Suture repair of umbilical hernia during caesarean section: a case-control study

Purpose: The objective of this study was to investigate the additional burdens in terms of pain, prolongation of surgery and morbidity which is added to elective caesarean section if umbilical hernia suture repair is performed simultaneously. Secondly, patient's satisfaction and hernia recurrence rate were assessed. Methods: Consecutive women with symptomatic umbilical hernia undergoing internal or external suture repair during elective caesarean were included in this retrospective cohort-control study. Data on post-operative pain, duration of surgery and morbidity of a combined procedure were collected. These patients were matched 1:10 to women undergoing caesarean section only. Additionally, two subgroups were assessed separately: external and internal suture hernia repair. These subgroups were compared for patient's satisfaction, cosmesis, body image and recurrence rate. Results: Fourteen patients with a mean age of 37years were analysed. Internal suture repair (n=7) prolonged caesarean section by 20min (p=0.001) and external suture repair (n=7) by 34min (p<0.0001). Suture repair did not increase morphine use (0.38±0.2 vs. 0.4±02mg/kg body weight), had no procedure-related morbidity and prolonged hospitalization by 0.5days (p=0.01). At a median follow-up of 37 (5-125) months, two recurrences in each surgical technique, internal and external suture repair, occurred (28%). Body image and cosmesis score showed a higher level of functioning in internal suture repair (p=0.02; p=0.04). Discussion: Despite a high recurrence rate, internal suture repair of a symptomatic umbilical hernia during elective caesarean section should be offered to women if requested. No additional morbidity or scar is added to caesarean section. Internal repair is faster, and cosmetic results are better, additional skin or fascia dissection is avoided, and it seems to be as effective as an external approach. Yet, women must be informed on the high recurrence rat

Patient and physician gender concordance in preventive care in university primary care settings.

OBJECTIVE: To assess the quality of preventive care according to physician and patient gender in a country with universal health care coverage. METHODS: We assessed a retrospective cohort study of 1001 randomly selected patients aged 50-80years followed over 2years (2005-2006) in 4 Swiss university primary care settings (Basel, Geneva, Lausanne, Zürich). We used indicators derived from RAND's Quality Assessment Tools and examined percentages of recommended preventive care. Results were adjusted using hierarchical multivariate logistic regression models. RESULTS: 1001 patients (44% women) were followed by 189 physicians (52% women). Female patients received less preventive care than male patients (65.2% vs. 72.1%, p&lt;0.001). Female physicians provided significantly more preventive care than male physicians (p=0.01) to both female (66.7% vs. 63.6%) and male patients (73.4% vs. 70.7%). After multivariate adjustment, differences according to physician (p=0.02) and patient gender (p&lt;0.001) remained statistically significant. Female physicians provided more recommended cancer screening than male physicians (78.4 vs. 71.9%, p=0.01). CONCLUSIONS: In Swiss university primary care settings, female patients receive less preventive care than male patients, with female physicians providing more preventive care than male physicians. Greater attention should be paid to female patients in preventive care and to why female physicians tend to provide better preventive care

Qubits made by advanced semiconductor manufacturing

AbstractFull-scale quantum computers require the integration of millions of qubits, and the potential of using industrial semiconductor manufacturing to meet this need has driven the development of quantum computing in silicon quantum dots. However, fabrication has so far relied on electron-beam lithography and, with a few exceptions, conventional lift-off processes that suffer from low yield and poor uniformity. Here we report quantum dots that are hosted at a 28Si/28SiO2 interface and fabricated in a 300 mm semiconductor manufacturing facility using all-optical lithography and fully industrial processing. With this approach, we achieve nanoscale gate patterns with excellent yield. In the multi-electron regime, the quantum dots allow good tunnel barrier control—a crucial feature for fault-tolerant two-qubit gates. Single-spin qubit operation using magnetic resonance in the few-electron regime reveals relaxation times of over 1 s at 1 T and coherence times of over 3 ms.</jats:p

Nifedipine gastrointestinal therapeutic system (GITS) as an alternative to slow-release for tocolysis—Tolerance and pharmacokinetic profile

OBJECTIVE: To determine nifedipine plasma concentrations after a loading dose of nifedipine 10mg capsules, 40 mg over 1h followed by slow-release tablets (60 mg/d) versus gastrointestinal therapeutic system (GITS) tablets (90 mg/d) for tocolysis. STUDY DESIGN: Prospective study in 14 pregnant women treated for threatened preterm labor. RESULTS: Following capsule administration there was a rapid rise in plasma concentration of drug achieving a peak of 97.5 microg/l (median) at 1h, then declined to 59.5 microg/l (median) at 5h. The concentration measured at 7200 min (120 h) was non-significantly higher in the slow-release group (median 25.5, range 6.9-67.2 microg/l) than in the GITS group (median 14.6, range 6.0-20.0 microg/l). Area under the curve (AUC) increased with the applied dose in both groups in a linear regression. Headache was more frequent in the slow-release group than in the GITS group (P=0.001). CONCLUSIONS: GITS tablets 90 mg/d are an alternative dosage regimen to previous used slow-release tablets 60 mg/d for tocolysis with similar pharmacokinetic profile and a good tolerance. However, tocolysis with GITS tablets is simpler than that with slow-release tablets and may be associated with a higher compliance. GITS tablets are therefore also qualified for home monitoring

Systematic classification of maternal and fetal intervention-related complications following open fetal myelomeningocele repair - results from a large prospective cohort

OBJECTIVE To systematically categorise all maternal and fetal intervention-related complications after open fetal myelomeningocele (fMMC) repair of the first 124 cases operated at the Zurich Centre for Fetal Diagnosis and Therapy. DESIGN A prospective cohort study. SETTING Single centre. POPULATION Mothers and fetuses after fMMC repair. METHODS Between 2010 and 2019, we collected and entered all maternal complications following fMMC repair into the Clavien-Dindo classification. For fetal complications, a classification system based on the Medical Dictionary for Regulatory Activities terminology of Adverse Events was used including the preterm definitions of the World Health Organization. MAIN OUTCOME MEASURES Systematic classification of maternal and fetal complications following fMMC repair. RESULTS Gestational ages at surgery and birth were 25.0 ± 0.8 and 35.4 ± 2.0 weeks, respectively. In 17% of all cases, no maternal complications occurred. Maternal intervention-related complications were observed as follows: 69% grade 1, 36% grade 2, 25% grade 3, 6% grade 4 and 0% grade 5. In 34%, no fetal complications were noted; however, 43% of the fetuses developed a grade 1, 14% a grade 2, 8% a grade 3, 2% a grade 4 and 2% a grade 5 complication. CONCLUSION This study raises awareness of complications following open fMMC repair; 6% of mothers and 2% of fetuses experienced a severe complication (grade 4) and perinatal death rate of 2% was observed (grade 5). These data are useful for prenatal counselling, they help to improve the system of fetal surgical care, and they allow benchmarking with other centres as well as comparison with fetoscopic approaches. TWEETABLE ABSTRACT Systematic classification of all maternal and fetal intervention-related complications following open fMMC repair

Systematic classification of maternal and fetal intervention‐related complications following open fetal myelomeningocele repair – results from a large prospective cohort

OBJECTIVE To systematically categorise all maternal and fetal intervention-related complications after open fetal myelomeningocele (fMMC) repair of the first 124 cases operated at the Zurich Centre for Fetal Diagnosis and Therapy. DESIGN A prospective cohort study. SETTING Single centre. POPULATION Mothers and fetuses after fMMC repair. METHODS Between 2010 and 2019, we collected and entered all maternal complications following fMMC repair into the Clavien-Dindo classification. For fetal complications, a classification system based on the Medical Dictionary for Regulatory Activities terminology of Adverse Events was used including the preterm definitions of the World Health Organization. MAIN OUTCOME MEASURES Systematic classification of maternal and fetal complications following fMMC repair. RESULTS Gestational ages at surgery and birth were 25.0 ± 0.8 and 35.4 ± 2.0 weeks, respectively. In 17% of all cases, no maternal complications occurred. Maternal intervention-related complications were observed as follows: 69% grade 1, 36% grade 2, 25% grade 3, 6% grade 4 and 0% grade 5. In 34%, no fetal complications were noted; however, 43% of the fetuses developed a grade 1, 14% a grade 2, 8% a grade 3, 2% a grade 4 and 2% a grade 5 complication. CONCLUSION This study raises awareness of complications following open fMMC repair; 6% of mothers and 2% of fetuses experienced a severe complication (grade 4) and perinatal death rate of 2% was observed (grade 5). These data are useful for prenatal counselling, they help to improve the system of fetal surgical care, and they allow benchmarking with other centres as well as comparison with fetoscopic approaches. TWEETABLE ABSTRACT Systematic classification of all maternal and fetal intervention-related complications following open fMMC repair

Spatial noise correlations in a Si/SiGe two-qubit device from Bell state coherences

We study spatial noise correlations in a Si/SiGe two-qubit device with integrated micromagnets. Our method relies on the concept of decoherence-free subspaces, whereby we measure the coherence time for two different Bell states, designed to be sensitive only to either correlated or anticorrelated noise, respectively. From these measurements we find weak correlations in low-frequency noise acting on the two qubits, while no correlations could be detected in high-frequency noise. We expect nuclear spin noise to have an uncorrelated nature. A theoretical model and numerical simulations give further insight into the additive effect of multiple independent (anti)correlated noise sources with an asymmetric effect on the two qubits as can result from charge noise. Such a scenario in combination with nuclear spins is plausible given the data and the known decoherence mechanisms. This work is highly relevant for the design of optimized quantum error correction codes for spin qubits in quantum dot arrays, as well as for optimizing the design of future quantum dot arrays.QCD/Vandersypen LabQuTechQN/Vandersypen La