Digital Commons Network^™

Bariatric Surgery Outcomes In Appalachia Influenced By Surgery Type, Diabetes, And Depression, Makenzie L. Barr, Lawrence E. Tabone, Stephanie J. Cox, Cassie Brode, Nova Szoka, I. Mark Olfert, Laura Davisson, Melissa D. Olfert

Faculty & Staff Scholarship

Background

Most effective treatment for morbid obesity and its comorbidities is bariatric surgery. However, research is limited on weight loss and associated outcomes among patients in Appalachia. The objective of this study was to examine demographic and comorbidity influence on surgical outcomes of this population including age, sex, race, state of residence, education, marital status, body mass index (BMI kg/m2), excess body weight (EBW), percent excess weight loss (%EWL), blood pressure, diagnosed depression, diagnosed type 2 diabetes (T2D), Beck Depression Inventory-II (BDI-II), and laboratory values (i.e., hemoglobin A1c).

Methods

A retrospective electronic medical record (EMR) data extraction was performed on …

Development And Testing Of Program Evaluation Instruments For The Icook 4-H Curriculum, Douglas R. Mathews, Zachary J. Kunicki, Sarah E. Colby, Lisa Franzen-Castle, Kendra K. Kattelmann, Melissa D. Olfert, Adrienne A. White

Faculty & Staff Scholarship

Objective

To develop and test the validity of program outcome evaluation instruments for cooking, eating, and playing together for obesity prevention during iCook 4-H.

Design

Instrument development for both youth and adults through pre-post testing of items newly constructed and compiled to address key curriculum constructs. Testing occurred throughout program intervention and dissemination to determine dimensionality, internal consistency and test-retest reliability, and validity.

Setting

A 5-state out-of-school program in cooperative extension and other community sites.

Participants

Youths aged 9–10 years; adults were main food preparers; the first phase involved 214 dyads and the second phase, 74 dyads.

Main Outcome …

Dna Methylation And Mirna-1296 Act In Concert To Mediate Spatiotemporal Expression Of Kpna7 During Bovine Oocyte And Early Embryonic Development, Lei Wang, Jacqelyn M. Hand, Liyuan Fu, George W. Smith, Jianbo Yao

Faculty & Staff Scholarship

Abstract

Background: Epigenetic regulation of oocyte-specific maternal factors is essential for oocyte and early embryonic development. KPNA7 is an oocyte-specific maternal factor, which controls transportation of nuclear proteins important for early embryonic development. To elucidate the epigenetic mechanisms involved in the controlled expression of KPNA7, both DNA methylation associated transcriptional silencing and microRNA (miRNA)-mediated mRNA degradation of KPNA7 were examined.

Results: Comparison of DNA methylation profiles at the proximal promoter of KPNA7 gene between oocyte and 6 different somatic tissues identified 3 oocyte-specific differentially methylated CpG sites. Expression of KPNA7 mRNA was reintroduced in bovine kidney-derived CCL2 cells after treatment …

Cecal Perforation In The Setting Of Campylobacter Jejuni Infection, Seema Jain, Weston Betrner, Dane Olevian, Dhiraj Yadav

Faculty & Staff Scholarship

Campylobacter infection is the leading cause of bacterial gastroenteritis worldwide, yet life-threatening complications are extremely rare. We present a 32-year-old previously healthy man who presented with dysentery from Campylobacter jejuni, which was complicated by cecal perforation and secondary bacterial peritonitis.

Dietary Quercetin And Kaempferol: Bioavailability And Potential Cardiovascular-Related Bioactivity In Humans, Wijdan M. Dabeek, Melissa Ventura Marra

Faculty & Staff Scholarship

Fruit and vegetable intake has been associated with a reduced risk of cardiovascular disease. Quercetin and kaempferol are among the most ubiquitous polyphenols in fruit and vegetables. Most of the quercetin and kaempferol in plants is attached to sugar moieties rather than in the free form. The types and attachments of sugars impact bioavailability, and thus bioactivity. This article aims to review the current literature on the bioavailability of quercetin and kaempferol from food sources and evaluate the potential cardiovascular effects in humans. Foods with the highest concentrations of quercetin and kaempferol in plants are not necessarily the most bioavailable …

The “Motor Of The Day”: Parent And School-Age Children’S Cognitions, Barriers, And Supports For Breakfast, Kaitlyn M. Eck, Colleen L. Delaney, Rashel L. Clark, Miriam P. Leary, Karla Pagan Shelnutt, Melissa D. Olfert, Carol Byrd-Bredbenner

Faculty & Staff Scholarship

Despite the many benefits of regular breakfast consumption few parents and children consume this meal every day and research examining the determinants of breakfast consumption is limited. Thus, the purpose of this study was to examine breakfast-related cognitions (i.e., beliefs, attitudes, facilitators, barriers) of parents and school-age children (ages 6–11 years) using the constructs of Social Cognitive Theory as a guide. Parents (n = 37) and children (n = 41) participated in focus group discussions held in community settings in 3 states (FL, NJ, WV). Data were qualitatively content analyzed to detect trends. Parents felt breakfast was important for numerous …

Time-Activity Budgets Of Stiff-Tailed Ducks In Puerto Rico, Nickolas S. Goodman, Jack C. Eitniear, James T. Anderson

Faculty & Staff Scholarship

Habitat loss and degradation have contributed to declining populations of stiff-tailed ducks including the migratory northern ruddy duck (Oxyura jamaicensis rubida), and non-migratory masked duck (Nomonyx dominicus) and West Indian ruddy duck (Oxyura j. jamaicensis). Studies collecting time-activity budgets on waterfowl can provide important insight into habitat use, behavior, and niche partitioning. Even though the northern ruddy duck and West Indian ruddy duck are recognized as the same species, we treated them separately to appraise possible ecological differences. We recorded 24-h time-activity budgets for masked ducks (n = 142), northern ruddy ducks ( …

Nutritional Condition And Physiological Stress Levels Of Elk In The Black Hills, South Dakota, Chadwick P. Lehman, Christopher T. Rota, Joshua J. Millspaugh

Faculty & Staff Scholarship

Percent of body fat and physiological stress are important correlates to wildlife demographics. We studied winter percent of body fat and physiological stress levels for a declining elk (Cervus canadensis nelsoni) population in South Dakota, 2011–2013. We obtained percent of winter body fat, pregnancy status, lactation status, and physiological stress data from 58 adult females (2+ years old). We compared physiological stress level data from 2011 with data collected from this same herd when elk densities were much higher (1995–1997). Our objectives were to determine percent of body fat during winter, examine if winter body fat was correlated with pregnancy …

Climatic Trends Of West Virginia: A Representative Appalachian Microcosm, Evan Kutta, Jason Hubbart

Faculty & Staff Scholarship

During the late 19th and very early 20th centuries widespread deforestation occurred across the Appalachian region, USA. However, since the early 20th century, land cover rapidly changed from predominantly agricultural land use (72%; 1909) to forest. West Virginia (WV) is now the USA’s third most forested state by area (79%; 1989–present). It is well understood that land cover alterations feedback on climate with important implications for ecology, water resources, and watershed management. However, the spatiotemporal distribution of climatic changes during reforestation in WV remains unclear. To fill this knowledge gap, daily maximum temperature, minimum temperature, and precipitation data were acquired …

Meniscal Repair In Pediatric Populations: A Systematic Review Of Outcomes, Daniel J. Liechti, David S. Constantinescu, Taylor J. Ridley, Jorge Chahla, Justin J. Mitchell, Alexander R. Vap

Faculty & Staff Scholarship

Background: Loss of meniscal tissue in the pediatric population can have long-term consequences on joint health, highlighting the importance of meniscal preservation in this group. Purpose: To systematically review reported knee outcome measures and complication rates after repair of meniscal tears in children and adolescents. Study Design: Systematic review; Level of evidence, 4. Methods: A review of the literature regarding the existing evidence for pediatric meniscal tear outcomes was performed through use of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-present), and MEDLINE (1980-present). Included were articles in English that reported the outcomes …

Genome-Wide Association Study Identifies Genomic Loci Affecting Filet Firmness And Protein Content In Rainbow Trout, Ali Ali, Rafet Al-Tobasei, Daniela Lourenco, Tim Leeds, Brett Kenney, Mohamed Saleem

Faculty & Staff Scholarship

Filet quality traits determine consumer satisfaction and affect profitability of the aquaculture industry. Soft flesh is a criterion for fish filet downgrades, resulting in loss of value. Filet firmness is influenced by many factors, including rate of protein turnover. A 50K transcribed gene SNP chip was used to genotype 789 rainbow trout, from two consecutive generations, produced in the USDA/NCCCWA selective breeding program. Weighted single-step GBLUP (WssGBLUP) was used to perform genome-wide association (GWA) analyses to identify quantitative trait loci affecting filet firmness and protein content. Applying genomic sliding windows of 50 adjacent SNPs, 212 and 225 SNPs were associated …

Ancient Polyploidy And Genome Evolution In Palms, Craig F. Barrett, Michael R. Mckain, Brandon T. Sinn, Xue Jun Ge, Yuqu Zhang, Alexandre Antonelli, Christine D. Bacon

Faculty & Staff Scholarship

Mechanisms of genome evolution are fundamental to our understanding of adaptation and the generation and maintenance of biodiversity, yet genome dynamics are still poorly characterized in many clades. Strong correlations between variation in genomic attributes and species diversity across the plant tree of life suggest that polyploidy or other mechanisms of genome size change confer selective advantages due to the introduction of genomic novelty. Palms (order Arecales, family Arecaceae) are diverse, widespread, and dominant in tropical ecosystems, yet little is known about genome evolution in this ecologically and economically important clade. Here, we take a phylogenetic comparative approach to investigate …

Cooking Frequency Associated With Dietary Quality In Icook-4h Youth Participants At Baseline, Amber D. Ford, Sarah E. Colby, Marissa Mcelrone, Lisa Franzen-Castle, Melissa D. Olfert

Faculty & Staff Scholarship

Background: Increased intakes of ready-made and fast foods paralleled with decreased homemade food consumption have been associated with increased rates of obesity. Researchers have shown associations between cooking self-efficacy (SE) and cooking frequency (CF) with dietary quality and weight status. Some cooking interventions have shown positive associations with dietary outcomes, such as increased fruit and vegetable intake and decreased fast food consumption. There is still much unknown about SE and CF, especially among youth. Objective: Determine baseline SE and CF and the associations with dietary quality and body mass index (BMI) of youth enrolled in iCook 4H. Methods: Youth (n=228, …

The Identification Of Differentially Expressed Genes Between Extremes Of Placental Efficiency In Maternal Line Gilts On Day 95 Of Gestation, Shanice K. Krombeen, Vijay Shankar, Rooksana E. Noorai, Christopher A. Saski, Julia L. Sharp, Matthew E. Wilson, Tiffany A. Wilmoth

Faculty & Staff Scholarship

Background: Placental efficiency (PE) describes the relationship between placental and fetal weights (fetal wt/placental wt). Within litters, PE can vary drastically, resulting in similarly sized pigs associated with differently sized placentas, up to a 25% weight difference. However, the mechanisms enabling the smaller placenta to grow a comparable littermate are unknown. To elucidate potential mechanisms, morphological measurements and gene expression profiles in placental and associated endometrial tissues of high PE and low PE feto-placental units were compared. Tissue samples were obtained from eight maternal line gilts during gestational day 95 ovario-hysterectomies. RNA was extracted from tissues of feto-placental units with …

Portable X-Ray Fluorescence Spectroscopy For Rapid And Cost-Effective Determination Of Elemental Composition Of Ground Forage, Yadav Sapkota, Louis M. Mcdonald, Thomas C. Griggs, Thomas J. Basden, Brandon Lee Drake

Faculty & Staff Scholarship

The recent development of portable X-ray fluorescence spectrometers (PXRF) has created new avenues for rapid plant elemental concentration determination at reduced cost while avoiding hazardous chemicals. A few studies have indicated the potential use of PXRF for homogenous plant tissue analysis. However, there is a lack of information for analysis of heterogeneous plant samples like livestock forage, which consists of a mixture of several species and plant parts, each varying in elemental concentration. Our objective was to evaluate PXRF for forage analysis, specifically the effect of forage particle size and scan time on important elements including P, K, Ca, and …

Transcriptional And Chemical Changes In Soybean Leaves In Response To Long-Term Aphid Colonization, Jessica D. Hohenstein, Matthew E. Studham, Adam Klein, Nik Kovinich, Kia Barry, Young-Jin Lee, Gustavo C. Maclntosh

Faculty & Staff Scholarship

Soybean aphids (Aphis glycines Matsumura) are specialized insects that feed on soybean (Glycine max) phloem sap. Transcriptome analyses have shown that resistant soybean plants mount a fast response that limits aphid feeding and population growth. Conversely, defense responses in susceptible plants are slower and it is hypothesized that aphids block effective defenses in the compatible interaction. Unlike other pests, aphids can colonize plants for long periods of time; yet the effect on the plant transcriptome after long-term aphid feeding has not been analyzed for any plant–aphid interaction. We analyzed the susceptible and resistant (Rag1) transcriptome …

Understanding The Impact Of Neurologic Complications In Patients With Cirrhosis, Sanath K. Allampati, Kevin D. Mullen

Faculty & Staff Scholarship

Patients with cirrhosis may experience neurologic complications, including hepatic encephalopathy. Hepatic encephalopathy may be classified as covert (mild symptoms (e.g. lack of awareness)) or overt (moderate to severe symptoms (e.g. confusion or coma)), and symptoms may overlap with other neurologic conditions (e.g. epilepsy, stroke). Managing hepatic encephalopathy includes identifying and treating precipitating factors (e.g. dehydration). First-line treatment for patients with overt hepatic encephalopathy is typically lactulose; to reduce the risk of overt hepatic encephalopathy recurrence, lactulose plus the nonsystemic antibiotic rifaximin is recommended. Rifaximin reduced the risk of breakthrough overt hepatic encephalopathy by 58% versus placebo over 6 months (p < 0.001; 91% of patients in each group were on concomitant lactulose). However, neither pharmacologic hepatic encephalopathy treatment nor liver transplantation may completely reverse neurologic impairment in patients with hepatic encephalopathy. Additional neurologic considerations for patients with cirrhosis include preventing falls, as well as managing sleep-related issues, hyponatremia, and cerebral edema. Thus, monitoring neurologic impairment is an important component in the management of patients with cirrhosis.

Nutrition Risk Is Associated With Leukocyte Telomere Length In Middle-Aged Men And Women With At Least One Risk Factor For Cardiovascular Disease, Melissa V. Marra, Margaret A. Drazba, Ida Holaskova, William L. Belden

Faculty & Staff Scholarship

Poor diet quality has been associated with several age-related chronic conditions, but its relationship to telomere length, a biological marker of cellular aging, is unclear. The purpose of this cross-sectional study was to determine whether overall diet quality was associated with relative leukocyte telomere length (rLTL) in a sample (n = 96) of nonsmoking middle-aged adults in Appalachia with at least one risk factor for cardiovascular disease. Diet quality was assessed using the Healthy Eating Index (HEI-2015), the alternate Mediterranean diet score (aMed), and the Dietary Screening Tool (DST). Peripheral rLTL was measured by quantitative real-time polymerase chain reaction. The …

“If My Family Is Happy, Then I Am Happy”: Quality-Of-Life Determinants Of Parents Of School-Age Children, Kaitlyn M. Eck, Colleen L. Delaney, Melissa D. Olfert, Karla P. Shelnutt, Carol Byrd-Bredbenner

Faculty & Staff Scholarship

Objective:

Obesity is a public health concern for children and adults and effective obesity prevention programming is needed urgently. The effectiveness of health-related messaging and interventions is influenced by the way content is framed. HomeStyles is an obesity prevention program, which aims to promote health through the frame of improved quality of life.

Methods:

Thus, focus groups were conducted with English- and Spanish-speaking parents of school-aged children (ages 6–11) to identify key quality-of-life determinants as described by parents.

Results:

Parents (n = 158) reported that their quality of life was influenced by family happiness and parent and child health (e.g. …

Sense Of Coherence And Caregivers Of Persons With Dementia, Kristina M. Childers

Faculty & Staff Scholarship

Unpaid caregivers (CG) provide most of the assistance to persons with dementias (PWD) living in the community. This study explores the current state of knowledge regarding the concept of sense of coherence (SOC) and CG of PWD via a concept analysis. The identified defining attributes were health, health-related quality of life (HRQoL), CG burden, CG stress, coping as a strength, gender, and decreasing sense of CG coherence over the progression of the disease (dementia). Further study by health care professionals using clinical observations, large samples of respondents, a consistent theory, valid and reliable instruments used to measure defining attributes consistently, …

Sex Differences In Lifestyle Behaviors Among U.S. College Freshmen, Melissa D. Olfert, Makenzie L. Barr, Camille C. Charlier, Geoffrey W. Greene, Wenjun Zhou, Sarah E. Colby

Faculty & Staff Scholarship

Within lifestyle behavior research, the sex of populations causes differences in behaviors and outcomes of studies. This cross-sectional study investigated lifestyle behavior patterns in college students, examining sex differences in four areas: Nutrition, physical activity, sleep, and stress. Data from over 1100 college freshmen across 8 United States universities were used for this cross-sectional analysis. Self-reported data assessed fruit and vegetable intake, fat percent intake, physical activity, perceived stress, and sleep quality. Statistical analysis included Pearson chi-squared and Mann–Whitney’s U tests for scores by sex. Likewise, healthy cut-offs were used to determine frequency of participants within range of the five …

Vegetal-Derived Biostimulant Enhances Adventitious Rooting In Cuttings Of Basil, Tomato, And Chrysanthemum Via Brassinosteroid-Mediated Processes, Hye-Ji Kim, Kang-Mo Ku, Seunghyun Choi, Mariateresa Cardarelli

Faculty & Staff Scholarship

Plant-derived protein biostimulants exhibit hormone-like activities promoting plant growth and yield, yet detailed investigations on hormonal function have remained limited. This study was conducted to investigate the effects of vegetal-derived-biostimulant on morphological and metabolic changes in cuttings of three herbaceous species demonstrating different rooting ability, basil (Ocimum basilicum L.), tomato (Solanum lycopersicum L.), and chrysanthemum (Chrysanthemum indicum L.), in comparison to auxin. Unrooted cuttings were applied with or without biostimulant (100, 1000, 5000, and 10,000 mg L⁻¹) or auxin [1% indole-3-butyric acid (IBA) plus 0.5% 1-naphthaleneacetic acid (NAA); 100, 200, 300, and 500 mg L⁻¹] as …

Interventions For Self-Management Of Type 2 Diabetes: An Integrative Review, Roger Carpenter, Toni Dichiacchio, Kendra Baker

Faculty & Staff Scholarship

Background

Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes?

Purpose/Objectives

The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus.

Design

An integrative review …

Epichloë (Formerly Neotyphodium) Fungal Endophytes Increase Adaptation Of Cool-Season Perennial Grasses To Environmental Stresses, Dariusz P. Malinowski, David P. Belesky

Faculty & Staff Scholarship

Many cool-season grass species have evolved with asexual, nonsymptomatic fungal endophytes of the genus Epichloë (formerly Neotyphodium) of the family Clavicipitaceae. These associations range from parasitic to mutualistic and have dramatic effects on grass host chemistry, increasing resistance to abiotic (drought, soil mineral imbalance) and biotic (vertebrate and invertebrate herbivory, nematodes, plant pathogens, plant competition) stresses. Native endophyte strains produce a range of bioprotective alkaloid and other nonalkaloid secondary compounds, several of them known to have detrimental effects on grazing animals. In the past two decades, epichloid endophyte strains have been selected with marginal or no capacity of producing …

Breast Cancer Survivors’ Perceptions Of Prevention Versus Control Of Future Cancer Recurrence, Monira Alwhaibi, Christa L. Lilly, Hannah Hazard, Kimberly M. Kelly

Faculty & Staff Scholarship

Background. The Institute of Medicine has established Survivorship Care Planning as a critical component of cancer care to ensure that cancer survivors receive the appropriate follow-up care in a timely manner and support cancer survivors in dealing with the risk of recurrence, yet little is known about how cancer survivors think about preventing or controlling future cancer recurrence. This study sought to assess breast cancer women’s perceived prevention and perceived control of future cancer recurrence. Methods. Women with a history of breast cancer (n=114) were surveyed, and data were analyzed using concurrent mixed methods. Binary logistic regression models examined predictors …

Leisure Time Physical Activity Reduces The Risk For Stroke In Adults: A Reanalysis Of A Meta-Analysis Using The Inverse-Heterogeneity Model, George A. Kelley, Kristi S. Kelley

Faculty & Staff Scholarship

Objective. Apply more robust and additional analyses to a previous meta-analysis that reported statistically significant associations between leisure time physical activity (LTPA) and stroke. Methods. A reanalysis of a previous meta-analysis that included nine prospective cohort studies representing 269,594 men and women 25-84 years of age and in which the association between LTPA and incident stroke was examined. Follow-up periods ranged from 7.7 to 32.0 years. Relative risks (RR) from each study were pooled using the inverse-heterogeneity model. Heterogeneity was examined using the Q statistic, inconsistency using I2, and small-study effects using Doi plots and the LFK index. Influence and …

Redesign, Field-Testing, And Validation Of The Physical Activity Campus Environmental Supports (Paces) Audit, Tanya M. Horacek, Elif D. Yildirim, Dean Seidman, Carol Byrd-Bredbenner, Sarah Colby, Adrienne A. White, Karla P. Shelnutt, Melissa D. Olfert, Anne E. Matthews, Kristin Riggsbee, Lisa Frazen-Castle, Jesse S. Morrell, Kendra Kattelmann

Faculty & Staff Scholarship

This paper describes the redesign, field-testing, and convergent validity of a practical tool—Physical Activity Campus Environmental Supports (PACES) audit. Methods. The audit includes two parts: (1) PACES-Programs, which is comprised of questions regarding populations served, fees, programs (recreation/fitness classes and intramurals), proximity, adequacy of facilities, and marketing, and (2) PACES-Facilities, which is comprised of questions regarding built environment (aesthetics, bike racks, stairs, and universal design), recreation equipment, staff, amenities, and access. Each item criterion is specifically scored using a five-point, semantic-differential scale ranging from limited to extensive environmental support. A few questions utilize select all that apply for a summed …

Dental Care Utilization Among Veterans By Smoking Status, R Constance Wiener, Ruchi Bhandari, Alcinda K. Trickett Shockey, Christopher Waters

Faculty & Staff Scholarship

Background. Given the critical importance of dental care utilization among veterans and the overall health consequences of tobacco use in all populations, the purpose of this research is to examine smoking as a risk factor for poor dental care utilization among United States Veterans. Methods. A secondary data analysis of cross-sectional data from the National Survey of Veterans was conducted. The primary outcome was dental care utilization (Yes, No). Frequency, chi-square analyses, and multivariate logistic regression statistical tests were performed while adjusting for confounding factors. Results. There were 6,308 veterans in the study. Veterans who were current smokers were less …

More Than Fast Food: Development Of A Story Map To Compare Adolescent Perceptions And Observations Of Their Food Environments And Related Food Behaviors, Kristin A. Riggsbee, Jonathon Riggsbee, Melissa J. Vilaro, Lauren Moret, Marsha Spence, Elizabeth A. Steeves, Wenjun Zhou, Melissa D. Olfert, Lisa Franzen-Castle, Tanya Horacek, Elizabeth Hall, Sarah Colby

Faculty & Staff Scholarship

The purpose of this convergent, multiphase, mixed methods study was to better understand the perceptions of adolescents’ food environments and related food behaviors using grounded visualization and story mapping. Adolescents from one high school (13–16 years) in the southeastern United States were evaluated via data from health behavior surveys (n = 75), school environment maps, focus groups (n = 5 groups), and Photovoice (n = 6) from October 2016 to April 2017. Data from each phase were integrated using grounded visualization and new themes were identified (n = 7). A story map using ArcGIS Online was developed from data integration, …

Pro-Con Debate: Nitrous Oxide For Labor Analgesia, Manuel C. Vallejo, Mark I. Zakowski

Faculty & Staff Scholarship

This Pro-Con debate will provide the practitioner with an evidence-based knowledge approach to assist the clinician in determining whether to employ (Pro) or not to employ (Con) this technique in the obstetrical suite for labor analgesia. Nitrous oxide has been used safely in dentistry and medicine for many centuries. However, accumulating preclinical and clinical evidence increasingly suggests previously unrecognized adverse maternal and fetal effects of nitrous oxide, which warrants reconsideration of its use in pregnant women and a more detailed informed consent. Nitrous oxide is associated with metabolic, oxidative, genotoxic, and transgenerational epigenetic effects in animals and humans that may …