bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Performance of hrHPV Primary Screening Using Vaginal versus Cervical Samples to Detect High-grade Intraepithelial Lesions
Authors: King Jonathan , Flores Yvonne N. , Meneses-León Joacim , Hernández-Salazar Sonia , Robles-Rivera Karina , Rivera-Paredez Berenice , León-Maldonado Leith , Hernández-López Rubí , Torres-Ibarra Leticia , Lazcano-Ponce Eduardo , Salmerón Jorge 
Published: October 2023

Abstract

High-risk human papillomavirus (hrHPV) testing is now the most recommended primary method for cervical cancer screening worldwide. Clinician-collected cervical sampling continues to be the main sampling method, but hrHPV vaginal self-sampling is an appealing alternative because of its greater acceptability and potentially higher cost-effectiveness. This study aimed to determine whether hrHPV vaginal self-sampling is comparable with clinician-collected cervical sampling for detecting histologically confirmed high-grade cervical intraepithelial neoplasia (CIN2/3) as part of a cervical cancer screening program in Mexico. We analyzed data from 5,856 women screened during a hrHPV-based screening study. Clinical performance and diagnostic efficiency metrics were estimated for the two sampling methods for the CIN3 and CIN2+ endpoints, using three triage strategies: HPV16/18 genotyping, HPV16/18/33/58 extended genotyping, and HPV16/18/31/33/58 extended genotyping. hrHPV-positivity was found in 801 (13.7%) cervical and 897 (15.3%) vaginal samples. All women with hrHPV-positive samples were referred to colposcopy, which detected 17 total CIN3 cases before considering retrospective triage strategies. Using the HPV16/18/31/33/58 extended genotyping strategy, 245 women had hrHPV-positive cervical samples and 269 had hrHPV-positive vaginal samples. Ten CIN3 cases were detected each among women with hrHPV-positive cervical samples and among those with hrHPV-positive vaginal samples when using this strategy, with no significant differences in sensitivity and specificity observed. We observe that self- and clinician-collected sampling methods are comparable for detecting CIN3 and CIN2+ regardless of the triage strategy used. These findings can help public health officials to develop more cost-effective cervical cancer screening programs that maximize participation.

Prevention Relevance:
We found that hrHPV vaginal self-sampling is comparable with hrHPV clinician cervical sampling when using any triage strategy to refer women to colposcopy, so self-sampling is a viable cervical screening method. Therefore, policymakers should consider incorporating self-sampling into cervical screening programs to increase screening coverage and reduce cervical cancer burden.
See related Spotlight, p. 649
Immune-related Adverse Events after Immune Checkpoint Blockade–based Therapy Are Associated with Improved Survival in Advanced Sarcomas
Authors: Rosenbaum Evan , Seier Kenneth , Bradic Martina , Kelly Ciara , Movva Sujana , Nacev Benjamin A. , Gounder Mrinal M. , Keohan Mary L. , Avutu Viswatej , Chi Ping , Thornton Katherine A. , Chan Jason E. , Dickson Mark A. , Donoghue Mark T.A. , Tap William D. , Qin Li-Xuan , D'Angelo Sandra P. 
Published: October 2023

AbstractThe association between immune-related AEs (irAE) and outcome in patients with sarcoma is not known. We retrospectively reviewed a cohort of patients with advanced sarcoma treated with immune checkpoint blockade (ICB)-based therapy. Association of irAEs with survival was assessed using a Cox regression model that incorporated irAE occurrence as a time-dependent covariate. Tumor samples with available RNA sequencing data were stratified by presence of an irAE to identify patterns of differential gene expression. A total of 131 patients were included. Forty-two (32%) had at least one irAE of any grade and 16 (12%) had at least one grade ≥ 3 irAE. The most common irAEs were hypothyroidism (8.3%), arthralgias (5.3%), pneumonitis (4.6%), allergic reaction (3.8%), and elevated transaminases (3.8%). Median progression-free survival (PFS) and overall survival (OS) from the time of study entry were 11.4 [95% confidence interval (CI), 10.7–15.0) and 74.6 weeks (CI, 44.9–89.7), respectively. On Cox analysis adjusting for clinical covariates that were significant in the univariate setting, the HR for an irAE (HR, 0.662; CI, 0.421–1.041) approached, but did not reach statistical significance for PFS (P = 0.074). Patients had a significantly lower HR for OS (HR, 0.443; CI, 0.246–0.798; P = 0.007) compared with those without or before an irAE. Gene expression profiling on baseline tumor samples found that patients who had an irAE had higher numbers of tumor-infiltrating dendritic cells, CD8+ T cells, and regulatory T cells as well as upregulation of immune and inflammatory pathways.Significance:irAE after ICB therapy was associated with an improved OS; it also approached statistical significance for improved PFS. Patients who had an irAE were more likely to have an inflamed tumor microenvironment at baseline.
Delegation of Legislative Power between Levels of Government in Nigeria and Kenya
Authors: Adigun Muyiwa 
Published: October 2023

Abstract
The concept of delegated legislation has always been examined between three arms of government. However, the concept has not been seriously addressed between levels of government. This study therefore seeks to examine the concept of delegated legislation between levels of government in Nigeria and Kenya. The study finds that in both Nigeria and Kenya, the concept of delegated legislation within levels of government has not been seriously explored and that in both countries, there is ethnic tension and the need for devolution of power. The study therefore argues that delegated legislation between levels of government if carefully managed may be used to achieve devolution of power and douse ethnic tension in Nigeria and Kenya. The study concludes that Nigeria and Kenya should explore the concept of delegated legislation at levels of government.
Interpreting single-step genomic evaluation as a neural network of three layers: pedigree, genotypes, and phenotypes
Authors: Zhao Tianjing , Cheng Hao 
Published: October 2023

AbstractThe single-step approach has become the most widely-used methodology for genomic evaluations when only a subset of phenotyped individuals in the pedigree are genotyped, where the genotypes for non-genotyped individuals are imputed based on gene contents (i.e., genotypes) of genotyped individuals through their pedigree relationships. We proposed a new method named single-step neural network with mixed models (NNMM) to represent single-step genomic evaluations as a neural network of three sequential layers: pedigree, genotypes, and phenotypes. These three sequential layers of information create a unified network instead of two separate steps, allowing the unobserved gene contents of non-genotyped individuals to be sampled based on pedigree, observed genotypes of genotyped individuals, and phenotypes. In addition to imputation of genotypes using all three sources of information, including phenotypes, genotypes, and pedigree, single-step NNMM provides a more flexible framework to allow nonlinear relationships between genotypes and phenotypes, and for individuals to be genotyped with different single-nucleotide polymorphism (SNP) panels. The single-step NNMM has been implemented in the software package “JWAS’.
Genome-wide identification, comparative analysis and functional roles in flavonoid biosynthesis of cytochrome P450 superfamily in pear (Pyrus spp.)
Authors: Zhang Wei , Li Hongxiang , Li Qionghou , Wang Zewen , Zeng Weiwei , Yin Hao , Qi Kaijie , Zou Ying , Hu Jian , Huang Baisha , Gu Peng , Qiao Xin , Zhang Shaoling 
Published: October 2023

Abstract
Background
The cytochrome P450 (CYP) superfamily is the largest enzyme metabolism family in plants identified to date, and it is involved in many biological processes, including secondary metabolite biosynthesis, hormone metabolism and stress resistance. However, the P450 gene superfamily has not been well studied in pear (Pyrus spp.).

Results
Here, the comprehensive identification and a comparative analysis of P450 superfamily members were conducted in cultivated and wild pear genomes. In total, 338, 299 and 419 P450 genes were identified in Chinese white pear, European pear and the wild pear, respectively. Based on the phylogenetic analyses, pear P450 genes were divided into ten clans, comprising 48 families. The motif and gene structure analyses further supported this classification. The expansion of the pear P450 gene family was attributed to whole-genome and single-gene duplication events. Several P450 gene clusters were detected, which have resulted from tandem and proximal duplications. Purifying selection was the major force imposed on the long-term evolution of P450 genes. Gene dosage balance, subfunctionalization and neofunctionalization jointly drove the retention and functional diversification of P450 gene pairs. Based on the association analysis between transcriptome expression profiles and flavonoid content during fruit development, three candidate genes were identified as being closely associated with the flavonoid biosynthesis, and the expression of one gene was further verified using qRT-PCR and its function was validated through transient transformation in pear fruit.

Conclusions
The study results provide insights into the evolution and biological functions of P450 genes in pear.
The role of apheresis and insulin therapy in hypertriglyceridemic acute pancreatitis—a concise review
Authors: Gubensek Jakob 
Published: October 2023

AbstractSevere hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP) and is involved in its pathogenesis. Chylomicrons increase blood viscosity and induce ischemia, while free fatty acids induce inflammation and distant organ damage. Conservative treatment options include fasting and insulin; limited evidence shows their comparable efficacy. Plasma exchange might provide more rapid lowering of triglycerides and amelioration of systemic effects of severe AP. Available data from controlled studies show only moderately faster lowering of triglycerides with apheresis (about 70% vs. 50% with conservative treatment within 24 h) and limited data from non-randomized studies show no improvement in clinical outcomes. New evidence is expected soon from ongoing large randomized trials. Until then, insulin may be used in mild HTG-AP and plasma exchange should be considered only in severe HTG-AP, especially if the decline of triglycerides with conservative treatment is slow, and in HTG-AP during pregnancy.
Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer
Authors: Zheng Xue-Cong , Su Jin-Bo , Zheng Jin-Jie 
Published: October 2023

Abstract
Background
The routine establishment of a diverting stoma (DS) remains controversial in every patient undergoing Dixon operation. We aimed to establish a model for the risk assessment of rectal anastomotic leak (RAREAL) after Dixon in non-emergency patients with rectal cancer, using routinely available variables, by which surgeons could individualize their approach to DS.

Methods
323 patients who underwent Dixon operation for rectal cancer from January 2015 to December 2018 were taken as the model group for retrospective study. Univariable and multivariable logistic regression analysis was used to determine the independent risk factors associated with anastomotic leakage. We constructed the RAREAL model. 150 patients who underwent Dixon operation due to rectal cancer from January 2019 to December 2020 were collected according to the uniform criteria as a validation group to validate the RAREAL model.

Results
In the model group, multivariable analysis identified the following variables as independent risk factors for AL: HbA1c (odds ratio (OR) = 4.107; P = 0.044), Left colic artery (LCA) non preservation (OR = 4.360; P = 0.026), Tumor distance from the anal margin (TD) (OR = 6.373; P = 0.002). In the model group, the area under the curve (AUC) of the receiver operating characteristic (ROC) for evaluating AL with RAREAL was 0.733, and when RAREAL score = 2.5, its sensitivity, specificity and Youden index were 0.385, 0.973, 0.358, respectively. The AUC was 0.722 in the validation group and its sensitivity and specificity were 0.333 and 0.985, respectively, when RAREAL score = 2.5.

Conclusion
The RAREAL score can be used to assess the risk of AL after Dixon operation for rectal cancer, and prophylactic DS should be proactively done when the score is greater than 2.5.
Leptospirosis in humans and selected animals in Sub-Saharan Africa, 2014–2022: a systematic review and meta-analysis
Authors: Gizamba Jacob Mugoya , Mugisha Lawrence 
Published: October 2023

Abstract
Background
Leptospirosis is an emerging neglected tropical zoonotic disease of public health importance causing substantial morbidities and mortalities among humans. The infection is maintained within the population through interactions between humans, animals, and the environment. Understanding the burden of disease in both humans and animals is necessary for effective prevention and control in Sub-Saharan Africa (SSA). Therefore, we aimed to determine the seroprevalence of leptospirosis in humans, selected domestic animals, and rodents in SSA.

Methods
A comprehensive search was done in six databases: Scopus, PubMed, Google Scholar, CINAHL, Web of Science, and African Journals Online databases for articles published between 01 January 2014 and 30 August 2022. Thirty-seven articles distributed across 14 out of 46 countries in SSA were included. The random effects meta-analysis model was used to pool the extracted seroprevalence data.

Results
The overall pooled seroprevalence of leptospirosis among humans was 12.7% (95% CI: 7.5,20.8), 15.1% (95% CI: 9.4,23.5), and 4.5% (95% CI: 0.4, 35.6) based on results obtained using ELISA, MAT, and PCR diagnostic methods respectively. The pooled seroprevalence estimates among cattle were 29.2%, 30.1%, and 9.7% based on ELISA, MAT, and PCR respectively. Further, the pooled seroprevalence in goats was 30.0% for studies that used MAT, and among rodents, the pooled seroprevalence estimates were 21.0% for MAT and 9.6% for PCR diagnostic criteria. The seroprevalence of leptospirosis varied extensively between studies, across SSA regions and study setting (rural or urban).

Conclusion
Leptospirosis is widespread in SSA in both humans and animals based on the current results of the pooled seroprevalence in the limited studies available. The burden is high in animals and humans and underestimated due to limited studies and challenges with limited diagnostic capacity in most healthcare settings in SSA. Hence, we recommend that leptospirosis should be listed as a disease of concern and be included on the list of routine diagnostics among patients presenting with febrile illness in healthcare settings. Further, we recommend the enhancement of surveillance of leptospirosis in all countries in SSA and the development of strategies with a One Health perspective to effectively prevent and control leptospirosis.
Community-associated methicillin-resistant Staphylococcus aureus infection of diabetic foot ulcers in an eastern diabetic foot center in a tertiary hospital in China: a retrospective study
Authors: Chen Yixin , Yang Jie , Wang Ying , You Jiaxing , Zhu Weifen , Liu Chao , Luan Yi , Li Lin , Li Hong 
Published: October 2023

Abstract
Background
Diabetic foot concerns are a major public health problem. Methicillin-resistant Staphylococcus aureus (MRSA) plays a significant role in diabetic foot ulcers. Community-associated MRSA has become notorious for skin and skin soft tissue infections over the last two decades. This study investigated MRSA infection in diabetic foot patients at a tertiary hospital, focusing on the epidemiology and characteristics of community-associated MRSA.

Methods
A total of 149 patients with diabetic foot infection whose culture results indicated Staphylococcus aureus as the source were selected. Epidemiological investigations, clinical characteristics, laboratory index records, antibiotic susceptibility analysis, and clinical outcome tracking were performed in all cases. Based on oxacillin resistance using the Vitek Compact 2 system, cases were divided into methicillin-sensitive Staphylococcus aureus and MRSA groups. Subgroup analysis of the MRSA group was performed in accordance with the Centers for Disease Control definition: community-associated MRSA and hospital-associated MRSA.

Results
The MRSA group (n = 41, 27.5%) had a longer duration of ulcers and hospital stay and higher hospitalization costs than the methicillin-sensitive Staphylococcus aureus group (n = 108, 72.5%). According to the classification criteria of Infectious Diseases Society of America, the severity of infection in the community-associated MRSA group was higher than that in the hospital-associated MRSA group. The analysis of antimicrobial susceptibility of 41 MRSA isolates showed that the resistance rates to erythromycin, clindamycin, quinolone, gentamicin, tetracycline, and rifampicin were 78.0%, 68.3%, 31.7%, 17.1%, 9.8%, and 2.4%, respectively. All the MRSA strains were sensitive to linezolid, tigecycline, and vancomycin. The resistance rates to quinolones and gentamycin in the community-associated MRSA group (both 0%) were lower than those in the hospital-associated MRSA group.

Conclusion
Emergence of MRSA in diabetic foot ulcer was associated with a prolonged wound duration and increased consumption of medical resources. Community-associated MRSA strains predominated among MRSA isolates from diabetic foot wounds and caused more severe infections.
A case report of reversible cerebral vasoconstriction syndrome with thunderclap headache significantly exacerbated in the supine position and alleviated in the standing position
Authors: Toyama Genri , Tsuboguchi Shintaro , Igarashi Kazuya , Saji Etsuji , Konno Takuya , Onodera Osamu 
Published: October 2023

Abstract
Background
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden onset thunderclap headache and multiple segmental reversible cerebral vasoconstrictions that improve within 3 months. The postpartum period is a well-known precipitating factor for the onset of RCVS. Cerebral venous thrombosis (CVT) causes thunderclap headaches in the postpartum period. While headache in CVT is sometimes exacerbated in the supine position, the severity of the headache in RCVS is usually independent of body position. In this study, we report a case of RCVS with thunderclap headache exacerbated in the supine position, and headache attacks that resolved quickly in the standing position during the postpartum period.

Case presentation
A 33-year-old woman presented with a sudden increase in blood pressure and thunderclap headache on the fifth postpartum day (day 1: the first sick day). The headache was severe and pulsatile, with onset in the supine position in bed, and peaked at approximately 10 s. It was accompanied by nausea and chills but there were no scintillating scotomas or ophthalmic symptoms. The headache resolved in the standing or sitting position but was exacerbated and became unbearable within a few seconds when the patient was in the supine position. Therefore, she was unable to lie supine at night. Computed tomography angiography (CTA) of the head on day 2 and magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) on day 3 showed no abnormalities. However, considering the possibility of RCVS, verapamil was initiated on day 3. The headache resolved the following day. MRA of the head on day 10 revealed diffuse and segmental stenoses in the bilateral middle and posterior cerebral arteries and basilar artery. Therefore, the patient was diagnosed with RCVS. The headache gradually resolved and disappeared completely on day 42. Cerebral vasoconstriction was also improved on MRA on day 43.

Conclusions
This postpartum RCVS case was notable for the exacerbation of headaches in the supine position. For the diagnosis of thunderclap headache in the postpartum period, RCVS should be considered in addition to CVT when the patient presents with a headache that is exacerbated in the supine position.
The existential dimension of the experience of seclusion: a qualitative study among former psychiatric inpatients
Authors: Trapman Eva S. , Braam Arjan W. 
Published: October 2023

Abstract
Background
Seclusion is a coercive measure - temporary confinement in an almost empty, non-stimulating room in a closed psychiatric admission ward to prevent (further) urgent danger due to a mental disorder. Although there is observational research about patients’ behaviors during separation (e.g. hitting walls or doors, sleeping, or praying), research into the subjective and existential dimension of the experience of seclusion in psychiatry is rare.

Aim
Aim of the current study is to describe and analyze - using the theoretical lenses of Yalom (1980) and Jaspers (1919) - how clients experience their involuntary stay in a seclusion room in a closed psychiatric clinic in existential terms.

Methods
A qualitative study was carried out among former clients (N = 10) who were asked, in retrospect, about their existential concerns in the seclusion room. In the thematic analysis, the main, deductive codes were theory based (Yalom, Jaspers), composed of subcodes that were inductively derived from the interviews.

Results
The respondents affirmed the ultimate existential concerns about death (e.g. sensing to be dead already), lack of freedom (e.g. loss of agency), isolation (e.g. interpersonal, not able to speak, feeling an object) and meaninglessness. With respect to the latter, the respondents reported a rich variety of spiritual experiences (both negative, such as knowing to be in hell, as positive, hearing/imagining a comforting voice or noticing/imagining a scenery of nature in the room).

Discussion
Although some experiences and behaviors may conflate with symptoms of psychosis, the participants generally expressed a relief about the ability to talk about their experiences. Sharing and discussing the existential experiences fits into the paradigm of psychiatric recovery and personalized care. Their intensity was obvious and might have warranted additional support by a chaplain or spiritual counselor in mental health care settings.