bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benefit–Risk of Rivaroxaban for Extended Thromboprophylaxis After Hospitalization for Medical Illness: Pooled Analysis From MAGELLAN and MARINER
Authors: Raskob Gary E. , Spyropoulos Alex C. , Spiro Theodore E. , Lu Wentao , Yuan Zhong , Levitan Bennett , Suh Eunyoung , Barnathan Elliot S. 
Published: November 2021

Background
Thromboprophylaxis extended after hospital discharge in medically ill patients currently is not recommended by practice guidelines because of uncertainty about the benefit for preventing major or fatal thromboembolic events, and the risk of bleeding.

Methods and Results

We assessed the benefit and risk of thromboprophylaxis with rivaroxaban 10 mg once daily extended for 25 to 45 days after hospitalization for preventing major thromboembolism in medically ill patients using the pooled data in 16 496 patients from 2 randomized trials, MARINER (Medically Ill Patient Assessment of Rivaroxaban Versus Placebo in Reducing Post‐Discharge Venous Thrombo‐Embolism Risk) and MAGELLAN (Multicenter, randomized, parallel‐group efficacy and safety study for the prevention of venous thromboembolism in hospitalized medically ill patients comparing rivaroxaban with enoxaparin). The data from the MARINER trial were pooled with the data from the MAGELLAN trial in patients who were free of thrombotic or bleeding events up to the last dose of enoxaparin/placebo and who continued in the outpatient phase of thromboprophylaxis. The composite outcome of major thromboembolic events (symptomatic deep vein thrombosis, nonfatal pulmonary embolism, myocardial infarction, and nonhemorrhagic stroke) and all‐cause mortality was used to assess benefit and was compared with the risk of the composite of fatal and critical site bleeding. The incidence of the composite efficacy outcome was 1.80% (148 of 8222 patients) in the rivaroxaban group, compared with 2.31% (191 of 8274 patients in the placebo group) (HR, 0.78 [95% CI, 0.63–0.97],
P
=0.024). Fatal or critical site bleeding events were infrequent and occurred in <0.1% of patients in both groups (rivaroxaban 0.09%; placebo 0.04%; HR, 2.36;
P
=0.214).

Conclusions
The results suggest a benefit for reducing major thromboembolic outcomes (number needed to treat: 197), with a favorable trade‐off to fatal or critical site bleeding (number needed to harm: 2045).

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifiers: NCT00571649 and NCT02111564.
The Effects of Steering Locomotion on User Preference and Accuracy in
Virtual Environments
Authors: Rebenitsch Lisa , Engle Delaina 
Published: November 2021

Abstract
Locomotion in virtual environments presents challenges due to the discrepancy between the virtual and the real-world space. Teleportation has been suggested for rapid transit and low cybersickness. However, users often find the method disorienting and difficult over short distances. This is problematic in many gaming scenarios where moderate distances are common. We examined three methods of self-directed, steering locomotion for short to mid-range distances. The methods were pointing, head, and semi-decoupled head and controller. The decoupled method was to explore if game console navigation would be preferred due to familiarity. The experiment focused on user preference and accuracy and had 19 participants. We anticipated that more intuitive methods would be preferred. The pointing method had the greatest impact on accuracy. History of motion sickness susceptibility and prior use of video games did not affect preference with participants favoring the pointing method twice as often over the head method and with none preferring the semi-decoupled method. The pointing method also had lower average illness scores, although not statistically significant. The results suggest that pointing provides an accurate method of locomotion while also being a lower cybersickness option for steering navigation.
Impact of Internal Climate Variability on the Relationship between Spring Northern Tropical Atlantic SST Anomalies and Succedent Winter ENSO: The Role of the North Pacific Oscillation
Authors: Chen Shangfeng , Chen Wen , Yu Bin , Li Zhibo 
Published: November 2021

Abstract
Previous studies suggested that spring sea surface temperature anomalies (SSTAs) in the northern tropical Atlantic (NTA) have a marked influence on the succedent winter El Niño–Southern Oscillation (ENSO). In this study, we examine the spring NTA SSTA–winter ENSO connection in a 50-member large-ensemble simulation conducted with the Canadian Centre for Climate Modelling and Analysis second-generation Canadian Earth System Model (CanESM2) and a 100-member ensemble simulation conducted with the Max Planck Institute Earth System Model (MPI-ESM). The observed out-of-phase relation of spring NTA SSTA with winter ENSO can be captured by the multimember ensemble means of the large-ensemble simulations from both models. However, the relation shows a large diversity among different ensemble members attributing to the internal climate variability. The preceding winter North Pacific Oscillation (NPO) is suggested to be an important source of the internal climate variability that modulates the spring NTA SSTA–ENSO connection. The modulation of the winter NPO on the subsequent spring NTA SSTA–winter ENSO relation is seen in both climate modeling and observational datasets. When winter NPO and spring NTA SSTA indices have the same (opposite) sign, the linkage between the spring NTA SSTA and the following winter ENSO tends to be weak (strong). The NPO modulates the spring NTA SSTA–winter ENSO relation mainly via changing the zonal wind anomalies over the tropical western-to-central Pacific induced by the spring NTA SSTA. In addition, our analysis indicates that winter NPO may have a marked effect on the predictability of winter ENSO based on the condition of spring NTA SSTA.
Acupuncture combined with opioids for cancer pain: a pilot pragmatic randomized controlled trial
Authors: He Yihan , Zhang Haibo , Li Yifang , Long Shunqin , Xiao Shujing , May Brian H , Lin Zhang Anthony , Guo Xinfeng , Xue Charlie Changli , Lu Chuanjian 
Published: November 2021

Objective: Given the existing evidence for the analgesic effect of acupuncture, the current study aimed to assess whether acupuncture could be feasible and manageable as an adjunctive therapy for cancer pain in a real-world hospital setting. Methods: Thirty patients in an Oncology department with moderate or severe pain were recruited and randomized to an adjunctive acupuncture group or control group, who received pharmacotherapy for pain management without acupuncture. The duration of the treatment course was 1 week with a 2-week follow-up. In total, four acupuncture sessions were administered, on days 1/2/4/6 of the trial. Pain intensity was measured using a numerical rating scale (NRS) and the daily opioid dose was recorded. Results: The overall trends favored acupuncture for both pain intensity and daily opioid consumption. The proportion of participants experiencing at least a 2-point reduction in the NRS at the end of the treatment was 93% (n = 14/15) for the acupuncture group and 57% (n = 8/14) for the control group (risk difference (RD) 36.1%, 95% confidence interval (CI) [7.4%–65.0%]; relative risk (RR) 1.63, 95% CI [1.02–2.62]; p = 0.04). There were no serious adverse events and no dropouts during the treatment. Conclusion: This pilot study showed that adding acupuncture to routine analgesia for patients with cancer pain was feasible and acceptable to patients. The clinical effects of adding acupuncture as an adjunctive therapy need to be further evaluated. Clinical trial registration number: ChiCTR1800017023 (Chinese Clinical Trial Registry)
Trends in East Asian nurses recognizing ethical behavioral practices
Authors: Nishimura Akiko , Yamada Mitsuko 
Published: November 2021

Background: Nurses are expected to make and implement autonomous decisions to provide patients with excellent quality nursing while practicing complex, high-level care. However, studies have shown that nursing practice based on autonomous decision-making is difficult, and a gap exists between decision-making and implementation. Research question/aim/objectives: This study aims to clarify trends among nursing professionals who recognize they are practicing ethical behavior in their nursing practice. Research design/Participants and research context: We surveyed the basic attributes of and used the Ode’s Ethical Behavior Scale for Nurses with 3467 nursing professionals working at 34 hospitals in suburban cities of Japan and investigated the relationships among these factors. Ethical considerations: This study was approved by the appropriate research ethics committee. The Ethical Behavior Scale for Nurses was used with the authors’ permission. Findings/results: Significant differences were found in the mean “ethical behavior” scores between nurses and licensed practical nurses and midwives and licensed practical nurses. Mean scores for the “justice” subscale differed significantly between the low experience group and mid-level experience group and between the high experience group and mid-level experience group. Significant differences were also found in the mean scores between those with ethics education experience and those without, those with ethics training experience and those without, and those with ethics conference experience and those without. Discussion: Midwives and nurses had higher ethical behaviors than licensed practical nurses. Nursing professionals with low and high experience had higher justice scores than those with mid-level experience. Finally, nursing professionals with ethics education, training, or conference experience had higher ethical behavior than those without such experience. Conclusion: Nursing professionals who recognize they are practicing ethical behavior tend to be midwives or nurses with low or high levels of experience who attended ethics education, training, or conferences.
Outcomes of nephron sparing surgery and cortical sparing adrenalectomy in the management of Von Hippel–Lindau syndrome
Authors: Jayanth Selvin Theodore , Mukherjee Partho , George Arun Jacob Philip , Chandrasingh J. , Nirmal T. J. , Mukha Rajiv Paul , Kumar Santosh , Devasia Antony 
Published: November 2021

Abstract
Background
The management of Von Hippel–Lindau syndrome (VHLS) is multidisciplinary. The urologist is involved in treating the renal, epididymal tumors and often adrenal pheochromocytoma. Preservation of renal and adrenal function is a challenge. We present 17 cases of VHLS in a tertiary care center in South India.

Methods
A retrospective review of the patients who underwent surgical treatment under urology for VHLS from January 2009 to November 2018 was conducted. The demographic data, the spectrum of manifestation, treatment, change in glomerular filtration rate, adrenal insufficiency, and recurrence-free survival were analyzed.

Results
There were 17 patients diagnosed with VHLS. The median age of diagnosis was 39 years (range 23–41). The spectrum of clinical manifestation was: multifocal RCC (88%), pancreatic cysts/tumors (70%), cerebellar hemangioblastoma (59%), retinal angiomas (47%), epididymal cysts/tumors (47%), pheochromocytomas (41%), and spinal hemangiomas (30%). There were seven patients with ten pheochromocytoma lesions. Three underwent cortical sparing and seven total adrenalectomies; 13 patients underwent nephron sparing surgery (NSS), of which seven patients had bilateral tumors. The median duration of follow-up was 6.5 years (range 2–12 years). Following NSS, seven patients had a local recurrence, and one developed pancreatic metastasis. Two patients (11%) were lost to follow-up. Renal function was preserved in all patients at the last follow-up, and there was no postoperative adrenal crisis or mortality.

Conclusion
Nephron sparing surgery and cortical sparing adrenalectomy are the treatment of choice for multifocal RCC and pheochromocytomas in patients with VHLS providing good oncological outcomes and preservation of renal and adrenal function.
Mechanical power normalized to predicted body weight is associated with mortality in critically ill patients: a cohort study
Authors: Zhu Yanhong , Peng Wenyong , Zhen Shuai , Jiang Xiaofeng 
Published: November 2021

Abstract
Background
Mechanical power (MP), defined as the amount of energy produced by mechanical ventilation and released into the respiratory system, was reportedly a determining factor in the pathogenesis of ventilator-induced lung injury. However, previous studies suggest that the effects of MP were proportional to their involvement in the total lung function size. Therefore, MP normalized to the predicted body weight (norMP) should outperform the absolute MP value. The objective of this research is to determine the connection between norMP and mortality in critically ill patients who have been on invasive ventilation for at least 48 h.

Methods
This is a study of data stored in the databases of the MIMIC–III, which contains data of critically ill patients for over 50,000. The study involved critically ill patients who had been on invasive ventilation for at least 48 h. norMP was the relevant exposure. The major endpoint was ICU mortality, the secondary endpoints were 30-day, 90-day mortality; ICU length of stay, the number of ventilator-free days at day 28.

Result
The study involved a total of 1301 critically ill patients. This study revealed that norMP was correlated with ICU mortality [OR per quartile increase 1.33 (95% CI 1.16–1.52), p <  0.001]. Similarly, norMP was correlated with ventilator-free days at day 28, ICU length of stay. In the subgroup analysis, high norMP was associated with ICU mortality whether low or high Vt (OR 1.31, 95% CI 1.09–1.57, p = 0.004; OR 1.32, 95% CI 1.08–1.62, p = 0.008, respectively). But high norMP was associated with ICU mortality only in low PIP (OR 1.18, 95% CI 1.01–1.38, p = 0.034).

Conclusion
Our findings indicate that higher norMP is independently linked with elevated ICU mortality and various other clinical findings in critically ill patients with a minimum of 48 h of invasive ventilation.
Experience with a triplex arbovirus nucleic acid test (NAT) at a Canadian Public Health Laboratory
Authors: Choudhury Saugata , Tellier Raymond , Fonseca Kevin , Berenger Byron M. 
Published: November 2021

Abstract
Background
Dengue, chikungunya and zika infections occur in tropical and subtropical regions of the world. We describe the utilization of an in-house nucleic acid test (NAT) targeting all three viruses for febrile returning travelers in Alberta, Canada.

Methods
NAT was performed until 40 days from symptom onset or exposure due to the prolonged duration of zika virus RNA detection. From Sept 1, 2017 to August 31, 2019, 2552 specimens from 1932 patients were tested.

Results
Approximately 2% of patients tested were NAT positive for dengue virus (n = 42), chikungunya virus (n = 4), and zika virus (n = 1). The majority presented with fever, myalgia and rash. Regions with the most frequent travel included SouthEast Asia (68.5%), South America (25%) and the Caribbean (6.5%). Ct values were stronger (~ 1.5 logs) for patients within 1–3 days following onset of clinical symptoms than those presenting later. Nineteen patients had urine and plasma submitted; 5 were positive for both specimens and 2 were positive only for dengue virus in the urine. Also, Ct values were lower for plasma when compared to the corresponding urine. RNA was detected until 10 days and 5 days post-exposure in plasma and urine respectively for dengue virus.

Conclusions
Owing to dengue viremia detected beyond the conventional 7 days and low levels of circulating zika virus globally, a cutoff of 14 days from symptom onset to NAT is sufficient to diagnose acute cases. Inclusion of a zoonotic history form that collects appropriate clinical history results in improved test utilization.
Perceptions of physical activity and technology enabled exercise interventions among people with advanced chronic kidney disease: a qualitative study
Authors: Weber Mary Beth , Ziolkowski Susan , Bootwala Ahad , Bienvenida Alan , Anand Shuchi , Lobelo Felipe 
Published: November 2021

Abstract
Background
Exercise improves health outcomes and quality of life in persons with chronic kidney disease (CKD). The numbers of persons with advanced CKD meeting physical activity guidelines however is low. We undertook a qualitative study of men and women aged 36–74 from various race/ethnic populations with advanced CKD not requiring dialysis to describe their experiences and opinions around prior physical activity, motivating factors for and barriers to exercise, and perceptions of exercise-promoting technology and group-based programming designed to improve physical activity levels.

Methods
Nineteen persons with advanced CKD not requiring dialysis were interviewed at two high volume nephrology clinics enriched with racial/ethnic minority patients (Emory University and Santa Clara Valley Medical Center). We used thematic analysis to identify dominant themes (n = 4) and subthemes (n = 19) around exercise experience, barriers, motivators, views, and preferences.

Results
Four dominant themes and 19 subthemes were identified. The most common motivators to exercise included physical and mental health benefits, appearance, improvement in energy levels, and potential social interaction in group-based programs. Common barriers included health concerns, particularly complications related to other co-morbidities, as well as time and transportation constraints. Participants were skeptical of exercise programs solely reliant on technology.

Conclusions
The use of group-based exercise programs may motivate persons with CKD to increase exercise levels, while programs entirely based on technology may be less effective.
Study on the application of King’s combined uterine suture for hemostasis during cesarean section
Authors: Xia Li , Lin Jinxiao , Dai Yan , Wang Xinrui 
Published: November 2021

Abstract
Introduction
Postpartum hemorrhage is a serious complication of childbirth and is still the leading cause of maternal death worldwide. Lower uterine segment hemorrhage during cesarean section is an important cause of postpartum hemorrhage. Our objective is to expore the efficacy and safety of King’s combined uterine suture for hemostasis during cesarean section.

Methods
We examined 48 cases: 16 cases of pernicious placenta previa (including one case of twins), 11 cases of central placenta previa (including one case of twins), 18 cases of uterine scarring (including two cases of twins), as well as one case of twin pregnancy, two cases of breech presentation, and one case of pulmonary hypertension. The “King’s combined uterine suture” method for hemostasis was used in patients with lower uterine segment hemorrhage during cesarean section.

Results
The results showed that all patients had successful hemostasis during surgery, and there were no cases of hysterectomy.

Conclusion
We have concluded that King’s combined uterine suture is a fast and safe hemostasis method for cesarean section that can effectively reduce blood loss and restore the normal shape of the lower uterine segment. Furthermore, this suture method can reduce postpartum hemorrhage and hysterectomy rate, as well as improve maternal prognosis.
Protein deubiquitylase USP3 stabilizes Aurora A to promote proliferation and metastasis of esophageal squamous cell carcinoma
Authors: Shi Ke , Zhang Jin Zhong , Yang Liang , Li Ning-Ning , Yue Ying , Du Xiu-Hong , Zhang Xiu-Zhi , Lu Yu Cheng , Guo Dan 
Published: November 2021

AbstractAurora A kinase is a cell cycle regulator that is dysregulated in several different malignancies. Nevertheless, its regulatory mechanisms are still not fully understood. Here, we report that ubiquitin specific peptidase 3 (USP3) promotes proliferation and metastasis of esophageal squamous cell carcinoma (ESCC) cells by mediating deubiquitination of Aurora A. Analysis of human clinical samples indicated that USP3 and Aurora A are highly expressed in ESCC. Cellular experiments confirmed that high expression of USP3 and Aurora A in ESCC cells promoted malignant cell proliferation and invasion. In this mechanism, USP3 leads to suppression of Aurora A ubiquitination, resulting less proteasome degradation. We constructed the deubiquitinated mimetic K143R of Aurora A and found that K143R significantly promoted the proliferation and invasion of ESCC cells and was not regulated by the deubiquitination of USP3. Moreover, Aurora A K143R potentiated the kinase activity of Aurora A in ESCC cells. Thus, our findings demonstrate that the tumorigenic feature of ESCC is in part mediated by USP3-facilitated deubiquitination of Aurora A.
The effect of oral ondansetron on QT interval in children with acute gastroenteritis; a retrospective observational study
Authors: Yang Heewon , Jeon Woochan , Ko Yura , Jeong Sooin , Lee Jisook 
Published: November 2021

Abstract
Background
In mildly to moderately dehydrated patients with acute gastroenteritis (AGE), oral rehydration therapy (ORT) is the treatment of choice. Though ondansetron is a very effective antiemetics and leads to succeed ORT, there have been reports QT prolongation in patients using it. We investigated the effect of oral ondansetron on QT interval in mildly to moderately dehydrated children with AGE.

Methods
This retrospective observational study was conducted in a single pediatric emergency department (ED) of a tertiary university hospital. We collected the medical records of patients with a primary diagnosis of AGE who received oral ondansetron and underwent an electrocardiogram between January 2017 and June 2018. A pediatric emergency physician calculated the corrected QT interval (QTc) by Bazett’s method, and the calculations were reviewed by a pediatric cardiologist. QTc values before (preQTc) and after (postQTc) ondansetron administration were analyzed. ΔQTc was calculated as the change from preQTc to postQTc. We also investigated any cardiac complications from oral ondansetron.

Results
Total 80 patients were included. The mean age of the patients was 53.31 ± 32.42 months, and 45% were male. The mean dose of oral ondansetron was 0.18 ± 0.04 mg/kg. The mean interval from administration of ondansetron to performance of the electrocardiogram was 65 ± 26 min. The mean preQTc was 403.3 ± 24.0 ms, and the mean postQTc was 407.2 ± 26.7 ms. Two patients had a preQTc ≥460 ms, and one patient had a postQTc ≥460 ms. ΔQTc was ≥30 ms in seven patients (8.8%). No ΔQTc was ≥60 ms. No pre- or postQTc was ≥500 ms. No patient had a fatal cardiac arrhythmia after taking ondansetron.

Conclusion
Oral administration of a single dose of ondansetron in children with AGE did not cause high-risk QTc prolongation or fatal arrhythmia.