Estimation of economic burden throughout course of cervical squamous intraepithelial lesion and cervical cancer in China:A nationwide multicenter cross-sectional study

Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment.Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated.Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage.Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.

Application Analysis of High Risk HPV Detection Combined with Cervical Cytology, Colposcopy and Pathology in Cervical Lesions of Women in Tiandeng County

Purpose: To understand the application of high-risk HPV detection combined with cervical cytology, colposcopy and pathology in cervical lesions of women in Tiandeng County. Method: Women in the outpatient and inpatient departments of our hospital from January 2021 to October 2022 were collected for high-risk HPV testing, TCT, colposcopy and pathological examination according to their personal wishes, to understand the application of relevant examinations in cervical lesions. Result: In 2021, the number of patients was 5801, among whom 1743 patients had received cervical cancer examination in the past, accounting for 30.05% of the total number of patients, and 5795 who had volunteered for TCT examination this time, accounting for 99.90% of the total;A total of 289 cases of atypical squamous cells with unclear significance (ASC-US) were detected, excluding 11 cases of high-grade squamous intraepithelial lesions (ASC-H), 122 cases of low-grade squamous intraepithelial lesions (LSIL), 16 cases of high-grade squamous intraepithelial lesions (HSIL), 2 cases of squamous cell carcinoma (SCC), and 4 cases of atypical adenocyte (AGC);Atypical cervical adenocytosis and cervical carcinoma in situ were not detected. The number of people who volunteered for high-risk HPV testing was 4237, and the number of positive cases was 740, accounting for 17.47% of the screening population;Among 740 HPV-positive patients, 488 high-risk HPV-positive patients were selected for TCT examination, and 87 patients were found to be TCT positive;From 401 high-risk HPV-positive and TCT negative patients, 287 patients with possible lesions were screened out for colposcopy;The results showed that 60 patients may have certain cervical lesions and need further pathological examination and the results showed that 28 patients had CTN1 and 18 patients had CIN2 - 3. In 2022, 8840 patients received medical treatment, among which 3188 patients had received cervical cancer examination in the past, accounting for 36.06% of the total number of patients, and 8314 patients voluntarily underwent TCT examination, accounting for 94.05% of the total number of patients. 434 cases of atypical squamous cells with ambiguous meaning (ASC-US) were detected, excluding 13 cases of high-grade squamous intraepithelial lesions (ASC-H), 217 cases of low-grade squamous intraepithelial lesions (LSIL), 35 cases of high-grade squamous intraepithelial lesions (HSIL), 1 case of squamous cell carcinoma, and 4 cases of atypical adenocarcinoma (AGC);Atypical cervical adenocytosis and cervical carcinoma in situ were not detected. The number of volunteers for high-risk HPV testing was 3871 cases, and the number of positive cases was 654 cases, accounting for 16.89% of the screening number. 527 high-risk HPV-positive patients were selected from 654 HPV-positive patients for TCT examination, and the number of TCT-positive patients was found to be 49. From 478 high-risk HPV-positive patients with TCT negative, 276 patients with possible lesions were screened out for colposcopy;The results showed that 66 patients may have certain cervical lesions and need further pathological examination;and then the results showed that 31 cases of CTN1 and 6 cases of CIN2 - 3. Conclusion: Gynecological high-risk HPV examination can provide better etiological sources for cervical cancer screening;Cervical cytology examination has high sensitivity;Colposcopy examination has high specificity;Pathological examination can be used as an effective supplement for cervical cytology examination and colposcopy;So high-risk HPV combined with cytology examination, colposcopy examination and pathological examination has high clinical application value;It is worth popularizing and applying.

Detection of Human Papillomavirus DNA and E6/E7 mRNA from HPV Genotypes 16, 18, 31 and 33 in Histologically Confirmed Cases of Cervical Cancer and Precancerous Lesions in Burkina Faso

Introduction: Cervical cancer, caused by persistent high-risk human papillomavirus (HPV) infection, remains a global public health problem. The cellular transformation and maintenance of the malignant phenotype of these HPVs are attributed to the viral oncoproteins E6 and E7. Objective: This study aims to detect the presence of human papillomavirus DNA and E6/E7 oncoprotein mRNA of HPV genotypes 16, 18, 31 and 33 in cases of cervical cancer and precancerous lesions, histologically confirmed in Burkina Faso. Methods: This descriptive cross-sectional study focused on cases of cervical cancer and high-grade intraepithelial neoplasia (CIN) and was conducted from June to December 2022. One hundred (100) samples of fixed and paraffin-embedded tissues were collected from the pathological anatomy and cytology laboratories of hospitals in the capital of Burkina Faso. High-risk human papillomavirus (HR-HPV) DNA was detected using multiplex real-time PCR, while the presence of E6 and E7 mRNA in cervical cancer and high-grade CIN samples was determined using real-time Reverse Transcriptase-PCR (RT-PCR) with TaqMan probes. Results: The mean age of women diagnosed with cervical cancer and high-grade CIN was 50.81 ± 13.65 years, ranging from 22 to 82 years. Cervical cancer and high-grade CIN were positive for at least one high-risk human papillomavirus (HR-HPV) in 80% of cases. The most prevalent genotypes observed were HPV16, 18, 31, and 33, collectively accounting for 70.08% of cases. Of the 89 samples that tested positive for HR-HPV genotypes 16, 18, 31, and 33, 88 (98.88%;95% CI: [94.58 - 99.94]) were also positive for the presence of mRNA encoding the E6 and E7 oncoproteins of HPV16, 18, 31, and 33. Conclusion: In the presence of HPV DNA, testing for E6 and E7 oncoprotein mRNA could serve as a promising biomarker and valuable tool for improved assessment of the progression to cervical cancer.

Clinical Significance of hTERC Gene Amplification Detection by FISH in the Screening of Cervical Lesions

This study evaluated the clinical significance of hTERC gene amplification detection by fluorescence in sire hybridization （FISH） in the screening of cervical lesions. Cervical specimens of 50 high risk patients were detected by thin liquid-based cytology. The patients whose cytological resuits were classified as ASCUS or above were subjected to the subsequent colposcopic biopsies. Slides prepared from these 50 cervical specimens were analyzed for hTERC gene amplification using interphase FISH with the two-color hTERC probe. The results of the cytological analysis and those of subsequent biopsies, when available, were compared with the FISH-detected hTERC abnormalities. It was found that the positive rates of hTERC gene amplification in NILM, ASCUS, LSIL, HSIL, and SCC groups were 0.00, 28.57%, 57.14%, 100%, and 100%, respectively. The positive rates ofhTERC gene amplification in HSIL and SCC groups were significantly higher than those in NILM, ASCUS and LSIL groups （all P〈0.05）. The mean percentages of cells with hTERC gene amplification in NILM, ASCUS, LSIL, HSIL, and SCC groups were 0.00, 10.50%, 36.00%, 79.00%, and 96.50%, respectively. Patients with HSIL or SCC cytological diagnoses had significantly higher mean percent- ages of cells with hTERC gene amplification than did patients with NILM, ASCUS or LSIL cytological diagnoses （all P〈0.05）. It was concluded that two-color interphase FISH could detect hTERC gene amplification to accurately distinguish HS1L and ISIL of cervical cells. It may be an adjunct to cytology screening, especially high-risk patients.

Analysis of Human Papillomavirus Infection in Cervical Exfoliated Cells

To screen patients with early cervical lesions by analyzing the infection of high-risk Human papillomavirus (HR-HPV). Research Methods: The cervical exfoliated cell specimens and their clinical data were collected. The HPV infection types of the collected specimens were detected by fluorescence quantitative PCR, and the correlation between HPV infection and clinicopathological features was analyzed statistically. Results: 725 cases were HR-HPV positive from 2605 cases, including 15 high-risk types of HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68. Different histological types ranged from NILM to HSIL, and the positive rate of HPV showed an increasing trend with the aggravation of cervical lesions. Conclusion: The positive rate of 15 high-risk HPV types in the collected specimens was 27.8%. Patients with early cervical lesions could be screened for 15 high-risk HPV infection types.

Ankylosing spondylitis complicated with andersson lesion in the lower cervical spine: A case report

BACKGROUND Andersson lesion(AL)is an uncommon complication in ankylosing spondylitis(AS),which is characterized by nonneoplastic bone destruction and often appears as bone destruction and sclerosis in the vertebral body and/or the area involving the intervertebral disc.According to the literature,Andersson lesion commonly occur in the thoracic and lumbar spine and rarely in the cervical spine.CASE SUMMARY This case involved a 78-year-old man with a long history of AS who developed AL in the cervical spine(C5/6 and C6/7).One-stage anterior-posterior approach surgery was successfully performed.At the 6-month follow-up,the pain was significantly reduced,and the limb function was gradually improved.CONCLUSION AL uncharacteristically appears in the cervical spine and tends to be misdiagnosed as vertebral metastases or spinal tuberculosis.Posterior combined with anterior surgery achieves solid biological stabilization in the treatment of AL bone destruction.

Profile of Radiotherapy Side Effects in Patients Treated for Cervical Cancer in Cameroon: Case of the Douala General Hospital

Background: Radiotherapy is one of the main therapeutic strategies used in cervical cancer. The first radiotherapy services in Cameroon have existed since 1987 and still treat by conventional radiation techniques. With the evolution of radiation techniques, acute, subacute, and late complications are minimized. Our study aimed to describe the profile of side effects in patients with uterine cervix cancer treated by conventional radiotherapy, still used in our services. Methods: This was a retrospective and descriptive study of the records of patients treated in the radiotherapy department of the Douala General Hospital from January 2015 to December 2019. Data concerning radiation-induced toxicities were collected using the CTCAE Version 4.0 classification. Data analysis was performed using SPSS version 20.0. Results: A total of 270 records were selected. The median age was 54 years. The mean total radiation dose was 55.9 ± 11.8 Gy and 71.1% of patients were treated for less than 8 weeks. We found a frequency of 66.7% of radio-induced lesions with 99% being acute. The main acute lesions encountered were radio dermatitis (40%), radiation cystitis (17.7%), and radiation proctitis (17.1%). As late lesions, we found one case of vaginal fibrosis (0.4%). Exclusive radiotherapy, classical fractionation, and total doses lower than 45 Gy seemed to decrease the toxicity linked to conventional radiotherapy. Conclusion: The frequency of side effects of radiotherapy for cervical cancer at the Douala General Hospital remains high. Early lesions are the most encountered but strategies should be put in place to better evaluate late lesions.

Quality of life in women with cervical precursor lesions and cancer:a prospective, 6-month, hospital-based study in China

The overall survival of patients with cervical cancer has improved due to detection at an early stage and availability of comprehensive treatments in China. As patients' lives prolonged, it is important to understand their health-related quality of life(QoL) during and after treatment. We used the EQ-5D questionnaire to assess QoL of 194 patients with cervical lesions at Sichuan University West China Second Hospital between May 2010 and January 2011. Patients were surveyed before primary treatment and at 1, 3, and 6 months after primary treatment. Results showed a consistent decline in EQ-5D scores in the spectrum of cervical lesions at each time point after treatment(all P < 0.05). For patients with precursor lesions, there was an increasing trend along the timeline of treatment(P < 0.01). For patients with early-stage cervical cancer, EQ-5D scores declined in the first month(P = 0.01) and gradually increased to higher levels at 6 months post-treatment than those before treatment(P < 0.01). EQ-5D scores followed a similar trend in patients with advanced cervical cancer(P = 0.04), though they did not statistically rebound after 6 months(0.84 ± 0.19 vs. 0.86 ± 0.11, P = 0.62). Regarding advanced cervical cancer, EQ-5D scores for women above 40 years of age appeared to recover more rapidly and reached higher levels than those for women below 40 years(P = 0.03). Caution and extra care are recommended in the early period of cervical cancer treatment given the slight deterioration in the QoL, and in particular, for younger cervical cancer patients. Our study implies that health care providers may need to improve the health-related QoL of cervical cancer patients.

Diagnostic value of the combination of TruScreen and Pap smear in screening cervical epithelial lesions: Does it add advantages over the Pap smear alone?

Introduction: Pap smear is a well known test in screening of epithelial cell abnormalities of the cervix. However, adding other screening methods to this test may increase the sensitivity and specificity of case finding. Current study has been designed to assess the sensitivity and specificity of the combination of Tru-Screen and Pap tests in comparison to Pap smear alone in women referred for annual screening. Methods: This case-control study was conducted in two groups of 66 and 73 women with epithelial cell abnormality and normal results on Pap smear, respectively. Both groups were subsequently tested with Tru-Screen and colposcopy. Positive finding in any of the three studies made the patient candidate for biopsy as the standard diagnostic test. SPSS software was used to analyze sensitivity, specificity, positive predictive value, and negative predictive value of TruScreen, Pap smear, colposcopy and the combination of TruScreen and Pap tests. Results: 105 out of 139 women underwent biopsy. Of these, 32 (30.5%) had abnormal result in biopsy. Combination of True screen and Pap smear led to a sensitivity of 93.8% and specificity of 79.5% which means an improvement in both parameters. False negative rate decreased to 6.3% but false positive rate increased to 82.2%. Positive and negative predictive values of the combined tests were 33.3% and 86.7%, respectively. Conclusion: Combination of TruScreen and Pap smear is associated with a significant improvement in both sensitivity and specificity for early screening of preneoplastic and neoplastic cervical epithelial lesions.

TLR4 May Accelerate Hypoxia Reaction to Promote the Occurrence and Progress of Cervical Lesions by Infected Pathogenic Microorganisms Other than HPV

Objective: To explore what role the inflammatory immune response is playing in the occurrence and development of HPV related cervical disease. Methods: To detect the expression of TLR4, HIF-1α and HPV16 E7 in the specimens of HPV related cervical lesions, for example normal cervix, cervicitis, cervical intraepithelial neoplasia and cervical cancer by RT PCR methods. Results: The expression of TLR4 and HIF-1α ascent from normal cervix to cervicitis, then to CIN tissue, and then to cervical cancer (P 0.05). The expression of HPV16 E7 was higher in cervicitis than that in normal cervix (P 0.05) while there was no significant ascendance from cervicitis to CIN tissue, either from CIN tissue to cervical cancer although it seemed ascending (P > 0.05). Conclusion: TLR4 may promote the occurrence and progress of cervical lesions by accelerating the hypoxia reaction. And the natural immune reaction mediated by TLR4 may be correlated to other pathogenic microorganisms infecting the cervical tissue, rather than HPV.

Research of cervical cytology screening in diagnosis of 370,000 cases with cervical lesion in Guangdong

Objective： Analysis of the results of 37 million cases by using cervical liquid-based cytology screening, discussion the situation of cervical cancer and precancerous lesions in Guangdong province. Methods： From 2002 to 2006, using liquid-based thin-layer cytology （TCT） method screening cervical lesions within 371,929 women in Guangdong. Cytological diagnosis adopt TBS （the Bethesda system） Standard （TBS improved 2001 version of the diagnostic criteria）, statistic positive rate by age and region respectively. Results： 371,929 cases of gynecology cervical samples in Guangdong, 331,251 cases were negative, accounted for 91.23%; cytology positive cases： 32,548 cases were squamous intraepithelial lesions （8.96%）, 486 cases were glandular epithelial lesions （0.13%）; grouped according to age： 30 to 40-year-old positive rate was 9.13%, 40 to 50-year-old positive rate was 9.60%, the latter had higher cytology positive rate; grouped according to region： the total samples in PRD areas were 304.951 cases, accounted for 81.99%, in which 24301 cases were positive （8.14%）, in 66978 cases （18.01%） of NON-PRD regions, 7645 cases were positive （11.87%）, there were 1858 cases had biopsy/follow-up results from 2004 to 2005, and the rate was 2.88%. Conclusion： The cytological positive rate of cervical cancer and its precancerous lesions was 9.09% in Guangdong （of which the rate of cytological diagnosis as precancerous lesions was 3.40%）, 30 to 50 age group had the high incidence of cervical cancer and its precursor lesions, and also the main stage of prevention for cervical cancer. Cytology positive rate was 11.87% in economic underdevelopment Non-Pearl River Delta regions, much higher than the Pearl River Delta region.

Prevalence and Risk Factors of Cervical Neoplastic Lesions in Patients Attending a Healthcare Specialty Clinic, King Abdulaziz Medical City, Saudi Arabia

Background: Screening programs for cervical neoplasm among women in the Kingdom of Saudi Arabia (KSA) are very limited. Objective: To investigate the prevalence and risk factors of cervical epithelial abnormalities among patients attending a health care specialty center (HCSC) of King Abdulaziz Medical City, Riyadh, KSA. Design: A questionnaire was developed to collect information about socio-demographic variables followed by cytopathological analysis of Papanicolaou (Pap) smear. Settings: Female patients attending the gynecology clinic in the HCSC for cervical abnormalities during 2006 and 2008 were selected for the study. Subjects and Methods: Pap smear was collected and subjected to cytopathological analysis, which was further classified according to the revised Bethesda 2001 system. Information on socio-demographic variables, type and duration of oral contraceptives usage, active or passive smoking, history of sexually transmitted disease, or cervical cancer was collected by trained healthcare professionals. Results were analyzed using chi-square test and t-test. Main outcome measures: Lower frequency of cervical lesions among KSA females in comparison with the western countries. Results: A total of 495 Pap smears were studied, out of which 31 Pap smears were found to be unsatisfactory and therefore excluded. Among the remaining Pap smears, 6.5% were found to be abnormal;however, this was not statistically significant. None of the studied socio-demographic factors were found to be significantly correlated with the appearance of abnormal Pap smears, except for passive smoking. Conclusion: Saudi Arabia had a lower frequency of cervical lesions in comparison with the western countries. Further, this study can serve as a pilot study for a larger national screening program for the identification of prevalence and risk factors of cervical lesions in the women of KSA. Limitations: Cases included in the study belong to the particular period, and patients with abnormal Pap smears were not followed up. In-extension, the included data were not restricted for a particular community.

Noncarious Cervical Lesions: Correlation between Abfraction and Wear Facets in Permanent Dentition

Non-carious cervical lesions (NCCLs) are defined as the loss of dental hard tissue at the cement-enamel junction. Erosion, abrasion, and attrition have been associated with this disorder. Objective: Recently, occlusal stress causing of cervical enamel cracks (abfraction) has been considered as an additional etiology for NCCLs to facilitate the erosion and abrasion mechanisms in tooth wear. Study Design: The prevalence of NNCLs and wear facets in a population with permanent dentition in absence of any clear etiological factors related to erosion and abrasion causes is evaluated. A total 295 subjects are enrolled for this study and divided into four age groups (subjects aged 15 - 27 years, 28 - 42 years, 43 - 57 years and 58 - 75 years respectively). An overall of 6629 teeth are investigated to find NCCLs and wear facets. The occlusion is analyzed in each patient. Results: An overall of 801 teeth (12%) show NCCLs and 623 of them (78%) highlight also wear facets. The higher number of teeth with NCCLs and of these with simultaneous presence also of wear facets are found on teeth of patients of group-3 (11% of all teeth examined for group and 81% respectively) and to group-4 (24.4% of all teeth examined for group and 86.5% respectively) of remaining teeth without NCCLs (5828) only 138 (2.4%) shown wear facets. Conclusion: The results of this study held the occlusal forces as the main cause of NCCLs on teeth in presence of wear facets.

Retrospective Analysis of the Association of Non-Carious Cervical Lesions with Bruxism

Recently, bruxism became the center of attention for the etiological research of non-carious cervical lesions (NCCLs). The present study aims to investigate the presence and types of NCCLs associated with bruxism. Retrospective keywords search of the clinical notes of all patient charts in axiUmTM was performed using the terms “bruxism”, “attrition”, “abrasion”, “erosion”, and “abfraction”. All bruxer patients 18 years and older who presented to the UNLV School of Dental Medicine (01/01/2014 to 09/30/2018) with the complete record were included. To determine the statistical analysis implications, the chi-square test was used. Commonest types of NCCL associated with bruxism were attrition and abfraction. Five hundred seventeen cases had multifactorial lesions. Anterior maxillary teeth followed by mandibular anterior were the most affected teeth. Abfraction lesions were mainly sighted in maxillary premolars, followed by maxillary canines. Within the limitation of the present investigation, it was concluded that attrition and abfraction were highly associated with bruxism.

Biomarkers Expression in Cervical Cancer and High Grade Squamous Intraepithelial Lesions

Objectives: The finding of new prognostic factors in human cervix cancer is necessary to improve present conventional treatments. The aim of the present study was to determine the expression and evaluate the prognostic value of hypoxia-inducible factor-1(HIF-1α), vascular endothelial growth factor (VEGF) and eritropoyetin receptor (EpoR) in cervix cancer stages IIA-IIB and in preinvasive high grade squamous intraepithelial lesions (HSIL) Methods: The study included 70 patients with cervix cancer, FIGO stages IIA-IIB, 28 patients with HSIL and normal cervix (n = 28). HIF-1α, VEGF and EpoR expression were analyzed in tissue samples by immunohistochemistry using commercial antibodies. Expression and overexpression of the tumor markers were quantified according to German Immunoreactive Score. Results: HIF-1α, EpoR and VEGF overexpression was detected in 30%, 37% and 51% of cancer patients respectively. Patients with HSIL showed enhanced expression only of EpoR and VEGF (39.2% and 71.4%) while VEGF was overexpressed in 21% of the specimen. No correlation was found between VEGF and EpoR with disease-free overall survival (OS), tumor recurrences or prognostic factors. Only overexpression of HIF-1 was associated with less median survival measured up to 24 months, unless it was not maintained a long time. Conclusion: Although any of the markers could be considered as independent prognostic factor for cervix cancer patients, our data showed a significant increase in their expression from the premalignant lesion up to the invasive stages of tumor progression.

Correlation of HPV infection with TLRs pathway activation and downstream gene expression in cervical precancerous lesions

Objective: To study the correlation of HPV infection with TLRs pathway activation and downstream gene expression in cervical precancerous lesions. Methods: Cervical precancerous lesion tissues from surgical resection or cone biopsy in Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University between June 2014 and May 2017 were collected and divided into HR-HPV positive group and HR-HPV negative group according to the condition of high-risk HPV infection;normal cervical tissues surgically removed due to fibroid in Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University during the same period were collected as the control group. The contents of TLRs pathway molecules as well as the expression of apoptosis-related genes and invasion-related genes in the cervical precancerous lesion tissues and normal cervical tissues were determined. Results:TLR2, TLR3, TLR4, TLR9 and NF-κB contents as well as CyclinD1, PCNA, iNOS, Gal-9, N-cadherin, HIF-1α and VEGF mRNA expression in HR-HPV positive group and HR-HPV negative group were significantly higher than those in control group whereas p53, Beclin1, LC3-II and SFRP2 mRNA expression were significantly lower than those in control group, and TLR2, TLR3, TLR4, TLR9 and NF-κB contents as well as CyclinD1, PCNA, iNOS, Gal-9, N-cadherin, HIF-1α and VEGF mRNA expression in HR-HPV positive group were significantly higher than those in HR-HPV negative group whereas p53, Beclin1, LC3-II and SFRP2 mRNA expression were significantly lower than those in HR-HPV negative group. Conclusion: HPV infection in cervical precancerous lesions can regulate downstream apoptosis and invasion gene expression by activating multiple TLRs pathways.

Research Progress of HPV L1 Capsid Protein in Prediction of Cervical Lesions

Cervical cancer is one of the most common malignant gynecological tumors and has the second highest incidence of all malignancies in females.Chronic and persistent infection with High Risk Human Papillomavirus(HR-HPV)is the main cause of cervical cancer.There is a distinct lack of methodology by which to determine whether cervical epithelial dysplasia is cancerous following HPV infection.HPV L1 capsid protein is a major structural protein of human papillomavirus(HPV),and it is the main target of the local cellular immune response aiming to combat human papillomavirus after HPV infection within cervical cells.Greater understanding of HPV L1 capsid protein and its association with cervical cytology,histopathology,patient age and human papillomavirus viral load has the potential to contribute toward improved the diagnosis and management of cervical cancer,providing useful information for gynecological clinicians in the hope of improving patient treatment and quality of life.This article reviews the predictive utility of HPV L1 capsid protein for cervical lesions.

The Relationship between p53 Expression and Human Papillomavirus in Premalignant and Malignant Uterine Cervical Lesions

Objective: We aimed to retrospectively examine a series of premalignant and malignant cervical tissues to study a high-risk HPV 16 infection that, among cervical tissue lesions, carries the greatest risk of conversion to cancer, and the presence of p53 protein immunoreactivity, a tumor suppressor gene product. Methods: Paraffin blocks were studied via immunohistochemical (IHC) method to explore the presence of HPV 16 in 59 premalignant and malignant cervical lesions as well as immunoreactivity of the p53 oncoprotein, the most common cellular tumor suppressor gene product in human cancers. Results: In our series, mutant p53 positivity rate was 35.3% for low-grade CIL, 40% for high-grade CIL, and 46.8% for invasive carcinoma cases. Immune staining for high-risk HPV 16 type yielded a positive staining rate of 47% in low-grade CIL, 80% in high-grade CIL, and 50% in invasive carcinoma. Conclusion: The results of our study indicate a progressive increase in p53 oncoprotein reactivity from cervical intraepithelial neoplasia to invasive carcinoma. This suggests the clinical importance of p53 immunoreactivity in dysplastic progression and neoplastic transformation. HPV is the most commonly encountered oncogenic type in cervical lesions, especially in high-grade CIL and invasive carcinomas. Results of the previous reports suggest that HPV-positive carcinomas release wild type p53 and HPV-negative ones release mutant type p53 were not confirmed by our results, which indicated a mutant type p53 reactivity in HPV- 16 positive carcinoma cases.

Comprehensive overview of genotype distribution and prevalence of human papillomavirus in cervical lesions

Acrosscervical squamousandgl and ular lesions,a spectrum of human papillomavirus(HPV)genotypes has been identified.This review aims to provide a comprehensive summary detailing the distribution and profile of HPV genotypes detected in cervical lesions,leveraging insights from histological and cytological findings.High-risk HPV(HR-HPV)genotypes exhibit varying degrees of oncogenic potential,with HPV16 and HPV18 identified as the most prevalent and oncogenic types.Thedistribution of HR-HPVgenotypes varies among different degrees of the cervical lesions and varies between squamous andglandular neoplasia.HPV16 is predominantly associated with severe lesions(precancers and carcinomas),while HPV18 demonstrates a significantly higher prevalence in endocervical as compared with squamous neoplasia.The distribution of HR-HPV in severe squamous lesions is complex,involving many HR-HPV genotypes in addition to HPV16,while the distribution of HR-HPV genotypes in endocervical glandular lesions is mainly limited in HPV18 and HPV16.Large datasets from China have identified the three mostcommon HR-HPVgenotypes in this population as stratified by diagnostic category:HPV52,HPV16,HPV58 in histologically negative cases and cervical intraepithelial neoplasia 1(CIN1);HPV16,HPV52,HPV58 in CIN2/3;HPV16,HPV58,HPV52 or HPV18 in squamous cell carcinoma(SCC);HPV16,HPV18 and HPV52 in endocervical adenocarcinoma in situ(AIS),invasiveadenocarcinoma,as well asmixedsquamous and glandular lesions.HPV33 is the fourth most common HPVtype in CIN2/3and SCC,whileHPV45occursmore commonly in AIS and adenocarcinoma,compared with squamous lesions.The prevalence and distribution of multiple HR-HPV coinfections vary across different cervical diseases.The clinical significance and pathogenesis of these multiple HR-HPV infections remain uncertain,although recent two large studies demonstrate that multiple HR-HPV infections are not associated with cumulatively higher risk of high-grade cervical squamous lesiondevelopment,suggestingcompetitiveand/or cooperative interactions among HPVgenotypes.Extensive HPV genotyping aids in risk assessment and optimising clinical approaches for women with mild abnormalities in Pap cytology.Women with atypical squamous cells of undetermined significance(ASC-US)and low-grade squamous intraepithelial lesion(LSIL)Pap test results and with the infection of some HR-HPV genotypes carry a very low risk of high-grade cervical lesions.HPV genotyping can allow for risk stratification and triage optimisation for these HR-HPV-positive women.Women with atypical glandular cell(AGC)Pap test results showed a specific HPV genotyping pattern and extended HPV genotyping may be helpful for the clinical management of AGCs.Continual advancements in clinical guidelines integrating extended genotyping would increase diagnostic accuracy and refine strategies in clinical management.

Large pelvic mass arising from the cervical stump: A case report

BACKGROUND A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare.After supracervical hysterectomy,there is a risk of various lesions occurring in the cervical stump.We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy.Gynecologists should choose the most suitable surgical method based on both the patient’s condition and wishes.If the cervix is retained,patients require a close follow-up.CASE SUMMARY A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass.Her chief complaint was abdominal distention for two months.She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior.Abdominal ultrasonography detected a 9.1 cm×8.5 cm×8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53(HPV53)was positive.The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump.We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion.The pelvic mass was removed,and a bilateral adnexectomy was implemented.Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion.After successful intervention,the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo.CONCLUSION When addressing benign uterine diseases,gynecologists should pay adequate attention to retaining the cervix.If the cervix is retained,patients require a close follow-up.