Predictive Value of Albumin and Neutrophil Combined Prognostic Grade in Advanced Gastric Cancer Patients Treated With anti-PD-1 Therapy

Background The application of immunotherapy is gradually increasing in advanced gastric cancer (AGC), but only some patients could benefit from it. Validated biomarkers can screen out the beneficiaries. The objective of this research is to explore the predictive value of albumin and neutrophil combined prognostic grade ( ANPG) in AGC patients receiving immunotherapy. Methods A total number of 268 AGC patients were included. The cut-off value of albumin was 38 g/L obtained by the median value, and neutrophil was 4.16 g/L estimated by the average value. The high levels of albumin (≥38 g/L) and neutrophil (≥4.16 g/L) were considered to be two risk factors for ANPG. Based on these two risk factors, patients were categorized into 3 groups：the risk factor number for the "good" group was 0, for the "intermediate" group was 1, and for the "poor" group was 2. Results Patients with the good ANPG was related to longer progression free survival (PFS) and overall survival (OS), compared to those with the intermediate and the poor ANPG (5.6 months vs 5.3 months vs 3.4 months, 17.8 months vs 11.8 months vs 8.2 months). The poor group was independently correlated with an over 1.9 times risk of disease progression (HR=1.901; 95% CI, 1.314-2.750; P=0.001) and an over 2 times risk of death (HR=2.003; 95% CI, 1.306-3.072; P=0.001) than the good group. The intermediate group was independently correlated with an over 1.3 times risk of disease progression (HR=1.385; 95% CI, 1.004-1.911; P=0.048) and an over 1.4 times risk of death (HR=1.484; 95% CI, 1.046-2.106; P=0.027) than the good group. Conclusion Our study verifies, for the first time, that ANPG is an independent factor affecting survival of AGC patients receiving immunotherapy. Patients with the good ANPG could benefit from immunotherapy.

The intersectional effects of ethnicity/race and poverty on health among community-dwelling older adults within multi-ethnic Asian populace: a population-based study

Background Ethnicity/race and poverty are among determinants of health in older persons. However, studies involving intersectional effects of ethnicity/race and poverty on health of older adults within multi-ethnic Asian populace is limited. Hence, this study aimed to examine the intersectional effects of ethnicity/race and poverty on cognitive function, depressive symptoms, and multimorbidity among community-dwelling older adults in Malaysia. Methods Data were obtained from the first wave of a Peninsular Malaysia national survey - “Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly”. Log-binomial regression was used to identify intersectional effects and associations between control variables and health outcomes. A comparison between Malay and non-Malay older adults within the same poverty group, as well as hardcore poor and non-hardcore poor older people within the same ethnicity groups, were conducted to understand the intersectional effects of ethnicity/race and poverty on health. Results Prevalence of cognitive impairment was highest among hardcore poor Malay group, while the risk of depression and multimorbidity were highest among hardcore poor non-Malays. In the hardcore poor group, Malay ethnicity was associated with higher prevalence of cognitive impairment but lower prevalence of depression risk and multimorbidity. In the Malay group, hardcore poor was associated with higher prevalence of cognitive impairment; however, no association was found between hardcore poor with depression risk and multimorbidity after controlling for covariates. Conclusions Health outcomes of Malaysian older adults differ according to ethnicity and socioeconomic status. Given the importance of demographic characteristics on health outcomes, design of interventions targeting older adults within multi-ethnic settings must address specific characteristics, especially that of ethnicity and sociodemographic status so as to fulfil their needs. Several implications for future practice were discussed.

Assessing Water Poverty of Livelihood Groups in Peri-Urban Areas around Dhaka under a Changing Environment

Water poverty, measured by the Water Poverty Index (WPI), is traditionally applied at country and community levels. This study presents a livelihood-inclusive approach for measuring WPI at the livelihood group level. The specific objectives are to evaluate present and future WPIs for different livelihood groups, such as large and small male farmers, female farmers, male and female industrial workers and economically inactive women. Primary data are collected from three peri-urban areas around Dhaka using a mixed approach, including a semi-structured questionnaire survey of 260 respondents. The WPIs are calculated by using a weighted multiplicative function, and the component weights are assigned by principal component analysis. The results show that the economically inactive women are presently the most water-poor group, with a WPI value of 41, whereas the small male farmers would be the most water-poor group in the future, with a WPI value of 34. Environmental changes, such as high temperature, variability in rainfall and surface water, lowering of groundwater level, rapid population growth and unplanned urbanization, are found to be responsible for the dynamism in WPIs for different livelihood groups. The Resource and Environment components should be paid immediate attention in order to protect peri-urban livelihood groups from future water poverty.

Revision and description of three new species of the Palaearctic subgenus Gulanthidium of the wool carder bee genus Anthidium (Apoidea: Megachilidae: Anthidiini)

The subgenus Anthidium (Gulanthidium) is a species-poor group of similar species, which is distributed across the West Palaearctic, from Morocco in the west to central Asia in the east. Due to some incorrect species determinations in the literature, the taxonomic situation remains to be fully understood. The situation is reviewed with reference to a rich, still unpublished resource of material from throughout the range. Anthidium flavissimum sp. nov. is described from Afghanistan, A. preoccipitale sp. nov. from Iran, and A. occidentale sp. nov. from Morocco, based on a combination of colour, structural traits, genital morphology, and morphometry. The subgenus as treated here now comprises six species for which a key is presented. Some of the species are sympatric. Species of the subgenus Gulanthidium are very close to A. (Proanthidium) and it should be further examined as to whether these two subgenera should be better combined in a single subgenus.

Medical service utilization and out-of-pocket spending among near-poor National Health Insurance members in South Korea

Background The public health care system in South Korea is a two-tiered system. The lowest-income population is covered by the Medical Aid program, and the remaining population is covered by the National Health Insurance. The near poor, a relatively low-income population which is excluded from South Korea’s Medical Aid program due to exceeding the income threshold, experiences insufficient use of medical services and incurs high out-of-pocket expenses due to a lack of coverage under the country’s National Health Insurance (NHI) program. This study aims to examine medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditures among the near-poor group compared to both Medical Aid beneficiaries and other (higher income) NHI members. Methods A cross-sectional study was conducted drawing upon a nationally representative dataset derived from the 2018 Korea Welfare Panel Study. The study classified people into three groups: Medical Aid beneficiaries; the near-poor population below 50 % of the median income threshold but still not qualifying for Medical Aid and thus enrolled in NHI; and NHI members above the threshold of 50 % of the median income. Using a generalized boosted model to estimate the propensity score weights between study groups, this study examined medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditure among the study groups. Results The findings suggest that the utilization of medical services was not significantly different among the study groups. However, out-of-pocket spending and the occurrence of catastrophic health expenditure were significantly higher in the near-poor group compared to the other two groups. Conclusions The study found that the near-poor group was the most vulnerable among the Korean population because of their higher chance of incurring greater out-of-pocket spending and catastrophic health expenditures than is the case among the Medical Aid beneficiary and above-poverty line groups. Health policy needs to take the vulnerability of this near-poor population into account.

The Efficacy of Biofeedback Therapy for the Treatment of Fecal Incontinence After Soave Procedure in Children for Hirschsprung's Disease

Introduction: Hirschsprung's disease is a common digestive tract malformation in children, and the Soave procedure is one of the classic surgical methods for Hirschsprung's disease (HD). Fecal incontinence is one of the most common postoperative complications that can cause significant distress to the patients and their family, the incidence of which is 20% in a recent series. Biofeedback therapy (BFT) can be an effective treatment for managing anorectal disorders, but there has been little report of the efficacy of BFT for the treatment of fecal incontinence after the Soave procedure, and the main objective of this study is to evaluate it.Methods: We retrospectively analyzed postoperative fecal incontinence in 46 children who received the Soave procedure for HD and who received BFT at our institution from March 2016 to February 2020, which included 38 males and 8 females (mean age 8.1 years, from 3.7 to 14 years). Anal sphincter contraction training was performed using BFT for 10 days per session in the hospital, one time each day, and 20 min each time. BFT was performed by employing visual and verbal feedback techniques using the biofeedback instrument. Long-term functional outcomes were objectively assessed using the Rintala Bowel Function Score (RBFS), and the patients were scored according to the sum total as excellent (18–20 points, 0 case), good (11–16 points, 0 case), fair (9–11 points, 9 cases), or poor (6–9 points, 37 cases). Defecation questionnaires and anorectal manometry were completed pretreatment and after three, six, or nine sessions, and primary outcome measures of anorectal manometry were anal maximal contraction pressure (AMCP), anal longest contraction time (ALCT), rectal rest pressure (RRP), and anal rest pressure (ARP).Results: Followed up from 6 months to 4 years, the symptoms of fecal incontinence disappeared completely in 39 (84.78%) patients. Among them, 14 (30.43%) had complete disappearance of symptoms after 3 sessions of treatment, 25 (54.34%) patients had improved symptoms after 6 sessions of treatment, symptoms completely disappeared after 6 sessions of treatment, and 7 (15.22%) cases still suffered fecal incontinence mildly. The AMCP after three and six sessions in the poor group was significantly increased compared with that before treatment [(85.87 ± 31.75) mmHg vs. (135.33 ± 37.69) mmHg vs. (128.41 ± 33.45) mmHg, P < 0.05]. The ALCT and ARP showed the same trend, while the RRP after three and six sessions were not significant (P > 0.05). The mean (±SD) score of the RBFS increased from 9 to 17.40 ± 0.84 in the fair group, while it increased from 7.22 ± 0.76 to 16.58 ± 1.66 in the poor group after six sessions (P < 0.05).Conclusion: Biofeedback therapy is a safe and effective treatment of fecal incontinence after the Soave procedure of children for Hirschsprung's disease. It is beneficial to design the individualized treatment programs for the children with varying degrees of fecal incontinence.

Decomposition of inequality determinants of stressful events in Tehran; Oaxaca–Blinder analysis

Purpose Social determinants of stressful events (SE) play an important role in justifying the cause of inequality in the experience of SE. The purpose of this study is to investigate the determinants that impact on inequality in the experience of SE. Design/methodology/approach The statistical population of this study includes all residents of Tehran. The statistical sample was 5,895 people who were selected by multistage cluster method and were proportional to the population size. The research tool is a researcher-made questionnaire designed to measure SE in Tehran, which includes 11 psychological stressors. The Oaxaca–Blinder decomposing method was used to analyze data. Findings In a total of 11 psychological SE, in 6 of those events, there was significant inequality in the experience of SE. Concentration Index (CI) of political SE is (CI = −0.27, 95% CI: −0.47, −0.07) and in favor of the rich (pro-rich). Education (OR = 1.60) in poor group and region development in poor and rich (respectively in all of the following) (OR = 0.42–0.73) are the main determinants of inequality in this stressor. CI of neighborhood underdevelopment SE is (CI = −0.47, 95% CI: 0.66, −0.28) and pro-rich. Education (OR = 1.26–1.27) and region development (OR = 1.18–2.24) are the main determinants of inequality in this stressor. CI of livelihood problems SE is (CI = −0.58, 95% CI: 0.68, −0.32) and pro-rich. Education (OR = 1.40) and health status (OR = 1.63) in poor group are the main determinants of inequality in this stressor. CI of future uncertainty SE is (CI = −0.12, 95% CI: 0.34, −0.08) and pro-rich. Gender (OR = 1.22) in poor group and region development (OR = 0.24–0.58) are the main determinants of inequality in this stressor. CI of education problems (CI = 0.19, 95% CI: 0.05, 0.32) and pro-poor. Age (OR = 0.32–0.34) and education (OR = 3.65–3.30) are the main determinants of inequality in this stressor. CI of housing problems is (CI = −0.29, 95% CI: −0.49, −0.08) and pro-rich. Education (OR = 1.31) and region development (OR = 1.64) in poor group are the main determinants of inequality in this stressor. Research limitations/implications The first limitation is related to the level of data analysis, and the second limitation is the lack of comprehensive data on social determinants. Practical implications Social determinants affecting the formation of inequality in the experience of SE. Some social determinants, such as the level of education and development of the region, play a more prominent role in justifying inequality in the experience of stress between rich and poor groups. Social implications Inequality in the experience of SE is a serious threat to mental and social health. One of the ways to reduce the experience of psychological and social stress is to pay attention to social determinants that play a role in the formation of stress. Originality/value This original paper was conducted by examining the effect of social determinants on the formation of inequality in the experience of stress, which draws the serious attention of policymakers.

Pre-Operative Modified Glasgow Prognostic Score 2 For The Prediction of Poor Post-Operative Performance Status Following Palliative Surgery For Pathological Spinal Fracture: A Retrospective Cohort Study

Background: Skeletal-related events due to spinal metastasis in cancer significantly impair patients’ activities of daily living and quality of life. Most of these events occur suddenly. To reduce their impairment occurred suddenly, and to allow them to return to their normal life immediately, many patients undergo palliative surgery; however, some patients do not improve their performance status (PS) as expected. There is little evidence regarding the factors influencing a patient’s PS after palliative surgery. We aimed to investigate the pre-operative predictors of poor PS 1 month after surgery.Methods: The study included a consecutive series of 71 patients with pathological spinal fracture who underwent palliative surgery. Pre-operative predictors of poor post-operative PS were investigated. The participants were categorized into two groups according to PS; the Good group (PS 0, 1, or 2) and the Poor group (PS 3 or 4). We performed univariate and multivariable logistic regression analyses on demographic information, unidentified primary site, AIS grade, poor PS, spinal instability neoplastic score, revised Tokuhashi score, New Katagiri score, modified Glasgow Prognostic Score (mGPS), neutrophil-lymphocyte ratio(NLR), and prognostic nutrition index (PNI). Results: Post-operatively, the Poor group included 38.0% of the patients. Univariate analysis revealed that the following pre-operative factors were related to poor outcomes (p<0.05): BMI<18.5; AIS grade C; poor PS; revised Tokuhashi score 0−8; New Katagiri score 7−10; mGPS 2; and PNI. In the multivariate analysis, mGPS 2 (OR = 22.8, 95% CI = 2.59−202.00, p<0.01) was a significant pre-operative predictor of poor post-operative PS. Conclusion: mGPS 2 was a predictive clinical factor that influenced PS 1 month after surgery. Patients with mGPS 2 should be carefully evaluated to determine their treatment, especially whether they should undergo palliative surgery.

Split-footed lacewings declined over time: indications from the morphological diversity of their antlion-like larvae

Nymphidae, the group of split-footed lacewings, is a rather species-poor group. Split-footed lacewings nowadays are restricted to Australasia, while fossil forms are also known from other areas of the world, indicating that the group was more species-rich and therefore likely diverse in the past. Split-footed lacewings have rather distinct larvae, roughly resembling antlion larvae, but differing from the latter especially with regard to the mandibles. Antlion larvae usually have three prominent teeth on each mandible, while at least extant larvae of split-footed lacewings only have a single prominent tooth per mandible. Fossils interpreted as larvae of split-footed lacewings are well known from amber from Myanmar (ca. 100 myr; Burmese amber) and by a single specimen from Baltic amber (about 40 myr). We here report additional fossil specimens from Myanmar amber, expanding the known record of fossil forms from six depicted specimens to 15. For the extant fauna, we could compile 25 larvae. We compare the diversity of shape of extant and fossil larvae through time using an outline analysis (based on elliptic Fourier transformation) of the head. The results of this analysis indicate that the morphological diversity, or disparity, of split-footed lacewing larvae was higher in the past than it is today. With this type of analysis, we can show a loss of diversity over time, without the necessity to identify the fossil larvae down to a narrow taxonomical range. A similar pattern has already been recognised in silky lacewings, Psychopsidae. This might indicate a general loss of diversity of lacewing larvae.

Farmer Producer Organizations (FPOs) – Analysis of Profile of FPOs and Its Members in Medak District of Telangana

This paper focused to study the profile of selected FPOs and its members. With respect to the profile of FPO members, twelve profile characteristics selected were grouped under group composition, governance and management and membership commitment. An Ex-post-facto research design was adopted for the study. Three FPOs were selected randomly from 3 different promoting institutes working in the Medak district viz., Suraksha Farmers Producer Company Ltd (SFPCL) promoted by independent research organization Centre for Sustainable Agriculture (CSA), Marpalli Kisan Kranthi Producer Company Ltd (MKKPCL) promoted by Vrutti NGO and Siddipet Kisan Agro Farmers Producer Company Ltd (SKAFPCL) promoted by International Crops Research Institute for the Semi-arid Tropics (ICRISAT). The results of the study revealed that under group composition, majority were small farmers with middle age (55.55%), primary school education (35.55%), with medium farming experience (47.77%) and with medium annual income (60.00%). Majority of respondents perceived that with respect to management and governance characteristics of FPO had poor group leadership (41.11%), fair group communication (58.88%) and medium adherence to rules(41.11%). With respect to membership commitment majority of respondents had low group participation (43.33%), medium group cohesiveness (47.77%) and low team spirit (43.33%).