[Human papillomavirus vaccination for men who have sex with men in China: demand and suggestions]

MSM are a high-risk population for HPV infection and related diseases. MSM can be effectively protected by quadrivalent and nine-valent HPV vaccines. This paper outlines the significance of providing HPV vaccination to MSM, summarizes the basis of HPV vaccination in MSM, and puts forward the following recommendations. First, China should expedite the development and approval of the HPV vaccine for male use. Second, HIV-positive MSM should vaccinate against HPV as soon as possible. Third, prioritize HPV vaccination for MSM individuals aged 26 or less. Fourth, for MSM aged over 26, catch-up vaccination or opportunistic vaccination should be provided when HPV vaccine resources are sufficient. Implementing this vaccination strategy can provide protection for the MSM and control the spread of sexually transmitted diseases.

[Progress in research of long-term protective efficacy of human papillomavirus vaccine]

The efficacy of HPV vaccine in preventing cervical cancer has been demonstrated in numerous clinical trials and clinical uses. The follow-up after clinical trials usually last for 5-6 years to evaluate the long-term efficacy, and a series of long-term follow-up studies have been conducted in some regions. The literature retrieval of HPV vaccine long term efficiency research both at home and abroad indicated that the protective efficacy of the vaccine against vaccine-type-related cervical intraepithelial neoplasia grade 2 and above is higher than 90%.

[Infection of human papillomavirus and head and neck cancer]

High-risk human papillomavirus (HPV)-related cancers consist of cervical cancer, anal cancer, penile cancer, vulvar cancer, vaginal cancer, and head and neck cancer (HNC). Of these, the disease burden of HNC is second only to cervical cancer. HNC mostly originates from malignant lesions of squamous epithelial cells and mainly includes oral cavity cancer, pharyngeal cancer (including nasopharyngeal cancer, oropharyngeal cancer, and hypopharyngeal cancer), and laryngeal cancer. Tobacco use, alcohol abuse, and HPV infection are three primary risk factors. Recently, there is an upward trend of HNC incidence globally, especially in high-income countries. In China, the disease burden and trends of HPV-related HNC are still not clear. A few small sample size and single-center studies suggest a high HPV prevalence and increasing trend in HNC. Methodological differences in HPV testing and regional variabilities still exist among these studies. Among the anatomic sites, oropharyngeal cancer has been shown to be caused by HPV infection, but the association of HPV with other sites is still under debate. In addition, there is a paucity of relevant studies. Here, this review narrates the association between HPV infection and HNC, compares the differences between global and Chinese studies, and then explores the importance of HPV infection in various anatomical sites. The main objective is to highlight the research on HPV-related HNC and promote relevant prevention and treatment programs.

[Analysis on cancer incidence and mortality attributed to human papillomavirus infection in China, 2016]

Objective: We aim to evaluate the morbidity and mortality of cancer attributable to human papillomavirus (HPV) infection in China in 2016. Methods: Based on the cancer incidence and mortality rates, national population data, and population attributable fraction (PAF) in China, we calculated the number of incidence and death cases attributed to HPV infection in different areas, age groups, and gender in China in 2016. The standardized incidence and mortality rates for cancer attributed to HPV infection were calculated by using Segi's population. Results: In 2016, a total of 124 772 new cancer cases (6.32 per 100 000) were attributed to HPV infection in China, including 117 118 cases in women and 7 654 cases in men. Of these cancers, cervical cancer was the most common one, followed by anal cancer, oropharyngeal cancer, penile cancer, vaginal cancer, laryngeal cancer, oral cancer, and vulvar cancer. A total of 41 282 (2.03 per 100 000) deaths were attributed to HPV infection, of which 37 417 occurred in women and 3 865 in men. Most deaths were caused by cervical cancer, followed by anal cancer, oropharyngeal cancer, penile cancer, laryngeal cancer, vaginal cancer, oral cancer, and vulvar cancer. The incidence and mortality rates of cervical cancer increased rapidly with age, peaked in age group 50-54 years, then decreased obviously. The morbidity and mortality rates of non-cervical cancer increased with age. The cancer case and death numbers in rural areas (57 089 cases and 19 485 deaths) were lower than those in urban areas (67 683 cases and 21 797 deaths). However, the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of cervical cancer were higher in rural areas than in urban areas. There were no significant differences in ASIR and ASMR of non-cervical cancers between urban areas and rural areas. Conclusions: The incidence of cancers attributed to HPV infection in China was lower than the global average, but the number of incidences accounted largely, furthermore there is an increasing trend of morbidity and mortality. The preventions and controls of cervical cancer and male anal cancer are essential to contain the increases in cancer cases and deaths attributed to HPV infection.

[Causes and countermeasures of the rapidly rising burden on cervical cancer in Chinese women]

The world is entering a new era of accelerated elimination of cervical cancer, while the age-standardized incidence, and mortality of cervical cancer in China are rising rapidly. This article summarizes and describes the current situation and trends of the burden of cervical cancer in China, reviews and analyzes the comprehensive prevention practice of cervical cancer, focusing on critical reasons for the increasing burden of cervical cancer, from the perspectives of sociology, behavior, and epidemiology in the population. Countermeasures are proposed to provide guidance and theoretical reference for the precise prevention of cervical cancer to eliminate cervical cancer.

[World Health Organization guidance Ethical and Governance of Artificial Intelligence for health and implications for China]

With the explosive growth of deep learning and big data technology, artificial intelligence has penetrated into various fields of medical and health care, bringing efficient and high-quality health services to patients, but also a series of ethical and social governance issues have emerged. In order to avoid and eliminate the foreseeable ethical risks and governance challenges in the development of medical artificial intelligence, the World Health Organization (WHO) first released the Ethical and Governance of Artificial Intelligence for Health guidance on June 28, 2021, aimed to provide a framework for ethical guidelines on the deployment of artificial intelligence in clinical practice. At present, there are still shortcomings and this paper takes Healthy China 2030 agenda and the WHO guidelines as strategic ideas, and proposes to shape a consensus on the ethics of medical artificial intelligence, establish rules for human subjects and ownership of responsibilities, improve the legal and regulatory system, and determine human decision-making and moral subject status, taking into account the cultivation of interdisciplinary talents' ethical literacy and other Chinese inspirations are expected to promote the development of medical artificial intelligence ethics governance.

[WHO global strategy on digital health and its implications to China]

The World Health Organization (WHO) released the global strategy report on digital health (2020-2025) in Geneva in 2019, which established the priority of the digital health strategy and formulated strategic objectives, guiding principles, action framework and implementation plans to promote the development of global digital health, and to achieve universal health coverage and the health-related sustainable development goals. Despite China's rapid development in the field of digital health, there is still a big gap between the realization of the goal of digital health. Therefore, it is urgent to grasp the major historical opportunity and step into a new era of digital health with the support of digital technology platform.

[Interpretation of"WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition"]

Cervical cancer can be eliminated through primary, secondary, and tertiary prevention. Yet it remains one of the gravest threats to women's lives worldwide. In November 2020, WHO officially launched the global strategy to accelerate the elimination of cervical cancer, and underlined that screening and treatment for cervical pre-cancer lesions are two of three key measures for the elimination. In July 2021, the World Health Organization (WHO) issued the second edition of"WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention"to provide important guidance to countries to support them in achieving the target of cervical cancer elimination in all women. This article will interpret the methods for the guideline development, the recommendations/good practice statements on screening and treatment to prevent cervical cancer (including the age to start/stop screening, screening methods, screening interval, the management of screen-positive women and treatment of the precancerous lesions, etc.) and its impact globally, providing reference for the updates of guideline and policy making on cervical cancer prevention and control in China.

[Molluscicidal activity of the Bacillus velezensisis Y6 strain against Oncomelania hupensis and its preliminary mechanisms of molluscicidal actions]

OBJECTIVE

To assess the molluscicidal activity of the of Bacillus Y6 strain against Oncomelania hupensis in laboratory, and to preliminarily investigate its mechanisms of molluscicidal actions.

METHODS

Biological identification of the Y6 strain was performed based on analysis of its morphological and physiochemical features and homology analysis of the 16S rDNA gene sequence. Bacillus Y6 suspensions were formulated at concentrations of 0.005, 0.010 g/mL and 0.015 g/mL, and the molluscicidal activity of Bacillus Y6 suspensions against O. hupensis was tested in laboratory using the immersion method. In addition, the Bacillus Y6 content and glycogen content were detected in O. hupensis following exposure to Bacillus Y6 suspensions to preliminarily explore the molluscicidal mechanism of the Bacillus Y6 strain against O. hupensis.

RESULTS

The colony of the Bacillus Y6 strain appeared non-transparent milky white, and mycoderma was produced on the surface of the nutrient agar liquid medium. The Y6 stain was Gram positive and rod-shaped, and the endospore was located at the center of the Bacillus Y6 strain and appeared an achromatic, transparent and refractive body, which was encapsulated by the Y6 strain. The Y6 strain was positive for the lecithinase test, and the 16S rDNA gene sequence showed a 100% homology with those of multiple B. velezensisis strains, B. amyloliquefaciens and B. subtilis. The Y6 strain was therefore identified as B. velezensisis. Following immersion in the Bacillus Y6 suspensions at concentrations of 0.005, 0.010 g/mL and 0.015 g/mL for 24, 48 h and 72 h, the mortality rates of Oncomelania snails were 28.3%, 31.7% and 81.6%, 43.3%, 58.3% and 93.3%, and 63.3%, 78.3% and 98.3%, respectively. The molluscicidal activity of the Bacillus Y6 suspensions increased with the suspension concentration and duration of immersion. Microscopy and colony counting revealed the highest Y6 content in dead snails and the lowest in living snails following immersion in Bacillus Y6 suspensions, and the mean glycogen contents were (0.68 ± 0.06), (1.09 ± 0.16) μg/mg and (2.56 ± 0.32) μg/mg in the soft tissues of dead, dying and living snails following immersion in Bacillus Y6 suspensions (F = 59.519, P < 0.05), and the mean glycogen content was significantly higher in living snails than in dead (t = 14.073, P < 0.05) and dying snails (t = 10.027, P < 0.05), while the mean glycogen content was significantly higher in dying snails than in dead snails (t = 5.983, P < 0.05).

CONCLUSIONS

The B. velezensisis Y6 strain shows a high molluscicidal activity against O. hupensis snails, and its invasion may cause glycogen metabolism disorders, leading to snail death.

[Global development of human papillomavirus vaccination guidelines: a systematic review]

Objective: To systematically summarize the development of global human papillomavirus (HPV) vaccination guidelines. Methods: The retrieval for all the Chinese and English literature published before August 2020 was conducted in PubMed, Embase and China Biomedical Literature Database, with "papillomavirus vaccines" "wart virus vaccine" "guideline" "practice guideline" "health planning guidelines" "guidelines as topic" "practice guidelines as topic" "immunization programs" in English as well as "papillomavirus vaccines" "HPV vaccine" "guideline" "recommendation" "consensus" in Chinese as search keywords. A total of 18 guidelines were included for data extraction and analysis. Results: The 18 pieces of guidelines included 1 pieces of World Health Organization (WHO) position paper, 6 pieces of guidelines at national or provincial level and other 11 pieces of by academic institutions. In national or provincial guidelines, the recommendation for routine vaccination mainly focused on 11-13 year-old adolescents and the recommendation for catch-up vaccination extends to 17-26 years old. Recommendation of guidelines by academic institutions were similar to the WHO position paper: girls aged 9-14 as the primary target for the routine vaccination; females aged 15-26 years old as the secondary target populations when it's feasible, affordable and cost-effective; women aged over 26 could be vaccinated at an individual level. There were only three guidelines simultaneously updated with the national immunization programme and covered four aspects: the vaccinated population (girls-only to gender-neutral vaccination), the periodic catch-up immunization, the dose schedule updates and the change of vaccine types. Conclusions: It's recommended that the development of Chinese HPV vaccination guidelines refer to global guidelines and updates and take full consideration of the epidemiological evidence, resources and current status of the immunization system in China.

[Meta-analysis of annual probability of outcome for different cervical disease states]

Objective: To explore the annual probabilities of outcomes for different cervical disease states. Methods: Cohort studies related to the natural history of cervical cancer were retrieved from PubMed, Embase and China Biomedical Literature Database, and the retrieval time was from the establishment of the database to May 2020. Newcastle-Ottawa scale was used to evaluate the quality of the included literatures. The annual outcome probabilities of different cervical disease states in high-risk human papillomavirus (hrHPV) positive, negative and cervical intraepithelial neoplasia grade 1 (CIN1) population were calculated (95%CI). Random-effects model was used for meta-analysis. Egger's test was used to evaluate publication bias; sensitivity analysis was used to evaluate the robustness of the combined parameters. Meta-regression was used to explore factors associated with the heterogeneity of annual outcome probability. Results: A total of 37 studies were included, including 12, 20 and 15 studies involving hrHPV negative, hrHPV positive and CIN1 population, respectively, with a Newcastle -Ottawa scale (NOS) score of 7.05±1.20. The annual probability (95%CI) of progression to CIN1, CIN2 and CIN3+ in hrHPV-positive population were 0.022 2 (0.014 3, 0.031 0), 0.017 0 (0.012 0, 0.022 0) and 0.016 2 (0.012 6, 0.019 8), respectively. The annual probability (95%CI) of progression to CIN1, CIN2 and CIN3+ in hrHPV-negative population was 0.002 7 (0.000 9, 0.004 6), 0.000 7 (0.000 3, 0.001 1) and 0.000 6 (0.000 3, 0.000 9), respectively. The annual probability (95%CI) of reversal to normal, maintenance of CIN1 status and progression to cervical intraepithelial neoplasia grade 2 or above (CIN2+) in CIN1 population were 0.578 1 (0.369 9, 0.786 3), 0.400 1 (0.167 4, 0.632 9), 0.056 9 (0.034 9, 0.078 9), respectively. Egger's test showed that there was publication bias in the annual outcome probability of hrHPV positive progression to CIN2 and CIN3+ and hrHPV negative progression to CIN2 and CIN1 progression to CIN2+, with t values of 5.50, 2.36, 2.80 and 4.12, respectively (all P values<0.05). Sensitivity analysis showed that when excluding any of the studies, the range of annual probability of progression to CIN1, CIN2 and CIN3+ were 0.016 6-0.024 7, 0.014 9-0.018 9 and 0.013 6-0.017 7 among hrHPV-positive population; 0.002 4-0.003 5, 0.000 6-0.000 9 and 0.000 5-0.000 7 among hrHPV-negative population and the range of annual probability of CIN1 reversal to normal, maintenance as CIN1 and progression to CIN2+ were 0.531 8-0.631 2, 0.321 9-0.443 3, and 0.052 0-0.061 0, respectively. Meta-regression analysis showed that region, population origin, population cytological diagnosis, follow-up time, and NOS score were not associated with the heterogeneity of annual outcome probability (all P values>0.05). Conclusion: The annual outcome probability of different cervical disease states in hrHPV positive population is high, and the CIN1 population only needs close follow-up.

[Effectiveness of the thermal ablation in the treatment of human papillomavirus infection and cervical intraepithelial neoplasia in Chinese women]

Objective: To evaluate the effectiveness of thermal ablation in the treatment of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) in Chinese women. Methods: The high-risk HPV-positive women aged 20-65 who were detected through a cervical cancer screening project implemented in three rural sites (Etuoke counties in Inner Mongolia, Xiangyuan and Yangcheng counties in Shanxi Province) and one urban site (Shenzhen) in China were included in this prospective study. Follow up evaluation was performed on HPV positive women who underwent thermal ablation (n=166) as well as received no treatment (n=2 716) in cervical cancer screening program. For women with thermal ablation treatment, HPV test and cytology were used for follow-up with the interval of 6 months or longer after treatment. For women without treatment, HPV test was used for annual follow-up. Women with positive results in either of the HPV tests or abnormal cytology were referred for a colposcopy or biopsy if necessary. The HPV clearance rate and the cure rate of CIN were compared between the two groups. Results: A total of 152 women treated with thermal ablation and 2 539 women without treatment reported for follow-up evaluation with the age M(Q1, Q3) of 42 (36, 48) and 47 (41, 54) years old, and the median time to follow-up time of 23.4 (12.4, 24.5) and 23.5 (12.4, 24.0)months, respectively. The HPV clearance rate in women undergoing thermal ablation was significantly higher than that in women with no treatment (73.0% vs 46.1%, P<0.001). The HPV16, HPV52 and HPV58 clearance rates among women receiving thermal ablation were higher than that in women without treatment with the OR (95%CI) of 2.8 (1.3-6.1), 3.2 (1.3-7.9) and 5.8 (2.1-15.6). For women with histologically confirmed CIN at baseline, cure rates were 77.4%(n=72) for thermal ablation. Cure rates of the thermal ablation were 81.0%(n=47) for CIN grade one (CIN1) and 71.4% (n=25) for CIN grade two or worse (CIN2+). Conclusions: Thermal ablation is effective to clear the HPV infection as well as to treat CIN. Particularly for the HPV genotypes with the paramount attributable proportion to cervical cancer and precancerous in China, the HPV clearance rate was significantly higher than that reported in the women without treatment.

Study on the characteristics and mechanism of pulsed laser cleaning of polyacrylate resin coating on aluminum alloy substrates

The behavior of paint removal with a pulsed laser has been investigated using an Nd:YAG fiber laser. Experimental and theoretical analyses are conducted to reveal the underlying mechanism of the paint removal. The results show that the depth, radius, and volume of the pit formed by a single pulse become larger with increases in the energy density. The ideal parameters for the complete removal of paint have been achieved. During the paint removal, burning occurred over the surface, and the variation in element content has been attributed to the absorption of laser energy. Under the action of the pulsed laser, there was breakage and rearrangement of chemical bonds such as C-C, C-N, and C-O in the molecular chain of the polyacrylate paint coating. Through these analyses, the paint removal mechanism was shown to be based on chemical bond breakage, combustion, and mechanical action provided by the thermal expansion and plasma shock.

[Performance of high-risk HPV typing test in early diagnosis of cervical cancer]

Objective: To evaluate the performance of High-risk HPV typing detection in cervical cancer screening. Methods: A total of 3 231 women were recruited as the subjects of cervical cancer screening from Jiyuan city of Henan provinces from June to July 2017. All women underwent HPV DNA test. The women with cytological examination ≥ASCUS or cytological examination negative and HPV 16/18 positive underwent colposcopy biopsy and pathological examination. Pathological diagnosis was used as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value(NPV) as well as corresponding 95% confidence interval (CI) of HR-HPV and HPV 16/18 were calculated. Results: The mean age of 3 231 subjects selected in this study was 46.84±10.00 (21-64) years old. 524 subjects had the positive results of HR-HPV, including 91 of HPV16 and 15 of HPV18. Pathological test result CIN2+ was the gold standard. The sensitivity and specificity of HR-HPV for cervical precancer lesions screening were 93.75 (95%CI: 79.85-98.27) and 84.56% (95%CI: 83.26-85.77), respectively. To compared with HR-HPV, HPV16/18 had low sensitivity (65.63%, 95%CI: 48.31-79.59)and higher specificity (97.44%, 95%CI: 96.83-97.93). After age stratification by age 30 and 45, the sensitivity of HPV 16/18 was same with HR-HPV (100%, 95%CI: 34.24-100.00), the specificity of HPV 16/18 was higher than HR-HPV (98.71%, 95%CI: 96.27-99.56 vs 84.48%, 95%CI: 79.27-88.58) in<30 age group.The sensitivity of HR-HPVin 30-45 and ≥45 age group were higher than HPV16/18 (85.71%, 95%CI: 48.69-97.43 vs 71.43%, 95%CI: 35.89-91.78, 95.65%, 95%CI: 79.01-99.23 vs 60.87%, 95%CI: 40.79-77.84), but the specificity werelower than HPV16/18 (86.89%, 95%CI: 84.58-88.90 vs 98.51%, 95%CI: 97.51-99.11、83.49%, 95%CI: 81.81-85.04 vs 96.80%, 95%CI: 95.94-97.48). Conclusions: HR-HPV detection has relatively high sensitivity and specificity in cervical cancer screening. For >30 years old women, HR-HPV is more recommended in cervical cancer screening. Therefore, HR-HPV detection is an effective method for cervical cancer screening.

[Development and achievements regarding the prevention and control of cervical cancer in the last 20 years in China]

Cervical cancer is the fourth common cancer in women globally, with the number of new cases accounted for 18.6% among all the cancer patients, in China. It is well known that the situation of prevention and control programs are quite challenging. Based on the efforts being made in the last 20 years, the etiology and carcinogenesis on cervical cancer had been clearly understood. Breakthroughs had been achieved in the development of prophylactic human papillomovirus vaccine and the technology of in screening. Various screening strategies are already available in areas with different economic status. Nevertheless, the capacity of health care services at the primary care clinics needs to be improved to narrow the gap between the reality and the demands.

[Characteristic analysis of aeroallergens of allergic rhinitis patients in Wuhan]

Objective:To analyze the distribution characteristics of common aeroallergens in patients with allergic rhinitis（AR）in Wuhan. Method:Serum specific IgE（ssIgE）was detected in 1 983 patients with clinically diagnosed AR by Midiwiss Allergen Screen system. Data was analyzed statistically. Result:Among the 1 983 patients，1 507（76.0%）had at least one positive ssIgE. The most common aeroallergens were Dermatophagoides pteronyssinus（62.0%），mixed fungi（32.1%）and house dust（27.3%）.Single positive allergen（43.8%），dual positive allergen（28.1%）and triple positive allergen（15.4%）were the most common combinations. The proportion of single positive allergens in the juvenile group（1 to 17 years old）（35.2%）was lower than adult group（≥18 years old）（46.7%），while the proportion of multiple positive allergens was higher than adult group. The positive rates of mulberry and mixed grass in male group were higher than female group. The positive rates of house dust，cat fur and dog fur in the juvenile group were higher than the adult group，while the positive rate of mulberry，cockroach and mixed grass were lower than the adult group. In the elder group（60-88 years old），the positive rates of Dermatophagoides pteronyssinus and mixed fungi were higher than the other three groups. The positive rates of Dermatophagoides pteronyssinus in summer and autumn were higher than that in winter and spring. The positive rate of mixed grass in autumn was much higher and the positive rate of mixed trees and mulberry trees in spring was higher than summer and autumn. Conclusion:Dermatophagoides pteronyssinus，mixed fungi and house dust were the most common aeroallergens among patients with allergic rhinitis in Wuhan. The distribution characteristics in different genders，ages and seasons were different..

[Study on direct economic burden and influencing factors in patients with cervical cancer and precancerous lesions]

Objective: To account the direct cost of uterine cervix carcinoma treatment in China and to explore the related factors which influence the direct financial burden of the disease. Methods: Data was collected through the medical record system and telephone interviews in 14 county-level hospitals and 9 provincial and municipal hospitals from 14 provinces/municipalities enrolled in the Chinese National Health Industry Research Project in 2015. The direct financial burden of uterine cervix carcinoma treatment consisted of the direct medical cost and the direct non-medical cost of treatment in different pathological cervical cancer stages and precancerous lesions. Multiple liner regression method was used to analyze the factors affecting the costs. Results: The age of the 3 246 patients was (46.40±10.43) years, including 2 423 patients from provincial and municipal hospitals and 823 patients from county-level hospitals. The direct financial burden for one patient of pathological uterine cervix carcinoma stage or precancerous lesion ranged from 10 156.3 yuan to 75 716.4 yuan in provincial and municipal hospitals, and for patients from county-level hospitals, the cost was between 4 927.9 yuan and 47 524.8 yuan per person. There was a wide gap between the direct financial burden of patients in different disease stages. The direct financial burden of patients with precancerous lesions ranged from 4 927.9 yuan per person to 11 243.0 yuan per person, as for patients of pathological uterine cervix carcinoma stages, the direct financial burden was between 29 274.6 yuan and 75 716.4 yuan per person. The factors which influence direct financial burden would include: the levels of the hospital, pathological period, medicare reimbursement, days of treatment, and the methods of treatment (P<0.001). Conclusion: The direct financial burden of diseases in patients with pathological uterine cervix carcinoma stage or precancerous lesion differed in different levels of hospital and pathological periods. In addition, medicare reimbursement, days of treatment, and the methods of treatment all had impact on it.

[Real-world research on cervical cancer screening program and effect evaluation for Chinese population]

Objective: To evaluate the actual efficacy of cervical cancer and precancerous lesions screening approaches in real-world regions with different economic levels in China. Methods: The demonstrative application and effect evaluation of cervical cancer screening program were conducted in 21 hospitals nationwide from 2015 to 2018. Multi-stage sampling method was adopted to divide the country into 7 large areas according to geographical location. Two to four screening sites of two types of cancer (cervical cancer and breast cancer) were selected in each area, and the grassroots screening sites were implemented under the guidance of superior hospitals. In rural areas, women were initially screened using cytology, human papillomavirus (HPV) testing and visual inspection. The women with positive cytology or visual inspection were referred for colposcopy, and the women with positive HPV infection were randomly referred for reflex cytology or visual inspection, or direct colposcopy examination. In urban areas, women were primarily randomized into cytology or HPV testing groups. The women with abnormal cytology or positive HPV 16/18 infection were directly referred for colposcopy examination, whereas the women with positive infection of the other 12 high-risk subtypes of HPV were referred for reflex cytology or colposcopy. All of recruited women would be follow-up and screened by the baseline screening techniques in the third year while the positive women underwent colposcopy examination. The positive rates, referral rates, the detection rates of grade 2 and above of cervical intraepithelial neoplasia (CIN 2+ ) were compared. Results: A total of 63 931 women were recruited at the baseline. Among them, 11 rural sites included 33 823 women: 15 577, 11 157 and 7 089 women were screened by HPV testing, visual inspection via acetic acid or Lugol's iodine (VIA/VILI) and cytology, respectively. Additionally, 30 108 women were from 10 urban sites: 9 907 and 20 201 women were screened by cytology and HPV subtyping, respectively. The HPV positive rate for urban women was 9.34%, whereas that for rural women was 12.53%. The abnormal rate of cytology for urban women was 5.63%, and that for rural women was 4.24%. The positive rate of VIA/VILI in the rural women was 12.25% Furthermore, the detection rate of CIN2+ at the baseline was 0.56%, and that was statistically higher in HPV-positive group than cytology-positive group (P<0.05). Conclusions: All of screening sites completed the baseline screening tasks as expected. The prevalence of HPV infection is higher in rural women than urban women. The performance of HPV testing is better than cytology for detecting CIN2+ cases. This real-world demonstration study provides evidences for cervical cancer prevention and control in different regions.

[A long journey of cervical cancer prevention in China]

Cervical cancer is the fourth most common cancer in women worldwide. More than 80% of cervical cancer deaths occur in low- and middle-income countries. Global health faces enormous challenges. Prevention and control of cervical cancer have a promising prospect, owing to the etiology of carcinogenesis being clearly understood, great efficacy of HPV prophylactic vaccine being proved, technologies of early detection and treatment being well-established, and the various screening strategies being available for communities with different social and economic status. In this commentary, we focused on China and discussed the challenges and opportunities faced by the grass-roots hospitals and clinics, considering the large population load in China and unbalanced allocation of scarce healthcare resources across the nation. In the framework of "Healthy China 2030" , much needs to be done to prevent and control cervical cancer in the upcoming 12 years.

[Interpretation of guidance for establishing the performance characteristics of in vitro diagnostic devices for the detection or detection and differentiation of high-risk human papillomaviruses issued by Food and Drug Administration of United States and China]

To establish the standardization of clinical verification designs for in vitro diagnostic devices(IVDs) of human papillomavirus, China Food and Drug Administration (CFDA) and United States Food and Drug Administration (FDA) issued guidelines of detailed study designs and effectiveness evaluation for accuracy validation and clinical performance of nucleic acid detection, respectively, including triage of a typical squamous cells of undetermined significance(ASC-US) patients and validation of combined screening and preliminary screening. The design, study population, sample size estimation and statistical analysis of guidelines were moderately different from America to China, however, the evaluation indication was similar. According to the guideline issued by CFDA, prospective design suggested by FDA could be replaced by cross sectional study design to validate the triage of ASC-US patients. Alternatively, prospective design could be used to conduct the HPV product declaration and cellular parallel detection for the same natural population, and the clinical effectiveness of declared products could be validated by at least 3 years follow-up of cytology.

[Risk stratification of type-specific human papillomavirus for cervical precancers: evidence from a cross-sectional study in Shenzhen]

Objective: To analyze the epidemiological genotype features of human papillomavirus (HPV) in cervical infection and their risks for cervical precancers among women in Shenzhen area. Methods: A total of 2 717 individuals ranging in age from 30~59 years were recruited in 18 community health centers of Shenzhen city from March 1 to June 15, 2015 by a cluster sampling method. The results of genotype of HPV, liquid-based cytology (LBC), colposcopy and pathology were analyzed. The clinical sensitivity and specificity as well as positive (PPV) and negative (NPV) predictive values of the combination of different HPV genotype in screening the cervical intraepithelial neoplasia (CIN) 2 and above were estimated. Results: The HPV infection rate in Shenzhen area was 15.9% (432/2 717). The most common HPV genotype was HPV52 (22.9%), followed by HPV16 (12.7%), HPV53 (10.0%), HPV51 (8.6%) and HPV58 (8.1%). Compared with HPV16/18 genotyping, HPV33/16 genotyping had a higher sensitivity (57.1% vs. 42.9%, P<0.05) and an analogous specificity (87.3% vs. 86.9%, P>0.05) in predicting CIN2+ . The sensitivity of combination of HPV33/16 genotyping and low grade squamous intraepithelial lesion (LSIL) positive tested by LBC in predicting CIN2+ was 75.0%, significantly higher than 64.3% of atypical squamous cells of undetermined significance (ASC-US) positive tested by LBC alone (P<0.05). The specificities of these two methods mentioned above in predicting CIN2+ were 83.5% and 89.2%, respectively, without statistical difference (P>0.05). Conclusions: Women infected by HPV have distinct risks for CIN2+ according to different high-risk HPV genotypes. The top five risks were HPV 33, 16, 58, 56, and 68. HPV-positive women triaged by LBC LSIL+ combined with HPV33/16 genotyping may be a potential strategy for cervical cancer screening in developed urban area.

[Role of HPV viral loads in random biopsy under normal colposcopy]

Objective: To explore the role of HPV viral loads in random biopsy under normal colposcopy. Methods: 908 atypical squamous cells of undetermined significance (ASC-US) and HPV positive women, recruited in cluster sampling in 9 provinces including 5 urban areas and 9 rural areas in China from 1999 to 2008 and meeting the inclusion and exclusion criteria were included in this analysis. According to relative light units/cutoff (RLU/CO) value, subjects were stratified as low (286 cases), intermediate (311 cases) and high (311 cases) viral load groups. Risks of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among different viral load groups were compared with linear trend Chi-square test. Results: Detection rate of CIN3+ in low, intermediate and high viral load groups were 2.1% (6 cases), 2.6% (8 cases) and 6.8% (21 cases) (Chi-square test for trend χ(2)=8.91, P=0.003) and were 60.3, 74.0 and 201.3 times higher than ASC-US and HPV negative women, respectively. Among 908 subjects, 27.0% (245 cases) were abnormal under colposcopy and 68.6% (623 cases) diagnosed as normal. Under normal colposcopy, detection rate of CIN3+ in low, intermediate and high viral load groups were 0.9% (2 cases), 0.9% (2 cases) and 3.8% (7 cases) (χ(2)=6.42, P=0.040). Conclusion: HPV viral loads display satisfactory risk stratification ability among ASC-US and HPV positive women under normal colposcopy. Women with high HPV viral loads show a significantly increased detection rate of existing CIN3+ and could be recommended to perform random biopsy for histologic diagnosis.

[Distribution and associated factors of high-risk HPV genotypes infection among HPV-positive women who participated cervical screening test in Shenzhen, 2014-2016, China]

Objective: To analyze the distribution and associated factors of high-risk genotypes of HPV in cervical infection among women in Shenzhen. Methods: The information on sociodemographic characteristics and HPV genotypes of HPV-positive women who participated cervical screening test from January 2014 to December 2016 was downloaded from Shenzhen Maternity and Child Healthcare Management Information System. According to the pathogenicity, the high-risk HPV genotypes were divided into 15 types including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66 and 68; and there were 6 low-risk genotypes including HPV 6, 11, 42, 43, 44, and 81. Chi-square tests were applied to compare the proportions of high-risk HPV infection among women who had different sociodemographic characteristics. A non-conditional logistic regression model was used to analyze the associated factors for high-risk HPV infection. Results: In total, all HIV positives received HPV genotyping, with an average age of (38.08±9.38) years old. There were 9 979 (93.9%) high-risk and 645 (6.1%) low-risk HPV infections. The proportions of HPV infections for high-risk type in each year were 91.5%, 93.8%, and 95.6%, increasing with the screening years (χ(2)=54.79, P<0.001). Multivariate logistic regression analysis showed that compared with women younger than 25 years old, women in other age groups (at age 26 to 30 years, 31 to 35 years, 36 to 40 years, 41 to 45 years, and 50 years or older) had increased risks of high-risk HPV infection, with OR (95%CI) of 1.67 (1.20-2.31), 1.49 (1.09-2.03), 1.71 (1.23-2.37), 1.65 (1.19-2.31), and 1.84 (1.26-2.67), respectively; compared with the married, single women had a decreased risk of high-risk HPV infection (OR (95%CI): 0.71 (0.50-1.00)); women received HPV testing in 2015 and 2016 showed higher risk of high-risk HPV infection than those in 2014 (OR (95%CI): 1.43 (1.17-1.74) and 2.03 (1.68-2.46)). The 5 most common HPV genotypes were HPV52 (25.1%, 2 670 cases), followed by HPV16 (19.2%, 2 041 cases), HPV58 (13.3%, 1 413 cases), HPV18 (9.9%, 1 048 cases), and HPV51 (9.3%, 993 cases). Conclusion: Age, marital status, and screening year were associated with high-risk HPV infections. Besides HPV16 and HPV18, the prevention and control on HPV infections for HPV52, HPV58, and HPV51 should be prioritized in Shenzhen area.

[Roles of HPV detection in 28 923 patients with atypical squamous cells of undetermined significance: analysis of 104 studies from China]

Objective: To investigate the human papillomavirus (HPV) positive rate and its usefulness in predicting CIN2+ in women with atypical squamous cells of undetermined significance (ASC-US) cervical cytology. Methods: A pooled analysis was conducted using published data of hospital classification, HPV positive rate and histopathologic diagnosis in ASC-US population during 2005 to 2017 from 104 studies which enrolled 28 923 ASC-US samples. Results: The overall HPV positive rate was 52.09% (range from 12.06% to 88.68%). The HPV positive rate in 79 tertiary hospitals of 21 244 cases was 52.46%, slightly higher than the 50.87% in 22 second-class hospitals of 6 925 cases. There was no significant difference between specialized hospitals and general hospitals. In addition, the positive rate of HC2 conducted in 66 hospitals with 19 791 cases was 53.13%, which was slightly higher than 51.10% of reverse hybridization from 24 hospitals with 6 338 cases. In 73 studies of 18 163 cases with histological diagnosis, the sensitivity of HPV for detecting CIN2+ was 90.16% (95%CI: 88.91% to 91.28%), specificity was 53.08% (95%CI: 53.02% to 54.57%), positive predictive value was 23.24% and negative predictive value was 97.24%. Conclusion: HPV detection is clinically validated for ASC-US triage, but there is a wide variation of HPV positive rate in population of cervical cytological diagnosis as ASC-US in China, suggesting different diagnostic level between regions and hospitals and further improvement is needed.

[Diagnostic value of p16/mcm2 dual staining in cervical intraepithelial neoplasia and its association with high-risk HPV infection]

Objective: To study the expression of p16/mcm2 immunocytochemical dual staining in cervical lesions and its association with high-risk HPV infection, and discuss its clinical value in cervical cancer screening. Methods: From May to December 2015, a total of 1 127 women receiving cervical cancer screening, high-risk HPV (HR-HPV) test and liquid-based cytology test were included in the study. p16/mcm2 immunocytochemical dual staining was performed on residual cytology specimens and the results were compared with histopathology results. Results: p16/mcm2 had a higher expression risk in HPV16/18 group and other HR-HPV group compared with HPV negative group, with OR of 15.95 (95%CI: 9.59-26.51) and 10.53 (95%CI: 7.41-14.98), respectively. The positive rate of p16/mcm2 increased with cervical intraepithelial neoplasia (CIN) severity, and was higher in both CIN2 group and CIN3 group than in benign lesion group (P<0.05). The overall sensitivity of p16/mcm2 to detect CIN2+and CIN3+lesions were 86.1% and 92.0%, respectively, and the overall specificity were 46.1% and 44.4%, respectively. In group with cytologic diagnoses of atypical squamous cells (ASC) and low-grade squamous intraepithelial lesion (LSIL), the sensitivity to detect CIN2+and CIN3+lesions were 85.7% and 87.5%, respectively, and the specificity were 45.5% and 44.1%, respectively. Conclusions: p16/mcm2 dual staining has higher sensitivity than cytology test and better specificity than HPV test. It can identify high-grade cervical lesions and guide the classification of CIN. p16/mcm2 might be used as an innovative biomarker for cervical cancer screening.

[Clinical value of p16/Ki-67 immunocytochemical dual staining in cervical cancer screening]

Objective: to investigate the clinical value of p16/Ki-67 immunocytochemical dual staining (abbreviated as p16/Ki-67 dual staining) in cervical intraepithelial neoplasia (CIN) and cervical cancer screening. Methods: From July to November 2015, a total of 980 women attending cervical cancer screening and receiving high-risk human papillomavirus (HR-HPV) test and thinprep cytologic test (TCT) were included in the study. p16/Ki-67 immunocytochemical dual staining was performed on residual cytologic specimens and compared with histopathology results. Results: The expression risks of p16/Ki-67 in HPV16/18 group and another HR-HPV group were higher than HPV negative group, with an odds ratio of 10.64 (95%CI: 5.66~20.02) and 5.40 (95%CI: 3.62~8.04), respectively. The positive rate of p16/Ki-67 increased with the grade of TCT and histologic diagnosis, and was higher in both CIN2 and CIN3 groups than normal group (P<0.05). The sensitivity of p16/Ki-67 to detect CIN2+ and CIN3+ lesions was 89.3% and 94.1%, respectively, and the specificity was 69.3% and 66.8%, respectively. The sensitivity of TCT to detect CIN2+ and CIN3+ lesions was 60.7% and 64.7%, respectively, and the specificity was 49.3% and 49.1%, respectively. Conclusions: Compared with TCT, p16/Ki-67 dual staining has higher sensitivity and specificity. It can identify high-grade cervical lesions and guide the classification of CIN. p16/Ki-67 dual staining in conjunction with HPV test may be considered as an efficient method for cervical cancer screening.

[Basic characteristics and survival analysis of patients with hepatocellular carcinoma]

Objective: To analyze the basic characteristics of patients with hepatocellular carcinoma (HCC), and further explore the major factors affecting the prognosis of HCC patients. Methods: A total of 800 HCC patients were randomly selected from the Cancer Hospital, Chinese Academy of Medical Sciences. Their clinical and follow-up information was obtained from medical record. Univariate analysis of variance, Kaplan-Meier method and Cox regression analysis were used to analyze the patients' age at diagnosis and survival time, etc. Results: The average age of diagnosis was 55.04 years among all the 800 HCC patients, and the sex ratio of male to female was 4.48. The infection rates of HBV and HCV were 78.6% (629/800) and 5.8% (46/800), respectively. The smoking rate was 41.0% (328/800) and the alcohol consumption rate was 38.5% (328/800). 259 (32.4%) patients underwent radical treatments with liver resection as major therapy, and 541 (67.6%) patients adopted non-radical treatments with transcatheter arterial chemoembolization (TACE) as major therapy. The 1-, 3- and 5-year survival rates of the HCC patients were 73.2%, 53.7% and 42.4%, respectively. The risk factors for prognosis included alcohol abuse and treatment methods. The HR of alcohol abuse was 1.326 (95%CI: 1.058 to 1.661) and HR of treatment methods was 3.301 (95% CI: 2.483 to 4.387). Conclusions: Men account for the majority of HCC patients, and most patients have a lower age at diagnosis and adopt non-radical treatments. The exposure rates of HBV infection and alcohol abuse of HCC patients are significantly higher than those of general population. The major risk factors affecting prognosis and survival are treatments and alcohol abuse. Alcohol abuse and HBV may have synergistic effects on the survival of HCC patients.

[Changes in genotype prevalence of human papillomavirus over 10-year follow-up of a cervical cancer screening cohort]

Objective: To evaluate the dynamic variation of genotypes distribution of human papillomavirus (HPV) over 10-year follow-up in a cervical cancer screening cohort. Methods: Based on the Shanxi Province Cervical Cancer Screening Study Ⅰ cohort, we detected HPV genotypes on the well-preserved exfoliated cervical cells from women who were tested HPV positive from year 2005 to year 2014 using reverse linear probe hybridization assay. The changes of prevalence of type-specific HPV over time among the overall population were estimated using linear mixed models. The association between the type-specific HPV and cervical intraepithelial neoplasia grade 2 or worse (CIN2 +) was calculated by linear Chi-square test. Finally, the trends of multiple infections of HPV with the increase of the age were analyzed. Results: During the cervical cancer screening of the overall population from 2005 to 2014, the most common genotypes among the population were HPV16 and 52. The prevalence of HPV16 decreased over time from 4.6% in 2005 to 2.2% in 2010 and 2014 (F=8.125, P<0.001). The prevalence of HPV52 remained pretty stable and HPV33, 51 and 58 slightly decreased then apparently increased. Further stratification analysis by pathological lesions showed the same trend of the HPV prevalence for the histology normal women with the overall population. Of note, for those women with the cervical intraepithelial neoplasia (CIN2 +), the detection rate of HPV16 decreased from 65.22% in 2005 to 41.03% in 2010 and finally to 31.58% in 2014 (χ(2)=4.420, P=0.036) and that of HPV33 substantially increased. No significant variation was found for other types of HPV. Multiple infection rate varied with the growing age of the women. Conclusions: The genotypes prevalence of HPV tended to vary over time during cervical cancer screening in the context of regular screening combining with immediate treatment for those CIN2 + women. HPV16 prevalence significantly decreased over time, which indicated that the variation of type-specific HPV prevalence should be considered when regular cervical cancer screening was organized using HPV technique.

Application values of detection of serum CA199, CA242 and CA50 in the diagnosis of pancreatic cancer

Pancreatic cancer is characterized by rapid onset, high malignancy and high mortality, thus its early diagnosis is effective for improving the survival rate of patients. To discuss the values of detection of carbohydrate antigen (CA) 50, CA242 and CA199 in the diagnosis of pancreatic cancer, this study randomly selected 112 patients who were confirmed as having stage Ia~IIb pancreatic ductal adenocarcinoma (PDAC) in the Shandong Provincial Hospital, China, from May 2012 to May 2013 as a malignant group. One hundred patients with benign pancreatic lesions and 90 healthy people were selected in the same period as a benign group and a healthy control group, respectively. The levels of serum CA199, CA242 and CA50 were detected using electrochemiluminescence. Results demonstrated that the levels of serum CA199, CA242 and CA50 of the malignant group were significantly higher than those of the benign group and the healthy control group (P=0.001; P=0.003; P=0.000). The positive rate of the tumor markers of the malignant group was higher than that of the benign group and the healthy control group, and the differences had statistical significance (P=0.006; P=0.004; P=0.005). In the malignant group, sensitivity of CA199 was the highest (81.42%) as was the specificity of CA242 (80.14%). The detection of two or more markers could improve sensitivity (joint detection based on parallel tests) and specificity (joint detection based on serial tests). Thus the levels of serum tumor markers including CA199, CA242 and CA50 could be used as the assisted indicators for the diagnosis of early-stage PDAC. Joint detection of the three tumor markers is of great significance to improve the diagnostic sensitivity and accuracy of early PDAC.

[China faces a challenge of breast cancer prevention and control]

The incidence and mortality of breast cancer is in an increasing trend. In contrast to the global breast cancer situation, the prevention and control is challenging in China. Some suggestions are presented to the project of breast cancer prevention and control in China. Combining the global screening experiences with the epidemiological features of Chinese female breast cancer, aims to improve the population screening and early detection rate. Standardizing clinical diagnosis and treatment practice, aims to increase the efficacy and decrease the mortality. Intervening lifestyle and dietary behaviors, and intends to reduce risk exposure and incidence. Building national breast cancer registry provides preventive strategies. Great efforts should be made to carry out large sample multicenter clinical trails and translational research on the prevention and cotrol of breast cancer coordiated by health care service and science and technology administrations. Breast cancer prevention and control has a long way to go in China.

Clinicopathological features of invasive lobular carcinoma of the breast: A nationwide multicenter study in China

OBJECTIVE

To analyze the clinicopathological features of invasive lobular carcinoma (ILC) and compare them with invasive ductal carcinoma (IDC), hoping to find the fact of ILC in China and assist the decision makers with proper individualized treatment.

MATERIALS AND METHODS

A nationwide multicenter retrospective study was performed. A total of 4211 primary breast cancer cases were randomly selected from 1999 to 2008 in seven regions of China. ILC cases were compared with IDC by clinicopathological features and molecular subtypes.

RESULTS

A total of 135 (3.2%) ILC and 3471 (82.4%) IDC cases were included for analysis. The age, tumor size, menopausal state, family history, nodal status, and stage of ILC were similar to that of IDC. ILC was more likely to be positive for estrogen receptor (65.5% vs. 57.7%) and progesterone receptor (64.7% vs. 58.5%), and less likely to overexpress human epidermal growth factor receptor-2 (17.3% vs. 23.6%). Even though, these differences are not significant, the proportion of luminal A type of ILC is significantly larger than that of IDC (54.8% vs. 42.7%; P < 0.05).

CONCLUSION

ILC has a larger proportion of luminal A type compared with IDC. Larger sample size study for better known of molecular subtypes of ILC is needed in future to individualize the treatment decision.

Attributable causes of cancer in China

BACKGROUND

Most cancers are due to modifiable lifestyle and environmental risk factors, and are potentially preventable. No studies have provided a systematic quantitative assessment of the burden of cancer mortality and incidence attributable to known risk factors in China.

METHODS

We calculated the proportions of cancer deaths and new cases attributable to known risk factors in China, based on the prevalence of exposure around 1990 and national data on cancer mortality and incidence for the year 2005.

RESULTS

Chronic infection is the main risk factor for cancer in China, accounting for 29.4% of cancer deaths (31.7% in men and 25.3% in women), followed by tobacco smoking (22.6% with 32.7% in men and 5.0% in women), low fruit intake (13.0%), alcohol drinking (4.4%), low vegetable intake (3.6%) and occupational exposures (2.7%). The remaining factors, including environmental agents, physical inactivity, the use of exogenous hormones and reproductive factors are each responsible for <1.0%.

CONCLUSIONS

Modifiable risk factors explain nearly 60% of cancer deaths in China, with a predominant role of chronic infection and tobacco smoking. Our findings could provide a basis for cancer prevention and control programs aimed at reducing cancer risk in other developing countries.

Use of an expanded gold standard to estimate the accuracy of colposcopy and visual inspection with acetic acid

We estimate the accuracy of colposcopy and visual inspection with acetic acid (VIA) while minimizing the effects of misclassification bias, and maximizing ascertainment of disease. VIA was performed by experienced physicians on a population-based sample of women aged 30 to 49 years in rural Shanxi province, China. Each woman received VIA, liquid-based cytology (LBC) and hybrid capture 2 (hc2, QIAGEN, Gaithersburg, MD; formerly Digene Corporation). Any woman who tested positive on any test had colposcopy, endocervical curettage (ECC) with directed biopsies as necessary and 4-quadrant random biopsies from normal-appearing areas of the cervix. A standard diagnosis based on colposcopy and directed biopsy, and an expanded diagnosis including ECC and 4-quadrant random biopsy were generated for each woman. In 1,839 women, use of the expanded versus the standard diagnostic criteria increased the prevalence of histologically confirmed high-grade cervical intraepithelial neoplasia and cancer (CIN2+) from 3.2% (59/1,839) to 4.2% (77/1,839) and decreased the sensitivity of VIA for CIN2+ from 69.5% (95% CI: 56.8-79.8) to 58.4% (95% CI: 47.3-68.8%) with little change in specificity of approximately 89%. Compared with the expanded diagnostic criterion, the sensitivity of a visual diagnosis of high-grade CIN or cancer by a colposcopist was 49.4% (95% CI: 38.2-60.5). The use of an expanded diagnostic criterion in this study yielded more conservative estimates of the sensitivity of VIA and colposcopy.

Human papillomavirus type-distribution in condylomata acuminata of mainland China: a meta-analysis

The aim of this work was to study the human papillomavirus (HPV) type-distribution in condylomata acuminata (CA) of mainland China and to estimate the potential role of HPV prophylactic vaccines for CA in mainland China. Forty-three studies using polymerase chain reaction to detect HPV were included in this meta-analysis, and totally 5247 CA cases and 436 controls were included. The overall and type-specific prevalence of HPV 6, 11, 40, 42, 43, 44 were estimated using non-conditional logistic regression model. Overall HPV prevalence was 84.2% and 4.6% for CA and controls, respectively. Estimated HPV types 6, 11, 40, 42 positive fractions in CA were 54.9%, 41.1%, 2.7% and 2.0%, respectively, and exactly 0% for HPV types 43 and 44. HPV 6 and/or 11-positive fractions were 83.0% in mainland China. Thus, prophylactic HPV vaccine has the potential to protect up to 83% of CA cases in mainland China.

Human papillomavirus type-distribution in the cervix of Chinese women: a meta-analysis

Summary

The aim of the study was to determine human papillomavirus (HPV) type-distribution in the cervix of Chinese women, and to estimate the potential future impact of HPV prophylactic vaccines for cervical cancer prevention in China. A total of 32 studies using polymerase chain reaction for HPV detection were included in the meta-analysis, including 2844 invasive cervical cancer (ICC), 820 high-grade squamous intraepithelial lesions (HSIL), 432 low-grade squamous intraepithelial lesions (LSIL) and 2902 women with normal cytology/histology. The overall and type-specific HPV prevalence of 18 HPV types (HPV 6, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 70, 73 and 82 of different cervical stages) were estimated. Overall HPV prevalence was 83.7%, 66.2%, 61.3% and 11.2% in ICC, HSIL, LSIL and normal, respectively. HPV 16 was the predominant type in all cervical stages. Estimated HPV 16/18-positive fractions in ICC, HSIL, LSIL and normal were 69.7%, 45.5%, 32.23% and 4.6%, respectively. HPV-16/18 vaccine has the 69.7% potential prevention in ICC. HPV 58 and 52 were the priority HPV types in Chinese women.

Human papillomavirus infection in Shenyang City, People's Republic of China: A population-based study

To investigate the prevalence of, and risk factors for, cervical infection with human papillomavirus (HPV) in Shenyang City, People's Republic of China, we interviewed and obtained cervical cell samples from 685 women aged 15-59 years enumerated from local population lists. Human papillomavirus DNA was detected in cervical cell samples using a GP5+/6+-based PCR assay for 44 HPV types. Human papillomavirus prevalence was 16.8% overall and 13.6% among women without cervical abnormalities (16.6% and 12.4%, respectively, age-standardised to the world standard population), with no significant trends in HPV prevalence by age group. Of the 32 types identified, high-risk HPV types predominated in all age groups, HPV16 being the most common (3.4% of all women), followed by HPV52 (2.5%) and 58 (1.9%). Multiple-type infections accounted for 31.3% of all infected women. Not being married, reporting multiple sexual partners and husband's extramarital sexual relationships were all significantly associated with being HPV-positive. The disclosure of a relatively high HPV prevalence in Shenyang, in comparison with other worldwide populations, raises important questions concerning the prevention of cervical cancer in China, especially given the promising efficacy of prophylactic HPV vaccines.

Prevalence of dementia in rural China: impact of age, gender and education

OBJECTIVE

To determine the prevalence of dementia and Alzheimer's disease (AD) in rural China.

METHODS

A cross-sectional study was conducted within a cohort of adults older than 50 years of age in Linxian County, China. A Chinese version of the Mini-Mental State Examination (CMMSE) was used to screen cases of possible dementia. Three different cutoff points on CMMSE were applied depending on the participant's level of education. The participants then were given psychiatric interviews, medical and neurological examinations, and psychometric tests to ascertain the clinical diagnoses of dementia and AD.

RESULTS

Among the 16,095 participants, 5.26% were screened positive with 374 diagnosed as having dementia. Among them, AD accounted for 80.5%. The adjusted prevalence rates were 0.33%, 0.89%, 3.43%, and 8.19% in people in age groups 50-54, 55-64, 65-74, and 75 and above, respectively. The prevalence of AD correlated with the participant's level of education, and was 2.61%, 0.94%, and 0.56% in the illiterate group, in the primary school group, and in the middle school or higher group, respectively. Adjusted by education levels a higher prevalence in women was observed in the illiterate group.

CONCLUSIONS

The prevalence of dementia in this population is similar to that reported from other areas in mainland China and Taiwan with aging being a significant risk factor. After controlling for age, being a female and having received less number of years of education were associated with an higher prevalence of AD.

Human papillomavirus infection in Shanxi Province, People's Republic of China: a population-based study

To investigate the prevalence of, and risk factors for, cervical infection with human papillomavirus (HPV) in the rural province of Shanxi, People's Republic of China, which has relatively high cervical cancer mortality rates, we interviewed and obtained cervical cell samples from 662 women aged 15–59 years. A total of 24 different HPV types were identified using a GP5+/6+-based PCR assay able to detect 44 different HPV types. Human papillomavirus prevalence was 14.8% overall and 9.6% among women without cervical abnormalities (14.2 and 8.9%, respectively, age standardised to the world standard population). Multiple-type infections accounted for 30.6% of all infections. By far the most commonly found type was HPV16 (5.7% of all women and 38.8% of HPV-positive women), followed by HPV 58, 52, 33 and 18. Unlike most previous studies published, HPV prevalence was lower among women younger than 35 years (8.7%) than those older than 35 years (17.8%). High-risk HPV types predominated in all age groups. Although low-risk HPV types were rare in young women, they became more common with increasing age. 92.3% of women with cervical intraepithelial neoplasia grade 3 were infected with high-risk HPV types, but none with low-risk types only. No significant difference in HPV positivity was observed by educational level, sexual habits, reproductive history or use of contraceptive methods in this rural low-income Chinese population.

Dietary factors and smoking as risk factors for PD in a rural population in China: a nested case-control study

BACKGROUND

Dietary factors and history of smoking remain elusive in the pathogenesis of Parkinson's disease (PD).

OBJECTIVE

We investigated the association of environmental factors with PD in a rural population in China.

METHODS

Subjects were participants of a past nutritional intervention trial. Information on their characteristics was collected during the baseline interview of the trial. Control subjects were randomly selected from the same cohort and frequency matched for sex, age and residential area.

RESULTS AND CONCLUSION

Among 16,488 subjects surveyed, we diagnosed 464 subjects with PD. Then, four sex- and age-matched controls were paired with each definite PD case. A total of 85 cases and 340 controls were analyzed. Meat consumption and the body mass index (BMI) were inversely associated with PD. The PD risk declined with the increment of BMI. A history of gastric ulcer was associated with an increased risk of PD. As to smoking, there seemed an increased risk of PD among individuals who smoked regularly, non-significantly. However, a significantly increased risk of PD was found among those who smoked more than 30 pack-years.

The prevalence of PD in a nutritionally deficient rural population in China

OBJECTIVES

In most reports, the prevalence of PD in mainland China is lower than in western populations. To estimate PD prevalence in China, we performed a cross-sectional study in a rural population in Linxian County, China.

PRIMARY OUTCOMES

Clinical diagnosis of PD.

RESULTS

Among the 16,488 participants examined, the overall age- and gender-adjusted prevalence rate of PD was 522/100,000 (95% CI: 477-567) assuming no cases of PD would be found among those younger than 50 years of age. The gender-adjusted prevalence rates were 103 (95% CI: 83-123), 621 (95% CI: 572-670), 902 (95% CI: 843-961), and 1744 (95% CI: 1662-1826) per 100,000 in age groups 50-59, 60-69, 70-79, and 80 and above, respectively.

CONCLUSIONS

The estimated prevalence of PD in Linxian, China is higher than most of those reported from other areas in China, and similar to those reported from non-Asian populations.

Shanxi Province cervical cancer screening study II: Self-sampling for high-risk human papillomavirus compared to direct sampling for human papillomavirus and liquid based cervical cytology

The objective of this study was to compare the sensitivity and specificity of a new method for self-sampling for high risk human papillomavirus (HPV) with direct sampling and liquid based cervical cytology. In Shanxi Province, China, 8,497 women (ages 27-56) underwent a self-sample for HPV using a conical-shaped brush placed into the upper vagina and rotated. Three to sixteen months later the women were screened with liquid-based cytology and direct HPV tests. Subjects with any abnormal test underwent colposcopy and multiple biopsies. Mean age was 40.9 years. 4.4 percent of subjects had >or=CIN II, 26% a positive self-sample and 24% a positive direct test for HPV. The sensitivity for detection of >or=CIN II was 87.5% for self-sampling, and 96.8% for the direct test (P < 0.001). The specificity was 77.2% for the self-sample and 79.7% for the direct test. With an abnormal Pap defined as ASCUS or greater the sensitivity of the Pap for the detection of >CIN II was 88.3% and the specificity was 81.2%. We conclude that self-sampling for HPV is less sensitive for >CIN II than the direct test, but similar to liquid based cytology.

Shanxi Province cervical cancer screening study II: Self-sampling for high-risk human papillomavirus compared to direct sampling for human papillomavirus and liquid based cervical cytology

The objective of this study was to compare the sensitivity and specificity of a new method for self-sampling for high risk human papillomavirus (HPV) with direct sampling and liquid based cervical cytology. In Shanxi Province, China, 8,497 women (ages 27–56) underwent a self-sample for HPV using a conical-shaped brush placed into the upper vagina and rotated. Three to sixteen months later the women were screened with liquid-based cytology and direct HPV tests. Subjects with any abnormal test underwent colposcopy and multiple biopsies. Mean age was 40.9 years. 4.4 percent of subjects had ≥CIN II, 26% a positive self-sample and 24% a positive direct test for HPV. The sensitivity for detection of ≥CIN II was 87.5% for self-sampling, and 96.8% for the direct test (P < 0.001). The specificity was 77.2% for the self-sample and 79.7% for the direct test. With an abnormal Pap defined as ASCUS or greater the sensitivity of the Pap for the detection of ≥ CIN II was 88.3% and the specificity was 81.2%. We conclude that self-sampling for HPV is less sensitive for ≥ CIN II than the direct test, but similar to liquid based cytology.

Patient Acceptance of Self-Sampling for Human Papillomavirus in Rural China

OBJECTIVE.: To test a new survey instrument and determine the acceptance and potential barriers of cervicovaginal self-sampling for high-risk human papillomavirus in rural Chinese women. MATERIALS AND METHODS.: Data from thirteen survey questions assessed acceptance of the self-sampling procedure. Pain, comprehension, and cultural beliefs were potential barriers evaluated by the survey. RESULTS.: A total of 1,560 women were surveyed. The average and mode number of steps of the self-sampling procedure recalled was 5 (out of 7). Ninety-one percent preferred performing the test at a clinic versus their home. The major barrier encountered was related to the educational level of the women. CONCLUSIONS.: The measure performed well in this population. The self-collection brush was well accepted by these women. Education is the largest hurdle to overcome in implementing a self-sampling screening program.

[Status of screening tests for cervical cancer and its precancerous lesion]

Several screening methods for cervical cancer and its precancerous lesion are reviewed. Cervical cancer screening using visual inspection, colposcopy, oncogenic human papillomavirus DNA testing, liquid-based monolayers and automated Pap smear screening instruments are all potentially valuable when used alone or in combination. Newly developed techniques provide an opportunity to extend practical cervical cancer screening to large population in limited resource areas, and help do more cost-effectiveness of screening tests in high risk population.

Shanxi Province Cervical Cancer Screening Study: a cross-sectional comparative trial of multiple techniques to detect cervical neoplasia

OBJECTIVE

The aim of this study was to design a cervical cancer screening algorithm for the developing world that is highly sensitive for cervical intraepithelial neoplasia (CIN) II, III, and cancer and highly specific for CIN II and III, making it possible to ablate the transformation zone without histologic confirmation.

METHODS

In rural Shanxi Province, China, we examined 1997 women ages 35-45. Each subject underwent a self-test for intermediate and high-risk HPV (by HC-II assay), fluorescence spectroscopy, a liquid-based Pap (read manually and by computer and used as a direct test for HPV), a visual inspection (VIA) diagnosis, and colposcopy with multiple cervical biopsies.

RESULTS

Mean age was 39.1 +/- 3.16 years, mean number of births was 2.6 +/- 0.93. Based on tests administered, 4.3% subjects had > or =CIN II. All subjects with > or =CIN II had either a ThinPrep Pap (> or =ASCUS) or a positive HPV direct test. The sensitivity and specificity for the detection of > or =CIN II were, respectively, 83 and 86% for the HPV self-test, 95 and 85% for the HPV direct test, 94 and 78% for the ThinPrep Pap (> or =ASCUS), 77 and 98% for the ThinPrep Pap (> or =HGSIL), 94 and 9% for fluorescence spectroscopy, 71 and 74% for VIA, and 81 and 77% for colposcopy.

CONCLUSION

Based on these data and the existing healthcare infrastructure in China, we believe that further refinement of primary HPV screening using centralized labs is indicated. Self-testing in the local villages may be effective with improvements in the devices and techniques.

Sphingolipids as biomarkers of fumonisin exposure and risk of esophageal squamous cell carcinoma in china

OBJECTIVE

Ecologic studies of esophageal squamous cell carcinoma (ESCC) have reported an association with consumption of maize contaminated with Fusarium verticillioides, which produce fungal toxins referred to as fumonisins. Fumonisins disrupt sphingolipid metabolism and serum sphingolipids have been proposed as biomarkers of fumonisin exposure. We conducted a prospective nested case-control study to examine the relationship between serum sphingolipids and ESCC incidence.

METHODS

Cases and controls were selected from a large prospective trial conducted in Linxian, People's Republic of China. Ninety-eight ESCC cases were randomly selected from the 639 incident ESCC ascertained during the initial 5.25 years of follow-up: 185 controls were also randomly selected based on the distribution of cases among six age and sex strata. Concentrations of sphinganine and sphingosine were determined by high-performance liquid chromatography in serum collected at the study baseline.

RESULTS

No significant associations were found between serum sphingosine, sphinganine, or the sphinganine/ sphingosine ratio and ESCC incidence in conditional and unconditional logistic regression models with adjustment for age, sex, tobacco use. and alcohol use.

CONCLUSION

Our study is the first prospective study to assess the relationship between sphingolipid levels, as biomarkers of fumonisin exposure, and cancer incidence. We found no significant association between sphingolipid levels and risk of ESCC.