scholarly journals The development of laparoscopic technology in light of cholecystectomies performed between 1994 and 2007

2009 ◽  
Vol 150 (48) ◽  
pp. 2189-2193
Author(s):  
Péter Lukovich ◽  
Tímea Vanca ◽  
Dániel Gerő ◽  
Péter Kupcsulik
Keyword(s):  
Laparoscopic Surgery ◽  
Gastrointestinal Surgery ◽  
Minimal Invasive ◽  
Chi Square ◽  
Female Ratio ◽  
Surgical Method ◽  
Male Female Ratio ◽  
Significance Levels ◽  
Gallstone Spillage ◽  
Laparoscopic Techniques

The spread of laparoscopy has required surgeons to familiarize with a completely new surgical method and by today this method has clearly become of major importance in gastrointestinal surgery. The evolution of laparoscopic cholecystectomy offers many good lessons to learn for the purposes of advanced laparoscopic surgeries and surgeons may benefit from this experience in any process of introducing new minimal invasive techniques. Methods and Material: We have made a retrospective analysis of the data of the cholecystectomies made in the 1st. Department of Surgery, Semmelweis University, right after laparoscopy had become a widely spread, routine surgical method (1994) as well as 13 years later (2007). The data have been processed using the SPSS 16.0 application package. Significance levels have been established with the chi-square probe. Results: Within the analyzed timeframe we could clearly see a growing use of laparoscopic techniques (52.09% vs. 90.13%) with a growing number of cases (263/304), unchanged average age (~53.5 years) and constant male/female ratio (75/25%). The BMI increased moderately (26.5 vs. 27.6), but the frequency of laparoscopic interventions on extremely obese patients grew (BMI: 25–30 37.93% vs. 44.39%, 30–35 13.79% vs. 20.6% 35–40 6.89% vs. 5.82% and 40 \lt; 0% vs. 1.34%) while the postoperative hospitalization decreased dramatically from 5.9 days to 2.3. In year 1994, patients spent on the average 2.9 days in hospital after a laparoscopic surgery, while in year 2007 nearly 25% of the patients left the hospital 1 day after surgery. The duration of a laparoscopic surgery decreased from 78 minutes to 53, and the occurrence of intraoperative bleeding, gall bladder perforation and gallstone spillage also decreased. The conversion ratio increased from 2.7% to 4.9%. In 3% of the laparoscopic cholecystectomies (10 patients) only 3 ports were used during surgery. Discussion: As surgeons have come to master the new technique, the previous relative and absolute pros and cons have been revised and at present 90% of cholecystectomies are made using laparoscopy. The data collected in the analysis of laparoscopic techniques can be used to research, learn and eventually introduce Natural Orifice Transluminal Endoscopic Surgery.

scholarly journals Epidemiology of COVID-19 cases diagnosed at quarantine facilities in Paraguay

2021 ◽  
Vol 31 (1) ◽  
pp. e39374
Author(s):  
Pasionaria Rosa Ramos Ruiz Diaz ◽  
Gladys Velázquez ◽  
Elder Oliveira da Silva ◽  
Claudia Carolina Centurión Viveros ◽  
Roberto Esperanza Dullack Peña ◽  
...  
Keyword(s):  
Public Health ◽  
Retrospective Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Female Ratio ◽  
Infected People ◽  
Rapid Spread ◽  
Male Female Ratio ◽  
Epidemiological Characteristics ◽  
Access Data

Aims: This study aimed to describe the epidemiological characteristics of COVID-19 cases diagnosed in quarantine facilities in Paraguay.Methods: This was a descriptive, cross-sectional, temporarily retrospective study. The time scope was from April 1 to September 30 2020. The variables were sex, age and administrative departments. The open access data available on the website of the Ministry of Public Health and Social Welfare was used. Frequencies expressed in percentages and the Chi square value were calculated to observe the statistically significant differences between cases and age and sex.Results: from April 4 to September 30 2020, 1.581 cases were diagnosed in COVID-19. The fewest number of positive cases were reported in April (50) and the highest number was reported in May (628). From the total, 69.6% (1.101) were male, (male / female ratio 2.3), 42.1% (666) were aged between 20-29 years, the average age was 30.23 years (range 0 to 87, standard deviation 14.66. 95% CI 1.5 - 58.95). The departments with the highest number of cases were Caaguazú 21.7 % (343), Alto Paraná 17.3 % (274), Central 13.3% (210) and Asunción 11.4% (180). The least number of cases of COVID-10 in women were registered in the Departments of Amambay, Pdte. Hayes, Ñeembucú and Boquerón, and in men the Departments of Ñeembucú and Boquerón. The largest number of male cases were registered in Caaguazú 70.8% (243), Alto Paraná 66.1% (181), Central 69.5% (146) and Asunción 68.9% (124). The number of Covid-19 infected people in quarantine facilities presented statistically significant differences between the variables sex and age.Conclusion: the quarantine facilities are one of the measures that the Paraguayan government needed to avoid the rapid spread and dispersion of the virus. The epidemiology of the cases diagnosed in them corresponds to what was expected according to the characteristics of the country.

scholarly journals Bleeding Source Identification and Treatment in Brain Arteriovenous Malformations

2011 ◽  
Vol 17 (3) ◽  
pp. 323-330 ◽  
Author(s):  
N. Mjoli ◽  
D. Le Feuvre ◽  
A. Taylor
Keyword(s):  
Intracerebral Haemorrhage ◽  
P Value ◽  
Chi Square ◽  
Female Ratio ◽  
Bleeding Source ◽  
Good Target ◽  
Brain Avm ◽  
Male Female Ratio ◽  
Technical Complication ◽  
Chi Square Analysis

Arteriovenous malformation (AVM) patients who initially present with intracerebral haemorrhage may have an identifiable source of bleeding on angiogram, which can be a treatment target. Previous work suggests that the re-bleed rate may be lowered if a weak area is eliminated. A retrospective cohort study was conducted on patients who presented over a six-year period with a bled AVM. Cases were reviewed looking for the source of the hemorrhage by correlating haematoma location on CT or MRI and any angio-architectural weakness seen on digital subtraction angiography (DSA). Neuroendovascular notes were reviewed to identify the treatment targets. One hundred patients presented with a brain AVM with a 1.7:1 male: female ratio, 41 patients had an initial presentation of hemorrhage. The source of hemorrhage was identified in 18 subjects with 11 intranidal false aneurysms, five flow-related aneurysms, two associated aneurysms and one venous pouch. The location of haemorrhage on the presenting scan significantly correlated with the identified bleeding source using Chi-square analysis (P-value 0.039). Partial targeted embolization was used successfully in 90% with a 9% related technical complication rate not resulting in long-term morbidity or mortality. The mean follow-up period was 34 months with an annual hemorrhage rate of 0.7%. In just under half the patients with AVM bleeding a source of haemorrhage can be identified on DSA and in most cases this will be an intranidal false aneurysm. Flow-related and associated aneurysms in patients with brain AVM can cause haemorrhage and these patients are more likely to have SAH than intracerebral haemorrhage. These weak points are a good target for partial endovascular treatment, are usually accessible and may reduce the higher haemorrhage rate expected over the next two years.

Đánh giá kết quả sớm điều trị ung thư đại tràng bằng phẫu thuật nội soi

2021 ◽  
Author(s):  
Thanh Xuan Nguyen
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Intraoperative Complications ◽  
Common Disease ◽  
Diagnostic Colonoscopy ◽  
Female Ratio ◽  
Operative Outcomes ◽  
Male Female Ratio ◽  
Duration Of Hospitalization ◽  
The Mean

TÓM TẮT Đặt vấn đề: Ung thư đại tràng là một bệnh lý hay gặp ở Việt Nam, đứng hàng thứ hai sau ung thư dạ dày trong ung thư đường tiêu hóa. Điều trị ung thư đại tràng chủ yếu là phẫu thuật cắt đoạn đại tràng mang theo khối u kèm hạch và hóa chất bỗ trợ. Phẫu thuật nội soi điều trị ung thư đại tràng mang lại nhiều hiệu quả và ngày càng được ứng dụng rộng rãi. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, lâm sàng mô tả 35 bệnh nhân được chẩn đoán là ung thư đại tràng được phẫu thuật nội soi tại bệnh viện Trung ương Huế cơ sở 2 từ tháng 1/2019 đến 6/2021. Kết quả: Tuổi trung bình 62,4 ± 17,8 (34 - 82), giới tính nam/nữ: 1,2. Vị trí u bao gồm: u đại tràng phải chiếm 31,4%, đại tràng ngang 11,5%, đại tràng trái 25,7%, đại tràng sigma 31,4%. Hình ảnh quan sát qua nội soi đại tràng thể sùi chiếm tỷ lệ cao nhất 82,9%. Nồng độ CEA tăng trước mổ chiếm 42,9%. Theo TNM u tập trung ở giai đoạn II, III chiếm tỉ lệ cao nhất 80%. Thời gian phẫu thuật trung bình: 168,7 ± 31,4 phút, thời gian nằm viện sau mổ trung bình: 10,8 ± 4,9 ngày. Tai biến trong mổ không có, biến chứng sớm sau phẫu thuật có 5/35 bệnh nhân nhiễm trùng vết mổ. Kết luận: Phẫu thuật nội soi điều trị ung thư đại tràng là một phương pháp hiệu quả, an toàn, tỉ lệ tai biến và biến chứng sau mổ ít. ABSTRACT OPERATIVE OUTCOMES OF LAPAROSCOPIC SURGERY FOR COLON CANCER Background: Colon cancer is a common disease in Vietnam, ranking second after gastric cancer in gastrointestinal cancers. Treatment of colon cancer is mainly based on surgery to excise the colon with tumor and adjuvant chemotherapy. Laparoscopic surgery for colon cancer increasingly shows its effectiveness and is widely used. Methods: A prospective, descriptive study was conductedon 35 patients with colon cancer who were treated by laparoscopicsurgery at the Hue Central Hospital - Branch 2 from January 2019 to June 2021. Result: The mean age was 62.4 ± 17.8 (34 - 82); the male/ female ratio was 1.2. The sites of cancer were: right colon 31.4%; transverse colon 11.5%; left colon 25.7%; sigma colon 31.4%. Protrusive tumors were accounted for 82.9% by diagnostic colonoscopy. Elevation of CEA serum level wasfound in 42.9% preoperatively. TNM stage of II and III were the most 80%. The mean operativetime was 168.7 ± 31.4 minutes. The mean duration of hospitalization was 10.8 ± 4.9 days. No intraoperative complications were found. The rate of wound infection was 14.3%. Conclusion: Laparoscopic surgery for colon cancer is a safe and effective surgical technique with less postoperative pain and a low rate of postoperative complications. Keywords: Colon cancer, laparoscopic.

Suicide in Nógrád County, Hungary, 1970-1994

Crisis ◽  
1999 ◽  
Vol 20 (2) ◽  
pp. 64-70 ◽  
Author(s):  
Tamás Zonda
Keyword(s):  
High Risk ◽  
Psychiatric Disorders ◽  
Suicide Rate ◽  
Risk Groups ◽  
The Elderly ◽  
Female Ratio ◽  
Suicide Notes ◽  
Suicidal Intention ◽  
Male Female Ratio

The author examined completed suicides occurring over a period of 25 years in a county of Hungary with a traditionally low (relatively speaking) suicide rate of 25.8. The rates are clearly higher in villages than in the towns. The male/female ratio was close to 4:1, among elderly though only 1.5:1. The high risk groups are the elderly, divorced, and widowed. Violent methods are chosen in 66.4% of the cases. The rates are particularly high in the period April-July. Prior communication of suicidal intention was revealed in 16.3% of all cases. Previous attempts had been undertaken by 17%, which in turn means that 83% of suicides were first attempts. In our material 10% the victims left suicide notes. Psychiatric disorders were present in 60.1% of the cases, and severe, multiple somatic illnesses (including malignomas) were present in 8.8%. The majority of the data resemble those found in the literature.

CLINICAL, ENDOSCOPIC AND PATHOGICAL CHARACTERISTICS OF COLORECTAL CANCER AT DA NANG HOSPITAL FROM 2016 TO 2017

2018 ◽  
pp. 9-14
Author(s):  
Thanh Trung Nguyen ◽  
Duc Nhan Le ◽  
Van Xung Nguyen ◽  
Hieu Trung Doan
Keyword(s):  
Colorectal Cancer ◽  
Descriptive Study ◽  
Bloody Stool ◽  
Key Words Colorectal Cancer ◽  
Right Colon ◽  
Female Ratio ◽  
Histopathological Classification ◽  
Male Female Ratio ◽  
Female Male Female ◽  
Colorectal Cancer Patients

Objective: To study the clinical, endoscopy and pathogical characteristics of colorectal cancer at Da Nang Hospital. Methods: A retrospectively descriptive study, performed from 01/01/2016 to 31/12/2017 at Da Nang Hospital. Results: During two years, there were 205 cases of colorectal cancer patients hospitalized to Da Nang Hospital. Male: 59.51%, female: 40.49%, mean age: 65.8 ± 16.07. Male is higher than female, male/ female ratio is 1.4/1. The period from the first symptoms to admission < 3months predominated (83.8%). The predominant symptoms: Abdominal pain (85.85%), bloody stool (63.41%), defecation (62.44%), anemia (34.63%), weight loss (25.85%), fatigue (17.56%), abdominal distention (12.19%), nausea and vomiting (5.36%). Location of Lesions: Rectum (43.42%), sigmoid colon (20%), right colon (10.73%),cecum (10.73%), transverse colon (7.80%), left-colon (7.32%). Type of lesion on endoscopy: Exophytic (63.41%), ulceration-Exophytic (21.95%), ulceration (7.32%), polyp chemotherapy (7.32). Tumor size: ≥ 3/4 perimeter (39%), occupying the whole circumference (37.0%), occupying ≥ 1/2 perimeter (15.6%), accounting for 1/4 Perimeter (8.4%). The colon completely narrowed rate: 70.73%., incompletely was 29.27%. Histopathological classification: adenocarcinoma (85.85%), Mucinous adenocarcinoma: (9.27%) and non-differentiated epithelial carcinoma was 4.88%. Conclusion: Colorectal cancer was quite popular and was usually detected at advanced stages.Therefore, screening for subjects with risk factors for early detection and treatment is recommended. Key words: Colorectal cancer, endoscopy, pathogical characteristics...

CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

2017 ◽  
pp. 50-55
Author(s):  
Duc Luu Ngo ◽  
Tu The Nguyen ◽  
Manh Hung Ho ◽  
Thanh Thai Le
Keyword(s):  
Clinical Features ◽  
University Hospital ◽  
Female Ratio ◽  
Tube Obstruction ◽  
Level Ii ◽  
Study Results ◽  
Male Female Ratio ◽  
Hospital Patients ◽  
Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

scholarly journals Prognostic significance of peritoneal cytology in low-risk endometrial cancer: comparison of laparoscopic surgery and laparotomy

2021 ◽  
Author(s):  
Satoe Fujiwara ◽  
Ruri Nishie ◽  
Shoko Ueda ◽  
Syunsuke Miyamoto ◽  
Shinichi Terada ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Laparoscopic Surgery ◽  
Retrospective Study ◽  
Prognostic Significance ◽  
Low Risk ◽  
Peritoneal Cytology ◽  
Chi Square ◽  
Significant Difference ◽  
Chi Square Test ◽  
Positive Peritoneal Cytology

Abstract Background There is uncertainty surrounding the prognostic value of peritoneal cytology in low-risk endometrial cancer, especially in laparoscopic surgery. The objective of this retrospective study is to determine the prognostic significance of positive peritoneal cytology among patients with low-risk endometrial cancer and to compare it between laparoscopic surgery and conventional laparotomy. Methods From August 2008 to December 2019, all cases of pathologically confirmed stage IA grade 1 or 2 endometrial cancer were reviewed at Osaka Medical College. Statistical analyses used the Chi-square test and the Kaplan–Meier log rank. Results A total of 478 patients were identified: 438 with negative peritoneal cytology (232 who underwent laparotomy and 206 who undertook laparoscopic surgery) and 40 with positive peritoneal cytology (20 who underwent laparotomy and 20 who received laparoscopic surgery). Survival was significantly worse among patients with positive peritoneal cytology compared to patients with negative peritoneal cytology. However, there was no significant difference among patients with negative or positive peritoneal cytology between laparoscopic surgery and laparotomy. Conclusion This retrospective study suggests that, while peritoneal cytology is an independent risk factor in patients with low-risk endometrial cancer, laparoscopic surgery does not influence the survival outcome when compared to laparotomy.

scholarly journals Risk Factors, Pattern and Outcome of Motorcycle-associated Head Injury in Sokoto: An Analysis of 184 Cases

2021 ◽  
Author(s):  
Henry Olayere Obanife ◽  
Nasiru Jinjiri Ismail ◽  
Ali Lasseini ◽  
Bello B. Shehu ◽  
Ega J. Otorkpa
Keyword(s):  
Developing Countries ◽  
Head Injury ◽  
Road Traffic ◽  
Negative Impact ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Female Ratio ◽  
Incidence And Mortality ◽  
Male Female Ratio ◽  
Significant Negative Impact

Abstract Background Road traffic accident (RTA) is the eighth leading cause of death worldwide. Motorcycle-associated head injury is the leading cause of road traffic associated morbidity and mortality in developing countries. Even though the incidence and mortality of head injury from motor cycle crash is on the increase in developing countries, especially in the African continent, most of the studies published in the literature on this subject matter took place in the developed Western countries. Methods This is a retrospective cross-sectional study of data from patients managed in our institution between December 2014 and November 2016. Results One hundred and eighty-four patients were analyzed. None of the patients used safety helmet for protection. The mean age was 27.6 ± 17.2 years with male female ratio of 6.7:1. Lone crash by cyclists and collisions accounted for 66.8% and 33.1% of the cases, respectively. Passengers and riders comprised 75% of the patients, while 25% were vulnerable pedestrians. The most frequently abused substance by the patients was tramadol (65.52%). Severe head injury and pupillary abnormality were found in 23.9% and 45.5% of the patients, respectively. Cranial CT scan showed abnormalities in 40.2% of the patients. Surgery was done in 28.3% of the patients with mortality rate of 20.7%. Conclusions The use of motorcycle as a mean of transportation has caused significant negative impact on the society. Young people, who constitute the workforce, are majorly affected, and this invariably leads to a serious economic burden on the concerned families and communities.

scholarly journals AB0287 HEMATOLOGICAL SIDE EFFECTS OF BIOLOGICAL THERAPY IN RHEUMATOLOGY: DATA FROM THE TUNISIAN REGISTER

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1442.2-1442
Author(s):  
H. Bettaieb ◽  
S. Boussaid ◽  
S. Jemmali ◽  
S. Rekik ◽  
E. Cheour ◽  
...  
Keyword(s):  
Side Effects ◽  
Biological Treatment ◽  
Blood Count ◽  
Biological Therapy ◽  
National Registry ◽  
Close Monitoring ◽  
Female Ratio ◽  
Therapy Initiation ◽  
Male Female Ratio ◽  
The Mean

Background:During the last decade, the treatment of chronic inflammatory rheumatism (CIR) has been greatly improved with the advent of biotherapy.However, the use of biological treatment can lead to a number of side effects including abnormalities in the blood count.Objectives:The aim of this study was to assess the different hematological side effects of biological treatment in patients with rheumatoid arthritis (RA) and spondyloarthitis (SA).Methods:This study included patients with RA (ACR/EULAR 2010) and SA (ASAS 2009) registred with the Tunisian Biologic National Registry (BINAR).Patients were followed and treated with biologics for 2 years of less. Clinical data relative to biological treatment, including haematological side effects, have been collected.Results:Two hundred and ninety-eight patients (178 women and 111 men) were included in the study.The mean age was 49.2 ± 14.1 years. The male/female ratio was 0.6. The mean diseases durations for RA and SA were respectively 6.7 ± 3.5 years and 6.5 ±3.6 years.Anti-TNFα agents were prescribed in 87.9% of patients (n = 263) with respectively: Infliximab (20.4%) Etanercept (23.1%), Adalimumab (24.6%) and Certolizumab (26.5%).Tocilizumab and Rituximab were prescribed in 10.4% and 5% of the patients, respectively.Blood count abnormalities were noted in 15.4 % of patients (n=46).Neutropenia was the most frequently anomaly met on the hemogram (9.1%) followed by anemia (3.4%) and thrombocytopenia (3%). Pancytopenia was found in 11.4% of patients (n=34).The median time between biological therapy initiation and the onset of hematologic manifestations was 4.8 months [1-12]. Biological treatment was interrupted in two patients.In the other cases, the biological treatment was maintained with close monitoring of blood cell count. No case of death related to these hematological disturbances has been reported.Conclusion:In our registry, hematological side effects of biological treatment were found in 15.4% of cases and were noted with a median delay of 4.8 [1-12] months after the treatment initiation. Further studies are needed to confirm our preliminary results.Disclosure of Interests:None declared

scholarly journals Clinicopathological features of pilomatricoma cases: Analysis of 21 cases

2014 ◽  
Vol 4 (7) ◽  
pp. 530-533
Author(s):  
D Ghartimagar ◽  
A Ghosh ◽  
K Gautam ◽  
S Thapa ◽  
SR Shrestha ◽  
...  
Keyword(s):  
Hair Follicle ◽  
Needle Aspiration ◽  
Common Finding ◽  
Clinical Impression ◽  
Aspiration Cytology ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Needle Aspiration Cytology ◽  
Age Range ◽  
Slow Growing

Background: Pilomatricoma is a slow-growing, asymptomatic tumour originating from outer sheath cells of hair follicle. In this study, we describe the clinical presentation and histopathological features of pilomatricoma. Materials and Methods: This was a hospital based retrospective study carried out in all patients who were diagnosed as pilomatricoma over a period of January 2001 to December 2013. The study was done in department of pathology, Manipal Teaching Hospital, Nepal. Results: A total of 21 cases of pilomatricoma were reported with age range of 9-53 years (mean age 23.7) and male female ratio of 1:1.1. The most common site of occurrence was neck and preauricular region. The size of the tumour ranged from 0.3 to 4.7cm with a mean of 1.2cm. Multiple occurrences were seen in 3 patients and ossifying pilomarticoma was seen in 4 cases. Conclusion: Pilomatricoma is a benign skin neoplasm of hair follicle matrix cells. Calcification is a common finding while dystrophic ossification also can occur in the tumour. Histopathology gives the definite diagnosis as fine needle aspiration cytology and clinical impression may be misleading. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10293 Journal of Pathology of Nepal (2014) Vol. 4, 530-533

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