Cervical Cancer Screening of Adolescents and Young Women: Further Evidence Shows a Lack of Clinical Value

Study ObjectiveTo assess the prevalence of cytological abnormalities among young people from a large population in the city of São Paulo (Brazil).DesignRetrospective, observational analysis of data from the institution's data processing center.SettingA private laboratory in São Paulo (Brazil).ParticipantsComparison of 3 different groups (ie, adolescent women [aged ≤19 years], young adult women [aged between 20 and 24 years], and adult women [aged 25 years and older]).InterventionsAssessment of results from all cervical-vaginal smears collected for cytology between January 2010 and December 2015.Main Outcome MeasuresComparative analysis of cytological abnormalities in the 3 different groups.ResultsA total of 1,026,671 satisfactory cytology tests were performed. The proportion of cytological abnormalities was found to decrease with age (P < .001) and was similar in the groups comprised of adolescents and young adults, with 3.405/ 20.921 (16.3%) and 13,635/ 78,277 (17.4%), respectively, and 74,320/ 927,473 (8.0%) in the group of adult patients (P < .001). Among the positive cytologies in the group of adolescents, 3,331/ 3,405 (97.8%) represented low-grade lesions and 74/ 3,405 (2.2%) high-grade lesions, whereas among adults older than 25 years old, these figures were 69,092/ 74.320 (93%) and 5,228/ 74.320 (6.9%), respectively. No cases of cancer were found in the group of adolescents.ConclusionCytological screening of young people is not recommended because of the low prevalence of high-grade cytological abnormalities in this population, with cancer being a rare event. This inadvertent screening could lead to unnecessary complementary exams and overtreatment, which could compromise the reproductive future of these young women.     

120例慢性咽炎患者临床症状与病理学改变分析

目的了解慢性咽炎口咽部炎症改变与临床症状之间的关系。方法对门诊120例主诉咽部不适的患者按照病程长短以及炎性症状进行分组,分别在患者口咽部采取标本,进行染色、固定、观察、分析。结果通过对症状轻型组与重型组、口咽部检查炎症轻型绀与重型组的脱落细胞学资料的统计分析,发现以上各组相互间在粒细胞、淋巴细胞、炎症细胞、组织细胞等方面均无明显差异（P〉0．05）。结论口咽部炎症改变与临床症状之间无明显关系。口咽部炎性症状的致病因素较多,对经常出现临床症状的人要进行仔细检查、认真分析,查找原发病及致病因素,以明确诊断,不要草率下“慢性咽炎”的结论,以免引起患者恐慌,造成不必要的精神负担。     

Phenotypically resembling myeloid derived suppressor cells are increased in children with HIV and exposed/infected with Mycobacterium tuberculosis

Increased disease susceptibility during early life has been linked to immune immaturity, regulatory T‐cell/TH2 immune biasing and hyporesponsiveness. The contribution of myeloid derived suppressor cells (MDSCs) remains uninvestigated. Here, we assessed peripheral MDSC in HIV‐infected and ‐uninfected children with tuberculosis (TB) disease before, during and after TB treatment, along with matched household contacts (HHCs), HIV‐exposed, ‐infected and ‐uninfected children without recent TB exposure. Serum analytes and enzymes associated with MDSC accumulation/activation/function were measured by colorimetric‐ and fluorescence arrays. Peripheral frequencies of cells phenotypically resembling MDSCs were significantly increased in HIV‐exposed uninfected (HEU) and M.tb‐infected children, but peaked in children with TB disease and remained high following treatment. MDSC in HIV‐infected (HI) children were similar to unexposed uninfected controls; however, HAART‐mediated MDSC restoration to control levels could not be disregarded. Increased MDSC frequencies in HHC coincided with enhanced indoleamine‐pyrrole‐2,3‐dioxygenase (IDO), whereas increased MDSC in TB cases were linked to heightened IDO and arginase‐1. Increased MDSC were paralleled by reduced plasma IP‐10 and thrombospondin‐2 levels in HEU and significantly increased plasma IL‐6 in HI HHC. Current investigations into MDSC‐targeted treatment strategies, together with functional analyses of MDSCs, could endorse these cells as novel innate immune regulatory mechanism of infant HIV/TB susceptibility.     

CUSUM模型在北京市流感流行起始预警中的应用

目的 应用CUSUM模型探讨北京市流感流行起始时间.方法 应用CUSUM模型,对北京市2014年至2016年流感监测数据进行预警分析,并与流感病原学“金标准”判断流行高峰和流感流行预警基线的时间进行比较.结果 2014-2015监测年,CUSUM模型在2014年第46周发出预警,较“金标准”流行起始时间提起前1周,较ILI％预警基线提前3周.2015-2016监测年,CUSUM模型在2015年第46周发出预警,较“金标准”流行起始时间提前8周,较ILI％预警基线提前7周.结论 应用CUSUM模型对北京市流感监测数据进行分析,可以及时预警流感流行起始时间.     

基质金属蛋白酶9及热休克蛋白60检测对早期胃癌的诊断价值

目的 探讨血浆基质金属蛋白酶9(MMP-9)与热休克蛋白60(HSP-60)联合检测对早期胃癌患者的诊断价值.方法 选取我院收治的临床疑诊早期胃癌136例患者,根据患者确诊诊断分为:对照组(70例,排除胃癌诊断)和研究组(66例,确诊胃癌诊断).检测并比较两组患者MMP-9、HSP-60 、CA19-9、CA72-4以及CEA水平差异.采用Logistic回归分析影响早期胃癌发生的临床因素.运用ROC曲线评估MMP-9与HSP-60对诊断早期胃癌患者的最佳值.结果 研究组血浆MMP-9、HSP-60、CA19-9、CA72-4与CEA水平均高于对照组(P均＜0.05).多因素Logistic回归分析结果显示,血浆MMP-9与HSP-60是早期胃癌发生的危险因素(P＜0.05).血浆MMP-9与HSP-60诊断早期胃癌的ROC曲线下面积分别为0.781和0.667(P=0.024,0.011).当MMP-9≥ 364.5 μg/L和HSP60 ≥2.84 μg/L为cut-off值,对判断早期胃癌发生的灵敏度为53.0％,特异性为81.4％,准确度为67.6％,ROC曲线下面积为0.862.结论 血浆MMP-9与HSP-60联合检测对早期胃癌发生具有较好的诊断价值.     

传统心肌酶谱联合损伤相关蛋白IMA、TnI-Ultra检测对急性心肌梗死早期诊断的价值分析

目的 探讨肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、同型半胱氨酸(HCY)和乳酸脱氢酶(LDH)等心肌酶,联合血清缺血修饰清蛋白(IMA)和超敏肌钙蛋白I(TnI-Ultra)等心肌损伤相关蛋白检测在急性心肌梗死(acute myocardial infarction,AMI)早期诊断中的应用.方法 选取我院于2014年1月至2017年1月期间收治的AMI患者150例,病发后6h内采集静脉血,检测患者心肌酶谱(CK、CK-MB、HCY和LDH)及IMA和TnI-Ultra等生化指标.同期选取100例非AMI患者血液样本作为对照组.结果 150例AMI患者血清CK、CK-MB、LDH(U/L)和HCY(μmol/L)水平分别为:688.5±68.7、86.4±9.2、364.7±55.2和34.5±9.4.与对照组相比,CK和CK-MB水平明显升高(P<0.01),而LDH和HCY与对照组相比差异无统计学意义(P>0.05),但IMA(65.5±11.7 U/L)和TnI-Ultra(10.6±3.5μg/L)水平均明显升高,差异有统计学意义(P<0.01).结论 CK、CK-MB、HCY和LDH等心肌酶指标在AMI患者中有较高的阳性率,但某些非AMI类疾病也可能导致以上指标异常升高;IMA和TnI-Ultra等心肌损伤相关蛋白对AMI诊断有较高的特异性.心肌酶联合心肌损伤相关蛋白检测有助于AMI的早期诊断,对降低AMI风险具有重要意义.     

食管上皮癌变过程的恶性肿瘤特异性生长因子测定

目的：观察食管上皮癌变过程中ＴＳＧＦ（恶性肿瘤特异性生长因子）的变化,验证ＴＳＧＦ对早期食管癌的检测能力。方法：双盲测定食管上皮癌变不同阶段人群ＴＳＧＦ水平;实验数据使用ＳＡＳ软件拟合（ＧＬＭ）过程,用最小显著差法进行分析。结果：食管上皮病变组（食管上皮重度增生、原位癌及中、晚期癌）的ＴＳＧＦ水平均高于正常组,（Ｐ〈０．０５）。在癌变过程中,ＴＳＧＦ水平逐渐增高,至癌前病变达到最高值;当癌前病变发     

Early weight bearing of porous HA/TCP (60/40) ceramics in vivo: a longitudinal study in a segmental bone defect model of rabbit

Porous interconnected hydroxyapatite (HA) and HA/tricalcium phosphate (TCP) (60/40) ceramics are promising materials for hard tissue repair. However, the mechanical properties of these materials have not been accurately determined under weight-bearing conditions. In this study, newly developed HA and HA/TCP (60/40) ceramics were used with intramedullary fixation in segmental bone defects of rabbits. Early radiological, histological, densitometric and biomechanical changes were evaluated. The mean radiological grade of healing and bonding to bone was higher in HA/TCP (60/40) ceramics than that of pure HA ceramics but the difference was not statistically significant. The densities of both implanted ceramics improved with time, supported by the histological evaluation of bone matrix ingrowth into ceramic pores, whereas the densities at the bone–ceramic interface decreased gradually. Flexural resonant frequencies and three-point bending strength increased, revealing an increase in mechanical stability during this early critical time interval where implant and/or bone–implant interface failures occur frequently. It can be concluded that both HA and HA/TCP (60/40) ceramics have a limited application in the treatment of load-bearing segmental bone defects but did not fail at the early stages of implantation.