Current molecular methods for the detection of hepatitis C virus in high risk group population:A systematic review

Hepatitis C virus(HCV) is an emerging infection worldwide and the numbers of persons infected are increasing every year. Poor blood transfusion methods along with unsafe injection practices are potential sources for the rapid spread of infection. Early detection of HCV is the need of the hour especially in high riskgroup population as these individuals are severely immunocompromised. Enzyme Immunoassays are the most common detection techniques but they provide no evidence of active viremia or identification of infected individuals in the antibody-negative phase and their efficacy is limited in individuals within high risk group population. Molecular virological techniques have an important role in detecting active infection with utmost specificity and sensitivity. Technologies for assessment of HCV antibody and RNA levels have improved remarkably, as well as our understanding of how to best use these tests in patient management. This review aims to give an overview of the different serological and molecular methods employed in detecting HCV infection used nowadays. Additionally, the review gives an insight in the new molecular techniques that are being developed to improve the detection techniques particularly in High Risk Group population who are severely immunocompromised.

Screening and early detection of pancreatic cancer in high risk population

Pancreatic cancer is a serious growing health issue in developed countries.For patients diagnosed with pancreatic cancer,the five year survival rate is below 5%.One major important reason leads to the poor survival rate is lack of early detection of pancreatic cancer.Over 80% of the patients are diagnosed in advanced disease stages.Screening for pancreatic cancer is a desirable option for high risk individuals to allow early detection and treatment of curable pancreatic neoplasms at a pre-invasive stage.This article highlights the need,endpoint,population,method,diagnostic yield,and the problems of current screening programs.

ESTABLISHMENT OF HIGH RISK POPULATION AND PRECANCEROUS LESION OF NASOPHARYNGEAL CARCINOMA(NPC)

A prospective study was done by the examination of nasopharyngoscope, reaction of EB virus's antigens and antibodies, nasopharyngofibroscope, pathological and EB virus's DNA, EBERs, etc. of about 100000 persons in high risk area of NPC in Guangdong Province, China from 1986 to 1995. If any one of the following four conditions is present in some persons, i.e., (1) EBV VCA/IgA titer>1:80, (2) EBV EDAb>60%, (3) Dual or triple positiveness in VCA/IgA, EA/IgA and EDAb, (4) Any one of VCA/IgA, EA/IgA and EDAb keeps high titer or going up, they should be regarded as in precancerosis of NPC. The moderate or severe heteroplasia and heterometaplasia of nasopharyngeal mucosa are the precancerous lesions of NPC. Some individual who is in precancerosis or with precancerous lesion should be regarded as the high risk population of NPC. The results are of important scientific basis for screening and second degree prevention of NPC.

A STUDY OF PRECANCEROUS GASTRIC LESIONS IN A HIGH RISK POPULATION

A study of precancerous gastric lesion was conducted in a randomly selected high risk population in Linqu, Shandong Province of China. 849 subjects aged from 30-64 were examined bioptically. There were 8 cases of gastric cancer, the prevalence rate was 0.9%. 169 subjects were diagnosed to be dysplasia, the prevalence rate of dysplasia was increased significantly with age. The regression equation was Y=0.47X-0.25. The prevalence of CAG was found in 36 per cent of the studied subjects and both dysplasia and CAG were more serious in the antrum than the. fundus. The results showed a natural history of precancerous gastric lesions in a high risk population in a high risk area.

Large Population Screening Identified the Main Risk Factors of Stroke in Shashi District of Jingzhou City

Objective: This paper aims to screen and analyze the current status of high-risk stroke patients in Shashi District of Jingzhou City and the exposure levels of related risk factors, and provides suggestions as the references for prevention and treatment of stroke. Methods: Using cluster sampling, on-site investigations were conducted on 1060 permanent residents aged 40 years and over at 3 townships and 2 communities in Shashi District of Jingzhou City from January 2018 to December 2018. Risk assessment of stroke is based on the stroke risk screening form. Statistical analysis was performed by using SPSS 22.0 software. Results: After making a stroke risk assessment, a total of 313 high-risk stroke patients were screened, and the detection rate was 29.53%. The exposure rate of risk factors from high to low was hypertension (70.93%), dyslipidemia (46.33%), less physical exercise (46.01%), diabetes (36.10%), overweight (33.55%), smoking (33.23%), family history of stroke (24.92%), atrial fibrillation or valvular heart disease (7.35%). There are statistically significant differences among all risk factors between the high-risk group and middle and low-risk groups (P Conclusion: The detection rate of high-risk stroke patients in Shashi District of Jingzhou City is high. Hypertension, dyslipidemia and less physical exercise are the main risk factors of stroke occurrence and recurrence in the region. The prevention and treatment of risk factors for stroke should be strengthened to control the incidence and recurrence rate of stroke.

MODIFIED CLASSIC RISK FACTORS FOR CORONARY ARTERY DISEASE IN CHINESE HAN POPULATION

Objective To investigate the levels of cardiovascular disease risk factors and their relations to clinical phenotype associated with coronary artery disease(CAD).Methods The subjects were recruited from five independent cardiovascular centers.Coronary angiography was employed to define the CAD with stenosis in each major vessel ≥70% and control with stenosis <10% in every lesion.The classic risk factors including family history,body mass index,smoking habits,hypertension,diabetes mellitus,and serum lipid levels were surveyed according to established criteria.Associations between risk levels and clinical phenotypes were assessed by case control and correlation analysis.Results A total of 762 individuals were collected,including 481 men and 281 women,aged from 17 to 81(mean 60±10) years.The patients with CAD accounted for 55.5% of all participants,and controls 44.5%,respectively.Compared with the pattern in published data,our study showed that mean serum high density lipoprotein cholesterol(HDL-C) level was significantly lower(P<0.001) and triglycerides was significantly higher(P<0.001),while total cholesterol(TC) and low density lipoprotein cholesterol levels were comparative(both P>0.05).The prevalence of low HDL-C(<40 g/L) and hypertriglyceridemia(>150 g/L) were 27.2% and 41.4%,respectively.Mean serum levels of HDL-C and apolipoprotein A1 were significantly higher in female subjects than in male(P<0.001).Lower HDL-C functioned as an independent risk factor for CAD only in men(RR=2.8,95%CI:1.5-4.2,P<0.001),yet increased non-HDL cholesterol combined with diabetes mellitus and obesity seemed to play a key role in the development ofCAD in women.Similarity in risk association with CAD was found for hypertension and TC/HDL ratio in male and female subjects,while family history had no relationship with the presence of CAD.Conclusion It is remarkable that emphasis of intervention in future should be given on the prevalent low serum HDL-C and its strong risk correlation with the presence of CAD in male subjects of Chinese Han population.

The Changing Trends of HIV/AIDS in An Ethnic Minority Region of China: Modeling the Epidemic in Liangshan Prefecture, Sichuan Province

Objective This study was to investigate the HIV current situation in Liangshan prefecture, in order to predict prevalence and transmission trends. Methods Region-specific population, behavior, serosurveillence, and policy/program data （from 1995 to 2020） were gathered from various local and national organizations and applied to the Asian Epidemic Model （AEM） and used to derive estimates of future HIV prevalence, epidemic trends, and outcomes of intervention strategies. Results The AEM projections for 2020 included increased number of people living with HIV （PLHIV; to 136 617）, increased HIV prevalence （2.51%）, and 8037 deaths from acquired immunodeficiency syndrome （AIDS） in this region. However, the overall HIV incidence rate （per 10 000） was projected to decline from 27 in 2015 to 22 in 2020, largely due to a predicted decrease in HIV infection rate （per 10 000） from 658 in 2013 to 621 in 2020 among intravenous drug users. In contrast, the cases of HIV infection per i0 000 was projected to increase from 420 in 2010 to 503 in 2020 among men who have sex with men, and from 8 in 2010 to 15 in 2020 among the general population. The predominant risk factor for HIV transmission over the next decade in Liangshan was casual sex. Community-based outreach strategies to reduce injected drug use and casual sex, and to promote condom use, were predicted as effective interventions to decrease HIV transmission. Conclusion Implementation of a comprehensive public health program, with targeting to the region-specific at-risk populations, will help to mitigate HIV/AIDS spread in Liangshan.

基于临床基线特征与颈动脉超声参数构建脑卒中高危人群颈动脉易损斑块模型

背景:研究表明,颈动脉斑块的易损性和弹性与斑块内新生血管的存在及形成程度有关。超声作为筛查和评价颈动脉易损斑块的首选检查手段,具有无创、操作便捷、可重复性高和无辐射等的特点。目的:基于临床基线特征与颈动脉超声参数,探讨脑卒中高危人群颈动脉易损斑块的影响因素,基于独立危险因素构建并验证风险列线图(Nomogram)预测模型。方法:回顾性选取2021年11月到2023年11月于抚州市第一人民医院行脑卒中筛查确定为脑卒中高危人群的180例患者作为研究对象,将180例患者按7∶3比例分为建模集(n=126)和验证集(n=54),根据颈动脉超声检查结果将建模集研究对象分为易损斑块组(n=54)和非易损斑块组(n=72)。通过多因素Logistic回归得出独立危险因素,构建Nomogram模型,并使用R语言绘制决策曲线以评估模型的临床效益。采用受试者工作特征曲线和校准曲线检验模型的预测效能,同时分析验证集的病例数据进行外部验证。结果与结论:①多因素Logistic回归结果显示,年龄、脑卒中家族史、颈动脉斑块最大厚度值、颈动脉斑块数量、尿微量白蛋白和尿微量白蛋白/肌酐均与脑卒中高危人群颈动脉易损斑块有关(P<0.05)。②构建的Nomogram模型受试者工作特征曲线下面积为0.917,灵敏度和特异度分别为79.6%和91.7%;决策曲线结果显示,该模型的潜在临床获益可观,可用性较高;校准曲线结果提示,模型具备较好的预测准确性;验证集结果显示,模型的外部预测性能良好。③结果说明,脑卒中高危人群颈动脉易损斑块受年龄、脑卒中家族史、颈动脉斑块最大厚度值等因素影响,基于各独立危险因素构建的风险Nomogram预测模型的预测性能良好,可为临床上治疗此类高危人群提供有力的参考依据。

Correlative analysis between clinical stage of hepatocellular carcinoma and disease-free survival after hepatectomy

objective: To explore the correlation between clinical stages of hepatocellular carcinoma (HCC) and disease-free survival,and the importance of screening in the high risk population of HCC. Methods: A ret rospective survey of 1 725 cases with HCC after radical and relatively radical operation was performed. The follow-up rate was 84. 5%. The significant factors were analysed using Cox proportional hazards survival analysis model,and the disease-free survival was analysed using Kapalan-Meier estimination. Results: Uni variate analysis shows twelve prognostic clinicopathological factors. Multivariate analysis revealed 4 signifi cant prognostic factors: preoperative tumor number,tumor size,daughter nodules and vascular invasion. Ka palan-Meier estimination showed disease-free survival in subclinical stage was much better than in stage 2 or 3. Conclusion:Screening in the high risk population of HCC and having check-up of AFP and B ultrasono graphy of liver regularly themselvs can detect tumor of patients in early stage,so that they can have surgical treatment in subclinical stage,and have their disease-free survival time increased much more.

Factors Associated with Mental Depression among Men Who Have Sex with Men in Southern India

Background: Mental health has been a largely neglected issue among Men Who Have Sex with Men (MSM) across the world. This study examines the prevalence and correlates of depression among MSM. Data and Methods: Data for this study are used from a cross-sectional Behavioral Tracking Survey—2012 conducted among 1176 MSM from Andhra Pradesh (undivided), a southern state of India. Depression of MSM was assessed using Patient Health Questionnaire-2 scale. Descriptive statistics, bivariate and multivariate logistic regression techniques were used for analysis. Results: More than one-third of MSMs (35%) in the survey reported to have depression. The likelihood of experiencing depression was 5 times higher among MSM who were mobile for sex work outside their place of residence (55% vs 17%, AOR: 5.2, 95% CI: 3.7 - 7.3) and had experienced physical or sexual violence (82% vs 33%, AOR: 6.0, 95% CI: 2.1 - 17.4) than their respective counterparts. Rates of depression were significantly higher among MSM who had experienced Sexually Transmitted Infections symptoms;knowledge of their HIV positivity;who didn’t use condoms during anal sex with any clients/partners;those who consumed alcohol and were in financial debt at the time of survey than others. Those who were associated with any community groups have significantly less chances of reporting depression. Discussion: The study certainly highlighted that the HIV prevention efforts with MSM in India require an integrated approach on addressing the mental health issues. To support this, programs and research-based evidence will be highly needed to ensure that mental health issues are properly addressed among MSM and other high risk groups.

郑州市肺癌早期筛查患病风险横断面研究

目的分析参加肺癌早期筛查者风险及相关影响因素,并根据生存情况研究预后因素,以期最终为肺癌防治提供基线数据。方法采取整群抽样的方法,选取2020年郑州市10区6县40~75岁郑州市户籍居民为筛查对象,通过自愿参加并填写评估问卷,评估出肺癌高危人群,再对高危人群行复筛三项(肿瘤标志物、低剂量螺旋CT及肺功能)检查。最后采取主动加被动随访方式收集确诊肺癌患者信息。对筛查的数据进行统计描述,表述不同特征人群流行病学结果;采用多因素logistic回归方法进行统计分析,比较不同因素各项结果差异。结果2020年郑州市肺癌早期筛查完成评估50128例,完成率100.26%,调查平均年龄(59.86±17.67)岁,男女比例为0.81∶1。其中高危检出率为30.15%。多因素logistic回归分析显示:男性(吸烟)(OR=5.43,95%CI:5.20~5.67)、有烟草接触史(OR=3.82,95%CI:3.67~3.98)、一级亲属曾患肺癌(OR=12.06,95%CI:11.02~13.20)等人群更易患肺癌(均P<0.05)。结论男性(吸烟)、接触二手烟、一级亲属患癌、曾经确诊其他肿瘤、肺部感染症状、“日常生活中出现胸闷,气促,呼吸困难”、“近3年内曾经受较大的精神创伤”因素是肺癌高危的独立危险因素,应重点关注并加以有效干预措施。

郑州市上消化道恶性肿瘤高危人群内镜筛查现状及其影响因素

目的分析郑州市上消化道恶性肿瘤高危人群内镜筛查现状及其影响因素。方法于2017年10月至2022年10月参照《癌症早诊早治项目技术方案(2011年版)》,采用整群随机抽样法以郑州市常住居民为研究对象,通过评估筛查出上消化道恶性肿瘤高危人群共18500例。分析上消化道恶性肿瘤高危人群的基本情况;比较郑州市不同特征上消化道恶性肿瘤高危人群内镜筛查现状;采用多因素Logistic回归分析郑州市上消化道恶性肿瘤高危人群内镜筛查参与情况。结果18500例上消化道恶性肿瘤高危人群中有3407例参与了消化道内镜筛查,参与率为18.42%。女性、45~64岁、初中及以上学历、未婚/离异/丧偶、既往吸烟、正在饮酒、有反流性食管炎史、浅表性胃炎史、胃溃疡史、十二指肠溃疡史、胃息肉史、上消化道癌家族史的上消化道恶性肿瘤高危人群内镜筛查参与率高于其他特征人群,差异具有统计学意义(P<0.05)。女性、45~64岁、初中及以上学历、未婚/离异/丧偶、既往吸烟、正在饮酒、有反流性食管炎史、浅表性胃炎史、胃溃疡史、十二指肠溃疡史、胃息肉史、上消化道癌家族史是上消化道恶性肿瘤高危人群内镜筛查参与情况的影响因素(P<0.05)。结论郑州市上消化道恶性肿瘤高危人群进行内镜筛查的参与率较低,女性、45~64岁、初中及以上学历等人群进行内镜筛查的依从性较好。

高危人群低剂量CT与肿瘤标志物联合检查早期肺癌的效能研究

目的探讨低剂量螺旋CT(low dose spiral computed tomography,LDCT)扫描联合细胞角质蛋白片段21-1(CYFRA21-1)、鳞状上皮细胞癌抗原(SCC)、神经特异性烯醇化酶(NSE)、胃泌素释放肽前体(GRP)、癌胚抗原(CEA)、糖类抗原125(CA125)等6种肺癌肿瘤标志物(tumor Markers,TM)检测对高危人群早期肺癌筛查的效能。方法统计分析2015年-2019年间在本院进行LDCT检查且有病理结果的受试者以及CT结果阴性受试者相关数据,对比分析CT、血清TM的水平以及CT征象及血清TM联合检测对肺癌的诊断价值。结果CT检出肺癌的敏感性为81.48%,特异度为50.00%;TM检出肺癌的敏感性为66.67%,特异度为66.67%;CT联合TM对肺癌的灵敏度为62.96%,漏诊率37.04%,特异度为100.00%。肺癌组患者TM明显高于LDCT结果阴性受试者组,而CT结果阴性受试者的TM检测结果均为阴性,两组差异有统计学意义(P<0.05),结论LDCT敏感性较高,特异度低,肿瘤标志物特异度高,LDCT与TM检测较高合理组合应用,可以优势互补,减少LDCT的假阳性率,对早期肺癌的筛查具有较大价值,可作为辅助筛查手段。而对CT结果阴性者不建议常规做TM检测。

734例慢性阻塞性肺疾病高危人群临床症状及中医证素分布特征

目的:分析慢性阻塞性肺疾病(COPD)高危人群患病特点及中医证素分布特点,为COPD早期干预和诊治提供参考。方法:2022年5月—2022年11月在安徽部分地区对COPD高危人群进行横断面调查,从临床表现提取病位及病性证素。使用SPSS 21.0软件,采用频次分析和聚类分析分别对症状和证素进行分析。结果:共纳入734例COPD高危人群,咳嗽、咳痰、健忘、腰膝酸软、口干口苦、气促、乏力为高频症状,高危人群中患呼吸系统疾病的占34.74%,包括慢性支气管炎、过敏性鼻炎、支气管哮喘、咽炎、肺气肿、肺大疱、肺结节等。对734例COPD高危人群进行证素分析,得到病位证素7个,病性证素10个。病位证素降序排列为肺(49.59%)、肾(28.20%)、脾(26.70%)、肝(17.44%)、卫表(12.81%)、心(神)(7.36%)、胃(6.95%);病性证素降序排列为气虚(53.00%)、痰(26.3%)、湿(13.22%)、阴虚(11.58%)、阳虚(11.44%)、热(10.63%)、血瘀(4.77%)等。聚类分析发现6种组合规律:(1)病位证素肺、脾、胃+病性证素痰、气虚、湿;(2)病位证素肾+病性证素阴虚、阳虚;(3)病位证素血瘀;(4)病位证素肝+病性证素阳亢、热、气滞;(5)病位证素心(神);(6)病位证素卫表。结论:COPD高危人群在发展为COPD前已经有肺气虚的表现,COPD的发展以肺气虚为始,进一步损伤脾、肾,逐步演变为虚实夹杂。

早期胃癌预测模型对胃癌高危人群疾病进展的预测价值

目的:分析基于幽门螺杆菌(helicobacter pylori,Hp)状态与外周血胃蛋白酶原I(pepsinogenⅠ,PGⅠ)、PGⅡ、胃泌素-17(gastrin-17,G-17)水平组成的预测模型对于胃癌高危人群疾病进展的预测价值。方法:回顾性选取2023年1月至2024年1月于天津大学津南医院完善PGⅠ、PGⅡ、G-17、C14尿素呼气试验和胃镜取组织病理活检的126例胃癌高危人群临床资料,根据胃镜取组织病理活检结果将胃癌高危人群分为对照组、癌前病变组、早期胃癌组,比较各组患者PGⅠ、PGⅡ、G-17、C14尿素呼气试验等指标的诊断效能,并构建预测模型。结果:早期胃癌组Hp阳性率为82.35%、PGⅡ为22.73 ng/mL均高于癌前病变组、对照组,PGⅠ为51.36 ng/mL低于癌前病变组、对照组,癌前病变组G-17为5.17 pmoL/L低于对照组、早期胃癌组(P<0.05)。PGⅠ、PGⅡ、G-17与Hp联合时,其受试者工作特征(receiver operating curve,ROC)曲线下面积(area under curve,AUC)可达到0.899,敏感度为94.12%,特异度为95.65%,对胃癌的诊断效能最为理想。根据预测模型,癌前病变分值界限为10分,早期癌症的临界值为19分。结论:对胃癌高危人群实施C14尿素呼气试验与PGⅠ、PGⅡ、G-17联合检测,有助于分析胃癌高危人群疾病进展情况。

乌鲁木齐市35~75岁体检人群心血管病高危预测模型的建立与验证

目的了解乌鲁木齐市35~75岁体检人群心血管病(CVD)高危人群检出情况并建立多因素Logistic回归模型与决策树模型预测CVD高危人群,对比分析模型预测效果及准确率,为CVD的预防控制提供参考依据。方法于2023年6月-2024年1月采用便利抽样方法在乌鲁木齐市某三甲医院体检中心抽取40364名35~75岁体检者进行问卷调查和体格检查,分析CVD高危人群检出情况;应用多因素Logistic回归分析方法以及决策树模型建立CVD高危预测模型,并对模型的预测效果和准确性进行比较和分析。结果40364名35~75岁体检人群中,检出CVD高危人群10858名,CVD高危人群检出率为26.9%。多因素Logistic回归分析结果显示,年龄>40岁、商业服务业、退(离)休人员、吸烟、饮食中肉食摄入过多或过少是35~75岁体检人群CVD高危人群检出的危险因素。女性、初高中以上文化程度、专业技术人员、办事人员或职员、农林牧渔生产人员以及生产运输设备操作工人、每周运动1次及以上是乌鲁木齐市35~75岁体检人群CVD高危人群检出的保护因素。CVD高危人群体质指数、收缩压、舒张压、臀围、腰围、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白和低密度脂蛋白胆固醇中除高密度脂蛋白低于非高危人群外,其余均高于非高危人群,差异有统计学意义(均P<0.001)。以人口学特征(年龄、吸烟习惯、饮食习惯)和体检指标(收缩压、舒张压、空腹血糖、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白)为自变量,通过多因素Logistic回归以及决策树模型建立CVD高危预测模型,两个模型均具有较好的预测准确率,多因素Logistic回归模型与决策树模型的AUC值均为0.867(95%CI=0.864~0.871,P<0.001)。结论乌鲁木齐市35~75岁体检人群CVD高危人群检出率相对较高。构建的多因素Logistic回归模型以及可视化的决策树模型均具有较好的预测效果。可以预测个体未来成为心血管病高危人群的可能性,为识别CVD高危人群提供了筛查工具,对推进心血管疾病的零级预防有一定的指导作用。

北京某三甲医院健康体检女性HPV感染情况及TCT结果分析

目的探讨北京某三甲医院健康体检女性HPV感染情况及TCT结果分析,为本地区宫颈癌防治提供参考。方法回顾分析2022年7月至2023年9月于中日友好医院进行健康体检的10124例女性HPV及TCT结果。结果健康体检女性10124例中,HPV阳性率为7.34%,不同年龄段间HPV阳性率比较差异具有统计学意义(χ^(2)=29.721,P<0.001)。高危型HPV占比前五位亚型是HPV⁃52、HPV⁃58、HPV⁃51、HPV⁃16和HPV⁃39。TCT结果阳性率为2.49%,≥61岁人群ASC和HSIL占比最高,21~岁人群LSIL组占比最高。随着宫颈病变加重,从ASC到LSIL再到HSIL,HPV的阳性率逐渐升高(51.41%,70.18%,88.89%),不同程度宫颈病变的HPV阳性率比较差异具有统计学意义(χ^(2)=485.453,P<0.001),不同程度宫颈病变之间HPV感染类型比较差异有统计学意义(χ^(2)=18.943,P<0.001)。结论宫颈病变程度加重,HPV感染率升高,应重视本地区适龄妇女宫颈癌筛查。

高危人群癌症风险感知测评工具的研究进展

总结癌症风险感知测评工具的研究进展,包括普适性与特异性测评工具的主要内容、信效度及应用现状。提出癌症高危人群癌症风险感知测评工具的研究对于高危人群早期筛查方案及干预策略的制定具有重要意义;目前癌症风险感知测评工具繁多,未来研究者应研制更适合中国国情的测评工具,以利于针对性策略的制定。