bluuebunny/crossref_metadata_2025_split huggingface dataset:
A rare but treatable cause of recurrent chest pain - Ictal chest pain
Authors: Khoo Ching Soong , Lee Dongah , Park Kang Min , In Lee Byung , Kim Sung Eun 
Published: December 2019

Abstract
Background
Chest pain as the primary manifestation of epilepsy is extremely rare and has only been reported once to date.

Case presentation
We herein describe a 47-year-old woman with recurrent chest pain for 3 years. The cause of her chest pain remained elusive despite extensive investigations including comprehensive cardiac work-up. She was referred to the neurology clinic for one episode of confusion. Video-electroencephalographic monitoring detected unequivocal ictal changes during her habitual chest pain events. She has remained chest pain (seizure) free with a single antiseizure drug.

Conclusions
This case underlines the importance of epilepsy as a rare yet treatable cause of recurrent chest pain. Further studies are required to determine the pathophysiology of ictal chest pain.
Functional MRI study in a case of Charles Bonnet syndrome related to LHON
Authors: Vacchiano V. , Tonon C. , Mitolo M. , Evangelisti S. , Carbonelli M. , Liguori R. , Lodi R. , Carelli V. , La Morgia C. 
Published: December 2019

Abstract
Introduction
Charles Bonnet syndrome is characterized by simple or complex visual hallucinations (VH) due to damage along the visual pathways. We report a functional MRI study of brain correlates of VH in the context of a severe optic atrophy in a patient with Leber’s Hereditary Optic Neuropathy (LHON).

Case report
A 62-year-old man was diagnosed with LHON (11778/ND4 mtDNA mutation) after subacute visual loss in left eye (right eye was amblyopic). One month later, he experienced VH of a few seconds consisting in “moving red and blue miniature cartoons”. One year later VH content changed in colored mosaic (10–15 s duration), usually stress-related, and blue and white flashes (2–5 s), triggered by unexpected auditory stimuli. Audiometry revealed mild sensorineural hearing loss. Three block design functional MRI paradigms were administrated: 1) random “clap”, 2) “checkerboard” and 3) non-random “beep”. After random “claps” simple flashes were evoked with bilateral activation of primary and secondary visual cortex, cuneus, precuneus and insula. Neither hallucinations nor cortex activation were registered after “checkerboard” stimulation, due to the severe visual impairment. Primary and secondary auditory cortices were “beep”-activated, without eliciting VH by non-random “beep”.

Conclusions
The peculiarity of our case is that VH were triggered by random auditory stimuli, possibly due to a cross-modal plasticity between visual and auditory networks, likely influenced by the sensorineural deafness. Functional alterations of both networks in resting conditions have been demonstrated in LHON patients, even without an auditory deficit. Finally, the absence of VH triggered by expected stimuli is consistent with the “expectation suppression theory”, based on increased neural activations after unexpected but not by predicted events.
Sudden intrauterine unexplained death: time to adopt uniform postmortem investigative guidelines?
Authors: Lavezzi Anna M. , Piscioli Francesco , Pusiol Teresa , Jorizzo Gianfranco , Ferrero Stefano 
Published: December 2019

Abstract
Background
Worldwide approximately 2.6 million are stillborn, mostly occurring in developing countries. In the great part these deaths are inexplicable. The evenness and standardisation of the diagnostic criteria are prerequisites to understand their pathogenesis. The core goal of this article is to propose new evidence based investigative post-mortem guidelines that should be adopted in all the Institutions especially when a fetal death, after a routine autopsy procedure, is diagnosed as “unexplained”. The proposed protocol is mainly focused on the anatomopathological examination of the autonomic nervous system and in particular of the brainstem where the main centers that control vital functions are located.

Methods
Updated investigative guidelines for the examination of unexplained stillbirths, prevalently focused on the histological examination of the brainstem, where the main centers that are involved in monitoring the vital functions are located, are here presented. A section of this protocol concerns the Immunohistochemical evaluation of specific functional markers such as the neuronal nuclear antigen, nicotinic acetylcholine receptors, serotonin, orexin, apoptosis and gliosis. The important role of risk factors, having regard in particular to maternal smoking and air pollution is also contemplated in these guidelines.

Results
Specific morphological and/or functional alterations of vital brainstem structures have been found with high incidence in over 100 cases of unexplained fetal death sent to the “Lino Rossi Research Center” of the Milan University according to the Italian law. These alterations were rarely detected in a group of control cases.

Conclusions
We hope this protocol can be adopted in all the Institutions notably for the examination of unexplained fetal deaths, in order to make uniform investigations. This will lead to identify a plausible explanation of the pathogenetic mechanism behind the unexplained fetal deaths and to design preventive strategies to decrease the incidence of these very distressing events for both parents and clinicians.

Trial registration
not applicable for this study.
Risk factors and racial disparities related to low maternal birth satisfaction with labor induction: a prospective, cohort study
Authors: Hamm Rebecca F. , Srinivas Sindhu K. , Levine Lisa D. 
Published: December 2019

AbstractBackgroundDecreased birth satisfaction has been associated with labor induction. Yet, there is a paucity of data evaluating risk factors for decreased satisfaction associated with labor induction. We aimed to determine what factors impact low birth satisfaction in labor induction and evaluate racial disparities in birth satisfaction.MethodsWe performed a prospective cohort study of women with term, singleton gestations undergoing labor induction at our institution from Jan 2018 to Jun 2018. Women completed the validated Birth Satisfaction Scale-Revised postpartum, which is subdivided into 3 domains: (1) quality of care provision, (2) women’s personal attributes, and (3) stress experienced during labor. A total satisfaction score above the mean was classified as “satisfied”, and below as “unsatisfied.” Domain and item scores were compared by race.ResultsThree hundred thirty of 414 (79.7%) eligible women were included. There was no significant difference in birth satisfaction by age, body mass index, Bishop score, or labor induction agent. Black women were 75% more likely to be unsatisfied than non-Black women (54.0% vs. 37.2%, OR 1.75 [95% CI 1.11–2.76],p = 0.037), nulliparas were 71% more likely to be unsatisfied than multiparas (54.2% vs. 40.9%, OR 1.71 [95% CI 1.09–2.67],p = 0.019), and women whose labor resulted in cesarean birth were almost 3 times more likely to be unsatisfied than women with a vaginal birth (67.4% vs. 42.3%, OR 2.82 [95% CI 1.69–4.70],p < 0.001). Additionally, increased labor length quartile was associated with decreased satisfaction >(p = 0.003). By race, domain 3 scores, which reflect preparedness for labor, were lower for Black women. No differences were seen for domain 1 or 2.ConclusionsBlack race, cesarean birth, and increasing labor length were identified as risk factors for low birth satisfaction among women who underwent labor induction. Further studies should explore interventions to target women at risk for low birth satisfaction.
Group B Streptococcus detection in pregnant women: comparison of qPCR assay, culture, and the Xpert GBS rapid test
Authors: Vieira Laura L. , Perez Amanda V. , Machado Monique M. , Kayser Michele L. , Vettori Daniela V. , Alegretti Ana Paula , Ferreira Charles F. , Vettorazzi Janete , Valério Edimárlei G. 
Published: December 2019

Abstract
Background
Group B Streptococcus (GBS) is one of the most important causative agents of neonatal sepsis. As administration of prophylactic antibiotics during labor can prevent GBS infection, routine screening for this bacterium in prenatal care before the onset of labor is recommended. However, many women present in labor without having undergone such testing during antenatal care, and the turnaround time of detection methods is insufficient for results to be obtained before delivery.

Methods
Vaginal and anorectal specimens were collected from 270 pregnant women. Each sample was tested by Xpert GBS, qPCR, and culture for GBS detection.

Results
The overall prevalence of maternal GBS colonization was 30.7% according to Xpert GBS, 51.1% according to qPCR, and 14.3% according to cultures. Considering the qPCR method as the reference, the Xpert GBS had a sensitivity of 53% and specificity of 93%. Positive Xpert GBS results were correlated to marital status (married or cohabitating) and with prematurity as a cause of neonatal hospitalization. Positive cultures were related with ischemic–hypoxic encephalopathy requiring therapeutic hypothermia.

Conclusions
Combined enrichment/qPCR and the Xpert GBS rapid test found a high prevalence of GBS colonization. The Xpert GBS technique gives faster results and could be useful for evaluating mothers who present without antenatal GBS screening results and are at risk of preterm labor, thus allowing institution of prophylactic antibiotic therapy.
Prevalence and determinants of stillbirth in Nigerian referral hospitals: a multicentre study
Authors: Okonofua Friday E. , Ntoimo Lorretta Favour C. , Ogu Rosemary , Galadanci Hadiza , Mohammed Gana , Adetoye Durodola , Abe Eghe , Okike Ola , Agholor Kingsley , Abdus-salam Rukiyat , Randawa Abdullahi 
Published: December 2019

Abstract
Background
In 2015, Nigeria’s estimated 317,700 stillbirths accounted for 12.2% of the 2.6 million estimated global stillbirths. This suggests that Nigeria still makes substantial contribution to the global burden of stillbirths. This study was conducted to determine the prevalence and identify the causes and factors associated with stillbirth in eight referral hospitals in Nigeria.

Methods
This was a cross-sectional study of all deliveries over a period of 6 months in six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the north) in Nigeria. The study population was women delivering in the hospitals during the study period. A pre-tested study protocol was used to obtain clinical data on pregnancies, live births and stillbirths in the hospitals over a 6 months period. Data were analyzed centrally using univariate, bivariate and multivariate logistic regression analyses. The main outcome measure was stillbirth rate in the hospitals (individually and overall).

Results
There were 4416 single births and 175 stillbirths, and a mean stillbirth rate of 39.6 per 1000 births (range: 12.7 to 67.3/1000 births) in the hospitals. Antepartum (macerated) constituted 22.3% of the stillbirths; 47.4% were intrapartum (fresh stillbirths); while 30.3% was unclassified. Acute hypoxia accounted for 32.6% of the stillbirths. Other causes were maternal hypertensive disease (6.9%), and intrapartum unexplained (5.7%) among others. After adjusting for confounding variables, significant predictors of stillbirth were referral status, parity, past experience of stillbirth, birth weight, gestational age at delivery and mode of delivery.

Conclusion
We conclude that the rate of stillbirth is high in Nigeria’s referral hospitals largely because of patients’ related factors and the high rates of pregnancy complications. Efforts to address these factors through improved patients’ education and emergency obstetric care would reduce the rate of stillbirth in the country.

Trial registration
Trial Registration Number NCTR91540209.
Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/
Registered April 14th 2016.
The effect of distraction techniques on pain and stress during labor: a randomized controlled clinical trial
Authors: Amiri Paria , Mirghafourvand Mojgan , Esmaeilpour Khalil , Kamalifard Mahin , Ivanbagha Reyhaneh 
Published: December 2019

Abstract
Background
Pain control and the stress associated with labor and delivery are among the most important issues of health care system. Use of distraction techniques during childbirth is reported to reduce pain and stress of labor. However, there is a limited publication that looked on the effect of distraction techniques on labor pain and stress. Thus, the aim of this study was to determine the effect of distraction techniques on labor pain and stress (primary outcomes), fear of childbirth, length of delivery stages, first minute Apgar score and oxytocin consumption (secondary outcomes).

Methods
A randomized controlled clinical trial was conducted on 68 pregnant women. Participants were allocated into two groups (intervention and control groups) by blocked randomization. Participants in the intervention group received distraction techniques in four sessions. Questionnaires of Fear of Childbirth (W-DEQ version A) and PSS once were completed before intervention and again at the 36th week for the W-DEQ and in the active phase for the PSS through interviews. The pain was assessed through VAS during active phase per hour. The length of delivery stages was recorded in the partograph chart. Data were analyzed by independent t-test and ANCOVA.

Results
The mean of perceived stress during labor in the intervention group was significantly less than that of the control group (AMD: -3.2; 95% CI: − 0.8 to − 6.0; P = 0.01). The mean (SD) of pain intensity during labor was less than in the intervention and control groups compare to the control group (6.2 vs 7.5; P < 0.001). There was no significant difference between the two groups in terms of fear of childbirth score (AMD: 5.3; 95% CI: 13.0 to − 6.0; P = − 2.3). Moreover, there was no statistically significant difference between the two groups in terms of the active phase of labor (P = 0.504), second stage of delivery (P = 0.928), total length of delivery (P = 0.520), Apgar score (P = 1.000) and frequency of oxytocin consumption (P = 0.622).

Conclusion
According to the results, distraction techniques can reduce the pain and stress of labor, but further studies by using the distraction techniques are needed to reach a decisive conclusion.

Trial registration
IRCT2017042910324N39; Name of registry: Iranian Registry of Clinical Trials; Registered 11 September 2017. URL of registry: https://fa.irct.ir/user/trial/10814/view. Date of enrolment of the first participant to the trial: September 2017.
Prevalence and contributing factors of birth asphyxia among the neonates delivered at Nigist Eleni Mohammed memorial teaching hospital, Southern Ethiopia: a cross-sectional study
Authors: Abdo Ritbano Ahmed , Halil Hassen Mosa , Kebede Biruk Assefa , Anshebo Abebe Alemu , Gejo Negeso Gebeyehu 
Published: December 2019

Abstract
Background
Birth asphyxia is a major contributor to neonatal mortality worldwide. In Ethiopia, birth asphyxia remains a severe condition that leads to significant mortality and morbidity. This study aims to assess the prevalence and contributing factors of birth asphyxia among the neonates delivered at the Nigist Eleni Mohammed Memorial Teaching Hospital, Southern Ethiopia.

Methods
This hospital-based cross-sectional study was carried out on 279 participants using the systematic sampling method during June 1–30, 2019. Data were collected using a pretested structured interviewer administered questionnaire, check list and chart review, which was used to retrieve medical information and mother’s test results that could not be captured by the interview. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Multivariable regression analysis was used to identify the association between the independent variables and outcome variable with a 95% confidence interval (CI).

Result
The overall prevalence of birth asphyxia among newborns was found to be 15.1%. Factors that were significantly associated with birth asphyxia included mothers aged ≥35 (AOR = 6.4; 95% CI = 2.0–20.5), primigravida (AOR = 5.1; 95% CI =2.0–13.3), prolonged second stage of labor (AOR = 4.6; 95%CI =1.6–13.3), preterm birth (AOR = 4.7; 95% CI =1.5–14.1), meconium stained amniotic fluid (AOR = 7.5; 95% CI =2.5–21.4) and tight nuchal (AOR = 3.1; 95% CI =1.2–9.3).

Conclusion
Birth asphyxia is still prevalent in the study setting. The obtained findings indicated that the mothers aged ≥35, being primigravida, preterm birth, meconium stained amniotic fluid and tight nuchal were the factors associated with birth asphyxia. The results of this study show the need for better maternal care, creating awareness about contributing factors of birth asphyxia to the maternity health professionals, careful monitoring of labor, and identifying and taking proper measures that could help in reducing the occurrence of birth asphyxia.
Proposal for a definition of "Oligometastatic disease in pancreatic cancer"
Authors: Damanakis Alexander I. , Ostertag Luisa , Waldschmidt Dirk , Kütting Fabian , Quaas Alexander , Plum Patrick , Bruns Christiane J. , Gebauer Florian , Popp Felix 
Published: December 2019

Abstract
Background
To date, patients with metastasized pancreatic ductal adenocarcinoma (PDAC M1) are regarded as a uniform collective. We hypothesize the existence of oligometastatic disease (OMD): a state of PDAC M1 disease with better tumor biology, limited metastasis, and increased survival.

Methods
Data of 128 PDAC M1 patients treated at the University of Cologne between 2008 and 2018 was reviewed. Interdependence between clinical parameter was calculated using the Mann-Whitney U-Test. Survival curves were generated using the Kaplan-Meier method and analyzed using the log-rank test.

Results
Eighty-one (63%) patients had metastases confined to one organ (single organ metastasis, SOG) whereas the remaining 47 (37%) showed multiple metastatic sites (multi-organ metastasis, MOG). Survival analysis revealed a median overall survival (OS) of 12.2 months for SOG vs 4.5 months for MOG (95% CI 5.7–9.8; p < 0.001). We defined limited disease by the presence of ≤4 metastases in liver or lung. Limited disease together with CA 19–9 baseline < 1000 U/ml and response or stable disease after first-line chemotherapy defined OMD. We identified 8 patients with hepatic metastases and 2 with pulmonary metastases matching all OMD criteria. This group of 10 (7.8%) had a median overall survival of 19.4 vs 7.2 months compared to the remaining patients (95% CI 5.7–9.8; p = 0.009).

Conclusion
We propose a definition of oligometastatic disease in PDAC including anatomical criteria and biological criteria reflecting better tumor biology. The 10 OMD patients (7.8%) survived significantly longer and might even benefit from surgical resection in the future.
Impact of dexamethasone-sparing regimens on delayed nausea caused by moderately or highly emetogenic chemotherapy: a meta-analysis of randomised evidence
Authors: Celio Luigi , Bonizzoni Erminio , Zattarin Emma , Codega Paolo , de Braud Filippo , Aapro Matti 
Published: December 2019

Abstract
Background
Nausea can be particularly prominent during the delayed period. Therefore, we performed a meta-analysis of the available randomised evidence to assess the average effect of palonosetron plus one-day dexamethasone (DEX; also called the DEX-sparing strategy) compared with palonosetron plus 3-day DEX for control of chemotherapy-induced nausea and vomiting (CINV), focusing on delayed nausea.

Methods
Eligible studies were identified through MEDLINE, Embase, and CENTRAL. Data on acute and delayed CINV were collected. Efficacy end points were complete response (CR; no vomiting, and no use of rescue medication), complete protection (CP; CR plus no clinically significant nausea), and total control (TC; CR plus no nausea) during the delayed period (days 2–5 after chemotherapy initiation). All randomised studies comparing palonosetron plus single-dose DEX (with or without another active agent) on day 1 followed by either no further DEX or additional DEX doses (both alone or in combination with another active agent) qualified.

Results
Of 864 citations screened, 8 studies with 1970 patients were included in the meta-analysis. During the delayed period, the combined odds ratio (OR) for all comparisons was 0.92 (95% confidence interval [CI], 0.76–1.12) for CR, 0.85 (95% CI, 0.71–1.03) for CP, and 0.92 (95% CI, 0.77–1.11) for TC in patients undergoing moderately emetogenic chemotherapy (MEC) or anthracycline and cyclophosphamide-containing chemotherapy (AC). The absolute risk difference (RD) computations for all end points in the delayed period did not exceed the threshold of − 4% (range, − 1% to − 4%). The effect was similar in subgroups defined by various study design parameters. The absolute RD computations in the acute period did not exceed the threshold of 1% (range, 0 to 1%). For one-day vs. 3-day DEX, numbers needed to be treated in order for one additional patient to not experience CR, CP and TC over the delayed period were 100, 25 and 50, respectively.

Conclusions
This meta-analysis demonstrates that DEX-sparing regimens do not cause any significant loss in protection against not only vomiting but also nausea induced by single-day MEC or AC during the delayed period. These data should lead clinicians to optimise use of prophylactic DEX in clinical practice.
An analysis about heterogeneity among cancers based on the DNA methylation patterns
Authors: Liu Yang , Gu Yue , Su Mu , Liu Hui , Zhang Shumei , Zhang Yan 
Published: December 2019

Abstract
Background
It is generally believed that DNA methylation, as one of the most important epigenetic modifications, participates in the regulation of gene expression and plays an important role in the development of cancer, and there exits epigenetic heterogeneity among cancers. Therefore, this study tried to screen for reliable prognostic markers for different cancers, providing further explanation for the heterogeneity of cancers, and more targets for clinical transformation studies of cancer from epigenetic perspective.

Methods
This article discusses the epigenetic heterogeneity of cancer in detail. Firstly, DNA methylation data of seven cancer types were obtained from Illumina Infinium HumanMethylation 450 K platform of TCGA database. Then, differential methylation analysis was performed in the promotor region. Secondly, pivotal gene markers were obtained by constructing the DNA methylation correlation network and the gene interaction network in the KEGG pathway, and 317 marker genes obtained from two networks were integrated as candidate markers for the prognosis model. Finally, we used the univariate and multivariate COX regression models to select specific independent prognostic markers for each cancer, and studied the risk factor of these genes by doing survival analysis.

Results
First, the cancer type-specific gene markers were obtained by differential methylation analysis and they were found to be involved in different biological functions by enrichment analysis. Moreover, specific and common diagnostic markers for each type of cancer was sorted out and Kaplan-Meier survival analysis showed that there was significant difference in survival between the two risk groups.

Conclusions
This study screened out reliable prognostic markers for different cancers, providing a further explanation for the heterogeneity of cancer at the DNA methylation level and more targets for clinical conversion studies of cancer.