Embryonal rhabdomyosarcoma of the uterine cervix in an adult female

ABSTRACT Embryonal rhabdomyosarcoma (RMS) of the female genital tract is an uncommon malignancy, presenting mainly in the pediatric and adolescent populations, primarily affecting the first two decades of life. This malignancy presentation in adulthood is rare and is seldom seen. The incidence of this tumor affecting adult females is approximately 0.4 - 1%, with the common site being the vagina. This tumor infrequently involves the cervix. RMS has a poor survival rate and once diagnosed, it requires aggressive management by radical surgery accompanied by chemoradiation. We present a case of an anaplastic variant of embryonal RMS of the uterine cervix presenting as a cervical polyp in a 36-year-old female who complained of dyspareunia and post-coital bleeding.

Virus del papiloma humano de alto riesgo y factores asociados en mujeres de Ecuador / High-risk human papillomavirus and associated factors in women in Ecuador / Papilomavírus humano de alto risco e fatores associados nas mulheres equatorianas

El cáncer de cérvix en el 99% de los casos, es causado por el Virus del Papiloma Humano (VPH) de alto riesgo, su prevalencia es elevada en países de bajos ingresos debido a la escasez de recursos para realizar programas generalizados de detección precoz, inmunización y tratamiento adecuado. El objetivo de la investigación fue identificar la frecuencia y los factores de riesgo de las infecciones del VPH de alto riesgo, en mujeres de 21 a 65 años de tres cantones de la zona 6 del Ecuador, periodo 2019. Este fue un estudio analítico, de corte transversal; con una muestra de registros clínicos de 109 pacientes encuestadas a partir del proyecto de epidemiologia en la provincia de El Oro que cumplieron los criterios inclusión. Los datos se recogieron en un formulario validado por método Delphi. Se usó programa SPSS v 24, para la asociación de las variables: Intervalo de Confianza 95%, Chi cuadrado (con valor de p < 0.05), Odds Ratio. Los resultados observados fueron de 31 (28,4%) casos de pacientes con VPH AR, de estas se identificó como el genotipo más común al VPH AR 39 (11,01%) en las participantes del estudio, seguido del VPH AR 31 (8,26%). Fueron factores considerados asociados a la infección del VPH AR sin significancia estadística el inicio de la vida sexual (IVSA) antes de los 20 años (OR = 1,2); y el número de parejas sexuales igual o mayor a 2 (OR = 1,7). Se concluye que el inicio de vida sexual temprano y el numero compañeros sexuales fueron factores asociados, pero sin significancia estadística.

Cervical cancer in 99% of cases is caused by high-risk Human Papillomavirus (HPV), its prevalence is high in low-income countries due to the scarcity of resources for widespread early detection programs, immunization and adequate treatment. The objective of the research was to identify the frequency and risk factors of high-risk HPV infections in women aged 21 to 65 years in three cantons of zone 6 of Ecuador, period 2019. This was an analytical, cross-sectional study; with a sample of clinical records of 109 patients surveyed from the epidemiology project in the province of El Oro who met the inclusion criteria. Data were collected in a form validated by Delphi method. SPSS v 24 software was used for the association of variables: 95% confidence interval, Chi-square (with p value < 0.05), Odds Ratio. The results observed were 31 (28.4%) cases of patients with AR HPV, of which AR HPV 39 (11.01%) was identified as the most common genotype in the study participants, followed by AR HPV 31 (8.26%). Factors considered to be associated with AR HPV infection without statistical significance were sexual debut before the age of 20 years (OR = 1.2); and the number of sexual partners equal to or greater than 2 (OR = 1.7). It was concluded that early sexual debut and the number of sexual partners were associated factors, but without statistical significance.

Em 99% dos casos, o câncer cervical é causado pelo papilomavírus humano de alto risco (HPV), e sua prevalência é alta em países de baixa renda devido à escassez de recursos para a detecção precoce generalizada, imunização e programas de tratamento adequados. O objetivo da pesquisa era identificar a freqüência e fatores de risco para infecções por HPV de alto risco em mulheres entre 21-65 anos de idade em três cantões da zona 6 do Equador, período 2019. Este foi um estudo analítico de corte transversal com uma amostra de registros clínicos de 109 pacientes pesquisados do projeto de epidemiologia na província de El Oro que preenchiam os critérios de inclusão. Os dados foram coletados em um formulário validado pelo método Delphi. O software SPSS v 24 foi utilizado para a associação de variáveis: Intervalo de confiança 95%, Qui-quadrado (com valor de p < 0,05), Odds Ratio. Os resultados observados foram 31 (28,4%) casos de pacientes com AR HPV, dos quais AR HPV 39 (11,01%) foi identificado como o genótipo mais comum nos participantes do estudo, seguido por AR HPV 31 (8,26%). Fatores considerados associados à infecção por AR HPV sem significado estatístico foram a iniciação sexual (SAIV) antes dos 20 anos de idade (OR = 1,2); e número de parceiros sexuais igual ou maior que 2 (OR = 1,7). Concluímos que a estreia sexual precoce e o número de parceiros sexuais foram fatores associados, mas sem significado estatístico.

Clinical characteristics of human papillomavirus infection in young women and progress in diagnosis and treatment of cervical precancerous lesions / 中国基层医药

Cervical cancer is a serious threat to women's life and health. Studies have shown that the incidence of cervical cancer in China ranks second in the world. With increasing application of cervical cancer screening technology, cervical cancer mortality shows a downward trend, but the incidence of cervical cancer in young women shows an upward trend. The affected population tends to be young. Young women are the population at high risk for a human papillomavirus (HPV) infection because they have high levels of estrogen and active sexual behavior. Persistent high-risk HPV infection is the key factor that promotes development of precancerous lesions toward cervical cancer. This paper reviews the clinical characteristics of HPV infection in young women and the research progress in diagnosis and treatment strategy of precancerous lesions.

Histerectomía vaginal convencional y vaginal asistida por laparoscopia en pacientes sin prolapso uterino / Conventional and laparoscopic-assisted vaginal hysterectomy in patients without uterine prolapse

RESUMEN Fundamento: la histerectomía es el procedimiento quirúrgico ginecológico más realizado a nivel mundial. En la actualidad no existe consenso sobre la vía de abordaje, donde es un problema a resolver. Objetivo: comparar los resultados de la aplicación de la histerectomía vaginal y la vaginal asistida por laparoscopia en pacientes con afecciones benignas del útero sin prolapso uterino. Métodos: se realizó un estudio descriptivo, transversal y retrospectivo en el Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey desde enero de 2017 a septiembre de 2019. El universo estuvo formado por todas las pacientes con enfermedades benignas del útero excluyendo el prolapso, operadas con las técnicas de histerectomía vaginal convencional y la asistida por laparoscopia en el período de estudio. Como fuente se utilizaron las historias clínicas y una planilla confeccionada para vaciar los datos. La variable dependiente fue: resultados que se clasificaron en satisfactorios o insatisfactorios. Las variables independientes fueron: edad, método quirúrgico, indicación quirúrgica, paridad, cirugías abdominales previas, tiempo quirúrgico, pérdidas sanguíneas transoperatorias, complicaciones y estadía hospitalaria. Resultados: predominó la histerectomía vaginal convencional a la asistida por laparoscopia. No existieron resultados insatisfactorios en ninguno de los dos grupos. El grupo de edad que prevaleció fue el de 40 a 49 años. La mayoría de las enfermas eran multíparas y sin antecedentes de cirugías previas. La histerectomía vaginal convencional mostró menor tiempo quirúrgico y las pérdidas sanguíneas fueron menores de 250 ml, con ambas técnicas. Las complicaciones de mayor frecuencia fueron las relacionadas con la cúpula vaginal, la estadía hospitalaria que predominó fue menor de 24 horas. Conclusiones: la histerectomía vaginal convencional, así como la asistida por la laparoscopia constituyen las técnicas quirúrgicas de elección ante las enfermedades benignas del útero que no sean el prolapso, en aquellas instituciones con personal entrenado y equipamiento necesario para su realización.

ABSTRACT Background: hysterectomy is the most widely performed gynecological surgical procedure worldwide. Currently, there is no consensus on when to use one or the other approach, which is a problem to solve. Objective: to compare the results of the application of laparoscopic-assisted vaginal and vaginal hysterectomy in patients with benign conditions of the uterus without uterine prolapse. Methods: a descriptive, cross-sectional and retrospective study was carried out at the Manuel Ascunce Domenech University Hospital in the period from January 2017 to September 2019. The universe consisted of all patients with benign diseases of the uterus excluding prolapse, who underwent surgery with conventional vaginal hysterectomy and laparoscopic assisted techniques in the study period. The medical records and a prepared spreadsheet were used as a source to empty the data. The dependent variable was the results; it was classified as satisfactory or unsatisfactory. Independents variables were: age, surgical method, surgical indication, parity, previous abdominal surgeries, surgical time, intraoperative blood loss, surgical complications, and hospital stay. Results: the conventional vaginal hysterectomy technique predominated over the one assisted by laparoscopy. There were not unsatisfactory results in no one of the two groups. The age group that prevailed in the patients was that of 40 to 49 years. Most of the patients were multiparous and had no history of previous abdominal surgeries. Conventional vaginal hysterectomy showed less surgical time and blood losses were less than 250 ml, with both techniques. The most frequent complications were related to vaginal cupules, as well as the prevailing hospital stay was less than 24 hours. Conclusions: conventional vaginal hysterectomy, as well as laparoscopic-assisted hysterectomy, are the surgical techniques of choice for patients with benign uterine diseases other than prolapse, in those institutions where there are trained personnel and the necessary equipment to carry them out.

Value of colposcopy screening independently for cervical lesions in basic hospitals / 中国医师杂志

Objective To evaluate the value of colposcopy screening independently for cervical lesions in basic hospitals.Methods A retrospective cohort study of 574 patients who both underwent colposcopy and had pathologic results in our department.The consistency,authenticity and predictability of colposcopy and pathological results,the relevant factors affecting the accuracy of colposcopy diagnosis,and the analysis of unsatisfactory colposcopy results were analyzed.Results Agreement between colposcopic diagnosis and cervical pathology was 50.57％,and Kappa value of consistency was 0.358 (P ＜ 0.01).Agreement within one grade was 91.38 ％ (Kappa value was 0.871,P ＜0.01).The sensitivity of colposcopy in diagnosing of low-grade squamous intraepithelial lesion (LSIL) and above was high (96.91％),while the specificity was 52.60％ (81/154);False positive rate was 47.40％,and false negative rate was 3.09％.The sensitivity of colposcopy in diagnosing of high-grade squamous intraepithelial lesion (HSIL) and above was 81.82％ (153/187),and the specificity in diagnosing of LSIL and below was 90.68％ (146/161);False positive rate was 9.3％,and false negative rate was 18.2％.The stage of cervical cancer and skills of colposcopist would be factors that influence the accuracy of colposcopy screening in HSIL and above (P ＜0.01).Average age in unsatisfactory colposcopy was (52 ± 9) y,which was significantly different from satisfactory colposcopy cases (P ＜ O.O1).The proportion of early cervical lesions in patients with unsatisfactory colposcopy HSIL or above was high.Conclusions The complete coincidence rate between colposcopy and pathological diagnosis is limited,but the consistency within one grade is good;the stage of cervical lesions and the experience of examiners are the factors related to the accuracy of colposcopy in diagnosing HSIL and above lesions;Unsatisfactory colposcopy cases can be further combined with cytology and HPV examination for shunt and treatment.

Doença inflamatória do colo do útero: indicador indireto da saúde reprodutiva da mulher / Inflammatory disease of cervix uteri: indirect indicator of women's reproductive health / Cervicitis: indicador indirecto de la salud reproductiva de las mujeres

Objetivo: analisar as internações por doença inflamatória do colo do útero e os fatores que influenciam a sua ocorrência. Método: estudo seccional, prospectivo, baseado em um inquérito de morbidade hospitalar realizado em 2013, com amostra de 429 mulheres internadas em hospitais no município de Guarapuava. Os dados foram analisados por meio de análise bivariada e regressão logística. O projeto foi aprovado por Comitê de Ética em Pesquisa. Resultados: do total de mulheres internadas, 45 (10,4%) foram por doença inflamatória do colo do útero. Pertencer ao público alvo, ter realizado o exame no mínimo uma vez, procurar o serviço regularmente para o controle de saúde e apresentar o resultado dentro dos limites de normalidade em 1 ano atuaram como fatores de proteção contra a ocorrência dessas internações. Conclusão: o conhecimento dos fatores que se relacionam ao desfecho fornece subsídios para a readequação dos serviços que prestam assistência às mulheres, a fim de prevenir as internações.

Objective: to examine hospital admissions for inflammatory disease of the cervix uteri and the related factors. Method: this prospective, cross-sectional study based on a hospital morbidity survey was conducted in 2013 with a sample of 429 women admitted to hospitals in the city of Guarapuava. Data were analyzed by bivariate analysis and logistic regression. The project was approved by the institution's research ethics committee. Results: 45 (10.4%) of the women were hospitalized for inflammatory disease of the cervix uteri. Protective factors against the occurrence of such hospitalizations included belonging to the target public, having performed the examination at least once, attending the service regularly for a health check and returning a result within normal limits in the prior year. Conclusion: knowledge of the factors relating to the outcome provides input for adjusting women's care services in order to prevent hospitalizations.

Objetivo: analizar las internaciones por cervicitis y los factores que influencian su ocurrencia. Método: estudio seccional, prospectivo basado en una encuesta de morbilidad hospitalaria realizada en 2013, con muestra de 429 mujeres internadas en hospitales en el municipio de Guarapuava. Los datos se analizaron por medio de análisis bivariado y regresión logística. El estudio fue aprobado por Comité de Ética en Investigación. Resultados: del total de mujeres internadas, 45 (10,4%) lo fueron por cervicitis. Pertenecer al público objetivo, haber realizado el examen al menos una vez, buscar el servicio regularmente para el control de salud y presentar el resultado dentro de los límites de la normalidad en 01 año actuaron como factores de protección respecto a la ocurrencia de estas hospitalizaciones. Conclusión: el conocimiento de los factores que se relacionan al desenlace propo

An immunohistochemistry and histopathological study of ankaferd blood stopper in a rat model of cervical inflammation

SUMMARY OBJECTIVE: Ankaferd Blood Stopper (ABS) is a medicinal plant extract used topically as a hemostatic, anti-inflammatory, and anti-oxidant agent. Its cytoprotective effect mainly depends on its pleiotropic properties by modulating inflammatory mediators such as IL-1β, IL-6, and TNF-α. This study aims to test the possible therapeutic effect of ABS in the treatment of erosive and inflammatory conditions occurring in the uterine cervix. METHODS: Twenty-four female Wistar Albino rats were used in the present study. Trichloracetic acid was applied intravaginally to establish an experimental rat model of cervicitis. The rats were randomly divided into three groups: group I (injury), group II (injury+isotoinc saline), and group III (injury+ABS). After 3 estrous cycles of ABS and isotonic saline treatment, the amount of inflammation, vascular congestion and erosion were evaluated in the cervical tissues by using a modified semi-quantitative scale of 0-3. Immunohistochemical staining with monoclonal antibodies against IL-1β was also performed. RESULTS: Compared with group I and II, the ABS group showed the least inflammatory cell infiltration, vascular congestion and cervical erosion, compared with the ABS group prominent IL-1β staining observed in group I and group II. CONCLUSION: Our data suggest that ABS is a highly effective alternative to induce normal cervical epithelium and can be used safely in the treatment of cervical inflammation with or without cervical erosion.

RESUMO OBJETIVO: Ankaferd Blood Stopper (ABS) é um extrato de plantas medicinais utilizado topicamente como um agente hemostático, anti-inflamatório e antioxidante. O seu efeito citoproteico depende principalmente das suas propriedades pleiotrópicas por meio da modulação de mediadores inflamatórios tais como IL-1β, IL-6 e TNF-a. O objetivo deste estudo é testar o possível efeito terapêutico do ABS no tratamento de condições erosivas e inflamatórias que ocorrem no colo uterino. MÉTODOS: Vinte e quatro ratas Wistar Albino foram utilizadas no presente estudo. O ácido tricloroacético foi aplicado intravaginalmente para estabelecer um modelo experimental de cervicite em ratos. Os ratos foram divididos aleatoriamente em três grupos: grupo I (lesão), grupo II (lesão + fisiológico sérico) e grupo III (lesão + ABS). Após três ciclos estrais de ABS e tratamento fisiológico sérico, as quantidades de inflamação, congestionamento vascular e erosão foram avaliadas nos tecidos cervicais usando uma escala semiquantitativa modificada de 0-3. Coloração imuno-histoquímica com anticorpos monoclonais contra IL-1β também foi realizada. RESULTADOS: Em comparação com os grupos I e II, o grupo ABS mostrou menos infiltração de células inflamatórias, congestionamento vascular e erosão cervical. Além disso, em comparação com o grupo ABS, observou-se uma coloração proeminente de IL-1β no grupo I e no grupo II. CONCLUSÃO: Nossos dados sugerem que o ABS é uma alternativa altamente eficaz para induzir o epitélio cervical normal e pode ser utilizado com segurança no tratamento da inflamação cervical com ou sem erosão cervical.

Expression and clinical significance of galectin-9 in different cervical lesions and different types of human papillomavirus infection / 中国基层医药

Objective@#To analyze the expression differences and clinical significance of galectin 9(Gal-9) in different cervical lesions and human papillomavirus(HPV) type infection.@*Methods@#From May 2016 to April 2018, 42 cases of cervical cancer(CC group), 45 cases of high level cervical intraepithelial neoplasia (HSIL group), 45 cases of lower cervical intraepithelial neoplasia (LSIL group) in Yangzhou Maternal and Child Health-Care Hospital were selected, and 45 cases of normal outpatient medical examination in our hospital were selected as the control group(NC group). Enzyme-linked immunosorbent assay(ELISA) method was used to detect the serum level of Gal-9.The gene amplification technique and the principle of diversion hybridization were used to detect the 37 types of HPV.@*Results@#Of women with cervical lesions, 50 cases(28.3%) were 50 years or more, the CC group had 32 cases (76.2%), HSIL group had 10 cases (22.2%), LSIL group had 8 cases (17.8%), the age of CC group compared with HSIL group and LSIL group had significant differences(t=7.959, 10.440, all P<0.01). The serum level of Gal-9 in CC group [(22.27±1.72)ng/L], HSIL group [(15.43±2.14)ng/L], LSIL group [(15.24±1.89)ng/L] was significantly higher than that in NC group [(12.08±2.13)ng/L](t=16.360, 18.100, 24.440, all P<0.05). The HPV infection rate in patients with cervical lesions reached 84.84%(112/132), the positive rate of HPV16 in CC group was 83.3%(35/42), HSIL group was dominated by HPV16(28.8%), HPV33(20.0%), HPV52(17.7%) and HPV58(13.3%), LSIL group was dominated by HPV52(26.7%), HPV58(24.4%), HPV16(20.0%) and HPV18(8.9%). There was no statistically significant difference in the levels of Gal-9 of HPV16, HPV58, HPV52 and HPV33 patients, indicated that there was no statistically significant correlation between Gal-9 level and the type of HPV infection.@*Conclusion@#Early intervention in patients with high HPV infection and Gal-9 levels can help reduce the incidence of cervical cancer.

Study of a two?way referral mode for the treatment of cervical disease within a medical alliance / 中华健康管理学杂志

Objective To explore the establishment of a two-way referral system for the treatment of cervical diseases within a medical alliance. The two-way referral system was introduced to reduce the morbidity and mortality of cervical cancer through better management of patients'who have tested positive for cervical disease, screening effectively for early diagnosis and treatment of cervical precancerous lesions, and providing early interventions for cervical cancer patients. Methods The control group consisted of 2, 515 patients who had screened positive for cervical disease between January 2018 and December 2018 at one of four community health service centers that were not within the medical alliance. The experimental group consisted of 2, 384 patients who had screened positive for cervical disease at one of four community health service centers in the medical alliance. The control group was treated using the original management mode;the experimental group's treatment was managed within the two-way referral system, which included standardized screening, referral, follow-up, health education, and professional training. The hospital visit rates, time intervals from diagnosis to the start of interventions, detection rates, and treatment rates were observed for both groups of women. Results The hospital visit rates, detection rates, and treatment rates were higher for those in the experimental group than the control group. The time interval from receiving a diagnosis to the first hospital visit was (16.9±11.5) days for patients in the experimental group and (25.7±20.9)days for those in the control group. The difference was a statistically significant (-0.05). Conclusion The management of cases in a two-way referral system within a medical alliance facilitates patients receiving earlier diagnosis and treatment for cervical pre-cancerous lesions and malignant tumors. Such efficiency improvements may reduce morbidity and mortality as well as help control medical costs, all of which have long-term economic and social significance.

Clinical value of new rapid pathological diagnosis technique in the examination of cervical lesions in primary medical institution / 中国基层医药

Objective@#To explore the clinical value of new rapid pathological diagnosis technology in the examination of cervical lesions in primary medical institution.@*Methods@#In the Affiliated Hospital of Yangzhou University, 25 cases of cervical scraping and 22 cases of cervical biopsy were selected.Twenty-five cases of cervical scraping scraped two wipers during operation, the results were compared with conventional pathological techniques and new rapid pathological diagnosis techniques.Twenty-two cases of cervical biopsy used a new rapid pathological diagnosis technique to perform cytological diagnosis of biopsy tissue rolls in biopsy operation.According to the results of rapid pathological diagnosis, the biopsy operation plan was adjusted to analyze the clinical value of the new rapid pathological diagnosis technique in cervical lesions in primary medical institution.@*Results@#The new rapid pathological diagnosis technology required less space and no pollution, and the diagnosis took about 2-3 min, which did not affect the normal inspection operation.Twenty-five cases of cervical scraping were produced with new rapid pathological diagnosis technique, and the quality of cervical scraping produced with conventional pathological technique was consistent, which could satisfy the needs of pathological cytological diagnosis; twenty-two cases of cervical biopsy under the vaginal device were assisted by this technology and it could increase the positive rate of the first biopsy.@*Conclusion@#Cervical scraping and cervical biopsy are still the main methods for cervical lesions examination in primary hospitals.The new rapid pathological diagnosis technology can provide the real-time pathological diagnosis of cervical scraping, improve the positive detection rate of the first biopsy of cervical biopsy, and the cost is low, suitable for promotion in primary medical institution.

Application and clinical significance of human papilloma virus E6/E7 mRNA detection in cervical atypical glandular cells / 中国医师进修杂志

Objective To investigate the application and clinical significance of human papilloma virus (HPV) E6/E7 mRNA detection in cervical atypical glandular cells (AGC). Methods Four hundred and forty-five cervical AGC patients diagnosed by thin-layer liquid-based cytology in the Maternity Affiliated Hospital of Dalian Medical University from January 2014 to March 2018 were collected. Histological follow-up data and HPV E6/E7 mRNA detection results were analyzed, and histological differences in HPV E6/E7 mRNA positive and negative patients were compared. Results The histological result of 445 patients with cervical AGC showed that negative was in 306 cases (68.76%), and clinical significant lesion was in 129 cases (28.99%). In 445 patients with cervical AGC, HPV E6/E7 mRNA result was positive in 121 cases (27.19%), among whom the positive rate of HPV 16 and 18/45 type was 54.55% (66/121); HPV E6/E7 mRNA result was negative in 324 cases (72.81% ), including 13 non-cervical lesions. The negative rate of histological results in HPV E6/E7 mRNA negative patients was significantly higher than that in HPV E6/E7 mRNA positive patients: 91.05% (295/324) vs. 9.09% (11/121), and there was statistical difference (P＜0.01); the rates of adenocarcinoma in situ (AIS), high-grade squamous intraepithelial lesion (HSIL) and cervical adenocarcinoma of histological result in HPV E6/E7 mRNA positive patients were significantly higher than those in HPV E6/E7 mRNA negative patients: 40.50% (49/121) vs. 1.23% (4/324), 44.63% (54/121) vs. 1.23% (4/324), 3.31% (4/121) vs. 0.31% (1/324), and there were statistical differences (P＜0.01). The sensitivity of HPV E6/E7 mRNA in detecting clinical significant lesion of cervical AGC patients was 82.95% (107/129), the specificity was 95.57% (302/316), positive predictive value was 88.43% (107/121), and negative predictive value was 93.21% (302/324). Conclusions The histological result of cervical AGC shows that the amount of negative patients is significantly higher than clinical significant lesion. For cervical AGC patients with HPV E6/E7 mRNA negative results, conservative follow-up can be adopted after excluding extracervical lesions and fully assessing the risk of cervical lesions. However, the cervical AGC patients with HPV E6/E7 mRNA positive results need further examination to detect lesion and choose treatment earlier.

Clinical value of new rapid pathological diagnosis technique in the examination of cervical lesions in primary medical institution / 中国基层医药

Objective To explore the clinical value of new rapid pathological diagnosis technology in the examination of cervical lesions in primary medical institution.Methods In the Affiliated Hospital of Yangzhou University,25 cases of cervical scraping and 22 cases of cerrical biopsy were selected.Twenty-five cases of cervical scraping scraped two wipers during operation,the results were compared with conventional pathological techniques and new rapid pathological diagnosis techniques.Twenty-two cases of cervical biopsy used a new rapid pathological diagnosis technique to perform cytological diagnosis of biopsy tissue rolls in biopsy operation.According to the results of rapid pathological diagnosis,the biopsy operation plan was adjusted to analyze the clinical value of the new rapid pathological diagnosis technique in cervical lesions in primary medical institution.Results The new rapid pathological diagnosis technology required less space and no pollution,and the diagnosis took about 2-3 min,which did not affect the normal inspection operation.Twenty-five cases of cervical scraping were produced with new rapid pathological diagnosis technique,and the quality of cervical scraping produced with conventional pathological technique was consistent,which could satisfy the needs of pathological cytological diagnosis;twenty-two cases of cervical biopsy under the vaginal device were assisted by this technology and it could increase the positive rate of the first biopsy.Conclusion Cervical scraping and cervical biopsy are still the main methods for cervical lesions examination in primary hospitals.The new rapid pathological diagnosis technology can provide the real-time pathological diagnosis of cervical scraping,improve the positive detection rate of the first biopsy of cervical biopsy,and the cost is low,suitable for promotion in primary medical institution.

Clinical multicenter study of carboprost methylate suppository for cervical ripening prior to diagnostic hysteroscopy / 中华妇产科杂志

Objective To evaluate the effectiveness of carboprost methylate suppository for cervical ripening before diagnostic hysteroscopy in premenopausal women. Methods From July 2014 to July 2015, 1614 women who were undergone diagnostic hysteroscopy in 12 hospitals were randomly assigned into study group(n=1209)and control group(n=405). The cases in study group were given 1 mg carboprost methylate suppository in vagina before hysteroscopy, the cases in control group were given 1 mg placebo. The extent of cervical ripening, the time of dilated cervix, pain scoring, incidence of drug side reactions after 24, 48, 72 hours, satisfaction degree of operators and patients, the time of hysteroscopy, incidence of complications between the two groups were observed and compared. Results (1) Mean cervical widths in the study and control groups were 6.11 ± 1.11 and 5.95 ± 1.11, and showed a significant difference(P=0.034);the percentage of women requiring cervical dilatation in study group was lower than the percentage in control group significantly [28.3％(342/1209)versus 34.6％(140/405), P=0.020].(2) The time of dilated cervix in study group was shorter than the time in control group significantly [(34 ± 25) versus(52 ± 49)s, P=0.028] for the patients whose mean cervical widths≤4.(3)There was no significant difference in pain scores between the two groups(P>0.05).(4)The incidence of side reactions 24, 48, 72 hours after operation were no significant difference between the two groups (P>0.05). (5) The satisfaction degree of operators and patients, the time of hysteroscopy, incidence of complications between the two groups were no singnifcant difference between the two groups (all P>0.05). Conclusion Application of carboprost methylate suppository by vagina before hysteroscopy is an effective and safe method of cervical ripening.

Prevalence of high-risk human papillomavirus among women in two English-speaking Caribbean countries / Prevalencia del virus del papiloma humano de alto riesgo en las mujeres de dos países del Caribe de habla inglesa / Prevalência do papilomavírus humano de alto risco em mulheres em dois países do Caribe anglófono

ABSTRACT Objective To characterize high-risk human papillomavirus (HPV) infections in a sample of women in two small English-speaking Caribbean countries: Saint Kitts and Nevis and Saint Vincent and the Grenadines. Methods Sexually active women ≥ 30 years old attending primary care health facilities participated in the study. Each participant had a gynecological examination, and two cervical specimens were collected: (1) a specimen for a Papanicolaou (Pap) test and (2) a sample of exfoliated cervical cells for HPV DNA testing, using the HPV High Risk Screen Real-TM (Sacace). High-risk HPV genotypes were assessed in 404 women in Saint Kitts and Nevis and 368 women in Saint Vincent and the Grenadines. Results High-risk HPV was detected in 102 of 404 (25.2%) in Saint Kitts and Nevis and in 109 of 368 (29.6%) in Saint Vincent and the Grenadines. High-risk HPV genotypes 52, 35, 51, 45, and 31 were the most common high-risk types in Saint Kitts and Nevis. In Saint Vincent and the Grenadines, the most common high-risk HPV genotypes were 45, 35, 31, 18, and 51. Current age was found to be significantly associated with high-risk HPV infection in both countries. In addition, in Saint Vincent and the Grenadines, high parity (> 3 pregnancies) and having had an abnormal Pap smear were found to be independent risk factors for high-risk HPV. Conclusions These results contribute to the evidence on HPV prevalence for small island states of the Caribbean and support the accelerated introduction of the 9-valent HPV vaccine in the two countries and elsewhere in the English-speaking Caribbean. Use of the study’s results to guide the development of policy regarding implementation of HPV testing as the primary screening modality for older women is recommended.

RESUMEN Objetivo Caracterizar la infección por el virus del papiloma humano (VPH) de alto riesgo en una muestra de mujeres de dos países pequeños del Caribe de habla inglesa: Saint Kitts y Nevis, y San Vicente y las Granadinas. Métodos Participaron en el estudio mujeres sexualmente activas ≥ 30 años que acudieron a centros de atención primaria. Se realizó un examen ginecológico a todas las participantes y se le tomaron dos muestras cervicouterinas: 1) una muestra para efectuar la prueba de Papanicolaou y 2) células cervicouterinas exfoliadas para efectuar la prueba de ADN del VPH, mediante la prueba de detección del VPH de alto riesgo en tiempo real (HPV High Risk Screen Real-TM, Sacace). Se evaluaron los genotipos de alto riesgo del VPH en 404 mujeres en Saint Kitts y Nevis, y en 368 mujeres en San Vicente y las Granadinas. Resultados Se detectó VPH de alto riesgo en 102 de 404 mujeres (25,2%) de Saint Kitts y Nevis, y en 109 de 368 (29,6%) de San Vicente y las Granadinas. Los genotipos 52, 35, 51, 45 y 31 de VPH de alto riesgo fueron los detectados con más frecuencia en Saint Kitts y Nevis. En San Vicente y las Granadinas, los más frecuentes fueron los genotipos 45, 35, 31, 18 y 51. Se observó una relación significativa entre la edad actual y la infección por el VPH de alto riesgo en los dos países. Además, en San Vicente y las Granadinas, se halló que la multiparidad (> 3 embarazos) y los resultados anómalos de la prueba de Papanicolaou son factores de riesgo independientes de la infección por el VPH de alto riesgo. Conclusiones Estos resultados aportan datos acerca de la prevalencia del VPH en los estados insulares pequeños del Caribe y respaldan la introducción acelerada de la vacuna nonavalente contra el VPH en los dos países y en los demás países del Caribe de habla inglesa. Se recomienda aplicar los resultados de este estudio para guiar la formulación de políticas con respecto a la incorporación de las pruebas de detección del VPH como método primario de tamizaje en las mujeres mayores.

RESUMO Objetivo Caracterizar as infecções pelo papilomavírus humano (HPV) de alto risco em uma amostra de mulheres de dois países pequenos do Caribe anglófono: São Cristóvão e Nevis e São Vicente e Granadinas. Métodos Mulheres sexualmente ativas com ≥ 30 anos de idade atendidas em unidades básicas de saúde participaram do estudo. Cada participante foi submetida a exame ginecológico e coleta de duas amostras do colo do útero: (1) uma amostra para exame de Papanicolau e (2) uma amostra de citologia esfoliativa para teste de DNA do HPV, utilizando o kit HPV High Risk Screen Real-TM (Sacace). A presença de genótipos de HPV de alto risco foi avaliada em 404 mulheres em São Cristóvão e Nevis e 368 mulheres em São Vicente e Granadinas. Resultados HPV de alto risco foi detectado em 102/404 mulheres (25,2%) em São Cristóvão e Nevis e em 109/368 (29,6%) em São Vicente e Granadinas. Os genótipos 52, 35, 51, 45 e 31 do HPV foram os tipos de alto risco mais comuns em São Cristóvão e Nevis. Em São Vicente e Granadinas, os genótipos do HPV de alto risco mais comuns foram 45, 35, 31, 18 e 51. Foi constatada associação significante entre idade atual e infecção por HPV de alto risco em ambos os países. Além disso, em São Vicente e Granadinas, multiparidade (>3 gestações) e Papanicolau anormal foram fatores de risco independentes para o HPV de alto risco. Conclusões Esses resultados contribuem informações sobre a prevalência do HPV nas pequenas nações insulares do Caribe e apoiam a introdução acelerada da vacina nonavalente contra o HPV nestes dois países e no restante do Caribe anglófono. Recomenda-se o uso dos resultados deste estudo para orientar a formulação de políticas com relação à implementação do exame de HPV como modalidade primária de triagem para mulheres mais velhas.

Prevalence of cervical cancer and associated mortality in Grenada, 2000-2010 / Prevalencia del cáncer cervicouterino y mortalidad asociada en Granada, 2000-2010

ABSTRACT Objective To assess cervical cancer prevalence and associated mortality in Grenada, West Indies during 2000–2010. Methods Records of visits to hospital and clinical facilities were obtained from the histopathology laboratory of the Grenada General Hospital. Records were de-identified and electronically compiled. Cervical cancer prevalence was assessed via cross-sectional analysis of this secondary data. Of a total 12 012 records, 2 527 were selected for analysis using sampling without replacement. Cases were matched to corresponding patient data from death registries, where possible, and used to calculate associated mortality rates. Results The observed prevalence of cervical cancer was 52.4 per 100 000 women (ages 15 and above). The highest rates of cervical cancer occurred in the 35–44 age group, with the second highest among 45–64-year-olds. A total of 65 deaths were attributable to cervical cancer during 2000–2010, more than 50% of which were among women > 65 years old. The observed mortality rate was 16.7 per 100 000, almost twice the rate estimated by WHO for the region. Conclusions This study demonstrates the need for a comprehensive cervical cancer-screening program in Grenada. Results should contribute to informing future studies on how to appropriately generate and execute public health policy for education, screening, prevention, and control of cervical cancer in Grenada.

RESUMEN Objetivo Evaluar la prevalencia del cáncer cervicouterino y la mortalidad asociada en Granada, Antillas Menores, entre el 2000 y el 2010. Métodos Se obtuvieron los registros de las visitas al hospital y a consultorios clínicos a partir del laboratorio de histopatología del Hospital General de Granada. Se borraron los datos personales de los registros y se los compiló electrónicamente. La prevalencia de cáncer cervicouterino se evaluó por medio del análisis transversal de estos datos secundarios. De un total de 12 012 registros, fueron seleccionados para el análisis 2 527 mediante un método de muestreo sin reemplazo. Los casos se compararon con los datos correspondientes de pacientes en los registros de defunciones, cuando fue posible, y se usaron para calcular las tasas de mortalidad asociadas. Resultados La prevalencia observada de cáncer cervicouterino fue 52,4 por 100 000 mujeres (de 15 años o más). Las tasas más elevadas de cáncer cervicouterino se observaron en el grupo de edad de 35 a 44 años, seguido por el grupo de 45 a 64 años. Del 2000 al 2010, 65 defunciones fueron atribuibles al cáncer cervicouterino, más del 50% en mujeres mayores de 65 años. La tasa de mortalidad observada fue 16,7 por 100 000, casi el doble de la calculada por la Organización Mundial de la Salud para la región. Conclusiones Este estudio indica la necesidad de establecer un programa integral de detección del cáncer cervicouterino en Granada. Los resultados deben servir como base para estudios futuros sobre cómo generar y ejecutar apropiadamente políticas de salud pública para la educación en la materia, la detección, la prevención y el control del cáncer cervicouterino en Granada.

Pap test accuracy and severity of squamous intraepithelial lesion.

BACKGROUND: Cytology smears and guided biopsies are the most widely used diagnostic standards for cervical cancer (CC) screening in the developing countries. AIM: To evaluate the performance of conventional cytology in estimating the presence and grade of cervical disease against the reference standard of histopathology. SETTINGS AND DESIGN: After primary screening for CC, directed biopsies were performed and compared with histopathology results. MATERIALS AND METHODS: Papanicolaou (Pap) smears and biopsies from 3194 women in the age group of 14‑98 years were included. Cytology results were provided by doctors who performed the cervical biopsies. STATISTICAL ANALYSIS: The accuracy of Pap smear was measured by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) calculated using the statistical analysis program PSPP 0.7.8. RESULTS: The sensitivity of conventional cytology (Pap smear) for women with low‑grade cervical intraepithelial neoplasia or less serious lesions (CIN1‑) was 93% and specificity was 73%. The sensitivity and specificity of cytology for women with high‑grade cervical intraepithelial neoplasia or cancer (CIN2+) was 64% and 84%, respectively. CONCLUSION: Cytology is a sufficiently sensitive test for detection of cervical lesions and can be used as a primary testing tool to triage.

Effect evaluation of white acetate solution on cervical lesion screening / 中国医师进修杂志

Objective To explore the value of cervical lesions screened with white acetate solution. Methods Four hundred and eighty-five patients who were suspected with cervical lesion during Janurary to March 2016 were enrolled in this study. The patients were asked about the medical history, filled the registration form, and performed routine gynecological examinations with white acetate solution, thinprep cytology test (TCT) and vaginal endoscopic biopsy. The value of white acetate solution in clinic was assessed. Results In 485 patients, 450 patients (92.78%) were pathologically diagnosed of inflammation (92.78%), 24 patients (4.95%) were diagnosed of low-grade squamous intraepithelial lesion (LSIL), 10 patients (2.06%)were diagnosed of high-grade squamous intraepithelial lesion (HSIL), and one patient (0.21%) was diagnosed of cervical cancer. The detection rate of white acetate solution and TCT were gradually increased with the increase of the degree of cervical lesions. The detection rate of white acetate solution in the inflammation was 1.33%, in LSIL was 91.67%, in HSIL was 9/10, and in cervical cancer was 1/1. The detection rate of TCT in the inflammation was 8.44%, in LSIL was 66.67%, in HSIL was 6/10, and in cervical cancer was 1/1. The sensitivity, specificity and coincidence rate of the diagnostic results with white acetate solution were 84.21%, 99.33%, 98.14%, and with TCT were 62.30%, 93.63%, 89.69%. There were significant differences (P<0.05). Conclusions Cervical lesions screened with white acetate solution is good in sensitivity and specificity, which is an effective way for screening cervical cancer.

The relationship between cervical lesions in patients with high -risk human papilloma virus infection and serum interleukin-1 beta,interleukin-2,interleukin-10 / 中国基层医药

Objective To explore the relationship between cervical lesions in patients with high -risk human papilloma virus(HPV)infection and serum interleukin -1 beta(IL -1 ),interleukin 2(IL -2),interleukin 10(IL -10).Methods 180 cases of cervical lesions were treated in our hospital from August 2013 to August 2015. Among them,105 cases were infected with HPV,and 75 cases were not infected by HPV.The serum levels of IL -2, IL -10 and IL -1βwere observed in two groups,and compared the levels of serum IL -2,IL -10 and IL -1βin patients with different DNA hr -HPV load,the correlation between DNA hr -HPV load and IL -1β,IL -2 and IL -10 levels was analyzed.Results The levels of IL -1β,IL -10,IL -2 were (0.85 ±0.23)ng/L,(182.35 ± 10.02)ng/L,(38.97 ±5.23)ng/L in patients with HPV infection,the levels of IL -1β,IL -10,IL -2 in patients without HPV infection were (0.62 ±0.18)ng/L,(305.42 ±11.13)ng/L,(25.18 ±3.16)ng/L.The levels of IL -1β,IL -10 were significantly higher in HPV group than in without HPV infection group,the level of IL -2 in HPV group was significantly lower than that of uninfected HPV group,and the differences were statistically significant (t =7.222,20.328,-7.558,all P 1 000,100 -1 000 and 1 000.DNA hr -HPV load was positively correlated with serum IL -1βand IL -10 levels in patients with cervical lesions and HPV infection(r =0.452,0.422,P =0.035,0.019),and nega-tively correlated with IL -2 level(r =-0.398,P =0.027).Conclusion hr -HPV infection is closely correlated with serum IL -1β,IL -2,IL -10 levels in cervical lesions patients,IL -1,IL -2 and IL -10 can be used as impor-tant index for clinical monitoring.

The relationship between human papillomavirus genotypes and cervical lesions / 肿瘤研究与临床

Objective To investigate the prevalence and genotype distribution of human papilloma virus (HPV) infection among patients with cervical carcinoma or precancerous lesions in Xuzhou region. Methods 688 patients with cervical lesions confirmed by colposcopic biopsy were assigned to three groups:low-grade squamous intraepithelial lesion (LSIL) (187 cases), high-grade squamous intraepithelial lesion (HSIL) (359 cases) and cervical carcinoma (142 cases). The genotypes of HPV were determined by nucleic acid hybridization technique. The prevalence and genotype distribution of HPV were further analyzed. Results The infection rates of HPV in LSIL , HSIL and ICC group were 68.98 % (129/187), 94.99 % (341/359), 95.78 % (136/142), respectively. These rates were statistically significant different (P< 0.05). With the aggravation of cervical lesions, HR-HPV infection rate was gradually increased and LR-HPV infection rate was gradually decreased. The most common HPV types were listed below in order of decreasing prevalence. LSIL:HPV16, 52, 58, 18, 31; HSIL: HPV16, 58, 33, 31, 52; cervical carcinoma: HPV16, 31, 58, 18, 33. Based on the cumulative logistic regression model, confidence intervals of the relevance between the overall HPV prevalence and occurrence of cervical lesions were calculated: HPV16 (OR= 7.215, P< 0.05), HPV31 (OR=2.768, P<0.05), HPV33 (OR=1.846, P<0.05), HPV58 (OR=1.726, P<0.05) Conclusions The prevalence of HR-HPV infections increased with the aggravation of cervical carcinoma in Xuzhou region. In order of decreasing prevalence, the most prevalent of HPV types are HPV16, 31, 33, 58. The results indicate that HPV18 have strong tumorigenicity, but is not popular in Xuzhou region. By contrast HPV52 is more common in LSIL than that in cervical carcinoma.