bluuebunny/crossref_metadata_2025_split huggingface dataset:
Second opinions for spinal surgery: a scoping review
Authors: Ferreira Giovanni E. , Zadro Joshua , Liu Chang , Harris Ian A. , Maher Chris G. 
Published: March 2022

Abstract
Background
Second opinions have the goal of clarifying uncertainties around diagnosis or management, particularly when healthcare decisions are complex, unpleasant, and carry considerable risks. Second opinions might be particularly useful for people recommended surgery for their back pain as surgery has at best a limited role in the management of back pain.

Methods
We conducted a scoping review. Two independent researchers screened PubMed, EMBASE, Cochrane CENTRAL and CINAHL from inception to May 6th, 2021. Studies of any design published in any language were eligible provided they described a second opinion intervention for people with spinal pain (low back or neck pain with or without radicular pain) either considering surgery or to whom surgery had been recommended. We assessed the methodological quality with the Downs & Black scale. Outcomes were: i) characteristics of second opinion services for people considering or who have been recommended spinal surgery, ii) agreement between first and second opinions in terms of diagnoses, need for surgery and type of surgery, iii) whether they reduce surgery and improve patient outcomes; and iv) the costs and healthcare use associated with these services. Outcomes were presented descriptively.

Results
We screened 6341 records, read 27 full-texts, and included 12 studies (all observational; 11 had poor methodological quality; one had fair). Studies described patient, doctor, and insurance-initiated second opinion services. Diagnostic agreement between first and second opinions varied from 53 to 96%. Agreement for need for surgery between first and second opinions ranged from 0 to 83%. Second opinion services may reduce surgery rates in the short-term, but it is unclear whether these reductions are sustained in the long-term or if patients only delay surgery. Second opinion services may reduce costs and healthcare use (e.g. imaging), but might increase others (e.g. injections).

Conclusions
Second opinion services typically recommend less surgical treatments compared to first opinions and may reduce surgery rates in the short-term, but it is unclear whether these reductions are sustained in the long-term or if patients only delay surgery. There is a need for high-quality randomised trials to determine the value of second opinion services for reducing spinal surgery.
High pericoronary adipose tissue attenuation on computed tomography angiography predicts cardiovascular events in patients with type 2 diabetes mellitus: post-hoc analysis from a prospective cohort study
Authors: Ichikawa Keishi , Miyoshi Toru , Osawa Kazuhiro , Nakashima Mitsutaka , Miki Takashi , Nishihara Takahiro , Toda Hironobu , Yoshida Masatoki , Ito Hiroshi 
Published: March 2022

AbstractBackgroundPericoronary adipose tissue (PCAT) attenuation on coronary computed tomography angiography (CTA) is a non-invasive biomarker for pericoronary inflammation. We aimed to investigate the prognostic value of PCAT attenuation in patients with type 2 diabetes mellitus (T2DM).MethodsWe included 333 T2DM patients (mean age, 66 years; male patients, 211; mean body mass index, 25 kg/m2) who underwent clinically indicated coronary CTA and examined their CT findings, coronary artery calcium score, pericardial fat volume, stenosis (> 50% luminal narrowing), high-risk plaque features of low-attenuation plaque and/or positive remodelling and/or spotty calcification, and PCAT attenuation. We assessed PCAT attenuation in Hounsfield units (HU) of proximal 40-mm segments of the left anterior descending artery (LAD) and right coronary artery (RCA). Cardiovascular events were defined as cardiac death, hospitalisation for acute coronary syndrome, late coronary revascularisation, and hospitalisation for heart failure.ResultsDuring a median follow-up of 4.0 years, we observed 31 cardiovascular events. LAD-PCAT attenuation was significantly higher in patients with cardiovascular events than in those without (− 68.5 ± 6.5 HU vs − 70.8 ± 6.1 HU, p = 0.045), whereas RCA-PCAT attenuation was not (p = 0.089). High LAD-PCAT attenuation (> − 70.7 HU; median value) was significantly associated with cardiovascular events in a model that included adverse CTA findings, such as significant stenosis and/or high-risk plaque (hazard ratio; 2.69, 95% confidence interval; 1.17–0.20, p = 0.020). After adding LAD-PCAT attenuation to the adverse CTA findings, the C-statistic and global chi-square values increased significantly from 0.65 to 0.70 (p = 0.037) and 10.9–15.0 (p = 0.043), respectively.ConclusionsIn T2DM patients undergoing clinically indicated coronary CTA, high LAD-PCAT attenuation could significantly predict cardiovascular events. This suggests that assessing LAD-PCAT attenuation can help physicians identify high-risk T2DM patients.
Engineering the next-generation of CAR T-cells with CRISPR-Cas9 gene editing
Authors: Dimitri Alexander , Herbst Friederike , Fraietta Joseph A. 
Published: March 2022

AbstractChimeric Antigen Receptor (CAR) T-cells represent a breakthrough in personalized cancer therapy. In this strategy, synthetic receptors comprised of antigen recognition, signaling, and costimulatory domains are used to reprogram T-cells to target tumor cells for destruction. Despite the success of this approach in refractory B-cell malignancies, optimal potency of CAR T-cell therapy for many other cancers, particularly solid tumors, has not been achieved. Factors such as T-cell exhaustion, lack of CAR T-cell persistence, cytokine-related toxicities, and bottlenecks in the manufacturing of autologous products have hampered the safety, effectiveness, and availability of this approach. With the ease and accessibility of CRISPR-Cas9-based gene editing, it is possible to address many of these limitations. Accordingly, current research efforts focus on precision engineering of CAR T-cells with conventional CRISPR-Cas9 systems or novel editors that can install desired genetic changes with or without introduction of a double-stranded break (DSB) into the genome. These tools and strategies can be directly applied to targeting negative regulators of T-cell function, directing therapeutic transgenes to specific genomic loci, and generating reproducibly safe and potent allogeneic universal CAR T-cell products for on-demand cancer immunotherapy. This review evaluates several of the ongoing and future directions of combining next-generation CRISPR-Cas9 gene editing with synthetic biology to optimize CAR T-cell therapy for future clinical trials toward the establishment of a new cancer treatment paradigm.
Using experience to create evidence: a mixed methods process evaluation of the new free family planning policy in Burkina Faso
Authors: Browne Lalique , Cooper Sarah , Tiendrebeogo Cheick , Bicaba Frank , Bila Alice , Bicaba Abel , Druetz Thomas 
Published: March 2022

Abstract
Background
In 2019, Burkina Faso was one of the first countries in Sub-Saharan Africa to introduce a free family planning (FP) policy. This process evaluation aims to identify obstacles and facilitators to its implementation, examine its coverage in the targeted population after six months, and investigate its influence on the perceived quality of FP services.

Methods
This process evaluation was conducted from November 2019 through March 2020 in the two regions of Burkina Faso where the new policy was introduced as a pilot. Mixed methods were used with a convergent design. Semi-directed interviews were conducted with the Ministry of Health (n = 3), healthcare workers (n = 10), and women aged 15–49 years (n = 10). Surveys were also administered to the female members of 696 households randomly selected from four health districts (n = 901).

Results
Implementation obstacles include insufficient communication, shortages of consumables and contraceptives, and delays in reimbursement from the government. The main facilitators were previous experience with free healthcare policies, good acceptability in the population, and support from local associations. Six months after its introduction, only 50% of the surveyed participants knew about the free FP policy. Higher education level, being sexually active or in a relationship, having recently seen a healthcare professional, and possession of a radio significantly increased the odds of knowing. Of the participants, 39% continued paying for FP services despite the new policy, mainly because of stock shortages forcing them to buy their contraceptive products elsewhere. Increased waiting time and shorter consultations were also reported.

Conclusion
Six months after its introduction, the free FP policy still has gaps in its implementation, as women continue to spend money for FP services and have little knowledge of the policy, particularly in the Cascades region. While its use is reportedly increasing, addressing implementation issues could further improve women’s access to contraception.
Molecular characterization of enterovirus detected in cerebrospinal fluid and wastewater samples in Monastir, Tunisia, 2014–2017
Authors: Rmadi Yosra , Elargoubi Aida , González-Sanz Rubén , Mastouri Maha , Cabrerizo Maria , Aouni Mahjoub 
Published: March 2022

Abstract
Background
Enteroviruses (EVs) are considered the main causative agents responsible for aseptic meningitis worldwide. This study was conducted in the Monastir region of Tunisia in order to know the prevalence of EV infections in children with meningitis symptoms. Detected EV types were compared to those identified in wastewater samples.

Methods
Two hundred CSF samples collected from hospitalized patients suspected of having aseptic meningitis for an EV infection between May 2014 and May 2017 and 80 wastewater samples collected in the same time-period were analyzed. EV detection and genotyping were performed using PCR methods followed by sequencing. Phylogenetic analyses in the 3′-VP1 region were also carried-out.

Results
EVs were detected in 12% (24/200) CSF and in 35% (28/80) wastewater samples. EV genotyping was reached in 50% (12/24) CSF-positive samples and in 64% (18/28) sewage. Most frequent types detected in CSF were CVB3, E-30 and E-9 (25% each). In wastewater samples, the same EVs were identified, but also other types non-detected in CSF samples, such as E-17,CVA9 and CVB1 from EV species B, and EV-A71 and CVA8 from EV-A, suggesting their likely lower pathogenicity. Phylogenetic analysis showed that within the same type, different strains circulate in Tunisia. For some of the EV types such as E-9, E-11 or CVB3, the same strains were detected in CSF and wastewater samples.

Conclusions
Epidemiological studies are important for the surveillance of the EV infections and to better understand the emergence of certain types and variants.
Human papillomavirus prevalence and genotype distribution landscapes in Shannan City, Tibet Tibetan Autonomous Region, China
Authors: Feng Dilu , Wei Sitian , Chen Jun , Yu Zhicheng , Lhamo Yeshe , Wang Hongbo , Zhu Xiaowu 
Published: March 2022

Abstract
Background
Data regarding human papillomavirus (HPV) prevalence and genotype distribution are limited in Shannan City, Tibet Tibetan Autonomous Region, China. The purpose of this study is to provide reliable data for guiding women in Shannan City in cervical cancer screening and HPV vaccine innoculation.

Methods
HPV testing was performed on women aged 16–109 years (mean age 44.03 ± 9.25 years) from Shannan City in 2019 and 2020, which was implemented technically by gynecological examination, vaginal discharge smear microscopy, cytology, and HPV detection. The overall prevalence, age-specific prevalence, and genotype distribution were analyzed.

Results
A total of 48,126 women received HPV testing, of which 3929 were detected human papillomavirus. The HPV-positive rate was 8.16% (3929/48,126), and the highest prevalence was in the ≤ 25-year-old age group (12.68%). After the age of 25, the prevalence rate decreased rapidly, and then slowly increased from 7.49% in the 46–55 age group to 9.82% in the ≥ 66 age group, showing a “U-shaped” pattern. The positive prevalence of HPV 16 or 18-only was 1.43%, that of other HPV genotypes except HPV 16 or 18 was 6.39%, and mixed HPV infections including HPV 16 or 18 was 0.34%.

Conclusions
The HPV infection rate in Shannan city is rather low, and the age-specific prevalence of HPV infection presents a “U” curve, suggesting the importance of screening among younger women and the necessity of detection among older women.
Traditional knowledge of edible plants used as flavoring for fish-grilling in Southeast Guizhou, China
Authors: He Jianwu , Peng Liping , Li Wei , Luo Jin , Li Qiang , Zeng Hanyong , Ali Maroof , Long Chunlin 
Published: March 2022

Abstract
Background
The local Dong people in Qiandongnan Prefecture, Guizhou Province, China, with rich biocultural diversity, have developed the traditional rice-duckweed-fish-duck agroecosystem (RDFDA) to support biodiversity conservation and to meet food and cultural needs. However, there is still not much research on traditional ecological knowledge (TEK) in this area. In particular, there is a lack of traditional knowledge of edible plants used by the Dong people as flavoring to grill fish (Cyprinus carpio) collected from RDFDA, which is extremely valuable in their traditional culture. The study focused on documenting plant species used in grilling fish and analyzing the status of its TEK.

Methods
Twenty-one sampling points of three Dong minority villages in Qiandongnan were selected for the research. The local TEK associated with plant resources for fish-grilling was recorded through free listing and semi-structured interviews. Fidelity level (FL) and ethnoecological importance value (EIV) indicators were designed to determine the socioeconomic influence of TEK. The non-metric multidimensional scaling (NMDS) method was used to evaluate the differentiation of edible plant species distribution in dissimilar accessibility types.

Results
A total of 430 people were interviewed about grilled fish, of whom 75% were men and 85% were farmers. Thirty-four edible plants were documented for fish-grilling in three Dong villages. They belong to 16 plant families, such as Apiaceae, and Asteraceae. The life forms included herbaceous (76%), shrubs (18%) and trees (6%). Leaves are the most commonly used part of for grilling fish, followed by aerial parts, and whole plants. Among these edible plants, Allium hookeri, A. macrostemon and Houttuynia cordata with the highest fidelity level (100%) were cited as edible plants for grilling fish by all informants. The NMDS showed different accessibility types of collection sites, with different importance values. Paddy rice field edge (2.03) has the highest value, followed by forest-farming ecotone (1.74), streamsides (1.71) and woodland (0.48).

Conclusion
The purpose of this study was to investigate the traditional knowledge of edible plant materials used by the Dong people for grilling fish. The results demonstrate the strong connection between local people, the bio-environment and agroecosystem services. The survey and comparative analysis revealed that plant species with high FL values may be potential sources of natural flavors.
A cationic lipid mediated CRISPR/Cas9 technique for the production of stable genome edited citrus plants
Authors: Mahmoud Lamiaa M. , Kaur Prabhjot , Stanton Daniel , Grosser Jude W. , Dutt Manjul 
Published: March 2022

Abstract
Background
The genetic engineering of crops has enhanced productivity in the face of climate change and a growing global population by conferring desirable genetic traits, including the enhancement of biotic and abiotic stress tolerance, to improve agriculture. The clustered regularly interspaced short palindromic repeats (CRISPR/Cas9) system has been found to be a promising technology for genomic editing. Protoplasts are often utilized for the development of genetically modified plants through in vitro integration of a recombinant DNA fragment into the plant genome. We targeted the citrus Nonexpressor of Pathogenesis-Related 3 (CsNPR3) gene, a negative regulator of systemic acquired resistance (SAR) that governs the proteasome-mediated degradation of NPR1 and developed a genome editing technique targeting citrus protoplast DNA to produce stable genome-edited citrus plants.

Results
Here, we determined the best cationic lipid nanoparticles to deliver donor DNA and described a protocol using Lipofectamine™ LTX Reagent with PLUS Reagent to mediate DNA delivery into citrus protoplasts. A Cas9 construct containing a gRNA targeting the CsNPR3 gene was transfected into citrus protoplasts using the cationic lipid transfection agent Lipofectamine with or without polyethylene glycol (PEG, MW 6000). The optimal transfection efficiency for the encapsulation was 30% in Lipofectamine, 51% in Lipofectamine with PEG, and 2% with PEG only. Additionally, plasmid encapsulation in Lipofectamine resulted in the highest cell viability percentage (45%) compared with PEG. Nine edited plants were obtained and identified based on the T7EI assay and Sanger sequencing. The developed edited lines exhibited downregulation of CsNPR3 expression and upregulation of CsPR1.

Conclusions
Our results demonstrate that utilization of the cationic lipid-based transfection agent Lipofectamine is a viable option for the successful delivery of donor DNA and subsequent successful genome editing in citrus.
Navigating intersecting public health crises: a qualitative study of people with opioid use disorders' experiences during the COVID-19 pandemic
Authors: Watson Dennis P. , Staton Monte D. , Grella Christine E. , Scott Christy K. , Dennis Michael L. 
Published: March 2022

Abstract
Background
The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises.

Methods
The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions.

Results
The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support.

Conclusions
The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.
Impairment characteristics of static balance and plantar load distribution of patients undergoing tibial cortex transverse distraction for diabetic foot ulcers
Authors: Fan Zhi-Qiang , Liu De-Wu 
Published: March 2022

AbstractObjectiveTibial cortex transverse distraction (TCTD) has been recently reported for the treatment of diabetic foot ulcers. Herein, we explored the characteristics of the impairments in static balance and plantar load distribution in patients.MethodsWe performed a retrospective study of 21 patients with diabetic foot ulcers who underwent TCTD, who were regularly followed up for > 1 year after surgery, and 20 healthy individuals (control group). A pressure platform was used to assess the standing balance functions of the lower extremities and the plantar load distribution.ResultsOne patient underwent amputation because of severe infection. In patient group, center of pressure (COP) ellipse sway area, COP path length and angleθwere all larger, compared with those of control group (250.15 ± 98.36 mm2vs. 135.67 ± 53.21 mm2, 145.15 ± 67.43 mm vs. 78.47 ± 34.15 mm, 39.75 ± 17.61° vs. 22.17 ± 14.15°), with statistically significant differences (P < 0.01). The average plantar load and backfoot load of the unaffected side was significantly larger than that of the affected side (58.4 ± 5.5% vs. 41.6 ± 5.5%, 45.3 ± 6.4% vs. 36.5 ± 5.6%), but they were similar for the two feet of members of the control group.ConclusionsAlthough TCTD may represent an appropriate method for the treatment of diabetic foot ulcers, postoperative impairments in static balance and plantar load distribution remain in the long term. These potential long-term problems should be taken into account in further rehabilitation planning.Type of study/level of evidence: Therapeutic III.
Risk factors for lymph node metastasis of soft tissue sarcomas of the head, neck, and extremities, and the clinical significance of negative lymph node dissection
Authors: Liu Qi-Kun , Yu Xiao-Jun , Wang Ying-Guang , Lu Rui , Wang Shan-Xi , Xu Hao-Ran , Kang Hao 
Published: March 2022

Abstract
Background
This study sought to define the risk factors for lymph node metastasis (LNM) of soft tissue sarcomas (STS) of the head, neck, and extremities, and the clinical significance of negative lymph node dissection (NLND).

Methods
STS patient data in the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2015 were extracted and pooled. Logistics regression analysis was used to identify risk factors for LNM, Cox proportional hazards and Fine–Grey’s models were used for survival analysis, and Propensity score matching analysis (PSM) was used to assess the impact of NLND on patient prognosis.

Results
A total of 3276 patients were enrolled in the study, of whom 283 (8.6%) developed LNM. Rhabdomyosarcoma had the highest rate of LNM (25.3%), followed by clear cell sarcoma (16.8%) and epithelioid sarcoma (12.4%), while leiomyosarcoma had the lowest rate of LNM (1.3%). Sex, tumor size, grade, histology, and site were significantly associated with LNM. For specific histologic subtypes of STS, NLND significantly improves overall survival (HR: 0.718, 95%CI 0.535–0.962; P = 0.026) and cancer-specific survival (HR: 0.699, 95%CI 0.506–0.967; P = 0.031) and reduces cancer-specific mortality (Gray’s test, P = 0.017). However, NLND did not improve overall survival (P = 0.46) or reduce cancer-specific mortality (Gray’s test, P = 0.772) of patients with leiomyosarcoma.

Conclusions
Histology is an independent risk factor for LNM in STS of the head, neck, and extremities. Prophylactic NLND treatment was necessary and had a clinical benefit for patients with STS who were at high risk for LNM but had no significant impact on the prognosis of patients with leiomyosarcoma.