Rapid On-Site AI-Assisted Grading for Lung Surgery Based on Optical Coherence Tomography.

The determination of resection extent traditionally relies on the microscopic invasiveness of frozen sections (FSs) and is crucial for surgery of early lung cancer with preoperatively unknown histology. While previous research has shown the value of optical coherence tomography (OCT) for instant lung cancer diagnosis, tumor grading through OCT remains challenging. Therefore, this study proposes an interactive human-machine interface (HMI) that integrates a mobile OCT system, deep learning algorithms, and attention mechanisms. The system is designed to mark the lesion's location on the image smartly and perform tumor grading in real time, potentially facilitating clinical decision making. Twelve patients with a preoperatively unknown tumor but a final diagnosis of adenocarcinoma underwent thoracoscopic resection, and the artificial intelligence (AI)-designed system mentioned above was used to measure fresh specimens. Results were compared to FSs benchmarked on permanent pathologic reports. Current results show better differentiating power among minimally invasive adenocarcinoma (MIA), invasive adenocarcinoma (IA), and normal tissue, with an overall accuracy of 84.9%, compared to 20% for FSs. Additionally, the sensitivity and specificity, the sensitivity and specificity were 89% and 82.7% for MIA and 94% and 80.6% for IA, respectively. The results suggest that this AI system can potentially produce rapid and efficient diagnoses and ultimately improve patient outcomes.

Seaward Migration and Larval Release Coincide with Lunar and Light-dark Cycles in Supratidal Land Crabs Cardisoma carnifex and Epigrapsus notatus.

Herein we investigated the synchronous breeding migration and larval release of ovigerous females in two dominant supratidal land crabs Cardisoma carnifex and Epigrapsus notatus in the mixed semidiurnal tidal regime in Taijiang National Park (Tainan, Taiwan). We mainly focused on the monthly and daily rhythms during the breeding season of migration and larval release for these two crabs. We also sought to understand what the main environmental cues were for these monthly and diel rhythms. Both lunar and tidal amplitude cycles are potential proximate causes for the monthly lunar/semilunar reproductive rhythm in crabs. Likewise, either the 24-hour (diel) light cycle or tidal cycle can act as the proximate cause for diel reproduction rhythm, and we investigated which one was the main factor that entrains the diel rhythm for these two species. We found that the season of migration and larval release in C. carnifex occured mainly between June and September during the rainy season while those of E. notatus occurred mainly between September and October, near the end of the rainy season. Regarding the rhythm of migration and larval release in monthly time scale, C. carnifex exhibited a semilunar rhythm following the syzygies and E. notatus exhibited a lunar rhythm following the full moon. However, these rhythms did not occur with the maximum amplitude nocturnal and diurnal high tides. This implies that the lunar cycle is a more important environmental cue than the tidal amplitude in the entrainment of the synchronous monthly breeding rhythm for these two species. This pattern is different from other intertidal crabs, most of which use the tidal amplitude cycle as the main environmental cue for larval release. In addition to Chiromantes haematocheir (a supratidal crab), our study provided two more species that live in the supratidal zone time their reproduction with respect to the lunar light cycle and independent of the tide amplitude cycles. For the diel rhythm, both species migrated to the shore and released larvae in the first half of the night during the flood tide. This suggests that the diel light cycle is a dominant cue for the determination of larval release timing for these two species. Larval release does not track the high slack tides, since larvae are only released during the first half of the night and these high slack tides occur only after midnight (0000-0600H) during the days of larval release for these two crab species.

Intraoperative application of optical coherence tomography for lung tumor.

On-site instant determination of benign or malignant tumors for deciding the types of resection is crucial during pulmonary surgery. We designed a portable spectral-domain optical coherence tomography (SD-OCT) system to do real-time scanning intraoperatively for the distinction of fresh tumor specimens in the lung. A total of 12 ex vivo lung specimens from six patients were enrolled. Three patients were diagnosed with invasive adenocarcinoma (IA), while the others were benign. After OCT-imaged reconstruction, we compared the qualitative morphology of OCT and histology among malignant, benign, and normal tissues. In addition, through analysis of the quantitative data, a discrete difference in optical attenuation coefficients around the junctional surface was shown by our data processing. This study demonstrated a feasible OCT-assisted resection guide by a rapid on-site tumor diagnosis. The results indicate that future deep learning of OCT-captured image systems able to improve diagnostic and therapeutic efficiency is warranted.

Impact of Perineural Invasion and Preexisting Type 2 Diabetes on Patients with Esophageal Squamous Cell Carcinoma Receiving Neoadjuvant Chemoradiotherapy.

Neoadjuvant chemoradiotherapy (neoCRT) followed by surgery is the cornerstone treatment strategy in locally advanced esophageal squamous cell carcinoma (ESCC). Despite this high- intensity multimodality therapy, most patients still experience recurrences and metastases, especially those who do not achieve a pathological complete response (pCR) after neoCRT. Here, we focused on identifying poor prognostic factors. In this retrospective cohort study; we enrolled 140 patients who completed neoCRT plus surgery treatment sequence with no interval metastasis. Overall, 45 of 140 patients (32.1%) achieved a pCR. The overall survival, disease-free survival (DFS), and metastasis-free survival was significantly better in patients with a pCR than in patients with a non-pCR. In the non-pCR subgroup, the presence of perineural invasion (PNI) and preexisting type 2 diabetes (T2DM) were two factors adversely affecting DFS. After adjusting for other factors, multivariate analysis showed that the hazard ratio (HR) was 2.354 (95% confidence interval [CI] 1.240-4.467, p = 0.009) for the presence of PNI and 2.368 (95% CI 1.351-4.150, p = 0.003) for preexisting T2DM. Patients with a combination of both factors had the worst survival. In conclusion, PNI and preexisting T2DM may adversely affect the prognosis of patients with ESCC receiving neoadjuvant chemoradiotherapy.

Molecular phylogeography reveals multiple Pleistocene divergence events in estuarine crabs from the tropical West Pacific.

Due to the lack of visible barriers to gene flow, it was a long-standing assumption that marine coastal species are widely distributed, until molecular studies revealed geographically structured intraspecific genetic differentiation in many taxa. Historical events of sea level changes during glacial periods are known to have triggered sequential disjunctions and genetic divergences among populations, especially of coastal organisms. The Parasesarma bidens species complex so far includes three named plus potentially cryptic species of estuarine brachyuran crabs, distributed along East to Southeast Asia. The aim of the present study is to address phylogeography and uncover real and hidden biological diversity within this complex, by revealing the underlying genetic structure of populations and species throughout their distribution ranges from Japan to West Papua, with a comparison of mitochondrial COX1 and 16S rRNA gene sequences. Our results reveal that the P. bidens species complex consists of at least five distinct clades, resulting from four main cladogenesis events during the mid to late Pleistocene. Among those clades, P. cricotum and P. sanguimanus are recovered as monophyletic taxa. Geographically restricted endemic clades are encountered in southeastern Indonesia, Japan and China respectively, whereas the Philippines and Taiwan share two clades. As individuals of the Japanese clade can also be found in Taiwan, we provide evidence of a third lineage and the occurrence of a potential cryptic species on this island. Ocean level retreats during Pleistocene ice ages and present oceanic currents appear to be the main triggers for the divergences of the five clades that are here addressed as the P. bidens complex. Secondary range expansions converted Taiwan into the point of maximal overlap, sharing populations with Japan and the Philippines, but not with mainland China.

The role of anthropogenic disturbance and invasion of yellow crazy ant in a recent decline of land crab population.

The yellow crazy ant, Anoplolepis gracilipes was first reported in Kenting National Park, Taiwan, in the 2000s, raising the concern of this invasive ant's potential effects on the native land crab populations. We investigated the distribution and abundance of A. gracilipes and its adverse effect on the land crab populations at four land crab hotspots within the park. Our survey results indicated that A. gracilipes was widespread and abundant at three of the study sites (Hsiangchiaowan, Shadao, and Natural Spring), while the distribution was much more confined at the fourth site (Houwan). Land crab populations experienced a notable decline at all the study sites except Houwan, indicating an inverse relationship between the population of land crabs and distribution/abundance of A. gracilipes. Combining the results of visual observations, the decline of land crab populations can be attributed, at least partially, to direct attacks by A. gracilipes on land crabs in their natural habitat and during the breeding migration season. Generalized additive model showed that worker abundance of this ant is associated with human disturbance levels, suggesting that anthropogenic disturbance may have contributed to the decline in land crab populations via promoting the abundance of A. gracilipes.

Dietary preferences of brachyuran crabs from Taiwan for marine or terrestrial food sources: evidence based on fatty acid trophic markers.

BACKGROUND: Trophic interactions are key processes, which determine the ecological function and performance of organisms. Many decapod crustaceans feed on plant material as a source for essential nutrients, e.g. polyunsaturated fatty acids. Strictly herbivorous feeding appears only occasionally in marine decapods but is common in land crabs. To verify food preferences and to establish trophic markers, we studied the lipid and fatty acid composition of the midgut glands of two marine crab species (Grapsus albolineatus and Percnon affine), one semi-terrestrial species (Orisarma intermedium, formerly Sesarmops intermedius), and one terrestrial species (Geothelphusa albogilva) from Taiwan. RESULTS: All species showed a wide span of total lipid levels ranging from 4 to 42% of the dry mass (%DM) in the marine P. affine and from 3 to 25%DM in the terrestrial G. albogilva. Triacylglycerols (TAG) were the major storage lipid compound. The fatty acids 16:0, 18:1(n-9), and 20:4(n-6) prevailed in all species. Essential fatty acids such as 20:4(n-6) originated from the diet. Terrestrial species also showed relatively high amounts of 18:2(n-6), which is a trophic marker for vascular plants. The fatty acid compositions of the four species allow to clearly distinguish between marine and terrestrial herbivorous feeding due to significantly different amounts of 16:0, 18:1(n-9), and 18:2(n-6). CONCLUSIONS: Based on the fatty acid composition, marine/terrestrial herbivory indices were defined and compared with regard to their resolution and differentiating capacity. These indices can help to reveal trophic preferences of unexplored species, particularly in habitats of border regions like mangrove intertidal flats and estuaries.

Multiple Environmental Factors Increase the Niche Complexity and Species Diversity of Brachyuran Crabs in an Intertidal Algal Reef Ecosystem in Northwestern Taiwan.

Algal reefs are one of the world's rare and poorly understood ecosystems. They are mainly distributed in the Mediterranean Sea, but one notable exception-an intertidal algal reef ecosystem in northwestern Taiwan-stretches for 27 km along the coast of Taoyuan, making it probably the largest algal reef coast found in shallow water. Despite the reef's rarity and striking characteristics, the coastal land that it is part of has undergone a series of developments and is now surrounded by industrial parks. Brachyuran crabs are one of the most abundant and visible groups of organisms in the intertidal zone. In the present study, we investigated the brachyuran crab community in this reef to provide a more detailed record of brachyuran crab species compositions in this intertidal algal reef ecosystem and illustrate the characteristics of this understudied ecosystem by comparing its species diversity and abundance with three natural variables- sampling time, tidal level, and season-in a wildlife refuge and north of the refuge. Two methods were used in the study: a qualitative method (to determine the species richness) and a quantitative method (to estimate the population density). We identified a total of 52 brachyuran species from 13 families in the habitats. The highest species richness was found in Datan G2, north of the wildlife refuge. The crab species composition in this algal reef is different from its compositions in coral and rocky reefs. Our analysis indicated that the species abundance is affected by multiple factors, and a single investigation is not enough to reflect the true population density of brachyuran crabs on this reef. In addition, we found that the sites outside the wildlife refuge were in much better condition than those in the wildlife refuge, and should therefore be included in the wildlife refuge. In particular, Datan, located north of the wildlife refuge, had the highest species richness, and the area's species composition was different from that of the nearby wildlife refuge. Thus, we strongly recommend that a) the Datan area be protected to maintain this high crab diversity and b) further research be performed to better understand brachyuran crab biology in the intertidal algal reef ecosystem.

Effects of Individualized Aerobic Exercise Training on Physical Activity and Health-Related Physical Fitness among Middle-Aged and Older Adults with Multimorbidity: A Randomized Controlled Trial.

The presence of multimorbidity in middle-aged and older adults, which reduces their physical activity and quality of life, is a global health challenge. Exercise is one of the most important health behaviors that individuals can engage in. Previous studies have revealed that aerobic exercise training is beneficial for healthy middle-aged and older adults and those with various chronic diseases, but few studies have designed individualized aerobic exercise training for individuals with multimorbidity. Although individuals with multimorbidity are considerably less adherent to physical activity interventions, telephone-based motivational interviewing may help in strengthening motivation and promoting behavioral change for increasing physical activity and health-related physical fitness. This study aimed to examine whether a 12-week individualized aerobic exercise training in a rehabilitation center combined with telephone-based motivational interviewing is effective in promoting physical activity and health-related physical fitness among middle-aged and older adults with multimorbidity. A randomized controlled trial was conducted. Forty-three participants (aged > 40) were recruited and randomly assigned to the intervention group, comparison group, or control group. The participants' physical activity and health-related physical fitness were assessed at baseline and at 12 weeks. The results indicated that after individualized aerobic exercise training combined with telephone-based motivational interviewing, the participants reported increased total physical activity (Fin = 481.3, p = 0.011), vigorous-intensity physical activity (Fin= 298.9, p = 0.007), dominant and nondominant hand grip (kg) (Fin = 1.96, p = 0.019; Fin = 2.19, p = 0.027, respectively), FEV1/FVC (Fin = 0.045, p = 0.043), VO2 max (ml/kg/min) (Fin = 5.30, p = 0.001), VO2 max predicted (%) (Fin = 21.6, p = 0.001), work (watts) (Fin = 22.5, p = 0.001), and anaerobic threshold (L/min) (Fin = 0.165, p = 0.011). Twelve weeks of individualized aerobic exercise training in the rehabilitation center combined with telephone-based motivational interviewing can increase the total physical activity, vigorous physical activity, and cardiorespiratory fitness of middle-aged and older adults with multimorbidity.

Effects of hyperinsulinemia on acquired resistance to epidermal growth factor receptor-tyrosine kinase inhibitor via the PI3K/AKT pathway in non-small cell lung cancer cells in vitro.

Patients with lung cancer harboring activating epidermal growth factor (EGFR) mutations and pre-existing diabetes have been demonstrated to exhibit poor responses to first-line EGFR-tyrosine kinase inhibitor (TKI) therapy. Strategies for the management of acquired resistance to EGFR-TKIs in patients with advanced non-small cell lung cancer (NSCLC) are urgently required. Only a limited number of studies have been published to date on the effects of insulin on EGFR-TKI resistance in NSCLC. Hence, the aim of the present study was to investigate the roles of hyperinsulinemia and hyperglycemia in mediating gefitinib resistance in NSCLC cells with activating EGFR mutations. In the present study, the HCC4006 cell line, which harbors EGFR mutations, was co-treated with gefitinib and long-acting insulin glargine. Whether hyperinsulinemia is able to mediate EGFR-TKI resistance in the NSCLC cell line harboring activating EGFR mutations was also investigated, and the possible underlying mechanisms responsible for these actions were explored. The inhibition of cell proliferation, and the potential mechanism of gefitinib resistance, were examined using an MTS proliferation assay and western blot analysis, and through the transfection of siRNAs. Whether the inhibition of AKT is able to overcome EGFR-TKI resistance induced by long-acting insulin was also investigated. The results obtained suggested that hyperinsulinemia induced by glargine upregulated NSCLC cell proliferation and survival, and induced gefitinib resistance. By contrast, the morphology and proliferation of the cells in a medium containing a 2-fold concentration of glucose were not significantly affected. Gefitinib resistance induced by hyperinsulinemia may have been mediated via the phosphoinositide 3-kinase (PI3K)/AKT pathway rather than the mitogen-activated protein kinase extracellular signal regulated kinase (MAPK/ERK) pathway. AKT serine/threonine kinase 1 knockdown by siRNA rescued the gefitinib resistance that was induced by hyperinsulinemia. In conclusion, hyperinsulinemia, but not hyperglycemia, was identified to cause the development of gefitinib resistance in NSCLC cells with activating EGFR mutations. However, additional studies are required to investigate strategies, such as co targeting hyperinsulinemia and the PI3K/AKT pathway, for overcoming EGFR-TKI resistance in patients with NSCLC.

Curcumin downregulates 8-br-cAMP-induced steroidogenesis in mouse Leydig cells by suppressing the expression of Cyp11a1 and StAR independently of the PKA-CREB pathway.

Although curcumin was widely applied as a functional food for different diseases, it was found to reduce serum testosterone level and fertility in male animals by unknown molecular mechanisms. Here in our study, we investigated the possible mechanisms of curcumin-suppressed testosterone production in Leydig cells. Our enzyme immunoassay results showed that curcumin cell-autonomously suppressed ovine luteinizing hormone-stimulated testosterone production in primary Leydig cells and 8-bromo-cyclic adenosine monophosphate (8-br-cAMP)-induced progesterone production in MA-10 cells. Furthermore, our real-time PCR, Western blot, and 22R-OHC/pregnenolone supplementing experiment data demonstrated that curcumin suppressed 8-br-cAMP-induced steroidogenesis in Leydig cells by inhibiting the expression of StAR and Cyp11a1. Interestingly, our Western blot data showed that although curcumin suppressed PKA activity, it did not alter the 8-br-cAMP-induced phosphorylation of CREB. On the contrary, the real-time PCR results showed that curcumin suppressed 8-br-cAMP-induced expression of Nr5a1 and Fos, which are crucial for cAMP-stimulated StAR and Cyp11a1 expression in Leydig cells. Collectively, our data demonstrated that curcumin may suppress cAMP-induced steroidogenesis in mouse Leydig cells by down-regulating Nr5a1/Fos-controlled StAR and Cyp11a1 expression independently of the PKA-CREB signaling pathway.

Long-term feeding of high-fat plus high-fructose diet induces isolated impaired glucose tolerance and skeletal muscle insulin resistance in miniature pigs.

BACKGROUND: During the prediabetic development, the changes in ß-cell function and tissue-specific insulin resistance have been described. However, there are conflicting views in insulin secretory capacity between early clinical observation and recent proposed mathematical model. On the basis of digestive and metabolic similarities with humans, swine have great potential as an animal model to investigate the progressive mechanisms of prediabetes. The aim of this study was to investigate the insulin secretory response and tissue-specific insulin resistance in a dietary-induced prediabetic porcine model. METHODS: Adult male Taiwan Lee-Sung miniature pigs were randomized into two groups: (1) low-fat diet and (2) high-fat plus high-fructose diet (HFHF; 20.9% crude fat and 17.8% fructose). During the 12-month dietary intervention, body weights and blood glucose levels were measured monthly. Intravenous glucose tolerance test was used for measuring glucose tolerance and insulin secretory capacity. At the end of the experiment, liver and soleus muscle specimens were collected for ex vivo insulin sensitivity testing. RESULTS: The results showed that the HFHF group had obesity, hyperinsulinemia, and dyslipidemia, but normal fasting glucose levels. The HFHF pigs exhibited enhanced first- and second-phase insulin secretion and high 2-h postload glucose levels in intravenous glucose tolerance test. Furthermore, the skeletal muscle specimens from the HFHF group were desensitized to insulin stimulation as shown by the lack of AKT Ser473 phosphorylation; however, the liver specimens remained a normal response. CONCLUSIONS: In conclusion, the HFHF diet-fed pigs developed isolated impaired glucose tolerance corresponding to prediabetes with an intense insulin secretory response and skeletal muscle insulin resistance.

Dosimetric predictors of acute haematological toxicity in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy.

OBJECTIVE: Haematological toxicity (HT) is common in patients with oesophageal cancer (EC) treated with chemoradiotherapy (CRT). The Quantitative Analysis of Normal Tissue Effects in the Clinic guidelines provide no dose constraints for the bone marrow (BM) to avoid HT. We aimed to determine dosimetric factors associated with HT during CRT for EC. METHODS: 41 patients with EC treated with neoadjuvant cisplatin and 5-fluorouracil-based CRT were retrospectively reviewed. Associations between the dose-volume histogram parameters of thoracic bones and blood cell count changes during CRT were assessed using logistic regression analyses. Receiver-operating characteristic curves were used to derive optimal dosimetric planning constraints. Vx indicates the total organ volume percentage exceeding a radiation dose of x (Gy). RESULTS: Greater thoracic vertebrae and rib irradiation doses, including mean vertebral dose (MVD), thoracic vertebrae V5-30 (TVV5-30), mean rib dose and rib V5-20, were associated with increased leukopenia (grade ≥ 3) risk. Additional BM sites (sternum, scapulae and clavicles) did not influence HT. White blood cell and absolute neutrophil count nadirs were associated with increased irradiation doses to the thoracic vertebrae, ribs and sternum. Chemotherapy cycle number was not significantly associated with severe neutropenia or leukopenia. Cut-off values with the highest likelihood of avoiding leukopenia were MVD < 25.9 Gy, TVV20 < 70% and TVV10 < 77%. CONCLUSION: Thoracic bone irradiation dose was significantly associated with HT after adjusting for chemotherapy effects. Efforts to maintain MVD < 25.9 Gy, TVV10 < 77% and TVV20 < 70% could reduce HT. ADVANCES IN KNOWLEDGE: This is the first study addressing issues concerning HT in patients with neoadjuvant CRT-treated EC.

Species diversity of fiddler crabs, genus Uca Leach, 1814 (Crustacea: Ocypodidae), from Taiwan and adjacent islands, with notes on the Japanese species.

The fiddler crabs, genus Uca Leach, 1814 (Decapoda, Ocypodidae) of Taiwan, including the offshore islands of Penghu (Pescadores), Kinmen (Quemoy), Matsu (Matzu), and Dongsha (Pratas), are revised, with the recognition of five subgenera and 15 species, viz. Uca (Austruca) Bott, 1973: U. lactea (De Haan, 1835), U. perplexa (H. Milne Edwards, 1837), U. triangularis (A. Milne-Edwards, 1873); U. (Gelasimus) Latreille, 1817: U. borealis Crane, 1975, U. jocelynae Shih, Naruse & Ng, 2010, U. tetragonon (Herbst, 1790), U. vocans (Linnaeus, 1758); U. (Paraleptuca) Bott, 1973: U. crassipes (White, 1847), U. splendida (Stimpson, 1858); U. (Tubuca) Bott, 1973: U. acuta (Stimpson 1858), U. arcuata (De Haan, 1835), U. coarctata (H. Milne Edwards, 1852), U. dussumieri (H. Milne Edwards, 1852), U. paradussumieri (Bott, 1973); and U. (Xeruca) Shih, 2015: U. formosensis Rathbun, 1921. Among them, U. acuta, U. paradussumieri, and U. vocans are confirmed to be distributed in Taiwan. Uca formosensis is endemic to Taiwan. The Uca species of the main islands of Japan are also listed. Four species (U. arcuata, U. lactea, U. crassipes and U. borealis) are known, but the recent additional records of U. perplexa and U. vocans need further confirmation. Except U. acuta, U. borealis, U. formosensis, U. lactea, and U. paradussumieri, other 10 Taiwanese species can be found from the Ryukyus too. Only one endemic species, U. boninensis, is reported from the Ogasawara (Bonin) Islands. A key to the 18 species of Uca found in East Asia is also provided in this study.

A chest drainage system with a real-time pressure monitoring device.

BACKGROUND: Tube thoracostomy is a common procedure. A chest bottle may be used to both collect fluids and monitor the recovery of the chest condition. The presence of the "tidaling phenomenon" in the bottle can be reflective of the extent of patient's recovery. OBJECTIVES: However, current practice essentially depends on gross observation of the bottle. The device used here is designed for a real-time monitoring of change in pleural pressure to allow clinicians to objectively determine when the lung has recovered, which is crucially important in order to judge when to remove the chest tube. METHODS: The device is made of a pressure sensor with an operating range between -100 to +100 cmH2O and an amplifying using the "Wheatstone bridge" concept. Recording and analysis was performed with LABview software. The data can be shown in real-time on screen and also be checked retrospectively. The device was connected to the second part of a three-bottle drain system by a three-way connector. RESULTS: The test animals were two 40-kg pigs. We used a thoracoscopic procedure to create an artificial lung laceration with endoscopic scissors. Active air leaks could result in vigorous tidaling phenomenon up to 20 cmH2O. In the absence of gross tidaling phenomenon, the pressure changes were around 0.25 cmH2O. CONCLUSIONS: This real-time pleural pressure monitoring device can help clinicians objectively judge the extent of recovery of the chest condition. It can be used as an effective adjunct with the current chest drain system.

Bilateral pulmonary metastectomy through a unilateral single-port thoracoscopic approach.

A 58-year-old woman underwent radical proctectomy 19 months prior to admission. The initial diagnosis was rectal adenocarcinoma of pathological stage T2N0M0. She was discharged five days after the operation. She was followed by abdominal computed tomographic (CT) scan at 3, 9 and 18 months after the operation. Eighteen months after the operation, follow-up abdominal CT scan revealed tiny nodules in the bilateral lower lobes. Subsequent CT scan of the chest showed two tiny nodules in the right lower lobe and a single tiny nodule in left lower lobe. She then underwent single port thoracoscopic surgery through the right side for resection of the nodules. Using a single port wound, we excised the two tiny nodules on the right side and the one tiny nodule in the left lower lobe across the mediastinum. She was discharged four days later. The final pathology report showed those three nodules were metastases from an adenocarcinoma in the colon.

A preliminary report on the feasibility of single-port thoracoscopic surgery for diaphragm plication in the treatment of diaphragm eventration.

INTRODUCTION: Thoracoscopic surgery is a popular widely used surgical technique in the treatment of common chest conditions. Conventional thoracoscopic surgery utilizes multiple small wounds for carrying out the procedure. Many procedures can also be performed with a single small port wound. In this study, we performed diaphragm plication using the techniques of single-port thoracoscopic surgery. MATERIALS AND METHODS: From July 1st, 2008 to December 31th, 2011, there were 21 patients admitted to our hospital due to diaphragm eventration. All of them underwent diaphragm plication. The initial 11 patients underwent two-port thoracoscopic surgery while the subsequent 10 patients underwent single-port thoracoscopic surgery. RESULTS: The side of diaphragm eventration was on the left in all of the cases. The mean operative time was 87.3 minutes and the mean follow-up time was 17 months. There was no procedure-related complication or mortality. The time required for surgery and the postoperative pain scores were similar in the two groups. CONCLUSION: Single-port thoracoscopic surgery for diaphragm plication is a safe procedure. It can serve as an alternative to conventional thoracoscopic approaches to diaphragm surgery.

Video-guided tube thoracostomy with use of an electrical nonfiberoptic endoscope.

PURPOSE: Tube thoracostomy is a common and generally safe procedure. However, potential hazards can occur during placement of the chest tube. Inasmuch as unexpected injuries may arise from tube thoracostomy, we propose a novel video-guided method. DESCRIPTION: We used an independent complementary metal oxide semiconductor image sensor with a processing chip to obtain a front view image of the chest cavity. The device is connected to an aluminum shaft with four small light-emitting diode crystals in the tip, and a detachable small monitor with a battery inside. The apparatus is small and can be used to direct vision-guided tools in tube thoracostomy. EVALUATION: We performed video-guided tube thoracostomy in 6 patients with pleural adhesions. All patients experienced good tolerance to the procedure and had no immediate adverse events. The thoracostomies were performed by a single surgeon with good acceptability, and each procedure was completed in less than 10 minutes. CONCLUSIONS: In some cases of pleural adhesion, the video-guided thoracostomy may be a safer alternative to non-image guided tube thoracostomy.

Surgery for elderly lung cancer.

OBJECTIVE: There are still controversies about the surgical benefits for elderly lung cancer.The aims of this study were to assess impacts of aging for non-small cell lung cancer(NSCLC) following pulmonary resection. METHODS: A retrospective study was undertaken for patients operated at a curative intent from January 1998 to October 2008. Patients were divided into two groups: Group 1 consisted of patients aged at least 75 years old, and group 2 were patients less than 75 years old. Perioperative characteristics and details, hospital courses, surgery-related morbidities, surgical mortality, and survival were compared between groups. RESULTS: Of 442 eligible patients, 73 patients (16.5%) were in group 1 (mean age 78.3 years) and 369 (83.5%) patients were in group 2 (mean age 62.5 years). The following data were compared with statistical significance: hospital stay (17.8 vs. 8.9 days), mortality rate (8.2 vs. 2.2%), morbidity rate (26.0 vs. 13.3%), and length in intensive care unit (5.7 vs. 3.2 days). The main causes for morbidities in group 1 showed cardiopulmonary-related. Tumor stage without considering age had statistically significant influence on survival. Survivals of two groups were comparative. (p= 0.10) Intriguingly, the disease-related survival (28.3 months; p= 0.008) and progression-free survival (25.0 months; p<0.001) in group 1 were significantly better than group 2 (20.2 and 12.2 months). CONCLUSIONS: Although operation for NSCLC in the elderly patients causes more complications, especially in the cardiopulmonary system, their outcome showed better than their younger counterparts. Pulmonary resection for elderly patients may get longer disease control. Elderly patients with physical fit for surgery should not be considered as a contraindication to pulmonary resection based on age alone.

The adequacy of single-incisional thoracoscopic surgery as a first-line endoscopic approach for the management of recurrent primary spontaneous pneumothorax: a retrospective study.

BACKGROUND: Thoracoscopic surgery is a commonly used endoscopic surgical treatment approach in patients with primary spontaneous pneumothorax. The conventional thoracoscopic approach utilizes three or more small wounds for surgery. Currently, a single port approach is a potential alternative procedure in general thoracoscopic surgery. We investigated whether a single-port approach is suitable as a first-line endoscopic approach for all patients with primary spontaneous pneumothorax requiring surgery. METHODS: From July 1st, 2008 to Dec 31, 2009, a total of 62 patients was included in this study. All the patients were admitted to our ward because they had surgical indications for surgery. Twenty-six patients underwent conventional three-port thoracoscopic surgery and thirty-six underwent single-port thoracoscopic surgery. All of the clinical data were analyzed retrospectively. Variables were compared and analyzed to determine the outcomes of the different surgical approaches. RESULTS: The mean age of the 62 patients was 27.2 years. Forty-nine patients were men and thirteen patients were women. The mean time required for the operation was 61.6 minutes. There was one patient who had a recurrence in single-port group and 2 patients had a recurrence in three-port group during the period of follow-up. The average pain scores at 24 and 48 hrs after the operation were similar, but the pain scores at 72 hrs in the single-port group were better than the three-port group. There was no case that required conversion from a single-port to multiple wound approach in this study. There was no immediate postoperative recurrence. The follow-up duration was greater than 12 months. CONCLUSION: This study showed that single-port thoracoscopic surgery is a feasible and reasonable first-line endoscopic approach in the surgical treatment of primary spontaneous pneumothorax.