bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Application of the Internal Mammary Artery Perforator Adipofascial Flap
Authors: Nishimon Mari , Ohara Hirotoshi , Ohara Kanetoshi , Ogata Hisao , Kishi Kazuo 
Published: March 2019

Background:
Skin ulcers on the anterior chest wall are caused mainly by radiation therapy for breast cancer and anterior mediastinitis after thoracotomy, and they are often refractory. Some muscle flaps are commonly used for anterior chest wall reconstruction, but muscle flaps accompany high invasion. We used the internal mammary artery perforator (IMAP) adipofascial flap and IMAP skin flap for the anterior chest wall reconstruction.

Methods:
We examined the IMAPs using a handheld Doppler device and contrast-enhanced computerized tomography preoperatively. Each flap was designed based on the location of the IMAP and the size of the flap was dependent on the coverage required by the size and location of the skin ulcer. The location of the IMAPs functioned as the pivot point of the flap and the flap was flipped or swung on the defect.

Results:
We used IMAP adipofascial flap for 2 cases and IMAP skin flap for 1 case. In those 3 cases, we could elevate the flap with no complications even after the internal mammary artery had been harvested. There was no recurrence of the skin ulcer or wound infection after the operation.

Conclusions:
In this study, we reported 3 cases of skin ulcer on the anterior chest wall reconstructed with the IMAP adipofascial and skin flap. To our knowledge, this is the first report of the use of the IMAP flap as an adipofascial flap. The IMAP adipofascial flap accompanies less invasion than muscle flaps and the surgical procedure is relatively easy. The IMAP adopofascial flap is considered as one of the effective means for anterior chest wall reconstruction.
Muscle Dysfunction in Smokers and Patients With Mild COPD
Authors: Fonseca Jéssica , Nellessen Aline Gonçalves , Pitta Fabio 
Published: March 2019

Purpose:
To describe and discuss the available evidence in the literature concerning muscle function and the association between smoking and muscle dysfunction in smokers and patients with mild chronic obstructive pulmonary disease (COPD).

Methods:
The literature search involved the following databases: PubMed, Pedro, CINAHL, Cochrane Library, Lilacs, and EMBASE. Studies were included if they investigated muscle strength and/or endurance and/or cross-sectional area (CSA) in smokers and/or patients with COPD classified as Global Initiative for Obstructive Lung Disease (GOLD) I and without lung cancer. Two authors screened and identified the studies for inclusion.

Results:
Eighteen studies were identified. Some studies found lower values in a variety of muscle strength variables in smokers compared with nonsmoking controls, whereas others found similar values between these groups. When comparing patients with COPD classified as GOLD I with smokers, COPD patients showed lower muscle strength. Two studies found no differences in muscle CSA between smokers compared with nonsmoking controls. Some preliminary evidence also shows that patients with COPD classified as GOLD I had lower CSA in comparison with smokers.

Conclusion:
Results concerning muscle dysfunction in smokers are divergent, since some studies have shown worse results in a variety of muscle strength variables in smokers compared with nonsmoking controls, whereas other studies have not. Moreover, there is rather preliminary evidence indicating worse muscle dysfunction and lower CSA in patients with mild COPD in comparison with healthy (or non-COPD) smokers.
Radiation Biology and Its Role in the Canadian Radiation Protection Framework
Authors: Leblanc Julie E. , Burtt Julie J. 
Published: March 2019

Abstract
The linear no-threshold (linear-non-threshold) model is a dose-response model that has long served as the foundation of the international radiation protection framework, which includes the Canadian regulatory framework. Its purpose is to inform the choice of appropriate dose limits and subsequent as low as reasonably achievable requirements, social and economic factors taken into account. The linear no-threshold model assumes that the risk of developing cancer increases proportionately with increasing radiation dose. The linear no-threshold model has historically been applied by extrapolating the risk of cancer at high doses (>1,000 mSv) down to low doses in a linear manner. As the health effects of radiation exposure at low doses remain ambiguous, reducing uncertainties found in cancer risk dose-response models can be achieved through in vitro and animal-based studies. The purpose of this critical review is to analyze whether the linear no-threshold model is still applicable for use by modern nuclear regulators for radiation protection purposes, or if there is sufficient scientific evidence supporting an alternate model from which to derive regulatory dose limits.
PATIENTS PRESENTING EMERGENTLY WITH PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Hinkle John W. , Flynn Harry W. , Banta James T. , Vanner Elizabeth A. 
Published: March 2019

Purpose:
To determine the rate of follow-up after emergent encounters for proliferative diabetic retinopathy and to identify patient or visit characteristics associated with follow-up compliance.

Methods:
A retrospective cohort study of patients presenting to an ophthalmic emergency department with active proliferative diabetic retinopathy between May 2014 and December 2016 was conducted. Demographic data and encounter data were gathered for each emergency department visit. Compliance with follow-up was defined as a completed clinic visit as scheduled after the emergency encounter.

Results:
A total of 590 emergency department encounters were included. The overall follow-up rate was 61.9%. Married patients and those with Public Health Trust insurance had increased odds of compliance (odds ratio [OR]: 1.507, P = 0.04; OR: 2.749, P < 0.0001). Patients with Medicaid had reduced odds (OR: 0.543, P = 0.004). Patients with longer emergency department encounters and longer intervals to follow-up had reduced odds (OR: 0.948, P = 0.001; OR of 0.941, P < 0.0001). The other characteristics were not significantly associated with follow-up compliance.

Conclusion:
Patients who present emergently with active proliferative diabetic retinopathy are at high risk of following up noncompliance. Characteristics with significant effects on the odds of follow-up compliance include specific insurance payer, marriage status, length of visit, and interval to follow-up.
Long-term Follow-up of Partial Bleb Excision in Late-onset Bleb-related Complications by a Single Surgeon Using Conjunctival Advancement
Authors: Canut María I. , Cobián Ramón , Fernández-Vega Andrés , Julio Gemma , Barraquer Rafael I. 
Published: March 2019

Purpose:
The purpose of this study was to describe the long-term results of partial bleb excision in late-onset bleb-related complications by a single experienced surgeon using the same surgical technique.

Patients and Methods:
This was a retrospective study of 21 eyes of 11 women and 10 men aged 34 to 87 years (mean 64±12.8 y) who underwent first repair of late-onset bleb leaks with or without numerical hypotony (NH) and dysesthesia. The surgical technique consists of removing nonviable conjunctiva until the functional tissue becomes visible, thus adapting to individual conditions, and later conjunctival advancement. Complete success was defined as maintenance of intraocular pressure control without additional bleb revision, surgery, or glaucoma medications. Qualified success met these criteria, but with glaucoma medications.

Results:
The mean follow-up was 5.6±4.4 years (1 to 17 years). Sixty-two percent of the cases were considered complete success, and a moderate number of cases (19%) needed glaucoma medication for achieving qualified success at the end of the follow-up period. Interestingly, bleb leak with NH seems to have long-term outcomes, like the other bleb-related complications (in terms of success and failures), with a significant intraocular pressure increase at 1 month after revision that tended to remain within normal values and lead to visual acuity recovery without recurrent NH.

Conclusions:
Partial bleb excision seems to be a good technique for different late-onset bleb-related complications. Bleb leak with NH showed a good long-term response, like the other bleb revision indications.
Dyslipidemia, Dyslipidemia Treatment, and Open-angle Glaucoma in the Korean National Health and Nutrition Examination Survey
Authors: Shon Kilhwan , Sung Kyung Rim 
Published: March 2019

Purpose:
The purpose of this study was to investigate the association between dyslipidemia treatment and open-angle glaucoma (OAG).

Patients and Methods:
We included 16,939 participants aged ≥40 years from the Korea National Health and Nutrition Examination Survey (2008 to 2012) and classified them into 2 groups based on current dyslipidemia treatment. The prevalence of OAG was determined using the modified International Society of Geographical and Epidemiological Ophthalmology criteria. The association between dyslipidemia treatment and OAG was evaluated using logistic mixed-effects model and propensity-score-weighted odds ratios.

Results:
Analyses using the 2 abovementioned models revealed that dyslipidemia treatment was not associated with OAG (odds ratio, 1.08; 95% confidence interval, 0.75-1.56; P=0.838 and 1.03; 0.71-1.48; P=0.882, respectively), presence of optic disc hemorrhage (0.64; 0.15-2.73; P=0.648 and 1.10; 0.39-3.11; P=0.855), high vertical cup-to-disc ratio or asymmetry (1.02; 0.81-1.28; P=0.736 and 0.95; 0.75-1.20; P=0.650), presence of retinal nerve fiber layer defects (0.97; 0.67-1.42; P=0.857 and 1.03; 0.75-1.42; P=0.857), and presence of visual field defects (0.93; 0.55-1.54; P=0.931 and 0.97; 0.81-1.52; P=0.528). Total cholesterol and high-density lipoprotein cholesterol were also not associated with OAG. However, higher serum triglyceride levels were associated with OAG in the treated patients (1.31; 1.02-1.68; P=0.027) but not in the untreated patients (1.03; 0.93-1.14; P=0.079).

Conclusions:
In the Korean population, dyslipidemia treatment was not significantly associated with open-angle glaucoma. However, hypertriglyceridemia was associated with OAG in treated patients.
Establishing the Reliability of a Tool for Assessing Israeli Physical Therapy Students' Clinical Performance
Authors: Schwartz Donny , Jacob Tamar 
Published: March 2019

Introduction.
The evaluation of students' abilities in the clinical setting requires the use of a valid and reliable assessment tool. The assessment tool currently used for this purpose in all physical therapy (PT) undergraduate programs in Israel has never been evaluated for these parameters. This study aimed to find an established assessment tool, translate it into Hebrew, and determine the inter-rater reliability of the translated version and whether it could be a viable substitute for the currently used assessment tool.

Review of the Literature.
Revealed that the Assessment of Physiotherapy Practice (APP) is an established, valid, and reliable assessment tool.

Subjects.
Assessors: 21 clinical educators; assessed: 30 undergraduate PT students.

Methods.
The APP was translated into Hebrew using the translation–retranslation method. Clinical educators were briefly trained to use the APP before the study. Following 8 weeks of clinical practice in an assigned outpatient clinic, each student was assessed by 2 clinical educators, each of whom used both the APP and the currently used assessment tool. Intraclass correlation coefficient (ICC) was used to measure the inter-rater reliability of the APP. Cronbach's alpha was used to measure the internal consistency of the sections of the APP. Percentage of agreement between assessors was measured for each item.

Results.
The ICC for the total APP was 0.88 (95% confidence interval: 0.77–0.94). The internal consistency of APP sections ranged from 0.65 to 0.93 Cronbach's alpha. Exact agreement between assessors on 12 of the 20 items was identical in 63% or more occasions.

Discussion and Conclusion.
The ICC for the total score on the Hebrew APP was similar to that of the original APP, and the percentage of agreement among assessors was slightly lower than that of the original version. The latter may be due to the educators' limited experience with this assessment tool. The inter-rater reliability and validity of the Hebrew APP established it as a good substitute for the currently used assessment tool.
Implementation of a Hospital-Based Orthopaedic Physical Therapy Residency Program: A Case Report Describing Clinical Outcomes, Productivity, and Perceived Benefits
Authors: Winslow John , Costello Michael 
Published: March 2019

Background and Purpose.
Currently, there are 264 credentialed physical therapy residencies across the United States. Most residency programs take a limited number of residents per year, thus the opportunity for the projected 10,721 physical therapy students graduating in 2019 was relatively small. One of the challenges to developing a new physical therapy residency is convincing the host institution that it will be beneficial in the long-term. The purpose of this case report was to describe the effect of implementing a hospital-based orthopaedic physical therapy residency program on clinical outcomes, productivity, and the perceived benefits of the residency program by staff physical therapists and hospital administrators.

Case Description.
The Patient-Specific Functional Scale (PSFS) was used to assess treatment outcomes for 2 years before the start of the residency program (2007–2008) and for each of the 4 years after the inauguration of the first resident (2009–2012). A total of 3,717 patient outcome scores were used in the analysis. Productivity, measured in “patient visits” and zip code data, representing the service area, was also collected. In addition, staff physical therapists and administrators completed a survey to determine their perceived benefits of the residency program.

Outcomes.
There was a steady improvement in clinical outcomes from 2007 to 2012. In 2007, the average change in the PSFS was 3.81 and in 2012, 4 years after the start of the residency program, the average change in PSFS increased 37% to 5.21. The number of patient visits increased to 60,983 (+17,071), and patients were travelling from outside the service area (41 additional zip codes) to receive treatment at the hospital from staff physical therapists with specialized training. Survey results indicate that both staff physical therapists and hospital administrators had a very positive view of the impact of the residency program on job satisfaction, professional development, staff retention, and success of the department.

Discussion and Conclusion.
The results of this study suggest that hospital-based orthopaedic physical therapy residency programs have the potential to improve clinical outcomes, increase productivity, and create a “culture of excellence.” It provides some justification for hospitals and other physical therapy facilities to invest in residency training.
Text messaging as an intervention for weight loss in emerging adults
Authors: Keating Sharon R. , McCurry Mary 
Published: March 2019

ABSTRACT

Background and purpose:
Rates of overweight and obesity in emerging adults are rapidly increasing and associated with many chronic illnesses, quality of life concerns, and increased health care spending. Effective weight management interventions are needed for this population. The purpose of this study was to examine effects of a text-messaging weight loss intervention on motivation, stage of change for weight loss, and BMI.

Methods:
Overweight and obese emerging adults were enrolled (n = 188) and randomized to control or intervention groups. Weight loss information was delivered via a website to both groups. The intervention group also received daily weight loss–related text messages. Motivation, stage of change, and BMI were assessed online, via self-report at baseline, 4, and 8 weeks.

Conclusions:
Ninety-five participants were included in the final data analysis. There was a significant increase in motivation and stage of change and decrease in BMI over the study duration, with no significant differences between groups.

Implications for practice:
Nurse practitioners are well positioned to provide innovative weight loss interventions in a variety of settings. These results provide important insights for the design of effective weight loss treatment for emerging adults and support the use of web-based and text message–based interventions.
Risk Factors for Gastrointestinal Symptoms Following Successful Eradication of Clostridium difficile by Fecal Microbiota Transplantation (FMT)
Authors: Allegretti Jessica R. , Kassam Zain , Fischer Monika , Kelly Colleen , Chan Walter W. 
Published: March 2019

Background:
Fecal microbiota transplantation (FMT) is a promising therapy for recurrent Clostridioides difficile infection (CDI). Many patients report altered bowel habits including constipation, bloating, gas and loose stool post-FMT despite resolution of CDI, and the etiology remains unclear.

Methods:
This was a prospective cohort study of adult patients with recurrent CDI who underwent FMT (1) via colonoscopy with patient-selected donor stool, (2) via colonoscopy from a universal stool bank donor, or (3) via capsules from a universal stool bank. Reassessment occurred 8 weeks post-FMT. Those cured were assessed for gastrointestinal symptoms (bloating, loose stools, constipation). Multivariate logistic regression was performed to assess predictors of post-FMT gastrointestinal symptoms.

Results:
A total of 150 subjects underwent FMT for recurrent CDI, of which 68.7% (103) were female, mean age was 61.5 years±18.1 and 31 patients (20.7%) had preexisting irritable bowel syndrome. Thirty-six had FMT via colonoscopy with a patient-selected donor, 67 via colonoscopy with stool bank donors, and 47 via FMT capsules from stool bank donors. Among those cured, 41 (31.2%) had gastrointestinal symptoms post-FMT. The factors associated with symptoms included younger age (57.2 vs. 64.1 y, P=0.03), a baseline history of irritable bowel syndrome (36.6% vs. 13.3%, P=0.002) and preexisting inflammatory bowel disease (31.7% vs. 10%, P=0.002). Small bowel exposure to donor stool was not related to symptoms (63.4% vs. 62.2%, P=0.89).

Conclusions:
Altered bowel habits are a consequence of CDI and are common after FMT. This study suggests that donor type and FMT delivery modality are not related to the presence of irregular gastrointestinal symptoms after FMT.
Pain and sickle cell disease
Authors: Aich Anupam , Jones Michael K. , Gupta Kalpna 
Published: March 2019

Purpose of review
Pain is a major comorbidity of sickle cell disease (SCD). Opioids are the mainstay for pain treatment but remain suboptimal. We discuss mechanism-based treatable targets devoid of opioids to prevent and/or treat SCD pain.

Recent findings
Understanding the pathogenesis of pain is critical to develop targeted therapies. Nevertheless, acute and chronic pain can have independent and/or overlapping mechanisms. The origin of pain involves neurovascular and neuroimmune interactions from the periphery and/or central nervous system. Immunomodulatory components of acute and/or chronic sickle pain for targeting/preventing pain genesis include mast cell and microglial activation, neurogenic inflammation, and leukocyte-derived elastase. Vascular modulators include hypoxia/reperfusion injury, oxidative stress, hemolysis, and adhesion molecules. However, existent pain requires analgesics devoid of an inadvertent effect on sickle pathobiology. Recent analgesic targets include cannabinoid and nociceptin receptors and serotonergic spinothalamic pathway. Complementary approaches (e.g., acupuncture, hypnosis, perception-based therapies) have shown analgesic potential. Owing to heterogeneity in pain development, it remains challenging to combat SCD pain with any one therapy.

Summary
SCD pain involves neuroimmune and neurovascular interactions. Such interactions have pronociceptive impacts and impart therapy resistance. Elucidating molecular and cellular entities affecting neuronal interactions in sickle microenvironment may prevent SCD pain and/or provide improved analgesic approaches.
Mixed Lipid, Fish Oil, and Soybean Oil Parenteral Lipids Impact Cholestasis, Hepatic Phytosterol, and Lipid Composition
Authors: Isaac Daniela Migliarese , Alzaben Abeer S. , Mazurak Vera C. , Yap Jason , Wizzard Pamela R. , Nation Patrick N. , Zhao Yuan‐Yuan , Curtis Jonathan M. , Sergi Consolato , Wales Paul W. , Mager Diana R. , Turner Justine M. 
Published: March 2019

ABSTRACTObjectives:In parenteral nutrition‐dependent infants and children, intestinal failure (IF)‐associated liver disease (IFALD) remains an important problem. A comparative study was undertaken of parenteral mixed lipid (ML), ω‐3 predominant fish oil (FO), and ω‐6 predominant soybean oil (SO) emulsions in regards to hepatic phytosterol, neutral lipid, fatty acid (FA) content, and the relationship to cholestasis in piglets.Methods:Neonatal piglets received parenteral nutrition, varying in lipid dose (5 or 10 g· kg−1 · day−1) and formulation: SO5 (n = 5), SO10 (n = 5), FO5 (n = 5), and ML10 (n = 5). On day 14, liver chemistry, bile flow, histology and neutral lipid staining were assessed. Hepatic triglyceride FA content was determined using thin layer and gas chromatography, and phytosterol content was assessed using gas chromatography‐mass spectrometry.Results:SO groups had higher prevalence of biochemical cholestasis (P < 0.04) and lower bile flow (P < 0.0001). Hepatic campesterol, stigmasterol, and β‐sitosterol were highest in SO10 (P < 0.0001). Hepatic FA (P < 0.03) and ω‐6/ω‐3 FA ratio (P < 0.0001) were higher in the SO groups. Neutral lipid accumulation (P = 0.3) and liver histology (P = 0.16) were not different between groups. Univariate predictors of bile flow were: campesterol (r = −0.77, P = 0.001), β‐sitosterol (r = −0.74, P = 0.002), stigmasterol (r = −0.74, P = 0.002), ω‐6 FA (r = −0.72, P = 0.002), and ω‐3 FA (r = 0.59, P = 0.02). Only campesterol independently predicted bile flow.Conclusions:ML and FO lipid emulsions reduce cholestasis in association with lowered hepatic phytosterol and lipid content. Lower hepatic phytosterol and ω‐6 FA content, and higher ω‐3 FA content are hepatoprotective. Multivariate analysis suggests reduced phytosterol accumulation may best explain the hepatoprotective effect of fish oil‐containing lipids.