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The Value of High Risk Human Papillomavirus Detection for Cervical Cancer Screening

【摘要】 目的 评价人乳头状瘤病毒(HPV)DNA检测在宫颈癌筛查中的价值。 方法 采用第二代杂交捕获(HCⅡ)技术和液基细胞学测试(LCT)2种方法,对1026例在妇科病中心就诊的受检者进行同步盲法检测,同时进行阴道镜检查。以宫颈活检组织病理学检查结果为诊断标准。评价该方案在宫颈癌筛查中的应用价值。 结果 病理检查结果显示,宫颈上皮内瘤变(CIN)Ⅰ级152例,CINⅡ级108例,CINⅢ级109例,宫颈浸润癌28例。筛查高危型HPV感染366例,阳性率3570%, 在不同宫颈病变中的阳性率分别是:宫颈癌9290%(26/28),CINⅢ900%(99/109),CINⅡ8890%(96/108),CINⅠ8750%(133/152)。高危HPV对宫颈高级别病变的敏感性、特异性、阳性预测值,阴性预测值分别是9860%、8610%、1480%和9980%;HPV与LCT联合检测(平行试验)的以上各指标分别是10000%、8090%、1210%和10000%。 结论 高危型人乳头状瘤病毒检测在宫颈癌前病变的筛查中有较高的敏感度和阴性预测值,联合LCT检测是目前宫颈癌筛查具有诊断价值的方法。【Abstract】 Objective To investigate the value of high risk human papillomavirus(HPV) DNA dectection for cervical cancer screening. Methods Hybrid capture Ⅱ(HCⅡ)human papillomavirus (HPV) test and liquid based cytology test (LCT) were performed in 1026 patients treaed in Xuzhou No.1 hospital from May 2008 to May 2009,and the abnomal cytological or HPV DNA findings were further biopsied under the colposcopeto to appraise the appicational importance of each approach for screening cervical cancer. Results Pathological results showed that cervical intraepithelial neoplasial(CIN)Ⅰin 152 patients,CIN Ⅱ in 108 patients,CIN Ⅲ 109 patients,invasive cervical cancer in 28 patients.HPV infected 366 patients in detection, with 3570% positive rate. The infection rate of HPV in cervical cancer was 929%(26/28),in CIN Ⅲ was 908%(99/109),in CIN Ⅱ was 889%(96/108),and in CIN Ⅰwas 875%(133/152).The pathological results treated as standard,the sensitivity, soecificiy, positive prevalue, negative prevalue of HCⅡ HPV for detecting highgrade cervical lesions were 986%,861%,148% and 998%.The values for HPVLCT parallel test were 1000%,809%,121% and 100%. Conclusion Highrisk HPV DNA test is of high sensitivity and negativepredictive value. The combination of HCⅡ HPV and LCT tests are of great value for screening cervical cancer at present.

REVERSED ARTHROSC OPIC SUBACROMIAL DEC OMPRESSION FOR TREATMENT OF ROTATOR CUFF TEARS

ObjectiveTo investigate the effectiveness of reversed arthroscopic subacromial decompression in the treatment of rotator cuff tears. MethodsBetween November 2012 and January 2015, 53 patients with rotator cuff tears were treated with reversed arthroscopic subacromial decompression and rotator cuff repair. Of 53 patients, 38 were male and 15 were female, with the age of 47-61 years (mean, 53.4 years). The injury was caused by falling in 36 cases and other in 17 cases without an obvious history of trauma. All patients had shoulder pain and limited shoulder movement before operation. Visual analogue scale (VAS) was 6.4±0.9, and University of California at Los Angeles (UCLA) score was 16.3±1.9. MRI showed that distal supraspinatus tear was observed in 41 cases and distal infraspinatus tear in 12 cases; partial-thickness rotator cuff tear was observed in 9 cases and full-thickness tear in 44 cases. And the tear size was from 1 to 3 cm (mean, 1.9 cm). Combined injuries included tendinitis of long head of biceps brachii in 31 cases, Bankart lesion in 5 cases, and superior labrum anterior and posterior lesion in 2 cases. ResultsIncision healed by first intention in all patients; no infection or nerve injury occurred. Forty-nine cases were followed up from 12 to 35 months (mean, 22.8 months). After operation, shoulder pain relief was achieved in 42 cases; 7 cases had anterior shoulder pain at 3 months after operation, which was relieved after symptomatic treatment. At last follow-up, VAS score was significantly decreased to 0.5±0.6 (t=40.565, P=0.000). UCLA score was significantly increased to 33.8±1.7 (t=-79.799, P=0.000). The results were excellent in 42 cases, good in 6 cases, and fair in 1 case; the excellent and good rate was 98.0%. ConclusionReversed arthroscopic subacromial decompression can avoid coracoacromial arch injury and achieve good recovery of joint function, so it can be used in rotator cuff tears procedure.

腓肠神经营养血管逆行皮瓣临床应用21例

逆行腓肠神经营养血管皮瓣交腿移位的临床应用

目的 总结应用逆行腓肠神经营养血管皮瓣交腿移位修复小腿软组织缺损的临床效果。方法 1999年7月～2006年2月，应用逆行腓肠浅动脉筋膜蒂皮瓣交腿移位修复小腿软组织缺损6例。患者均为男性，年龄19～47岁。均为车祸伤致小腿中、下段开放性骨折合并皮肤软组织损伤。其中胫前皮肤缺损2例，足跟部皮肤缺损2例，足背部和内踝皮肤缺损各1例。皮肤缺损范围5cm×4cm～14cm×12cm。伤后至手术时间14～30d。皮瓣范围6cm×4cm～15cm×13cm。结果 术后皮瓣均成活，供受区切口均Ⅰ期愈合。患者获随访4～24个月，平均7个月。2例皮瓣稍臃肿，余皮瓣质地良好，无明显挛缩。X线片示骨折愈合时间7～13个月，平均9个月。修复肢体功能恢复。结论 应用逆行腓肠神经营养血管皮瓣交腿移位修复对侧小腿软组织缺损具有手术操作简便、风险小及修复效果好等优点，是修复小腿软组织缺损的有效方法之一。