Objective:To evaluate the clinical performance of high-risk human papillomavirus (HR-HPV) genotyping in cervical cancer screening.Methods:Between June and July 2017, a prospective cervical cancer screening cohort was established in Xiaye Town, Jiyuan City, Henan Province, China by recruiting 3 254 women aged 21 to 64 years. At baseline screening, cervical exfoliated cell specimens were collected for HR-HPV genotyping and liquid-based cytology testing. Follow-ups were conducted over a 3-year period, with cytology testing in the first and second years and both HR-HPV genotyping and cytology testing in the third year. Women meeting the referral criteria were referred for colposcopy, with cervical biopsy and histopathological diagnosis performed as necessary. The endpoint was defined as cervical intraepithelial neoplasia grade 2 (CIN2) or higher confirmed by histopathological diagnosis. The sensitivity and specificity for detecting CIN2 or higher lesions of HR-HPV genotyping were calculated, as well as the cumulative risk of developing CIN2 or higher lesions over the 4-year study period in women with different baseline HR-HPV genotyping results.Results:A total of 2 741 women were included in the statistical analysis. Baseline HR-HPV genotyping detected 453 HR-HPV positive cases (16.53%), including 98 HPV 16/18 positive cases (3.58%) and 355 other HR-HPV positive cases (12.95%). During the 4-year period, 83 cases of CIN2 or higher were diagnosed. The sensitivity and specificity of baseline HR-HPV positivity for CIN2 or higher were 89.16% (95% CI: 80.66%-94.19%) and 85.74% (95% CI: 84.36%-87.02%), respectively. The corresponding rates for HPV 16/18 positivity were 43.37% (95% CI: 33.24%-54.09%) and 97.67% (95% CI: 97.02%-98.18%). The 4-year cumulative absolute risk of CIN2 or higher was highest in the HPV 16/18 positive group (36.73%, 95% CI: 27.85%-46.62%), followed by other HR-HPV positive groups (10.70%, 95% CI: 7.87%-14.38%), and the HR-HPV negative group was the lowest (0.39%, 95% CI: 0.19%-0.76%). Conclusions:HR-HPV genotyping testing exhibits high sensitivity and specificity for detecting CIN2 or higher lesions in cervical cancer screening. It also provides a scientific basis for stratifying the individual risk of developing CIN2 or higher lesions to guide subsequent management. Therefore, the HR-HPV genotyping testing can be considered as an effective method for cervical cancer screening.

[Purpose]To explore the association between body weight change and long-term risk of esophageal cancer mortality based on Linxian General Population Nutrition Intervention study.[Methods]A total of 21 028 healthy residents aged 40～69 years old at baseline in Linxian of Henan Province were recruited as the study cohort,their body weight were measured in late 1985 and early 1991,and the esophageal cancer mortality was prospectively followed up until March 2016.The cohort was divided into four groups according to weight difference between the two measure-ments,the body weight maintenance group(change＜2 kg)was used as the reference group.The Cox proportional risk model was used to estimate the hazard ratio(HR)and 95％confidence inter-val(CI)for death from esophageal cancer in the weight loss ≥2 kg group,weight gain 2～5 kg group and weight gain ≥5 kg group.[Results]A total of 1 681 esophageal cancer deaths oc-curred during the follow-up after the last weight measurement.After adjusting for baseline age and sex,the risk of esophageal cancer death was 13％(HR=0.87,95％CI:0.77～1.00)and 16％(HR=0.84,95％CI:0.72～1.00)lower in the weight gain 2～5 kg and ≥5 kg groups compared to the weight maintenance group,respectively.The risk of esophageal cancer death was 23％higher in the weight loss ≥2 kg group than in the weight maintenance group(HR=1.23,95％CI:1.09～1.38).After adjusting for age,sex,baseline BMI group,smoking status,alcohol consumption,family history of cancer,education level,commune and nutritional intervention arms,weight loss ≥2 kg was still associated with a significantly increased risk of esophageal cancer death(HR=1.19,95％CI:1.06～1.34).Subgroup analysis showed there was no statistically significant interaction between changes in body weight and age,sex,and baseline BMI status on the risk of esophageal cancer death.[Conclusion]Weight loss is associated with an increased risk of esophageal cancer death.People in the high incidence area of esophageal squamous cell carcinoma should maintain their current weight or gain weight appropriately while maintaining a healthy weight state to reduce the risk of esophageal cancer death.

Objective:To evaluate the diagnostic performance of artificial intelligence-assisted diagnostic systems in cervical cytopathological examination.Methods:Cervical cytology slide data were retrospectively collected from four hospitals for the external validation of the developed artificial intelligence-assisted diagnostic system. Subsequently, prospective data collection was conducted for human-machine assisted studies.Results:In the retrospective study, a total of 3 162 valid samples were collected as external validation data. The system showed an area under the curve (AUC) of 0.890 (95% CI: 0.878-0.902), accuracy of 0.885 (95% CI: 0.873-0.896), sensitivity of 0.928 (95% CI: 0.914-0.941), and specificity of 0.852 (95% CI: 0.834-0.867). In the prospective study, 212 valid samples were collected, and five junior cytologists participated in the human-machine assisted study. Without artificial intelligence assistance, the average AUC for the five cytologists was 0.686 (95% CI: 0.650-0.722), the accuracy was 0.699 (95% CI: 0.671-0.727), the sensitivity was 0.653 (95% CI: 0.599-0.703), the specificity was 0.719 (95% CI: 0.685-0.750), the Fleiss κ value was 0.510, and the reading time was 223 seconds. With artificial intelligence assistance, the AUC, accuracy, sensitivity, and specificity increased by 0.166, 0.143, 0.225, and 0.107, respectively. Additionally, Fleiss κ was 0.730 and the reading time decreased by 188 seconds. All differences were statistically significant (all P<0.001). Conclusions:Artificial intelligence-assisted diagnosis system shows excellent performance and good generalizability, significantly improving the diagnostic accuracy, consistency, and efficiency of junior cytologists. It can be an effective auxiliary tool for junior cytologists in clinical practice.

With the rapid advancement and iterative development of new artificial intelligence technologies, there remains a regulatory vacuum in corresponding governance measures among governments worldwide. Simultaneously, a technological and governance gap exists between developing countries and developed economies. In response, the World Health Organization (WHO) has released "Ethics and Governance of Artificial Intelligence for Health: Guidance on Large Multi-Modal Models" to assist governments in strengthening governance capabilities in this field. This paper provides an in-depth analysis of the Guidance, aiming to identify challenges and risks associated with the application of multimodal large models in healthcare. Guided by ethical principles for advancing health through artificial intelligence, the paper examines the three-tier governance framework and recommendations outlined in the Guidance. Additionally, it evaluates the current state of AI governance in China, offering insights and reference points for improving AI governance in China′s healthcare sector.

Objective To analyze the prevalence and risk factors of underscreening among cervical cancer screening participants in Wuxiang County,Shanxi Province in 2019,providing evidence-based support for optimizing mobilization strategies.Methods Data from cervical cancer screening programs conducted between 2019 and 2024 in Wuxiang County were retrospectively collected.The follow-up screening behaviors of women screened in 2019 were analyzed,and factors associated with underscreening were identified.Results A total of 3759 women underwent cervical cancer screening in 2019.Among them,492 women(13.09％)with abnormal primary screening results requiring follow-up in 12 months,yet only 43(8.74％)completed;2154 women(57.30％)with negative liquid-based cytology testing(LCT)results needed re-screening after 3 years,701(32.54％)completed;1113 women(29.61％)with negative HPV/combined results needed re-screening after 5 years,734(65.95％)completed.Overall,2299 women(60.69％)exhibited underscreening.Multivariate analysis showed that underscreening was more likely among community residents than rural residents(OR=2.309,P=0.018),older women(OR=1.065,P＜0.001),those in organized screening compared to opportunistic screening(OR=3.789,P＜0.001),those undergoing LCT(OR=4.607,P＜0.001)or combined screening instead of human papillomavirus testing(OR=3.624,P＜0.001),and those with abnormal screening results(OR=6.859,P＜0.001).Conclusion Substantial proportions of cervical cancer screening participants demonstrate poor adherence to guideline-recommended screening intervals,and particularly need to focus on older women and those with abnormal screening results.Implementation of electronic screening record systems and emphasizing knowledge of periodical screening in health education could enhance compliance with"70％screening coverage"target for cervical cancer prevention.

Cervical cancer is one of the most common malignant tumors among women worldwide and represents a significant public health issue threatening women's health. In recent years, the disease burden of cervical cancer in China has been increasing, with women aged 45 and older bearing a particularly heavy burden. This population not only has the highest incidence and mortality rates but also represents the second peak age group for high-risk human papilloma virus (HR-HPV) infection, with the HR-HPV infection rate remaining consistently high. The causes of this situation are multifaceted. On one hand, the target group for HPV vaccination in China is women aged 9-45, which has resulted in very limited vaccination rates among middle-aged and older women when they were within the recommended age range. Additionally, this demographic has relatively low awareness of the HPV vaccine. On the other hand, aging-related declines in immune function and hormonal changes increase the risk of persistent HR-HPV infection in this group. The latent nature of HPV infection further complicates the early detection of the disease. At the same time, cervical cancer screening coverage among middle-aged and older women in China remains low and shows significant regional disparities, with screening rates in economically disadvantaged areas being markedly lower than those in more affluent regions. Furthermore, physiological changes associated with aging reduce the accuracy of conventional screening methods in this population, leading to insufficient early detection and intervention for cervical cancer. As a result, many patients are diagnosed at an advanced stage of the disease, significantly increasing treatment difficulty and disease burden. This article reviewed the burden of cervical cancer and HR-HPV infection among middle-aged and older women in China, the associated influencing factors, and the status of comprehensive prevention and control measures, aiming to provide a reference for improving cervical cancer prevention strategies for middle-aged and older women in China and contribute to the country's efforts to eliminate cervical cancer.

Cervical cancer is one of the most common malignant tumors among women worldwide and represents a significant public health issue threatening women's health. In recent years, the disease burden of cervical cancer in China has been increasing, with women aged 45 and older bearing a particularly heavy burden. This population not only has the highest incidence and mortality rates but also represents the second peak age group for high-risk human papilloma virus (HR-HPV) infection, with the HR-HPV infection rate remaining consistently high. The causes of this situation are multifaceted. On one hand, the target group for HPV vaccination in China is women aged 9-45, which has resulted in very limited vaccination rates among middle-aged and older women when they were within the recommended age range. Additionally, this demographic has relatively low awareness of the HPV vaccine. On the other hand, aging-related declines in immune function and hormonal changes increase the risk of persistent HR-HPV infection in this group. The latent nature of HPV infection further complicates the early detection of the disease. At the same time, cervical cancer screening coverage among middle-aged and older women in China remains low and shows significant regional disparities, with screening rates in economically disadvantaged areas being markedly lower than those in more affluent regions. Furthermore, physiological changes associated with aging reduce the accuracy of conventional screening methods in this population, leading to insufficient early detection and intervention for cervical cancer. As a result, many patients are diagnosed at an advanced stage of the disease, significantly increasing treatment difficulty and disease burden. This article reviewed the burden of cervical cancer and HR-HPV infection among middle-aged and older women in China, the associated influencing factors, and the status of comprehensive prevention and control measures, aiming to provide a reference for improving cervical cancer prevention strategies for middle-aged and older women in China and contribute to the country's efforts to eliminate cervical cancer.

Objective:To evaluate the diagnostic performance of artificial intelligence-assisted diagnostic systems in cervical cytopathological examination.Methods:Cervical cytology slide data were retrospectively collected from four hospitals for the external validation of the developed artificial intelligence-assisted diagnostic system. Subsequently, prospective data collection was conducted for human-machine assisted studies.Results:In the retrospective study, a total of 3 162 valid samples were collected as external validation data. The system showed an area under the curve (AUC) of 0.890 (95% CI: 0.878-0.902), accuracy of 0.885 (95% CI: 0.873-0.896), sensitivity of 0.928 (95% CI: 0.914-0.941), and specificity of 0.852 (95% CI: 0.834-0.867). In the prospective study, 212 valid samples were collected, and five junior cytologists participated in the human-machine assisted study. Without artificial intelligence assistance, the average AUC for the five cytologists was 0.686 (95% CI: 0.650-0.722), the accuracy was 0.699 (95% CI: 0.671-0.727), the sensitivity was 0.653 (95% CI: 0.599-0.703), the specificity was 0.719 (95% CI: 0.685-0.750), the Fleiss κ value was 0.510, and the reading time was 223 seconds. With artificial intelligence assistance, the AUC, accuracy, sensitivity, and specificity increased by 0.166, 0.143, 0.225, and 0.107, respectively. Additionally, Fleiss κ was 0.730 and the reading time decreased by 188 seconds. All differences were statistically significant (all P<0.001). Conclusions:Artificial intelligence-assisted diagnosis system shows excellent performance and good generalizability, significantly improving the diagnostic accuracy, consistency, and efficiency of junior cytologists. It can be an effective auxiliary tool for junior cytologists in clinical practice.

With the rapid advancement and iterative development of new artificial intelligence technologies, there remains a regulatory vacuum in corresponding governance measures among governments worldwide. Simultaneously, a technological and governance gap exists between developing countries and developed economies. In response, the World Health Organization (WHO) has released "Ethics and Governance of Artificial Intelligence for Health: Guidance on Large Multi-Modal Models" to assist governments in strengthening governance capabilities in this field. This paper provides an in-depth analysis of the Guidance, aiming to identify challenges and risks associated with the application of multimodal large models in healthcare. Guided by ethical principles for advancing health through artificial intelligence, the paper examines the three-tier governance framework and recommendations outlined in the Guidance. Additionally, it evaluates the current state of AI governance in China, offering insights and reference points for improving AI governance in China′s healthcare sector.

Objective To analyze the prevalence and risk factors of underscreening among cervical cancer screening participants in Wuxiang County,Shanxi Province in 2019,providing evidence-based support for optimizing mobilization strategies.Methods Data from cervical cancer screening programs conducted between 2019 and 2024 in Wuxiang County were retrospectively collected.The follow-up screening behaviors of women screened in 2019 were analyzed,and factors associated with underscreening were identified.Results A total of 3759 women underwent cervical cancer screening in 2019.Among them,492 women(13.09％)with abnormal primary screening results requiring follow-up in 12 months,yet only 43(8.74％)completed;2154 women(57.30％)with negative liquid-based cytology testing(LCT)results needed re-screening after 3 years,701(32.54％)completed;1113 women(29.61％)with negative HPV/combined results needed re-screening after 5 years,734(65.95％)completed.Overall,2299 women(60.69％)exhibited underscreening.Multivariate analysis showed that underscreening was more likely among community residents than rural residents(OR=2.309,P=0.018),older women(OR=1.065,P＜0.001),those in organized screening compared to opportunistic screening(OR=3.789,P＜0.001),those undergoing LCT(OR=4.607,P＜0.001)or combined screening instead of human papillomavirus testing(OR=3.624,P＜0.001),and those with abnormal screening results(OR=6.859,P＜0.001).Conclusion Substantial proportions of cervical cancer screening participants demonstrate poor adherence to guideline-recommended screening intervals,and particularly need to focus on older women and those with abnormal screening results.Implementation of electronic screening record systems and emphasizing knowledge of periodical screening in health education could enhance compliance with"70％screening coverage"target for cervical cancer prevention.