HPV在宫颈炎、宫颈癌前病变、宫颈癌中的检测及其临床意义研究

目的研究并探讨人乳头状瘤病毒(human papillomavirus,简称HPV)在宫颈炎、宫颈癌前病变、宫颈癌中的检测价值及临床意义。方法选取菏泽市妇幼保健院2014年1月—2016年12月期间收治的120例慢性宫颈炎患者、90例宫颈癌前病变患者、60例宫颈癌患者作为研究对象,分别设置为宫颈炎组、癌前病变组、宫颈癌组,并将癌前病变组分为CIN Ⅰ级、CIN Ⅱ级、CIN Ⅲ级,所有患者均接受HPV检测,比较其HPV阳性率、HPV DNA负荷载量、HPV感染持续时间,计算HPV感染持续时间、HPV DNA负荷载量与宫颈癌发生的相关性。结果宫颈炎组、癌前病变组、宫颈癌组的HPV阳性率、HPV DNA负荷载量、HPV感染持续时间比较,差异均具有统计学意义(P0.05),从高至低依次为宫颈癌组、癌前病变组、宫颈炎组,且不同分级宫颈癌前病变患者的HPV DNA负荷载量、HPV感染持续时间均存在显著差异(P0.05);经相关性分析,HPV感染持续时间、HPV DNA负荷载量均与宫颈癌的发生密切相关,呈正相关。结论HPV感染可能参与到宫颈癌前病变、宫颈癌的发生、发展中,开展HPV检测可对宫颈癌前病变、宫颈癌进行筛查,有利于宫颈癌的防治。     

循证护理模式对关节镜下前交叉韧带重建术患者康复锻炼遵从性的影响

目的探讨了循证护理模式对关节镜下前交叉韧带重建术患者康复锻炼遵从性的影响。方法选取在武汉科技大学附属孝感医院接受治疗的63例关节镜下前交叉韧带重建术患者,随机分为观察组32例,对照组31例,对照组行常规护理,观察组实施循证护理,比较两组护理前后康复锻炼总遵从率。结果护理后对照组总遵从率为77.42%,观察组为100%,组间比较差异具有统计学意义(P0.05)。结论对关节镜下前交叉韧带重建术患者行循证护理,可有效提高患者康复锻炼遵从性。     

微创经皮钢板技术治疗胫骨复杂骨折的临床研究

目的探究胫骨复杂骨折行微创经皮钢板治疗的临床效果。方法回顾分析2014年5月—2015年2月来宜春市中医院接受微创经皮钢板技术治疗的53例胫骨复杂骨折病人的临床资料,为患者行微创经皮钢板技术治疗,观察其临床效果。结果本组53例病人在经过微创经皮钢板技术治疗后进行12个月随访,全部患者骨性均有效愈合,平均愈合时间4.5个月,无患者出现钢板螺钉松动和断裂及骨不连情况。术后1例(1.89%)病人切口感染,经抗感染药物治疗后痊愈。Johner-Wruhs关节功能及治疗效果评价结果为:优秀36例(67.92%);良好11例(20.75%);中6例(11.33%),优良率88.67%。结论在胫骨复杂骨折的临床治疗中微创经皮钢板技术效果良好。     

宫颈环形电切术联合纳米银凝胶应用于慢性宫颈炎的临床探讨

目的分析宫颈环形电切术联合纳米银凝胶应用于慢性宫颈炎的临床疗效。方法选择2014年10月至2015年10月在上栗县长平卫生院接受治疗的122例慢性宫颈炎患者作为研究对象。将122例患者随机分为常规组和实验组。常规组使用宫颈环形电切术进行治疗;实验组使用宫颈环形电切术联合纳米银凝胶进行治疗。对比两组患者的治疗效果以及阴道感染率及出血率。结果两组患者经过不同的治疗之后实验组患者的治疗总有效率(100.0%)显著高于常规组治疗总有效率(80.3%),数据差异显著,具备统计学意义(P0.05);实验组患者的阴道感染率(1.64%)及出血率(3.28%)分别明显低于常规组的阴道感染率(13.11%)与出血率(18.03%),两组数据差异显著,具备统计学意义(P0.05)。结论宫颈环形电切术联合纳米银凝胶应用于慢性宫颈炎的临床疗效显著,纳米银凝胶能够极大程度地帮助患者减少阴道出血、阴道感染的情况发生,能够很好地弥补宫颈环形电切术的不足,能够极大程度提升患者治疗效果,是慢性宫颈炎的理想治疗方式,值得临床推广。     

经皮冠状动脉介入治疗冠心病合并心力衰竭临床疗效评价

目的：探讨冠心病合并心力衰竭患者行经皮冠状动脉介入（PCI）治疗的临床疗效。方法选取2010年12月至2013年12月广东医学院治疗的65例冠心病合并心力衰竭患者,应用 PCI治疗,根据测量患者术前、术后1周和术后6个月的心功能指标变化,比较患者治疗前后的心功能变化情况。结果男性患者及女性患者, PCI 治疗成功率分别为94．4％（34/36）和96．5％（28/29）,术后2周,心功能已改善,术后6个月改善明显（均 P ＜0．05）,围术期并发症1．5％,死亡率为0。结论经皮冠状动脉介入治疗能够明显缓解冠心病合并心力衰竭患者的症状,并能改善患者心功能,且有较高的安全性。     

经腹联合经阴道彩超在评估凶险型前置胎盘合并胎盘植入中的应用价值

本文对经腹联合经阴道彩超在评估凶险型前置胎盘(PPP)合并胎盘植入中的应用价值进行了探讨。选取我院2017年6月~2019年6月PPP患者172例,所有患者均给予经腹彩超、经阴道彩超检查,以产后病理结果为对照,分析经腹彩超、经阴道彩超,以及二者联合,对PPP合并胎盘植入的评估价值。产后病理结果显示,172例PPP患者中,有合并胎盘植入患者120例(69.77%)、无合并胎盘植入患者52例(30.23%)。对PPP合并胎盘植入的敏感度、特异度、准确度进行评估,结果显示,经腹彩超其值分别为76.67%、73.08%、75.58%,经阴道彩超分别为83.33%、80.77%、82.56%,经腹联合经阴道彩超则分别为96.67%、96.15%、96.51%,二者联合明显高于经腹彩超、经阴道彩超,差异有统计学意义(P<0.05)。证实经腹、经阴道彩超是评估PPP合并胎盘植入的有效检查方法,且二者联合的评估价值更高,值得临床推广。     

关节镜治疗肩关节脱位合并肱骨大结节骨折的近期效果分析

目的探讨分析关节镜在治疗肩关节脱位合并肱骨大结节骨折时的近期临床效果。方法回顾性分析广东省清远市人民医院骨科自2013年11月到2014年11月之间收治的肩关节脱位合并肱骨大结节骨折的患者16例,其中男性有10例,女性6例,年龄从36~68岁,平均年龄为(46±2)岁。所有患者均有明确的受伤史;其中有14例患者为摔伤,有2例患者为坠落伤;有12例为左侧肩部受伤,有4例为右侧肩部受伤;然后对所有患者采取关节镜下进行修复,其中有6例患者为完全关节镜下修复,有10例为采取关节镜下辅助小切口进行修复。结果经治疗后,所有患者切口均达到Ⅰ期愈合标准,未出现伤口感染、出血等并发症。术后2~6个月内对患者行X线片检查,发现肱骨大结节骨折的愈合从3~6月,平均为4.1个月。对所有患者均进行了定期(每半年1次,共3次)随访观察。术后第6个月随访时,有3例患者出现肩关节外展,外旋活动轻度受限,有1例患者出现前屈活动受限;有1例患者出现前屈时疼痛。后经积极的康复训练,均恢复良好。所有患者肩关节未出现再次脱位。采用Constant-Murley肩关节评分系统为(32.88±4.12)分;本组优11例,良4例,可1例,优良率93.75%。结论临床上,在治疗肩关节脱位合并肱骨大结节骨折时采用关节镜技术不仅手术创伤小,术后恢复快,而且治疗效果满意,与保守治疗相比并发症少,值得临床医生学习推广。     

下腔静脉滤网置入术介入治疗双下肢深静脉血栓性静脉炎的护理对策

目的探讨下腔静脉滤网置入术介入治疗双下肢深静脉血栓性静脉炎的护理对策。方法选取佛山市第一人民医院2014年1月至2015年1月期间双下肢深静脉血栓性静脉炎患者65例,全部患者均实施下腔静脉滤网置入术作为介入治疗手段,同时采用综合护理对策。结果 65例双下肢深静脉血栓性静脉炎患者下腔静脉滤网置入术介入治疗一次性成功率为100.00%(65/65),未出现下腔静脉损伤、下腔静脉滤网移位等现象,手术顺利,无并发症出现。术后随访6~12个月发现59例患者经彩色多普勒超声检测均无双下肢深静脉血栓形成,随访期间均未出现下腔静脉滤网倾斜、变形与移位,无并发肺栓塞。结论采用综合护理对策有助于提高下腔静脉滤网置入术介入成功率,提高护理质量。     

开颅手术院内感染的相关危险因素及护理对策分析

目的研究开颅手术院内感染的危险因素及护理干预对策。方法收集患者基础信息,包括年龄、性别、基础疾病、手术时间、术前血糖水平、手术次数、有无气管切开或插管、是否输血,参考卫生部2001年颁发的《医院感染诊断标准》进行不同患者院内感染的评估,得出发生率及危险因素,并根据得出的危险因素对相应的护理措施进行讨论。结果 234例患者共51例发生感染,感染发生率21.79%,结果显示年龄越大、手术时间越长、术后再次手术、输血、气管切开或插管、合并脑血管疾病为开颅手术患者院内感染危险因素,而不同性别、术前血糖水平及是否合并神经系统肿瘤患者院内感染发生率差异无统计学意义(P0.05)。结论年龄越大、手术时间越长、术后再次手术、输血、气管切开或插管、合并脑血管疾病为开颅手术患者院内感染危险因素,需引起临床护理的重视,并采取针对性的护理干预,从而降低院内感染发生率。     

无溶剂Ugi四组分反应合成新型含氟Philanthotoxin-12衍生物及杀虫活性

以无溶剂Ugi四组分反应合成关键含氟中间体,然后经三氟乙酸脱除保护基,合成了8个未见文献报道的新型含氟Philanthotoxin-12衍生物。重要的中间体和目标化合物的结构经¹H NMR、¹³C NMR和HRMS或MS的确认。对目标化合物进行了初步的杀虫活性测试,其中含氟的化合物6b在100 mg/L浓度下对棉铃虫和菜青虫的杀死率分别为44%和42%。     

Effectiveness of Photodynamic Therapy in Elimination of HPV‐16 and HPV‐18 Associated with CIN I in Mexican Women

This study aimed to determine the effectiveness of photodynamic therapy (PDT), using δ‐aminolevulinic acid (5‐ALA), in the elimination of premalignant cervical lesions in Mexican patients with human papillomavirus (HPV) infection and/or cervical intraepithelial neoplasia (CIN). Thirty women diagnosed with CIN I and/or positive for HPV participated in the study. Topical 6% 5‐ALA in gel form was applied to the uterine cervix; after 4 h, the lesion area was irradiated with a light dose of 200 J cm^?2 at 635 nm. This procedure was performed three times at 48‐h intervals. Clinical follow‐up was performed at 3, 6, and 12 months after the initial PDT administration, by colposcopy, cervical cytology, histopathological analysis, polymerase chain reaction, and hybrid capture. Of HPV‐infected patients without evidence of CIN I, 80% cleared the infection, while HPV associated with CIN I was eliminated in 83% of patients (P < 0.05). At 12 months, CIN I had regressed in 57% of patients, although this response was not statistically significant. PDT using 6% 5‐ALA is concluded to be effective in eliminating HPV infection associated or not with CIN I.     

Treatment of HPV infection-associated cervical condylomata acuminata with 5-aminolevulinic acid-mediated photodynamic therapy

The aim of this study was to investigate the efficacy of 5-aminolaevulinic acid (ALA)-mediated photodynamic therapy (PDT) in treatment of human papillomavirus (HPV)-associated cervical condylomata. A total of 56 patients with cervical and external condylomata lesions were recruited for this open-label study. HPV genotyping of exfoliated cells collected from the cervix and external lesions was performed. Cervical lesions were treated with PDT by applying ALA gel (10%) to the surface of the cervix for 4 h followed by irradiating with a 635 nm laser at 100 J cm(-2). PDT was repeated at 2-week intervals if lesion and HPV infection remained. Patients were followed up for 6-24 months. Genotyping analysis revealed four HPV subtypes (HPV6, 11, 16 and 18). The overall complete remission rate of 1-4 sessions of treatments was 98.2% and the corresponding HPV clearance rate was 83.9%. Ten cases showed complete removal of cervical lesions and HPV infection after a single treatment. Recurrence rate was 3.6%. Adverse effects were minimal and no structural complications were reported. In conclusion, topical ALA PDT is safe and effective for eradicating cervical HPV infection and eliminating condylomata lesion. Its definitive role in treating cervical condylomata deserves further investigation.     

Synthesis of Aromatic Macrocyclic Amphiphiles and their Self‐Assembling Behavior in Aqueous Solution

A triblock amphiphilic macrocycle consisting of a macrocyclic aromatic segment, a hydrophilic oligo(ethylene oxide) branch, and a hydrophobic alkyl dendron is successfully synthesized and characterized. The resulting cyclic amphiphile is observed to self‐assemble into hollow double‐layered capsules in aqueous solution, as confirmed by dynamic light scattering and cryogenic transmission electron microscopy investigations. The capsules are able to encapsulate hydrophobic guest molecules through aromatic interactions with high stability.

     

Simple charge transfer complexes of some new and of some known heterocyclic compounds of selenium and tellurium

Charge transfer (CT) complexes (1:1) of 2,5-dihydrotellurophene and the 3-methyl and 3,4-dimethyl compounds with TCNQ and tetrachlorobenzoquinone (TCB) are reported. The organotellurium compounds failed to give complexes with p-dinitrobenzene (DNB). The variation of solid state (disc) conductivity with temperature and as a function of methyl substituents is considered. The complexes show semi-conducting behaviour and a consideration of these data, together with IR and UV spectroscopic data, in comparison with those for 1,3-dihydro-2-telluraindene given the following order of donor power with respect to TCNQ:

Full-size image

With respect to a given donor, the order to acceptor power is TCNQ> TCB> DNB.

1,3-Dihydro-2-selanaindene forms a complex with TCNQ. The molecular ionisation potential of the selanaindene is 7.4 eV (by mass spectroscopy) and it has been shown that the compound may be electrochemically oxidized to materials such as C₈H₈SePF₆.

New quinoxalino-1-chalcogenacyclopentanes are reported; namely those derived from selenium, and for the 7,8-dimethyl series, those based on both selenium and tellurium. Their preparation and characterisation are described, and their chemistry shown to be strongly analogous to that of quinoxalino-1-telluracyclopentane. CT complexes of the new Se^II and Te^II compounds (1:1) are prepared with TCNQ which are believed to be strongly ionic.     

临床分级护理干预护理后上消化道出血患者再出血率观察

目的研究临床分级护理干预护理后上消化道出血患者再出血率。方法选择2012年10月至2014年10月来孝感市中心医院就诊的80例上消化道出血患者作为研究对象,随机分为对照组和观察组,每组40例。对照组给予常规护理干预,观察组在常规护理基础上给予临床分级护理干预,护理结束后随访半年,观察两组再出血率。结果观察组护理后总有效率为97.5%,显著高于对照组的85%,差异具有统计学意义(P0.05)。观察组术后1月、3月及6月再出血率均显著低于对照组,差异具有统计学意义(P0.05)。结论临床分级护理干预可显著降低上消化道出血患者再出血率,提高总有效率。     

Immunocytochemical detection of HPV16 E7 in cervical smear

Cervical cancer is characterized by a long period of preclinical dysplasia or carcinoma in situ progressing into invasive cancer. Although Papanicolaou (Pap) smear test has contributed significantly to the early detection of precursor lesions, the cytological screening has inherent problems that produce considerable false negative/positive results. Since the infection of high-risk type of human papillomavirus (HPV) is strongly associated with cervical cancer, we investigated the feasibility of an immunostaining test to detect cells infected by HPV in cervical smear. We produced monoclonal antibodies against HPV16 E7 in mice by repeated injections with the recombinant HPV16 E7. Western blot analysis and immunocytochemical assay demonstrated that the selected monoclonal antibody, mAb (130-9-7), reacts specifically with cultured cervical cancer cell lines infected by HPV16. Specific staining was observable with the HPV16-positive smear specimens obtained from the cervical cancer patients, whereas no staining was detected with the HPV-negative smear specimens. To achieve the desired sensitivity, specificity and reproducibility, we modified and optimized the conventional immunocytochemical procedure for cervical smear specimens. Our results suggest that this immunostaining method for detecting high-risk HPV in cervical smear may be used as a strategy to distinguish a high-risk group, especially those patients with low grade cytological abnormality.     

DNA vaccines for cervical cancer: from bench to bedside

More than 99% of cervical cancers have been associated with human papillomaviruses (HPVs), particularly HPV type 16. The clear association between HPV infection and cervical cancer indicates that HPV serves as an ideal target for development of preventive and therapeutic vaccines. Although the recently licensed preventive HPV vaccine, Gardasil, has been shown to be safe and capable of generating significant protection against specific HPV types, it does not have therapeutic effect against established HPV infections and HPV-associated lesions. Two HPV oncogenic proteins, E6 and E7, are consistently co-expressed in HPV-expressing cervical cancers and are important in the induction and maintenance of cellular transformation. Therefore, immunotherapy targeting E6 and/or E7 proteins may provide an opportunity to prevent and treat HPV-associated cervical malignancies. It has been established that T cell-mediated immunity is one of the most crucial components to defend against HPV infections and HPV-associated lesions. Therefore, effective therapeutic HPV vaccines should generate strong E6/E7-specific T cell-mediated immune responses. DNA vaccines have emerged as an attractive approach for antigen-specific T cell-mediated immunotherapy to combat cancers. Intradermal administration of DNA vaccines via a gene gun represents an efficient way to deliver DNA vaccines into professional antigen-presenting cells in vivo. Professional antigen-presenting cells, such as dendritic cells, are the most effective cells for priming antigen-specific T cells. Using the gene gun delivery system, we tested several DNA vaccines that employ intracellular targeting strategies for enhancing MHC class I and class II presentation of encoded model antigen HPV-16 E7. Furthermore, we have developed a strategy to prolong the life of DCs to enhance DNA vaccine potency. More recently, we have developed a strategy to generate antigen-specific CD4(+) T cell immune responses to further enhance DNA vaccine potency. The impressive pre- clinical data generated from our studies have led to several HPV DNA vaccine clinical trials.