Lymph node metastasis (LNM) is the primary mode of cervical cancer (CC) metastasis and is associated with a poorer prognosis. A comprehensive understanding of the underlying mechanisms driving LNM is critical to improving CC patient outcomes. Previous studies have demonstrated that alterations in the intratumor microbiome contribute to tumor progression, with metabolic regulation as a key mechanism. This study aims to investigate the role of intratumor microbiota and tumor metabolism in CC LNM. The microbiome analysis revealed significant differences in the diversity and composition of the intratumor microbiome between CC with and without LNM. Caulobacter and Porphyromonas were the most prominent genus markers for CC with LNM and CC without LNM, respectively. Alterations in tumor metabolism were also observed through global untargeted metabolomics and high-resolution spatial metabolomics, with pathways such as breast cancer, prolactin signaling, histidine metabolism, ovarian steroidogenesis, cysteine and methionine metabolism, and estrogen signaling being significantly altered in CC with LNM. Correlation analysis identified a strong association between specific intratumor microbes (especially Porphyromonas and Virgibacillus) and tumor metabolism. Additionally, our findings suggest a potential trend of phospholipid upregulation in tumor tissues during CC LNM. In summary, our findings underscore the critical role of intratumor microbiota and tumor metabolism in CC LNM, providing valuable insights for developing novel diagnostic markers and therapeutic strategies to address this challenging aspect of cervical cancer.IMPORTANCEThis study comprehensively characterized the intratumor microbiota and tumor metabolism associated with lymph node metastasis (LNM) of cervical cancer (CC) by performing 16S ribosomal RNA sequencing, global untargeted metabolomics, and high-resolution spatial metabolomics on surgical CC specimens. Our findings revealed distinct compositions and diversities of intratumor microbiota between CC with and without LNM. Each group exhibited specific bacterial genera that could potentially serve as diagnostic tools for CC LNM, and Caulobacter and Porphyromonas were the most prominent biomarkers for CC with and without LNM, respectively. The significantly different distribution trend of metabolites was also observed between CC with and without LNM. Correlation analysis identified a strong association between specific intratumor microbes (especially Porphyromonas and Virgibacillus) and tumor metabolism. This study not only provides valuable insights for developing novel diagnostic markers and therapeutic strategies for CC LNM but also contributes to a deeper understanding of the underlying molecular mechanisms of it.

The cervicovaginal microbiome and its associated metabolites play a pivotal role in the persistence of human papillomavirus (HPV) infection. Here, we investigated the contribution of the cervicovaginal microbiome and metabolome to 5-aminolevulinic acid photodynamic therapy (ALA-PDT)-mediated HPV clearance in patients with cervical high-grade squamous intraepithelial lesions (HSIL). 16S ribosomal RNA sequencing analysis identified significant differences in cervicovaginal microbiota before ALA-PDT between the HPV clearance and non-clearance groups. The HPV non-clearance group exhibited higher abundances of Anaerococcus and Gemella. ALA-PDT exerted a more substantial impact on cervicovaginal microbiota diversity in the HPV clearance group, characterized by increased abundances of Finegoldia, Corynebacterium, Lancefieldella, and Winkia, and a decreased abundance of Anaeroglobus following treatment. Global untargeted metabolomics analysis further revealed distinct cervicovaginal metabolic profiles before ALA-PDT between the two groups. The pathways of mineral absorption and valine, leucine, and isoleucine biosynthesis were significantly enriched in the HPV clearance group. Alterations in cervicovaginal metabolic profiles following ALA-PDT were also observed. Moreover, several key differential metabolites were observed to be significantly correlated with Anaeroglobus. Our findings underscore the critical involvement of the cervicovaginal microbiome and metabolome in ALA-PDT-mediated HPV clearance, providing valuable clues for predicting and improving the effect of HPV clearance following ALA-PDT.

Background and Objective The detection rate of multicentric squamous intraepithelial lesions (SILs) in the female lower genital tract increased, recently. This study evaluates the efficacy and safety of topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in treating multicentric SILs. Methods A total of 101 patients with multisite SILs and underwent ALA-PDT were enrolled in this study. they were followed up at 3, 6, 9, and 12 months after the end of treatment, and every six months thereafter. Results At 6-month follow-up, the lesion complete remission (CR) rates in groups of cervical with vaginal SIL, cervical with vulvar SIL, vaginal with vulvar SIL, and cervical with vaginal and vulvar SIL were 78.3%, 89.5%, 100% and 85.7%, respectively. The HPV clearance rates were 53.6%, 53.6%, 50.0% and 28.6%, respectively. Conclusion ALA-PDT is a effective and safet reatment for multisite SILs. It removes the lesions while avoiding extensive damage to the female lower genital tract.

OBJECTIVE:This study aimed to investigate the clinical efficacy of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of high-risk cervical low-grade squamous intraepithelial lesion (LSIL) and to analyze the influence of different risk factors on the efficacy. METHODS:The clinical data of 173 patients with persistent cervical LSIL and high-risk human papillomavirus (HR-HPV) infection were retrospectively analyzed. After treatment, HPV and TCT were reexamined every 3 months, and colposcopic biopsy was performed if necessary. RESULTS:At 6 months of follow-up, the HPV clearance rate, complete remission (CR) rate, persistence rate, and progression rate were 73.41%, 89.60%, 8.09%, and 2.31%, respectively. The HPV clearance rate showed an upward trend with time. Moreover, the CR rates of patients with 41-50 years old group, positive HPV16/18 genotyping, and type 3 transformation zone (TZ) were 77.14%, 84.52%, and 83.33%, respectively; these rates were significantly lower compared to patients without the corresponding high-risk factors (P = 0.021, 0.045, 0.042), but had no significant effect on HPV clearance rate. A subgroup analysis based on TCT results revealed no significant effect on the efficacy of ALA-PDT in the treatment of high-risk cervical LSIL. Furthermore, the 6-month CR rate and 2-year HPV clearance rate of the patients with both positive HPV16/18 genotyping and TZ3 were significantly lower than those of the patients without the two high-risk factors (73.53% vs. 94.74%, P = 0.010; 78.95% vs. 97.67%, P = 0.028, respectively). CONCLUSION:ALA-PDT is a safe and effective treatment for high-risk cervical LSIL. Its efficacy could be affected by patient age, HPV type, and cervical TZ type.

Gastric cancer is one of the major health threats to human beings and has a low response rate to emerging immunotherapy. We herein reported a novel indole-based LSD1-targeted antigastric agent 7ae, which was able to enhance the sensitivity of gastric cancer cells to a T-cell-mediated immune response. It exhibited potent LSD1 inhibitory activity (IC50 = 0.080 ± 0.002 μM) and reduced the expression of PD-L1, which in turn promoted the T-cell killing response in gastric cancer cells. As a result, 7ae acted as an active LSD1 inhibitor, exerting excellent anti-invasion and anti-migration effects in gastric cancer cells and leading to significant suppression of the growth of xenograft gastric tumors without obvious toxicity in vivo. Collectively, 7ae has been demonstrated to be a novel, potent LSD1 inhibitor with the potential to be used as an antigastric agent, as well as a useful tool compound for exploratory studies of T-cell-mediated immunity and/or immunotherapy in gastric cancer.

Objective: To compare the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and surgery in treating vaginal high-grade squamous intraepithelial lesions (HSIL) after hysterectomy due to cervical cancer (CC) or precancerous lesions. Methods: A retrospective study was performed comprising 41 women with histologically confirmed vaginal HSIL after hysterectomy for CC or cervical HSIL. Patients were treated with surgery or ALA-PDT and were followed up at 3, 6 and 12 months and then every six months afterwards. Clinical data were collected and the efficacy and safety of the two groups were analyzed. Results: Of the 41 patients with vaginal HSIL after hysterectomy, 18 were treated with ALA-PDT and 23 underwent surgery. There was no significant difference in the lesions' complete remission (CR) rate or the human papillomavirus (HPV) clearance rate between the ALA-PDT group and the surgery group (P > 0.05). In the surgery group, the clearance rate of HPV16/18 was higher than that of other high-risk HPV (HR-HPV) and HPV16/18 combined with other HR-HPV (87.50 % vs. 45.45 % vs. 0.00 %, P = 0.014). No significant difference in the recurrence rate between the two groups was noted (P > 0.05). And none of the patients progressed. In the surgery group, one patient developed significant thickening of the vaginal stump, and one patient had increased vaginal discharge. In women treated with ALA-PDT, there was no vaginal bleeding or harmful effects on the organizational structure or functions compared to the surgery group. Conclusions: The efficacy of ALA-PDT was comparable to that of surgery in treating vaginal HSIL following hysterectomy due to CC or cervical HSIL, with fewer side effects.

BackgroundEndometrial carcinoma (EC) is one of the most prevalent gynecological malignancies and the onset age of EC tends to be younger. This case report explored the feasibility of surgery combined with photodynamic therapy (PDT) in two young patients with early-stage EC.MethodsA 31 years old patient and a 24 years old patient were treated with surgery and PDT, respectively. The intraoperative PDT was performed 3 h after oral administration of 5-aminolevulinic acid (ALA) with intrauterine light irradiation of 630 nm laser light.ResultsThe patients were followed up for 3 years and 4 months, respectively. There were no signs of recurrence.ConclusionIntraoperative and intrauterine PDT was feasible and might be used for EC patients who attempt to preserve fertility.

OBJECTIVE:The study aimed to compare the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and surgery in treating recurrent cervical high-grade squamous intraepithelial lesions (HSIL) after surgery due to precancerous lesions.METHODS:A total of 41 patients with recurrent cervical HSIL after surgery for precancerous lesions were studied retrospectively. Patients underwent ALA-PDT or surgery and were followed up at 3, 6, 9 and 12 months and then every six months after that. Clinical data were collected and the efficacy and safety of the two treatment methods were compared.RESULTS:Of the 41 patients with recurrent cervical HSIL after conization, 15 cases received ALA-PDT and 26 received surgery. At the six-month follow-up, the lesions' complete remission (CR) rate was 93.33 % in ALA-PDT group and 88.46 % in the surgery group. The human papillomavirus (HPV) clearance rates were 66.67 % and 73.08 %, respectively. No significant differences concerning the lesions' CR rate and the HPV clearance rate were observed between the two groups (P>0.05). At the twelve-month follow-up, the HPV clearance rates were 80.00 % and 91.67 %. No significant differences concerning the HPV clearance rate were observed between the two groups (P>0.05). In the surgery group, the HPV clearance rate and the lesions' CR rate were lower in patients over 45 years of age (25.00% vs. 81.82 %, P = 0.031; 50.00% vs. 95.45 %, P = 0.052). During the follow-up, there was no significant difference in the recurrence rate between the two groups (P>0.05). In addition, none of the patients progressed. In women treated with ALA-PDT, there was no vaginal bleeding, and no harmful effects on the cervical organizational structure or functions compared to the surgery group, and two women delivered successfully after ALA-PDT treatment.CONCLUSIONS:The efficacy of ALA-PDT was similar to that of surgery in treating recurrent cervical HSIL following surgery, with fewer side effects.

Clear cell adenocarcinoma of the cervix (CCAC) is a special type of HPV-independent cervical cancer. It has a low incidence rate, can be difficult to diagnose early, has a poor prognosis. Its peak incidence is in adolescence, which poses a great threat to women's health. Therefore, it is very important to explore the pathogenesis of cervical clear cell adenocarcinoma to guide subsequent treatment and prevention. This study analyzed 3 juvenile patients with CCAC diagnosed at the First Affiliated Hospital of Zhengzhou University. Using next-generation sequencing methods, we analyzed the pathogenesis of the patients and their close relatives by analyzing the genetic alterations of patients. CMTM5 was identified as the only shared mutated gene. Using published literature and comparative analyses of related disease-causing genes, 6 of the 19 genes (ALKBH7, MYCBP, MZF1, RNF207, RRS1, and TUSC2) were screened as genes with mutations in patients and had higher mutation rates in reproductive cancers. Pathway analysis showed that downregulated genes in non-HPV cervical cancer were mainly related to the immune system response, suggesting that non-HPV cervical cancer differs from HPV-infected cervical cancer in that the immune response is weaker, which is consistent with the weak correlation with viral infection.

Background: Vulvar squamous intraepithelial lesion (SIL) is a precursor lesion of vulvar squamous cell carcinoma. The current clinical treatments for vulvar SIL cause damage to the vulvar structure, chronic pain and psychological distress. Topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a novel, non-invasive therapy for intraepithelial lesions. The objective of this study was to compare the clinical efficacy and safety of ALA-PDT with local surgical resection for vulvar SIL. Methods: A total of 56 patients with vulvar SIL were enrolled in this retrospective study. Among them, 16 patients received local resection and 40 patients received ALA-PDT. HPV genotyping and ThinPrep cytologic test (TCT) were used to evaluate treatment efficacy. In addition, colposcopy-directed biopsy was performed in all patients at 3-month follow-up and in patients with positive high-risk human papillomavirus (HR-HPV) and/or abnormal TCT results during the follow-up. Results: At 3-month follow-up and in HSIL group the complete remission (CR) rate of the ALA-PDT group and surgery group was 90.6% (29/32) and 87.5% (14/16) (P = 1.000), respectively. The HPV clearance rate of the ALA-PDT group and surgery group was 45.2% (14/31) and 43.8% (7/16) (P = 0.927), respectively. The average numbers of ALA-PDT treatments were 5.34 for HSIL patients and 4.88 for LSIL patients, respectively. The CR rate of HSIL patients and LSIL patients was 90.6% (29/32) and 75.0% (6/8) (P = 0.550), respectively. The HPV clearance rate of HSIL patients and LSIL patients was 45.2% (14/31) and 37.5% (3/8) (P = 1.000), respectively. The ALA-PDT group showed similar clinical efficacy and milder adverse effects compared with the surgical group. Conclusion: ALA-PDT showed similar clinical efficacy as surgery in the treatment of vulvar SIL, but with milder adverse effects and maintaining the integrity of the vulvar structure.

目的 探讨p16/Ki67细胞双染和配对盒家族基因1(PAX1)甲基化检测在细胞学未明确意义的不典型鳞状上皮细胞(ASC-US)患者中的分流作用.方法 选取2019年7月—2020年9月于郑州大学第一附属医院行宫颈癌筛查的患者25 532例,其中TCT结果为ASC-US,并接受p16/Ki67细胞双染、PAX1甲基化检测及阴道镜下活检且结果有效的患者共431例,以组织病理诊断为金标准,采用灵敏度、特异度、准确率、约登指数比较p16/Ki67细胞双染、PAX1甲基化及p16/Ki67细胞双染+PAX1甲基化联合检测(以下简称联合检测)诊断CIN2+、CIN3+的效能,并计算不同方法的阴道镜转诊率.结果 p16/Ki67细胞双染、PAX1甲基化和联合检测的阳性率均随着宫颈病变严重程度升高而升高.PAX1甲基化诊断CIN2+和CIN3+的灵敏度、特异度、准确率及约登指数分别为60.28％、92.07％、81.67％、0.524和78.48％、86.93％、85.38％、0.654,特异度和准确率均高于p16/Ki67细胞双染及联合检测(P＜0.05),且约登指数最大.使用PAX1甲基化进行分流时,阴道镜转诊率降低73.13％.联合检测诊断CIN2+和CIN3+的灵敏度高于p16/Ki67细胞双染、PAX1甲基化单独检测,差异有统计学意义(P＜0.05).使用联合检测分流时,阴道镜转诊率降低44.78％,且诊断宫颈癌的准确率为100％.结论 对于分流细胞学ASC-US的患者,PAX1甲基化检测具有较高的特异度,可在一定程度上降低阴道镜转诊率.联合检测可提高灵敏度,对宫颈癌的诊断具有重要作用.

Aim: To explore the appropriate triage methods for women infected with high-risk human papillomavirus (hrHPV). Materials & methods: A total of 424 out of 872 hrHPV-infected women were divided into cervicitis (n = 123), cervical intraepithelial neoplasia grade 1 (CIN1; n = 89), CIN2 (n = 72), CIN3 (n = 87) and cervical cancer (n = 53) groups. Results: The sensitivity/specificity of ZNF582m, PAX1m and liquid-based cytology (LBC) for hrHPV-infected women with transformation zone 3 CIN3+ was 83.9/93.1, 77.4/90.6 and 80.6/58.5%, respectively. The ZNF582m/PAX1m test had a higher specificity than LBC (p < 0.001) and similar sensitivity to that observed for LBC (p > 0.05). ZNF582m/PAX1m improved the positive predictive value of CIN3+ (64.7/60.0%) in low-grade LBC (negative predictive value: 91.7/88.7%). Conclusion: ZNF582m was superior to PAX1m and LBC tests in detecting CIN3+ in hrHPV-infected women.

BACKGROUND:Vulvovaginal candidiasis (VVC) is a public health issue worldwide. Little is known of the optimal treatment of recurrent VVC (RVVC) has not been established. OBJECTIVE:Through the in vitro antifungal susceptibility profiling of VVC isolates, we hope to foster significant improvements in the control and treatment of this disease. METHODS:Candida isolates from VVC patients were collected from 12 hospitals in 10 cities across China. Species were identified by phenotype analysis and DNA sequencing. Species were identified by phenotype analysis and DNA sequencing. Susceptibilities to 11 drugs were determined by Clinical and Laboratory Standards Institute broth microdilution. RESULTS:543 strains were isolated from those VVC patients enrolled in this study, of which, 15.7% were from RVVC. The most commonly identified species was C. albicans (460, 84.71%), and the most commonly non-albicans Candida spp. (NAC) was C. glabrata (47, 8.66%). NAC also included C. Krusei, Meyerozyma Guillermondii, Meyerozyma Caribbica, C. Tropicalis, C. Parapsilosis, and C. Nivariensis. Most C. albicans isolates were susceptible to caspofungin (99.8%), followed by fluconazole (92%) and voriconazole (82.6%). The proportion of C. albicans strains with wild type (WT) MICs that were susceptible to amphotericin B and caspofungin were 98%, followed by posaconazole at 95%, itraconazole at 86%, fluconazole at 74% and voriconazole at 54%. The fluconazole MICs for C. albicans were lower than those for NAC (P < 0.05), while the itraconazole MICs showing no significant difference (P > 0.05). The susceptible rate of uncomplicated VVC to fluconazole was 92%. The proportion of WT strains to fluconazole in RVVC was much lower than that in other types of VVC (67 vs. 77%, P < 0.05). However, the proportions of WT strains to itraconazole in RVVC was over 85%, which was much higher than that to fluconazole (87 vs. 67%, P < 0.05). CONCLUSIONS:C. albicans was still the predominant pathogen for VVC in China, while C. glabrata was the main species in NAC. Fluconazole could still be used as an empirical treatment for uncomplicated VVC. However, fluconazole may not be the first choice for the therapy of RVVC. In such cases, itraconazole appears to be the more appropriate treatment. As for VVC caused by NAC, nonfluconazole drugs, such as itraconazole, may be a good choice.

Introduction: With the younger onset age of female lower genital tract diseases, there are increasing demands for protecting organ and tissue structures to preserve fertility and, therefore, effective fertility-sparing treatments that cause minimal normal tissue damage and less adverse reactions are urgently needed. Objective: This study is aimed at reviewing information and achieving consensus on recommendations on the clinical applications of aminolevulinic acid-based photodynamic therapy (ALA-PDT) in female lower genital tract diseases. Methods: Members of the expert panel held online and in-person meetings to discuss and revise drafts created by the steering committee based on the literature review and the clinical experiences of the expert panel. Opinions of the experts were transcribed and discussed in detail to ensure that the consensus statement best reflects the current advances in the field and the experts' view. Results: After numerous rounds of meetings, experts unanimously agreed on the importance of ALA-PDT in the treatment of cervical squamous intraepithelial lesions (SIL), vaginal SIL, vulvar SIL, vulvar lichen sclerosus (VLS), and condyloma acuminatumon (CA). Experts also reached consensus on the recommended treatment regimen and treatment methods. Conclusion: This consensus aimed to provide practical basis and guidance for the clinical applications of ALA-PDT in female lower genital tract diseases in China. Of note, this is the only expert consensus prepared by board -certified specialists in gynecology and obstetrics in China. More evidence-based clinical studies should be made to update and expand the current recommendations.

Background: E6 and E7 high-risk human papillomavirus (HR-HPV) oncoproteins are closely associated with the initiation and progression of cervical cancer (CC) and pre-cancerous lesions. Cervical high-grade squamous intraepithelial lesions (HSIL), as pre-cancerous lesions, have a 5% chance of progressing to invasive cancer. Topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a novel non-invasive targeted therapy for intraepithelial lesions. Herein, we analyzed the effect of HR-HPV E6/E7 mRNA on ALA-PDT for cervical HSIL. Methods: A retrospective analysis of 148 HR-HPV-positive patients diagnosed with cervical HSIL and receiving ALA-PDT was carried out. ALA-PDT was performed with 20% ALA thermosensitive gel, and irradiation at wavelength of 635 nm and density of 80-100 J/cm(2) for 20-30 min. The therapeutic instruments of LED and semiconductor laser were applied for cervical lesions and lesions in endocervical canal, respectively. All patients were tested for HPV E6/E7 mRNA before and after PDT, and then followed up at 3, 6, and 12 months after treatment, and every six months thereafter. Results: At the 6-month follow up, the complete remission (CR) rate of patients' lesions was 86.5% (128/148), whereas the total HPV clearance rate was 72.3% (107/148). It was evident that positive E6/E7 mRNA before treatment had a significant effect on HPV clearance rate (66.3% VS 81.4%, P = 0.045) and CR rate (80.9% VS 94.9%, P = 0.015). The E6/E7 mRNA associated with HPV16/18 and HPV16/18 combined with other HR-HPV (HPV16/18 and other HR-HPV) affected HPV clearance (P = 0.035) and lesions CR (P = 0.039), respectively. Moreover, persistently positive E6/E7 mRNA after treatment was closely associated with poor efficacy (HPV clearance rate: P = 0.000, CR rate: P = 0.000). Throughout the follow up period, two cases recurred but none of the patients progressed. Conclusions: This study has shown that ALA-PDT is an effective, safe, and alternative treatment for cervical HSIL, especially for the patients of childbearing age. However, its efficacy is relatively poor in patients with persistently positive E6/E7 mRNA before and after treatment, who are relatively insensitive to ALA-PDT.

Objective: To compare the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and local surgical excision in the treatment of high-grade vaginal intraepithelial neoplasia (VAIN). Methods: This was a retrospective study of a single center. Patients with biopsy-proven high-grade VAIN were counseled on the option of excision or ALA-PDT. After treatment patients were followed up at 3, 6 and 12 months and every 6 months afterwards. Clinical data of two groups were analyzed. Results: Sixty patients were treated with ALA-PDT and 40 patients underwent excision surgery. The clinical characteristics of patients in the two groups were similar. The mean ages of patients treated with ALA-PDT and local surgical excision were 41.93+13.08 (18-70) and 43.25+11.64 (22-61) years old, respectively. The treat-ment times of PDT for patients in the ALA-PDT group were 5.48 +/- 1.41 (2-8) times. At 3-6 months after treatment, the overall complete remission (CR) rate was 93.33% (56/60) in PDT group and 82.5% (33/40) in local surgical excision group. In PDT group, a 12-and 24-month follow-up, the total HPV clearance rate was 68.97% and 77.55%, respectively. At 12-month and 2-year follow-up after local surgical excision, the total HPV clearance rate was 60% and 64.52%, respectively. Further analysis showed that the clinical efficacy was comparable between the two treatments. Patients over 45 years old exhibited a lower HPV clearance rate (P < 0.05) than those under 45 years old. It was also observed that persistent HPV infection is a major risk factor for persistent disease. Further comparative analyses showed no significant difference in the CR rate and treatment times between VAINII and VAINIII in ALA-PDT group. Moreover, 4 patients (11.36%) developed recurrent lesions during follow-up after ALA-PDT, whereas 3 patients (8.33%) in the local excision group developed recurrent lesions. In addition, there was no significant difference in the recurrent rate between two groups. Conclusions: ALA-PDT shows similar efficacy and less side effects compared to local surgical excision.

BACKGROUND:Recent data has shown increased rate of vaginal intraepithelial neoplasia (VAIN) in younger individuals. Traditional VAIN treatments exert adverse effects on the anatomy and functions of the vagina. Topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a novel, non-invasive targeted therapy for intraepithelial lesions. Here, we aimed to investigate the efficacy and safety of ALA-PDT in VAIN with high-risk HPV (HR-HPV) infection.METHODS:This study enrolled a total of 82 HR-HPV-positive women diagnosed with VAIN, who were receiving ALA-PDT. The effect of ALA-PDT was evaluated using HPV genotyping and Thinprep cytologic test (TCT). Besides, colposcopy directed biopsies were performed in all patients at 3-month follow-up, and in patients with positive HR-HPV and/or abnormal TCT results during the follow-up period.RESULTS:Our data showed that the HPV clearance rate was 53.7% (44/82) at 6-month follow-up and 67.1% (55/82) at 12-month follow-up. Patients with HPV16/18 combined with other HR-HPV (HPV16/18 & other HR-HPV) infection, those with a history of hysterectomy and/or older age were had significantly lower HPV clearance rate. Besides, the lesion complete remission (CR) rate was 90.2% (74/82). These results show that HPV16/18 & other HR-HPV infection was associated with significantly lower CR rates. Throughout the follow-up, 2 cases had persistent lesions (2.4%), 6 cases had partial remission (7.3%), 2 cases recurred (2.7%) but none of the patients had disease progression.CONCLUSIONS:Taken together, our data showed that ALA-PDT is an effective, safe, and alternative treatment for VAIN patients with HR-HPV infection. However, the ALA-PDT efficacy was relatively poor in patients with older age, HPV16/18 & other HR-HPV infection and/or those with a history of hysterectomy.

Background: Lesions in both the cervix and vagina require an efficacious non-invasive treatment therapy such as 5-Aminolevulinic acid photodynamic therapy(5-ALA-PDT). In this study, we evaluate clinical efficacy and safety of 5-ALA PDT for cervical intraepithelial neoplasia with vaginal intraepithelial neoplasia (CIN & VAIN). Methods: A retrospective analysis was performed on 48 patients diagnosed with CIN & VAIN and receiving 5-ALA PDT. All patients were first followed up at 3, 6 and 12 months after treatment, then every 6 months thereafter. Results: Out of 1051 patients referred for CIN (4.56%), 48 were diagnosed with CIN&VAIIN. The patients had statistically significant average vaginal and cervical lesion areas of 1.22 and 0.41 cm(2) respectively. 4 patients were lost during follow-up. The patients' complete remission (CR) rate was 88.64% (39/44) at 3-6 months after treatment, while the total HPV clearance rate was 46.34 and 60.98% at 3- and 12-months follow-up,respectively. HPV16/18 combined with other high-risk human papillomaviruses (hrHPV) (HPV16/18 and other hrHPV) infection exhibited a lower HPV clearance rate (P = 0.006). The treatment time in high-grade intraepithelial neoplasia (HSIL) was higher than that of low-grade intraepithelial neoplasia (LSIL). Notably, atypical vessels and endocervical canal lesions involvement significantly affected 5-ALA PDT. Moreover, 5 patients had residual lesions (11.36%) during follow-up, one patient presented recurrence (2.56%), while 4 had successful pregnancy. Conclusions: 5-ALA-PDT is a non-invasive, effective, and safe therapy for treating CIN & VAIN and can maintain the structural and functional integrity of target organs. However, its efficacy is relatively poor in patients with endocervical canal lesions involvement, atypical vessels, and HPV16/18 and other hrHPV infection.

目的 探讨抗生素不同疗程及时机使用对子宫肌瘤术后血清炎症因子水平及不良反应的影响.方法 选择2018-05-01-2021-05-31郑州万安妇产医院行子宫肌瘤切除术的96例患者作为研究对象.以信封法将患者随机分为3组,每组32例.所有患者均行开腹子宫肌瘤剔除术,A组在术后给予注射用头孢美唑钠1 g静脉滴入,2次/d,连续3 d;B组在术前30 min静脉注射头孢美唑钠1 g,术后给予注射用头孢美唑钠1 g静脉滴入,2次/d,连续3 d;C组在术后给予注射用头孢美唑钠1 g静脉滴入,2次/d,连续5 d.比较3组患者手术一般情况、切口愈合情况、感染情况、炎症因子及不良反应发生情况.结果 3组患者手术时间、术中出血量、术后排气时间比较,差异无统计学意义,均P>0.05;A组住院时间为(5.18±1.07)d,B组为(5.25±1.13)d,C组为(6.25±1.49)d,A组>C组,B组>C组,差异有统计学意义,F=7.410,P=0.001.3组患者甲级愈合、乙级愈合及丙级愈合情况比较,差异无统计学意义,均P>0.05.A组总感染率为28.13％,C组总感染率为31.25％,均高于B组的6.25％,差异有统计学意义,χ2=6.949,P=0.030;A组与C组的感染率差异无统计学意义,P>0.05.术前3组患者干扰素γ、白细胞介素-1及白细胞介素-8水平比较,差异无统计学意义,均P>0.05;术后A组干扰素γ水平为(6.41±1.73)ng/mL,B组为(5.18±1.39)ng/mL,C组为(6.25±1．81)ng/mL,均高于术前,且B组低于A组与C组,F=5.235,P=0.007;A组白细胞介素-1水平为(2.43±0.61)μg/mL,B组为(1.63±0.37)μg/mL,C组为(2.29±0.69)μg/mL,均高于术前,且B组低于A组与C组,F=17.788,P<0．001;A组白细胞介素-8水平为(95.86±21.06)μg/mL,B组为(80.63±16.91)μg/mL,C组为(91.05±18.25)μg/mL,均高于术前,且B组低于A组与C组,F=5.476,P=0.006.A组共出现3例(9.38％)不良反应,B组出现4例(12．50％),C组出现5例(15.63％),3组不良反应发生率比较,差异无统计学意义,P>0.05.结论 子宫肌瘤术前30 min及术后给予注射用头孢美唑钠连续3 d治疗的抗菌、抗感染效果最好且不增加不良反应发生率.