bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing pregnancy, childbirth, and neonatal outcomes in women with idiopathic polyhydramnios: a prospective cohort study
Authors: Vanda Raziyeh , Bazrafkan Mahnaz , Rouhani Maryam , Bazarganipour Fatemeh 
Published: May 2022

Abstract
Background
In this prospective cohort study, the perinatal outcome in idiopathic polyhydramnios compared with normal pregnancies was examined.

Methods
This was a prospective cohort study of 180 singleton pregnancies who received care at the referral gynecology clinic of Yasuj, Iran between 2018–2020. The inclusion criteria comprised singleton pregnancies, gestational age > 34 weeks; fetuses without structural and chromosomal abnormalities in pregnancy screening test, no maternal diabetes, negative TORCH negative screening test, no Rh factor isoimmunization. Polyhydramnios was defined as: (i) amniotic fluid index ≥ 24 cm; (ii) maximal vertical pocket of ≥ 8 cm. Perinatal outcomes were recorded in both groups.

Results
Postpartum hemorrhage (7.8% vs. 2.2; OR: 1.60; 95% CI 1.09–2.34) and cesarean delivery (51.11% vs. 21.11; OR: 1.88; 95% CI 1.42–2.50) and respiratory distress (4.4 v vs. 0; OR: 2.04; 95 C CI 1.75–2.80) was significantly higher in the idiopathic polyhydramnios (P ≤ 0.05) compared to normal pregnancy, which increased with severity of idiopathic polyhydramnios.

Conclusion
In conclusion, the results of the current study, suggest that idiopathic polyhydramnios may be associated with a higher rate of postpartum hemorrhage, cesarean delivery, and respiratory distress than a normal pregnancy.
Opioid exposure during pregnancy and the risk of congenital malformation: a meta-analysis of cohort studies
Authors: Wang Xinrui , Wang Yushu , Tang Borui , Feng Xin 
Published: May 2022

Abstract
Background
Opioid exposure during pregnancy has increased alarmingly in recent decades. However, the association between prenatal opioid exposure and congenital malformation risk has still been controversial. We aim to assess the association between opioid exposure during pregnancy and the risk of congenital malformations.

Method
PubMed, Embase, and Cochrane library of clinical trials were systematically searched to September 13th, 2021. Cohort studies reporting risk of congenital malformation after opioid exposure compared with non-exposure during pregnancy were included. Risk of studies was appraised with the ROBINS-I tool. Meta-analysis was conducted using the random-effects model. Subgroup analyses were conducted for the primary outcome based on indication, exposed period, whether adjusted data was used, and risk of bias assessment. Meta-regression was performed to evaluate the relation of publication year.

Main results
Eighteen cohort studies with 7,077,709 patients were included. The results showed a significant increase in the risk of overall congenital malformation (RR = 1.30, 95%CI: 1.11–1.53), major malformation (RR = 1.57, 95%CI:1.11–2.22), central nervous system malformation (RR = 1.36, 95% CI:1.19–1.55), and limb malformation (RR = 2.27, 95%CI:1.29–4.02) with opioid exposure during pregnancy. However, the predictive interval conveyed a different result on overall congenital malformation (95%PI: 0.82–2.09) and major malformation (95%PI: 0.82–2.09). No association between opioid exposure and overall congenital malformation in the first trimester (RR = 1.12, 95%CI:0.97–1.31) and prescribed for analgesic or antitussive treatment (RR = 1.03, 95%CI:0.94–1.13) were observed. In subgroups that study provided data adjusted for confounders (RR = 1.06, 95%CI:0.93–1.20) or identified moderate or serious risk of bias (RR = 1.00, 95%Cl: 0.85–1.16; RR = 1.21, 95%Cl: 1.60–2.68), no association was found.

Conclusion
Opioid exposed in the first trimester or prescribed for analgesic or antitussive treatment did not increase the risk of overall congenital malformation. The findings should be discussed in caution considering the situation of individual patients and weigh out its potential risk of congenital malformation.

Trial registration
Registration number: CRD42021279445.
Trends of overweight and obesity among preschool children from 2013 to 2018: a cross-sectional study in Rhine-Neckar County and the City of Heidelberg, Germany
Authors: Liu Weina , He Mike Z. , Dambach Peter , Schwertz Rainer , Chen Simiao , Yu Fengyun , Marx Michael 
Published: May 2022

Abstract
Background
Early childhood overweight and obesity is a growing public health concern worldwide. Few recent studies have addressed how time trends varied by sociodemographic characteristics at the regional level using large and high-quality data. This study determines how time trends vary in the prevalence of early childhood overweight and obesity by age, gender, and migration background at the regional level.

Methods
We used a Kernel-density curve to describe the BMI distribution, and evaluated the trends of overweight and obesity by age, gender, and migration background using logistic regression.

Results
Mean BMI and the overall prevalence of overweight and obesity increased among preschool children aged 4–6 years in the Rhine-Neckar County and the City of Heidelberg. After adjusting for age, sex, and migration background, trends of overweight significantly increased only among male children in the age 5 year group with migration background (P < 0.05), and an upward trend of obesity was observed only among male children in the age 5 year group and female children in the age 6 year group with migration background (P < 0.05).

Conclusions
BMI distribution as well as general prevalence of overweight and obesity are still increasing among preschool children. Children with migration backgrounds, particularly male children in the age 5 year groups and female children in the age 6 year group should be prioritized. Health promotion strategies for children with migration backgrounds will help address this challenge.
A cross-sectional hospital-based study of correlates of disability in patients with chronic low back pain in KwaZulu-Natal, South Africa
Authors: Kahere Morris , Ginindza Themba 
Published: May 2022

Abstract
Background
Chronic low back pain (CLBP) is the leading cause of disability globally and is a major concern in public health. However, there is limited evidence on the prevalence and correlates of disability among adults in Sub-Saharan Africa. Thus, this study aimed at determining factors influencing disability among adult patients with CLBP in KwaZulu-Natal.

Methods
This analytical cross-sectional hospital-based study was conducted among adult CLBP patients in KwaZulu-Natal, South Africa. Data on disability, fear avoidance beliefs and illness behavior were gathered from 554 adult participants using self-administered questionnaires. Multiple linear regression analysis was conducted to determine factors associated with disability. Statistical significance was set at p < 0.05.

Results
Based on the multivariable linear regression, being a female (β = 0.343, p < 0.001) and fear avoidance beliefs about work (β = 0.221, p = 0.044) were significantly associated with greater disability, while, smoking 1 to 10 cigarettes per day (β = -0.106, p = 0.011) and higher illness behaviour scores (β = -0.165, p = 0.024) were significantly associated with less disability The model accounted for 20% of the total variance in Oswestry disability scores.

Conclusion
This study has concluded that disability in CLBP is predicted by multiple of factors, with psychosocial factors (fear avoidance beliefs and heavy cigarette smoking) playing a significant role. Manual work was also identified as a significant predictor of CLBP disability. Therefore, guidelines should emphasize on early identification of these yellow flags in primary care.
Preventive foot self-care practice and associated factors among diabetic patients attending the university of Gondar comprehensive specialized referral hospital, Northwest Ethiopia, 2021
Authors: Mekonen Enyew Getaneh , Gebeyehu Demssie Tizita 
Published: May 2022

AbstractBackgroundDiabetes mellitus is emerging as a major worldwide health problem that has a social, financial, and developmental impact on developing countries. Foot complications are among the most serious and costly complications of diabetes which lead to lower extremity amputation due to diabetic foot ulcers. Poor diabetic foot self-care practice is identified by different studies as a major contributing factor to diabetic foot ulcers. Therefore, this study was intended to assess foot self-care practice and associated factors among diabetic patients attending the University of Gondar comprehensive specialized referral hospital.MethodsA hospital-based cross-sectional study was conducted from July 1 to August 30, 2021, at the University of Gondar comprehensive specialized referral hospital. A systematic random sampling technique was employed to select 384 diabetic patients. A structured pretested interviewer-administered questionnaire was used to collect data. The data was entered in epi-info version 7, analyzed using SPSS version 21, and presented using frequencies, percentages, tables, and graphs. Bivariable and multivariable analyses were investigated using a binary logistic regression model.P-value < 0.05 and an odds ratio with a 95% confidence interval were used to determine the significance and strength of the association.ResultsOf the 384 diabetic patients, 46.4% (95% CI (41.1%-51.6%)) of them had poor foot self-care practice. Being male [AOR = 0.54, 95% CI (0.32, 0.89)], couldn’t read and write and completed primary education [AOR = 2.35, 95% CI (1.01, 5.43)] & [AOR = 2.92, 95% CI (1.39, 6.12)], living in rural area [AOR = 3.84, 95% CI (1.91, 7.75)], having diabetic complications [AOR = 2.19, 95% CI (1.07, 4.46)], taking both injection and pills [AOR = 0.33, 95% CI (0.12, 0.88)], having previous information about foot care [AOR = 0.12, 95% CI (0.06, 0.24)], and family support [AOR = 0.57, 95% CI (0.34, 0.94)] were determinants of poor foot self-care practice.ConclusionThe adherence of diabetic patients toward foot self-care practice was poor. Being male, having low educational status, living in a rural area, having diabetic-related complications, taking both injections and pills, not having previous information about foot care, and having poor family support increases the odds of having poor foot self-care practice. Giving health education to patients and their caregivers about the basic principles of diabetes foot care, like regular inspection of feet and appropriate footwear at their regular follow-up time, should be emphasized.
An extremely rare disconnection of the external iliac artery and novel collateral remodeling in an endometrial stromal sarcoma woman
Authors: Wang Shixuan , Zhou Ting , Yu Nan , Liu Ronghua 
Published: May 2022

Abstract
Background
Injury to the external iliac artery can have serious consequences and can be extremely challenging for surgeons. Here, we report a patient with bizarre disconnection of the external iliac artery during a laparoscopic operation.

Case presentation
On May 27, 2020, during a laparoscopic pelvic lymphadenectomy operation to treat endometrial stromal sarcoma, we encountered an unusual anatomy: abnormal disconnection of the left external iliac artery in a 26-year-old female patient. The proximal and distal ends of the left external iliac artery demonstrated old narrowing without active bleeding, and the distance between the two disconnected ends was more than 3 cm. The scenario was surprising to all the staff in the operating theater. After a comprehensive assessment of skin temperature, arterial pulsation and arterial blood flow, a multidisciplinary team determined that collateral circulation of the left lower limb had been established and could meet the blood supply of the lower limbs, which was also confirmed three times by computed tomography angiography and Doppler ultrasound of the blood vessels in the abdomen and lower limbs. Sixteen months after the operation, the patient had no obvious abnormality, and the daily activities of the left lower limb were not affected. Follow-up after treatment for the patient is still in progress.

Conclusions
We describe the details of the whole case of disconnection of the external iliac artery. We hope to summarize the experience and lessons learned through this case and a relevant literature review to improve the safety and orderliness of our future clinical work.
Changing HCW attitudes: a case study of normalizing HIV service delivery in emergency departments
Authors: Rao Aditi , Chen Victoria H. , Hill Sarah , Reynolds Steven J. , Redd Andrew D. , Stead David , Hoffmann Christopher , Quinn Thomas C. , Hansoti Bhakti 
Published: May 2022

ABSTRACT

Background
Delays in the implementation of evidence-based practices are significant and ubiquitous, compromising health outcomes. Resistance to change is a key factor in hindering adoption and integration of new evidence-based interventions. This study seeks to understand the impact of exposure to HIV testing within a research context on provider attitudes towards HIV counselling and testing (HCT) in emergency departments (ED).

Methods
This is a pre-and-post study design measuring the effect of a new ED-based HCT intervention, conducted by lay counsellors, on provider attitudes in Eastern Cape, South Africa. A validated, anonymized, 7-item survey was self-completed by routine care providers (physicians, nurses, and case managers). Questions were scored on a 5-point Likert scale with 5 consistently reflecting a positive attitude. Mean scores were calculated for each question and compared using a two-sample t-test to assess change in sample means for attitudes among providers surveyed before and after the intervention.

Results
A total of 132 surveys were completed across three EDs. Majority of respondents were female (70.5%), 20–29 years old (37.9%), of African race (81.1%), nurses (39.4%), and practicing medicine for 0–4 years (37.9%). Pre-intervention, providers displayed a positive attitude towards ‘the benefit of offering ED-based HCT to patients’ (4.33), ‘the ED offering HCT’ (3.53), ‘all ED patients receiving HCT’ (3.42), ‘concern about patient reaction to HCT’ (3.26), and ‘comfort with disclosing HCT results’ (3.21); and a mildly negative attitude towards ‘only high-risk ED patients receiving HCT’ (2.68), and ‘the burden of offering HCT in a clinical environment’ (2.80). Post-intervention, provider attitudes improved significantly towards ‘all ED patients receiving HCT’ (3.86, p < 0.05), ‘only high-risk ED patients receiving HCT’ (2.30, p < 0.05), ‘the burden of offering HCT in a clinical environment’ (3.21, p < 0.05), and ‘comfort with disclosing HCT results’ (3.81, p < 0.05).

Conclusions
Controlled exposure to new practices with a structured implementation period can shift attitudes beginning a process of practice normalization. In our study, we observed improvements in provider attitudes regarding the benefits of HCT and the burden of offering HCT to all patients in the ED. Research activities may have a role in mitigating resistance to change and supporting intervention adoption.
Potential clinical utility of liquid biopsies in ovarian cancer
Authors: Zhu Jie Wei , Charkhchi Parsa , Akbari Mohammad R. 
Published: May 2022

AbstractBackgroundOvarian cancer (OC) is the most lethal gynecologic malignancy worldwide. One of the main challenges in the management of OC is the late clinical presentation of disease that results in poor survival. Conventional tissue biopsy methods and serological biomarkers such as CA-125 have limited clinical applications. Liquid biopsy is a novel sampling method that analyzes distinctive tumour components released into the peripheral circulation, including circulating tumour DNA (ctDNA), circulating tumour cells (CTCs), cell-free RNA (cfRNA), tumour-educated platelets (TEPs) and exosomes. Increasing evidence suggests that liquid biopsy could enhance the clinical management of OC by improving early diagnosis, predicting prognosis, detecting recurrence, and monitoring response to treatment. Capturing the unique tumour genetic landscape can also guide treatment decisions and the selection of appropriate targeted therapies. Key advantages of liquid biopsy include its non-invasive nature and feasibility, which allow for serial sampling and longitudinal monitoring of dynamic tumour changes over time. In this review, we outline the evidence for the clinical utility of each liquid biopsy component and review the advantages and current limitations of applying liquid biopsy in managing ovarian cancer. We also highlight future directions considering the current challenges and explore areas where more studies are warranted to elucidate its emerging clinical potential.
A surgical case of high-grade urothelial carcinoma of the renal pelvis complicated with giant hydronephrosis, giving rise to diagnostic difficulties on a cytological examination
Authors: Takata Mao , Kumagai Motona , Tsubata Yumi , Okanemasa Yoshiiku , Takenaka Michiho , Terauchi Toshie , Yamashita Manabu , Shioya Akihiro , Yamada Sohsuke 
Published: May 2022

Abstract
Background
We report a surgical case of urothelial carcinoma of the renal pelvis, resulting in diagnostic difficulties on cytological examination.

Case presentation
A man in his late 70s underwent nephrectomy for giant hydronephrosis and renal cysts after nephrostomy and renal cyst puncture and drainage. On all cytological examinations performed before surgery, including nephrostomy urine, renal cyst fluid, catheterized bladder urine, and bladder washings, we were unable to make any conclusive diagnosis of malignancy. The pathological diagnosis of the surgical specimen concluded that this was a case of high-grade urothelial carcinoma of the renal pelvis with focal squamous differentiation (pT4). Liver and lung metastases were identified 3 months after surgery, and the patient died 2 months later.

Conclusion
It was very difficult to make a conclusive diagnosis using cytological specimens because of the presence of a small number of atypical cells with severe degenerative changes. Since clinicians cannot predict the potential for malignancy on preoperative imaging findings, it is critical to consider the difficulties in clinically making a correct diagnosis of urothelial carcinoma of the upper urinary tract, especially in cases complicated with giant hydronephrosis.
Lobectomy versus segmentectomy in patients with stage T (> 2 cm and ≤ 3 cm) N0M0 non-small cell lung cancer: a propensity score matching study
Authors: Wang Linlin , Ge Lihui , You Sibo , Liu Yongyu , Ren Yi 
Published: May 2022

Abstract
Background
The safety and effectiveness of lung segmentectomy in patients with early non-small cell lung cancer (NSCLC) remains controversial. We have therefore reviewed the clinicopathologic characteristics and survival outcomes of patients treated with lobectomy or segmentectomy for early T (> 2 and ≤ 3 cm) N0M0 NSCLC.

Methods
We obtained data from the Surveillance, Epidemiology, and End Results database for patients who underwent lobectomy or segmentectomy between 2004 and 2015. To reduce bias and imbalances between the treatment groups, propensity score matching analysis was performed. We used Kaplan–Meier curves to estimate overall survival (OS) and lung cancer-specific survival (LCSS). We conducted univariate and multivariate Cox proportional hazards regression analyses to identify independent prognostic factors for OS and cancer-specific survival, and applied the Cox proportional hazards model to create forest plots.

Results
Before matching, both univariate and multivariate Cox regression analyses revealed that patients who underwent lobectomy exhibited better OS (P < 0.001) and LCSS (P = 0.001) than patients who underwent segmentectomy. However, after matching, survival differences between the groups were not significant; OS (P = 0.434) and LCSS (P = 0.593). Regression analyses revealed that age and tumor grade were independent predictors of OS and LCSS (P < 0.05).

Conclusions
Patients with stage T (> 2 and ≤ 3 cm) N0M0 NSCLC undergoing segmentectomy can obtain OS and LCSS similar to those obtained with lobectomy. Further studies are required considering the solid component effects and pathologic tumor types regarding segmentectomies. Additional long-term survival and outcome analyses should be conducted with larger cohorts.
Activation of the stress response among the cardiac surgical residents: comparison of teaching procedures and other (daily) medical activities
Authors: Awad George , Pohl Robert , Darius Sabine , Thielmann Beatrice , Varghese Sam , Wacker Max , Schmidt Hendrik , Wippermann Jens , Scherner Maximilian , Böckelmann Irina 
Published: May 2022

Abstract
Background
The aim of this Pilot study was to investigate the cardiac surgical residents’ workload during different surgical teaching interventions and to compare their stress levels with other working time spent in the intensive care unit or normal ward.

Methods
The objective stress was assessed using two cardiac surgical residents’ heart rate variability (HRV) both during surgical activities (32 selected teaching operations (coronary artery bypass graft n = 26 and transcatheter aortic valve implantation n = 6), and during non-surgical periods. Heart rate, time and frequency domains as well as non-linear parameters were analyzed using the Wilcoxon test.

Results
The parasympathetic activity was significantly reduced during the surgical phase, compared to the non-surgical phase: Mean RR (675.7 ms vs. 777.3 ms), RMSSD (23.1 ms vs. 34.0 ms) and pNN50 (4.7% vs. 10.6%). This indicates that the residents had a higher stress level during surgical activities in comparison to the non-surgical times.
The evaluation of the Stress Index during the operations and outside the operating room (8.07 vs. 10.6) and the parasympathetic nervous system index (− 1.75 to − 0.91) as well as the sympathetic nervous system index (1.84 vs. 0.65) confirm the higher stress level during surgery. This can be seen too used the FFT Analysis with higher intraoperative LF/HF ratio (6.7 vs. 3.8).

Conclusion
HRV proved to be a good, objective method of identifying stress among physicians both in and outside the operating room. Our results show that residents are exposed to high psychological workloads during surgical activities, especially as the operating surgeon.