Performance of combined liquid based cytology and HPV nucleic acid test for detecting cervical precancer among women attending screening / 中华肿瘤杂志

Objective@#To evaluate the clinical performance of HPV genotyping with cytology for detecting cervical precancer among women attending co-testing.@*Methods@#A total of 2 883 females who participated in cervical cancer screening program were recruited from Erdos in 2016. All the participants were tested by cytology and HPV genotyping. In 2017, women with abnormal cytology results or HPV positive were followed up. Pathological cervical intraepithelial neoplasia (CIN) 2+ was the study end-point. Clinical performance indexes were calculated, including sensitivity, specificity, positive predictive value, negative predictive value, referral rate and missed cases.@*Results@#INNO-LiPA resulted in a detection rate of 18.87%(544/2 883) for the 14-type high risk HPV. HPV16 was the most common infectious genotype (4.06%), followed by HPV52 (3.61%), HPV51 (2.50%), HPV58 (1.98%), and HPV18 (1.56%). With more HPV genotypes added into the group, sensitivity increased and the specificity decreased. Addition of HPV16, 58, 33, 39, 52, 18, 31 for detection lead to the maximun value of area under the curve (AUC)=0.913 (95%CI: 0.882-0.944). Compared with traditional screening method by cytology, cotesting decreased the number of missed diagnosis. Meanwhile, the fifth method (co-testing: triage of women with HPV16/18+ , cytological minor abnormalities and HPV58, 33, 39, 52, 31+ or cytological high grade abnormalities) did not increase referral rate (8.99% vs. 8.71%, P=0.525), with five cases of missed diagnosis (sensitivity of 92.1% and specificity of 93.2%).@*Conclusions@#Co-testing with triage of women with HPV16/18+ , cytological minor abnormalities and HPV58, 33, 39, 52, 31+ or cytological high grade abnormalities would provide better clinical performance. In co-testing, triage of HPV16/18 was used in women with normal cytology; triage of HPV58, 33, 39, 52 and 31 was used in women with low-grade abnormal cytology; referral colposcopy was used in women with high-grade abnormal cytology, which would provide better clinical performance.

Association between high risk human papillomavirus DNA load and cervical lesions in different infection status / 中华肿瘤杂志

Objective@#To explore the relationship between high risk HPV (HR-HPV) DNA load and cervical lesions in HR-HPV single/ multiple infections.@*Methods@#Two thousand six hundred and forty-six women from Shanxi, Henan and Xinjiang were recruited into a cervical cancer screening program. Cervical exfoliated cell specimens collected from all of the participants were detected by hybrid capture Ⅱ (HC2), cytological diagnosis was performed according to the Bethesda System, and pathological diagnosis was interpreted using cervical intraepithelial neoplasia (CIN) terminology.Totally 571 cervical specimens were selected and retested to ascertain the HPV types and single/ multiple infections by liner array, a PCR-based method. Semi-quantitative result of HR-HPV DNA load (pg/ml) was estimated by HR HC2.According to the taxonomy of "International Human Papillomavirus Reference Center" , 13 HR-HPVs, including HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68, which could be detected by HR HC2 were divided into 4 subgroups.@*Results@#The positive rate of HR-HPV in normal cervix (436 cases), CIN1 (88 cases), CIN2+ (47 cases) group were 29.82%, 85.23% and 100%, respectively. The overall prevalence and median viral load increased coordinating with the pathological degree of cervical lesions (P<0.001). The positive rate and viral load of single infection with HR-HPV belongs to α9 species increased coordinating with the pathological degree of cervical lesions (P<0.05). The viral load of single infection with HR-HPV belongs to α7 species in CIN1 group was higher than those of normal group and CIN2+ group, but without statistical significance (P=0.130). The viral load of multiple infections in CIN1 group was 559.13 pg/ml, significantly higher than 37.73 pg/ml of normal histology (P=0.025), but without significant difference of 332.91 pg/ml of CIN2+ group (P=0.790). The median viral load of HPV single infection in CIN1 group was 167.93 pg/ml, significantly lower than 559.73 pg/ml of multiple infections (P=0.044). The incidence of co-infection with HR-HPVs belong to α9 species was 80.56%, dominated in all patterns of multiple infections and their median viral load increased coordinating with the pathological degree of cervical lesions, but without significant difference (P>0.05). The incidence of co-infection with HR-HPVs belong to α7 species was 66.67%, their median viral load in CIN1 group was higher than that of CIN2+ group, but without statistical significance (P>0.05).@*Conclusions@#Viral loads of single/ multiple infections with HR-HPVs belong to different species show different tendencies coordinating with the pathological degree of cervical lesions. Women with high grade of cervical lesion were dominantly infected with high viral load of HR-HPVs belong to α9 species, and the viral load of multiple infections is higher than that of single infection in low grade of cervical lesion.

Multi-center cross-sectional study on type-specific human papillomavirus infection among Chinese women / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the type-specific prevalence of human papillomavirus (HPV) infection among women in China and to provide evidence for primary prevention and screening of cervical cancer programs.</p><p><b>METHODS</b>From May, 2004 to April, 2007, a population-based multicenter cross-sectional study was conducted by the Cancer Hospital, Chinese Academy of Medical Sciences. Women aged 17-59 years from 4 urban areas and 4 rural areas, were screened, under both liquid based cytological and HPV tests for cervical cancer. Specimens of cervical cell were used for genotyping with Linear Array or enzyme-linked immunesorbent assay. Women showed positive in primary screening were referred to exams for further colposcopy and/or histo-pathological detections.</p><p><b>RESULTS</b>A total of 6723 women were included in the data analysis. The overall prevalence of HPV infection was 15.5%. Two age-specific peaks of prevalence of HPV infection were detected among the different age groups. The first peak occurred in 17-24 year-old women in both rural areas and urban areas, while the second one occurred in 40-44 year-old women in urban areas and in 45-49 year-old women in rural areas. The prevalence of HPV infection increased with the severity of diagnosed cervical intraepithelial lesions by cytological or histo-pathological test (χ(2)=62.857, 22.113, P<0.001). HPV16 (3.2%) was seen the most common high risk HPV type, followed by HPV58 (1.8%) , HPV52 (1.5%) , HPV18 (1.0%) and HPV33 (1.0%) respectively. Other common types would include HPV66 (0.64%) , HPV42 (0.58%) and HPV53 (0.46%). The prevalence of HPV16 infection in rural women was significantly higher than that in urban women (χ(2)=4.696, P< 0.05).</p><p><b>CONCLUSION</b>Prevalence of HPV infection in Chinese women seemed to be high and with two age-specific peaks. HPV16 appeared the most commonly seen type in women with cervical lesions. HPV58 and 18 were the predominant types. Type-specific distribution of HPV infection should be taken into consideration in the development of comprehensive cervical cancer prevention strategies in China.</p>

Evaluation of screening performance of HPV DNA test on specimens from different sites of the female genital tract / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the diagnostic performance of different specimens for detecting CIN2(+), and to find the solution of the problem that why the performance of self-collected specimen is worse than cervical specimen collected by physician.</p><p><b>METHODS</b>The cervix, lower 1/3 vagina, upper 1/3 vagina and self-collected specimens from each of the 806 women who took part in this multi-center screening program from May 2006 to April 2007 were tested by hybrid capture 2 (HC2) technique. The diagnostic performance of HC2 on the four specimens for detecting CIN2(+) lesions was calculated. Linear array was performed on the four specimens from 489 out of the 806 women and the diagnostic performance of linear array on the four specimens for detecting CIN2(+) lesions was also calculated. Z test was used to compare the area under ROC and McNemar or χ(2) test was used to compare the sensitivity and specificity of different specimens.</p><p><b>RESULTS</b>The area under ROC of the cervix, 1/3 upper vagina, 1/3 lower vagina and self-collected samples testing by HC2 for detecting CIN2(+) lesions were 0.902, 0.793, 0.769 and 0.773, respectively (P < 0.001). Using 1 RUL/CO as the cut-point of HC2, the sensitivity of the cervix, upper vagina, lower vagina and self-collected samples were 98.0%, 91.8%, 83.7% and 81.6%. Compared with the cervical specimen, the sensitivity of self-collected specimen for detecting CIN2(+) lesions was significantly lower (P = 0.008). Lowering the cutoff value for HC2 test could improve the sensitivity of self-collected specimen, but it significantly compromised the specificity. The sensitivity of self-collected specimen tested by linear array for detecting CIN2(+) lesions was 95.7% and it was not significantly different compared with the sensitivity of cervical specimen (97.9%) tested by HC2.</p><p><b>CONCLUSIONS</b>The performance of self-collected specimen tested by HC2 for detecting CIN2(+) lesions is lower than that of physician-collected cervical specimen, and lowering the cutoff value can't improve its diagnostic performance. Using linear array as the HPV DNA test can significantly improve the screening diagnostic performance of self-collected specimens.</p>

Serum anti-hepatitis E virus IgG antibody and risk factors among female residents of Xinmi in Henan Province / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To determine the distribution of anti-hepatitis E virus (HEV) IgG antibody and anti-human papilloma virus (HPV) IgG antibody among female residents of Xinmi and investigate the risk factors of HEV infection.</p><p><b>METHODS</b>A questionnaire was used to collect data on the demographic characteristics and suspected risk factors of HEV infection, including behavioral habits. All questionnaire responders also provided peripheral blood samples for investigation by enzyme-linked immunosorbent assay to detect HEV-IgG. Demographic data were statistically evaluated by t-test and univariate analysis, and HEV infection risk factors were statistically evaluated by a binary logistic regression model.</p><p><b>RESULTS</b>The average age of the 952 questionnaire responders was 47.16 + 8.09 years. The demographic parameters of education level, income, experience of stillbirth, and age were associated with HEV-IgG positivity (all P less than 0.05). Age, occupation, and income were identified as independent risk factors for HEV-IgG positivity (all P less than 0.05). No statically association was found between sexual behavior and anti-HEV or anti-HPV levels, or HEV infection.</p><p><b>CONCLUSION</b>The female population surveyed in Xinmi, Henan Province showed a higher HEV-IgG positive rate than generally reported in the literature, and this rate shows an increasing trend with age, Risk factors for HEV infection among this group are age, income and occupation.</p>

Feasibility of HEV vaccine as control in HPV vaccine study and comparison of serological and risk factors between HEV and HPV infection among females / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Investigating the distribution of anti-hepatitis E virus (HEV-IgG), anti-human papillomavirus (HPV L1-IgG) and risk factors among female residents in Xinmi County, to explore the influencing factors of HPV vaccine study using HEV vaccinated population as a control.</p><p><b>METHODS</b>A screening study of cervical cancer in Xinmi County, Henan Province, was performed. The information of demographic characteristics and risk factors was collected using standard questionnaire. Nine ml blood was drawn from each woman for enzyme-linked immunosorbent assay to detect HEV-IgG and HPV L1-IgG antibody. Percentile, histogram and binary logistic regression model were used to describe the distribution of risk factors and their correlation to HPV and HEV infection.</p><p><b>RESULTS</b>The average age of the Xinmi female residents was 47.2 years, their positive rate of HPV L1 antibody was 26.8%, and that of HEV-IgG antibody was 31.0%, both of which were raised with age (P < 0.001). Single factor analysis showed that non-education, low-income and growing age were associated with HEV-IgG antibody positivity, and non-education, lowering ages of first sexual life and growing age were associated with HPV L1-IgG antibody positivity. Multivariable analysis showed that growing age, low-income and work as peasantry were independent risk factors for HEV-IgG antibody positivity, and lowering ages of first sexual life, non-education and growing age were independent risk factors for HPV L1-IgG antibody positivity.</p><p><b>CONCLUSIONS</b>Both the HEV-IgG and HPV L1-IgG antibodies positive rates increase with age. Age is the common risk factor of HEV-IgG and HPV L1-IgG antibodies in female residents in Xinmi County. The risk factors of HEV-IgG and HPV L1-IgG antibodies have no statistical association, neither cross reaction was found in the HEV-IgG and HPV L1-IgG detection.</p>

The effect of neurolytic celiac plexus block on liver inflammatory reaction after partial hepatectomy in rats / 中华肝胆外科杂志

Objective To investigate the effect of neurolytic celiac plexus block (NCPB) on the inflammatory reaction of the remaining liver tissue and liver function after partial hepatectomy (PH) in rats.Methods Thirty male Sprague-Dawley rats of SPF were constructed as a PH model with deligation and ablation operated on their left and middle lobes,respectively.Then,they were randomly divided into two groups:NCPB group and control group.Twelve hours after the surgery,0.5％ lidocaine was given in the NCPB group once a day,while 0.9％ saline was given in the control group.Determination of liver function,generation of the remaining liver,and deposition of IL-β,TNF-α of the pathological section was respectively made on Day 1,3 and 7 after the surgery.Results On Day 1,3 and 7 after surgery,both the aspartate aminotransferase (AST) and the alanine aminotransferase (ALT) levels in NCPB group were,to different degrees,lower than those in the control group (P ＜ 0.05).Strikingly,total bilirubin in NCPB group was lower than that in control group (P ＜ 0.01) on Day 7,while the level of semm albumin was higher than that in control group (P ＜ 0.01).There was no statistically significant difference on the generation of the remaining livers between NCPB and control groups.On Day 3 and 7,the deposition of IL-β,TNF-α in the pathological sections of NCPB group were lower than those in control group.Conclusion NCPB can not only effectively reduce the damage of liver function caused by PH surgery,but also improve the inflammatory reaction of the residual liver.

Experience in dealing with iatrogenic bile duct injury due to laparoscocpic cholecystecomy / 中华普通外科杂志

Objective To explore the diagnosis and treatment of iatrogenic bile duct injury during choledochocystectomy. Methods Clinical data of 24 cases of iatrogenic bile duct injury were analyzed retrospectively from 2005 to 2009. Results Eight patients underwent early repair of bile duct within 4 days after the injury. 14 patients with later recognized bile duct injury underwent selective operations, and two patients were discharged after their jaundice were relieved without any surgical treatment. Supporting T tubes were left in place in 22 patients for 8 to 14 months after operations, without any biliary obstruction found after one year and six months to five year follow-up. Conclusions Early bile duct injury within 4 days was easily treated, but later bile duct injury should have selective operation. The patients with jaundice could be diagnosed with PTCD and ERCP to observe the bile duct injury. During operation membrane-to-membrane wide hepatojejunostomy helps prevent later anastomotic stenosis. The left in drainage tube in anastomotic stoma for more than 8 months improves success rate in the process of injuried bile duct repair.

Distribution of type-specific human papillomavirus and its characters on age in paraffin-embedded adenocarcinoma specimens / 肿瘤研究与临床

Objective Human Papillomavirus (HPV) is necessary to the development of cervical cancer.Until now,the distribution of specific HPV type has not been identified clearly yet.Besides,the relationship between age and the HPV type-specific distribution in cervical adenocarcinoma needs to be further investigated.Methods This study included 32 specimens of cervical adenocarcinoma out of a multicenter clinical study in China.The specimen blocks were sliced by sandwich method.DNA was amplified by SPF10-PCR method.DNA genotyping used LiPA method.All biopsy specimens had pathologic diagnosis.The prevalence of HPV type-specific distribution was described and the differences were analyzed statistically.Results 32 adenocarcinoma cases were included in this sttudy.HPV positive rate was 53.1％ (17/32).HPV-18 was the most prevalent type,which took up 47.4 ％ (8/17) of the total HPV positive cases,followed by HPV-16,which took up 26.3 ％ (5/17) of the total HPV positive cases.Other HPV types detected were HPV-39,HPV-45 and HPV-66.One multi-infection case was found (HPV-18 and HPV-66 co-infection).The average ages of HPV-16 and HPV-18 were 48.6 and 40.6 years old respectively,which showed statistically difference (P =0.049).When the patients younger than 50 years old were compared with the patients equal or older than 50 years old as two age groups,HPV positive rate did not show significantly statistical difference (P =0.074) between the two age groups.The prevalence of HPV-18 manifested significant differences between the two age groups in both HPV positive adenocarcinoma cases and overall adenocarcinoma cases (P =0.029and P =0.003 respectively).The prevalence of HPV-16 did not show any significant statistical difference between the two age groups in either HPV positive adenocarcinoma cases or overall adenocarcinoma cases (P =0.6 and P =1 respectively).HPV-16 and/or HPV-18 infection (at least one positive) in HPV positive adenocarcinoma cases did not have statistical significance (P =0.052),while in overall adenocarcinoma cases,HPV-16 and/or HPV-18 infection presented significant statistical difference (P =0.005).Conclusion HPV-18 and HPV-16 were two most prevalent HPV types in cervical adenocarcinoma.HPV infection and HPV-18infection were more common in young women.The prevalence of HPV-16 was more common in older adenocarcinoma cases compared with HPV-18.Those findings will provide evidence for the evaluation of HPV vaccine in preventing cervix related diseases.

Prolene hernia system in the tension-free repair operation of inguinal saddle hernia / 国际外科学杂志

Objective To explore the therapeutic efficacy and operation experience of Prolene Hernia System (PHS) in the tension-free repair operation of inguinal saddle hernia. Methods All 41 cases using PHS were selected as the subjects of this study and the results were analyzed. Results All patients were performed operation under the local anesthesia, and lasted from 25 min to 60 min. They had been keeping in ward for observation from 24 h to 72 h. No serotal swelling, hematoma, and incisional wound infection hap-pened after the operation. The follow-up time had been lasting from 6 months to 42 months, and none of pa-tients catehed a relapse or had the sensation of the foreign bodies. Conclusions Using PHS is safe and ef-fective in the tension-free repair operation, and it is more suited to inguinal saddle hernia. The key of opera-tion success is attaching importance to operation skills.

The role of Egr-1 in liver injury in acute pancreatitis in rat / 解放军医学杂志

Objective To evaluate the role of early growth response gene1 (Egr-1) in liver injury in taurocholate-induced acute pancreatitis rat model. Methods Twenty-four male rats were divided into 4 groups. Egr-1 immunohistochemistry staining and pancreatic pathologic scoring were assessed, and the serum levels of AST, LDH, TNF-? and IL-1 ? were measured. Egr-1 mRNA levels of primary hepatocyte culture stimulated with TNF-? and pretreated primary hepatocytes with PD98059 followed by TNF-? stimulation were also observed. Results Egr-1 expression of liver correlated with degree of liver injury in acute pancreatitis in rat, and high Egr-1 mRNA expression of primary hepatocyte was observed when hepatocyte injury occurred. After pretreated with PD98059, TNF-?-stimulated hepatocytes showed a lower level of Egr-1 mRNA compared with hepatocytes without pretreatment. Conclusions Egr-1 may play an important role in liver injury in acute pancreatitis, and this effect depended partly upon extracellular signal-regulated kinase 1/2 (ERK1/2) pathway.