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Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma (PS), which can cause drastic changes in lifestyle and physical perceptions.To determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery.A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve.The PS rate after sphincter-saving surgery was 15.1% (59/391) in our study after a median follow-up of 47.3 mo (range 7-114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time were independent risk factors for PS. These identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903 (95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model.Several risk factors for PS after sphincter-saving surgery were identified. Our nomogram exhibited perfect predictive ability and will improve a physician's ability to communicate the benefits and risks of various treatment options in shared decision making.

BACKGROUND Streptococcal toxic-shock syndrome after hemorrhoidectomy is rare but may be catastrophic. Group A streptococci have produced various surface proteins and exotoxins due to genetic changes to fight the human body’s immune response. Though life threatening infection after hemorrhoidectomy rarely occurs, all surgeons should be aware of the potential complications of severe sepsis after hemorrhoidectomy and keep in mind their clinical presenting features in order to diagnose early and administer appropriate and effective therapeutic drugs early. CASE SUMMARY Here, we present a case of a 56-year-old man with a painful thrombotic external hemorrhoid who presented to our outpatient department for management. There was no history of systemic diseases or recent disease infection. Hemorrhoidectomy was suggested and performed. After surgery, the patient developed hypotension, tachycardia, fever with chills and renal function impairment on day 2 post-operation. The clinical condition progressed to severe septic shock and metabolic acidosis. The patient responded poorly to treatment and expired after 1 d even with use of extracorporeal membrane oxygenation. The results of the blood and wound cultures showed group A streptococcus pyogenes. CONCLUSION Although extremely uncommon, all surgeons should be aware of these potential life-threatening septic complications and alert to the presenting features for patients receiving hemorrhoidectomy.

The perioperative and short-term oncological outcomes of robotic-assisted rectal surgery (RRS) are unclear. This retrospective observational study enrolled patients with rectal adenocarcinoma undergoing RRS from three high-volume institutions in Taiwan. Of the 605 enrolled patients, 301 (49.75%), 176 (29.09%), and 116 (19.17%) had lower, middle, and upper rectal cancers, respectively. Low anterior resection (377, 62.31%) was the most frequent surgical procedure. Intraoperative blood transfusion was performed in 10 patients (2%). The surgery was converted to an open one for one patient (0.2%), and ten (1.7%) patients underwent reoperation. The overall complication rate was 14.5%, including 3% from anastomosis leakage. No deaths occurred during surgery and within 30 days postoperatively. The positive rates of distal resection margin and circumferential resection margin were observed in 21 (3.5%) and 30 (5.0%) patients, respectively. The 5-year overall and disease-free survival rates for patients with stage I–III rectal cancer were 91.1% and 86.3%, respectively. This is the first multi-institutional study in Taiwan with 605 patients from three high-volume hospitals. The overall surgical and oncological outcomes were equivalent or superior to those estimated in other studies. Hence, RRS is an effective and safe technique for rectal resection in high-volume hospitals.

Vocabulary development is critical for second language (L2) learners in both English as a Second Language (ESL) and English as a Foreign Language (EFL) contexts. Recently, a large body of research has been dedicated to how computer-assisted language learning (CALL) and mobile-assisted language learning (MALL) can facilitate vocabulary knowledge in L2 learners in both EFL and ESL settings. A number of reviews on this topic have been conducted, however, little attention has been given to learners in PreK-12. Also missing from the existing research is an in-depth examination of the theories underlying vocabulary learning within technological programs. However, understanding theoretical foundations of vocabulary learning is critical for both researchers and educators who seek to improve vocabulary development in L2 learners. The current study aims to close these gaps by investigating research on the use of technology for L2 vocabulary learning for learners in PreK-12 between 2011 and 2020. Using systematic review procedures, a total of 80 articles were identified for analysis. Results showed information/cognitive theories were most frequently and explicitly referenced, followed by social theories of learning. Consistent with previous research syntheses on CALL and MALL, many studies did not articulate an explicit theoretical framework used in their research. These findings suggest that research on technology-mediated vocabulary learning for Prek-12 L2 learners should be conducted from more diverse and explicit theoretical perspectives.

With the escalating growth of English language learners (ELLs) worldwide, educational technology has been identified as an important learning tool with significant potential to support second langu...

As the global population ages, the number of geriatric patients requiring surgery for colon cancer would inevitably increase. Radical oncological surgery in the elderly colorectal cancer patient has been recognized to be associated with a higher rate of postoperative complications and mortality compared to the young. While less aggressive management options may be reasonable in patients with limited life expectancy and significant comorbidities, many elderly patients have preserved function despite their chronological age. The advances in minimally invasive surgery (MIS) now provide a feasible means of achieving safe oncological treatment for these geriatric patients. This review focuses on the evidence behind MIS in the geriatric patient with colon cancer.

Lexical stress plays a critical role in multisyllabic word reading in English. However, assignment of English lexical stress, which is neither fixed nor marked in writing, can pose significant challenges for English learners and has not been well-understood. The present study aims to fill the research gap by studying sensitivity to lexical stress cues and its contribution to their word reading performance among young English-language learners whose first language is Korean. The fundamental differences in prosodic systems between Korean and English provide theoretical significance of studying how bilingual children having no lexical stress in their first language process English lexical stress. This study focuses on two major cues to English lexical stress: morphological and orthographic cues. Findings revealed that the participants are sensitive to the two stress cues, with better performance with orthographic cues to stress assignment. However, no statistically significant correlations were found among variables on stress cue sensitivity with those on reading.

This study aimed to identify the risk factors for permanent stoma (PS) in patients who underwent sphincter-saving operations for rectal cancer.We retrospectively reviewed 597 consecutive patients with rectal cancer from January 2012 to December 2020 at Taipei Medical University Hospital. Univariate and multivariable analyses were used to analyze risk factors for PS.After a mean follow-up of 47.3 months (range 7-114 months), 59 patients (15.1%) were alive with a PS, including 46 patients who did not undergo reversal surgery and 13 patients who underwent stoma re-creation after reversal surgery. The mean period between primary surgery and stoma reversal was 6.0 months. Multivariate analysis revealed that the risk factors for PS were local recurrence [odd ratio (OR), 25.58; 95% confidence interval (CI), 4.428-147.761; p 0.001], perirectal abscess [OR, 154.34; 95% CI, 15.806 -999; p 0.001], anastomosis site stenosis [OR, 187.081; 95% CI, 22.193 -999; p 0.001], perineural invasion [OR, 4.782; 95% CI, 1.22-18.736; p = 0.025], and operation time (min) [OR, 1.008; 95% CI, 1.002-1.014; p = 0.01].Local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, and operation time were independent risk factors for PS. Therefore, before a patient undergoes surgery for rectal cancer, surgeons should consider the possibility of the need for a PS, and patients should be informed before the operation that closure of the temporary stoma may not always be possible.

Background: The purpose of this study was to investigate the prevalence of ypN+ status according to ypT category in patients with locally advanced rectal cancer treated with chemoradiotherapy and total mesorectal excision, and to assess the impact of ypN+ on disease recurrence and survival by pooled analysis of individual-patient data.Methods: Individual-patient data from 10 studies of chemoradiotherapy for rectal cancer were included. Pooled rates of ypN+ disease were calculated with 95 per cent confidence interval for each ypT category. Kaplan-Meier and Cox regression analyses were undertaken to assess influence of ypN status on 5-year disease-free survival (DFS) and overall survival (OS).Results: Data on 1898 patients were included in the study. Median follow-up was 50 (range 0-219)months. The pooled rate of ypN+ disease was 7 per cent for ypT0, 12 per cent for ypT1, 17 per cent for ypT2, 40 per cent for ypT3, and 46 per cent for ypT4 tumours. Patients with ypN+ disease had lower 5-year DFS and OS (46.2 and 63.4 per cent respectively) than patients with ypN0 tumours (74.5 and 83.2 per cent) (P

The use of wearable devices (WDs) in healthcare monitoring and management has attracted increasing attention. A major problem is patients’ adherence and acceptance of WDs given that they are already experiencing a disease burden and treatment side effects. This scoping review explored the use of wrist-worn devices in the cancer population, with a special focus on adherence and clinical outcomes. Relevant articles focusing on the use of WDs in cancer care management were retrieved from PubMed, Scopus, and Embase from 1 January 2017 to 3 March 2022. Studies were independently screened and relevant information was extracted. We identified 752 studies, of which 38 met our inclusion criteria. Studies focused on mixed, breast, colorectal, lung, gastric, urothelial, skin, liver, and blood cancers. Adherence to WDs varied from 60% to 100%. The highest adherence was reported in the 12-week studies. Most studies focused on physical activity, sleep analysis, and heart vital signs. Of the 10 studies that described patient-reported outcomes using questionnaires and personal interviews, 8 indicated a positive correlation between the patient-reported and wearable outcomes. The definitions of the outcome measures and adherence varied across the studies. A better understanding of the intervention standards in terms of the clinical outcomes could improve adherence to wearables.

Robotic surgery (RS) may overcome the limitations of laparoscopic colorectal surgeries (LS) in obese patients, but remains less well studied. This systematic review and meta-analysis aims to evaluate the outcomes of obese patients who have undergone robotic colorectal surgery. This study was performed according to the PRISMA guidelines. A search was performed on Medline, EMBASE, and the Cochrane Library to identify relevant articles. Dichotomous and continuous outcomes were analyzed as risk ratio (RR) and mean difference (MD), respectively. All post-operative outcomes were within 30 days after surgery. The quality of studies was assessed using the Newcastle–Ottawa Scale. Meta-regression analysis was conducted to identify sources of heterogeneity. Three studies totaling 262 subjects compared LS (45.0%) against RS (55.0%) in obese patients. The RS group had a significantly reduced length of hospital stay (LOS) (MD − 2.55 days, 95%CI − 3.13 to − 1.97 days, P

While the relationship between vocabulary, morphological awareness, and reading comprehension has been examined extensively, research on this relationship among adult second language learners has only been explored recently. The present study addresses this gap by examining how adult English as a foreign language learners developed different types of English vocabulary and morphological awareness over the course of one academic year. Participants included 523 college freshmen in Taiwan with varying reading proficiency levels. Results from a series of mixed-measure analyses of variance revealed that (a) even the more proficient college English as a foreign language learners failed to fully grasp morphological principles; (b) the gap in vocabulary between the less skilled readers, the average, and the skilled readers widened significantly over the course of one academic year; (c) the effect of phonological and orthographic changes involved in morphologically complex words differed for the assessment of base meaning, but did not vary across proficiency levels; (d) progress in different aspects of morphological awareness, such as interpreting the meaning of the suffix or identifying the base of a morphologically complex word, varied significantly among readers of different proficiency levels; and (e) suffixes of different parts of speech posed different challenges to learners. Theoretical and pedagogical implications of the findings are discussed.

Literacy instruction in science and math in elementary education lays a critical foundation for later content literacy development and the learning of content subjects in middle and high school. However, limited research has investigated the theoretical basis of instructional practices for science and math literacy instruction at the elementary level. Extending Wright et al., (2016), the present systematic review aims to critically examine the connection between theory and practice for K-5 science and math literacy instruction. Instructional practices recommended in the Reading Teacher, a flagship practitioner–oriented journal published by the leading literacy education association, International Literacy Association, were analyzed to identify the underlying theories. Our findings revealed that most of the science and math literacy practices recommended to elementary reading teachers are well aligned with social theories, which dominate the field of literacy education and conceptualize literacy as a social practice. Following social theories of literacy development, students are encouraged to make connections between the text and their personal interest and life experiences. The current study also revealed gaps between theory and practice in elementary science and math literacy instruction, where key theories were not or underrepresented in practices. Further strengthening the connection between theory and practice requires a joint effort between researchers and practitioners.

The current trend of speakers of English as a second or an additional language (English language learners) outnumbering speakers of English as a first language (native English speakers) has shifted the focus of English language teaching from the nativeness principle to the intelligibility principle. Following the intelligibility principle, this review examined the effectiveness of interventions on the intelligibility of English language learners (ELLs) and the comprehensibility of their speech by native speakers in two related but independent meta-analytic studies. Study 1 focused on intervention studies for ELLs to improve intelligibility in their speech. Robust variance estimation (RVE) generated significant effect sizes of 0.62 ( p = 0.00) from 33 effect sizes in 18 independent studies. Study 2 focused on interventions for L1 native English speakers to improve their comprehensibility of ELL speech. RVE generated a statistically significant effect size of 0.24 ( p = 0.04) with 20 effect sizes in 10 independent studies. Moderating analyses revealed that the measures of intelligibility and comprehensibility, and the speech task type, were significant factors explaining the effect size variations between the included studies in both analytic reviews. However, the length of scales did not significantly differentiate the effectiveness of interventions. The effects of pronunciation instruction are not sensitive to research setting, and interventions aiming to change native English speakers’ (NESs’) attitudes towards ELLs’ accented English rather than those aiming to improve NESs’ familiarity with ELLs’ accented English have statistically significant effects. The current analysis generated unique and important implications for future educational practice and research on intelligible and comprehensible communication between L1 speakers and language learners beyond English.

BACKGROUND The aim of this study was to evaluate the impact of surgeons' learning curve in robotic surgery for rectal cancer on circumferential resection margin (CRM) involvement and reoperation rates. METHODS Learning curve data were prospectively collected from four centers. Patients undergoing robotic proctectomy for resectable rectal cancer were included. CRM was involved when ≥1 mm. TME quality was classified as complete, nearly complete, or incomplete. T-test and χ2 tests were used to compare continuous and categorical variables, respectively. Risk-adjusted cumulative sum (RA-CUSUM) analysis was utilized to evaluate the effect of the learning curve on primary endpoints. Univariate analysis of potential risk factors for CRM involvement and reoperation was performed. Factors with the P value ≤0.2 were included in the multivariate logistic regression model for further RA-CUSUM analysis. RESULTS A total of 221 patients (80, 36, 62, and 43 patients operated on by surgeons 1, 2, 3, and 4, respectively) who underwent robotic surgery for rectal cancer during the surgeons' learning curves were included. CRM involvement rate was 0%, 11%, 3%, and 5% in surgeons 1, 2, 3, and 4, respectively. Reoperation rate was 3.7%, 8.3%, 4.8%, and 11.6%, respectively. RA-CUSUM analysis of CRM involvement (R2=0.9886) and reoperation (R2=0.9891) found a statistically significant decreasing trend in aggregate CUSUM values throughout the learning curve. CONCLUSIONS This study found a continued significant decrease in CRM involvement and reoperation rates throughout the learning curve in robotic rectal cancer surgery.

Background This systematic review sought to compare the urogenital functions after laparoscopic (LAP) and robotic (ROB) surgery for rectal cancer. Methods This study conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Twenty-six studies (n = 2709 for ROB, n = 2720 for LAP) were included. There was a lower risk of 30-day urinary retention in the ROB group (risk ratios 0.78, 95% confidence interval [CI] 0.61-0.99), but the long-term risk was comparable (p = 0.460). Meta-regression showed a small, positive relationship between age and risk of 30-day urinary retention in both the ROB (p = 0.034) and LAP groups (p = 0.004). The International Prostate Symptom Score was better in the ROB group at 3 months (mean difference [MD] -1.58, 95% CI -3.10 to -0.05). The International Index of Erectile Function score was better in the ROB group at 6 months (MD 4.06, 95% CI 2.38 - 5.74). Conclusion While robotics may improve urogenital function after rectal surgery, the quality of evidence is low based on the Grading of Recommendations, Assessment, Development and Evaluation approach.

Background Ergonomics, as defined by the optimization of one's physical environment to enhance work performance, is an important consideration in surgery. While there have been reviews on the ergonomics of laparoscopy, this has not been the case for robotic surgery despite the rising number of publications. Methods This study was performed in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A search was performed on main databases to identify relevant articles. Results Twenty-nine articles were included, comprising 3074 participants. Studies employing objective measurement tools showed that robotics conferred superior ergonomic benefits and reduced work load compared to laparoscopy, for both surgeons and trainees. Survey studies also demonstrated that self-reported discomfort was lower in robotic procedures compared to laparoscopy and open surgery. Compared to other subspecialities, gynecological procedures seem to be associated with greater surgeon-reported strain. Conclusion Robotic surgery is ergonomically superior to open and laparoscopic surgery. However, rates of physical strain remain significant and should be addressed by formal ergonomic training and adequate console familiarization.

Background: Studies reporting the results of associated factors of pathological completed response (PCR) and tumor regression response in patients with rectal cancer following neoadjuvant chemoradiation therapy (nCRT) are inconsistent. Objective: The purpose of this study was to identify the prognostic factors of tumor response and outcome in rectal cancer patients. Design: The study was a retrospective analysis. Settings: The study was conducted in a single large institution in Taiwan. Patients: Newly diagnosed rectal cancer patients who underwent nCRT followed by surgery from 2010 to 2014 with 5 years of follow-up. Main Outcome Measures: The primary outcomes were associated factors of pathological completed response and downstaging. The risk factors of survival outcome and disease recurrence were also observed. Results: A total of 169 rectal cancer patients were included. The PCR rate was 17.8%, and the downstaging rate was 60.9%. Patients with a histology type of adenocarcinoma associated with PCR, and patients positive for clinical N stage were associated with downstaging. Kaplan-Meier analysis showed the PCR group performed better to a statistically significant level both in overall survival and disease recurrence free survival than the no PCR group (p= 0.033 & 0.025, respectively). Patients with a downstaging response also showed better overall survival benefits and disease recurrence free survival benefits than their counterparts (both p

The purpose of this study was to examine the relationship between input and literacy/ metalinguistic development in bilingual children. Participants included fourth-grade Chinese-English bilinguals from Taiwan and the USA. The two groups were comparable in socioeconomic status, non-verbal IQ, and the amount of literacy instruction in Chinese and English, but the bilingual participants from Taiwan had more exposure to Chinese and less exposure to English outside of school than their US counterparts. A battery of standardized and researcher-developed measures of literacy and metalinguistic skills were administered in English and Chinese. Results showed that, in general, the greater the amount of input, the more superior the linguistic/metalinguistic development. However, advantages associated with input appeared to be offset by a more balanced bilingual experience on measures that assessed higher levels of metalinguistic awareness. In addition, hierarchical regression analyses showed that morpho-syntactic awareness made a unique contribution to reading comprehension beyond that by vocabulary and morphological awareness only among the participants in Taiwan. The findings make several noteworthy contributions to research on input among bilingual learners. Firstly, the present study highlights the importance of recognizing the variations of bilinguals who speak the same pair of languages, and the impact of linguistic input outside of the school context on language and literacy development in academic settings. Secondly, findings from the present study call for a broader conceptualization of the relationship between input and linguistic/metalinguistic development, and underscore the importance of examining how input may impact the relationship of linguistic and metalinguistic variables. Finally, the present study highlights the need to re-conceptualize input. Indicators of input should go beyond to the quantity or quality of exposure to the assessed language, and be expanded to include the degree of balance in both languages.

Background. Transanal minimally invasive surgery (TAMIS) was developed as a less aggressive alternative treatment for rectal lesions. The purpose of this study was to report the results of robotic TAMIS for such patients. Methods. Patients eligible for TAMIS were operated on using the da Vinci robotic surgical system and GelPOINT Path Transanal Access Platform. Patient demographics, lesion characteristics, perioperative data, complications, and follow-up of all patients were recorded retrospectively. Results. Between March 2015 and August 2018, 24 patients underwent robotic TAMIS by using the da Vinci Si or Xi. The median operative time was 129.6 minutes, and the estimated blood loss was minimal. The mean length of hospital stay was 4.6 days, with no operative complications and no 30-day mortality. There were no statistically significant differences in clinical results and pathological outcomes between the 2 generations of da Vinci systems. Conclusions. With the use of robotic technology, transanal local excision for rectal lesions can be performed with relative ease and safety and can be potentially decreasing the morbidity associated with more aggressive surgical techniques.

Background A beneficial impact of robotic proctectomy on circumferential resection margin (CRM) is expected due to the robot's articulating instruments in the pelvis. There are however concerns about a negative impact on the quality of total mesorectal excision (TME) due to the lack of tactile feedback. The aim of this study was to assess whether surgeons' learning curve impacted CRM and TME quality. Methods In a multicenter study, individual patient data of robotic proctectomy for resectable rectal cancer were pooled. Patients were stratified into two phases of surgeons’ learning curve. Cumulative sum (CUSUM) analysis was used to determine the transition from learning phase (LP) to plateau phase (PP), which were compared. CRM was microscopically measured in mm by pathologists. TME quality was classified by pathologists as complete, nearly complete or incomplete. T-test and Chi-squared tests were used to compare continuous and categorical variables, respectively. Results 235 patients underwent robotic proctectomy by five surgeons. 83 LP patients were comparable to 152 PP patients for age (p = 0.20), gender (67.5% vs. 65.1% males; p = 0.72), BMI (p = 0.82), cancer stage (p = 0.36), neoadjuvant chemoradiation (p = 0.13), distance of tumor from anal verge (5.8 ± 4.4 vs. 5.5 ± 3.3; p = 0.56). CRM did not differ (7.7 ± 11.4 mm vs. 8.4 ± 10.3 mm; p = 0.62). The rate of complete TME quality was significantly improved in PP patients as compared to LP patients (73.5% vs. 92.1%; p Conclusion While learning had no impact on circumferential resection margins, the quality of TME significantly improved during surgeons’ plateau phase as compared to their learning phase.

Recent technological advancements have changed how literacy is perceived, and it is no longer confined to the interaction with print text. The evolving definition of literacy has been reflected in the increasing number of teachers who are incorporating technology into their reading instruction. However, less is known about the extent to which these technology-integrated instructional practices are supported by reading theories. The purpose of this study is to systematically review how technology has been implemented in reading instruction and to explore how transitions of instructional practice from traditional classrooms to digital settings have been grounded in reading theories. The present study reviewed articles published over the past twelve years in flagship practitioner journals to examine the connections and the gaps between theory and practice. Our review uncovered that technology has served in reading instruction primarily in three ways: 1) to increase reading motivation, 2) to present information in multi-modalities, and 3) to promote collaborative learning. Consistent with other domains of reading instruction, social theories were found to be the prominent theoretical bases supporting technology-integrated practices; dual-coding theory has also emerged in recent years as the theoretical basis for technology use in reading instruction. However, most of the theories were rarely referred explicitly. Implications for researchers and practitioners were provided based on the gaps between theory and practice revealed in the current review.

Robotic intersphincteric resection (ISR) has been introduced for sphincter-preservation in the treatment of low rectal cancer. However, many patients experience anorectal symptoms and defecatory dysfunction after ISR. This study aims to evaluate the anorectal complications that develop after ISR. The medical records of 108 patients who underwent robotic ISR at Taipei Medical University Hospital, Taipei, Taiwan between December 2011 and June 2016 were retrospectively reviewed. Photographic records of perineal conditions were documented at the following time intervals after surgery: 1 day, 2 weeks, 1, 2, 3 and 6 months. Clinical outcomes and treatment results were analysed. Eighty-five patients (78.7%) developed edematous hemorrhoids after surgery. These subsided at a median of 56 days after operation (range 23–89 days). Forty-six patients (42.6%) were found to have anal stenosis requiring anal dilatation. Sixteen patients (14.8%) had neorectal mucosal prolapse, which was noted to occur at an average of 98 days after surgery (range 41–162 days). Multivariate analysis showed that the occurrence of edematous hemorrhoids was associated with operating time (P = 0.043), and male gender was a significant risk factor for anal stenosis (P = 0.007). This is the first study reporting on the clinical outcomes of anorectal status after robotic ISR. Further studies are needed to assess the long-term effects of these anorectal complications.

Background & Aims: Contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) are used to assess the response of hepatocellular carcinoma after transarterial chemoembolization. Our aim was to perform a systematic review to compare CEUS and CECT for therapeutic response assessment to transarterial chemoembolization in the treatment of hepatocellular carcinoma. Method: PubMed, Embase, and the Cochrane Library databases were searched from inception until January 1, 2016. Participants: patients with hepatocellular carcinoma. Intervention: transarterial chemoembolization and CECT vs CEUS. Results. Sixteen studies were included in the systematic review. The total number of patients was 858 and the mean patient age ranged from 42 to 73 years. The mean tumor size ranged from 1.0 cm to 4.3 cm. The sensitivity and specificity of CEUS ranged from 46% to 100% and 65% to 100%, respectively, and that of CECT ranged from 34% to 87% and 92% to 100%, respectively. The accuracy of CEUS ranged from 72.6% to 100% and that of CECT from 61% to 94%. Marked heterogeneity was present among the studies. Conclusion: CEUS is comparable with CECT for the therapeutic response assessment after transarterial chemoembolization. Abbreviations: CECT: Contrast-enhanced CT; CEUS: Contrast-enhanced Ultrasound; CT: Computed Tomography; HCC: Hepatocellular Carcinoma; MDCT: Multidetector row CT; MRI: Magnetic Resonance Imaging; mRECIST: modified Response Evaluation Criteria in Solid Tumors; NPV: Negative Predictive Value; PPV: Positive Predictive Value; QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies; RFA: Radiofrequency Ablation; TACE: Transcatheter Arterial Chemoembolization.

Transanal total mesorectal excision (taTME) has been proposed to overcome the limitations of laparoscopic TME. The robotic surgical platform has already established its benefits in providing superior ergonomics, and the purported advantages of taTME may play less important a role in the era of robots.

Background: Minimally-invasive surgery has been shown to more demanding on the surgeon than open surgery. This can be manifested as physical fatigue and impaired dexterity, affecting the performance of the surgeon. In this study, we aimed to use hand dexterity and grip strength test as objective measures to compare the difference in surgeon fatigue associated with robotic and laparoscopic colorectal surgery. Methods: A pilot study was conducted between February 2019 and May 2019, recruiting consecutive colorectal patients operated on by a single surgeon using laparoscopy or robotics. We used the Purdue Pegboard Test (PBT) to assess hand dexterity, and the Camry Electronic Handgrip Dynamometer to assess hand grip strength. Before each operative procedure, the surgeon was tasked to perform both tests in a standardized sequence. These tests were repeated two hours into surgery.Results: Eighteen patients were operated on, including 10 robotic and 8 laparoscopic cases. Statistical analysis revealed no difference in dexterity or muscle fatigue after operating with the robot. In contrast, there was a significant difference in the hand grip strength of both hands after laparoscopic surgery (P = 0.04 and 0.02, respectively).Conclusions: Our results show that the resultant fatigue after laparoscopy affects both hands of the surgeon. In contrast, there was no difference in dexterity or muscle fatigue after operating with the robot. Given the demands of complex colorectal surgeries, robotics may be a means of optimizing surgeon performance by reducing fatigue.

In recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorectal cancer has attracted widespread attention. The potential benefits of NOSES including reduction in postoperative pain and wound complications, less use of postoperative analgesic, faster recovery of bowel function, shorter length of hospital stay, better cosmetic and psychological effect have been described in colorectal surgery. Despite significant decrease in surgical trauma of NOSES have been observed, the potential pitfalls of this technique have been demonstrated. Particularly, several issues including bacteriological concerns, oncological outcomes and patient selection are raised with this new technique. Therefore, it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery. After three rounds of discussion by all members of the International Alliance of NOSES, the consensus is finally completed, which is also of great significance to the long-term progress of NOSES worldwide. info:eu-repo/semantics/publishedVersion

Robot-assisted rectal surgery is gaining popularity, and robotic single-site surgery is also being explored clinically. We report our initial experience with robotic transanal total mesorectal excision (R-taTME) and radical proctectomy using the robotic single-site plus one-port (R-SSPO) technique for low rectal surgery. Between July 2015 and March 2016, 15 consecutive patients with ultra-low rectal lesions underwent R-taTME followed by radical proctectomy using the R-SSPO technique by a single surgeon. The clinical and pathological results were retrospectively analyzed. The median operative time was 473 (range, 335–569) min, and the estimated blood loss was 33 (range, 30–50) mL. The median number of lymph nodes harvested was 12 (range, 8–18). The median distal resection margin was 1.4 (range, 0.4–3.5) cm, and all patients had clear circumferential resection margins. We encountered a left ureteric transection intraoperatively in one patient, and another patient required reoperation for postoperative adhesive intestinal obstruction. There was no 30-day mortality. R-taTME followed by radical proctectomy using the R-SSPO technique for patients with low rectal lesions is technically feasible and safe without compromising oncologic outcomes. However, there were considerable limitations and a steep learning curve using current robotic technology.

The purpose of this study was to examine the relationship between bilingualism and phonological awareness by re-evaluating structural sensitivity theory and expanding cross-language transfer theory. The study was conducted with three groups of 1st and 2nd graders matched in age, SES and non-verbal IQ: a) monolingual English-speaking children from a general education program, b) native Japanese-speaking children from a Japanese-English two-way immersion bilingual program and c) native English-speaking children from the same bilingual program. An odd-man-out task that took into account the phonological and orthographical contrasts between English and Japanese was developed to assess onset awareness. The results showed that the bilingual children outperformed their monolingual peers in processing onsets that are shared between the two languages, which provided empirical support for the first hypothesis derived from structural sensitivity theory and highlighted the importance of contextual variability in bilingual metalinguistic processing. The second hypothesis derived from structural sensitivity theory, which predicated that bilingual advantage would be more evident in processing novel stimuli, was not confirmed in the present study. The absence of the predicted group difference may be attributed to the disparity in the extent of novelty of the stimuli and the difference in the comparability of participants’ degrees of bilingualism between the present study and previous research. Finally, expanding existing research, results from this study showed that cross-language transfer can occur at a phonetic featural level. Future research and theoretical implications were discussed.

Pancreatic cancer remains the fourth leading cause of cancer-related death in the USA with a 5-year survival rate of 5 %. The effects of epidermal growth factor receptor and vascular endothelial growth factor A blockade with chemotherapy on pancreatic tumor growth were examined. Mice bearing human PANC-1 cell xenografts were divided into three groups: T-CR (gemcitabine, cisplatin, and 5-fluorouracil), T-TR (cetuximab, bevacizumab, gemcitabine, cisplatin, and 5-fluorouracil), and vehicle control (T). The therapies were administered via intraperitoneal injections every 4 days for seven cycles from 7 weeks after cancer cell implantation. Mice treated with T-TR had significant reductions in tumor weight as compared to the control group (p

Much is known about the impact of vocabulary instruction on reading skills, word knowledge, and reading comprehension. However, knowledge of the underlying theories that guide vocabulary instruction and their potential impact on teachers&rsquo, performance and/or students&rsquo, achievement has not been investigated. In this content analysis, articles published in The Reading Teacher and Journal of Adolescent and Adult Literacy between 2007 and 2017 were dissected to identify and code embedded word-learning strategies, grade levels addressed, target student populations, and desired outcomes (receptive or productive vocabulary). Our primary goal was to examine the embedded word-learning strategies within the articles, and to identify the theories on which they were built. Findings showed that a combination of theories guided most strategy recommendations: Social constructivism and sociocultural theories, schema and psycholinguistic theories, motivation theory, and dual coding theory. We also parallel-coded our findings with a recent review of literature on vocabulary instruction by Wright and Cervetti (2017), and found that they corresponded with the original coding. Follow-up quantitative studies can use the salient theories detected in this content analysis to investigate whether knowledge of underlying theories has an impact on teachers&rsquo, performance and student vocabulary and reading comprehension achievement.

Taiwanofungus camphoratus is a parasitic mushroom found in the heartwood of Cinnamomum kanehirai and is used as a nutritional supplement. It has an anticancer action, both alone and synergistically with amphotericin B (AmB).The study intended to assess the efficacy of a T camphoratus ethanol extract (TCEE) combined with AmB for patients with metastatic cancer whose cancer did not respond to multiline chemotherapy or who were unwilling to receive chemotherapy.The research team performed a retrospective analysis as a pilot study.The study took place at a single hospital (Taipei Medical University Hospital, Taipei, Taiwan).Participants were 9 patients at the hospital who were terminally ill with metastatic cancer.The participants had received daily doses of 2-3 g of the TCEE in combination with a weekly dose of 20-25 mg of AmB in 500 cc of 5% glucose water, given intravenously in 4-6 h.Outcome measures included (1) a primary evaluation index measuring the efficacy of the treatment; (2) a measure of tumor burden that was estimated using the response evaluation criteria in solid tumors (RECIST 1.1), (3) a secondary evaluation index measuring survival duration, and (4) safety.The mean treatment time was 54.4 ± 18.3 wk. At the end of the study, 2 patients showed a continued complete response, 1 patient had a continued partial response, and 1 patient showed a stable disease. The other 5 participants had times to progression ranging from 24 to 48 wk, with a mean of 35.6 wk. The mean survival time was 57.8 ± 18.5 wk, and 5 patients were still alive at the end of the study.For patients whose metastatic cancer did not respond to multiline chemotherapy or who were unwilling to receive chemotherapy, the use of TCEE as an adjuvant therapy to AmB resulted in tumor suppression and a delay in time to disease progression. The preliminary results reported here can be used to guide a future, more extensive clinical study of the combination.

This study aims to examine the relationship between bilingual experience and children's development of morphological and morpho-syntactic awareness. To capture both universal and language-specific bilingual effects, the study included four groups of participants: English-speaking children from a general education programme, Spanish-speaking and English-speaking children from a Spanish–English dual-language programme, and Chinese-speaking children from a Chinese–English dual-language programme. Findings from the analyses of teacher talk and measures of morphological and morpho-syntactic awareness show that certain aspects of morphological awareness, such as the ability to decipher derived words, were likely to be affected by both instruction and cross-language transfer, while others, such as cognate awareness, appeared to develop through mere exposure to two languages despite the absence of explicit instruction. Furthermore, morpho-syntactic awareness was mostly enhanced through greater emphasis on explici...

Many journal articles detail recommendations to naturally integrate literacy instruction into content-area classes, particularly science, claiming that such instructional practices will support both literacy and content-knowledge acquisition. This begs the question, are the literacy strategies recommended for content-area instruction founded in established educational theories? The purpose of the current study is to examine the implicit and explicit theories driving science disciplinary literacy instruction. Theories assist in organizing and advancing research in a systematic manner. Information on the status of theory is essential to both practitioners (who are implementing strategies) and researchers (who are making recommendations for classroom instruction). Our study revealed that in science literacy, vocabulary instructional practices are frequently supported with Schema and Dual-Coding theories. Articles also frequently used theories grounded in social dynamics, including social constructionism and sociocultural perspective, to support literacy instruction. However, recommendations for other aspects of instructional practices in science literacy are generally not well-grounded in major reading theories.

Existing research on the impact of bilingualism on metalinguistic development has concentrated on the development of phonological awareness. The present study extended the scope of existing research by focusing on morphological awareness, an aspect of metalinguistic awareness that becomes increasingly important beyond the initial phase of literacy development. Participants included three groups of fourth-grader children from the same school with comparable SES and non-verbal IQ: (a) monolingual English-speaking children from a general education programme, (b) Spanish-speaking children from a Spanish–English dual-language programme and (c) English-speaking children from the same Spanish–English dual-language programme. Researcher-developed measures of vocabulary and morphological awareness were administered. Results suggested that bilingual education can have a positive impact on the development of morphological awareness through cross-language transfer as well as increased sensitivity to structural langua...

This study examined the influence of teachers’ instructional moves on students’ relational thinking during small-group collaborative discussions. One hundred and twenty 4th grade students and 6 teachers participated in a series of 10 discussions, generating a video-recorded corpus containing 32,511 turns for speaking. A microanalysis of a subset of the corpus showed that teacher prompts for relational thinking, rather than lower level prompts or prompts for evaluation, had an immediate effect on student relational thinking, triggering further relational thinking from students over several speaking turns. Students were unlikely to emulate a teacher’s relational thinking strategy but highly likely to emulate another student’s. Behavioral management but not cognitive management increased the likelihood of relational thinking. Specific praise for cognitive or social strategies enhanced relational thinking, and the bidirectional association between praise and relational thinking suggested a transactional model of teacher–student interaction. The results underscore the importance of teacher influences in peer collaboration, even when the absolute rate of teacher talk is low.

This microgenetic study strived to understand instantaneous peer influences on the moment-by-moment and session-by-session development of relational thinking within and across dialogic small-group discussions using an approach called Collaborative Reasoning. An analysis encompassing 32,511 turns for speaking during 176 discussions indicated that peer support and refutation influenced the development of relational thinking within (micro-level) and across (macro-level) discussions, and was mediated by friendship and peer status. Support was mainly mediated by friends and children with high status. Observing reciprocated friends' supportive talk encouraged students to generate confirmational relational thinking in the next turn for speaking. Refutation was mainly mediated by children with high status. Quiet students generated less refutation. The study documents the proximal effects of peer status and friendship on the social and cognitive dynamics of collaborative discussions.

Although the literature on compliments and compliment responses is abundant, very few studies have examined complimenting behaviour and the influence of gender on complimenting behaviour in Persian language. More scarce is the number of studies that investigated speech act behaviour of Persian speakers in cyberspace in general and in social networking sites such as Facebook in particular. This research on Iranian Facebook (FB) users’ complimenting response behaviour was carried out in order to broaden the scope of studies in pragmatics to include non-Western languages and to extend the scope of speech act studies to cyberspace. The study probed into Iranian FB users’ compliment response behaviour in same-gender and cross-gender interactions. The current research also sought to explore the extent to which compliment response behaviour on Facebook resembles its counterpart in face-to-face interactions. The findings revealed that online medium of communication and technological affordances on Facebook have brought new norms of communication into existence. The findings also suggested that some emerging sociocultural factors such as cyber-feminism might have impacted the participants’ preferences for more egalitarian patterns of language use when responding to compliments from an opposite gender. More importantly, the findings showed how marginalized groups such as women in Iran benefit from virtual spaces such as FB to assert a linguistic identity of self that is not easily possible to share publically in real life settings.

Recent literature suggests that the benefit of adjuvant chemotherapy (aCT) for rectal cancer patients might depend on the response to neoadjuvant chemoradiation (CRT). Aim was to evaluate whether the effect of aCT in rectal cancer is modified by response to CRT and to identify which patients benefit from aCT after CRT, by means of a pooled analysis of individual patient data from 13 datasets. Patients were categorized into three groups: pCR (ypT0N0), ypT1-2 tumour and ypT3-4 tumour. Hazard ratios (HR) for the effect of aCT were derived from multivariable Cox regression analyses. Primary outcome measure was recurrence-free survival (RFS). One thousand seven hundred and twenty three (1723) (52%) of 3,313 included patients received aCT. Eight hundred and ninety eight (898) patients had a pCR, 966 had a ypT1-2 tumour and 1,302 had a ypT3-4 tumour. For 122 patients response, category was missing and 25 patients had ypT0N+. Median follow-up for all patients was 51 (0-219) months. HR for RFS with 95% CI for patients treated with aCT were 1.25(0.68-2.29), 0.58(0.37-0.89) and 0.83(0.66-1.10) for patients with pCR, ypT1-2 and ypT3-4 tumours, respectively. The effect of aCT in rectal cancer patients treated with CRT differs between subgroups. Patients with a pCR after CRT may not benefit from aCT, whereas patients with residual tumour had superior outcomes when aCT was administered. The test for interaction did not reach statistical significance, but the results support further investigation of a more individualized approach to administer aCT after CRT and surgery based on pathologic staging.