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g-C3N4 nanosheets photoelectrode was prepared by a facile drop coating method. The influences of precursor materials and bias voltages on the photoelectrocatalytic properties towards tetracycline degradation using as-prepared g-C3N4 nanosheets photoelectrode (DUCN) were studied. The results demonstrate that the DUCN photoelectrode prepared by calcination of urea and dicyandiamide precursor mixtures exhibits the highest pollutant removal efficiency, which may be due to its best film formation property and highest photoelectron-hole separation efficiency. In addition, in the process of photoelectrocatalysis (PEC), photocatalysis (PC) and electrocatalysis (EC) promote and optimize each other, showing a significant synergistic effect. The DUCN photoelectrode displays the highest removal rate of tetracycline with an initial concentration of 5 mg/L at a bias of 1.0 V, which are 5.6 times and 3.8 times of that obtained by single photocatalytic and electrocatalytic process, respectively. The reason for the enhanced pollutant removal efficiency may be that the external bias voltage enables the photogenerated electrons transfer to the counter electrode more efficiently under the photoelectric synergistic effect, which promotes the separation of photogenerated electrons and holes.

Objective To understand the prevalence and trend of hepatitis A and E in Yantai from 2011 to 2022, and to conduct serological research on hepatitis A and hepatitis E in the community population so as to provide data for effective prevention and control of two types of hepatitis. Methods The case-related information came from the monitoring data of China Disease Prevention and Control Information System. Descriptive epidemiological methods were used to analyze the prevalence of hepatitis A and hepatitis E in Yantai City from 2011 to 2022. Two areas in Yantai were selected bymulti-stage random cluster sampling method to carry out monitoring of hepatitis A and hepatitis E antibody levels in community populations. Enzyme linked immunosorbent assay (ELISA) was used to detect serum levels of anti-hepatitis A virus (HAV) and hepatitis E virus (HEV) antibodies. Results A total of 858 cases of hepatitis A and 3 145 cases of hepatitis E were reported from 2011 to 2022.The annual average incidence rate of hepatitis A was 1.01/100 000, and the incidence was sporadic throughout the year. The annual average incidence rate of hepatitis E was 3.72/100 000.The incidence was mainly in winter and spring. The reported cases of hepatitis A and hepatitis E were mainly concentrated in the northern coastal areas. 86.48% of the reported cases of hepatitis A are 25-69 years old, while 91.86% of the reported cases of hepatitis E were 35-79 years old. The composition of hepatitis A and hepatitis E was mainly men and farmers. A total of 600 blood samples were collected from healthy people, the overall seroprevalence of HAV IgM, HEV IgM, HAV IgG and HEV IgG were 1.83%, 85.67% and 32%, respectively. In terms of age, the positive rate of HAV IgM was the highest in 61-70 years old group (3.9%), HAV IgG positive rate in over 70 years old group was the highest, HEV IgM positive rate in 51-60 years old group was the highest (4.21%), and HEV IgG positive rate in over 70 years old group was the highest. Farmers had the highest positive rates of HAV IgG and HEV IgG, while students, household workers, and unemployed individuals have the highest positive rates of HAV IgM and HEV IgM. Farmers had the highest positive rates of HAV IgG (92.52%) and HEV IgG (46.26%), students had the highest positive rates of HAV IgM (2.78%) and housework and unemployed people had the highest positive rates of HAV IgM and HEV IgM (3.17%). Conclusion The incidence of hepatitis A and hepatitis E remained at a relatively high level in Yantai from 2011 to 2022, and the positive levels of HAV IgG and HEV IgG antibodies were relatively high. Further efforts need to be made to promote and intervene in key populations, especially men and farmers, to carry out relevant prevention and control measures and reduce infection rates. [ABSTRACT FROM AUTHOR]

Coral fossil is formed by various geological effects while buried under the ground for a long time. Current research on coral fossils is focused mainly on the geological and biological evolution of the coral fossils, but less on their components and microstructure. X-ray Diffraction (XRD), Differential Thermal Analysis (DTA), Thermo-gravimetric Analysis (TG) and Scanning Electron Microscope (SEM) and other methods were conducted to determine composition, content and microstructure characteristics of coral fossil samples collected from Shanxi province. The results show that the coral fossils from Shanxi province are composed mainly of calcium carbonate (CaCO3), and the average content is as high as 98.6%. Phase transition of coral fossils occurred at 700℃ with a sharp decline in the mass, namely the CaCO3 decomposed to CaO and CO2. The internal structure of Coral fossils showed a large number of pores whose size is 1-5 μm. Fracture morphology is the same as cleavage fracture, corresponding with 'river pattern'. Coral fossil storage and processing methods to avoid acidic substances and high temperature are described. The highest temperature is 650℃. It is important to avoid a cleavage plane or make an angle between a facet and cleavage plane during processing.

The article is to correct some errors in the Description of Kang Youwei's Disciples and make up for the shortcomings of its related description. At the same time, the author not only comprehensively analyzes and studies the geographical origin, the reform cause, the knowledge structure and the writing remains of Kang Youwei's disciples, but also compares his disciples with Jian s pupils during the same period, in order to find specific path to modern transformation of scholars and academic in Guangdong and promote the research on Kang Youwei's disciples over the past two decades. [ABSTRACT FROM AUTHOR]

Zhu Ciqi burned his works which reshaped the teacher image of Zhu Ciqi cooperated with Jian Chaoliang before his death. That to inherit the break between Zhu Ciqi and Jiang Chaoliang can not only reflect that of Zhu Ciqi and Jiang Chaoliang are inseparable, but also that it is important to follow the trend of times. [ABSTRACT FROM AUTHOR]

Jian Chaoliang is the famous scribe in the modern Guangdong, whose classics books are not only the precedent of the hermeneutics body in Guangdong, but also mark the arrival of the crest period about classics in Guangdong. The exegetical written is the means of Jian Chaoliang's hermeneutics body and the phonetic and definitions are its content. Using the rhyming dictionary and marking local sound , from picking word for sound to universal phonetic and exegetical text depend on some books like Er Ya, Shuo Wen, Shi Wen, gloss of Han Song dynasty and interflowing with classics and history are all the characteristics of Jian Chaoliang's phonetic notation and definitions. While somewhat arbitrary, hollow words and repeated expression are his main shortcomings. [ABSTRACT FROM AUTHOR]

Gliomas are malignant tumors with strong invasiveness. The current treatment strategy is surgical treatment assisted by a variety of radiotherapies, chemotherapies and immunotherapies. However, the curative efficacy is limited. Adrenergic receptor (AR) is an important stress hormone receptor, which is highly involved in the regulation of the tumorigenesis and progression of various tumors by activating different downstream signal transduction pathways. Recent studies have shown that AR is dysregulated in glioma cells and tissues, and plays an important role in a series of biological behaviors such as tumorigenesis, invasion and metastasis of glioma. This article reviews the research progress of AR in the field of glioma in recent years, which provides a theoretical basis for the prevention and treatment of glioma targeting the AR.

To compare the appearances, tastes, contents of bioactive components and antioxidant activity of Lyceum ruthenicum under different drying methods, so as to direct its production practice. The folin-phenol colorimetric method, UV, extinction coefficient method and DPPH, as well as fluorescence recovery after photobleaching (FRAP) method to determine the contents of polyphenols, proanthocyanidins, total anthocyanin and antioxidant activity under different drying methods： vacuum freeze drying, low-temperature oven drying and air drying for L. ruthenicum. The results showed that the drying methods had certain effects on its appearances, tastes, contents of bioactive components and antioxidant activity. The appearances and tastes were best after the L. ruthenicum was dried by vacuum freeze drying, with significantly lower moisture than air drying method. The contents of total polyphenols, anthocyanin and proanthocyanidins were highest by air-drying but lowest by low temperature oven drying in L. ruthenicum. The scavenging ability to DPPH was strongest by freeze-drying and lowest by low temperature oven drying, while the antioxidant activity was strongest by air-drying in the FRAT method. In addition, the appearances and tastes were poor in air drying, with higher moisture but highest contents of the three bioactive components. Therefore, the drying methods for L. ruthenicum shall be comprehensively considered., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Chinese Pharmaceutical Association.)

Objective: To observe the effect of electroacupuncture (EA) of "Zusanli" (ST 36) on myocardium ischemic damage following intestinal ischemia-reperfusion (I/R) in rats., Methods: Thirty SD rats were randomly divided into five groups:sham, I/R-1 h, I/R-4 h, EA-I/R-1 h and EA-I/R-4 h ( n =6 in each group). The intestinal I/R model was established by occlusion of the superior mesenteric artery. EA (2 Hz/100 Hz, 2-3 mA) was applied to bilateral ST 36 for 30 min. In rats of the sham group, only the stomach was opened. Plasma dopamine (DA) and tumor necrosis factor (TNF)-α contents, and myocardial myeloperoxidase (MPO) activity and methane dicarboxylic aldehyde (MDA) content were assayed using ELISA, and plasma creastine kinase isoenzyme (CK-MB) and lactate dehydrogenese (LDH) activities were detected using a fully biochemical analyser. Myocardial pathological changes were observed under microscope after H.E. staining., Results: Compared with the sham group, plasma DA content was significantly decreased in both I/R-1 h and I/R-4 h groups, while plasma TNF-α content and CK-MB and LDH activities, and myocardial MPO activity and MDA content in both I/R-1 h and I/R-4 h groups were obviously increased ( P <0.05). After EA, the decreased plasma DA and the increased plasma TNF-α contents and the increased plasma CK-MB and LDH and myocardial MPO activities and MDA contents in the EA-I/R-1 h and EA-I/R-4 h groups were reversed ( P <0.05). The inhibitory rates of EA on myocardial MDA content and MPO activity were 9% and 13% in the EA-I/R-1 h group and 30% and 15% in the EA-I/R-4 h group, respectively, suggesting a better protective effect of EA intervention on myocardium in the EA-I/R-4 h group., Conclusions: EA of ST 36 has a better protective action on myocardium in intestinal I/R injury rats, which may be related to its effects in up-regulating plasma DA level and down-regulating circulating pro-inflammatory factor TNF-α content, and reducing myocardial oxygen free radicals.

To compare the predictive values of 5% acetic acid stain and visual inspection, human papillomavirus (HPV) Self test, ThinPrep Pap and HPV direct test in screening for cervical cancer with biopsy as gold standard. Positive predictive values and negative predictive values were compared simultaneously by joint hypothesis tests and then either positive predictive values or negative predictive values of the any two screening tests were compared by marginal regression based on both GEE and weighted least square methods. Hochberg method was used for multiplicity adjustment. It was showed that HPV direct test had the highest negative predictive value and ThinPrep Pap the highest positive predictive value. 5% acetic acid stain and visual inspection had both the lowest positive predictive value and negative predictive value. Both HPV direct test and ThinPrep Pap were efficient, but the latter required compatible infrastructure and skilled caregivers to go with. Both 5% acetic acid stain and visual inspection were inexpensive, and their positive predictive value and negative predictive value were lower than HPV self-test. They also had similar positive predictive value with HPV direct test and similar negative predictive value with ThinPrep Pap. HPV self-test appeared to be efficient, suggesting that it had significant potential for screening program to be implemented in the rural areas of China since the test could be performed without speculum examination in low-resource regions.

A method was developed by hydride generation atomic fluorescence spectrometry (HG-AFS)for the determination of selenium in plant samples. Effects of reagent and pre-reduction method on the fluorescence intensity of selenium were studied. The influence of coexisting foreign ions on the determination of selenium was also investigated. Under the optimized digestive and experimental conditions, the linear regression equation was I = 139.98c + 27.71 for Se. The linear range, the correlation coefficient,and the detection limit of Se was 0-10 ng x mL(-1), 1.0000, and 1.45 ng x g(-1) respectively. The recovery of Se (98.9%-101%, mean=100%) was determined through the use of standard reference material. The relative standard deviation for nine replicate analyses was 0.73% for Se content in shrub leaves. This method was verified by analyzing the national reference material (GSV-1)and the found value was in good agreement with the certified value. The proposed method that was successfully used for the determination of Se in plant samples has the advantages of simple operation, low cost, and high efficiency.

Objective: The aim of this study was to discuss the clinical effectiveness of high intensity focused ultrasound (HIFU) combined with gemcitabine administered by intra-arterial infusion on intermediate and advanced pancreatic cancer., Methods: Forty-eight patients with intermediate and advanced pancreatic cancer were divided into two groups. Twenty-four patients of the experimental group were treated by HIFU combined with gemcitabine, and 24 patients of the the HIFU group were treated by HIFU alone. Then the curative effect, extent of pain relief, and survival time were compared in the course of the treatment between the two groups., Results: As compared with those in the control group, the overall response rate, level of pain relief, and 12-month survival rate after therapy were higher and the median survival time was longer in the joint group (P < 0.05)., Conclusions: Ultrasound imaging, CT and associated tumor marker detection can make effective measurement to evaluate curative effect on pancreatic carcinoma. HIFU plus gemcitabine administered by intra-arterial infusion can improve the clinical therapeutic efficacy, pain relief, quality of life and long-term survival rate of patients with pancreatic cancer.

Objective: To study clinical efficacy on cesarean scar pregnancy (CSP) treated by transvaginal surgery., Methods: From Jan. 2008 to Mar. 2011, 31 cases with CSP were managed by transvaginal surgery in Anshan Women and Children Hospital. Based on ultrasonograpy examination and intraoperative exposure of lesion, variable surgical options were executed. Fifteen cases in group A were treated by debridement resection and vaginal repair of uterine wall, 7 cases in group B were treated by transvaginal uterine artery ligation and curettage, 9 cases were treated by cutting the anterior wall in the lower uterine segment and repairing uterine. The intraoperative blood loss, operation time, hospital stay, hCG fluctuation at postoperative period and complications were analyzed among those groups., Results: All cases in 3 groups were cured well in one time. (1) The intraoperative blood loss were (41 ± 21) ml in group A, (27 ± 7) ml in group B and (148 ± 132) ml in group C. There was no statistically different blood loss between group A and group B (P > 0.05), however, the amount blood loss in group C was significantly more than those in group A and group B (P < 0.05). (2) The average surgical time, the mean hospital stay, postoperative recovery time of blood hCG were (40 ± 11) minutes, (4.7 ± 0.8) days and (2.7 ± 1.0) weeks in group A, (44 ± 5) minutes, (4.0 ± 0.8) days and (2.9 ± 1.0) weeks in group B, (40 ± 12) minutes, (4.9 ± 1.0) days and (2.8 ± 0.9) weeks in group C. Those clinical index were no statistically different among those 3 groups (P > 0.05). (3) No bladder injury and other complications were observed in those groups., Conclusions: Transvaginal surgery is efficacy, easy to operate, to keep the uterus, safe and economy in treatment of CSP. Surgery in group A is suitable to treat early and exogenous lesions; surgery in group B is suitable to treat endogenous lesions; surgery in group C is suitable to treat failure cases in group A and B, however, the injury is greater than those in group A and B.

Objective: To investigate the association between CTLA-4 +49A/G polymorphisms and the risk of susceptibility to cervical cancer., Methods: A hospital-based case-control study was conducted. 314 cases with primary cervical cancer and 320 healthy controls were collected and genotyped by PCR-based RFLP for +49A/G polymorphisms in the CTLA-4 gene., Results: The A allele and AA genotype of CTLA-4 gene were 32.5% and 9.6% in the patients, and 25.8% and 5.6% in the controls, respectively. Subjects with CTLA-4 +49AA genotype conferred a higher risk of cervical cancer (OR = 2.06, 95%CI: 1.10 - 3.85; P = 0.024). However, the correlation between AA genotype in CTLA-4 polymorphisms and clinicopathological characteristics was not significant., Conclusion: The results of this study suggest that CTLA4 gene is associated with cervical cancer risk and may be a susceptible gene of cervical cancer.

Objective: To assess the feasibility and accuracy of different cervical cancer screening algorithms suitable for different regions, and promote the prevention and control of cervical cancer in China., Methods: Using the data of a cross-sectional comparative trial of multiple techniques to detect cervical intraepithelial neoplasia in Xiangyuan County, Shanxi Province, conducted in 1999, to evaluate the feasibility and accuracy of different cervical cancer screening algorithms. All the women were screened by six screening tests, including liquid based cytology (LBC), fluorescence spectroscopy, visual inspection with 5% acetic acid staining (VIA), colposcopy, self-sampled HPV DNA and clinician-sampled HPV DNA test, and each woman had histopathological diagnosis. Different screening algorithms were developed by combining the screening tests in parallel or in serial, and the performance indexes of the algorithms such as sensitivity, specificity, colposcopy referral rate and receiver operating characteristic (ROC) curve for detecting the high grade lesions (>or= CIN 2) were compared., Results: Among the algorithms combined by LBC and HPV DNA testing, for the combination in parallel (either cytology was greater than ASC-US or HPV positives), its sensitivity was 100%, specificity was 68.6%, and colposcopy referral rate was 34.4%; for the algorithm of LBC as primary screening test, with ASC-US women triage by HPV DNA testing, its sensitivity was 93.0%, specificity was 89.9%, and colposcopy referral rate was 13.7%; for the algorithm of HPV DNA testing as the primary screening test, with HPV positive women triage by LBC, its sensitivity was 91.7%, specificity was 93.0%, and colposcopy referral rate was 10.6%. ROC analysis showed that LBC primary testing followed by HPV triage and HPV primary testing followed by LBC triage were much better than the combination in parallel (P = 0.0003, P = 0.0002). Among the algorithms with LBC or HPV DNA testing solely as primary screening test, the sensitivity, specificity and colposcopy referral rate of LBC were 94.2%, 77.3%, 25.7% and 87.2%, 93.5%, 10.0%, respectively, for cutoff by ASC-US or by LSIL; the sensitivity, specificity and colposcopy referral rate of HPV DNA testing were 97.6%, 84.8%, 18.8% and 83.5%, 85.9%, 17.1%, respectively, for clinician-sampled and self-sampled. Clinician-sampled HPV DNA testing was better than LBC cutoff by ASC-US or self-sampled HPV DNA testing (P = 0.005, P = 0.002). Among the algorithms combined by VIA and HPV DNA testing, the sensitivity, specificity and colposcopy referral rate were 70.9%, 74.3% and 27.6% for VIA alone as primary screening test; the sensitivity, specificity and colposcopy referral rate were 65.9%, 95.2% and 7.4% for HPV as primary screening test with HPV positive women triage by VIA. HPV primary testing followed by VIA triage was better than VIA alone (P = 0.004)., Conclusion: Considering the health-resource settings and women's preference, both HPV primary testing followed by LBC triage and LBC primary testing followed by HPV triage are suitable for developed regions, moderately developed regions may choose either LBC or HPV as the screening approach, VIA is a suitable primary screening test in less developed regions, and HPV primary testing followed by VIA triage will be more effective if low cost HPV test is available in the future.

Objective: To determine the prevalence of cervical type-specific human papillomavirus (HPV) infection as well as risk factors associated in Tibet Autonomous Region of China., Methods: A cluster sampling study was performed in Lasa, Rikaze and Naqu of Tibet. An epidemiological questionnaire was applied and 3036 cervical specimens were obtained for liquid-based cytology and HPV DNA detection. Statistical analysis included Wald Chi-square and stepwise logistic regression model., Results: The overall HPV prevalence of involved 3036 women was 9.19% (279/3036), of which 7.05% (214/3036) of the women were infected by high-risk types (including 14 sorts of types) and 2.14% (65/3036) by low-risk types (including 6 sorts of types). There were no significant differences of HPV prevalence between age groups (P = 0.936), race (P = 0.718) and areas (P = 0.746), respectively. Twenty-one types of HPV were detected, of which HPV16 (1.52%) was the most common type, followed by HPV33 (1.42%), HPV58 (1.22%), HPV52 (1.15%), and HPV31 (1.05%). HPV type distribution was varied by age. Of the 279 HPV infected women, 14.3% (40/279) exhibited multiple HPV infections. Independent risk factors for HPV infection were smoking (P = 0.027), number of sex partners (P = 0.198) and early age of first intercourse (P = 0.237)., Conclusion: The overall prevalence of HPV infection in Tibet Autonomous Region is lower than that in China or abroad, in which the most common genotype is HPV16 and the independent risk factors for HPV infection included early age of first intercourse, smoking, and number of sex partners.

Objective: To assess the feasibility of nerve sparing radical hysterectomy (NSRH) technique and the impact on the improvement of postoperative bladder function in patients with cervical cancer., Methods: Forty-two patients with FIGO stage Ib1 approximately Ib2 cervical cancer were selected to receive NSRH (study group, 21 cases) or routine hysterectomy (RH) (control group, 21 cases). Duration of surgery, blood loss and mean length of postoperative stay were compared between the two groups. Immunohistochemical analysis of surgical margins using a general nerve marker (S-100) was performed to compare the nerve damages., Results: The operation time of NSRH group and RH group was (248 +/- 24) min and (227 +/- 27) min, respectively, with a significant difference between the two groups (P < 0.01). No significant difference in blood loss was found between the NSRH and RH group [(459 +/- 143) ml vs. (454 +/- 121) ml, P > 0.05]. However, the median urinary catheterization time was 7 days in NSRH group versus 16 days in the RH group, with a statistically significant difference between the two groups (P < 0.01). The rate of patients who had postoperative residual urine volume in bladder (PVR) < or =100 ml was 66.7% in the NSRH group versus 19.0% in the RH group, with a significant difference between the two groups (P < 0.01). No severe perioperative complications occurred in both groups. After a follow-up of 11 to 16 months (median: 14 months), no recurrence was detected in the two groups. Immunohistochemistry with S-100 staining revealed only small nerve fibers in the surgical margins of the NSRH group, but full with large nerve bundles in that of the RH group. There was a significant difference between two group (P < 0.01)., Conclusion: The results of our preliminary study indicate that nerve sparing radical hysterectomy (NSRH) for the patients with FIGO stage Ib1 approximately Ib2 cervical cancer is safe and feasible, and can well preserve the pelvic autonomic nerves and improve the recovery of bladder voiding function.

Objective: To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN)., Methods: Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00), low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load > or = 100.00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression., Results: The HR-HPV infection rate of the population was 14.51% (2515/17334). 100.00% (29/29) of SCC, 97.63% (206/211) of CIN 3, 93.43% (199/213) of CIN 2, 75.04% (421/561) of CIN 1 and 10.17% (1660/16320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC, CIN 3, CIN 2, CIN 1 and normal were 320.85, 158.05, 143.70, 125.34 and 9.64, respectively. There were significant differences among the distributions of viral loads in each lesion (chi2 = 6190.40, P < 0.01). The severity of CIN increased with the viral load (chi2 = 5493.35, P <0.01). Compared with the risks of CINs in HR-HPV negative population, the risks of CINs in low, moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9.01(6.31 - 12.87), 24.96(18.23 - 34.17) and 68.42(51.40 - 91.08); CIN 2 : 26.44(12.07 - 57.95), 98.53(49.54 - 195.98) and 322.88(168.62 - 618.27); CIN 3+ : 72.89(24.02-221.18); 343.58(121.81-969.09) and >999.99(473.38 - >999.99)], and there were obvious dose-response relationships (chi2trend was 3115.05, 2413.95 and 3098.57, respectively. P< 0.01). In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95% CI): <35 : 4.71(1.23 - 18.09) and 15.06(4.40 - 51.49); 35 -: 4.01 (1.62 -9.90) and 14.09(6.15 -32.28); 40 - : 3.06(1.52 -6.16) and 7.78(4.05 -14.95); > or =45: 3.50(1.36 -9. 01) and 7.57(3.13 - 18. 30)], and there was a positive correlation between the risk of CIN 2+ and the viral load (chi2trend was 51.33, 66.28, 53.64 and 51.00, respectively. P <0.01). The risk of CIN 2 + was highest among the women aged 40 - with high viral load [OR (95% CI) : 2.02 (1.15 - 3.52)]., Conclusion: There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3, and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.

Objective: To estimate the sensitivity and specificity of dynamic helical CT scanning for detecting pelvic lymph node metastasis in patients with uterine cervix carcinoma., Methods: Totally 275 patients with pathologically confirmed uterine cervix carcinoma from Jun 2005 to Jul 2007 included bilateral pelvic lymphadenectomy were eligible. CT was performed within 30 days of surgery. The imaging and pathologic findings for each patient and each side pelvic lymph node were compared., Results: The finding of pathology as reference standard, according to diagnostic criteria of most diameter > or = 10 mm or > or = 15 mm with or without central necrosis of imaging of each side pelvic lymph node as the positive diagnosis of CT scan, respectively. The sensitivity and specificity of CT in predicting nodal metastasis were determined. The sensitivity was 62.0%, 33.8%, respectively, and the specificity was 93.5%, 99.0%, respectively., Conclusions: Dynamic helical CT is moderately specific in predicting lymph node metastasis pre-operatively in patients with uterine cervix carcinoma. The sensitivity is rather higher according to diagnostic criteria of most diameter > or = 10 mm.

Objective: To investigate the clinical features, treatment outcomes and possible prognostic factors in elderly patients with cervical cancer., Methods: Clinical data of 215 elderly women (> or = 65-years-old) with cervical cancer were retrospectively analyzed. Most patients (89.3%) had advanced stage ( II b-IV) disease. Eight of the 215 patients (3.7%) underwent surgical treatment, and six of those received postoperative radiotherapy. 133 patients received radiotherapy alone, and 74 patients underwent concurrent chemotherapy and radiotherapy., Results: The median follow-up time was 48 months (range: 12-102 months). The overall 5-year survival rate was 63.7%. The 5-year survival rate for stage I, II, III, IV were 83.2%, 76.4%, 39.0% and 0, respectively. There was no significant difference in 5-year survival rate between patients treated with concurrent chemotherapy combined with radiotherapy and radiotherapy alone. In multivariate analysis, lymph node metastasis, advanced stage, non-squamous histologies and poor differentiation were all negative prognostic factors for the overall survival., Conclusion: The treatment strategy for elderly cervical cancer patients should be individually planned according to the disease stage and performance status of the patients. Usually, one radical therapy modality can be chosen, and combined modality therapy is not suggested.

Objective: To explore the clinical-pathologic characteristics, treatment modalities and prognosis of patients with vaginal intraepithelial neoplasia (VAIN)., Methods: The clinical, pathologic and follow-up data of 20 cases with vaginal intraepithelial neoplasia treated primarily in Cancer Hospital of Chinese Academy of Medical Sciences from Jan. 1999 to Dec. 2007, were reviewed and analyzed retrospectively., Results: There were not any of symptoms on diagnosis in all patients, and most of them (17 cases, 85%) were frequently detected VAIN for the abnormal pap smears or pelvic examination from cervical carcinoma patients and under the colposcopy as well as colposcopic biopsies. There were 3 cases (15%) with cervical cancer were diagnosed as VAIN during the postoperative follow up, while 17 cases (85%) of patients were accompanied with cervical cancer (12 cases) or cervical intraepithelial neoplasia (CIN, 5 cases) concomitantly or antecedently. Ninety percent of patients were diagnosed as VAIN III, 17 cases (85%) were mainly localized in the upper third of vagina, and 13 cases (65%) affected to the multiple vaginal walls. Thirteen cases were performed surgery, and 7 cases were treated by irradiation. The local control rate was achieved to 100% in all of patients. Three cases (included 1 post-irradiated and 2 post-operative) were relapsed after treatment, but still be controlled completely by radiotherapy or surgery., Conclusions: VAIN was difficult to be diagnosed independently, which was frequently accompanied by cervical cancer or CIN, significantly localized in the upper third of vagina involving the multiple walls of vagina, and treated synchronously with cervical carcinoma and CIN accompanying. Surgery and radiotherapy was equally effective to control VAIN, and then follow-up post-treatment should be closely to detect, diagnose and treat recurrent VAIN as soon as possible after treatment.

Objective: To investigate the association between apoptosis genes Fas/Fas L promoter polymorphisms and the risk of the development of cervical cancer., Methods: Blood samples were collected from 314 cases with primary cervical cancer and 615 healthy controls. Genotypes of Fas/Fas L genes were determined by polymerase chain reaction-based restriction fragment length polymorphism. The associations with the risk of cervical cancer and impact of clinicopathological characteristics were estimated by logistic regression., Results: Fas L-844CC genotype was significantly associated with increased risk of cervical cancer compared with Fas L-844TC or -TT genotype (OR = 3.05; P < 0.01). However, there was no significant difference of Fas-670A/G or -1377G/A genotypes. Interaction of genetic polymorphism between Fas and Fas L was observed. Stratification analysis revealed that Fas-670G or -1377A allele was significantly higher in squamous carcinoma in situ (OR = 1.77 or 1.93; P < 0.05) while Fas L-844CC genotype had an increased risk of invasive squamous carcinoma compared with that of Fas L-844TT genotype (OR = 3.33; P < 0.01). No significant associations were observed between polymorphisms in Fas/Fas L and clinical FIGO stage, cell differentiation, size of tumors, serum squamous cell carcinoma antigen value at the diagnosis and so on., Conclusion: The results of this study suggest that genetic polymorphisms of Fas and Fas L in apoptotic pathway are associated with the risk of development of cervical carcinoma.

Objective: To observe the correlation between human papillomavirus (HPV) infection and cervical lesion among women living in community of Beijing., Methods: A total of 795 women at age 20-54, living in Zhanlanlu District of Beijing were screened for cervical lesion. Samples of cervical cytology (LCT) and HPV test (hc2) were collected. Colposcopy and biopsy were conducted in women with positive LCT., Results: In those 795 women, the infection rate of HPV was 14.1% (112/795). In 40 women who were LCT positive 1 early invasive cervical cancer, 4 cervical intra-epithelial neoplasia (CIN3), 3 CIN2 and 7 CIN1 were noticed. In 750 women with negative LCT, 5 CIN1 and 1 low-grade CGIN were diagnosed. In those women who were Cyto(+) and HPV(+), 15 cases (55.6%, 15/27) were diagnosed with > or = CIN1 (including 7 CIN1, 3 CIN2, 4 CIN3 and 1 early invasive cancer)., Conclusion: The risk of cervical lesion significantly increased in women showing positive in cytology and HPV test.

Objective: To investigate the efficiency of concurrent radiotherapy and chemotherapy for advanced cervical cancer., Methods: Between Dec. 1999 and Dec. 2003, 158 women with cervical cancer were treated with concurrent radiotherapy and chemotherapy. The regimen was 45 Gy/25 fraction radiation to the pelvis, intracavitary after-loading 7-9 fractions, (42 +/- 7) Gy to point A and 10-30 Gy to cervical submucosa 0.5 cm for debulking; meanwhile, chemotherapy was given with cisplatin 60 mg/m2, d1-d4, and 5-Fu 2400 mg/m2, over a 96-hour period., Results: The rate of local resistence and pelvic recurrence was 4.4% and 3.2%, respectively. The rate of distant metastasis was 17.1%. The overall 5-year survival rate was 66.3%, without statistically significant difference between concurrent chemoradiation group and radiation alone group during the same period. The adverse effect included grade 3 or grade 4 leukopenia in 12.7% of these patients, grade 3 thrombocytopenia in 1.3%, anemia in 3.2%, diarrhoea in 17.8%, cardiac toxicity in 10.1% and radiation- related rectitis in 13.3% and cystitis in 0.6%, but alopecia was rare., Conclusion: Concurrent chemotherapy and radiotherapy may not be able to improve survival for advanced cervical cancer, however, adverse effect is tolerable.

Objective: To study the incidence and the risk factors of dysphagia after ischemic stroke in Chengdu City, China., Methods: Review was made with unified questionnaire on dysphagia after ischemic stroke in 563 patients from four hospitals, from January to December 2005. Over 20 risk factors related to dysphagia after ischemic stroke were analyzed by logistic regression., Results: The total incidence of dysphagia after ischemic stroke was 13.3% in Chengdu. Data from logistic regression analysis indicated that gender, morbidity frequency, basal nuclei, periventricular lesion, hypertension, pneumonia, hyperlipemia, cervical spondylosisi, internal carotid artherosclerosis were closely related to dysphagia after ischemic stroke,with OR values as 0.416, 0.489, 0.327, 0.454, 2.187, 2.146, 0.352, 0.242 and 0.273 respectively., Conclusion: The total incidence was lower than literature published from home and abroad. Gender, morbidity frequency, basal nuclei, periventricular lesion, hypertension, pneumonia, hyperlipemia, cervical spondylosisi and internal carotid artherosclerosis seemed to be risk factors to dysphagia after ischemic stroke.

Objective: To explore the model and the feasibility of newborn hearing and ocular disease simultaneous screening program and to study the birth prevalence of newborn hearing loss and newborn ocular diseases., Methods: The universal newborn hearing screening (UNHS) was performed using transient otoacoustic emission (TEOAE) in well baby nursery and by a two-stage TEOAE and auto auditory brainstem response (AABR) protocol in neonatal intensive care unit (NICU). The UNHS was simultaneous done with newborn ocular disease screening program. The examination technical method was following: the response to light, external inspection of the eyes and lids, pupil examination, red reflex examination, funduscope examination after pupil dilation for referral (for all newborn in NICU). The infants who were referred by two-stage hearing screening and/or had high-risk factors of hearing loss received following-up and routine audiological evaluation and personalized intervention from 6 months to 3 years of age. The cases had positive sign and (or) abnormal results of the ocular disease screening were referred for further examination by pediatric ophthalmologists., Results: A total of 16 800 children born in Jinan Maternal and Child Hospital from October 1, 2002 to April 30, 2005. Of these infants, 15 398 cases (91.7%) had access to the simultaneous screening program for hearing and ocular diseases. The incidence of congenital sensorineural hearing loss (SNHL) among infants who did UNHS was 0.312% (48/15 398) in bilateral and 0.227% (35/15 398) in unilateral; Of the 4 cases of congenital SNHL complicated with newborn ocular diseases: 1 profound SNHL (bilateral), auditory neuropathy with congenital cataract (bilateral), 1 mild SNHL (bilateral) with membrana papillaris perseverance (left) and 1 mild SNHL (bilateral) with retina vein dilatation (bilateral), 1 mild SNHL (right) with persistent hyaloid artery (bilateral). In all 15 398 newborns, 15 neonates with congenital cataract were detected (22 eyes, 0.10%). Twenty seven neonates with less than 1500 g birth weight admitted to NICU, retinopathy of prematurity was detected in 3 neonates (6 eyes)., Conclusion: Hearing loss and ocular diseases was not rare in neonatal and infancy. Newborn hearing and ocular disease simultaneous screening program was not only feasible but also effective in detecting hearing loss and (or) ocular disorders. Early intervention was important for the prevention or treatment of neonatal hearing loss and (or) ocular diseases, such as newborn hearing loss with congenital cataract, retinopathy of prematurity and so on.

Objective: To investigate the effect of microsurgical treatment of trigeminal neurinomas with middle fossa extradural approach., Methods: Between January 1996 and December 2005, 27 patients with trigeminal schwannomas were treated by middle fossa extradural approach. The clinical data were retrospectively analyzed., Results: Total resection was achieved in 25 patients and subtotal resection in the other 2 patients. The cranial nerve deficits were improved in 18 patients, unchanged in 4 patients and worsened in 5 patients postoperatively. New Incomplete paralysis of cranial nerve were observed in 4 patients. Cerebrospinal fluid leakages and bacterial meningitis occurred in 2 cases, which were cured by lumber draining and antibiotic therapy. There was not operative mortality. Twenty six patients were followed up for 6 - 48 months. Tumor recurrence was found in 1 case after 40 months and was excised again., Conclusion: This approach can provide better exposure of these tumors and multiple working angles with minimal brain retraction and can improve the surgical results in terms of increased complete tumor resection rate and reduced complications rate.

Objective: To determine the presence, distribution, and metastasis incidence of parametrial lymph nodes (PLN) of patients with cervical cancer and to investigate the role of lymphatic mapping and topographic section in PLN identification., Methods: Sixty patients with early stage (Ib-IIa) cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy were included in the study. Before surgery 4 ml methylene was injected into the cervix around the tumor. The blue-dyed lymph nodes were identified as sentinel lymph nodes (SLN) during operation. An immediate topographic section on uterine specimen was performed to separate the PLN from parametria for pathologic examination., Results: Ninety five PLN were presented in 38 (63%) of 60 specimens, with a mean size in diameter of (0.46 +/- 0.24) cm. Among the total PLN, 57 (60%) were located parallel to uterine artery through the entire broad ligament, and the other 38 (40%) were scattered in cardinal ligament, sacral ligament and vesicocervical ligament. After lymphatic mapping, 69 (73%) of PLN were dyed and identified as SLN. Parametrial metastasis was found in 12 (20%) patients, and parametrium was the only site containing positive nodes in 2 patients with parametrial metastasis. On routine pathologic evaluation, 17 PLN were found to be positive. Among the remaining 78 PLN, multilevel sectioning in conjunction with immunohistochemical analysis was carried out and 3 PLN containing micrometastases were identified., Conclusions: The study shows that PLN are usually found in the parametria, and these nodes often contain metastatic diseases which are easily overlooked. Lymphatic mapping followed by meticulous topographic section is feasible in PLN identification in patients with cervical cancer.

Objective: To analyze the causes and therapeutic approaches for the complications of radical hysterectomy plus pelvic lymphadenectomy in cervical cancer patients., Methods: From Jan. 1995 to Dec. 2003, 219 such patients were treated by radical hysterectomy plus pelvic lymphadenectomy. The stages were: 26 stage IA (17 stage IA1 and 9 stage IA2) (11.9%); 142 stage IB (78 stage IB1, 64 stage IB2) (64.8%); 40 stage IIA (18.3%) and 3 stage IIB (1.4%). 204 patients in this series were treated by radical hysterectomy plus pelvic lymphadenectomy and 15 by modified radical hysterectomy with pelvic lymphadenectomy., Results: a total of 49 patients (22.4%) developed postoperative complications. The major complications included: bladder dysfunction (10.0%); formation of lymphocysts (7.8%); wound infection (6.8%); hydronephrosis (1.4%) and formation of ureteral fistulas (0.5%). The patients in the group treated by radical hysterectomy plus pelvic lymphadenectomy was likely to develop postoperative complication compared with the patients in the group by modified radical hysterectomy plus pelvic lymphadenectomy (24.0% versus 0, P = 0.067). The postoperative complication incidence in the patients who had preoperative neoadjuvant chemotherapy through intra-arterial catheter or radical radiotherapy in the other hospitals were 50.0% (2/4) and 100.0% (1/1), which were higher than that of the patients treated primarily in our hospital (21.3%, 25.3%) though without statistically significant difference among the groups. Of 52 patients who had previous abdominal surgery history, 13 developed posoperative complications, there was no significant difference between the patients with or without previous abdominal surgery history. The complication incidence of 87 patients treated with preoperative afterloaded radiotherapy was higher than that of 124 patients primarily treated by surgery (25.3% versus 19.4%), but the difference between two groups was statistically not significant (P = 0.239)., Conclusion: The complication of radical hysterectomy with pelvic lymphadenectomy is correlated with the surgery mode. Preoperative afterloaded radiotherapy may not increase postoperative complication incidence. Properly reducing the extent of surgery may decrease incidence of complications.

Objective: To investigate the relationship between chronic blepharitis and evaporative loss dry eye., Methods: Forty-one patients (82 eyes) were diagnosed as chronic blepharitis from November 2002 to April 2003 in Beijing Tongren Eye Center, of which 22 cases were male and 19 female. All patients' ocular surface was judged by Schirmer I test, tear film break up time (BUT) and Tearscope. Meibomian gland secretion was used for bacteria culture and antibiotic sensitivity test. Thirty patients (60 eyes) of glaucoma, cataract and LASIK before surgery were used as control, which included 16 male and 14 female. Microbiological results of meibomian gland secretion were compared and the statistical difference was evaluated by chi(2) test., Results: Of the blepharitis group, ST value was less than 10 mm in 30 eyes (36.6%), BUT less than 10 s in 56 eyes (68.3%) and tear film tearscope evaluation more than 3 grade in 46 eyes (56.1%). The bacteria spectrum of meibomian secretion in both groups was similar, which included staphylococcus epidermidis, staphylococcus aureus and corynebacterium. However, the bacterium culture positive rate and antibiotic sensitivity showed significant difference (P < 0.05)., Conclusion: The chronic blepharitis is one of important cause in evaporative loss dry eyes.

Objective: To review the diagnosis methods and treatment modalities of vulvar intraepithelial neoplasia III (VINIII) and to analyse its prognostic factors., Methods: The data of 24 patients with VINIII from 1992 to 2002 were retrospectively reviewed and analysed., Results: Among these 24 patients, 62.5% (15 patients) were aged less than 40 years and 37.5% (9 patients) over 40 years. Human papillomavirus (HPV) infection was found in 53.3% and 2/9 of these two groups. Treatment modality for all patients was surgical excision including extended local excision (33.3%) and simple vulvectomy (66.7%). 3 patients (12.5%) developed recurrence. Positive resection margin was correlated with recurrence, while age, HPV infection, multifocality and resection modality were not., Conclusion: During recent years, the incidence of VIN has been on the increase in younger woman patients which maybe due to the increase of HPV infection, and the data show that the recurrence rate is correlated with positive margin. Treatment should be individualized and either extended local excision or simple vulvectomy is appropriate. Periodical follow-up should be done.

Objective: To assess prognostic factors in patients with cervical adenocarcinoma., Methods: Totally 159 cases of primary cervical adenocarcinoma were diagnosed in Cancer Hospital, Peking Union Medical College between 1992 and 2002. Clinical and pathological data including patients'age, delivery, tumor size, stage, grade, histological subtype, Pap smear, serum CA125 and treatment were reviewed. Mean age at presentation was 51.4 years. And the mean follow-up time was 59.8 months. According to the International Federation of Gynecology and Obstetrics (FIGO), patients with stages I-IV accounted for 13.2%, 34.0%, 45.3% and 7.5%, respectively. Survival analysis was carried out using SPSS software version 11.0., Results: The overall 5-year survival rate was 47.9%. It was 86.1%, 56.4%, 36.0% and 0 for stages I, II, III and IV respectively. And 29.6% cases experienced recurrence or distant metastasis. The 5-year survival rate for them was 17.3%. In univariate analysis, tumor size (P = 0.009), stage (P < 0.01) and elevated serum CA125 values (P = 0.039) were significant factors for survival. In the group of 27 cases who received surgery, the survival was significantly poorer for cases with pelvic lymph node metastases (P = 0.001) and deep stromal invasion (P = 0.009). Only stage and pelvic lymph node metastases remained significant predictors for survival when multivariate analysis was performed., Conclusions: This retrospective study suggests that FIGO stage and pelvic lymph node metastasis are independent factors in prediction of survival in cervical adenocarcinoma. Survival rate remains to be improved.

Objective: To determine the mechanism of staphylococcal enterotoxin B (SEB) induced immune tolerance in the treatment of high-risk corneal transplantation in the rat., Methods: Fisher 344 rats were used as donors and Lewis rats were used as recipients. Corneal neovascularization was induced by sutures. The rats were divided randomly into five groups in a masked fashion. In the 4 SEB-treated groups, 0.2 ml SEB were intraperitoneally injected before the keratoplasty at concentrations of 25 microg/kg, 50 microg/kg, 75 microg/kg and 100 microg/kg, respectively. The control group received a saline buffer injection intraperitoneally. All allografts were observed and scored for 30 days. Meanwhile, the infiltration of lymphocytes in the allografts, the percentage of lymphocyte subpopulations in the immune organs, the proliferation ability of the lymphocytes and the cytokines in the serum were measured., Results: The SEB at the concentration of 25 microg/kg did not prolong the survival time of the allografts as compared to the control group. With the increase of the concentration of SEB, the survival time in the other three SEB-treated groups were prolonged significantly and the 75 microg/kg group showed the best results. The infiltration of the lymphocytes in the allografts and the percentages of CD4+ and CD8+ lymphocytes in the immune organs in the SEB treated groups were reduced. The proliferation ability of the lymphocytes in SEB treated groups was decreased; the concentration of IL-2 was lower while the concentration of IL-10 was higher in the serum in the SEB treated groups., Conclusions: SEB at an optimal concentration is effective in inhibiting immune rejection in high-risk corneal transplantation. The mechanism of SEB induced immune tolerance is related to the reduction of the number and the immune tolerance status of the lymphocytes.

Objective: To determine the association between viral load of high risk type human papillomavirus (HR-HPV) and stage of cervical intraepithelial neoplasia (CIN) lesion., Methods: Cervical exfoliated cells were collected from 1997 women aged 35-45 in a cross-sectional screening study. HPV DNA was detected by hybrid capture 2 (HC2) system, and viral load was measured by the ratios of relative light units compared to standard positive control (RLU/PC). Log10RLU/PC were categorized into four groups: negative (< 0), low viral load (0 - 1.12), medium viral load (1.13 - 2.23), and high viral load (2.24 - 3.37). Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2-3, and squamous cervical cancer (SCC). Association between HR-HPV and CINs were evaluated by unconditional multinomial logistic regression., Results: 100% (12/12) SCC, 97.3% (72/74) of CIN 2-3, 58.3% (74/127) of CIN 1, and 11.5% (205/1784) of normal women were positive for HPV DNA. The median log10RLUs for the positive women with SCC, CIN 2-3, CIN 1 and in normal women were 2.60, 2.32, 2.18 and 1.18 respectively. The odds ratio (OR) between low viral load of HPV DNA and CIN 1 was 3.8 (1.9 - 7.3) while between high viral load and CIN 2-3 was OR=865.9 (200.1 - 3738.0) which showed that higher viral load could increase the risk of cervical lesions (P <0.001)., Conclusion: Both cervical cancer and CINs were highly influenced by HR-HPV viral load.

Background & Objective: A number of prognostic factors have been evaluated in endometrial carcinoma. Among them, only a few factors have been recognized as major adverse factors affecting prognosis independently. This study was to explore the independent prognostic factors in endometrial carcinoma., Methods: A total of 265 patients who accepted primary surgical treatment in our hospital from Jan. 1990 to Dec. 2000 were studied retrospectively. Prognostic factors were analyzed using univariate model and multivariate regression model., Results: The 5-year recurrence-free survival rate of all patients was 83.3%, and 5-year overall survival rate was 84.3%. The univariate model revealed that clinical stage, pathological stage, pathologic grade, pathologic subtype, depth of muscularis invasion, cervical invasion, lymph node metastasis, peritoneal cytology, lymph-vascular invasion, and adnexa metastasis significantly associated with 5-year recurrence-free survival, and 5-year overall survival (P< 0.05), while age, and complications have no significant association with prognosis (P >0.05). However,on multivariate regression analysis, only pathohistological stage, pathologic grade, depth of muscularis invasion, and cervical invasion significantly correlated with 5-year recurrence-free survival, and 5-year overall survival (P< 0.05); clinical stage correlated with 5-year recurrence-free survival significantly (P< 0.001), but not with 5-year overall survival (P=0.074). Hematogenous dissemination rate of patients with muscularis invasion of >50% was significantly higher than that with muscularis invasion of

Objective: To evaluate prognostic factors in patients with stage IB-IIA of cervical carcinoma treated by surgery., Methods: Between December 1992 and December 2001, 111 patients with stage IB-IIA cervical cancer surgically treated were analyzed. Median age 40 years. According to 1994 FIGO Staging System: IB 80 (IB1 40, IB2 40) and IIA 31. There were 93 cases of squamous cell carcinoma (83.5%), 17 cases of adenocarcinoma (15.3%) and one case of small cell carcinoma. All patients were treated by radical hysterectomy and pelvic lymphadenectomy, 74 patients had preoperative adjuvant radiotherapy, 24 patients had postoperative adjuvant treatment. Kaplan-Meier method was used to evaluate the survival, the related prognostic factors were assessed by Cox regression and chi(2) test., Results: The overall 5-year survival rate was 85.9%, being 89.1%, 90.7% and 78.4% for stage IB1, IB2 and IIA, respectively. Univariate analysis showed that tumor size (hazards ratio [HR] = 1.479, P = 0.152), tumor type (HR = 1.440, P = 0.264), clinical stage (HR = 1.380, P = 0.354), adjuvant treatment (HR = 1.210, P = 0.450), lymph node metastasis (HR = 1.432, P = 0.540), endocervical involvement (HR = 2.244, P = 0.036), depth of myometrial invasion (HR = 3.295, P = 0.06) and multiple sexual partners during pregnancy (HR = 10.172, P = 0.000) were of prognostic significance. The latter two were the most important factors indicative of poor prognosis., Conclusion: The depth of myometrial invasion and multi-partners combined with pregnancy are closely related to the prognosis while the pre- and/or postoperative adjuvant therapy should be considered for stage IB-IIA cervical cancer with deep myometrial invasion and in pregnant patients with multiple sexual partners.

Objective: To study the value of endocervical curettage (ECC) in the detection of cervical intraepithelial neoplasia (CIN) and cervical cancer, and the necessity of ECC during colposcopic examination., Methods: In the high prevalent area of cervical cancer in Shanxi Province, China, a total of 1997 women aged 35 approximately 45 years old were enrolled. Cervical cytology, colposcopy and targeted multiple biopsies, as well as ECC were performed for all women., Results: Among the 1997 women received ECC, 31 was positive for abnormal histologic changes with a frequency of 1.6%. Of the 31 cases, 9 had low grade squamous intraepithelial lesions (LSIL, 0.5%), 20 had high grade squamous intraepithelial lesions (HSIL, 1.0%), and 2 had squamous-cell carcinoma. No pathologic diagnosis could be made in 131 women because the tissue curretaged was insufficient. The women with positive cytologic findings had higher frequency (5.3%) of abnormal ECC than those with negative cytologic findings (0.3%). There was positive correlation between the frequency of abnormal ECC and the grade of cytolologic findings. Abnormal ECC was present in 9.1% of those with unsatisfactory colposcopy while 1.3% of those with satisfactory colposcopy (P < 0.01). The frequency of abnormal ECC was 0.6% in patients with negative colpocopy, 0.9% in LSIL and 24.1% in HSIL. Frequency of abnormal ECC in women with a negative colposcopy or LSIL was significantly lower than that with HSIL. The positive rate of ECC pathologically verified was 3.3% in LSIL, 22.2% in HSIL and 50.0% in squamous carcinoma, respectively (P < 0.01). Of the 316 patients with positive cytology but negative colposcopy, ECC was abnormal in 8 (2.5%), of which HSIL cytologically verified was in 3., Conclusion: If cytology or colposcopy shows HSIL or more severe changes, and cytology is positive while colposcopy is unsatisfactory, ECC should be done routinely.

Objective: To explore the relationship between loads of human papillomavirus in cervical carcinoma and cervical intraepithelial neoplasia., Methods: From December 2001 to May 2002, 9075 married women aged from 35 to 50 years who lived in the areas with a high incidence of cervical carcinoma of Shanxi Province were screened high risk types of human papillomavirus (HPV) infection using hybrid capture II (HC-II). Of them, 2087 women with positive human papillomavirus further underwent colposcopy and multi-focal directed punch biopsies plus endocervical currettage., Results: Two thousand and eighty-seven women were found with positive human papillomavirus infection, comprising 1402 (67.2%) women who were diagnosed as cervicitis, 663 (31.8%) women diagnosed as cervical intraepithelial neoplasia [including cervical intraepithelial neoplasia (CIN) I to III], and 22 (1.1%) women diagnosed as cervical squamous cell carcinoma (SCC). HPV-DNA loads of women with chronic and acute cervicitis were 150 +/- 11 and 108 +/- 13, respectively, with no significant difference between two groups statistically (P = 0.225). HPV-DNA loads for women with CIN I, CIN II and CIN III were 332 +/- 29, 358 +/- 35, and 370 +/- 31, respectively, all significantly higher than that of women with cervicitis (P = 0.000), but there were no significant differences among three groups (P > 0.05). HPV-DNA loads of women with cervical squamous cell carcinoma was 593 +/- 86, much higher than those of women with varied grades of cervical intraepithelial neoplasia and cervicitis (P < 0.05 and P < 0.01)., Conclusions: The new technology using HC-II is an effective method to detect HPV infection in cervix. Viral loads of HPV-DNA increase with severity of cervical neoplasia. So it could be used for screening primary cervical carcinoma.

Objective: To study the clinical characteristics, treatment and prognostic factors of ovarian Setoli-Leydig cell tumor., Methods: During 1962 - 2002, a total of 11 patients with Setoli-Leydig cell tumor were retrospectively analyzed., Results: Microscopically, seven of the neoplasms were well differentiated, 3 were moderately differentiated and 1 was poorly differentiated. Nine of the tumors were stage Ia, 1 was stage IIc and 1 was stage IIIc. The most frequent symptoms were abdominal-pelvic masses. Six patients presented with androgenization and virilization, 3 of which had their serum testosterone tested, and the levels were elevated. Five patients presented with metromenorrhagia and abnormal vaginal bleeding. One of them was both androgenized and estrogenized. In addition, five patients had diseases associated with excessive estrogenic stimulation, such as uterine myoma and endometrial hyperplasia. Two patients suffered from breast cancer. All patients were subjected to operation. And 5 patients with poorly differentiated or stage II-III tumors were subjected to postoperational chemotherapy. After 6 months to 34 years follow-up, no patient died of this disease. Three patients who received conservative surgery achieved normal menstruation 1 - 3 months after operation, and one of them gave birth to a child., Conclusions: Ovarian Setoli-Leydig cell tumor has good prognosis. Surgery alone is a currently acceptable treatment for patients with well-differentiated early stage tumors. For patients with poorly differentiated or advanced tumors, postoperational chemotherapy seems to be necessary. Conservative surgery should be the treatment of choice in young patients who need future fertility.

Background & Objective: The preoperative diagnosis and management of stage IA(1) squamous carcinoma of the cervix remains a controversial subject. The aim of this study was to discuss diagnosis and appropriate management options of this disease., Methods: Clinical data and pathological materials of 30 patients with stage IA(1) squamous carcinoma of the cervix, who were treated in Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College between 1992 to 2001, were reviewed., Results: Seven of 30 patients (23.3%) had neither specific symptoms nor signs. Twenty-three patients had cytological examination with the positive rate of 86.9% (20/23). Colposcopy was performed in 23 of the women; the accuracy of colposcopical impression was 78.2%(18/23). Of 10 endocervical curettage (ECC) specimens, 4 cases had abnormal pathology. Among 30 patients, 22 (73.3%) were treated with radical hysterectomy, 6 with simple hysterectomy, and 2 with cold conization only. There was no parametrical involvement and no positive vaginal margin in any of 28 patients who had hysterectomy. Lymphadenectomy was performed in 8 cases; the mean number of lymph nodes removed was 22, and no metastasis was found. The two conization specimens had free surgical margin. The preoperative diagnosis agreed with final diagnosis in only 56.7% (17/30); there was statistically significant difference between them (P< 0.01). During median 34 months follow-up (range, 17-111 months), no developed recurrences and no died from cancer., Conclusion: The diagnostic accuracy of colposcopically directed biopsy is quite poor for stage IA(1) cervical carcinoma. Cervical cold conization may increase the diagnostic accuracy and may be recommended for patients who desire conservation of fertility.

Objective: The purpose of this study was to investigate the clinical value of sentinel lymph node (SLN) detection in the management of early stage cervix cancer., Methods: Twenty eight patients with early stage (Ia - IIa) cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy were included in the study. 37 Mbq (0.4 ml) (99m)Tc-labeled dextran ((99m)Tc-DX) was injected to the cervix at two locations (2 and 10 o'clock) 18 hours before the operation followed by preoperative lymphoscintigraphy to detect the SLNs. During the operation, SLNs were identified from dissected LN by gamma-counter. The samples of SLNs and non-SLNs (NSLN) were recorded separately and compared with the final pathology results., Results: SLN was identified in 27 of 28 (96%) patients. A total of 123 SLNs were identified from 814 lymph nodes. Six (21%) patients had altogether 11 positive lymph nodes, which were all SLNs. No patient had false-negative SLNs., Conclusions: SLNs can successfully predict the lymphatic metastasis in patients with cervical cancer. The clinical validity of this technique should be further evaluated.

Background & Objective: At present, the incidence of cervical cancer is still high in less developed areas of China; one of the reasons is that cytology in screening for cervical cancer is not feasible in these areas. The aim of this study was to analyze the sensitivity and specificity of acetic acid smear test as a cervical cancer screening test, and evaluate the value of this method for cervical cancer screening., Methods: Acetic acid smear test was performed on 1997 previously unscreened women aged 35-45 years in Xiangyuan County, Shanxi Province. All women had cervical cytology, testing for high-risk types of human papillomavirus DNA, colposcopy, an endocervical curettage and at least five cervical biopsies. Biopsies were done at the lesions, or one biopsy at 2, 4, 8, 10 o'clock at the squamocolumnar junction in each normal quadrant., Results: According to histological diagnosis, 43 women had CIN II, 31 had CIN III, and 12 had invasive carcinoma. In two women only the endocervix was positive. Smear test yielded normal results in 1445 women (72.4%), low-grade squamous intraepithelial lesions (LSILs, CIN I) in 525 (26.3%), high-grade squamous intraepithelial lesions (HSILs, CIN II- III) in 21 (1.1%), and cancer in 6 (0.3%). With abnormal visual inspection defined as LSILs or worse, the sensitivity of acetic acid smear test for HSILs or worse was 70.9% (61 of 86), the specificity was 74.3% (1420 of 1911). The sensitivity was 64.9% for smaller lesions (37 of 57), and 88.9% for larger lesions (24 of 27) (P=0.03). The sensitivity of colposcopy for high-grade SILs or worse was 81.4% (70 of 86), the specificity was 76.5% (1462 of 1911)., Conclusion: This study showed the high specificity and sensitivity of acetic acid smear test as a primary screening test for cervical cancer. Acetic acid smear test and colposcopy have similar specificity profiles for CIN II or more severe lesions. Acetic acid smear test as a primary screening test will be possible and effective with the benefits of low-cost and simple test in low-resource settings.

Objective: By detecting the expression of IL-1RI and TGF-beta(1) on the normal rat cornea and graft, and the amount of IL-1 beta in the aqueous humor of normal rat eye and the eye after keratoplasty, to investigate the relationship between these cytokines and graft rejection and to observe the effects of IL-1 receptor antagonist (IL-1ra) on graft rejection., Methods: All rats after keratoplasty were divided into five groups. Immunohistochemistry method and enzyme-linked immunosorbent assay (ELISA) were used to detect the expression of IL-1RI and TGF-beta(1) on the normal rat cornea and graft and the amount of IL- 1 beta in the aqueous humor of normal rat eye and the eye after keratoplasty at different time points: pre-rejection, acute-rejection and two weeks after surgery., Results: IL-1RI could be detected in normal rat cornea. TGF-beta(1) expressed mainly in the epithelium of normal cornea, especially the basal cell layer and the basement membrane. After keratoplasty, IL-1RI and TGF-beta(1) could be detected in the corneal epithelium, stroma and endothelium, and the level of expression decreased in sequence as negative control group, 50 micro g IL-1ra group, 100 micro g IL-1ra group, 200 micro g IL-1ra group and dexamethasone group. In the acute rejection period, the expression of IL-1RI and TGF-beta(1) in the 200 micro g IL-1ra group was less than that of the 50 micro g IL-1ra group, the difference was significant (P < 0.01). The expression of IL-1RI and TGF-beta(1) in the negative control group was higher than that of all experimental groups, the difference was significant (P < 0.01). IL-1 beta was detected in normal aqueous humor; the mean level was (96.0 +/- 11.3) ng/L. In the eye after keratoplasty, the IL-1 beta level increased significantly compared to normal aqueous humor (P < 0.01). In the acute rejection period, the quantity of IL-1 beta reached its peak at (552.2 +/- 68.3) ng/L in the negative control group, which was the highest quantity of IL-1 beta in all experimental groups (P < 0.01). The IL-1 beta level in all experimental groups in the pre-rejection period had no difference compared with that in the acute rejection period (P > 0.05), but the level of IL-1 beta in the pre-rejection and rejection periods was significantly different compared with that in the post-rejection period (P < 0.01)., Conclusions: IL-1RI and TGF-beta(1) play a active role in the corneal graft immunogenic rejection. IL-1 beta is a key factor in starting corneal graft rejection. The keratoplasty graft rejecting reaction can be reduced and mean survival time can be prolonged by IL-1ra, which inhibits the expression of IL-1RI and TGF-beta(1) and decreases the level of IL-1 beta in the aqueous humor.

Background & Objective: Cold knife conization (CKC) is a classic diagnostic and therapeutic procedure. The authors analyzed pathological features of 62 cone specimens and determined the effectiveness of CKC on diagnosis and treatment of cervical intraepithelial neoplasia (CIN)., Methods: Comparative analysis on pathological findings of cone specimens and multiple biopsies (MB) of 62 CIN patients was performed., Results: There were close similarities in pathology between CKC and MB in 44 cases (71%). Eighteen cases (29%) showed histological difference between CKC and MB; among them, 4 cases that were given a diagnosis of CIN2 or CIN3 by MB were classified into CIN3 or microinvasive carcinoma by CKC. All 62 cases were squamous epithelial lesions; 34 of them subjected to CIN3 or higher than CIN3. The lesions were mainly located in transformation zone, mostly with cervical canal involvement. Thirty cases showed equal to or more than 2 quadrants involved. Thirty-seven cases (59.7%) had histological evidences for HPV infection. Thirty-one cases(50%) had squamous metaplasia, some with variable dysplasia. Resection margin positive rates were 3.2%(>or=CIN2) and 8.1% (CIN1), respectively, lower than those by loop electrosurgical excision procedure (Leep) reported in literature. Fifty-six cases were closely followed up after operation (4 months-14 years). No recurrences were found and 3 patients had pregnancy and delivery., Conclusion: CKC is significantly effective and cannot be replaced by MB. Squamous metaplasia and CIN development are intrinsically correlated with each other.

Objective: To evaluate the clinical characteristics, results of treatment, and prognostic factors of patients diagnosed as having primary female genital system lymphoma (PFGSL)., Methods: Twenty-eight cases of PFGSL were retrospectively surveyed and the clinical data of the patients were analyzed by statistic software package of SPSS10.0 for relation between clinical stage, grade, pathologic feature, treatment and prognosis., Results: The median age was 44 in the cohort. It mainly involved cervix uterus, ovary and vulva. The disease had a broad range of pathologic type and 20 patients were diagnosed as suffering from B-cell by immunophenotyping, 4 patients were diagnosed as T-cell and 4 patients lesions were indefinite. According to International Working Formulation (IWF), 66.7% belonged to the intermediate-grade. The Ann Arbor stage included: Stage I(E)-12 pts (42.86%), Stage II(E)-3 pts (10.7%), Stage III(E)-1 pts (3.6%) and Stage IV-12 pts (42.86%). According to International Prognostic Index (IPI), 10 were low risk, 9 low-medium risk, 3 medium-high risk and 6 high risk, The median follow-up of the surviving patients was 2.0 years (range: 3 months-17 years), The 5-year overall survival rate was 39.3%. Most patients were given comprehensive treatment without any mode showing significant advantage over the others in survival (P = 0.2554), The involved organs, Ann Arbor stage, IWF and also IPI were significant prognostic factors for survival,, Conclusion: The management of PFGSL should be based on comprehensive treatment including chemotherapy as the chief means. The significant prognostic factors of survival is Ann Arbor stage, IPI, IWF and the kind of involved organs.

Objectives: To investigate the prevalence of oncogenic type of human papillomavirus (HPV) infection and identify the high risk population for conducting immuno/chemoprevention of cervical cancer., Methods: All married women aged 30 to 50 with no history of hysterectomy, pelvic radiation and non-pregnant from certain villages of Xiangyuan and Yangcheng County were invited. This study was conducted through two phases. In phase one, subjects sampled the vaginal secretions using the collectors after signing the informed consent. And physicians sampled exfoliated cells from cervix in the phase two. All the specimens were tested with the Hybrid Capture 2 test. The data was managed and analyzed by VFP and SPSS software., Results: There were 9,683 women participated in this study. Local women welcomed this study and population compliance rate was 75.4%. In tested population, we found 2,666 subjects of HPV DNA positive and HPV prevalence was 27.5%. The rates of different age group were 24.5% (30-34 yrs), 27.4% (35-39 yrs), 28.2% (40-44 yrs), 27.4% (45-50 yrs) respectively and had no significant differences (P = 0.604). The rates were slightly increased with the higher education level and had no differences (P = 0.106). The rate in mountain areas was higher than that in half-mountain areas (P = 0.001)., Conclusions: The prevalence of HPV infection is indeed high in this region. Local women and health professionals welcome the activities of cervical cancer screening and prevention. It is an emergent task to improve their sanitary condition and prevent them from cervical cancer in these women. A women health cohort is established successfully among high HPV exposed women in rural China. The extensive biologic specimen repository has been successfully established to simultaneously study the etiology, early detection, and immuno/chemoprevention of cervical cancer.