scholarly journals The role of the macrophage polarization type in the pathogenesis of endometrioid disease

2021 ◽  
Vol 23 (5) ◽  
pp. 644-650
Author(s):  
Y. А. Orlova ◽  
A. М. Gromova ◽  
O. Ye. Akimov ◽  
O. М. Ketova
Keyword(s):  
Peritoneal Fluid ◽  
Macrophage Polarization ◽  
Main Group ◽  
Reproductive Age ◽  
Control Group ◽  
Marker Enzymes ◽  
Inos Activity ◽  
The Mean ◽  
Degree Of Severity ◽  
M2 Phenotype

Endometriosis today occupies one of the leading places in the structure of general gynecological pathology. Theories of the onset and progression of this disease are controversial. One of the most widespread theories is the assumption that endometriosis is a disease of macrophages. The question of which the macrophage phenotype, M1 or M2, is the leading one, however, remains controversial. The aim. To determine the type of macrophage polarization (M1/M2) and the quantitative activity of their marker enzymes (iNos/Arg1) in the endometrium and peritoneal fluid in endometrioid disease. Materials and methods. The total number of reproductive age (30.95±6.49) women enrolled in the study was 80. The main group consisted of 50 women with endometrioid disease. The control group included 30 women without signs of endometrioid disease. Women from the main group (n=24) and the control group (n=27) underwent endometrial sampling using an intrauterine Pipelle catheter in the first phase of the menstrual cycle before a surgery. During laparoscopic or laparotomy approaches, peritoneal fluid was taken (in the main group n=24, in the control group n=28). The type of macrophage polarization (M1 or M2) was determined based on the ratio of marker enzymes (Arg1, iNos) activity in each patient using a spectrophotometric method in the endometrium and peritoneal fluid. The polarization to the M1 phenotype was determined at iNos>Arg1, and at Arg1>iNos– the polarization to the M2 phenotype. Results. As a result of the study, it was revealed that in women with endometrioid disease, pelvic adhesions were much more common, 84.0% versus 46.7% in women without it, and especially 3 and 4 degree of severity (P<0.05). When assessing the type of macrophages in the peritoneal fluid, a significantly greater number of the main group women had the M2 phenotype of macrophage polarization compared to the control group (58.3% versus 28.6%, P=0.03). It was the macrophage polarization to the M2 phenotype that influenced the severity of endometrioid disease, especially the 4 degree of severity. The mean values of the iNOS activity in the main group women, both in the peritoneal fluid and in the endometrium, significantly differed from those in the control group patients (by 1.73 and 1.77 times, respectively). Conclusions. Thus, we can conclude that endometriosis is a disease, the development and progression of which is induced by the M2 phenotype of macrophages. Considering the increase in the mean levels of iNOS activity both in the peritoneal fluid and in the endometrium, it can be concluded that iNOS influences the pathogenesis of endometrioid disease.

The effect of probiotics on the level of immunoglobulin A in women with violation of the biocenosis of the vagina

2017 ◽  
pp. 85-88
Author(s):  
O.I. Ostapenko ◽  
◽  
V.P. Kvashenko ◽  
I.K. Akimova ◽  
I.N. Nosova ◽  
...  
Keyword(s):  
Immunoglobulin A ◽  
Lactobacillus Rhamnosus ◽  
Test System ◽  
Main Group ◽  
Reproductive Age ◽  
Local Action ◽  
Serum Immunoglobulin ◽  
Control Group ◽  
Local Immunity ◽  
Serum Iga

The objective: the study of immunomodulatory effects of a probiotic, which contains lyophilized Lactobacillus (Lactobacillus rhamnosus) – 13 mg (2,0ґ109 CFU) and lyophilized bifidobacteria (Bifidobacterium lactis) – 4 mg (2,0ґ109 CFU) the level of serum immunoglobulin IgA as a marker of local immunity in the plasma of women of reproductive age with the violation of the biocenosis of the vagina. Patients and methods. The study involved 86 patients of reproductive age with the violation of the vaginal biocenosis, which were divided into two groups according to received treatment. A survey was conducted for all patients in both groups: determine the level of serum IgA, measuring pH of vaginal environment and the quantification of lactobacilli and pathogenic flora with the help of test-system «Florotsenoz» before treatment and in 6 weeks after treatment. The state of vaginal microbiocenosis in both groups before treatment was homogeneous. Patients in both groups as therapy at the first stage of treatment received, if necessary antimicrobial therapy depending on the selected flora. In the second stage (restoration of microflora) patient of the main group received systemic probiotic combined with a complex prebiotic local action, patients in the control group, the probiotic localy in the form of the vaginal candles or tablets. Results. The research stated the increasing level of serum IgA in blood plasma of patients of the main group compared to control group at 20%, normalizing the pH of the vaginal environment in the main group in 94% of cases, which indicates an increase of immunity in mucosal. Conclusion. The inclusion of the systemic probiotic in the scheme of treatment of disorders of biocenosis of the vagina system enhances the increasing of immunity of the mucous membranes, and the vaginal tablets prebiotic of local action restores the own normal microflora of the vagina. Key words: serum immunoglobulin A, local immunity, vaginal dysbiosis, probiotics, prebiotics, vaginal microbiocenosis, the pH of the vaginal environment.

scholarly journals Erythropoietin level in normal and abnormal human seminal fluid

2021 ◽  
Vol 21 (4) ◽  
pp. 54-59
Author(s):  
D. Yu. Sosnin ◽  
K. R. Galkovich ◽  
A. V. Krivtsov1
Keyword(s):  
Seminal Plasma ◽  
Seminal Fluid ◽  
Solid Phase ◽  
Human Sperm ◽  
Test System ◽  
Main Group ◽  
Reproductive Age ◽  
Control Group ◽  
Study Objective ◽  
Synthesis Of Hormones

Background. There are not enough publications devoted to the study of erythropoietin in human sperm. According to the results of these studies, the erythropoietin takes part in the regulation of spermatogenesis, affecting the synthesis of hormones, in particular steroid ones. Currently, the physiological and pathogenetic effects of erythropoietin on human ejaculate have not been thoroughly studied. In this regard, the study of this protein in the ejaculate in patients with diseases of the male reproductive system, as well as in their absence, is relevant.The study objective is to determine the concentration of erythropoietin in ejaculate samples of healthy and men with oligoastenozoospermia.Materials and methods. Samples of ejaculate of 52 men of reproductive age were examined. The ejaculate was examined using the SQA-V sperm analyzer (MES, Israel). According to the results of the study, two groups were identified: the main group (n = 18) with reduced fertility and the control group (n = 34) with normal spermogram indicators. In seminal plasma samples, the concentration of erythropoietin was determined by solid-phase enzyme immunoassay using the test system “Erythropoietin-IFA-BEST” (A-8776) (Vector-best LLC, Russia).Results. Erythropoietin was detected in all ejaculate samples, the results ranged from 9.37 to 193.95 mME / ml and varied 20.7 times (p = 0.3). The median concentration in the main group was 64.49 mME / ml (41.96; 118.16 mME / ml) and 1.36 times higher than the results of the comparison group, which were 47.16 mME / ml (18.15; 90.94 mME / ml). No statistically significant regularities were found between the concentration of erythropoietin and the indicators of ejaculate fertility (r <|0,3|).Conclusion. In oligoastenozoospermia, there is a tendency to increase the content of erythropoietin in the seminal plasma, which requires further research, taking into account a more detailed stratification of the groups examined for reasons that caused a decrease in the number of spermatozoa.

The content of cytokines IL-6, IL-8, TNF-α, IL-4 and the level of expression in macrophages CD86 and CD163 in peritoneal fluid has a reverse correlation with the degree of severity of external genital endometriosis

2019 ◽  
Vol 65 (5) ◽  
pp. 432-436
Author(s):  
A.M. Krasnyi ◽  
A.A. Sadekova ◽  
T.G. Sefihanov ◽  
V.V. Vtorushina ◽  
E.G. Krechetova ◽  
...  
Keyword(s):  
Inflammatory Cytokines ◽  
Peritoneal Fluid ◽  
Inflammatory Marker ◽  
Inflammatory Activity ◽  
Control Group ◽  
Reverse Correlation ◽  
Tnf Α ◽  
Ifn Γ ◽  
Anti Inflammatory ◽  
Degree Of Severity

Concentrations of eight different cytokines and the level of expression of CD86 and CD163 macrophages were studied in peritoneal fluid in women with endometriosis. It was found that the concentration of both inflammatory (IL-6, IL-8, TNF-α) and anti-inflammatory cytokines (IL-4) as well as the level of macrophage expression of the proinflammatory marker CD86 and anti-inflammatory marker CD163 increased in women with mild external genital endometriosis (1-2 stage), and did not differ from the control group in women with severe endometriosis (3-4 stage). The content of IL-2, IL-10, CM-CSF and IFN-γ in the peritoneal fluid of women with endometriosis did not differ significantly from the control group. The results of the study indicate that the development of external genital endometriosis may be based on insufficient both inflammatory and anti-inflammatory activity of macrophages in the peritoneal fluid.

Aspects of the Wound Process in the Choice of Surgical Treatment of the Ventral Hernias

10.12737/5900 ◽  
2014 ◽  
Vol 21 (3) ◽  
pp. 62-65
Author(s):  
Агаларян ◽  
A. Agalaryan ◽  
Ротькин ◽  
E. Rotkin ◽  
Хохлова ◽  
...  
Keyword(s):  
Standard Method ◽  
Infectious Complications ◽  
Main Group ◽  
Control Group ◽  
Macrophage Activity ◽  
Hernial Sac ◽  
Effective Activity ◽  
Bed Days ◽  
The Mean ◽  
Ventral Hernias

The examination of the wound process in 140 patients after the alloplasty, according to the standard method «on-lay» and developed method with the use of the flaps of the hernial sac was carried out. All patients were divided into 2 groups. The main group was consisted of the patients treated by the developed method using the flaps of the hernial sac, the control group of patients – by means of the standard method «on-lay». According to the data of the cytological study of the exudates in the both groups it has been found that the flaps of the hernial sac situated in the subprosthetic space contribute to the high content of the cells having the macrophage activity (neutrophils, macrophagocytes) in the surgical intervention field. In the main group, the mean volume of the secretion was 113ml, it was in 2 times less than the volume of the serous drainage in the patients of the control group. Decrease of the exudates volume in the main group influenced to the drainage terms (3 days average) and to the hospital stay (as many as 8 bed-days average). The absence of the infectious complications in the patients treated by method with the use of the hernial sac flaps is explained by the effective activity of the cells immunity factors in the wound.

scholarly journals ПОРУШЕННЯ ВАРІАБЕЛЬНОСТІ СЕРЦЕВОГО РИТМУ ЯК МЕТОД ОЦІНЮВАННЯ АДАПТАЦІЙНИХ РЕАКЦІЙ ОРГАНІЗМУ ВАГІТНИХ ПРИ НАЯВНОСТІ ШКІДЛИВИХ ЗВИЧОК

2018 ◽  
Author(s):  
V. H. Korniienko ◽  
A. S. Fitkalo
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Nervous System ◽  
Pregnant Women ◽  
Cardiac Rhythm ◽  
Main Group ◽  
Reproductive Age ◽  
Control Group ◽  
Cardiac Rhythm Variability ◽  
Adaptive Reactions

According to modern data, the cardiovascular system is a kind of indicator of the organism's adaptive activity, and the structure of the heart rhythm carries information about the development of adaptive reactions in response to irritating factors of the external and internal environment.The aim of the study – to investigate the functional state of the autonomic nervous system in pregnant women who have harmful habits by evaluating and analyzing the parameters of heart rate variability in order to prevent complications of non-delivery of gestational process.Materials and Methods. The study involved 73 pregnant women, 53 of them were pregnant (the main group) who had malignant habits in history. Before studying adaptive reactions in pregnant women, a study of cardiac rhythm variability was performed in practically healthy non-pregnant women of reproductive age (25.3±2.2) years). The control group consisted of 20 pregnant women without any harmful habits. Determination of heart rate variability was performed on the basis of peripheral heart rate recording, which included measuring the sequence of RR intervals for 5 minutes, followed by mathematical analysis using the PlsMntr software product.Results and Discussion. It was established that in the main group, in the complicated failure to pass the gestational process, violations of cardiac rhythm variability were detected in 59.7 % of cases. There is an increase in the frequency of very low frequency (VL F) waves (43.5 % relative to control, p<0.05), indicating a predominance of humoral and metabolic rate of regulation of the cardiac rhythm. At the threat of premature births, a decrease in the particle (LF) is observed at 36.6 %, a decrease in the share of high-frequency waves (НF) by 30.8 %. Taking into account the results of the study, one can speak of a decrease in the tone of the sympathetic and parasympathetic nervous system, reducing the influence of the reflexive vegetative level of regulation, which, in turn, indicates the depletion of regulatory mechanisms and the lack of an adaptive protective effect of n.vagus on the heart.Conclusions. Our innovative low-invasive method of evaluating the adaptive reactions of the organism through the determination and analysis of indicators of cardiac rhythm variability in pregnant women with the existing harmful habits offers us the opportunity to observe manifestations of functional stress of regulatory systems of pregnant women, preceding the development of complication of non-delivery of gestational process.

Safety assessment of preoperative oil chemoembolization with nanoparticle albumin-bound paclitaxel in patients with pancreatic head adenocarcinoma

2020 ◽  
Vol 22 (4) ◽  
pp. 67-71
Author(s):  
A. V. Pavlovskii ◽  
A. A. Statsenko ◽  
S. A. Popov ◽  
V. E. Moiseenko ◽  
A. A. Polikarpov
Keyword(s):  
Preoperative Chemotherapy ◽  
Combined Treatment ◽  
Pancreatic Head ◽  
Main Group ◽  
Ductal Adenocarcinoma ◽  
Control Group ◽  
Postoperative Pancreatitis ◽  
Body Level ◽  
Degree Of Severity ◽  
Group Grade

Results of combined treatment of 36 patients suffering from pancreatic head ductal adenocarcinoma are evaluated, including preoperative chemotherapy using nanodispersed albumin-stabilized paclitaxel (nab-paclitaxel) in intraarterial oil chemoembolization or intravenous administration and radical surgical treatment. Intraarterial oily chemoembolization of the pancreatic head consisted of the introduction of 17 patients (main group) into the gastroduodenal artery of an emulsion of super-liquid lipiodol (Lipiodol Ultra Fluid) in an aqueous solution of nab-pacliaxel 50 mg/m2 and gemcitabine 400 mg/m2. 19 patients (control group) were administered nab-paclitaxel 100 mg/m2 and gemcitabine 1000 mg/m2 intravenously according to standard guidelines. Safety and tolerability assessment of combined treatment with preoperative application of nab-paclitaxel was carried out in advance. Pil-preserving pancreatoduodenal resection is considered safe on day 710, after completion of preoperative chemotherapy with nab-paclitaxel. The use of nab-paclitaxel in preoperative intraarterial oily chemoembolization of the pancreatic head requires extension of the pancreatic crossing boundary to body level. Postoperative lethality and 4th degree complications according to the Clavien-Dindo classification were not observed. In the main group, grade 3a complication was observed in 2 (12%) patients and was represented by bleeding from acute gastric erosions resolved endoscopically. In the control group, complications of degree 3 were also noted in 2 (11%) patients and were represented by: one bleeding from acute stomach erosions that required endoscopic hemostasis and an intraabdominal abscess allowed by percutaneous drainage. In the main group, complications of the 2nd degree were recorded in 8 (47%) patients: in 3 (17%) patients the formation of pancreatic fistula was noted, in 4 (23%) postoperative pancreatitis was detected, and in 1 (6%) gastrostasis phenomena that required conservative therapy. In the control group, complications of the 2nd degree were observed in 11 (58%) patients and were presented: pancreatic fistulae in 2 (10%) patients, postoperative pancreatitis in 6 (31%) and gastrostasis in 3 (16%) patients. The most common complication observed in both groups was the suppression of a postoperative wound, corresponding to the 1st degree of severity: in the main group in 5 (29%) patients, in the control group in 7 (37%) patients. Thus, the use of intraarterial oil chemoembolization with nab-paclitaxel as a preoperative antitumor treatment can be considered safe.

Modern approaches to the treatment of bacterial vaginosis and mixed nonspecific vaginitis

2017 ◽  
pp. 89-95
Author(s):  
O.V. Golyanovsky ◽  
◽  
V.V. Mehedko ◽  
M.A. Budchenko ◽  
◽  
...  
Keyword(s):  
Bacterial Vaginosis ◽  
Standard Treatment ◽  
Main Group ◽  
Reproductive Age ◽  
Control Group ◽  
Complete Disappearance ◽  
Complete Elimination ◽  
Women Of Reproductive Age ◽  
High Effectiveness ◽  
Treatment Regimens

The objective: to evaluate the effectiveness of treatment of women with various dysbiotic vaginal conditions with Limenda. Materials and methods. 58 women of reproductive age with BV and mixed nonspecific vaginitis participated in the study. The main group included 30 women, whose treatment was carried out with Limenda drug. The control group consisted of 28 women, whose treatment was performed according to the standard scheme using a combination of drugs. Results. Based on the results of control tests, complete elimination of pathogens occurred in 29 (96.67%) patients of the main group and in 26 (92.86%) patients of the control group. Five days after the treatment, all 30 (100%) women in the main group noted complete disappearance of symptoms on the control visit, and 2 (7.14%) of the control group complained of minor discomfort in the vagina, which required continued treatment. The conclusion. For the treatment of nonspecific vaginitis and bacterial vaginosis, especially chronic and often recurrent forms, it is better to use combined local remedies. The results of this study reliably testify to the high effectiveness of the combined drug Limenda compared with standard treatment regimens. Key words: vaginitis, bacterial vaginosis, vaginal biocenosis, conditional resistance, metronidazole, miconazole, Limenda.

Concentrations of Neopterin and Interleukin-10 in Peritoneal Fluid and in Serum of Women with Endometriosis

Pteridines ◽  
2004 ◽  
Vol 15 (1) ◽  
pp. 20-27 ◽  
Author(s):  
Zdzislawa Kondera-Anasz ◽  
Justyna Sikora ◽  
Anna Mertas ◽  
Piotr Miciñski ◽  
Bartlomiej Bednarz
Keyword(s):  
Growth Factors ◽  
Peritoneal Fluid ◽  
Interleukin 10 ◽  
Peritoneal Macrophages ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Serum Concentrations ◽  
Macrophage Activity ◽  
The Mean

Abstract Endometriosis is a gynaecological disorder characterized by increased number and activation of peritoneal macrophages and release of macrophage-derived cytokines and growth factors. The aim of our work was t(5 study the level of neopterin and interleukin (TL)-10 in peritoneal fluid and serum of women with endometriosis in relation to stage of disease. Concentrations of neopterin and IL-10 were measured by enzyme linked immunosorbent assay in PF and serum of 58 women; 43 with endometriosis and 15 without endometriosis. In our study present of neopterin in PF of women with endometriosis whereas neopterin could not be detected in the control group. Neopterin serum concentrations were significantly higher in affected women compared with control. Significantly increased neopterin concentrations were observed in peritoneal fluid and serum of women with advanced endometriosis. The mean peritoneal fluid and serum IL-10 concentrations were significantly higher ainong studied women than control. In women with early endometriosis, significantly increased concentration of IL-10 in peritoneal fluid and serum was observed. In conclusions, both increased concentrations of neopterin and IL-10 in the peritoneal fluid and serum suggest an important role of these Compounds in pathogenesis of endometriosis and indicate an enhanced macrophage activity in this disease.

scholarly journals Characteristics of phenotypes (clinical variants) of polycystic ovary syndrome in women of reproductive age

2021 ◽  
Vol 2 ◽  
pp. 27-31
Author(s):  
V.G. Syusyuka ◽  
M.Y. Sergienko ◽  
G.I. Makurina ◽  
O.A. Yershova ◽  
A.S. Chornenka
Keyword(s):  
Polycystic Ovary ◽  
Free Testosterone ◽  
Main Group ◽  
Reproductive Age ◽  
Control Group ◽  
Women Of Reproductive Age ◽  
Ovary Syndrome ◽  
Comprehensive Examination ◽  
Clinical Variants ◽  
Research Show

The objective: on the basis of a comprehensive examination of women of reproductive age to establish the frequency of phenotypes (clinical variants) of polycystic ovary syndrome (PCOS).Materials and methods. 34 patients (main group) who complained of menstrual disorders and/or dermatopathies by recommendation of a dermatologist were examined. The control group is represented by 30 women without gynecological and somatic pathology. The mean age of women in the main group was 26,4±0,9 years and 29,1±0,9 years in the control group (p>0,05). The age of women in the study groups ranged from 18 to 35 years. Patients underwent a comprehensive examination to assess the severity of hirsutism and the severity of acne, as well as the body mass index was determined. All women underwent ultrasound examination in the dynamics and quantitative assessment of the concentration of hormones in the blood plasma, namely cortisol, thyroid-stimulating hormone, prolactin, free testosterone and its index, androstenedione, dehydroepiandrosterone sulfate, 17-α-OH-progesterone, sex hormone binding globulin. Variation-statistical processing of the results was carried out using the program «STATISTICA 13».Results. The results of the conducted research show that 73,5% had menstrual irregularities, and 52,9% – infertility. Acne and hirsutism in every 3rd woman were combined and were diagnosed in 47,1% and 41,2% of women, respectively. Ultrasound signs of polycystic ovaries were found in 94,1% of patients according to the criteria for the diagnosis of PCOS, and in 88,2% – anovulation. According to the laboratory examination, hyperadrogenism was found in 55,9%, which is confirmed by statistically significant (p<0,05) predominance in the main group compared with the control group of androstenedione, free testosterone and its index. In addition, it should be noted statistically significant (p<0,05) higher levels of 17-α-OH-progesterone and prolactin in the main group, but their indicators were within the reference values of the norm. Analyzing the frequency of phenotypes (clinical variants) of PCOS, it was found that phenotype A (classical) occurred in 32,4%. Phenotype B (incomplete classical) was diagnosed in 14,7%, and phenotype C (ovulatory) – only 8,8%. The most often, namely in 15 (44,1%) women with PCOS, the phenotype D (non-androgenic) was established.Conclusions. The results of the conducted research show that in women with PCOS clinical symptoms are characterized by menstrual dysfunction (73,5%), infertility (52,9%) and dermatopathies, namely acne (47,1%) and hirsutism (41,2%). According to the laboratory exanination, hyperadrogenism was found in 55,9%, which is confirmed by statistically significant (p<0,05) predominance in the main group compared with the control group of androstenedione, free testosterone and its index. Among the clinical variants of PCOS, the non-androgenic phenotype (phenotype D) was the most often diagnosed, the frequency of it was 44,1%. Classical (phenotype A) and incomplete classical (phenotype B) were found in 32,4% and 14,7%, respectively. It should be noted that only 8,8% of women with PCOS are diagnosed with phenotype C (ovulatory).

scholarly journals Medical-social risk factors of cervical cancer development among women of reproductive age

2019 ◽  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Comparison Group ◽  
Main Group ◽  
Reproductive Age ◽  
Control Group ◽  
Social Risk ◽  
Social Risk Factors ◽  
Sociological Study ◽  
Female Population

Cervical cancer is one of the widespread diseases that have a negative impact on the reproductive health. However, medical-social risk factors which provoke this pathology aren't studied sufficiently yet. We have identified the most significant medical-social risk factors of cervical cancer's development and progression based on data analysis of a sociological study. Thus, it was found that cervical cancer can't be associated with predominantly late reproductive age of women in conditions of the Republic of Belarus: most of the patients with this pathology (more than 53%) were under the age of 35 years old. The group of patients suffered from cervical cancer was quite homogeneous in their social status, which was average and relatively stable in a large majority of them (more than 90%), despite employment in various sectors of the national economy. Social functioning of these patients wasn't significantly different from the main population of women in reproductive age. Thus, early sexual activity and random early sexual relations weren't characteristic for the majority of them: 86.1±4.46% (the control group – 87.3±5.51%, the comparison group – 78.2±3.96%) and 83.5±4.72% (the control group – 89.1±4.28%, the comparison group – 75.2±2.36%). Moreover, the married patients of the main group had the most ordered sexual behavior (p<0.01; tau=0.572) which determined the low prevalence of artificial abortions among them, including menstrual cycle regulation (less than 8%). However, the revealed different defects of health-saving behavior in the main group of patients (more than 70%), including an insufficient level of valeological knowledge, the presence of common harmful habits and low medical activity, indicate that there are significant reserves for improvement of the preventive activities of medical stuff in the field of primary medical care for the development of a healthy lifestyle among female population of reproductive age and providing clinical examination among this contingent of females in reproductive age with the purpose of cervical cancer prevention.

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