Screening High-risk Populations Research Articles

Effect of cancer screening with multi-cancer early detection testing and whole body MRI on cancer worry in a high-risk population.

10520 Background: Multi-cancer Early Detection tests (MCED) and whole-body imaging are being increasingly utilized for early cancer detection but are not included in cancer screening guidelines. Our aims were to 1) determine the feasibility of MCED testing and whole-body MRI (WBM) to screen people at high-risk for cancer after germline testing and cancer genetics evaluation and 2) understand the impact of MCED and WBM on cancer worry and anxiety. Methods: We conducted a feasibility trial of people >50 years old with a strong family history of cancer and/or a pathogenic/likely pathogenic germline variant in a cancer susceptibility gene for which WBM is not part of standard risk management. Participants completed a baseline survey including the SF12, State Trait Anxiety Index (STAI), and modified cancer worry scale (CWS). They then underwent non-contrast whole body 3T MRI and liquid biopsy using DEEPGEN, a mutational-based MCED. Results were reported to participants and additional imaging studies or consultations were obtained as needed. Participants were surveyed 6 months after testing using SF12, STAI, CWS, and a questionnaire on acceptability of the intervention. Results: 100 participants were enrolled; 73 have completed 6-month follow-up. Median age was 62 years (IQR 57-66) and 64% of participants were women. MCED was positive in 4 participants, none of which had suspicious findings on WBM. 27 (27%) underwent additional imaging to further evaluate findings identified on WBM. 4 (4%) had cancer diagnosed based on WBM findings and subsequent work up (lung adenocarcinoma, prostate cancer, duodenal neuroendocrine carcinoma, and ovarian Brenner tumor); all 4 underwent surgical resection. One participant underwent bone marrow biopsy due to JAK2 mutation and thrombocytosis (evaluation ongoing) and one participant had a thyroid biopsy for a benign nodule. 62 (85%) somewhat/strongly agreed that study participation reduced cancer worry. Composite CWS scores showed decreased worry at 6 months compared with baseline (12.7 vs 13.7, p=0.003). At baseline, 30 (41%) reported that they somewhat/very often worry about getting cancer, compared with 14 (18%) at 6 months (p<0.001). 8 (11%) reported at baseline that cancer worry affected their mood somewhat/very often, compared with 2 (3%) at 6 months (p<0.001). There were no significant differences in STAI or SF12 composite scores between baseline and 6 months. 69 (95%) somewhat/strongly agreed that they would like to participate in future testing with WBM and MCED. Conclusions: MCED and WBM testing is feasible and was associated with decreased cancer worry at 6 months. In this high-risk cohort, cancer was detected in 4% of patients. Further evaluation of cancer screening in high-risk populations using WBM and MCED testing is warranted particularly with respect to patient-centered outcomes, cancer outcomes, and healthcare resource utilization. Clinical trial information: NCT05868486 .

Clinical performance of a prefabricated immunofluorescence assay for nasopharyngeal cancer screening.

Epstein-Barr virus (EBV) IgA serology for viral capsid antigen (VCA) and early antigen (EA) aids early detection of nasopharyngeal cancer (NPC), resulting in improved survival. We evaluated the diagnostic performance of a prefabricated immunofluorescent assay (IFA) for NPC screening in high-risk individuals. Sera from 96 biopsy-proven patients with NPC diagnosed at the outpatient clinic and 96 healthy family members were tested for EBV-VCA IgA and EBV-EA IgA using the prefabricated IFA from EUROIMMUN (EI) and the traditional immunofluorescence method. The AUC of EI EBV-VCA IgA and EBV-EA IgA was 0.907 (95% confidence interval [CI]: 0.894-0.965) and 0.898 (95% CI: 0.848-0.947), respectively. Combined testing with the prefabricated assay at a threshold of VCA ≥1:320 or EA ≥1:10 showed 92.7% sensitivity and 81.2% specificity. Overall, the traditional EBV-EA IgA assay demonstrated the best accuracy (sensitivity 91.7% and specificity 96.9%) at a threshold of ≥1:5. While the traditional IFA method was more accurate, the prefabricated IFA test kit can be a useful tool for NPC screening in high-risk populations.

#2766 Impact of CKD screening in high-risk populations and guideline-directed therapy on CV event occurrence and costs in Europe: an IMPACT CKD analysis

Abstract Background and Aims Chronic kidney disease (CKD) is a growing health problem in Europe exacerbated by aging and the rise of comorbidities such as diabetes mellitus (DM) and hypertension (HTN). Patients with CKD are often multi-morbid and commonly present with cardiovascular (CV) complications. While CV events including myocardial infarction (MI), stroke, and hospitalization for heart failure (HHF) occur more often in patients with advanced CKD, patients with early-stage CKD are also at increased risk. Patients with CKD also experience an increased risk of CV-related mortality, with many patients dying from CV events prior to kidney failure and renal replacement therapy. CV events also present a significant burden to clinicians and healthcare systems due to the high costs and resource use required to manage and treat them. Despite this multidimensional burden, CKD is currently underdiagnosed in Europe, and CKD screening and treatment are rarely included in public health strategies to improve mortality and health outcomes. This study aims to explore the impact of targeted CKD screening followed by guideline-directed therapy in high-risk populations on CV event occurrence and associated treatment costs across Europe. Method The IMPACT CKD microsimulation model simulates CKD progression, CV events, and comorbidities. CKD status is assigned based on estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio levels (UACR), and CKD progression is predicted by an annual eGFR decline rate. The model was used to compare two scenarios in four country populations (Germany, Netherlands, Spain, United Kingdom [UK]): 1) targeted screening for people with DM and/or HTN followed by optimal compliance to guideline-directed therapy and 2) current practice (no screening, underdiagnosis, low treatment rates). Annual targeted screening assumed both eGFR and UACR testing. Treatment initiation for people diagnosed with CKD was based on Kidney Disease Improving Global Outcomes guidelines with a 90% compliance assumed to approximate maximum clinical benefit. Therapies were assumed to have a multiplicative treatment effect on eGFR decline and CV events. Current practice assumed observed diagnosis rates without screening and observed treatment rates in each country. For both scenarios, the model projected incidence of CV events and associated management costs in year 10 (2032) and cumulatively over the 10 simulated years (2023-2032). Results Results compare the targeted screening followed by guideline-directed treatment scenario to continuation of current practices for Germany, Netherlands, Spain, and UK (Table 1). The timely diagnosis of patients with CKD and effective treatment was associated with a reduction of 46.7-53.3%, 38.9-41.6%, and 42.1-50.5% in the number of MI, stroke, and HHF events, respectively in 2032 across the four countries. These decreases in the number of CV events were accompanied by proportional reductions in costs to treat the events. Additionally, this policy approach resulted in declines in the cumulative 10-year CV event development and associated healthcare costs, with MI having the largest reductions (40.6-47.2%), followed by HHF (37.4-43.0%), and stroke (29.8-36.1%) across the four countries. Conclusion This study illustrated that early identification of high-risk patients with CKD coupled with guideline-directed treatment would yield substantial clinical and economic benefits from reducing CV events across all four European countries. Fewer MI, stroke, and HHF events were projected in patients with CKD in both 2032 and cumulatively from 2023 to 2032 due to delayed disease progression following effective interventions. Driven by the reduced clinical burden, lower healthcare costs for CV event management were also predicted. These findings support the need for the adoption of policies for early diagnosis and treatment of CKD to slow disease progression and mitigate the growing CV disease burden among patients with CKD and for health systems. Future studies should explore the costs associated with targeted CKD screening and the guideline-directed pharmacological therapies for CKD.

#2617 Impact of CKD screening in high‑risk populations and guideline-directed therapy on RRT, CV events, and mortality in Europe: an IMPACT CKD analysis

Abstract Background and Aims Despite the rising and substantial burden of chronic kidney disease (CKD), there is a lack of recognition of CKD as a health priority in Europe. This contributes to underdiagnosis of CKD despite the potential for early detection and effective intervention to delay progression to late-stages (associated with costly and resource-intensive renal replacement therapy [RRT; i.e., dialysis and transplantation]). Further, diagnosed patients are undertreated when compared to current and upcoming CKD guidelines, leading to increased risk for progression to RRT and cardiovascular (CV) or other events. Early detection and intervention in high-risk populations, such as those with diabetes mellitus (DM) and hypertension (HTN) have shown cost-effectiveness; however, the broader implications of these strategies on CKD progression and clinical outcomes in a European context remains underexplored. Our study aims to illustrate the clinical benefit of targeted screening followed by an optimal compliance to guideline-directed treatment use to provide insight into potential CKD policies across Europe. Method Four country populations (Germany, Netherlands, Spain, United Kingdom [UK]) were simulated for 10-years (baseline: 2022; simulated years: 2023-2032) using the validated IMPACT CKD model to compare two scenarios: targeted screening for people with DM and/or HTN followed by 90% compliance to guideline-directed therapy versus current practice (i.e., underdiagnosis without screening and low treatment rates). Annual targeted screening was modelled using estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing. Initiation of therapies for people with diagnosed CKD was based on Kidney Disease Improving Global Outcomes guidelines. A 90% compliance to guideline-directed therapies was assumed to approximate maximum clinical benefit. Current practice was modelled based on the observed diagnosed rate without screening and the observed treatment rate in each country. The incremental population initiated on recommended therapies were modelled to experience a multiplicative treatment effect on GFR decline, CV events, and acute kidney injury (AKI) events. The model projected CKD and RRT prevalence, incidence of CV and AKI events with results shown for year 10 (2032), as well as cumulative all-cause mortality over the simulated 10-years. Results Results compare the high-risk population screening followed by guideline-directed treatment scenario to continuation of current practices for the four countries (Fig. 1). The identification of undiagnosed CKD, as well as lower rates of progression due to guideline-directed treatment was associated with a small rise in the number of total CKD patients, with increases in stage 1-2 by 3.5% to 5.0%, and stage 3-5 by 0.2% to 1.2%. There was a reduction in the number of undiagnosed CKD stage 1-2 patients by 49.2% to 71.6%, and stage 3-5 by 60.2% to 69.8%. The largest reductions were predicted for CV events (44.6% to 49.1%) followed by dialysis (22.6% to 41.9%). The strategy resulted in a decrease in cumulative 10-year all-cause mortality between 4.5% to 9.1% in CKD patients. Conclusion The study predicted significant clinical benefits from targeted CKD screening followed by guideline-directed interventions across all four European countries. Notably, this approach was forecasted to reduce undiagnosed CKD cases, dialysis, CV events, and mortality. These findings underscore the potential of acting earlier on CKD to mitigate the future CKD burden.

Early detection of pancreatic cancer in the era of precision medicine.

Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related mortality and it is often diagnosed at advanced stages due to non-specific clinical presentation. Disease detection at localized disease stage followed by surgical resection remains the only potentially curative treatment. In this era of precision medicine, a multifaceted approach to early detection of PDAC includes targeted screening in high-risk populations, serum biomarkers and "liquid biopsies", and artificial intelligence augmented tumor detection from radiologic examinations. In this review, we will review these emerging techniques in the early detection of PDAC.

Assessing the Feasibility and Effectiveness of Screening for Indoor Tanning in the Primary Care Setting: A Report of Preliminary Findings

Introduction: Indoor tanning is a major modifiable risk factor in the development of both melanontic and non-melanotic skin cancers. Investigation of behavior-altering interventions is an area of active research. As with other preventative measures, screening of high-risk populations can be an important aspect of a multimodality public health intervention. We sought to further the limited understanding of indoor tanning screening practices in the primary care setting.Methods: Physicians practicing within the scope of primary care in the northeast were surveyed in 2022 on practice patterns around frequency of indoor tanning screening, barriers encountered with implementing screening, and actions taken with a positive screen. Research methodology adhered to the Joanna Briggs Institute research study critical appraisal checklist.Results: Of 26 primary care physicians (PCPs), only 7.7% routinely screened for indoor tanning. Barriers identified included time limitations (76.9%) and prioritization of other health concerns (96.2%). All PCPs (100%) reacted to reports of indoor tanning with an intervention, most commonly counseling on the risks of indoor tanning (92.6%).Conclusions: Our data suggests that screening for indoor tanning use could be improved. We recommend the incorporation of a standardized screening question regarding indoor tanning in intake forms.

Low-cost conventional PCR techniques enable simultaneous detection of bacterial sexually transmitted infections with enhanced sensitivity and specificity

PurposeNeisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Mycoplasma hominis (MH), the three most common treatable bacterial sexually transmitted infections (STIs) worldwide can lead to many complications if remain untreated. Screening of high-risk population with highly sensitive methods will lead to significant improvement in patient outcomes and will prevent downward transmission. The advantages of Polymerase chain reaction (PCR) based assay are not only high sensitivity and specificity, but also detection of multiple organisms in a single reaction which reduce the result turn-around time. The aim of the present study was to evaluate the feasibility of a multiplex PCR assay method targeting 16S rRNA gene for simultaneous detection of NG, CT and MH infection along with their trend and occurrence among high-risk population in Assam, Northeast India. MethodsA cross-sectional study was undertaken, where a total of 200 randomly selected patients from high-risk population were included. After validation of singleplex PCR, Multiplex PCR (M-PCR) was performed along with the traditional culture method for NG. Results & conclusionThe overall agreement of M-PCR with singleplex PCR was very high (100%). The occurrence of STI was found to be very high (101/200; 50.5%). Furthermore, co-infection was detected in 10/200; 5%) individuals. Infection was more common among young individuals (p < 0.05) and males out-numbered females (p < 0.05). The most common organism detected was CT (42/200; 21%) followed by NG (41/200; 20.5%) and MH (20/200; 10%). The M-PCR assay workflow is simple, cost effective and can be used in routine diagnostic laboratories with basic molecular facilities.

Fetal cardiac screening: 1st trimester and beyond.

Congenital heart defects (CHD) are the most common birth defect and a leading cause of infant morbidity and mortality. CHD often occurs in low-risk pregnant patients, which underscores the importance of routine fetal cardiac screening at the time of the 2nd trimester ultrasound. Prenatal diagnosis of CHD is important for counseling and decision-making, focused diagnostic testing, and optimal perinatal and delivery management. As a result, prenatal diagnosis has led to improved neonatal and infant outcomes. Updated fetal cardiac screening guidelines, coupled with technological advancements and educational efforts, have resulted in increased prenatal detection of CHD in both low- and high-risk populations. However, room for improvement remains. In recent years, fetal cardiac screening for specific high-risk populations has started in the 1st trimester, which is a trend that is likely to expand over time. This review discusses fetal cardiac screening throughout pregnancy.

Interpretation of global lung cancer statistics

Lung cancer remains one of the leading cause of global cancer-related mortality, posing a significant burden of disease. Tobacco exposure stands as the foremost risk factor for lung cancer. Since the 1960, global efforts have gradually been implemented to control tobacco exposure, consequently reducing tobacco exposure levels within populations. This shift in exposure levels may have altered the epidemiological characteristics of lung cancer globally. This study aims to describe global lung cancer incidence data across five dimensions: age, gender, region, stage at diagnosis, and survival status, using global cancer registry data and relevant research findings. The objective is to elucidate the current epidemiological features of lung cancer worldwide, providing a scientific basis for lung cancer prevention and control. Furthermore, this study offers corresponding measures and recommendations for lung cancer prevention and control, aligning with the three-tiered cancer prevention strategy. Findings indicate that the incidence and mortality burden of lung cancer is significantly higher among the elderly population (aged 65 years and above) compared to the working-age population (aged 15-64 years). The aged-standardized incidence rate of lung cancer remains higher in males than in females, but the overall aged-standardized incidence rate of lung cancer in males shows a declining trend, while that in females shows an increasing trend. Regions with high and very high human development index (HDI) exhibit a substantially higher incidence and mortality burden of lung cancer compared to regions with low and very low HDI. Japan ranks highest in the diagnosis of stage Ⅰ lung cancer, with a diagnosis rate of 38.6%. Its age-standardized 5-year net survival rate is relatively high at 32.9%. Despite improvements in the survival status of lung cancer in certain countries like China and Japan, the overall prognosis for lung cancer remains pessimistic. Given the current epidemiological characteristics of lung cancer, reinforcing tobacco control measures and reducing female-specific lung cancer risk factors stand as significant goals for primary prevention. Promoting low-dose computed tomography screening for high-risk population, minimizing false-positive rates in lung cancer screening, and promoting medical system reforms and standardized treatment constitute principal measures for secondary and tertiary lung cancer prevention, respectively.

The close association of micronutrients with COVID-19

ObjectivesThe present study was conducted to explore the performance of micronutrients in the prediction and prevention of coronavirus disease 2019 (COVID-19). MethodsThis is an observational case-control study. 149 normal controls (NCs) and 214 COVID-19 patients were included in this study. Fat-soluble and water-soluble vitamins were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis, and inorganic elements were detected by inductively coupled plasma-mass spectrometry (ICP-MS) analysis. A logistic regression model based on six micronutrients were constructed using DxAI platform. ResultsMany micronutrients were dysregulated in COVID-19 compared to normal control (NC). 25-Hydroxyvitamin D3 [25(OH)D3], magnesium (Mg), copper (Cu), calcium (Ca) and vitamin B6 (pyridoxic acid, PA) were significantly independent risk factors for COVID-19. The logistic regression model consisted of 25(OH)D3, Mg, Cu, Ca, vitamin B5 (VB5) and PA was developed, and displayed a strong discriminative capability to differentiate COVID-19 patients from NC individuals [area under the receiver operating characteristic curve (AUROC) = 0.901]. In addition, the model had great predictive ability in discriminating mild/normal COVID-19 patients from NC individuals (AUROC = 0.883). ConclusionsOur study showed that micronutrients were associated with COVID-19, and our logistic regression model based on six micronutrients has potential in clinical management of COVID-19, and will be useful for prediction of COVID-19 and screening of high-risk population.

Application of machine learning techniques in the diagnostic approach of PTSD using MRI neuroimaging data: A systematic review

BackgroundAt present, the diagnosis of post-traumatic stress disorder（PTSD） mainly relies on clinical symptoms and psychological scales, and finding objective indicators that are helpful for diagnosis has always been a challenge in clinical practice and academic research. Neuroimaging is a useful and powerful tool for discovering the biomarkers of PTSD,especially functional MRI (fMRI), structural MRI (sMRI) and Diffusion Weighted Imaging（DTI）are the most commonly used technologies, which can provide multiple perspectives on brain function, structure and its connectivity. Machine learning (ML) is an emerging and potentially powerful method, which has aroused people's interest because it is used together with neuroimaging data to define brain structural and functional abnormalities related to diseases, and identify phenotypes, such as helping physicians make early diagnosis. ObjectivesAccording to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) declaration, a systematic review was conducted to assess its accuracy in distinguishing between PTSD patients, TEHC(Trauma-Exposed Healthy Controls), and HC(healthy controls). MethodsWe searched PubMed, Embase, and Web of Science using common words for ML methods and PTSD until June 2023, with no language or time limits. This review includes 13 studies, with sensitivity, specificity, and accuracy taken from each publication or acquired directly from the authors. ResultsAll ML techniques have an diagnostic accuracy rate above 70%，and support vector machine（SVM） are the most commonly used techniques. This series of studies has revealed significant neurobiological differences in key brain regions among individuals with PTSD, TEHC, and HC. The connectivity patterns of regions such as the Insula and Amygdala hold particular significance in distinguishing these groups. TEHC exhibits more normal connectivity patterns compared to PTSD, providing valuable insights for the application of machine learning in PTSD diagnosis. ConclusionIn contrast to any currently available assessment and clinical diagnosis, ML techniques can be used as an effective and non-invasive support for early identification and detection of patients as well as for early screening of high-risk populations.

Prevention and treatment of endometrial cancer

Endometrial cancer is rising in incidence, especially in young women. This rise in incidence has implications for both primary prevention and screening in high-risk population. In the past several years, our understanding of the integration of clinically related genomic and pathologic data optimized the management of endometrial cancer. The updated 2023 FIGO staging includes the histological and molecular classification to better reflect the improved understanding of the heterogenous nature of endometrial carcinoma. Standard primary treatment is quite essential, however, selection of patients for adjuvant radiation or chemotherapy remains in controversy. Molecular characterization of endometrial cancer is becoming critical in directing treatment for advanced and recurrent disease, and the addition of immunotherapy to frontline chemotherapy is becoming the standard of care. More attention should be given to increase awareness of survivorship issues and improve patient quality-of-life.

Interobserver agreement in the interpretation of anal cytology.

Anal cytology represents a tool for anal cancer screening in high-risk populations. In addition to accuracy, the reproducibility of the interpretation is of key importance. The authors evaluated the agreement of anal cytologic interpretation between two cytopathologists. Liquid-based cytologic slides from human immunodeficiency virus (HIV)-negative men who have sex with men (MSM) were evaluated by two readers with at least 10 years of expertise in cervical cytology. Cases with a discordant interpretation were reviewed, and a consensus was reached. Human papillomavirus (HPV) genotyping was performed using a proprietary HPV genotyping test. Unweighted and weighted Cohen kappa and 95% confidence interval (CI) values were calculated. Overall, 713 slides that were adequate for interpretation were evaluated (MSM: median age, 33 years). An HPV test was performed on 620 samples (87.0%). Considering a dichotomous interpretation (negative for intraepithelial lesion or malignancy vs. atypical squamous cells of undetermined significance or worse), the crude agreement between the two readers was 93.3% (kappa=0.82; 95% CI, 0.77-0.87). Once a consensus for discordant cases was reached, the best agreement was found for the negative for intraepithelial lesion or malignancy category (511 of 528 samples; 96.8%), whereas the atypical squamous cells of undetermined significance category showed the lowest agreement (90 of 117 samples, 76.9%). Considering the individual cytologic categories, overall agreement was 92.1% (kappa=0.85; 95% CI, 0.81-0.89). The discordant interpretations were not associated with high-risk HPV infection, HPV16 infection, or MSM age. The results indicating excellent interobserver agreement in this study substantiate the use of anal cytology in the setting of human immunodeficiency virus-negative MSM.

Racial disparities of gastric cancer in the USA: an overview of epidemiology, global screening guidelines, and targeted screening in a heterogeneous population.

Gastric cancer is the fifth most common cancer diagnosis and fourth leading cause of cancer-related death globally. The incidence of gastric cancer in the USA shows significant racial and ethnic disparities with gastric cancer incidence in Korean Americans being over five times higher than in non-Hispanic whites. Since gastric cancer is not common in the USA, there are no current screening guidelines. In countries with higher incidences of gastric cancer, screening guidelines have been implemented for early detection and intervention and this has been associated with a reduction in mortality. Immigrants from high incidence countries develop gastric cancer at lower rates once outside of their country of origin, but continue to be at higher risk for developing gastric cancer. This risk does seem to decrease with subsequent generations. With increasing availability of endoscopy, initiating gastric cancer screening guidelines for high-risk groups can have the potential to improve survival by diagnosing and treating gastric cancer at an earlier stage. This article aims to provide context to gastric cancer epidemiology globally, review risk factors for developing gastric cancer, highlight racial and ethnic disparities in gastric cancer burden in the USA, examine current guidelines that exist in high incidence countries, and suggest future studies examining the efficacy of additional screening in high-risk populations to reduce gastric cancer mortality and disparate burden on ethnic minorities in the USA.

Interventions to Improve Endoscopic Screening Adherence of Cancer in High-Risk Populations: A Scoping Review.

Colorectal, and gastric cancers have the second, and fourth mortality rates worldwide, respectively. Endoscopic screening is a crucial diagnostic tool for colorectal, and gastric cancers. Effective interventions can improve adherence to endoscopic screening in high-risk populations, which is important for cancer prevention and mortality reduction. This study aimed to identify interventions that could improve adherence to endoscopic screening for cancer in high-risk populations. Combination keywords including colorectal cancer, gastric cancer, screening adherence, and interventions were used to search for articles in PubMed, Web of Science, Cochrane Library, and MEDLINE Complete. The review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR). A total of 12 articles were included in this review: 9 randomized controlled trials(RCT) and 3 quasi-experimental studies(QEDs). Among the extracted studies, 11 were about colorectal cancer, and 1 was about gastric cancer. Most studies used lecture-based or Information Technology-based health education interventions. Narrative interventions have proven to be novel and effective approaches for promoting adherence to endoscopic screening. Health education interventions included cancer epidemiology, cancer risk factors, warning symptoms, and screening methods. All interventions involved were effective in increasing individual knowledge of cancer-related endoscopic screening, willingness to undergo screening, and screening behaviors. These findings provide a reference for designing endoscopy-related cancer screening interventions.

New perspectives on advances in diagnosis through imaging in chronic respiratory diseases: a systematic literature review

Background: Chronic respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, and cystic fibrosis, present substantial global health challenges. This systematic review explores recent advances in imaging-based diagnostic methods for these conditions, emphasizing high-resolution computed tomography (HRCT), magnetic resonance imaging (MRI), positron emission tomography (PET), and artificial intelligence (AI). Methodology: A systematic search of databases identified studies published in the last five years, focusing on innovative imaging techniques for chronic respiratory diseases. Inclusion criteria emphasized diagnostic accuracy and advancements in imaging modalities. Results: Seven studies were included, covering interventions in intensive care, mesenchymal stem cell therapy for COVID-19-induced acute respiratory distress syndrome (ARDS), endovascular treatment for aortic arch aneurysms, and lung cancer screening. MSC therapy demonstrated positive outcomes in ARDS patients, while endovascular repair showed technical success. LungSEARCH highlighted the effectiveness of lung cancer screening in high-risk populations. Discussion: Recent imaging technologies, including HRCT, MRI, PET, and AI, have revolutionized chronic respiratory disease diagnosis. The review emphasizes their clinical applications, impact on patient outcomes, and potential for personalized medicine. AI enhances image analysis accuracy, yet challenges like cost and interpretation discrepancies persist. Conclusion: Imaging technologies, particularly HRCT, MRI, PET, and AI, show promise in improving diagnostic accuracy and personalized treatment for chronic respiratory diseases. Collaboration among healthcare professionals, researchers, and industry stakeholders is crucial for addressing challenges and ensuring widespread access to advanced diagnostic tools. Future directions involve refining imaging methods for routine clinical integration, advancing patient care, and reducing the burden of respiratory diseases.

Geographic and ethnicity variation in the prevalence of middle-aged and elderly adult obesity in China in 2020.

The objective of this study is to evaluate the mean body mass index (BMI), general obesity and abdominal obesity in adults aged ≥40 years residing in China in 2020, and to analyse variations in these factors across different geographic areas and subpopulations. We utilized data from the National Stroke High-Risk Population Screening programme to calculate and compare the mean BMI and prevalence of obesity across various demographics, including sex, age, urban-rural locality, geographical region (province) and ethnicity status. In our study, we found that the standardized mean BMI level was 24.65 kg/m2 [95% confidence interval (CI): 24.50-22.84] in men and 24.31 kg/m2 (95% CI: 24.15-24.45) in women. Using the criteria from China, we found that the standardized prevalence of general obesity and abdominal obesity was 13.13% (95% CI: 13.05-13.21%) and 33.03% (95 CI: 32.92-33.14%), respectively. Our study also identified significant effects of age, sex, urban-rural locality, province and ethnicity status on the prevalence of obesity. Overall, our study estimated that in 2020, approximately 91.1 million adults aged ≥40 years in China were obese (46.5 million men and 44.6 million women), while 229.2 million adults (110.4 million men and 118.8 million women) were diagnosed with abdominal obesity. Our research has revealed compelling new evidence about the obesity epidemic among Chinese adults aged ≥40 years, particularly at the provincial and ethnic levels. As a result, more targeted and effective prevention strategies should be developed to alleviate the burden of obesity.

Multi-omics combined test performance effectiveness on opportunistic screening of high-risk liver cancer population

Objective: To validate the performance of a multi-omics combined test for early screening of high-risk liver cancer populations. Methods: 173 high-risk patients with liver cancer were prospectively screened in a real-world setting, and 164 cases were finally enrolled. B-ultrasound, alpha-fetoprotein (AFP), and HCC screens were conducted in all patients. A multi-omics early screening test was performed for liver cancer in combination with multi-gene methylation, TP53/TERT/CTNNB1 mutations, AFP, and abnormal prothrombin (PIVKA-II). Differences in rates were compared using the chi-square test, adjusted chi-square test, or Fisher's exact probability method for count data. A non-parametric rank test (Mann-Whitney) was used to compare the differences between the two groups of data. Results: The HCCscreen detection had a sensitivity of 100% for liver cancer screening, 93.8% for liver cancer and precancerous diseases, 34.1% for positive predictive value, 99.2% for negative predictive value, and 0.89 for an area under the curve (AUC). Parallel detection of AFP, AFP+B-ultrasound, and methylation+mutation had a sensitivity/specificity and AUC of 31.3%/88.5% (AUC=0.78), 56.3%/88.2% (AUC=0.86), and 81.3%/82.4 % (AUC=0.84). At the same time, the disease severity range was significantly correlated with the methylation+mutation score, HCCscreen score, or positive detection rate (PDR). There was no significant correlation between AFP serum levels and methylation+mutation or HCCscreen scores, while there was a significant linear correlation between methylation+mutation scores and HCCscreen scores (r = 0.73, P < 0.001). Conclusion: In real-world settings, HCCscreen shows high sensitivity for screening opportunistic, high-risk liver cancer populations. Furthermore, it may efficaciously detect liver cancer and precancerous diseases, with superior performance to AFP and AFP+ultrasound. Hence, HCCscreen has the potential to become an effective screening tool that is superior to existing screening methods for high-risk liver cancer populations.

Causal associations between modifiable risk factors and isolated REM sleep behavior disorder: a mendelian randomization study.

This Mendelian randomization (MR) study identified modifiable risk factors for isolated rapid eye movement sleep behavior disorder (iRBD). Genome-wide association study (GWAS) datasets for 29 modifiable risk factors for iRBD in discovery and replication stages were used. GWAS data for iRBD cases were obtained from the International RBD Study Group. The inverse variance weighted (IVW) method was primarily employed to explore causality, with supplementary analyses used to verify the robustness of IVW findings. Co-localization analysis further substantiated causal associations identified via MR. Genetic correlations between mental illness and iRBD were identified using trait covariance, linkage disequilibrium score regression, and co-localization analyses. Our study revealed causal associations between sun exposure-related factors and iRBD. Utilizing sun protection (odds ratio [OR] = 0.31 [0.14, 0.69], p = 0.004), ease of sunburn (OR = 0.70 [0.57, 0.87], p = 0.001), childhood sunburn occasions (OR = 0.58 [0.39, 0.87], p = 0.008), and phototoxic dermatitis (OR = 0.78 [0.66, 0.92], p = 0.003) decreased iRBD risk. Conversely, a deep skin color increased risk (OR = 1.42 [1.04, 1.93], p = 0.026). Smoking, alcohol consumption, low education levels, and mental illness were not risk factors for iRBD. Anxiety disorders and iRBD were genetically correlated. Our study does not corroborate previous findings that identified smoking, alcohol use, low education, and mental illness as risk factors for iRBD. Moreover, we found that excessive sun exposure elevates iRBD risk. These findings offer new insights for screening high-risk populations and devising preventive measures.

Integrating artificial intelligence into lung cancer screening: a randomised controlled trial protocol

IntroductionLung cancer (LC) is the most common cause of cancer-related deaths worldwide. Its early detection can be achieved with a CT scan. Two large randomised trials proved the efficacy of...