bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognosis and Expanded Definition of Pregnancy-associated Breast Cancer: A Dose-Response Meta-Analysis
Authors: Shao Chunchun , Yu Zhi Gang , Xiao Juan , Liu Li Yuan , Hong Fan Zhen , Zhang Yuan , Jia Hong Ying 
Published: November 2019

Abstract
Background Pregnancy-associated breast cancer (PABC) is defined as breast cancer that is diagnosed during pregnancy and/or postpartum period. Deﬁnitions of the duration in the postpartum have controversial and this variability may led to diverse results on the prognosis. Moreover, evidence on the dose-response association between the time from last pregnancy to breast cancer diagnosis and overall mortality has not been synthesized. Methods We systematically searched PubMed, Embase, and the Cochrane Database for observational studies about the prognosis of PABC published up to June 1, 2019. We estimated summary adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs). Subgroup analyses based on diagnosed time, PABC definition, geographic region, year of publication and the way of HR estimate were performed. Additionally, the dose–response analysis was conducted by using the variance weighted least-squares regression (vwls) trend estimation. Results A total of 54 articles (76 studies) were included in our study. PABC is associated with poor prognosis on overall survival (OS), disease-free survival (DFS) and cause-special survival (CSS), and the pooled HRs with 95% CIs were 1.45 (1.30-1.63), 1.39 (1.25-1.54) and 1.40 (1.17-1.68), respectively. According to subgroup analyses, the varied definition of PABC led to diverse results. The dose-response analysis indicated a non-linear association between the time from last pregnancy to breast cancer diagnosis and overall mortality ( P <0.001). Compared with nulliparous women, PABC had a HR for all cause death that peaked at 1.62 (95% CI, 1.46-1.80) at 28 months since last pregnancy, starting from 78 months since last pregnancy became insignificant 1.07(95%CI, 0.99-1.26). It suggested that the definition of PABC should be extended to include cases diagnosed up to about six-years postpartum (78 months since last pregnancy) in order to capture this ongoing increased risk. Conclusion This meta-analysis suggests that PABC is associated with poor prognosis, and the definition of PABC should be extended to include cases diagnosed up to about six-years postpartum.
Value of preoperative neutrophil-to-lymphocyte ratio in predicting thyroid cancer in intermediate category fine needle aspiration pathology: retrospective study
Authors: Ozdenkaya Yasar , Basim Pelin , Olmuscelik Oktay , Arslan Naciye Cigdem 
Published: November 2019

Abstract
Background The management of thyroid nodules with intermediate category of the Bethesda System for Reporting Thyroid Cancer (TBSRTC) is still debatable. Aim of this study is to investigate the diagnostic accuracy of neutrophil-to-lymphocyte ratio (NLR) in detecting cancer in intermediate TBSRTC categories.Methods Data of the patients who underwent thyroidectomy between 2012 and 2018 were analyzed retrospectively. Demographic characteristics, complete blood count, TSH value, TBSRTC categories and postoperative pathology of the patients were collected. The association with preoperative NLR and postoperative pathology was assessed.Results Of 146 patients included in the study, 57 (39%) were in TBSRTC III, IV and V category. The mean NLR in this subgroup was 2.1±0.8 and similar between TBSRTC III, IV and IV groups (p=0.737). Thyroid cancer was detected in 38 (66.7%) patients. The mean NLR was 2.4±0.8 in thyroid cancers and significantly higher when compared with patients with benign postoperative pathology (1.6±0.4, p=0.014). There was a significant difference between papillary and follicular cancer; the mean NLR was 2.3±0.8 in papillary cancer and 2.6±0.7 in follicular cancer patients (p=0.005). The cut-off value of NLR for predicting cancer at 89% sensitivity and 53% specificity was 1.6 (Area under curve: 0.769, 95% confidence interval: 0.643-0.895, p=0.001).Conclusions Preoperative NLR is elevated in patients with thyroid cancer in intermediate TBSRTC categories. Despite low diagnostic accuracy, considering its availability and low costs, NLR has merit for further studies.
Neck Lymph Node Metastasis Detection in Patients with Differentiated Thyroid Carcinoma (DTC) in Long-Term Follow-up: a ¹³¹I-SPECT/CT Study
Authors: Spanu Angela , Nuvoli Susanna , Marongiu Andrea , Gelo Ilaria , Mele Luciana , Piras Bastiana , Madeddu Giuseppe 
Published: November 2019

Abstract
Background: The prognostic importance of neck lymph node (LN) metastases in differentiated thyroid carcinoma (DTC) is controversial even if their presence at surgery often correlates with tumor recurrences that it is mandatory to identify. To this purpose, in the present study, we used 131 I-SPECT/CT as diagnostic imaging procedure. Methods: We retrospectively evaluated 224 consecutive DTC patients already submitted to total thyroidectomy and radioiodine therapy, all of them with ascertained neck radioiodine-avid foci at ¹³¹I-SPECT/CT during long-term follow-up; at surgery, 62 patients were classified at high risk (H), 64 at low risk (L), 98 at very low risk. All patients underwent ¹³¹I-Whole body scan (WBS) followed by SPECT/CT. Result: In the 224 patients, 449 neck iodine avid foci were ascertained at SPECT/CT, while 322 were evidenced at WBS in 165/224 patients. WBS classified as residues 263/322 foci and as unclear 59/322 foci; among the former foci SPECT/CT correctly characterized 8 LN metastases and 3 physiologic uptakes and among the latter it pinpointed 26 LN metastases, 18 residues and 15 physiologic uptakes. SPECT/CT also classified 127 foci occult at WBS as 59 LN metastases and 68 residues. Globally, SPECT/CT identified 93 LN metastases in 59 patients (26 H, 20 L, 13 VL), while WBS evidenced 34 in 25 cases. All 13 VL patients,T1aN0M0, 5 of whom with LN near sub-mandibular glands, had thyroglobulin undetectable or <2.5 ng/ml. Globally, SPECT/CT obtained an incremental value than WBS in 45.5 % of patients, a more correct patient classification changing therapeutic approach in 30.3 % of cases and identified WBS false positive findings in 8% of cases. Conclusion: ¹³¹I-SPECT/CT proved to correctly detect and characterize neck LN metastases in DTC patients in long-term follow-up, improving WBS performance. SPECT/CT routine use is suggested, its role being particularly significant in patients with WBS inconclusive, VL, T1aN0M0 and with undetectable or very low thyroglobulin levels.
Do Africans really need to go overseas for Phaco training? Performance audit of a locally trained phaco surgeon in rural Kenya
Authors: Niyonzima Jean Claude , Gichuhi Stephen , Sitati Sarah , Ollando Ernest 
Published: November 2019

Abstract
Purpose: To audit phacoemulsification cataract surgeries performed independently after a short - term training completed in a rural hospital in Kenya, and to benchmark the outcomes against WHO recommendations. Methods: This retrospective case-series study recruited patients who had had phacoemulsification cataract surgery at Sabatia Eye Hospital from January to December 2018. All the surgeries were performed by a single surgeon following a brief training in the same center. Data were collected retrospectively using a detailed questionnaire. Results: Of the one hundred and twenty eyes operated on during this period, one-hundred and sixteen eyes of 86 patients met the inclusion criteria. The mean age was 62 years and the majority of the eyes (83.6%) had vision less than 6/18 preoperatively. Co-morbidities included diabetic retinopathy (3.4%), age-related macular degeneration (2.6%), trauma (1.7%) and glaucoma (0.9%). Surgical complications were not severe enough to affect the final best-corrected visual acuity, unlike the comorbidities that were negatively correlated with visual outcomes (p-value< 0.001). Good outcomes were 81% against a WHO target of 80% for uncorrected visual acuity category, and 96.6% in the best-corrected visual acuity category against a target of 90%. The Royal College of Ophthalmology database of cataract surgery outcomes and the European Registry of Quality Outcomes for cataract and refractive surgery had comparable results. Conclusions: This local training model was based on apprenticeship and skills transfer. It can achieve high-quality visual outcomes meeting WHO recommendations.
Countertransference feelings and personality disorders: A psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-12)
Authors: Breivik Randi , Wilberg Theresa , Evensen Julie , Røssberg Jan Ivar , Dahl Hanne Sofie , Pedersen Geir A. Feigum 
Published: November 2019

Abstract
Background The Feeling Word Checklist (FWC) is a self-report questionnaire designed to measure therapists’ countertransference (CT) feelings. The primary aim of the study was to evaluate the psychometric properties of a brief version of the Feeling Word Checklist comprising twelve feeling words (FWC-12). The second aim was to validate the factor structure by examining the associations between the FWC-12 factors, patients’ personality pathology and therapeutic alliance (TA). Methods Therapists at 13 different outpatient units within the Norwegian Network of Personality Disorders completed the FWC-12 every 6 months during the course of treating a patient with a personality disorder (PD), over a period of up to 2.5 years. A large sample of patients with personality pathology participated in the study. The data were analysed with exploratory (EFA) and confirmatory (CFA) factor analysis. Internal consistency was estimated using Cronbach’s alpha. The Structured Clinical Interview for DSM-IV – Axis II (SCID II) and Mini International Neuropsychiatric Interview (MINI) were used as diagnostic instruments, and patient-rated TA was assessed using the Working Alliance Inventory (WAI-SR). Results Factor analyses revealed three clinically meaningful factors: Inadequate, Idealised and Confident. These factors had acceptable psychometric properties. Most notably, a number of borderline PD criteria correlated positively with the factors Inadequate and Idealised, and negatively with the factor Confident. All the factors correlated significantly with at least one of the WAI-SR subscales. Conclusions The FWC-12 measures three clinically meaningful aspects of therapists’ CT feelings. This brief version of the FWC seems satisfactory for use in further research and in clinical contexts. Keywords: Countertransference, Feeling Word Checklist, factor analysis, personality disorder, psychometrics
Prevalence and patterns of birth defects among newborns in Southwestern Ethiopia: Retrospective study
Authors: Geneti Soressa Abebe , Gebru Girmai , Amenu Demisew , Dube Lemessa 
Published: November 2019

Abstract
Background : Intrauterine development can be considered as normal development as well as abnormal development. Abnormal development commonly called birth defects occur because of interference of normal development from genetic disorders, environmental factors and the combination of both genetic and environment factors during the critical period of embryogenesis. The present study aimed to evaluate the prevalence and patterns of birth defects at birth in Southwestern Ethiopia. Methods : Institutions based cross-sectional study design was used. Six hospitals were selected from the existing hospitals in southwestern Ethiopia purposively based on case load. The study was conducted from September 2011 to December 2015 during which 45,951 deliveries were attained. All records of births that were occurred in the selected hospitals during the study period were identified from medical records, to locate the birth defect records.Results : Twenty-one different birth defects were recorded. Of these, 49.6 % of the birth defects recorded were Anencephaly and Hydrocephalus. Five types of birth defects namely: Anencephaly (25.0%), Hydrocephalus (24.6%), Spinal bifida (13.1%), Meningomyelocele (7.1%), and Umbilical hernia (4.8 %) accounted about three-fourth (75%) of all recorded birth defects. The present study revealed that the prevalence of the birth defects at birth was found to be 5.5 per 1000 births. Among twenty one birth defects identified in this study, the neural tube defects were the most frequent with prevalence rate of 4.1 per 1000 birth followed by gastrointestinal defects (0.7 per 1000 births)Conclusions: As compared to other study, the prevalence of birth defect identified in the present study was found to be higher. The neural tube defects were the most prevalent with the frequency of 4.05 cases per 1000.The present study also identified that nearly equal proportions of birth defect occurred among males and females newborns. The majority of the mother who gave birth to birth defects was younger than 35 years old. As the birth defect was found to be a main cases of infant mortality and morbidity, there need to an urgent interventions to control the cases.
Higher fatty liver index is associated with increased risk of new onset heart failure in healthy adults: A nationwide population-based study in Korea
Authors: Roh Jae-Hyung , Park Jae-Hyeong , Lee Hanbyul , Yoon Yong-Hoon , Kim Minsu , Kim Yong-Giun , Park Gyung-Min , Lee Jae-Hwan , Seong In-Whan 
Published: November 2019

Abstract
Background Heart failure (HF) is relatively common cardiovascular disease with high mortality and morbidity. Although it is associated with many cardiovascular risk factors, the association between nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease, and HF has not been evaluated in a large-scale cohort study. Thus, we evaluated the ability of the fatty liver Index (FLI), a surrogate marker of NAFLD, to predict the development of HF in healthy individuals.Methods We evaluated 308,578 healthy persons without comorbidities who underwent the National Health check-ups in the republic of Korea from 2009 to 2014. The association between the FLI and HF was analyzed using multivariate Cox proportional-hazards models.Results During a median of 5.4 years’ follow-up, 2,532 subjects (0.8%) were newly diagnosed with HF. Subjects were categorized into quartile groups according to FLI (Q1, 0-4.9; Q2, 5.0-12.5; Q3, 12.6-31.0; and Q4, >31.0). The cumulative incidence of HF was significantly higher in subjects with the highest FLI than in those with the lowest FLI (Q1, 307 [0.4%] and Q4, 890 [1.2%]; P<0.001). Adjusted hazard ratios (HRs) indicated that the highest FLI was independently associated with an increased risk for HF (HR between Q4 and Q1, 2.709; 95% confidence interval=2.380-3.085; P<0.001). FLI was significantly associated with increased risk of new-onset HF regardless of their baseline characteristics. Conclusions Higher FLI was independently associated with increased risk of HF in healthy Korean population.
FIGO IVB cervical cancer patients benefit from locoregional surgery: a retrospective study from the SEER database
Authors: Wang Yanhong , Ouyang Yi , Su Jingjing , Bai Zhigang , Cai Qunrong , Cao Xinping 
Published: November 2019

Abstract
Background: We aimed to analyze the clinical value of primary site surgery in improving survival of initial metastatic cervical cancer. Methods: A population-based retrospective study which analyzed clinical data extracted from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database was conducted. Stratified analysis was employed to evaluate the effect of cervical surgery on cervical cancer specific survival (CCSS) and overall survival (OS). Then COX regression models were performed to adjust potential confounders, and assess the survival benefit of cervical surgery for patients with primary metastatic cervical cancer. Results: The median CCSS and OS in the surgery group were more than twice of that in the group without surgery. Primary site surgery conferred prognosis superiority for patients with metastases merely to lung, and other site or distant LN, but not multiple metastasis and bone, liver. Pelvic lymph node dissection conducted in combination with cervical surgery provided a survival advantage over hysterectomy. Moreover, an aggressive treatment that integrated locoregional surgery with radiotherapy or chemotherapy showed the better survival when compared to surgery alone. The survival advantage provided by primary site surgery was not influenced by the histological type, lymph node status. Finally, after adjusting confounders using COX regression, local cervical surgery reduced the cancer related and overall mortality rate by about 30%. Conclusions: Surgical procedures could promote the survival of patients with primary metastatic cervical cancer, and should be considered as a therapeutic option for carefully chosen patients.
A Call for Consensus in Defining Efficacy in Clinical Trials for Opioid Addiction: Combined Results from a Systematic Review and Qualitative Study in Patients Receiving Pharmacological Assisted Therapy for Opioid Use Disorder
Authors: Dennis Brittany B. , Sanger Nitika , Bawor Monica , Naji Leen , Worster Andrew , Baptist-Mohseni Natasha , Hillmer Alannah , Rice Danielle , Corace Kim , Hutton Brian , Tugwell Peter , Thabane Lehana , Samaan Zainab 
Published: November 2019

Abstract
Background: Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms. We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature.
Methods: We searched nine commonly used databases (e.g. EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment.
Results: We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g. abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n=28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, however they also stressed goals under-reported in clinical trials.
Conclusion: There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important.

PROSPERO ID: CRD42013006507
Key Words: opioid addiction; clinical trials; efficacy; methodology; patient important outcomes; treatment effectiveness
The Cost-Effectiveness of specialized Nursing Interventions for people with Parkinson’s Disease: the NICE-PD study protocol for a randomized controlled clinical trial
Authors: Radder Danique LM , Lennaerts Herma H , Vermeulen Hester , Asseldonk Thies van , Delnooz Cathérine CS , Hagen Rob H , Munneke Marten , Bloem Bastiaan R , de Vries Nienke M 
Published: November 2019

Abstract
Background Current guidelines recommend that every person with Parkinson’s disease (PD) should have access to Parkinson’s Disease Nurse Specialist (PDNS) care. However, there is little scientific evidence on the cost-effectiveness of PDNS care. This hampers wider implementation, creates unequal access to care and possibly leads to avoidable disability and costs. Therefore, we aim to study the (cost-)effectiveness of specialized nursing care provided by a PDNS compared to usual care (without PDNS) for people with PD in all disease stages. To gain more insight into the deployed interventions and their effects, a pre-planned subgroup analysis will be performed based on disease duration (diagnosis <5, 5-10, or >10 years ago). Methods We will perform an 18-month, single-blind, randomized controlled clinical trial in eight community hospitals in the Netherlands. A total of 240 people with PD that have not been treated by a PDNS over the past two years will be included, independent of disease severity or duration. In each hospital, 30 patients will randomly be allocated in a 1:1 ratio to either care by a PDNS (who works according to a recent guideline on PDNS care) or usual care. We will use two co-primary outcomes: quality of life (measured with the Parkinson’s Disease Questionnaire-39) and motor symptoms (measured with the MDS-UPDRS part III). Secondary outcomes include non-motor symptoms, health-related quality of life, experienced quality of care, self-management, medication adherence, caregiver burden and coping skills. Data will be collected after 12 months and 18 months by a blinded researcher. A healthcare utilization and productivity loss questionnaire will be completed every 3 months. Discussion The results of this trial will have an immediate impact on the current care of people with PD. We hypothesize that, by offering more patients access to PDNS care, quality of life will increase. We also expect healthcare costs to remain equal, as increases in direct medical costs (funding additional nurses) will be offset by a reduced number of consultations with the general practitioner and neurologist. If these outcomes are reached, wide implementation of PDNS care is warranted. Trial registration ClinicalTrials.gov: NCT03830190. Registered February 5, 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03830190.
Comparative Genomics of Mycoplasma pneumoniae isolated from Children with Pneumonia: South Korea, 2010-2016
Authors: Lee Joon Kee , Seong Moon-Woo , Shin Dongjin , Kim Jong-Il , Han Mi Seon , Yeon Youbin , Cho Sung Im , Park Sung Sup , Choi Eun Hwa 
Published: November 2019

Abstract
Background Mycoplasma pneumoniae is a common cause of respiratory tract infections in children and adults. This study applied high-throughput whole genome sequencing (WGS) technologies to analyze the genomes of 30 M. pneumoniae strains isolated from children with pneumonia in South Korea during the two epidemics from 2010 to 2016 in comparison with a global collection of 48 M. pneumoniae strains which includes seven countries ranging from 1944 to 2017. Results The 30 Korean strains had approximately 40% GC content and ranged from 815,686 to 818,669 base pairs, coding for a total of 809 to 828 genes. Overall, BRIG revealed 99% to > 99% similarity among strains. The genomic similarity dropped to approximately 95% in the P1 type 2 strains when aligned to the reference M129 genome, which corresponded to the region of the p1 gene. MAUVE detected four subtype-specific insertions (three in P1 type 1 and one in P1 type 2), of which were all hypothetical proteins except for one tRNA insertion in all P1 type 1 strains. The phylogenetic associations of 30 strains were generally consistent with the multilocus sequence typing results. eBURST analysis demonstrated two clonal complexes which are accordant with the known P1 typing, with higher diversity among P1 type 2 strains. The phylogenetic tree constructed with 78 genomes including 48 genomes outside Korea formed three clusters, in which the sequence type 3 strains from Korea were divided into two P1 type 1 clusters. Conclusions The comparative genome analysis of the 78 M. pneumoniae strains including 30 strains from Korea by WGS reveals structural diversity and phylogenetic associations, even though the similarity across the strains was very high.