阴道镜Reid评分法诊断宫颈病变的价值

目的：探讨阴道镜结合Reid评分法对宫颈病变筛查的价值。方法：收集2004年1月-2006年12月行阴道镜检查和宫颈组织活检的病例867例,采用阴道镜Reid评分法分析阴道镜图像,比较Reid评分结果和宫颈活检病理结果的符合情况。结果;宫颈病理结果示宫颈炎264例,人乳头瘤状病毒（HPV）感染150例,宫颈上皮内瘤变（CIN）1级153例,CIN2级147例,CIN3级87例,宫颈癌66例。736例阴道镜图像对照Reid评分标准进行评分,其中与病理诊断相符的共557例,准确率为75．7％。宫颈癌中除宫颈表面出血或较大赘生物20例,不满意阴道镜图像4例外,其余42例Reid评分均超过3分。Reid评分法中4项指标（病变边缘、颜色、血管改变和碘试验）评分高低与病理级别高低显著相关。结论：阴道镜检查结合Reid评分法与宫颈活检病理结果一致性较高,可提高阴道镜对宫颈癌前病变诊断的准确性。     

Genital warts and cervical cancer. IV. A colposcopic index for differentiating subclinical papillomaviral infection from cervical intraepithelial neoplasia

Five colposcopic signs (thickness, color, contour, vascular atypia, and iodine staining) were graded into three objective categories representing (1) subclinical papillomaviral infection, (2) lower-grade dysplasia, and (3) grade 3 cervical intraepithelial neoplasia. Seventy-two colposcopically different biopsy specimens (25 of subclinical papillomaviral infection and 18 of grade 1, 18 of grade 2, and 11 of grade 3 cervical intraepithelial neoplasia) were collected from 52 women and interpreted by validated, quantitative histologic analysis. Attempts to grade lesions by the prominence of the acetowhitening reaction or the mere presence of aberrant surface capillaries were unsuccessful. In contrast, each of five new colposcopic criteria were significantly correlated with histologic severity. Differences in color, vascular atypia, and iodine staining were more predictive than those of thickness and contour. Combined into a weighted index, these colposcopic features were 96% correct in forecasting approximate histologic findings. Because this method relies upon critical analysis rather than pattern recall, the use of this colposcopic index greatly simplifies the learning of colposcopy.     

阴道镜Reid评分对宫颈人乳头瘤病毒感染的诊断价值

目的 探讨阴道镜Reid评分对宫颈人乳头瘤病毒(HPV)感染的诊断价值.方法 因宫颈疾病行阴道镜检查及宫颈活组织检查者528例,以组织病理学诊断为标准,分析阴道镜Reid评分诊断宫颈HPV感染的价值.结果 阴道镜Reid评分诊断宫颈HPV感染及宫颈上皮内瘤变(CIN)的符合率为52.66%,诊断宫颈低度病变(包括HPV感染和CIN I)的敏感性为51.05%,诊断宫颈高度病变(包括CIN II和CIN Ⅲ)的敏感性为66.67%;病理诊断为HPV感染者,边界、颜色、血管等评分项目分值与Reid评分总分呈正相关,而边界、颜色分值分别与血管分值无显著相关性.结论 阴道镜检查结合Reid评分对诊断宫颈HPV感染有一定的临床应用价值.     

Amiodarone in the treatment of life-threatening ventricular tachycardia: role of Holter monitoring in predicting long-term clinical efficacy

Forty-two patients with refractory, recurrent life-threatening ventricular tachycardia and spontaneous ventricular tachycardia (greater than or equal to 3 beats, heart rate greater than 100 beats/min) on baseline 24 hour Holter recording were treated with amiodarone. After 1 week of amiodarone therapy and during the follow-up period (22 +/- 11 months, mean +/- SD), patients had serial 24 hour Holter recordings (10.6 +/- 3.8 per patient). Twenty-four hour, 48 hour or 72 hour Holter monitoring was performed during the second week of therapy. Ventricular tachycardia was suppressed on all follow-up serial Holter recordings in 17 patients (40%). Ventricular tachycardia was suppressed in 34 (81%) of 42 patients with 24 hour Holter recordings, 21 (72%) of 29 patients with 48 hour recordings and 20 (69%) of 29 patients with 72 hour recordings during the second week of therapy. At follow-up 24 patients (57%) were free of clinical arrhythmic events (Sustained ventricular tachycardia or sudden death). The sensitivity, specificity, positive and negative predictive values and predictive accuracy of ventricular tachycardia on 24, 48 and 72 hour Holter recordings during the second week of therapy for predicting subsequent events were analyzed. The positive and negative predictive values were 100 and 71% for 24 hour Holter recordings, 88 and 71% for 48 hour recordings and 89 and 75% for 72 hour recordings. Overall predictive accuracy was 76, 76 and 79%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

对宫颈不典型鳞状细胞患者临床分流处理的研究

目的：探讨宫颈细胞学诊断为不典型鳞状细胞（ASCUS）患者的分流处理方法。方法：对130例ASCUS患者均进行高危型HPV检测、改良阴道镜Reid评分及宫颈活检组织病理学检查。结果：130例ASCUS患者中病理结果为正常或炎症31例（23．90％）,CINⅠ级29例（22．30％）,CINⅡ级14例（10．80％）,CINⅢ级或原位癌55例（42．30％）,浸润癌1例（0．80％）。改良阴道镜Reid评分,结果显示0分32例（24．60％）,1～2分36例（27．70％）,3～4分47例（36．10％）,5～6分15例（11．60％）。改良阴道镜Reid评分检测ASCUS中CIN及宫颈癌的敏感性为98．99％（98／99）,特异性为51．61％（16／31）。 hr-HPV检测ASCUS中CIN及宫颈癌的敏感性为96．97％（96／99）,特异性为32．26％（10／31）。结论：改良阴道镜Reid评分与hr-HPV检测均可用于分流ASCUS中的CIN及宫颈癌患者,但改良阴道镜Reid评分在敏感性和特异性方面均优于hr-HPV检测。     

Evaluation of techniques for induction of ovulation in outpatients employing pulsatile gonadotropin releasing hormone

The efficacy, safety, and patient's acceptance of intravenous and subcutaneous therapy with gonadotropin releasing hormone (GnRH) with the use of either an autoinfusion pump or a smaller manual pen pump delivery system have been evaluated during the induction of ovulation in outpatients with hypothalamic hypogonadotropic amenorrhea. An ovulatory response to intravenous GnRH was highly reproducible, even at low doses, and complications associated with the intravenous route of delivery were infrequent and readily treated. Although no complications were observed during subcutaneous GnRH therapy, the response to the subcutaneous route of delivery was unpredictable over a wide range of dosages and delivery schedules. The pen pump was rated more highly by subjects than the autoinfusion pump, because the pen pump was both light and inconspicuous.     

Genital warts and cervical cancer. VI. The relationship between aneuploid and polyploid cervical lesions

Human papillomaviral infection is now widely implicated in the causation of cervical neoplasia. Genotype analysis provides the best guide to biologic outcome; most polyploid lesions regress and most aneuploid ones persist or progress. This prospective survey examined the relationships between cell ploidy and 24 objectively validated criteria of human papillomaviral infection or premalignant change in 52 biopsies from a dysplasia clinic. Histologic evidence of benign warty expression and human papillomaviral capsid antigen production decreased steadily as DNA content ranged from diploidy to polyploidy to aneuploidy. In contrast, premalignant change increased with progressive distortion of nuclear DNA content. No absolute discriminants were found between polyploidy and aneuploidy, as evidenced by the detection of human papillomaviral proteins in three of 21 aneuploid epithelia and the recognition of abnormal mitotic figures in five of 17 polyploid lesions. Polyploid and aneuploid lesions differed only in severity, and it appears that some polyploid epithelia may be transition forms between diploidy and aneuploidy.     

Amino acid variations in amniotic fluid and maternal plasma from Rh-sensitized pregnancies. II

Amino acids were quantitated by ion-exchange chromatography in amniotic fluid and maternal plasma from Rh-sensitized pregnancies. Twenty-four patients of 34 to 40 weeks' gestation were studied, and results were compared to those in normal pregnancy. Significant differences were found for amino acid concentrations in amniotic fluid and maternal plasma from those patients in whom fetal death occurred. When the fetus survived, amino acid levels were similar to normal levels. In particular, it was noted that proline levels were markedly elevated in the amniotic fluid of patients in whom fetal death occurred (p < 0.001). From this preliminary work arises the interesting possibility that an increased amniotic fluid versus maternal plasma proline level may be of diagnostic assistance in severe Rh disease.     

Unmaking a murderer: behaviour sequence analysis of false confessions

The causes of false confessions are an important issue in legal studies and forensics. Recent advances in DNA testing have increased the number of proven false confessions; however, there are probably many cases without scientific evidence to refute the guilty verdict. The current research provides a novel approach to understand the structure and process of police interrogation techniques, in the United States behaviour sequence analysis. This method allows complex interactions in interrogations to be broken down and the progression of techniques analysed clearly. A case study is provided of an individual who confessed to a series of very serious crimes. The results show that several psychological techniques, such as leading statements, pressure, empathy, and inducements, are used, in increasing frequency, which resulted in the suspect's confession. This research provides support for behaviour sequence analysis as a new method to understand the structure of police interrogations and how psychological techniques may be used to gain false confessions.