Given an abstract, generate a keyword (a noun phrase) that best describes the focus or contribution of the paper. Such keywords can be directly from the given abstract or outside it.
One example: Abstract: Some patients converted from ventricular fibrillation to organized rhythms by defibrillation - trained ambulance technicians(EMT - Ds) will refibrillate before hospital arrival.The authors analyzed 271 cases of ventricular fibrillation managed by EMT - Ds working without paramedic back - up.Of 111 patients initially converted to organized rhythms, 19(17 % ) refibrillated, 11(58 % ) of whom were reconverted to perfusing rhythms, including nine of 11(82 % ) who had spontaneous pulses prior to refibrillation.Among patients initially converted to organized rhythms, hospital admission rates were lower for patients who refibrillated than for patients who did not(53 % versus 76 % , P = NS), although discharge rates were virtually identical(37 % and 35 % , respectively).Scene - to - hospital transport times were not predictively associated with either the frequency of refibrillation or patient outcome.Defibrillation - trained EMTs can effectively manage refibrillation with additional shocks and are not at a significant disadvantage when paramedic back - up is not available.
Solution is here: Ventricular Fibrillation
Explanation: This term is directly present in the abstract and it is one of the main topic in it. So can be chosen as the medical subject heading.

Now, solve this: Abstract: Use of the colposcope for vulvar and vaginal examination in four cases of long-standing vulvodynia led to the identification of lesions with an unusual appearance. In the vulvar vestibule, epithelial projections resembling cactus, camel humps or stony colonial pavement were observed. In the vagina, the lesions looked more like cerebral folds. Biopsies of these lesions showed histopathologic changes diagnostic of human papillomavirus infection, scored according to Reid's criteria. In one case, capsid antigen was detected with the peroxidase technique in the nuclei of the superficial cells. Past history and positive findings in the sexual partners of some of the patients suggested long-standing herpesvirus activity in the lower genital tract. In some cases of recalcitrant vulvodynia, colposcopic examination of the vulva and vagina may lead to a viral explanation for symptoms previously considered psychosomatic in origin.
Solution:
Adult