Global incidence of prostate cancer in developing and developed countries with changing age structures.

To investigate the global incidence of prostate cancer with special attention to the changing age structures. Data regarding the cancer incidence and population statistics were retrieved from the International Agency for Research on Cancer in World Health Organization. Eight developing and developed jurisdictions in Asia and the Western countries were selected for global comparison. Time series were constructed based on the cancer incidence rates from 1988 to 2007. The incidence rate of the population aged ≥ 65 was adjusted by the increasing proportion of elderly population, and was defined as the "aging-adjusted incidence rate". Cancer incidence and population were then projected to 2030. The aging-adjusted incidence rates of prostate cancer in Asia (Hong Kong, Japan and China) and the developing Western countries (Costa Rica and Croatia) had increased progressively with time. In the developed Western countries (the United States, the United Kingdom and Sweden), we observed initial increases in the aging-adjusted incidence rates of prostate cancer, which then gradually plateaued and even decreased with time. Projections showed that the aging-adjusted incidence rates of prostate cancer in Asia and the developing Western countries were expected to increase in much larger extents than the developed Western countries.

Monotherapy Is Good Enough for Patients with Mild-to-Moderate Alzheimer's Disease: A Network Meta-analysis of 76 Randomized Controlled Trials.

Memantine and the Acetylcholinesterase inhibitors (AChEIs) are two classes of drugs that are used to treat patients with Alzheimer's disease. We conducted a network meta-analysis of randomized controlled trials to compare the treatment effectiveness of monotherapy or combination therapy A total of 23,707 AD patients in 76 randomized trials were identified. In patients with mild-to-moderate AD, monotherapy with donepezil, galantamine or rivastigmine were superior to placebo in enhancing cognitive functions and activities of daily living (ADL), whereas monotherapy with donepezil or memantine were superior to placebo in improving behavioral symptoms. However, combination therapy with AChEIs and memantine did not show additional benefit than monotherapy. In patients with moderate-to-severe AD, neither monotherapy nor combination therapy were superior to placebo in any domain measurement. Combination therapy with memantine and AChEIs is confirmed to have no additional benefits over monotherapy. This article is protected by copyright. All rights reserved.

Risk factors for advanced colorectal neoplasms in the proximal colon in 6218 subjects undergoing complete colonoscopy.

BACKGROUND AND AIM: Proximal migration of colonic lesion has been observed; however, risk factors of lesions in the proximal colon remain uncertain. This study aimed to investigate risk factors of lesions in the proximal colon. METHODS: Consecutive subjects with complete colonoscopy were included. The primary outcome was risk factors associated with advanced neoplasm (AN) and serrated lesion in the proximal colon. Age, gender, first-degree relative (FDR) with colorectal cancer (CRC), smoking, alcohol consumption, body mass index, hypertension, diabetes, ischemic heart disease, and the use of aspirin, non-steroidal anti-inflammatory drug, and anticoagulants were fitted into a regression model, with reference to subjects without colonic finding. Results were measured by odds ratio (OR) with 95% confidence interval (CI). RESULTS: Among 6218 subjects (mean age 56.65 ± 6.15 years; 46.8% male), 352 (5.7%) had AN; 809 (13.0%) had serrated lesions, and 3648 (58.7%) had no colonic finding. There were 148 (2.4%) and 235 (3.8%) subjects having AN and serrated lesion in the proximal colon. Age ≥ 50 (OR: 13.30; 95% CI: 1.85-95.76), male gender (OR: 1.82; 95% CI: 1.26-2.62), FDR with CRC (OR: 2.12; 95% CI: 1.43-3.15), and hypertension (OR: 1.86; 95% CI: 1.30-2.68) were associated with AN in the proximal colon. Age ≥ 50 (OR: 5.72; 95% CI: 2.10-15.53), male gender (OR: 1.54; 95% CI: 1.15-2.05), and smoking (OR: 1.85; 95% CI: 1.23-2.79) increased risk of serrated lesions in the proximal colon. CONCLUSION: Age ≥ 50 and male gender were associated with both proximally located AN and serrated lesion; FDR with CRC and hypertension increased the risk of proximal AN, while ever smoking increased the risk of proximal serrated lesion. FDR with CRC was not associated with serrated lesion.

Risk of gastrointestinal bleeding and benefit from colorectal cancer reduction from long-term use of low-dose aspirin: A retrospective study of 612 509 patients.

BACKGROUND AND AIM: Aspirin, commonly used for prevention of cardiovascular and cerebrovascular diseases, is well known to protect against development of colorectal cancer (CRC) but increases risk of gastrointestinal bleeding (GIB). This cohort study aims to evaluate the benefit of low-dose aspirin to prevent CRC and its associated risk of GIB. METHOD: A population-based dataset was used to compare incidence and mortality of CRC and GIB among patients receiving low-dose aspirin with sex-matched and age-matched controls (1:2). A total of 204 170 aspirin users taking aspirin for at least 6 months and 408 339 nonusers were analyzed. Patients' clinical outcomes were documented for up to 14 years or until death. RESULTS: A total of 612 509 patients were included; 5118 (2.51%) out of 204 170 aspirin users were diagnosed with CRC; and 2073 (1.02%) died of the malignancy. On the other hand, 13 336 (3.27%) out of 408 339 non-aspirin users were diagnosed with CRC, and 6953 (1.70%) died. Using the competing risk regression, aspirin usage significantly reduced CRC mortality (subdistribution hazard ratio = 0.59; 95% confidence interval = 0.56 to 0.62). A total of 9483 (4.64%) aspirin users developed GIB, and 820 (0.40%) died, while 11 198 (2.74%) nonusers developed GIB, and 1488 (0.36%) died. Aspirin usage marginally increased risk of bleeding-related mortality (subdistribution hazard ratio = 1.09; 95% confidence interval = 1.00 to 1.19). Subgroup analyses showed the use of acid-secreting agents significantly reduced aspirin-induced mortality. CONCLUSION: The long-term use of aspirin reduces both incidence and mortality of CRC and at the same time increases incidence and mortality risk of GIB. With combination use of acid-secreting agents, the bleeding risk can be reduced.

Recall Tests Are Effective to Detect Mild Cognitive Impairment: A Systematic Review and Meta-analysis of 108 Diagnostic Studies.

BACKGROUND: Mild cognitive impairment (MCI) is a prevalent symptom associated with the increased risk of dementia. There are many cognitive tests available for detection of MCI, and investigation of the diagnostic performance of the tests is deemed necessary. OBJECTIVE: This study aims to evaluate the diagnostic performance of different cognitive tests used for MCI detection. DATA SOURCES: A list of cognitive tests was identified in previous reviews and from online search engines. Literature searches were performed on each of the cognitive tests in MEDLINE, Embase, and PsycINFO from the earliest available dates of individual databases to December 31, 2016. Google Scholar was used as a supplementary search tool. STUDY SELECTION: Studies that were used to assess the diagnostic performance of the cognitive tests were extracted with inclusion and exclusion criteria. Each test's performance was compared with the standard diagnostic criteria. Bivariate random effects models were used to summarize the test performance as a point estimate for sensitivity and specificity, and presented in a summary receiver operating characteristic curve. Reporting quality and risk of bias were evaluated. RESULTS: A total of 108 studies with 23,546 participants were selected to evaluate 9 cognitive tests for MCI detection. Most of the studies used the Mini-Mental State Examination (MMSE) (n = 58) and the Montreal Cognitive Assessment (MoCA) (n = 35). The combined diagnostic performance of the MMSE in MCI detection was 0.71 sensitivity [95% confidence interval (CI): 0.66-0.75] and 0.74 specificity (95% CI: 0.70-0.78), and of the MoCA in MCI detection was 0.83 sensitivity (95% CI: 0.80-0.86) and 0.75 specificity (95% CI: 0.69-0.80). Among the 9 cognitive tests, recall tests showed the best diagnostic performance with 0.89 sensitivity (95% CI: 0.86-0.92) and 0.84 specificity (95% CI, 0.79-0.89). In subgroup analyses, long- or short-delay recall tests have shown better performance than immediate recall tests. CONCLUSIONS: Recall tests were shown to be the most effective test in MCI detection, especially for the population with symptoms of memory deterioration. They can be potentially used as the triage screening test for MCI in primary care setting. But when a patient shows cognitive impairments beyond memory deterioration, a more comprehensive test such as the MoCA should be used.

Comparison of diagnostic performance of Two-Question Screen and 15 depression screening instruments for older adults: systematic review and meta-analysis.

BackgroundScreening for depression in older adults is recommended.AimsTo evaluate the diagnostic accuracy of the Two-Question Screen for older adults and compare it with other screening instruments for depression.MethodWe undertook a literature search for studies assessing the diagnostic performance of depression screening instruments in older adults. Combined diagnostic accuracy including sensitivity and specificity were the primary outcomes. Potential risks of bias and the quality of studies were also assessed.ResultsA total of 46 506 participants from 132 studies were identified evaluating 16 screening instruments. The majority of studies (63/132) used various versions of the Geriatric Depression Scale (GDS) and 6 used the Two-Question Screen. The combined sensitivity and specificity for the Two-Question Screen were 91.8% (95% CI 85.2-95.6) and 67.7% (95% CI 58.1-76.0), respectively; the diagnostic performance area under the curve (AUC) was 90%. The Two-Question Screen showed comparable performance with other instruments, including clinician-rated scales. The One-Question Screen showed the lowest diagnostic performance with an AUC of 78%. In subgroup analysis, the Two-Question Screen also had good diagnostic performance in screening for major depressive disorder.ConclusionsThe Two-Question Screen is a simple and short instrument for depression screening. Its diagnostic performance is comparable with other instruments and, therefore, it would be favourable to use it for older adult screening programmes.

Predicted Increases in Incidence of Colorectal Cancer in Developed and Developing Regions, in Association With Ageing Populations.

BACKGROUND & AIMS: Population growth and changes in demographic structure are linked to trends in colorectal cancer (CRC) incidence. The aim of this study is to estimate future CRC incidence in the ageing population, and compare trends across developing and developed regions. METHODS: Cancer and population data were extracted from the International Agency for Research on Cancer. Annual incidence rates for the major types of cancer in 118 selected populations were extracted from 102 cancer registries in 39 countries worldwide. We selected 8 jurisdictions (from the United States, Europe, and Asia) that reported 20-year cancer incidence rates since 1988. Time series models were constructed to project cancer incidence, by sex and age, to 2030. Incidence rates for persons older than 65 years were combined and further adjusted for change of ageing population. We compared age-adjusted incidence rates among the jurisdictions. RESULTS: The total population older than 65 years old was 12,917,794 in 1988, and the number increased by almost 40% to 17,950,115 in 2007. In developed countries in the West CRC incidence is predicted to decrease by 16.3% in the United States, increase by 4.8% in the United Kingdom, and increase by 4.7% in Sweden by 2030. In developing countries, such as China (Shanghai), Croatia, and Costa Rica, CRC incidence is predicted to increase in a steep curve by 2030 because of the growing population and ageing effect; in 2030, the incidence increases were 60.5% for China, 47.0% for Croatia, and 18.5% for Costa Rica. We also predict CRC incidence will increase greatly by 2030 in Japan and Hong Kong, which are developed regions. CONCLUSIONS: With the exception of the United States, the incidence of CRC is expected to continue to rise in most regions in the coming decades, due to population growth and changes in demographic structure. The predicted increases are more marked in developing regions with limited health care resources.

Cancer burden with ageing population in urban regions in China: projection on cancer registry data from World Health Organization.

Background: China is facing the challenges of an expanding ageing population and the impact of rapid urbanization, cancer rates are subsequently increasing. This study focuses on the changes of the ageing population and projects the incidence of common ageing-related cancers in the urban regions in China up to 2030. Sources of data: Cancer incidence data and population statistics in China were extracted from the International Agency for Research on Cancer. Areas of agreement: Due to improving longevity in China, continuous and remarkable increasing trends for the lung, colorectal and prostate cancers are expected. Growing points: The rate of expanding ageing population was taken into account when predicting the trend of cancer incidence; the estimations of ageing-related cancers were more factual and significant than using the conventional approach of age standardization. Areas timely for developing research: The incidence rates of lung, colorectal and prostate cancers will continue to rise in the future decades due to the rise of ageing population. Lifestyle modification such as cutting tobacco smoking rates and promoting healthier diets as well as cancer screening programs should be a health system priority in order to decrease the growing burden of cancer-related mortality and morbidity.

Combination Therapy Showed Limited Superiority Over Monotherapy for Alzheimer Disease: A Meta-analysis of 14 Randomized Trials.

BACKGROUND: Acetylcholinesterase inhibitor (AChEI) and memantine are recognized drug treatments with limited clinical efficacy. Combination therapy for patients with Alzheimer disease (AD) was suggested, but the additional benefit of combination therapy is still controversial. AIM: To evaluate the additional benefit of combination therapy over monotherapy with either AChEI or memantine. METHODS: Prospective randomized controlled trials were searched from the OVID databases. The trials were eligible if study subjects were diagnosed with AD, and were randomized to compare combination therapy with monotherapy. Any clinical assessment measured using validated scales on cognitive function, activities of daily living, behavioral problems, and global changes were the primary outcomes, and any reported adverse events were the secondary outcomes. Quality of studies and risk of bias were evaluated. RESULTS: Fourteen randomized trials were identified between 2004 and 2015 from the United States, Canada, Germany, Japan, China, and Korea. A total of 5019 patients with AD were randomly assigned to receive combination therapy of AChEI and memantine or monotherapy with AChEI or memantine. Combination therapy showed no significant benefit on cognitive function (mean difference [MD] of MMSE = 0.06, 95% CI -0.52 to 0.65), activities of daily living (MD of ADCS-ADL = -0.15, 95% CI -1.08 to 0.78), neuropsychiatric symptoms and behavioral problems (MD of NPI = -1.85, 95% CI -4.83 to 1.13), and global changes (MD of CIBIC-plus = 0.01, 95% CI -0.25 to 0.28). In subgroup analyses, combination therapy can improve cognitive function more than memantine alone; and it can significantly relieve neuropsychiatric symptoms and behavioral problems when concomitantly used with donepezil. No additional adverse event was reported in the combination therapy. CONCLUSION: Combination therapy only showed the benefit on neuropsychiatric symptoms and behavioral problems in moderate-to-severe AD, but no other superiority in terms of cognitive function, activities of daily living, and global changes. Although reported adverse events were comparable, the additional cost for combination therapy may be unnecessary.

Time to Treatment Initiation in People With Alzheimer Disease: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Alzheimer disease (AD) is a global health problem which afflicts millions of old age population worldwide. Acetylcholinesterase inhibitors and memantine are recognized drug treatments with limited clinical efficacy. It is uncertain if earlier initiation of these drugs will result in better outcomes in the longer term. AIM: To evaluate the benefit of early treatment among people with AD. METHODS: Prospective randomized controlled trials were systematically searched from the OVID databases. The trials were eligible if study participants diagnosed with AD and were randomized to have early or late treatment. Any clinical assessment scales on cognitive function, physical function, behavioral problems, and the overall clinical status were the primary outcomes, and any reported adverse events were the secondary outcomes. RESULTS: Ten randomized trials were identified between 2000 and 2010. A total of 3092 participants with AD with mean age 75.8 years were randomly assigned to receive early treatment or treatment delayed by placebo intervention for around 6 months. Compared with late treatment, early AD drug treatment showed no significant benefit on cognitive function [mean difference (MD) of Alzheimer's Disease Assessment Scale- Cognitive Subscale = -0.49, 95% CI = -1.67 to 0.69], physical function (MD of Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory = 0.47, 95% CI = -1.44 to 2.39), behavioral problems (MD of Neuropsychiatric Inventory = -0.26, 95% CI = -2.70 to 2.18), and clinical status (MD of Clinician's Interview-Based Impression of Change plus Caregiver Input = 0.02, 95% CI = -0.23 to 0.27). Nausea was the most common adverse events in acetylcholinesterase inhibitor users, while memantine did not result in more side effects than the placebo group. For both drugs, early treatment had comparable adverse events when compared with late treatment. CONCLUSIONS: Earlier AD drug treatment by around 6 months did not result in significant difference in cognitive function, physical function, behavioral problems, and clinical status. This study included relative high proportion of early AD with the follow-up less than 2 years. Future studies can be conducted to further investigate the long-term findings.

Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials.

BACKGROUND: Computer-assisted cognitive remediation (CACR) has been demonstrated to enhance cognition of patients with severe mental illness (SMI). Patients with improved cognitive skills may find it easier to be employed, and the ability to maintain employment is an important sign of recovery. AIM: To assess whether CACR is an effective method to enhance work-related outcomes in patients with SMI. METHOD: Prospective controlled trials evaluating CACR on productivity outcomes were systematically identified from the OVID databases. Employment rates, total days of work in a year, and total annual earnings were defined as the productivity outcomes. RESULTS: Nine trials were published between 2005 and 2014 and were conducted in the United States, Germany, Italy, Singapore and Japan. A total of 740 patients with mean age of 36.4 years were included. The duration of CACR ranged from 2 months to 2 years, and the patients were followed-up from 1 year to 3 years. Patients receiving CACR showed 20% higher employment rate (95% CI = 5%-35%), worked 19.5 days longer in a year (95% CI = 2.5-36.6 days), and earned US$959 more in total annual earnings (95% CI = US$285 to US$1634) than those not receiving CACR. CONCLUSION: CACR can enhance productivity outcomes for patients with SMI, including higher employment rate, longer duration of work and higher income. The economic benefit of CACR can enhance the quality of life for patients with SMI, and may reduce financial burden on the health and welfare system. Therefore, CACR can be recommended and incorporated into regular vocational rehabilitation programs.

Cognitive Tests to Detect Dementia: A Systematic Review and Meta-analysis.

IMPORTANCE: Dementia is a global public health problem. The Mini-Mental State Examination (MMSE) is a proprietary instrument for detecting dementia, but many other tests are also available. OBJECTIVE: To evaluate the diagnostic performance of all cognitive tests for the detection of dementia. DATA SOURCES: Literature searches were performed on the list of dementia screening tests in MEDLINE, EMBASE, and PsychoINFO from the earliest available dates stated in the individual databases until September 1, 2014. Because Google Scholar searches literature with a combined ranking algorithm on citation counts and keywords in each article, our literature search was extended to Google Scholar with individual test names and dementia screening as a supplementary search. STUDY SELECTION: Studies were eligible if participants were interviewed face to face with respective screening tests, and findings were compared with criterion standard diagnostic criteria for dementia. Bivariate random-effects models were used, and the area under the summary receiver-operating characteristic curve was used to present the overall performance. MAIN OUTCOMES AND MEASURES: Sensitivity, specificity, and positive and negative likelihood ratios were the main outcomes. RESULTS: Eleven screening tests were identified among 149 studies with more than 49,000 participants. Most studies used the MMSE (n = 102) and included 10,263 patients with dementia. The combined sensitivity and specificity for detection of dementia were 0.81 (95% CI, 0.78-0.84) and 0.89 (95% CI, 0.87-0.91), respectively. Among the other 10 tests, the Mini-Cog test and Addenbrooke's Cognitive Examination-Revised (ACE-R) had the best diagnostic performances, which were comparable to that of the MMSE (Mini-Cog, 0.91 sensitivity and 0.86 specificity; ACE-R, 0.92 sensitivity and 0.89 specificity). Subgroup analysis revealed that only the Montreal Cognitive Assessment had comparable performance to the MMSE on detection of mild cognitive impairment with 0.89 sensitivity and 0.75 specificity. CONCLUSIONS AND RELEVANCE: Besides the MMSE, there are many other tests with comparable diagnostic performance for detecting dementia. The Mini-Cog test and the ACE-R are the best alternative screening tests for dementia, and the Montreal Cognitive Assessment is the best alternative for mild cognitive impairment.

Immunogenicity and reactogenicity of tetravalent vaccine for measles, mumps, rubella and varicella (MMRV) in healthy children: a meta-analysis of randomized controlled trials.

BACKGROUND: Varicella is a highly infectious childhood disease. Tetravalent measles-mumps-rubella-varicella (MMRV) vaccine was introduced as one-syringe dose. OBJECTIVE: To evaluate the immunogenicity and reactogenicity of MMRV vaccine versus trivalent MMR with varicella (V) vaccines in healthy children and to assess the respective safety issue. METHODS: Randomized controlled trials (RCTs) were searched from the OVID databases. Trials were eligible if healthy children were randomized to receive MMRV or MMR+V vaccine. Seroconversions in serum antibody titers were the primary outcomes; adverse events were the secondary outcomes. RESULTS: Ten RCTs with 8961 healthy children were identified. MMRV and MMR+V vaccines showed comparable immunogenicity against measles (relative risk [RR] = 0.99, 95% CI = 0.98-1.00), mumps (RR = 0.99, 95% CI = 0.97-1.00), rubella (RR = 1.00, 95% CI = 1.00-1.01) and varicella (RR = 0.98, 95% CI = 0.95-1.01). At least 93% of children in both groups had seroconverted within 6 weeks. MMRV group showed significantly higher incidences of fever (RR = 1.19, 95% CI = 1.09-1.31) and rash (RR = 1.23, 95% CI = 1.06-1.43). CONCLUSIONS: The immunogenicities of MMRV and MMR+V vaccines were comparable in healthy children; however, MMRV vaccination showed higher incidences of fever and rash.

Serrated polyps and the risk of synchronous colorectal advanced neoplasia: a systematic review and meta-analysis.

OBJECTIVES: Serrated polyps of the colon comprise a heterogeneous group of lesions with distinct histological and malignant features. The presence of serrated polyps has been associated with synchronous advanced neoplasia, although the magnitude of this relationship is unclear. METHODS: Using studies identified from systematic literature search up to February 2014, we performed a systematic review and meta-analysis to estimate the pooled prevalence of serrated polyps and their association with synchronous advanced neoplasia. Random-effects models were used to combine estimates from heterogeneous studies, and odds ratios (ORs) with 95% confidence intervals (CIs) were presented. RESULTS: Nine studies with 34,084 participants were included. The mean age of subjects was 59.9±6.6 years and 52.5% of the subjects were male. Pooled prevalence of serrated polyps was 15.6% (95% CI, 10.3-22.9%). The pooled OR of advanced neoplasia in individuals with serrated polyps was 2.05 (95% CI, 1.38-3.04). Pooled analysis showed that the presence of proximal serrated polyps (OR=2.77, 95% CI, 1.71-4.46) and large serrated polyps (OR=4.10, 95% CI, 2.69-6.26) was associated with an increased risk of synchronous advanced neoplasia. The pooled OR for advanced neoplasia in individuals with proximal and large serrated polyps was 3.35 (95% CI, 2.51-4.46). Considerable heterogeneity was observed in most analyses. CONCLUSIONS: Our meta-analysis showed that serrated polyps are associated with a more than twofold increased risk of detection of synchronous advanced neoplasia. Individuals with proximal and large serrated polyps have the highest risk. These individuals deserve surveillance colonoscopy.

Cardiovascular mortality in hypertensive patients newly prescribed perindopril vs. lisinopril: a 5-year cohort study of 15,622 Chinese subjects.

BACKGROUND: Perindopril and lisinopril are two common ACE inhibitors prescribed for management of hypertension. Few studies have evaluated their comparative effectiveness to reduce mortality. This study compared the all-cause and cardiovascular related mortality among patients newly prescribed ACE inhibitors. METHODS: All adult patients newly prescribed perindopril or lisinopril from 2001 to 2005 in all public clinics or hospitals in Hong Kong were retrospectively evaluated, and followed up until 2010. Patients prescribed the ACE inhibitors for less than a month were excluded. The all-cause mortality and cardiovascular-specific (i.e. coronary heart disease, heart failure and stroke) mortality were compared. Cox proportional hazard regression model was used to assess the mortality, controlling for age, sex, socioeconomic status, patient types, the presence of comorbidities, and medication adherence as measured by the proportion of days covered. An additional model using propensity scores was performed to minimize indication bias. RESULTS: A total of 15,622 patients were included in this study, in which 6910 were perindopril users and 8712 lisinopril users. The all-cause mortality (22.2% vs. 20.0%, p<0.005) and cardiovascular mortality (6.5% vs. 5.6%, p<0.005) were higher among lisinopril users than perindopril users. From regression analyses, lisinopril users were 1.09-fold (95% C.I. 1.01-1.16) and 1.18-fold (95% C.I. 1.02-1.35) more likely to die from any-cause and cardiovascular diseases, respectively. Age-stratified analysis showed that this significant difference was observed only among patients aged >70 years. The additional models controlled for propensity scores yielded comparable results. CONCLUSIONS: The long-term all-cause and cardiovascular related mortality rates of lisinopril users was significantly different from those of perindopril users. These findings showed that intra-class variation on mortality exists among ACE inhibitors among those aged 70 years or older. Future studies should consider a longer, large-scale randomized controlled trial to compare the effectiveness between different medications in the ACEI class, especially among the elderly.

Systematic review with meta-analysis: accuracy of interferon-gamma releasing assay and anti-Saccharomyces cerevisiae antibody in differentiating intestinal tuberculosis from Crohn's disease in Asians.

BACKGROUND AND AIMS: Distinguishing Crohn's disease (CD) from intestinal tuberculosis (ITB) is a clinical challenge. This meta-analysis assessed the clinical usefulness of Interferon-gamma releasing assay (IGRA) and anti-Saccharomyces cerevisiae antibody (ASCA) in the diagnosis of ITB and CD, respectively. METHODS: Systematic search without language restriction was conducted in AMED, EBM, MEDLINE, EMBASE, and Google Scholar until September 2013. Studies that have evaluated performance of IGRA (QuantiFERON-TB Gold or T-SPOT.TB) or ASCA in distinguishing ITB from CD were eligible. Main outcome measures included sensitivity and specificity. Random-effects models were used to combine estimates from studies with significant heterogeneity. Area under the curve (AUC) was used to measure accuracy of the tests. RESULTS: Eleven studies (five IGRA, three ASCA, three IGRA and ASCA) involving 1081 subjects were included. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of IGRA for the diagnosis of ITB was 81% (95% CI, 75-86%), 85% (95% CI, 81-89%), 6.02 (95% CI: 4.62-7.83), and 0.19 (95% CI: 0.10-0.36), respectively. The AUC was 0.92. The pooled sensitivity and specificity of ASCA for the diagnosis of CD was 33% (95% confidence interval [CI], 27%-38%) and 83% (95% CI, 77-88%), respectively with an AUC of 0.58. T-SPOT.TB showed a higher sensitivity than QuantiFERON-TB Gold for the diagnosis of ITB. CONCLUSIONS: IGRA and ASCA have a high specificity for the diagnosis of ITB. Both IGRA and ASCA may have a supplementary role in the differential diagnosis between ITB and CD when conventional workup is not diagnostic.

Predictors of advanced colorectal neoplasia for colorectal cancer screening.

BACKGROUND: The Asia-Pacific Colorectal Screening (APCS) score based on age, gender, family history, and smoking is useful to predict advanced colorectal neoplasia (ACN) in asymptomatic Asian subjects. PURPOSE: To evaluate the factors in addition to those of APCS associated with ACN colonoscopic findings. METHODS: Data from 5,220 asymptomatic subjects aged between 50 and 70 years who underwent screening colonoscopy in a community center between 2008 and 2012 were analyzed. One binary logistic regression analysis was conducted in 2013 with the presence of ACN or cancer as the outcome, controlling for APCS score, alcohol consumption, BMI, hypertension, and other chronic diseases as independent variables. RESULTS: The average participant age was 57.7 years (SD=4.9) and 47.5% were men. Advanced neoplasms or cancers were identified at colonoscopy in 5.6% of all screening participants. From multivariate regression analysis, APCS score≥4 (adjusted OR [AOR]=1.74, 95% CI=1.34, 2.25, p<0.001); overweight (BMI=23-24.9, AOR=1.52, 95% CI=1.12, 2.07, p=0.007); obesity (BMI≥25, AOR=1.56, 95% CI=1.15, 2.10, p=0.004); hypertension (AOR=1.58, 95% CI=1.21, 2.06, p=0.001); and alcohol consumption (AOR=1.47, 95% CI=1.05, 2.06, p=0.025) were associated with ACN. The c-statistic of APCS score alone was 0.560 (95% CI=0.524, 0.595, p=0.001) and that of APCS score plus BMI, hypertension, and alcohol consumption was 0.613 (95% CI=0.578, 0.648, p<0.001). CONCLUSIONS: Alcohol consumption, hypertension, and BMI are independent predictors of ACN, which could be incorporated into the APCS for prioritizing Asian asymptomatic subjects for colorectal cancer screening.

Comparison of positional therapy versus continuous positive airway pressure in patients with positional obstructive sleep apnea: a meta-analysis of randomized trials.

BACKGROUND: Obstructive sleep apnea (OSA), caused by the obstruction of the upper airway, is the most common type of sleep apnea. Continuous positive airway pressure (CPAP) and positional therapy have been shown to be effective to improve positional OSA. AIM: To compare the effectiveness of positional therapy versus CPAP on positional OSA. METHODS: Prospective randomized trials were systematically searched from the OVID databases. The trials comparing positional therapy versus CPAP in patients with positional OSA were included. Apnea-hypopnea index (AHI), mean oxygen saturation level, arousal index, sleep efficiency, and sleep time were the outcomes of this meta-analysis. RESULTS: Three crossover trials were identified from Canada, New Zealand, and United States from 1999 to 2010. A total of 71 patients were randomly assigned to receive CPAP or positional therapy and the mean age of patients was 51 y. Positional therapy showed higher AHI (mean difference, MD: 4.28, 95% CI: 0.72-7.83) and lower oxygen saturation level (MD: -1.04, 95% CI: -1.63 to -0.46) than CPAP. It showed no distinct advantage over CPAP in terms of arousal index, sleep efficiency, and total sleep time, but CPAP reduced sleep time in the supine position. CONCLUSION: CPAP is superior to positional therapy in reducing the severity of sleep apnea and increasing the oxygen saturation level in patients with positional OSA.

A validated tool to predict colorectal neoplasia and inform screening choice for asymptomatic subjects.

OBJECTIVE: We aim to develop and validate a clinical scoring system to predict the risks of colorectal neoplasia to better inform screening participants and facilitate their screening test choice. DESIGN: We recruited 5220 Chinese asymptomatic screening participants who underwent colonoscopy in Hong Kong during 2008-2012. From random sampling of 2000 participants, independent risk factors were evaluated for colorectal neoplasia, defined as adenoma, advanced neoplasia, colorectal cancer or any combination thereof using binary regression analysis. The ORs for significant risk factors were used to develop a scoring system ranging from 0 to 6: 0-2 'average risk' (AR) and 3-6 'high risk' (HR). The other 3220 screening participants prospectively enrolled between 2008 and 2012 for screening colonoscopy formed an independent validation cohort. The performance of the scoring system for predicting colorectal neoplasia was evaluated. RESULTS: The prevalence of colorectal neoplasia in the derivation and validation cohorts was 31.4% and 30.8%, respectively. Using the scoring system developed, 78.9% and 21.1% in the validation cohort were classified as AR and HR, respectively. The prevalence of colorectal neoplasia in the AR and HR groups was 27.1% and 44.6%, respectively. The subjects in the HR group had 1.65-fold (95% CI 1.49 to 1.83) increased prevalence of colorectal neoplasia than the AR group. CONCLUSIONS: The scoring system based on age, gender, smoking, family history, Body Mass Index and self-reported diabetes is useful in predicting the risk of colorectal neoplasia.

Prospective cohort study of compliance with faecal immunochemical tests for colorectal cancer screening in Hong Kong.

OBJECTIVE: This study aims to examine the rate and determinants of faecal immunochemical test (FIT) compliance over a four-year period among asymptomatic participants in a colorectal cancer (CRC) screening programme in Hong Kong. METHOD: Self-referred screening participants aged between 50 and 70 years who chose FIT for annual screening were followed up for four years (2008-2012). All participants were reminded up to three times yearly for FIT retrieval within two months of the expected screening date. The proportions of screening participants who failed to adhere to annual FIT tests in 1, 2, 3 and 4-years, respectively, after the initial screening uptake were evaluated. The factors associated with non-compliance with FITs in any year were assessed by a binary logistic regression analysis. RESULTS: From 5700 consecutive screening participants, the compliance rates to FIT were 95.1%, 79.9%, 66.2% and 68.4% at years one to four, respectively. The proportions of people missing one, two and three tests were 6.2%, 19.6% and 2.1%, respectively. From multivariate regression analysis, male subjects, younger participants, smokers and those with positive family history of CRC were more likely to be non-compliant. CONCLUSION: Participants identified as at higher risk for screening non-compliance should be especially considered for individual reminders to enhance screening effectiveness.