P-NiFe2O4/N-doped carbon nanotubes/NiFe multi-phase heterojunctions for overall water splitting and urea electrolysis.

The design and construction of highly efficient electrocatalysts for overall water splitting and urea electrolysis are significantly important for promoting energy conversion and realizing green hydrogen production. In this work, we constructed a multi-phase heterojunction through a simple hydrothermal and phosphorization process. The P-doped NiFe2O4 (P-NiFe2O4) nanoparticles were uniformly anchored on the bamboo-like N-doped carbon nanotubes (NCNTs) grown via a NiFe-alloy autocatalysis. The electronic structure and coordination environment of active species were optimized by the synergistic action of P doping, well-dispersed ultrafine NiFe2O4, and NCNTs matrix with good conductivity, enhancing their quantity and activity for electrocatalysis. Consequently, the P-NiFe2O4/NCNTs/NiFe exhibits excellent HER and OER activities with an overpotential of 111 and 266 mV at 10 mA cm-2 in 1 M KOH, respectively. The symmetrical overall water-splitting cell using P-NiFe2O4/NCNTs/NiFe as both anode and cathode delivers 10 mA cm-2 at a voltage of 1.604 V in 1 M KOH. Notably, the two-electrode cell requires a low voltage of 1.467 V to achieve a current density of 10 mA cm-2 in 1 M KOH solution with 0.6 M urea. This designed catalysts display outstanding reaction kinetics and catalytic stability. This work provides useful guidance for applying transition metal-based catalysts for hydrogen production.

Wide Response Range Photoelectrochemical UV Detector Based on Anodized TiO2-Nanotubes@Ti@quartz Structure.

Conventional sandwich structure photoelectrochemical UV detectors cannot detect UV light below 300 nm due to UV filtering problems. In this work, we propose to place the electron collector inside the active material, thus avoiding the effect of electrodes on light absorption. We obtained a TiO2-nanotubes@Ti@quartz photoanode structure by precise treatment of a commercial Ti mesh by anodic oxidation. The structure can absorb any light in the near-UV band and has superior stability to other metal electrodes. The final encapsulated photoelectrochemical UV detectors exhibit good switching characteristics with a response time below 100 ms. The mechanism of the oxidation conditions on the photovoltaic performance of the device was investigated by the electrochemical impedance method, and we obtained the optimal synthesis conditions. Response tests under continuous spectroscopy confirm that the response range of the device is extended from 300-400 nm to 240-400 nm. This idea of a built-in collector is an effective way to extend the response range of a photoelectrochemical detector.

Synthesis of Carboranylated Dihydropyrrolo[1,2-a]quinoxalines and Dihydroindolo[1,2-a]quinoxalines by BF3·OEt2-Catalyzed Heterocyclization of C-Formyl-o-carboranes and Investigation of Their Oxidation Stability.

A BF3·OEt2-catalyzed synthesis of carboranylated dihydropyrrolo[1,2-a]quinoxalines and dihydroindolo[1,2-a]quinoxalines in 30-99% yields is presented through the heterocyclization of various C-modified C-formyl-o-carboranes with 1-(2-aminophenyl)-pyrroles/indoles. A systematic comparative investigation of their oxidation stability in air confirmed that 4-carboranyl-4,5-dihydropyrrolo[1,2-a]quinoxaline had better stability than the 4-phenyl analogue. A cage-deboronation reaction for N-acetyl-substituted carboranylated dihydropyrrolo[1,2-a]quinoxaline produced the corresponding 7,8-nido-carborane cesium salt. A kinetic resolution was also realized to obtain an optically pure carboranylated N-heterocycle scaffold bearing a carborane cage carbon-bonded chiral stereocenter.

Enantioselective Synthesis of Biphenyl-Bridged ϵ-Sultams by Organocatalytic Mannich Reactions of Cyclic N-Sulfonylimines with Unactivated Ketones.

A highly enantioselective Mannich reaction of biphenyl-bridged seven-membered cyclic N-sulfonylimines with methyl alkyl ketones is disclosed in this study. The reaction was performed under organocatalysis by using a quinine-derived primary amine as the catalyst in combination with a Brønsted acid as the co-catalyst. High yields (up to 89 %) and excellent enantioselectivities (up to 97 % ee) were observed. For methyl alkyl ketones containing a larger alkyl substituent, specific regioselective addition to the C=N bond is favored at the methyl group. On the contrary, ketones containing a smaller alkyl substituent or hydroxyacetone substrates gave major syn selective Mannich products at the methylene group.

Development and evaluation of a risk assessment tool for the personalized screening of breast cancer in Chinese populations: A prospective cohort study.

INTRODUCTION: Breast cancer is a significant contributor to female mortality, exerting a public health burden worldwide, especially in China, where risk-prediction models with good discriminating accuracy for breast cancer are still scarce. METHODS: A multicenter screening cohort study was conducted as part of the Cancer Screening Program in Urban China. Dwellers aged 40-74 years were recruited between 2014 and 2019 and prospectively followed up until June 30, 2021. The entire data set was divided by year of enrollment to develop a prediction model and validate it internally. Multivariate Cox regression was used to ascertain predictors and develop a risk-prediction model. Model performance at 1, 3, and 5 years was evaluated using the area under the curve, nomogram, and calibration curves and subsequently validated internally. The prediction model incorporates selected factors that are assigned appropriate weights to establish a risk-scoring algorithm. Guided by the risk score, participants were categorized into low-, medium-, and high-risk groups for breast cancer. The cutoff values were chosen using X-tile plots. Sensitivity analysis was conducted by categorizing breast cancer risk into the low- and high-risk groups. A decision curve analysis was used to assess the clinical utility of the model. RESULTS: Of the 70,520 women enrolled, 447 were diagnosed with breast cancer (median follow-up, 6.43 [interquartile range, 3.99-7.12] years). The final prediction model included age and education level (high, hazard ratio [HR], 2.01 [95% CI, 1.31-3.09]), menopausal age (≥50 years, 1.34 [1.03-1.75]), previous benign breast disease (1.42 [1.09-1.83]), and reproductive surgery (1.28 [0.97-1.69]). The 1-year area under the curve was 0.607 in the development set and 0.643 in the validation set. Moderate predictive discrimination and satisfactory calibration were observed for the validation set. The risk predictions demonstrated statistically significant differences between the low-, medium-, and high-risk groups (p < .001). Compared with the low-risk group, women in the high- and medium-risk groups posed a 2.17-fold and 1.62-fold elevated risk of breast cancer, respectively. Similar results were obtained in the sensitivity analyses. A web-based calculator was developed to estimate risk stratification for women. CONCLUSIONS: This study developed and internally validated a risk-adapted and user-friendly risk-prediction model by incorporating easily accessible variables and female factors. The personalized model demonstrated reliable calibration and moderate discriminative ability. Risk-stratified screening strategies contribute to precisely distinguishing high-risk individuals from asymptomatic individuals and prioritizing breast cancer screening. PLAIN LANGUAGE SUMMARY: Breast cancer remains a burden in China. To enhance breast cancer screening, we need to incorporate population stratification in screening. Accurate risk-prediction models for breast cancer remain scarce in China. We established and validated a risk-adapted and user-friendly risk-prediction model by incorporating routinely available variables along with female factors. Using this risk-stratified model helps accurately identify high-risk individuals, which is of significant importance when considering integrating individual risk assessments into mass screening programs for breast cancer. Current clinical breast cancer screening lacks a constructive clinical pathway and guiding recommendations. Our findings can better guide clinicians and health care providers.

Event-triggered distributed secure state estimation for homologous sensor attacks.

Network security technology is capable of mitigating attack signals launched by malicious attackers, thereby safeguarding and bolstering system security. Secure state estimation is a type of network defense technology that involves reconstructing the system state by measuring potential attacks. The relevant research has also been expanded to distributed systems to enable collaborative secure state estimation among different agents facing homogeneous attacks; however, such research significantly enhance the communication load of the system. On the other hand, if the homogeneous attack is non-existent or consistent, excessive network communication is definitely inefficient. An event-triggered approach is a potent technique that can alleviate communication overhead while having minimal impact on system performance. This paper proposes a mechanism for event-triggered transmission in the context of distributed secure state estimation. While communication latency and data transmission disorder may be present within the communication network, the estimation error of the proposed observer is constrained and bounded. The simulation results indicate that for stable malicious attack signals, system communication can be divided into high-frequency and low-frequency communication periods. The simulation results also shows that the maximum estimation error is proportional to the trigger threshold, allowing the observer's performance to be finely tuned to the required precision.

Photoelectrochemical UV Detector Based on High-Temperature Resistant ITO Nanowire Network Transparent Conductive Electrodes: Both the Response Range and Responsivity Are Improved.

UV transparent conductive electrodes based on transferable ITO nanowire networks were prepared to solve the problem of low UV light utilization in conventional photoelectrochemical UV detectors. The mutually cross-linked ITO nanowire network achieved good electrical conductivity and light transmission, and the novel electrode had a transmission rate of more than 80% throughout the near-UV and visible regions. Compared to Ag nanowire electrodes with similar functionality, the chemical stability of the ITO nanowire transparent conductive electrode ensured that the device worked stably in iodine-based electrolytes. More importantly, ITO electrodes composed of oxides could withstand temperatures above 800 °C, which is extremely critical for photoelectrochemical devices. After the deposition of a TiO2 active layer using the high-temperature method, the response range of the photoelectrochemical UV detector was extended from a peak-like response between 300-400 nm to a plateau-like response between 200-400 nm. The responsivity was significantly increased to 56.1 mA/W. The relationship between ITO nanowire properties and device performance, as well as the reasons for device performance enhancement, were intensively investigated.

Autocorrelation Feature Analysis for Dynamic Process Monitoring of Thermal Power Plants.

Accurate process monitoring plays a crucial role in thermal power plants since it constitutes large-scale industrial equipment and its production safety is of great significance. Therefore, accurate process monitoring is very important for thermal power plants. The vigorous nature of the production process requires dynamic algorithms for monitoring. Since the common dynamic algorithm is mainly based on data expansion, the online computing complexity is too high because of data redundancy. Accordingly, this article proposes an innovative, dynamic process monitoring algorithm called autocorrelation feature analysis (AFA). AFA mines the dynamic information of continuous samples by calculating the correlation between the current time and past time features. While improving the monitoring effect, the AFA algorithm also has extremely low online computational complexity, even lower than common static algorithms, such as principal component analysis. Furthermore, this study exhibits the general form of dynamic additive faults for the first time and verifies the reliability of the algorithm through fault detectability analysis. Conclusively, the superiority of the AFA algorithm is verified on a numerical example, continuous stirred tank reactor (CSTR), and real data measured from a 1000-MW ultrasupercritical thermal power plant.

Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study.

BACKGROUND: Low-dose computed tomography (LDCT) screening is effective in reducing lung cancer mortality in smokers; however, the evidence in nonsmokers is scarce. OBJECTIVE: This study aimed to evaluate the participant rate and effectiveness of one-off LDCT screening for lung cancer among smokers and nonsmokers. METHODS: A population-based prospective cohort study was performed to enroll participants aged between 40 and 74 years from 2013 to 2019 from 4 cities in Zhejiang Province, China. Participants who were evaluated as having a high risk of lung cancer from an established risk score model were recommended to undergo LDCT screening. Follow-up outcomes were retrieved on June 30, 2020. The uptake rate of LDCT screening for evaluated high-risk participants and the detection rate of early-stage lung cancer (stage 0-I) were calculated. The lung cancer incidence, lung cancer mortality, and all-cause mortality were compared between the screened and nonscreened groups. RESULTS: At baseline, 62.56% (18,818/30,079) of smokers and 6% (5483/91,455) of nonsmokers were identified as high risk (P<.001), of whom 41.9% (7885/18,818) and 66.31% (3636/5483) underwent LDCT screening (P<.001), respectively. After a median follow-up of 5.1 years, 1100 lung cancer cases and 456 all-cause death cases (116 lung cancer death cases) were traced. The proportion of early-stage lung cancer among smokers was 60.3% (173/287), which was lower than the proportion of 80.3% (476/593) among nonsmokers (P<.001). Among smokers, a higher proportion was found in the screened group (72/106, 67.9%) than the nonscreened group (56/114, 49.1%; P=.005), whereas no significance was found (42/44, 96% vs 10/12, 83%; P=.20) among nonsmokers. Compared with participants who were not screened, LDCT screening in smokers significantly increased lung cancer incidence (hazard ratio [HR] 1.39, 95% CI 1.09-1.76; P=.007) but reduced lung cancer mortality (HR 0.52, 95% CI 0.28-0.96; P=.04) and all-cause mortality (HR 0.47, 95% CI 0.32-0.69; P<.001). Among nonsmokers, no significant results were found for lung cancer incidence (P=.06), all-cause mortality (P=.89), and lung cancer mortality (P=.17). CONCLUSIONS: LDCT screening effectively reduces lung cancer and all-cause mortality among high-risk smokers. Further efforts to define high-risk populations and explore adequate lung cancer screening modalities for nonsmokers are needed.

Catalytic asymmetric synthesis of carboranylated diols bearing two adjacent stereocenters located at the α,ß-position of o-carborane cage carbon.

Despite the great interest in carborane-containing molecules, there is a lack of literature on the generation of central chiralities, via catalytic asymmetric transformations using prochiral carboranyl substrates. Herein, we have synthesized novel optically active icosahedral carborane-containing diols via Sharpless catalytic asymmetric dihydroxylation of carborane-derived alkenes, under mild conditions. The reaction showed a good substrate scope with 74-94% yields and 92->99% ee. This synthetic approach facilitated the creation of two adjacent stereocenters respectively located at the α,ß-position of o-carborane cage carbon, with a single syn-diastereoisomer. In addition, the obtained chiral carborane-containing diol product can be transformed to cyclic sulfate and can subsequently undergo a nucleophilic substitution and reduction to obtain the unexpected nido-carboranyl derivatives of chiral amino alcohols in the form of zwitterions.

High Temperature-Resistant Transparent Conductive Films for Photoelectrochemical Devices Based on W/Ag Composite Nanonetworks.

The traditional Ag nanowire preparation means that it cannot meet the demanding requirements of photoelectrochemical devices due to the undesirable conductivity, difficulty in compounding, and poor heat resistance. Here, we prepared an Ag nanonetwork with superior properties using a special template method based on electrospinning technology. The transparent conductive films based on Ag nanonetworks have good transmittance in a wide range from ultraviolet to visible. It is important that the films have high operability and are easy to be compounded with other materials. After compounding with high-melting-point W metal, the heat-resistance temperature of the W/Ag composite transparent conductive films is increased by 100 °C to 460 °C, and the light transmission and electrical conductivity of the films are not significantly affected. All experimental phenomena in the study are analyzed theoretically. This research can provide an important idea for the metal nanowire electrode, which is difficult to be applied to the photoelectrochemical devices.

Anti-windup ADRC design for temperature control systems with output delay against asymmetric input constraint.

To tackle the asymmetric input constraint typically involved with industrial temperature control systems, e.g., there is a tuning range from 0 to 100% in the heating power, an anti-windup active disturbance rejection control (ADRC) is proposed for the practical application, in particular for dealing with output delay. Based on an artificial symmetric transformation for the asymmetric input constraint along with a delay-free output prediction, an anti-windup extended state observer (AESO) is firstly constructed to simultaneously estimate the delay-free system state and external disturbance for control design. When the input saturation constraint occurs, the proposed AESO could also offer anti-windup compensation. Then, a feedback controller is analytically derived by assigning repetitive-type poles for the characteristic equation of the closed-loop structure, followed by a set-point prefilter design to ensure no overshoot and output tracking deviation. Tractable linear matrix inequality based conditions are rigorously established to guarantee the asymptotic stability of the resulting closed-loop system under a specified initial condition. A benchmark example from a recent reference is used to verify the superiority of the proposed control method over some existing anti-windup control designs. Moreover, a real application to the temperature control of a jacketed crystallizer is shown in comparison with a recently developed control method with no anti-windup compensation.

Membership-function-dependent dynamic output feedback H∞ controller design of continuous-time T-S fuzzy systems via non-quadratic Lyapunov function.

The dynamic output feedback H∞ (DOFH) control under imperfect premise matching (IPM) is studied in this paper for continuous-time Takagi-Sugeno (T-S) fuzzy systems. Different from the existing results, the DOFH switching controller, which enjoys membership functions (MFs) distinct from the fuzzy systems, is designed. First, the non-quadratic Lyapunov function (NQLF) based on MFs is utilized to design the controller. The time derivatives of MFs are addressed by the switching strategy. Second, a method based on linear matrix inequality (LMI) is given to make the controller gains solvable. Third, an improved method is developed to incorporate the more boundary information of MFs into the stability conditions to reduce conservatism. Finally, three examples are used to certify the advantage of the approach.

Correction: Cost-Effectiveness of Lung Cancer Screening Using Low-Dose Computed Tomography Based on Start Age and Interval in China: Modeling Study.

[This corrects the article DOI: 10.2196/36425.].

Chiral Chalcogenide-Catalyzed Enantioselective Electrophilic Hydrothiolation of Alkenes.

A new strategy for the construction of chiral sulfides by catalytic enantioselective hydrothiolation of alkenes via an electrophilic pathway has been developed. Using this strategy, cyclic and acyclic unactivated alkenes efficiently afforded various chiral products in the presence of electrophilic sulfur reagents and silanes through chiral chalcogenide catalysis. The obtained products were easily transformed into other types of valuable chiral sulfur-containing compounds. Mechanistic studies revealed that the superior construction of chiral thiiranium ion intermediate is the key to achieving such a transformation.

Cost-Effectiveness of Lung Cancer Screening Using Low-Dose Computed Tomography Based on Start Age and Interval in China: Modeling Study.

BACKGROUND: Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death in China. The effectiveness of screening for lung cancer has been reported to reduce lung cancer-specific and overall mortality, although the cost-effectiveness, optimal start age, and screening interval remain unclear. OBJECTIVE: This study aimed to assess the cost-effectiveness of lung cancer screening among heavy smokers in China by incorporating start age and screening interval. METHODS: A Markov state-transition model was used to assess the cost-effectiveness of a lung cancer screening program in China. The evaluated screening strategies were based on a screening start age of 50-74 years and a screening interval of once or annually. Transition probabilities were obtained from the literature and validated, while cost parameters were derived from databases of local medical insurance bureaus. A societal perspective was adopted. The outputs of the model included costs, quality-adjusted life years (QALYs), and lung cancer-specific mortality, with future costs and outcomes discounted by 5%. A currency exchange rate of 1 CNY=0.1557 USD is applicable. The incremental cost-effectiveness ratio (ICER) was calculated for different screening strategies relative to nonscreening. RESULTS: The proposed model suggested that screening led to a gain of 0.001-0.042 QALYs per person as compared with the findings in the nonscreening cohort. Meanwhile, one-time and annual screenings were associated with reductions in lung cancer-related mortality of 0.004%-1.171% and 6.189%-15.819%, respectively. The ICER ranged from 119,974.08 to 614,167.75 CNY per QALY gained relative to nonscreening. Using the World Health Organization threshold of 212,676 CNY per QALY gained, annual screening from a start age of 55 years and one-time screening from the age of 65 years can be considered as cost-effective in China. Deterministic and probabilistic sensitivity analyses were conducted. CONCLUSIONS: This economic evaluation revealed that a population-based lung cancer screening program in China for heavy smokers using low-dose computed tomography was cost-effective for annual screening of smokers aged 55-74 years and one-time screening of those aged 65-74 years. Moreover, annual lung cancer screening should be promoted in China to realize the benefits of a guideline-recommended screening program.

Using Period Analysis to Timely Assess and Predict 5-Year Relative Survival for Liver Cancer Patients From Taizhou, Eastern China.

Introduction: While timely assessment of long-term survival for patients with liver cancer is essential for the evaluation of early detection and screening programs of liver cancer, those data are extremely scarce in China. We aimed to timely and accurately assess long-term survival for liver cancer patients in eastern China. Methods: Patients diagnosed with liver cancer during 2004-2018 from four cancer registries with high-quality data from Taizhou, eastern China, were included. The period analysis was used to calculate the 5-year relative survival (RS) for overall and the stratification by sex, age at diagnosis, and region. The projected 5-year RS of liver cancer patients during 2019-2023 was also assessed using a model-based period analysis. Results: The overall 5-year RS for patients with liver cancer during 2014-2018 reached 32.4%, being 29.3% for men and 36.1% for women. The 5-year RS declined along with aging, decreasing from 38.2% for age <45 years to 18.8% for age >74 years, while the 5-year RS for urban area was higher compared to rural area (36.8% vs. 29.3%). The projected overall 5-year RS of liver cancer patients could reach 41.4% during the upcoming period 2019-2023. Conclusions: We provided, for first time in China using the period analysis, the most up-to-date 5-year RS for patients with liver cancer from Taizhou, eastern China, and also found that the 5-year RS for liver cancer patients have improved greatly during 2004-2018, which has important implications for the timely evaluation of early detection and screening programs for patients with liver cancer in eastern China.

Cost-effectiveness of Low-Dose Computed Tomography With a Plasma-Based Biomarker for Lung Cancer Screening in China.

Importance: China, which has one-third of the worldwide smoking population, has a substantial cancer burden, with lung cancer being the leading cause of cancer-related death. The effectiveness of lung cancer screening for mortality reduction has been confirmed, but the cost-effectiveness of diverse screening modalities remains unclear. Objective: To compare the cost-effectiveness of low-dose computed tomography (LDCT) with a biomarker (micro-RNA signature classifier [MSC]) with that of LDCT alone by screening interval and cumulative smoking exposure. Design, Setting, and Participants: In this economic evaluation, a comparative cost-effectiveness analysis used Markov state transition models that simulated the 1947 to 1971 China birth cohort. Simulated individuals in 8 cohorts of 10 000 entered the study between ages 50 and 74 years and were followed up until death or age 79 years, corresponding to a study period from January 1, 2021, to December 31, 2050. The model was run with a cycle length of 1 year. All the transition probabilities were validated, and health utility values were extracted from published literature. Cost parameters were derived from the databases of local medical insurance bureaus. Main Outcomes and Measures: Primary outcomes included life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) with future costs and outcomes discounted by 5%. Screening strategies with a mean ICER less than Chinese yuan (CNY) 212 676 per QALY gained were deemed to be cost-effective. The cost-effectiveness of 7 alternative screening strategies with a screening starting age of 50 years, minimum cumulative smoking exposure of 20 vs 30 pack-years, and screening interval of annual vs 1 time was estimated, including the 2021 China guideline-recommended strategy (LDCT, annual, 30 pack-years) and the 2018 China guideline-recommended strategy (LDCT, annual, 20 pack-years). Results: In a simulated population of 80 000 individuals, the conjunctive LDCT and MSC screening strategy was estimated to obtain an ICER of CNY -793 995.17 to 254 417.46 (minimum cumulative smoking exposure, 20-30 pack-years) per QALY gained compared with LDCT screening alone. China's 2021 guideline-recommended strategy was not cost-effective compared with the 2018 guideline-recommended strategy, with higher costs and fewer QALYs gained; the QALY loss ranged from 0.02 to 0.15 per person and the increase in cost ranged from CNY 945.89 to CNY 5131.29 per person. LDCT and MSC screening beginning at age 70 to 74 years in individuals with a 20 pack-year smoking history was the most cost-effective strategy, with an ICER of CNY -793 995.17 per QALY gained. Lowering the minimum cumulative smoking exposure for screening from 30 to 20 pack-years and maintaining annual screening were associated with greater cost savings regardless of the screening tool. Conclusions and Relevance: This economic evaluation found that China's 2018 recommendation for lung cancer screening was more cost-effective than the 2021 recommendation. Moreover, the cost-effectiveness of lung cancer screening was improved when MSC was included with LDCT. These findings may be useful for the modification of guidelines for lung cancer screening.

One-sample quantitative and two-sample qualitative faecal immunochemical tests for colorectal cancer screening: a cross-sectional study in China.

OBJECTIVES: Quantitative faecal immunochemical tests (FITs) are widely used for colorectal cancer (CRC) screening in the Western countries, whereas qualitative FITs are preferred in China. The present study aimed to compare the screening yield between one-sample quantitative FIT and two-sample qualitative FIT for CRC screening. DESIGN: A cross-sectional study. SETTING: A population-based CRC screening programme was conducted in 28 communities in Haining City, Zhejiang Province, China. PARTICIPANTS: Consecutive participants aged 40-74 years were invited to undergo the CRC screening programme. Two-sample qualitative FITs were offered between January 2019 and December 2019, and one-sample quantitative FIT was offered between August 2019 and February 2020. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were detection rates of advanced neoplasms, including CRCs and advanced adenomas. Secondary outcomes were positivity rates and colonoscopy resource demand for the two FITs. The positivity thresholds were 20 µg and 1-5 µg haemoglobin per gram of faeces for the quantitative and qualitative FITs, respectively. RESULTS: A total of 19 131 and 28 804 invitees were assigned to the two-sample qualitative and one-sample quantitative groups, respectively. Positivity rates were 14.2% for the two-sample qualitative FIT and 5.4% for the one-sample quantitative FIT. Detection rates of advanced colorectal neoplasms at colonoscopy using one-sample quantitative FIT and two-sample qualitative FIT were 17.6% (95% CI: 14.6% to 20.6%) and 10.5% (95% CI: 8.7% to 12.4%), respectively. Both detection rates of cancer and advanced adenoma were higher in the one-sample quantitative FIT group than those in the two-sample qualitative FIT group. Moreover, one-sample quantitative FIT significantly reduced the colonoscopy load for detection of one advanced neoplasm case (5, 95% CI: 5 to 7) than the two-sample qualitative FIT (10, 95% CI: 8 to 11). CONCLUSIONS: The one-sample quantitative FIT for CRC screening increases the detection rate of advanced neoplasia and reduces the colonoscopy workload compared with the two-sample qualitative FIT.

Cost-effectiveness of risk-tailored screening strategy for colorectal cancer: A systematic review.

BACKGROUND AND AIM: Though one-size-fits-all age-based screening for colorectal cancer (CRC) is effective in reducing the incidence and mortality, the evidence regarding on personized screening based on individual risk factors has been growing. The study aimed to perform a systematic review to synthesize economic evidence of risk-tailored CRC screening strategies. METHODS: This systematic review was conducted in EMBASE, Web of Science, PubMed, Cochrane Library, Econlit, and National Institute for Health Research Economic Evaluation Database from inception to June 30, 2021. We calculated the incremental cost-effectiveness ratio (ICER) of cost per life year or quality-adjusted life year gained for the risk-tailored screening compared with no screening or uniform screening. A strategy was cost-effective with less cost and equal or more effectiveness than the comparator along with lower ICER than the willingness-to-pay threshold. RESULTS: Our review finally comprised seven studies. Five studies reported the results of comparisons of risk-tailored CRC screening with no screening, and supported that risk-tailored screening was cost-effective. All of seven studies reported the ICERs of risk-tailored screening and age-based screening. Disparities in the discrimination of risk-prediction tool, accuracy of adopted techniques, uptake rate of screening and cost estimation impacted the cost-effectiveness. CONCLUSIONS: Studies on the economic evaluation of risk-tailored CRC screening are limited, and current evidence is not sufficient to support the replacement of risk-tailored screening for traditional age-based screening.