bluuebunny/crossref_metadata_2025_split huggingface dataset:
Canonical amplifications and CDKN2A/B loss refine IDH1/2-mutant astrocytoma prognosis
Authors: Ghosh Hia S , Patel Ruchit V , Claus Elizabeth B , Gonzalez Castro Luis Nicolas , Wen Patrick Y , Ligon Keith L , Meredith David M , Bi Wenya Linda 
Published: November 2024

Abstract

Background
Molecular features have been incorporated alongside histologic criteria to improve glioma diagnostics and prognostication. CDKN2A/B homozygous-loss associates with worse survival in IDH1/2-mutant astrocytomas (IDHmut-astrocytomas), the presence of which denotes a grade 4 tumor independent of histologic features. However, no molecular features distinguish survival amongst histologically defined grade 2 and 3 IDHmut-astrocytomas.

Methods
We assembled a cohort of patients ≥19 years old diagnosed with an IDHmut-astrocytoma between 1989 and 2020 from public datasets and several academic medical centers. Multivariate modeling and unbiased clustering were used to stratify risk.

Results
We identified 998 IDHmut-astrocytoma patients (41.5% female; 85.6% white). Tumor grade, CDKN2A/B loss, and/or ≥1 focal amplification were associated with reduced survival. Grade 2/3 patients with intact CDKN2A/B and no focal amplifications survived the longest (OS 205.7 months). Survival for grade 2/3 cases with either CDKN2A/B hemizygous-loss or focal amplifications (80.4, 88.7 months respectively) did not differ significantly from grade 4 cases with intact CDKN2A/B and no amplifications (91.5 months, P = .93). Grade 4 patients with either hemizygous or homozygous loss of CDKN2A/B had the shortest survival (OS 31.9, 32.5 months respectively), followed by grade 4 cases with intact CDKN2A/B and focal gene amplifications (OS 55.9 months). Integrating CDKN2A/B status and amplifications alongside histopathologic grade refined overall survival prediction. Unbiased clustering revealed 9 distinct molecular profiles, with differential survival. IDHmut-astrocytomas with any CDKN2A/B loss clustered together, regardless of grade, and exhibited the poorest outcomes.

Conclusions
Combining CDKN2A/B hemizygous-loss and focal gene amplifications reveals a group of IDHmut-astrocytoma patients with an intermediate prognosis, refining IDHmut-astrocytoma classification.
A rare case of endoscopic visualization of a metallic coil in a duodenal ulcer after transcatheter arterial embolization
Authors: Ameyaw Prince A , Jajja Ans A , Ilagan-Ying Ysabel 
Published: November 2024

Abstract
Transcatheter arterial embolization is the therapy of choice for recurrent peptic ulcer bleeding refractory to standard endoscopic hemostatic techniques. It offers a minimally invasive approach with high efficacy, lower mortality, and complication rates compared to surgery. However, rare adverse events attributed to coil migration including pulmonary embolism, stroke, myocardial infarction, and bowel obstruction have been reported. We report the case of a 72-year-old female with a massive duodenal ulcer bleed refractory to endoscopic hemostatic techniques of epinephrine injection and bipolar cautery. She had a successful transcatheter arterial embolization of the culprit vessels. Repeat esophagogastroduodenoscopy for increasing vasopressor requirements and transfusion unresponsive anemia revealed the visualization of the metallic coil in the duodenal ulcer base with no active bleeding which was successfully managed conservatively through multidisciplinary consultation.
Posterior localized nodular scleritis mimicking malignancy, a case report and clinical approach
Authors: Motamed Shariati Mehrdad , Shekarchian Farid , Sabermoghaddam Aliakbar , Abadi Mitra Karimi Amir , Shoeibi Nasser 
Published: November 2024

Abstract
Aim: To report a patient with choroidal bulging, sub-retinal fluid, and optic nerve head (ONH) swelling who was finally diagnosed with focal nodular posterior scleritis. Case report: A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20 and hand motion (HM) for the right eye (RE) and LE, respectively. Fundus examination of the LE showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the optic nerve and sclera junction. Oncology and rheumatology work-ups were unremarkable. With the clinical diagnosis of nodular posterior scleritis oral prednisolone 50 mg/Kg was started. Conclusion: Posterior scleritis is an uncommon inflammatory condition that could be misdiagnosed with choroidal tumors, posterior uveitis, and orbital inflammation.
Induction chemotherapy plus chemoradiotherapy in esophageal cancer: long-term results and exploratory analyses of a randomized controlled trial
Authors: Liu Shiliang , Chen Baoqing , Zhu Yujia , Wang Sifen , Cheng Xingyuan , Wang Ruixi , Hu Yonghong , Liu Hui , Li Qiaoqiao , Zhang Li , Zhao Lei , Liu Mengzhong , Xi Mian 
Published: November 2024

Abstract

Background
Previous results of our trial demonstrated that the addition of induction chemotherapy (IC) prior to definitive chemoradiotherapy (CRT) failed to significantly improve the response rate or 3-year survival in patients with locally advanced esophageal squamous cell carcinoma (ESCC). Here, we report long-term results and exploratory analyses to further evaluate the therapeutic value of IC.

Methods
Patients with previously untreated, unresectable, stage II-IVA ESCC were randomly assigned to receive IC followed by CRT or CRT alone. The relationship between tumor response to IC and long-term survival was analyzed. Baseline tumor biopsies were collected for RNA-Seq to identify patients who may benefit from IC.

Results
Eligible patients were randomized to either the IC + CRT group (n = 55) or the CRT group (n = 55). With a median follow-up of 74.9 months, the 5-year overall survival rate was 31.8% in the IC + CRT group and 29.1% in the CRT group (P =.675; HR, 0.91; 95% CI, 0.58-1.43). Similarly, no significant differences were identified in 5-year progression-free survival between groups (30.5% vs 25.5%, P =.508; HR, 0.86; 95% CI, 0.56-1.34). Patients who responded to IC had significantly better survival than nonresponders. A risk-score model incorporating 6 key genes to predict IC efficacy was also constructed.

Conclusions
Compared with definitive CRT alone, the addition of IC before CRT still failed to demonstrate superior survival in patients with unselected ESCC, based on long-term follow-up. However, because IC responders were associated with more favorable survival, potential molecular biomarkers were identified for selection of benefit population from IC.

Clinical Trials Registration
NCT02403531.
Mongolia
Authors: Batbold Amarsanaa , Dashbalbar Gangabaatar 
Published: November 2024

Abstract
Mongolia has experienced a number of peaceful transfers of power within the thirty-two years of its democratic constitutional history. The 1992 Constitution has created a vibrant civil society, free media, and played a vital role in establishing a system of government based on a separation of powers. The State Great Khural of Mongolia adopted three sets of constitutional amendments within the last five years and this made the stability of the constitution a challenging issue. Whether these amendments will consolidate the still fragile democratic constitutionalism in Mongolia remains to be seen. This chapter focuses on constitutional reform in Mongolia and investigates the current challenges.
Warrior or guardian? Public perceptions of law enforcement during traffic encounters and domestic disputes
Authors: Graham Amanda , Somers Logan J 
Published: November 2024

Abstract
While police reform efforts have pushed for the adoption of a guardian mindset over that of a warrior, the public’s perception of these orientations is also relevant. As such, this study sought to use two experimental vignettes (N = 1,143) to understand the conditions that led officers to be viewed as guardians or warriors. Officers in both vignettes were more likely to be viewed as guardians when they provided a friendly and polite demeanor (as opposed to matter-of-fact) and a verbal warning (as opposed to a formal outcome). Additionally, whether the officer was viewed as a warrior or guardian weighed heavily on the perceived fairness of the outcomes. Thus, even with a shift in officer mindset from warrior to guardian, officers may face an uphill battle to be viewed by the public as guardians, especially when the use of formal sanctions is sometimes necessary.
Perceptions, Reality, and Tolerance for Voting Wait Times in American Elections and Their Consequences for Democracy
Authors: Panagopoulos Costas , Moniz Philip 
Published: November 2024

Abstract
Since 2012, voters in U.S. presidential elections have faced increasingly long wait times, depressing turnout, and undermining public confidence in the vote. While past studies have quantified differing levels of actual wait times, voters' perceptions about these wait times, which could directly influence their decision to vote, remain a black box. Using a novel nationally representative survey of the U.S. population, this study measures voters' perceptions of wait times, actual wait times, and willingness to wait. We ask whether some groups of voters expect longer waits and whether some are willing to wait longer than others. We also examine whether Americans who expect longer waits are actually less likely to vote. Overall, there seems to be more than willing to wait at the polls: 78 percent say they would wait over 30 minutes, while only 17 percent said they actually waited that long. At the individual level, women and nonwhite voters expect longer wait times, while lower-education voters marginally do. Women and less-educated voters, but not nonwhite voters, are less willing to wait at the polls. And the longer voters expect to wait, the less likely they are to vote. A voter who expects to wait 3 hours as opposed to not at all is 2.6 percentage points less likely to turn out. These findings highlight discrepancies between who expects and who is willing to wait through longer lines to cast their ballot. They bring with them important implications for policymakers.
Snail vectors of Schistosoma mansoni in Alagoas, Northeast Brazil: spatial distribution in the hydrographic grid of the state
Authors: Lima Maria Wilma da Silva , da Silva Glória Isabel Lisboa , Silva Laryssa Oliveira , Machado João Paulo Vieira , Lima Pedro Dantas , Ramos Rosália Elen Santos , Bezerra Leticia Pereira , Santos Israel Gomes de Amorim 
Published: November 2024

Abstract
Schistosomiasis mansoni is a parasitic infectious disease of significant epidemiological importance caused by Schistosoma mansoni. The intermediate hosts are snails of the genus Biomphalaria spp. As gastropods are crucial for the spread of the disease, this study aimed to assess the influence of water bodies on the distribution of snails responsible for transmitting S. mansoni in the state of Alagoas. It is an ecological study with a spatial approach, carried out from 1997 to 2017. We considered all Biomphalaria snails captured and positive for S. mansoni in the state. Representative maps were created for better data visualization, having as unit of analysis the municipalities of Alagoas. We also calculated the natural infection rate of the snails (number of positives/number of captured). During the study period, 34 619 Biomphalaria snails were captured, consisting of Biomphalaria glabrata (30 132), Biomphalaria straminea (4445) and Biomphalaria tenagophila (42). The seventh Health Region (HR) of the state had the highest number of specimens collected (B. glabrata=15 676), while the sixth HR had the highest positivity rate (9.2%). Regarding hydrography, these snails were primarily found along the Jacuípe, Mundaú, Paraíba, São Miguel, Coruripe, Piauí, Perucaba and Boacica rivers. Our data reinforce the occurrence of the three medically significant snail species responsible for schistosomiasis transmission in Alagoas. Additionally, our findings can be used as a basis for malacological activities because we report the presence of these animals in the main rivers of the state.
Long-term co-circulation of multiple arboviruses in southeast Australia revealed by xeno-monitoring and viral whole-genome sequencing
Authors: Vieira Carla Julia S. P , Onn Michael B , Shivas Martin A , Shearman Damien , Darbro Jonathan M , Graham Melissa , Freitas Lucas , van den Hurk Andrew F , Frentiu Francesca D , Wallau Gabriel L , Devine Gregor J 
Published: November 2024

Abstract
Arbovirus surveillance of wild-caught mosquitoes is an affordable and sensitive means of monitoring virus transmission dynamics at various spatial-temporal scales, and emergence and re-emergence during epidemic and interepidemic periods. A variety of molecular diagnostics for arbovirus screening of mosquitoes (known as xeno-monitoring) are available, but most provide limited information about virus diversity. Polymerase chain reaction (PCR)-based screening coupled with RNA sequencing is an increasingly affordable and sensitive pipeline for integrating complete viral genome sequencing into surveillance programs. This enables large-scale, high-throughput arbovirus screening from diverse samples. We collected mosquitoes in CO2-baited light traps from five urban parks in Brisbane from March 2021 to May 2022. Mosquito pools of ≤200 specimens were screened for alphaviruses and flaviviruses using virus genus-specific primers and reverse transcription quantitative PCR (qRT-PCR). A subset of virus-positive samples was then processed using a mosquito-specific ribosomal RNA depletion method and then sequenced on the Illumina NextSeq. Overall, 54,670 mosquitoes representing 26 species were screened in 382 pools. Thirty detections of arboviruses were made in 28 pools. Twenty of these positive pools were further characterized using RNA sequencing generating 18 full-length genomes. These full-length sequences belonged to four medically relevant arboviruses: Barmah Forest, Ross River, Sindbis-like, and Stratford viruses. Phylogenetic and evolutionary analyses revealed the evolutionary progression of arbovirus lineages over the last 100 years, demonstrating that different epidemiological, immunological, and evolutionary processes may actively shape the evolution of Australian arboviruses. These results underscore the need for more genomic surveillance data to explore the complex evolutionary pressures acting on arboviruses. Overall, our findings highlight the effectiveness of our methodology, which can be applied broadly to enhance arbovirus surveillance in various ecological contexts and improve understanding of transmission dynamics.
Characteristics and career effect on PA graduates of a doctor of medical science program
Authors: Kilgore James R. , Colletti Thomas , Rolfs Jenna , Shuler James A. , Watkins Elyse , Welsh Jeremy M. , Lewia Stephen 
Published: November 2024

ABSTRACT

Objective:
This study examined the characteristics and effect of a doctoral degree on career metrics of physician associate/assistant (PA) graduates.

Methods:
This was a comparative analysis study of doctor of medical science (DMSc) program graduates. Characteristics from this survey were compared with program data and the National Commission on Certification of Physician Assistants Statistical Profile of Board Certified PAs for 2022.

Results:
Graduates self-reported that the DMSc degree was beneficial for receiving raises, promotions, and new leadership positions.

Conclusions:
The DMSc degree was considered a positive career benefit by graduates.
Low Prevalence of Anaerobic Bacteria in Pediatric Septic Arthritis Makes Obtaining Anaerobic Cultures of Questionable Value
Authors: Regan Maia D. , Spiegel David A. , Smith Kenneth , Goodbody Christine M. , Baldwin Keith D. 
Published: November 2024

Background:
Pediatric acute septic arthritis necessitates urgent identification and treatment to avoid irreversible joint damage if not recognized and treated in a timely manner. Many centers routinely obtain both aerobic and anaerobic cultures for the purpose of pathogen identification; however, the yield of anaerobic culture results has been called into question. The goal of this study was to determine the positivity rate of anaerobic cultures collected intraoperatively in pediatric patients with clinically diagnosed septic arthritis.

Methods:
Patients with a clinical diagnosis of septic arthritis were extracted from a search of musculoskeletal infections at a large tertiary care pediatric hospital from 2007 to 2021. Cultures obtained from the operating room or through arthrocentesis were examined.

Results:
We identified 470 cases of pediatric septic arthritis of which only 3 cultures were positive (0.6%) for anaerobic organisms. All cases involved a single isolate. The anaerobic bacteria that were detected included 1 facultative anaerobe, 1 strict anaerobe, and 1 relatively aerotolerant anaerobe. Four aerobic organisms grew on the anaerobic cultures. Three of the false positives also grew on aerobic culture media, whereas 1 aerobic specimen grew explicitly on anaerobic media. Neither the facultative anaerobe nor the aerotolerant anaerobe grew on aerobic culture media.

Conclusions:
Over a 14-year period, only 0.6% (3 cases) of septic arthritis cases yielded positive anaerobic cultures that were not able to be cultured on aerobic media. As such, an anaerobic culture was more likely to culture a bacterium that would have also been cultured on aerobic media. In addition, a true positive anaerobic culture that would not have been diagnosed on aerobic cultures only occurs about once every 5 years at our institution. If one were to decide against obtaining anaerobic cultures, they would only miss 3 infections out of almost 500 (0.6%), and antibiotics would only have changed 0.6% of the time. These results suggest that routinely obtaining anaerobic cultures may be of limited value in pediatric septic arthritis. The false-positive rate of anaerobic labs exceeds that of true-positive cases. These results provide actionable opportunity to help guide clinician decision-making in a more cost-effective and efficient management of pediatric septic arthritis.

Level of Evidence:
IV.
Cutaneous Hemophagocytosis in a Sweet Syndrome—An Unusual Phenomenon in a Rare Guise
Authors: Avci Pinar , Page Basile , Blum Roland , Borradori Luca , Feldmeyer Laurence , Wolf Ronald 
Published: November 2024

Abstract:
Cutaneous hemophagocytosis is typically known as skin manifestation of syndromal hemophagocytic lymphohistiocytosis, which presents with fever, splenomegaly, cytopenia, hyperferritinemia, and hypertriglyceridemia. Pathophysiologically, an ineffective pathogen elimination has been postulated, which is compensated by excessive macrophage activation. In this study, we present an unusual case of skin limited cutaneous hemophagocytosis within a rare manifestation of a Sweet syndrome triggered by an upper respiratory infection and drug cofactors. A 38-year-old female patient presented with a painful skin rash and a right swollen knee joint that occurred after the onset of streptococcal angina treated with amoxicillin and acetylsalicylic acid. Skin lesions presented as succulent livid red plaques from the forehead to the extensor sides of the upper arms. Clinically, a classical Sweet syndrome was diagnosed by postinfectious onset, distribution and morphology of skin lesions, and abnormal laboratory values including neutrophilic leukocytosis. Histopathologic examination revealed typical characteristics of an acute Sweet syndrome but further showed hemophagocytosis of neutrophils and eosinophils by macrophages. There was a rapid regression of the complaints and skin lesions under systemic high-dose prednisone therapy. Extensive investigations are recommended only if indicators for a syndromal hemophagocytic lymphohistiocytosis are present.
Secondary Syphilis Presenting With an Interstitial Granuloma Annulare-Like Histopathologic Pattern: A Report of 2 Cases
Authors: João David Afonso , Pancsa Tamás , Kicko Peter , Langerová Eliška , Šíma Radek , Hercogová Jana , Skálová Alena , Michal Michal , Kacerovská Denisa 
Published: November 2024

Abstract:
Syphilis, known as “the great mimicker,” is caused by the spirochete Treponema pallidum and is characterized by a diverse array of clinical and histopathologic presentations. In secondary cutaneous syphilis, the most consistent morphological features include a superficial and deep perivascular infiltrate containing plasma cells, varying degrees of endothelial swelling, irregular acanthosis, elongation of rete ridges, a vacuolated pattern, and the presence of plasma cells. Although serologic tests are essential for definitive diagnosis, spirochetes can sometimes be directly identified in silver-stained tissue slides or through immunohistochemistry. Granuloma annulare is a relatively common, benign, self-limiting condition with 3 main variants: conventional, subcutaneous, and interstitial, each with distinct characteristics. In this study, we report 2 cases of cutaneous secondary syphilis with a striking granulomatous reaction pattern that closely mimics the interstitial variant of granuloma annulare. Owing to the severity of the tertiary stage of syphilis, distinguishing between these 2 entities is crucial.
Spinoplastic Reconstruction Using Iliac Crest Vascularized Bone Graft following Sacral Ependymoma Resection
Authors: Reece Edward M. , Van Spronsen Nicole , Velluto Calogero , Jeger Jonathan L. , Fullmer Christopher , Abdulwadood Isra , Meyer Jenna , Ropper Alexander E. , Winocour Sebastian , Bohl Michael A. , Kalani Maziyar A. 
Published: November 2024

Summary:
Sacral reconstruction post tumor resection has historically been executed with the placement of hardware or free tissue transfer. Reconstruction using a vascularized bone graft is an alternative that avoids the complications associated with hardware placement or free tissue transfer. This article describes the first documented case of spinoplastic reconstruction using an iliac crest vascularized bone graft (IC-VBG) after the resection of a sacral ependymoma. This is a case of a 17-year-old boy with a history of a sacral myxopapillary ependymoma. He presented to a local emergency department complaining of 6 months of urinary incontinence and progressive paresthesias affecting the left lower extremity. Magnetic resonance imaging was significant for a lesion located in the extradural spinal canal. Biopsy confirmed a myxopapillary ependymoma, World Health Organization grade II. The initial intervention involved tumor resection with titanium hardware placement. He subsequently required replacement of the titanium hardware with carbon fiber, secondary to the need for surveillance imaging. He underwent harvesting and inset of the IC-VBG at the time of hardware replacement. IC-VBG is a safe and effective modality for spinoplastic reconstruction. It enhances the potential for solid bony union and offers a practical alternative to free bone transfer. This approach provides an asset to add to a reconstructive surgeon’s armamentarium, making it an essential tool for reconstructive surgeons working in conjunction with spinal surgery colleagues.