bluuebunny/crossref_metadata_2025_split huggingface dataset:
Position Paper on Global Extracorporeal Membrane Oxygenation Education and Educational Agenda for the Future: A Statement From the Extracorporeal Life Support Organization ECMOed Taskforce*
Authors: Zakhary Bishoy , Shekar Kiran , Diaz Rodrigo , Badulak Jenelle , Johnston Lindsay , Roeleveld Peter Paul , Alinier Guillaume , Lai Peter Chi Keung , Ramanathan Kollengode , Moore Elizabeth , Hassan Ibrahim , Agerstrand Cara , Ngai Wallace Chun-wai , Salazar Leonardo , Raman Lakshmi , Bembea Melania M. , Davidson Mark , Gomez-Gutierrez Rene D. , Mateo-Sidrón Jose Alfonso Rubio , Kukutschka Jeannie , Antonini Marta V. , Dickstein Marc L. , Schmidt Matthieu , Abrams Darryl , Ogino Mark T. 
Published: December 2019

Objectives:
The purpose of this position paper is two-fold: first, to describe the state of extracorporeal membrane oxygenation education worldwide, noting current limitations and challenges; and second, to put forth an educational agenda regarding opportunities for an international collaborative approach toward standardization.

Design:
Relevant medical literature was reviewed through literature search, and materials from national organizations were accessed through the Internet. Taskforce members generated a consensus statement using an iterative consensus process through teleconferences and electronic communication.

Setting:
In 2018, the Extracorporeal Life Support Organization convened the ECMOed Taskforce at two structured, face-to-face meetings of 40 healthcare practitioners and educators with expertise in caring for the extracorporeal membrane oxygenation patient and in extracorporeal membrane oxygenation education.

Patients:
None.

Interventions:
None.

Measurements and Main Results:
The ECMOed Taskforce identified seven educational domains that would benefit from international collaborative efforts. Of primary importance, the Taskforce outlined actionable items regarding 1) the creation of a standardized extracorporeal membrane oxygenation curriculum; 2) defining criteria for an extracorporeal membrane oxygenation course as a vehicle for delivering the curriculum; 3) outlining a mechanism for evaluating the quality of educational offerings; 4) utilizing validated assessment tools in the development of extracorporeal membrane oxygenation practitioner certification; and 5) promoting high-quality educational research to guide ongoing educational and competency assessment development.

Conclusions:
Significant variability and limitations in global extracorporeal membrane oxygenation education exist. In this position paper, we outline a road map for standardizing international extracorporeal membrane oxygenation education and practitioner certification. Ongoing high-quality educational research is needed to evaluate the impact of these initiatives.
Age at last birth and risk of developing breast cancer: a meta-analysis
Authors: Wu Yanjun , Wang Mingyue , Sun Wenjun , Li Suyun , Wang Weijing , Zhang Dongfeng 
Published: December 2019

Objectives
Results from epidemiologic studies on age at last birth (ALB) and the risk of developing breast cancer were inconsistent. Therefore, we conducted this meta-analysis to evaluate the association between ALB and the risk of developing breast cancer quantitatively.

Methods
Relevant articles published up to May 2019 were identified by searching systematically in PubMed, Web of Science, China National Knowledge Infrastructure, and Wan Fang Med Online. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Dose-response relationship was assessed by restricted cubic spline model.

Results
Fourteen studies with 132 133 cases and 1 314 005 participants were eligible for this meta-analysis. The pooled RR (95% CI) of breast cancer for the highest vs. the lowest stratification of ALB was 1.22 (1.04–1.42). In the subgroup analysis, significant positive associations were also found in studies conducted in Europe (RR: 1.21, 95% CI: 1.06–1.38), studies with results adjusted for parity (RR: 1.26, 95% CI: 1.04–1.54), and studies with results adjusted for age at first birth (RR: 1.37, 95% CI: 1.08–1.74). The results of the dose-response analysis indicated that the departure from linearity was NS between ALB and the risk of breast cancer (P
nonlinearity = 0.711), but the linear associations were NS.

Conclusion
This meta-analysis suggested that ALB was positively associated with the risk of breast cancer. The risk of developing breast cancer increased gradually with the ALB for women. Our findings may have implications for family planning.
Effectiveness of vitamin D supplementation on the outcome of pulmonary tuberculosis treatment in adults: a meta-analysis of randomized controlled trials
Authors: Zhang Jing , Chen Chun , Yang Jin 
Published: December 2019

AbstractBackground:Tuberculosis (TB) is one of the most debilitating diseases worldwide. Current studies have shown that vitamin D plays a significant role in host immune defense againstMycobacterium tuberculosis, but clinical trials reported inconsistent results. Therefore, we systematically reviewed the literature to investigate whether vitamin D supplementation could improve the effect of anti-TB therapy.Methods:We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from their inception to February 8th, 2019 for randomized controlled trials on vitamin D supplementation in patients with pulmonary TB receiving anti-TB therapy. The primary outcomes were time to sputum culture and smear conversion and proportion of participants with negative sputum culture. The secondary outcomes were clinical response to treatment and adverse events. A random-effects model was used to pool studies. Data were analyzed using RevMan 5.3 software.Results:Five studies with a total of 1126 participants were included in our meta-analysis. Vitamin D supplementation did not shorten the time to sputum culture and smear conversion (hazard ratio [HR] 1.04, 95% confidence interval [CI] 0.89–1.23,P = 0.60; HR 1.15, 95% CI 0.93–1.41,P = 0.20, respectively) and did not lead to an increase in the proportion of participants with negative sputum culture (relative risk [RR] 1.04, 95% CI 0.97–1.11,P = 0.32). However, it reduced the time to sputum culture conversion in the sub-group of participants withTaqItt genotype (HR 8.09, 95% CI 1.39–47.09,P = 0.02) and improved the multidrug-resistant (MDR) TB sputum culture conversion rate (RR 2.40, 95% CI 1.11–5.18,P = 0.03). There was no influence on secondary outcomes.Conclusions:Vitamin D supplementation had no beneficial effect on anti-TB treatment, but it reduced the time to sputum culture conversion in participants with tt genotype of theTaqIvitamin D receptor gene polymorphism and improved the MDR TB sputum culture conversion rate.
Effects of keto acid supplements on Chinese patients receiving maintenance hemodialysis: a prospective, randomized, controlled, single-center clinical study
Authors: Li Hai-Long , Li Hui , Cao Yi-Fu , Qi Yue , Wang Wei-Qi , Liu Shi-Qin , Yang Chen-Die , Yu Xiao-Yan , Xu Tao , Zhu Yan , Chen Wei , Tao Jian-Ling , Li Xue-Wang 
Published: December 2019

Abstract

Background:
The effects of keto acid (KA) supplements on Chinese patients receiving maintenance hemodialysis (MHD) are unclear. This study aimed to evaluate the effects of KA supplementation on nutritional status, inflammatory markers, and bioelectric impedance analysis (BIA) parameters in a cohort of Chinese patients with MHD without malnutrition.

Methods:
This was a prospective, randomized, controlled, single-center clinical study conducted in 2011 till 2014. Twenty-nine patients with MHD were randomly assigned to a control (n = 14) or a KA (n = 15) group. The control group maintained a dietary protein intake of 0.9 g/kg/day. The KA group received additional KA supplement (0.1 g/kg/day). BIA was used to determine the lean tissue mass, adipose tissue mass, and body cell mass. The patients’ nutritional status, dialysis adequacy, and biochemical parameters were assessed at the ends of the third and sixth months with t test or Wilcoxon rank-sum test.

Results:
The daily total energy intake for both groups was about 28 kcal/kg/day. After 6 months, the Kt/V (where K is the dialyzer clearance of urea, t is the dialysis time, and V is the volume of the distribution of urea) was 1.33 ± 0.25 in KA group, and 1.34 ± 0.25 in the control group. The median triceps skin-fold thickness in KA group was 12.00 and 9.00 mm in the control group. In addition, the median hand-grip strength in KA group was 21.10 and 25.65 kg in the control group. There were no significant differences between the groups with respect to the anthropometry parameters, dialysis adequacy, serum calcium and phosphorus levels, inflammatory markers, and amino-acid profiles, or in relation to the parameters determined by BIA. Both groups achieved dialysis adequacy and maintained nutritional status during the study.

Conclusions:
In this cohort of Chinese patients with MHD, the patients in the control group whose dietary protein intake was 0.9 g/kg/day and total energy intake was 28 kcal/kg/day, maintained well nutritional status during study period. The KA supplement (0.1 g/kg/day) did not improve the essential amino acid/non-essential amino acid ratio, nor did it change the patients’ mineral metabolism, inflammatory parameters, or body compositions.
Does An Augmented Reality-based Portable Navigation System Improve the Accuracy of Acetabular Component Orientation During THA? A Randomized Controlled Trial
Authors: Ogawa Hiroyuki , Kurosaka Kenji , Sato Atsuko , Hirasawa Naoyuki , Matsubara Masaaki , Tsukada Sachiyuki 
Published: December 2019

Abstract

Background
We developed an augmented reality (AR)-based portable navigation system in which the surgeon can view the pelvic plane and placement angle of an acetabular cup on the display of a smartphone during THA.

Questions/purposes
(1) Is acetabular component placement more accurate using the AR-based portable navigation system compared with the conventional freehand technique? (2) Is intraoperative measurement of placement angle more accurate when using the AR-based portable navigation system compared with a goniometer?

Methods
Forty-six patients were randomly assigned to undergo acetabular cup placement during THA using the AR-based portable navigation system (AR navigation group) or placement of a mechanical alignment guide (conventional group). All surgeries were performed with the patient in the lateral decubitus position. We compared the absolute value of the difference between the targeted placement angle and postoperative measured placement angle between the groups using two types of imaging (radiography and CT).

Results
In terms of radiographic inclination, the mean differences between the targeted placement angle and postoperative measured angle were smaller in the AR navigation group than in the conventional group for both radiographs and CT images (2.3° ± 1.4° versus 3.9° ± 2.4°, respectively; p = 0.009 and 1.9° ± 1.3° versus 3.4° ± 2.6°, respectively; p = 0.02). There were no differences in radiographic anteversion between the two groups. No complications were associated with the use of the AR-based portable navigation system.

Conclusions
This system yielded no differences in acetabular anteversion accuracy, and no clinically important differences in acetabular inclination. Therefore, at this time we cannot recommend this device as its costs and risks cannot be justified based on the absence of a clinically meaningful difference in cup placement accuracy. Although we detected no complications, this was a small series, and this approach adds both surgical time and pins in the ilium.

Level of Evidence
Level I, therapeutic study.
Breast and axillary surgery in malignant breast disease: a review focused on literature of 2018 and 2019
Authors: Ditsch Nina , Rubio Isabel T. , Gasparri Maria L. , de Boniface Jana , Kuehn Thorsten 
Published: December 2019

Purpose of review
There have been fundamental changes in the surgical approach to breast cancer management over the last decades. The primary objective of achieving locoregional control, however, remains unchanged.

Recent findings
In addition to strategies optimizing systemic treatment and radiotherapy, current discussions focus on improving the surgical approach to breast cancer. Especially in view of the increasingly pivotal role of neoadjuvant chemotherapy NAT/NAC (NACT), gauging the extent of tissue removal in the breast and the width of resection margins in breast-conserving surgery is highly important, as is the extent of axillary surgery. Although sentinel lymph node (SLN)-positive patients always underwent axillary lymph node dissection in the past, this paradigm has been challenged in recent years. Targeted axillary dissection (TAD) has emerged as a new staging option in biopsy-proven node-positive patients who convert to clinical node negativity (cN0) after NACT. TAD combines the removal of the SLN and of the target lymph node marked prior to NACT. The accuracy of axillary staging both before and after NACT plays an important role for prognostication and multidisciplinary treatment plans, while its extent has significant effects on patients’ arm morbidity and quality of life.

Summary
The current review focuses on recent evidence regarding surgical management of the breast and axilla in patients with primary breast cancer based on a PubMed and EMBASE literature search for publication years 2018 and 2019.
Prognostic and predictive markers for adjuvant therapy
Authors: Schmidt Marcus 
Published: December 2019

Purpose of review
To avoid both overtreatment and undertreatment accurate risk assessment is mandatory. The present review gives an overview of recently published articles covering prognostic and predictive factors for adjuvant therapy in early breast cancer.

Recent findings
Gene expression signatures enhance prognostic accuracy with a high level of evidence. These signatures can be further improved by incorporating traditional pathological factors like tumor size. Newer genomic techniques like next-generation sequencing lead to a deeper understanding of the relationship between somatic mutations and prognosis or prediction of therapeutic efficacy. Furthermore, circulating tumor cells, and circulating cell-free or tumor DNA can lead to a better estimation of the risk of recurrence in early breast cancer. In addition, recent results underscore the prognostic and predictive importance of tumor-infiltrating lymphocytes and subtyping of immune cell infiltrates especially in triple-negative breast cancer.

Summary
The current review highlights recent studies improving prognostication and prediction of therapeutic efficacy in early breast cancer. These advances should lead to a better risk stratification and thereby to an improved tailoring of therapies.
Optimizing immunotherapy for gynecologic cancers
Authors: Rubinstein Maria M. , Makker Vicky 
Published: December 2019

Purpose of review
This review will provide an update on the most recent clinical developments in immuno-oncology in advanced gynecologic cancers and will also highlight ongoing studies in this field.

Recent findings
Although immune checkpoint blockade (ICB) therapy is rapidly altering the treatment landscape in a myriad of solid tumors, the efficacy of ICB therapy with antibodies directed against CTLA-4, PD-1, and PD-L1 in advanced gynecologic cancers has been limited. The exception has been the PD-1 inhibitor pembrolizumab in microsatellite instability high (MSI-H) or mismatch repair-deficient (dMMR) advanced endometrial cancers, highlighted by the recent conditional approval of pembrolizumab in recurrent/metastatic PD-L1-positive cervical cancers and the accelerated approval of pembrolizumab and lenvatinib in microsatellite stable (MSS) or mismatch repair-proficient (pMMR) advanced endometrial cancer. The discovery of novel, rational ICB combinatorial approaches in advanced gynecologic cancers is highly warranted.

Summary
Recent advances in the genomic characterization of gynecologic malignancies have informed clinical trial design. However, improved molecular and immunophenotypic biomarkers to more accurately identify patients who will most benefit from immunotherapeutic approaches are urgently needed. This is especially critical as we attempt to integrate immune-oncology agents, chemotherapy, targeted therapy, and radiation therapy in the management of gynecologic cancers.
Endometrial cancer in the morbidly obese: a review
Authors: Liu Marisa C. , Gardner Austin B. , Wolford Juliet E. , Tewari Krishnansu S. 
Published: December 2019

Purpose of review
With a worldwide increase in obesity, there has been an increase in obesity-related diseases. Endometrial cancer is a common cause of cancer for women worldwide. Incidence of endometrial cancer has risen worldwide. Accompanying these patients are risk factors and challenges that may prevent standard of care from being delivered.

Recent findings
The current article describes recent literature describing surgical approaches to the obese patient and special considerations in this population. This article also reviews bariatric surgery and endometrial cancer as well as new updates in radiation, chemotherapy and hormonal therapy research in the obese population.

Summary
The current article reviews therapeutics and surgery in the morbidly obese for the treatment of endometrial cancer.
Is there a problem with respect? Risk of neochordal rupture
Authors: Bozso Sabin J. , Shan Shubham D. , Nagendran Jeevan 
Published: December 2019

Purpose of review
In this review, we summarize the history of mitral valve repair, discuss the broad principles of neochord preparation and implantation, and highlight comparative outcomes between mitral valve repair strategies while focusing on the risk of neochordal rupture.

Recent findings
There have been several recent studies comparing outcomes been leaflet-resection and nonresection, neochord-based mitral valve repair. Operative mortality was very low regardless of repair strategy; however, the rate of mitral valve reoperation is lower in those that undergo a neochord-based repair with overall lower mean mitral gradients postrepair. The introduction of minimally invasive approaches to mitral valve repair has preferentially favored an increase in neochord-based repair, given the technical simplicity compared with resection-based approaches. In very rare cases, neochord rupture can occur, likely secondary to a combination of chordal calcification and mechanical stress.

Summary
The method of performing mitral valve repair with neochord implantation has demonstrated superior durability over leaflet resection approaches with equivalent operative outcomes. Although the risk of neochord rupture exists, it is exceedingly rare, and should not be considered a limitation to a neochord-based mitral valve repair. Recurrent mitral regurgitation secondary to neochord rupture is incredibly rare; however, regular echocardiographic evaluation of these patients appears warranted, especially when follow-up extends over 10 years.
Predicting Reduced Tinnitus Burden After Cochlear Implantation in Adults
Authors: Dixon Peter R. , Crowson Matthew , Shipp David , Smilsky Kari , Lin Vincent Y. , Le Trung , Chen Joseph M. 
Published: December 2019

Objective:
Explore patient characteristics associated with tinnitus improvement after cochlear implantation.

Study Design:
Retrospective cohort.

Setting:
Tertiary referral.

Patients:
Adults with bilateral severe-to-profound hearing loss and tinnitus.

Interventions:
Unilateral cochlear implantation.

Results:
From 1996 to 2018, 358 patients endorsed pre-implant tinnitus and had ascertainable tinnitus status at 1-year. Clinically significant improvement in Tinnitus Handicap Inventory (THI) (reduction by at least 7-points) was observed in 262 (73.2%) patients, of whom 155 (59.2%) reported complete resolution. Of the 24 characteristics explored, four were identified as independent predictors of improved tinnitus in logistic regression models. In a multivariable model including identified independent predictors, each 10-percentage point increase in baseline hearing in noise test was associated with an 14% reduction in odds of tinnitus resolution or clinically significant improvement (odds ratio [OR] 0.86, 95% confidence limits [CL] 0.77, 0.96) and preoperative use of a hearing aid in the contralateral ear was associated with a 72% reduction (OR 0.28; 95% CL 0.11, 0.73). Each 10-point increase in baseline Hearing Handicap Inventory for Adults (HHI) score was associated with a 28% increase in odds of tinnitus improvement (OR 1.28; 95% CL 1.07, 1.54). Higher baseline burden of tinnitus was associated with higher odds of tinnitus improvement (OR 1.21 per 10-point THI increase, 95% CL 1.04, 1.40).

Conclusions:
Worse residual hearing and higher baseline hearing and tinnitus handicap are associated with higher odds of tinnitus improvement. Expectations of patients seeking reduced tinnitus burden following cochlear implantation should be managed by counselling regarding odds of tinnitus improvement compared to those with similar residual hearing and tinnitus burden.
Systematic Review of Pathogenic GJB2 Variants in the Latino Population
Authors: Bouzaher Malek H. , Worden Cameron P. , Jeyakumar Anita 
Published: December 2019

Objectives:
Define the extent to which GJB2-related hearing loss is responsible for non-syndromic hearing loss (NSHL) in the Latino population.

Methods:
Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PubMed and MEDLINE were accessed from 1966 to 2019 using permutations of the MeSH terms: “Hearing Loss,” “Hearing Impairment,” “Deafness,” “Latin American,” “Latino,” “GJB2,” and “Genetic.” Additionally, countries designated as Latino by the US Office of Management and Bureau were cross-referenced as key terms against the aforementioned search criteria. Exclusion criteria included non-English publications, a non-Latino study population, and literature not investigating GJB2. An allele frequency analysis of pathogenic GJB2 variants in the Latino population was performed and stratified by country of origin and reported ethnicity.

Results:
One hundred twenty two unique studies were identified of which 64 met our inclusion criteria. Forty three studies were included in the GJB2 systematic review. A total of 38 pathogenic GJB2 variants were identified across 20 countries in the Latino population. The prevalence of pathogenic GJB2 variants varied by country; however, were generally uncommon with the exception of c.35delG (p.Gly12Valfs∗) which displayed an allele frequency of 3.1% in the combined Latino population; ranging from 21% in Colombia to 0% in Guatemala.

Conclusion:
Variation in the prevalence of pathogenic GJB2 variants by country likely reflect the heterogeneous nature of ethnic ancestral contributions to the Latino population. Additional research utilizing next generation sequencing might aid in the development of assays for high throughput diagnosis of inherited hearing loss in the multitude of ethnic sub-groups that comprise this and other traditionally marginalized populations.