Eliminat Cervical Cancer, Focusing on Primary Prevention / 肿瘤防治研究

As one of the most severe malignant tumors, cervical cancer poses a significant threat to women. In 2020, the World Health Organization (WHO) introduced the "Global Strategy to Accelerate the Elimination of Cervical Cancer" in response to well-established tertiary prevention measures. Primary prevention measures prioritize health education and the administration of prophylactic human papillomavirus (HPV) vaccines. China currently offers five HPV vaccines supported by extensive research data specific to the Chinese population. This paper discusses the application of HPV vaccines in China and related issues that need to be paid attention to.

Screening for cervical cancer and diversion of abnormal screening results / 中国医师杂志

Cervical cancer is still a serious threat to the health of women in China. The current strategy is a three-level prevention strategy, among which the diversion of screening and screening abnormalities in the secondary prevention is an important link in preventing cervical cancer. For more than 20 years, China has implemented diversified screening methods such as cytological examination, high-risk human papillomavirus (HPV) testing, and naked eye screening. With the discovery that high-risk HPV infection is closely related to the occurrence of cervical cancer, the screening method for cervical cancer has shifted from cytological examination to HPV testing as the preferred screening method. This article introduces the advantages and disadvantages of high-risk HPV testing and cytological examination as screening methods, and proposes the issues that need to be paid attention to in screening; The principle of diverting screening abnormalities was proposed, and it was proposed that in the process of diverting, individualized and refined management principles should be implemented for screening abnormality projects based on the patient′s age and fertility requirements.

Effect of ultrasound-guided intervention with methotrexate combined with lauromacrogol on uterine wall thickness and menstrual recovery time in patients with uterine scar pregnancy / 中国基层医药

Objective:To investigate the effects of ultrasound-guided intervention with methotrexate combined with lauromacrogol on uterine wall thickness and menstrual recovery time in patients with uterine scar pregnancy.Methods:Sixty patients with uterine scar pregnancy who received treatment in Jinhua Wenrong Hospital, Jinhua Central Hospital, and Yiwu Maternity and Children Hospital from February 2019 to February 2020 were included in this study. They were randomly assigned to receive either uterine artery embolization treatment ( n = 30, control group) or ultrasound-guided interventions with methotrexate combined with lauromacrogol ( n = 30, study group). The success rate of treatment, uterine wall thickness at the scar, menstrual recovery time, hospitalization time, hospitalization expenses, incidence of adverse reactions, serum levels of beta-human chorionic gonadotropin (β-HCG) and high sensitivity C-reactive protein (hs-CRP) after 7 days of treatment and uterine wall thickness before and after treatment were compared between the study and control groups. Results:After treatment, the success rate of treatment in the study group was significantly higher than that in the control group [96.67% (29/30) vs. 70.00% (21/30), χ 2 = 7.680, P < 0.05]. Before treatment, there were no significant differences in β-HCG and hs-CRP levels between the control and study groups ( t = -0.197, 0.197, both P > 0.05). After treatment, serum level of β-HCG in the control and study groups was significantly decreased ( t = 22.803, 10.233, both P < 0.01), and serum level of hs-CRP in the control and study groups was significantly increased ( t = -16.357, 7.854, both P < 0.001) compared with before treatment. After treatment, there were no significant differences in serum β-HCG and hs-CRP levels between the control and study groups ( t = 20.413, -20.306, both P < 0.05). After treatment, the incidence of adverse reactions in the study group was significantly lower than that in the control group [6.67% (2/30) vs. 30.00% (9/30), χ 2 = 5.455, P < 0.05). After treatment, menstrual recovery time, hospitalization time and hospitalization expenses in the study group were shorter or less than those in the control group ( t = 5.080, 5.398, 7.599, all P < 0.05). There was no significant difference in the thickness of uterine wall at the scar site between the two groups ( t = -1.045, P > 0.05). Conclusion:Ultrasound-guided intervention with methotrexate combined with lauromacrogol for treatment of uterine scar pregnancy can effectively increase the success rate of treatment, promote the restoration of menstruation, shorten the length of hospital stay, and is highly safe.

Clinical analysis of 18 children with Prader-Willi syndrome / 中华实用儿科临床杂志

Objective:To study the clinical features of children with Prader-Willi syndrome(PWS).Methods:Eighteen cases of PWS were collected from July 2016 to November 2018 in Shenzhen Maternal and Child Healthcare Hospital, Southern Medical University.The clinical data of children with PWS were analyzed retrospectively.Results:There were 12 males and 6 females in 18 cases with PWS.The diagnosis age ranged from 25 days to 9.5 years old [(3.09±3.02) years old]. Among them, 11 cases were in infancy (≤3 years old) and 7 cases after infancy (>3 years old). The main clinical features of infants with PWS were 11 cases of gonadal dysplasia (100.0%), 11 cases of psychomotor retardation (100.0%), 10 cases of hypotonia (90.1%), 6 cases of feeding difficulty and weak cry (54.5%). After infancy the main clinical features included 7 cases of psychomotor retardation (100.0%), 5 cases of hyperphagia(71.4%), 5 cases of obesity (71.4%), 5 cases of abnormal behavior problems (71.4%) and 4 cases of visual problems (57.1%). The clinical features of all patients throughout the developmental stage were as follows: decreased fetal movement, hypoplasia, neonatal hypotonia, weak cry, feeding difficulty, psychomotor delay, hyperphagia, obesity, abnormal behavior problems, and so on.Conclusions:The clinical features of PWS vary with age.The main clinical features in the infancy are hypotonia, weak cry, difficulty feeding and gonadal dysplasia.After infancy, there are hyperphagia, obesity, behavior and visual problems.And psychomotor retardation is present in the whole developmental stage of children with PWS.Early diagnosis and treatment are important for improving the prognosis of PWS.

Survey of the acceptance status of HPV self-sampling screening in female population for cervical cancer / 中华妇产科杂志

Objective To investigate the acceptance of HPV self-sampling mode in cervical cancer screening population and explore its feasibility. Methods From March 5 to 15, 2018, researchers investigated women who participated in cervical cancer screening organized by Beijing Shunyi Women＇s and Children＇s Hospital in the form of questionnaires. Questionnaires were conducted on their acceptance status and the factors that affect the self-sampling experience. The specific contents of the questionnaires were as follows: (1) the experience of using self-sampling included operability, comfortable, sample time-consuming, bleeding or not after sampling; (2) psychological changes after self-sampling, including the willingness to accept self-sampling again, the worrying problems during self-sampling process. According to whether or not have operating video guidance, the self-sampling experience and psychological changes after self-sampling were compared. Results (1) There were 1 375 women participated in the questionnaire survey, and 86.55% (1 190/1 375) of them thought the self-sampling was convenient, 78.40% (1 078/1 375) thought it was not uncomfortable, 88.58% (1 218/1 375) thought the sampling time was fast (less than 5 minutes), 94.04% (1 293/1 375) self-sampling without bleeding; and 83.27% (1 145/1 375) were willing to self-sampling for cervical cancer screening again, 85.82% (1 180/1 375) were afraid of inaccurate sampling. (2) Among the 1 375 women, 1 202 were in the video guidance group and 173 were in the non-guidance group. The self-sampling experience of women in video guidance group was better than those of non-guidance group in operability, comfortable, sampling time-consuming and bleeding after sampling. The proportion of women who willing to self-sampling again was higher than that of non-guidance group (86.69% vs 59.54%, respectively). The proportion of women who worried operating incorrectly was lower than that of non-guidance group (11.23% vs 32.37%, respectively). The differences were significant (all P<0.05). Conclusions Self-sampling for HPV testing in cervical cancer screening is easy to operate and has little discomfort complaint. It is feasible in cervical cancer screening. Operational video guidance during the screening process could effectively improve the women＇s experience and willingness to self-sampling again in the future.

Study on clinical management of HPV+/Pap-during cervical cancer screening / 中华妇产科杂志

Objective To study the clinical management way for HPV+/papanicolaou (Pap)-during cervical cancer screening.Methods To analyze retrospectively the data from the patients who had loop electrical excision procedure (LEEP) for biopsy confirmed cervical intraepithelial neoplasia (CIN)Ⅱ in Peking University People's Hospital from Jan.2010 to Dec.2014.Results (1) For biopsy confirmed CINⅡ,HPV positive rate was 98.5％ (135/137),Pap test positive [≥atypical squamous cell of undetermined significance (ASCUS)] rate was 69.3％ (95/137),there was significant difference between them (x5=43.32,P＜0.01).(2) For the 42 patients with HPV+/Pap-,whose cytology slides were reviewed again.Among them,the interpretations of there were 16 cases confirmed as the same before,while 26 cases were changed to abnormal (≥ASCUS).Cytology be misdiagnosed was 19.0％ (26/137) at the first review.Among the 26 cases,13 (50.0％) cases were missed for the little amount of abnormal cells,8 (30.8％) cases for mild atypical morphology changed;the other 5 (19.2％) cases missed for stain problems.(3) For the cervical LEEP samples,37 cases of the pathology diagnosis were upgrade to CIN Ⅲ+,among them,2 cases of microinvasive cervical carcinoma,1 case of invasive cancer,34 cases of CIN Ⅲ;37 cases were CINⅠ or no lesion found;63 cases were still CIN Ⅱ.Four to six months later after LEEP,the cytology abnormal rate was 11.7％ (16/137),and the HR-HPV positive rate was 34.3％ (47/137).Conclusions Compared with cytology alone,cytology combined with HPV testing increase the sensitivity of cervical high grade lesion.For the cases of HPV+/Pap-cases,the cytology slides should be reviewed.The quality control of cervical exfoliate sample collection and interpretation should be strengthened.LEEP procedure is not only a treatment method,but also it could provide samples to confirm the diagnosis.

Effect of Tegafur,Gimeracil and Oteracil Potassium Capsules on peripheral blood TPS,sMICA,HIF-1αand Her-2 in advanced cervical cancer / 中国生化药物杂志

Objective To investigate the effect of Tegafur, Gimeracil and Oteracil Potassium Capsules ( TS-1 ) on peripheral blood tissue polypeptide antigen (TPS), soluble MHC class I chain-related molecules A (sMICA), hypoxia-inducible factor-1 (HIF-1α) and human epidermal growth factor receptor 2 ( Her-2 ) in the treatment of patients with advanced cervical cancer.Methods 80 cases with advanced cervical cancer were selected and divided into two groups, 40 cases in the control group were treated with routine clinical therapy, 40 cases in the experimental group were treated with TS-1.Tumor markers, TPS,sMICA,HIF-1αand Her-2 were compared before and after the treatment.Results Compared with the control group, the levels of tumor antigen TA-4,carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCCA) in the experimental group were lower (P<0.05); the TPS, HIF-1, sMICA and Her-2 were lower (P<0.05), and the total effective rate in the treatment group was higher (P<0.05).Conclusion TS-1 has a obvious clinical efficacy in the treatment of advanced cervical cancer.It is speculated that the possible mechanism may reduce the serum tumor marker levels via reducing the TPS and SMICA, HIF-1 alpha, HER-2 levels.

Effect of neonatal resuscitation training in both Mandarin and Uygur in Uygur area in Xinjiang,China / 中华围产医学杂志

ObjectiveTo explore an appropriate way and its effect on neonatal resuscitation training in Uygur area of Xinjiang, China.MethodsFrom October 2014 to February 2015, obstetricians, neonatologists (pediatricians), midwives and anesthetists from Turpan Region Central Hospital, Turpan City People's Hospital,Aksu Region First People's Hospital and other five hospitals at county level were chosen to attend the training course of neonatal resuscitation. The textbook for the course was Guidelines for Resuscitation which had been translated to Uygur language from English and the class was lead by less than ten Uygur trainees with Mandarin and Uygur when necessary in addressing some difficult or important points. The duration of theoretic courses took 6 h and the operational course took 8 h. Theorectical exam was taken before, immediately after and three months after (before re-training) the training. The accuracy rate was applied to assess the effect of training through evaluation for each resuscitation techniques. Repeated measures analysis of variance andChi-square test were used for statistical analysis.ResultsA total of 220 health care staff were included in the study. The average score of theoretical examination after the training was higher than that before (85.68±8.52 vs 65.37±12.08,t=18.532,P=0.000), and that before re-training was lower than that after training (80.08±12.70 vs 85.68±8.52,t=-4.943,P=0.000). After the training, the proportions of Done in each item, including rapid assessment, preliminary resuscitation, correct positive pressure artificial ventilation, external cardiac massage together with artificial ventilation, proper endotracheal intubation and proper administration of resuscitation drugs, were all higher that those before [72.7%(160/220) vs 1.4%(3/220), 40.0%(88/220) vs 0%(0/220), 15.9%(35/220) vs 0%(0/220), 37.7%(83/220) vs 8.2%(18/220), 51.8%(114/220) vs 5.9%(13/220) and 48.2%(106/220) vs 10.5%(23/220), allP<0.01]. But at the time before re-training, only one proportion ofDone which was higher than those immediately after initial training was proper administration of resuscitation drugs [49.6%(109/220) vs 48.2%(106/220),χ2=9.129,P<0.05].ConclusionBilingual (Mandarin and Uygur) neonatal resuscitation training in Xinjiang minority areas might enhance the recovery skills for local medical personnel.

The Application of Noninvasive Central Blood Pressure Detection in Blood Pressure Management and Vessel Function Assessment of Hypertension / 中国医疗器械杂志

<p><b>OBJECTIVES</b>To explore the significance of noninvasive central blood pressure detection in blood pressure management and vessel function assessment of hypertension.</p><p><b>METHODS</b>A total of 348 subjects were recruited in the study and A-pulse CASP software were derived to measure the parameters of CASP and vessel function. The recruited subjects were divided into different groups for analysis according to age and disease.</p><p><b>RESULTS</b>(1) CASP in hypertension group were both higher than those in normal group, while RAI and PRT lower. (2) Hypertensive patients of which brachial blood pressure were controlled have lower CASP and RAI than those above the level. (3) Hypertensive patients whose brachial blood pressure were controlled have significantly higher CASP than normal subjects.</p><p><b>CONCLUSIONS</b>Central blood pressure is more reflective of actural blood pressure and vessel function. Enhanced control of CASP in hypertensive patients contributes to improving vessel compliance.</p>

Predictors of recurrence and prognosis in patients with stage Ⅰ and Ⅱ endometrial carcinoma / 中华妇产科杂志

Objective To explore the high-risk clinicopathological features for the recurrence and prognosis of endometrial carcinoma diagnosed as International Federation of Gynecology and Obstetrics (FIGO) stages Ⅰ and Ⅱ.Methods Three hundreds ninety-eight consecutive patients with clinical stage I,Ⅱ endometrial adenocarcinoma underwent primary surgical therapy between Oct.1990 to Oct.2010 were studied retrospectively to analyze the correlation between clinicopathological risk factors and the disease recurrence or prognosis.Results Thirty-six patients (9.0％,36/398) developed recurrence,21 of them (58.3％,21/36) relapsed within 5 years of treatment.The results shown that the disease recurrence were significantly associated with clinicopathological factors including:age [≤50 years versus ＞ 50 years,1.9％ (2/103) versus 11.5％ (34/295) ; P =0.004] ; histologic types [adenocarcinoma versus serous papillary adenocarcinoma,8.0％ (27/338) versus 6/14; P =0.000] ; tumor grade [grade 1,2 (7.4％,25/338) versus grade 3 (17.9％,10/56) ;P =0.022] ; depth of myometrial invasion [none (3.4％,2/59) versus ＜ 1/2 (7.5 ％,18/240) versus ≥ 1/2 (16.2％,16/99) ; P =0.011] ; tumor size [≤ 2 cm (5.9％,17/287) versus ＞ 2 cm (17.1％,19/111) ; P =0.000].peritoneal cytology [negative (6.9％,22/317) versus positive (23.8％,5/21) ;P =0.019] ;ER status[negative (20.8％,11/53) versus positive (5.5％,16/293) ; P =0.000] ; PR status [negative (30.0％,15/50) versus positive (4.1％,12/295) ; P =0.031].But lympho vascular space invasion (LVSI),p53 or PTEN status were not significant effect on recurrence and prognosis.Univariate analysis of survival indicated that age,histology,tumor grade,depth of myometrial invasion,tumor size,peritoneal cytology and PR status were correlated with overall survival(OS) and disease free survival (DFS ; all P ＜ 0.05),while ER status only impact on DFS (P ＜ 0.05).Conclusions The results showed that age,histologic type of carcinoma,myometrial invasion,tumor grade,peritoneal cytology,tumor size,ER and PR status are significant predictors for recurrence and prognosis of FIGO Ⅰ,Ⅱ stage endometrial carcinoma.Regular follow-up after treatment is essential for patients within 5 years.

Clinical implications and prognostic value of single and combined biomarkers in endometrial carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endometrial carcinoma is one of the most common gynecological cancers and the incidence has been increasing. This study was to identify the relationship of estrogen receptor (ER), progestrone receptor (PR), P53 protein, Ki-67 and phosphatase and tensin homolog deleted on chromosome ten (PTEN) with endometrial carcinoma, the assessment of these biomarkers and their association with clinicopathological parameters was performed.</p><p><b>METHODS</b>A total of 198 cases of primary endometrial carcinoma were investigated for ER, PR, Ki-67, P53, and PTEN antigens by immunohistochemical methods. The association of these markers with age, menopause status, histological type, FIGO stage, grading, depth of invasion, lymph node involvement and serum tumor marker was examined.</p><p><b>RESULTS</b>The percentages of Ki-67- and P53-negative endometrial tumors were significantly higher in ER-positive compared with ER-negative tumors (both P = 0.000). The same trend was evident with PR status. The percentage of PTEN-positive tumors was significantly higher in PR-positive compared with PR-negative tumors (P = 0.021), but was no difference in tumors with different ER status. There was no clear association between PTEN positivity and clinicopathological parameters except more relevance with endometrioid histotype (P = 0.013). There was a statistically significant difference in the distribution of the different combined biological factors examined in disease-free survival.</p><p><b>CONCLUSIONS</b>ER and PR status were significant predictors with staging, grading and recurrence. P53 and Ki-67 expression were inversely correlated with both ER and PR expression and have more aggressive clinicopathological features. PTEN expression was inversely correlated with PR expression but not with ER expression. The combined type of ER+PR+P53-PTEN+ was in the majority in endometrial cancer and seemed to be related to better clinical outcome. The combination of ER-PR-P53+PTEN- represented the worst disease-free survival and was strongly associated with poorest survival rate.</p>

Effect of a pilot intervention on setting up hospital-based neonatal resuscitation leading group in 12 hospitals in China / 中华围产医学杂志

Objective To evaluate the effect of a pilot intervention on setting up a hospital-based neonatal resuscitation leading group in 12 hospitals. Methods One provincial-level, two prefecturelevel and one county-level hospitals in Jiangxi, Liaoning and Hunan province were selected to participate in the intervention. A neonatal resuscitation leading group was set up in each hospital to investigate the mode of resuscitation practice training and re-training, improve and carry on the cooperation between obstetricians and pediatricians, record the steps of neonatal resuscitation of asphyxia cases and lead the exploration of the problems occurred during the process in their own hospital. The changes of asphyxia incidence and neonatal resuscitation process were analyzed to evaluate the effect of the intervention. Results (1) Incidence of neonatal asphyxia during intervention period: 315 neonatal asphyxia cases were recorded, among which 89.5 % (n = 282) were mild and 10. 5% (n=33) cases were severe asphyxia. The mean one-minute Apgar score was the lowest in county-level hospitals (5. 40±1.56), followed by provincial-level hospitals (5.63 ±1.67)and prefecture-level hospitals (6.03 ± 1.41). (2) Resuscitation was not performed according to the guidelines in 47. 9% (151/315) of asphyxia cases. Bag and mask ventilation was not performed according to guideline in 36. 5% (115/315) of cases. (3) Changes of asphyxia incidence after the intervention: the incidence of asphyxia in provincial-level (4.23 % vs 2.66 %, χ2 = 5. 021, P＜0.05)and prefecture-level (2.83% vs 1.67%, χ2 = 4. 948, P＜0.05) hospitals decreased significantly after the intervention. The incidence of severe asphyxia in both provincial-level (χ2 =3. 001, P＞0.05) and prefecture-level (χ2= 0. 966, P＞ 0. 05) hospitals decreased with no statistical significance. The asphyxia incidence in county-level hospitals decreased from 2. 48% to 1. 22% (χ2 = 2. 989, P =0. 084). The incidence of severe asphyxia in county-level hospitals decreased from 0.39% to 0. 00%(χ2=2. 567, P= 0. 035). Conclusions Setting up a hospital-based neonatal resuscitation leading group is an effective method to strengthen resuscitation practice training, promote the cooperation between departments, improve the level of neonatal resuscitation practice and therefore decrease the incidence of neonatal asphyxia in the hospital.

Cleaning and Health / 环境与健康杂志

The sanitary habitation and office are very important for human health, so cleaning is an absolutely necessary part in our living. Although cleaning presents a substantial perceived benefits for our living, there are still some risks for our health. Except for the exposures to dust and other particulate matter suspended during cleaning activities, the main health problem caused by cleaning is the cleaning products. The main hazard composition of cleaning products, air pollution, inhalation pathways, health adverse effects and the measures for reducing the exposures to indoor air pollution caused by cleaning were reviewed in this paper.

Diagnoses Evaluation of 64-slice Spiral CT Angiography in Cerebral Vascular Lesions / 医疗卫生装备

Objective To explore the diagnosis evaluation of 64-slice spiral CT angiography(CTA) in cerebral vascular disease.Methods 64-slice spiral CT angiography of 48 patients with suspected clinically cerebral vascular diseases were analyzed retrospectively.The source images were got by TOSHIBA Aquilion VCT Scanner,and all axial images were transferred to an external workstation.The reconstructed images were processed into volume rendering(VR),multiplanner reconstruction(MPR) and maximum intensity projection(MIP),the values were valuably compared with the results of surgery or DSA.Results 30 cases were aneurysms,4 cases were AVM,8 cases were cerebral artery stenosis or occlusion,6 cases were normal.Conclusion The 64-slice spiral CTA is a valuable diagnostic method for various cerebral vascular diseases.