Cervical Pathology Research Articles

Comparing Mid-Term Outcomes Between ACDF and Minimally Invasive Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy.

Retrospective cohort study. To compare minimally invasive posterior cervical foraminotomy (MI-PCF) and anterior cervical discectomy and fusion (ACDF) in the treatment of unilateral cervical radiculopathy. MI-PCF has been shown to be equally effective as ACDF in treating cervical radiculopathy due to foraminal stenosis and similar pathologies. Additionally, it has been hypothesized that preserving motion and avoiding fusion reduces risk for adjacent segment disease, but potentially increases risk for subsequent revision to an ACDF. With similar short-term outcomes and substantial advantages, MI-PCF may be an effective alternative to ACDF for addressing appropriate cervical pathology. A retrospective review was performed to identify patients between 2009 and 2013 who underwent ACDF or MI-PCF with a minimum follow-up of 7 years. Demographic data was recorded. Revision rates and average time to revision between cohorts were compared. Clinical outcomes were assessed at each follow-up visit with Neck Disability Index and Visual Analog Scale for neck and Visual Analog Scale for arm pain scores. All complications were reviewed. Standard binomial and categorical comparative analysis were performed. A total of 251 consecutive patients were included (205 ACDF, 46 MI-PCF). Mean follow-ups for the ACDF and MI-PCF groups were 98.3 and 95.9 months, respectively. Complication rates were 2.9% and 2.2% for the ACDF and MI-PCF cohorts, respectively (P = 0.779). Revision rates were 7.8% for the ACDF cohort and 8.7% for the MI-PCF cohort (P = 0.840). Both cohorts experienced significant improvements in their clinical scores compared with their preoperative values. Final Visual Analog Scale for neck pain (ACDF: 2.6; MI-PCF: 1.6) and Visual Analog Scale for arm pain (ACDF: 1.1; MI-PCF: 0.4) scores differed significantly at final follow-up (P = < 0.001; P = < 0.001). MI-PCF is a safe and effective alternative to ACDF in the treatment of cervical radiculopathy, demonstrating substantial benefit. After final follow-up, MI-PCF demonstrated superior improvements in Visual Analog Scale scores, without increased complication or revision rates.Level of Evidence: 3.

Bariatric surgery diminishes spinal diagnoses in a morbidly obese population: A 2-year survivorship analysis of cervical and lumbar pathologies

The effects of bariatric surgery on diminishing spinal diagnoses have yet to be elucidated in the literature. The purpose of this study was to assess the rate in which various spinal diagnoses diminish after bariatric surgery. This was a retrospective analysis of the NYSID years 2004–2013. Patient linkage codes allow identification of multiple and return inpatient stays within the time-frame analyzed (720 days). Time from bariatric surgery until the patient’s respective spinal diagnosis was no longer present was considered a loss of previous spinal diagnosis (LOD). Included: 4,351 bariatric surgery pts with a pre-op spinal diagnosis. Cumulative LOD rates at 90-day, 180-day, 360-day, and 720-day f/u were as follows: lumbar stenosis (48%,67.6%,79%,91%), lumbar herniation (61%,77%,86%,93%), lumbar spondylosis (47%,65%,80%,93%), lumbar spondylolisthesis (37%,58%,70%,87%), lumbar degeneration (37%,56%,72%,86%). By cervical region: cervical stenosis (48%,70%,84%,94%), cervical herniation (39%,58%,74%,87%), cervical spondylosis (46%, 70%,83%, 94%), cervical degeneration (44%,64%,78%,89%). Lumbar herniation pts saw significantly higher 90d-LOD than cervical herniation pts (p < 0.001). Cervical vs lumbar degeneration LOD rates did not differ @90d (p = 0.058), but did @180d (p = 0.034). Cervical and lumbar stenosis LOD was similar @90d & 180d, but cervical showed greater LOD by 1Y (p = 0.036). In conclusion, over 50% of bariatric patients diagnosed with a cervical or lumbar pathology before weight-loss surgery no longer sought inpatient care for their respective spinal diagnosis by 180 days post-op. Lumbar herniation had significantly higher LOD than cervical herniation by 90d, whereas cervical degeneration and stenosis resolved at higher rates than corresponding lumbar pathologies by 180d and 1Y f/u, respectively.

Cardiorespiratory findings during iohexol contrast myelography in horses under total intravenous anaesthesia

SummaryBackgroundIohexol myelography is used to investigate cervical vertebral pathology in horses but the cardiorespiratory changes during the procedure under total intravenous anaesthesia (TIVA) have not yet been reported.ObjectivesTo analyse heart rate (HR), arterial blood pressure (ABP) and respiratory rate (RR) changes in horses during iohexol contrast myelography under TIVA.Study designRetrospective review of anaesthetic records.MethodsAnaesthetic records from 70 horses undergoing iohexol contrast myelography under TIVA were reviewed. Heart rate, arterial blood pressure and respiratory rate at six time points; baseline (10 min prior to needle insertion), needle insertion, withdrawal of cerebrospinal fluid (CSF), iohexol contrast injection, needle removal and post‐procedure (10 min after needle removal) were analysed. Data were analysed using paired and two‐sample t‐tests, Mann–Whitney U test, Wilcoxon signed rank test, ANOVA, Pearson’s correlation and logistic regression.ResultsForty‐five records contained complete data. Mean HR and ABP were not significantly different from baseline at any time point during the procedure. Overall, median RR was significantly higher during contrast injection (p &lt; 0.001), at needle removal (p &lt; 0.001) and post‐procedure (p &lt; 0.001) compared to baseline. Premedication with acepromazine, romifidine and butorphanol (ARB) was associated with a significantly lower RR at needle removal compared to premedication with romifidine (R), romifidine and butorphanol (RB) or acepromazine and romifidine (AR) (p &lt; 0.05). Premedication with ARB or AR was associated with a lower incidence of tachypnoea (RR &gt;20 breaths/min) at needle removal compared to R and RB (p = 0.005).Main limitationsRetrospective design and small sample size.ConclusionsThere was little fluctuation in HR and ABP during iohexol myelography in healthy horses under TIVA. Tachypnoea occurred during or after subarachnoid iohexol administration in 55% of horses. Acepromazine premedication reduced the incidence of tachypnoea, however, the cause of this respiratory response requires further investigation.

Effectiveness of local application of antiseptic with octenidin dihydrochloride molecule in smoking women with ASC-US and LSIL

This article presents the results of our own experience of topical use of the Prodexin antiseptic that is contained an octenidine dihydrochloride molecule as a monotherapy for ASC-US and LSIL cervical pathology (identified with in fluid cytology) associated with human papillomavirus in smoking women.Study objective: To study the efficacy of topical application of the octenidine dihydrochloride molecule in the Prodexin vaginal suppositories in the treatment of smoking women with ASC-US and LSIL.Materials and methods. The study involved 45 female smokers with identified ASC-US or LSIL. The complex of examination included: Pap test based on liquid cytology, testing for human papillomavirus 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 types in a quantitative format, screening for the causes of vaginitis, extended colposcopy to exclude cervical intraepithelial neoplasia II+. Prodexin suppositories were used according to a 3-month treatment regimen (20 suppositories daily, and then 10 suppositories in two consecutive cycles).Results. Clinical and laboratory assessment of the therapy effectiveness has convincingly shown its positive effect on the vagina and cervix. Treatment with the Prodexin antiseptic associated with microbiota normalization, colposcopic picture improvement and changes in the Pap smear to NILM I or II. Regress to NILM was recorded in 20 (86.9%) patients with ASC-US and in 15 (68.8%) women with LSIL.Conclusions. Prodexin allows to avoid a worsening of the situation and prevent the changes progression in HSIL. Proposed treatment had no side effects, was convenient to use and did not require additional visits to doctor during therapy. The control over the human papillomavirus and study of the viral load has been postponed for 6–12 months from the beginning of the examination, that will be the second stage of work.

Cervical cancer: monitoring of the main indicators characterizing this pathology in Khabarovsk Krai (2009–2019)

Aim. Conduct a comparative assessment of the main indicators of the incidence of cervical cancer in Khabarovsk Krai (20092019) аnd the prevalence of types of human papillomavirus among the female population.&#x0D; Materials and methods. A comparative analysis of the data of the official statistics of the Ministry of Health of Khabarovsk Krai, using the Rosstat database for the period 20092019, taking into account the incidence, mortality, prevalence of types of human papillomavirus, was carried out. The dynamics trend was determined in the process of graphical analysis of the diagram and by modeling trends. The results of the studies were subjected to the methods of statistical information processing.&#x0D; Results. The results revealed in our study indicate that the increase in the incidence of cervical cancer in Khabarovsk Krai from 2009 to 2019 was 44.4% (with an average annual growth rate of 4.5%). Most often, cervical cancer in Khabarovsk Krai is detected in urban residents. The share of urban women with this pathology in 2019 reached 77.2%. The proportion of stage III cancer detected exceeds the proportion of stage IIIIV cancer by 2.5 times. Mortality in patients with cervical cancer in Khabarovsk Krai exceeds that in the Russian Federation. Of the 1617 residents of the city of Khabarovsk of reproductive age, 883 (54%) women had the presence of human papillomavirus. For our region, most often, women had highly oncogenic types of human papillomavirus 16, 56, 51.&#x0D; Conclusion. Statistical analysis based on the results of diagnosing early and advanced stages of cervical cancer, mortality from this nosological form, and the spread of the human papillomavirus remain among the most important criteria. The data obtained make it possible to assess the effectiveness of the chosen tactics in the regions and take timely corrective measures aimed at both early detection of cervical cancer and a decrease in the persistence of the human papillomavirus in women with background cervical pathology.

58 Rates of unanticipated pathology at the time of hysterectomy performed for pelvic organ prolapse in an underscreened population: An observational cohort study

To describe the rates of unanticipated pathology at the time of hysterectomy performed for pelvic organ prolapse in an underscreened population. A secondary objective was to determine risk factors for unanticipated pathology. Hysterectomies performed for pelvic organ prolapse at a large public hospital between July 2007 and July 2019 were reviewed. Patients undergoing surgery for malignancy or atypical hyperplasia were excluded. Medical records were reviewed for demographic information, medical history, pre-operative work up, and final pathology. Frequencies of abnormal pathologies were calculated. Demographic and screening factors were correlated with pathologic findings by Fisher’s exact test or Mann-Whitney U test, as appropriate. This study was IRB approved. Between 2007 and 2019, 759 patient cases were identified. Most patients self-identified as Hispanic (87.9 %). The median age was 57 years old and 66.5 % of patients were post-menopausal. Abnormal uterine bleeding history was present in 28.6 % of patients. The majority of patients underwent preoperative ultrasonography (65.4 %) and 38.3 % underwent preoperative endometrial biopsy. Of the 744 uterine specimens that had available histology results, there were two cases of endometrial hyperplasia and one case of endometrial cancer. Of the 729 cervical specimens that were available for review, there was one case of intraepithelial neoplasia and two cases of cervical cancer. In the 246 patients who underwent oophorectomy, no ovarian malignancies were found. Those with endometrial hyperplasia or endometrial cancer were younger than those with benign findings (P=0.05) and had a thicker endometrium on ultrasound (P=0.024). Two of the three patients who had abnormal endometrial findings at the time of hysterectomy had benign pre-operative endometrial biopsies. There were no demographic or preoperative findings that were significantly different between patients with abnormal cervical pathology and benign cervical findings (all P>0.05). For patients undergoing hysterectomy for pelvic organ prolapse in a public hospital setting, the rates of endometrial dysplasia or cancer were 0.4% and the rates of cervical dysplasia or cancer were 0.4%. Given that this medically under screened population underwent appropriate perioperative evaluation, these results underscore the importance of considering screening history when interpreting perioperative diagnostic results.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Gender‐neutral HPV elimination, cervical cancer screening, and treatment: Experience from Bhutan

Cervical cancer is preventable and also curable when detected early and treated adequately, yet it remains a leading cause of morbidity and mortality among women. In Bhutan, cervical cancer is the most common cancer among women. Bhutan was the first country among the low- and middle income economies to have instituted a national human papillomavirus (HPV) vaccination program in 2010 and has achieved >90% coverage. In 2019, Bhutan launched a cervical cancer elimination flagship program well ahead of the World Health Organization's launch of the global strategy for accelerated elimination of cervical cancer. Bhutan initiated vaccination of adolescent boys and adopted a gender-neutral vaccination program beginning September 2020 through its well-established network of primary health care centres. The flagship program aims to screen women aged 30-69 years with HPV testing using liquid based cytology (LBC) as triaging for screen positive women. For women 25-29 years, LBC will be continued as per ASCCP guideline. Colposcopy and treatment will be done in camps to decrease loss of follow-up of screen positive women. This program is also expected to improve early diagnosis of cervical cancer and provide timely and adequate cancer treatment and palliative care services. This article reviews the progress made and the challenges facing the 2030 cervical cancer elimination targets in Bhutan.

Human papilloma virus infection of uterine cervix and spectrum of cervical pathology in human immunodeficiency virus/AIDS

Human papilloma virus (HPV) is one of the most common causes of sexually transmitted viral diseases worldwide. High-risk HPV types such as HPV16 and 18 are known to cause cervical dysplasia and carcinoma. In human immunodeficiency virus (HIV)-positive individual, chance of HPV coinfection and risk of cervical dysplasia/carcinoma have been found to be significantly more than in HIV-negative individuals. In this institution-based, cross-sectional, observational study, we aim to find out the relationship of HPV infection of the uterine cervix with cervical dysplasia and neoplasia in HIV-infected/AIDS patients. Conventional Pap smears were taken from HIV-infected individuals admitted in the department of gynecology and obstetrics and reported by the Bethesda system. A second sample was sent to the virology unit of ICMR for detection and typing of HPV. Control samples were taken from HIV-negative individuals. Fifty HIV-positive patients were included in this study. On cervical Pap smear examination, 32 cases were cytologically benign and 18 cases showed atypical cytomorphology. Twenty-four cases were HPV positive, among which 16 were cytologically atypical and 8 were benign. HPV 16 was the most common subtype (50%) followed by HPV 18 (37.5%) and others (12.5%) in HIV-positive patients. Chance of cervical dysplasia increased with age independent of HIV infection and with progressive lower CD4 count. Koilocytosis was a significant predictor of HPV infection. Majority of patients were asymptomatic. Peak incidence of HPV infection occurred in reproductive age group (20-40 years). The association between HIV and HPV coinfection (P = 0.002) and between HPV infection and cytology atypia (P < 0.0001) was statistically significant. Present study highlights the necessity of routine cervical Pap smear screening in HIV infected reproductive age-group women. Early detection enables dysplasia to revert or be effectively managed.

Biomechanical Cervical Assessment Using 2-Dimentional Transvaginal Shear Wave Elastography in Nonpregnant and Pregnant Women: A Prospective Pilot Study.

This study evaluated the technical feasibility of 2-dimensional transvaginal shear wave elastography to quantify cervical stiffness in nonpregnant and pregnant women and established normal values in each group. With institutional review board approval, we performed a prospective study with an age-matched historical control design. Sixteen premenopausal nonpregnant women without cervical pathology and 17 low-risk pregnant women (gestational age 17-33 weeks) were enrolled. Cervical shear wave speeds were measured on a SuperSonic Aixplorer machine. The mean shear wave speeds of anterior cervix were 4.96 ± 1.96 m/s in nonpregnant women and 1.92 ± 0.31 m/s in pregnant women. No significant stiffness difference was found between the anterior and posterior cervix (P = 0.15). The upper cervix was stiffer than the lower cervix in the pregnant women (P = 0.00012). Transvaginal shear wave elastography reveals that cervix at a midterm gestation is significantly softer than nonpregnant cervix (P < 0.0001) and suggests a spatial stiffness gradient along the length of the cervix, consistent with histopathology and limited elastography literature. Our results indicate the potential of transvaginal shear wave elastography to provide objective and quantitative estimates of cervical stiffness, especially during pregnancy.

Second ever reported case of central cause of unilateral foot drop due to cervical disc herniation: Case report and review of literature.

BackgroundFoot drop is defined as a weakness in the ankle and foot dorsiflexors. A disruption of the neural pathway starting from the motor prefrontal cortex and ending in the peroneal nerve can lead to foot drop. Foot drop due to lower motor neuron injury is well documented. However, foot drop due to a central cause of cervical disc prolapse is very rare.Case presentationA 55-year-old male presenting with neck pain, right and left arms radicular pain and numbness, and unilateral right foot drop following cervical disc prolapse. The patient presented with upper motor neuron lesion signs. MRI showed cervical disc prolapse at two levels, confirming central cause of foot drop. The patient underwent anterior cervical decompression and fusion surgery.DiscussionFollowing decompression and fusion of involved cervical spine disc pathology, the patient had complete recovery of his right foot drop.ConclusionsCentral causes, although rare, should be considered in the differential diagnosis of foot drop. Causes could be due to the compression effect of the cortico-spinal tract of the cervical spinal cord. Satisfactory results can be achieved upon correcting the causative lesion.

INFLAMMATORY HEMATOLOGICAL MARKERS IN PREDICTION OF CERVICAL INTRAEPITHELIAL NEOPLASIA RECURRENCE IN NEGATIVE SURGICAL MARGINS

Objective: This study aimed to evaluate the predictive value of preoperative neutrophil-lymphocyte ratio in cervical intraepithelial neoplasia recurrence after conization surgery. Materials and Methods: In this retrospective study, patients who underwent conization due to cervical intraepithelial neoplasia were analyzed. Inclusion criteria were cervical intraepithelial neoplasia in the conization specimen with negative surgical margins and at least 12 months follow-up period at our clinical database. Demographic, clinical, pathological data, and preoperative complete blood count findings of the patients were extracted from medical files. Results: There were a total of 105 patients divided into two groups: the recurrence group (n = 30) and the control group (n =85). There were no statistically significant differences between the two groups in terms of cervical intraepithelial neoplasia pathology grades. There was statistically increased number of postconization endocervical positive results in the recurrence group. In the recurrence group, the mean of recurrence free survival was 10.5 months. There were no statistically significant differences in the preoperative neutrophil-lymphocyte ratio and in other hematologic parameters between the groups. In logistic regression analysis, only endocervical curettage positivity was predictive in estimating recurrence (p=0.002, %95 CI 0.084-0.365). Conclusion: Preoperative neutrophil-lymphocyte ratio and other inflammatory markers were not predictive of recurrence after conization in women with negative surgical margins. Positive postconization endocervical curettage was the only prognostic factor associated with recurrence after excisional therapy.

C5 palsy after cervical laminectomy: natural history in a 10-year series

BACKGROUND CONTEXTC5 palsy is a well-known complication following cervical laminectomy, however the cause of this complication remains elusive, with many studies providing conflicting reports on prognosis and the impact of specific risk factors. PURPOSETo describe the natural history of and risk factors for C5 palsy after first time cervical laminectomy involving C4 and/or C5, in a large series with a high rate of postoperative palsy. STUDY DESIGN/SETTINGThis is a retrospective case series. PATIENT SAMPLEPatients undergoing first time cervical laminectomy for degenerative spine pathologies at a single institution between January 2008 and July 2018. Adult patients were included if a complete laminectomy was performed at C4 or C5 for degenerative pathology and pre- and postoperative upright lateral x-rays were performed. OUTCOME MEASURESThe primary outcome measure was postoperative C5 palsy, defined as a decrease in strength of at least one point in deltoid and/or biceps within 30 days of operation. The secondary outcome measure was recovery of function. METHODSA retrospective database of patients who underwent posterior cervical spine surgery was created and further focused by utilizing specific Common Procedural Technology (CPT) codes associated with our desired patient population. Patients were excluded from our study if they had inadequate pre- and postoperative imaging, as well as patients with a history of prior cervical spine surgery, concurrent anterior surgery, intradural pathology, spinal tumor, or spinal trauma. Patient history, surgical specifics, and neurologic function were recorded. RESULTSA total of 190 patients were treated by 13 surgeons. 53 (27.9%) developed C5 palsy postoperatively. Of patients with C5 palsy, 40 (75.5%) recovered to baseline strength, 46 (86.6%) had at least grade 4 strength at last follow up, and 4 (7.5%) had strength worse than baseline and motor grade less than 4. Median time to recovery was 2.0 (IQR: 0.18 to 8.24) months. Age, gender, preoperative motor score, number of levels decompressed, smoking history, and comorbidities were not associated with a significant increase in the odds of C5 palsy. Risk of C5 palsy increased by 35% for every additional level fused below C4. CONCLUSIONThe risk of C5 palsy is increased with instrumentation caudal to C5 in operations addressing degenerative cervical pathology. This should be taken into consideration during operative planning. Overall prognosis of C5 palsy is good; however, incidence of this condition may be greater than previously reported.

Cervical intervertebral disc denervation during rotator cuff tendon plasty

Objective. To analyze the effect of denervation of intervertebral discs in the cervical spine on the results of surgical treatment of patients with injuries to rotator cuff tendons of the shoulder joint.Material and Methods. Study design: descriptive hypothesis-generating study. The study included patients requiring surgical treatment of rotator cuff tear. Two groups were identified: Group A included 28 patients who underwent plastic repair of rotator cuff tear with additional denervation of intervertebral discs, and Group B – 30 patients who underwent only plastic surgery for rotator cuff tear. The intensity of pain according to the VAS, functional activity due to neck pain (NDI), functionality of the shoulder joint (UCLA), and the degree of intervertebral disc degeneration according to MRI were assessed, and the effectiveness of treatment was determined. Statistical calculations were performed using the RStudio program.Results. In the group of patients with denervation of intervertebral discs, a more pronounced decrease in the intensity of pain syndrome at 3, 6, and 12 months (p &lt; 0.001; p &lt; 0.001; and p = 0.002), a more proportion of effectively treated patients at 3 months (p = 0.003), and significant increase in functional activity according to NDI at 3, 6 and 12 months of follow-up period (p &lt; 0.001; p = 0.010; and p = 0.045) were observed.Conclusions. There is an underestimation of the role of degenerative cervical spine pathology in the occurrence of shoulder joint pain. In the case of rotation cuff plasty the additional denervation reduces the intensity of pain syndrome in the shoulder joint in the postoperative period.

Comparison of Conventional Pap Smear, Colposcopy, and HPV Testing in Diagnosis of CIN

To access prevalence of repeated smears in routine health screening and comparison of its outcome with colposcopy, and HPV testing in early diagnosis of cervical neoplasia. Cross-sectional study. Cervical screening of 1200 healthy patients 21 years and above was carried out at health camp. Conventional Pap staining was done in all cases. Abnormal cases were subjected to further testing. The result of conventional Pap smear, repeat Pap smear, HPV test, and colposcopy was compared in repeated smears. Sensitivity specificity and area under curve (AUC) were calculated with 95% CI with standard histopathology. 31.08% (N = 373) cases were followed by a repeat Pap smear. Sensitivity for conventional Pap smear in detecting CIN was found to be 82.93% and specificity was 84.76%,while sensitivity and specificity for colposcopy were 99.8% and 96.19%, respectively. Sensitivity for HPV in detecting CIN was 48.94%. AUC for Pap was 0.851, 95% CI (0.783–0.905). AUC for colposcopy was 0.981, 95% CI (0.943–0.996). In a routine health camp, as many as 31.08% of cases were repeated. 12.4% of patient’s Pap was repeatedly abnormal which shows a high prevalence of undetected cervical pathology in population. Our study also shows colposcopy has more sensitivity and specificity in detecting CIN as compared to repeat Pap smear in cases of inflammatory reactive and ASCUS cases. HPV, however, has low sensitivity in comparison with both methods.

CORRELATION OF BIOPSY AND AgNOR COUNTS IN PREMALIGNANT AND MALIGNANT LESIONS OF CERVIX

Background- Cervical cancer is the commonest cancer among women in developing countries. Screening methods like cervical cytology has brought down the incidence of cervical cancer. AgNOR represents Nucleolar organizer regions stained with silver and are related to cell proliferation rate and tumor malignant potential. The present study was aimed at evaluating the diagnostic role of AgNOR in cervical carcinogenesis. Material and Methods- The present study was conducted in the Pathology department of Gajra Raja Medical College, Gwalior from January 2019 to May 2020 on 500 patients who attended the Gynae OPD. Women of suspected cervical pathology and who underwent Pap smear test followed by subsequent biopsies were included. Results- AgNOR count in chronic cervicitis was 2.72±0.32, in CIN I was 4.02±0.38, in CIN II was 5.47±0.21 in CIN III was 5.59±0.18, in Well differentiated KSCC was 6.48±0.40 and in adenocarcinoma was 6.93±0.21. The study showed that the mean AgNOR count per nucleus was signicantly higher in CIN and malignant cervical lesions. Conclusion- AgNOR count is reproducible, simple, efcient and inexpensive method which can be used as an adjunct to histopathology and cytology especially in differentiating doubtful cases of CIN.

New Trends of Cervical Cancer Incidence in Kazakhstan.

Objective:The epidemiological features of the cervical cancer (CC) incidence and its spatial and temporal assessment in Kazakhstan were studied. Methods:The retrospective study was done for the period 2009-2018. Descriptive and analytical methods of oncoepidemiology were used. Results:During the study period, 16,441 new cases of CC were registered. The average annual crude and age-standardized incidence rate were 18.6±0.5 and 17.7±0.4 cases per 100,000 population of female, respectively, and their trends tended to increase (Тup=+2.3%; R2=0.708 and Тup=+1.9%; R2=0.615, respectively). The analysis of ASIR showed unimodal growth with a peak at 50-54 years – 45.3±1.1 cases per 100,000 population of female. Trends of ASIR decreased up to 30 years (Tdown=−1.8%; R2=0.111) and 35-59 years (Tdown=−0.9%; R2=0.103), in other age groups the trends increased, and were most pronounced in 40-44 (Тup=+4.1%; R2=0.878) and 65-69 years (Тup=+4.4%; R2=0.537). Trends in ASR of СС tended to grow in almost all regions, with higher levels in Mangystau (Тup=+4.1%; R2=0.482) and Aktobe (Тup=+6.3%; R2=0.846) regions. The cartograms of ASR per 100,000 population of female were allocated according to the following criteria: low – up to 16.3, average – from 16.3 to 19.2, high – above 19.2. The results of the spatial analysis showed the regions with a higher levels of CC incidence rate per 100,000 population of female: East Kazakhstan (19.8), Aktobe (20.0), Almaty (20.1), Kostanay region (20.9), Atyrau (21.7) regions and Almaty city (22.0). Conclusion:The study of trends of the cervical cancer incidence has the theoretical and practical value: monitoring and evaluation of screening programmes, which are implemented in the country, and conduction of secondary prevention of cervical pathology. Health authorities should consider the obtained results in the in the organization of anti-cancer activities.

Evaluation and management of patients referred to our center with suspicion of cervical pathology

Amaç: Bölgemizdeki İnsan Papilloma Virüs (HPV) pozitiflik prevalansını belirlemek ve HPV pozitif olguların tip dağılımını ve yönetimini incelemektir.Gereç ve Yöntem: Servikal patoloji şüphesi ile ileri tetkik ve inceleme için Ocak 2018 – Aralık 2019 tarihleri arasında Sağlık Bilimleri Üniversitesi Trabzon Kanuni Sağlık Uygulama ve Araştırma Merkezi’ne başvuran hastalar retrospektif olarak incelendi. Hastaların demografik verileri belirlendi. Hastalarda saptanan HPV tiplendirilmesi ve smear sonuçları kaydedildi. Yüksek riskli HPV tipi gözlenen ve kolposkopi yapılan hastaların biyopsi sonuçları değerlendirildi. Çalışma verileri tanımlayıcı istatistiki metodlar kullanılarak analiz edildi. Bulgular: Çalışmaya HPV testi yapılan 6186 hasta dahil edildi. Hastaların yaş ortalaması 43,87 ± 7,1 yıl, vücut kitle indeksi 27,1 ± 6,56 kg/m2, gravidası 3,4 ± 0,43 idi. Sigara kullanım oranı %22,8, HPV pozitifliği %5,45 (n=337/6186) olarak saptandı. Hastaların servikal smear sonuçlarının dağılımı; normal %54,3 (n=183), enfeksiyon %19,29 (n=65), ASC-US %5,64 (n=19), L-SIL %2,37 (n=8), AGC %0,30 (n=1) olarak tespit edildi. HPV tiplendirmesinde en sık görülen tipler 91 hastada HPV 16 (%27), 45 hastada HPV 31 (%13,4), 43 hastada HPV 51 (%12,8), 43 hastada HPV 52 (%12,8) şeklinde idi. Kolposkopik biyopsi sonuçlarında %49,6 (n=167) servikal intraepitelyal neoplazi (CIN) 1, %7,4 (n=25) CIN 2-3, %1,2 (n=4) skuamöz hücreli karsinom tespit edildi. Sonuç: Çalışmamız sonuçları dahilinde cinsel aktif kadınlarda servikal kanser taramasının önemi bir kere daha ortaya konmuştur. 30 yaş üzerinde HPV DNA ve servikal smear kombinasyonu ile yapılan serviks kanseri tarama programlarına katılmanın önemi akılda tutulmalıdır. Çalışmamız Doğu Karadeniz Bölgesi’nin HPV prevalansını kesitsel olarak göstermesi açısından bir ilktir.

Method for predicting the development of cervical caries and teeth with wedge-shaped defect in young people

Annotation. Significant prevalence of cervical caries and teeth with wedge-shaped defect is the reason for the search for ways to predict their development that is possible only with an individual approach. The purpose of the study is to design and test the method for predicting the development of cervical caries and teeth with wedge-shaped defect in young people based on the results of determining the chemical composition of enamel, dentin and oral fluid. The chemical composition of the enamel and dentin of 29 teeth was examined using JSM-6490 LV focused beam electron microscope (scanning). We determined the content of the chemical elements in the oral fluid of 33 patients: Сa2+, РО43-, SO42 - by spectrophotometric method, Na+, К+, Al3+ by atomic emission spectrometry, Mg2+, Zn2+ by atomic absorption spectrometry, Cl- using chloride selective electrode of pH meter. Statistical analysis was performed using the computer program Statistica 8.0 (STA862D175437Q). Analysis of variance (Welch test), Pearson's parametric correlation method (Brave-Pearson coefficient (r)) was used. The reliability of the obtained results was evaluated by Student's t-test, the correlation between the indicators – by Student's test using the Z-test (Fisher's z-test) at p≤0.05. It was determined that the values of the К/Na+Са/Сl coefficient in enamel (equator, cervical region), dentin (cervical region), oral fluid significantly differed depending on the state of hard dental tissues (p≤0.05). Direct correlation of moderate and high strength was revealed between Са/Р and К/Na+Са/Сl – coefficients in cervical enamel and saliva (p≤0.0001). Obtained results became the basis for the development of the method for individual prediction of the development of cervical pathology in young people. Its approbation was carried out in 43 patients, its effectiveness was assessed a year later. With the values of the К/Na+Са/Сl 2 coefficient and lower we diagnosed the absence of the risk of developing cervical caries and wedge-shaped defect, from 2.1 to 5.3 the risk of developing cervical caries was diagnosed, from 5.4 and more the risk of developing wedge-shaped defect was found out. It was confirmed that the proposed method is informative (the prediction accuracy reaches 83,7%), its non-invasiveness is the basis for widespread use. We consider the search for the ways to predict particularly the development of teeth cervical pathology based on the parameters of the oral fluid and dental biofilm to be promising.

The Utility of Prolonged Prophylactic Systemic Antibiotics (PPSA) for Subfascial Drains After Degenerative Spine Surgery.

Retrospective cohort study. The aim of the current investigation was to evaluate the impact of prolonged prophylactic systemic antibiotics (PPSA) on the development of surgical site infection rate (SSIR) in degenerative spine surgery. Surgical drains are utilized postoperatively in posterior spine surgery to help minimize the risk of seroma formation. Prophylactic antibiotics while drains are in place are frequently used to reduce SSIR, though the practice remains controversial. We performed a single center, retrospective review of all patients that underwent posterior spinal surgery for cervical and lumbar degenerative pathology over a 3.5 year period (January 2016-July 2019). Patients underwent a traditional open posterior midline procedure with postoperative placement of a subfascial surgical drain. Antibiotics were administered for the duration of the drain (PPSA group) or for 24 hours postoperatively (non-PPSA group). The number of surgical site infections, organism, and Clostridium difficile infections was recorded. Three hundred thirty six patients were identified, 168 patients in the PPSA group and 168 in the non-PPSA groups. The overall SSIR was 5.36% (18/336). The SSIR for the non-PPSA and PPSA groups were 7.14% (12/168) and 3.57% (6/168), respectively (P = 0.146). While difference of SSIR between the groups was two-fold, it was not statistically significant. For the non-PPSA and PPSA groups, the SSIR for cervical (5.95% [5/84] vs. 2.38% [2/84], P = 0.443) and lumbar (8.33% [7/84], vs. 4.76% [4/84], P = 0.535) regions were not significantly different. C. difficile cases in the PPSA and non-PPSA groups were 1/168 and 0/168 respectively (P = 1.00). Our series demonstrate a two-fold reduction of SSI with implementation of PPSA regimen. This benefit was demonstrated separately for both cervical and lumbar regions. Randomized trials and increase in sample size are warranted to elucidate the significance of PPSA in posterior spinal surgery.Level of Evidence: 3.

Analysis of the agreement between colposcopic impression and histopathological diagnosis of cervical biopsy in a single tertiary center of Chengdu

The aim of this retrospective study was to analyze the agreement between colposcopic impression and histopathological diagnosis of cervical biopsy. The medical records of patients underwent a colposcopy-guided cervical biopsy at Chengdu Women's and Children's Central Hospital between January 2017 and January 2019 were collected, including age, menopausal status, cervical cytology and human papillomavirus (HPV) test results, type of transformation zone, colposcopic diagnosis and histopathological outcomes of cervical biopsy. Colposcopy was carried out using 2011 colposcopic terminology of International Federation for Cervical Pathology and Colposcopy (IFCPC). Related variables were analyzed. A total of 495 patients were collected in this study. The perfect agreement between colposcopic impression and histopathological diagnosis was 46.9%, and the strength of agreement with kappa value was 0.283 (P < 0.001), and the agreement within 1 grade was 93.5%. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, false-positive rate and false-negative rate of detecting HSIL or more (HSIL +) were 93.1%, 57.8%, 80.9%, 93.9%, 6.1% and 45.3%, respectively. Colposcopic diagnosis more often underestimated (43.2%) [especially in HSIL (59.3%) and carcinoma (70.7%) patients] than overestimated (9.9%) in cervical lesions. The results of cytology, HPV status, patients' age and different experiences of practitioners were the factors for under-diagnosis of HSIL + by colposcopy. Colposcopy is an excellent tool to estimate cervical high-grade lesion but is imprecise. Many factors can bias the diagnosis of colposcopy, especially the known results of cervical cytology and HPV. Precise diagnosis of cervical lesion should rely on the colposcopy-directed biopsy.