Effect of positive end-expiratory pressure ventilation on plasma nitric oxide, endothelin-1 and vascular celladhesion molecule-1 levels in patients undergoing uvulopalatopharyngoplasty.

BACKGROUND: During uvulopalatopharyngoplasty (UPPP), cardiovascular adverse events may occur which can be harmful to patients. OBJECTIVE: To evaluate the effect of the protective ventilation strategy on the function of vascular endothelial cells. METHODS: Forty obstructive apnea syndrome (OSA) patients who underwent uvulopalatopharyngoplasty (UPPP) were enrolled. Patients were randomly divided into the control group (group C, PEEP = 0 cm H2O) and PEEP group (group P, PEEP = 5 cm H2O). Each group (n= 20) received intermittent volume controlled ventilation (VCV) with tidal volume 6 ml/kg of the predicted body weight, I:E 1:2, rate titrated for ETCO2 35-45, FiO2 0.7. Blood from the radial artery was sampled for blood gas analysis at four time points: the fifth minute of inhaling pure oxygen (T0), after tracheal intubation (T1), at the end of the operation (T2), and 20 minutes after extubation (T3). Three ml of arterial blood was retained, preserved at -20∘C after serum isolation, and plasma nitric oxide (NO), endothelin-1 (ET-1) and vascular celladhesion molecule-1 (VCAM-1) levels were determined by enzyme linked immunosorbent assay (ELISA). RESULTS: Compared with group C, plasma ET-1 at T3 decreased in group P, and plasma NO levels at T2 and T3 increased (P< 0.05). Compared with samples collected at T0, plasma VCAM-1 levels at T1, T2 and T3 increased in group C, while plasma VCAM-1 levels at T2 and T3 decreased in group P (P< 0.05). Compared with group C, plasma VCAM-1 levels T2 and T3 decreased in group P (P< 0.05). CONCLUSIONS: Positive end-expiratory pressure (PEEP) ventilation has a protective effect on vascular endothelial cell function in patients during UPPP.

[Investigation on the prevalence of high risk human papillomavirus and cervical cancer among adult women, in Shenzhen].

OBJECTIVE: To investigate the prevalence of high risk human papillomavirus (HPV) genital infection and cervical cancer in adult women from Shenzhen. METHODS: Cluster sampling was used to investigate the prevalence of HPV infection and cervical cancer from women aged 20 - 59 years old living in Luohu, Futian, Nanshan, Longgang and Baoan districts in Shenzhen from April 2006 to April 2010. All women were detected for liquid-based cytology test (LCT) or Thinprep cytologic test (TCT) and high-risk HPV-DNA test with hybrid capture II (HC-II). All women with ≥ ASC-US by cytology and/or a positive HC-II test were asked to return for colposcopy and four-quadrant biopsy. Endocervical curettage was performed. Pathological finding were used as the gold standard of the diagnosis of cervical intraepithelial neoplasia. RESULTS: 10 210 women were involved in the study and 10 017 of them having completed data. The overall positive rate of high-risk HPV-DNA was 16.29%. HPV positive rates in 20-, 30-, 35-, 40-, 45-, 50-59 age groups were 17.37%, 15.59%, 16.33%, 14.74%, 17.16% and 17.98%, respectively. The curve of HPV infection rates in different age groups appeared a 'W' shape. HPV infection rates in the 25-years-olds and 50-59 year-olds groups were significantly higher than the other age groups (χ(2) = 4.50, P = 0.03). The overall prevalence rate of cervical intraepithelial lesions (CIN) was 7.52%, of which the prevalence rates of low-grade cervical intraepithelial lesions (CIN I) was 5.32% high-grade cervical intraepithelial lesions (CIN II/III) was 2.21%, cervical cancer was 0.12%. The prevalence of CIN I was significantly higher than the CIN II/III (χ(2) = 134.15, P < 0.001). The prevalence of cervical cancer in 45-age group was 0.12%, the highest. HPV infection rates increased with the grades of cervical lesions including women without CIN as 44.31%, in CINI as 70.73%, in CINII as 86.73%, and in CIN III as 96.75% and in cancer as 100.00%. The HPV infection rates were different in districts (χ(2) = 17.81, P = 0.03), with Futian and Luohu higher than those of Nanshan, Longgang and Baoan district. The prevalence rate of CIN in Baoan was lower than other districts. The CIN prevalence rates were not significantly different among the other districts of Shenzhen (χ(2) = 4.84, P = 0.18). CONCLUSION: The prevalence of cervical cancer was low in adult women living in Shenzhen, with cervical lesions still in the early stage. Prevention of HPV infection and treatment of CIN were the key points for the prevention of cervical cancer.

[Role of cytological test for cervices to identify human papillomavirus in the screening program on serious cervical lesion].

OBJECTIVE: To evaluate the value of cervical cytology and hybrid capture II (HC- II) human papillomavarus (HPV) test for screening cervical lesion. METHODS: Conventional papanicolaou (Pap) smear by improved take-samples, liquid-based cytology test (LCT) and HC- II human papillomavarus test were performed in 425 women in Shang Mei-lin community of Futian region in Shenzhen city, from December 2007 to March 2008 and the above methods were performed in 75 women in Shenzhen Hospital of Peking University at the same time. Age stratified sampling was used. Samples of Pap were taken a broom-type sampling device (take-samples used for LCT) with split-sampling method. Those women with HPV-positive, Pap> or =atypical squamous cells of undetermined sign (ASCUS) or LCT> or =ASCUS received multi-spot biopsy and endocervical curettage under colposcopy. Final diagnosis would depend on pathological findings as well, to evaluate the values of Pap, LCT, HC-II HPV, Pap-HPV parallel test, LCT-HPV parallel test, Pap-HPV serial test and LCT-HPV serial test for the screening program on cervical cancer. RESULTS: (1) In this study, 7 women had cervical intraepithelial neoplasia (CIN) II, another 7 had CIN III, 1 had cervical cancer in the community; 9 had CIN II, 11 had CIN III, 3 had cervical cancer in the hospital, respectively. (2) The sensitivity of HC-II HPV and cytology-HPV parallel test for detecting > or =CIN II was >95.0% while negative pre-value were nearly 100.0%. (3) There were no significant differences of screening effectiveness and unsatisfactory rates between Pap of improved take-samples and LCT. (4) The cost-effectiveness ratio of Pap-HPV parallel test was higher than LCT-HPV parallel test. CONCLUSION: It was suggested that the first choice for screening of cervical serious lesion were HC-II HPV and cytology-HPV parallel test while Pap-HPV parallel test was the best method for screening purposes.

[Human papillomavirus infection and cervical intraepithelial neoplasia morbidity of women from different occupations in Shenzhen city, China].

OBJECTIVE: To investigate the human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) morbidity of women from different occupations in Shenzhen city. METHODS: 2045 women of five kinds of occupation in Shenzhen city, including 130 teachers, 385 workers, 316 service women, 199 poverish women, 420 doctors or nurses and 595 general residents were included. We screened these women by methods of detecting high risk HPV of hc2 combing with LCT. Women with screening positive results were diagnosed CIN by colposcopic biopsy. RESULTS: (1) High risk factors on HPV infection rate in different occupations were different with the highest in service occupation (19.3%) while the lowest appeared in medical workers (11.9%). (2) In those 2045 women, we found 199 cervical lesions including pathological HPV infection, CIN1, 2, 3 and cervical cancers, with morbidity rates as 4.11%, 3.28%, 1.67%, 0.54% and 0.15% respectively. Along with the progress of the cervical lesions, the morbidity decreased. (3) The morbidity rates of CIN in different occupations were different, with the highest of HSIL in service occupation and the lowest in teachers. CONCLUSION: Women of different occupations in Shenzhen city had different high risk HPV infection rates and CIN morbidity. The HPV infection rate and HSIL morbidity were highest among women having service related jobs.

[Evaluation of gene chip technology for high risk type human papillomavirus in cervical cancer screening].

OBJECTIVE: To investigate the clinical value of gene chips technology for human papillomavirus (HPV) in cervical cancer screening. METHODS: A population-based cross-sectional screening study was conducted among 1137 women aged 15-59 in a community, Shenzhen city. Hybrid capture 2 (hc2) and gene chip technology were performed to examine the high risk type human papillomavirus in the exfoliated cervical cells. Liquid-based cytology test (LCT) was also performed at the same time. The HPV-positive women with LCT > or = atypical squamous cells of undetermined sign (ASCUS) and the HPV-negative women with LCT > or = low grade squamous intraepithelial lesion (LSIL) underwent biopsy under colposcopy. The pathological results were used as the gold standard to evaluate the two HPV test methods. RESULTS: Totally 122 biopsy specimens were obtained. Pathological examination showed no cervical cancer case, 3 cases of grade III cervical intraepithelial neoplasia (CIN), 11 cases of grade II CIN, 36 cases of grade I CIN, 69 cases of chronic cervicitis and metaplasia of squamous epithelium, and 3 cases of normal cervix. The HPV-positive rate was 14.0% by hc2 and 9.8% by gene chips with a HPV-positive rate by hc2 higher than that by gene chips (P < 0.001) and an mediocre accordance rate between these methods (kappa = 0.498). The. HPV-positive rate increased along with the increase of the grade of cervical lesions (P < 0.05). The sensitivity, specificity, accuracy, positive prevalue, negative prevalue, positive likelihood ratio and negative likelihood ratio of hc2 for high-risk HPV were 100%, 87.1%, 87.3%, 8.8%, 100%, 7.7 and 0.000, respectively; and those of gene chips were 78.6%, 91.1%, 90.9%, 9.9%, 99.7%, 8.8 and 0.235 respectively. CONCLUSION: At present hc2 high risk HPV testing is still the better method for cervical cancer screening. Gene chips technology is able to rival hc2 except that its sensitivity for cervical high grade lesions need be improved.

[Distribution of human papillomavirus types in Shenzhen women].

OBJECTIVE: To investigate the status of genital infection as well as distribution of types of human papillomavirus (HPV) in women in Shenzhen and provide population data for the future vaccine intervention on cervical cancer. METHODS: Women with age between 15 and 59 years were selected in cluster stratified sampling from Huaqiaocheng community, Nanshan district, Shenzhen and received a population-based cervical cancer screening. After consent, every woman was interviewed by using questionnaire and tested by liquid-based cytology and HPV DNA (hybrid capture 2 and gene chips typing) separately. RESULTS: Totally 1 137 women were screened. The rate of high risk HPV of hybrid capture 2 test (14. 0% ) was higher than gene chips typing test (9. 8%) (chi(2) = 27. 198, P < 0. 001) ; the consistency of the two tests was acceptable ( kappa = 0. 498, P < 0. 001). The rates of low risk HPV types and other types of gene chips typing test in this population were 1. 9% and 0. 2% respectively. The percentages of HPV 16, 18 and 58 in HPV positive women were 29. 7% , 18. 9% and 18. 9%. The rates of different age group of low risk HPV were 1. 4% (17-34), 1. 7% (35-44) and 3. 2% (45-59) , respectively. CONCLUSIONS: HPV 16, 18, and 58 are the most popular types in the study population. The differences of infection rates of high risk HPV are due primarily to the variation of HPV16 distribution among age-specific population. The chances of being affected by low risk HPV will increase with age.