Invited review: Systematic review of diagnostic tests for reproductive-tract infection and inflammation in dairy cows

The objective of this study was to conduct a systematic and critical appraisal of the quality of previous publications and describe diagnostic methods, diagnostic criteria and definitions, repeatability, and agreement among methods for diagnosis of vaginitis, cervicitis, endometritis, salpingitis, and oophoritis in dairy cows. Publications (n = 1,600) that included the words “dairy,” “cows,” and at least one disease of interest were located with online search engines. In total, 51 papers were selected for comprehensive review by pairs of the authors. Only 61% (n = 31) of the 51 reviewed papers provided a definition or citation for the disease or diagnostic methods studied, and only 49% (n = 25) of the papers provided the data or a citation to support the test cut point used for diagnosing disease. Furthermore, a large proportion of the papers did not provide sufficient detail to allow critical assessment of the quality of design or reporting. Of 11 described diagnostic methods, only one complete methodology, i.e., vaginoscopy, was assessed for both within- and between-operator repeatability (κ = 0.55–0.60 and 0.44, respectively). In the absence of a gold standard, comparisons between different tests have been undertaken. Agreement between the various diagnostic methods is at a low level. These discrepancies may indicate that these diagnostic methods assess different aspects of reproductive health and underline the importance of tying diagnostic criteria to objective measures of reproductive performance. Those studies that used a reproductive outcome to select cut points and tests have the greatest clinical utility. This approach has demonstrated, for example, that presence of (muco)purulent discharge in the vagina and an increased proportion of leukocytes in cytological preparations following uterine lavage or cytobrush sampling are associated with poorer reproductive outcomes. The lack of validated, consistent definitions and outcome variables makes comparisons of the different tests difficult. The quality of design and reporting in future publications could be improved by using checklists as a guideline. Further high-quality research based on published standards to improve study design and reporting should improve cow-side diagnostic tests. Specifically, more data on intra- and interobserver agreement are needed to evaluate test variability. Also, more studies are necessary to determine optimal cut points and time postpartum of examination.     

我国聚焦超声治疗技术的迅速崛起与展望

治疗超声技术被推选为当今世界的前沿科学技术。高强聚焦超声（High Intensity Focused Ultrasound,HIFU）技术被认为是21世纪治疗肿瘤的新技术,已被成功地用于临床＂消融＂多种肿瘤。我国在使用聚焦超声技术治疗妇科外阴白色病、宫颈炎等也取得巨大成功,引起广泛重视。但这些新的治疗技术仍有很大的发展空间。并且指出了存在的问题和面临的挑战,以及为确保我国在这一领域的领先地位需要采取的应对措施。     

钬激光联合安达芬栓治疗慢性宫颈炎102例疗效观察

目的:通过观察钬激光联合安达芬栓(重组人干扰素а-2b栓)与单纯用钬激光治疗慢性宫颈炎的疗效,探讨治疗慢性宫颈炎的简单有效的方法。方法:收集我院妇科门诊2006年1~9月治疗的慢性宫颈炎病例102例,随机分为两组,观察组予以钬激光治疗后联合安达芬栓阴道用药,对照组单纯用钬激光治疗。结果:钬激光联合安达芬栓观察组的自觉症状、并发症的发生率和临床治愈率与对照组有显著性差异。结论:钬激光联合安达芬栓是治疗慢性宫颈炎的一种简便、有效、临床治愈率高的方法。     

聚焦超声治疗慢性宫颈炎临床观察

目的：探讨聚焦超声治疗慢性宫颈炎的有效性及安全性。方法：采用海极星超声妇科治疗仪对384例宫颈糜烂患者进行聚焦超声治疗的临床观察,根据超声治疗后的临床症状、体征的改善情况,进行统计学分析与疗效评价。结果聚焦超声治疗后,白带多,性交后出血等症状基本缓解,轻、中和重度宫颈糜烂有效率分别达到100%、95.68%和96.98%。聚焦超声治疗后,宫颈局部组织有短暂的渗出性炎症反应,阴道排液的时间约3~21天,1月后可基本恢复正常;无组织结痂脱落出血的过程,无宫颈瘢痕形成。结论：治疗剂量的聚焦超声波能安全有效地治疗慢性宫颈炎。     

重组人干扰素a_(2a)栓剂对慢性盆腔结缔组织炎的疗效

目的应用重组人干扰素 ａ２ａ栓剂对慢性盆腔结缔组织炎患者进行疗效观察。方法用 ５ ｘ１０５ＩＵ ａ２ａ干扰素栓剂,经宫颈局部用药,治疗合并慢性宫颈炎的慢性盆腔结缔组织炎８３例,并对部分病例进行了治疗前 后宫颈分泌物的ＨＰＶ－ＤＮＡ,ＨＣＷＶ－ＥＡ检测。结果慢性盆腔结缔组织炎痊愈率、显效率、总显效率、有效率、总有 效率依次为５９．７％、２５．４％、８５．１％、９.０％和９４．１％,显著优于洗必泰栓的疗效;慢性盆腔结缔组织炎疗效与慢性宫 颈炎疗效密切相关,与ＨＰＶ－ＤＮＡ、ＨＣＭＶ－ＤＮＡ阴转密切相关。结论重组人干扰素ａ２ａ栓剂经宫颈局部用药,对慢 性盆腔结缔组织炎的疗效随着宫颈局部ＨＣＷＶ、ＨＰＶ感染的有效控制而获得较满意的结果。