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Abstract: Drought and aphids are the key abiotic and biotic stresses on potato, respectively. Understanding the adaptability of aphid populations on potato cultivars that exhibit contrasting drought-tolerance (hereafter as different potato cultivars) under drought conditions is key for developing effective aphid management strategies in the context of climate change. We assessed the adaptability of the peach potato aphid, Myzus persicae, on various potato cultivars under drought conditions using the age-stage, two-sex life table theory. We found that drought reduced M. persicae adaptability in the three cultivars: Qingshu 9 (drought-tolerant), Longshu 3 (moderately drought-tolerant), and Atlantic (drought-susceptible). This was demonstrated by the longer developmental duration and total pre-reproductive period, lower adult longevity, survival rate, and fecundity, shorter reproduction days, as well as the lower net reproductive rate (R 0), intrinsic rate of increase (r), finite rate of increase (λ), and population size under drought conditions. Under drought conditions, M. persicae pre-adult survival rate, proportion of female adults (Nf /N), and R 0 suffered a greater reduction on Qingshu 9. Population projection showed a 100-fold reduction of aphid population size on Qingshu 9 after 90 days. The findings suggest that drought increased the resistance of the drought-tolerant cultivar to the aphid. Based on the present findings, drought-tolerant cultivars are encouraged to plant in arid lands under drought conditions to increase potato resistance to aphids while maintaining their growth under drought conditions.

Study objectives: Video-assisted thoracic surgery (VATS) has gained a prominent role in routine thoracic surgery practice. This study discusses the clinical aspects and utility of VATS in spontaneous hemopneumothorax (SHP). [...]

Byline: Hui-Ping Liu, Chau-Hsiung Chang, Pyng Jing Lin, Ming-Jang Hsieh Abstract: Surgeons who have gained experience and confidence with video-assisted thoracic surgery are now routinely applying the minimally invasive approach to treat patients with spontaneous pneumothorax. Although the endoscopic stapling device may be a preferred method for resection of parenchymal blebs or bullae, the stapling device is not inexpensive. In an effort to contain costs since we started performing the video-assisted thoracoscopic procedure in chest surgical diseases, we have used a self-made endoscopic loop as an alternative method. It has assisted us in performing bulla ablation in a cost-effective manner. Over a 4-year period (1992 to 1996), we assessed the efficacy of ligating parenchymal blebs and bullae with a self-made endoscopic loop by video-assisted techniques. A total of 263 ligations were performed in 250 patients. Surgical indications included recurrence (n = 146), bilaterality of the disease (n = 13), hemopneumothorax (n = 7), radiologically demonstrated large bulla (n = 9), persistent air leak (n = 52), and nonexpansion of the lung (n = 23). There were no operative deaths. Early postoperative complications included a dislodged endoscopic loop necessitating reexploration in one patient and postoperative minor wound infections in 13. The average postoperative hospitalization was 4.5 days. Two hundred seventeen patients (86.8% of all patients) were followed up for a median of 28 months (1 to 46 months) after the operation. There have been no recurrences to date. Our results showed that thoracoscopic loop ligation is safe and effective in managing blebs and parenchymal bullae, with a lower cost, fewer complications, and a lower recurrence rate than provided by standard surgical techniques. On the basis of our results, we advocate the use of the self-made endoscopic loop for ligation of parenchymal blebs and bulla in patients with spontaneous pneumothorax to achieve a truly cost-effective and minimally invasive thoracoscopic procedure. (J Thorac Cardiocasc Surg 1997:113:50-4) Article History: Received 9 February 1996; Revised 8 April 1996; Revised 13 May 1996; Accepted 4 June 1996 Article Note: (footnote) [star] Address for reprints: Hui-Ping Liu, MD, Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 199, Tun-Hwa North Rd., Taipei, Taiwan, Republic of China., [star][star] 0022-5223/97 $5.00 + 0 12/1/75521

Objectives: Video-assisted endoscopic techniques had been applied in the surgical correction of patent ductus arteriosus, vascular ring, or coronary artery disease. However, it has been used only recently in the [...]

A total of 82 consecutive patients with recurrent or persistent spontaneous pneumothorax were considered for thoracoscopic blebectomy or bullectomy and pleurodesis. The median age was 47 years, and 70% were [...]

Byline: Pyng Jing Lin, Chau-Hsiung Chang, Pei-Chin Yao, Hui-Ping Liu, Hung-Chang Hsieh, Kuei-Ton Tsai Abstract: Experiments were designed to determine whether hyperkalemic crystalloid cardioplegic solution enhances endothelium-dependent contraction of coronary arteries. Segments of canine coronary arteries (n = 8 in each group) were preserved in cold (4[degrees] C) crystalloid cardioplegic solution (group 1) and physiologic solution (group 2) for 60 minutes. Segments of preserved and control (group 3) coronary arteries with or without endothelium were suspended in organ chambers to measure isometric force. Perfusate hypoxia (oxygen tension 35 [+ or -] 5 mm Hg) caused endothelium-dependent contraction in the arteries of all three groups. However, vascular segments with endothelium of group 1 exhibited hypoxic contraction (68.5% [+ or -] 15.3% of the initial tension contracted by prostaglandin F.sub.2.sub.[alpha] 2 x 10.sup.-6 mol/L, p < 0.05) that was significantly greater than contraction of the group 2 and group 3 segments with endothelium (26.6% [+ or -] 5.6% and 20.6 [+ or -] 4.4%). The hypoxic contraction in arteries of group 1 could be attenuated by N.sup.G -monomethyl-l-arginine, the blocker of endothelial cell synthesis of the nitric oxide from l-arginine. The action of N.sup.G -monomethyl-l-arginine could be reversed by l-arginine but not d-arginine. Thus after preservation with cardioplegic solution, augmented endothelium-dependent contraction, occurs by l-arginine-dependent pathway, would favor coronary vasospasm after cardiac operation. (J T horac C ardiovasc S urg 1995;109:99-105) Author Affiliation: Taipei, Taiwan, Republic of China Article History: Received 6 January 1994; Accepted 30 May 1994 Article Note: (footnote) [star] From the Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China., [star][star] Supported in part by grant NSC 83-0412 B-182-018 from the National Science Council, Executive Yuan, Taiwan, Republic of China, and by the grant 355 from the Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China., a Address for reprints: Pyng Jing Lin, MD, Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 199, Tun-Hwa North Rd., Taipei, Taiwan, Republic of China., aa 0022-5223/95 $3.00 + 0, acents 12/1/57990

A preliminary report is made on the use of videothoracoscopy to achieve pulmonary lobectomy in 16 patients, including 12 with centrally located pulmonary metastases and 4 with benign lesions (3 [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2007.02.006 Byline: Tzu-Ping Chen, Chi-Hsiao Yeh, Yi-Cheng Wu, Hui-Ping Liu Author Affiliation: Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan. Article History: Received 30 January 2007; Accepted 7 February 2007

Microstructure damage and evolution in 4H-SiC under He-ion implantation and post-annealing have been investigated by the combination of fourier transform infrared spectrometer (FTIR), Raman scattering spectroscopy and high resolution X-ray diffractometer (HRXRD). After implantation, the 4H-SiC specimen exhibits a heavy damage and some amorphous state appear. With increasing annealing temperature, to some extent recovery in damaged lattices was observed, as a result of the peaks of Raman and HRXRD regain their intensities. However, the reverse annealing behavior in damaged peaks was displayed after annealed at 973K. This reverse annealing effect was revealed to be due to the formation and the growth of He bubbles above 973K.

Surface morphology, compositions, microstructure and optical properties of GaN film irradiated by highly charged Krq+(q= 23, 15, 11) in two geometries to a fluence of 1 × 1015krq+/cm2were studied using AFM, XPS, PL, Raman scattering and UV–visible spectroscopy. The AFM observation shows that the irradiated GaN area is a swollen terrace. The swelling rate increased with the charge state (potential energy). For the same charge state, the swelling rate of tilted incidence was greater than that for normal incidence. The XPS measurements reveal that N deficiency, Ga enrichment and Ga–O and Ga dangling bonds generated on the irradiated GaN surface increased with the charge state, and more N was lost for normal incidence than that for tilted incidence. The UV–Vis results show that the transmittance decreased with increasing charge state. For the same charge state, the transmittance for tilted incidence is higher than that for normal incidence. The PL spectra present that, with increasing charge state, the YL band intensity decreased, with a blueshift in its peak position; while the NBE peak intensity increased first and then reduced, and a blue luminescence band appeared. A rapid quenching of both the YL and the NEB for normal incidence was observed. Raman spectra display that screw dislocations perhaps were produced near the surface for normal incidence.

In order to explore phytoremediation and physiological effect of plant to heavy metal, physiological and biochemical changes of tall fescue seedlings were comparatively analyzed when they were contaminated by lead at different times and concentrations. The results showed that: At three lead concentrations, superoxide dismutase (SOD) and peroxidase (POD) activity in tall fescue increased initially and then decreased overall with stress times. Change of POD is slower. It indicated that lead can rapid induce tall fescue protecting enzyme activity at low concentrations or in a short period. Malondialdehyde (MDA) contents were positively correlated with stress time and stress concentrations, which indicated that with the increase of stress concentration and time, membrane lipid peroxidation strengthen. Changes of chlorophyll total concentration increased first and then decreased at low concentration (500 and 1000 mg·L-1), and continued to decline at high concentration. It indicated tall fescue may adapt low lead stress by increasing chlorophyll to, and lose regulation at high concentrations.Proline content decreased initially and then increased with time at 500,1000 mg·L-1, however, it was opposite at 1500 mg·L-1. They were higher than controls, indicating that osmotic adjustment ability enhanced after lead stress. Changes of soluble sugar content were down - up - down with times at three concentrations, eventually they reduced significantly. Therefore, in the process of lead stress, changes of physiological characteristics in tall fescue showed their actively adapt and resistance at low stress, and tolerance and injury at high stress.

Transoral endoscopic surgery has been shown to be feasible and safe in both humans and animal models. The purpose of this study was to evaluate the safety and efficacy of transoral and conventional thoracoscopy for thoracic exploration, surgical lung biopsy, and pericardial window creation.The animals (n= 20) were randomly assigned to the transoral endoscopic approach group (n= 10) or conventional thoracoscopic approach group (n= 10). Transoral thoracoscopy was performed with a flexible bronchoscope via an incision over the vestibulum oris. In conventional thoracoscopy, access to the thoracic cavity was obtained through a thoracic incision. Surgical outcomes (body weight, operating time, operative complications, and time to resumption of normal diet), physiologic parameters (respiratory rate, body temperature), inflammatory parameters [white blood cell (WBC) counts and C-reactive protein (CRP)], and pulmonary parameters (arterial blood gases) were compared for both procedures.The surgical lung biopsy and pericardial window creation were successfully performed in all animals except one animal in the transoral group. There was no significant difference in operating times between the groups. The increase in WBC in the transoral thoracoscopy group was significantly smaller on postoperative day 1 than in the conventional thoracoscopy group (p= 0.0029). The transoral group had an earlier return to preoperative body temperature (p= 0.041) and respiratory rate (p= 0.045) on day 7. With respect to pulmonary parameters, there was no significant difference in blood pH, pCO2, or PaCO2between the transoral and transthoracic groups. All animals survived without complications 14 days after surgery.This study demonstrated that the transoral approach was comparable to conventional thoracoscopic surgery for lung biopsy and pericardial window creation in terms of safety and efficacy.

n this article, graphite oxide was prepared via Hummers method, then reduced by L-ascorbic acid to obtain colloidal suspension of graphene. The resultant graphene was characterized by FT-IR, UV-vis, Raman, XRD, AFM, TEM in detail, and it was found that the the sp2 domain of graphene oxide is restored efficiently, the suspension is very stable and most of the graphene is single-layer. Compared to hydrazine hydrate, L-ascorbic acid has higher deoxygenation efficiency and inclines to gain few-layer graphene and its stable suspensions.

n this paper, we fabricated a bionanocomposite film of glucose oxidase/Pt nanoparticles/graphene-chitosan (GOD/PtNPs/GR-Chit) for glucose sensing. The hybrid bionanocomposites modified GCE were characterized by scanning electron microscopy (SEM), cyclic voltammetry, and amperometric i-t curve. It was found that the PtNPs were uniformly deposited on the surface of GR-Chit hybrid film. The resultant PtNPs/GR-Chit/GCE exhibited a high electrochemical catalytic ability to hydrogen peroxide (H2O2), due to the electrocatalytic synergy of GR and PtNPs. The redox behavior of the GOD/PtNPs/GR-Chit/GCE is a surface-controlled process. Finally, we obtained the amperometric response of the GOD/PtNPs/GR-Chit/GCE toward different concentration of glucose, and also achieved a sensitive glucose oxidase biosensor with a detection limit of 4.6μM glucose.

To prepare nanoscale coordination polymers (NCPs) which can exhibit intense luminescence have attract an increasing interest. In this paper, we present the synthesis of a novel example of discus-like luminescent nanoscale Eu (III)-carboxylate coordination polymers. The organic ligand is a derivative of terephthalate (Na2L) with a big side group. The Eu (III)-L NCPs was synthesized through microemulsion method, and the morphology can alter along with the changing of metal: ligand ratios. XRD results reveal that the self-assembled disk-like NCPs exhibit long-range ordered structures. The luminescent measurements showed that the resultant NCPs not only exhibits typical fluorescence of Eu (III), but also can maintain the inherent fluorescence of the ligands.

The influences of pH values and aluminum precursors of “glucose-water-aluminum salt” reaction system on the hydrothermal synthesis of mesoporous Al2O3 were investigated. With the aid of scanning electron microscopy (SEM), electron diffraction spectrum (EDS) and X-ray diffraction (XRD) characterizations, we found that, under hydrothermal treatment at 180 ºC for 20 h, aluminum nitrate (Al(NO3)3) could be used as the precursor to synthesize the spherical flower-like Al2O3 by using the synthesis solutions with different pH values in a certain scope; using aluminum chloride (AlCl3) as precursor, we can only get a small amount of Al2O3 composed of micro-spheres and sheets; while adopting aluminum sulfate (Al2(SO4)3) as precursor, a small amount of cubic-shape aluminum sulfate crystal can be obtained.

Abstract: Background: The success of natural orifice transluminal endoscopic surgery (NOTES) depends on an adequate exploration of surgical regions. Currently, limited data are available regarding the optimal position for the NOTES approach for thoracic surgery. This study therefore aimed to evaluate the effectiveness of transoral thoracic exploration in a canine model placed in a lateral decubitus position. Methods: A total of 14 dogs were used in this study. Transoral thoracoscopy was performed using a custom-made metal tube via an incision over the vestibular incision with the animal in a supine position. After thoracic exploration, the animal was placed in a lateral decubitus position. The thoracic intervention (surgical lung biopsy, pericardial window creation, and dorsal sympathectomy) was performed by passing a flexible bronchoscope through the lumen of a metal tube. Results: The mean operative time for this procedure was 70 min (range 45–100 min). For 12 dogs, all procedures were completed without major complications. However, for one dog, the exploration of the thoracic cavity was incorrect (the right lower lobe had been misinterpreted as the left lower lobe). Another dog had minor bleeding because of an intercostal artery injury that occurred during sympathectomy. Conclusion: The posterior aspect of the thoracic cavity can be exposed via a transoral approach with the animal in a lateral decubitus position. This approach may be considered as an adjuvant to the supine approach, in which exploration of the posterior thoracic cavity is restricted.

This paper puts forward a C/S control model that is made up of the double--robot polishing system. Based on the double-robot system which is made up of two MT-Arm 6-DOF serial robots, the method of motion control and communication between two robots are introduced. In the end, the mutual communication can be accomplished by two robots and the robot position and status information can be transported with programming of the win socket.

This paper puts forward a multi-Agent alliance control model that is made up of the series robot Agent, the parallel moving platform Agent and the polishing tool system Agent and so on by the MAS theory. Based on the multi-robot system which is made up of the MOTOMAN - HP3 serial robot and NPT800 parallel robot, the MOTOMAN-HP3 serial robot communication, the NPT800 parallel robot of motion control and communication between two robots are introduced respectively. In the end, the mutual communication can be accomplished by two robots and the robot position and status information can be transported with programming of the win socket. The satisfied polishing effect on the curved surfaces can be obtained and the demand of the polishing can be achieved by the MAS.

The choice of strains directly relate to the yield of cheeses, the time of processing cheeses, their maturity time, flavors, and their functional characteristics. In this paper, the main strain used to make Mozzarella cheese was TCC-3, which contain Lactobacillus bulgaricus subsp. Thermophilus and Streptococcus thermophilic subsp. while the auxiliary starters we chose were Lactobacillus casei and Lactobacillus helveticus. The reduced fat Mozzarella cheese was made from partially skimmed milk(milk containing 18 g of milk-fat L-1) and 9 g corn oil W1/O/W2 multiple emulsions(stabilized by amidated carboxymethylcellulose (CMC)), which deviated greatly from previous fat substitutes, the control group cheese was made with TCC-3 only(0.23g / 5L milk). Through mixture experiment design, we got 9 different groups, which the proportion of the three cultures was different. Through comparing natures of the 9 groups, we concluded that, the group (TCC-3: 0.005%; Lactobacillus casei: 0.004%; Lactobacillus helveticus: 0%) was the best one in improving quality, because it not only increased species of flavor compounds, but also had a great help for functional properties such as stretchability, meltability and so on. Also we confirmed that lactobacillus helveticus was not suitable for auxiliary ferment in our research.

Milk samples with low (L-SCC, 130,000/ml), medium (M-SCC, 1,040,000/ml) and high(H-SCC, 3,120,000/ml) Somatic Cell Counts (SCC) were obtained from a dairy farm. In order to evaluate the quality’s changes of Low-fat mozzarella cheese with different SCC during ripening period, the change of texture properties, microstructure were measured. With the increase of somatic cells in milk, the structure of the cheese became worse.

Mg-4.9Zn-0.9Y-0.7Zr alloy and Mg-4.9Zn-0.7Zr used as compared alloy were prepared by ingot metallurgy method. The influence of Y addition on microstructure and properties was studied. Phase analysis, microstructure and morphology of second phases were investigated by XRD, OM and SEM. The component and morphology of the second phases was analyzed by EDAX and TEM. The results showed that, Y was an effective element strengthening Mg-Zn-Zr alloy, a large number of Mg3Zn6Y phase was formed due to the addition of Y. During the process of hot rolling, Mg3Zn6Y phase was pulverized into large amount of dispersion particles, which pinned dislocation effectively, so ultimate strength and yield strength at room temperature were improved, as well as good plasticity was remained.

In this paper, Provolone Cheeses were radialized by 60Co-γ of different doses, and they were stored. The impact of texture in the cheese after radialization was studied, the peculiar smell resulted from radialization were analyzed, the mechanisms and preventing methods were discussed. Main conclusions are as follows: Volatile flavors of Provolone cheeses of different radialization doses were detected by HS-SPME-GC-MS. The result showed that the variety and quantity of volatile flavors were changed obviously after radicalization: esters and phenols were reduced numerously; while aldehydes, ketones, aromatic hydrocarbons and alkyl olefin had increased significantly; Irradiation cause sulfur compounds such as sulfur alcohols and sulfur ketone.

The aim of the present study was to investigate the effects of improving ripening temperature on Gouda cheese. In order to evaluate the quality changes of Gouda cheese with different temperature (12°C,15°C,18°C) during its ripening period, the change of soluble nitrogen (SN）, protein hydrolysis, texture properties were measured. Ripening temperature had a significant effects on SN concentration and protein degradation. Results showed that the Gouda cheese with best quality was ripened at 15°C after 90d.

On the base of the domestic and international studies, the effect of high-pressure treatment on maturation is analyzed in this thesis. In order to evaluate the quality’s changes of Gouda cheese with different high pressure treatment (50MPa, 225MPa, 400MPa treating 60min) during ripening period, the change of texture properties, microstructure and sensory analysis were measured. High pressure treatment for 60 minutes can accelerate cheese maturing significantly when the applied pressure is higher than 225MPa. The effect of accelerated ripening at 50MPa is not significant. The quality of Gouda cheese treated at 400MPa is the best after ripening 90d.

Abstract: Background: The aim of this study was to evaluate the performance of a novel transtracheal endoscopic technique for thoracic evaluation and intervention in a large animal model. Methods: In 12 animals (6 pigs and 6 dogs) under general anesthesia, a tracheal incision was made on the right lateral wall of the lower trachea and used as an entrance for thoracic evaluation and intervention. Postoperative follow-up included endoscopy at 1 and 2 weeks after surgery and necropsy at 2 weeks after surgery. Results: Transtracheal opening and thoracic exploration were achieved in all animals. Four animals (3 pigs and 1 dog) died as a result of complications from the procedure. At the follow-up endoscopy, healing at the tracheal opening region was noted in seven animals. Conclusions: The transtracheal approach to the thoracic cavity is technically feasible in both porcine and canine models (4/12 animals died). The canine model is perhaps more suitable than the porcine model for the study of the transtracheal approach to the thoracic cavity.

The whey protein has a highly nutritional value but poor functional properties. Ultra-high pressure (UHP) is a new technology for food processing. It dose not cause environmental pollution and could maintain food nutrition as much as possible. The effects of applied pressure and treatment time on functional properties and conformation changes of whey protein isolated (WPI) treated by UHP were studied in present paper. The results indicated that WPI treated by UHP showed reduced solubility, foaming and emulsifying property with the increasing of applied pressure and prolonging of treatment time. For WPI treated at 400MPa for 15min, the 1-anilinonaphthalene-8-sulphonate (ANS) studies showed the increasing fluorescence regions when the applied pressure increased. The most fluorescence regions were exposed to aqueous solution for WPI treated at 400MPa for 5min, and degree of exposure reduced when treatment time was prolonged. With the increasing of applied pressure and prolonging of treatment time, the amino acid residues having ultraviolet absorbance showed the same change as hydrophobic group.

Dichloroacetate (DCA) is an investigational drug for certain metabolic diseases. It is biotransformed principally by the zeta-1 family isoform of glutathione transferase (GSTz1), also known as maleylacetoacetate isomerase (MAAI), which catalyzes the penultimate step in tyrosine catabolism. DCA causes a reversible peripheral neuropathy in several species, including humans. However, recent clinical trials indicate that adults are considerably more susceptible to this adverse effect than children. We evaluated the kinetics and biotransformation of DCA and its effects on tyrosine metabolism in nine patients treated for 6 months with 25 mg/kg/day and in rats treated for 5 days with 50 mg/kg/day. We also measured the activity and expression of hepatic GSTz1/MAAI. Chronic administration of DCA causes a striking age-dependent decrease in its plasma clearance and an increase in its plasma half-life in patients and rats. Urinary excretion of unchanged DCA in rats increases with age, whereas oxalate, an end product of DCA metabolism, shows the opposite trend. Low concentrations of monochloroacetate (MCA), which is known to be neurotoxic, increase as a function of age in the urine of dosed rats. MCA was detectable in plasma only of older animals. Hepatic GSTz1/MAAI-specific activity was inhibited equally by DCA treatment among all age groups, whereas plasma and urinary levels of maleylacetone, a natural substrate for this enzyme, increased with age. We conclude that age is an important variable in the in vivo metabolism and elimination of DCA and that it may account, in part, for the neurotoxicity of this compound in humans and other species.

Abstract

Managing the airway of patients with critical tracheal stenosis remains a formidable challenge to surgeons and anesthiologists. Various methods for controlling the airway have been established to solve this problem. This study describes the critical tracheal stenosis is managed by dilating and coring technique under direct vision with a rigid bronchoscope. From 2001 to 2003, 34 patients (23 males/11 females) with critical tracheal stenosis (>90%) underwent 37 surgical interventions. The etiologies included 8 cases of post-intubation, 7 cases of post-tracheostomy, 5 cases of post-anastomotic, 14 cases of endotracheal tumor (4 primary, 10 secondary), and 3 cases (1 tuberculosis, 1 laser burn, and 1 idiopathic) of other etiologies. All procedures could achieve airway control with rigid bronchoscope. Other endoscopic procedures (laser, and stent placement) were required to achieve a patent airway and seven patients received airway reconstruction as a definite procedure. Rigid bronchoscopy could provide good results for controlling airway in patients with critical trachea stenosis.

PURPOSE: To evaluate risk factors for pneumothorax and bleeding after computed tomography (CT)-guided percutaneous coaxial cutting needle biopsy of lung lesions. MATERIALS AND METHODS: This study involved 117 consecutive patients with 117 intrapulmonary lesions. Statistical analysis of factors related to patient characteristics, lung lesions, and biopsy technique was performed to determine possible contribution to the occurrence of pneumothorax and bleeding. Interactions between related factors were considered to prevent colinearity. RESULTS: Pneumothorax occurred in 12% (14 of 117) of patients. Needle aspiration of two moderate asymptomatic pneumothoraces were performed; there was no chest tube insertion. Lesion depth (P = .0097), measured from the pleural puncture site to the edge of the intrapulmonary lesion along the needle path, was the single significant predictor of pneumothorax. The highest risk of pneumothorax occurred in subpleural lesions 2 cm or shorter in depth (this represented 33% of lung lesions but caused 71% of all pneumothoraces; OR = 7.1; 95% CI, 1.3-50.8). Bleeding presented as lung parenchyma hemorrhage and hemoptysis in 30 patients (26%). Hemoptysis occurred in four patients (3%). Univariate analysis identified lesion depth (P < .0001), lesion size (P < .015), and pathology type (P = .007) as risk factors for bleeding. Multivariate logistic regression analysis identified lesion depth as the most important risk factor, with the highest bleeding risk for lesions more than 2 cm deep (14% of lesions caused 46% of all bleeding; OR = 17.3; 95% CI, 3.3-121.4). CONCLUSIONS: In CT-guided coaxial cutting needle biopsy, lesion depth is the single predictor for risk of pneumothorax, which occurs at the highest rate in subpleural lesions. Increased risk of bleeding occurs in lesions deeper than 2 cm.

Seven genes, napKEFDABC, encoding the periplasmic nitrate reductase system were cloned from the denitrifying phototrophic bacterium Rhodobacter sphaeroidesf. sp. denitrificansIL106. Two transmembrane proteins, NapK and NapE, an iron-sulfur protein NapF, a soluble protein NapD, a catalytic subunit of nitrate reductase precursor NapA, a soluble c-type diheme cytochrome precursor NapB, and a membrane-anchored c-type tetraheme cytochrome NapC were deduced as the gene products. Every mutant in which each napgene was disrupted by Ω-cassette insertion lost nitrate reductase activity as well as the ability of cells to grow with nitrate under anaerobic-dark conditions. A transconjugant of the napD-disrupted mutant with a plasmid bearing the napKEFDABCgenes recovered both nitrate reductase activity and nitrate-dependent anaerobic-dark growth of cells. Denitrification activity, which was not observed in the napDmutant, was also restored by the conjugation. These results indicate that the periplasmic nitrate reductase encoded by the napKEFDABCgenes is the enzyme responsible for denitrification in this phototroph, although the presence of a membrane-bound nitrate reductase has been reported in the same strain.

Spontaneous pneumothorax in apparently healthy individuals is a relatively common occurrence. The management of patients with spontaneous pneumothorax remains controversial. With the advances in thoracoscopic techniques and instrumentation, video-assisted thoracic surgery (VATS) is now accepted by many as the procedure of choice for surgical treatment of spontaneous pneumothorax. We report our combined experience with 757 patients who suffered from recurrent or persistent spontaneous pneumothorax treated by VATS over a 5-year period. Surgical indications included persistent air leak (n= 165), recurrence (n= 325), radiologically demonstrated huge bulla (n= 12), spontaneous hemopneumothorax (n= 13), incomplete expansion of the lung (n= 212), and bilateral involvement (n= 30). Several surgical procedures were undertaken, based on the thoracoscopic findings: endoscopic stapled bullectomy (n= 312), argon beam coagulation (n= 6), endoscopic suturing (n= 52), and endoloop ligation (n= 352). In 49 cases, mechanical or chemical pleurodesis was the only procedure performed. There were no mortalities or intraoperative hazards. Complications consisted of wound infections (n= 16), localized empyema (n= 2), chest wall bleeding (n= 1), and persistent air leaks (bulla type III) (n= 31). The median duration of the operation was 55 minutes (15–160 minutes), and the average postoperative hospital stay was 4.5 days (range 0–27 days). There were 16 recurrences (2.1%), after a mean follow-up of 30 months (range 1–60 months). Seven patients had recurrence from 9 to 17 months after stapled bullectomy. All the remaining patients had recurrence after failed pleurodesis. On the basis of our results, we conclude that video-assisted thoracoscopic management allows effective, safe performance of standard surgical procedures, avoiding a formal thoracotomy incision. We consider thoracoscopy the treatment of choice for patients with pneumothorax requiring surgical therapy.

Objective.In order to understand the prognostic factors of placental site trophoblastic tumors (PSTT), we performed a MEDLINE search for cases from 1976 through 1998 and report three cases.

Abstract. We operated on 403 patients with spontaneous pneumothorax between 1992 and 1996. Among these cases, 11 (2.7%) were spontaneous hemopneumothorax. The patients were all men, with ages ranging from 19 to 28 years (mean 23.8 years). The amount of blood drainage ranged from 650 to 2300 ml. Video-assisted thoracoscopic surgery was performed on these patients within 1 day after admission. The sources of bleeding were in the parietal and visceral pleurae of ruptured bullae (: n = 6), the parietal pleura ( n = 4), or the visceral pleura ( n = 1). During operation, the ruptured bullae can be managed by an endoscopic linear stapler for a bullectomy, and the bleeding parietal pleura of the torn adhesion can be coagulated directly. Postoperative recovery of the 11 patients was uneventful, and they were discharged 4 to 10 days after the operation. No recurrence of spontaneous hemopneumothorax or any other complications occurred during follow-up. Thus spontaneous hemopneumothorax can be readily managed by cauterizing a bleeding site where appropriate, excising the apicocystic disease, and pleurodesis. As a minimally invasive method, video-assisted thoracoscopic surgery may be considered an initial treatment procedure in patients with spontaneous hemopneumothorax.

Although video-assisted thoracoscopy has only recently been applied to treat a variety of thoracic spine lesions, many problems and difficulties are encountered with this technique owing to limited trocar space and lack of suitable endoscopic instruments. Between November 1995 and March 1996, we practiced a new approach for video-assisted thoracoscopic surgery, the “extended manipulating channel method,” for treating 18 patients with thoracic spinal lesions endoscopically. The thoracoscopic portals were made larger (usually 3–4 cm) and placed slightly more posterior than usual, which allows use of a combination of conventional spinal instruments and video-assisted thoracoscopy to enter the chest cavity and be manipulated similar to that with techniques used for standard open surgical procedures. In our series the endoscopic spinal procedures included biopsy only (n= 1), thoracic discectomy (n= 1), multilevel anterior discectomy and fusion (n= 1), corpectomy for decompression (n= 4), decompressions and interbody fusions (n= 10), and internal instrumentations (n= 4). Throughout the operation only one trocar was used for introducing the thoracoscope. There were no intraoperative deaths, and no patients showed neurologic deterioration due to the procedures. We conclude that such a technique makes thoracoscopy-assisted spinal surgery simpler and easier and has proved to be an effective, promising procedure. It does not appear to compromise the therapeutic goals set for the patients. The intraoperative vessel bleeding can be easily controlled, and the number of portals for the procedures can be reduced (on average, three portals are enough). Few endoscopic materials were used with our patients, and thus the total economic cost to the patients was reduced.

Video-assisted endoscopy has been applied in the management of a variety of intrathoracic vascular lesions. Here we report its use in the correction of intracardiac congenital defects.

Actinomycotic infection is uncommon and primary actinomycosis of the lung and chest wall has been less frequently reported. This disease may present as chronic debilitating illness with radiographic manifestation simulating lung tumor, pulmonary infiltrating lesion, or chronic suppuration. From 1984 to 1990, we experienced 17 cases of thoracic actinomycosis. There were nine patients who presented with a clinical picture of a suppurative lesion and the remaining eight were suspected of having primary lung tumor initially. In no case was an accurate diagnosis made at the time of hospital admission. Final diagnosis was based on aspiration (n = 3), anaerobic sputum culture (n=l), bronchoscopic biopsy specimens (n = 4), and histologic examination of the resected tissue in the remaining 9 patients who received surgical excision. Among the 17 patients, 8 were treated medically and the other 9 received surgical intervention followed by antibiotic treatment. Regarding the surgically treated patients, suspected malignancy is the most common indication for operation (seven of nine). However, both medically and surgically treated patients achieved good clinical results, and the postoperative courses were uneventful. We would like to remind physicians of this unusual entity and review our own experience with particular emphasis on the clinical diagnosis and management of this unique disease.

A 39-year-old woman having a pure gonadal choriocarcinoma with lung metastasis was referred to our hospital after hysterectomy and bilateral salpingo-oophorectomy. She was found to have a 45XO/46XY karyotype and gonadal dysgenesis. The patient's serum β-hCG was normalized after six courses of chemotherapy with cisplatin and etoposide of conventional dose (100 mg/m2, 100 mg/m2× 3 days), but began to fluctuate. Thoracoscopic resection of a remaining pleural lesion was negative for malignancy. However, the disease relapsed as multiple metastatic nodules in bilateral lung fields and the mediastinum. After one course of priming chemotherapy with conventional dose (1 g/m2cyclophosphamide, 400 mg/m2carboplatin, and 500 mg/m2etoposide), high-dose chemotherapy with a total dose of 1500 mg/m2carboplatin, 1200 mg/m2etoposide, and 5 g/m2ifosfamide followed by autologous bone marrow transplantation and peripheral stem cell support was given. Thoracoscopic surgery was performed to resect two residual solitary metastatic lung lesions. With these salvage treatments, the patient obtained complete remission and remained disease free at last follow-up (17 months). Our result suggests that high-dose chemotherapy may be effective in chemosensitive nongestational choriocarcinoma when first chemotherapy has failed.

Background. Hypothermic fibrillatory arrest without aortic cross-clamping is a technique for quieting the heart during coronary artery bypass grafting. This report reviews the preliminary results with this technique in 4 patients having video-assisted coronary artery bypass grafting.

Abstract: Background: This study aimed to determine the feasibility of a novel transtracheal endoscopic technique for thoracic and mediastinum evaluation in a canine model. Methods: In two dogs under general anesthesia, a transverse incision was made in the right lateral wall of the lower trachea and used as an entrance for thoracic and mediastinum evaluation. Results: Transtracheal thoracoscopic evaluation was possible in both animals. One animal experienced massive subcutaneous emphysema immediately after evaluation of the thoracic cavity and required chest tube drainage. The follow-up endoscopies 2 weeks after surgery showed good healing of the tracheal openings in both animals. Conclusions: The transtracheal approach to the thoracic cavity and mediastinum appears to be feasible. This technique may provide an intriguing platform for the development of natural orifice transluminal surgery (NOTES) in the thoracic cavity.

Patients with liver cirrhosis undergoing gastrointestinal surgery still suffer from high operative morbid-mortality despite advancements in surgical critical care. The objective of this study is to see if this same relationship applies to patients undergoing esophagectomy for cancer. From 1993 to 2003, sixteen esophageal cancer patients with liver cirrhosis were operated on. They were all male with a mean age of 51.5 years. According to the Child-Pugh classification, 10 patients were Child 'A', 4 patients Child 'B' and Child 'C' in 2 patients. The surgical procedure was through an Ivor-Lewis esophagogastrectomy with intra-thoracic anastomosis. Major morbidity included: 4 respiratory failure, 2 acute renal failure, 3 pneumonia, and one in each of the patients with gastrointestinal bleeding and hepatic failure. The mean follow up among the survivors was 19.1 months. The hospital mortality was 25% (4/16). Using the rate according to Child classification, the mortality rates were: A: 1/10 (10%), B: 2/4 (50%) and C: 2/2 (100%). We conclude that patients with liver cirrhosis in Child-Pugh A could tolerate esophagectomy with an acceptable risk. However, patients with a more advanced state of liver dysfunction are at higher risk for esophagogastrectomy. Careful patient selection and meticulous peri-operative care is warranted in those embarking on surgical resection.

We used a silicone tracheal stent successfully to seal a huge benign tracheoesophageal fistula and restore airway patency after treatment with double metallic stenting of the trachea and esophagus failed. The patient was weaned from the ventilator 16 days after the procedure and after 7 months of ventilatory support.

This study incorporated a silicone tracheal stent into a metallic stent in a complicated airway stenosis patient. The silicone tracheal stent provided a stable and patent airway. The patient was discharged smoothly after the procedure. At 5 months after surgery, the patient remained stable and resumed all daily activities without any respiratory symptoms.

Esophageal tuberculosis (TB) is relatively rare. This study presents a case of primary esophageal TB mimicking submucosal tumor. The diagnostic methods and therapeutic options are reviewed.

We used combined Mongomery T-stent and Hood stent in a long segment (11 cm), benign tracheal stenosis after treatment with a standard Mongomery T-stent failed. Respiratory and phonation function was restored immediately after the procedure. The patient became pregnant 2 months later. Her baby was born at full-term with a smooth vaginal delivery. She was in good health 18 months after the operation.