bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterizing Congenital Double Punctum Anomalies: Clinical, Endoscopic, and Imaging Findings
Authors: Timlin Hannah M. , Keane Pearse A. , Ezra Daniel G. 
Published: March 2019

Double puncta coexist with a range of other nasolacrimal pathologies. OCT suggests that the medial of the 2 double puncta is the abnormal one, with DCG and endoscopy demonstrating a range of accessory canaliculus lengths.

Purpose:
To characterize the anatomical anomaly of congenital double puncta, identify factors contributing to epiphora and its treatment.

Methods:
Retrospective review of patients presenting with epiphora and a double lacrimal punctum over a 6-month period.

Results:
Five consecutive patients (3 female) were identified. The median age was 50 years (range 34–76). Investigations included punctum optical coherence tomography, dacryocystography, and canalicular endoscopy. The medial punctum was more morphologically abnormal when compared with healthy puncta, with optical coherence tomography showing no vertical canalicular component in 80% (4/5) of patients, and a more superficial than usual horizontal canaliculus in 80% (4/5). Dacryocystography and canalicular endoscopy showed the junction of the 2 inferior canaliculi, which was very proximal in 1, mid canalicular in 2, and at the level of the common canaliculus in 2. In 1 patient, the only abnormality identified was the double lower punctum, with a high tear meniscus and delayed fluorescence dye disappearance test. They underwent endonasal dacryocystorhinostomy with improvement of epiphora. In the other 4 patients, causes of epiphora were nasolacrimal duct stenosis with mucocoele, punctal stenosis, common canalicular stenosis with nasolacrimal duct stenosis, upper canaliculitis, and blepharitis. Their treatments included endonasal dacryocystorhinostomy, punctoplasty, canaliculotomy, and blepharitis treatment. All had improvement of epiphora following treatment.

Conclusions:
These findings suggest that the underlying canalicular anomalies are varied and that the clinical manifestation is also heterogenous. Optical coherence tomography imaging suggests that the medial of the 2 puncta is the more morphologically abnormal one, with dacryocystography and canalicular endoscopy demonstrating different accessory canaliculi lengths.
Acute Physical and Occupational Therapy and Serum Potassium: When Is It Safe?
Authors: Myszenski Adele , Hannum Nanette , Hudson Michael , Yee Jerry 
Published: March 2019

Purpose:
High or low serum potassium (K+) levels are associated with increased risk of cardiac arrhythmias. No research-based guidelines or suggested values for K+ in regard to safe provision of physical therapist (PT) and occupational therapist (OT) services for patients in an acute care setting are currently available. This study was designed to determine whether patients with serum K+ levels of 3.1 to 5.9 mmol/L can participate safely in acute PT and OT interventions without serious adverse events.

Methods:
A total of 380 subjects admitted to an acute care hospital were stratified into groups with hypokalemia (K+ levels of 3.1-3.4 mmol/L), hyperkalemia (K+ levels of 5.1-5.9 mmol/L), or normal K+ levels (K+ levels of 3.5-5.0 mmol/L) and provided with standard PT or OT intervention. Baseline clinical characteristics and adverse outcomes were compared between groups.

Results:
No serious adverse events occurred. Termination of treatment due to minor adverse events occurred in 8 (2%) subject cases and all occurred in the normal K+ group (n = 8, 3%) (P = .029). Rates of adverse outcomes did not differ significantly between normal (n = 37, 15.5%) and abnormal K+ (n = 26, 16.4%) groups.

Conclusions:
Results of this study suggest that provision of PT and OT interventions for patients with serum K+ levels of 3.1 to 5.9 mmol/L is safe.
Complementary Alternative Therapies
Authors: Zito Patrick M. , Murgia Robert D. 
Published: March 2019

ABSTRACT
Drugs are medications or substances that are used to modify physiologic responses and alleviate associated symptoms. In dermatology, medications and substances are utilized on a daily basis and include topical treatments to anesthetics in micrographic surgery to biologic-acting immunologic agents. The purposes of this section are to focus on drug, specifically how it works and how it is utilized, and to discuss routine alternatives (if available). In this column, we will focus on the uses, mechanism of action, and adverse effects of green tea in acne vulgaris.
To Mohs or Not to Mohs
Authors: Crumpton Kristen 
Published: March 2019

ABSTRACT
Mohs micrographic surgery is a common procedure used to treat nonmelanoma skin cancers. With a clearance rate of approximately 98% in small primary basal cell carcinomas and approximately 97% in small primary squamous cell carcinomas, it is the gold standard of care. When considering a Mohs procedure, several criteria are reviewed and evaluated to make sure that Mohs is an appropriate treatment option for the specific tumor, and that the patient is an appropriate candidate to undergo Mohs. However, there are no such criteria for a specific age or functional status at which Mohs is deemed inappropriate (Connolly et al., 2012). Some may argue that patients in their 90s with a nonfatal skin cancer should not undergo an invasive surgery, as their quality of life may be impacted. Others may argue that, if they are healthy, surgery is the best answer. It is necessary for elderly patients and their caregivers to be fully informed about what type of skin cancer the patient has, its prognosis, and how it affects the patient’s quality of life. All possible treatment regimens should be explained by the provider with opinions and advice given in respect to the patients’ current health status and wishes in mind. Ultimately, care of the elderly patient regarding having or not having Mohs surgery should be a decision made between patient and provider, with the patient’s preference as the priority.
Using Social Media to Assess Mental Health and Quality of Care Among Patients With Darier Disease
Authors: McLawhorn Justin M. , Balamurugan Appathurai , Gardner Jerad M. , Kaley Jennifer R. , George Masil J. 
Published: March 2019

ABSTRACT
Darier disease (DD) is a rare skin condition that has been associated with debilitating mood disorders. This is the first study on patients with DD to investigate quality of care and prevalence of psychiatric symptoms wherein the participants were recruited through social media on the World Wide Web. The objective of this report is to assess the subjective experience of DD as it relates to symptom severity, mental health, quality of life, and interdisciplinary care management using Facebook as a means of data acquisition. We developed and distributed a survey to a Facebook DD support group entitled, “Darier’s Disease, let’s know each other!!!”. We found that a third of our patient population experienced symptoms that imparted at least a significant negative impact on their quality of life. Furthermore, most respondents were not screened for depressive symptoms by standard intake questionnaires at their dermatology office visits, despite most of these patients having previously sought mental health services for anxiety/depression/or other mood symptoms secondary to their DD manifestations. We concluded that social media support groups may be a practical tool to recruit patients and assess quality of care. Furthermore, screening for the psychodermatological aspects of DD should be routine protocol for dermatology clinic nurses and dermatologists on every clinical visit.
Transtibial Prosthetic Socket Design and Suspension Mechanism: A Literature Review
Authors: Al Shuaili Nadhira , Aslani Navid , Duff Lynsey , McGarry Anthony 
Published: March 2019

ABSTRACT

Introduction
The body weight of the prosthetic user is supported and distributed by the prosthetic socket during the stance phase of gait. Throughout swing phase, inertial forces (pressure and shear) are exerted by the socket suspension mechanism onto the residuum to facilitate suspension. Objectives in the study were to identify and investigate available evidence in transtibial (TT) socket design and suspension to highlight the most effective weight transfer mechanisms and suspension techniques.

Methods
A literature research was conducted comprising two parts: socket design and suspension. Boolean search terms and truncation were used using relevant keywords in online search engines to obtain precise results.

Results
Seventeen articles that met inclusion criteria were reviewed.

Conclusions
A conclusion on whether socket preference is due to the suspension mechanism or socket design itself cannot be drawn. Patellar tendon bearing (PTB) sockets are still successfully used and, in some studies, preferred over total surface bearing (TSB) sockets. Biomechanically, however, TSB sockets allow for a more even weight distribution when combined with suction, particularly vacuum-assisted socket suspension (VASS). Some limited evidence exists to support that such designs may have some effect on wound healing and early ambulation. Further research must be conducted to standardize acclimation periods. Crossover randomized controlled trials with larger sample sizes are required to establish an evidence base to improve clinical practice.
Method to Evaluate the Sagittal Plane Mobility of the Medial Arch of the Shod Foot with Foot Orthosis
Authors: Papadopoulos Anthony 
Published: March 2019

ABSTRACT

Introduction
Midfoot mobility plays an important role in the orthotic treatment of foot pathomechanical disorders, such as flexible pes planus and abnormal foot pronation. The sagittal plane mobility of the medial arch of only the unshod foot with a foot orthosis has been evaluated for improving therapeutic outcomes. Because foot orthoses are in-shoe devices, it is necessary to evaluate the sagittal plane mobility of the medial arch of the shod foot with a foot orthosis to optimize in-shoe orthotic effectiveness.

Materials and Methods
This technical note describes a procedure using digital photography to evaluate the sagittal plane mobility of the medial arch of the shod foot with a foot orthosis. The procedure involves digitally photographing two weight-bearing states of the shoe in which the foot orthosis supports the foot: 1) 10% of body weight achieved by sitting, and 2) 50% of body weight achieved by standing. The two digital images of the shoe are then geometrically analyzed to calculate the displacement of the medial height of the dorsal surface of the shoe in response to the change in the two weight-bearing states.

Conclusions
Clinicians and researchers can use the method described in this note to evaluate the sagittal plane mobility of the medial arch of the shod foot with a foot orthosis. The method is clinically useful for optimizing the in-shoe effectiveness of foot orthoses to treat foot pathomechanical disorders.
Unlimbited Wellness: Telehealth for Adults with Upper-Limb Difference
Authors: Latour Debra 
Published: March 2019

ABSTRACT

Introduction
Individuals with upper-limb loss/difference often require specialized services, including occupational therapy that may be difficult to access. Also, individuals are likely to encounter secondary conditions that include pain, overuse, perceptions of isolation, and social stigma. The program was developed to meet the needs vocalized by the target population, to offer a pathway using telehealth (TH) to access peers, and to become better informed about strategies that would help to prevent physical overuse and social isolation and facilitate improved self-advocacy skills with medical practitioners.

Methods
Unlimbited Wellness is based on results of a needs assessment that specifically focused on the challenges experienced by this population. Participants of the Unlimbited Wellness program interacted with peers via a TH model to learn about physical and psychosocial health conditions that may cause them disparity and to share strategies to prevent or manage them.

Results
Effectiveness of the program was assessed via a survey of participant TH experiences and changes in perceptions of pain, ability, and quality of life as measured by the McGann Client Feedback Form and the Pizzi Health and Wellness Assessment. Overall, participant post-group perceptions of health, well-being, and prosthetic satisfaction improved as compared with pre-group experiences. During the 1:1 interviews, all participants stated they felt empowered due to their engagement in peer discussions and collaborative exercises during the Unlimbited Wellness program.

Conclusions
The program results indicate that a TH service delivery can be beneficial to enact health behavior change and empower individuals with upper-limb difference.
The Accuracy of Variously Positioned Pedometers for Lower-Limb Prosthesis Users
Authors: Guerra Gary , Smith John D. , Gomez Paula , Siriwatsopon Juthamas 
Published: March 2019

ABSTRACT

Introduction
Tracking the physical activity of persons with amputation is a valuable outcome measure. Identifying affordable and accurate ways of measuring activity for individuals with amputation in developed and resource-limited environments is equally valuable. Limited walking data and methods to reliably measure walking of persons with amputation exist. The purpose of this study was to evaluate accuracy of the Omron HJ-329 worn by persons with lower-limb amputations at different locations.

Methods
Nineteen lower-limb prosthesis wearers wore pedometers around the neck, in both affected and nonaffected side pockets, and on the hip of both the affected side and the contralateral side while walking at a self-selected pace for 200 m. Actual step counts (ACs) were recorded by a hand tally counter. Repeated-measures analysis of variance was used to determine differences in pedometer counts between affected and nonaffected sides and between ACs. Agreement was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots, and absolute percent error was calculated using ([steps detected by pedometer − AC]/AC) × 100. Alpha was set at 0.05 for all tests.

Results
No significant differences existed in pedometer counts between affected and nonaffected sides (P > 0.05), nor were any significant differences evident between any of the pedometers and ACs (P > 0.05). In our sample, there were more left affected participants; among all participants, ICCs were highest on the left hip followed by the right hip, and least in the left pocket and around the neck. Limits of agreement in the Bland-Altman plots reflected this trend as well. Absolute percentage error of pedometers was greatest in the left pocket (6.8%) and lowest for the pedometer located at the left hip (2.2%) and right hip (2.6%).

Conclusions
The individual with amputation can wear the activity monitor at any of the locations and on either the affected or nonaffected side, and it seems wearing the devices on the hip will provide the most accurate results. Among the individuals with unilateral amputation, there were no differences in metrics between affected and nonaffected limbs. For our bilateral participants, the same nondifferences were observed. The Omron HJ-329 is thus an affordable, viable activity monitor for the population of persons with lower-limb amputation.
High risk twin pregnancy complicated with severe rachiterata and huge dorsal mass suffering from refractory infection
Authors: Yang Fan , Wan Li , Qi XiaoRong 
Published: March 2019

Abstract

Rationale:
Severe rachiterata is rarely described as a complication of pregnancy, and it was assumed as a contraindication to pregnancy. We first report a case of severe spinal deformity associated both with scoliosis and kyphosis in pregnancy.

Patient concerns:
A 38-year-old pregnant woman [28+1 weeks of twin pregnancy, gravida 3, para 2 (G3P2)] was admitted to the emergency department with complaints of persistent productive cough, with increased expectoration, dyspnea, dizziness, fatigue, and irregular abdominal pain. She had obvious spinal protrusion of lateral bending deformity and kyphosis with “S” type distortion, and had a huge dorsal mass with refractory infection. In the third trimester of pregnancy, the anatomical changes resulted in thoracic cavity deformation, unmanageable pulmonary infections, and serious skin infections on the surface of the dorsal mass.

Diagnosis:
Single chorionic twin pregnancy with severe rachiterata and a huge dorsal mass.

Interventions:
Management was focused on treating pulmonary and skin infections and promoting fetal lung maturation. Appropriate timing of pregnancy termination and manner of delivery were decided through a multidisciplinary discussion. The patient was placed in a special position and assisted by a professional midwife during delivery.

Outcomes:
The patient and her children survived after careful care and treatment.

Lessons:
Severe spinal deformities are not contraindications for pregnancy, but the changes in the thoracic cavity caused by these deformities can result in respiratory function decline, which becomes more apparent in the third trimester, which could likely cause pulmonary infection that is difficult to treat. In the future, studies investigating prenatal care procedures, timing of pregnancy termination, and appropriate delivery method are warranted.
Relationship between mental health and awareness of the knowledge on mental health in left-behind middle school students
Authors: Du Jinling , Li Zhongchen , Jia Guodong , Zhang Qian , Chen Wenqiang 
Published: March 2019

Abstract
To explore the relationship between mental health of left-behind middle school students and awareness of mental health.
Using cluster sampling method to select 428 left-behind middle school students in Jinan, using the mental health scale of middle school students and self-compiled mental health cognitive attitude questionnaire.
We found left-behind middle school students’ mental health level of force, paranoia, hostility and interpersonal sensitivity, depression, anxiety, learning pressure, maladjustment, mood swings, the psychological imbalance and total score were significant difference compared with the norm of middle school students (t = 10.67, 3.86, 3.78, 7.54, 2.51, 10.18, 8.79, 3.54, 6.56, −2.13, 6.83, P < .05). The top 5 detection rates of psychological moderate health problems are learning stress, anxiety, force, emotional instability and interpersonal sensitivity. There were significant differences in the scores of left-behind middle school students with different awareness of mental health knowledge (F = 4.880, P < .01) and emotional instability (F = 4.51 4, P < .05). The awareness of mental health knowledge was significantly negatively correlated with the total score of mental health, hostility, interpersonal sensitivity, maladjustment, emotional instability, and psychological imbalance scores. (r = 0.135, 0.182, 0.194, 0.189, −0.2, 0.124, P < .05).
Left-behind middle school students’ psychological health status is poorer, and closely related with the awareness of the knowledge on mental health; to improve the level of cognitive evaluation of left-behind middle school students on mental health is expected to improve their psychological health.
Hepatoid adenocarcinoma of fallopian tube
Authors: Li Maomao , Yang Kaixuan , Wang Ping 
Published: March 2019

Abstract

Rationale:
Hepatoid adenocarcinoma (HAC) of the fallopian tubes is a rare malignant tumor in the female reproductive system.

Patient concerns:
An 81-year-old Chinese woman presented with an elevated serum alpha-fetoprotein (AFP) level.

Diagnosis:
Positron emission tomography-computed tomography (PET-CT) scan revealed a mass of approximately 47 × 27 mm located in the right adnexa. The tumor was diagnosed as a HAC arising from fallopian tube by immunohistochemical and histochemical technique.

Interventions:
This patient underwent surgical treatment including a bilateral adnexectomy and appendectomy. In addition, the patient underwent 5 cycles of postoperative chemotherapy.

Outcomes:
The disease has recurred approximately six months after surgery and therefore, this patient will continue to be observed.

Lessons:
Up to this point, only 4 known cases of HAC originating in fallopian tube have been published in the English literature. Further studies are needed to better understand the clinical characteristics, the prognosis, and the pathological mechanism of HAC development in the fallopian tubes.
The efficacy of flexible ureteroscopy lithotripsy and miniaturized percutaneous nephrolithotomy for the treatment of renal and proximal ureteral calculi of ≤2 cm
Authors: Jiao Binbin , Lai Shicong , Xu Xin , Zhang Meng , Diao Tongxiang , Zhang Guan 
Published: March 2019

Abstract
To assess the clinical effect of miniaturized percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy lithotripsy (FURL) for the treatment of renal and proximal ureteral calculi of ≤2 cm.
A retrospective analysis was carried out on clinical data of 106 patients with kidney or upper urethral calculi. Among these patients, 58 underwent the MPCNL, and 48 received FURL. Stone-free rates, operating time, blood loss, hemoglobin drop, length of hospital stay, complications, and renal damage indexes were compared.
The stone removal rates of the FURL and MPCNL groups were 81.25% versus 87.93% (p > .05). Although operating time was significantly shorter in the MPCNL group, hospital stays were significantly shorter in the FURL group. In addition, pooled analysis showed that mean estimated blood loss was significantly higher in the PCNL group but the hemoglobin decline of the FURL group and PCNL group had no significant difference. The PCNL group had no significant difference in complications compared to the FURL group. Differences on the creatinine levels and urea nitrogen levels before the operation and after the operation were not statistically significant.
FURL is an effective method for treating renal stone. FURL not only had a similar stone-free rate as compared to MPCNL but also was associated with less blood loss and more favorable recovery time. However, FURL had a longer operative time.