bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare Utilization and Out-of-Pocket Expenditures Associated with Depression in Adults: A Cross-Sectional Analysis in Nepal
Authors: Rajan Selina , Rathod Sujit D , Luitel Nagendra P , Murphy Adrianna , Roberts Tessa , Jord Mark JD 
Published: February 2020

Abstract
Background:
Despite attempts to improve universal healthcare coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression.
Aims:
We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal.
Methods:
We analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We examined associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared utilization of specific outpatient service providers and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more.
Results:
We classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7%-22%, p<0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p<0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD).
Conclusions:
In this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Future studies should evaluate whether provision of mental health services as an integrated component of UHC can improve overall health and reduce healthcare utilisation and expenditure, thereby alleviating financial pressures on families.
Community-level socioeconomic inequality in the incidence of ischemic heart disease: a nationwide cohort study
Authors: Gwon Jun Gyo , Choi Jimi , Han Young Jin 
Published: February 2020

Abstract
Background
The purpose of this study was to confirm that inequalities in community-level social economic status (SES) do actually impact the incidence of ischemic heart disease (IHD) using the Korean population-based cohort study of the National Health Insurance Service–National Sample Cohort (NHIS-NSC) database.
Methods
This study used the NHIS-NSC database, a population-based cohort database established by the NHIS in South Korea. Community-level SES was classified into three categories, i.e. low, moderate, and high, according to the rank. The outcome measure of interest was IHD, which was defined according to the International Classification of Disease, 10th Revision (ICD-10) codes.
Results
In the low community-level SES group, the incidence of IHD was 3.56 per 1,000 person years (cumulative incidence rate, 1.78%), and in the high community level SES group, it was 3.13 per 1,000 person years (cumulative incidence rate, 1.57%). Multivariate analysis showed that the incidence of IHD was higher in the low community-level SES group (p=0.029). The log-rank test showed that the cumulative incidence of IHD was higher in the low community level SES group than the high community-level SES group (adjusted hazard ratio, 1.16; 95% CI, 1.01-1.32)
Conclusions
People living in areas with low community-level SES show an increased incidence of IHD. Therefore, intervention in active, health-risk behavior corrections at the local level will be required to reduce the incidence of IHD.
Modular stem in total hip arthroplasty for patients with trochanter valgus deformity: surgical technique and case series
Authors: Kong Xiangpeng , Chai Wei , Yang Minzhi , Ong Alvin , Chen Jiying , Wang Yan , Zhou Yonggang 
Published: February 2020

Abstract
Background: Trochanter valgus deformity (TVD) is a rare condition of total hip arthroplasty (THA). Femoral osteotomy could be required in correcting the deformity to implant femoral stem in severe TVD. In this study, we described one unpublished technique of reverse sleeve of S-ROM to get through the complex situation. This study aimed to summarize and evaluate its technical challenges, safety and effectiveness.Methods: From January 2006 to December 2014, we enrolled patients whose sleeves were implanted towards the great trochanter in THA with TVD. Their demographics, perioperative and postoperative information were recorded. To explore its indication, we measured and analyzed the ratio of greater trochanter/lesser trochanter (G/L ratio) and trochanter valgus angle (TVA).Results: Twelve patients (1 male and 11 female, average age 42.30±10.23) had mean follow-up of 6 years. Among them, only two patients had intraoperative femoral fracture. The survivorship of femoral prosthesis was 100%. The Harris hip score (HHS) increased from preoperative 34.31±14.43 to postoperative 84.12±11.33. All patients’ G/L ratio were larger than 1.50.Conclusions: The reverse sleeve of S-ROM was a reliable method for the patients with severe TVD, which brought satisfying clinical outcomes in mid-term follow-up.Keywords: cementless modular stem; reverse sleeve; total hip arthroplasty; trochanter valgus deformity.
Different profiles of body mass index variation among patients with multidrug-resistant tuberculosis: a retrospective cohort study.
Authors: Diallo Alhassane , Diallo Boubacar Djelo , Camara Lansana Mady , Kounoudji Lucrèce Ahouéfa Nadège , Bah Boubacar , N’Zabintawali Fulgence , Carlos-Bolumbu Miguel , Diallo Mamadou Hassimiou , Sow Oumou Younoussa 
Published: February 2020

Abstract
Background: Despite the predictive role of body weight variation in treatment outcome in multidrug-resistant tuberculosis (MDR-TB), few corroborating data are available. We studied weight variation in patients with MDR-TB to identify groups of weight change and to determine factors that influence these changes. Methods: We analyzed patients with rifampicin resistance who were treated with an MDR-TB treatment regimen between June 07, 2016 and June 22, 2018 at three major drug-resistant TB centers in Guinea. Patients were seen monthly until the end of treatment. Clinical outcome was the body mass index (BMI). We used a linear mixed model to analyze trajectories of BMI and a latent class mixed model to identify groups of BMI trajectories. Results: Of 232 patients treated for MDR-TB during the study period, 165 were analyzed. These patients had a total of 1387 visits, with a median of 5 visits (interquartile range, 3 – 8 visits). Monthly BMI increase was 0.24 (SE 0.02) per kg/m 2 . Factors associated with faster BMI progression were success of MDR-TB treatment (0.24 [SE 0.09] per kg/m 2 ; p = 0.0205) and absence of lung cavities on X-ray (0.18 [0.06] per kg/m 2 ; p = 0.0068). Two groups of BMI change were identified: rapid BMI increase (n = 121; 85%) and slow BMI increase (n = 22; 15%). Patients in the slow BMI increase group were mostly female (68%) had no history of TB treatment (41%), had a positive HIV infection (59%), and had a more severe clinical condition at baseline, characterized by a higher frequency of symptoms including depression (18%), dyspnea (68%), poor adherence to MDR-TB treatment (64%), lower platelet count, and higher SGOT. These patients also had a longer time to initial culture conversion (log-rank test: p = 0.0087). Conclusion: Quantitative BMI data on patients with MDR-TB treated with a short regimen allowed the identification of subgroups of patients with different trajectories of BMI and emphasized the usefulness of BMI as a biomarker for the monitoring of MDR-TB treatment outcome.
Milk exosome-derived miRNAs from water buffalo are implicated in immune response and metabolism process
Authors: Chen Zujing , Xie Yueqin , Luo Junyi , Chen Ting , Xi Qianyun , Zhang Yongliang , SUN JIAJIE 
Published: February 2020

Abstract
Background: Buffalo milk is rich in various nutritional components and bioactive substances that provide more essential health benefits to human body. Recently, exosome identified in the breast milk has been reported as a neotype nutrient and can mediate intercellular communication with exosomal miRNAs. In the present study, we therefore hypothesized that exosome-derived miRNAs from buffalo milk would play the potential physiological importance of consumption of buffalo milk.Results: We isolated exosomes from buffalo and cow milk samples that were obtained at mid-lactation period, and the exosomal miRNA profiles were then generated using miRNA-seq. In addition, miRNAomes of pig, human and panda milk exosomes were downloaded from GEO database. Finally, a total of 27 milk exosomal miRNA profiles that included 4 buffalo, 4 cow, 8 pig, 4 human and 7 panda were analyzed using the miRDeep2 program. A total of 558 unique miRNA candidates existed across all species, and the top 10 highly expressed miRNA were evolutionarily conserved across multiple species. Functional analysis revealed that these milk enriched miRNAs targeted 400 putative sites to modulate disease resistance, immune responsiveness and basic metabolism events. In addition, a total of 32 miRNAs in buffalo milk were significantly up-regulated compared with non-buffalo milks, while 16 were significantly down-regulated. Of interest, functional analysis showed that up-regulated miRNA were mainly related to host metabolism processes, while the predicted functions of down-regulated miRNAs were enriched in immune response.Conclusion: In this study, we explored the exosomal miRNAome differences between milks of different animals, expanding the theoretical basis for potential applications of the miRNA-containing vesicles.
Longitudinal assessment of antibiotic resistance gene profiles in gut microbiomes of infants at risk of eczema
Authors: Loo Evelyn , Zain Amanda , Yap Gaik Chin , Purbojati Rikky W , Drautz-Moses Daniela I , koh Yan Qing , Chong Yap Seng , Tan Kok Hian , Gluckman Peter D , Yap Fabian , Eriksson Johan Gunnar , Tham Elizabeth , shek lynette , kjelleberg Staffan , Schuster Stephan C , Banerjee Ritu , Lee Bee Wah 
Published: February 2020

Abstract
Background While there is increasing knowledge about the gut microbiome, the factors influencing and the significance of the gut resistome are still not well understood. Infant gut commensals risk transferring multidrug-resistant antibiotic resistance genes (ARGs) to pathogenic bacteria. The rapid spread of multidrug-resistant pathogenic bacteria is a worldwide public health concern. Better understanding the naïve infant gut resistome may build the evidence base for antimicrobial stewardship in both humans and in the food industry. Given the high carriage rate of extended spectrum beta-lactamase (ESBL)- producing Enterobacteriaceae in Asia, we aimed to evaluate community prevalence, dynamics, and longitudinal changes in antibiotic resistance gene (ARG) profiles and prevalence of ESBL-producing .E coli and K. pneumoniae in the intestinal microbiome of infants participating in the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study, a longitudinal cohort study of pregnant women and their infants. Methods We analysed ARGs in the first year of life among 75 infants who had stool samples collected at multiple timepoints using metagenomics. Results The mean number of ARGs per infant increased with age. The most common ARGs identified confer resistance to aminoglycoside, beta-lactam, macrolide and tetracycline antibiotics; all infants harboured these antibiotic resistance genes at some point in the first year of life. Few ARGs persisted throughout the first year of life. Beta-lactam resistant Escherichia coli and Klebsiella pneumoniae were detected in 4 (5.3%) and 32 (42.7%) of subjects respectively. Conclusion In this longitudinal cohort study of infants living in a region with high endemic antibacterial resistance, we demonstrate that the majority of the infants harboured several antibiotic resistance genes in their gut and showed that the infant gut resistome is diverse and dynamic over the first year of life.
MiR-423-5p may regulate ovarian response to ovulation induction via CSF1
Authors: Xie Shi , Zhang Qiong , Zhao Jing , Hao Jie , Fu Jing , Li Yanping 
Published: February 2020

Abstract
Background
We have previously shown that hsa-miR-423-5p expression in ovarian granulosa cells is decreased in high ovarian response populations. The objective of the present study was to find the target gene and mechanism for miR-423-5p involved in ovarian response regulation.
Methods
(a) TargetScan was used to predict the target gene of hsa-miR-423-5p. (b) A model for hsa-miR-423-5p overexpression or inhibition was constructed by transfecting KGN cells with lentivirus. CSF1 mRNA and protein expression and luciferase activity were measured. (c) The cell cycles of control and lentivirus treated KGN cells were analyzed. Western blot was used to measure the expression of CDKN1A in KGN cells. (d) The concentration of estradiol in KGN cell culture medium were measured.
Results
(a) TargetScan revealed that the 3′ un-translated region of CSF1 matched 11 bases at the 5′ end of miR-423-5p, making it a likely target gene. (b) Overexpression or inhibition of miR-423-5p were associated with respective decreases or increases in CSF1 expression (both mRNA and protein) (p < 0.05) and luciferase activity (p < 0.05). (c) When miR-423-5p expression increased, the number of G0/G1 phase cells and the expression of CDKN1A protein increased while estradiol concentrations in the cell culture solution decreased (p<0.05). However, when miR-423-5p expression decreased, the number of S phase cells increased and estradiol concentrations increased while the expression of CDKN1A protein decreased (p < 0.05).
Conclusions
Colony stimulating factor 1 is a target gene of miR-423-5p and that it may regulate ovarian response to ovulation induction by affecting granulosa cells proliferation and estrogen secretion.
Oxidative stress and gut-derived lipopolysaccharides in children affected by Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.
Authors: Loffredo Lorenzo , Spalice Alberto , Salvatori Francesca , Giovanna De Castro , Guido Cristiana Alessia , Zicari Anna Maria , Ciacci Paolo , Battaglia Simona , Brindisi Giulia , Ettorre Evaristo , Nocella Cristina , Salvatori Guglielmo , Duse Marzia , Violi Francesco , Carnevale Roberto 
Published: February 2020

Abstract
Background: pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections syndrome (PANDAS) identifies patients with acute onset of obsessive-compulsive and tic disorders. The objective of this study was to assess NOX2 levels, as well as serum 8-iso-prostaglandin F2α (iso-PGF2α) and lipopolysaccharide (LPS) derived from Gram-negative bacteria in the gut of patients with PANDAS. Methods: a cross sectional study was performed to compare serum levels of soluble NOX-2-dp (sNOX-2-dp), isoprostanes and LPS in 60 consecutive subjects, including 30 children affected by PANDAS and 30 controls (CT) matched for age and gender. Serum zonulin was used to assess gut permeability. Results: compared with CT, PANDAS children had higher values of sNOX-2-dp, 8-iso-PGF2-alpha and LPS. Simple linear regression analysis showed that sNOX2-dp was signiﬁcantly correlated with serum LPS (Rs=0.359; p=0.005), zonulin (Rs=0.444; p<0.001) and iso-PGF2α (Rs=0.704; p<0.001). LPS signiﬁcantly correlated with serum zonulin (Rs=0.610; p<0.001), and iso-PGF2α (Rs=0.591; p=0.001). A multiple linear regression analysis was performed to define the independent predictors of sNOX-2-dp. Isoprostanes and zonulin emerged as the only independent predictive variables associated with sNOX2-dp (R2=68%). Conclusion: this study provides evidences that children affected by PANDAS have high circulating levels of sNOX2-dp, isoprostanes and of LPS that could be potentially implicated in the process of neuroinflammation.
Continuous Renal Replacement Therapy in patients with HIV/AIDS
Authors: Guo Hebing , Liu Jingyuan , Pu Lin , Hao Jingjing , Yin Ningning , Liu Yufeng , Xiong Haofeng , Li Ang 
Published: February 2020

Abstract
Background :AKI is a common complication among human immunodeficiency virus (HIV)--infecting patients and resulting in increased morbidity and mortality. CRRT is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in ICU and explore the influence factors correlated with CRRT and prognosis.Methods: We performed a retrospective case-control study, in ICU of Beijing Ditan Hospital Capital Medical University, which is a top three hospital majoring in infectious diseases. From June 1,2005 to May 31,2017, 225 cases were enrolled in this research eventually.Results: 122(54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1/2/3 were respectively 38(31.1%)/23(18.9%)/61(50%). 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By multivariate logistics analysis, it showed that the use of vasoactive agents (OR=174.31,95% CI 1.743-65.271, p=0.018), diagnosis of PCP(OR=27.136,95% CI 1.855-397.066, p=0.016) and longer duration of CRRT (OR=1.034,95% CI 1.004-1.065, p=0.028) were independent risk factors for predicting patients’ death of CRRT in ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p =0.309).Conclusions: The incidence of AKI was 54.2% in HIV-infected patients admitted to the ICU, and about 26.2% AKI patients received CRRT during the stay of ICU.56.25%CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. The use of vasoactive agents, diagnosis of PCP were independent risk factors for predicting patients’ death of CRRT in ICU. The cumulative survival of AKI 3 patients between CRRT and non-CRRT groups shows no significant differences.
Association of ABO Polymorphisms and Pancreatic Cancer/ Cardiocerebrovascular Disease: a Meta-analysis.
Authors: Li Yanxia , Liu Luyang , Huang Yubei , Zheng Hong , Li Lian 
Published: February 2020

Abstract
Background: ABO gene polymorphisms have been reported to be associated with the risk of multiple cancers and cardiocerebrovascular disease s. However, the results remained controversial. In this study, we conducted a systematic review and meta-analysis to clarify the association between two SNPs (rs505922 and rs657152) in ABO gene and cancers/ cardiocerebrovascular disease s.
Method: All eligible case-control studies come from PubMed, Embase and Web of Science up to Jan. 1, 2019. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the corresponding associations. Sensitivity analysis, publication bias assessment, and heterogeneity test were performed using STATA 12.0.
Results : A total of nineteen articles involving twenty-two case-control populations were included according to inclusion and exclusion criteria. Twelve populations (20,820 cases and 27,837 controls) were used to evaluate the relationship between rs505922 and overall cancers and nine populations (22,275 cases and 71,549 controls) were included to assess the association between rs505922 and cardiocerebrovascular diseases. The results showed a significant association between the rs505922 polymorphism and cancers (CvsT: OR=1.13, 95%CI=1.05-1.22, P =0.001), and cardiocerebrovascular diseases (OR=1.36, 95%CI=1.19-1.57, P <0.001). Five populations (8,660 cases and 10,618 controls) were included to evaluate association between rs657152 and cancers and five populations (8,105 cases and 6,712 controls) were included to estimate the relationship between rs657152 and cardiocerebrovascular diseases. The result of meta-analysis reveals that rs657152 was significantly associated with cancers (OR=1.18, 95%CI=1.13-1.23, P <0.001) and cardiocerebrovascular diseases (OR=1.54, 95%CI=1.24-1.92, P <0.001).
Conclusion: Our study suggested that ABO polymorphisms might serve as a risk factor of pancreatic cancers and cardiocerebrovascular diseases.
Hypoxia promotes tenocyte differentiation of mesenchymal stem cells
Authors: Chen Guanyin , zhang wangqian , Gu Jintao , Gao Yuan , He Lei , wang shuning , Li Weina , Zhang Cun , Li Meng , Zhang Wei , Hao Qiang , Zhang Yingqi 
Published: February 2020

Abstract
Background: Tendon injury is a common but tough medical problem. Unsatisfactory clinical results have been reported in tendon repair using mesenchymal stem cells (MSCs) therapy, creating a need for a better strategy to induce MSCs to tenogenic differentiation. This study was designed to investigate the role of hypoxia in the tenogenic differentiation of MSCs in vitro and in vivo and to compare the tenogenic differentiation capacities of different MSCs under hypoxia condition in vitro. Methods: Adipose tissue-derived MSCs (AMSCs) and bone marrow-derived MSCs (BMSCs) were isolated and characterized by the expression of MSC-specific markers and tri-lineage differentiation. The expression of hypoxia induced factor-1 alpha (Hif-1α) and the proliferation of AMSCs and BMSCs were examined in order to confirm the establishment of hypoxia condition. qRT-PCR, western blot, and immunofluorescence staining were used to evaluate the expression of tendon-associated marker Col-1a1, Col-3a1, Dcn, and Tnmd in AMSCs and BMSCs under hypoxia and/or Tgf-β1 condition. In vivo, a patellar tendon injury model was established. Normoxic and hypoxic BMSCs were cultured and implanted. Histological, biomechanical and transmission electron microscopy analyses were performed to assess the improved healing effect of hypoxic BMSCs on tendon injury. Results: Hypoxia remarkably increased the expression of Hif-1α and the proliferation of AMSCs and BMSCs. Our in vitro results detected that hypoxia not only promoted a significant increase in tenogenic markers in both AMSCs and BMSCs compared with the normoxia group, but also showed higher inductility compared with Tgf-β1. In addition, hypoxic BMSCs exhibited higher potential of tenogenic differentiation than hypoxic AMSCs. Our in vivo results demonstrated that hypoxic BMSCs possessed better histological and biomechanical properties than those of normoxic BMSCs, as evidenced by histological scores, quantitative analysis of immunohistochemical staining for Col-1a1 and Tnmd, the range and average of collagen fibril diameters and patellar tendon biomechanical tests. Conclusions: These findings suggested that hypoxia may be a practical and reliable strategy to induce tenogenic differentiation of BMSCs for tendon repair and could enhance the effectiveness of MSCs therapy in treating tendon injury.