Distribution of High-Risk Human Papillomavirus Genotypes among Women with Colposcopic Diagnosis of Cervical Intraepithelial Neoplasia in Bangladesh

Background: The incidence of cervical cancer is high in Bangladesh and there is a high prevalence of preinvasive lower genital tract disease among women of reproductive age. Persistent high-risk Human Papilloma Virus (HPV) infection is the main underlying cause of cervical cancer and its precursor, cervical intraepithelial neoplasia (CIN). Objective: The aim of the study was to identify the subtypes of high-risk HPV infection among women with the colposcopic diagnosis of cervical intraepithelial neoplasia in Bangladesh. Methods: This cross-sectional observational study was conducted in the colposcopy clinic of Dhaka Medical College Hospital over a six-month period. A total of 100 participants were enrolled. Married women, between 30 - 60 years of age with colposcopically diagnosed cervical intra epithelial neoplasia were enrolled. Women with chronic illness, pregnancy, and women unable to consent were excluded from this study. After counselling, colposcopically directed punch biopsies were taken from each CIN case concurrently with high-risk HPV testing by polymerase chain reaction (PCR). Results: The mean age of the patients was 38.69 (SD ±7.76) years. CIN 1 was diagnosed in 57% of participants, while 24% had CIN II and 19% had CIN III lesions. High-risk HPV was present in 52 patients. HPV 16 was the most common identified in 28 (53.84%) and HPV 18 was the second most common with 20 (38.46%) either singly or in combination with other high-risk subtypes. The other HPV strains, HPV 31, 33, 35, 52, 56 and 58, were also detected either as mono or co-infections. Out of the 52 HPV positive cases, 29 (55.8%) had mono infection and 23 (44.2%) had co-infection with several subtypes. The highest incidence (50%) of oncogenic HPV infections was present among women aged 35 - 45 years. Risk factors associated with HPV positive cases were high parity (P 0.05), early age at marriage (P = 0.754) and early age of first child. Conclusion: This study identified a high prevalence of HPV 16 and 18 genotypes. HPV vaccination with the current 9-valent HPV vaccine, which contains HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Will be an effective public health measure to eradicate cervical cancer in Bangladesh.

Efficacy and safety of Lianhuaqingwen capsules in high-risk common type COVID-19 pneumonia:A multicenter retrospective study

Objective:To evaluate the clinical safety and efficacy of Lianhuaqingwen(LHQW)capsules in patients with high-risk common type COVID-19 pneumonia.Methods:A retrospective multicenter study on 383 high-risk common type COVID-19 pneumonia cases was conducted.Patients were categorized as the standard treatment(SDT)group(n=168)and the LHQW+SDT group(n=215).The primary endpoint was the rate of symptom(fever,fatigue,coughing)recovery and the secondary endpoints included the time to symptom recovery,the proportion of patients with improvement in chest CT images,the proportion of patients with clinical cure,the timing and rate of negative conversion of SARS-CoV-2 RNA assay.Results:The recovery rate was significantly higher in the LHQW+SDT group as compared with the SDT group(89.7%vs.72.0%,P<0.01).The combined use of LHQW+SDT also showed shorter time for symptom recovery,as well as shorter time for individual symptom of fever,fatigue and coughing recovery than use of SDT alone.A higher proportion of patients in the LHQW+SDT group with improvements in chest CT images and clinical cure(77.7%vs.57.1%,P<0.01)but the proportion of patients deteriorating to severe cases(1%vs.25%,P<0.01)in this group was significant lower than those in the SDT group.No significant difference in negative conversion rate of viral assay results was observed(76.8%vs.75.0%,P>0.05).No serious adverse events were reported.Conclusions:LHQW capsules could be recommended to ameliorate clinical symptoms and reduce the rate of deteriorating to severe cases for high-risk common type COVID-19 pneumonia.

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.

Acupuncture-based treatments on cervical spondylosis of vertebral artery type

Cervical spondylosis of vertebral artery type is one of the chief patterns of cervical spondylosis.It is often described as neck pain accompanied with radiating pain and neurologic symptoms,such as sudden dizziness,blurred vision,tinnitus,nausea,vomiting,memory loss,and sudden fainting.The incidence of cervical spondylosis increases and patients with cervical spondylosis become progressively younger.Acupuncture in the cervical spondylosis of vertebral artery type treatment has a local positive reaction“Liuhe point”,in order to dredge the local Qi and blood.More and more evidences into the effectiveness and safety of cervical spine acupuncture for cervical spondylosis,specific neck pain,cervical radiculopathy,etc.This article summarizes the recent literature on acupuncture and acupuncture combined with other therapies for cervical spondylosis of vertebral artery type treatment and provides a comprehensive review from the perspectives of acupuncture therapy,warm needle moxibustion therapy,electroacupuncture,and acupuncture combined with other therapies,in order to provide reference and reference for clinical treatment.

Clinical Efficacy of Acupuncture Combined with Massage on Cervical Spondylopathy of Vertebral Artery Type and Its Effect on Hemodynamics of Patients

Objective:To investigate the clinical efficacy of acupuncture combined with massage on cervical spondylopathy of vertebral artery type and its effect on hemodynamics of patients.Methods:Sixty patients with vertebral artery type cervical spondylosis treated in our hospital from July 2017 to October 2019 were selected as the research subjects and randomly divided into 2 groups of 30 cases each.The control group was treated with acupuncture,and the observation group was treated with acupuncture combined with massage,and the clinical efficacy and hemodynamic index of the two groups were compared after 1 month of treatment[peak systolic blood velocity(PSV),pulsatile index(PI),time mean flow velocity(TMFV)].Results:There was no statistical difference in the PSV,PI,and TMFV between the two groups before treatment(P>0.05).After treatment,the observation group had a higher treatment efficacy than the control group with PSV and TMFV increasing and PI decreasing in both groups,and the change in the observation group was greater than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Acupuncture combined with massage on cervical spondylopathy of vertebral artery type can improve the clinical efficacy and improve the hemodynamic index of patients,which is worthy of clinical application.

Relationship between the high-risk HPV infection and the expression of oncogenes, anti-oncogenes in cervical dysplasia

Objective:To study the relationship between the infection of high-risk HPV in cervical precancerous lesion and the expression of oncogene, anti-oncogene.Methods:218 cases ofcervical intraepithelial neoplasia patients in our hospital during May 2014–May 2016 were chosed and divided into high-risk HPV group (n=107), low-risk HPV group (n=111) according to cervical tissue HPV test;another 100 cases of patients received cervical biopsy and confirmed as benign lesions were enrolled in the control group. RT-PCR method was used to detect the mRNA expression of proto-oncogene and anti-oncogene in three groups, Western-blot method was used to detect the protein expression of Sox-2 and Wnt/β-catenin signal pathway.Results: mRNA expression of oncogene DEK, Bmi-1, c-fos, K-ras, Prdx4 in high-risk HPV group were higher than low-risk HPV group and control group (P<0.05);mRNA expression of anti-oncogene P27, P16, DAPK, PTEN, eIF4E3 in high-risk HPV group were lower than low-risk HPV group and control group (P<0.05);expression of Sox-2 and Wnt/β-catenin signaling pathway protein Sox-2,β-catenin, wnt-1, wnt-3a in high-risk HPV group were higher than low-risk HPV group and control group (P<0.05).Conclusions:High-risk HPV infection can increase the expression of oncogenes and reduce the expression of anti-oncogenes in cervical dysplasia tissues on Sox-2- and Wnt/β-catenin signaling pathway manners.

VARIATION ANALYSIS OF HPV16 CELL-TYPE-SPECIFIC ENHANCER IN CERVICAL CARCINOMA

Objective To investigate the cell-type-specific enhancer (CTSE) in HPV16 and its variation in cervical carcinoma. Methods CTSEs were detected by polymerase chain reaction (PCR) in 58 cervical carcinoma from Shaanxi province; in addition variation of CTSEs was analyzed through single-strand conformation polymorphisms (SSCP). Results HPV16 CTSEs were detectable in 34 of 58 (57%) specimens and mutant rate was 41%(14/34) and the main mutations of chosen randomly variant CTSE (CTSEv) happened at YY1 binding sites in addition to glucocoticoid response elements (GRE). Conclusion CTSE in some specimens of Shaanxi province was obviously different from that in HPV16 wild type and variant CTSE might affect the transcriptional regulation of LCR on viral P97, which regulates over-expression of viral oncogenes in cervical carcinoma.

Acupuncture of different stimulation for the treatment of neck type cervical spondylosis:a randomised controlled trial

Objective:To observe the difference in clinical efficacy of acupuncture with strong and weak stimulation in treating neck type cervical spondylosis.Methods:64 patients with neck type cervical spondylosis were randomly divided into strong stimulation group and weak stimulation group,with 32 cases in each group.The acupoints selected are Jingjiaji 5-7(cervical acupoints EX-B2 C5-C7),Tianzhu(BL10)on both sides,Houxi(SI3)on both sides,Hegu(LI4)on both sides,Geshu(BL17)on both sides,and Ashi.In the strong stimulation group,deep needling with 0.25 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method.The twisting angle was 90°-180°,the frequency was 60-90 times/min,and the needles were applied for 1 min at each point.Keep the needle for 30 minutes,twisting was performed every 10 min during the retention period.Change hands once.In the weak stimulation group,shallow acupuncture with a 0.18 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method,with a twisting angle of 60°-90°,a frequency of 30-60 times/min,and acupuncture for 10 seconds at each acupoint.Keep the needle for 30 minutes,and no needle during the retention period.Patients in both groups were treated once every 1 to 2 days,3 times a week for 2 weeks,and followed up for 1 month after all treatments.The two groups of patients were compared before and after treatment and during follow-up.The McGill pain questionnaire score and the cervical spine dysfunction index score were compared to determine the clinical efficacy.Statistical analysis was performed using SPSS 22.0 statistical software.Results:1 case drop-out in the strong stimulation group and 1 case in the weak stimulation group.The total effective rate of the strong stimulation group was 90.32%,the total effective rate of the weak stimulation group was 83.87%,and the total effective rate of the strong stimulation group was higher than that of the weak stimulation group(P<0.05).The total scores of the short-form McGill pain questionnaire,the VAS score,and the cervical spine dysfunction index scores of the two groups of patients were significantly lower than those of this group before treatment,and the difference was statistically significant(P<0.05).The total scores of the short-form McGill pain questionnaire,visual analogue scale score,and cervical spine dysfunction index scores of the strong stimulation group after treatment and follow-up were significantly lower than those of the weak stimulation group(P<0.05).Conclusion:Acupuncture with strong and weak stimulation can effectively treat patients with cervical spondylosis,and deep acupuncture with filiform needles and strong stimulation have better effect.

SEARCH FOR HERPES SIMPLEX VIRUS TYPE2（HSV－2）AND HUMAN PAPILLOMAVIRUS（HPV）IN THE NORMAL AND ABNORMAL CERVICAL SAMPLES

The specimens of 111 cervical carcinomas. 68 chronic cervicitis and 43 normal cervical exfoliated epithelial cells were examined for the presence of HSV2 DNA sequences with DNA hybridization using HSV2 BgL Ⅱ N fragment probe labelled by 32PdCTP. The result showed that the infection rates of HSV2 in the samples of cervical cancer.chronic cervicitis and normal epithelial cells were 1 4. 41 %(16/111). 27.94%( 19/68) and 25.58% ( 11/43),respectively. It was implied that early stages carcinogenesis of cervical epithelial cells might be correlated with the HSV2 infection.Sixteen HSV 2 positive samples of cervical carcinomas were also examined for the presence of the sequences homologous to human papillomavirus (HPV) type 6B/11. 16 and 18 DNA using dot blot hybridization (Tm17℃). The result indicated that 13 out of 16 were HPV 16 DNA hybridization positive accounting for 81. 2% of all HSV-2 positive samples and none of them were positive for HPV type 6B/11 and 18. The result indicated that double infection of HSV 2 and HPV16 in the same cervical carcinoma tissues may provide a strong evidence of the viral synergistic interaction in the induction of female cervical

Polymorphism in the upstream regulatory region of human papilloma virus type 16 from the cervical cancer biopsies in Xinjiang Uygur women

To investigate the mutations in the upstream regulatory region (URR) of human papillomavirus type 16 (HPV-16) from the cervical cancer biopsies in Xinjiang Uygur women and its relationship to the high incidence of cervical cancer in the southern Xinjiang, the tissue DNA was extracted from the cervical cancer biopsies, and the URR segment of HPV-16 DNA was amplified, sequenced and analyzed. Thereafter, the polymorphism of URR in HPV-16 was then analyzed. It was demonstrated that the positive rate detected for the presence of URR in HPV-16 was 89.47% (17/19). Compared with the previously published sequence in URR of prototype HPV-16, some mutations were detected in the sequence of URR. The mutations in 17 URR fragments of HPV-16 could be divided into 11 patterns (XJU-1 to XJU-11) at nucleic acid level, in which each of XJU-1 and XJU-4 accounted for 23.53% (4/17), and other patterns of mutation accounted for 5.88% (1/17) . In comparison with the URR of prototype HPV-16, the DNA identity of these patterns was 98.50%-99.68% . In these 17 URR fragments, two point mutations occurred at position 7192 (G to T) and position 7520 (G to A) and they appeared to be constant in Xinjiang area. These two mutations were ubiquitous in the Asia-American type and conferred strong infection activity and carcinogenicity of this virus. In addition, the mutations at position 7729 (A to C), position 7843 (A to G) and position 7792 (C to T) could enhance its transcription activity considerably. It is concluded that some mutations occur in URR gene of HPV-16 in the cervical cancer biopsies taken from Uygur women in Xinjiang area, suggesting that certain relationship exists among the mutations in URR of HPV-16, the phylogeny of HPV-16 and the high incidence of cervical cancer in southern part of Xinjiang area.

Treatment of Cervical Vertigo of Atlanto-occipital Type with Massotherapy

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A CLINICAL OBSERVATION ON THE THERAPEUTIC EFFECT OF CERVICAL SPONDYLOPATHY OF NERVE ROOT TYPE TREATED BY COMBINED CERVICAL TRACTION AND ELECTROACUPUNCTURE

Objective: To observe the therapeutic effect of combined cervical traction and electroacupuncture (EA) on Cervical Spondylopathy of Nerve Root Type (CSNRT). Methods: 145 patients diagnosed as CSNRT were randomized into 3 groups: combined treatment group, EA group, and cervical traction (CT) group. The combined group was treated with traction followed by EA of Dazhui (大椎 GV 14), Fengchi (风池 GB 20), cervical Jiaji (夹脊 EX-B 2), etc.. Patients of two control groups were only treated by either CT or EA. Results: The markedly-effective rate and total effective rate were 76.0% and 94.0% respectively in the combined treatment group, 62.5% and 81.25% respectively in CT group, and 63.82% and 82.97% respectively in EA group. The therapeutic effect of the combined treatment group was significantly superior to that of two control groups (P<0.05). At 6-month follow-up, the above two markedly-effective and total effective rates in the combined treatment group remained 74.0% and 92.0%, still significantly higher than that in two control groups. Conclusion: Combining cervicle traction with EA treatment can effectively eliminate or relieve the symptoms and signs in patients with nerve root type cervical spondylopathy.

Relationship of high-risk HPV infection with MEKK3 and NF-κB expression in cervical intraepithelial neoplasia tissue

Objective:To study the relationship of high-risk human papilloma virus (HPV) infection with mitogen-activated protein kinase/extracellular signal-regulated kinase 3 (MEKK3) and nuclear factorκB (NF-κB) expression in cervical intraepithelial neoplasia tissue.Methods:125 cases of cervical biopsy specimens between May 2013 and March 2016 were collected. The cervical inflammation specimens, cervical intraepithelial neoplasia specimens and cervical cancer specimens were included in inflammation group, CIN group and malignant group respectively. HPV-DNA typing detection kits were used to determine HPV typing, immunohistochemical kits were used to determine MEKK3 and NF-κB protein expression, and fluorescent quantitative PCR kits were used to determine the mRNA expression of MEKK3, NF-κB and downstream molecules.Results: MEKK3 and NF-κB protein expression in high-risk HPV-positive cervical tissue were significantly higher than those in high-risk HPV-negative cervical tissue (P<0.05), and MEKK3, NF-κB, Bcl-2, XIAP, Bmi-1, TGF-β and Vimentin mRNA expression in high-risk type HPV-positive cervical tissue were significantly higher than those in high-risk HPV-negative cervical tissue (P<0.05);Bcl-2, XIAP, Bmi-1, TGF-β and Vimentin mRNA expression in tissue with positive MEKK3 and NF-κB expression were significantly higher than those in tissue with negative MEKK3 and NF-κB expression (P<0.05).Conclusions:High-risk HPV infection will increase the expression of proliferation genes Bcl-2, XIAP and Bmi-1 as well as invasion genes TGF-β and Vimentin in cervical intraepithelial neoplasia tissue through MEKK3/NF-κB pathway.

MULTI-CENTER RANDOMIZED CONTROLLED TRIALS OF COMBINED TREATMENT OF VERTEBRAL ARTERY TYPE CERVICAL SPONDYLOSIS WITH ACUPUNCTURE AND MASSAGE

Objective:To evaluate the clinical value of synthetical therapy of acupuncture and massage for treating vertebral artery type cervical spondylosis (VACS). Methods: In the present study, triple-center, single-blind, randomized and control methods were adopted. Qualified subjects were randomly assigned to three groups: acupuncture-massage (acu-mas) group, acupuncture group, and massage group (60 subjects in each group). Bilateral Fengchi (风池GB 20), Jiaji (夹脊EX-B 2, C_ 4-7) and Baihui (百会GV 20) were punctured in combination with massage at the neck-shoulder and back region. The treatment was conducted once daily, 14 times altogether. Results: After treatment, of the 60 cases in each of acu-mas, acupuncture and massage groups, 28, 11 and 13 were cured, 13, 20 and 17 markedly effective, 12, 14 and 16 effective, and 7, 15 and 14 ineffective, with the total effective rates being 88.3%, 75.0% and 76.7% respectively. The therapeutic effect of acu-mas group was significantly superior to that of simple acupuncture and massage groups (P<0.05). The scores of clinical symptoms and signs in 3 groups all declined significantly after treatment (P<0.01), and the score of symptoms of acu-mas was markedly lower than those of acupuncture and massage groups (P<0.05). No significant differences were found among 3 groups in the score of clinical signs and between acupuncture and massage groups in the score of clinical symptoms (P>0.05). The time for producing therapeutic effects in acu-mas group was significantly shorter than those of acupuncture and massage groups (P<0.01, 0.05), meaning a faster of acu-mas group in producing clinical effect. No adverse events were found in all the 3 groups. Conclusion: Acupuncture and massage are effective and safe in the treatment of VACS, and the therapeutic effect of acupuncture combined with massage is superior to that of simple acupuncture and simple massage therapy.

OBSERVATION ON THE TREATMENT OF VERTEBROARTERY TYPE CERVICAL SPONDYLOPATHY INDUCED VERTIGO WITH HYDRO-ACUPUNCTURE THERAPY

Objective: To observe the therapeutic effect of hydro acupuncture therapy for treatment of vertigo induced by vertebroartery type cervical spondylopathy and to study its action mechanisms. Methods: A total of 54 cases of vertebroartery type cervical spondylopathy patients were observed in the present study. Fengfu (GV 16) and Jiaji (EX B 2) near the regenerated cervical vertebral body were used for injection of Ligustrazine injectio, 1 mL every acupoint, once every other day, with 7 sessions being a therapeutic course. Before and after treatment, cerebral blood flow volume was determined using a Doppler velocimeter. Results: After 2 weeks’ treatment, of the 54 cases, 28 (51.9%) had their vertigo disappeared, 13 (24.1%) had remarkable improvement, 10 (18.5%) had improvement and 3 (5.5%) failed in the treatment, with an effective rate of 94.5%. After treatment, the peak and mean values of the blood flow velocity of the bilateral vertebral arteries and the basilar artery increased significantly in comparison with pre treatment ( P <0.01). Conclusion: Hydro acupuncture therapy has an obvious therapeutic effect for relieving vertebroartery type vertigo and ameliorating cerebral blood supply.

CLINICAL OBSERVATION ON TREATMENT OF NERVE-ROOT TYPE CERVICAL SPONDYLOSIS WITH ACUPUNCTURE, TRACTION PLUS SELF-EXERCISE OF QIGONG

Purpose: To observe the therapeutic effect of acupuncture combined with traction and Qigong exercise for treatment of nerve root type cervical spondylosis. Methods: A total of 130 nerve root type cervical spondylosis patients were randomly divided into acupuncture + traction + Qigong exercise (ATQE) group (n=59), acupuncture + Qigong exercise (AQE) group (n=40) and traction + Qigong exercise (TQE) group (n=31). Main acupoints used were Fengchi (GB 20) and cervical Jiaji (EX B 2) on the affected side. Results: After one month’s treatment, in ATQE, AQE and TQE groups, 43 (72.88%), 18 (45.00%) and 12 (45.16%) had remarkable amelioration, 14 (23.72%), 14 (35.00%) and 10 (32.26%) were effective, and 2 (3.39%), 8 (20.00%) and 7 (22.58%) had no apparent changes with the total effective rates being 96.61%, 80.00% and 77.41% respectively. The therapeutic effect of ATQE group was significantly superior to that of AQE and TQE groups (P<0.01).

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACPUNCTURE COMBINED WITH MASSAGE FOR CERVICAL SPONDYLOSIS OF VERTEBRAL ARTERIAL TYPE BY USING TRANCRANIAL DOPPLYER ULTRASONOGRAPHY

Objective: To observe the effect of acupuncture combined with massage on blood flow velocity of the vertebro-basilar artery in cervical spondylosis of vertebral arterial type (CSVAT) patients. Methods: In the present study, methods of evidence-based medicine, triple-centers, single-blindness, randomization and control were used. A total of 100 cases of CSVAT patients were randomized into acupuncture plus massage (acu-massage) group (n=38), acupuncture group (n=32) and massage group (n=30). Acupoints used were Fengchi (风池GB 20), cervical Jiaji (颈夹脊EX-B 2), Baihui (百会GV 20), and the methods of massage used were kneading-rolling, adhesion-separating and acupoint-digital pressing, topical digital pressing and rubbing, traction-extending and mild palm-rubbing. The treatment was conducted once daily, with 7 sessions being a therapeutic course and continuously for 2 courses. Changes of peak velocity (Vp), end-diastolic velocity (Vd), mean velocity (Vm) of blood flow of the vertebral artery (VA) and basilar artery (BA), etc were detected before and after the treatment by using transcranial Doppler (TCD) ultrasonography. Results: After the treatment, the abnormally low Vp of both VA and BA in acu-massage, acupuncture and massage groups, Vm of VA in acu-massage and acupuncture groups, Vm of BA in acu-massage and massage groups, and Vd of VA and BA in the 3 groups all increased significantly in comparison with their own pretreatment (P<0.05, 0.01), and the therapeutic effects of acu-massage group in the 3 indexes were significantly superior to those of acupuncture group and/or massage group (P<0.05, 0.01). The abnormally increased Vp of VA in acu-massage and acupuncture groups, Vm of VA in the 3 groups, and Vd of VA in acu-massage and massage groups decreased obviously after the treatment in comparison with their own pretreatment (P<0.05, 0.01), and the therapeutic effects of acu-massage group were significantly superior to those of acupuncture and/or massage group in the 3 indexes of VA (P<0.05, 0.01). In addition, the abnormally increased Vp, Vm and Vd of BA in the 3 groups showed a similar tendency. No significant differences between acupuncture and massage groups in 3 indexes (P>0.05). Conclusion: The therapeutic effects of acupuncture plus massage is significantly superior to those of simple acupuncture and simple massage therapies in improving abnormal blood dynamics of vertebral and basilar arteries in CSVAT patients.

TREATMENT OF VERTEBRAL－ARTERY TYPE CERVICAL SPONDYLOPATHY WITH NEEDLE－KNIFE THERAPY

In the present paper, 62 cases of vertebral-artery type cervical spondylopathy were treated with needie-knife therapy (acupotomy). After 2- 6 sessions of treatment, 23 cases (37. 1%) were cured, 19 (30. 7%)showed marked improvement, 15 (24.2%) had some improvement and 5 (8.1 % ) failed in the treatment. The total effective rate was 91.9 %. It indicates that acupotomy therapy is a highly effective remedy for treating vertebral-artery type cervical spndylopathy.

Biology and treatment of cervical adenocarcinoma

Uterine cervical adenocarcinoma （ADC） has been increasing in its prevalence world widely despite the decrease of squamous cell carcinoma （SCC）. It comprises nearly 20-25% of the all cervical malignancy in developed countries. The worse biological behavior had been reported in patients with intermediateand high risk factors after surgery, and in advanced stage over III, radiotherapy （RT） alone and concurrent chemo-radiotherapy （CCRT） with cisplatin was not always effective. As for chemotherapy （CT）, the iaduction CT has not established, as well. Further molecular targeted therapy （MTT） has been studied. The targets of oncogenic driver mutations were vascular endothelial growth factor （VEGF） in SCC, or tyrosine kinase （TK） of endothelial growth factor receptor 2 （EGFR2, Her2/neu）-Ras-MAPK-ERK pathway. Bevacizumab （Bey, anti-VEGF monoclonal antibody） is considered as one of key agent with paclitaxel and carboplatin in SCC, but not for ADC. This article focuses on up-to-date knowledge of biology and possible specific therapeutic directions to explore in the management of cervical ADC.

Expression and Significance of SHP-2 in Human Papillomavirus Infected Cervical Cancer

This study investigated the expression and prognostic value of SHP-2 in cervical cancer caused by human papillomavirus (HPV) infection. Forty-five specimens from patients with cervical cancer (stageⅠ-Ⅲ), 32 specimens from patients with cervical intraepithelial neoplasia (CIN) (Ⅰ, Ⅱ) and 20 normal cervical samples from patients with hysteromyoma were collected in Department of Pathology for comparison. The expression levels of SHP-2 and IFN-β proteins were detected by using immunohistochemistry. The mRNA expression level of SHP-2 was detected by using quantitative real-time polymerase chain reaction (PCR). HPVs were detected by HPV GenoArray Test. The Spearman correlation was used to compare the expression level of SHP-2 in HPV infected cervical cancer vs non-HPV infected normal cervix. The level of SHP-2 protein expression in the cancer tissues (88.8%) was significantly higher than in CIN tissues (62.5%) and normal cervixes (45%) (P<0.05 and P<0.05, respectively). The SHP-2 mRNA levels in the cancer tissues were upregulated as compared with those in the normal cervixes (P<0.05). Twenty-one (46.7%) cervical cancers, 25 (78.1%) CINs and 17 (85%) normal cervixes showed IFN-β positive staining in cytoplasm. There was statistically significant difference in the expression rate of IFN-β between cervical cancer and normal cervix (χ2=8.378, P<0.05) as well as between cervical cancer and CIN (χ2=7.695, P<0.05). HPV16/18 infections could be found in normal cervixs (15%), CINs (68.7%) and cervical cancers (84.4%). There was a correlation between HPV infection and SHP-2 expression in cervical cancer (rs=0.653, P<0.05). SHP-2 may be a useful prognostic and diagnostic indicator for HPV infected cervical cancer. In cervical cancers, SHP-2 mRNA and protein overexpression was associated with IFN-β lower-expression.