404例梅毒患者发病情况分析

目的回顾性分析2010~2015年404例梅毒患者的发病特点,以探讨近年来梅毒发病率居高不下的相关原因。方法将404例梅毒患者按发病年度、发病年龄及临床分期进行分类,探讨其临床表现及特征,总结各期诊断和治疗上的薄弱环节。结果整体发病比率呈逐年上升趋势,除Ⅰ期梅毒为男女,Ⅱ期梅毒和潜伏梅毒均男女,总发病情况男女比例为1∶1.04。患病年龄:性活跃人群288例,占71.29%,60岁以上老年人107例,占26.49%。传播途径及职业:非婚性接触传染仍为主要传播途径,通过男男性行为感染的传播方式也不容忽视;职业分布以农牧民及无业人员为主,占73.51%。教育程度:梅毒患者的受教育程度普遍较低,可能与普遍缺乏对健康知识的了解和性传播疾病的认识有关。结论通过对本地区404例梅毒的发病情况分析,其传播途径以非婚性接触为主;需要加强对老年人性传播疾病的防控,且防控工作重点应向农村牧区转移。     

One or two doses of hepatitis A vaccine in universal vaccination programs in children in 2020: A systematic review

BackgroundHepatitis A virus (HAV) is a global health concern as outbreaks continue to occur. Since 1999, several countries have introduced universal vaccination (UV) of children against HAV according to approved two-dose schedules. Other countries have implemented one-dose UV programs since 2005; the long-term impact of this schedule is not yet known.MethodsWe conducted a systematic literature search in four electronic databases for data published between January 2000 and July 2019 to assess evidence for one-dose and two-dose UV of children with non-live HAV vaccines and describe their global impact on incidence, mortality, and severity of hepatitis A, vaccine effectiveness, vaccine efficacy, and antibody persistence.ResultsOf 3739 records screened, 33 peer-reviewed articles and one conference abstract were included. Rapid declines in incidence of hepatitis A and related outcomes were observed in all age groups post-introduction of UV programs, which persisted for at least 14 years for two-dose and six years for one-dose programs according to respective study durations. Vaccine effectiveness was ≥95% over 3–5 years for two-dose programs. Vaccine efficacy was >98% over 0.1–7.5 years for one-dose vaccination. Antibody persistence in vaccinated individuals was documented for up to 15 years (≥90%) and ten years (≥74%) for two-dose and one-dose schedules, respectively.ConclusionExperience with two-dose UV of children against HAV is extensive, demonstrating an impact on the incidence of hepatitis A and antibody persistence for at least 15 years in many countries globally. Because evidence is more limited for one-dose UV, we were unable to draw conclusions on immune response persistence beyond ten years or the need for booster doses later in life. Ongoing epidemiological monitoring is essential in countries implementing one-dose UV against HAV. Based on current evidence, two doses of non-live HAV vaccines are needed to ensure long-term protection.     

The impact of immunochemical faecal occult blood testing on colorectal cancer incidence

BackgroundThe efficacy of colorectal cancer screening based on faecal immunochemical test, in terms of reduction of colorectal cancer incidence, is under debate. In the district of Florence, an organized screening programme based on faecal immunochemical test has been running since the early 1990s. The aim of this study was to compare the risk of developing colorectal cancer for subjects undergoing faecal immunochemical test with those who did not undergo the test in the same period.MethodsTwo cohorts were analyzed: subjects who underwent an initial faecal immunochemical test between 1993 and 1999 (“attenders”), and unscreened residents in the same municipalities invited to perform the faecal immunochemical test in the same period (“non-attenders”). Kaplan–Meier and Cox regression analysis were performed to evaluate the risk of developing colorectal cancer.ResultsThe attenders’ and non-attenders’ cohorts included 6961 and 26,285 subjects, respectively. Cox analysis showed a reduction in colorectal cancer incidence of 22% in the attenders’ compared to the non-attenders’ cohort (hazard ratio = 0.78, 95% Confidence Interval: 0.65–0.93).ConclusionOur results support the hypothesis that screening based on a single faecal immunochemical test every 2 years produces a significant decrease in colorectal cancer incidence after an average follow-up observation period of 11 years.     

Underutilisation of breast cancer prevention medication in Australia

Increased implementation of proven prevention strategies is required to combat rising breast cancer incidence. We assessed use of risk reducing medication (RRMed) by Australian women at elevated breast cancer risk. Only 2.4% had ever used RRMed. Higher breast cancer risk was statistically significantly associated with use of RRMed (OR 1.82, 95%CI: 1.08–3.07, p = 0.02 for ≥30% lifetime risk compared with 16%–29% lifetime risk), but parity, education level and family history of breast cancer were not. Breast cancer prevention medications are underutilised. Efforts are needed to incorporate breast cancer risk assessment and risk management discussions into routine health assessments for women.     

Incidence and risk factors for suicide death in male patients with genital-system cancer in the United States

BackgroundA diagnosis of cancer is associated with increased risks of suicidal ideation and suicide attempts. Genital-system cancer comprises nearly a third of all cancers in males. We used the SEER database to identify the incidence of and risk factors for suicide death in male patients with genital-system cancer in the United States.MethodPatients were selected from the SEER database, and X-tile software was used to find the best cutoffs for stratifying age. Logistic regression was used to identify independent risk factors for suicide death. Only variables that were statistically significant in the univariate logistic regression models were analyzed in multivariate logistic regression models.ResultThis study found that age (18–66 vs ≥ 76 years: OR = 3.300, P < 0.001; 67–75 vs ≥ 76 years: OR = 1.832, P < 0.001), being unmarried (OR = 1.332, P = 0.010), being divorced, separated, or widowed (OR = 1.338, P = 0.002), caucasian (OR = 2.074, P = 0.003) and not receiving surgery or having an unknown surgery status (OR = 1.405, P < 0.001) significantly increased the risk of suicide death. A particularly important finding was that a time of <1 year after the diagnosis was related to an increased risk of suicide death (<1 vs ≥ 10 years: OR = 1.761, P = 0.008).ConclusionWe found that a number of factors significantly increased the risk of suicide. Importantly, a time of <1 year after the diagnosis was related to an increased risk of suicide death, which indicates the importance of identifying and treating people at risk of suicide as early as possible. These can help clinicians to understand suicidal patients and provide them with appropriate support.     

Intraductal carcinoma of the prostate: What we know and what we do not know

Intraductal carcinoma of the prostate (IDC-P) is a malignant, clonal proliferation of cells growing within the basement membrane-bound structures of the prostate. IDC-P is usually associated with unfavorable clinicopathologic parameters such as large tumor volume, high-grade Gleason score, extra prostatic extension and seminal vesicle invasion. Majority of laboratory and patient data suggest that IDC-P represents intraductal spread of invasive carcinoma, rather than a precursor lesion. Additionally, relationship of IDC-P and adjacent invasive carcinoma has been investigated in a series of molecular studies. The differential diagnosis of IDC-P from other lesions is critical for patient management. In this article, we summarize current literatures regarding what we know about IDC-P, including its pathological morphology, incidence, differential diagnosis, molecular features and clinical significance. In addition, we propose several issues that we currently do not know about IDC-P. Further research is needed to better understand the biological nature of IDC-P.     

Gender-specific incidence of autoimmune diseases from national registers

BackgroundIt is widely believed that autoimmune diseases affect predominantly in women, but the available evidence came from case control study with potential selection and recall bias. We aimed to examine the gender-specific incidence of autoimmune diseases by using national wide registers in Sweden.MethodsSwedish Hospital Discharge Register and Outpatient Register were used to identify a set of autoimmune diseases between 1987 and 2010. Gender-specific incidence rate was standardized directly according to the Swedish age distribution in 2000.ResultsA total of 403,757 individuals were diagnosed with autoimmune diseases between 1987 and 2010 in Sweden. The overall incidence of 32 autoimmune disease was 60% higher in women than men. Female predominance was noted in 18 specific diseases, whereas the rest of them showed no difference or male predominance. The age of onset was different between men and women in 27 autoimmune diseases.ConclusionsOur study suggested that the classical view of female predominance of autoimmune diseases may be far from striking than previously believed. Further studies are needed to examine whether there is true difference between men and women.