Specific Risk Groups Research Articles

Prevention of cognitive decline and dementia by treatment of risk factors

In Germany, approximately 1.6 million people are currently suffering from dementia. The prevalence of the disease is expected to double by 2060. To date there is no treatment that can prevent the onset of dementia. For this reason, the development of prevention strategies for cognitive decline and dementia is crucial. Presentation of studies on dementia prevention by treatment of arterial hypertension. Overview of current multidomain interventional studies on dementia prevention. Narrative review. Whereas in three previous randomized controlled trials on antihypertensive treatment areduction of dementia risk could not be found, the recent SPRINT-MIND study demonstrated areduced risk of mild cognitive impairment (MCI) and in the trend for dementia by intensified hypotensive treatment. Multidomain interventional studies suggest preventive effects, particularly in specific risk groups and also highlight the challenge of adherence to lifestyle modifications. The treatment of modifiable risk factors can have a preventive effects on cognitive decline and dementia. More research is needed to identify subgroups with the greatest likelihood of benefits.

Assessment of the factors influencing primary care physicians' approach to vaccination of adult risk groups in Istanbul, Turkey.

BackgroundWe aimed to assess the factors influencing primary care physicians’ (PCPs) approach to adult vaccination in specific risk groups and evaluate the compliance to adult immunization guidelines.MethodsThis cross-sectional study performed between January 2016 and April 2016 in İstanbul, Turkey. A questionnaire designed to obtain physicians’ demographical data, experience, immunization status, and attitude on prescribing or recommending vaccines for adults in the risk group. Healthy individuals older than 65 and patients suffer from chronic diseases or had splenectomy before are considered as a risk group. The questionnaire was sent via email to a randomly selected group of 1,500 PCPs. The data of 221 physicians who responded emails were recorded for statistical analysis.ResultsOf the 221 participants (123 women, 98 men), the majority were aged 31–40 years. Their vaccination rates were 74.2% for hepatitis B, 54.3% for seasonal influenza, and 47.1% for tetanus. Among participants, the highest recommendation and prescription rate of adult vaccines was recorded in PCPs aged 31–40 years. In addition, PCPs with <10 years occupational experience were found to prescribe adult vaccines more frequently than PCPs with longer occupational experience.ConclusionsPrimary care physicians with lower age and relatively less experience are more intent to prescribe adult vaccines to patients that are in risk groups. This result may be due to increased awareness of adult immunization among PCPs who had more recent medical training. However, many other factors could have caused this difference, including physicians’ approach to primary medical care.

Model of Building Stakeholder Engagement in the Functioning of the Organization – Trust and Risk

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Emerging trends in contraceptive use, transitions and preferences among female sex workers screened for an HIV prevention clinical trial in Kisumu, Kenya: a cross-sectional study

Background: Globally about 210 million women conceive annually and 38% of these pregnancies are unintended. Female sex workers (FSWs) are at increased risk of both unintended pregnancy and acquiring HIV, which could lead to adverse sexual and reproductive health (SRH) outcomes. We sought to assess contraceptive use or non-use, preferences and determinants among a cohort of FSWs screened for an HIV prevention clinical trial in Kisumu, Kenya. Methods: A cross sectional study of healthy FSWs referred for possible recruitment into the Antibody Mediated HIV Prevention (AMP) Study was conducted between December 2016 and September 2018. Potentially eligible participants were screened for HIV and data on social-demographic, contraceptive use and other SRH characteristics were collected. Those not on a method recorded their contraceptive preferences. Results: Data on 210 FSWs with a median age of 24.5 years (interquartile range, IQR 22-26) are presented. Of these, 187 (89.1%) had two children or fewer; only 56 (26.7%) had completed secondary or higher education. At the time of the interview, 18 (8.6%) were HIV-infected and 181 (86.2%) were using a modern contraceptive. Implants (48.6%) and depot injections (37.6%) were the most commonly used methods. Most (41.4%) of those not on family planning preferred oral pills. Respondents who had two or more children were three times more likely than their primiparous and nulliparous counterparts to report use of a contraceptive. Use of modern contraception methods did not differ by respondent’s ownership of a medical insurance cover or other occupation. Conclusion: There is high use of modern contraception among FSWs in Kisumu with the majority using subdermal implants. Reproductive health programs should implement targeted SRH interventions for specific populations and risk groups. Effective contraceptive counselling and interventions among FSWs should consider the client’s parity and level of education.

Latent Character Strength Profile and Grouping Effects

Previous studies have shown that personality types may lead to different health status. The current study aims to refine a previous typological profile of strength using a heterogeneous sample (N = 5776) and clarify further the associations between strength profiles and mental wellbeing (e.g., flourishing), mental illbeing (e.g., depression, anxiety, and stress), strength knowledge, and strength use. Latent profile analysis was implemented to distinguish subgroups on the basis of the three-dimensional inventory of character strengths (e.g., self-control, inquisitiveness, and caring). Results refined previous findings and indicated three specific profiles, namely, Strength, Common, and Risk Groups. The Strength Group scored relatively high on self-control and inquisitiveness but low on caring; the Common Group scored relatively high on caring; and the Risk Group had relatively high scores on self-control. As expected, the Strength Group had the highest strength knowledge and strength use, whereas the Risk Group had the least strength knowledge and strength use. The three proposed profiles have significant differences of anxiety, stress, and flourishing; however, the difference of depression between the Strength and Risk Groups was insignificant compared with the Common Group. This study can be helpful in refining strength typologies for future effective strength-based interventions.

TRIM24 as an independent prognostic biomarker for prostate cancer

IntroductionSimply applicable biomarkers for prostate cancer patients predicting the clinical course are urgently needed. Recently, TRIM24 has been identified to promote androgen receptor signaling and to correlate with an aggressive prostate cancer phenotype. Based on these data, we proofed TRIM24 as a prognostic biomarker for risk stratification. Materials and MethodsWe performed TRIM24 immunohistochemistry on 2 independent cohorts including a total of 806 primary tumors, 26 locally advanced/recurrent tumors, 30 lymph node metastases, 30 distant metastases, and 129 benign prostatic samples from 497 patients as well as on 246 prostate needle biopsies. Expression data were correlated with clinic-pathological data including biochemical recurrence-free survival (bRFS) as endpoint. ResultsBenign samples show no or low TRIM24 expression in 94%, while tumor tissues demonstrate significant higher levels. Strongest expression is observed in advanced and metastatic tumors. In multivariate analyses, TRIM24 up-regulation on radical prostatectomy specimens correlates with shorter bRFS independent of other prognostic parameters. 5-(10-) year bRFS rates for TRIM24 negative, low, medium and high expressing tumors are 93.1(93.1)%, 75.4(68.5)%, 54.9(47.5)% and 43.1(32.3)%, respectively. Of interest, tumors diagnosed as indolent disease, TRIM24 expression stratifies patients into specific risk groups. Increased TRIM24 expression associates with higher grade group, positive nodal status and extraprostatic tumor growth. TRIM24 assessment on prostate needle biopsies taken prior to treatment decision at time of initial diagnosis significantly correlates with recurrence after surgery. ConclusionUsing 2 large independent radical prostatectomy specimen cohorts, we found that TRIM24 expression predicts patients’ risk to develop disease recurrence with high accuracy and independent from other established biomarkers. Further, this is the first study exploring TRIM24 expression on prostate needle biopsies which represents the clinically relevant tissue type on which biomarkers guide treatment decisions. Thus, we strongly suggest introducing TRIM24 evaluation in prostate needle biopsies in clinical routine as an inexpensive and simple immunohistochemical test.

Should a Multigene Signature be Used in all Luminal Early Breast Cancers.

Background: Multigene signatures refine the risk of recurrence and guide adjuvant chemotherapy decision in luminal breast cancers. The decision to perform the assay is highly variable among oncologists. In order to guide the appropriate clinical group in whom to perform a genomic signature, our study analyzed in a homogeneous cohort which clinical risk groups triggered the use of the PAM50-based signature and their concordance with the genomic risk.Methods: A real life cohort of 222 early breast cancer patients with hormone receptor positive and HER2 negative disease had a commercial PAM50-based assay (Prosigna®) performed at our institution. The assay provided the risk group, the 10-year risk of distant recurrence and the intrinsic molecular subtype of breast cancer.Results: Based on nodal involvement, Ki67, tumor grade, mitotic index, and tumor size, no clinical pattern could identify a specific genomic risk group. The discordance with the genomic risk was high in patients with clinical low risk tumors, both in node negative and node positive patients. Up to 60% of them had a 10% or more risk of distant recurrence. Moreover, we identified a subgroup of luminal A tumors with a high genomic risk of recurrence. Genomic risk and intrinsic subtype were strong determinants of chemotherapy decision.Conclusions: Clinical profiles could not reliably identify genomic risk groups and guide the decision to use a multigene signature. Significant discordance with the genomic risk was observed within low clinical risk and luminal A tumors.

Intra-abdominal Complications After Pediatric Kidney Transplantation: Incidence and Risk Factors.

The incidence and types of intra-abdominal complications after pediatric transplantation are not well established, and specific risk groups have not been clearly identified. A retrospective chart review of all pediatric transplant recipients between 1995 and 2016 was undertaken. Intra-abdominal complications were grouped into 4 categories: fluid collections, gastrointestinal, vascular, and urogenital. Donor, recipient, and transplant characteristics were evaluated using univariate and multivariate logistic regressions. There were 146 transplants meeting the inclusion criteria. The mean follow-up time was 4.6 ± 3.7 years (range, 0.3-18 y). The mean weight at transplantation was 31.5 ± 16.5 kg (range, 9-78), with 24 (16%) recipients being <15 kg and 23% younger than 5 years. Thirty-four (23%) patients had previous abdominal surgery. There were 32 complications identified in 27 (18%) transplant recipients. Fluid collections requiring surgical drainage developed in 9 (6.2%), gastrointestinal surgical complications in 12 (8.2%), vascular complications in 5 (3.5%), and urogenital complications in 6 (4.1%). There were only 3 graft losses due to abdominal complications, all after renal vein thrombosis. Weight <15 kg at the time of transplant (P = 0.016), previous abdominal surgery (P = 0.047), and intraperitoneal surgical technique (P = 0.008) were risk factors in the univariate analysis using Cox regression models, whereas only weight <15 kg (P = 0.003) and previous abdominal surgery (P = 0.008) were retained in the multivariate analysis. Intraabdominal complications occur in almost 1 in 5 pediatric renal transplant recipients. Weight <15 kg and previous abdominal surgery are risk factors for developing such complications.

PS987 RIBOMETHYLOME CHANGES DEPEND ON DISTINCT PATTERNS OF C/D BOX SNORNAS IN AML SUBTPYES

Background:Small nucleolar RNAs (snoRNAs) are a group of non‐coding RNAs. The most prominent role for snoRNA is to guide small nucleolar ribonucleoproteins (snoRNPs) to complementary regions of ribosomal (rRNA), where the snoRNP complexes catalyze ribosomal modifications. snoRNAs are divided into the two major classes: box C/D and box H/ACA snoRNAs. C/D box snoRNAs are involved in 2‐O‐methylation, whereas H/ACA snoRNAs guide pseudouridylation. Beyond the role in rRNA modification, functions in splicing and chromatin have been proposed. Recently, we demonstrated that snoRNAs play a critical role for AML1‐ETO induced leukemia (Zhou et al., Nat Cell Biol 2017).Aims:We aimed to elucidate snoRNA expression patterns and functions in acute myeloid leukemia and establish the first global map of 2’‐methylation of rRNA in AML patients.Methods:We analyzed snoRNA expression patterns in a cohort of 161 AML patients using small‐RNA sequencing. All patient samples were obtained at the time of diagnosis. Expression levels were calculated for known C/D‐box and H/ACA‐box snoRNA. Only regions with at least one reads per million (RPM) in at least one patient sample were included for further investigation. We applied ribomethseq to elucidate the entire ribosomal 2’‐0 methylation pattern in AML patients. We calculated the methylation scoreC from 5’‐read ends for all known sites from snOPY and an updated list from Krogh et al. 2016, Further, methylation patterns and snoRNA patterns were analysed with regard to AML mutations as analysed by panel sequencing.Results:Next generation sequencing data revealed expression o 354 known C/D box snoRNAs and 160 H/ACA box snoRNAs in primary AML patient samples. Expression patterns of snoRNAs varied according to specific genetic risk groups. High levels of snoRNA expression were observed in intermediate molecular risk group patients (215 C/D box and 68 H/ACA box snoRNAs, p≤0.05). Also, high levels of snoRNA were found in patients with a poor response to the first cycle of induction therapy (144 C/D box and 61 H/ACA box snoRNAs, p≤0.05). Of note, NPM1 mutations were associated with wide ranging changes in expression (almost all downregulation) in 232 C/D box and 61 H/ACA box snoRNA. In contrast, AMLs with ASXL1 or RUNX1 mutations predominantly expressed higher levels of snoRNA expression. We established the first map of ribosomal 2’‐0 methylation patterns in AML patients on published modification sites. This resulted in RiboMethylome data constituting 107 high quality ribosomal sites which were methylated in AML patients. In most instances, C/D box snoRNA expression was positively correlated with the respective levels of 2́‐O‐methylation in rRNA. Importantly, NPM1 mutation status strongly influenced the RiboMethylome in affected AML blasts.Summary/Conclusion:AML with different mutation patterns exhibit striking differences in snoRNA expression levels. Our data reveal widespread plasticity of epitranscriptomic modifications in the ribosomes of AML patients. These findings suggest that driver mutations in AML could induce specialized ribosomes which may contribute to leukemic transformation.

Research of practical aspects of the modeling of the risk tolerance management system of business models of restaurant business enterprise

The object of research is the risk tolerance management process of the business model of a restaurant enterprise. One of the most problematic places in the implementation of the business model of the enterprise is the timely recognition of risk and minimization of its impact on activities. The restaurant business is the most profitable and profitable in the world. Competition in this area increases over time. Risk arises where there is profit and competition, as well as various options related to the likelihood of risk occurring in conditions of uncertainty. Identification and consideration of risk factors is the basis for making management decisions on the timely transformation of the current business model of the enterprise in accordance with changes in the external environment. It is shown that the risk tolerance management process of a restaurant business enterprise is associated with the difficulty of identifying key aspects of the risk tolerance of its business model and the need to take into account risks arising in the process of creating value. This is due to the peculiarities of the set of risks and the nature of their manifestation in the restaurant business. The restaurant industry is characterized by specific risk groups. These risks are associated with the formation and promotion of value propositions, revenue streams and customer/consumer relationships. The stages of modeling the risk tolerance management system of the business model of a restaurant enterprise have been determined. These stages include identifying the main risk groups and key value management systems, assessing their parameters and allow to define a set of management decisions to improve the risk tolerance level of the business model of the restaurant business enterprise. To implement the stages of modeling the risk tolerance management system of the business model of a restaurant business enterprise, an algorithm is proposed based on the theory of fuzzy sets with the ability to assess the compliance of the actual system parameters with their target value. This ensures the possibility of assessing the actual state of the risk tolerance management system of the enterprise's business model by key business processes. A set of management decisions has been developed that makes it possible for a restaurant enterprise to respond in a timely manner to various kinds of risks in the context of resource and time constraints.

Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society.

Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) <50 nmol/L or 20 ng/mL) is common in Europe and the Middle East. It occurs in <20% of the population in Northern Europe, in 30-60% in Western, Southern and Eastern Europe and up to 80% in Middle East countries. Severe deficiency (serum 25(OH)D <30 nmol/L or 12 ng/mL) is found in >10% of Europeans. The European Calcified Tissue Society (ECTS) advises that the measurement of serum 25(OH)D be standardized, for example, by the Vitamin D Standardization Program. Risk groups include young children, adolescents, pregnant women, older people (especially the institutionalized) and non-Western immigrants. Consequences of vitamin D deficiency include mineralization defects and lower bone mineral density causing fractures. Extra-skeletal consequences may be muscle weakness, falls and acute respiratory infection, and are the subject of large ongoing clinical trials. The ECTS advises to improve vitamin D status by food fortification and the use of vitamin D supplements in risk groups. Fortification of foods by adding vitamin D to dairy products, bread and cereals can improve the vitamin D status of the whole population, but quality assurance monitoring is needed to prevent intoxication. Specific risk groups such as infants and children up to 3 years, pregnant women, older persons and non-Western immigrants should routinely receive vitamin D supplements. Future research should include genetic studies to better define individual vulnerability for vitamin D deficiency, and Mendelian randomization studies to address the effect of vitamin D deficiency on long-term non-skeletal outcomes such as cancer.

Starting points for resilience promotion in medical education: What keeps future doctors healthy?

A trend towards reduced resilience to stress and impaired psychosocial well-being begins early on in medical education. Our own results confirm the early deterioration of the psychosocial health of medical students observed internationally. Students who simultaneously demonstrate high levels of perfectionism, an insufficient ability to distance themselves from work, as well as a lack of regular physical activity appear to form a special risk group. Therefore, it seems rational to implement interventions that counteract this development by enhancing individual resources and preventing harmful curriculum-associated influences as early as possible during medical education. Interventions should target both individual behaviour and experience patterns of students as well as the setting. The medical curriculum itself was viewed as a priority starting point for resilience-promoting interventions by the students. It should be in the interest of all parties involved to enable all students to stay well during their medical education and to provide them with resources for their work like, e. g. good resilience, which, in turn, will have a sustainable positive effect on the quality of patient care. To date, the evidence base with regard to protective factors for medical students' health and effective resilience-promoting interventions is insufficient in terms of quantity and quality. Moreover, there are only a few meaningful studies that deal specifically with German-speaking areas. Our own studies show that the willingness to participate in resilience-promoting interventions is high in spite of the additional expenditure of time because students consider such interventions to be helpful. Interventions employing the concepts of Mind Body Medicine seem to be especially promising in the context of medical education.

Features of the clinic and diagnosis of chronic heart failure in patients with chronic obstructive pulmonary disease

To elucidate clinical and diagnostic features of chronic heart failure (CHF) in patients with chronic obstructive pulmonary disease (COPD). The study included 239 patients with COPD and 42 patients with CHF without COPD. The first subgroup consisted of 60 patients with a history of myocardial infarction (MI) and the second subgroup consisted of 79 patients without a history of MI. A general clinical examination, EchoCG, measurements of N-terminal pro B-type natriuretic peptide (NT-proBNP), galectin 3, and high-sensitivity C-reactive protein (hsCRP) were performed for all patients. The risk group for excluding HF as a cause of progressive dyspnea in COPD patients consisted of patients with the bronchitic phenotype who belonged to GOLD groups C and D with frequent exacerbations, increased hsCRP, reduced oxygen saturation, and impaired exercise tolerance. Patients with a history of MI constituted a special group of risk. Measuring specific biomarkers, primarily BNP or NT-proBNP, is recommended to confirm the presence/absence of CHF and to evaluate CHF severity in patients with these risk factors. A combination of COPD and CHF produces a number of clinical and, specifically, diagnostic problems, which have not been completely solved so far.

Polymerase Chain Reaction Detection ofCapnocytophaga canimorsusandCapnocytophaga cynodegmias the Emerging Zoonosis

Background: Capnocytophaga canimorsus and C. cynodegmi, as gram-negative rods, are commensal in the oral cavities of dogs and cats and C. canimorsus can occasionally cause fatal systemic infections in humans. In addition, most human infections, caused by C. canimorsus, are associated with dog bites, licking pre-existing wounds, or the other contact with dogs. Therefore, the aim of this study was to evaluate the role of polymerase chain reaction (PCR) in detecting C. canimorsus and C. cynodegmi in oral swab samples of dogs and cats. Methods: To this end, oral swabs were taken from 125 dogs and 35 cats enriched in the anaerobic atmosphere and then were used for DNA isolation and evaluated by PCR. Results: In 125 dog oral swabs, DNA of Capnocytophaga genus was prespecified in 32% of these samples (n=40). Further, 20 and 36 samples were positive for DNA of C. canimorsus and C. cynodegmi, respectively, when PCR was performed for the DNA of Capnocytophaga spp. Similarly, 23 out of 35 oral swabs of the cats were positive for the presence of the DNA of Capnocytophaga genus. Finally, all the samples were positive for the DNA of C. cynodegmi when they were analyzed by the primer specified Capnocytophaga species while only 15 samples were positive for the presence of DNA of C. canimorsus. Conclusions: Overall, the risk of infection with C. canimorsus is high because of the presence of the bacteria in the mouth of cats and dogs and severe consequences of infection for humans. Therefore, the owners of cats and dogs should be informed about this risk, especially if the owners belong to specific risk groups like young children, pregnant women, elderly people, and immunocompromised patients

Subclinical eating disorder symptoms and positive vs. negative affect in high school students: the mediating role of self-regulation

BackgroundSubclinical symptoms of eating disorders (ED) appear early, and adolescents still represent a specific risk group. Are there strat-egies of self-regulation which can protect adolescents against severe symptoms? We investigated differential mediators between subclinical eating disorder symptoms and negative vs. positive affect in adolescents.Participants and procedureData were collected twice. Adolescents (ages 17-18, N = 98) filled in the Eating Disorders Inventory (EDI-2), the Volitional Competences Questionnaire (VCQ), the Personality Style and Disorders Inventory (PSDI) and the Positive and Negative Affect Schedules (PANAS). We postulated two different serial multiple mediation models originating in eating disorders, one leading to negative affect (through depressive personality style and self-motivation) and the other leading to positive affect (through self-regulation competences: self-relaxation and self-motivation).ResultsThe serial multiple mediation models were confirmed, with the postulated variables serving as mediators of positive and negative affect. In addition to body dissatisfaction, there were two additional predictors for positive affect (ineffectiveness and social insecurity) and five predictors for negative affect (drive for thinness, bulimia, perfectionism, interoceptive awareness, asceti-cism).ConclusionsThese experiences of eating disorders are associated with affect, through self-regulation of emotion (self-motivation), which along with depression or self-relaxation leads to either a decrease in the negative affect or an increase in the positive affect. Self-regulation is an important factor in preventing eating disorders and protecting the overall emotional well-being in high school students.

Progress in the HIV epidemic: Identifying goals and measuring success.

Substantial progress has been made towards the goal of ending the HIV/AIDS epidemic due to advancements in both prevention and treatment of HIV. However, major challenges still remain. We describe basic principles of epidemic control in the context of HIV and identify a number of attainable goals in terms of control and elimination of HIV in specific populations and risk groups, given currently available HIV prevention and treatment methods. Currently available HIV prevention methods make it a feasible goal to eliminate HIV transmission attributable to mother-to-child transmission and blood transfusions. Reductions in transmission attributable to sexual behavior and injection drug use are feasible, but elimination of these modes of transmission will require further advancements in behavioral and biomedical HIV prevention. With regard to HIV-related mortality, we argue that elimination of death due to HIV-related causes is a feasible goal. HIV-related deaths should be treated as sentinel events triggering epidemiological investigation into the breakdowns in the HIV care continuum that led to them. We briefly discuss additional considerations that will affect the success of HIV prevention programs.

Symptoms of infectious diseases in HIV-positive travellers: A prospective study with exposure-matched controls.

Recently, the number of HIV-infected travellers to (sub)tropical areas has increased substantially. In the Netherlands, HIV-positive travellers with CD4-cells of <500/mm3 are advised to carry stand-by antibiotic treatment against travellers' diarrhoea. Our aim was to determine whether HIV infection is associated with travel-related symptomatic diseases. A prospective study was performed among HIV-infected travellers and age-matched HIV-uninfected travel companions serving as controls, attending two travel clinics in Amsterdam. Participants filled out daily questionnaires before, during, and after their trip. Overall, 52 pairs were included. All participants were male, and 91.3% were born in a Western country. Prevalence of travel-related diarrhoea was 50% among HIV-positive travellers and 40% among controls. No significant differences were observed for incident travel-related diarrhoea (incidence rate ratio = 1.60, 95%CI = 0.79-3.27) or duration of symptoms (odds ratio = 1.49, 95%CI = 0.65-3.45). There were no significant differences in symptom incidence or duration for travel-related vomiting, cough, rhinitis, pruritus, fatigue, or nausea. Only 6.3% of HIV-positive travellers with CD4-cells of <500/mm3 and diarrhoea used their stand-by antibiotic treatment as recommended. Travel-related symptoms were not significantly more frequent or longer lasting among HIV-infected travellers compared to controls. Most HIV-infected travellers with CD4-cells of <500/mm3 and diarrhoea did not take stand-by antibiotic treatment. These results may question the need for routine prescription of stand-by antibiotics among this specific risk group. Further research, especially among HIV infected VFR travellers and in larger study groups is needed.

The impact of a cervical dysplasia diagnosis on individual cancer prevention habits over time: a bicentric case-control study.

Annual cervical cancer screening is recommended in Germany as a part of the statutory preventive care. Abnormal results can provoke psychological distress and anxiety, compromising women's adherence. Little is known about how a cervical dysplasia impacts adherence follow-up visits and prevention habits over time. To optimize care strategies, this study aims to identify women at risk for nonadherence to follow-up visits after a screening event. Between November 2015 and May 2017, participants with an abnormal Pap smear at the Heidelberg and Leipzig University Hospitals received a four-part questionnaire (sociodemographic data, PHQ-D, self-designed fear and prevention habit questions) at the first consultation (T1) and subsequently after 3 (T2) and 6 (T3) months; healthy controls completed the questionnaire at T1. 132 women with an abnormal Pap smear [with conization: S1 (n = 68, 51.5%), without intervention: S2 (n = 64, 48.5%)] and healthy controls (K, n = 101) generally adhered to gynecological checkups, except S1 6 months after the first diagnosis (S1/T3 - 0.47, signed rank p < 0.0005). Knowledge of primary prevention information, i.e., HPV vaccination, was significantly higher among K (K 58%, S1 29%, S2 44%, Chi-squared p = 0.01) as was vaccine uptake (K 39% versus S1/S2 7% and 17%, respectively, Chi-squared p = 0.0004). Fear of upcoming Pap smears rose significantly over time (S1/T1-S1/T2-S1/T3, Wilcoxon signed-rank test p < 0.001) and was higher among those with conization at T2 (Chi-square test, p = 0.01) and partially accompanied by panic disorders at T1 (Chi-square test p = 0.035). Realization of general preventive habits rose significantly among women without an operative procedure (S2) over the study. This study advances the understanding of non-participation in follow-up visits after a dysplasia diagnosis, identifying post-conization women as a special risk group for decreased adherence.

Comparison of Two Predictive Scores for the Development of Incisional Hernia

Introduction: Incisional Hernia (IH) is a frequent complication of abdominal surgery, with an incidence of 10-23%, which can increase to 38% in specific risk groups. So far there is no ideal method to identify patients at high risk of developing IH, this variety in the criteria of inclusion of patients in different studies makes is very complicate to compare the results. The aim of this study is comparing the two predictive scores of incisional hernias (Hernia project Vs Van Ramshorst) with higher diagnostic performance and determine which is better to predict IH. Methods: An analytical, observational study was conducted between June and December 2018, in patients of both sexes, who were 18 years or older, undergoing midline laparotomy, regardless of their background diagnosis either urgently or scheduled between 2007 to 2016. The two different classifications, the Hernia Project score and Van Ramshorst score, were applied to each of the patients. With the identification of patients with hernia, two groups, healthy and ill, were performed and Bayesian statistics were made with it and to identify which scale best predicts the presence of this complication. Results: The records of 1085 patients undergoing midline laparotomy were reviewed. 296 patients were ruled out because their follow-up was not complete. Both tests were compared to determine the best diagnostic performance using the ROC curve and the area under the curve, finding that the Hernia Project Score has a larger area 0.724 compared to a 0.663 of Van Ramshorst. Discussion: In our patient cohort, the Hernia Project score has a greater predictive capacity, with an area under the best curve (0.72 vs. 0.66) however both They have a poor sensitivity and this is the main measure of the predictive capacity of any diagnostic test, so with these results, we can affirm that the Project hernia scale has a greater diagnostic capacity than the Van Ramshorst scale but still its diagnostic capacity is limited. Conclusions: Both scores have low sensitivity. We can affirm that the Hernia Project score has a greater diagnostic capacity than the Van Ramshorst score, but both have a limited diagnostic capacity.

Prevalence of ERG expression and PTEN loss in a Brazilian prostate cancer cohort.

PTEN is the most commonly inactivated tumor suppressor gene in primary prostate cancer (PCa) and its loss is associated with poor clinical outcomes. ERG rearrangement is a genomic alteration frequently found in PCa and its prognostic significance has yielded mixed results. Although the association of PTEN and ERG biomarkers has potential impact on clinical outcomes, studies examining the two genes simultaneously are scarce in Brazilian populations. In this study, we retrospectively examined the relationship between ERG expression and PTEN loss in 119 surgically treated prostate cancer patients from Northeastern Brazil through immunohistochemical analysis. ERG expression was found in 41.0% (48/117) of cases and the loss of PTEN detected in 38.1% (40/105) of samples. ERG-positive cases were significantly associated with lower prostate weight; ERG negatively correlated with Gleason score above 6. The lack of associations for PTEN loss alone in this cohort is counter to the literature, which shows that PTEN loss is usually associated with more aggressive disease. The overlapping of the two biomarkers revealed that samples with positive ERG expression without PTEN loss were associated with lower Gleason and lower Grade group. This study contributes with the discussion about the development of the molecular profiling of prostate cancer. The further development of similar studies could help in stratifying specific risk groups, leading to a more personalized therapeutic decision for prostate cancer treatment.