bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of ophthalmic adverse events in patients treated with immune checkpoint inhibitor regimens: A systematic review and meta-analysis
Authors: Hou Yan-li , Wang Di-ya , Tian Ru-yue , Hu Jie-xuan , Wang Wei , Su Qiang , Wang Yan-ling , Burnier Miguel N. 
Published: October 2019

Abstract
Background We performed a systematic review and meta-analysis to evaluate the risks of ophthalmic adverse events (AEs) associated with immune checkpoint inhibitors (ICIs) in patients with solid tumors.Methods Eligible studies were selected after a comprehensive search of multiple databases including phase II/III randomized controlled trials (RCTs) investigating ICIs in patients with the solid tumor. The data was analyzed by R software.Results After exclusion of ineligible studies, 21 RCTs met our strict inclusion criteria for the meta-analysis, included 11930 patients. Compared with chemotherapy, the odds ratio of all-grade ophthalmic treatment-related adverse events (trAEs) were significantly lower for PD-L1 inhibitors (OR: 0.18; 95% CI: 0.08-0.39; p<0.0001) and PD-1 inhibitors (OR 0.44, 95% CI: 0.23-0.83, p<0.050). The combination therapy of PD-1 plus CTLA-4 inhibitors significantly increased the risks of all-grade ophthalmic trAEs (OR 5.29, 95% CI: 1.59-17.57, p<0.05) and all-grade ophthalmic immune-related AEs (irAEs) ( OR: 3.67; 95%CI: 1.08-12.50; p<0.05) compared with PD-1 or CTLA-4 inhibitors monotherapy. The combination therapy of ICIs plus chemotherapy also significantly increased the risks of all-grade ophthalmic trAEs (OR, 3.44; 95%CI, 1.72-6.88; p<0.001) and all-grade ophthalmic irAEs ( OR: 3.69; 95%CI: 1.32-10.32; p<0.05) compared with chemotherapy. The risks of high-grade ophthalmic AEs had no difference in any subgroup compared with control.Conclusions Our meta-analysis demonstrated that compared with chemotherapy, PD-L1/PD-1 inhibitors had lower risks of all-grade ophthalmic trAEs and non-specific ophthalmic trAEs (NS-trAEs) but had the same risk of ophthalmic irAEs. Combination therapy of ICIs plus chemotherapy had higher risks of all-grade ophthalmic trAEs and irAEs. Compared with PD-1 or CTLA-4 inhibitors monotherapy, PD-1 plus CTLA-4 inhibitors combination therapy had significantly higher risks of all-grade ophthalmic trAEs and irAEs.
Determinants of utilization of maternal health care services among mothers in Harare, Zimbabwe
Authors: Mundagowa Paddington Tinashe , Nyarambi Eunice , Chadambuka Elizabeth 
Published: October 2019

Abstract
Background: Provision of quality maternal health care services is an essential component in ensuring a healthy mother-baby dyad both pre- and post-delivery. In Africa, antenatal care, postnatal care, and skilled birth attendances are very low when compared to high-income countries. The continent has a high burden of maternal and infant morbidity as well as mortality rates. According to the Harare Annual Report of 2016, the number of women seeking maternal health care services was gradually declining from 2014 and pregnant women reported various challenges in accessing health care services. Methods: A 1 to 1 case-control study was conducted in Harare West South Western District using pretested interviewer-administered questionnaires. The study was carried out at all three clinics in the district and a total of 73 cases and 73 controls were selected using a systematic random sampling method. Quantitative data were analyzed using Epi Info statistical package and qualitative data was analyzed thematically. Results: The median ages for cases and controls were 29 and 24 years, respectively and the age-group 19 to 24 years constituted the majority of participants (41%). Predictors of utilization of services were young age ( < 24 years), birth order of < 2, maternal and paternal occupation, and religion. Enabling factors included: asking for permission to seek care, absence of transport challenges, a shorter distance to the health facility, affordability of health services, and a higher household income. Besides the shortage of skilled staff at the clinics, mothers endured long waiting hours to be served. The majority of the cases (78.1 %) and controls (72.6%) preferred to be attended by male nurses. Mothers were required to pay a $25 fee for booking and city medical staff rarely visited the clinics. Conclusion: The utilization of maternal health care services in Harare is dependent on the individual, household, and system-related factors. There was a need to articulate policies and design maternal health care programs that target socially and economically marginalized women. Creating women-friendly health facilities with extended hours for the antenatal care, delivery care and post-natal care services for mothers can help to decongest the health facilities.
Cardiac Surgical Outcome Prediction by Blood Pressure Variability Indices Poincaré plot and Coefficient of Variation: an Observational Study
Authors: K Senthil Packiasabapathy , Prasad Varesh , Rangasamy Valluvan , Popok David , Xu Xinling , Novack Victor , Subramaniam Balachundhar 
Published: October 2019

Abstract
Background Recent literature suggests a significant association between blood pressure variability (BPV) and postoperative outcomes after cardiac surgery. However, its outcome prediction ability remains unclear. Current prediction models use static preoperative patient factors. We aimed to test the performance of Poincaré plots and coefficient of variation (CV) independently by measuring intraoperative BP variability.Methods In this retrospective, observational, cohort study, 3687 adult patients undergoing cardiac surgery from 2008 to 2013 were included. Poincaré plots from BP data and descriptors SD1, SD2 by ellipse fitting technique were computed. The outcomes analyzed were the 30-day mortality and postoperative renal failure. Logistic regression models adjusted for preoperative and surgical factors were constructed to evaluate the association between BPV parameters and outcomes. C-statistics were used to analyse the predictive ability.Results Analysis found that, 99 (2.7%) patients died within 30 days and 105 (2.8%) patients suffered from in-hospital renal failure. Logistic regression models including BPV parameters (SD1, SD2 and CV) performed poorly in predicting postoperative 30-day mortality and renal failure. They did not add any significant value to the conventional prediction model.Conclusions We demonstrate the feasibility of applying Poincaré plots for BP variability analysis. Patient comorbid conditions and other preoperative factors are still the gold standard for outcome prediction. Future directions include analysis of dynamic parameters such as complexity of physiological signals in identifying high risk patients and tailoring management accordingly.
Fear-avoidance beliefs are associated with exercise compliance: Secondary analysis of a randomised controlled trial among female healthcare workers with recurrent low back pain
Authors: Taulaniemi Annika , Kankaanpää Markku , Rinne Marjo , Tokola Kari , Parkkari Jari , Suni Jaana Helena 
Published: October 2019

Abstract
Background Exercise is recommended for the treatment and management of low back pain (LBP) and the prevention of chronicity. Compliance with exercise has proved to be only modest in intervention studies among people with musculoskeletal pain. Fear-avoidance beliefs (FABs) are known to affect exercise adherence.The purpose of the study was twofold: to examine which bio-psycho-social factors contributed to exercise compliance during a 6-month neuromuscular exercise intervention among female healthcare workers with recurrent LBP, and to investigate how exercising affects FABs at 6 and 12 months’ follow-up.Methods A total of 219 healthcare workers aged 30–55 years with mild-to-moderate re-current non-specific LBP were originally allocated to four groups (exercise, counselling, combined exercise and counselling, control). In the present study, the exercise groups (exercise only and exercise + counselling) and non-exercise groups (counselling only and control) were merged. Baseline factors of the exercise compliers (exercising ≥24 times over 24 weeks; n=58) were compared to those of the non-compliers (exercising <1 time/week, 0–23 times; n=52). The effects of the exercise programme on FABs were analysed by a generalised linear mixed model according to the intention-to-treat principle (exercisers; n= 110 vs non-exercisers; n=109) at three measurement points (baseline, 6, and 12 months). A per-protocol analysis compared the more exercised to the less exercised and non-exercisers.Results A low education level (p=0.026), shift work (p=0.023), low aerobic (p=0.048) and musculoskeletal (p=0.043) fitness level, and high FABs related to physical activity (p=0.019) at the baseline contributed to lower exercise compliance. The exercise programme reduced levels of both physical activity- and work-related FABs, and there was a dose response: FABs reduced more in persons with better exercise compliance.Conclusion Healthcare workers who had lower education and fitness levels, worked shifts, and had high physical activity-related FABs had a lower compliance to the 6-month neuromuscular exercise programme. Exercising with good compliance reduced levels of FABs, which are known to be linked with prolonged LBP. In exercise interventions, motivational strategies should be targeted at persons with low education and fitness levels and high FABs in order to achieve better exercise compliance.
Is arthroscopic decompression better than conservative management for shoulder impingement? A systematic review and meta-analysis
Authors: Liu Shujing , Yu Yingying , Lu Guangxu , Dong Hui , Wang Wenliang 
Published: October 2019

Abstract
Background Arthroscopic decompression is commonly used to treat shoulder impingement, while the role of conservative treatment in these patients remains unclear. The objective of this paper is to synthesise available evidence regarding the effectiveness of subacromial decompression for shoulder impingement compared with conservative treatment to verify whether arthroscopic surgery is superior to conservative treatment. Methods We systematicly retrieved the Cochrane databases, Embase as well as Pubmed (from inception to July. 02, 2019) for randomized controlled trials. Cochrane risk-of-bias tool was used to assess all referred studies’ quality and we pooled outcomes with a random-effects model. We divided the outcomes into short-term subgroup(<2 years) and long-term subgroup (≥2 years). Results 7 randomised controlled trials (RCTs) were included, involving a total of 607 patients, 297 patients operated arthroscopic decompression, compared to 310 patients treated with conservative management. We found no significant differences either in shoulder pain scores or shoulder function scores between arthroscopic decompression and conservative management wether in long-term or short-term follow-up subgroups. Conclusion No significant difference was demonstrated on the treatment outcomes of shoulder impingement between arthroscopic decompression and conservative management in our meta-analysis. Thus, we suggested that conservative management should be chosen firstly for patients with shoulder impingement, when patients’ symptom cannot be relieved from the conservative treatment, arthroscopic decompression should be taken into consideration.Levels of Evidence Level-I study
1-1-8 one-step sevoflurane wash-in scheme for low-flow anesthesia: simple, rapid, and predictable induction
Authors: Tribuddharat Sirirat , Sathitkarnmanee Thepakorn , Vattanasiriporn Naruemon , Thananun Maneerat , Nonlhaopol Duangthida , Somdee Wilawan 
Published: October 2019

Abstract
Background Sevoflurane is suitable for low-flow anesthesia (LFA). LFA needs a wash-in phase. The reported sevoflurane wash-in schemes lack simplicity, target coverage, and applicability. We proposed a one-step 1-1-8 wash-in scheme for sevoflurane LFA to be used with both N 2 O and Air. The objective of our study was to identify time for achieving each level of alveolar concentration of sevoflurane (F A S) from 1% to 3.5% in both contexts.Methods We recruited 199 adults requiring general anesthesia with endotracheal intubation and controlled ventilation—102 in group N 2 O and 97 in group Air. After induction and intubation, a wash-in was started using a fresh gas flow of O 2 :N 2 O or O 2 :Air at 1:1 L·min -1 plus sevoflurane 8%. The ventilation was controlled to maintain end-tidal CO 2 of 30-35 mmHg.Results The rising patterns of F A S and inspired concentration of sevoflurane (F I S) are similar, running parallel between the groups. The F A S/F I S ratio increased from 0.46 to 0.72 within 260 sec in group N 2 O and from 0.42 to 0.69 within 286 sec in group Air. The respective time to achieve an F A S of 1%, 1.5%, 2%, 2.5%, 3%, and 3.5% was 1, 1.5, 2, 3, 3.5, and 4.5 min in group N 2 O and 1, 1.5, 2, 3, 4, and 5 min in group Air. The heart rate and blood pressure of both groups significantly increased initially then gradually decreased as F A S increased.Conclusions The 1-1-8 wash-in scheme for sevoflurane LFA has many advantages, including simplicity, coverage, swiftness, safety, economy, and that it can be used with both N 2 O and Air. A respective F A S of 1%, 1.5%, 2%, 2.5%, 3%, and 3.5% when used with N 2 O and Air can be expected at 1, 1.5, 2, 3, 3.5, and 4.5 min and 1, 1.5, 2, 3, 4, and 5 min. This scheme may be applied for sevoflurane LFA in situations where an anesthetic gas analyzer is unavailable.
Lived experiences of patients with idiopathic pulmonary fibrosis: navigating through the complex healthcare system
Authors: Lyu Yang , Jia Yanrui , Gao Fengli , Huang Yaling , Lin Frances 
Published: October 2019

Abstract
Background : Over the last decade, idiopathic pulmonary fibrosis (IPF) has been attracting health care professionals’ attention worldwide due to its impact on poor survival rate and quality of life, such as ongoing physical and emotional distress experienced by patients and their families. The diagnosis and management of IPF patients often remain as a significant challenge for clinicians. Therefore, it is imperative to gain an in-depth understanding on experiences of IPF patients during their disease journey in order to improve the care delivered to this vulnerable group. The aim of this study was to explore the lived experiences of the disease journey and care needs of patients with IPF. Methods : A semi-structured face-to-face one on one interview was conducted with a purposive sampling of 16 IPF patients admitted to a respiratory medicine department of a tertiary hospital in Beijing, China. The consolidated criteria for reporting qualitative research checklist was used. Results : Four themes emerged from the qualitative data included the long and confusing journal to reach diagnosis, living with the disease, understanding the disease and treatment, and desire for continuity of care. Conclusions : The findings provide an in-depth understanding of the lived experience of the disease journey and the care needs in patients with IPF. There is an urgent need to improve the care delivery to this vulnerable population. To meet the health demands of this group of patients, it is of paramount importance to develop effective education programs for health professionals and IPF patients and also to improve the care models of healthcare systems, especially in the remote area in order to enhance the principle of continuing care for IPF patients in the communities.
Diagnostic procedure for idiopathic eosinophilic pleural effusion: A single-center experience
Authors: Luo Weizhan , Zeng Yunxiang , Shen Panxiao , He Jianxing , Wang Jinlin 
Published: October 2019

Abstract
Background: Eosinophilic pleural effusion (EPE) is attributed to many known and obvious causes, but some patients remain idiopathic even after thorough clinical work-up. The present study aims to better characterize idiopathic EPE (IEPE) and to outline the diagnostic procedure for this disease. Methods: The complete clinical data of eleven prospectively collected consecutive patients with IEPE were analysed and preliminary diagnostic procedure of IEPE in our hospital was performed. Results: All the 11 patients had respiratory symptoms and unilateral pleural effusion (PE) occurred in 4 patients. The mean percentage of eosinophils in PE was 22.4% (range, 12.4%-50.5%). Lactate dehydrogenase, adenosine deaminase, protein and carcinoembryonic antigen in PE were 246.0 U/L (range, 89.8-421.9 U/L), 13.8 U/L (range, 1.8-24.0 U/L), 42.6 g/dl (range, 32.8-52.6 g/dl) and 2.17 mg/mL (range, 0.46-4.31 mg/mL), respectively. A parasite-specific IgG antibody in blood and parasite eggs in stool were negative. No evidence of tuberculosis or malignancy was observed in pleural biopsy. Symptoms and abnormal pulmonary imaging were eliminated after glucocorticoid use. Conclusions: IEPE is a diagnosis of exclusion. Patients with EPE without a clear cause should be asked for complete medical, surgical and drug-related history, and we recommend a thorough work-up and follow-up after the use of glucocorticoid until the effusion does not reappear.
Association of ADHD symptoms, depression and suicidal behaviors with anxiety in Chinese medical college students
Authors: Shen Yanmei , Zhang Yaru , Chan Bella Siu Man , Meng Fanchao , Yang Tingyu , Luo Xuerong 
Published: October 2019

Abstract
Background Anxiety is one of the most common psychiatric disorders and imposes a great burden on both individuals and societies. Previous studies indicate a high comorbidity of anxiety disorders and Attention Deficit Hyperactivity Disorder (ADHD). However, few studies have examined the comorbidity of anxiety and ADHD among medical college students in mainland China. This study aimed to examine the prevalence of anxiety and the associated risk factor of anxiety disorder as well as to explore the association between ADHD symptoms, depression, suicidal behaviors and anxiety.Methods A cross-sectional design was employed among 4882 medical college students who were recruited and enrolled with convenience sampling. Self-reported demographic information and clinical characteristics were collected online on a computer or through a social media app named Wechat. Results: The prevalence of anxiety in this study was 19.9%. Students with anxiety were more likely to have a poor relationship with parents, be of Han nationality, have smoking or drinking habits, have an extensive physical disorder history and have engaged in suicidal behaviors. The independent risk factors for anxiety were: smoking, physical disorder history, suicidal ideations, suicide attempts, inattention and hyperactivity. Significant associations were observed between anxiety and depression, inattention, hyperactivity, suicide plans and suicide attempts. Limitations: The participants were mainly females.Conclusions Nearly 1 in five medical students suffered from anxiety. The findings of this study indicate the importance of addressing both anxiety and ADHD symptoms in order to better promote mental health and the well-being of medical students as well as reduce suicidal behaviors.
Ameliorative Effects of Jasmonic Acid and Humic Acid on Antioxidant Enzymes and Salt Tolerance of Forage Sorghum under Salinity Conditions
Authors: Ali Adam Yousif Adam , Ibrahim Muhi Eldeen Hussien , Zhou Guisheng , Nimir Nimir Eltyb Ahmed , Jiao Xiurong , Zhu Guanglong , Elsiddig Aboagla Mohammed Ibrahim , Zhi Wenfang , Chen Xubing , Lu Haitong 
Published: October 2019

Salinity is one of the most important factors that reduce the growth and antioxidant defense of plants. A controlled pot experiment was conducted to investigate the ameliorative effects of jasmonic acid (JA) priming (0, 5, and 10 mM) and humic acid (HA) (0, 3, and 6 g HA kg−1 soil) amendment on antioxidant enzymes and salt tolerance of forage sorghum seedling (Sorghum bicolor L.) grown under three salinity conditions (0, 100, and 200 mM NaCl). Salinity stress reduced emergence seedling index (ESI), promptness index (PI), emergence stress tolerance index (ESTI), dry weight stress tolerance index (DWSTI), and the activities of the peroxidase (POD) and catalase (CAT) enzymes. The activity of superoxide dismutase (SOD) and malondialdehyde (MDA) content increased with salinity. Application of JA positively affected all parameters except CAT and MDA. Humic acid significantly increased all measured parameters except ESTI, DWSTI, and SOD activity. At the 200 mM NaCl level, JA and HA increased CAT, POD, SOD, ESI, DWSTI, ESTI, PI, and MDA as compared with the control. The application of HA at 6 g kg−1 soil decreased SOD and ESI relative to the control at high salinity. The application of 10 mM JA combined with HA at 6 g kg−1 soil was most effective in alleviating salinity stress. Therefore, the combined application of JA and HA on forage sorghum may improve salt tolerance and increase antioxidant enzymes that alleviate damages caused by salinity stress.Core Ideas

Application of jasmonic acid and humic acid (HA) mitigated salinity stress.
Jasmonic acid (JA) and HA increased the antioxidant enzymes.
Applying a combination of JA and HA at high levels of salinity improved salt tolerance.
Effects of Drought and Low Nitrogen Stress on Provitamin A Carotenoid Content of Biofortified Maize Hybrids
Authors: Ortiz‐Covarrubias Yadhira , Dhliwayo Thanda , Palacios‐Rojas Natalia , Ndhlela Thokozile , Magorokosho Cosmos , Aguilar‐Rincón Victor H. , Cruz‐Morales Andrea S. , Trachsel Samuel 
Published: October 2019

ABSTRACTMaize (Zea mays L.) hybrids with enhanced provitamin A (proVA) content have been deployed in sub‐Saharan Africa, where low soil nitrogen and drought stress are common. The objectives of this study were to assess: (i) the effects of drought and low‐N stress on grain proVA content of hybrids with enhanced proVA content, and (ii) the inheritance of proVA carotenoids under these stress conditions. An 11‐line diallel cross (55 F1 crosses) was evaluated for carotenoid content and grain yield under optimum conditions, drought, and low‐N stress. Compared with the optimum treatment, mean proVA was lower under both stress treatments. The consistency of genetic effects across stress treatments suggested that hybrids with improved proVA content can be developed for a broad range of environments, provided they are sufficiently adapted. General combining ability (GCA) was significant (P < 0.01), and accounted for >85% of the variation among hybrids, whereas specific combining ability (SCA) effects were generally weak (P < 0.05), accounting for 5 to 15% of hybrid sums of squares across the three treatments. These results indicated that the inheritance of proVA was not affected by stress treatments. A negative correlation between grain yield and proVA carotenoids was detected, but the data suggested that it was caused by the genetic background of the germplasm used rather than pleiotropy. Our results provide insights that may help breeders design effective breeding strategies to develop proVA‐enriched cultivars for resource‐limited farming systems.