Objective: This study aimed to demonstrate the feasibility of laparoscopic-resection of the abdominal cystic lymphangiomas in Pediatric Surgery and describe the morbidity associated to this management in Queen fabiola...Objective: This study aimed to demonstrate the feasibility of laparoscopic-resection of the abdominal cystic lymphangiomas in Pediatric Surgery and describe the morbidity associated to this management in Queen fabiola children’s university hospital (HUDERF) in Brussels. Methods: We retrospectively conducted a study at the Pediatric Surgery Department of HUDERF, Brussels. The studied period was from January 1, 2014, to January 1, 2024;a span of 10 years. All patients with a confirmed diagnosis of cystic lymphangiomas and who underwent laparoscopic surgery were included in our study. Those who have been operated exclusively by open surgery have been excluded. The technique involved either total laparoscopic resection or laparoscopic-assisted with extra-abdominal resection of the tumor. Parameters that were studied included age, sex, weight, symptoms, preoperative diagnosis, imaging assessment, location, size of the tumor, type of mass, surgical procedure, duration of the surgery, conversion to open surgery, morbidity, and histopathology. Data were analyzed using Microsoft Office Excel 2010 and SPSS. Results: We retrieved 10 files of patients presenting with abdominal cystic lymphangiomas within two patients underwent exclusive open surgery and have excluded from our study. Then our sample was constituted with 8 patients. The mean age of the patients was 6.4 years (standard deviation: 3.6 years, range: 1 to 11 years). Male patients were predominant. The mean weight was 26.7 kg (standard deviation: 14.7 kg, range: 10 to 55 kg). The most common symptom was abdominal pain. Preoperative diagnosis of abdominal cystic lymphangioma was made in 8 cases. Abdominal ultrasound was performed in all patients. MRI was done in 5 patients, and CT scan in 2 patients. All patients presented a multicystic mass. Pure laparoscopic resection of the cyst was done in 2 cases. Laparoscopic-assisted resection in 4 cases (with extra-peritoneal with small bowel resection and mesenteric detorsion in 1 case), and conversion in 2 cases due to the complex location of the cyst. After a follow-up period of 5 years, morbidity was noted in one patient (Patient 3) who developed postoperative bowel obstruction 1 month post-surgery. This patient was re-operated on with a favorable clinical outcome following conventional small bowel resection and anastomosis. The other patients (1, 2, 4, 5, 6, 7 and 8) had a simple clinical course, and no recurrence was observed in our series. Conclusion: Laparoscopic-resection of the abdominal cystic lymphangiomas is feasible in Pediatric Surgery. As minimally invasive surgery it gives many advantages even for complex abdominal cystic lymphangiomas with less morbidity as shown in our series.展开更多
The predictability of a coupled system composed of a coupled reduced-order extratropical ocean-atmosphere model forced by a low-order three-variable tropical recharge-discharge model is explored with emphasis on its l...The predictability of a coupled system composed of a coupled reduced-order extratropical ocean-atmosphere model forced by a low-order three-variable tropical recharge-discharge model is explored with emphasis on its long-term forecasting capabilities.Highly idealized ensemble forecasts are produced taking into account the uncertainties in the initial states of the system,with specific attention to the structure of the initial errors in the tropical model.Three main types of experiments are explored:with random perturbations along the three Lyapunov vectors of the tropical model;along the two dominant Lyapunov vectors;and along the first Lyapunov vector only.When perturbations are introduced along all vectors,forecasting biases develop even if in a perfect model framework and with known initial uncertainty properties.Theses biases are considerably reduced only when the perturbations are introduced along the dominant Lyapunov vector.Furthermore,this perturbation strategy allows a reduced mean square error to be obtained at long lead times of a few years,as well as reliable ensemble forecasts across the whole time range.These very counterintuitive findings further underline the importance of appropriately controlling the initial error structure in the tropics through data assimilation.展开更多
Space exploration is significant for scientific innovation,resource utilization,and planetary security.Space exploration involves several systems including satellites,space suits,communication systems,and robotics,whi...Space exploration is significant for scientific innovation,resource utilization,and planetary security.Space exploration involves several systems including satellites,space suits,communication systems,and robotics,which have to function under harsh space conditions such as extreme temperatures(−270 to 1650℃),microgravity(10^(-6)g),unhealthy humidity(<20%RH or>60%RH),high atmospheric pressure(~1450 psi),and radiation(4000–5000 mSv).Conventional energy-harvesting technologies(solar cells,fuel cells,and nuclear energy),that are normally used to power these space systems have certain limitations(e.g.,sunlight dependence,weight,degradation,big size,high cost,low capacity,radioactivity,complexity,and low efficiency).The constraints in conventional energy resources have made it imperative to look for non-conventional yet efficient alternatives.A great potential for enhancing efficiency,sustainability,and mission duration in space exploration can be offered by integrating triboelectric nanogenerators(TENGs)with existing energy sources.Recently,the potential of TENG including energy harvesting(from vibrations/movements in satellites and spacecraft),self-powered sensing,and microgravity,for multiple applications in different space missions has been discussed.This review comprehensively covers the use of TENGs for various space applications,such as planetary exploration missions(Mars environment monitoring),manned space equipment,In-orbit robotic operations/collision monitoring,spacecraft’s design and structural health monitoring,Aeronautical systems,and conventional energy harvesting(solar and nuclear).This review also discusses the use of self-powered TENG sensors for deep space object perception.At the same time,this review compares TENGs with conventional energy harvesting technologies for space systems.Lastly,this review talks about energy harvesting in satellites,TENG-based satellite communication systems,and future practical implementation challenges(with possible solutions).展开更多
Objectives:Colorectal cancer(CRC)is a major global health burden,and Urolithin A(Uro-A)has emerged as a promising anticancer agent.This systematic review aims to synthesize current in vitro evidence on the anticancer ...Objectives:Colorectal cancer(CRC)is a major global health burden,and Urolithin A(Uro-A)has emerged as a promising anticancer agent.This systematic review aims to synthesize current in vitro evidence on the anticancer effects of Uro-A in CRC,highlighting effective concentration ranges,exposure times,relevant outcomes,and underlying molecular mechanisms.Methods:Following PRISMA 2020 guidelines,a systematic search was conducted in PubMed,Scopus,and Web of Science using the following strategy:(colorectal cancer)AND(urolithin a)OR(3,8-dihydroxy-6H-dibenzo(b,d)pyran-6-one).Eligibility criteria were defined by the PICO framework:(P)in vitro CRC cell models;(I)Uro-A alone or combined treatments;(C)No intervention,vehicle or other treatments;(O)Relevant anticancer outcomes of Uro-A in CRC.Only original,full-text,in vitro studies in English were included.Risk of bias was assessed using ToxRTool.A qualitative synthesis was performed due to the heterogeneity of the included studies.Results:Fifteen studies met inclusion criteria,involving CRC cell lines(Caco-2,HCT-116,HT-29,SW480,SW620)and normal colon fibroblasts(CCD18-Co).Uro-A inhibited CRC cell proliferation,clonogenic growth,cancer stem cells properties,migration,and invasion,and induced cell cycle arrest,apoptosis,autophagy,and senescence,through modulation of key signaling pathways and proteins.Co-treatments with conventional chemotherapeutics and microbiota-derived metabolites showed additive or synergistic effects.Discussion:The findings support UroA’s potential as a preventive or adjuvant agent in CRC treatment.However,preclinical nature of the evidence and methodological heterogeneity hinder clinical extrapolation to in vivo contexts.Human clinical trials are necessary to overcome these limitations.Other:This review was registered in PROSPERO(CRD420251070874)and supported by FCT/MCTES UIDP/05608/2020 and UIDB/05608/2020.Institutional.展开更多
Background:The Colorectal Cancer(CRC)pathogenesis and therapeutic efficacy are influenced by the gut microbiome,making it a promising biomarker for predicting treatment responses and adverse effects.This systematic re...Background:The Colorectal Cancer(CRC)pathogenesis and therapeutic efficacy are influenced by the gut microbiome,making it a promising biomarker for predicting treatment responses and adverse effects.This systematic review aims to outline the gut microbiome composition in individuals with CRC undergoing the same therapeutic regimen and evaluate interindividual microbiome profile variations to better understand how these differences may influence therapeutic outcomes.Methods:Key studies investigating the microbiome’s role in therapeutic approaches for CRC were searched in both PubMed and Cochrane databases on 12 and 22 March 2025,respectively.Eligible studies included free full-text English-language randomized clinical trials and human observational studies reporting on gut microbiome composition and treatment outcomes.RoB 2 and ROBINS-I were employed in the evaluation of bias for randomized trials and observational studies,respectively.Data extracted was narratively analyzed.Results:Six studies involving a total of 361 individuals were included.Therapeutic interventions,either standard treatments and/or those targeting the gut microbiome,generally increased probiotic taxa and reduced pro-carcinogenic bacteria.However,no consistent pattern of improved clinical outcomes was observed,suggesting that treatment mechanisms,the tumor’s nature,and individual characteristics play critical roles in microbiome modulation.Conclusion:The gut microbiome holds significant potential in clinical settings.Nonetheless,further research is needed to better understand its functional aspects and to consider the influence of treatment mechanisms,the tumor’s nature,and individual characteristics as modulators,in order to optimize clinical outcomes.展开更多
Cities often have a substantial green infrastructure,which provides local ecosystem services that improve the quality of life of urban residents.These services should be explicitly addressed in urban development polic...Cities often have a substantial green infrastructure,which provides local ecosystem services that improve the quality of life of urban residents.These services should be explicitly addressed in urban development policies,and areas with insufficient vegetation and limited access to public green spaces should be identified.This paper presents two spatially explicit urban green indicators that are derived using remote sensing imagery,freely available map data and spatial analysis tools from open source geospatial libraries and commercial software.The first indicator represents proportional green cover(public as well as private)in the vicinity of each building within a city.The second indicator quantifies the proximity of public green spaces as walking distances from buildings to actual park entrances.A dasymetric mapping approach was used to take spatial variations in population density into account.This allows representing the indicators from the perspective of citizens instead of buildings,which may be more meaningful for deriving statistics at city level or at the level of neighbourhoods or administrative zones.The potential use of these indicators in a planning context is discussed on a case study carried out for the city of Brussels,Belgium.展开更多
Azoospermia is characterized by the absence of sperm in the ejaculate and is categorized into obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).For men with NOA,testicular sperm extraction(TESE)is the onl...Azoospermia is characterized by the absence of sperm in the ejaculate and is categorized into obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).For men with NOA,testicular sperm extraction(TESE)is the only method to obtain sperm for assisted reproductive technology(ART).Given the rarity of these sperm and the unpredictable success of subsequent retrieval attempts,cryopreservation of microdissection-TESE-obtained sperm is essential.Effective cryopreservation prevents the need for repeated surgical procedures and supports future ART attempts.After first delving into the physiological and molecular aspects of sperm cryopreservation,this review aims to examine the current methods and devices for preserving small numbers of sperm.It presents conventional freezing and vitrification techniques,evaluating their respective strengths and limitations in effectively preserving rare sperm,and compares the efficacy of using fresh versus cryopreserved testicular sperm.展开更多
In order to find closed form solutions of nonintegrable nonlinear ordinary differential equations,numerous tricks have been proposed.The goal of this short review is to explain how a theorem of Eremenko on meromorphic...In order to find closed form solutions of nonintegrable nonlinear ordinary differential equations,numerous tricks have been proposed.The goal of this short review is to explain how a theorem of Eremenko on meromorphic solutions of some nonlinear ODEs together with some classical,19th-century results,can be turned into algorithms(thus avoiding ad hoc assumptions)which provide all(as opposed to some)solutions in a precise class.To illustrate these methods,we present some new such exact solutions,physically relevant.展开更多
The development of innovative surgical techniques has been a constant and fundamental aspect in liver transplantation(LT)to address chronic organ shortage.Domino liver transplantation(DLT),initially performed by Furta...The development of innovative surgical techniques has been a constant and fundamental aspect in liver transplantation(LT)to address chronic organ shortage.Domino liver transplantation(DLT),initially performed by Furtado et al.in Lisbon in 1995,is an innovative technique in which a liver from a patient with a metabolic disorder is transplanted into a recipient with end-stage liver disease[1].展开更多
Portal hypertension and cirrhosis are associated with severe hemodynamic changes in hepatic and systemic circulation in the adult population.During cirrhosis progression,circulation becomes hyperdynamic,with cardiac,p...Portal hypertension and cirrhosis are associated with severe hemodynamic changes in hepatic and systemic circulation in the adult population.During cirrhosis progression,circulation becomes hyperdynamic,with cardiac,pulmonary and renal consequences.Cirrhotic adults also present with cirrhotic cardiomyopathy,with systolic and diastolic dysfunction and electrophysiological abnormalities.This article provides an update on normal liver hemodynamics,a brief reminder of the liver and systemic hemodynamics in cirrhotic adults,and a description of liver and systemic hemodynamics in cirrhotic children.This review attempts to clarify whether liver and systemic hemodynamics are altered in cirrhotic children like they are in adults.The characterization of these hemodynamic disturbances could contribute to a better understanding of hepatic and systemic physiopathology in pediatric cirrhosis.展开更多
We investigate high-frequency traders’behavior in the context of the fastest and most extreme price movements(EPMs)that can be observed in the market,specifically ultrafast flash events,challenging the methodologies ...We investigate high-frequency traders’behavior in the context of the fastest and most extreme price movements(EPMs)that can be observed in the market,specifically ultrafast flash events,challenging the methodologies employed in the academic and practitioner literature for identifying sudden liquidity black holes.To refine the price-shock identification methodology,we introduce a new approach called sequence-based flash events(SFEs),which relies on tick sequences instead of predetermined fixed-time intervals within which all flash events in the sample are assumed to occur.This alternative methodology offers the advantage of pinpointing the exact time and duration of a crash,which,in turn,provides a way to more accurately define the observation windows around it.We compare our sample of SFEs with both the so-called“mini flash crashes”,as identified by the Nanex detection algorithm,and the so-called EPMs,as identified by Brogaard et al.(2018).We use close and open prices,as well as high and low prices.Based on our sample of SFEs,we find no evidence that HFTs trigger extreme price shocks.However,we find that HFTs exacerbate SFEs by increasing the net imbalance in the direction of these shocks as they occur.Finally,we show that the choice of the price-shock identification methodology is critical.Thus,we urge regulators to exercise caution and avoid hasty conclusions regarding HFTs’contribution to price stability in stressful market conditions.展开更多
Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metast...Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metastases,HAI’s app-lication has expanded to the adjuvant setting following hepatic resection,with early studies indicating improved hepatic disease-free survival.Recent research demonstrates that combining HAI with modern systemic therapies enhances conversion to resectability and prolongs both recurrence-free and overall survival,even in heavily pretreated patients with diverse RAS mutational statuses.Person-alization through approaches like microsatellite instability status and dose mo-difications further optimize outcomes.However,the complexity of HAI requires expertise across multidisciplinary teams,limiting its widespread adoption to specialized centers.Ongoing clinical trials continue to investigate HAI’s role in CRLM management,highlighting its potential to become a cornerstone of liver-directed therapy.We explore how HAI chemotherapy,in combination with personalized medicine,can advance treatment strategies for metastatic colorectal cancer.展开更多
The increasing demand for sustainable energy solutions necessitates innovative approaches to biomass utilization.This study introduces a comprehensive biorefinery model that valorizes poplar biomass into high-value pr...The increasing demand for sustainable energy solutions necessitates innovative approaches to biomass utilization.This study introduces a comprehensive biorefinery model that valorizes poplar biomass into high-value products,including ethanol,furfural,phenol,and biochar.These products not only serve as promising sources for biofuel and renewable chemicals but also contribute to pollution mitigation.The approach employs a biphasic pretreatment system utilizing p-toluenesulfonic acid,pentanol,and AlCl_(3) under optimized conditions(120℃ for 45 min),achieving remarkable efficiencies of 95.8%xylan removal,90.2%delignification,and 90.7%glucan recovery.The underlying mechanism,elucidated through density functional theory,demonstrates how the disruption of lignin-carbohydrate complexes via electrostatic and hydrogen-bonding interactions enhances product yields.The cellulose-rich substrate yielded 71.3 g/L ethanol,while solubilized xylan converted to 86.7%furfural without additional acid.Furthermore,lignin pyrolysis produced bio-oil containing over 45.2%phenolic compounds,while biochar demonstrated significant adsorptive capacity for perfluorooctanoic acid.Scaling this biorefinery model to process 140 million tons of poplar biomass annually reduces CO_(2)emissions by 75.3 million tons and provides socioeconomic savings of $17.3 billion,supporting sustainable industrial transformation.展开更多
The contribution of knowledge capital to firm value has increased significantly,from 25%in the 1970s to 45%in the 2010s(Belo et al.in Decomposing firm value J Financ Econ 143:619–639,2022).However,what influences fi...The contribution of knowledge capital to firm value has increased significantly,from 25%in the 1970s to 45%in the 2010s(Belo et al.in Decomposing firm value J Financ Econ 143:619–639,2022).However,what influences firms’ability to maximize the effect of knowledge capital on firm value?Drawing on insights from upper echelons,agency,and behavioral agency theories,we show that CEO characteristics are crucial in enabling firms to take advantage of knowledge stock.We empirically demonstrate that short-term CEO compensation structures are detrimental to a firm’s ability to take advantage of its knowledge stock.We further show that CEO power enhances knowledge stock and R&D intensity.Our study provides direct empirical evidence of the importance of CEO compensation structure and corporate governance in understanding firm value in a knowledge economy.展开更多
The first liver transplantation(LT)in humans was performed by Thomas Starzl on March 1,1963[1,2](Fig.1).During the period 1963-1983,this challenging procedure was performed in four centers only,one in the USA and thre...The first liver transplantation(LT)in humans was performed by Thomas Starzl on March 1,1963[1,2](Fig.1).During the period 1963-1983,this challenging procedure was performed in four centers only,one in the USA and three in Western Europe:Denver,Cambridge,Hannover and Groningen.Their collected experience including only 540 cases(meaning 27(!)cases yearly)was the basis of the 1983 National Institutes of Health(NIH)development consensus conference leading to the conclusion that LT could become“a promising alternative to the current therapy in the management of the late phase of several forms of serious liver disease…candidates are those who exhausted alternative medical and surgical treatments…and are approaching the terminal phase of their illness”.Patients presenting liver tumors and inherited,liver based,metabolic diseases could also be considered for LT[3].This conference put forward ten absolute and five relative contraindications restricting thereby the access to LT to a minority of very well selected liver diseased patients.展开更多
Purpose:We aimed to measure the variation in researchers’knowledge and attitudes towards bibliometric indicators.The focus is on mapping the heterogeneity of this metric-wiseness within and between disciplines.Design...Purpose:We aimed to measure the variation in researchers’knowledge and attitudes towards bibliometric indicators.The focus is on mapping the heterogeneity of this metric-wiseness within and between disciplines.Design/methodology/approach:An exploratory survey is administered to researchers at the Sapienza University of Rome,one of Europe’s oldest and largest generalist universities.To measure metric-wiseness,we use attitude statements that are evaluated by a 5-point Likert scale.Moreover,we analyze documents of recent initiatives on assessment reform to shed light on how researchers’heterogeneous attitudes regarding and knowledge of bibliometric indicators are taken into account.Findings:We found great heterogeneity in researchers’metric-wiseness across scientific disciplines.In addition,within each discipline,we observed both supporters and critics of bibliometric indicators.From the document analysis,we found no reference to individual heterogeneity concerning researchers’metric wiseness.Research limitations:We used a self-selected sample of researchers from one Italian university as an exploratory case.Further research is needed to check the generalizability of our findings.Practical implications:To gain sufficient support for research evaluation practices,it is key to consider researchers’diverse attitudes towards indicators.Originality/value:We contribute to the current debate on reforming research assessment by providing a novel empirical measurement of researchers’knowledge and attitudes towards bibliometric indicators and discussing the importance of the obtained results for improving current research evaluation systems.展开更多
Rare earth elements(REEs)play a crucial role in many technologies from daily appliances in cell phones to more advanced wind turbines and electric cars.Permanent magnets account for a quarter of total global REEs prod...Rare earth elements(REEs)play a crucial role in many technologies from daily appliances in cell phones to more advanced wind turbines and electric cars.Permanent magnets account for a quarter of total global REEs production and have high recycling value.In this study,smelting process was used to selectively oxidize REEs in the permanent magnets by adding Fe_(2)O_(3).This separates REEs into a slag phase from an iron-rich metallic phase.B_(2)O_(3) was also added to the system as a flux to lower the slag melting temperature.This minimizes REEs loss to the metallic phase and allows a more efficient phase separation.The effect of flux and oxidizing agent addition was investigated on both regular and cerium-rich NdFeB(NdCeFeB)magnets.At 1350℃and for 1 h,the slag phase was successfully separated from the metallic phase with the addition of 0.8 stoichiometric amount of Fe_(2)O_(3) and 40 wt%of B_(2)O_(3).Scanning electron microscopy-energy dispersive X-ray spectroscopy(SEM-EDX)analysis reveals that REEs in the magnet do not migrate to the metal phase while the REE-rich slag phase contains almost no iron.After the selective removal of iron into the metallic phase,REEs are recovered from the slag phase through an acid leaching process allowing>99%of REEs recovery.Boron in the magnet can also be recovered as useful boric acid by evaporation and crystallisation technique.The proposed process in this study is reagent and energy-efficient with almost complete valorisation of both NdCeFeB and NdFeB magnets.展开更多
Membrane technology has thus far played an essential role in promoting environmental sustainability through improving the quality of water.Taking into account the current growth rate of membrane products along with th...Membrane technology has thus far played an essential role in promoting environmental sustainability through improving the quality of water.Taking into account the current growth rate of membrane products along with the market capacity,a tremendous rise in the amount of end-of-life(EoL)membranes is inevitable.In 2022,the global records of EoL membranes reached 35,000 tons.Recycling and resource utilization of EoL membranes is a viable option and hold significant promises for energy conservation and carbon neutralization.The present work provides an extensive overview of the latest progress in the field in relation with the prominent application cases.Furthermore,the avenues for the contributions of membrane recycling treatment technology within the framework of“carbon neutrality”are discussed with emphasis on permeability,pollutant interception capacity,and other relevant factors associated with the recycled membranes.This review strives to summarize the recycling and efficient utilization of EoL membranes,aiming at providing technical support to reduce operational costs and promote the low-carbon development of membrane technology.展开更多
A substantial body of research has been conducted with the objective of enhancing the understanding of Non-Timber Forest Products (NTFP) in Central Africa. A significant proportion of the studies focus on medicinal pl...A substantial body of research has been conducted with the objective of enhancing the understanding of Non-Timber Forest Products (NTFP) in Central Africa. A significant proportion of the studies focus on medicinal plants, in contrast to those that examine food products. Nevertheless, studies on edible wild mushrooms as NTFPs and cultivated mushrooms, on their economic potential and value chains in the Great Lakes Region, remain scarce and largely absent for some NTFPs. In light of the aforementioned considerations, the present study aims to examine the economic potential and value chain of the production sector of wild edible mushrooms (WEM) and cultivated mushrooms (CM) within the Virunga National Park (PNVi) and its surrounding areas in North Kivu, Democratic Republic of the Congo (DRC). To this end, a sample of 432 respondents was selected, distributed equitably among the actors of the Goma-Kitshanga-Mweso value chain, the Goma-Rutshuru chain, the Beni-Mutwanga chain, and the Beni-Mangina chain. A digital questionnaire consisting of open and closed questions was administered, and observations were carried out concurrently. The quantities of mushrooms sold were weighed and photographed. The results demonstrated that, when the eight-month fruiting period of wild and cultivated mushrooms was considered as a single year for all actors within the value chain, a picker could sell 6.1 kg at $2 and earn $12. A seller could sell 16 kg at $4 and earn $64, while a grower could sell 502 kg at $3 and earn $1506. Consequently, the CM grower generates a significantly higher profit than other participants in the value chain, despite the expenses he incurs. Ultimately, the domestication of WEM, highly prized by the local population of the Virunga National Park, has the potential to enhance their household incomes, as evidenced by the findings of this study.展开更多
Objective:Drawbacks of human papillomavirus(HPV)primary screening,including high referral rates and low specificity,highlight the necessity for triage strategies to balance the screening benefits with potential harms....Objective:Drawbacks of human papillomavirus(HPV)primary screening,including high referral rates and low specificity,highlight the necessity for triage strategies to balance the screening benefits with potential harms.Methods:A cross-sectional,population-based diagnostic study was conducted in rural Xinjiang,China involving 8,638 women≥25 years of age who participated in organized cervical cancer screening between 2023 and 2024.The study evaluated the accuracy and efficiency of multiple HPV-based"screen-triage"strategies.Histologically confirmed cervical intraepithelial neoplasia grade 2 or worse(CIN2+and CIN3+)served as disease outcomes.Results:Among single-step triage strategies,only extended genotyping for the seven most carcinogenic HPV types(HPV16/18/31/33/45/52/58)maintained sensitivity for CIN2+comparable to HPV screening without triage(90.0%vs.92.5%,P=0.50)but significantly improved specificity(94.7%vs.90.8%,P<0.001).This approach led to a 38%reduction in colposcopy referrals(relative rate,0.62;95%CI:0.59±0.65).Two-step triage algorithms(HPV16/18 with reflex ASC-US+or methylation)showed slightly lower but non-significant sensitivity(87.5%,P=0.13/89.6%,P=0.50)than HPV primary screening without triage,yet achieved significantly increased specificity(>95%,P<0.001)and reduced colposcopy referral by~50%(relative rate,0.5;P<0.001).If negative for cytology or methylation,women positive for 12 high-risk HPV types(excluding HPV16/18)had a<2%risk of CIN2+(CIN3+risk<1%),indicating delayed follow-up.Conclusions:Focusing on the seven high-risk HPV types within a one-step"screen-triage"framework effectively balances minimal sensitivity loss with significant gains in specificity,reducing unnecessary referrals and treatments,especially valuable in resourcelimited settings.Integrating HPV genotyping with methylation results improves the accurate identification of women requiring immediate referral,which is advisable when resources allow.展开更多
文摘Objective: This study aimed to demonstrate the feasibility of laparoscopic-resection of the abdominal cystic lymphangiomas in Pediatric Surgery and describe the morbidity associated to this management in Queen fabiola children’s university hospital (HUDERF) in Brussels. Methods: We retrospectively conducted a study at the Pediatric Surgery Department of HUDERF, Brussels. The studied period was from January 1, 2014, to January 1, 2024;a span of 10 years. All patients with a confirmed diagnosis of cystic lymphangiomas and who underwent laparoscopic surgery were included in our study. Those who have been operated exclusively by open surgery have been excluded. The technique involved either total laparoscopic resection or laparoscopic-assisted with extra-abdominal resection of the tumor. Parameters that were studied included age, sex, weight, symptoms, preoperative diagnosis, imaging assessment, location, size of the tumor, type of mass, surgical procedure, duration of the surgery, conversion to open surgery, morbidity, and histopathology. Data were analyzed using Microsoft Office Excel 2010 and SPSS. Results: We retrieved 10 files of patients presenting with abdominal cystic lymphangiomas within two patients underwent exclusive open surgery and have excluded from our study. Then our sample was constituted with 8 patients. The mean age of the patients was 6.4 years (standard deviation: 3.6 years, range: 1 to 11 years). Male patients were predominant. The mean weight was 26.7 kg (standard deviation: 14.7 kg, range: 10 to 55 kg). The most common symptom was abdominal pain. Preoperative diagnosis of abdominal cystic lymphangioma was made in 8 cases. Abdominal ultrasound was performed in all patients. MRI was done in 5 patients, and CT scan in 2 patients. All patients presented a multicystic mass. Pure laparoscopic resection of the cyst was done in 2 cases. Laparoscopic-assisted resection in 4 cases (with extra-peritoneal with small bowel resection and mesenteric detorsion in 1 case), and conversion in 2 cases due to the complex location of the cyst. After a follow-up period of 5 years, morbidity was noted in one patient (Patient 3) who developed postoperative bowel obstruction 1 month post-surgery. This patient was re-operated on with a favorable clinical outcome following conventional small bowel resection and anastomosis. The other patients (1, 2, 4, 5, 6, 7 and 8) had a simple clinical course, and no recurrence was observed in our series. Conclusion: Laparoscopic-resection of the abdominal cystic lymphangiomas is feasible in Pediatric Surgery. As minimally invasive surgery it gives many advantages even for complex abdominal cystic lymphangiomas with less morbidity as shown in our series.
基金supported by the National Key R&D Program of China(Grant No.2023YFF0805100)。
文摘The predictability of a coupled system composed of a coupled reduced-order extratropical ocean-atmosphere model forced by a low-order three-variable tropical recharge-discharge model is explored with emphasis on its long-term forecasting capabilities.Highly idealized ensemble forecasts are produced taking into account the uncertainties in the initial states of the system,with specific attention to the structure of the initial errors in the tropical model.Three main types of experiments are explored:with random perturbations along the three Lyapunov vectors of the tropical model;along the two dominant Lyapunov vectors;and along the first Lyapunov vector only.When perturbations are introduced along all vectors,forecasting biases develop even if in a perfect model framework and with known initial uncertainty properties.Theses biases are considerably reduced only when the perturbations are introduced along the dominant Lyapunov vector.Furthermore,this perturbation strategy allows a reduced mean square error to be obtained at long lead times of a few years,as well as reliable ensemble forecasts across the whole time range.These very counterintuitive findings further underline the importance of appropriately controlling the initial error structure in the tropics through data assimilation.
基金supported by Swedish Research Council(Vetenskapsradet,2023-04962).
文摘Space exploration is significant for scientific innovation,resource utilization,and planetary security.Space exploration involves several systems including satellites,space suits,communication systems,and robotics,which have to function under harsh space conditions such as extreme temperatures(−270 to 1650℃),microgravity(10^(-6)g),unhealthy humidity(<20%RH or>60%RH),high atmospheric pressure(~1450 psi),and radiation(4000–5000 mSv).Conventional energy-harvesting technologies(solar cells,fuel cells,and nuclear energy),that are normally used to power these space systems have certain limitations(e.g.,sunlight dependence,weight,degradation,big size,high cost,low capacity,radioactivity,complexity,and low efficiency).The constraints in conventional energy resources have made it imperative to look for non-conventional yet efficient alternatives.A great potential for enhancing efficiency,sustainability,and mission duration in space exploration can be offered by integrating triboelectric nanogenerators(TENGs)with existing energy sources.Recently,the potential of TENG including energy harvesting(from vibrations/movements in satellites and spacecraft),self-powered sensing,and microgravity,for multiple applications in different space missions has been discussed.This review comprehensively covers the use of TENGs for various space applications,such as planetary exploration missions(Mars environment monitoring),manned space equipment,In-orbit robotic operations/collision monitoring,spacecraft’s design and structural health monitoring,Aeronautical systems,and conventional energy harvesting(solar and nuclear).This review also discusses the use of self-powered TENG sensors for deep space object perception.At the same time,this review compares TENGs with conventional energy harvesting technologies for space systems.Lastly,this review talks about energy harvesting in satellites,TENG-based satellite communication systems,and future practical implementation challenges(with possible solutions).
基金supported by FCT/MCTES UIDP/05608/2020(https://doi.org/10.54499/UIDP/05608/2020,accessed on 01 July 2025)UIDB/05608/2020(https://doi.org/10.54499/UIDB/05608/2020,accessed on 01 July 2025).Institutional.
文摘Objectives:Colorectal cancer(CRC)is a major global health burden,and Urolithin A(Uro-A)has emerged as a promising anticancer agent.This systematic review aims to synthesize current in vitro evidence on the anticancer effects of Uro-A in CRC,highlighting effective concentration ranges,exposure times,relevant outcomes,and underlying molecular mechanisms.Methods:Following PRISMA 2020 guidelines,a systematic search was conducted in PubMed,Scopus,and Web of Science using the following strategy:(colorectal cancer)AND(urolithin a)OR(3,8-dihydroxy-6H-dibenzo(b,d)pyran-6-one).Eligibility criteria were defined by the PICO framework:(P)in vitro CRC cell models;(I)Uro-A alone or combined treatments;(C)No intervention,vehicle or other treatments;(O)Relevant anticancer outcomes of Uro-A in CRC.Only original,full-text,in vitro studies in English were included.Risk of bias was assessed using ToxRTool.A qualitative synthesis was performed due to the heterogeneity of the included studies.Results:Fifteen studies met inclusion criteria,involving CRC cell lines(Caco-2,HCT-116,HT-29,SW480,SW620)and normal colon fibroblasts(CCD18-Co).Uro-A inhibited CRC cell proliferation,clonogenic growth,cancer stem cells properties,migration,and invasion,and induced cell cycle arrest,apoptosis,autophagy,and senescence,through modulation of key signaling pathways and proteins.Co-treatments with conventional chemotherapeutics and microbiota-derived metabolites showed additive or synergistic effects.Discussion:The findings support UroA’s potential as a preventive or adjuvant agent in CRC treatment.However,preclinical nature of the evidence and methodological heterogeneity hinder clinical extrapolation to in vivo contexts.Human clinical trials are necessary to overcome these limitations.Other:This review was registered in PROSPERO(CRD420251070874)and supported by FCT/MCTES UIDP/05608/2020 and UIDB/05608/2020.Institutional.
基金supported by FCT/MCTES UIDP/05608/2020(https://doi.org/10.54499/UIDP/05608/2020)UIDB/05608/2020(https://doi.org/10.54499/UIDB/05608/2020).
文摘Background:The Colorectal Cancer(CRC)pathogenesis and therapeutic efficacy are influenced by the gut microbiome,making it a promising biomarker for predicting treatment responses and adverse effects.This systematic review aims to outline the gut microbiome composition in individuals with CRC undergoing the same therapeutic regimen and evaluate interindividual microbiome profile variations to better understand how these differences may influence therapeutic outcomes.Methods:Key studies investigating the microbiome’s role in therapeutic approaches for CRC were searched in both PubMed and Cochrane databases on 12 and 22 March 2025,respectively.Eligible studies included free full-text English-language randomized clinical trials and human observational studies reporting on gut microbiome composition and treatment outcomes.RoB 2 and ROBINS-I were employed in the evaluation of bias for randomized trials and observational studies,respectively.Data extracted was narratively analyzed.Results:Six studies involving a total of 361 individuals were included.Therapeutic interventions,either standard treatments and/or those targeting the gut microbiome,generally increased probiotic taxa and reduced pro-carcinogenic bacteria.However,no consistent pattern of improved clinical outcomes was observed,suggesting that treatment mechanisms,the tumor’s nature,and individual characteristics play critical roles in microbiome modulation.Conclusion:The gut microbiome holds significant potential in clinical settings.Nonetheless,further research is needed to better understand its functional aspects and to consider the influence of treatment mechanisms,the tumor’s nature,and individual characteristics as modulators,in order to optimize clinical outcomes.
文摘Cities often have a substantial green infrastructure,which provides local ecosystem services that improve the quality of life of urban residents.These services should be explicitly addressed in urban development policies,and areas with insufficient vegetation and limited access to public green spaces should be identified.This paper presents two spatially explicit urban green indicators that are derived using remote sensing imagery,freely available map data and spatial analysis tools from open source geospatial libraries and commercial software.The first indicator represents proportional green cover(public as well as private)in the vicinity of each building within a city.The second indicator quantifies the proximity of public green spaces as walking distances from buildings to actual park entrances.A dasymetric mapping approach was used to take spatial variations in population density into account.This allows representing the indicators from the perspective of citizens instead of buildings,which may be more meaningful for deriving statistics at city level or at the level of neighbourhoods or administrative zones.The potential use of these indicators in a planning context is discussed on a case study carried out for the city of Brussels,Belgium.
文摘Azoospermia is characterized by the absence of sperm in the ejaculate and is categorized into obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).For men with NOA,testicular sperm extraction(TESE)is the only method to obtain sperm for assisted reproductive technology(ART).Given the rarity of these sperm and the unpredictable success of subsequent retrieval attempts,cryopreservation of microdissection-TESE-obtained sperm is essential.Effective cryopreservation prevents the need for repeated surgical procedures and supports future ART attempts.After first delving into the physiological and molecular aspects of sperm cryopreservation,this review aims to examine the current methods and devices for preserving small numbers of sperm.It presents conventional freezing and vitrification techniques,evaluating their respective strengths and limitations in effectively preserving rare sperm,and compares the efficacy of using fresh versus cryopreserved testicular sperm.
基金partially supported by RGC(No.17307420)supported by NSFC(No.12471077)。
文摘In order to find closed form solutions of nonintegrable nonlinear ordinary differential equations,numerous tricks have been proposed.The goal of this short review is to explain how a theorem of Eremenko on meromorphic solutions of some nonlinear ODEs together with some classical,19th-century results,can be turned into algorithms(thus avoiding ad hoc assumptions)which provide all(as opposed to some)solutions in a precise class.To illustrate these methods,we present some new such exact solutions,physically relevant.
文摘The development of innovative surgical techniques has been a constant and fundamental aspect in liver transplantation(LT)to address chronic organ shortage.Domino liver transplantation(DLT),initially performed by Furtado et al.in Lisbon in 1995,is an innovative technique in which a liver from a patient with a metabolic disorder is transplanted into a recipient with end-stage liver disease[1].
文摘Portal hypertension and cirrhosis are associated with severe hemodynamic changes in hepatic and systemic circulation in the adult population.During cirrhosis progression,circulation becomes hyperdynamic,with cardiac,pulmonary and renal consequences.Cirrhotic adults also present with cirrhotic cardiomyopathy,with systolic and diastolic dysfunction and electrophysiological abnormalities.This article provides an update on normal liver hemodynamics,a brief reminder of the liver and systemic hemodynamics in cirrhotic adults,and a description of liver and systemic hemodynamics in cirrhotic children.This review attempts to clarify whether liver and systemic hemodynamics are altered in cirrhotic children like they are in adults.The characterization of these hemodynamic disturbances could contribute to a better understanding of hepatic and systemic physiopathology in pediatric cirrhosis.
文摘We investigate high-frequency traders’behavior in the context of the fastest and most extreme price movements(EPMs)that can be observed in the market,specifically ultrafast flash events,challenging the methodologies employed in the academic and practitioner literature for identifying sudden liquidity black holes.To refine the price-shock identification methodology,we introduce a new approach called sequence-based flash events(SFEs),which relies on tick sequences instead of predetermined fixed-time intervals within which all flash events in the sample are assumed to occur.This alternative methodology offers the advantage of pinpointing the exact time and duration of a crash,which,in turn,provides a way to more accurately define the observation windows around it.We compare our sample of SFEs with both the so-called“mini flash crashes”,as identified by the Nanex detection algorithm,and the so-called EPMs,as identified by Brogaard et al.(2018).We use close and open prices,as well as high and low prices.Based on our sample of SFEs,we find no evidence that HFTs trigger extreme price shocks.However,we find that HFTs exacerbate SFEs by increasing the net imbalance in the direction of these shocks as they occur.Finally,we show that the choice of the price-shock identification methodology is critical.Thus,we urge regulators to exercise caution and avoid hasty conclusions regarding HFTs’contribution to price stability in stressful market conditions.
文摘Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metastases,HAI’s app-lication has expanded to the adjuvant setting following hepatic resection,with early studies indicating improved hepatic disease-free survival.Recent research demonstrates that combining HAI with modern systemic therapies enhances conversion to resectability and prolongs both recurrence-free and overall survival,even in heavily pretreated patients with diverse RAS mutational statuses.Person-alization through approaches like microsatellite instability status and dose mo-difications further optimize outcomes.However,the complexity of HAI requires expertise across multidisciplinary teams,limiting its widespread adoption to specialized centers.Ongoing clinical trials continue to investigate HAI’s role in CRLM management,highlighting its potential to become a cornerstone of liver-directed therapy.We explore how HAI chemotherapy,in combination with personalized medicine,can advance treatment strategies for metastatic colorectal cancer.
基金funded by the National Natural Science Foundation of China(22278189,22478154)the Fundamental Research Funds for the Central Universities(Jiangnan University,JUSRP202501024)the Priority Academic Program Development of Jiangsu Higher Education Institutions,the 111 Project(No.111-2-06)。
文摘The increasing demand for sustainable energy solutions necessitates innovative approaches to biomass utilization.This study introduces a comprehensive biorefinery model that valorizes poplar biomass into high-value products,including ethanol,furfural,phenol,and biochar.These products not only serve as promising sources for biofuel and renewable chemicals but also contribute to pollution mitigation.The approach employs a biphasic pretreatment system utilizing p-toluenesulfonic acid,pentanol,and AlCl_(3) under optimized conditions(120℃ for 45 min),achieving remarkable efficiencies of 95.8%xylan removal,90.2%delignification,and 90.7%glucan recovery.The underlying mechanism,elucidated through density functional theory,demonstrates how the disruption of lignin-carbohydrate complexes via electrostatic and hydrogen-bonding interactions enhances product yields.The cellulose-rich substrate yielded 71.3 g/L ethanol,while solubilized xylan converted to 86.7%furfural without additional acid.Furthermore,lignin pyrolysis produced bio-oil containing over 45.2%phenolic compounds,while biochar demonstrated significant adsorptive capacity for perfluorooctanoic acid.Scaling this biorefinery model to process 140 million tons of poplar biomass annually reduces CO_(2)emissions by 75.3 million tons and provides socioeconomic savings of $17.3 billion,supporting sustainable industrial transformation.
文摘The contribution of knowledge capital to firm value has increased significantly,from 25%in the 1970s to 45%in the 2010s(Belo et al.in Decomposing firm value J Financ Econ 143:619–639,2022).However,what influences firms’ability to maximize the effect of knowledge capital on firm value?Drawing on insights from upper echelons,agency,and behavioral agency theories,we show that CEO characteristics are crucial in enabling firms to take advantage of knowledge stock.We empirically demonstrate that short-term CEO compensation structures are detrimental to a firm’s ability to take advantage of its knowledge stock.We further show that CEO power enhances knowledge stock and R&D intensity.Our study provides direct empirical evidence of the importance of CEO compensation structure and corporate governance in understanding firm value in a knowledge economy.
文摘The first liver transplantation(LT)in humans was performed by Thomas Starzl on March 1,1963[1,2](Fig.1).During the period 1963-1983,this challenging procedure was performed in four centers only,one in the USA and three in Western Europe:Denver,Cambridge,Hannover and Groningen.Their collected experience including only 540 cases(meaning 27(!)cases yearly)was the basis of the 1983 National Institutes of Health(NIH)development consensus conference leading to the conclusion that LT could become“a promising alternative to the current therapy in the management of the late phase of several forms of serious liver disease…candidates are those who exhausted alternative medical and surgical treatments…and are approaching the terminal phase of their illness”.Patients presenting liver tumors and inherited,liver based,metabolic diseases could also be considered for LT[3].This conference put forward ten absolute and five relative contraindications restricting thereby the access to LT to a minority of very well selected liver diseased patients.
基金supported by the Sapienza Universitàdi Roma Sapienza Awards no.6H15XNFS.
文摘Purpose:We aimed to measure the variation in researchers’knowledge and attitudes towards bibliometric indicators.The focus is on mapping the heterogeneity of this metric-wiseness within and between disciplines.Design/methodology/approach:An exploratory survey is administered to researchers at the Sapienza University of Rome,one of Europe’s oldest and largest generalist universities.To measure metric-wiseness,we use attitude statements that are evaluated by a 5-point Likert scale.Moreover,we analyze documents of recent initiatives on assessment reform to shed light on how researchers’heterogeneous attitudes regarding and knowledge of bibliometric indicators are taken into account.Findings:We found great heterogeneity in researchers’metric-wiseness across scientific disciplines.In addition,within each discipline,we observed both supporters and critics of bibliometric indicators.From the document analysis,we found no reference to individual heterogeneity concerning researchers’metric wiseness.Research limitations:We used a self-selected sample of researchers from one Italian university as an exploratory case.Further research is needed to check the generalizability of our findings.Practical implications:To gain sufficient support for research evaluation practices,it is key to consider researchers’diverse attitudes towards indicators.Originality/value:We contribute to the current debate on reforming research assessment by providing a novel empirical measurement of researchers’knowledge and attitudes towards bibliometric indicators and discussing the importance of the obtained results for improving current research evaluation systems.
基金Project supported by the Science and Engineering Research Board of India(SRG/2020/002096)。
文摘Rare earth elements(REEs)play a crucial role in many technologies from daily appliances in cell phones to more advanced wind turbines and electric cars.Permanent magnets account for a quarter of total global REEs production and have high recycling value.In this study,smelting process was used to selectively oxidize REEs in the permanent magnets by adding Fe_(2)O_(3).This separates REEs into a slag phase from an iron-rich metallic phase.B_(2)O_(3) was also added to the system as a flux to lower the slag melting temperature.This minimizes REEs loss to the metallic phase and allows a more efficient phase separation.The effect of flux and oxidizing agent addition was investigated on both regular and cerium-rich NdFeB(NdCeFeB)magnets.At 1350℃and for 1 h,the slag phase was successfully separated from the metallic phase with the addition of 0.8 stoichiometric amount of Fe_(2)O_(3) and 40 wt%of B_(2)O_(3).Scanning electron microscopy-energy dispersive X-ray spectroscopy(SEM-EDX)analysis reveals that REEs in the magnet do not migrate to the metal phase while the REE-rich slag phase contains almost no iron.After the selective removal of iron into the metallic phase,REEs are recovered from the slag phase through an acid leaching process allowing>99%of REEs recovery.Boron in the magnet can also be recovered as useful boric acid by evaporation and crystallisation technique.The proposed process in this study is reagent and energy-efficient with almost complete valorisation of both NdCeFeB and NdFeB magnets.
基金supported by the National Natural Science Foundation of China(Nos.52322001,52070183,and 52330001)the National Key R&D Program of China(No.2023YFE0113800)the Excellent Member of the Youth Innovation Promotion Association,Chinese Academy of Sciences(No.Y2023010).
文摘Membrane technology has thus far played an essential role in promoting environmental sustainability through improving the quality of water.Taking into account the current growth rate of membrane products along with the market capacity,a tremendous rise in the amount of end-of-life(EoL)membranes is inevitable.In 2022,the global records of EoL membranes reached 35,000 tons.Recycling and resource utilization of EoL membranes is a viable option and hold significant promises for energy conservation and carbon neutralization.The present work provides an extensive overview of the latest progress in the field in relation with the prominent application cases.Furthermore,the avenues for the contributions of membrane recycling treatment technology within the framework of“carbon neutrality”are discussed with emphasis on permeability,pollutant interception capacity,and other relevant factors associated with the recycled membranes.This review strives to summarize the recycling and efficient utilization of EoL membranes,aiming at providing technical support to reduce operational costs and promote the low-carbon development of membrane technology.
文摘A substantial body of research has been conducted with the objective of enhancing the understanding of Non-Timber Forest Products (NTFP) in Central Africa. A significant proportion of the studies focus on medicinal plants, in contrast to those that examine food products. Nevertheless, studies on edible wild mushrooms as NTFPs and cultivated mushrooms, on their economic potential and value chains in the Great Lakes Region, remain scarce and largely absent for some NTFPs. In light of the aforementioned considerations, the present study aims to examine the economic potential and value chain of the production sector of wild edible mushrooms (WEM) and cultivated mushrooms (CM) within the Virunga National Park (PNVi) and its surrounding areas in North Kivu, Democratic Republic of the Congo (DRC). To this end, a sample of 432 respondents was selected, distributed equitably among the actors of the Goma-Kitshanga-Mweso value chain, the Goma-Rutshuru chain, the Beni-Mutwanga chain, and the Beni-Mangina chain. A digital questionnaire consisting of open and closed questions was administered, and observations were carried out concurrently. The quantities of mushrooms sold were weighed and photographed. The results demonstrated that, when the eight-month fruiting period of wild and cultivated mushrooms was considered as a single year for all actors within the value chain, a picker could sell 6.1 kg at $2 and earn $12. A seller could sell 16 kg at $4 and earn $64, while a grower could sell 502 kg at $3 and earn $1506. Consequently, the CM grower generates a significantly higher profit than other participants in the value chain, despite the expenses he incurs. Ultimately, the domestication of WEM, highly prized by the local population of the Virunga National Park, has the potential to enhance their household incomes, as evidenced by the findings of this study.
基金supported by grants from The Key Research and Development Program of Xinjiang Uygur Autonomous Region of China(Grant No.2022B03019-2)the National Natural Science Foundation of China(Grant Nos.82260660 and 72264038)the CAMS Innovation Fund for Medical Sciences(Grant No.CAMS 2021-I2M-1-004)。
文摘Objective:Drawbacks of human papillomavirus(HPV)primary screening,including high referral rates and low specificity,highlight the necessity for triage strategies to balance the screening benefits with potential harms.Methods:A cross-sectional,population-based diagnostic study was conducted in rural Xinjiang,China involving 8,638 women≥25 years of age who participated in organized cervical cancer screening between 2023 and 2024.The study evaluated the accuracy and efficiency of multiple HPV-based"screen-triage"strategies.Histologically confirmed cervical intraepithelial neoplasia grade 2 or worse(CIN2+and CIN3+)served as disease outcomes.Results:Among single-step triage strategies,only extended genotyping for the seven most carcinogenic HPV types(HPV16/18/31/33/45/52/58)maintained sensitivity for CIN2+comparable to HPV screening without triage(90.0%vs.92.5%,P=0.50)but significantly improved specificity(94.7%vs.90.8%,P<0.001).This approach led to a 38%reduction in colposcopy referrals(relative rate,0.62;95%CI:0.59±0.65).Two-step triage algorithms(HPV16/18 with reflex ASC-US+or methylation)showed slightly lower but non-significant sensitivity(87.5%,P=0.13/89.6%,P=0.50)than HPV primary screening without triage,yet achieved significantly increased specificity(>95%,P<0.001)and reduced colposcopy referral by~50%(relative rate,0.5;P<0.001).If negative for cytology or methylation,women positive for 12 high-risk HPV types(excluding HPV16/18)had a<2%risk of CIN2+(CIN3+risk<1%),indicating delayed follow-up.Conclusions:Focusing on the seven high-risk HPV types within a one-step"screen-triage"framework effectively balances minimal sensitivity loss with significant gains in specificity,reducing unnecessary referrals and treatments,especially valuable in resourcelimited settings.Integrating HPV genotyping with methylation results improves the accurate identification of women requiring immediate referral,which is advisable when resources allow.
