Objective With the development of blood transfusion technology,the blood testing model is relatively de-centralized,inefficient and costly in blood stations in China.Blood centralized detection not only effectively improves the quality of blood testing,but is also more cost-effective in labor and equipment.The purpose of this paper is to create a mini-mum cost model for blood testing that integrates the transportation cost,testing cost and center operating cost.Methods A mixed-integer planning model was developed with the annual cost of blood testing as the objective function,and sample pro-cessing capacity,sample allocation,logistic relationship between transportation and center construction,and consistency of transportation decisions with transportation volume as constraints.The empirical analysis takes Sichuan province as an exam-ple,collects data through expert interviews and research,does linear processing and adjustments to the segmented data to meet the modeling needs,and carries out modeling operations and verifies the optimal solution through python coding.Re-sults A mixed integer programming model suitable for the number and location of centralized testing laboratories in China was developed.In the empirical analysis of Sichuan,the data required for the model was collected and the segmented data was linearized.A detailed cost analysis was conducted,revealing that the most cost-effective option was to establish central-ized testing laboratories in Chengdu and Suining.The least cost-effective option identified in this study involved independent testing at 21 blood stations.Compared to this baseline,the most cost-effective strategy(establishing centralized testing labo-ratories in Chengdu and Suining)can reduce expenses by 29.433%.To ensure the reliability of these results,multiple rounds of validation were performed.Further analysis revealed that the strategy of establishing testing centers in Chengdu and Bazhong was a suboptimal choice,which can achieve a cost reduction of 29.431%.Conclusion This paper constructs a mixed-integer planning model for the number and location of centralized testing laboratories,which for the first time provides a decision-making basis for the location of regional centralized blood testing in China from the perspective of cost,and car-ries out an empirical analysis of Sichuan to develop the most cost-effective option.

Background::Whether the dynamic weight change is an independent risk factor for mortality remains controversial. This study aimed to examine the association between weight change and risk of all-cause and cause-specific mortality based on the Linxian Nutrition Intervention Trial (NIT) cohort.Methods::Body weight of 21,028 healthy residents of Linxian, Henan province, aged 40-69 years was measured two times from 1986 to 1991. Outcome events were prospectively collected up to 2016. Weight maintenance group (weight change <2 kg) or stable normal weight group was treated as the reference. Cox proportional hazard model was performed to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) to estimate the risk of mortality.Results::A total of 21,028 subjects were included in the final analysis. Compared with the weight maintenance group, subjects with weight loss ≥2 kg had an increased risk of death from all-cause (HR All-cause = 1.14, 95% CI: 1.09-1.19, P <0.001), cancer (HR Cancer = 1.12, 95% CI: 1.03-1.21, P = 0.009), and heart disease (HR Heart diseases = 1.21, 95% CI: 1.11-1.31, P <0.001), whereas subjects with weight gain ≥5 kg had 11% (HR Cancer = 0.89, 95% CI: 0.79-0.99, P = 0.033) lower risk of cancer mortality and 23% higher risk of stroke mortality (HR Stroke = 1.23,95% CI: 1.12-1.34, P <0.001). For the change of weight status, both going from overweight to normal weight and becoming underweight within 5 years could increase the risk of total death (HR Overweight to normal = 1.18, 95% CI: 1.09-1.27; HR Becoming underweight = 1.35, 95% CI: 1.25-1.46) and cancer death (HR Overweight to normal = 1.20, 95% CI: 1.04-1.39; HR Becoming underweight = 1.44, 95% CI: 1.24-1.67), while stable overweight could increase the risk of total death (HR Stable overweight = 1.11, 95% CI: 1.05-1.17) and death from stroke (HR Stable overweight = 1.44, 95% CI: 1.33-1.56). Interaction effects were observed between age and weight change on cancer mortality, as well as between baseline BMI and weight change on all-cause, heart disease, and stroke mortality (all Pinteraction <0.01). Conclusions::Weight loss was associated with an increased risk of all-cause, cancer, and heart disease mortality, whereas excessive weight gain and stable overweight were associated with a higher risk of stroke mortality. Efforts of weight management should be taken to improve health status.Trial registration::https://classic.clinicaltrials.gov/, NCT00342654.

The rapid development of artificial intelligence in the field of healthcare has greatly improved diagnosis accuracy, disease prediction, personalized treatment and healthcare resource management. However, with the widespread application of medical artificial intelligence, challenges has emerged in the aspects of medical data, model development and evaluation, and societal considerations. Therefore, this study aims to explore challenges in the application of artificial intelligence in healthcare and suggest a series of feasible solutions to improve medical professional and researchers' understanding of medical artificial intelligence and enhance the quality of healthcare in clinical practice

Objectives:To examine the proportion and trends of cervical adenocarcinoma in cervical cancer (ICC), mainly including cervical adenocarcinoma (CADC) and squamous cervical cancer (SCC) in China, and to analyze the distribution of human papilloma virus (HPV) in CADC and SCC.Methods:Published studies reporting HPVs distribution in various histological types or relative proportions of CADC in ICC in China were identified manually and searched systematically in Medline, Embase, Cochrane Library databases, CNKI and Wanfang since the databases were established until October 2022. Meta-analysis was performed using Stata 16.0 software. And we applied the random-effects models to estimate the combined effect values due to the high heterogeneity.Results:Twenty-three studies were eligible. The relative prevalence of CADC was 9.0% (95% CI, 7.7%－10.3%). According to the diagnosis time of ICC, the patients were divided into three time periods, which is 1979-2005, 2006-2011, 2012-2022 respectively. The prevalence of CADC by time was: 6.0% in 1979-2005, 8.1% in 2006-2011, and 9.5% in 2012-2022, respectively, with no statistically significant trend in proportions over time (χ 2=5.03, P=0.081). Meanwhile, the percentage of CADC also varies by regions, and the highest percentage of CADC was found in the eastern region (11.2%), followed by the western region (7.3%) and the central region (5.9%). The total prevalence of HPV infection in CADC was 72.3%, which was lower than 92.0% in SCC, and the difference was statistically significant (χ 2=300.89, P＜0.01). To be specific, the top three HPV types prevalent in CADC were HPV18 (45.0%), HPV16 (22.0%), and HPV52 (7.3%), and those prevalent in the SCC were HPV16 (64.2%), HPV52 (5.6%), HPV18 (5.4%). The results of the Egger's test, and Begg's test showed that there was no publication bias in this study and sensitivity analysis showed that the results of this study were fairly stable. Conclusions:The proportion of CADC in China has increased in a limited way in the past decades, and there are regional differences in the proportion of CADC. The predominant type is HPV18 in CADC and HPV16 in SCC. To eliminate the limitations of the secondary literature, a multicenter study with consistent diagnostic levels and identical HPV genotyping tests is still needed in the future to better characterize the relative proportion of cervical adenocarcinoma and the trend of HPV changes, which will provide a basis for the improvement of HPV vaccine and screening policies.

Objective:To evaluate the 10-year protective effect and immunogenicity of quadrivalent human papillomavirus (HPV) vaccine in Chinese women aged 20 to 45 years.Methods:From October 2019 to April 2020, a long-term follow-up study was conducted on the subjects of the Phase III clinical trial of the quadrivalent HPV vaccine (NCT00834106). Participants underwent a questionnaire survey, venous blood sampling, gynecological examination, cervical exfoliated cell pathology examination, and serum neutralizing antibody titers for HPV-6, 11, 16, and 18 were measured using a pseudovirus neutralization assay. The results of the cytological examination and the positive rate and titers of serum antibodies of different cervical exfoliated cells were compared.Results:A total of 889 subjects were followed up, including 240 in the control group, 453 in the vaccination group and 196 in the post-trial vaccination group. The age of the control group was (40±7) years old, which was higher than that of the supplementary vaccination group and the vaccination group [(38±4) and (38±6) years old, respectively] ( P<0.05). There were no statistically significant differences in condom use and sexual frequency among all groups (all P values>0.05). The abnormal proportion of cervical exfoliation cytopathology in the vaccination group was 3.7% (17/453), which was significantly lower than that in the control group [9.6% (23/240)] and post-trial vaccination group [5.6% (11/196)] ( P<0.05). There were two cases of cervical intraepithelial neoplasia (CIN) grade 1 in the vaccination group, two cases of CIN grade 1 and three cases of CIN grade 2 and above in the control group, and no CIN grade 1 and above cases in the post-trial vaccination group. The positive rate of HPV-18 antibody was 35.5% (161/453) in the vaccination group and 76.0% (149/196) in the post-trial vaccination group, which was significantly lower than that of other types ( P<0.05). The neutralizing antibody GMT ratio between the vaccination group and the control group ranged from 2.62 to 25.33 (9.05 to 83.08). Conclusion:Protective neutralizing antibodies are sustained in Chinese women aged 20 to 45 years after ten years of vaccination with quadrivalent HPV vaccine.

Objectives:To examine the proportion and trends of cervical adenocarcinoma in cervical cancer (ICC), mainly including cervical adenocarcinoma (CADC) and squamous cervical cancer (SCC) in China, and to analyze the distribution of human papilloma virus (HPV) in CADC and SCC.Methods:Published studies reporting HPVs distribution in various histological types or relative proportions of CADC in ICC in China were identified manually and searched systematically in Medline, Embase, Cochrane Library databases, CNKI and Wanfang since the databases were established until October 2022. Meta-analysis was performed using Stata 16.0 software. And we applied the random-effects models to estimate the combined effect values due to the high heterogeneity.Results:Twenty-three studies were eligible. The relative prevalence of CADC was 9.0% (95% CI, 7.7%－10.3%). According to the diagnosis time of ICC, the patients were divided into three time periods, which is 1979-2005, 2006-2011, 2012-2022 respectively. The prevalence of CADC by time was: 6.0% in 1979-2005, 8.1% in 2006-2011, and 9.5% in 2012-2022, respectively, with no statistically significant trend in proportions over time (χ 2=5.03, P=0.081). Meanwhile, the percentage of CADC also varies by regions, and the highest percentage of CADC was found in the eastern region (11.2%), followed by the western region (7.3%) and the central region (5.9%). The total prevalence of HPV infection in CADC was 72.3%, which was lower than 92.0% in SCC, and the difference was statistically significant (χ 2=300.89, P＜0.01). To be specific, the top three HPV types prevalent in CADC were HPV18 (45.0%), HPV16 (22.0%), and HPV52 (7.3%), and those prevalent in the SCC were HPV16 (64.2%), HPV52 (5.6%), HPV18 (5.4%). The results of the Egger's test, and Begg's test showed that there was no publication bias in this study and sensitivity analysis showed that the results of this study were fairly stable. Conclusions:The proportion of CADC in China has increased in a limited way in the past decades, and there are regional differences in the proportion of CADC. The predominant type is HPV18 in CADC and HPV16 in SCC. To eliminate the limitations of the secondary literature, a multicenter study with consistent diagnostic levels and identical HPV genotyping tests is still needed in the future to better characterize the relative proportion of cervical adenocarcinoma and the trend of HPV changes, which will provide a basis for the improvement of HPV vaccine and screening policies.

Objective:To evaluate the 10-year protective effect and immunogenicity of quadrivalent human papillomavirus (HPV) vaccine in Chinese women aged 20 to 45 years.Methods:From October 2019 to April 2020, a long-term follow-up study was conducted on the subjects of the Phase III clinical trial of the quadrivalent HPV vaccine (NCT00834106). Participants underwent a questionnaire survey, venous blood sampling, gynecological examination, cervical exfoliated cell pathology examination, and serum neutralizing antibody titers for HPV-6, 11, 16, and 18 were measured using a pseudovirus neutralization assay. The results of the cytological examination and the positive rate and titers of serum antibodies of different cervical exfoliated cells were compared.Results:A total of 889 subjects were followed up, including 240 in the control group, 453 in the vaccination group and 196 in the post-trial vaccination group. The age of the control group was (40±7) years old, which was higher than that of the supplementary vaccination group and the vaccination group [(38±4) and (38±6) years old, respectively] ( P<0.05). There were no statistically significant differences in condom use and sexual frequency among all groups (all P values>0.05). The abnormal proportion of cervical exfoliation cytopathology in the vaccination group was 3.7% (17/453), which was significantly lower than that in the control group [9.6% (23/240)] and post-trial vaccination group [5.6% (11/196)] ( P<0.05). There were two cases of cervical intraepithelial neoplasia (CIN) grade 1 in the vaccination group, two cases of CIN grade 1 and three cases of CIN grade 2 and above in the control group, and no CIN grade 1 and above cases in the post-trial vaccination group. The positive rate of HPV-18 antibody was 35.5% (161/453) in the vaccination group and 76.0% (149/196) in the post-trial vaccination group, which was significantly lower than that of other types ( P<0.05). The neutralizing antibody GMT ratio between the vaccination group and the control group ranged from 2.62 to 25.33 (9.05 to 83.08). Conclusion:Protective neutralizing antibodies are sustained in Chinese women aged 20 to 45 years after ten years of vaccination with quadrivalent HPV vaccine.

Objective:To summarize the trend of disease burden of esophageal cancer in 4 countries with high incidence of esophageal cancer and analyse the proportion of death attribution of three common risk factors, which helps to provide reference for the prevention and control of esophageal cancer.Methods:Based on the 2019 Global Burden of Disease Study (GBD2019) database and visualization platform, the absolute number and age-standardized rates of incidence, mortality and disability adjusted life years (DALY) of esophageal cancer in 4 countries with high incidence of esophageal cancer (China, Iran, Russia and South Africa) from 1990 to 2019 were described. The Joinpoint regression model was used for time trend analysis, and the annual percentage change (APC) and average annual percentage change (AAPC) of age-standardized incidence, age-standardized mortality, and age-standardized DALY rate of esophageal cancer were calculated. The proportion of death attribution of three common risk factors (smoking, alcohol consumption and low fruit intake) in 2019 was compared, and the differences in the population attributable fraction (PAF) for risk factors globally and in 4 countries were analyzed. The incidence and mortality of esophageal cancer under different socio-demographic index (SDI) were analyzed by drawing fitting curves.Results:From 1990 to 2019, the age-standardized incidence, mortality and DALY rates of esophageal cancer showed an overall decreasing trend globally and in 4 countries with high incidence of esophageal cancer. The age-standardized incidence rate of esophageal cancer in China decreased from 21.0/100 000 to 13.9/100 000 (AAPC = -1.4%, 95% CI -1.3% - -1.1%), the age-standardized mortality rate decreased from 22.1/100 000 to 13.1/100 000 (AAPC = -1.8%, 95% CI -1.9% - -1.7%), and the age-standardized DALY rate decreased from 507.0/100 000 to 227.5/100 000 (AAPC = -2.1%, 95% CI -2.2% - -1.9%). These rates in China had been decreasing at a much faster rate than the other 3 countries. Both Chinese men and Russian men had higher rates of esophageal cancer deaths due to smoking and alcohol consumption than the global average (PAF smoking: 59.2%, 56.7% vs. 51.2%; PAF alcohol consumption: 29.7%, 38.3% vs. 28.4%). The proportion of alcohol-related esophageal cancer deaths in Russian women was higher than the global average for women (PAF: 14.9% vs. 7.3%). Attributing low fruit intake to esophageal cancer deaths in South African men and women were higher than the global average for men and women (PAF men: 20.8% vs. 9.8%; PAF women: 21.3% vs. 11.7%). The age-standardized incidence and mortality rates in China and South Africa were consistently higher than would be expected for the same level of SDI, while those in Iran were consistently lower than would be expected, and Russia was broadly in line with expectation. Conclusions:Although the disease burden of countries with high incidence of esophageal cancer in the world has been effectively controlled, the disease burden of esophageal cancer in China is still higher than that in other countries. Targeted prevention measures should be made according to the epidemiological characteristics of esophageal cancer in Chinese population.

Objective To investigate the cognition of colorectal cancer-related knowledge and influencing factors of patients with middle- and advanced-stage colorectal cancer in ethnic minority areas of Inner Mongolia. Methods According to the national population and the prevalence of colorectal cancer, 277 patients with colorectal cancer were selected by stratified and random sampling in Inner Mongolia. The patients were surveyed in Baotou, Chifeng, Bayannaoer, and other hospitals. The questionnaire included patients' basic information, cognition of colorectal cancer risk factors and screening knowledge, screening information, etc. Results Before suffering from the disease, the patients' knowledge of colorectal cancer (risk factors, early screening knowledge, treatment methods) was low. About 54.9% of patients were unaware of high risk factors for colorectal cancer, 75.8% of patients did not understand the knowledge of early screening of colorectal cancer, and 37.5% of patients did not underst and the treatment of colorectal cancer. The main influencing factors of colorectal cancer cognition were education level and occupation. Patients who work in institutions and enterprises and with higher education level had better cognition. Conclusion Patients with middle- and advanced-stage colorectal cancer in Inner Mongolia have poor knowledge and awareness of risk factors and screening of colorectal cancer before diagnosis. Education level and occupation are factors influencing colorectal cancer cognition, therefore, people with low knowledge rate of colorectal cancer and low education level as well as unemployed laid-off people should be given priority intervention.

MSM are a high-risk population for HPV infection and related diseases. MSM can be effectively protected by quadrivalent and nine-valent HPV vaccines. This paper outlines the significance of providing HPV vaccination to MSM, summarizes the basis of HPV vaccination in MSM, and puts forward the following recommendations. First, China should expedite the development and approval of the HPV vaccine for male use. Second, HIV-positive MSM should vaccinate against HPV as soon as possible. Third, prioritize HPV vaccination for MSM individuals aged 26 or less. Fourth, for MSM aged over 26, catch-up vaccination or opportunistic vaccination should be provided when HPV vaccine resources are sufficient. Implementing this vaccination strategy can provide protection for the MSM and control the spread of sexually transmitted diseases.