bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations of mitochondrial DNA 3777–4679 region mutations with maternally inherited essential hypertensive subjects in China
Authors: Zhu Ye , You Jia , Xu Chao , Gu Xiang 
Published: May 2020

AbstractBackgroundNuclear genome or family mitochondrial screening system has become the hot focus of studies into essential hypertension. The role of mitochondrial DNA (mtDNA) in sporadic Chinese patients with hypertension has not been fully understood. The study was to evaluate the associations of mtDNA mutations with maternally inherited essential hypertensive subjects in China.MethodsFrom June 2009 to June 2016, a total of 800 gender-matched Chinese patients with maternally inherited essential hypertension (MIEH) and control group were 1:1 enrolled in this case-control study. Genomic DNA was extracted from each person’s peripheral blood cells. The main mtDNA locations for MIEH were screened with oligodeoxynucleotides 3777-4679 bp, analyzed and compared with the updated consensus Cambridge Sequence. Pathogenic mtDNA mutations were identified from the mitochondrial map.ResultsMIEH subjects presented significantly higher values than those of control group in abdominal circumference (AC), waist circumference (WC), body mass index (BMI), fasting blood glucose (FBG), triglyceride (TG), low-density lipoprotein cholesterol (LDL) and renal function (P < 0.05). MIEH subjects carried more amino acid changes and coding sequence variants (P < 0.01) than control group. The allele frequencies of the eight single nucleotide polymorphisms (SNPs) were significantly different between the two groups, includingm.3970 C > T, m.4048G > A, m.4071C > T, m.4086C > T, m. 4164A > G and m.4248 T > Cin ND1 gene, andm.4386 T > Candm.4394C > Tin tRNAGlngene(P < 0.001). Fifty-five homoplasmic or heteroplasmic mutations were detected in 5 genes: ND1, tRNAIle, tRNAMet, tRNAGlnand ND2 gene. The ND1 gene was the main mutation site, where the most mtDNA mutation wasm.3970 C > T.ConclusionsThe mtDNA mutations were involved in the process of MIEH. We identified mitochondrial genetic characteristics in MIEH patients in China. The present research serves as a solid foundation for further detailed research on the association between MIEH and mitochondrial dysfunction, and their causal relationship in Chinese and other populations with a similar lifestyle.
Clinical outcomes after mix-and-match implantation of diffractive multifocal intraocular lenses with + 2.75 and + 4.00 diopter add powers
Authors: Lee Jae Hyuck , Lee Hun , Lee Jin Ah. , Yoo Aeri , Kim Jae Yong , Tchah Hungwon 
Published: May 2020

Abstract
Background
To evaluate the clinical outcomes of bilateral mix-and-match implantation of diffractive multifocal intraocular lenses (IOLs) with different add powers.

Methods
We retrospectively reviewed the medical records of 18 patients who underwent bilateral mix-and-match implantation of diffractive multifocal IOLs with different add powers. Multifocal IOLs with add powers of + 2.75 diopters (D) and + 4.00 D were implanted into the patients’ dominant and nondominant eyes, respectively. At 1 and 3-month postoperatively, monocular and binocular visual acuity was measured using logMAR charts and manifest refraction was performed. Specifically, logMAR charts were used to measure uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and corrected distance visual acuity (CDVA). Defocus curves, contrast sensitivity, and patient satisfaction were assessed at 3-month postoperatively.

Results
Binocular logMAR measurements (mean ± standard deviation) at 3-month postoperatively were 0.01 ± 0.04 (UDVA), 0.16 ± 0.05 (UIVA), and 0.11 ± 0.07 (UNVA). Postoperative spherical equivalent was − 0.43 ± 0.35 D and − 0.39 ± 0.21 D in the dominant and nondominant eyes, respectively. Defocus curves showed significant differences between − 1.50 and − 4.00 D among binocular, dominant, and nondominant eye measurements, except between − 2.50 and − 3.00 D. Eyes implanted with + 2.75 and + 4.00 D IOLs showed good contrast sensitivity under photopic and mesopic conditions. Over 80% of patients reported high satisfaction with their near vision.

Conclusions
Bilateral mix-and-match implantation of diffractive multifocal IOLs with add powers of + 2.75 D and + 4.00 D showed good near, intermediate, and far vision.
Validity and reliability of social anxiety disorder diagnoses in the Swedish National Patient Register
Authors: Vilaplana-Pérez Alba , Isung Josef , Krig Sonja , Vigerland Sarah , Jolstedt Maral , Bjureberg Johan , Högström Jens , Isomura Kayoko , Rautio Daniel , Serlachius Eva , Rück Christian , Mataix-Cols David , Fernández de la Cruz Lorena 
Published: May 2020

Abstract
Background
Population-based administrative registers are often used for research purposes. However, their potential usefulness depends on the validity of the registered information. This study assessed the validity of the recorded codes for social anxiety disorder (SAD), also known as social phobia, in the Swedish National Patient Register (NPR).

Methods
The personal identification numbers of 300 randomly selected individuals with a diagnosis of SAD recorded in the NPR were obtained from the Swedish National Board of Health and Welfare. The medical files of these individuals were then requested from clinics nationally. A total of 117 files were received and two independent raters reviewed each file to assess the presence or absence of SAD, according to the definition of the International Classification of Diseases, Tenth Edition (ICD-10) and the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). When disagreements between the two raters were found, a third rater reviewed the file to establish a best estimate diagnosis. Positive predictive values (PPV) and agreement between the two initial raters (using Cohen’s kappa) were calculated. Additionally, raters completed the Clinical Global Impression – Severity (CGI-S) and the Global Assessment of Functioning (GAF) rating scales for each file. Inter-rater agreement for the CGI-S and the GAF was assessed using intraclass correlation coefficients (ICC).

Results
After exclusion of files not containing sufficient information, 95 files were included in the analyses. Of these, 77 files (81.05%) were considered to be ‘true positive’ cases (PPV = 0.81, 95% confidence interval = 0.72–0.88). Inter-rater agreement regarding the presence or absence of SAD was substantial (κ = 0.72). CGI-S and GAF scores indicated that patients were in the moderate range of severity and functional impairment. Inter-rater agreement for the CGI-S and the GAF was moderate to good (ICC = 0.72 and ICC = 0.82, respectively).

Conclusions
The ICD-10 codes for SAD in the Swedish NPR are generally valid and reliable, but we recommend sensitivity analyses in future register-based studies to minimise the impact of potential diagnostic misclassification. Most patients were moderately severe and impaired, suggesting that results from register-based studies of SAD may be generalizable.
Adherence to ready-to-use food and acceptability of outpatient nutritional therapy in HIV-infected undernourished Senegalese adolescents: research-based recommendations for routine care
Authors: Niasse Fatou , Varloteaux Marie , Diop Karim , Ndiaye Sidy Mokhtar , Diouf François Niokhor , Mbodj Pape Birane , Niang Babacar , Diack Aminata , Cames Cecile 
Published: May 2020

Abstract
Background
Ready-to-use food (RUF) is increasingly used for nutritional therapy in HIV-infected individuals. However, practical guidance advising nutrition care to HIV-infected adolescents is lacking, so that little is known about the acceptability of such therapy in this vulnerable population. This study assesses the overall acceptability and perception of a RUF-based therapy and risk factors associated with sub-optimal RUF intake in HIV-infected undernourished adolescents in Senegal.

Methods
Participants 5 to 18 years of age with acute malnutrition were enrolled in 12 HIV clinics in Senegal. Participants were provided with imported RUF, according to WHO prescription weight- and age-bands (2009), until recovery or for a maximum of 9–12 months. Malnutrition and recovery were defined according to WHO growth standards. Adherence was assessed fortnightly by self-reported RUF intake over the period. Sub-optimal RUF intake was defined as when consumption of the RUF provision was < 50%. RUF therapy acceptability and perceptions were assessed using a structured questionnaire at week 2 and focus group discussions (FGDs) at the end of the study. Factors associated with sub-optimal RUF intake at week 2 were identified using a stepwise logistic regression model.

Results
We enrolled 173 participants, with a median age of 12.5 years (Interquartile range: 9.5–14.9), of whom 61% recovered from malnutrition within the study period. Median follow-up duration was 66 days (21–224). RUF consumption was stable, varying between 64 and 57% of the RUF provided, throughout the follow-up. At week 2, sub-optimal RUF intake was observed in 31% of participants. Dislike of the taste of RUF (aOR = 5.0, 95% CI: 2.0–12.3), HIV non-disclosure (5.1, 1.9–13.9) and food insecurity (2.8, 1.1–7.2) were the major risk factors associated with sub-optimal RUF intake at week 2. FGDs showed that the need to hide from others to avoid sharing and undesirable effects were other constraints on RUF feeding.

Conclusions
This study revealed several factors reducing the acceptability and adherence to RUF therapy based on WHO guidelines in HIV-infected adolescents. Tailoring prescription guidance and empowering young patients in their care are crucial levers for improving the acceptability of RUF-based therapy in routine care.

Trial registration
ClinicalTrials.gov identifier: NCT03101852, 04/04/2017.
Multilevel analysis of factors associated with unmet need for family planning among Malawian women
Authors: Nkoka Owen , Mphande Watanja M. , Ntenda Peter A. M. , Milanzi Edith B. , Kanje Victor , Guo Shiaau J. G. 
Published: May 2020

Abstract
Background
Malawi has a high fertility rate which is also characterized by a relatively high prevalence of unmet need for contraception. However, little is known about the influence of individual- and community- level characteristics on unmet need in Malawi. This study examined the individual- and community- level factors associated with unmet need for family planning (FP) among Malawian women.

Methods
Data from the 2015–16 Malawi demographic and health survey were used to analyze 15, 931 women. The association between individual- and community- level factors and unmet need was assessed using multilevel binary logistic regression models.

Results
The prevalence of total unmet need was 21.0%. Women aged ≥35 years were more likely to have total unmet need [adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.04–1.35] compared with those aged 15–24 years. Women who were married [aOR = 0.41, 95% CI = 0.35–0.48], and those employed [aOR = 0.78, 95% CI = 0.71–0.85] were associated with less likelihood of having total unmet need compared with unmarried, and unemployed women, respectively. At community-level, women from communities with a high percentage of women from rich households [aOR = 0.81, 95% CI = 0.67–0.96], and those from communities with a middle and high percentage of educated women [aOR = 0.86, 95% CI = 0.76–0.96 and aOR = 0.81, 95% CI = 0.70–0.93, respectively] were less likely to have total unmet need for FP compared with those from communities with low percentages of rich and educated women, respectively. The proportional change in variance showed that about 36.0% of total variations in the odds of unmet need across the communities were explained by both individual- and community-level factors. Moreover, the intraclass correlation showed that about 3.0% of the total variation remained unexplained even after controlling for both individual- and community-level factors.

Conclusion
Both individual- and community- level factors influenced unmet need for FP in Malawi. Public health practitioners should conduct community profiling and consider individual and community factors when designing FP programs.
Values of different specimen preparation methods for the diagnosis of lung cancer by endobronchial ultrasound guided transbronchial needle aspiration
Authors: Xu Youzu , Lin Jian , Chen Meifang , Zheng Haihong , Feng Jiaxi 
Published: May 2020

Abstract
Background
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has been become an important procedure for the diagnosis and staging of lung cancer. Our research identified the effects of different pathological preparation on the diagnosis of lung cancer for specimens obtained by biopsy.

Methods
Patients were clinically considered if lung cancer was accompanied by mediastinal or hilar lymph node enlargement between March 2014 and November 2017. Specimens obtained by EBUS-TBNA were treated by three methods: traditional smear cytology, liquid-based cytology (LBC) and histopathology.

Results
Of a total of 154 puncture sites from 153 patients, the total positive rate of combination for the three pathological treatment types (histopathology, direct traditional smear, and LBC) was 77.3%. The diagnostic positive rate for histopathology was 68.6%, direct traditional smear was 65.6%, and LBC was 60.4%; there was no significant differences among the three single pathological treatment types (P = 0.29), but there was a statistically significant difference between the combination of three treatments and any single pathological treatment type (P = 0.01). The diagnostic sensitivities of histopathology combined with traditional smear and histopathology combined LBC were 94.4 and 92.8%, respectively, the specificities and PPVs were both 100%, and the diagnostic accuracies were 95.5 and 94.2%, respectively; the sensitivities, specificities and diagnostic accuracies above were all higher than those of single specimen treatment and lower than those of the three combined.

Conclusion
When EBUS-TBNA is used for the diagnosis and staging of lung cancer, the use of histopathological sections combined with direct cytological smear should be sufficient and is the most economical choice.
In vivo assessment of the elastic properties of women’s pelvic floor during pregnancy using shear wave elastography: design and protocol of the ELASTOPELV study
Authors: Gachon Bertrand , Fritel Xavier , Pierre Fabrice , Nordez Antoine 
Published: May 2020

Abstract
Background
Animal studies have reported an increase in pelvic floor muscle stiffness during pregnancy, which might be a protective process against perineal trauma at delivery. Our main objective is to describe the changes in the elastic properties of the pelvic floor muscles (levator ani, external anal sphincter) during human pregnancy using shear wave elastography (SWE) technology. Secondary objectives are as follows: i) to look for specific changes of the pelvic floor muscles compared to peripheral muscles; ii) to determine whether an association between the elastic properties of the levator ani and perineal clinical and B-mode ultrasound measures exists; and iii) to provide explorative data about an association between pelvic floor muscle characteristics and the risk of perineal tears.

Methods
Our prospective monocentric study will involve three visits (14–18, 24–28, and 34–38 weeks of pregnancy) and include nulliparous women older than 18 years, with a normal pregnancy and a body mass index (BMI) lower than 35 kg.m− 2. Each visit will consist of a clinical pelvic floor assessment (using the Pelvic Organ Prolapse Quantification system), an ultrasound perineal measure of the anteroposterior hiatal diameter and SWE assessment of the levator ani and the external anal sphincter muscles (at rest, during the Valsalva maneuver and during pelvic floor contraction), and SWE assessment of both the biceps brachii and the gastrocnemius medialis (at rest, extension and contraction). We will collect data about the mode of delivery and the occurrence of perineal tears. We will investigate changes in continuous variables collected using the Friedman test. We will look for an association between the elastic properties of the levator ani muscle and clinical / ultrasound measures using a Spearman test at each trimester. We will investigate the association between the elastic properties of the pelvic floor muscles and perineal tear occurrence using a multivariate analysis with logistic regression.

Discussion
This study will provide original in vivo human data about the biomechanical changes of pregnant women’s pelvic floor. The results may lead to an individualized risk assessment of perineal trauma at childbirth.

Trial registration
This study was registered on https://clinicaltrials.gov on July 26, 2018 (NCT03602196).
Association of vitamin D2 and D3 with type 2 diabetes complications
Authors: Ahmed Lina H. M. , Butler Alexandra E. , Dargham Soha R. , Latif Aishah , Robay Amal , Chidiac Omar M. , Jayyousi Amin , Al Suwaidi Jassim , Crystal Ronald G. , Atkin Stephen L. , Abi Khalil Charbel 
Published: May 2020

Abstract
Aims
Vitamin D measurement is a composite of vitamin D2 (25(OH)D2) and D3 (25(OH)D3) levels, and its deficiency is associated with the development of type 2 diabetes (T2DM) and diabetic complications; vitamin D deficiency may be treated with vitamin D2 supplements. This study was undertaken to determine if vitamin D2 and D3 levels differed between those with and without T2DM in this Middle Eastern population, and the relationship between diabetic microvascular complications and vitamin D2 and vitamin D3 levels in subjects with T2DM.

Methods
Four hundred ninety-six Qatari subjects, 274 with and 222 without T2DM participated in the study. Plasma levels of total vitamin D2 and D3 were measured by LC-MS/MS analysis.

Results
All subjects were taking vitamin D2 and none were taking D3 supplements. Vitamin D2 levels were higher in diabetics, particularly in females, and higher levels were associated with hypertension and dyslipidemia in the diabetic subjects (p < 0.001), but were not related to diabetic retinopathy or nephropathy. Vitamin D3 levels measured in the same subjects were lower in diabetics, particularly in females (p < 0.001), were unrelated to dyslipidemia or hypertension, but were associated with retinopathy (p < 0.014). Neither vitamin D2 nor vitamin D3 were associated with neuropathy. For those subjects with hypertension, dyslipidemia, retinopathy or neuropathy, comparison of highest with lowest tertiles for vitamin D2 and vitamin D3 showed no difference.

Conclusions
In this Qatari cohort, vitamin D2 was associated with hypertension and dyslipidemia, whilst vitamin D3 levels were associated with diabetic retinopathy. Vitamin D2 levels were higher, whilst vitamin D3 were lower in diabetics and females, likely due to ingestion of vitamin D2 supplements.
Sustained effects of faculty leadership development modules for clinical instructors of core competences education in Taiwan: a four-year explanatory case study
Authors: Lee Fa-Yauh , Yang Ying-Ying , Huang Chia-Chang , Huang Ling-Ju , Chang Ching-Chih , Liang Jen-Feng , Huang Shiau-Shian , Lee Wei-Shin , Lu Dai-Yin , Chuang Chiao-Lin , Yang Ling-Yu , Huang Hui-Chun , Shulruf Boaz , Chen Chen-Huan , Kao Shou-Yen 
Published: May 2020

AbstractBackgroundThe Accreditation Council for Graduate Medical Education (ACGME) core competencies (CC) in general medicine-based primary care are essential for junior medical trainees. In this country, aregularfaculty development (FD) program aimed at training faculty in instructing (teaching and assessing) these CC had operated. However, leadership was not emphasized. In a newinterventionmodule, the roles and associated responsibilities ofclinical instructorstoconduct,design, andleadCC-based education were emphasis.AimsThis follow-up explanatory case study compares the effectiveness ofinterventionmodule with that of the previousregularmodule.MethodsTheregulargroup (n = 28) comprised clinical instructors who participated in the FD module during the 2013–2014 year while theinterventiongroup (n = 28) was composed of 2015–2016 participants. Prior to the formal (hands-on) training, participants in theinterventiongroup were asked to study the online materials of theregularmodule. These participants then received a 30-h hands-on training inconducting,designing, andleadingskills. Finally, they prepared a 10-h reflective end-of-module presentation of their real-world practices.ResultsFollowing the training, a higher degree improvement in participants self-reported familiarity with CC education, self-confidence in their ability to deliver CC education and sustained involve CC education were noted among theinterventionFD group, compared with theregularFD group. In theinterventiongroup,senioracademicians (associate and full professor) are more substantially involved indesigningandleadingCC-based courses than junior academicians (lecturers and assistant professors). Among non-teaching award winners of in theinterventionFD group, the follow-up degree of sustained involvement indelivering, designing and leadingCC-based courses was significantly higher than that of theregulargroup.ConclusionsOur study demonstrated that leadership training in theinterventionFD modules substantially motivated clinical instructors to become leaders in CC education.
Variability in clinicians’ understanding and reported methods of identifying high-risk surgical patients: a qualitative study
Authors: Selwood Amanda , Blakely Brette , Senthuran Siva , Lane Paul , North John , Clay-Williams Robyn 
Published: May 2020

Abstract
Background
High-risk patients presenting for surgery require complex decision-making and perioperative management. However, given there is no gold standard for identifying high-risk patients, doing so may be challenging for clinicians in practice. Before a gold standard can be established, the state of current practice must be determined. This study aimed to understand how working clinicians define and identify high-risk surgical patients.

Methods
Clinicians involved in the care of high-risk surgical patients at a public hospital in regional Australia were interviewed as part of an ongoing study evaluating a new shared decision-making process for high-risk patients. The new process, Patient-Centred Advanced Care Planning (PC-ACP) engages patients, families, and clinicians from all relevant specialties in shared decision-making in line with the patient’s goals and values. The semi-structured interviews were conducted before the implementation of the new process and were coded using a modified form of the ‘constant comparative method’ to reveal key themes. Themes concerning patient risk, clinician’s understanding of high risk, and methods for identifying high-risk surgical patients were extricated for close examination.

Results
Thirteen staff involved in high-risk surgery at the hospital at which PC-ACP was to be implemented were interviewed. Analysis revealed six sub-themes within the major theme of factors related to patient risk: (1) increase in high-risk patients, (2) recognising frailty, (3) risk-benefit balance, (4) suitability and readiness for surgery, (5) avoiding negative outcomes, and (6) methods in use for identifying high-risk patients. There was considerable variability in clinicians’ methods of identifying high-risk patients and regarding their definition of high risk. This variability occurred even among clinicians within the same disciplines and specialties.

Conclusions
Although clinicians were confident in their own ability to identify high-risk patients, they acknowledged limitations in recognising frail, high-risk patients and predicting and articulating possible outcomes when consenting these patients. Importantly, little consistency in clinicians’ reported methods for identifying high-risk patients was found. Consensus regarding the definition of high-risk surgical patients is necessary to ensure rigorous decision-making.