青少年疲劳性颈椎脱位与后凸畸形的诊断与治疗

目的：探讨青少年疲劳性颈椎脱位与后凸畸形的诊断与治疗.方法：回顾性分析2002年3月-2009年3月本院治疗青少年疲劳性颈椎脱位与后凸畸形患者20例,其中寰枢椎半脱位1例,后凸畸形19例 保守治疗16例,手术治疗4例.结果：全部患者治疗后VAS评分均得到显著改善,由治疗前平均7.9分下降至治疗后1个月平均2.8分,最终随访平均1.2分.经平均24.1个月 （12～84个月） 随访,17例患者一期治愈（半年以上无复发） 另3例保守治疗者分别于治愈后6～17个月复发,其中2例再次牵引后支具固定而治愈,1例支具固定半年后治愈.结论：有长期低头学习、玩电脑游戏或工作病史的青少年,出现颈部疼痛不适、头痛头晕、恶心等症状,X线有颈椎失稳或畸形表现者,即可诊断 早期牵引等保守治疗有效,对症状严重牵引治疗无效者应积极手术治疗.     

薄层液基细胞学制片联合阴道镜检查对宫颈病变的诊断价值

目的评价薄层液基细胞学制片联合阴道镜检查对宫颈病变的诊断价值。方法对2006年1月～2008年12月在哈尔滨医科大学附属第四医院妇科门诊检查的1220例患者行宫颈薄层液基细胞学制片(TCT)检查,对其中186例细胞学提示阳性或临床高度可疑的患者行阴道镜下活组织病理检查,以病理诊断为金标准,对结果进行分析。结果宫颈薄层液基细胞学制片检查1220例中,异常涂片157例(12.59%),临床高度可疑的患者45例行阴道镜检查下活检。病理结果显示:CINⅠ39例,CINⅡ9例,CINⅢ3例,子宫颈鳞癌3例。TCT检查诊断宫颈病变符合率为84.0%,阴道镜检查对宫颈病变的诊断符合率为88.0%,两者比较差异具有显著性(P0.05),二者联合病变检出率为98.0%。结论采用薄层液基细胞学制片检查配合阴道镜下病理检查可明显提高对宫颈病变诊断的准确率,能满足早期发现癌前病变的需要。     

The human papillomavirus (HPV) vaccine,HPV related diseases and cervical cancer in the post-reproductive years

Prophylactic HPV vaccines have demonstrated high efficacy against a range of HPV related diseases. They have been widely adopted as population health interventions in many jurisdictions and their routine use has been endorsed by the WHO. The development of these vaccines comes after an increased understanding of the natural history and epidemiology of HPV infection and disease in both males and females. Persistent HPV infection with oncogenic types induces malignant transformation in a range of epithelia including the cervix, anogenital regions, the penis and a number of head and neck sites. In relation to HPV disease prevention in the post-reproductive years, most infections occur soon after commencement of sexual activity but new infections do occur throughout the age spectrum. This reduces the likely impact of prophylactic vaccines in this population. The major impact on HPV related disease in this age group will come from advances in screening and early detection of HPV and neoplastic precursors. The most appropriate prevention for any individual man or women in this age group will be an individualised combination of vaccination, screening and early detection depending on the individual's own circumstances.     

Intra-uterine fluid collection in postmenopuasal women with cervical stenosis

OBJECTIVES: The aim of the study was to assess the clinical significance of intra-uterine fluid collection in postmenopausal women with cervical stenosis with and without vaginal bleeding. METHODS: A group of 82 consecutive postmenopausal women with cervical stenosis and sonographically confirmed intra-uterine fluid collection underwent D&C with or without hysteroscopy. Diagnostic hysteroscopy was performed in all patients with an endometrial thickness (ET) was greater than 8mm, or with irregular endometrium at any degree of ET. The patients were divided and evaluated prospectively into two groups according to the presence or absence of postmenopausal bleeding (PMB). Twenty-six women were with PMB and 56 women were asymptomatic. RESULTS: The groups were similar as far as endometrial thickness and histopathological results were concerned. Atrophic endometrium was found in 69 patients (84%), 23 in the PMB group (89%) and 46 in the other group (82%), proliferative endometrium in 7 (9%) and endometrial polyps were found in 35 patients (43%), 12 in the PMB group (46%) and 23 in the other group (41%). When ET was > or =8 mm, in 93% of the cases an endometrial polyp was found (25 out of 27). No case of endometrial cancer was found. A premalignant condition was diagnosed in one patient with an endometrial polyp in the PMB group. All patients with endometrial thickness of less than 3 mm in ultrasound had atrophic endometrium. The incidence of intrauterine pathology increased with the increasing thickness of endometrium as observed by ultrasound. CONCLUSIONS: The presence of intra-uterine fluid collection in postmenopausal patients with cervical stenosis seems to be a benign condition. Normal endometrium of less than 3mm observed by ultrasound in postmenopausal women without vaginal bleeding does not necessarily need further surgical investigation.     

Comparison of hormonal changes of estrous cycle with cytology of cervical mucosa and hematological parameters in dairy heifers

Cervical mucosa cytology and hematological parameters in heifers were determined during different phases of the estrous cycle. Ten healthy Holstein heifers were synchronized by two injections of PGF_2α at 14 days interval. Blood and cervical mucosa samples were collected at days of 0, 2, 10 and 19 of estrous cycle. Differential cell counts were performed, and the progesterone level was measured by radioimmunoassay. Progesterone levels in diestrus and the percentages of neutrophils in metestrus were shown to be higher than in other phases of the estrous cycle (P<0.05). In contrast, the percentages of epithelial cells in metestrus were lower than other phases (P<0.05). A difference was also seen (P<0.05) in blood progesterone levels between four estrous cycle phases. However, there was no significant difference in RBCs, hemoglobin, hematocrit, WBCs, neutrophils, lymphocytes, monocytes, and eosinophils between four estrous cycle phases. Hormonal changes in different phases of estrous cycle affect neutrophil presence in cervical mucosa. It is important to consider cervical cytology and hormonal assay together for evaluation of dairy cow reproductive tract function.     

Human papillomaviruses bind a basal extracellular matrix component secreted by keratinocytes which is distinct from a membrane-associated receptor

Human papillomaviruses (HPVs) have previously been shown to adsorb to cultured cells via membrane-associated heparan sulfate (HS) and alpha6 integrin. We demonstrate that cultured keratinocytes uniquely secrete a component into the basal extracellular matrix (ECM) which can function to adsorb HPV particles which can then be internalized by adherent cells. This uncharacterized basal ECM adsorption receptor was secreted by normal human epidermal keratinocytes (NHEK) and by each of the four keratinocyte-derived cell lines we examined, but not by non-keratinocyte cell lines. Multiple HPV types bound preferentially to this keratinocyte-specific receptor over the membrane-associated receptor, and binding to the basal ECM adsorption receptor was refractory to inhibition by heparin. Like the membrane-associated receptor, this basal ECM component was functional as an adsorption receptor in our in vitro infection model using HPV-11. Unlike particle adsorption, however, successful infection with HPV-11 virions remained sensitive to the pretreatment of virions with heparin. The secreted basal ECM receptor did not colocalize with antibodies against HS, perlecan, or alpha6 integrin, but colocalized with antibody against laminin-5, a marker of keratinocyte ECM and an abundant component of the basement membrane in mucosa and skin. These findings suggest a model for natural infections in which HPV virions, nonspecifically adsorbed to HS on suprabasal keratinocytes throughout an epithelial wound, might be transferred to mitotically active migrating keratinocytes via an intermediate association with the ECM secreted by these cells as they reestablish the basement membrane.     

Human papillomavirus type 16 E5 protein as a therapeutic target

Cervical cancer is a progressive disease with an onset of one to two decades on average. During the productive replication stage, the Human papillomavirus (HPV) genome is maintained episomally in the infected cervical epithelium and early gene products, including E5, are expressed. Therefore, E5 has a potential to contribute to the HPV-associated carcinogenic process. In invasive malignancies, the HPV genomes are commonly integrated into the host genome, and E6 and E7 genes remain intact. However, the E5 is lost or, if present, under-expressed as compared with the E6 and E7 proteins. This suggests that E5 may play a critical role in the genesis of cervical cancer but less of a role in its persistence or progression. In the initiation of neoplasia and the premalignant stage, there are fewer malignant cells than in the invasive malignancies. Moreover, cells in the invasive malignant stage are found to have a very low level of MHC class I and II, which could hamper the presentation of the antigen and lead to a decreased immune response. Since the E5 protein is likely to play a role during the early tumorigenesis stage, a therapeutic vaccine to target and eliminate the E5-expressing cells may be a good strategy to prevent premalignant lesions from progressing toward invasive cervical cancers. This paper provides an overview of HPV-induced cervical carcinogenesis and strategies for designing prophylactic and therapeutic vaccines to prevent and cure the cervical cancer. In particular, focus will be on the rationale of targeting the E5 protein to develop therapeutic vaccines.     

Comparative study of the expression of cellular cycle proteins in cervical intraepithelial lesions

Interaction of human papilloma virus oncoproteins E6 and E7 with cell cycle proteins leads to disturbances of the cell cycle mechanism and subsequent alteration in the expression of some proteins, such as p16^INK4a, cyclin D1, p53 and KI67. In this study, we compared alterations in the expression of these proteins during several stages of intra-epitelial cervical carcinogenesis. Accordingly, an immunohistochemical study was performed on 50 cervical biopsies, including negative cases and intraepithelial neoplasias. The expression patterns of these markers were correlated with the histopathological diagnosis and infection with HPV. The p16^INK4a, followed by Ki67, showed better correlation with cancer progression than p53 and cyclin D1, which recommends their use in the evaluation of cervical carcinogenesis. These monoclonal antibodies can be applied to cervical biopsy specimens to identify lesions transformed by oncogenic HPV, separating CIN 1 (p16^INK4a positive) and identifying high-grade lesions by an increase in the cellular proliferation index (Ki67). In this way, we propose immunomarkers that can be applied in clinical practice to separate patients who need a conservative therapeutic approach from those who require a more aggressive treatment.     

前路减压椎间植骨治疗脊髓型颈椎病

目的：探讨颈前路椎管减压植骨融合术在治疗脊髓型颈椎病中的应用价值。方法：采用颈前路椎管减压椎间植骨方法手术治疗脊髓型颈椎病80例。病变部位位于C3-4 5例，C4-5 4例，C5-6 31例，C6-7 1例，C4-6 18例，C5-7 9例，C3-6 4例，C4-7 8例。结果：随访73例，平均随访时间3a 2个月，均于术后3—4个月植骨融合。脊髓功能恢复情况按Frankel分级，术前术后比较：BB1例，CC2例，CD21例，CE10例，DE39例。术后恢复的椎间高度再丢失4例，颈椎生理弧度平直3例、反曲1例，颈僵硬活动受限2例，邻近减压节断再发者2例。结论：经颈前路椎管减压加植骨融合术是治疗脊髓型颈椎病的有效方法之一，加用带锁钢板内固定效果更好。     

Lymphatic vessel density as a prognostic indicator for patients with stage I cervical carcinoma

Lymphatic vessel density (LVD) was recently considered important for spread of several malignant tumors. However, there are no reports describing the situation in cervical carcinoma. The purpose of this study was to investigate whether LVD could serve as a risk factor for nodal metastasis and recurrence of cervical carcinoma in 147 cases of stage I patients. Other questions were if depth of invasion, proliferation rate, and tumor size could be used as predictive markers for Chinese patients with cervical carcinoma. The lymphatics were determined by immunohistochemistry with the antibody to LYVE-1, a specific lymphatic endothelium marker, and average LVD was calculated. Double immunohistochemistry and double immunofluorescence staining for LYVE-1/CD34 were used to distinguish between lymphatic and blood vessels. The results showed that average LVD in cervical carcinoma was statistically associated with inflammatory cell infiltration of carcinoma tissues, but not associated with other pathological parameters. Average LVD of the cases with nodal metastasis or recurrence was significantly higher than the cases without metastasis and recurrence in both stage IA and stage IB cervical carcinomas. The correlation between both depth of invasion and tumor size with nodal metastasis and recurrence of cervical carcinoma was also statistically significant. Ki-67 labeling index was found to be correlated with the recurrence of disease, but not to be correlated with nodal metastasis. We concluded that for the patients with stage I cervical carcinoma, increased LVD could serve as a high-risk factor for nodal metastasis and recurrence. Depth of invasion and tumor size could also be useful indicators.