bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparative study of patients’ satisfaction in different levels of hospitals in Beijing: Why do patients prefer high-level hospitals?
Authors: Cui Chengsen , Zuo Xu , Wang Yujia , Song Haiyan , Shi Jingyu , Meng Kai 
Published: February 2020

Abstract
Background: In order to promote integration of medical resources, Beijing built medical alliances since 2012, but this reform did not change the state of disordered medical treatment. Patients are still willing to go to high-level hospitals for medical treatment. What causes patients to prefer high-level hospitals? In order to explore the reasons for the high-level medical treatment behavior of patients and guide patients to visits orderly, we conducted the study and compared the patients' satisfaction in different level hospitals under the background of the medical resource integration.
Methods: This study conducted a questionnaire survey among 1,250 patients who were selected in 18 medical alliances in Beijing from October to December 2016. The study type is a comparative study based on cross-sectional data. The patients’ satisfaction was the main outcome, descriptive analysis, a chi-square test, a nonparametric test and binary logistic regression analysis were used. The level of statistical significance was set at p<0.05.
Results: The overall satisfaction score of the medical alliances is 3.375, and the satisfaction score of core hospitals and cooperative hospitals is 2.77 and 3.07. The overall patient satisfaction rate is 44.62%, and the satisfaction rate of core hospitals and cooperative hospitals is 34.34% and 50.43%. The type of hospital and understanding of medical alliance policy are the associated factors of the patients’ satisfaction with the medical alliance.
Conclusions: The patients’ satisfaction of cooperative hospitals was higher than that of core hospitals. Although the patients are more satisfied with the service attitude of the cooperative hospitals, they still prefer core hospitals due to their higher expectation for medical treatment and greater trust in the medical technology of the core hospitals. It is necessary to explore the establishment of the closed medical alliances under the unified management of human and financial resources, to promote medical alliances to become a community of common interests and provide integrated medical services for patients.
The mutational spectrum of Hunter syndrome reveals correlation between biochemical and clinical profiles in Tunisian patients
Authors: chkioua latifa , Grissa Oussama , Leban Nadia , Gribaa Moez , Boudabous Hela , Turkia Hadhami Ben , Ferchichi Salima , Tebib Neji , Laradi Sandrine 
Published: February 2020

Abstract

Background: Mucopolysaccharidosis type II (MPS II) or Hunter syndrome is an X-linked recessive lysosomal storage disorder resulting from deficient activity of iduronate 2-sulfatase (IDS) and the progressive lysosomal accumulation of sulfated glycosaminoglycans (GAGs). Methods: A diagnosis of MPS II or Hunter syndrome was performed based on the following approach after a clinical and paraclinical suspicion. Two biochemical and molecular tests were carried out separately and according to the availability of the biological material. Results: All patients in this cohort presented the most common MPS II clinical features. Electrophoresis of GAGs on a cellulose acetate plate in the presence of a high concentration of heparane sulfate showed an abnormal dermatan sulfate band in the patients compared with that in a control case. Furthermore, leukocyte IDS activity ranged from 0.00 to 0.75 nmol/h/mg of leukocyte protein in patients. Five previously reported mutations were identified in this study patients: one splice site mutation, c.240+1G>A; two missense mutations, p.R88P and p.G94D; a large deletion of exon 1 to exon 7; and one nonsense mutation, p.Q396*. In addition, two novel alterations were identified in the MPS II patients: one frame shift mutation, p.D450Nfs*95 and one nonsense mutation, p.Q204*. Additionally, five known IDS polymorphisms were identified in the patients: IVS3-16 (c.419-16 delT), p.T214M (c.641C>T), p.T146T (c.438 C>T), IVS5-87 (c.709-87G>A), and IVS7+38 (c.1006+38T>C). Conclusions: The high level of urine GAGs and the deficiency of iduronate 2-sulfatase activity was associated with the phenotype expression of Hunter syndrome. Molecular testing was useful for the patients’ phenotypic classification and the detection of carriers.
Dilation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and Stone Extraction in Patients with Secondary Choledocholithiasis
Authors: Yang Xiao-Bin , Xu An-Shu , Li Jian-Gang , Xu Yong-Ping , Xu De-Song , Fu Chao-Chun , Deng Da-Bo , Li Jie , Zhang Ma-Zhong 
Published: February 2020

Abstract
Background: Many options exist for the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made to ensure minimally invasive or noninvasive management of the common bile duct (CBD). For this purpose, we modified the surgical modality, exploring the use of laparoscopic transcystic dilation of the cystic duct confluence in CBD exploration (LTD-CBDE). Based on our preliminary experience, we can use this technique to resolve patients with secondary common bile duct stones, and the effect is better than placing T tubes.Methods: Sixty-eight patients were randomly offered the new LTD-CBDE technique from December 2015 to April 2018. During the surgery, we dilated the cystic duct confluence with separation forceps and/or a columnar dilation balloon. Subsequently, CBD exploration and stone extraction were performed with a choledochoscope. The entrance of the CBD was covered with a cystic duct stump wall and was subjected to primary closure at the end of surgery.Results: Forty-nine females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 year). Of these patients, 62 (91.2%) were successfully treated with the LTD-CBDE technique, and bile leakage was observed in 3 patients (4.4%). The mean operation time was 106 minutes, and the mean hospital stay was 5.9 days. Among the other 6 patients, 3 were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at Calot’s triangle (n=2) or Mirizze syndrome (n=1); LCBDE was performed in 3 patients due to cystic duct atresia (n=2) and low level of flow from the gallbladder duct into the CBD (n=1). These patients had a smooth postoperative course. In total, 43/68 of the patients presented no radiological evidence of retained CBD stones at the postoperative follow-up (40 patients treated with LTD-CBDE) one year later.Conclusions: The current work suggests that LTD-CBDE for the management of cholelithiasis and secondary choledocholithiasis is a feasible, safe and effective technique with a low complication rate. LTD-CBDE offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled studies are needed to demonstrate its efficacy, safety, and impact on CBD stenosis.
Disentangling the mechanisms shaping the surface ocean microbiota
Authors: Logares Ramiro , Deutschmann Ina M. , Junger Pedro C. , Giner Caterina R. , Krabberød Anders K. , Schmidt Thomas S.B. , Rubinat-Ripoll Laura , Mestre Mireia , Salazar Guillem , Ruiz-González Clara , Sebastián Marta , de Vargas Colomban , Acinas Silvia G. , Duarte Carlos M. , Gasol Josep M. , Massana Ramon 
Published: February 2020

Abstract

Background The ocean microbiota modulates global biogeochemical cycles and changes in its configuration may have largescale consequences. Yet, the underlying ecological mechanisms structuring it are unclear. Here we investigate how fundamental ecological mechanisms ( selection , dispersal and ecological drift ) shape the smallest members of the tropical and subtropical surface-ocean microbiota: prokaryotes and minute eukaryotes (picoeukaryotes). Furthermore, we investigate the agents exerting abiotic selection on this assemblage as well as the spatial patterns emerging from the action of ecological mechanisms. To explore the previous, we analysed the composition of surface-ocean prokaryotic and picoeukaryotic communities using DNA-sequence data (16S- and 18S-rRNA genes) collected during the circumglobal expeditions Malaspina-2010 and TARA-Oceans . Results We found that the two main components of the tropical and subtropical surface-ocean microbiota, prokaryotes and picoeukaryotes, appear to be structured by different ecological mechanisms. Picoeukaryotic communities were predominantly structured by dispersal-limitation, while prokaryotic counterparts appeared to be shaped by the combined action of dispersal-limitation, selection and drift. Temperature-driven selection appeared as a major factor, out of a few selected factors, influencing species co-occurrence networks in prokaryotes but not in picoeukaryotes, indicating that association patterns may contribute to understand ocean microbiota structure and response to selection. Other measured abiotic variables seemed to have limited selective effects on community structure in the tropical and subtropical ocean. Picoeukaryotes displayed a higher spatial differentiation between communities and a higher distance decay when compared to prokaryotes, consistent with a scenario of higher dispersal limitation in the former after considering environmental heterogeneity. Lastly, random dynamics or drift seemed to have a more important role in structuring prokaryotic communities than picoeukaryotic counterparts. Conclusions The differential action of ecological mechanisms seems to cause contrasting biogeography, in the tropical and subtropical ocean, among the smallest surface plankton, prokaryotes and picoeukaryotes. This suggests that the idiosyncrasy of the main constituents of the ocean microbiota should be considered in order to understand its current and future configuration, which is especially relevant in a context of global change, where the reaction of surface ocean plankton to temperature increase is still unclear.
The relationship between symptom burden and systemic inflammation differs between male and female athletes following concussion.
Authors: Battista Alex P Di , Churchill Nathan , Rhind Shawn G. , Richards Doug , Hutchison Michael G. 
Published: February 2020

Abstract
Background: Inflammation appears to be an important component of concussion pathophysiology. However, its relationship to symptom burden is unclear. Therefore, the purpose of this study was to evaluate the relationship between symptoms and inflammatory biomarkers measured in the blood of male and female athletes following sport-related concussion (SRC). Results Forty athletes (n = 20 male, n = 20 female) from nine interuniversity sport teams at a single institution provided blood samples within one week of an SRC. Twenty inflammatory biomarkers were quantitated by immunoassay. The Sport Concussion Assessment Tool version 5 (SCAT-5) was used to evaluate symptoms. Partial least squares (PLS) analyses were used to evaluate the relationship(s) between biomarkers and symptoms. In males, a positive correlation between interferon (IFN)- and symptom severity was observed following SRC. The relationship between IFN- and symptoms was significant among all symptom clusters, with cognitive symptoms displaying the largest effect. In females, a significant negative relationship was observed between symptom severity and cytokines IFN-, tumor necrosis factor (TNF)-, and myeloperoxidase (MPO); a positive relationship was observed between symptom severity and MCP-4. Inflammatory mediators were significantly associated with all symptom clusters in females; the somatic symptom cluster displayed the largest effect. Conclusion: These results provide supportive evidence for a divergent relationship between inflammation and symptom burden in male and female athletes following SRC. Future investigations in SRC should be cognizant of the potentially sex-specific pathophysiology underlying symptom presentation.
Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar
Authors: Miller Ann , Garchitorena Andres , Rabemananjara Faramalala , Cordier Laura , Randriamanambintsoa Marius , Rabeza Victor , Razanadrakoto Hery-Tiana Rahaniraka , Ramakasoa Ranaivozafindary Rakoto , Ratsimbazafy Baolova Nathaline , Ouenzar Mohammed Ali , Bonds Matthew H. , Ratsifandrihamanana Lisy 
Published: February 2020

Abstract
Background: 50% of Malagasy children have moderate to severe stunting. In 2016, a new 10-year National Nutrition Action Plan (PNAN III) was initiated to help address stunting and developmental delay. We report factors associated with risk of developmental delay in 3 and 4 year olds in the rural district of Ifanadiana in southeastern Madagascar in 2016.
Methods: The data are from a cross-sectional analysis of the 2016 wave of IHOPE panel data (a population-representative cohort study begun in 2014). We interviewed women ages 15-49 using the MICS Early Child Development Indicator (ECDI) module, which includes questions for physical, socio-emotional, learning and literacy/numeracy domains. We analyzed ECDI data using standardized z scores for relative relationships for 2 outcomes: at-risk-for-delay vs. an international standard, and lower-development-than-peers if ECDI z scores were >1 standard deviation below study mean. Covariates included demographics, adult involvement, household environment, and selected child health factors. Variables significant at alpha of 0.1 were included a multivariable model; final models used backward stepwise regression, clustered at the sampling level.
Results: Of 432 children ages 3 and 4 years, 173 (40%) were at risk for delay compared to international norms and 68 children (16.0%) had lower-development than peers. This was driven mostly by the literacy/numeracy domain, with only 7% of children considered developmentally on track in that domain. 50.5% of children had moderate to severe stunting. 76 (17.6%) had >=4 stimulation activities in past 3 days.

Greater paternal engagement (OR 1.59(1.13, 2.21)) was associated with increased delay vs. international norms. Adolescent motherhood (OR3.89 (1.32, 11.48)) decreased children’s development vs. peers. Engagement from a non-parental adult reduced odds of delay for both outcomes (OR(95%CI =0.76 (0.61, 0.93) & 0.28(0.16, 0.50) respectively). Stunting was not associated with delay risk (1.33 (0.83, 2.14) or low development (0.91(0.47, 1.74)) when controlling for other factors.
Conclusions: In this setting of high child malnutrition, stunting is not independently associated with developmental risk. A low proportion of children receive developmentally supportive stimulation from adults, but non-parent adults provide more stimulation in general than either mother or father. Stimulation from non-parent adults is associated with lower odds of delay
Health care use and treatment-seeking for depression symptoms in rural India: An exploratory cross-sectional analysis
Authors: Roberts Tessa Naomi , Shidhaye Rahul , Patel Vikram , Rathod Sujit D 
Published: February 2020

Abstract
Background There is a large “treatment gap” for depression worldwide. This study aimed to better understand the treatment gap in rural India by describing health care use and treatment-seeking for depression. Methods Data were analysed from a two round cross-sectional community survey carried out in rural Madhya Pradesh between May 2013 and December 2016. We examined the proportion of individuals who screened positive for depression (≥10) on the Patient Health Questionnaire (PHQ-9) who sought treatment in different sectors, for depression symptoms and for any reason, and compared the latter with health service use by screen-negative individuals. We analysed the frequency with which barriers to healthcare utilisation were reported by screen-positive adults. We also analysed the association between seeking treatment for depression and various predisposing, enabling and need factors. Results 86% of screen-positive adults reported seeking no depression treatment. However, 66% had used health services for any reason in the past 3 months, compared to 46% of screen-negative individuals (p<0.0001). Private providers were most frequently consulted by screen-positive adults (32%), while only 19% consulted traditional providers. Structural barriers to healthcare use such as cost and distance to services were frequently reported (54% and 52%, respectively) but were not associated with treatment-seeking for depression. The following factors were found to be positively associated with treatment-seeking for depression: higher symptom severity; reporting lack of energy, lack of interest/pleasure, low self-esteem, or slow movements/restlessness on more than 7 days in the past 2 weeks; being married; having discussed depression symptoms; and reporting problems with medication availability and supply as a barrier to healthcare. No evidence was found for an association between treatment-seeking for depression and most socio-economic, demographic or attitudinal factors. Conclusions These findings suggest that the majority of adults who screen positive for depression seek healthcare, although not primarily for depression symptoms, indicating the need to improve detection of depression during consultations about other complaints. Private providers may need to be considered in programmes to improve depression treatment in this setting. Further research should test the hypotheses generated in this descriptive study, such as the potential protective role of marriage in facilitating treatment-seeking.
Risk Factors of Malnutrition in Chinese Children with Congenital Heart Defect
Authors: Zhang Mingjie , Wang Liping , Huang Rui , Sun Chongrui , Xu Zhuoming 
Published: February 2020

Abstract
Background : The study aimed to investigate the risk factors of malnutrition in children with congenital heart defect (CHD) in China. Methods: This cohort study was performed at the biggest pediatric heart center in China; 3252 patients with CHD who underwent cardiac surgeries in 2013 were included. Anthropometric measurements included weight for age Z score (WAZ), weight for height Z score (WHZ), and height for age Z score (HAZ). The patients were classified as normal nutritional status and malnutrition, based on a cut-off Z score of <-2. Factors associated with malnutrition were determined using logistic regression analysis. Results: The prevalence of preoperative WAZ <-2 (underweight), HAZ <-2 (stunting), and WHZ<-2 (wasting) was 23.3%, 23.3%, and 14.3%, respectively. The multivariable analysis of preoperative malnutrition showed that hospitalization, age at surgery, risk adjustment for congenital heart surgery-1 >3, mechanical ventilation, pulmonary hypertension, and acyanotic heart disease were associated with underweight. Parents’ height, single ventricle, and cyanotic heart disease were associated with stunting. Hospitalization and pulmonary hypertension were associated with wasting. After surgery, the patients presented a significant improvement in growth within the first year in all three parameters and grew to the normal range of WAZ (-0.3±0.9, P<0.001), HAZ (0.2±0.8, P=0.001), and WHZ (0.03±0.6, P<0.001) at two years after surgery. The prevalence of underweight, stunted, and wasting declined to 3.2%, 2.7%, and 1.9% three years after surgery. Malnutrition after surgery was associated with cardiac residual cardiac abnormalities (OR=35.3, p<0.0001), high Ross classiﬁcation of heart function (OR=27.1, p<0.0001), and long-term taking oral diuretics (OR=20.5, P=0.001). Conclusions: Malnutrition is still a problem in children with CHD in China, especially before the surgery. There is need to strengthen the nutrition support for children with CHD before surgery. Hemodynamic factors were found to be the risk factors associated with malnutrition after operation.
Occurrence and removal of illicit drugs in different wastewater treatment plants with different treatment techniques
Authors: Deng Yanghui , Guo Changsheng , Zhang Heng , Yin Xingxing , Chen Like , Wu Daishe , Xu Jian 
Published: February 2020

Abstract
Background: As a class of contaminants of emerging concern (CECs), illicit drugs should be taken into account in the water management because of their social and public health risks. Wastewater treatment plants (WWTPs) are usually considered as the source and sink of contaminants, and drug residues are observed in their effluents due to the inefficient removal of CECs. In this study, wastewater samples were collected from eight WWTPs in Changzhou City for assessment of the abuse of 12 illicit drugs in the city by wastewater-based epidemiology (WBE) method.
Results: Drug concentrations ranged from
Association between gene polymorphisms of voltage-dependent Ca2+ channels andhypertension in the Dai people of China: a case-control study
Authors: Huang LiFan , Chu Yan , Huang Xiaoqin , Ma Shaohui , Lin Keqin , Huang Kai , Sun Hao , Yang Zhaoqing 
Published: February 2020

Abstract
Background: Abnormal calcium homeostasis related to the development of hypertension. As the key regulator of intracellular calcium concentration, voltage-gated calcium channels (VDCCs), the variations in these genes may have important effects on the development of hypertension. Here we evaluate VDCCs variability with respect to hypertension in the Dai ethnic group of China.Methods: A total of 1034 samples from Dai individuals were collected, of which 495 were used as cases, and 539 were used as controls. Blood pressure was measured using a standard mercury measurement method, three times with a rest for 5 min, and the average was used for analyses. Seventeen single nucleotide polymorphisms (SNPs) in the four protein-coding genes (CACNA1A, CACNA1C, CACNA1S, CACNB2) of VDCCs were identified by multiplex PCR-SNP typing technique. Chi-square tests and regression models were used to analyse the associations of SNPs with hypertension. Results: The results of chi-square tests showed that the allele frequencies of 5 SNPs were significantly different between the case and the control groups (P<0.05), but the statistical significance was lost after Bonferroni’s correction. However, after adjusting for BMI, age, sex and other factors by logistic regression analyses, the results showed that 5 SNPs consistent with chi-square tests (rs2365293, rs17539088, rs16917217, rs61839222 and rs10425859) were still statistically positive. Conclusions: This finding suggested that the significant association of these SNPs with hypertension may be noteworthy in future studies.