[Tobacco dependence status and influencing factors among smokers aged 40 or older in China].

Objective: To understanding tobacco dependence and its influencing factors among smokers aged 40 or older in China and provide scientific data for the implementation of smoking cessation intervention. Methods: The data of this study were collected from 125 surveillance sites in 31 provinces (autonomous regions and municipalities) of chronic obstructive pulmonary disease (COPD) surveillance in China (2014 and 2015). The relevant variables of smoking status and tobacco dependence among people aged 40 or older were collected by face-to-face interview. The weighted proportion of tobacco dependence and its 95%CI and influencing factors among current smokers and daily smokers aged 40 or older in China were estimated with complex sampling weights. Results: A total of 22 380 current smokers and 19 999 daily smokers were included in the analysis. The proportion of high tobacco dependence of current smokers aged 40 or older was 31.1% (29.3%-32.9%). The proportion of high tobacco dependence was higher in men than in women, and higher in rural smokers than urban smokers. The proportion was 33.3% (31.3%-35.2%) in 40 to 59 years old smokers, which was higher than older age group. The proportion of high tobacco dependence among daily smokers aged 40 or older was 35.0% (33.0%-37.0%), and was 35.8% (33.8%-37.8%) in men and 22.0% (16.8%-27.2%) in women. Among current smokers and daily smokers, with the decrease of education level, the proportion of high tobacco dependence increased. The proportion of high tobacco dependence of smokers who started smoking before 18 years old was significantly higher than those who started smoking after 18 years old. The ratio of high tobacco dependence of smokers with chronic respiratory symptoms was higher than that of asymptomatic smokers. There was no significant difference in the tobacco dependence between patients with chronic diseases or chronic respiratory diseases and non patients (P>0.05). Smokers with diabetes, cardiovascular and cerebrovascular diseases and hypertension had a slightly lower proportion of high tobacco dependence than smokers without above diseases (P<0.05). Multivariate logistic regression analysis showed that men, central and eastern regions, 40-59 age group, engaged in agriculture, forestry, animal husbandry, fishery industry, water conservancy, manufacture, transportation and commercial services occupation, low education level and smoking onset age less than 18 years old had a high risk of high tobacco dependence. Conclusions: The proportion of high tobacco dependence among current smokers aged 40 or older is high in China, so there is a huge demand for smoking cessation interventions. Effective measures should be taken to promote smoking cessation intervention in China.

[Analysis of cervical cancer screening and related factors in China].

Objective: To study the cervical cancer screening rate and related factors among women in China. Methods: In 2015, Chinese Chronic Diseases and Risk Factors Surveillance in Adults was conducted in 298 counties or districts using the multistage stratified cluster sampling in China. The study investigated 91 348 women aged 20 years or older who lived in the local at least 6 months in the past year. We collected the information about cervical cancer screening and socio-demographic factors through face-to-face interview. The screening rate was calculated by the complex sampling design and populating weighting. Rao-Scott χ2 was used to test the differences in screening rates within subgroups. Multivariable logistic regression was used to explore the factors associated with the uptake of cervical cancer screening. Results: The mean age of participants was (51±14) years old. The cervical cancer screening rate was 23.6% (n=21 346), and there was a significant difference in the screening rates among age groups. The cervical cancer screening rate in women aged 40-49 years was 34.8% (n=7 043). There was significant difference in the screening rates among geographic areas and the highest screening rate was 27.9% (n=6 707) in the eastern China. The more likelihood of uptake of cervical cancer screening was significantly associated with living in high-income regions, higher education, non-agriculture employment, higher household income, having medical insurance, and having health check-up during the past three years, and the cervical screening rate was higher (all P<0.05) . Conclusion: The cervical cancer screening rate is low in China and there was significant difference in the age and geographic areas. The uptake of cervical cancer screening is associated with local economic status, household income, education, employment, health insurance, and health check-up.

[The Breast Cancer Cohort Study in Chinese Women: the methodology of population-based cohort and baseline characteristics].

Objective: Breast cancer has been the first cancer among women with the incidence increasing gradually. In September 2016, the Breast Cancer Cohort Study in Chinese Women (BCCS-CW) was initiated, aiming to establish a standardized and sharable breast cancer-specific cohort by integrating the existing cohort resource and improving the quality of follow-up. The BCCS-CW may provide a research basis and platform for the precision prevention and treatment of breast cancer in etiology identification, prevention, early diagnosis, treatment, and prognosis prediction. Methods: We conducted a population-based perspective cohort by questionnaire interview, anthropometry, biological specimens, breast ultrasound and mammography. The cohort was followed by using regional health surveillance and ad hoc survey. Results: Finally, BCCS-CW included 112 118 women, in which 55 419 women completed the standardized investigation and blood specimens were collected from 54 304 women. The mean age of participants was 51.7 years old, 62.7% were overweight or obese, and 48.9% were menopausal. Conclusion: The BCCS-CW will provide population-based cohort resource and research platform for the precise prevention and treatment of breast cancer in Chinese women.

[The Breast Cancer Cohort Study in Chinese Women: research design and preliminary results of clinical multi-center cohort].

Objective: The incidence of breast cancer in Chinese women continues to rise. The large breast cancer cohort studies in China are relatively scarce. There are many bottlenecks in the construction of large clinical cohort for breast cancer diagnosis, treatment, and prognoses, such as inconsistent standards, high rates of lost follow-up, repeated construction, and inability to share. To better solving the difficulties and problems faced by large-scale clinical cohort research in China, this project will cooperate with several tertiary A hospitals to establish a breast cancer cohort in Chinese women. It also provides a data platform and technical support for breast cancer multi-center clinical cohort research. Methods: Based on the evidence-based medicine and expert opinion and consensus, we established a breast cancer cohort standardized indicator set-recording baseline information, diagnosis and treatment-related information of the enrolled patients, and collecting biological specimens. According to the technical specification of long-term follow-up for the endpoint, data management, and data security and in the large population-based cohort study, a standardized follow-up system for the diagnosis, treatment, and prognosis of breast cancer prospective cohorts is formed. Results: Based on standardized data sets and the computer discipline's advantage from the University of Science and Technology Beijing, we integrate the new information technology methods, including dynamic information collection terminals and social networks. Thus, the quality of control programs on compliance and intelligence data was improved, and a Chinese women breast cancer cohort database was developed. By February 2020, 12 147 patients were included in the clinical cohort database. Biological specimens'resources in cohort construction were collected and cooperated with Shandong University to research the multi-center quality control system and shared evaluation system of biobanks. Building an open and shared biobank network and forming a full chain of breast cancer research platform. Conclusion: With the implementation of the "13(th) Five-Year Plan" precision medicine research, this study provides a research foundation for precision diagnosis and treatment of breast cancer and provides data support for the country to formulate relevant medical policies.

[The Breast Cancer Cohort Study in Chinese Women: the construction and progress of the pan-shared biobank].

Objective: Biobank construction plays an irreplaceable role in the research of accurate prevention and treatment of diseases. Shared biobank network based on a large crowd queue is the way of the future. This subject is one of the key contents of national precision medicine "The Breast Cancer Cohort Study in Chinese Women: (BCCS-CW)" , aiming to solve the bottleneck of insufficient standardization and sharing. Methods: The establishment of "entity library-information library-extension library" , the widely Shared network of biobank of breast cancer specific disease cohort, and the establishment of strict standard setting and quality control standard to construct the standardized biobank. Results: This biobank provides a shared biobank resource for breast cancer risk assessment, prediction and early warning, early screening, classification, individualized treatment, efficacy and safety prediction and monitoring and other accurate prevention and treatment programs and clinical decision-making system research. Conclusion: The data of this biological sample bank is refined and complete, and the sample size of cases is sufficient, which can meet the research needs of medical big data, genomics, metabonomics, epigenetics and other fields.

[Smoking cessation in chronic obstructive pulmonary disease patients aged 40 years or older in China, 2014-2015].

Objective: To understand the smoking cessation behaviors in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China and provide evidence for COPD control and prevention. Methods: COPD patients with post-bronchodilator FEV(1)/FVC<70% were selected from COPD surveillance (2014-2015) of China, in which 5 791 current or former smokers defined by questionnaire survey were included in the study. The smoking cessation rate/ratio and the successful smoking cessation rate in COPD patients, the successful smoking cessation rate in COPD patients who ever smoked daily and the rate of attempting to quit smoking in current smokers with COPD were estimated using data adjusted by complicated sampling method. Results: The smoking cessation rate was 25.0% and the successful smoking cessation rate was 19.1% in COPD patients aged 40 years or older who ever smoked. The smoking cessation ratio was 23.1% and the successful smoking cessation ratio was 17.6% in COPD patients who ever smoked daily. The rate and ratio were higher in urban area than rural area (P<0.05) and increased with age (P<0.05). Patients who were aware of smoking being a risk factor for COPD had higher rate and ratio than patients who were not aware (P<0.05). Patients with more severe airflow limitation and patients smoking less had higher rate and ratio (P<0.05). Conclusions: The smoking cessation rate and ratio were low in COPD patients in China. More health education for COPD patients about smoking cessation needs to be strengthened. It is suggested for healthcare workers to actively advise smoking cessation and suggest smoking cessation ways for patients who smoke in their routine clinical service to increase the successful smoking cessation rate/ratio in COPD patients.

[Effect and mechanism of PCSK9 on lectin-like oxidized low-density lipoprotein receptor-1 mediated oxidized low-density lipoprotein uptake by THP-1 derived macrophages].

Objective: To investigate the effect and mechanism of proprotein convertase subtilisin type 9 (PCSK9) on lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) mediated oxidized low-density lipoprotein (ox-LDL) uptake by mononuclear macrophage (THP-1) derived macrophages. Methods: THP-1 monocyte was incubated with PMA for 48 hours to induce the differentiation into macrophages. Macrophages were pretreated with human recombinant PCSK9 protein for 1 hour and incubated with ox-LDL for 24 hours to induce foam cells. Oil red O staining was used to observe the accumulation of lipid in the control group (foam cells) and groups treated with different concentrations of recombinant PCSK9 protein, and the intracellular cholesterol content was measured by enzyme method, and mRNA and protein expressions of LOX-1 were detected by real-time PCR and Western blot. The uptake of Dil-labeled oxidized low density lipoprotein (Dil-ox-LDL) was observed by fluorescence microscopy in control group (macrophage), PCSK9 protein treated group and PCSK9 protein plus anti-LOX-1 antibody and IgG antibody treated group. mRNA and protein expression of toll-like receptor 4 (TLR4), nuclear factor-kappa B (NF-κB), cyclooxygenase-2 (COX-2) were detected in control and PCSK9 protein treated group in the absence and presence of TLR4 inhibitor (TAK-242), NF-κB inhibitor (PDTC). In addition, reactive oxygen species (ROS) production was evaluated in the absence or presence of COX-2 inhibitor (NS-398) or reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor (DPI). The mRNA and protein expression of LOX-1 in the control group (PCSK9 protein pretreated foam cells) and PCSK9 protein group in the absence or presence of TAK-242, PDTC, NS-398 and DPI respectively. Results: (1) The total optical density of intracellular lipid droplets, total cholesterol level, cholesterol ester level and cholesterol ester/total cholesterol ratio as well as expression of LOX-1 were significantly higher in PCSK9 group than those in control group (all P<0.05). (2) The fluorescence intensity of Dil-ox-LDL was significantly higher in PCSK9 group and PCSK9+IgG antibody group than in the control group (all P<0.05). The fluorescence intensity was significantly lower in PCSK9+anti-LOX-1 antibody group than in PCSK9 group and PCSK9+IgG antibody group (all P<0.05). (3) The expressions of TLR4, NF-κB and COX-2 were significantly higher in PCSK9 group than in control group (all P<0.05). The expressions of TLR4, NF-κB and COX-2 were significantly lower in PCSK9+TAK-242 group and PCSK9+PDTC group than in PCSK9 group (all P<0.05). The ROS level was significantly higher in PCSK9 group than in the control group (P<0.05). The ROS levels were significantly lower in PCSK9+NS-398 and PCSK9+DPI groups than in PCSK9 group (all P<0.05). (4) The expressions of LOX-1 mRNA and protein were lower in respective PCSK9 protein plus TAK-242, PDTC, NS-398 or DPI group than in PCSK9 protein alone (all P<0.05). Conclusion: PCSK9 may regulate LOX-1 mediated ox-LDL uptake by the THP-1 derived macrophage via TLR4/NF-κB/COX-2/ROS pathway.

[The impact of five-year Chinese rural area cervical cancer screening program on screening rate].

Objective: To assess the impact of Chinese Cervical Cancer Screening Program for Rural Area (NACCSPRA) on population-based screening rates. Methods: The subjects were selected from 2013-2014 Chinese Chronic Diseases and Risk Factors Surveillance (CDRFS2013), which adopting multi-stage stratified cluster sampling from 31 provinces. A total of 169 632 participants aged 18 years and older in 297 surveillance points were interviewed, of whom 65 476 women aged 35-64 years were included in the analysis. The surveillance points in CDRFS 2013 were divided into the screening areas and the control areas by matching points in CDRFS2014 with counties in NACCSPRA. The difference in socioeconomic status between areas was compared. The screening rates and 95% confidence interval (95%CI) were estimated by Tylar series variance method. The Propensity Score was evaluated for individuals by multivariate logistic regression and the greedy matching method based on propensity score value was used to conduct 1∶1 matching sample for the screening areas and the control areas. After matching, multivariate conditional logistic regression model was fitted to assess the impact of national cervical cancer screening intervention on the likelihood of undergoing cervical cancer screening at population level. Results: Among 65 476 subjects, 48.6% (n=31 794) was in the screening areas. Before matching, in the rural area the screening rate in the screening areas (24.0% (4 763/19 838), 95%CI: 21.8%-26.3%) was higher than that in the control areas (15.6% (2 331/14 942), 95%CI: 13.4%-17.8%); whereas in the urban area the screening rate in the screening areas (28.5% (3 413/11 956), 95%CI: 26.1%-31.0%) was similar to that in the control areas (26.3% (4 923/18 740), 95%CI: 24.1%-28.4%). After matching, in rural area the screening rate in the screening areas (23.2% (3 454/14 875), 95% CI: 20.9%-25.5%) was higher than that in the control areas (15.6% (2 315/14 875), 95% CI: 13.3%-17.8%); in urban area the screening rate in the screening areas (28.7% (3 202/11 146), 95% CI: 26.2%-31.2%) was higher than that in the control areas (23.1% (2 571/11 146), 95%CI: 20.9%-25.3%). Multivariate conditional logistic regression model showed that the cervical cancer screening rates in intervention areas significantly increased among women aged 35-64 years both in urban areas (OR=1.44, 95%CI: 1.34-1.54) and rural areas (OR=1.78, 95%CI: 1.67-1.90) as compared with those in control areas. Conclusion: The implementation of Chinese cervical cancer screening program during the five years substantially increased the population-based screening rates both in urban and rural areas.

[Survey of smoking prevalence in adults aged 40 years and older in China, 2014].

Objective: Smoking is the most important risk factor for COPD. Understanding the smoking rate, current smoking rate, average age to start smoking and average daily consumption of cigarettes among people aged ≥40 years in China can provide scientific evidence for the effective control and prevention of COPD. Methods: Data were from COPD surveillance in China (2014 to 2015) which covered 31 provinces, autonomous regions and municipalities. A total of 75 107 adults aged ≥40 years selected through multi-stage stratified cluster sampling from 125 surveillance sites (county/district) were surveyed by electronic questionnaire during face to face interviews. The smoking rate and other smoking index were estimated by using weighting complex sampling design. Results: The smoking rate and current smoking rate were 40.0% (95%CI: 38.5%-42.0%) and 31.0% (95%CI: 29.7%-32.0%), respectively, among the Chinese aged ≥40 years in 2014. The smoking rate and current smoking rate in males (74.1% and 57.6%) were much higher than those in females (5.4% and 4.0%). And the two rates were significantly higher in rural area (41.2% and 32.4%) than in urban area (38.8% and 29.5%). The mean age of smokers to start smoking was 20.1 (95%CI: 19.7-20.5) years. The younger the smokers were, the earlier their average age to start smoking was (The ages to start smoking for smokers aged 40-, 50-, 60-, ≥70 years were 18.3, 19.2, 20.9 and 23.1 years, respectively). Average daily cigarette consumption of current daily smokers was 18.9 (95%CI: 18.1-19.7) cigarettes, and the daily cigarette consumption was higher in males (19.3 cigarettes) than in females (12.5 cigarettes). Conclusion: The smoking rate in males aged ≥40 years is high in China. Compared with urban area, the smoking rate in rural area is higher, posing a big challenge for COPD control and prevention.

[Analysis on passive smoking exposure in adults aged 40 years and older in China, 2014].

Objective: To describe and analyze the passive smoking exposure level in adults aged ≥40 years in China. Methods: A total of 75 107 adults from 125 sites of COPD surveillance points in China were surveyed by electronic questionnaire during face to face interviews. After comprehensive weighting of the samples, the passive smoking exposure level was analyzed. Results: The passive smoking exposure rate of the adults aged ≥40 years was 44.9% (95%CI: 42.3%-47.5%). The exposure rate was highest in those aged from 40 to 49 years (51.0%, 95%CI: 47.9%-54.1%) in term of age groups, in those with senior high school education level and above (48.6%, 95%CI: 44.9%-52.2%) in term of education level, and in office workers (57.7%, 95%CI: 51.8%-63.7%) in term of occupation. The adults reporting passive smoking exposure every days in a week accounted for 27.7% (95%CI: 25.5%-29.8%), and those reporting household passive smoking exposure accounted for 28.3% (95%CI: 26.2%-30.5%). Logistic regression analysis showed that the passive smoking exposure level was different in different age groups and occupation groups. Conclusion: The passive smoking exposure level is still high in adults in China. Age and occupation are the influencing factors of passive smoking exposure level.

[Analysis on occupational exposure to dust and harmful gas and corresponding protection in adults aged 40 years and older in China, 2014].

Objective: To understand the current status of dust and/or harmful gas exposure in adults aged ≥40 years and corresponding protection in China, and provide evidence for strengthening the occupational protection against dust and harmful gas exposure. Methods: The data were obtained from 2014-2015 COPD surveillance in China. A total of 75 107 adults aged ≥40 years selected through multi-stage stratified cluster sampling from 125 surveillance points in 31 provinces (autonomous regions and municipalities) were surveyed in face to face interviews. Occupational exposure was defined as occupational exposure to dust and/or harmful gas for more than 1 year. The weighted percentages of exposure were estimated by using complex sampling design. Results: Among eligible 71 061 participants, the exposure rate of dust and/or harmful gas was 46.3%. The exposure rate in rural area (51.7%) was significantly higher than that in urban area (40.3%), and the exposure rate in the western area was higher than those in the eastern and central areas (P<0.001). Among the groups with different education level, the exposure rate in those with education level of primary school and below was highest (49.7%, P<0.001). The exposure protection rate was 26.7%, and the exposure protection rate was highest in the eastern area (29.9%), followed by that in the central area (27.0%) and that in the western area (22.9%) The exposure protection rate in urban area was significantly higher than that in rural area, and the exposure protection rate was lowest in those with education level of primary school and below. The regular exposure protection was taken by only 50.7% of the adults surveyed. Conclusion: The exposure rate of dust and/or harmful gas is high in China, while the exposure protection rate is very low. Health education, occupational protection and supervision should be strengthened among those with low education level, and those living in rural area and in the western area.

[Awareness of knowledge about chronic obstructive pulmonary disease and related factors in residents aged 40 years and older in China, 2014].

Objective: To understand the awareness of knowledge about COPD and related factors in residents aged ≥40 years in China. Methods: Through multi-stage stratified cluster sampling, residents aged ≥40 years were selected from 125 sites of COPD surveillance (2014-2015) in 31 provinces of China for a face to face questionnaire survey. The demographic characteristics and awareness rate of knowledge about COPD among 75 082 subjects were described as frequency and percentage. The awareness rate of knowledge about COPD and its 95% confidence interval (CI) among the residents aged ≥40 years were estimated with complicated sampling weights. Meanwhile, the knowledge awareness related factors were screened in complicated sampling data. Results: The awareness rate of COPD was 9.2%. The awareness rate of pulmonary function test was 3.6% and the awareness rate of COPD-related knowledge was 5.8%. All of the awareness rates were associated with gender, age, education level and occupation. Besides, the awareness rate of pulmonary function test and COPD-related knowledge were related with living area. Compared with females, the ORs of the three awareness rates among males were 0.88, 0.81 and 0.78. Compared with the residents aged ≥70 years, the ORs of the three awareness rates among those aged 60-69 years were 1.28, 1.08 and 1.51. Compared with the residents with education level of primary school or below, the ORs of the three awareness rates among those with college degree or above were 2.28, 3.43 and 3.14. The OR of the awareness rate of pulmonary function test among the residents in the eastern area was 1.77 compared with those in the central area. The ORs of the awareness rate of COPD-related knowledge among the residents in the eastern and western areas were 1.95 and 2.16 compared with those in the central area(all above P<0.05). Among COPD symptoms, the awareness rate of dyspnea was highest (67.9%), and among the risk factors for COPD, the awareness rate of smoking was highest (81.3%). The source of awareness of COPD for most residents was television program (38.2%). Conclusion: The awareness rate of knowledge about COPD was low in residents aged ≥40 years in China in 2014. It is necessary to strengthen the health education about COPD to improve the prevention and control of the disease.

[Study on the coverage of cervical and breast cancer screening among women aged 35-69 years and related impact of socioeconomic factors in China, 2013].

Objective: To estimate the cervical and breast cancer screening coverage and related factors among women aged 35-69 years who were in the National Cervical and Breast Screening Program, to provide evidence for improving cervical and breast cancer control and prevention strategy. Methods: Data used in this study were abstracted from the 2013 Chinese Chronic Diseases and Risk Factors Surveillance Program. A total of 66 130 women aged 35-64 years and 72 511 women aged 35-69 years were included for this study. Weighted prevalence, (with 95% confidence interval, CI) was calculated for complex sampling design. Rao-Scott χ(2) method was used to compare the screening coverage among subgroups. A random intercept equation which involved the logit-link function, was fitted under the following five levels: provincial, county, township, village and individual. Fix effects of all explanatory variables were converted into OR with 95%CI. Results: In 2013, 26.7% (95%CI: 24.6%-28.9%) of the 35-64 year-old women reported that they ever had been screened for cervical cancer and 22.5% (95% CI: 20.4%-24.6%) of the 35-69 year-olds had ever undergone breast cancer screening. Lower coverage was observed among women residing in rural and central or western China than those in urban or eastern China (P<0.000 1). The coverage among women aged 50 years or older was substantially lower than those aged 35-49 years. Those who were with low education level, unemployed, low household income and not covered by insurance, appeared fewer number on this cervical or breast cancer screening program (P<0.000 1). Women living in rural and western China were having less chance of receiving the breast cancer screening (P<0.05), but the difference was not statistically significant. Conclusion: It is essential to strengthen the community-based cervical and breast cancer screening programs, in order to increase the coverage. More attention should be paid to women aged 50 years or older, especially those socioeconomically disadvantaged ones.

[Clinical and pathologic analysis of 414 cases of renal angiomyolipomain in a single institution].

Objective: To study the different clinicopathological characteristics between classic and epithelioid renal angiomyolipoma, and the relationships between clinicopathological characteristics and biological behaviors as basis for clinical treatment. Methods: The clinicopathological and follow-up data for the patients diagnosed with renal angiomyolipoma between 2004 and 2011 were retrospectively reviewed and analyzed. Results: There were 414 cases of renal angiomyolipoma diagnosed over 8 years ago, accounting for 8.1% (414/5 287) of all renal parenchymal tumors. The patients included 122 male and 292 female (male-to-female ratio of 1.0∶2.4), mean age 44.0 years (range 15-74 years). Of these, 195(47.1%) tumors occurred in the left kidney, 212(51.2%) in the right kidney and seven (1.7%) were bilateral. Clinically, some cases presented with hypochondrial pain, hematuria or palpable masses. Histologically, 394(95.2%) were classic angiomyolipoma, 20(4.8%) were epithelioid angiomyolipoma; 54, 23 and 7 cases had hemorrhage, necrosis and cystic degeneration, respectively; and 5, 30 and 14 cases had perirenal fat invasion, atypical cells and polymorphic/giant tumor cell. There was a positive correlation between atypical cells and epithelioid tumor type, respectively. The other clinicopathological parameters did not correlate with histological type. Follow-up data was available in 360 patients, with follow-up period of 3 to 99 months. One case died from other causes. The remaining patients were free of disease. Conclusions: Angiomyolipoma is a common renal parenchyma tumor. Clinically, it is usually biologically benign. Histologically, it can be either classic or epithelioid types. The epithelioid type should be differentiated from the classic renal cell carcinoma, Mit family translocation renal tumor and renal hemangioblastoma. Atypical cells, more commonly found in the epithelioid angiomyolipoma, do not affect the clinical prognosis of patients.

[Analysis on mortality of cervical cancer and its temporal trend in women in China, 2006-2012].

Objective: To analyze the mortality of cervical cancer and its temporal trend in women in China between 2006 and 2012. Methods: The cause-of-death data about cervical cancer, which was abstracted from National Disease Surveillance Points and adjusted by special survey for underreporting, was used to analyze the age and area specific crude mortality rates of cervical cancer in China during 2006-2012. The age-standardized mortality rate was calculated by using world standardized population (Segi's). The Joinpoint regression model was used to obtain annual percentage change and 95%CI for assessing the time trend of mortality rate of cervical cancer from 2006 to 2012. Results: In 2012, the crude mortality rate of cervical cancer was 3.15 per 100 000 in women in China. The mortality rate in rural area (3.45/100 000) was higher than that in urban area (2.76/100 000), while the central area had the highest mortality rate of cervical cancer (3.77/100 000) compared with western area (3.23/100 000) and eastern area (2.54/100 000). The Segi's age-standardized mortality rate in eastern area increased by 2.9% (95%CI: 0.8%-5.0%) annually, an increase of 6.0% was observed in age group 30-59 years (95%CI: 1.6%-10.5%). However, the Segi's age-standardized mortality rate in central area declined by 4.6% (95%CI: -5.9% - -3.3%), where the declines of 3.2% and 5.7% were observed in age groups 30-59 years and ≥60 years (95%CI: - 5.0%-- 1.4% and 95% CI: - 9.3% --2.0%) and respectively. There was no significant change in cervical cancer mortality in western area. The similar trends were observed in the age-standardized mortality rate calculated according to the population of China. Conclusions: The decline of overall mortality rate of cervical cancer tended to stop in China and significant differences still exist among different areas. Our results suggest that the central/western areas and rural areas are still key areas for cervical cancer prevention and control and close attention should be paid to the increase of cervical cancer mortality in women aged 35-59 years in eastern area. It is essential to establish a systematic cervical cancer prevention network with larger population coverage to reduce the deaths caused by cervical cancer.

[The strategy for establishment of comprehensive cervical cancer prevention and control in the world].

Cervical cancer is one of the most common malignancies among women. Screening programs for cervical cancer have been implemented in many developed countries. Comprehensive systems for cervical cancer prevention and control have improved over the past 30 years, which has led to a significant decline in the morbidity and mortality of cervical cancer. Since 2009, the Chinese government has conducted the Cervical Cancer and Breast Cancer Screening Program for Rural Women on a national scale, which has substantially improved cervical cancer prevention and control. However, a comprehensive system for cervical cancer prevention has been not established in China. It is essential to investigate suitable strategies for cervical cancer prevention system in the country by referring to the experiences of developed nations in comparison with the situation in China, with respect to system operations, compatibility with the existing health care system, choice of suitable technologies, and information and evaluation platforms.

[Disease burden of thyroid cancer in the Chinese population, in 1990 and 2013].

OBJECTIVE: To analyze the disease burden of thyroid cancer in the Chinese population, in 1990 and 2013. METHODS: Data on China from the Global Burden of Disease 2013 (GBD2013) was used to analyze the related parameters as mortality, prevalence,years of life lost due to premature mortality (YLL), years lived with disability (YLD) and disability-adjusted life years (DALY) of thyroid cancer in China in 1990 and 2013 among all the Chinese population. RESULTS: There were 33 939 thyroid cancer patients identified in 2013 (7 146 men and 26 793 women), with an increase of 21 898 patients than the number in 1990. The incidence rate of thyroid cancer increased by 181.86%. The incidence rates of thyroid cancer showed an increase in females but a decrease in males. In 2013, 4 974 people (2 292 men and 2 682 women) died of thyroid cancer, with an increase of 1 810 patients, compared with the figures in 1990. The mortality rate of thyroid cancer in 2013 decreased by 14.29%, compared with the figures in 1990. The mortality rate of thyroid cancer decreased in females while the incidence rate in males showed an increase. The incidence rates increased with age in females, reaching a peak at the 50-54 years old group. The mortality rate of thyroid cancer increased with age. The DALY, YLL and YLD due to thyroid cancer appeared as 13.35, 11.42 and 1.93 ten thousand person years, respectively, in 2013. Between 1990 to 2013, the age-standardized rates on DALY, YLL and YLD decreased from 10.33/100 000 to 8.84/100 000, from 9.60/100 000 to 7.61/100 000 and increased from 0.72/100 000 to 1.23/100 000, respectively. In 2013 the top three incidence rates were recorded in Qinghai, Xinjiang and Fujian provinces while the lowest was in Tibet. Compared with those in 1990, the incidence rates increased in all the provinces except for Tianjin. The top three high mortality rates were recorded in Qinghai, Hong Kong and Fujian and the lowest was also in Tibet. The mortality rates increased in five provinces. CONCLUSIONS: Compared with those in 1990, the incidence of thyroid cancer increased, but the mortality decreased in 2013. Although significant decrease of DALY due to thyroid cancer was seen in 2013, the YLD burden was still increasing.

[Relationship between N-nitrosodimethylamine and risk of digestive tract cancers: a Meta analysis based on cohort studies].

OBJECTIVE: To analyze the relationship between N-nitrosodimethylamine(NDMA)and the risk of digestive tract cancers. METHODS: The papers about the relationship between NDMA and the risk of digestive tract cancers published from 1980 to 2012 were retrieved following databases: Chinese BioMedical Literature Database(CBM), the Chinese Journal Full-text Database(CNKI), Wanfang Database, PubMed and EBSCO. The fix and random effect model was used and statistical analyses were conducted by using RevMan 5.1 software. RESULTS: Thirteen papers were found, in which 7 about digestive tract cancers were used in this Meta analysis. The NDMA had significant positive effect on the incidence of digestive tract cancers(RR=1.12, 95% CI: 1.03-1.21). The relationship between NDMA and esophageal cancer was not significant(RR=1.18, 95%CI: 0.98-1.41)but NDMA could increase the risk of gastric cancer(RR=1.08, 95% CI: 1.00-1.18). For the subtypes of esophageal and gastric cancer, NDMA had positive relationship with esophageal squamous cell carcinoma(RR=1.72, 95% CI: 1.01-2.96), but had no significant relationship with esophageal adenocarcinoma, cardiac carcinoma and gastric adenocarcinoma. CONCLUSION: The population-based cohort studies have showed that the NDMA could significantly increase the risk of digestive tract cancers, but the effects differed with subtypes of esophageal and gastric cancer. However, it is necessary to collect more evidence due to the limited studies and obvious differences in the study design, sampling and exposure measurement of these cohort studies.

[Analysis of the control level and the affecting factors in 4-11 years old children with asthma].

OBJECTIVE: To assess the control level of 4-11 years old children with asthma and to explore the correlative factors affecting the control level of asthma. METHODS: One cross-sectional study was conducted of the 4-11 years old children with asthma from Pediatrics Outpatient Department of Peking University Third Hospital from October 2013 to February 2014. According to asthma control test (ACT), the control levels of asthma children could be divided into three levels: fully controlled, partly controlled and non-controlled. The partly controlled group and the non-controlled group were merged into the non-full controlled group. Life quality was compared between the full controlled group and the non-full controlled group. The correlative factors affecting the controlled level of asthma were analyzed by Logistic regression. The correlative case information was collected and the data were entered with EpiData software and analyzed with SPSS 17.0 software. RESULTS: Ninety asthma children were enrolled.The children from the full controlled group and the non-full controlled group accounted for 61.1% (55/90) and 38.9% (35/90), respectively. Life quality of the full controlled group was higher than that of the non-fully controlled group. There was no significant difference between the two groups on body mass index (BMI), education level of parents, parents or relative smoking, times of respiratory tract infection within 3 months, using asthma control drugs within 4 weeks before seeing a doctor and regularly taking medicine according to the doctor's advice (P>0.05). The binary Logistic regression analysis obtained three correlative factors affecting the control level of asthma: non-regular follow-up (OR=8.364, 95%CI: 1.816-38.532, P<0.05), being diagnosed with or suffering from allergic rhinitis (OR=6.728, 95% CI: 1.699-26.644, P<0.05) and accompanying with other allergic diseases (OR=3.926, 95%CI: 1.210-12.744, P<0.05). CONCLUSION: The results from the single center have shown that the asthma full-controlled rate of 4-11 years old children with asthma is not high. The higher control level, the better the life quality. Non-regular follow-up and being diagnosed with or suffering from allergic rhinitis are the correlative factors affecting the control level of 4-11 years old children with asthma. Meanwhile, accompanying with other allergic diseases, such as atopic dermatitis and food allergy is the protective factor for asthma control. The data from the multi-center and further study will be needed to demonstrate the results of this study.