Myasthenia gravis complicated with pulmonary infection by Nocardia cyriacigeorgica: a case report and literature review.

Myasthenia gravis (MG) is an autoimmune disease. Patients with MG due to compromised autoimmune regulation, progressive muscle weakness, and prolonged use of immunosuppressants and glucocorticoid, often present with concomitant infections. However, cases of MG complicated by Nocardia infection are rare. In this case, we report MG complicated with pulmonary infection by Nocardia cyriacigeorgica. A 71-year-old male farmer who was admitted for management of MG. After 7 weeks of treatment of MG, the patient reported improvement. However, clinical presentation, inflammatory markers, and imaging findings supported a diagnosis of pulmonary infection. To further elucidate the etiology, Nocardia was identified in sputum smear microscopy and sputum culture, with 16S rRNA gene sequencing confirming N. cyriacigeorgica. The patient was prescribed trimethoprim-sulfamethoxazole. After 1 month of treatment, clinical symptoms of MG and pulmonary nocardiosis showed significant improvement. Additionally, we searched PubMed for case reports of Nocardia cyriacigeorgica pulmonary infection from 2010 to 2024 and conducted a statistical analysis of the case information. This report aims to highlights the increased risk of pulmonary Nocardia infection in MG patients after the use of steroids and immunosuppressants, thereby enhancing clinical awareness.

Molinostrongylus longmenensis n. sp. (Strongylida: Molineidae) in the bat Scotophilus kuhlii (Leach; Chiroptera: Vespertilionidae) from China.

A new species of nematode, Molinostrongylus longmenensis n.sp., parasite of the genus Molinostrongylus, is described based on specimens recovered from the small intestine of Scotophilus kuhlii Leach, 1822 (Chiroptera: Vespertilionidae) in Longmen County, Guangdong Province, China. To date, 135 species of bat-parasitic nematodes have been reported worldwide. Overall, 13 species belonging to seven genera in three families have been described in China. The new species is characterized by the presence of three ventral and three dorsal longitudinal cuticular ridges perpendicular to the body surface, which appear posterior to the cephalic vesicle and extend to the caudal bursa in males and the posterior end in females. The female tail has two medium-sized subventral conical processes of equal length, as well as one large dorsal conical process, and one thin spine, lateral alae that extend to the position of the vulva, with a fin-like ending. In addition, the new species was also characterized using molecular approaches, such as sequencing and analyzing the internal transcribed spacer 1 (ITS-1) of the ribosomal DNA.

Factors associated with newly graduated nurses' work readiness during a pandemic: A cross-sectional study.

BACKGROUND: Newly graduated nurses may experience reality shock and leave the career early, if not adequately prepared. The pandemic has significantly impacted nursing education, clinical placements, working conditions and employment opportunities, leaving newly graduated nurses' work readiness unknown. AIM: To investigate the work readiness and its associated factors of newly graduated nurses who studied and graduated during a pandemic. DESIGN: A descriptive, cross-sectional correlational study design was employed. SETTINGS: The study was conducted at a large public health service in Victoria, Australia. PARTICIPANTS: Newly graduated registered nurses who studied during the pandemic and graduated between January 2022 and June 2023 (N = 206). METHODS: Participants were recruited between November 2022 and June 2023. Participants' self-perceived work readiness was measured using the Work Readiness Scale for Graduate Nurses, covering personal work characteristics, work competence, social intelligence and organisational acumen. Pearson correlation, multiple regression and hierarchical logistic regression analysis were applied to test the relationship between explanatory variables and participants' work readiness. RESULTS: Mean (SD) values were 50.7 (14.6) for personal work characteristics, 100.5 (18.8) for work competence, and 58.2 (12.4) for social intelligence. Median (IQR) for organisational acumen was 145.5 (18.0). Prior Australian registered nurse or enrolled nurse experience significantly predicted personal work characteristics (ß = 0.16, p = 0.037), while previous overseas registered nurse experience significantly predicted work competence (ß = 0.14, p = 0.049). Participants who were native-English speakers had a significantly lower work competence (ß = -0.15, p = 0.032). Being a female (p = 0.002, 95 % CI = 1.75, 13.21) and the length of a final clinical placement (p = 0.033, 95 % CI = 1.02, 1.59) significantly predicted organisational acumen. CONCLUSION: Despite challenges encountered during the pandemic, participants reported a relatively high self-perceived work readiness. Influencing factors include individual characteristics, clinical placement experiences, and previous healthcare employment.

Case report: Rare pulmonary fungal infection caused by Penicillium digitatum: the first clinical report in China.

Penicillium digitatum is a common plant pathogen that causes citrus rot, which is extremely rare in humans. We report a case of a 66-year-old man with a history of consuming large amounts of citrus fruits, smoking for 30 years, and a history of emphysema. He had experienced intermittent coughing with sputum for more than 10 years and was admitted to the hospital due to worsening of symptoms over the past month. Despite antibiotic treatment, his condition did not improve. Subsequently, bronchoalveolar lavage fluid (BALF) was detected by metagenomic next-generation sequencing (mNGS), which showed the presence of P. digitatum. The fungal culture of BALF also indicated the presence of the Penicillium genus. The diagnosis was lung infection caused by P. digitatum, and the patient was treated with itraconazole. The lung infection was controlled. This is the third reported case of invasive pulmonary fungal infection caused by P. digitatum worldwide at the genus level, and the first reported case in China. Although human infections caused by P. digitatum are rare, as an emerging opportunistic pathogen, the detection of this fungus in immunocompromised patients should still be clinically important.

Mycobacterium marinum hand infection: a case report and literature review.

Mycobacterium marinum, a photochromogenic, slow-growing mycobacterium, thrives in both marine and freshwater environments. Optimal growth occurs between 25°C and 35°C, with survival becoming challenging above 37°C. Typically, M. marinum enters the body via skin abrasions, often leading to infections of the upper extremities. Diagnosis of M. marinum infection is frequently challenging and delayed due to the difficult pathogen identification. At present, a standardized treatment protocol has yet to be established. Presented herein is a case study detailing an infection of the right hand's middle finger caused by M. marinum. Notably, his occupation as a chef, handling fish and seafood post-injury, was a significant factor. Histological examination of the skin biopsy and positive acid-fast staining were consistent with a diagnosis of mycobacterial infection. Pathological examination confirmed a skin infection with infectious granuloma, and tissue section acid-fast staining revealed acid-fast bacill. Cultures on Columbia blood agar yielded rough, flattened, yellow-fleshy colonies after 10 days, which was identified as M. marinum through 16S rRNA sequencing. The patient responded well to a 3-month regimen of oral moxifloxacin (0.4 qd) and linezolid (0.6 qd), resulting in rash resolution and pain relief, with no recurrence observed for 1-year follow-up. This report presents the first documented acid-fast staining images of M. marinum tissue sections and colony morphology photographs, offering an in-depth view of M. marinum's morphological characteristics. It aims to enhance awareness of M. marinum infections, underscore the necessity for clinicians to delve into patient histories, and provide a review of the clinical manifestations, diagnostic techniques, therapeutic approaches, and pathogenic mechanisms associated with M. marinum.

The second cutaneous anthrax infection diagnosed by metagenomic next-generation sequencing: A case report.

RATIONALE: Anthrax is a severe zoonotic infectious disease caused by Bacillus anthracis. Most reported cases were traditionally diagnosed through culture and microscopy. We reported here the second case of cutaneous anthrax diagnosed by metagenomic next-generation sequencing (mNGS). PATIENT CONCERNS: A 63-year-old man had a history of contact with an unwell sheep, developing local redness and swelling on wrist. The dorsal side of the left hand and forearm, with tension blisters on the back of the left. DIAGNOSIS: B anthracis was detected from culturing and mNGS of tension blisters. INTERVENTIONS: On the second day of admission, the patient was administered 3.2 million units of penicillin every 6 hours, and isolated and closely observed. OUTCOMES: The patient improves and is discharged. LESSONS: Traditional bacterial cultures are time-consuming, while mNGS offers the advantage of accurate, quick, high-throughput, unbiased sequencing of all genetic material in a sample, which is a good technical tool for assisting in the diagnosis of rare pathogen infections.

Rare occurrence of pulmonary coinfection involving Aspergillus fumigatus and Nocardia cyriacigeorgica in immunocompetent patients based on NGS: A case report and literature review.

RATIONALE: In our search on PubMed, we found that reports of co-infections involving Aspergillus fumigatus and Nocardia cyriacigeorgica in the literature are notably scarce. Most cases have been documented in patients with compromised immune systems or underlying pulmonary conditions. In contrast, our patient did not present with any of these risk factors. Furthermore, there have been no recent incidents such as near-drowning or other accidents in the patient history. To the best of our knowledge, this case represents a hitherto unreported clinical scenario. To enhance comprehension, we conducted a comprehensive literature review by compiling a total of 20 case reports (spanning from 1984 to 2023) on co-infections involving Aspergillus and Nocardia species, retrieved from PubMed. PATIENT CONCERNS AND DIAGNOSIS: Chest CT revealed the presence of multiple nodules and clustered high-density shadows in both lungs. Bronchoscopy revealed mucosal congestion and edema in the apical segment of the right upper lobe of the lung, along with the presence of 2 spherical polypoid new organisms. The pathological analysis reported severe chronic inflammation with evidence of Aspergillus within the tissue. Next-Generation Sequencing of bronchoalveolar lavage fluid revealed the presence of reads corresponding to A fumigatus and N cyriacigeorgica. Positive cultures for A fumigatus and the Nocardia genus were yielded by prolonging the incubation of samples in the microbiology laboratory. INTERVENTIONS: Treatment with voriconazole for A fumigatus and sulfamethoxazole-trimethoprim for N cyriacigeorgica infection was given. OUTCOMES: The patient improved and was discharged. After 6 months of telephone follow-up, the patient reported no clinical symptoms, discontinued the medication on his own. LESSONS: A fumigatus and N cyriacigeorgica can manifest as a co-infection in immunocompetent patients. Clinicians should prioritize the significant advantages and value of NGS in detecting rare and mixed pathogens associated with pulmonary infections.

The impact of integrating bioscience and nursing subjects in a first-year nursing curriculum: A retrospective study.

AIM: The aim of this study is to explore the effects of integrating bioscience and nursing units on academic achievement and perception in the first-year nursing curriculum. BACKGROUND: Nursing students have historically found biosciences difficult and struggle to relate it to nursing practice. In response, nursing and non-nursing academics have employed different teaching modes and integration strategies to enhance learning. Despite these efforts, substantial gaps still persist concerning the integration of biosciences within nursing curriculum and the effect of integration on student academic achievement and student perception. DESIGN: Retrospective descriptive. The setting was a large University in Victoria Australia with two undergraduate nursing campuses (metropolitan and non-metropolitan). METHOD: Student academic records and online evaluation surveys that were completed from 2014 to 2019 were examined. Students self-reported their experiences of the unit using a five-point Likert scale and two open-ended questions. Descriptive and inferential statistics were used to analyse the data. Content analysis was used to analyse the two open-response survey items. RESULTS: First-year student records from 2014 to 2016 (pre-integration) and 2017-2019 (post-integration) were examined. Student mean age was 24.5 years (SD 7.2) and 20.9 years (SD 4.8) pre-integration and post-integration respectively. There was a statistically significant decrease in student attrition from pre-integration (n=536, 29.9%) to post-integration (n=358, 20.2%) (p <0.001), and a significant improvement in students' mean academic scores post-integration in the first semester 61.9 (SD 15.9) and 67.0 (SD 14.9) respectively, confidence interval 3.9-6.2 (p <0.001). Student satisfaction with the units improved post-integration, from 77.8% to 85.8% (χ2 = 10.1076) (p=0.001). However, there was no significant difference in students' perception of feeling overwhelmed, and their self-reported ability to link theory to practice. CONCLUSION: Integrating bioscience and clinical nursing practice units in the first-year curriculum can help decrease student attrition rates, improve student academic results and increase student satisfaction which may lead to an overall improvement in student learning experiences.

Virulence, antimicrobial resistance, and molecular characteristics of carbapenem-resistant Klebsiella pneumoniae in a hospital in Shijiazhuang City from China.

Carbapenem-resistant Klebsiella pneumoniae (CRKP), as one of the most common drug-resistant bacteria threatening human health, is hyper-resistant to multiple antimicrobial drugs and carbapenems, which can be dealt with only limited clinical treatment options. This study described the epidemiological characteristics of CRKP in this tertiary care hospital from 2016 to 2020. Specimen sources included blood, sputum, alveolar lavage fluid, puncture fluid, secretions from a burn wound, and urine. Among the 87 carbapenem-resistant strains, ST11 was the predominant isolate, followed by ST15, ST273, ST340, and ST626. These STs were in broad agreement with the STs defined by pulsed-field gel electrophoresis clustering analysis in discriminating clusters of related strains. Most CRKP isolates contained the blaKPC-2 gene, some isolates carried the blaOXA-1, blaNDM-1, and blaNDM-5 genes, and the isolates carrying carbapenem resistance genes were more resistant to the antimicrobials of ß-lactams, carbapenems, macrolides, and fluoroquinolone. The OmpK35 and OmpK37 genes were detected in all CRKP strains, and the Ompk36 gene was detected in some CRKP strains. All detected OmpK37 had 4 mutant sites, and OmpK36 had 11 mutant sites, while no mutant sites were found in OmpK35. More than half of the CRKP strains contained the OqxA and OqxB efflux pump genes. The virulence genes were most commonly combined with urea-wabG-fimH-entB-ybtS-uge-ycf. Only one CRKP isolate was detected with the K54 podoconjugate serotype. This study elucidated the clinical epidemiological features and molecular typing of CRKP, and grasped the distribution of drug-resistant genotypes, podocyte serotypes, and virulence genes of CRKP, providing some guidance for the subsequent treatment of CRKP infection.

Molecular Characteristics and Antibiotic Resistance of Staphylococcus aureus Isolated from Patient and Food Samples in Shijiazhuang, China.

Staphylococcus aureus (S. aureus) is a common opportunistic and zoonotic pathogen in the world and could easily cause human infections and food contaminations. This study investigated the sequence typing and resistance profiles of S. aureus isolates from patient and food samples in Shijiazhuang, China. A total of 101 S. aureus isolates were distributed into six clonal complexes (CCs) and 16 singletons. A total of 86 patient isolates were distributed into six clonal CCs and 12 singletons, including a new ST. CC59, CC5, CC22, and CC398 were the predominant CCs of patient isolates. A total of 15 foodborne S. aureus isolates were distributed into 3 CCs and 4 STs, and CC1 was the most prevalent CC. Moreover, 101 S. aureus isolates had high resistance to penicillin and low resistance to chloramphenicol and rifampicin. A total of 39 strains of methicillin-resistant Staphylococcus aureus (MRSA) were detected in this study, including thirty-eight strains of patient isolates (44.2%, 38/86) and one strain of food isolates (6.7%, 1/15). MRSA-ST5, MRSA-ST59, and MRSA-ST239 were the predominant MRSA isolates in hospitals. The present study explained the relationship between S. aureus isolated from patient and food samples and indicated the risks of S. aureus in infectious diseases.

Horizontal integration of bioscience and nursing in first-year nursing curricula: A systematic review.

OBJECTIVES: To systematically identify, appraise and summarise available evidence related to the horizontal integration of bioscience and nursing in first-year nursing curricula; to examine students', nurses' and academics' perceptions of the integration and provide recommendations for future curriculum development, practice and research priorities. DESIGN: A systematic review. DATA SOURCES: An online search of Ovid Medline, Ovid Emcare, CINAHL, Embase Classic + and Embase, ERIC, A+Education, Scopus (Elsevier) and Google Scholar was conducted between July and September 2021. A manual search of the reference list of included articles was also undertaken. REVIEW METHODS: This systematic review followed The PRISMA Statement. The study selection process was managed using the Covidence software platform and quality was assessed using JBI Critical appraisal tools and Mixed Methods Appraisal tools. A narrative synthesis of included studies was undertaken. RESULTS: Six articles were identified which met the inclusion criteria. The study population included students, academics and registered nurses. Four studies used clinical scenarios as a method of horizontally integrating bioscience and nursing content. The integration outcomes were measured by student understanding and learning, satisfaction and motivation. Students', nurses' and academics' perceptions of integration challenges were: i) depth of bioscience content; ii) structure of bioscience content; and iii) knowledge and experience. CONCLUSIONS: This systematic review did not identify a wide range of methods to integrate bioscience in first year nursing curricula. The use of clinical scenarios increased student understanding and learning. However, teaching academics needed to be cognizant of both nursing and bioscience to achieve the required depth of bioscience content and demonstrate integration of bioscience in nursing practice. There is a need for further investigations of methods of horizontal integration of bioscience and nursing in the first-year nursing curricula.

Molecular Characteristics of Staphylococcus aureus From Food Samples and Food Poisoning Outbreaks in Shijiazhuang, China.

As an opportunistic pathogen worldwide, Staphylococcus aureus can cause food poisoning and human infections. This study investigated the sequence typing, the penicillin (blaZ) and methicillin (mec) resistance profiles of S. aureus from food samples and food poisoning outbreaks in Shijiazhuang City, and the staphylococcal enterotoxin (SE) types of the S. aureus isolates from food poisoning. A total of 138 foodborne S. aureus isolates were distributed into 8 clonal complexes (CCs) and 12 singletons. CC1, CC5, CC8, CC15, CC97, CC59, CC398, CC88, and CC7 were the predominant CCs of foodborne S. aureus isolates. Moreover, CC59, CC15, and CC5 were the most prevalent CCs in food poisoning outbreaks. SEE was the most commonly detected SE in food poisoning isolates. One hundred thirty-three S. aureus isolates harbored the penicillin-resistant gene blaZ, and nine isolates carried the mec gene. The present study further explained the relationship between S. aureus and foods and food poisoning and indicated the potential risk of S. aureus infection.

Using metaphor method to interpret and understand meanings of international operating room nurses' experiences in organ procurement surgery.

AIMS: To demonstrate how metaphor method can be employed in health care research, through a rainbow metaphor to conceptualise lived experiences, and represent a sense of verisimilitude, in a phenomenological study of international nurses' experiences of organ procurement procedures. BACKGROUND: International operating room nurses are likely to form unique attitudes towards multi-organ procurement. Phenomenology is used to focus on discovering human experiences and the meanings of certain phenomena. Phenomenological writing can mediate people's reflections and actions, measure people's thoughtfulness and help people to see and show lived experiences from their lifeworlds. DESIGN: Metaphor was used to interpret meanings of international operating room nurses' experiences in organ procurement surgery. The meanings were identified through a phenomenological approach informed by the work of van Manen. METHODS: A metaphor method was used to interpret and understand the lived experiences of eighteen international OR nurses recruited from nine different countries. Thematic data analysis was used to portray their lived experiences in organ procurement procedure. RESULTS: Using a rainbow as metaphor, a vivid picture was portrayed reflecting international OR nurses' experiences and organ procurement journey in Australia as challenging, with mixed feelings. According to the relationship between certain colours and emotions, four essential themes evolved into the concept of a four-colour rainbow to signify the meanings of international OR nurses' experiences in organ procurement procedures. The essential themes represented by these four colours were as follows: Orange-"The surreality of experiencing death," Red-"Personal and professional challenges," Green-"Becoming stronger" and Purple-"My beliefs, my wishes." CONCLUSION: Interpreting the meanings of their organ procurement experiences using metaphor method provided valuable insights about what personal and professional challenges these nurses faced, how they coped and managed their challenges, what support and care they required from others, and suggestions for future practice. RELEVANCE TO CLINICAL PRACTICE: Operating room nurses in practice needed a range of workplace supports and the rainbow metaphor provides a suitable approach for reflection and understanding of their experiences in organ procurement, with a focus on international, newly graduated and less experienced nurses. Practice improvement is a likely outcome when nurses have a better understanding of their experiences and the experiences of others in their team and this will assist in identifying their knowledge and professional support needs. The method demonstrates how metaphor can be applied to understand clinical nursing situations.

Grape Seed Proanthocyanidin Extract Ameliorates Streptozotocin-induced Cognitive and Synaptic Plasticity Deficits by Inhibiting Oxidative Stress and Preserving AKT and ERK Activities.

Progressive memory loss and cognitive impairment are the main clinical manifestations of Alzheimer's disease (AD). Currently, there is no effective drug available for the treatment of AD. Previous studies have demonstrated that the cognitive impairment of AD is associated with oxidative stress and the inhibition of AKT and ERK phosphorylation. Grape seed proanthocyanidin extract (GSPE) has been shown to have strong antioxidant effect and can protect the nervous system from oxidative stress damage. This study aimed to investigate the protective effect of GSPE on the cognitive and synaptic impairments of AD using a sporadic AD rat model induced by intracerebroventricular (ICV) injection of streptozotocin (STZ) (ICV-STZ). Rats were treated with GSPE (50, 100, or 200 mg/kg every day) by intragastrical (ig.) administration for continuous 7 weeks, and ICV-STZ (3 mg/kg) was performed on the first day and third day of week 5. Learning and memory abilities were assessed by the Morris water maze (MWM) test at week 8. After behavioral test, hippocampal long-term potentiation (LTP) was recorded, and the levels of malondialdehyde (MDA), superoxide dismutases (SOD), glutathione (GSH) and the protein expression of AKT and ERK were measured in the hippocampus and cerebral cortex of rats. Our study revealed that ICV-STZ significantly impaired the working learning ability and hippocampal LTP of rats, significantly increased the levels of MDA, and decreased the activity of SOD and GSH in the hippocampus and cerebral cortex. In contrast, GSPE treatment prevented the impairment of cognitive function and hippocampal LTP induced by ICV-STZ, decreased the level of MDA, and increased the level of SOD and GSH. Furthermore, Western blot results showed that GSPE treatment could prevent the loss of AKT and ERK activities in the hippocampus and cerebral cortex induced by ICV-STZ. Our findings demonstrate that GSPE treatment could ameliorate the impairment of cognitive ability and hippocampal synaptic plasticity in a rat model of sporadic AD by inhibiting oxidative stress and preserving AKT and ERK activities. Therefore, GSPE may be an effective agent for the treatment of cognitive deficits associated with sporadic AD.

International Operating Room Nurses' Challenges in Providing Person-Centered Care During Organ Procurement Surgery.

PURPOSE: International operating room (OR) nurses assisting in organ procurement surgery believe that it is their responsibility to provide continued and comprehensive person-centered care to donors through their surgical journeys. This study explored the challenges these nurses encountered in providing person-centered care during surgical care stages of organ procurement surgery in Australia. DESIGN: The phenomenological approach by van Manen was used to portray 18 OR nurses' organ procurement experiences. METHODS: Semistructured interview data were transcribed verbatim. FINDINGS: International OR nurses encountered challenges in providing person-centered care during organ procurement surgery, which were described in different surgical care stages. They faced emotional challenges in handling family grief and clinical challenges in interacting with other health professionals. These challenges could cause personal distress and affect their professional practice. CONCLUSIONS: Recognizing and managing these challenges is essential for supporting staff and providing quality person-centered care to deceased donors and their families during the organ procurement process.

Lived experiences of international operating room nurses in organ procurement surgery: A phenomenological study.

International operating room nurses come from different regions of the world with diverse social and cultural backgrounds, religions, personal beliefs, and education. They are likely to form unique attitudes toward multi-organ procurement that potentially might affect their opinions and clinical practices. The aim of this phenomenological study was to explore the lived experiences of international operating room nurses participating in deceased organ procurement procedures in Australia. Semistructured interviews were conducted with 18 international operating room nurses. van Manen's phenomenological data analysis method was adopted to uncover and interpret meanings from these nurses' descriptions. Four essential themes emerged and evolved to signify the meanings of participants' experiences in organ procurement procedures: the surreality of death, personal and professional challenges, becoming stronger, and personal beliefs and wishes. The present study highlights the importance of cultural awareness in dealing with death, organ procurement, and interprofessional collaboration in the multi-cultural perioperative context. It is essential to provide clinical education and support around culture and practice transition for international operating room nurses to increase and maintain their professional confidence, career satisfaction, health, and well-being during organ procurement surgery.

The downregulation of Rap1 GTPase-activating protein is associated with a poor prognosis in colorectal cancer and may impact on tumor progression.

Rap1 GTPase-activating protein (Rap1GAP) has been reported to serve an important role in various types of cancer by specific stimulation as a negative regulator of Rap1 activity. However, the role of Rap1GAP in colorectal cancer (CRC) has yet to be fully elucidated. The aim of the present study was to investigate the expression of Rap1GAP in CRC tissues and to elucidate its clinical significance. The expression of Rap1GAP, matrix metallopeptidase 9 (MMP-9) and E-cadherin in 227 CRC tissues and paired para-carcinoma tissues was detected by immunohistochemistry. Associations between Rap1GAP expression and clinicopathological characteristics, and between Rap1GAP expression and prognostic value (OS + DFS) in CRC were investigated. Furthermore, associations between Rap1GAP expression and MMP-9 expression, and between Rap1GAP expression and E-cadherin expression were also investigated. Rap1GAP expression was markedly downregulated in CRC tissues compared with para-carcinoma tissues. Decreased expression of Rap1GAP was significantly associated with depth of invasion, lymph node metastasis, advanced Tumor-Node-Metastasis stage and a poor prognosis in patients with CRC following surgery. Furthermore, univariate and multivariate analyses revealed that Rap1GAP was an independent poor prognostic factor for disease-free survival and overall survival. In addition, Rap1GAP expression was negatively associated with MMP-9 and positively associated with E-cadherin in 227 CRC samples. In brief, the results of the present study suggested that Rap1GAP may be involved in tumor progression in CRC and may serve as a potential target for prognostic prediction of patients with CRC.

Perioperative nurses' attitudes towards organ procurement: a systematic review.

AIMS AND OBJECTIVES: To explore and evaluate perioperative nurses' experience of organ procurement. BACKGROUND: Organ procurement is part of the organ donation process, and is typically performed in the perioperative setting. This experience may contribute to perioperative nurses' feelings of distress and negative attitudes towards organ donation. DESIGN: Systematic review of the literature. METHOD: Primary research studies, published in the English language between 1990-2014 were identified, screened and appraised using Joanna Briggs Institute appraisal tools. Data extraction and analysis followed. RESULTS: The quality assessment resulted in seven qualitative and three quantitative research studies. The main findings were: (1) Perioperative nurses reported feeling emotionally distressed, challenged, lonely and physically drained throughout the entire organ procurement procedure. (2) Perioperative nurses reported finding their own unique self-coping strategies and ways of eliciting support. (3) Perioperative nurses had positive and negative attitudes towards organ donation. CONCLUSION: Perioperative nurses reported feelings of sadness, feeling challenged and physically drained through the entire organ procurement procedure, which were influenced by differing factors in the preoperative, intraoperative and postoperative stages. It is acknowledged that personal coping strategies and support are important to help perioperative nurses improve their psychological well-being, and their experiences and attitudes towards organ procurement and donation. The meaningfulness of these findings for practice policy and research is described. RELEVANCE TO CLINICAL PRACTICE: Perioperative nurses play a vital role in the organ procurement procedure and require ongoing support to ensure their psychological welfare, in particular, newly qualified or inexperienced nurses' participating in organ procurement.

Bilateral areolar approach endoscopic thyroidectomy for low-risk papillary thyroid carcinoma: a review of 137 cases [corrected].

PURPOSE: The aim of this study was to analyze the clinicopathologic characteristics and postoperative outcomes and to evaluate the feasibility of the bilateral areolar approach (BAA) endoscopic thyroidectomy for low-risk papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: From January 2012 to February 2013, 137 low-risk PTC patients underwent BAA endoscopic thyroidectomy. Their clinicopathologic characteristics and postoperative outcomes (postoperative cosmetic satisfaction, type of thyroidectomy, number of lymph nodes, postoperative complications, and recurrence of disease) were analyzed. RESULTS: The 137 patients comprised 135 female and 2 male individuals. The average age of patients was 32.02±8.32 years. The mean tumor size was 0.82±0.41 cm. The ratio of minimal extrathyroidal extension patients was 1:19.6. According to the American Joint Committee on Cancer tumor stage, 132 cases were stage I and 5 cases were stage III. The mean follow-up period was 7.80±3.86 months (range, 3 to 15 mo, and median, 7 mo). At 3 months, postoperatively, patients were very satisfied with the cosmetic result as evaluated by a 10-point visual analogue scale (9.14±1.17). After surgery, the mean number of lymph nodes was 5.70±2.92, whereas the mean number of lymph node metastases was 1.06±1.96. Regarding the major postoperative complications, the rates of transient recurrent laryngeal nerve palsy and transient hypoparathyroidism were 4.4% and 27.7%, respectively. None of the patients experienced a thyroid cancer-related death or recurrence. CONCLUSIONS: BAA is feasible and safe for the treatment of low-risk PTC patients, with favorable cosmesis. Thus, it is an alternative therapeutic treatment for selected patients with low-risk PTC. However, oncologic safety of BAA thyroidectomy for PTC patients needs to be verified by a large comparative series and long-term follow-up.

Application of minimally invasive video-assisted technique in papillary thyroid microcarcinoma.

BACKGROUND: Minimally invasive video-assisted technique (MIVAT) was initially described by Miccoli and colleagues in Italy. The MIVAT without gas infusion was introduced in the clinical practice to treat small benign thyroid nodules and had advantages in terms of cosmetic results compared with the conventional approach. OBJECT: To compare the outcome in papillary thyroid microcarcinoma (PTMC) patients treated with MIVAT and conventional procedure, and evaluate the feasibility of MIVAT applied in PTMC patients. MATERIALS AND METHODS: Data of 35 PTMC patients with MIVAT and 33 others with conventional procedure were analyzed and compared, including postoperative outcomes, operative time, incidence of complications, the completeness of operation, and the prognosis of tumor after a follow-up of 5 years. RESULTS: With regard to the postoperative outcomes, a significantly statistical difference was found between MIVAT group and the conventional procedure group. The mean operative time in the MIVAT group was longer than that in the conventional group. However, it was similar to the convention group when only the mean operative time of the last 5 patients in the MIVAT group was estimated. The rate of temporary hypoparathyroidism was significantly lower in MIVAT group compared with the convention group, and the incidences of other complications had no significant difference. With regard to the completeness of operation and the prognosis of tumor, no differences were found between the 2 groups. CONCLUSIONS: MIVAT can be safely applied in PTMC patients with positive impact on patients outcome by comparable results to a conventional procedure after a median follow-up of 5 years. Thus it is a better alternative therapeutic treatment for patients with PTMC.