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6-45.9%, p = 0.007-0.02). Restraint stress decreased by 32.4-39.8% (p = 0.002-0.01) the mean optical density ratio for proliferating cell nuclear antigen/terminal deoxynucleotidyl transferase dUTP nick end labeling. Methyl thiazolyl tetrazolium assay showed a dose-dependent decrease in proliferative activity of endometrial stromal cells (from 52 of 154 pregnant E5 control mice) incubated with H2O2 (100-1000 μM) in vitro. These findings supported the hypothesis that restraint stress negatively influences endometrial adaptive remodeling via an oxidative stress pathway, which resulted in fewer implantation sites.

To critically analyse the characteristics of the benefit levers that are required for effective system-wide spread of evidence-based practice.

Evidence-based nursing practice is the cornerstone of quality patient care and merits system-wide implementation. Achieving system-wide spread of evidence-based innovations requires adoption of four benefit levers (the facilitators for spreading innovations), conceptualized by Edwards and Grinspun alignment, leadership for change, permeation plans and supporting and reinforcing structures. Although these concepts have been explored and described in primary studies, they were only recently identified as benefit levers and their characteristics have not been reviewed in the context of health care using an integrative literature review.

An integrative literature review using an adapted Whittemore and Knafl design.

A comprehensive search using multiple sites such as Scopus, EBSCOhost, ProQuest, ScienceDirect, Cochrane Library, Nexus, SAePublications, Sabinet, Googltudies concerning benefit levers, specifically regarding 'alignment' and 'permeation plans', are required to promote system-wide spread of best healthcare practices.Irreversible electroporation (IRE) is a novel therapy that has shown to be a feasible and promising alternative to conventional ablative techniques when treating tumors near vital structures or blood vessels. The clinical efficacy of IRE has been evaluated using established imaging criteria. This study evaluates the histologic and imaging response of hepatic and pancreatic malignancies that were surgically resected after IRE. In total, 12 lesions ablated with IRE were included, including 3 pancreatic carcinomas, 5 primary tumors of the liver, and 4 metastatic tumors of the liver. The rate of complete response to IRE was 25% based on the histologic evaluation of the resected tumors. Cirtuvivint Although treatment-related vessel wall changes were noted in several cases in histologic findings, there was no evidence of vascular luminal narrowing or obliteration in any of the specimens. The imaging response to IRE before surgical resection usually resulted in underestimation of disease burden when compared with the histologic response seen on the resected specimens.Irreversible electroporation (IRE) induces cell death by exposing it to high-voltage, low-energy DC current pulses. The mechanism of cell death and healing is a departure from the other existing technologies such as radiofrequency ablation, microwave ablation, and cryoablation. These thermal ablative technologies have several applications in oncology but have limitations that have also been established. IRE has shown promise to overcome some of these limitations and has enabled the use of an ablative technology in treating lesions close to the bile ducts and vasculature and in organs such as the pancreas. This review highlights some of the niche applications of IRE and the data so far.Image-guided tumor ablation techniques have significantly broadened the treatment possibilities for primary and secondary hepatic malignancies. A new ablation technique, irreversible electroporation (IRE), was recently added to the treatment armamentarium. As opposed to thermal ablation, cell death with IRE is primarily induced using electrical energy electrical pulses disrupt the cellular membrane integrity, resulting in cell death while sparing the extracellular matrix of sensitive structures such as the bile ducts, blood vessels, and bowel wall. The preservation of these structures makes IRE attractive for colorectal liver metastases (CRLM) that are unsuitable for resection and thermal ablation owing to their anatomical location. This review discusses different technical and practical issues of IRE for CRLM the indications, patient preparations, procedural steps, and different "tricks of the trade" used to improve safety and efficacy of IRE. Imaging characteristics and early efficacy results are presented. Much is still unknown about the exact mechanism of cell death and about factors playing a crucial role in the extent of cell death. At this time, IRE for CRLM should only be reserved for small tumors that are truly unsuitable for resection or thermal ablation because of abutment of the portal triad or the venous pedicles.Despite advances in the treatment of unresectable locally advanced pancreatic cancer, outcomes remain poor. Irreversible electroporation is a nonthermal ablative modality whose role in the management of locally advanced pancreatic cancer is being studied. This review highlights patient selection, preparation, and follow-up as well as discusses the techniques to achieve safe and effective tumor ablation in this challenging location.Focal therapy is a novel strategy that attempts to enhance the therapeutic ratio of standard radical treatment in prostate cancer. Irreversible electroporation (IRE) has some inherent characteristics that may be ideal for focal therapy. Precise confined ablation in the treatment area obtained via nonthermal damage with potential for minimal toxicity to surrounding structures may lead to optimal treatment with improved preservation of continence and erectile function. Initial data of focal IRE of the prostate are encouraging although further assessment is awaited to confirm these findings using robust methodology. In this article, we provide a comprehensive step-by-step description of our technique to deliver focal IRE in selected men with localized prostate cancer located in a discrete area of the prostate.Irreversible electroporation (IRE) is a relatively new ablation modality that uses electric currents to cause cell death. It is commonly used to treat primary and secondary liver tumors in patients with normal liver function and preexisting cirrhosis. Retrospective analysis of 205 procedures sought to evaluate changes in liver function after IRE. Liver function tests (LFTs) results before and after IRE were evaluated from 174 procedures in 124 patients. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase (ALKP), and total bilirubin levels were analyzed. The study was Health Insurance Portability and Accountability Act compliant and institutional review board approved. Informed consent was waived. Changes in LFT results after IRE were compared with baseline and were followed up over time to see if they resolved. Changes were compared with volume of ablation. The greatest perturbations were in transaminase levels. The levels increased sharply within 24 hours after IRE in 129 (74.1%) procedures to extreme levels (more than 20 times the upper limit of normal in one-third of cases). Resolution occurred in 95% and was demonstrated to have occurred by a mean of approximately 10 weeks, many documented as early as 7 days after procedure. ALKP levels elevated in 10% procedures, was slower to increase, and was less likely to resolve. Total bilirubin level demonstrated 2 different patterns of elevation--early and late--and similar to ALKP, it was more likely to remain elevated. There was no increased risk in patients with cirrhosis or cholangiocarcinoma. There was no correlation of levels with volume of ablation. IRE results in significant abnormalities in LFT results, but in most of the cases, these are self-limiting, do not preclude treatment, and are similar to the changes seen after radiofrequency and cryoablation in the liver.Irreversible electroporation (IRE) is a new nonthermal ablation modality that can be used to treat primary and metastatic lesions in the liver. This article describes the way IRE works, reviews safety and efficacy data, and presents strategies and recommendations for its use in everyday practice. In a series of liver lesions of various histologies, initial success was 100%; local recurrence rates were greater in larger lesions. In another series of hepatocellular carcinoma only, there was a 79% complete response rate overall and 93% in lesions less than 3 cm. Safety is comparable with those of other ablation modalities. IRE has advantages over other ablation modalities with comparable success rates.Irreversible electroporation (IRE) is a novel nonthermal focal ablation technique that uses a series of brief but intense electric pulses delivered by paired electrodes into a targeted region of tissue, killing the cells by irreversibly disrupting cellular membrane integrity. Unlike other ablation methods, IRE has relatively little effect on connective tissues and nerves and has a low patient effect. The ability of IRE to achieve cell death immediately adjacent to large vessels without effect on the vessels themselves has raised the possibility of better treatment of advanced pancreatic cancer. Because of the low effect on the patient, IRE is well suited for use in conjunction with chemotherapeutic agents. The IRE effect is not uniform and is dependent on the intrinsic conductivity of the tissue, the number of pulses delivered, the current flow achieved, and the total time for the treatment. It is currently under investigation for a wide range of solid tumors and prostate cancer in humans and in animals in the breast, brain, and spinal cord. In clinical practice, IRE can be administered either percutaneously under imaging guidance or at open operation under direct vision. In animals there is some evidence of an immune response presumably due to exposure of the intracellular target material, resulting in a greater therapeutic effect. Unlike many other cancer treatments, IRE has been introduced for human clinical use at a very early stage of development of the technique and much of the basic understanding of how and when to use IRE is still under investigation.Adolescence is a sensitive period for changes in both sleep and affect. Although past research has assessed the association between affect and sleep among adolescents, few studies have examined both trait (typical) and day-to-day changes in affect, and fewer still have specifically examined negative social evaluative emotions (e.g. embarrassment) in relation to sleep. Both between- and within-person variations in daily affect were examined in relation to four objectively-measured sleep outcomes (sleep hours; sleep latency; sleep efficiency; and length of wake bouts) among adolescents. Participants (N = 77 high-school students; 42.9% female; M = 14.37 years) wore an actiwatch and completed daily-diaries for 3 days. The results of hierarchical linear models (controlling for age, gender, race, ethnicity, parental employment status, income, puberty and caffeine) indicated that negative social evaluative emotions and high-arousal affective experiences generally predicted poor sleep outcomes, whereas low-arousal affective experiences were associated with good sleep outcomes.