Optimal screening interval for intraocular pressure measurement for Asian glaucoma patients

AIM: To explore the optimal interval of intraocular pressure(IOP) measurement for screening glaucoma in healthy people.METHODS: From January to December 2005, we consecutively enrolled all participants(> 20 years old) attending the Center for Preventive Medicine at St. Luke's International Hospital in Tokyo, Japan, for the annual health check program. The program promoted the early detection of chronic diseases and their risk factors. We excluded people who had glaucoma or a high IOP(≥ 22 mm Hg) at baseline. The annual health check-ups collected all demographic information and medical history with an initial evaluation, including IOP measurement. IOP was measured in both eyes with a full autotonometer TX-F(Canon, Tokyo, Japan). Participants with an IOP ≥ 22 mmH g in either eye were considered to require additional evaluation for glaucoma. We divided the participants into two groups based on age: under 65 years old and over 65 years old. The United States Department of Health and Human Services Cen-ters for Medicare and Medicaid Services guideline was used as a reference. RESULTS: From January 2005 to July 2008, 12 385 participants underwent check-ups each year. The mean ± SD IOP in the higher eye at baseline was 13.4(2.6) in 2005, 13.2(2.7) in 2006, 13.3(2.6), and 12.8(2.6) in 2008. In addition, we analyzed the differences with an analysis of variance(ANOVA), and additional analysis was performed with Bonferroni's correction. The difference between the 4 years was significant(P < 0.01) with ANOVA. Bonferroni analysis revealed significant differences between 2005 and 2006(P < 0.01), 2005 and 2008(P < 0.01), 2006 and 2007(P < 0.01), 2006 and 2008(P < 0.01), and 2007 and 2008(P < 0.01). Only the difference between 2005 and 2007 was not significant(P = 0.1). Logistic regression suggested that only age(P < 0.01) and baseline IOP(P < 0.01) were associated with high IOP; the presence of diabetes, HgbA 1c level, gender, systolic blood pressure, diastolic blood pressure, low-density lipoprotein and family history were non-significant.CONCLUSION: Annual IOP check-ups may be recommended for participants aged ≥ 65 years with baseline IOPs of 17-21 mm Hg. A check-up every 3 years or more may be recommended for patients with IOPs < 17 mmH g.

Risk assessment of self-sampling HPV tests based on PCR, signal amplification to guide the appropriate screening intervals: A prospective study in China

Objective:We assessed the longitudinal risk of developing cervical intraepithelial neoplasia(CINs)with self-sampling human papillomavirus(HPV)tests,based on polymerase chain reaction(PCR)and signal amplification(care HPV),to explore the appropriate intervals for cervical cancer screening.Methods:A prospective study was conducted in China during 2017-2020.Participants were invited for PCR and care HPV tests with self-samples at baseline.Women positive in either HPV test underwent colposcopy and biopsy if necessary.Women with baseline CIN grade one(CIN1)or less were followed up over 3 years.The absolute risk was assessed by the immediate risk(IR)and cumulative risk(CR),and the relative risk was assessed by the hazard ratio(HR)with a 95%confidence interval(CI).Results:A total of 8,126 women were included in the final analysis.Women positive for the PCR HPV test had comparable IRs of CIN2+and CIN3+to those positive on the care HPV test.With triage by HPV genotyping,women with HPV 16/18 infection had the highest IRs of CIN2+(21.15%)and CIN3+(9.67%).For CR,women negative for PCR HPV test had a lower risk of CIN2+than that reported in women negative on care HPV test(0.57%versus 0.98%,HR=0.58,95%CI:0.38,0.87),but no significant difference was found in the CRs of CIN3+between them(0.25%versus 0.39%,HR=0.64,95%CI:0.34,1.20).Among women with CIN1 or less at baseline,women who were persistent or recurrent positive on care HPV or PCR HPV test had a higher risk of developing CIN3+(11.36%-14.59%),compared with women remained HPV negative from baseline throughout follow-up(≤0.28%).Conclusions:Routine screening with 3-year intervals is acceptable for self-sampling HPV tests based on PCR or care HPV test.Women positive on HPV16/18 triaging at baseline or with CIN1 or less at baseline while being per-sistent or recurrent positive on care HPV or PCR HPV test during 3-year follow-up require immediate colposcopy or treatment.

Comparative effectiveness of different hepatocellular carcinoma screening intervals or modalities:a systematic review and meta-analysis

Background:Current guidelines recommend hepatocellular carcinoma(HCC)screening in high-risk populations.However,the ideal HCC screening interval and screening modality have not been determined.This study aimed to compare the screening efficacy among different modalities with various intervals.Methods:PubMed and other nine databases were searched through June 30,2021.Binary outcomes were pooled using risk ratio(RR)with 95%confidence intervals(CIs).Survival rates were also pooled using RR with 95%CIs because most eligible studies only provided the number of survival patients instead of hazard ratio.Results:In all,13 studies were included.Two random controlled trials(RCTs)and six cohort studies compared screening intervals for ultrasonography(US)screening and found no significant differences between shorter(3-or 4-month)and longer(6-or 12-month)screening intervals in terms of early HCC proportion,HCC significant mortality,1-year survival rate;screening at 6-month interval significantly increased the proportion of early HCC(RR=1.17,95%confidence interval[CI]:1.08-1.26)and prolonged the 5-year survival rate(RR=1.39,95%CI:1.07-1.82)relative to the 12-month interval results.Three other RCTs and two cohort studies compared different screening modalities in cirrhosis or chronic hepatitis B,which indicated no statistical differences in the proportion of early HCC(RR=0.89,95%CI:0.40-1.96)and HCC mortality(RR=0.69,95%CI:0.23-2.09)between the biannual US and annual computed tomography(CT screening).Biannual US screening showed a lower proportion of early HCC than biannual magnetic resonance imaging(MRI)(RR=0.60,95%CI:0.37-0.97)and biannual US combined with annual CT(RR=1.31,95%CI:1.13-1.51)screening.The proportion of early HCC in the contrast-enhanced US group was slightly higher than that in the B-mode US(RR=1.08,95%CI:1.00-1.23)group.Conclusions:The evidence suggests that 6 months may be the best HCC screening interval for US screening.The effectiveness of CT and MRI is better than US during same screening intervals.However,MRI and CT are more expensive than US,and CT also can increase the risk of radiation exposure.The selection of CT or MRI instead of US should be carefully considered.Registration:No.CRD42020148258 at PROSPERO website(https://www.crd.york.ac.uk/PROSPERO/).