bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic and Cardiovascular Effects of Body Weight Support Treadmill Walking in Healthy Adults
Authors: Van Zant R. Scott , Colchagoff Wick , Kunish Mike , Kunz Tamara , Marshall Mark , McDermott Sara , Myers Trevor , Sunga Byron 
Published: September 2020

Purpose:
Limited and conflicting evidence exists regarding the metabolic and cardiovascular responses of body weight support (BWS) treadmill training (BWSTT). The purpose of this study was to describe the metabolic (as assessed by oxygen uptake) and cardiovascular responses to varying levels of BWSTT in healthy adult subjects.

Methods:
Twenty-one subjects (10 females; 34.5 [6.7] yr.; 74.6 [14.3] kg; 170.8 [6.9] cm; 26.1 [5.3] kg/m2) provided their informed consent to participate in 3 5-minute walking trials at a self-selected treadmill speed, with BWS of 0%, 15%, and 30%. Test order was randomized. Subjects rested at least 5 minutes between trials and did not begin another trial until the heart rate (HR) was <5 bpm of HR rest. Mean HR, blood pressure (BP), oxygen uptake, and rating of perceived exertion (RPE) were determined from the last 3 minutes of each trial. Mean values for all variables were assessed for difference between trials using repeated-measures analysis of variance.

Results:
At rest, HR was 78.2 (11.5) bpm and BP was 121.2 (7.9)/76.9 (8.0) mm Hg. Mean walking speed of subjects was 65.4 m/min. Heart rate and systolic BP significantly (P < .05) increased from rest with exercise at each level of BWS, with no significant difference in diastolic BP seen from rest to exercise at all BWS levels. There was no statistical difference among levels of BWS for HR, BP, RPE, oxygen uptake, respiratory exchange ratio, respiratory rate, tidal volume, and metabolic equivalent of tasks.

Conclusions:
Healthy adult subjects walking at self-selected speeds at BWS levels up to 30% fail to demonstrate significant changes in metabolic and cardiovascular responses.
Beyond Skin Tumors: A Systematic Review of Mohs Micrographic Surgery in the Treatment of Deep Cutaneous Fungal Infections
Authors: Zargham Hanieh , Gabrielli Sofianne , Giordano Cerrene N. , Higgins Harold William 
Published: September 2020

BACKGROUND
Deep cutaneous fungal infections (DCFIs) can cause significant morbidity in immunocompromised patients and often fail medical and standard surgical treatments because of significant subclinical extension. Although rarely considered in this setting, Mohs micrographic surgery (MMS) offers the advantages of comprehensive margin control and tissue conservation, which may be beneficial in the treatment of DCFIs that have failed standard treatment options.

OBJECTIVE
To review the benefits, limitations, and practicality of MMS in patients with DCFIs.

METHODS
A systematic review of PubMed and EMBASE was conducted to identify all cases of fungal skin lesions treated with MMS.

RESULTS
Eight case reports were identified consisting of a total of 8 patients. A majority of patients had a predisposing comorbidity (75%), with the most common being a solid organ transplant (n = 3, 37.5%). The most commonly diagnosed fungal infection was phaeohyphomycosis (n = 5, 62.5%), followed by mucormycosis (n = 2, 25%). No recurrence or complication post-MMS was noted at a mean follow-up of 11.66 months.

CONCLUSION
Although not a first-line treatment, MMS can be considered as an effective treatment alternative for DCFIs in cases of treatment failure and can be particularly helpful in areas where tissue conservation is imperative.
Orbital Osteomas: Report of 3 Rapidly Progressive Cases in Adolescents and Systematic Literature Review
Authors: Tooley Andrea A. , Paulose Sefy A. , Tran Ann Q. , Godfrey Kyle J. , Kazim Michael 
Published: September 2020

Purpose:
The purpose of this study was to describe the clinical characteristics, management, and outcomes of orbital osteomas in the pediatric age group, and compare these to osteomas managed in the adult population.

Methods:
A retrospective review of 3 cases of rapidly progressive orbital osteomas in young patients was performed. In addition, a systematic review of the literature following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted to describe the clinical characteristics, management, and outcomes of orbital osteomas in the pediatric age group. The PubMed/MEDLINE database was searched in December 2019 for studies reporting data on patients with orbital osteomas.

Results:
Fifty-nine patients were included in this pediatric review, 39 male patients (68%), 18 female patients (32%), and 2 cases with unreported genders. Average age was 15.9 years with a range of 4–21 years. Average osteoma size measured 30.7 mm with a range of 9–60 mm. Adult osteoma size for comparison was smaller than 10 mm in majority of cases. The most common location of pediatric osteomas was the ethmoid sinus. The frontal sinus was the most common location in adult patients. Ninety-seven percent of reported pediatric cases required surgical intervention, compared with only 6.5% in adults.

Conclusions:
Orbital osteomas in younger patients are larger when identified, grow faster, are more likely to be symptomatic, and more likely to require surgical intervention compared with those identified in older patients. We recommend close monitoring of osteomas identified in young patients as well as counseling regarding the potential need for future resection.
Femtosecond laser–assisted cataract surgery in eyes with shallow anterior chamber depth: comparison with conventional phacoemulsification
Authors: Mencucci Rita , De Vitto Chiara , Cennamo Michela , Vignapiano Roberto , Buzzi Matilde , Favuzza Eleonora 
Published: September 2020

Purpose:
To compare the postoperative outcomes between femtosecond laser–assisted cataract surgery (FLACS) and conventional phacoemulsification in eyes with shallow anterior chamber depth (ACD).

Setting:
Eye Clinic, NEUROFARBA Department, University of Florence, Italy.

Design:
Prospective case series.

Methods:
Forty eyes of 40 patients with senile cataract and true ACD less than 2.00 mm underwent FLACS (femto group, n = 20) or manual phacoemulsification (phacoemulsification group, n = 20). Preoperatively and 1 week and 1 month and 6 months postoperatively, central corneal thickness (CCT) and endothelial cell density were evaluated; basal epithelial cell (BEC) and Langerhans dendritic cell (LDC) densities and keratocyte activation were assessed using in vivo corneal confocal microscopy. Intraoperative parameters such as cumulative dissipated energy (CDE) and ultrasound (US) power were recorded.

Results:
Endothelial cell loss (ECL) was significantly lower in the femto group at all timepoints (P ≤ .001). In the phacoemulsification group, the CCT was significantly higher 1 week (P < .001) and 1 month (P < .001) postoperatively than preoperatively; conversely, in the femto group, it was higher only after 1 week (P < .001). BECs and LDCs significantly increased at 1 postoperative week (P < .001), returning to preoperative values after 1 month in both groups. Keratocyte activation remained significantly higher at 1 postoperative month only in the phacoemulsification group (P = .005). CDE and US power were lower in the femto group (P = .017 and P = .001, respectively); they were correlated with ECL (r = 0.662, P = .000; r = 0.389, P = .013).

Conclusions:
In eyes with shallow ACD, FLACS was a safe and an effective technique, significantly reducing the postoperative ECL and corneal inflammation compared with conventional phacoemulsification.
Chlamydia Prevalence by Age and Correlates of Infection Among Pregnant Women
Authors: Simons Janice Leahgrace , McKenzie Jessica S. , Wright Nicole C. , Sheikh Shainela A. , Subramaniam Akila , Tita Alan T. N. , Dionne-Odom Jodie 
Published: September 2020

Background
There is a paucity of population-based data on chlamydia in pregnancy despite rising rates in US women. Our objectives were to assess chlamydia prevalence by age group and to identify factors associated with infection in pregnant women to inform screening guidelines.

Methods
This cross-sectional study included pregnant women tested for chlamydia who delivered at the University of Alabama at Birmingham between November 1, 2012, and December 31, 2017. The primary outcome was chlamydia prevalence, defined as a positive urogenital chlamydia nucleic acid amplification test result documented in the electronic medical record. Multivariable logistic regression was used to identify factors associated with infection.

Results
Among 17,796 women who delivered during the study period, 13,657 (77%) had chlamydia testing performed at the University of Alabama at Birmingham. Chlamydia prevalence (95% confidence interval) was 7.4% (7.0%–7.9%). Age-stratified prevalence rates were 14.6%, 4.3%, and 1.7% for women younger than 25 years, 25 to 29 years, and 30 years or older, respectively. Chlamydia in pregnancy remained strongly associated with age (adjusted odds ratio [95% confidence interval], 7.2 [5.6–9.2] for age <25 years, and 2.3 [1.7–3.0] for ages 25–29 years, when compared with >30 years) after adjustment for race, urban residence, and insurance status.

Conclusions
Among pregnant women living in the southeastern United States, chlamydia was detected in 1 of 14 women who were tested. Chlamydia positivity was highest among women younger than 30 years. Study findings support broad screening for chlamydia in pregnancy.
Fluid Reservoir Thickness and Corneal Edema during Open-eye Scleral Lens Wear
Authors: Fisher Damien , Collins Michael J. , Vincent Stephen J. 
Published: September 2020

SIGNIFICANCE
There is debate concerning corneal oxygenation during scleral lens wear due to the potential additive hypoxic effect of a lens plus a fluid reservoir. This study investigated the agreement between theoretical models and empirical measurements of scleral lens–induced corneal edema with respect to central fluid reservoir thickness.

PURPOSE
The purpose of this study was to examine the effect of altering the fluid reservoir thickness on central corneal edema during short-term open-eye scleral lens wear and to compare these empirical measurements with predictive theoretical models.

METHODS
Ten participants (age, 30 ± 4 years) with normal corneas wore highly oxygen-permeable scleral lenses (141 Dk ×10−11 cm3 O2 (cm)/[(s) (cm2) (mmHg)]) on separate days with either a low (mean, 144; 95% confidence interval [CI], 127 to 160 μm), medium (mean, 487; 95% CI, 443 to 532 μm), or high (mean, 726; 95% CI, 687 to 766 μm) initial fluid reservoir thickness. Epithelial, stromal, and total corneal edema were measured using high-resolution optical coherence tomography after 90 minutes of wear, before lens removal. Data were calculated or extracted from published theoretical models of scleral lens–induced corneal edema for comparison.

RESULTS
Scleral lens–induced central corneal edema was stromal in nature and increased with increasing fluid reservoir thickness; mean total corneal edema was 0.69% (95% CI, 0.34 to 1.04%), 1.81% (95% CI, 1.22 to 2.40%), and 2.11% (95% CI, 1.58 to 2.65%) for the low, medium, and high thickness groups, respectively. No significant difference in corneal edema was observed between the medium and high fluid reservoir thickness groups (P = .37). “Resistance in series” oxygen modeling overestimated the corneal edema observed for fluid reservoir thickness values greater than 400 μm.

CONCLUSIONS
Scleral lens–induced central corneal edema increases with increasing reservoir thickness, but plateaus at a thickness of around 600 μm, in agreement with recent theoretical modeling that incorporates factors related to corneal metabolism.
Case Report: Managing a Postgraft Keratoconus Patient with Scleral Lenses
Authors: Gulmiri Anita , Jawanda Amrit 
Published: September 2020

ABSTRACT

SIGNIFICANCE
Because the prognosis of corneal regrafting is worse than a primary graft, it is pertinent to recognize other clinical management options to postpone the need for surgical intervention. Scleral lenses are a viable option in achieving excellent vision and comfort for post-graft patients; however, close monitoring is vital to success.

PURPOSE
The purpose of this study was to report a case in which a post-graft keratoconus patient can be successfully fit and refit with scleral lenses as their corneal tissue changes shape with time. Ultimately, the goal for this patient was to delay the need for regrafting procedures.

CASE REPORT
This case presents a 57-year-old patient who has undergone penetrating keratoplasty in both eyes secondary to keratoconus. His original corneal grafts were 15 years or older. Because of a history of graft rejection in the right eye, he had a regraft in 2004. The left eye has signs of early rejection. The patient has been a scleral lens wearer since 2008. Within the past 24 months, he has required lens adjustments and refits because his fragile corneal tissue has changed shape. Lens changes were indicated when he presented with complaints of fogging associated with redness and irritation. We continued to work closely with the patient's corneal ophthalmologist, who recommended we maximize scleral lens wear in lieu of a corneal regraft. Because of the change from an oblate to prolate cornea, fitting this patient in a scleral lens has been a challenging task.

CONCLUSIONS
Scleral lenses are a viable option in post-graft patients who present with ectatic changes to their corneal tissue. This patient continues to see 20/20 in each eye and comfortably wears his lenses for up to 6 hours. By fitting this patient in a scleral lens, we have been able to avoid the need for a regraft and the possible negative outcomes that can be associated.
Scleral Lens–Induced Corneal Edema after Penetrating Keratoplasty
Authors: Kumar Mukesh , Shetty Rohit , Khamar Pooja , Vincent Stephen J. 
Published: September 2020

SIGNIFICANCE
Modern highly oxygen-permeable nonfenestrated scleral lenses induce approximately 1 to 2% corneal edema after short periods of lens wear in healthy individuals. This study investigated the magnitude and regional variation in scleral lens-induced central corneal edema after penetrating keratoplasty.

PURPOSE
The purpose of this study was to examine the magnitude and regional variation in corneal edema after a short period of scleral lens wear in post–penetrating keratoplasty eyes and a control group of eyes with healthy corneas.

METHODS
Nine post–penetrating keratoplasty eyes (nine participants; mean age, 32 years) were fitted with highly oxygen-permeable nonfenestrated scleral lenses (Dk 100 × 10−11 cm3 O2 (cm)/[(s) (cm2) (mmHg)]). Central corneal thickness was measured using Scheimpflug imaging before lens insertion and immediately after lens removal (mean wearing time, 6.2 hours). Corneal edema was quantified across the central 6 mm and compared with data obtained from a historical control group of healthy eyes using a similar experimental paradigm.

RESULTS
Post–penetrating keratoplasty eyes exhibited significant corneal edema after lens wear (2.99% [95% confidence interval, 1.13 to 4.85%]) averaged across the central 6 mm (P = .006) and regional variations in edema (P < .001) (greater swelling toward the graft-host junction inferiorly). Compared with healthy eyes, post–penetrating keratoplasty eyes displayed a greater magnitude of corneal edema (by ~3×) and greater variability in the corneal response (by ~2.5×).

CONCLUSIONS
Scleral lens–induced central corneal edema is greater in post–penetrating keratoplasty eyes and varies regionally compared with healthy corneas after short-term wear. Lens design and fitting factors contributing to hypoxic and mechanical corneal stress should be carefully considered for all post–penetrating keratoplasty scleral lens fits to minimize potential graft rejection or failure in the longer-term.
Integration of Chronic Disability Management in a Medical Student Curriculum
Authors: Bosques Glendaliz , Philip Kemly , Francisco Gerard E. 
Published: September 2020

Abstract
Increasing exposure to the needs of patients with chronic disability is important in fostering confidence and comfort in disability knowledge and management among medical students and residents of all disciplines. The 2013 Association of American Medical Colleges Graduation Survey of graduating medical students revealed that 33% expressed inadequate exposure to disability management and rehabilitative care. To address this, a 3- to 4-wk rehabilitation elective course was modified to include lectures, media-based reflections, and a hands-on wheelchair experience. Responses and reflections from students from November 2015 to February 2019 were analyzed to assess the impact of the intervention on medical student knowledge and clinical practice using a disability pretest and posttest design. Preintervention data revealed limited knowledge of terminology in disability health that improved greatly in the postelective assessment. Medical students also gained knowledge on disability laws, available resources, and improved identification of appropriate accommodations to limit barriers to care. Moreover, this novel, interdisciplinary rehabilitation elective experience increased medical student knowledge and exposure of disability management. Incorporating these changes into the medical school curriculum will be invaluable in training future physicians to close the gap in access to care for persons with disabilities.
Performance of a short, self-report adherence scale in a probability sample of persons using HIV antiretroviral therapy in the United States
Authors: Wilson Ira B. , Tie Yunfeng , Padilla Mabel , Rogers William H. , Beer Linda 
Published: September 2020

Background:
Excellent adherence to HIV antiretroviral therapy (ART) remains a cornerstone of HIV care. A three-item adherence self-report scale was recently developed and validated, but the scale has not been previously tested in a nationally representative sample.

Design:
We administered the adherence scale to participants in the Centers for Disease Control and Prevention's Medical Monitoring Project, which is a probability sample of US adults with diagnosed HIV.

Methods:
We combined sociodemographic and clinical participant data from three consecutive cycles of the Medical Monitoring Project (6/2015–5/2018). We used medical record reviews to determine most recent viral load, and whether viral loads were suppressed at all measurement points in the past 12 months. We describe the relationship between adherence scale score and two measures of viral load suppression (most recent and sustained), and estimate linear regression models using sampling weights to determine independent predictors of ART adherence scores.

Results:
Of those using ART, the median adherence score was 93 (100 = perfect adherence), and the standardized Cronbach's alpha was 0.83. For both measures of viral load suppression, the relationship with the adherence score was generally linear; there was no ‘cutoff’ point indicating good vs. poor adherence. In the multivariable model, younger age, nonwhite race, poverty, homelessness, depression, binge-drinking, and both non-IDU and IDU were independently associated with lower adherence.

Conclusion:
The adherence measure had good psychometric qualities and a linear relationship with viral load, supporting its use in both clinical care and research. Adherence interventions should focus on persons with the highest risk of poor adherence.
Brief Report: CYP27B1 rs10877012 T Allele Was Linked to Non-AIDS Progression in ART-Naïve HIV-Infected Patients: A Retrospective Study
Authors: Jiménez-Sousa María Angeles , Jiménez José Luis , Bellón José María , Fernández-Rodríguez Amanda , Iribarren Jose Antonio , López-Cortés Luís Fernando , Olalla-Sierra Julián , Martín-Rodrigo María Dolores , Muñoz-Fernández María Ángeles , Resino Salvador 
Published: September 2020

Background:
HIV/AIDS progression is linked to vitamin D, which is regulated by several key cytochromes P450 (CYP). Single nucleotide polymorphisms (SNPs) in CYP genes influence vitamin D metabolism and serum levels. The objective of this study was to evaluate the association between CYP SNPs and the clinical AIDS progression in antiretroviral treatment (ART)-naïve HIV-infected patients.

Methods:
We performed a retrospective study in 661 ART-naïve HIV-infected patients who were stratified by their AIDS progression pattern [181 long-term nonprogressors (LTNPs), 332 moderate progressors, and 148 rapid progressors (RPs)]. Four CYP SNPs (CYP2R1 rs10500804, CYP2R1 rs1993116, CYP27B1 rs10877012, and CYP24A1 rs6013897) were genotyped using Agena Bioscience's MassARRAY platform. Correction for multiple testing was performed using the false discovery rate (Benjamini–Hochberg procedure).

Results:
The adjusted regression showed a significant association only for CYP27B1 rs10877012 SNP. When analyzing all HIV patients, the rs10877012 T allele was protective against AIDS progression (ordinal outcome) under the dominant [adjusted odds ratio (aOR) = 0.69; P = 0.021) and additive (aOR) = 0.75; P = 0.025] inheritance models. When analyzing LTNPs versus RPs, the rs10877012 T allele also showed a significant protective association under the dominant (aOR = 0.45; P = 0.004) and additive (aOR = 0.54; P = 0.008) inheritance models. P values remained significant after correcting by multiple comparisons only for the comparison of LTNPs versus RPs (extreme phenotypes).

Conclusions:
The CYP27B1 rs10877012 T allele was linked to non-AIDS progression in ART-naïve HIV-infected patients. The rs10877012 SNP seems to have an impact on the clinical AIDS progression, possibly modifying vitamin D levels, which could be relevant for the pathogenesis of HIV infection.
A Comprehensive View on MRI Techniques for Imaging Blood-Brain Barrier Integrity
Authors: Elschot Elles P. , Backes Walter H. , Postma Alida A. , van Oostenbrugge Robert J. , Staals Julie , Rouhl Rob P.W. , Jansen Jacobus F.A. 
Published: September 2020

Abstract
The blood-brain barrier (BBB) is the interface between the blood and brain tissue, which regulates the maintenance of homeostasis within the brain. Impaired BBB integrity is increasingly associated with various neurological diseases. To gain a better understanding of the underlying processes involved in BBB breakdown, magnetic resonance imaging (MRI) techniques are highly suitable for noninvasive BBB assessment. Commonly used MRI techniques to assess BBB integrity are dynamic contrast-enhanced and dynamic susceptibility contrast MRI, both relying on leakage of gadolinium-based contrast agents. A number of conceptually different methods exist that target other aspects of the BBB. These alternative techniques make use of endogenous markers, such as water and glucose, as contrast media. A comprehensive overview of currently available MRI techniques to assess the BBB condition is provided from a scientific point of view, including potential applications in disease. Improvements that are required to make these techniques clinically more easily applicable will also be discussed.