bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum homocysteine and folate concentrations in early pregnancy and subsequent events of adverse pregnancy outcome: the Sichuan Homocysteine study
Authors: Liu Chenggui , Luo Dan , Wang Qin , Ma Yan , Ping Longyu , Wu Ting , Tang Jian , Peng Duanliang , PingZhao  
Published: March 2020

Abstract
Background
Hyperhomocysteinemia may be a risk factor for endothelial dysfunction. Folate and vitamin B12 regulate the homocysteine metabolic process. This study aimed to evaluate the associations between subsequent events of adverse pregnancy outcome and early variables of homocysteine, folate, and vitamin B12 in pregnant women.

Methods
This multicenter, retrospective, case–control study involved 563 pregnant women with adverse pregnancy outcome and 600 controls. Adverse pregnancy outcomes included one or more of the following events: preeclampsia, preterm birth, low birth weight, and stillbirth. The associations between subsequent events of adverse pregnancy outcome and early variables of homocysteine, folate, and vitamin B12; metabolic parameters; inflammatory markers; anthropometrics; and lifestyle habits at 11–12 weeks of gestation were analyzed using the logistic regression model.

Results
Compared to the lower quartile homocysteine concentrations, the upper quartile homocysteine concentrations were associated with preeclampsia, preterm birth and low birth weight. On the contrary, the lower quartile folate concentrations were associated with preeclampsia, preterm birth and low birth weight compared with the upper quartile folate concentrations. The incidence of adverse pregnancy outcome increased progressively from the first to fourth homocysteine quartiles but decreased progressively from the first to fourth folate quartiles. After adjusting for confounding factors, multivariate logistic regression analysis showed that besides systolic blood pressure, diastolic blood pressure, body mass index and age, homocysteine (IV vs I quartile, aOR 5.89, 95% CI 4.08–8.51, P < 0.001), folate (IV vs I quartile, aOR 0.35, 95% CI 0.25–0.50, P < 0.001), folate supplementation (yes vs no, aOR 0.55, 95% CI 0.35–0.86, P = 0.010) during early pregnancy were independently associated with subsequent events of adverse pregnancy outcome, and vitamin B12 was rejected. Of these, the homocysteine revealed the highest odds ratio in all risk variables, and folate showed the lowest odds ratio in all protective variables.

Conclusions
Higher homocysteine concentration and lower folate level during early pregnancy were associated with adverse pregnancy outcome. However, no association was found between vitamin B12 and adverse pregnancy outcome. Supplementation with folate in early pregnancy may reduce adverse pregnancy outcome.
Study protocol: watchful observation of patients with limited small cell lung cancer instead of the PCI—prospective, multi-center one-arm study
Authors: Nawrocki Sergiusz , Sugajska Anna 
Published: March 2020

Abstract
Background
Prophylactic cranial irradiation (PCI) is a current standard of care after confirmed response to radical chemoradiotherapy for limited disease small cell lung cancer (LD-SCLC). This standard is mostly based on results of old randomized studies when brain imaging with magnetic resonance (MRI) was not available. Survival benefit of PCI in extended disease SCLC was recently challenged by the results of randomized phase III study from Japan.

Methods
Eighty patients with LD-SCLC after response to chest chemoradiotherapy will be enrolled. Patients will be followed up by brain MRI every 3 to 6 months up to 3 years. Neurocognitive function tests will be performed at baseline and after 12 and 24 months. Patients who develop brain metastases will be irradiated with stereotactic (SRT) or whole brain RT (WBRT). The primary endpoint is overall survival. The secondary endpoints are: response rate to radiotherapy of early detected brain metastases, analysis of efficacy of SRT and WBRT; assessment and analysis of neurocognitive functions and QoL in the studied cohorts: QLQ-C30 questionnaire and the California Verbal Learning Test, Color connection test, Benton visual retention test, and verbal fluency test will be carried out.

Discussion
The results of this trial may contribute to changing of LD-SCLC clinical management by deescalating the treatment. There is a lack of prospective, recent studies in LD-SCLC patients with omission of PCI and modern radiation therapy technologies for developed brain metastases. The comprehensive neurocognitive function testing will help to assess the impact of modern radiotherapy (SRT) compared with WBRT and no-PCI in SCLC patients. A subgroup of long-term survivors, who will not develop brain metastases, will not be exposed to unnecessary brain irradiation with its deleterious consequences. The limitation of our study is a lack of parallel randomized control arm. This is a potential source of bias; however, randomized study will be difficult to complete for two major reasons: (1) limited population of LD-SCLC eligible for the study and (2) opinions of our patients, who after information and discussion about benefits and potential harms of PCI, often choose to omit PCI in our practice.

Trial registration
ClinicalTrials.gov Identifier: NCT04168281, 19 Nov. 2019.
Chronic cutaneous candidiasis in children: should we stop there? Report of two cases associated with auto-immune polyendocrinopathy syndrome type I
Authors: Minka Basilice Mireille , Sibetcheu T Aurélie , Sap Suzanne Ngo Um , Bissa Maryse Césarine 
Published: March 2020

Abstract
Background
Auto-immune polyendocrinopathy syndrome type I is a rare genetic disease, usually revealed by chronic superficial candidiasis and autoimmune endocrine dysfunction in childhood.

Cases presentation
We report the cases of 2 children, a 4 years-11 months old boy and 13 years old adolescent, admitted and followed up in the endocrinology unit of the Mother and Child Centre of Chantal Biya’s Foundation for auto-immune polyendocrine syndrome type 1.

Conclusion
The occurrence of chronic cutaneous candidiasis in a child should always imply endocrine screening, to exclude auto-immune polyendocrine syndrome type I.
Soil-transmitted helminths and schistosomiasis among pre-school age children in a rural setting of Busia County, Western Kenya: a cross-sectional study of prevalence, and associated exposures
Authors: Masaku Janet , Njomo Doris W. , Njoka Ann , Okoyo Collins , Mutungi Faith M. , Njenga Sammy M. 
Published: March 2020

Abstract
Background
Soil-transmitted helminths (STH) and schistosomiasis continue to cause serious health problems among affected communities. To ensure that infection transmission levels are reduced, repeated mass drug administration at regular intervals has been recommended by World Health Organization. Pre-school age children (PSAC) have been neglected both in terms of research activities and in control programmes in the past for reasons that they carry insignificant infection levels. The current study determined risk factors that contribute to differences in infection prevalence among enrolled and non-enrolled PSAC in Busia County, western Kenya.

Methods
This was a comparative cross-sectional study that compared STH and Schistosoma mansoni infections among enrolled and non-enrolled PSAC in Busia County. Simple random sampling was used to select study participants. A total of 327 enrolled and 326 non-enrolled PSAC (n = 653) were recruited from five participating schools, and the neighboring villages. Statistical analysis was performed using STATA version 14 (STATA Corporation, College Station, TX, USA). Differences in proportions were assessed using the z-test statistic for testing sample proportions. Univariable and multivariable logistic regression were used to test the associations between the variables.

Results
The prevalence of STH and Schistosoma mansoni infection was 17.0% (95%CI: 13.1–22.1), and 11.8% (95%CI:11.0–12.9) respectively. Specific STH species prevalence were 12.9% (95%CI:7.0–23.5) for Trichuris trichiura, 8.3% (95%CI:8.2–8.3) for Ascaris lumbricoides, and 1.2% (95%CI:1.2–1.2) for hookworms. Prevalence of T. trichiura was higher among enrolled PSAC 16.9% (95%CI: 6.8–41.9); p = 0.003, compared to the non-enrolled 8.9% (95%CI:4.3–18.2). From univariable analysis, lack of improved water source for drinking OR 2.01, (95%CI:1.29–3.13); p = 0.002, and not wearing shoes OR 3.42, (95%CI:1.14–10.29); p = 0.028, were some of the significant factors associated with STH infection. While for multivariable analysis, bathing/swimming in a river daily, aOR 3.99 (95%CI:1.98–8.06); p = 0.001 was a key significant factor for S. mansoni infections.

Conclusion
There was high prevalence of STH infection among enrolled PSAC despite having participated in the national school-based deworming programme. Hence the need for continued mass drug administration to reduce the intensity of infections among these age group. In addition, further research maybe needed to identify drivers of STH infection particularly T. trichiura among PSAC.
A two-step surgery and a multidisciplinary approach in a centenarian patient with an acute presentation of right colon cancer
Authors: Giannotti Chiara , Massobrio Andrea , Cannata Daniela , Nencioni Alessio , Monacelli Fiammetta , Aprile Alessandra , Soriero Domenico , Scabini Stefano , Pertile Davide 
Published: March 2020

Abstract
Background
As surgery remains the cornerstone of colorectal cancer (CRC) treatment, the number of older patients presented for colorectal resection is rapidly increasing. Nevertheless, the choice to operate an oldest-old patient still remain challenging and requires a careful assessment of risk to benefit ratio in order to guarantee appropriate surgical strategies and perioperative management.

Case presentation
A centenarian patient, acutely admitted to the emergency department, was diagnosed with an ileus caused by stenosing ascending colon cancer with abnormal distension of the right colon at high risk of perforation. Facing with this complex clinical scenario, a lateral decompressive cecostomy as alternative surgical procedure, was performed in local anesthesia in order to avoid the stressful event of an emergency surgery. Thereafter, the patient was admitted to the surgical ward and followed by a geriatrician who performed a comprehensive geriatric assessment (CGA) and daily clinical evaluations. This integrated plan of care was mainly focused on rehabilitation, nutritional interventions and therapeutic reconciliation, maximizing patient’s clinical conditions and performance status. Then, the second surgical step, the radical colon surgery with curative intent and bowel continuity reestablishment was performed, demonstrating to be feasible and safety also in a very advanced age patient in term of prolonged survival and preservation of an adequate quality of life.

Conclusions
This is the first case-report that illustrates a successful two step surgery for CRC in a centenarian patient thanks to a multidisciplinary based approach, overwhelming the mere concept of chronological age.
Can a second resection be avoided after initial thulium laser endoscopic en bloc resection for non-muscle invasive bladder cancer? A retrospective single-center study of 251 patients
Authors: Zhou Wenhao , Wang Wei , Wu Wenbo , Yan Tingmang , Du Guofang , Liu Haitao 
Published: March 2020

AbstractBackgroundThis study aimed to evaluate the efficacy of transurethral thulium laser en bloc resection of the bladder tumor (TmLRBT) in patients with non-muscle invasive bladder cancer (NMIBC) and to investigate whether a second resection can be avoided.MethodsFrom June 2012 to June 2018, 251 newly diagnosed patients with NMIBC were enrolled in this retrospective study; all patients received regular administration of pirarubicin after the initial resection. A second transurethral resection (TUR) was performed in patients within 2–6 weeks after the initial TmLRBT in group 1. Patients in group 2 only underwent cystoscopy at 3 months.ResultsSecond surgery results indicate that recurrence was detected histopathologically in 6/108 and 11/143 patients in group 1 and 2, respectively (P = 0.52); Progression was observed in 2 patients in each group (P = 0.34). The mean follow-up duration was 40.1 months, with no significant difference between the groups (P = 0.32). Recurrence was observed in 23 (21.3%) and 39 (27.3%) patients in groups 1 and 2 during the follow-up, respectively (P = 0.34); disease progression occurred in 4 (3.8%) patients in group 1 compared with 7 (4.0%) in group 2 (P = 0.20).ConclusionComplete removal of tumors can be achieved by TmLRBT. This technique may decrease the number of second TURs.
What makes an online problem-based group successful? A learning analytics study using social network analysis
Authors: Saqr Mohammed , Nouri Jalal , Vartiainen Henriikka , Malmberg Jonna 
Published: March 2020

Abstract
Background
Although there is a wealth of research focusing on PBL, most studies employ self-reports, surveys, and interviews as data collection methods and have an exclusive focus on students. There is little research that has studied interactivity in online PBL settings through the lens of Social Network Analysis (SNA) to explore both student and teacher factors that could help monitor and possibly proactively support PBL groups. This study adopts SNA to investigate how groups, tutors and individual student’s interactivity variables correlate with group performance and whether the interactivity variables could be used to predict group performance.

Methods
We do so by analyzing 60 groups’ work in 12 courses in dental education (598 students). The interaction data were extracted from a Moodle-based online learning platform to construct the aggregate networks of each group. SNA variables were calculated at the group level, students’ level and tutor’s level. We then performed correlation tests and multiple regression analysis using SNA measures and performance data.

Results
The findings demonstrate that certain interaction variables are indicative of a well-performing group; particularly the quantity of interactions, active and reciprocal interactions among students, and group cohesion measures (transitivity and reciprocity). A more dominating role for teachers may be a negative sign of group performance. Finally, a stepwise multiple regression test demonstrated that SNA centrality measures could be used to predict group performance. A significant equation was found, F (4, 55) = 49.1, p < 0.01, with an R2 of 0.76. Tutor Eigen centrality, user count, and centralization outdegree were all statistically significant and negative. However, reciprocity in the group was a positive predictor of group improvement.

Conclusions
The findings of this study emphasized the importance of interactions, equal participation and inclusion of all group members, and reciprocity and group cohesion as predictors of a functioning group. Furthermore, SNA could be used to monitor online PBL groups, identify important quantitative data that helps predict and potentially support groups to function and co-regulate, which would improve the outcome of interacting groups in PBL. The information offered by SNA requires relatively little effort to analyze and could help educators get valuable insights about their groups and individual collaborators.
When patients decide the admission – a four year pre-post study of changes in admissions and inpatient days following patient controlled admission contracts
Authors: Nyttingnes Olav , Ruud Torleif 
Published: March 2020

Abstract
Background
Mental health professionals usually decide patients’ access to inpatient care to ensure the rational and fair distribution of care based on need and prognosis. The purpose of the current study is to investigate the effects of increasing patients’ influence on admission by enabling patients to initiate brief inpatient stays of up to five days at a community mental health center. Patients can initiate admission according to their own discretion, outside the existing referral and gatekeeping system.

Methods
Patient-controlled admission (PCA) contracts were offered to eligible patients for inpatient stays in four community mental health centers in one health trust in Norway. Data on included patients’ inpatient stays at any of the hospitals’ mental health or addiction wards were collected by hospital electronic journal data extraction specialists for the two years before PCA contracts were introduced and the first two years after PCA contracts were introduced for the included patients.

Results
The included patients (n = 57) had 406 PCAs in the two years following signing PCA contracts. When comparing the periods before and after the introduction of the contracts, the total number of admissions increased from 203 to 498 (p < .001), while the number of inpatient days decreased from 7172 to 3178 (p < .001). No significant change in involuntary care was observed. A comparison of box plots of inpatient day use in the eight half-year periods of the study indicates a gradual increase in median inpatient days up to the signing of a PCA contract for the sample, and an abrupt reduction to a stable median level of inpatient days after signing a contract.

Conclusions
The included patients’ use of inpatient days changed profoundly after signing PCA contracts, similar to what previous studies of PCAs have indicated. In spite of the marked reductions in inpatient days, the pre-post design makes it impossible to rule out that the reductions were caused by regression toward the mean. No study of PCAs has reported negative effects, indicating that giving patients control over very short admissions is a feasible and potentially positive scheme in mental health care wards.
The role of mediation in solving medical disputes in China
Authors: Wang Mengxiao , Liu Gordon G. , Zhao Hanqing , Butt Thomas , Yang Maorui , Cui Yujie 
Published: March 2020

Abstract
Background
Medical litigation represents a growing cost to healthcare systems. Mediation, arbitration, and other alternative dispute resolution (ADR) methods are increasingly used to help solve the disputes and improve healthcare satisfaction. In China, the increasing number of medical disputes has contributed to concern for the safety of physicians and mistrust between physician and patients resulting in ADR processes being established in several provinces in recent years. Our aim was to describe and explain the impact of this new mediation process in the Chinese healthcare system.

Methods
Our study investigated mediation practices in China using case-level data from 5614 mediation records in Guangdong Province between 2013 and 2015. We investigated how the resolution success as well as the compensations are associated with the case characteristics using regression analysis.

Results
Among the cases analyzed, 1995 (41%) were solved with agreement through mediation, 1030 were closed by reconciliation, 559 were closed by referring to court and 1017 cases were withdrawn after mediation. Five hundred five Yinao cases were solved with the help of mediators on the spot. We find that mediation solved about 90% of medical disputes under present mechanisms, while more police support is needed to cope with Yinao. The average compensation of mediation is CNY60,200 and average length of mediation is 87 days. Longer time taken to reach resolution and more money claimed by patients are associated with lower resolution success rate (p < 0.01) and higher compensation levels (p < 0.01).

Conclusion
Our results show the performance of mediation mechanisms in China to help solve medical disputes. ADR plays a role in reducing the need for initiating litigation and may ultimately increase satisfaction with the healthcare system.
Variations in accelerometry measured physical activity and sedentary time across Europe – harmonized analyses of 47,497 children and adolescents
Authors:   On behalf of the Determinants of Diet and Physical Activity knowledge hub (DEDIPAC); International Children’s Accelerometry Database (ICAD) Collaborators, IDEFICS Consortium and HELENA Consortium, Steene-Johannessen Jostein , Hansen Bjørge Herman , Dalene Knut Eirik , Kolle Elin , Northstone Kate , Møller Niels Christian , Grøntved Anders , Wedderkopp Niels , Kriemler Susi , Page Angie S. , Puder Jardena J. , Reilly John J. , Sardinha Luis B. , van Sluijs Esther M. F. , Andersen Lars Bo , van der Ploeg Hidde , Ahrens Wolfgang , Flexeder Claudia , Standl Marie , Shculz Holger , Moreno Luis A. , De Henauw Stefaan , Michels Nathalie , Cardon Greet , Ortega Francisco B. , Ruiz Jonatan , Aznar Susana , Fogelholm Mikael , Decelis Andrew , Olesen Line Grønholt , Hjorth Mads Fiil , Santos Rute , Vale Susana , Christiansen Lars Breum , Jago Russ , Basterfield Laura , Owen Christopher G. , Nightingale Claire M. , Eiben Gabriele , Polito Angela , Lauria Fabio , Vanhelst Jeremy , Hadjigeorgiou Charalambos , Konstabel Kenn , Molnár Dénes , Sprengeler Ole , Manios Yannis , Harro Jaanus , Kafatos Anthony , Anderssen Sigmund Alfred , Ekelund Ulf 
Published: March 2020

Abstract
Background
Levels of physical activity and variation in physical activity and sedentary time by place and person in European children and adolescents are largely unknown. The objective of the study was to assess the variations in objectively measured physical activity and sedentary time in children and adolescents across Europe.

Methods
Six databases were systematically searched to identify pan-European and national data sets on physical activity and sedentary time assessed by the same accelerometer in children (2 to 9.9 years) and adolescents (≥10 to 18 years). We harmonized individual-level data by reprocessing hip-worn raw accelerometer data files from 30 different studies conducted between 1997 and 2014, representing 47,497 individuals (2–18 years) from 18 different European countries.

Results
Overall, a maximum of 29% (95% CI: 25, 33) of children and 29% (95% CI: 25, 32) of adolescents were categorized as sufficiently physically active. We observed substantial country- and region-specific differences in physical activity and sedentary time, with lower physical activity levels and prevalence estimates in Southern European countries. Boys were more active and less sedentary in all age-categories. The onset of age-related lowering or leveling-off of physical activity and increase in sedentary time seems to become apparent at around 6 to 7 years of age.

Conclusions
Two third of European children and adolescents are not sufficiently active. Our findings suggest substantial gender-, country- and region-specific differences in physical activity. These results should encourage policymakers, governments, and local and national stakeholders to take action to facilitate an increase in the physical activity levels of young people across Europe.