Early complications after robot-assisted laparoscopic radical cystectomy and their risk factors / 中南大学学报(医学版)

To identify risk factors for early complications in patients after robot-assisted laparoscopic radical cystectomy (RARC) and a standardized reporting model to predict complications precisely and recommend reasonable prophylaxis.
 Methods: A total of 90 patients with bladder cancer, who underwent RARC in the Second Xiangya Hospital and the Third Xiangya Hospital of Central South University from January 2016 to January 2018, were enrolled for this study. Their clinical information, preoperative examination and follow-up data within 90 d after RARC were collected. Univariable and multivariable logistic regressions were performed to identify risk factors for early complications after RARC.
 Results: The overall incidence of complications within 90 d after RARC was 48.9% (44/90), including 9 cases of Clavien grade 1, 17 cases of Clavien grade 2, 4 cases of Clavien grade 3, 12 cases of Clavien grade 4, and 2 cases of Clavien grade 5. Acute renal injury (22.2%), intestinal obstruction (16.7%), urinary tract infection (14.4%) and lymphatic leakage (10.0%) were the most common complications within 90 d after the operation. Two patients (2.2%) died within 90 d after the operation. Preoperative BMI (OR=1.16, 95% CI 1.02 to 1.32), postoperative instant (≤30 min) serum creatinine (OR=1.02, 95% CI 1.00 to 1.03), and pT stage (OR=1.67, 95% CI 1.05 to 2.68) were the risk factors for early complications after RARC. 
 Conclusion: The incidence of early complications after RARC is high. Preoperative hemodialysis, correction of anemia, intraoperative protection of renal function, and early recovery after surgery are helpful to prevent early complications after RARC.

Research progress of cancer stem cells in triple-negative breast cancer / 国际肿瘤学杂志

There are abundant cancer stem cells (CSCs) in triple-negative breast cancer TNBC).CSCs can maintain their phenotype by unique molecular mechanism and tumor microenvironment,and can promote the chemotherapy resistance and recurrence of TNBC.Blocking these key molecules or altering tumor microenvironment can reduce CSCs,and then inhibited cancer growth and reverse chemotherapy resistance of TNBC.

Correlation between mismatch-repair protein expression and clinicopathologic features in 658 colorectal cancers / 中华病理学杂志

Objective@#To investigate the expression of mismatch repair (MMR) proteins (MLH1, MSH2, MSH6 and PMS2) in colorectal cancers and to explore the relationship between MMR expression and clinicopathologic features.@*Methods@#Six hundred and fifty-eight colon cancers were collected from January 2016 to January 2017 at Shengjing Hospital of China Medical University. Of the 658 patients there were 409 male and 249 female. The patients were 20 to 92 years old, with average age of (63±5) years old. Expression of MLH1, MSH2, MSH6 and PMS2 protein was detected by immunohistochemical method. Immunohistochemistry for BRAF V600E was performed in colorectal cancers with loss of MLH1 protein expression. Relationship between MMR protein expression and clinicopathologic features was analyzed statistically. @*Results@#Forty-four cases of 658 cases (6.7%) lost at least one MMR protein expression. Expression deficiency rates of MLH1, MSH2, MSH6 and PMS2 were 4.1%(27/658), 2.3%(15/658), 2.4% (16/658), and 4.3% (28/658), respectively. MMR expression deficiency mainly consisted of combined loss of MLH1/PMS2 (61.4%, 27/44) and MSH2/MSH6 (34.1%, 15/44). Two unique mutations were identified including one MSH6-deficient(2.3%, 1/44) and PMS2-deficient(2.3%, 1/44). Seven cases (25.9%, 7/27) had positive BRAF V600E expression, suggesting BRAF gene mutation related sporadic colorectal cancers. No correlation was observed between the expression of MMR and depth of tumor infiltration, lymph node metastasis, vascular tumor emboli, clinical stage or hematogenous metastasis (P>0.05). MMR status was associated with tumor cell differentiation, histological type and tumor location (P<0.01). Tumors with combined MLH1 and PMS2 loss were associated with mucinous differentiation (P=0.049, P=0.013) and located in the right hemi-colon (P=0.006, P=0.002). Combined MSH2 and PMS2 loss was related to gender, while loss of MSH2 protein was observed more frequently in female patients (P=0.048) and loss of PMS2 protein was seen more frequently in male patients (P=0.031). @*Conclusions@#Patients with MMR protein deficiency have a younger onset age and poorly differentiated tumors. Most tumors are located in the right hemi-colon and have mucinous differentiation.

A new method for asses sing symmetry of breast / 中华内分泌外科杂志

Objective To compare a novel mirror-overlap method with the traditional manual measurement and the subjective assessment in assessing breast symmetry after oncoplastic surgery.Methods 59 patients with breast cancer who underwent conservation/reconstruction surgery were recruited.The post-operative assessment for breast symmetry was conducted using manual measurement,subjective assessment by the patient,their family member and a nurse,and the mirror-overlap method respectively.The latter method involved using the Photoshop to assess the area differences in breast outlines and shadows created by a flashlight when bilateral images were overlapped in the axis of midline.Results The distance differences between bilateral breasts measured using manual method were negatively correlated with symmetric coefficients in the mirror-overlap method (P＜0.05).There was a positive correlation between the average scores in the subjective assessment and symmetric coefficients of mirror-overlap method (P＜0.05).Conclusion The mirror-overlap method is an easy,feasible and cheap method which collects 3D breast information and provides an effective approach to assess breast symmetry after oncoplastic surgery.

Progress of the drug efflux mechanisms underlying fungi multidrug resistance / 药学实践杂志

The multidrug resistance (MDR) ,characterized by the simultaneous acquisition of resistance to chemically and structurally different drugs ,has caused antifungal treatment failure .This review focused on recent progresses in under-standing of the multidrug resisitance associated drug efflux transporter superfamily in Saccharomyces cerevisiae ,the opportun-istic fungal pathogens Candida albicans ,Candida glabrata ,and Aspergillus fumigates ,along with the mechanisms underly-ing efflux pump and the regulatory networks involved .Investigation of these mechanisms and their impact on drug resistance may lead to strategies to overcome fungal multidrug resistance and improvement of drug efficacy .

Stress response of Candida albicans to human hosts / 第二军医大学学报

Candida albicans (C. albicans'), one of the most commonly-seen opportunistic fungal pathogen, has drawn great public health concern in recent years. C. albicans faces numerous challenges when entering human hosts, including temperature, pH, osmotic stress and oxidative damage. How to adapt to these challenges is critical to the survival and infection ability of C. albicans. This article summarizes the stress response pathways of C. albicans to human host, and it is suggested that studying the stress response pathways may help to find newantifungal targets for C. albicans.

Life Experiences of Mothers in Parenting Children with Hunter's Syndrome

PURPOSE: The purpose of this study was to explore the experiences of Korean mothers in parenting children with Hunter's syndrome, an X linked recessive genetically inherited disease usually affecting boys. METHODS: Data were collected from 14 mothers having children with Hunter's syndrome, through two focus group interviews and individual in-depth interviews. Qualitative data from the field notes and transcribed notes were analyzed using the grounded theory methodology developed by Strauss & Corbin (1998). RESULTS: The core category about the process of rearing children with Hunter's syndrome was identified as "navigating in the maze". The process of rearing children with Hunter's syndrome passed through three phases; 'entering an unknown region', 'struggling to escape from the unknown region', 'settling down in the unknown region'. CONCLUSION: In this study "navigating in the maze", as the core category deeply showed joys and sorrows of mothers in the process of rearing their children with Hunter's syndrome. In this rearing process they gradually adjusted themselves to their given condition. Also they gained initiatively coping strategies to care for, and protect their children. Therefore health care providers can establish supportive programs in the clinical field to empower these mothers by reflecting their proactive coping strategies.

Parents' Knowledge about Enterobiasis Might Be One of the Most Important Risk Factors for Enterobiasis in Children

To know the prevalence of Enterobius vermicularis infection and what are the most important risk factors, we evaluated the incidence and risk factors of enterobiasis among children attended in kindergartens in Busan metropolitan city, Republic of Korea. A total of 1,674 children from 21 kindergartens in 11 of 16 autonomous districts of Busan were evaluated for E. vermicularis infection by the cellotape anal swab technique. The overall egg-positive rate for E. vermicularis was 10.7% (179/1,674), and the prevalence of enterobiasis in each kindergarten ranged between 0% and 32.4%. There was an increasing tendency of the egg positive rate according to the population density; the higher the population density communities had, the higher egg-positive rate for E. vermicularis was detected (P = 0.001). Among personal hygiene factors involving children, thumb-sucking (P = 0.036) and fingernail-trimming (P = 0.024) were highly associated with enterobiasis. In addition, taking anthelmintic medications against E. vermicularis infection was strongly associated with enterobiasis (P = 0.014). Moreover, parents' knowledge of enterobiasis was correlated significantly with the incidence of enterobiasis of their children (P = 0.006). In conclusion, we need to consider not only personal hygiene but also parents' knowledge about enterobiasis as a factor in order to develop new strategies for elimination or to complete reduction of enterobiasis in Korea.

The Role Adaptation Process of The Executive Director of Nursing Department

PURPOSE: The purpose of this study was to identify the role adaptation process experienced by executive directors of nursing department of general hospitals. METHODS: Data were collected from 9 executive nursing directors though in-depth interviews about their experiences. The main question was "How do you describe your experience of the process of role adaptation as an executive nursing director?" Qualitative data from field and transcribed notes were analyzed using Strauss & Corbin's grounded theory methodology. RESULTS: The core category of experience of the process of role adaptation as an executive nursing director was identified as "entering the center with pushing and pulling". The participants used five interactional strategies; 'maintaining modest attitudes', 'inquiring about trends of popular feeling', 'making each person a faithful follower', 'collecting & displaying power', 'leading with initiative'. The consequences of role adaptation in executive nursing directors were 'coexisting with others', 'immersing in one's new role with dedication', and 'having capacity for high tolerance'. The types of role adaptations of executive directors in nursing department were friendly type, propulsive type, accommodating type. CONCLUSION: The results of this study produced useful information for executive nursing directors on designing a self-managerial program to enhance role adaptation based on interactional strategies.

The Experience of Hospice Nurses on Spiritual Care: The Process of Untying a Knot of Mind / 종양간호학회지

PURPOSE: The purpose of this study was to describe the experience of hospice nurses on spiritual care. METHODS: Data was collected from 9 hospice nurses by using in-depth interview. The main questions include what they understand as spiritual care, when they feel the needs of spiritual care, how they perform spiritual care, and what is the outcome of spiritual care. The data was analyzed by grounded theory methodology developed by Strauss and Corbin. RESULTS: The core category of experience of hospice nurses on spiritual care was identified as "Untie a knot of mind". In the process of spiritual care in hospice nurses was consisted of soothing, dwelling with, releasing, giving meaning, plunging, and going beyond a life. CONCLUSION: The result of this study was expected to give useful information to nurses and nursing managers about the real situation of performance of spiritual care. The findings of this study contributes to developing programs and supportive policies for encouraging spiritual care.

The Lived Experience of Struggling against Illness for Patients with Amyotrophic Lateral Sclerosis

PURPOSE: The purpose of this study was to identify and describe phenomenological structures of the lived experience of struggling against an illness for patients with Amyotrophic Lateral Sclerosis (ALS). METHODS: The participants were 7 patients with ALS recruited by snowball sampling who agreed to participate in this research and could verbally communicated with the researcher. Data were collected by long term-repeated interviews with participants in their own homes. Data were analyzed using Colaizzi's method of phenomenology. RESULTS: Four categories were extracted as follows: 'Being seized with fear of death', 'Living a marginal life', 'Accepting hard fate', and 'Clinging to faint life'. Seven theme clusters were identified as: 'Wandering to find a healing method with ominous signs in the body', 'Having a diagnosis of ALS is like a bolt from the blue and struggling against illness with faint hope', 'Being forced out to the edge of life with anguish', 'Filling one's heart with hatred and longing toward becoming estranged from the world', 'Living with stigma as a stumbling block with bitter grief in one's heart', 'Accepting every things as one's fate with self controlled fear of death', and 'Attaching to desire to live'. CONCLUSION: The results of this study can be used to develop the programs to support patients with ALS and their family.

Treatment of hyperplastic nonunion of the tibia with interlocking intramedullary nailing,fascia pedicled callus flap and bone grafting / 中国矫形外科杂志

[Objective]To observe the clinical effect of the treatment of hyperplastic nonunion of the tibia with interlocking intramedullary nailing,fascia pedicled callus flap and bone grafting.[Method]Twelve cases of nonunion of the tibia were treated with intramedullary interlocking nailing,fascia pedicled callus flap and bone grafting,and there were 8 males and 4 females.The patients age ranged from 26 to 64 years,with an average of 45 years.[Result]All cases were followed-up for an average of 48 months and achieved a solid union within 4～6 months.[Conclusion]Intramedullary interlocking nailing,fascia pedicled callus flap and bone grafting have the design of the reasonable biomechanics,the function of untispinning and unticurtailing,less partial blood decompose.The fascia pedicled callus flap and iliac bone grafting could result in solid union and it is a recomment method for promoting bone-healing up after grafting and forming.

Experience of Patients Living with Chronic Renal Failure / 간호학회지

The Purpose of the study was to understand the experience of chronic renal failure patients for the qualified individual care for them. The purpose of this study was to explore the experience of patients living with chronic renal failure and to identify the meaning and structure of their experience. The subjects were four patients, two females and two males. The age range was from 21 to 54. Data was collected with a few in-depth interviews by the authors until the data was fully saturated. The framework and methodology of this study was based on Parse's "Human Becoming methodology," an existential phenomenological research methodology. The findings of this study were as follows. Three experience structures of chronic renal failure patients were : 1. Sufferings and conflicts originated in the frustration caused by uncurable disease. 2. Dependence upon God and significant others with complex emotions. 3. Acceptance of sufferings, emerging hope for serving people, and gratitude for living. In conclusion the experience of chronic renal failure patients could be described from the findings (three structures) as "Experiencing the sufferings, conflicts originated in the frustration caused by uncurable disease, dependence upon God and significant others with complex emotion, acceptance of the suffering and hope for serving people, and gratitude for living." The three structures of the lived experience of patients with chronic renal failure, the findings of this study, could be explained by the three concepts of "Theory of Human Becoming," the first structure could be explained with values, the second with revealing-concealing, and the third with transforming.

Inadvertent Dural Puncture during Epidural Block / 대한마취과학회지

Evaluation of inadevertent dural puncture occuring among 308 epidural blocks done for the relief of pain from various conditions was performed. Dural puncture was suspected in 5 out of 308 eqidural bloks(1.6%). Aspiration of CSF was negative 3 cases in which dural puncture was suspected only after developing spinal anesthesia. Of the 3 negative CSF aspirations, one case had a history of laminectomy. Adhesions of the adjacent tissues might result in the loss of flexibility and a decreases in potential epidural space which might cause dural tearing during injection and subarachoid injection of the local anesthetic followed by high spinal anesthesia. In another case, the needle tip was obstructed by tissue which led to negative aspiration of CSF and failure to feel loss of resistance. The second injection at the same site many cause subarachonold injection of the local anesthetic through the previously perforated dura mater and in turn, lead to spinal anesthesia. In the last case, there was no reason to suspect dural puncture since the loss of resistance plus air rebound were definite and aspiration of CSF was negative, but dural puncture was suspected after the patient developed spinal anesthesia.