Search

We present a novel thermal management design for InGaP/GaAs power amplifiers (PAs) by placing the graphene heat spreader (GHS) at the backside of GaAs/InGaAs/InGaP collector-up (C-up) heterojunction bipolar transistors (HBTs), including n-p-n and p-n-p types. The GHS was used to create extra escape channel for thermal spread, and a physics-based analysis was performed to justify heat-dissipation improvements. Temperature distribution in the GHS and the application of these spreaders to ameliorate thermal coupling effects on multifinger transistors were discussed. Compared to the n-p-n device, the p-n-p device exhibits greater thermal stability enhancement results, which are extraordinary and reproducible. Both numerical simulation and experimental measurement were achieved to scrutinize thermal performance of the GHS. This brief demonstrates the potential of the suggested structure in replacing the conventional thermal-removal configuration of GaAs-based HBTs used in high-efficiency cellular handset PAs. [ABSTRACT FROM AUTHOR]

Background Few prospective studies have examined the longitudinal associations of total dietary fibre intake and water insoluble and soluble fibres with cancer and all-cause mortality. The present study aimed to examine these associations. Methods We studied the effects of total dietary fibre intake and water insoluble and soluble fibres on cancer and all-cause mortality, using data from 15 740 adult participants [mean ( SD) age: 44.53 (19.22) years, 46.60% male] in the National Health and Nutrition Examination Survey ( NHANES) III, 1988-1994, who had completed a 24-h dietary recall. Death certificate data were obtained up to 2006. Participants had been followed for 13.74 years on average. Cox regression was used to estimate the hazard ratios ( HRs) of total dietary, insoluble and soluble fibres on cancer and all-cause mortality, with the first quartile as the reference group, adjusted for demographics, lifestyle and dietary factors. Results Relative to those in the first quartile of total fibre intake, only the third quartile was associated with all-cause mortality, with an adjusted HR of 0.87 [95% confidence interval ( CI) = 0.79, 0.97, P = 0.021], and cancer mortality, with an adjusted HR of 0.77 (95% CI = 0.61, 0.99, P = 0.05). The third quartile of insoluble fibre intake was associated with cancer mortality, with an adjusted HR of 0.76 (95% CI = 0.60, 0.96, P = 0.023), and colorectal-anal cancer mortality (in grouped data as provided for public use), with an adjusted HR of 0.42 (95% CI = 0.19, 0.91, P = 0.03). Conclusions Dietary fibre showed protective benefits in terms of mortality risk. Investigating the mechanisms and components of dietary fibres underlying the different protective benefits remains an important consideration for research on fibre-mortality risk. [ABSTRACT FROM AUTHOR]

Phase change memory has been considered as one of the most promising alternatives for next-generation nonvolatile semiconductor memory. Modification of phase change materials by impurity doping has been proved to be an effective way to improve phase change memory device performance. In this study, the most common phase change material, Ge2Sb2Te5 (GST), was employed, and its intrinsic properties were modified using boron-ion implantation. The GST films were implanted with 20 keV boron ions to fluences of 5 × 1014 and 5 × 1015 ions/cm2. The characteristics of the virgin and boron-implanted GST films were investigated by SIMS, XRD, and in situ resistance measurement. The kinetics of the thermally activated phase transition was also analyzed on the basis of the Arrhenius relationship. The results revealed that both crystallization temperature and activation energy of crystallization increase with increasing the boron fluence. The data retention capability is also enhanced from 83 to 88 °C, corresponding to a criterion of 10-year archival lifetime. In addition, the XRD spectra indicated that high-fluence boron-ion implantation partially inhibits the transition of the GST films from face-centered cubic phase to hexagonal close-packed phase. In conclusion, the thermal stability of the GST films can be improved through boron-ion implantation. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The equivalent inclusion method is presented to derive the Stokes flow of multiple drops moving in a viscous fluid at a small Reynolds number. The drops are replaced by inclusions with the same viscosity as the fluid, but an eigenstrain rate field that is a fictitious nonmechanical strain rate field is introduced to represent the viscosity mismatch between each drop and the matrix fluid. The velocity and pressure fields can be solved by considering the body force and eigenstrain rate on the inclusions with the Green's function technique. When one spherical drop is considered, the solution recovers the closed-form classic solution. This method is versatile and can be used in the simulation of a many-body system with different drop size, elongation ratio, and viscosity. Numerical examples demonstrate the capability and accuracy of the proposed formulation and illustrate particles' rotation and motion caused by particle interactions. [ABSTRACT FROM AUTHOR]

Abstract: We extend some known results on radicals and prime ideals from polynomial rings and Laurent polynomial rings to -graded rings, i.e, rings graded by the additive group of integers. The main of them concerns the Brown–McCoy radical and the radical , which for a given ring is defined as the intersection of prime ideals of such that is a ring with a large center. The studies are related to some open problems on the radicals and of polynomial rings and situated in the context of Koethe’s problem. [Copyright &y& Elsevier]

The main purpose of this paper is to investigate an additive range-inclusive map from a semiprime ring with idempotents into its maximal right quotient ring. As a corollary to our main result we obtain a simple proof of a result by Brešar. Our approach is based on connecting range-inclusive maps with the theories of local derivations and biderivations. [ABSTRACT FROM AUTHOR]

Let R be a simple ring with nontrivial zero-divisors. It is proved that every commutator in R is a sum of nilpotent elements if R contains nontrivial idempotents, but it is not so if R does not. An example is also given to show that not every commutator in a prime ring with nontrivial idempotents can be expressed as a sum of nilpotent elements. [ABSTRACT FROM PUBLISHER]

Abstract: It is shown that the Behrens radical of a polynomial ring, in either commuting or non-commuting indeterminates, has the form of “polynomials over an ideal”. Moreover, in the case of non-commuting indeterminates, for a given coefficient ring, the ideal does not depend on the cardinality of the set of indeterminates. However, in contrast to the Brown–McCoy radical, it can happen that the polynomial ring in an infinite set of commuting indeterminates over a ring is Behrens radical while the polynomial ring in an infinite set of non-commuting indeterminates over is not Behrens radical. This is connected with the fact that the matrix rings over Behrens radical rings need not be Behrens radical. The class of Behrens radical rings, which is closed under taking matrix rings, is described. [Copyright &y& Elsevier]

α-Synuclein, a synaptic protein of unknown function, is a major component of Lewy bodies and may play a role in the pathophysiological process of Parkinson’s disease (PD). In this study, we measured the plasma α-synuclein levels in 105 patients with PD, 38 patients with multiple system atrophy (MSA), and 51 age-matched controls. The α-synuclein level was significantly elevated in patients with PD (79.9 ± 4.0 pg/ml, p < 0.001) and in those with MSA (78.1 ± 3.5 pg/ml, p = 0.019) compared with the level in controls (76.1 ± 3.9 pg/ml). The α-synuclein level was higher in patients with PD than in those with MSA (79.9 ± 4.0 vs 78.1 ± 3.5, p = 0.016). Our study demonstrated that the α-synuclein level in plasma is elevated in patients with PD and MSA. [ABSTRACT FROM AUTHOR]

Background and Purpose: The pathogenesis of deep white matter medullary (WMM) artery infarcts remains controversial. To address this question, we analysed the stroke patterns of WMM infarcts using diffusion weighted magnetic resonance imaging (DWI) to detect embolic signals and investigate stroke subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications. Methods: We identified WMM infarcts on DWI using templates to determine the subcortical vascular territories. We classified WMM infarcts into those with small artery disease (SAD), large artery disease (LAD), cardioembolism (CE), two or more aetiologies, or undetermined aetiology. Clinical course, risk factors, and cortical spotty lesions were compared. Results: Of the 1420 consecutive patients, 103 (7.3%) met the criteria for WMM infarcts. The stroke subtypes were as follows: 65 (63.1%) patients with LAD, 18 (17.5%) with SAD, 12 (11 .7%) with CE, four (3.9%) with two or more aetiologies, three (2.1%) with undetermined aetiology, and one (1.0%) with other determined aetiology. LAD (87.7%) or CE (83.3%) was significantly accompanied by cortical embolic signals as compared to SAD (0%, p<0.001). The LAD infarcts were larger and tended to be chain-like in shape. Ischaemic stroke recurrence was more common in strokes with cortical embolic signals than in those without embolic signals (18.9% v 0%, p = 0.009). Conclusions: In present study, the most common pathogenesis of WMM infarcts was LAD. Our study indicates that WMM infarcts accompanying cortical embolic signals warrant evaluation of the underlying embolic sources in the large artery or the heart. [ABSTRACT FROM AUTHOR]

Recent clinical and experimental studies suggest that ischemic strokes may play an important role in the pathogenesis of Alzheimer’s disease (AD). Beta amyloid (Aβ), a major component of senile plaque in AD, is known to be derived from ischemic brain or activated platelets. We prospectively enrolled 62 patients with acute ischemic stroke and 27 age-matched controls. The serum Aβ and P-selectin levels were determined using the Sandwich-ELISA. We divided ischemic strokes into subgroups according to the clinical syndrome, pathogenesis, and infarct size, and compared the Aβ level between each subgroup. The Aβ1–40 level was markedly elevated in ischemic stroke patients, as compared to controls (140.2 ± 54.0 vs 88.44 ± 34.96 pg/ml, p<0.001). Cardioembolic and larger artery atherosclerotic infarcts had higher Aβ1–40 level than small vessel disease ( p = 0.001). Both infarct size and the initial NIHSS score had significantly positive correlations with the serum level of Aβ1–40 ( r = 0.539, p<0.001 and r = 0.425, p = 0.001, respectively). However, the P-selectin level was not significantly correlated with serum Aβ1–40. Our data suggest that elevated circulating Aβ1–40 in ischemic stroke patients may be derived from brain as a consequence of ischemic insults. [ABSTRACT FROM AUTHOR]

Background: Apart from diffusion-weighted imaging (DWI) lesion volume and diffusion-perfusion mismatching, there is limited information about neuroradiological predictors of early prognosis after an ischaemic stroke. This study sought to identify specific DWI lesion patterns that would help prediction of early prognosis of three different endpoints: unstable hospital course, recurrence of stroke, and poor neurological outcome at 90 days after ischaemic stroke.Methods: A total of 426 patients with acute cerebral infarcts within the middle cerebral artery territory were prospectively studied. Using the DWI data the patients were divided into six groups (territorial, other cortical, small superficial, internal border zone, small deep, and other deep infarcts), and any recurrent strokes and prognosis over the following 90 days were recorded.Results: DWI lesion pattern was a stronger and more consistent independent outcome predictor than DWI lesion volume. The specific DWI lesion patterns associated with each endpoint differed. An unstable hospital course was frequently observed in patients with internal border zone infarcts, whereas recurrent strokes after the index stroke were commoner in those who had small superficial infarcts (p<0.05 in both cases). Similarly, poor outcome after stroke was associated with older age, severe neurological deficits at admission, and a DWI lesion pattern showing internal border zone infarcts.Conclusions: The results of the present study indicate that the DWI lesion pattern may help in recognition of the likely differences in the early prognostic endpoints after ischaemic stroke, and DWI analysis may guide targeted interventions to prevent negative outcomes. [ABSTRACT FROM AUTHOR]

Background: The apparent differences in risk factors for intra- and extracranial atherosclerosis are unclear and the mechanisms that underlie strokes in patients with intracranial atherosclerosis are not well known. We investigated the conventional vascular risk factors as well as other factors in stroke patients with large artery atherosclerosis.Methods: Using diffusion weighted imaging (DWI) and vascular and cardiologic studies, we selected patients with acute non-cardioembolic cerebral infarcts within the middle cerebral artery (MCA) territory. Patients were divided into two groups: those with atherosclerotic lesions on the carotid sinus (n = 112) and those with isolated lesions on the proximal MCA (n = 160). Clinical features, risk factors, and DWI patterns were compared between groups.Results: There were no differences in conventional risk factors, but markers for inflammation were significantly higher in patients with carotid atherosclerosis than in those with isolated MCA atherosclerosis (p < 0.01 for both). After adjustments for age/sex and the severity of stroke, an inverse correlation was observed between C-reactive protein levels and MCA atherosclerosis (odds ratio 0.57 per 1 mg/dl increase; 95% confidence interval 0.35 to 0.92; p = 0.02). Internal borderzone infarcts suggestive of haemodynamic causes were the most frequent DWI pattern in patients with MCA occlusion, whereas territorial infarcts suggesting plaque ruptures were most common in those with carotid occlusion.Conclusions: Our results indicate that inflammatory markers, rather than conventional risk factors, reveal clinical and radiological differences between patients with carotid and MCA atherosclerosis. Plaques associated with MCA atherosclerosis may be more stable than those associated with carotid atherosclerosis. [ABSTRACT FROM AUTHOR]

Parkinsonism associated with dural arteriovenous fistula (DAVF) has been described rarely; however, isolated parkinsonism as the presenting symptom of DAVF has not been reported. Here, we describe a patient with DAVF showing reversible isolated parkinsonism after embolization, which was well correlated with perfusion status of basal ganglia, suggesting that a perfusion defect was responsible for the pathogenesis of the parkinsonism in our DAVF patient. [ABSTRACT FROM AUTHOR]

Background and Objective: Spinocerebellar ataxia 7 (SCA7) is characterised by cerebellar ataxia and visual loss. The aim of the present study was to elucidate the magnetic resonance imaging (MRI) findings characteristic of patients with SCA7.Methods: Twenty patients with SCA (eight SCA3, three SCA6, and nine SCA7) and 20 control subjects underwent an MRI-based volumetric analysis.Results: The pontine volume in patients with SCA7 was decreased by a greater amount than in patients with other types of SCA (p<0.01), whereas the cerebellar volume was not different from that in other types of SCA (p>0.05). Pontine atrophy was a consistent finding in all patients with SCA7 regardless of the degree of cerebellar atrophy or the severity or duration of illness. In contrast, cerebellar atrophy was not found in those with a short duration of illness or mild ataxia, but became prominent as the severity and duration of illness progressed.Conclusions: Our study suggests that neurodegeneration is ongoing during the life of individuals with SCA7, and that the primary pathology in these individuals involves the brainstem rather than the cerebellum. In addition, pontine atrophy is a prominent, consistent finding in SCA7, and may help in establishing the clinical diagnosis of SCA7. [ABSTRACT FROM AUTHOR]

Background: Isolated atherosclerotic middle cerebral artery (MCA) disease is often difficult to differentiate from cardioembolic disease if intracranial atherosclerosis coexists with cardiac disease.Objectives: To evaluate whether clinical and neuroradiological features of isolated MCA disease differ according to the underlying aetiology.Methods: Isolated MCA disease was defined as a unilateral angiographically occlusive lesion of the MCA on the symptomatic side without lesions of other intracranial or extracranial vessels. Patients with isolated MCA disease were divided into atherosclerotic and potentially cardioembolic, and the clinical, laboratory, and neuroradiological data analysed.Results: Among the 850 consecutive patients with acute ischaemic stroke or transient ischaemic attack, 107 (12.6%) met the criteria for isolated MCA disease (76 with atherosclerotic disease and 31 with a potential source of cardiac embolism). Total anterior circulation infarcts were more common and baseline NIHSS score was higher in potentially embolic occlusions than in atherosclerotic disease (each p<0.001). While cortical infarcts and territorial infarcts were more common in the potential embolism group (p = 0.028 and p<0.001, respectively), subcortical border zone infarcts were more common in the atherosclerotic group (p<0.001). Multiple regression analysis showed that border zone infarcts and mild stroke were independently associated with atherosclerotic MCA disease, while territorial and cortical infarcts were associated with potential cardiac embolic disease.Conclusions: Clinical and neuroradiological characteristics can differentiate isolated atherosclerotic MCA disease from MCA disease associated with potential sources of cardiac embolism, and may reflect the differences in underlying pathogenesis. [ABSTRACT FROM AUTHOR]

Describes the stereoselective, conjugate additions of primary amines to chiral bicyclic lactams. Facial diastereoselectivities; Transformation of optically pure amino bicylic lactams by reductive cleavage to chiral-3-aminopyrrolidines.

Cardiac sympathetic dysfunction was investigated using 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in 20 patients with drug induced parkinsonism (DIP). The mean heart to mediastinum ratio was significantly greater in patients with DIP than in those with Parkinson's disease (mean (SD): 2.07 (0.39) v 1.28 (0.15), p<0.001). MIBG uptake was not different between the DIP patients and controls. Two DIP patients whose MIBG uptake was significantly reduced showed persistent parkinsonism and responded dramatically to levodopa. [ABSTRACT FROM AUTHOR]

Astasia, inability to stand unsupported despite good strength, resembles the marked balance impairment of patients with vestibulocerebellar disease. We describe a patient with unilateral thalamic infarct that presented with astasia. A 76-year-old hypertensive woman was admitted to our hospital because of marked unsteadiness. On neurological examination, she could not stand unsupported and the woman's body swayed back and forth markedly. The swaying was not compensated for by her taking a step forward or backward, and she frequently collapsed when support was withdrawn. Diffusion-weighted magnetic resonance image revealed a discrete infarct within the right posterolateral thalamus. Brain single photon emission computerized tomography revealed markedly decreased regional cerebral blood flow within in the right thalamus with concomitant left superior cerebellar region. We discuss the possible pathomechanisms of thalamic astasia. [ABSTRACT FROM AUTHOR]

We report on a fast framing camera designed to image imploding foils driven by inductive storage drivers. The camera has several front ends which are disposable, they allow for imaging in either the visible, UV, or x-ray regions; it also has very large dynamic range which allows it to record sequences of events where the brightness changes by many orders of magnitude. [ABSTRACT FROM AUTHOR]

The purpose of the paper is to study prime rings R such that the central closure RC is a simple ring with 1 and it is finitely generated over R by elements of the extended centroid C , that is, R C = R [ c 1 , … , c n ] , for some c 1 , … , c n ∈ C . In particular, we will show that if there exists a prime ring with zero center whose central closure is simple with 1 and generated by finitely many central elements, then there exists such a ring whose central closure is generated by two central elements. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article about the 16q-linked autosomal dominant cerebellar ataxia in a Korean family.

A letter to the editor reporting the case of a patient with a dystonic head tremor associated a with parietal lesion is presented.

We discuss several problems on the structure of nil rings from the linear algebra point of view. Among others, a number of questions and results are presented concerning algebras of infinite matrices over nil algebras, and nil algebras of infinite matrices over fields, which are related to the famous Koethe's problem. Some questions on radicals of tensor products of algebras related to Koethe's problem are also discussed. [ABSTRACT FROM AUTHOR]

Let K be a commutative ring with unit, R be a prime K-algebra with center Z(R), right Utumi quotient ring U and extended centroid C, and I a nonzero right ideal of R. Let g be a nonzero generalized derivation of R and f(X1,...,Xn) a multilinear polynomial over K. If g(f(x1,...,xn)) f(x1,...,xn) ∈ C for all x1,...,xn ∈ I, then either f(x1,...,xn)xn+1 is an identity for I, or char(R)=2 and R satisfies the standard identity s4(x1,...,x4), unless when g(x)=ax+[x,b] for suitable a, b ∈ U and one of the following holds: (i) a, b ∈ C and f(x1,...,xn)2 is central valued on R; (ii) a ∈ C and f(x1,...,xn) is central valued on R; (iii) aI=0 and [f(x1,...,xn), xn+1]xn+2 is an identity for I; (iv) aI=0 and (b-β)I=0 for some β ∈ C. [ABSTRACT FROM AUTHOR]

As the epidemiological pattern of breast cancer in modernising Asian countries differs greatly from that in Western countries, it is worthwhile to investigate the long-term prognoses of unilateral and bilateral breast cancer in these nations. A retrospective cohort study composed of 1907 Taiwanese women was conducted to follow 1863 unilateral and 44 bilateral cases of breast cancer. Time-dependent Cox regression was used to assess the risk of breast cancer death by considering the time course of unilateral and bilateral tumour development. The 15-year survival rates were 68.37, 62.63, and 26.42% for unilateral, synchronous bilateral, and metachronous bilateral breast cancer, respectively. Differences among types were most apparent after 5 years of follow-up. After adjusting for significant prognostic factors, the risk of death for overall bilateral breast cancer was 2.50-fold greater (95% CI, 1.43-4.37) compared to unilateral breast cancer. The corresponding figures were 1.12-fold (95% CI, 0.42-3.02) and 6.11-fold (95% CI, 3.14-11.89) for synchronous and metachronous bilateral breast cancer, respectively. Taiwanese women, who are frequently diagnosed with breast cancer before 50 years of age, showed poorer survival for metachronous bilateral than for synchronous bilateral or unilateral breast cancer. Survival was markedly poorer compared to recent data from Sweden. [ABSTRACT FROM AUTHOR]

Abstract: Our objectives were to assess the characteristics of donors for living-donor liver transplantation (LDLT) and to examine the impact of donation on LDLT donor quality of life (QOL) regarding physical and psychological distress. Methods: Data were collected from a mailed survey or an interview using a cross-sectional prospective study design. We used the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF), Physical Symptom Disturbance Scale, and Psychological Distress Scale. LDLT donors were recruited from a teaching hospital located in a metropolitan area of northern Taiwan. Results: The 35 LDLT donors have a mean age 34.0 ± 8.6 years and were recruited at a median of 25.9 months after donation (range, 0.6–92 months). The average scores in the four domains of the WHOQOL-BREF scale ranged from 13.5 to 14.9. LDLT Donors reported higher QOL scores in social and environment domains but lower scores in physical and psychological domains than healthy adults. Numbers of physical symptoms experienced by each donor ranged from one (n = 4) to 27 (n = 2). Feeling throbbing, itching or numbness around the wound was the most common physical symptom disturbance reported by donors (n = 26, 74%). Approximately 40% of the donors reported having one to three metrics of psychological distresses. “Easily feel distress and angry” was the most common psychological distress reported by 57% (n = 20) of donors. Conclusions: This study indicated that liver donation had a mild negative impact on donors physical and psychological facets of QOL. These results may assist professionals to provide appropriate clinical management. [Copyright &y& Elsevier]

Background and purpose: As a major antioxidant, uric acid (UA) is known to be associated with the clinical progression of Parkinson's disease (PD). This study investigated whether baseline UA levels are associated with the risk for levodopa‐induced dyskinesia (LID) in PD in a sex‐dependent manner. Methods: In all, 152 patients with de novo PD (78 males and 74 females) who were followed up for >2 years were enrolled. The effect of baseline serum UA levels on LID‐free survival was assessed by Cox regression, separately for sex, whilst being adjusted for potential confounding factors. The optimal UA level cut‐off value to determine the high‐risk group for LID was set using Contal and O'Quigley's method. Results: Levodopa‐induced dyskinesia developed in 23 (29.5%) male patients and 30 (40.5%) female patients. Cox regression showed a significant interaction between UA level and sex. Higher UA levels were associated with a higher risk for LID in male PD patients (hazard ratio 1.380; 95% confidence interval 1.038–1.835; P = 0.027), although this relationship was not observed in female PD patients. The optimal UA level cut‐off for LID in male PD was 7.2 mg/dl, and the high UA group had a 5.7‐fold higher risk of developing LID than the low UA group. Conclusions: Contrary to a presumptive beneficial role of UA, the present study demonstrated that higher UA levels are associated with increased risk of LID occurrence in male patients with PD, suggesting a sex‐dependent role of UA in LID. [ABSTRACT FROM AUTHOR]

We have developed a model for electromagnetic wave propagation in and scattering from random media. Scattering potentials are introduced to account for the reflections and refractions from boundaries. The differential cross sections for backscatter are calculated in the Kirchhoff approximation. We find that, in single scattering processes, the polarizations of differential cross sections are conserved and the differential cross sections are independent of the polarizations. The cross-polarized differential cross sections are symmetric and solely attributed to multi-scattering processes. Our results are in good agreement with experimental measurements. © 1998 American Institute of Physics. [ABSTRACT FROM AUTHOR]

The Trailmaster/Pioneer 1 series of imploding plasma experiments are aimed at using an inductive storage driver to implode an ultrathin aluminum foil with a multimegampere, submicrosecond electrical pulse. The power pulse is produced by an explosive flux compression generator and a fast plasma compression opening switch. The goal is to obtain an intense source of soft x rays from the thermalization of the plasma kinetic energy when pinch occurs on axis. An important target diagnostic is a fast camera which measures the dynamics of foil run-in and implosion symmetry. These measurements are made in the visible, UV, and x-ray portions of the electromagnetic spectrum. UV/x-ray images are first converted to visible light, then transmitted by visible light optics to a framing camera, which is located at a safe distance. For UV/soft x-ray imaging, we mount a disposable pinhole camera with a p-terphenyl-coated converter screen on the target chamber. For soft/hard x-ray imaging, a microchannel plate is used in front of the pterphenyl-coated screen to boost quantum detection efficiency and signal gain. For faster temporal response the p-terphenyl can be replaced by NE-111 or other fast fluors. Image transmission is accomplished by means of two large mirrors (150-250 mm diam) and a large catadioptric telescope. The framing camera consists of four gated microchannet plates with adjustable gate and interframe times. The framing camera is a versatile and rugged instrument, it has performed satisfactorily for each and every Pioneer shot. Experimental data indicate that this camera, which uses individual gated microchannel plates, is far superior to commercial streak/ framing cameras, because it has a dynamic range which is orders of magnitude larger than commercial cameras, each channel can be attenuated separately, further increasing the dynamic range of the imaging system. This makes our framing camera especially suitable for recording sequences of events where the... [ABSTRACT FROM AUTHOR]

Background and purpose: Anosognosia refers to a deficit of self‐awareness or impaired insight for cognitive and behavioral problems. Cognitive anosognosia was explored in de novo patients with Parkinson's disease (PD) and its relationship to cognitive function and neuropsychiatric symptoms was investigated. Methods: The cross‐sectional study enrolled 340 drug‐naïve patients with PD. According to the presence of mild cognitive impairment (MCI) and subjective cognitive complaint, patients were classified as patients with cognitive anosognosia (PD‐CA, n = 74), with normal cognitive recognition (PD‐NR, n = 184) or with cognitive underestimation (PD‐CU, n = 82). After controlling for covariates, cognitive performance and neuropsychiatric symptoms were compared between the PD groups. Results: Cognitive anosognosia was found in 21.8% of patients with de novo PD. The PD‐CA group showed poorer performance in all cognitive domains except for attention. Amongst PD patients with MCI, those with cognitive anosognosia showed lower composite z‐scores in the Stroop color reading test than those without. The Beck Depression Inventory score in the PD‐NR group was lower than that in the PD‐CU group and higher than that in the PD‐CA group. The Cognitive Complaints Interview score mediated the association between cognitive anosognosia and Beck Depression Inventory score. Conclusions: Cognitive anosognosia in PD was associated with greater frontal dysfunction and lower depression. Since cognitive anosognosia has a harmful impact on PD patients and their caregivers due to overestimation of their abilities in everyday life, early identification of cognitive anosognosia in PD is important in management and prognosis. [ABSTRACT FROM AUTHOR]

Background and purpose: The aim was to investigate the relationship between the serum urate (UA) levels and patterns of striatal dopamine depletion in patients with de novo Parkinson's disease (PD). Methods: In all, 167 de novo PD patients who underwent 18F‐fluorinated N‐3‐fluoropropyl‐2‐beta‐carboxymethoxy‐3‐beta‐(4‐iodophenyl) nortropane positron emission tomography scans were enrolled. After quantifying dopamine transporter (DAT) availability in each striatal subregion, sex‐dependent patterns of striatal dopamine depletion were analysed by measuring (i) dopamine depletion in the other striatal subregions and posterior putamen (intersubregional ratio, ISR) and (ii) the interhemispheric asymmetry of dopamine depletion in the posterior putamen (asymmetric ratio, AR). Results: The interaction analysis revealed a significant interaction effect of sex and serum UA levels on the ISR but not on the AR. The ISR was negatively correlated with the serum UA levels in all patients with PD (r = −0.156, P = 0.045), and this association was more prominent in male PD patients (r = −0.422, P < 0.001). However, no significant association between the AR and serum UA levels was found in any of the patients. In addition, serum UA levels were significantly associated with DAT availability in the posterior putamen on both the more affected side (r = 0.312, P = 0.005) and the less affected side (r = 0.312, P = 0.005) only in male PD patients. Conclusions: The present study demonstrated the potentially close sex‐specific relationship between the serum UA levels and the anterior–posterior gradient of DAT patterns, suggesting a sex‐specific protective effect of UA on nigrostriatal dopaminergic neurons in de novo PD. [ABSTRACT FROM AUTHOR]

Background and purpose: Subcortical structures are affected by neurodegeneration in Alzheimer's disease (AD) and Lewy body disease (LBD). Although the co‐occurrence of AD and LBD pathologies and their possible interaction have been reported, the effect of AD and LBD on subcortical structures remains unknown. The effects of AD and LBD on subcortical atrophy and their relationship with cognitive dysfunction were investigated. Methods: The cross‐sectional study recruited 42 patients with pure AD related cognitive impairment (ADCI), 30 patients with pure LBD related cognitive impairment (LBCI), 58 patients with mixed ADCI and LBCI, and 29 normal subjects. A general linear model was used to compare subcortical volume and shape amongst the groups, to investigate the independent and interaction effects of ADCI and LBCI on subcortical shape and volume, and to analyze the relationship between subcortical volume and cognitive dysfunction in each group. Results: Alzheimer's disease related cognitive impairment and LBCI were independently associated with subcortical atrophies in the hippocampus and amygdala and in the hippocampus and putamen respectively, but their interaction effect was not significant. Compared to the control group, the pure LBCI group exhibited additional local atrophies in the amygdala, caudate and thalamus. Subcortical atrophies correlated differently with cognitive dysfunction according to the underlying causes of cognitive dysfunction. Conclusions: The patterns of subcortical atrophies and their correlation with cognitive dysfunction differ according to the underlying AD, LBD or concomitant AD and LBD. [ABSTRACT FROM AUTHOR]

We demonstrate by experiment that, in addition to the local surface slope, local surface elevation can also be directly measured using the refracted light beam traversing an air-water interface, thus showing the feasibility of a new surface slope and wave height amplitude gauge for use in studying water waves. We have achieved surface height resolutions as small as 40 μm for the range of surface wavelengths λ ∼ 1.2-2.4 cm used in the present experiments. This measurement principle is readily adaptable to waves of different scale. The available dynamic range defined by the ratio of maximum wave amplitude to minimum resolvable amplitude need only be limited by the useful dynamic range of the photodetector when matched to a laser of suitable frequency and sufficient power. [ABSTRACT FROM AUTHOR]

Background and purpose: To clarify whether subtyping of amnestic and non‐amnestic mild cognitive impairment (MCI) is clinically relevant in Parkinson's disease (PD) by analyzing patterns of neuroimaging and longitudinal cognitive changes. Methods: We performed comparative analyses of cortical thickness, hippocampal volume, white matter integrity and resting‐state functional connectivity between the patients with de‐novo PD with amnestic MCI (PD‐aMCI) (n = 50) and non‐amnestic MCI (PD‐naMCI) (n = 50) subtypes. Additionally, we assessed the longitudinal rate of cognitive decline in each cognitive domain over time and the rate of dementia conversion in patients with de‐novo PD‐aMCI (n = 125) and PD‐naMCI (n = 61). Results: The demographic data showed that scores in memory domains were lower in the PD‐aMCI group compared with the PD‐naMCI group. There were no significant differences in cortical thickness, hippocampal volume and white matter integrity between the two groups, although the PD‐aMCI group exhibited more cortical thinning and hippocampal atrophy relative to the control group. The PD‐aMCI group exhibited increased functional connectivity in the left posterior parietal region with the salience network relative to the PD‐naMCI group. The longitudinal cognitive assessment demonstrated that patients with PD‐aMCI exhibited a more rapid cognitive decline in frontal/executive function than those with PD‐naMCI (P = 0.022). In addition, the PD‐aMCI group had a higher risk of dementia conversion than the PD‐naMCI group. Conclusions: This study suggests that the designation of PD‐MCI subtypes based on memory function would highlight the heterogeneity of functional correlates as well as the longitudinal cognitive prognosis. [ABSTRACT FROM AUTHOR]

The use of cyclosporine was traditionally monitored by the trough level (C0). However, the immunosuppressive effects of cyclosporine correlate with its drug exposure, represented by the area under curve (AUC). It was also noted that cyclosporine C0 level correlated with AUC poorly, while C2 level (concentration at 2 hours after drug administration) satisfactorily correlated with AUC. Most recent studies concern the use of C2 levels in de novo renal transplant patients; target levels of C2 have been suggested. There is rare discussion about the C2 target level for long-term cyclosporine-maintenance patients. Our objectives were to analyze the cyclosporine C2 levels of patients more than 12 months after transplantation as well as changes in C2 with time and the correlation between C2 level and renal function.This was a cross-sectional case-controlled study of 101 kidney recipients immunosuppressed with a cyclosporine-based regimen for at least 12 months. Both C0 and C2 levels were examined at various time points during outpatient clinic follow-up. The patients were stratified according to the time after transplant surgery, or to their renal function.The 101 patients were divided into three groups based on the time after renal transplant surgery. Groups 1, 2, and 3 represented patients transplanted for 1 to 3 years (n = 16), 4 to 6 years (n = 35), and more than 6 years (n = 50), respectively. The C2 levels for each group were 657 ± 232, 561 ± 186, and 580 ± 243 ng/mL, respectively, (P = NS). When stratified into low versus high C2 groups, there were no significant differences in renal function both at the beginning and at the end of 1 year follow-up. Seven of 67 patients shifted to stronger immunosuppression in the low C2 group, but only 2/34 in the high C2 group, a difference that was not significant (P = .234 by Fisher Exact Test). Patients with creatinine levels greater than 1.5 mg/dL or lower than 1.5 mg/dL showed no difference in C2 on C0 levels. Patients with deterioration of renal function during this period had no different C2 levels as those with no deterioration of renal function.The average C2 levels among long-term cyclosporine-maintained patients were significantly lower than those previously suggested. C2 levels did not correlate with the long-term outcome of renal function in patients at least 1 year after renal transplantation. [Copyright &y& Elsevier]

Lithium manganese oxide nanopowders doped with Ce ions are synthesized using modified sol-gel method and the effect of annealing atmosphere (air vs. nitrogen) on the structure, morphology, and phase composition is studied thoroughly. Electrochemical testing is conducted to evaluate the effect of annealing atmosphere on electrochemical performance. The X-ray diffraction indicates the cubic spinel structure for all the obtained samples. The lattice parameter is observed to slightly decrease with increasing concentration of Ce 3+ ions substituting Mn 3+ ions from 8.230 to 8.228 Ẵ and from 8.227 to 8.224 Ẵ for air annealing and for nitrogen-air annealing, respectively. A limited solubility of cerium in LiMn 2 O 4 is also observed, as small amounts of cerium dioxide is detected on the surface of LiMn 2-x Ce x O 4 grains and confirmed by XPS analysis of cerium which shows only the spectrum of Ce 4+ ions. Electrochemical testing is conducted to evaluate the effect of annealing atmosphere on electrochemical performance. It is shown that annealing in nitrogen and then in air results in excellent capacity retention with minimal, 4–8% capacity loss after 150 cycles. LiMn 1.99 Ce 0.01 O 4 samples prepared that way display better high rate performance in comparison with pristine LiMn 2 O 4 . [ABSTRACT FROM AUTHOR]

Background and purpose Rapid eye movement sleep behaviour disorder ( RBD) is related to striatal dopamine depletion. This study was performed to confirm whether clinically probable RBD (cp RBD) in patients with Parkinson's disease ( PD) is associated with a specific pattern of striatal dopamine depletion. Methods A prospective survey was conducted using the RBD Screening Questionnaire ( RBDSQ) in 122 patients with PD who had undergone dopamine transporter ( DAT) positron emission tomography scan. Results Patients with cp RBD (RBDSQ ≥ 7) exhibited greater motor deficits, predominantly in the less-affected side and axial symptoms, and were prescribed higher levodopa-equivalent doses at follow-up than those without cp RBD (RBDSQ ≤ 4), despite their similar disease and treatment durations. Compared to patients without cp RBD, those with cp RBD showed lower DAT activities in the putamen, particularly in the less-affected side in all putaminal subregions, and a tendency to be lower in the ventral striatum. In addition, greater motor deficits in patients with cp RBD than in those without cp RBD remained significant after controlling for DAT binding in the putamen and other confounding variables. Conclusions These results demonstrated that the presence of RBD in patients with PD is associated with different patterns of both motor deficit distribution and striatal DAT depletion, suggesting that the presence of RBD represents a distinct PD subtype with a malignant motor parkinsonism. [ABSTRACT FROM AUTHOR]

Background The optimal period of conservative treatment for adhesive small bowel obstruction remains controversial. This study sought to determine whether a 24-h abdominal radiograph after oral Urografin is a reliable indicator for operation in patients with adhesive small bowel obstruction. Methods One hundred and sixty-one patients who suffered from adhesive intestinal obstruction without clinical evidence of strangulation or gangrene underwent a Urografin study. Some 40 ml Urografin mixed with 40 ml distilled water was administered either orally or via a nasogastric tube to each patient. Serial plain abdominal radiographs were taken 4, 8, 16 and 24 h later. If an earlier plain radiograph showed that contrast medium had reached the ascending colon, subsequent radiographs were not taken. Results Contrast medium reached the colon within 24 h in 112 patients (70 per cent). These patients were all treated successfully with non-operative methods. Contrast medium was not observed in the colon within the first 24 h in 49 patients (30 per cent). Operation was performed in 47 of these patients and non-operative treatment was given in two. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of Urografin reaching the colon within 24 h as an indicator for non-operative treatment were 98, 100, 99, 100 and 96 per cent respectively. Conclusion All patients with evidence of Urografin reaching the colon within 24 h were treated successfully with non-operative methods. The results of this prospective study suggest that patients with adhesive intestinal obstruction in whom contrast medium fails to reach the colon within 24 h should receive prompt surgical intervention. [ABSTRACT FROM AUTHOR]

Background and purpose Reduction of metaiodobenzylguanidine ( MIBG) uptake has been observed in almost all patients with Parkinson's disease ( PD), associated with hyposmia, orthostatic hypotension and rapid eye movement sleep behavioral disorder ( RBD). In contrast, a subgroup of patients with PD with normal MIBG uptake have been reported to have milder disease and preserved cognition compared with those with lower MIBG. The aim of this study was to investigate whether non-motor manifestations of PD differ between patients with normal and abnormal myocardial MIBG uptake. Methods Among 160 de-novo cases of PD, 44 had normal MIBG uptake. Twelve candidate non-motor features were evaluated using questionnaires and laboratory tests. Results Patients with decreased MIBG uptake had more constipation, RBD, cognitive impairment, hyposmia and orthostatic hypotension than did those with normal MIBG uptake. On linear regression analysis, orthostatic hypotension, olfactory function and probable RBD were significantly associated with MIBG uptake in PD. The principal component analysis showed that the group with normal MIBG was not associated with non-motor impairments. Conclusions These results suggest that patients with PD with normal MIBG scans have a relatively low disease burden compared with those with abnormal MIBG. Fewer synuclein pathologies in the myocardia and sympathetic ganglia in PD with preserved MIBG uptake might be associated with lower threshold patterns of Braak synuclein pathology for non-motor manifestations compared with PD with decreased MIBG. [ABSTRACT FROM AUTHOR]

Background and purpose Although early cerebellar symptoms are one of the exclusive criteria in the diagnosis of progressive supranuclear palsy ( PSP), cerebellar involvement in PSP is evident both clinically and pathologically. However, structural analysis focusing on the cerebellum has not been previously studied in patients with PSP. We aimed to evaluate cerebellar involvement in PSP using a magnetic resonance imaging-based segmental volumetric analysis. Methods We retrospectively enrolled 48 patients with PSP composed of 25 patients with PSP-Richardson's syndrome ( RS) and 23 patients with pure akinesia with gait freezing, 39 patients with Parkinson's disease ( PD) and 34 healthy controls. Data on both the whole and segmented cerebellar volumes were analyzed using a fully automated procedure. Results A general linear model showed that whole cerebellar volume in patients with PSP was significantly smaller compared with that of patients with PD or controls after controlling for age, sex and intracranial volume ( P = 0.34). In addition, patients with PSP exhibited decreased regional volume in the crus I, lobule VIIIa and lobule VIIIb, which play roles as secondary representations of motor tasks, compared with patients with PD or controls. In subgroup analysis of PSP, volume loss in the whole and segmental cerebellum was more pronounced in patients with PSP- RS than in those with pure akinesia with gait freezing, PD or control subjects. Conclusion These data demonstrate that cerebellar atrophy is evident in patients with PSP and is especially prominent in the PSP- RS group. These findings increase understanding of the clinicopathological basis of cerebellar involvement in PSP. [ABSTRACT FROM AUTHOR]

Background and purpose The association of serum uric acid, cerebrospinal fluid ( CSF) biomarkers of Alzheimer's disease ( AD) and longitudinal cognitive decline was evaluated using the AD Neuroimaging Initiative database. Methods In 271 healthy subjects, 596 mild cognitive impairment patients and 197 AD patients, serum uric acid and CSF AD biomarkers were measured at baseline, and Mini-Mental State Examination and AD Assessment Scale − Cognitive Subscale ( ADAS-cog) were assessed serially (mean duration, 2.9 years). The effect of uric acid on longitudinal cognitive decline was evaluated using linear mixed effect models for Mini-Mental State Examination and ADAS-cog scores in female and male subjects separately, with possible confounders controlled (model 1). To determine the effects of uric acid independent of CSF biomarker (Aβ1-42 or tau) and to test whether the detrimental effects of CSF biomarker differ according to uric acid, CSF biomarker and its interaction with uric acid were further included in model 1 (model 2). Results Higher levels of uric acid were associated with slower cognitive decline, particularly in the mild cognitive impairment and dementia subgroups, and more prominently in female subjects. Model 2 with CSF Aβ1-42 showed that higher levels of uric acid were associated with a slower cognitive decline and alleviated the detrimental effect of Aβ1-42 on cognitive decline. Model 2 with CSF tau showed that higher levels of uric acid alleviated the detrimental effect of tau on cognitive decline in female subjects but not in male subjects. Conclusion Higher levels of uric acid had protective effects on longitudinal cognitive decline independent of and interactively with CSF AD biomarkers. [ABSTRACT FROM AUTHOR]

Background and purpose To evaluate whether white matter hyperintensities ( WMHs) may act as an independent predictor for progression of cognitive status, the authors analyzed the longitudinal effects of WMHs on cognitive dysfunction in non-demented patients with Parkinson's disease (PD). Methods A total of 111 patients with PD were enrolled, including subjects with mild cognitive impairment ( MCI, n = 65) and cognitively normal subjects ( CN, n = 46). These individuals were classified as MCI converters ( n = 22) or MCI non-converters ( n = 43) and CN converters ( n = 18) or CN non-converters ( n = 28) based on whether they were subsequently diagnosed with PD dementia or PD-MCI during a minimum 24-month follow-up. The WMH burden and the Cholinergic Pathway Hyperintensities Scale ( CHIPS) and their relationships to longitudinal changes in cognitive performance were examined. Results PD-MCI converters had larger WMH volume (14421.0 vs. 5180.4, P < 0.001) and higher CHIPS score (22.6 vs. 11.2, P = 0.001) compared with PD- MCI non-converters. Logistic regression analysis revealed in patients with PD- MCI that WMH volume (odds ratio 1.616, P = 0.009) and CHIPS score (odds ratio 1.084, P = 0.007) were independently associated with PD dementia conversion. However, WMH volume and CHIPS score did not differ between PD-CN converters and PD- CN non-converters. In patients with PD- MCI, both WMH volume and CHIPS score were closely associated with longitudinal decline in general cognition, semantic fluency and Stroop test scores. Conclusions The present study demonstrates that WMH burden is a significant predictor of conversion from PD-MCI to PD dementia and is related to ongoing decline in frontal-lobe-based cognitive performance. [ABSTRACT FROM AUTHOR]

Background: The laparoscopic approach for the treatment of sigmoid volvulus has been a rare surgical indication. This phase 2 study investigated the feasibility and surgical outcomes of elective laparoscopic surgery for sigmoid volvulus.Methods: Patients with sigmoid volvulus were first offered colonoscopic decompression for their acute colonic obstruction. If the colonic decompression was successful, complete bowel preparation was performed, followed by elective laparoscopically assisted sigmoidectomy. The details of the laparoscopic procedures are shown in the video. Briefly, the redundant sigmoid colon is totally mobilized by a laparoscopic medial-to-lateral dissection sequence, after which it is exteriorized, transected, and reconstructed by end-to-end anastomosis. In the authors' experience, the medial-to-lateral approach is highly efficient for the laparoscopic mobilization of the redundant sigmoid colon. We believe that the longer the lateral abdominal wall attachment of the sigmoid colon is preserved, the better the exposure and the easier the dissection. If the risk of anastomotic leakage is considered high in a specific case, protective ileostomy is selectively preformed. Before entering the current study, the patients were well informed about the advantages and disadvantages of laparoscopic surgery. The enrollment of patients was selective according to the appropriate eligibility criteria. This study was approved by the Institutional Review Board of the National Taiwan University Hospital. The patients' clinicopathologic data and surgical outcomes were prospectively evaluated.Results: Between August 2001 and April, 2005, a total of 14 patients (10 men and 4 women) with sigmoid volvulus were treated with the described procedure. The age distribution of the patients was 68.4 +/- 12.2 years. The attack of sigmoid volvulus was the first episode for eight patients, the second episode for 4 patients, and the third episode (or more) for two patients. The body mass index (BMI) of the patients was 26.8 +/- 4.4 kg/m(2). The physical status (classification of American Society of Anesthesiology [ASA]) was 1 for five patients, 2 for eight patients, and 3 for 1 patient. During the laparoscopy, all the patients presented with the pathognomonic findings of sigmoid volvulus including redundant sigmoid colon, narrow sigmoid mesenteric pedicle, and mesosigmoiditis with mesenteric fibrosis and scarring, as shown in the video. The length of the resected colon was 32 +/- 6 cm. The operation time was 194.6 +/- 32.4 min, and the blood loss was 44.0 +/- 12.4 ml. The abdominal wound consisted of four 5 to 12 mm working ports and a 5 cm major wound for exteriorization of the sigmoid colon. Some surgeons have shown that a sigmoid volvulus can be resected through a 5-cm left lower quadrant incision with very little mobilization of the colon because of its redundancy. In this context, the laparoscopic approach competed with the minilaparotomy method in terms of adequate sigmoid resection, lysis of mesosigmoid adhesion, and tension-free colorectal anastomosis. Protective ileostomy was performed for the only patient with a physical status of ASA 3. There was no mortality in this case series. However, pneumonia developed postoperatively in one patient, acute myocardial infarction in one patient, and wound infection in two patients. Excluding the two patients who experienced postoperative pneumonia and acute myocardial infarction, the duration of the postoperative ileus was 48 +/- 12 h, the postoperative hospitalization was 7 +/- 1 days, and the degree of postoperative pain was 3.5 +/- 0.5 according to the visual analog scale. The return to partial activity required 18 +/- 2.5 days, and the return to full activity required 28.4 +/- 5.6 days. As compared with the overall costs for a conventional sigmoid colectomy, which are completely covered by the National Bureau of Health Insurance of Taiwan, the expenses for the patients undergoing laparoscopic procedures were significantly higher by approximately 24,000.0 NT dollars +/- 2,635.0 (1 U.S. dollar = 32 NT dollars). These higher expenses must be borne by the patients themselves.Conclusion: Considering that patients with sigmoid volvulus often are elderly and chronically ill, laparoscopic elective surgery after a successful colonoscopic decompression may be a good choice for a selected group of patients in terms of minimized surgical complications and quick convalescence. [ABSTRACT FROM AUTHOR]

Background: The appropriateness of the laparoscopic approach for the resection of rectal cancer has been controversial, although it is well established in colon cancer. This is a phase II study of laparoscopic abdominoperineal resection (APR) in the treatment of lower rectal cancers.Methods: Patients with lower rectal adenocarcinoma located within 6 cm above the anal verge were recruited and subjected to laparoscopic APR. The surgical principle included en bloc resection with high ligation of inferior mesenteric vessels by no-touch isolation and total mesorectal excision. Details of the surgical procedures are presented in the video. The technical efficiency and outcome of this surgical approach were evaluated prospectively. This study was approved by the institutional review board of National Taiwan University Hospital (NTUH).Results: A total of 22 patients were enrolled in the study from January 2003 to December 2004 under the ethical guidelines of clinical trials in NTUH. There were 12 females and 10 males, with an age distribution of 62.5 +/- 10.4 years. The body mass index was 24.8 +/- 4.0 kg/m2. Physical status (American Society of Anesthesiology classification) was class I in 12, class II in eight, and class III in two patients. Tumor size was 44.0 +/- 12.0 mm in diameter. Two patients were in pathologic TNM stage I, 14 in stage II, and six in stage III. The operation time was 214.0 +/- 28.4 min. Blood loss was 54.0 +/- 14.0 ml. Because the tumor specimen was retrieved from a perineal wound, the five 5 to 12 mm working ports constituted the abdominal wound. There were no major complications. However, wound infection of port sites was detected in one patient. The patients had a quick convalescence, as evaluated by the length of postoperative ileus (48.0 +/- 12.0 h), length of hospitalization (8.0 +/- 2.0 days), and degree of postoperative pain (3.5 +/- 0.5 visual analogue scale). Return to partial activity, full activity, and work was 2.0 +/- 0.5, 4.0 +/- 0.8, and 6.0 +/- 0.5 weeks, respectively. The number of cleared lymph nodes was 14.0 +/- 2.0. During follow-up (median, 18 months; range, 6-30), lung metastasis and local pelvic recurrence developed in one and two patients, respectively. Besides the expenses covered by the National Bureau of Health Insurance of Taiwan, the additional payment by patients undergoing laparoscopic procedures was NTD 24,000 +/- 3000 (1 U.S. dollar = 32 NTD).Conclusions: In our clinical setting, laparoscopic APR can be performed with good technical efficiency, quick functional recovery, and mild disability. The short-term oncologic results of laparoscopic APR seem to be acceptable, but further long-term follow-up for these patients is mandatory to define the oncologic outcomes of this approach. [ABSTRACT FROM AUTHOR]

Background: The appropriateness of the laparoscopic approach for the resection of rectal cancer has been controversial, although it is well established in colon cancer. This is a phase II study of laparoscopic abdominoperineal resection (APR) in the treatment of lower rectal cancers. Methods: Patients with lower rectal adenocarcinoma located within 6 cm above the anal verge were recruited and subjected to laparoscopic APR. The surgical principle included en bloc resection with high ligation of inferior mesenteric vessels by no-touch isolation and total mesorectal excision. Details of the surgical procedures are presented in the video. The technical efficiency and outcome of this surgical approach were evaluated prospectively. This study was approved by the institutional review board of National Taiwan University Hospital (NTUH). Results: A total of 22 patients were enrolled in the study from January 2003 to December 2004 under the ethical guidelines of clinical trials in NTUH. There were 12 females and 10 males, with an age distribution of 62.5 ± 10.4 years. The body mass index was 24.8 ± 4.0 kg/m². Physical status (American Society of Anesthesiology classification) was class I in 12, class II in eight, and class III in two patients. Tumor size was 44.0 ± 12.0 mm in diameter. Two patients were in pathologic TNM stage I, 14 in stage II, and six in stage III. The operation time was 214.0 ± 28.4 min. Blood loss was 54.0 ± 14.0 ml. Because the tumor specimen was retrieved from a perineal wound, the five 5 to 12 mm working ports constituted the abdominal wound. There were no major complications. However, wound infection of port sites was detected in one patient. The patients had a quick convalescence, as evaluated by the length of postoperative ileus (48.0 ± 12.0 h), length of hospitalization (8.0 ± 2.0 days), and degree of postoperative pain (3.5 ± 0.5 visual analogue scale). Return to partial activity, full activity, and work was 2.0 ± 0.5, 4.0 ± 0.8, and 6.0 ± 0.5 weeks, respectively. The number of cleared lymph nodes was 14.0 ± 2.0. During follow-up (median, 18 months; range, 6–30), lung metastasis and local pelvic recurrence developed in one and two patients, respectively. Besides the expenses covered by the National Bureau of Health Insurance of Taiwan, the additional payment by patients undergoing laparoscopic procedures was NT $24,000 ± 3000 (1 U.S. dollar = 32 NT$). Conclusions: In our clinical setting, laparoscopic APR can be performed with good technical efficiency, quick functional recovery, and mild disability. The short-term oncologic results of laparoscopic APR seem to be acceptable, but further long-term follow-up for these patients is mandatory to define the oncologic outcomes of this approach. [ABSTRACT FROM AUTHOR]