bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancy outcomes of dichorionic triamniotic triplet pregnancies after in vitro fertilization-embryo transfer: multifoetal pregnancy reduction versus expectant management
Authors: Cai Pei , Ouyang Yan , Gong Fei , Li Xihong 
Published: February 2020

Abstract
Background: Trichorionic triplet pregnancy reduction to twin pregnancy is associated with a lower risk of preterm delivery but not with a lower risk of miscarriage. However, data on dichorionic triamniotic (DCTA) triplet pregnancy outcomes are lacking. This study aimed to compare the pregnancy outcomes of DCTA triplets conceived via in vitro fertilization-embryo transfer (IVF-ET) managed expectantly or reduced to a monochorionic (MC) singleton or monochorionic diamniotic (MCDA) twins at 11-13+6 gestational weeks.Methods: Two hundred ninety-eight patients with DCTA triplets conceived via IVF-ET between 2012 and 2016 were retrospectively analysed. DCTA triplets with three live foetuses were reduced to a MC singleton (group A) or MCDA twins (group B) or underwent expectant management (group C). Each multifoetal pregnancy reduction (MFPR) was performed at 11-13+6 gestational weeks. Pregnancy outcomes in the 3 groups were compared.Results: Eighty-four DCTA pregnancies were reduced to MC singleton pregnancies, 149 were reduced to MCDA pregnancies, and 65 were managed expectantly. There were no significant differences among groups A, B, and C in miscarriage rate (8.3 vs. 7.4 vs. 10.8%, respectively) and live birth rate (90.5 vs. 85.2 vs. 83.1%, respectively) (P > 0.05). Group A had significantly lower rates of preterm birth (8.3 vs. 84.6%; odds ratio (OR) 0.017, 95% confidence interval (CI) 0.006-0.046) and low birth weight (LBW; 9.2 vs. 93.2%; OR 0.007, 95% CI 0.003-0.020) than group C (P < 0.001). Group B had significantly lower preterm birth (47.0 vs. 84.6%; OR 0.161, 95% CI 0.076-0.340) and LBW rates (58.7 vs. 93.2%; OR 0.103, 95% CI 0.053-0.200) than group C (P < 0.001). Group A had significantly lower preterm birth (8.3 vs. 47.0%; OR 0.103, 95% CI 0.044-0.237; P < 0.001), LBW (9.2 vs. 58.7%; OR 0.071, 95% CI 0.032-0.162; P < 0.001) and perinatal death rates (1.3 vs. 9.1%; OR 0.132, 95% CI 0.018-0.991; P = 0.021) than group B.Conclusion: The MFPR of DCTA triplets to singleton or MCDA pregnancies was associated with better pregnancy outcomes compared to expectant management. DCTA triplets reduced to singleton pregnancies had better perinatal outcomes than DCTA triplets reduced to MCDA pregnancies.
Relationship of lymphovascular invasion with lymph node metastasis and prognosis in superficial esophageal carcinoma: Systematic review and meta-analysis
Authors: Yang Jinxin , Lu Zhouyi , Li Lintao , Li Yong , Tan Yulong , Zhang Dekang , Wang An 
Published: February 2020

Abstract
Background: The development of tumor cells inside the lymphatics or blood vessels is known as lymphovascular invasion (LVI). The correlation between LVI, lymph node metastasis (LNM), and the diagnosis of superficial esophageal carcinoma (SEC) remains unclear. Methods: We searched Embase, PubMed, Web of Science, and Cochrane Library databases for prospective articles to better understand the relationship between LVI, LNM, and SEC diagnosis. Results: We included 23 articles containing data for 4749 patients (range: 54-598) in our meta-analysis. The hazard ratio between LVI and overall survival (OS) was 1.85 with 95% confidence interval (CI) (1.10-3.11, P = 0.02). LNM rate was higher in SEC patients with LVI than SEC patients without LVI (univariate: OR = 4.94, 95% CI: 3.74-6.53, P < 0.0001; multivariate: OR = 5.72, 95%CI: 4.38-7.4, P < 0.0001). No obvious publication was found. Conclusions: The results indicate that LVI plays a dominant role in the prognosis of LNM in SEC and in the prognostic prediction for SEC. Keywords: Lymphovascular invasion; lymph node metastasis; prognosis; superficial esophageal carcinoma
Prevalence and associations of active trachoma among rural preschool children in Wadla district, northern Ethiopia
Authors: Kassaw Mesfin Wudu , Abebe Ayele Mamo , Tegegne Kirubel Dagnaw , Getu Mikiyas Amare , Bihonegn Woldemichael Tadesse 
Published: February 2020

Abstract
Background፡Trachoma is a neglected eye problem and an important cause of preventable corneal blindness. In endemic areas, initial infection can occur in early childhood, and following recurrent episodes of infection, it progresses to scarring and blindness. In past decades, trachoma disappeared from developed countries through enhancements of hygiene and sanitation but the disease is still a problem in developing countries. In Ethiopia, data indicate that Amhara is the region with the highest prevalence of active trachome. The aim of this study was to asse{Birlie, 2016 #48}ss prevalence and association of active trachoma among rural preschool children in Wadla district, north Wollo zone, Amhara. Methods: A total of 596 children aged 1–5 years living in 30 of Wadla’s 150 rural villages were screened for signs of active trachoma using a cluster sampling technique. Following pre-testing of the survey instrument in a different district, questions about socio-demographic status were asked of heads of households by health informatics professionals. Integrated eye care workers, previously trained to undertake trachoma screening over one month, performed eye examination. Logistic regression was used to look for associations of active trachoma.Results: The prevalence of active trachoma among rural pre-school age children in Wadla district was 22%. Low economic status (adjusted odds ratio [AOR] 3.8 (95% CI 1.3–11.4), being 37– 48 months old (4.2;1.5–12.0), living in a house with thatched roof (4.4;1.4–13.6), presence of flies in the home (4.6;2.1–9.9), once-weekly face-washing frequency (8.6;2.5–29.3), having a face that had not been washed for longer than a week (10.6;2.9–37.7), and not using soap when washing hands (4.5;1.8–11.3) were associated with active trachomaConclusion: The prevalence of active trachoma among rural pre-school children was high and it is still a major public health problem in Wadla. Thus, the woreda health office should create awareness for Wadla woreda communities.
Plasmacytoma in patients with multiple myeloma: morphology and immunohistochemistry
Authors: Firsova Maiia , Mendeleeva Larisa , Kovrigina Alla , Solovev Maxim , Savchenko Valery 
Published: February 2020

Abstract
Background. To study the histological structure and immunohistochemical (IHC) parameters of the plasmacytoma tumour substrate in patients with multiple myeloma (MM).
Methods. The study included 21 patients (10 men/11 women) aged 23 to 73 years old with newly diagnosed MM complicated by plasmacytoma. Bone plasmacytoma was diagnosed in 14 patients, and extramedullary plasmacytoma was diagnosed in 7 patients. Plasmacytoma tissue specimens were examined using a LEICA DM4000B microscope. Anti-CD56, anti-CD166, anti-CXCR4, anti-Ki-67, and anti-c-MYC antibodies were used for IHC study of plasmacytoma biopsies.
Results. When comparing the morphology of bone and extramedullary plasmacytoma, no significant differences were revealed; however, the substrate of extramedullary plasmacytoma was more often represented by tumour cells with an immature morphology than was the bone plasmacytoma substrate (57.1% vs. 28.6%, respectively). We revealed a significant difference in the expression of CD166 between bone and extramedullary plasmacytoma. The mean values ​​of CD166 expression in bone plasmacytoma cells were significantly higher (36.29 ± 7.61% versus 9.57 ± 8.46%, respectively; p = 0.033) than those in extramedullary plasmacytoma cells. We noticed that in extramedullary plasmacytoma cells, there were higher values for the Ki-67 index than in bone plasmacytoma cells, and this result was independent of cell morphology.
Conclusion. The mechanisms involved in the dissemination of tumour plasma cells are currently unexplored. Even in such a small sample, some differences in expression could be identified, which may indicate that different mechanisms lead to the formation of bone and extramedullary plasmacytomas. Specifically, the expression of CD166 in extramedullary plasmacytoma cells was almost 4 times lower than that in bone plasmacytoma cells, which may indicate the involvement of CD166 in the mechanisms of bone destruction. The proliferative activity of extramedullary plasmacytoma cells was shown to be higher than that of bone plasmacytoma cells.
Meta-analysis reveals severe pollen limitation for the flowering plants growing in the East Himalaya-Hengduan Mountains region.
Authors: jiang xianfeng , Xie Yanping 
Published: February 2020

Abstract
Background: Pollen limitation occurs widely and has an important effect on flowering plants. The East Himalaya-Hengduan Mountains region is a global biodiversity hotspot. However, to our knowledge, no study has synthetically assessed the degree of pollen limitation in this area. The present study aims to reveal the degree of pollen limitation for the flowering plants growing on the East Himalaya-Hengduan Mountains and to test whether the reproductive features or the elevation is closely correlated with the degree of pollen limitation in this area.Results: We complied data from 76 studies, which included 96 species and 108 independent data records. We found that the flowering plants in this area undergo severe pollen limitation (overall Hedges’ d=2.004, with a 95% confidence interval [1.3264, 2.6743]) that is much higher than that of the flowering plants growing in many other regions around the world. The degree of pollen limitation was tested to determine the correlation with the capacity for autonomous self-reproduction and with the pollination pattern (generalized vs. specialized pollination) of plants. In addition, we found a clear relationship between elevation and the degree of pollen limitation, which indicates that plants might undergo more severe pollen limitation in relatively high places.Conclusions: This paper is the first to address the severe pollen limitation of the flowering plants growing in the East Himalaya-Hengduan Mountains region. Moreover, we reveal the positive correlation between elevation and the degree of pollen limitation.
Modified Bunnell suture versus bundle-to-bundle suture for acute Achilles tendon rupture: A prospective comparative study of patients aged &lt;45 years
Authors: wang xiaomeng , Liu Huixin , li dengke , luo zixuan , Li Yansen , Zhang Fengqi 
Published: February 2020

Abstract
Background: This study was performed to compare the operative outcome between percutaneous repair (modified Bunnell suture) and open repair (bundle-to-bundle suture) for treatment of acute Achilles tendon rupture.Methods: Seventy-two consecutive patients who underwent surgical treatment of Achilles tendon rupture were evaluated. Thirty-six patients were treated by the bundle-to-bundle suture technique (Group A), and 36 patients were treated by the modified Bunnell suture technique (Group B). Functional examination included measurement of the calf muscle circumference and performance of the single-leg heel-rise test. The length and diameter of the Achilles tendon were compared between the injured and uninjured sides using magnetic resonance imaging. The number of single-leg heel rises (height of >5 cm) performed within 15 s was compared between the injured and uninjured sides. The ankle joint range of motion was also recorded. The Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale score, and visual analog scale (VAS) pain score were used to evaluate the clinical outcome after a minimum 12-month postoperative follow-up period.Results: In total, 61 patients were followed up. The mean follow-up time was not significantly different between Group A (23.73 ± 2.81 months) and Group B (22.61 ± 3.96 months). However, there were significant differences in the heel-rise test (Group A, 1.74 ± 0.96; Group B, 2.37 ± 1.42) and length of the Achilles tendon (Group A, 11.98 ± 1.64 cm; Group B, 11.11 ± 1.74 cm). The calf circumference of the injured side was significantly larger in Group A than B (p = 0.043). The cross-sectional diameter of the Achilles tendon after open repair was significantly different from that after percutaneous repair. There were no significant differences in the ATRS, AOFAS score, or VAS score at the final follow-up between the two groups. One patient in Group A had delayed wound healing, which resolved in about 40 days.Conclusions: Both suture methods described in this report can provide good clinical results. The bundle-to-bundle suture technique is more effective for restoration of the Achilles tendon length and muscle function. This method is safe, effective, and worthy of promotion.
Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya
Authors: Otieno Peter O. , Wambiya Elvis Omondi Achach , Mohamed Shukri M , Mutua Martin Kavao , Kibe Peter M , Mwangi Bonventure , Donfouet Hermann Pythagore Pierre 
Published: February 2020

Abstract
Background: Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage (UHC) policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya.
Methods: The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recoded into tertiles with categories labeled as poor, moderate and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios and 95 percent confident intervals were used to interpret the strength of associations.
Results : The odds of being in the lowest versus combined moderate and highest access tertile were significantly higher for female than male-headed households (AOR 1.91 [95% CI 1.03-3.54]; p < .05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥$30 had significantly lower odds of being in the lowest versus combined moderate and highest access tertile compared to those spending ≤ $5 quarterly (AOR 0.33 [95% CI 0.50-1.90]; p< .001). Households that sought care from private facilities had significantly higher odds of being in the lowest versus combined moderate and highest access compared to the public facilities (AOR 3.77 [95% CI 2.16-6.56]; p < .05).

Conclusion : In Nairobi slums in Kenya, living in a female-headed household and seeking care from private facilities are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize the regulation of private health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare.
Keywords: Access to primary healthcare, Universal health coverage, Urban slums, Penchansky and Thomas’s model.
Components of metabolic syndrome in patients with multiple myeloma and smoldering multiple myeloma
Authors: Markus Efrat , Trestman Svetlana , Cohen Yael , Angel Yoel , Sofer Yael , Mittelman Moshe , Avivi Irit , Stern Naftali , Izkhakov Elena 
Published: February 2020

Abstract
Background: The prevalences of diabetes mellitus and hypertension, both of which are components of metabolic syndrome, are known to be increased among patients with multiple myeloma (MM), but remain undetermined among patients with smoldering MM (SMM). Methods: Changes in various components of metabolic syndrome were investigated during the follow-up of patients with either MM or SMM compared to healthy controls. The data of 153 patients (105 with MM and 48 with SMM) and 138 controls were accessed from our medical center’s records between 2008-2015. We analyzed the patients’ data at diagnosis (baseline) and after 1, 3, and 5 years of follow-up. Results: Patients with SMM had a significantly higher prevalence of diabetes, hypertension, and dyslipidemia at baseline compared to controls. A multivariate Cox regression analysis revealed a higher risk to develop dyslipidemia after 1, 3, and 5 years of follow-up among the SMM patients. The MM patients had a higher risk to develop diabetes after 1 year, hypertension after 5 years, and dyslipidemia after 1, 3, and 5 years of follow-up. Conclusions: These data demonstrate that patients with SMM and those with MM are more prone to develop various components of metabolic syndrome, and they stress the importance of following-up metabolic syndrome components in both groups of patients.
Hidden analyses: A review of reporting practice and recommendations for more transparent reporting of initial data analyses
Authors: Huebner Marianne , Vach Werner , Cessie Saskia le , Schmidt Carsten Oliver , Lusa Lara 
Published: February 2020

Abstract
Background In the data pipeline from the data collection process to the planned statistical analyses, initial data analysis (IDA) typically takes place between the end of the data collection and do not touch the research questions. A systematic process for IDA and clear reporting of the findings would help to understand the potential shortcomings of a dataset, such as missing values, or subgroups with small sample sizes, or shortcomings in the collection process, and to evaluate the impact of these shortcomings on the research results. A clear reporting of findings is also relevant when making datasets available to other researchers. Initial data analyses can provide valuable insights into the suitability of a data set for a future research study. Our aim was to describe the current practice of reporting of initial data analyses in observational studies in five highly ranked medical journals with focus on data cleaning, screening, and reporting of findings which led to a potential change in the analysis plan. Methods This review was carried out using systematic search strategies with eligibility criteria for articles to be reviewed. A total of 25 papers about observational studies were selected from five medical journals. Each paper was reviewed by two reviewers and IDA statements were further discussed by all authors. The consensus was reported. Results IDA statements were reported in the methods, results, discussion, and supplement of papers. Ten out of 25 papers (40%) included a statement about data cleaning. Data screening statements were included in all articles, and 18 (72%) indicated the methods used to describe them. Item missingness was reported in 11 papers (44%), unit missingness in 15 papers (60%). Eleven papers (44%) mentioned some changes in the analysis plan. Reported changes referred to missing data treatment, unexpected values, population heterogeneity and aspects related to variable distributions or data properties. Conclusion Reporting of initial data analyses were sparse, and statements on IDA were located throughout the research articles. There is a lack of systematic reporting of IDA. We conclude the article with recommendations on how to overcome shortcomings in the current practice of IDA reporting in observational studies.
The effect of simulation-based training in non-physician anesthetists in Tigray region, Ethiopia
Authors: Etanaa Naod Bulti , Benwu Kore Menjie , Gebremedhin Hagos Gebregzabiher , Desta Haftom Birhane 
Published: February 2020

Abstract
Objective : In Ethiopia simulation-based anesthesia education is a new way of teaching method which started in Mekelle University as of January, 2019. Hence, the purpose of this study is to evaluate whether simulation-based training improves non-physician anesthetists’ knowledge and attitude on maternal and neonatal anesthesia cares or not.
Results : Out of 50 study subjects, 66% had a working experience of less than 5 years.. Knowledge score improved significantly from 49.78% and 66.22% in pretest and posttest results respectively. The posttest result was significantly improved (P< 0.001) for all knowledge questions. The respondents were asked about a negative statement and a positive statement about the need to have effective closed lope communication, maternal resuscitation and neonatal resuscitation. The attitude score improved from 72.45% to 79.11% in pretest and posttest respectively. From the 9 questions the attitudinal mean score for pretest was 6.52 and posttest 7.12. The null hypothesis of equal knowledge and attitude was rejected, t (49) = -5.54, p < 0.001 and t (49) = -2.25, p < 0.03 respectively.
Hospital Managers Skills Required and Onward Challenges: A Qualitative Study
Authors: Moradi Farideh , Ziapour Arash , Abbas Jaffar , Baharirad Nadya , soroush ali 
Published: February 2020

Abstract
Background : The qualification of managers in terms of management skills is one of the most important factors in the continuous success of each organization and utilizing such skills can have a positive contribution in the effectiveness of the organization while improving the performance of the employees in line with the objectives and goals of the organization. The main objective of the current study was to explore the necessary skills and the challenges of hospital managers from the point of view of managers at different levels of a hospital. Methods: This study is a qualitative one where the statistical population includes the mid-level and senior-level managers of the hospital. The sample size was 22 individuals. The interviews were analyzed by a MAXQDA software application after transcription. Results This study includes 5 main themes and 15 secondary themes. The strategic skill, the perceptive skill, the human relation skill, work experience, and personal characteristics were among the skills necessary for hospital managers. Some of the challenges facing the hospital managers included rapid changes in the policies, the limitations of financial resources, and lack of proportion between the educational and occupational spheres. Conclusion: Because of their existential philosophy and differences with other service sectors, managing hospitals poses a particular sensitivity. In this regard, the role of the hospital manager is very important. Therefore, in order to meet the satisfaction of those receiving services, decision makers, and policy makers must think twice when selecting and appointing hospital managers and evaluate and appraise this group in terms of abilities and skills necessary for managing such an important service section.