bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic autoimmune disease as a cause of death: mortality burden and comorbidities
Authors: Mitratza Marianna , Klijs Bart , Hak A Elisabeth , Kardaun Jan W P F , Kunst Anton E
Published: August 2020

Objectives

Systemic autoimmune diseases (SAIDs) have chronic trajectories and share characteristics of self-directed inflammation, as well as aspects of clinical expression. Nonetheless, burden-of-disease studies rarely investigate them as a distinct category. This study aims to assess the mortality rate of SAIDs as a group and to evaluate co-occurring causes of death.

Methods

We used death certificate data in the Netherlands, 2013–2017 (N = 711 247), and constructed a SAIDs list at the fourth-position ICD-10 level. The mortality rate of SAIDs as underlying cause of death (CoD), non-underlying CoD, and any-mention CoD was calculated. We estimated age-sex-standardized observed/expected (O/E) ratios to assess comorbidities in deaths with SAID relative to the general deceased population.

Results

We observed 3335 deaths with SAID on their death certificate (0.47% of all deaths). The mortality rate of SAID was 14.6 per million population as underlying CoD, 28.0 as non-underlying CoD, and 39.7 as any-mention CoD. The mortality rate was higher for females and increased exponentially with age. SAID-related deaths were positively associated with all comorbidities except for solid neoplasms and mental conditions. Particularly strong was the association with diseases of the musculoskeletal system (O/E = 3.38; 95% CI: 2.98, 3.82), other diseases of the genitourinary system (O/E = 2.73; 95% CI: 2.18, 3.38), influenza (O/E = 2.71; 95% CI: 1.74, 4.03), blood diseases (O/E = 2.02; 95% CI: 1.70, 2.39), skin and subcutaneous tissue diseases (O/E = 1.95; 95% CI: 1.54, 2.45), and infectious diseases (O/E = 1.85; 95% CI: 1.70, 2.01).

Conclusion

Systemic autoimmune diseases constitute a rare group of causes of death, but contribute to mortality through multiple comorbidities. Classification systems could be adapted to better encompass these diseases as a category.
Sex and gender differences in axial spondyloarthritis: myths and truths
Authors: Rusman Tamara , van Bentum Rianne E , van der Horst-Bruinsma Irene E
Published: August 2020

Mounting evidence reveals evident sex differences in physiology, disease presentation and response to medication in axial SpA (axSpA). Unfortunately these data are often neglected in clinical practice and research. In this review, myths that still exist on diagnosis, disease manifestation and drug effectiveness were argued against data of the most recent literature. The aim is to increase awareness of sex differences in the clinical aspects of axSpA.
Power and spectral Doppler ultrasound in suspected active sacroiliitis: a comparison with magnetic resonance imaging as gold standard
Authors: Falsetti Paolo , Conticini Edoardo , Mazzei Maria Antonietta , Baldi Caterina , Sota Jurgen , Bardelli Marco , Gentileschi Stefano , D’Alessandro Roberto , Al Khayyat Suhel Gabriele , Acciai Caterina , Cantarini Luca , Frediani Bruno
Published: August 2020

Objectives

The objectives of this study were to study with Power Doppler US (PDUS) the SI joints (SIJs) of patients with suspected active sacroiliitis, to describe SIJ flows with spectral wave analysis (SWA) on Doppler US, and to correlate US data with both clinical characteristics and presence of SIJ bone marrow oedema (BME) in subsequent MRI.

Methods

A total of 42 patients (32 females and 10 males, mean age 46.8 years) with recent onset of inflammatory back pain (IBP) were included. Every patient underwent US examination with a convex 1–8 MHz probe [scoring PDUS signals with a three-point scale and describing flows in SWA calculating the mean Resistive Index (RI)] and subsequent MRI of the SIJs.

Results

PDUS signals were detected in 34 patients and 62 SIJs. In 29 patients and 56 SIJs, MRI revealed BME. A definite diagnosis of SpA was made in 32 patients. PDUS signals were more frequent (P < 0.0001) in patients with a final diagnosis of SpA, yielding a higher PDUS score (P = 0.0304). PDUS grading correlated with both BME grading (r = 0.740, P = 0.0001) and AS DAS (ASDAS) (r = 0.6257, P = 0.0004), but not with inflammatory reactants nor anthropometric data. Mean RI were, respectively, 0.60 and 0.73 (P < 0.0001) in patients with or without diagnosis of active sacroiliitis. The most inclusive RI cut-off resulted <0.70 [positive predictive value (PPV) 94%, accuracy 90%, P = 0.0001]. The best Likelihood Ratio (5.471) for RI to detect pathologic cases was obtained with a cut-off of <0.60 (PPV 96%).

Conclusions

PDUS and SWA of SIJs demonstrate good diagnostic accuracy for active sacroiliitis compared with MRI.
Banking structure, economic resilience and unemployment trajectories in US counties during the great recession
Authors: Schneiberg Marc , Parmentier Eleanor
Published: August 2020

How might the structure of banking affect economic resilience? We address this question by analyzing how the organizational structures of banks and banking markets were associated with unemployment trajectories in local economies during the Great Recession. Two county-level analyses yield convergent results. Increasing branch densities of giant derivative holding banks within local economies were associated with greater surges in unemployment, weaker employment recoveries and stronger recession effects on unemployment from 2007 through 2016. Increasing branch densities of community banks and credit unions and localism in banking were associated with lower unemployment spikes, stronger recoveries and dampened crisis effects. These findings advance sociological studies of finance by providing new quantitative evidence for links between the social structures of banking and economic performance. They also confound arguments that decentralized systems of small, locally based financial institutions are inherently fragile by design, suggesting instead that alternatives to ‘too-big-to-fail’ banking can enhance local economies’ capacities to adapt proactively, withstand crisis and sustain employment during recessions.
2,4,6-Tribromophenol Disposition and Kinetics in Pregnant and Nursing Sprague Dawley Rats
Authors: Knudsen Gabriel A , Chapman Margaret , Trexler Andrew W , Juberg Christopher T , Birnbaum Linda S
Published: August 2020

2,4,6-Tribromophenol (TBP, CAS no. 118-79-6) is a brominated chemical used as a precursor, flame retardant, and wood antifungal agent. TBP is detected in environmental matrices and biota, including human breast milk, placenta, and serum. To address reports of TBP accumulation in human placenta and breast milk, studies were conducted to characterize TBP disposition and toxicokinetics in timed-pregnant or nursing Sprague Dawley rats following a single oral dose to the dam. Animals were administered [14C]-TBP (10 μmol/kg, 25 µCi/kg, 4 ml/kg) by gavage on gestation day 12 and 20, or postnatal day 12 and serially euthanized between 15 min and 24 h for collection of blood and tissues from the dam and fetuses/pups. Observed plasma TBP Cmax (3 and 7 nmol/ml) occurred at 15 min in both GD12 and GD20 dams while Cmax (3 nmol/ml) was observed at 30 min for PND12 dams. Concentrations in tissues followed plasma concentrations, with kidneys containing the highest concentrations at 30 min. GD12 litters contained a sustained 0.2%–0.3% of the dose (5–9 nmol/litter) between 15 min and 6 h while GD20 fetuses (2%–3%) and placentas (0.3%–0.5%) had sustained levels between 30 min and 12 h. The stomach contents (approx. 1 nmol-eq/g, 6–12 h), livers (0.04–0.1 nmol-eq/g) and kidneys (0.1–0.2 nmol-eq/g) of PND12 pups increased over time, indicating sustained exposure via milk. Systemic exposure to TBP and its metabolites occurs in both the directly exposed mother and the indirectly exposed offspring and is rapid and persistent after a single dose in pregnant and nursing rats.
The neglected role of Faith-based Organizations in prevention and control of COVID-19 in Africa
Authors: Vilakati Phesheya Ndumiso , Villa Simone , Alagna Riccardo , Khumalo Bongani , Tshuma Sarah , Quaresima Virginia , Nieman Nicole Rose , Cirillo Daniela Maria , Raviglione Mario Carlo
Published: August 2020

The COVID-19 pandemic has exposed health system weaknesses of economically wealthy countries with advanced technologies. COVID-19 is now moving fast across Africa where small outbreaks have been reported so far. There is a concern that with the winter transmission will grow rapidly. Despite efforts of African Governments to promptly establish mitigating measures, rural areas, especially in sub-Saharan Africa, risk being neglected. In those settings, faith-based and other non-governmental organizations, if properly equipped and supported, can play a crucial role in slowing the spread of COVID-19. We describe our experience in two rural health facilities in eSwatini and Ethiopia highlighting the struggle towards preparedness and the urgency of international support to help prevent a major public health disaster.
Developing and validating a clinical algorithm for the diagnosis of podoconiosis
Authors: Deribe Kebede , Florence Lyndsey , Kelemework Abebe , Getaneh Tigist , Tsegay Girmay , Cano Jorge , Giorgi Emanuele , Newport Melanie J , Davey Gail
Published: August 2020

Background

Difficulties in reliably diagnosing podoconiosis have severely limited the scale-up and uptake of the World Health Organization–recommended morbidity management and disability prevention interventions for affected people. We aimed to identify a set of clinical features that, combined into an algorithm, allow for diagnosis of podoconiosis.

Methods

We identified 372 people with lymphoedema and administered a structured questionnaire on signs and symptoms associated with podoconiosis and other potential causes of lymphoedema in northern Ethiopia. All individuals were tested for Wuchereria bancrofti–specific immunoglobulin G4 in the field using Wb123.

Results

Based on expert diagnosis, 344 (92.5%) of the 372 participants had podoconiosis. The rest had lymphoedema due to other aetiologies. The best-performing set of symptoms and signs was the presence of moss on the lower legs and a family history of leg swelling, plus the absence of current or previous leprosy, plus the absence of swelling in the groin, plus the absence of chronic illness (such as diabetes mellitus or heart or kidney diseases). The overall sensitivity of the algorithm was 91% (95% confidence interval [CI] 87.6 to 94.4) and specificity was 95% (95% CI 85.45 to 100).

Conclusions

We developed a clinical algorithm of clinical history and physical examination that could be used in areas suspected or endemic for podoconiosis. Use of this algorithm should enable earlier identification of podoconiosis cases and scale-up of interventions.
Diversity of the Pterasteridae (Asteroidea) in the Southern Ocean: a molecular and morphological approach
Authors: Jossart Quentin , Kochzius Marc , Danis Bruno , Saucède Thomas , Moreau Camille V E
Published: August 2020

An integrative approach is crucial in discrimination of species, especially for taxa that are difficult to identify based on morphological characters. In this study, we combine genetics and morphology to assess the diversity of Pterasteridae, a sea star family diversified in deep-sea and polar environments. Because of their derived anatomy and the frequent loss of characters during preservation, Pterasteridae are a suitable case for an integrative study. The molecular identification of 191 specimens (mostly from the Southern Ocean) suggests 26–33 species in three genera (Diplopteraster, Hymenaster and Pteraster), which match the morphological identification in 54–62% of cases. The mismatches are either different molecular units that are morphologically indistinguishable (e.g. Pteraster stellifer units 2 and 4) or, conversely, nominal species that are genetically identical (e.g. Hymenaster coccinatus/densus/praecoquis). Several species are shared between the Northern and Southern Hemispheres (e.g. Pteraster jordani/affinis). In conclusion, the taxonomic status of some groups is confirmed, but for others we find the need to re-evaluate the taxonomy at both genus and species levels. This work significantly increases the DNA barcode library of the Southern Ocean species and merges taxonomic information into an identification key that could become a baseline for future studies (pterasteridae-so.identificationkey.org).
Genetic, morphological and acoustic differentiation of African trident bats (Rhinonycteridae:Triaenops)
Authors: Rossoni Daniela M , Demos Terrence C , Goodman Steven M , Yego Richard K , Mohlman Jessica L , Webala Paul W , Patterson Bruce D
Published: August 2020

Rhinonycteridae (trident bats) are a small Palaeotropical family of insectivorous bats allied to Hipposideridae. Their taxonomy has been in a state of flux. Here, we use mitochondrial and nuclear sequences to evaluate species relationships, confirming the monophyly of both Triaenops and Paratriaenops. Although most Triaenops afer specimens are recovered as a group, mitochondrial analyses strongly support some Kenyan individuals as members of Triaenops persicus. Analyses of four nuclear introns (ACOX2, COPS7A, RODGI and STAT5A) strongly support the mitochondrial topology. Morphometric analysis of the skull, external morphology and echolocation calls confirm that the Triaenops from the Rift Valley in Kenya (Nakuru, Baringo and Pokot counties) are distinct from typical T. afer in coastal (Kilifi and Kwale counties) or interior (Laikipia and Makueni counties) colonies. We interpret these analyses to indicate that two species of Triaenops occur in East Africa: T. afer in coastal regions along the Indian Ocean and in the highlands of central Kenya and Ethiopia, and T. persicus in the Rift Valley of Kenya. Although they appear widely disjunct from Middle Eastern populations, Kenyan T. persicus might be more widely distributed in the Rift Valley; they are somewhat differentiated from Middle Eastern populations in terms of both cranial morphology and vocalizations.
Estimation of Pulmonary Artery Occlusion Pressure Using Doppler Echocardiography in Mechanically Ventilated Patients
Authors: Brault Clément , Marc Julien , Mercado Pablo , Diouf Momar , Tribouilloy Christophe , Zerbib Yoann , Maizel Julien , Vignon Philippe , Slama Michel
Published: August 2020

Objectives:

Evaluation of left atrial pressure is frequently required for mechanically ventilated critically ill patients. The objective of the present study was to evaluate the 2016 American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines for assessment of the pulmonary artery occlusion pressure (a frequent surrogate of left atrial pressure) in this population.

Design:

A pooled analysis of three prospective cohorts of patients simultaneously assessed with a pulmonary artery catheter and echocardiography.

Settings:

Medical-surgical intensive care department of two university hospitals in France.

Patients:

Mechanically ventilated critically ill patients.

Interventions:

None.

Measurements and Main Results:

Of 98 included patients (males: 67%; mean ± sd age: 59 ± 16; and mean Simplified Acute Physiology Score 2: 54 ± 20), 53 (54%) experienced septic shock. Using the 2016 American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines, the predicted pulmonary artery occlusion pressure was indeterminate in 48 of the 98 patients (49%). Of the 24 patients with an elevated predicted left atrial pressure (grade II/III diastolic dysfunction), only 17 (71%) had a pulmonary artery occlusion pressure greater than or equal to 18 mm Hg. Similarly, 20 of the 26 patients (77%) with a normal predicted left atrial pressure (grade I diastolic dysfunction) had a measured pulmonary artery occlusion pressure less than 18 mm Hg. The sensitivity and specificity of American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines for predicting elevated pulmonary artery occlusion pressure were both 74%. The agreement between echocardiography and the pulmonary artery catheter was moderate (Cohen’s Kappa, 0.48; 95% CI, 0.39–0.70). In a proposed alternative algorithm, the best echocardiographic predictors of a normal pulmonary artery occlusion pressure were a lateral e′-wave greater than 8 (for a left ventricular ejection fraction ≥ 45%) or an E/A ratio less than or equal to 1.5 (for a left ventricular ejection fraction < 45%).

Conclusions:

The American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines do not accurately assess pulmonary artery occlusion pressure in ventilated critically ill patients. Simple Doppler measurements gave a similar level of diagnostic performance with less uncertainly.
Economic Analysis of Mandated Protocolized Sepsis Care in New York Hospitals*
Authors: Bourne Donald S. , Davis Billie S. , Gigli Kristin H. , Chang Chung-Chou H. , Yabes Jonathan G. , Martsolf Grant R. , Kahn Jeremy M.
Published: August 2020

Objectives:

Initial evidence suggests that state-level regulatory mandates for sepsis quality improvement are associated with decreased sepsis mortality. However, sepsis mandates require financial investments on the part of hospitals and may lead to increased spending. We evaluated the effects of the 2013 New York State sepsis regulations on the costs of care for patients hospitalized with sepsis.

Design:

Retrospective cohort study using state discharge data from the U.S. Healthcare Costs and Utilization Project and a comparative interrupted time series analytic approach. Costs were calculated from admission-level charge data using hospital-specific cost-to-charge ratios.

Setting:

General, short stay, acute care hospitals in New York, and four control states: Florida, Massachusetts, Maryland, and New Jersey.

Patients:

All patients hospitalized with sepsis between January 1, 2011, and September 30, 2015.

Interventions:

The 2013 New York mandate that all hospitals develop and implement protocols for sepsis identification and treatment, educate staff, and report performance data to the state.

Measurements and Main Results:

The analysis included 1,026,664 admissions in 520 hospitals. Mean unadjusted costs per hospitalization in New York State were $42,036 ± $60,940 in the pre-regulation period and $39,719 ± $59,063 in the post-regulation period, compared with $34,642 ± $52,403 pre-regulation and $31,414 ± $48,155 post-regulation in control states. In the comparative interrupted time series analysis, the regulations were not associated with a significant difference in risk-adjusted mean cost per hospitalization (p = 0.12) or risk-adjusted mean cost per hospital day (p = 0.44). For example, in the 10th quarter after implementation of the regulations, risk-adjusted mean cost per hospitalization was $3,627 (95% CI, –$681 to $7,934) more than expected in New York State relative to control states.

Conclusions:

Mandated protocolized sepsis care was not associated with significant changes in hospital costs in patients hospitalized with sepsis in New York State.
Genome-Wide Linkage Analysis of the Risk of Contracting a Bloodstream Infection in 47 Pedigrees Followed for 23 Years Assembled From a Population-Based Cohort (the HUNT Study)*
Authors: Rogne Tormod , Damås Jan Kristian , Solligård Erik , DeWan Andrew Thomas
Published: August 2020

Objectives:

Bloodstream infection is an important cause of death worldwide. The main objective of this study was to identify genetic loci linked to risk of contracting a bloodstream infection.

Design:

Genome-wide linkage analysis.

Setting:

Population-based, Norwegian cohort, followed between 1995 and 2017.

Subjects:

Among 69,423 genotyped subjects, there were 47 families with two or more second-degree relatives with bloodstream infection in the follow-up period. There were 365 subjects in these families, of which 110 were affected.

Interventions:

None.

Measurements and Main Results:

The cohort was genotyped using Illumina HumanCoreExome (Illumina, San Diego, CA) arrays. Before linkage analysis, single-nucleotide polymorphisms were pruned and clumped. In nonparametric linkage analysis using an exponential model, we found three loci with a suggestive linkage to bloodstream infection, all on chromosome 4, at 46.6 centimorgan (logarithm of odds, 2.3), 57.7 centimorgan (logarithm of odds, 3.2), and 70.0 centimorgan (logarithm of odds, 2.1). At the peak of the lead region are three genes: TLR10, TLR1, and TLR6.

Conclusions:

Variations in the TLR10/1/6 locus appear to be linked with the risk of contracting a bloodstream infection.
Effect of Electrical Muscle Stimulation on Upper and Lower Limb Muscles in Critically Ill Patients: A Two-Center Randomized Controlled Trial
Authors: Nakanishi Nobuto , Oto Jun , Tsutsumi Rie , Yamamoto Tomoko , Ueno Yoshitoyo , Nakataki Emiko , Itagaki Taiga , Sakaue Hiroshi , Nishimura Masaji
Published: August 2020

Objectives:

Electrical muscle stimulation is widely used to enhance lower limb mobilization. Although upper limb muscle atrophy is common in critically ill patients, electrical muscle stimulation application for the upper limbs has been rarely reported. The purpose of this study was to investigate whether electrical muscle stimulation prevents upper and lower limb muscle atrophy and improves physical function.

Design:

Randomized controlled trial.

Setting:

Two-center, mixed medical/surgical ICU.

Patients:

Adult patients who were expected to be mechanically ventilated for greater than 48 hours and stay in the ICU for greater than 5 days.

Interventions:

Forty-two patients were randomly assigned to the electrical muscle stimulation (n = 17) or control group (n = 19).

Measurements and Main Results:

Primary outcomes were change in muscle thickness and cross-sectional area of the biceps brachii and rectus femoris from day 1 to 5. Secondary outcomes included occurrence of ICU-acquired weakness, ICU mobility scale, length of hospitalization, and amino acid levels. The change in biceps brachii muscle thickness was –1.9% versus –11.2% in the electrical muscle stimulation and control (p = 0.007) groups, and the change in cross-sectional area was –2.7% versus –10.0% (p = 0.03). The change in rectus femoris muscle thickness was –0.9% versus –14.7% (p = 0.003) and cross-sectional area was –1.7% versus –10.4% (p = 0.04). No significant difference was found in ICU-acquired weakness (13% vs 40%; p = 0.20) and ICU mobility scale (3 vs 2; p = 0.42) between the groups. The length of hospitalization was shorter in the electrical muscle stimulation group (23 d [19–34 d] vs 40 d [26–64 d]) (p = 0.04). On day 3, the change in the branched-chain amino acid level was lower in the electrical muscle stimulation group (40.5% vs 71.5%; p = 0.04).

Conclusions:

In critically ill patients, electrical muscle stimulation prevented upper and lower limb muscle atrophy and attenuated proteolysis and decreased the length of hospitalization.
Advances in simian--human immunodeficiency viruses for nonhuman primate studies of HIV prevention and cure
Authors: Bauer Anya M. , Bar Katharine J.
Published: August 2020

Purpose of review

Simian--human immunodeficiency viruses (SHIVs), chimeric viruses that encode HIV-1 Env within an SIV backbone, are key reagents for nonhuman primate studies of antibody-based vaccines, broadly neutralizing antibodies (bnAbs), and other Env-targeting reagents. Here, we discuss the provenance and characteristics of currently relevant SHIVs, novel technical advances, recent discoveries enabled by SHIV challenge studies, and the continued development of SHIVs for persistence and cure experiments.

Recent findings

SHIV SF162P3, SHIV AD8EO, and transmitter/founder SHIVs with Env375 mutations are now common reagents in nonhuman primate studies, with increased use and validation establishing their properties and potential applications. Genetic barcoding of SIV and SHIV, which allows tracing of individual lineages and elucidation of viral kinetics from transmission through latency has expanded the experimental capacity of SHIV models. SHIV challenge studies have determined the neutralizing antibody titers that correlate with protection for passive and active immunization and enabled complementary human and nonhuman primate studies of vaccine development. SHIV models of latency continue to evolve, aided by descriptions of SHIV persistence on ART and the proviral landscape.

Recent advances and more thorough characterization of SHIVs allow for expanded applications and greater confidence in experimental results.
Haematoma, abscess or meningitis after neuraxial anaesthesia in the USA and the Netherlands
Authors: Bos Elke M.E. , Posner Karen L. , Domino Karen B. , de Quelerij Marcel , Kalkman Cor J. , Hollmann Markus W. , Lirk Philipp
Published: August 2020

BACKGROUND

Severe complications after neuraxial anaesthesia are rare but potentially devastating.

OBJECTIVE

We aimed to identify characteristics and preventable causes of haematoma, abscess or meningitis after neuraxial anaesthesia.

DESIGN

Observational study, closed claims analysis.

SETTING

Closed anaesthesia malpractice claims from the USA and the Netherlands were examined from 2007 until 2017.

PATIENTS

Claims of patients with haematoma (n = 41), abscess (n = 18) or meningitis (n = 14) associated with neuraxial anaesthesia for labour, acute and chronic pain that initiated and closed between 2007 and 2017 were included. There were no exclusions.

MAIN OUTCOME MEASURES

We analysed potential preventable causes in patient-related, neuraxial procedure-related, treatment-related and legal characteristics of these complications.

RESULTS

Patients experiencing spinal haematoma were predominantly above 60 years of age and using antihaemostatic medication, whereas patients with abscess or meningitis were middle-aged, relatively healthy and more often involved in emergency interventions. Potential preventable causes of unfavourable sequelae constituted errors in timing/prescription of antihaemostatic medication (10 claims, 14%), unsterile procedures (n = 10, 14%) and delay in diagnosis/treatment of the complication (n = 18, 25%). The number of claims resulting in payment was similar between countries (USA n = 15, 38% vs. the Netherlands n = 17, 52%; P = 0.25). The median indemnity payment, which the patient received varied widely between the USA (€285 488, n = 14) and the Netherlands (€31 031, n = 17) (P = 0.004). However, the considerable differences in legal systems and administration of expenses between countries may make meaningful comparison of indemnity payments inappropriate.

CONCLUSIONS

Claims of spinal haematoma were often related to errors in antihaemostatic medication and delay in diagnosis and/or treatment. Spinal abscess claims were related to emergency interventions and lack of sterility. We wish to highlight these potential preventable causes, both when performing the neuraxial procedure and during postprocedural care of patients.
Oral fluid intake during the first stage of labour
Authors: Rousset Julien , Clariot Simon , Tounou Félix , Burey Julien , Hafiani El M. , Féliot Elodie , Quesnel Christophe , Bonnet Francis , Fischler Marc
Published: August 2020

BACKGROUND

Obstetric anaesthesia has been associated with concern for the inhalation of gastric contents for many years, justifying fasting during labour. However, many anaesthesiologists and obstetricians now allow fluid intake during labour.

OBJECTIVE(S)

We hypothesised that allowing oral fluid intake during labour is not associated with increased gastric contents. We used ultrasound assessment of gastric contents to evaluate this hypothesis.

DESIGN

A randomised, single-blind and intention-to-treat noninferiority trial comparing antral area measured by ultrasound in fasting parturients and in those who were allowed to drink fluid for 90 min after randomisation.

SETTING

Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.

PATIENTS

Pregnant women, aged from 18 to 40 years and from week 36 of an uncomplicated singleton gestation, were randomised into a fasting group and a fluid intake group after admission to the delivery room. Of the 184 patients screened, data from 125 were analysed: fasting group (62), fluid intake group (63).

INTERVENTION

Women in the fluid intake group were allowed to drink up to 400 ml of apple juice for 90 min after randomisation.

MAIN OUTCOME MEASURE

We compared the percentage of women with an ‘empty stomach’ between the two groups: empty stomach was defined as an antral cross-sectional area (CSA) less than 300 mm2 assessed in a semirecumbent position with a 45-degree head-up tilt.

RESULTS

At full cervical dilatation an antral CSA less than 300 mm2 was measured in 76 and 79% of the parturients in the fasting group and the fluid intake groups respectively (P = 0.633).

CONCLUSION

The current study reveals that the percentage of pregnant women with an ‘empty stomach’, defined by an antral CSA less than 300 mm2 in a semirecumbent position with a 45-degree head-up tilt, was comparable at full cervical dilation among those who remained nil by mouth and those allowed to drink up to 400 ml for 90 min after their randomisation.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT 02362815.
The use of personal protective equipment in clinical ophthalmology during corona virus disease-2019: a review of international guidelines and literature
Authors: Tang Samuela W.K. , Romano Mario Rosario , Wong Daniel H.T. , Montericcio Alessio , Yip Nelson K.F. , Montalbano Clara , Raimondi Raffaele , Li Kenneth K.W.
Published: August 2020

Purpose of review

The use of nonpharmaceutical interventions can prevent viral spread in COVID-19 pandemic and PPE forms a crucial part of this strategy. However, there are discrepancies in existing guidelines and a lack of consensus among ophthalmic communities. This review aims to identify general consensus and provides recommendation of PPE for most common ophthalmological scenarios. With a global shortage of PPE, extended use and reuse strategies are also discussed.

Recent findings

In this review, guidelines and resources were selected, based on a three-tier process. The first-tier resources were from international infection control organizations. The second-tier resources were from ophthalmological professional associations and colleges. The third-tier resources involved a PubMed search using the keywords ‘COVID-19; coronavirus; personal protective equipment’ performed on 1 May 2020. Non-English guidelines and literatures were excluded.

On the basis of our methodology, we included a total of 30 documents, including 5 resources from tier 1, 14 resources from tier 2 and 15 from tier 3. Different levels of protection are necessary. Whenever performing an aerosol generating procedure, maximum protection should be ensured, this includes FFP3 respirator, fluid resistant gown, goggles or face-shield and disposable gloves. Similar protection should be used for handling COVID-19-positive/suspected case but the use of FFP2 respirator is acceptable. During routine outpatient clinic in cases of negative triage, it is recommended to use ASTM III surgical mask, plastic apron, disposable gloves and eye protection with goggles or face-shield. Lastly, patients should be encouraged to wear surgical masks whenever possible.
Controversies in artificial intelligence
Authors: Liu T.Y. Alvin , Bressler Neil M.
Published: August 2020

Purpose of review

To review four recent controversial topics arising from deep learning applications in ophthalmology.

Recent findings

The controversies of four recent topics surrounding deep learning applications in ophthalmology are discussed, including the following: lack of explainability, limited generalizability, potential biases and protection of patient confidentiality in large-scale data transfer.

These controversial issues spanning the domains of clinical medicine, public health, computer science, ethics and legal issues, are complex and likely will benefit from an interdisciplinary approach if artificial intelligence in ophthalmology is to succeed over the next decade.
Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh
Authors: Alnajashi Saleh Sulaiman , Alayed Salem Ali , Al-Nasher Saeed Moshbab , Aldebasi Bader , Khan Muhammad Mujahid
Published: August 2020

As surgeries are performed around the clock, the time of surgery might have an impact on outcomes. Our aim is to investigate the impact of daytime and nighttime shifts on surgeons and their performance. We believe that such studies are important to enhance the quality of surgeries and their outcomes and help understand the effects of time of the day on surgeons and the surgeries they perform.

A retrospective cohort study was conducted using the database from the King Abdulaziz Medical City trauma center. We selected 330 cases of patients between 2015 and 2018, who underwent a trauma intervention surgery within 24 hours after admission. Patients were aged 15 years and above who underwent 1 or more of the following trauma interventions: neurosurgery, general surgery, plastic surgery, vascular surgery, orthopedics, ophthalmology, and/or otolaryngology. We divided the work hours into 3 shifts: 8 am to 3:59 pm, 4 pm to 11:59 pm, and midnight to 7:59 am.

Participants’ mean age was 31.4 (standard deviation ± 13) years. Most surgeries occurred on weekdays (68.4%). Complications were one and a half times more on weekends, with 5 complicated cases on weekends (1.55%) and 3 (0.9%) on weekdays. Half of all surgeries were performed in the morning (152 cases, 53.15%); 73 surgeries (25.5%) were performed in the evening and 61 (21.3%) were performed late at night. Surgeries performed during late-night shifts were marginally better. Complications occurred in 4 out of 152 morning surgeries (2.6%), 2 out of 73 evening surgeries (2.7%), and only 1 out of 61 late-night surgeries (1.6%). The earlier comparison scored a P-value of >.99, suggesting that patients in morning and evening surgeries were twice more likely to experience complications than late-night surgeries.

This study may support previous research that there is little difference in outcomes between daytime and nighttime surgeries. The popular belief that rested physicians are better physicians requires further assessment and research.
A correlation study of emergency department nurses’ fatigue, perceived stress, social support and self-efficacy in grade III A hospitals of Xi’an
Authors: Wu Chao , Ge Yiling , Xu Chao , Zhang Xinyan , Lang Hongjuan
Published: August 2020

Fatigue is a universal and challenging problem in a nurse's career, particularly for those working in the emergency department. Through analyzing the current status of emergency department nurses’ fatigue, the purpose of this study is to provide guidance for occupational health promotion strategies making and fatigue relief.

Cross-sectional study was conducted among nurses working in emergency department in 6 grade III A hospitals in Xi’an, China. Convenience sample of 346 nurses agreed to participate in this study. Data collection was based on the questionnaires. Descriptive statistics, hypothesis tests and correlation analysis were used to describe the samples’ characteristics and identify associations amongst participants’ characteristics.

The fatigue score of those emergency nurses from grade III A hospitals in Xian was 8.71 ± 3.01, a high fatigue level. Moreover, there were significant differences in fatigue scores of different age groups, sleep qualities, work stress levels and physical states (P < .01). Further, the dimension of physical fatigue in various age groups, job title, marital status, sleep qualities, work stress levels and physical states was significantly different (P < .05) and the dimension of mental fatigue with different sleep qualities, work stress levels and physical states was significantly different (P < .01). The results of correlation analysis showed that fatigue was positively correlated with perceived stress while negatively correlated with social support and self-efficacy (P < .01). The multiple stepwise linear regression analysis indicated that the independent variables in the fatigue regression equation were perceived stress, physical condition and work stress in turn (P < .01), and the independent variables in the the dimensions of physical fatigue regression equation were perceived stress, physical condition,work stress and job title in turn (P < .05); the independent variables in the the dimensions of mental fatigue regression equation were perceived stress,subjective support and physical condition in turn (P < .05).

The current status of high fatigue level of emergency nurses should be taken seriously. It is imperative to take effective measures to help emergency nurses reduce stress, improve social support, promote the self-efficacy, and thus relieve fatigue.
Association of miR-4293 rs12220909 polymorphism with cancer risk
Authors: Liu Rongqiang , Fu Hongyuan , Yu Yajie , Xu Qianhui , Fang Jiangwen , Ge Qianmin , Shao Yi
Published: August 2020

Background:

Several studies have investigated miR-4293 rs12220909 polymorphisms and cancer susceptibility and yielded different results. Because of this controversy, we designed a meta-analysis to assess comprehensively the association of the rs12220909 polymorphism with cancer risk.

Methods:

Relevant articles were collected by searching the databases of PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and WanFang. Data on rs12220909 in cancer patients and controls were extracted. Sensitivity analyses and publication bias assessments were performed.

Results:

Five studies with 3820 cases and 4574 controls were included in our meta-analysis. Pooled analyses showed that the rs12220909 polymorphism was not associated with cancer risk in any genetic model. (C vs G: odds ratio [OR] = 0.89, 95% confidence interval [CI] = 0.74–1.07; GC vs GG: OR = 0.83, 95% CI = 0.67–1.03; CC vs GG: OR = 1.06, 95% CI = 0.82–1.36; CC+GC vs GG: OR = 0.84, 95% CI = 0.69–1.03; CC vs GC+GG: OR = 1.10, 95% CI = 0.85–1.40).

Conclusions:

Our results indicate that rs12220909 is not associated with cancer risk. Larger, well-designed multicenter studies are needed to further explore the association of miR-4293 rs12220909 polymorphism with cancer risk.
A phase 2 basket trial of combination therapy with trastuzumab and pertuzumab in patients with solid cancers harboring human epidermal growth factor receptor 2 amplification (JUPITER trial)
Authors: Takahashi Kenta , Ishibashi Eri , Kubo Toshio , Harada Yohei , Hayashi Hideyuki , Kano Masayuki , Shimizu Yasushi , Shirota Hidekazu , Mori Yukiko , Muto Manabu , Ishioka Chikashi , Dosaka-Akita Hirotoshi , Matsubara Hisahiro , Nishihara Hiroshi , Sueoka-Aragane Naoko , Toyooka Shinichi , Hirakawa Akihiro , Tateishi Ukihide , Miyake Satoshi , Ikeda Sadakatsu
Published: August 2020

Introduction:

Human epidermal growth factor receptor 2 (HER2) gene amplification and mutations have emerged as oncogenic drivers and therapeutic targets not limited to breast and gastric cancers, but also in a variety of cancers. However, even if an actionable gene alteration is found, the incidence of HER2 amplification in these cancers is less than 5%. It is too difficult to conduct a conventional randomized, controlled trial in a rare fraction. Therefore, we have designed a organ-agnostic basket study, which covers a variety of solid cancers harboring HER2 amplification, in 1 study protocol.

Methods/Design:

This trial is a multicenter, single-arm, basket phase 2 study in Japan. Patients with solid cancers harboring HER2 amplification that have progressed with standard treatment, or rare cancers for which there is no standard treatment, will be eligible. Target cancers include bile duct, urothelial, uterine, ovarian, and other solid cancers where HER2 amplification is detected by comprehensive genomic profiling using next-generation sequencing technology. A total of 38 patients will be treated with combination therapy with trastuzumab and pertuzumab every 3 weeks until disease progression, unmanageable toxicity, death, or patient refusal. The primary endpoint is the objective response rate, and secondary endpoints are progression-free survival, overall survival, and duration of response.

Discussion:

The aim of this trial is to evaluate the safety and efficacy of combination therapy with trastuzumab and pertuzumab in patients with locally advanced or metastatic, solid cancers harboring HER2 amplification. Instead of focusing on 1 organ type, our trial design uses a basket study focusing on HER2 amplification, regardless of the site or origin of the cancer. The results of our study will advance clinical and scientific knowledge concerning the treatment of locally advanced, rare solid cancers harboring HER2 amplification, using the combination of trastuzumab and pertuzumab.

Trial registration:

This trial was registered in Japan Registry of Clinical Trials (jCRT) on February 25, 2019, as jRCT2031180150.
Clinical characteristics of patients with uremia undergoing maintenance hemodialysis complicated with COVID-19
Authors: Wang You , Hu Manli , Ye Gang , Zhao Yuanyuan , Yin Qingqiao , Pi Pei , Luo Dan
Published: August 2020

This study aimed to evaluate the onset characteristics of patients with uremia undergoing maintenance hemodialysis complicated with COVID-19, so as to improve the understanding, diagnosis, and treatment.

26 cases were confirmed cases of COVID-19. Confirmed patients with COVID-19 undergoing maintenance hemodialysis in the blood purification center were recruited. The general data of patients, including age, sex, duration of dialysis, and basic diseases, were analyzed. The clinical features included fever, respiratory symptoms, and gastrointestinal symptoms. The items for laboratory tests included blood routine examination, liver function, C-reactive protein, procalcitonin, creatine kinase, creatine kinase-MB, markers of myocardial injury, B-type natriuretic peptide, D-dimer, and so forth. The imaging examinations referred mainly to computed tomography imaging findings of the lungs.

Twenty-one cases were complicated with chronic basic diseases, such as hypertension or diabetes. In terms of clinical manifestations, 13 cases had fever, which was close to the number of cases without fever (13 cases). The respiratory symptoms included dry cough (19 cases), shortness of breath (9 cases), fatigue (11 cases), and so forth. Further, 15 patients had hypoxemia, indicating more severe patients. Sore throat (2 cases) was not significant, and a few patients reported gastrointestinal symptoms (3 cases). The results of blood routine examination showed decreased absolute lymphocyte count (0.7 ± 0.4 × 10∼9/L), lower hemoglobin level (105.2 ± 20 g/L), and normal absolute neutrophil count 4.2 (3.0, 5.9) × 10∼9/L. Of the inflammatory indexes, procalcitonin was 0.69 (0.24, 2.73) ng/mL; C reactive protein was 17.2 (5.2, 181.6) mg/L, which was higher than normal. Blood biochemistry revealed lower albumin level (38.0 ± 4.0 g/L) and higher troponin 0.11(0.035, 6.658) ng/mL and myoglobin levels (538.5 ± 240.5 ng/mL), suggesting myocardial injury.

The patients with uremia and confirmed COVID-19 undergoing maintenance hemodialysis are more common in males. Although the proportion of fever patients is 50%, the proportion of hypoxemia patients is high (58%). With poor cardiac function. They were prone to respiratory failure complicated with heart failure. According to the onset characteristics of this population, early diagnosis and treatment could help reduce the risk of developing a critical illness and control the spread of the COVID-19 epidemic.
An empirical study on the index system of rational drug use in children with primary nephrotic syndrome
Authors: Lin Mao , Huang Liang , Zeng Linan , Zhang Lingli
Published: August 2020

In the study's early stage, the research group had established an evaluation index system for the rational drug use of primary nephrotic syndrome in children. To assess the feasibility of the established index system, we conducted this empirical study.

The cross-sectional study was conducted by using the Hospital Information System to extract some general clinical data of hospitalized children with primary nephrotic syndrome, which included registration number, age, sex, diagnosis and medication, etc. Utilize the SPSS23.0 software and Excel 2016 to descriptively analyze information.

224 hospitalized children with primary nephrotic syndrome who met the inclusion criteria were included, ranging from 18 years old and 10 months to 11 months and 23 days, with an average age of 8.40, plus or minus 4.30 years. 148 males (66.07%) and 76 females (33.93%). The duration of hospitalization was 1–57 days, with an average hospitalization time of 10.59 days. The most common is respiratory infections, such as the bronchopneumonia, the mycoplasma pneumonia, etc. This study had successfully completed the measurement of the evaluation index system for the rational drug use of primary nephrotic syndrome in children.

All indicators are feasible, but the operability and applicability need further research and improvement.
Effects of Baduanjin exercise on essential hypertension
Authors: Guan Yuanyuan , Hao Yang , Guan Yun , Wang Hongwu
Published: August 2020

Objectives:

To analyze the influence of Baduanjin exercise on blood pressure in patients with essential hypertension.

Methods:

Randomized controlled trials were identified in Chinese and English databases to study the impact of Baduanjin exercise on essential hypertension. Qualified trials were selected and methodologic quality was critically evaluated. Two reviewers selected studies independently of each other.

Results:

Twelve trials were included. There was a significant difference between the Baduanjin exercise intervention and control groups with regard to the change in systolic blood pressure (SBP) [SMD = − 1.80, 95% CI (− 2.86, − 0.73), P = .0009] and diastolic blood pressure (DBP) [SMD = −0.22, 95% CI (−2.00, −0.57), P = .0004]. Taking into account the subgroup analyses, the combined results showed that Baduanjin plus Antihypertensive drugs significantly reduced both SBP and DBP over a period > 12 weeks in all studies.

Conclusions:

Compared with control interventions, Baduanjin exercise seems to be an effective physical exercise in treating essential hypertension. Different training durations can lead to different effects.
Pharmacological intervention for ambulatory surgery
Authors: Choi Geun Joo , Seong Hee-Kyeong , Kang Hyun
Published: August 2020

Background:

We aim to perform a network meta-analysis (NMA) to quantify and rank-order the efficacy and safety of analgesic medications for ambulatory surgery.

Methods:

We will search MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar databases to identify all randomized controlled trials (RCTs) of analgesics, beginning from their inception to February 2020. The primary endpoints will be pain score measured using a visual analog scale (VAS) or a numerical rating scale (NRS) at 3 different time points: Phase I recovery, phase II recovery, and recovery at home. Adverse events, including nausea, vomiting, headache, dizziness, arrhythmia, and respiratory depression, will be also assessed.

We will conduct NMA and use surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of analgesic medication. A comparison-adjusted funnel plot will be used to assess the presence of small study effects. The quality of the included studies will be assessed using the risk of bias tool 2.0. All statistical analyses will be performed using Stata SE version 15.0.

Results:

The results of this systematic review and NMA will be published in a peer-reviewed journal.

Conclusion:

This systematic review and NMA will provide comprehensive and convincing evidence regarding analgesic medication for pain after ambulatory surgery.

Trial registration number:

CRD42018100000.