BACKGROUND & AIMS: :The objective of this study was to confirm whether hemoglobin (Hb) levels during chemoradiotherapy are associated with survival in patients with locally advanced cervical carcinoma and to assess impact of the Hb level on survival according to lymph node (LN) metastasis. A retrospective review of 85 cervical carcinoma patients treated with concurrent chemoradiotherapy was conducted. The stage of disease ranged between FIGO stage IB and stage IVA. Disease-free and overall survivals were evaluated by univariate and multivariate analyses. After median follow-up of 35.7 months, 24 patients developed recurrence of disease and 14 patients died from their disease. Stage, LN metastasis, and squamous cell carcinoma antigen and Hb levels during chemoradiation were correlated significantly with survival (P < 0.05). Maintenance of Hb above 10.0 g/dL was associated with better survival (P < 0.05). However, no such benefits were observed in patients with LN metastasis by magnetic resonance imaging (MRI). Multivariate Cox regression hazard model showed that Hb levels during chemoradiation were an independent prognostic factor in patients without LN metastasis by MRI. Maintenance of Hb during chemoradiation is of benefit in cervical carcinoma patients without LN metastasis but not with LN metastasis by MRI.

背景与目标： : 本研究的目的是确认放化疗期间血红蛋白 (Hb) 水平是否与局部晚期宫颈癌患者的生存相关，并根据淋巴结 (LN) 转移评估Hb水平对生存的影响。回顾性分析了85例同期放化疗治疗的宫颈癌患者。疾病的阶段介于FIGO IB期和IVA期之间。通过单变量和多变量分析评估无病生存率和总体生存率。中位随访35.7个月后，24例患者出现疾病复发，14例患者死于疾病。分期、LN转移、放化疗期间鳞状细胞癌抗原和Hb水平与生存率显著相关 (P <0.05)。Hb维持在10.0g/dL以上与较好的生存率相关 (P <0.05)。然而，通过磁共振成像 (MRI) 在LN转移患者中未观察到这种益处。多因素Cox回归风险模型显示，放化疗期间的Hb水平是MRI无LN转移患者的独立预后因素。化疗期间维持血红蛋白对无LN转移但无LN转移的宫颈癌患者有好处。

BACKGROUND & AIMS: AIM:To determine the knowledge, attitudes and practice of women living in peri-urban settlements with regard to screening for cervical cancer. METHOD:A community-based questionnaire survey of 165 women living in a defined area of Khayelitsha, a peri-urban settlement on the outskirts of Cape Town. RESULTS:Two hundred households were visited, with a response rate of 84%. Median age of respondents was 27.5 years. The majority of interviewees were married (53.3%), unemployed (61.5%), had an educational status of standard 4 or less (58.1%) and had been living in Cape Town for 4 years or more (64.3%). The median parity was 2 (range 0-11). Most interviewees were currently using contraception (52.4%). One-third (35.4%; 95% CI 28.1-42.7%) of interviewees had heard of the Pap smear. Of these women, most had obtained their information from the midwife obstetric unit (MOU), and this was the most commonly reported facility where Pap tests were known to be done. The majority of interviewees did not regard the test (or the prospect thereof) as embarrassing (88.4%), painful (89.1%) or harmful (90.9%), and indicated that they would have the test done (89.1%). The most important reason for choice of where the test should be done was proximity to place of residence (83.9%). More than one-third of interviewees reported having had a Pap test (37.2%; 95% CI 28.8-44.8%). The most common reason for not having had a test was that the interviewee had never heard of it (81.3%). Most had undergone the test at a MOU (65.6%), where it had been part of an antenatal work-up (80.3%). Fewer than half of the interviewees who had undergone a test knew the result of their test. CONCLUSION:The antenatal, obstetric and family planning services in the area have been effective, to a limited extent, in providing information and conducting screening. However, these services are missing many opportunities to fulfill this function, and knowledge and practice of cervical cytology screening in this community are poor. With the implementation of a rational policy for screening in this area there is the potential to achieve good coverage.

背景与目标：

BACKGROUND & AIMS: :In a patient with temporomandibular disorder who does not respond to conservative treatment, treatment with intra-articular injection of high molecular weight sodium hyaluronate can be suggested. In our study, 27 patients with nonreduced disc displacement were diagnosed clinically and confirmed by magnetic resonance imaging. The age range was from 21 to 63 years old, with a mean of 39.3 years. Two cycles of injection of high molecular weight sodium hyaluronate was performed on alternative weeks. Pain intensity was measured by the visual analog scale. Maximal mouth opening, clicking joint noise, and lateral movement were measured before and after injection for more than 6 months. Reduction of pain intensity and improvement in the maximum mouth opening parameter was statistically significant. In conclusion, this intra-articular injection using high molecular weight sodium hyaluronate looks very positive for patients affected by nonreduced disc displacement and is encouraged to be used as a primary treatment of temporomandibular joint dysfunction.

背景与目标： : 对于对保守治疗无反应的颞下颌疾病患者，建议使用关节内注射高分子量透明质酸钠进行治疗。在我们的研究中，临床诊断出27例椎间盘移位未减少的患者，并通过磁共振成像证实。年龄范围为21至63岁，平均39.3岁。在其他星期进行了两个周期的高分子量透明质酸钠注射。疼痛强度通过视觉模拟量表测量。注射前后6个月以上，测量最大张口，点击关节噪声和侧向运动。疼痛强度的降低和最大张口参数的改善具有统计学意义。总之，这种使用高分子量透明质酸钠的关节内注射对于受椎间盘移位不全影响的患者看起来非常积极，并被鼓励用作颞下颌关节功能障碍的主要治疗方法。

BACKGROUND & AIMS: :In the present pilot study, the feasibility of a site-of-care cervicovaginal self-sampling methodology for HPV-based screening was tested in 346 women residing in underserved rural areas of Northern Greece. These women provided self-collected cervicovaginal sample along with a study questionnaire. Following molecular testing, using the cobas® HPV Test, Roche®, HPV positive women, were referred to colposcopy and upon abnormal findings, to biopsy and treatment. Participation rate was 100%. Regular pap-test examination was reported for 17.1%. Among hrHPV testing, 11.9% were positive and colposcopy/biopsy revealed 2 CIN3 cases. Non-compliance was the most prevalent reason for no previous attendance. Most women reported non-difficulty and non-discomfort in self-sampling (77.6% and 82.4%, respectively). They would choose self-sampling over clinician-sampling (86.2%), and should self-sampling being available, they would test themselves more regularly (92.3%). In conclusion, self-sampling is feasible and well-accepted for HPV-based screening, and could increase population coverage in underserved areas, helping towards successful prevention.

背景与目标： : 在本试点研究中，对居住在希腊北部服务不足的农村地区的346名妇女进行了基于HPV筛查的护理现场宫颈阴道自采样方法的可行性进行了测试。这些妇女提供了自我收集的宫颈阴道样本以及研究问卷。在分子测试之后，使用cobas®罗氏HPV检测®HPV阳性女性被转诊至阴道镜检查和异常发现后，进行活检和治疗。参与率为100%。报告定期进行17.1% 巴氏试验检查。在hrHPV检测中，11.9% 例为阳性，阴道镜/活检显示2例CIN3。不遵守是以前没有出席的最普遍原因。大多数妇女报告说，自我取样没有困难，也没有不适 (分别为77.6% 和82.4%)。他们将选择自采样而不是临床医生采样 (86.2%)，并且如果自采样可用，他们将更定期地测试自己 (92.3%)。总之，自我采样对于基于HPV的筛查是可行的且被广泛接受，并且可以增加服务不足地区的人口覆盖率，从而有助于成功预防。

BACKGROUND & AIMS: :The eye-antennal disc of Drosophila gives rise to numerous adult tissues, including the compound eyes, ocelli, antennae, maxillary palps and surrounding head capsule. The fate of each tissue is governed by the activity of unique gene regulatory networks (GRNs). The fate of the eye, for example, is controlled by a set of fourteen interlocking genes called the retinal determination (RD) network. Mutations within network members lead to replacement of the eyes with head capsule. Several studies have suggested that in these instances all retinal progenitor and precursor cells are eliminated via apoptosis and as a result the surrounding head capsule proliferates to compensate for retinal tissue loss. This model implies that the sole responsibility of the RD network is to promote the fate of the eye. We have re-analyzed eyes absent mutant discs and propose an alternative model. Our data suggests that in addition to promoting an eye fate the RD network simultaneously functions to actively repress GRNs that are responsible for directing antennal and head capsule fates. Compromising the RD network leads to the inappropriate expression of several head capsule selector genes such as cut, Lim1 and wingless. Instead of undergoing apoptosis, a population of mutant retinal progenitors and precursor cells adopt a head capsule fate. This transformation is accompanied by an adjustment of cell proliferation rates such that just enough head capsule is generated to produce an intact adult head. We propose that GRNs simultaneously promote primary fates, inhibit alternative fates and establish cell proliferation states.

背景与目标： : 果蝇的眼触角盘会产生许多成年组织，包括复眼，ocelli，触角，上颌触角和周围的头囊。每个组织的命运受独特基因调控网络 (grn) 的活性控制。例如，眼睛的命运由一组称为视网膜测定 (RD) 网络的十四个连锁基因控制。网络成员内的突变导致用头囊代替眼睛。几项研究表明，在这些情况下，所有视网膜祖细胞和前体细胞都通过凋亡被消除，结果周围的头囊增殖以补偿视网膜组织的损失。该模型意味着RD网络的唯一责任是促进眼睛的命运。我们重新分析了没有变异盘的眼睛，并提出了另一种模型。我们的数据表明，除了促进眼睛的命运外，RD网络还同时发挥作用，积极抑制负责指导触角和头囊命运的grn。损害RD网络会导致一些头部胶囊选择基因 (例如cut，Lim1和wingless) 的不适当表达。突变的视网膜祖细胞和前体细胞群没有发生凋亡，而是采用了头囊命运。这种转化伴随着细胞增殖速率的调整，从而仅产生足够的头部囊来产生完整的成年头部。我们建议grn同时促进初级命运，抑制替代命运并建立细胞增殖状态。

BACKGROUND & AIMS: :B7-H3 is an immune regulatory molecule whose aberrant expression in tumors is associated with adverse outcomes. Upregulation of B7-H3 may promote tumor cell proliferation and metastasis in vitro, but the role of B7-H3 in cervical cancer has not yet been investigated. We measured B7-H3 expression in 90 cervical cancer patient and 20 non‑cervical lesion patient tissues using immunohistochemistry and in 30 cervical cancer patient and 30 healthy donor blood samples using ELISA. The association of B7-H3 expression and the prognosis of cervical cancer patients was investigated. B7-H3 knockdown in CaSki and SiHa cell lines was performed using small hairpin (sh)RNA lentiviral transfection and B7-H3 overexpression in CaSki and HeLa cell lines was performed using plasmid-vector lentivirus transduction. Cell proliferation, invasion and migration were then measured using MTT and Transwell assays in vitro. B7-H3 expression was significantly higher in the cervical cancer tissues compared to that noted in the normal cervical tissues (mean 72.22 vs. 15.00%; p<0.001). Using Kaplan‑Meier and Cox analyses, our data revealed that patients with strong intensity staining were significantly more likely to have a worse prognosis. The B7-H3 level in cervical cancer patient blood was significantly higher than that in the normal donors (13.41±6.12 vs. 9.90±3.16 ng/ml; p=0.007). MTT assay revealed that high expression of B7-H3 promoted cervical cancer cell proliferation. Transwell assay data revealed that high expression of B7-H3 enhanced cervical cancer cell migration and invasion (CaSki, p=0.003; HeLa, p=0.03). In conclusion, expression of B7-H3 was significantly higher in cervical cancer tissues compared to normal cervical tissues, and this high expression was associated with worse prognosis for cervical cancer patients. In addition, B7-H3 promoted proliferation, invasion and migration of cervical cancer and may be a potential target for treating cervical cancer.

背景与目标： : B7-H3是一种免疫调节分子，其在肿瘤中的异常表达与不良后果有关。B7-H3的上调可能在体外促进肿瘤细胞的增殖和转移，但B7-H3在宫颈癌中的作用尚未得到研究。我们使用免疫组织化学方法测量了90例宫颈癌患者和20例非宫颈病变患者组织中的B7-H3表达，并使用ELISA测量了30例宫颈癌患者和30例健康供体血样中的表达。研究了B7-H3表达与宫颈癌患者预后的关系。使用小发夹 (sh)RNA慢病毒转染在CaSki和SiHa细胞系中进行B7-H3敲除，并使用质粒载体慢病毒转导在CaSki和HeLa细胞系中进行B7-H3过表达。细胞增殖，然后在体外使用MTT和Transwell测定法测量侵袭和迁移。与正常宫颈组织相比，宫颈癌组织中的B7-H3表达明显更高 (平均72.22对15.00%; p<0.001)。使用kaplan-meier和Cox分析，我们的数据显示，强染色的患者预后更差。宫颈癌患者血液中的B7-H3水平明显高于正常供体 (13.41 ± 6.12 vs. 9.90 ± 3.16 ng/ml); p = 0.007)。MTT分析显示B7-H3的高表达促进了宫颈癌细胞的增殖。tranwell分析数据显示B7-H3的高表达增强了宫颈癌细胞的迁移和侵袭 (CaSki，p = 0.003; HeLa，p = 0.03)。总之，b7-H3在宫颈癌组织中的表达明显高于正常宫颈组织，这种高表达与宫颈癌患者预后差有关，此外，B7-H3促进了宫颈癌的增殖、侵袭和迁移，可能是治疗宫颈癌的潜在靶点。

BACKGROUND & AIMS: BACKGROUND:Recent evidence indicated that the aberrant expression of microRNA plays a crucial role in the development of cervical cancer. The overall shorter survival was strongly related to the abnormal expression of microRNA-34a (miR-34a) and microRNA-206 (miR-206), which target B cell lymphoma-2(Bcl2) and c-Met. Hepatocyte growth factor (HGF)/c-Met pathway is related to the occurrence, development and prognosis of cervical cancer, and c-Met is significantly overexpressed in cervical squamous cell carcinoma. Bcl2 is also considered to be a promising target for developing novel anticancer treatments. METHODS:In this study, we detect the expression of miR-34a and miR-206 in the cervical cancer tissue through quantificational real-time polymerase chain reaction (qRT-PCR) assay, and the expression of Bcl2 and c-Met from cervical cancer tissue were detected by immunohistochemistry. RESULTS:The expression of miR-34a and miR-206 were down-regulated in the cervical cancer tissue through qRT-PCR assay. As target genes of miR-34a and miR-206, Bcl2 and c-Met were up-regulated in cervical cancer tissues through qRT-PCR assay and immunohistochemistry. Kaplan-Meier and log-rank analysis revealed that down-regulated expression of miR-34a and miR-206 were strongly related to shorter overall survival. Multivariate Cox proportional hazards model for all variables that were statistically significant in the univariate analysis demonstrated that miR-34a (P = 0.038) and miR-206 (P = 0.008) might be independent prognostic factors for overall survival of patients suffering from cervical cancer. CONCLUSIONS:The up-regulation of Bcl2 and c-Met promotes the cervical cancer's progress, and the expression of miR-34a and miR-206 significantly correlated with the progression and prognosis in cervical cancer. All of these suggested that miR-34a and miR-206 might be the novel prognostic and therapy tools in cervical cancer.

背景与目标：

BACKGROUND & AIMS: :Cervical screening attendance among women aged 25-29 years in England is lower than at older ages. There is some evidence that pre-notification leaflets motivate women who have not yet considered their response to a health intervention. We aimed to identify key information to motivate young women at their first cervical screening invitation. Six focus groups were conducted, five with young women aged 17-25 registered with a General Practice in Manchester, UK, and one with Practice nurses. Some women took part in two further groups to discuss leaflet design. There was low awareness of the purpose or procedures of cervical screening, and most women were de-motivated by reports of bad experiences. Some intended to be screened, but not immediately after invitation. Screening was viewed as a test for a cancer that affected older women. Since none of the participants believed that they had cervical cancer, screening seemed unnecessary. We conclude that the perception that screening is unimportant when you are young needs to be challenged. Women also need to be better informed of screening procedures. A pre-notification leaflet incorporating key information was designed and will be tested in a randomized trial of complex interventions within the routine cervical screening programme.

背景与目标： : 英格兰25-29岁女性的子宫颈筛查出勤率低于老年人。有证据表明，预先通知的传单会激励尚未考虑对健康干预措施做出反应的妇女。我们的目标是确定关键信息，以激励年轻女性首次接受子宫颈筛查邀请。进行了六个重点小组，其中五个是在英国曼彻斯特注册的17-25岁的年轻女性，其中一个是执业护士。一些妇女参加了另外两个小组，讨论传单设计。人们对宫颈筛查的目的或程序的认识不足，大多数妇女因不良经历的报道而缺乏动力。有些人打算放映，但不是在邀请后立即放映。筛查被视为对影响老年妇女的癌症的测试。由于没有参与者相信自己患有宫颈癌，因此筛查似乎没有必要。我们得出的结论是，年轻时筛查不重要的看法需要受到挑战。妇女还需要更好地了解筛查程序。设计了包含关键信息的预通知传单，并将在常规子宫颈筛查计划中进行复杂干预的随机试验中进行测试。

BACKGROUND & AIMS: OBJECTIVE:Anticipated pain with intrauterine device (IUD) insertion may be a barrier to widespread use. Our objective was to evaluate the efficacy of intracervical 2% lidocaine gel for pain relief with IUD insertion. STUDY DESIGN:We performed a double-blind, randomized controlled trial of women undergoing IUD insertion. Participants were randomly assigned to 2% lidocaine or placebo gel. Study gel (3 mL) was placed 3 minutes prior to IUD insertion. Pain scores were measured at various time points using a 10-point visual analog scale. RESULTS:Of the 200 participants randomized, 199 completed the study. Pain scores among lidocaine and placebo arms were similar at tenaculum placement (lidocaine and placebo: median, 4; range, 0-10; P = .15) and with insertion (lidocaine: median, 5; range, 1-10; placebo: median, 6; range, 0-10; P = .16). These results did not differ by parity. CONCLUSION:Topical or intracervical 2% lidocaine gel prior to IUD insertion does not decrease pain scores.

背景与目标：

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :The objectives of this study were to examine aspects of organization of a proposed national screening programme based in general practice. The target population of women aged 25-59 years and their general practitioners (GPs), in a defined inner city area, was identified from a population register of persons eligible for free medical services; a computerized system was developed for invitations and record linkage of cytology results. Smears were examined in one laboratory and follow up of women with abnormal smears was undertaken by one gynaecologist. A random sample of non-responders was surveyed by questionnaire. Response following two invitations was only 20%. Practices with male doctors only had significantly lower response rates (P < 0.001) than those with a female doctor/nurse. A survey of non-responders showed that over 20% of addresses were incorrect and 16% of those interviewed were ineligible for smear tests. A preference for a female to undertake smears was expressed by 67%, and 77% believed that the purpose of the cervical smear was to detect cancer. An accurate population register, health promotion, support for GP practices, provision of alternative venues for smear tests, development of computer systems, accurate data entry and fail-safe follow up are aspects of a cervical screening service which must be addressed prior to setting up a national service.

背景与目标： : 这项研究的目的是根据一般实践研究拟议的国家筛查计划的组织方面。从有资格获得免费医疗服务的人的人口登记册中确定了在确定的内城地区25-59岁妇女及其全科医生的目标人群; 开发了一个计算机化系统，用于邀请和细胞学结果的记录联系。在一个实验室中检查了涂片，并由一名妇科医生对涂片异常的妇女进行了随访。通过问卷调查对无反应者进行了随机抽样调查。仅20% 了两次邀请后的答复。男性医生的实践仅比女性医生/护士的实践具有显着较低的反应率 (P <0.001)。对无应答者的调查显示，超过20% 的地址不正确，并且16% 的受访者不符合涂片检查的资格。67% 表示偏爱女性进行涂片检查，77% 认为宫颈涂片检查的目的是检测癌症。准确的人口登记、健康促进、对全科医生做法的支持、提供涂片检查的替代场所、计算机系统的开发、准确的数据输入和故障安全随访是子宫颈筛查服务的各个方面，在建立国家服务之前必须解决这些问题。

BACKGROUND & AIMS: BACKGROUND:Recognizing resistance or susceptibility to the current standard cisplatin and paclitaxel treatment could improve therapeutic outcomes of metastatic or recurrent cervical cancer. METHODS:Forty-five tissue samples from patients participating in a phase II trial of cisplatin and ifosfamide, with or without paclitaxel were collected for retrograde analysis. Immunohistochemistry and genotyping was performed to test ERCC1, III β-tubulin, COX-2, CD4, CD8 and ERCC1 (C8092A and N118 N) and MDR1 (C3435T and G2677 T) gene polymorphisms, as possible predictive and prognostic markers. Results were statistically analyzed and correlated with patient characteristics and outcomes. RESULTS:Patients with higher levels of ERCC1 expression had shorter PFS and OS than patients with low ERCC1 expression (mPFS:5.1 vs 10.2 months, p = 0.027; mOS:10.5 vs. 21.4 months, p = 0.006). Patients with TT in the site of ERCC1 N118 N and GT in the site of MDR1 G2677 T polymorphisms had significantly longer PFS (p = 0.006 and p = 0.027 respectively). ERCC1 expression and the ERCC1 N118 N polymorphism remained independent predictors of PFS. Interestingly, high III beta tubulin expression was associated with chemotherapy resistance and fewer responses [5/20 (25%)] compared to lower III β-tubulin expression [15/23 (65.2%)] (p = 0.008). Finally, ΙΙΙ β-tubulin levels and chemotherapy regimen were independent predictors of response to treatment. CONCLUSIONS:ERCC1 expression proved to be a significant prognostic factor for survival in our metastatic or recurrent cervical cancer population treated with cisplatin based chemotherapy. ERCC1 N118 N and MDR1 G2677 T polymorphism also proved of prognostic significance for disease progression, while overexpression of III β-tubulin was positively correlated with chemotherapy resistance.

背景与目标：

BACKGROUND & AIMS: OBJECT:A variety of factors may affect the neurological improvement in patients with cervical compression myelopathy (CCM) after surgery. The aim of this study was to report and discuss the prognostic factors in a group of patients with insufficient decompression of the spinal canal. METHODS:A prospective follow up and analysis of 20 consecutive patients with CCM treated between 2000 and 2002 was performed. All patients were surgically treated via an anterior approach, either by anterior cervical discectomy and fusion with instrumentation or by cervical corpectomy and fusion with instrumentation. The surgical results were examined using the modified Japanese Orthopaedic Asssociation disability scale, with reference to the findings of magnetic resonance imaging, computed tomography, and radiography. Seventeen patients (85%) experienced a 50% or more recovery rate as calculated using the Hirabayashi formula during the follow-up period (mean 32.5 months), despite a persistently narrow spinal canal and permanent or increased intramedullary high-intensity signal after surgery. CONCLUSIONS:Results of the study showed that patients with CCM benefited from anterior cervical discectomy and fusion with instrumentation or cervical corpectomy and fusion with instrumentation procedures despite insufficient decompression of the spinal canal. Fusion of the affected level(s) might be the reason for the acquired high recovery rates. The authors also conclude that the neurological improvement is not correlated with the reversal of or decrease in the intramedullary high-intensity signal change after surgery.

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:The role of botulinum toxin as a therapeutic agent for several conditions is expanding. We sought to determine if botulinum toxin is safe and effective in treating patients with cervical dystonia and maxillofacial conditions. Our purpose was to establish a safety and efficacy profile to determine whether or not this treatment may be used prophylactically in patients undergoing dental implant therapy. METHODS:We performed a systematic search of the literature to identify randomized clinical trials evaluating patients treated with botulinum toxin as an adjunct to dental implant therapy, maxillofacial conditions including temporomandibular disorders (TMD), and cervical dystonia. RESULTS:Four randomized controlled trials (RCTs) met our search criteria in the area of cervical dystonia and chronic facial pain. No RCTs were identified evaluating dental implant therapy. Patients with cervical dystonia exhibited significant improvements in baseline functional, pain, and global assessments compared to placebo. Adverse events were mild and transient with numbers needed to harm (NNH) ranging from 12 to 17. Patients with chronic facial pain improved significantly from baseline in terms of pain compared to placebo. Rates of adverse events were less than 1%. CONCLUSION:Botulinum toxin appears relatively safe and effective in treating cervical dystonia and chronic facial pain associated with masticatory hyperactivity. No literature exists evaluating its use in dental implantology. Randomized clinical trials are warranted to determine its safety and efficacy in dental implantology and other maxillofacial conditions such as bruxism.

背景与目标：

BACKGROUND & AIMS: :The complex problem of combined neck and shoulder pain was investigated in 26 operations in 13 patients who had a shoulder procedure (subacromial decompressions or rotator cuff repairs) and an anterior cervical spine fusion. This select group of complex patients illustrates the diagnostic studies required to determine whether the pain comes primarily from the cervical spine, shoulder, or both. Good pain relief was accomplished after 24 of the 26 surgical procedures (average follow-up, 4.3 years). In the 13 patients, eight presented with nearly equal neck and shoulder pain as the chief complaint, whereas in the remaining five patients, the initial complaint was predominantly neck pain with only minor shoulder involvement. The shoulder pain became more significant after the anterior cervical fusion in these five patients. This study emphasizes the need for a careful evaluation of patients with combined neck-shoulder pain syndrome in a systematic approach allowing appropriate treatment.

背景与目标： : 在13例接受肩部手术 (肩峰下减压或肩袖修复) 和颈椎前路融合术的患者中，对26例颈肩疼痛的复杂问题进行了研究。这一组复杂的患者说明了诊断研究，以确定疼痛是否主要来自颈椎，肩膀或两者。在26次外科手术中的24次 (平均随访4.3年) 后，疼痛缓解良好。在13例患者中，有8例的颈部和肩部疼痛几乎是主要主诉，而在其余5例患者中，最初的主诉主要是颈部疼痛，仅轻微的肩部受累。在这五名患者中，颈椎前路融合后，肩部疼痛变得更加明显。这项研究强调需要以系统的方法对合并颈肩疼痛综合征的患者进行仔细评估，以进行适当的治疗。