US$0.10). Suggested strategies to improve use require multi-center validation.