Human papillomavirus (HPV) self-sampling can increase screening uptake among women not engaged in clinic-based screening, but evidence remains limited on how implementation strategies can be developed and integrated into routine screening workflows in low-resource rural settings. We aimed to develop and specify implementation strategies for integrating HPV self-sampling into a rural screening system using a rapid stakeholder-engaged application of the Implementation Research Logic Model (IRLM). We conducted a pre-implementation study in two rural counties of China. The existing organized cervical cancer screening program provided clinic-based, clinician-collected screening. The planned intervention was a “mobilization plus self-sampling option”, in which village doctors would offer HPV self-sampling to hard-to-reach women who declined the routine screening. Using the IRLM, we organized determinants, implementation strategies, hypothesized mechanisms, and planned outcomes along a prospective pathway. Stakeholder interviews were guided by the Consolidated Framework for Implementation Research (CFIR). Barriers were matched to candidate strategies through the CFIR-ERIC (Expert Recommendations for Implementing Change) matching tool. In a co-design workshop, stakeholders prioritized strategies by discussion and dot voting, specified them using Proctor’s categories, and linked them to hypothesized mechanisms. Outcomes were organized using Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. A pilot pretest checked the intervention delivery workflow and data capture procedures. The study was conducted from March 23 to April 21, 2025, covering 26 activity days and 331.6 person-hours. CFIR-based interviews included 43 stakeholders, 25 of whom joined the co-design workshop. Three major barriers were identified: insufficient legitimacy of village doctor-led mobilization, gaps between initial agreement and correct self-sampling completion, and poor alignment between the self-sampling workflow and existing service responsibilities and incentives. CFIR-ERIC matching generated 46 candidate strategies; nine received at least 60

OBJECTIVE:To estimate long-term outcomes of biopsy-confirmed cervical intraepithelial neoplasia grade 1 (CIN1) or normal cervix and identify the cofactors during disease progression. METHODS:In 1999, a cervical cancer screening cohort in Shanxi, China, enrolled 1997 women aged 35-45. They were followed up at year 6, 11, and 15 after enrollment with high-risk human papillomavirus (hrHPV) DNA testing, liquid-based cytology, and visual inspection with acetic acid. Progression, persistence, and regression rates were calculated, stratified by baseline hrHPV and cytological status. Risk factors associated with hrHPV acquisition, persistence, and progression were examined. RESULTS:The cumulative rates of progression to CIN2+ among CIN1 over 6, 11, and 15 years were 7.5%, 21.4%, and 24.0%, respectively; the regression rates to normal cervix were 85.0%, 76.7%, and 72.9%, respectively. Over 6, 11, and 15 years, 0.7%, 2.9%, and 5.2% of normal cervix developed CIN2+, respectively, but over 90% remained normal after 15 years. CIN1 or normal cervix positive for hrHPV had significantly higher progression rates to CIN2+ than those without hrHPV. Similarly, the severity of cytological status was found to be associated with an increased risk of developing CIN2+. Women who had an earlier sexual debut were at a higher risk of acquiring new HPV infection and repeated HPV infections. CONCLUSIONS:Clinical follow-up strategies for women with CIN1 or normal cervix could be adjusted accordingly based on hrHPV/cytology status.

Women are anticipated to go through more than two rounds of cervical screening in their lifetime. Human papillomavirus (HPV) testing is increasingly used as the primary cervical cancer screening test. However, triage strategies for HPV-positive women were usually evaluated at baseline screening. We assessed the effect of sequential rounds of cervical screening on several algorithms for HPV triage. A total of 1,997 women ages 35-45 years were enrolled in 1999 in Shanxi, P.R. China and followed up three times at approximately 5-year intervals. Cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) prevalence by prior HPV results and performance of 12 triage algorithms with cytology, genotyping, and prior HPV were examined among 229 HPV-positive women at the fourth round. CIN2+ prevalence varied from 56.5% (95% confidence interval, 36.8%-74.4%) following 15 years HPV persistence to 3.5% (1.2%-9.9%) with an incident HPV within 15 years. Triage with cytology (with threshold of atypical squamous cells of undetermined significance) yielded positive predictive value (PPV) of 21.4% (13.8%-29.0%), entailing immediate colposcopic referral, and negative predictive value (NPV) of 97.4% (94.6%-100%), permitting retesting at short intervals. Triage with genotyping (16/18/31/33/45/52/58) or prior HPV results showed comparable performance with cytology. Among 11 triage algorithms with similar NPV to cytology, triage with prior HPV results and reflex genotyping (16/18) achieved highest PPV of 28.9% (18.8%-39.1%) and lowest colposcopy referral of 33.2% (27.4%-39.5%). HPV persistence across rounds is an effective risk stratifier in HPV-positive women. Mainstream cytology and genotyping, with or without consideration of prior HPV results, remain effective for HPV triage at fourth round. Prevention Relevance: The study highlights the sustained effectiveness of mainstream HPV triage methods, such as cytology and genotyping, after sequential rounds of cervical screening. It also suggests that use of HPV persistence across rounds can improve management of HPV-positive women in cervical cancer screening.

目的 了解农村地区妇女和医务人员对宫颈癌及宫颈癌筛查的认知和评价,分析宫颈癌筛查在实施中的现实问题,为进一步提高宫颈癌筛查项目提供科学依据.方法 采用横断面调查方法,对筛查妇女和医务人员进行关于宫颈癌以及筛查的认知和评价的问卷调查.结果 共调查2292名妇女和14名医务人员,其中1988名妇女(87.3％)听说过宫颈癌,但仅有228名(10.0％)知道HPV是宫颈癌的主要病因,认知度与年龄、文化程度、职业、经济条件有关(P＜0.05).大部分妇女(87.7％)不了解宫颈癌筛查技术,但2036名(89.1％)妇女希望接受筛查技术相关的培训.参与筛查最主要的原因是为了解自身健康状况(83.2％),不愿意参与筛查的主要原因是觉得自己没有症状,不需要筛查(63.7％).超过60％的妇女对筛查秩序、对妇科医生较为满意.作为医务人员,仍有21.4％不了解HPV可以导致哪些疾病.结论 大部分妇女对宫颈癌筛查项目比较满意,但妇女和医务人员对宫颈癌筛查的认知均需进一步提高,加强健康教育是提高宫颈癌筛查质量的关键.

A Pd-free activation pretreatment process was developed for electroless Ni-P plating on NiFe2O4 particles. The main influencing factors, including NiCl2·6H2O concentration, pH of electroless bath and temperature, were investigated. Microstructures of the coating layers were characterized by scanning electron microscopy. It was found that a more uniform and compact Ni-P coating layer was successfully formed by electroless plating via Pd-free activation pretreatment than Pd as sited plating. The coating layers plated by Pd-free activation pretreatment were thicker than those by the sensitization and activation pretreatment on average (9 vs. 5 μm). The new process did not need conventional sensitization or activation pretreatments, because the Ni particles dispersed uniformly on the NiFe2O4 substrate became catalytic activation sites for nickel electroless plating. Such improvement was beneficial to shortening the preparation process and reducing the production costs with the use of noble metal Pd.

Objective. Self-collected HPV testing could substantially reduce disparities in cervical cancer screening, with slightly lower sensitivity compared to physician-collected specimens cross-sectionally. We aimed to evaluate the comprehensive long-term performance of self-collected HPV testing prospectively. Methods. In 1999, 1997 women were screened by HPV testing on self-collected and physician-collected samples, cytology and visual inspection with acetic acid (VIA) and followed up in 2005, 2010 and 2014, respectively. HPV testing was performed with Hybrid Capture II. Prospective performance, baseline clinical efficiency, and 15 year cumulative risk of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) were analyzed. Results. Self-collected HPV testing prospectively detected 83.3% (95% CI:74.9%,89.3%), 70.3% (95% CI:62.5%,77.2%) and 63.3% (95% CI:55.7%, 70.2%) of cumulative CIN2+ at 6-year, 11-year and 15-year follow-up, respectively. Relative cumulative sensitivity of physician-collected HPV testing versus self-collected HPV testing was stable over 15 years at about 1.16. Cumulative sensitivity of self-collected HPV testing was comparable to cytology and significantly higher than VIA. Among women positive by self-collected HPV testing at baseline, 26.2% (95% CI:21.5%, 30.9%) developed CIN2+ during 6-year follow-up and no difference was observed with physician-collected HPV testing even 15 years after baseline. Negative self-collected HPV results provided greater protection against CIN2+ than VIA and ascertained CIN2+ cumulative incident rates as low as 1.1% at the 6-year follow-up. Conclusions. Self-collected HPV testing demonstrates lower sensitivity than physician-collected HPV testing but performs comparably to cytology prospectively and provides satisfactory assurance against CIN2+, indicating an alternative role in cervical cancer primary screening with five-year interval as an option especially in low resource settings. (C) 2018 Published by Elsevier Inc.

The present study shows a new manufacturing process for improving the quality of Al alloy foams by powder metallurgy method. Foaming process was accelerated by combining the actions of the modification of Al-1%Mg-xSn (x=0, 3 and 5 wt%)/7%SiC precursor and the application of foaming mould providing high heating rate. The liquid Sn filled up the voids in the precursor and helped to capture the liberated H-2 during foaming. The early expansion stage occurred in advance with addition of Sn. Foaming behaviors and the morphologies of the Al foams revealed that the stability and the final cellular structure were improved significantly.

[Objective] To evaluate the role of HPV16/18 DNA genotyping in predicting the risk of cervical precancerous or cancerous lesions in women with atypical squamous cells of undetermined significance(ASC -US),compared with hrHPV DNA testing.[Methods] The current study was conducted based on the cohort of Shanxi Province Cervical Cancer Screening Study Ⅰ (SPOCCS I).During the follow-up,women received hrHPV DNA testing (hybird capture 2,HC2),liquid-based cytology and visual inspection with acetic acid concurrently.Those with any positive screening result would be transferred to colposcopy and take biopsies if necessary.Meanwhile,HPV genotyping was performed on residual cervical exfoliated cell samples in HC2-positive women using reverse linear probe hybridization assay (LiPA).416 ASC-US women from the cohort were included to estimate the immediate risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) by hrHPV DNA,HPV16/18 genotyping status,as well as their clinical performances.The 5-year cumulative risk of CIN2+ and relative risk were assessed in the 253 ASC-US women detected in 2005.[Results] Among women with positive hrHPV,those infected with HPV16/18 had higher immediate risk of CIN2+ (9.7％) than those with other hrHPV infections (3.8％),but there was no significantly statistical difference (0R=2.7,95％CI:0.4～17.3).No case was found in hrHPV-negative women.Compared with hrHPV-negative women (1.9％),the 5-year cumulative risks of CIN2+ increased in groups of other hrHPV type positive [5.3％,RR=2.7(95％CI:0.3～23.0)],hrHPV positive [8.5％,RR=4.5(95％CI:1.1 ～17.8)] and HPV16/18positive (11.8％,RR=6.2 (95％CI:1.1～33.9)].Compared with hrHPV DNA testing,the sensitivity of HPV 16/18 genotyping for detecting CIN2+ declined [relative sensitivity:0.6 (95％CI:0.3～1.2)],and the specificity to exclude CIN2+ increased [relative specificity:1.3(1.2～1.4)].[Conclusion] Triaging ASC-US women with HPV16/18 genotyping can obtain higher specificity while losing some sensitivity.HPV16/18 genotyping can discriminate the instant and long-term CIN2+ risk in hrHPV-positive population,so it can be used to manage or triage ASC-US women.

Objective To assess the triage strategy suitable for HPV positive women in cervical cancer screening in rural China,and provid scientific evidence for cervical cancer screening in the real world.Methods Women aged 35-64 years were recruited from Xiangyuan County and Yangcheng County in Shanxi Province between July 2015 and October 2015 for cervical cancer screening.Care HPV detection method was used as the primary screening technique,and after the initial screening,women with positive HPV results were randomly divided into three groups:cytology triage (82 patients),VIA/VILI triage (83 patients) and direct colposcopy without triage (83 patients).Cytology and VIA/VILI positive women transferred to colposcopy.If colposcopy screening showed abnormal results,biopsy was performed for pathological doagnosis.Results A total of 1503 women were enrolled.The positive rate of HPV was 16.5％ (248/1503).The detection rates of moderate and above cervical intraepithelial neoplasia (CIN2 +) was 0.7％ (11/1503).Among the 248 women,237 women completed triage,and the compliance rate was 95.6％ (237/248).There were 81,79 and 77 women in cytology triage group,VIA/VILI triage group and non shunt direct colposcopy group respectively.The triage positive rate,CIN2 + detection rate and positive predictive value were 19.8％,1.2％ and 11.1％ respectively for cytology group,17.5％,3.6％ and 21.4％ respectively for VIA/VILI group,and 19.5％,8.4％ and 9.5％ for colposcopy group.There were no obvious statistical difference in all the above positive rates and CIN2 + detection rates (all P ＞ 0.05).There was an increasing trend of HPV positive rates with the increasing of age(P ＜ 0.05),but colposcopy group showed a down trend (P ＜ 0.05).No obvious differences were found in changes of positive rates with the increasing of age between VIA/VILI group and cytology group (P ＞ 0.05).Conclusion Among the three methods,VIA/VILI may be a suitable triaged method for HPV positive women in rural China.

BackgroundComprehensive long-term evaluation for self-collected human papilloma virus (HPV) testing is not well established. We aimed to assess its predictive capacity from a long-term perspective compared with other cervical cancer mainstream screening methods.Methods1997 women aged 35–45 years from Shanxi, China were screened by self-collected HPV testing, doctor-collected HPV testing, liquid based cytology, and visual inspection with acetic acid in 1999. The women were followed up in 2005, 2010, and 2014 with doctor-collected HPV testing, liquid based cytology, and visual inspection with acetic acid (except in 2014). On the basis of baseline screening results, we calculated cross-sectional and prospective clinical performance and 15-year cumulative incidence rates (CIRs) of cervical intraepithelial neoplasia grade 2 or higher (CIN2+).FindingsIncident sensitivities for CIN2+ of all methods decreased with time, whereas incident specificity remained stable. Self-collected HPV testing predicted 84·2%, 53·2%, and 43·4% CIN2+ incident cases in 2005, 2010, and 2014, respectively, showing no significant difference with doctor-collected HPV testing and cytology at cutoff atypical squamous cells of undetermined significance (ASC-US), but higher than cytology (p=0·008, 0·004 and 0·008) and visual inspection with acetic acid (p=0·004, 0·003, 0·029) at cutoff low-grade squamous intraepithelial lesions at follow-up in 2005, 2010, and 2014, respectively. The difference of incident sensitivity between self-collected HPV testing and cotest was comparable until at 15-year follow-up (43·4% vs 56·6%, p=0·006). Women with baseline-positive self-collected HPV testing showed comparable CIN2+ CIRs with those women who were baseline-positive by doctor-collected HPV testing during 15-year follow-up, but higher than cytology at cutoff ASC-US (p=0·004), cotest (p<0·0001), and visual inspection with acetic acid (p<0·0001). The assurance provided by baseline negative results of self-collected HPV testing was better than visual inspection with acetic acid (p=0·006) and comparable with other screening methods.InterpretationSelf-collected HPV testing showed comparable longitudinal performance to doctor-collected HPV testing and cytology, indicating an alternative role in primary cervical cancer screening. Self-collected HPV with 5 year interval could be an option.FundingNational Natural Science Foundation of China (81322040) and Chinese Academy of Medical Sciences Initiative for Innovative Medicine (CAMS-I2M-1-019).

BackgroundThe long-term risk of progression or regression in women with biopsy-confirmed normal cervical epithelium or cervical intraepithelial neoplasia grade 1 (CIN1) is unclear. The aim of the study was to assess the rates of progression and regression of women with histological CIN1 or normal cervical epithelium in rural China.MethodsA screening cohort for cervical cancer was built in 1999 in Xiangyuan County, Shanxi Province, with a sample size of 1997 women aged 35–45 years, who were followed up in 2005 (6-year follow-up), 2010 (11-year follow-up), and 2014 (15-year follow-up) with human papillomavirus (HPV) DNA testing, liquid-based cytology, and visual inspection with acetic acid (except in 2014). Progression and regression rates of histological normal and CIN1 at different follow-up timepoints were calculated stratified by baseline HPV status.FindingsThe cumulative rate of progression to CIN2+ among women who were CIN1 baseline was 7% (8/107) at 6-year follow-up, 21% (22/103) at 11-year follow-up, and 24% (23/96) at 15-year follow-up. Women who were CIN1 and HPV-positive had significantly higher progression rates (13% [8/63] at 6 years, 33% [20/60] at 11 years, and 36% [21/59] at 15 years) than did those who were CIN1 but were negative for HPV (0% [0/44], 5% [2/43], and 5% [2/37], respectively; p=0·014 at 6 years, p=0·0005 at 11 years, and p=0·0007 at 15 years). Meanwhile, up to 95% of women who were CIN1 and HPV negative at baseline regressed to normal during the 15-year period. Furthermore, the rates of progression to CIN2+ among women who were histologically normal was 1% (11/1543) at 6-year follow-up, 3% (40/1358) at 11-year follow-up, and 5% (60/1162) at 15-year follow-up; more than 90% of women maintained at normal during the 15-year period.InterpretationHPV testing could be helpful to monitor women with CIN1 or normal cervical epithelium. The screening interval for those without HPV infection could be safely extended to 5–10 years, but those who are HPV-positive should be followed closely.FundingNational Natural Science Foundation of China (grant number 81050018, 81322040, 81402748); Chinese Academy of Medical Science Initiative for Innovative Medicine (2016-I2M-1-019).

ObjectiveCareHPV is a human papillomavirus (HPV) DNA test for low-resource settings (LRS). This study assesses optimum triage strategies for careHPV-positive women in LRS.MethodsA total of 2,530 Chinese women were concurrently screened for cervical cancer with visual inspection with acetic acid (VIA), liquid-based cytology and HPV testing by physician- and self-collected careHPV, and physician-collected Hybrid Capture 2 (HC2). Screen-positive women were referred to colposcopy with biopsy and endocervical curettage as necessary. HPV-positivity was defined as ≥1.0 relative light units/cutoff (RLU/CO) for both careHPV and HC2. Primary physician-HC2, physician-careHPV and self-careHPV and in sequential screening with cytology, VIA, or increased HPV test-positivity performance, stratified by age, were assessed for cervical intraepithelial neoplasia (CIN) grade 2/3 or worse (CIN2/3+) detection.ResultsThe sensitivities and specificities of primary HPV testing for CIN2+ were: 83.8%, 88.1% for physician-careHPV; 72.1%, 88.2% for self-careHPV; and 97.1%, 86.0% for HC2. Physician-careHPV test-positive women with VIA triage had a sensitivity of 30.9% for CIN2+ versus 80.9% with cytology triage. Self-careHPV test-positive women with VIA triage was 26.5% versus 66.2% with cytology triage. The sensitivity of HC2 test-positive women with VIA triage was 38.2% versus 92.6% with cytology triage. The sensitivity of physician-careHPV testing for CIN2+ decreased from 83.8% at ≥1.0 RLU/CO to 72.1% at ≥10.00 RLU/CO, while the sensitivity of self-careHPV testing decreased from 72.1% at ≥1.0 RLU/CO to 32.4% at ≥10.00 RLU/CO; similar trends were seen with age-stratification.ConclusionsVIA and cytology triage improved specificity for CIN2/3 than no triage. Sensitivity with VIA triage was unsuitable for a mass-screening program. VIA provider training might improve this strategy. Cytology triage could be feasible where a high-quality cytology program exists. Triage of HPV test-positive women by increased test positivity cutoff adds another LRS triage option.

E6 oncoprotein is a necessary agent of HPV driven oncogenic transformation. This study is aimed at evaluating the risk stratification potency of HPV 16/ 18 E6 oncoprotein (E6) as a triage method for HPV positivity. Moreover, it also acts as a predictor of cervical intraepithelial neoplasia grade 3 or worse (CIN31). The screening cohort of 1,997 women was followed for a 15 year period in approximate five-year intervals. Participants were concurrently screened by HPV DNA testing (HC2), liquid based cytology (LBC), visual inspection with acetic acid (VIA) and were referred to colposcopy and biopsy if any tests reflected positive. E6 was performed on cervical samples collected from this cohort in 2005 and 2014. The ability of E6 to predict CIN31 risk after the five-and ten-year interval was evaluated. Among HPV positive women in 2005, E6 indicated the lowest positive rate (9.9%) compared to LBC (48.4%) and VIA (28.0%), however, a higher prevalence rate (10.3%) and 10-year cumulative incidence rate (53.0%) of CIN31 were detected among women who were E6 positive. Meanwhile, only 4.2% and 2.9% of women with abnormal LBC and positive VIA were diagnosed as prevalent CIN31 in 2005, 23.0% and 16.5% developed to CIN31 after year 10, respectively. Strong associations were found between precedent and subsequent HPV persistence and E6 oncoprotein expression (ORadjusted540.0 and 21.2, respectively). E6 oncoprotein could serve as a low-cost, highly specific, strongly indicative point-of-care method in the triage and treatment of HPV positive women.

Objective To evaluate the 15 years changing trends of prevalence of high risk HPV (HR?HPV) infection and the risks of cervical cancer and precancerous lesions (CIN2+) among a Chinese rural population. Methods The screening cohort with 1 997 women aged 35 to 45 years old was built in 1999 in Xiangyuan County, Shanxi province ( SPOCCS?I) and followed up by cytology and HR?HPV testing in the years of 2005, 2010, and 2014. The changes of HR?HPV prevalence and the risks of cervical precancerous lesions with CIN2+ as the endpoints were analyzed during the past 15 years. Results The detection rates of HPV infection and CIN2+ were 15.7%?22.3% and 1.1%?4.3% for the baseline visit and the other 3 follow?ups, respectively. The cumulative risk of CIN2+ in HR?HPV positive women at baseline was significantly higher than HR?HPV negative women ( P<0.01) during the 15?year follow?up. The risk of CIN2+ in the four?times HPV positive group was 40. 0%, while the group with four?times negative HPV results was 0.6% (Adjusted RR = 55.0, 95% CI: 11.3 to 268.4). Conclusions The prevalence of HR?HPV infection and CIN2+ lesions were high in Xiangyuan county during the 15 years. HR?HPV positivity elevated the risk of CIN2+ compared to women whose HR?HPV test was negative. The risks of CIN2+incidence in 6 years were low among women with negative HR?HPV test. The risk of CIN2+ increased with the numbers of HPV infection events. The screening interval could be extended to 5?6 years.

NiFe2O4 ceramic inert anode for aluminum electrolysis, strengthened by adding NiFe2O4nanopowder, was preparedvia powder metallurgy method. The effects of NiFe2O4 nanopowder content on sintering behavior and properties of NiFe2O4 ceramic inert anode were studied. Linear shrinkage and scanning electron microscope (SEM) were employed to characterize the sintering property and microstructure. The results show that the sintering shrinkage degree increases gradually as increase of NiFe2O4 nanopowder content, while the sintering temperature and apparent activation energy of initial stage of sintering decrease. When nanopowder content is 40%, the sharp sintering shrinkage begins from 900℃ and the apparent activation energy of initial stage of sintering drops to 291.43 kJ/mol. Volume density, bending strength and fracture toughness are enhanced firstly and then decreased with the increase of nanopowder content, while the porosity and static corrosion rate display opposite tendency. The maximum value of fracture toughness is 3.12 MPa?m1/2 with nanopowder content of 30%, which is 2.14 times that of without adding nanopowder. The toughening effect is realized by the elevated fracture surface energy, which is attributed to the enhanced grain boundary cohesive bond and the reduced porosity with addition of NiFe2O4 nanopowder.

[目的]评价careHPV检测技术在农村宫颈癌筛查中的应用情况.[方法]对山西襄垣县2270名35～64岁妇女采用careHPV检测技术进行官颈癌初筛,初筛阳性者接受液基细胞学分流,分流阳性者召回阴道镜检查及活检,以病理结果为金标准.[结果]参加筛查的妇女平均年龄45.7±6.8岁,careHPV阳性率为12.9％(292/2270),阴道镜转诊率为4.8％(109/2270),CIN1、CIN2+检出率分别为1.4％(31/2270)和1.7％(38/2270).在既往筛查史上,参加过筛查的妇女CIN2+的检出率要低于从未参加过筛查的妇女(x2=4.50,P=0.042).[结论]careHPV检测技术初筛细胞学分流的筛查策略有助于在降低阴道镜转诊率的同时,提高宫颈病变的检出率,扩大筛查覆盖面.该策略适用于资源相对贫乏的农村地区.