bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of Shear Stress Values Along Endothelial Tip Cells Past the Lumen of Capillary Sprouts
Authors: Courtney Connor , Rozenblum Maximillian , Hu Nien-Wen , Murfee Walter L. , Sarntinoranont Malisa
Published: April 2020

Shear stress is commonly recognized as a regulator of endothelial cell dynamics associated with angiogenesis. A full understanding of how shear stresses influence endothelial cell phenotype and function during angiogenesis requires the identification of local stress distribution along capillary sprouts. However, the actual shear stress magnitudes experienced by endothelial cells remain unknown in large part to the difficulty in experimentally measuring local velocity profiles. The objective of this study was to estimate shear stress magnitudes due to local interstitial flow along endothelial tip cells that extend past capillary sprout lumens. A computational fluid dynamics model was used to estimate flows within a blind‐ended vessel, transendothelial flow out of through the vessel wall, and flow through a perivascular space. The two dimensional axisymmetric model consisted of 4 regions: vessel lumen, vessel wall, perivascular space and interstitium. The vessel wall was assumed to be porous media with 1 μm thickness. Blood plasma was represented as an incompressible Newtonian fluid with density and viscosity equal to 1050 kg/m3 and 1.2 cp, respectfully. Model parameters and geometric dimensions were selected based on previously reported literature values. Shear stresses along the wall of the tip cell extended past the lumen were calculated for varying sprout lengths (100, 200, and 500 μm), perivascular space channel width (1, 4, and 9 μm) and sprout permeability (1×10−18 and 1×10−17 m2). For the 200 μm sprout length scenario, shear stress values ranged from 0.009 to 5 dyne/cm2. Increasing sprout length, increasing permeability and decreasing perivascular space served to increase shear stress values. These results suggest the potential for endothelial cells past the lumen of a capillary sprout to experience negligible to stimulatory shear stresses dependent on sprout wall permeability and interstitial flow pathways.
Two-Year Delayed Healing of an Endovascular Access Site Related to an Unusual Etiology
Authors: Bohanon Carol Jeorg , Kiemele Lester James
Published: April 2020

In this case report, the authors describe a patient who underwent an endovascular abdominal aortic aneurysm repair complicated by more than a 2-year delay in healing of the left inguinal fold access site. Providers initially suspected a chronic infection or foreign body reaction, but eventually the patient was diagnosed with superficial granulomatous pyoderma. Once the correct etiology was determined and appropriate treatment begun, the access site healed within 3 weeks.
Construction and Validation of an Instrument for Assessing the Feet of Persons with Diabetes
Authors: da Costa Saulo Pereira , Chavaglia Suzel Regina Ribeiro , Ohl Rosali Isabel Barduchi , Costa Bruna Yara , Barbosa Maria Helena , Woo Kevin , Gamba Mônica Antar
Published: April 2020

OBJECTIVE

To construct and validate an assessment instrument to evaluate the feet of people with diabetes mellitus in Brazil.

METHODS

Methodological research developed in three stages: construction of the Assessment Instrument for the Feet of People with Diabetes Mellitus, validation of face and content validity, and field research with 131 participating patients. The Pearson (r) and Spearman correlation coefficients (ρ) were used for criterion validity. To test reliability, the internal consistency of the Cronbach α domains was evaluated and simple κ, weighted κ, and intraclass correlation coefficients for interobserver evaluation were determined.

RESULTS

The instrument demonstrated validity and reliability. The content validity index represented a high internal consistency (α > .70). The interclass correlation coefficient was high (>0.98). The Pearson (r) and Spearman (ρ) correlation tests confirmed a correlation between the two variables.

CONCLUSIONS

The instrument was valid and reliable for assessing the feet of people with diabetes mellitus in Brazil. Future studies should identify the cut off point for the diagnosis of neuropathic and vascular impairment of the feet of diabetic persons through appropriate statistical methods.
Fifth Metatarsal Osteotomy
Authors: Madeley Nicola Jane , Halai Mansur , Senthil Kumar Chinnasamy
Published: April 2020

Fifth metatarsal osteotomy is performed for correction of bunionette deformities, occurring alone or in combination with other deformities such as hallux valgus. This article will discuss the pathoanatomy of the bunionette, its classification and our surgical approach to the varying degrees of this entity.
Cloning of two splice variants of Spalax heparanase encoding for truncated proteins
Authors: Nasser Nicola J. , Avivi Aaron , Vlodavsky Israel , Nevo Eviatar
Published: April 2020

Heparanase is an endoglycosidase that degrades heparan sulfate side chains of heparan sulfate-proteoglycans. It liberates heparan sulfate-bound growth factors and thereby promotes blood vessel sprouting and angiogenesis. The subterranean blind mole rat, Spalax, is a wild mammal that lives most of its life in underground tunnels where it experiences sharp fluctuations in oxygen and carbon dioxide levels. We described two splice variants of heparanase from Spalax, Splice 7 and splice 36, both devoid of heparanase enzymatic activity. Splice 7 increases tumor growth, while splice 36 functions as a dominant negative to wild-type heparanase and decreases tumor growth and metastasis. Here, we describe two novel splice variants of Spalax heparanase, splice 67 and splice 612. These splice variants result in production of a shorter heparanase proteins that are similar to the wild-type native heparanase in their N-terminal but have unique C-terminals. Both splice 67 and 612 lack heparan sulfate degradation activity.
Chidamide combined with paclitaxel effectively reverses the expression of histone deacetylase in lung cancer
Authors: Zhang Na , Sun Pan , Jin Haizhen , Yang Yuqin , Zhao Qingya , Zhou Lin , Guo Lili , Yang Xiaohua , Lu Liming
Published: April 2020

The role of histone deacetylases (HDACs) in lung cancer has been extensively studied. Inhibition of HDAC activities have been used as a new cancer treatment strategy. To date, many HDAC inhibitors have been shown to induce apoptosis and inhibit tumorigenesis. Chidamide (CS055) is a new member of HDAC inhibitors. In China, Chidamide has been approved for the treatment of relapsed or refractory peripheral T-cell lymphoma. However, the efficacy of Chidamide in non-small cell lung cancer remains unclear. In this study, we used lung cancer primary cells and investigated the effects of Chidamide combined with paclitaxel on lung cancer. We found that Chidamide combined with paclitaxel effectively inhibited the expression and activity of HDAC in primary lung cancer cells, induced their apoptosis and blocked cell cycle. Chidamide combined with paclitaxel may therefore provide a new promising therapeutic treatment for lung cancer.
Integrative profiling analysis identifies the oncogenic long noncoding RNA DUXAP8 in oral cancer
Authors: Chen Mingwei , Zheng Yanliang , Xie Jingfang , Zhen Enming , Zhou Xiaoqing
Published: April 2020

A growing number of studies have revealed the critical roles of long noncoding RNAs (lncRNAs) in the tumorigenesis and cancer progression. Recently, next-generation sequencing technologies combined with bioinformatic have demonstrated that a great number of dysregulated lncRNAs are associated with diverse cancers. However, lots of lncRNAs’ function and their underlying molecular mechanisms in oral carcinoma (OC) cancer remain unclear. In this study, we performed integrative lncRNA profiling analysis using the TCGA RNA sequencing data and gene microarray data from Gene Expression Omnibus to identify more OC associated lncRNAs. A total of 619 differentially expressed lncRNAs were identified between the five data sets, and only the double homeobox A pseudogene 8 (DUXAP8) was screened among the up-regulated lncRNAs in all the five groups. Meanwhile, univariate Cox regression analyses disclosed that some lncRNAs are associated with the outcome of OC patients, such as DUXAP8, LINC00152, MIR4435-2HG and LINC00582. Furthermore, we uncovered that silenced DUXAP8 expression exerted suppressive impact on the proliferation of OC cells through interacting with histone-lysine N-methyltransferase enzyme Enhancer of zeste homolog 2 (EZH2) and repressing KLF2 expression. In a word, we identified a lot of unreported OC associated lncRNAs, which may provide a useful resource of lncRNAs for other studies.
Temporary Transvenous Diaphragmatic Neurostimulation in Prolonged Mechanically Ventilated Patients: A Feasibility Trial (RESCUE 1)
Authors: Ataya Ali , Silverman Erin P. , Bagchi Aranya , Sarwal Aarti , Criner Gerard J. , McDonagh David L.
Published: April 2020

Objectives:

Prolonged mechanical ventilation promotes diaphragmatic atrophy and weaning difficulty. The study uses a novel device containing a transvenous phrenic nerve stimulating catheter (Lungpacer IntraVenous Electrode Catheter) to stimulate the diaphragm in ventilated patients. We set out to determine the feasibility of temporary transvenous diaphragmatic neurostimulation using this device.

Design:

Multicenter, prospective open-label single group feasibility study.

Setting:

ICUs of tertiary care hospitals.

Patients:

Adults on mechanical ventilation for greater than or equal to 7 days that had failed two weaning trials.

Interventions:

Stimulation catheter insertion and transvenous diaphragmatic neurostimulation therapy up to tid, along with standard of care.

Measurements and Main Results:

Primary outcomes were successful insertion and removal of the catheter and safe application of transvenous diaphragmatic neurostimulation. Change in maximal inspiratory pressure and rapid shallow breathing index were also evaluated. Eleven patients met all entry criteria with a mean mechanical ventilation duration of 19.7 days; nine underwent successful catheter insertion. All nine had successful mapping of one or both phrenic nerves, demonstrated diaphragmatic contractions during therapy, and underwent successful catheter removal. Seven of nine met successful weaning criteria. Mean maximal inspiratory pressure increased by 105% in those successfully weaned (mean change 19.7 ± 17.9 cm H2O; p = 0.03), while mean rapid shallow breathing index improved by 44% (mean change –63.5 ± 64.4; p = 0.04).

Conclusions:

The transvenous diaphragmatic neurostimulation system is a feasible and safe therapy to stimulate the phrenic nerves and induce diaphragmatic contractions. Randomized clinical trials are underway to compare it to standard-of-care therapy for mechanical ventilation weaning.
Tyrosine Kinase Inhibitors and the Relationship With Adherence, Costs, and Health Care Utilization in Commercially Insured Patients With Newly Diagnosed Chronic Myeloid Leukemia
Authors: Phuar Hsiao Ling , Begley Charles E. , Chan Wenyaw , Krause Trudy Millard
Published: April 2020

Objective:

To examine the association among tyrosine kinase inhibitor (TKI) out-of-pocket costs, adherence, and health care costs and utilization in a large group of commercially insured patients with chronic myeloid leukemia (CML).

Materials and Methods:

Patients with CML aged 18 to 64 years were identified using IBM MarketScan Commercial Database between April 1, 2011 and December 31, 2014. Patients were required to be continuously enrolled 3 months before and 12 months after TKI (imatinib, dasatinib, or nilotinib) initiation. TKI adherence is estimated using the proportion of days covered (PDC), defined as the percentage of the PDC by the prescription fill during the 12-month study period (adherent patients have PDC ≥80%). Health care cost differences between adherent and nonadherent patients were estimated using generalized linear models. Health care utilization was compared using negative binomial regression models. All models were controlled for potential confounding factors.

Results:

The study sample consisted of 863 patients, where 355 (41.1%) patients were classified as adherent. Over the study period, nonadherent patients incurred US$10,974 more in medical costs (P<0.001), and US$1663 more in non-TKI pharmacy costs (P<0.01). Adherent patients incurred US$28,184 more in TKI pharmacy costs (P<0.001) that resulted in US$18,305 more in overall total health care costs (P<0.001). Adherent patients, however, were estimated to be less likely to have all-cause hospitalizations (incidence rate ratio, 0.32; P<0.001), or CML-specific hospitalizations (incidence rate ratio, 0.31; P<0.01).

Conclusions:

Patients with CML with better adherence experienced fewer hospitalizations, resulting in medical service cost savings. These lower medical costs, however, were more than offset by higher TKI medication costs observed during the first year of TKI therapy.
The Impact of the COVID-19 Pandemic on Cancer Patients
Authors: Al-Quteimat Osama M. , Amer Amer Mustafa
Published: April 2020

In December 2019, a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused an outbreak of coronavirus disease 2019 (COVID-19). Severe complications have been reported to occur in 33% of patients with COVID-19 and include acute respiratory distress syndrome, acute renal failure, acute respiratory injury, septic shock, and severe pneumonia. Currently, there is no specific treatment or approved vaccine against COVID-19 and many clinical trials are currently investigating potential medications to treat COVID-19. The immunosuppressed status of some cancer patients (whether caused by the disease itself or the treatment) increases their risk of infection compared with the general population. This short review aims to focus on the impact of COVID-19 on a cancer patient and discuss management options and recommendation in addition to highlighting the currently available clinical guidelines and resources.
Pharmacologic Treatment of Transplant Recipients Infected With SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug–Drug Interactions
Authors: Elens Laure , Langman Loralie J. , Hesselink Dennis A. , Bergan Stein , Moes Dirk Jan A.R. , Molinaro Mariadelfina , Venkataramanan Raman , Lemaitre Florian
Published: April 2020

Background:

COVID-19 is a novel infectious disease caused by the severe acute respiratory distress (SARS)-coronavirus-2 (SARS-CoV-2). Several therapeutic options are currently emerging but none with universal consensus or proven efficacy. Solid organ transplant recipients are perceived to be at increased risk of severe COVID-19 because of their immunosuppressed conditions due to chronic use of immunosuppressive drugs (ISDs). It is therefore likely that solid organ transplant recipients will be treated with these experimental antivirals.

Methods:

This article is not intended to provide a systematic literature review on investigational treatments tested against COVID-19; rather, the authors aim to provide recommendations for therapeutic drug monitoring of ISDs in transplant recipients infected with SARS-CoV-2 based on a review of existing data in the literature.

Results:

Management of drug–drug interactions between investigational anti-SARS-CoV-2 drugs and immunosuppressants is a complex task for the clinician. Adequate immunosuppression is necessary to prevent graft rejection while, if critically ill, the patient may benefit from pharmacotherapeutic interventions directed at limiting SARS-CoV-2 viral replication. Maintaining ISD concentrations within the desired therapeutic range requires a highly individualized approach that is complicated by the pandemic context and lack of hindsight.

Conclusions:

With this article, the authors inform the clinician about the potential interactions of experimental COVID-19 treatments with ISDs used in transplantation. Recommendations regarding therapeutic drug monitoring and dose adjustments in the context of COVID-19 are provided.
Characteristics of Streptococcus pyogenes Versus Streptococcus pneumoniae Pleural Empyema and Pneumonia With Pleural Effusion in Children
Authors: Megged Orli
Published: April 2020

Background:

Streptococcus pneumoniae is the most common cause of complicated pneumonia in children, but its incidence is decreasing since the introduction of the antipneumococcal conjugated vaccines. Streptococcus pyogenes is an uncommon cause of community-acquired pleuropneumonia/empyema in children, but its relative incidence is rising.

Methods:

The medical records of all children 0–18 years of age from 2004 to 2019, with discharge diagnoses of pleuropneumonia or empyema, and a positive blood and/or pleural effusion culture for group A streptococcus (GAS) (S. pyogenes), or S. pneumonia (SP) were reviewed. A comparison of clinical and laboratory characteristics for the 2 etiologies was performed.

Results:

Ninety cases of community-acquired pleuropneumonia/empyema caused by these organisms were included: 20 GAS and 70 SP. Compared with children with SP, those with GAS were more likely to have larger pleural effusion requiring drainage and longer hospitalization, and less likely to have a positive blood culture. The relative portion of GAS empyema increased over the study period.

Conclusions:

Compared with patients with SP empyema, GAS appears to cause more morbidity and a longer hospital stay. This organism is more frequently recovered from pleural fluid without bacteremia, and thus necessitates pleural fluid tap for accurate diagnosis.
Fresnel prism effect and chromatic aberration produced by posterior capsular folds after intraocular lens implant
Authors: Ali Zaria C. , Usmani Hasan A. , Vishwanath Mandagere
Published: April 2020

We present a previously unreported positive dysphotopsia of an alternating green and red diagonal line after developing posterior capsular folds following uneventful cataract surgery and its management. A 73-year-old man presented complaining of seeing multicolored ray of light obliquely across luminous sources from his left eye 3 weeks after phacoemulsification. He was found to have 3 folds on the posterior capsule, which were perpendicular to the axis of the line of the red and green rays. This was managed with routine Nd:YAG laser posterior capsulotomy, after which his symptoms instantly resolved. To our knowledge, there is no other published report of this multifaceted visual aberration due to posterior capsular folds. Through our case, we highlight that a thorough examination can find a simple solution for a seemingly complex presenting complaint and can avoid unnecessary investigations and invasive procedures.
Preoperative assessment of posterior capsular integrity using a posterior segment OCT with a +20 D lens: The 'conical sign' to suggest capsular deficiency in posterior polar cataracts
Authors: Pujari Amar , Selvan Harathy , Yadav Saumya , Urkude Jayanand , Singh Rashmi , Mukhija Ritika , Makwana Tarjani , Sharma Namrata
Published: April 2020

Purpose:

To study the morphology of posterior polar cataracts and posterior lens capsules using modified posterior segment optical coherence tomography (m-OCT).

Setting:

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Design:

A prospective observational case series.

Methods:

Patients with clinically diagnosed posterior polar cataracts were included. The routine posterior segment OCT was modified by placing an aspheric +20.00 diopter lens along its aperture, enabling it to visualize the anterior segment structures. Cases of posterior polar cataract were assessed preoperatively using this method to study the morphology of posterior lens cortex and the posterior capsule. All m-OCT observations were performed by 2 observers, and findings were recorded.

Results:

A total of 26 eyes of 17 patients were included. The mean age of patients was 53 years. The morphology of the cataract appeared as hyperreflective opacity just anterior to the posterior capsule, subsequently involving it, and with variable hyporeflective spaces. An intact posterior capsule showed a regularly convex contour, whereas a loss in the tracing of posterior capsule at the paracentral region and disturbance in contour with a localized protrusion of lens matter (the conical sign) depicted a possible posterior capsule dehiscence. Four (15.38%) of 26 eyes showed the conical sign, and this posterior capsule defect was confirmed intraoperatively in all cases.

Conclusions:

In posterior polar cataracts, the conical sign could be a valuable clue to predict preexisting posterior capsule dehiscence and could be identified on a m-OCT.
Where to buy face masks? Survey of applications using Taiwan’s open data in the time of coronavirus disease 2019
Authors: Yuan Eunice J. , Hsu Chia-An , Lee Wui-Chiang , Chen Tzeng-Ji , Chou Li-Fang , Hwang Shinn-Jang
Published: April 2020

Background:

The coronavirus disease 2019 (COVID-19) had spread rapidly since late December 2019. Personal protective equipment was essential to prevent transmission. Owing to shortage of face masks, Taiwan government began to implement quasi rationing on February 6, 2020, by allowing each resident to purchase two masks in seven days. Taiwan National Health Insurance Administration offered online data with real-time updates on face mask availability in all contracted pharmacies and selected local health centers. Based on the open data, numerous software applications quickly emerged to assist the public in finding sales locations efficiently.

Methods:

Up until March 15, 2020, the Public Digital Innovation Space of Taiwan government had recorded 134 software applications of face mask availability, and 24 software applications were excluded due to defect, duplicate, and unavailability. These applications were analyzed according to platform, developer type, and display mode.

Results:

Of the 110 valid software applications, 67 (60.9%) applications were deployed on websites, followed by 21 (19.1%) on social networking sites, 19 (17.3%) as mobile applications, and 3 (2.7%) in other modes. Nearly two thirds (n = 70) of applications were developed by individuals, one third (n = 37) by commercial companies, only two applications by central and local governments, and one by a nongovernmental organization. With respect to the display mode, 47 (42.7%) applications adopted map-view only, 41 (37.3%) adopted table-view only, and 19 (17.3%) adopted both modes. Of the remaining three applications, two offered voice user interfaces and one used augmented reality.

Conclusion:

Taiwan’s open data strategy facilitated rapid development of software applications for information dissemination to the public during the COVID-19 crisis. The transparency of real-time data could help alleviate the panic of the public. The collaborative contributions from the grassroots in disasters were priceless treasures.
The Effect of Contextualized Racial and Gendered Stressors, Social Support, and Depression on Hypertension Illness Perceptions and Hypertension Medication Adherence in Young African American Women With Hypertension
Authors: Spikes Telisa , Higgins Melinda , Lewis Tené , Dunbar Sandra
Published: April 2020

Background

Poor adherence to hypertensive medication has been suggested to be a major contributor to uncontrolled hypertension (HTN) in African Americans. The impact that social determinants have on the various patient-level factors, including HTN beliefs, mental well-being, and social support, may provide insight into the development and tailoring of culturally targeted interventions, thus improving adherence.

Objective

The aim of this study was to examine the relationships of exposures to contextualized racial and gendered stressors, social support, and depressive symptoms with HTN illness perceptions and blood pressure (BP) medication adherence.

Methods

Participants (N = 85) were hypertensive African-American women aged 18 to 45 years (mean [SD], 39.2 [5.4] years) recruited from the community setting and outpatient medical clinics in a large metropolitan city. Hypertension illness beliefs were assessed using the 8-item Brief Illness Perception Questionnaire (“How much does your blood pressure affect your life?”) and medication adherence was assessed with the 7-item Adherence to Refills and Medication Scale (“How often do you forget to take your BP medicine?”). Logistic regression analyses were performed to examine the associations with medication adherence and linear regression analyses were performed to examine the associations of continuous variables and HTN illness perceptions.

Results

The sample was predominantly nonadherent (81.2%). In the adjusted multivariable regression model, systolic BP (odds ratio, 0.95; P = .05) and the “Consequence” dimension of HTN beliefs (odds ratio, 0.76; P = .02) were associated with medication adherence. In the adjusted linear regression model, systolic BP (β = 0.22, P < .01) and depressive symptoms (β = 1.11, P < .01) were associated with HTN illness beliefs.

Conclusions

Assessing beliefs and the mental well-being before initiating BP medications is essential for adherence and BP control.
Illness Perceptions, Self-efficacy, and Self-reported Medication Adherence in Persons Aged 50 and Older With Type 2 Diabetes
Authors: Kim Hyejin , Sereika Susan M. , Lingler Jennifer H. , Albert Steven M. , Bender Catherine M.
Published: April 2020

Background

Illness perceptions, patients' beliefs about their health condition, may affect medication adherence as well as self-efficacy for managing the condition in type 2 diabetes (T2DM).

Objectives

The aims of this study were to investigate the associations between illness perceptions, self-efficacy, and self-reported medication adherence among persons (≥50 years of age) with T2DM and explore whether the number of comorbid conditions moderates these associations.

Methods

This secondary analysis of cross-sectional data used baseline data from persons with T2DM. Self-administered questionnaires, including the Brief Illness Perception Questionnaire, Self-efficacy for Managing Chronic Disease, and the 4-item Morisky-Green-Levine Medication Adherence Scale, were used. We performed hierarchical multiple linear regression analyses.

Results

Participants (N = 146) were 57.5% female, 67.1% white, and on average 64 years old. Six dimensions of illness perceptions (ie, consequences, personal control, treatment control, identity, concerns, and emotional representations) were associated with self-efficacy for managing T2DM. Five dimensions (ie, timeline, personal control, treatment control, coherence, and emotional representations) were significant predictors of self-reported medication adherence. Whereas the number of comorbid conditions was significantly associated with self-efficacy for managing T2DM in all models (P values < .001), the number of comorbid conditions was not associated with self-reported medication adherence.

Conclusions

This study suggests that illness perceptions and comorbid conditions may play a critical role in either self-efficacy or self-reported medication adherence in persons (≥50 years of age) with T2DM. Future research should incorporate an individual's illness perceptions and comorbid conditions into the development of interventions that may improve both self-efficacy and medication adherence in T2DM.
Mental and Physical Health Behaviors of Doctor of Physical Therapy Students
Authors: Ellison Jennifer , Mitchell Katy , Bogardus Jennifer , Hammerle Kristi , Manara Carly , Gleeson Peggy
Published: April 2020

Introduction.

High incidences of mental health issues in the undergraduate and graduate students are reported nationwide. The purpose of this study was to assess the Doctor of Physical Therapy (DPT) students' depression, anxiety, and stress levels using the 21-item Depression, Anxiety, and Stress Scale (DASS-21) to investigate how mental and physical behaviors correlate with DPT students' mental health and to identify the coping strategies of DPT students to guide the intervention strategies of PT programs.

Methods.

A 49-item survey with demographic questions and 3 open-ended questions was developed to assess the students' mental and health behaviors. The DASS-21 was imbedded in the survey. Email invitations to 136 DPT students from one DPT program in the Southwestern region of the United States resulted in 59 responses.

Results.

Most students had normal DASS-21 scores for stress (66%), anxiety (64%), and depression (73%). However, only 46% had normal ranges for all 3 scales and a concerning number of students scored in the moderate and severe ranges for stress (19%), anxiety (25%), depression (12%), and previous suicide ideation (7%). No correlation was found between the DASS-21 scores and the gender or relationship status. No significant difference was found between the years in the program in the subscores of stress (P = .189), anxiety (P = .095), or depression (P = .149). All subscores of the DASS-21 were inversely correlated with hours of sleep: stress (r = −0.317, P = .014), anxiety (r = −0.467, P ≤ .005), and depression (r = −0.310, P = .017). Depression subscores were associated with lower frequency of aerobic (r = −0.335, P = .01) and strengthening exercises (r = −0.259, P = .049).

Discussion and Conclusions.

Physical therapist education programs should address the mental health issues of students by providing education on how to incorporate active positive coping strategies into their very busy lives. Students in this study are aware of healthy physical and mental strategies but do not use them consistently.
Perceptions of Academic Rights and Responsibilities in Physical Therapy Students and Faculty
Authors: Goehring Meri Tienn , Kinne Bonni Lynn , Vaughn Daniel Wayne
Published: April 2020

Introduction.

The purpose of this study was to compare the perceived academic entitlement of physical therapy students with the way in which physical therapy faculty members perceived their students' academic rights and responsibilities. Three groups of researchers have published academic entitlement questionnaires. Although several researchers have attempted to measure the academic entitlement of undergraduate students, very few studies have investigated the same issue because it relates to graduate students. In addition, only one study has attempted to measure the academic entitlement of graduate students enrolled in a health care curriculum.

Methods.

The participants were Doctor of Physical Therapy (DPT) faculty members and DPT students at a public liberal arts university in the Midwest part of the United States. The data collection tool was the 15-item academic entitlement questionnaire created by Greenberger et al. A comparison of how the DPT faculty members and the DPT students answered the individual questionnaire items was calculated using the Fisher Exact Test, and a comparison of how the DPT faculty members and the DPT students responded to the entire questionnaire was calculated using Cronbach's Alpha.

Results.

There was no statistically significant difference between the way in which the DPT faculty members answered the individual questionnaire items and the way in which the DPT students responded to each question. When the entire questionnaire was taken into consideration, the overall academic entitlement of the DPT students was significantly greater than the way in which the DPT faculty members perceived their students' academic rights and responsibilities (P = .0452).

Discussion and Conclusion.

This study found that some DPT students may have an inflated sense of their academic entitlement. Therefore, DPT faculty members should explore meaningful ways in which to convey expectations regarding academic rights and responsibilities.
Development and implementation of an e-visit objective structured clinical examination to evaluate student ability to provide care by telehealth
Authors: Quinlin Linda , Clark Graham Margaret , Nikolai Carol , Teall Alice M.
Published: April 2020

The provision of care through telehealth is emerging as a strategy to meet the challenges of a changing health care system; however, educational experiences associated with telehealth are limited in nursing curricula. In 2018, the National Organization of Nurse Practitioner Faculties (NONPF) recommended incorporating telehealth modalities in nurse practitioner education, including clinical skills assessment. Objective structured clinical examinations (OSCEs) have been used as formative and summative evaluations of health science students since the 1970s to assess application of didactic learning in clinical practice. Although few studies have investigated integrating OSCEs, virtual simulation, or telehealth in distance education, those that exist demonstrate significant improvement in clinical decision making. This article describes the development and implementation of an OSCE at a large Midwestern university delivered via web conferencing to evaluate online family nurse practitioner (FNP) students' abilities to deliver care using telecommunication technology. An e-visit notification listing the types of symptoms available for treatment by telehealth served as a content list. Students completed a 15-minute e-visit assessing and managing the care of a standardized patient presenting with a recent onset of dysuria. The video conference included the FNP student, standardized patient, and faculty evaluating in real time using a rubric incorporating NONPF competencies for telehealth. Structured group debrief, an integral part of the learning process in clinical simulations, followed the e-visit OSCE using free conference calling. Faculty and student feedback and evaluations of this summative OSCE implemented for three cohort groups (103 students) positively reflect the importance of preparing students for practice in a transformed health care system.
First Successful Treatment of Coronavirus Disease 2019 Induced Refractory Cardiogenic Plus Vasoplegic Shock by Combination of Percutaneous Ventricular Assist Device and Extracorporeal Membrane Oxygenation: A Case Report
Authors: Bemtgen Xavier , Krüger Kirsten , Supady Alexander , Duerschmied Daniel , Schibilsky David , Bamberg Fabian , Bode Christoph , Wengenmayer Tobias , Staudacher Dawid L.
Published: April 2020

The novel coronavirus severe acute respiratory syndrome coronavirus 2 is infecting hundreds of thousands of humans around the globe. The coronavirus disease 2019 (COVID-19) is known to generate mild as well as critical courses. Complications on the intensive care units include acute respiratory distress syndrome, acute cardiac, and kidney injury as well as shock. Here, we present the first case report of a successful treatment of a COVID-19 patient presenting with adult respiratory distress syndrome plus refractory combined cardiogenic and vasoplegic shock, which could be successfully stabilized after implantation of a percutaneous ventricular assist device plus an extracorporeal membrane oxygenation. Although such intense treatment might not be feasible in case of a health care disaster as described for the hot spots of the COVID-19 pandemic, it might encourage treatment of younger patients on intensive care units not overcrowded by critically ill patients.
Extracorporeal cardiopulmonary resuscitation for cardiac arrest
Authors: Kalra Rajat , Kosmopoulos Marinos , Goslar Tomaz , Raveendran Ganesh , Bartos Jason A. , Yannopoulos Demetris
Published: April 2020

Purpose of review

Extracorporeal cardiopulmonary resuscitation (ECPR) is a contemporary resuscitation approach that employs veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This approach is increasingly used worldwide to mitigate the widespread hemodynamic and multiorgan dysfunction that accompanies cardiac arrest.

Recent findings

In this review, the physiology of VA-ECMO and ECPR, the role of ECPR in contemporary resuscitation care, the complications associated with ECPR and VA-ECMO usage, and intensive care considerations for this population are discussed.

ECPR offers a promising mechanism to mitigate multiorgan injury and allow time for the institution of supportive interventions required to effectively treat cardiac arrest. More prospective data in the context of extensive prehospital and hospital collaboration is needed to promote its successful use.
Drugs during cardiopulmonary resuscitation
Authors: Vallentin Mikael F. , Granfeldt Asger , Holmberg Mathias J. , Andersen Lars W.
Published: April 2020

Purpose of review

The current narrative review outlines the evidence for the most common drugs given during adult cardiopulmonary resuscitation.

Recent findings

Two large clinical trials recently made the roles of adrenaline and antiarrhythmic drugs clearer. Adrenaline leads to a substantially higher rate of return of spontaneous circulation and a moderate increase in survival. Amiodarone and lidocaine increase short-term outcomes, and point estimates suggest a small but uncertain effect on long-term survival. There is still a lack of high-quality evidence for other drugs during cardiac arrest such as bicarbonate, calcium, and magnesium, but small-scale randomized clinical trials show no effect. A promising entity may be the combination of vasopressin and glucocorticoids, but external validation of preliminary trials is needed. Data from observational studies and subgroup analyses of trials generally favor intravenous over intraosseous access, while the latter remains a reasonable alternative.

Guidelines for the above-mentioned drugs have been updated yet remain largely unchanged over the last decades. There are still multiple unanswered questions related to drugs during cardiopulmonary resuscitation. On the contrary, only few trials are ongoing.
Monitoring mitochondrial PO2: the next step
Authors: Mik Egbert G. , Balestra Gianmarco M. , Harms Floor A.
Published: April 2020

Purpose of review

To fully exploit the concept of hemodynamic coherence in resuscitating critically ill one should preferably take into account information about the state of parenchymal cells. Monitoring of mitochondrial oxygen tension (mitoPO2) has emerged as a clinical means to assess information of oxygen delivery and oxygen utilization at the mitochondrial level. This review will outline the basics of the technique, summarize its development and describe the rationale of measuring oxygen at the mitochondrial level.

Recent findings

Mitochondrial oxygen tension can be measured by means of the protoporphyrin IX-Triplet State Lifetime Technique (PpIX-TSLT). After validation and use in preclinical animal models, the technique has recently become commercially available in the form of a clinical measuring system. This system has now been used in a number of healthy volunteer studies and is currently being evaluated in studies in perioperative and intensive care patients in several European university hospitals.

PpIX-TSLT is a noninvasive and well tolerated method to assess aspects of mitochondrial function at the bedside. It allows doctors to look beyond the macrocirculation and microcirculation and to take the oxygen balance at the cellular level into account in treatment strategies.
Individualized blood pressure targets during postcardiac arrest intensive care
Authors: Skrifvars Markus B. , Åneman Anders , Ameloot Koen
Published: April 2020

Purpose of review

To discuss recent findings relevant to optimizing blood pressure targets in adult, postcardiac arrest (PCA) patients and whether to tailor these based on specific patient, cardiac arrest or treatment characteristics.

Recent findings

Observational data suggest that mean arterial pressure (MAP) below 65–75 mmHg in PCA patients is associated with worse outcome. A higher MAP could be beneficial in patients with chronic hypertension who more frequently have a right shift of the cerebral autoregulation curve. Two recent randomized pilot trials compared lower and higher MAP targets during PCA care and found no significant effect on biomarkers of neurological injury. The haemodynamic interventions in those studies did not use any cerebral perfusion endpoints beyond a static MAP targets during ICU stay. Individualized, dynamic MAP targets based on assessments of cerebral perfusion and tailored to the specifics of the patient, cardiac arrest circumstances and treatment responses may be more conducive to improved outcomes. Pilot data suggest that near infrared spectroscopy monitoring may be used to determine the cerebral autoregulatory capacity and an optimal MAP, but this approach is yet to be tested in clinical trials.

Current evidence suggests targeting a MAP of at least 65–75 mmHg in PCA patients. Future studies should focus on whether certain patient groups could benefit from higher and dynamic MAP targets.
The efficacy of dexamethasone on pain management for knee arthroscopy
Authors: Peng Chuangang , Li Chen , Yuan Baoming , Jiao Jianhang
Published: April 2020

Introduction:

The impact of dexamethasone on pain management for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexamethasone for knee arthroscopy.

Methods:

We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2018 for randomized controlled trials (RCTs) assessing the effect of dexamethasone on pain intensity for patients with dental implant. This meta-analysis is performed using the random-effect model.

Results:

Four RCTs involving 228 patients are included in the meta-analysis. Overall, compared with control group for knee arthroscopy, dexamethasone supplementation has no notable effect on pain scores at 4 to 6 hours (Std. MD = 0.99; 95% CI = −2.97 to 4.95; P = .62), but exerts significantly favorable promotion to pain scores at 12 hours (Std. MD = −1.06; 95% CI = −1.43 to −0.69; P < .00001), duration of block (Std. MD = 1.87; 95% CI = 0.65 to 3.10; P = .003), time to first analgesic requirement (Std. MD = 0.90; 95% CI = 0.51 to 1.29; P < .00001), analgesic consumption (Std. MD = -1.62; 95% CI = −2.31 to −0.93; P < .00001), and patient satisfaction (Std. MD = 1.15; 95% CI = 0.73 to 1.58; P < .00001).

Conclusions:

Dexamethasone supplementation has importantly positive influence on pain control for knee arthroscopy.
Traditional Chinese medicine combined with western medicine for the treatment of secondary pulmonary tuberculosis
Authors: Li Xiangwen , Li Xinghui , Liu Qiling , Sun Na , Zhang Bei , Shi Chuandao , Zhang Rongqiang
Published: April 2020

Objective:

To evaluate the differences between traditional Chinese medicine combined with western medicine and western medicine alone for the treatment of secondary tuberculosis and its impact on the evaluation of clinical efficacy and safety of patients in randomized controlled trials.

Methods:

A literature search of all major academic databases was conducted (PubMed, CNKI, Wanfang, VIP). Meta-analysis was conducted using RevMan 5.3 and Stata 12.0 software for those studies that satisfied the inclusion criteria. Ethical approval was not necessary because no people or animals were selected as subjects in this meta-analysis.

Results:

Twenty-three randomized controlled trials were included in this meta-analysis. The following indicators in the treatment group (traditional Chinese medicine decoction combined with western medicine chemotherapy) improved in comparison with those in the control group:focus absorption rate (RR:1.18; 95% CI: 1.15–1.22);sputum smear negative rate (RR: 1.17; 95% CI: 1.09–1.27);comprehensive clinical effective rate (RR: 1.18; 95% CI: 1.14–1.22);cavity closure rate (RR: 1.37; 95% CI: 1.12–1.67).

The difference of Immune function indicator likes CD4+ level (SMD: 0.76; 95% CI: −0.25 to 1.76) between the treatment group and the control group was not significant. In addition, safety evaluation indicators like the decrease rate of white blood cell (WBC) and platelets (PLT) and the elevation rate of alanine aminotransferase (ALT) and uric acid (UA) in the treatment group were reduced compared with those in the control group (P < .05).

Conclusions:

The curative effect of combining traditional Chinese and western medicine for the treatment of secondary tuberculosis is better than that of western medicine alone and is conducive to reducing the incidence of adverse reactions.
Peripheral artery disease: how much inter-leg symmetry? A contrast-enhanced magnetic resonance angiography study
Authors: Secchi Francesco , Di Leo Giovanni , Delnevo Alessandra , Alì Marco , D’Angelo Ida Daniela , Nardella Veronica Gaia , Sardanelli Francesco
Published: April 2020

The aim of this observational retrospective study was to qualitatively and quantitatively evaluate the symmetry of atherosclerotic plaques in patients with peripheral artery disease (PAD) undergoing contrast-enhanced magnetic resonance angiography of lower limbs. We retrospectively evaluated the peripheral magnetic resonance angiography of 82 patients considering the iliac, femoral and tibial arteries. Stenosis was scored 0 (none), 1 (<50%), 2 (50%–74%), 3 (75%–99%), and 4 (occluded). Symmetry was quantified as the percentage of bilaterally-diseased arteries and using the inter-leg absolute score difference (0–4). Signs test and Cohen κ were also calculated. Seventy-one (87%) patients had ≥1 bilaterally-diseased artery, and 168 (20%) of 820 artery pairs were bilaterally affected. At least 1 bilateral stenosis was observed from 11% (right internal iliac) to 73% (right superficial femoral). All 10 arteries showed symmetry, none of the inter-leg comparisons being significantly different (P ≥ .100). Cohen κ ranged from 0.208 (common femoral) to 0.533 (internal iliac). This study showed that PAD was symmetrically distributed between the 2 legs, with the internal iliac artery being the most symmetric segment. Symmetry of PAD was quantified in 20%.
Effects of 9 oral care solutions on the prevention of oral mucositis: a network meta-analysis of randomized controlled trials
Authors: Yu Ya-Ting , Deng Jia-Lin , Jin Xian-Rong , Zhang Zhong-Zu , Zhang Xiao-Hua , Zhou Xin
Published: April 2020

Background:

Oral mucositis (OM) is a common, disabling, and severe early effect of chemotherapy and radiotherapy that limits the effectiveness of anticancer therapy. The prevention and treatment of OM in patients with malignant tumors is an urgent problem in the field of anticancer therapy.

Methods:

Databases including PubMed, Embase, Scopus, The Cochrane Library, and Google Scholar were searched to collect published randomized control trials (RCTs) about the effects of different oral care solutions on the prevention of OM from inception to January 2019. We used the Cochrane Handbook to assess the methodological quality of the RCTs. Two of the authors independently extracted the articles and predefined data. Network meta-analysis was then performed using Stata 15.0 software.

Results:

A total of 28 RCTs involving 1861 patients were included. The results of network meta-analysis showed that chlorhexidine, benzydamine, honey, and curcumin were more effective than placebo (P < .05) and that honey and curcumin were more effective than povidone-iodine (P < .05). Probability ranking according to the Surface Under the Cumulative Ranking curve showed the following treatments: curcumin, honey, benzydamine, chlorhexidine, allopurinol, sucralfate, granulocyte-macrophage colony-stimulating factor, povidone-iodine, and aloe.

Conclusion:

Our preliminary results indicate that curcumin and honey may serve as the preferred options for patients to prevent OM. The findings may offer an important theoretical basis for clinical prevention and treatment. However, this conclusion still requires an RCT with a larger sample size for further verification.