Background It is worthwhile to identify women at risk of developing postpartum depression during pregnancy. This study aimed to determine the optimal time and cutoff score for antenatal screening for prediction of postpartum depressive symptoms (PDS) using the Edinburgh Postnatal Depression Scale (EPDS) and to identify risk factors for PDS. Methods The target population was healthy pregnant women receiving antenatal care at a university hospital in Tokyo, Japan. During the first, second, and third trimesters, 3–4 days postpartum, and one month postpartum, they were asked to take the Japanese version of the EPDS questionnaire. The primary outcome of the study was PDS, defined as an EPDS score ≥ 9 at one month postpartum. The area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EPDS scores at each antenatal screening time were calculated. Results From 139 pregnant women, 129 were successfully followed up throughout the study. The number of women with an EPDS score ≥ 9 during the first, second, and third trimesters, 3–4 days postpartum, and one month postpartum were 6/126 (4.8%), 9/124 (7.3%), 5/117 (4.3%), 17/123 (13.8%), and 15/123 (12.2%), respectively. Screening during the second trimester had the highest AUC to predict PDS (0.89) among antenatal screenings. The optimal EPDS cutoff score during the second trimester was 4/5 (sensitivity: 85.7%; specificity: 77.1%; PPV: 33.3%; NPV: 97.6%). An EPDS score ≥ 5 during the second trimester (adjusted odds ratio [aOR]: 15.9; 95% confidence interval [95%CI]: 3.2–78.1) and a family history of mental illness (aOR: 4.5; 95%CI: 1.2–17.5) were significantly associated with PDS. Conclusions Our study suggests that the EPDS score at the second trimester with the cutoff value of 4/5 may be adequate for initial screening for prediction of PDS. Women with an EPDS score ≥ 5 at the second trimester require more elaborate follow-up.
Ovarian clear cell carcinoma (OCCC) is a subtype of epithelial ovarian cancer (EOC) and associated with elevated interleukin-6 (IL-6) expression, resistance to chemotherapy, and increased mortality. Although bevacizumab (Bev) is a widely used anti-angiogenic agent for EOC, the efficacy of Bev and the role of IL-6 in modulating angiogenesis in OCCC are unknown. We performed tube formation assays on human umbilical vein endothelial cells (HUVEC) cultured in OCCC conditioned media and in direct co-culture with OCCC cells and observed that IL-6 inhibition significantly mitigated the ability of Bev to impede tube formation in both cases. Furthermore, the IL-6 blockade not only disrupted the anti-angiogenic efficacy of Bev but also the concomitant anti-tumor activity. We also found that IL-6 inhibition resulted in a significant increase in the secreted levels of angiopoietin-1 (Ang1) in addition to decreased vascular endothelial growth factor (VEGF) expression. Clinical specimens also exhibited this reciprocal relationship between IL-6 and Ang1 expression. Finally, knockdown of Ang1 prevented IL-6 inhibition from mitigating the effects of Bev, demonstrating that IL-6 supports the anti-angiogenic activity of Bev by suppressing Ang1 and promoting dependence on VEGF for angiogenesis. Altogether, our data suggest that OCCC tumors with high IL-6 are candidates for Bev therapy.
Cervical cancer is a cancer with evidence-based and cost-effective preventive measures; Human Papilloma Virus (HPV) vaccination for school girls and cancer screening for women. In Cambodia, cervical cancer accounts for an estimated 11.4% and 10.4% of women's cancer and deaths in 2020, respectively. This study aimed to identify the knowledge of cervical cancer, its information sources, and the experiences of cervical cancer screening among female primary school teachers, who are key influencers of HPV vaccination. A cross-sectional study was conducted using telephone interviews with 100 female primary school teachers in Phnom Penh, the capital of Cambodia. All 100 participants had heard of cervical cancer, 94 (94%) had heard of screening, and 49 (49%) had ever undergone a screening. When asked about their knowledge regarding cause(s), symptom(s), detection, and treatment(s) of cervical cancer, 31%, 44%, 35%, and 55% respondents said "Do not know". Those who did not reply "Do not know" were asked open-ended questions. Many of their answers were judged as "incorrect" by gynecologists. Consequently only 1%, 38%, 63% and 28% of respondents replied with at least one correct answer regarding cause(s), symptom(s), detection and treatment(s) respectively. The most common sources of information were family and friends, followed by doctors, television, and the Internet. Among female primary school teachers with an above-average educational level, their knowledge of cervical cancer was generally low. To promote cervical cancer prevention, it is necessary to provide correct knowledge in a broad and accessible manner through involvement of local medical doctors and healthcare providers.
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