bluuebunny/crossref_metadata_2025_split huggingface dataset:
Manual Lymph Drainage and Fascial Release for the Treatment of Chylous Ascites Following Radical Nephrectomy: A Case Report
Authors: Kramp Mary Ellen 
Published: July 2018

Background:
Chylous ascites is “a rare complication of retroperitoneal and mediastinal surgery caused by the unrecognized interruption of major retroperitoneal lymphatic channels and establishment of a lymphoperitoneal fistula.” Chylous ascites occurs 1% to 2% of the time and typically only after surgical injury to the retroperitoneal lymph glands, vessels, or cysterna chyle. Risk factors include manipulation of the para-aortic and superior mesenteric artery root areas, retroperitoneal invasion, focal chronic pancreatitis, having more than 32 lymph nodes removed, several positive lymph nodes, and early enteral feeding.

Case Description:
Six weeks postradical nephrectomy with complete lymphadenectomy of the periaortic nodes, a 60-year-old otherwise healthy, independent woman was found to have a high-volume chylous ascites. The leakage was attempted to be controlled by a low-fat diet, but she still required 4 paracentesis procedures to remove chylous fluid from her abdomen. Total parenteral nutrition was advised, and the patient declined and referred herself to physical therapy. Other than diet restrictions, she was active and had no functional deficits.

Clinical Impression:
It had been 6 months since her nephrectomy with lymphadenectomy, it was probable that there was fascial restriction that was preventing closure of the lymphatic vessel wound and allowing chyle to continually leak into the abdomen.

Intervention:
The chylous ascites was addressed by physical therapy with manual lymph drainage to facilitate the evacuation of fluid out of the abdomen plus fascial releases to mobilize adhesions that may have been impacting the healing of the deep abdominal lymphatic vessels.

Measurements and Results:
Upon initial examination, her abdomen measured 102 cm at the umbilicus and had multiple large pockets of fluid on the ultrasound scan. On her fourth visit 16 days later, her abdomen measured 81 cm with no appreciable pockets of fluid noted. An 8-week follow-up visit revealed no return of fluid in the abdomen. She was able to return to a normal diet.

Discussion:
Further research is warranted to determine if fascial release and manual lymph drainage is a viable treatment of chylous ascites.
Oncology EDGE Task Force on Prostate Cancer Outcomes: A Systematic Review of Outcome Measures for Functional Mobility
Authors: Davies Claire C. , Colon Genevieve , Geyer Hannah , Pfalzer Lucinda , Fisher Mary Insana 
Published: July 2018

Background:
The medical treatment of prostate cancer results in multiple impairments in body structure and declines functional abilities, resulting in activity limitations and participation restrictions. Measurement of functional mobility is an essential outcome measure in survivorship care.

Purpose:
The purpose of this systematic review is to make recommendations of the best measurement tools to assess functional mobility in men treated for prostate cancer based on psychometric properties and clinical utility.

Methods:
Multiple electronic databases were searched from February to March 2014. Studies of tools used to assess functional mobility were included if they met the following criteria: reported psychometric properties, were clinically feasible methods, and were published in the English language. Each outcome measure was reviewed independently and rated by 2 reviewers separately. A single Cancer EDGE (Evaluation Database to Guide Effectiveness) Task Force Outcome Measure Rating Form was completed for each category of functional mobility assessment, and a recommendation was made using the 4-point Cancer EDGE Task Force Rating Scale.

Results:
Of the original 38 373 articles found, 87 were included in this review.

Conclusion:
Seven tests are highly recommended by the Oncology EDGE Task Force, 2-Minute Walk Test and 6-Minute Walk Test, 10-Meter Timed Walk, Timed Up and Go, 5 times sit to stand, based on good clinical utility and psychometric properties.
What Is Clinically Important in Lymphedema Management? A Systematic Review
Authors: Tidhar Dorit , Armer Jane M. , Stewart Bob R. 
Published: July 2018

Objective:
To summarize published reports on the clinical effectiveness of conservative lymphedema management by reporting on outcomes that use anchor- and distribution-based approaches.

Data Sources:
MEDLINE and EBSCO databases from inception to April 2017.

Study Selection:
Articles were selected if they included an estimate for minimal clinically important difference (MCID).

Data Synthesis:
Twenty-four articles involving 938 patients met our inclusion criteria. Years of publication ranged from 1991 to 2016. Of these, 16 studies examined outcomes after the intervention was completed. The other 8 studies tested the reliability of measurement tools. Data were stratified according to different outcomes: limb volume (20 studies, 785 patients), symptoms (6 studies, 288 patients), skin changes (1 study, 28 patients), infection rate (5 studies, 255 patients), quality of life (4 studies, 148 patients), and strength, function, endurance, fitness, and disability (3 studies, 89 patients). Most studies covered cancer-related lymphedema (22/23), especially as related to breast cancer (19/22). Large heterogeneity was found in the methods of estimations with regard to improvement, exacerbation, and stability of lymphedema.

Conclusion:
There is limited evidence to draw conclusions regarding the recommended MCIDs for different populations, outcomes, and periods of time. Further studies are needed to facilitate the process of improving clinical care of lymphedema.
Effect of Common Medications on Breast Cancer-Related Lymphedema
Authors: Tesar Emily , Armer Jane M. 
Published: July 2018

Background:
It is estimated that 15% to 28% of breast cancer survivors suffer from breast cancer–related lymphedema (BCRL). As the population of survivors grows, so does their risk for developing other chronic diseases such as cardiac disease, type II diabetes, chronic obstructive pulmonary disease, and other cancers. Minimal literature exists about the effect that medications taken for other chronic conditions have on BCRL.

AIMS:
The purpose of this article is to highlight how common medications can impact peripheral and generalized edema, thereby contributing to lymphedema, and outline ongoing research.

Methods:
This article also identifies 6 classifications of chronic disease medications with known profiles for potentiating edema that could mimic or exacerbate lymphedema.
Heart Rate and Blood Pressure Assessment by Physical Therapists in the Outpatient Setting—An Observational Study
Authors: Millar A. Lynn , Village David , King Tiffany , McKenzie Germyn , Lee Jody , Lopez Coronel 
Published: July 2018

Purpose:
Although physical therapists (PTs) are equipped and trained with the knowledge of the importance of vital sign assessment and cardiovascular risk factors, there seems to be a discrepancy between the practice guidelines and the actual practice in the clinic. Therefore, the purpose of this study was to observe the frequency with which PTs take and record heart rate (HR) and blood pressure (BP) in the orthopedic outpatient setting during therapy sessions.

Methods:
Physical therapists from 6 area clinics were observed, including 15 licensed PTs, during 74 patient sessions. The frequency with which the PTs measured patients' BP and HR during initial assessment and/or follow-up treatment sessions was documented. Physical therapist demographics and patient diagnosis, comorbidities, age, and sex were recorded.

Results:
Of the 74 patient sessions, 15 were initial visits, 54 were follow-up, and 5 were discharge sessions. Although 26% (n = 19) of the patients had hypertension as a comorbidity, initial HR and BP were only taken in 2 sessions, and only once taken after exercise.

Conclusions:
Within our limited sample, PTs in outpatient settings were not following HR and BP screening or exercise monitoring practice guidelines. This could put patients at risk for cardiovascular incidents during therapy sessions.
Provision of Physical Therapy at a Long-Term Acute Care Hospital for Patients Awaiting Lung Transplantation: A Case Report With 3 Participants
Authors: Thrush Aaron , Skrzat Julie 
Published: July 2018

Introduction:
Although the number of individuals awaiting lung transplantation is increasing, little is known about the impact of physical therapy (PT), particularly among candidates who require prolonged hospitalization and high levels of supplemental oxygen. This article describes the provision and outcomes of PT for 3 lung transplant candidates at a long-term acute care hospital (LTACH).

Case Presentation:
Each patient was admitted to a hospital with exacerbation of lung disease and, after being medically stabilized and listed for transplant, transferred to our LTACH for continued medical care of his tenuous medical state. Patients participated in PT to maintain their function and remain candidates for transplant, and to promote improved outcomes after transplant. Length of stay varied from 21 to 107 days.

Results:
All patients made clinically important improvements in Six-Minute Walk Test distance. Physical therapy was scheduled 5 times per week and was completed 95% of the time.

Conclusions:
All 3 patients made significant gains despite end-stage disease and exceptionally low pulmonary reserve, and were able to participate in daily PT during prolonged hospitalizations. The results demonstrate the potential for favorable functional improvements in a subset of people with more severe disease and more critical ongoing medical needs than previously described in the literature.
Background and Expertise of Faculty Teaching Cardiovascular and Pulmonary Content in Entry-Level DPT Programs
Authors: Bartlo Pamela , Lefebvre Kristin , Wellmon Robert 
Published: July 2018

Purpose:
The purposes of this study were (1) to examine the qualifications and expertise of individuals teaching cardiovascular and pulmonary physical therapy (CVP-PT) content at entry-level DPT education programs and (2) to determine the amount of time devoted to the content and method of delivery.

Methods:
A survey sent through email to 206 program directors of accredited DPT programs assessed institutional demographics, the faculty teaching the CVP-PT content, and the method of delivery. The responses were examined descriptively using frequency counts and percentages.

Results:
There was a 49.5% response rate with 102 completed surveys. Among faculty teaching CVP-PT content, 54% had a PhD/EdD, 32% a DPT, and 19% had other degrees. Only 43% teaching the CVP-PT content had a Cardiovascular and Pulmonary Clinical Specialist (CCS) certification. Approximately, 83% of the institutions employed a full-time faculty member to teach the CVP-PT content. Most programs used a single course to deliver the CVP-PT content and 84% reported the use of simulation for CVP-PT content delivery.

Conclusions:
These results demonstrated that entry-level DPT programs responding to the survey had qualified faculty with CVP-PT expertise and that there is a need to encourage further professional development of faculty with CCS credentials.
Clinical Markers of Exercise Intensity as a Surrogate for Blood Lactate Levels Only During Low-Intensity Exercise in Patients With Coronary Artery Disease
Authors: Gurovich Alvaro N. , Heiser Brittany , Hayes Chase , Marshall Emily , Roath Stephanie , Kabous Neil G. 
Published: July 2018

Purpose:
To determine if clinical markers of exercise intensity, such as heart rate (HR) and rate of perceived exertion (RPE), reflect physiological demands, measured via blood lactate (La) levels, during a graded exercise test (GXT) in cardiac patients.

Methods:
Thirty-one subjects (19 men and 12 women; age, 58 ± 12 years) were recruited for a GXT. Heart rate, RPE, and La were assessed at rest and after each GXT stage. Pearson correlations were performed between variables (percentage of maximal HR [%HRmax], RPE, La). Bland–Altman analyses were performed to determine agreement between La and %HRmax and RPE.

Results:
Overall, 113 GXT stages were included in the analysis. It was found that La correlated with RPE (r = 0.72; P < .01) and %HRmax (r = 0.76; P < .01); %HRmax correlated with RPE (r = 0.76; P < .01). However, there was no agreement between La and RPE (72.6% of the sample laid outside 95% CI [−0.25, 0.25 mmol/L]) and between La and %HRmax (85% of the sample laid outside 95% CI [0.54, 1.04 mmol/L]).

Conclusions:
The significant associations between La, %HRmax, and RPE could be explained by the direct relationship between these variables that occur during the increasing exercise intensity, characteristic of a GTX. However, HR and RPE should not be used as a surrogate to a La-based descriptor of exercise intensity in patients with coronary artery disease exercising at high intensity.
Body Position Affects Ultrasonographic Measurement of Diaphragm Contractility
Authors: Brown Christopher , Tseng Shih-Chiao , Mitchell Katy , Roddey Toni 
Published: July 2018

Purpose:
(1) Determine whether ultrasonography can detect differences in diaphragm contractility between body positions. (2) Perform reliability analysis of diaphragm thickness measurements in each test condition.

Methods:
We used a repeated-measures experimental design with 45 healthy adults where 3 B-mode ultrasound images were collected at peak-inspiration and end-expiration in supine, sitting, and standing. Mean diaphragm thickening fractions were calculated for each test position. Statistical significance was tested using 1-way repeated-measures analysis of variance with planned comparisons. For reliability analysis, the intraclass correlation coefficient (3, 3) was calculated.

Results:
Mean diaphragm thickening fraction increased from 60.2% (95% confidence interval [CI] 53.0%, 67.9%) in supine, to 96.5% (95% CI 83.2%, 109.9%) while seated and to 173.8% (95% CI 150.5%, 197.1%) while standing. Body position was a significant factor overall (P < .001), as were comparisons between each individual position (P < .001). Intraobserver reliability was excellent (>0.93) for all body positions tested.

Conclusions:
Ultrasound imaging detected positional differences in diaphragm contractility. The effect of gravitational loading on diaphragm length-tension, and body position-mediated changes in intra-abdominal pressure may explain the differences found. Future research should address methodological concerns and apply this method to patients participating in early mobilization programs in the intensive care unit.
Partners of Individuals with Borderline Personality Disorder: A Systematic Review of the Literature Examining Their Experiences and the Supports Available to Them
Authors: Greer Holly , Cohen Jacqueline N. 
Published: July 2018

Abstract
Over a third of individuals with borderline personality disorder (BPD) are in long-term romantic partnerships, yet little is known about the experiences of their partners. Because difficulties in interpersonal relationships are a hallmark of BPD, it is especially important to understand the support needs of their romantic partners. This systematic review investigates the experiences of romantic partners of adult individuals with BPD and the interventions designed to support them. Twenty-two articles were found, 13 of which pertained to partner experiences and 9 to interventions. Thematic analysis was used to identify three main themes in the descriptions of partners’ experiences: emotional challenges, dual roles as both a romantic partner and parental/therapeutic figure, and lack of control. The available interventions, which consisted of educational and skills-based programs with limited efficacy data, addressed only a small portion of the subthemes identified in the literature describing partners’ experiences. The discrepancy between the needs identified in the partner-experience literature and the interventions available suggests a need to develop and evaluate more partner-oriented programming. Such programming should use psychoeducation, peer support, and individual- and relationship-based skills development to address and therefore improve the experiences of partners of individuals with BPD.
ASYMMETRIC HYDROXYCHLOROQUINE MACULAR TOXICITY WITH APHAKIC FELLOW EYE
Authors: Mack Heather G. , Fuzzard Dujon R. W. , Symons R. C. Andrew , Heriot Wilson J. 
Published: July 2018

Background/Purpose:
Retinal toxicity associated with antimalarial drug use in inflammatory conditions is well described and may be more common than previously recognized. Antimalarial drugs bind to melanin in ocular tissues, particularly the retinal pigment epithelium, but the mechanism of toxicity and its relation to light is unclear.

Methods:
Case report.

Results:
A 62-year-old white woman with erosive rheumatoid arthritis developed hydroxychloroquine toxicity in her phakic eye, with her aphakic fellow eye only mildly affected.

Conclusion:
We report the clinical evaluation of this rare case of asymmetrical hydroxychloroquine retinopathy and present a hypothesis regarding the mechanism of drug toxicity.
Optimized thiopurine therapy before withdrawal of anti-tumour necrosis factor-α in patients with Crohn’s disease
Authors: Bohn Thomsen Sandra , Kiszka-Kanowitz Marianne , Theede Klaus , Gluud Lise Lotte , Mertz Nielsen Anette 
Published: July 2018

Objective
Two meta-analyses have found that the risk of relapse in Crohn’s disease (CD) was ~40 and 50% 1 and 2 years, respectively, after withdrawal of anti-tumour necrosis factor-α (anti-TNFα). The aim of this study was to evaluate relapse rates in CD when thiopurine therapy was optimized before anti-TNFα withdrawal.

Patients and methods
An observational study was conducted including patients with CD in remission with optimized thiopurine therapy before anti-TNFα withdrawal. We defined optimized thiopurine therapy as 6-thioguanine levels of at least 150 nmol/mmol haemoglobin (∼300 pmol×108 red blood cells) and clinical/biochemical remission as Harvey-Bradshaw Index of 5 or less and faecal calprotectin of 200 µg/g or less.

Results
We included 33 patients (median age: 31 years, 55% males, and median disease duration: 7 years) followed for a median of 36 months. A total of three (9%) patients relapsed during the first year and six patients (in total 27%) relapsed after 2 years. After 2 years, none of the additional patients relapsed. The disease duration and duration of anti-TNFα treatment and faecal calprotectin levels before inclusion did not predict relapse. Calprotectin levels of at least 180 after 1 year predicted relapse at year 2.

Conclusion
This study found that 73% of patients with CD maintained remission (>2 years) when thiopurine therapy was optimized before withdrawal of anti-TNFα. Additional prospective evidence is needed to confirm the findings.
Orbital Air Embolism After Intravenous Injection
Authors: Rossiter-Thornton Michael , Varma Aditya , Verma Nitin , Hewitt Alex W. 
Published: July 2018

Abstract:
An asymptomatic air embolism in the right superior ophthalmic vein was discovered incidentally during a cerebral computed tomography, most likely due to a preceding intravenous fluid bolus. This case illustrates the potential risk of air emboli being propagated to the cerebral venous circulation during routine injections and fluid resuscitation.
Imaging Striatal Dopamine Release Using a Non-Genetically Encoded Near-Infrared Fluorescent Catecholamine Nanosensor
Authors: Beyene Abraham G. , Delevich Kristen , Bonis-O’Donnell Jackson Travis Del , Piekarski David J. , Lin Wan Chen , Wren Thomas A. , Yang Sarah J. , Kosillo Polina , Yang Darwin , Wilbrecht Linda , Landry Markita P. 
Published: July 2018

AbstractNeuromodulation plays a critical role in brain function in both health and disease. New optical tools, and their validation in biological tissues, are needed that can image neuromodulation with high spatial and temporal resolution, which will add an important new dimension of information to neuroscience research. Here, we demonstrate the use of a catecholamine nanosensor with fluorescent emission in the 1000-1300 nm near-infrared window to measure dopamine transmission in ex vivo brain slices. These near-infrared catecholamine nanosensors (nIRCats) represent a broader class of nanosensors that can be synthesized from non-covalent conjugation of single wall carbon nanotubes (SWNT) with single strand oligonucleotides. We show that nIRCats can be used to detect catecholamine efflux in brain tissue driven by both electrical stimulation or optogenetic stimulation. Spatial analysis of electrically-evoked signals revealed dynamic regions of interest approximately 2 microns in size in which transients scaled with simulation intensity. Optogenetic stimulation of dopaminergic terminals produced similar transients, whereas optogenetic stimulation of glutamatergic terminals showed no effect on nIRCat signal. Bath application of nomifensine prolonged nIRCat fluorescence signal, consistent with reuptake blockade of dopamine. We further show that the chemically synthetic molecular recognition elements of nIRCats permit measurement of dopamine dynamics in the presence of dopamine receptor agonists and antagonists. These nIRCat nanosensors may be advantageous for future use because i) they do not require virus delivery, gene delivery, or protein expression, ii) their near-infrared fluorescence facilitates imaging in optically scattering brain tissue and is compatible for use in conjunction with other optical neuroscience tool sets, iii) the broad availability of unique near-infrared colors have the potential for simultaneous detection of multiple neurochemical signals, and iv) they are compatible with pharmacology. Together, these data suggest nIRCats and other nanosensors of this class can serve as versatile new optical tools to report dynamics of extracellular neuromodulation in the brain.
Stationary Equations for Non-Markovian Biochemical Systems
Authors: Zhang Jiajun , Zhou Tianshou 
Published: July 2018

AbstractWe develop a new approach for stochastic analysis of biochemical reaction systems with arbitrary distributions of waiting times between reaction events. Specifically, we derive a stationary generalized chemical master equation for a non-Markovian reaction network. Importantly, this equation allows to transform the original non-Markovian problem into a Markovian one by introducing a mean reaction propensity function for every reaction in the network. Furthermore, we derive a stationary generalized linear noise approximation for the non-Markovian system, which is convenient to the direct estimation of the stationary noise in state variables. These derived equations can have broad applications, and exemplars of two representative non-Markovian models provide evidence of their applicability.
Episodic Control as Meta-Reinforcement Learning
Authors: Ritter S , Wang JX , Kurth-Nelson Z , Botvinick M 
Published: July 2018

AbstractRecent research has placed episodic reinforcement learning (RL) alongside model-free and model-based RL on the list of processes centrally involved in human reward-based learning. In the present work, we extend the unified account of model-free and model-based RL developed by Wang et al. (2018) to further integrate episodic learning. In this account, a generic model-free “meta-learner” learns to deploy and coordinate among all of these learning algorithms. The meta-learner learns through brief encounters with many novel tasks, so that it learns to learn about new tasks. We show that when equipped with an episodic memory system inspired by theories of reinstatement and gating, the meta-learner learns to use the episodic and model-based learning algorithms observed in humans in a task designed to dissociate among the influences of various learning strategies. We discuss implications and predictions of the model.