Patient Quality of Life and Symptoms after Surgical Treatment for Endometriosis

Study Objective

To assess the impact of surgical treatment of endometriosis on quality of life and pain over a 3-year period of postoperative follow-up.

Oral nutrition in labour: ‘Whose choice is it anyway?’ A review of the literature

Objective

to identify factors affecting women’s oral nutrition in labour.

Design

literature review (1988–2009).

Setting

Westernised maternity care settings.

Participants

women, midwives, obstetricians, anaesthetists and hospitals.

Measurements and findings

when addressing labour stages, the risk categorisation of women and maternal/fetal birthing outcomes, there was a lack of consistent evidence identifying adverse outcomes for mothers/infants when oral nutrition in labour had occurred.

Key conclusions

little evidence exists to support the continuance of restrictive practices around oral nutrition in labour for all women. Women’s choice is impacted by health practitioners’ opinions, experience and practice methods and policy (or lack thereof). Policies are not reflective of current evidence.

Implications for practice

women’s choices and desires regarding oral nutrition in labour need to be addressed. Clear guidelines/policies need to be established based on current evidence. Midwives need greater exposure to research, as well as involvement in policy development and implementation.     

Gestational diabetes: a strong independent risk factor for severe neonatal respiratory failure after 34 weeks

Purpose  

To evaluate if gestational diabetes (GD) exposes neonates delivered after 34 weeks to an increased risk of severe neonatal respiratory failure (NRF).     

Hi-TENS combined with PCA-morphine as post caesarean pain relief

Objectives

to examine effectiveness and overall opiate consumption between high-sensory transcutaneous electrical nerve stimulation (Hi-TENS) combined with patient-controlled analgesia with morphine and patient-controlled analgesia with morphine alone following elective (e.g. scheduled) caesarean birth.

Design

randomised, controlled study.

Setting

a county hospital in south-west Sweden.

Participants

42 multiparous women.

Measurements and findings

participants were randomly assigned and connected to patient-controlled analgesia with morphine alone or in combination with Hi-TENS apparatus. Levels of morphine consumed were calculated every third hour during the first 24 hours post partum. Pain and sedation were assessed by visual analogue scale at one, three, six, nine, 12 and 24 hours post partum. Total consumption of morphine differed significantly between the groups: morphine with TENS was 16.2±12.6 mg and morphine alone was 33.1±20.9 mg (p=0.007). Assessment of pain relief showed no significant difference. Sedation differed significantly between the groups (p=0.045), especially between three and 12 hours post partum (p=0.011).

Key conclusions and implications for practice

pain relief from a combination of Hi-TENS and patient-controlled analgesia with morphine was as effective as patient-controlled analgesia with morphine alone, produced less sedation and reduced morphine use by approximately 50%. Women undergoing a caesarean section should be given the opportunity to make an informed choice about post operative pain relief before surgery. A presumed benefit of this treatment combination is that the mother is more alert and better able to interact with her newborn during the first hours after birth without drowsiness due to large doses of opiates.     

Loss of heterozygosity proximal to the M6P/IGF2R locus is predictive for the presence of disseminated tumor cells in the bone marrow of ovarian cancer patients before and after chemotherapy

Disseminated tumor cells (DTC) in the bone marrow (BM) are present in about 35% of ovarian cancers before surgery and after chemotherapy and are associated with worse prognosis. A molecular biomarker in the primary tumor predicting tumor cell spread would be highly desirable. The purpose of the study was to investigate loss of heterozygosity (LOH) in primary ovarian tumors at four ovarian cancer-relevant chromosomal loci involved in apoptosis, platinum sensitivity, or DNA-repair, to assess the prognostic value of LOH and to correlate LOH with DTC occurrence before surgery and after chemotherapy. Primary tumor DNA of 88 patients was analyzed for LOH at four polymorphic microsatellite markers using PCR-based fluorescence microsatellite analysis. BM aspirates were analyzed for DTC by immunocytochemistry using the pan-cytokeratin antibody A45-B/B3. LOH at the entire marker set correlated with tumor grading (P = 0.0001) and histology (P = 0.004). LOH at marker D10S1765 correlated with FIGO stage (P = 0.046) and grading (P = 0.05), whereas LOH at D17S855 significantly associated with grading (P = 0.023) and histology (P = 0.012), respectively. DTC were detected in 49% of patients before surgery and in 50% of patients after chemotherapy. Interestingly, LOH proximal to D6S1581 significantly correlated with DTC presence before surgery (P = 0.05) and after chemotherapy (P = 0.022). Conclusively, our data suggest that allelic loss at D6S1581 (proximal to M6P/IGF2R locus) serves as a molecular biomarker for the presence of DTC in the BM before and after chemotherapy.     

Analysis of a 1‐megabase deletion in 15q22‐q23 in an autistic patient: Identification of candidate genes for autism and of homologous DNA segments in 15q22‐q23 and 15q11‐q13

We have identified a one megabase deletion in the 15q22‐15q23 region in a patient with autism, developmental delay, and mild dysmorphism. Genes that map within the deletion region and genes that are interrupted or rearranged at the deletion breakpoints are candidate genes for autism. Fluroescence in situ hybridization studies in this patient revealed that part or all of the PML gene is absent from one chromosome 15 and a BAC clone containing the D15S124 gene locus hybridizes to only one chromosome 15. BAC clones containing the PTPN9, and SLP‐1[hUNC24] genes showed markedly reduced hybridization in the 15q22‐q23 region on one chromosome 15 in the patient. These BACs also hybridize to the 15q11‐q13 region in close proximity to SNRPN and HERC2, and in this region there is equal intensity of signal on the normal and on the deleted chromosome. There are previous reports of deletions and duplications of the 15q11‐q13 region in patients with autism. Our patient represents the first report of a 15q22‐q23 deletion. Hybridization of the PTPN9 and Slp‐1 Bac clones to the 15q11‐q13 and the 15q22‐q23 regions of chromosome 15 may be due to the presence of PTPN9 or SLP‐1 gene sequences or to the presence of other gene sequences or to non‐coding homologous DNA sequences. The PTPN9 gene encodes a non‐receptor protein tyrosine phosphatase. The Slp‐1 [hUNC24] gene is expressed mainly in the brain. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:765–770, 2000. © 2000 Wiley‐Liss, Inc.     

Pleomorphic lobular carcinoma in situ

Lobular carcinoma in situ (LCIS) is often identified as incidental finding in breast biopsies. Pleomorphic LCIS can be associated with invasive lobular carcinoma and also occurs as an isolated lesion presenting with mammographic calcification. Histologically PLCIS may mimic DCIS but the diagnosis is facilitated by greater awareness and the use of immunohistochemistry particularly e-cadherin. It comprises large dyscohesive cells which may be associated with comedo necrosis and calcification. Apocrine and signet ring morphology can be prominent. PLCIS usually arises in a background of classical LCIS; however, the morphological and molecular features suggest that it is biologically a more aggressive disease. The lesion is associated with a significant risk of invasive carcinoma, particularly of lobular type. In its pure form, PLCIS on core biopsy is coded and managed as for DCIS.     

Comparison of potentials of stem cells isolated from tendon and bone marrow for musculoskeletal tissue engineering

The use of tendon-derived stem cells (TDSCs) as a cell source for musculoskeletal tissue engineering has not been compared with that of bone marrow stromal cells (BMSC). This study compared the mesenchymal stem cell (MSC) and embryonic stem cells (ESC) markers, clonogenicity, proliferative capacity, and multilineage differentiation potential of rat TDSC and BMSC in vitro. The MSC and ESC marker profiles of paired TDSC and BMSC were compared using flow cytometry and quantitative real-time polymerase chain reaction (qRT-PCR), respectively. Their clonogenicity and proliferative capacity were compared using colony-forming and 5-bromo-2'-deoxyuridine assays, respectively. The expression of tenogenic, osteogenic, and chondrogenic markers at basal state were examined using qRT-PCR. Their osteogenic, chondrogenic, and adipogenic differentiation potentials were compared using standard assays. TDSC and BMSC showed similar expression of CD90 and CD73. TDSC expressed higher levels of Oct4 than BMSC. TDSC exhibited higher clonogenicity, proliferated faster, and expressed higher tenomodulin, scleraxis, collagen 1 α 1 (Col1A1), decorin, alkaline phosphatase, Col2A1, and biglycan messenger RNA levels than BMSC. There was higher calcium nodule formation and osteogenic marker expression in TDSC than BMSC upon osteogenic induction. More chondrocyte-like cells and higher glycosaminoglycan deposition and chondrogenic marker expression were observed in TDSC than BMSC upon chondrogenic induction. There were more oil droplets and expression of an adipogenic marker in TDSC than BMSC upon adipogenic induction. TDSC expressed higher Oct4 levels, which was reported to positively regulate mesendodermal lineage differentiation, showed higher clonogenicity and proliferative capacity, and had greater tenogenic, osteogenic, chondrogenic, and adipogenic markers and differentiation potential than BMSC. TDSC might be a better cell source than BMSC for musculoskeletal tissue regeneration.     

Multivariate genetic analyses of cognition and academic achievement from two population samples of 174,000 and 166,000 school children

The genetic influence on the association between contemporaneously measured intelligence and academic achievement in childhood was examined in nationally representative cohorts from England and The Netherlands using a whole population indirect twin design, including singleton data. We identified 1,056 same-sex (SS) and 495 opposite-sex (OS) twin pairs among 174,098 British 11?year-olds with test scores from 2004, and, 785 SS and 327 OS twin pairs among 120,995 Dutch schoolchildren, aged 8, 10 or 12?years, with assessments from 1994 to 2002. The estimate of intelligence heritability was large in both cohorts, consistent with previous studies (h (2)?=?0.70?±?0.14, England; h (2)?=?0.43?±?0.28-0.67?±?0.31, The Netherlands), as was the heritability of academic achievement variables (h (2)?=?0.51?±?0.16-0.81?±?0.16, England; h (2)?=?0.36?±?0.27-0.74?±?0.27, The Netherlands). Additive genetic covariance explained the large majority of the phenotypic correlations between intelligence and academic achievement scores in England, when standardised to a bivariate heritability (Biv h (2)?=?0.76?±?0.15-0.88?±?0.16), and less consistent but often large proportions of the phenotypic correlations in The Netherlands (Biv h (2)?=?0.33?±?0.52-1.00?±?0.43). In the British cohort both nonverbal and verbal reasoning showed very high additive genetic covariance with achievement scores (Biv h (2)?=?0.94-0.98; Biv h (2)?=?0.77-1.00 respectively). In The Netherlands, covariance estimates were consistent across age groups. The heritability of intelligence-academic achievement associations in two population cohorts of elementary schoolchildren, using a twin pair extraction method, is at the high end of estimates reported by studies of largely preselected twin samples.