bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of visual and performing arts to raise cultural awareness through obesity course within pharmacy education
Authors: Jungsuwadee Paiboon , Iwuchukwu Otito , Patel Shreya 
Published: April 2020

IntroductionThe 2016 Accreditation Council for Pharmacy Education Standards call for exposure to cultural factors within pharmacy curriculum. Current efforts to meet these standards using common pedagogical techniques have had some success; however, there is still a need to identify different ways of teaching and learning cultural competency. An obesity elective course offered in the third professional year used visual and performing arts as a student‐centered learning tool to raise cultural awareness and advocate for culturally inclusive treatment.Research questionCan visual and performing arts be used as a student‐centered learning tool to raise cultural awareness and advocate for culturally inclusive treatment approaches?Study designStudents were randomized into groups and charged with selecting one patient group at risk for weight based biases from a pre‐specified list. The groups were then required to use one form of visual and performing arts (e.g., song, print media, etc.) to raise cultural awareness and present culturally inclusive treatment options for their chosen at‐risk patient group.MethodsThe use of visual and performing arts was assessed on creativity, attractiveness, and content accuracy in the context of obesity. An online audience response system and a multiple choice quiz was utilized to assess student learning. Students’ perception of how well the activity met its intended aims was assessed through a survey questionnaire.ResultsSix groups consisting of 4 to 5 students completed the activity. Student scores on creativity, attractiveness and content accuracy ranged from 97.3% to 77.8%, with an average of 83.8%. On the quiz, 90% of students achieved a score of 85% or higher. For students’ perception, 86% of students agreed that the activity improved their understanding and 91% agreed the activity improved their awareness of cultural differences associated with weight biases.ConclusionVisual and performing arts can be used as a student‐centered learning tool to expose students to cultural disparities within pharmacy curriculum.
Activation of Autophagy Restores Nitric Oxide as the Primary Mechanism of Flow‐Mediated Dilation in the Absence of Telomerase Reverse Transcriptase Activity
Authors: Hughes William Edward , Gutterman David D. , Beyer Andreas M. 
Published: April 2020

Arteriolar vasodilation to shear stress, termed flow‐mediated dilation, is endothelium‐dependent, primarily mediated by nitric oxide (NO) in health, and hydrogen peroxide (H2O2) in subjects with coronary artery disease (CAD). Previous evidence has demonstrated that autophagy and the catalytic subunit of telomerase, telomerase reverse transcriptase (TERT), govern the mediator of arteriolar FMD such that inhibition of telomerase activity or autophagy initiate a switch in mechanism of dilation from NO to H2O2 in non‐CAD, while activation of either telomerase or autophagy switch the mechanism of dilation from H2O2 to NO in CAD arterioles. We examined whether autophagy is necessary for the vascular effects of TERT utilizing a rat loss of function model that phenocopies the vascular changes observed in subjects with CAD. We hypothesized that activation of autophagy will switch the mechanism of dilation from H2O2 to NO, despite absence of TERT. Trehalose, an autophagy activator was administered in drinking water (2%) for 4 weeks. Mesenteric arterioles (3rd or 4th order) were isolated from TERT KO and wild‐type (WT) littermates and prepared for video and fluorescent microscopy. Control KO and WT animals received normal drinking water. Internal diameters were measured following increases in intraluminal flow (pressure gradient) in the presence/absence of a NOS inhibitor (L‐NAME; 100μM) or H2O2 scavenger (Peg‐Catalase, Peg‐Cat; 500 units/mL). Shear‐induced autophagy was examined using Lysotracker Red DND‐99 in response to sustained shear (100 cmH2O) for 1 hour. FMD is expressed as % maximal dilation, while Lysotracker data is expressed as relative fold change in fluorescent signal above static. In arterioles from untreated KO rats H2O2 is the primary mechanism of FMD (Vehicle: 64±9% vs. L‐NAME: 70±8% vs. Peg‐Cat: 16±4%; n=9; P<0.05), while NO predominates in WT arterioles (P<0.05). 4 weeks of 2% trehalose supplementation initiated a switch to NO as the primary mechanism of dilation in KO arterioles (Vehicle: 55±9% vs. L‐NAME: 19±6% vs. Peg‐Cat: 58±13%; n= 6–8; P<0.05). Similarly, in WT arterioles, NO is maintained as the primary mechanism of dilation (P<0.05). In KO rats shearinduced autophagy was reduced, while trehalose augmented the shear‐induced activation of autophagy in both KO and WT relative to untreated KO and WT animals (P<0.05). Our data demonstrate that trehalose initiates a switch from H2O2 to NO in KO rats, and augments shearinduced autophagy in both KO and WT. Taken together, autophagy is necessary for maintenance of NO as the primary mechanism of FMD in the absence of TERT activity.Support or Funding InformationFunded by T32GM089586‐09 (WEH), R01‐HL135901‐02 (DDG), and R01‐HL133029‐02 (AMB)
Treatment of Tibial and Femoral Bone Defects With Bone Transport Over an Intramedullary Nail
Authors: Bas Ali , Daldal Fehmi , Eralp Levent , Kocaoglu Mehmet , Uludag Serkan , Sari Seckin 
Published: April 2020

Objectives:
To evaluate the results of the bone transport over an intramedullary nail (BTON) technique for the treatment of segmental bone defects.

Design:
Retrospective review of case series.

Setting:
Level 1 trauma center.

Patients/Participants:
We included 40 patients who underwent reconstruction of the lower limb with BTON technique between 2000 and 2018. The technique was performed in the tibial segments in 21 patients and in the femoral segments in 19 patients.

Intervention:
The surgical technique was performed in 2 stages for patients with infected nonunion. Infection was eradicated in all patients at the first stage. For the BTON at the second stage, monolateral external fixators and circular external fixators were used for femoral and tibial defects, respectively. In cases of defects without any infection, debridement with a single-stage BTON was performed.

Main Outcome Measurements:
Complications as well as radiological and clinical results were evaluated according to the criteria of Paley–Maar.

Results:
Minor complications occurred in 11 patients: pin site problems (9), cellulitis (1), and skin detachment due to Schanz screw (1). Major complications occurred in 8 patients: docking site nonunion (4), early consolidation and Schanz screw failure (1), knee flexion contracture (1), and ankle equinus contracture (2). Four patients had osteomyelitis as residual sequelae. Bone score was excellent in 27 patients. Excellent functional results were obtained in 31 patients.

Conclusions:
The BTON technique is associated with low cost because of the short treatment period, low complication risk, and rapid rehabilitation and is not limited by the amount of bone transport.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Serial Casting in Neuromuscular and Syndromic Early-onset Scoliosis (EOS) Can Delay Surgery Over 2 Years
Authors: LaValva Scott , Adams Alexander , MacAlpine Elle , Gupta Purnendu , Hammerberg Kim , Thompson George H. , Sturm Peter , Garg Sumeet , Anari Jason , Sponseller Paul , Flynn John , Cahill Patrick J. 
Published: April 2020

Background:
The primary goal in managing early-onset scoliosis (EOS) is delaying/preventing surgical intervention while allowing improved spinal growth and chest wall and lung development to improve life expectancy. The effectiveness of serial casting for patients with neuromuscular and syndromic EOS is unclear.

Methods:
Patients from 2 multicenter registries who underwent serial casting for nonidiopathic scoliosis (NIS) were reviewed retrospectively. Comparisons were made between precasting and postcasting major and compensatory curves and spine height. The need for surgical intervention and any treatment complications were documented. Risk factors for major curve progression from baseline to casting cessation were evaluated via univariate analysis.

Results:
Forty-four patients (23 females; 21 males) with NIS (26 syndromic, 18 neuromuscular) and a mean age of 3.2 years at baseline were included. Mean follow-up and casting duration was 3.9 and 2.0 years, respectively. There were no statistically significant differences between mean precasting and postcasting major curve (55 vs. 60 degrees; P=0.348), minor curve (31 vs. 33 degrees; P=0.510), or rib-vertebra angle difference (18 vs. 29 degrees; P=0.840). However, thoracic height (15.5 vs. 16.8 cm; P=0.031) and lumbar height (8.9 vs. 9.8 cm; P=0.013) were significantly greater upon casting cessation. Currently, 13 patients (30%) have had successful casting (improvement of major curve ≥10 degrees) while 24 patients (55%) experienced major curve progression (worsening), and 19 patients (43%) required surgical intervention. Mean time from first casting to surgery was 34.5±15.1 months. There were no statistically significant predictors for major curve progression on univariate analysis.

Conclusions:
Spinal deformity progression despite casting and the subsequent need for surgical intervention for NIS were significantly higher compared with those reported for idiopathic EOS. However, serial casting did afford a substantial delay in surgical intervention. Ultimately, serial casting for neuromuscular or syndromic EOS is an effective strategy for delaying surgical intervention, despite suboptimal radiographic outcomes.

Level of Evidence:
Level III.
Alterations of B Cells in Immunosuppressive Phase of Septic Shock Patients*
Authors: Dong Xijie , Liu Qinxin , Zheng Qiang , Liu Xinghua , Wang Yuchang , Xie Zhenxing , Liu Tao , Yang Fan , Gao Wei , Bai Xiangjun , Li Zhanfei 
Published: April 2020

Objectives:
Septic shock is a subset of sepsis related to acute circulatory failure characterized by severe immunosuppression and high mortality. Current knowledge about B-cell status in the immunosuppressive phase of septic shock is sparse. The aim of this study was to investigate the alterations of B Cells in the immunosuppressive phase of septic shock.

Design:
Prospective cohort study.

Setting:
Adult ICUs at a university hospital.

Patients:
Adult septic shock patients without any documented immune comorbidity.

Interventions:
None.

Measurements and Main Results:
The absolute counts of lymphocytes and B cells of 81 patients and 13 healthy controls, and serum immunoglobulin levels of 64 patients and 10 healthy controls were determined by clinical laboratory. The percentages and counts of B-cell subsets of 33 patients and 10 healthy controls and the immunoglobulin M expression on B-cell subsets of 20 patients and five healthy controls were quantified by flow cytometry. Immunoglobulin levels produced by B cells after stimulation in vitro of 20 patients and five healthy controls were tested by enzyme-linked immunosorbent assay. Redistribution and selective depletion of B-cell subsets in septic shock patients were discovered, and a decrease in immunoglobulin M levels was associated with a reduction in resting memory B-cell counts. These alterations were more pronounced in nonsurvivors compared with survivors. Additionally, receiver operating characteristic curve analysis showed that the data of B-cell subsets had the best predictive value for mortality risk.

Conclusions:
Severe B-cell abnormalities are present in the immunosuppressive phase of septic shock and are associated with prognosis.
Nebulized Poractant Alfa Reduces the Risk of Respiratory Failure at 72 Hours in Spontaneously Breathing Surfactant-Deficient Newborn Piglets
Authors: Rey-Santano Carmen , Mielgo Victoria E. , Gomez-Solaetxe Miguel Angel , Bianco Federico , Salomone Fabrizio , Loureiro Begoña 
Published: April 2020

Objectives:
We have setup for the first time a long-term (72 hr) respiratory distress syndrome model in spontaneously breathing surfactant-deficient newborn piglets to investigate the continuous positive airway pressure failure rate with nebulized poractant alfa compared with that with the intubation surfactant extubation technique or continuous positive airway pressure only.

Design:
Prospective randomized animal study.

Setting:
Biocruces-Bizkaia Health Research Institute Animal Facility.

Subjects-Interventions:
Eighteen newborn piglets (n = 6/group) with surfactant-deficient respiratory distress syndrome were randomized to three continuous positive airway pressure–ventilated groups: 1) nebulized surfactant (poractant alfa 400 mg/kg) via a customized investigational eFlow-Neos vibrating membrane nebulizer system, 2) bolus administration using the Intubation Surfactant Extubation method (200 mg/kg), or 3) continuous positive airway pressure alone.

Measurements and Main Results:
Pulmonary and hemodynamic variables were assessed at 6-hour intervals for 72 hours. Lung and brain histological analyses were performed. After bronchoalveolar lavages, piglets developed respiratory distress syndrome. Over the follow-up, both surfactant-treated groups had significantly better pulmonary outcomes than the continuous positive airway pressure alone group. Furthermore, unlike in the continuous positive airway pressure group, there were no cases of respiratory failure in either of the surfactant-treated groups.

Conclusions:
In newborn piglets with respiratory distress syndrome, the nebulization of 400 mg/kg of poractant alfa using a customized investigational eFlow-Neos nebulizer was found to be safe and effective in reducing the risk of respiratory failure in the 72 hours after treatment.
Knowledge, awareness, and practices of cervical cancer, its risk factors, screening, and prevention among women in Karachi, Pakistan
Authors: Hirani Samina , Khan Sarah , Akram Sidra , Virji Safna Naozer , Shaikh Preet Ayoub , Naeem Ehsun , Chaudhry Rayaan Asad , Khalid Ahmed Bilal , Khan Jalal Ud Din , Qasim Muhammad Suhaib , Jehan Imtiaz 
Published: April 2020

Background
Cervical cancer has a high mortality rate worldwide; in Pakistan it kills more than 7000 women every year. Prevention is possible through vaccination against human papilloma virus, the causative agent of cervical cancer, or by screening for premalignant lesions through routine Pap smear tests. We have studied the knowledge and practices regarding cervical cancer, its risk factors, screening and prevention and the role of human papilloma virus vaccination and Pap smear testing, among young women of Karachi.

Methods
Information was gathered using a modified version of Cervical Cancer Awareness Measure Toolkit version 2.1 from 384 women aged 15 to 50 with no medical background attending outpatient clinics of AKUH, Karachi. Data entry was done through EpiData and analysis was done using SPSS version 22.0.

Results
Our respondents’ mean age was 30 (±7.6) years. Out of the 61.2% of women who had heard about cervical cancer, 47.0% had heard about Pap smear test and among them, 73% had gotten a Pap test. A total of 25.5% of women out of the 61.2%, knew that a vaccine existed for prevention and out of them only 9.8% had vaccinated against human papilloma virus.

Conclusion
Majority of women in our study belonged to a higher socioeconomic class and were mostly educated but their knowledge and practices regarding prevention and screening of cervical cancer were poor. This reflects that the knowledge levels as a whole would be considerably lower in the city’s general population.
Association between dietary sodium intake and blood pressure variability in Chinese patients with hypertension
Authors: Wang Chi , Liu Tong-Bo , Mu Lei , Wang Miao , Li Yao , Yao Si-Yu , Zhao Mao-Xiang , Xue Hao 
Published: April 2020

Abstract

Background
The association between dietary sodium intake and blood pressure variability (BPV) in hypertensive patients remains unclear. The objective of this study was to demonstrate whether dietary sodium intake is a predictor of elevated BPV in Chinese patients with hypertension.

Methods
A total of 235 patients with essential hypertension were enrolled in the Department of Cardiology, Chinese People's Liberation Army (PLA) General Hospital in 2018 to 2019, all of whom underwent 24-h ambulatory blood pressure monitoring. BPV was calculated as the standard deviation (SD), coefficient of variation (CV), variation independent of mean (VIM) of blood pressure measurements, respectively, and divided into diurnal systolic BPV (SBPV), diurnal diastolic BPV (DBPV), nocturnal SBPV, and nocturnal DBPV. 24-h urine samples were collected to measure 24-h urine sodium excretion, which represents dietary sodium intake. The relationship between dietary sodium intake and BPV was analyzed by using Spearman correlations and multiple linear regression analysis.

Results
Nocturnal SBPV-SD, CV, VIM, and nocturnal DBPV-SD in the high urine sodium excretion group were significantly higher than those in the medium and low urine sodium excretion groups, whereas diurnal SBPV-SD, CV, VIM, diurnal DBPV-SD, CV, VIM, and nocturnal DBPV-CV, VIM were not. Using the Spearman correlation analysis, we found a linear correlation between 24-h urine sodium excretion and nocturnal SBPV-SD, CV, VIM (SD, r = 0.22, P = 0.001; CV, r = 0.17, P = 0.009; VIM, r = 0.16, P = 0.020), nocturnal DBPV-SD (r = 0.21, P = 0.001), respectively. After further adjusting for confounding factors by multiple linear regression, the positive correlations remained between 24-h urine sodium excretion and nocturnal SBPV-SD, CV, VIM (SD, β = 0.224, P < 0.001; CV, β = 0.211, P = 0.001; VIM, β = 0.213, P = 0.001), nocturnal DBPV (SD, β = 0.215, P = 0.001), respectively.

Conclusions
Dietary sodium intake is associated with nocturnal SBPV in Chinese patients with hypertension.
Effect of High Homocysteine Level on the Severity of Coronary Heart Disease and Prognosis After Stent Implantation
Authors: Li Shanshan , Sun Liping , Qi Liqun , Jia Yongsheng , Cui Zhuo , Wang Zhongsuo , Li Fengshuai , Zhao Xiaofeng 
Published: April 2020

Objectives:
To determine the effect of high homocysteine (HCY) levels on the severity of coronary artery disease and prognosis after stent implantation.

Methods:
A prospective study was conducted on 667 patients with coronary heart disease who underwent drug-eluting stent implantation for the first time at the Department of Cardiology, Huludao Central Hospital, from January 2015 to December 2017. The patients were divided into the control and hyperhomocysteinemia (H-HCY) groups based on the serum HCY levels. The demographic and clinical characteristics of both groups were compared. In addition, the patients were followed up for 1 year to compare the incidence of major adverse cardiovascular and cerebrovascular events (MACCE). Multivariate logistic regression was used to determine the correlation between serum HCY levels and MACCE.

Results:
Compared with the control group, the stenosis degree was significantly higher among patients in the H-Hcy group, as indicated by more coronary artery lesions (P < 0.001) and higher SYNTAX scores (P < 0.001). After 1 year of follow-up, the incidence of MACCE was also significantly higher in the H-HCY versus control group (9.5% vs. 15.1%; P = 0.042). Furthermore, age, history of diabetes, discontinuation of antiplatelet aggregation drugs, and HCY levels were independent predictors of MACCE.

Conclusions:
High HCY level is associated with severe coronary artery disease in patients with coronary heart disease and is an independent predictor of MACCE after stent implantation.
Cardiovascular Pharmacology in the Time of COVID-19: A Focus on Angiotensin-Converting Enzyme 2
Authors: Buckley Leo F. , Cheng Judy W. M. , Desai Akshay 
Published: April 2020

Abstract:
Coronavirus disease-2019 (COVID-19) has emerged as a pandemic affecting millions of adults. Severe acute respiratory syndrome coronavirus-2019 (SARS-CoV-2), the causative virus of COVID-19, infects host cells through angiotensin-converting enzyme 2 (ACE2). Preclinical models suggest that ACE2 upregulation confers protective effects in acute lung injury. In addition, renin–angiotensin aldosterone system inhibitors reduce adverse atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease outcomes, but may increase ACE2 levels. We review current knowledge of the role of ACE2 in cardiovascular physiology and SARS-CoV-2 virology, as well as clinical data to inform the management of patients with or at risk for COVID-19 who require renin–angiotensin–aldosterone system inhibitor therapy.
Activation of sphingosine-1-phosphate receptor subtype 1 in the central nervous system contributes to morphine-induced hyperalgesia and antinociceptive tolerance in rodents
Authors: Doyle Timothy M. , Janes Kali , Chen Zhoumou , Grace Peter M. , Esposito Emanuela , Cuzzocrea Salvatore , Largent-Milnes Tally M. , Neumann William L. , Watkins Linda R. , Spiegel Sarah , Vanderah Todd W. , Salvemini Daniela 
Published: April 2020

Abstract
Morphine-induced alterations in sphingolipid metabolism in the spinal cord and increased formation of the bioactive sphingolipid metabolite sphingosine-1-phosphate (S1P) have been implicated in the development of morphine-induced hyperalgesia (OIH; increased pain sensitivity) and antinociceptive tolerance. These adverse effects hamper opioid use for treating chronic pain and contribute to dependence and abuse. S1P produces distinct effects through 5 G-protein-coupled receptors (S1PR1-5) and several intracellular targets. How S1P exerts its effects in response to morphine remains unknown. Here, we report that S1P contributes to the development of morphine-induced hyperalgesia and tolerance through S1P receptor subtype 1 (S1PR1) signaling in uninjured male and female rodents, which can be blocked by targeting S1PR1 with S1PR1 antagonists or RNA silencing. In mouse neuropathic pain models, S1PR1 antagonists blocked the development of tolerance to the antiallodynic effects of morphine without altering morphine pharmacokinetics and prevented prolonged morphine-induced neuropathic pain. Targeting S1PR1 reduced morphine-induced neuroinflammatory events in the dorsal horn of the spinal cord: increased glial marker expression, mitogen-activated protein kinase p38 and nuclear factor κB activation, and increased inflammatory cytokine expression, such as interleukin-1β, a cytokine central in the modulation of opioid-induced neural plasticity. Our results identify S1PR1 as a critical path for S1P signaling in response to sustained morphine and reveal downstream neuroinflammatory pathways impacted by S1PR1 activation. Our data support investigating S1PR1 antagonists as a clinical approach to mitigate opioid-induced adverse effects and repurposing the functional S1PR1 antagonist FTY720, which is FDA-approved for multiple sclerosis, as an opioid adjunct.