bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sexual Assault Against Women: A Retrospective Study of 292 Cases in Fujian Province, China
Authors: Shi Lei , Lu Ting , Li Yuan , Deng Zhen-hua 
Published: September 2021

ABSTRACT

Introduction
In China, rape is defined as forced sexual intercourse against a woman's will by violence, coercion, or any other means or intentionally having sexual intercourse with a girl under the age of 14 years who is legally incompetent of giving consent.

Method
A retrospective study of 292 cases of rape in Fujian Province, China, between the years 2014 and 2017 was conducted. Sociodemographic characteristics of victims and perpetrators, perpetration patterns of rape, and associated factors were reviewed and analyzed.

Results
Over a quarter of rape victims were under the age of 18 years. In over half of cases, the perpetrators were known to the victims, which was more frequent in minors than in adult victims. Over half of perpetrators were within the age range of 18–30 years. Most perpetrators had received a low level of education and were from low-income populations. Nighttime has the highest occurrence of rapes: 39.9% of rapes occurred during late night; and 24.6%, during early night. Victim perpetrator relationship and the location were significantly related (χ2 = 23.667; df = 3, 266; p < 0.001). Risk evaluation showed that 30.8% and 28.1% of cases occurred under medium- and high-risk settings, respectively. Sexual motivation was present in over 95% of cases. Physical force was used in almost half of cases. Less than half of victims received forensic clinical examination after perpetration.

Conclusions
The findings provide population-based data to contribute to the future development of prevention strategies and to raise awareness of the urgent need for victim assistance services.
The Effect of Rigid Spinal Orthosis on the Muscular Capacity of Patients With Low Back Pain - A 3-Month Follow-up Study
Authors: Rimaud Diana , Rieffel Naomi , Fayolle-Minon Isabelle , Vedreine Philippe , Ebermeyer Eric , Salmochi Jean-François , Jacquin Olivier , Dye Emmanuel , Mazel Clément , Calmels Paul 
Published: September 2021

ABSTRACT

Introduction
In chronic low back pain, the use of lumbar orthosis treatment is not part of general recommendations due to a lack of supporting evidence. However, interest in segmental immobilization at the mechanical and postural level is still current in practice, with, however, the belief of negative effects on muscular capacity. The objective of our study was to assess the evolution of muscle capacity after wearing custom-made rigid corset in patients with chronic low back pain.

Materials and Methods
This is a multicenter study in patients with chronic low back pain, for which the wearing of a rigid postural immobilization corset for 3 months was prescribed. Twenty-two patients completed all follow-up assessments at baseline, 45 days, and 3 months. Evaluations included Biering-Sørensen test, Shirado test, chair test, hand/ground test, lateral inclination test, Quebec scale, and visual analog scale.

Results
The results revealed a significant improvement of Biering-Sørensen test after 3 months (37.0 ± 53.6 seconds at D0, 41.3 ± 51.7 seconds at D45, and 53.2 ± 60.5 seconds at D90; P < 0.05), in hand/ground distance (21.8 ± 28.5 cm at D0, 15.5 ± 17.8 cm at D45, and 12.2 ± 15.5 cm at D90; P < 0.05), in disability based on the Quebec questionnaire (0.52 ± 0.21 at D0, 0.45 ± 0.19 at D45, and 0.39 ± 0.19 at D90; P < 0.05), and significant reductions in visual analog scale measures of pain (6.0 ± 1.7 at D0, 3.7 ± 1.7 at D45, and 2.7 ± 1.9 at D90; P < 0.05).

Conclusions
This study shows that the wearing of a rigid orthosis does not alter the muscular endurance capacities of the trunk muscles. In view of the results, wearing a rigid orthosis may be an alternative to treating chronic low back pain. It does not induce muscle loss and may even contribute to motor disinhibition, resulting in improved spinal mobility and functional abilities.

Clinical Relevance
The common belief that wearing a spinal orthosis leads to muscle loss should no longer be an obstacle to its prescription since it helps to maintain muscle capacity and reduces pain.
Impacts of a Robotic Arm on People with Upper-Limb Disabilities Due to Neuromuscular Disorder
Authors: Routhier François , Lettre Josiane , Bouffard Jason , Archambault Philippe , Lemay Martin , Gélinas Isabelle 
Published: September 2021

ABSTRACT

Introduction
Research is still limited on the impacts of robotic arms in improving independent living and social participation of individuals with upper-limb disabilities, and several knowledge gaps remain. This study aims to investigate the impacts of the JACO robotic arm on individuals with upper-limb impairments due to a neuromuscular disease.

Methods
For this prospective study, participants used the robotic arm in their daily life for a 2-month period. The effectiveness of the robotic arm was objectively observed during activities performed in a controlled environment. The perception of the users and of their main family caregivers was also documented. Finally, the nature and importance of activities carried out with the robotic arm in a community-living environment were explored.

Results
Participants' abilities with the JACO robotic arm improved continuously during the trial duration. Participants actively took part in more life habits, perceived fewer difficulties, and were more satisfied with their social participation. Despite these findings, very few life habits could be performed completely independently, limiting the impacts on global caregivers' burden.

Conclusions
Even if participants encountered some difficulties, this study demonstrates short-term benefits of the robotic arm for individuals with upper-limb impairments due to a neuromuscular disorder. Future studies should mainly focus on the psychosocial, economic, and occupational long-term impacts of the robotic arm. The development of services to assist the integration of such devices in people's lives could optimize their impacts.

Clinical Relevance
The results of this study contribute to the body of knowledge of clinicians for the prescription of a robotic arm.
Patient Blood Management in intensive care patients
Authors: Hof Lotta , Choorapoikayil Suma , Meybohm Patrick , Zacharowski Kai 
Published: September 2021

Purpose of reviewPatients admitted to ICUs are a heterogeneous group, displaying multiple anaemia risk factors and comorbidities. Clinicians should therefore take all possible measures to identify modifiable risks. Patient Blood Management (PBM) is an approach promoting the timely application of evidence-based interventions designed to maintain patients own blood mass.Recent findingsWithin ICU-patients, anaemia is highly prevalent. Generally, anaemia is associated with impaired outcome and need of blood transfusion. Currently, with ICUs working at full capacity and the global blood reserves exhausted, the SARS-CoV-2 pandemic reinforces the need for PBM implementation. For instance, implementation of a comprehensive coagulation management and measures to avoid iatrogenic blood loss may prevent bleeding-associated complications and adherence to blood transfusion guidelines may reduce adverse events associated with transfusion.SummaryCritically ill patients display various morbidities often requiring individualized treatment. PBM offers patient-centred measures to improve outcome any time during hospital stay.
Controversies in paediatric acute kidney injury and continuous renal replacement therapy: can paediatric care lead the way to precision acute kidney injury medicine?
Authors: Stanski Natalja L. , Fuhrman Dana , Basu Rajit K. 
Published: September 2021

Purpose of review
Paediatric patients represent a unique challenge for providers managing acute kidney injury (AKI). Critical care for these children requires a precise approach to assessment, diagnostics and management.

Recent findings
Primarily based on observational data, large epidemiologic datasets have demonstrated a strong association between AKI prevalence (one in four critically ill children) and poor patient outcome. Drivers of AKI itself are multifactorial and the causal links between AKI and host injury remain incompletely defined, creating a management paradigm primarily supportive in nature. The previous decades of research have focused primarily on elucidating the population-level epidemiologic signal of AKI and use of renal replacement therapy (RRT), but in order to reverse the course of the AKI ‘epidemic’, future decades will require more attention to the individual patient. A patient-level approach to AKI in children will require sophisticated approaches to risk stratification, diagnostics and targeted utilization of therapies (both supportive and targeted towards drivers of injury).

Summary
In this review, we will summarize the past, present and future of AKI care in children, discussing the ongoing work and future goals of a personalized approach to AKI medicine.
Outcomes of early versus delayed endoscopy in cirrhotic patients with acute variceal bleeding: a systematic review with meta-analysis
Authors: Bai Zhaohui , Wang Ran , Cheng Gang , Ma Dapeng , Ibrahim Mostafa , Chawla Saurabh , Qi Xingshun 
Published: September 2021

Objectives
Endoscopy is the mainstay treatment option for acute variceal bleeding (AVB) in liver cirrhosis. However, the optimal timing of endoscopy in such patients remains unclear.

Methods
PubMed, EMBASE and Cochrane Library databases were searched. We compared the mortality, incidence of rebleeding, length of stay, endoscopic hemostasis, need for salvage and units of transfusion between cirrhotic patients with AVB who underwent early and delayed endoscopy. Meta-analyses were performed by using a random-effect model. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Subgroup analysis was performed in studies where early endoscopy was defined as <12 h.

Results
Nine retrospective studies involving 2824 patients were included. The early endoscopy group had a significantly lower overall mortality than the delayed endoscopy group in overall analysis (OR = 0.56, 95% CI, 0.33–0.95, P = 0.03), but the difference between them was NS in subgroup analysis (OR = 0.72, 95% CI, 0.38–1.38, P = 0.33). In-hospital (OR = 0.77, 95% CI, 0.26–2.32, P = 0.65) and 6-week (OR = 0.78, 95% CI, 0.42–1.47, P = 0.45) mortality were not significantly different between them. Overall rebleeding was not significantly different between early and delayed endoscopy groups in both overall (OR = 0.88, 95% CI, 0.51–1.51, P = 0.63) and subgroup (OR = 1.04, 95% CI, 0.55–1.95, P = 0.90) analyses. In-hospital (OR = 1.41, 95% CI, 0.67–2.96, P = 0.37) and 6-week (OR = 0.93, 95% CI, 0.40–2.17, P = 0.86) rebleeding remained not significantly different between them. Additionally, the length of stay, endoscopic hemostasis, need for salvage and units of transfusion were not significantly different between them.

Conclusions
Early endoscopy may improve the survival of cirrhotic patients with AVB, but has no remarkable benefit on the prevention of rebleeding. These findings should be further validated by high-quality studies.
No evidence of “weekend effect” in upper gastrointestinal bleeding in Italy: data from a nationwide prospective registry
Authors: Soncini Marco , Occhipinti Vincenzo , Zullo Angelo , Marmo Riccardo ,   on behalf of GISED - Gruppo Italiano per lo Studio dell’Emorragia Digestiva
Published: September 2021

Objectives
The literature offers conflicting information about ‘weekend effect’ in acute upper gastrointestinal bleeding (AUGIB). Aim of our study was to compare clinical outcomes of patients admitted for AUGIB during the weekend or on weekdays in Italy.

Methods
We analyzed data from a prospective registry of AUGIB (either nonvariceal, NV-AUGIB or variceal, V-AUGIB) from 50 Italian hospitals from January 2014 to December 2015. Mortality, rebleeding, need for salvage procedures and length of hospitalization were compared among patients admitted during the weekend or on weekdays.

Results
In total 2599 patients (mean age 67.4 ± 15.0 years, 69.2% males) were included, 2119 (81.5%) with NV-AUGIB and 480 (18.5%) with V-AUGIB. Totally 494 patients with NV-AUGIB (23.3%) and 129 patients with V-AUGIB (20.7%) were admitted during the weekend. The two study groups were similar in terms of physical status (American Society of Anesthesiologists score, comorbidities) and bleeding-specific prognostic scores. We did not find differences in terms of mortality (5.6 vs. 4.9%; P = 0.48), rebleeding (5.9 vs. 5.1%; P = 0.39), need for salvage procedures (4.0 vs. 3.6%; P = 0.67) or duration of hospitalization (8.5 ± 6.9 vs. 8.3 ± 7.2 days; P = 0.58) between patients admitted during weekend or weekdays. Considering separately NV-AUGIB and V-AUGIB, the only difference found in clinical outcomes was a higher rebleeding risk in patients with V-AUGIB admitted during the weekend (13.2 vs. 7.4%; P = 0.05).

Conclusions
Data from our large, prospective multicenter registry shows that in Italy there is no significant ‘weekend effect’ for either NV- or V-AUGIB. Our results show that the Italian hospital network is efficient and able to provide adequate care and an effective therapeutic endoscopy even during the weekend.
The performance of COBRA, a decision rule to predict the need for intensive care interventions in intentional drug overdose
Authors: Wiersma Tim , van den Oever Huub L.A. , van Hout Freek J.H.A. , Twijnstra Minke J. , Mauritz Gert-Jan , van ’t Riet Esther , Jansman Frank G.A. 
Published: September 2021

Background
COBRA was developed as a decision rule to predict which patients visiting the emergency department (ED) following intentional drug overdose will not require intensive care unit (ICU) interventions. COBRA uses parameters from five vital systems (cardiac conduction, oxygenation, blood pressure, respiration, and awareness) that are readily available in the ED. COBRA recommends against ICU admission when all these parameters are normal.

Objective
The primary aim of this study was to determine the negative predictive value (NPV) of COBRA in predicting ICU interventions. Secondary outcomes were the sensitivity, specificity and positive predictive value (PPV), and the observation time required for a reliable prediction.

Design
Observational cohort study.

Settings and participants
Patients with a reported intentional overdose with drugs having potential acute effects on neurological, circulatory or ventilatory function were included, and data necessary to complete the decision rule was collected. The attending physician in the ED made the actual admission decision, on the basis of clinical judgement. COBRA was measured 0, 3 and 6 h after arrival at the ED.

Outcome measures
Need for ICU interventions (treatment of convulsion; defibrillation; mechanical or noninvasive ventilation; intravenous administration of vasopressive agents, antiarrhythmics, atropine, calcium, magnesium or sedation; continuous hemofiltration or administration of antagonist/antidote and fluid resuscitation).

Main results
Of 230 new cases (144 unique patients), 59 were immediately referred to the psychiatric services and/or sent home by the attending physician, 27 went to a regular ward, and 144 were admitted to the ICU. Of these 144 cases, 40 required one or more ICU interventions. By the time the first parameters were collected, the NPV of COBRA was 95.6%. After 3 h of observation, NPV was 100%, while sensitivity, specificity and PPV were 100, 61.1 and 35.1%, respectively. None of these values improved by prolonging the observation time to 6 h.

Conclusion
In patients with a reported intentional overdose with drugs having potential acute effects on neurological, circulatory or ventilatory function, the COBRA decision rule showed good performances in predicting the need for intensive care interventions, with a NPV of 100% after 3 h of observation.
Breastfeeding and the developmental origins of mucosal immunity: how human milk shapes the innate and adaptive mucosal immune systems
Authors: Dawod Bassel , Marshall Jean S. , Azad Meghan B. 
Published: September 2021

Purpose of review
Breastfeeding provides passive immunity while the neonatal immune system matures, and may also protect against chronic immune-mediated conditions long after weaning. This review summarizes current knowledge and new discoveries about human milk and mucosal immunity.

Recent findings
New data suggest that certain microbes in maternal milk may seed and shape the infant gut microbiota, which play a key role in regulating gut barrier integrity and training the developing immune system. Human milk oligosaccharides, best known for their prebiotic functions, have now been shown to directly modulate gene expression in mast and goblet cells in the gastrointestinal tract. Epidemiologic data show a reduced risk of peanut sensitization among infants breastfed by peanut-consuming mothers, suggesting a role for milk-borne food antigens in tolerance development. Cross-fostering experiments in mice suggest the soluble Toll-like receptor 2, found in human milk, may be critical in this process. Finally, interest in human milk antibodies surged during the pandemic with the identification of neutralizing severe acute respiratory syndrome coronavirus 2 antibodies in maternal milk following both natural infection and vaccination.

Summary
Human milk provides critical immune protection and stimulation to breastfed infants. Understanding the underlying mechanisms could identify new therapeutic targets and strategies for disease prevention across the lifespan.
Pharmacogenomics insights into precision pediatric oncology
Authors: Ramos Kristie N. , Gregornik David , Ramos Kenneth S. 
Published: September 2021

Purpose of review
Pharmacogenomic insights provide an opportunity to optimize medication dosing regimens and patient outcomes. However, the potential for interindividual genomic variability to guide medication dosing and toxicity monitoring is not yet standard of care. In this review, we present advances for the thiopurines, anthracyclines and vincristine and provide perspectives on the actionability of pharmacogenomic guidance in the future.

Recent findings
The current guideline on thiopurines recommends that those with normal predicted thiopurine methyltransferase and NUDT15 expression receive standard-of-care dosing, while ‘poor metabolizer’ haplotypes receive a decreased 6-mercaptopurine starting dose to avoid bone marrow toxicity. Emerging evidence established significant polygenic contributions that predispose to anthracycline-induced cardiotoxicity and suggest this knowledge be used to identify those at higher risk of complications. In the case of vincristine, children who express CYP3A5 have a significantly reduced risk of peripheral neuropathy compared with those expressing an inactive form or the CYP3A4 isoform.

Summary
The need for adequately powered pediatric clinical trials, coupled with the study of epigenetic mechanisms and their influence on phenotypic variation and the integration of precision survivorship into precision approaches are featured as important areas for focused investments in the future.
Effects of obesity and weight-loss surgery shift the microbiome and impact alloimmune responses
Authors: Zhou Hao , Tullius Stefan G. 
Published: September 2021

Purpose of review
Obesity is a worldwide health problem with increasing rates in both children and adults. Bariatric surgery (BS) represents the only effective long-term treatment. Beneficial effects of BS may be mediated through shifts of the gut microbiome. Here, we introduce data linking the microbiome to alloimmune responses.

Recent findings
The rapid development of microbiome sequencing technologies in addition to the availability of gnotobiotic facilities have enabled mechanistic investigations on modulations of alloimmune responses through microbiomes. BS has been shown to improve comorbidities and chronic inflammation caused by obesity. Changes in microbiota and microbiota-related metabolites may play a role. Patients either listed or having received a transplant have undergone weight loss surgery, thus allowing to dissect mechanisms of microbial shifts to alloimmunity.

Summary
Weight loss and BS have the potential to improve transplant outcomes by ameliorating alloimmune responses. Those effects may be carried out through alterations of the gut microbiome.
The Cutting Edge of Gastroenteritis
Authors: Arostegui Dalia , Wallach Thomas 
Published: September 2021

ABSTRACTIn recent years, multiple advances have been made in the care, diagnosis, and mechanistic understanding of acute gastroenteritis (AGE). In this review, we discuss the current state of the art of diagnosis and management, as well as how changes in practice can improve care and decrease costs. We will discuss present study demonstrating the effect of AGE on the microbiome and how that may be linked to secondary effects or long‐term changes. We will explore the use of novel technologies to further our capacity to understand how gastrointestinal infections occur and promulgate. Finally, will discuss advances in our understanding of how gastrointestinal infections capacitate other changes such as post‐viral motility or other post viral intestinal dysfunction.
Multidisciplinary Care for Refractory Pediatric Functional Abdominal Pain Decreases Emergency and Inpatient Utilization
Authors: Chu Andrew S. , Torres Laura , Kao Grace , Gilbert Caroyl , Monico Evelyn Caro , Chumpitazi Bruno P. 
Published: September 2021

ABSTRACTChildren with refractory functional abdominal pain (FAP) experience functional disability and may utilize emergency department (ED) and/or inpatient services. Whether multidisciplinary programs which help care for children with refractory FAP affect acute healthcare utilization is unknown. A retrospective chart review of children initially evaluated by the outpatient Multidisciplinary Abdominal Pain Program (MAPP) from October 2016 to May 2019 was completed. Patient characteristics and number of ED visits and hospitalizations for abdominal pain in the year prior to versus year after MAPP evaluation were captured. Thirty‐eight children (ages 9–17 years [median 13 years]) were included. The median number of ED visits/patient/year decreased from 1 (range: 0–7) to 0 (range: 0–3) (P < 0.0001). Seven (18%) children had been hospitalized and, in these children, the median number of hospitalizations/patient/year decreased from 1 (range: 1–5) to 0 (range: 0–1) (P < 0.05). These data suggest multidisciplinary outpatient intervention for refractory FAP is associated with significant decreases in acute healthcare utilization.