Volume 101 ·  Issue 24 ·  2021

Cervical cancer is a common malignant tumor that seriously threatens the health of Chinese women. The situation of prevention and control is still serious. In the past decade, the Chinese government has made great efforts to cervical cancer prevention and control and achieved remarkably in HPV vaccine development, sound health screening system, and treatment capacity of early cervical cancer and precancerous lesions. However, due to the large population base, unequal allocation of health resources, and uneven service quality across regions, there is still a significant gap to achieve the WHO′s goal of eliminating cervical cancer by 2030. In order to fulfill the Global Strategy to accelerate the elimination of cervical cancer, China urgently needs to learn from the international experience, combined with the real situation of cervical cancer prevention and control and the latest research progress in China and to put forward appropriate action recommendations and implementation approaches, which will contribute to promote the cervical cancer elimination process and to build a paradigm for “Healthy China” cancer prevention.

Since the first publication in 2017, the Chinese society of clinical oncology breast cancer guidelines have been updated in four editions, and nearly 300 000 volumes have been published, which has been widely recognized by scholars at home and abroad. The important updates from pathological diagnosis to therapies in the newest guideline has been updated in accordance with evidence, drug accessibility and expert opinions. Meanwhile, more chapters, like drug adverse reaction management, real-world research, biosimilar drugs, have been added, making a comprehensive guideline in guiding breast cancer standardized diagnosis and treatment.

In recent years, the number of guidelines published in China has increased rapidly, and the quality of guidelines has also improved steadily, but there is still a certain gap with international guidelines. In order to further improve the quality of guidelines published by Chinese Medical Association series journals, the Cooperation Center for Guidelines Implementation and Knowledge Transformation of World Health Organization and Chinese Medical Association Journal jointly established the Guidelines and Standards Research Center of Chinese Medical Association Journal, invited clinical experts and methodologists at home and abroad to evaluate the methodological quality and report quality of the guidelines published by Chinese Medical Association series journals in 2020, formed a guideline evaluation report, and put forward suggestions for future guideline quality research work, so as to provide decision-making basis for guideline makers, users and managers.

Hepatocellular carcinoma (HCC) is a malignant tumor originating from hepatocellular cells. More than 80% of HCC patients in China are complicated with hepatitis B virus infection. HCC is usually a tumor with rich blood supply. On the one hand, arterial chemoembolization (TACE) treatment blocks the blood supply of the tumor, and at the same time, high concentrations of chemotherapeutic drugs are accumulated in the tumor to maximize the killing effect on tumor cells. It is recognized as the primary treatment for unresectable HCC treatment. After discussion, experts from the Interventionist Branch of Chinese Medical Doctors Association updated the 2018 edition of the Clinical Practice Guidelines for Transarterial Chemoembolization of Hepatocellular Carcinoma (TACE) in China.

To analyze the effectiveness of the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in China.

Data were collected in the form of quarterly statistical tables reported by NCCSPRA counties in 30 provinces (Hong Kong, Macao and Taiwan province of China were not included into the NCCSPRA, and Tibet Autonomous Region carried out the program but did not reported the data) from 2009 to 2018. The women aged 35-64 years with sexual behavior and the identity (Hukou) of rural area in these project counties were included into the NCCSPRA, and women receiving hysterectomy for non-cervical cancer or non-cervical lesions were excluded. The following indicators were analyzed: the positive rates of different screening methods, the abnormality rates of colposcopy and histopathology, the detection rate of precancerous lesions, the detection rate of cervical cancer and the rate of early diagnosis.

A total of 85 041 490 women aged 35-64 in rural areas received free cervical cancer screening and diagnosis if necessary. On the whole, the abnormality rate of cytology, HPV testing, VIA/VILI, colposcopy and histopathology was 3.71%(2 567 610), 9.91%(331 158), 10.10%(1 167 930), 28.85%(1 420 847), and 21.20%(303 068) respectively. The detection rate of cervical precancerous lesions was 153.88/100 000, and increased from 106.85/100 000 in 2012 to 223.89/100 000 in 2018 (P<0.001). Regionally, the east (207.37/100 000) reached higher rate than the middle (177.65/100 000), and the middle higher than the west (108.65/100 000) (P<0.001). The detection rate of invasive cervical cancer was 21.58/100 000, and increased from 18.02/100 000 in 2012 to 26.54/100 000 in 2018 (P<0.001). Regionally, the middle of China (25.46/100 000) reached the higher rate than the east (19.62/100 000) and the west (19.30/100 000) (P<0.001). The rate of early detection was 91.24%(136 140), which increased from 89.60% (11 883)in 2012 to 92.80%(26 962) in 2018 (P<0.001). Regionally, the east of China (94.02%, 37 600) reached the higher rate than the middle(91.06%, 56 488), and the middle higher than the west (89.12%, 42 052) (P<0.001).

There are obvious difference in terms of the detection rate of cervical precancerous lesions and the rate of early diagnosis reflecting cervical cancer screening capacity among the eastern, middle and western regions,which showed service inequity among different areas indirectly. The middle and western regions, especially the western regions, are still the focus of future works.

To study the cervical cancer screening rate and related factors among women in China.

In 2015, Chinese Chronic Diseases and Risk Factors Surveillance in Adults was conducted in 298 counties or districts using the multistage stratified cluster sampling in China. The study investigated 91 348 women aged 20 years or older who lived in the local at least 6 months in the past year. We collected the information about cervical cancer screening and socio-demographic factors through face-to-face interview. The screening rate was calculated by the complex sampling design and populating weighting. Rao-Scott χ² was used to test the differences in screening rates within subgroups. Multivariable logistic regression was used to explore the factors associated with the uptake of cervical cancer screening.

The mean age of participants was (51±14) years old. The cervical cancer screening rate was 23.6% (n=21 346), and there was a significant difference in the screening rates among age groups. The cervical cancer screening rate in women aged 40-49 years was 34.8% (n=7 043). There was significant difference in the screening rates among geographic areas and the highest screening rate was 27.9% (n=6 707) in the eastern China. The more likelihood of uptake of cervical cancer screening was significantly associated with living in high-income regions, higher education, non-agriculture employment, higher household income, having medical insurance, and having health check-up during the past three years, and the cervical screening rate was higher (all P<0.05) .

The cervical cancer screening rate is low in China and there was significant difference in the age and geographic areas. The uptake of cervical cancer screening is associated with local economic status, household income, education, employment, health insurance, and health check-up.

To evaluate the effectiveness of thermal ablation in the treatment of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) in Chinese women.

The high-risk HPV-positive women aged 20-65 who were detected through a cervical cancer screening project implemented in three rural sites (Etuoke counties in Inner Mongolia, Xiangyuan and Yangcheng counties in Shanxi Province) and one urban site (Shenzhen) in China were included in this prospective study. Follow up evaluation was performed on HPV positive women who underwent thermal ablation (n=166) as well as received no treatment (n=2 716) in cervical cancer screening program. For women with thermal ablation treatment, HPV test and cytology were used for follow-up with the interval of 6 months or longer after treatment. For women without treatment, HPV test was used for annual follow-up. Women with positive results in either of the HPV tests or abnormal cytology were referred for a colposcopy or biopsy if necessary. The HPV clearance rate and the cure rate of CIN were compared between the two groups.

A total of 152 women treated with thermal ablation and 2 539 women without treatment reported for follow-up evaluation with the age M(Q₁, Q₃) of 42 (36, 48) and 47 (41, 54) years old, and the median time to follow-up time of 23.4 (12.4, 24.5) and 23.5 (12.4, 24.0)months, respectively. The HPV clearance rate in women undergoing thermal ablation was significantly higher than that in women with no treatment (73.0% vs 46.1%, P<0.001). The HPV16, HPV52 and HPV58 clearance rates among women receiving thermal ablation were higher than that in women without treatment with theOR (95%CI) of 2.8 (1.3-6.1), 3.2 (1.3-7.9) and 5.8 (2.1-15.6). For women with histologically confirmed CIN at baseline, cure rates were 77.4%(n=72) for thermal ablation. Cure rates of the thermal ablation were 81.0%(n=47) for CIN grade one (CIN1) and 71.4% (n=25) for CIN grade two or worse (CIN2+).

Thermal ablation is effective to clear the HPV infection as well as to treat CIN. Particularly for the HPV genotypes with the paramount attributable proportion to cervical cancer and precancerous in China, the HPV clearance rate was significantly higher than that reported in the women without treatment.

To systematically summarize and evaluate the current cervical cancer screening guidelines worldwide.

“Cervical cancer/cervical intraepithelial neoplasia”, “screening”, and “guidelines/recommendations” were searched as keywords in PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data for cervical cancer screening guidelines. The language was limited to Chinese and English. A total of 29 guidelines were included before September 1, 2020. The basic information and recommendations of the guidelines issued were summarized.

Among the 29 cervical cancer screening guidelines, most guidelines targeted on the population aged 25-65 years. Cytology and human papillomavirus (HPV) testing are two commonly used methods for the cervical cancer screening, and HPV testing is increasingly recommended as the primary screening methods. Most guidelines recommended five years interval for the HPV testing-based screening or co-testing (HPV testing and cytology) based screening and three years for the cytology-based. For managing population with abnormal cervical cancer screening, triage or screening repeatedly to identify high-risk populations were more recommended. Direct colposcopy or treatment were allowed for women with higher risk of cervical intraepithelial neoplasia (CIN) during the screening procedure. Several guidelines involving HPV vaccination population recommended them the same strategy as the general population without vaccination.

Currently, most of the cervical cancer screening guidelines applied to the population with the average risk of the CINs and were issued by the developed countries. Primary methods for the cervical cancer screening have gradually changed from the cytology to the HPV testing. There is a lack of recommendations targeting special population on cervical cancer screening in the current guidelines.

To systematically summarize the development of global human papillomavirus (HPV) vaccination guidelines.

The retrieval for all the Chinese and English literature published before August 2020 was conducted in PubMed, Embase and China Biomedical Literature Database, with “papillomavirus vaccines” “wart virus vaccine” “guideline” “practice guideline” “health planning guidelines” “guidelines as topic” “practice guidelines as topic” “immunization programs” in English as well as “papillomavirus vaccines” “HPV vaccine” “guideline” “recommendation” “consensus” in Chinese as search keywords. A total of 18 guidelines were included for data extraction and analysis.

The 18 pieces of guidelines included 1 pieces of World Health Organization (WHO) position paper, 6 pieces of guidelines at national or provincial level and other 11 pieces of by academic institutions. In national or provincial guidelines, the recommendation for routine vaccination mainly focused on 11-13 year-old adolescents and the recommendation for catch-up vaccination extends to 17-26 years old. Recommendation of guidelines by academic institutions were similar to the WHO position paper: girls aged 9-14 as the primary target for the routine vaccination; females aged 15-26 years old as the secondary target populations when it′s feasible, affordable and cost-effective; women aged over 26 could be vaccinated at an individual level. There were only three guidelines simultaneously updated with the national immunization programme and covered four aspects: the vaccinated population (girls-only to gender-neutral vaccination), the periodic catch-up immunization, the dose schedule updates and the change of vaccine types.

It′s recommended that the development of Chinese HPV vaccination guidelines refer to global guidelines and updates and take full consideration of the epidemiological evidence, resources and current status of the immunization system in China.

To explore the annual probabilities of outcomes for different cervical disease states.

Cohort studies related to the natural history of cervical cancer were retrieved from PubMed, Embase and China Biomedical Literature Database, and the retrieval time was from the establishment of the database to May 2020. Newcastle-Ottawa scale was used to evaluate the quality of the included literatures. The annual outcome probabilities of different cervical disease states in high-risk human papillomavirus (hrHPV) positive, negative and cervical intraepithelial neoplasia grade 1 (CIN1) population were calculated (95%CI). Random-effects model was used for meta-analysis. Egger′s test was used to evaluate publication bias; sensitivity analysis was used to evaluate the robustness of the combined parameters. Meta-regression was used to explore factors associated with the heterogeneity of annual outcome probability.

A total of 37 studies were included, including 12, 20 and 15 studies involving hrHPV negative, hrHPV positive and CIN1 population, respectively, with a Newcastle -Ottawa scale (NOS) score of 7.05±1.20. The annual probability (95%CI) of progression to CIN1, CIN2 and CIN3+ in hrHPV-positive population were 0.022 2 (0.014 3, 0.031 0), 0.017 0 (0.012 0, 0.022 0) and 0.016 2 (0.012 6, 0.019 8), respectively. The annual probability (95%CI) of progression to CIN1, CIN2 and CIN3+ in hrHPV-negative population was 0.002 7 (0.000 9, 0.004 6), 0.000 7 (0.000 3, 0.001 1) and 0.000 6 (0.000 3, 0.000 9), respectively. The annual probability (95%CI) of reversal to normal, maintenance of CIN1 status and progression to cervical intraepithelial neoplasia grade 2 or above (CIN2+) in CIN1 population were 0.578 1 (0.369 9, 0.786 3), 0.400 1 (0.167 4, 0.632 9), 0.056 9 (0.034 9, 0.078 9), respectively. Egger′s test showed that there was publication bias in the annual outcome probability of hrHPV positive progression to CIN2 and CIN3+ and hrHPV negative progression to CIN2 and CIN1 progression to CIN2+, with t values of 5.50, 2.36, 2.80 and 4.12, respectively (all P values<0.05). Sensitivity analysis showed that when excluding any of the studies, the range of annual probability of progression to CIN1, CIN2 and CIN3+ were 0.016 6-0.024 7, 0.014 9-0.018 9 and 0.013 6-0.017 7 among hrHPV-positive population; 0.002 4-0.003 5, 0.000 6-0.000 9 and 0.000 5-0.000 7 among hrHPV-negative population and the range of annual probability of CIN1 reversal to normal, maintenance as CIN1 and progression to CIN2+ were 0.531 8-0.631 2, 0.321 9-0.443 3, and 0.052 0-0.061 0, respectively. Meta-regression analysis showed that region, population origin, population cytological diagnosis, follow-up time, and NOS score were not associated with the heterogeneity of annual outcome probability (allP values>0.05).

The annual outcome probability of different cervical disease states in hrHPV positive population is high, and the CIN1 population only needs close follow-up.

To investigate the long-term mesh-related complications and treatment outcome of total pelvic reconstruction surgery with tension-free transvaginal mesh (PROSIMA^TM pelvic floor repair system).

From July 2010 to June 2012, 48 patients with severe pelvic organ prolapse(POP)who underwent PROSIMA^TM were enrolled and treated in Peking Union Medical College Hospital. 29 patients (60.4%) were followed up periodically for at least 3 years to observe the occurrence of long-term mesh-related complications, and the clinical characteristics, classification of complications and treatment outcome of these cases were summarized.

The 29 cases with an average age of (65.1±5.2) years were followed up for an average of (71.6±21.2) months. The last follow-up was 36-105 months after treatment. The long-term success rate of the treatment was 79.3% (n=23). There were 18 cases of mesh exposure (18/48, 37.5%), of which 10 cases (55.6%) were new and persistent. 4 cases (4/18) had symptoms; the rest were found by pelvic examination. Ten patients (10/18) were positive for vaginal swab culture. As for treatment outcome, one case suffered from mesh erosion into the bladder. 4 patients (6.9%) complained of postoperative pain. Twenty-nine patients were divided into the exposure group (n=18) and the non-exposure group (n=11) according to mesh exposure occurrence. There was a significant difference in the proportion of positive swab culture results between the two groups (P=0.019), but no significant difference in the incidence of postoperative pain (P=0.566).

The incidence of long-term mesh exposure in PROSIMA^TM is not low, and most of patients with which had no symptoms.

To investigate the characteristics of regional homogeneity (ReHo) of the resting-state magnetic resonance imaging (fMRI) in first-episode childhood and adolescence-onset schizophrenia (CAOS) and to analyze the relationship between the severity of auditory hallucinations and ReHo.

Seventy-nine cases of first-episode CAOS patients (case group) aged 10 to 16 were collected from October 2017 to December 2019 in the Second Affiliated Hospital of Xinxiang Medical University. There were 28 males and 51 females with a mean age of (14.1±1.3) years. And meantime, 32 healthy children matched with the patients in baseline data were selected as healthy controls (HCs). The patients with CAOS were divided into three groups according to the auditory verbal hallucinations (AVH) assessment of positive symptoms scale (SAPS): non-AVH group (0-1 point), 20 cases; mild-to-moderate AVH group (2-3 points), 36 cases; severe AVH group (4-5 points), 23 cases. The severity of psychiatric symptoms was evaluated using the Positive and Negative Syndrome Scale (PANSS). ReHo analysis was performed on the resting state fMRI scan data of all subjects. Covariance analysis (ages was used as a covariate) was performed between the case group and the HCs, and the three case groups were analyzed to find the different brain areas. Finally, covariance analysis (ages as a covariate) was performed on ReHo values between the case group and the HCs, and among the three groups of patients. Correlation analysis was conducted between the ReHo values in different brain regions and PANSS scores, as well as AVH scores.

Compared with the HCs, the decreased ReHo of patients were mainly located in the left superior frontal gyrus, right superior temporal gyrus, left central anterior gyrus, and right central anterior gyrus (all P<0.05). Besides, the ReHo deficits were in the right superior temporal gyrus, left middle frontal gyrus, precuneus lobe, and left central anterior gyrus among the three groups (allP<0.05). Moreover, the severe-AVH group showed decreased ReHo values in precuneus lobe compared with the non-AVH group (P<0.05), and showed decreased ReHo values in left middle frontal gyrus and left central anterior gyrus compared with the mild-to-moderate AVH group (bothP<0.05). Furthermore, the ReHo in the right superior temporal gyrus and the left anterior central gyrus were negatively correlated with the AVH score (rs=-0.34, -0.32, P<0.05); and the positive symptom score was negatively correlated with the ReHo in the right superior temporal lobe (r=-0.23, P<0.05).

Firstly, decreased ReHo is found in multiple brain regions in CAOS. Secondly, the occurrence of auditory hallucinations may be related to the abnormal activity of local neurons in the resting state. Consequently, Abnormal brain function may be the underlying neural basis for the first-episode CAOS.

To analyze the association of the cadmium internal exposure with chronic kidney disease (CKD) in Chinese adults aged 18 and older.

A total of 9 821 adults aged 18-79 from the China National Human Biomonitoring (CNHBM) from 2017 to 2018 were included. Blood and urine cadmium exposure levels were measured by inductively coupled plasma mass spectrometry (ICP-MS), and urine cadmium levels were adjusted with urine creatinine; CKD were defined by estimated glomerular filtration (eGFR) using the chronic kidney disease epidemiology collaboration (CKD-EPI). Weights were considered due to complex sampling process for in statistical analysis. Logistic regression is used to analyze the association of blood cadmium, urine cadmium, and urine cadmium adjusted with creatinine exposure levels with CKD, and restricted cube spline (RCS) was used to assess the exposure-response curve of blood cadmium, urine cadmium and urine cadmium adjusted with creatinine with CKD.

The weighted age was 44.75 and males accounted for 61.1%. The prevalence rate of CKD was 12.7%. The geometric mean values of blood cadmium, urine cadmium, and urine cadmium adjusted with creatinine were 0.96(0.03) μg/L, 0.61(0.03) μg/L, and 0.58(0.03) μg/g. After adjusting for confounding factors, the weighted logistic regression showed that the lowest quintile (Q₁) was compared with the odds ratio (OR) of the highest quintile (Q₅) of blood cadmium, urine cadmium, and urine cadmium adjusted with creatinine and the 95% confidence interval (CI) was 1.80 (1.02-3.20), 1.77 (0.94-3.31) and 1.94 (1.11-3.37) respectively. In the restricted cubic spline regression model, non-linear association of blood cadmium, urine cadmium, and urine cadmium adjusted with creatinine with CKD were observed after adjusting for related confounding factors (P<0.001, 0.018, 0.031 respectively). The risk of CKD increased with the increment of cadmium exposure without risk threshold, and the exposure response curve was steeper at low cadmium exposure.

Among Chinese adults aged 18 and older, cadmium exposure is positively associated with the risk of chronic kidney disease.

To investigate the immunomodulatory effect of tacrolimus in severe aplastic anemia (SAA).

Patients diagnosed with SAA at the Department of Hematology, General Hospital of Tianjin Medical University from June 2015 to January 2018 were enrolled. CD8⁺T cells were sorted by immunomagnetic separation from peripheral blood of SAA patients. MTT method was used to detect the proliferation of CD8⁺T cells. The SAA mouse model was established by total body irradiation (TBI) and donor lymphocyte infusion (DLI). There were 10 normal controls without pretreatment, 10 rats in TBI group, 15 rats received TBI and DLI. The expression of perforin and granzyme in CD8⁺T cells and the ratio of CD4⁺/CD8⁺cells in peripheral circulation were measured by flow cytometry. The level of interferon-γ (IFN-γ) in medium supernatant of cultured CD8⁺T cells was tested with enzyme-linked immunosorbent assay (ELISA). SAA mouse model was established to study the recovery of hemogram and survival time after treatment.

A total of 16 SAA patients were enrolled, and there were 10 males and 6 females, with a median age of 35 (22-49) years. Tacrolimus inhibited the proliferation of CD8⁺T cells when IL-2 concentration was 20.0,200.0 and 2 000.0 U/ml (P<0.05). The expression of perforin in CD8⁺T cells of SAA patients treated with tacrolimus was significantly lower than that in blank control group and IL-2 group [(2.25±0.76)%, (6.70±0.82)% vs (9.10±1.90)%,all P<0.05]. The level of IFN-γ in CD8⁺T cells group after applying tacrolimus was significantly lower than that in the blank control group (P<0.05). After 10 days of administration, the peripheral blood hemoglobin (Hb), white blood cell (WBC) and platelet (PLT) counts of SAA mice in tacrolimus group were all higher than those in SAA group (allP<0.05). The expression of perforin in CD8⁺T cells in tacrolimus group was significantly lower than that in SAA group [(18. 39±6.65) vs (29. 99±9.83),P<0.05]. The median survival time of SAA group was 18.6 days, and the 90 day survival rate was 0. The median survival time of tacrolimus group was 44.6 days, and the 90 day survival rate was 80%. The survival time of SAA mice in tacrolimus group was significantly longer than that in SAA group (P<0.05).

The immunomodulatory effect of tacrolimus in SAA is similar to CsA. It has an immunosupressive effect on CD8⁺T lymphocyte.

This article reports the case of a female infant with enlarged clitoris and pubic hair growth, testosterone and 17 α-hydroxyprogesterone levels above the upper limit of normal reference values, and 21 hydroxylase deficiency was considered. Testosterone was partially decreased after hydrocortisone treatment at the initial visit, but the inhibition test of medium-dose dexamethasone showed that testosterone was not inhibited, the gene test for 21 hydroxylase deficiency was negative, and the adrenal B-ultrasound and CT showed that the right adrenal gland occupied space. After surgery, the adrenal gland was removed to occupy the space, and the testosterone decreased to normal. The postoperative pathological diagnosis was an adrenal androgen-secreting adenoma. After 8 years of regular follow-up, testosterone has been stable within the normal reference range. It is hoped that this case will strengthen clinicians' understanding of adrenal androgen-secreting adenoma.

The lung is one of the most frequently involved organs in systemic vasculitis, and the pleura, pulmonary interstitium, pulmonary parenchyma, airway and blood vessels may be involved. Pulmonary involvement of giant cell arteritis and polyarteritis nodosa is rare, while Takayasu arteritis is relatively common, which can involve the pleura and lung parenchyma. Some patients show thickening of the pulmonary artery wall and thrombosis, and the pulmonary lesions usually improve after the primary inflammation is controlled. The most common pulmonary manifestations of Behcet's disease are pulmonary infarction and pulmonary aneurysm. Anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis is commonly associated with interstitial lung disease (ILD), among which microscopic polyangiitis (MPA) is the most important. Anti-myeloperoxidase (MPO) antibody has been found to be closely related to ILD. Pulmonary nodules, masses and cavity formation are the most common and characteristic manifestations of granulomatous polyangiitis, and the changes in pulmonary nodules often parallel the systemic condition. Diffuse alveolar hemorrhage is the main pulmonary manifestation of MPA, and significantly affects the prognosis of the disease. The most common pulmonary imaging manifestation of eosinophilic granulomatous polyangiitis is bilateral migratory consolidation without cavities, which resolves rapidly after glucocorticoid treatment. The pulmonary manifestations of systemic vasculitis are complex and diverse, and insufficient understanding of this may lead to delay in diagnosis and treatment. This article summarizes and reviews the characteristics of pulmonary involvement of various primary systemic vasculitis.

Patients with glucocorticoid-resistant acute severe ulcerative colitis are in urgent need of conversion therapy, i.e. surgery or drug rescue therapy, the latter including infliximab, cyclosporine A or tacrolimus therapy. After one of the above-mentioned drug treatment schemes fails, the rescue treatment scheme of choosing another drug is sequential rescue treatment. This review comprehensively and systematically describes the international research progress on the efficacy and safety of rescue therapy (especially sequential rescue therapy), aiming to provide more evidence for choosing sequential rescue therapy in clinical practice.

Inflammatory anemia is a kind of "iron deutilization" anemia caused by the disorder of the axis of pro-inflammatory factor-hepcidin-membrane iron transporter, which is a perfection and supplement to the traditional "chronic anemia". Inflammatory anemia accurately describes the pathogenesis of such anemia, broadens the scope of the disease, updates the diagnostic criteria, and makes its treatment strategy more perfect.

At present, the coverage of immunization programs for human papillomavirus (HPV) vaccines for girls of school age in most countries around the world is still far below the 90% threshold recommended in the global cervical cancer elimination strategy. In order to promote the implementation of HPV vaccination programs in various regions, the study estimated the expected incidence of cervical cancer among women born between 2005 and 2014 without HPV vaccination based on data released by GLOBOCAN 2018 and the United Nations, and quantitatively evaluated the impact of HPV vaccine on improving the global burden of cervical cancer disease. By 2094, 11.6 million cervical cancer patients are expected to occur worldwide among women born in the 2005-2014 cohort. Africa and Asia have the highest burden of disease with approximately 10.13 million (87.4%) cases of cervical cancer, followed by Latin America with approximately 870,000 (7.4%) cases. North America, Europe and Oceania are expected to be 600,000 cases (5.2%). Countries with a high burden of cervical cancer disease at present also have a higher expected incidence of cervical cancer among women born in the cohort from 2005 to 2014. The burden of cervical cancer disease in this population also increased with the decrease of the national human development index (HDI). The expected burden of cervical cancer disease in low-medium HDI countries (8 million) is almost 10 times that in very high HDI countries (800,000). Nearly 8.7 million cases of cervical cancer can be prevented if HPV vaccination (for HPV16 and 18, with partial cross-protection for 31, 33, and 45) is administered to women born in the cohort from 2005 to 2014. This means that about 95% of cases in Africa, Asia and Latin America and about 70% of cases in low-medium HDI countries can be prevented by vaccination. This study data highlights the health benefits of carrying out HPV vaccine immunization programs and helps to improve the vaccine hesitancy in advancing HPV vaccination and improving coverage at this stage.

In 2020, the World Health Assembly approved the Global Strategy for Accelerating the Elimination of Cervical Cancer formulated by WHO, and China said it would fully support the strategy. By integrating China's current medical and health resources and possible new technologies for cervical cancer prevention and treatment in the future, this study adopted a validated hybrid model of cervical cancer epidemiology, and took all the people living in China from 2015 to 2100 as the research object, and comprehensively evaluated the costs and benefits of cervical cancer screening strategies for routine HPV vaccination of appropriate-age girls (9-14 years old), HPV vaccination of other women (over 15 years old) and women with different immunization histories (unvaccinated, bivalent vaccine and nine-valent vaccine), and selected an optimal path for cervical cancer elimination.

Human papillomavirus (HPV) vaccination is one of the most effective measures to prevent cervical cancer, but public concerns about adverse events of vaccination hinder the promotion and application of HPV vaccine. In June 2016, South Korea included HPV vaccine in the national immunization program, and implemented two doses of bivalent or quadrivalent HPV vaccine among girls aged 12 to 13. To enhance public confidence in HPV vaccines and supplement the safety data of HPV vaccines in Korea, Sungkyunkwan University in Korea conducted a nationwide cohort study using the Immunization Registry Information System and the National Health Information System to assess the association between HPV vaccination and serious adverse events.