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BACKGROUND Rectal cancer patients who have undergone lower anterior resection with sphincter-saving surgery often experience loss of bowel control. We currently do not have suitable treatment regimens for such patients. OBJECTIVE The aim of this study was to explore the experiences of losing bowel control in patients who have undergone lower anterior resection with sphincter-saving surgery for rectal cancer in Taiwan. METHODS A descriptive phenomenological study design was adopted. Purposive sampling and one-on-one semistructured interviews were conducted for data collection. Narratives were analyzed using Colaizzi's method. RESULTS Data saturation was achieved after interviewing 12 patients (8 men, 4 women) whose average age was 61 years. Three themes and 11 subthemes emerged: physical problems (pain from broken perianal skin, insomnia, decreased physical strength, and body weight loss), adverse psychological reactions (worries, helplessness, and social isolation), and the use of coping strategies (avoidance of inappropriate foods to reduce bowel irritation and peristalsis, reduction of food intake, and use of antidiarrheal drugs and perianal skincare products). CONCLUSION The study supports the importance of having a good understanding of patient experiences by healthcare professionals to provide more effective healthcare. Furthermore, awareness of the cultural issue of social isolation was deemed important for providing individualized healthcare. IMPLICATIONS FOR PRACTICE Education, counseling, and psychological support can enhance patients' abilities to use coping strategies to overcome the physical and mental challenges of bowel symptoms. For example, appropriate diet-related education programs must be developed to reduce the trial-and-error learning process commonly adopted by patients to identify inappropriate foods.

Objectives: In 2009 and again in 2012, the American Society of Regional Anesthesia and Pain Medicine assembled an expert panel to assess the evidence basis for ultrasound guidance as a nerve localization tool for regional anesthesia. Methods: The 2012 panel reviewed evidence from the first advisory but focused primarily on new information that had emerged since 2009. A new section was added regarding the accuracy and reliability of ultrasound for determining needle-to-nerve proximity. Jadad scores are used to rank study quality. Grades of recommendations consistent with their level of evidence are provided. Results: The panel offers recommendations based on synthesis and analysis of literature related to (1) the technical capabilities of ultrasound equipment and its operators, (2) comparison of ultrasound to other methods of nerve localization with regard to block characteristics, (3) comparison of block techniques where ultrasound is the sole nerve localization modality, and (4) major complications. Assessment of evidence strength and recommendations are made for upper- and lower-extremity, truncal, neuraxial, and pediatric blocks. Conclusions: Scientific evidence from the past 5 years has clarified and strengthened our understanding of ultrasound-guided regional anesthesia as a nerve localization tool. High-level evidence supports ultrasound guidance contributing to superior characteristics with selected blocks, although absolute differences with the comparator technique are often relatively small (especially for upper-extremity blocks). The clinical meaningfulness of these differences is likely of variable importance to individual practitioners. The use of ultrasound significantly reduces the risk of local anesthetic systemic toxicity as well as the incidence and intensity of hemidiaphragmatic paresis, but has no significant effect on the incidence of postoperative neurologic symptoms. What9s New in This Update? This evidence-based assessment of ultrasound-guided regional anesthesia reviews findings from our 2010 publication and focuses on new meta-analyses, randomized controlled trials, and large case series published since 2009. New to this exercise is an in-depth analysis of the accuracy and reliability of ultrasound guidance for identifying needle-to-nerve relationships. This version no longer addresses ultrasound for interventional pain medicine procedures, because the growth of that field demands separate consideration. Since our 2010 publication, new information has either supported or strengthened our original conclusions. There is no evidence that ultrasound is inferior to alternative nerve localization methods.

The acquisition of resistance to anticancer drugs is widely viewed as a key obstacle to successful cancer therapy. However, detailed knowledge of the initial molecular events in the response of cancer cells to these chemotherapeutic and stress responses, and how these lead to the development of chemoresistance, remains incompletely understood. Using microRNA array and washout and rechallenge experiments, we found that short term treatment of leukemia cells with etoposide led a few days later to transient resistance that was associated with a corresponding transient increase in expression of ABCB1 mRNA, as well as microRNA (miR)-135b and miR-196b. This phenomenon was associated with short-term exposure to genotoxic agents, such as etoposide, topotecan, doxorubicin and ionizing radiation, but not agents that do not directly damage DNA. Further, this appeared to be histiotype-specific, and was seen in leukemic cells, but not in cell lines derived from solid tumors. Treatment of leukemic cells with either 5-aza-deoxycytidine or tricostatin A produced similar increased expression of ABCB1, miR-135b, and miR-196b, suggesting a role for epigenetic regulation of this phenomenon. Bioinformatics analyses revealed that CACNA1E, ARHGEF2, PTK2, SIAH1, ARHGAP6, and NME4 may be involved in the initial events in the development of drug resistance following the upregulation of ABCB1, miR-135b and miR-196b. In summary, we report herein that short-term exposure of cells to DNA damaging agents leads to transient drug resistance, which is associated with elevations in ABCB1, miR-135b and miR-196b, and suggests novel components that may be involved in the development of anticancer drug resistance.

Objectives: The American Society of Regional Anesthesia and Pain Medicine charged an expert panel to examine the evidence basis for ultrasound guidance as a nerve localization tool in the clinical practices of regional anesthesia and interventional pain medicine. Methods: The panel searched, examined, and assessed the literature of ultrasound-guided regional anesthesia (UGRA) from the past 20 years. The qualities of studies were graded using the Jadad score. Strength of evidence and recommendations were graded using an accepted rating tool. Results: The panel made specific literature-based assessments concerning the relative advantages and limitations of UGRA relative to traditional nerve localization methods as they pertained to block characteristics and complications. Assessments and recommendations were made for upper and lower extremity, neuraxial, and truncal blocks and include pediatrics and interventional pain medicine. Conclusions: Ultrasound guidance improves block characteristics (particularly performance time and surrogate measures of success) that are often block specific and that may impart an efficiency advantage depending on individual practitioner circumstances. Evidence for UGRA impacting patient safety is currently limited to the demonstration of improvements in the frequency of surrogate events for serious complications.