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Introduction The coronavirus disease 2019 pandemic has reinforced the necessity and importance of telepractice. Although studies suggest frameworks to facilitate telepractice implementation, how parents learn related therapeutic skills via telepractice remains unexplored. The purpose of this study was to explore the perspectives and performance changes of parents with children enrolled in aural–oral rehabilitation who transition from in-person sessions to telepractice. Methods A total of 456 parents were enrolled in an aural–oral rehabilitation program with different online session formats [telepractice ( n = 392), consultation ( n = 23), and hybrid ( n = 41)] during the pandemic. The Parental Teaching Skil Scale and the Parental Behavioral Skills Scale were used to examine parent performance changes before and during the lockdown. Furthermore, semi-structured interviews were conducted with 10 parents. Results Parents who scored higher in in-person courses were more likely to enrol in telepractice and make steady progress. Parents who participated in hybrid sessions tended to score lower on Parental Teaching Skill Scale before lockdown and reported that the dual-track, parallel learning method provided them with a set amount of time to discuss teaching difficulties with their therapists without being disturbed by their children. Parents who attended the consultation sessions scored higher on Parental Behavioral Skills Scale than on Parental Teaching Skill Scale during the in-person courses. Discussion Parents who continued online courses during the lockdown showed consistent and significant gains in most skills related to aural–oral rehabilitation, regardless of session format. Moreover, parents who scored better on Parental Behavioral Skills Scale than in Parental Teaching Skill Scale during in-person courses tended to request consultation sessions during the lockdown.

Background/Purpose Connective tissue growth factor (CCN2) has been associated with the pathogenesis of various fibrotic diseases, including oral submucous fibrosis (OSF). The chemical constituents of areca nut along with the mechanical trauma cause OSF. The coarse fibers of areca nut injure the mucosa and hence sphingosine-1-phosphate (S1P) is released at the wounded sites. Recent studies have shown that S1P is involved in wound healing and the development of fibrosis. The aims of this study were to investigate the effects of S1P on CCN2 expression in human buccal fibroblasts (HBFs) and identify the potential targets for drug intervention or chemoprevention of OSF. Methods Western blot analyses were used to study the effects of S1P on CCN2 expression and its signaling pathways in HBFs and whether epigallocatechin-3-gallate (EGCG), the main and most significant polyphenol in green tea, could inhibit this pathway. Results S1P significantly enhanced CCN2 synthesis in HBFs. This effect can be inhibited by c-Jun NH2-terminal kinase (JNK) inhibitor and extracellular signal-regulated kinase inhibitor but not by P38 mitogen-activated protein kinase inhibitor. Interestingly, EGCG completely blocked S1P-induced CCN2 expression via suppressing S1P-induced JNK phosphorylation. Conclusion S1P released by repetitive mechanical trauma during AN chewing may contribute to the pathogenesis of OSF through upregulating CCN2 expression in HBFs. EGCG could be an adjuvant to the current offered therapy options or the prevention of OSF through suppression of JNK activation.

In the past 5 years, cerebral perfusion pressure (CPP) management has become the standard in the treatment of severe head injuries. Guidelines published in 2000 suggest that CPP should be at least 70 mmHg; however, there is still debate about the optimal CPP. The purpose of the present study was to evaluate the effectiveness of these three widely used therapies: (i) intracranial pressure (ICP) targeted; (ii) CPP-targeted with CPP >70 mmHg; and (iii) modified CPP-targeted (mCPP) therapy with CPP >60 mmHg. The clinical procedures, complications and outcomes of patients in the different groups were compared. Data, including patient age, sex, initial Glasgow Coma Scale, ICP, CPP, fluid status, amount of mannitol and vasopressor used, daily fluid intake and output, complications and clinical results, were collected from 213 patients with severe head injuries over a 12-year period. Patients were categorized into three groups (ICP, CPP, mCPP) according to the treatment protocol used. Retrospective data collection was performed by chart review. The mortality rate was 28.6%, 14.3% and 13.5% in the ICP, CPP, and mCPP groups, respectively. Highest intake/output ratio, amount of vasopressor used and pulmonary complications were seen in the CPP patients. The mCPP patients showed the best clinical outcome and lowest complication rate. Although CPP-targeted therapy is the most recommended therapeutic protocol, our data show that patients treated with modified CPP-target therapy with CPP >60 mmHg have better clinical outcomes and fewer complications.