Performance of vaginal self-sampling high-risk HPV genotyping as primary and combining cytology or viral load as secondary in cervical cancer screening / 中华妇产科杂志

Objective:To evaluate the efficacy of high-risk HPV (HR-HPV) genotyping with vaginal self-sampling in primary screening and combining cytology or viral load for HR-HPV positive as secondary screening strategies.Methods:The data referring to HR-HPV genotyping of self-collected sample with mass array matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF-MS), HR-HPV viral load of physician-collected sample with hybrid capture Ⅱ (HC-Ⅱ), liquid-based cytology and histology of 8 556 women were from Shenzhen cervical cancer screening trial Ⅱ (SHENCCAST-Ⅱ) conducted between April 2009 and April 2010. The data were reanalyzed to determine the sensitivity and specificity to cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN Ⅱ +), CIN of grade 3 or worse (CIN Ⅲ +) when HR-HPV genotyping combining with colposcopy as primary screening strategy based on varied HR-HPV subtype (strategy 1, including 5 sub-strategies: 1a: HPV 16/18 positive; 1b: HPV 16/18/58 positive; 1c: HPV 16/18/58/31/33 positive; 1d: HPV 16/18/58/31/33/52 positive; 1e: any HR-HPV positive). The data were also compared to determine the efficacy of cytology (strategy 2, including 5 sub-strategies: 2a, 2b, 2c, 2d, 2e) or HR-HPV viral load (strategy 3, including 4 sub-strategies: 3a, 3b, 3c, 3d) of physician-collected sample as a triage with HR-HPV genotyping for self-sampling HR-HPV positives. Results:(1) The HR-HPV positive rate was 13.77% (1 178/8 556) in the self-collected samples of 8 556 pregnant women. Of them,the prevalences of HPV 16/18, HPV 16/18/58, HPV 16/18/58/31/33 and HPV 16/18/58/31/33/52 were 3.16% (270/8 556), 5.14% (440/8 556), 6.66% (570/8 556) and 9.81% (839/8 556), respectively. The HR-HPV viral load ≥10 relative light units/control (RLU/CO) was 8.87%(759/ 8 556), while cytological results ≥atypical squamous cell of undetermined signification (ASCUS) were 12.05% (1 031/8 556). (2) The strategy 1e had the highest sensitivities for CIN Ⅱ +, CIN Ⅲ + which were 92.70% and 94.33%,respectively,among 14 sub-strategies,while the lowest specificity and positive predictive value (PPV). Meanwhile,the required colposcopy referral rates were much higher than other 13 sub-strategies (13.77%). The other 4 sub-strategies of strategy 1 (1a, 1b, 1c, 1d), strategy 1a had the highest specificities for CIN Ⅱ + and CIN Ⅲ + (97.92%, 97.69%, respectively), while 1d had the highest sensitivities for CIN Ⅱ + and CIN Ⅲ + (88.41%, 92.20%, respectively). (3) Both strategies of referring self-sampling HPV 16/18 positives for immediate colposcopy followed by triage physician-collected sample cytology (≥ASCUS) or viral load (≥10 RLU/CO) for non-HPV 16/18 positives had significantly higher sensitivity and specificity for CIN Ⅱ, CIN Ⅲ +, as well as lower referral rates (strategy 2a and 3a). Additionally, based on these two secondary screening strategies, cumulatively using the other four HR-HPV (HPV 58, 31, 33 and 52) positives as triage for immediate colposcopy showed an enhanced sensitivity. Conclusions:Primary HR-HPV cervical cancer screening strategy based on self-sampling with triage of cytology (≥ASCUS) or viral load (≥10 RUL/CO) provides a good balance among sensitivity, specificity for CIN Ⅱ + and CIN Ⅲ + and the number of tests required, referral rates. The efficacy of HR-HPV genotyping combining cytology or viral load secondary screening strategies will have a spiral escalation when HPV 58, 31, 33, 52 are included.

Clinical value of p16 INK4a immunocytochemistry in cervical cancer screening / 中华妇产科杂志

Objective:To evaluate the value of p16 INK4a detected by p16 INK4a immunostaining as a new generation of cervical cytology for primary screening and secondary screening in population-based cervical cancer screening, and in improving cytological diagnosis. Methods:Between 2016 and 2018, 5 747 non-pregnant women aged 25-65 years with sexual history were recruited and underwent cervical cancer screening via high-risk (HR)-HPV/liquid-based cytological test (LCT) test in Shenzhen and surrounding areas. All slides were immuno-stained using p16 INK4a technology, among them, 902 cases were offered p16 INK4a detection during primary screening, and the remaining 4 845 cases were called-back by the virtue of abnormal HR-HPV and LCT results for p16 INK4a staining. Participants with complete LCT examination, HR-HPV test, p16 INK4a staining and histopathological examination results were included in this study. The performance of p16 INK4a in primary and secondary screening, and in assisting cytology to detect high grade squamous intraepithelial lesion [HSIL, including cervical intraepithelial neoplasia (CIN) Ⅱ or Ⅲ] or worse [HSIL (CIN Ⅱ) + or HSIL (CIN Ⅲ) +] were analyzed. Results:(1) One-thousand and ninety-seven cases with complete data of p16 INK4a and histology were included. Pathological diagnosis: 995 cases of normal cervix, 37 cases of low grade squamous intraepithelial lesion (LSIL), 64 cases of HSIL and one case of cervical cancer were found. Among them, 65 cases of HSIL (CIN Ⅱ) + and 34 cases of HSIL (CIN Ⅲ) + were detected. The positive rate of p16 INK4a in HSIL (CIN Ⅱ) + was higher than that in CINⅠ or normal pathology (89.2% vs 10.2%; P<0.01). (2) p16 INK4a as primary screening for HSIL (CIN Ⅱ) + or HSIL (CIN Ⅲ) + was equally sensitive to primary HR-HPV screening (89.2% vs 95.4%, 94.1% vs 94.1%; P>0.05), but more specific than HR-HPV screening (89.8% vs 82.5%, 87.7% vs 80.2%; P<0.05). p16 INK4a was equally sensitive and similarly specific to cytology (≥LSIL; P>0.05). (3) The specificity of LCT adjunctive p16 INK4a for detecting HSIL (CIN Ⅱ) + or HSIL (CIN Ⅲ) + were higher than that of LCT alone or adjunctive HR-HPV ( P<0.01), while the sensitivity were similar ( P>0.05). (4) p16 INK4a staining as secondary screening: p16 INK4a was significantly more specific (94.1% vs 89.7%, 91.9% vs 87.4%; P<0.01) and comparably sensitive (84.6% vs 90.8%, 88.2% vs 91.2%; P>0.05) to cytology for triaging primary HR-HPV screening. HPV 16/18 to colposcopy and triage other HR-HPV with p16 INK4a was equally sensitive (88.2% vs 94.1%; P=0.500) and more specific (88.3% vs 83.0%; P<0.01) than HPV 16/18 to colposcopy and triage other HR-HPV with LCT≥ atypical squamous cells of undetermined significance (ASCUS), and the referral rate decreased (14.0% vs 19.4%; P=0.005). Conclusions:For primary screening, p16 INK4a is equally specific to cytology and equally sensitive to HR-HPV screening. p16 INK4a alone could be an efficient triage after primary HR-HPV screening. In addition, p16 INK4a immunostaining could be used as an ancillary tool to cervical cytological diagnosis, and improves its accuracy in cervical cancer screening.

Evaluation of the effectiveness of BMRT-HPV for cervical cancer screening / 中华妇产科杂志

Objective:Evaluation of the clinical value of the BioPerfectus multiplex real time (BMRT)-HPV for cervical cancer screening.Methods:Physician-collected specimens of 1 495 women who were positive of Cobas 4800 HPV (Cobas-HPV), HPV genotyping based on SEQ uencing (SEQ-HPV), and (or) cytology ≥low grade squamous intraepithelial lesion (LSIL) in the primary screening of Chinese Multiple-center Screening Trial (CHIMUST), and 2 990 women selected from those who were negative of primary screening in the same project through nested control randomization with age-matching were tested for BMRT-HPV, which reported type-specific viral loads/10 000 cells in each specimen. With comparing to Cobas-HPV results and taking cervical histopathological diagnosis as the endpoint, the concordance of high-risk (HR)-HPV subtypes among the three assays was explored ,and the sensitivity and specificity of BMRT-HPV for cervical cancer screening were evaluated.Results:(1) The overall agreenment of HR-HPV subtypes between BMRT-HPV and Cobas-HPV, or SEQ-HPV test sample was 94.8%, 94.4%, with Kappa values 0.827, 0.814. (2) The sensitivity and specificity for cervical intraepithelial neoplasia (CIN) Ⅱ + of BMRT-HPV, Cobas-HPV and SEQ-HPV were 92.62%, 94.26%, 93.44% and 84.67%, 83.25%, 82.76%, respectively. There were no significant difference in sensitivity among the three HPV assays (all P>0.05), but the specificity of BMRT-HPV for CIN Ⅱ + was higher than those of Cobas-HPV and SEQ-HPV ( P<0.01). The sensitivity for CIN Ⅲ + of three HPV assays were all 100.00%, and the specificity for CIN Ⅲ + of BMRT-HPV was higher than those of Cobas-HPV and SEQ-HPV (83.40% vs 81.95%, 83.40% vs 81.50%; P<0.01). The number of pathological examinations of colposcopy for cervical biopsy detected in 1 case of CIN Ⅱ + or CIN Ⅲ + in BMRT-HPV was less than those in Cobas-HPV and SEQ-HPV ( P<0.01). When using HPV 16/18 + cytology ≥atypical squamous cell of undetermined signification (ASCUS) to triage HPV positive women among three assays, there was no different in the sensitivities of detecting CIN Ⅱ + and CIN Ⅲ + ( P>0.05). The specificity BMRT-HPV was slightly higher than those in Cobas-HPV or SEQ-HPV (all P<0.05), and the colposcopy referral rate was lower than those in Cobas-HPV and SEQ-HPV (all P<0.05). Conclusions:BMRT-HPV is as sensitive as Cobas-HPV or SEQ-HPV for primary cervical cancer screening, and has higher specificity. Therefore it could be used as a primary screening method for cervical cancer, which is worthy of clinical application.

Analysis on the influencing factors of 31-day unplanned readmission in obstetrics department of public hospitals / 中华医院管理杂志

Objective:To explore the influencing factors of 31-day unplanned readmission in obstetrics.Methods:The medical records and relevant clinical data of 29 public hospitals in a province in 2017 were collected to construct a two-level logistic regression model on the influencing factors of 31-day unplanned readmission.Results:In 2017, there were 71 330 obstetric patients discharged from 29 public hospitals, 690 of whom were unplanned readmitted in 31 days, accounting for 0.97%. The type of medical insurance payment, number of previous hospitalization, condition of previous hospitalization, age, history of cesarean section, pregnancy complications and complications during delivery were all the factors influencing the 31-day unplanned readmission of obstetrics.Conclusions:The condition of 31-day unplanned readmission could be influenced by the factors of sociology, previous visit and clinical. These factors should be considered reasonably in the evaluation and management of obstetric quality.

Relationship between cervical lesions and the type?specific viral load of high risk HPV reflected by the Ct value of Cobas 4800 HPV system / 中华妇产科杂志

Objective To explore the relationship between cervical lesions and high risk HPV (HR-HPV) viral load reflected by the cycle threshold (Ct) values of Cobas 4800 HPV (Cobas 4800) system. Methods From August 2016 to September 2017, 7 000 women from Shenzhen, were recruited for cervical cancer screening with Cobas 4800 system and cytology co-test. Colposcope biopsies were performed on women who were positive of HPV 16, 18, and positive of HPV types other than 16, 18 with cytology [≥atypical squamous cell of undetermined signification (ASCUS)], or HPV negative but abnormal of cytology [≥low grade squamous intraepithelial lesion (LSIL)]. The Ct values of HPV 16, 18 and all combined other types coming from Cobas 4800 system were used as an indicator of viral load to analyze the relationship between type-specific HPV load and the cervical lesions. Results (1) Among the 7 000 screening women, 370 cases were positive for cervical cancer screening, 325 of them underwent colposcope biopsies, and coloposcopy referred rate was 87.8% (325/370). Among 325 women undergoing cervical biopsy, pathological diagnosis was 119 cases of normal cervical cervix, 151 cases of LSIL, and 55 cases of high-grade squamous intraepithelial lesion (HSIL) and above (HSIL+; including 53 cases of HSIL, 1 case of cervical adenocarcinoma, and 1 case of cervical squamous cell carcinoma). (2) The Ct value of HPV 16 was inversely correlated with the upgrading of the lesions (r=-0.617, P=0.000), and significant different among normal cervix,LSIL and HSIL+(35.4±4.5 vs 31.0±6.0 vs 26.5±4.0; F=25.537, P=0.000). There was no correlation between Ct value of HPV 18 and cervical lesions (r=-0.021, P=0.902). The Ct value of other 12 HPV types was statistically difference among normal normal cervix , HSIL+and cervicitis (33.0±5.3 vs 29.9±7.2 vs 29.8±5.8; F=5.087, P=0.007). Among them, LSIL and HSIL+ were significantly lower than normal cervix (P<0.05), but there was no significant difference between LSIL and HSIL+(P>0.05). Conclusion The Ct value of HPV 16 detecting in Cobas 4800 system as an indicator of virus load obviously correlates with different grades of cervical lesions, therefore could be a reference of cervical lesion existence and an indicator of lesion prognosis.

Value of the BioPerfectus multiplex real time HPV assay for self-collected samples cervical cancer screening / 中华妇产科杂志

Objective To evaluate the feasibility of the BioPerfectus multiplex real time (BMRT) HPV assay for self-sample cervical cancer screening. Methods Eight hundreds and thirty-nine self-collected and physician-obtained DNA samples from the Shenzhen cervical cancer screening trialⅣ(SHENCCAST-Ⅳ) study collected samples for cervical cancer screening during June 2013 to September 2014 were detected by BMRT HPV assay to evaluate the screening efficacy. Results A total of the 839 women who were screened, 804 with complete BMRT HPV data was included in the study, and average age was (46±7) years. Of the 804 women, the positive rates of 14 high-risk HPV genotypes (including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66 subtype) of self-sample and physician-obtained samples were 12.2% (98/804) and 12.8% (103/804), respectively (χ2=0.14, P=0.71). Self-collected samples with HPV-positive had significantly more cells (median 19 901.0) than physician-obtained samples (median 1 778.4), and there was statistically significant difference (Z=-7.61, P<0.01). The degree of agreement between self-sample and physician-obtained samples of HPV 16, HPV 18 and other 12 high risk HPV genotype was 99.8%, 100.0% and 96.1%, respectively. And the consistent Kappa value was 0.95,1.00 and 0.81, respectively. Of 804 samples, there were 6 cervical intraepithelial neoplasia (CIN)Ⅱ+cases. There were no missed CINⅡ+cases by BMRT HPV assay. Conclusion BMRT HPV assay is feasible for self-sample cervical cancer screening.

Evaluation of CIN2+ /CIN3+ risk of different HPV subtypes infection combined with abnormal cytology status / 中华肿瘤杂志

Objective@#To determine the morbidity of cervical intraepithelial neoplasia 2+ (CIN2+ ) and CIN3+ of different human papillomavirus(HPV) subtype infection combined with different cytology status.@*Methods@#The Shenzhen Cervical Cancer Screening Trial Ⅰ & Ⅱ (SHENCCASTⅠ&Ⅱ) are population-based cross-sectional cervical cancer screening studis conducted in Shenzhen and surrounding area from 2008 to 2010. A total of 12 097 women who aged 25-59 years were included in the analysis. All of these women were detected by liquid-based cytology test and several high-risk HPV-DNA tests. The ones with HPV positive or atypical squamous cells of undetermined sign (ASC-US) were sequentially conducted by cervical biopsy vaginoscopy. Finally, 10 805 samples with complete data of hybrid capture 2(HC2), the polymerase chain reaction-based matrix-assisted laser desorption/ionization time-of-flight assay (MALDI-TOF), HPV genotyping detection, cytology and pathology results were analyzed.@*Results@#The top 6 infection rates of HR-HPV in CIN2+ and CIN3+ were HPV16, HPV52, HPV58, HPV33, HPV31, HPV18. The highest constituent ratio of cytology in CIN2+ and CIN3+ was high grade squamous intraepithelial lesion(HSIL). The morbidities of CIN2+ of patients infected with HPV16, HPV31, HPV58, HPV33, HPV18, HPV52 were 41.3%, 31.5%, 30.6%, 28.7%, 28.2%, 17.7%, respectively, while the morbidities of CIN3+ of those were 33.5%, 20.5%, 19.4%, 15.7%, 19.2%, 8.3%, respectively.The morbidities of CIN2+ in negative intraepithelial lesion or malignancy (NILM), ASC-US, low grade squamous intraepithelial lesion (LSIL), atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high grade squamous intraepithelial lesion (HSIL), atypical glandular cell (AGC) samples were 0.4%, 6.9%, 11.1%, 36.4%, 82.0%, 16.7%, respectively, while the morbidities of CIN3+ of those were 0.2%, 3.1%, 4.2%, 22.7%, 64.8%, 0.0%, respectively. The morbidities of CIN2+ in NILM combined with HPV16, HPV18, HPV31, HPV33 infection were 12.6%, 13.3%, 15.8% and 11.5%, respectively, while the morbidities of CIN3+ of those were 10.3%, 11.1%, 7.9% and 7.7%, respectively.The morbidities of CIN2+ and CIN3+ in ASC-US combining with hrHPV infection were high, and the top 6 subtypes associated with high risk of CIN2+ were HPV31 (35.7%), HPV33 (26.9%), HPV16 (26.5%), HPV58 (22.4%), HPV52 (18.6%), HPV68 (15.4%), while those associated with high risk of CIN3+ were HPV16 (20.4%), HPV31 (14.3%), HPV33 (11.5%), HPV58 (8.6%), HPV68 (7.7%), HPV52 (5.8%).@*Conclusions@#Cytology combined with HPV genotyping detection can more effectively estimate the morbidity risks of CIN2+ and CIN3+ . Both high prevalence rates and high risks associated with CIN2+ and CIN3+ of HPV31, HPV33, HPV52 and HPV58 are observed. NILM and ASC-US status combined with these subtypes mentioned above are advised to be conducted by colposcopy.

Characteristics of invisible cervical intraepithelial neoplasia Ⅲ under colposcopy / 中华妇产科杂志

Objective To explore the human papilomavirus(HPV)genotypes and epithelial thickness of invisible cervical intraepithelial neoplasia Ⅲ(CIN Ⅲ)under colposcopy. Methods One hundred and sixty-nine biopsies from 93 patients with a final diagnosis of CIN Ⅲwere extracted from the Shenzhen cervical cancer screening trialⅡ(SHENCCASTⅡ).The SHENCCASTⅡwas conducted from 2009 to 2010.All the cervical blocks from these patients were re-cut and placed on 6 slides,i.e.sandwich model, with the top and bottom sections being stained with HE, the top second be processed for other studies, 3 sections for HPV genotypes by matrix-assisted laser desorption ionization-time of flight-mass spectrometry(MALDI-TOF-MS)assay.The thickness of squamous epithelium of CINⅢwas measured by a microscope(×10)after re-cut. Colposcope directed CIN Ⅲ biopsies positively was defined as visible CIN Ⅲ, while random CIN Ⅲ biopsies positively was defined as invisible CIN Ⅲ. Results HPV16 positivity was 37.2%(16/43)and 55.6%(70/126)between invisible and visible CIN Ⅲ biopsies, respectively(χ2=4.318,P=0.038).Forty-nine cases of the 93 CINⅢpatients were HPV16 positive,while 44 of them non-HPV16 positive. The proportion of patients with ≥45 years of age for other non-HPV16 positive 40.9%(18/44)was significantly higher than that HPV16 positive 20.4%(10/49; χ2=4.630, P=0.031).Patients with HPV16 positive were more likely to have lesions ≥1 quadrant(χ2=7.786,P=0.005) than other non-HPV16 positive. Compared the average epithelium thickness of invisible CIN Ⅲ tissue (140±12)μm,the average epithelium thickness of visible CIN Ⅲtissue(161±9)μm was thicker.There was statistical difference between two groups(t=4.383,P=0.038).The mean average epithelial thickness of CIN Ⅲwith HPV16 positive(172±11)μm was thicker than that the mean average epithelial thickness of CIN Ⅲ with non-HPV16 positive(130±10)μm(t=4.784,P=0.031). Conclusions Invisible lesions is difficult to identify under colposcopy and is related to non-HPV16 positive, small lesion size and thinner squamous epithelium. For non-HPV16 positive or older women should be performed colposcope directed biopsies and randomly multi-sites biopsies by colopscopy,which may be helpful to improve the detection of CINⅢand to reduce miss diagnosis.

Effect of noninvasive mechanical ventilation in the treatment of obstructive sleep apnea hypopnea syndrome and its effect on serum inflammatory factors / 中国基层医药

Objective To investigate the effect of non －invasive ventilator in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect on C－reactive protein (CRP),endothelin－1(ET－1) and tumor necrosis factor －alpha (TNF－α).Methods From February 2016 to August 2017,86 patients with moderate and severe OSAHS in the First People's Hospital of Jinzhong were divided into the observation group and the control group according to the different treatment methods ,with 43 cases in each group.The observation group was treated with noninvasive ventilator ,and the control group was treated with conservative treatment .The differences of PSG and inflammatory factors were compared between the two groups before and after treatment ,and the correlation between AHI,ODI,LSpO2,MSpO2and CRP,ET－1,and TNF－αwas analyzed.Results After treatment,AHI,ODI,MSpO2 of the two groups were decreased significantly ,LSpO2increased significantly,and the AHI [(13.7 ±8.6)times/h vs. (43.1 ±13.6)times/h],ODI [(15.4 ±12.9)times/h vs.(42.5 ±12.6)times/h],LSpO2[(79.6 ±16.8)% vs. (62.3 ±19.27)%],MSpO2[(92.2 ±25.6)% vs.(80.3 ±30.4)%] in the observation group were better than those in the control group,the differences were statistically significant (t ＝5.291,4.258,3.998,4.651,all P＜0.05).After treatment,the levels of CRP,ET－1,TNF －αin the observation group were decreased significantly , which in the control group had no statistically significant differences compared with those before treatment .After treat－ ment,the CRP [(3.7 ±0.7)mg/L vs.(6.1 ±1.8)mg/L],ET－1 [(32.3 ±11.9)ng/L vs.(46.5 ±16.6)ng/L], TNF－α[(19.1 ±3.2)ng/L vs.(31.3 ±9.2)ng/L] in the observation group were significantly lower than those in the control group,the difference were statistically significant (t＝8.255,6.594,5.227,all P＜0.05).After Pearson correlation analysis,AHI and ODI were positively correlated with CRP,ET－1 and TNF－α(r＝0.33,0.56,0.44, 0.26,0.55,0.63),while LSpO2and MSpO2were negatively correlated with CRP,ET－1,TNF－α(r＝－0.36,－0.44,－0.54,－0.28,－0.36,－0.59).Among them,the positive correlation coefficient of ODI and TNF －αwas the largest(0.63).The negative correlation coefficient of MSpO2 and TNF－was the largest(－0.59).Conclusion Non－invasive ventilator in the treatment of OSAHS is effective and can obviously reduce the level of inflammatory factors in the body.

Comparison of the efficacy of tiotropium combined with salmeterol and fluticasone propionate on different specifications of elderly patients with stable chronic obstructive pulmonary disease / 中国基层医药

Objective To compare the curative effect of tiotropium bromide combined with salmeterol flutica-sone of different specifications in treatment of chronic obstructive pulmonary disease(COPD)at stable stage in senile patients.Methods 84 senile patients of COPD were selected.All the patients were divided into observation group (42 cases)and control group(42 cases).And both groups were provided with basic treatment of tiotropium bromide, on the basic treatment,the patients in the observation group were provided with 50μg/250μg salmeterol fluticasone, and the control group with 50μg/500μg salmeterol fluticasone.The course of treatment in the two groups was 12 months.The arterial blood gas,lung function,motor function and clinical efficacy were compared between the two groups after treatment.Results 12 months after treatment,the arterial oxygen partial pressure(PaO2 ),arterial carbon dioxide partial pressure(PaCO2 ),forced expiratory volume in one second(FEV1 ),forced vital capacity(FVC),1 second forced expiratory volume accounted for the percentage of forced vital capacity(FEV1 /FVC)of the control group were (51.66 ±3.96)mmHg,(66.58 ±4.90)mmHg,(1.39 ±0.09)L,(2.41 ±0.09)L,(60.40 ±4.25)%,(366.01 ± 17.21)m respectively,which of the observation group were (46.29 ±3.38)mmHg,(75.83 ±5.09)mmHg,(1.59 ± 0.12)L,(2.65 ±0.10)L,(67.33 ±485)%,(325.69 ±15.62)m respectively.The arterial blood gas,lung function and exercise capacity of the two groups were significantly improved,among them,PaO2 of the control group was significantly better than that of the observation group,the difference was statistically significant (t =6.684,P <0.001).PaCO2 of the control group was significantly better than that of the observation group,the difference was statistically significant(t =-8.485,P <0.001).FEV1 of the control group was significantly better than that of the observation group,the difference was statistically significant(t =-8.641,P <0.001).FVC of the control group was significantly better than that of the observation group,the difference was statistically significant(t =-11.561,P <0.001).FEV1 /FVC of the control group was significantly better than that of the observation group,the difference was statistically significant(t =-6.964,P <0.001).6MWD of the control group was significantly better than that of the observation group,the difference was statistically significant(t =-11.243,P <0.001).After 12 months of treatment, the total effective rate of the observation group was 97.62%,which was significantly higher than that of the control group 85.71%(χ2 =3.896,P =0.048).Conclusion The comprehensive effect of tiotropium bromide combined with 50μg/500μg salmeterol fluticasone is better than that of tiotropium bromide combined with 50μg/250μg salmeterol fluticasone.

Clinic application of BiPAP in stable COPD patients with typeⅡrespiratory failure / 中国基层医药

Objective To evaluate the clinical efficacy of Bilevel non -invasive positive air pressure ventila-tion(BiPAP)in the treatment of stable COPD patients with typeⅡrespiratory failure.Methods 36 patients had stable COPD with typeⅡrespiratory failure was treated with BiPAP.And observed the changes of clinical symptoms and arte-rial blood gases before and after the treatment.Results The Blood gas index[(7.28 ±0.04)vs (7.37 ±0.06)], heart rate[(116 ±11)times/min vs (85 ±10)times/min],breath rate[(26 ±4)times/min,(17 ±3)times/min], frequence of hospitalization[(3.50 ±0.89)times vs (0.23 ±0.11)times],and hospital days[(22.3 ±8.8)d vs (11.4 ±4.6)d]significantly changed after treatment(all P <0.01),the symptoms,including the shortness of breath, and chest distress improved greatly,and also the exercise tolerance were much better than patients did before treatment.Conclusion BiPAP is an efficient treatment method,and valuable for stable COPD patients with type Ⅱrespiratory failure.

Study of high intensity focused ultrasound in cervix intraepitheliar neoplasia grade Ⅰ prognosis / 中华超声影像学杂志

Objective To evaluate the effectiveness of cervical intraepitheliar neoplasia grade Ⅰ (CIN Ⅰ) after treated by high intensity focused ultrasound (HIFU) Ⅰ.Methods 155 CIN Ⅰ cases in treatment group started following after HIFU method,548 cases in control group started following after cervical biopsy under the colposcope.The following intermissions were 6 months,12 months,24 months,36 months,Liquid based cytological test (LCT) and hybrid captured-Ⅱ for high rate-humanpapilomavirus (HR-HPV)test were used in every following test,and if the LCT result was atypical squamous cells (ASC-US) and HR-HPV positive,or the LCT result was greater than or equal,cervical biopsy was undergone by the colposcope to make sure the CIN Ⅰ diagnosis.Results (1) The lost rates of treatment group and control group in 36 months were 18.66％ and 10.22％.(2) The inversion rates in 6 months,12 months,24 months and 36 months were 77.51 ％,80.38 ％,86.12 ％ and 88.28 ％,inversion cases were rose up by the treatment gradually,succession rates were 33.01 ％,22.97％,9.33％ and 1.44％,and descended down gradually.(3)The inversion rates in treatment group and control group increased with observation time,there were significant differences during the 6 months,12 months,24 months and 36 months (P ＜ 0.05) ; the succession rates in treatment group and control group descended with observation time,there were significant differences during the 6 months,12 months and 24 months (P ＜ 0.05),and there were not significant differences in the 36 months,but significant differences between treatment group's and control group s progressive rate.Conclusions No solid scar,improving lesions inversion,reducing succession rate,guarding against the canceration were the advantages of HIFU in treatment for CIN I.

Clinical application of telomerase RNA component gene amplification assay in cervical lesions / 中华妇产科杂志

Objective To investigate the significance of genomic amplification of the telomerase RNA component (TERC) gene to serve as a genetic biomarker in the screening of cervicallesions.Methods A total of 715 cases were recruited,with liquid-based cytology diagnosis as normal (n=347),atypical squamous cells of undetermined significance (ASCUS,n=180),atypical squamous cells cannot exclude a high-grade lesion (ASC-H,n=13),low-grade squamous intraepithelial lesions (LSIL,n=115),high-grade squamous intraepithelial lesions(HSIL,n=59)and atypical glandular cells(AGC,n=1).The remaining cervical cells in the cytological preserving fluid were analyzed using a two-color fluorescence in situ hybridization (FISH) probe targeted to chromosome 3q26 containing TERC gene.The TERC gene findings were compared to the cytological and histological detected results,as well as high-risk human papillomavirus (HPV) detected results.Results Genomic amplification of TERC gene was found in 5.8% of normal specimens,22.2% of ASCUS.30.8% of ASC-H,27.8% of LSIL,86.4% of HSIL and 1/1 of AGC.The positive rate was significantly lower in normal,ASCUS,ASC-H and ISIL.compared with HSIL(all P<0.01).Significantly more cells with genomic amplification of TERC gene were found in cervical intraepithelial lesion(CIN) Ⅱ-Ⅲ than CIN Ⅰ (77.8% vs.9.3%),as well as invasive cervical cancer (96.7% vs.9.3%).both P < 0.01.The rate of TERC gene amplification was higher in HPV positive patients (33.5%) than in HPV negative patients(5.2%,P<0.01).The sensitivity of TERC gene amplification was significantly higher than that of cytological screening (81.88% vs.36.96%,P<0.01) in the differentiation of CIN Ⅱ or higher and CIN Ⅰ or lower diseases,its specificity Was hisher than high-risk HPV test (93.32% vs.33.93%,P<0.01) and positive prediction value (81.29%) was similar with cytological method (86.44%,P>0.05);but its negative prediction value (93.56%) was lower than HPV test (97.06%,P<0.05).Conclusions The positive rates of TERC gene amplification increased as cervical diseases worsened.TERC gene amplification is related to HPV infection.The gain of chromosome 3q26 in cytological specimens is an effective molecular genetic biomarker in screening of CIN Ⅱ or higher and invasive cervical cancer.

The investigation of high risk type human papillomavirus prevalence and incidence rates of cervical intraepithelial neoplasia in Shenzhen women with different screen / 中国癌症杂志

Background and purpose:HPV infection is known as the primary cause of cervical cancer worldwide To investigate high risk type human papillomavirus (HPV) prevalence and incidence rates of cervical intraepithelial neoplasia (CIN) and their screen risk factors in women with different methods of screening.Methods:1137 residents, workers and service women aged 15-59 from Shenzhen city were investigated for cervical cancer in an epidemiology screening study.The high risk types of human papillomavirus of liquid-based cytology samples were tested by hybrid capture 2 (HC-Ⅱ) and liquid-based cytology test (LCT) was also performed at the same time. Women for HPV-positive with LCT ≥ atypical squamous cells of undetermined sign (ASCUS) or HPV-negative with LCT ≥ low grade squamous intraepithelial lesion (LSIL) were biopsied in colposcopy and then were examined by pathology. All data was managed by Foxbase. ?2 test and unconditional Logistic regression model were used for data analysis by SPSS 10.0.Results:1137 women were eligible in our research, the overall rates of HPV infection was 14.0%. HPV detection rates in residents, workers and service women were 14.1%,9.2%,18.9% respectively. HPV detection rates in workers group was significantly lower than that of service women and residents (P

Mifepristone following conservative surgery in the treatment of endometriosis / 中华妇产科杂志

Objective To compare the efficacy and safety of mifepristone and danazol after conservative surgery in the treatment of patients with endometriosis Methods Sixty one patients with endometriosis (RAFS stage Ⅰ～Ⅳ) after conservative surgery were treated orally either with mifepristone 10 mg/d (group M, n =31) or danazol 200 mg 2～3 times/d (group D, n =30) for 3 months Changes of symptoms and signs, serum reproductive hormone levels as well as side effects were assessed before and at the end of therapy Moreover, biochemical parameters of bone metabolism: urinary deoxypyridine /creatinine (UDpd/Cr),serum alkaline phosphatase (AKP) and bone gala protein (BGP) were also measured before and after treatments Results During treatment symptoms and signs were remarkbly relieved in both groups Side effects including hot flushes, irregular vaginal bleeding, back pain, weight gain and acne, were less commnly seen in group M as compared with group D Serum luteal hormone (LH), follicular stimulating homone (FSH) levels remained in the range of follicular phase in both groups So was serum estradiol (E 2) levels in group M[(204 9?45 3 ) pmol/L], but declined to postmenopausal level in group D [(94 3?33 0) pmol/L] About two weeks after discontinuation of the thrapy, serum E 2 levels [(1 221 6? 384 2) pmol/L] was not significantly different from the normal ovulatory range in group M, but significantly lower in group D [(815 1?376 0) pmo/L, P

Regulatory effects of mifepristone and progesterone on the secretion of interleukin-6 by cultured eutopic and ectopic endometrial cells / 中华妇产科杂志

Objective To investigate the regulatory effects of mifepristone and progesterone on the secretion of interleukin 6 (IL 6) by endometrial and endometriosis cells in vitro. Methods Primary cultures of eutopic and ectopic endometrial cells from 9 cases of endometriosis were exposed to mifepristone (10 -6 mol/L, 10 -4 mol/L) and progesterone (1?10 -7 mol/L, 1?10 -5 mol/L) respectively. IL 6 secretion was analyzed in the culture medium by enzyme linked immunosorbent assay (ELISA). Results Mifepristone inhibited the IL 6 secretion of ectopic endometrial cells, with the concentrations of IL 6 was (1 914 33?799 28) ?g/L in the 1?10 -6 mol/L group ( P 0 05). Conclusion The inhibitory effects on the secretion of IL 6 by ectopic and (or) eutopic endometrium may provide one of the cellular therapeutic mechanisms of mifepristone and progesterone on endometriosis.

Expression of T-lymphocytes and cytokines in the decidua of mifepristone with misoprostol for terminating early pregnancy / 中华妇产科杂志

0 05) Conclusions Mifepristone with misoprostol for terminating early pnegnaney might be affect the expression of lymphocyte and cytokines and induce the disorder of decidual micro environment which might be the reason of medical abortion