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The impact of a single round of screening of visual inspection with acetic acid (VIA) on cervical cancer incidence and mortality was investigated in a cluster randomized trial in south India. Women 30 -59 years of age in 113 clusters in Dindigul District were randomized to VIA screening (57 clusters, 48,225 women) by nurses and to a control group (56 clusters, 30,167 women). 30,577 eligible women were screened between May 2000 and April 2003; 2,939 (9.6%) screen-positive women were investigated with colposcopy by nurses and 2,777 (9.1%) women had biopsy. CIN 1 was diagnosed in 1,778 women, CIN 2-3 lesions were found in 222, and there were 69 screen detected invasive cervical cancers. The detection rates of lesions per 1,000 screened women were 58.2 for CIN 1, 7.3 for CIN 2-3, and 2.3 for invasive cancer. The detection rate of high-grade lesions in our study was 2-3-fold higher than those observed in repeatedly screened populations in developed countries. 71% of women with CIN 1 and 80% of those with CIN 2-3 lesions accepted cryotherapy provided by nurses and surgical treatment by mid-level clinicians. Overall, 97 and 34 incident cervical cancer cases were observed in the intervention and control arms, respectively. The intervention arm accrued 124,144 person years and the control arm accrued 90,172 during the study period. The age standardized cervical cancer incidence rates were 92.4/ 100,000 person-years in the intervention and 43.1/100,000 in the control arms. In the screened arm, 35.0% of cases were in Stage I as opposed to none in the control arm. The preliminary findings from our study indicate that not only is a VIAbased screening programme feasible, safe and acceptable to a population in rural settings, it also results in early detection of cervical neoplasia. © 2004 Wiley-Liss, Inc. Key words: visual inspection with acetic acid; VIA; cytology; cervical cancer; screening; detection; prevention; control; developing countries India is a high-risk country for cervical cancer accounting for 25% (126,000 new cases, 71,000 deaths around the year 2000) of the world burden. 1 The age-standardized incidence rates varies between 11-55/ 100,000 women in different regions. 2,3 Most cases present in advanced stages and the overall 5-year survival is Ͻ40%. 4 Although prevention of cervical cancer is a priority of the National Cancer Control Programme of India, no organized screening programs exist in the country. The financial and logistics burden of operating an organized screening programme based on cytology is considerable, and has encouraged the evaluation of alternative methods such as visual inspection with acetic acid (VIA). [5][6][7][8] VIA is a simple, inexpensive test that can be provided by midwives, nurses and health workers. The sensitivity and specificity of VIA have been widely studied and found to be satisfactory. 6 -16 Although model based studies 17,18 suggest VIA will be a cost-effective method of reducing cervical cancer burden, reduced incidence and mortality from cervical cancer following...

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Tissue engineered constructs with rapid restoration of mechanical and biological properties remain a challenge, emphasizing the need to develop novel scaffolds. Here, we present a multicomponent composite three-dimensional scaffold structure with biomimetic reinforcement and biomolecule functionalization for meniscus tissue engineering. The scaffold structure was developed using 3:1 silk fibroin (SF) and polyvinyl alcohol (PVA). Autoclaved eggshell membrane (AESM) powder (1-3%w/v) was used as reinforcement to enhance biomechanical properties. Further to improve cell attachment and proliferation, these scaffolds were functionalized using an optimized unique combination of biomolecules. Comprehensive analysis of scaffolds was carried out on morphological, structural, mechanical and biological functionalities. Their mechanical properties were compared with different native human menisci. The results indicated that, functionalized SF-PVA with 3%AESM has shown similar order of magnitude of compressive and dynamic mechanical properties as in human meniscus. Moreover, 3% AESM based scaffolds were found to support better primary human meniscal cellular proliferation and extracellular matrix secretion. Immunohistochemical analysis revealed angiogenesis and biocompatibility with minimal inflammatory response for subcutaneously implanted scaffolds in New Zealand white rabbits. The developed reinforced and functionalized SF-PVA scaffolds can uniquely combine the potential for load-bearing properties with improved in vitro and in vivo support for meniscus tissue regeneration. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 1722-1731, 2018.

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