Volume 86  ·   Issue 05  ·  2006

In recent years, with the extensive development of cervical cancer screening, invasive carcinoma has become relatively rare in clinic, and the number of cervical intraepithelial neoplasia (CIN) is increasing, so it is increasingly important to correctly and standardizedly treat CIN. The American Association of Colposcopy and cervical Pathology (ASCCP) held a special seminar in 2001 to formulate the management guidelines for histological diagnosis of CIN by colposcopy biopsy. After 2 years of clinical practice, the guidelines were published in July 2003 [1], which provided a basis for standardizing the treatment of CIN. However, how to standardize the treatment of CIN according to the actual situation in China and avoid over or under treatment is still a problem worth exploring. The papers published in this issue of Chinese Medical Journal have certain reference value for the formulation of clinical treatment plan of CIN.

In the past 20 years, due to the introduction of advanced methods such as thin-layer liquid-based cytology, cervical cytology Bethesda (TBS) reporter system and hybrid capture (HCII) detection of human papillomavirus (HPV), the diagnostic level of cervical intraepithelial neoplasia has been greatly improved. In the diagnosis, a basic point is to follow the "three-step" model, namely, the diagnosis should be carried out according to the steps of cervical cytology screening and HPV detection (if necessary) -colposcopy-cervical biopsy/cervical canal diagnosis and curettage (ECC). In the treatment, the principle of individualization should also be followed. The treatment of cervical intraepithelial neoplasia includes observation and follow-up, freezing, laser, electrocoagulation, circular resection, cervical conization, hysterectomy, drug and photodynamic therapy, etc. How to choose the treatment standardized and reasonable is not only common in clinic, Another very important issue. The choice of treatment methods should be comprehensively considered according to factors such as the grade of the lesion, the scope of the lesion, the age of the patient, the status of marriage and childbirth, the follow-up conditions and technical equipment. No matter what method is used for treatment, the patient must be followed up closely.

Objective to establish a new drug susceptibility test model by quantitative biological analysis of cuticle fungi, so as to better evaluate the in vitro and in vivo consistency of antifungal drugs.Methods Twenty-one healthy volunteers were randomly divided into two groups and received different doses of itraconazole (200mg,twice/d; 200mg,once/d) for 1 week; Skin cuticle of volunteers was taken as culture medium (skin cuticle strip) before and at different times after taking medication, and the bacterial suspensions of Trichophyton rubrum, Trichophyton pallidum, Microsporum caninum, Candida albicans, Candida glabrata and Candida tropicalis were inoculated on them respectively. After culture, iodic acid-Schiff (PAS) staining was performed; The area covered by spores and hyphae was measured by quantitative bioanalysis of fungi in stratum corneum with computer-aided image analysis. Results All six fungi could grow on the stratum corneum medium of the two groups, but the colony size, hyphae density and spore number were also different with the different content (concentration) of drugs in the stratum corneum. The growth of fungi was inhibited by drugs, especially the area covered by fungi was significantly lower after 7 days of administration than before administration (P<0.01). The inhibitory effects of the two different drugs on the three kinds of dermatophyten, Candida albicans and Candida tropicalis were not statistically significant, all P>0.05. However, the difference was statistically significant for Candida glabrata, P<0.01. The bioavailability of itraconazole in human stratum corneum was higher, and it showed high antifungal activity against six strains. Conclusion the improved quantitative biological analysis of fungi in stratum corneum supplemented by computer graphic analysis is different from the traditional drug susceptibility test in vitro. A new model similar to the in vivo environment is established, which has certain reference value for evaluating the in vivo and in vitro consistency of antidermatofungal drugs.

Objective to investigate the clinical characteristics, treatment and prognosis of supratentorial cavernous hemangioma (CA) in children.Methods The clinical data of 25 children with supratentorial cavernous hemangioma admitted from 1994 to 2003 were analyzed retrospectively, and the relationship between the preoperative epilepsy course and prognosis was compared.Results The first symptom was epilepsy in 14 children, all of them were resected, and the epilepsy disappeared in 8 cases with preoperative epilepsy course less than 1 year. In 6 cases with epilepsy course more than 1 year, 3 cases of epilepsy disappeared after surgery, 11 cases of first symptom were hemorrhage and neurological involvement caused by it, and 10 cases of surgical resection, there was no rebleeding at the original lesion site and no seizure after surgery. Conclusion Surgical resection of supratentorial CA in children can well control the occurrence of postoperative rebleeding and epilepsy, and it was found that early surgery after seizure can improve the postoperative epilepsy control rate.

Objective to investigate the reliability of atlantoaxial transarticular screw fixation (Magerl operation) without orthopedic fluoroscopy.Methods Magerl operation was performed in 75 patients, 48 males and 27 females, with an average age of 35.1 years. During the operation, the position of the screws in the orthopedic position of the atlantoaxial lateral mass was obtained by directly looking at the axial isthmus and indirectly judging the position of the atlantoaxial lateral mass. Postoperatively, the position of 150 screws in the atlantoaxial lateral mass was analyzed by observing the X-ray opening position, lateral position and CT reconstruction images.The lateral mass of the atlantoaxial vertebra was divided into three regions: A, B and C. Area A: located in the articular plane of the lateral mass, and the fixation strength of the screws in this region was reliable; Area B: Located in the bone around the articular surface (medial B1, lateral B2). The fixation strength of the screw in this area is unreliable, and there is too little bone on one side around the screw; Area C: Located outside the lateral mass (in the C1 spinal canal, in the C2 transverse process foramen), no fixation effect, injury to spinal cord or vertebral artery.Results Of 150 screws, 139 screws were located in area A, accounting for 92.7%,8 screws were located in area B1, and 3 screws were located in area B2, accounting for 7.3%.No screws were located in area C. All the atlantoaxial bone grafts were fused at 3 months post-operative follow-up.Conclusion The method of placing screws in the lateral mass of the atlas can obtain a satisfactory screw position in the atlas without orthoscopy.

Objective to investigate the characteristics and regularity of cytoglobin expression in lung adenocarcinoma cells after hypoxia. Methods Human lung adenocarcinoma cell line A549 was amplified and divided into four groups: normoxic group (control group) and hypoxic group for 4, 12, 24 h. The control group was cultured in conventional incubator (5%CO2, 95% air, 37℃), and each hypoxic group was cultured in hypoxic incubator (2%O2, 5%CO2, 93%N2, 37℃) for different times (4, 12, 24 h). After immunohistochemical staining and immunoblotting, the distribution and expression of protein levels were analyzed, and the changes of cytoglobin mRNA levels were analyzed by reverse transcription PCR. Results Immunohistochemical staining showed that cytoglobin was mainly distributed in the cytoplasm of lung adenocarcinoma cells, and the staining intensity of cytoglobin in hypoxic group was higher than that in normoxic group. The results of immunoblotting gray scale analysis showed that the expression of cytoglobin in hypoxic group was higher than that in normoxic group (153.5±7.1,233.3±26.8,276.2±41.4 vs 95.7±13.1,P<0.05). Conclusion Cytoglobin is a kind of globin distributed in the cytoplasm of lung adenocarcinoma cells, and the expression of cytoglobin is up-regulated in lung adenocarcinoma cells after hypoxia for 4 hours, and the increase of cytoglobin expression may be a kind of compensatory response of cells to hypoxic tumors.

Objective to investigate the effect of vagus nerve on the induction rate of atrial fibrillation in different parts of pulmonary vein under the condition of deautonomization. Methods Ten healthy breed dogs were treated with deautonomization model by cutting off bilateral cervical vagus trunks and destroying cervical sympathetic ganglia. S1S1 and S1S2 program stimulation were performed in the right atrial appendage, left atrial appendage, left atrium and the proximal, middle and distal segments of four pulmonary veins, respectively. Under the condition of basal stimulation and simultaneous stimulation of bilateral cervical vagus nerve or atropine, the changes of atrial fibrillation induction rate in different parts of atrium and pulmonary vein were observed. Results Under the basal state, S1S2 program stimulation in all parts of atrium and pulmonary vein could induce premature atrial beats or short atrial tachycardia, but less atrial fibrillation. When S1S1 stimulation was accompanied by bilateral cervical vagus nerve stimulation, the induction rate of atrial fibrillation in all parts of atrium and pulmonary vein was significantly higher than that in basal stimulation (22.2% vs 59.3% in right atrial appendage, 14.8% vs 55.6% in left atrial appendage, 18.5% vs 51.9% in left atrium, 33.3% vs 66.7% in upper left upper pulmonary vein, P<0.05, P<0.01). Compared with basal stimulation, atropine effect did not affect the induction rate of atrial fibrillation in pulmonary vein (all P>0.05). Conclusion For atrial fibrillation of pulmonary vein origin, vagus nerve may also be an important induction factor involving the initiation of atrial fibrillation.

Background clinical nutrition support is generally considered to include providing patients with comprehensive nutrients through oral, enteral or parenteral routes. Currently, it includes enteral nutrition (EN) and parenteral nutrition (PN) in clinical practice.

Objective to investigate the expression of various cyclin from human papillomavirus (HPV) E6 and E7 sites in cervical carcinoma. Methods Seventy-three HPV16-positive cervical squamous cell carcinoma tissues were selected, 35 from Australia and 38 from China. The expressions of p53, pRb, p16INK4A, p21CIP1/WAF1, p27KIP1 and cyclin D1 were detected by semi-quantitative immunohistochemistry. Results There were no significant differences in mean age, lymph node metastasis and tumor cell differentiation between the two groups, but the number of patients with advanced cervical cancer (>stage Ⅱa) in the Chinese group was more than that in the Australian group (P =0.007). The positive expression rate of p53 and the upregulation rate of pRb, p21 and p27 in the Australian group were 3%, 56%, 63% and 34%, respectively, and that in the Chinese group were 23%, 89%, 97% and 89%, respectively. The upregulation of p16 and cyclin D1 in the two groups The overall up-regulation rates of pRb, p16, p21, p27 and cyclinD1 were 74%, 99%, 81%, 63% and 7%, respectively. Conclusion the overexpression of pRb, p16, p21 and p27 in HPV-16 positive cervical cancer was obviously present, and the overexpression rate of p53 and pRb, p21 and p27 in Chinese cervical cancer was significantly higher than that in Australian group. This suggests that the molecular pathway of HPV-induced cervical cancer is complex, and further research is necessary in different races.

Objective to evaluate the clinical value of human papillomavirus (HPV) typing gene chip detection technology in the screening of cervical carcinoma. Methods From November 2004 to December 2004, a population-based cross-sectional survey was conducted among women aged 15-59 years who had sex in OCT community of Nanshan District, Shenzhen. The cervical exfoliated cells of all screened women were detected by second-generation hybrid capture technology (HC2) and gene chip technology, and cervical cytology was performed by liquid-based cell thin layer smear technology (LCT). The women with HPV positive and LCT ≥ atypical squamous epithelial cells (ASCUS) or HPV negative but LCT ≥ low-grade squamous intraepithelial neoplasia (LSIL) were examined by colposcopy. The pathological results were used as the reference standards to verify the detection of the two kinds of HPV. Results A total of 122 tissue specimens were collected. The pathological results confirmed that there were no cases of cervical cancer in this population, including 3 cases of cervical intraepithelial neoplasia (CIN) grade Ⅲ, 11 cases of CIN grade Ⅱ, 36 cases of CIN grade Ⅰ, and chronic cervical neoplasia (CIN) grade Ⅲ The total detection rate of HPV was 14.0% by HC2 method and 9.8% by gene microarray method. The detection rate of HPV by HC2 method was significantly higher than that by gene microarray method (P<0.001), and the agreement between them was average (Kappa =0.498); The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of high-risk HPV detection in high-grade cervical intraepithelial neoplasia were 100%, 87.1%, 87.3%, 8.8%, 100%, 7.7 and 0.000, respectively, and the above indicators of HPV typing using gene chip were 78.6%, 91.1%, 90.9%, 9.9%, 99.7%, 8.8 and 0.235, respectively. Conclusion the second generation hybrid capture technique (HC2) is still a better method for cervical cancer screening.

Objective to evaluate the accuracy of colposcopic biopsy in the diagnosis of cervical intraepithelial neoplasia (CIN). Methods the clinicopathological data of 153 patients who were diagnosed with CIN by colposcopic biopsy and underwent cervical circular resection (LEEP) in the past 3 years were retrospectively analyzed. The results of colposcopic biopsy and final pathological results were compared by self-control, and the correlation factors of missed diagnosis of invasive cervical cancer were analyzed. Results Among 153 patients, the results of colposcopic biopsy were consistent with the final diagnosis in 106 cases (69.3%) and 47 cases (30.7%), of which 22 cases (14.4%) were over-diagnosed and 25 cases (16.3%) were under-diagnosed. Among 153 patients, the final diagnosis of invasive cervical carcinoma was 18 cases (11.8%). The missed diagnosis rate of invasive cervical carcinoma was significantly higher in patients with high grade squamous intraepithelial lesions (HSIL) or above than those with low grade squamous intraepithelial lesions (LSIL) or below (χ 2=8.208, P<Conclusion Biopsy under direct colposcopy is not reliable enough for the diagnosis of CIN, and there is a possibility of missed diagnosis of cervical invasive carcinoma; When the cytological findings are high-grade squamous intraepithelial lesion (HSIL) or above, we should be alert to the possibility of missing the diagnosis of cervical invasive carcinoma.

Objective to investigate the clinical characteristics and treatment methods of cervical carcinoma in situ, and to summarize the effects of different treatment methods on survival, recurrence and pregnancy of cervical carcinoma patients.Methods The clinical manifestations,diagnostic methods,surgical methods,pathological results and prognosis of 118 patients with cervical carcinoma in situ who underwent surgical treatment from January 1987 to October 2002 were retrospectively analyzed.The age of the patients was 24~77 years old, with an average of 38.8 years old.The cervical cytology examination mainly showed cervical intraepithelial neoplasia Ⅲ and cervical high-grade squamous intraepithelial neoplasia.118 patients underwent colposcopy, mainly with multi-quadrant lesions.All patients underwent cervical conization, which included cold knife conization and electrosurgical conization.Results Cold knife conization in 64 cases, accounting for 54%; There was no significant difference between the two methods in pathological clearance degree and surgical complications. 71 cases (60%) were followed up by conectomy, 47 cases (40%) were followed up by total hysterectomy (or double adnexal), 17 cases were pregnant after cervical conectomy, and 118 cases were followed up with no recurrence of tumor. Conclusion Cervical conectomy should be performed to confirm the diagnosis of cervical carcinoma in situ, in which cervical cytology and colposcopy play an important role.

Case Abstract A 55-year-old male, whose platelets (30~35) ×109/L were found in other hospitals due to diarrhea in 1997, was not diagnosed and treated. In May 2000, he was prone to gingival bleeding, epistaxis and fatigue when brushing his teeth, and the platelets were found in other hospitals to be 20×109/L; Serum creatinine (Cr) was normal, urea nitrogen (BUN) was 8.2 mmol/L; B-ultrasound: spleen thickness 48 mm; Bone marrow image: thrombocytopenic purpura; Bone biopsy (-), considered as essential thrombocytopenic purpura, given aminopeptin and creatinine treatment, because the platelets did not increase significantly, the drug was discontinued.

The concept of dose intensity has been introduced in the treatment of malignant tumors for 20 years [1]. The dose intensity of chemotherapeutic drugs is very important for improving the efficiency of treatment of malignant tumors, especially for those tumors that are sensitive to chemotherapy. Increasing the dose intensity can be achieved by increasing the single dose (dose escalation) or shortening the dose density (dose density).

A 3-year-old male was found to have a mass in the right scrotum in May 2002. He came to hospital in June 2003 because of the progressive enlargement of the mass in the lower right scrotum for 1 week. The appearance of the right scrotum was slightly larger than the left side, and there was a mass of about 2.0 cm ×1.5 cm in the right scrotum, with hard texture and smooth surface. The upper pole extends to the groin, and the intact testis can be reached below it, with a size of about 1.0 cm ×0.6 cm. B-ultrasound examination showed a mass extending to the groin above the right testis, with a size of about 21 mm ×14 mm, with uneven texture, a little blood flow signal (CDFI) and suspected calcification, with a diameter of about 1~2mm.

Glomerular filtration rate (GFR) is an important index in clinical evaluation of renal function. GFR (gGFR) measured by 99mTc-DTPA (technetium 99m-diethylenetriamine pentaacetic acid) renal dynamic imaging (Gates method) can measure the renal function of patients without collecting blood and urine samples, and it has been widely used in clinical practice. In recent years, foreign studies on the accuracy of gGFR have confirmed that this method is significantly different from the real GFR (tGFR) and cannot replace tGFR [1,2]. Because of the limited number of cases, the accuracy of gGFR in evaluating tGFR at different levels of renal function cannot be elucidated. In this study, the clearance rate of 99mTc-DTPA by double plasma method was used as a reference standard to evaluate the applicability of gGFR in different stages of chronic kidney disease (CKD).

Lupus nephritis (LN) is the most common visceral complication in patients with systemic lupus erythematosus (SLE), and it is one of the three major causes of death [1]. A large number of clinical studies have shown that anti-dsDNA antibodies are closely related to lupus nephritis, and those with high anti-dsDNA antibody titers have more serious renal damage and poor prognosis [2]. At present, it is still unclear how dsDNA anti-dsDNA antibodies are involved in the pathogenesis of lupus nephritis. There is pure dsDNA without any histone in the nucleus and kinetic matrix of Trypanosoma pestis equina, so the anti-dsDNA antibodies in serum of SLE patients are usually detected by blood smear method of Trypanosoma pestis equina. This suggests that there are the same antigenic determinants in the dsDNA structure of Trypanosoma pestis equina as the pathogenic dsDNA in patients. Compared with the dsDNA in mammals, the dsDNA of Trypanosoma pestis equina is simpler and easier to obtain. We established a method by extracting the kinetic matrix DNA (kDNA) of Trypanosoma pestis equina and injecting it into normal mice by specific immune route

In order to prevent and treat the recurrence and metastasis of liver cancer after liver transplantation, chemotherapeutic drugs have been routinely used. epirubicin (Epi) is the commonly used chemotherapeutic drug for liver cancer at present. cyclosporine (CsA) and tacrolimus (FK506) are the basic immunosuppressants after organ transplantation, and their direct effects on liver cancer cells and whether they are high risk factors for tumor recurrence after liver transplantation are still controversial [1]. In this study, the effects of immunosuppressants such as cyclosporine or FK506 on the growth activity of liver cancer cells and the sensitivity to epirubicin were observed by in vitro experiments, and the possible mechanisms were preliminarily discussed.

Peritoneal metastasis is the most common recurrence form after radical gastrectomy in advanced gastric carcinoma, and it is the main cause of death in patients with gastric carcinoma. Studies have shown that transforming growth factor β 1 (TGF-β 1) is closely related to tumor growth, invasion and metastasis [1]. Small interfering RNA (siRNA) technology is a new gene therapy technology, which can efficiently and specifically degrade the mRNA of related genes in cells, and has become an important hot spot in the field of exploring tumor-related genes [2]. In this study, we constructed a vector that can transcribe functional siRNA in cells, and stably transfected human gastric cancer cell line SGC-7901, so as to explore the significance of TGF-β 1 siRNA in the gene therapy of gastric cancer peritoneal metastasis.

Asthma is a T cell-mediated eosinophilic airway allergic inflammation. As the most powerful antigen presenting cells, dendritic cells (DC) play a key role in T cell immune migration. Nuclear factor κ B (NF-κ B) is a p50/p65 heterodimer, and I κ B α is the most important member of NF-κ B inhibitor (I κ B) family, and the combination of the two is located in the quiescent cytoplasm as a trimer. Phosphorylation and degradation of the N-terminal serine (Ser) 32/36 site of I κ B α is a common pathway of NF-κ B activation. Studies have shown that NF-κ B overactivation is an important basis for the persistence and expansion of chronic airway inflammation in asthma [1]. Recently, we cloned the 801 bp (203-1003 bp) long I κ B α mutant (I κ B α) gene of human placental tissue with N-terminal Ser 32/36 phosphorylation site removed, and obtained a novel NF-κ B superinhibitor that is not easily degraded, and constructed its replication-defective recombinant adenovirus ADI κ B α m [

CD44 is a group of widely distributed cell surface transmembrane proteins, which participate in the specific adhesion process between cells and cells and between cells and matrix. Many studies have shown that CD44 plays an important role in the occurrence, development, invasion and metastasis of malignant tumors, but there are some controversies. Hal et al. [1] reported that CD44v6 does not play a role in the invasion and metastasis of squamous cell carcinoma of head and neck. In this study, the expression levels of CD44v6 in different laryngeal tissues were compared by reverse transcription-polymerase chain reaction (RT-PCR) and flow cytometry (FCM) to investigate the role of CD44v6 in the occurrence, development, invasion and metastasis of laryngeal carcinoma.

progesterone replacement therapy can promote bone formation and reduce bone loss in postmenopausal osteoporosis (OP), and the mechanism of progesterone replacement therapy has not been completely elucidated. It was found that osteoblast proliferation and apoptosis play an important role in bone remodeling [1]. We observed the effect of progesterone (P) on the proliferation and apoptosis of human osteoblast cells (hOB), aiming to explore the mechanism of progesterone in postmenopausal OP.

idiopathic pulmonary fibrosis (IPF) is a chronic progressive interstitial pneumonia with poor prognosis. Its pathogenesis is related to the abnormal progressive fibrosis response caused by repeated lung injury, which is also the reason for the poor effect of glucocorticoids and immunosuppressants. Because oxidation-antioxidation imbalance may play a role in the disease progression, and acetylcysteine is the precursor of the main antioxidant glutathione, it has been confirmed that 1800 mg of acetylcysteine daily can increase the level of glutathione in the lung and improve the lung function of patients with fibrous alveolitis. Therefore, Demedts et al. conducted an international multicenter, double-blind, randomized, placebo-controlled, parallel trial to observe whether prednisone and azathioprine combined with high-dose acetylcysteine for one year can delay the decline of lung function in patients with IPF. The results were published in New England Journal of Medicine, Vol. 353, Nov. 24, 2005.