bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acceptability and consumption of tofu as a meat alternative among secondary school boarders in Enugu State, Nigeria
Authors: Eze Ngozi M. , Okwume Ukamaka G. , Eseadi Chiedu , Udenta Elizabeth A. , Onyeke Nkechi G. , Ugwu Elizabeth N. , Akubue Benedette N. , Njoku Helen A. , Ezeanwu Amaka B. 
Published: November 2018

Abstract
Tofu, a food made of condensed soymilk that originated in China, has both nutritional and health benefits. The main objective of this study was to determine the acceptability and consumption of tofu as a meat alternative among students in boarding secondary schools in Enugu State, Nigeria.
In this study, the authors adopted a cross-sectional analytic design. A representative sample of 603 adolescents in the boarding secondary schools took part in the study. Power analysis was conducted to estimate the appropriate sample size for the current study. Correlations analysis, moderation analysis, χ
2, analysis of variance (ANOVA), and t tests were employed for the analysis of the data.
Students’ acceptance of the 3 cooking options of tofu (steamed, boiled, and fried) did not significantly differ by gender. It was found that 94.5% of the respondents recognized the benefits of tofu; there is no significant difference between the male and female students on the extent to which they would eat tofu in school; the recognition of benefits of tofu is not significantly associated with acceptance of steamed, boiled, and fried tofu among the students; and the recognition of benefits of tofu is not significantly associated with consumption of tofu among the students. The finding further revealed that gender did not significantly moderate the association between recognition of benefits of tofu and students’ acceptability of tofu. Also, it was found that gender did not significantly moderate the association between recognition of benefits of tofu and consumption of tofu among students.
Further research is needed to identify the level of tofu acceptability and consumption among adolescents in boarding secondary schools in other states of Nigeria. Further research on factors influencing how recognition of benefits of tofu is associated with its acceptability among the Nigerian student population can have implications for nutritional counseling and regional health.
Clinical results of closed versus mini-open reduction with percutaneous pinning for supracondylar fractures of the humerus in children
Authors: Tomori Yuji , Nanno Mitsuhiko , Takai Shinro 
Published: November 2018

Abstract
To compare the clinical outcomes of 2 procedures, closed or mini-open reduction with percutaneous pinning (ORPP), for the treatment of supracondylar fractures of the humerus in children.
Patients aged less than 15 years who had undergone surgery for supracondylar fracture of the humerus between 2004 and 2013 were identified. The case records and radiographs from 34 patients were reviewed. Twenty-one patients had undergone closed reduction followed by percutaneous pinning (CRPP), while 13 had undergone mini-open reduction through the anterior approach with percutaneous pinning (mini-ORPP). The average age of the patients at the time of surgery was 5.4 (1–13) years in the CRPP group and 5.4 (2–9) years in the mini-ORPP group. The average age of the patients at the time of surgery was 5.4 (1–13) years in the CRPP group and 5.4 (2–9) years in the mini-ORPP group. Based on the Gartland classification system, the CRPP group included 12 type 2 and 9 type 3 fractures, while the mini-ORPP group included 4 type 2 and 9 type 3 fractures. The average postoperative follow-up duration was 8 (3–21) months in the CRPP group and 10 (3–10) months in the mini-ORPP group. The investigated parameters were postoperative complications, radiographic evaluation, and clinical evaluation, including range of motion (ROM) and Flynn's criteria. To evaluate the deformity of the humerus, Baumann's angle and the carrying angle (CA) were calculated on anteroposterior radiographs.
Although no patient showed loss of reduction, deep infection, or neurovascular complications, 1 patient in the CRPP group had a cubitus varus deformity. The average CA loss in the injured elbow compared with the CA of the contralateral side was significantly larger in the CRPP group than the mini-ORPP group. In accordance with Flynn's criteria, the results in the CRPP group were excellent in 12 patients, good in 8, and poor in 1; the results in the mini-ORPP group were excellent in 12, and good in 1.
To eliminate the possibility of postoperative cubitus varus deformity, the mini-ORPP is the optimal procedure for supracondylar fracture of the humerus in children.
Association between the aspartic acid D-repeat polymorphisms and osteoarthritis susceptibility
Authors: Wang Honglin , Zhang Xu , Wu Wentao , Zhang Mingyue , Sam Napoleon Bellua , Niu Lei 
Published: November 2018

Abstract

Objectives:
Association between the D-repeat of asporin (ASPN) gene and osteoarthritis (OA) was still inconsistent. We performed this meta-analysis to systematically assess the D-repeat polymorphisms in OA susceptibility.

Methods:
Relevant studies were enrolled by searching databases. Odd ratios (ORs) with 95% confidence intervals (95% CIs) were used for evaluating the association between ASPN gene and OA. Heterogeneity was calculated using the Q statistic, and three different subgroup analyses were performed on ethnicity, gender, and OA positions respectively. False discovery rate (FDR) was applied to regulate the multiple comparisons.

Results:
Twelve qualified articles involving 5190 OA patients and 5167 healthy controls were included. With D13 polymorphism, Caucasian male patients have low OA susceptibility (P = .008, P
FDR = .024, OR [95% CI] = 0.83 [0.73–0.95]). As to D14 polymorphism, all male patients (P = .0004, P
FDR = .001, OR [95% CI] = 1.38 [1.15–1.64]), Asian male patients (P = .01, P
FDR = .01, OR [95% CI] = 1.72 [1.11–2.66]), and Caucasian male patients (P = .005, P
FDR = .001, OR [95% CI] = 1.32 [1.09–1.60]) have high OA susceptibility. In the pooled-population of KOA with D14 polymorphism, overall male patients (P = .03, P
FDR = .045, OR [95% CI] = 1.35 [1.02–1.78]) and Asian male patients (P = .01, P
FDR = .03, OR [95% CI] = 1.72 [1.11–2.66]) have high OA risk. With D16 polymorphism, Latin America patients may have high OA risk (P = .04, P
FDR = .15, OR [95% CI] = 1.43 [1.02–2.01]).

Conclusion:
Our results suggest that D-repeat of ASPN gene is mainly associated with male patients. The D13 polymorphism plays a protective role for OA in Caucasians male individuals while D14 plays a risk factor for KOA in male patients.
Clinical signs of retroperitoneal abscess from colonic perforation
Authors: Ruscelli Paolo , Renzi Claudio , Polistena Andrea , Sanguinetti Alessandro , Avenia Nicola , Popivanov Georgi , Cirocchi Roberto , Lancia Massimo , Gioia Sara , Tabola Renata 
Published: November 2018

Abstract

Rationale:
Retroperitoneal colonic perforation is a rare cause of retroperitoneal abscess. It presents, more frequently in frail elderly patients, with heterogeneous signs and symptoms which hamper the clinical diagnosis. Subcutaneous emphysema with pneumomediastinum and iliopsoas muscle abscess are unusual signs. Colonic retroperitoneal perforation may be consequent to diverticulitis or locally advanced colon cancer. Due to the anatomy of the retroperitoneal space and different physiopathology, diverticular perforation may present with air and pus collection; on the other hand perforated colon cancer may cause groin mass and psoas abscess. We reported 2 cases of colonic retroperitoneal perforation from diverticulitis and locally advanced colon cancer, respectively. Aim of this report is to improve differential diagnosis based on clinical signs.

Patients’ concerns:
A 71-year-old man presented with pain in his left side, fatigue, fever, nausea, massive subcutaneous emphysema of the neck, and Blumberg sign in the left iliac fossa. A 67-year-old man presented with abdominal pain, sub-occlusion, left groin mass, left groin, and lower limb pain during walking, negative Blumberg sign.

Diagnosis:
In the first patient the computerized tomography revealed pneumoperitoneum, gas in the mesosigma, pneumomediastinum, wall thickening of the descending colon, and retroperitoneal collection from diverticular perforation. In the second patient abdominal CT scan found thickening of the sigmoid colon adherent to the iliopsoas and fluid collection.

Interventions:
In the first patient, a left hemicolectomy extending to the transverse colon, followed by a toilette and debridement of the retroperitoneum were performed. In the second patient, tumor of descending colon perforated in the retroperitoneum with iliopsoas abscess was treated with left hemicolectomy and a drainage of the abscess.

Outcomes:
The first patient underwent right colectomy with ileostomy in the 7th postoperative day for large bowel necrosis. He died of sepsis 2 days after. The second patient had regular postoperative and he is still alive.

Lessons:
The spread of retroperitoneal abscess in complicated colonic diverticulitis is different from that in advanced colonic cancer. The former can present with a subcutaneous emphysema, the latter with a groin mass. Hence a thorough clinical examination and radiological studies are needed to diagnose these conditions.
Retrospective analysis of 52 patients with prolactinomas following endoscopic endonasal transsphenoidal surgery
Authors: Han Yan-Long , Chen Dong-Ming , Zhang Cheng , Pan Miao , Yang Xiao-Peng , Wu Yong-Gang 
Published: November 2018

Abstract

Background:
Prolactinomas affect patients’ quality of life and even endanger lives. The study aimed to investigate the effect of the endoscopic endonasal transsphenoidal approach (EETA) on 52 patients with prolactinomas.

Methods:
A total of 52 patients with prolactinomas who had previously undergone EETA in the People's Hospital of Xinjiang Uygur Autonomous Region between January 2013 and December 2017 were retrospectively analyzed. Factors affecting the extent of resection and postoperative remission rates were also investigated.

Results:
All the patients were pathologically diagnosed with prolactinomas. Compared with giant adenomas, the total removal rate of microadenomas and macroadenomas was significantly increased (P < .05). In addition, the total removal rate of patients with noninvasive prolactin adenomas was significantly higher than patients with invasive prolactinadenomas (P < .05). Furthermore, there were no significant differences in postoperative remission rates among patients with prolactin adenomas from different ethnic groups (P > .05). Also preoperative administration of bromocriptine and preoperative prolactin (PRL) levels did not significantly affect therapeutic outcomes postsurgery (P > .05). Postoperative menstruation was improved or normalized in 20 (38.5%) female patients, vision was improved or normalized in 15 (28.8%) patients, and headaches were improved or normalized in 22 (42.3%) patients. Sexual function was improved in 2 male patients following surgery. A total of 6 patients exhibited a recurrence following surgery. A number of patients suffered from postoperative complications, including transient diabetes insipidus in 5 (9.6%) patients and postoperative transient cerebrospinal fluid leakage in 2 (3.8%) patients.

Conclusion:
The results of this study demonstrated that tumor size, preoperative PRL levels, and invasion of adenomas represent independent factors that can affect the success of surgery. The results suggested that EETA represents a therapeutic strategy for the treatment of patients with prolactinoma with high remission rates and low complication rates. Therefore, EETA should be considered a primary treatment for patients with prolactinomas who are not responsive to treatment with medical therapy.
Different weight shift trainings can improve the balance performance of patients with a chronic stroke
Authors: Liao Wan-Chun , Lai Chung-Liang , Hsu Pi-Shan , Chen Kun-Chung , Wang Chun-Hou 
Published: November 2018

Abstract

Background:
Improving balance ability, increasing walking ability, and reducing the occurrence of falls are important objectives in the rehabilitation of stroke patients. Do the posture balance training and the intervention of lateral wedge insoles to improve of balance function and increase walking ability in patients with a chronic stroke?

Methods:
A randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blinded assessors. Participants who had a chronic stroke (onset >6 months) were recruited from the rehabilitation and neurology departments of a hospital in central Taiwan. Subjects were divided into 3 groups: a visual biofeedback balance training group, a lateral wedge group, and a control group; apart from their usual rehabilitation program, and both experimental groups received a 6-week training session program. The primary outcome was the balance computerized adaptive test (balance CAT), and secondary outcome was timed up and go (TUG) test. All subjects were evaluated at the baseline, posttraining (6-week), 1st follow-up (10-week), and 2nd follow-up (18-week).

Results:
A total of 56 subjects were participated in this study, including 38 males and 18 females. The mean age of the subjects was 59.1 years old, and the mean time was 43.7 months after the onset of the stroke. This study found the interaction in groups and measurement time points reached statistical significance of the balance CAT and TUG test (F = 5.740, P < .001; F = 2.926, P = .011; respectively). In addition, the performance of both the visual biofeedback training and lateral wedge group was superior to that of the control group.

Conclusion:
Six-week visual biofeedback training and intervention of 5° lateral wedge insoles can improve the balance ability of patients with a chronic stroke.

Trial registry:

http://www.chictr.org.cn, ChiCTR-IPR-15007092.
Vaginal delivery in a pregnant woman with cord prolapse, velamentous cord insertion, and fetal vertex presentation
Authors: Li Pei-Chen , Ding Dah-Ching 
Published: November 2018

Abstract

Rationale:
We report a rare case of a pregnant woman with cord prolapse, velamentous cord insertion (VCI), and fetal vertex presentation who completed vaginal delivery.

Patient concerns:
Without having undergone regular antepartum examinations, a 31-year-old pregnant woman, gravida 6, para 4, abortion 1, presented at 37 weeks and 3 days of gestation. She had regular labor pain and bloody show.

Diagnoses:
Cord prolapse during labor and VCI after delivery.

Interventions:
Per vaginal examination at 11:20 pm revealed a fully dilated cervix. Thirty minutes later, artificial rupture of the membrane was performed, and an overt prolapsed cord approximately 10-cm long was palpated in the vagina. Fetal heartbeat decelerated to 60 bpm. After fundal pushing for some minutes, a female baby weighing 2130 g was delivered at 11:54 pm with a pediatrician on standby. Apgar scores were 7 (0 minute), 9 (5 minutes), and 10 (10 minutes). The placenta weighed 870 g and was delivered 5 minutes later, and VCI was discovered.

Outcomes:
Her postpartum course was uncomplicated and both the patient and infant were discharged 3 days later.

Lessons:
A pregnant woman with umbilical prolapse, VCI, and a fetal vertex presentation can successfully deliver a baby through the vagina. Factors contributing to the success of the reported vaginal delivery might have been a small fetus, multipara status, and immediate management.
Exploration of Mindfulness Among Ethnic Minority Undergraduate Nursing Students
Authors: Young-Brice Amber , Thomas Dreifuerst Kristina 
Published: November 2018

Background
Meeting projected needs for ethnically diverse nurses depends on a strong pipeline of diverse students within nursing programs. Colleges assume students readily navigate the university; however, this may not be the reality especially among ethnic minority students.

Purpose
The purpose was to explore the concept of mindfulness among ethnic minority nursing students. Exploring mindfulness, and a lack thereof, may provide strategies for overcoming challenges ethnic minority students experience in prelicensure nursing programs.

Methods
A qualitative study using thematic analysis of semistructured in-depth interviews was conducted with 20 ethnic minority undergraduate nursing students.

Results
Themes that emerged reveal positive associations of mindfulness and negative implications when there is a lack of mindfulness.

Conclusion
Based on the findings from this study, using consistent mindfulness techniques could positively influence coping skills for dealing with the stressors of college, resulting in overall success and retention of ethnic minority and first-generation students in a nursing program.
Early Peritoneal Dialysis and Major Adverse Events After Pediatric Cardiac Surgery: A Propensity Score Analysis*
Authors: Namachivayam Siva P. , Butt Warwick , Millar Johnny , Konstantinov Igor E. , Nguyen Cattram , d’Udekem Yves 
Published: November 2018

Objectives:
Early peritoneal dialysis may have a role in modulating the inflammatory response after cardiopulmonary bypass. This study sought to test the effect of early peritoneal dialysis on major adverse events after pediatric cardiac surgery involving cardiopulmonary bypass.

Design:
In this observational study, the outcomes in infants post cardiac surgery who received early peritoneal dialysis (within 6 hr of completing cardiopulmonary bypass) were compared with those who received late peritoneal dialysis. The primary outcome was a composite of one or more of cardiac arrest, emergency chest reopening, requirement for extracorporeal membrane oxygenation, or death. Secondary outcomes included duration of mechanical ventilation, length of intensive care, and hospital stay. A propensity score methodology utilizing inverse probability of treatment weighting was used to minimize selection bias due to timing of peritoneal dialysis.

Setting:
Cardiac ICU, The Royal Children’s Hospital, Melbourne, VIC, Australia.

Patients:
From 2012 to 2015, infants who were commenced on peritoneal dialysis after cardiac surgery were included.

Measurements and Main Results:
Among 239 eligible infants, 56 (23%) were commenced on early peritoneal dialysis and 183 (77%) on late peritoneal dialysis. At 90 days, early peritoneal dialysis as compared with late peritoneal dialysis was associated with a decreased risk of primary outcome (relative risk, 0.16; 95% CI, 0.05–0.47; p < 0.001 and absolute risk difference, –18.1%; 95% CI, –25.1 to –11.1; p < 0.001). Early peritoneal dialysis was also associated with a decrease in duration of mechanical ventilation and intensive care stay. Among infants with a cardiopulmonary bypass greater than 150 minutes, early peritoneal dialysis was also associated with a survival advantage (relative risk, 0.14; 95% CI, 0.03–0.84; p = 0.03 and absolute risk difference, –7.8; 95% CI, –13.6 to –2; p = 0.008).

Conclusions:
Early peritoneal dialysis in infants post cardiac surgery is associated with a decrease in the rate of major adverse events. The role of early peritoneal dialysis warrants the conduct of randomized trials both in high and low-to-middle income countries; any beneficial effects if confirmed have the potential to strongly influence outcomes for children born with congenital heart disease.
Confronting Subconscious Bias
Authors: Dreisinger Naomi , Soorma Haresh 
Published: November 2018

Abstract
Physicians are only human. Upon graduating from medical school, physicians take an oath declaring veracity and fidelity toward our patients. We are told to lay aside negative feelings toward patients in exchange for integrity, truth, honor, and compassion. The idea is simple, but following through on it is quite a challenge. Pediatric emergency medicine physicians generally have rapid focused patient interactions, yet even in these brief encounters, instantaneous and subconscious reactions to difficult patients occur. Difficult patients are those who raise negative feelings within the clinician such as anxiety, frustration, guilt, and dislike. Recognition of these reactions and emotions will help physicians understand more about themselves, and assist in interacting more favorably with challenging patients. It is common for doctors to attempt to suppress their human reactions to maintain clinical objectivity, yet these reactions facilitate a better doctor-patient relationship. Allowing ourselves to yield to our emotions help the patient realize that the physician is a human being.
Reflexive Laboratory-Based Cryptococcal Antigen Screening and Preemptive Fluconazole Therapy for Cryptococcal Antigenemia in HIV-Infected Individuals With CD4 <100 Cells/µL: A Stepped-Wedge, Cluster-Randomized Trial
Authors: Meya David B. , Kiragga Agnes N. , Nalintya Elizabeth , Morawski Bozena M. , Rajasingham Radha , Park Benjamin J. , Mubiru Anthony , Kaplan Jonathan E. , Manabe Yukari C. , Boulware David R. ,   on behalf of the ORCAS study team
Published: November 2018

Background:
HIV-infected persons with cryptococcal antigenemia (CrAg) are at high risk for meningitis or death. We evaluated the effect of CrAg screening and preemptive fluconazole therapy, adjunctive to antiretroviral therapy (ART), on 6-month survival among persons with advanced HIV/AIDS.

Methods:
We enrolled HIV-infected, ART-naive participants with <100 CD4 cells/µL, in a stepped-wedge, cluster-randomized trial from July 2012 to December 2014 at 17 Ugandan clinics. Clinics participated in a prospective observational phase, followed by an interventional phase with laboratory-based, reflexive CrAg screening of residual CD4 count plasma. Asymptomatic CrAg+ participants received preemptive fluconazole therapy. We assessed 6-month survival using Cox-regression, adjusting for nadir CD4, calendar time, and stepped-wedge steps.

Results:
We included 1280 observational and 2108 interventional participants, of whom 9.3% (195/2108) were CrAg+. CD4-, time-, and stepped-wedge–adjusted analyses demonstrated no difference in survival in the observational vs the interventional arms (hazard ratio = 1.34; 95% confidence interval: 0.86 to 2.10; P = 0.20). Fewer participants initiated ART in the interventional (73%) versus the observational phase (82%, P < 0.001). When ART initiation was modeled as a time-dependent covariate or confounder, survival did not differ. However, 6-month mortality of participants with CrAg titers <1:160 and CrAg-negative patients did not differ. Patients with CrAg titers ≥1:160 had 2.6-fold higher 6-month mortality than patients with titers <1:160.

Conclusions:
We observed no overall survival benefit of the CrAg screen-and-treat intervention. However, preemptive antifungal therapy for asymptomatic cryptococcosis seemed to be effective in patients with CrAg titer <1:160. A more aggressive approach is required for persons with CrAg titer ≥1:160.
The impact of frailty on acute care general surgery patients: A systematic review
Authors: Ward Mellissa A. R. , Alenazi Abdullah , Delisle Megan , Logsetty Sarvesh 
Published: November 2018

BACKGROUND
Frailty may predict negative health outcomes more accurately than chronological age alone. This review examines evidence for the impact of frailty on adverse outcomes in patients admitted with an acute care general surgery (ACS) diagnosis.

METHODS
A systematic literature search for studies reporting frailty and outcomes after admission with an ACS diagnosis was performed. We searched PubMed and SCOPUS from inception until September 2017.

RESULTS
A total of 8,668 records were screened, of which seven studies examined the relationship between frailty and outcomes in ACS patients. Frailty was associated with higher 30-day mortality patients (odds ratio, 3.04; 95% confidence interval, 2.67–3.46; p < 0.01), postoperative complications, length of stay, institutional discharge, and critical care admission.

CONCLUSIONS
There is emerging evidence that frailty is associated with worse outcomes in patients with an unplanned admission due to an ACS diagnosis. Further investigation is warranted with regard to how frailty may impact patients with an acute illness more severely.

LEVEL OF EVIDENCE
Systematic review, level III.