Significance of site-specific prognosis of cancer stem cell marker CD44 in head and neck squamous-cell carcinoma

In several recent studies, CD44 expression has been associated with aggressive behavior in cancers of different types. CD44 expression is also linked to cancer stem cells, which have been shown to play a significant role in tumor progression and poor prognosis in head and neck squamous cell carcinoma (HNSCC), as well as in other cancers. Although CD44 is a potential prognostic marker, it has not been adopted to wider clinical use as a part of treatment planning in HNSCC patients. The aim of this research was to study whether CD44 overexpression is associated with 5year overall survival in HNSCC. We also studied site-specific associations between increased CD44 expression and 5year overall survival. Associations between relative tumor CD44 expressions and smoking, heavy alcohol consumption, histological grade of cancer, TNM staging and HNSCC staging were also studied. In total, 135 paraffin-embedded blocks from HNSCC patients were stained immunohistochemically with a CD44 antibody and were classified by the anatomic location of the tumor. CD44 overexpression had statistically significant association with decreased 5year survival rates when all HNSCC samples were studied (p<0.001). Significant association between intense CD44 expression and poor 5year survival rates was found in the patients with SCC of the oro- and hypopharynx (p<0.001) and the larynx (p=0.042). In patients suffering from HNSCC in the oral cavity, CD44 overexpression did not have a significant effect on overall 5year survival rates. Heavy smoking of over 10 pack years had a significant association with tumor CD44 overexpression (p=0.009). Only pharyngeal (p=0.046) and laryngeal (p=0.047) SCC, but not oral-cavity SCC, had statistically significant associations between heavy smoking and CD44 overexpression when HNSCC was studied in regional groups. Alcohol consumption and tumor grade did not have a significant association with the tumor's CD44 expression. Our results suggest that CD44 overexpression could be used as a sign of aggressiveness, in addition to the HNSCC staging, as a prognostic factor in pharyngeal and laryngeal HNSCC and to assist in treatment selection.     

Associations between psychosomatic symptoms in adolescence and mental health symptoms in early adulthood

Kinnunen P, Laukkanen E, Kylmä J. International Journal of Nursing Practice 2010; 16 : 43–50
Associations between psychosomatic symptoms in adolescence and mental health symptoms in early adulthood
This longitudinal study explored associations between psychosomatic symptoms in adolescence and mental health symptoms in early adulthood. The baseline data were collected in 1996 from 14-year-old pupils ( n  = 235; 116 girls, 119 boys) at schools using a structured questionnaire that included a 14-item scale of psychosomatic symptoms. The follow-up data were collected in 2006 from the same persons at the age of 24 using the Symptom Checklist-90. Follow-up questionnaires were returned by 149 (63.4%) young adults (88 women and 61 men). Young adults who had many psychosomatic symptoms in adolescence suffered more often than the others from somatization and anxiety symptoms in early adulthood. In addition, women had more symptoms of depression and paranoid ideation, and men had more interpersonal sensitivity and psychotic symptoms. Psychosomatic symptoms in adolescence might be important signals of mental health and this should be taken seriously in school health and in general primary care.     

Perfusion in free breast reconstruction flap zones assessed with positron emission tomography

The aim of this pilot study was to determine the postoperative blood perfusion (BF(PET)) and perfusion heterogeneity (BF(PET) HG) in free microvascular breast reconstruction flap zones with positron emission tomography (PET). Regional BF(PET) and BF(PET) HG of the adipose tissue in medial, central, and lateral parts of 13 free flaps were assessed on the first postoperative morning with PET using oxygen-15-labeled water ([(15)O]H(2)O) in 12 patients undergoing breast reconstruction with a deep inferior epigastric perforator (DIEP) or a transverse rectus abdominis muscle (TRAM) flap. The mean BF(PET) values did not differ between DIEP and TRAM flaps (P = 0.791). The mean BF(PET) values were higher in zone III compared with zone I (P = 0.024). During follow-up, fat necrosis was identified in three patients in the medial part (zone II) of the flap. However, the adipose tissue BF(PET) assessed on the first postoperative day from all zones of the flap using PET with radiowater was normal. The BF(PET) HG was higher in the control side (i.e., in the healthy breast tissue) compared with the flap (P = 0.042). The BF(PET) HG was lower in zone III than in zone I (P = 0.03) and in zone II (P < 0.001). In this pilot study, PET was used for the first time for studying the adipose tissue perfusion in different zones in free flaps in a clinical setup, finding that the mean BF(PET) values did not differ between DIEP and TRAM flaps, and that zone II was sometimes not as well perfused as zone III supporting revisited zone division.     

Pregnancy weight gain from 1960s to 2000 in Finland

OBJECTIVE: To study secular trends in average pregnancy weight gain between the 1960s and 2000 in Finland, and whether the changes were related to body mass index (BMI), age or parity. DESIGN: Three cross-sectional population surveys in Finland from three different periods. SUBJECTS: Women who were pregnant in Helsinki in the period 1954-1963 (N=2262), or in Tampere in the period 1985-1986 (N=1771) or in 2000-2001 (N=371). MEASUREMENTS: Pregnancy weight gain was determined from self-reported prepregnancy weight and measured weights during pregnancy. RESULTS: The mean age and prepregnancy BMI of all pregnant women increased between the 1960s and 2000 (from 26.5 to 29.6 y, from 21.9 to 23.7 kg/m(2)). The mean pregnancy weight gain, adjusted for mother's age, BMI and parity, increased from the 1960s to the mid-1980s from 13.2 to 14.3 kg. The increase was observed in all BMI categories. Compared to the 1960 cohort, the proportion of women with a pregnancy weight gain of less than 10 kg decreased and the proportion of women with a weight gain of 15 kg or more increased in the 1980 cohort. After the mid-1980s, the average pregnancy weight gain remained the same. In all cohorts, overweight women gained least weight during pregnancy, but age and parity were not associated with BMI and parity-/age-adjusted pregnancy weight gain. Higher pregnancy weight gain was associated with higher mean child's birthweight and higher proportion of high birthweight babies in all cohorts. CONCLUSIONS: The mean pregnancy weight gain has increased since the 1960s, which may be of importance with regard to the development of later obesity. Factors other than changes in prepregnancy BMI, age and parity must explain the increased pregnancy weight gain over time.     

What degree of work overload is likely to cause increased sickness absenteeism among nurses? Evidence from the RAFAELA patient classification system

AIM: This paper reports a study examining whether nurses' work overload is associated with increased sick leave and quantifying the loss of working days from work overload. BACKGROUND: The RAFAELA patient classification system indicates nursing care intensity in relation to an optimum and is one of the few validated monitoring instruments of patient-associated workload among nurses. However, it is not clear whether work overload is a risk factor for increased sickness absenteeism, an important occupational problem in health care. METHOD: An observational cohort study was carried out with 877 nurses, 31 wards and five Finnish hospitals. Patient-associated workload scores from the RAFAELA system were based on a 6-month monitoring period in 2004. Records of 12-month self certified (1-3 days) and medically certified (>3 days) periods of sick leave in the same year were obtained from employers' registers. FINDINGS: The mean workload was 9% (sd = 8%) above the optimum. There was a linear trend between increasing workload and increasing sick leave (P < or = 0.006). Among nurses with workload > or =30% above the optimum the rate of self certified periods of sick leave was 1.44 (95% CI 1.13-1.83) times higher than among those with an optimum workload. The corresponding rate ratio for medically certified sick leave was 1.49 (1.10-2.03). These excess rates of sickness absence resulted in 12 extra sick leave days per person-year. CONCLUSION: Measuring nurses' workload may be an important part of strategic human resource management of nurses to reduce sick leave among nurses.     

Evaluating nursing documentation – research designs and methods: systematic review

Title.  Evaluating nursing documentation – research designs and methods: systematic review.
Aim.  This paper is a report of a review conducted to assess the research methods applied in the evaluation of nursing documentation.
Data sources.  The material was drawn from three databases: CINAHL, PubMed and Cochrane using the keywords nursing documentation , nursing care plan , nursing record system , evaluation and assessment . The search was confined to relevant electronically-retrievable studies published in the English language from 2000 to 2007. This yielded 41 studies, including two reviews.
Methods.  Content analysis produced a classification into three themes: nursing documentation, patient-centred documentation and standardized documentation. Each study was assessed according to its research design, methodology, sample size and focus of data collection. In addition, the studies categorized under the heading of standardized documentation were assessed in terms of their outcomes.
Results.  Most of the studies ( n  = 19) focused on patient-centred documentation. Most ( n  = 20) were retrospective studies and used data collected from patient records ( n  = 35). An audit instrument was used to assess nursing documentation in almost all the studies. Studies classified under the heading of standardized documentation showed more positive than negative effects with respect to quality, the nursing process and terminology use, knowledge level and acceptance of computer use in documentation.
Conclusion.  The use of structured nursing terminology in electronic patient record systems will extend the scope of documentation research from assessing the quality of documentation to measuring patient outcomes. More data should also be collected from patients and family members when evaluating nursing documentation.     

Hydropneumopericardium Presenting as an Acute Coronary Syndrome: A Rare Complication of Paraesophageal Hernia

Hydropneumopericardium is a very rare complication of long-standing paraesophageal hernia, occurring as a result of rupture of the intrathoracic gastric volvulus into the pericardium. A chronic paraesophageal hernia that is complicated by gastric volvulus can develop into such surgical emergencies as acute gastric obstruction, strangulation, perforation, and rupture into adjacent structures. Subsequent hydropneumopericardium constitutes an acute emergency that requires immediate surgical treatment and pericardial drainage. Herein, we discuss what we believe to be the 1st reported case of hydropneumopericardium that presented as an acute coronary syndrome in a patient who had a chronic paraesophageal hernia (as a result of rupture of the gastric volvulus into the pericardium). The 80-year-old patient did not survive the condition.Key words: Aged, 80 and over; diagnosis, differential; hernia, paraesophageal; pneumopericardium/complications/diagnosis/etiology/mortality/physiopathology/surgery/therapy; stomach volvulus/complicationsHydropneumopericardium is a very rare complication of long-standing paraesophageal hernia, occurring as a result of rupture of the intrathoracic gastric volvulus into the pericardium. A chronic paraesophageal hernia can be complicated by gastric volvulus and can present as various surgical emergencies, including acute gastric obstruction, strangulation, perforation, and rupture into adjacent structures.^1,2 Subsequent hydropneumopericardium constitutes an acute emergency that requires immediate surgical treatment and pericardial drainage. The mortality rate of this condition has been reported to be as high as 58%.³ Here, we present the case of an 80-year-old woman whose hydropneumopericardium presented as an acute coronary syndrome (ACS).