bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved Clinical Outcome Using Transarterial Chemoembolization Combined with Radiofrequency Ablation for Patients in Barcelona Clinic Liver Cancer Stage A or B Hepatocellular Carcinoma Regardless of Tumor Size: Results of a Single-center Retrospective Case Control Study
Authors: Ren Yanqiao , Cao Yanyan , Ma Hong , Kan Xuefeng , Zhou Chen , Liu Jiacheng , Shi Qin , Feng Gansheng , Xiong Bin , Zheng Chuansheng 
Published: October 2019

Abstract
Background To determine the safety and efficacy of transarterial chemoembolization (TACE) combined with radiofrequency ablation (hereafter, TACE-RFA) in treating Barcelona Clinic Liver Cancer (BCLC) Stage A or B (hereafter, BCLC A/B) hepatocellular carcinoma (HCC) patients, and to explore the range of tumor sizes suitable for combination therapy. Methods This retrospective study assessed the consecutive medical records of HCC patients with BCLC A/B who received TACE-RFA or TACE from September 2009 to September 2018. Progression-free survival (PFS), overall survival (OS), therapeutic response, and complications were compared between the two groups. Results Among 2447 patients who received TACE-RFA or TACE, 399 eligible patients were enrolled in our study, including 128 patients in the TACE-RFA group and 271 patients in the TACE group. Compared with the TACE group, the PFS and OS rates of 1,3,5,8 years in the TACE-RFA group were significantly better, with higher objective tumor regression rate and better disease control rate. RFA treatment did not increase the risk of death in patients with HCC, and both liver subcapsular hematoma and bile duct injury were improved by symptomatic treatment.. Serum α-fetoprotein level and treatment method were important independent prognostic factors for OS, whereas albumin, hepatitis B and treatment method were important independent prognostic factors for PFS. Subgroup analysis showed that patients in the TACE-RFA group always showed better OS and PFS. Conclusions TACE-RFA had an advantage over TACE alone in prolonging PFS and improving OS in HCC patients with BCLC A/B, and can benefit patients regardless of tumor size.
Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study
Authors: Cui Xueliang , chen Hui , Ma Binbin , Fan Wenbin , Li He 
Published: October 2019

Abstract
Abstract
Background: Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs.
Methods: A retrospective review was performed on 60 three- and four-part PHFs . The outcomes were assessed for 35 patients in the LCP group and 25 in the LCP with fibular allograft (FA) group, with a mean age of 72.75 years (60 to 88), at a mean follow-up of 31.95 months (24 to 40). Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). Loss of anatomic fixation was defined if the varus malalignment of the neck-shaft angle (NSA) was more than 5° or if the change in HHH was more than 3 mm. The clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score.
Result: The average radiological changes were higher in the LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p<0.001] and NSA of 9.94° versus 3.12° [p﹤0.001 ]). The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p=0.024] and ASES score of 72.80 vs 78.64 [p=0.022]). The FA group showed better forward elevation (p=0.010) and abduction (p=0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p<0.001).
Conclusion: For comminuted PHFs in elderly patients, locking plate fixation with a fibular strut allograft showed satisfactory radiological and clinical outcomes.
Trial registration: ZDYJLY(2018)New-9.
Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University.
URL of registry: http://www.njzdyy.com. Date of registration: 2018-05-17
Key words: proximal humeral fracture; fibular allograft; locking plate; elderly patients
Quality of life and the prevalence of urinary incontinence after surgical treatment for gynecologic cancer: A questionnaire survey
Authors: Nakayama Noriko , Tsuji Tetsuya , Aoyama Makoto , Fujino Takafumi , Liu Meigen 
Published: October 2019

Abstract
Background Although there have been a number of reports on urinary voiding symptoms associated with surgical interventions for gynecologic cancer and post-voiding symptoms, there have been few reports on urinary storage symptoms such as urinary incontinence (UI) and overactive bladder (OAB). The purpose of this study was to examine the rates and impact on quality of life (QOL) of urinary storage symptoms after gynecologic cancer surgery.
Methods A questionnaire survey, including Japanese-language versions of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Overactive Bladder Symptom Score (OABSS), and Incontinence Impact Questionnaire-7 (IIQ-7), was distributed to gynecologic cancer patients who underwent hysterectomy between 2008 and 2013.
Results Of the 145 patients analyzed, 49 (33.8%) had UI pre-surgery and 76 (52.4%) had UI post-surgery, including 34 (35.4%) first-time UI patients, with a significant difference between pre- and post-surgery. Of the 49 subjects with UI pre-surgery, 43 (87.7%) had stress incontinence, while of the 76 patients with UI post-surgery, 44 (57.1%) had stress incontinence, and 24 (31.2%) had mixed incontinence. Seven (4.8%) subjects had OAB pre-surgery, whereas 19 (13.1%) had OAB symptoms post-surgery (including 15 first-time OAB patients), with a significant difference between pre- and post-surgery. IIQ-7 scores were markedly higher for patients with mixed incontinence post-surgery than for those with stress incontinence, indicating a lower QOL. Logistic regression analysis identified the number of Cesarean sections and days of urinary bladder catheterization as risk factors for postoperative UI.
Conclusions UI and OAB rates were higher after gynecologic cancer surgery than in the general female population. The mixed incontinence rate was markedly higher post-surgery; QOL was low for such patients due to the combination of urgency and stress incontinence. Multiple Cesarean sections and urinary bladder catheterization post-surgery were risk factors for post-surgical UI.
Controlled Trial to compare the Achilles Tendon load during running in flatfeet participants using a customized arch support orthoses vs an orthotic heel lift
Authors: Lee Kawin KW , Ling Samuel Ka Kin , Yung Patrick SH 
Published: October 2019

Abstract
Background: Achilles tendinopathy is one of the most common overuse injuries in running, and forefoot pronation, seen in flatfeet participants, has been proposed to cause additional loading across the Achilles tendon. Foot orthoses are one of the common and effective conservative treatment prescribed for Achilles tendinopathy, it works by correcting the biomechanical malalignment and reducing tendon load. Previous studies have shown reduction of Achilles Tendon load (ATL) during running by using customized arch support orthosis (CASO) or an orthotic heel lift (HL). However, there are still little biomechanical evidence and comparative studies to guide orthotic prescriptions for Achilles tendinopathy management. Therefore, this study seeks to investigate the two currently employed orthotic treatment options for Achilles tendinopathy: CASO and HL for the reduction of ATL and Achilles tendon loading rate (ATLR) in recreational runners with flatfeet.
Methods: 12 participants were recruited and run along the runway in the laboratory for three conditions: (1) without orthoses, (2) with CASO (3) with HL. Kinematic and kinetic data were recorded by 3D motion capturing system and force platform. Ankle joint moments and ATL were computed and compared within the three conditions.
Results: Participants who ran with CASO (p=0.001, d=0.43) or HL (p=0.001, d=0.48) associated with a significant reduction in ATL when compared to without orthotics. There was no difference between the two types of orthoses, the mean peak ATL of CASO was slightly lower than HL. Regarding the ATLR, both orthoses, CASO (p=0.003, d= 0.93) and HL (p=0.004, d= 0.78), exhibited significant lower value than the control but similarly, no significant difference was noted between them in which the use of CASO yielded a slightly lower loading rate than that of HL.
Conclusions: Both CASO and HL were able to cause a significant reduction in peak ATL and ATLR comparing to without orthotics condition. There were subtle but no statistically significant differences in the biomechanical effects between the two types of orthoses. The findings help to quantify the effect of CASO and HL on load reduction of Achilles tendon and suggests that foot orthoses may serve to prevent the incidence of Achilles tendon pathologies.
Multilevel modelling of factors associated with Caesarean Section in Ethiopia: Community Based Cross Sectional Study
Authors: Azene Abebaw Gedef , Aragaw Abiba Mihret , Gedefaw Mihretie 
Published: October 2019

Abstract
Objective: The aim of this study was to identify socio-demographic and health related factors associated with caesarean section in Ethiopia.
Results: A total of 256 mothers undergoing to CS among 7193 delivery. Average maternal age of a participant was 29.26 years and 80% of mothers having two and more children. A woman delivered in private institution was 30% (AOR=1.29; 95% CI: 1.25, 1.32) more likely undergoing CS as compared to home delivery. Factors associated with CS were higher education level (AOR= 1.09, 95% CI: 1.07, 1.12), preceding birth interval (AOR= 1.01; 95% CI: 1.00. 1.03), multiple pregnancy (AOR=1.11; 95% CI 1.08, 1.15), multiple parity (AOR=0.98; 95% CI:0.97, 0.99), large size the child (AOR=1.01; 95% CI: 1.001, 1.02), richest households (AOR = 0.98; 95% CI: 0.97, 0.99), rural residence (AOR = 0.98 95% CI:0.96, 0.99) and Addis Ababa (AOR=1.06; 95% CI: 1.04,1.09). As a conclusion and recommendation, the prevalence of CS higher in private institutions and Addis Ababa, so professionals should apply CS alone medical indication.
Second drug-eluting stent implantation versus coronary artery bypass grafting in treatment of young patients with left main and/or multivessel coronary disease
Authors: Chen Xue , Zhang Xuehui , Yan Yunfeng , Zhao Xin , Nie Maoxiao , Feng Tingting , Liang Zhe , Zhao Quanming 
Published: October 2019

Abstract
Background
Many studies have compared outcomes of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) for complex coronary artery disease (CAD). However, no trials have focused on young patients (< 45 years) with complex CAD. We conducted a retrospective evaluation to compare the outcomes of a 2nd drug-eluting stent and CABG in young patients with LM or three-vessel disease.
Methods
In the young patients with complex CAD who underwent PCI or CABG, Kaplan-Meier analysis and Cox regression before and after propensity-score matching were used to compare major adverse cardiac and cerebrovascular events (MACCE), including myocardial infarction (MI), stoke, death and repeat revascularization.
Results
During the follow-up, MACCE occurred in 20.5% of patients in the PCI group and 8.6% in the CABG group (hazard ratio [HR]: 3.263, 95% confidence interval [CI]: 1.379 to 7.722, p=0.007). Repeat revascularization occurred more frequently in the PCI group (18.9% vs. 3.7% respectively, HR: 6.968, 95% CI: 2.036 to 23.842, p=0.002). There were no significant differences in other endpoints. After propensity-score matching, no conclusions were changed.
Conclusions
In young patients with LM or three-vessel disease, PCI showed a higher incidence of MACCE, which was mainly driven by repeat revascularization. However that did not translate into hard endpoints differences. Therefore, PCI is an alternative treatment to CABG in young patients with complex CAD.
Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders
Authors: Laar Amos K. , Adler Alma J. , Kotoh Agnes M. , Legido-Quigley Helena , Lange Isabelle L. , Perel Pablo , Lamptey Peter 
Published: October 2019

Abstract
Background Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognised as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, however, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. Methods A total of 55 informants – comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policy makers – were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after informed consent. Results Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, the benefits, as well as drawbacks of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers – increasing providers’ knowledge on hypertension and patients’ awareness of same, there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence, and the phenomenon of medical pluralism in Ghana, were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and therefore similarly designed future programmes. Conclusions This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.
Rationale and Study Design: The Screening of Congenital Heart Disease by Cardiac Auscultation and 12-Leads Electrocardiograph Examination in First-grade Elementary School Children in Province of Yogyakarta, Indonesia
Authors: Dinarti Lucia Kris , Hartopo Anggoro Budi , Murni Indah Kartika , Dewanto Vera Christina , Pritazahra Armalya , Hadwiono Muhammad Reyhan , Anggrahini Dyah Wulan 
Published: October 2019

Abstract
Background Congenital heart diseases (CHD) cause declining of functional capacity, cyanosis, arrhythmia, stroke, and death in adulthood. The screening for congenital heart disease in children has not been established in Indonesia. This results in a relatively high prevalence of uncorrected CHD in adulthood, who mostly have developed pulmonary artery hypertension. The screening program by cardiac auscultation and electrocardiography (ECG) in schoolchildren has been proven to be feasible in developed countries, which may also be feasible in Indonesia.Aim This study was planned to test and assess CHD screening methods based on electrocardiography examination in school children.Methods We conducted a screening program in first grade elementary school children in the Province of Yogyakarta, Indonesia. The schools were determined by purposive sampling. Trained general practitioners in community health centers participated in the screening. The physical examinations were done, which focused on cardiac auscultation and ECG examination. Those who had abnormal findings underwent trans-thoracic echocardiography to confirm the CHD.Results We collaborated with local governments in recruiting the participating community health centers and elementary schools. A total of 130 elementary schools from 5 districts in Yogyakarta Province were recruited, all without prior information on students’ presentation of symptoms.Conclusions This study is the first screening program that focuses on heart diseases in elementary school students in Indonesia. The success and feasibility of this program will give a valuable impact on preventing CHD complications during adulthood.
The Effect of Occupational Stress on Depression and Insomnia: a Cross-sectional Study Among Employees in a Ghanaian Telecommunication Company
Authors: Kploanyi Emma Edinam , Dwomoh Duah , Dzodzomenyo Mawuli 
Published: October 2019

Abstract
Background Depression and insomnia are major psychiatric conditions that are predicted by occupational stress. However, the influence of occupational stress on these two conditions is under-explored in telecommunication companies, especially in Africa. This research was conducted to assess occupational stress in a Ghanaian telecommunication company and its effect on depression and insomnia.Methods An analytical cross-sectional study was conducted among employees at a telecommunication company in Accra. Structured self-administered questionnaires were used in collecting data from 235 respondents using simple random sampling. Chi-square test of independence and the Wilcoxon Rank-Sum test were employed to assess the significance of associations with subsequent sensitivity analysis using Multiple logistic, Poisson and Probit regression models. Occupational stress was matched on three variables: age of the workers, responsibility for dependents and work experience, to improve on the estimation of its impact on symptomatic depression and insomnia using the coarsened exact matching procedure.Results More males (52.8%) than females participated in this study. The age range for study participants was 20-49 years with a mean of 30.8 ± 6.9 years. The prevalence of occupational stress among the employees was 32.8% (95% CI= 26.7-38.8). More than half of respondents (51%) reported depressive symptoms in the past week and only a few (6%) reported being diagnosed with insomnia in the past year. Age, responsibility for dependents and work experience were the only background characteristics that were significantly associated with perceived occupational stress. After controlling for background characteristics, the estimated risk of reporting symptoms of depression among employees who perceived stress from work was only 5% higher [ARR; 95% CI=1.05 (0.94-1.17)] whereas it was 2.58 times the risk of reporting insomnia [ARR; 95% CI=2.58(0.83-8.00)] compared to those who did not perceive stress from their jobs. The relative risk reduced to 2.46[ARR; 95% CI=2.46(0.77-7.87)] and 1.03[ARR; 95% CI=1.03(0.91-1.17)] for insomnia and depression respectively after employing Poisson regression with CEM.Conclusion The study found a higher risk of insomnia among employees who reported occupational stress compared to those who did not. However, there was not enough statistical evidence to conclude that occupational stress was associated with depression among the study participants.
Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study
Authors: Wallin Amanda Regodón , Tielsch James M , Khatry Subarna K , Mullany Luke C , Englund Janet A , Chu Helen , LeClerq Steven C , Katz Joanne 
Published: October 2019

Abstract
Background: Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite (NVP) during pregnancy on birth outcomes in rural Nepal. Methods: Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011-2013. Symptoms of NVP were recorded monthly throughout pregnancy; exposure was defined as NVP at any point during pregnancy and by trimester. Adverse outcomes were low birth weight (LBW), preterm birth, and small for gestational age (SGA). Adjusted relative risk (RR) with 95% CIs is reported from Poisson regressions with robust variance. Results: Among 3,623 pregnant women, the prevalence of NVP was 49.5% (n=1793) any time during pregnancy and 60.6% (n=731) in the first trimester. Significantly higher RRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher RRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower RR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher RRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). Conclusions: NVP during pregnancy is associated with birth outcomes in a setting with limited resources, especially beyond the first trimester. Trial registration: ClinicalTrials.gov number (NCT01034254) Keywords: Nausea and vomiting in pregnancy, adverse birth outcomes, pregnancy, birthweight, low birth weight, small for gestational age, preterm birth, Nepal