bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age-Related Differences in Mood, Diabetes-Related Distress, and Functional Outcomes in Adults With Type 2 Diabetes Mellitus and Comorbid Obstructive Sleep Apnea and Insomnia
Authors: Jeon Bomin , Sereika Susan M. , Callan Judith A. , Luyster Faith S. , DiNardo Monica M. , Chasens Eileen R. 
Published: September 2020

Purpose The purpose of this study was to examine age-related differences in mood, diabetes-related distress, and functional outcomes in activities sensitive to impaired sleep in adults with type 2 diabetes mellitus (T2DM) and comorbid obstructive sleep apnea (OSA) and insomnia. This study also evaluated the associations of age, insomnia severity, and OSA severity on outcome variables. Methods This study was a secondary analysis of pooled baseline data from 2 randomized controlled trials among adults with T2DM with symptoms of sleep disorders (N = 145,109 younger adults, 36 older adults; 46.2% male; 67.6% white). Comorbid OSA and insomnia was defined as Apnea-Hypopnea Index ≥5 events per hour and Insomnia Severity Index ≥10. Outcome variables included mood, diabetes-related distress, and functional outcomes. Results Older adults reported better mood, lower diabetes-related distress, and higher functional outcomes relative to younger adults (all Ps < .05). Insomnia severity was associated with worse mood ( b = 2.59, P < .001) and diabetes-related distress ( b = 1.40, P < .001) and lower functional outcome ( b = −0.22, P < .001). Older age was associated with lower diabetes-related distress ( b = −0.44, P = .040). Conclusion Older age was a protective factor of mood disturbance, diabetes-related distress, and functional impairment in adults with T2DM and comorbid OSA and insomnia. Insomnia severity was associated with greater mood disturbance, diabetes-related distress, and functional impairment when OSA and insomnia coexist. The results suggest that diabetes care and education specialists should assess patients for impaired sleep.
The Impact of Including Costs and Outcomes of Dementia in a Health Economic Model to Evaluate Lifestyle Interventions to Prevent Diabetes and Cardiovascular Disease
Authors: Breeze Penny , Thomas Chloe , Thokala Praveen , Lafortune Louise , Brayne Carol , Brennan Alan 
Published: September 2020

Objectives Economic evaluations of lifestyle interventions, which aim to prevent diabetes/cardiovascular disease (CVD), have not included dementia. Lifestyle interventions decrease dementia risk and extend life expectancy, leading to competing effects on health care costs. We aim to demonstrate the feasibility of including dementia in a public health cost-effectiveness analysis and quantify the overall impacts accounting for these competing effects. Methods The School for Public Health Research (SPHR) diabetes prevention model describes individuals’ risk of type 2 diabetes, microvascular outcomes, CVD, congestive heart failure, cancer, osteoarthritis, depression, and mortality in England. In version 3.1, we adapted the model to include dementia using published data from primary care databases, health surveys, and trials of dementia to describe dementia incidence, diagnosis, and disease progression. We estimate the impact of dementia on lifetime costs and quality-adjusted life years (QALYs) gained of the National Health Service diabetes prevention program (NHS DPP) from an NHS/personal social services perspective with 3 scenarios: 1) no dementia, 2) dementia only, and 3) reduced dementia risk. Subgroup, parameter, and probabilistic sensitivity analyses were conducted. Results The lifetime cost savings of the NHS DPP per patient were £145 in the no-dementia scenario, £121 in the dementia-only scenario, and £167 in the reduced dementia risk scenario. The QALY gains increased by 0.0006 in dementia only and 0.0134 in reduced dementia risk. Dementia did not alter the recommendation that the NHS/DPP is cost-effective. Conclusions Including dementia into a model of lifestyle interventions was feasible but did not change policy recommendations or modify health economic outcomes. The impact on health economic outcomes was largest where a direct impact on dementia incidence was assumed, particularly in elderly populations.
Cultural Competency Among Pediatric Registered Nurses in Saudi Arabia: A Cross-Sectional Design
Authors: Alharbi Manal F. , Alhamlan Manal H. , Aboshaiqah Ahmad E. 
Published: September 2020

Introduction Saudi Arabia’s culturally diverse population is growing rapidly. The need for cultural competence is greatest in pediatric units where nurses provide care to children in collaboration with their parents. Method Nonprobability sampling of 394 nurses and cross-sectional descriptive design was used to investigate nurses’ cultural competence, and to examine the relationships between the variables and participants’ demographic data in pediatric units across five hospitals in Riyadh, Saudi Arabia, by asking nurses to complete a self-report questionnaire. Results The results suggest a high degree of cultural competency. Participants’ scores indicated high levels of perceived cultural awareness, sensitivity, and cultural competence behavior for performance. Discussion This study supports the 3-D Puzzle Model of culturally congruent care for cultural competence, which assumes that cultural competence is deeply influenced by one’s experiences. The findings revealed a high level of cultural competence despite a lack of information with respect to patient views.
Comparison of Outcome of Deltoid Ligament Repair According to Location of Suture Anchors in Rotational Ankle Fracture
Authors: Park Young Hwan , Jang Kyu Sun , Yeo Eui Dong , Choi Gi Won , Kim Hak Jun 
Published: September 2020

Background: The suture anchors for the repair of deltoid ligament in rotational ankle fracture are inserted mostly into the medial malleolus, but sometimes are placed into the talus depending on the rupture site. This study sought to compare the radiological and clinical outcomes of deltoid ligament repair according to using these 2 locations for suture anchor placement. Methods: The cases of 131 patients (114 patients with suture anchors on the medial malleolus and 17 patients with suture anchors on the talus) who underwent deltoid ligament repair along with ankle fracture fixation were retrospectively reviewed. Medial clear space oblique (MCSo), medial clear space perpendicular (MCSp), tibiofibular clear space (TFCS), and tibiofibular overlap (TFO) were measured as radiological outcomes, while the Olerud-Molander Ankle Score (OMAS) and visual analog scale (VAS) score for pain were calculated as clinical outcomes. The follow-up period did not differ between the 2 groups (16.8 ± 10.9 months in the medial malleolus group vs 17.9 ± 14.3 months in the talus group; P = .670). Results: There were no differences in MCSo, MCSp, TFCS, and TFO at 3 months after surgery and final follow-up. The OMAS and VAS for pain did not show intergroup differences at final follow-up. Conclusion: The surgical outcome of deltoid ligament repair in rotational ankle fracture did not differ whether the suture anchors were inserted into the medial malleolus or into the talus. Level of Evidence: Level III, retrospective comparative study.
Multimodal imaging of chorioretinal folds induced by orbital vascular malformation in two cases
Authors: Gündüz Ahmet Kaan , Shields Carol L , Bekdemir Şükran , Shields Jerry A 
Published: September 2020

Purpose: To investigate the alterations in the retinal pigment epithelium (RPE) in the crest and trough portions of chorioretinal folds (CRFs) induced by an orbital vascular tumor. Methods: Review of multimodal imaging in two eyes of two patients with globe compression and CRFs from an orbital vascular tumor. Results: Fundus photography demonstrated obliquely extending CRFs with alternating hyperpigmented and hypopigmented linear alterations in both eyes. Fundus autofluorescence (AF) imaging showed obliquely oriented hypoAF lines, incompletely alternating with hyperAF lines. In Case 1, the hyperAF lines had interspersed hypoAF segments and Case 2 had peripapillary mottling of AF. Fluorescein angiography (FA) showed alternating hyper and hypofluorescent lines in the late phase in Case 1. Optical coherence tomography (OCT) documented relative thinning of RPE at the folded crests in Case 1 and preservation of RPE in Case 2. Swept-source OCT angiography (SS-OCTA) demonstrated oblique hyporeflective lines in the outer retina and choriocapillaris layers in Case 2. These findings suggest that the crest of a CRF represents thinned or rarified RPE with hypoAF, transmission hyperfluorescence (FA), partially attenuated RPE layer (OCT), and isoreflectivity (SS-OCTA) while the trough represents compressed RPE with irregular hyperAF, transmission hypofluorescence (FA), thickened RPE layer (OCT), and hyporeflectivity (SS-OCTA). Conclusion: The anatomic and functional status of the RPE in CRFs based on multimodal imaging reveals normal to attenuated RPE with hypofunctionality at the fold crest and compacted, thickened RPE at the trough with segmental functional impairment on AF imaging. Anatomic information regarding CRFs is evident on OCT, FA, and SS-OCTA while the functional status is depicted on AF.
Relation of Helicobacter pylori infection to peripheral arterial stiffness and 10-year cardiovascular risk in subjects with diabetes mellitus
Authors: Yang Yun-Feng , Li Yun , Liu Ju-Hua , Wang Xiao-Ming , Wu Bi-Hua , He Cheng-Shi , Gu Jian-Wei 
Published: September 2020

Purpose: This study was conducted to investigate the relation of HP infection to peripheral arterial stiffness and 10-year cardiovascular risk in diabetes mellitus (DM). Methods: DM subjects who underwent the C13-breath test were enrolled and divided into DMHP+ and DMHP− groups. Peripheral arterial stiffness was measured using brachial to ankle pulse wave velocity (baPWV). Framingham score (FRS) and Chinese evaluation method of ischemic cardiovascular diseases (ICVD) were used to clarify 10-year cardiovascular risk. Results: A total of 6767 subjects were included, baPWV and proportion of subjects with severe peripheral arterial stiffness were lower in DMHP− group than DMHP+ group (1556.68 ± 227.54 vs 2031.61 ± 525.48 cm/s, p < 0.01; 21.9% vs 62.7%, p < 0.01). Multivariate logistic regression analysis demonstrated that HP infection was independently associated with baPWV. Furthermore, cardiovascular risk score and the proportion of subjects with high risk were lower in DMHP− group than DMHP+ group (FRS: 12.09 ± 3.77 vs 13.91 ± 3.77, 17.2% vs 38.8%; ICVD: 8.56 ± 2.99 vs 10.22 ± 3.16, 43.9% vs 65.4%, with all p < 0.05). Conclusion: DM subjects with HP infection had more severe peripheral arterial stiffness compared those without HP infection, a higher cardiovascular risk score and 10-year cardiovascular risk stratification were observed in those subjects.
The TAT Protein Transduction Domain as an Intra-Articular Drug Delivery Technology
Authors: Mailhiot Sarah E. , Thompson Matthew A. , Eguchi Akiko E. , Dinkel Sabrina E. , Lotz Martin K. , Dowdy Steven F. , June Ronald K. 
Published: September 2020

Objective Intra-articular drug delivery holds great promise for the treatment of joint diseases such as osteoarthritis. The objective of this study was to evaluate the TAT peptide transduction domain (TAT-PTD) as a potential intra-articular drug delivery technology for synovial joints. Design Experiments examined the ability of TAT conjugates to associate with primary chondrocytes and alter cellular function both in vitro and in vivo. Further experiments examined the ability of the TAT-PTD to bind to human osteoarthritic cartilage. Results The results show that the TAT-PTD associates with chondrocytes, is capable of delivering siRNA for chondrocyte gene knockdown, and that the recombinant enzyme TAT-Cre is capable of inducing in vivo genetic recombination within the knee joint in a reporter mouse model. Last, binding studies show that osteoarthritic cartilage preferentially uptakes the TAT-PTD from solution. Conclusions The results suggest that the TAT-PTD is a promising delivery strategy for intra-articular therapeutics.
The prognostic value of histopathological pattern of the pelviureteric junction in the outcome of pyeloplasty in children
Authors: Sebaey Ahmed , Sherif Hammouda , Abdelrahman Mohamed , Elshazli Ali , Abdelsamee Tagreed , Gharib Tarek 
Published: September 2020

Abstract
Background
The cause of pyeloplasty failure remains unclear; therefore, increasing interest has been directed to identify the reason for dissatisfactory surgical results. Some studies attempted to investigate the role of the histopathological pattern. The aim of the work is to study the correlation between the histopathological pattern of obstructed pelviureteric junction (PUJ) segment and the outcome of pyeloplasty in children with the PUJ.

Methods
Fifty-four patients with pelviureteric junction obstruction (PUJO) were included in the study; patients were evaluated preoperative. All patients were operated by the same surgeon using Anderson–Hynes pyeloplasty; the resected obstructed PUJ segment examined histopathological using light microscope and image analyzer system to identify mean renal pelvis smooth muscle thickness (mRPSMT), collagen-to-smooth muscle ratio and elastin content.

Results
The study includes 50 patients with mean age Mean 24.48 ± 15.3 months. Two patients show no improvement, while 24 improved at 3 months, 16 improved at 6 months, and 8 improved at 12 months. mRPSMT showed significant difference between improvement groups (136.02 ± 44.4, 173.47 ± 49.69 and 258.56 ± 96.82 μm), while elastin content or collagen-to-smooth muscle ratio showed no significant difference.

Conclusions
Our data showed a clear relationship between mRPSMT and the time over which radiological improvement occurs; increase in mRPSMT is associated with a delay in postoperative radiological improvement time. We found no relation between elastin content nor collagen-to-smooth muscle thickness and postoperative improvement course.
Atypical hemolytic and uremic syndrome due to C3 mutation in pancreatic islet transplantation: a case report
Authors: Bahougne Thibault , Olagne Jérome , Munch Marion , Braun-Parvez Laura , Chenard Marie-Pierrette , Frémeaux-Bacchi Véronique , Caillard Sophie , Baltzinger Philippe , Greget Michel , Kessler Laurence , Moulin Bruno 
Published: September 2020

Abstract
Background
We here report on the first observation of a C3 mutation that is related to atypical hemolytic and uremic syndrome (aHUS), which occurred in a pancreatic islet transplant patient. Immunosuppressive treatments, such as calcineurin inhibitors, have been linked to undesirable effects like nephrotoxicity.

Case presentation
A 40-year-old man with brittle diabetes, who was included in the TRIMECO trial, became insulin-independent 2 months after pancreatic islet transplantation. About 15 months after islet transplantation, the patient exhibited acute kidney injury due to aHUS. Despite plasma exchange and eculizumab treatment, the patient developed end-stage renal disease.
A genetic workup identified a missense variant (p.R592Q) in the C3 gene. In vitro, this C3 variant had defective Factor I proteolytic activity with membrane proteins as cofactor proteins, which was thus classified as pathogenic. About 1 year after the aHUS episode, kidney transplantation was carried out under the protection of the specific anti-C5 monoclonal antibody eculizumab. The patient had normal kidney function, with preserved pancreatic islet function 4 years later.

Conclusions
Pancreatic islet transplantation could have triggered this aHUS episode, but this link needs to be clarified. Although prophylactic eculizumab maintains kidney allograft function, its efficacy still needs to be studied in larger populations.
Moyamoya-like vasculopathy associated to MYH9-related thrombocytopenia manifested by multiple cerebral ischemic lesions: a case report
Authors: Ribigan Athena Cristina , Badea Raluca Stefania , Ciocan Alida , Stefan Dana , Casaru Bogdan , Ioan Patricia , Antochi Florina , Băjenaru Ovidiu 
Published: September 2020

Abstract
Background
Moyamoya-like vasculopathy (MMV) and myosin heavy chain 9-related platelet disorders (MYH9-RPDs) or macrothrombocitopenias are rare syndromes. Their association is even more infrequent.

Case presentation
A 29-year-old female with history of MYH9-RPD, presented to our department for episodes suggesting transient ischemic attacks. Based on the imaging studies that revealed multiple ischemic lesions and stenoses of both distal internal carotid arteries and the arteries of the circle of Willis, the diagnosis of MMV was established. The treatment with Verapamil was initiated, leading to symptom remission. Two months later, the patient presented one episode of dysarthria, followed by involuntary movements of the right upper limb, few days later. Long-term electroencephalogram monitoring depicted epileptiform abnormalities. Resolution of symptoms was obtained after increasing the dose of Verapamil, and initiating Levetiracetam.

Conclusions
This is an interesting case of a patient with two rare pathologies, who presented with cerebral ischemic strokes. To our knowledge there are few cases described in the literature presenting with cerebral hemorrhagic events but none of them with multiple cerebral ischemic lesions. As these cases are very rare, it is important to gather evidence regarding the best approach and treatment strategy.
Ultrasonographic diagnosis, classification, and treatment of cervical lymphatic malformation in paediatric patients: a retrospective study
Authors: Li Jiaoling , Zhong Wei , Geng Xiuping , Liu Xiaofang , Zhang Xiangxiang , Wang Yurun , Li Haibo 
Published: September 2020

Abstract
Background
To explore the imaging features, key diagnostic points, classification, treatment, and prognosis of cervical lymphatic malformation.

Methods
Overall, 320 patients diagnosed with cervical lymphatic malformation were retrospectively analysed in our hospital between 1 January 2014 and 31 December 2017. Imaging modalities included colour Doppler ultrasound, magnetic resonance imaging, and contrast-enhanced computed tomography. Cervical lymphatic malformations were classified by cyst diameter. Treatments included interventional therapy, surgery, and expectant treatment.

Results
Cervical lymphatic malformation was identified in 320 of 1192 patients with lymphatic malformation. Four were excluded due to misdiagnosis by ultrasonography. Cervical lymphatic malformation was classified as mixed, macrocystic, and microcystic in 184 (57.5%), 117 (36.56%), and 19 (5.94%) patients, respectively. Sixty-four (20%), ten (3.12%), seven (2.19%), and three (0.94%) patients experienced intracystic haemorrhage, infection, concurrent intracystic haemorrhage and infection, and calcification, respectively. Among 260 (81.25%) patients who underwent interventional sclerotherapy, 163 (50.94%) received it once and 96 (30%) received it two or more times. Twenty-eight (8.75%), five (1.56%), and 27 (8.44%) patients underwent surgical resection, interventional sclerotherapy plus surgery, and expectant management, respectively.

Conclusions
Ultrasonography is useful for diagnosing definite cervical lymphatic malformation. Interventional therapy is the first choice for children with confirmed cervical lymphatic malformation.
Medical service demand forecasting using a hybrid model based on ARIMA and self-adaptive filtering method
Authors: Huang Yihuai , Xu Chao , Ji Mengzhong , Xiang Wei , He Da 
Published: September 2020

Abstract
Background
Accurate forecasting of medical service demand is beneficial for the reasonable healthcare resource planning and allocation. The daily outpatient volume is characterized by randomness, periodicity and trend, and the time series methods, like ARIMA are often used for short-term outpatient visits forecasting. Therefore, to further enlarge the prediction horizon and improve the prediction accuracy, a hybrid prediction model integrating ARIMA and self-adaptive filtering method is proposed.

Methods
The ARIMA model is first used to identify the features like cyclicity and trend of the time series data and to estimate the model parameters. The parameters are then adjusted by the steepest descent algorithm in the adaptive filtering method to reduce the prediction error. The hybrid model is validated and compared with traditional ARIMA by several test sets from the Time Series Data Library (TSDL), a weekly emergency department (ED) visit case from literature study, and the real cases of prenatal examinations and B-ultrasounds in a maternal and child health care center (MCHCC) in Ningbo.

Results
For TSDL cases the prediction accuracy of the hybrid prediction is improved by 80–99% compared with the ARIMA model. For the weekly ED visit case, the forecasting results of the hybrid model are better than those of both traditional ARIMA and ANN model, and similar to the ANN combined data decomposition model mentioned in the literature. For the actual data of MCHCC in Ningbo, the MAPE predicted by the ARIMA model in the two departments was 18.53 and 27.69%, respectively, and the hybrid models were 2.79 and 1.25%, respectively.

Conclusions
The hybrid prediction model outperforms the traditional ARIMA model in both accurate predicting result with smaller average relative error and the applicability for short-term and medium-term prediction.
Inter-embryo gene expression variability recapitulates the hourglass pattern of evo-devo
Authors: Liu Jialin , Frochaux Michael , Gardeux Vincent , Deplancke Bart , Robinson-Rechavi Marc 
Published: September 2020

Abstract
Background
The evolution of embryological development has long been characterized by deep conservation. In animal development, the phylotypic stage in mid-embryogenesis is more conserved than either early or late stages among species within the same phylum. Hypotheses to explain this hourglass pattern have focused on purifying the selection of gene regulation. Here, we propose an alternative—genes are regulated in different ways at different stages and have different intrinsic capacities to respond to perturbations on gene expression.

Results
To eliminate the influence of natural selection, we quantified the expression variability of isogenetic single embryo transcriptomes throughout fly Drosophila melanogaster embryogenesis. We found that the expression variability is lower at the phylotypic stage, supporting that the underlying regulatory architecture in this stage is more robust to stochastic variation on gene expression. We present evidence that the phylotypic stage is also robust to genetic variations on gene expression. Moreover, chromatin regulation appears to play a key role in the variation and evolution of gene expression.

Conclusions
We suggest that a phylum-level pattern of embryonic conservation can be explained by the intrinsic difference of gene regulatory mechanisms in different stages.