BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still...BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not optimistic.In China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been conducted.Therefore,it is necessary to develop a simple and efficient early screening model for CRC.AIM To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.METHODS Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively analyzed.The cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect data.Of 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were not.The participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve analysis.Finally,the model was validated internally using a bootstrap resampling technique.RESULTS Seven variables,including demographic,lifestyle,and family history information,were examined.Multifactorial logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P<0.001],body mass index(BMI)(OR:1.07,95%CI:1.06-1.08,P<0.001),waist circumference(WC)(OR:1.03,95%CI:1.02-1.03 P<0.001),lifestyle(OR:0.45,95%CI:0.42-0.48,P<0.001),and family history(OR:4.28,95%CI:4.04-4.54,P<0.001)were the most significant predictors of high-risk CRC.Healthy lifestyle was a protective factor,whereas family history was the most significant risk factor.The area under the curve was 0.734(95%CI:0.723-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training set ROC curve.The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.CONCLUSION The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age,BMI,WC,lifestyle,and family history exhibited high accuracy.展开更多
In the last decade,several studies have explored various modalities and strategies for colorectal cancer(CRC)screening,taking into account epidemiological data,individual characteristics,and socioeconomic factors.In t...In the last decade,several studies have explored various modalities and strategies for colorectal cancer(CRC)screening,taking into account epidemiological data,individual characteristics,and socioeconomic factors.In this editorial,we comment further on a retrospective study by Agatsuma et al published in the recent issue of the World Journal of Gastroenterology.Our focus is on screening trends,particularly in relation to efforts to improve the currently suboptimal uptake among the general population worldwide,aiming to enhance early diagnosis rates of CRC.There is a need to raise awareness through health edu-cation programs and to consider the use of readily available,non-invasive screening methods.These strategies are crucial for attracting screen-eligible populations to participate in first-line screening,especially those in high-or average-risk groups and in regions with limited resources.Liquid biopsies and biomarkers represent rapidly evolving trends in screening and diagnosis;however,their clinical relevance has yet to be standardized.展开更多
Objective:The aim of our study was to estimate the cost of colorectal cancer screening and to provide evidence for the cost control of colorectal cancer screening among general population in rural area of China.Method...Objective:The aim of our study was to estimate the cost of colorectal cancer screening and to provide evidence for the cost control of colorectal cancer screening among general population in rural area of China.Methods:We determined the net cost for colorectal cancer mass-screening in Jiashan County,and evaluated the cost-benefit and cost effectiveness.Results:The compliance rate of primary screening and intensive screening were 84.6% and 78.7%,respectively.In primary screening,the average cost for each individual was 27.2 yuan,and the average cost for identifying one high-risk individual was 180.5 yuan.The mean cost to diagnose one colorectal cancer patient was 42963.3 yuan.As for identification of adenoma,the average cost for each case was 4384.0 yuan.Based on the calculation,the average cost of reducing one colorectal cancer patient was 12768 yuan by conducting the mass-screening protocol.Conclusion:It was beneficial to do the cost-benefit analysis of colorectal cancer screening in area of high incidence.Based on the results of cost-benefit analysis,more efforts should be made to reduce the cost and to improve the efficiency of the colorectal cancer screening.展开更多
Ultra-high-dimensional data with grouping structures arise naturally in many contemporary statistical problems,such as gene-wide association studies and the multi-factor analysis-of-variance(ANOVA).To address this iss...Ultra-high-dimensional data with grouping structures arise naturally in many contemporary statistical problems,such as gene-wide association studies and the multi-factor analysis-of-variance(ANOVA).To address this issue,we proposed a group screening method to do variables selection on groups of variables in linear models.This group screening method is based on a working independence,and sure screening property is also established for our approach.To enhance the finite sample performance,a data-driven thresholding and a two-stage iterative procedure are developed.To the best of our knowledge,screening for grouped variables rarely appeared in the literature,and this method can be regarded as an important and non-trivial extension of screening for individual variables.An extensive simulation study and a real data analysis demonstrate its finite sample performance.展开更多
Celiac disease(CeD)is a chronic gluten-induced enteropathy with plethoric manifestations.The typical manifestations of CeD such as chronic diarrhea and malabsorption are widely recognized,however,many patients have at...Celiac disease(CeD)is a chronic gluten-induced enteropathy with plethoric manifestations.The typical manifestations of CeD such as chronic diarrhea and malabsorption are widely recognized,however,many patients have atypical manifestations like iron deficiency anemia,idiopathic short stature,hypertransaminesemia or infertility,etc.These patients often present to the primary care physicians and/or non-gastrointestinal specialties.However,due to a lack of awareness among the healthcare professionals about the various atypical manifestations,many patients are not screened for CeD.In this review,we have summarized the available literature about the prevalence of CeD in various gastrointestinal(chronic diarrhea)and non-gastrointestinal conditions(iron deficiency anemia,short stature,cryptogenic hypertransaminesemia,cryptogenic cirrhosis or idiopathic ataxia etc.)where the diagnosis of CeD should be considered.In addition,we also discuss special scenarios where screening for CeD should be considered even in absence of symptoms such as patients with type 1 diabetes,Down’s syndrome,and first-degree relatives of patients with CeD.Further,we discuss the diagnostic performance and limitations of various screening tests for CeD such as IgA anti-tissue transglutaminase antibodies,antiendomysial antibodies and anti-deamidated gliadin antibodies.Based on the current recommendations,we propose a diagnostic algorithm for patients with suspected CeD.展开更多
Pancreatic cancer is difficult to diagnose at an early stage and generally has a poor prognosis. Surgical resection is the only potentially curative treatment for pancreatic carcinoma. To improve the prognosis of this...Pancreatic cancer is difficult to diagnose at an early stage and generally has a poor prognosis. Surgical resection is the only potentially curative treatment for pancreatic carcinoma. To improve the prognosis of this disease, it is essential to detect tumors at early stages, when they are resectable. The optimal approach to screening for early pancreatic neoplasia has not been established. The International Cancer of the Pancreas Screening Consortium has recently finalized several recommendations regarding the management of patients who are at an increased risk of familial pancreatic cancer. In addition, there have been notable advances in research on serum markers, tissue markers, gene signatures, and genomic targets of pancreatic cancer. To date, however, no biomarkers have been established in the clinical setting. Advancements in imaging modalities touch all aspects of the clinical management of pancreatic diseases, including the early detection of pancreatic masses, their characterization, and evaluations of tumor resectability. This article reviews strategies for screening high-risk groups, biomarkers, and current advances in imaging modalities for the early detection of resectable pancreatic cancer.展开更多
基金Supported by the Project of NINGBO Leading Medical Health Discipline,No.2022-B11Ningbo Natural Science Foundation,No.202003N4206Public Welfare Foundation of Ningbo,No.2021S108.
文摘BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not optimistic.In China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been conducted.Therefore,it is necessary to develop a simple and efficient early screening model for CRC.AIM To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.METHODS Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively analyzed.The cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect data.Of 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were not.The participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve analysis.Finally,the model was validated internally using a bootstrap resampling technique.RESULTS Seven variables,including demographic,lifestyle,and family history information,were examined.Multifactorial logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P<0.001],body mass index(BMI)(OR:1.07,95%CI:1.06-1.08,P<0.001),waist circumference(WC)(OR:1.03,95%CI:1.02-1.03 P<0.001),lifestyle(OR:0.45,95%CI:0.42-0.48,P<0.001),and family history(OR:4.28,95%CI:4.04-4.54,P<0.001)were the most significant predictors of high-risk CRC.Healthy lifestyle was a protective factor,whereas family history was the most significant risk factor.The area under the curve was 0.734(95%CI:0.723-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training set ROC curve.The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.CONCLUSION The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age,BMI,WC,lifestyle,and family history exhibited high accuracy.
文摘In the last decade,several studies have explored various modalities and strategies for colorectal cancer(CRC)screening,taking into account epidemiological data,individual characteristics,and socioeconomic factors.In this editorial,we comment further on a retrospective study by Agatsuma et al published in the recent issue of the World Journal of Gastroenterology.Our focus is on screening trends,particularly in relation to efforts to improve the currently suboptimal uptake among the general population worldwide,aiming to enhance early diagnosis rates of CRC.There is a need to raise awareness through health edu-cation programs and to consider the use of readily available,non-invasive screening methods.These strategies are crucial for attracting screen-eligible populations to participate in first-line screening,especially those in high-or average-risk groups and in regions with limited resources.Liquid biopsies and biomarkers represent rapidly evolving trends in screening and diagnosis;however,their clinical relevance has yet to be standardized.
文摘Objective:The aim of our study was to estimate the cost of colorectal cancer screening and to provide evidence for the cost control of colorectal cancer screening among general population in rural area of China.Methods:We determined the net cost for colorectal cancer mass-screening in Jiashan County,and evaluated the cost-benefit and cost effectiveness.Results:The compliance rate of primary screening and intensive screening were 84.6% and 78.7%,respectively.In primary screening,the average cost for each individual was 27.2 yuan,and the average cost for identifying one high-risk individual was 180.5 yuan.The mean cost to diagnose one colorectal cancer patient was 42963.3 yuan.As for identification of adenoma,the average cost for each case was 4384.0 yuan.Based on the calculation,the average cost of reducing one colorectal cancer patient was 12768 yuan by conducting the mass-screening protocol.Conclusion:It was beneficial to do the cost-benefit analysis of colorectal cancer screening in area of high incidence.Based on the results of cost-benefit analysis,more efforts should be made to reduce the cost and to improve the efficiency of the colorectal cancer screening.
基金supported by the National Natural Science Foundation of China(CN)(11571112)the National Social Science Foundation Key Program(17ZDA091)+1 种基金Natural Science Fund of Education Department of Anhui Province(KJ2013B233)the 111 Project of China(B14019).
文摘Ultra-high-dimensional data with grouping structures arise naturally in many contemporary statistical problems,such as gene-wide association studies and the multi-factor analysis-of-variance(ANOVA).To address this issue,we proposed a group screening method to do variables selection on groups of variables in linear models.This group screening method is based on a working independence,and sure screening property is also established for our approach.To enhance the finite sample performance,a data-driven thresholding and a two-stage iterative procedure are developed.To the best of our knowledge,screening for grouped variables rarely appeared in the literature,and this method can be regarded as an important and non-trivial extension of screening for individual variables.An extensive simulation study and a real data analysis demonstrate its finite sample performance.
基金support of Department of Biotechnology,Government of India,for creation of Indian Consortium on Celiac Disease and National Celiac Disease Biorepositorysupport from Research Section of our institution for facilitating the research on Celiac disease.
文摘Celiac disease(CeD)is a chronic gluten-induced enteropathy with plethoric manifestations.The typical manifestations of CeD such as chronic diarrhea and malabsorption are widely recognized,however,many patients have atypical manifestations like iron deficiency anemia,idiopathic short stature,hypertransaminesemia or infertility,etc.These patients often present to the primary care physicians and/or non-gastrointestinal specialties.However,due to a lack of awareness among the healthcare professionals about the various atypical manifestations,many patients are not screened for CeD.In this review,we have summarized the available literature about the prevalence of CeD in various gastrointestinal(chronic diarrhea)and non-gastrointestinal conditions(iron deficiency anemia,short stature,cryptogenic hypertransaminesemia,cryptogenic cirrhosis or idiopathic ataxia etc.)where the diagnosis of CeD should be considered.In addition,we also discuss special scenarios where screening for CeD should be considered even in absence of symptoms such as patients with type 1 diabetes,Down’s syndrome,and first-degree relatives of patients with CeD.Further,we discuss the diagnostic performance and limitations of various screening tests for CeD such as IgA anti-tissue transglutaminase antibodies,antiendomysial antibodies and anti-deamidated gliadin antibodies.Based on the current recommendations,we propose a diagnostic algorithm for patients with suspected CeD.
文摘Pancreatic cancer is difficult to diagnose at an early stage and generally has a poor prognosis. Surgical resection is the only potentially curative treatment for pancreatic carcinoma. To improve the prognosis of this disease, it is essential to detect tumors at early stages, when they are resectable. The optimal approach to screening for early pancreatic neoplasia has not been established. The International Cancer of the Pancreas Screening Consortium has recently finalized several recommendations regarding the management of patients who are at an increased risk of familial pancreatic cancer. In addition, there have been notable advances in research on serum markers, tissue markers, gene signatures, and genomic targets of pancreatic cancer. To date, however, no biomarkers have been established in the clinical setting. Advancements in imaging modalities touch all aspects of the clinical management of pancreatic diseases, including the early detection of pancreatic masses, their characterization, and evaluations of tumor resectability. This article reviews strategies for screening high-risk groups, biomarkers, and current advances in imaging modalities for the early detection of resectable pancreatic cancer.
