bluuebunny/crossref_metadata_2025 huggingface dataset:
Mandatory Police Training: The Epitome of Dissatisfaction and Demotivation?
Authors: Honess Richard
Published: December 2019

This article reports on a piece of survey research completed by 809 police officers of a Federated Rank in England and Wales. The survey examined the attitudes of the officers with regards to the provision of ongoing training within the police service and their motivation to undertake it, with a particular emphasis on training delivered by e-learning on the National Centre for Applied Learning Technologies platform. The results are discussed through the theoretical framework of andragogy (adult education theory) and self-determination theory with recommendations for improvement made based on these results.
Police Reform in a Post-Conflict Context: The Case of Solomon Islands
Authors: Dinnen Sinclair , Watson Danielle
Published: December 2019

Police reform in much of the developing world reflects a preoccupation with either shifts away from paramilitaristic policing models or restoration of law and order in post-conflict societies. For many Pacific Island Countries (PICs), dialogue on reform reflects the prioritization of internal organizational restructuring and capacity building, with minimal emphasis on responding to ever-changing stakeholder demands. What is also common is for police reform efforts to closely align with prioritized focal areas of donor countries or powerful neighbours in developed countries with different contextual realities. Here we discuss police reform efforts in a PIC that has been the recipient of a major regional post-conflict state-building intervention and highlight the complexities specific to piecing together the police reform architecture. We also make reference to Solomon Islands to support our argument that problematic police reform can be largely attributed to focal imbalances between internal and external transformation agendas. The article concludes with a summary of the constraints associated with police reform in post-conflict contexts and recommendations for navigating the reform process.
Is modelling complexity always needed? Insights from modelling PrEP introduction in South Africa
Authors: Grant Hannah , Foss Anna M , Watts Charlotte , Medley Graham F , Mukandavire Zindoga
Published: December 2019

Background

Mathematical models can be powerful policymaking tools. Simple, static models are user-friendly for policymakers. More complex, dynamic models account for time-dependent changes but are complicated to understand and produce. Under which conditions are static models adequate? We compare static and dynamic model predictions of whether behavioural disinhibition could undermine the impact of HIV pre-exposure prophylaxis (PrEP) provision to female sex workers in South Africa.

Methods

A static model of HIV risk was developed and adapted into a dynamic model. Both models were used to estimate the possible reduction in condom use, following PrEP introduction, without increasing HIV risk. The results were compared over a 20-year time horizon, in two contexts: at epidemic equilibrium and during an increasing epidemic.

Results

Over time horizons of up to 5 years, the models are consistent. Over longer timeframes, the static model overstates the tolerated reduction in condom use where initial condom use is reasonably high ($\ge$50%) and/or PrEP effectiveness is low ($\le$45%), especially during an increasing epidemic.

Conclusions

Static models can provide useful deductions to guide policymaking around the introduction of a new HIV intervention over short–medium time horizons of up to 5 years. Over longer timeframes, static models may not sufficiently emphasise situations of programmatic importance, especially where underlying epidemics are still increasing.
The dilemmas and uncertainties in assessing the societal impact of research
Authors: Lauronen Juha-Pekka
Published: December 2019

In the 2000s, many European Union countries have established research impact assessment practices as part of the scrutiny of the third mission of universities. The Finnish research evaluation system has widely adopted a societal impact criterion. In this study, the question is what guiding principles does impact assessment rely on. This point of view is based on the experiences and opinions of experts interviewed for the study. Four implicit principles of impact assessment which guide assessment goals and practical implementations were found. The guiding principles have several social and methodological dilemmas due to liminal interpretations between social interests and academic endeavor. This study recommends that the evaluation scholars should consider the actual social purpose vis-à-vis consistent methodological approaches to assessment before applying ‘all-round’ solutions to scholarly fields.
Evolution of an Eleusine-Specific Subgroup of Pyricularia oryzae Through a Gain of an Avirulence Gene
Authors: Asuke Soichiro , Tanaka Masaki , Hyon Gang-Su , Inoue Yoshihiro , Vy Trinh Thi Phuong , Niwamoto Daisuke , Nakayashiki Hitoshi , Tosa Yukio
Published: December 2019

Eleusine isolates (members of the Eleusine pathotype) of Pyricularia oryzae are divided into two subgroups, EC-I and EC-II, differentiated by molecular markers. A multilocus phylogenetic analysis revealed that these subgroups are very close to Eragrostis isolates. EC-II and Eragrostis isolates were exclusively virulent on finger millet and weeping lovegrass, respectively, while EC-I isolates were virulent on both. The avirulence of EC-II on weeping lovegrass was conditioned by an avirulence gene, PWL1. All EC-II isolates shared a peculiar structure (P structure) that was considered to be produced by an insertion (or translocation) of a DNA fragment carrying PWL1. On the other hand, all EC-I and Eragrostis isolates were noncarriers of PWL1 and shared a gene structure that should have predated the insertion of the PWL1-containing fragment. These results, together with phylogenetic analyses using whole-genome sequences, suggest that the Eleusine-specific subgroup (EC-II) evolved through a loss of pathogenicity on weeping lovegrass caused by a gain of PWL1.
Epigenetic silencing of microRNA‐874‐3p implicates in erectile dysfunction in diabetic rats by activating the Nupr1/Chop‐mediated pathway
Authors: Huo Wei , Li Hongyan , Zhang Yun , Li Hai
Published: December 2019

Diabetes is a global medical problem that causes many deaths every year. Complications caused by diabetes are serious and affect patients’ quality of life. Diabetes mellitus erectile dysfunction (DMED) affects more than half of male diabetes patients. In this study, we determined the role of microRNA‐874‐3p (miR‐874‐3p) and nuclear protein‐1 (Nupr1) in streptozocin‐induced DMED rats. Control rats received equal amount of vehicle. These rats were also injected with lentiviral vector or agomir to silence or overexpress miR‐874‐3p or Nupr1. Apomorphine (100 μg/kg, s.c.) was used to induce erection and time of erection was recorded. Intracavernosal and mean arterial pressure ratio (ICP/MAP) were also recorded. O2− level and concentration of thiobarbituric acid reactive substances (TBARs) were detected using lucigenin‐derived chemiluminescence method and Colorimetry. Rat cavernosum tissues were collected for subsequent experiments. Cavernosum smooth muscle cells (CSMCs) were also used for in vitro experiments. Nupr1 was found highly expressed (by RT‐qPCR and Western blot analysis) in cavernosum tissues from DMED rats. Nupr1 silencing improved the ICP/MAP ratio and erection time. Nupr1 silencing also reduced CSMC apoptosis (by TUNEL assay) as well as decreased O2− level and TBAR concentration. Nupr1 was targeted and inhibited by miR‐874‐3p (by luciferase activity and RNA immunoprecipitation assays), which was downregulated in DMED. miR‐874‐3p downregulation was due to increased methylation at the promoter region (methylation‐specific PCR). miR‐874‐3p overexpression improved erection time and reduced apoptosis. In summary, miR‐874‐3p was downregulated which led to increased apoptosis and erectile dysfunction in DMED rats, through inhibition of Nupr1‐mediated pathway. This study may also provide a new therapeutic direction for the treatment of DMED.
Promoting Cultural Humility in Nursing Education Through the Use of Ground Rules
Authors: Smith Ariel , Foronda Cynthia
Published: December 2019

The National League for Nursing advocates for improved efforts related to diversity and inclusion in nursing education. By incorporating cultural humility into teaching and learning processes, faculty may be able to reduce bias and promote the inclusive learning environment necessary to retain diverse nursing students. This article emphasizes the importance of cultural humility in nursing education and presents novel ground rules, based on the literature, for implementation within the classroom to foster an academic environment suitable for students from all backgrounds.
Exploring Family Nurse Practitioners' Practices in Recommending mHealth Apps to Patients
Authors: Mueller Rebecca C.
Published: December 2019

Patients frequently download mHealth apps, which can be used to support health promotion. It remains unclear, however, if family nurse practitioners are recommending apps to patients. This study identified family nurse practitioners' current practices of recommending apps to patients and described their use and intent to use mHealth apps for health promotion with their patients. Nearly 70% of the 303 participants surveyed recommended mHealth apps to their patients, with the most common types comprising patient portal, diet and nutrition, and fitness apps. However, the frequency with which apps were recommended was low. Participants reported that apps complement patient care, enable health promotion behaviors, are easy to use, and improve clarity of patient data. These factors facilitated their intent to recommend mHealth apps to patients. Healthcare organizational support influenced participants' intent to recommend apps, and access to trustworthy apps and electronic health records compatibility increased usage. Barriers to recommending involved patient-specific characteristics and provider concerns about reliability, privacy, and efficacy of apps. Family nurse practitioners must be supported in guiding patients to use reliable, safe, and HIPAA-compliant apps. To help engage patients, clinicians should be educated on methods to evaluate mHealth apps and how to incorporate them into patient care.
Cardiovascular Sequelae of Sickle Cell Disease
Authors: Aujla Amandeep , Dutta Dibyendu , Amar Salomon , Frishman William , Lim Seah H.
Published: December 2019

Sickle cell disease (SCD) is one of the most common hereditary hemoglobinopathies worldwide. It is a multisystem disease that causes considerable patient morbidity. Despite advances in medical treatment, cardiopulmonary complications remain the most common cause of death in individuals with SCD. A growing body of evidence has shown that SCD results in a spectrum of cardiovascular complications through a variety of mechanisms, including chronic hemolysis, local tissue hypoxia, increased oxidative stress, and autonomic instability. Herein, we will examine the pathophysiology of sickle cell vasculopathy and discuss the spectrum of cardiovascular sequelae of the disease, while highlighting the impact of SCD on the cardiovascular health of the patients.
Beta Adrenergic Blocker Use in Patients With Chronic Obstructive Pulmonary Disease and Concurrent Chronic Heart Failure With a Low Ejection Fraction
Authors: Mtisi Tafadzwa F. , Frishman William H.
Published: December 2019

Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and present clinicians with diagnostic and therapeutic challenges. Beta-blockers are a cornerstone of CHF treatment, in patients with a low ejection fraction, while beta-agonists are utilized for COPD. These 2 therapies exert opposing pharmacological effects. COPD patients are at an increased risk of mortality from cardiovascular events. In addition to CHF, beta-blockers are used in a number of cardiovascular conditions because of their cardioprotective properties as well as their mortality benefit. However, there is reluctance among physicians to use beta-blockers in patients with COPD because of fear of inducing bronchospasms, despite increasing evidence of their safety and mortality benefits. The majority of this evidence comes from observational studies showing that beta-blockers are safe and well tolerated, with minimal effect on respiratory function. Furthermore, beta-blockers have been shown to lower the mortality risk in patients with COPD alone, as well as in those with COPD and CHF. Large clinical trials are needed in order to dispel the mistrust of beta-blocker use in COPD patients. The current evidence supports the use of cardioselective beta-blockers in patients with COPD. As the population continues to live longer, comorbidities become ever more present, and cardioselective beta-blockers should not be withheld from patients with COPD and coexistent CHF, because the benefits outweigh the risks.
Laparoscopic Compared With Open Resection for Colorectal Cancer and Long-term Incidence of Adhesional Intestinal Obstruction and Incisional Hernia: A Systematic Review and Meta-analysis
Authors: Udayasiri Dilshan K. , Skandarajah Anita , Hayes Ian P.
Published: December 2019

BACKGROUND:

Incisional hernia and adhesional intestinal obstruction are important complications of laparoscopic and open resection for colorectal cancer. This is the largest systematic review of comparative studies on this topic.

OBJECTIVE:

This study aimed to investigate whether laparoscopic surgery decreases the incidence of incisional hernia and adhesional intestinal obstruction compared to open surgery for colorectal cancer.

DATA SOURCES:

Online databases PubMed, EMBASE, and the Cochrane Library were searched. Abstracts from the annual meetings of the American Society of Colon and Rectal Surgeons and the European Society of Coloproctology were performed to cover gray literature.

STUDY SELECTION:

We included both randomized and nonrandomized comparative studies.

INTERVENTIONS:

Laparoscopic resection was compared to open resection for patients with colorectal cancer.

MAIN OUTCOMES MEASURES:

The primary outcomes measured were incisional hernia and adhesional intestinal obstruction.

RESULTS:

Fifteen studies met inclusion criteria (6 randomized comparative studies/9 nonrandomized comparative studies); 84,172 patients. Meta-analysis showed decreased odds of developing incisional hernia in the laparoscopic cohort (OR, 0.79; 95% CI, 0.66–0.95; p = 0.01) but no difference in requirement for surgery (OR, 1.07; 95% CI, 0.64–1.79; p = 0.79). Similarly, there were decreased odds of developing adhesional intestinal obstruction in the laparoscopic cohort (OR, 0.81; 95% CI, 0.72–0.92, p = 0.001), but no difference in requirement for surgery (OR, 0.84; 95% CI, 0.53–1.35; p = 0.48).

LIMITATIONS:

Incisional hernia and adhesional intestinal obstruction were poorly defined in many studies.

CONCLUSION:

Laparoscopic surgery is associated with decreased odds of incisional hernias and adhesional intestinal obstructions compared with open surgery for colorectal cancer.
Combination therapy
Authors: Yuan-Dong Sun , Hao Zhang , Hui-Rong Xu , Jing-Zhou Liu , Hui-Yong Wu , Jian-Jun Han , Yu Jin-Ming
Published: December 2019

Background:

This study systematically reviews the data for transcatheter arterial chemoembolization (TACE) alone or combined TACE and cryoablation therapy of hepatocellular carcinoma, aiming to provide clinical choice references for treatment of cancer.

Methods:

Electronic databases (PubMed, EMBASE, China National Knowledge Infrastructure, and Google Scholar) were systematically searched to include relevant studies published in English and Chinese between Jan 1, 2000, to July 31, 2017. The analysis was conducted in RevMan 5.3 based on random effects models.

Results:

Nineteen trials (n = 1427) were included. Combined TACE and cryoablation therapy had higher survival rate (1-year survival [RR 1.37; 95%-CI 1.26,1.49], 2-year survival [RR 1.50; 95%-CI 1.25,1.79], 3-year survival [RR 1.67; 95%-CI 1.16,2.40]), complete necrosis [RR 2.53; 95%-CI 2.07,3.10] and tumor control [RR 1.57; 95%-CI 1.40,1.75], which is more favorable for long-term efficacy of non-surgical hepatocellular carcinoma. Tumor recurrence of control group was above combination therapy [RR 0.27; 95%-CI 0.17, 0.43]. Compared with transcatheter arterial chemoembolization, effect of combination therapy occurred mainly in the survival, complete necrosis, tumor control, and recurrence. Taking combination therapy was generally more effective than taking TACE only.

Conclusion:

Compared with TACE only used to treat cancer, combination therapy had the best effect profile in general, and it had better survival in HCC when taking an integrated approach. The prognosis of treatments based on combination therapy is modulated by cryoablation.
Stiff limb syndrome with lower limb myoclonus
Authors: Zhang Chang-Guo , Li Lan-Lan , Feng Yao-Yao , Chen Jing
Published: December 2019

Rationale:

stiff limb syndrome (SLS) is a variant of stiff-man syndrome, primarily affecting a specific limb. Its diagnosis has always been challenging due to the lack of a specific confirmation test. We present a rare case of a patient with lower limb myoclonus and rigidity.

Patient concerns:

A 53-year-old male presented with a sudden onset of progressive left lower extremity myoclonus and muscle rigidity for 3 days. He rapidly showed signs of right lower limb involvement with severe joint stiffness and inability to walk.

Diagnosis:

The symptoms nature, physical examination, careful elimination of differential diagnosis suggested a diagnosis of stiff limb syndrome.

Interventions:

Intravenous infusion of gamma globulin 0.4 mg/kg coupled with baclofen and clonazepam were given after admission. He also received an injection of botulinum toxin A to relieve his muscle stiffness.

Outcomes:

The patients’ condition improved after the initial treatment with complete disappearance of muscle twitching. Further improvements were seen later on after the local administration of botulinum toxin A.

Lessons:

Stiff limb syndrome shares the same complex symptoms with many other conditions. Its diagnosis relies heavily on clinical presentations and on ruling out other conditions. However, unusual symptoms such as myoclonus can occur in few cases and together with the rarity of the condition, the prevalence of misdiagnosis is high. Therefore, being aware and recognizing the signs and symptoms is crucial for proper management. Additionally, EMG is a very important test if the present condition is suspected. However, a negative EMG result or a negative anti-glutamic acid decarboxylase antibody test should not exclude SLS diagnosis.
Renal actinomycosis with retroperitoneal abscess in a cirrhotic patient
Authors: Liao Wei-Kai , Huang Shih-Che , Hu Sung-Yuan , Tsai Che-An , Wang Ren-Ching
Published: December 2019

Rationale:

Renal actinomycosis is a rare clinical infection, subacute to chronic presentation caused by the Actinomyces bacteria. Actinomyces israelii is diagnosed in the overpowering majority of reported cases. Abdominopelvic manifestation forms 10% to 20% of all actinomycosis, and may be misdiagnosed as either a malignancy or chronic inflammation due to the lower correct preoperative diagnostic rate (<10%).

Patient concerns:

A 38-year-old man with alcoholic liver cirrhosis experienced right flank pain, abdominal pain, and fever for 3 days. Leukocytosis, acute kidney injury, and impaired liver function were found. A computed tomographic scan demonstrated multiple renal cystic lesions, along with fluid accumulation at the right subphrenic and retroperitoneal spaces.

Diagnoses:

Renal actinomycosis was confirmed via cultures of both the abscess and nephrectomy specimen which grew A israelii and the pathological findings of multiple renal abscesses of actinomycosis with the characteristics of sulfur granules.

Interventions:

A nephrectomy was performed for an inadequate percutaneous drainage of renal abscess.

Outcomes:

A full course of antibiotics with intravenous penicillin G (3 million units every 4 hours) was prescribed for 2 weeks, followed by oral penicillin V given at a dose of 2 grams per day for 6 months at our out-patient facility.

Lessons:

A precise diagnosis of primary renal actinomycosis depends on any histopathological findings and/or cultures of specimens. A high dose of intravenous penicillin G is the first choice, followed by oral penicillin V, with the duration of each being dependent upon the individual condition.
Prognostic value of site-specific metastases for patients with advanced intrahepatic cholangiocarcinoma
Authors: Cheng Rui , Du Qiang , Ye Jingmin , Wang Bi , Chen Yanling
Published: December 2019

Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy with poor prognosis and increasing incidence. Due to its asymptomatic manifestation, ICC often progresses to a metastatic stage on diagnosis. The current study attempted to evaluate the prognostic value of site-specific metastases in patients with metastatic ICC.

Surveillance, Epidemiology, and End Results (SEER) database (2010–2015) was queried and metastatic ICC patients were classified according to the metastatic sites. Kaplan–Meier analysis was used for survival comparisons and multivariate analysis was performed to elicit characteristics independently associated with survival.

A total of 1567 patients were identified and included in the analysis. Compared with those with multiple-site metastases, patients with single-site metastases had better prognostic outcomes. Among the single-site metastases, regional lymph nodes metastases had the best prognosis; liver metastases had better prognostic outcomes than bone metastases; no significant difference was found between lung and bone or liver metastasis. Local treatment of primary tumor might benefit patients with isolated lymph nodes metastases and few exceptional cases of patients with liver metastases.

Different metastatic sites have distinct impact on the survival outcomes of patients with advanced ICC and highly selected subset of them might benefit from the local treatment of the primary tumor.
Cardiac angiosarcoma
Authors: Linfeng Qian , Xingjie Xu , Henry Davies , Zhedong Wan , Hongfei Xu , Haige Zhao
Published: December 2019

Rationale:

Primary cardiac angiosarcoma is a rare malignant cardiac neoplasm with early metastasis and poor prognosis. As there are currently no guidelines or effective therapeutic strategies, management of this condition depends on previous experiences of the clinician treating and the consideration of reported cases.

Patient concerns:

A 65-year-old male presented to our department with a 4-day history of chest tightness, dyspnea, lower extremity weakness and occasional dizziness, and a transthoracic echo (TTE) revealed a right atrium occupying mass.

Diagnoses:

TTE showed right atrium occupation, and the post-operative histopathology showed the tumor to be a primary cardiac angiosarcoma.

Interventions:

Right atrium tumor resection and right atrium reconstruction with a bovine pericardium were performed.

Outcomes:

The patient recovered from surgery and discharged but died 10 months after surgery because of complete resection was impossible and adjuvant therapy was not performed.

Lessons:

Resection of primary cardiac angiosarcomas should be integrated with a combination of chemotherapy, radiotherapy, and targeted therapy based on tumor cell gene mutation and altered expression.
Does synbiotic supplementation affect body weight, body mass index, and high-sensitivity C-reactive protein levels in patients with type 2 diabetes? Protocol for a systematic review and meta-analysis
Authors: Chen Yuan , Li Zhenhua , Yang Maoyi , Shui Jiacheng , Yue Rensong
Published: December 2019

Background:

The number of patients with type 2 diabetes mellitus (T2DM) is surging currently. Synbiotic as a supplement based on gut microbiota may be beneficial to improve the metabolism of T2DM. However, the results of clinical studies show that the role of synbiotic in weight management in patients with T2DM is controversial. In this context, we have formulated this protocol. The study will evaluate the effects of synbiotic supplementation on body weight, body mass index (BMI), and high-sensitivity C-reactive protein (hs-CRP) levels in patients with T2DM.

Methods:

The electronic databases PubMed, Embase, and the Cochrane Library will be searched for relevant literature from inception. Literature search, data extraction, and methodological quality assessment will be carried out independently by two researchers. All randomized controlled trials (RCTs) that met the criteria will be included. A meta-analysis will be conducted using weighted mean difference (WMD) and 95% confidence interval (CI) as effect measures.

Results:

This systematic review and meta-analysis will mainly assess the effects of synbiotic supplementation on body weight and BMI in T2DM patients. Secondary outcome indicators will include hs-CRP.

Conclusion:

This systematic review and meta-analysis will quantify the value of synbiotic supplement in weight management of patients with T2DM through a comprehensive evaluation of the current clinical evidence, so as to provide a basis for clinical application.

PROSPERO registration number:

CRD42019132974.
Factors, influencing medication errors in prehospital care
Authors: Ramadanov Nikolai , Klein Roman , Schumann Urs , Aguilar Abner Daniel Valdez , Behringer Wilhelm
Published: December 2019

To determine the frequency of medication errors in prehospital care and to investigate the influencing factors – diagnostic agreement (DA), the medical educational status, the specialty, the approval for emergency medicine of the prehospital emergency physician, the patient age and sex and the time of deployment.

We retrospectively reviewed 708 patients from 2013 to 2015, treated by the prehospital emergency physicians of the emergency medical service center Bad Belzig, Germany. The medication appropriateness was determined by a systematic comparison of the administered medication in prehospital deployments with the discharge diagnosis, according to current guidelines. The influencing factors were examined by univariate analysis of medication appropriateness (MA), using the χ2, the Mann–Whtiney U and the Welch tests. We calculated a cut-off value with the Youden index to predict absent MA, according to patients age. The significance level was P = .05.

MA was absent in 220 of 708 patients (31.1%). In the case of present DA, MA was absent in 103 of 491 patients (20.9%). In the case of absent DA, MA was absent in 117 of 217 patients (53.9%) (P = .01). MA was absent in 82 of 227 patients (36.1%), treated by specialist and in 138 of 481 patients (28.7%), treated by resident physicians (P = .04). The calculated cut-off value to predict absent MA was 75.5 years. MA was absent in 100 of 375 patients (26.7%) of the younger patient age group (≤75.5 years), MA was absent 120 of 333 patients (36.0%) of the older patient age group (>75.5 years) (P = .01). Absent MA showed peak values (46.7%–60%) at night from 3 to 6 AM (P = .01) The other investigated factors had no influence on MA.

The correctness of medication as a quality feature in prehospital care shows a necessity for improvement with a proportion of 31.1% medication errors. The correct diagnosis by the prehospital emergency physician and his rapid accumulation of experience had an impact on the correctness of medication in prehospital care. Elderly patients (75+ years) and nighttime prehospital deployments (3–6 AM) were identified as high risk for medication errors by the emergency physicians.
Three-dimensional vs 2-dimensional laparoscopic gastrectomy for gastric cancer
Authors: Chen Lian , Li Bo , Zeng Lianli , Zhao Jiani , Lei Jun , Luo Hongliang , Yi Fengming , Zhang Wenxiong
Published: December 2019

Background:

Both 3-dimensional (3D) laparoscopic gastrectomy (LG) and 2-dimensional (2D) LG are commonly used for gastric cancer (GC). To investigate their safety and efficacy, we performed this meta-analysis.

Methods:

PubMed, The Cochrane Library, Science Direct, Embase, Scopus, and Web of Science were systematically searched to identify relevant studies. The total number of lymph node dissections (LNDs), operation time, blood loss, postoperative hospital stay, postoperative complications, and hospitalization cost were extracted as major endpoints.

Results:

Among 904 articles that were enrolled, 9 studies were included for analysis. The 3D group was observed to have shorter operation times [95% confidence interval (CI): −0.54 to −0.06; P = .01] and less blood loss (95% CI: −0.41 to −0.19; P < .00001) than the 2D group. Compared with the 2D group, slightly higher hospitalization cost was found in the 3D group (95% CI: 0.06–0.37; P = .008). However, the outcomes among the total LNDs, postoperative hospital stay, and postoperative complications were similar. Subgroup analysis suggested that the 3D LG group had more 11p (2.22 ± 1.80 vs 1.47 ± 1.99, P = .019) and 8a (2.52 ± 1.88 vs 1.48 ± 1.43, P = .001) LNDs compared to the 2D LG group.

Conclusions:

3D LG has advantages for GC, with shorter operation times, less blood loss, and possibly more LNDs. However, the cost was slightly higher than that of 2D LG.
Case report of laparoscopic reduction of retro-ureter incarcerated small bowel obstruction
Authors: Cho Sungwoo , Yun Sangchul , Lee Yunhee , Ihn Myong Hoon
Published: December 2019

Rationale:

Various types of internal hernias have been reported including paraduodenal, intersigmoidal, pericecal, foramen of Winslow, as well as transmesenteric and retroanastomotic hernias. However, small bowel obstruction secondary to an internal hernia caused by the ureter is rare, and only a few cases have been reported worldwide. We report a case of small bowel herniation caused by the ureter in a woman who underwent radical hysterectomy for cervical cancer.

Patient concerns:

A 53-year-old woman presented with acute abdominal pain and vomiting and reported a history of radical hysterectomy for cervical cancer 6 years prior to presentation.

Diagnoses:

Computed tomography revealed segmental luminal dilatation of pelvic ileal loops, 2 transition zones with the beak sign in the left-sided pelvic cavity, and reduced enhancement of bowel loops. Hydronephrosis with abrupt luminal narrowing of the left distal ureter was also observed.

Interventions:

Exploratory laparoscopy revealed incarcerated bowel segments beneath an adhesive band. We did not immediately cut the adhesive band and continued to trace the course of the small bowel and attempted reduction of the hernia. Reduction of the hernia was not difficult; therefore, the entire small bowel could be disentangled from the pelvic adhesions without any small bowel injury. After reduction of the herniated small bowel, we could confirm that the adhesive band was the left ureter (ureteral peristalsis was observed). The reduced segments of the small bowel appeared viable, and resection was not required.

Outcomes:

The patient was discharged 2 days postoperatively without any complication.

Lessons:

Cutting band during adhesiolysis enables release of bowel obstruction. However, owing to the different types of internal hernias that are known to occur, it is essential to confirm the patient's history and preoperative CT findings to avoid complications.
Nasal-type extranodal natural killer/T-cell lymphoma presenting with a mass on the buttock
Authors: Liu Shuzhong , Zhou Xi , Song An , Huo Zhen , Wang Yipeng , Liu Yong
Published: December 2019

Rationale:

Nasal-type extranodal natural killer (NK)/T-cell lymphoma is a highly unusual disease with no standard curative managements yet. Our focus is to emphasize a very rare case of nasal-type extranodal NK/T-cell lymphoma with onset of the mass on the buttock successfully operated by combination of surgical excision together with chemotherapy. The management of these unique cases is of great clinical guiding significance.

Patient concerns:

A 20-year-old woman presented with a 2-month history of continuous and progressive severe pain on her left buttock. Since December 2017, the patient developed nasal congestion, accompanied with mild pain in the left eye, and new subcutaneous nodules on both cheeks.

Diagnosis:

Postoperative pathology confirmed the diagnosis of extranodal NK/T cell lymphoma. This is an extremely rare presentation of nasal-type NK/T-cell lymphoma.

Interventions:

The patient underwent enlarged resection of the tumor on the buttock. After the diagnosis of extranodal NK/T-cell lymphoma was established, the patient received chemotherapy and autologous hematopoietic stem cell transplantation.

Outcomes:

The patient's symptoms improved significantly after the surgery, and the postoperative period was uneventful at the 1-year follow-up visit. There were no complications associated with the operation and adjuvant therapies during the follow-up period.

Lessons:

Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Extranodal NK/T-cell lymphoma, although rare, should be part of the differential diagnosis when the patient presents with the mass on the buttock. We recommend enlarged excision of the extranodal lymphoma. Combined of surgical excision of the extranodal lymphoma, chemotherapy and autologous hematopoietic stem cell transplantation are good choice for proper treatment.
Hallermann-Streiff syndrome with uncommon ocular features, ultrasound biomicroscopy and optical coherence tomography findings
Authors: Shen Wei , Dai Min , Su Yunshan , Zhang Qing , Li Hongsong
Published: December 2019

Rationale:

Hallermann-Streiff syndrome (HSS) is a rare congenital disorder characterized by craniofacial malformations, sparse hair, degenerative skin changes, eye abnormalities, dental defects, and proportionate short stature.

Patient concerns:

A 24-year-old Chinese male patient presented to the ophthalmologist because of his sore eye and blurred vision.

Diagnoses:

The final diagnosis of presented case is HSS having the main features of the syndrome, however, associated with uncommon ocular features, ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT)changes, including aphakia, glaucoma, long eye axes, cilliary abnormalities, and chorioretinal atrophy.

Interventions:

Antiglaucomatous medical therapy failed to reduce the pressure in the right eye and a cyclocryotherapy was carried out. The antiglaucoma eye drops was continued in the left eye.

Outcomes:

The intraocular pressure has been reduced to the normal range, but the vision has not improved.

Lessons:

In the diagnosis of HSS, we should not ignore the extraordinary information especially uncommon ophthalmic features, UBM and OCT changes. We highlight the necessity of a multidisciplinary approach for accurate diagnosis and appropriate management.
Cardiac papillary fibroelastoma arising from the opening of the left inferior pulmonary vein in left atrium
Authors: Lu Na , Wei Na , Wang Lei , Yuan Ye
Published: December 2019

Rationale:

Cardiac papillary fibroelastoma is a small, benign endocardial tumor, while it is clinically important because of its strategic position and propensity for causing embolic events and hemodynamic complications.

Patient concerns:

A 59-year-old female presented our hospital for investigation and treatment of a sudden onset of syncope lasted about 2 minutes.

Diagnoses:

Cardiac papillary fibroelastoma arising from left inferior pulmonary vein in left atrium.

Interventions:

The tumor was successfully removed by cardiac surgery.

Outcomes:

The patient's postoperative course was uneventful, and she was discharged 10 days after surgery. The patient remained free of neurologic deficits and had no evidence of residual or recurrence of tumor with echocardiography during 1 year of follow-up.

Lessons:

Cardiac papillary fibroelastoma is a benign tumor, with increased risk of thromboembolic events. It is often diagnosed in patients with echocardiography by chance or after a neurologic event. Complete surgical resection should be considered when the patient is indicated and the long-term postoperative prognosis is excellent.
Dynamic changes in neural retinal images during the development of a lamellar macular hole
Authors: Ozawa Yoko , Shinoda Hajime , Nagai Norihiro , Tsubota Kazuo
Published: December 2019

Rationale:

Lamellar macular hole (LMH) comprises a partial-thickness defect of the macula, the central part of the neural retina. Classification of LMHs into degenerative and tractional types has been proposed based on macular morphology observed on optical coherence tomography (OCT) imaging. Although LMHs are assumed to develop from aborted full-thickness macular holes, the clinical course of LMH development is not fully understood.

Patient concerns:

A 67-year-old man noticed slight changes in his central vision, and exhibited gradual change in macular morphology.

Diagnosis:

The patient was first diagnosed with macular hole, which closed spontaneously. He then developed an LMH.

Interventions:

The patient was placed under observation.

Outcomes:

The patient first exhibited a macular hole, which resolved spontaneously. However, the tractional force at the surface of the macula became more severe, thereby causing retinoschisis-like appearance, which is the characteristic finding of a tractional LMH. The same eye then developed a lamellar hole-associated epiretinal proliferation (LHEP)-like structure, which is often observed in a degenerative LMH; importantly, the retinoschisis-like appearance persisted. Finally, the macula formed a typical degenerative LMH, characterized by intraretinal cavitation with persistent LHEP and disappearance of the retinoschisis-like structure.

Lessons:

The present report shows dynamic changes of neural retinal morphology during development of an LMH: a tractional LMH developed initially; it then transformed into a degenerative LMH, which comprises a neurodegenerative disease. The findings in this report may help to understand the pathogenesis of LMHs and to elucidate the neurodegenerative disease process in various fields.
Case Management for Southwestern Hospice Organization
Authors: Rumsey Christopher M. , Hopkins Elizabeth
Published: December 2019

Studies have shown that registered nurses are inadequately prepared to care for patients requiring hospice and palliative care. Reasons include inadequate curriculum, along with a lack of structured education related to hospice/palliative care and symptom management, which includes inadequate education on delivering home-based hospice/palliative case management. Challenges at the Southwestern Hospice Organization are consistent with industry standards, evidenced by a high level of afterhours triage phone calls related to ineffective case management setup and delivery upon patient admission to hospice service. Many of these triage inquires could be prevented with improved registered nurse case management education and subsequent execution. Through analyzing Southwestern Hospice Organization afterhours triage phone data, a deficiency in effective patient case management setup and delivery was defined. Best practices in hospice/palliative case management were then identified, and a quality improvement plan in the form of a nurse driven, hands-on, home hospice/palliative case management simulation was generated. Quality improvement for patient case management at the Southwestern Hospice Organization was the end goal.
Family Functioning and Suicide Among the Elderly in Rural China
Authors: Wei Yan-Xin , Liu Bao-Peng , Ma Zhen-Yu , Zhou Liang , Jia Cun-Xian
Published: December 2019

This study aimed to examine the association between family functioning and suicide among the elderly in rural China. This 1:1 paired case-control psychological autopsy study included 242 suicides at age 60 or more and an equal number of controls matched on age (±3 years), gender, and residency. Family functioning was assessed by the Family Adaptation Partnership Growth Affection Resolve Index. Family dysfunction was reported more frequently in suicides than in paired controls. Severe family dysfunction denoted a significant risk factor for suicide only in women after adjusting for potential confounding factors. Suicides with family dysfunction were prone to have unstable marital status, physical illness, mental disorders, family suicide history, and more stressful life events than those with good family functioning. The findings suggest that the intervention enhancing family functioning may be effective in decreasing suicide among the elderly in rural China.
Quantitative Oral HPV16 and HPV18 Detection in Persons Attending Dental Clinics
Authors: Stankiewicz Karita Helen C. , Magaret Amalia , Huang Meei-Li , Jerome Keith R. , Feng Quinne , Wald Anna
Published: December 2019

Objective

This study aimed to assess quantitative human papillomavirus (HPV) type 16 and HPV18 detection in oral rinses obtained in dental offices in Seattle, Washington.

Methods

We evaluated oral rinses collected during dental visits from 2016 to 2018. Multiplex TaqMan quantitative polymerase chain reaction was used to determine HPV16 and HPV18 viral load (VL).

Results

Of 15,313 persons, 152 (1%) had detectable oral HPV16/18. Men were at higher risk of oral HPV16/18 infection than women (1.6% vs. 0.6%; odds ratio, 3.2; 95% confidence interval, 2.1–4.4). Compared with women, men with HPV16 were older (median, 55 vs. 48 years; P < 0.001) and had higher VL (39.7 vs. 1.1 copies/mL, P < 0.001). Of 39 with HPV16 at baseline and a second oral rinse, 13 remained positive at subsequent rinse; of 8 with HPV18 at baseline, 2 remained positive at subsequent rinse. Persons with consecutive positive test results were all men and had higher baseline VL compared with those with first positive and second negative samples.

Conclusion

Oral rinse is an acceptable method of HPV testing, and persons are interested in testing. Overall HPV16/18 prevalence was low, and detection was more frequent among men than women, especially at higher copy numbers. HPV16 persistence was more common in men with high VL at baseline test. Future studies are needed to evaluate the feasibility of an effective secondary prevention strategy for oropharyngeal cancer using quantitative oral HPV detection.
Burn-Induced Coagulopathies: a Comprehensive Review
Authors: Ball Robert L. , Keyloun John W. , Brummel-Ziedins Kathleen , Orfeo Thomas , Palmieri Tina L. , Johnson Laura S. , Moffatt Lauren T. , Pusateri Anthony E. , Shupp Jeffrey W.
Published: December 2019

Burn-induced coagulopathy is not well understood, and consensus on diagnosis, prevention, and treatments are lacking. In this review, literature on burn-induced (and associated) coagulopathy is presented along with the current understanding of the effects of burn injury on the interactions among coagulation, fibrinolysis, and inflammation in the acute resuscitative phase and reconstructive phase of care. The role of conventional tests of coagulopathy and functional assays like thromboelastography or thromboelastometry will also be discussed. Finally, reported methods for the prevention and treatment of complications related to burn-induced coagulopathy will be reviewed.
Using Didactics and Simulation to Enhance Comfort, Knowledge, and Skills of Nonsurgical Trainees Caring for Patients With Tracheostomy and Laryngectomy
Authors: Davis Kevin Allen , Edgar-Zarate Courtney L. , Bonilla-Velez Juliana , Atkinson Timothy N. , Tulunay-Ugur Ozlem E. , Agarwal Amit
Published: December 2019

Introduction

Management of tracheostomy and laryngectomy is an important skill for physicians who often care for patients with multiple, comorbid, chronic medical conditions. There is little published literature on training for tracheostomy and laryngectomy care during nonsurgical specialty residencies. This project was designed to assess and improve comfort with, knowledge of, proficiency in tracheostomy and laryngectomy care.

Methods

This prospective observational study comprised 122 physician trainees from internal medicine, emergency medicine, and anesthesia training programs at the University of Arkansas for Medical Sciences participating in a simulation-based curriculum from April 2016 to December 2016. The curriculum included didactic session, hands-on experience performing a tracheostomy change, and practicing emergency scenarios on interactive, high-fidelity simulation mannequins. Preintervention and postintervention assessments of self-perceived comfort, objective knowledge, and tracheostomy change proficiency were performed and results compared.

Results

Self-perceived comfort improved from a mean Likert score from 2.12 to 4.43 (P = 0.009). Knowledge mean scores improved from 57% to 82% (P < 0.001) on multiple-choice testing. Tracheostomy change proficiency mean scores improved from 41% to 84% (P < 0.001) of proficiencies correctly performed. Six-month follow-up assessment of comfort and knowledge showed statistically significant retention of comfort (P = 0.002) and knowledge (P = 0.026).

Conclusions

Comprehensive tracheostomy and laryngectomy education, which combines enhancement of knowledge with simulation of both routine and emergent aspects of care, is an effective strategy in improving confidence with, knowledge of, proficiency in tracheostomy and laryngectomy care. Retention of confidence and knowledge was demonstrated 6 months later.
Design and Evaluation of a Low-Cost Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Simulator
Authors: Kattan Eduardo , Vera Magdalena , Putz Francisca , Corvetto Marcia , De la Fuente Rene , Bravo Sebastian
Published: December 2019

Introduction

Bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT) is an invasive procedure regularly performed in the intensive care unit. Risk of serious complications have been estimated in up to 5%, focused during the learning phase. We have not found any published formal training protocols, and commercial simulators are costly and not widely available in some countries. The objective of this study was to present the design and simulator performance of a low-cost BG-PDT simulator.

Methods

A simulator was designed with materials available in a hardware store, synthetic skin pads, ex vivo bovine tracheas, and a pipe inspection camera. The simulator was tested in 8 experts and 9 novices. Sessions were video recorded, and participants were equipped with the Imperial College Surgical Device, a hand motion–tracking device. Performance was evaluated with a multimodal approach, including first attempt success rate, global success rate, total procedural time, Imperial College Surgical Device–derived proficiency parameters, and global rating scale applied blindly by 2 expert observers. A satisfaction survey was applied after the procedure.

Results

A simulator was successfully constructed, allowing multiple iterations per assembly, with a fixed cost of US $30 and $4 per use. Experts had greater global and first attempt success rate, performed the procedure faster, and with greater proficiency. It presented high user satisfaction and fidelity.

Conclusions

A low-cost BG-PDT simulator was successfully constructed, with the ability to discriminate between experts and novices, and with high fidelity. Considering its ease of construction and cost, it can be replicated in almost any intensive care unit.