bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.

Summary
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.

Summary
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.

Summary
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

Abstract
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

Abstract
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

Abstract

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

Abstract

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

Abstract
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.