DETECTION OF PATHOGENS CAUSING GENITAL ULCER DISEASE BY MULTIPLEX POLYMERASE CHAIN REACTION

Objective To establish a multiplex polymerase chain reaction (M-PCR) assay for simultaneous detection of pathogens causing genital ulcer disease (GUD). Methods Based on the gene-specific region of the following pathogens: Chlamydia trachomatis omp1/ompb, herpes simplex virus (HSV) DNA polymerase, Treponema pallidum tpp47, Haemophilus ducreyi 16s rRNA, four sets of primers were designed and an M-PCR assay was developed to detect four pathogens in one test. The assay was evaluated with diagnostic result of golden standard for each pathogen. Results Of the 51 clinical samples, M-PCR showed slightly higher positive rate (47.1%) of HSV than cell culture (23.6%).Meanwhile, the positive rate of T. pallidum detected by M-PCR and dark-field microscopy was 19.6% (10/51) and 15.7% (8/51), respectively. Only one sample was positive for H. ducreyi and no sample was positive for C. trachomatis detected by both M-PCR assay and culture. Conclusion This primary study indicated that M-PCR assay can simultaneously and rapidly detect the four etiologic pathogens causing GUD.

Clinical Application of Multiplex PCR Assay for the Diagnosis of the Etiology of Genital Ulcer Disease Among Patients Attending STD Clinics in Guangzhou, China

Objectives: To develop a method of simultaneous PCRdetection of Haemophilus ducreyi, Treponema pallidum, andHerpes Simplex Virus Types 1 and 2 from genital ulcersamong patients attending STD clinics in Guangzhou, China;and evaluate the clinical application of multiplex PCR (M-PCR) assay for diagnosing the etiology of genital ulcerdiseases (GUD). Methods: 244 patients with a genital ulcer were evaluated.Clinical etiology of GUD was based on physical appearanceand microbiologic evaluations that included dark fieldmicroscopy examination (D-F) and serology test for syphilis(STS). Swabs of each genital ulcer were tested for HSVantigen by enzyme immunoassay (EIA) and processed in anM-PCR assay for simultaneous detection of T. pallidum, HSVand H. ducreyi. Results: The standard strains of T. pallidum, HSV and H.ducreyi were amplified by M-PCR, producing amplifiedproducts of 260bp,432bp,170bp, respectively. The sensitivityof M-PCR is 102pg DNA. M-PCR assay for T. pallidum, HSVand H. ducreyi showed good agreement when compared withD-F detection for T. pallidum, STS, H. ducreyi culture and EIAfor HSV antigen (Kappa scores are 0.774,0.704,0.793,0.756,respectively). Conclusions: The M-PCR is a convenient, accurate andreliable assay for the detection of T. pallidum, HSV and H.ducreyi from genital ulcers, and can be used as a method of diagnosing the etiology of GUD.

Male genital damage in COVID-19 patients:Are available data relevant?

Over the past few weeks,we have observed increasing concern about the possible impact of coronavirus disease 2019(COVID-19)which is caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2 virus)on male fertility.Precise mechanisms of male reproductive damages are still unclear,but it seems that high temperature resulting from persistent fever and triggering a secondary autoimmune response leading to an autoimmune orchitis are the most likely involved mechanisms.Also,angiotensin conversion enzyme 2(ACE2)plays a highly important role in cellular entry for SARS-CoV-2 and male genital system presents high ACE2 expression.All these preliminary findings suggest that COVID-19 could impact men's reproductive health.Thus,we examined available data including published and unpublished articles to assess the potential risk of COVID-19 in particular on the male reproductive system.

不孕不育人群生殖道沙眼衣原体感染影响因素分析

目的了解不孕不育门诊人群生殖道沙眼衣原体(CT)感染现状及影响因素,为制定该人群的CT防治策略提供依据。方法2021年4—12月在深圳市宝安区4家开设有不孕不育门诊的医疗机构的常规就诊者中招募调查对象。在获得知情同意情况下,收集其社会人口学相关信息并采集尿液标本进行CT核酸检测。运用Logistic回归分析该人群CT感染的影响因素。结果共招募954例不孕不育患者,CT阳性率为3.56%。Logistic回归分析结果表明,年龄<25岁(OR=3.91,95%CI:1.58~9.67)、文化程度为大专(OR=4.33,95%CI:1.23~15.24)、最近1年性伴数量≥2个(OR=4.25,95%CI:1.72~10.55)是该人群感染CT的危险因素。在调查对象中,74.42%不了解CT感染的相关症状,73.90%既往未检测过CT。结论深圳市宝安区不孕不育人群CT感染率较高,性活跃年龄段、文化程度相对较低、有多个性伴是CT感染的危险因素,应在不孕不育专科门诊中针对以上人群开展CT筛查,同时开展健康宣传,提高人群生殖健康。

Small Cell Neuroendocrine Carcinoma of the Vulva: Case Report and Literature Review

Background: Neuroendocrine neoplasms are those that develop from a neuroendocrine cell. They most commonly affect the lungs, gastrointestinal tract, and pancreas, being rare conditions in the female genital tract. When present, these neoplasms often manifest with nonspecific signs and symptoms such as pain, itching, swelling, single-focus lesions, bleeding, and enlargement of inguinal lymph nodes, in addition to the presence of progressively enlarging vulvar nodules. Consequently, the diagnostic investigation involves histopathological examination and confirmation through immunohistochemistry. Objective: To present a comprehensive understanding of this rarely studied pathology. The primary objective is to provide valuable insights that could aid in the future development of universally applicable treatment guidelines. Case Presentation: A 57-year-old female, with no prior comorbidities, menopause at 36, who presented with a left vulvar nodule accompanied by intense pain and swelling, later diagnosed with small cell neuroendocrine carcinoma in the vulva. Conclusion: This case report highlights the importance of enhancing our knowledge regarding small cell neuroendocrine carcinoma in the vulva, given its scarcity in medical literature. The information presented here underscores the need for standardized diagnostic and treatment approaches, paving the way for future consensus on managing this uncommon but challenging neoplasm.

环状RNA在生殖系统的研究进展

环状RNA(circular RNA,circRNA)是一类不具有5′末端帽子和3′末端多聚腺苷酸尾巴并以共价键形成封闭环状结构的内源性非编码RNA(non-coding RNA,ncRNA)。由于circRNA结构的特殊性,其对RNA外切酶R(ribonucleic acid exonuclease R,RNaseR)具有高度抵抗性,因此在细胞质中的分布相当丰富。高通量测序和生物信息学方法的不断发展揭示了circRNA具有高度保守性、稳定性、疾病特异性和组织特异性的特点,使其在临床早期诊断中具有作为生物标志物的潜能。研究已证实circRNA在女性生殖系统中与卵子发生、卵巢功能不全、卵巢相关性疾病以及在男性生殖系统中与精子发生、睾丸发育之间相互作用,有望成为多种生殖系统疾病新的诊断和治疗靶点。综述circRNA在生殖系统发育中的生物学功能及其调控作用。

CLINICAL ANALYSIS OF EXTRAMAMMARY PAGET’S DISEASE OF VULVA

Objective: To review our experience in diagnosis, pathology, treatment, and prognosis of extramammary Paget's disease of the vulva. Methods: Seven patients with vulvar Paget's disease who were treated at the Cancer Hospital cAMS were retrospectively reviewed for the period from 1960 to 2002. The symptoms, location of disease, pathology, mode of treatment and current status of the patients were evaluated. Results: A total of seven women with Paget抯 disease of the vulva were admitted to the Department of Gynecologic of Oncology. The mean age was 67.3 years (range 54~81 years). Vulvar lesion and pruritus were the common symptoms and it took average 3.4 years to confirm the diagnosis. All patients underwent surgery as initial treatment, vulvectomy was performed for 2 patients and radical vulvectomy plus groin node dissection for 5 patients. Two patients had invasive disease and four were associated with underlying adenocarcinoma. Five patients experienced recurrence, on average, 16.2 months after the surgery. Four of them underwent radiotherapy or chemotherapy and the other received no further treatment. The mean follow-up time was 41.1 months. Three patients, with invasive lesion or underlying adenocarcinoma were dead of the disease. Conclusion: There is a delay in the diagnosis of vulvar Paget's disease. The major treatment is surgery. Recurrence is relatively common. Patients with invasive disease or underlying carcinoma have a poor prognosis.

干细胞外泌体在妇科疾病中的临床应用

干细胞外泌体(stem cell-derived exosome,SC-Exo)是从干细胞中释放的一种微小囊泡,不同细胞或组织来源的外泌体在疾病的发生发展过程中起到不同的作用,已在临床各领域取得重要的成果和进展,其在复发性流产、多囊卵巢综合征、卵巢功能减退、宫腔粘连、阴道手术创面修复、妇科肿瘤和盆底功能障碍等妇科疾病中的应用价值正不断被发掘。SC-Exo可通过释放核酸、蛋白质、脂质和细胞因子等多种生物活性分子,介导靶向细胞间的信号传递及遗传信息的功能转移,对妇科相关疾病的治疗具有潜在的益处,是一种新颖而有前途的治疗策略。

基于年龄-时期-队列模型分析1990—2019年中国妇科疾病负担趋势

目的:了解中国女性1990—2019年妇科疾病负担变化趋势及其年龄、时期、队列效应,为妇科疾病的预防和控制策略的制定提供科学依据。方法:利用2019年全球疾病负担研究(Global Burden of Disease Study 2019,GBD 2019)数据,采用Joinpoint回归模型分析中国妇科疾病发病率和伤残调整寿命年(disability adjusted life year,DALY)率的变化趋势,基于年龄-时期-队列模型探讨年龄、时期和队列效应对发病率和DALY率的影响,并分析经前期综合征、生殖器脱垂、子宫肌瘤、子宫内膜异位症、多囊卵巢综合征发病率和DALY率的顺位。结果:1990—2019年中国妇科疾病发病率和DALY率均呈下降趋势,平均每年分别下降0.63%(95%CI:-0.73%~-0.54%,P<0.05)和0.34%(95%CI:-0.43%~-0.24%,P<0.05)。年龄-时期-队列模型结果显示,1990—2019年中国妇科疾病发病率和DALY率的纵向年龄曲线均呈先上升后下降的趋势,在30~34岁达高峰。随着时期的推移,妇科疾病的发病风险和DALY风险均呈下降趋势,以2000—2004年为参考时期(RR=1),2015—2019年时期发病风险下降至最低(RR=0.73,95%CI:0.74~0.71)。1905—1909至1985—1989年出生队列的发病风险和DALY风险呈下降趋势,1990—1994至2000—2004年出生队列略呈上升趋势。1990和2019年常见妇科疾病中经前期综合征发病率(7245.53/10万、5695.02/10万)和DALY率(222.21/10万、197.95/10万)居于首位。结论:我国减少妇科疾病负担的工作已取得一定进展,但疾病负担仍然严重,应加强对年轻女性妇科疾病的健康宣传教育,开展有针对性的普查,提高诊断和治疗技术,继续降低我国的妇科疾病负担。

脂肪间充质干细胞外泌体在妇科疾病的应用及进展

随着干细胞研究的发展,脂肪间充质干细胞(adipose derived mesenchymal stem cell,ADSC)和脂肪间充质干细胞外泌体(adipose derived mesenchymal stem cell exosome,ADSC-Exo)成为妇科领域的研究热点。ADSC是一类来源于脂肪组织的间充质干细胞,与其他间充质干细胞一样具有较高的增殖能力和多向分化潜能,ADSC-Exo还可通过释放的细胞外囊泡传递各种生物活性分子,如微小RNA、蛋白质和细胞因子,对目标细胞发挥一定的调节作用。ADSC-Exo在妇科领域的应用日益受到关注。有研究表明,ADSC-Exo可以促进子宫内膜的再生和修复,为宫腔粘连和不孕症的患者带来了希望。此外,一些研究提到ADSC-Exo在慢性子宫内膜炎、卵巢功能不全、多囊卵巢综合征和妇科恶性肿瘤等疾病的治疗中也具有一定的潜力。综述ADSC-Exo在妇科领域的应用及进展。

Viral disease

970228 The therapeutic effect of purified human leu-cocytic interferon-a on hemorrhagic fever with renalsyndrome. BAI Jingyu(白敬羽), et al. Changzhou 3rdPeople’s Hosp, Changzhou, 213001. Chin J Intern Med1997; 36(2): 90-93. Objective:To explore the therapeutic effect of puri-

Clinical characteristics and survival outcomes of perianal Paget’s disease:A SEER population-based study

Objective The aim of the study was to analyze the clinical features of patients with perianal Paget’s disease(PPD)and investigate prognosis risk factors.Methods The SEER*Stat software was used to identify 116 PPD patients from 1975 to 2015 in the SEER research database.The Kaplan-Meier method was used to conduct a univariate analysis for PPD patients.The differences in survival rates were evaluated using the log-rank test.The differences in the clinicopathological features of PPD patients with or without anorectal carcinoma were compared using the chi-square test.Results The median survival time of PPD patients was 44 months.The median age of onset was 73 years old.The 43.10%of the patients were alive at the end of follow up,and only 12.93%of the patients died of PPD.Elderly(age>70 years;χ^2=9.453,P=0.002),poor differentiation(χ^2=46.557,P=0.000)and abdominal perineal resection(APR;χ^2=46.557,P=0.000)were unfavorable risk factors of prognosis.Nearly 50%of PPD had combined with other malignancies,and over 22.41%of those had multiple primary neoplasms(3 or more).PPDs predisposed concurrent malignancy,and 48.21%of PPD patients with other malignancies combined with anorectal carcinoma in the study.Stage(χ^2=10.127,P=0.018),and surgical method(χ^2=12.245,P=0.007)were statistically significant in the PPD patients with or without anorectal carcinoma.The 16.07%of patients had multiple lesions of Paget’s.Conclusion Patients with PPD have a favorable survival,while the disease-specific mortality is low.Diagnosed age,differentiation,and surgical methods were the influence factors of prognosis in PPD patients.PPDs with anorectal carcinoma is of most important in further investigation.

m^(6)A甲基化修饰在生殖相关疾病中的研究进展

N^(6)-甲基腺苷(N^(6)-methyladenosine,m^(6)A)甲基化修饰是真核生物最常见的RNA修饰,通过控制RNA代谢、选择性剪接、降解和翻译等过程调控基因表达和生物学功能。近年研究发现m^(6)A甲基化修饰在生殖系统中发挥重要的调节作用,参与多囊卵巢综合征、子宫内膜异位症、早发性卵巢功能不全、子宫腺肌病等多种女性生殖内分泌疾病和女性生殖系统肿瘤的发生、发展。此外,m^(6)A甲基化修饰还可以调节人类精子发生和睾丸功能,与男性少弱精子症和男性生殖系统肿瘤相关。提示m^(6)A甲基化修饰可能是生殖相关疾病调控的新靶点。综述m^(6)A甲基化修饰的作用机制及其在生殖相关疾病中的研究进展,对生殖相关疾病的诊断和治疗具有一定指导意义。

169例女性生殖器疱疹患者的流行病学特征分析

目的分析女性生殖器疱疹的流行病学特点,为防控疾病、促进女性生殖健康提供依据。方法从中国疾病预防控制信息系统收集北京市海淀区2005—2022年女性生殖器疱疹的传染病报告卡,分析其流行病学特征。结果169例中,年龄18~78岁,中位数30岁,发病年龄集中在22~34岁(60.4%);职业类型中占比前5位的依次为家务及待业41例(24.3%)、不详33例(19.5%)、干部职员例24(14.2%)、商业服务16例(9.5%)、其他12例(7.1%);发病到诊断的间隔时间最短0 d,最长达2年以上。结论生殖器疱疹对女性生殖健康影响较大,应加强宣教生殖器疱疹的预防知识,并提高医院生殖器疱疹的报告水平。

2018-2022年北京市海淀区女性生殖道沙眼衣原体感染情况分析

目的分析2018—2022年北京市海淀区女性生殖道沙眼衣原体感染的流行病学特点,为制订防控策略提供依据。方法从中国疾病预防控制信息系统中选取2018—2022年女性生殖道沙眼衣原体感染病例资料,分析女性生殖道沙眼衣原体感染的流行病学特点。结果2018—2022年北京市海淀区报告女性生殖道沙眼衣原体感染1761例,职业类型中占比最高为家务及待业(40.2%),年龄主要分布在20~40岁(87.7%),发病到诊断间隔时间集中在0~14 d(81.7%)。结论建议北京市海淀区加强对重点人群生殖道沙眼衣原体的筛查,并加大防病知识的宣传,进一步提升医院诊疗服务水平。

先天性孤立肾单中心病例总结

目的探讨先天性孤立肾(CSK)患者病情特点。方法收集了2012-2020年北京协和医院诊断为先天性孤立肾的患者,对其病例资料及术后随访结果进行分析。结果共纳入本院233例CSK患者,男性58例,女性175例。其中最常见伴发畸形为生殖道畸形,其次为先天性脊柱侧凸。15%的CSK患者存在其他肾脏相关疾病。5例患者行泌尿外科手术,随访中均未出现术后并发症。仅1例肾部分切除术后1年出现复发转移,遂行二次手术治疗。结论发现CSK畸形的同时,有必要进行全身多系统的评估。此类患者即使症状隐匿也应定期监测,就诊治疗过程更需谨慎保护肾功能。

外阴皮肤活检4736例临床及组织病理诊断回顾性分析

目的分析外阴皮肤活检患者的病种构成和临床病理诊断的一致性。方法收集复旦大学附属华山医院2011年1月—2020年12月4736例外阴皮肤活检组织,进行苏木精-伊红染色,部分行免疫组化染色检查,回顾性研究其临床和组织病理诊断资料。结果根据组织病理诊断结果,将疾病分为9大类超50种,以尖锐湿疣、硬化萎缩性苔藓、乳腺外Paget病最为常见,且不同性别及年龄段患者的疾病构成存在差异。总体来看,外阴疾病临床和组织病理诊断一致率较低,最高为50.44%(乳房外Paget病),最低为0%(疣状癌、恶性黑素瘤)。其中1022例(21.58%)进一步行免疫组化染色明确诊断。结论外阴皮肤疾患的病种有别于身体其他部位,且诊断准确率低,故临床上有必要提高对外阴疾病的认识,并纳入皮肤活检辅助诊断。

穴位埋线治疗早泄的疗效观察及对阴茎头部振动感觉阈值的影响

目的 观察穴位埋线治疗早泄的临床疗效及对患者阴茎头部振动感觉阈值的影响。方法 将66例早泄患者随机分为治疗组(36例)和对照组(30例)。治疗组行穴位埋线治疗,对照组口服帕罗西汀治疗。比较两组临床疗效,观察两组治疗前后患者早泄诊断量表(premature ejaculation diagnostic tool,PEDT)评分、阴道内射精潜伏时间(intravaginal ejaculation latency time,IELT)以及阴茎头部震动感觉阈值(vibration perception threshold,VPT)的变化。结果 治疗组总有效率为83.3%,对照组总有效率为73.3%,组间比较差异具有统计学意义(P<0.05)。治疗后,两组IELT及阴茎头部VPT均较治疗前提高(P<0.05),且治疗组均优于对照组(P<0.05)。治疗后,两组PEDT评分较治疗前均下降(P<0.05),且治疗组低于对照组(P<0.05)。结论 穴位埋线能提高早泄患者阴茎头部震动感觉阈值,延长患者的阴道内射精潜伏时间,疗效优于口服帕罗西汀治疗。

广州地区生殖器溃疡性疾病与HIV感染的相关性研究

[目的]了解性病门诊生殖器溃疡性疾病(GUD)的HIV感染状况及其与HIV感染的关系。[方法]取GUD患者溃疡处分泌物进行暗视野显微镜检查、多重聚合酶链反应,同时取上述患者和非溃疡性性传播疾病(STD)患者尿道或宫颈或阴道分泌物进行淋球菌、沙眼衣原体、支原体、单纯疱疹病毒、人类乳头瘤病毒、念珠菌、滴虫及加特纳菌等检测;检测所有STD患者血清的HIV抗体及梅毒血清学试验。[结果]在8962例病人中,就诊时生殖器有溃疡的STD与生殖器无溃疡的STD病人中HIV感染率分别为1.75％(5/285)和1.53％(133/8677),两者无统计学意义(x^2=0.09,P>0.05; OR=1.15,95％ CI=0.47～2.81);梅毒、生殖器疱疹和其他STD病人的HIV感染率分别为2.81％(22/784)、0.74％(6/814)和1.49％(110/7364),梅毒病人的HIV感染率明显高于生殖器疱疹和其他STD病人的HIV感染率,有统计学意义(2.81％ vs 0.74％,x^2=9.92,P<0.05,OR=3.89,95％ CI=1.67～9.05;2.81％ vs 1.49％,x^2=7.66,P<0.001,OR=1.90,95％ CI=1.21～3.00)。[结论]本研究提示本组GUD病人HIV感染率较国外低,梅毒与HIV感染有明显相关性;生殖器疱疹病人与HIV感染的关系尚待进一步研究。

经直肠超声在妇科疾病诊断中的价值

目的:探索经直肠超声(TRS)技术在妇科疾病诊断中的价值,并与经腹超声(TAS)及经阴道超声(TVS)技术进行比较。方法:随机抽取87例无性生活史妇科疾病患者行TAS检查,同时采用阴式腔内探头行TRS检查。另外,随机抽取54例妇科疾病患者仅行TVS检查。比较TRS、TAS、TVS3种技术的显像差异。对行TRS和TAS检查的87例患者进行随访,并比较TRS、TAS技术的诊断符合率。结果:TRS技术在以子宫和卵巢为中心的近场图像的细微显影分辨能力,明显优于TAS技术(P<0.01),其对无性生活史女性的妇科疾病诊断符合率(88.14%)明显高于TAS技术(42.37%),P<0.001。TRS与TVS技术,两者的轮廓显影及组织细微显影能力均无显著性差异(P>0.05),TRS在妇科细微显影能力上与TVS技术具有相似的效果。结论:TRS作为妇科可选择的超声技术之一,对子宫和卵巢具有良好的显影分辨能力,更适用于需要提供细微图像数据但无性生活史的妇科疾病患者。