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Prevalence of Precancerous Lesions Based on Digital Cervicography with VIA/VILI among Women Positive for high-risk Human Papillomavirus Serotypes: A Screening Center-Based Study in Cameroon

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Open Journal of Obstetrics and Gynecology 2024年第6期14卷 967-978页

作者： Jeffrey-Lewis Nzang Cliford Ebontane Ebong Simon Manga Florence Manjuh Félix Essiben Isidore Tompeen Judith Seungue Serge Robert Nyada Jeanne Hortence Fouedjio Ymele Fouelifack Julius Sama Dohbit Kloukanmey Zonal Hospital Mdecins Sans Frontires Kloukanmey Benin Faculty of Medicine and Biomedical Sciences University of Yaound 1 Yaound Cameroon Gynecology and Obstetrics Unit Central Hospital of Yaound Yaound Cameroon Womens Health Program Cameroon Baptist Convention Health Services Yaound Cameroon Department of Obstetrics and Gynaecology Gyneco-Obstetric and Pediatric Hospital of Yaound Yaound Cameroon Expanded Program of Immunization Ministry of Health Yaound Cameroon Department of Obstetrics and Gynaecology Gynaecological Endoscopic Surgery and Human Reproductive Teaching Hospital Yaounde Cameroon Department of Obstetrics and Gynaecology University of Dschang Dschang Cameroon higher Institute of Medical Technology Nkolondom Yaound Cameroon

Background: Since 2021, high-risk Human Papilloma Virus (HR-HPV) testing has been the recommended screening test for cervical cancer for all settings;either used alone in a “test and treat” strategy, or with a triage test, with or without biopsy, before treatment. Cameroon has rolled out immunization against HPV 16 and 18, but studies show a higher prevalence of non-16/18 HR-HPV types. Objectives: Determine the prevalence of precancerous lesions, in women with HR-HPV infection and evaluate association of digital cervicography (DC) VIA/VILI positivity with HPV serotype, as a measure of their contribution to precancer and cancer incidence. Methodology: The study was cross-sectional, descriptive, and analytic. It took place at the Etoug-Ebe and Ekoudoum Baptist Hospitals in Yaoundé, during the period April-September 2022. We reviewed the records of women screened for cervical cancer between February 2020 and December 2021 and evaluated the prevalence of lesions on digital cervicography (DC) with VIA/VILI for women positive for HR-HPV serotypes. The data were analyzed using SPSS version 20.0 for Windows. P values Results: We identified 315 cases with a positive HR-HPV deoxyribonucleic acid (DNA) test, 224 (71.1%) had a DC VIA/VILI triage test done. Of these, 30 (13.4%) women had a positive DC VIA/VILI, with five women (2.2%) having lesions suggestive of cancer. Out of 11 cases positive for HPV 16 alone, 05 (45.5%) had a positive DC VIA/VILI test. Of the 14 cases positive for HPV 18 alone, 03 (21.4%) had a positive VIA/VILI, meanwhile only 19 (10.7%) of the 177 cases positive for non-16/18 HPV had a positive VIA/VILI test. Conclusion: A high proportion of women (13.4%) with HR HPV had a positive DC VIA/VILI, with a significant proportion (2.2%) having lesions suggestive of invasive cervical cancer HR-HPV serotype was associated with DC VIA/VILI positivity;HPV 16 had the strongest association (45.5%), followed by HPV 18 (21.4%), and non-16/18 HR-HPV (10.7%), suggesting a decreasing order of oncogenicity.

关键词： high-risk Human Papillomavirus Precancerous Digital Cervicography VIA/VILI Serotype

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Two-step strategy—conjunctival flap covering surgery combined with secondary deep anterior lamellar keratoplasty for the treatment of high-risk fungal keratitis

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International Journal of Ophthalmology(English edition) 2023年第7期16卷 1065-1070页

作者： Yu-Chen Wang Jia-Song Wang Bei Wang Xi Peng Hua-Tao Xie Ming-Chang Zhang Department of Ophthalmology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022Hubei ProvinceChina

AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.

关键词： high-risk fungal keratitis conjunctival flap deep anterior lamellar keratoplasty two-step strategy

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Exploring Experiences with "321" Model Management for high-risk Pregnancy: A Qualitative Study

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Maternal-Fetal Medicine 2023年第1期5卷 51-53页

作者： Wen Sun Peili Du Lin Yu Xiaoyi Wang Fang He Jingsi Chen Chunhong Su Dunjin Chen Department of Obstetrics and Gynecology Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhou Medical Centre for Critical Pregnant WomenGuangdong Provincial Key Laboratory of Major Obstetric DiseasesGuangzhou 510150Chin

To editor:In recent years,obstetricians have needed to managemore complex pregnancies involving acute and chronicmedical disorders,and a greater number of pregnancieseach year are now delivered by critical care services.1Datafrom the United States show that poorly controlled maternal medical conditions can have an adverse impact on preg-nancy outcomes.

关键词： Pregnancy high-risk Prenatal care Qualitative research Patient satisfaction

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Outcomes of intermediate-risk to high-risk stage I endometrial cancer: 10-year clinical experiences of using in-house multi-channel applicators in a single center

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Chinese Medical Journal 2019年第16期132卷 1935-1941页

作者： Xiao-Rong Hou Lang Yu Ke Hu Fu-Quan Zhang Department of Radiation Oncology Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijing 100730China.

Background: There are only very few reports on clinical outcomes using multi-channel applicators (MCA) for patients with endometrial cancer (EC) in China. We aimed to evaluate the clinical experience of treating intermediate-risk (IR) to high-risk (HR) stage I EC using in-house made multi-channel applicators (IH-MCA) in a single institution. Methods: Three hundred and ninety patients with stage I IR to HR EC were treated with hysterectomy and adjuvant radiotherapy from 2003 to 2015. All patients received post-operative vaginal cuff brachytherapy (VBT) alone or as a boost after external beam radiotherapy (EBRT). The prescriptions were 500 cGy per fraction for a total of 5 to 6 fractions with brachytherapy alone or 400 to 600 cGy per fraction for 2 to 3 fractions if it was combined with EBRT. Two types of applicators including a traditional rigid IH-MCA and a recent model custom-made with 3 dimension printing technology were used for treatment. The Kaplan-Meier method was used to calculate survival rate. Results: Follow-up rate was 92.8% and the median follow-up time was 48 months (range 4–172 months). The 5-year overall survival (OS), progression-free survival, local recurrence, and distant metastasis rates for all patients were 96.3%, 92.1%, 2.9%, and 4.8% respectively. Two patients had isolated relapse in vagina outside the irradiated volume. The univariate and multivariate analysis showed that age and grade were the prognostic factors correlated with OS (hazard ratio: 0.368, 95% confidence interval [CI]: 0.131–1.035, P = 0.048;hazard ratio: 0.576, 95% CI: 0.347–0.958, P = 0.026,). Conclusions: For patients with IR to HR stage I EC, adjuvant VBT alone or in combination with EBRT using IH-MCA led to excellent survival and recurrence rates. Age and grade were the prognostic factors correlated with OS.

关键词： Endometrial cancer high-risk Intermediate-risk Multi-channel applicator Vaginal cuff brachytherapy

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Predictors of rebleeding after initial hemostasis with epinephrine injection in high-risk ulcers

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World Journal of Gastroenterology 2010年第43期16卷 5490-5495页

作者： Ming-Luen Hu King-Wah Chiu Yi-Chun Chiu Yeh-Pin Chou Tsung-Hui Hu Shue-Shian Chiou Seng-Kee Chuah Division of Hepatogastroenterology Department of Internal Medicine Chang Gung Memorial Hospital-Kaohsiung Medical Center Chang Gung University College of Medicine

AIM: To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers. METHODS: Recent studies have revealed that endoscopic thermocoagulation, or clips alone or combined with EI are superior to EI alone to arrest ulcer bleeding. However, the reality is that EI monotherapy is still common in clinical practice. From October 2006 to April 2008, high-risk ulcer patients in whom hemorrhage was stopped after EI monotherapy were studied using clinical, laboratory and endoscopic variables. The patients were divided into 2 groups: sustained hemostasis and rebleeding. RESULTS: A total of 175 patients (144, sustainedhemostasis; 31, rebleeding) were enrolled. Univariate analysis revealed that older age (≥ 60 years), advanced American Society of Anesthesiology (ASA) status (category Ⅲ , Ⅳ and Ⅴ ), shock, severe anemia (hemoglobin high EI dose and SBS were independent predictors. Among 31 rebleeding patients, 10 (32.2%) underwent surgical hemostasis, 15 (48.4%) suffered from delayed hemostasis causing major complications and 13 (41.9%) died of these complications. CONCLUSION: Endoscopic EI monotherapy in patients with high-risk ulcers should be avoided. Initial hemostasis with thermocoagulation, clips or additional hemostasis after EI is mandatory for such patients to ensure better hemostatic status and to prevent subsequent rebleeding, surgery, morbidity and mortality.

关键词： Epinephrine injection high-risk ulcers Initial hemostasis Predictors Rebleeding

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high-risk prostate cancer： is androgen deprivation monotherapy still appropriate？

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Asian Journal of Andrology 2012年第3期14卷 419-420,I0006页

作者： Vahakn B Shahinian Department of Internal Medicine University of MichiganAnn Arbor MI 48109-2029 USA

The optimal management of high-risk prostate cancer, defined by tumor stage T3a or higher, a Gleason score ot 8-10 or a prostate-specific antigen level 〉20 ng m1-1, is unclear, and continues to be a source of substantial controversy.1 Though now much less common with the widespread adoption of prostate-specific antigen screening, it remains important as a cause of prostate cancer death. In large clinical trials,

关键词： high-risk androgen

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Comparison of two adjuvant hormone therapy regimens in patients with high-risk localized prostate cancer after radical prostatectomy, primary results of study CU 1005

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Asian Journal of Andrology 2016年第3期18卷 452-455,I0010页

作者： Kun Chang Xiao-Jian Qin Hai-Liang Zhang Bo Dai Yao Zhu Guo-Hai Shi Yi-Jun Shen Yi-Ying Zhu Ding-Wei Ye Department of Urology Fudan University Shanghai Cancer Center Shanghai 200032 China Department of Oncology Shanghai Medical Coilege Fudan UniversityShanghai 200032 China.

The role of adjuvant hormonal therapy and optimized regimens for high-risk localized prostate cancer after radical prostatectomy remains controversial. Herein, the clinical trial CU 1005 prospectively evaluated two regimens of maximum androgen blockage or bicalutamide 150 mg daily as immediate adjuvant therapy for high-risk localized prostate cancer. Overall, 209 consecutive patients were recruited in this study, 107 of whom received 9 months of adjuvant maximum androgen blockage, whereas 102 received 9 months of adjuvant bicalutamide 150 mg. The median postoperative follow-up time was 27.0 months. The primary endpoint was biochemical recurrence. Of the 209 patients, 59 patients developed biochemical recurrence. There was no difference between the two groups with respect to clinical characteristics, including age, pretreatment prostate-specific antigen, Gleason score, surgical margin status, or pathological stages. The maximum androgen blockage group experienced longer biochemical recurrence-free survival （P = 0.004） compared with the bicalutamide 150 mg group. Side-effects in the two groups were similar and could be moderately tolerated in all patients. In conclusion, immediate, 9-month maximum androgen blockage should be considered as an alternative to bicalutamide 150 mg as adjuvant treatment for high-risk localized prostate cancer patients after radical prostatectomy.

关键词： adjuvant bicalutamide high-risk maximum androgen blockage prostate cancer radical prostatectomy

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Haploidentical-versus identical-sibling transplant for high-risk pediatric AML:A multi-center study

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Cancer Communications 2020年第2期40卷 93-104页

作者： Feng-Mei Zheng Xi Zhang Chun-Fu Li Yi-Fei Cheng Li Gao Yue-Lin He Yu Wang Xiao-Jun Huang National Clinical Research Center for Hematologic Disease Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University People’s HospitalPeking University Institute of HematologyBeijing100044P.R.China Department of Hematology Xinqiao HospitalArmy Military Medical UniversityChongqing400037P.R.China Department of Pediatrics Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdong510515P.R.China Peking-Tsinghua Center for Life Sciences Beijing100871P.R.China

Background:Human leukocyte antigen-identical sibling donor(ISD)-hematopoietic stem cell transplantation(SCT)is a potentially curative treatment for high-risk pediatric acute myeloid leukemia(AML).A haploidentical donor(HID)is readily available to almost all children.Previous studies have demonstrated that patients with HID-SCT had similar outcomes compared to ISD-SCT for pediatric and adult AML.However,the role of HID-SCT in high-risk pediatric AML is unclear.Methods:To compare the overall survival of high-risk AML children who underwent either HID-SCT or ISD-SCT,we analyzed 179 cases of high-risk AML patients under 18 years of age treated with either ISD-SCT(n=23)or HID-SCT(n=156).Granulocyte colony-stimulating factor plus anti-thymocyte globulin-based regimens were used for HID-SCT.We also analyzed the subgroup data of AML patients at first complete remission(CR1)before SCT with known cytogenetic risk.Results:The numbers of adverse cytogenetic risk recipients were 8(34.8%)and 13(18.8%)in the ISD-SCT group and the HID-SCT group,and the number of patients with disease status beyond CR1 were 6(26.1%)and 14(20.3%)in the two groups.The cumulative rates of grades II-IV acute graft-versus-host disease(GVHD)were 13.0%in the ISD-SCT group and 34.8%in the HID-SCT group(P=0.062),with a three-year cumulative rates of chronic GVHD at 14.1%and 34.9%,respectively(P=0.091).The relapse rate in the ISD-SCT group was significantly higher than that in the HID-SCT group(39.1%vs.16.4%,P=0.027);with non-relapse mortality at 0.0%and 10.6%(P=0.113),respectively.The three-year overall survival rates were 73.0%for the ISD-SCT group and 74.6%for the HID-SCT group(P=0.689).In subgroup analysis,the three-year relapse rate in the ISD-SCT group was higher than that in the HID-SCT group(50.0%vs.9.2%,P=0.001)and the three-year DFS in the ISD-SCT group(50.0%)was lower than that in the HID-SCT group(81.2%)(P=0.021).Conclusions:Unmanipulated HID-SCT achieved DFS and OS outcomes comparable to those of ISD-SCT for high-risk pediatric AML patients wi

关键词： Acute myeloid leukemia high-risk pediatric transplantation haploidentical identical sibling propensity score matching graft-versus-host disease overall survival disease-free survival

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Prevalence and Determinants of high-risk HPV Infection among 11549 Women from an Opportunistic Screening in Hubei Province

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Current Medical Science 2019年第4期39卷 622-630页

作者： Quan-fu MA Yu-lin GUO Han GAO Bin YAN Xuan DAI Meng XU Yu-jing XIONG Qiu-zi PENG Ying WANG Miao ZOU Xu-feng WU Department of Gynecologic Oncology Maternal and Child Health Hospital of Hubei ProvinceWuhan 430070China Cervical Cancer Control Center of Hubei Province Wuhan 430070China

high-risk human papillomavirus (hrHPV) infection plays an important role in the development of cervical intraepithelial neoplasia and cervical cancer.A total of 11 549 women were enrolled from the Maternal and Child Health Hospital of Hubei Province.Each participant accepted hrHPV testing and completed a self^administered questionnaire about basic information and potential risk factors.The univariable and multivariable logistic regression model was used to explore the associations between variants and hrHPV infection.Our results showed that hrHPV prevalence was 16.09% in Hubei Province,among which,hrHPV was more likely to be positive in women aged 51 years or above (OR=1.65,95% CI:1.28-2.14),and in women who had symptoms of bleeding after intercourse (OR=1.32,95% CI:1.17-1.50),had first sexual intercourse at the age of 18 years or below (OR=1.33,95% CI:1.07-1.64),had at least three male sexual partners (OR=2.50,95% CI:2.07-3.03),and who had been diagnosed with sexually transmitted infections (OR=1.50,95% CI:1.12-2.03).Married women (OR=0.66,95% CI:0.55-0.78) and women who frequently used condoms (OR=0.75,95% CI:0.67-0.84) had a relatively lower hrHPV prevalence.This study confirms that hrHPV infection was associated with age,marital status,symptoms of intercourse bleeding,history of sexually transmitted infections,and sex-related behaviors.Above all,this study provides a baseline database prior to obtaining vaccinations for dynamic tracking of the changes in hrHPV prevalence.

关键词： high-risk human papillomavirus cervical cancer prevalence risk factors China

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Influencing factors of the neurodevelopment of high-risk infants

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General Psychiatry 2018年第6期31卷 140-145页

作者： Yuan Tian Chuncao Zhang Guangjun Yu Xiangying Hu Zheng Pu Liyu Ma Department of Child Health Management Children's Hospital of Shanghai Department of Child Healthcare Shanghai Jingan Maternity and Infant Health Hospital Department of Child Healthcare Shanghai Jiading Maternity and Infant Health Hospital Department of Child Healthcare Shanghai Putuo Maternity and Infant Health Hospital

Background high-risk infants refer to newborns exposed to high-risk factors in the prenatal, natal or postnatal period. high-risk infants are at high risk of developmental retardation, and early identification of developmental abnormalities plays a vital role in improving high-risk infants' quality of life.Aims To describe the neurodevelopment of high-risk infants aged less than 1 year old, and to analyse the incidences and influencing factors of neurodevelopmental abnormalities in order to provide a basis for neurodevelopment monitoring and management of highrisk infants.Methods high-risk infants born between January 2016 and December 2016 in the maternity and infant health hospitals of three districts in Shanghai were followed up.The Gesell Developmental Scale was used to assess the neurodevelopmental level at the time of recruitment(0-2 months) and at 9 months. Univariate and multivariate analyses of the influencing factors were conducted.Results 484 high-risk infants(male 51 %, female 49%)with an average gestation age of 36.5±2.2 weeks were recruited. At the time of recruitment, the average age was2.1(0.8) months, and the developmental quotient(DQ)scores of full-term high-risk infants in motor(t=3.542,p=0.001), cognitive(t=3.125, p=0.002), language(t=3.189, p=0.002) and social(t=3.316, p=0.001) areas were higher than those of preterm infants. The incidences of developmental abnormalities of full-term high-risk infants in motor(χ~2 =9.452, p=0.002), cognitive(χ~2=6.258, p=0.012), language(χ~2 =12.319, p =0.001) and social(χ~2 =6.811, p=0.009) areas were lower than the preterm infants. At 9 months, there was no difference in the DQ scores and incidences of developmental abnormalities in four areas between full-term and preterm high-risk infants, and the incidence of developmental abnormalities was around 10%.Conclusion The incidence of neurodevelopmental abnormalities in high-risk infants aged less than 1 year old is high. Preterm birth and parental bad habits are significant factors affecting the neurodevelopm

关键词： infants high-risk factors abnormalities developmental

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