Relationship between preoperative nitrogen balance and energy and protein intake in patients with esophageal cancer.

BACKGROUND & AIMS: Nitrogen balance (NB) is an important indicator of protein utilization in the body, and a positive NB is essential for maintaining and improving nutritional status. However, information is lacking on the target values of the energy and protein levels required to maintain positive NB in cancer patients. This study aimed to verify the energy and protein requirements for positive NB in preoperative esophageal cancer patients. METHODS: This study included patients for esophageal cancer surgery who were admitted for radical surgery. Urine urea nitrogen (UUN) levels were measured based on 24-h urine storage. Energy and protein intakes were calculated from the dietary intake during hospitalization and the amount administered from enteral and parenteral nutrition. The characteristics of the positive and negative NB groups were compared, and patients' characteristics related to UUN excretion were analyzed. RESULTS: Seventy-nine patients with esophageal cancer were included, and 46% of patients were negative NB. All patients with energy intake ≥30 kcal/kg/day and protein intake ≥1.3 g/kg/day had positive NB. Whereas, in the group with energy intake ≥30 kcal/kg/day and protein intake <1.3 g/kg/day, 67% of patients were positive NB. There was a significant positive relation between UUN excretion and retinol-binding protein in multiple regression analyses adjusted for several patients' characteristics (ß = 0.28, p = 0.048). CONCLUSION: In preoperative esophageal cancer patients, 30 kcal/kg/day of energy and 1.3 g/kg/day of protein were the guideline values for positive NB. Good short-term nutritional status was a factor associated with increased UUN excretion.

Enteral Diet Enriched with ω-3 Fatty Acid Improves Oxygenation After Thoracic Esophagectomy for Cancer: A Randomized Controlled Trial.

BACKGROUND: Although the anti-inflammatory effects of immunomodulating diets (IMDs) have recently attracted attention, the efficacy of enteral feeding of such diets after radical surgery remains controversial. Thus, we conducted a new prospective, randomized controlled study to elucidate any beneficial effect of an IMD containing eicosapentaenoic acid (EPA) and γ-linolenic acid (GLA) in patients undergoing radical esophagectomy for thoracic esophageal cancer. METHODS: From November 2009 to July 2011, 87 consecutive patients were randomized to receive either an IMD enriched with EPA, GLA, and antioxidants (n = 42) or a standard isocaloric, isonitrogenous diet (control group, n = 45) after esophagectomy with radical lymphadenectomy. The primary outcome measure was changes in the oxygenation status (PaO2/FIO2 ratio), and the secondary outcome measures were body composition, inflammation-related factors, coagulation markers, cholesterol concentrations, and major clinical outcomes. RESULTS: Oxygenation was significantly better on postoperative days (PODs) 4, 6, and 8 in the IMD than control group (366.5 ± 63.3 vs. 317.3 ± 58.8, P = 0.001; 361.5 ± 52.6 vs. 314.0 ± 53.2, P < 0.001; 365.4 ± 71.2 vs. 315.2 ± 56.9, P = 0.001, respectively). Changes in the ratio of body weight on PODs 14 and 21 and lean body weight on POD 21 were significantly greater in the IMD than control group. No significant differences were observed in other measures. CONCLUSIONS: An enteral IMD enriched with EPA and GLA improved oxygenation and maintained the body composition of patients undergoing radical esophagectomy, indicating the potential efficacy of such a diet after esophagectomy.

Sonographic appearance of pyomyositis of the sternocleidomastoid muscle: A case report.

Pyomyositis in the neck has rarely been described. We present the sonographic findings in a case of pyomyositis of the sternocleidomastoid muscle. A 62-year-old man with poorly controlled diabetes presented with an induration of the neck and fever. On gray-scale sonography, a part of the sternocleidomastoid muscle appeared swollen and contained irregularly shaped hypoechoic areas. Power Doppler imaging showed increased vascularity in the muscle. Sonographic-guided aspiration confirmed abscesses in the sternocleidomastoid muscle. Surgical drainage was successfully performed along with antibiotic treatment. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:520-523, 2017.

Sonographic diagnosis of acute mastoiditis and subsequent retroauricular abscess in a pediatric cochlear implant recipient: A case report.

When acute mastoiditis occurs in cochlear implant recipients, it can progress to subsequent retroauricular abscess due to the absence of the external mastoid cortex resulting from mastoidectomy performed for cochlear implantation. The management goal is to control infection while preserving the implanted device. A 2-year-old boy with cochlear implants developed acute mastoiditis and a subsequent retroauricular abscess. The patient underwent a surgical intervention based on the diagnosis made utilizing gray-scale and power Doppler sonography. This case illustrates the diagnostic usefulness of sonography in this rare situation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:515-519, 2017.

Association of the Clinical Subtype and Etiology for Delirium with the Outcome after Risperidone Monotherapy in Patients Having Cancer.

Background Delirium is the most frequent psychiatric syndrome in patients with advanced cancer, but its management is complicated by its multifactorial pathology. In this study, we investigated the association of the clinical subtypes, possible etiologies, and reversibility of delirium in patients having cancer with risperidone monotherapy. Methods This study included 16 inpatients with advanced cancer who were consecutively referred to psychiatric consultation service or palliative care team and were diagnosed with delirium by a psychiatrist. These patients were assessed using the Delirium Rating Scale Revised 98 (DRS-R98) at baseline and on a follow up visit (seventh day). The etiologies of delirium were determined using the Delirium Etiology Checklist. Oral risperidone was given once a day (0.5 or 1 mg/day) with routine clinical management. A detailed examination of the association between each clinical factor and their reversibility after risperidone treatment was examined retrospectively. Results Of the 15 patients (mean age 64.1? 9.5 years) whose data were available, 53% had hyperactive delirium and 47% had mixed delirium, while no patient showed hypoactive delirium. The most frequent etiology of delirium was metabolic/endocrine disturbance, drug intoxication, and systemic infection. In 10 patients (67%), remission of delirium was achieved, according to the DRS-R98. Neither clinical subtypes nor possible etiologies were associated with delirium reversibility after risperidone treatment. Conclusions Risperidone monotherapy is effective for treating delirium in patients with advanced cancer.

Parahippocampal Atrophy is Associated with Depressive Symptoms in Alzheimer's Disease.

Background Alzheimer's disease (AD) patients frequently show depressive symptoms, yet the pathological background remains unclear. The voxel-based specific regional analysis system for AD (VSRAD) allows quantification of atrophy in the medial temporal structures. We measured the degree of parahippocampal atrophy in AD patients using VSRAD, and investigated the association between imaging analysis results and the severity of depressive symptoms. Methods Brain magnetic resonance imaging (MRI) was conducted in 39 AD outpatients, and all MRI data were analyzed using VSRAD. The target region of interest (ROI) mainly consisted of the parahippocampal gyrus. The degree of atrophy in the ROI was obtained from the averaged positive z score (Z-score) of the ROT. AD patients were divided into two groups based on the severity of their depressive symptoms using the Geriatric Depression Scale (GDS), the depressive group (D group: 20 patients) and non- depressive group (ND group: 19 patients), and the clinical characteristics and VSRAD results of both groups were compared. Results There were no significant differences in demographics or cognitive function between the two groups. The Z-scores of the D group were significantly higher than those of the ND group (p<0.05). Additionally, there was a significant positive correlation between the GDS score and Z-scores in the parahippocampal gyrus. Conclusions Our findings suggested that the severity of depressive symptoms is associated with the severity of parahippocampal atrophy in AD patients.

The Relationship Between Medial Temporal Lobe Atrophy and Cognitive Impairment in Patients With Dementia With Lewy Bodies.

BACKGROUND: The relationship between medial temporal lobe atrophy (MTA) and cognitive impairment in patients with dementia with Lewy bodies (DLB) remains unclear. We examined this relationship using voxel-based specific regional analysis system for Alzheimer disease (VSRAD) advance software, which allowed us to quantify the degree of MTA on images obtained from magnetic resonance imaging (MRI) scans. METHODS: Thirty-seven patients diagnosed with DLB were recruited and scanned with a 1.5 Tesla MRI scanner. All MRI data were analyzed using VSRAD advance. The target volume of interest (VOI) included the entire region of the entorhinal cortex, hippocampus, and amygdala. The degree of MTA was obtained from the averaged positive z-score (Z score) on the target VOI, with higher scores indicating more severe MTA. Mini-Mental State Examination (MMSE) and the Revised Hasegawa Dementia Scale (HDS-R), which strengthened the measures of memory and language more than MMSE, were used to assess the presence of cognitive impairment. RESULTS: A negative correlation was found between the Z score and MMSE total scores or the HDS-R total scores. A stepwise multiple regression analysis performed to adjust the covariate effects of sex, age, the onset age of the disease, duration of DLB, years of education, and donepezil treatment showed that the HDS-R total scores were independently associated with the Z score, whereas MMSE total scores were not. CONCLUSIONS: These results suggest that MTA is related to cognitive impairment in patients with DLB, particularly the regions of orientation, immediate and delayed recall, and word fluency.

C-reactive Protein is a Useful Marker for Early Prediction of Anastomotic Leakage after Esophageal Reconstruction.

BACKGROUND: Esophageal anastomotic leakage is one of the most fatal complications after esophagectomy and increases the hospitalization length. We aimed to identify a convenient clinical marker of anastomotic leakage in the early postoperative period. METHODS: In total, 108 patients who underwent esophagectomy were retrospectively screened, and 96 were used to validate the overall results. All 108 patients underwent physical examinations and determination of their white blood cell count, C-reactive protein level, platelet count, fibrinogen level, fibrin degradation product level, and antithrombin III level until postoperative day 6. RESULTS: Anastomotic leakage occurred in 21 of the 108 patients (median detection, 8 days). The C-reactive protein level on postoperative day 3 and fibrinogen level on postoperative day 4 in the leakage group were significantly higher than those in the nonleakage group. Receiver operating characteristic curves for detection of anastomotic leakage were constructed; the cutoff value of C-reactive protein on postoperative day 3 was 8.62 mg/dL, and that of fibrinogen on postoperative day 4 was 712 mg/dL. Anastomotic leakage occurred in 23 of the 96 patients in the validation group. There was a significant difference between the leakage and nonleakage groups when the C-reactive protein threshold on postoperative day 3 was set at 8.62 mg/dL. However, there was no difference between the groups when the fibrinogen threshold on postoperative day 4 was set at 712 mg/dL. CONCLUSIONS: The C-reactive protein level on postoperative day 3 is a valuable predictor of anastomotic leakage after esophagectomy and might allow for earlier management of this complication.

Correlation between right medial temporal lobe atrophy and persecutory delusions in patients with dementia of the Alzheimer's type demonstrated on VSRAD advance.

BACKGROUND: The relationship between focal brain atrophy and delusions in patients with Dementia of the Alzheimer's Type (DAT) is not well understood. Few studies have been reported on the association between medial temporal atrophy (MTA) and persecutory delusions in patients with DAT. We investigated the relationship between MTA and persecutory delusions in patients with DAT using voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) advance software, which allows us to quantify the laterality and the degree of MTA on magnetic resonance imaging (MRI) scans. METHODS: Thirty-one patients diagnosed with DAT were recruited and scanned with a 1.5 tesla MRI scanner. All MRI data were analyzed using VSRAD advance. The target volume of interest (VOI) included the entire region of the entorhinal cortex, hippocampus, and amygdala. The degree of MTA was obtained from the averaged positive z score (Z-score) on the target VOI, with higher scores indicating more severe. These DAT patients were divided into a group with (D group: n = 13) and without (ND group: n = 18) persecutory delusions. RESULTS: In the D group, the mean the bilateral, right, and left Z-scores were 2.45, 2.69, and 2.19, respectively. These mean Z-scores of the ND group were 2.00, 2.00, and 1.95, respectively. The right Z-scores for the D group were significantly higher than those for the ND group (p < 0.05). CONCLUSIONS: These findings suggest that right MTA could contribute to the development of persecutory delusions in patients with DAT.

Effects of body composition on early postoperative discharge and postoperative complications in patients with esophageal cancer.

BACKGROUND: Patients with esophageal cancer are prone to nutrition deterioration during the perioperative period and have a high incidence of postoperative complications, prolonging hospitalization. Decreased muscle mass is a known contributor to this deterioration, but there is insufficient evidence on the effects of preoperative maintenance and improvement of muscle mass. In this study, we evaluated the relationship between body composition, early postoperative discharge, and postoperative complications in patients with esophageal cancer. METHODS: This was a retrospective cohort study. Patients were divided into an early discharge group and a control group, who were discharged ≤21 days postoperatively and >21 days, respectively. The relationship of body composition to postoperative complications and discharge time in patients was evaluated via multivariate logistic regression using isotemporal substitution (IS) models. RESULTS: The early discharge group comprised 31 of the 117 patients (26%) included. This group had significantly lower incidences of sarcopenia and postoperative complications than the control group. In logistic regression analyses estimating the effect of changes in body composition using the IS models, preoperative replacement of 1 kg of body fat with 1 kg of muscle mass was associated with significantly higher odds of early discharge (odds ratio [OR], 1.28; 95% CI, 1.03-1.59) and lower odds of postoperative complications (OR, 0.81; 95% CI, 0.66-0.98). CONCLUSION: In patients with esophageal cancer, a preoperative increase in muscle mass may reduce postoperative complications and hospital stay duration.

Hypomethylation of Alu repetitive elements in esophageal mucosa, and its potential contribution to the epigenetic field for cancerization.

BACKGROUND: Aberrant hypermethylation of specific genes is present in esophageal squamous cell carcinomas (ESCCs). Such hypermethylation is also present in normal-appearing esophageal mucosae of ESCC patients and is considered to contribute to the formation of a field for cancerization. On the other hand, the presence of global hypomethylation in ESCCs or in their background esophageal mucosae is unknown. METHOD: We collected 184 samples of esophageal mucosae (95 normal mucosae from healthy subjects, and 89 non-cancerous background mucosae from ESCC patients) and 93 samples of ESCCs. Methylation levels of repetitive elements (Alu, LINE1) and cancer/testis antigen genes (NY-ESO-1, MAGE-C1) were measured by bisulfite pyrosequencing and quantitative methylation-specific PCR, respectively. RESULTS: Methylation levels of Alu, LINE1, NY-ESO-1, and MAGE-C1 were significantly lower in ESCCs than in their background and normal mucosae. Also, in the background mucosae, a significant decrease of the Alu methylation level compared with the normal mucosae was present. In ESCCs, methylation levels of the two repetitive elements and the two cancer/testis antigen genes were correlated with each other. CONCLUSION: This is the first study to show the presence of global hypomethylation in ESCCs, and even in their non-cancerous background mucosae. Alu hypomethylation might reflect the severity of an epigenetic field for cancerization.

Synthesis of manzacidin A and C: efficient construction of quaternary carbon stereocenters bearing nitrogen substituents.

An efficient synthetic method for stereoselective construction of asymmetric quaternary carbon stereocenters, bearing nitrogen in the form of Boc-protected allyl amines, has been developed. This methodology is employed in the synthesis of marine alkaloids, manzacidin A and C.

Identification and validation of DNA methylation markers to predict lymph node metastasis of esophageal squamous cell carcinomas.

BACKGROUND: The presence of lymph node metastasis in esophageal squamous cell carcinoma (ESCC) patients is a critical factor for decision of treatment strategy. However, there have been no molecular markers to assess lymph node metastasis. In this study, we aimed to identify CpG islands (CGIs) whose DNA methylation statuses are associated with the presence of lymph node metastasis. MATERIALS AND METHODS: A total of 96 ESCCs were divided into a screening set (n = 48) and a validation set (n = 48). Genome-wide methylation analysis was performed by methylated DNA immunoprecipitation-CGI microarray analysis. Methylation levels were analyzed by quantitative methylation-specific PCR (qMSP). RESULTS: Genome-wide methylation analysis identified 25 CGIs differentially methylated between 8 ESCCs with lymph node metastasis and 4 without. In the screening set, 7 CGIs had significantly different methylation levels (P < 0.05) between the ESCCs with and without lymph node metastasis, and cut-off methylation levels for these CGIs were determined. The validation set was analyzed with the prefixed cut-offs, and methylation statuses of 2 CGIs in the vicinities of PAX6 and ENST00000363328 were validated to be associated with the presence of lymph node metastasis. Using these 2 markers, the presence was predicted with a sensitivity of 93% and specificity of 57%. In addition, the methylation statuses of the 2 CGIs were significantly associated with disease-free survival (P = 0.006). CONCLUSIONS: Methylation statuses of these 2 CGIs were significantly associated with the presence of lymph node metastasis of ESCCs. These CGIs are promising markers to predict the presence of lymph node metastases.

[Thoracoscopic radical esophagectomy for cancer treatment].

More than 15 years have passed since thoracoscopic surgery was first employed in Japan as a treatment for esophageal cancer with curative intent. Because of the proliferation of techniques that can be used to obtain an adequate operative field, such as hand assist, placing the patient in the prone position, etc., the number of approaches to thoracoscopic surgery has been increasing, contrary to expectations of standardization. The technique of mediastinal dissection has been refined with increasing knowledge of microanatomy, which can be clarified under the magnified view provided in thoracoscopic surgery. Comparable pulmonary function and survival are achieved after both thoracoscopic surgery and open-chest surgery. The accreditation board of the Japan Society for Endoscopic Surgery is now standardizing the thoracoscopic technique. To avoid surgical mistakes, thorough knowledge and adherence to the proper indications are essential.

Relationship between GLIM criteria and disease-specific symptoms and its impact on 5-year survival of esophageal cancer patients.

BACKGROUND & AIMS: Malnutrition is common in patients with esophageal cancer, which affects their prognosis. The global leadership initiative on malnutrition (GLIM) criteria was recently proposed as the world's first diagnostic criteria for malnutrition. However, the association between esophageal cancer patients and the GLIM criteria is unclear. The purpose of this study was to evaluate the percentage of patients diagnosed with malnutrition preoperatively using the GLIM criteria, assess the impact of disease-specific symptoms on the severity of malnutrition, and assess the prognostic relevance of GLIM defined malnutrition in patients with esophageal cancer. METHODS: This was a retrospective single-center cohort study. Preoperative nutritional status of patients with esophageal cancer hospitalized between June 2009 and July 2011 was evaluated according to the GLIM criteria. Factors related to severe malnutrition as per the GLIM criteria were analyzed using multivariable logistic regression analysis. The association between the severity of malnutrition based on the GLIM criteria and 5-year survival was assessed using a multivariable Cox proportional hazard model. RESULTS: Overall, 117 esophageal cancer patients were nutritionally assessed. The percentage of moderate malnutrition and severe malnutrition was 21% and 23%, respectively. Subjective dysphagia [odds ratio (OR): 7.39, 95% confidence interval (CI): 1.46-37.52] and subjective esophageal obstruction (OR: 10.49, 95% CI: 3.47-31.70) were independent risk factors for severe malnutrition. The hazard ratio (HR) for 5-year mortality tended to be higher for moderate malnutrition (HR: 2.12, 95% CI: 0.91-4.95); however, it was not significantly associated with either moderate malnutrition or severe malnutrition (HR: 1.30, 95% CI: 0.52-3.27). Cases that were censored during the follow-up period probably affected the survival results. CONCLUSION: Subjective feelings of dysphagia and esophageal obstruction might be related to malnutrition severity in esophageal cancer patients. Malnutrition assessed by the GLIM criteria was not significantly associated with 5-year survival.

A case of peripancreatic plexiform schwannoma.

BACKGROUND: Plexiform schwannoma is one of the least common variants of schwannoma, accounting for only 5% of all schwannoma cases. It generally occurs in the skin and subcutaneous tissues and is uncommon in deep soft tissue or viscera. We present an extremely rare case of plexiform schwannoma arising from the peripancreatic plexus. CASE PRESENTATION: A 29-year-old man presented with hyperglycemia detected during a medical checkup. He was diagnosed with type 1 diabetes based on the clinical findings and laboratory tests. During the diagnostic process for diabetes, a 2.5 cm mass was incidentally detected in the pancreas by abdominal ultrasound. Contrast-enhanced computed tomography revealed a mass that was gradually enhanced at the body and tail of the pancreas. Magnetic resonance imaging revealed low signal intensity of the mass on T1-weighted images and high signal intensity on T2-weighted and diffusion-weighted images. Magnetic resonance cholangiopancreatography showed no abnormal findings in the main pancreatic duct. Endoscopic ultrasonography (EUS) showed a lobulated, low-echoic mass with a clear boundary. EUS-guided fine needle biopsy was performed, and spindle-shaped cells that were diffusely immunopositive for S-100 and negative for c-kit and desmin were detected, resulting in a diagnosis of a neurogenic tumor arising from the pancreas or the peripancreatic nerve plexus. The patient underwent laparoscopic spleen-preserving distal pancreatectomy. Although the tumor was connected to the splenic plexus, the splenic artery could be divided along its adventitial plane. Macroscopic findings of the excised tumor consisted of multiple yellowish-white nodules, and its histopathological features were consistent with plexiform schwannoma. There was no pancreatic tissue on the dorsal surface of the tumor, which suggested that the tumor arose from the peripancreatic nerve plexus. CONCLUSIONS: The findings documented herein can aid in the differential diagnosis of peripancreatic schwannoma and in planning appropriate treatment.

[A case of SIADH developed during neoadjuvant chemotherapy using nedaplatin and 5-fluorouracil in a patient with esophageal cancer].

A 77-year-old male with thoracic esophageal cancer (cT3N3M0, Stage III) received nedaplatin at 80mg/m2 for 1 day and 5-fluorouracil at 800mg/m2 for 5 days as neoadjuvant treatment. On the fifth day of treatment, he lapsed into a coma (Japan Coma Scale 30), and his serum sodium concentration was found to be decreased to 116mEq/L. We concluded hyponatremia due to SIADH (syndrome of inappropriate secretion of antidiuretic hormone) induced by chemotherapy based on the fact that the patient had no finding of dehydration, particular history of related disorders, serum hypoosmolality accompanied by urine hyperosmolality and persistent urinary sodium excretion. We treated him with fluid restriction, sodium supplement and administration of loop diuretic. Then he regained consciousness and appropriate serum sodium level. Thereafter, hyponatremia was corrected without recurrence, and the patient underwent radical esophagectomy safely. He has been in good condition without recurrence of esophageal cancer after surgery.

A two-year follow-up study of chronic fatigue syndrome comorbid with psychiatric disorders.

AIMS: Chronic fatigue syndrome patients often have comorbid psychiatric disorders such as major depressive disorders and anxiety disorders. However, the outcomes of chronic fatigue syndrome and the comorbid psychiatric disorders and the interactions between them are unknown. Therefore, a two-year prospective follow-up study was carried out on chronic fatigue syndrome patients with comorbid psychiatric disorders. METHODS: A total of 155 patients who met the Japanese case definition of chronic fatigue syndrome were enrolled in this study. Comorbid psychiatric disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria. Patients with comorbid psychiatric disorders received psychiatric treatment in addition to medical therapy for chronic fatigue syndrome. Seventy patients participated in a follow-up interview approximately 24 months later. RESULTS: Of the 70 patients with chronic fatigue syndrome, 33 patients were diagnosed as having comorbid psychiatric disorders including 18 major depressive disorders. Sixteen patients with psychiatric disorders and eight patients with major depressive disorders did not fulfill the criteria of any psychiatric disorders at the follow up. As for chronic fatigue syndrome, nine out of the 70 patients had recovered at the follow up. There is no significant influence of comorbid psychiatric disorders on the outcome of chronic fatigue syndrome. CONCLUSIONS: Chronic fatigue syndrome patients have a relatively high prevalence of comorbid psychiatric disorders, especially major depressive disorders. The outcomes of chronic fatigue syndrome and psychiatric disorders are independent. Therefore treatment of comorbid psychiatric disorders is necessary in addition to the medical treatment given for chronic fatigue syndrome.

New Insight on Fumigation Action of Essential Oil, Commercial Fungicide and Low Oxygen Microenvironment on Museum Mold, Alternaria alternata.

Fumigation has been the most convenient method in the field of pest control in museums. In this study, as fumigants, ethanol 70%, deltamethrin (commercial pesticide (CP) ) , essential oil (EO) from Pinus regida, and low oxygen microenvironment (0.1%, (LOM) ) were tested individually and jointly against museum fungal strain Alternaria alternata. Three concentrations of each CP and EO were chosen for evaluating the individual effect. In the joint action fumigation process, three lower concentrations of CP and EO were tested in LOM. The rate of mycelial growth inhibition at each fumigation process was determined by two steps: 1) directly after the fumigation process and 2) after 7 d of the inoculation of the fumigated spores in new medium and incubating it in normal condition. The results demonstrated that applying of each chemical (CP or EO) in LOM enhanced its fungicidal activity and that effect of EO improved from fungistatic to fungicidal by jointing with LOM.

Clinical Outcome and Surgical Technique of Laparoscopic Posterior Rectopexy Using the Mesh With Anti-adhesion Coating.

We herein present an innovative technique of laparoscopic posterior mesh rectopexy (LPMR) for full-thickness rectal prolapse and report the clinical outcomes in our institution. Ten consecutive patients who were treated with our latest LPMR technique using mesh with an anti-adhesion coating from June 2014 to May 2017 were retrospectively analyzed. All patients were women with a mean age of 63.6 years (range, 39 to 82 y). The median operative time and blood loss volume were 197.5 minutes (range, 156 to 285 min) and 0 mL (range, 0 to 152 mL), respectively. No perioperative complications occurred, including surgical site infection, pneumonia, urinary dysfunction, and intestinal obstruction. The median follow-up duration was 768 days (range, 396 to 1150 d). During the follow-up, the cumulative incidence of full-thickness rectal prolapse and any mesh-related complications was 0. It may be possible to eliminate retroperitoneal closure using a mesh with an anti-adhesion coating. Our LPMR technique appears safe and acceptable.