Diagnostic accuracy of multitarget stool DNA testing for colorectal cancer screening: A systematic review and meta-analysis / Precisión diagnóstica de las pruebas de DNA en heces con objetivos múltiples para la detección del cáncer colorrectal: una revisión sistemática y un metaanálisis

Introduction: This study aimed to collect and summarize test data and conduct a meta-analysis, with respect to the Multitarget Stool DNA test sensitivity and specificity, compared to colonoscopy. Material and methods: All manuscripts were screened for eligibility according to inclusion criteria. Participants were a normal population at an average risk of developing CRC. Intervention was Stool based and DNA panel tests compared with colonoscopy, and outcome was detection of CRC and any pre-cancerous lesions. Inter-study and inconsistency (using the I-squared test) were assessed. Results: Meta-analyses of the Mt-sDNA test showed a combined sensitivity of 89%, 51%, and 76% for the detection of CRC, advanced adenoma (AA), and combined CRC and AA, respectively. The overall specificity was 91%, 89%, and 90% for the detection of CRC, AA, and combined CRC and AA, respectively. Conclusion: Mt-sDNA had significantly acceptable diagnostic accuracy for CRC and AA diagnosis, but still has lower sensitivity and specificity than colonoscopy.(AU)

Introducción: Este estudio tuvo como objetivo recopilar y resumir los datos de las pruebas y realizar un metaanálisis con respecto a la sensibilidad y especificidad de la prueba de DNA en heces multiobjetivo, en comparación con la colonoscopia. Material y métodos: Todos los manuscritos fueron examinados para determinar su elegibilidad de acuerdo con los criterios de inclusión. Los participantes eran una población normal con un riesgo promedio de desarrollar CRC. La intervención se basó en heces y pruebas de panel de DNA en comparación con la colonoscopia, y el resultado fue la detección de CRC y cualquier lesión precancerosa. Se evaluaron la inconsistencia entre estudios y la inconsistencia (mediante la prueba de I cuadrado). Resultados: Los metaanálisis de la prueba Mt-sDNA mostraron una sensibilidad combinada del 89%, 51% y 76% para la detección de CRC, adenoma avanzado (AA) y CRC y AA combinados, respectivamente. La especificidad general fue del 91%, 89% y 90% para la detección de CRC, AA y CRC y AA combinados, respectivamente. Conclusión: Mt-sDNA tuvo una precisión diagnóstica significativamente aceptable para el diagnóstico de CRC y AA, pero aún tiene una sensibilidad y especificidad más bajas que la colonoscopia.(AU)

Cross-cultural validation of stool Based Colorectal cancer screening methods in the North West of Iran.

Background: Globally, colorectal cancer (CRC) is the third most common cancer and the second leading cause of death from cancer. Incidence and mortality from CRCboth can be reduced and prevented using screening and early detection programs. The current study aimed to assess the feasibility of the colorectal cancer screening program in Northwest of Iran. Methods: The study designed as a cross-cultural analytic study, to evaluate the diagnostic accuracy of stool-based tests compared with colonoscopy, during 2016-2020. All individuals first were assessed with our CRC risk assessment tool, then eligible volunteers entered the study. Colonoscopy was performed on all participants, also stool-based tests including traditional guaiac, high-sensitivity guaiac-based, fecal immunochemical test (FIT), and multitarget stool DNA (Mt-sDNA) panel tests were performed. Results: Mt-sDNA test panel had a sensitivity of 77.8% (95% CI: 40-97.2)for detecting colorectal cancer with a specificity of 91.2% (95% CI:85.4-95.2). The FIT test alone had a lower sensitivity (66.7%; 95% CI:29.9-92.5) and almost the same specificity of 93.9% (95% CI: 88.7-97.2) for cancer detection. Mt-sDNA test had better diagnostic accuracy than the FIT (AUC = 0.85 vs 0.80), and is a more useful screening test. Positive and negative predictive values for cancer detection for both Mt-sDNA and FIT tests were almost the same results, however Mt-sDNA test had better NPV results than the FIT test alone. Conclusion: Our results showed that both Mt-sDNA panel and the FIT test had acceptable cut-off points for cancer detection, however, Mt-sDNA test had better diagnostic accuracy.

Expression profiles of miR-196, miR-132, miR-146a, and miR-134 in human colorectal cancer tissues in accordance with their clinical significance : Comparison regarding KRAS mutation.

BACKGROUND: Colorectal cancer (CRC) is among the most widespread malignancies in the world. MicroRNA (miRNA) has been identified as an important modulator of the biological processes of the cells. This group of noncoding RNAs also has a pivotal function in the growth and development of human cancers, including CRC. Among these miRNAs, miR-196, miR-132, miR-146a, and miR-134 have fundamental impacts on the regulation of cancers. The current study aimed to investigate the involvement of these miRNAs in CRC patients. METHODS: In this study, 50 pairs of tumor and tumor margin samples of CRC patients were investigated to assess the expression levels of miR-196, miR-132, miR-146a, and miR-134 in this cancer. For this purpose, firstly, quantitative real-time PCR (qRT-PCR) was applied. Also, KRAS mutation and clinicopathological characteristics of the CRC patients were analyzed in the study groups. RESULTS: The findings demonstrated the overexpression of miR-196 (P-value = 0.0045) and miR-146a (P-value = 0.0033) in tumor tissues compared to controls. Conversely, the expression levels of miR-132 (P-value = 0.00032) and miR-134 (P-value < 0.0001) were downregulated in tumor tissues. Also, miR-146a was the only miRNA with significant expression change in the case of the KRAS gene mutation. Interestingly, the expression ratio of these miRNAs was significantly associated with some of the clinicopathological features of the patients, such as lymph node and distant metastases. CONCLUSION: Our data demonstrated that these miRNAs appear to be promising novel biomarkers for early diagnosis of CRC and may pave the way for the future establishment of novel therapeutic options for CRC.

Infertile Women's Opinion Concerning Gestational Surrogacy: A Systematic Review and Meta-Analysis.

BACKGROUND: This systematic review and meta-analysis of the observational studies aimed at evaluating the infertile women's attitude toward gestational surrogacy. METHODS: Published studies until Jan 2019 were searched using PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, ISI Web of Science, Proquest and Google scholar, MagIran, SID and IranMedex. Studies in English or Persian language surveyed attitudes toward surrogacy for infertile women published until Jan 2019. Animal studies and studies with poor methodological quality were excluded from the review. RESULTS: Six eligible studies including 1359 infertile women were identified. Of these, 559 and 742 women agreed and disagreed with surrogacy respectively. The overall event rate of positive attitude for surrogacy in infertile women was %39.7 (%95 CI=24.5 to 57.1, P=0.245). CONCLUSION: The infertile women's attitude toward surrogacy is not strongly positive. We believe, more studies should be conducted among different socioeconomic, religious and cultural groups.

Targeting immune checkpoints: Building better therapeutic puzzle in pancreatic cancer combination therapy.

Pancreatic cancer is related to a very weak diagnosis; the close parallel between disease incidence and mortality rates from pancreatic cancer reflects the fatal nature of this disease. Although early detection procedures are growing, they are not applicable yet for pancreatic cancer. The majority of cancer patients suffer from advanced disease, in which surgery has no potential effect. Based on the growing evidence, it is predicated that cancer immunotherapy alone or in combination will probably be an essential section of different cancer treatment methods. There are different kinds of immune processes, including various antitumour and tumour-promoting leukocytes. Moreover, tumour cells utilise numerous approaches to overwhelm the immune response. Use of antibody in the therapeutic protocols is proving significant success and is probably a key element of cancer treatment. This method is directed against numerous negative immunologic regulators and immune checkpoints. In the present review, the clinical outlines of immune checkpoint inhibition are discussed in pancreatic cancer.

Correction: The short Persian version of motorcycle riding behavior questionnaire and its interchangeability with the full version.

[This corrects the article DOI: 10.1371/journal.pone.0201946.].

Effective Factors of Utilization of Inpatient, Outpatient, Diagnostic, and Pharmaceutical Health Services: A Systematic Review.

Utilization is one of the dimensions of equity in health systems. Identifying the factors affecting utilization of health services can be helpful for interventional purposes. This study systematically reviewed the factors affecting the utilization of inpatient, outpatient, diagnostic, and pharmaceutical services. This systematic review was conducted between 2016 and 2017. The search was performed using keywords based on MeSH in valid databases such as Scopus, Embase, ProQuest, ScienceDirect, PubMed, and Web of Science in the fields of title, abstract, and keyword. Related papers published from 2000 to 2017 were searched. First, the retrieved studies were screened and checked for quality; then, the useful data were extracted and analyzed. Out of the 1178 retrieved publications, 20 studies were included in the final analysis. The identified factors were categorized into 5 areas, including demographic (4 items), socioeconomic (13 items), health services-related (13 items), health status-related (7 items), and health insurance-related factors (2 items), and reported. The findings of this study can be a useful source and a comprehensive body of evidence on the utilization of health services. The results can be used by the policy makers and managers in designing interventions for changing the utilization patterns of health services.

The short Persian version of motorcycle riding behavior questionnaire and its interchangeability with the full version.

The aim of current study was to develop a valid and reliable short motorcycle riding behavior questionnaire (SMRBQ) and assess its interchangeability with the original 48-item tool. Through a psychometric study in Bukan district of Iran in 2015, the most recent available Persian version of the motorcycle riding behavior questionnaire (MRBQ) was used as a reference to develop its short version, the SMRBQ. The preliminary version was prepared through expert reviews, and its dimension was further reduced through principal component analysis (PCA). An exploratory factor analysis (EFA) was then applied on the remaining items and the final version was developed with 23 items. The validity, consistency, agreement and interchangeability of the SMRBQ were assessed in parallel with the MRBQ using several statistical methods including Kendall's Tau, intra-class correlation coefficient (ICC), Bland-Altman plot and receiver operating characteristics (ROC) curve analysis. All the 340 participants were males. The mean age of the participants was 30.2 (SD = 9.1). SMRBQ was developed including 23 items. The mean normalized score for the full version was 30.5 (SD = 11.2) and it was 30 (SD = 13.9) for the short version. There was a high correlation between the normalized scores of MRBQ and SMRBQ (Kendall's Tau = 0.82). The ICC of the interchangeability of the full version and short version scales was as high as 0.92 (95% CI: 90.2-93.5). The scale had adequate internal consistency based on the calculated Cronbach's alpha which was 0.85 for the scale. Bland-Altman and ROC curve analysis confirmed the interchangeability and criterion validity of the SMRBQ. The Persian version of SMRBQ was found to be a valid, reliable and feasible tool for assessing motorcycle riding behavior in the studied population.

A Qualitative Study of Bottlenecks and Causes of Fractions for Dedicated Incomes of Health Centers and Solutions for their Reduction.

BACKGROUND: Primary health care is one of effective approaches for improving public health. Providing optimal cares requires supplication of various resources such as financial resources. "Fractions of incomes" in health centers is one of the remarkable problems for the domain of financial resources management in Iran. This study was aimed to identify bottlenecks and causes of fractions for incomes in health centers and solutions for their reduction. METHODS: The current study was conducted in a qualitative phenomenology method in East Azerbaijan province of Iran in 2014. Data collection method was focus group discussion and semi-structured interview. Purposive sampling was used for selecting participants. Focus group discussions and interviews were conducted based on pre-prepared guidance and continued till data saturation. Validity of guidance was approved by qualitative studies experts. Data were analyzed using content analysis method. RESULTS: Based on the opinions of participants, two and six themes were respectively extracted for bottlenecks of fractions and causes and solutions for their reduction. Themes for bottlenecks of fractions included cash (monetary) and non-cash (non-monetary) fractions and themes for causes and solutions included causes and solutions for fractions per capita, insurance deductions, fractions related to sending documents, registration fractions, discounts fractions, and incomplete deposit of cash incomes. CONCLUSION: All cash and non-cash incomes of health centers are subject to fractions. The causes of fractions are related to the whole process of converting services to incomes and insurance requirements. Identified solutions and interventions also focus on these areas.

Reliability and validity of the March of dimes preconception/prenatal family health history questionnaire: The Persian version.

In recent years, there has been a remarkable gap between rapid advancements in genetic technology and public health practice. Looking at the familial health history may bridge this gap for easier and cheaper diagnosis and prevention of congenital anomalies. The aim of this study was to validate and culturally adapt the March of Dimes Preconception/Prenatal Family Health History Questionnaire for the Iranian population. After obtaining written permission from March of Dimes, the translation-back translation of the original questionnaire was performed. The content validity was assessed by a team of 12 experts. Based on a sample of 50 general practitioners and 100 subjects referred to health centers from September to November 2014 in Tabriz, Iran, test-retest reliability and inter-rater reliability were evaluated by Kappa and Intra-class Correlation Coefficient (ICC). Content validity of the Persian version of the questionnaire was confirmed according to the modified kappa value above 0.76 for all the items included in this tool. Inter-rater reliability assessment yielded a kappa value between 0.62 and 0.92 for variables with dichotomous measurement scales and ICC ranged from 0.6 to 0.9 for variables with numeric scales. Test-retest re-administration produced kappa ranging from 0.62 to 0.92 for variables with dichotomous measurement scales and ICC from 0.6 to 0.9 for variables with numeric scales. The Persian version of the March of Dimes preconception/prenatal family health history questionnaire showed acceptable reliability and validity and may be used as a simple tool for the detection of risk factors of birth defects in Iranian population.

Prevalence of congenital anomalies: a community-based study in the northwest of iran.

Background. Congenital anomalies are responsible for a remarkable proportion of mortality and morbidity in newborns. The aim of this study was to document the epidemiological features of congenital anomalies in rural areas, northwest of Iran. Method. The study population included live births born between 2004 and 2012 in rural areas of Tabriz district. All health records of the children under 8 years were assessed retrospectively. Results. Of 22500 live births, 254 cases were identified with a primary diagnosis of congenital anomalies giving a prevalence rate of 112.89 per 10 000 births (95% CI: 99.08 to 126.69). Anomalies of the nervous system were the most common defects, accounting for 24% of birth defects followed by the heart diseases anomalies. The highest prevalence rate for birth defects was observed in the south-western region with 386 per 10 000 births (95% CI: 215 to 556) compared to the similar rate in the north-western region with 15 per 10 000 births (95% CI: -14 to 45). Conclusion. The considerable geographic disparities in the prevalence of congenital anomalies in the region might be attributed to the highly polluted industrial zone in the area (including air and water pollution, etc.). This needs further etiological investigations in the region.

How accurate is diagnosis of congenital anomalies made by family physicians?

BACKGROUND: Although family physicians have a key role in clinical management of many diseases and in community health, the accuracy of the diagnosis for congenital anomalies by family physicians still needs more investigations. The aim of this study was to assess the accuracy of family physicians in case detection and diagnosis of congenital anomalies in rural areas, northwest of Iran. METHODS: In a community-based study of 22500 children born between 2004 and 2012, all 172 cases of congenital anomalies diagnosed by family physicians were assessed by a qualified pediatrician in 47 health houses in rural areas of Tabriz District, northwest Iran. A group of 531 children was compared as control subjects. RESULTS: The overall sensitivity and specificity of family physicians? diagnosis for congenital anomalies were estimated 98% (95% Confidence Interval (CI): 95.9 to 100) and 100% (95% CI: 99.3 to 100), respectively. Sensitivity for diagnosis of congenital heart diseases was 97% (95% CI: 93 to 100), and for genitourinary tract, it was 86% (95% CI: 59 to 100). Specificity was estimated 100% for both groups of heart and genitourinary tract anomalies. CONCLUSION: The performance of family physicians was found accurate enough in the diagnosis of congenital anomalies. Health care system may consider family physician program as an effective approach to detect and clinical management of congenital anomalies.