Primary cervical lymphoma: the role of cervical cytology

Two cases of primary malignant lymphoma of the uterine cervix are reported. Both were confirmed by histology as high grade B cell lymphomas. In one case, the diagnosis was made on a second colposcopic biopsy after an initial cervical smear and colposcopic biopsy were negative. In the second case, dyskaryotic cells of uncertain type were identified in a cervical smear taken at colposcopy performed as part of follow up for previous cervical intraepithelial neoplasia (CIN)I. The cytologic features and differential diagnosis of this rare cervical neoplasm are discussed, with emphasis on the role of the Papanicolaou smear in the initial diagnosis of this tumour.     

宫颈疾病与宫颈微生态特征的研究进展

宫颈微生态是一个复杂的生态系统,可随年龄、月经周期、妊娠、外源性因素等原因而发生动态变化,这种平衡对于机体健康至关重要。宫颈微生态包括菌群、局部pH、内分泌调节和免疫系统等,其中大量定植的宫颈菌群是微生态体系的核心组成部分。当发生感染、局部pH改变、雌激素减退等情况时,菌群生态平衡可被破坏,致病菌可过量繁殖成为优势菌,同时提升人乳头瘤病毒(HPV)感染风险,引起宫颈炎、宫颈鳞状上皮化生、宫颈癌等等。研究认为,宫颈微生态的改变与HPV感染、宫颈疾病的发生具有密切的相关性。然而国内关于宫颈微生态与宫颈疾病的直接关系的报道尚不多见,本文就宫颈微生态失衡与其引起的常见宫颈疾病,如宫颈炎、宫颈上皮内瘤变、宫颈癌等之间的相关性进行探讨。     

Analysis of the structure and expression of the c-myc oncogene in cervical tumor and in cervical tumor-derived cell lines

The structure of the c-myc oncogene in 17 cervical tumors and patient-matched nontumor tissues from Chinese patients residing in Taiwan was analysed. In contrast to recent reports on Mexican patients, none of the samples showed rearrangements and sequence amplification in the c-myc gene. The discrepancy may be explained by different carcinogenesis mechanisms being in operation in different geographic regions. Although no structural alterations in the c-myc gene were found in seven cervical carcinoma cell lines analysed, Northern blot analysis indicated different levels of c-myc gene expression which may be related to the presence of human papillomavirus (HPV) sequence in the cell and suggests a possible c-myc-hpv interaction in some stages of the transformation process.     

Immunocytochemical staining of cervical smears for the diagnosis of cervical intraepithelial neoplasia

A total of 233 cervical smears were stained by immunocytochemical methods for epithelial membrane antigen (EMA); the findings were compared with those from Papanicolaou-stained smears from the same women. Squamous epithelial cells from normal cervices did not stain, but cells shed from cervices with cervical intraepithelial neoplasia (CIN) did express the EMA marker. Metaplastic cells from normal and abnormal cervices also frequently stained. The results confirm that this marker detects cervical intraepithelial neoplasia in vitro, but its potential use in an automated screening program may be limited by the staining of the metaplastic cells.     

Costs and benefits of cervical screening. I. The costs of the cervical screening programme

In 1991, the average total Health Service cost of a cervical smear, including follow up at the colposcopy clinic, was almost £22.70 in the Perth and Kinross district of Scotland. The average cost per colposcopy clinic visit was £30. The main cost elements were in general practice (55% of total) and the laboratory (33%), and most of the cost was for staff time.     

Costs and benefits of cervical screening IV: valuation by women of the cervical screening programme

OBJECTIVES: To assess the value of the cervical smear test to women, taking account of the positive and negative aspects of the cervical screening service. DESIGN: A postal survey. SETTING: Tayside Health Board region of Scotland. PARTICIPANTS: A sample of 2000 women aged 20-59. MAIN OUTCOME MEASURES: Maximum willingness to pay (WTP) for a cervical smear test. RESULTS: Women were prepared to pay 50.20 British pounds per smear on a 3-yearly basis. Willingness to pay was positively related to income, but unrelated to age and whether or not the respondent had previously had a smear. CONCLUSIONS: Previous studies have estimated the cost per screen or cost per life year saved by cervical screening. This study used the economic instrument of WTP to take account of other potential (dis)benefits to women. The value women place on having a smear was more than the cost to the National Health Service (NHS) of providing the service. The output of a WTP study is potentially useful at the policy level. Future work should explore both the value of alternative approaches to cervical screening, and the value of competing health care interventions.     

Tennis elbow and the cervical spine.

The exact cause of tennis elbow, a common condition, is still obscure. While the condition may well be entirely due to a local disorder at the elbow, the results of a study of 50 patients whose condition was resistant to 4 weeks of treatment directed to the elbow suggest that the underlying condition may have been (at least in these patients) a reflex localization of pain from radiculopathy at the cervical spine. Clinical, radiologic and electromyographic findings supported this suggestion. The pain was demonstrated to be muscular tenderness, which was maximal and specific at motor points. Treatment directed to the cervical spine appeared to give relief in the majority of patients. The more resistant the condition, the more severe were the radiologic and electromyographic findings in the cervical spine.     

Fixed cervical count and the origin of the mammalian diaphragm

Why is mammalian cervical count fixed across the historically long and ecologically broad mammalian radiation? Multiple lines of evidence, considered together, suggest a link between fixed cervical count and the muscularization of the diaphragm, a key innovation in mammalian history. We test this hypothesis by documenting the anteroposterior (AP) movement of the diaphragm, a lateral plate derivative, relative to that of the somitic thoracolumbar transition in unusually patterned mammals, by comparing the temporal occurrence of an osteological proxy for the diaphragm and fixed cervical counts in the fossil record, and by quantifying morphological differentiation within the mammalian cervical series. We then integrate these anatomical observations with details of diaphragm function and development to propose a sequence of innovations in mammalian evolution that could have led to fixed cervical count. We argue that the novel commitment of migratory muscle precursor cells (MMPs) of mid‐cervical somites to a fate in the abaxial diaphragm defined these somites as a new and uniquely mammalian modular subunit. We further argue that the coordination of primaxial abaxial patterning constrained subsequent AP migration of the forelimb, thereby secondarily fixing cervical count.     

宫颈上皮内瘤变与宫颈微生物群落结构的相关性

目的分析宫颈上皮内瘤变与宫颈微生物群落结构的相关性。方法选取2017年1月至2018年10月于我院就诊的253例女性进行回顾性分析,根据是否患有宫颈上皮内瘤变分为CIN组(86例)及对照组(167例)。采集纳入对象的宫颈菌群并提取细菌基因组DNA,对细菌16S rRNA V3、V4区片段进行PCR扩增,并采用Illuminate Miseq测序平台对PCR产物进行测序,分析两组对象宫颈微生物群落结构,并分析患者宫颈微生物群落结构与宫颈上皮内瘤变的相关性。结果两组对象宫颈微生物群落的Simpson指数及Shannon指数比较差异无统计学意义(t=1.474、1.636,P0.05),而CIN组的Chao指数及ACE指数均高于对照组(t=9.213、10.420,P0.05)。16S rRNA分析显示放线菌是宫颈部位的主要菌群。CIN组女性宫颈微生物群落中放线菌、奇异菌属、放线菌门、阴道奇异菌及奇异变形菌占主要优势(LDA4log10),对照组中杆菌、厚壁菌门等占主要优势。Spearman相关分析示卷曲乳杆菌、惰性乳杆菌、格氏乳杆菌、詹氏乳杆菌与宫颈上皮内瘤变呈负相关,而加特纳菌、阴道奇异菌、普雷沃氏菌、粪球菌与宫颈上皮内瘤变呈正相关(均P0.05)。结论 CIN女性宫颈菌群与健康女性存在明显差异,其中卷曲乳杆菌、惰性乳杆菌、格氏乳杆菌、詹氏乳杆菌与宫颈上皮内瘤变呈负相关,而加特纳菌、阴道奇异菌、普雷沃氏菌、粪球菌与宫颈上皮内瘤变呈正相关。