The Influence of Advanced Hyperbaric Medical Training on Arterial Gas Embolism Treatment.

3d Reconnaissance Battalion, a forward-deployed Marine Corps unit in Okinawa, Japan, frequently performs diving operations. Often throughout the year, several reconnaissance teams are diving simultaneously in different locations for training. We present a case of an otherwise healthy 30-year-old-male Reconnaissance Marine who surfaced from a dive with abnormal symptoms and received prompt care from exercise participants who were nonmedical personnel. Studies have demonstrated improved morbidity outcomes in decompression illness patients with shorter times to hyperbaric treatment following the onset of symptoms. High-risk military exercises with diving components have a mandatory safety structure that includes recompression chamber support. All United States Marine Corps Reconnaissance, Marine Corps Special Operations Command, and U.S. Navy dive operations are required to have at least one diving supervisor. To expand the diving capabilities of the unit, Marines are encouraged to attend training and qualify as diving supervisors. This case study demonstrates the efficacy and importance of training Recon Marines to recognize decompression illness as diving supervisors.

Remission of Type II Diabetes Mellitus after Duodenal Switch: the Contribution of Common Channel Length.

INTRODUCTION: The role of the common channel length in duodenal switch (DS) on remission of type II diabetes mellitus (DM), when stratifying patients based on diabetes severity, is not well understood. METHODS: We retrospectively reviewed 341 consecutive patients with DM undergoing DS with one of three different common channel (CC) lengths (100 cm, 150 cm, and 200 cm), each with a fixed 300 cm alimentary limb (AL). Patients were stratified by insulin dependence (IDDM) versus non-insulin dependent diabetes (NIDDM). Data was collected at one year and at the last available follow-up. RESULTS: The NIDDM group had a similar average HbA1c at last follow-up for each of the CC lengths. However, the IDDM group had lower average HbA1c with shorter CC lengths (100 cm = 5.4%, 150 cm = 6%, 200 cm = 6.4%, p < 0.05). Shorter CC lengths resulted in a greater proportion of patients achieving remission in the IDDM group (66%, 50%, 32% in the 100 cm, 150 cm, and 200 cm CC, respectively, p < 0.01). Improvements in HbA1c were independent of weight loss and average DiaRem scores were similar between CC lengths. Rates of nutritional deficiencies were higher in shorter common channel lengths. Revision for malnutrition was similar between common channel lengths (100 cm group: 3.7%; 150 cm group: 1.8%; 200 cm group: 0%, p = NS). CONCLUSIONS: When the AL is fixed, shortening CC lengths results in improved glycemic control and remission of DM in patients with the need for insulin preoperatively. Milder forms of DM are treated well with any of the CC lengths.

Molecular phylogeny of Thoracotremata crabs (Decapoda, Brachyura): Toward adopting monophyletic superfamilies, invasion history into terrestrial habitats and multiple origins of symbiosis.

The Thoracotremata is a large and successful group of "true" crabs (Decapoda, Brachyura, Eubrachyura) with a great diversity of lifestyles and well-known intertidal representatives. The group represents the largest brachyuran radiation into terrestrial and semi-terrestrial environments and comprises multiple lineages of obligate symbiotic species. In consequence, they exhibit very diverse physiological and morphological adaptations. Our understanding of their evolution is, however, largely obscured by their confused classification. Here, we resolve interfamilial relationships of Thoracotremata, using 10 molecular markers and exemplars from all nominal families in order to reconstruct the pathways of lifestyle transition and to prepare a new taxonomy corresponding to phylogenetic relationships. The results confirm the polyphyly of three superfamilies as currently defined (Grapsoidea, Ocypodoidea and Pinnotheroidea). At the family level, Dotillidae, Macrophthalmidae, and Varunidae are not monophyletic. Ancestral state reconstruction analyses and divergent time estimations indicate that the common ancestor of thoracotremes already thrived in intertidal environments in the Late Cretaceous and terrestrialization became a major driver of thoracotreme diversification. Multiple semi-terrestrial and terrestrial lineages originated and radiated in the Early Eocene, coinciding with the global warming event at the Paleocene-Eocene Thermal Maximum (PETM). Secondary invasions into subtidal regions and colonizations of freshwater habitats occurred independently through multiple semi-terrestrial and terrestrial lineages. Obligate symbiosis between thoracotremes and other marine macro-invertebrates evolved at least twice. On the basis of the current molecular phylogenetic hypothesis, it will be necessary in the future to revise and recognize seven monophyletic superfamilies and revisit the morphological character states which define them.

The Identity of Homoioplax haswelli (Miers, 1884) (Crustacea: Decapoda: Brachyura).

The brachyuran crab Pseudorhombila haswelli Miers, 1884, described on the basis of two juveniles from the Arafura Sea, is a poorly known species of uncertain systematic position. It was made the type and only species of Homoioplax Rathbun, 1914, and assigned to the Prionoplacinae (Goneplacidae). Subsequent revisions of the goneplacids showed Prionoplacinae to be a junior synonym of Eucratopsinae Stimpson, 1871, as a member of the Panopeidae Ortmann, 1893, but no one has re-evaluated the position of Homoioplax. As a result, Homoioplax has remained in the Panopeidae as the only Indo-West Pacific representative of the family. This study assesses the systematic status of Homoioplax haswelli based on a re-examination of the type and other material of the species. Homoioplax haswelli is here attributed to Carcinoplax H. Milne Edwards, 1852 (Goneplacidae), justifying the recognition of the species described by Miers as C. haswelli. Moreover, Carcinoplax haswelli is shown to be a senior synonym of C. sinica Chen, 1984, described from the South China Sea. Therefore, C. haswelli is now known to range from southern Taiwan and the Philippines, through the South China Sea, northern Vietnam, the eastern waters of Singapore to the Madura Straits in eastern Java and Arafura Sea, northern Australia, at 25-187 m, but usually less than 100 m depth.

Breast Cancer Stigma Scale: A Reliable and Valid Stigma Measure for Patients With Breast Cancer.

Purpose: This study aims to develop and validate a stigma scale for Chinese patients with breast cancer. Methods: Patients admitted to the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, for breast cancer treatment participated in this study. Development of the Breast Cancer Stigma Scale involved the following procedures: literature review, interview, and applying a theoretical model to generate items; the Breast Cancer Stigma Scale's content validity was assessed by a Delphi study (n = 15) and feedback from patients with breast cancer (n = 10); exploratory factor analysis (n = 200) was used to assess the construct validity; convergent validity was assessed with the Social Impact Scale (n = 50); internal consistency Cronbach's α (n = 200), split-half reliability (n = 200), and test-retest reliability (N = 50) were used to identify the reliability of the scale. Results: The final version of the Breast Cancer Stigma Scale consisted of 15 items and showed positive correlations with the Social Impact Scale (ρ = 0.641, P < 0.001). Exploratory factor analysis (EFA) revealed four components of the Breast Cancer Stigma Scale: self-image impairment, social isolation, discrimination, and internalized stigma, which were strongly related to our perceived breast cancer stigma model and accounted for 69.443% of the total variance. Cronbach's α for the total scale was 0.86, and each subscale was 0.75-0.882. The test-retest reliability with intra-class correlation coefficients of the total scale was 0.947 (P < 0.001), and split-half reliability with intra-class correlation coefficients of the total scale was 0.911 (P < 0.001). The content validity index (CVI) was 0.73-1.0. Conclusion: The newly developed Breast Cancer Stigma Scale offers a valid and reliable instrument for assessing the perceived stigma of patients with breast cancer in clinical and research settings. It may be helpful for stigma prevention in China.

Unmet needs of 1210 Chinese breast cancer survivors and associated factors: a multicentre cross-sectional study.

BACKGROUND: Breast cancer survivors (BCSs) often have potential unmet needs. Identification of the specific needs of BCSs is very significant for medical service provision. This study aimed to (1) investigate the unmet needs and quality of life (QoL) of BCSs in China, (2) explore the diverse factors associated with their unmet needs, and (3) assess the association between their unmet needs and QoL. METHODS: A multicentre, cross-sectional survey was administered to 1210 Chinese BCSs. The Cancer Survivor Profile-Breast Cancer and the Functional Assessment of Cancer Therapy-Breast scale were administered to survivors who gave informed consent to participate. Data were analysed using t-test, ANOVA, multiple regression analysis, and Pearson correlations. RESULTS: The 1192 participants completed questionnaires (response rate 98.51%). Our study reveals that the most prevalent unmet needs were in the 'symptom burden domain'. The unmet needs of BCSs depend on eleven factors; age, time since diagnosis, education level, occupation, payment, family income status, stage of cancer, treatment, family history of cancer, pain, and physical activities. To ensure the provision of high-quality survivorship care and a high satisfaction level, more attention should be paid to actively identifying and addressing the unmet needs of BCSs. The problem areas identified in the Cancer Survivor Profile for breast cancer were negatively associated with all subscales of QoL except the health behaviour domain, with the correlation coefficient ranging from - 0.815 to - 0.011. CONCLUSION: Chinese BCSs exhibit a high demand for unmet needs in this study, and the most prevalent unmet needs were in the 'symptom burden domain'. There was a significant association between patients' unmet needs (as defined in the Cancer Survivor Profile for breast cancer) and QoL. Future research should focus on enhancements to survivorship or follow-up care to address unmet needs and further improve QoL.

Effectiveness of virtual reality-based interventions in rehabilitation management of breast cancer survivors: protocol of a systematic review and meta-analysis.

INTRODUCTION: Breast cancer is the leading cause of global cancer incidence and represents 11.7% of all new cancer cases. However, breast cancer survivors (BCS) suffer from many intense physical and psychological symptoms, functional deficits and adverse effects during and after treatment, significantly affecting their quality of life. Virtual reality (VR) technology uses computer technology to create an interactive three-dimensional world by visual, audio and touch simulation and is being used in breast cancer rehabilitation management. This paper reports on the protocol for a systematic review and meta-analysis exploring the efficacy of VR-based interventions in the rehabilitation management of BCS. METHODS AND ANALYSIS: This protocol for conducting a systematic review and meta-analysis was prepared according to the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 statement. Web of Science, PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, CNKI, Wanfang, VIP and SinoMed will be used in the search. The search will include randomised controlled trials, quasi-experimental studies and case-controlled trials published in English and Chinese. Further, the risk of bias of the studies included in the systematic review and meta-analysis will be assessed using the Cochrane risk-of-bias tool. The statistical program Review Manager V.5.3 will be used in the meta-analysis. The I² test will be used to determine statistical heterogeneity among the included studies. ETHICS AND DISSEMINATION: Ethics approval will not be needed because the data to be used in this systematic review and meta-analysis will be extracted from published studies. The systematic review and meta-analysis will focus on whether VR-based interventions are effective in the rehabilitation management of BCS. It will be disseminated by publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42021250727.

The Effectiveness of Virtual Reality-Based Interventions in Rehabilitation Management of Breast Cancer Survivors: Systematic Review and Meta-analysis.

BACKGROUND: Breast cancer survivors (BCSs) can present with various physical and psychological symptoms and functional deficits that impact their quality of life. Virtual reality (VR) technology is being used in breast cancer rehabilitation management to improve the emotional, cognitive, and physical well-being of BCSs. OBJECTIVE: This systematic review aimed to examine the effectiveness of VR-based interventions on health-related outcomes in BCSs. A meta-analysis was conducted to evaluate the effectiveness of VR-based interventions in the rehabilitation management of BCSs. METHODS: A systematic search was conducted on PubMed, Web of Science, EMBASE, CINAHL with Full Text, the Cochrane Central Register of Controlled Trials, CNKI, WanFang, VIP, and CBM, from inception to May 25, 2021. The inclusion criteria of the selected studies were as follows: (1) adults diagnosed with breast cancer; (2) any type of VR-based interventions (immersive and nonimmersive virtual environment); (3) comparison of traditional rehabilitation methods; (4) outcomes including pain, depression, anxiety, fatigue, cognitive function, shoulder range of motion (ROM), hand grip strength, lymphedema, cybersickness symptoms, fear of movement, bleeding, effusion, and flap necrosis, both during and after treatment; and (5) randomized controlled trials (RCTs), case-controlled trials, and quasi-experimental studies. The Cochrane Collaboration Tool was used to evaluate the risk of bias. Review Manager version 5.3 (Cochrane Collaboration) was used to conduct the meta-analysis. The mean difference (MD) and SDs with 95% CIs were used to calculate continuous variables. RESULTS: Twelve articles were included in this systematic review, of which 10 contributed information to the meta-analysis. A total of 604 participants were analyzed. The statistical analysis showed significant results for flexion (standard mean difference [SMD] 1.79; 95% CI 0.55 to 3.03; P=.005), extension (SMD 1.54; 95% CI 0.83 to 2.25; P<.001), abduction (MD 17.53; 95% CI 14.33 to 20.72; P<.001), adduction (MD 15.98; 95% CI 14.02 to 17.94; P<.001), internal rotation (MD 7.12; 95% CI 5.54 to 8.70; P<.001), external rotation (SMD 0.96; 95% CI 0.62 to 1.29; P<.001), anxiety (MD -6.47; 95% CI -7.21 to -5.73; P<.001), depression (MD -4.27; 95% CI -4.64 to -3.91; P<.001), pain (MD -1.32; 95% CI -2.56 to -0.09; P=.04), and cognitive function (MD 8.80; 95% CI 8.24 to 9.36; P<.001). The meta-analysis indicated little to no difference in hand grip strength (MD 1.96; 95% CI -0.93 to 4.85; P=.18). CONCLUSIONS: Findings of this review noted a weak but consistent positive association between VR-based interventions and outcomes. However, these results must be interpreted with caution due to the limited number of controlled trials analyzed, small sample sizes, and poor methodological quality. Well-designed, large, high-quality trials may have a significant impact on our confidence in the results. Future studies should identify specific aspects that improve the clinical impact of VR-based interventions on major outcomes in BCSs in the clinical setting. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42021250727; https://tinyurl.com/2p89rmnk.

Breast cancer application protocol: a randomised controlled trial to evaluate a self-management app for breast cancer survivors.

INTRODUCTION: The eHealth technologies that are being designed for chronic disease constitute a global trend towards health assessment and self-management. However, most of these approaches tend to focus on a single symptom or problem rather than on the multiple problems that are characteristic of many of these chronic illnesses. The aim of this study is to examine the effectiveness of and adherence to a self-management application (app) that identifies multiple problem areas related to surviving breast cancer as the targeted chronic illness. METHODS AND ANALYSIS: This is a randomised controlled study. Eligible participants will be allocated randomly into either an intervention group or a control group at a 1:1 ratio. The intervention group will be assigned to the self-management app ('Be-with-You'), while the control group will use a general health app ('Sham' app). The primary outcomes will include the differences between the two groups in their health literacy, problem-solving skills and self-management skills. The secondary outcomes will include group differences in self-efficacy, readiness for change and health-related quality of life. All of these outcomes will be measured at baseline and at 4 weeks and 12 weeks after intervention. In addition, usability of these two mobile apps will be measured at 4 weeks and 12 weeks after intervention. The planned sample size is 476. ETHICS AND DISSEMINATION: The Human Subjects Ethics Sub-committee of The Hong Kong Polytechnic University approved the study (HSEARS20190922001, 24 September 2019). Dissemination of findings will occur at the local, national and international levels. TRIAL REGISTRATION NUMBER: ChiCTR1900026244.

Single-anastomosis duodenal ileostomy with sleeve is a safe and effective option for patients in an ambulatory surgical center.

BACKGROUND: The single-anastomosis duodenal ileostomy with sleeve gastrectomy (SADI-S) is gaining popularity in the United States as an alternative to the gastric bypass for patients with a high body mass index (BMI) or who are less likely to succeed with a sleeve. While SADI-S has similar weight loss to the gastric bypass, the complication rate is significantly lower, allowing surgeons to perform SADI-S in an ambulatory surgical center with a 23-hour stay. OBJECTIVES: To determine if SADI-S can be safely performed in an ambulatory surgical setting. SETTING: Private practice. METHODS: All SADI-S procedures performed from August 2015 to March 2019 at 2 bariatric centers were included in this study. Patients selection for SADI-S in the ambulatory surgical center required no end organ damage, no evidence of severe sleep apnea, and BMI <55 for males and BMI <60 for females. All data were gathered retrospectively from prospectively kept databases. Thirty-day complication rates were analyzed using the Clavien-Dindo scale to assess the safety of performing SADI-S in an ambulatory surgical center. RESULTS: Eighty-two patients were included in this study. The sample was 72% female with an average age of 46 and BMI of 45. All patients received planned intravenous fluid within 3 days after the procedure. There were 2 (2.4%) grade IIIb to V complications. There were no mortalities in this series. CONCLUSION: SADI-S can be performed safely in an ambulatory surgery 23-hour setting with appropriate patient selection, perioperative support, and enhanced recovery after surgery protocols.

A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis Duodeno-Ileal Bypass as a Surgical Revision Option After Sleeve Gastrectomy.

INTRODUCTION: Recently, a single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has become increasingly popular for patients with BMI > 50 as a primary or staged surgery. Staging allows surgeons to do the sleeve gastrectomy (SG) first with the conversion only happening when a failure or technical challenge is identified. PURPOSE: We present the mid-term outcomes of SADI bypass surgery after SG. METHOD: A retrospective analysis was performed on a prospective database from four institutions. Ninety-six patients were identified from 2013 to 2018. Patients were divided into two groups: one had two-stage SADI because of insufficient weight loss, the second had planned two-stage SADI because of super obesity (BMI > 50 kg/m2). Incidence of complications was divided into < 30 days and > 30 days. RESULT: Of 96 patients, 3 patients were completely lost to follow-up. The mean age was 44.8 ± 11.3 years. There were no deaths or conversion to open surgery. The postoperative early complication and late complication rate was 5.3% and 6.4% respectively. At 24 months, group 2 had higher %weight loss (WL) and change in BMI units compared to group 1 with statistically significant difference. The average WL and change in BMI for entire patient's population at 24 months after 2nd stage SADI was 20.5% and 9.4 units respectively. The remission rate for DM was 93.7% with or without the use of medication. CONCLUSION: The two-stage approach to SADI-S appears technically simpler than a single compromised operation. However, this approach needs more patients to understand its limitations.

Duodenal switch: Fully stapled technique.

BACKGROUND: Duodenal switch and single anastomosis modifications continue to gain greater interest among bariatric surgeons. Limiting factors to adoption include concerns around the nutritional management, patient compliance and follow-up, and the technical challenge of the operation. The majority of techniques offered currently use a hand-sewn duodenoileostomy. This approach is limited by the steep learning curve as well as longer operating times. OBJECTIVES: We present a video demonstrating the fully stapled technique for duodenoileostomy and ileileostomy. We offer technical pearls around the technique, specifically focused on maintaining a widely patent anastomosis, open biliopancreatic limb, safe duodenal dissection, and correct loop orientation. METHODS: Laparoscopic fully stapled duodenoileostomy for duodenal switch and single anastomosis modification. SETTING: Community hospital, single institution, 3 surgeons. CONCLUSION: Triple staple offers a reproducible and safe technique for the duodenoileostomy and specifically for construction of a Roux or loop anastomosis in duodenal switch.

Carcinoplax fasciata, a new species of deep-water goneplacid crab from southwestern India (Crustacea: Decapoda: Brachyura: Goneplacoidea).

A new species of Carcinoplax H. Milne Edwards, 1852 (family Goneplacidae) is described from southern India. Carcinoplax fasciata n. sp. is closest to C. specularis Rathbun, 1914, but can be distinguished by its different coloration in life as well as structures of the carapace surface, anterolateral armature, supraorbital margin, chela and male first gonopod.

Splenic injury as a complication of colonoscopy: more common than we think?

Splenic injury during colonoscopy is thought to be rare. The case reported here would not have been diagnosed if the patient had not presented with a pleural effusion. It is likely that this complication may present with differing severities of clinical features with a significant proportion being thought to be due to expected postcolonoscopy insufflation discomfort. This complication is under-recognised and under-reported and therefore is unlikely to be thought of as a diagnosis. A 63-year-old woman had an elective day case colonoscopy but did not seek medical attention for the abdominal pain following the procedure. She presented to hospital 6 weeks after the procedure with dyspnoea and hypoxia. She was diagnosed with a parapneumonic pleural effusion but the CT scan also discovered a splenic haematoma for which there was no other cause in her history other than the colonoscopy 6 weeks prior.

On the identity of Cancer urania Herbst, 1801 (Crustacea: Decapoda: Brachyura: Leucosiidae).

Cancer urania Herbst, 1801, is the type species of the leucosiid genus Coleusia Galil, 2006. Its identity has been a subject of confusion due to various taxonomical and nomenclatural issues. We redescribe the species, discuss its complex history and taxonomy, and a female syntype is designated as the lectotype of the species to clarify any lingering ambiguities concerning the type material of Cancer urania Herbst, 1801.

Fluorescence in situ hybridization (FISH) as an aid for the diagnosis of graft-versus-host disease in two multivisceral organ transplant patients.

We herein describe 2 cases of adult multivisceral transplant patients who developed graft-versus-host disease manifesting predominantly as lichenoid skin papules and plaques. The diagnosis was supported by histopathology but ultimately corroborated by the utilization of the fluorescence in situ hybridization (FISH) technique using X and Y chromosome probes on unstained biopsy slides. In both cases, FISH revealed a high percentage of donor-derived cells as part of the inflammatory infiltrate in the skin biopsy. This report adds to the previous publications showing the utility of FISH in corroborating the diagnosis of graft-versus-host disease in transplant patients with unmatched sex donor.

Low-temperature approach to highly emissive copper indium sulfide colloidal nanocrystals and their bioimaging applications.

We report our newly developed low-temperature synthesis of colloidal photoluminescent (PL) CuInS2 nanocrystals (NCs) and their in vitro and in vivo imaging applications. With diphenylphosphine sulphide (SDPP) as a S precursor made from elemental S and diphenylphosphine, this is a noninjection based approach in 1-dodecanethiol (DDT) with excellent synthetic reproducibility and large-scale capability. For a typical synthesis with copper iodide (CuI) as a Cu source and indium acetate (In(OAc)3) as an In source, the growth temperature was as low as 160 °C and the feed molar ratios were 1Cu-to-1In-to-4S. Amazingly, the resulting CuInS2 NCs in toluene exhibit quantum yield (QY) of ~23% with photoemission peaking at ~760 nm and full width at half maximum (FWHM) of ~140 nm. With a mean size of ~3.4 nm (measured from the vertices to the bases of the pyramids), they are pyramidal in shape with a crystal structure of tetragonal chalcopyrite. In situ (31)P NMR (monitored from 30 °C to 100 °C) and in situ absorption at 80 °C suggested that the Cu precursor should be less reactive toward SDPP than the In precursor. For our in vitro and in vivo imaging applications, CuInS2/ZnS core-shell QDs were synthesized; afterwards, dihydrolipoic acid (DHLA) or 11-mercaptoundecanoic acid (MUA) were used for ligand exchange and then bio-conjugation was performed. Two single-domain antibodies (sdAbs) were used. One was 2A3 for in vitro imaging of BxPC3 pancreatic cancer cells. The other was EG2 for in vivo imaging of a Glioblastoma U87MG brain tumour model. The bioimaging data illustrate that the CuInS2 NCs from our SDPP-based low-temperature noninjection approach are good quality.