Guozhang Xu

Background: The World Health Organization Global Initiative for Childhood Cancer has set a target of achieving a 60% survival rate by 2030. However, current evidence is insufficient to guide governments and medical institutions in developing the necessary policies and interventions to reach this goal. Therefore, it is imperative to systematically evaluate the current status and trends of childhood cancer survival worldwide. Methods: Focusing on mortality-to-incidence ratio (MIR), disability-adjusted life-years (DALY), and death, the study described the distribution and trends of these survival related indicators for childhood cancer using the data from GBD2021. The study characterized the disease spectrum of childhood cancer in Sociodemographic Index (SDI) regions and predicted the future trend using ARIMA mo MIR reflected the disparities in global countries and regions; Jointpoint model and age-period-cohort model were used to analyze the long-term trend; finally, the DALY of childhood cancer contribute to risk factors was assessed. Results: In 2021, 25 level 3 childhood cancers contributed to 114.50 thousand (95% UI 104.70–124.31) death and 9343.21 thousand (95% UI 8529.00–10157.41) DALYs globally, and the MIR was 0.41 (IQR 0.26–0.58). In the high SDI region, brain and central nervous system cancers have ranked first in age-standardized DALY rate (AS-DALY) and age-standardized death rate (ASDR), and it is estimated that the AS-DALYs of nervous system cancer likely to surpass those of hematologic malignancy by 2024. The childhood cancer burden decreased with increasing SDI levels. The largest MIR [31.83 (95%UI 20.38–53.14)] between low and high SDI region was observed in eye cancer, followed by testicular cancer, Hodgkin lymphoma, and malignant skin melanoma (MIR > 10) in 2021. There has been a global downward trend in AS-DALYs and ASDR for childhood cancer; however, breast cancer has been increasing continuously. Although the number, rate, period risk, and cohort risks for childhood cancer DALY decreased across all SDI regions, the absolute burden increased by 35.92% (95% CI: 11.64 to 67.70) in low SDI region, with a concurrently observed rise in the absolute value and risks for nervous system cancer. Besides, the DALY rate of liver cancer attributable to drug use consistently increased, especially in high SDI region. Conclusion: This study identified several key points newly and could contribute to more precise recommendations for childhood cancer healthcare. It is imperative to pay more attention to the first rank on DALY of brain and central nervous system cancer in high SDI region, setting the priority to narrow the burden gap on retinoblastoma, testicular cancer, Hodgkin lymphoma, and malignant cutaneous melanoma through conducting more economical and inclusive interventions worldwide. Also, breast cancer and drug use-induced liver cancer should not be ignored.

The 4-valent (4 v) and 9-valent (9 v) human papillomavirus (HPV) vaccines are approved in China for females aged 9–45 years. However, the real-world impact of 4vHPV or 9vHPV vaccination for the prevention of high-grade cervical disease in Chinese women is lacking. Two post-marketing surveillance studies will be conducted to measure the occurrence of high-grade cervical lesions in Chinese women who had received ≥1 dose of the 4vHPV (aged 20–45 years) or 9vHPV (aged 16–26 years) vaccine in Ningbo, China. Vaccination data will be extracted from the Ningbo Regional Health Information Platform (NRHIP) from the date of the first 4vHPV (January 9, 2018) or the first 9vHPV (January 25, 2019) vaccination to March 31, 2021. The primary 4vHPV and 9vHPV vaccinated cohorts will include women vaccinated per protocol. The 4vHPV/9vHPV vaccinated test-negative (cervical HPV negative; ThinPrep cytology test negative) and corresponding matched unvaccinated HPV test-negative sub-cohorts will also be assessed. Outcomes will be the occurrence of new-onset cervical intraepithelial neoplasia grade 2/3, adenocarcinoma in situ, and invasive cervical cancer. This study aims to demonstrate that such a methodological approach is feasible and can be used to assess the impact of HPV vaccination in other regions across China.

Pneumocystis jirovecii is a prevalent opportunistic fungal pathogen that can lead to life-threatening Pneumocystis pneumonia in immunocompromised individuals. Given that timely and accurate diagnosis is essential for initiating prompt treatment and enhancing patient outcomes, it is vital to develop a rapid, simple, and sensitive method for P. jirovecii detection. Herein, we exploited a novel detection method for P. jirovecii by combining recombinase polymerase amplification (RPA) of nucleic acids isothermal amplification and the trans cleavage activity of Cas12a. The factors influencing the efficiency of RPA and Cas12a-mediated trans cleavage reaction, such as RPA primer, crRNA, the ratio of crRNA to Cas12a and ssDNA reporter concentration, were optimized. Our RPA-Cas12a-based fluorescent assay can be completed within 30–40 min, comprising a 25–30 min RPA reaction and a 5–10 min trans cleavage reaction. It can achieve a lower detection threshold of 0.5 copies/µL of target DNA with high specificity. Moreover, our RPA-Cas12a-based fluorescent method was examined using 30 artificial samples and demonstrated high accuracy with a diagnostic accuracy of 93.33%. In conclusion, a novel, rapid, sensitive, and cost-effective RPA-Cas12a-based detection method was developed and demonstrates significant potential for on-site detection of P. jirovecii in resource-limited settings.

Background: Sexual transmission among men who have sex with men (MSM) has become the major HIV transmission route. However, limited research has been conducted to investigate the association between transactional sex (TS) and HIV incidence in China. Objective: This study aims to investigate HIV incidence and distinguish sociodemographic and sexual behavioral risk factors associated with HIV incidence among MSM who engage in TS (MSM-TS) in China. Methods: We conducted a prospective cohort study using a WeChat-based platform to evaluate HIV incidence among Chinese MSM, including MSM-TS in Ningbo, recruited from July 2019 until June 2022. At each visit, participants completed a questionnaire and scheduled an appointment for HIV counseling and testing on the WeChat-based platform before undergoing offline HIV tests. HIV incidence density was calculated as the number of HIV seroconversions divided by person-years (PYs) of follow-up, and univariate and multivariate Cox proportional hazards regression was conducted to identify factors associated with HIV incidence. Results: A total of 932 participants contributed 630.9 PYs of follow-up, and 25 HIV seroconversions were observed during the study period, resulting in an estimated HIV incidence of 4.0 (95% CI 2.7-5.8) per 100 PYs. The HIV incidence among MSM-TS was 18.4 (95% CI 8.7-34.7) per 100 PYs, which was significantly higher than the incidence of 3.2 (95% CI 2.1-5.0) per 100 PYs among MSM who do not engage in TS. After adjusting for sociodemographic characteristics, factors associated with HIV acquisition were MSM-TS (adjusted hazard ratio [aHR] 3.93, 95% CI 1.29-11.93), having unprotected sex with men (aHR 10.35, 95% CI 2.25-47.69), and having multiple male sex partners (aHR 3.43, 95% CI 1.22-9.64) in the past 6 months. Conclusions: This study found a high incidence of HIV among MSM-TS in Ningbo, China. The risk factors associated with HIV incidence include TS, having unprotected sex with men, and having multiple male sex partners. These findings emphasize the need for developing targeted interventions and providing comprehensive medical care, HIV testing, and preexposure prophylaxis for MSM, particularly those who engage in TS.

Background: The association between soy product consumption and cancer risk varies among studies. Therefore, this comprehensive meta-analysis of observational studies examines the association between soy product consumption and total cancer risk. Methods: This study was conducted following the PRISMA guidelines. Up to October 2023, all eligible published studies were searched through PubMed and Web of Science databases. Results: A total of 52 studies on soy product consumption were included in this meta-analysis (17 cohort studies and 35 case–control studies). High consumption of total soy products (RR: 0.69; 95% CI: 0.60, 0.80), tofu (RR: 0.78; 95% CI: 0.70, 0.86), and soymilk (RR: 0.75; 95% CI: 0.60, 0.93) were associated with reduced total cancer risk. No association was found between high consumption of fermented soy products (RR: 1.18; 95% CI: 0.95, 1.47), non-fermented soy products (RR: 0.95; 95% CI: 0.77, 1.18), soy paste (RR: 1.00; 95% CI: 0.88, 1.14), miso soup (RR: 0.99; 95% CI: 0.87, 1.12), or natto (RR: 0.96; 95% CI: 0.82, 1.11) and cancer risk. A 54 g per day increment of total soy products reduced cancer risk by 11%, a 61 g per day increment of tofu reduced cancer risk by 12%, and a 23 g per day increment of soymilk reduced cancer risk by 28%, while none of the other soy products were associated with cancer risk. Conclusion: Our findings suggest that high total soy product consumption, especially soymilk and tofu, is associated with lower cancer risk. More prospective cohort studies are still needed to confirm the causal relationship between soy product consumption and cancer risk.

Background: As the HIV epidemic continues to grow, transmitted drug resistance(TDR) and determining relationship of HIV transmission are major barriers to reduce the risk of HIV transmissions.This study aimed to examine the molecular epidemiology and TDR and evaluated the transmission pattern among newly diagnosed people living with HIV/AIDS(PLWHA) in Ningbo city, which could contribute to the development of targeted precision interventions. Methods: Consecutive cross-sectional surveys were conducted in Ningbo City between January 2018 and December 2021. The HIV-1 pol gene region was amplified and sequenced for drug resistance and genetic transmission network analysis. TDR was determined using the Stanford University HIV Drug Resistance Database. Genetic transmission network was visualized using Cytoscape with the genetic distance threshold of 0.013. Results: A total of 1006 sequences were sequenced successfully, of which 61 (6.1%) showed evidence of TDR. The most common mutations were K103N (2.3%), E138A/G/Q (1.7%) and V179D/E (1.2%). 12 HIV-1 genotypes were identified, with CRF07_BC being the major genotype (43.3%, 332/767), followed by CRF01_AE (33.7%, 339/1006). 444 (44.1%) pol sequences formed 856 links within 120 transmission clusters in the network. An increasing trend in clustering rate between 2018 and 2021(χ² = 9.546, P = 0.023) was observed. The odds of older age (≥ 60 years:OR = 2.038, 95%CI = 1.072 ~ 3.872, compared to < 25 years), HIV-1 genotypes (CRF07_BC: OR = 2.147, 95%CI = 1.582 ~ 2.914; CRF55_01B:OR = 2.217, 95%CI = 1.201 ~ 4.091, compared to CRF01_AE) were significantly related to clustering. Compared with CRF01_AE, CRF07_BC were prone to form larger clusters. The largest cluster with CRF07_BC was increased from 15 cases in 2018 to 83 cases in 2021. Conclusions: This study revealed distribution of HIV-1 genotypes, and genetic transmission network were diverse and complex in Ningbo city. The prevalence of TDR was moderate, and NVP and EFV were high-level NNRTI resistance. Individuals aged ≥ 60 years old were more easily detected in the networks and CRF07_BC were prone to form rapid growth and larger clusters. These date suggested that surveillance and comprehensive intervention should be designed for key rapid growth clusters to reduce the potential risk factors of HIV-1 transmission.

BACKGROUND Sexual transmission among men who have sex with men(MSM) has become the major HIV transmission route. However, little is known about the association between transactional sex(TS) and HIV incidence in China. OBJECTIVE This study aimed to investigate HIV incidence and distinguish sociodemographic and sexual behavioral risk factors associated with HIV incidence among MSM who engage in TS (MSM-TS) in China. METHODS We conducted a prospective cohort study using a WeChat-based platform to assess the HIV incidence among Chinese MSM, including MSM-TS in Ningbo, recruited from July 2019 until June 2022. At each visit, participants completed an online questionnaire and made an appointment for HIV counseling and testing on the Wechat-based platform before they had HIV tests offline. HIV incidence density was calculated as the number of HIV seroconversions divided by person-years(PYs) over the observed time, and univariate and multivariate Cox proportional hazards regression was conducted to identify factors associated with HIV incidence. RESULTS 932 participants contributed 630.9 PYs of follow-up, and 25 HIV seroconversions occurred during the follow-up period, yielding an estimated HIV incidence of 4.0/100 PYs(95%CI:2.7~5.8). HIV incidence among MSM-TS was 18.4/100 PYs(95%CI:8.7~34.7), which was significantly higher than that of 3.2/100 PYs(95%CI:2.1~5.0) among MSM who do not engage in TS (MSM-NTS). After adjusting for sociodemographic characteristics, factors associated with HIV acquisition were being MSM-TS (aHR=3.93,95% CI:1.29~11.93), having unprotected sex with men(aHR=10.35, 95%CI:2.25~47.69) and multiple male sex partners (aHR=3.43, 95%CI:1.22~9.64) in the past six months. CONCLUSIONS This study found that the incidence of HIV among MSM-TS in Ningbo was high. The risk factors associated with HIV incidence include TS, having unprotected sex with men and multiple male sex partners, emphasizing the need for developing new interventions and providing medical care, HIV testing, and pre-exposure prophylaxis for MSM, particularly MSM-TS.

Background: As the HIV epidemic continues to grow, transmitted drug resistance(TDR) and determining relationship of HIV transmission are major barriers to reduce the risk of HIV transmissions.This study aimed to examine the molecular epidemiology and TDR and evaluated the transmission pattern among newly diagnosed people living with HIV/AIDS(PLWHA) in Ningbo city, which could contribute to the development of targeted precision interventions. Methods: Consecutive cross-sectional surveys were conducted in Ningbo City between January 2018 and December 2021. The HIV-1 pol gene region was amplified and sequenced for drug resistance and genetic transmission network analysis. TDR was determined using the Stanford University HIV Drug Resistance Database. Genetic transmission network was visualized using Cytoscape with the genetic distance threshold of 0.013. Results: A total of 1006 sequences were sequenced successfully, of which 61 (6.1%) showed evidence of TDR. The most common mutations were K103N (2.3%), E138A/G/Q (1.7%) and V179D/E (1.2%). 12 HIV-1 genotypes were identified, with CRF07_BC being the major genotype (43.3%, 332/767), followed by CRF01_AE (33.7%, 339/1006). 444 (44.1%) pol sequences formed 856 links within 120 transmission clusters in the network. An increasing trend in clustering rate between 2018 and 2021(χ²=9.546, P=0.023) was observed. The odds of older age (≥60 years:OR =2.038, 95%CI=1.072~3.872, compared to Conclusions: This study revealed distribution of HIV-1 genotypes, and genetic transmission network were diverse and complex in Ningbo city. The prevalence of TDR was moderate, and NVP and EFV were high-level NNRTI resistance. Individuals aged≥60 years old were more easily detected in the networks and CRF07_BC were prone to form rapid growth and larger clusters. These date suggested that surveillance and comprehensive intervention should be designed for key rapid growth clusters to reduce the potential risk factors of HIV-1 transmission.