Treating ureteric obstruction secondary to gynecological disease assisted with retrograde ureteroscopic stenting.

OBJECTIVE: To analyze the technical experience and clinical efficacy of ureteroscopic treatment of middle and lower ureteral obstruction due to gynecological disease. PATIENTS AND METHODS: From January 2007 to December 2015, 58 cases of ureteral obstruction were collected in 55 patients caused by gynecological factors. 19 cases had the history of gynecological iatrogenic injury and 39 cases were secondary to gynecological tumors. Different situations of luminal stenosis included obliteration, suture penetration, transection and unrecognized ureteral orifice. The ureteral stents were retrogradely placed ureteroscopically assisted by holmium laser or transurethral plasma kinetic resection. RESULTS: A total of 51 cases of operations were completed successfully by one-stage ureteroscopic stenting with the mean operation time of 33.5 min. No severe complications were observed. The serum creatinine two weeks after operation had a significant decline compared with that of preoperation (p<0.05). The mean follow-up time was 5.3 months. 44 cases with successful stent placement showed nice improvement of hydronephrosis by ultrasound. CONCLUSIONS: Ureteroscopic stent placement with the use of holmium laser or plasma kinetic resection device, has good clinical effects, which provides a relatively simple and minimal-invasive treatment option to resolve middle and lower ureteral obstruction caused by complex gynecological factors.

Spontaneous retropharyngeal emphysema: A case report.

Retropharyngeal emphysema is usually secondary to trauma, iatrogenic injury, and obstructive respiratory diseases. Without prompt and adequate treatment, severe complication such as airway compromise may occur. Spontaneous retropharyngeal emphysema, defined by the presence of free air in the retropharyngeal space without any precipitating cause, is a rare clinical condition in pediatric otolaryngology. The predominant symptoms are sore throat, odynophagia, dysphagia, and neck pain. Here, we report a case of spontaneous retropharyngeal emphysema.

Particulate Air Pollutants, Brain Structure, and Neurocognitive Disorders in Older Women.

Introduction: An increasing number of studies have suggested that exposure to particulate matter (PM) may represent a novel - and potentially amendable - environmental determinant of brain aging. The current longitudinal environmental epidemiological study addressed some important knowledge gaps in this emerging field, which combines the study of air pollution and neuroepidemiology. The investigators hypothesized that long-term PM exposure adversely influences global brain volume and brain regions (e.g., frontal lobe or hippocampus) that are critical to memory and complex cognitive processing or that are affected by neuropathological changes in dementia. It was also hypothesized that long-term PM exposure results in neurovascular damage and may increase the risk of mild cognitive impairment (MCI) and -dementia. Methods: The investigators selected a well-characterized and geographically diverse population of older women (N = 7,479; average age = 71.0 ± 3.8 years at baseline) in the Women's Health Initiative (WHI) Memory Study (WHIMS) cohort (1996-2007), which included a subcohort (n = 1,403) enrolled in the WHIMS-Magnetic Resonance Imaging (WHIMS-MRI) study (2005-2006). Residence-specific yearly exposures to PM ≤ 2.5 µm in aerodynamic diameter (PM2.5) were estimated using a Bayesian maximum entropy spatiotemporal model of annual monitoring data (1999-2007) recorded in the U.S. Environmental Protection Agency (U.S. EPA) Air Quality System (AQS). Annual exposures (1996-2005) to diesel PM (DPM) were assigned to each residential census tract in a nationwide spatiotemporal mapping, based on a generalized additive model (GAM), to conduct census tract-specific temporal interpolation of DPM on-road estimates given by the U.S. EPA National-Scale Air Toxics Assessment Program. Multiple linear regression and multicovariate-adjusted Cox models were used to examine the associations, with statistical adjustment for multiple potential confounders. Results: The investigators found that participants had smaller brain volumes, especially in the normal-appearing white matter (WM), if they lived in locations with higher levels of cumulative exposure (1999-2006) to PM 2.5 before the brain MRI scans were performed. The associations were not explained by sociodemographic factors, socioeconomic status, lifestyle factors, or other clinical characteristics. Analyses showed that the adverse effect on brain structure in the participants was driven primarily by the smaller WM volumes associated with cumulative PM2.5 exposures, which were present in the WM divisions of the association brain area (frontal, parietal, and temporal lobes) and corpus callosum. Increased DPM exposures were associated with larger ventricular volume, suggesting an overall atrophic effect on the aging brains. The participants tended to have smaller gray matter (GM) volumes if they lived in areas with the highest (i.e., fourth quartile) estimated cumulative DPM exposure in the 10 years before the brain MRI scans, compared with women in the first to third quartiles. This observed association was present in the total brain GM and in the association brain cortices. The associations with normal-appearing WM varied by DPM exposure range. For women with estimated cumulative exposure below that of the fourth quartile, increased DPM estimates were associated with smaller WM volumes. However, for women with increased cumulative DPM exposures estimates in the fourth quartile, WM volumes were larger. This pattern of association was found consistently in the association brain area; no measurable difference was found in the volume of the corpus callosum. These observed adverse effects of cumulative exposure to PM2.5 (linking exposure with smaller WM volumes) and to DPM (linking exposure in the highest quartile with smaller GM volumes) were not significantly modified by existing cardiovascular diseases, diabetes mellitus, obesity, or measured white blood cell (WBC) count. MRI measurements of the structural brain showed no differences in small-vessel ischemic diseases (SVID) in participants with varying levels of cumulative exposure to PM2.5 (1999-2006) or DPM (1996-2005), and no associations between PM exposures and SVID volumes were noted for total brain, association brain area, GM, or WM. For neurocognitive outcomes followed until 2007, the investigators found no evidence for increased risk of MCI/dementia associated with long-term PM exposures. Although exploratory secondary analyses showed different patterns of associations linking PM exposures separately with MCI and dementia, none of the -results was statistically significant. A similar lack of associations between PM exposures and MCI/dementia was found across the subgroups, with no strong indications for effect modification by cardiovascular diseases, diabetes mellitus, obesity, or WBC count. Conclusions: The investigators concluded that their study findings support the hypothesized brain-structure neurotoxicity associated with PM exposures, a result that is in line with emerging neurotoxicological data. However, the investigators found no evidence of increased risk of MCI/dementia associated with long-term PM exposures.To better test the neurovascular effect hypothesis in PM-associated neurotoxic effects on the aging brain, the investigators recommend that future studies pay greater attention to selecting optimal populations with repeated measurements of cerebrovascular damage and address the possibility of selection biases accordingly. To further investigate the long-term consequence of brain-structure neurotoxicity on pathological brain aging, future researchers should take the pathobiologically heterogeneous neurocognitive outcomes into account and design adequately powered prospective cohort studies with improved exposure estimation and valid outcome ascertainment to assess whether PM-associated neurotoxicity increases the risks of pathological brain aging, including MCI and dementia.

Tube Feeding among Elder in Long-Term Care Facilities: A Systematic Review and Meta-Analysis.

OBJECTIVE: The use of tube feeding for elderly patients with poor nutritional intake is a ubiquitous method of feeding. This systematic review and meta-analysis were carried out to compare nutritional benefits of enteral feeding versus oral feeding in long-term care facilities. SETTING: Databases including the Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science and Google Scholar through April 2014 using keywords including enteral feeding, tube feeding or oral feeding combined with long term care facilities or nursing home. PARTICIPANTS: Eight articles, with 841 participants were included in meta-analysis and 13 articles were included in systematic review. The elderly had to live in long-term care institutions and could not be on any mechanically assisted ventilation systems or be in any type of post-operative status. MEASUREMENTS: The three investigators extracted and appraised data using the same study design, baseline characteristics, and outcomes, independently. RESULTS: Following a systematic review, 13 articles out of 8218 original research articles were selected for this analysis. Meta-analysis of tube-fed patients found lower levels of hemoglobin (Weighted Mean Difference (WMD -0.21g/dl; 95% CI -0.42 to -0.01; p=0.04) and creatinine (WMD -0.08g/dl; 95% CI -0.17 to 0.00, p=0.05). Moreover, the results showed that there were no benefits regarding body mass index (BMI), albumin, dietary intake of proteins, total calories and fat. CONCLUSIONS: The results show that tube feeding does not increase patients' nutrients absorption to improve nutritional status. Instead, these results indicate that oral feeding is better regarding some nutritional biochemical parameters.

Oxygen Uptake Efficiency Slope Predicts Major Cardiac Events in Patients With End-Stage Heart Failure.

INTRODUCTION: Oxygen uptake efficiency slope (OUES) has been shown as a predictor of stable heart failure (HF) survival. However, there is a lack of evidence for end-stage HF. OBJECTIVES: We aimed to investigate the prognostic value of OUES in end-stage HF patients. METHODS: The study design was a retrospective cohort. End-staged HF patients who had cardiopulmonary exercise testing (CPET) for evaluation between 2004 and 2009 were included. The primary outcomes were cardiac death and heart transplantation. The independent survival predictors were determined using Cox regression hazard model adjusted for demographics, New York Heart Association (NYHA) classification, medication, and left ventricular ejection fraction (LVEF). The Kaplan-Meier survival curves and log-rank test were used. Probability values less than .05 were considered significant. RESULTS: Mean age of the 128 patients was 50 ± 12 years and 93 were male. Mean LVEF was 23% ± 9%. Forty-three subjects suffered cardiac events (5 cardiac deaths and 38 urgent heart transplantations) during the 2-year follow-up period. Cox regression indicated that OUES and diuretics were significant predictors of 2-year survival, although peak oxygen uptake and ventilatory equivalent of carbon dioxide were not. Patients with high OUES (≥1.6) had a higher survival rate (P < .001; odds ratio [OR], 13.10; 95% confidence interval [CI], 3.30-58.63). The Kaplan-Meier curves show survival was significantly higher in those with OUES ≥1.6. CONCLUSIONS: OUES might be an aid in prognosis of patients with end-stage HF and useful in the assessment of patients unable to perform maximal exercise testing.

p38 mitogen-activated protein kinase activation in amygdala mediates κ opioid receptor agonist U50,488H-induced conditioned place aversion.

κ opioid receptor agonists produce aversive effects in rodents, however the underlying mechanisms remain unclear. Activation of p38 mitogen-activated protein kinase (MAPK) has been discovered to play a critical role in the modulation of affective behaviors. The present study was undertaken to detect the possible involvement of p38 MAPK in the aversive effects induced by κ opioid receptor activation. We found that the κ opioid receptor agonist trans-(±)-3,4-Dichloro-N-methyl-N-[2-(1-pyrrolidinyl)-cyclohexyl]benzenacetamide methanesulfonate salt (U50,488H) produced significant place aversion in mice as measured by the conditioned place preference procedure, accompanied with significant p38 MAPK activation in the amygdala, but not in the nucleus accumbens and hippocampus. Stereotaxic microinjection of the p38 MAPK inhibitor 4-(4-fluorophenyl)-2-(4-methylsulfonylphenyl)-5-(4-pyridy-l)-1H-imidazole (SB203580) into amygdala significantly inhibited p38 MAPK activation and completely blocked the conditioned place aversion in mice. Thus, these results suggested that activation of p38 MAPK in the amygdala was required to mediate κ opioid receptor-induced aversive behavior.

Risks of peripheral arterial occlusive disease in patients with obstructive sleep apnoea: a population-based case-control study.

OBJECTIVES: This study aimed to evaluate the risk of peripheral arterial occlusive disease (PAOD) in patients with obstructive sleep apnoea (OSA) using a nationwide claim database in Taiwan. DESIGN: A population-based case-control study. SETTING: Data from the Longitudinal Health Insurance Database 2000 of the Taiwan's National Health Insurance Research Database. PARTICIPANTS: Eleven thousand eight hundred and seventeen adult patients diagnosed with PAOD between January 1, 2001 and December 31, 2010 and 35 451 controls without PAOD frequency matched by sex, 10-year age interval and year of index date. MAIN OUTCOME MEASURES: Obstructive sleep apnoea and a number of comorbidities prior to the index date were assessed and analysed with logistic regression analyses. RESULTS: Univariate logistic regression analysis showed that PAOD was significantly associated with OSA (odds ratio, OR = 1.60, P < 0.001). Multivariate logistic regression analysis, adjusted for coronary artery disease or myocardial infarction, chronic kidney disease, hyperurecaemia and obesity, also showed that PAOD was significantly associated with OSA (adjusted OR = 1.37, P = 0.014). However, the association was attenuated when it was further adjusted for hypertension, hyperlipidaemia and diabetes mellitus (DM). CONCLUSION: Findings from this nationwide population-based study indicated that PAOD was significantly associated with OSA. Further studies are warranted to determine whether OSA may contribute to the development of PAOD indirectly via increasing the risks of hypertension, hyperlipidaemia and/or DM.

Thermal conductivity of graphene laminate.

We have investigated thermal conductivity of graphene laminate films deposited on polyethylene terephthalate substrates. Two types of graphene laminate were studied, as deposited and compressed, in order to determine the physical parameters affecting the heat conduction the most. The measurements were performed using the optothermal Raman technique and a set of suspended samples with the graphene laminate thickness from 9 to 44 µm. The thermal conductivity of graphene laminate was found to be in the range from 40 to 90 W/mK at room temperature. It was found unexpectedly that the average size and the alignment of graphene flakes are more important parameters defining the heat conduction than the mass density of the graphene laminate. The thermal conductivity scales up linearly with the average graphene flake size in both uncompressed and compressed laminates. The compressed laminates have higher thermal conductivity for the same average flake size owing to better flake alignment. Coating plastic materials with thin graphene laminate films that have up to 600× higher thermal conductivity than plastics may have important practical implications.

Genetic correlation of blood pressure responses to dietary sodium and potassium intervention and cold pressor test in Chinese population.

We examined the genetic association between blood pressure (BP) responses to dietary sodium and potassium intervention and to cold pressor test (CPT) in a large family-based dietary feeding study. The dietary intervention and CPT were conducted among 1906 participants in rural China. The dietary intervention included three 7-day periods of low-sodium feeding (51.3 mmol per day), high-sodium feeding (307.8 mmol per day) and high-sodium feeding plus potassium supplementation (60 mmol per day). BP responses to high-sodium intervention had strong genetic correlations (ρ(G)) with both BP responses to low sodium (ρ(G)=-0.43 to -0.54, P-values=0.0005 to 0.03) and to potassium supplementation (ρ(G)=-0.41 to -0.49, P-values=0.001 to 0.005) interventions. Most environmental correlations between BP responses to various dietary interventions were significant. The ρ(G) between BP responses to CPT and to high-sodium intervention and potassium supplementation were statistically significant. For example, the ρ(G) between maximum BP responses to CPT and BP responses to high-sodium intervention was 0.37 (P=0.006) for systolic BP (SBP) and 0.41 (P=0.002) for diastolic BP (DBP). The ρ(G) between maximum BP responses to CPT and BP responses to potassium intervention was -0.42 (P=0.001) for SBP and -0.46 (P=0.001) for SBP. Our study suggests that there are common genetic determinants that influence BP responses to dietary sodium and potassium interventions and to CPT.

Anti-diabetic effect of methylswertianin and bellidifolin from Swertia punicea Hemsl. and its potential mechanism.

In this study, we continued to investigate the hypoglycemic activity of Swertia punicea Helmsl., the hypoglycemic and hypolipidemic effects of methylswertianin and bellidifolin from the active ethyl acetate (EtOAc) fraction, and the potential mechanism(s) underlying the improvement of insulin resistance. Streptozotocin (STZ)-induced type 2 diabetic male BABL/c mice treated with methylswertianin and bellidifolin at different doses (orally, 200 and 100mg/kg body wt./day) for 4 weeks were analyzed in comparison to untreated mice. The results proved that methylswertianin and bellidifolin significantly reduced fasting blood glucose (FBG). The administration of both compounds also improved the oral glucose tolerance and lowered fasting serum insulin (FINS). Moreover, post-administration evaluation revealed lower serum total cholesterol (TC), low density lipoprotein cholesterol (LDL) and triglyceride (TG) levels and increased relative high density lipoprotein cholesterol (HDL) concentrations (HDL/TC). Methylswertianin and bellidifolin appeared to improve insulin resistance by enhancing insulin signaling. The expression levels of insulin-receptor alpha subunit (InsR-alpha), insulin-receptor substrate-1 (IRS-1), and phosphatidylinositol 3-kinase (PI3K) were also increased after administration. Meanwhile, methylswertianin and bellidifolin increased hepatic glycogen content, decreased glucokinase (GK) activities and increased glucose-6-phosphatase (G6Pase) activities. In conclusion, these result indicated that methylswertianin and bellidifolin could be useful for treating type-2 diabetes, likely via the improvement of insulin resistance (IR).

A method for the non-invasive assessment of chest wall growth in pectus excavatum patients.

INTRODUCTION: Various scales and measurement methods including X-rays and computed tomography (CT) have been used to quantify the degree of deformity in pectus excavatum. This study describes a non-invasive method for recording the deviation of the anterior chest wall (ACW) in pectus excavatum (PE) patients. Data obtained using this non-invasive method were compared with CT data. MATERIALS AND METHODS: Twenty-one patients treated at our institutions between June 2008 and February 2009 were enrolled in this study. All patients underwent CT and thermal plastic strip measurement. A thermal plastic strip was positioned and taped to the supine patient's ACW at the skin level from the posterior axillary line, over the depressed sternum, to the contralateral posterior axillary line and used to create a casting of the ACW. RESULTS: The funnel index (FI) was defined as the width of the ACW divided by its height; the concave index (CI) was defined as the breadth of the depressed area of the funnel chest divided by its depth. Pearson's correlation coefficient was used to compare the FI and CI obtained with the thermal plastic strip method and with CT; measurements obtained with both methods were found to correlate well (FI: r (2)=0.965; CI: r (2)=0.947). CONCLUSIONS: The thermal plastic strip measurement method provides a two-dimensional record of the shape of the anterior chest wall. The measurement can be repeated, does not involve the patient being exposed to radiation, and offers a good longitudinal assessment of chest wall growth in PE patients.

Prognostic value of 18-FDG uptake in early stage NSCLC.

BACKGROUND: We assessed whether the standard uptake of 18-fluorodeoxyglucose (18-FDG) in non-small cell lung cancers (NSCLC) differed between stage I and non-stage I tumors. METHODS: We reviewed 163 patients with NSCLC who underwent surgical lymph node dissection after tumor resection in 2002-2003. Patients with clinical stage I NSCLC who were investigated with preoperative positron emission tomography integrated computed tomography (PET-CT) scans using 18-FDG uptake were included; those with N2 disease were excluded. We reviewed 55 patients with a mean follow-up of 68 months. RESULTS: We analyzed 36 patients with stage I (Group 1) and 19 patients with non-stage I NSCLC (Group 2; 8 stage II, 7 stage III and 4 stage IV). There were no statistical differences in sex, age, tumor size, histological type, location or tumor differentiation between the groups. Group 1 had lower maximum standard 18-FDG uptake values (SUVmax) than Group 2 (4.9 +/- 2.7 vs. 8.1 +/- 3.8; P = 0.001). Using multiple logistic regression, patients with higher preoperative SUVmax and serum carcinoembryonic antigen (CEA) levels showed advanced tumor stages postoperatively (SUVmax > 4.7, odds ratio 7.65; CEA > 3.5 ng/mL, odds ratio 8.39). High 18-FDG uptake was significantly associated with reduced median survival (62.69 months for SUVmax < 4.7 and 40.89 months for SUVmax > 4.7). CONCLUSIONS: High preoperative 18-FDG uptake of tumors was significantly associated with reduced overall patient survival. The SUVmax of the tumor and serum CEA levels demonstrated aggressive tumors and could be helpful preoperatively when considering patients for induction therapy or resection.

Comprehensive evaluation of a novel nuclear factor-kappaB inhibitor, quinoclamine, by transcriptomic analysis.

BACKGROUND AND PURPOSE: The transcription factor nuclear factor-kappaB (NF-kappaB) has been linked to the cell growth, apoptosis and cell cycle progression. NF-kappaB blockade induces apoptosis of cancer cells. Therefore, NF-kappaB is suggested as a potential therapeutic target for cancer. Here, we have evaluated the anti-cancer potential of a novel NF-kappaB inhibitor, quinoclamine (2-amino-3-chloro-1,4-naphthoquinone). EXPERIMENTAL APPROACH: In a large-scale screening test, we found that quinoclamine was a novel NF-kappaB inhibitor. The global transcriptional profiling of quinoclamine in HepG2 cells was therefore analysed by transcriptomic tools in this study. KEY RESULTS: Quinoclamine suppressed endogenous NF-kappaB activity in HepG2 cells through the inhibition of IkappaB-alpha phosphorylation and p65 translocation. Quinoclamine also inhibited induced NF-kappaB activities in lung and breast cancer cell lines. Quinoclamine-regulated genes interacted with NF-kappaB or its downstream genes by network analysis. Quinoclamine affected the expression levels of genes involved in cell cycle or apoptosis, suggesting that quinoclamine exhibited anti-cancer potential. Furthermore, quinoclamine down-regulated the expressions of UDP glucuronosyltransferase genes involved in phase II drug metabolism, suggesting that quinoclamine might interfere with drug metabolism by slowing down the excretion of drugs. CONCLUSION AND IMPLICATIONS: This study provides a comprehensive evaluation of quinoclamine by transcriptomic analysis. Our findings suggest that quinoclamine is a novel NF-kappaB inhibitor with anti-cancer potential.

Cavernous hemangioma of the sternum.

Chest wall osseous hemangioma is a rare disease entity accounting for only 0.7% of all hemangiomas. Hemangioma of the sternum is extremely rare, and only three cases have been reported in the literature. We present an additional case of a sternal hemangioma with confirmation by surgical resection. There was no local recurrence during three years' follow-up. We review the pertinent literature and discuss the management of the entity.

Effect of ultrasonic treatment on the total phenolic and antioxidant activity of extracts from citrus peel.

Application of ultrasound to extract a variety of biologically active compounds from plant materials has been widely investigated. However, there are few reports on the local effect of ultrasonic irradiation on the yields of these compounds. In the present article, the local effect of ultrasonic treatment on total phenolic content (TPC) and antioxidant activities (ATT) of extracts from citrus peels was investigated. To optimize the extraction process, a response surface methodology (RSM) was used to evaluate the effects of ultrasonic variables including ultrasonic power, ultrasonic time, and extraction temperature on extracts from penggan (Citrus reticulata) peel. The results showed that TPC and ATT increased on increasing ultrasonic time and temperature. The maximum of TPC and ATT by ultrasonic treatment was observed in near ultrasonic irradiation surface, in which ultrasonic power appeared to be positive effect. Furthermore, when the effect of the 3 independent variables was evaluated simultaneously using RSM, the optimal ultrasonic conditions for responses were determined as: 42 to 45 W, 23 to 25 min, 31 to 34 degrees C. The results presented here emphasized that application of ultrasound should be considered both the optimization of ultrasonic variables and available ultrasonic device.

Brain nociceptive imaging in rats using (18)f-fluorodeoxyglucose small-animal positron emission tomography.

Preclinical exploration of pain processing in the brain as well as evaluating pain-relief drugs in small animals embodies the potential biophysical effects in humans. However, it is difficult to measure nociception-related cerebral metabolic changes in vivo, especially in unanesthetized animals. The present study used (18)F-fluorodeoxyglucose small-animal positron emission tomography to produce cerebral metabolic maps associated with formalin-induced nociception. Anesthesia was not applied during the uptake period so as to reduce possible confounding effects on pain processing in the brain. The formalin stimulation at the hind paw of rats resulted in significant metabolic increases in the bilateral cingulate cortex, motor cortex, primary somatosensory cortex, secondary somatosensory cortex, insular cortex, visual cortex, caudate putamen, hippocampus, periaqueductal gray, amygdala, thalamus, and hypothalamus. Among the measured areas, clear lateralization was only evident in the primary somatosensory cortex and hypothalamus. In addition, pretreatment with lidocaine (4 mg/kg, i.v.) and morphine (10 mg/kg, i.v.) significantly suppressed formalin-induced cerebral metabolic increases in these areas. The present protocol allowed identification of the brain areas involved in pain processing, and should be useful in further evaluations of the effects of new drugs and preclinical therapies for pain.

Clinical experience of Nuss procedure for pectus excavatum in adult female patients.

BACKGROUND: Pectus excavatum (PE) repair by Nuss procedure is well established in pediatrics, but studies of adult female patients are rare. We analyzed the efficacy of the Nuss procedure in adult, female PE patients. METHODS: We retrospectively reviewed adult patients who underwent Nuss repair of PE from April 2005 to November 2007. Precise morphologic characterization of the pectus allowed an appropriate shaping of the bars to achieve a symmetric repair. RESULTS: Out of 126 consecutive adult patients who underwent the Nuss procedure at our institution, 15 women with a mean age of 24.6 +/- 4.01 years were enrolled in the study. Their preoperative Haller index had a mean of 5.72 +/- 2.38. Seven patients (46.67 %) underwent repair with the insertion of double pectus bars. Complications included transient bilateral pneumothorax (n = 1) and right-sided pleural effusion (n = 1). One patient received a subsequent breast augmentation, which yielded a better thoracic contour. CONCLUSIONS: The Nuss procedure offers a high satisfaction rate and an acceptable complication rate for PE repair in adult female patients. A subsequent surgery for breast augmentation can be considered after the Nuss repair has stabilized.