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Objective:To evaluate high-risk human papillomavirus (hrHPV) genotyping and viral load in predicting CIN (cervical intraepi-thelial neoplasia (CIN) grade 2 or worse in a Chinese rural area population with limited health resources. Methods:We performed a population-based prospective study and enrolled 2,257 women aged 35 to 64 years from three rural screening sites of Jiangxi prov-ince. We conducted a hybrid capture (HC-2) assay to predict viral load. A HC-2 relative light unit (RLU) threshold of 10 was set to differ-entiate samples between low (<10) and high (≥10) viral loads. We also carried out a HybriMax test to detect different hrHPV geno-types in the samples. Women exhibiting positive HC-2 or HybriMax results underwent colposcopy and colposcopically directed biopsy. Women with negative or positive hrHPV test results but with normal biopsy or CIN1 were followed-up for 24 months without interven-tion (n=2,211). We used histopathological findings as outcome. Results:Of the 2,211 women, 1,636 provided complete follow-up data. Of the 132 women with a high viral load, 4 (3.03%) developed CIN2+in the same period. The relative risk (RR) of CIN2+for HC-2 posi-tivity at baseline was 42.24 (95%CI=4.76-375.2). Of the 159 women who were positive for HPV16 or HPV18 upon screening, 4 (2.52%) progressed to CIN2+(RR=33.06, 95%CI=3.72-293.9). The 2-year cumulative incidence rates of CIN2+did not significantly differ be-tween the high viral load group and the HPV16/18 group. Conclusion:The risks of CIN2+progression were higher among women with a high viral load or HPV16/18 positivity than among women with negative hrHPV. Increasing the HC-2 cut-off value to 10 RLU or using HPV16/18 positivity may be similarly used to triage hrHPV-positive women for immediate colposcopy and comprehensive follow-up.Both approaches were equally predictive of the CIN2+risk in rural area. Increasing the HC-2 cut-off value to 10 RLU may also help allo-cate health resources effectively.
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Objective: To analyze clinical characteristics and risk factors in patients with acute myocardial infarction (AMI) complicated with cardiac rupture (CR) and to explore the prevention and treatment strategy in clinical practice. Methods: A case control study was conducted in 2 groups: CR group, the patients with coronary angiography conifrmed AMI with CR,n=44 and Control group, the patients with simultaneous STEAMI and by 1:3 pair-matched ratio,n=132. Clinical information was compared between 2 groups and the relevant risk factors for predicting CR were studied by Logistic regression analysis. Results: Compared with Control group, CR group had the lower ratio of β-receptor blocker application (22.7% vs 81.4%),P<0.05. Univariate regression analysis indicated that lower body mass index, incipient MI, anterior MI, no-reperfusion therapy, delayed reperfusion therapy, lower blood pressure at admission, post-infarction angina, ventricular aneurysm, higher Gensini score, high blood levels of cretinine and BNP, low ejection fraction were the risk factors for CR occurrence in STEAMI patients, allP<0.05. Multivariate regression analysis presented that incipient MI (P<0.049, OR=7.462), post-infarction angina (P<0.000, OR=8.591), ventricular aneurysm (P<0.005, OR=4.617) and higher Gensini score (P<0.001, OR=2.788) were risk factors for CR occurrence in STEAMI patients. Conclusion: Incipient MI, post-infarction angina, ventricular aneurysm and higher Gensini score are the risk factors for CR occurrence in STEAMI patients.
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Cervical cancer is the most common malignant cancer in reproductive organ among females in China, particularly in rural areas. Primary prevention [human papillomavirus (HPV) vaccination] was not performed on a large scale, according to a popula-tion-based study in China. Therefore, we aimed to develop a secondary cervical cancer prevention model. Such model would be suit-able for national conditions in China, scientific and reasonable, of low cost, and ideal for popularization in rural areas. Jing'an county in Jiangxi province was the high risk area of cervical cancer in China. The methods of early diagnosis and treatment effectively reduced the mortality and the detection rates of cervical cancer for 40 years. The characteristics of theJing'an modelwere gradually devel-oped.Jing'an modelcan be used for cervical cancer prevention and control in China's rural areas and can be applied in other develop-ing areas worldwide.
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Objective:To investigate the prevalence of cervical infection with high-risk human papillomavirus (hr-HPV) among the rural women of Jing-an County in Jiangxi Province. Methods:A population-based cross-sectional study was conducted among rural women of ages 35 years to 59 years in Jing-an County between May 2012 and November 2012. A total of 4 673 women were enrolled. Hybrid capture2 (hc2) was detected in 2 491 women, whereas HybriMax was detected in 2 182 women to understand the different hr-HPV types. Results:The overall hr-HPV prevalence was 11.9%. Multiple-type infections accounted for 41.5%. The most commonly seen hr-HPV type was HPV52 (2.8%), followed by HPV58, HPV16, and HPV39. No significant difference was observed in the preva-lence of hr-HPV infection between women in the mountainous and the plain areas in Jing-an County. However, the age distribution of HPV infection significantly differed (P<0.001). Conclusion:Hr-HPV infection rate in Jing-an County was close to that of other areas in China. HPV52 and HPV58 appeared to be the most prevalent HPV types and should be employed as a basis for HPV prevention in this area.
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Objective To investigate the risk factors of cervical cancer in Chinese married women in recent 10 years in order to provide evidence based approaches for cervical cancer prevention and control Methods Eight case-control studies from 2002 to 2011 were selected from research literatures by using keywords such as cervical cancer, risk factors, influential factors and case-control study, cancer, risk factors, factors andcase-control study as the search term.We adopted the Mentel-Haensel fixed effect model and Dersimonion-Laird random effect model to gain a comprehensive and quantitative assessment of cervical cancer and its risk factors.Results Among the 8 case-control studies,the total number of cases and controls were 2868 and 8045,respectively.The risk factors included human papilloma virus (HPV) (RR =5.47,95 ％ CI:3.40-8.82),family history of cervical cancer (RR =2.40,95 ％ CI:1.39-4.16),number of abortions (RR =1.74,95％ CI:1.49-2.03),first sexual intercourse age number of sexual partners (1.72,95％ CI:1.36-2.16),low cultural level (RR =1.68,95％ CI:1.18-2.40).Conclusion The major risk factors for cervical cancer among married women in China included HPV,family history of cervical cancer,number of abortions,first sexual intercourse age number of sexual partners and low cultural level.
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Objective To compare the clinical effects and side events between simple synchronal radiochemotherapy(group A) and cervical local implantation chemotherapy combined with synchronal radiochemotherapy(group B) in advanced cervical cancer.Methods Sixty patients with primary cervical cancer,admitted to our hospital from January 2009 to December 2009,were enrolled into the study.The clinical staging of these patients ranged from Ⅱb to Ⅲb.The patients were randomly divided into two different therapy groups.In group A,patients received external irradiation by X-rays and intracavitary by 192 Ir and PT chemotherapy(n=30).In group B,patients received cervical local implantation of fluorouracil palliative 400-500 mg in addition of external irradiation by X-rays and intracavitary by 192 Ir and PT chemotherapy(n=30).The short-term effect and complications were compared between the two groups.Results The effective rate of group A was significantly higher than the second group(97% vs.80%,x2=4.706,P＜ 0.05).The most common complication was myelosuppression.In group A we observed 8 cases had grade Ⅰ,10 cases had grade II,9 cases had grade Ⅲ,3 cases had grade Ⅳ myelosuppression.In group B we observed 8 cases had grade Ⅰ,12 cases had grade Ⅱ,7 cases had grade Ⅲ,3 cases had grade Ⅳ myelosuppression.There were no significantly differences in the comparisons of this complication between the two groups(x2=0.432,P＞0.05).Conclusion The cervical local implantation chemotherapy combined with synchronal radiochemotherapy might improve the prognosis in advanced cervical cancer patients without increasing toxic side effects.
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e the individual choice depending on their different conditions.
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Objective To evaluate the feasibility and safety of vaginal enlarged amputation of cervix to treat patients with cervical cancer of stage Ⅰ a1 and cervical intraepithelial neoplasia grade Ⅲ(CIN Ⅲ)who were unfit for conization surgery.Methods From July 2002 to May 2007,patients with cervical cancer at stage Ⅰ a1,diagnosed by pathology after loop electrosurgical excision procedure(LEEP),large area CIN Ⅲ(the area of lesion≥3/4 on colposcopy),CIN Ⅲ coexisted with vaginal intraepithelial neoplasia (VAIN)in the superior segment of vagina,CIN Ⅱ-Ⅲ recurrence or with residual lesion,positive margin after conization of cervix,who wanted to preserve fertility and(or)corpus uteri were selected to receive vaginal enlarged amputation of cervix.Results Forty-eight eases including 5 with cervical cancer in stage Ⅰ a1,38 with large area CIN Ⅲ(9 with gland involvement),2 with residual lesion and 2 with positive margin after LEEP,1 recurrence after cold knife conization,received the procedure successfully.The median age was 34 years(range 27-40),median operation time was 60 minutes(range 30-100),median blood loss was 40 ml(range 5-300),and median hospital stay was 10 days(range 7-17).After follow-up 1-39 months,no patient had postoperative complications and recurrence,and all patients resumed normal menstrual cycle and sexual life.Condusion Vaginal enlarged amputation of cervix appears to be a safe and feasible procedure for patients with cervical cancer at stage Ⅰ a1 and CIN Ⅲ who are unfit for conization surgery.
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Objective To investigate the risk factors for ovarian metastasis and the possibility of ovarian preservation in patients with endometrial carcinoma.Methods The clinicopathological features of endometrial carcinoma patients who were diagnosed and treated initially with a surgical staging procedure from Jan 1997 to Dec 2006 in our hospital were retrospectively reviewed.Results Of the 638 cases reviewed,36(5.6%,36/638)had ovarian metastasis.Univariate analysis revealed that histological type and grade,myometrial invasion,positive peritoneal fluid cytology,pelvic lymph node metastasis,invasion of parauterine,para-aortic node metastasis and invasion of uterine serosa were significantly associated with ovarian metastasis(P＜0.05);while age,lymph-vascular invasion and cervical invasion wen not significantly associated with ovarian metastasis(P＞0.05). Factors predictive of ovarian metastasis by multivariate analysis were ranked as follows according to risk intensity:pelvic lymph node metastasis,positive peritoneal cytology,and histological grade.Conclusion In young patients with grode 1 endometrioid carcinoma,with no pelvic lymph node metastasis,no para-aortic lymph node metastasis,no myometrial invasion and with negative peritoneal fluid cytology,ovarian preservation could be considered.
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Objective To analyze the changes in epidemiology and treatment of hospitalized patients with cervical cancer during 1990-2007.Methods Overall.4648 patients witIl cervical cancer were diagnosed in our hospital from Jan 1990 to Nov 2007.but only 4223 patients with initial treatment in Oily hospital were studied retrospectively.Pearson Chi-square test was used to compare tlle age,stage,histopathologie type and treatment metheds between different times.Results (1)The meal]age of cervical cancer patients gradually decreased over the past 18 years,from 54.4 years during 1990-1999 to 47.2 years during 2000-2007:the proportion of young patients aged≤35 years increased from 4.77%(89/1865)during 1990-1999 to 11.75%(277/2358)during 2000-2007.(2)The proportion of patients with cervical cancer(stage I a-H a)increased from 14.32%(267/1865)during 1990-1999 to 40.75%(961/2358)during 2000-2007,whereas the proportion of patients with cervical cancer(stage Ⅱ b-lV)decreased from 85.68%(1598/1865)during 1990-1999 to 59.25%(1397/2358)during 2000-2007.(3)There was no significant change in histopathologie type of cervical cancer,and squamous cell careinoma of cervix remained the main type of cervical cancer.(4)The treatment pattern of cervical cancer changed significantly:radiotherapy was the main method(75.28%)for eervical cancer during 1990-1 999.but during 2000-2007.it was replaced by concurrent chemoradiotherapy(35.79%).Conclusions The proportion of young women with cervical cancer was increased during 1990-2007.and at the same period early stage cervical cancer increased.but late stage cervical cancer decreased.It is obvious that chemotherapy has become the important therapy in cervical cancer.