Characteristics of vaginal microbiota in various cervical intraepithelial neoplasia: a cross-sectional study.

BACKGROUND: Precancerous lesions of cervical cancer exhibit characteristics indicative of natural progression. To prevent overtreatment of patients whose cervical intraepithelial neoplasia (CIN) in regression and to predict the onset of invasive cervical cancer at an early stage, we've identified the vaginal microbiome as a potential key factor, which is associated with both HPV infection and the various cervical intraepithelial neoplasia. This study aims to investigate the microbiome characteristics of patients with various cervical intraepithelial neoplasia. METHODS: Utilizing high-throughput 16S ribosomal RNA (16S rRNA) sequencing technology, a description of the characteristics and community composition of Vaginal Microbiota (VMB) was conducted among 692 Chinese women infected with the High-risk Human Papillomavirus (HR-HPV). RESULTS: As the grade of the lesions increased, the proportions of Lactobacillus and Pseudomonas demonstrated a significant declining trend, while the proportions of Gardnerella, Dialister, and Prevotella significantly increased. The diversity of the VMB was more significant in high-grade CIN. Furthermore, KEGG pathway enrichment analysis indicates that high-grade cervical intraepithelial neoplasia can inhibit various pathways, including those of phosphotransferase system, transcription factors, Fructose and mannose metabolism, amino sugar and nucleotide sugar metabolism, and galactose metabolism, which may contribute to the development of early cervical cancer symptoms. CONCLUSION: Patients with CIN exhibit a distinct vaginal microbial profile characterized by a decrease in Lactobacillus and Pseudomonas, and an increase in Gardnerella, Prevotella, and Dialister. The proliferation and diminution of these two types of microbial communities are interrelated, suggesting a mutual restraint and balance among them. Disruption of this regulatory balance could potentially lead to the onset of cervical lesions and carcinogenesis. Retrospectively registered: This study was approved by the Ethics Committee of the Beijing Chaoyang Hospital affiliated with the Capital Medical University (NO.2023-S-415).

Oncological and reproductive outcomes of adenocarcinoma in situ of the cervix managed with the loop electrosurgical excision procedure.

BACKGROUND: The standard treatment for cervical adenocarcinoma in situ (AIS) is hysterectomy, which is a more aggressive treatment than that used for squamous intraepithelial lesions. Several previous studies have primarily demonstrated that the loop electrosurgical excision procedure (LEEP) is as safe and effective as cold knife cone (CKC) biopsy when AIS is unexpectedly found in a loop excision. This study evaluated the safety of LEEP as the initial treatment for patients with AIS who were strictly selected and evaluated before and after loop resection. METHODS: The oncological and reproductive outcomes of a series of AIS patients who underwent LEEP as the initial treatment between February 2006 and December 2016 were retrospectively evaluated. RESULTS: A total of 44 women were eligible for analysis. The mean age at diagnosis was 36.1 years, and 14 patients were nulliparous. Multiple lesions were identified in 4 (9.1%) patients. Either hysterectomy (6 patients) or repeat cone biopsies (3 patients) were performed in 8 of the 10 patients who presented positive or not evaluable surgical resection margins (SMs) on the initial LEEP specimens. Residual disease was detected in two patients. All patients were closely followed for a mean of 36.9 months via human papillomavirus testing, PAP smears, colposcopy, and endocervical curettage when necessary. No recurrences were detected. Of the 16 patients who desired to become pregnant, 8 (50%) successfully conceived, and the full-term live birth rate was 83.3% among this subgroup. CONCLUSIONS: LEEP with negative SMs was a safe and feasible fertility-sparing surgical procedure for patients with AIS, and the obstetric outcome was satisfactory. However, long-term follow-up is mandatory.

[Significance for the detection of human papillomavirus DNA in cervical atypical glandular cells].

OBJECTIVE: To evaluate the potential link between high-risk human papilloma virus (HPV)DNA testing and histological diagnosis in women referred for atypical glandular cells (AGC) at Pap smear. METHODS: All cervical cytological examinations with the diagnosis of AGC between January 2007 and Dec 2009 were identified by means of a computerized database in 97 patients. The histopathological results of cervix were analyzed by colposcopic biopsy, dilatation and curettage (D&C), cervical loop electrosurgical excision procedure (LEEP) and high-risk human papilloma virus DNA testing. RESULTS: (1) All patient were monitored by colposcopy, histopathology and HPV DNA test. Sixty-four patients had pathologic lesions. (2) In predicting the presence of high-grade of cervical intraepithelial neoplasia, the sensitivity of human papilloma virus was 96%, specificity 92.86%, positive predictive value 96% and negative predictive value 92.86%. (3) 98.9% of the AGC patients received colposcopic, cytological examinations and HPV test at follow-ups: 3 cases of PAP smear and 6 cases of HPV testing were abnormal at the first follow-up, and 100% negative for cytological examination and HPV test at the second follow-up visit. CONCLUSION: HPV DNA test and colposcopic examination are effective in the initial evaluation and subsequent follow-ups of cytological atypical glandular cells.

[Multicenter randomized, double-blind, placebo-controlled trial of prostaglandin E1 cream for female sexual arousal disorder].

OBJECTIVE: To investigate the efficacy and safety of alprostadil cream in management of female sexual arouse disorder (FSAD), and its appropriate dose for clinical prescription. METHODS: The volunteers were assigned randomly to four groups which received alprostadil cream in different dosage (500 µg, 700 µg and 900 µg) or placebo cream, respectively. The cream was applied to the clitoris and G-spot before coitus. The efficacy was assessed by comparing the satisfactory rate of sexual arousal, the score of female sexual function index (FSFI) and female sex disorder scale (FSDS) and the general appraised question (GAQ) before and after the treatment. The safety was evaluated by the adverse effects that appeared including symptoms, physical and biochemical examination. RESULTS: Totally, 400 women enrolled in this study with 374 assigned to the group for efficacy evaluation and 387 cases to the group for safety analysis. No significant difference was found among the four groups in the demographic characters and sexual baseline. The increase of satisfactory percentage of sexual arousal in the four groups (placebo, 500 µg, 700 µg and 900 µg) was 22.63%, 36.67%, 34.01%, and 44.29%, respectively (P<0.05), and the increase was statistically higher in the 900 µg group than in the placebo group (P<0.0167). The elevated FSFI score above the baseline in the treatment groups (900 µg 22.89, 700 µg 21.69, and 500 µg 20.71) were higher than that in the placebo group (14.68, P<0.05), while the reduced FSDS score below the baseline (900 µg 25.97, 700 µg 21.98, and 500 µg 20.27) were higher than that of the placebo (17.60, P<0.05). No significant difference was found in the four groups in GAQ (P=0.054). The main common adverse effect was topical stimulation. No adverse effect was reported in physical and biochemical examination, electrocardiogram (ECG) or Thinprep cytologic test (TCT). CONCLUSION: Alprostadil cream can treat female sexual arousal disorder effectively with the maximum effect at the dose of 900 µg and without significant adverse effect except for mild topical stimulation.

[Clinical significance on atypical cervical glandular cytology].

OBJECTIVE: To determine the pathological features and clinical implications of atypical glandular cells of undetermined significance (AGC) in cervical cytological results. METHODS: All 87 cases of cervical cytological examinations with AGC were identified by a computerized database in our patient population. The authors analyzed the cervical histopathological results by colposcopic biopsy, dilatation and curettage (D&C), cervical loop electrosurgical excision procedure (LEEP)and follow-ups. RESULTS: (1) Thirty-five cases (40.23%) had cervical and endometrial neoplasic findings: ten glandular lesions (11.49%) and squamous lesion was present in 25 patients (28.74%). (2) Among 61 patients with Pap smears subclassified as "AGC-not otherwise specified", there were 18 pathological abnormalities. Sixteen patients with AGC as "favor intraepithelial neoplasia" were of 9 pathological abnormalities. Ten patients with AGC as "adenocarcinoma in situ" or "adenocarcinoma" were of 6 pathological abnormalities. (3) 100% of patients with AGC had both of colposcopic and cytologic follow-ups: 1 case CIN1, 1 case CIN2 and 1 case CIN3. (4) One of 10 patients was younger than 35 years old with CGIN1 and the other 9 patient aged over 35 years old had a greater diversity of glandular lesions. CONCLUSION: A finding of AGC requires both colposcopy and an aggressive workup because of a high rate of cancer and precancerous lesions. The onset of disease is age-related. Women aged over 35 years old has a greater diversity of glandular lesions and account for most cases of cervical and endometrial adenocarcinoma.

[Clinical significance of atypical squamous cells and low grade squamous intraepithelial lesions in cervical smear].

OBJECTIVE: To investigate the clinical significance of atypical squamous cells (ASCUS) and low-grade squamous intraepithelial lesions (LSIL). METHODS: A total of 800 patients cytologically diagnosed with ASCUS and LSIL were referred for colposcopy. The histopathology diagnosis undergoing colposcopic biopsy, endocervical curettage (ECC), cervical loop electrosurgical excision procedure (LEEP) were analyzed. Using pathology as gold criterion, the sensitivity, specificity and positive predictive value of colposcopy to detect cervical lesions and cervical cancer were measured. The follow-up results were recorded. RESULTS: (1) Among the 405 patients with ASCUS, the percentage with chronic cervicitis was 57.04%, LSIL was 34.81%, HSIL was 3.95%, otherwise 2 cases (0.49%) of microinvasive cervical cancer and 15 cases (3.70%) of vulvar intraepithelial neoplasia (VIN) were found respectively. Among the 395 patients with LSIL, the percentage with chronic cervicitis was 34.18%, LSIL was 50.89%, HSIL was 10.38%, 2 cases (0.51%) of microinvasive cervical cancer, 1 case (0.25%) of vulva squamous cancer and 15 cases (3.80%) of VIN was identified respectively. (2) The impression undergoing colposcopy was consistent with the histologically diagnosis in 637 of 800 cases (79.63%). The sensitivity, specificity and positive predictive value was 96.17%, 58.41% and 73.34% respectively. (3) All patients with HSIL or above regressed to normal after 1 year of follow-up. 501 of 738 patients with chronic cervicitis, LSIL and VIN were followed up more than 1 year. CONCLUSION: ASCUS and LSIL does not represent a single biologic entity; it subsumes changes that are unrelated to neoplasia as well as findings that suggest the possible presence of underlying Cervical intraepithelial neoplasia (CIN) and rarely carcinoma. Thorough evaluation using colposcopy will detect early not only the histological cervical HSIL and cervical cancer, but also VIN and vulvar squamous cancer. Colposcopy is a viable option in management patients with ASCUS/LSIL.