Systemic lupus erythematosus (SLE) is an autoimmune disease that is characterized by T-cells imbalance. There are ongoing controversies about the role of specific T-helper cell subsets and their cytokines. The study aimed to confirm the disturbance of Th17/Treg ratio in SLE patients.+L17 whilst Treg as CD4+Foxp3+. Final result is stated as Th17/Treg ratio.Subjects were SLE patients who met the American College of Rheumatology 1997 criteria. Disease activity assessment was measured by SLAM index. Th17 and Treg level was measured by flow cytometry. Th17 level was evaluated as CD4Thirty female subjects with active SLE had mean SLAM Score of 29.3±3.88, C3 level 25.2 (6-59.5), C4 level 15.25 (5-54.3), ESR 62.1±37.85, CRP 30.16±59.45, and anti-dsDNA 155.32±186.10. Higher Th17 level was found in SLE patients compared to healthy subjects . However, it did not correlate to disease activity . Regarding Treg level, there was no significant difference between active SLE and healthy subjects . Treg level negatively correlated to SLE disease activity . Th17/Treg ratio was 3.28±2.22% and it positively correlated to SLE disease activity .Th17/Treg ratio is positively correlated with disease activity. Th17 level is elevated but not correlated with disease activity. Decrease of Treg level is not significant though correlated with disease activity in SLE patients. Systemic lupus erythematosus (SLE) is an autoimmune disease that is triggered by overly activated autoantigen-specific T cells and characterized by the presence of multiple autoantibodies in target organs , 2. ThesIL-17 level is abnormally high in active SLE patients. Thus, the higher IL-17 level found in SLE patient, more organ damage occurs -9. Treg Compared to Treg, Th17 levels are essentially higher in the early stage of SLE. This imbalance is deemed to be connected to the disease activity of SLE itself, which can be measured by a valid 0.9) and reliable (0.83) scoring system like Systemic Lupus Activity Measure (SLAM) index. SLAM index is applicable for SLE patients who have not undergone treatment using immunosuppressive agents  and reli, 13. It Subjects and Sampling Method: This study was approved by the Ethics Committee of Dr. Soetomo General Hospital for human research number 155/Panke. KKE/III/2017 and informed consent was obtained from all participants. Subjects in this study were enrolled using consecutive sampling method. Sample size was determined by the following formula  SLE criteria and had an active disease characterized by Systemic Lupus Activity Measure (SLAM) index > 20. Based on a previous study, higher than 20 SLAM index indicates highly active SLE. These patients were hospitalized in the Internal Medicine ward, Dr. Soetomo General Hospital, Surabaya, Indonesia. All SLE patients in this study were females, considering the number of SLE case from Indonesian female population is 40 times higher than male population . PatientSLAM Index Scoring: SLAM index was introduced in 1988 by Liang et al. It consists of 31 items to evaluate clinical symptoms and laboratory findings and to review 11 system-organs using 1-3 scoring system. The total score depends on the severity of organ damage, ranging from 0 to 86 points. The higher the score implies more active disease. The sensitivity of SLAM index compared to SLEDAI/BILAG are identical, despite Petri et al. (2005) mentioned that SLEDAI is the most sensitive  from peripheral blood. Peripheral blood mononuclear cells (PBMCs) are separated from 4 ml of heparinized venous blood by a density gradient centrifugation method using Ficoll Histopaque. Stimulation of the cells: Normal PBMCs were stimulated in media for 5 hours using PMA/Ionomycin (at 50 ng/ml and 1μg/ml respectively for 1 million cells) in the presence of BD GolgiStop™ protein transport inhibitor (Cat No. 554724). 4 μl of BD GolgiStop™ was added for every 6 ml of cell culture and mixed thoroughly. BD GolgiStop™ should not be kept in the culture for longer than 12 hours. Staining of the cells: Cells were collected in vitro using a protein transport inhibitor, centrifuged (250 x g) out of the medium containing BD GolgiStop™, and suspended in BD Pharmingen™ Stain Buffer (FBS); Cat No. 554656. Cells were counted and adjusted with concentration to 20 million cells/ml in stain buffer (FBS). Cells were fixated gently by re-suspending a pellet of 1 million cells in residual volume of wash buffer and adding 2ml of 1x human FoxP3 buffer A. Afterwards, cells were incubated for 10-20 minutes at RT in the dark and centrifuged 500 x g for 5 minutes, and then got the fixative removed. Cells were then washed and each pellet was re-suspended in 2ml of stain buffer (FBS), and centrifuged 500 x g for 5 minutes. Lastly, the buffer was removed and cells were stored or preceded to permeabilization of cells.Permeabilizing the fixed cells: DMSO was removed from frozen cells by washing twice with 2 ml/tube of stain buffer (FBS) and centrifuged 500 x g for 5 minutes at RT, got the buffer removed and washed again. Cells were permeabilized gently by suspending the pellet in residual volume of buffer and then adding 0.5 ml of 1x working Human FoxP3 Buffer C solution to each tube. Next, cells were incubated for 30 minutes at RT protected from light and washed twice with 2 ml/tube of stain buffer (FBS), centrifuged 500 x g for 5 minutes at RT and got the buffer and stain removed.Staining with the cocktail: Cells were thoroughly suspended and fixed/permeabilized in 50 μl -150 μl of stain buffer (FBS) and added 20 μl/test of cocktail or appropriate negative control. Next, cells were incubated at RT for 40 minutes in the dark and should be protected from light throughout staining and storage. Afterwards, cells were washed twice with 2 ml/tube of stain buffer (FBS), centrifuged 500 x g for 5 minutes at RT and got the buffer removed then analyzed.Flow cytometry analysis: Flow cytometry analysis was performed to measure Th17 and Treg percentages using human Th17/Treg phenotyping kit  and Becton & Dickinson Flow Cytometry. Both of these cells were measured from PBMCs of the SLE patients and controls. + antibody  for Treg identification. Flow cytometry was analyzed using BD CellQuest Pro software .Cells were fixed and permeabilized with Fix/Perm buffer . Afterwards, cells were labeled with PEanti-human IL-17A  for Th17 identification and FITC anti-human CD4 antibody/PerCP anti-human FoxP3Statistical analysis: All collected data were arranged in tabular form and processed statistically using the SPSS 21.0 program . Test of data normality was analyzed using Shapiro-Wilk normality test. The correlation between the Th17/Treg ratio and disease activity was analyzed using Pearson’s correlation coefficient test  or Spearman’s rank correlation coefficient test ; A p<0,05 was considered statistically significant.Demography and clinical characteristics of the subjects: Thirty female patients with active SLE had their SLAM index scored and resulted with 29.3±3.88. The mean age of SLE patients in this study was 31.3±10.5 years old. Most of subjects were anemic with serum hemoglobin level of 7.12±2.32. ESR level was at 62.1±37.85 and considered as high. Both C3 and C4 level were low, at 25.2 (6-59.5) and 15.25 (5-54.3) respectively. High level of anti-dsDNA was found at 155.32±186.1. The clinical information and the laboratory results of the subjects are shown in In this study, ANA test was found positive in 73.3% subjects and followed by 46.7% subjects with positive anti-dsDNA. Th17 and Treg level in patients with active SLE: The measurement of Th17 and Treg levels was performed by analyzing PBMCs using flow cytometry. All dots captured in a form of scatter diagram by either forward or side scatter represent the whole leukocytes . CD4 lymphocytes expressed both IL-17A and Foxp3 plotted within gating area (R1) which were then processed and analysed separately  and SLAM score in total SLE patients. As shown in Th17/Treg ratio correlation to disease activity in patients with active SLE: Pearson’s correlation test was used for analysis between Th17/Treg ratio and SLAM score in each SLE patient. In In this study, all subjects were productive young women who presented high SLE activity confirmed by SLAM index, complement level, ESR, and CRP. We expected lower Treg level and elevated Th17/Treg ratio occurs in active SLE patients. Our results showed that higher Th17 level, lower Treg level, and higher Th17/Treg ratio were found in SLE patients compared to healthy patients. It was consistent to previous studies involving active SLE subjects. Our results also confirmed that Treg level has an inverse correlation with disease activity measured by SLAM index, whilst Th17/Treg ratio shows a strong correlation to disease activity.Elevated Th17 level was found in active SLE patients. According to past studies, Th17 and IL-17 have a significant role in SLE progression and are found higher in active SLE compared to inactive SLE . We obseYang et al. found that Th17 level in SLE patient was correlated to disease activity and its level would increase during lupus flare and decrease after treatment . High ILOur study demonstrated that there was no substantial decrease of Treg level in SLE patients. Previous studies provided inconsistent evidence; some stated the decrease Treg level , others In association with disease activity in our study, Treg had a significant inverse correlation. These findings were in accordance to a study by Maraghy et al., (2016) in which Treg had a significant correlation with renal impairment and hematological impairment . Treg CDFurthermore, our study found a correlation between Th17/Treg ratio and disease activity of SLE. This study confirmed that Th17/Treg ratio could be used to differentiate active and inactive SLE, as well as its severity . The greAccording to Lam & Petri 2005), a measurement of C3 and C4 level is helpful for diagnosing SLE, although hypocomplementemia is not specific for SLE. On the other side, no correlation was found for ESR, CRP and anti-dsDNA levels. ESR measurement has many limitations and a low diagnostic value. It is only useful for treatment response evaluation 005, a me. Most ofIn conclusion, elevated Th17 level and insignificant decrease of Treg level, and Th17/Treg ratio correlate to disease activity and disease severity in patients with active SLE. Elevated Th17 level significantly contributes to chronic inflammation process in SLE. Imbalance of Th17/Treg ratio is an important determinant for SLE disease activity and disease severity.


Sorafenib has been used in the treatment of advanced hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC). Sorafenib-associated organ reduction have been reported on imaging, such as thyroid, pancreas and muscle, but there has been no research on prostate volume reduction (PVR).We retrospectively analyzed 26 patients (twenty with HCC and six patients with RCC) who underwent sorafenib therapy for 31 to 1225 days . PVR was estimated by two independent readers using CT volumetry.3 on the baseline CT and 20.4 ± 10.6 cm3 on the follow-up CT (p < 0.001), and that measured by reader 2 was 22.3 ± 13.9 cm3 on the baseline CT and 19.2 ± 10.6 cm3 on the follow-up CT (p < 0.001). The concordance correlation coefficient for the prostate volume measured by the two readers was 0.95 on the baseline CT scans and 0.94 on the follow-up CT scans. Sorafenib-associated PVR demonstrated slight dependence to the exposure time (r = –0.23). One patient with benign prostatic hyperplasia (BPH) showed PVR  after sorafenib administration. Sorafenib-associated PVR occurred in patients both with and without underlying liver dysfunction with relative prostate volume changes of 86.7 ± 12.0% and 85.0 ± 9.0%, respectively.The sum of all prostate volumes measured by reader 1 was 24.2 ± 13.8 cmOur study demonstrated significant PVR with sorafenib treatment in patients regardless of the presence of BPH and underlying liver dysfunction. Tyrosine kinase inhibitors (TKIs) form an important class of drugs used in molecularly targeted therapy, and they have been widely used in the management of various advanced malignancies 23. The t2112Recently, as the patients’ prognosis with molecularly targeted therapy has been improving, a growing number of unexpected effects are being reported. In addition to the common adverse effects of sorafenib such as diarrhea, hand-foot skin reaction (HFSR), and pancreatitis 34, some 3789101113This retrospective study was approved by our Institutional Review Board (H29-110). The requirement for written informed consent was waived by the Institutional Review Board due to the retrospective nature of the study.Among the male patients with HCC or RCC who underwent computed tomography (CT) scans between April 2008 and March 2017, those who were treated with sorafenib were located. The inclusion criteria for the study were as follows: (i) sorafenib therapy had been continued for at least one month; (ii) a baseline CT scan was obtained before initiating the therapy; and (iii) at least one follow-up CT scan was obtained during sorafenib treatment. The following patients were excluded from the patient group: (i) those who were previously diagnosed with prostate malignancy; and (ii) those who had received hormonal replacement therapy. We identified 26 patients eligible to participate in this study: twenty with HCC and six with RCC.9/L) Clinical data regarding age, underlying liver disease, underlying BPH, the number of days from the beginning of treatment to the follow-up CT scan, the cumulative dose of sorafenib received from the beginning of the treatment to the sequential follow-up CT scans, and the grade of the adverse effects according to the National Cancer Institute Common Toxicity Criteria for Adverse Events version 4.0 were retrospectively collected. Patients were assumed to have underlying BPH if they had been clinically diagnosed with BPH before initiating sorafenib therapy. Patients who had been clinically diagnosed with cirrhosis or other chronic liver dysfunction before initiating sorafenib therapy were considered to have underlying liver disease. The degree of liver fibrosis in patients with liver dysfunction was assessed by the FIB-4 score, which is a noninvasive estimate of liver fibrosis defined as (AST (IU/L) × age (year))/. The collimation width of each detector was 0.625 mm in the iCT256 and Brilliance 64 scanners, and 1.5 mm in the Brilliance 16 and M × 8000 IDT 16 scanners. In all patients, CT scans were performed in the supine position during inspiration breath-hold. The beam pitch was 0.45 to 0.90. Patients with no contraindication for the intravenous injection (IV) of iodinated contrast agents had undergone contrast-enhanced abdominal CT scans. In our study, the contrast-enhanced CT images in the portal venous phase were included for analysis. Patients with renal insufficiency in whom IV contrast agents were contraindicated underwent plain CT scans. The images without contrast enhancement in these patients were also included.In patients with HCC, the portal venous phase images were automatically initiated 50 seconds after the attenuation of the abdominal aortic blood reached 150 Hounsfields units. In patients with RCC, the portal venous phase images were acquired 80 seconds after the contrast agent was injected. All 20 patients with HCC and five out of six patients with RCC were administered iodinated contrast agents IV for their baseline CT studies. In patients with HCC, 31 follow-up CTs were performed and in patients with RCC 17 follow-up CTs were performed. Of these, 29 and 11 follow-up CTs, respectively, were in the portal venous phase. The remaining CT scans were performed without using an IV contrast agent.The Centricity Universal Viewer 6.0 sp7 and Advanced Visualization 3.2  were used for image analysis. The volume of the prostate in each CT scan was measured using the “Auto Contour” function, which helped the interpreter to easily perform automated volumetric measurements by area summation. All the 2 mm axial thin slice images of the selected CT scans were anonymized and sent to the workstation. The margins of the prostate were manually outlined by two independent readers  Figure . The surThe prostate volumes in the baseline and in the final follow-up CT scans that were measured by the two independent readers were assessed by the Wilcoxon signed rank test. The inter-observer agreement for the prostate volume measurements from the baseline and follow-up CT scans were assessed using the concordance correlation coefficient. The agreement between the two readers was visually demonstrated by using Bland-Altman plots with 95% limits. The Wilcoxon rank sum test was used to assess the difference of the prostate volume in the baseline CT and the change in the prostate volume from the baseline CT to the final follow-up CT between patients with liver dysfunction and those without liver dysfunction. The associations between the continuous variables were investigated using the Pearson’s correlation coefficient. In the latter two statistical analyses, we averaged the value of prostate volume measured by the two readers. P values of the respective statistical tests were calculated. All data were analyzed with the statistical software R (version 3.3.2).The patient characteristics are summarized in Table 3 on the baseline CT, and 20.4 ± 10.6 cm3 on the final follow-up CT (p < 0.001) when measured by reader 1; and it was 22.3 ± 13.9 cm3 on the baseline CT and 19.2 ± 10.6 cm3 on the final follow-up CT (p < 0.001) when measured by reader 2. Significant prostate volume reductions after sorafenib administration were observed by both the readers across the entire cohort, the patients with HCC, and those with RCC.The therapy duration ranged from 31 to 1225 days  and the cumulative dose of sorafenib ranged from 11.2 to 364 g . The baseline CT scans were performed at a mean of 25.9 days (range 0–148 days) before initiating sorafenib treatment. The prostate volumes before and after sorafenib treatment as measured by the two independent readers are summarized in Table The concordance correlation coefficient for the prostate volumes measured by the two readers was 0.95  on the baseline CT scans and 0.94  on all the follow-up CT scans. The agreement between the two readers was assessed by the Bland-Altmann plots Figure . The meaThe relative prostate volume changes on the final follow-up CT scans from the baseline CT scans, obtained by averaging the values measured by the two observers, were 86.4 ± 11.4% (65.1 to 113.1%) in all patients, 85.3 ± 12.2% (65.1 to 113.1%) in HCC patients, and 86.6 ± 9.0% (74.4 to 95.5%) in RCC patients. Of the 26 patients, 23 showed PVR when treated with sorafenib. Three patients showed increased prostate volume of 113.1%, 101.0%, and 103.2%, respectively. The therapy durations and cumulative doses of sorafenib in the three patients were 131 days (52.8 g), 172 days (39.2 g), and 66 days (29.8 g), respectively.Each patient’s relative prostate volume change from the baseline CT to the follow-up CT scans was plotted as a function of the follow-up interval Figure  and as a3 in patients with liver dysfunction , and 26.9 ± 9.1 cm3 in patients without liver dysfunction . The difference between the two groups showed no statistical significance (p = 0.178). The relative prostate volume changes from the baseline CT scans to the final follow-up CT scans were 86.7 ± 12.0% in patients with liver dysfunction and 85.0 ± 9.0% in patients without liver dysfunction (p = 0.753). The FIB-4 score in patients with liver dysfunction ranged from 1.5 to 13.6 (median: 3.3). Sorafenib-associated prostate volume change demonstrated dependence on the FIB-4 score (r = 0.26) in patients with liver dysfunction , and 83.7 cm3 (reader 2) on the baseline CT, and 61.5 cm3 (reader 1), and 61.6 cm3 (reader 2) on the final follow-up CT  and 23.0 cm3 (reader 2) on the baseline CT, and 15.7 cm3 (reader 1) and 19.2 cm3 (reader 2) on the final follow-up CT. The duration of sorafenib therapy was 1225 days and the cumulative dose was 184 g.One patient with HCC also had BPH (patient 1). The prostate volume of this patient was 80.4 cmT Figure . The durOur study investigated the prostate volume change after sorafenib treatment. Two independent readers measured the prostate volumes of 26 patients who underwent sorafenib therapy . Statistically significant PVR was observed in the respective measurements performed by the two readers. The concordance correlation coefficient for the prostate volume calculated by the two readers was substantial on the baseline CT scans (0.95) and the moderate on the follow-up CT scans (0.94), suggesting that the interrater agreement was good.Our study also revealed that sorafenib-associated prostate volume change tend to be dependent on the exposure time (r = –0.23). The PVR of Patient 1 was observed within a relatively short period of sorafenib exposure (the therapy duration was 31 days). However, three other patients showed increases in their prostate volumes within 180 days of therapy. With long-term sorafenib therapy, the effect of PVR was more certain Figure .3 to 61.5 cm3 (reader 1), and from 83.7 cm3 to 61.6 cm3 (reader 2) after sorafenib therapy , and from 23.0 cm3 to 19.2 cm3 (reader 2) after therapy. Hatano et al. demonstrated that RCC patients who had undergone sunitinib administration showed a significant PVR and an improvement in urinary symptoms at week 24 [One patient (Patient 1) with HCC who had been clinically diagnosed with BPH also showed PVR after sorafenib administration. He did not take any medication for BPH during the observation period. His prostate volume reduced from 80.4 cmy Figure . On revi week 24 . Therefo3 in patients with cirrhosis (n = 60) whereas it was 27.6 ± 8.6 cm3 in controls (n = 20) [3) when compared to those with liver dysfunction (22.4 ± 14.7 cm3), although the difference between the two groups was not statistically significant (p = 0.178). Our study showed that although sorafenib-associated PVR occurred regardless of the presence of underlying liver dysfunction, it was slightly dependent on the FIB-4 score (r = 0.26). Our findings suggested that PVR with sorafenib therapy could occur even in patients with decreased androgenic activity due to liver dysfunction, but that the degree of PVR might be relatively small in patients with progressive liver fibrosis.It has been reported that BPH occurred in fewer cirrhotic patients when compared to the general population . Frea et(n = 20) . These r(n = 20) 19. This The molecular mechanism by which PVR occurs with sorafenib is considered to be different from that of existing drugs. For instance, Chiu et al. demonstrated that finasteride, a 5α-reductase inhibitor used in BPH, also causes PVR with an average reduction in prostate volume from 39.8 ± 21.1 mL to 33.6 ± 20.5 mL with finasteride treatment when evaluated by ultrasonography 2223. Sor22Our retrospective pilot study had several limitations. First, some CT scans were taken without IV contrast enhancement due to renal dysfunction, and the timings of the portal venous images were different between patients with HCC and those with RCC. This could have caused slight differences in visualizing the boundaries of prostate and might have affected the volume estimated by the two readers to some extent. This was unavoidable since we included RCC patients in the analysis, who were prone to develop renal dysfunction. Second, we did not analyze the correlation between the PVR and the patients’ prognosis. This is because, we considered the prostate volume reduction to be a relatively early onset adverse effect and included patients who were administered sorafenib for shorter durations. Thus, any prognostic information obtained from our study cohort would have had little value. Third, due to the retrospective nature of the study, we could evaluate urinary symptoms in the patients only by investigating their medical records. Further quantitative analysis, including IPSS score, urine flow measurement, and residual urine measurement, would be necessary to assess the correlation between sorafenib-associated PVR and urinary functions.Our pilot study has made the novel demonstration of prostate volume reduction with sorafenib therapy. Sorafenib-associated prostate volume reduction could occur in patients regardless of the presence of liver dysfunction or BPH.The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


Human Immunodeficiency Virus infection (HIV) remains a public health concern in Cameroon that requires regular surveillance for informed policy-making to guide programmatic interventions. Using data from the 2016 HIV national sentinel survey in Cameroon, we ascertained HIV prevalence and factors associated with risk of infection among pregnant womenA cross-sectional study was conducted throughout 2016 in the 10 regions of Cameroon, targeting 7000 first antenatal care (ANC-1) attendees  in 60 sentinel health facilities. HIV serological test was performed using the national serial algorithm at the National Reference Laboratory (NRL). Prevalence was determined, and multivariate logistic regression was used to assess determinants of HIV infection, with p-value<0.05 considered statistically significant.Of the 7000 targeted participants, a total of 6859 first ANC-1 attendees were enrolled (98.0% sampling coverage). Median age was 26 [IQR: 21–30] years and 47,40% had a secondary school level of education. The national prevalence of HIV was 5.70% (95% CI: 4.93–6.40) and range from 9.7% in East region to 2.6% in North region. The prevalence was 5.58% (95% CI: 95%: 4.88–6.35) in urban and 5.87% (95% CI: 5.04–6.78) in rural settings. Factors that were associated with HIV infection included marital status, women who were married or living with their partner are less likely to be infected than singles women , multiparity [aOR = 1.5(95%CI:1.0–2.2)] and been living in the Centre, East, North-west and South-west regions. HIV infection was also significantly associated with age, with the risk of being infected increasing with age.Pregnant women in Cameroon are still disproportionately infected with HIV compared with the general population . Preventive actions to curb the epidemic amongst pregnant women should prioritize interventions targeting single pregnant women, who are older, and residing particularly in the Centre, East, North West and South West regions of the country. According to the Joint United Nations program on HIV/AIDS (UNAIDS), 36.9 million people were living with HIV in 2017 and 1.8 million were newly infected across the globe. Sub-Saharan Africa bears the greatest burden of the epidemic with 25.7 million people infected in this region. The HIV infection is significantly corelated with the employment status. The odds of HIV were almost two time among employee of informal sector compared to housewife [OR = 1.83 (95% CI:1.36–2.51)]. Education level was also significantly related to HIV infection, the women who reported having achieved primary school education [OR = 2.26 (95%CI:1.49–3.28)] and secondary school education [OR = 1.71(95%CI:1.16–2.47)] had higher prevalence as compared to those who reported never having attended school. The odds of being infected with HIV was higher among women residing in the Center [OR = 3.15(95%CI:1.19–5.17)], East [OR = 3.20(95%CI:1.97–5.24)], Nord-West [OR = 2.02(95%CI:1.19–3.41)] and South-West [OR = 2.96((95%CI:1.80–4.85)] regions of the country. The HIV infection increase with age group. The odds of HIV infection was more than three times among women age above 20 years as compared with those aged less than 20 years (20–24 years [OR = 3.03(95%CI:1.76–5.18)], 25–29 years [OR = 3.86(95%CI:2.27–6.57)], 30–34 years [OR = 5.61(95%CI:3.29–9.56)], age >34 years [OR = 7.13(95%CI:4.13–12.28)]). Multiparous are almost three time more at risk of infection than nulliparous [OR = 2.79 (95%CI: 2.01–3.88)] and the odds of infection are even higher among grand multiparity (4 and more deliveries) [OR = 1.47 (95%CI:1.81–1.82).Being married or cohabiting ([OR = 0.76 (95% CI = 0.59–0.96)]) as well as being a student ([OR = 0.45 (95%CI:0.30–0.69)]) were found to be associated with lower odds HIV infection. There was no statistical association between HIV infection and the area of residence  .Multivariate logistic regression analysis revealed that age is significantly associated with HIV infection. (Women aged 20–24 years [aOR = 2.8 (95% CI:1.6–4.9)] and those aged 25–29 years [aOR = 3.1 (95% CI:1.7–5.7)] are three times more likely to be infected than those less than 20 years of age Those aged 30–34 years and > 34 years are four [aOR = 2.9(95%CI:1.5–5.6)] and five [aOR = 4.2(95%CI:2.2–8.72)] times more likely to be infected as compared to those less than 20). Multiparity is also associated to the risk of infection [aOR = 1.5(95%CI:1.1–2.2)] as well as living in the Centre [aOR = 2.6(95%CI:1.5–4.4)], East [aOR = 3.2(95%CI:1.9–5.2)] and South-West [aOR = 2.4(95%CI:1.4–4.0)] regions compared to living to Adamawa. However, married [aOR = 0.5(95%CI:0.4–0.7)] compared single and student [aOR = 0.5(95%CI:0.3–0.8)] compared to housewife were inversely associated with HIV. infection. No significant interaction with level of education was observed .The overall goal of this study was to assess the factors associated with HIV infection among pregnant women in Cameroon. The national HIV prevalence was estimated in this vulnerable population and then risk factors associated with infection, were analyzed. The results of the study show that HIV infection among pregnant women is decreasing. In 2012, the prevalence of HIV in this group was 7.8%  while our results show a prevalence of 5.7%  , 8. ThisOur results showed that single women are two time more likely to be infected by HIV than those who are married or cohabiting. Others study had reported similar findings that peoples engaged in a marital relationship are less exposed to HIV infection This canThe odds of being infected with HIV increased with age. Women aged 25 years and above are at least two times more at risk of being infected with HIV compared with those that are younger. This result is in accordance with the distribution of HIV infection in the general population, were the prevalence of HIV is higher in the higher age-groups. The ageIn addition, the odds of HIV infection increased with gravidity. Higher gravidity implies more exposure to unprotected sex, hence higher risk of being infected with the virus. As we stated before, the improvement registered in the implementation of prevention programs particularly among women has certainly contributed to reduce new infection, with primigravid women newly enrolled into ANC care having less odds of being infected with HIV than multi-gravid women. Beyond the desire of pregnancy, higher numbers of previous pregnancies can also reflect inadequate power of women to negotiate protected sex. This has been demonstrated in many studies to be a risk factor of HIV infection. This rePregnant women living in the Centre, East, North-West and South-West regions were more at risk of HIV infection than those in the other regions. These four regions are the most affected in the country after the South region which has the highest HIV prevalence . These rThe bivariate analysis showed an association between level of education and HIV infection amongst pregnant women, as many other studies have , 15. ButThe strength of our study is the large population size and the fact that it covers all ten regions of the country offers the possibility to generalize the results. A possible limitation is the limited number of factors considered in the study. The economic characteristics as well as the cultural environment of participants, which have been shown in previous studies to be significantly related to HIV infection, were not collected in this study. Nevertheless, the general socio-cultural and economic situation of the different regions which have been well established in previous studies were considered in explaining the results of the study.Our results showed that even though HIV infection among pregnant women is decreasing, this group is still disproportionately affected as the HIV prevalence is still higher than that of the general population. For the HIV prevention program amongst pregnant women to be effective, it must specifically target older pregnant women, who are single or divorced and having a higher gravidity. Special attention should be paid Centre, South-West, North-West and East regions where comprehensive prevention strategies should be undertaken.S1 Table(DOCX)Click here for additional data file.


Microbiological contamination of retrieved tissues is a critical aspect of allograft safety and tissue banks must continuously implement decontamination procedures to minimize tissue contamination. In this study we compared the decontamination efficacy of a new antibiotic cocktail  with the cocktail previously adopted at Treviso Tissue Bank Foundation (FBTV) . Two decontamination steps were carried out, the first immediately after retrieval, the second after processing. The contamination rate was calculated before processing (Time 1) and cryopreservation (Time 2) for total tissues, musculoskeletal tissues and cardiovascular tissues, and the bacterial species involved were analyzed. Cocktail A was used to decontaminate 3548 tissues, of which 266 were cardiovascular and 3282 musculoskeletal tissues. For cocktail A, total tissue contamination was 18.6% at Time 1 and 0.9% at Time 2, with 15.7% contaminated musculoskeletal tissues at Time 1 and 0.4% at Time 2, respectively, while cardiovascular tissues were 50% contaminated at Time 1 and 6.4% at Time 2. Cocktail B was used to decontaminate 3634 tissues of which 318 were cardiovascular and 3316 musculoskeletal tissues. For cocktail B, total tissue contamination was 8.6% at Time 1 and 0.2% at Time 2, with 7.6% contaminated musculoskeletal tissues at Time 1 and 0.03% at Time 2, respectively. Contamination of cardiovascular tissues was 20.4% at Time 1 and 1.9% at Time 2. Intergroup and intragroup contamination rates decreased statistically significantly (p<0.05). Our results have shown that cocktail B was more effective than cocktail A in killing bacteria in both cardiovascular and musculoskeletal tissues during the two decontamination cycles. Of the 29 positive Group A tissues, 12 were MST and 17 were CVT, while in Group B, 1 was MST and 6 were CVT. The percentage of the total MST testing positive differed significantly, decreasing from 0.4% (95% CI 0.20–0.62) in Group A to 0.03% (95% CI 0.002–0.149) in Group B (p = 0.002), while the percentage of total positive CVT dropped from 6.4% (95% CI 3.89–9.84) in Group A to 1.9% (95% CI 0.77–3.88) in Group B (p = 0.005).A total of 29 out of the 3548 tissues proved positive in Group A  and a total of 7 tissues of the 3634 tissues tested positive in Group B [0.2% (95% CI 0.08–0.38)] , followed by several genera whose detection and percentages differed in the two groups . The remaining contaminations were due to a higher number of genera than observed in MST, and there was overlap between the two groups, but with different percentages among the various species  for shorter periods. Decontamination efficacy was found to increase . However, this decontamination method, which is not adopted by our institution, would have prevented us from comparing bactericidal efficacy among the various decontamination solutions.As highlighted by the statistical analysis, cocktail B clearly had far greater eradicating power than cocktail A considering that it reduced positive findings by 50% more than cocktail A after the first decontamination, although some tissues did remain positive at the end of the process and were therefore discarded. The change in cocktail has evidently had a beneficial effect in that less tissues were discarded than before, after deducting the tissues contaminated by non-compliers, which were discarded in any case. As part of the In conclusion, targeted decontamination minimizes the risk of false negatives and, consequently, the risk of infections in recipients. In this work we compared the efficacy of two antibiotic formulations providing evidence that a cocktail including Gentamicin, Ciprofloxacin or Meropenem was more effective than the previously adopted solution composed of Ceftazidime, Lincomycin, Polymyxin B and Vancomycin, resulting in less tissues being discarded after the second decontamination step. Finally, this study highlights the need for tissue banks to systematically assess their antimicrobial cocktail to determine which one most efficiently eradicates potential pathogens from their allografts.


Camellia oleifera Abel (C. oleifera) absorb nutrients from surrounding soils and its yield is highly influenced by these nutrients and by fertilizer application. Thus, the soil nutrients play a central role in C. oleifera production. This study investigated the effects of biogas slurry applications on soil nutrients and economic traits of C. oleifera fruits. Five different amounts of biogas slurry  were used as fertilizer for C. oleifera plants in 2015 and 2016. The nutrients of rhizosphere soil and the economic traits, including fruit yield, seed rate, and oil yield of C. oleifera fruit, were measured each year. The results showed that fertilization with biogas slurry significantly increased soil organic matter, available nitrogen (N), phosphorus (P), and potassium (K) both in 2015 and 2016. Increases in soil available N, P, and K were maximal in the highest slurry application group followed by the second highest application group. The oil yield correlated with the content of soil available P in both 2015 and 2016, and with soil organic matter in 2015. Fertilization with biogas slurry decreased the saturated fatty acid content in fruit but had no effect on the unsaturated fatty acid content. In conclusion, fertilization with biogas slurry increased rhizosphere soil nutrients and fruit economic traits of C. oleifera and rates of at least30 kg/plant/year had the most positive effects. This study expands the knowledge of fertilization with biogas slurry in C. oleifera production. All five treatments did not receive fertilization with chemical fertilizers. The biogas slurry was fertilized three times a year  with the furrow method into the drip line of trees (The experiment was conducted using a randomized block design with five treatments according to the level of applied biogas slurry: (1) no biogas slurry [group Bof trees . The bio4F and 0.5 M HCL and estimated via the molybdenum-antimony colorimetric method; available K was extracted with neutral 1M NH4OAC and was estimated by flame emission spectroscopy [Immediately after fruit harvest, mixed soil samples were collected from five replication plants in each plot. These soil samples were cleared of roots and all other organic debris and subsequently air-dried, ground, and sieved (1 mm) for analysis of soil available nutrition and further sieved (0.149 mm) for organic matter detection. Organic matter was estimated via organic carbon using the conventional conversion: organic matter = 1.724 × organic carbon; organic carbon was determined by the Walkley-Black wet oxidation method; available N was estimated with the Kjeldahl method; available P was extracted with 1 M NHC. oleifera yield fluctuates each year [0 (g), then transferred to Soxhlet extraction using petroleum ether (60–90°C) at 80°C for 12h. After the solvent was evaporated in vacuum, the residual was dried at 60°Cto a constant weight of w1 (g) in vacuum. The oil weight was calculated according to the formula: oil weight = w0—w1. Fatty acids in fresh fruits were measured according to the Chinese Standard , by a gas chromatograph  [Fruits were harvested in October and single tree yield was calculated by immediately weighing all fresh fruit from each tree. Thirty representative fruit samples of each tree were collected. Because ach year , 26, the, Japan) –29. The The concentrations of organic matter, available N, P, and K between 2015 and 2016 were statistically analyzed by ANOVA using SPSS 19.0. Means were compared by least significant difference (LSD) tests at p < 0.05, and the data in the result represent the average ± STD. The effects of biogas slurry on soil nutrients  and yield were tested via correlation analysis.0, the organic matter concentration of B1, B2, B3, and B4 groups increased by 32.2% (p<0.05), 55.8% (p<0.01), 70.9% (p<0.01), and 72.6% (p<0.01), respectively. Multiple comparisons showed significant increases of soil organic matter between the fertilized groups and control group; no significant differences were found among treatments B2, B3, and B4. During the second experimental year (2016), the situation was similar to that in 2015. All biogas slurry application rates led to increased organic matter compared the control group. Treatments B3 and B4 achieved higher enhancement rates than those in 2015, with increments of 142.28% and 137.56%, respectively.Fertilization with biogas slurry significantly increased the organic matter concentration of rhizosphere soils . During 4, (the treatment with the most biogas slurry fertilization), resulted in the highest improvement of available nitrogen in both 2015 (249.07%) and 2016 (499.2%). Low slurry application  led to similar levels of soil available N in the two experimental years; however, at the second highest slurry addition rate (B3), soil available nitrogen continued to increase in 2016.During the experiment, soil available nitrogen decreased from 2015 to 2016 in the control group. Fertilization with biogas slurry increased soil available nitrogen both in 2015 (p = 0.009) and 2016 (p = 0.000) . When co1, B2, B3, and B4) had increments of 151.81%, 139.97%, 119.96%, and 135.82% of available P, respectively, compared to the control group. Multiple comparisons showed no significant differences among the four fertilized groups in 2015. In 2016, compared to the control group, the enhancement of available P was larger with higher slurry addition rates  with increments of 161.95%, 188.88%, 210.10%, and 255.05%, respectively.All four biogas slurry fertilized groups had higher concentrations of available phosphorus in 2016 than in 2015 . However1) treatments . In 2016, treatments B3 and B4 still showed significant enhancements of 117.07% (p < 0.01) and 132.52% (p < 0.01), respectively.Available K decreased from 2015 to 2016 in both the control and the lowest slurry addition  and 2016  had the highest fresh fruit yield, fresh seed rate, and dry seed rate, and resulted in a higher oil yield per plant. Therefore, biogas slurry plays an important role in the production increase of C. oleifera, and might be an effective substitution for chemical fertilization in C. oleifera production.In the present study, the effects of biogas slurry on the nutrients in rhizosphere soil and fruit economic traits of S1 Table(XLSX)Click here for additional data file.S2 Table(XLSX)Click here for additional data file.S3 Table(XLSX)Click here for additional data file.S4 Table(XLSX)Click here for additional data file.S5 Table(XLSX)Click here for additional data file.


This study aimed to determine the association between nutritional status and academic performance among primary school children in Debre Markos Town, northwest Ethiopia, 2017.The prevalence of stunting, underweight and wasting were 27.5% (95% CI 23.2–31.9%), 20.4% (95% CI 16.5–24.3%) and 8.7% (95% CI 6.2–11.5%), correspondingly. The low level of educational performance was significantly higher (p < 0.05) among the stunted, underweight and wasted children than that of the normal children. In multivariable logistic regression, age of the child (Adjusted Odds Ratio (AOR) = 0.177, 95% CI 0.07, 0.4), monthly income less < 1000.00 birr , stunted children  and under-weight  were associated with academic performance. This study revealed that indicators of undernutrition were prevalent among school-age children. Thus, collaboration between the health and education sectors is required to alleviate the problem.The online version of this article (10.1186/s13104-018-3909-1) contains supplementary material, which is available to authorized users. Quality education plays a pivotal role in the economic, social and political development. Currently, getting children into schools is not enough; government ensure that children attain the basic knowledge and skills needed for personal well-being . PrimaryNutrition is also a vital component of human health, life, and brain development through the entire lifespan . BalanceOn this background, there is a necessity to overlook the relationship between nutritional status and educational performance among school-age children in the Debre Markos town. This study was aimed to determine nutritional status and correlation with academic performance among first cycle governmental primary school in Debre Markos Town, northwest Ethiopia.The study was conducted at Debre Markos town primary school. In the town, there were a total of 7473 population. Of them, 3831 were females studying in the school. Debre Markos is a city of East Gojjam Zone which is located 299 km away from Addis Ababa in the North. It had 15 governmental and 8 private primary schools. The study was conducted between January15 to March 17/2018.Study design and population: An institutional-based, cross-sectional study was employed at primary school in Debre Markos town.Sample size and sampling techniques: The sample size was determined using double population proportion by considering the following statistical assumptions: prevalence of stunting among school children (p1) is 48% and p2 is 29% and level of significance (α) = 5%, at 95% level of confidence, power of the study 90% and design effect 1.5. Finally, the overall sample size was found 442.Sampling procedure: Participants were carefully chosen using a multi- stage sampling technique. Out of 15 primary schools, 4 schools were selected randomly by lottery method at stage one. Students were allocated proportionally at stage two. Then participants from selected schools were selected by systematic random sampling method using students’ name list by calculating ‘k’ value for each class.Data collection methods: Data were collected using a pre-tested structured questionnaire and translated into the local language (Amharic version) by trained and experienced data collectors. Respondents were parents/caregivers of the children identified in the study schools. After students were systematically selected from the schools, their household address was traced in the students’ parent database. Then data collectors went to the children’s house to interview parents/caretakers. Training on the standard procedures and technique how to collect data were given for the data collectors and supervisors for 2 consecutive days. The contents on questionnaires were briefly described to reduce interviewer bias.Data processing and analysis: Data were entered into Epi-Data version 3.1 and then exported to SPSS version 20 for further analysis. Emergency Nutrition Assessment (ENA) for SMART software was used to calculate the Z-score of weight-for-age, height-for-age and weight -for-height of the children. Variables which were significant at p-value < 0.2 in the bivariable analyses were candidate for entering into the multivariable logistic regression model to identify the independent predictors for academic performance. Before inclusion of factors, we checked multicollinearity using variance inflation factor (VIF) < 10.The overall subjects the students were given in the academic year 2017/18 were considered to examine the academic achievements of the students. The annual average score was computed by taking the result of two consecutive semesters of the year. To verify the relationship between nutritional status and academic performance, average marks of the overall subjects the students received were either poor academic achievement or good academic achievement, in accordance with an average mark of 50%. This cut off average point was decided by considering the pass mark set by Ethiopian ministry of education.A total of 436 children were included in the study with a response rate of 98.6%. Of them, 245 (56.2%) were males. The mean age of the study participants was 8.57 ± 1.12) ranging from 7 to 10 years. Majority of the study participants 398 (90.8%) were located in urban, 389 (89.2%) orthodox and 153 (35.1%) from grade one. Educational status of parents of the study participants showed that 81 (19.5%) mothers and 67 (17.7%) fathers had no formal education  were being sick in the last semester and only 140 (32.1%) of school-age children were attending preschool. Majority of study participants 403 (92.44) were traveled to school with in 2.18 km , 20.4% (95% CI 16.5–24.3%) and 8.7% (95% CI 6.2–11.5%) respectively. The percentage of children having any kind of under nutrition  was 56.2%. The prevalence of stunting was significantly higher in males than females . Age of the child , Monthly income less < 1000.00 birr , stunted children  and under-weight  were significantly associated with academic performance. Students those nutritional status had stunted were 79% less likely to score high academic performance as compared with normal. Students whose nutritional status had under-weight were 37% less likely to score high academic performance compared with their counterparts  had significant positive associations with academic achievement of students .Additional file 2: Table S2. Prevalence of low educational performance .


The anatomy of parathyroid glands (PTG) is highly variable in the population. The aim of this study was to conduct a systematic analysis on the prevalence and location of PTG in healthy and hyperparathyroidism (HPT) patients.An extensive search of the major electronic databases was conducted to identify all studies that reported relevant data on the number of PTG per patient and location of PTG. The data was extracted from the eligible studies and pooled into a meta-analysis.n = 7005 patients; n = 23,519 PTG) on the number of PTG showed that 81.4% (95% CI 65.4–85.8) of patients have four PTG. A total of 15.9% of PTG are present in ectopic locations, with 11.6% (95% CI 5.1–19.1) in the neck and 4.3% (95% CI 0.7–9.9) in mediastinum. The subgroup analysis of ectopic PTG showed that 51.7% of ectopic PTG in the neck are localized in retroesophageal/paraesophageal space or in the thyroid gland. No significant differences were observed between the healthy and HPT patients and cadaveric and intraoperative studies.The overall analysis of 26 studies  contains supplementary material, which is available to authorized users. Parathyroid glands (PTG) are nodular structures that are usually located along the posterior wall of the thyroid Fig. . Their pThe anatomy of PTG is highly variable in the population. Classically, four PTG are present, but previous research reported fewer and cases of up to 12 glands per patient . The supBilateral neck exploration is the classical approach to parathyroidectomy. Preoperative identification of PTG is of crucial importance, especially in patients with PHPT requiring excision of only one or few PTG and allows for a less invasive approach. Ultrasonography (USG), technetium-99m scintigraphy, or computed tomography are used to identify PTG preoperatively. Moreover, intraoperative PTH assay ensures that all PTG causing hyperparathyroidism are removed during surgery. Substantial research has been done to untangle the variable prevalence and location of PTG, but the results are inconsistent. Knowledge regarding the prevalence, location, and anatomy of PTG is essential for surgeons planning for and carrying out parathyroidectomies, as any unidentified PTG, either supernumerary or those in an ectopic location, can result in unsuccessful treatment and the need for reoperation. Moreover, the preservation of PTG is of utmost importance during thyroidectomies. Therefore, the aim of this study was to conduct a systematic analysis on the prevalence, location, and morphometric data of PTG in both healthy patients and those with hyperparathyroidism (HPT).PRISMA) guidelines were strictly followed throughout this study  was used to conduct statistical analysis. The pooled prevalence estimates (PPE) were calculated using a random effects model. The heterogeneity of the included studies was assessed with chiThe data was divided into several subgroups. Whenever possible, the type of study, patient’s health characteristic , and geographical location were analyzed separately. Moreover, sensitivity analysis by exclusion of studies with sample size smaller than 500 was performed to further investigate the source of heterogeneity. Confidence intervals were used to compare two groups, with any overlap as an indication of statistically insignificant difference [The flow of articles through the study is presented in Fig. Finally, a total of 27 articles were included into the meta-analysis.n = 7106 patients, n = 23,519 PTG) analyzing the prevalence, location, or morphology of PTG were included. The dates of the included studies ranged from 1916 to 2016. Eleven studies originated from Europe, 6 from North America, 4 from South America, 5 from Asia, and 1 from Australia, and a total of 12 countries. Twelve studies analyzed healthy patients, and 10 studies analyzed patients with HPT, 2 with MEN1 and 2 with various thyroid diseases  on the number of parathyroid glands showed that 81.4% (95% CI 65.4–85.8) have four PTG  revealed that 82.2% (95% CI 59.1–92.7) of patients have four PTG (Table n = 2776 patients) showed that majority of patients have four PTG. Subgroup analysis of the healthy group based on geographical location revealed smaller prevalence of patients with four PTG both in North  and South America  than in Europe ; however, the differences were not significant. Overall, 4.9% and 6.3% of healthy and HPT patients, respectively, have five or more PTG  showed that 15.9% of PTG are present in ectopic locations, with 11.6% (95% CI 5.1–19.1) in the neck and 4.3% (95% CI 0.7–9.9) in mediastinum (Table n = 4324 PTG) of healthy patients and three studies (n = 1046 PTG) of HPT patients revealed that 94.7% and 82.5% of PTG are localized along the posterior wall of thyroid glands in or within close proximity to their orthotopic locations.Overall analysis of eight studies  showed that 31.4% (95% CI 0.6–63.8) of ectopic PTG in the neck are localized in retroesophageal/paraesophageal space, followed by 20.3% (95% CI 0.0–48.2) in the thyroid gland, 17.7% (95% CI 0.0–44.8) in the carotid sheath, 17.0% (95% CI 0.0–43.9) in the thyrothymic ligament, 5.1% (95% CI 0.0–25.1) in the tracheoesophageal groove, and 8.4% in other locations . The subgroup analysis of mediastinal PTG revealed that majority were located in the thymus.The subgroup analysis . The number of studies analyzing morphology of the PTG was also limited.Most healthy and hyperparathyroidism patients have four parathyroid glands, but about 20% present with fewer or more glands. The number of ectopic glands reaches 16% and is located in the neck or mediastinum. Surgeons should be aware of the most frequent potential locations of ectopic PTG to assure successful surgery and treatment.Supplement 1PRISMA) checklist (DOC 63 kb)Preferred Reporting Items for Systematic Reviews and Meta-Analyses (


The identification of prognostic factors of gastric cancer (GC) has allowedto predict the evolution of patients. Assess the reliability of the lymphoparietal index in the prediction oflong-term survival in GC treated with curative intent.Prospective study of the Universidad de Chile Clinical Hospital, between May2004 and May 2012. Included all gastric cancer surgeries with curativeintent. Exclusion criteria were: gastrectomies due to benign lesions, stage4 cancers, R1 resections, palliative procedures, completeesophagogastrectomies and emergency surgeries. A total of 284 patients were included; of the sample 65.4% were male,mean ageof 64.5 years,75% were advanced cancers, 72.5% required a total gastrectomy,30 lymph nodes harvest. Surgical morbidity and mortality were 17.2% and1.7%. 5-year survival was 56.9%. The N+/T index could predict long-termsurvival in all de subgrups (p<0.0001), although had a reliableprediction in early GC (p=0.005), advanced GC (p<0.0001), signet ringcell GC (p<0.0001), proximal GC (p<0.0001) and distal GC(p<0.0001). The ROC curves N+/T index, LNR and T classification presentedareas below the curve of 0.789, 0.786 and 0,790 respectively, without asignificant statistical difference (p=0.96).The N+/T index is a reliable quotient in the prognostic evaluation of gastricadenocarcinoma patients who have been resected with curative intent. Thus, an increase in patients withundifferentiated cancers (particularly signet cell cancer), tumors in the superiorthird of the stomach,and a greater proportion of total gastrectomies have beenobserved, in addition to a significant decrease in surgical mortality and animprovement in a 5-year global survival rate(SVg5),,,Identification of some prognostic factors has contributed in the therapeutic decisionmaking processThe main objective of this study was to assessthe reliability of the lymphoparietalindex in the prediction of long-term survival in GC treated with curative intent.Prospective analysis of the oncological database of a Chilean University Hospital between May 2004 and May 2012.This articledoes not contain any experimental studies with human or animal subjects performed byany of the authors.All patients with gastric adenocarcinoma and Siewert II and III esophagogastricjunction in the adult population, surgically treated with a curative intent,were included. Subtotal, total and extendedgastrectomies were included. th edition TNM classification, R1 resections,palliative procedures, complete esophagogastrectomiesand emergencysurgeries.Exclusion criteria included: gastrectomies due to benign lesions, stage 4 cancersaccording to the 7Defined in previous reporttheditionWere used: 1) TNM classification was standarized using the AJCC 7The present study had 100% follow up. The database was completed in a prospectivemanner: the survival update was carried out annually using the database of ourhospital and the Chilean Civil Registry. In accordance with thistest, the continuous variables with parametric distribution  wereexpressed on average and with a standard deviation (SD), while for thecontinuous variables with non parametric distribution  the median andinter-quartile (IC25%-75%) ranges were used. The categoricalvariables were described in percentages. The Fisher, xR14 program was used and p<0.05 wasconsidered statistically significant. Univariate and multivariate analyses wereperformed calculating the odds ratio (OR) with a 95% confidence interval (CI).The Kaplan-Meier method in the Prism7MR program was used to calculatethe survival curves. The StataR program was used to create the ROCcurves.The prognostics factors evaluated were demographic, clinical, surgical,anatomopathological and prognostic indexes. The distribution of variables wasdetermined by the Shapiro-Wilk testA total of 284 patients were included with a mean age of 64.5 years (+/-12.7 DS) ofwhich 65.4% were male. 69.7% of all patients presented co-morbidities with highblood pressure, tobacco use and diabetes being the most common with 38.3%, 34.8% and17.6 % respectively. 24.6% of all patients presented first-degree relatives withgastric cancer. 25-75%: 22-41). The number of lymph nodes harvested during D1lymphadenectomies were 28 (IC25%-75%:19-32.5), while 33 were harvested inD2 lymphadenectomies (IC25%-75%: 24-44). Mean operating time was 208 min(+/-63.8 DS. All samples (100%) were R0 resections. In reference to the surgical technique, 72.5% of patients required a totalgastrectomy, 19.7% a subtotal gastrectomy and 7.8% an extended gastrectomy. Theorgans additionally resected included the pancreas (41%), distal esophagus (27%),colon (14%), small intestine (14%) and kidney (4%). The lymphadenectomy was D1 in14.7% and D2 in 85.2%. The mean global lymph node harvest was 30 lymph nodes(IC25-75%: 7-11).Postoperative surgical morbidity corresponded to 17.2%, while surgical mortalityconsisted of five patients  whichrepresented 1.7%.The mean hospital stay of patients was nine days (CI25-75%: 0-9). Table1 shows the TNM classification of patients. The histopathological study revealed that 58.4% of tumors were of the intestinal typewhile 36.6% diffuse (undifferentiated or with signet ring cells) and 4.9% weremixed. 25% of the study corresponded to incipient cancers and 75% to advanced.Patients with signet ring cells represented 24.2% of the total sample.Lymphovascular invasion was identified in 50.3% of the sample, while perineuralinvasion was observed in 41.5%. The mean of compromised lymph nodes per person was2. The rate of patients with a SVg5 was 56.9%. The SVg5 of these was 90.1% inincipient and 44.6% in advanced GC. Global survival according to the N+/T index in our population presented significantdifferences in each group  with p<0.0001 . SurvivaThe ROC curve of the N+/T index and the comparative curves between the T and lymphnode ratio predictive variables are represented in The main results of this study suggest the following: 1) The oncological resultscomply with the quality models currently used for modern management of gastriccancer; 2) the N+/T index can be a very useful tool for predicting survival for morethan five years in patients who underwent surgery for gastric adenocarcinoma withcurative intent. ,The presentation and treatment of GC have changed over the past 40years. Thefrequency of distal tumors decreased from 64% to 25%, the intestinal typeproportion: diffuse went from 3-4:1 to almost 1:1; the resectability rate hasincreased from 48% to 85% (p<0.001); 75% of all cases are total gastrectomies andsurgical mortality has decreased from 25% to 0.8% (p<0.0001),The epidemiological changes have different explanationsThe patients studied in this article reflect part of these changes. This is thereason why practically 40% of cases are due to diffuse lesions, 2/3 of thepopulation required a total gastrectomy. The postoperative morbidity was 25.9% andsurgical mortality was 1.7%. These quality standards were within the parameterspresented n the latest Pan American gastric cancer consensus in 2016.,The SVg5 of the patients in this study was 56.9%, with this number being comparableto others published in the literatureWith regards to the prognostic factors of long-term survival, guidelines have beendeveloped with the objective of providing assistance for deciding which therapeuticstrategies should be pursued. In this manner, TNM,,5,11,20.The prognostic effectiveness of the TNM classification and its studies are well knownand have been analyzed by different international,,Regarding the N+/T index, it is reasonable to think that the lymph node metastaticpotential of a tumor, depending on its level of invasion, could reliably predictpatient prognosis. Thus, the ratio between compromised lymph nodes and Tclassification was devised, which was able to demonstrate significantdifferentiation between the global survival curves of the different subgroups  and diffFurthermore, the analysis of ROC curves  demonstrThe strengths of this investigation are the following: 1) The study of a numerouspopulation that represents the international and domestic reality; 2) saidpopulation has been managed following international treatment standards for gastriccancer with a curative intent by a reduced number of expert surgeons; 3) theprovision of a new survival prediction index.th and 7thedition) which impacted the classification and quite possibly the management ofthese patients; 2) it doesn`t include the adjuvant therapy used in the analysis,this limitation is due to the absence of chemotherapy scheme registration in morethan 20% of patients, the information bias of this under registration, cannot makeconclusion reliable in adjuvant therapy. This happens because some healthprovisional system of patients in our hospital, can mandate an externalization ofthe service to another institution. The weaknesses of this investigation are as follows: 1) It covers a period of time inwhich there was a change in TNM classification (6The N+/T index is a reliable quotient in the prognostic evaluation of gastricadenocarcinoma patients who have been resected with curative intent.


Cervical cancer is the second most prevalent cancer among women of child-bearing age in Ethiopia. The aim of this study was to determine human papilloma virus (HPV) genotype distribution among HIV-negative women with normal and abnormal cervical cytology results.We investigated a consecutive of 233 HIV-negative women between December 2008 and March 2009 presenting in a Tertiary Gynecology Referral Clinic in Ethiopia. Screening was done by Pap cytology and HPV detection and genotyping method was nested PCR  and sequencing of the nested products. Sequencing of the non-purified nested PCR products was performed following re-amplification with Big dye terminator, using the GP6 primer.p < 0.0001). The most frequent genotypes identified were HPV16 (44.1%), followed by HPV35 and HPV45 (each 6.2%), HPV31 (4.4%), HPV56 (3.7%), HPV18 and HPV59 (each 3.1%), HPV58 (2.5%) and HPV39 (1.9%). While the most common HR-HPV infections among women with normal cytology were HPV16 (20.3%), followed by HPV35 (8.7%), HPV56 and HPV58 (each 5.8%), HPV18, HPV31 and HPV39 (each 4.4%), HPV45 (2.9%) and HPV59 and HPV68 (each 1.5%), the most common HR-HPV infections in women with abnormal cytology included HPV16 (62%), followed by HPV45 (8.7%), HPV 31, HPV35 and HPV59 (each 4.4%), and HPV18, HPV52 and HPV56 (each 2.2%). We also noted low prevalence of multiple HPV infections in women with normal or abnormal cytology. Multivariable logistic analysis showed that residing in rural area , being multipara  and having abnormal cervical cytology results  were all independently associated with HPV16 genotype.Of the 233 study participants, 92 (39.5%) had abnormal cytology. All women with abnormal cervical cytology had positive HPV DNA compared to only 48.9% of those presenting with normal cytology. Of these women, the frequency of high-risk (HR)-HPV was 83.2% and its prevalence in women with abnormal cervical cytology was significantly higher than those with normal cytology  contains supplementary material, which is available to authorized users. Cervical cancer is the second most common cancer among women worldwide and the leading cause of mortality in developing countries . It is tStudy participants were recruited between December 2008 and March 2009 from the population of women attending the out-patient clinic of the Department of Gynecology and Obstetrics, Tikur-Anbessa Tertiary General Hospital, Health Sciences College, Addis Ababa University, Addis Ababa, Ethiopia. The hospital is a tertiary referral facility with primary responsibility in medical education. Thus, several patients are referred to this hospital, which is located in the capital city of Ethiopia, for advanced diagnosis, management and care. The out-patient clinic of the Department of Gynecology and Obstetrics has several units, of which this specific study was undertaken at the Oncology Unit of the department, which runs once per week. On average, about 1500 patients are seen annually in the Unit. At presentation, potential participants were informed about the study. The criteria for enrollment included: age above 18 years, willingness to participate in the study and willingness for HIV counseling and testing. Exclusion criteria were age less than 18 years, pregnancy, women on menstrual cycle, women who did not start sexual activity, presence of cervical cancer and unwillingness to participate in the study.All women who agreed to participate in the study provided written informed consent. At the enrolment visit, data on detailed socio-demographic information, as well as a clinical history and information on behavioral risk factors were collected using standardized questionnaire by senior nursing staff. Trainings on sensitive data management topics were provided to all staff involved in the research project, which included topics like data recording, data collection, data validation, double entry, correction of data, data export, data security and safety, harmonisation and merging datasets. Common data safety and quality assurance policy were applied. In addition, full clinical examination was done by senior gynecologist and two cervical specimens were collected: one was for smear onto glass slides to be used for routine cytology and a second cervical swab was taken for HPV detection. The latter was placed in 1 ml of RNA/DNA stabilization reagent and then immediately placed in ice before transfer where it was stored at -80 °C until further analysis for HPV DNA PCR and genotyping at the Virology Laboratory, Hadassah University Hospital in Jerusalem, Israel. In addition, whole blood specimen was collected for HIV-1 serology.The smears were stained with the Pap stain and routinely reported by a pathologist according to the criteria of the Bethesda classification system . DiagnosCervical swabs were put onto lysis buffer and were incubated at 37 °C for 2–3 h and then heated to 96 °C for 10 min. The samples were subjected to DNA extraction (Roche – Magnapure). Sample adequacy for DNA amplification was validated by examination of the cellular gene RNase P, which was assayed using the Taqman RNase P kit (Applied Biosystems) according to the manufacturer’s instructions. Five μL of the eluted DNA were subjected to nested PCR amplification using primers derived from HPV L1 region  and reactive samples were tested again by HIV 1/2 STAT-PAK assay . Discordant samples were subjected to a tie-breaker test using Unigold HIV .The protocol was reviewed and approved by Institutional Review Committees of Addis Ababa University Health Sciences College and Hadassah University Hospital as well as the National Ethical Review Committee of the National Science and Technology Ministry, Addis Ababa, Ethiopia.X2 test and student’s t-test. Logistic regression analysis was also used to identify the association between the presence of HPV infection and a range of demographic, behavioral and morbidity characteristics. Multiple logistic regression analysis was carried out in order to see the effects of confounding factors. P value of less than 0.05 was considered indicative of statistical significance. All statistical analyses were performed using the Stata  and SPSS  Statistical Software packages.Questionnaire responses, cervical cytology results, HPV results and other laboratory data were entered onto a database. Through-out the study, double-data entry was undertaken in order to assure quality of the data. Proportions were compared using pearson’s A total of 233 HIV-negative women were enrolled for the study. The mean (95% CI) age of the patients was 41.7 years (40.1–43.2). Furthermore, a significant proportion of these women had multiple sexual partners, were multipara with low income status and no formal education . Furthermore, of those women referred, only 21.3% (95%CI:14.4-28.1) had normal cytology results that was significantly lower compared to those with abnormal cytology .Of the total of 233 patients included and evaluated for cytology examination, the results revealed that 141 (60.5%) samples were normal while 92 (39.5%) were abnormal. Of those with abnormal cytology results, the prevalence of high grade squamous intraepithelial lesion (HSIL) at 68.5% (95% CI: 58.8–78.2) was significantly higher than low grade squamous intraepithelial lesion (LSIL) at 6.5% (95% CI: 1.4–11.7) and invasive cervical carcinoma (ICC) at 25% (95% CI: 16–34.1). The prevalence of abnormal cytology findings among women also presenting with STI appears to be significantly higher from those without STI . The overall prevalence for HR-HPV was 83.2%. The prevalence of HR-HPV among women with normal cervical cytology was significantly lower than those with abnormal cytology . HPV was identified in all specimens from patients with abnormal cytology results and the prevalence of HR-HPV was 83.3%, 95.2% and 87% among those with LSIL, HSIL and ICC, respectively.Table n = 134), the most frequent genotypes was HPV16 (44.1%), followed by HPV35 and HPV45 (each 6.2%), HPV31 (4.4%), HPV56 (3.7%), HPV18 and HPV59 (each 3.1%), HPV58 (2.5%), HPV39 (1.9%) and HPV52 (1.2%). While the most common HR-HPV infections among women with normal cytology were HPV16 (20.3%), followed by HPV35 (8.7%), HPV56 and HPV58 (each 5.8%), HPV18, HPV31 and HPV39 (each 4.4%), HPV45 (2.9%) and HPV59 and HPV68 (each 1.5%), the most common HR-HPV infections in women with abnormal cytology included HPV16 (62%), followed by HPV45 (8.7%), HPV 31, HPV35 and HPV59 (each 4.4%), and HPV18, HPV52 and HPV56 (each 2.2%).Of all HR-HPV infections (p < 0.0001). The most frequent HR-HPV types in LSIL lesions were HPV16 (66.7%) and HPV45 (16.7%); in HSIL lesions were HPV16 (63.5%), HPV31, HPV45 and HPV59 (each 6.4%), HPV35 (4.8%), HPV18 (3.2%) and HPV56 (1.6%), and in ICC lesions were HPV16 (56.5%), HPV45 (13%), HPV52 (8.7%) and HPV35 and HPV56 (each 4.4%).Overall, the prevalence of HPV16 is significantly higher among women with abnormal cytology compared to the prevalence among women with normal cytology . This is somewhat higher than a previous reported results done in Ethiopia showing a prevalence of precancerous lesions of 22.1% , but is Our study also revealed a significant risk of infection with HR-HPV. Moreover, the overall prevalence of HR-HPV and the most prevalent genotype, HPV16, were also significant among women with normal cervical cytology , which is in accordance with the 93% reported by Abate E et al. from Ethiopia –9. The dIn the current study, the most important independent risk factors associated with HR-HPV was related to residence in rural setting. Though underlying conditions have not been studied in detail in the current study, it might be related to lower socio-economic status, as noted in previous studies from Mexico , differeThis study, unlike previous studies done in Ethiopia, included evaluation of cytological status. Indeed, this is the first study to investigate HPV prevalence and genotype distribution among women with normal cytology. The data provided herewith provide some information about the background HPV genotype distribution and also the lower diagnostic sensitivity of Pap smear compared to HR-HPV DNA PCR methods in identifying risk factors for cervical cancer –19.The limitation of the study includes the inclusion of a significant proportion of women who were referred for advanced diagnosis and management and those from rural area resulting in increased prevalence rates of abnormal cytology results as well as HPV infections. The fact that the selected women are mostly referred because of gynecological problems might limit the use of the current data for epidemiological purposes. The HPV genotype distribution in the current study was performed almost 10 years ago, nonetheless data from Ethiopia are still hardly available  and we bTo our knowledge, this study is the first comprehensive assessment of the overall prevalence and distribution of HPV genotypes among Ethiopian women presenting with normal and abnormal cervical cytology findings. Data from the present study indicate that vaccines currently available could prevent nearly 67% of all cervical cancer cases in women in Ethiopia. Moreover, our data suggests that newly licensed 9-valent HPV vaccines would prevent almost 80% of cancer cases in Ethiopian women. Current WHO guidelines advocate “screen and treat” approach for resource constrained settings . Such prEthiopia has no comprehensive national cancer control program. Likewise, there is no national HPV vaccination program. A pilot feasibility study is underway in two sites of the country before scale-up for national HPV vaccination programme. A more comprehensive and representative molecular epidemiology studies are also warranted to understand the real situation in Ethiopia.Additional file 1:Table S1. Socio-demographic characteristics. (DOCX 15 kb)


Background: To investigate the pathological spectrum of glomerular disease in patients with renal insufficiency (RI) from 2008 to 2017.Methods and results: We calculated the estimated glomerular filtration rate (eGFR) with the Chronic Kidney Disease Epidemiology Collaboration creatinine (CKD-EPI) equation and defined RI as an eGFR <60 ml/min/1.73 m2. A total of 969 RI patients were included in our study. IgA nephropathy (IgAN) was the most common subtype of primary glomerulonephritis (37.2%). The frequencies of IgAN and non-IgA mesangioproliferative glomerulonephritis decreased from 27.3% and 9.5% during 2008–2012 to 20.7% and 2.6% during 2013–2017, respectively. However, the frequency of membranous nephropathy increased from 6.8% to 16.2%. Lupus nephritis was the most common subtype of secondary glomerulonephritis (32.1%). The frequencies of both ANCA-associated systemic vasculitis and diabetic nephropathy increased from 3.8% to 7.6% and from 4.3% to 7.6%, respectively. The number of elderly patients (≥60 years) in our study increased sharply, from 15.6% in 2008 to 35.0% in 2017. Membranous nephropathy, minimal change disease, membranoproliferative glomerulonephritis, lupus nephritis and renal amyloidosis are more frequently observed in the elderly patients than in nonelderly patients (<60 years) (p < .05). Excluding those with acute kidney injury, IgAN was the leading cause of RI (24.9%), followed by membranous nephropathy (13.3%) and lupus nephritis (12.0%).Conclusions: IgAN and lupus nephritis were the most prevalent primary glomerulonephritis and secondary glomerulonephritis in patients with RI, respectively. The frequencies of membranous nephropathy, ANCA-associated systemic vasculitis and diabetic nephropathy increased significantly. The number of elderly patients with RI increased sharply. Chronic kidney disease (CKD) has become a worldwide public health issue due to its high incidence, poor prognosis and extensive economic burden. The prevalence of CKD is 10.8% among the 13 Chinese provinces and is as high as 14.2% in some central cities  were divided into three groups according to the GFR categories in CKD: CKD3 (GFR 30–59 ml/min/1.73 m2), CKD4 (GFR 15–29 ml/min/1.73 m2) and CKD5 (GFR <15 ml/min/1.73 m2) [Patients with an estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 mIndications for renal biopsy were categorized into the following clinical syndromes ,4: (1) nThe preferred site for renal biopsy was the lateral aspect of the lower pole of the left kidney under real-time ultrasound guidance with the patient in the prone position. An automated biopsy gun and a 16- or 18-gauge needle were used to ensure that the biopsy sample contained a minimum of 10 glomeruli.Pathologic diagnosis was made on the basis of the detailed histologic features, which included the results of light microscopy (LM), electron microscopy (EM) and immunofluorescence (IF). LM  and IF  were routinely performed for pathological examination of the biopsy specimens on all patients. All antibodies used for immunofluorescence were purchased from Dako . Some patients were suggested to send specimens to the First Hospital of Peking University for EM according to diagnostic needs before November 2014; we began to perform EM in our center afterwards. The percentage of patients who received EM was 48.6% in total.The histologic findings were classified according to the Revised Protocol for Histological Typing of Glomerulopathy  and refeU test was used for non-normally distributed parameters. Differences were considered statistically significant if p < .05.Data were analyzed using SPSS 12.0 , and graphs were constructed using GraphPad Prism 6  for Mac. The cases frequencies are expressed as percentages, and numerical variables in the descriptive analyses are reported as the means ± SDs or medians as appropriate for their distribution. The chi-square test or Fisher exact test was used for categorical variables to test differences in disease frequencies between different groups, and the Mann–Whitney 2, and the median age was 48 years old. Approximately 52.3% of patients were in the young adult group (15–49 years), and the percentage of elderly patients was 26.6%, which was higher than that of the middle-age group (21.1%). The number of patients increased from 149 during 2008–2009 to 252 during 2016–2017. The median eGFR and median age were not significantly different between males and females . The distributions of age stratification and the time of receiving renal biopsies were not significantly different between different sexes, as shown in p = .154, p = .405).From January 2008 to December 2017, a total of 969 RI patients  were diagnosed with glomerular disease. The median eGFR level was 37 ml/min/1.73 mAs shown in IgAN was the most common subtype of PGN, accounting for 37.2%. Patients with MN and FSGS accounted for 19.5% and 12.1% of cases in PGN, respectively. The percentages of MCD and MsPGN were 11.5% and 8.7%, respectively. All remaining subtypes of PGN had a percentage of no more than 5%.LN was the most frequently observed SGN, with a percentage of 32.1%, followed by DN (16.8%) and AASV (16.2%). MANS and BANS was found in 39 and 38 patients, respectively, accounting for 10.9% and 10.6%, respectively. All remaining subtypes of SGN had percentages of less than 5%.To demonstrate how the pathological spectrum changed during the last 10 years, we calculated the cases of each pathological subtype during 2008–2012 and 2013–2017 separately and analyzed the frequency of glomerular diseases at different times, as shown in In PGN, the frequencies of IgAN, MN and MsPGN changed significantly. The frequencies of IgAN and MsPGN declined from 27.3% and 9.5% during 2008–2012 to 20.7% and 2.6% during 2013–2017, respectively. However, the frequency of MN increased from 6.8% to 16.2%. No significant changes were observed in the frequencies of other types of PGN.In SGN, the frequencies of AASV and DN were both increased, with the former increasing from 3.8% to 7.6% and the latter increasing from 4.3% to 7.6%. No significant changes were observed in the frequencies of other SGN.In RI patients diagnosed with glomerular disease, the number of elderly patients markedly increased. The percentage of elderly patients increased from 15.6% in 2008 to 35.0% in 2017 . We thenp < .01). CreGN, AASV and MANS patients had higher percentages in CKD5 than in CKD3 (p < .01). Approximately 78.6% of CreGN patients and nearly 47.8% of MANS patients had GFR <15 ml/min/1.73 m2. In AASV, 41.9% of the patients had GFR of 15–29 ml/min/1.73 m2. Approximately 76.5% of MN patients had GFR of 30–59 ml/min/1.73 m2.Seventy-one RI patients with glomerular disease were diagnosed with AKI; among these patients, 38.0% had AASV, 22.5% had MANS, and 18.3% had CreGN. After excluding patients with AKI, we analyzed the pathological distribution of CKD patients with different GFR categories (CKD3-5), as shown in Due to improvements in technique, PRBs are widely performed in RI patients, with few complications reported. This study was the first to present a kidney biopsy series of RI patients with glomerular disease in northeastern China and to provide detailed information on the distributions of biopsy-proven glomerular diseases, which vary among patients with different degrees of RI.In terms of sex composition, the sex ratio  of glomerular disease patients with RI was 1.23:1. The sex ratios of data in all renal biopsies from the United States, Brazil and central China were 0.90:1, 0.96:1 and 0.87:1, respectively . Howeverp < .001). This result is consistent with that from Peking University First Hospital [2.5) may be associated with an increased risk of MN in China, and this relationship is nonlinear. For PM2.5 > 70 µg/m3, each 10 µg/m3 increase in PM2.5 concentration is associated with a 14% greater risk of developing MN [PGN was the major cause of glomerular disease 63.1%), which is consistent with previous reports ,14,15. THospital . Some re3.1%, whioping MN . The patoping MN ,20,21, boping MN . FSGS isoping MN . The peroping MN .LN is the main pathological type of SGN in the Brazil, Cyprus and the Czech Republic ,25,26. AWe compared the distributions of glomerular disease in elderly and nonelderly patients, and the results showed that the elderly patients with MN, MCD, MsPGN, LN and RAMY were more likely to develop into RI. However, the results for elderly patients with IgAN and BANS were contradictory. As China’s aging problem continues to worsen, it is essential for nephrologists to determine how to prevent aging-related renal disease.The glomerular disease spectrum of RI patients was analyzed in our research excluding AKI. IgAN was the leading cause in RI of different degrees due to its high incidence. Most glomerular diseases cause only mild RI, except for crescentic glomerulonephritis, AASV, thrombotic microangiopathy and MANS. These diseases generally have more serious pathological damage; thus, this result was considered reasonable.PRB is still the gold standard for diagnosing glomerular disease in RI patients. Our study helps to elucidate the pathological distribution of RI patients in northeastern China. We believe that these epidemiological data may provide useful information for analyzing the disease states leading to RI and renal failure. There are also several limitations in our study. First, patients may have multiple glomerular diseases at the same time. For example, diabetic patients can have both diabetic kidney disease and nondiabetic kidney disease . The finIn conclusion, the pathological spectrum of glomerular disease patients with RI changed dramatically, especially for MN, IgAN, MsPGN, AASV and DN. The number of elderly patients with glomerular disease increased sharply over the study period. Renal biopsy is important for patients with RI for early diagnosis and timely treatment.