Seven important items of medical research from China

N95 masks don't work for Chinese faces
The specialised N95 face masks used to protect against infections such as influenza are not shaped to fit Chinese faces and most would fail to prevent transmission because of poor fit and leakage, tests by Wuhan researchers have shown. Evaluation tests on ten different types of N95 mask found that only two performed within acceptable limits to prevent transmission of infections. Performance of some masks was better when users were trained and they were specially fitted, the study in PLOS One showed.
"This study indicated that widely used N95 filtering facepiece respirators in China didn't fit well and can't provide desired protection for respirator users," the researchers concluded.

Malaria from Africa now a problem in China
Malaria has been virtually eliminated in China but doctors now face the problem of treating malaria in Chinese workers who have returned from Africa. In Jiangsu there have been 918 malaria cases and six deaths in the last decade due to malaria imported from other countries. The imported cases make up 12% of all malaria cases and account for all malaria deaths, according to researchers from the Jiangsu Institute of Parasitic Diseases, Wuxi, writing in the Malaria Journal.

No cardiovascular treatment for many Chinese patients
Two out of three Chinese people with cardiovascular disease are still going untreated, a major study has found. Data from of 512,891 Chinese adults showed that 5% had a history of cardiovascular disease. However, of these only 35% had been treated with any cardiovascular medicine for secondary prevention such as statins, antiplatelet drugs or antihypertensives. The findings from a team from Oxford and Beijing universities, are published in the International Journal of Cardiology.

Shenzhen women have high rates of HPV
More than one in ten women in Shenzhen are have HPV serotypes that put them at risk of cervical cancer, researchers say. A study of 4, 413 women measured HPV infection rates and the prevalance was 14%. The high risk HPV types 16 and 18 that are likely to cause cervical cancer were found in 3.5% of women and 1.27% of women, according to the study published in the Asia Pacific Journal of Cancer Prevention.

Avian H7N9 flu virus on way to mutation
The H7N9 influenza virus is genetically much more diverse than previously thought, suggesting that it is reassorting and closer to mutating into a pandemic virus, researchers from the Jiangsu Provincial Center for Disease Control and Prevention, have shown. They report their findings in Nature.

Medical teacher burnout
Staff at medical colleges in China have high rates of burnout, a study from Shanxi shows. Staff who had a love of teaching and those who received praise and recognition were less likey to suffere burnout, according to the study in Archives of Environmental & Occupational Health.

Pancreatic cancer in Shanghai
The diagnosis and treatment of pancreatic cancer in Shanghai has room for improvement, according to researchers from Fudan University. In a review of management of pancreatic cancer published in Cancer Letters, they report that most patients miss out on the recommended histologically verified diagnosis and the 1-year and 2-year survival rates were 35% and 14.4%, respectively.

China medical news in brief

Headache and migraine a problem for one in ten Chinese children

A study of 4812 children and adolescents in Shanghai, China has found that 10% experienced a headache in the past three months. Of those who had headache, 45% were classified as having migraine. with the highest rates of migraine found at ages 14 years and 15 years. Tension-type headache accounted for 29% of headaches, while  cluster and other headache were responsible for 6.2% and 20%, respectively.
Source: Clinical Journal of Neuroscience 

Zhejiang prostitutes have high HPV rates and cervical cancer risk

Two out of three sex workers are infected with high risk subtypes of HPV putting them at increased risk of cervical cancer, a Zhejiang study has found.
Cervical samples from almost 300 female sex workers  in Huzhou, Zhejiang, showed that the prevalence of HPV was 67%, compared to 19% in the general population. Among the different types of HPV found,  HPV-16 (29%) was the most prevalent, followed by HPV-58 (24%) and HPV-52 (21%), and these were significantly associated with abnormal cervical cytology. The rate of cervical abnormalities was also higher among female sex workers (21%) than among the general population (5%). Researchers from the Huzhou Central Hospital conclude that female sex workers in the city have a greater probability of being infected with high-risk HPV, and novel vaccines against HPV-58 and HPV-52 should be developed. Using condoms could reduce the risk of infection.
Source: International Journal of Gynecology & Obstetrics 

Jiangsu simplifies medical insurance claims

Medical insurance claims can now be settled on the spot for outpatients in  Jiangsu. Outpatients from 13 cities including Changzhou, Nantong, and Wuxi can immediately settle their medical insurance if they go to see a doctor with their medical insurance cards, according to Jiangsu provincial Human Resources and Social Security Bureau.
Source: Jiangsu China.


Gay men in Yunnan have high HIV risk

More intensive HIV and STD screening and prevention campaigns are needed for gay men in Yunnan, say researchers who found a high incidence of new infections. In an 18 month study of 378 seronegative gay men in Yunnan they found that 11 became infected with HIV and 15 were infected with syphilis. Subgroups at high risk included students, retirees and minority ethnic groups, say the researchers from the No.1 Hospital of China Medical University, Nanjing.
Source: BMC Infectious Diseases.

Cervical cancer more common in China than previously thought

New review shows high rates of high risk HPV infection and pre-cancerous CIN lesions in Chinese women

by Michael Woodhead
New findings show a high prevalence of high risk-HPV infection and precancerous lesions (CIN2+ ) in Chinese women, suggesting that the cervical cancer burden in China is much greater than previously thought, and that comprehensive screening and HPV immunisation efforts are warranted.
Researchers from the Cancer Institute/Hospital at the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, say that estimates of cervical cancer rates in China have been based on a small and potentially unrepresentative pool of women in relatively affluent and developed urban areas such as Beijing.
Therefore they reviewed HPV and CIN rates in studies involving 30,207 women throughout China who had HPV testing and liquid-based cytology.
They found that the overall high-risk HPV prevalence was 17.7%. The study also showed high prevalence of every grade of CIN among Chinese women. Nearly 2% of women in the study harbored CIN3+, "an elevated prevalence that is most probably explained by the inadequacy of past and current cervical cancer screening practices in China, particularly among rural women," the researchers say.
Rates of high-risk HPV prevalence were similar in rural and urban areas but showed declines in women aged 25–29  in rural areas and at age 35–39  in urban women. These transient declines may be because the period of childbearing in China and elsewhere tends be accompanied by stronger family ties and fewer extramarital sexual affairs. The earlier dip in high-risk HPV prevalence in rural women may  be explained by the fact that age at first intercourse and first birth were 3 and 4 years earlier, respectively, for rural women compared to urban women. Furthermore, more rural women reported having two or more lifetime sexual partners (22%) than urban women (16%).
In rural and urban women, the CIN2 prevalence was 1.5% and 0.7% respectively and CIN3+ prevalence was 1.2%  and 0.6%, respectively. The prevalence of CIN3+ steadily increased with age, peaking in 45- to 49-year-old women. The steady rise of CIN3+ up to the age group of 45–49 is attributable to lack of lesion removal through screening.
The combined prevalence of CIN2 and CIN3+ in Chinese women (∼3%) was higher than the corresponding prevalence in other Asian countries, where it ranged between 0.5% in Thailand and 1.6% in Mongolia. In addition, the maximal prevalence of combined CIN2 and CIN3+ was observed in Chinese women older than 40–44 years, which was later than the maximal prevalence of CIN2+ in a recent meta-analysis of Asian women.
"Our findings document the inadequacy of current cervical cancer screening in China while indirectly raising the possibility that the cervical cancer burden in China is under-reported," they conclude.
"The high prevalence of CIN2+ in middle-age Chinese women should inform cervical cancer screening policies in China and other low- and intermediate-resource countries. Current cervical cancer screening recommendations are that women between the ages of 35 and 40 years be screened at least once  ... however, our findings show that Chinese women aged 40 years or older should also be screened as they harbour a substantial proportion of precancerous cervical lesions that accumulated over time and may still be the target of life-saving treatments," they suggest.
Read more: International Journal of Cancer

HPV linked to five fold higher risk of throat cancers

HPV is linked to many head and neck cancers

 A study by Beijing researchers has linked human papillomavirus (HPV) to a five times greater risk of laryngeal.
Researchers led by Dr. Xiangwei Li, from the Chinese Academy of Medical Sciences and Peking University Medical College in Beijing, analyzed 12 studies that compared cancerous and non-cancerous tissues from a total of 638 patients. They found the cancerous throat tissue had 5.4 times the odds of testing positive for HPV infection, compared to non-cancerous tissue.
The analysis was published last week in the Journal of Infectious Diseases.
Other researchers said that of all head and neck cancers, HPV seems to play the biggest role not in laryngeal cancer, but in cancer of the tonsils and back of the tongue.
However, they added, "the exposure is probably decades earlier. Someone who develops a base of tongue cancer when they're 50, they probably were exposed to the virus years before, in their teens or 20s."
At least half of sexually-active people get HPV at some point in their lives, according to the Centers for Disease Control and Prevention (CDC), but the virus is usually cleared by the immune system. Only some of the 40-plus HPV strains have been tied to cancer.
Based on the current findings, it's difficult to know how many of the laryngeal cancers in the original studies were actually caused by the virus, researchers said.
But Mendenhall said extending HPV vaccination to boys and young men, as the CDC has recommended, "will hopefully reduce at least some of these HPV-related cancers."
Source: Journal of Infectious Diseases