Treatment Of Cervical Disease Research Articles

Features of the course of external genital endometriosis due to cervical pathology

Background. In modern literature, there is a limited number of publications devoted to the characteristics of the course of endometriosis in patients with cervical diseases (CD), the choice of management tactics for cervical diseases and the prevention of relapses of these diseases.Objective. To analyze clinical, anamnestic and laboratory data in patients of reproductive age with a combination of benign cervical diseases and external genital endometriosis.Materials and methods. A retrospective cohort study was conducted that included 100 women of reproductive age with external genital endometriosis. The main group consisted of 56 patients with a combination of benign cervical diseases and external genital endometriosis. The comparison group consisted of 44 patients with external genital endometriosis without cervical cancer. An assessment was made of clinical and anamnestic data, the results of a cytological examination of a cervical smear, extended colposcopy and the level of hormones AMH, FSH, estradiol, performed by enzyme immunoassay on days 2-5 of the menstrual cycle. Statistical analysis was carried out using the SPSS Statistics 26.0 program.Results. External genital endometriosis in 56% of cases is associated with benign cervical diseases, in the structure of which non-inflammatory diseases predominate (63%). Inflammatory diseases of the cervix were observed in 16% of patients, and combined pathology of the cervix was observed in 21% of women with external genital endometriosis. The presence of concomitant cervical pathology in 83.3% of cases is accompanied by endometriosis-associated infertility, this is significantly more common than in patients with inflammatory (22.2%) and non-inflammatory (42.9%) cervical diseases, p < 0.05. Surgical treatment of endometriosis did not lead to pregnancy within one year after surgery in any planning patient with concomitant cervical pathology (0/11); this figure in women with non-inflammatory cervical diseases was 14.3% (4/32), whereas in 75.0% (3/4) with inflammatory diseases of the cervix, pregnancy occurred within a year after surgery, p<0.05. In turn, the presence of inflammatory cervical diseases was associated with a significantly lower level of AMH (1.4±0.5 ng/ml) compared to patients with non-inflammatory cervical diseases (3.0±0.4 ng/ml) and combined cervical cancer pathology (3.4±0.5 ng/ml), p<0.017. A significant decrease in ovarian reserve in the future can also lead to impaired fertility in this category of patients.Conclusion. The results of the study indicate the need for a comprehensive assessment of the condition of the cervix in patients with genital endometriosis, including a thorough history taking, cytological examination and extended colposcopy in combination with determination of HPV virus carriage. Timely measures for the diagnosis and treatment of cervical diseases in patients with endometriosis-associated infertility will improve fertility rates in this category of patients.

Development of human papillomavirus and its detection methods (Review).

Human papillomavirus (HPV) infection plays an important role in cervical cancer. HPV is classified within the Papillomaviridae family and is a non-enveloped, small DNA virus. HPV infection can be classified into two distinct scenarios: i) With or without integration into the host chromosomes. Detection of its infection can be useful in the study of cervical lesions. In the present review, the structural and functional features of HPV, HPV typing, infection and transmission mode, the risk factors for cervical susceptibility to infection and HPV detection methods are described in detail. The development of HPV detection methods may have far-reaching significance in the prevention and treatment of cervical disease. This review summarizes the advantages and limitations of each HPV detection method.

Automatic Segmentation of Cervical Cells Based on Star-Convex Polygons in Pap Smear Images.

Cervical cancer is one of the most common cancers that threaten women's lives, and its early screening is of great significance for the prevention and treatment of cervical diseases. Pathologically, the accurate segmentation of cervical cells plays a crucial role in the diagnosis of cervical cancer. However, the frequent presence of adherent or overlapping cervical cells in Pap smear images makes separating them individually a difficult task. Currently, there are few studies on the segmentation of adherent cervical cells, and the existing methods commonly suffer from low segmentation accuracy and complex design processes. To address the above problems, we propose a novel star-convex polygon-based convolutional neural network with an encoder-decoder structure, called SPCNet. The model accomplishes the segmentation of adherent cells relying on three steps: automatic feature extraction, star-convex polygon detection, and non-maximal suppression (NMS). Concretely, a new residual-based attentional embedding (RAE) block is suggested for image feature extraction. It fuses the deep features from the attention-based convolutional layers with the shallow features from the original image through the residual connection, enhancing the network's ability to extract the abundant image features. And then, a polygon-based adaptive NMS (PA-NMS) algorithm is adopted to screen the generated polygon proposals and further achieve the accurate detection of adherent cells, thus allowing the network to completely segment the cell instances in Pap smear images. Finally, the effectiveness of our method is evaluated on three independent datasets. Extensive experimental results demonstrate that the method obtains superior segmentation performance compared to other well-established algorithms.

Comparative evaluation of posterior percutaneous endoscopy cervical discectomy using a 3.7\u2009mm endoscope and a 6.9\u2009mm endoscope for cervical disc herniation: a retrospective comparative cohort study

BackgroundPosterior percutaneous endoscopy cervical discectomy (p-PECD) is an effective strategy for the treatment of cervical diseases, with a working cannula ranging from 3.7 mm to 6.9 mm in diameter. However, to date, no studies have been performed to compare the clinical outcomes of the use of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of patients with unilateral CDH treated with p-PECD using a 3.7 mm endoscope and a 6.9 mm endoscope.MethodsFrom January 2016 to June 2018, a total of 28 consecutive patients with single-level CDH who received p-PECD using either the 3.7 mm or the 6.9 mm endoscope were enrolled. The clinical results, including the surgical duration, hospitalization, visual analog scale (VAS) score and modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were also performed during follow-up.ResultsTthere was a significant difference in regard to the average identification time of the “V” point (18.608 ± 3.7607 min vs. 11.256 ± 2.7161 min, p < 0.001) and the mean removal time of the overlying tissue (16.650 ± 4.1730 min vs. 12.712 ± 3.3079 min, p < 0.05) for the use of the 3.7 mm endoscope and the 6.9 mm endoscope, respectively. The postoperative VAS and MacNab scores of the two endoscopes were significantly improved compared with those the preoperative scores (p < 0.05).ConclusionThe application of both the 3.7 mm endoscope and 6.9 mm endoscope represent an effective method for the treatment of CDH in selected patients, and no significant difference can be observed in the clinical outcomes of the endoscopes. The 6.9 mm endoscope shows superiority to the 3.7 mm endoscope in terms of the efficiency of “V” point identification, the removal of overlying soft tissue and the prevention of spinal cord injury. However, the 6.9 mm endoscope may be inferior to the 3.7 mm endoscope in regards to anterior foraminal decompression due to its large diameter; this result needs to be further evaluated with the support of a large number of randomized controlled trials.

Approaches to managing patients with CIN in routine clinical practice

Objective : analyze the validity of destructive treatments for cervical diseases in clinical practice. Materials and methods : analyzed archival medical documentation (medical records of an inpatient patient, form 003/y) of 258 patients who underwent surgical treatment of cervical diseases in 2017 – 2018. Statistical data were calculated on a personal computer using the Microsoft Excel 2011 for Mac program and the «Statistica» statistical program. Results : an analysis of medical documentation revealed that a complete set of diagnostic methods, regulated by the clinical recommendations “Benign and precancerous cervical diseases from the perspective of cancer prevention” (2017), including HPV genotyping, was carried out in 28.7 % women. Before surgical treatment, a cytological examination of the cervix was carried out in 89.5 % cases, HPV-test — 31.4 % patients. As a result of the comparison of 258 histological and pre-operative clinical diagnoses, overdiagnosis of low- and high-grade cervical lesions (LSIL and HSIL) was noted in 16 (23.2 %) patients who did not have a history of childbirth and 42 (22.0 %) women who had previously given birth, which determined the use of destructive treatments without indications in 58 (22.5%) cases. An underestimation of the severity of cervical damage among unborn patients was found in 9 (13.0 %) patients, as well as in 40 (21.2 %) women with a history of childbirth. Conclusions : overdiagnosis of the degree of intraepithelial cervical lesions entails the unreasonable use of destructive methods of treatment in young unborn women who violate the anatomic-functional integrity of the cervix and the architectonics of the cervical canal.

A randomized clinical study of the treatment of white lesions of the vulva with a fractional ultrapulsed CO2 laser.

White lesions of the vulva are a common vulvar disease of unclear etiology. Although a variety of treatments have been used to treat the disease in clinical practice, there is currently a lack of effective radical therapies. This study aimed to compare the feasibility and effectiveness of fractional ultrapulsed CO2 laser with that of high-intensity focused ultrasound in the treatment of white lesions of the vulva. A total of 60 patients with pruritus vulvae who were treated at the Center for Diagnosis and Treatment of Cervical Diseases in our hospital between December, 2017, and December 2018 were enrolled in this study. The possibility of malignant lesions of the vulva was ruled out by histopathological diagnosis following colposcopic biopsy. The patients were randomly divided into two groups: a laser treatment group (group L, n=30) and a focused ultrasound treatment group (group U, n=30). The patients were monitored for changes in signs and symptoms during and after treatment, and the treatment outcomes of the two groups were compared. The local symptoms of pruritus were alleviated by both the fractional ultrapulsed CO2 laser and high-intensity focused ultrasound. The patients in group L had no significant adverse reactions during the operation and needed no special postoperative treatment. The total effective rate in group L was 96.7%. In group U, five patients felt mild burning during the operation, painful blisters arose on the skin of the ablated area, and long-lasting local edema was observed. Seven patients had subcutaneous nodules. The total effective rate in group U was 90.0%. Fractional ultrapulsed CO2 laser is a minimally invasive, effective, and safe treatment for white lesions of the vulva. It causes few complications and does not affect the daily and working life of patients. Therefore, it should be widely applied in clinical practice.

Clinical factors of development of squamous intraepithelial cervical lesions of high grade in patients with papillomavirus infection

Purpose of the study. To assess the chances of development of squamous intraepithelial cervical lesions of high degree (H‑SIL) in patients infected with human papillomavirus (HPV).Patients and methods. 75 HPV positive patients. The main group — with a histological diagnosis of H‑SIL (n=50), the control group — with a histological diagnosis without H‑SIL (n=25). Liquid-based cytology, colposcopy, cervical excision; HPV test, diagnosis of sexually transmitted infections — PCR in real time; a comprehensive bacteriological study. Assessment tool interconnections — odds ratio, categorical data analysis — statistical packages STATISTICA 6.0 and SPSS 22 "Statistical Package for the Social Sciences".Results. In the age group up to 30 years, the chances of H‑SIL development are 26 times higher, 30–40 years — 38 times higher compared to patients over 50 years (p&lt;0.05). With a menstrual cycle of more than 35 days, the chances of H‑SIL development are 71 times greater than in patients with a normal menstrual cycle (p&lt;0.05).Comparison of the chances of the presence of abnormal colposcopic patterns — the presence of significant lesions related to the II degree of colposcopic changes increases the chances of H‑SIL 8.4 times compared to the normal colposcopic pattern. The chances of development of H‑SIL in patients with colposcopy results of minor lesions (I degree), do not differ from those who have a normal colposcopic picture (p&gt;0.05). The presence of chronic inflammatory diseases of the pelvic organs. Earlier treatment of cervical diseases by destruction reduces the risk of H‑SIL 0.08 times. The presence of chronic diseases of the pelvic organs increases the risk of H‑SIL 24 times (p&lt;0.05).Conclusion. The group at greatest risk of having H‑SIL -women 30–40 years, whose menstrual cycle is more than 35 days, with significant lesions according to the results of colposcopic examination, chronic diseases of the pelvic organs, which had not previously been carried out destruction of the cervix.

HPV-associated cervical diseases: screening, methods of examination, principles of treatment

This article presents information about modern principles of diagnosis and treatment of HPV-associated diseases. Behind cervical cancer morbidity and mortality rates over the past 10 years increase significantly. Examination and observation of patients with human papillomavirus persistence of highly oncogenic types is important a link in cancer prevention. The article presents diagnostic methods, treatment of cervical diseases, as well as the possibility of pharmacotherapy in HPV-associated diseases.

Zero-Profile Versus Cage and Plate in Anterior Cervical Discectomy and Fusion with a Minimum 2 Years of Follow-Up: A Meta-Analysis

In recent years, increasing numbers of cervical disease cases have been treated with zero-profile devices in anterior cervical discectomy and fusion (ACDF). Its short-term efficacy has been widely recognized; however, the evidence for long-term efficacy remains insufficient. The present study assessed the mid-term and long-term efficacy of zero-profile compared with cage and plate structures in ACDF by analyzing the clinical and radiological outcomes after treatment of cervical diseases with a minimum 2 years of follow-up. We conducted a comprehensive database or platform search in PubMed, ISI Web of Science, Embase, and Cochrane Central Register of Controlled Trials using the PRISMA guidelines and identified 10 reports, with 772 patients (375 in the zero-profile group and 397 in the cage and plate group) that met our inclusion criteria. All patients had been followed up for ≥2 years. Two of us used a standardized data collection form to extract relevant data and check its accuracy independently. The zero-profile group had statistically significant (P < 0.05) less intraoperative blood loss, improved postoperative C2-C7 Cobb angle, and decreased incidence of postoperative dysphagia and adjacent segment degeneration compared with the cage and plate group. The operative time, postoperative Japanese Orthopaedic Association score, Neck Disability Index score, and bone fusion rate showed no statistically significant differences between the 2 groups. The zero-profile and cage and plate structures achieved comparable mid-term and long-term clinical and radiological outcomes in ACDF. In addition, the zero-profile group showed reduced intraoperative blood loss, improved postoperative C2-C7 Cobb angle, and decreased incidence of dysphagia and adjacent segment degeneration complications.

Posterior enlargement of spinal canal for the treatment of multi-segmental cervical diseases without cervical lordosis

Objective To evaluate the feasibility and efficacy of posterior enlargement of spinal canal for the treatment of multi-segmental cervical diseases without cervical lordosis. Methods From January 2013 to June 2017, a retrospective study was conducted with 21 patients of multi-segmental cervical diseases accompanied cervical lordosis loss, and the complete follow-up data was obtained. There were 14 males and 7 females, with an average age of 53.9±7.3 years (range, 42-65 years). There were 14 multi-segmental cervical spondylotic myelopathy, 5 ossification of posterior longitudinal ligament, and 2 congenital cervical stenosis included in this study. The cervical lordotic angle and cervical curvature index were measured preoperatively and 1 year postoperatively. To access the enlargement of spinal canal and spinal cord, the anteroposterior diameter and cross section area of spinal canal or spinal cord were measured on MRI preoperatively and 1 year postoperatively. The Japanese Orthopaedic Association Scores (JOA) was applied to evaluate the neurological function at preoperation and postoperation. Visual Analogue Scales (VAS) was applied to evaluate the pain degree at preoperation and postoperation. Frankel classification was used to assess the severity of spinal cord injury at preoperation and postoperation. Results The follow-up time was 12-26 months, with an average of 16.4 months. The cervical lordosis angle was 3.1°±2.3° preoperatively, and 4.2°±1.6° 1 year postoperatively with a significant difference. The cervical curvature index was 4.4%±1.7% preoperatively and 5.0%±1.5% 1 year postoperatively with no statistically difference. Except for C7T1 level, the preoperative anteroposterior diameter and cross section area of spinal canal at C2,3, C3,4, C4,5, C5,6, and C6,7 level were lower than that at 1 year after operation with a significant difference. Except for C2,3 and C7T1 and level, the preoperative anteroposterior diameter and cross section area of spinal cord at C3,4, C4,5, C5,6, and C6,7 level were significantly lower than that at 1 year after operation. The average JOA score preoperatively was 8.9±1.7. The average JOA score at 3 months postoperatively was 13.1±2.0, which was significantly higher than that preoperatively. At 3 months postoperatively, the average improvement rate was 52.0%, and the superior rate was 52.3%. At 1 year postoperatively, the average JOA score was 13.3±2.1, which improved significantly from that preoperatively. The average improvement rate was 54.3%, and the superior rate was 61.9%. The VAS score at preoperatively was 3.0±2.4, and which was 2.7±1.7 at 1 year postoperatively with no significant differences. At pre-operation, the level of Frankel classification was C level in one (4.8%) case, D level in 8 (38.1%) cases and E level in 12 (57.1%) cases. At 1 year postoperatively, the level of Frankel classification was C level in one (4.8%) case, D level in 6 (28.6%) cases and E level in 14 (66.7%) cases, compared with that at preoperatively, there was no statistically significant difference. One patients suffered from neurologic deterioration at 1 year after surgery and recovered after anterior cervical surgery. No other serious complications were occurred. Conclusion For the patients with multi-segmental cervical diseases accompanied cervical lordosis loss, effective spinal decompression by cervical posterior laminoplasty was feasible, and a good clinical efficacy was achieved. Key words: Cervical vertebrae; Spinal stenosis; Spinal cord compression

Comparative study of acupuncture treatment and conventional drug treatment on cervical disease with severe sleep disorders

Objective To compare the clinical efficacy and safety of acupuncture treatment and conventional drug treatment on cervical disease with severe sleep disorders. Methods 80 cervical disease patients with severe sleep disorders were randomly divided into acupuncture group (n=40) and conventional drug group (n=40) according to the digital table.The conventional drug group was given alprazolam tablets, the acupuncture group was given acupuncture.2 weeks for a course, the two groups were treated for 2 courses.The subjective pain was evaluated by visual analogue scale (VAS), the sleep quality was assessed by PSQI, the clinical efficacy and incidence of adverse reactions were compared. Results The scores of VAS in acupuncture group and conventional group were (1.08±0.66)points and (2.53±0.75)points, which were decreased significantly (t=7.175 and 5.264, all P<0.01), and the decrease of VAS in acupuncture group was greater than that in control group (t=5.663, P<0.01). The scores of PSQI, sleep quality, sleep latency, sleep time, sleep efficiency, and daytime function in the acupuncture group and the conventional group were (2.60±0.12)points and (4.24±0.15)points, (0.52±0.20)points and (0.95±0.35)points, (0.42±0.30)points and (0.45±0.28)points, (0.45±0.18)points and (0.72±0.20)points, (0.38±0.18)points and (0.40±0.14)points, (0.43±0.15)points and (0.78±0.30)points, (0.30±0.16)points and (0.94±0.40)points, which were significantly lower than those before treatment (t=14.502 and 10.265, 9.431 and 7.312, 8.873 and 7.062, 7.607 and 6.313, 7.492 and 6.815, 8.263 and 5.672, 8.141 and 5.515, all P<0.01). The sleep quality, sleep time, sleep disturbance, and daytime function score of the acupuncture group were significantly higher than those of the control group (t=7.719, 4.633, 5.141, 4.223, 5.645, all P<0.01). The total effective rate in the acupuncture group was 97.5%, which was significantly higher than that in the control group (87.5%), the difference was statistically significant (χ2=9.372, P<0.05). Conclusion Acupuncture treatment has exact effect in the treatment of cervical disease with severe sleep disorders, it can significantly reduce the pain score, improve sleep quality, it is simple and convenient, and worthy of clinical application. Key words: Sleep Disorders; Spinal diseases; Cervical vertebrae; Moxibustion; Acupuncture

The efficacy of unilateral open-door laminoplasty with reserved bilateral semispinalis in treating multi-level cervical diseases

Objective To evaluate the efficacy of unilateral open-door laminoplasty with reserved bilateral semispinalis for the treatment of multi-level cervical diseases. Methods A retrospective study of prospectively collected data from hospital was conducted. From January 2013 to December 2015, thirty-three patients with multi-level cervical disease underwent C3-C6 unilateral open-door laminoplasty with reserved bilateral semispinalis. There were 19 males and 14 females with average age 57.22±10.75 years (range 35-75 years). Moreover, 32 patients with multi-level cervical disease underwent unilateral open-door laminoplasty with only reserved supraspinal ligamentum, and 35 underwent C3-C7 traditional open-door laminoplasty at the same time. The demographics, operation duration, blood loss volume, cervical curvature, range of motion, axial symptoms, visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, the neck disability index (NDI) and complications were recorded and analyzed at preoperation, postoperation and at final follow-up. Results The demographics, cervical curvature and range of motion at preoperation, operation duration and blood loss were not significantly difference among three groups (P>0.05). Cervical curvature and range of motion of traditional open-door laminoplasty were 34.38°±7.96° and 11.89°±7.70° at final follow-up (P 0.05), while VAS score, NDI score were significantly different (P<0.05). In particular, VAS and NDI of unilateral open-door laminoplasty with reserved bilateral semispinalis were better than other groups. Early pain was reported in each patients. Two patients (6%) with axial symptom was present in unilateral open-door laminoplasty with reserved bilateral semispinalis, 5 patients (16%) in unilateral open-door laminoplasty with only reserved supraspinal ligamentum and 12 patients (34%) in traditional open-door laminoplasty. There were significantly difference among these groups (P<0.05). One patient with C5 nerve root palsy was reported in unilateral open-door laminoplasty with reserved bilateral semispinalis and unilateral open-door laminoplasty with only reserved supraspinal ligamentum, and two patients in traditional open-door laminoplasty. No cerebrospinal fluid leakage, spinal cord injury, door-hinge fracture, infection, implant loosening or breakage and other complications were observed in each groups. Conclusion Unilateral open-door laminoplasty with reserved bilateral semispinalis is an effective technique in treating multi-level cervical disease. The technique not only guaranteed to have good recovery of neurological functional and to maintain cervical curvature and range of motion, but also contributed to decrease the occurrence of postoperative axial symptom. Key words: Cervical spondylosis; Ossification of posterior longitudinal ligament; Spinal stenosis; Treatment outcome

Pay attention to the treatment of cervical arterial disease, and prevent the stroke occurrence

This paper describes the carotid ischemic disease is an important factor leading to stroke, and reviews the anatomical basis of clinical relevance of the carotid lesions and stroke. Moreover, this paper introduced research progress of treatment of carotid artery disease treatment and prevention of stroke events from many domestic scholars, and evaluated these new academic point. Key words: Carotid artery diseases/TH; Stroke/PC; Editorial

How many preterm births in England are due to excision of the cervical transformation zone? Nested case control study.

BackgroundPreterm births (as a proportion of all births) have been increasing in many countries. There is growing evidence of increased risk of preterm birth following excisional treatment of the cervix. We estimate the number of preterm births attributable to excisional treatments with a length of 10 mm or more in England.MethodsCase–control study nested in a record linkage cohort of women with a histological sample at 13 hospitals in England. We combined observed age at first excisional treatment in our cohort with the weighted distribution of excision length from the case–control study to estimate the length distribution by age at first treatment among the cohort. The number of births after excision for each 5-year age group was estimated using national fertility data; published absolute risks of preterm (<37 gestational weeks) and very preterm birth (<32 weeks) were applied to these to estimate the number of preterm births per 100 women treated. Excess preterm births were estimated assuming all treatments were small. The attributable risk of preterm birth following excisional treatment in England was estimated.ResultsThe majority of first excisional treatments at colposcopy were small (47.5 %) or medium (39.1 %), 9.5 % were large and 4.1 % were very large excisions. 4.0 % of women treated before birth had more than one excisional treatment. Thus based on our cohort of 10,711 treated women and the length of treatment observed in the case control study we estimate an excess of 240 preterm births (including 57 very preterm) or 2.2 (including 0.5 very preterm) per 100 women treated. At a population level (for England) we estimate that 39,101 women aged 20–39 would be treated each year and that these treatments will lead to an excess of 840 preterm births (including 196 very preterm) in England each year.ConclusionsAssuming associations between preterm birth and treatment for cervical disease are causal; we estimate that an excess 840 (2.5 %) preterm birth in England each year are due to excisional treatments of 10 mm or more. Those that go on to become pregnant should be closely monitored during antenatal period to reduce their risk of preterm birth.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0664-3) contains supplementary material, which is available to authorized users.

Morphological study of the posterior osseous structures of subaxial cervical spine in a population from northeastern China.

BackgroundLaminar screws and lateral mass screws have been increasingly used in the treatment of cervical diseases. The purpose of this study is to determine the morphological characteristics of the posterior anatomical structures of the subaxial cervical vertebrae in a northeastern Chinese population.MethodsSixty-one consecutive patients underwent cervical spine computed tomography (CT). We analyzed a total of 610 axial images and 61 sagittal images. The following parameters were measured: lamina outer width (LOW), lamina inner width (LIW), lamina axis length (LAL), lamina transverse angle (LTA), lateral mass longitudinal diameter (LMLD), lateral mass transverse diameter (LMTD), sagittal spinous process length (SSPL), axial spinous process length (ASPL), spinal canal transverse diameter (SCTD), spinal canal longitudinal diameter (SCLD), osseous spinal canal area (OSCA), and Pavlov ratio (PR). The participants were classified into male and female groups and developmental canal stenosis (DCS; PR ≤0.75) and non-DCS (NDCS; PR >0.75) groups.ResultsSignificant differences were observed among the different vertebral levels for almost all evaluated parameters, except for LTA and OSCA. Statistical differences were found between the right and left sides in all parameters, except for LIW and LOW. All linear parameters, except for SCLD and the angular parameter LTA, significantly differed between the sexes. Significant differences were found between the DCS and NDCS groups in terms of all parameters, except for SCTD.ConclusionsVarious measurements of the posterior structures of subaxial cervical vertebrae differed between the left and right sides, females and males, and the DCS and NDCS groups. Different techniques for lateral mass screw insertion should be used according to different vertebral level. Only C7 laminar may be able to safely accommodate a 2.5-mm translaminar screw. The study data can help doctors to make better surgical decisions and develop more appropriate implants for northeastern Chinese patients.

Is the increased risk of preterm birth following excision for cervical intraepithelial neoplasia restricted to the first birth post treatment?

ObjectiveTo explore whether the increased risk of preterm birth following treatment for cervical disease is limited to the first birth following colposcopy.DesignNested case–control study.SettingTwelve NHS hospitals in England.PopulationAll nonmultiple births from women selected as cases or controls from a cohort of women with both colposcopy and a hospital birth. Cases had a preterm (20–36 weeks of gestation) birth. Controls had a term birth (38–42 weeks) and no preterm.MethodsObstetric, colposcopy and pathology details were obtained.Main outcome measuresAdjusted odds ratio of preterm birth in first and second or subsequent births following treatment for cervical disease.ResultsA total of 2798 births (1021 preterm) from 2001 women were included in the analysis. The risk of preterm birth increased with increasing depth of treatment among first births post treatment [trend per category increase in depth, categories <10 mm, 10–14 mm, 15–19 mm, ≥20 mm: odds ratio (OR) 1.23, 95% confidence interval (95% CI) 1.12–1.36, P < 0.001] and among second and subsequent births post treatment (trend OR 1.34, 95% CI 1.15–1.56, P < 0.001). No trend was observed among births before colposcopy (OR 0.98, 95% CI 0.83–1.16, P = 0.855). The absolute risk of a preterm birth following deep treatments (≥15 mm) was 6.5% among births before colposcopy, 18.9% among first births and 17.2% among second and subsequent births post treatment. Risk of preterm birth (once depth was accounted for) did not differ when comparing first births post colposcopy with second and subsequent births post colposcopy (adjusted OR 1.15, 95% CI 0.89–1.49).ConclusionsThe increased risk of preterm birth following treatment for cervical disease is not restricted to the first birth post colposcopy; it remains for second and subsequent births. These results suggest that once a woman has a deep treatment she remains at higher risk of a preterm birth throughout her reproductive life.Tweetable abstractRisk of preterm birth following large treatments for cervical disease remains for second and subsequent births.

Optimal screw orientation for the fixation of cervical degenerative disc disease using nonlinear C3-T2 multi-level spinal models and neuro-genetic algorithms.

Anterior cervical discectomy and fusion is a common surgical procedure performed to remove a degenerative or herniated disc in cervical spine. Unfortunately, clinical complications of anterior cervical plate (ACP) systems still occur, such as weak fixation stability and implant loosening. Previous researchers have attempted to ameliorate these complications by varying screw orientations, but the screw orientations are mainly determined according to the investigator's experiences. Thus, the aim of this study was to discover the optimal screw orientations of ACP systems to achieve acceptable fixation stability using finite element simulations and engineering algorithms. Three-dimensional finite element models of C3-T2 multi-level segments with an ACP system were first developed to analyze the fixation stability using ANSYS Workbench 14.5. Then, artificial neural networks were applied to create one objective function, and the optimal screw orientations of an ACP system were discovered by genetic algorithms. Finally, the numerical models and the optimization study were validated using biomechanical tests. The results showed that the optimal design of the ACP system had highest fixation stability compared with other ACP designs. The neuro-genetic algorithm has effectively reduced the time and effort required for discovering for the optimal screw orientations of an ACP system. The optimum screw orientation of the ACP system could be successfully discovered, and it revealed excellent fixation stability for the treatment of cervical degenerative disc disease. This study could directly provide the biomechanical rationale and surgical suggestion to orthopedic surgeons.

Clinical analysis of 56 patients with cervical cancer after cold knife conization

To evaluate the clinical value of conization in the diagnosis of cervical cancer to optimize its management. Fifty-six patients diagnosed with cervical cancer after conization at our hospital between 2008 and 2012 were reviewed. The pathological profiles of colposcopic multiple biopsies and treatment options were analyzed. Among them, there were stage Ia1 (n = 39), stage Ia2 (n = 2) and stage Ib1 (n = 15). And there was not much correspondence between cervical conization and colposcopic multiple biopsies in 46 cases. Among 23 patients with stage Ia1 undergoing further surgery, 12 (52.17%) had residual diseases, including CINI (n = 5), CINII(n = 3), CINIII (n = 3). No recurrence was found in 16 cases without further surgical intervention. All cases of stages Ia2 and Ib1 underwent repeat surgery while 8 cases received preoperative chemotherapy, including stage Ia2 (n = 1) and stage Ib2 (n = 7). Cold knife conization plays a very important role in the diagnosis and treatment of cervical diseases. Further treatment options should be selected individually and comprehensively based on such factors as patient age, degrees of dysplasia, surgical margin status, fertility requirements and so on.

Pregnancy Outcomes After Treatment for Cervical Intraepithelial Neoplasia in a Single NHS Hospital

The objective of this study was to assess the adverse pregnancy outcomes in women who had treatment for cervical intraepithelial neoplasia. This was a retrospective cohort using data linkage. Pathology databases from Whipps Cross University Hospital were used to identify women with a histological sample taken at colposcopy between 1995 and 2009. Births for these women were identified through the hospitals' obstetric database. A total of 876 births (from 721 women) were identified. Logistic regression was used to assess the relationship between adverse pregnancy outcomes and treatment for cervical intraepithelial neoplasia before delivery. Results were adjusted by ethnicity, deprivation, and parity. After taking into account parity, socioeconomic status, and ethnicity, receiving any type of excisional treatment (single or multiple) before birth increased the risk of preterm labor compared with having a punch biopsy only (adjusted relative risk, 1.61; 95% confidence interval, 1.11-2.32). Preterm deliveries that occurred after a spontaneous onset of labor were found to be more likely after treatment for cervical disease (adjusted relative risk, 1.68; 95% confidence interval, 1.11-2.52). Women receiving any type of excisional treatment before delivery are at increased risk of preterm delivery when compared with women attending colposcopy but not treated. Although we took into account the effects of parity, socioeconomic status, and ethnicity, residual confounding factors may be unidentified.

Clinical effect of loop electrosurgical excision procedure (LEEP) in diagnosis and treatment of cervical diseases

Objective To study the clinical effect of cervical loop electrosurgical excision procedure (LEEP) in diagnosis and treatment of cervical diseases (including cervical intraepithelial neoplasia of different grade, cervical erosion of moderate and severe degree, cervical with human papillomavims (HPV) infection and cervi-cal polyp) . Method The data of 136 cases with cervical disease treated by LEEP were analyzed retrospectively. Re-sult The postoperative diagnosis were upgraded in 18 cases (13.2%) ,and downgraded in 38cases (27.9 %) . The preoperative diagnosis of 80 cases (58.8 %) were in accordance with the postoperative ones. The difference was sig-nificant(P<0.05). The mean operative time was 11minutes, the mean bleeding volume was 15 ml. Postoperative bleeding of LEEP occurred in 2.2 % (3/136) patients. Postoperative cervical conglutination of LEEP occurred in 1. 5 % (2/136) patients. The cure rate of CIN was 96 % after LEEP. The residual CIN occurred in 4 patient (4 %). Recurrence CIN occurred in 2 patient (2 %). At 12th months after LEEP,the negative rate of HPV detection was 86. 7% and the persistent positive rate was 13.3%. The HPV clearance rate was increased gradually after LEEP. Conclu-sion LEEP was safe and effective for the treatment of the cervical disease and was a kind of good method to clear HPV infection in cervical. Key words: Cervical intraepithelial neoplasia; Microwaves; Gynecologic surgical procedures