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Background: Conventional noninvasive methods have well-known limitations for the detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). However, advancements in Doppler echocardiography permit transthoracic imaging of coronary flow velocities (CFV) and measurement of coronary flow reserve (CFR). Our aim was to evaluate the diagnostic value of transthoracic CFR measurements for detection of significant left anterior descending (LAD) stenosis in patients with LBBB and compare it to that of myocardial perfusion scintigraphy (MPS). Methods: Simultaneous transthoracic CFR measurements and MPS were analyzed in 44 consecutive patients with suspected CAD and permanent LBBB. Typical diastolic predominant phasic CFV Doppler spectra of distal LAD were obtained at rest and during a two-step (0.56-0.84 mg/kg) dipyridamole infusion protocol. CFR was defined as the ratio of peak hyperemic velocities to the baseline values. A reversible perfusion defect at LAD territory was accepted as a positive scintigraphy finding for significant LAD stenosis. A coronary angiography was performed within 5 days of the CFR studies. Results: The hyperemic diastolic peak velocity (44 ± 9 cm/sec vs 62 ± 2 cm/sec; P= 0.01) and diastolic CFR (1.38 ± 0.17 vs 1.93 ± 0.3; P= 0.001) were significantly lower in patients with LAD stenosis compared to those without LAD stenosis. The diastolic CFR values of < 1.6 yielded a sensitivity of 100% and a specificity of 94% in the identification of significant LAD stenosis. In comparison, MPS detected LAD stenosis with a sensitivity of 100% and a specificity of 29%. Conclusions: CFR measurement by transthoracic Doppler echocardiography is an accurate method that may improve noninvasive identification of LAD stenosis in patients with LBBB. [ABSTRACT FROM AUTHOR]

Double-orifice mitral valve is a rare congenital anomaly. Although it is more frequently associated with other cardiac abnormalities, it may occur as an isolated lesion. There are 2 forms of myocardial noncompaction: isolated and nonisolated myocardial noncompaction. Nonisolated myocardial noncompactions are occasionally reported postnatally in association with congenital heart anomalies such as ventricular septal defect, pulmonic stenosis, and atrial septal defect. To our knowledge, this is the first case presentation reporting a double-orifice mitral valve associated with nonisolated myocardial noncompaction. [ABSTRACT FROM AUTHOR]

The predictive accuracy of electrocardiographic markers in identifying the infarct-related artery of myocardial infarctions has been a subject of extensive investigation. The present study was designed to test whether the index L II/L III ratio adapted to exercise electrocardiograms could be utilized as a marker to distinguish right coronary and left circumflex arteries as culprit coronaries in acute inferior myocardial infarctions. For this purpose, 82 patients with a positive-symptom-limited and/or submaximal treadmill exercise test with modified Bruce protocol after an acute inferior myocardial infarction were studied. Those patients with ST segment elevation during the stress test were included in the study. ST segment index was defined as the ratio of exercise-induced ST elevation amplitude in L II/L III. Patients were classified as having an index > 1 (n=24) and < 1 (n=58), and the findings were compared with the findings on coronary angiography. The groups were comparable with respect to age, gender, peak exercise level, and double products achieved. Circumflex artery was the infarct-related one in the majority (21/24; 88%) of patients with an index > 1, whereas most (51/58; 88%) patients with an index < 1 had the culprit lesion in their right coronary artery (p<0.001). The ratio of exercise-induced ST elevations in leads L II and L III has a significantly high ability to discriminate the infarct-related coronary artery in patients with uncomplicated inferior myocardial infarction. Considering the prognostic importance of the type of coronary involvement, this index could be a part of predischarge evaluation in this patient group. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the validity and reliability of the Turkish version of the Ottawa Sitting Scale (OSS-T) in patients with acute stroke., Materials and Methods: The Berg Balance Scale (BBS) and Trunk Impairment Scale (TIS) were used to determine the validity of the OSS-T. The OSS-T was re-applied by the same rater after an interval of 7 days to determine the reliability. To test inter-rater reliability, the evaluation was repeated by a second rater 1 day after the first evaluation. Reliability was quantified using intraclass correlation coefficients (ICC), and validity was assessed by correlating the OSS-T scores with the results of the other measures., Results: The ICC of the total OSS-T score for inter-rater reliability was 0.996 and for intra-rater reliability, it was 0.951. The Cronbach's α coefficient used to determine internal consistency was 0.980, which indicates excellent reliability. A strong positive correlation was found between OSS-T and TIS (rho = 0.861, p  < 0.001), and between OSS-T and BBS (rho = 0.875, p  < 0.001). An evident 2-factor structure was shown by the results of the factor analysis., Conclusions: The results of this study indicated that the OSS-T has strong measurement properties, making it a valid and reliable tool for research and clinical practice in patients with acute stroke.IMPLICATIONS FOR REHABILITATIONIndependent sitting function is an important indicator of functional recovery and discharge from hospital.Unlike other sitting balance tools, the Ottawa Sitting Scale can even categorize patients with low balance reserve by applying all the items with and without foot support.The Turkish version of the Ottawa Sitting Scale is a valid and reliable tool to evaluate sitting balance in patients with acute stroke.

Introduction: The application of the refinements of linking rules to the outcome measurement methods provides an opportunity to obtain information concerning what the available instruments actually measure and how the instrument measures certain outcomes. The purpose of the study was to analyze the content of 4 commonly used upper limb amputee scales using the refined International Classification of Functioning, Disability, and Health (ICF) linking rules., Methods: The Upper Extremity Functional Status module of the Orthotics and Prosthetics User Survey (OPUS-UEFS), Trinity Amputation and Prosthesis Experience Scales, Southampton Hand Assessment Procedure (SHAP), and Quick Disability of the Arm, Shoulder, and Hand were analyzed by 2 health professionals for a content comparison based on ICF categories. The Kappa statistic was used to calculate the degree of agreement between 2 professionals., Results: The scale questions were linked with 43 different ICF codes in this study. Trinity Amputation and Prosthesis Experience Scale addresses all ICF domains. All items of SHAP and most items of OPUS-UEFS were linked to the activity-participation domain. Quick Disability of the Arm, Shoulder, and Hand items were linked with activity-participation and body function domains. The perspectives of OPUS-UEFS and SHAP are descriptive. The perspectives of Quick Disability of the Arm, Shoulder, and Hand were descriptive and appraisal. The perspectives of Trinity Amputation and Prosthesis Experience Scale subscales were descriptive, appraisal, and needs or dependency. Estimated kappa values ranged from 0.44 to 0.91 for ICF codes., Conclusions: Most concepts in the scales were frequently linked to the activity-participation domain. We think that the results of this study will be a useful guide to clinicians and researchers in selecting relevant and appropriate outcome measurements for upper limb amputee rehabilitation., (Copyright © 2023 International Society for Prosthetics and Orthotics.)

Background: It is obvious that educational activities were affected globally due to the pandemic., Objective: This study was planned to examine the effects of online education on undergraduate degree (UD) and associate degree (AD) Orthotics and Prosthesis education in the COVID-19 pandemic., Study Design: A crossectional online survey., Method: The Google Forms questionnaire was delivered to students of Orthotics and Prosthesis in the level of undergraduate degree and AD and academicians conducted in the study. Next, the participants were reviewed regarding their knowledge about devices used for online education and related technical problems. A 5-point Likert-type questionnaire with 18 questions that was developed specifically for this study was applied to examine their views on online education., Results: The study included 472 participants who had a mean age of 21.30 ± 0.22 years. Among the participants, 262 were AD students (55.5%). Approximately 82% of the participants were used their mobile phones for connection. The connection problems, and inappropriateness of online education in applied course, preference of online education for theoretical courses, insufficiency of digital course materials, failure to access education easily, insufficiency of online examinations for measurement and evaluation, and preference of homework over online education were stated by 79%, 88.3%, 41.9%, 54.5%, 70.1%, 41.7%, and 42.8% of the participants, respectively., Conclusion: Both academicians and students experienced connection problems, and applied courses were not suitable for online education. Motivation to attend the courses was low in online education, relevant workload increased, online examinations were not sufficient for measurement and evaluation, and studies were more unplanned. It is necessary to switch to formal education after the pandemic., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Background: Backward walk training has an important place in the rehabilitation programs of lower extremity amputees., Objective: This study aimed to investigate the test-retest validity and reliability of the 3-meter backward walk test (3MBWT), minimal detectable change, and the cutoff time in high functional level adults with lower limb amputations (LLAs). Adults with LLA (n = 30) and healthy adults (n = 29) were included in the study., Study Design: This is a randomized cross-sectional study., Methods: The Modified Fall Efficacy Score, Rivermead Mobility Index, and Timed Up and Go test with the 3MBWT were used to evaluate the concurrent validity of the test. The second evaluation (retest) was performed by the same physiotherapist 1 week following the first evaluation (test). The validity was assessed by correlating the 3MBWT times with the scores of other measures and by comparing the 3MBWT times between adults with LLA and healthy adults., Results: Test-retest reliability of the 3MBWT was excellent. The intraclass correlation coefficient for the 3MBWT was 0.950. The standard error of measurement and minimal detectable change values were 0.38 and 0.53, respectively. A moderate correlation was found between the 3MBWT, Modified Fall Efficacy Score, Timed Up and Go test, and Rivermead Mobility Index ( p < 0.001). Significant differences in the 3MBWT times were found between adults with LLA and healthy controls ( p < 0.001). The cutoff time of 3.11 s discriminates healthy adults from high functional level adults with LLA., Conclusions: The 3MBWT was determined to be valid, reliable, and easy-to-apply tool in high functional level adults with LLA. This assessment is a useful and practical measurement for dynamic balance in high functional level adults with LLA., (Copyright © 2023 International Society for Prosthetics and Orthotics.)

Premenstrual syndrome (PMS) has been known to have emotional, physical, and behavioral effects in reproductive age. To evaluate the effects of premenstrual syndrome (PMS) on pain and quality of life in women, who perform regular yoga exercises in the long term. 30 women with PMS and 30 control (31.17 ± 5.28 years old) participated in this randomized controlled, single blinded study. The demographics of the PMS and control groups were similar ( p  < 0.05). A significant difference was found in a depressive mood, anxiety, fatigue, pain, depressive thoughts, sleeping habits subscales, and total scores of the PMSS, WHOQOL-BREF scale, and VAS scores between yoga and control groups ( p  < 0.05). It is determined that long-term and regular yoga practice for women with PMS will improve their, PMS symptoms, quality of life, and pain level.

Purpose: Virtual reality is widely used in patients with chronic musculoskeletal problems. However, the short-term effects on individuals with transtibial (TT) amputation during this process remain unclear. This study aimed at investigating the effects of virtual reality on rehabilitation outcomes in TT amputees. Methods: The study included 20 TT amputees who were using TT prostheses. The participants were divided into two groups randomly as follows: physiotherapy (PT) and virtual reality (VR). Participants were treated 3 days a week, for 4 weeks, and evaluations were made before and after treatment; a 6-minute walk test was used for performance, a single-leg balance test for balance, Trinity Amputation Prosthesis Experience Scale for prosthesis satisfaction, a 10-meter walking test for gait speed, and a wearable smart t-shirt to determine cadence. Results: It was found that there was a statistically significant difference in performance, balance, prosthesis satisfaction, cadence, and gait speed before and after PT ( P  < 0.05). There were differences in terms of performance, prosthesis satisfaction, balance, cadence, and gait speed before and after VR ( P  < 0.05). There was no statistically significant difference between PT and VR ( P  > 0.05). Conclusion: The 4 weeks of VR training improved performance, prosthesis satisfaction, balance, cadence, and gait speed in TT amputation rehabilitation similar to physiotherapy methods. The addition of VR training to amputation rehabilitation will bring improvements since it is a fun and safe intervention. Clinical Trial Registration: The trial is registered at Clinical Trials.gov, Trial No: NCT03872193.

Background: Repeated overload by body weight in the adolescents affects the foot structure., Objective: This study aimed to evaluate plantar pressure distribution in adolescents with different body mass indices during gait and standing., Study Design: This is a randomized, cross-sectional study., Methods: One hundred eighty-six adolescents between the ages of 8 and 15 years were included. The individuals were divided into groups according to body mass index (BMI). Plantar pressure distributions were examined during gait and standing. Surface areas, plantar pressures, forefoot-hindfoot load, surface amounts, and foot angles of the individuals were determined during gait and standing., Results: Significant differences were detected in left-right surfaces, maximum load quantities, average pressures, forefoot-hindfoot surface areas between static and dynamic plantar pressure distributions of underweight, normal, overweight, and obese adolescents (P < 001). Maximum, average pressure, right forefoot foot load, and foot angles increased in the obese group during standing as BMI increased; total surface areas, and loads in forefoot, hindfoot surface areas in right and left feet also increased in maximum and average pressures during gait (P < .05). No differences were detected between groups in foot angles during standing and gait (P > .05)., Conclusions: This study show that increased BMI causes increased plantar pressures during gait and standing, and weight gain would cause problems in adolescents., (Copyright © 2022 International Society for Prosthetics and Orthotics.)

Purpose: The temporary cessation and profound changes in ophthalmic care delivery that occurred as a result of the coronavirus disease 2019 (COVID-19) pandemic have yet to be fully understood. Our objective is to assess patients' self-reported impact of health care lockdown measures on their fears and anxieties during the crisis period of the COVID-19 pandemic in New York City., Methods: We conducted a digital, self-reported, patient care survey distributed by an e-mail at Columbia University's Department of Ophthalmology outpatient faculty practice. Inclusion criteria were age greater than or equal to 18 years, a diagnosis of either retinal disease or glaucoma, and a canceled or rescheduled ophthalmology established patient appointment during the acute phase of the COVID-19 pandemic in New York City. Patients without an e-mail address listed in their electronic medical records were excluded. The survey occurred between March 2, 2020, to May 30, 2020. Primary measures were survey responses to assess key areas of patient anxiety or concern during the pandemic including the safety of care delivery in a COVID pandemic, difficulties contacting or being seen by their ophthalmologist, concern of vision loss or disease progression, and concern over missed or access to treatments. Secondary measures were correlating survey response to factors such as visual acuity, intraocular pressure, diagnosis, disease severity, follow-up urgency, recent treatments, and diagnostic testing data., Results: Of the 2594 surveys sent out, 510 (19.66%) were completed. Over 95% of patients were at least as concerned as in normal circumstances about their ocular health during the peak of the pandemic. Overall, 76% of respondents were more concerned than normal that they could not be seen by their ophthalmologist soon enough. Increased concern over ocular health, disease progression, and access to care all showed positive correlations (P<0.05) with worse disease severity as measured with testing such as visual fields and optical coherence tomography. In addition, 55% of patients were afraid of contracting COVID-19 during an office visit., Conclusion and Relevance: We found a majority of our patients were concerned about limitations in access to ophthalmic care and were fearful of disease progression. In addition, we found a number of demographic and clinical factors that correlated with increased anxiety in our patients., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Virtual reality exercises (VRE) offers functional, multipurpose usage with a motivational approach. This study aimed to compare VRE and short foot exercises (SFE) in individuals with flexible pes planus., Methods: Forty participants with pes planus were assigned to the SFE group (n = 20) or VR exercise group (n = 20). Both groups performed exercises three times a week for four weeks. The groups were assessed with a navicular drop test for the height of the medial longitudinal arch, craig Test for femoral anteversion, Star Excursion Test for balance,10 step test for performance., Results: For two groups there is a statistically significant difference between before and after treatments(p < 0.05). There is no difference between VRE and SFE groups after treatments for all parameters(p > 0.05)., Conclusions: Two different 4-week-exercise programs for pes planus have a similar effect on performance, balance, and navicular drop values in both groups. It was considered that the practice of VR exercises like short foot exercises could also address rehabilitation goals, which included improving balance, performance, and foot posture. CLINICALTRIALS., Gov Identifier: NCT04283357., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Successful use of prostheses after lower-limb amputation (LLA) depends on undergoing physiotherapy and rehabilitation both physically and psychologically. The aim of this systematic literature review is to systematically review the scientific evidence regarding prosthetic rehabilitation and physiotherapy after LLA., Methods: A systematic literature search was conducted using PubMed, Web of Science, Cochrane, CINAHL, EMBASE, SCOPUS, and EMB Reviews databases on December 31, 2015. Studies with the search keywords were identified and independently assessed by reviewers. The search yielded 403 potentially relevant articles after the removal of duplicates. Of these, only nine articles met the inclusion criteria. All studies were original articles, one of which was a randomized controlled study. Different measurement methods were used and positive results in terms of functional status, weight-lifting capacity with prosthesis, walking and balance ability, and acute care process were gained with a physiotherapy program. Conventional methods still possess high importance; however, it is safe to say that virtual reality and software-based programs for rehabilitation are increasingly being developed and getting more and more support., Discussion: LLA rehabilitation is a topic that requires the focus of current and future studies; evidence-based studies are required on the approaches to rehabilitation for specific LLA groups.

Uveal melanoma represents ∼85% of all ocular melanomas and up to 50% of patients develop metastatic disease. Metastases are most frequently localised to the liver and, as few patients are candidates for potentially curative surgery, this is associated with a poor prognosis. There is currently little published evidence for the optimal management and treatment of metastatic uveal melanoma and the lack of effective therapies in this setting has led to the widespread use of systemic treatments for patients with cutaneous melanoma. Uveal and cutaneous melanomas are intrinsically different diseases and so dedicated management strategies and therapies for uveal melanoma are much needed. This review explores the biology of uveal melanoma and how this relates to ongoing trials of targeted therapies in the metastatic disease setting. In addition, we consider the options to optimise patient management and care., Competing Interests: RDC received non-financial support from AstraZeneca, during the conduct of this work; RDC has received grants, personal fees and non-financial support from AstraZeneca, personal fees from Janssen, personal fees from Thompson Reuters, personal fees from Merck, personal fees from Biogen Idec, personal fees from Aura Biosciences, grants from Melanoma Research Foundation, grants from Melanoma Research Alliance, grants from NIH and grants from ASCO, outside the submitted work. PDN reports personal fees from AstraZeneca, outside the submitted work., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: The aim of this study was to investigate the differences in temporospatial parameters in according to severity of knee osteoarthritis (OA)., Methods: The study included a total of 110 subjects with no orthopedic or neurologic disease that might affect gait were divided into three study and one control groups. Eighty subjects (mean age: 53.13 ± 6.78 years) were diagnosed with bilateral knee OA and divided into groups according to Kellgren-Lawrence radiologic scale: the Phase 1 group included 29 subjects, Phase 2, 28 subjects, and Phase 3, 23 subjects. The control group was composed of 30 healthy subjects (25 females, 5 males; mean age: 41.50 ± 5.79 years). Temporospatial gait data were evaluated using a gait analysis system., Methods: There were no significant differences in all temporospatial parameters between the control group and the Phase 1 and 2 OA groups (p>0.05). There was a significant decrease in cadence, gait velocity, stride length and step length (p<0.008) and a significant increase in stride time, double support time, step time, single support time and stance phase length in patients with Phase 3 knee OA compared to the other groups (p<0.008)., Conclusion: Changes in temporospatial parameters of patients with Phase 3 knee OA may be correlated with loss of gait stabilization and increase in risk of falling. In subjects with knee OA, gait stabilization and balance loss must be examined and evaluated in terms of risk of falling and necessary precautions must be taken.

Background: Systemic inflammation is accepted as one of the pathophysiological mechanisms of atrial fibrillation (AF). The role of inflammation has been shown previously. Interleukin (IL) system is the main modulator of the inflammatory responses and genetic polymorphisms of IL-1 cluster genes are associated with increased risk for inflammatory diseases., Objectives: To investigate the association between polymorphisms of IL-1 cluster genes and lone AF., Subjects and Methods: DNA samples were collected from 70 proven lone AF patients and 70 healthy subjects. Genomic DNA was typed for the variable number of the tandem repeat (VNTR) IL-1 receptor antagonist (RN) gene polymorphism, IL-1B -511 C > T(rs16944) promoter polymorphism, and +3953 C > T(rs1143634) polymorphism in exon 5 by polymerase chain reaction., Results: In lone AF group the frequency of IL-1RN2/2 and IL-1RN1/2 genotypes were higher than in the control group (7.2% vs 4.3% and 48.5% vs 22.8%, respectively; χ(2) = 14.1; P = 0.028). The frequency of allele 2 was significantly higher in the lone AF group (32.1% vs 15.7%; χ(2) = 10.7; P = 0.005). Allele and genotype distribution of IL-1B -511 C > T and +3953 C > T polymorphisms were not statistically different between the groups. C-reactive protein (CRP) levels were higher in lone AF patients compared to the control group (median = 1.25, interquartile range [IQR] = 0.85 vs median = 1.08, IQR 0.46 mg/L, respectively; P = 0.02). In multivariate regression analysis, presence of allele 2 of IL-1 VNTR polymorphism and elevated plasma high-sensitive-CRP levels were the independent predictors of lone AF., Conclusion: Presence of allele 2 of VNTR polymorphism of IL-1RN gene may cause increased risk for lone AF probably due to the inadequate limitation of inflammatory reactions., (©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.)