bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wireless versus routine physiologic monitoring after cesarean delivery to reduce maternal morbidity and mortality in a resource-limited setting: protocol of type 2 hybrid effectiveness-implementation study
Authors: Boatin Adeline A. , Ngonzi Joseph , Wylie Blair J. , Lugobe Henry M. , Bebell Lisa M. , Mugyenyi Godfrey , Mohamed Sudi , Martinez Kenia , Musinguzi Nicholas , Psaros Christina , Metlay Joshua P. , Haberer Jessica E. 
Published: February 2021

Abstract
Background
Women in sub-Saharan Africa have the highest rates of morbidity and mortality during childbirth globally. Despite increases in facility-based childbirth, gaps in quality of care at facilities have limited reductions in maternal deaths. Infrequent physiologic monitoring of women around childbirth is a major gap in care that leads to delays in life-saving interventions for women experiencing complications.

Methods
We will conduct a type-2 hybrid effectiveness-implementation study over 12 months to evaluate using a wireless physiologic monitoring system to detect and alert clinicians of abnormal vital signs in women for 24 h after undergoing emergency cesarean delivery at a tertiary care facility in Uganda. We will provide physiologic data (heart rate, respiratory rate, temperature and blood pressure) to clinicians via a smartphone-based application with alert notifications if monitored women develop predefined abnormalities in monitored physiologic signs. We will alternate two-week intervention and control time periods where women and clinicians use the wireless monitoring system during intervention periods and current standard of care (i.e., manual vital sign measurement when clinically indicated) during control periods. Our primary outcome for effectiveness is a composite of severe maternal outcomes per World Health Organization criteria (e.g. death, cardiac arrest, jaundice, shock, prolonged unconsciousness, paralysis, hysterectomy). Secondary outcomes include maternal mortality rate, and case fatality rates for postpartum hemorrhage, hypertensive disorders, and sepsis. We will use the RE-AIM implementation framework to measure implementation metrics of the wireless physiologic system including Reach (proportion of eligible women monitored, length of time women monitored), Efficacy (proportion of women with monitoring according to Uganda Ministry of Health guidelines, number of appropriate alerts sent), Adoption (proportion of clinicians utilizing physiologic data per shift, clinical actions in response to alerts), Implementation (fidelity to monitoring protocol), Maintenance (sustainability of implementation over time). We will also perform in-depth qualitative interviews with up to 30 women and 30 clinicians participating in the study.

Discussion
This is the first hybrid-effectiveness study of wireless physiologic monitoring in an obstetric population. This study offers insights into use of wireless monitoring systems in low resource-settings, as well as normal and abnormal physiologic parameters among women delivering by cesarean.

Trial registration
ClinicalTrials.gov, NCT04060667. Registered on 08/01/2019.
Impact of nicotine and maternal BMI on fetal birth weight
Authors: Günther Veronika , Alkatout Ibrahim , Vollmer Christoph , Maass Nicolai , Strauss Alexander , Voigt Manfred 
Published: February 2021

Abstract
Background
According to the World Health Organization, smoking is the most important risk factor for adverse pregnancy outcomes in industrialized nations. As the individual factors (body mass index – BMI (kg/m2) – and cigarette consumption) have been extensively investigated in pregnancy, we aimed to establish how maternal BMI and nicotine interact with regard to perinatal outcomes and birth weight.

Methods
Data from 110.047 singleton pregnancies, achieved from the German Perinatal Survey in Schleswig-Holstein and registered between 2010 and 2017 were analyzed in August 2018 concerning maternal BMI and smoking. The BMI was taken from the maternity log. Information concerning the smoking status were self-reported and further subdivided into the following four categories: a) non-smokers; b) 1–7 cigarettes/day; c) 8–14 cigarettes/ day; and d) ≥ 15 cigarettes/ day.
Furthermore, we classified women by their BMI into underweight, normal weight, overweight and obese. Comparisons between non-smokers and the respective smoking group, and their relationship with maternal BMI were performed by the t-test (birth weight). A P-value ≤0.05 was considered to indicate statistical significance.

Results
A number of 97.092 women (88.2%) were non-smokers and 12.955 (11.8%) were smokers. Furthermore 10.3% of women of normal weight smoked during pregnancy, but both high and low BMI were associated with a high prevalence of smoking. The proportion of smokers was highest (18.1%) among underweight women (BMI ≤ 18.5 kg/m2). A large number of smokers (15.5%) were registered in the obesity group (BMI ≥ 30 kg/m2).
Mean birth weight (≥ 37 + 0 gestational age) increased with increasing maternal BMI, and was reduced by smoking for every BMI category. The differences between smokers and non-smokers were always highly significant (p < 0.001). Mean birth weight varied between 2995 g in underweight frequent smokers and 3607 g in obese non-smokers.

Conclusion
Both maternal BMI and smoking during pregnancy influences the birth weight and therefore pregnancy outcome. Smoking during pregnancy was significantly associated with low birth weight. Pregnant women should be advised to cease or at least reduce smoking in order to improve the birth weight of the newborn and to minimize child morbidities.
Maternal age at first cesarean delivery related to adverse pregnancy outcomes in a second cesarean delivery: a multicenter, historical, cross-sectional cohort study
Authors: Bi Shilei , Zhang Lizi , Chen Jingsi , Huang Minshan , Huang Lijun , Zeng Shanshan , Li Yulian , Liang Yingyu , Jia Jinping , Wen Suiwen , Cao Yinli , Wang Shaoshuai , Xu Xiaoyan , Feng Ling , Zhao Xianlan , Zhao Yangyu , Zhu Qiying , Qi Hongbo , Zhang Lanzhen , Li Hongtian , Wang Zhijian , Du Lili , Chen Dunjin 
Published: February 2021

AbstractBackgroundTo determine the effects of maternal age at first cesarean on maternal complications and adverse outcomes of pregnancy with the second cesarean.MethodsThis was a multicenter, historical, cross-sectional cohort study involving singleton pregnancies ≥28 gestational weeks, with a history of 1 cesarean delivery, and who underwent a second cesarean between January and December 2017 at 11 public tertiary hospitals in 7 provinces of China. We analyzed the effects of maternal age at first cesarean on adverse outcomes of pregnancy in the second cesarean using multivariate logistic regression analysis.ResultsThe study consisted of 10,206 singleton pregnancies. Women were at first cesarean between 18 and 24, 25–29, 30–34, and ≥ 35 years of age; and numbered 2711, 5524, 1751, and 220 cases, respectively. Maternal age between 18 and 24 years at first cesarean increased the risk of placenta accreta spectrum (aOR, 1.499; 95% CI, 1.12–2.01), placenta previa (aOR, 1.349; 95% CI, 1.07–1.70), intrahepatic cholestasis of pregnancy (aOR, 1.947; 95% CI, 1.24–3.07), postpartum hemorrhage (aOR, 1.505; 95% CI, 1.05–2.16), and blood transfusion (aOR, 1.517; 95% CI, 1.21–1.91) in the second cesarean compared with the reference group (aged 25–29 years). In addition, maternal age ≥ 35 years at first cesarean was a risk factor for premature rupture of membranes (aOR, 1.556; 95% CI, 1.08–2.24), placental abruption (aOR, 6.464, 95% CI, 1.33–31.51), uterine rupture (aOR, 7.952; 95% CI, 1.43–44.10), puerperal infection (aOR, 6.864; 95% CI, 1.95–24.22), neonatal mild asphyxia (aOR, 4.339; 95% CI, 1.53–12.32), severe asphyxia (aOR, 18.439; 95% CI, 1.54–220.95), and admission to a neonatal intensive care unit (aOR, 2.825; 95% CI, 1.54–5.17) compared with the reference group (aged 25–29 years).ConclusionsMaternal age between 18 and 24 years or advanced maternal age at first cesarean was an independent risk factor for adverse maternal outcomes with the second cesarean. Advanced maternal age at the first cesarean specifically increased adverse neonatal outcomes with the second. Therefore, decisions as to whether to perform a first cesarean at a young or advanced maternal age must be critically evaluated.
High fascin-1 expression in colorectal cancer identifies patients at high risk for early disease recurrence and associated mortality
Authors: Tampakis Athanasios , Tampaki Ekaterini-Christina , Nonni Afrodite , Kostakis Ioannis D. , Posabella Alberto , Kontzoglou Konstantinos , von Flüe Markus , Felekouras Evangelos , Kouraklis Gregory , Nikiteas Nikolaos 
Published: February 2021

Abstract
Background
Fascin is the main actin cross-linker protein that regulates adhesion dynamics and stabilizes cell protrusion, such as filopodia. In human cancer, fascin expression correlates with aggressive clinical features. This study aimed to determine the expression patterns of fascin-1 and assessed its prognostic significance in colorectal cancer.

Methods
One hundred eleven specimens of patients with primary resectable colorectal cancer were examined via immunohistochemistry for the expression of fascin-1, and the results were correlated with clinicopathological characteristics and survival data.

Results
Fascin-1 staining displayed strong intensity in the cytoplasm of the colorectal cancer cells and endothelial cells of tumor blood vessels. Moderate to high fascin-1 expression was associated with progressive anatomic disease extent (p < 0.001), higher T classification (p = 0.007), the presence of lymph node (p < 0.001) and distant metastasis (p = 0.002), high grade tumors (p = 0.002) and vascular invasion (p < 0.001). Patients displaying moderate and high fascin-1 expression demonstrated a significantly worse 5-year overall survival [HR; 3.906, (95%CI) = 1.250–12.195] and significantly worse 3-year progression-free survival [HR; 3.448, (95%CI) = 1.401–8.475] independent of other clinicopathological characteristics. Besides, high fascin-1 expression in early-stage cancer only was associated with a dismal prognosis.

Conclusions
High fascin-1 expression in colorectal cancer is an independent negative prognostic factor for survival, increasing the risk for disease recurrence or death almost by sevenfold. Fascin-1 expression could be potentially utilized to identify high-risk patients prone to metastasis already in early-stage disease.
Association of UCP1 and UCP2 variants with diabetic retinopathy susceptibility in type-2 diabetes mellitus patients: a meta-analysis
Authors: Liu Xujia , Jiang Zehua , Zhang Guihua , Ng Tsz Kin , Wu Zhenggen 
Published: February 2021

AbstractBackgroundGenetic association of uncoupling proteins (UCPs) variants with the susceptibility of diabetic retinopathy (DR) in diabetes mellitus (DM) patients has been reported but with controversy. Here we aimed to conduct a meta-analysis to confirm the association of different UCPs variants with DR.MethodsThree databases (Medline Ovid, Embase Ovid and CENTRAL) were applied in the literature search. Five genetic models, including allelic, homozygous, heterozygous, dominant and recessive models, were evaluated. Odds ratios (OR) were estimated under the random or fixed-effects models. Subgroup analyses, publication bias and sensitivity analyses were also conducted.ResultsEleven studies on 2 UCPs variants (UCP1rs1800592 andUCP2rs659366) were included. Our meta-analysis showed thatUCP1rs1800592 was not associated with DR in type-2 DM patients, andUCP2rs659366 also showed no association with DR. In the subgroup analyses on the stage of DR, allele G ofUCP1rs1800592 significantly increased the susceptibility of proliferative diabetic retinopathy (PDR) in type-2 DM patients in the allelic (OR = 1.26,P = 0.03) and homozygous models (OR = 1.60,P = 0.04). Subgroup analysis on ethnicity did not found any significant association of rs1800592 and rs659366 with DR.ConclusionOur meta-analysis confirmed the association ofUCP1rs1800592 variant with PDR in patients with type-2 DM, suggesting its potential as a genetic marker for PDR prediction in population screening.
Knowledge, attitude, practice and associated factors among patients with type 2 diabetes in Cotonou, Southern Benin
Authors: Alaofè Halimatou , Hounkpatin Waliou Amoussa , Djrolo Francois , Ehiri John , Rosales Cecilia 
Published: February 2021

Abstract
Background
Type 2 diabetes (T2D) is becoming an epidemic with significant disability and premature death in Sub-Saharan Africa, including Benin. However, little is known about the level of knowledge, attitude, and practice (KAP) necessary for diabetic patients to enhance therapeutic outcomes and prevent diabetes complications. The study aimed to assess patients’ KAP levels and identify the factors associated in Cotonou, southern Benin.

Methods
A cross-sectional study was conducted from July to August 2019 among 300 diabetic patients from four health centers. Data was collected using validated questionnaires. KAP levels were determined by calculating the scores, and multivariate logistic regression was used to explore factors influencing KAP scores.

Results
About 53, 52, and 47% of all patients had good knowledge, attitude, and practice towards diabetes. In logistic regression, factors such as being female, married, educated, government/non-government employee, and longer duration of diabetes were significantly associated with good knowledge. Being married, having a longer duration of diabetes, and good knowledge were significantly associated with a good attitude while being educated, having a longer duration of diabetes, and good knowledge with good practice.

Conclusions
Lack of knowledge, poor attitude, and inadequate practice were found in this surveyed community, suggesting a need for structured educational programs to assist diabetic patients. However, education should be considered a priority for male, newly diagnosed, and uneducated patients.
The prognostic value of external vs internal pancreatic duct stents after pancreaticoduodenectomy in patients with FRS ≥ 4: a retrospective cohort study
Authors: Jiang Yuancong , Chen Qin , Shao Yi , Gao Zhenzhen , Jin Ming , Gao Bingqiang , Zhou Bo , Yan Sheng 
Published: February 2021

Abstract
Background
The prognostic value of external vs internal pancreatic duct stents after pancreaticoduodenectomy remains controversial. This study aimed to evaluate the benefits of external and internal stents using the Fistula Risk Score system with regard to the incidence of clinically relevant postoperative pancreatic fistula.

Methods
A total of 382 patients who underwent pancreaticoduodenectomy with duct to mucosa pancreaticojejunostomy were retrospectively enrolled from January 2015 to October 2019. The receiver operating characteristic curve was performed for subgroup analysis of the patients at different levels of risk for pancreatic fistula.

Results
There were no significant differences in terms of pancreatic fistula or other postoperative complications. According to the receiver operating characteristic curve threshold of 3.5, 172 patients with a Fistula Risk Score ≥ 4 and 210 patients with a Fistula Risk Score < 4 were divided into separate groups. The number of valid cases was insufficient to support the subsequent research in patients with a Fistula Risk Score < 4. In patients with a Fistula Risk Score ≥ 4, the use of an external pancreatic duct stent was significantly more effective than the use of an internal stent, especially with regard to the risk for pancreatic fistula (Grade C) (P = 0.039), at ameliorating the incidence of clinically relevant postoperative pancreatic fistula (P = 0.019). Additionally, the incidence of lymphatic leakage was significantly higher in the external stent group compared with the internal stent group (P = 0.040).

Conclusions
Compared with internal stents, the use of an external stent could reduce the incidence of clinically relevant postoperative pancreatic fistula in patients with a Fistula Risk Score ≥ 4. More large-scale prospective clinical trials are warranted to further clarify our results.
A modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection for upper rectal or lower sigmoid colon cancer: a retrospective study
Authors: Yu Si , Ji Yong , Luo Tedong , Xu Pengjie , Zhen Zuojun , Deng Jianzhong 
Published: February 2021

Abstract
Background
In recent years, natural orifice specimen extraction surgery (NOSES) has become a field of special interest for colorectal surgeons. Some researchers have reported transanal specimen extraction in the laparoscopic anterior rectal resection, including intersphincteric resection (ISR) and rectal eversion-resection. However, these surgical procedures have certain limitations. Based on the proven expertise in laparoscopic surgery, our center has developed a modified technique of transanal specimen extraction. The aim of this study was to investigate the safety and feasibility of a modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection.

Methods
From January 2011 to January 2014, the patients with upper rectal or lower sigmoid colon cancer who had undergone laparoscopic anterior rectal resection with specimen extraction by a modified transanal technique were enrolled in the observation group, and the patients who had undergone laparoscopic anterior rectal resection with specimen extraction via an abdominal incision by the same surgeons during the same period were enrolled in the control group.

Results
A total of 36 patients were included in the observation group and 128 patients were included in the control group. There were no significant differences (P > 0.05) between the two groups in terms of the mean operative time [144 ± 10 min vs. 141 ± 11 min], mean intraoperative blood loss [63 ± 6 ml vs. 61 ± 7 ml], and the mean time to anal exhaust [67 ± 7 h vs. 65 ± 8 h]. However, there were significant differences (P < 0.05) between the two groups in terms of the mean postoperative Visual Analogue Scale (VAS) pain scores [3.4 ± 1.1 vs. 4.5 ± 1.2], mean postoperative hospital stay [6.0 ± 1.1 days ± vs. 7.2 ± 1.2 days], and incidence of postoperative complications (4/36 vs. 15/128). Long-term follow-up results showed that there was no significant difference (P > 0.05) between the two groups in terms of the 3- or 5-year overall survival.

Conclusions
The modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection fulfilled the principle of no-neoplasm touch technique, with advantages, such as minimal trauma, rapid recovery, and fewer complications. Long-term follow-up results also showed satisfactory oncological outcomes.
The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review
Authors: Agnes Annamaria , Puccioni Caterina , D’Ugo Domenico , Gasbarrini Antonio , Biondi Alberto , Persiani Roberto 
Published: February 2021

Abstract
Background
The gut microbiota (GM) has been proposed as one of the main determinants of colorectal surgery complications and theorized as the “missing factor” that could explain still poorly understood complications. Herein, we investigate this theory and report the current evidence on the role of the GM in colorectal surgery.

Methods
We first present the findings associating the role of the GM with the physiological response to surgery. Second, the change in GM composition during and after surgery and its association with colorectal surgery complications (ileus, adhesions, surgical-site infections, anastomotic leak, and diversion colitis) are reviewed. Finally, we present the findings linking GM science to the application of the enhanced recovery after surgery (ERAS) protocol, for the use of oral antibiotics with mechanical bowel preparation and for the administration of probiotics/synbiotics.

Results
According to preclinical and translational evidence, the GM is capable of influencing colorectal surgery outcomes. Clinical evidence supports the application of an ERAS protocol and the preoperative administration of multistrain probiotics/synbiotics. GM manipulation with oral antibiotics with mechanical bowel preparation still has uncertain benefits in right-sided colic resection but is very promising for left-sided colic resection.

Conclusions
The GM may be a determinant of colorectal surgery outcomes. There is an emerging need to implement translational research on the topic. Future clinical studies should clarify the composition of preoperative and postoperative GM and the impact of the GM on different colorectal surgery complications and should assess the validity of GM-targeted measures in effectively reducing complications for all colorectal surgery locations.
Mucormycosis originated total maxillary and cranial base osteonecrosis: a possible misdiagnosis to malignancy
Authors: Park Young Long , Cho Sura , Kim Jin-Woo 
Published: February 2021

Abstract
Background
This is a case of mucormycosis originated osteonecrosis of the maxilla extended to the cranial base, initially suspected of malignancy. The patient was first suspected with osteolytic sarcomatous lesion but was later diagnosed with total maxillary necrosis and cranial base through biopsy-proven invasive mucormycosis.

Case presentation
A 71-year-old male was presented with unknown total maxillary osteonecrosis. CT and MRI results showed extensive osteolytic change with bone destruction of the cranial base, and PET-CT showed irregular hypermetabolic lesion in the area suspected of malignancy. The first biopsy results only presented tissue inflammation. Thus, several further endoscopic biopsy were performed through posterior pharyngeal wall. The patient was eventually diagnosed with mucormycosis and associated osteomyelitis with subsequent bone necrosis. With confirmed diagnosis, partial maxillectomy of the necrosed bone was performed under general anesthesia. At the 4 week follow-up, the patient showed full mucosal healing and no recurrence or aggravation of the maxilla and cranial base lesion was observed.

Conclusions
Accurate diagnosis of atypical symptoms, timely diagnosis, and proper combination therapy of surgical intervention, antifungal agent, and antibiotic use for skull base osteomyelitis are all critical for proper treatment planning. In addition, biopsy and CT scans are essential in differentiating osteonecrosis from malignancy.