Table of Content

15 November 2015, Volume 34 Issue 6
Previous Issue    Next Issue
---
述评
热点问题
讲座
综述
标准与指南
论著
综述


For Selected:

Download Citations EndNote Ris BibTeX

Toggle Thumbnails

述评

Select

The Challenges of HPV Infection in China XUE Feng-xia;WANG Bao-chen 2015, 34 (6):  445-449.  Abstract ( 1463 )   PDF (672KB) ( 7658 )   Human papillomavirus（HPV） infection has become one of the most serious disease burdens for women. HPV infection not only causes the common sexually transmitted disease（STD），and also closely related to genital tract tumors. Particularly，the persistent infection of high-risk HPV （HR-HPV） is the most important risk factor of cervical cancer. Although the clinical research about HPV infection and cervical cancer has become a hot spot over the past decade，there are still many problems and challenges about the epidemiology of HPV infection，such as the role of HR-HPV testing in cervical cancer screening，how to block the HRHPV persistent infection, and the use of HPV vaccine in China. Related Articles | Metrics

热点问题

Select

HPV Persistent Infection in Genital Tract of Women QU Peng-peng 2015, 34 (6):  450-452.  Abstract ( 1436 )   PDF (413KB) ( 7527 )   HPV infection can lead to cervical lesions or cancer only if the infection of the high-risk type(s) of HPV persists for a long time. Although the HPV infection in cervix is common, most women with HPV infection can clear away HPV within a period of time. Some of them develop into the persistent HPV infection which is a high-risk factor of the high-grade cervical intraepithelial lesion. A small number of women with the persistent HPV infection develop into cervical cancer. The following factors have been found to increase the risk of the persistent HPV infection, such as age, multiple sexual partners, the infection of HPV plus other sexually transmitted viruses, multiple parturition（＞3 children）, hypoimmunity, and so on. The exact mechanism associated with clearance of HPV infection is not clarified. There is a lot of evidence to support the view that the HPV persistent infection is related to the immune status of host and the HPV-induced immune evasion. The role of immune system, including immune cells and cytokines, is important in viral clearance. Related Articles | Metrics

Select

Clinical Applications of HPV Testing in Obstetrics and Gynecology FU Yun-feng;XIE Xing 2015, 34 (6):  453-456.  Abstract ( 1359 )   PDF (682KB) ( 7556 )   The infection with human papillomavirus（HPV） in women genital tract is common, and the persistent infection of high-risk type HPV is the major cause of cervical cancer. The main purpose of HPV testing is to determine whether there is a high-grade cervical intraepithelial neoplasia（ＣＩＮ） or cancer, rather than an infection itself，though various methods are available for HPV testing. The four HPV assays approved by the Food and Drug Administration（FDA） for cervical cancer screening are hybrid capture 2 HPV (HC2-HPV)，Cervista HPV，Cobas HPV and Aptima HPV. Above assays were demonstrated to have similar sensitivity and specificity for the detection of high-grade CIN. The current clinical applications of HPV testing in obstetrics and gynecology were included：①to screen cervical cancer and precursors by sole HPV testing or the HPV testing combined with cytopathology; ②to triage cervical lesions for women with cytopathological abnormalities；③to follow-up visit for women after treatment or women with abnormal screening results. The HPV primary screening is as effective as the combined screening, and that the testing times are less when compared with the combined screening. However，the HPV primary screening has lower specificity than the cervical cytopathology. Moreover, some women with cervical cancer may be misdiagnosed by an HPV-only screening. It is necessary to explore how to apply the HPV testing to the best advantage in the prevention and treatment of cervical cancer. Related Articles | Metrics

Select

Test Methods of HPV Infection and Related Issues LI Yuan;XIANG Yang 2015, 34 (6):  457-461.  Abstract ( 1411 )   PDF (642KB) ( 7584 )   Cervical cancer is associated with the persistent high-risk human papillomavirus（HR-HPV） infection. The test methods of HR-HPV infection have been developed and applied in cervical cancer screening. Four HR-HPV detection methods have been approved in United States and Europe: ①HC2（Hybrid Capture 2）, ②Cervista HR-HPV HR and Cervista HR-HPV 16/18, ③Cobas 4800 HPV, ④Aptima HPV and Aptima 16,18/45. Each method varies in principal and technique, so the indications in the cervical cancer screening strategy are different. The HR-HPV infection detection is applied to find those women at high risk for CINⅡ+, rather than HPV infection. It is possible that the primary HR-HPV screening substitute the cytology-based screening in the future. Related Articles | Metrics

Select

Clinical Application of HPV Vaccine ZHAO Chao;WEI Li-hui 2015, 34 (6):  462-466.  Abstract ( 1477 )   PDF (616KB) ( 7635 )   We introduced the structure of human papilloma virus（HPV）, the mechanism of prophylactic HPV vaccines and their clinical application. Three kinds of prophylactic HPV vaccines have been approved by FDA in the United States, including the quadrivalent HPV vaccine（Gardasil）, the bivalent HPV vaccine （Cervarix） and the nine-valent HPV vaccine （Gardasil9）. The Gardasil was designed to work on the HPV 6/11/16/18, the Cervarix on the HPV 16/18, and the Gardasil9 on the HPV 6/11/16/18/31/33/45/52/58. The data of clinical trials of prophylactic HPV vaccines and the clinical data post-marketing were reviewed. Three kinds of HPV vaccines were showed their persistent protective efficacy during the follow-up visit, up to now, without serious adverse reaction. Of course, it is necessary to evaluate unceasingly the efficacy, and to monitor long-term the potential adverse reaction. The bivalent HPV vaccine developed independently by our country has been doing the PhaseⅢ clinical trial. It is hopeful in near future that the cervical cancer vaccine be applied in Chinese women. Related Articles | Metrics

Select

Genital HPV Infection in Pregnancy and Impacts on Pregnancy LIU Jian-hua 2015, 34 (6):  467-470.  Abstract ( 1436 )   PDF (550KB) ( 7548 )   Human papillomavirus（HPV） can infect mucosa and skin，which causes benign or malignant lesion. HPV infection of genital mucosa is the most common mucosa infection, while there are specificities of genital HPV infection in pregnant women. The mother-to-fetus or mother-to-newborn HPV transmission （vertical transmission） may occur in the HPV-infected pregnancy, which is considered to cause fetal abnormality, spontaneous abortion, premature birth, etc. The ways of HPV vertical transmission include the direct contact with infected cells of vagina and cervix during birth，and the transmission by placenta and so on. More studies showed that sperm and oocyte could be infected by HPV, and that embryonic development could be affected seriously. Therefore it is also reasonable that the HPV-negative mother occasionally delivers an HPV-positive baby. It is necessary to study further the effects of the HPV-infected pregnancy on the pregnant outcomes, and embryonic and children′s health. Related Articles | Metrics

讲座

Select

Findings of HPV Infection by Colposcope ZHAO Yun;WEI Li-hui 2015, 34 (6):  471-474.  Abstract ( 1362 )   PDF (580KB) ( 7535 )   A few patients with persistent human papillomavirus（HPV） infections could develop cervical intraepithelial neoplasia（CIN）. CINs are divided into two kinds, high-grade lesion and low-grade lesion, while the high-grade lesion is the true precancerous lesion. With the help of acetic acid and Lugol′s solution, CIN could be recognized by colposcopist. Colposcopy is mainly used to find the high-grade lesion. It is difficult to differentiate the low-grade lesion from immature metaplasia by colposcope. The International Federation of Cervical Pathology and Colposcopy（IFCPC） terminology should be used in clinical practice, so as to academic exchange and the unified understanding. Besides tissue biopsy, colposcopy is used to locate the lesion and to estimate the degree. All these information would be benefit to make an individual management for patient. Nowadays, it is very important for the cervical cancer prevention to strengthen the colposcopy training and quality control. With the increasing coverage of primary and secondary prevention, colposcopy will face the challenge how to preferably distinguish the HPV related lesion. Related Articles | Metrics

Select

Diagnosis and Treatment of Cervical Lesions Due to HPV Infection XIE Feng;SUI Long 2015, 34 (6):  475-479.  Abstract ( 1340 )   PDF (720KB) ( 7558 )   The main strategy of diagnosis of cervical lesions caused by human papillomavirus（HPV） infection is the three-steps strategy, cytological test and/or HPV testing, colposcopy and histology. Currently, the feasible transitional screening program is as follows: no routine screening for women younger than 21 years, cytological preliminary screening for women between 21 and 24 years, HPV screening and typing for women older than 25 years and cytological test for those women with positive HPV excluding 16 and 18 types, and stop HPV screening for those women over 65 years and without the history of cervical lesions. The "See and Treat" should be taken for patients with the high-grade squmous intarepithelil lesions（HSIL） diagnosed by cytological test. The regular treatment for patients with cervical lesions caused by HPV infection includes follow-up, excision and ablation. There is not an absolute method, because there are advantages and disadvantages in each therapy. The most suitable selection of the individualized treatment should be based on the residue of lesion, side effect, economic cost, age and fertility desire, and offering more adequate and reliable sample for histological examination than colposcopy. Related Articles | Metrics

Select

The Diagnosis and Treatment of Condylomata Acuminate Caused by Human Papillomavirus CHE Ya-min;KE Wu-jian 2015, 34 (6):  480-483.  Abstract ( 1366 )   PDF (738KB) ( 7577 )   Condylomata acuminata（CA） is one of the most common viral sexually transmitted diseases （STDs） in China. It is a highly contagious STD caused by some types of human papillomavirus（HPV）, especially low-risk HPV 6 and 11, particularly the former. CA is spread directly through the skin/mucosa-to-skin/mucosa contact, usually during oral, genital, or anal sexual contact with an infected partner. Clinical presentation is mostly of hyperplastic lesion in the anogenital region. The treatment principle is included the excision of wart, improved symptom and reduced recurrence. The prevention of HPV can be achieved by the HPV vaccine. However, there are different advantages and disadvantages in the existing methods of detection and treatment of CA. Related Articles | Metrics

综述

Select

Local Immune Function of Vagina and HPV Outcome in Patients with Cervical Lesions MENG Jing-wei;SONG Jing-hui 2015, 34 (6):  484-487.  Abstract ( 1318 )   PDF (635KB) ( 7611 )   The persistent infection of HPV is a risk factor of cervical lesions. The local humoral immunity and cellular immunity are the first defense against the viral infection and disease progression during the cervical infection of HPV and cervical lesions, which is related to the pathogenesis and progression of tumor. The local cellular immune plays main roles in antiviral and inhibition of viral replication, while the local humoral immunity has an important synergistic effect. The vaginal local humoral immune and cellular immune function are changed by HPV infection before and after treatment of cervical lesions, suggesting that the local immune function could be a marker of the HPV outcome and the prognosis of cervical lesions. It is necessary to study whether it is possible to improve the immune function as the adjuvant prevention and treatment of cervical lesions. We discussed here the vaginal local immune function, and the HPV outcomes, in those patients with cervical lesions after treatment. Related Articles | Metrics

Select

Vaginitis, HPV Infection and Cervical Intraepithelial Neoplasia PIAO Jin-lan;ZHANG Rui-yi;GENG Li 2015, 34 (6):  488-490.  Abstract ( 1410 )   PDF (402KB) ( 7577 )   It was found that vaginitis was associated with HPV infection and cervical intraepithelial neoplasia（CIN）. The positive rate of trichomonas vaginitis in those HPV-positive patients was significantly higher than that in HPV-negative patients. The HPV clearance rate in both patients with the newly diagnosed vulvovaginal candidiasis and patients with recurrent vulvovaginal candidiasis was lower than that in patients without candida infections. The women with high-risk HPV persistent infections were more likely to have bacterial vaginosis than those with the high-risk HPV clearance，while bacterial vaginosis was related to the delayed clearance of high-risk HPV. The positive rate of bacterial vaginosis in CIN patients was higher than that in health women. It was also found that the HPV infection was related to the microbial constituent and pH value in vagina. The reduction, or absence, of vaginal lactobacilli were associated with HPV infection, CIN and cervical cancer. It is necessary to explore further all of above problems. Related Articles | Metrics

Select

Research Progress and Clinical Application of Human Papillomavirus E6/E7 LU Meng-han;LI Ya-li 2015, 34 (6):  491-494.  Abstract ( 1477 )   PDF (521KB) ( 7603 )   The human papillomavirus (HPV) is a crucial causative agent of cervical cancer. The persistent expression of HPV E6/E7 protein degradates or inactivates p53 and pRb proteins, which induces the immortalization and malignant transformation of cells by interacting with multifarious cytokines and variable pathways. The level of E6/E7 mRNA indicates the transcription activity of HPV, suggesting that the E6/E7 mRNA can be used to diagnose cervical diseases. In some clinical practice, the level of HPV E6/E7 mRNA has been used in different population to screen and predict cervical lesions and to predict the risk of cervical diseases. However, there was not agreement at present in the clinical application. The difference in the methods to detect HPV E6/E7 mRNA may be one of causes of this disagreement. The HPV E6/E7 protein analysis was hardly used in clinical practice. The immunotherapy targeting the E6/E7 protein is a research hotspot, which has made some progress in animal experiment and preclinical study. Related Articles | Metrics

标准与指南

Select

Interpretation of 2015 Interim Clinical Guidance for American Cervical Cancer Screening WANG Bao-chen;XUE Feng-xia 2015, 34 (6):  495-498.  Abstract ( 1369 )   PDF (598KB) ( 7518 )   Cervical cancer is an important disease burden of women in the world. The persistent infection of high-risk HPV（HR-HPV） is one of major factors of cervical cancer. At present，the major methods of cervical cancer screening in the United States are the cervical cytology testing and the co-screening with cytology and HR-HPV testing. HR-HPV testing alone could be one of the primary screening methods for cervical cancer, which is proposed by the 2015 American Interim Clinical Guidance. HR-HPV testing alone could be a alternative strategy for the cytology testing and the co-screening. We herein interpret the background，main content and evidence of this guidance. Related Articles | Metrics

论著

Select

The Effect of In Vitro Manipulation on Sperm Parameters and ROS SHI Xiao;WANG Ting;LIU Li;QIU Zhuo-lin;ZHAN Xiao-min;CHEN Si-mei;QUAN Song 2015, 34 (6):  503-506.  Abstract ( 1387 )   PDF (747KB) ( 7476 )   Objective：To study the effects of various physical interventions [such as centrifugation, repeated pipetting, Percoll gradient centrifugation （ＰＧＣ）] on the recovery rate, motility, membrane integrity （MI） and intercellular ROS （ＤＣＦＭＦＩ） of mice spermatozoa. Methods: The mice sperms were treated by different centrifugation force and time （200×g, 400×g, 600×g, 800×g; 5 min, 10 min, 15 min, 20 min）, different pipetting times （2, 4, 6, 8, 10 times） and PGC condition （600×g, 800×g, 1 000×g, 1 200×g; 15 min, 30 min）, so as to explore the impact factors and optimal procedure of sperm treatment. Results: The factorial analysis showed that the centrifugation force and centrifugation duration were two factors of the sperm recovery rate in centrifugation procedure and the percentage of motile sperm in PGC procedure（P＜0.05）. The centrifugation force was a single factor of the percentage of motile sperm in centrifugation procedure and the MI in PGC procedure（P＜0.05）. The pipetting procedure was related to the MI and the percentage of motile sperm（P＜0.05）. The percentage of motile sperm was significantly decreased when the centrifugation force reached to 600×g （P＜0.05）. The MI and percentage of motility sperm were significantly decreased when the pipetting times were more than 4 （P＜0.05）. The percentage of motile sperm was significantly increased when the centrifugation force was more than 800×g and the centrifugation duration was 30 min in PGC procedure （P＜0.05）. However, the MI was significantly decreased when the centrifugation force was over 1 000×g （P＜0.05）. There was not significant change in the DCFMFI after different sperm treatments （P＞0.05）. Conclusions: During mouse sperm treatment, the centrifugation force should be controlled under 600×g, the pipetting times less than 4, and the optimal PGC procedure is 800×g 30 min. Related Articles | Metrics

Select

Pregnancy Outcomes of Two Methods of Endometrium Preparation for Froze-Thawed Embryos Transfer: Retrospective Study ZHU Su-fang;MA Yu-zhen 2015, 34 (6):  507-509.  Abstract ( 1233 )   PDF (495KB) ( 7532 )   Objective：To investigate the effects of two methods of endometrium preparation for froze-thawed embryos transfer（FET）, using natural cycle and hormone replacement therapy. Methods：111 cycles of ＦＥＴ were retrospectively analyzed. Those cycles were divided into two groups：the natural cycle group （69 cases）, and the hormone replacement group （４２ ｃａｓｅｓ）. The clinical parameters were compared between the two groups, including age, infertility duration, the number of thawed embryo, the number of transplanted embryo, the number of high-quality post-implantation embryo, endometrial thickness on the day of endometrial transformation, embryo implantation rate, clinical pregnancy rates and early abortion rate. Results：There were no significant differences between the two groups in age, infertility duration, the number of thawed embryo, the number of transplanted embryo, the number of high-quality post-implantation embryo, endometrial thickness on the day of endometrial transformation, clinical pregnancy rate, embryo implantation rate and early abortion rate（P＞0.05）. Conclusions：There are same pregnancy outcomes using the two ways of endometrium preparation for FET. The way to prepare endometrium for those FET patients should be taken individually. Related Articles | Metrics

综述

Select

Application of MSOME and IMSI in Assisted Reproduction GONG Yi;MENG Xiang-qian;QUAN Song 2015, 34 (6):  511-513.  Abstract ( 1530 )   PDF (471KB) ( 7525 )   Sperm morphology is closely related to male fertility. Abnormal sperm morphology is one of main causes of male infertility. Since the intracytoplasmic sperm injection（ＩＣＳＩ） was successfully developed in 1992, it has helped so many infertile couples with abnormal sperm parameters to obtain their children. Under a magnification of ×400, the only major defects in sperm morphology could be found. Those sperms with many abnormities in subcellular organelles might not be identified, which could affect the success rate of ICSI. The motile sperm organelle morphology examination（ＭＳＯＭＥ） established by Bartoov in 2001 allowed to assess the subcellular organelles of sperm under high magnification, which is helpful to pick out sperm with normal morphology. The intracytoplasmic morphologically selected sperm injection（ＩＭＳＩ）, combined MSOME with ICSI，provided a new technique for the clinical ICSI practice. Related Articles | Metrics

Select

Research Progress of Fertility Preservation Treatment in Patients with Borderline Ovarian Tumors LI Shu-chang;LU Mei-song 2015, 34 (6):  514-518.  Abstract ( 1429 )   PDF (713KB) ( 7518 )   Borderline ovarian tumors（BOTs） are characterized by the histopathologic feature and biologic behavior which intermediate between clearly benign and frankly malignant ovarian tumors. The patients are young women, with a trend of younger, one-third of them have not completed childbearing. Because of BOTs′ unique pathological and clinical characteristics, the diagnosis and management of BOTs are different from those of ovarian cancer. For those young patients with BOTs, the fertility preservation surgery is the best option. This conservative surgery is still relatively safe, because the success rate of fertility is higher and the mortality of BOTs recurrence of conservative surgery is not increased although the recurrence rate is higher than that of non-conservative surgery. The detailed surgical option should be based on the individual circumstance. Chemotherapy should not be recommended as a routine. The complications followed by pregnancy are few，and pregnancy seems to have little impact on disease progression. The assisted reproductive technology can improve the pregnancy outcome in those BOTs patients after fertility preservation operation. The ovulation induction can be used in those patients with early-stage BOTs after fertility preservation operation, however it should be carefully used in those patients with advanced-stage BOTs. Related Articles | Metrics

Select

Poor Response in Controlled Ovarian Hyperstimulation: Diagnosis and Treatment ZHANG Yang-yang;XU Yang 2015, 34 (6):  519-523.  Abstract ( 1487 )   PDF (694KB) ( 7594 )   Poor ovarian response（POR）, which means insensitive to gonadotrophin in the controlled ovarian hyperstimulation （ＣＯＨ）, can result in fewer retrieved oocytes, higher cycle cancel rate and reduced clinical pregnancy rate. About 9%-24% of women who received COH treatment could have POR, which is one of the most challenging tasks in reproductive medicine. Until now, there is not accordant diagnostic criteria of POR. In 2011, ESHRE （European Society of human Reproction and Embryology） reached the Bologna Criteria: ①Age over or equal to 40 years, or other high-risk factor; ②History of POR (the number of retrieved oocytes in routine COH was less than or equal to 3）; ③The lowered ovarian function, such as AFC＜5-7 or AMH＜0.5-1.1 ng/mL. POR can be diagnosed if there are two in above three criterions. In this paper, we also introduced the treatment progress of POR, such as the adjusting COH, the increasing dose of gonadotrophin in COH, the pretreatment with androgens and oral contraceptive pills, and the adding growth hormone and aspirin. Related Articles | Metrics