In response to the incidence of cervical intraepithelial neoplasia and cervical cancer in China and global screening strategies, a collaborative effort was undertaken by seven Chinese medical associations to develop this guideline for cervical cancer screening. The guideline recommends high-risk human papillomavirus (hr-HPV) testing as the preferred method for primary screening, which should have been approved by authoritative institutions and clinically validated for primary screening. In areas without access to HPV testing, cytology can be used as an alternative. However, it is recommended to replace cytology with HPV-based screening as conditions permit. Cotesting (HPV testing in combination with cytology) is recommended for areas with sufficient medical resources, opportunistic screening populations, and partial special populations. The guideline recommends that individuals with a cervix initiate cervical cancer screening at the age 25 years and undergo HPV testing alone or cotesting every five years, or cytology alone every three years. Women over the age of 65 who have had documented adequate negative prior screening in the past may terminate screening. Corresponding screening programs are proposed for different special populations. The development of these guidelines is an important step in the effort to eliminate cervical cancer in China.
Immune checkpoint inhibitors (ICI) have shown efficacy for some patients with gynecological tumors, which are mainly used to treat persistent, recurrent, or metastatic patients. Immunotherapy with ICI has shown good objective responses and survival benefit in patients with endometrial cancer. However, the rate of response to immunotherapy in patients with ovarian cancer remains modest. Some patients with recurrent or resistant gestational trophoblastic neoplasia benefit from ICI. ICI often has optimal duration of response. Accurately evaluating the indications and responses, recognizing and managing immune-related adverse events are essential to ICI treatment. With regards to ICI, the clinical benefit of monotherapy is limited; however, combinations of ICI with other therapies may have clinical benefit.
Objective:To investigate short-term and long-term clinical effects of laparoscopic uterine artery temporary occlusion assisted uterine curettage on the treatment of type Ⅱ or Ⅲ cesarean scar pregnancy（CSP）.Methods:The clinical data of 88 patients with type Ⅱor Ⅲ CSP in the First Affiliated Hospital of Soochow University from January 2016 to June 2021 were analyzed retrospectively.40 patients were selected as the control group and then treated with uterine artery embolization in addition to ultrasound-guided uterine curettage.48 patients were selected as the laparoscopic group, and thus treated with laparoscopic uterine artery temporary occlusion assisted uterine curettage and additional scar repair with fertility requirements.The short-term and long-term complication rate and re-pregnancy status were compared between the two groups.Result:The preoperative and postoperative hemoglobin bias, the length of stay, number of complications in the laparoscopic group were significantly lower than those in the control group（all P＜0.05）.There were 15 cases（31.3%） of spanomenorrhea in the laparoscopic group, which was lower than that in control group[21 cases（52.5%）]accompanied by a 1 case of premature ovarian failure（P＜0.05）.When re-pregnancy occurred, abnormal pregnancy rate in the laparoscopic group was significantly lower than that in the control group（P＜0.05）.Conclusions:Compared with UAE,laparoscopic uterine artery temporary occlusion assisted treatment has the advantages of a little intraoperative bleeding, lower postoperative complication rate, and lower abnormal re-pregnancy rate.It is a safe and effective method worthy of clinical popularization.
目的:研究5 例具有白化病家族史的家系病因、胎儿的产前诊断和妊娠结局,并评价全外显子测序在白化病家系致病基因鉴定中的临床价值.方法:采用全外显子测序技术结合Sanger测序鉴定5 例具有白化病家系受检者基因型,进一步采用绒毛活检术/羊膜腔穿刺技术获取胎儿标本,进行产前基因诊断.结果:家系1 在TYR基因发现变异位点c.1184G>A和c.929dupC,家系2 在TYR基因存在致病变异c.929dupC和c.61C>T,家系3 在TYR基因存在致病变异位点c.1112_1113delAT 和c.929dupC,家系 4 在OCA2 基因上存在c.1001C>T和c.2051T>G变异,家系5 在HPS1 基因上存在变异位点c.972dupC和c.1932delC.对2 例胎儿进行产前诊断,1 例为白化病携带者,1 例基因型正常,出生后随访临床表型未见异常.结论:全外显子测序技术可全面、精准地鉴定白化病家系的致病因素,对有再生育需求的家庭起到优生优育指导作用,具有重要的临床意义.
目的:建立并验证局部晚期宫颈癌(LACC)患者放疗学结局的列线图.方法:回顾分析江西省妇幼保健院肿瘤科2013 年1 月至2017 年12 月收治的1567 例LACC患者的临床病理资料.结果:随机将 1567 例LACC患者分为训练集(1097 例)和验证集(470 例).收集的数据包括临床特征和随访信息.缺失数据采用多重推断方法进行估计.单因素分析发现,年龄、FIGO分期、T分期、N分期、肿瘤最大径线、治疗方案、总治疗时间是影响LACC患者放疗学结局的危险因素,通过正向逐步选择对多变量Cox比例风险模型中的变量进行识别并创立列线图,包括T分期、N分期、年龄、肿瘤最大经线、治疗方式、总治疗时间.C指数与AUC显示,列线图模型具有良好的预测能力.列线图在临床适用性校准和决策曲线分析中表现良好.按列线图评分分层的 3 个风险组中,患者的OS存在显著差异(P<0.001).结论:本研究开发了一种新的列线图来预测LACC患者经标准治疗的总生存率.列线图具有显著的鉴别能力和预测精度,有助于临床医生评估LACC患者的预后,并制定个体化的治疗和随访策略.
