bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monitoring and interventions are needed to reduce the very high Caesarean section rates in Vietnam
Authors: Giang Hoang Thi Nam , Ulrich Sarah , Tran Hoang Thi , Bechtold‐Dalla Pozza Susanne 
Published: April 2018

AbstractAimThe aim of this study was to estimate the prevalence of Caesarean sections in the third largest city in Vietnam and identify the associated risk factors.MethodsThis descriptive study was conducted in Da Nang from April 2015 to March 2016 and the hospital‐based sample comprised 20 535 women who delivered during this period. Caesarean section cases were categorised into private and public hospitals and groups of primiparous and multiparous women.ResultsWe recruited 10 of the 12 hospitals in the City and they covered 90% of births during the study period. The overall Caesarean section rate was 58.6%: 57.9% in public hospitals and 70.6% in private hospitals. The three main indications for Caesarean sections were previous Caesarean sections, cephalopelvic disproportion and foetal distress. The factors that increased the likelihood of Caesarean sections were the mother being over 30, having an office job, a history of abortions, having a male infant and a higher neonatal birth weight.ConclusionOur study demonstrated an extremely high rate of Caesarean section and associated factors in public and private hospitals in one of the biggest cities in Vietnam. The findings highlight the need for monitoring and interventions to reduce the Caesarean section rates.
Resources for nurturing childcare practices in urban and rural settings: Findings from the Colombia 2010 Demographic and Health Survey
Authors: Urke H. B. , Mittelmark M. B. , Amugsi D. A. , Matanda D. J. 
Published: May 2018

AbstractBackgroundThe health and development potential of young children is dependent on nurturing care (NC) provided by primary caregivers. NC encompasses attention to nutrition; symptom management; early learning, attachment, and socialization; and security and safety. Despite the importance of NC to child health and development, the measurement and study of NC are neglected. This has become a point of major concern in the public health field in low‐ and middle‐income countries (LMICs) such as Colombia where many families are hard pressed for childcare resources. The aims of this study were therefore to (a) create age‐specific NC summary indexes (0–5, 6–11, and 12–23 months) suitable for research in LMICs and (2) examine the relationship of NC to maternal resources.Methods2010 Colombia Demographic and Health Survey data were obtained from mothers and their children ages 0–5 months (n = 1,357); 6–11 months (n = 1,623); and 12–23 months (n = 3,006). Age‐specific NC indexes were created including information on child feeding, immunization, hygiene, response to illness symptoms, and psychosocial care. Independent variables included mother's education level and household assets, and enrolment in a government child development programme. Regression analyses with NC as the outcome variable were conducted with urban and rural subsamples in the 3 age groups.ResultsAmong rural children, NC was significantly higher with greater household assets, maternal decision latitude, and development programme participation, with variation by child age. Among urban children, higher maternal education and white‐collar occupation also predicted higher NC, with some variation by age.ConclusionIt is feasible to measure age‐specific NC in survey research, and NC is related to maternal resources. Age and urban–rural differences in how NC is related to social factors are observed. The findings support the importance of subgroup analysis in the study of NC in LMICs such as Colombia.
Preconception management of thyroid dysfunction
Authors: Okosieme Onyebuchi E. , Khan Ishrat , Taylor Peter N. 
Published: April 2018

SummaryUncorrected thyroid dysfunction in pregnancy has well‐recognized deleterious effects on foetal and maternal health. The early gestation period is one of the critical foetal vulnerability during which maternal thyroid dysfunction may have lasting repercussions. Accordingly, a pragmatic preconception strategy is key for ensuring optimal thyroid disease outcomes in pregnancy. Preconception planning in women with hypothyroidism should pre‐empt and mirror the adaptive changes in the thyroid gland by careful levothyroxine dose adjustments to ensure adequate foetal thyroid hormone delivery in pregnancy. In hyperthyroidism, the goal of preconception therapy is to control hyperthyroidism while curtailing the unwanted side effects of foetal and maternal exposure to antithyroid drugs. Thus, pregnancy should be deferred until a stable euthyroid state is achieved, and definitive therapy with radioiodine or surgery should be considered in women with Graves’ disease planning future pregnancy. Women with active disease who are imminently trying to conceive should be switched to propylthiouracil either preconception or at conception in order to minimize the risk of birth defects from carbimazole or methimazole exposure. Optimal strategies for women with borderline states of thyroid dysfunction namely subclinical hypothyroidism, isolated hypothyroxinaemia and thyroid autoimmunity remain uncertain due to the dearth of controlled interventional trials. Future trial designs should aspire to recruit and initiate therapy before conception or as early as possible in pregnancy.
Role of local anaesthetic nerve block in endoscopic sinus surgery: A systematic review and meta‐analysis
Authors: Shamil E. , Rouhani M.J. , Basetti S. , Bast F. , Hopkins C. , Surda P. 
Published: April 2018

ObjectiveThe aim of the study was to perform a systematic review of existing evidence on the role of local anaesthetic nerve block (LAB) in patients undergoing endoscopic sinus surgery (ESS).DesignThe databases searched were the Cochrane Register of Controlled Trials, MEDLINE and Embase using the Ovid portal (1946‐2017).ResultsSeven randomised controlled trials were included. Due to considerable heterogeneity of data, only two studies were pooled into meta‐analysis which demonstrated a statistically significantly better surgical field quality during ESS in the LAB group compared with the control group (MD −0.86; 95% CI −2.24, 0.51; P = .009). No adverse events related to LAB toxicity were reported.ConclusionsSphenopalatine ganglion LAB with adrenaline carries relatively low risk of morbidity, but may improve the quality of the surgical field in terms of bleeding. However, there are limitations of the study due to heterogeneity of methods, quality and size of the studies. Well‐conducted large RCTs are needed using standardised inclusion criteria, balanced baseline characteristics of cohorts, and validated subjective and objective outcome measures.
Risk factors including the presence of inflammation at the resection margins for colorectal anastomotic stenosis following surgery for diverticular disease
Authors: Bressan A. , Marini L. , Michelotto M. , Frigo A. C. , Da Dalt G. , Merigliano S. , Polese L. 
Published: April 2018

AbstractAimThe aim of this study was to investigate risk factors for anastomotic stenosis in patients operated on for diverticular disease. Histological inflammation and diverticula at the resection margins were also considered.MethodPatients’ characteristics, the surgical technique and postoperative complications were collected from the medical records. Anastomotic stenoses were evaluated prospectively by rigid sigmoidoscopy during follow‐up examination. Histological specimens were examined by a single pathologist who investigated inflammation and diverticula at the resection margins. Twenty patients with anastomotic colorectal stenosis from a single tertiary centre were compared with 24 consecutive patients without stenosis. They were all operated on for diverticular disease over a specified time period.ResultsHistological inflammation and diverticula were found in 25% and 30% of the resection margins respectively. Univariate analysis showed that age > 71 years (P = 0.0002), female gender (P = 0.0069) and anastomoses located below 12 cm from the anal verge (P = 0.020) were risk factors for stenosis. No correlation was found between anastomotic stenosis and the presence of histological inflammation or diverticula at the resection margins. By multivariate analysis, only age > 71 years was found to be a statistically significant risk factor for stenosis (P = 0.0003, OR = 60.8, 95% CI: 6.4–575.5).ConclusionAnastomotic stenosis is a frequent, long‐term complication following surgery for diverticular disease. An analysis demonstrated that age is a risk factor for colorectal stenosis and that histological inflammation and the presence of diverticula near/at the resection margins have no effect on the incidence of stenosis.
Effect of pathologist's dedication on lymph node detection rate and postoperative survival in colorectal cancer
Authors: Unger L. W. , Muckenhuber M. , Riss S. , Argeny S. , Stift J. , Mesteri I. , Stift A. 
Published: April 2018

AbstractAimAs adjuvant chemotherapy in colorectal cancer relies on the identification of lymph node metastases, the pathologist's dedication may have a considerable influence on postoperative survival.MethodThe aim of this retrospective study was to assess the impact of the pathologist's dedication on lymph node detection rate and postoperative survival in patients operated on by a single experienced colorectal surgeon within a 5‐year period. We assessed 229 patients undergoing total mesorectal excision or complete mesocolic excision by the senior author between 1 January 2009 and 31 December 2013. Pathologists were grouped as ‘general pathologist’ or ‘dedicated pathologist’ depending on their dedication/specialization.ResultsDedicated pathologists found statistically significantly more lymph nodes in colorectal specimens than general pathologists [23 (interquartile range 24) vs 14 (interquartile range 11), respectively; P < 0.001]. The detection rate of ≥ 12 lymph nodes per specimen was significantly higher in the dedicated pathologist group [65/74 (87.8%) vs 105/155 (67.7%); P = 0.016]. However, postoperative survival did not differ in the respective subgroups. In the multivariable analysis by Cox proportional hazard model, International Union against Cancer Stage IV was the only factor associated with decreased disease‐specific survival (hazard ratio 28.257; 95% CI 3.850–207.386; P = 0.001).ConclusionIn our centre, the pathologist's dedication has an impact on lymph node detection rate but does not influence postoperative disease‐specific survival.
Factors predicting early postpartum glucose intolerance in Japanese women with gestational diabetes mellitus: decision‐curve analysis
Authors: Kondo M. , Nagao Y. , Mahbub M. H. , Tanabe T. , Tanizawa Y. 
Published: April 2018

AbstractAimsTo identify factors predicting early postpartum glucose intolerance in Japanese women with gestational diabetes mellitus, using decision‐curve analysis.MethodsA retrospective cohort study was performed. The participants were 123 Japanese women with gestational diabetes who underwent 75‐g oral glucose tolerance tests at 8–12 weeks after delivery. They were divided into a glucose intolerance and a normal glucose tolerance group based on postpartum oral glucose tolerance test results. Analysis of the pregnancy oral glucose tolerance test results showed predictive factors for postpartum glucose intolerance. We also evaluated the clinical usefulness of the prediction model based on decision‐curve analysis.ResultsOf 123 women, 78 (63.4%) had normoglycaemia and 45 (36.6%) had glucose intolerance. Multivariable logistic regression analysis showed insulinogenic index/fasting immunoreactive insulin and summation of glucose levels, assessed during pregnancy oral glucose tolerance tests (total glucose), to be independent risk factors for postpartum glucose intolerance. Evaluating the regression models, the best discrimination (area under the curve 0.725) was obtained using the basic model (i.e. age, family history of diabetes, BMI ≥25 kg/m2 and use of insulin during pregnancy) plus insulinogenic index/fasting immunoreactive insulin <1.1. Decision‐curve analysis showed that combining insulinogenic index/fasting immunoreactive insulin <1.1 with basic clinical information resulted in superior net benefits for prediction of postpartum glucose intolerance.ConclusionsInsulinogenic index/fasting immunoreactive insulin calculated using oral glucose tolerance test results during pregnancy is potentially useful for predicting early postpartum glucose intolerance in Japanese women with gestational diabetes.
Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years
Authors: Riordan F. , McHugh S. M. , Harkins V. , Marsden P. , Kearney P. M. 
Published: April 2018

AbstractAimTo examine the quality of care delivered by a structured primary care‐led programme for people with Type 2 diabetes mellitus in 1999–2016.MethodsThe Midland Diabetes Structured Care Programme provides structured primary care‐led management. Trends over time in care processes were examined (using a chi‐squared trend test and age‐ and gender‐adjusted logistic regression). Screening and annual review attendance were reviewed. A composite of eight National Institute for Health and Care Excellence‐recommended processes was used as a quality indicator. Participants who were referred to diabetes nurse specialists were compared with those not referred (Student's t‐test, Pearson's chi‐squared test, Wilcoxon–Mann–Whitney test). Proportions achieving outcome targets [HbA1c ≤58 mmol/mol (7.5%), blood pressure ≤140/80 mmHg, cholesterol <5.0 mmol/l] were calculated.ResultsData were available for people with diabetes aged ≥18 years: 1998/1999 (n=336); 2003 (n=843); 2008 (n=988); and 2016 (n=1029). Recording of some processes improved significantly over time (HbA1c, cholesterol, blood pressure, creatinine), and in 2016 exceeded 97%. Foot assessment and annual review attendance declined. In 2016, only 29% of participants had all eight National Institute for Health and Care Excellence processes recorded. A higher proportion of people with diabetes who were referred to a diabetes nurse specialist had poor glycaemic control compared with those not referred. The proportions meeting blood pressure and lipid targets increased over time.ConclusionsStructured primary care led to improvements in the quality of care over time. Poorer recording of some processes, a decline in annual review attendance, and participants remaining at high risk suggest limits to what structured care alone can achieve. Engagement in continuous quality improvement to target other factors, including attendance and self‐management, may deliver further improvements.
Prospective evaluation of the effect of deferasirox on hematologic response in transfusion‐dependent patients with low‐risk MDS and iron overload
Authors: Rose Christian , Lenoir Caroline , Gyan Emmanuel , Hacini Maya , Amé Shanti , Corront Bernadette , Beyne‐Rauzy Odile , Adiko Didier , Loppinet Elena , Ali‐Ammar Nadia , Laribi Kamel , Wattel Eric , Dreyfus François , Roué Claire S. , Cheze Stephane 
Published: May 2018

AbstractObjectivesTo assess the reduction of transfusions rate in transfusion‐dependent patients with low‐risk myelodysplastic syndrome (MDS) with iron overload treated with deferasirox.MethodsProspective observational study. Primary endpoint was reduction in transfusion requirements (RTR) at 3 months, (assessed on 8‐week period). Secondary endpoints were hematologic improvement according to International Working Group (IWG) 2006 criteria at 3, 6, and 12 months.ResultsFifty‐seven patients were evaluable. After 3 months of chelation, no effect was seen on transfusion requirement (5.9 packed red blood cells (PRBC) vs 5.8 before chelation). According to the Kaplan‐Meier analysis, the probability of RTR at 3, 6, and 12 months was assessed as 3.5%, 9.1%, and 18.7%, respectively. Median duration of RTR was 182 days. However, during the 12‐month follow‐up after deferasirox initiation, 17 patients (31.5%) achieved minor erythroid response [HI‐E] according to IWG criteria, 10 of whom having achieved Hb improvement at month 12.ConclusionAfter 3 months of treatment, deferasirox had no impact on transfusion requirement in regularly transfused patients with low‐risk MDS. However, deferasirox could induce 31% of erythroid response during the 12‐month follow‐up period thus suggesting that iron chelation therapy with deferasirox may induce an effect on hematopoiesis in a subset of patients with MDS and iron overload.
Targeted gene disruption by use of CRISPR/Cas9 ribonucleoprotein complexes in the water flea Daphnia pulex
Authors: Hiruta Chizue , Kakui Keiichi , Tollefsen Knut E. , Iguchi Taisen 
Published: May 2018

The microcrustacean Daphnia pulex is an important model for environmental, ecological, evolutionary and developmental genomics because its adaptive life history displays plasticity in response to environmental changes. Even though the whole‐genome sequence is available and omics data have actively accumulated for this species, the available tools for analyzing gene function have thus far been limited to RNAi (RNA interference) and TALEN (the transcription activator‐like effector nuclease) systems. The development of the CRISPR/Cas9 (clustered regularly interspaced short palindromic repeats/CRISPR‐associated 9) system is thus expected to further increase the genetic tractability of D. pulex and to advance the understanding of this species. In this study, we developed a genome editing system for D. pulex using CRISPR/Cas9 ribonucleoprotein complexes (Cas9 RNPs). We first assembled a CRISPR single‐guide RNA (sgRNA) specific to the Distal‐less gene (Dll), which encodes a homeodomain transcription factor essential for distal limb development in invertebrates and vertebrates. Then, we injected Cas9 RNPs into eggs and evaluated its activity in vivo by a T7 endonuclease I assay. Injected embryos showed defective formation of the second antenna and disordered development of appendages, and indel mutations were detected in Dll loci, indicating that this technique successfully knocked out the target gene.
Modelling variation in calling rates to develop a reliable monitoring method for the Australasian Bittern Botaurus poiciloptilus
Authors: Williams Emma M. , Armstrong Doug P. , O'Donnell Colin F. J. 
Published: April 2018

Monitoring the abundance of cryptic species inevitably relies on the use of index methods. Unfortunately, detectability is often confounded by unidentified covariates. One such species is the critically endangered Australasian Bittern Botaurus poiciloptilus. Current monitoring relies upon the ability to count males based on the conspicuous breeding calls of males. However, as in many vocal species, calling rates vary spatially and temporally, making it necessary to account for this when using call counts to index abundance. We undertook 461 15‐min call counts of Australasian Bitterns, in a range of conditions, during two breeding seasons at Whangamarino wetland, New Zealand. We fitted a range of generalized linear mixed models to these data to determine which factors were the best predictors of calling rate per individual Bittern (CRPI), allowing us to make recommendations regarding the optimum time and conditions for monitoring. Bittern CRPI was predictable in terms of time of day, month, cloud cover, rainfall and certain moon parameters, but some spatial and temporal variation remained unexplained. Results showed that the best time to detect Australasian Bitterns was 1 h before sunrise, in September (austral spring), on a moonlit night with no cloud or rain. Such models are useful for identifying times and conditions when counts are the highest and least variable, and could be applied to any species or cue count monitoring method where detection depends on counting calling individuals. Results can be used to standardize index counts, or sensibly to adjust and compare counts from different times. Standardizing monitoring in this way can lead to the development of monitoring methods that have a greater power to show population changes across shorter time periods. Moreover, the use of modelling processes to estimate effect sizes creates potential for such methods to be applied in circumstances where monitoring conditions are rarely optimum and standardization creates logistical trade‐offs, something that is particularly common in studies of cryptic species.
Width proportion of the urethral plate to the glans can serve as an appraisal index of the urethral plate in hypospadias repair
Authors: Ru Wei , Shen Jing , Tang Daxing , Xu Shan , Wu Dehua , Tao Chang , Chen Guangjie , Gao Lei , Wang Xiaohao , Shen Yiding 
Published: May 2018

ObjectivesTo find a new appropriate evaluation for urethral plate quality in hypospadias repair, with particular interest in the width proportion of the urethral plate to the glans, serving as an appraisal index.MethodsData were prospectively collected from prepubertal boys who underwent primary tubularized incised plate hypospadias repair between January 2014 and April 2016 in one center. Intrinsic parameters of the penis (meatal location, glans width, urethral plate width and curvature degree) were measured during the operation. Urethroplasty complications were recorded during follow up. The correlation between width proportion of the urethral plate to the glans and urethroplasty complications was analyzed.ResultsPrimary tubularized incised plate repair was carried out in 442 patients (mean age 2.8 years, range 0.5–12 years). At mean follow up of 26 months (range 12–38 months), urethroplasty complications occurred in 59 (13.3%) patients. The width proportion of the urethral plate to the glans was weakly correlated to both the glans width and meatal location. The width proportion of the urethral plate to the glans ranged from 0.18 to 0.73, with a mean of 0.39. The cut‐off value of width proportion of the urethral plate to the glans was determined to be 0.36 by the receiver operating characteristic curve. Urethroplasty complications occurred in 17 out of 254 patients (6.7%) with width proportion of the urethral plate to the glans >0.36, and 42 out of 188 patients (22.3%) with width proportion of the urethral plate to the glans ≤0.36. The width proportion of the urethral plate to the glans ≤0.36 showed an increased odds of 4.819‐fold (95% confidence interval 2.548–9.112, P < 0.001) risk of urethroplasty complications compared with width proportion of the urethral plate to the glans >0.36. Midshaft and proximal meatal location also increased the risk of urethroplasty complications.ConclusionsThe present study highlights the value of the width proportion of the urethral plate to the glans for objectivity and accuracy in urethral plate evaluation, which in turn serves as an independent factor influencing outcomes in tubularized incised plate repair.