Augmented fluoroscopic bronchoscopy (AFB) versus percutaneous computed tomography-guided dye localization for thoracoscopic resection of small lung nodules: a propensity-matched study.

BACKGROUND: Dye localization is a useful method for the resection of unidentifiable small pulmonary lesions. This study compares the transbronchial route with augmented fluoroscopic bronchoscopy (AFB) and conventional transthoracic CT-guided methods for preoperative dye localization in thoracoscopic surgery. METHODS: Between April 2015 and March 2019, a total of 231 patients with small pulmonary lesions who received preoperative dye localization via AFB or percutaneous CT-guided technique were enrolled in the study. A propensity-matched analysis, incorporating preoperative variables, was used to compare localization and surgical outcomes between the two groups. RESULTS: After matching, a total of 90 patients in the AFB group (N = 30) and CT-guided group (N = 60) were selected for analysis. No significant difference was noted in the demographic data between both the groups. Dye localization was successfully performed in 29 patients (96.7%) and 57 patients (95%) with AFB and CT-guided method, respectively. The localization duration (24.1 ± 8.3 vs. 21.4 ± 12.5 min, p = 0.297) and equivalent dose of radiation exposure (3.1 ± 1.5 vs. 2.5 ± 2.0 mSv, p = 0.130) were comparable in both the groups. No major procedure-related complications occurred in either group; however, a higher rate of pneumothorax (0 vs. 16.7%, p = 0.029) and focal intrapulmonary hemorrhage (3.3 vs. 26.7%, p = 0.008) was noted in the CT-guided group. CONCLUSION: AFB dye marking is an effective alternative for the preoperative localization of small pulmonary lesions, with a lower risk of procedure-related complications than the conventional CT-guided method.

Computed tomography-guided dual localization with microcoil and patent blue vital dye for deep-seated pulmonary nodules in thoracoscopic surgery.

BACKGROUND/PURPOSE: In video-assisted thoracic surgery (VATS) resection of small lung nodules, preoperative dye marking around the visceral pleura provides surface localization to help initiate resection, while implantation of a fiducial marker such as a microcoil can provide inner localization to aid nodule resection under fluoroscopic guidance. We aimed to determine whether dual localization with microcoil placement and dye marking is safe and useful for guiding the resection of small deep-seated lung nodules. METHODS: We retrospectively evaluated data pertaining to 39 consecutive patients (40 nodules) managed between January 2016 and December 2017 in our hospital. Dual localization with patent blue V dye and microcoil was performed preoperatively because the pulmonary nodules were expected to be difficult to visualize or palpate intraoperatively. The patients underwent computed tomography-guided dual localization in a single puncture and were then transferred to the operation room. Intraoperative fluoroscopy was used to ensure that the lung tissue resected included the microcoil. RESULTS: All 40 lesions were successfully resected using the dual localization technique followed by fluoroscopy-assisted thoracoscopic surgery. The median lesion diameter and depth were 0.9 and 1.7 cm, respectively, while the median margin/diameter ratio in the first resected specimen was 1.25. One patient had failure of localization due to partial release of the microcoil into the chest wall. Localization-related pneumothorax was detected in six of 39 patients (15.4%) and was always self-limited. CONCLUSION: Dual localization with microcoil placement and dye marking is safe and supports successful VATS resection of small deep-seated lung nodules.

Application of capillary electrophoresis with electrokinetic supercharging and sweeping for the on-line preconcentration of phenolic acids.

Phenolic acids are natural antioxidants. Many studies have confirmed that these compounds can reduce the risk of developing chronic diseases such as diabetes, cardiovascular diseases, and certain cancers. In this work, we developed a rapid and efficient capillary electrophoresis method with an on-line preconcentration technique that could be used to simultaneously analyze 10 commonly found phenolic acids in plants. Briefly, phosphate buffer solution (pH 2) was filled into an uncoated fused silica capillary as the leading electrolyte, and then samples which were prepared in borate buffer (as the terminating ion) were loaded by electrokinetic injection (-10 kV, 900 s). After sample injection, both ends of the capillary were switched to the vial containing phosphate buffer with sodium dodecyl sulfate. The separation was then performed in micellar electrokinetic chromatography (MEKC) mode at -20 kV. During the method validation, the correlation coefficient of the regression curve was measured as greater than 0.997 and the relative standard deviation and relative error were lower than 9.63 % and 4.7 %, respectively. The limits of detection (LODs, S/N = 3) of these 10 analytes ranged from 0.01 to 2.5 ng/mL. Compared with the conventional capillary zone electrophoresis (CZE) method, the sensitivity for the analytes could be increased up to 25,000-fold. The method that we developed here was applied successfully to the detection of phenolic acids in fruit juices.

Graphene oxide-based micropatterns via high-throughput multiphoton-induced reduction and ablation.

In this study, a developed temporal focusing-based femtosecond laser system provides high-throughput multiphoton-induced reduction and ablation of graphene oxide (GO) films. Integrated with a digital micromirror device to locally control the laser pulse numbers, GO-based micropatterns can be quickly achieved instantly. Furthermore, the degree of reduction and ablation can be precisely adjusted via controlling the laser wavelength, power, and pulse number. Compared to point-by-point scanning laser direct writing, this approach offers a high-throughput and multiple-function approach to accomplish a large area of micro-scale patterns on GO films. The high-throughput micropatterning of GO via the temporal focusing-based femtosecond laser system fulfills the requirement of mass production for GO-based applications in microelectronic devices.

Prognostic factors for successful varicocelectomy to treat varicocele-associated male infertility.

The present study identified prognostic factors for successful varicocelectomy for the treatment of varicocele-induced male infertility. All varicoceles were diagnosed and graded by physical examination and ultrasound. Pre- and postoperative analysis of semen specimens measured sperm density, morphology and motility. 'Responder' and 'non-responder' status was determined by semen analyses at 3, 6 and 12 months postoperatively. Varicocele Grades 1, 2 and 3 were found in 16, 36 and 28 patients, respectively; 49 patients (61.3%) were responders based on improved seminograms. Significant postoperative increases were noted in sperm density (from 18.20 ± 14.76 × 10(6) to 32.36 ± 24.81 × 10(6)mL(-1); P<0.001), sperm morphology (from 57.21 ± 17.35% to 62.66 ± 15.18%; P=0.006) and percentage motility (from 29.89 ± 14.71% to 50.92 ± 19.30%; P<0.001). Multivariate logistic regression indicated that age (odds ratio (OR) 0.56; P<0.001) and preoperative sperm density (OR 1.22; P=0.001) had significant unfavourable and favourable associations, respectively, with the likelihood of successful varicocelectomy. Furthermore, a preoperative sperm density of 12 × 10(6)mL(-1) as a cut-off point was able to predict successful varicocelectomy with a sensitivity of 77.6% and specificity of 77.4% (area under the curve=0.85; P<0.001; 95% confidence interval 0.76-0.92). Age and preoperative sperm density are prognostic factors for successful varicocelectomy. The results of the present study may allow clinicians to predict surgical improvement in fertility in patients with varicocele.

Cohnella formosensis sp. nov., a xylanolytic bacterium isolated from the rhizosphere of Medicago sativa L.

A Gram-positive, spore-forming, aerobic, rod-shaped, xylanolytic bacterium designated strain CC-Alfalfa-35(T) was isolated from the rhizosphere of Medicago sativa L. in Taiwan. Phylogenetic analysis based on 16S rRNA gene sequence showed that strain CC-Alfalfa-35(T) was affiliated to the genus Cohnella. Strain CC-Alfalfa-35(T) shared 95.3 % pairwise 16S rRNA gene sequence similarity to the type strain of the type species of the genus Cohnella (Cohnella thermotolerans DSM 17683(T)) besides showing a similarity of 97.4-93.6 % with other recognized species of the genus Cohnella. The DNA-DNA hybridization value between CC-Alfalfa-35(T) and Cohnella thailandensis KCTC 22296(T) was 37.7 % ± 1.7 % (reciprocal value, 55.7 % ± 3.0 %). Predominant cellular fatty acids were iso-C16 : 0 and anteiso-C15 : 0. The polar lipid profile constituted diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol, lysyl-phosphatidylglycerol, three unidentified phospholipids and three unidentified aminophospholipids. The major respiratory quinone was MK-7 and the DNA G+C content was 58.3 mol%. Strain CC-Alfalfa-35(T) contained meso-diaminopimelic acid as the major diamino acid in the cell-wall peptidoglycan. Based on the polar lipid and fatty acid profiles, which were in line with those of C. thermotolerans DSM 17683(T), coupled with additional distinguishing genotypic, phenotypic and chemotaxonomic features, strain CC-Alfalfa-35(T) is proposed to represent a novel species within the genus Cohnella, for which the name Cohnella formosensis sp. nov. is proposed. The type strain is CC-Alfalfa-35(T) ( = JCM 18405(T) = BCRC 80428(T)).

Detection of Trichomonas vaginalis Infection in Chronic Prostatitis/Chronic Pelvic Pain Syndrome Patients by Rapid Immunochromatographic Test.

This study aims to evaluate associations between the immunochromatographic rapid test technique and Trichomonas vaginalis (TV) infection in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in Taiwan. All patients received post-prostate massage urine (VB3) Trichomonas rapid tests. The demographic characteristics and urogenital symptoms of CP/CPPS were recorded. Routine urinalysis of VB3 was also performed, and laboratory examination results of semen were recorded if available. A total of 29 patients with TV infection and 109 without TV infection were enrolled, which reflected that the prevalence in patients with TV infection was approximately 21%. Patients with TV infection displayed a significantly higher frequency of suprapubic/lower abdominal pain (p = 0.034), semen leukocyte > 5/high-power field (HPF) (p = 0.020), and an inflammatory type (category IIIA) (p = 0.005) than patients without TV infection. A higher prevalence of TV infection was found in patients with category IIIA (47.37%). No significant difference was found in the symptom duration and other clinical symptoms. In conclusion, the high prevalence of TV infection was revealed in CP/CPPS patients using the VB3 rapid Trichomonas test, especially in CP/CPPS patients with category IIIA. Thus, rapid TV testing might be vital for CP/CPPS patients in the hospital.

Efficacy and Safety of the Sandwich Method in Patients with Benign Prostate Hyperplasia: Bipolar Transurethral Resection with GreenLight Vaporization.

Benign prostate hyperplasia (BPH) refers to the nonmalignant enlargement of the transition zone of the prostate gland. While holmium laser enucleation of the prostate and open simple prostatectomy are effective in the management of patients with large prostates, they have some limitations. Thus, this study aimed to analyze the efficacy and safety of the sandwich method of bipolar transurethral resection of the prostate (B-TURP) and GreenLight photoselective vaporization of the prostate (GLPVP) in patients with large prostates. Patients diagnosed with BPH who underwent the sandwich method with B-TURP and GLPVP from 2015 to 2020 were included. Efficacy analyses included the change in the uroflowmetry results in both group A (prostate volume < 80 g) and group B (prostate volume ≥ 80 g), and complication analyses included perioperative complications, early postoperative complications at three months and late postoperative complications at 12 months. The cohort comprised 188 and 44 patients in groups A and B, respectively. The prostate volume of groups A and B were 50.83 ± 14.14 g and 102.03 ± 19.36 g (p < 0.001), respectively. The peak (Qmax) and average (Qavg) flow rates were comparable between the two groups. The only significant difference noted was in the postoperative post-void residual (PVR) urine. Improvement was seen in all the variables including the Qmax, Qavg and PVR urine in each group. No patient experienced perioperative complications. Analysis of the overall one-year complication rate showed no significant difference between the two groups. The sandwich method of B-TURP and GLPVP may be feasible for the management of patients with large prostate.

The Effect of Intrathoracic Lesion Location on Initial Tyrosine Kinase Inhibitor Response in Advanced Oncogene-Addicted Non-Small Cell Lung Cancer: A Comparison Between RECIST 1.1 and a Novel Method of Response Assessment (MAX).

INTRODUCTION: Different subtypes of non-small cell lung cancer (NSCLC) are associated with different patterns of metastatic spread. Anatomic location of lesions in the chest may influence patterns of cancer growth and the shrinkage to therapy. Consequently, lesion location could affect apparent response rates per RECIST. We sought to explore this and develop, as needed, treatment response assessments less affected by the location. METHODS: Cases of advanced oncogene-addicted NSCLC (EGFR, ALK, and ROS1) with pre- and on-therapy imaging during initial targeted therapy were identified. Lesions located in the lung parenchyma, pleural space or intra-thoracic lymph nodes were identified and analyzed separately from each other by RECIST 1.1 (unidimensional measurements) and by a novel MAX methodology (bidimensional measurements) which takes the axis with the greatest absolute percentage change on therapy in each location as the representative measurement. RESULTS: Three hundred three patients with 446 unidimensional measured lesions were included for RECIST analysis. Two hundred forty nine patients with 386 bidimensional measured lesions were included for MAX analysis, as well as the analysis comparing RECIST and MAX. Intrathoracic location significantly impacted percentage shrinkage and the response rate per RECIST. The response rates for pleural, intra-parenchymal and nodal lesions were 34.1%, 49.6%, and 68.3%, respectively (P = .0002). The MAX methodology both increased the apparent treatment effect and made it consistent between intrathoracic locations. For pleural, parenchymal and nodal lesions, the MAX calculated response rate were 83.7%, 72.2%, and 75.4%, respectively (P-value = .24). CONCLUSION: Intrathoracic lesion location affects RECIST-based treatment effectiveness estimations. The MAX methodology neutralizes location effect when examining impact of treatment and should be explored further.

Lactate peak in muscle disclosed by magnetic resonance spectroscopy in a patient with CPEO-plus syndrome.

A 25-year-old man complained of progressive diplopia and limb weakness for 3 years. Mitochondrial myopathy was suspected according to clinical presentation, elevated serum lactate concentration, and muscle histopathology. However, next-generation mtDNA sequencing (mtDNA NGS) of the blood only revealed a likely benign variant in the MT-CO1 gene (m.6510G > A). An mtDNA NGS study on the muscle sample revealed a large mtDNA deletion (m.5788-m.16071). The patient was diagnosed as having CPEO-plus syndrome related to the large mtDNA deletion. Notably, magnetic resonance spectroscopy revealed a doublet peak at 1-2 ppm in his edematous right vastus lateralis, which indicated lactate accumulation. Thus, muscle imaging and appropriate genetic tests facilitated the diagnosis of mitochondrial myopathy.

The reliability of ultrasonographic measurements for testicular volume assessment: comparison of three common formulas with true testicular volume.

The aim of this study was to determine the correlation of ultrasonographic estimates of testicular volume with true testicular volume and to compare the accuracy and precision of the three most commonly utilized formulas. A total of 15 patients underwent high-resolution ultrasonography (US) analysis for testicular volume before orchiectomy. Testicular volume was calculated using three common formulas: (1) length (L) x width (W) x height (H) x 0.52; (2) the empirical formula of Lambert: L x W x H x 0.71; and (3) L x W2 x 0.52. The actual volume of each removed testis was estimated directly by a water displacement method. Thus, four volume measurements were obtained for each of the 30 testes. The obtained data were analyzed by paired t-test and linear regression analysis. All three US formula measurements significantly underestimated the true testicular volume. The largest mean biases were observed with US formula 1, which underestimated the true volume by 3.3 mL (31%). US formula 2 had a smaller mean difference from the true volume, with an underestimation of only 0.6 mL (6%). Regression analysis showed that formulas 1 and 2 had better R2 values than formula 3. However, all three US formulas displayed a strong linear relationship with the true volume (R2= 0.872-0.977; P < 0.001). Among the commonly used US formulas, the empirical formula of Lambert (L x W x H x 0.71) provided better accuracy than the other two formulas evaluated, and better precision than formula 3. Therefore, the formula of Lambert is the optimal choice in clinical practice.

Combined virtual-assisted lung mapping (VAL-MAP) with CT-guided localization in thoracoscopic pulmonary segmentectomy.

BACKGROUND/OBJECTIVE: Virtual assisted lung mapping (VAL-MAP) is a bronchoscopic lung marking technique developed to assist in navigational lung resection. It can be used for nodule localization and segmental identification. This article presents our initial experience of thoracoscopic pulmonary segmentectomy using combined VAL-MAP and computed tomography (CT)-guided localization. MATERIAL AND METHODS: Markings with India Ink were made bronchoscopically, before surgery, using a virtual bronchoscopy system (LungPoint® Planner) without fluoroscopy guidance. Post VAL-MAP CT scans localized the actual markings. All data on patients, markings, and outcomes were retrospectively collected, and the contribution of VAL-MAP to the operation was graded by the surgeon. RESULTS: From March 2017 to September 2017, 24 consecutive patients received the VAL-MAP marking procedure before thoracoscopic segmentectomy. Nineteen patients also received pre-operative CT-guided percutaneous localization after VAL-MAP; fifteen patients received CT-guided localization with dye (patent blue V) and microcoil, and four patients received with dye only. Of the 101 marking attempts made in all the patients, 71 (70.3%) were identified as contributing to the surgery. No clinically evident complications were associated with the procedure. A total of 24 segmentectomies were thoracoscopically conducted for 18 cases of lung cancer and six cases of benign diseases. CONCLUSION: The combination of VAL-MAP and CT-guided percutaneous localization contribute to precise thoracoscopic pulmonary segmentectomy.

Nitrite Protects Neurons Against Hypoxic Damage Through S-nitrosylation of Caspase-6.

Aims: The coordination of neurons to execute brain functions requires plenty of oxygen. Thus, it is not surprising that the chronic hypoxia resulting from chronic obstructive pulmonary diseases (COPD) can cause neuronal damage. Injury in the cortex can give rise to anxiety and cognitive dysfunction. This study investigated what causes hypoxia-induced neuronal injury and what strategies might be used to protect neurons against such damage. Results: This study found that hypoxia in primary cortical neurons caused neurite retraction, a caspase-6-dependent process. The hypoxic stress activated caspase-6 within the neurite, leading to microtubule disassembly and neurite retraction. The effect of hypoxia on caspase-6 activation, microtubule disassembly, and neurite retraction was alleviated by nitrite treatment. The protective role of nitrite was further supported by the observation that the active-site Cys146 of caspase-6 was S-nitrosylated in hypoxic neuro-2a cells treated with nitrite. We further validated the beneficial effect of nitrite on neuronal function against hypoxic stress in vivo. Using the wild-type or Apo E-/- mice exposed to chronic hypoxia as a model, we demonstrated that supplementing drinking water with nitrite suppressed active caspase-6 in the cortex of the brain, concomitant with the prevention of hypoxia-induced anxiety in the animals. Innovation: These results are the first evidence of a new pathway for the activation of caspase-6 and the first to indicate that nitrite can protect neurons against chronic hypoxic insult. Conclusion: Our findings suggest that nitrite holds great potential for the treatment of diseases such as COPD associated with hypoxia-induced neuronal injury.

The extract of Hibiscus syriacus inducing apoptosis by activating p53 and AIF in human lung cancer cells.

Natural products including plants, microorganisms and marine life provide rich resources for anticancer drug discovery. The root bark of Hibiscus syriacus has been used as an antipyretic, anthelmintic and antifungal agent in Asia. The antiproliferative effects of H. syriacus on human lung cancer cells were evaluated with bio-assays. The apoptotic activity was detected by Hoechst 33342 DNA staining and annexin V staining. The expression of caspases, p53, apoptosis induced factor (AIF), Bcl-2 and Bax were evaluated with Western blotting. The in vivo anticancer activity was evaluated using A549-xenograft model. The acetone extract of H. syriacus (HS-AE) exhibited a better cytotoxic effect on lung cancer cells than its methanol extract (HS-ME) or water extract (HS-WE). The IC(50) values of HS-AE on A549 (adenocarcinoma), H209 (squamous cell carcinoma) or H661 (large cell carcinoma) lung cancer cells ranged from 14 to 22 microg/ml after 48 hours of treatment. After 48 hours of exposure, HS-AE (15 microg/ml) induced A549 cell apoptosis to 48 +/- 3.6% of the control. Using Western blotting, HS-AE appears to suppress the expression of p53 and AIF. The results of the in vivo study showed that HS-AE suppresses growth in A549 subcutaneous xenograft tumors. These results indicate that HS-AE exerts significant and dose-dependent antiproliferative effects on cancer cells in vitro and in vivo, which prompts us to further evaluate and elucidate the bioactive component(s) of H. syriacus.

Complete genome sequence of Siansivirga zeaxanthinifaciens CC-SAMT-1T, a flavobacterium isolated from coastal surface seawater.

Here we present the complete genome sequence of Siansivirga zeaxanthinifaciens CC-SAMT-1T, a flavobacterium isolated from coastal surface seawater. A 3.3Mb genome revealed remarkable specialization of this bacterium particularly in the degradation of sulfated polysaccharides available as detritus or in dissolved phase. Besides utilizing high molecular weight organic biopolymers, this strain appears to accomplish assimilatory sulfate reduction, sulfide oxidation, and acquisition and inter-conversion of inorganic carbon. Genes encoding zeaxanthin and three different kinds of DNA photolyase/cryptochrome (senses blue light) were present, while genes that code for blue light sensing BLUF domain proteins and red/far-red light sensing phytochromes were absent. Furthermore, CC-SAMT-1T lacked the rhodopsin photosystem and all other genes that confer any other known forms of phototrophy. The genomic data revealed that CC-SAMT-1T is highly adapted to sulfur-rich coastal environments, where it most likely contributes to marine carbon and sulfur cycles by metabolizing sulfated polysaccharides as well as inorganic sulfur.

A pilot study on Trichomonas vaginalis in women with recurrent urinary tract infections.

BACKGROUND: Trichomoniasis and recurrent urinary tract infections (UTIs) shared similar risk factors, age distribution and overlapping symptoms. The aim of this study was to determine the prevalence of Trichomonas vaginalis (TV) in women with recurrent UTIs, attending a urology clinic in a medical center, in order to inform screening and treatment policies. METHODS: Women with recurrent UTIs, defined as the presence of lower urinary tract symptoms (dysuria, frequency and urgency) and three positive urine cultures on voided urine specimens in the previous year, were enrolled prospectively from January 2013 to April 2014. Urine samples were collected for culture and tested for TV using immunochromatographic strip. Outpatient follow-up was arranged to diagnose any symptomatic UTI recurrence. RESULTS: Sixty-five women were recruited. Mean age was 57.4 ± 14.3 year-old and follow-up duration was 9.5 ± 4.0 months. The prevalence of TV was 16.9% (11/65). Eight women had UTI recurrence in the follow-up period. Recurrence rate did not differ in patients with and without concomitant TV infection. CONCLUSIONS: Given the high prevalence of TV, we suggest that testing for TV should be considered in women with recurrent UTIs. Further larger studies are needed to evaluate the potential benefit of treating TV in this group of patients.

Early endoscopic primary realignment decreases stricture formation and reduces medical costs in traumatic complete posterior urethral disruption in a 2-year follow-up.

BACKGROUND: There are presently several options for the management of posterior urethral disruption. However, these options remain controversial for several reasons. Thus, this medical issue has been continuously investigated. METHODS: From 1991 to 2001, 22 patients with complete posterior urethral disruption out of 720 urethral injury cases were retrospectively reviewed using strict criteria. The 22 cases were grouped into two different management groups, the endoscopic early realignment (ER) group and the delayed urethrotomy (DU) group. The frequency of optic internal urethrotomy for urethral strictures and individual medical costs were evaluated over a two-year period. RESULTS: The ER group had a mean frequency of 1.3 ± 0.82 urethrotomies in the first year and 1.8 ± 1.23 over two years while the DU group had a significantly higher urethrotomy frequency, 2.5 ± 1.35 in the first year and 4.1 ± 1.91 over two years. The costs for the DU group were 50% higher than the ER group at the end of second year. CONCLUSION: An early endoscopic realignment operation saved up to NT 36,000 (New Taiwan Dollars) in costs with an average of 2.3 fewer further urethrotomy procedures in each case during the 2-year follow-up period. Therefore, early urethral realignment for traumatic complete posterior urethral disruption should be encouraged to prevent intractable urethral stricture and lower medical costs.

Intravenous paclitaxel against metastasis of human gastric tumors of diffuse type.

PURPOSE: Gastric cancer is one of the leading cancerous diseases worldwide. It is diagnosed often at the advanced stage for which chemotherapy is the main treatment option. The prognosis remains poor for metastatic, especially the diffuse type, gastric cancers. We investigated the efficacy of intravenously administered paclitaxel treating metastases of locally disseminated gastric tumors of diffuse type. METHODS: Transfection of green fluorescent proteins (GFP)-expressing plasmid into human gastric cancer MKN45 cells of diffuse type was performed, and MKN45-GFP cells constitutively expressing GFP were isolated. The MKN45-GFP cells were orthotopically inoculated into the mouse peritoneal cavity, and tumor growth and organ metastases were monitored. Liver metastases were harvested, re-inoculated, monitored for liver metastases again, and harvested for further inoculation. This in vivo selection procedure was repeated to isolate a subline with high metastatic abilities demonstrated by in vitro invasion abilities using Transwell((R)) system. By visualizing the GFP-expressing tumors, the effects of intravenously administered paclitaxel against the growing peritoneally disseminated and metastasized tumors in nude mice without laparotomy were measured. RESULTS: An in vivo selected gastric cancer cell line MKN45-GFP-ip4 with high metastatic ability was established. Its invasion ability was inhibited by paclitaxel treatments in vitro. The growths of metastatic and intraperitoneally disseminated MKN45-GFP-ip4 tumors were significantly suppressed by intravenous paclitaxel treatments in nude mice. CONCLUSIONS: We found that intravenous paclitaxel is active against the metastases of human gastric cancer of peritoneal diffuse type, which warrants further investigations on optimizing the perioperative regimens with intravenous paclitaxel therapy for gastric cancer in patients.

Loupe-assisted vs microsurgical technique for modified one-layer vasovasostomy: is the microsurgery really better?

OBJECTIVES: To compare the outcome of loupe-assisted, modified one-layer vasovasostomy (MOLV) and conventional microsurgical MOLV for vasectomy reversal. PATIENTS AND METHODS: We retrospectively analysed data for 74 patients who had a MOLV between 1993 and 2003; 42 had the standard microsurgical (x10-16) MOLV (group 1, mean age 40.5 years, SD 6.3, range 30-58) and 32 a loupe-assisted (x 3) MOLV (group 2, mean age 41.3 years, SD 6, range 28-64). With general anaesthesia, each operation was performed as an outpatient procedure or with hospitalization for one night after surgery. The patients' characteristics, patency rate, paternity rate, and operative duration were compared. RESULTS: The mean (SD, range) duration of obstruction was 8.1 (5.0, 0.33-25) years in group 1 and 9.2 (4.8, 0.33-27) years in group 2. The postoperative patency and pregnancy rates were 91% and 43% for group 1 and 89% and 39% for group 2. There were no complications during or after surgery in either group, but the surgery was significantly faster for group 2. CONCLUSIONS: There was no significant difference in the patency and paternity rates between loupe-assisted and microsurgical MOLV. The surgery was significantly faster with the loupe-assisted method. Because of the shorter operation duration and less expensive instruments required that should reduce the cost, the loupe-assisted MOLV should be considered as the best choice for simple vasectomy reversal.