Clinical Evaluation Methods Research Articles

The correlation between dermoscopy and clinical and pathological tests in the evaluation of skin photoaging.

There are no standards for evaluating skin photoaging. Dermoscopy is a non-invasive detection method that might be useful for evaluating photoaging. To assess the correlation between the dermoscopic evaluation of photoaging and clinical and pathological evaluations. The age, clinical evaluation (Fitzpatrick classification, Glogau Photoaging Classification, and Chung's standardized image ruler), histopathology (Masson staining and MMP-1 immunohistochemistry), and dermoscopy (Hu's and Isik's) of 40 donor skin samples were analyzed statistically, and Spearman rank correlation analysis was performed. There was a robust correlation between the total Hu scores and Isik dermoscopy. The correlation of dermoscopy with histopathology was higher than that of clinical evaluation methods. There is a strong correlation between telangiectases and lentigo. Xerosis, superficial wrinkle, diffuse erythema, telangiectases, and reticular pigmentation were significantly correlated with the three clinical evaluation methods. Superficial wrinkles were correlated with Masson, MMP-1, various clinical indicators, and other dermoscopic items. There is a good correlation between dermoscopy and clinical and histopathological examination. Dermoscopy might help evaluate skin photoaging.

The effect of escape room clinical evaluation method on satisfaction, learning, and preparedness to practice as interns of nursing students: A quasi-experimental quantitative study.

Clinical evaluation utilizing the escape room game is recognized as a novel method for assessing the team-oriented performance of learners. It is a tool for evaluating teamwork skills in clinical settings, which can boost student motivation and learning. This study aimed to investigate the effect of clinical evaluation through escape rooms and feedback provision through the PEARLS (promoting excellence and reflective learning in simulation) approach on pre-internship nursing students' satisfaction, learning, and preparedness to practice as interns. The current research is a quasi-experimental quantitative study conducted with a census sample of 42 sixth-semester undergraduate nursing students in 2022. The escape room method was utilized to evaluate entry preparedness into the clinical field. Reliable and valid researcher-made questionnaires were administered to assess the impact of the intervention on learning, satisfaction, and preparedness. The data were analyzed in SPSS version 26 using descriptive and inferential tests. The significance level was considered to be less than 0.05. Twenty-six males and 16 females constituted the 42 participants (mean age: 23.46 years). The clinical evaluation method of the escape room game was deemed satisfactory or highly satisfactory by 80% of students. From the perspective of 72% of students, escape rooms were definitely or highly effective in shaping their preparedness to enter the clinical field. Comparing the students' mean learning scores (self-assessment of clinical skills) before and after the test revealed that their post-test scores (55/16 ± 13/33) were significantly higher than their pre-test scores (45/58 ± 16/58) (P < 0.001). It appears that using the escape room evaluation method in conjunction with other student evaluation methods has helped improve students' interpersonal communication, problem-solving skills, critical thinking, and teamwork. The experience of working in a group not only improves these skills and is enjoyable to students but can also enhance their learning. Clinical education is dependent on teamwork. The escape room test can be viewed as a valuable tool for encouraging students to collaborate as a team. Therefore, it is suggested that students in all medical education groups be evaluated clinically using this test.

Generation of 3D-Multicellular Human iPSC-Heart Organoids for the Noninvasive Assessment of Cardiac Fibrosis.

The lack of a precise noninvasive, clinical evaluation method for cardiac fibrosis hinders the development of successful treatments that can effectively work in physiological settings, where tissues and organs are interconnected and moderating drug responses. To address this challenge and advance personalized medicine, researchers have turned to human-induced pluripotent stem (iPS) cells, which can be differentiated to resemble the human heart in terms of structure, function and cellular composition. In this chapter, we present an assay protocol that uses these iPS cells to generate heart organoids for the in vitro evaluation of cardiac fibrosis. By establishing this biological platform, we pave the way for conducting phenotype evaluation and treatment screening in a multiscale approach, aiming to discover effective interventions for the treatment of cardiac fibrosis.

DNase improves the efficacy of antimicrobial photodynamic therapy in the treatment of candidiasis induced with Candida albicans.

The study evaluated the association of DNase I enzyme with antimicrobial photodynamic therapy (aPDT) in the treatment of oral candidiasis in mice infected with fluconazole-susceptible (CaS) and -resistant (CaR) Candida albicans strains. Mice were inoculated with C. albicans, and after the infection had been established, the tongues were exposed to DNase for 5 min, followed by photosensitizer [Photodithazine®(PDZ)] and light (LED), either singly or combined. The treatments were performed for 5 consecutive days. Treatment efficacy was evaluated by assessing the tongues via fungal viable population, clinical evaluation, histopathological and fluorescence microscopy methods immediately after finishing treatments, and 7 days of follow-up. The combination of DNase with PDZ-aPDT reduced the fungal viability in mice tongues immediately after the treatments by around 4.26 and 2.89 log10 for CaS and CaR, respectively (versus animals only inoculated). In the fluorescence microscopy, the polysaccharides produced by C. albicans and fungal cells were less labeled in animals treated with the combination of DNase with PDZ-aPDT, similar to the healthy animals. After 7 days of the treatment, DNase associated with PDZ-aPDT maintained a lower count, but not as pronounced as immediately after the intervention. For both strains, mice treated with the combination of DNase with PDZ-aPDT showed remission of oral lesions and mild inflammatory infiltrate in both periods assessed, while animals treated only with PDZ-aPDT presented partial remission of oral lesions. DNase I enzyme improved the efficacy of photodynamic treatment.

Psoriatic onychodystrophy: Clinical course, diagnosis and therapeutic aspects

Psoriatic onychodystrophy is observed in about 80% of patients with psoriasis. Psoriasis can affect two nail structures ― the matrix and the nail bed.&#x0D; Involvement of the nail matrix in the pathological process can lead to the formation of leukonychia, thimble symptom, red spots in the area of the hole and destruction of the nail plate. On the other hand, the lesion of the nail bed is characterized by the formation of onycholysis, subcutaneous hyperkeratosis and subcutaneous hemorrhages.&#x0D; Nail lesions in psoriasis are accompanied by functional disorders and aesthetic defects, and also indicate a severe course of psoriasis.&#x0D; Treatment of psoriatic onychodystrophy includes topical medications, systemic therapy in cases accompanied by extensive skin lesions.&#x0D; This article is an overview of the main clinical features, diagnostic issues and evaluation methods, as well as treatment options for nail psoriasis.

Sarcopenia and Osteoporosis.

Osteoporosis and sarcopenia are major health issues which are going to have a significant impact in an aging global population. Osteoporosis, which reduces bone density and increases fracture risk, and sarcopenia, which causes muscle loss and strength loss, have a complicated risk profile with consequences that go beyond bone and muscle health. This chapter illuminates the complex link between osteoporosis and sarcopenia, including overlapping causes, clinical consequences, and new treatments. This chapter covers bone and muscle biology, age-related changes that cause osteoporosis and sarcopenia, and the importance of physical exercise and diet in their prevention and management. It also discusses clinical evaluation methods, risk assessment and diagnostic criteria for early diagnosis and intervention. Novel therapies and continuing research in the management of osteoporosis and sarcopenia are also discussed. Medications, exercise, and nutrition can promote bone and muscle health. This chapter aims to explore the recent concepts by elucidating the complex relationship between osteoporosis and sarcopenia and advocating for integrated care paradigms.

3 Rey Complex Figure Scoring Made Simple: Data from the Emory Healthy Brain Study

Objective:The Rey Complex Figure (CF) is a popular test to assess visuospatial construction and visual memory, but its broader use in clinical research is limited by scoring complexity. To widen its application, we developed a new CF scoring system similar to the Benson Figure in which 10 primary CF elements are scored according to presence and location. A novel recognition task was also created for each of these 10 items consisting of a 4-choice recognition condition containing the primary rectangle and major interior lines with qualitative variations of target elements as distractors. The current investigation was designed to characterize the relationship between scoring methods and establish whether comparable results are obtained across both traditional and new CF scoring approaches.Participants and Methods:Participants from the Emory Health Brain Study (EHBS) who had completed the Rey CF copy during their cognitive study visit were studied. All participants were self-identified as normal, and administered the CF according to our previously published procedure that included the Copy, Immediate Recall (∼ 30 seconds), and 30-minute Delayed Recall (Loring et al., 1990). Following delayed recall, CF recognition was assessed using the Meyers and Myers (1995) recognition followed by the newly developed forced choice recognition. The final sample included 155 participants ranging in age from 51.6 years to 80.0 years (M=64.9, SD=6.6). The average MoCA score was 26.8/30 (SD=6.6).Results:Mean performance levels across conditions and scoring approaches are included in the table. Correlations between Copy, Immediate Recall, Delayed Recall, and Recognition were calculated to evaluate the relationship between the traditional 18 item/36 point Osterrieth criteria and newly developed CF scoring criteria using both parametric and non-parametric approaches. Pearson correlations demonstrated high agreement between approaches when characterizing performance levels across all CF conditions (Copy r=.72, Immediate Recall r=.87, Delayed Recall r=.90, and Recognition r=.52). Similar correlations were present using non-parametric analyses (Copy ρ=.46, Immediate Recall ρ=.83, Delayed Recall ρ=.91, and Recognition ρ=.42). Table. Mean performance levels across conditions and scoring approachesConclusions:The high correlations, particularly for Immediate and Delayed Recall conditions, suggest that the modified simpler scoring system is comparable to the traditional approach, thereby suggesting potential equivalence between scoring methods. When comparing Rey’s original 47 point scoring approach to his 36 point scoring system, Osterrieth (1944) reported a correlation in fifty adults of ρ=.95 and a correlation in twenty 6-year-olds of ρ=.92. In this investigation, lower correlations were observed for copy and recognition conditions, in part representing smaller response distribution across participants. Although these preliminary results are encouraging, to implement the new EHBS scoring method in clinical evaluation, we are developing normative data in participants across the entire EHBS series, many of whom were not administered the new CF Recognition. We are also examining performances in patients undergoing DBS evaluation for Parkinson Disease to explore its clinical sensitivity. Simpler scoring will permit greater CF clinical and research application.

ASPECTS OF ASSESSING AESTHETIC PARAMETERS IN PATIENTS

Main goal. To study the state of the maxillofacial system in patients with defects in the hard tissues of the teeth and dentition for the presence of aesthetic problems and the prevalence of aesthetic treatment methods with indirect restorations.&#x0D; Matherials and methods. To study the state of the maxillofacial system , we have created the “Map of determining the level of aesthetics” , which includes an analysis of the shape and colour of the teeth , the condition of the gums , the presence of restorations , the state of occlusal relationships and oral hygiene. 230 people aged 18-45 were examined, intraoral scanning and model scanning were used. General clinical examination methods were carried out, radiological methods were used. In order to evaluate metal-free restorations, clinical evaluation methods according to USPHS criteria (Ryge) were applied.&#x0D; Research results. During the examination of patients, we found that 72.0% of the subjects were not satisfied with their aesthetic appearance. The reasons for this are the discrepancy between the color and shape of predominantly direct restorations, changes in tooth position, and different levels of gingival attachment. We found that in a significant part of patients, fixed metal-ceramic or metal-acrylic fixed structures and direct composite restorations for a period of 3 years or more prevailed, which led to the development of an inflammatory process in the marginal periodontal tissues and gingival bleeding. Significant causes of aesthetic dissatisfaction in the examined patients were changes in the color and shape of teeth or restorations in 67.2% of the examined patients, changes in the position of teeth in 35.6%, and unequal level of gingival attachment of the anterior teeth in 18.4%. In addition, the reasons for the aesthetic dissatisfaction of patients were the inappropriate shape of the cutting edge, the condition of the gums and oral hygiene, direct and indirect restorations. Based on the data obtained, we proposed the Aesthetics Index, which takes into account a set of factors: tooth color, tooth shape, tooth position, level of gingival attachment, shape of the cutting edge, gum condition, condition of direct restorations, condition of indirect restorations, state of oral hygiene, frequency of visits to the dentist. When examining patients according to 10 criteria, a high level (41-50 points) of aesthetics was found in 16.8%, and an average level (31-40 points) in 56.8%. It should be noted that a low level of aesthetic satisfaction (up to 30 points) was found in 26.4% of patients during subjective and confirmed by objective examination.&#x0D; Conclusions. We have proposed the Aesthetic Index, which takes into account the main aesthetic parameters and the state of the hard tissues of teeth and restorations. This index is accessible and simple, and can be used by dentists in their practice. The obtained results indicate that only 16.8% of patients have aesthetic restorations that fully meet the requirements, and 26.4% have a low level of patient aesthetic satisfaction. The main reasons for this are changes in the color, shape, position of the teeth and the level of gum attachment.

A mouse model of food allergy permitting skin and nasal symptoms

PurposeDeveloping experimental animal models that show clinical symptoms and methods for quantitative and objective evaluation are important for understanding food allergies. Therefore, this study aimed to develop an ovalbumin (OVA)-induced mouse model of food allergy and a useful method to evaluate the symptoms of food allergy. Material/methodsMice were sensitized via intraperitoneal injection of OVA. Subsequently, local sensitization was performed once weekly by oral administration of OVA. Itching and nasal symptoms were observed after oral administration of the antigen. First, we examined the dose-dependency of the antigen. Symptoms were checked weekly. In order to confirm food allergy symptoms, the effect of histamine H1 receptor antagonist was examined. Finally, we measured antigen-specific IgE antibody levels in the serum. ResultsScratching behavior, sneezing and nasal rubbing were increased. Both itching and rhinitis symptoms increased steadily, after which, the number of symptoms remained almost constant. No difference was observed between the results of 3- and 5-week-old mice. Cetirizine inhibited these symptoms in a dose-dependent manner. In addition, antigen-specific IgE antibodies were produced in both 3- and 5-week-old mice. ConclusionsThis method may be useful for evaluating the symptoms of skin and rhinitis that could not be assessed in the conventional food allergy model and could be induced with a low dose of antigen. In particular, the developed method, which measures the number of itching and nasal symptoms, may enable quantitative, objective, and noninvasive evaluation of food allergy severity.

Postoperative complications in patients with intracranial meningiomas who underwent surgery

Introduction and Aim: A benign tumor of the central nervous system known as a meningioma of the brain can be effectively treated surgically to assure complete patient recovery. The objective of this study was to investigate intracranial postoperative complications in meningiomas, identify factors that are prognostically significant, assess the results of surgical therapy, and provide rational solutions for difficulties associated with brain meningiomas. Materials and Methods: The 202 observations of patients with supratentorial meningiomas who had surgery provided the basis for the current study. In the 20 patients who survived, we looked at a number of surgical problems. Clinical evaluation and instrumental diagnostic methods were used to confirm their nature. Results: Most patients with basal located meningiomas experience surgical issues. Meningiomas were discovered to be basal in 12 (60.0%) of the survivors who encountered postoperative complications. Patients with postoperative complications from meningiomas frequently encountered many cumulative issues, with a death rate of 5 (2.5%) and one or occasionally two complications in survivors. Conclusion: The growth of tumors, surgical trauma, and the body's general reaction to the removal of neoplasms all affect the body's activity at all levels (subcellular, cellular, organ, and systemic) in patients with supratentorial meningiomas, leading to postoperative complications.

Impact of gingival phenotype on the periodontal disease.

The aims of the present study were to explore the relations between the gingival phenotype (GP) and the periodontal health status and find the prevalence of a specific gingival phenotype in a small Bulgarian population.

Comparative Evaluation of the Accuracy of Gingival Thickness Measurement by Clinical Evaluation and Intraoral Ultrasonography.

This study aimed to investigate the accuracy of gingival thickness measurement by two methods of clinical evaluation and intraoral ultrasonography. The gingival thickness was measured in the midbuccal area of the right maxillary lateral incisor and first molar teeth in 30 individuals. For clinical measurement, a #15 K-file with rubber stops was vertically inserted 2 mm apical to the gingival margin and the length of the file in the tissue was measured using a digital caliper. Ultrasonographic measurement was performed using an intraoral probe on the gingival surface in the midbuccal area, at the entry point of the file. Statistical analysis was performed by paired t-test, correlation coefficient, and receiver operating characteristic (ROC) curve (α = 0.05). In the anterior region, the mean gingival thicknesses using ultrasonography (1.517 ± 0.293 mm) and clinical evaluation (1.610 ± 0.272 mm) were not significantly different (p = 0.434). In the posterior region, the mean gingival thicknesses were significantly different between ultrasonography (1.372 ± 0.442 mm) and clinical evaluation (1.626 ± 0.310 mm) (p = 0.006). The area under ROC curve values for ultrasonographic measurements in the anterior and posterior regions were 0.681 and 0.597, respectively. The use of ultrasonography with an intraoral probe has acceptable accuracy for the determination of gingival thickness, especially for the anterior regions.

Bioanalytical RP-HPLC Method for Simultaneous Quantification of Rivaroxaban and Ticagrelor in Spiked Human Plasma: Validation and Stability

For the effective assessment of preclinical, biopharmaceutical and clinical pharmacological investigations, selective and sensitive analytical methods for the quantitative evaluation of drugs and their metabolites (analytes) are essential. Using Rilpivirine as an internal standard (IS), a simple, fast, sensitive, precise and accurate high performance liquid chromatographic method for simultaneous determination of Rivaroxaban and Ticagrelor in human plasma was developed. The analytes were extracted using a direct protein precipitation method with acetonitrile from 500μL aliquots of human plasma. The content of the drugs was assessed using a mobile phase consisting of acetonitrile and 0.1% orthophosphoric acid buffer in a 40:60 v/v ratio and with a flow rate of 1.0ml/min, and an injection volume of 10μL. A Kromasil C18 (250×4.6mm; 5µm) analytical column was used for chromatographic separation and the effluents were monitored at 265nm using a photo diode array (PDA) detector.Rivaroxaban, Ticagrelor and Rilpivirine had retention times of 4.716min, 6.396min and 5.405 min, respectively. Rivaroxaban was shown to be linear at concentrations ranging from 0.018µg/mL - 1.80µg/mL, whereas Ticagrelor was found to be linear between 0.020µg/Ml - 2.00µg/mL. The method was validated according to US-FDA guidelines, and the findings satisfied the acceptance criteria. It was successfully used to determine Rivaroxaban and Ticagrelor in human plasma at the same time and this method is applicable for the pre-clinical and clinical estimation of drugs in biological fluids.

Problems and thoughts in clinical safety evaluation of traditional Chinese medicine

Amid the modernization and internationalization of traditional Chinese medicine(TCM), the safety of TCM has attracted much attention. At the moment, the government, scientific research teams, and pharmaceutical enterprises have made great efforts to explore methods and techniques for clinical safety evaluation of TCM. Although considerable achievements have been made, there are still many problems, such as the non-standard terms of adverse reactions of TCM, unclear evaluation indicators, unreasonable judgment methods, lack of evaluation models, out-of-date evaluation standards, and unsound reporting systems. Therefore, it is urgent to further deepen the research mode and method of clinical safety evaluation of TCM. Based on the current national requirements for the life-cycle management of drugs, this study focused on the problems in the five dimensions of clinical safety evaluation of TCM, including normative terms, evaluation modes, judgment methods, evaluation standards, and reporting systems, and proposed suggestions on the development of a life-cycle clinical safety evaluation method that conformed to the characteristics of TCM, hoping to provide a reference for future research.

Clinical validation of next-generation sequencing-based clonality assays for minimal residual disease tracking in multiple myeloma.

e20037 Background: The prognosis of multiple myeloma (MM) patients is dependent on minimal residual disease (MRD) status after treatment. Multicolor flow cytometry (MFC) as a clinical MRD evaluation method has certain limitations regarding sample requirement, sensitivity and specificity. Next-generation sequencing (NGS)-based B cell receptor (BCR) clonality assessment has an edge in lymphoid clone MRD detection, with easier sample preparation and higher sensitivity. NGS-based BCR clonality assays were performed to evaluate curative effect and track MRD of MM patients, and its performance in testing samples with limited DNA contents was explored. Methods: In this retrospective study, newly diagnosed or relapsed MM patients with paired sample collected before and after initial treatment were included, and OriMIRACLE L NGS assay were used for BCR clonality detection in genomic DNA (gDNA) extracted from clinical residual marrow smear samples. The quantitative accuracy of NGS was compared to MFC. The concordance of MRD between MFC, NGS and clinical response assessment were analyzed. Results: From December 2016 to April 2022, 29 patients were included with a median age of 65 years old. The gDNA input of the sample collected before treatment was 100.0 ng, and the median DNA content of the sample collected after treatment was 1673.4 ±594.8 ng. The quantitative results of NGS and MFC were consistent in samples with a frequency of cancer cells of above 1x10-4 among all nucleated cells. BCR clonality detection in 23 newly diagnosed and 6 relapsed cases showed a 100% sensitivity at diagnosis. For post-treatment monitoring, patients with positive MRD by both MFC and NGS (n = 18), the MRD results were consistent with clinical response assessment. One of the patients achieved complete response (CR), while the remaining patients were unable to achieved CR. The CR patient was relapsed after 134 days. The clinical responses of 11 cases with negative MRD by MFC and positive MRD by NGS were reviewed. There were 7 cases with CR, 3 cases with very good partial response or partial response, and one case with stable disease. Among those CR patients, except for one patient who was lost to follow-up, 4 patients who underwent continuous treatment were still CR and 2 patients who had treatment discontinued recurred at 67 and 134 days. Conclusions: OriMIRACLE L NGS assay showed the higher sensitivity and specificity of MRD evaluation than MFC. For patients with negative MRD by MFS and positive MRD by NGS, recurrence might occur in case of treatment discontinuation. It is recommended to consider carefully that whether maintenance treatment is required in such cases.

A self-assessment survey to identify the risk of screen failure in phase I clinical trials (SCITEP score).

e18725 Background: Screen failures (SF) in early phase clinical trial are deleterious for patients, physicians and drug companies. It is therefore crucial to identify risk factors of SF, in order to optimize drug development and maximize patient’s benefit. Self- patient reporting is a new method of clinical evaluation based on the patient's experience that can meaningfully evaluate patient’s outcome. Methods: We created a self-assessment survey comprising 15 questions extracted from the ESAS, EQ-5D and PALLIA 10 scores, which evaluate patient’s (pts) symptoms and quality of life, each item being scored from 0 to 10, for a total of 0 to 150. Patients entering a phase I clinical trial at Gustave Roussy cancer center between January 10th and October 26th 2022 were surveyed at screening (T0), and subsequently every month (T1, T2,..) until end of treatment. Results: 227 of 275 pts entering a Ph1T were assessed between January 10th and October 26th 2022. Most frequent tumor types were lung (18%), GI (16%), hematological (10%) and gynecological cancer (9.3%); 56% were female. At data cut off (December 19th 2022), 25 pts were considered SF. There was no difference observed between SF pts and pts who went on with the trial in terms of ECOG, RMH score, albumin and LDH levels, number of previous lines of treatments and of metastatic sites at baseline (Table 1). At T0, there was a significant difference in the SCITEP score between SF pts and the others (median score 41 [IQR 26-63] vs 20 [IQR 10-38], p &lt; 0.001). Internal validity of the score was good (cronbach alpha &gt; 0.7). With a cutoff of ≥35, sensitivity of the survey to identify pts at high risk of SF was of 66.6% and specificity of 70.5%. Regarding overall survival, pts with a score ≥35 (n = 68) at T0 were at higher risk of death (survival rate at 3 months of 53% vs 65%, p &lt; 0.01). Conclusions: Self-assessment of risk of SF by pts entering a phase I clinical trial is feasible with the SCITEP score. A score ≥35 seemed associated with a higher risk of SF and of death at 3 months. Independent cohorts are needed to revalidate this score as a tool to better detect pts at risk of SF and thereby optimize drug development. [Table: see text]

Features of echocardiographic examination in patients with COVID-19

Novel coronavirus infection has become one of urgent health problems of the 21st century. The associated disorders often result in the development of cardiopulmonary pathology, which requires creation of a new paradigm in diagnosis and treatment. Studies performed during the pandemic have demonstrated an important role of echocardiography (EchoCG) in diagnosis of right ventricular (RV) dysfunction in patients with respiratory insufficiency in COVID-19. The analysis of EchoCG parameters with a high prognostic value showed that in EchoCG, a special attention should be paid to right heart dimensions, RV contractility, and pulmonary artery (PA) systolic pressure, which are the most sensitive indexes of RV afterload and indirect markers of pulmonary disease severity. RV FAC can be recommended for evaluation of the RV systolic function as the most informative variable. Also, it was demonstrated that the RV longitudinal strain has an additional significance for early identification of signs of systolic dysfunction and risk stratification in patients with COVID-19. In addition to the effectiveness and reproducibility of this method, an important advantage of EchoCG is its availability, possibility of saving images for remote interpretation by other specialists, and tracking changes in morphological and functional parameters of the heart. Thus, the analysis of international literature suggests that EchoCG plays an important role in prediction of severe cardiopulmonary disorders and timely selection of the treatment for patients with COVID-19. For these reasons, EchoCG should serve as an additional method of clinical evaluation, particularly in persons with moderate or severe disease.

BIOMECHANICAL OPTIMIZATION OF CO2 ANGIOGRAPHY

Carbon dioxide (CO2) angiography represents an important technique to overcome most clinical problems related to the use of iodine contrast medium. The recent technologic advancements in the fields of gas injection and image reconstructions made CO2 angiography a very efficient method for clinical evaluation of peripheral cardiovascular system. Despite that, some challenges are still open and a better knowledge of the biomechanical behavior of CO2 and its interactions with blood flowing into the vessels is necessary to optimize this technology and to expand its field of application. This paper presents a quick overview about biomechanical behavior of carbon dioxide during injection, suggesting possible optimization tricks to make CO2 angiography procedures more effective to improve imaging and reduce the patients’ radiological dose. Particular attention has been also paid to 3D imaging techniques, which can certainly be opened to the use of carbon dioxide.

Continuous Monitoring of Buried Free Bone Flap Microcirculation Using a Near-Infrared Spectroscopy System.

Postoperative evaluation of free flaps remains a challenging task. The current accepted standard for diagnosis of vascular compromise remains clinical observation. In recent years, near-infrared spectroscopy (NIRS) has been widely used as a noninvasive objective monitoring tool for postoperative evaluation of soft-tissue flaps. However, methods for monitoring bone flaps remain inadequate. In this study, NIRS was applied for the first time to monitor free buried bone flaps that were used for mandibular reconstruction. The penetrating property of NIRS was used to measure the tissue oxygenation index (TOI) of deep tissues, which reflected the microcirculatory status of the tissues. Changes in TOI values were monitored continuously in 59 cases of free bone flaps up to 72 hours after surgery. Five cases of vascular compromise were noted by clinical observation. Two fibula flaps were total failures, one of which showed a sharp decrease in TOI value to 45% in a short period of time; the other showed a continual gradual decrease to 55%. The observed sudden (<50%) and continuous (>10%) decreases in TOI values suggest that more attention should be paid to revision surgical procedures. The authors conclude that NIRS holds promise as an objective and valid method for clinical evaluation of buried bone flaps.

DIFFERENCES IN RESULTS OF LEARNING EVALUATION OF DELIVERY CARE USING OSCE AND NON-OSCE

The midwifery Diploma 3 education curriculum includes theoretical learning as wellas clinical skills that must be possessed to carry out proper midwifery practice.Learning evaluation should cover all areas including clinical skills. Delivery care isone of the main competencies that must be ensured by midwifery students. PoltekkesJakarta 3 Midwifery Department D3 Midwifery Study Program conducts evaluationsusing various methods. Clinical skills evaluation methods can be through OSCE ornon-OSCE.The purpose of this study was to find out the differences in the results of theevaluation of clinical skills in delivery care by comparing the OSCE and non-OSCEmethods.This research method uses descriptive analytic. The population in this study wereLevel II students of the D3 Midwifery study program, totaling 80 students. The resultsof this study indicate that the clinical skill passing rate of students using the OSCEmethod is 97.5% higher than that of the non-OSCE method, which is 95%. The groupof students who used the OSCE evaluation method with a mean of 3.40 and the classwith the non-OSCE evaluation method was 3.13. Based on the results of theIndependent T Test Samples statistical test, the results obtained a significance of0.001 (P value &lt;0.005). These results indicate a significant difference between theevaluation results of the OSCE method and the non-OSCE method on the clinicalskills of midwifery students in Midwifery Care for Maternity. The results of this studyare in accordance with several other research results which recommend the OSCEmethod to be one of the evaluation methods in midwifery Diploma 3 education.