Modeling the impact of age and sex on a dimension of poly-substance use in adolescence: A longitudinal study from 11- to 17-years-old

We examined the conceptual utility of modeling use of multiple substances as a trait represented by a unified dimension throughout adolescence. Adolescents (710 males and 676 females) participating in a longitudinal community study were asked whether they had used alcohol, tobacco, marijuana, other controlled substances, or uncontrolled substances (i.e. over-the-counter medications and inhalants) at ages 11, 14, and 17. Using an item response theory framework, model fit indices demonstrated that although all substance use remained part of a single latent dimension, model parameters differed with age and according to sex. The impact of sex was observed at the level of the overall dimension, with reported substance use generally indicating a higher trait level (i.e. greater severity) in females than in males. While using these substances provided good information on individual trait level in mid- to late-adolescence, the trait was poorly characterized by substance use in early adolescence. Across ages and sexes, use of alcohol and tobacco tended to indicate lower trait levels than use of marijuana, other controlled substances, and uncontrolled substances. All substances provided a similar amount of information on the underlying dimension (except for uncontrolled substances, which provided the least information). This suggests that measurement and interpretation of adolescent substance use is enhanced by the consideration of a wide range of substances.     

Development of callosal topography in visual cortex of normal and enucleated rats

In normal rats callosal projections in striate cortex connect retinotopically corresponding, nonmirror-symmetric cortical loci, whereas in rats bilaterally enucleated at birth, callosal fibers connect topographically mismatched, mirror-symmetric loci. Moreover, retina input specifies the topography of callosal projections by postnatal day (P)6. To investigate whether retinal input guides development of callosal maps by promoting either the corrective pruning of exuberant axon branches or the specific ingrowth and elaboration of axon branches at topographically correct places, we studied the topography of emerging callosal connections at and immediately after P6. After restricted intracortical injections of anterogradely and retrogradely transported tracers we observed that the normal, nonmirror-symmetric callosal map, as well as the anomalous, mirror-symmetric map observed in neonatally enucleated animals, are present by P6-7, just as collateral branches of simple architecture emerge from their parental axons and grow into superficial cortical layers. Our results therefore do not support the idea that retinal input guides callosal map formation by primarily promoting the large-scale elimination of long, nontopographic branches and arbors. Instead, they suggest that retinal input specifies the sites on the parental axons from which interstitial branches will grow to invade middle and upper cortical layers, thereby ensuring that the location of invading interstitial branches is accurately related to the topographical location of the soma that gives rise to the parental axon. Moreover, our results from enucleated rats suggest that the cues that determine the mirror-symmetric callosal map exert only a weak control on the topography of fiber ingrowth.     

Postchemoradiation laparoscopic resection and intraoperative electron-beam radiation boost in locally advanced rectal cancer: long-term outcomes

Background

In selected patients with rectal cancer, laparoscopic surgery is as safe as open surgery, with similar resection margins and completeness of resection. In addition, recovery is faster after laparoscopic surgery. We analyzed long-term outcomes in a group of patients with locally advanced rectal cancer (LARC) treated with preoperative therapy followed by laparoscopic surgery and intraoperative electron-beam radiotherapy (IOERT).

Methods and materials

From June 2005 to December 2010, 125 LARC patients were treated with 2 induction courses of FOLFOX-4 (oxaliplatin 85 mg/m²/d1, intravenous leucovorin at 200 mg/m²/d1–2, and an intravenous bolus of 5-fluorouracil 400 mg/m²/d1–2) and preoperative chemoradiation (4,500–5,040 cGy) followed by total mesorectal excision (laparoscopic, 35 %; open surgery, 65 %) and a presacral boost with IOERT.

Results

Patients in the laparoscopic surgery group lost less blood (median 200 vs 350 mL, p < 0.01) and had a shorter hospital stay (7 vs 11 days; p = 0.02) than those in the open surgery group. Laparoscopic procedures were shorter than open surgery procedures (270 vs 302 min; p = 0.67). Postoperative morbidity (32 vs 44 %; p = 0.65), RTOG grade ≥3 acute toxicity (25 vs 25 %; p = 0.97), and RTOG grade ≥3 chronic toxicity (7 vs 9 %; p = 0.48) were similar in the laparoscopy and open surgery groups. The median follow-up time for the entire cohort of patients was 59.5 months (range 7.8–90); no significant differences were observed between the groups in locoregional control (HR 0.91, p = 0.89), disease-free survival (HR 0.80, p = 0.65), and overall survival (HR 0.67, p = 0.52).

Conclusions

Postchemoradiation laparoscopically assisted IOERT is feasible, with an acceptable risk of postoperative complications, shorter hospital stay, and similar long-term outcomes when compared to the open surgery approach.     

Choledocholithiasis in elderly patients with gallbladder in situ - is ERCP sufficient?

Abstract

Introduction: Along with increased life expectancy, the proportion of elderly patients with choledocholithiasis will increase and with this, the need for endoscopic cholangiopancreatography (ERCP). Current recommendations suggest laparoscopic cholecystectomy in all patients with choledocholithiasis to prevent biliary events. However, adherence to these recommendations is low, especially in older patients.

Methods: Retrospective study that included non-cholecystectomized patients aged >?=75 years who underwent ERCP for choledocholithiasis from 2013–2016 (n?=?131). A new biliary event was defined as the need for a new ERCP, cholecystitis, cholangitis or gallstone pancreatitis.

Aim: The aim of this study was to compare the outcomes of new biliary events and mortality in cholecystectomized vs non-cholecystectomized patients after ERCP.

Results: Cholecystectomy was performed in 22% of the patients (92% laparoscopic). The post-cholecystectomy complication rate was 13% and the mortality rate was 7%. During the follow-up period (669?±?487 days) a new biliary event occurred in 20% of patients - 10% new ERCP, 9% cholecystitis, 9% cholangitis and 2% pancreatitis. Cholecystectomized patients had fewer events (7% vs 24%, p?=?.048) and longer time to event (p?=?.016). There was no statistically significant difference in all-cause mortality (14% vs 27%, p?=?.13), mortality related to lithiasis (0% vs 9%, p?=?.11) or time to mortality from all causes (p?=?.07) and related to biliary events (p?=?.07).

Conclusions: In this group of elderly patients, cholecystectomy after ERCP prevented the occurrence of new biliary events but resulted in a non-statistically significant difference in mortality.     

Introduction to the law

OBJECTIVES: To provide an introduction to the legal concepts that are involved in negligence suits involving oncology nurses. DATA SOURCES: Medline, Lexis, Westlaw, legal literature and texts. CONCLUSIONS: To avoid liability and guard against negligence or malpractice suits, the oncology nurse must be aware of the legal responsibilities of each aspect of the nursing role. IMPLICATIONS FOR NURSING PRACTICE: Protecting yourself against medical malpractice begins by understanding terms and concepts that are essential in instituting legal action against the nurse and incorporating the appropriate risk reduction practices into daily practice.     

Intraoperative ultrasonography in urologic oncology

Ultrasonography is a powerful nonionizing imaging modality that has generally been underused by American Urologists in the past. Innovative investigators and clinicians, however, are realizing the great potential of ultrasonography and are applying it increasingly not only in the clinic but in the operating room. In this commentary we outline some of the current and future uses of intraoperative ultrasonography in urologic oncology.