Gastric Carcinogenesis and Potential Role of the Transient Receptor Potential Vanilloid 1 (TRPV1) Receptor: An Observational Histopathological Study.

The potential role of the transient receptor potential Vanilloid 1 (TRPV1) non-selective cation channel in gastric carcinogenesis remains unclear. The main objective of this study was to evaluate TRPV1 expression in gastric cancer (GC) and precursor lesions compared with controls. Patient inclusion was based on a retrospective review of pathology records. Patients were subdivided into five groups: Helicobacter pylori (H. pylori)-associated gastritis with gastric intestinal metaplasia (GIM) (n = 12), chronic atrophic gastritis (CAG) with GIM (n = 13), H. pylori-associated gastritis without GIM (n = 19), GC (n = 6) and controls (n = 5). TRPV1 expression was determined with immunohistochemistry and was significantly higher in patients with H. pylori-associated gastritis compared with controls (p = 0.002). TRPV1 expression was even higher in the presence of GIM compared with patients without GIM and controls (p < 0.001). There was a complete loss of TRPV1 expression in patients with GC. TRPV1 expression seems to contribute to gastric-mucosal inflammation and precursors of GC, which significantly increases in cancer precursor lesions but is completely lost in GC. These findings suggest TRPV1 expression to be a potential marker for precancerous conditions and a target for individualized treatment. Longitudinal studies are necessary to further address the role of TRPV1 in gastric carcinogenesis.

The effect of ATLS/PHTLS spinal motion restriction protocol on the incidence of spinal cord injury, a nationwide database study.

PURPOSE: To study trends in incidence and outcome of patients with traumatic spinal cord injury (TSCI) in the Netherlands before, during and after implementation of the Advanced Trauma Life Support (ATLS®) and Pre-Hospital Trauma Life Support (PHTLS®)- Spinal Motion Restriction(SMR) protocol. METHODS: In an observational database we studied national hospital admission and emergency department databases to analyse incidence rates and outcome of traumatic spinal cord injury and spinal fractures in the emergency department and in admittances in The Netherlands between 1986 and 2021. RESULTS: A significant increase of 39% in TSCI in admitted patients with spinal fractures over the past 35 years (p < 0.001). This increase was especially prevalent in cervical spinal fractures (132%), while thoracic and lumbosacral spinal fractures showed a decrease in accompanied TSCI (64% and 88% respectively). The overall increase in spinal fractures was not significant. The duration of hospital admission decreased for spinal fractures without TSCI and with TSCI (66% and 56% respectively). CONCLUSION: Since implementation of the SMR-protocol was aiming to limit TSCI in patients who suffered a spinal fracture, the increase in TSCI is an unexpected finding. Exact explanation for this increase is unclear and the contribution of the SMR-protocol is not fully understood due to confounders in the used datasets. Either way, the scientific evidence supporting this costly time- and labor-intensive SMR-protocol remains debated, along with evidence contradicting it. Therefore it stresses the need for clear, evidencebased reasoning for spinal immobilization according to ATLS, as this is currently lacking.

Is sexual autonomy a protective factor against intimate partner violence? Evidence from 27 sub-Saharan African countries.

BACKGROUND: Though women in sub-Saharan Africa have increased risk of intimate sexual violence, research on the association between sexual autonomy and intimate partner violence among this population has not received the requisite attention. Consequently, we investigated if sexual autonomy is a protective factor against intimate partner violence among women in sub-Saharan Africa. METHODS: Secondary data analysis was conducted based on the Demographic and Health Surveys (DHSs) of 27 sub-Saharan African countries from 2008 to 2021. A total of 104,523 married or cohabitating women were included in the study. We applied a multilevel Poisson regression model with robust variance to identify associated factors. Variables with a p-value<0.2 in the bi-variable multilevel Poisson regression analysis were considered for the multivariable analysis. The Adjusted Prevalence Ratio (APR) with its 95% confidence interval (CI) was reported, and variables with a p-value <0.05 were included in the multivariable analysis. RESULTS: The prevalence of intimate partner violence and sexual autonomy among women in SSA were 32.96% [95% CI: 32.68%, 33.25%] and 88.79% [95% CI: 88.59%, 88.97%], respectively. Women in Sierra Leone had the highest prevalence of IPV (52.71%) while Comoros had the lowest prevalence of IPV (8.09%). The prevalence of sexual autonomy was highest in Namibia (99.22%) and lowest in Mali (61.83%). The MOR value in the null model was 1.26. We found that women who had sexual autonomy are 1.28 times [APR = 1.28, 95% CI: 1.17, 1.40] more likely to experience IPV than women who had no sexual autonomy. CONCLUSION: This study has demonstrated that sexual autonomy is significantly associated with intimate partner violence, however, it does not necessarily act as a protective factor. The study suggests the need for more education on intimate partner violence targeting women's partners. This can help secure the commitment of the perpetrators to rather become proponents of anti-intimate partner violence and further offer women the necessary support for them to attain their full fundamental rights in all spheres of life.

Determinants of iron-rich food deficiency among children under 5 years in sub-Saharan Africa: a comprehensive analysis of Demographic and Health Surveys.

BACKGROUND: Iron deficiency is a major public health problem that affects the physical and cognitive development of children under 5 years of age (under-5 children) in sub-Saharan Africa (SSA). However, the factors associated with the limited consumption of iron-rich foods in the region are poorly understood. OBJECTIVE: This study examined the prevalence and determinants of iron-rich food deficiency among under-5 children in 26 SSA countries. DESIGN: This nationally representative quantitative study employed pooled data from Demographic and Health Surveys conducted between 2010 and 2019. METHODS: Representative samples comprising 296 850 under-5 children from the various countries were used. Bivariate and multivariate logistic regression models were used to determine the associations between the lack of iron-rich food uptake and various sociodemographic factors. RESULT: The overall prevalence of iron-rich food deficiency among the children in the entire sample was 56.75%. The prevalence of iron-rich food deficiency varied widely across the 26 countries, ranging from 42.76% in Congo Democratic Republic to 77.50% in Guinea. Maternal education, particularly primary education (OR 0.62, 95% CI 0.57 to 0.68) and higher education (OR 0.58, 95% CI 0.52 to 0.64), demonstrated a reduced likelihood of iron-rich food deficiency in the sample. Likewise, paternal education, with both primary education (OR 0.69, 95% CI 0.63 to 0.75) and higher education (OR 0.66, 95% CI 0.60 to 0.73) showed decreased odds of iron-rich food deficiency. Postnatal visits contributed significantly to reducing the odds of iron-rich food deficiency (OR 0.90, 95% CI 0.83 to 0.95), along with antenatal visits, which also had a positive impact (OR 0.84, 95% CI 0.74 to 0.95). Finally, residents in rural areas showed slightly higher odds of iron-rich food deficiency (OR 1.12, 95% CI 1.10 to 1.28). CONCLUSION: Based on the findings, interventions targeting iron-food deficiency in the SSA region should take into strong consideration the key determinants highlighted in this study.

Guía clínica del carcinoma urotelial de vejiga no músculo-invasivo de la Asociación Europea de Urología. Actualización de 2011 / EAU Guidelines on Non-Muscle-Invasive Urothelial Carcinoma of the Bladder, the 2011 Update

Contexto y objetivo: Presentar la guía clínica de la Asociación Europea de Urología (EAU) de 2011 del carcinoma de vejiga no músculo-invasivo (CVNMI). Adquisición de la evidencia: Se ha realizado una revisión sistemática de la literatura publicada entre 2004 y 2010 acerca del diagnóstico y el tratamiento del CVNMI. Se actualizaron las guías clínicas previas, y se asignó un nivel de evidencia (NE) y un grado de recomendación (GR). Síntesis de la evidencia: Los tumores en estadio Ta, T1 o carcinoma in situ (CIS) se agrupan como CVNMI. El diagnóstico depende de la cistoscopia y de la evaluación histológica del tejido obtenido por resección transuretral (RTU) en los tumores papilares o por biopsias de vejiga múltiples en el CIS. En las lesiones papilares, una completa RTU es esencial para el pronóstico del paciente. Cuando la primera resección es incompleta o cuando se detecta un tumor de alto grado o T1, se debe realizar una segunda RTU a las 2-6 semanas. En los tumores papilares, el riesgo tanto de recurrencia como de progresión se puede calcular de manera individual mediante los sistemas de puntuación y tablas de riesgo. La estratificación de los pacientes en grupos de riesgo bajo, intermedio y alto (separando la recidiva y la progresión) es fundamental para recomendar un tratamiento adyuvante. Para los pacientes con bajo riesgo de recurrencia y progresión se recomienda una instilación inmediata de quimioterapia. Los pacientes con riesgo intermedio o alto de recurrencia y riesgo intermedio de progresión deben recibir una instilación inmediata de quimioterapia seguida de un mínimo de un año con inmunoterapia intravesical con bacilo de Calmette-Guérin (BCG) o más instilaciones de quimioterapia. Los tumores papilares con alto riesgo de progresión y CIS deben recibir BCG intravesical durante un año. Se puede ofrecer una cistectomía a los pacientes de más alto riesgo, y por lo menos se recomienda a los pacientes en los que ha fallado la BCG. Conclusión: La versión reducida de esta guía clínica de la EAU presenta una información actualizada sobre el diagnóstico y el tratamiento del CVNMI para la incorporación a la práctica clínica (AU)

Context and objective: To present the 2011 European Association of Urology (EAU) guidelines on non-muscle-invasive bladder cancer (NMIBC).Evidence acquisition: Literature published between 2004 and 2010 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the level of evidence and grade of recommendation were assigned. Evidence synthesis: Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient’s prognosis. Where the initial resection is incomplete or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. In papillary tumours, the risks of both recurrence and progression maybe estimated for individual patients using the scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups (separately for recurrence and progression) is pivotal to recommending adjuvant treatment. For patients with a low risk of tumour recurrence and progression, one immediate instillation of chemotherapy is recommended. Patients with an intermediate or high risk of recurrence and an intermediate risk of progression should receive one immediate instillation of chemotherapy followed by a minimum of 1 yr of bacillus Calmette-Guérin (BCG) intravesical immunotherapy or further instillations of chemotherapy. Papillary tumours with a high risk of progression and CIS should receive intravesical BCG for 1 yr. Cystectomy may be offered to the highest risk patients, and it is at least recommended in BCG failure patients. Conclusions: These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice (AU)

Guía clínica para el diagnóstico y tratamiento de los carcinomas de las células uroteliales de las vías urinarias superiores: actualización de 2011 / European Guidelines for the Diagnosis and Management of Upper Urinary Tract Urothelial Cell Carcinomas: 2011 Update

Contexto: El Grupo de Guías Clínicas sobre el carcinoma de células uroteliales de las vías urinarias superiores (CCU-VUS) de La Asociación Europea de Urología (EAU) ha elaborado una nueva guía clínica para ayudar a los médicos a evaluar el tratamiento del CCU-VUS basado en los datos científicos, y a incorporar las presentes recomendaciones a la práctica clínica diaria. Objetivo: Este documento ofrece una breve visión general de la guía clínica de la EAU sobre el CCU-VUS como una ayuda para los médicos en su práctica diaria. Adquisición de datos científicos: Las recomendaciones proporcionadas en la guía actual se basan en una meticulosa revisión de las guías y documentos sobre CCU-VUS disponibles, identificados mediante una búsqueda sistemática en Medline. Los datos sobre neoplasias uroteliales malignas y CCU-VUS en la literatura se buscaron mediante Medline con las siguientes palabras clave: cáncer del tracto urinario, carcinomas uroteliales, tracto urinario superior, carcinoma, células de transición, pelvis renal, uréter, cáncer vesical, quimioterapia, nefroureterectomía, tratamiento adyuvante, tratamiento neoadyuvante, recidiva, factores de riesgo y supervivencia. Un equipo de expertos sopesó las referencias Síntesis de los datos científicos: Hay una falta de datos en la literatura actual para proporcionar recomendaciones consistentes, debido a la rareza de la enfermedad. Una serie de recientes estudios multicéntricos ya están disponibles, mientras que las publicaciones anteriores se basaban solo en poblaciones limitadas. Sin embargo, la mayoría de estos estudios han sido análisis retrospectivos. Se recomienda la clasificación TNM2009. Se hacen recomendaciones para el diagnóstico, así como para el tratamiento radical y conservador; también se tratan los factores pronósticos. Se proporcionan recomendaciones para el seguimiento del paciente después de diferentes opciones terapéuticas. Conclusiones: Esta guía contiene información para el diagnóstico y tratamiento de los pacientes individuales de acuerdo a un enfoque estándar actual. Al determinar el régimen de tratamiento óptimo, los médicos deben tener en cuenta las características clínicas específicas de cada paciente con respecto a la función renal, incluyendo comorbilidades médicas, localización del tumor, grado y estadio y el estado de los marcadores moleculares (AU)

Context: The European Association of Urology (EAU) Guideline Group for urothelial cell carcinoma of the upper urinary tract (UUT-UCC) has prepared new guidelines to aid clinicians in assessing the current evidence-based management of UUT-UCC and to incorporate present recommendations into daily clinical practice. Objective: This paper provides a brief overview of the EAU guidelines on UUT-UCC as an aid to clinicians in their daily practice. Evidence acquisition: The recommendations provided in the current guidelines are based on a thorough review of available UUT-UCC guidelines and papers identified using a systematic search of Medline. Data on urothelial malignancies and UUT-UCCs in the literature were searched sing Medline with the following keywords: urinary tract cancer, urothelial carcinomas, upper urinary tract, carcinoma, transitional cell, renal pelvis, ureter, bladder cancer, chemotherapy, nephroureterectomy, adjuvant treatment, neoadjuvant treatment, recurrence, risk factors, and survival. A panel of experts weighted the references. Evidence synthesis: There is a lack of data in the current literature to provide strong recommendations due to the rarity of the disease. A number of recent multicentre studies are now available, whereas earlier publications were based only on limited populations. However, most of these studies have been retrospective analyses. The TNM classification2009 is recommended. Recommendations are given for diagnosis as well as for radical and conservative treatment; prognostic factors are also discussed. Recommendations are provided for patient follow-up after different therapeutic options. Conclusions: These guidelines contain information for the diagnosis and treatment of individual patients according to a current standardised approach. When determining the optimal treatment regimen, physicians must take into account each individual patient’s specific clinical characteristics with regard to renal function including medical comorbidities; tumour location, grade and stage; and molecular marker status (AU)

Estudio radiográfico del segmento vertebral superior / Radiographic study for the upper vertebral segment

La técnica radiográfica tradicional antero-posterior para visualizar el segmento vertebral superior (atlasaxis), da como resultados imágenes no siempre satisfactorias para la gran sobreproyección de estructuras anatómicas. En el presente trabajo se logró mejores imágenes modificando los puntos de reparo anatómico para dicha técnica tradicional; además, se proponen 2 modificaciones que brindan imágenes radiográficas con menos sobreproyección de structuras y mejor valor diagnóstico