微小RNA与宫颈癌

微小RNA（microRNA,miRNA）是一类内源性非编码调节性小RNA,通过与3’非转录区（3’UTR）互补配对来调节其靶基因的蛋白翻译或者mRNA降解过程,从而在转录后水平调节靶基因的表达。成熟的miRNA通过调节靶基因的表达行使其生物学功能,参与细胞增长、细胞凋亡等多种细胞癌变过程。研究表明,miRNA在宫颈癌中的差异性表达有可能使其成为诊断、临床病理学特征和评价预后的新指标。miRNA也可以用于指导治疗以及成为治疗用药的靶点,为临床应用提供广泛前景。     

三阶梯技术在筛查妊娠期妇女宫颈病变的临床应用

目的探讨三阶梯技术在诊断孕妇宫颈病变的临床价值和安全性。方法采用队列研究方法,选择2008年1月1日至2011年12月31日在密云县妇幼保健院产科门诊初次检查的孕10—32周、1年内未进行过宫颈液基薄层细胞学检查（TCT）的6649例孕妇,先行TCT筛查,对TCT结果异常者在知情同意后进行阴道镜检查和阴道镜指引下宫颈多点活检。结果①TCT筛查6649例孕妇,其中TCT结果异常154倒,发生率为2．32％;②114例孕妇的阴遭镜图像满意度为93．86％（107／114）,阴道镜拟诊慢性宫颈炎12例、鳞状上皮低度病变（LSIL）67例、鳞状上皮高度病变（HSIL）35例;③114例孕妇全部进行了宫颈活检,病理结果为宫颈炎及宫颈湿疣共48例,宫颈上皮内瘤样病变（CIN）136例、CINⅡ18例、CINⅢ10例、宫颈癌早浸2例;④与宫颈活检病理结果比较,阴道镜检查拟诊炎症和LSIL79例,其中71例与宫颈活检病理结果相同,符合率为89．87％（71／79）,79例拟诊炎症和LSIL患者中,无鳞状细胞癌（SCC）病例。拟诊为HSIL的35例孕妇中,20例活检病理结果为CINⅡ或CINⅢ,2例为早浸,符合率为57．14％（20／35）;⑤未发生与阴道镜检查和宫颈活检相关的不良事件。结论对1年内未进行宫颈细胞学筛查的孕妇进行TCT检查是必要的,对TCT结果异常者应进行阴道镜检查,阴道镜检查拟诊宫颈炎或LSIL可以随诊;对阴道镜检查下拟诊高级别宫颈病变的孕妇,应行阴道镜下宫颈活检以明确病理学诊断。     

对2544936例20～64岁健康妇女宫颈癌筛查结果分析

目的：调查20～64岁健康妇女宫颈癌患病状况。方法以2008至2013年江苏省淮安市20～64岁健康妇女为研究对象,每年进行1次宫颈癌筛查,确诊宫颈癌后上报。结果6年间共筛查2544936例,确诊宫颈癌159例,平均宫颈癌发病率6．25/10万。其中2009年宫颈癌发病率最高10．20/10万,与2010至2013年宫颈癌发病率比较有统计学差异（χ2值分别为9．60、5．54、11．36、6．88,均P＜0．05）。2013年随机选取两组妇女,分别采用液基薄层细胞检测和巴氏涂片筛查宫颈癌,两组筛查率无显著性差异（χ2＝0．30,P＞0．05）。结论加大宫颈癌防治力度可降低健康妇女宫颈癌发病率,宫颈液基薄层细胞检测法或巴氏涂片法对宫颈肿瘤检出率无明显差异。     

Dedicated two-stent technique in complex bifurcation percutaneous coronary intervention with use of everolimus-eluting stents: The EES-bifurcation study

Objectives

To compare the outcomes of initial one-stent (1S) versus dedicated two-stent (2S) strategies in complex bifurcation percutaneous coronary intervention (PCI) using everolimus-eluting stents (EES).

Background

PCI of true bifurcation lesions is technically challenging and historically associated with reduced procedural success and increased restenosis. Prior studies comparing initial one-stent (1S) versus dedicated two-stent (2S) strategies using first-generation drug-eluting stents have shown no reduction in ischemic events and more complications with a 2S strategy.

Methods

We performed a retrospective study of 319 consecutive patients undergoing PCI at a single referral center with EES for true bifurcation lesions, defined by involvement of both the main vessel (MV) and side branch (SB). Baseline, procedural characteristics, quantitative coronary angiography and clinical outcomes in-hospital and at one year were compared for patients undergoing 1S (n = 175) and 2S (n = 144) strategies.

Results

Baseline characteristics were well-matched. 2S strategy was associated with greater SB acute gain (0.65 ± 0.41 mm vs. 1.11 ± 0.47 mm, p < 0.0001). In-hospital serious adverse events were similar (9% with 2S vs. 8% with 1S, p = 0.58). At one year, patients treated by 2S strategy had non-significantly lower rates of target vessel revascularization (5.8% vs. 7.4%, p = 0.31), myocardial infarction (7.8% vs. 12.2%, p = 0.31) and major adverse cardiovascular events (16.6% vs. 21.8%, p = 0.21).

Conclusion

In this study of patients undergoing PCI for true coronary bifurcation lesions using EES, 2S strategy was associated with superior SB angiographic outcomes without excess complications or ischemic events at one year.     

Cervical intraepithelial neoplasia grade 2 or worse in Galicia,Spain: HPV 16 prevalence and vaccination impact

Introduction

The etiology of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) can influence the efficacy of Public Health preventive strategies. This study aimed to determine the high-risk papillomavirus (HR-HPV) prevalence in CIN2+ cases in unvaccinated women in Galicia (Spain), the expected impact of bivalent vaccination, and the distribution of HPV 16 in squamous lesions.

Material and methods

Ninety-four histologically confirmed cases of CIN2+ (2009–2010) were retrospectively studied: 23 CIN2, 58 CIN3− squamous carcinoma in situ (CIN3-CIS), 5 adenocarcinoma in situ (AIS), and 8 invasive squamous cervical cancer (SCC). Linear Array HPV Genotyping Test (Roche Diagnostics, Mannheim, Germany) was performed on the cervical specimens. Bivalent vaccination impact was calculated, based on regional vaccination coverage data, local HR-HPV prevalence, and reported efficacy (direct and cross-protection) of the vaccine.

Results

HR-HPV prevalence was 96.8%. The most frequent genotypes were HPV 16 (48.8–58.2%) and HPV 31 (9.3%–12.1%), considering single infections or single-multiple infections, respectively (hierarchical attribution). In squamous lesions, HPV 16 prevalence in women younger than 45 years of age increased in severe lesions (CIN3-CIS/SCC, OR 4.2), and was higher than in older women (OR 5.5). The vaccine could reduce the cumulative incidence of CIN2+ by 50.6% (direct protection), or by 62.7% (direct and cross-protection).

Conclusion

HPV vaccination could have a great impact in women younger than 45 years of age due to the high prevalence of HPV 16 in their lesions.     

脊髓型颈椎病单开门扩大成形术后轴性痛危险因素分析

 目的 探讨脊髓型颈椎病患者行单开门扩大成形术后轴性痛发生特点、病理机制及危险因素。方法 回顾性分析2012-01至2015-01武警特色医学中心骨科行单开门扩大成形联合开门侧微型钛板固定治疗的79例脊髓型颈椎病患者,随访时间均在24个月以上,减压范围不低于4个节段。比较术后轴性痛组和非轴性痛两组患者间,术前合并颈椎失稳与否、术后颈椎曲度、前凸指数、屈伸活动度、椎管正中矢径、Pavlov比值、椎板开门角、硬膜囊面积不同变化幅度内病例分布构成比,单因素Logistic回归分析上述指标对PAP发作的影响程度,选取初筛P<0.10的参数,再经多元Logistic回归分析进一步验证与PAP发作的相关性。评估术前已合并和未合并颈椎失稳两组间,术后屈伸度不同矫正范围内患者所占比例。结果 单因素Logistic回归分析示术前有颈椎失稳、椎板开门角大小、术后屈伸度和颈椎前凸指数变化程度均与术后轴性痛发生相关(P<0.10)。多元Logistic回归分析示术后屈伸度明显下降和术前有颈椎失稳系预测术后轴性痛发作的独立危险因素(P<0.05)。术后轴性痛患者术前合并颈椎失稳比例高于非轴性痛组,差异有统计学意义(P<0.05)。术后轴性痛患者颈椎屈伸活动度显著下降比例高于非轴性痛组,差异有统计学意义(P<0.05)。术前有颈椎失稳患者,其术后屈伸度显著下降比例高于术前无失稳组,差异有统计学意义(P<0.05)。结论 脊髓型颈椎病患者如术前合并颈椎失稳,更易因后路单开门扩大成形术后屈伸度显著下降而继发轴性痛。建议微型钛板仅用于固定非失稳节段,而术前失稳节段可选择侧块或椎弓根钉棒固定,以减少继发术后失稳和轴性痛发生可能。     

Increased signal intensity of spinal cord on T2W magnetic resonance imaging for cervical spondylotic myelopathy patients: Risk factors and prognosis (a STROBE-compliant article)

To investigate the risk factors for progression of increased signal intensity (ISI) on T2W magnetic resonance imaging (MRI) and its prognostic value in patients with cervical spondylotic myelopathy (CSM).A total of 109 patients with CSM were included in this study. All the patients were treated with anterior cervical discectomy and fusion. MRI was performed for all 109 patients preoperatively and at the final follow-up. Radiological evaluation included ISI, anterior compression (AC) of dural and spinal cord, hyperintensity region (HR) at the involved level. Clinical data including Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI) score, and Visual Analogue Scale were collected and evaluated. Patients were divided into 2 groups according to ISI grades (Group A: no hyper-intensity; Group B: presence of ISI). Then all patients presented with ISI were divided into 2 subgroups based on the range of HR (Group B1: hyper-intensity diameter accounts for less than half of the spinal cord diameter at the involved level; Group B2, hyper-intensity diameter accounts for more than half of the spinal cord diameter at the involved level). AC, disease duration, age, and gender were analyzed as potential risk factors.Significantly better JOA and NDI scores were observed in Group A preoperatively and at the final follow-up, compared to Group B (P < .05). Disease duration was found significantly longer in patients with ISI (P < .05). Notably better JOA and NDI scores were noticed in Group B1 rather than Group B2 (P < .05). Logistical regression showed that disease duration was the only factor that significantly correlated with the progress of ISI (P < .001).CSM patients with ISI on T2W MR images had poorer surgical outcomes compared to others, while the increased range of HR may deteriorate preoperative neurological function. Moreover, patients with longer disease duration had greater risk of ISI in spinal cord.