bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Nitrous Oxide Use on Long-term Neurologic and Neuropsychological Outcome in Patients Who Received Temporary Proximal Artery Occlusion during Cerebral Aneurysm Clipping Surgery
Authors: Pasternak Jeffrey J. , McGregor Diana G. , Lanier William L. , Schroeder Darrell R. , Rusy Deborah A. , Hindman Bradley , Clarke William , Torner James , Todd Michael M. 
Published: February 2009

Background
The authors explored the relationship between nitrous oxide use and neurologic and neuropsychological outcome in a population of patients likely to experience intraoperative cerebral ischemia: those who had temporary cerebral arterial occlusion during aneurysm clipping surgery.

Methods
A post hoc analysis of a subset of the data from the Intraoperative Hypothermia for Aneurysm Surgery Trial was conducted. Only subjects who had temporary arterial occlusion during surgery were included in the analysis. Metrics of short-term and long-term (i.e., 3 months after surgery) outcome were evaluated via both univariate and multivariate logistic regression analysis. An odds ratio (OR) greater than 1.0 denotes a worse outcome in patients receiving nitrous oxide.

Results
The authors evaluated 441 patients, of which 199 received nitrous oxide. Patients receiving nitrous oxide had a greater risk of delayed ischemic neurologic deficits (i.e., the clinical manifestation of vasospasm) (OR, 1.78, 95% confidence interval [CI], 1.08-2.95; P = 0.025). However, at 3 months after surgery, there was no difference in any metric of gross neurologic outcome: Glasgow Outcome Score (OR, 0.67; CI, 0.44-1.03; P = 0.065), Rankin Score (OR, 0.74; CI, 0.47-1.16; P = 0.192), National Institutes of Health Stroke Scale (OR, 1.02; CI, 0.66-1.56; P = 0.937), or Barthel Index (OR, 0.69; CI, 0.38-1.25; P = 0.22). The risk of impairment on at least one test of neuropsychological function was reduced in those who received nitrous oxide (OR, 0.56; CI, 0.36-0.89; P = 0.013).

Conclusion
In this patient population, use of nitrous oxide was associated with an increased risk for the development of delayed ischemic neurologic deficits; however, there was no evidence of detriment to long-term gross neurologic or neuropsychological outcome.
Safety and Efficacy of Intensive Insulin Therapy in Critical Neurosurgical Patients
Authors: Bilotta Federico , Caramia Remo , Paoloni Francesca P. , Delfini Roberto , Rosa Giovanni 
Published: February 2009

Background
Intensive insulin therapy to maintain blood glucose at or below 6.11 mM reduces morbidity and mortality after cardiac surgery and morbidity in medical intensive care unit (ICU) patients. The authors investigated the clinical safety and outcome effects of intensive insulin therapy compared to conventional insulin therapy in patients receiving postoperative intensive care after neurosurgical procedures.

Methods
In this prospective randomized controlled trial, 483 patients undergoing elective or emergency brain surgery were prospectively and randomly assigned either to intensive insulin therapy (241 patients), receiving insulin titrated to maintain blood glucose levels within the range of 4.44-6.11 mM, or to conventional insulin therapy (242 patients), receiving insulin to maintain blood glucose levels below 11.94 mM. Primary endpoint was incidence of hypoglycemia (defined as blood glucose < 2.78 mM). Efficacy measures included the length of ICU stay, infection rate, and 6 months follow-up Glasgow outcome scale score and overall survival.

Results
Hypoglycemia episodes were more frequent in patients receiving intensive insulin therapy, median (min-max): 8 (0-23) versus 3 (0-4); P < 0.0001. The length of stay in the ICU was shorter (6 vs. 8 days; P = 0.0001), and the infection rate was lower (25.7% vs. 39.3%; P = 0.0018). Glasgow outcome scale score and overall survival at 6 months were similar in the two groups.

Conclusions
Intensive insulin therapy in patients admitted to a postoperative neurosurgical ICU after brain surgery is associated with iatrogenic hypoglycemia, but it can also reduce the infection rate and shorten the ICU stay.
Strict Glucose Control Does Not Affect Mortality after Aneurysmal Subarachnoid Hemorrhage
Authors: Thiele Robert H. , Pouratian Nader , Zuo Zhiyi , Scalzo David C. , Dobbs Heather A. , Dumont Aaron S. , Kassell Neal F. , Nemergut Edward C. 
Published: February 2009

Background
The effects of both hyperglycemia and hypoglycemia are deleterious to patients with neurologic injury.

Methods
On January 1, 2002, the neurointensive care unit at the University of Virginia Health System initiated a strict glucose control protocol (goal glucose < 120 mg/dl). The authors conducted an impact study to determine the effects of this protocol on patients presenting with aneurysmal subarachnoid hemorrhage.

Results
Among the 834 patients admitted between 1995 and 2007, the in-hospital mortality was 11.6%. The median admission glucose for survivors was lower (135 vs. 176 mg/dl); however, on multivariate analysis, increasing admission glucose was not associated with a statistically significant increase in the risk of death (P = 0.064). The median average glucose for survivors was also lower (116 vs. 135 mg/dl). This was significant on multivariate analysis (P < 0.001); however, the effect was small (odds ratio, 1.045). Implementation of the strict glucose protocol decreased median average glucose (121 vs. 116 mg/dl, P < 0.001) and decreased the incidence of hyperglycemia. Implementation of the protocol had no effect on in-hospital mortality (11.7% vs. 12.0%, P = 0.876 [univariate], P = 0.132 [multivariate]). Protocol implementation was associated with an increased incidence of hypoglycemia (P < 0.001). Hypoglycemia was associated with a substantially increased risk of death on multivariate analysis (P = 0.009; odds ratio = 3.818).

Conclusions
The initiation of a tight glucose control regimen lowered average glucose levels but had no effect on overall in-hospital mortality.
Goal-directed Colloid Administration Improves the Microcirculation of Healthy and Perianastomotic Colon
Authors: Kimberger Oliver , Arnberger Michael , Brandt Sebastian , Plock Jan , Sigurdsson Gisli H. , Kurz Andrea , Hiltebrand Luzius 
Published: February 2009

Background
The aim of this study was to compare the effects of goal-directed colloid fluid therapy with goal-directed crystalloid and restricted crystalloid fluid therapy on healthy and perianastomotic colon tissue in a pig model of colon anastomosis surgery.

Methods
Pigs (n = 27, 9 per group) were anesthetized and mechanically ventilated. A hand-sewn colon anastomosis was performed. The animals were subsequently randomized to one of the following treatments: R-RL group, 3 ml x kg(-1) x h(-1) Ringer lactate (RL); GD-RL group, 3 ml x kg(-1) x h(-1) RL + bolus 250 ml of RL; GD-C group, 3 ml x kg(-1) x h(-1) RL + bolus 250 ml of hydroxyethyl starch (HES 6%, 130/0.4). A fluid bolus was administered when mixed venous oxygen saturation dropped below 60%. Intestinal tissue oxygen tension and microcirculatory blood flow were measured continuously.

Results
After 4 h of treatment, tissue oxygen tension in healthy colon increased to 150 +/- 31% in group GD-C versus 123 +/- 40% in group GD-RL versus 94 +/- 23% in group R-RL (percent of postoperative baseline values, mean +/- SD; P < 0.01). Similarly perianastomotic tissue oxygen tension increased to 245 +/- 93% in the GD-C group versus 147 +/- 58% in the GD-RL group and 116 +/- 22% in the R-RL group (P < 0.01). Microcirculatory flow was higher in group GD-C in healthy colon.

Conclusions
Goal-directed colloid fluid therapy significantly increased microcirculatory blood flow and tissue oxygen tension in healthy and injured colon compared to goal-directed or restricted crystalloid fluid therapy.
Methadone Pharmacokinetics Are Independent of Cytochrome P4503A (CYP3A) Activity and Gastrointestinal Drug Transport
Authors: Kharasch Evan D. , Hoffer Christine , Whittington Dale , Walker Alysa , Bedynek Pamela Sheffels 
Published: February 2009

Background
Methadone clearance is highly variable, and drug interactions are problematic. Both have been attributed to CYP3A, but actual mechanisms are unknown. Drug interactions can provide such mechanistic information. Ritonavir/indinavir, one of the earliest protease inhibitor combinations, may inhibit CYP3A. We assessed ritonavir/indinavir effects on methadone pharmacokinetics and pharmacodynamics, intestinal and hepatic CYP3A activity, and intestinal transporters (P-glycoprotein) activity. CYP3A and transporters were assessed with alfentanil and fexofenadine, respectively.

Methods
Twelve healthy human immunodeficiency virus-negative volunteers underwent a sequential three-part crossover. On three consecutive days, they received oral alfentanil/fexofenadine, intravenous alfentanil, and intravenous plus oral (deuterium-labeled) methadone, repeated after acute (3 days) and steady-state (2 weeks) ritonavir/indinavir. Plasma and urine analytes were measured by mass spectrometry. Opioid effects were assessed by miosis.

Results
Alfentanil apparent oral clearance was inhibited more than 97% by both acute and steady-state ritonavir/indinavir, and systemic clearance was inhibited more than 90% due to diminished hepatic and intestinal extraction. Ritonavir/indinavir increased fexofenadine area under the plasma concentration-time curve four- to five-fold, suggesting significant inhibition of gastrointestinal P-glycoprotein. Ritonavir/indinavir slightly increased methadone N-demethylation, but it had no significant effects on methadone plasma concentrations or on systemic or apparent oral clearance, renal clearance, hepatic extraction or clearance, or bioavailability. Ritonavir/indinavir had no significant effects on methadone plasma concentration-effect relationships.

Conclusions
Inhibition of both hepatic and intestinal CYP3A activity is responsible for ritonavir/indinavir drug interactions. Methadone disposition was unchanged, despite profound inhibition of CYP3A activity, suggesting little or no role for CYP3A in clinical methadone metabolism and clearance. Methadone bioavailability was unchanged, despite inhibition of gastrointestinal P-glycoprotein activity, suggesting that this transporter does not limit methadone intestinal absorption.
Risk Associated with Preoperative Anemia in Noncardiac Surgery
Authors: Beattie W Scott , Karkouti Keyvan , Wijeysundera Duminda N. , Tait Gordon 
Published: February 2009

Background
Preoperative anemia is an important risk factor for perioperative red blood cell transfusions and has been shown to be independently associated with adverse outcomes after noncardiac surgery. The objective of this observational study was to measure the prevalence of preoperative anemia and assess the relationship between preoperative anemia and postoperative mortality.

Methods
Data were retrospectively collected on 7,759 consecutive noncardiac surgical patients at the University Health Network between 2003 and 2006. Preoperative anemia was defined as a hemoglobin concentration less than 12.0 g/dl for women and less than 13.0 g/dl for men. The unadjusted and adjusted relationship between preoperative anemia and mortality was assessed using logistic regression and propensity analyses.

Results
Preoperative anemia was common and equal between genders (39.5% for men and 39.9% for women) and was associated with a nearly five-fold increase in the odds of postoperative mortality. After adjustment for major confounders using logistic regression, anemia was still associated with increased mortality (odds ratio, 2.36; 95% confidence interval, 1.57-3.41). This relationship was unchanged after elimination of patients with severe anemia and patients who received transfusions. In a propensity-matched cohort of patients, anemia was associated with increased mortality (odds ratio, 2.29; 95% confidence interval, 1.45-3.63).

Conclusions
Anemia is a common condition in surgical patients and is independently associated with increased mortality. Although anemia increases mortality independent of transfusion, it is associated with increased requirement for transfusion, which is also associated with increased mortality. Treatment of preoperative anemia should be the focus of investigations for the reduction of perioperative risk.
Cancer epigenomics: Implications of DNA methylation in personalized cancer therapy
Authors: Toyota Minoru , Suzuki Hiromu , Yamashita Toshiharu , Hirata Koichi , Imai Kohzoh , Tokino Takashi , Shinomura Yasuhisa 
Published: February 2009

Genetic alterations in cancer can provide information for predicting a tumor's sensitivity to chemotherapeutic drugs. But although such information is certainly useful, the relatively low frequency of mutations seen in many cancers limits the utility of pharmacogenomics in large numbers of cancer patients, necessitating consideration of other approaches. Epigenetic changes such as DNA methylation are a hallmark of human cancers. Methylation of genes involved in DNA repair and maintaining genome integrity (e.g. MGMT, hMLH1, WRN, and FANCF), and cell‐cycle checkpoint genes (e.g. CHFR and 14‐3‐3 σ, CDK10, and p73), all reportedly influence the sensitivity to chemotherapeutic drugs, suggesting that DNA methylation could serve as a molecular marker for predicting the responsiveness of tumors to chemotherapy. However, the comprehensive study of pharmacoepigenomics awaits the advent of genome‐wide analysis of DNA methylation using microarrays and next‐generation sequencers. (Cancer Sci 2009; 100: 787–791)
Human immature dental pulp stem cells’ contribution to developing mouse embryos: production of human/mouse preterm chimaeras
Authors: Siqueira da Fonseca S. A. , Abdelmassih S. , De Mello Cintra Lavagnolli T. , Serafim R. C. , Clemente Santos E. J. , Mota Mendes C. , De Souza Pereira V. , Ambrosio C. E. , Miglino M. A. , Visintin J. A. , Abdelmassih R. , Kerkis A. , Kerkis I. 
Published: February 2009

AbstractObjectives:  In this study, we aimed at determining whether human immature dental pulp stem cells (hIDPSC) would be able to contribute to different cell types in mouse blastocysts without damaging them. Also, we analysed whether these blastocysts would progress further into embryogenesis when implanted to the uterus of foster mice, and develop human/mouse chimaera with retention of hIDPSC derivates and their differentiation.Materials and Methods:  hIDPSC and mouse blastocysts were used in this study. Fluorescence staining of hIDPSC and injection into mouse blastocysts, was performed. Histology, immunohistochemistry, fluorescence in situ hybridization and confocal microscopy were carried out.Results and Conclusion:  hIDPSC showed biological compatibility with the mouse host environment and could survive, proliferate and contribute to the inner cell mass as well as to the trophoblast cell layer after introduction into early mouse embryos (n = 28), which achieved the hatching stage following 24 and 48 h in culture. When transferred to foster mice (n = 5), these blastocysts with hIDPSC (n = 57) yielded embryos (n = 3) and foetuses (n = 6); demonstrating presence of human cells in various organs, such as brain, liver, intestine and hearts, of the human/mouse chimaeras. We verified whether hIDPSC would also be able to differentiate into specific cell types in the mouse environment. Contribution of hIDPSC in at least two types of tissues (muscles and epithelial), was confirmed. We showed that hIDPSC survived, proliferated and differentiated in mouse developing blastocysts and were capable of producing human/mouse chimaeras.
Do the determinants of physical activity change by physical activity level?
Authors: Kim Hyun Kyung , Kim Mi Ja , Park Chang Gi , Kim Hyeon Ok 
Published: February 2009

AbstractTitle.  Do the determinants of physical activity change by physical activity level? Aim.  The paper reports on a study to describe the determinants of physical activity according to physical activity level among rural women in Korea.Background.  The benefits of physical activity for promoting health and preventing illness are well known, and gender and regional disparities in physical activity have been reported. Although the number of women who perform physical activity has increased, many still do not meet the recommended levels to gain health benefits.Method.  A cross‐sectional descriptive study was conducted using a structured questionnaire. A convenience sample of 245 women living in a rural area of Korea was recruited during 2004. Self‐efficacy, benefits, barriers and sociodemographics were examined in relation to three levels of physical activity: inactive, insufficiently active and active. Descriptive statistics and multinomial logistic regression were used for data analysis.Result.  Perceived self‐efficacy, benefits and barriers were statistically significant determinants only when the insufficiently active group was compared with the inactive group. Sociodemographic factors related to work and family roles statistically significantly explained the physical activity levels of rural women.Conclusion.  Nursing interventions to increase self‐efficacy and benefits, or decrease perceived barriers could be effective for initiating physical activity for inactive women, whereas the same may not apply for insufficiently active women. Insufficiently active women may have false confidence that their physical activity will help them gain health benefits. Reducing the burdens of work and family roles of rural women might improve their physical activity levels.
Moral distress questionnaire for clinical nurses: instrument development
Authors: Eizenberg Michal Mashiach , Desivilya Helena Syna , Hirschfeld Miriam J. 
Published: February 2009

AbstractTitle.  Moral distress questionnaire for clinical nurses: instrument development. Aim.  This paper is a report of a study to develop and test the psychometric properties of a culture‐sensitive moral distress questionnaire among nurses employed in a variety of work settings.Background.  In the course of the last decade, there has been increased interest in capturing healthcare professionals’ experiences of stress associated with ethical dilemmas. Ethical issues emerge in grey areas and are often blurred, and have thus received insufficient attention.Method.  The study comprised two phases: a qualitative phase to elicit the culture‐specific themes and a quantitative phase, comprising the design of a 15‐item questionnaire. The questionnaire was then completed by a convenience sample of 179 nurses from a variety of work settings. The data were collected in 2006.Results.  Factor analysis resulted in three factors representing moral distress: (1) problems caused by work relationships among staff; (2) problems due to lack of resources; and (3) problems caused by time pressure. With regard to the construct validity of the questionnaire, differences between community and hospital nurses were tested, and a statistically significant difference was found between them in two among the three factors (relationships and time). The stability of the measures was examined by test‐retest reliability and revealed statistically significant results.Conclusions.  The instrument exhibits acceptable reliability and validity in the Israeli cultural context. Further research is needed to evaluate the measure in other cultural settings.
Mental health nurses’ attitudes towards severe perinatal mental illness
Authors: McConachie Susan , Whitford Heather 
Published: February 2009

AbstractTitle.  Mental health nurses’ attitudes towards severe perinatal mental illness. Aim.  This paper reports on a study exploring the experiences and attitudes of generic mental health nurses towards care of women with severe mental illness during the perinatal period.Background.  Severe mental disorder in the perinatal period is a global public health concern. However, there are concerns that mental health nurses other than dedicated perinatal mental health teams may lack knowledge, skills and experience in caring for such disorders, because of their low prevalence.Methods.  Sixteen generic Registered Mental Nurses working in public adult mental health services participated in three focus groups during 2007.Findings.  Participants did not perceive any difference between symptoms during perinatal and non‐perinatal periods. There were mixed attitudes towards caring for women with severe mental illness in the perinatal period. Fear and anxiety was expressed by the nurses when caring or feeling responsible for the babies of clients. Lack of communication between professional groups and decreased clinical decision‐making following the introduction of the Edinburgh Post Natal Depression Scale caused frustration. Confidence was displayed when working with known and trusted colleagues.Conclusion.  Generic mental health nurses would benefit from more education on perinatal mental health and there may be a need for them to be supported by specialist perinatal mental health practitioners.
Self‐efficacy with application to adolescent smoking cessation: a concept analysis
Authors: Heale Roberta , Griffin Mary T.Q. 
Published: February 2009

AbstractTitle.  Self‐efficacy with application to adolescent smoking cessation: a concept analysis. Aim.  This paper is a report of a concept analysis of adolescent smoking cessation self‐efficacy.Background.  Smoking cessation is a key preventive care/health promotion strategy offered by nurses worldwide. Most programming is tailored to adults although the reasons for smoking, along with coping strategies, resources and developmental stage, differ in adolescence. Understanding of the concept of self‐efficacy as it relates to the adolescent population will assist nurses in addressing smoking cessation behaviours with this population.Data sources.  The CINAHL and Proquest Nursing databases were searched for papers published between 1977 and 2007 using the keywords self‐efficacy, adolescents and smoking cessation. The Walker and Avant method of concept analysis was applied.Findings.  Adolescent smoking cessation self‐efficacy is the confidence, perceived capacity and perceived ability that the teen possesses to quit smoking. Identified antecedents include developmental stage, past life support, emotional support, coping strategies, resources and emotional status. Consequences are smoking cessation: positive or negative. Empirical measures are identified.Conclusion.  Levels of self‐efficacy have been shown to be an important consideration in the approach of nurses to smoking cessation counselling with the adolescent client. The theoretical definition for this concept will provide the basis for nurses to design appropriate interventions for use in smoking cessation programmes targeted to adolescents. This definition identifies the key attributes of this concept that should be addressed when caring for this population.