MRI Assessed Placental Location as a Diagnostic Tool of Placental Invasiveness and Maternal Peripartum Morbidity.

Placenta accreta spectrum (PAS) disorder is one of the leading causes of peripartum maternal morbidity and mortality; its early identification during pregnancy is of utmost importance to ensure the optimal clinical outcome. The aim of the present study is to investigate the possible association of the presence and type/location of placenta previa on MRI with PAS and maternal peripartum outcome. One hundred eighty-nine pregnant women (mean age: 35 years; mean gestational age: 32 weeks) at high risk for PAS underwent a dedicated placental MRI. All women underwent a C-section within 6 weeks from the MRI. All MRIs were evaluated by two experienced genitourinary radiologists for presence, type (complete/partial vs. marginal/low lying), and location (anterior vs. anterior-posterior vs. posterior) of placenta previa. Statistical analysis was performed for possible association of type/location of previa with placental invasiveness and peripartum outcomes. Intraoperative information was used as a reference standard. Complete/partial previa was detected in 143/189 (75.6%) and marginal/low lying previa in 33/189 (17.5%) women; in 88/189 (46.6%) women, the placenta had anterior-posterior, in 54/189 (28.6%) anterior and in 41/189 (21.7%) posterior. Complete/partial previa had an at least 3-fold probability of invasiveness and was more frequently associated with unfavorable peripartum events, including massive intraoperative blood loss or hysterectomy, compared to low-lying/marginal placenta. Posterior placental location was significantly associated with lower rates of PAS and better clinical outcomes. In conclusion, the type and location of placenta previa shown with MRI seems to be associated with severity of complications during delivery and should be carefully studied.

Creating and running an escape room for healthcare curricula: AMEE Guide No. 168.

In this guide we provide instructions and recommendations about creating and running escape rooms for healthcare education. In recent years there has been a growing interest in adopting escape rooms as an educational tool to be included in healthcare curricula, and we attempt to explain why and how these tools are fit for the particularities of this type of education. We first describe the steps that a design team will have to follow to create an educational escape room from scratch, from core characteristics like target audience and learning goals to actual puzzle design and testing. We then continue by providing recommendations to operators and lecturers about how to run such escape room as part of an overall teaching session that also includes a lecture, briefing, debriefing and evaluation. We finalise this guide by listing a set of tools for validating and evaluating these types of escape rooms.

Postural balance ability and vertical jumping performance in female veteran volleyball athletes and non-athletes.

Lifetime participation in sports is associated with improved components of physical conditioning. The main purpose was to cross-sectionally investigate postural balance and vertical jumping performance in athletes with different histories of sports participation and secondarily to examine the restriction of vision on balance ability. A final aim was to investigate possible associations between balance and jumping performance. We hypothesized higher balance and jumping performance in active veteran volleyball athletes compared to retired athletes and non-athletes, suggesting a positive effect of continuous systematic training in active veteran athletes. We also hypothesized greater negative effect of vision removal on balance in the veteran compared to non-athletes due to athletes' stronger reliance on visual information. Eighty-one healthy middle-aged women (mean (standard deviation) 50 (5) years) were assigned to three experimental groups, a retired (n = 39, recreationally active former athletes), an active (n = 27, training 2days/week x 1.5 h/session) veteran volleyball athletes' and a control group (n = 15, sedentary participants). Participants completed an assessment of single-legged quiet stance trials with either left or right leg with eyes open while standing barefoot on a force plate and two-legged trials with both eyes open or closed. They also executed a protocol of countermovement jumps. Statistical analyses included univariate and full factorial ANOVAs with group and vision as fixed and repeated-measures factors and simple linear regression analysis. In the single-legged balance task, solely the mediolateral sway range was greater for the active (p < 0.001) and retired athletes (p < 0.001) compared to non-athletes, whereas in the two-legged stance, no differences among groups were found (p > 0.05). Restriction of vision deteriorated balance performance similarly in the three groups as a significant vision effect was found for path length (p < 0.001), anteroposterior (p < 0.001) and mediolateral sway (p < 0.05). The active and retired athletes had significantly (p < 0.001) greater height, mean and maximal power in countermovement jump compared to non-athletes. Results showed weak associations (average R2 = 9.5%) of balance with jumping performance only in the veteran volleyball athletes' group. Overall, the findings showed that retired volleyball athletes exhibited similar balance ability and vertical jumping performance as the active ones, suggesting a positive impact of prior experience in systematic training.

Collaborative Learning Using Escape Designs and Pedagogies. A Needs Analysis Protocol.

Considerable attention nowadays has been given to collaborative learning as a powerful way of learning, however, the ability to provide student-centered learning, meet student needs and provide them with the opportunity to learn, is a challenging task and has received significant research attention. CLUEDUP proposes an innovative educational protocol that integrates game-based learning with pedagogical approaches that matches students' needs and skills and promotes collaborative interactive and decision-based learning.

Augmenting the Doctor of the 21st Century with Patient-Centered Communication Skill-Sets: The FOR21 Project.

The delivery of quality healthcare by medical doctors involves not only the clinical treatment of patients but also the ability to communicate effectively with them in order to establish a caring relationship. FOR21 project applies collaborative learning pedagogies and advanced learning technology to implement a patient-centered communication skills programme within the existing medical curricula of 6 medical institutions in Kazakhstan, Russian Federation and Uzbekistan.

Comparison between 1.5-T and 3.0-T MRI for the diagnosis of placenta accreta spectrum disorders.

PURPOSE: Accurate antenatal diagnosis of placenta accreta spectrum (PAS) is important for optimal management. The purpose of this study was to compare the respective capabilities of 1.5-T and 3.0-T MRI in the diagnosis of PAS. MATERIALS AND METHODS: Between March 2016-March 2021, 190 pregnant women at high risk for PAS underwent dedicated prenatal MRI with either 1.5-T or 3.0-T units at a tertiary imaging center. Cesarian section and MRI were performed less than 6 weeks from each other. Prospectively collected data were evaluated by two experienced genitourinary radiologists for presence and extent of PAS. A comparative study was designed to investigate differences in predictive ability between 1.5-T and 3.0-T MRI groups. Sensitivity, specificity, accuracy, negative and positive prognostic values relative to intraoperative/histological findings, were computed for both groups and were compared with chi-square (χ 2) test. Interobserver agreement was estimated using Kappa test. RESULTS: One hundred-eighty-two gravid women were included in the study; of these, 91/182 (50%) women were evaluated with 1.5-T (mean age, 35 ± 5.1 [SD] years; mean gestational age: 32.5 weeks) and 91/182 (50%) with 3.0-T MRI (mean age, 34.9 ± 4.9 [SD] years; mean gestational age, 32.1 weeks). 1.5-T MRI yielded 95.7% sensitivity (95% CI: 87.8-99.1) and 81.8% specificity (95% CI: 59.8) and 3.0-T MRI 93.8% sensitivity (95% CI: 86.0-97.9) and 83.3% specificity (95% CI: 48.2-97.7) for PAS identification, with no differences between the two groups (P = 0.725 and P >0.999, respectively). MRI showed excellent predictive ability for detecting extrauterine placental spread with 100% sensitivity (95% CI: 89.4-100.0), 96.7% specificity (95% CI: 88.1-99.6) for 1.5-T and 97% sensitivity (95% CI: 84.2-99.9), 96.7% specificity (95% CI: 88.1-99.6) for 3.0-T without differences between the two groups (P > 0.999). Interobserver agreement was excellent for both groups. The most frequently detected MRI signs of PAS for both 1.5-T and 3.0-T groups were placental heterogeneity (n = 85, 93.5% vs. n = 90, 98.9%; P = 0.413), and intraplacental fetal vessels (n = 64, 70.3% vs. n = 65, 71.4%; P = 0.870). CONCLUSION: This study suggests that 3.0-T MRI and 1.5-T MRI are equivalent for the diagnosis of PAS.

Postural Balance Ability and the Effect of Visual Restriction on Older Dancers and Non-Dancers.

Dance has been suggested to be an advantageous exercise modality for improving postural balance performance and reducing the risk of falls in the older population. The main purpose of this study was to investigate whether visual restriction impacts older dancers and non-dancers differently during a quiet stance balance performance test. We hypothesized higher balance performance and greater balance deterioration due to visual restriction in dancers compared with non-dancers, indicating the superior contribution of the visual channel in the expected higher balance performances of dancers. Sixty-nine (38 men, 31 women, 74 ± 6 years) healthy older adults participated and were grouped into a Greek traditional dance group (n = 31, two to three times/week for 1.5 h/session, minimum of 3 years) and a non-dancer control group (n = 38, no systematic exercise history). The participants completed an assessment of one-legged quiet stance trials using both left and right legs and with eyes open while standing barefoot on a force plate (Wii, A/D converter, 1,000 Hz; Biovision) and two-legged trials with both eyes open and closed. The possible differences in the anthropometric and one-legged balance parameters were examined by a univariate ANOVA with group and sex as fixed factors. This ANOVA was performed using the same fixed factors and vision as the repeated measures factor for the two-legged balance parameters. In the one-legged task, the dance group showed significantly lower values in anteroposterior and mediolateral sway amplitudes (p = 0.001 and p = 0.035) and path length measured in both directions (p = 0.001) compared with the non-dancers. In the two-legged stance, we found a significant vision effect on path length (p < 0.001) and anteroposterior amplitude (p < 0.001), whereas mediolateral amplitude did not differ significantly (p = 0.439) between closed and open eyes. The dance group had a significantly lower CoP path length (p = 0.006) and anteroposterior (p = 0.001) and mediolateral sway amplitudes (p = 0.003) both in the eyes-open and eyes-closed trials compared with the control group. The superior balance performance in the two postural tasks found in the dancers is possibly the result of the coordinated, aesthetically oriented intersegmental movements, including alternations between one- and two-legged stance phases, that comes with dance. Visual restriction resulted in a similar deterioration of balance performance in both groups, thus suggesting that the contribution of the visual channel alone cannot explain the superior balance performance of dancers.

Intraplacental Fetal Vessel Diameter May Help Predict for Placental Invasiveness in Pregnant Women at High Risk for Placenta Accreta Spectrum Disorders.

Background Prenatal identification of placenta accreta spectrum (PAS) disorder is essential for treatment planning. More objective means for predicting PAS and clinical outcome may be provided by MRI descriptors. Purpose To investigate the association of intraplacental fetal vessel (IFV) diameter at MRI with PAS and peripartum complications. Materials and Methods Between March 2016 and October 2019, 160 gravid women suspected of having PAS underwent placental MRI as part of a prospective trial. Secondary analysis was performed by two experienced genitourinary radiologists for presence and maximum diameter of IFVs. Relative risk ratios were computed to test the association of IFVs with presence and depth of PAS invasiveness. Receiver operating characteristic analysis was used to evaluate the ability of IFV diameter to help predict PAS, placenta percreta, and peripartum complications and for comparison of the area under the curve (AUC) versus that from other combined MRI predictors of PAS (eg, myometrial thinning, intraplacental T2-hypointense bands, uterine bulge, serosal hypervascularity, and signs of extrauterine placental spread). Intraoperative and histopathologic findings were the reference standard. Results A total of 155 women were evaluated (mean age, 35 years ± 5 [standard deviation]; mean gestational age, 32 weeks ± 3). PAS was diagnosed in 126 of 155 women (81%) (placental percreta in 68 of 126 [54%]). At delivery, 30 of 126 women (24%) experienced massive blood loss (>2000 mL). IFVs were detected at MRI in 109 of 126 women with PAS (86%) and in 67 of 68 women with placental percreta (98%). The relative risk ratio was 2.4 (95% CI: 1.6, 3.4; P < .001) for PAS and 10 (95% CI: 1.5, 70.4; P < .001) for placental percreta when IFVs were visible. IFVs of 2 mm or greater were associated with PAS (AUC, 0.81; 95% CI: 0.67, 0.95; P = .04). IVFs of 3 mm or greater were associated with placenta percreta (AUC, 0.81; 95% CI: 0.73, 0.89; P < .001) and with peripartum complications, including massive bleeding (AUC, 0.80; 95% CI: 0.71, 0.89; P < .001). Combining assessment of IFVs with other MRI descriptors improved the ability of MRI to predict PAS (AUC, 0.94 vs 0.89; P = .009). Conclusion Assessment of intraplacental fetal vessels with other MRI descriptors improved the ability of MRI to help predict PAS. Vessel diameter of 3 mm or greater was predictive of placenta percreta and peripartum complications. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Dighe in this issue.

Attentional bias in Internet users with problematic use of social networking sites.

BACKGROUND AND AIMS: Evidence from the field of addictive disorders suggests that attentional bias for stimuli related to a substance or activity of abuse (e.g., gambling) exacerbates the addictive behavior. However, evidence regarding attentional bias in PIU is sparse. This study aims to investigate whether individuals who express problematic tendencies toward social networking sites (SNS), a subtype of PIU, show attentional bias for stimuli associated with social media. METHODS: Sixty-five participants performed Visual Dot-Probe and Pleasantness Rating Tasks containing SNS-related and matched control images during eye movements were recorded, providing a direct measure of attention. Participants were assessed on their levels of SNS Internet use (ranging from problematic to non-problematic) and their levels of urges to be online (high vs. low). RESULTS: Problematic SNS users and, in particular, a subgroup expressing higher levels of urges to be online showed an attentional bias for SNS-related images compared to control images. CONCLUSION: These results suggest that attentional bias is a common mechanism associated with problematic Internet use as well as other addictive disorders.

Rituximab as Rescue Therapy for Aggressive Pediatric Multiple Sclerosis.

Multiple sclerosis is a chronic, debilitating disease. Almost one in ten patients with MS has a history of disease onset during childhood. Although numerous therapeutic options exist for adult MS, the available treatments for pediatric patients are still limited. One of the emerging therapies is rituximab, a monoclonal anti-CD20 chimeric antibody that can deplete the CD20+ lymphocyte populations. A 12-year-old boy presented with ataxia, paresthesias, and headache while his brain MRI showed numerous T2 contrast-enhancing lesions. Gamma globulin, steroids, and cyclophosphamide failed to intercept his disease, and he progressed to a rapid clinical and radiological deterioration. Treatment with rituximab reversed the disease course in a dramatic fashion, leading to complete remission.

Stripped fetal vessel sign: a novel pathological feature of abnormal fetal vasculature in placenta accreta spectrum disorders with MRI correlates.

Abnormal intraplacental hypervascularity is a well-known MRI feature of Placenta Accreta Spectrum (PAS), but the precise nature of these vessels has not yet been specified. Histopathological examination of eleven PAS-hysterectomy specimens and subsequent review of the corresponding MRIs, revealed the presence of large fetal vascular trunks extending deep towards the placental periphery and demonstrating deficient branching along their course ('stripped-fetal-vessel' sign). To our knowledge, this is the first report to describe the pattern of abnormal fetal vasculature in correlation with MRI in PAS.

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders.

BACKGROUND: Placenta accreta spectrum (PAS) disorders may be associated with significant mortality and morbidity for both mother and fetus. PURPOSE/HYPOTHESIS: To identify MRI risk factors for poor peripartum outcome in gravid patients at risk for PAS. STUDY TYPE: Prospective. POPULATION: One hundred gravid women (mean age: 34.9 years) at third trimester, with placenta previa. FIELD STRENGTH/SEQUENCE: T2 -SSTSE (single-shot turbo spin echo), T2 -TSE, T1 -TSEFS (TSE images with fat-suppression) at 1.5T. ASSESSMENT: Fifteen MRI features considered indicative of PAS were recorded by three radiologists and were tested for any association with the following adverse peripartum maternal and neonatal events: increased operation time, profound blood loss, hysterectomy, bladder repair, ICU admission, prematurity, low birthweight, and 5-minute APGAR score <7. STATISTICAL TESTS: Kappa (K) coefficients were computed as a measure of agreement between intraoperative information/histology and MRI results as well as for interobserver agreement; chi-square and Fisher's exact tests were used to explore the association of the MRI signs with clinical complications. A score was calculated by adding all recorded MRI signs and its predictive ability was tested using receiver operating characteristic (ROC) analysis, against all complications, separately; odds ratios (ORs) for optimal cutoffs were determined with logistic regression analysis. RESULTS: There was excellent agreement (K >0.75, P < 0.001) between MRI and intraoperative findings for invasive placenta, bladder and parametrial involvement. Intraplacental T2 dark bands, myometrial disruption, uterine bulge, and hypervascularity at the utero-placental interface or parametrium, showed significant association (P < 0.005) with poor clinical outcome for both mother and fetus. The MRI score showed significant predictive ability for each adverse maternal event (area under the curve [AUC]: 0.85-0.97, P < 0.001). The presence of ≥3 MRI signs was the cutoff point for a complicated delivery (OR: 19.08, 95% confidence interval [CI]: 6.05-60.13) and ≥6 MRI signs was the cutoff point for massive bleeding (OR: 90.93, 95% CI: 11.3-729.23), hysterectomy (OR: 72.5, 95% CI: 17.9-293.7), or extensive bladder repair (OR: 58.74, 95% CI: 7.35-469.32). The MRI score was not significant for predicting adverse neonatal events including preterm delivery (P = 0.558), low birthweight (P = 0.097), and 5-minute Apgar score (P = 0.078). DATA CONCLUSION: Preoperative identification of specific MRI features may predict peripartum course in high-risk patients for PAS. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:602-618.

MRI Features Predictive of Invasive Placenta With Extrauterine Spread in High-Risk Gravid Patients: A Prospective Evaluation.

OBJECTIVE: The objective of our study was to evaluate MRI diagnostic ability in predicting invasive placenta with extrauterine spread in high-risk gravid patients. SUBJECTS AND METHODS: Between March 2016 and June 2017, 49 patients (mean age, 35.7 years; mean gestational age, 32.5 weeks) with sonographically confirmed placenta previa underwent dedicated MRI. All MRI examinations were reviewed by two experienced radiologists prospectively. Intraoperative and pathologic findings were the standard of reference. Kappa values were calculated to assess the agreement between MRI findings and histologic results as well as interrater reliability. ROC curve analysis was used to test the discriminative ability of MRI features for invasive placenta with extrauterine spread. Stepwise multiple logistic regression analysis was performed to identify any MRI findings predictive of invasive placenta and of bladder and parametrial involvement. RESULTS: MRI exhibited significant overall accuracy (AUC = 0.77, p = 0.006) in identifying invasive placenta with 100% sensitivity and negative predictive values; it was highly specific (100%) in identifying placental extension to both bladder and parametrial tissues. Lumpy tapering of the placental edges, intraplacental dark T2 bands, prominent intraplacental vascularity, and serosal hypervascularity were independently associated with an increased risk for invasive placenta. Serosal hypervascularity and vesicouterine space hypervascularity were independent predictors of bladder invasion; abnormal vascularization within the parametrial fat was significant for parametrial invasion. CONCLUSION: MRI is highly accurate in depicting placental extrauterine spread. The presence of abnormal vessels at the uterine serosa was the most important MRI feature for identifying invasive placenta. An abnormal vascular network within the vesicouterine space or parametrium was the most reliable MRI sign for detecting bladder or parametrial involvement.

Operating length and velocity of human M. vastus lateralis fascicles during vertical jumping.

Humans achieve greater jump height during a counter-movement jump (CMJ) than in a squat jump (SJ). However, the crucial difference is the mean mechanical power output during the propulsion phase, which could be determined by intrinsic neuro-muscular mechanisms for power production. We measured M. vastus lateralis (VL) fascicle length changes and activation patterns and assessed the force-length, force-velocity and power-velocity potentials during the jumps. Compared with the SJ, the VL fascicles operated on a more favourable portion of the force-length curve (7% greater force potential, i.e. fraction of VL maximum force according to the force-length relationship) and more disadvantageous portion of the force-velocity curve (11% lower force potential, i.e. fraction of VL maximum force according to the force-velocity relationship) in the CMJ, indicating a reciprocal effect of force-length and force-velocity potentials for force generation. The higher muscle activation (15%) could therefore explain the moderately greater jump height (5%) in the CMJ. The mean fascicle-shortening velocity in the CMJ was closer to the plateau of the power-velocity curve, which resulted in a greater (15%) power-velocity potential (i.e. fraction of VL maximum power according to the power-velocity relationship). Our findings provide evidence for a cumulative effect of three different mechanisms-i.e. greater force-length potential, greater power-velocity potential and greater muscle activity-for an advantaged power production in the CMJ contributing to the marked difference in mean mechanical power (56%) compared with SJ.

Physiological markers of biased decision-making in problematic Internet users.

Background and aims Addiction has been reliably associated with biased emotional reactions to risky choices. Problematic Internet use (PIU) is a relatively new concept and its classification as an addiction is debated. Implicit emotional responses were measured in individuals expressing nonproblematic and problematic Internet behaviors while they made risky/ambiguous decisions to explore whether they showed similar responses to those found in agreed-upon addictions. Methods The design of the study was cross sectional. Participants were adult Internet users (N = 72). All testing took place in the Psychophysics Laboratory at the University of Bath, UK. Participants were given the Iowa Gambling Task (IGT) which provides an index of an individual's ability to process and learn probabilities of reward and loss. Integration of emotions into current decision-making frameworks is vital for optimal performance on the IGT and thus, skin conductance responses (SCRs) to reward, punishment, and in anticipation of both were measured to assess emotional function. Results Performance on the IGT did not differ between the groups of Internet users. However, problematic Internet users expressed increased sensitivity to punishment as revealed by stronger SCRs to trials with higher punishment magnitude. Discussion and conclusions PIU seems to differ on behavioral and physiological levels with other addictions. However, our data imply that problematic Internet users were more risk-sensitive, which is a suggestion that needs to be incorporated into in any measure and, potentially, any intervention for PIU.

Medical Content Searching, Retrieving, and Sharing Over the Internet: Lessons Learned From the mEducator Through a Scenario-Based Evaluation.

BACKGROUND: The mEducator Best Practice Network (BPN) implemented and extended standards and reference models in e-learning to develop innovative frameworks as well as solutions that enable specialized state-of-the-art medical educational content to be discovered, retrieved, shared, and re-purposed across European Institutions, targeting medical students, doctors, educators and health care professionals. Scenario-based evaluation for usability testing, complemented with data from online questionnaires and field notes of users' performance, was designed and utilized for the evaluation of these solutions. OBJECTIVE: The objective of this work is twofold: (1) to describe one instantiation of the mEducator BPN solutions (mEducator3.0 - "MEdical Education LINnked Arena" MELINA+) with a focus on the metadata schema used, as well as on other aspects of the system that pertain to usability and acceptance, and (2) to present evaluation results on the suitability of the proposed metadata schema for searching, retrieving, and sharing of medical content and with respect to the overall usability and acceptance of the system from the target users. METHODS: A comprehensive evaluation methodology framework was developed and applied to four case studies, which were conducted in four different countries (ie, Greece, Cyprus, Bulgaria and Romania), with a total of 126 participants. In these case studies, scenarios referring to creating, sharing, and retrieving medical educational content using mEducator3.0 were used. The data were collected through two online questionnaires, consisting of 36 closed-ended questions and two open-ended questions that referred to mEducator 3.0 and through the use of field notes during scenario-based evaluations. RESULTS: The main findings of the study showed that even though the informational needs of the mEducator target groups were addressed to a satisfactory extent and the metadata schema supported content creation, sharing, and retrieval from an end-user perspective, users faced difficulties in achieving a shared understanding of the meaning of some metadata fields and in correctly managing the intellectual property rights of repurposed content. CONCLUSIONS: The results of this evaluation impact researchers, medical professionals, and designers interested in using similar systems for educational content sharing in medical and other domains. Recommendations on how to improve the search, retrieval, identification, and obtaining of medical resources are provided, by addressing issues of content description metadata, content description procedures, and intellectual property rights for re-purposed content.

Synthetic augmented suture anchor reconstruction for a complete traumatic distal triceps tendon rupture in a male professional bodybuilder with postoperative biomechanical assessment.

Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the "off-season" and "precompetition" phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports.

Self-esteem and self-efficacy as predictors of attrition in associate degree nursing students.

There is a serious and growing shortage of nurses in the United States, and the high rate of student attrition from nursing programs has further added to this problem. The challenge for schools of nursing is to recruit increased numbers of qualified candidates into their programs and to determine ways to decrease the rate of student attrition. The purpose of this study was to determine whether self-esteem, self-efficacy, and life stressors were significantly related to student attrition in first-semester associate degree nursing students. A descriptive correlational design and nonprobability convenience sample of first-semester associate degree nursing students was used. Data were gathered using the Rosenberg Self-Esteem Scale, the General Self-Efficacy Scale, and the Holmes and Rahe Social Readjustment Rating Scale. Findings indicated that self-esteem was significantly associated with student attrition. Results from this study provide the basis for targeted interventions designed to decrease student attrition rates in associate degree nursing programs.

Isomorph expression of BAG-1 gene, ER and PR in endometrial cancer.

BACKGROUND: BAG-1 isomorphs are regulating proteins with antiapoptotic action in endometrium. ERa and PRA isomorphs seem to have an important role in endometrial cancer. PATIENTS AND METHODS: We investigated the expression of BAG-1, ERa and PRA isomorphs in endometrioid adenocarcinoma and we correlated them with clinicopathological findings of the tumor. Fresh endometrial tissues were obtained from 33 patients with endometrial carcinoma and 191 paraffin-embedded tissues were analyzed by real-time PCR and immunochemistry for BAG-1, ER and PR. RESULTS: BAG-1 protein is expressed in both nucleus and cytoplasm. Grade 3 tumors were considered to have the highest intensity. Only 4 out of 79 samples showed intense expression of ERa, while 37 samples out of 72 samples strongly expressed PRA. CONCLUSION: BAG-1 nuclear isomorph appeared more frequently in grade 2 tumors than in grade 1 and 3 tumors, and the cytoplasmatic isomorph was expressed more strongly than the nuclear one.

BCL-2, BAX and P53 expression profiles in endometrial carcinoma as studied by real-time PCR and immunohistochemistry.

BACKGROUND: Apoptotic genes regulate apoptosis by the action of their pro- and antiapoptotic products. Among the most important proteins are p53 and Bcl-x family proteins. PATIENTS AND METHODS: The differential expression of these apoptotic genes were analyzed in relation to clinicopathological criteria in women with endometrial carcinoma. Thirty-three fresh tissues and 191 paraffin-embedded tissues were analyzed by real-time PCR for bcl-2/bax ratio and immunohistochemistry for p53, bcl-2 and bax proteins. RESULTS: Bcl-2/bax ratio tended to increase in grade 3 samples compared to grade 1 tumors. Mutated p53 was frequently observed in serous-papillary endometrial carcinomas (p=0.018). Low (<10%) and moderate (10-50%) expression of mutated p53 was observed in tumors with high expression of bax protein (>0.7). CONCLUSION: The Bcl-2/bax ratio is increased in grade 3 tumors. Bax protein shows a strong tendency for expression in the third group of clinical staging (stage IIb, III and IV). Poorly differentiated tumors highly expressed mutated p53.