It is unknown why a minority of women fail to clear human papillomavirus (HPV) and develop precancer/cancer. Differences in T-cell receptor (TCR) repertoires may identify HPV16-infected women at ...highest-risk for progression to cancer. We conducted a proof-of-principle study nested within the Guanacaste HPV Natural History Study to evaluate the utility of next-generation sequencing for interrogating the TCR repertoires among women who cleared and failed to clear cervical HPV16.
TCR repertoires of women with HPV16-related intraepithelial neoplasia grade 3 or higher (CIN3+; n = 25) were compared to women who cleared an incident HPV16 infection without developing precancer/cancer (n = 25). TCR diversity (richness and evenness) and relative abundance (RA) of gene segment (V n = 51, D n = 2, J n = 13) usage was evaluated; receiver operating curve analysis assessed the ability to differentiate case-control status.
TCR repertoire richness was associated with CIN3+ status (P = 0.001). Relative abundance (RA) of V-gene segments was enriched for associations between cases and controls. A single V-gene (TRBV6-7) was significantly associated with CIN3+ status (RA = 0.11%, 0.16%, among cases and controls, respectively, Bonferroni P = 0.0008). The estimated area under the curve using richness and V-gene segment RA was 0.83 (95% confidence interval: 0.73-0.90).
Substantial differences in TCR repertoire among women with CIN3+ compared to women who cleared infection were observed.
This is the first study to use next-generation sequencing to investigate TCR repertoire in the context of HPV infection. These findings suggest that women with HPV16-associated cervical lesions have significantly different TCR repertoires from disease-free women who cleared HPV16 infection.
Purpura is defined as a visible hemorrhage in the skin or mucosa, which is not evanescent upon pressure. Proper classification allows a better patient approach due to its multiple diagnoses. Purpuras ...can be categorized by size, morphology, and other characteristics. The course varies according to the etiology, as do the diagnostic approach and treatment. This review discusses pigmented purpuras and some cutaneous vascular occlusion syndromes.
Vaginal pH is related to genital tract inflammation and changes in the bacterial flora, both suggested cofactors for persistence of human papillomavirus (HPV) infection. To evaluate the relationship ...between vaginal pH and HPV, we analyzed data from our large population-based study in Guanacaste, Costa Rica. We examined vaginal pH and the risk of HPV infection, cytological abnormalities, and C. trachomatis infection.
Our study included 9,165 women aged 18-97 at enrollment with a total of 28,915 visits (mean length of follow-up = 3.4 years). Generalized estimating equations were used to evaluate the relationship between vaginal pH and HPV infection (both overall and single versus multiple types) and low-grade squamous intraepithelial lesions (LSIL), the cytomorphic manifestation of HPV infection. The relationship between enrollment vaginal pH and C. trachomatis infection was assessed by logistic regression. Results were stratified by age at visit.
Detection of HPV was positively associated with vaginal pH, mainly in women < 35 years (p-trend = 0.009 and 0.007 for women aged < 25 and 25-34 years, respectively). Elevated vaginal pH was associated with 30% greater risk of infection with multiple HPV types and with LSIL, predominantly in women younger than 35 and 65+ years of age. Detection of C. trachomatis DNA was associated with increased vaginal pH in women < 25 years (OR 2.2 95% CI 1.0-5.0).
Our findings suggest a possible association of the cervical microenvironment as a modifier of HPV natural history in the development of cervical precancer and cancer. Future research should include studies of vaginal pH in a more complex assessment of hormonal changes and the cervicovaginal microbiome as they relate to the natural history of cervical neoplasia.
Carcinogenic human papillomavirus (HPV) infections are very common after sexual debut and nearly all become undetectable (“clear”) within a few years. Following clearance, the long‐term risks of ...type‐specific HPV re‐appearance and subsequent risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) are not well defined. In the 7‐year, population‐based cohort study in Guanacaste, Costa Rica, we studied how often type‐specific carcinogenic HPV infections re‐appeared after clearance and how often re‐appearance led to CIN2+. We considered 1,740 carcinogenic HPV infections detected by MY09/11 PCR among 2,805 women (18–91 years old, median 34) who were actively followed at 6‐ or 12‐month intervals. We identified women with one or more type‐specific HPV infections that cleared and re‐appeared and further defined a subgroup of “definite clearance and re‐appearance” (≥2 intervening negative results over a period of ≥1 year). We determined the absolute risk of CIN2+ among the different groups. p values are two‐sided. Only 7.7% (81/1,052) of HPV‐infected women had intervening negative results. Very few (3.7%, 39/1,052) had “definite clearance and re‐appearance”, of which 5.1% (2/39) subsequently persisted to a diagnosis of CIN2. There were zero CIN3+ lesions. Extremely few women (2/2,805 of women in our cohort) had a type‐specific carcinogenic HPV infection clear, re‐appear and lead to CIN2+. If confirmed, this argues against vaccination to avoid re‐appearance that leads to precursor lesions and against the need of frequent HPV screening after initial negative results.
The integration of artificial intelligence into clinical workflows requires reliable and robust models. Repeatability is a key attribute of model robustness. Ideal repeatable models output ...predictions without variation during independent tests carried out under similar conditions. However, slight variations, though not ideal, may be unavoidable and acceptable in practice. During model development and evaluation, much attention is given to classification performance while model repeatability is rarely assessed, leading to the development of models that are unusable in clinical practice. In this work, we evaluate the repeatability of four model types (binary classification, multi-class classification, ordinal classification, and regression) on images that were acquired from the same patient during the same visit. We study the each model's performance on four medical image classification tasks from public and private datasets: knee osteoarthritis, cervical cancer screening, breast density estimation, and retinopathy of prematurity. Repeatability is measured and compared on ResNet and DenseNet architectures. Moreover, we assess the impact of sampling Monte Carlo dropout predictions at test time on classification performance and repeatability. Leveraging Monte Carlo predictions significantly increases repeatability, in particular at the class boundaries, for all tasks on the binary, multi-class, and ordinal models leading to an average reduction of the 95% limits of agreement by 16% points and of the class disagreement rate by 7% points. The classification accuracy improves in most settings along with the repeatability. Our results suggest that beyond about 20 Monte Carlo iterations, there is no further gain in repeatability. In addition to the higher test-retest agreement, Monte Carlo predictions are better calibrated which leads to output probabilities reflecting more accurately the true likelihood of being correctly classified.
Erwinia amylovora es una enterobacteria generadora de tizón de fuego o mancha de fuego, siendo esta una enfermedad de la familia Rosácea en las que se afectan principalmente el manzano, peral y ...membrillo, actualmente está presente en más de 40 países. El manzano es una de las especies de mayor difusión a escala mundial, siendo México uno de los principales productores. La mancha de fuego es una enfermedad letal para el árbol generando pérdidas millonarias entre los agricultores a nivel mundial, y hasta la fecha no se tiene una cura concreta lo que la hace peligrosa. Una de las técnicas para determinar que tan agresivas pueden ser las cepas de Erwinia amylovora, es la utilización de la técnica de bioensayos de virulencia y patogenicidad, lo que permite poder manejar de mejor manera esta enfermedad y tener pérdidas mínimas al enfrentarse a la enfermedad mancha de fuego.
Los sistemas de educación actual promueven la inclusión educativa de estudiantes con necesidades especiales en la escuela regular. Los alumnos diagnosticados con síndrome de Asperger (SA) representan ...un reto para las instituciones educativas dado que, en la actualidad, se conoce muy poco acerca de los efectos de las estrategias y los desafíos para lograr la inclusión educativa. El sistema educativo mexicano requiere avanzar hacia la inclusión por medio del estudio de las situaciones cotidianas que se suscitan en los salones de clase. El propósito de esta investigación es brindar una nueva comprensión de los procesos de inclusión educativa. Más específicamente, la investigación buscó examinar cómo se construyen los procesos de inclusión educativa en escuelas de nivel primaria de Chihuahua, México a través de: (1) las interacciones educativas entre docentes-alumnos con SA y (2) las estrategias de enseñanza-aprendizaje en el aula. La perspectiva metodológica que se siguió en este estudio fue la cualitativa por medio del estudio de casos. La investigación se realizó en el periodo escolar enero-julio de 2019 en dos grupos de 3er grado de nivel básico. Los datos se obtuvieron por medio de la observación de las interacciones docentesestudiantes y las actividades académicas en el aula, fueron codificados manualmente y se analizaron mediante el método de comparación constante desarrollado por Glaser y Strauss (1967). Se identificaron algunos desafíos como son la falta de estrategias para el desarrollo de habilidades sociales de los estudiantes con SA. El análisis de las interacciones profesores-estudiantes con SA permite interpretar que los salones de clases son fundamentalmente, en los casos estudiados, espacios orientados al logro de objetivos académicos y el desarrollo cognitivo de los estudiantes, más que al desarrollo de sus habilidades sociales y personales.
IntroductionHuman papillomavirus (HPV) vaccines protect against incident HPV infections, which cause cervical cancer.ObjectivesWe estimated the prevalence and incidence of HPV infections in young ...adult women to understand the impact of an HPV vaccination programme in this population.MethodsWe collected cervical specimens from 6322 unvaccinated women, aged 18–37 years, who participated in the Costa Rica Vaccine Trial and its long-term follow-up. Women were followed for (median) 4.8 years and had (median) 4.0 study visits. Cervical specimens were tested for the presence/absence of 25 HPV genotypes. For each age band, we estimated the percentage of women with 1+ prevalent or 1+ incident HPV infections using generalised estimating equations. We also estimated the prevalence and incidence of HPV as a function of time since first sexual intercourse (FSI).ResultsThe model estimated HPV incident infections peaked at 28.0% (95% CI 25.3% to 30.9%) at age 20 years then steadily declined to 11.8% (95% CI 7.6% to 17.8%) at age 37 years. Incident oncogenic HPV infections (HPV16/18/31/33/35/39/45/51/52/56/58/59) peaked and then declined from 20.3% (95% CI 17.9% to 22.9%) to 7.7% (95% CI 4.4% to 13.1%); HPV16/18 declined from 6.4% (95% CI 5.1% to 8.1%) to 1.1% (95% CI 0.33% to 3.6%) and HPV31/33/45/52/58 declined from 11.0% (95% CI 9.3% to 13.1%) to 4.5% (95% CI 2.2% to 8.9%) over the same ages. The percentage of women with 1+ incident HPV of any, oncogenic, non-oncogenic and vaccine-preventable (HPV16/18, HPV31/33/45, HPV31/33/45/52/58, and HPV6/11) types peaked <1 year after FSI and steadily declined with increasing time since FSI (p for trends <0.001). We observed similar patterns for model estimated HPV prevalences.ConclusionYoung adult women may benefit from HPV vaccination if newly acquired vaccine-preventable oncogenic infections lead to cervical precancer and cancer. HPV vaccination targeting this population may provide additional opportunities for primary prevention.Trial registration number NCT00128661.
Este ensayo, elaborado a partir de conversaciones entre el arqueólogo Alejandro Haber —investigador y docente de la Universidad de Catamarca— y las antropólogas sociales Mariela Eva Rodríguez y Ana ...Cecilia Gerrard —editoras del dossier especial por los setenta años de la revista Runa. Archivo para las Ciencias del Hombre—, se presenta como una oportunidad para reflexionar colectivamente. Sus autores recorren diversos temas, entre los cuales se encuentran el potencial de la Arqueología indisciplinada para revertir la violencia epistémica que motoriza las teorizaciones, metodologías y prácticas de la ciencia colonial; las distancias entre la Arqueología y la Antropología Social; el desafío de dejarse interpelar en los encuentros intersubjetivos de la experiencia etnográfica; las implicancias de hacer, pensar y sentir desde los márgenes; los procesos de subjetivación presentes en la reflexividad, la textualización y la lectura; y las consecuencias de nuestros posicionamientos éticos y políticos en las luchas de los sujetos y grupos subalternizados.
Resumen Objetivo: evaluar el cambio longitudinal de la anemia y su asociación con el indigenismo, el nivel socioeconómico (NSE) y la inseguridad alimentaria (IA) en una población infantil mexicana ...beneficiaria de dos programas sociales. Métodos: estudio longitudinal de 1164 niños menores de 18 meses de localidades rurales, residentes en tres estados de México. Se midió la concentración de hemoglobina en 2008 y 2012, y se determinó el cambio intrasujeto en la condición de anemia. Indigenismo, NSE e IA se obtuvieron en 2008. Su asociación con cuatro categorías de cambio de la anemia se evaluó mediante modelos de regresión logística multinomial ajustados por covariables. Resultados: en 2008, el 40,5 % de los niños padecían anemia. Para 2012, un 85,2 % de ellos ya no la tenían y el 9,8 % de los que no la habían tenido la presentaron. Las distribuciones de las categorías de cambio de estado de la anemia no se asociaron con la IA, mientras que sí se detectaron diferencias estadísticamente significativas en relación con el indigenismo y el NSE. Conclusiones: la alta prevalencia de la anemia que aqueja a la población infantil justifica la implementación de intervenciones basadas en la evidencia y de probada efectividad para su combate.
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