bluuebunny/crossref_metadata_2025 huggingface dataset:
Regular Exercise to Prevent the Recurrence of Gestational Diabetes Mellitus
Authors: Guelfi Kym J. , Ong Ming Jing , Crisp Nicole A. , Fournier Paul A. , Wallman Karen E. , Grove J. Robert , Doherty Dorota A. , Newnham John P.
Published: September 2016

OBJECTIVE:

To investigate the effect of a supervised home-based exercise program on the recurrence and severity of gestational diabetes mellitus (GDM) together with other aspects of maternal health and obstetric and neonatal outcomes.

METHODS:

This randomized controlled trial allocated women with a history of GDM to an exercise intervention (14-week supervised home-based stationary cycling program) or to a control group (standard care) at 13±1 weeks of gestation. The primary outcome was a diagnosis of GDM. Secondary outcomes included maternal fitness, psychological well-being, and obstetric and neonatal outcomes. A sample size of 180 (90 in each group) was required to attain 80% power to detect a 40% reduction in the incidence of GDM.

RESULTS:

Between June 2011 and July 2014, 205 women provided written consent and completed baseline assessments. Of these, 33 (16%) were subsequently excluded as a result of an elevated baseline oral glucose tolerance test (OGTT), leaving 172 randomized to exercise (n=85) or control (n=87). Three women miscarried before the assessment of outcome measures (control=2; exercise=1). All remaining women completed the postintervention OGTT. The recurrence rate of GDM was similar between groups (control 40% [n=34]; exercise 40.5% [n=34]; P=.95) and the severity of GDM at diagnosis was unaffected by the exercise program with similar glucose and insulin responses to the OGTT (glucose 2 hours post-OGTT 7.7±1.5 compared with 7.6±1.6 mmol/L; P>.05). Maternal fitness was improved by the exercise program (P<.01) and psychological distress was reduced (P=.02). There were no differences in obstetric and neonatal outcomes between groups (P>.05).

CONCLUSION:

Supervised home-based exercise started at 14 weeks of gestation did not prevent the recurrence of GDM; however, it was associated with important benefits for maternal fitness and psychological well-being.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, https://clinicaltrials.gov, NCT01283854.
Ovarian Conservation and Overall Survival in Young Women With Early-Stage Low-Grade Endometrial Cancer
Authors: Matsuo Koji , Machida Hiroko , Shoupe Donna , Melamed Alexander , Muderspach Laila I. , Roman Lynda D. , Wright Jason D.
Published: September 2016

OBJECTIVE:

To characterize contributing factors for ovarian conservation during surgical treatment for endometrial cancer and to examine the association of ovarian conservation on survival of young women with early-stage, low-grade tumors.

METHODS:

This was a population-based study using the Surveillance, Epidemiology, and End Results program to identify surgically treated stage I type I (grade 1–2 endometrioid histology) endometrial cancer cases diagnosed between 1983 and 2012 (N=86,005). Multivariable models were used to identify independent factors for ovarian conservation. Survival outcomes and cause of death were examined for women aged younger than 50 with stage I type I endometrial cancer who underwent ovarian conservation (1,242 among 12,860 women [9.7%]).

RESULTS:

On multivariable analysis, age younger than 50 years, grade 1 endometrioid histology, and tumor size 2.0 cm or less were noted to be independent factors for ovarian conservation (all,P<.001). For 9,110 women aged younger than 50 years with stage I grade 1 tumors, cause-specific survival was similar between ovarian conservation and oophorectomy cases (20-year rates 98.9% compared with 97.7%,P=.31), whereas overall survival was significantly higher in ovarian conservation cases than oophorectomy cases (88.8% compared with 82.0%,P=.011). On multivariable analysis, ovarian conservation remained an independent prognostic factor for improved overall survival (adjusted hazard ratio 0.73, 95% confidence interval [CI] 0.54–0.98,P=.036) and was independently associated with a lower cumulative risk of death resulting from cardiovascular disease compared with oophorectomy (20-year rates, 2.3% compared with 3.7%, adjusted hazard ratio 0.40, 95% CI 0.17–0.91,P=.029). Contrary, cause-specific survival (20-year rates 94.6% compared with 96.1%,P=.68) and overall survival (81.0% compared with 80.6%,P=.91) were similar between ovarian conservation and oophorectomy among 3,750 women aged younger than 50 years with stage I grade 2 tumors.

CONCLUSION:

Ovarian conservation is performed in less than 10% of young women with stage I type I endometrial cancer. Ovarian conservation is associated with decreased mortality in young women with stage I grade 1 tumors.
Utilization and Outcomes of Sentinel Lymph Node Biopsy for Vulvar Cancer
Authors: Cham Stephanie , Chen Ling , Burke William M. , Hou June Y. , Tergas Ana I. , Hu Jim C. , Ananth Cande V. , Neugut Alfred I. , Hershman Dawn L. , Wright Jason D.
Published: September 2016

OBJECTIVE:

To examine the use and predictors of sentinel node biopsy in women with vulvar cancer.

METHODS:

The Perspective database, an all-payer database that collects data from more than 500 hospitals, was used to perform a retrospective cohort study of women with vulvar cancer who underwent vulvectomy and lymph node assessment from 2006 to 2015. Multivariable models were used to determine factors associated with sentinel node biopsy. Length of stay and cost were compared between women who underwent sentinel node biopsy and lymphadenectomy.

RESULTS:

Among 2,273 women, sentinel node biopsy was utilized in 618 (27.2%) and 1,655 (72.8%) underwent inguinofemoral lymphadenectomy. Performance of sentinel node biopsy increased from 17.0% (95% confidence interval [CI] 12.0–22.0%) in 2006 to 39.1% (95% CI 27.1–51.0%) in 2015. In a multivariable model, women treated more recently were more likely to have undergone sentinel node biopsy, whereas women with more comorbidities and those treated at rural hospitals were less likely to have undergone the procedure. The median length of stay was shorter for those undergoing sentinel node biopsy (median 2 days, interquartile range 1–3) compared with women who underwent inguinofemoral lymphadenectomy (median 3 days, interquartile range 2–4). The cost of sentinel node biopsy was $7,599 (interquartile range $5,739–9,922) compared with $8,095 (interquartile range $5,917–11,281) for lymphadenectomy.

CONCLUSION:

The use of sentinel node biopsy for vulvar cancer has more than doubled since 2006. Sentinel lymph node biopsy is associated with a shorter hospital stay and decreased cost compared with inguinofemoral lymphadenectomy.
What Is New in Endometrial Cancer?
Authors: Wright Jason D.
Published: September 2016

This month we focus on current research in endometrial cancer. Dr. Wright discusses four recent publications, which are concluded with a “bottom line” that is the take-home message. The complete reference for each can be found in Box 1 on this page, along with direct links to the abstracts.
Impact of Surgical Complications Following Resection of Locally Advanced Rectal Adenocarcinoma on Adjuvant Chemotherapy Delivery and Survival Outcomes
Authors: Jamnagerwalla Murtaza , Tay Rebecca , Steel Malcolm , Keck Jamie , Jones Ian , Faragher Ian , Gibbs Peter , Wong Rachel
Published: September 2016

BACKGROUND:

Surgical complications after resection for locally advanced rectal cancer may influence adjuvant treatment outcomes and survival. Few studies have examined this effect.

OBJECTIVE:

This study aimed to examine the impact of surgical complications on adjuvant therapy delivery and survival in patients with locally advanced rectal cancer treated with long-course chemoradiation followed by surgery.

DESIGN:

This is a retrospective analysis of a prospectively collected multicenter colorectal cancer database.

SETTINGS:

Data were collected from the Australian Comprehensive Cancer Outcomes and Research Database.

PATIENTS:

All patients who completed neoadjuvant chemoradiotherapy followed by surgery for locally advanced rectal cancer between January 2003 and December 2014 were selected.

MAIN OUTCOME MEASURES:

We examined the types and frequency of surgical complications and their impact on the delivery of adjuvant chemotherapy and survival.

RESULTS:

Data were available for 517 patients, of whom 147 (28%) had a surgical complication. Patients with a surgical complication were less likely to commence adjuvant chemotherapy (33% vs 66%; p = 0.0005) and more likely to have adjuvant treatment commencing more than 8 weeks from surgery (71.8% vs 21.2%; p = 0.004). Wound-related complications (p = 0.001), return to operating theater (p = 0.004), and readmission within 30 days (p = 0.02) had the most significant negative impact on the delivery of adjuvant chemotherapy. Surgical complications were significantly more likely in males (31.6% vs 20.8%, p = 0.003) and laparoscopic converted cases (47.8% vs 21.8%, p = 0.03). For the entire patient population, adjuvant chemotherapy compared with surveillance was not associated with an improved recurrence-free survival (HR, 1.06; p = 0.83) but was associated with an improved overall survival (HR, 0.53; p = 0.04).

LIMITATIONS:

This study was limited by its retrospective design.

CONCLUSION:

Surgical complications in patients having surgery following neoadjuvant chemoradiotherapy for locally advanced rectal cancer were associated with significantly reduced uptake and delays to receiving adjuvant therapy. Surgical complications, however, were not associated with either significantly reduced recurrence-free or overall survival. Adjuvant chemotherapy delivery was associated with improved overall survival.
No Difference in Overall Survival Between Hospital Volumes for Patients With Colorectal Cancer in The Netherlands
Authors: Bos Amanda C. R. K. , van Erning Felice N. , Elferink Marloes A. G. , Rutten Harm J. , van Oijen Martijn G. H. , de Wilt Johannes H. W. , Lemmens Valery E. P. P.
Published: September 2016

BACKGROUND:

High-volume hospitals have been associated with improved patient outcomes for tumors with a relatively low incidence that require complex surgeries, such as esophageal and pancreatic cancer. The volume-outcome association for colorectal cancer is under debate.

OBJECTIVE:

This study investigated whether hospital volume for colorectal cancer is associated with surgical care characteristics and 5-year overall survival.

DESIGN:

This is a population-based study.

SETTING:

Data were gathered from the Netherlands Cancer Registry. Hospitals were grouped by volume for colon (<50, 50–74, 75–99, and ≥100 resections per year) and rectum (<20, 20–39, and ≥40 resections per year).

PATIENTS:

All of the patients with primary nonmetastatic colorectal cancer who underwent resection between 2005 and 2012 were included.

MAIN OUTCOME MEASURES:

Differences in surgical approach, anastomotic leakage, and postoperative 30-day mortality between hospital volumes were analyzed using χ2 tests and multivariable logistic regression analyses. Cox proportional hazard models were used to investigate the effect of hospital volume on overall survival.

RESULTS:

This study included 61,394 patients with colorectal cancer. In 2012, 31 of the 91 hospitals performed less than 50 colon cancer resections per year, and 21 of the 90 hospitals performed less than 20 rectal cancer resections per year. No differences in anastomotic leakage rates between hospital volumes were observed. Only small differences between hospital volumes were revealed for conversion of laparoscopic to open resection (OR of less than 50 versus 100 or more resections per year = 1.25 (95% CI, 1.06–1.46)) and postoperative 30-day mortality (colon: OR of less than 50 versus 100 or more resections per year = 1.17 (95% CI, 1.02–1.35); rectum: OR of less than 20 versus 40 or more resections per year = 1.42 (95% CI, 1.09–1.84)). No differences in overall survival were found between hospital volumes.

LIMITATIONS:

Although we adjusted for several patient and tumour characteristics, data regarding comorbidity, surgeon volume, local recurrences, and specific postoperative complications other than anastomotic leakage were not available.

CONCLUSIONS:

In the Netherlands, no differences in 5-year survival rates were revealed between hospital volumes for patients with nonmetastatic colorectal cancer.
Patient-Reported Roles, Preferences, and Expectations Regarding Treatment of Stage I Rectal Cancer in the Cancer Care Outcomes Research and Surveillance Consortium
Authors: Tyler Ellis C. , Charlton Mary E. , Stitzenberg Karyn B.
Published: September 2016

BACKGROUND:

Historically, stage I rectal cancer was treated with total mesorectal excision. However, there has been growing use of local excision, with and without adjuvant therapy, to treat these early rectal cancers. Little is known about how patients and providers choose among the various treatment approaches.

OBJECTIVE:

The purpose of this study was to identify patient roles, preferences, and expectations as they relate to treatment decision making for patients with stage I rectal cancer.

DESIGN:

This is a population-based study.

SETTINGS:

The study included a geographically diverse population and health-system–based cohort.

PATIENTS:

A total of 154 adults with newly diagnosed and surgically treated stage I rectal cancer between 2003 and 2005 were included.

MAIN OUTCOME MEASURES:

We compared patients by surgical treatment groups, including total mesorectal excision and local excision. Clinical, sociodemographic, and health-system factors were assessed for association with patient decision-making preferences and expectations.

RESULTS:

A total of 80% of patients who underwent total mesorectal excision versus 63% of patients who underwent local excision expected that surgery would be curative (p = 0.04). The total mesorectal excision group was less likely to report that radiation would cure their cancer compared with the local excision group (27% vs 63%; p = 0.004). When asked about their preferred role in decision making, 28% of patients who underwent total mesorectal excision preferred patient-controlled decision making compared with 48% of patients who underwent local excision (p = 0.046). However, with regard to the treatment actually received, 38% of the total mesorectal excision group reported making their own surgical decision compared with 25% of the local excision group (p = 0.18).

LIMITATIONS:

The study was limited by its sample size.

CONCLUSIONS:

The preferred decision-making role for patients did not match the actual decision-making process. Future efforts should focus on bridging the gap between the decision-making process and patient preferences regarding various treatment approaches. This will be particularly important as newer innovative procedures play a more prominent role in the rectal cancer treatment paradigm.
Impact of Preoperative Radiotherapy on Anastomotic Leakage and Stenosis After Rectal Cancer Resection: Post Hoc Analysis of a Randomized Controlled Trial
Authors: Qin Qiyuan , Ma Tenghui , Deng Yanhong , Zheng Jian , Zhou Zhiyang , Wang Hui , Wang Lei , Wang Jianping
Published: September 2016

BACKGROUND:

Evidence regarding the effect of preoperative radiotherapy on anastomotic integrity remains conflicting in rectal cancer surgery. Prospective comparisons with appropriate controls are needed.

OBJECTIVE:

This study aimed to assess the impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection.

DESIGN:

This was a post hoc analysis of a randomized controlled trial (NCT01211210).

SETTINGS:

Data were retrieved from the leading center of the trial, which is a tertiary hospital.

PATIENTS:

The full analysis population of 318 patients was included.

INTERVENTIONS:

Patients were randomly assigned to receive preoperative radiation (50 Gy per 25 fractions) and 5-fluorouracil infusion, alone (arm A) or combined with oxaliplatin (arm B), or preoperative chemotherapy with 5-fluorouracil and oxaliplatin without radiation (arm C).

MAIN OUTCOME MEASURES:

The rates of anastomotic leakage and stenosis were calculated for each treatment arm. Multivariate analysis was used to verify the effect of preoperative radiotherapy.

RESULTS:

The treatment arms were comparable in terms of most baseline characteristics, but more diversions were used in the chemoradiotherapy arms. Anastomotic leakage occurred in 20.2% of patients in arm A, 23.6% of patients in arm B, and 8.5% of patients in arm C (p = 0.007). The corresponding rates of stenosis were 17.0%, 18.9%, and 6.8% (p = 0.02). Multivariate analysis confirmed the correlation between preoperative radiotherapy and clinical leakage (p = 0.02), which was associated with delayed stenosis (p < 0.001). For patients undergoing chemoradiotherapy, radiation proctitis was identified as an independent risk factor for clinical leakage (p = 0.01) and stenosis (p < 0.001).

LIMITATIONS:

The main limitations were discrepancies in stoma creation and chemotherapy regimen among the treatment arms.

CONCLUSIONS:

Preoperative radiotherapy increases the risk of anastomotic leakage and stenosis after rectal cancer resection. Clinical leakage independently contributes to the development of stenosis.
Significant Individual Variation Between Pathologists in the Evaluation of Colon Cancer Specimens After Complete Mesocolic Excision
Authors: Munkedal Ditte Louise E. , Laurberg Søren , Hagemann-Madsen Rikke , Stribolt Katrine J. , Krag Søren R. P. , Quirke Philip , West Nicholas P.
Published: September 2016

BACKGROUND:

After the introduction of complete mesocolic excision, a new pathological evaluation of the resected colon cancer specimen was introduced. This concept has quickly gained acceptance and is often used to compare surgical quality. The grading of colon cancer specimens is likely to depend on both surgical quality and the training of the pathologist.

OBJECTIVE:

The purpose of this study was to validate the principles of the pathological evaluation of colon cancer specimens.

DESIGN:

This was an exploratory study.

SETTINGS:

The study was conducted in Aarhus, Denmark, and Leeds, United Kingdom.

PATIENTS:

Colon cancers specimens were used.

MAIN OUTCOME MEASURES:

The agreement of gradings between participants was of interest. Four specialist GI pathologists and 2 abdominal surgeons evaluated 2 rounds of colon cancer specimens, each at 2 separate time points. Each round contained 50 specimens. After the first round, a protocol of detailed principles for the grading procedure was agreed on. Results from an experienced pathologist were considered as the reference results.

RESULTS:

In the first round, the distribution of gradings between participants showed substantial variation. In the second round, the variation was reduced. Intraobserver agreement was mostly fair to good, whereas interobserver agreement was frequently poor. This did not significantly change from round 1 to round 2.

LIMITATIONS:

The small sample size of 100 specimens provided a very small number of specimens resected in the muscularis propria plane, which renders the evaluation of this group potentially unreliable. The evaluations were made on photos and not on fresh specimens.

CONCLUSIONS:

This study demonstrates significant variation in the pathological evaluation of colon cancer specimens. It demonstrates that it cannot be used in clinical studies, and care should be taken when comparing results between different hospitals.
Improving Health-Related Quality of Life in Wounded Warriors: The Promising Benefits of Laser Hair Removal to the Residual Limb–Prosthetic Interface
Authors: Miletta Nathanial R. , Kim Sang , Lezanski-Gujda Amanda , Rossi Anthony M. , Marquart Jason D.
Published: September 2016

BACKGROUND

Wounded warriors with lower limb amputations using prosthetics commonly develop dermatologic complaints at the residual limb–prosthetic interface, which impact their health-related quality of life (HRQOL). To optimize this interface, military dermatologists routinely treat the subset of issues related to the pilosebaceous unit with laser hair removal (LHR).

OBJECTIVE

To characterize the impact of residual limb skin conditions on HRQOL in wounded warriors using lower limb prosthetics before and after treatment with LHR.

METHODS AND MATERIALS

Twenty wounded warriors with lower limb amputations using prosthetics were administered a validated HRQOL survey, the Skindex-16, before and after an average of 3 treatments of LHR to their residual lower limbs. Responses were statistically analyzed within the symptoms, emotions, and functioning subscales of the survey and in aggregate.

RESULTS

Statistically significant (p < .05) improvement in HRQOL was observed across the symptoms, emotions, and functioning subscales and in aggregate.

CONCLUSION

Dermatologic complaints at the residual limb–prosthetic interface in patients with traumatic lower limb amputation are well-established in the literature. The authors present the first report subjectively quantifying this impact on HRQOL and the marked improvement observed with LHR to the residual limb.
Psychological and Physiological Markers of Stress in Concussed Athletes Across Recovery Milestones
Authors: Hutchison Michael G. , Mainwaring Lynda , Senthinathan Arrani , Churchill Nathan , Thomas Scott , Richards Doug
Published: September 2016

Background:

Sport-related concussions are associated with a range of physical, cognitive, and behavioral disturbances that are highly variable across individuals. Much remains unknown about the effects of sport concussion, and changes in markers of psychological and physiological stress over the recovery timeline.

Objective:

To examine psychological (mood, stress, sleep quality, and symptoms) and physiological (heart rate variability and salivary cortisol) measures in concussed athletes over clinical recovery milestones.

Setting:

University athletic program, sport medicine clinic, Canada.

Participants:

A sample of 52 interuniversity athletes (32 male and 20 female), 26 with concussion and 26 healthy controls.

Design:

Case-control repeated measures study at 3 time points of the clinical recovery process. Measures were administered to a matched control sample of uninjured athletes as well.

Main Measures:

Physiological measures were heart rate variability and salivary cortisol; psychological measures were mood, perceived stress, and quality of sleep.

Results:

Psychological measures were significantly worse for concussed athletes relative to controls at the symptomatic phase (acute injury), but significantly better at return-to-play (RTP). Multivariate analysis of heart rate variability identified main effects of sex and concussion, with reduced high-frequency heart rate variability for females and concussed athletes extending into the post-RTP phase. An interaction effect was also observed, showing the cardiac response of female athletes was more sensitive to concussion compared with males. Conversely, male athletes showed greater suppression of low-frequency heart rate variability associated with mood disturbances.

Conclusion:

This integrated study of psychological and physiological markers in concussed athletes confirmed the resolution of mood disturbances, symptoms, and sleep quality by RTP, but identified autonomic nervous system disturbances, as measured by depressed heart rate variability beyond RTP.
Effect of Aerobic Exercise Training on Mood in People With Traumatic Brain Injury: A Pilot Study
Authors: Weinstein Ali A. , Chin Lisa M. K. , Collins John , Goel Divya , Keyser Randall E. , Chan Leighton
Published: September 2016

Background:

Exercise training is associated with elevations in mood in patients with various chronic illnesses and disabilities. However, little is known regarding the effect of exercise training on short and long-term mood changes in those with traumatic brain injury (TBI).

Objective:

The purpose of this study was to examine the time course of mood alterations in response to a vigorous, 12-week aerobic exercise training regimen in ambulatory individuals with chronic TBI (>6 months postinjury).

Methods:

Short and long-term mood changes were measured using the Profile of Mood States-Short Form, before and after specific aerobic exercise bouts performed during the 12-week training regimen.

Results:

Ten subjects with nonpenetrating TBI (6.6 ± 6.8 years after injury) completed the training regimen. A significant improvement in overall mood was observed following 12 weeks of aerobic exercise training (P = .04), with moderate to large effect sizes observed for short-term mood improvements following individual bouts of exercise.

Conclusions:

Specific improvements in long-term mood state and short-term mood responses following individual exercise sessions were observed in these individuals with TBI. The largest improvement in overall mood was observed at 12 weeks of exercise training, with improvements emerging as early as 4 weeks into the training regimen.
Ascending Aortic Endoballoon Occlusion Feasible despite Moderately Enlarged Aorta to Facilitate Robotic Mitral Valve Surgery
Authors: Breves Sarah L. , Hong Inki , McCarthy James , Kashem Mohammed , Moser G. William , Kelley Thomas M. , Mills Erin E. , Wheatley Grayson H. , Guy T. Sloane
Published: September 2016

Objective

Aortic occlusion with an endoballoon is a well-established technique to facilitate robotic and minimally invasive mitral valve surgery. Use of the endoballoon has several relative contraindications including ascending aortic dilatation greater than 38 mm in size. We sought to review our experience using the endoballoon in cases of totally endoscopic mitral valve surgery with aortic diameters greater than 38 mm.

Methods

A retrospective review of our single-site database was conducted to identify patients undergoing totally endoscopic mitral valve surgery by a single surgeon using an endoballoon and who had ascending aortic dilation. We defined aortic dilation as greater than 38 mm. Computed tomography was done preoperatively on all patients to evaluate the aortic anatomy as well as iliofemoral access vessels. Femoral artery cannulation was done in a standardized fashion to advance and position the endoballoon, to occlude the ascending aorta, and to deliver cardioplegia.

Results

From October 2011 through June 2015,196 patients underwent totally endoscopic mitral valve surgery using an endoballoon at our institution. Twenty-two patients (11.2%) had ascending aortic diameters greater than 38 mm (range, 38.1–16.6 mm; mean, 40.5 ± 2.5 mm). In these cases, there were no instances of aortic dissection or other injury due to balloon rupture, balloon migration, device movement leading to loss of occlusion, or inability to complete planned surgery due to occlusion failure.

Conclusions

Our experience suggests that it is possible to successfully use endoaortic balloon occlusion in patients with ascending aortic dilation with proper preoperative imaging and planning.
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
Authors: Bell Susan
Published: September 2016

Idiopathic intracranial hypertension has been recognized in the literature for over 100 years. It is a disease of elevated intracranial pressure without evidence of a space-occupying lesion found most often in obese women of childbearing age. The signs and symptoms have been well described; however, the etiology is yet unknown. Medical and surgical treatment is aimed at the preservation of vision and improvement in symptoms. The medical literature is replete with articles addressing the epidemiology, pathophysiology, clinical and imaging features, and treatment. There are limited nursing reports (Lehman, 2003; McDonald, 1984; Revta, 1977). The objective of this manuscript is to provide an overview for the neuroscience nurse of the clinical features, diagnostic work-up, and therapeutic options available for patients with idiopathic intracranial hypertension.
Implementation of Intranasal Midazolam for Prolonged Seizures in a Child Neurology Practice
Authors: Crawford Daniel
Published: September 2016

Currently, evidence supports the use of intranasal midazolam as an effective, and in many cases, preferable treatment option for prolonged seizures in children. Despite this knowledge, intranasal midazolam is not routinely found as a standard of care. The goal of this project was to implement the use of intranasal midazolam as a rescue medication for prolonged seizures within a child neurology practice and, in doing so, create a model for implementation that would be replicable for other practice sites. This project focused on the development of a process to make intranasal midazolam available as a treatment option and then the creation of an educational intervention for providers within a child neurology practice. Provider surveys analyzed provider attitudes toward intranasal midazolam and its frequency of use. Because of this project, a dramatic increase in the prescribing of intranasal midazolam was observed within a child neurology practice.
Implementation of a Stroke Competency Program to Improve Nurses’ Knowledge of and Adherence to Stroke Guidelines
Authors: Reynolds Staci Sue , Murray Laura L. , McLennon Susan M. , Bakas Tamilyn
Published: September 2016

Background: Nurses play an integral part in providing evidence-based care to patients with stroke, yet some patients receive unnecessary or even harmful care. The literature supports the use of multifaceted strategies to promote implementation of evidence-based practice; however, there is a gap in knowing which combinations of strategies are most successful. Purpose: The purpose of this study was to determine if a tailored, multifaceted Stroke Competency Program would improve nurses’ knowledge of and adherence to evidence-based practices in the care of patients with stroke. This program bundled implementation strategies of local opinion leaders, printed educational materials, and educational outreach. Methods: This study used a pretest/posttest program design. Nursing adherence was measured via documentation audits with knowledge measured by an author-developed assessment. Findings: Most participating nurses had approximately 10 years of nursing experience and were baccalaureate prepared; participation ranged from 32% to 58% (n = 88). Overall, an improvement in nursing adherence was noted after the program as well as significant improvements in nursing knowledge. Conclusion: Although the Stroke Competency Program improved nursing knowledge of and adherence to stroke guidelines, future research should seek to extend these findings to identify which bundle of strategies are most effective for implementing evidence into nursing practice using psychometrically sound outcome measures.
Pectus Excavatum: A Multimodal Pathway for Patients Undergoing the Nuss Procedure
Authors: Kroeplin Gina
Published: September 2016

Pectus excavatum is a chest wall deformity affecting 1 in 400–1,000 births. There are two surgical correction techniques to repair this chest wall deformity; the Ravitch procedure and the Nuss procedure. Pain issues after the Nuss procedure are potentially more significant than those after the open repair, although minimally invasive. The pain issues have significant impacts on the capacity for deep breathing, early mobilization/ambulation, opioid consumption, and length of hospital stay. CHOP has developed an enhanced multimodal pathway for patients undergoing the procedure. The work group included general surgeons, anesthesiologists, APNs, RNs, physical therapists, and psychologists as well as project and process managers. The goal is to standardize the care of the postoperative pain management, thereby resulting in a decreased length of stay and a 10% decrease in pain scores over a 3-month period.
Ethical issues in pediatric genetic testing and screening
Authors: Botkin Jeffrey R.
Published: September 2016

Purpose of review

Developments in genetic test technologies enable a detailed analysis of the genomes of individuals across the range of human development from embryos to adults with increased precision and lower cost. These powerful technologies raise a number of ethical issues in pediatrics, primarily because of the frequent lack of clinical utility of genetic information, the generation of secondary results and questions over the proper scope of parental authority for testing.

Recent findings

Several professional organizations in the fields of genetics and pediatrics have published new guidance on the ethical, legal, and policy issues relevant to genetic testing in children. The roles of predictive testing for adult-onset conditions, the management of secondary findings and the role of informed consent for newborn screening remain controversial. However, research and experience are not demonstrating serious adverse psychosocial impacts from genetic testing and screening in children. The use of these technologies is expanding with the notion that the personal utility of test results, rather than clinical utility, may be sufficient to justify testing.

The use of microarray and genome sequencing technologies is expanding in the care of children. More deference to parental decision-making is evolving in contexts wherein information and counseling can be made readily available.
Self-awareness of “Gum Disease” Among US Adults
Authors: Luo Huabin , Wu Bei
Published: September 2016

Background:

To assess the extent of self-awareness of gum disease among adults in the United States.

Methods:

Data were from the 2009-2012 National Health and Nutrition Examination Survey. The outcome variable is self-awareness of gum disease. Multivariate logistic regression models were used to examine the relationship between self-awareness and clinically diagnosed periodontitis. The analytical sample included 6876 participants.

Results:

Among those participants (30 years or older) who were classified as having periodontitis, 27% (95% confidence interval [CI], 24.4-29.8) were self-aware of the disease (positive predicted value = 25%). Of those who self-reported having gum disease, 14.1% had a diagnosis of periodontitis (sensitivity = 75%). Older adults were less likely to be aware of gum disease (P < .05). Non-Hispanic blacks (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.53-0.85) were less likely to be aware of the disease than non-Hispanic whites. Adults with diabetes (AOR = 1.61; 95% CI, 1.25-2.06), or with lung disease (AOR = 1.61; 95% CI, 1.25-2.08), or current smokers (AOR = 1.72; 95% CI, 1.29-2.31) were more likely to be aware of the disease.

Conclusion:

The study showed that self-awareness of gum disease among adults was low. Our study findings suggest that there is a great need to improve oral health knowledge and awareness among the adult population in the United States.
Treatment of hepatitis E virus
Authors: Dalton Harry R. , Kamar Nassim
Published: September 2016

Purpose of review

Over the last 10 years, it has become apparent that hepatitis E virus (HEV) is a pathogen of global significance. In contrast to HEV in the developing world, HEV in developed countries is caused by HEV genotypes 3 and 4, which are enzoonotic with a porcine primary host and cause both acute and chronic infection. Chronic infection occurs in the immunosuppressed, including transplant recipients, and untreated can cause rapidly progressive cirrhosis.

Recent findings

Ribavirin has been used successfully to treat acute hepatitis E in high-risk patients. Ribavirin monotherapy is the treatment of choice for patients chronically infected with HEV, with sustained virological response (SVR) of approximately 85%. A minority of chronically infected patients fail to achieve SVR with ribavirin monotherapy, possibly because of viral mutants. The treatment of patients who fail to achieve SVR with ribavirin monotherapy is problematic.

Ribavirin is an effective treatment for hepatitis E, but further studies are required to determine which other antiviral agents are of clinical utility in treating HEV in the minority of patients who do not respond to ribavirin.
Biomechanics of shear-sensitive adhesion in climbing animals: peeling, pre-tension and sliding-induced changes in interface strength
Authors: Labonte David , Federle Walter
Published: September 2016

Many arthropods and small vertebrates use adhesive pads for climbing. These biological adhesives have to meet conflicting demands: attachment must be strong and reliable, yet detachment should be fast and effortless. Climbing animals can rapidly and reversibly control their pads' adhesive strength by shear forces, but the mechanisms underlying this coupling have remained unclear. Here, we show that adhesive forces of stick insect pads closely followed the predictions from tape peeling models when shear forces were small, but strongly exceeded them when shear forces were large, resulting in an approximately linear increase of adhesion with friction. Adhesion sharply increased at peel angles less thanca30°, allowing a rapid switch between attachment and detachment. The departure from classic peeling theory coincided with the appearance of pad sliding, which dramatically increased the peel force via a combination of two mechanisms. First, partial sliding pre-stretched the pads, so that they were effectively stiffer upon detachment and peeled increasingly like inextensible tape. Second, pad sliding reduces the thickness of the fluid layer in the contact zone, thereby increasing the stress levels required for peeling. In combination, these effects can explain the coupling between adhesion and friction that is fundamental to adhesion control across all climbing animals. Our results highlight that control of adhesion is not solely achieved by direction-dependence and morphological anisotropy, suggesting promising new routes for the development of controllable bio-inspired adhesives.
Reconstructing dynamic molecular states from single-cell time series
Authors: Huang Lirong , Pauleve Loic , Zechner Christoph , Unger Michael , Hansen Anders S. , Koeppl Heinz
Published: September 2016

The notion of state for a system is prevalent in the quantitative sciences and refers to the minimal system summary sufficient to describe the time evolution of the system in a self-consistent manner. This is a prerequisite for a principled understanding of the inner workings of a system. Owing to the complexity of intracellular processes, experimental techniques that can retrieve a sufficient summary are beyond our reach. For the case of stochastic biomolecular reaction networks, we show how to convert the partial state information accessible by experimental techniques into a full system state using mathematical analysis together with a computational model. This is intimately related to the notion of conditional Markov processes and we introduce the posterior master equation and derive novel approximations to the corresponding infinite-dimensional posterior moment dynamics. We exemplify this state reconstruction approach using both
in silico
data and single-cell data from two gene expression systems in
Saccharomyces cerevisiae
, where we reconstruct the dynamic promoter and mRNA states from noisy protein abundance measurements.
Critical review on the mechanisms of maturation stress generation in trees
Authors: Alméras Tancrède , Clair Bruno
Published: September 2016

Trees control their posture by generating asymmetric mechanical stress around the periphery of the trunk or branches. This stress is produced in wood during the maturation of the cell wall. When the need for reaction is high, it is accompanied by strong changes in cell organization and composition called reaction wood, namely compression wood in gymnosperms and tension wood in angiosperms. The process by which stress is generated in the cell wall during its formation is not yet known, and various hypothetical mechanisms have been proposed in the literature. Here we aim at discriminating between these models. First, we summarize current knowledge about reaction wood structure, state and behaviour relevant to the understanding of maturation stress generation. Then, the mechanisms proposed in the literature are listed and discussed in order to identify which can be rejected based on their inconsistency with current knowledge at the frontier between plant science and mechanical engineering.
Tale of a multifaceted co-activator, hADA3: from embryogenesis to cancer and beyond
Authors: Chand Vaibhav , Nandi Deeptashree , Mangla Anita Garg , Sharma Puneet , Nag Alo
Published: September 2016

Human ADA3, the evolutionarily conserved transcriptional co-activator, remains the unified part of multiple cellular functions, including regulation of nuclear receptor functions, cell proliferation, apoptosis, senescence, chromatin remodelling, genomic stability and chromosomal maintenance. The past decade has witnessed exciting findings leading to considerable expansion in research related to the biology and regulation of hADA3. Embryonic lethality in homozygous knockout Ada3 mouse signifies the importance of this gene product during early embryonic development. Moreover, the fact that it is a novel target of Human Papillomavirus E6 oncoprotein, one of the most prevalent causal agents behind cervical cancer, helps highlight some of the crucial aspects of HPV-mediated oncogenesis. These findings imply the central involvement of hADA3 in regulation of various cellular functional losses accountable for the genesis of malignancy and viral infections. Recent reports also provide evidence for post-translational modifications of hADA3 leading to its instability and contributing to the malignant phenotype of cervical cancer cells. Furthermore, its association with poor prognosis of breast cancer suggests intimate association in the pathogenesis of the disease. Here, we present the first review on hADA3 with a comprehensive outlook on the molecular and functional roles of hADA3 to provoke further interest for more elegant and intensive studies exploring assorted aspects of this protein.
The BTG4 and CAF1 complex prevents the spontaneous activation of eggs by deadenylating maternal mRNAs
Authors: Pasternak Michał , Pfender Sybille , Santhanam Balaji , Schuh Melina
Published: September 2016

Once every menstrual cycle, eggs are ovulated into the oviduct where they await fertilization. The ovulated eggs are arrested in metaphase of the second meiotic division, and only complete meiosis upon fertilization. It is crucial that the maintenance of metaphase arrest is tightly controlled, because the spontaneous activation of the egg would preclude the development of a viable embryo (Zhanget al.2015J. Genet. Genomics42, 477–485. (doi:10.1016/j.jgg.2015.07.004); Combelleset al.2011Hum. Reprod.26, 545–552. (doi:10.1093/humrep/deq363); Escrichet al.2011J. Assist. Reprod. Genet.28, 111–117. (doi:10.1007/s10815-010-9493-5)). However, the mechanisms that control the meiotic arrest in mammalian eggs are only poorly understood. Here, we report that a complex of BTG4 and CAF1 safeguards metaphase II arrest in mammalian eggs by deadenylating maternal mRNAs. As a follow-up of our recent high content RNAi screen for meiotic genes (Pfenderet al.2015Nature524, 239–242. (doi:10.1038/nature14568)), we identifiedBtg4as an essential regulator of metaphase II arrest.Btg4-depleted eggs progress into anaphase II spontaneously before fertilization. BTG4 prevents the progression into anaphase by ensuring that the anaphase-promoting complex/cyclosome (APC/C) is completely inhibited during the arrest. The inhibition of the APC/C relies on EMI2 (Tanget al.2010Mol. Biol. Cell21, 2589–2597. (doi:10.1091/mbc.E09-08-0708); Oheet al.2010Mol. Biol. Cell21, 905–913. (doi:10.1091/mbc.E09-11-0974)), whose expression is perturbed in the absence of BTG4. BTG4 controls protein expression during metaphase II arrest by forming a complex with the CAF1 deadenylase and we hypothesize that this complex is recruited to the mRNA via interactions between BTG4 and poly(A)-binding proteins. The BTG4–CAF1 complex drives the shortening of the poly(A) tails of a large number of transcripts at the MI–MII transition, and this wave of deadenylation is essential for the arrest in metaphase II. These findings establish a BTG4-dependent pathway for controlling poly(A) tail length during meiosis and identify an unexpected role for mRNA deadenylation in preventing the spontaneous activation of eggs.
p38 (Mapk14/11) occupies a regulatory node governing entry into primitive endoderm differentiation during preimplantation mouse embryo development
Authors: Thamodaran Vasanth , Bruce Alexander W.
Published: September 2016

During mouse preimplantation embryo development, the classically described second cell-fate decision involves the specification and segregation, in blastocyst inner cell mass (ICM), of primitive endoderm (PrE) from pluripotent epiblast (EPI). The active role of fibroblast growth factor (Fgf) signalling during PrE differentiation, particularly in the context of Erk1/2 pathway activation, is well described. However, we report that p38 family mitogen-activated protein kinases (namely p38α/Mapk14 and p38β/Mapk11; referred to as p38-Mapk14/11) also participate in PrE formation. Specifically, functional p38-Mapk14/11 are required, during early-blastocyst maturation, to assist uncommitted ICM cells, expressing both EPI and earlier PrE markers, to fully commit to PrE differentiation. Moreover, functional activation of p38-Mapk14/11 is, as reported for Erk1/2, under the control of Fgf-receptor signalling, plus active Tak1 kinase (involved in non-canonical bone morphogenetic protein (Bmp)-receptor-mediated PrE differentiation). However, we demonstrate that the critical window of p38-Mapk14/11 activation precedes the E3.75 timepoint (defined by the initiation of the classical ‘salt and pepper’ expression pattern of mutually exclusive EPI and PrE markers), whereas appropriate lineage maturation is still achievable when Erk1/2 activity (via Mek1/2 inhibition) is limited to a period after E3.75. We propose that active p38-Mapk14/11 act as enablers, and Erk1/2 as drivers, of PrE differentiation during ICM lineage specification and segregation.
Nuclear conversion theory: molecular hydrogen in non-magnetic insulators
Authors: Ilisca Ernest , Ghiglieno Filippo
Published: September 2016

The hydrogen conversion patterns on non-magnetic solids sensitively depend upon the degree of singlet/triplet mixing in the intermediates of the catalytic reaction. Three main ‘symmetry-breaking’ interactions are brought together. In a typical channel, the electron spin–orbit (SO) couplings introduce some magnetic excitations in the non-magnetic solid ground state. The electron spin is exchanged with a molecular one by the electric molecule–solid electron repulsion, mixing the bonding and antibonding states and affecting the molecule rotation. Finally, the magnetic hyperfine contact transfers the electron spin angular momentum to the nuclei. Two families of channels are considered and a simple criterion based on the SO coupling strength is proposed to select the most efficient one. The denoted ‘electronic’ conversion path involves an emission of excitons that propagate and disintegrate in the bulk. In the other denoted ‘nuclear’, the excited electron states are transients of a loop, and the electron system returns to its fundamental ground state. The described model enlarges previous studies by extending the electron basis to charge-transfer states and ‘continui’ of band states, and focuses on the broadening of the antibonding molecular excited state by the solid conduction band that provides efficient tunnelling paths for the hydrogen conversion. After working out the general conversion algebra, the conversion rates of hydrogen on insulating and semiconductor solids are related to a few molecule–solid parameters (gap width, ionization and affinity potentials) and compared with experimental measures.