الملخص
Objective:To investigate the accuracy of colposcopic cervical biopsy in the diagnosis of cervical precancerous lesions and the factors of missed diagnosis of cervical cancer.Methods:A total of 327 cases of gynecological clinic in Liuzhou people's Hospital of Guangxi Zhuang Autonomous Region from January 2018 to May 2019 were selected. All patients underwent colposcopic biopsy and were histologically diagnosed as cervical intraepithelial neoplasia (CIN) Ⅰ, CIN Ⅱ, CIN Ⅲ, chronic cervicitis, cervical carcinoma in situ, and condyloma plana or condyloma-like change. The loop electrosurgical excision procedure (LEEP) was performed for treatment and pathological examination after operation was done. The results of pathological examination after colposcopic cervical biopsy and LEEP operation were compared. Univariate and multivariate logistic regression analysis was performed on the factors affecting missed diagnosis of cervical cancer by colposcopic cervical biopsy.Results:The diagnostic accuracy of colposcopic cervical biopsy for chronic cervicitis was 59.70% (40/67), for condyloma plana or condyloma-like lesions was 51.58% (49/95), for CINⅠ diagnosis was 85.14% (63/74), for CINⅠ, CINⅢ and carcinoma in situ was 73.63% (67/91). A total of 219 patients were consistent with the postoperative pathological results of LEEP, and the total diagnostic accuracy rate was 66.97% (219/327). The postoperative pathological results showed that there were 43 patients (13.15%) with acatalepsia and 48 patients (14.68%) with excessive diagnosis. The results of multivariate logistic regression analysis showed that the area of cervical lesions <50% of the cervix area, unsatisfactory colposcopy image quality, and the patient's age ≥50 years old were independent influencing factors for missed diagnosis of cervical cancer (all P < 0.05). Conclusions:Cervical biopsy under colposcopy has a certain inaccuracy in the diagnosis of cervical precancerous lesions, and it is prone to missed diagnosis of cervical cancer. Clinicians should improve the skills of colposcopy operation, and pay attention to the examination of elderly women and patients with unsatisfactory colposcopy images in order to further reduce the missed diagnosis rate of cervical cancer.
الملخص
Objective To investigate the wound-healing process in a rat model of skin full-thickness incisions and to detect related possible mechanism.Methods Twenty-four female rats were selected and the dorsal skin of rats was used as the experimental area.A cutaneous excision (6 mm diameter) was made on the back of each animal,close to the cervical area.The dorsal skin of every rat was allocated to three groups which were treated with physiological saline,human recombinant epidermal growth factor (rhEGF),and CDPs,respectively.After making a rat model of skin incisions,we observed the wound healing process,took photos of the wounds under a digital microscope,and use sulfuric graph paper to record the size of every wound.At the 3rd,6th,9th,12th day after modeling,6 rats were killed,and mRNA expression of K10,K14,and EGF was detected in the skin tissues using a RT-PCR technique.Results At the 6th and 12th day after modeling,there were significant differences between the experimental group and the blank control group (P＜0.05).The gene expression of EGF,K-14 in the third day and that of EGF,K-10 and K-14 in the 6th and 12th day were upregulated compared with control group,and there were significant differences between them (P ＜ 0.05).Conclusions CDPs have a beneficial effect on the acceleration of skin wound healing,possibly due to increasing keratinocyte proliferation and up-regulating the expression of K10,K14 and EGF genes.
الملخص
Objective To determine the expression of cathepsin L2 (CTSL2)and evaluate its activity in skin lesions of seborrheic keratosis (SK),to observe the ultrastructural changes of melanosomes in the skin lesions of SK,and to estimate the effect of CTSL2 on the degradation of melanosomes.Methods Twenty patients with SK were enrolled from the Department of Dermatology,Renmin Hospital of Wuhan University.The lesional tissue and the perilesional normal skin were biopsied from each patient.Among 15 of the 20 patients,hematoxylin and eosin (HE)staining and Fontana-Masson silver staining were performed to observe the distribution of melanin granules,transmission electron microscopy (TEM)was conducted to observe the ultrastructural changes of melanosomes,and immunohistochemical staining was performed to estimate the cellular proliferative activity.RT-PCR and fluorogenic substrate cleavage assay were performed in the other 5 patients to determine the mRNA expression of CTSL2 and evaluate its activity,respectively.Sucrose density gradient ultracentrifugation was performed to isolate and purify melanosomes from the retinal pigment epithelium (RPE) harvested from a discarded eyeball of a 35-year old male patient with informed consent.The purified melanosomes were incubated with epidermal lysates of SK lesions,and TEM was used to observe the changes in the membrane structure of melanosomes.Statistical analysis was carried out by paired t test,and a P value ＜ 0.05 was considered statistically significant.Results A large number of melanin granules were deposited in SK lesions,while the linear deposition of melanin granules was only seen in the basal layer of the normal skin.TEM showed that the percentage of damaged melanosomes was much higher in the normal skin (49.00％ ± 4.00％) than in the SK lesions (24.33％ ± 3.06％)(t =8.49,P ＜ 0.05).RT-PCR revealed that the mRNA expression and activity of CTSL2 were both significantly lower in the SK lesions than in the normal skin (mRNA:0.35 ± 0.09 vs.0.43 ± 0.08,t =3.17,P ＜ 0.05;activity:17.46 ± 0.45 vs.28.78 ± 0.58,t =34.29,P ＜ 0.05).Moreover,TEM also showed that the percentage of damaged melanosome was lower in the SK lesion lysate-treated group (32.33％ ± 4.93％) than in the normal skin lysate-treated group (43.00％ ± 2.65％,t =3.30,P ＜ 0.05).Conclusion Decreased expression of CTSL2 in the SK lesions can affect the degradation of melanosomes by keratinocytes.However,whether CTSL2 directly takes part in the pathogenesis of SK or not is still needed to be further confirmed.