Analysis of fertility preservation and HPV negative conversion rate of LEEP by separating the vesicorectal space / 复旦学报（医学版）

Objective To explore the eradication rate of human papillomavirus(HPV)and gestational outcome of patients with high-grade squamous intraepithelial disease of the cervix(HSIL)after loop electrosurgical excision procedure(LEEP)by transvaginal dissection of the vesicorectal form the cervix.Methods A total of 53 patients treated with LEEP by transvaginal dissection of the vesicorectal form the cervix in Obstetrics and Gynecology Hospital,Fudan University from Jan to Dec,2019 were investigated.Clinical information of cervical cytological examination,HPV test and cervical biopsy under colposcopy were followed up for 6,12 and 24 months post-LEEP were collected.HPV infection in these 53 patients were compared before and after LEEP surgery.The rate of successful fertility of the cohort,the HPV conversion rate of patients with hysterectomy and LEEP done were compared.The association between the pathological type and positive surgical margin and the association between HPV infection type and positive surgical margin were analyzed.Results HPV infection rate of was 94.3%(50/53)and the proportion of HPV16 and/or 18 infection was 75.5%(40/53).Mono-HPV infection rate(69.8%,37/53)was significantly higher than mixed HPV infection rate(22.7%,13/53).Thirty-eight patients(71.7%)were found with positive surgical margin in previous LEEP operation.Fifteen patients had recurrence(28.3%)and 40 patients(75.5%)successfully delivered baby after surgery.Postoperative pathology was mainly HSIL,accounting for 66%(30/53),and 28.3%patients(15/53)had no pathological change.Forty cases had satisfying fertility-conservative operation outcome with negative surgical margin,and 38 patients eradicated HPV infection after LEEP,which took up 95%of patients with satisfying fertility-conservative operation.There was no significant difference of positive resection margin rate in between groups of HPV16/18 infection and other types.Five cases had successful delivery(12.5%,5/40)with 1 case of vaginal delivery and 4 cases of cesarean section.Among these 5 cases,3 cases undertook preventive cervical cerclage,with 1 case of vaginal delivery and 2 cases of cesarean sections.Conclusion HPV eradication rate and surgical outcome could be significantly improved by LEEP with transvaginal dissection of the vesicorectal from the cervix,which satisfied the fertility preservation of females at reproductive age.

Features of eight segments of liver perfusion with the second generation dual-source computed tomography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the features of eight segments of liver perfusion with the second generation dual-source computed tomography (DSCT) .</p><p><b>METHODS</b>Totally 15 patients with pancreatic endocrine diseases underwent abdominal CT perfusion with the second generation DSCT. The liver perfusion images were then transferred to workstation, and perfusion parameters were calculated, and then the artery liver perfusion (ALp) , portal-vein liver perfusion (pVp) , and hepatic perfusion index (HpI) of the eight hepatic segments were calculated.</p><p><b>RESULTS</b>ALp was significantly different between segments 3, 4 and segments 5-8 (P<0.05) . pVp was significantly different between segments 2 and segments 6, 7 (P<0.05) . pVp and HpI were significantly different between segment 3 and segments 5-8 (P<0.05,P<0.01) .</p><p><b>CONCLUSIONS</b>The second generation DSCT can be used to evaluate the perfusion conditions in all eight hepatic segments. The perfusion differs among eight segments of liver, which may be related with the anatomy of the liver vessels and the position of DSCT scanning. Its clinical significance needs further research.</p>

Application of dual-energy computed tomography for detecting uric acid deposition in patients with gout / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the value of dual energy computed tomography (DECT) for the detection of uric acid (UA) deposition in patients with gout.</p><p><b>METHODS</b>A total of 37 patients with tophaceous gout (including 8 crystal-proven cases) and 10 control patients (5 with unknown arthropathy, 3 with rheumatoid arthritis, and 2 with osteoarthritis) were included. DECT was performed for all peripheral joints (wrists, hands, elbows, knees, ankles and feet) . Color coding was used to display the localization of UA deposition. Images were reviewed independently by two trained radiologists.</p><p><b>RESULTS</b>With DECT, patients with gout were found to have UA deposits in hands and wrists 46% (17/37) , elbows 16% (6/37) , knees 27% (10/37) , ankles and feet 89% (33/37) . No UA deposit was observed in all 10 control patients (P=0.000) . Among the 37 patients with gout, the number of UA deposition sites detected by DECT (n=297) was 2.25 times of that detected by physical examinations (n=132) (P=0.000) .</p><p><b>CONCLUSIONS</b>DECT allows the visualization of UA deposition in gouty arthropathy. Even subclinical disease can be delineated with this technique. However, the accuracy of DECT requires further investigations.</p>