Association of adult attachment with delays in accessing specialist care in women with ovarian cancer

OBJECTIVE: Advanced stage at diagnosis and delayed presentation are common in ovarian cancer (OC). The objective of the current study was to explore the association of adult attachment pattern with delays in accessing specialist oncology care in patients with OC. METHODS: A cross-sectional structured interview study of patients with OC presenting to an Indian cancer center was undertaken. Consenting patients completed Experiences of Close Relationships-Relationship Style questionnaire (ECR-RS) and Medical Outcome Survey-Social Support Survey (MOS-SSS). Multivariate linear regression with "time to presentation to cancer specialist" as the dependent variable was undertaken. RESULTS: In all, 132 of 155 (85%) patients with OC who were invited were interviewed. An increased ECR-RS attachment anxiety score (P = .01) and being part of a multigenerational extended household (P = .04) were both independently associated with delay in presentation to a cancer specialist. There was no association between delay in presentation and social support. CONCLUSIONS: Among patients with OC, adult attachment may contribute to delays in presentation. It may be important for the cancer symptom awareness efforts in primary care to include educating physicians on recognizing and interacting with patients with insecure attachment styles. The association of delays in presentation for women with OC living in multigenerational extended households needs more indepth exploration. Supplemental data for this article is available online at https://doi.org/10.1080/07347332.2022.2025510

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Parenting children with Autism Spectrum Disorder (ASD): explore the experiences in different social levels in the context of Bangladesh

The study aimed to explore the various dynamics of experiences in parenting children with ASD and how these experiences live in different social levels in the context of Bangladesh. The study selected participants through purposive sampling. Total ten families - both parents/ nineteen parents participated in the study from two social levels. The qualitative research design was employed since the study intended to understand lived reality of parental experiences intensively. Data was collected using online and face to face interviews, and through thematic analysis, the study presented the findings. The study revealed diverse experiences in perceptions, relations, gender roles and challenges in parenting, along with the gaps in the state’s initiatives to curtail these challenges in Bangladesh. Data showed parents took various coping strategies to lessen their hardship; in this case, adequate formal and informal supports work as strength and stress reliever to parents. Besides, parents identified essential requirements for themselves and their children that are possible to fulfill by proper policy measures and implementations. By looking at different parenting experiences dynamics, the study highlighted the relationship between parental experiences and their social levels. In this case, the study reveals various commonalities as well as diversity in experiences between social levels. However, the study revealed that parents from the high social level have more access to different resources than parents from low social status.The study aimed to explore the various dynamics of experiences in parenting children with ASD and how these experiences live in different social levels in the context of Bangladesh. The study selected participants through purposive sampling. Total ten families - both parents/ nineteen parents participated in the study from two social levels. The qualitative research design was employed since the study intended to understand lived reality of parental experiences intensively. Data was collected using online and face to face interviews, and through thematic analysis, the study presented the findings. The study revealed diverse experiences in perceptions, relations, gender roles and challenges in parenting, along with the gaps in the state’s initiatives to curtail these challenges in Bangladesh. Data showed parents took various coping strategies to lessen their hardship; in this case, adequate formal and informal supports work as strength and stress reliever to parents. Besides, parents identified essential requirements for themselves and their children that are possible to fulfill by proper policy measures and implementations. By looking at different parenting experiences dynamics, the study highlighted the relationship between parental experiences and their social levels. In this case, the study reveals various commonalities as well as diversity in experiences between social levels. However, the study revealed that parents from the high social level have more access to different resources than parents from low social status

Tracing remnant of subducted Indian felsic crust: insight from zircon studies

Fig. S1

Putative G-quadruplex Formation in the Upstream Region of mTOR Gene

The mammalian target of rapamycin (mTOR) and its signaling pathways are highly critical for maintaining cell homeostasis. The mTOR signaling pathway is often hyperactivated in many types of cancers making it an attractive therapeutic target for cancer. The efficacy of current mTOR protein inhibitors in therapy has seen limited success. The search for alternative means of therapy may lie in the regulation of mTOR gene expression using DNA structures. In the current study, we explore and report the presence of a novel G4 structure in the upstream region of mTOR gene. We have demonstrated the G-quadruplex formation in the mTOR G4 region using biophysical experiments. This study paves the way for the design of novel selective DNA G4 binders for mTOR G4 for anticancer therapeutics

Small Molecule Driven Stabilization of Promoter G‑Quadruplexes and Transcriptional Regulation of c‑MYC

G-quadruplexes have been considered attractive therapeutic targets for the development of anticancer agents. We herein report synthesis of a series of carbazole derivatives by employing modular one-pot Cu­(I) catalyzed cycloaddition. These carbazole derivatives are easily synthesizable, soluble in aqueous media, and able to strongly interact with quadruplexes. FRET based melting assay and fluorescence titration experiments suggest that a carbazole derivative, <b>Cz-1</b>, preferentially binds <i>c-MYC</i> quadruplex DNA over other investigated quadruplex and duplex DNAs. The biological studies revealed that <b>Cz-1</b> inhibits cancer cell proliferation by inducing apoptosis. Moreover, <b>Cz-1</b> inhibits the expression of <i>c-MYC</i> at transcriptional as well as translational levels. Exon-specific-assay confirms that the downregulation of <i>MYC</i> expression is mainly driven by the binding of <b>Cz-1</b> with the promoter G-quadruplex structures. Immunocytochemistry, using quadruplex binding antibody BG4, further suggests that <b>Cz-1</b> induces and stabilizes G-quadruplexes in a cellular system