Beneficial effects of endoscopic screening on gastric cancer and its optimal screening interval: a population-based study

Background and study aims: The effectiveness of endoscopic screening on gastric cancer (GC) is less investigated and screening interval of repeated screening is yet to be optimized in China. Patients and methods: In a population-based prospective study, we included 375,800 subjects based on the Upper Gastrointestinal Cancer Early Detection Program in Linqu, a GC high-risk area in China, 14,670 of which underwent endoscopic screening(2012-2018). We assessed the associations of the risk of incident GC and GC-specific deaths with endoscopic screening and examined the changes in overall survival (OS) and disease-specific survival (DSS) of GCs by endoscopic screening. The optimal screening interval of repeated endoscopy for early detection of GC was explored. Results: Ever receiving endoscopic screening significantly decreased the risk of invasive GC(age and sex-adjusted RR=0.69, 95%CI:0.52-0.92) and GC-specific deaths(RR=0.33, 95%CI: 0.20-0.56), particularly for non-cardia GC. Repeated screening strengthened the beneficial effect on invasive GC-specific deaths by one-time screening. Among invasive GCs, screening-detected cases had significantly better OS(RR=0.18, 95%CI: 0.13-0.25) and DSS(RR=0.18, 95%CI: 0.13-0.25) than cases in the unscreened group, particularly for those receiving repeated endoscopy. For individuals with intestinal metaplasia or low-grade intraepithelial neoplasia, repeated endoscopy at an interval of less than two years, particularly within one year, significantly enhanced the detection of early GC, compared with repeated screening after two years(P-trend=0.02). Conclusion: Endoscopic screening prevented GC occurrence and death and improved its prognosis in a population-based study. Repeated endoscopy enhanced the effectiveness, for which screening interval needs to be defined in conformity with the severity of gastric lesions.

Evaluation of Repeated Web-Based Screening for Predicting Postpartum Depression: Prospective Cohort Study

Background Postpartum depression (PPD) is a severe mental disorder that often results in poor maternal-infant attachment and negatively impacts infant development. Universal screening has recently been recommended to identify women at risk, but the optimal screening time during pregnancy has not been defined so far. Thus, web-based technologies with widespread use among women of childbearing age create new opportunities to detect pregnancies with a high risk for adverse mental health outcomes at an early stage. Objective The aim of this study was to stratify the risk for PPD and to determine the optimal screening time during pregnancy by using a web-based screening tool collecting electronic patient-reported outcomes (ePROs) as the basis for a screening algorithm. Methods In total, 214 women were repeatedly tested for depressive symptoms 5 times during and 3 times after pregnancy by using the Edinburgh Postnatal Depression Scale (EPDS), accessible on a web-based pregnancy platform, developed by the authors of this study. For each prenatal assessment, the area under the curve (AUC), sensitivity, specificity, and predictive values for PPD were calculated. Multivariate logistic regression analyses were applied to identify further potential predictors, such as age, education, parity, relationship quality, and anxiety, to increase predictive accuracy. Results Digitally collected data from 214 pregnant women were analyzed. The predictive accuracy of depressive symptoms 3 and 6 months postpartum was reasonable to good regarding the screening in the second (AUC=0.85) and third (AUC=0.75) trimester. The multivariate logistic regression analyses resulted in an excellent AUC of 0.93 at 3 months and a good AUC of 0.87 at 6 months postpartum. Conclusions The best predictive accuracy for PPD has been shown for screening between the 24th and the 28th gestational week (GW) and seems to be beneficial for identifying women at risk. In combination with the aforementioned predictive factors, the discriminatory power improved, particularly at 3 months postpartum. Screening for depression during pregnancy, combined with the women’s personal risk profile, can be used as a starting point for developing a digital screening algorithm. Thereby, web-based assessment tools constitute feasible, efficient, and cost-effective approaches. Thus, they seem to be beneficial in detecting high-risk pregnancies in order to improve maternal and infant birth outcomes in the long term.

Evaluation of the Psychometric Properties of the Chinese Internet Gaming Disorder Checklist (C-IGDC) Among Chinese Adolescents

As the first DSM-5 based, multidimensional screening tool of Internet gaming disorder (IGD) designed for Chinese gamers, the Chinese Internet Gaming Disorder Checklist (C-IGDC) has shown satisfactory psychometric properties among Chinese young adults. Given the high vulnerability to IGD among adolescents, the present study aimed to examine the applicability of C-IGDC to Chinese adolescents to address shortfalls in the existing literature regarding the assessment of adolescent IGD screening. Through a two-stage sampling method in a cross-sectional survey, we obtained a sample of 1,253 Chinese past-year adolescent gamers (43.8% female; Mage = 14.49 years, SDage = 1.60 years) from local junior or senior high schools in Macao, China for data analysis. Our results confirmed a good model fit of the original two-level, nine-subfactor structure of the 27-item C-IGDC, and indicated adequate internal consistency and test–retest reliability, as well as good concurrent validity as evidenced by expected associations with IGD functioning impairments, gameplay characteristics, and depressive symptoms. An optimal screening cutoff score (≥20) was proposed to identify probable disordered gamers among Chinese adolescents with past-year gaming experience. The findings support the extended use of C-IGDC to Chinese adolescents as a reliable and valid assessment tool for evaluating IGD severity levels and screening for probable IGD cases. Its use can facilitate a proper screening procedure for probable IGD cases in both school and clinical settings.

Potential Contributors to Increased Pulmonary Embolism Hospitalizations During the COVID-19 Pandemic: Insights From the German-Wide Helios Hospital Network

Background: After the first COVID-19 infection wave, a constant increase of pulmonary embolism (PE) hospitalizations not linked with active PCR-confirmed COVID-19 was observed, but potential contributors to this observation are unclear. Therefore, we analyzed associations between changes in PE hospitalizations and (1) the incidence of non-COVID-19 pneumonia, (2) the use of computed tomography pulmonary angiography (CTPA), (3) volume depletion, and (4) preceding COVID-19 infection numbers in Germany.Methods: Claims data of Helios hospitals in Germany were used, and consecutive cases with a hospital admission between May 6 and December 15, 2020 (PE surplus period), were analyzed and compared to corresponding periods covering the same weeks in 2016–2019 (control period). We analyzed the number of PE cases in the target period with multivariable Poisson general linear mixed models (GLMM) including (a) cohorts of 2020 versus 2016–2019, (b) the number of cases with pneumonia, (c) CTPA, and (d) volume depletion and adjusted for age and sex. In order to associate the daily number of PE cases in 2020 with the number of preceding SARS-CoV-2 infections in Germany, we calculated the average number of daily infections (divided by 10,000) occurring between 14 up to 90 days with increasing window sizes before PE cases and modeled the data with Poisson regression.Results: There were 2,404 PE hospitalizations between May 6 and December 15, 2020, as opposed to 2,112–2,236 (total 8,717) in the corresponding 2016–2019 control periods (crude rate ratio [CRR] 1.10, 95% CI 1.05–1.15, P < 0.01). With the use of multivariable Poisson GLMM adjusted for age, sex, and volume depletion, PE cases were significantly associated with the number of cases with pneumonia (CRR 1.09, 95% CI 1.07–1.10, P < 0.01) and with CTPA (CRR 1.10, 95% CI 1.09–1.10, P < 0.01). The increase of PE cases in 2020 compared with the control period remained significant (CRR 1.07, 95% CI 1.02–1.12, P < 0.01) when controlling for those factors. In the 2020 cohort, the number of preceding average daily COVID-19 infections was associated with increased PE case incidence in all investigated windows, i.e., including preceding infections from 14 to 90 days. The best model (log likelihood −576) was with a window size of 4 days, i.e., average COVID-19 infections 14–17 days before PE hospitalization had a risk of 1.20 (95% CI 1.12–1.29, P < 0.01).Conclusions: There is an increase in PE cases since early May 2020 compared to corresponding periods in 2016–2019. This surplus was significant even when controlling for changes in potential modulators such as demographics, volume depletion, non-COVID-19 pneumonia, CTPA use, and preceding COVID-19 infections. Future studies are needed (1) to investigate a potential causal link for increased risk of delayed PE with preceding SARS-CoV-2 infection and (2) to define optimal screening for SARS-CoV-2 in patients presenting with pneumonia and PE.

SARS-CoV-2 screening: effectiveness and risk of increasing transmission

Testing asymptomatic people for SARS-CoV-2 aims to reduce COVID-19 transmission. Screening programmes’ effectiveness depends upon testing strategy, sample handling logistics, test sensitivity and individual behaviour, in addition to dynamics of viral transmission. The interaction between these factors is not fully characterized. We investigated the interaction between these factors to determine how to optimize reduction of transmission. We estimate that under idealistic assumptions 70% of transmission may be averted, but under realistic assumptions only 7% may be averted. We show that programmes that overwhelm laboratory capacity or reduce isolation of those with minor symptoms have increased transmission compared with those that do not: programmes need to be designed to avoid these issues, or they will be ineffective or even counter-productive. Our model allows optimal selection of whom to test, quantifies the balance between accuracy and timeliness, and quantifies potential impacts of behavioural interventions. We anticipate our model can be used to understand optimal screening strategies for other infectious diseases with substantially different dynamics.

The Preoperative Diagnostic Value of MRI and Otoneural Tests in Acoustic Neuroma

ObjectivesTo determine the preoperative diagnostic accuracy of MRI and otoneural tests (ONT) for acoustic neuroma (AN) in a cohort of unselected patients with pontocerebellar angle tumors. To find a convenient way to screening out the potential asymptomatic AN patient earlier.DesignThis diagnostic accuracy study was performed in a central hospital and included a consecutive sample of unilateral incipient pontocerebellar angle tumor patients referred for MRI and ONT before surgery. Different AN features of MRI and ONT were collected and concluded into preoperative diagnostic variables or variable combinations. Those of MRI and ONT are analyzed and compared with biopsy results by multivariable receiver operating characteristic (ROC) analysis. The early-stage group, the course of which is 1 year or less, was separately computed and compared.ResultsEighty-three subjects were collected from June 2013 to June 2019; 62 were confirmed AN postoperatively by biopsy, whereas others are not AN. The area under the curve (AUC) of MRI was 0.611, whereas the AUC of ONT was 0.708. In the early-stage group, the AUC of MRI was 0.539, and the AUC of ONT was 0.744.ConclusionsONT was able to identify more subjects affected by unilateral incipient AN than MRI preoperatively. Given that ONT is a functional test for internal auditory canal nerves, it is an optimal screening test for AN patients because it provides more information than MRI for the further clinical plan. It is particularly noteworthy for identifying asymptomatic AN patients and for early stage. Therefore, it may help more patients from unnessesary surgery. Furthermore, an MRI follow-up is suggested if the patient was found alert in ONT.

Late relapse of germ cell tumors: Detection and treatment outcomes.

5007 Background: Late relapse (LR) of germ cell tumors (GCT) is defined as relapsed disease > 2 years from initial treatment. LR remains a challenge both for optimal screening methods and treatment. We report the method of detection, treatments received, and outcomes in patients with LR GCT. Methods: The prospectively maintained Indiana University testicular cancer database was queried identifying 2712 pts with GCT treated at Indiana University from January 2000 to January 2019. Method of detection of LR was recorded along with site, treatment received, chemo-naive vs chemo-exposed LR, and survival outcomes. Results: 90 pts with LR were identified. Median age at LR was 35.2 yr (range, 19.2-56.8). Primary tumor site was testis in 88 (98%), retroperitoneum in 1 (1%), and mediastinum in 1 (1%). Chemo-exposed accounted for 42 (47%) and chemo-naïve for 48 (53%) of cases. Table compares clinical characteristics and survival outcomes of chemo-exposed vs. chemo-naïve late relapse. 62% of chemo-exposed LR were diagnosed with elevated AFP. For the 42 chemo-exposed LR pts, 2-yr PFS based on treatment: surgery vs. chemo vs surgery+chemo was 48% vs 10% vs 45% (p = 0.105). For the 48 chemo-naïve LR pts, 2-yr PFS based on treatment: surgery vs. chemo vs. surgery+chemo was 100% vs 74% vs 37% (p = 0.004). Next generation sequencing was available for 9 patients. No actionable findings were found. Tumor mutational burden was low in all patients where genomic testing was available. Conclusions: Most pts with chemo-exposed LR will be diagnosed with an elevated AFP. GCT pts require lifetime follow-up with annual physical exam and tumor markers. Surgical resection, when feasible, remains our preferred treatment for chemo-exposed LR as chemotherapy alone offers only brief responses. Pts with chemo-naïve LR have more chemo-sensitive biology.[Table: see text]