bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of an infection control guideline on the incidence of ventilator-associated pneumonia in patients admitted to the intensive care units
Authors: Safavi Ali , Molavynejad Shahram , Rashidi Mahboobeh , Asadizaker Marziyeh , Maraghi Elham 
Published: April 2023

AbstractBackground and aimStandard airway care can reduce the incidence of ventilator-associated pneumonia (VAP). This study aimed to determine the effect of implementing infection control guidelines on the incidence of VAP in patients admitted to the intensive care unit (ICU).Materials and MethodsIn this clinical trial, 121 patients admitted to the intensive care units of Golestan and Imam Khomeini hospitals of Ahvaz, Iran who were under mechanical ventilation were assigned to two groups of control and intervention in non-randomly allocation. The study was conducted in two consecutive periods. In the intervention group, infection control guidelines were performed to prevent VAP and in the control group, routine care was performed. Data collection is done by used a three-part instrument. The first part included questions on the patients’ demographics and clinical information. The second part was the modified clinical pulmonary infection scale (MCPIS) for the early detection of VAP. The third part of the data collection instrument was a developed checklist through literature review. The MCPIS was completed for all patients on admission and the 5th day of the study.ResultsThe two groups were homogenous respecting their baseline characteristics (P > 0.05) including the mean MCPIS score (P > 0.05). However, the intervention group had lower body temperature (P < 0.001), lower white blood cell counts (P < 0.038), lower MCPIS score (P < 0.001), and higher PaO2/FIO2 (P < 0.013) at the end of the study. The incidence of VAP was significantly lower in the intervention group when compared to the control group (i.e. 30% vs. 65.6%, P < 0.001).ConclusionsThe implementation of infection control guidelines could significantly reduce the incidence of VAP and its diagnostic indicators in patients admitted to the ICU. Nurses are advised to use these guidelines to prevent VAP in patients admitted to ICU.
A pilot study to compare propranolol and misoprostol versus misoprostol and placebo for induction of labor in primigravidae; a randomized, single-blinded, placebo-controlled trial
Authors: Abdel Hamid Ahmed Sherif , El Zeneiny Hazem , Fathy Ahmed , Nawara Maii 
Published: April 2023

Abstract
Background
The Induction of labor is the most common obstetric procedure in daily practice. Introducing propranolol as a new drug to augment the action of prostaglandins will help in the induction process and decrease CS rates. Several researchers have used propranolol in the augmentation of labor.

Aim
This pilot study compares propranolol and misoprostol versus misoprostol alone for labor induction in primigravids.

Methods
This is a Randomized clinical trial, single-blinded, placebo-controlled trial at Ain Shams University Maternity hospital. This study included 128 pregnant full-term primigravid women candidates for labor induction, randomized into two groups. All candidates underwent labor induction with 25 µg of vaginal misoprostol. Group I received 20 mg of oral propranolol tablets, while group II received sugary pills as a placebo. Candidates who responded successfully to induction were assessed for possible augmentation of labor by amniotomy or oxytocin infusion. The Primary outcome was induction to delivery interval, while the secondary outcomes were the duration of the latent phase, mode of delivery, and APGAR score of the neonate.

Results
The induction-delivery time was (11.8 ± 8.1 h. vs. 12.6 ± 8.9 h., P value = 0.027) and the duration of the latent phase of labor (7.9 ± 5.6 h. vs. 9.2 ± 6.03 h., P value = 0.017) were significantly shorter in the group of misoprostol and propranolol compared to the group of misoprostol and placebo. There was no statistically significant difference between both groups’ mode of delivery, indications for cesarean section, misoprostol, and oxytocin doses, or neonatal outcome. (P value > 0.05).

Conclusion
Propranolol, when used with misoprostol for induction of labor, results in augmentation of action of misoprostol and a significantly shorter induction-delivery interval.

Trial registration
We retrospectively registered this trial in clinicaltrial.gov on 01/09/2020 (NCT04533841). https://clinicaltrials.gov/ct2/show/NCT04533841
Quantification of mitochondrial cfDNA reveals new perspectives for early diagnosis of colorectal cancer
Authors: Linke Christian , Hunger Richard , Reinwald Mark , Deckert Markus , Mantke René 
Published: April 2023

AbstractBackgroundTo unravel how the integrity of nuclear and mitochondrial circulating cell-free DNA (cfDNA) contributes to its plasma quantity in colorectal cancer (CRC) patients.MethodsCfDNA from plasma samples of 80 CRC patients stratified by tumour stage and 50 healthy individuals were extracted. Total cfDNA concentration was determined and equal template concentrations (ETC) were analyzed by quantitative real-time PCR (qPCR) resulting in small and long fragments of KRAS, Alu and MTCO3. The obtained data was also examined relative to the total cfDNA concentration (NTC) and diagnostic accuracy was estimated using receiver operating characteristics.ResultsTotal cfDNA levels were significantly higher in CRC group compared to healthy control and increased with tumour stage. Long nuclear fragment levels were significantly lower in CRC patients in ETC but not NTC condition. The integrity indices of nuclear cfDNA decreased from controls to patients with highly malignant tumor. Mitochondrial cfDNA fragment quantities were strongly reduced in early and late stages of tumor patients and prognostic value was higher in ETC. Predictive models based on either ETC or NTC predictor set showed comparable classification performance.ConclusionIncreased blood cfDNA concentration in late UICC stages inversely correlate with nuclear cfDNA integrity index and suggest that necrotic degradation is not a major cause for higher total cfDNA quantity. The diagnostic and prognostic value of MTCO3 is highly significant in early stages of CRC and can be evaluated more comprehensively, using ETC for qPCR analysis.Trial registrationThe study was registered retrospectively on DRKS, the german register for clinical trials (DRKS00030257, 29/09/2022).
Bayesian spatial modeling of childhood overweight and obesity prevalence in Costa Rica
Authors: Gómez Mario J. , Barboza Luis A. , Vásquez Paola , Moraga Paula 
Published: April 2023

AbstractBackgroundChildhood overweight and obesity levels are rising and becoming a concern globally. In Costa Rica, the prevalence of these conditions has reached alarming values. Spatial analyses can identify risk factors and geographical patterns to develop tailored and effective public health actions in this context.MethodsA Bayesian spatial mixed model was built to understand the geographic patterns of childhood overweight and obesity prevalence in Costa Rica and their association with some socioeconomic factors. Data was obtained from the 2016 Weight and Size Census (6 - 12 years old children) and 2011 National Census.ResultsAverage years of schooling increase the levels of overweight and obesity until reaching an approximate value of 8 years, then they start to decrease. Moreover, for every 10-point increment in the percentage of homes with difficulties to cover their basic needs and in the percentage of population under 14 years old, there is a decrease of 7.7 and 14.0 points, respectively, in the odds of obesity. Spatial patterns show higher values of prevalence in the center area of the country, touristic destinations, head of province districts and in the borders with Panama.ConclusionsEspecially for childhood obesity, the average years of schooling is a non-linear factor, describing a U-inverted curve. Lower percentages of households in poverty and population under 14 years old are slightly associated with higher levels of obesity. Districts with high commercial and touristic activity present higher prevalence risk.
Time outdoors positively associates with academic performance: a school-based study with objective monitoring of outdoor time
Authors: Wang Jingjing , Sankaridurg Padmaja , Naduvilath Thomas , Li Wayne , Morgan Ian G. , Rose Kathryn A. , Weng Rebecca , Xu Xun , He Xiangui 
Published: April 2023

Abstract
Background
To explore the relationship between outdoor time and academic performance among school-aged children.

Methods
This study was designed as a cross-sectional study. Data were derived from a school-based prospective children myopia intervention study (STORM). Outdoor time was recorded by self-developed algorithm-validated wristwatches in real-time and calculated as the cumulative average of 10 months. The academic performance was recorded and provided by the participating schools and further standardized. Other information was collected using an online standardized questionnaire. Mixed-effects model and B-Spline method were used to investigate the association between time spent on different types of daily activity, including outdoor activity and academic performance.

Results
A total of 3291 children with mean age 9.25 years were included in the final analysis. Overall, outdoor time was associated with academic performance in a non-linear manner; specifically, not exceeding 2.3 h per day, outdoor time was positively associated with academic performance; exceeding 2.3 h per day, this association became non-significant. Likewise, daily sleep duration and out-of-school learning time were associated with academic performance in a non-linear manner, resulting in turning points of 11.3 and 1.4 h per day, respectively. Separate analysis showed that outdoor time and sleep duration but not out-of-school learning time were positively associated with academic performance in Chinese, mathematics and English.

Conclusion
Outdoor time, sleep duration and out-of-school learning time were associated with academic performance in a non-linear manner. Promotion of outdoor time may not negatively impact on academic performance.

Trial registration
Our study was registered in ClinicalTrials.gov (Identifier: NCT02980445).
The ratio of respiratory rate to diaphragm thickening fraction for predicting extubation success
Authors: Eksombatchai Dararat , Sukkratok Chalermwut , Sutherasan Yuda , Junhasavasdikul Detajin , Theerawit Pongdhep 
Published: April 2023

Abstract
Background
Several parameters are used to predict successful extubation but their accuracy varies among studies. We hypothesized that combining conventional and diaphragmatic parameters would be more effective than using just one. Our primary objective was to evaluate the performance of the respiratory rate in relation to the diaphragm thickening fraction (RR/DTF) ratio to predict the success of extubation.

Methods
We enrolled 130 adult patients who required invasive mechanical ventilation, planned to be extubated, and used a spontaneous breathing trial (SBT) in the intensive care unit from July 2020 to April 2022. We measured the conventional parameters and the diaphragmatic parameters 2 h after SBT. The RR/DTF was calculated by dividing the respiratory rate (RR) by the diaphragm thickening fraction (DTF). The definition of weaning success is successful extubation within 48 h.

Results
Of 130 patients, 8 patients (6.2%) were reintubated within 48 h. The RR/DTF was significantly lower in the successful extubation group than in the extubation failure group (right hemidiaphragm; 0.47 (0.33–0.64) vs 1.1 (0.6–2.32), p < 0.001 and left hemidiaphragm; 0.45 (0.31–0.65) vs 0.78 (0.48–1.75), p < 0.001). The right RR/DTF using a cut-off point at ≤ 0.81 had a sensitivity of 87.7%, a specificity of 75%, and areas under the receiver operating characteristic curve (AUROC) of 0.762 for predicting successful extubation (p = 0.013). The sensitivity, specificity, and AUROC for predicting extubation success of right DTF at a cut-off point of ≥ 26.2% were 84.3%, 62.5%, and 0.775, respectively (p = 0.009).

Conclusion
The RR/DTF ratio is a promising tool for predicting extubation outcome. Additionally, using RR/DTF was more reliable than conventional or diaphragmatic parameters alone in predicting extubation success.
Causes and risk factors of an unplanned second craniotomy in patients with traumatic brain injury
Authors: Fu Shilong , Hou Pengwei , Wang Guofeng , Wang Shousen 
Published: April 2023

Abstract
Background
The purpose of this retrospective study was to evaluate the causes and risk factors of an unplanned second craniotomy in patients with traumatic brain injury (TBI).

Methods
A total of 219 patients with TBI who underwent initial unilateral intracranial supratentorial surgery between January 2016 to November 2021 were included. We evaluated the causes of an unplanned second craniotomy in 40 patients, and analyzed the risk factors for a contralateral second craniotomy in 21 patients using a multivariate logistic regression analysis.

Results
The most common cause for an unplanned second craniotomy was delayed or enlarged hematoma in the non-operation area (26/40; 65%), followed by recurrent hematoma in the operation area (8/40; 20%), ipsilateral massive cerebral infarction (3/40; 7.5%), diffuse brain swelling (2/40; 5%) and enlarged cerebral contusion (1/40; 2.5%). Multivariate logistic regression analysis showed that a contralateral craniocerebral injury feature (CCIF) (OR = 13.175), defined on preoperative computerized tomography scanning, was independent risk factor for a contralateral second craniotomy.

Conclusions
An unplanned second craniotomy in patients with TBI was mainly related to delayed or enlarged hematoma. An increased risk of a contralateral second craniotomy occurs in patients with CCIF.
Efficacy of emergency extracorporeal shock wave lithotripsy in the treatment of ureteral stones: a meta-analysis
Authors: Peng Cheng-Xia , Lou Yi-Kai , Xu Li , Wu Guang-Hao , Zhou Xie-Lai , Wang Kang-Er , Ye Chun-Hua 
Published: April 2023

Abstract
Objective
To compare the clinical efficiency and safety of emergency extracorporeal shock wave lithotripsy (eESWL) and delayed extracorporeal shock wave lithotripsy (dESWL) in the treatment of ureteral stones.

Methods
Cochrane Library, PubMed, Google Scholar, and Web of Science were searched from January 1, 1992 to September 30, 2022, and all comparative studies involving eESWL and dESWL for ureteral calculi were included. Statistical analysis was performed using Review Manager 5.3 software. Funnel plot was used to evaluated publication bias.

Results
A total of 9 articles involving 976 patients diagnosed with ureteral stones were included. The results showed that the stone-free rate (SFR) after four weeks was significantly higher in the eESWL group than in the dESWL group [relative risk (RR) = 1.22, 95% confidence interval (CI): 1.13–1.32, P < 0.01]. In subgroup analysis of different stone locations, proximal ureteral calculi [RR = 1.25, 95% CI: 1.14–1.38, P < 0.01] and mid-to-distal ureteral calculi [RR = 1.18, 95% CI: 1.03–1.34, P < 0.05] all showed a higher SFR in the eESWL group. eESWL significantly shortened the stone-free time(SFT) [mean difference (MD) = -5.75, 95% CI: -9.33 to -2.17, P < 0.01]. In addition, eESWL significantly reduced auxiliary procedures [RR = 0.53, 95% CI: 0.40–0.70, P < 0.01]. No significant difference in complications was found between the two groups [RR = 0.90, 95% CI: 0.69–1.16, P > 0.05].

Conclusion
eESWL can significantly improve SFR, shorten SFT, and reduce auxiliary procedures.
Transperitoneal laparoscopic umbilical resection of urachal remnants: a feasible surgical method
Authors: Yuki Hideo , Ohkubo Naoya , Kurashina Ryo , Sakamoto Kazumasa , Suzuki Issei , Takei Kohei , Betsunoh Hironori , Nukui Akinori , Yashi Masahiro , Kamai Takao 
Published: April 2023

Abstract
Background
To date, there is no standard established laparoscopic surgical method for managing urachal remnants because of their rarity, and several questions remain unanswered. Are there any problems for considering the operative indications about patients’ factors for example, body mass index and so on? This study aimed to determine the feasible surgical method for managing urachal remnants and presents the operative outcomes of our cases in relation to the findings from the existing literature.

Methods
We analyzed the data of 16 patients (7 women and 9 men; age range, 19–48 years) who underwent surgery for urachal remnants between January 2013 and March 2019 at our institution.

Results
In our cases, all urachal remnants were urachal sinuses, and the primary complaints were umbilical pain and pus discharge. Most of these symptoms were controlled using umbilical drainage and oral antibiotic intake; however, incisional drainage was required in two cases. In all cases, we performed a laparoscopic resection of the urachal remnants; one patient underwent an open conversion due to a very thick abdominal wall. Therefore, “peri-umbilical distanse” was proposed as an index to verify the periumbilical abdominal wall thickness. This index may clear the difficulties of the laparoscopic resection of the urachal remnunts. A postoperative complication—local infection that was treated using re-suturing—was observed in one patient. No adverse events occurred in the other cases. Our method was appropriate because it allowed for complete urachal resection with good cosmetic results, i.e., a small and natural scar appearance. Additionally, if bladder injury occurred, bladder re-suturing was easily possible because of the laparoscopic port’s position.

Conclusions
We present an feasible method for laparoscopic urachal resection. This method may be recommended for young patients with an peri-umbilical distanse of < 2 cm.
Primary hyperparathyroidism in an adolescent presenting with genu valgus progressing to extensive bone disease; a case report
Authors: de Silva Nipun Lakshitha , Jayalath Mihiran Denagama , Sampath W. K. Chaminda , Perera Ranga , Karunathilake Chandana 
Published: April 2023

AbstractBackgroundPrimary hyperparathyroidism which is rare in adolescents presents commonly with non-specific symptoms and systemic complaints. Though there are few reported cases of genu valgus, genu valgus progressing to extensive bone disease despite mildly elevated calcium had not been reported before.Case presentationA 12-year-old male had been evaluated for bilateral (left > right) genu valgus and short stature. Serum calcium and phosphate levels had been normal. X-ray of the femora and pelvic bones had not shown additional abnormalities. Valgus deformity progressed despite left femoral plating, and a left distal femoral medial closed wedge osteotomy had been performed at 15 years. Plain imaging at that time had shown localised osteopaenia. At the age of 17 years, he developed multiple fragility fractures of his left hip rendering him wheelchair-bound. Further evaluation revealed a serum PTH level of 2571 (10–65) pg/mL with calcium of 2.82 (2.2–2.6) mmol/L and inorganic phosphate of 1.7 (2.2–4.7) mg/dL. The lumbar spine DXA scan showed a Z-score of -5.8. A left parathyroid adenoma was localised and there was evidence of hyperparathyroid bone disease including brown tumours. He underwent left parathyroidectomy and left thyroid lobectomy after which his PTH level dropped to 4.03 pg/mL. He developed hypocalcaemia which was managed successfully with calcium and alfacalcidol replacement.ConclusionsPrimary hyperparathyroidism can present with genu valgus in adolescents. Initial normocalcaemia which could be due to concomitant vitamin D deficiency could mask this leading to delayed diagnosis until severe irreversible bone disease ensues.
Association of congenitally missing teeth with adult temporomandibular disorders in the urban health checkup population
Authors: Liu Yundong , Yin Tao , He Mi , Fang Changyun , Peng Shifang 
Published: April 2023

Abstract
Background
Congenitally missing tooth is the most common dental abnormality which leaves spaces in the arch, leads to numerous forms of malocclusion due to the Bolton index discrepancy and is even associated with abnormal craniofacial morphology. Even though the roles of malocclusion and tooth loss in temporomandibular disorders (TMD) development remain controversial, basic researches have found some common molecules are involved in osteoarthritis and dental agenesis. However, the association of congenitally missing teeth with TMD is unknown. We hence investigated the association of congenitally missing teeth with TMD.

Methods
A cross-sectional analysis of 586 control participants (male: 287, female: 299, 38.33 ± 11.65 years) and 583 participants with non-third molar congenitally missing teeth (male: 238, female: 345, 39.13 ± 11.67 years) who consecutively received routine dental and TMD checkup according to Diagnostic Criteria for Temporomandibular Disorders Axis I in Health Management Center, Xiangya Hospital was performed. Logistic regression analysis was used to study the association of congenitally missing teeth with TMD.

Results
The congenitally missing teeth group included 581 hypodontia and 2 oligodontia participants. The congenitally missing anterior teeth participants, the congenitally missing posterior teeth participants and participants with both congenitally missing anterior and posterior teeth accounted for 88.34%, 8.40% and 3.26% of the congenitally missing teeth group respectively. Congenitally missing teeth group had greater ratios of females and orthodontic history. Participants with congenitally missing teeth had a significantly higher prevalence of overall TMD (67.24%) in comparison to control participants (45.90%). After adjusting age, gender, presence of congenitally missing teeth, number of congenitally missing teeth, number of non-congenitally missing teeth, number of dental quadrants with missing teeth, visible third molar and orthodontic history, the variables of age, gender, presence of congenitally missing teeth and number of dental quadrants with missing teeth were significant for overall TMD. Multivariable logistic regression analysis showed congenitally missing tooth was significantly related with overall TMD [odds ratio (OR):1.689(1.080–2.642), P = 0.022], intra-articular TMD [OR: 1.711(1.103–2.656), P = 0.017] and pain-related TMD [OR: 3.093(1.321–7.239), P = 0.009].

Conclusion
Congenitally missing tooth is a risk factor for TMD. When treating the congenitally missing teeth population, TMJ evaluation and multidisciplinary strategies are necessary.