bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vaginal delivery in women with COVID-19: report of two cases
Authors: Cao Dongmei , Chen Miaomiao , Peng Min , Yin Heng , Sun Guoqiang 
Published: October 2020

Abstract
Background
During the ongoing global outbreak of COVID-19, pregnant women who are susceptible to COVID-19 should be highly concerned. The issue of vertical transmission and the possibility of neonatal infection is a major concern.

Case presentation
Case 1: A 35-year-old pregnant woman with a gestational age of 37 weeks and 6 days was admitted to our hospital at the point of giving birth. Except for the abnormalities in her chest CT image, she was asymptomatic. She had an uncomplicated spontaneous vaginal delivery, and her infant was discharged home for isolation. Because of the positive result of the maternal swabs for SARS-CoV-2 obtained on the 2nd day after sampling, we transferred the mother to the designated hospital and followed up with her by telephone interviews. Luckily, it was confirmed on February 23 that the newborn did not develop any COVID-19 symptoms after observation for 14 days after birth.
Case 2: Another pregnant woman, with a gestational age of 38 weeks and 2 days, was also admitted to our hospital because of spontaneous labor with cervical dilation of 5 cm. Since she had the typical manifestations of COVID-19, including cough, lymphopenia, and abnormal chest CT images, she was highly suspected of having COVID-19. Based on the experience from case 1, we helped the mother deliver a healthy baby by vaginal delivery. On the 2nd day after delivery, the maternal nasopharyngeal swab result was positive, while the infant’s result was negative.

Conclusion
There is still insufficient evidence supporting maternal-fetal vertical transmission for COVID-19-infected mothers in late pregnancy, and vaginal delivery may not increase the possibility of neonatal infection.
Pregnancy complications among nulliparous and multiparous women with advanced maternal age: a community-based prospective cohort study in China
Authors: Luo Jiayou , Fan Chunli , Luo Miyang , Fang Junqun , Zhou Shujin , Zhang Fenfang 
Published: October 2020

AbstractBackgroundThis study aimed to evaluate the incidence rates and risks of pregnancy complications among nulliparous and multiparous women with advanced maternal age (AMA, ≥35 years) in China.MethodsWe performed a community-based prospective cohort study of 10,171 pregnant women in selected two sub-districts and 11 towns of Liuyang from 2013 to 2015. All subjects were followed up from the first prenatal care (at ≤12 weeks) to delivery, and risks of pregnancy complications were compared by parity and maternal age groups.ResultsAmong nulliparas, women with AMA showed significantly increased risks for gestational hypertension (OR 8.44, 95%CI 1.68–2.88), preeclampsia/eclampsia (OR 9.92, 95%CI 4.87–18.78), premature rupture of membrane (OR 6.84, 95%CI 2.00–17.69), as compared to women in the 20–29-year age group. Among multiparas with AMA, increased risks were found for gestational diabetes mellitus (OR 3.29, 95%CI 1.76–5.94), anemia (OR 1.85, 95%CI 1.25–2.69), polyhydramnios (OR 3.29, 95%CI 1.56–6.64), premature rupture of membrane (OR 5.14, 95%CI 2.12–12.29), and preterm labor (OR 1.89, 95CI 1.42–2.50).ConclusionsWomen with AMA were associated with increased risks of pregnancy complications, and complications with increased risks differed in nulliparas and multiparas. Women with AMA should be identified as a high-risk group in clinical practice.
Combining 1,4-dihydroxy quininib with Bevacizumab/FOLFOX alters angiogenic and inflammatory secretions in ex vivo colorectal tumors
Authors: Kennedy Susan A. , Morrissey Maria E. , Dunne Margaret R. , O’Connell Fiona , Butler Clare T. , Cathcart Mary-Clare , Buckley Amy M. , Mehigan Brian J. , Larkin John O. , McCormick Paul , Kennedy Breandán N. , O’Sullivan Jacintha 
Published: October 2020

Abstract
Background
Colorectal cancer (CRC) is the second most common cause of cancer-related mortality worldwide with one in every five patients diagnosed with metastatic CRC (mCRC). In mCRC cases, the 5-year survival rate remains at approximately 14%, reflecting the lack of effectiveness of currently available treatments such as the anti-VEGF targeting antibody Bevacizumab combined with the chemotherapy folinic acid, fluorouracil and oxaliplatin (FOLFOX). Approximately 60% of patients do not respond to this combined treatment. Furthermore, Bevacizumab inhibits dendritic cell (DC) maturation in poor responders, a key process for tumor eradication.

Method
Following drug treatment, secreted expression levels of angiogenic and inflammatory markers in tumor conditioned media generated from human ex vivo colorectal tumors were measured by ELISA. Dendritic cell phenotypic and maturation markers were assessed by flow cytometry.

Results
Our novel compound, 1,4-dihydroxy quininib, acts in an alternative pathway compared to the approved therapy Bevacizumab. 1,4-dihydroxy quininib alone, and in combination with Bevacizumab or FOLFOX significantly reduced TIE-2 expression which is involved in the promotion of tumor vascularization. Combination treatment with 1,4-dihydroxy quininib significantly increased the expression level of DC phenotypic and maturation markers.

Conclusion
Our results indicate the anti-angiogenic small molecule 1,4-dihydroxy quininib could be an alternative novel treatment in combination therapy for CRC patients.
A 38-gene model comprised of key TET2-associated genes shows additive utility to high-risk prostate cancer cases in the prognostication of biochemical recurrence
Authors: Kamdar Shivani , Fleshner Neil E. , Bapat Bharati 
Published: October 2020

Abstract
Background
Early treatment of patients at risk for developing aggressive prostate cancer is able to delay metastasis and reduce mortality; as such, up-front identification of these patients is critical. Several risk classification systems, including CAPRA-S, are currently used for disease prognostication. However, high-risk patients identified by these systems can still exhibit wide-ranging disease outcomes, leading to overtreatment of some patients in this group.

Methods
The master methylation regulator TET2 is downregulated in prostate cancer, where its loss is linked to aggressive disease and poor outcome. Using a random forest strategy, we developed a model based on the expression of 38 genes associated with TET2 utilizing 100 radical prostatectomy samples (training cohort) with a 49% biochemical recurrence rate. This 38-gene model was comprised of both upregulated and downregulated TET2-associated genes with a binary outcome, and was further assessed in an independent validation (n = 423) dataset for association with biochemical recurrence.

Results
38-gene model status was able to correctly identify patients exhibiting recurrence with 81.4% sensitivity in the validation cohort, and added significant prognostic utility to the high-risk CAPRA-S classification group. Patients considered high-risk by CAPRA-S with negative 38-gene model status exhibited no statistically significant difference in time to recurrence from low-risk CAPRA-S patients, indicating that the expression of TET2-associated genes is able to separate truly high-risk cases from those which have a more benign disease course.

Conclusions
The 38-gene model may hold potential in determining which patients would truly benefit from aggressive treatment course, demonstrating a novel role for genes linked to TET2 in the prognostication of PCa and indicating the importance of TET2 dysregulation among high-risk patient groups.
Assessment of online patient education materials designed for people with age-related macular degeneration
Authors: Fortuna Jennifer , Riddering Anne , Shuster Linda , Lopez-Jeng Cassie 
Published: October 2020

Abstract
Background
Age-related macular degeneration (AMD) is a chronic eye condition that leads to permanent vision loss in the central visual field. AMD makes reading challenging and inefficient. People with AMD often find it difficult to access, process and understand written patient education materials (PEMs). To promote health literacy, the demands of written PEMs must match the literacy capacities of the target audience. This study aims to evaluate the readability (grade level) and suitability (appropriateness) of online PEMs designed for people with AMD.

Methods
Online PEMs were sourced from websites of national organizations providing patient education materials designed for people with AMD. The Flesch-Kincaid Grade Level formula and the Suitability Assessment of Materials instrument were used to assess the readability and suitability of PEMs. Descriptive statistics were used to compare online PEMs by organization based on national guidelines for readability level (≤ sixth grade) and the recommended suitability score (≥ 70%) for “superior” material.

Results
One hundred online PEMs were evaluated from websites of 16 professional organizations. The mean readability level was 9.3 (range 5.0–16.6). The mean suitability score was 53% (range 18–78%). Only six (6%) of PEMs achieved the recommended guidelines for readability level and suitability score.

Conclusion
The majority of online PEMs designed for people with AMD were written above the recommended readability level, and below the suggested suitability score. To promote health literacy, the demands of written health information must match the reading capacities of the target audience. Heeding to evidence-based guidelines for providing written information to patients with low health literacy and low vision is beneficial for both patients and health care providers. Future research is warranted.
Safety and efficacy of guanfacine extended-release in adults with attention-deficit/hyperactivity disorder: an open-label, long-term, phase 3 extension study
Authors: Iwanami Akira , Saito Kazuhiko , Fujiwara Masakazu , Okutsu Daiki , Ichikawa Hironobu 
Published: October 2020

Abstract
Background
To assess the safety and efficacy of long-term administration of guanfacine extended-release (GXR) in adults with attention-deficit/hyperactivity disorder (ADHD).

Methods
In this open-label, long-term, phase 3 extension study in Japan, 150 patients transitioned from a double-blind trial, and 41 newly enrolled patients received once daily GXR (starting dose 2 mg/day, maintenance dose 4–6 mg/day) for 50 weeks. Primary outcome measures were the frequency and nature of treatment-emergent adverse events (TEAEs); secondary outcome measures included the change from week 0 in ADHD Rating Scale IV with Adult Prompts (ADHD-RS-IV; Japanese version) total and subscale scores, Conners’ Adult ADHD Rating Scales (CAARS), Clinical Global Impression-Improvement (CGI-I) and Patient Global Impression-Improvement (PGI-I) scales, and quality of life (QoL) and executive functioning measures.

Results
Of all patients, 94.2% (180/191) reported ≥1 TEAE and 19.9% (38/191) discontinued because of a TEAE. Most TEAEs were mild to moderate in severity; there were two serious TEAEs and no deaths. Commonly reported TEAEs (≥10% of patients) were somnolence, thirst, nasopharyngitis, decreased blood pressure, postural dizziness, bradycardia, malaise, constipation, and dizziness. Mean changes from week 0 in ADHD-RS-IV total and subscale scores and CAARS subscale scores were significantly improved in former placebo or GXR patients and new patients at last observation (p < .0001), and the percentage of patients with very much or much improved CGI-I and PGI-I scores increased.

Conclusions
There were no major safety concerns during long-term GXR administration in adults with ADHD. After long-term treatment, patients had significant improvements from baseline in ADHD symptoms, QoL, and executive functioning.

Trial registration
Japan Primary Registries Network (https://rctportal.niph.go.jp/en/): JapicCTI-163232, registered 04/21/2016.
“A loving man has a very huge responsibility”: A mixed methods study of Malawian men’s knowledge and beliefs about cervical cancer
Authors: Lewis Samuel , Moucheraud Corrina , Schechinger Devon , Mphande Misheck , Banda Ben Allan , Sigauke Hitler , Kawale Paul , Dovel Kathryn , Hoffman Risa M. 
Published: October 2020

Abstract
Background
In Malawi, numerous barriers may prevent women from accessing cervical cancer screening services — including social factors such as male partner involvement. We conducted surveys that included open- and closed-ended questions with married Malawian men to evaluate their knowledge and beliefs about cervical cancer.

Methods
HIV-positive adult (≥18 years) men (married or in a stable relationship) were recruited from an antiretroviral therapy clinic in Lilongwe, Malawi. Men were asked a series of survey questions to assess their knowledge about cervical cancer, experience with cervical cancer, their female partner’s screening history, and their beliefs about gender norms and household decision-making. Following the survey, participants responded to a set of open-ended interview questions about cervical cancer screening, and men’s role in prevention.

Results
One hundred-twenty men were enrolled with average age 44 years and 55% having completed secondary school or higher education. Despite only moderate knowledge about cervical cancer and screening (average assessment score of 62% correct), all men expressed support of cervical cancer screening, and most (86%) believed they should be involved in their female partner’s decision to be screened. Over half (61%) of men said their female partner had previously been screened for cervical cancer, and this was positively correlated with the male respondent having more progressive gender norms around sexual practices. Some men expressed concerns about the screening process, namely the propriety of vaginal exams when performed by male clinicians, and whether the procedure was painful.

Conclusions
Male partners in Malawi want to be involved in decisions about cervical cancer screening, but have limited knowledge about screening, and hold rigid beliefs about gender norms that may affect their support for screening. Messaging campaigns addressing men’s concerns may be instrumental in improving women’s adoption of cervical cancer screening services in Malawi and similar settings.
Health status of female Moldovan migrants to Italy by health literacy level and age group: a descriptive study
Authors: Vianello Francesca Alice , Zaccagnini Federica , Pinato Carlo , Maculan Pietro , Buja Alessandra 
Published: October 2020

Abstract
Background
Migration flows from Eastern Europe to Italy have been large and continue to grow. The purpose of this study was to examine the health status of a population of Moldovan migrant women, and their access to health care services in northern Italy, by age group and health literacy level.

Methods
We administered an ad-hoc questionnaire to adult Moldovan women. A bivariate analysis was conducted to test the association between health literacy and age groups with other variables (lifestyles, symptoms and diseases, access to health services). A stepwise logistic regression analysis was run to test the association between access to primary care and health literacy. Moreover, the study compare Moldovan women data with a sample of Italian women of the same age range living in North-Eastern region.

Results
Our sample included 170 Moldovan women (aged 46.5 ± 12.3) in five occupational categories: home care workers (28.2%); cleaners (27.1%); health care workers (5.9%); other occupations (28.8%); and unemployed (10%). Active smokers were twice as prevalent among the women with a low health literacy. Health literacy level also determined access to primary healthcare services. For all age groups, the Moldovan sample reported a higher prevalence of allergies, lumbar disorders and depression than the Italian controls.

Conclusions
The reported prevalence of some diseases was higher among Moldovan migrant women than among Italian resident women. Health literacy was associated with the migrant women’s lifestyle and the use of primary health care services, as previously seen for the autochthonous population.
Uptake of routine vitamin A supplementation for children in Humbo district, southern Ethiopia: community-based cross-sectional study
Authors: Kassa Getnet , Mesfin Addisalem , Gebremedhin Samson 
Published: October 2020

AbstractBackgroundIn low- and middle-income countries routine vitamin A supplementation (VAS) is a key strategy for reducing vitamin A deficiency and mortality and morbidity of preschool children. However, in Ethiopia, there is paucity of evidence regarding the level and determinants of the uptake of the supplement. This study was designed to assess the coverage and predictors of VAS among preschool children in Humbo district, Southern Ethiopia.MethodsA cross-sectional study was conducted in April 2016. A total of 840 mothers/caregivers having children 6–59 months of age were selected using multistage cluster sampling technique from six rural villages implementing routine VAS program. Data were collected using interviewer administered questionnaire. Possible predictors considered in the study include distance from the nearby health facility, household socio-economic status, type of the household (model vs non-model), maternal access to health education on VAS, and knowledge on vitamin A and VAS. Multivariable logistic regression analysis was performed to identify predictors of uptake of VAS. The outputs are presented using adjusted odds ratio (AOR) with the respective 95% confidence interval (CI).ResultsThe coverage of VAS was 75.0% (95% CI: 72.1–77.9). Better knowledge of mothers about the importance of the supplement (AOR: 1.49, 1.02–2.17), obtaining VAS related information from frontline community health workers (AOR: 1.51, 1.34–2.72) than health professionals and being from households in the “rich” wealth tertile (AOR: 1.80, 95% CI: 1.07–3.03) were positively associated with uptake VAS.ConclusionThe VAS coverage of the area was approaching the expected national target of 80%. However, the uptake can be enhanced though awareness creation and improving socio-economic status of the community.
Clinical significance of peripheral blood-derived inflammation markers in advanced gastric cancer after radical resection
Authors: Gu Lihu , Wang Mian , Cui Xuena , Mo Jiahang , Yuan Lingling , Mao Feiyan , Zhang Kang , Ng Derry Minyao , Chen Ping , Wang Dongjie 
Published: October 2020

Abstract
Background
The prognostic significance of peripheral blood-derived inflammation markers in patients with gastric cancer (GC) has not been elucidated. This study aimed to investigate the relationship between systemic inflammatory markers and GC prognosis.

Methods
A prospective observational cohort study involving 598 patients was conducted to analyze the prognosis of GC based on systemic inflammatory markers. The following peripheral blood-derived inflammation markers were evaluated: the neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), systemic immune-inflammation index (SII), C-reactive protein/albumin (CRP/Alb) ratio, Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), prognostic nutrition index (PNI), and prognostic index (PI). The receiver operating characteristics (ROC) curve and the Youden index were used to determine the optimal cutoff values. Univariate and multivariate analysis of prognostic factors was conducted accordingly.

Results
The optimal cutoff values of the PNI, fibrinogen, NLR, PLR, SII, and CRP/Alb were 49.5, 397 ng/dl, 2.5, 154, 556, and 0.05, respectively. Multivariate analysis showed that age, PLR, TNM stage, and chemotherapy were the independent prognostic factors for advanced gastric cancer (AGC). Adjuvant chemotherapy improved the long-term prognosis of patients with PLR ≥154, but chemotherapy had no significant effect on the survival of patients with PLR < 154.

Conclusions
Our findings show that higher PLR (≥154) is an independent risk factor for poor prognosis in GC patients. Besides, PLR can predict adjuvant chemotherapy (oxaliplatin/5-fluorouracil combination) response in patients with GC after surgery.
A novel structure for online surgical undergraduate teaching during the COVID-19 pandemic
Authors: Chandrasinghe P. C. , Siriwardana R. C. , Kumarage S. K. , Munasinghe B.N.L , Weerasuriya A. , Tillakaratne S. , Pinto D. , Gunathilake B. , Fernando F. R. 
Published: October 2020

Abstract
Background
The Covid-19 pandemic necessitated the delivery of online higher education. Online learning is a novel experience for medical education in Sri Lanka. A novel approach to undergraduate surgical learning was taken up in an attempt to improve the interest amongst the students in clinical practice while maximizing the limited contact time.

Method
Online learning activity was designed involving medical students from all stages and multi consultant panel discussions. The discussions were designed to cover each topic from basic sciences to high-level clinical management in an attempt to stimulate the student interest in clinical medicine. Online meeting platform with free to use basic plan and a social media platform were used in combination to communicate with the students. The student feedback was periodically assessed for individual topics as well as for general outcome. Lickert scales and numeric scales were used to acquire student agreement on the desired learning outcomes.

Results
A total of 1047 student responses for 7 questionnaires were analysed. During a 6-week period, 24 surgical topics were discussed with 51 contact hours. Eighty-seven per cent definitely agreed (highest agreement) with the statement ‘students benefitted from the discussions’. Over 95% have either participated for all or most sessions. A majority of the respondents (83.4%) ‘definitely agreed’ that the discussions helped to improve their clinical sense. Of the total respondents, 79.3% definitely agreed that the discussions helped to build an interest in clinical medicine. Around 90% agreed that both exam-oriented and clinical practice-oriented topics were highly important and relevant. Most widely raised concerns were the poor Internet connectivity and limitation of access to the meeting platform.

Conclusion
Online teaching with a novel structure is feasible and effective in a resource-limited setting. Students agree that it could improve clinical interest while meeting the expected learning outcomes.
Validation of the French translation of the Dutch residency educational climate test
Authors: Majbar Mohamed Anass , Majbar Yassin , Benkabbou Amine , Amrani Laila , Bougtab Abdeslam , Mohsine Raouf , Souadka Amine 
Published: October 2020

AbstractBackgroundThe learning environment is one of the most influential factors in training of medical residents. The Dutch Residency Educational Climate Test (D-RECT) is one of the strongest instruments for measuring the learning environment. However, it has not been translated in French. The objective of this study is the psychometric validation of the DRECT French version.Material and methodsAfter translation of the D-RECT questionnaire into French, residents of five Moroccan hospitals were invited to complete the questionnaire between July and September 2018. Confirmatory factor analysis was used to evaluate the validity of the construct using the standardized root mean square residual (SRMR), the root mean square error approximation (RMSEA), the Comparative Fit Index (CFI) and the Tucker- Lewis Index (TLI). Reliability analysis was analysed using Internal consistency and Test-retest.ResultsDuring the study period, 211 residents completed the questionnaire. Confirmatory factor analysis showed an adequate model fit with the following indicators: SRMR = 0.058 / RMSEA = 0.07 / CFI = 0.88 / TLI = 0.87. The French translation had a good internal consistency (Cronbach alpha score >  0.7 for all subscales) and a good temporal stability (correlation score between two measurements = 0.89).ConclusionThis French version has an acceptable validity of the construct, a good internal consistency and good temporal reliability, and may be used to evaluate the learning climate. Additional research is necessary in other French-speaking contexts, in order to confirm these results.