bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for postpartum haemorrhage in women with histologically verified placenta accreta spectrum disorders: a retrospective single-centre cross-sectional study
Authors: Ghaem Maghami Naghmeh , Helfenstein Fabrice , Manegold-Brauer Gwendolin , Amstad Gabriela 
Published: November 2023

Abstract
Background
Placenta accreta spectrum (PAS) disorders have been reported with an increasing frequency of up to 3%. The increase in the incidence can be explained by the rising rate of Caesarean section (CS), assisted reproductive technology (ART) and previous uterine surgeries. PAS disorders are usually associated with postpartum haemorrhage (PPH). In our study, we investigated the risk factors for increased blood loss in women with histologically verified PAS disorders independent of delivery mode.

Methods
In a retrospective single-centre cross-sectional study, 2,223 pregnant women with histologically verified PAS disorders were included. Risk factors for PPH in women with PAS disorders were examined and compared between women with PPH (study group; n = 879) and women with normal blood loss (control group; n = 1150), independent of delivery mode. PAS disorders were diagnosed histologically from the following specimens: placenta, placental-bed specimens, uterine curettage, uterine resection and/or total/partial hysterectomy. Medical data were extracted from clinical records of pregnant women with PAS disorders delivering at the University Hospital Basel between 1986 and 2019. The placenta data of women with PAS disorders were obtained and identified through a search from the database of the Department of Pathology, University Hospital Basel.

Results
Between 1986 and 2019, there were 64,472 deliveries at the University Hospital Basel. PAS disorders were histologically verified in 2,223 women (2,223/64,472), and the prevalence of PAS disorders was 3.45%. A total of 879 women with PAS disorders showed PPH, independent of delivery mode (43.3%). Due to missing data for 194 women, the final analysis was conducted with the remaining 2,029 women. Placenta praevia (O.R. = 6.087; 95% CI, 3.813 to 9.778), previous endometritis (O.R. = 3.011; 95% CI, 1.060 to 9.018), previous manual placenta removal (O.R. = 2.530; 95% CI, 1.700 to 3.796), ART (O.R. = 2.169; 95% CI, 1.593 to 2.960) and vaginal operative birth (O.R. = 1.715; 95% CI, 1.225–2.428) can be considered important risk factors, and previous CS (O.R. = 1.408; 95% CI, 1.016 to 1.950) can be considered a moderate potential risk factor of PPH in women with PAS disorders.

Conclusions
Placenta praevia, previous endometritis, previous placenta removal, ART and vaginal operative birth can be considered important risk factors of PPH in women with PAS disorders.

Study registration
The study was registered under http://www.ClinicalTrials.gov (NCT05542043) on 15 September 2022.
Depression severity mediates stigma and quality of life in clinically stable people with schizophrenia in rural China
Authors: Zheng Siyuan , Wang Ruoqi , Zhang Shaofei , Ou Yangxu , Sheng Xuanlian , Yang Meng , Ge Menglin , Xia Lei , Li Jun , Zhou Xiaoqin 
Published: November 2023

Abstract
Background
Depressive symptoms associated with schizophrenia are closely related to stigma and quality of life(QOL). There is, however, no thorough research on the connection between the three. This study sought to investigate the possible factors influencing depressive symptoms in people with schizophrenia (PWS) in rural Chaohu, China, and to further explore the role of depression severity in stigma and lifestyle quality.

Methods
Eight hundred twenty-one schizophrenia patients accomplished the entire scale, including the 9-item Patient Health Questionnaire (PHQ-9), the Social Impact Scale (SIS), and the World Health Organization on Quality of Life Brief Scale(WHOQOL—BREF). A straightforward mediation model was employed to determine if the intensity of the depression could act as a mediator between stigma and QOL.

Results
Two hundred seventy-nine schizophrenia patients (34%) had depressive symptoms (PHQ ≥ 10), and 542 patients (66%) did not (PHQ < 10). Logistic regression showed that marital status, job status, physical exercise, standard of living, and stigma contributed to the depressed symptoms of schizophrenia. Depression severity partially mediated the effect between stigma and QOL, with a mediating effect of 48.3%.

Conclusions
This study discovered a significant incidence of depressed symptoms associated with schizophrenia, with depression severity serving as a mediator variable connecting stigma and QOL and partially moderating the association.
Comparison of temporary external and percutaneous k-wire fixations for treatment of ankle fracture–dislocations
Authors: Xie Wenjun , Li He , Zhang Cheng , Cui Xueliang , Zhang Sheng , Rui Yunfeng , Chen Hui 
Published: November 2023

Abstract
Purpose
Ankle fracture–dislocations are among the most severe injuries, and the use of an external fixator as a recommended fixation method has some disadvantages. The aim of this study was to compare the clinical outcomes and complication rates of external and K-wire fixations in the treatment of ankle fracture dislocations.

Methods
A total of 67 patients with ankle fracture–dislocations requiring temporary external or percutaneous K-wire fixation were included. The exclusion criteria were pilon fractures, open fractures, and those who required acute open reduction internal fixation (ORIF). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, a 10-point visual analog scale (VAS) score (range 0–10), and complications before and after the definitive surgery were recorded.

Results
A significant difference between the two groups was not observed for age, sex, affected side, fracture type, smoking status, or diabetes. The average AOFAS scores were 83.2 and 83.3, the median VAS scores were 3 and 3, and the complication rates were 32.4% and 6.7% in the external and K-wire fixation groups, respectively (p = 0.010). However, skin necrosis, re-dislocation of the ankle, surgical wound infection, and posttraumatic ankle osteoarthritis frequency were not significantly different between the groups, except for pin-sites infection (p = 0.036).

Conclusion
Ankle fracture–dislocations using percutaneous k-wire fixation showed a low rate of complications and favorable clinical outcomes. This method could be a good alternative treatment option for ankle fracture-dislocations.
Comparison between osteonecrosis of the humeral and femoral heads - epidemiological analysis of the surgical trend using the nationwide claims database of the republic of Korea
Authors: Jeong Hyeon Jang , Park Jung-Wee , Lee Young-Kyun , Koo Kyung-Hoi , Oh Joo Han 
Published: November 2023

Abstract
Backgrounds
The humeral head is the second most common site of osteonecrosis, after the femoral head. However, compared to osteonecrosis of the femoral head (ONFH), epidemiological information on osteonecrosis of the humeral head (ONHH) is scarce. We hypothesised that different biomechanical properties of the shoulder from the hip joint might present different epidemiological characteristics of ONHH from those of the ONFH. To evaluate epidemiological differences, we compared trends in the surgical treatment of ONHH and ONFH using the nationwide medical claims database of the Republic of Korea (ROK).

Methods
We analysed epidemiological data from the Health Insurance Review and Assessment (HIRA) database of the ROK between 2008 and 2018. HIRA database contains almost all medical information in an anonymised form, including demographics, diagnoses, and types of surgical procedures, generated through healthcare practices in ROK. The annual incidence rates of ONHH and ONFH were calculated based on the total number of the general population. Demographics, annual incidence, and the proportion of post-traumatic osteonecrosis and surgical procedures were compared according to the anatomical site and the affected year.

Results
The total number of patients treated for ONHH and ONFH during the study period was 1,028 and 66,260, respectively. Although the incidence of ONHH increased, it is a relatively rare disease compared to ONFH. ONHH occurred more frequently in females, while ONFH occurred predominantly in male patients (p < 0.001). Surgical treatment for ONHH was most frequently performed in older patients (63.7%), whereas middle-aged patients had the largest proportion of ONFH (48.9%, p < 0.001). The proportion of post-traumatic osteonecrosis was significantly higher in the ONHH (5.1%) than in the ONFH (1.9%, p < 0.001). Arthroplasty was performed more frequently in the ONHH (96.0%) than in the ONFH (92.9%, p < 0.001).

Conclusion
Despite the anatomical similarities between the hip and shoulder joints, the different biomechanical properties, such as weight-bearing functions, might cause epidemiological differences between ONHH and ONFH.
Lip and tongue strength associated with chewing patterns in aging population
Authors: Huang Yi-Fang , Chang Wei-Han , Liao Yu-Fang , Chen Mei-Hui , Chang Chung-Ta 
Published: November 2023

Abstract
Background
Improving chewing function of older adults increases the health-related quality of life. Few studies indicated the correlation between tongue, lip strength on masticatory performance in older people. The study aimed to investigate the association between lip, tongue strength on chewing pattern in aging population.

Methods
The older adults had independent daily intake without assistance were enrolled. They had intact dentition and no periodontitis. To estimate the number of chewing strokes and chewing time by consuming a cornstarch cookie were used to represent chewing pattern. Lip and tongue pressure were evaluated with an Iowa Oral Performance Instrument. Linear regression analysis was used to analyze the lip and tongue pressure associated with the chewing time and strokes. Spearman’s correlation analysis was utilized to evaluate the associations among chewing time and chewing strokes or lip and tongue pressure.

Results
35 women and 35 men with an average age of 73.2 years were investigated. Tongue pressure was significantly related to the chewing time and the number of chewing strokes (p = 0.01 and 0.03). There was a close association between chewing time and the number of chewing strokes (p < 0.0001). The correlation between lip and tongue pressure was significant (p < 0.0001).

Conclusion
The tongue strength significantly related to chewing ability in aging population. Increasing the tongue strength greatly reduced the number of chewing strokes and chewing time. Good masticatory ability could increase the motor function of tongue; raising the tongue strength might be able to improve mastication in older adults.
Comparative evaluation of antimicrobial efficacy of different combinations of calcium hydroxide against Enterococcus faecalis
Authors: Teja Kavalipurapu Venkata , Janani Krishnamchari , Srivastava Kumar Chandan , Shrivastava Deepti , Natoli Valentino , Di Blasio Marco , Cicciu Macro , Minervini Giuseppe 
Published: November 2023

Abstract
Background
The study aims to compare the synergistic antibacterial efficacy of different combinations of calcium hydroxide as an intracanal medicament against E. faecalis.

Material and methods
The current study included four hundred extracted human permanent mandibular premolar teeth. After complete chemo-mechanical preparation, the middle third of the root was sectioned using a rotary diamond disc and a total of 400 samples were obtained. The specimens were inoculated with E. faecalis for 21 days. After that, specimens were divided into five groups (n = 80) based on materials used for the disinfection of samples: Group I, calcium hydroxide alone; Group II, calcium hydroxide + 2% chlorhexidine gel; Group III, calcium hydroxide + 2% chitosan gel; Group IV, calcium hydroxide + 0.02% silver nanoparticle gel; Group V, calcium hydroxide + Bioactive glass S53P4. Dentin shavings from the apical third were obtained from the inner third of dentin were obtained using gates glidden no.1 to the apical depth, followed by no.2, 3, 4 and 5 analyzed for E. faecalis using the culture method. One-way analysis of variance (ANOVA) was used for data analysis, followed by post-hoc Tukey's test for multiple comparisons of means to check the difference in bacterial inhibition between the groups.

Results
ANOVA results revealed a significant reduction of bacterial counts in all the groups compared (p < 0.001). Intergroup comparison showed maximum bacterial reduction (p < 0.001) with calcium hydroxide + bioactive glass S53P4 compared with other groups.

Conclusion
Synergistic effect of calcium hydroxide showed better bacterial reduction compared to calcium hydroxide alone. Among the combinations evaluated, calcium hydroxide with bioactive glass, found to be most effective compared to other groups.
Comparative analysis of periodontal pain and quality of life in patients with fixed multibracket appliances and aligners (Invisalign®): longitudinal clinical study
Authors: Alvarado-Lorenzo Alfonso , Antonio-Zancajo Laura , Baptista Hugo , Colino Gallardo Pedro , Albaladejo-Martinez Alberto , Garcovich Daniele , Alcon Silvia 
Published: November 2023

Abstract
Backgrounds
The aim of this longitudinal clinical study is to analyse and compare according to location, degree and type, the pain presented by patients during their first year of treatment, as well as the quality of oral life after the placement of two types of orthodontic appliances: conventional brackets and removable Invisalign ® aligners.

Methods
The sample consisted of 140 patients grouped into 2 study groups of 70 patients each. The first group (brackets group- BG), with fixed multibracket appliances, using the MBT technique and a 0.022” slot. The second group (invisaling group- IG), in treatment with removable aligners (IG), using the Invisalign ® system. They were providen with a questionnare where they had to record the degree (mild, moderate or intense), the type and location of the pain monthly during the first year of treatment. The second form was the Spanish version of the OHIP-14, oral quality of life questionnaire, which was provided the twelfth month after the start of treatment.

Results
In both groups, we found that the most frequent location of pain occurred during the first phase: mandibular for the IG group and maxillary in the BG group. Throughout the whole analysis, the intensity was mild-moderate with lower values in the conventional brackets’ group. The BG group reported acute pain while the IG group reported sensitive pain during the first month; later both reported sensitive pain.

Conclusions
There are differences in terms of periodontal pain in its degree, location, and type according to the different orthodontic techniques used.

Trial registration
The study was approved by the bioethics committee of the University of Salamanca (USAL_20/516).
Combination of metformin and double antibiotic paste for the regeneration of non-vital immature teeth: a preliminary randomized clinical study
Authors: Sobhnamayan Fereshte , Sahebi Safoora , Moazami Fariborz , Malekzadeh Parastoo , Hasani Soheila 
Published: November 2023

AbstractBackgroundThe present study aimed to investigate whether incorporating metformin in double antibiotic paste (DAP) can promote the regeneration process of non-vital immature teeth.MethodsOut of 32 pediatric patients undergoing regenerative endodontic procedures (REPs), 6 cases with a follow-up period of less than 12 months or lack of documentation were excluded then the remaining 26 were analyzed. 15 cases received DAP, and 11 cases received a DAP + metformin as the intra-canal medicament, kept for an average of 23 days. During 18 months of follow-up, clinical and radiographic examinations were performed to evaluate the treatment outcomes based on the resolution of apical periodontitis, root development, and the occurrence of intracanal calcification. The chi-square test was used for the statistical analysis (P < 0.05).ResultsAll patients demonstrated resolution of apical periodontitis; however, complete apical closure was only seen in 50% of the patients. The rate of apical closure and root length was significantly higher in the DAP + metformin group (P = 0.047), although the two groups were not significantly different in terms of root width (P = 0.184). Canal obliteration was seen in 15% of cases, all of which were in the DAP group.ConclusionsAccording to the present findings, metformin could promote root development in the regeneration process when incorporated in DAP.Trial registrationThis clinical trial was registered on the Iranian Registry of Clinical Trials (IRCT20200120046197N1) on 26.2.2021.
Investigating the level of satisfaction of policyholders with supplementary health insurance in Iran
Authors: Hamzeh Asma , Hozarmoghadam Nasrin , Ghanbarzadeh Mitra 
Published: November 2023

AbstractThe importance of customer satisfaction in business prosperity is undeniable, so many organizations consider customer satisfaction as the main driver of their business growth and try to keep their customers satisfied. The business market has never been so competitive in most areas. This is the reason why things like customer experience and customer loyalty are more and more important and are considered an indicator to measure the success of the business. Based on this, in this research, we will examine the level of satisfaction of insurance policyholders with supplementary health insurance services in Iran using the SERVQUAL model. This model is one of the most common models used in the field of quality assessment in the service sector. The method of conducting this research is a descriptive survey. The sampling method in the current research is simply random the statistical population is insurance policyholders and the sample number is 686 people from the society. The findings of the current research showed that there is a negative and significant gap in all dimensions of service quality.
An interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints: a feasibility study
Authors: Lygre Ragnhild B. , Gjestad Rolf , Norekvål Tone M. , Mercer Stewart W. , Elgen Irene Bircow 
Published: November 2023

Abstract
Background
Children and adolescents with complex health complaints are often referred to several different healthcare specialists for assessments and treatment. This may result in fragmented care, higher risks of medical errors, and sub-optimal health outcomes. The aim of this non-controlled open label trial was to evaluate the feasibility of implementing a new interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints and to gather experiences from participating children, adolescents and parents.

Methods
In all, 47 children and adolescents aged 6–16 years with multiple referrals at a tertiary hospital were invited to participate. The intervention was a half-day consultation based on a biopsychosocial model. The aim of the intervention was to clarify the child/adolescent’s condition(s) and provide a joint understanding and treatment plan in collaboration with the family. A team consisting of a pediatrician, a physiotherapist and a psychologist delivered the intervention. Acceptance and completion rate was recorded, and child- and parent-experience measures were collected; the children and adolescents completed the Visual Consultation and Relational Empathy Scale (CARE) five questions and parents completed two de novo created measures about their experiences.

Results
Almost all invited families consented to participate (96%) and ultimately received the interdisciplinary intervention (92%). Mean age of the children and adolescents was 12 years, and under half were boys (40%). Before the intervention, 39 (91%) parents completed a questionnaire about previous experiences with healthcare. After the consultation 39 children and adolescents (91%) and 40 (93%) parents completed the questionnaire regarding their experience with the interdisciplinary intervention. Of the children and adolescents, 18–30 (47–77%) rated relational empathy in the intervention as “Very good” or “Excellent”. Of the parents, 35–39 (92–100%) rated their experience with the consultation using the more positive response options. The parents were significantly more content with the intervention compared to previously received healthcare (p < .001).

Conclusions
The present intervention was highly acceptable with positively reported experiences from parents of, and children and adolescents with, complex health complaints. A future randomized controlled trial is required to test the effectiveness of this intervention.

Trial registration
The study was registered at ClinicalTrials.gov NCT04652154 03.12.2020. Retrospectively registered.
Impact of psychiatric disorders on the hemodynamic and quality of life outcome of balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: a retrospective study
Authors: Hirose Kazutoshi , Minatsuki Shun , Saito Akihito , Yagi Hiroki , Takeda Norifumi , Hatano Masaru , Komuro Issei 
Published: November 2023

Abstract
Background
Balloon pulmonary angioplasty (BPA) has beneficial effects on pulmonary hemodynamics, exercise capacity, and quality of life (QOL) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Recently, emerging evidence suggests a relationship between CTEPH and psychiatric disorders (PD). However, data on the clinical efficacy of BPA in CTEPH patients with PD are lacking.

Methods
We retrospectively analyzed 75 patients with inoperable/residual CTEPH who underwent BPA and right-sided heart catheterization before the initial BPA and within 1 year after the last procedure. QOL was evaluated using the European Quality of Life Five Dimension (EQ-5D) scale in 27 patients before and after BPA sessions. Baseline and post-procedural hemodynamic, functional, and QOL parameters were compared between the patients with and without PD.

Results
Among the 75 participants, 22 (29.3%) patients were categorized in the PD group. Although PD group had a similar mean pulmonary artery pressure level compared with non-PD group (40 ± 7 vs. 41 ± 9 mmHg, p = 0.477), they tended to have unfavorable QOL status (0.63 ± 0.22 vs. 0.77 ± 0.19, p = 0.102). BPA significantly improved pulmonary hemodynamics, laboratory parameters and exercise tolerance in both groups. BPA also significantly improved EQ-5D scores in the non-PD group (from 0.77 ± 0.19 to 0.88 ± 0.13, p < 0.001), but the scores remained unchanged in the PD group (from 0.63 ± 0.22 to 0.67 ± 0.22, p = 0.770). During the long-term period [1,848 (1,055–2,565) days], both groups experienced similar mortality rates (PD 4.6% vs. non-PD 5.7%, p = 1.000).

Conclusions
BPA improved hemodynamic and functional parameters irrespective of PD, but its effect on QOL was limited in patients with PD.