The musculoskeletal consequences of breast reconstruction using the latissimus dorsi muscle for women following mastectomy for breast cancer: A critical review

Breast reconstruction using the latissimus dorsi (LD) flap following mastectomy is an important management option in breast cancer. However, one common, but often ignored, complication following LD flap is shoulder dysfunction. The aim of this critical review was to comprehensively assess the musculoskeletal impact of LD breast reconstruction and evaluate the functional outcome following surgery. Five electronic databases were searched including; Medline, Embase, CINAHL Plus (Cumulative Index to Nursing and Allied Health), PubMed and Web of Science. Databases were searched from 2006 to 2016, and only full text, English language articles were included. Twenty-two observational studies and two surveys were reviewed with sample sizes ranging from six to 206 participants. The majority of studies had small sample sizes and were retrospective in nature. Nevertheless, there is evidence to suggest that there is some degree of weakness and reduced mobility at the shoulder following LD muscle transfer. The literature demonstrates that there is considerable morbidity in the immediate post-operative period with functional recovery varying between studies. The majority of work tends to be limited and often gives conflicting results; therefore, further investigation is required in order to determine underlying factors that contribute to a reduction in function and activities of daily living.

Green leaf volatiles as antiaggregants for the mountain pine beetle,Dendroctonus ponderosae Hopkins (Coleoptera: Scolytidae)

We tested the hypothesis that green leaf volatiles act as antiaggregants for the mountain pine beetle (MPB),Dendroctonus ponderosac Hopkins. In coupled gas chromatographic-electroantennographic detection (GC-EAD) analysis MPB antennae responded to 30 ng doses of all six-carbon green leaf alcohols tested [1-hexanol, (E)-2-hexen-1-ol, (Z)-2-hexen-1-ol, (E)-3-hexen-1-ol, and (Z)-3-hexen-1-ol], but not to the aldehydes, hexanal or (E)-2-hexenal, or to alcohol or aldehyde homologues with more or fewer than six carbon atoms. In field trapping experiments a blend of green leaf alcohols [1-hexanol, (Z)-2-hexen-1-ol, (E)-3-hexen-1-ol and (Z)-3-hexen-1-ol] effectively disrupted the response to attractive semiochemicals; a blend of the aldehydes hexanal and (E)-2-hexenal was inactive. The two best disruptants. (E)-2-hexen-1-ol and (Z)-3-hexen-1-ol, reduced catches of both sexes to levels not significantly different from catches in unbaited control traps. They also reduced the attack on trees baited with attractive MBP pheromones to a level not significantly different from that on unbaited control trees. Neither of the clerid predators captured,Enoclerus sphegeus (F.) norThanasimus undatulus (Say), was repelled by green leaf volatiles. Our results suggest that green leaf alcohols are promising disruptants which may be used to supplement the antiaggregation pheromone, verbenone, in protecting single high-value trees as well as carefully selected stands with low-level populations of MPBs.

EYA4 is inactivated biallelically at a high frequency in sporadic lung cancer and is associated with familial lung cancer risk

In an effort to identify novel biallelically inactivated tumor suppressor genes (TSG) in sporadic invasive and pre-invasive non-small cell lung cancer (NSCLC) genomes, we applied a comprehensive integrated multi-‘omics approach to investigate patient matched, paired NSCLC tumor and non-malignant parenchymal tissues. By surveying lung tumor genomes for genes concomitantly inactivated within individual tumors by multiple mechanisms, and by the frequency of disruption in tumors across multiple cohorts, we have identified a putative lung cancer TSG, Eyes Absent 4 (EYA4). EYA4 is frequently and concomitantly deleted, hypermethylated and underexpressed in multiple independent lung tumor data sets, in both major NSCLC subtypes, and in the earliest stages of lung cancer. We find not only that decreased EYA4 expression is associated with poor survival in sporadic lung cancers, but EYA4 SNPs are associated with increased familial cancer risk, consistent with EYA4’s proximity to the previously reported lung cancer susceptibility locus on 6q. Functionally, we find that EYA4 displays TSG-like properties with a role in modulating apoptosis and DNA repair. Cross examination of EYA4 expression across multiple tumor types suggests a cell type-specific tumorigenic role for EYA4, consistent with a tumor suppressor function in cancers of epithelial origin. This work shows a clear role for EYA4 as a putative TSG in NSCLC.

Low back pain in people with a stoma: patients' views

PURPOSE

Low back pain (LBP) is a major health problem in western society. Stoma surgery, which involves creating a permanent opening in the abdominal wall, may interfere with the function of the abdominal muscles. Therefore people with a stoma may be at greater risk of developing LBP. A literature review revealed no research exploring a possible link between stoma formation and LBP, nor any study involving patients' perceptions. Therefore, the aims of this study were to determine (1) whether people with a stoma have LBP, (2) whether people with LBP and a stoma perceive that the conditions are linked, and (3) what issues regarding LBP should be included in a large survey of persons with a stoma.

METHODS

Members of the Ileostomy Association of Northern Ireland volunteered to participate in a focus group study. Events from this group were recorded, transcribed, and validated. Thematic analysis was performed.

RESULTS

Three themes were identified: (1) the presence of LBP, (2) a perceived link between LBP and a stoma, and (3) relevant issues for LBP. Ten of the 11 participants had experienced at least one episode of LBP, however 5 (50%) emphasized that they did not have a back problem. Six participants had no LBP prior to their surgery, but have experienced episodes of LBP since. The majority thought that the stoma and their LBP experience were linked. Suggested reasons for this link were changes in muscle strength, posture, and activities. Others included having an epidural or a pouching system that did not optimally suit their needs.

CONCLUSIONS

The results suggest that LBP is a problem for some people with an abdominal stoma and support the need for further study in this population. Two possible areas of future study are an investigation of what the term low back pain means to this population, and further study of the mechanisms that may link stoma surgery to an increased risk of LBP.

The need for inpatient palliative care facilities for noncancer patients in the Thames Valley

Inpatient facilities in palliative care units are generally considered to be mainly for cancer patients. We present and discuss the results of a survey that attempted to estimate the number of noncancer patients requiring inpatient palliative care. Questionnaires sent to all general practices in the Thames Valley area asked about the diagnosis and the number of bed-days that would have been required for each noncancer patient in the practice dying in the last year or still in their care. The replies suggest that about 11 noncancer patients per practice per year were in need of respite or continuing care. For the Thames Valley area this would amount to at least 66,000 bed-days per year for noncancer patients, compared with the current provision, mainly for cancer patients, of about 40,000 bed-days per year. The diagnoses involved and the reasons why our figures may overestimate need, are discussed. There can be no doubt that, if the need is to be met, current facilities will be inadequate and additional beds and services will be required.

The relation of mothers' controlling vocalizations to children's intrinsic motivation

Twenty-six mother-child dyads played together in a laboratory setting. Play sessions were surreptitiously videotaped (with mothers' permission), and each maternal vocalization was transcribed and coded, first into 1 of 24 categories and then ipso facto into one of three supercategories--namely, controlling, autonomy supportive, and neutral. The degree of mothers' controllingness was calculated as the percentage of vocalizations coded as controlling. This index was correlated with the intrinsic motivation of their 6- or 7-year-old children, as assessed primarily by the free-choice behavioral measure and secondarily by a child self-report measure of interest and liking for the task. Both correlations were significantly negative, thereby suggesting that the robust laboratory findings of a negative relation between controlling contexts and individuals' intrinsic motivation are directly generalizable to the domain of parenting. Results are discussed in terms of the processes that undermine intrinsic motivation and the means through which parental controllingness is communicated.

Pure tone audiograms from hearing-impaired children. II. Predicting speech-hearing from the audiogram

Pure tone audiograms and speech audiograms using sentence lists were obtained from 150 8-16-year-old children with pure tone hearing losses ranging from mild to severe. Most of the hearing impairments were cochlear in origin. Three 'speech-hearing' measures were selected from the speech audiograms, and it was shown that the correlation coefficients between two of these and the pure tone hearing thresholds were roughly in agreement with figures from previous studies of adults = 0.882 for Speech Reception Threshold and 0.533 for Discrimination Score. In addition, a correlation of 0.329 was found between the slope of the speech audiogram and pure tone thresholds. The strength of different summaries of the pure tone audiogram for predicting the various speech-hearing measures were compared. It was found that although the traditional summaries did quite well, their relative strengths varied according to the speech-hearing measure under consideration. The best summary predictors for all the speech-hearing measures were, either alone or in combination, two indices which have been proposed recently by the present authors, and which measure both the degree of pure tone hearing loss and the slope of the pure tone audiogram. However, the gains in predictive strength achieved with these indices were small.

Pure tone audiograms from hearing-impaired children. I. A statistical approach to summarizing audiogram information

Principal component analyses of the better-ear pure-tone audiograms from 201 hearing-impaired children are reported. The analyses show that two components, one measuring degree of hearing loss, the other the slope of the audiogram, account for 86% of the total variability. Two indices are proposed which correspond to the two components, but which have numerically simple coefficients and which, unlike the raw components, are perfectly "clean" measures of the two variables. Since these indices, 11 and 12, still account for 84% of the total audiogram variability, it is suggested that they may provide a quantitative basis for summarizing pure tone audiograms for general use.