Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

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HPV prevalence and genotyping in the cervix of Chinese women
Shao-Ming WANG, Jing LI, You-Lin QIAO
Front Med Chin. 2010, 4 (3): 259-263.

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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.

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Clinical significance of human papilloma virus infection in the cervical lesions
Shuang LI, Yu-Han MENG, Hu TING, Jian SHEN, Ding MA
Front Med Chin. 2010, 4 (3): 264-270.

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Cervical lesions have been regarded as the common and frequently occurring diseases in China. Recently, the morbidity and youth tendency of cervical cancer have gradually increased. Cervical cancer, related with human papilloma virus (HPV) infection, has been one of the severest diseases threatening health and life of women, and is an infectious disease. The universality of HPV infection in the reproductive tract should not be ignored. The well-known risk factors of HPV infection in cervical lesions consist of high-risk sexual behaviors, immunosuppression, age, contraceptive methods, the concurrent infection of other sexually transmitted diseases, etc. The variation of cervical lesions induced by HPV infection is involved in the continuous pathological process, including the subclinical, latent, and persistent infection of high risk (HR)-HPV, chronic cervicitis with abnormal results of cytological examination, cervical intraepithelial neoplasia (CIN), and cervical cancer. The outcome of patients with HPV infection is influenced by many factors, such as HPV subtype dominance, persistent HPV infection, HPV loading dose, and multiple HPV infection. Controlling HR-HPV persistent infection should be an important strategy for reducing cervical lesions.

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Current situation and development of prenatal diagnosis in China
Xu-Ming BIAN, Qi GUO, Qing-Wei QI
Front Med Chin. 2010, 4 (3): 271-274.

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Prenatal screening and diagnosis are major methods for control of birth defects, which is a very important problem in China. Here, we review current situation and development of prenatal screening and diagnosis in mainland China, including prenatal screening and prenatal diagnosis of fetal chromosome abnormalities, non-invasive prenatal diagnostic techniques and prenatal diagnosis of monogenic diseases, polygenic disease and congenital metabolic diseases. We also discuss epidemiology of birth defects and genetic diseases in China and related ethical issues of prenatal diagnosis.

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Pathogenesis, diagnosis, and treatment of recurrent spontaneous abortion with immune type
Qi-De LIN, Li-Hua QIU
Front Med Chin. 2010, 4 (3): 275-279.

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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.

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Polycystic ovary syndrome
Zi-Jiang CHEN, Yuhua SHI
Front Med Chin. 2010, 4 (3): 280-284.

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Polycystic ovary syndrome (PCOS) is a common gynecologic endocrinopathy. The pathogenesis of PCOS is associated with both heredity and environment. PCOS has adverse impacts on female endocrine, reproduction, and metabolism. PCOS can impact women’s reproductive health, leading to anovulatory infertility and higher rate of early pregnancy loss. PCOS has additional metabolic derangements, such as insulin resistance, impaired glucose tolerance, and dyslipidemia. The risks of diabetes, cardiovascular disease, hypertension, metabolic syndrome, and endometrial cancer among PCOS patients are significantly increased as well.

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Family planning technical services in China
Shang-Chun WU
Front Med Chin. 2010, 4 (3): 285-289.

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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.

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How to judge the association of postmenopausal hormone therapy and the risk of breast cancer
Ling XU
Front Med Chin. 2010, 4 (3): 290-293.

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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.

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High-intensity focused ultrasound tumor ablation: Review of ten years of clinical experience
Lian ZHANG, Zhi-Biao WANG
Front Med Chin. 2010, 4 (3): 294-302.

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High-intensity focused ultrasound (HIFU) is a technique to destroy tissue at depth within the body, selectively and without harming overlying and adjacent structures within the path of the beam because the ultrasonic intensity at the beam focus is much higher than that outside of the focus. Diagnostic ultrasound is the first imaging modality used for guiding HIFU ablation. In 1997, a patient with osteosarcoma was first successfully treated with ultrasound imaging-guided HIFU in Chongqing, China. Over the last decade, thousands of patients with uterine fibroids, liver cancer, breast cancer, pancreatic cancer, bone tumors, and renal cancer have been treated with ultrasound imaging-guided HIFU. Based on several research groups’ reports, as well as our ten-year clinical experience, we conclude that this technique is safe and effective in treating human solid tumors. HIFU is a promising technique. Most importantly, HIFU offers patients another alternative when those patients have no other treatment available.

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Difference between 2 h and 3 h 75 g glucose tolerance test in the diagnosis of gestational diabetes mellitus (GDM): Results from a national survey on prevalence of GDM
Xue-Lian GAO, Yu-Mei WEI, Hui-Xia YANG, Xian-Ming XU, Ling FAN, Jing HE, Ning LIU, San-Cun ZHAO, Ya-Li HU, Zi YANG, Yun-Ping ZHANG, Xing-Hui LIU, Xu CHEN, Jian-Ping ZHANG, Wen-Li GOU, Mei XIAO, Hai-Rong WU, Mei-Hua ZHANG
Front Med Chin. 2010, 4 (3): 303-307.

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The possibility of the 2 h oral glucose tolerance test (OGTT) as an alternative to the 3 h OGTT was investigated based on data from a national survey on pregnancy-associated diabetes. Data were retrieved from 4179 pregnant women who had OGTT performed after an abnormal 50 g glucose challenge test (GCT). All of the 4 glucose levels during their OGTT were collected and analyzed. According to American Diabetes Association (ADA) gestational diabetes mellitus (GDM) diagnostic criteria, among the 4179 pregnant women who required OGTT, 3429 (82.1%) were normal and 750 (17.9%) were diagnosed as GDM. If the 3rd h glucose levels were omitted from OGTT, 79 cases of GDM (10.5%) would be overlooked. No trend was shown where women with more risk factors were more likely to be overlooked if the 3rd h test was omitted (χ2 for trend= 0.038, P>0.05). No significant differences were found in the rate of cesarean section (CS), preterm births or macrosomia between the 79 cases and those with normal OGTT results and in the gestational weeks when OGTT was performed. It shows that in order to diagnose one woman with GDM, another 52 pregnant women would have an innocent 3rd h glucose test. Omission of the 3rd h glucose test in OGTT might be reasonable due to its convenience, better compliance and a small number of possibly miss-diagnosed cases, and their pregnancy outcomes have no significant difference from those of normal pregnant women.

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Early diagnosis and therapeutic choice of Klebsiella pneumoniae liver abscess
Jing LI, Ying FU, Ji-Yao WANG, Chuan-Tao TU, Xi-Zhong SHEN, Lei LI, Wei JIANG
Front Med Chin. 2010, 4 (3): 308-316.

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Nowadays, pyogenic liver abscess (PLA) is still a common and severe intra-abdominal infection, and Klebsiella pneumoniae had emerged as the most common pathogenic bacteria worldwide in the past ten years. Our study aims to achieve an early pathogenic diagnosis and rational therapy modality for Klebsiella pneumoniae liver abscess (KLA) through clinical data analysis. A total of 197 inpatients in Zhongshan Hospital, Shanghai, diagnosed as having liver abscess between March 2001 and September 2009 were enrolled. Patients with monomicrobial infection were divided into two groups: patients with K. pneumoniae liver abscess (KLA group, n=106) and those with non-Klebsiella pneumoniae liver abscess (NKLA group, n=56). A retrospective analysis was made between these two groups on the aspects of underlying diseases, clinical characteristics, laboratory data, culture results, and imaging findings. To evaluate the effects of different medical interventions, monomicrobial KLA patients were further divided into four subgroups (percutaneous liver aspiration, aspiration plus antibiotics flushing, aspiration plus retained catheter, and aspiration plus antibiotics flushing and retained catheter), and corresponding therapeutic effects were analyzed. KLA was more likely to occur in patients with coexisting diseases such as diabetes mellitus (53.77% vs 25.00%, P=0.001) and hepatic adipose infiltration (16.04% vs 5.36%, P=0.029). Compared to NKLA group, clinical characteristics including abdominal pain (40.57% vs 57.14%, P=0.044), hypodynamia (19.81% vs 46.43%, P=0.001), and hepatomegaly (4.72% vs 14.29%, P=0.033) were much milder, but with a higher fasting blood glucose level (7.84?±?0.36 vs 5.76?±?0.30, P=0.001) on admission in KLA group. In addition, KLA abscess often appeared singly in the right lobe of the liver with gas forming nature (32.88% vs 13.51%, P=0.039), unsmooth rim (71.23% vs 40.54%, P=0.002), and dynamic septum enhancement (41.10% vs 16.22%, P=0.009). Compared to mono aspiration subgroup, additional antibiotic flushing could not further improve clinical outcomes of KLA patients (P>0.05); however, the retained catheter showed obvious advantage in reducing abscess diameter (34.38?±?3.25 mm vs 22.67?±?2.37 mm, P=0.017). It can be concluded that the strong association with diabetes, milder clinical symptoms, and gas-forming nature in CT images makes early pathogenic diagnosis of KLA possible. Comparatively, ultrasonography-guided percutaneous liver aspiration with retained catheter may be the most rational intervention modality of KLA.

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Effect of salvia miltiorrhiza pretreatment on the CCK and VIP expression in hepatic ischemia-reperfusion-induced digestive tract congestion
Zhi-Yong ZHANG, Xiao-Ping CHEN, Qi-Ping LU
Front Med Chin. 2010, 4 (3): 317-322.

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The inhibitory effect of different reperfusion periods 45 min following hepatic ischemia on the expression of cholecystokinin (CCK) and vasoactive intestinal peptide (VIP) in the jejunum and the effect of salvia miltiorrhiza pretreatment were investigated, and the possible mechanism and implications were explored. Eighty rats were randomly divided into four groups: normal control group (CO group), sham-operated group (SO group), ischemia/reperfusion (I/R) injury group (IR group) and salvia miltiorrhiza pretreatment group (SM group). The rat model of I/R was established by using a non-invasive artery clamp to clip (45 min) or relax the hepatic pedicle. In the SM group, saline (40 mL/kg) and salvia miltiorrhiza injection (6 g/kg) were injected via the tail vein 30 min before clipping the hepatic pedicle. In the SO group only the porta hepatis was dissected after laparotomy without clamping the hepatic pedicle. At 0, 3, 12, 24 and 72 h post-reperfusion, respectively, upper jejunum samples were taken for immunohistochemistry of CCK and VIP. It was found that 0 h after I/R, the expression of CCK and VIP in the upper jejunum was upregulated. With prolongation of the reperfusion period, the expression of CCK and VIP was also increased, reached the peak at the 24th h, and gradually returned to the normal level at the 72nd h after reperfusion. The levels of both CCK and VIP in the SM group were lower than those in the IR group. It is suggested that the digestive tract congestion injury caused by liver ischemia can upregulate the expression of CCK and VIP in the jejunum following reperfusion. Salviae pretreatment can partly reduce the increased expression of CCK and VIP in the jejunum in the same period, which might contribute to the early recovery of gastrointestinal motility.

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Inhibition of NF-kappa B can enhance Fas-mediated apoptosis in leukemia cell line HL-60
Li WANG, Shi ZHAO, Hong-Xiang WANG, Ping ZOU
Front Med Chin. 2010, 4 (3): 323-328.

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This study explored the effects of nuclear factor-kappa B (NF-κB) inhibitor Bay 11-7082 on Fas/FasL system and Fas-mediated apoptosis in cell line HL-60 cells. The mRNA and protein levels of Fas, FasL, and X-linked inhibitor of apoptosis protein (XIAP) were detected by reverse transcription-polymerase chain reaction (RT-PCR) and flow cytometry (FCM); the level of sFasL was evaluated by enzyme-linked immunosorbent assay (ELISA); and apoptosis was determined by FCM. After treatment with Bay 11-7082, the mRNA and protein levels of FasL and XIAP in HL-60 cells were significantly lower than in the controls (P<0.05), but the mRNA and protein levels of Fas and sFasL did not change significantly (P>0.05). Apoptotic rate of HL-60 cells treated with Bay 11-7082 was significantly higher than in the controls (P<0.05). Therefore, we conclude that Bay 11-7082 can enhance Fas-mediated apoptosis in HL-60 cells by downregulating FasL and XIAP levels.

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Effects of resistin on skeletal glucose metabolism
Fang-Ping LI, Zhi-Zhen LI, Miao ZHANG, Li YAN, Zu-Zhi FU
Front Med Chin. 2010, 4 (3): 329-335.

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Resistin is an adipokine highly related to insulin resistance (IR). The purpose of our research was to investigate how resistin influences skeletal glucose metabolism and explore its mechanisms. We constructed the recombinant plasmid pcDNA3.1 expressing resistin and then transfected it into C2C12 myocytes. The expression of resistin in C2C12 myocytes was detected by Western blotting. Glucose uptake was measured by 3H labeled glucose; glucose oxidation and glycogen synthesis was detected with 14C-labeled glucose. GLUT4 mRNA was measured by reverse transcription polymerase chain reaction (RT-PCR). We observed that resistin was expressed in transfected myocytes, and resistin decreased insulin induced glucose uptake rate by 28%–31% and inhibited the expression of GLUT4 mRNA. However, there was no significant difference in basal glucose uptake, and glucose oxidation and glycogen synthesis remained unchanged in all groups. It is concluded that resistin inhibits insulin induced glucose uptake in myocytes by downregulating the expression of GLUT4 and it has no effects on glucose oxidation and glycogen synthesis. Our findings may provide a clue to understand the roles of resistin in the pathogenesis of skeletal IR.

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Autoimmune regulator regulates autophagy in THP-1 human monocytes
Liang SHI, Li-Hua HU, Yi-Rong LI
Front Med Chin. 2010, 4 (3): 336-341.

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The autoimmune regulator (AIRE) is a crucial factor for the induction of central tolerance, and mutations in this gene lead to abnormal immune responses. However, the role of AIRE in autophagy in immune cells, especially in monocytes, is obscure. In the present study, we found that overexpression of AIRE in THP-1 human monocytes resulted in increased endogenous light chain 3 (LC3)-II level and elevated LC3 positive vesicles. Moreover, an autophagy inhibitor or knockdown of AIRE by small interference RNA attenuated these effects. In contrast, the expression of p62/SQSTM1 remained unchanged in THP-1 cells after the corresponding treatment. Our findings indicate that AIRE plays a role in the regulation of autophagy in THP-1 human monocytes.

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The value of radionuclide hepatobiliary scintigraphy in combination with determination of bilirubin from duodenal drainage in differential diagnosis of infantile persistent jaundice
Sheng-Xuan LIU, Zhi-Hua HUANG
Front Med Chin. 2010, 4 (3): 342-345.

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The aim of this study was to investigate the value of technetium etifenin injection (99mTc-EHIDA) hepatobiliary scintigraphy in combination with determination of bilirubin from duodenal drainage in differential diagnosis between infantile hepatitis syndrome and biliary atresia. 99mTc-EHIDA hepatobiliary scintigraphy in combination with duodenal fluid examination was used for evaluation in 84 infants with persistent infantile jaundice. For diagnosing biliary atresia, the sensitivity and specificity of scintigraphy were 100% and 74.5%, respectively; the sensitivity and specificity of scintigraphy in combination with duodenal fluid examination were 100% and 100%, respectively. In conclusion, hepatobiliary scintigraphy, which is a noninvasive, safe, valuable examination method, in combination with examination of duodenal fluid, is of value for the differential diagnosis between infantile hepatitis syndrome and biliary atresia.

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Natural history of HIV infection in former plasma donors in rural China
Min ZHANG, Hong SHANG, Zhe WANG, Wei-Guo CUI, Qing-Hai HU
Front Med Chin. 2010, 4 (3): 346-350.

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Patients infected through commercial blood-selling practices (former plasma donors, FPDs) in China represent a unique patient population compared to individuals infected through sexual contact or intravenous drug use. FPDs all have an approximate time of human immunodeficiency virus (HIV) infection during the mid-1990s. Few studies about the natural history of HIV infection in these patients were performed. The current study focuses on characterizing the duration of asymptomatic infection as well as the time to disease and mortality of infected FPDs in China. A retrospective cohort study was conducted based on data collected from 5484 HIV-1 infected FPDs in Shangcai county, Henan province. Kaplan-Meier analysis was applied to estimate the asymptomatic duration from the time of infection to the onset of AIDS as well as the survival period from the onset of AIDS to the time of death. The estimated median asymptomatic phase was about 9.21 years, which is similar to that reported in other developing countries in Africa. The estimated median life span after the onset of symptoms was about 9.91 months, which is notably shorter than life spans reported elsewhere. This is the first large-scale retrospective study on the natural history of HIV infection in FPDs in rural China. The findings not only provide valuable insight into an understudied population, but should also serve as an important reference for patient management and care.

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16 articles