bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiences of Infertile Couples of West Bengal With Male Factor, Female Factor, and Unexplained Infertility Factor: A Qualitative Study
Authors: De Devika , Mukhopadhyay Pritha , Roy Prasanta Kumar
Published: August 2020

Background: Infertility is a very stressful life state of a couple. The consequences of infertility have a considerable differential effect not only on couples but also on culture and social strata. Inability to conceive can be a very troublesome matter for a couple and potentially it can turn into a traumatic experience with far-reaching consequences. Qualitative understanding of strain can be helpful for in-depth understanding of factors that might need psychosocial intervention.

Objective: The purpose of this study is to zero in on the multiple psychosocial aspects of infertile couples, ranging from male etiology, female determinants, and unexplained domains of infertility.

Materials and Methods: This was a qualitative cross-sectional content analysis study. 15 couples were interviewed with the mean age of (27± 2.95) years for females and (30±2.43) years for males. Data collection strategies employed in this research included semi-structured open face-to-face interviews and field notes.

Results: Qualitative data analysis identified 5 themes—negative emotional reactions, social pressure, marital and sexual dissatisfaction, decreased quality of life, and treatment problems.

Conclusion: The various psychosocial crises (unfulfilled maternal instinct, emotional support, unmet social role, diminished social security) related to various types of infertility are evident. Addressing those issues might be helpful to improve the quality of life of couples.
“Koro and Migration”: Observational Study of an Outbreak of Koro in a Migrant Population Working in South India
Authors: Banerjee Debanjan , Sharma Snehal , Antony Sojan
Published: August 2020

Introduction: Koro is a culture-bound syndrome, common in India, characterized by the belief that one’s genitals are shrinking followed by the fear of impending death. Significant social stressors can precipitate this syndrome in vulnerable populations. One such factor is migration which is associated with increased vulnerability to neurosis and poor coping. It has been a less studied factor in the genesis of Koro and the same has been an interesting association in this study.

Methods: There was an outbreak of Koro (13 cases: 8 males and 5 females) among a population (n = 52) from east and middle India who had migrated to the south for manual work. These cases presented in clusters to our psychiatry outpatient department within a span of 2 weeks. We did an observational study to explore the sociodemographic and clinical correlates of these patients. Their perceptions and attributions to the illness were also reported.

Results: Most patients were married men with lower socioeconomic status and no formal education. More females were however affected than earlier reported data. Most patients knew about the illness and believed that it was contagious. Death anxiety, loss of libido, and insomnia were common associated complaints. Males feared impotence, whereas females feared of “loss of child-bearing” abilities. The major attributing factors to the illness were migration, the stigma of working near a “mental hospital,” and sharing shelter with the affected. Pharmacotherapy and single-session cognitive behavioral therapy were used for treatment.

Conclusions: Our study revealed unique clinical correlates and belief-systems of patients affected with Koro. It is time we stop seeing it just as “culture-bound syndrome” and begin seeing it also as a social disorder caused by distortion of body-related beliefs. Migration being a significant environmental stressor can often precipitate such culture-bound syndromes. Further mixed-method studies are warranted.
“Their Untold Stories…”: Lived Experiences of Being a Transgender (Hijra), A Qualitative Study From India
Authors: Mondal Bithika , Das Sudeshna , Ray Deepshikha , Banerjee Debanjan
Published: August 2020

Background: Transgender is an umbrella term, used to encompass people who have a gender identity or gender expression, which differs from their sex assignment at birth. Being independent of sexual orientation, they have often been classified as the “third sex.” Based on various sociocultural traditions and beliefs, they are frequently “othered,” discriminated, and stigmatized against. This has led to their limited social inclusion and participation. In the social diversity of a populous country like India, transgenders are termed as “hijra’s,” belonging to a separate social community. Their experiences, perceptions, and unmet needs are rarely evaluated.

Methods: Qualitative approach was used to explore the “lived experience” of 4 individuals who are part of the “hijra” community in Kolkata. These individuals were born with ambiguous primary sex characteristics. In-depth interview was conducted with these participants with subsequent transcription. Interpretative phenomenological analysis (IPA) was used for analysis.

Results: A total of 2 superordinate themes (identity issues, relationship issues) and 6 subordinate themes emerged from the analysis (identification with feminine gender, perceptions regarding caregivers, perception regarding siblings, perception regarding childhood peer groups, identification with the hijra community, societal rejection). The findings have been discussed in terms of identity process, social and cultural construal of hijras in this part of the world.

Conclusion: In India, the transgenders (hijra community) represent a unique subculture besides the heterosexual groups. Understanding their relationships, sexuality and societal interactions are vital for their psychosocial well-being and related interventions. This study adds to the shared understanding of their marginalization and lived experiences, in their own voices.
Setting Up Psychosexual Medicine Unit: Insights From a Private University-Based Medical College Hospital
Authors: Nilakantam Sathish Raju , Manohar Shivanand , Rao Suman S. , Dayananda M. , Mathur Supriya , Gowdappa H. Basavanna , Mahadevappa Guruswamy , Raman Rajesh , Rao T. S. Sathyanarayana
Published: August 2020

Introduction: Sexual health issues are highly prevalent but are underdiagnosed and underrecognized in day-to-day clinical practice. The lack of awareness of the specific health care needs of the patients with sexual dysfunctions and resource limitations might be certain reasons why many hospitals are not been equipped with the sexual health care units. There is paucity of specialized psychosexual health care services across the country. Trained interdisciplinary team with prepared environment in sexual medicine is the need of the hour. We started this psychosexual medicine unit with an emphasis on sexual wellness to deliver comprehensive sexual health care which will be a primary care linkage to patients presenting with symptoms of sexual disorders, so also treatment emergent sexual dysfunction in psychiatry and other medical and surgical branches.

Aim: To portray the methods, opportunities, and challenges that we experienced in establishing a specialty psychosexual medicine facility as a different unit in a private university-based medical college and hospital in Mysuru, India.

Methods: This triweekly psychosexual medicine unit is situated in the Outpatient Division of Psychiatry and is staffed with a multidisciplinary group of health care professionals. Structured survey tools and proforma are utilized to assess all patients. Case conclusions are made according to International Classification of Diseases, Tenth Revision, symptomatic/clinical explanations and diagnostic recommendations, and furthermore Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) when required. Patient care included interventions in the form of psychotherapy and pharmacotherapy.

Results: It is possible to set up a functional psychosexual medicine facility as a different unit with a trained interdisciplinary group of professionals. Patient-centered approach is vital in our care plan and management. Postgraduate students and internees posted in psychiatry division have been undertaking rotations respectively as per their duty rota. There is also a robust academic program that includes once-weekly seminars pertaining to topics of psychosexual health and monthly journal club gatherings interchanging with seminars on sexual health and well-being appraisal devices.

Conclusion: By investing on improving infrastructure and available human resources, the specialty psychosexual medicine unit was established. The psychosexual medicine unit not only gave chances for a more comprehensive assessment of individuals with sexual disorders but also improved training and education for residents with focused interdisciplinary research in the field of sexual medicine. It portrays a versatile model that can be replicated in settings of similar type.
Single-cell DNA amplicon sequencing reveals clonal heterogeneity and evolution in T-cell acute lymphoblastic leukemia
Authors: Albertí-Servera Llucia , Demeyer Sofie , Govaerts Inge , Swings Toon , De Bie Jolien , Gielen Olga , Brociner Marco , Michaux Lucienne , Maertens Johan , Uyttebroeck Anne , De Keersmaecker Kim , Boeckx Nancy , Segers Heidi , Cools Jan
Published: August 2020

T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive leukemia that is most frequent in children and is characterized by the presence of few chromosomal rearrangements and 10 to 20 somatic mutations in protein-coding regions at diagnosis. The majority of T-ALL cases harbor activating mutations in NOTCH1 together with mutations in genes implicated in kinase signaling, transcriptional regulation, or protein translation. To obtain more insight in the level of clonal heterogeneity at diagnosis and during treatment, we used single-cell targeted DNA sequencing with the Tapestri platform. We designed a custom ALL panel and obtained accurate single-nucleotide variant and small insertion-deletion mutation calling for 305 amplicons covering 110 genes in about 4400 cells per sample and time point. A total of 108 188 cells were analyzed for 25 samples of 8 T-ALL patients. We typically observed a major clone at diagnosis (>35% of the cells) accompanied by several minor clones of which some were less than 1% of the total number of cells. Four patients had >2 NOTCH1 mutations, some of which present in minor clones, indicating a strong pressure to acquire NOTCH1 mutations in developing T-ALL cells. By analyzing longitudinal samples, we detected the presence and clonal nature of residual leukemic cells and clones with a minor presence at diagnosis that evolved to clinically relevant major clones at later disease stages. Therefore, single-cell DNA amplicon sequencing is a sensitive assay to detect clonal architecture and evolution in T-ALL.
Correction to: Impact of migraine on workplace productivity and monetary loss: a study of employees in banking sector in Malaysia
Authors: Wong Li Ping , Alias Haridah , Bhoo-Pathy Nirmala , Chung Ivy , Chong Yew Ching , Kalra Sonesh , Bahkt Sultan Shah Zia U.
Published: August 2020

An amendment to this paper has been published and can be accessed via the original article.
A sparse Bayesian factor model for the construction of gene co-expression networks from single-cell RNA sequencing count data
Authors: Sekula Michael , Gaskins Jeremy , Datta Susmita
Published: August 2020

Background

Gene co-expression networks (GCNs) are powerful tools that enable biologists to examine associations between genes during different biological processes. With the advancement of new technologies, such as single-cell RNA sequencing (scRNA-seq), there is a need for developing novel network methods appropriate for new types of data.

Results

We present a novel sparse Bayesian factor model to explore the network structure associated with genes in scRNA-seq data. Latent factors impact the gene expression values for each cell and provide flexibility to account for common features of scRNA-seq: high proportions of zero values, increased cell-to-cell variability, and overdispersion due to abnormally large expression counts. From our model, we construct a GCN by analyzing the positive and negative associations of the factors that are shared between each pair of genes.

Conclusions

Simulation studies demonstrate that our methodology has high power in identifying gene-gene associations while maintaining a nominal false discovery rate. In real data analyses, our model identifies more known and predicted protein-protein interactions than other competing network models.
Diversification and hybrid incompatibility in auto-pseudogamous species of Mesorhabditis nematodes
Authors: Launay Caroline , Félix Marie-Anne , Dieng Joris , Delattre Marie
Published: August 2020

Background

Pseudogamy is a reproductive system in which females rely on the sperm of males to activate their oocytes, generally parasitizing males of other species, but do not use the sperm DNA. The nematodeMesorhabditis belariuses a specific form of pseudogamy, where females produce their own males as a source of sperm. Males develop from rare eggs with true fertilization, while females arise by gynogenesis. Males thus do not contribute their genome to the female offspring. Here, we explored the diversity of reproductive mode within theMesorhabditisgenus and addressed species barriers in pseudogamous species.

Results

To this end, we established a collection of over 60Mesorhabditisstrains from soil and rotting vegetal matter. We found that males from pseudogamous species displayed a reduced size of their body, male tail and sperm cells compared to males of sexualMesorhabditisspecies, as expected for males that face little competition. Using rDNA sequences and crosses, we could define 11 auto-pseudogamous biological species, with closely related species pairs and a possible single origin of pseudogamy in theMesorhabditisgenus. Most crosses between males and females of different species did not even produce female progeny. This surprising species barrier in pseudogamous egg activation was pre or postcopulatory depending on the species pair. In the latter case, when hybrid embryos were produced, most arrested before the first embryonic cell division. Hybrid incompatibility between auto-pseudogamous species was due to defective interaction between sperm and oocyte as well as defective reconstitution of zygotic centrosomes.

Conclusions

We established a collection of sexual and pseudo-sexual species which offer an ideal framework to explore the origin and consequences of transition to asexuality. Our results demonstrate that speciation occurs in the pseudogamous state. Whereas genomic conflicts are responsible for hybrid incompatibility in sexual species, we here reveal that centrosomes constitute key organelles in the establishment of species barrier.
Analysis of β-catenin association with obesity in African Americans with premalignant and malignant colorectal lesions
Authors: Shokrani Babak , Brim Hassan , Hydari Tahmineh , Afsari Ali , Lee Edward , Nouraie Mehdi , Sherif Zaki , Ashktorab Hassan
Published: August 2020

Background

African Americans (AA) are at high risk for Colorectal Cancer (CRC). Studies report a 30–60% increase in CRC risk with physical inactivity, obesity and metabolic syndrome. Activation of the WNT/β-catenin (CTNNB1) signaling pathway plays a critical role in colorectal carcinogenesis. Accumulating evidence also indicates a role of WNT-CTNNB1 signaling in obesity and metabolic diseases.

Aim

To examine the association between obesity, β-Catenin expression and colonic lesions in African Americans.

Methods

We reviewed the pathology records of 152 colorectal specimens from 2010 to 2012 (46 CRCs, 74 advanced adenomas and 32 normal colon tissues). Tissue Microarrays (TMA) were constructed from these samples. Immunohistochemistry (IHC) for CTNNB1 (β-Catenin; clone β-Catenin-1) was performed on the constructed TMAs. The IHC results were evaluated by 2 pathologists and the nuclear intensity staining was scored from 0 to 4. BMI, sex, age, location of the lesion and other demographic data were obtained.

Results

Positive nuclear staining in normal, advanced adenoma and CRC was 0, 24 and 41%, respectively (P < 0.001). CRC was asso ciated with positive status for nuclear CTNNB1 intensity (adjusted OR: 3.40, 95%CI = 1.42–8.15, P = 0.006 for positive nuclear staining) compared to non-CRC samples (Normal or advanced adenoma). Nuclear staining percentage has a fair diagnostic ability for CRC with an AUC of 0.63 (95%CI = 0.55–0.71).

Overweight/obese patients (BMI > 25) did not show a significant difference in (p = 0.3) nuclear CTNNB1 staining (17% positive in normal weight vs. 27% positive in overweight/obese). The association between nuclear intensity and CRC was not different between normal and overweight patients (P for interaction = 0.6). The positive nuclear CTNNB1status in CRC stage III and IV (35% of all CRC) was not different from stage I and II (50% vs. 36%, respectively, P = 0.4).

Conclusion

In our study, advanced adenoma and CRC were associated with activation of β-catenin in physically fit, overweight and obese patients. Thus, obesity and WNT/β-Catenin pathway seem to be independent in African American patients. WNT/β-Catenin signaling pathway has a potential to be used as an effector in colon carcinogenic transformation. Whether or not BMI is a modifier of this pathway needs to be investigated further.
The sputum microbiome associated with different sub-types of AECOPD in a Chinese cohort
Authors: Wang Juan , Chai Jianmin , Sun Lina , Zhao Jiangchao , Chang Chun
Published: August 2020

Background

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases worldwide. Episodes of acute exacerbations of COPD (AECOPD) are associated with disease severity and progression. Although substantial progress has been made in understanding the dynamics of AECOPD, little is known about the sputum microbiome of AECOPD in the Chinese population.

Methods

In this study, we characterized the sputum microbiomes from sputum specimens collected from healthy controls (n = 10), stable (n = 4), AECOPD (n = 36), and recovery (n = 18) stages by sequencing the V3-V4 region of the 16S rRNA gene with a HiSeq sequencer.

Results

Streptococcus was the most dominant genus among all the different types of sputum. A random forest model was developed to identify bacterial taxa that differentiate AECOPD samples from others. Most of the top predictors, except Pseudomonas, were less abundant in AECOPD samples. We also developed random forest models to differentiate subtypes of AECOPD based on blood eosinophil counts, the frequency of AECOPD, and sputum eosinophils. Bacterial taxa associated with Pasteurellaceae, Fusobacterium, Solobacterium, Haemophilus, Atopobium, Corynebacterium and Streptococcus, were enriched in the sputum microbiomes of eosinophilic AECOPD. Random forest models also demonstrate that a total of 2 bacterial OTUs were needed to differentiate frequent from non-frequent AECOPDs, and 23 OTUs were enough to accurately predict sputum-eosinophilic (sputum eosinophilic concentration ≥ 3%) AECOPD.

Conclusion

This study expanded our understanding of the sputum microbiome associated with different subtypes and clinical status of patients with AECOPD in a Chinese cohort, which provides insights into novel and more targeted management of the different subtypes of AECOPD.
Strongyloides hyperinfection in an HIV-positive kidney transplant recipient: a case report
Authors: Lai Christina , Anderson Matthew , Davis Rebecca , Anderson Lyndal , Wyburn Kate , Chadban Steve , Gracey David
Published: August 2020

Background

Strongyloidiasis is caused by the helminth Strongyloides stercoralis and is well-recognised amongst transplant recipients. Serious complications, including Strongyloides hyperinfection which is a syndrome of accelerated autoinfection, or disseminated disease, can occur post-transplantation, resulting in significant morbidity and mortality. Here we present the first published case we are aware of, describing post-transplant Strongyloides hyperinfection in an HIV-positive kidney transplant patient. We discuss the diagnostic challenges and the role of pre-transplant screening.

Case presentation

A 58-year-old African-American male, originally from the Caribbean, received a deceased donor kidney transplant for presumed focal segmental glomerulosclerosis. He was known to be HIV-positive, with a stable CD4 count, and an undetectable viral load. Five months post-transplant, he developed gastrointestinal symptoms and weight loss. He had a normal eosinophil count (0.1–0.2 × 109/L), negative serum cytomegalovirus DNA, and negative blood and stool cultures. His Strongyloides serology remained negative throughout. A diagnosis of Strongyloides hyperinfection was made by the histological examination of his duodenum and lung, which identified the parasites. He completed his course of treatment with Ivermectin but exhibited profound deconditioning and required a period of total parenteral nutrition. He was subsequently discharged after a prolonged hospital admission of 54 days.

Conclusions

This case highlights the challenges in diagnosing Strongyloides infection and the need to maintain a high index of clinical suspicion. Non-invasive techniques for the diagnosis of Strongyloides may be insufficient. Routine pre-transplant serological strongyloidiasis screening is now performed at our centre.
Gene network in pulmonary tuberculosis based on bioinformatic analysis
Authors: Li Lili , Lv Jian , He Yuan , Wang Zhihua
Published: August 2020

Background

Pulmonary tuberculosis (PTB) is one of the serious infectious diseases worldwide; however, the gene network involved in the host response remain largely unclear.

Methods

This study integrated two cohorts profile datasets GSE34608 and GSE83456 to elucidate the potential gene network and signaling pathways in PTB. Differentially expressed genes (DEGs) were obtained for Gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis using Metascape database. Protein-Protein Interaction (PPI) network of DEGs was constructed by the online database the Search Tool for the Retrieval of Interacting Genes (STRING). Modules were identified by the plug-in APP Molecular Complex Detection (MCODE) in Cytoscape. GO and KEGG pathway of Module 1 were further analyzed by STRING. Hub genes were selected for further expression validation in dataset GSE19439. The gene expression level was also investigated in the dataset GSE31348 to display the change pattern during the PTB treatment.

Results

Totally, 180 shared DEGs were identified from two datasets. Gene function and KEGG pathway enrichment revealed that DEGs mainly enriched in defense response to other organism, response to bacterium, myeloid leukocyte activation, cytokine production, etc. Seven modules were clustered based on PPI network. Module 1 contained 35 genes related to cytokine associated functions, among which 14 genes, including chemokine receptors, interferon-induced proteins and Toll-like receptors, were identified as hub genes. Expression levels of the hub genes were validated with a third dataset GSE19439. The signature of this core gene network showed significant response to Mycobacterium tuberculosis (Mtb) infection, and correlated with the gene network pattern during anti-PTB therapy.

Conclusions

Our study unveils the coordination of causal genes during PTB infection, and provides a promising gene panel for PTB diagnosis. As major regulators of the host immune response to Mtb infection, the 14 hub genes are also potential molecular targets for developing PTB drugs.
Association of MC4R (rs17782313) with diabetes and cardiovascular disease in Korean men and women
Authors: Sull Jae Woong , Kim Gitae , Jee Sun Ha
Published: August 2020

Background

Diabetes is mostly assessed by the fasting glucose level. Several studies reported that serum fasting glucose levels and cardiovascular disease are associated with MC4R.

Methods

A total of 4294 subjects participated in this study. There were 1810 subjects with cardiovascular disease among the 4294 subjects. We used multivariate linear regression models and multiple logistic regression analysis.

Results

Individuals with the TC/CC genotype had a 1.29-fold higher risk of diabetes than did those with the TT genotype when adjusting for age, sex, and BMI (OR, 1.29; 95% CI, 1.04–1.60). For healthy subjects, the association was significant in women (OR, 1.99; 95% CI, 1.01–3.93). Men with the TC/CC genotype had a 1.21-fold higher risk of cardiovascular disease than did those with the TT genotype when adjusting for age, sex, and BMI (OR, 1.21; 95% CI, 1.04–1.41). The relationship between MC4R and cardiovascular disease was stronger in lean men (OR, 1.40; 95% CI, 1.12–1.74, p = 0.0028) than in overweight men.

Conclusions

This study suggests that the rs17782313 SNP in MC4R is related to diabetes and the SNP is also associated with cardiovascular disease in lean men.
A systematic review and meta-analysis to evaluate the diagnostic accuracy of recognition of stroke in the emergency department (ROSIER) scale
Authors: Han Fei , Zuo Chao , Zheng Guodong
Published: August 2020

Background

The present study aims to evaluate the performance and the clinical applicability of the Recognition of Stroke in the Emergency Department (ROSIER) scale via systematic review and meta-analysis.

Methods

Electronic databases of Pubmed and Embase were searched between 1st January 2005 (when ROSIER developed) and 8th May 2020. Studies that evaluated the diagnostic accuracy of the ROSIER scale were included. The sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were combined using a bivariate mixed-effects model. Fagan nomogram was used to evaluate the clinical applicability of the ROSIER scale.

Results

A total of 14 studies incorporating 15 datasets were included in this meta-analysis. The combined sensitivity, specificity, DOR and AUC were 0.88 [95% confidence interval (CI): 0.83–0.91], 0.66 (95% CI: 0.52–0.77), 13.86 (95% CI, 7.67–25.07) and 0.88 (95% CI, 0.85–0.90), respectively. Given the pre-test probability of 60.0%, Fagan nomogram suggested the post-test probability was increased to 79% when the ROSIER was positive. In comparison, it was decreased to 22% when ROSIER was negative. Subgroup analysis showed that the pooled sensitivity of ROSIER in the European population was higher than that in Asia. In contrast, the pooled specificity was not significantly different between them. Moreover, results also suggested the male-to-female ratio ≤ 1.0 subgroup, prehospital setting subgroup, and other trained medical personnel subgroup had significantly higher sensitivity compared with their counterparts. At the same time, no significant differences were found in the pooled specificity between them.

Conclusions

ROSIER is a valid scale with high clinical applicability, which has not only good diagnostic accuracy in Europe but also shows excellent performance in Asia. Moreover, the ROSIER scale exhibits good applicability in prehospital settings with other trained medical personnel.
PARP inhibitors combined with ionizing radiation induce different effects in melanoma cells and healthy fibroblasts
Authors: Weigert Verena , Jost Tina , Hecht Markus , Knippertz Ilka , Heinzerling Lucie , Fietkau Rainer , Distel Luitpold V.
Published: August 2020

Background

PARP inhibitors niraparib and talazoparib are FDA approved for special cases of breast cancer. PARP is an interesting repair protein which is frequently affected in cancer cells. We studied the combined action of talazoparib or niraparib with ionizing radiation in melanoma cells and healthy fibroblasts.

Methods

Homologous recombination (HR) status in six different melanoma cell lines and healthy fibroblasts was assessed. Cell cultures were treated with PARP inhibitors talazoparib or niraparib and ionizing radiation (IR). Apoptosis, necrosis and cell cycle distribution was analyzed via flow cytometry. Cell migration was studied by scratch assays.

Results

Studied melanoma cell cultures are HR deficient. Studied healthy fibroblasts are HR proficient. Talazoparib and niraparib have congruent effects within the same cell cultures. In all cell cultures, combined treatment increases cell death and G2/M arrest compared to IR. Combined treatment in melanoma cells distinctly increases G2/M arrest. Healthy fibroblasts are less affected by G2/M arrest. Treatment predominantly decelerates or does not modify migration. In two cell cultures migration is enhanced under the inhibitors.

Conclusions

Although the two PARP inhibitors talazoparib and niraparib appear to be suitable for a combination treatment with ionizing radiation in our in vitro studies, a combination treatment cannot generally be recommended. There are clear interindividual differences in the effect of the inhibitors on different melanoma cells. Therefore, the effect on the cancer cells should be studied prior to a combination therapy. Since melanoma cells increase more strongly than fibroblasts in G2/M arrest, the fractional application of combined treatment should be further investigated.
Comparison of overall survival of gastric neoplasms containing neuroendocrine carcinoma components with gastric adenocarcinoma: a propensity score matching study
Authors: Chen Jiahui , Wang Anqiang , Ji Ke , Bu Zhaode , Ji Jiafu
Published: August 2020

Background

Gastric neoplasms containing neuroendocrine carcinoma (NEC) components are rare malignancies with highly aggressive behavior and a poor prognosis and include pure NEC and mixed tumors containing NEC components. We aimed to investigate whether there is a distinct difference in overall survival (OS) between gastric neoplasms containing NEC components and gastric adenocarcinoma.

Methods

Surgically resected gastric neoplasms containing NEC components (n = 180) and gastric adenocarcinomas (n = 785) from January 2013 to December 2019 at Peking University Cancer Hospital were retrospectively analysed. Patients were categorized into a surgical group and a neoadjuvant group and adjusted using propensity score matching. In the two groups, gastric neoplasms containing NEC components were divided into pure NEC and mixed tumors with less than 30% (< 30% G-HMiNEN), between 30 and 70% (G-HMiNEN) and more than 70% (> 70% G-HMiNEN) neuroendocrine carcinoma components. OS was compared between these groups and the gastric adenocarcinoma group.

Results

The OS of gastric neoplasms containing neuroendocrine NEC components was poorer than that of gastric adenocarcinomas in the surgical group, regardless of whether the percentage of neuroendocrine cancer components was less than 30%, between 30 and 70%, more than 70% or 100%. Cox multivariable regression analysis suggested that tumor category (neoplasms containing NEC components or gastric adenocarcinoma) was an independent risk factor for prognosis. Interestingly, among patients receiving neoadjuvant therapy, the difference was not significant.

Conclusions

Gastric neoplasms containing any proportion of NEC components had poorer overall survival than gastric adenocarcinoma in patients treated with surgery directly, indicating that these neoplasms are more malignant than gastric adenocarcinoma. Among the patients receiving neoadjuvant therapy, the difference in overall survival was not significant, which was in sharp contrast with the results of the surgery group, suggesting that neoadjuvant therapy may have a good effect in the treatment of these neoplasms.
Probability of myopia in children with high refined carbohydrates consumption in France
Authors: Berticat Claire , Mamouni Sonia , Ciais Angelique , Villain Max , Raymond Michel , Daien Vincent
Published: August 2020

Background

Evaluate risk factors for paediatric myopia in a contemporary French cohort taking into account consumption of refined carbohydrates (starches and sugars).

Methods

An epidemiological cross-sectional study was conducted between May 2017 and May 2018.

Two hundred sixty-four children aged 4 to 18 years attending the Centre Hospitalier Universitaire Gui de Chauliac in Montpellier were recruited. Ophthalmologic or optometric cycloplegic refraction were measured. Evaluated risk factors for myopia were collected, including family history of myopia, outdoor time, reading time, screen time, physical activity, and consumption of refined carbohydrates. Association between the probability of at least one eye showing myopia (defined as < 0 D) and frequency of refined carbohydrates consumption adjusted for risk factors and control factors was tested.

Results

Overall, 86/264 (32.6%) children investigated showed myopia in at least one eye. We included 180 children exhibiting refraction < 3 D in both eyes: 88 (48.9%) girls and 92 (51.1%) boys. The consumption of refined carbohydrates significantly increased the probability of myopia for girls (odds ratio [OR] = 1.07; 95% confidence interval [CI], 1.02–1.13; P = 0.009) but decreased it for boys (OR = 0.94; 95% CI, 0.89–0.98; P = 0.011). The probability of myopia was marginally increased with increased screen time (OR = 2.32; 95% CI, 0.94–6.47; P = 0.083). Outdoor time seemed marginally protective (OR = 0.74; 95% CI, 0.54–1.01; P = 0.057).

Conclusion

Refined carbohydrates consumption could be associated with child myopia, with increased probability for girls and unexpected reduced probability for boys, possibly due to the fact that frequency of carbohydrates consumption do not really capture boy’s chronic hyperglycemia, boys being more physically active than girls at all ages. Some known risk/protective factors of myopia were marginally significant: screen time (risk) and outdoor time (protective). This study reinforces the belief that modifiable risk factors for myopia could be targets for future public health actions.
Exercise interventions for the prevention of depression: a systematic review of meta-analyses
Authors: Hu Mandy X. , Turner David , Generaal Ellen , Bos Daniel , Ikram M. Kamran , Ikram M. Arfan , Cuijpers Pim , Penninx Brenda W. J. H.
Published: August 2020

Background

Exercise may be a promising target for depression interventions. However, evidence for a beneficial effect of exercise interventions on the prevention of depression differs substantially across different studies.

Methods

A systematic search was performed up to July 2018 using PubMed, Embase, PsycINFO, and Cochrane. Articles were included if a meta-analysis of randomized controlled trials was performed that examined the effect of exercise interventions on the onset of depression or depressive symptoms in the general population. Meta-analyses focusing on treatment of diagnosed depression were excluded. Two authors independently screened the articles and graded the quality of included meta-analyses using AMSTAR 2.

Results

Eight meta-analyses were included that showed little overlap in 134 included studies. All meta-analyses reported on depressive symptoms rather than onset of depression. Five of these were rated as moderate quality and three of low quality. Six meta-analyses found significant effects, and two found non-significant effects of exercise interventions in reducing depressive symptoms in children, adolescents, adults and the elderly (effect sizes ranging from − 0.10 to − 0.81). Scarce evidence did not allow to draw conclusions about the role of sex and characteristics of exercise on depression. However, some findings suggest that low intensity exercise was as effective as high intensity exercise. Heterogeneity among primary studies was high, likely caused by differences in study quality and exercise characteristics.

Conclusions

The evidence from this study suggests that exercise interventions have a beneficial effect on depressive symptoms in the general population across a wide age-range.
The longitudinal NIHR ARC North West Coast Household Health Survey: exploring health inequalities in disadvantaged communities
Authors: Giebel Clarissa , McIntyre Jason C. , Alfirevic Ana , Corcoran Rhiannon , Daras Konstantinos , Downing Jennifer , Gabbay Mark , Pirmohamed Munir , Popay Jennie , Wheeler Paula , Holt Keith , Wilson Timothy , Bentall Richard , Barr Ben
Published: August 2020

Background

The Household Health Survey (HHS) was developed to understand the socioeconomic determinants of mental and physical health, and health inequalities in health and social care. This paper aims to provide a detailed rationale of the development and implementation of the survey and explore socio-economic variations in physical and mental health and health care.

Methods

This comprehensive longitudinal public health survey was designed and piloted in a disadvantaged area of England, comprising questions on housing, physical health, mental health, lifestyle, social issues, environment, work, and finances. After piloting, the HHS was implemented across 28 neighbourhoods – 10 disadvantaged neighbourhoods for learning (NfLs), 10 disadvantaged comparator sites, and eight relatively advantaged areas, in 2015 and 2018. Participants were recruited via random sampling of households in pre-selected neighbourhoods based on their areas of deprivation.

Results

7731 residents participated in Wave 1 (N = 4319) and 2 (n = 3412) of the survey, with 871 residents having participated in both. Mental health, physical health, employment, and housing quality were poorer in disadvantaged neighbourhoods than in relatively advantaged areas.

Conclusions

This survey provides important insights into socio-economic variations in physical and mental health, with findings having implications for improved care provision to enable residents from any geographical or socio-economic background to access suitable care.
H. Pylori is related to osteoporosis but only in premenopausal female: a cross-sectional study
Authors: Wang Jing-Wei , Dong Feng-Xiao , Su Hui , Zhu Licun , Shao Sujun , Liu Hong
Published: August 2020

Background

Recently, an increasing number of studies have focused on the extra-gastrointestinal effects of Helicobacter pylori (H. pylori), including metabolic syndrome, fatty liver, and rheumatic and skin diseases. Osteoporosis is an asymptomatic disease that can eventually lead to fractures and has a significant impact on the quality of life of elderly individuals. Sex is an influential factor that plays a crucial role in the development of osteoporosis. The aim of this study was to investigate the relationship between H. pylori infection and osteoporosis and to identify potential influencing factors.

Methods

We conducted a cross-sectional study of individuals older than 50 years old, who had undergone regular physical examinations at the Beijing Shijitan Hospital Health Examination Center from July to October 2018. We evaluated the associations of osteopenia and osteoporosis with H. pylori infection and related serum markers by using multiple linear regression and logistic regression. Then, we analysed the correlation between sex and potential serum biomarkers.

Results

There were significant relationships between H. pylori infection status and bone density in premenopausal females but not in males (P = 0.381) according to Fisher’s exact test. In females, H. pylori positivity (OR = 0.132, P = 0.023), Body Mass Index (BMI) (OR = 28.163, P = 0.021), and homocysteine (HCY) (OR = 17.218, P = 0.045) were associated with osteoporosis. Calcium had a trend but no statistically significant (OR = 0.060, P = 0.076) relationship with osteoporosis. Furthermore, the waist-to-hip ratio (OR = 5.783, P = 0.029), BMI (OR = 0.152, P = 0.014) and triglyceride levels (OR = 0.201, P = 0.036) were significantly different by sex, after adjusting for age as a confounder.

Conclusion

H. pylori positivity, BMI and HCY are associated with osteoporosis in premenopausal females. Chronic inflammation may be involved in the relationship between H. pylori and osteoporosis.
The development of a framework of entrustable professional activities for the intern year in Ireland
Authors: O’Dowd Emily , Lydon Sinéad , O’Connor Paul , Boland Josephine , Offiah Gozie , Byrne Dara
Published: August 2020

Background

Entrustable Professional Activities (EPAs) are units of professional practice that capture essential competencies in which trainees must become proficient before undertaking them independently. EPAs provide supervisors with a solid justification for delegating an activity to trainees. This study aimed to develop and ensure face validity of a set of EPAs for junior doctors in the first year of clinical practice in the Republic of Ireland.

Methods

An iterative eight stage consensus building process was used to develop the set of EPAs. This process was based on international best practice recommendations for EPA development. A series of surveys and workshops with stakeholders was used to develop a framework of EPAs and associated competencies. An external stakeholder consultation survey was then conducted by the Irish Medical Council. The framework of EPAs was then benchmarked against the 13 core EPAs developed by the Association of American Medical Colleges (AAMC).

Results

A framework of seven EPAs, and associated competencies resulted from this study. These EPAs address all core activities that junior doctors should be readily entrusted with at the end of the intern year, which is the first year of clinical practice in the Republic of Ireland. Each EPA contains a series of defined competencies. The final EPAs were found to be comparable to the AAMC core EPAs for entering residency.

Conclusions

A framework of EPAs for interns in Ireland that are appropriate for the intern year has been developed by key stakeholders. The implementation of the EPAs in practice is the next step, and is likely to result in an improved intern training process and increased patient safety.
Exploring links between resilience and the macro-level development of healthcare regulation- a Norwegian case study
Authors: Øyri Sina Furnes , Braut Geir Sverre , Macrae Carl , Wiig Siri
Published: August 2020

Background

The relationship between quality and safety regulation and resilience in healthcare has received little systematic scrutiny. Accordingly, this study examines the introduction of a new regulatory framework (the Quality Improvement Regulation) in Norway that aimed to focus on developing the capacity of hospitals to continually improve quality and safety. The overall aim of the study was to explore the governmental rationale and expectations in relation to the Quality Improvement Regulation, and how it could potentially influence the management of resilience in hospitals. The study applies resilience in healthcare and risk regulation astheoretical perspectives.

Methods

Thedesignis a single embedded case study, investigating the Norwegian regulatory healthcare regime. Data was collected by approaching three regulatory bodies through formal letters, asking them to provide internal and public documents, and by searching through open Internet-sources. Based on this, we conducted a document analysis, supplemented by interviews with seven strategic informants in the regulatory bodies.

Results

Therationalefor introducing the Quality Improvement Regulation focused on challenges associated with implementation, lack of management competencies; need to promote quality improvement as a managerial responsibility. Some informants worried that the generic regulatory design made it less helpful for managers and clinicians, others claimed a non-detailed regulation was key to make it fit all hospital-contexts. The Government expected hospital managers to obtain an overview of risks and toadaptrisk management and quality improvement measures to their specific context and activities.

Conclusions

Based on the rationale of making the Quality Improvement Regulation flexible to hospital context, encouraging the ability to anticipate local risks, along with expectations about the generic design as challenging for managers and clinicians, we found that the regulators did consider work as done as important when designing the Quality Improvement Regulation. These perspectives are in line with ideas of resilience. However, the Quality Improvement Regulation might be open for adaptation by the regulatees, but this may not necessarily mean that it promotes or encourages adaptive behavior in actual practice. Limited involvement of clinicians in the regulatory development process and a lack of reflexive spaces might hamper quality improvement efforts.
Assessing the capacity for conflict and health research in Lebanon: a qualitative study
Authors: El Achi Nassim , Honein-Abouhaidar Gladys , Rizk Anthony , Kobeissi Elsa , Papamichail Andreas , Meagher Kristen , Ekzayez Abdulkarim , Abu-Sittah Ghassan S. , Patel Preeti
Published: August 2020

Background

Conflicts pose new challenges for health systems, requiring rapid and practical approaches to meet emerging needs on the ground. Lebanon has been highly influenced by surrounding conflicts in the Middle East and North Africa (MENA) region, especially the Syrian crisis. Strengthening research capacity to collect evidence on conflict in the MENA region and beyond is crucial to inform healthcare policy and practice. For targeted capacity strengthening interventions, the main objective of this paper is to present key findings of a needs assessment of conflict and health research in Lebanon. This will support recent efforts to scale up context-specific policies, interventions to strengthen the country’s health system, and research capacity.

Methods

The study is based on 30 semi-structured interviews with key informants such as specialist academics, humanitarian workers and public sector officials.

Results

Despite being ranked third in the number of publications on biomedical and health research per capita in MENA and in hosting reputable universities which are considered central academic hubs in the region, lack of nationwide research culture, insufficient funding and limited access to data were reported to be major challenges for health researchers in Lebanon. Even with the ongoing efforts, poor impact of research on policy continues to be a persistent gap. Large disparities in research capacities and taught skills were reported between different universities in Lebanon, with a disproportionate emphasis on quantitative over qualitative skills. Most medical students are not trained to conduct research or to practice in conflict settings. Concerns were also expressed regarding the ethics of research conducted, specifically by local non-governmental organizations.

Recommendations

To conduct contextualized trainings on research skills with a stronger focus on qualitative approaches, medical practice, and ethical research in conflict. To better involve policymakers in designing research agendas by organizing multiple stakeholder meetings.

Conclusion

The study indicates that health research in Lebanon is characterized by considerable strengths in terms of human capital and research capacities of certain universities. However, the Lebanese research infrastructure needs further development in terms of ensuring sustainable funding, providing access to data, teaching qualitative research skills, conducting ethical and multidisciplinary research, and promoting cross-sectoral knowledge transfer.