Over the past three decades， China has made significant progress in the prevention and control of viral hepatitis， and the incidence rates of new-onset pediatric hepatitis B virus infections and acute viral hepatitis in the population have reduced to a relatively low level； however， there is still a heavy disease burden of chronic viral hepatitis in China， which severely affects the health status of the population. This study systematically summarizes the achievements of viral hepatitis prevention and control in China， analyzes existing problems and challenges， and proposes comprehensive prevention and control strategies and measures to eliminate viral hepatitis as a public health threat based on the national conditions of China， in order to provide a reference for related departments in China on how to achieve the action targets for eliminating viral hepatitis as a public health threat by 2030.

Objective:To analyze the incidence and spatiotemporal clustering of hepatitis B in China from 2006 to 2020 and provide reference for hepatitis B prevention and control.Methods:The incidence data of hepatitis B in 31 provinces (autonomous regions and municipalities) from 2006 to 2020 were collected from National Notifiable Infectious Disease Reporting System of China Information System for Disease Control and Prevention. The incidence trend analysis was conducted by using software Joinpoint 5.0.2, and the spatiotemporal scan analysis was performed by using software SaTScan 10.1.2.Results:From 2006 to 2020, a total of 1 049 546 cases of acute hepatitis B were reported in China. The average annual reported incidence rate was 5.17/100 000. The reported incidence rate showed a decreasing trend during this period. The incidence decreased from 3.00/100 000 to 0.41/100 000 in age group 0-14 years, from 14.15/100 000 to 3.44/100 000 in age group 15-34 years, and from 6.87/100 000 to 3.72/100 000 in age group ≥35 years, the differences were all significant (all P<0.001). From 2006 to 2020, a total of 10 732 017 cases of chronic hepatitis B were reported in China. The average annual reported incidence rate was 52.85/100 000. The reported incidence of chronic hepatitis B varied in different age groups, which decreased from 11.38/100 000 to 2.18/100 000 in age group 0-14 years, and from 73.17/100 000 to 61.40/100 000 in age group 15-34 years, while increased from 48.07/100 000 to 90.75/100 000 in age group ≥35 years, the differences were all significant (all P<0.05). Spatiotemporal scan analysis indicated that the age of reported acute hepatitis B cases became older over time, and the regions with high-incidence gradually shifted from western China to southwestern China. The overall reported incidence of chronic hepatitis B in those aged ≥35 years showed an upward trend, and the regions with high-incidence were mainly found in coastal area in southeastern China and in southwestern China. Conclusions:From 2006 to 2020, the overall reported incidence of acute hepatitis B in China showed a continuous downward trend, while the reported incidence of chronic hepatitis B in those aged ≥35 years showed an upward trend. It indicated that the need to improve the diagnosis and treatment of chronic hepatitis B in adults in coastal area in southeastern China and southwestern China.

Objective:To analyze the cost-effectiveness of administering two doses of different types of human papillomavirus (HPV) vaccines to 12-year-old female adolescents.Methods:A decision tree Markov model with genital warts and cervical cancer as target diseases was established to analyze the effects, costs, and Quality Adjusted Life Years (QALY) of strategies such as no vaccination, two doses of bivalent HPV (HPV-2), two doses of quadrivalent HPV (HPV-4), and two doses of nine-valent HPV (HPV-9) in a 12-year-old female adolescent cohort in 2023 using 50% of the procurement price or self-funded vaccination price in pilot provinces. The number of avoided cases of cervical cancer and genital warts and the incremental cost-utility ratio (ICUR) were compared between different strategies.Results:Compared with non-vaccination, female adolescents who received two doses of HPV-2, HPV-4 and HPV-9 were able to avoid 55.2% of cervical cancer cases with HPV-2, 77.11% and 78.68% of genital warts with HPV-4, and 54.99% and 73.46% of cervical cancer with HPV-9, respectively. The ICUR of strategies HPV-2, HPV-4, and HPV-9 was -28 470.44 yuan/QALY, 29 328.26 yuan/QALY and 48 106.85 yuan/QALY, respectively. HPV-2 was the most economical strategy and could achieve net cost savings. Single-factor sensitivity analysis showed that the results were robust, and the most influential factors were discount rate, vaccine prices and direct medical costs for low-grade precancerous lesions. The probability sensitivity analysis showed that compared with the national gross domestic product (GDP) per capita in 2023, the probability of cost-utility of HPV-2, HPV-4 and HPV-9 compared with non-vaccination was 99.51%, 89.03% and 67.81%, respectively. Only when the price of a single dose of HPV-4 and HPV-9 vaccines was lower than 26.12% and 20.68% of the current self-funded vaccination price, respectively, could there be a net cost saving.Conclusion:In the case where HPV-2 adopts the pilot province procurement price and the multivalent vaccine adopts a 50% self-funded vaccination price, the vaccination of 12-year-old female adolescents with HPV-2, HPV-4 and HPV-9 has cost-effectiveness, and HPV-2 is the most economical strategy.

Objective:To analyze the incidence and spatiotemporal clustering of hepatitis B in China from 2006 to 2020 and provide reference for hepatitis B prevention and control.Methods:The incidence data of hepatitis B in 31 provinces (autonomous regions and municipalities) from 2006 to 2020 were collected from National Notifiable Infectious Disease Reporting System of China Information System for Disease Control and Prevention. The incidence trend analysis was conducted by using software Joinpoint 5.0.2, and the spatiotemporal scan analysis was performed by using software SaTScan 10.1.2.Results:From 2006 to 2020, a total of 1 049 546 cases of acute hepatitis B were reported in China. The average annual reported incidence rate was 5.17/100 000. The reported incidence rate showed a decreasing trend during this period. The incidence decreased from 3.00/100 000 to 0.41/100 000 in age group 0-14 years, from 14.15/100 000 to 3.44/100 000 in age group 15-34 years, and from 6.87/100 000 to 3.72/100 000 in age group ≥35 years, the differences were all significant (all P<0.001). From 2006 to 2020, a total of 10 732 017 cases of chronic hepatitis B were reported in China. The average annual reported incidence rate was 52.85/100 000. The reported incidence of chronic hepatitis B varied in different age groups, which decreased from 11.38/100 000 to 2.18/100 000 in age group 0-14 years, and from 73.17/100 000 to 61.40/100 000 in age group 15-34 years, while increased from 48.07/100 000 to 90.75/100 000 in age group ≥35 years, the differences were all significant (all P<0.05). Spatiotemporal scan analysis indicated that the age of reported acute hepatitis B cases became older over time, and the regions with high-incidence gradually shifted from western China to southwestern China. The overall reported incidence of chronic hepatitis B in those aged ≥35 years showed an upward trend, and the regions with high-incidence were mainly found in coastal area in southeastern China and in southwestern China. Conclusions:From 2006 to 2020, the overall reported incidence of acute hepatitis B in China showed a continuous downward trend, while the reported incidence of chronic hepatitis B in those aged ≥35 years showed an upward trend. It indicated that the need to improve the diagnosis and treatment of chronic hepatitis B in adults in coastal area in southeastern China and southwestern China.

Objective:To analyze the cost-effectiveness of administering two doses of different types of human papillomavirus (HPV) vaccines to 12-year-old female adolescents.Methods:A decision tree Markov model with genital warts and cervical cancer as target diseases was established to analyze the effects, costs, and Quality Adjusted Life Years (QALY) of strategies such as no vaccination, two doses of bivalent HPV (HPV-2), two doses of quadrivalent HPV (HPV-4), and two doses of nine-valent HPV (HPV-9) in a 12-year-old female adolescent cohort in 2023 using 50% of the procurement price or self-funded vaccination price in pilot provinces. The number of avoided cases of cervical cancer and genital warts and the incremental cost-utility ratio (ICUR) were compared between different strategies.Results:Compared with non-vaccination, female adolescents who received two doses of HPV-2, HPV-4 and HPV-9 were able to avoid 55.2% of cervical cancer cases with HPV-2, 77.11% and 78.68% of genital warts with HPV-4, and 54.99% and 73.46% of cervical cancer with HPV-9, respectively. The ICUR of strategies HPV-2, HPV-4, and HPV-9 was -28 470.44 yuan/QALY, 29 328.26 yuan/QALY and 48 106.85 yuan/QALY, respectively. HPV-2 was the most economical strategy and could achieve net cost savings. Single-factor sensitivity analysis showed that the results were robust, and the most influential factors were discount rate, vaccine prices and direct medical costs for low-grade precancerous lesions. The probability sensitivity analysis showed that compared with the national gross domestic product (GDP) per capita in 2023, the probability of cost-utility of HPV-2, HPV-4 and HPV-9 compared with non-vaccination was 99.51%, 89.03% and 67.81%, respectively. Only when the price of a single dose of HPV-4 and HPV-9 vaccines was lower than 26.12% and 20.68% of the current self-funded vaccination price, respectively, could there be a net cost saving.Conclusion:In the case where HPV-2 adopts the pilot province procurement price and the multivalent vaccine adopts a 50% self-funded vaccination price, the vaccination of 12-year-old female adolescents with HPV-2, HPV-4 and HPV-9 has cost-effectiveness, and HPV-2 is the most economical strategy.

Objective:To analyze epidemiological characteristics and spatiotemporal clustering of hepatitis A in China from 2005 to 2023.Methods:The incidence data of hepatitis A in China during 2005-2023 were collected from the China Disease Control and Prevention Information System .Results:From 2005 to 2023, a total of 605 509 cases of hepatitis A were reported in China. The average annual reported incidence rate was 2.32/100 000, the incidence was 2.85/100 000 in men and 1.81/100 000 in women, and the incidence was 3.25/100 000 in age group 0-14 years, 2.10/100 000 in age group 15-64 years and 2.49/100 000 in age group ≥65 years , respectively. The case count in farmers was highest (40.57%, 245 639/605 509). The proportion of the cases in jobless or the unemployed increased most obviously (347.32%), and the proportion of the cases in students decreased most significantly (90.27%). The average annual reported incidence rate in the western China was highest (4.45/100 000), followed by that in northeastern China (2.02/100 000), central China (1.89/100 000) and eastern China (1.16/100 000). From 2020 to 2023, the incidence of hepatitis A showed no spatial clustering. From 2005 to 2019, the obvious hot spots and high-high clustering areas mainly distributed in provinces, such as, Sichuan, Qinghai, Xinjiang, Xizang and Gansu. The low-low clustering areas were mainly distributed in Beijing, Tianjin, Hebei, Shandong, Jiangsu, Shanghai, Zhejiang, Fujian, Henan, Anhui, Jiangxi, Jilin and Liaoning. An independent high-low clustering was found in Shanxi during 2014-2019. A total of 5 high incidence clustering areas were detected through spatiotemporal scanning analysis.Conclusions:The incidence rate of hepatitis A in China declined significantly from 2005 to 2023. The reported incidence rate in the elderly showed no obvious decrease, and the reported cases accounted for the highest proportion in the whole population. Before 2020, the reported incidence rate of hepatitis A showed high-high clustering in western China, the spatiotemporal clustering disappeared from 2020 to 2023, but the reported incidence rate of hepatitis A in western China was still high. It is suggested to pay attention to the prevention and control of hepatitis A in populations at high risk and areas with high incidence of hepatitis A.

ObjectiveTo observe the effect of Qinggan Jianpi Huoxue prescription（QGJPHXP） on the polarization of M1/M2 macrophages in rats with hepatic fibrosis induced by carbon tetrachloride（CCl₄）. MethodA rat hepatic fibrosis model was established by intraperitoneal injection of 40% CCl₄-olive oil suspension twice a week at the dosage of 2.0 mL·kg^-1 for 8 weeks. After the model was successfully established， these rats were randomly divided into the model group， QGJPHXP group（32.084 g·kg^-1） and Biejiajian pills（BJJP） group（0.925 5 g·kg^-1）， with 12 rats in each group. The blank group was injected intraperitoneally with the same amount of olive oil. The rats in the administration groups were given the corresponding solution according to the dose， and the blank and model groups were given the same dose of purified water， once a day. After 4 weeks of continuous administration， the liver tissues of rats were taken and stained with hematoxylin-eosin（HE） and Masson to observe the pathological changes. The serums were collected to detect the alanine aminotransferase（ALT） and aspartate aminotransferase（AST） levels. Interleukin（IL）-6， IL-12， IL-10， IL-1β， transforming growth factor-β₁（TGF-β₁） and tumor necrosis factor-α（TNF-α） levels in liver tissues were measured by enzyme-linked immunosorbent assay（ELISA）. The expression levels of CD86 and CD206 were detected by immunohistochemistry（IHC）. Western blot and real-time fluorescence quantitative polymerase chain reaction（Real-time PCR） were used to detect the protein and mRNA expression levels of inducible nitric oxide synthase（iNOS）， arginase-1（Arg-1）， phosphorylated p38 mitogen-activated protein kinase（p-p38 MAPK）， nuclear transcription factor-κB p65（NF-κB p65） in liver tissues of rats. ResultCompared with the blank group， the hepatic cell plate was irregularly arranged, and local inflammatory cell infiltration and fibrous hyperplasia were observed， while the serum levels of ALT and AST were significantly increased in the model group（P<0.01）， and IL-1β， IL-6， IL-12， TGF-β₁， TNF-α， CD86， CD206， iNOS， p-p38 MAPK，p38 MAPK and NF-κB p65 levels in liver tissues were obviously increased（P<0.05， P<0.01）， while the levels of IL-10 and Arg-1 were obviously decreased（P<0.05， P<0.01）. Compared with the model group， QGJPHXP group reduced the degree of liver cell fibrosis，and serum levels of ALT and AST（P<0.01）， and IL-1β， IL-6， IL-12， TGF-β₁， TNF-α， CD86， iNOS， p-p38 MAPK， p38 MAPK， and NF-κB p65 levels in liver tissues were obviously decreased（P<0.05， P<0.01）， the levels of IL-10， CD206 and Arg-1 were obviously increased in the QGJPHXP group（P<0.05， P<0.01）. ConclusionQGJPHXP has ability to inhibit the activation of pro-inflammatory M1 macrophages， induce the secretion of anti-inflammatory cytokines by M2 macrophages， reduce the release of pro-fibrogenic cytokines， and promote the macrophage polarization of M1 to M2 in liver for tissue repair， thereby serving as an anti-inflammatory and anti-hepatic fibrosis drug.

A female patient who was admitted to the hospital on March 4, 2020 due to the right kidney mass for 4 days by physical examination. Ultrasound examination revealed a single space-occupying lesion in the right kidney, and further examination of the abdominal enhanced CT and three-dimensional reconstruction showed two lesions in the right kidney. The retroperitoneal laparoscopic partial nephrectomy was carried out. The pathological diagnosis were renal leiomyoma and renal eosinophiloma, respectively. After 1 year follow-up, no recurrence or metastasis was found.

Objective:To evaluate the effect of microvascular invasion (MVI) on postoperative prognosis of microhepatocellular carcinoma by a meta-analysis system.Methods:Relevant literatures in PubMed, Cochrane Library, Embase, CNKI, VIP and Wanfang databases were systematically searched. The search period was from January 2012 to January 2022. The Chinese search terms were "liver cancer" , "hepatocellular carcinoma" , "2 cm" , "microvascular invasion" , and "prognosis" . The English search terms were "small" , "solitary small" , "up to 2 cm" , "< 2 cm" , "liver" , "hepatocellular carcinoma" , "microvascular invasion" . The differences in prognosis of patients with microhepatocellular carcinoma in MVI(+ ) group and MVI(-) group were compared. Meta-analysis was performed using Review Manager 5.4 software.Results:Finally, 7 articles were included in the systematic review, with a total of 1 319 patients. All included literatures were scored ≥7 on the modified Newcastle-Ottawa scale. The results of meta-analysis showed that there were no significant differences in 1-year overall survival (OS) between MVI(+ ) group and MVI(-) group ( OR=3.14, 95% CI: 0.92-10.72, P=0.068). The 5-year OS time of patients in the MVI(+ ) group was shorter than that in the MVI(-) group, and the differences were statistically significant ( OR=2.34, 95% CI: 1.62-3.36, P<0.001). The 1-year and 5-year disease-free survival of the MVI(-) group were better than those of the MVI(+ ) group, and the difference was statistically significant (1-year: OR=3.09, 95% CI: 1.75-5.44, P<0.001; 5 years: OR=1.76, 95% CI: 1.24-2.51, P=0.002). Conclusion:The 5-year and long-term survival of MVI(+ ) patients with microhepatocellular carcinoma was poor, and the postoperative recurrence rate was high.

A patient with intermittent right lumbar pain for more than one month and aggravating for one week was reported. The right laparoscopic radical nephrectomy was performed, and fibrosarcoma of the right kidney was diagnosed. The patient refused further radiotherapy or chemotherapy and was discharged on the 11th after surgery. One year after operation, the patient underwent chest CT, and subdural tumor of right lobe of liver was detected. A surgery was performed in another hospital, and liver metastasis from right renal fibrosarcoma was diagnosed. He was alive four months after operation.