Objective To explore the clinical value of high risk human papillomavirus(HR-HPV) test in shunting monitoring of atypical squamous cell of undetermined significance (ASCUS) and to seek the best treatment for patients with ASCUS.Methods 470 patients with ASCUS tested by TCT were given HR-HPV testing and biopsy under colposcopy.The clinical characteristics were analyzed.Results 470 cases of ASCUS contained a variety of cervical lesions:inflammation/acuminate accounted for 69.15％ (325/470),cervical intraepithelial neoplasia (CIN)accounted for 29.57％ (139/470),and invasive carcinoma accounted for 1.28％ (6/470).The positive rate of cervical pathological examination was 30.85％ (≥ CIN Ⅰ,145/470).The positive rate of HR-HPV was 50.43％(237/470).The detection rate of ≥CIN Ⅰ in HR-HPV positive group and negative group was 55.27％ (131/237)and 6.01％ (14/233),while the detection rate of ≥ CIN Ⅱ in HR-HPV positive group and negative group was 36.71％ (87/237) and 1.29％ (3/233).The differences were statistically significant(P ＜ 0.01).Incidence of ≥ CIN Ⅰ and invasive carcinoma in HR-HPV positive group was about 19.332 fold of that in HR-HPV negative group(95％ CI =10.632 ～ 35.152),while the incidence of ≥CIN Ⅱ and invasive carcinoma was about 44.467 fold of HR-HPV negative group (95％ CI =13.812 ～ 143.152).The detection sensitivity,specificity,positive predictive value,negative predictive value(NPV) of HR-HPV in the≥ CIN Ⅰ patients were 90.34％,67.38％,61.60％,93.99％.Those of ≥ CIN Ⅱ patients were 96.67％,60.53％,36.71％,98.71％.Conclusion ASCUS included partial CIN of high grades and cervical cancer,and the proportion of HPV infection is large,detection of high risk HPV-DNA is an effective shunting management method of ASCUS.

Objective:To analyze fetoscopic cord laser therapy for management of monochorionic monoamniotic (MCMA) twin pregnancies.Methods:The clinical data of fetoscopic cord laser therapy, including cord occlusion, transection, and disentanglement in three pairs of MCMA twins from January 2020 to January 2021 in Peking University Third Hospital were summarized. Literature on cord occlusion and/or transection in MCMA twins were retrieved from Cochrane Library, PubMed, EMBASE, CBM, WanFang, and CNKI from the time at establishment to December 2020. The clinical conditions, surgical indications and methods, disease progression, and maternal and infant prognosis were analyzed.Results:Three cases of MCMA twins in this study period received fetoscopic cord laser therapy between 17-24 weeks, among which two cases gave birth at full-term without any maternal or infant complications, and one was terminated due to fetal malformation. Seven English articles including 29 MCMA twin pregnancies were retrieved. In addition to the three cases reported in this article, a total of 32 cases were analyzed. The indication of cord occlusion and/or transection included twin-reversed arterial perfusion sequence (21.9%, 7/32), fetal malformation (46.9%, 15/32), selective fetal growth restriction (sFGR) (21.9%, 7/32), twin-to-twin transfusion syndrome (TTTS) (3.1%, 1/32), TTTS combined with sFGR (3.1%, 1/32), single intrauterine death (3.1%, 1/32). Gestational age at surgery was between 14 +1 to 27 +3 weeks. No maternal complication due to the operation was reported. After exclusion of two cases who did not receive cord transection and one case was terminated due to fetal malformation, all the other 29 co-twins were born alive at the gestational age between 24 +3 to 40 weeks and birth weight between 800-3 800 g. Among the 29 live born babies, four died soon after birth with unclarified reasons in the literature and one was born with multiple malformations which were detected prenatally, and the other 24 neonates were healthy during the follow-up from 1 month to 9 years old. Conclusions:For MCMA twin pregnant women with umbilical cord entanglement or other indications for fetal reduction, cord occlusion, transection, and disentanglement using fetoscopic cord laser is safe and effective for protecting the surviving fetus.