bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of cisplatin combined with topotecan in patients with advanced or recurrent ovarian cancer as second- or higher-line palliative chemotherapy
Authors: Lee Myung-Won , Ryu Hyewon , Song Ik-Chan , Yun Hwan-Jung , Jo Deog-Yeon , Ko Young Bok , Lee Hyo-Jin 
Published: April 2020

Abstract
The aim of this study was to evaluate the outcomes of patients with advanced or recurrent ovarian cancer treated with cisplatin combined with topotecan as second- or higher-line palliative chemotherapy.
We retrospectively reviewed the medical records of patients with advanced or recurrent ovarian cancer, who were treated with cisplatin (50 mg/m2 on day 1) and topotecan (0.75 mg/m2 on days 1–3). Treatment response, progression-free survival (PFS) and overall survival (OS) were analyzed, and laboratory data were reviewed to evaluate toxicities.
Thirty one patients were treated with cisplatin and topotecan. The objective response rate (ORR) was 22.6%, and the disease control rate (DCR) was 61.3%. The median PFS was 3.7 months (95% confidence interval [CI], 2.3–5.2 months) and the median OS was 44.5 months (95% CI, 35.5–53.5 months). The ORR (33.3% vs. 0%; P = .012) was significantly better in the platinum-sensitive group compared to the platinum-resistant group. The median PFS was significantly longer in the platinum-sensitive group compared to the platinum-resistant group (7.7 vs 2.5 months; P < .001), and the median OS was also significantly longer in the platinum-sensitive group (46.6 vs 19.3 months; P < .001). Almost all of the patients reported some degree of hematological toxicity. A high rate of grade 3–4 neutropenia (87.1%) was observed. Grade 3–4 thrombocytopenia (41.9%) and febrile neutropenia (19.4%) were also seen.
The results showed that cisplatin combined with topotecan, as second- or higher-line palliative chemotherapy for patients with advanced or recurrent ovarian cancer, might be effective, especially in the platinum-sensitive group. However, attention should be paid to the high hematological toxicity associated with this drug combination.
Correlation between body mass index, neck circumference, and waist-hip ratio as indicators of obesity among a cohort of adolescent in Bahrain
Authors: Tantawy Sayed A. , Kamel Dalia M. , Alsayed Noor , Rajab Ebrahim , Abdelbasset Walid Kamal 
Published: April 2020

Abstract
Neck circumference (NC) is an attractive method for determining overweight and obesity in school age children because it is inexpensive and culturally acceptable. However, this technique has not been assessed for its accuracy in school children from countries of the Gulf Cooperation Council, which have high prevalence of overweight and obesity.
The aim of this preliminary study was to investigate the correlation between the body mass index (BMI), NC, and waist-hip ratio and demographic characteristics among 10- to 18-year-old adolescent school children in Bahrain.
BMI was calculated using Center of Disease Control and Prevention Children's BMI Tool for Schools. Data was collected for a total of n = 397 adolescents from 4 different private schools with an average age of 12.91 years; 57.7% were male and 42.3% female.
In this sample of adolescents, 50.1% were either overweight (21.4%) or obese (28.7%). BMI was significantly associated with waist-hip ratio (P < .01), gender (P < .05), and age (P < .01). Multiple linear regressions revealed that NC was significantly associated with age (P < .001) and less so with gender (P = .071) and BMI was significantly associated with NC (P < .01), gender (P < .01), and age (P < .05). Analysis of the receiver operating characteristic for males and females combined showed fair sensitivity and specificity (Area under the curve (AUC) = 0.707; 95% CI: 0.656, 0.758).
NC is weakly correlated with BMI, and only a fair instrument for identifying overweight/obesity based on receiver operating characteristic curve analysis. Therefore, NC could only be used as an adjunct screening tool for weight status in this sample.
Analysis of nurses’ job burnout and coping strategies in hemodialysis centers
Authors: Ling Kuang , Xianxiu Wen , Xiaowei Zhang 
Published: April 2020

Abstract
In recent years, nursing has come to be considered a high-risk and high-pressure profession, given the fast-paced working environment and constant need to handle emergencies, especially for nurses working in hemodialysis centers. Nearly every day, nurses are confronted with life and death situations and are required to provide skilled, high quality care for their patients, in fast-paced and demanding environments. Thus, nurses are susceptible to both psychological stress and other mental health problems, making them more vulnerable to burnout when compared against other healthcare professions.
An anonymous online questionnaire was completed by a group of participating nurses, using the web-based survey platform WeChat. Registered nurses working in hemodialysis centers were randomly selected from 5 comprehensive tertiary level hospitals in Sichuan Province, China. The data collection instrument comprised two parts: demographic data and a nurse burnout questionnaire—the Maslach Burnout Inventory. Overall, 70 nurses were invited to participate, with 65 returning completed questionnaires, giving a response rate of 92.9%. In this survey, the burnout level was set at28.15 ± 12.39 for emotional exhaustion (EE), 10.23 ± 5.47 for depersonalization (DP), and 37.19 ± 8.31 for personal accomplishment (PA)—EE and DP levels are found to be high at the level of burnout.
Job burnout was found to exist widely among the nurses of hemodialysis centers, which may then result in adverse effects on their physical and mental health. Active interventions can significantly reduce job burnout and also help maintain the stability of nursing workforce levels.
Clinical practice on intra-operative fluid therapy in Poland
Authors: Szczepańska Anna J. , Pluta Michał P. , Krzych Łukasz J. 
Published: April 2020

Abstract
Intra-operative fluid therapy (IFT) is the cornerstone of peri-operative management as it may significantly influence the treatment outcome. Therefore, we sought to evaluate nationwide clinical practice regarding IFT in Poland.
A cross-sectional, multicenter, point-prevalence study was performed on April 5, 2018, in 31 hospitals in Poland. Five hundred eighty-seven adult patients undergoing non-cardiac surgery were investigated. The volume and type of fluids transfused with respect to the patient and procedure risk were assessed.
The study group consisted of 587 subjects, aged 58 (interquartile range [IQR] 40–67) years, including 142 (24%) American Society of Anesthesiology Physical Status (ASA-PS) class III+ patients. The median total fluid dose was 8.6 mL kg−1 h−1 (IQR 6–12.5), predominantly including balanced crystalloids (7.0 mL kg−1 h−1, IQR 4.9–10.6). The dose of 0.9% saline was low (1.6 mL kg−1 h−1, IQR 0.8–3.7). Synthetic colloids were used in 66 (11%) subjects. The IFT was dependent on the risk involved, while the transfused volumes were lower in ASA-PS III+ patients, as well as in high-risk procedures (P < .05).
The practice of IFT is liberal but is adjusted to the preoperative risk. The consumption of synthetic colloids and 0.9% saline is low.
Analysis of breast cancer cases according to county-level poverty status in 3.5 million rural women who participated in a breast cancer screening program of Hunan province, China from 2016 to 2018
Authors: Lili Xiong , Zhiyu Liu , Yinglan Wu , Aihua Wang , Hongyun Li , Ting Liang , Yingxia Wang , Guanghui Yang , Xianghua Chen , Junqun Fang , Donghua Xie , Fanjuan Kong 
Published: April 2020

Abstract
The Hunan provincial government has implemented a free breast cancer screening program for rural women aged 35 to 64 years from 2016, under a 2015 policy aimed at of poverty eradication and improving women's health in China. However, there has been no population study of the breast cancer screening program in China to date, especially considering exploring differences related to the area's poverty status. We explored differences in risk factors, clinical examination results, and clinicopathological features among breast cancer patients in poor compared with non-poor counties in rural areas of Hunan province from 2016 to 2018 using χ2 and Fisher's exact test, and multivariate logistic regression analysis. A total of 3,151,679 women from rural areas participated in the screening program, and the breast cancer prevalence was 37.09/105. Breast cancer prevalence was lower in poor (29.68/105) than in non-poor counties (43.13/105). There were differences between breast cancers in poor and non-poor counties in terms of cysts, margins, internal echo, blood flow in solid masses in the right breast on ultrasound examination, lump structure in mammograms, and clinicopathological staging and grading in pathological examinations. Breast cancer in poor counties was more likely to be diagnosed at later stages as determined by ultrasound, mammography, and pathological examinations. Furthermore, indexes of the breast screening program including early detection, prevalence, pathological examination, and mammography examination were lower in poor compared with non-poor counties. Multivariate logistic regression analysis showed that education, ethnicity, reproductive history and the year 2017 were associated with an increased risk of breast cancer in poor counties (odds ratio >1, P < .05). In conclusion, women in poor areas were more likely to be diagnosed with breast cancer at a later stage compared with women in non-poor areas. Women in poor areas of Hunan province should therefore have better access to diagnostic and clinical services to help rectify this situation.
Changes in inner retinal layer thickness in patients with exudative age-related macular degeneration during treatment with anti-vascular endothelial growth factor
Authors: Lee Seong Woo , Sim Ha Eun , Park Jae Yong , Kim Jae Suk , Chang In Beom , Park Young Soon , Hwang Je Hyung 
Published: April 2020

Abstract
The aim of this study was to identify any changes that occur in the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) in patients with exudative age-related macular degeneration (AMD) during treatment with anti-vascular endothelial growth factor (VEGF) injections.
Patients were enrolled in this retrospective study if they had exudative AMD, had received at least 3 injections of ranibizumab or aflibercept, and had a minimum of 12 months of follow-up. We analyzed the changes in the RNFL and GC-IPL using spectral-domain optical coherence tomography in rescan mode.
Fifty-two eyes of 52 patients who had been treated with repeated anti-VEGF injections for exudative AMD were included. At the final visit, there was no significant between-group difference in best-corrected visual acuity or intraocular pressure. There was a significant decrease in central macular thickness in all groups (P < .05). There was a decrease in RNFL thickness that was only statistically significant in the ranibizumab group and when the ranibizumab or aflibercept groups were combined (P = .036 and .044, respectively). The thickness of the GC-IPL layer was significantly decreased in the aflibercept and total group (P = .035 and P = .048, respectively).
The thicknesses of the RNFL and GC-IPL decreased in patients with exudative AMD who underwent repeated anti-VEGF injections.
Circulating microRNAs as biomarkers for severe coronary artery disease
Authors: Zhang Xuelin , Cai Haipeng , Zhu Minqi , Qian Yinfen , Lin Shanan , Li Xiaoqiang 
Published: April 2020

Abstract
Coronary artery disease (CAD) is the second leading cause of death after stroke in China. Percutaneous coronary intervention (PCI) significantly improves the prognosis of CAD patients. This study aimed to evaluate the diagnostic value of circulating microRNAs (miRNAs) in patients with severe CAD requiring PCI. The plasma miRNA profiles were determined using miRNA microarray. The relative expression levels of differentially expressed miRNA were measured by quantitative reverse transcription polymerase chain reaction (qRT-PCR). Nine miRNAs (ebv-miR-BART12, ebv-miR-BART16, let-7i-5p, miR-130a-3p, miR-26a-5p, miR-3149, miR-3152–3p, miR-32-3p, and miR-149-3p) were differentially expressed between severe CAD and control groups. Four miRNAs (let-7i-5p, miR-32-3p, miR-3149, and miR-26a-5p) validated by qRT-PCR showed good diagnostic accuracy, with the area under the receiver operating characteristic curves (AUCs) of 0.634 (95% confidence interval [CI] 0.528–0.739), 0.745 (95%CI 0.649–0.84), 0.795 (95%CI 0.709–0.88), and 0.818 (95%CI 0.739–0.897), respectively. Furthermore, the combination of these 4 miRNAs exhibited better diagnostic performance compared with any individual miRNA, with an AUC of 0.837 (95%CI 0.763–0.911). These data indicate that plasma let-7i-5p, miR-32–3p, miR-3149, and miR-26a-5p have promising diagnostic value for severe CAD.
Enhanced recovery after head and neck cancer surgery: a review of current literature
Authors: Watson Laura-Jayne , Ewers Caroline 
Published: April 2020

Purpose of review
Enhanced recovery after surgery (ERAS) is well documented in a number of surgical specialities. However, it remains an emerging concept in surgical head and neck cancer care. The purpose of this review is to appraise the current evidence investigating enhanced recovery in head and neck cancer, and explore areas for future clinical research.

Recent findings
There were three key themes in enhanced recovery from the current head and neck cancer literature: early oral feeding, fistula closure and service delivery. This evidence is emerging and the quality of papers remains variable which makes it difficult to draw robust clinical recommendations. However, there are some encouraging clinical findings with regards to early oral feeding protocols and suturing of the trachea-stoma.

Summary
There is limited literature in enhanced recovery in head and neck cancer, with questionable quality of the papers reviewed. As such, there is no consensus for a standardized enhanced recovery pathway which demonstrates effective service delivery and positive patient outcomes. It is clear that implementation of enhanced recovery pathways is complex and requires patient and clinician buy in. Future research should focus on co-design of a methodologically sound enhanced recovery pathway with evaluation of its implementation.
Management of infective complications of otitis media in resource-constrained settings
Authors: Bhutta Mahmood F. , Monono Martin E. , Johnson Walter D. 
Published: April 2020

Purpose of review
Complications of otitis media are a cause of significant morbidity and mortality, compounded in resource-constrained settings in which human and physical resources to manage disease are suboptimal. Here, we examine the current best evidence to devise a protocol for management, in particular exploring the opportunity for conservative or nonspecialist management.

Recent findings
Reviews of the literature suggest that intratemporal and extracranial infections can be managed with antibiotics in the first instance, with aspiration or incision and drainage of abscess. Failure to respond necessitates mastoidectomy, which need not be extensive, and can be performed with hammer and gouge. Suspected or possible intracranial extension requires referral for computed tomography (CT) imaging. Intracranial infection can in some instances be managed with antibiotics, but large or persistent intracranial abscess, or the presence of cholesteatoma requires management in a centre for specialist surgery.

Summary
Many complications of otitis media could be managed by nonspecialists in appropriately equipped local or regional health facilities, and supported by appropriate training. However, regional centres with CT imaging and specialist surgery are required for assessment and treatment of cases that are suspected of having complex or advanced disease, or that fail to respond to initial treatment. Those involved in planning healthcare provision should look to develop infrastructure to support such management.
Complicated sinusitis in developing countries: an African perspective
Authors: Searyoh Kafui , Bankah Patrick , Acquah Serwaa 
Published: April 2020

Purpose of review
Complicated rhinosinusitis continues to be a diagnosis not to be missed because of the potential life-threatening and life-changing outcomes. This is true for clinicians in both developed and developing countries. Advances in diagnostic imaging, appropriate antibiotic use and timely surgical intervention have resulted in better outcomes particularly in the developed world. This review focuses on the current management of complicated sinusitis in resource-limited settings.

Recent findings
Recent publications indicate leaning toward endoscopic sinus surgery as a standalone procedure or in combination with traditional external approaches in the management of complicated rhinosinusitis with less morbidity and shorter recovery time. It is becoming increasingly evident that multidisciplinary specialties should be involved in the effective management of patients with complicated sinusitis.

Summary
Early recognition, prompt surgical intervention and antibiotic therapy remain keys in the management of complicated rhinosinusitis. In many African countries and other developing countries, the absence of specialized imaging and endoscopic diagnostic equipment and endoscopic surgical facilities and expertise means that reliance must be placed on clinical acumen both for diagnosis and monitoring of treatment response of complicated sinus infections.
Vaping implications for children and youth
Authors: Gilley Meghan , Beno Suzanne 
Published: April 2020

Purpose of review
The development and uptake of E cigarettes are a relatively recent phenomenon. Because of aggressive marketing, attractive designs, enticing flavors and primarily reactionary legislation, we are now seeing soaring rates of adolescent vaping with associated consequences. This review explores how E cigarettes work, their health implications, epidemiology among youth and current regulatory strategies.

Recent findings
Recently, the Center for Disease Control and Prevention reported that 27% of high school students had used a tobacco product within the last month, the majority being E-cigarettes in 20.8% of high school students. Vaping has managed to reverse a decades long trend of declining nicotine use among youth. Long-term addiction is not the only concern related to youth vaping; there are also increasing reports of short-term health consequences, such as seizures, acute nicotine toxicity, burns and lung injury.

Summary
Industry has created and aggressively marketed a product that is enticing to adolescents. E cigarettes have sleek designs, desirable flavors and social acceptability with perceived safety among youth. This has resulted in epidemic E cigarette use in youth with resultant significant short-term and long-term health concerns. Legislation must include regulations that strictly avoid marketing and sales to youth, as well as reducing access to these products.
Vaping in adolescents: epidemiology and respiratory harm
Authors: Hamberger Eric Stephen , Halpern-Felsher Bonnie 
Published: April 2020

Purpose of review
This review highlights epidemiologic changes in e-cigarette use in adolescents, discusses recent advances in aerosolized nicotine delivery, and provides and updated profile of research related to the lung-specific harm of e-cigarettes.

Recent findings
In the past decade, nicotine-containing e-cigarettes have emerged as the most popular tobacco and nicotine delivery modality among adolescents in the United States.1 The surge in popularity of these devices has coincided with an outbreak of vaping-related lung injury, bringing e-cigarette use to national attention, and creating a great deal of confusion regarding their potential for respiratory harm. Newer pod-based devices and formulations of e-liquids have resulted in products appeal to youth and deliver nicotine with increasing efficiency. E-liquid aerosols are associated with direct harm to respiratory epithelium and have been shown to alter pulmonary function, inflammation, mucociliary clearance, and lung histology.

Summary
Although the long-term harms of regular e-cigarette use are unknown, numerous studies including early longitudinal data suggest e-cigarette use is associated with incidence of respiratory disease, independent of concurrent traditional cigarette use. Improved understanding and recognition of harm will contribute to the basis of further studies examining the role of e-cigarettes on chronic respiratory disease and will inform future prevention education.
Emerging issues in the ethical utilization of pediatric extracorporeal membrane oxygenation
Authors: Carlisle Erica M. , Loeff Deborah S. 
Published: April 2020

Purpose of review
As we have refined our extracorporeal membrane oxygenation (ECMO) capabilities and enhanced our ability to care for children with illnesses previously deemed lethal, the patient populations for whom ECMO is a medically appropriate intervention have expanded. Such expansion has prompted consideration of evolving ethical issues. In this review, we highlight several of the emerging ethical issues in pediatric ECMO.

Recent findings
Expansion of ECMO into increasingly diverse pediatric populations has prompted several ethical questions. First, some have found that there are specific clinical settings in which ECMO ought to be obligatory. Second, expanded use of ECMO may prompt disagreements among healthcare providers or between providers and family members regarding decisions about decannulation. Finally, analysis of the ethical challenges associated with integration of other disruptive healthcare modalities into patient care, will allow us insight into how to assure ethical expansion of pediatric ECMO.

Summary
Expansion of pediatric ECMO highlights several ethical issues including whether ECMO is ever ethically obligatory, how to ethically decannulate a patient when survival is deemed unlikely, and how to guide expansion of pediatric ECMO based upon lessons learned from the implementation of other disruptive healthcare interventions into practice.
Firearm-related injuries in children and adolescents: an emergency and critical care perspective
Authors: Flaherty Michael R. , Klig Jean E. 
Published: April 2020

Purpose of review
Firearms are a leading cause of death and injury in children, especially in the United States. Many of these injuries present to emergency departments and pediatric ICUs, prompting a need for updated prevention, interventions, and trauma-informed care. This review explores the evidence for prevention and screening for access to firearms, types of injuries, and considerations for mass casualty events.

Recent findings
Firearm-related injuries lead to over 20 000 emergency department visits annually in children and carry a higher risk of severe injury or death. Screening high-risk patients for access to firearms is suboptimal, despite evidence showing reduction in suicide deaths and increased safe storage. While mass casualty shootings represent a low proportion of all firearm-related morbidity, they have brought heightened attention to focus on quality research.

Summary
Firearm-related injury is a public health crisis and presents a unique risk to children and adolescents. A firearm in the home, especially one with children, significantly increases the risk of death by homicide or suicide. Research on gun violence is leading to important national conversations on gun control and the role of physicians in the prevention of injury and advocacy for effective interventions and legislation.