Efficacy of Pap test in combination with ThinPrep cytological test in screening for cervical cancer.

BACKGROUND: Our aim was to investigate the efficacy of the Pap test in combination with the ThinPrep cytological test (TCT) in screening for cervical cancer in China. DESIGN: From March 2006 to October 2008, 988 women with the mean age 46.4 ± 10.5 years (range, 23-80 years) were recruited to receive cervical cancer screening. Pap test results ≥ grade III and TCT findings ≥ ASCUS/AGUS were considered abnormal. Subjects with a Pap test result ≥ grade IIb received TCT. Colposcopy and biopsies were performed in all participants, and final diagnosis was based on pathological findings. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden index for predicting CIN I or above were determined. RESULTS: The sensitivity, specificity, PPV, NPV and Youden index of the Pap test were 43.1%, 97.2%, 70.0%, 91.9%, and 40.3%, respectively. The same values for TCT in predicting CIN were 80.0%, 63.2%, 16.0%, 97.3%, and 43.2%, respectively. The two tests in combination gave values for predicting CIN of 64.8%, 87.6%, 43.6%, 94.4%, and 53.5%, respectively. Combined testing exhibited the highest Youden index (53.4%). CONCLUSION: The Pap test with a reduced threshold in combination with the TCT has high sensitivity and high specificity in screening for cervical cancer.

[Survey on menopausal age and menstruation span in women in Pudong district of Shanghai].

OBJECTIVE: To investigate natural spontaneous menopausal age, menstruation span and their relationship with menarche age and parity in Pudong district of Shanghai. METHODS: From Jan 2007 to Jul 2008, 15 083 spontaneous menopause women undergoing cervical cancer screening were enrolled in this study. The questionnaire included menarche age, parity, spontaneous menopausal age and menstruation span. Those women were divided into four groups based on age, which were group of 56 - 60, 61 - 65, 66 - 70 and more than 70.Analysis of variance (ANOVA) was used for comparing difference between menopausal age and menstruation span. Multiple factor regressions was used to analyze the relationship between menarche age, parity and menopausal age and menstruation span. RESULTS: (1) Spontaneous menopausal age: the minimum was 29 years old, the maximum was 61 years old, and the mean age was (50.6 ± 3.7) years old. The mean spontaneous menopause age were (50.9 ± 3.4), (50.7 ± 3.7), (50.0 ± 4.1), (49.6 ± 4.0) years in groups of 56 - 60, 61 - 65, 66 - 70 and more than 70 years. With the increasing age range in four groups, the increasing trends of menopausal age were observed, which the difference of 1.36 year was shown between groups of 56 - 60 and more than 70 years. (2) Menstruation span: the mean of menstruation span was (34.3 ± 4.1) years, which the minimal age of 12 years and maximal age of 48 years were recorded. (34.6 ± 3.8), (34.3 ± 4.1), (33.9 ± 4.6), (33.2 ± 4.5) were observed in groups of 56 - 60, 61 - 65, 66 - 70 and more than 70 years. With the increasing age range in four groups, the increasing trends of menstruation span were observed, which the difference of 1.41 year was shown between groups of 56 - 60 and more than 70 years. (3) The impact of menarche age on menopausal age and menstruation span: there was no correlation between menarche age and menopausal age (r = 0.02); however, menstruation span was found to be negatively correlated with the menarche age (r = -0.43). (4) The impact of parity on menopausal age and menstruation span: the mean menopausal age of women who had 1 - 2 deliveries was significantly higher than those had no delivery or more than 3 deliveries (P < 0.05). However, there was no difference in menopausal age between women with 1 and 2 deliveries or between women without delivery and more than 3 deliveries (P > 0.05). Menstruation span of women with 1 delivery was significantly longer that those with more than 1 delivery (P < 0.05), similarly, women with 2 deliveries had longer menstruation span than women without delivery or more than 3 deliveries (P < 0.05). There were no difference in menstruation span between women with more than 3 deliveries and without delivery (P > 0.05). (5) Multifactor regression analysis for menstruation span: menarche age was correlated with menstruation span negatively (r = -0.97, P < 0.001). There was significantly different menstruation span between group of 61 - 65, 66 - 70 or more than 70 years and group of 56 - 60 (r = -0.18, P = 0.020; r = -0.78, P < 0.001 and r = -1.23, P < 0.001). Menstruation span in women with 1 - 2 deliveries was significantly longer than that of women without delivery or more than 3 deliveries. (6) Multifactor logistic analysis of menopausal age: there was no association between menarche age and menopausal age, however, significant differences were found in mean menopausal age between different groups, which show that menopausal age of group 56 - 60 years was significant higher than the other groups, including age-group 61 - 65 years, 66 - 70 years and over 70 years (r = -0.18, P = 0.020; r = -0.78, P < 0.001; r = -1.23, P < 0.001). Menopausal age in women with 1 - 2 deliveries was significantly higher than those of women without delivery or with more than 3 deliveries, however, no difference between women with 1 and 2 deliveries or between women without deliveries and more than 3 deliveries was observed. CONCLUSION: (1) Menopausal age and menstruation span exhibited increasing trends in Pudong district of Shanghai. (2) Menarche age and parity were the important factors influencing menopausal age and menstruation span. (3) With younger age of menarche, the menstruation span become longer.(4) Deliveries of 1 - 2 times can significantly delay the menopause and prolong menstruation span, however, the multiple deliveries (≥ 3 times) had no significant impact on menopausal age and menstruation span.

[Diagnosis of stress urinary incontinence using poster urethrovesical angel measured by ultrasonography].

OBJECTIVE: To evaluate the clinical value of ultrasonography detecting the poster urethrovesical angle (PUVA) in diagnosis of stress urinary incontinence (SUI). METHODS: From Jan. 2006 to Dec. 2008, the PUVA in resting phase (PUVA-r) and stress phase (PUVA-s) between 84 patients with SUI and 100 healthy women were measured by color Doppler ultrasound, including 57 cases in SUI degree I, 22 cases in SUI degree II, 5 cases in SUI degree III. RESULTS: (1) The PUVA-r and PUVA-s were (130+/-29) degrees and (158+/-36) degrees in SUI patients, which were significantly higher (113+/-19) degrees and (115+/-23) degrees in control group (P<0.01). (2) Correlation analysis showed that PUVA-s was positively correlated with the severity of SUI (P<0.01). (3) The area under the receiver operating characteristic curves (ROC) of PUVA-s was 0.82 (95% CI: 0.76-0.89) between SUI patients and healthy women. When PUVA-s>or=140 degrees was chosed as the cut-off value, the specificity, accuracy rate and positive predictive value in diagnosis of SUI were 84%, 79%, 81%, which were significantly higher than those when cut-off value of PUVA-s>or=120 degrees (54%, 68%, 62%; P<0.05). CONCLUSION: The PUVA-s in SUI patients are significantly increased and is positively correlated with the severity of SUI, which are indicated that PUVA-s>or=140 degrees should be used as cut-off value in diagnosis of SUI by ultrasonography.

[Survey on age of menarche in 56,924 women recruited from Pudong district of Shanghai].

OBJECTIVE: To survey age of menarche in Pudong district in Shanghai. METHODS: Data in this study were derived from 56,924 women at age of 20-81 years in screening for cervical cancer between January 2007 and July 2008 in Pudong district. The age of menarche were recorded in a questionnaire. To investigate the trends in age at menarche in different socioeconomic status, the subjects were divided into 12 groups in 5-year birth cohorts. The mean menarche age in each group was analyzed by analysis of variance (ANOVA). The percentage of menarche age at 10-12 years and more than 18 years was analyzed by chi2 method. RESULTS: (1) The minimum age of menarche recorded is 10 years old, and the maximum is 28 years old, with average age of menarche at 15.7 years. In all groups, the smallest average age of menarche is 14. 6 years in 26-30 years old age group, while the biggest average age of menarche age is 16.5 years in >75 years old group; The difference showed statistical significance (P < 0.01). (2) The percentages for participants with early menarche age (10-12 years old) or late menarche age (>18-year-old menarche) were 1.82% (1034/56,924) and 5.20% (2959/56,924) respectively. However, the maximum percentage for early menarche was recorded in 31-35 years old group (4.45%, 197/4431), only 0.84% (10/1191) of participants in >75 years old group was classified as early menarche. Meanwhile, the lowest percentage for late menarche was 0.38% (17/4431) in 31-35 years old group, and the highest percentage was 14.70% (91/619) in >75 years old group. The changes in the percentages for early menarche or late menarche are significantly associated with age differences (P < 0.01). CONCLUSION: The study suggested that the average of onset age of menarche in Pudong district has declined over the past decades in an age-based way, accompanied with the increase of the percentage for early menarche and the decrease of percentage for late menarche.

[Involvement of matrix metalloproteinase-2, -9, and tissue inhibitors of metalloproteinase-1, 2 in occurrence of the accrete placenta].

OBJECTIVE: To investigate the roles of matrix metalloproteinase-9, -2 (MMP-9, 2), and tissue inhibitors of metalloproteinase-1, 2 (TIMP-1, 2) in pathogenesis of the accretio placenta. METHODS: The women with the placenta accrete were recruited and the placenta (23) and deciduas tissues (9) after labor were obtained, and the placenta (28) and deciduas (11) from women without the placenta accreta were obtained as control to get, too. The expressions of MMP-9, -2, TIMP-1, 2 in the placental and decidual tissues were analyzed by real-time PCR. RESULTS: mRNA expression of MMP-9 in the placenta accreta was (3.21 +/- 0.76) copies/microg total RNA, significantly higher (P < 0.05) than that of normal placenta [(3.84 +/- 0.24) copies/microg total RNA)]. MMP-9 transcription in the decidua accreta was (2.50 +/- 0.49) copies/microg total RNA, significantly higher (P < 0.05) than that of normal decidua [(3.81 +/- 0.66) copies/microg total RNA]. mRNA expression of TIMP-1 in normal placenta and placenta accreta was (5.91 +/- 0.56) and (5.92 +/- 0.46) copies/microg total RNA, respectively, with no significant difference between the two groups. mRNA expression of TIMP-1 in the accrete deciduas was (6.63 +/- 0.51) copies/microg total RNA, significantly lower (P < 0.05) than that of normal decidua (7.09 +/- 0.55) copies/microg. mRNA expression of MMP-2 in the accrete placenta was (4.55 +/- 1.13) copies/microg total RNA, significantly higher (P < 0.05) than that of normal placenta (5.53 +/- 0.59) copies/microg. mRNA expression of MMP-2 in the accrete decidua and normal decidua was (6.07 +/- 0.83) and (5.97 +/- 0.76) copies/microg total RNA, respectively, with no significant difference between the two groups. mRNA expression of TIMP-2 in the accrete placenta was (4.69 +/- 0.60) copies/microg total RNA, significantly higher (P < 0.05) than that of normal placenta (3.79 +/- 1.06) copies/microg. mRNA expression of TIMP-2 in the accrete decidua was (5.06 +/- 0.33) copies/microg total RNA, higher significantly (P < 0.05) than that of normal decidua (3.98 +/- 0.60) copies/microg. CONCLUSIONS: The upregulation of MMP-9, MMP-2 in placenta and downregulation of TIMP-1 in decidua were involved in occurrence of the placental accreta, and the roles of TIMP-2 in occurrence of the placental accreta need to elucidated.