HPV prevalence and genotyping in the cervix of Chinese women

The role of human papillomavirus (HPV) as an etiologic factor of cervical cancer has been firmly established, and prophylactic vaccines are now available and have been approved in many countries. Vaccination implies a promising future for cervical cancer prevention especially for countries with very limited access to screening. However, the vaccines are not accessible in mainland China at the moment, and much needs to be understood about the potential benefit when HPV vaccines are applied to Chinese women, and to make the vaccines more specific to Chinese women. This article reviews advanced multi-center, hospital/population-based studies of most recent years, and aims to draw a definitive conclusion on HPV prevalence and genotyping in cervical cancer and precancerous lesions in China from the aspect of study population, geographic areas and time period.     

Splenic autotransplantation and oesophageal transection anastomosis in patients with portal hypertension (26 years clinical observation)

The surgical treatment methods for cirrhosis patients complicated with portal hypertension are complicated. In this study, we evaluated the effectiveness of a new treatment strategy: splenic auto-transplantation and oesophageal transection anastomosis on 274 patients from three aspects: clinical observation, splenic immunology and portal dynamics. From 1979 to 2005, 274 cirrhosis patients with portal hypertension who underwent the new treatment strategy were followed up to observe different clinical indexes, which were then compared with those of the traditional surgery treatment. From 1999 to 2002, a randomized control trial (RCT) was performed on 40 patients to compare their immune function after operation. From 1994 to 2004, another RCT was carried out on 28 patients to compare the portal dynamics through three-dimensional dynamic contrast enhanced MR angiography (3D DEC MRA) investigation after operation. Among 274 patients (mean age 41.8 years), the emergency operative mortality (4.4%), selective operative mortality (2.2%), complication rate (17.9%), morbidity of hepatic encephalopathy (<1%), bleeding rate of portal hypertension gastritis (PHG) (9.1%), and morbidity of hepatic carcinoma (8%) were similar to those under traditional operation; the spleen immunology function (Tuftsin, IgM) decreased among the groups 2 months after operation. Through 3D DCE MRA, the cross section area, the velocity and volume of blood flow of main portal vein decrease significantly after operation in both groups, the auto transplantation group was significantly lower in velocity and volume of blood flow than in the control group. Splenic auto transplantation and esophageal transection anastomosis are a safe, effective, and reasonable treatment strategy for portal hypertension with varicial bleeding. It can not only correct hypersplenism but also completely stanch blood, and auto transplanted spleen in the retroperitoneal space can preserve immune function and establish abroad collateral circulation.     

Achievements in burn surgery over the past 50 years in China

This paper reflects on the advancements of clinical and scientific research in the field of burn surgery in China. It includes emergency care of massive burns, resuscitation, anti-infection, prevention and cure of internal organ injuries, metabolic and nutritional support, wound repair and rehabilitation, and special types of burns; it also covers pathology, microbiology, immunology, cell biology, molecular biology, and tissue engineering.     

New spinal robotic technologies

Robotic systems in surgery have developed rapidly. Installations of the da Vinci Surgical System^® (Intuitive Surgical, Sunnyvale, CA,, USA), widely used in urological and gynecological procedures, have nearly doubled in the United States from 2010 to 2017. Robotics systems in spine surgery have been adopted more slowly; however, users are enthusiastic about their applications in this subspecialty. Spinal surgery often requires fine manipulation of vital structures that must be accessed via limited surgical corridors and can require repetitive tasks over lengthy periods of time — issues for which robotic assistance is well-positioned to complement human ability. To date, the United States Food and Drug Administration (FDA) has approved 7 robotic systems across 4 companies for use in spinal surgery. The available clinical data evaluating their efficacy have generally demonstrated these systems to be accurate and safe. A critical next step in the broader adoption of surgical robotics in spine surgery is the design and implementation of rigorous comparative studies to interrogate the utility of robotic assistance. Here we discuss current applications of robotics in spine surgery, review robotic systems FDA-approved for use in spine surgery, summarize randomized controlled trials involving robotics in spine surgery, and comment on prospects of robotic-assisted spine surgery.     

Xingnao Kaiqiao acupuncture combined with Angong Niuhuang Wan for a patient under persistent vegetative state: a case report

Persistent vegetative state (PVS) is a clinical condition wherein the cerebral cortex loses its function although brain stem function remains relatively intact. It has high mortality and disability rates. Although treatment for PVS is extensively studied in developed countries, little breakthrough has been made. In China, many PVS patients who were treated with traditional Chinese medicine (TCM) and acupuncture therapy were reported to have regained consciousness. In our department, we have been investigating TCM diagnosis and treatment methods for PVS for many years and have summarized a set of curative programs. Our patient is a male and 5 years and 3 months of age. He had traumatic brain injury and had been unconscious for three months on admission. Considering his condition, we adopted Xingnao Kaiqiao acupuncture, oral Angong Niuhuang Wan, and Xingnaojing intravenous drip. After the 50-day treatment, his health significantly improved and is nearly similar to that of a healthy child, indicating that the treatment is effective for PVS. Therefore, we decided to report the case and treatment methods.     

Current progress on internal medicine in China—2006 Part I

The growing interest has been placed in the current state of Chinaºs internal medicine from all over the world. Many data of internal medicine in China were collected by searching through some of the most prominent medical magazines published in China in 2006. Because there are many researches on the field of internal medicine, just some representative reports focusing on this topic were selected in this paper. In part I of this study, a summary of the advances made in cardiology, respiration diseases, and gastroenterology was presented.     

Barriers and countermeasures in developing traditional Chinese medicine in Europe

Traditional Chinese medicine (TCM) is one of the unique cultural treasures of Chinese; it represents a significant feature and prominent advantage of the healthcare cause in China. Data in this paper were from World Health Organization, Chinese Bureau of Statistics, China National Knowledge Infrastructure, and PubMed. In recent years, TCM has established a solid foundation in Europe, which made great strides in legislation, education, research, and international exchange, and has enjoyed a vast development space in the continent. Now, TCM is embracing unprecedented development opportunities in Europe. At the same time, the stiff international competition poses a grave threat to China’s TCM industry. With multiple cultural, legal, and institutional challenges, as well as talent shortages in the way, TCM is now facing many difficulties in Europe. To fully prepare and enact active and vigorous steps to seize opportunities, we should have a clear picture about the serious challenges hampering TCM development in Europe. The TCM development at overseas markets has shifted from a spontaneous trade activity into a national strategy spearheaded by the government and participated in by multiple stakeholders. We should make a systematic, comprehensive, and sustainable push in fields such as TCM therapy, healthcare, education, research, culture, and industry development. The ultimate goal is to bring TCMs to the global market and allow them to play a role in safeguarding public health along with modern medicines.     

A novel method for reconstruction in laparoscopic pancreaticoduodenectomy: an experience of 13 cases

Laparoscopic pancreaticoduodenectomy (LPD) is a challenging operation to general surgeon. Up to date, only about 135 cases have been reported, 16 cases in China, 119 cases outside China. The reconstruction of alimentary system is a key procedure to ensure success of the whole surgery. It is worth investigating the methods of reconstruction in LPD. A retrospective study is made to investigate the methods of reconstruction in LPD. We analyze 13 cases of LPD performed in our center. Child s or modified Child s method was used to make the reconstruction in our practice. We tried three methods to make the anastomosis of pancreaticojejunostomy, including end-to-end dunking binding pancreaticojejunostomy in two cases, end-to-end dunking pancreaticojejunostomy using interrupted suture in two cases, and duct-to-jejunal end-to-side embedding pancreaticojejunostomy in nine cases. The clinical data was collected and analyzed. Three of four patients, who underwent end-to-end pancreaticojejunostomy, had a little pancreatic leakage, especially in the first case. None of other nine patients, who underwent duct-to-jejunal end-to-side embedding pancreaticojejunostomy, was detected to have pancreatic leakage, and the operating time of these nine cases was less than other four cases. Duct-to-jejunal end-to-side embedding pancreaticojejunostomy is a safe and efficient method of reconstruction in LPD.     

Clinical and genetic risk factors for venous thromboembolism in Chinese population

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, carries significant mortality and morbidity. The most important and effective way to reduce VTE incidence is to identify the patients at risk and give necessary prevention. VTE is a multifactorial and complicated disorder. Major risk factors for VTE include surgery and trauma, acute medical illness, active cancer and pregnancy. Genetic factors increase susceptibility to the disease and are useful in predicting the development of VTE. Gene-gene and gene-environment interactions alter and magnify the clinical picture in this disorder. This brief review summarizes some selected clinical and genetic risk factors for VTE based on the current research in China.     

Immunoregulatory effects of Tripterygium wilfordii Hook F and its extracts in clinical practice

Tripterygium wilfordii Hook F (TwHF) and its extracts have long been used for the treatment of rheumatoid arthritis, autoimmune diseases, and kidney disease due to their anti-inflammatory, immunoregulatory, and other pharmacological effects. However, the clinical immunoregulatory effects of TwHF and its extracts remain unclear, so we reviewed their effects for use in clinical practice. This review provides a comprehensive summary of the recent literature on the immunoregulatory effects of TwHF and its extracts in clinical studies. TwHF and its extracts affect the proliferation and activation of T and B cells; ratio of T cell subsets; inflammatory response of monocytes, macrophages, and immunoglobulins; and secretion of many cytokines. Together, these effects dictate immune function in a variety of diseases. TwHF and its extracts can be used alone or in combination with existing therapies against many immune disorders through immunomodulation.     

Epidemiology of fungal infections in China

With the increasing number of immunocompromised hosts, the epidemiological characteristics of fungal infections have undergone enormous changes worldwide, including in China. In this paper, we reviewed the existing data on mycosis across China to summarize available epidemiological profiles. We found that the general incidence of superficial fungal infections in China has been stable, but the incidence of tinea capitis has decreased and the transmission route has changed. By contrast, the overall incidence of invasive fungal infections has continued to rise. The occurrence of candidemia caused by Candida species other than C. albicans and including some uncommon Candida species has increased recently in China. Infections caused by Aspergillus have also propagated in recent years, particularly with the emergence of azole-resistant Aspergillus fumigatus. An increasing trend of cryptococcosis has been noted in China, with Cryptococcus neoformans var. grubii ST 5 genotype isolates as the predominant pathogen. Retrospective studies have suggested that the epidemiological characteristics of Pneumocystis pneumonia in China may be similar to those in other developing countries. Endemic fungal infections, such as sporotrichosis in Northeastern China, must arouse research, diagnostic, and treatment vigilance. Currently, the epidemiological data on mycosis in China are variable and fragmentary. Thus, a nationwide epidemiological research on fungal infections in China is an important need for improving the country’s health.     

Pathogenesis,diagnosis, and treatment of recurrent spontaneous abortion with immune type

Recurrent spontaneous abortion (RSA), defined as three or more consecutive pregnancy losses before 20 weeks of gestation, is difficult to treat in the clinical setting. It affects 1%–5% of women of reproductive age. In the investigations of immunopathogenesis, diagnosis, and treatment of RSA since the late 1980s, it was found that RSA was associated with abnormal maternal local or systemic immune response. The pathogenesis of autoimmune RSA was mainly associated with antiphospholipid antibody (APA), while that of alloimmune RSA was due to the disturbance of maternofetal immunological tolerance. Systemic etiological screening process and diagnosis systems of RSA with immune type were developed, and anticardiolipin (ACL or ACA) + anti-β2-GP1 antibody combining multiple assays for effective diagnosis of RSA with autoimmune type was first established. According to the dynamic monitoring of clinical parameters before and during gestation, low-dose, short-course, and individual immunosuppressive therapy and lymphocyte immunotherapy for RSA with immune type were carried out. The outcomes of the offsprings of patients with RSA were followed up, and the safety and validity of the therapies were confirmed. The research achievement leads to great progress in the diagnosis and treatment of RSA in China.     

Genetic and clinical markers for predicting treatment responsiveness in rheumatoid arthritis

Although many drugs and therapeutic strategies have been developed for rheumatoid arthritis (RA) treatment, numerous patients with RA fail to respond to currently available agents. In this review, we provide an overview of the complexity of this autoimmune disease by showing the rapidly increasing number of genes associated with RA. We then systematically review various factors that have a predictive value (predictors) for the response to different drugs in RA treatment, especially recent advances. These predictors include but are certainly not limited to genetic variations, clinical factors, and demographic factors. However, no clinical application is currently available. This review also describes the challenges in treating patients with RA and the need for personalized medicine. At the end of this review, we discuss possible strategies to enhance the prediction of drug responsiveness in patients with RA.     

How to judge the association of postmenopausal hormone therapy and the risk of breast cancer

The relevance of postmenopausal hormone therapy (HT) for breast cancer risk has been long debated, although it is one of the most important barriers for women to accept HT. Various opinions have been reported from recent randomized clinical trials and epidemiological studies. These unanswered questions include: whether HT has a positive impact on breast cancer; whether risks of therapy with unopposed estrogen and combined estrogen-progestin are different; and whether different types and routes of estrogen and progestogens, as well as the duration and cessation of HT use, have different impacts on this disorder. Recently, there has been some good news such as the following: the currently available data do not provide sufficient evidence to prove a causal relationship between postmenopausal HT and breast cancer; breast cancer in postmenopausal women using HT usually has better prognosis than that of nonusers. In conclusion, HT is still the most effective method of relieving climacteric symptoms for many postmenopausal women. However, a possible risk of breast cancer associated with long-term HT usage should not be ignored. With respect to prevention of breast cancer, regular evaluation of individual breast cancer susceptibility and close follow-up through mammography and/or breast sonography are necessary strategies for the safety of HT use.     

Liver surgery and transplantation in China: Progress and Challenges

From the limited but available information, we traced the history of developments of liver surgery and transplantation in China. Liver surgery first started in the late 1950s in China, and it soon flourished mainly because of the great demand in liver surgery and the emergence of a number of giants in liver surgery. We recognized and honoured the important contributions of these Chinese pioneers in portal hypertension, recurrent pyogenic cholangitis, hepatocellular carcinoma and liver transplantation.     

PD-1/PD-L1 blockade in cervical cancer: current studies and perspectives

Cervical cancer (CC) is the fourth most commonly diagnosed female malignancy and a leading cause of cancer-related mortality worldwide, especially in developing countries. Despite the use of advanced screening and preventive vaccines, more than half of all CC cases are diagnosed at advanced stages, when therapeutic options are extremely limited and side effects are severe. Given these circumstances, new and effective treatments are needed. In recent years, exciting progress has been made in immunotherapies, including the rapid development of immune checkpoint inhibitors. Checkpoint blockades targeting the PD-1/PD-L1 axis have achieved effective clinical responses with acceptable toxicity by suppressing tumor progression and improving survival in several tumor types. In this review, we summarize recent advances in our understanding of the PD-1/PD-L1 signaling pathway, including the expression patterns of PD-1/PD-L1 and potential PD-1/PD-L1-related therapeutic strategies for CC.     

From SARS to MERS: evidence and speculation

The Middle East respiratory syndrome coronavirus (MERS-CoV) is a novel zoonotic pathogen. In 2012, the infectious outbreak caused by MERS-CoV in Saudi Arabia has spread to more than 1600 patients in 26 countries, resulting in over 600 deaths. Without a travel history, few clinical and radiological features can reliably differentiate MERS from SARS. But in real world, comparing with SARS, MERS presents more vaguely defined epidemiology, more severe symptoms, and higher case fatality rate. In this review, we summarize the recent findings in the field of MERS-CoV, especially its molecular virology, interspecies mechanisms, clinical features, antiviral therapies, and the further investigation into this disease. As a newly emerging virus, many questions are not fully answered, including the exact mode of transmission chain, geographical distribution, and animal origins. Furthermore, a new protocol needs to be launched to rapidly evaluate the effects of unproven antiviral drugs and vaccine to fasten the clinical application of new drugs.     

Role of brown adipose tissue in metabolic syndrome,aging, and cancer cachexia

Brown adipose tissue (BAT) plays a fundamental role in maintaining body temperature by producing heat. BAT that had been know to exist only in mammals and the human neonate has received great attention for the treatment of obesity and diabetes due to its important function in energy metabolism, ever since it is recently reported that human adults have functional BAT. In addition, beige adipocytes, brown adipocytes in white adipose tissue (WAT), have also been shown to take part in whole body metabolism. Multiple lines of evidence demonstrated that transplantation or activation of BAT or/and beige adipocytes reversed obesity and improved insulin sensitivity. Furthermore, many genes involved in BAT activation and/or the recruitment of beige cells have been found, thereby providing new promising strategies for future clinical application of BAT activation to treat obesity and metabolic diseases. This review focuses on recent advances of BAT function in the metabolic aspect and the relationship between BAT and cancer cachexia, a pathological process accompanied with decreased body weight and increased energy expenditure in cancer patients. The underlying possible mechanisms to reduce BAT mass and its activity in the elderly are also discussed.     

Mesenchymal stem cells and immune disorders: from basic science to clinical transition

As a promising candidate seed cell type in regenerative medicine, mesenchymal stem cells (MSCs) have attracted considerable attention. The unique capacity of MSCs to exert a regulatory effect on immunity in an autologous/allergenic manner makes them an attractive therapeutic cell type for immune disorders. In this review, we discussed the current knowledge of and advances in MSCs, including its basic biological properties, i.e., multilineage differentiation, secretome, and immunomodulation. Specifically, on the basis of our previous work, we proposed three new concepts of MSCs, i.e., “subtotipotent stem cell” hypothesis, MSC system, and “Yin and Yang” balance of MSC regulation, which may bring new insights into our understanding of MSCs. Furthermore, we analyzed data from the Clinical Trials database (http://clinicaltrials.gov) on registered clinical trials using MSCs to treat a variety of immune diseases, such as graft-versus-host disease, systemic lupus erythematosus, and multiple sclerosis. In addition, we highlighted MSC clinical trials in China and discussed the challenges and future directions in the field of MSC clinical application.     

Family planning technical services in China

Family planning is a basic state policy in China. Its aim is to control population growth and to enhance population quality. Technical services are the key measures for implementing the family planning policy. In order to ensure that people use safe, effective, and appropriate contraceptive methods based on the government’s commitment, China has established countrywide family planning service networks down to the township level. The people can access various and convenient contraceptive services. In urban areas, all contraceptive services are free. The contraceptive prevalence rate in 2007 was 84.6%, the percentage of intrauterine device (IUD) was 52.3%, that of female sterilization was 32.3%, and that of vasectomy was 6.1%. This means that more than 90% of married childbearing couples were using long-term contraceptives. At the same time, the government gives priority to supporting research on contraceptive technology. Studies’ results have provided scientific evidence for development, introduction, and expansion of contraceptive methods, and also for establishment and revision of the technical guidelines. Great efforts have been made in promoting “human-oriented and client-centered” services during the recent ten years. Remarkable success has been achieved in improving the quality of technical services.