bluuebunny/crossref_metadata_2025_split huggingface dataset:
In vivo confocal microscopy assessment of meibomian glands microstructure in patients with Graves’ orbitopathy
Authors: Cheng Shengnan , Yu Yueqi , Chen Jin , Ye Lin , Wang Xinghua , Jiang Fagang 
Published: June 2021

Abstract
Background
To evaluate microstructural changes in the meibomian glands (MGs) in patients with active and inactive Graves’ orbitopathy (GO), using in vivo confocal microscopy (IVCM), and to investigate the correlations between clinical and confocal findings.

Methods
Forty patients (80 eyes) with GO (34 eyes with active GO, 46 eyes with inactive GO), and 31 age- and sex-matched control participants (62 eyes) were enrolled consecutively. A researcher recorded the clinical activity score (CAS) for each patient. A complete ophthalmic examination was then performed, including external eye, ocular surface and MGs. IVCM of the MGs was performed to determine the MG acinar density (MAD), MG longest and shortest diameters (MALD and MASD), MG orifice area (MOA), MG acinar irregularity (MAI), meibum secretion reflectivity (MSR), acinar wall inhomogeneity (AWI), acinar periglandular interstices inhomogeneity (API), and severity of MG fibrosis (MF).

Results
All confocal microscopy assessments of MGs significantly differed among groups (all P = 0.000). Compared to controls, GO groups showed lower MOA (1985.82 ± 1325.30 μm2 in active GO and 2021.59 ± 1367.45 μm2 in inactive GO vs. 3896.63 ± 891.90 μm2 in controls, all P = 0.000) and MAD (87.21 ± 32.69 /mm2 in active GO and 80.72 ± 35.54 /mm2 in inactive GO vs. 114.69 ± 34.90 /mm2 in controls, P = 0.001 and 0.000, respectively); greater MALD (118.11 ± 30.23 μm in active GO and 120.58 ± 27.64 μm in inactive GO vs. 58.68 ± 20.28 μm in controls, all P = 0.000) and MASD (44.77 ± 19.16 μm in active GO and 46.02 ± 20.70 μm in inactive GO vs. 27.80 ± 9.90 μm in controls, all P = 0.000); and higher degrees of MAI, MSR, and MF (all P<0.05). Eyes with active GO had higher degrees of MAI (P = 0.015), AWI (P = 0.000), and API (P = 0.000), while eyes with inactive GO had higher degrees of MSR (P = 0.000) and MF (P = 0.017). In GO groups, AWI and API were positively correlated with CAS (r = 0.640, P = 0.000; r = 0.683, P = 0.000, respectively), and MF was negatively correlated with CAS (r = − 0.228, P = 0.042).

Conclusions
IVCM effectively revealed microstructural changes of MGs in eyes with GO and provided strong in vivo evidence for the roles of obstruction and inflammation in the ocular surface disease process. Furthermore, it revealed discernible patterns of MG abnormalities in eyes with active GO and inactive GO, which are not easily distinguishable by typical clinical examinations.
A national survey on depressive and anxiety disorders in Afghanistan: A highly traumatized population
Authors: Kovess-Masfety V. , Keyes Katherine , Karam Elie , Sabawoon Ajmal , Sarwari Bashir Ahmad 
Published: June 2021

Abstract
Background
This survey attempts to measure at a national level, exposures to major traumas and the prevalence of common mental health disorders in a low-income dangerous country, highly affected by conflicts: Afghanistan.

Methods
Trans-sectional probability survey in general population by multistage sampling in 8 provinces, represented nationwide: 4445 adults (4433 weighted),15 years or older, 81% participation rate. Face to face interviews used specific scales for measuring lifetime exposure (LEC 5 Life Events Checklist) and Post Traumatic Stress Disorder (PTSD Check List), a diagnostic standardized interview: Composite International Diagnostic Interview (Short Form) for.
Major Depressive Episode and Generalized Anxiety Disorder, plus scales for suicidal thoughts and attempts and psychological distress (MH5 and RE from SF36).

Results
52.62% of the population is illiterate, 84,61% of the women do not have any source of income; 70.92% of the population lives in rural areas, 60.62% are below 35 years, 80% lives in very dangerous areas. 64.67% of the Afghan population had personally experienced at least one traumatic event; 78.48% had witnessed one such event. 60.77% of the sample experienced collective violence in relation to war and 48.76% reported four or more events; this very much differs across regions and levels of danger; women are less at risk for trauma except sexual violence, 35 years and above are more at risk than younger. 12-month PTSD prevalence reaches a high rate: 5.34% as MDE 11,71%, whereas GAD 2.78%; suicidal thoughts 2.26%, lifetime suicidal attempts 3.50% are close to reported in other countries. Women have more risk for PTSD (0R = 1.93) and suicidal behaviours (attempts OR = 1.92) than men; the number of events increases risk for MDE, PTSD and suicidal attempts, whereas education is protective. Exposure to different war events produced different mental health effects. People suffering from PTSD have higher risk to report 12-months suicidal ideations and lifetime suicidal attempts.

Conclusion
Our findings highlight the need to map the extent and the types of mental disorders post conflict; this would help maximise the help to be offered in guiding proper choice of interventions, including education.
The mental health, quality of life and life satisfaction of internally displaced persons living in Nakuru County, Kenya: a critique
Authors: Mandishekwa Robson 
Published: June 2021

AbstractThe study titled ‘[t] he mental health, quality of life and life satisfaction of internally displaced persons living in Nakuru County, Kenya’ by Getanda, Papadopoulos and Evans identifies a critical area and contributed significantly to literature. Despite the contribution, there are some issues in that study that deserve attention. For example, the use of the satisfaction with life scale instead of the temporal satisfaction with life scale, for a pre-and post-displacement study, is questionable. It is important to note that the scores from the satisfaction with life scale can only measure life satisfaction at a particular point while the temporal satisfaction with life can be used to determine life satisfaction between pre-and post-displacement periods. Again, conflicting statements in the abstract and methods sections have been noted, where the abstract refers to refugee camps while methods refer to internally displaced persons’ camps. Finally, some reported statistics have been found to have errors. It is important to highlight these critical issues to readers for a better understanding. This study, therefore, endeavours to critique that study and clarify some of these issues so that readers get better understandings. Recommendations for future studies are made.
Process evaluation of the Sophia Step Study- a primary care based three-armed randomized controlled trial using self-monitoring of steps with and without counseling in prediabetes and type 2 diabetes
Authors: Rossen Jenny , Hagströmer Maria , Yngve Agneta , Brismar Kerstin , Ainsworth Barbara , Johansson Unn-Britt 
Published: June 2021

Abstract
Background
Describing implementation features of an intervention is required to compare interventions and to inform policy and best practice. The aim of this study was to conduct a process evaluation of the first 12 months of the Sophia Step Study: a primary care based RCT evaluating a multicomponent (self-monitoring of daily steps plus counseling) and a single component (self-monitoring of steps only) physical activity intervention to standard care on cardiometabolic health.

Methods
The evaluation was guided by the Medical Research Council Guidance for complex interventions. To describe the implementation communication with the health professionals implementing the interventions, attendance records and tracking of days with self-monitored pedometer-determined steps were used. Change in physical activity behaviour was measured at baseline, 6 and 12 months as daily steps by accelerometry.

Results
During April 2013 to January 2018 188 participants were randomized and intervened directly after inclusion. Response rate was 49% and drop out was 10%. A majority, 78%, had type 2 diabetes and 22% were diagnosed with prediabetes. Mean [Standard deviation (SD)] body mass index was 30.4 (4.4) kg/m2 and steps per day was 6566 (3086). The interventions were delivered as intended with minor deviation from the protocol and dose received was satisfying for both the multicomponent and single component group. The mean [95% Confidence Interval (CI)] change in daily steps from baseline to 6 months was 941(227, 1655) steps/day for the multicomponent intervention group, 990 (145, 1836) step/day for the single component group and − 506 (− 1118, 107) for the control group. The mean (95% CI) change in daily steps from baseline to 12 months was 31(− 507, 570) steps/day for the multicomponent intervention group, 144 (− 566, 853) step/day for the single component group and − 890 (− 1485, − 294) for the control group. There was a large individual variation in daily steps at baseline as well as in step change in all three groups.

Conclusions
Applying self-monitoring of steps is a feasible method to implement as support for physical activity in the primary care setting both with and without counseling support.

Trial registration
ClinicalTrials.gov, NCT02374788. Registered 2 March 2015.
Evaluation of full-endoscopic lumbar discectomy in the treatment of obese adolescents with lumbar disc herniation: a retrospective study
Authors: Yu Haijiang , Zhu Bin , Song Qingpeng , Liu Xiaoguang 
Published: June 2021

Abstract
Background
Obese patients are at risk of complications after spinal surgery. Full-endoscopic lumbar discectomy (FELD) has advantages over conventional open surgery in the treatment of obese adult patients with lumbar disc herniation (LDH) because it can decrease perioperative complications and enhance the degree of patient satisfaction. However, no clinical studies have evaluated the efficacy of FELD in obese adolescents with LDH (ALDH). This study aimed to evaluate the efficacy of FELD for the treatment of obese ALDH.

Methods
We retrospectively collected clinical data from 208 patients with single-segment ALDH who underwent FELD in our hospital between January 2015 and December 2019. According to the WHO classification of obesity, the patients were divided into obese (BMI ≥30 kg/m2) and non-obese (BMI < 30 kg/m2) groups (control group). Based on the preoperative baseline data of the two groups, propensity score matching was performed to select patients from these groups for a comparative study. Perioperative data included operative time, intraoperative blood loss, and length of postoperative hospitalization. The visual analog scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria were recorded as the main indicators of the surgical outcome. Recurrence rate and incidence of complications were recorded as minor indicators.

Results
Twenty-eight patients and 80 patients were included in the obese and non-obese groups, respectively, after 1:4 propensity score matching. Both groups showed improvements in VAS and ODI scores after surgery and at each follow-up time point (p < 0.05). However, there was no significant statistical difference in the surgical outcomes between the two groups at each follow-up time point (p > 0.05). The differences in operative time, intraoperative blood loss, and length of postoperative hospitalization were not statistically significant between the two groups (p > 0.05).

Conclusion
FELD is a safe and effective minimally invasive technique for treating obese patients with ALDH. The efficacy of FELD in obese and non-obese patients with ALDH was comparable.
Women of reproductive age in a tertiary intensive care unit: indications, outcome and the impact of pregnancy—a retrospective cohort study
Authors: Ramlakhan Karishma P. , Gommers Diederik , Jacobs Carmen E. R. M. , Makouri Khaoula , Duvekot Johannes J. , Reiss Irwin K. M. , Franx Arie , Roos-Hesselink Jolien W. , Cornette Jérôme M. J. 
Published: June 2021

Abstract
Background
To evaluate the indications for admission and mortality rates of women of reproductive age admitted to a tertiary Intensive Care Unit (ICU) and to compare the outcomes of obstetric and non-obstetric admissions.

Methods

A retrospective cohort study was performed, including all women aged 17–41 years admitted to a level 3 ICU in the Netherlands, between January 1, 2000 and January 1, 2016. Primary outcome was indication for admission and mortality. Mortality, length of stay (LOS), need for mechanical ventilation and APACHE II score were compared between obstetric and non-obstetric admissions. The obstetric group was further analyzed for maternal and perinatal outcomes.

Results
3461 women (median age 32 years) were included, with an overall mortality rate of 13.3%. The obstetric group consisted of 265 women (7.7%). The non-obstetric group (n = 3196) was admitted most often for cardiovascular disease (19.6%), followed by oncologic disease (15%). Mortality was the highest in women with oncologic disease (23.9%). The obstetric group had lower mortality compared to the non-obstetric group (4.9% vs. 14%, p < 0.001), despite higher APACHE II score (14 vs. 11, p < 0.001) and a higher ventilation rate (47.9% vs. 39%, p = 0.004). Major surgical or endovascular interventions, besides caesarean section, were performed in 46% of the obstetric group. Perinatal death occurred in 17.2% and of the surviving infants, 63.2% were born preterm and 45.1% required Neonatal Intensive Care Unit admission.

Conclusions
Cardiovascular disease is the most important indication for admission and oncologic disease is associated with highest mortality in women of reproductive age. Obstetric patients constitute a small percentage of all ICU admissions in a tertiary ICU center. They have lower mortality rates than non-obstetric young female patients, despite a more severe initial presentation. Nevertheless lasting maternal morbidity and perinatal mortality and morbidity is frequent.
Ameliorated biomechanical properties of carotid arteries by puerarin in spontaneously hypertensive rats
Authors: Fang Xiaoxia , Dong Sheng , Wu Yun , He Yun , Lu Min , Shi Dandan , Feng Na , Yin Songhe , Jiang Yan , Zhang Anhua , Ding Yan , Zhang Qiufang , Tang Junming , Zhang Wenjun , He Xiju 
Published: June 2021

Abstract
Background
An emerging body of evidence indicates that puerarin (PUE) plays an important role in the treatment of angina pectoris, myocardial ischemia-reperfusion injury, hypertension and other cardiovascular diseases, but how PUE affects the vascular remodeling of hypertensive rats has not been reported yet. This study aimed to investigate the effect and mechanism of PUE on carotid arteries of spontaneously hypertensive rats (SHR) to provide the basis for the clinical application of PUE.

Methods
Thirty male SHR and six male Wistar Kyoto rats (WKY) aged 3 months were used in this study, SHR rats were randomly divided into 5 groups, PUE(40 or 80 mg/kg/d, ip) and telmisartan (TELMI) (30 mg/kg/d, ig) were administrated for 3 months. We use DMT myography pressure-diameter system to investigate biomechanical properties of carotid arteries, 10 μM pan-classical transient receptor potential channels (TRPCs) inhibitor SKF96365, 200 nM specific TRPC6 inhibitor SAR7334 and 100 μM Orai1 inhibitor ANCOA4 were used in the mechanical test.

Results
PUE can significantly decrease systolic and diastolic blood pressure, long-term administration of PUE resulted in a mild reduction of thickness and inner diameter of carotid artery. PUE ameliorate NE-response and vascular remodeling mainly through inhibiting TRPCs channel activities of VSMC.

Conclusion
PUE can ameliorate biomechanical remodeling of carotid arteries through inhibiting TRPCs channel activities of VSMC in spontaneously hypertensive rats.
Student support systems for undergraduate medical students during the COVID-19 pandemic: a systematic narrative review of the literature
Authors: Ardekani Ali , Hosseini Seyed Ali , Tabari Parinaz , Rahimian Zahra , Feili Afrooz , Amini Mitra , Mani Arash 
Published: June 2021

AbstractBackgroundThe coronavirus disease 2019 (COVID-19) pandemic has boosted medical students’ vulnerability to various problems. Given the stressful nature of medical disciplines, considerable attention must be paid to student support systems during pandemics. This study aimed to review the current literature regarding medical student support systems systematically.MethodsWe performed a systematic review of six databases and grey literature sources in addition to a hand search in the references of the articles on April 5, 2021. We included all studies about support for undergraduate medical students delivered in response to the COVID-19 pandemic. In conducting this review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsA total of 3646 articles were retrieved from the databases, and 16 additional papers were extracted from other sources. After removing duplicates, we screened 2434 titles and abstracts according to our criteria. Among them, 32 full-text articles were assessed for eligibility. Ultimately, 10 studies were included for review. We identified two major themes: (a) academic support and (b) mental health support. All of the included studies utilized online methods whether for transitioning from previous support systems or developing novel approaches. Students and faculty members seemed to be receptive to these new systems. Despite indicating outstanding program outcomes, most studies merely described the positive effects of the program rather than providing a precise evaluation.ConclusionThere are several methods of supporting medical students who are experiencing unprecedented changes in their educational trajectory. Due to substantial differences in undergraduate medical education in different regions of the world, cultural and contextual-oriented support is indispensable for developing a safe learning environment. Future research should investigate the question of the extent to which online support can supersede in-person strategies.
Validation of the attitudes to patient safety questionnaire for nursing students in the Spanish context
Authors: Cervera-Gasch Águeda , González-Chordá Víctor M , Manrique-Abril Fred Gustavo , Andreu-Pejo Laura , Valero-Chillerón María Jesús , Mena-Tudela Desirée 
Published: June 2021

Abstract
Background
There are different instruments to assess the attitudes of nursing students towards patient safety. However, no questionnaire validated in Spanish with this objective was identified. The objective of this study was to validate the Attitudes to Patient Safety (APS) questionnaire for nursing students in Spain and to study the attitudes towards patient safety of nursing students at the Universitat Jaume I (Spain).

Design
Cross-sectional psychometric study developed in a sample of 177 undergraduate nursing students. The study was carried out in the second semester of 2016.

Methods
First, a nominal group was created to perform cross-cultural adaptation and determine content validity of the Attitude to Patient Safety Questionnaire (APQS-III). Second, a cross-sectional study was conducted to determine the psychometric properties of the questionnaire and to study nursing student attitudes towards patient safety.

Results
Exploratory factorial analysis explained 53.82 % of the variance, with good internal consistency (α = 0.808), and confirmatory factor analysis indicate an adequate fit between the model and the data (χ2 = 366; p < 0.001; χ2/df = 1.886; RMSEA = 0.07; IC95 %=0.059–0.081; CFI = 0.885). Intra-observer reliability was good (ICC = 0.792, p < 0.001). The mean overall score of the questionnaire was 3.92 (95 % CI = 3.88–4.03). Significant differences were observed regarding whether the students had completed a clinical practicum (p = 0.012) and the academic year (p = 0.25).

Conclusions
The psychometric properties of the APS questionnaire adapted for Spanish nursing students are adequate. Students show an adequate attitude towards patient safety; however, it is necessary to develop a strategy to guarantee the acquisition of competency for patient safety as well as to design and evaluate specific educational interventions.
Impact of baseline clinical asthma characteristics on the response to mepolizumab: a post hoc meta-analysis of two Phase III trials
Authors: Lemiere Catherine , Taillé Camille , Lee Jason Kihyuk , Smith Steven G. , Mallett Stephen , Albers Frank C. , Bradford Eric S. , Yancey Steven W. , Liu Mark C. 
Published: June 2021

Abstract
Background
Severe asthma is associated with a broad range of phenotypes and clinical characteristics. This analysis assessed whether select baseline patient characteristics could prognosticate mepolizumab efficacy in severe eosinophilic asthma.

Methods
This was a post hoc meta-analysis of data from the Phase III MENSA (NCT01691521/MEA115588) and MUSCA (NCT02281318/200862) studies. Patients aged ≥ 12 years with severe eosinophilic asthma and a history of exacerbations were randomised to receive placebo (MENSA/MUSCA), mepolizumab 75 mg intravenously (MENSA) or 100 mg subcutaneously (SC) (MENSA/MUSCA) every 4 weeks for 32 (MENSA) or 24 (MUSCA) weeks. The primary endpoint was the annual rate of clinically significant exacerbations; other outcomes included the proportion of patients with no exacerbations and changes from baseline in pre-bronchodilator forced expiratory volume in 1 s (FEV1), St George’s Respiratory Questionnaire (SGRQ) total score and Asthma Control Questionnaire (ACQ)-5 score. Analyses were performed by baseline age of asthma onset (< 18 years; 18–40 years; ≥ 40 years); lung function (% predicted FEV1 ≤ 60; 60–80; > 80); airway reversibility (reversible [≥ 12% change in FEV1]; non-reversible [< 12% change in FEV1]); perennial and/or seasonal allergen sensitivity (yes/no); asthma control (uncontrolled [ACQ-5 score ≥ 1.5]; partial/complete control [ACQ-5 score < 1.5]).

Results
Overall, 936 patients received mepolizumab 100 mg SC or placebo. Across age at asthma onset, lung function and airway reversibility subgroups, mepolizumab reduced the rate of clinically significant exacerbations by 49–63% versus placebo. Improvements in lung function, SGRQ total score and ACQ-5 score were also seen with mepolizumab versus placebo across most age and lung function subgroups. Clinically significant exacerbations were reduced with mepolizumab versus placebo irrespective of season or allergen sensitivity; SGRQ total and ACQ-5 scores were generally improved across seasons.

Conclusions
Mepolizumab efficacy was consistent for patients with varying age at asthma onset, lung function, airway reversibility and allergen sensitivities at baseline. Our results indicate that mepolizumab is likely to be beneficial for patients with severe eosinophilic asthma with a broad range of baseline clinical characteristics; large-scale real-world studies are needed to confirm the external validity of these findings.
Trial registration Post hoc meta-analysis of data from MENSA (NCT01691521/MEA115588) and MUSCA (NCT02281318/200862)