bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combining therapy with recombinant human endostatin and cytotoxic agents for recurrent disseminated glioblastoma: a retrospective study
Authors: Ge Jing-jing , Li Cheng , Qi Shao-pei , Xue Feng-jun , Gao Zhi-meng , Yu Chun-jiang , Zhang Jun-ping 
Published: January 2020

Abstract
Background
The optimal chemotherapeutics of recurrent disseminated glioblastoma has yet to be determined. We analyzed the efficacy and safety of recombinant human endostatin (rh-ES) combined with temozolomide and irinotecan in patients with recurrent disseminated glioblastoma.

Methods
We retrospectively reviewed 30 adult patients with recurrent disseminated glioblastoma treated with this combination chemotherapy at Department of Neuro-Oncology, Sanbo Brain Hospital, Capital Medical University of China from November 2009 to August 2018. Temozolomide was given orally at 200 mg/m2 daily for 5 days and rh-ES was administrated 15 mg/d daily for 14 days of each 28-day treatment cycle. Irinotecan was given intravenously every 2 weeks on a 28-day cycle at 340 mg/m2 or 125 mg/m2 depending on antiepileptic drugs. Primary endpoint was progression-free survival (PFS) at 6 months (6 m-PFS).

Results
The 6 m-PFS was 23.3%. The median PFS was 3.2 months. The overall survival rate (OS) at 12 months was 28.6%. The median OS was 6.9 months. Six out of 30 (20%) patients demonstrated partial radiographic response and 11 (36.7%) remained stable. The PFS of the 6 patients who got partial response was 5.8, 6.3, 6.9, 13.6, 15.8 and 16.6 months, respectively, and the median time interval of first response was 4 (range, 2.0–6.6) months. The most common adverse events were hematologic toxicities and gastrointestinal effects. The Grade ≥ 3 adverse event was hematologic toxicities. The adverse events were manageable.

Conclusions
Rh-ES, in combination with cytotoxic drugs, was an alternative effective regimen with manageable toxicities in treatment of recurrent disseminated glioblastoma.
Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis
Authors: Shen Yu , Lin Xiaoqin , Zhang Luyi , Wu Miaoqin 
Published: January 2020

Abstract
Background
The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane peeling in large macular holes (MH).

Methods
Related studies were reviewed by searching electronic databases of Pubmed, Embase, Cochrane Library. We searched for articles that compared inverted ILM flap technique with ILM peeling for large MH (> 400 μm). Double-arm meta-analysis was performed for the primary end point that was the rate of MH closure, and the secondary end point was postoperative visual acuity (VA). Heterogeneity, publication bias, sensitivity analysis and subgroup analysis were conducted to guarantee the statistical power.

Results
This review included eight studies involving 593 eyes, 4 randomized control trials and 4 retrospective studies. After sensitivity analysis for eliminating the heterogeneity of primary outcome, the pooled data showed the rate of MH closure with inverted ILM flap technique group was statistically significantly higher than ILM peeling group (odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.89 to 8.27; P = 0.0003). At the follow-up duration of 3 months, postoperative VA was significantly better in the group of inverted ILM flap than ILM peeling (mean difference (MD) = − 0.16, 95% CI = − 0.23 to 0.09; P < 0.00001). However, there was no difference in visual outcomes between the two groups of different surgical treatments at relatively long-term follow-up over 6 months (MD = 0.01, 95% CI = − 0.12 to 0.15; P = 0.86).

Conclusion
Vitrectomy with inverted ILM flap technique had a better anatomical outcome than ILM peeling. Flap technique also had a signifcant visual gain in the short term, but the limitations in visual recovery at a longer follow-up was found.
Comparison of cytokine levels in the aqueous humor of polypoidal choroidal vasculopathy and neovascular age-related macular degeneration patients
Authors: Zhou Huiying , Zhao Xinyu , Yuan Mingzhen , Chen Youxin 
Published: January 2020

Abstract
Background
The concentrations of cytokines in the aqueous humor from neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) may vary. The study was conducted to compare various cytokine levels in the aqueous humor of eyes with PCV, nAMD and control.

Methods
The present case control study included 49 treatment-naïve eyes from 49 patients (PCV 24, nAMD 11, and cataract 14 eyes). Totally 34 angiogenic and inflammatory cytokines in the aqueous humor were measured by Luminex bead-based multiplex array.

Results
After adjusting for gender and age by multivariate logistic analysis, concentrations of IL-31, LIF, SDF1-α, VEGF-A, VEGF-D were significantly higher in eyes with nAMD or PCV compared with control eyes (all P < 0.05, times in nAMD: 59.5, 6.0, 7.0, 4.5, 5.6, respectively, times in PCV: 51.9, 5.21, 6.6, 4.0, 5.1, respectively), and concentrations of HGF, IP-10, MCP-1, IL-13 were significantly lower in eyes with nAMD or PCV than in control eyes (all P < 0.05, times in nAMD: 2.6, 2.0, 4.5, 4.7, respectively, times in PCV: 1.9, 3.0, 3.0, 2.8, respectively), but none of the 34 cytokines, including VEGF and IL-8, showed significantly different between eyes with nAMD and PCV.

Conclusions
Various cytokines involved in inflammation and angiogenesis including elevated IL-31, LIF, SDF1-α, VEGF-A, VEGF-D might be involved in the pathogenesis of nAMD or PCV. None of the 34 cytokines may help to differentiate nAMD and PCV.
Hypertension and diabetes treatment affordability and government expenditures following changes in patient cost sharing in the “Farmácia popular” program in Brazil: an interrupted time series study
Authors: Emmerick Isabel Cristina Martins , Campos Mônica Rodrigues , da Silva Rondineli Mendes , Chaves Luisa Arueira , Bertoldi Andréa Dâmaso , Ross-Degnan Dennis , Luiza Vera Lucia 
Published: January 2020

Abstract
Background
Increasing medicines availability and affordability is a key goal of Brazilian health policies. “Farmácia Popular” (FP) Program is one of the government’s key strategies to achieve this goal. Under FP, antihypertension (HTN) and antiglycemic (DM) medicines have been provided at subsidized prices in private retail settings since 2006, and free of charge since 2011. We aim to assess the impact of sequential changes in FP benefits on patient affordability and government expenditures for HTN and DM treatment under the FP, and examine their implications for public financing mechanisms and program sustainability.

Methods
Longitudinal, retrospective study using interrupted time series to analyze: HTN and DM treatment coverage; total and per capita expenditure; percentage paid by MoH; and patient cost sharing. Analyzes were conducted in the dispensing database of the FP program (from 2006 to 2012).

Results
FP has increased its coverage over time; by December 2012 FP covered on average 13% of DM and 11.5% of HTN utilization, a growth of over 600 and 1500%, respectively. The overall cost per treatment to the MoH declined from R$36.43 (R$ = reais, the Brazilian currency) to 18.74 for HTN and from R$33.07to R$15.05 for DM over the period analyzed, representing a reduction in per capita cost greater than 50%. The amount paid by patients for the medicines covered increased over time until 2011, but then declined to zero. We estimate that to treat all patients in need for HTN and DM in 2012 under FP, the Government would need to expend 97% of the total medicines budget.

Conclusions
FP rapidly increased its coverage in terms of both program reach and proportion of cost subsidized during the period analyzed. Costs of individual HTN and DM treatments in FP were reduced after 2011 for both patients (free) and government (better negotiated prices). However, overall FP expenditures by MoH increased due to markedly increased utilization. The FP is sustainable as a complementary policy but cannot feasibly substitute for the distribution of medicines by the SUS.
Comprehensive knowledge of HIV prevention among fishing communities of Lake Kyoga, Uganda, 2013
Authors: Kwagonza Leocadia , Bulage Lilian , Okello Paul Edward , Kusiima Joy , Kadobera Daniel , Ario Alex Riolexus 
Published: January 2020

Abstract
Background
Compared to the general population in Uganda, fishing communities suffer greater burden of HIV/AIDS. We determined the level of comprehensive knowledge on HIV prevention and its associated factors among fishing communities of Lake Kyoga.

Methods
We conducted secondary analysis of data from the Lake Kyoga Behavioral Survey, a population-based sample survey on behavioral risk factors for HIV, syphilis, and schistosomiasis among adults in fishing communities of Lake Kyoga in 2013. We defined comprehensive knowledge as having correct knowledge on HIV prevention (consistent condom use, faithfulness, a healthy-looking person can have HIV, and HIV cannot be transmitted through food-sharing, witchcraft or handshake). We used logistic regression to determined potential factors associated with comprehensive knowledge on HIV prevention and control for confounding.

Results
Of 1780 persons in the sample, 51% (911/1780) were females. The mean age was 32 (range: 15–97) years. Overall, 51% (899/1780) of persons had comprehensive knowledge on HIV prevention. Level of comprehensive knowledge on HIV prevention was similar between females (52%, 449/911) and males (49%, 450/869). Males (76%, 658/869) had lower knowledge on HIV transmission from mother to child during breast feeding compared to females (81%, 738/911) (p-value 0.019). Fishermen (46%,324/711) who lived > 5 km away from a health center compared to 54% (572/1066) who lived within 5 km radius were less likely to have comprehensive knowledge on HIV prevention (PRRadj = 0.8; 95%CI = 0.5–0.92). Those who had ever tested for HIV were more likely to have comprehensive knowledge of HIV transmission (PRRadj = 1.1; 95% 1.03–1.70).

Conclusion
Half of the population of Lake Kyoga fishing community had comprehensive knowledge of HIV prevention. Long distances from health facilities reduced the level of comprehensive knowledge on HIV transmission. HIV testing increased the level of comprehensive knowledge on HIV transmission. Ministry of health should ensure that HIV/AIDS information; education and communication and HIV counseling and testing activities are intensified in fishing communities of Lake Kyoga, with more emphasis on communities living in distances of more than 5 km away from the health facility.
Burden of neck pain among medical students in Ethiopia
Authors: Weleslassie Gidey Gomera , Meles Hagazi Gebre , Haile Tsiwaye Gebreyesus , Hagos Gebreslassie Kahsay 
Published: January 2020

Abstract
Background
Neck pain is the major cause of morbidity and absenteeism from university lessons among medical students worldwide. Medical students are more exposed and appear to have neck pain because of their length of study to achieve their professional goals. However, up to the knowledge of the researcher, there is a scarcity of literature conducted on prevalence and associated factors of neck pain among medical students in Ethiopia. Therefore, the aim of this study was to determine the prevalence and factors associated with neck pain among medical students at Mekelle University, College of Health Sciences, Tigray, Ethiopia.

Method
Institutional based cross-sectional study was conducted from April 2018 to May 2018. A structured questionnaire adapted from the Nordic musculoskeletal questionnaire was distributed to 422 participants using a self-administered questionnaire in Mekelle University, College of Health Sciences Tigray, Ethiopia. Independent variables which had a significant association were identified using logistic regression models. Results were reported by using texts and frequency distribution tables.

Result
A total of 422 participants involved in this study, with a 99.3% response rate. Previous 12 months self-reported prevalence of neck pain among medical students was found to be 49.2% with 95%CI (44.5–54%). Previous history of neck pain (AOR: 11.811, 95%CI: 5.460–25.549), physical exercise (AOR: 2.044, 95%CI: 1.233–3.387), duration of reading (AOR: 1.502, 95%CI: 0.236–2.780) and awkward posture (AOR: 3.87, 95%CI: 2.311–6.484) were factors significantly associated with neck pain.

Conclusion and recommendation
The current study showed that nearly half of the study participants self-reported to have suffered neck pain in the preceding 12 months. Past history of neck pain, physical exercise, duration of reading and awkward neck posture are likely to be significantly associated neck pain among medical students in Ethiopia. Engaging in consistent physical exercise has a protective effect against neck pain. Therefore, Medical students are recommended to carry out a regular physical exercise for a minimum of twenty to thirty minutes per day.
Concomitant bilateral elastofibroma in the infrascapular and gluteal regions: a report of a rare case
Authors: Al Dandan Omran , Hassan Ali , Al Muhaish Mona , AlMatrouk Jumanah , Almuhanna Haidar , Hegazi Tarek 
Published: January 2020

Abstract
Background
Elastofibroma is a benign soft tissue tumor characterized by the presence of elastic fibers in a stroma of collagen and mature adipose tissue. It is reported to have a prevalence of 2.73%, as shown by a study through computed tomography (CT) images. However, multiple elastofibromas are uncommon.

Case presentation
We report a case of concomitant bilateral elastofibroma in the infrascapular and gluteal regions. A 63-year-old male patient presented with a 6-month history of gradually increasing painless swellings in the upper back. On physical examination, firm, painless bilateral infrascapular masses were identified; these masses were more noticeable on forward arm flexion. Contrast-enhanced computed tomography showed well-defined bilateral infrascapular masses deep to the serratus anterior muscles as well as poorly defined bilateral gluteal masses with attenuation similar to that of the adjacent skeletal muscle. Magnetic resonance imaging revealed heterogenous masses with internal fatty streaks, consistent with elastofibroma. The histopathological diagnosis of elastofibroma was established based on the results of image-guided core-needle biopsy. The patient underwent surgical excision of both infrascapular elastofibromas with no post-operative complications. As the gluteal masses were incidental, surgical management was not warranted.

Conclusion
The presence of multiple elastofibromas is unusual. This report describes a rare case of multiple elastofibromas and its typical imaging features, and alerts us that elastofibromas are not exclusive to the periscapular region.
New parathyroid function index for the differentiation of primary and secondary hyperparathyroidism: a case-control study
Authors: Guo Yanhong , Wang Qin , Lu Chunyan , Fan Pianpian , Li Jing , Luo Ximing , Chen Decai 
Published: January 2020

Abstract
Background
Patients with primary hyperparathyroidism (PHPT) may be asymptomatic, and some may present with normocalcemic PHPT (NPHPT). Patients with vitamin D deficiency may also be asymptomatic, with normal calcium and elevated PTH concentrations. These latter patients are usually diagnosed with vitamin D deficiency-induced secondary hyperparathyroidism (VD-SHPT). Therefore, it is very difficult to distinguish PHPT and NPHPT from VD-SHPT based on calcium or PTH concentrations in clinical settings. In this case-control study, we aimed to verify the diagnostic power of a new parathyroid function index (PFindex = Ca*PTH/P).

Methods
This study enrolled 128 patients with surgically and pathologically confirmed PHPT, including 36 with NPHPT, at a hospital in West China between January 2009 and September 2017. Thirty-seven patients with VD-SHPT and 45 healthy controls were selected from the population of a cross-sectional epidemiological study as the SHPT and healthy groups, respectively. We used the PFindex to describe the characteristics of PHPT, NPHPT, and VD-SHPT.. Differences between the four groups were compared, and a receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic power of PFindex.

Results
The PHPT group had the highest PFindex (454 ± 430), compared to the other three groups (NPHPT: 101 ± 111; SHPT: 21.7 ± 6.38; healthy: 12.2 ± 2.98, all p < 0.001). A PFindex cut-off value of 34 yielded sensitivity and specificity rates of 96.9 and 97.6% and of 94.4 and 94.6% for the diagnoses of PHPT and NPHPT, respectively. The use of a PFindex > 34 to differentiate NPHPT from VD-SHPT yielded the highest positive likelihood ratio and lowest negative likelihood ratio.

Conclusion
The PFindex provided excellent diagnostic power for the differentiation of NPHPT from VD-SHPT. This simple tool may be useful for guiding timely decision-making processes regarding the initiation of vitamin D treatment or surgery for PHPT.
Utilization of dental services and associated factors among preschool children in China
Authors: Gao Xiaoli , Ding Min , Xu Mengru , Wu Huijing , Zhang Chunzi , Wang Xing , Feng Xiping , Tai Baojun , Hu Deyu , Lin Huancai , Wang Bo , Zheng Shuguo , Liu Xuenan , Rong Wensheng , Wang Weijian , Wang Chunxiao , Si Yan 
Published: January 2020

Abstract
Background
This study sought to evaluate dental utilization among 3-,4-, and 5-year-old children in China and to use Andersen’s behavioural model to explore influencing factors, thereby providing a reference for future policy making.

Methods
This study is a cross-sectional study. Data of 40,305 children aged 3–5 years were extracted from the Fourth National Oral Health Survey, which was performed from August 2015 to December 2016. Patient data were collected using a questionnaire, which was answered by the child’s parents, and clinical data were collected during a clinical examination. Stratification and survey weighting were incorporated into the complex survey design. Descriptive statistics, bivariate correlations and hierarchical logistic regression results were then analysed to find the factors associated with oral health service utilization.

Results
The oral health service utilization prevalence during the prior 12 months were 9.5% (95%CI: 8.1–11.1%) among 3-year-old children, 12.1% (95%CI: 10.8–13.5%) among 4-year-old children, and 17.5% (95%CI: 15.6–19.4%) among 5-year-old children. “No dental diseases” (71.3%) and “dental disease was not severe” (12.4%) were the principal reasons why children had not attended a dental visit in the past 12 months. The children whose parents had a bachelor’s degree or higher (OR: 2.29, 95%CI: 1.97–2.67, p < 0.001), a better oral health attitude ranging from 5 to 8(OR: 1.64, 95%CI: 1.43–1.89, p < 0.001), annual per capital income more than 25,000 CNY (OR: 1.40, 95%CI: 1.18–1.65, p < 0.001),think their child have worse or bad oral health (OR: 3.54, 95%CI: 2.84–4.40, p < 0.001), and children who often have toothaches (OR: 9.72, 95%CI: 7.81–12.09, p < 0.001) were more likely to go to the dentist in the past year.

Conclusion
The prevalence of dental service utilization was relatively low among preschool children. It is necessary to strengthen oral health education for parents and children, thereby improving oral health knowledge as well as attitude, and promoting dental utilization.
Implementing the theory-based advance care planning ACP+ programme for nursing homes: study protocol for a cluster randomised controlled trial and process evaluation
Authors: Gilissen Joni , Pivodic Lara , Wendrich-van Dael Annelien , Gastmans Chris , Vander Stichele Robert , Engels Yvonne , Vernooij-Dassen Myrra , Deliens Luc , Van den Block Lieve 
Published: January 2020

Abstract
Background
Research has highlighted the need for improving the implementation of advance care planning (ACP) in nursing homes. We developed a theory-based multicomponent ACP intervention (the ACP+ programme) aimed at supporting nursing home staff with the implementation of ACP into routine nursing home care. We describe here the protocol of a cluster randomised controlled trial (RCT) that aims to evaluate the effects of ACP+ on nursing home staff and volunteer level outcomes and its underlying processes of change.

Methods
We will conduct a cluster RCT in Flanders, Belgium. Fourteen eligible nursing homes will be pair-matched and one from each pair will be randomised to either continue care and education as usual or to receive the ACP+ programme (a multicomponent programme which is delivered stepwise over an eight-month period with the help of an external trainer). Primary outcomes are: nursing home care staff’s knowledge of, and self-efficacy regarding ACP. Secondary outcomes are: 1) nursing home care staff’s attitudes towards ACP and ACP practices; 2) support staff’s and volunteer’s ACP practices and 3) support staff’s and volunteers’ self-efficacy. Measurements will be performed at baseline and eight months post-measurement, using structured self-reported questionnaires. A process evaluation will accompany the outcome evaluation in the intervention group, with measurements throughout and post-intervention to assess implementation, mechanisms of impact and context and will be carried out using a mixed-methods design.

Discussion
There is little high-quality evidence regarding the effectiveness and underlying processes of change of ACP in nursing homes. This combined outcome and process evaluation of the ACP+ programme aims to contribute to building the necessary evidence to improve ACP and its uptake for nursing home residents and their family.

Trial registration
The study is registered at ClinicalTrials.gov (no. NCT03521206). Registration date: May 10, 2018. Inclusion of nursing homes started March, 2018. Hence, the trial was retrospectively registered but before end of data collection and analyses.