Towards a better estimation of prevalence of female genital mutilation in the European Union : a situation analysis

Background:Female genital mutilation (FGM) is a harmful cultural practice that is predominantly documented inAfrica, but also occurs in other parts of the world. Due to migration, women who have undergone FGM can also befound in the European Union (EU). Due to a lack of systematic representative surveys on the topic in EU, theprevalence of FGM and the number of women and children subjected to the practice remains unknown. However,information on the magnitude of the problem in the EU is necessary for policy makers to design and trackpreventive measures and to determine resource allocation.Methods:Between March 2015 and May 2015, we performed a situation analysis consisting of a critical interpretivesynthesis and SWOT-analysis of available at the time peer reviewed and grey literature document on nationalprevalence studies on FGM in the EU. Studies estimating the prevalence of FGM and the number of girls and womensubjected to the practice in the EU were mapped to analyse their methodologies and identify their Strengths,Weakness, Opportunities and Threats (SWOT). Distinction was made between direct and indirect estimation methods.Results:Thirteen publications matched the prioritized inclusion criteria. The situation analysis showed that both directand indirect methodologies were used to estimate FGM prevalence and the number of girls and women subjected toFGM in the EU. The SWOT-analysis indicated that due to the large variations in the targeted population and the availablesecondary information in EU Member States, one single estimation method is not applicable in all Member States.Conclusions:We suggest a twofold method for estimating the number of girls and women who have undergoneFGMinthe EU. For countries with a low expected prevalence of women who have undergoneFGM, the indirect method will providea good enough estimation of the FGM prevalence. The extrapolation-of-FGM-countries-prevalence-data-method, based on thedocumented FGM prevalence numbers in DHS and MICS surveys, can be used for indirect estimations of girls and womensubjected to FGM in theEU. For countries with a high expected prevalence of FGM in the EU Member State, we recommendto combine both a direct estimation method (e.g. in the form ofa survey conducted in the target population) and an indirectestimation method and to use a sample design as developed bythe FGM-PREV project. The choice for a direct or indirectmethod will ultimately depend on available financial means and the purpose for the estimation

Comparison of phenotypic and genotypic tropism determination in triple-class-experienced HIV patients eligible for maraviroc treatment

BACKGROUND: Determination of HIV-1 tropism is a pre-requisite to the use of CCR5 antagonists. This study evaluated the potential of population genotypic tropism tests (GTTs) in clinical practice, and the correlation with phenotypic tropism tests (PTTs) in patients accessing routine HIV care. METHODS: Forty-nine consecutive plasma samples for which an original Trofile(TM) assay was performed were obtained from triple-class-experienced patients in need of a therapy change. Viral tropism was defined as the consensus of three or more tropism calls obtained from the combination of two independent population PTT assays (Trofile Biosciences, San Francisco, CA, USA, and Virco, Beerse, Belgium), population GTTs and GTTs based on ultra-deep sequencing. If no consensus was reached, a clonal PTT was performed in order to finalize the tropism call. This two-step approach allowed the definition of a reference tropism call. RESULTS: According to the reference tropism result, 35/49 samples were CCR5 tropic (R5) (patients eligible for maraviroc treatment) and 14/49 were assigned as non-R5 tropic. The non-R5 samples [patients not eligible for maraviroc treatment according to the FDA/European Medicines Agency (EMEA) label] group included both the CXCR4 (X4) samples and the dual and mixed CCR5/CXCR4 (R5/X4) samples. Compared with Trofile(TM) population PTTs, population GTTs showed a higher sensitivity (97%) and a higher negative predictive value (91%), but almost equal specificity and an equal positive predictive value. CONCLUSIONS: In line with recent reports from clinical trial data, our data support the use of population genotypic tropism testing as a tool for tropism determination before the start of maraviroc

Current and future diagnostic and treatment strategies for patients with invasive lobular breast cancer.

BACKGROUND: Invasive lobular breast cancer (ILC) is the second most common type of breast cancer after invasive breast cancer of no special type (NST), representing up to 15% of all breast cancers. DESIGN: Latest data on ILC are presented, focusing on diagnosis, molecular make-up according to the European Society for Medical Oncology Scale for Clinical Actionability of molecular Targets (ESCAT) guidelines, treatment in the early and metastatic setting and ILC-focused clinical trials. RESULTS: At the imaging level, magnetic resonance imaging-based and novel positron emission tomography/computed tomography-based techniques can overcome the limitations of currently used imaging techniques for diagnosing ILC. At the pathology level, E-cadherin immunohistochemistry could help improving inter-pathologist agreement. The majority of patients with ILC do not seem to benefit as much from (neo-)adjuvant chemotherapy as patients with NST, although chemotherapy might be required in a subset of high-risk patients. No differences in treatment efficacy are seen for anti-human epidermal growth factor receptor 2 (HER2) therapies in the adjuvant setting and cyclin-dependent kinases 4 and 6 inhibitors in the metastatic setting. The clinical utility of the commercially available prognostic gene expression-based tests is unclear for patients with ILC. Several ESCAT alterations differ in frequency between ILC and NST. Germline BRCA1 and PALB2 alterations are less frequent in patients with ILC, while germline CDH1 (gene coding for E-cadherin) alterations are more frequent in patients with ILC. Somatic HER2 mutations are more frequent in ILC, especially in metastases (15% ILC versus 5% NST). A high tumour mutational burden, relevant for immune checkpoint inhibition, is more frequent in ILC metastases (16%) than in NST metastases (5%). Tumours with somatic inactivating CDH1 mutations may be vulnerable for treatment with ROS1 inhibitors, a concept currently investigated in early and metastatic ILC. CONCLUSION: ILC is a unique malignancy based on its pathological and biological features leading to differences in diagnosis as well as in treatment response, resistance and targets as compared to NST

Human immunodeficiency virus: 25 years of diagnostic and therapeutic strategies and their impact on hepatitis B and C virus

The human immunodeficiency virus (HIV) had spread unrecognized in the human population as sexually transmitted disease and was finally identified by its disease AIDS in 1981. Even after the isolation of the causative agent in 1983, the burden and death rate of AIDS accelerated worldwide especially in young people despite the confection of new drugs capable to inhibit virus replication since 1997. However, at least in industrialised countries, this trend could be reversed by the introduction of combination therapy strategies. The design of new drugs is on going; besides the inhibition of the three enzymes of HIV for replication and maturation (reverse transcriptase, integrase and protease), further drugs inhibits fusion of viral and cellular membranes and virus maturation. On the other hand, viral diagnostics had been considerably improved since the emergence of HIV. There was a need to identify infected people correctly, to follow up the course of immune reconstitution of patients by measuring viral load and CD4 cells, and to analyse drug escape mutations leading to drug resistance. Both the development of drugs and the refined diagnostics have been transferred to the treatment of patients infected with hepatitis B virus (HBV) and hepatitis C virus (HCV). This progress is not completed; there are beneficial aspects in the response of the scientific community to the HIV burden for the management of other viral diseases. These aspects are described in this contribution. Further aspects as handling a stigmatising disease, education of self-responsiveness within sexual relationships, and ways for confection of a protective vaccine are not covered

Reply to Stojanowski et al.

In the accompanying Comment1, Stojanowski et al. challenge the evidence for inter-group conflict at Nataruk2. They make two arguments—first, that the lesions in three crania are due to soil compression; second, that there is a correlation between body position and age, reflecting different burial traditions. We believe that their interpretation is incorrect on both counts

Influence of the wind profile on the initiation of convection in mountainous terrain

International audienceA number of days with small precipitating convective cells were investigated using weather radars during the COPS (Convective and Orographically-induced Precipitation Study) field campaign in the region of the Vosges and the Rhine Valley in Central Europe. Depending on the weather situation, two distinct mechanisms could be identified for the initiation of convection. On some days, cells were initiated over the ridge of the Vosges, whereas on other days cells were initiated in the lee of the Vosges. The initiation of convection appeared to be concentrated in a few favourable locations. Using the Froude number, it was possible to describe the two distinct mechanisms. When the Froude number was low, the flow was diverted around the Vosges and thermally driven convergence at the ridge initiated convection, whereas when the Froude number was high, the flow passed through mountain gaps and then converged on the lee side with the flow in the Rhine Valley. The convergence on the lee side was enhanced at locations where the outflows through valleys converged. Low Froude numbers were accompanied by weak winds varying with height, whereas high Froude numbers were observed during situations with stronger southwesterly winds increasing with height