bluuebunny/crossref_metadata_2025 huggingface dataset:
Health service utilization, perspectives, and health-seeking behavior for maternal and child health services in the Amazon of Peru, a mixed-methods study
Authors: Westgard Christopher M. , Rogers Ally , Bello Giselle , Rivadeneyra Natalia
Published: October 2019

Background

Various factors influence health service utilization at the community level. Research on the barriers to uptake of local health services is essential to reduce maternal and child mortality and morbidity. The Amazon region of Peru has some of the poorest health indicators in the country. The current study set out to better understand the health-seeking behavior and perspectives of mothers in Amazonian communities, exploring individual- and contextual-level barriers for seeking care at local health facilities for common maternal and child health issues.

Methods

The study employed a mixed-methods design by conducting 50 structured interviews with mothers of children under the age of 4. The study took place in 5 communities in Loreto, Peru. The quantitative data was analyzed with descriptive statistics to identify participants’ socio-demographic characteristics and reported utilization of health services. The qualitative data was analyzed in three rounds: inductive codebook development, application of the codebook, and thematic synthesis to contextualize the quantitative results and better understand the perspectives of the mothers regarding maternal and child health issues and the local health services.

Results

Overall, reported health service utilization among study participants was relatively high. However, the mothers identified several individual- and contextual-level factors that may affect their experiences and the health-seeking behaviors of other mothers in their communities: (i) embarrassment, fear, and trust, (ii) insufficient number and poor attitudes of health personnel, (iii) limited supply of basic medicines and materials in the health facility, and (iv) low demand for family planning services and limited awareness of adolescent-specific services.

Conclusion

Several findings in the current study reflect the reduced conditions of health services, while others display that many mothers maintain a positive outlook on the health services available to them and are proactive in the care of their child. The study provides valuable insight into the use of local health services and the common perspectives that are hindering further uptake at the community level in the Amazon of Peru, with important implications for health policy.
Underpinnings of entangled ethnical and gender inequalities in obesity in Cochabamba-Bolivia: an intersectional approach
Authors: Mamani Ortiz Yercin , Gustafsson Per E. , San Sebastián Chasco Miguel , Armaza Céspedes Ada Ximena , Luizaga López Jenny Marcela , Illanes Velarde Daniel Elving , Mosquera Méndez Paola A.
Published: October 2019

Background

Social inequalities in obesity have been observed not only by gender but also between ethnic groups. Evidence on combined dimensions of inequality in health, and specifically including indigenous populations, is however scarce, and presents a particularly daunting challenge for successful prevention and control of obesity in Bolivia, as well as worldwide.

Objective

The aims of this study were i) to examine intersectional inequalities in obesity and ii) to identify the factors underlying the observed intersectional inequalities.

Methods

An intersectional approach study was employed, using the information collected in a cross-sectional community-based survey. The sample consisted of youth and adults with permanent residence in Cochabamba department (N = 5758), selected through a multistage sampling technique. An adapted version of the WHO-STEPS survey was used to collect information about Abdominal obesity and risk factors associated. Four intersectional positions were constructed from gender (woman vs. men) and ethnic group (indigenous vs. mestizo). Joint and excess intersectional disparities in obesity were estimated as absolute prevalence differences between binary groups, using binomial regression models. The Oaxaca-Blinder decomposition was applied to estimate the contributions of explanatory factors underlying the observed intersectional disparities, using Oaxaca command in Stata software v15.1.

Results

The prevalence of abdominal obesity had a higher prevalence in mestizos (men 35.01% and women 30.71%) as compared to indigenous (men 25.38% and women 27.75%). The joint disparity was estimated at 7.26 percentage points higher prevalence in the doubly advantaged mestizo men than in the doubly disadvantaged indigenous women. The gender referent disparity showed that mestizo-women had a higher prevalence than indigenous-women. The ethnic referent disparity showed that mestizo-men had a higher prevalence than indigenous men. The behavioural risk factors were the most important to explain the observed inequalities, while differences in socioeconomic and demographic factors played a less important role.

Conclusion

Our study illustrates that abdominal obesity is not distributed according to expected patterns of structural disadvantage in the intersectional space of ethnicity and gender in Bolivia. In the Cochabamba case, a high social advantage was related to higher rates of abdominal obesity, as well as the behavioural risk factors associated with them.
Assessing changes in costs of maternal postpartum services between 2013 and 2014 in Burkina Faso
Authors: Yugbaré Belemsaga Danielle , Goujon Anne , Degomme Olivier , Nassa Tchichihouenichidah , Duysburgh Els , Kouanda Seni , Temmerman Marleen
Published: October 2019

Introduction

In Africa, a majority of women bring their infant to health services for immunization, but few are checked in the postpartum (PP) period. TheMissed opportunities for maternal and infant health(MOMI) EU-funded project has implemented a package of interventions at community and facility levels to uptake maternal and infant postpartum care (PPC). One of these interventions is the integration of maternal PPC in child clinics and infant immunization services, which proved to be successful for improving maternal and infant PPC.

Aim

Taking stock of the progress achieved in terms of PPC with the implementation of the interventions, this paper assesses the economic cost of maternal PPC services, for health services and households, before and after the project start in Kaya health district (Burkina Faso).

Methods

PPC costs to health services are estimated using secondary data on personnel and infrastructure and primary data on time allocation. Data from two household surveys collected before and after one year intervention among mothers within one year PP are used to estimate the household cost of maternal PPC visits. We also compare PPC costs for households and health services with or without integration. We focus on the costs of the PPC intervention at days 6–10 that was most successful.

Results

The average unit cost of health services for days 6–10 maternal PPC decreased from 4.6 USD before the intervention in 2013 (Jan-June) to 3.5 USD after the intervention implementation in 2014. Maternal PPC utilization increased with the implementation of the interventions but so did days 6–10 household mean costs. Similarly, the household costs increased with the integration of maternal PPC to BCG immunization.

Conclusion

In the context of growingreproductive health expenditures from many funding sources in Burkina Faso, the uptake of maternal PPC led to a cost reduction, as shown for days 6–10, at health services level. Further research should determine whether the increase in costs for households would be deterrent to the use of integrated maternal and infant PPC.
Do modern family planning methods impact women’s quality of life? Jordanian women’s perspective
Authors: Alyahya Mohammad S. , Hijazi Heba H. , Alshraideh Hussam A. , Al-sheyab Nihaya A. , Alomari Dana , Malkawi Sara , Qassas Sarah , Darabseh Samah , Khader Yousef S.
Published: October 2019

Background

Although Jordan has made progress in meeting Family Planning (FP) needs in last decades, recently the use of FP methods has declined significantly. Women’s personal experiences, knowledge, and perceptions of how a FP method might impact their quality of life (QoL) can influence FP decisions. However, a lack of comprehensive understanding of the impact of modern FP methods on women’s QoL continues to exist among Jordanian couples. Therefore, this study aimed to investigate the relationship between the use of common modern FP methods and QoL among Jordanian women.

Methods

Using the WHOQOL-BREF questionnaire along with other questions, non-pregnant women of reproductive age were interviewed at their homes through face-to-face structured interviews. Women who visited the obstetrics and gynecology clinic of King Abdullah University Hospital for contraceptive advice and follow-up consultations were also included.

Results

A total of 548 women aged between 18 and 49 participated in the study. Based on the WHOQOL-BREF scale, the overall mean (SD) scores of the four domains were found to be average. Our findings show that women who used Intra Uterine Devices (IUDs) and women whose husbands used condoms had better QoL in the four domains (physical health, psychological health, social relationships, and environment) than those who used Oral Contraceptives (OCs). Women who used implant and injectable hormonal contraceptives had better QoL in terms of the physical health and social relationships domains. In contrast, women who had undergone permanent sterilization had lower QoL scores in all of the four domains. Further analysis revealed that women who had undergone tubal sterilization were less satisfied overall and more likely to experience side effects than women who used OCs.

Conclusion

The choice to use contraceptives and decide freely whether and when to have children is regarded as a fundamental reproductive health right and is strongly linked to women’s health and QoL. Women who use OCs and women who have undergone permanent sterilization are likely to have lower QoL than women who use IUDs or implant and injectable hormones and those whose husbands use condoms.
CD4+/CD8+ mucosa-associated invariant T cells foster the development of endometriosis: a pilot study
Authors: Li Caihua , Lu Zhimin , Bi Kaihuan , Wang Kangxia , Xu Yuping , Guo Peipei , Chen Ya , Zhou Ping , Wei Zhaolian , Jiang Huanhuan , Cao Yunxia
Published: October 2019

Background

Immune dysregulation is one of the mechanisms to promote endometriosis (EMS). Various T cell subpopulations have been reported to play different roles in the development of EMS. The mucosa-associated invariant T cell (MAIT) is an important T cell subset in the pathogenesis of various autoimmune diseases. Evidence has indicated that there are three functionally distinct MAIT subsets: CD4+, CD8+ and CD4/CD8−/− (double negative, DN) MAIT cells. Till now, the associations between endometriosis and MAIT have not been studied. Our research investigates different MAIT subpopulations in peripheral blood (PB) and peritoneal fluid (PF) from EMS patients.

Methods

Thirty-two EMS patients and eighteen controls were included. PB and PF were collected. Tests of cytokines in plasma and PF were performed by ELISA kit. Characterisations of MAIT were done by flow cytometry. MAIT cells have been defined as CD3 + CD161 + Vα7.2+ cells. Based on CD4 and CD8 expression, they were divided into CD8+MAIT, CD4+MAIT and DN MAIT.

Results

Enrichments of MAIT cells, especially CD4 and CD8 MAIT subsets were found. Moreover, CD8 MAIT cells had a high activation in the EMS group. EMS patients produced higher level of IL-8/12/17 as compared to these from controls. On the contrary, control patients exhibited an impressive upregulation of DN MAIT cells, however, these DN MAIT cells from controls showed a higher expression of PD-1. Lastly, we performed the relevance analysis, and discovered that the accumulation of PB MAIT cells positively correlated with an elevated level of serum CA125 production in EMS group.

Conclusion

These results suggest that different MAIT subsets play distinct roles in the progression of endometriosis.
Migrant physicians’ entrance and advancement in the Swedish medical labour market: a cross-sectional study
Authors: Sturesson Linda , Öhlander Magnus , Nilsson Gunnar H. , Palmgren Per J. , Stenfors Terese
Published: October 2019

Background

Worldwide, physicians are migrating to new countries and want to practise their profession. However, they may experience difficulties doing so. To optimise and accelerate their entrance into and advancement within the Swedish healthcare system, there is an urgent need to explore how they are currently doing so, as their competences should be put to use without any unnecessary delay. The aim of the study was to explore how migrant physicians with a medical degree from outside EU/EEA enter and advance within the medical labour market in Sweden and to identify perceived barriers and facilitating aspects in the process. The empirical findings are discussed in light of Bourdieu’s concept symbolic capital as adapted in the Swedish medical field.

Methods

A cross-sectional study with a self-administrated questionnaire was disseminated. A sample of 498 migrant physicians were identified. Descriptive statistical analysis and qualitative thematic analysis were used to analyse the data.

Results

The response rate was 57% (n = 283). Respondents mainly found their first positions via spontaneous job applications, during internships, while participating in an educational intervention or via personal contacts. Perceived barriers to entering and advancing within the medical field in Sweden were mainly related to having a medical degree from and/or originating from another country, which could in turn represent discrimination and/or having one’s competence undervalued as a result. Facilitating aspects included having or developing contacts in Swedish healthcare and gaining proficiency or fluency in the Swedish language.

Conclusions

When MPs find their first positions, the contacts they have developed appear to play a role, and when advancing in their positions, the active development of a variety of contacts seems to be beneficial. MPs experience a variety of barriers to entering and advancing within the field that could be related to discrimination. Many MPs perceived having their competences undervalued due to their origin or to being educated abroad. Based on the respondents’ experiences, our interpretation is that MPs as a group are hierarchically positioned lower in the Swedish medical field than physicians trained in the country. Facilitating aspects included educational interventions, having contacts and developing language skills. For optimal entry into the labour market, it is vitally important for MPs to learn the new language and obtain a job or internship in the field as soon as possible.
Role of diagnostic laparoscopy in patients with large cell neuroendocrine carcinoma of the ovary with cancerous peritonitis: case report and review of the literature
Authors: Tsuyoshi Hideaki , Yashiro Kenji , Yamada Shizuka , Yamamoto Makoto , Onuma Toshimichi , Kurokawa Tetsuji , Yoshida Yoshio
Published: October 2019

Background

Large cell neuroendocrine carcinoma is a very rare ovarian neoplasm that has a poor clinical outcome even in the early stage, and there is as yet no established treatment. Diagnostic laparoscopy has been used to determine the possibility of primary optimal cytoreductive surgery or neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer. However, the role of diagnostic laparoscopy is still unclear in large cell neuroendocrine carcinoma due to its rarity.

Case presentation

A 31-year-old woman with abdominal distention was referred to our hospital. She was strongly suspected of having advanced ovarian cancer because of a huge pelvic mass, massive ascites, and their appearance on medical imaging. However, cytological examinations from ascitic fluid by abdominal paracentesis did not show any malignant cells. She underwent diagnostic laparoscopy to evaluate the possibility of primary optimal cytoreductive surgery, and only tissue sampling was performed for pathological diagnosis because of the countless disseminated lesions of various sizes in the intraperitoneal organs. The patient had no postoperative complications, leading to the early start of postoperative chemotherapy.

Conclusions

To date, there have been no systematic reviews that focused on determining the treatment strategy using laparoscopy. Diagnostic laparoscopy can be helpful to determine the optimal treatment, including primary debulking surgery, neoadjuvant chemotherapy, or best supportive care, assisting in decision-making particularly for patients with advanced large cell neuroendocrine carcinoma with carcinomatous peritonitis.
Possible cytokine biomarkers in pediatric acute appendicitis
Authors: Stankovic Nikola , Surbatovic Maja , Stanojevic Ivan , Simić Radoje , Djuricic Slavisa , Milickovic Maja , Grujic Blagoje , Savic Djordje , Marinovic Vesna Milojkovic , Stankovic Miona , Vojvodic Danilo
Published: October 2019

Background

Diagnosis of acute appendicitis (AA) and decisions about its treatment remain among the most common dilemmas of pediatric surgical teams. Monitoring of immune response may be of importance for this purpose. Our aim was to measure and analyze serum and peritoneal fluid cytokines, in children who had undergone surgery for suspected AA.

Methods

Prospective investigation of serum and peritoneal fluid cytokine values was performed in 127 consecutive patients. According to the pathohistological findings, patients were divided into three groups: normal/early, uncomplicated and complicated AA. Determination of cytokine concentrations for 20 different cytokines was done using a commercial flow cytometry kit: Human Inflammation 20 plex BMS 819.

Results

Statistically significant differences in serum cytokine values between pathohistological groups were found for IP-10, MIP-1α and IL-10. Preoperative cut-off values of IP-10, MIP-1α and IL-10 between groups were obtained using ROC curve analysis. Positive correlations between serum and peritoneal concentrations were recorded for most of the analyzed cytokines.

Conclusion

IP-10, MIP-1α and IL-10 showed potential in assessment of AA in children. Confirmatory studies with a larger number of patients are required to prove reliability of these biomarkers.
The use of an external ultrasound fixator (Probefix) on intensive care patients: a feasibility study
Authors: Blans M. J. , Bosch F. H. , van der Hoeven J. G.
Published: October 2019

Background

In critical care medicine, the use of transthoracic echo (TTE) is expanding. TTE can be used to measure dynamic parameters such as cardiac output (CO). An important asset of TTE is that it is a non-invasive technique. The Probefix is an external ultrasound holder strapped to the patient which makes it possible to measure CO using TTE in a fixed position possibly making the CO measurements more accurate compared to separate TTE CO measurements. The feasibility of the use of the Probefix to measure CO before and after a passive leg raising test (PLR) was studied. Intensive care patients were included after detection of hypovolemia using Flotrac. Endpoints were the possibility to use Probefix. Also CO measurements with and without the use of Probefix, before and after a PLR were compared to the CO measurements using Flotrac. Side effects in terms of skin alterations after the use of Probefix and patient’s comments on (dis)comfort were evaluated.

Results

Ten patients were included; in eight patients, sufficient recordings with the use of Probefix could be obtained. Using Bland–Altman plots, no difference was found in accuracy of measurements of CO with or without the use of Probefix before and after a PLR compared to Flotrac generated CO. There were only mild and temporary skin effects of the use of Probefix.

Conclusions

In this small feasibility study, the Probefix could be used in eight out of ten intensive care patients. The use of Probefix did not result in more or less accurate CO measurements compared to manually recorded TTE CO measurements. We suggest that larger studies on the use of Probefix in intensive care patients are needed.
Testing the 2018 NIA-AA research framework in a retrospective large cohort of patients with cognitive impairment: from biological biomarkers to clinical syndromes
Authors: Carandini Tiziana , Arighi Andrea , Sacchi Luca , Fumagalli Giorgio G. , Pietroboni Anna M. , Ghezzi Laura , Colombi Annalisa , Scarioni Marta , Fenoglio Chiara , De Riz Milena A. , Marotta Giorgio , Scarpini Elio , Galimberti Daniela
Published: October 2019

Background

According to the 2018 NIA-AA research framework, Alzheimer’s disease (AD) is not defined by the clinical consequences of the disease, but by its underlying pathology, measured by biomarkers. Evidence of both amyloid-β (Aβ) and phosphorylated tau protein (p-tau) deposition—assessed interchangeably with amyloid-positron emission tomography (PET) and/or cerebrospinal fluid (CSF) analysis—is needed to diagnose AD in a living person. Our aim was to test the new NIA-AA research framework in a large cohort of cognitively impaired patients to evaluate correspondence between the clinical syndromes and the underlying pathologic process testified by biomarkers.

Methods

We retrospectively analysed 628 subjects referred to our centre in suspicion of dementia, who underwent CSF analysis, together with neuropsychological assessment and neuroimaging, and were diagnosed with different neurodegenerative dementias according to current criteria, or as cognitively unimpaired. Subjects were classified considering CSF biomarkers, and the prevalence of normal, AD-continuum and non-AD profiles in each clinical syndrome was calculated. The positivity threshold of each CSF biomarker was first assessed by receiver operating characteristic analysis, using Aβ-positive/negative status as determined by amyloid-PET visual reads. The agreement between CSF and amyloid-PET data was also evaluated.

Results

Among patients with a clinical diagnosis of AD, 94.1% were in the AD-continuum, whereas 5.5% were classified as non-AD and 0.4% were normal. The AD-continuum profile was found also in 26.2% of frontotemporal dementia, 48.6% of Lewy body dementia, 25% of atypical parkinsonism and 44.7% of vascular dementia. Biomarkers’ profile did not differ in amnestic and not amnestic mild cognitive impairment. CSF Aβ levels and amyloid-PET tracer binding negatively correlated, and the concordance between the two Aβ biomarkers was 89%.

Conclusions

The examination of the 2018 NIA-AA research framework in our clinical setting revealed a good, but incomplete, correspondence between the clinical syndromes and the underlying pathologic process measured by CSF biomarkers. The AD-continuum profile resulted to be a sensitive, but non-specific biomarker with regard to the clinical AD diagnosis. CSF and PET Aβ biomarkers were found to be not perfectly interchangeable to quantify the Aβ burden, possibly because they measure different aspects of AD pathology.
PSMA expression level predicts differentiated thyroid cancer aggressiveness and patient outcome
Authors: Sollini Martina , di Tommaso Luca , Kirienko Margarita , Piombo Chiara , Erreni Marco , Lania Andrea Gerardo , Erba Paola Anna , Antunovic Lidija , Chiti Arturo
Published: October 2019

Background

Prostate-specific membrane antigen (PSMA) is overexpressed on the endothelial cells of tumor neo-vessels of several solid malignancies, including differentiated thyroid cancer (DTC). We aimed to test the potential role of PSMA as a biomarker for DTC aggressiveness and outcome prediction.

We retrospectively screened all patients who underwent thyroidectomy between 1 January 2010 and 31 December 2017 in our institution. Applying the inclusion (histological diagnosis of thyroid cancer and tissue availability) and exclusion criteria (no clinical or follow-up data or diagnosis of medullary thyroid cancer), a cohort of 59 patients was selected. The monoclonal mouse anti-human PSMA antibody was used to stain tissue sections. A 3-point scale was used to score PSMA positivity: 0–5% expression was considered as negative (score 0), 6–50% as moderately positive (score 1), and 51–100% as highly positive (score 2). A cumulative score (0–10%, 11–79%, and 80–100%) was also explored. Univariate and multivariate logistic regression analyses were performed to predict the presence of distant metastases, chosen as endpoint of aggressiveness. The area under the curve (AUC) was calculated. Cox models were built to predict patient outcome in terms of recurrence, iodine refractoriness, and status at last follow-up, which were calculated using the Kaplan-Meier failure function.

Results

At immunostaining, 12, 25, and 22 patients had scores of 0, 1, and 2, respectively. According to the cumulative score, PSMA expression was ≤ 10% in 17 cases, 11–79% in 31 cases, and ≥ 80% in 11 cases. At multivariate analysis, age, sex, histotype, vascular invasion, T and N parameters, and PSMA positivity were significant predictors of distant metastases. The AUC was 0.92. Recurrence or progression occurred in 19/59 patients. Twelve patients developed radioiodine (RAI) refractoriness, after a median time of 17 months (range 2–32). One patient died of DTC; 46 of the 58 patients alive at last follow-up were disease free. Median DFS was 23 months (range 3–82). The final multivariate model to predict RAI refractoriness included as covariates the stage, high PSMA expression (≥ 80%), and the interaction between moderate PSMA expression (11–79%) and stage.

Conclusions

PSMA, a marker of neovasculature formation expressed by DTC, contributes in the prediction of tumor aggressiveness and patient outcome.
Supraglottic p16+ squamous cell carcinoma during pregnancy: A case report and review of the literature
Authors: Pugi Jakob , Levin Marc , Gupta Michael
Published: October 2019

Background

Head and neck cancer during pregnancy is uncommon. Specifically, laryngeal cancer in pregnancy has only been previously reported 10 times. HPV p16+ supraglottic cancer during pregnancy has never been described in the literature prior to this case report. This case is important to report to understand the most effective and safe diagnostic, treatment and follow-up options available for pregnant patients with laryngeal cancer.

Case presentation

This report describes a case of a 33-year-old patient who was 24 weeks pregnant presenting with dysphonia and odynophagia. After laryngeal biopsy and MRI she was diagnosed with T3N1M0, stage three p16+ squamous cell carcinoma of the supraglottis. After inter-disciplinary consultation as well as extensive patient discussion, an awake tracheostomy, PEG tube placement and then elective C-section at 28 weeks’ gestation was completed. This was followed by chemoradiotherapy. The patient has remained free from disease with a healthy child at four years post-treatment.

Conclusion

Supraglottic cancer during pregnancy is rare with only four previous cases reported in the literature. This case report elucidates the importance of including multiple specialities as well as patient preference in the decision-making process regarding treatment for patients with supraglottic cancer during pregnancy. Furthermore, diagnostic and treatment guidelines for pregnant patients with head and neck cancers should be established to promote the best possible oncological, obstetrical and neonatal care.
Development of research integrity in France is on the rise: the introduction of research integrity officers was a progress
Authors: Maisonneuve Hervé
Published: October 2019

Background

Implementing responsible conduct of research and monitoring bad practices requires time and tact. In France, it was in 2015 that the wishes of those in charge of research proposed the appointment of research integrity officers (RIOs) in all universities, national higher education schools, and research institutions. Our objectives were to search for information to describe the RI development and to analyze the RIOs’ profiles.

Methods

The OFIS (Office Français de l’Intégrité Scientifique) website lists all public research institutions and universities (RIUs) and their designated RIOs. During the period between 6 and 14 October 2018, and on 2 May 2019 (updating), we entered two keywords (“plagiat” and “intégrité”) into the search engines on the RIU homepages and retrieved the relevant information (including “research” and “scientific” integrity when “intégrité” was entered). We consulted the governance and downloaded the organigram to determine whether the RIO positions and names were mentioned. We searched for the domains of expertise, sex, and age of the RIOs from their CVs (institutional websites), LinkedIn profiles, and various Google links.

Results

The OFIS website lists 142 RIUs. Searching for the keyword “plagiarism” retrieved 25 RIUs; however, the web information was minimal, and consisted entirely of charters, interviews, and rare training modules. The keyword “integrity” turned up 23 RIUs. Nonetheless, there was little information available beyond notices for seminars, events, and a few training modules. Of the total 142 RIUs, 66.2% (n = 94) had named 96 RIOs. Furthermore, 29.2% RIOs (n = 28) were female and 70.8% (n = 68) were male; 38 RIOs were retired (> 65 years old) 58 were active (< 65 years old), and had a RIO function added to their usual laboratory activities.

Conclusion

There is a lack of information about RI on the websites of French universities and research organizations, which may reflect a lack of information and commitment in the institutions themselves.
Direct torque control of doubly fed induction motor using three-level NPC inverter
Authors: El Ouanjli Najib , Derouich Aziz , El Ghzizal Abdelaziz , Taoussi Mohammed , El Mourabit Youness , Mezioui Khalid , Bossoufi Badre
Published: October 2019

This article presents the direct torque control (DTC) strategy for the doubly fed induction motor (DFIM) connected to two three-level voltage source inverters (3LVSIs) with neutral point clamped (NPC) structure. This control method allows to reduce the torque and flux ripples as well as to optimize the total harmonic distortion (THD) of motor currents. The use of 3LVSI increases the number of generated voltage, which allows improving the quality of its waveform and thus improves the DTC strategy. The system modeling and control are implemented in Matlab/Simulink environment. The analysis of simulation results shows the better performances of this control, especially in terms of torque and flux behavior, compared to conventional DTC.
Effects of parental mental illness on children's physical health: systematic review and meta-analysis
Authors: Pierce Matthias , Hope Holly F. , Kolade Adekeye , Gellatly Judith , Osam Cemre Su , Perchard Reena , Kosidou Kyriaki , Dalman Christina , Morgan Vera , Di Prinzio Patricia , Abel Kathryn M.
Published: October 2019

Background

Children of parents with mental disorder face multiple challenges.

Aims

To summarise evidence about parental mental disorder and child physical health.

Method

We searched seven databases for cohort or case–control studies quantifying associations between parental mental disorders (substance use, psychotic, mood, anxiety, obsessive–compulsive, post-traumatic stress and eating) and offspring physical health. Studies were excluded if: they reported perinatal outcomes only (<28 days) or outcomes after age 18; they measured outcome prior to exposure; or the sample was drawn from diseased children. A meta-analysis was conducted. The protocol was registered on the PROSPERO database (CRD42017072620).

Results

Searches revealed 15 945 non-duplicated studies. Forty-one studies met our inclusion criteria: ten investigated accidents/injuries; eight asthma; three other atopic diseases; ten overweight/obesity; ten studied other illnesses (eight from low-and middle-income countries (LMICs)). Half of the studies investigated maternal perinatal mental health, 17% investigated paternal mental disorder and 87% examined maternal depression. Meta-analysis revealed significantly higher rates of injuries (OR = 1.15, 95% CI 1.04–1.26), asthma (OR = 1.26, 95% CI 1.12–1.41) and outcomes recorded in LMICs (malnutrition: OR = 2.55, 95% CI 1.74–3.73; diarrhoea: OR = 2.16, 95% CI 1.65–2.84). Evidence was inconclusive for obesity and other atopic disorders.

Conclusions

Children of parents with mental disorder have health disadvantages; however, the evidence base is limited to risks for offspring following postnatal depression in mothers and there is little focus on fathers in the literature. Understanding the physical health risks of these vulnerable children is vital to improving lives. Future work should focus on discovering mechanisms linking physical and mental health across generations.

Declaration of interest

None.
Ultra-rapid total abdominal FLASH irradiation in a preclinical model of ovarian cancer.
Authors: Levy Karen , Wang Jinghui , Natarajan Suchitra , Casey Keriann , Eggold Joshua Thomas , Rafat Marjan , Loo Billy W. , Rankin Erinn
Published: October 2019

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Background:Total abdominal irradiation (TAI) is no longer used in the treatment of ovarian cancer due to abdominopelvic toxicity. FLASH irradiation is known to spare the lung, skin and brain from radiation toxicity in preclinical models. Conventional radiotherapy delivers a dose-rate of 2-4 Gy/minute, while our small animal FLASH system uses a linear accelerator to generate a dose-rate of 200 Gy/second. We have demonstrated that FLASH-TAI produces less gastrointestinal (GI) toxicity and death compared to conventional (CONV) radiation in a murine model. Here we present the first data supporting the potential for both tumor control and GI sparing using FLASH-TAI in a syngeneic orthotopic preclinical model of ovarian cancer. Methods: Normal tissue toxicity was assessed through survival, total body weight, solid stool production, complete blood count and histologic analysis. For the tumor model, ID8 ovarian cancer cells were injected intraperitoneally into female C57BL/6mice. Radiation was delivered 10 days post-ID8 injection. Tumor burden was assessed at the time of morbidity. Flow cytometry was used to profile infiltrating immune cells. Results: At 16 Gy, 100% of CONV treated mice demonstrated lethal GI toxicity while 90% of FLASH treated mice recovered to normal bodyweight by day 14. Histologic analysis at 96 hours after 14 Gy FLASH found 3-fold more surviving small intestinal crypts compared to CONV. In the ID8 mice, 14 Gy FLASH spared GI function with a 2-fold higher solid stool production at 5 days post-TAI. Both modalities extended median overall survival in the ID8 model by 5 days and reduced tumor burden by 50% relative to unirradiated controls. Irradiated cohorts also demonstrated a 2-3 fold increase in the number of proliferating CD8+ and CD4+ T cells present in the ascites. Conclusions: Compared to CONV-TAI, FLASH-TAI spares gastrointestinal function, provides equivalent tumor control, and is associated with improved post-radiation recovery and overall survival in an orthotopic preclinical model of ovarian cancer. Our findings suggest an exciting new opportunity to improve the safety of TAI in the treatment of intra-abdominal tumors.
A signature predictive of early versus late recurrence after radiation (RT) for breast cancer that may inform the biology of early, aggressive recurrences.
Authors: Speers Corey Wayne , Chang S. Laura , Chandler Benjamin , Pesch Andrea , Michmerhuizen Anna , Wilder-Romans Kari , Nyati Shyam , Pierce Lori J.
Published: October 2019

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Background: Unmet clinical needs in breast cancer (BC) management include the identification of patients at high risk to fail locally despite standard local therapy and an understanding of the biology of these recurrences. We previously reported a radiation response signature and here extend those studies to identify a signature predictive of timing of recurrence after RT. Methods: 2 independent patient cohorts were used for training (119 pts) and validation (112 pts). All patients received RT after BCS and systemic therapy as appropriate. Spearman’s rank correlation to correlate gene expression to recurrence time was used for feature selection. Significant genes were used to train a linear model which was locked before validation. Cox regression was used for both UVA and MVA. Results: Spearman’s correlation identified 485 genes whose expression was significantly associated with recurrence time (+/-3 yrs). Feature reduction refined the list to 41 genes retained within the signature. In training, the correlation of score to recurrence time was 0.85, p-value < 1.3x10-31; AUC of 0.91. External validation in an independent BC validation set accurately identified patients with early vs. late recurrences (correlation= 0.75, p-value = 0.001, AUC = 0.92, sens.=0.75, spec.= 1.0, PPV = 1.0, NPV = 0.8). Unique associations of breast cancer intrinsic subtype to timing of local recurrence were found. In UVA and MVA the signature remained the most significant factor associated with recurrence. GSEA analysis of the 41 genes retained within the signature identified proliferation and EGFR concepts associated with early recurrences and luminal and ER-signaling pathways associated with late recurrences. Knockdown of genes associated with the early and late recurrences demonstrated novel effects on proliferation and clonogenic survival, respectively. Conclusions: We report a BC gene expression signatures that may be useful in identifying patients unlikely to respond to adjuvant RT and may be used to predict timing of recurrences, with implications for potential treatment intensification and duration of follow-up for women with breast cancer treated with RT.
Risk factors and therapeutic significance for inguinal lymph node metastasis in advanced lower rectal cancer.
Authors: Nozawa Hiroaki , Shiratori Hiroshi , Kawai Kazushige , Hata Keisuke , Tanaka Toshiaki , Nishikawa Takeshi , Shuno Yasutaka , Sasaki Kazuhito , Kaneko Manabu , Emoto Shigenobu , Murono Koji , Sonoda Hirofumi , Ishii Hiroaki , Ishihara Soichiro
Published: October 2019

120

Background: Which patients with lower rectal cancer are at risk of inguinal lymph node metastasis (ILNM) and how to treat ILNM remain unclear. This study aimed to clarify the predictors of ILNM and clinical significance of treatment for ILNM. Methods: Consecutive patients with rectal adenocarcinoma invading the anal canal who underwent curative surgery between 2003 and 2019 at a single institution were retrospectively reviewed. The pathological nodal involvement in mesorectal, lateral pelvic or inguinal lymph nodes (ILN) at the time of rectal surgery and of later onset were collectively defined as final nodal metastasis (f-LNM) in this study. Factors associated with f-LNM were analyzed. Moreover, the ‘modified therapeutic value index’ defined by the 5-year overall survival rate of patients treated against f-LNM multiplied by their frequency was calculated for each lymph node area. Results: A total of 145 patients were enrolled, among whom16 patients developed ILNM. For predicting f-ILNM, the cutoff 8.5 mm of ILN diameter gave area under the curve of 0.889. Dentate line involvement and ILN larger than a simplified cutoff of 8 mm were independently associated with the development of ILNM (odds ratio: 33.4 and 11.9, respectively). The modified therapeutic value indice of inguinal, lateral pelvic and mesorectal LNs in the entire population were 6.1, 8.2 and 20.3 points, respectively. In patients with dentate line invaded by cancer, they were 11.7, 5.8 and 16.2 points, respectively. Moreover, the index of ILN was 21.1 points when confined to patients with ILN larger than 8 mm. Conclusions: Dentate line involvement and ILN larger than 8 mm were predictive of developing ILNM in patients with rectal cancer invading the anal canal. Treatment of ILNM may be recommended for patients manifesting the above predictors, given the significant therapeutic outcomes.
LINC00184 involved in the regulatory network of ANGPT2 via ceRNA mediated miR-145 inhibition.
Authors: Piao Haiyan
Published: October 2019

17

Background: Abnormal gene expression is closely related to the development and poor prognosis of gastric cancer (GC). Since gene does not work alone, we are aimed to elucidate the potential networks between mRNA and non-coding RNAs (ncRNAs) in this study. Methods: Based on the TCGA database, we obtained the differentially expressed RNAs and constructed the competing endogenous RNA (ceRNA) regulatory network. Results: We found a regulatory network based on ANGPT2. We observed ANGPT2 is overexpressed in GC cells and tissues and associated with poor prognosis. ANGPT2 promotes proliferation, invasion, and EMT in GC cells, which could be abolished by miR-145. In addition, LINC00184 can be used as a ceRNA to inhibit the expression of miR-145, thus enhancing the carcinogenic effect of ANGPT2. Conclusions: Our results suggested that LINC00184/miR-145/ANGPT2 axis plays an important role in the occurrence and development of GC and may be potential biomarkers and targets for the treatment of GC.
Creating solutions through design thinking.
Authors: Bariani Giovanni M. , Ribeiro Rafael Lopes , Soares Leonardo de Morais , Katz Artur
Published: October 2019

20

Background: In recent years the impact of technology has marked a major transformation in the way society produces and generates services. Several initiatives have been developed in the health area to face this new reality. A major oncology center in Brazil carried out a project based on Design Thinking with the objective of understanding the current scenario and promoting innovative solutions for the care of cancer patients. Methods: Design Thinking is the set of ideas and insights to address problems related to information acquisition, knowledge analysis and proposal of solutions. This process took place in four stages designated as empathise (approach to the context of the problem and data collection), define (synthesis of collected information, and organization of insights in order to standardize and better understand the problem), ideate (stimulation of creativity and generation of solutions) and prototype (validation of the ideas). Results: A total of 130 interviews were carried out with hospital personnel and 46 with patients and caregivers, as well as workshops to develop the project activities. Twenty-six projects were generated, and the priorities differed according to personnel and patients. Among the projects are financial consultancy; predictability of the total cost of treatment; diversification of payment methods; customization of the food menu offered to patients; promotion of entertainment activities during waiting periods in the practice; increase interactivity of chemotherapy rooms; improvement of services offered to international patients; and development of digital tools that provide reliable information about cancer, promotes patient autonomy and strengthens patient’s relationship with the hospital personnel. Conclusions: There is a growing need to modernize oncology practices creating new products and services. The opinion of hospital personnel and patients diverged about priorities. The former have chosen projects to improve facilities and design new roles for the team while the latter have given their best evaluations to new systems and services. For patients using digital media is not only welcome but also necessary attributes to provide more information and increase their autonomy.
Adoption and utilization of NGS-based molecular profiling in community-based oncology practices: Insights from Sarah Cannon.
Authors: Burris III Howard A. , Schlauch Daniel , McKenzie Andrew , Sharma Yasha , Spigel David R. , Jones Suzanne Fields , Dilks Holli Hutcheson
Published: October 2019

34

Background: The price of NGS-based sequencing technologies is falling, and the adoption of NGS-based testing is increasing in oncology practices. To date, a survey of the adoption and utilization of NGS-based technologies as a part routine oncology clinical care has not been performed. Thus, a comprehensive analysis of physician adoption and utilization of commercial NGS testing in the non-academic medical center, community-setting between 2012 and 2018 was performed. Methods: Medical Oncologists in the Sarah Cannon Research Institute network ordered commercially-available NGS-based molecular profiling for their patients as standard of care. Data use agreements were initiated between SCRI, affiliated medical oncology practices, and commercial NGS testing providers, and patient NGS data was subsequently analyzed starting in 2012. Results: Community-based NGS testing rates with the Sarah Cannon network were 5.75/month in 2012 and 440/month in 2018. Plasma-based NGS testing began in 2014 and comprised 4.9% of total testing compared to 40.1% in 2018. The number of oncologist ordering molecular profiles increased from 11 in 2012 to 269 in 2018. Physician test utilization grew from an average of 6 tests/physician to 22 tests/physician in 2012 and 2018, respectively. NGS tests were performed on 34 different tumor types and biopsies were taken from both primary tumors (~40%) and metastatic sites (~60%). Tissue-based tests averaged 14 mutations/sample while plasma-based tests averaged 4 mutations/sample. There was a 74% decrease in median time between biopsy collection and NGS test results between 2012 and 2018 (131 and 34 days, respectively), indicating a shift toward the use of fresh – non-archival – tissue in recent years. Conclusions: These data establish NGS-based testing trends in community oncology practices and show that NGS-based tumor testing utilization has increased in the community-setting between 2012 and 2018. NGS testing is performed on a wide array of tumor types and oncologists order tests earlier and utilize fresher biopsies.
A single-cell atlas of hepatocellular carcinoma.
Authors: Sharma Ankur
Published: October 2019

46

Background: Tumors reside and evolve in a complex ecosystem of immune and non-immune stromal cells. Methods: We employed multi-sectoral single-cell RNA-seq to catalogue intra-tumor heterogeneity in human hepatocellular carcinoma (HCC). Results: We generated single-cell atlas of ~76,000 cells from fourteen HCC patients, each consisting of 2-5 tumor and matched adjacent normal sectors. In total, we profiled 57 individual tumor and normal sectors consisting of HBV+ and HBV- HCC. By analysing matched normal and malignant sectors we observed intriguing remodelling of the tumor microenvironment (TME).We identify >70 distinct cells-states in HCC including novel, previously uncharacterized subpopulations. Specifically, we demonstrate remarkable heterogeneity in hepatocytes, fibroblast and endothelial cells. Most importantly, we consistently observed a marked remodellingof stromal cells suggesting a role in dynamic tumor-TME interactions. Conclusions: We present the first comprehensive single-cell atlas of HCC. This resource provides unprecedented insights into liver cancer, which will pave the way for early detection and therapeutic targeting.