bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiopulmonary Exercise Testing Using the Modified Balke Protocol in Fully Ambulatory People With Multiple Sclerosis
Authors: Feasel Corey D. , Sandroff Brian M. , Motl Robert W. 
Published: October 2020

Purpose:
This study examined the application, outcomes, and validity of cardiopulmonary exercise test (CPET) outcomes using a modified Balke protocol on a motor-driven treadmill in fully ambulatory people with multiple sclerosis (MS).

Methods:
Fully ambulatory people with MS (N = 20) underwent assessments of disability (Expanded Disability Status Scale, EDSS), walking endurance (6-minute walk distance, 6MWD), and cognition (Symbol Digit Modalities Test, SDMT), and completed a maximal CPET (modified Balke protocol) on a motor-driven treadmill while expired gases were collected with indirect calorimetry. Serious adverse events (AEs) and AEs, defined by National Institutes of Health guidelines, and provision of a “maximal” effort test using standard criteria for a maximal effort were documented. The physiological outcomes derived from the CPET included oxygen uptake (V̇o
2), carbon dioxide production, ventilation (VE), respiratory exchange ratio, and heart rate (HR). Other outcomes were calculated using standard guidelines, including V̇o
2/HR slope and oxygen uptake efficiency slope (V̇o
2/log10VE). Descriptive statistics were summarized with mean ± SD and descriptively compared with normative data from apparently healthy individuals using a similar CPET protocol. Spearman's rho rank-order correlations (ρ) were performed among peak V̇o
2 and SDMT, 6MWD, and EDSS scores.

Results:
There were no AEs, and 17 of 20 tests were characterized as yielding a maximal effort and therefore interpretable. V̇o
2 peak derived from the modified Balke protocol was predictably different in MS (25.8 ± 6.3) than normative values for healthy samples men (43.4 ± 9.3) and women (35.0 ± 7.2). V̇o
2 peak positively correlated with SDMT (ρ = 0.53, P = .01) and 6MWD (ρ = 0.73, P = .0003), and negatively correlated with disability (ρ = −0.51, P = .02).

Conclusions:
Cardiopulmonary exercise test using a modified Balke protocol on a motorized treadmill is safe, feasible, and valid for the measurement of aerobic power in fully ambulatory people with MS.
Rehabilitation of Patients Presenting With Coronavirus Disease-19 and Hemiparesis: A Case Series
Authors: Jordan Jennifer L. , Rice Jeremy , Bassett Shane , Lazore Jessica , Weeks Douglas L. 
Published: October 2020

Introduction:
The novel coronavirus disease-19 (COVID-19) has many unique features in its presentation. One increasingly noted symptom is the incidence of hypercoagulability which may lead to ischemic stroke. Physical therapists (PTs) are an integral component of the medical team and contribute to the early identification of stroke-like symptoms in patients with COVID-19.

Case Presentation:
This case series will describe the rehabilitation process of 3 patients who survived critical illness due to COVID-19 and had secondary complications including right hemiparesis while in critical care. Patients received rehabilitation by PTs and occupational therapists on average 6 times per week with interventions focused on recovery of strength, functional mobility, neurological re-education, and cognition. The mobility status was assessed with the Perme Intensive Care Unit Mobility Score.

Conclusion:
Patients who present with COVID-19 need careful screening for neurological impairment. Conventional means to diagnose stroke, such as radiological imaging, can be difficult to obtain in these unique circumstances because of infection control measures. Physical therapists can assist in early identification of neurological impairment in the absence of traditional diagnostic methods through identification of deficits in abilities such as mobility and balance.
Barriers and facilitators of laparoscopic surgical training in rural north-east India: a qualitative study
Authors: Wilkinson Ellen , Aruparayil Noel , Gnanaraj Jesudian , Mishra Anurag , Bains Lovenish , Bolton William , Brown Julia , Jayne David 
Published: October 2020

Introduction:
Laparoscopic surgery has advantages for treating many abdominal surgical conditions, but its use in low and middle-income countries (LMICs) is limited by many factors, including a lack of training opportunities. The aim of this study was to explore the training experiences of surgeons in rural north-east India to highlight the barriers and facilitators to laparoscopic surgery.

Methods:
Eleven surgeons with experience in laparoscopy in rural north-east India were recruited using purposive and convenience sampling. Ethical approval was obtained from the Institutional Ethics Committee, Maulana Azad Medical College, New Delhi, India and the Leeds Institute of Health Sciences Research Ethics Sub-Committee, West Yorkshire, England. Consenting participants took part in semi-structured interviews, either between May 20 and 25, 2019 in rural north-east India or via Skype or at the University of Leeds in June 2019. Interviews were audio-recorded and transcribed and thematic content analysis performed.

Results:
Exposure to laparoscopy during postgraduate training was common, but training experiences were inconsistent and informal. Alternative training opportunities are limited by availability and cost. There is high demand for a structured curriculum, incorporating formal assessment and credentialing, to include observation and assistance in live surgery and laparoscopic simulation.

Conclusions:
Laparoscopic training experiences are highly variable, with limited training resources and lack of a curriculum. Poor accessibility is consistent with that recorded in literature. Current recommendations include government support and funding to guide development of a standardized curriculum and widen access to training programs for surgeons in rural settings.
Scheimpflug Densitometry in Keratoconus: A New Method of Visualizing the Cone
Authors: Jiménez-García Marta , Ní Dhubhghaill Sorcha , Consejo Alejandra , Hershko Sarah , Koppen Carina , Rozema Jos J. 
Published: October 2020

Purpose:
To report an observation made while performing Scheimpflug densitometry analysis on the corneal region affected in keratoconus (KC) that seems to delineate the base of the cone.

Methods:
Scheimpflug densitometries of 20 healthy subjects and 90 patients with KC were examined. Corneal densitometry was analyzed using both “1-layer” and “2-layer” approaches. The first considers the corneal transparency layer by layer at different depths, whereas the second averages densitometry between 2 corneal layers selected by the examiner. Fixed layers, 120 μm depth, and endothelium were selected. Repeated same-day scans and longitudinal series of scans were also evaluated to see whether the findings evolved over time.

Results:
Eighty-eight of 90 KC cases displayed a bright area on the densitometry map that corresponded to the cone location. The area's characteristics, such as its brightness, contrast, and the presence of a delimiting arc correlated with KC severity and was more noticeable in advanced cases. No similar marks were found in any of the normal subjects. The shape, location, and extent of the mark were consistent over consecutive measures taken on the same day. Changes over time were also seen in eyes with known clinical progression but was also seen in eyes considered clinically stable.

Conclusions:
The densitometry mark seems to correspond with the zone most affected by KC and could be a supplementary tool for documenting KC stage, alongside conventional parameters. Further studies are required to ascertain whether it could prove useful in KC detection, to determine progression, and to relate it to corneal biomechanical behavior.
Long-term Follow-up of 14 Eyes With Bilateral and Multiple Ciliary Body Cysts: Prognosis of this Rare Entity
Authors: Hugo Juliette , Feumi Charles , Morin Adèle , Nguyen Michelle , Lachkar Yves 
Published: October 2020

Purpose:
To describe the long-term outcomes of eyes with bilateral and multiple ciliary body cysts (CBC).

Methods:
This retrospective study included patients with multiple and bilateral CBC diagnosed by high-resolution ultrasound biomicroscopy and followed by a single glaucoma specialist from 2000 to 2020. All patients underwent complete ophthalmic examination including dynamic indentation gonioscopy, retinal nerve fiber layer (RNFL) measurement by optic coherence tomography and automated perimetry.

Results:
Seven patients (14 eyes) with bilateral and multiple CBC were included with a mean follow-up of 98±39 months. Four eyes of 2 patients had complete angle closure at first examination and 3 of them underwent trabeculectomy with good visual outcomes. Four eyes of 2 patients had a reversible angle-closure at first examination and underwent a ultrasound biomicroscopy–guided laser peripheral iridotomy (LPI) which reopened the irido-corneal angles. Two of these eyes needed intensification of hypotensive drops during the follow-up. Among the 6 eyes (3 patients) with open angle at first examination, all had had LPI at last follow-up visit, 5 had normal RNFL and visual field and 1 received an additional hypotensive drop because of RNFL progression.

Conclusion:
Our long-term cohort of bilateral and multiple CBC demonstrates that this rare entity may have a good prognosis if LPI is performed before extension of peripheral anterior synechiae. Irreversible angle closure required trabeculectomy in 75% of cases in our cohort with however good visual outcomes.
Sensitivity to Central Crowding for Faces in Patients With Glaucoma
Authors: Stievenard Aymeric , Rouland Jean F. , Peyrin Carole , Warniez Aude , Boucart Muriel 
Published: October 2020

Precis:
Some patients with glaucoma report difficulties to recognize faces when they are far away. We show that this deficit could result from a higher sensitivity to crowding in central vision.

Purpose:
The aim of the study is to investigate whether face recognition difficulties reported by some patients with glaucoma result from a greater sensitivity to inner crowding in central vision.

Methods:
Seventeen patients with glaucoma and 17 age-matched normally sighted controls participated in the study. An isolated mouth (uncrowded condition) or a mouth within a face (crowded condition) was randomly displayed centrally for 200 ms. For each condition, participants were asked to decide whether the mouth was closed or open. The stimuli were presented at 3 angular sizes (0.6×0.4, 1×0.72, and 1.5×1.08 degrees). Accuracy was measured.

Results:
Crowding affected performance differentially for patients and controls. Consistent with previous studies controls exhibited a “face superiority effect,” with a better accuracy when the mouth was located within the face than when it was isolated. Sensitivity to crowding, reflected in a better accuracy with the isolated mouth, was observed in 10 of 17 patients only for small images. Crowding disappeared for larger faces, as the facial features were spaced out. Five patients were not sensitive to crowding. Importantly, no difference was found between the 2 subgroups of patients (sensitive vs. nonsensitive) in terms of mean deviation, contrast sensitivity, acuity, thickness of the retinal nerve fiber layer, or macular ganglion cell-inner plexiform layer.

Conclusions:
An excessive sensitivity to central crowding might explain the difficulties in face perception and reading reported by some patients with glaucoma. The sensory or cognitive processes underlying this excessive sensitivity must be elucidated to improve central perception in glaucoma.
Assessment of Ocular Surface Disease in Glaucoma Patients in Ghana
Authors: Kobia-Acquah Emmanuel , Gyekye Gloria Atta-Penkra , Antwi-Adjei Ellen K. , Koomson Nana Y. , Cobbina Francis , Donkor Richard , Akowuah Prince K. 
Published: October 2020

Precis:
Dry eye disease (DED) observed in this study is associated with ocular surface abnormalities as shown by specific dry eye tests. Changes in tear quality may be responsible for dry eye symptoms among the participants.

Purpose:
This study sought to evaluate DED in glaucoma patients in Ghana.

Materials and Methods:
This was a hospital-based descriptive cross-sectional study involving glaucoma patients on topical glaucoma treatment for at least 6 months. The medical records of participants were thoroughly reviewed for information on demographics, ocular history, medical history, number of topical antiglaucoma medications used within the last 6 months, and any other ophthalmic medications used by the participants. An Ocular Surface Disease Index (OSDI) questionnaire was administered to each participant, after which Schirmer test and tear break-up time (TBUT) were performed on each participant in a controlled environment.

Results:
A total of 100 individuals participated in the study. The mean±SD age of participants was 60.44±14.05 years. The majority (60.0%) of the participants were females and 55.0% of participants used 2 or more topical antiglaucoma medication. Of the participants, 81.0% reported subjective dry eye symptoms. Schirmer test and TBUT showed that 55.0% and 87.0% of the participants had decreased tear production and abnormal tear quality, respectively. Multiple logistic regression showed a significant association between age and abnormal OSDI (P=0.037), Schirmer test (P=0.003), and TBUT (P=0.042); the number of topical glaucoma medications and OSDI (P=0.016) and Schirmer test (P=0.009). The prevalence of DED was 23.0%. Increasing age was associated with an ∼7 times higher odds of having DED (P=0.0019), using >2 glaucoma medications with ∼4.5 times higher odds of having DED (P=0.001), 5 or more years of glaucoma medication use with ∼4 times higher odds of DED (P=0.009), and both benzalkonium chloride and sodium chlorite as preservative was associated with ∼3.5 times higher odds of DED (P=0.047).

Conclusion:
DED is prevalent among glaucoma patients in Ghana and is associated with age, duration of glaucoma medication, type of preservatives, and number of topical glaucoma medications.
Hemorrhagic Descemet’s Membrane Detachment in Nonpenetrating Glaucoma Surgery
Authors: Djavanmardi Shirin , Arciniegas-Perasso Carlos A. , Duch Susana , Avila-Marrón Elena , Milla Elena 
Published: October 2020

Purpose:
To describe 5 representative cases of hemorrhagic Descemet’s membrane (DM) detachment in glaucoma surgery that had different origins, mechanisms and treatments.

Methods:
Clinical records of patients that had undergone a nonpenetrating glaucoma surgery, with a diagnosis of hemorrhagic DM detachment were reviewed for demographic data, clinical findings and treatment applied.

Results:
Five patients with hemorrhagic DM detachment were included in this case series. They all had different causes, namely a massive hemorrhage at the end of a canaloplasty procedure, a needling maneuver, autologous blood injection, Swan syndrome, and frequent eye rubbing. Hematoma evacuation was performed in 4 eyes, 1 of them from under the scleral flap of the deep sclerectomy and 3 of them through a surgical or laser perforation in DM. Air tamponade was done in most of these cases. One of these cases required transcorneal suture fixation. One case was observed expectantly. All cases successfully recovered but peripheral corneal stain was persistent in 2 cases.

Conclusion:
Hemorrhagic DM detachment is a rare but potential vision-threatening complication in glaucoma surgery. Different mechanisms may cause the bleeding and there are several techniques available to approach this complication. Pre-Descemet hematoma should be drained to avoid permanent corneal stain and air/gas tamponade may help to prevent recurrences.
Exposure to Air Pollution and Risk of Hip Fracture
Authors: Oh Tak Kyu , Song In-Ae 
Published: October 2020

Objectives:
We aimed to investigate whether exposure to air pollutants was associated with the risk of hip fracture.

Methods:
We extracted data on a 2010 cohort of the adult population (more than or equal to 30 years old) from a South Korean database.

Results:
A total of 178,147 individuals were included in the analysis, and hip fracture had occurred in 919 individuals (0.5%). In a multivariable logistic regression model, a 1 mcg/m3 increase in concentrations of particulate matter measuring of less than or equal to 10 μm was associated with 2% increase in hip fracture risk (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01 to 1.03; P = 0.039); there were no significant associations between hip fracture risk and exposure to SO2 (P = 0.076), ozone (P = 0.220), carbon monoxide (P = 0.698), or sulfur dioxide (P = 0.114).

Conclusions:
Particular matter air concentration may be a modifiable risk factor for hip fracture.
Creating a “Culture of Triage”: A Dual-Perspective Study of Interruptions During ICU Rounds
Authors: Rosenblatt Samuel A. , Balmer Dorene F. , Boyer Donald L. 
Published: October 2020

Objectives:
To explore interrupters’ and interruptees’ experiences of interruptions occurring during morning rounds in a PICU in an attempt to understand better how to limit interruptions that threaten patient safety.

Design:
Qualitative ethnographic study including observations, field interviews, and in-depth interviews.

Setting:
A 55-bed PICU in a free-standing, quaternary-care children’s hospital.

Subjects (Participants):
Attending physicians, fellow physicians, frontline clinicians (resident physicians and nurse practitioners), and nurses working in the PICU.

Interventions:
Data collection occurred in two parts: 1) field observations during morning rounds with brief field interviews conducted with participants involved in an observed interruption and 2) in-depth interviews conducted with selected participants from prior field observations.

Measurements and Main Results:
Data were coded using a constant comparative method with thematic analysis, clustering codes into groups, and subsequently into themes. We observed 11 rounding encounters (17 hr of observation and 48 patient encounters), conducting 25 field interviews and eight in-depth interviews. Themes included culture of interruption triage, interruption triage criteria, and barriers to interruption triage. Interruptees desired forming a culture of triage, whereby less-urgent interruptions were deferred until later or addressed through an asynchronous method; this desire was misaligned with interrupters who described ongoing interruption triage based on clinical changes, time-sensitivity, and interrupter comfort, despite not having a formal triage algorithm. Barriers to interruption triage included a lack of situational awareness and experience among interrupters and interruptees.

Conclusions:
Interrupters and interruptees did not have a shared understanding of the culture of triage within the PICU. Although interrupters attempted to triage interruptions, no formal triage algorithm existed and interruptees did not perceive a triaging culture. Using data from this study, we created a triage algorithm that could inform future studies, potentially decrease unnecessary interruptions, and optimize information sharing for essential interruptions.
Lumbar Spinal Stenosis and Potential Management With Prostaglandin E1 Analogs
Authors: Marcolina Austin , Vu Kevin , Annaswamy Thiru M. 
Published: October 2020

Abstract
Lumbar spinal stenosis is one of the most commonly diagnosed spinal disorders worldwide and remains a major cause for surgery in older adults. Lumbar spinal stenosis is clinically defined as a progressive degenerative disorder with low back pain and associated neurogenic intermittent claudication. Conservative and surgical management of lumbar spinal stenosis has been shown to be minimally effective on its symptoms. A treatment option that has not been investigated in the United States is the utilization of prostaglandin E1 analogs, which have been used primarily in Japan for the treatment of lumbar spinal stenosis since the 1980s. The vasodilatory and antiplatelet aggregation effects of prostaglandin E1 presumably improve symptoms of lumbar spinal stenosis by increasing blood flow to the spinal nerve roots. This brief report examines the potential vascular pathology of lumbar spinal stenosis, reviews evidence on the use of prostaglandin E1 analog limaprost in Japan for lumbar spinal stenosis, and briefly discusses misoprostol as a possible alternative in the United States. The studies summarized in this report suggest that prostaglandin E1 analogs may provide benefit as a conservative treatment option for patients with lumbar spinal stenosis. However, higher-quality studies conducted in the United States and comparison with other currently used conservative treatments are required before it can be recommended for routine clinical use.
Carpal Tunnel Syndrome in Autoimmune Rheumatic Diseases and Inflammatory Bowel Diseases
Authors: Hsu Po-Cheng , Chiu Jan-Wei , Yang Yi-Chiang , Jeng Mei-Jy 
Published: October 2020

Objective
The relationship between autoimmune rheumatic diseases, inflammatory bowel diseases, and carpal tunnel syndrome is unclear. We aimed to survey the occurrence and characteristics of carpal tunnel syndrome in autoimmune rheumatic diseases and inflammatory bowel diseases, compared with the general population.

Methods
We used the Longitudinal Health Insurance Database 2015 from Taiwan’s National Health Insurance Research Database. Patients diagnosed with autoimmune rheumatic diseases/inflammatory bowel diseases were identified. The incidence rates and surgical rates of carpal tunnel syndrome among individual diseases were calculated. The hazard ratios when compared with age and sex matched, and 1:1 ratio control groups were surveyed.

Results
A total of 2591 women and 701 men were identified. The incidence rate of carpal tunnel syndrome was highest in Crohn disease (1001 per 100,000 person-years, 95% confidence interval = 0–2747), followed by scleroderma and Sjögren syndrome. The incidence rate in the control group was 571 per 100,000 person-years (95% confidence interval = 314–829). Significantly increased adjusted hazard ratios were seen in Sjögren syndrome (1.44, 95% confidence interval = 1.09–1.90) and rheumatic arthritis (1.33, 95% confidence interval = 1.05–1.70). The overall surgical rate was 0.2% in patients with autoimmune rheumatic diseases/inflammatory bowel diseases and 0.3% in the control group, without a significant difference (P = 0.85).

Conclusions
Patients with Sjögren syndrome and rheumatic arthritis are susceptible to carpal tunnel syndrome. Patients with autoimmune rheumatic diseases/inflammatory bowel diseases have similar surgical rates as general population.