bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poor adherence to iron-folic acid supplementation and associated factors among pregnant women who had at least four antenatal care in Ethiopia. A community-based cross-sectional study
Authors: Asmamaw Desale Bihonegn , Debebe Negash Wubshet , Bitew Desalegn Anmut , Belachew Tadele Biresaw 
Published: December 2022

BackgroundIn developing countries, including Ethiopia, maternal mortality is a major public health concern. The Ethiopian Demographic Health Survey (EDHS) reported that the maternal mortality ratio (MMR) was 420 per 100,000 live births in 2016. Iron-folic acid supplementation (IFAS) is a key intervention to reduce these deaths. Therefore, this study aimed to assess the magnitude of poor adherence to IFAS and associated factors among pregnant women who had at least four antenatal care in Ethiopia.MethodsSecondary data analysis was used using 2016 Ethiopian Demographic and Health Survey (EDHS). We analyzed the data using Stata version 14. To identify factors associated with poor adherence to IFAS, a multilevel mixed-effect logistic regression model was fitted. Variables with a p &lt; 0.05 in the multilevel mixed-effect logistic regression model were declared as significant factors associated with poor adherence to IFAS.ResultThe magnitude of poor adherence to IFAS was 82.87% (95% CI: 80.96–84.65). Women education; primary [adjusted odds ratio (AOR) = 0.48; 95% CI: 0.31–0.75] and secondary (AOR = 0.52; 95% CI: 0.29–0.96), husband education; primary (AOR = 0.56; 95% CI: 0.36–0.86) and secondary (AOR = 0.51; 95% CI: 0.29–0.95), and community media exposure (AOR = 0.47; 95% CI: 0.27–0.79) were significantly associated with poor adherence to IFAS.ConclusionIn the current study, more than eight out of ten pregnant women who had at least four antenatal care had poor adherence to IFAS. Thus, promoting maternal and husband education and establishing community media with a priority on iron-folic acid supplementation and health-related programs are essential strategies to reduce poor adherence to IFAS.
Educational inequality in consumption of in natura or minimally processed foods and ultra-processed foods: The intersection between sex and race/skin color in Brazil
Authors: Crepaldi Barbara Virginia Caixeta , Okada Letícia Martins , Claro Rafael Moreira , Louzada Maria Laura da Costa , Rezende Leandro F. M. , Levy Renata Bertazzi , Azeredo Catarina Machado 
Published: December 2022

BackgroundIt remains uncertain how the intersection between educational, gender, and race/skin color inequalities influences food consumption in Brazil. In this study, we examined the educational inequality in the consumption of in natura/minimally processed and ultra-processed foods by Brazilians with an intersectional perspective between sex and race/color.MethodsWe used cross-sectional data from the Telephone Surveillance System (VIGITEL 2019), comprising 52,443 participants ≥ 18 years. Daily food consumption was considered high when consumption of ≥5 foods for each food group was reported the day before the survey. Educational inequality in food consumption was assessed by the slope index of inequality (SII) and the relative index of inequality (RII) according to sex and race/color (White; Black/Brown). Positive SII and RII values &gt; 1.0 indicate higher food consumption among more educated participants.ResultsThe consumptions of in natura/minimally processed and ultra-processed foods were more prevalent in those with the highest level of education (≥12 years) and intermediate education (9–11 years), respectively. However, highly educated White women had higher consumption of in natura/minimally processed foods than Black women with the same education level, and White men in low and intermediate school levels had higher consumption of these foods than Black men with the same education levels. We found higher absolute educational inequality for in natura/minimally processed foods among White women (SII 21.8, 95% CI 15.3, 28.4) and Black/Brown men (SII 19.3, 95% CI 12.5, 26.1). Black/Brown men (SII 7.3, 95% CI 0.5, 14.0) and Black/Brown women (SII 5.6, 95% CI 1.0, 10.2) had higher absolute educational inequality than White men (SII −3.3, 95% CI −10.9, 4.3; P = 0.04) in the consumption of ultra-processed foods.ConclusionEducational inequalities influenced the consumption of in natura/minimally processed more than ultra-processed foods, and, for the latter, inequalities were greater among Black/Brown men and women than among White men.
Association between nut consumption and mortality among Chinese older people: A national cohort study based on CLHLS from 2008 to 2018
Authors: He Dengxin , Huangfu Zheng , Pan Minghao 
Published: December 2022

BackgroundFew quantitative studies have explored the associations between nut consumption and better health outcomes among a national cohort of community-dwelling older Chinese people. Given the need for more evidence to support the health benefits of nuts among Chinese people, we investigated whether nut consumption was associated with subsequent 10-year mortality.MethodsWe analyzed data from the Chinese Longitudinal Healthy Longevity Survey. The data on nut consumption at baseline were collected using a questionnaire through face-to-face interviews. The vital status and date of death were ascertained by a close family member or village doctor of the deceased participant during the follow-up survey. Cox analyses were performed to explore the association between nut consumption and mortality. Subgroup analyses by age group (&lt;80 or ≥80 years), sex (male/female), activities of daily living (impaired or normal), and physical exercise (yes or no) were performed to assess whether the association between nut consumption and mortality differed across different populations.ResultsThe median survival time was 1,302 days for the 11,915 participants with complete information of survival time and nut consumption. The association between nut consumption and mortality was significant after the adjusting for significant factors in the univariate Cox analyses. The hazard ratios were lower in male participants, those who were &lt;80 years old, and those who did not engage in physical exercise at baseline. The association between nut consumption and mortality was not significant among participants with normal activities of daily living.ConclusionThe association between nut consumption and mortality was not significant among participants who had normal activities of daily living but was significant among participants who had impaired activities of daily living. Including nuts in the diets cloud help to extend the lifespan in older Chinese people, especially those with impaired activities of daily living.
The association between personal social capital and health-related quality of life among Chinese older people: A cross-sectional study
Authors: Jiang Dongdong , Yan Yajie , Zhou Han , Wang Quan 
Published: December 2022

BackgroundLower health-related quality of life (HRQoL) can result in adverse effects on the health of older people. This study aims to explore the relationship between personal social capital (PSC) and HRQoL among Chinese elderly people from rural-and-urban perspective.Materials and methods4,802 samples were included from China’s health-related quality of life Survey for Older Adults 2018 (CHRQLS-OA 2018). The PSC, including bonding and bridging social capital (BOC and BRC), was measured by the Chinese version of the Personal Social Capital Scale (PSCS-16). The HRQoL was evaluated by the European Five Dimensions Questionnaire (EQ-5D-3L). Linear and Tobit regression models were conducted to examine the relationship between PSC and HRQoL.ResultsThe BOC and BRC of rural older people were significantly lower than those of urban older people. Pain/discomfort and anxiety/depression were the most significant health problems affecting the older samples. In the five dimensions, the proportion of rural older people with problems was higher than that of urban older people. Among rural older people, BOC was significantly related to self-rated health and EQ-5D utility index (p &lt; 0.05); while BRC was insignificantly associated with self-rated health (p &gt; 0.05) but related to EQ-5D utility index (p &lt; 0.05). Both BOC and BRC were significantly correlated with self-rated health and EQ-5D utility index (p &lt; 0.05) among urban older people.ConclusionOur study reveals older people’s worrying PSC and HRQoL status. The relationship between PSC and HRQoL suggested that more social support and care of intimates should be encouraged to increase the PSC of older people, especially rural older people.
Impact of the time of surgical delay on survival in patients with muscle-invasive bladder cancer
Authors: Li Shuaishuai , Chen Rui , Raj Ashok , Xue Ning , Zhao Fangzheng , Shen Xihao , Peng Yunpeng , Zhu Haitao 
Published: December 2022

Background and objectivesPatients with muscle-invasive bladder cancer (MIBC) often experience a waiting period before radical surgery for numerous reasons; however, the COVID-19 outbreak has exacerbated this problem. Therefore, it is necessary to discuss the impact of the unavoidable time of surgical delay on the outcome of patients with MIBC.MethodsIn all, 165 patients from high-volume centers with pT2-pT3 MIBC, who underwent radical surgery between January 2008 and November 2020, were retrospectively evaluated. Patients’ demographic and pathological information was recorded. Based on the time of surgical delay endured, patients were divided into three groups: long waiting time (&gt; 90 days), intermediate waiting time (30–90 days), and short waiting time (≤ 30 days). Finally, each group’s pathological characteristics and survival rates were compared.ResultsThe median time of surgical delay for all patients was 33 days (interquartile range, IQR: 16–67 days). Among the 165 patients, 32 (19.4%) were classified into the long waiting time group, 55 (33.3%) into the intermediate waiting time group, and 78 (47.3%) into the short waiting time group. The median follow-up period for all patients was 48 months (IQR: 23–84 months). The median times of surgical delay in the long, intermediate, and short waiting time groups were 188 days (IQR: 98–367 days), 39 days (IQR: 35–65 days), and 16 days (IQR: 12–22 days), respectively. The 5-year overall survival (OS) rate for all patients was 58.4%, and that in the long, intermediate, and short waiting time groups were 35.7%, 61.3%, and 64.1%, respectively (P = 0.035). The 5-year cancer-specific survival (CSS) rates in the long, intermediate, and short waiting time groups were 38.9%, 61.5%, and 65.0%, respectively (P = 0.042). The multivariate Cox regression analysis identified age, time of surgical delay, pT stage, and lymph node involvement as independent determinants of OS and CSS.ConclusionIn patients with pT2-pT3 MIBC, the time of surgical delay &gt; 90 days can have a negative impact on survival.
Systematic literature review and meta-analysis of clinical outcomes and prognostic factors for melanoma brain metastases
Authors: Tan Xiang-Lin , Le Amy , Scherrer Emilie , Tang Huilin , Kiehl Nick , Han Jiali , Jiang Ruixuan , Diede Scott J. , Shui Irene M. 
Published: December 2022

BackgroundMore than 60% of all stage IV melanoma patients develop brain metastases, while melanoma brain metastases (MBM) is historically difficult to treat with poor prognosis.ObjectivesTo summarize clinical outcomes and prognostic factors in MBM patients.MethodsA systematic review with meta-analysis was conducted, and a literature search for relevant studies was performed on November 1, 2020. Weighted average of median overall survival (OS) was calculated by treatments. The random-effects model in conducting meta-analyses was applied.ResultsA total of 41 observational studies and 12 clinical trials with our clinical outcomes of interest, and 31 observational studies addressing prognostic factors were selected. The most common treatments for MBM were immunotherapy (IO), MAP kinase inhibitor (MAPKi), stereotactic radiosurgery (SRS), SRS+MAPKi, and SRS+IO, with median OS from treatment start of 7.2, 8.6, 7.3, 7.3, and 14.1 months, respectively. Improved OS was observed for IO and SRS with the addition of IO and/or MAPKi, compared to no IO and SRS alone, respectively. Several prognostic factors were found to be significantly associated with OS in MBM.ConclusionThis study summarizes pertinent information regarding clinical outcomes and the association between patient characteristics and MBM prognosis.
Changes in lung cancer-related serum tumor markers in patients with chronic kidney disease and determination of upper reference limit
Authors: Miao Qiang , Cai Bei , Niu Qian , Zhang Junlong 
Published: December 2022

AimsTo investigate the changes in lung cancer-related serum tumor markers in patients with chronic kidney disease (CKD) and determine the upper reference limit for patients with different stages.MethodsIncluded inpatients diagnosed with CKD who did not receive dialysis temporarily in our hospital from March to September 2020. Changes in serum CA125, HE4, CYFRA21-1, SCCA, NSE and ProGRP in CKD patients were analyzed. The non-parametric method was used to estimate the upper reference limit of the above indicators in patients with CKD stages 2-5.ResultsThe serum levels of HE4, CYFRA21-1, SCCA, and ProGRP in the CKD group were significantly higher than those in the healthy control group; CA125 and NSE levels were not statistically different. The false positives of SCC, CYFRA21-1, ProGRP, and HE4 increased significantly with the CKD stage. Still, NSE and CA125 did not show a significant increasing trend. Both HE4 and ProGRP have independent upper reference limits from CKD2 to CKD5 stage, namely 220.8 pmol/l and 101.4 pg/ml in the CKD2 stage, 496.7 pmol/l and 168.63 pg/ml in CKD3 stage, 4592.4 pmol/l and 272.8 pmol/l for CKD4 stage, CKD5 stage was 4778.2 pmol/l and 491.6 pmol/l.ConclusionThis study preliminarily determined the upper reference limits of Lung cancer-related tumor markers in patients with different CKD stages and provided laboratory support for the rational use and interpretation of Lung cancer-related tumor markers in special populations.
Case Report: Endoscopic manifestations and clinical features of small intestinal lymphangioma—A report of two cases
Authors: Wang Limei , Feng Huang , Chen Bingxin , Luan Fujuan 
Published: December 2022

ObjectiveThe aims of this study were to analyze the clinical characteristics, auxiliary examinations, and treatment measures of small intestinal lymphangioma and to improve the clinical diagnostic ability of clinicians.MethodsThis paper reports two cases of small intestinal lymphangioma in the Department of Gastroenterology, the First Affiliated Hospital of Soochow University, and makes a comprehensive analysis.ResultsA 31-year-old woman went to the hospital with complaints of dizziness, fatigue, and anemia. A 52-year-old woman complained of upper abdominal pain and went to the hospital with abdominal pain awaiting investigation. Both patients were subjected to three major routine examinations, tumor complete set, CT, capsule endoscopy, and deep enteroscopy, and both of them underwent complete resection of the affected intestinal segment. Pathology showed that both patients had small intestinal lymphangioma.ConclusionsThe clinical manifestations of small intestinal lymphangioma lack specificity. Capsule endoscopy and deep enteroscopy are helpful for clinical diagnosis, and pathological examination is still the gold standard. Surgical treatment can achieve better results.
Trends of sphincter-preserving surgeries for low lying rectal cancer: A 20-year experience in China
Authors: Zheng Kuo , Hu Qingqing , Yu Guanyu , Zhou Leqi , Yao Yuting , Zhou Yuan , Wang Hao , Hao Liqiang , Yu Enda , Lou Zheng , Zhang Yongjing , Qiu Hong , Meng Ronggui , Zhang Wei 
Published: December 2022

BackgroundOver the last 2 decades, patients with low rectal cancer have had better outcomes from improvements in surgical techniques in sphincter preservation. We aimed to quantify the trends in sphincter-preserving surgeries for low rectal cancer over 20 years in a top tertiary hospital in China.MethodsBetween 1999 and 2021, a cohort of patients with primary malignant rectal tumor ≤5cm from the anal verge and who received elective surgeries at Changhai Hospital, Shanghai, China, was identified. Data were extracted from electronic medical records. A Joinpoint Regression Model was used to analyze trends in surgical procedures by average annual percentage change (AAPC). Adjusted Cox proportional hazards regression model was used to assess overall survival.ResultsAmong a total of 4,172 patients during the study period, 3,111 (74.6%) underwent a sphincter-preserving surgery and 1,061 (25.4%) received APR. Sphincter-preserving surgery increased 3.6% per year (95%CI, 2.3-4.9). Low anterior resection was the most performed procedure (86.3%) and maintained a steady trend, while intersphincteric resection increased 49.4% annually (95%CI, 19.5-86.7) after initiation. Laparoscopic techniques increased 15.1% per year (95%CI, 8.4-43.4) after initiation. Sphincter-preserving surgery increased annually for tumors ≤2cm, 2-≤3cm and 3-≤4cm from the anal verge (AAPC 7.1, 4.5-9.8; 4.7, 3.1-6.3; 2.7, 1.7-3.6, respectively). Furthermore, patients with sphincter-preserving surgery had a better overall survival than abdominoperineal resection (APR) patients (adjusted HR 0.78, 95% CI, 0.65-0.93, p=.01).ConclusionsUtilization of sphincter-preserving surgeries increased significantly over the last 20 years. Patients with low rectal cancer who underwent sphincter preservation had better survival than similar patients who underwent APR.
Clinical diagnosis and treatment of subungual exostosis in children
Authors: Li Hao , Li Haichong , Qi Xinyu , Guo Dong , Cao Jun , Bai Yunsong , Yao Ziming , Zhang Xuejun 
Published: December 2022

ObjectiveTo analyze and summarize the clinical characteristics and treatment effects for subungual exostosis in children.MethodsClinical data for children with subungual exostosis treated in our department from January 2008 to September 2022 were evaluated.ResultsForty children with subungual exostosis were evaluated, comprising 31 boys (77.5%) and 9 girls (22.5%) with a median age of 9 years (4–17 years). The median disease course was 6 months (1–48 months). Seven patients (17.5%) had definite trauma history and 5 (12.5%) had infection. The toe or finger nail appearance was abnormal in 36 patients and normal in 4 patients. Twenty-seven patients (67.5%) had pain when wearing shoes and walking, and 25 (62.5%) had toenail tenderness. The lesions were located in the distal phalanxes of the toes in 37 patients (92.5%), with 14 patients affected on the left side and 23 on the right side. Twenty-two patients had lesions in the great toe, 6 in the second toe, 6 in the third toe, and 3 in the fourth toe. The lesions in the other 3 patients (7.5%) were located in the distal phalanxes of the fingers, with 2 patients affected in the second finger and 1 in the third finger. Regarding the relationship between lesion location and nail bed, 4 patients were type I, 21 were type II, and 15 were type III. All 40 patients received surgical treatment, with nail removal in 15. The median maximum lesion diameter was 1.0 cm (0.8–2 cm), median operation time was 25 min (20–45 min), median blood loss was 1 ml (1–2 ml), and median postoperative hospital stay was 2 days (1–4 days). All cases were histopathologically confirmed as subungual exostosis. The median follow-up time was 24 months (3–60 months), with normal appearance of the toe or finger nail. There were no complications in 38 patients (95.0%). Two patients (5.0%) relapsed at 3 months postoperatively and underwent a secondary operation, with no subsequent recurrence during 12 months of follow-up.ConclusionSubungual exostosis in children is a rare benign disease that often occurs in the toes. Selection of the appropriate incision and nail bed treatment based on the relationship between lesion location and nail bed is helpful for improving the treatment effect.
Efficacy and safety of tirzepatide in patients with type 2 diabetes: A systematic review and meta-analysis
Authors: Tang Yan , Zhang Lin , Zeng Yuping , Wang Xia , Zhang Mei 
Published: December 2022

Purpose: A systematic review and meta-analysis was conducted to combine the data available from clinical trials and evaluate the clinical efficacy and safety of tirzepatide in people with type 2 diabetes (T2D).Methods: We systematically searched the MEDLINE, Embase, Cochrane Library, and clinical trials registries (https://clinicaltrials.gov) up to 25 March 2022 for randomized controlled trials (RCTs) that compared tirzepatide with placebo or active hypoglycemic drugs in subjects with T2D. Heterogeneity was judged by the I2 value and Cochran’s Q test. The randomized effects model was adopted to calculate risk ratios and weighted mean differences (WMDs). The primary outcome was the change from baseline in HbA1c levels. Secondary efficacy endpoints were fasting serum glucose (FSG), change of body weight, blood pressure, fasting lipid profiles, and safety indexes.Results: Six trials comprising 6,579 subjects (4,410 in the tirzepatide group and 2,054 in the control group) fulfilled the pre-specified criteria and were included in the study. Tirzepatide treatment resulted in reducing HbA1c (WMD: -1.07%; 95% confidence intervals [CIs]: −1.44, −0.56), FSG (WMD, −21.50 mg/dl; 95% CI: −34.44, −8.56), body weight (WMD: −7.99 kg; 95% CI −11.36, −4.62), and blood pressure and ameliorated fasting lipid profiles, without increasing hypoglycemia, either as monotherapy or an add-on therapy. Tirzepatide increased the risk of gastrointestinal adverse events mainly in add-on therapy but not in terms of pancreatitis or cholelithiasis. Furthermore, tirzepatide presented a dose–response effect on the reduction in HbA1c and body weight and increase in nausea and vomiting.Conclusion: In patients with type 2 diabetes, tirzepatide shows superior blood glucose control and weight loss performance, without an increased risk of hypoglycemia.Systematic Review Registration: (https://www.crd.york.ac.uk/PROSPERO), identifier (CRD42022319442).