Prostate cancer is a common disease in the USA and Europe, with a gradually increasing incidence in China, and presents a significant health burden for older men. The lack of modifiable risk factors has made early detection as a strategy to reduce mortality. Current methods of screening involve the measurement of serum prostate-specific antigen (PSA) and digital rectal examination followed by biopsy. With PSA screening evidence of level I absent, the evidence on the use of PSA as a screening test is still highly controversial. Furthermore, there is controversy over whether screen-detected lesions will become clinically significant. There are three major treatment options for localized disease: radical prostatectomy, radical radiotherapy and monitoring with treatment if required. There is no evidence of randomized controlled trial (RCT) to suggest a survival advantage of any of these treatments. Opinions about the related benefits and risks of screening vary widely. In the absence of RCT of benefit for screening, many now suggest “informed consensus” screening, which encourages a discussion between the patient and his physician with both sides informed of all of the issues.
Diabetic retinopathy (DR) is the most common cause of preventable blindness in the working-age population. In addition to optimizing the hyperglycemia, hypertension, hyperlipidemia and other risk factors, regular fundus examination is essential for early diagnosis asymptomatic DR and timely treat the sight-threatening DR, so as to reduce blindness and severe visual impairment caused by DR. Clinical practice guidelines for the screening and management of DR have been implemented throughout the world, but there are reasonable differences between existing guidelines in the recommended timing of first retinal examination, screening intervals, methods for examination and criteria for referral to an ophthalmologist. It is of great clinical significance to have a detailed understanding of the current guidelines for DR screening and their clinical basis.
Objective To investigate the incidence of retinopathy of prematuri ty (ROP) in the area of Shanghai, and to provide the preliminary data for the ev aluation of present criteria for ROP screening. Methods Record s of 289 prematur e infants who had undergone ROP screening from the four NICU in Shanghai between February 2004 and January 2005 were analyzed. Screening criteria included prete rm infants or low birth weight (LBW) infants with BW of 2000g or less. The first examination starts at 4 to 6 weeks chronologic age or 32 weeks post conceptual age. Results In the 289 screened infants, 19 had developed acu te ROP. There we re 3 threshold ROP, 7 prethreshold ROP and 9 developed ROP less than prethreshol d. The incidence of ROP was 6.6%. According to the British recommended guideline s（BWle;1500 g or GAle;31 weeks）, only 119 out of 289 needed screening and one ca se of stage 1 ROP was missed; the incidence of ROP was 15.1% (18/119). When lowered sc reening criteria to the American guidelines（BWle;1500g or GAle;28 weeks）, t here were only 83 infants needed screening, and we missed 2 stage 1 and 1 prethreshold ROP and the incidence of ROP was 19.3% (16/83). Conclusions The i ncidence of ROP i s 6.6% according to our study. It is lower than other reports and it has somethi ng to do with our present screening guideline. Further epidemiological data are needed to modify the guideline accordingly.
ObjectiveTo systematically review the diagnostic efficacy of abbreviated magnetic resonance imaging sequence (AMRI) screening for hepatocellular carcinoma (HCC). MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on the diagnostic efficacy of AMRI screening for HCC from inception to March 2022. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies; then, meta-analysis was performed by using Stata 16.0 software. ResultsA total of 15 studies involving 2 823 participants were included. The results of meta-analysis showed that combined sensitivity and specificity of AMRI for HCC were 0.85 (95%CI 0.83 to 0.87) and 0.93 (95%CI 0.90 to 0.94). Subgroup analysis showed that, the combined sensitivity and specificity of NC AMRI and HBP AMRI were 0.84 (95%CI 0.81 to 0.87), 0.92 (95%CI 0.88 to 0.95) and 0.88 (95%CI 0.84 to 0.91), 0.93 (95%CI 0.91 to 0.94), respectively. The combined sensitivity and specificity of T2+DWI+HBP in HBP AMRI had the highest diagnostic efficacy. ConclusionCurrent evidence shows that all AMRI protocols have acceptable sensitivity and specificity for HCC screening. Among them, T2+DWI+HBP protocol shows the highest diagnostic efficiency. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the value of mass screening of serum pepsinogen test for Asian population with high-risk gastric carcinoma. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 12, 2013), CNKI, WanFang Data, VIP and CBM for diagnostic tests on serum pepsinogen test versus with pathological biopsy/X-ray examination (gold standard) between January 2004 and January 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was conducted using Meta-DiSc software (version 1.4). ResultsA total of 15 studies involving 180 934 subjects were included. ROC curve showed "shoulder-arm shape" distribution. The results of Spearman correlation analysis suggested a significance of the threshold effect (P=0.001). The results of meta-analysis showed that, the area under curve (AUC) was 0.74. ConclusionSerum pepsinogen has good value in the screening of gastric carcinoma among Asian permanent residents. Due to limited quality of studies, the above conclusion should be verified by conducting more high quality studies.
ObjectiveTo systematically review the clinical significance of Raman spectroscopy (RS) in the auxiliary diagnosis of colon cancer (CC). MethodsPubMed, Web of Science, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect diagnostic tests related to RS in the auxiliary diagnosis of CC from inception to October 1st, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 12.0 and Meta-Disc 1.4 software. ResultsA total of 21 studies involving 1 419 patients were included. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and positive posttest probability (PPP) for CC screening applying RS were 0.94 (95%CI 0.93 to 0.95), 0.91 (95%CI 0.90 to 0.92), 157.50 (95%CI 74.44 to 333.21), 10.40 (95%CI 6.62 to 16.33), 0.08 (95%CI 0.05 to 0.12) and 77%, respectively. The area under the curve (AUC) of summary receiver operating characteristic (SROC) curve was 0.98 (95%CI 0.96 to 0.99). ConclusionCurrent evidence shows that RS is a potentially useful tool for CC screening. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo evaluate the diagnostic performance of different screening tools for sarcopenia in the community for the elderly with sarcopenia, and to provide evidence-based support for the accurate screening of elderly patients with sarcopenia. MethodsThe PubMed, Web of Science, Cochrane Library, Embase, CINAHL, VIP, CBM, and WanFang Data databases were searched by computer, and the relevant research on the diagnosis of sarcopenia in the elderly by publicly published risk screening tools was found. The retrieval time was from inception to June 2023. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies, and then data analysis was performed by using Stata 15.1 and Meta Disc 1.4 software. ResultsA total of 24 studies were included, including 10 961 patients, involving 8 risk screening tools for sarcopenia in the elderly: leg circumference, MSRA-5, MSRA-7, upper arm circumference, ring test, Ishii score, SARC-CalF and SARC-F. Meta-analysis showed that the combined sensitivities of eight screening tools were 0.84 (95% CI 0.61 to 1.15), 0.82 (95% CI 0.48 to 1.38), 0.80 (95% CI 0.47 to 1.36) and 0.72 (95%CI 0.33 to 1.55), 0.67 (95%CI 0.37 to 1.21), 0.63 (95%CI 0.33 to 1.19), 0.49 (95%CI 0.38 to 0.63), 0.24 (95%CI 0.18 to 0.30), and the combined specificities were 0.39 (95%CI 0.18 to 0.82)、0.52 (95%CI 0.29 to 0.93)、0.54 (95%CI 0.29 to 1.03)、0.62 (95%CI 0.49 to 0.79)、0.63 (95%CI 0.50 to 0.78).The results of reticular meta-analysis showed that the surface under the cumulative ranking curve (SUCRA) of the eight screening tools ranked from high to low according to the cumulative sensitivity: calf circumference (67.4%) > MSRA-5 (65.3%) > MSRA-7 (64.1%) > upper arm circumference (54.5%) > ring test (46.5%) > Ishii score. The values of specificity SUCRA from highest to lowest were as follows: SARC-F (72.2%) > SARC-CALF (71.3%) > Ishii score (60.2%) > ring test (57.1%) > upper arm circumference (40.1%) > lower leg circumference (36.2%) > MSRA-5. ConclusionThe simple screening tool for common sarcopenia has high sensitivity and high specificity, so medical staff can give priority to the combination of the two screening tools, namely SARC-CalF. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Diabetes mellitus patients are usually at high risk of developing tuberculosis, the immune dysfunction caused by long-term high blood sugar, which can increase the susceptibility to tuberculosis. Severe tuberculosis could accelerate the course of diabetes mellitus and pose great difficulty to the clinical treatment. Therefore, early detection of potential tuberculosis patients in diabetes mellitus patients through tuberculosis screening and implementation of “three early” treatment can greatly improve the quality life of patients. This review summarizes the feasibility of tuberculosis screening in patients with diabetes mellitus, and to provide reference for the prevention and control of diabetes mellitus combined with tuberculosis.
ObjectiveTo investigate the diagnosis and classification of chronic obstructive pulmonary disease (COPD) in high risk populations living in metropolitan communities of Beijing. MethodsDuring January 2011 to December 2012,a cross-sectional survey including questionnaires and pulmonary function tests were performed in high risk populations of COPD (aged≥40 years with a history of smoking or chronic bronchitis) at 6 communities in Dongcheng District of Beijing. For those confirmed to have COPD,the dyspnea was rated by the modified Medical Research Council Dyspnea Scale (mMRC),and the frequency of acute exacerbations in the last year was recorded. The patients were classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2011) classification criteria. ResultsA total of 932 individuals,including 689 males (73.9%,aged 60.8±12.5 years) and 243 females(26.1%,aged 59.8±12.1 years),who had risk factors of COPD were included in the screening. COPD was confirmed in 203 patients,with the prevalence of 21.8%,and among whom only 31 cases (15.3%) had been diagnosed as COPD in the past. According to the revised GOLD classification in 2011,96(47.2%),38(18.7%),56(27.5%),and 13(6.4%) patients were classified into group A,B,C and D,respectively. The proportion of subgroup C1 (FEV1%pred <50% and the number of exacerbation in the last year <2) in group C was 71.4% (40/56). ConclusionIn the metropolitan communities of Beijing,screening the population with predisposing factors can increase the early diagnosis of COPD,which is often delayed by the lack of significant symptoms. The high proportion of patients in group C in this population implies that disease screening in high risk populations may be helpful for the prevention and treatment of COPD.
Neuroblastoma (NB) is the most common extracranial solid malignant tumor in children. NB has various clinical manifestations, many of which are not specific, which ultimately lead to the delayed diagnosis of the tumor. In order to provide guidance for the identification of paediatric NB, the guideline for the identification and referral of suspected paediatric neuroblastoma is formulated and complied using a standard formulation process, and has received input from multidisciplinary experts, based on existing evidence, clinical practices and China's national conditions.