bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decomposing the Effect of Women Educational Status on Fertility Across the Six Geo-political Zones in Nigeria: 2003-2018
Authors: Olowolafe Tubosun Alex 
Published: August 2020

Abstract
Background: High level of fertility has been consistently reported in Nigeria. Women education is often identified as one of the important factors that have contributed to reduction in fertility across countries. It is essential to identify the factors that explain the fertility variation in educational status and know the extent of association of these factors across the regions in Nigeria. Thus, this study aimed to examine the fertility differentials among uneducated and educated women in Nigeria.Methods: A cross-sectional population-based design which involved secondary data analyses of the weighted sample of 2003 (n1=7620), 2008 (n2=33385), 2013 (n3=38948) and 2018 (n4=41821) Nigeria Demographic and Health Survey data sets was used. Fertility was measured from information on the full births history of women aged 15-49 years. Oaxaca-Blinder decomposition was used to identify factors that explain fertility differentials among educated and not educate women (α=0.05).Result: Total fertility rate estimate was higher among uneducated women (6.7) than educated women (4.5) in 2018. The pattern was similar across the regions and survey periods. The mean children ever born among women aged 45-49 years was significantly higher among the uneducated than educated women in each of the survey year. Maternal age at first marriage, wealth index and age at first birth were contributory factors to the dissimilarities found in fertility between the educated and uneducated women. Risk difference (RD) of high fertility between uneducated-educated women was highest in South-East (RD=56.9; 95%CI=49.1-64.8) and least in North-East (RD=15.0; 95%CI=9.9-20.1).Conclusion: The fertility level in Nigeria was high but more prominent among the uneducated than educated. Improving the level of educational enrolment of women of reproductive age will facilitate reduction in the fertility rate in Nigeria.
Anxiety Amongst Physicians During COVID-19: Cross-Sectional Study in Pakistan
Authors: Mahmood Qaisar Khalid , Jafree Sara Rizvi , Jalil Aisha , Fischer Florian , Nadir Syed Mujtaba Hasnain 
Published: August 2020

Abstract
Background: Ensuring safety and wellbeing of healthcare providers is crucial, particularly during times of a pandemic. In this study, we aim to identify the determinants of anxiety in physicians on duty in coronavirus wards or quarantine centers. Methods: We conducted a cross-sectional quantitative survey with an additional qualitative item. Overall, 103 physicians completed the questionnaire. T-test results revealed significant associations between gender and anxiety. Results: Structural equation modeling identified that high workload contributed to greater exhaustion (β=0.41, R2=0.17, p<0.001) and greater family strain (β=0.47, R2=0.22, p<0.001). Exhaustion (β=0.17, p<0.005), family strain (β=0.34, p<0.001), and feelings of protection (β=-0.30, p<0.001) significantly explained anxiety (R2=0.28). Qualitative findings further identified specific needs of physicians with regard to protective equipment, compensation, quarantine management, resource allocation, security and public support, governance improvement, and health sector development. Conclusions: It is imperative to improve governmental and social support for healthcare providers during the corona pandemic. Immediate attention is needed to reduce anxiety, workload, and family strain in frontline practitioners treating coronavirus patients, and to improve their (perceptions of) protection. This is a precondition for patient safety.
An approach to determine the coronal plane deformity of the distal tibia intraoperatively in the treatment of tibial fracture with intramedullary nail fixation
Authors: Lu Yao , Yang Jie , Xu Yibo , Ma Teng , Li Ming , Ren Cheng , Wang Qian , Li Zhong , Zhang Kun 
Published: August 2020

Abstract
Background To develop a new approach to determine the existence of coronal plane deformity (valgus and varus) intraoperatively in the treatment of tibial fracture with closed reduction and intramedullary nail fixation. Methods A retrospective analysis was conducted by enrolling 33 consecutive patients with tibial fracture who underwent closed reduction and intramedullary nail fixation from January 2018 to January 2019 in our trauma center. There were 23 males and 10 females aged from 22 to 69 years old with an average of 41.3. The standard anteroposterior and lateral preoperative radiographs were performed routinely. After insertion of the tibial intramedullary nail through the standard entry point intraoperatively, the parallel relationship between the distal horizontal interlocking screw and the tibiotalar joint surface on the anteroposterior fluoroscopy was used to determine the occurrence of valgus or varus deformity of the distal tibial fragment. Results 33 patients were postoperatively followed up for 13 to 25 months (mean 18.7 months). The fractures achieved bone union in 4.3 months by average (ranging from 3 to 6 months). The lateral distal tibial angle (LDTA) of the unaffected side which is measured postoperatively was 87.3°-89.6 ° (average 88.7 °± 0.8°), and the LDTA of the affected side was 87.5°-90.4°(average 88.9°± 1.1°). There was no statistically significant difference between the unaffected side and the affected side (t=-1.865, p=0.068). The intraoperative measurement indicated 6 cases of valgus angulation and 3 cases of varus angulation deformities, and all the deformities were corrected accordingly during the surgery. According to the Olerud-Molander Ankle Score, the clinical outcomes demonstrated 22 excellent cases, 8 good cases, 2 fair cases, and 1 poor case of all the fractures at 12 months after surgery. Conclusion During closed reduction and intramedullary nail fixation for tibial fractures, the parallel relationship between the distal horizontal interlocking screw and the tibiotalar joint surface on the intraoperative anteroposterior films showed the better discriminative ability to determine the onset of valgus or varus deformity of the distal tibial fragment after the tibial intramedullary nail inserted through the standard entry point.Level of Evidence: Level IV, case series study.
A comparison of clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomy procedures in patients with medial osteoarthritis of the knee
Authors: Akamatsu Tomotaka , Kumagai Ken , Yamada Shunsuke , Nejima Shuntaro , Sotozawa Masaichi , Ogino Takahiro , Inaba Yutaka 
Published: August 2020

Abstract
Background: The aim of the present study was to assess differences in clinical outcomes and postoperative cartilage repair between opening wedge high tibial osteotomy (OWHTO) and closed wedge HTO (CWHTO) for medial osteoarthritis (OA) of the knee.Methods: A total of 90 knees of 76 patients who underwent HTO were investigated. OWHTO was performed in 45 knees of 40 patients with a correction angle of 15° or less, and CWHTO was performed in 45 knees of 36 patients with a correction angle of greater than 15°. Initial arthroscopy was performed at the time of HTO, and a second-look arthroscopy was performed at the time of plate removal. Cartilage repair was classified into the following stages: Stage 1 (no reparative change); Stage 2 (partial coverage with white cartilaginous tissue); and Stage 3 (full coverage with white cartilaginous tissue). Clinical outcomes were assessed using Knee Society scores, and radiographic assessment was carried out by measuring the femorotibial angle (FTA).Results: Regarding preoperative OA grade, varus alignment, and function score, CWHTO patients showed more advanced OA status than OWHTO patients. Knee scores and function scores were significantly improved after surgery with both HTO procedures (P<0.05), with no significant difference between the two procedures. Cartilage repair of stage 2 or 3 was found in more than 80% of the subjects in the medial femoral condyle and more than 60% in the medial tibial condyle. However, there were no significant differences between the two HTO procedures. There was no relationship between clinical outcomes and postoperative cartilage status in both HTO procedures. Multivariate logistic regression analysis showed that preoperative International Cartilage Repair Society (ICRS) grade was the only factor affecting cartilage repair.Conclusions: CWHTO improved clinical outcomes and cartilage status as much as OWHTO. Although the effects of cartilage repair on clinical outcomes are unknown, HTO is an effective treatment option even for severe medial OA of the knee.
Identification of Key Genes and Pathways Associated with Differences of Subchondral Bone in Osteoarthritis
Authors: Zhang Yiyuan , Yu Rongguo , Zhang Jiayu , Feng Eryou , Wang Haiyang , Li Zhanglai , Wang Wulian , Zhuo Youguang , Lin Liqiong , Huang Yuting , Wu Chunlin 
Published: August 2020

Abstract
BackgroundOsteoarthritis (OA) is a common chronic disease worldwide. Subchondral bone is an important pathological change in OA and responds more rapidly to adverse loading and events compared to cartilage. However, the pathogenic genes and pathways of subchondral bone are largely unclear.ObjectiveThis study aimed to identify signature differences in genes involved in knee lateral tibial (LT) and medial tibial (MT) plateaus of subchondral bone tissue while exploring their potential molecular mechanisms via bioinformatics analysis.MethodsFirst, the gene expression data of GSE51588 was downloaded from the GEO database. Differentially expressed genes (DEGs) between knee LT and MT were identified, and functional enrichment analyses were performed. Then, a protein-protein interactive network was constructed in order to acquire the hub genes, and modules analysis was conducted using STRING and Cytoscape for further analysis. The enriched hub genes were queried in DGIdb database to find suitable drug candidates in OA.ResultsA total of 202 DEGs (112 upregulated genes and 84 downregulated genes) were determined. In the PPI network, ten hub genes were identified. Five significant modules were identified using the MCODE plugin unit. Functional enrichment analysis revealed the most important signaling pathways. Six of the ten hub genes were targetable by a total of 35 drugs, suggesting their possible therapeutic use for OA .ConclusionsThe identified hub genes and functional enrichment pathways were implicated in the development and progression of subchondral bone in OA, thus improving our understanding of OA and offering molecular targets for future therapeutic modalities.
Causes and Challenges of Males’ Rhinoplasty in Iranian Population: Qualitative Study
Authors: Ghafari Zeinab , Jalali Amir , Abbasi Parvin , Yousefi-Labani Javad 
Published: August 2020

Abstract
Background: Rhinoplasty is a cosmetic surgery for which the society and the individual incur heavy costs. The present study is an attempt to elaborate on the causes and challenges of males’ rhinoplasty in Iranian population. Methods: The study was carried out as a qualitative study using content analysis method. Totally, 20 participants (16 clients, one family member, and three care-givers) were selected purposefully and participated in semi-structured and in-depth interviews. With 20 interviews, data saturation was achieved. Data analysis process was conducted manually along with the interviews following Lundman and Graneheim method.Results and conclusion: Data analysis revealed 614 primary codes and the continuous examination and removal or repetitious codes left 417 codes, nine sub-themes, and two themes namely the reasons for rhinoplasty (lack of confidence, hope for a better face, seeking attention, keeping up with the Joneses, and persuasion by others) and challenges (family challenge, social atmosphere, financial problems, and unwanted consequence). The lack of confidence and the hope of having a more beautiful face were the motivators. Family challenges, financial problem and the negative side effects of the surgery were challenges in the way of men for having rhinoplasty.
Identification and validation of a two‐gene metabolic signature for survival prediction in patients with kidney renal clear cell carcinoma
Authors: Guo Xudong , Sun Zhuolun , Jiang Shaobo , Jin Xunbo , Wang Hanbo 
Published: August 2020

Abstract
Background: Kidney renal clear cell carcinoma (KIRC) is one of the most common malignant tumors worldwide. Deregulated tumor cell metabolism is emerging as a common feature of tumorigenesis. The expression pattern and clinical significance of metabolism-related genes (MRGs) in KIRC remains unclear.Methods: We downloaded the RNA sequencing data and corresponding clinical information for KIRC from the Cancer Genome Atlas (TCGA) database and identified the differently expressed MRGs between tumors and normal tissues. According to the Cox regression analysis and least absolute shrinkage and selection operator (LASSO), we identified target genes for prognostic signature construction. We also analyzed the correlations of the signature risk score with clinicopathological features. The robustness of the signature was further examined by stratified survival analysis. A predictive nomogram was built for the optimal strategy to predict the survival possibility of KIRC patients. The expression levels of target genes were validated in multiple datasets. Gene set enrichment analyses (GSEA) were performed to unveil several significantly enriched pathways.Results: A total of 123 differentially expressed MRGs were identified, including 60 up-regulated genes and 63 down-regulated genes. Next, RRM2 and ALDH6A1 were identified as prognosis-related genes and used to construct a prognostic signature. The signature was proved to be an independent prognostic factor for KIRC survival by multivariable Cox regression analysis. Subgroup analysis indicated that this signature could serve as a classifier for the evaluation of low- and high-risk groups. Up regulation of RRM2 and down regulation of ALDH6A1 were associated with unfavorable prognosis in patients suffering from KIRC. Nomogram including the signature suggested some clinical net benefit for overall survival prediction. In addition, the calibration curves indicated the nomogram performed well in predicting 3‐ and 5-year OS compared with the ideal model. The expression level of RRM2 was significantly up-expressed, while ALDH6A1 were significantly down-expressed in KIRC samples compared with the normal samples in multiple datasets. Furthermore, RRM2 and ALDH6A1were significantly enriched in different pathways.Conclusion: Our study identified a two‐gene metabolic signature that had important clinical implications in KIRC prognosis prediction, which might provide potential biomarkers and targets of metabolic therapeutic relevance.
Prelabour Uterine Rupture In Two Patients With A Previous Caesarean Section For Placenta Previa
Authors: Dellino Miriam , Crupano Francesco Maria , He Xuemin , Vimercati Antonella 
Published: August 2020

Abstract
Background Spontaneous uterine rupture is a severe pregnancy complication. Several risk factors have been described, especially for women with a previous caesarean section.Method We reported two cases of uterine rupture (UR) occurred outside of labour in patients with a history of caesarean section for placenta previa were reports. Results The current study evaluates how a higher hysterotomy, combined with some risk factors, can increase the prevalence of UR in the next pregnancy. Conclusion These cases presentation provide a supplement to over-all knowledge about UR showing that a careful evaluation of risk factors could promote the early UR management and consequently, improve the maternal-fetal outcome.
Time for more evidence: a scoping review of the effects of sanctions on Iranian health
Authors: Majdzadeh Reza , Yahyaei Faeze , Sajadi Haniye Sadat , Danaei Goodarz 
Published: August 2020

Abstract
Background

Islamic Republic of Iran has been the target of massive sanctions since 1979, which got intensified in 2005, 2012, and also in 2015 following JCPOA cancellation. Long-term economic sanctions have impacted Iran’s health system. The aim of this study is to examine the impact of sanctions on health system in Iran, and Iranian people’s health.
Methods

A scoping review was performed. PubMed/Medline, Embase, Web of Science, Scopus, and Scientific Information Database were searched from 2012 using the sanction, health and Iran keywords to find the studies that examined the impacts of sanctions on health in Iran. After screening, only original studies, namely studies which collected data through experiments, surveys, observation, interviews, or review of the literature were included, and letters to the editors and secondary reports were excluded. Final listings of articles were supplemented with hand searches of reference listings to ensure completeness. Data on study characteristics and the impacts of sanctions on health were extracted and summarized.
Result

The preliminary search has identified 273 documents among which 11 articles had the eligibility criteria to be included. They showed remarkable effects of sanctions on access to medicines for the treatment of cancers, non-communicable diseases, asthma, epilepsy, addiction, and hemophilia.
Conclusion

While there is a scarcity of evidence in quantifying the sanction’s impact and also the potential impact on different dimensions of people’s health, it seems that innocent people suffered from the economic downturn caused by sanction. The exact impact of sanctions on different health related areas could be the subject of further studies. Furthermore, more vigorous monitoring and evaluation systems are needed to investigate the effects of sanctions on health outcomes and system to be sure that they do not violate people’s fundamental human right to health.
CT Radiomics and Morphologic Characteristics for Predicting PD-L1 Expression on Tumour Cells and Tumour Infiltrating Lymphocytes in Gastric Cancer
Authors: Qiao Xiangmei , Li Lin , Li Zhengliang , Ji Changfeng , Li Hui , Shi Tingting , Gu Qing , Liu Song , Zhou Kefeng , Zhou Zhengyang 
Published: August 2020

Abstract
Background

To explore CT radiomics and morphologic characteristics for predicting programmed cell death ligand 1 on tumour cells (PD-L1) and tumour infiltrating lymphocytes (PD-L1-TILs) status in gastric cancer (GC).
Methods

From March 2019 to October 2019, 101 patients identified with GCs who underwent surgery at our hospital were enrolled in this study retrospectively. Radiomic features were extracted from regions of interest manually drawn on venous CT images. Besides, 13 morphologic characteristics were evaluated. The signatures based on radiomics and morphologic characteristics were built using multiple classifiers (Support Vector Machine [SVM], Naive Bayes [NB], Decision Trees [DT], and Random Forest [RF]). Receiver operating characteristic (ROC) curve was performed to assess diagnostic efficiency.
Results

The adjacent adipose tissue (P = 0.009) and numerous radiomic features (all P < 0.05) differed significantly between GCs with different PD-L1 status. Six radiomic features showed significant differences between different PD-L1-TILs status (all P < 0.05). The highest areas under the ROC curves (AUCs) of signatures generated by classifiers were 0.807 (SVM) and 0.729 (NB) for the prediction of PD-L1 and PD-L1-TILs status, respectively.
Conclusions

It was promising to predict PD-L1 status in GCs noninvasively using CT radiomics combined with morphologic characteristics. It might help to improve clinical decision making with regard to immunotherapy. However, the prediction for PD-L1-TILs needs to be explored further.
WITHDRAWN: Management of canine insulinomas with toceranib phosphate: 30 cases (2009-2019)
Authors: Sheppard-Olivares Sabina , Bello Nora , Johannes Chad M , Hocker Samuel , Billler Barbara , McKee Talon , McMillan Mattison , Husbands Brian , Wood Elizabeth , Wouda Raelene M 
Published: August 2020

Abstract
BACKGROUNDInsulinomas are the most common tumour of the endocrine pancreas in dogs. These are malignant tumours with a high metastatic rate and limited efficacious chemotherapeutic options available. Recent literature supports the use of the multi-receptor tyrosine kinase inhibitor sunitinib malate for treatment of metastatic insulinoma in people. Toceranib phosphate is a veterinary targeted therapy that may provide benefit in treatment of canine insulinomas. The primary objectives of this retrospective study were to describe the control of clinical signs, response to toceranib in the case of measurable disease, and outcomes of toceranib therapy for canine insulinoma. A secondary objective was to describe the adverse effects of toceranib in dogs with insulinoma.RESULTSA medical record search identified 30 dogs diagnosed with insulinoma and treated with toceranib at five university hospitals and eight veterinary specialty referral hospitals. A majority (66.7%) of dogs with measurable disease experienced either complete response (CR), partial response (PR), or stable disease (SD) for a minimum of 10 weeks with toceranib therapy. The overall median progression free interval (PFI) was 561 days (95% confidence interval: [246, 727 days]). The overall medial survival time (OST) was 656 days [310, 1045 days]. Larger dogs were at increased risk for disease progression (P = 0.0310) and death (P = 0.0064), with every 1 kg increase in body weight resulting in hazard ratios (HRs) of 1.045 [1.003, 1.084] and 1.05 [1.012, 1.090], respectively. In addition, time to disease progression was associated with use of therapies prior to toceranib (P = 0.0050) and type of veterinary practice (P = 0.0025). The most common adverse events with toceranib therapy were grade 1 or 2 gastrointestinal toxicities.CONCLUSIONSClinical benefit was reported in the majority of dogs diagnosed with insulinoma treated with toceranib, but randomized, prospective studies are needed to assess and quantify the effect of this therapy. The most commonly observed adverse events (AEs) were grade 1 or 2 gastrointestinal AEs.