Nevin Manimala

World J Surg Oncol. 2022 May 11;20(1):152. doi: 10.1186/s12957-022-02616-z.

ABSTRACT

BACKGROUND: To evaluate the diagnostic accuracy of single gastroscopy, multi-slice spiral CT, HER-2 or tumor markers, and their combination in the diagnosis of gastric cancer.

METHODS: A total of 98 patients with gastric cancer were selected as the research subjects. All patients underwent preoperative gastroscopy, MSCT, and the expression levels of HER-2, CEA, CA199, CA724, and CA242 were detected. A control group of 98 normal adults was selected to compare the risk factors for gastric cancer and to analyze the data.

RESULTS: There was statistical significance in the expression of the 5 markers in tumor size (P < 0.05), but no statistical significance in other clinical data (P > 0.05). The tumor marker CEA in gastric mucosal tissue of patients with gastric cancer had the highest positive detection rate for gastric cancer, and the difference was statistically significant (P < 0.05) compared with gastroscopy, MSCT and other markers. The combined diagnosis had higher sensitivity, specificity and accuracy compared with the single diagnosis of gastric cancer staging, and the difference was statistically significant (P < 0.05). Compared with normal adults, patients with gastric cancer had statistically significant differences in diet, body mass index, and family genetic history (P < 0.05), while there was no statistically significant difference in whether they had type A blood (P > 0.05).

CONCLUSION: The combined diagnosis of gastroscopy, MSCT, immunohistochemical marker Her-2, and tumor markers CEA, CA199, CA724, and CA242 can more accurately determine the clinical staging and lesion invasion depth of patients with gastric cancer and can significantly improve the sensitivity of diagnosis.

PMID:35545785 | DOI:10.1186/s12957-022-02616-z

BMC Health Serv Res. 2022 May 12;22(1):630. doi: 10.1186/s12913-022-08031-0.

ABSTRACT

BACKGROUND: Facilitating the primary health care (PHC) system and maintaining people’s reasonable healthcare-seeking behavior are key to establishing a sustainable healthcare system. China has employed a multitiered copayment system/medical insurance differentiated payment policies to incentivize the public to utilize PHC services through its hierarchical medical care system; however, most people still prefer visiting tertiary care hospitals. We question whether the quality gap in healthcare services reduces the effect of the multitiered copayment system, which is considered an important factor in the lack of reform in the Chinese healthcare system. Thus, we explore the effect and influencing factors of the multitiered copayment system that drives primary healthcare-seeking behavior under the current situation with a large quality gap. We also consider the hypothetical situation of a reduced gap in the future.

METHODS: This study used the hypothetical quality improvement scenario to elicit people’s hypothetical behaviors, and a multistage stratified cluster random sampling method. This preliminary study was conducted in 2016 using 1829 individuals from four regions of Wenzhou in Zhejiang Province: Ouhai, Ruian, Yongjia, and Taishun. A descriptive statistical analysis, chi-square analysis, Fisher’s exact test, and multinomial logistic regression model were performed to introduce the effect of the multitiered copayment system, and to explore the factors affecting the selection of PHC institutions at pre- and post-change phases.

RESULT: The results show that compared with the large quality gap phase, the number of respondents who believed the multitiered copayment system had an effect on their selection of PHC institutions after the equalization of healthcare services quality increased threefold (from 14.0% to 50.8%). Moreover, the main determinants in people’s selection of PHC institutions changed from age and needs variables (self-rated health status) to age, needs variables (self-rated health status) and enabling variables (distance to a medical care facility).

CONCLUSION: The results indicate limited initial effects of the multitiered copayment system. However, they become more pronounced after the equalization of healthcare services quality. This study confirms that changes in the quality gap in healthcare services influence the effect of the multitiered copayment system. Hence, reducing this gap can help achieve the intended outcome of the tiered healthcare insurance schedule.

PMID:35545782 | DOI:10.1186/s12913-022-08031-0

BMC Endocr Disord. 2022 May 11;22(1):123. doi: 10.1186/s12902-022-01041-3.

ABSTRACT

OBJECTIVE: The prevalence of diabetes mellitus (DM), cardio-cerebrovascular diseases (CCVDs) has increased during recent decades. We aimed to investigate the relationship between body mass index (BMI) and each of several outcomes (DM, CCVDs, or mortality) based on the Korean National Health Insurance Service-Health Screening cohort.

METHODS: BMI was categorized as appropriate for Asian populations, into underweight (< 18.5 kg/m²), normal (18.5-< 23 kg/m²), overweight (23-< 25 kg/m²), grade 1 obesity (25-< 30 kg/m²), grade 2 obesity (30-< 35 kg/m²), and grade 3 obesity (≥35 kg/m²). In addition, BMI was further stratified into one unit. Multivariate Cox proportional hazards regression analyses were conducted to examine the association between BMI category and the primary outcomes (DM, CCVDs, or mortality).

RESULTS: A total of 311,416 individuals were included. The median follow-up was 12.5 years. Compared to normal BMI, underweight, overweight, and grade 1-3 obese individuals had a higher risk of the primary outcomes (hazard ratio [95% confidence intervals] 1.293 [1.224-1.365], 1.101 [1.073-1.129], 1.320 [1.288-1.353], 1.789 [1.689-1.897], and 2.376 [2.019-2.857], respectively, in men and 1.084 [1.010-1.163], 1.150 [1.116-1.185], 1.385 [1.346-1.425], 1.865 [1.725-2.019], and 2.472 [2.025-3.028], respectively, in women). Setting the reference BMI to 20-< 21 kg/m² and categorizing into one unit increment, BMI was associated with the primary outcomes in a J-shaped manner in both sexes. The risk of DM increased with higher BMI in both sexes, while all-cause mortality decreased in men with a BMI 21-< 31 kg/m² and women with BMI 22-< 30 kg/m².

CONCLUSIONS: BMI was associated with all-cause mortality in a J-shaped manner in both sexes, while it was associated with risk of DM in a dose-response relationship. The relationship between BMI and the primary outcomes was J-shaped.

PMID:35545762 | DOI:10.1186/s12902-022-01041-3

BMC Genomics. 2022 May 11;23(Suppl 4):362. doi: 10.1186/s12864-022-08580-y.

ABSTRACT

BACKGROUND: Multiple sclerosis (MS) is a debilitating immune-mediated disease of the central nervous system that affects over 2 million people worldwide, resulting in a heavy burden to families and entire communities. Understanding the genetic basis underlying MS could help decipher the pathogenesis and shed light on MS treatment. We refined a recently developed Bayesian framework, Integrative Risk Gene Selector (iRIGS), to prioritize risk genes associated with MS by integrating the summary statistics from the largest GWAS to date (n = 115,803), various genomic features, and gene-gene closeness.

RESULTS: We identified 163 MS-associated prioritized risk genes (MS-PRGenes) through the Bayesian framework. We replicated 35 MS-PRGenes through two-sample Mendelian randomization (2SMR) approach by integrating data from GWAS and Genotype-Tissue Expression (GTEx) expression quantitative trait loci (eQTL) of 19 tissues. We demonstrated that MS-PRGenes had more substantial deleterious effects and disease risk. Moreover, single-cell enrichment analysis indicated MS-PRGenes were more enriched in activated macrophages and microglia macrophages than non-activated ones in control samples. Biological and drug enrichment analyses highlighted inflammatory signaling pathways.

CONCLUSIONS: In summary, we predicted and validated a high-confidence MS risk gene set from diverse genomic, epigenomic, eQTL, single-cell, and drug data. The MS-PRGenes could further serve as a benchmark of MS GWAS risk genes for future validation or genetic studies.

PMID:35545758 | DOI:10.1186/s12864-022-08580-y

BMC Infect Dis. 2022 May 11;22(1):449. doi: 10.1186/s12879-022-07428-w.

ABSTRACT

BACKGROUND: In sub-Saharan Africa, data on virologic outcomes of young people living with HIV (YLWH) enrolled on antiretroviral therapy (ART) remains scarce. In this study, we describe the prevalence of HIV virological non-suppression (VNS) and its associated factors among YLWH aged 18-24 years from the Kenyan coast.

METHODS: Data were analyzed for 384 YLWH who participated in a larger cross-sectional study conducted between November 2018 and September 2019 in two counties at the Kenyan coast (Kilifi and Mombasa). Descriptive statistics were used to summarize sample characteristics and logistic regression was used for statistical modeling of factors associated with VNS. In this study, VNS was defined as plasma viral load ≥ 1000 copies/mL.

RESULTS: Among these YLWH with a mean age of 20.7 years (SD = 2.2); 55.5% females, the overall prevalence of VNS was 32.0% (95% Confidence interval (95% CI): 27.5, 36.9%). In the multivariable logistic regression analysis, being from a largely rural setting (adjusted Odds Ratio (aOR) 1.73, 95% CI 1.10, 2.71; p = 0.02), underweight (aOR 1.87, 95% CI 1.16, 3.01; p = 0.01) and low self-reported ART adherence (aOR 2.83, 95% CI 1.34, 6.00; p = 0.01) were significantly associated with higher odds of VNS in YLWH.

CONCLUSIONS: In this study, high levels of VNS were observed among YLWH and this was significantly associated with rural residency, nutritional and ART adherence problems. ART adherence counselling and nutritional support and education should be intensified in this setting targeting YLWH residing mostly in rural areas. Given the high frequency of VNS, there is need to closely monitor viral load and profile HIV drug resistance patterns in youths from the Kenyan coast with confirmed virologic failure. The latter will help understand whether drug resistance also contributes to poor viral suppression in addition to, or exclusive of suboptimal ART adherence.

PMID:35545757 | DOI:10.1186/s12879-022-07428-w

Acta Parasitol. 2022 May 11. doi: 10.1007/s11686-022-00559-9. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to determine the possible association between Toxoplasma gondii infection and COVID-19 outcomes among 133 patients with an RT-PCR-positive test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), hospitalized at Imam Khomeini Hospital, Sari, Mazandaran Province, northern Iran, during August to November 2020.

METHODS: A questionnaire was used to collect baseline data from the patients who were registered to the Iranian National Registry Center for Toxoplasmosis (INRCT). Also, blood samples were taken from each patient for detecting anti-T. gondii antibodies and T. gondii DNA using enzyme-linked immunosorbent assay (ELISA) and conventional-PCR methods, respectively. Variables related to the COVID-19 severity and outcomes were indicated based on multiple multinomial logistic regression models.

RESULTS: Of 133 patients enrolled in the INRCT with COVID-19 through RT-PCR, 50 (37.59%), 52 (39.1%), and 31 (23%) suffered from mild, moderate, and severe COVID-19, respectively. 57.1% of the patients who died had severe COVID-19, while among those with other outcomes, only 18.60% had severe COVID-19 (P < 0.05). Anti-T. gondii IgG was detected in 109/133 (81.95%) patients, which was not statistically significant (P > 0.05). Among those with negative and positive anti-T. gondii IgG, 2 (8.30%) and 29 (26.60%) had severe COVID-19, respectively (P > 0.05). T. gondii DNA and anti-T. gondii IgM were not found in any of the patients. Moreover, all deaths occurred in those with moderate or severe COVID-19 and a positive anti-T. gondii IgG.

CONCLUSION: To our knowledge, this is the first registry-based study concerning T. gondii infection among patients with COVID-19. Our data show the high rate of latent T. gondii infection among COVID-19 with different severity. However, there is no significant relationship between latent T. gondii infection and COVID-19 severity and outcomes. Thus, conducting multicenter studies in different geographic regions of the world could offer a better understanding of this relationship.

PMID:35545737 | DOI:10.1007/s11686-022-00559-9

Acta Parasitol. 2022 May 11. doi: 10.1007/s11686-022-00560-2. Online ahead of print.

ABSTRACT

PURPOSE: The present study aimed to estimate the prevalence and molecular characterization of Cryptosporidium spp. in six different fish species both from marine and freshwater environments.

METHODS: During a period of 2 years (2018-2020), a total of 415 fecal samples and 565 intestinal scrapings were collected in seven provinces from the central and eastern Algeria. From those, 860 fish belonged to six different species, two of which are cultured marine and four are wild freshwater fish. All samples were screened for Cryptosporidium spp. presence using molecular techniques. Nested PCR approach was performed to amplify partial sequences of the small subunit ribosomal RNA (SSU rRNA) and 60-kDa glycoprotein (GP60) genes for Cryptosporidium genotyping and subtyping. Detailed statistical analysis was performed to assess the prevalence variation of Cryptosporidium infection according to different risk factors.

RESULTS: Nested PCR analysis of SSU gene revealed 173 Cryptosporidium positive fish, giving an overall prevalence of 20.11% (17.5-23.0). Cryptosporidium spp. was detected in 8.93% (42/470) of cultured marine fish and 33.58% (131/390) of wild freshwater fish. Overall, the prevalence was affected by all studied risk factors, except the gender. Molecular characterization and subtyping of Cryptosporidium isolates showed occurrence of IIaA16G2R1 and IIaA17G2R1 subtypes of C. parvum in the fish species Sparus aurata.

CONCLUSION: The present study provides the first epidemiological data on the prevalence and associated risk factors of Cryptosporidium spp. in farmed marine and wild freshwater fish and the first molecular data on the occurrence of zoonotic C. parvum in fish from North Africa (Algeria).

PMID:35545736 | DOI:10.1007/s11686-022-00560-2

Nat Methods. 2022 May 11. doi: 10.1038/s41592-022-01463-w. Online ahead of print.

ABSTRACT

Photoactivated localization microscopy (PALM) produces an array of localization coordinates by means of photoactivatable fluorescent proteins. However, observations are subject to fluorophore multiple blinking and each protein is included in the dataset an unknown number of times at different positions, due to localization error. This causes artificial clustering to be observed in the data. We present a ‘model-based correction’ (MBC) workflow using calibration-free estimation of blinking dynamics and model-based clustering to produce a corrected set of localization coordinates representing the true underlying fluorophore locations with enhanced localization precision, outperforming the state of the art. The corrected data can be reliably tested for spatial randomness or analyzed by other clustering approaches, and descriptors such as the absolute number of fluorophores per cluster are now quantifiable, which we validate with simulated data and experimental data with known ground truth. Using MBC, we confirm that the adapter protein, the linker for activation of T cells, is clustered at the T cell immunological synapse.

PMID:35545712 | DOI:10.1038/s41592-022-01463-w

Aesthetic Plast Surg. 2022 May 11. doi: 10.1007/s00266-022-02907-6. Online ahead of print.

ABSTRACT

BACKGROUND: Mastectomy is the most common and sometimes the only surgery performed in FtM transgender individuals. In this study, it was aimed to evaluate the improvement in life standards of patients who underwent double incision mastectomy with free nipple-areolar complex graft and periareolar mastectomy by using TRANS-Q in trans men.

MATERIALS AND METHODS: TRANS-Q was performed in 71 trans men at the preoperative and postoperative 1st year, and the revision and complication rates in both groups were compared.

RESULTS: A statistically significant difference was observed in the postoperative satisfaction rates in both groups. We observed that the patients who underwent periareolar mastectomy had significantly higher satisfaction rates than the patients who underwent double incision mastectomy with free nipple areolar complex graft. In both groups, postoperative satisfaction rates were found to be significantly higher.

CONCLUSION: Improvement in life standards has been observed in trans men who underwent mastectomy, and late results should be evaluated with further prospective studies.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:35545705 | DOI:10.1007/s00266-022-02907-6

Nature. 2022 May 11. doi: 10.1038/s41586-022-04718-w. Online ahead of print.

ABSTRACT

Immunotherapies have achieved remarkable successes in the treatment of cancer, but major challenges remain^1,2. An inherent weakness of current treatment approaches is that therapeutically targeted pathways are not restricted to tumours, but are also found in other tissue microenvironments, complicating treatment^3,4. Despite great efforts to define inflammatory processes in the tumour microenvironment, the understanding of tumour-unique immune alterations is limited by a knowledge gap regarding the immune cell populations in inflamed human tissues. Here, in an effort to identify such tumour-enriched immune alterations, we used complementary single-cell analysis approaches to interrogate the immune infiltrate in human head and neck squamous cell carcinomas and site-matched non-malignant, inflamed tissues. Our analysis revealed a large overlap in the composition and phenotype of immune cells in tumour and inflamed tissues. Computational analysis identified tumour-enriched immune cell interactions, one of which yields a large population of regulatory T (T_reg) cells that is highly enriched in the tumour and uniquely identified among all haematopoietically-derived cells in blood and tissue by co-expression of ICOS and IL-1 receptor type 1 (IL1R1). We provide evidence that these intratumoural IL1R1⁺ T_reg cells had responded to antigen recently and demonstrate that they are clonally expanded with superior suppressive function compared with IL1R1^– T_reg cells. In addition to identifying extensive immunological congruence between inflamed tissues and tumours as well as tumour-specific changes with direct disease relevance, our work also provides a blueprint for extricating disease-specific changes from general inflammation-associated patterns.

PMID:35545675 | DOI:10.1038/s41586-022-04718-w