Bilateral Approach for Thoracoscopic Esophagectomy in a Patient with Esophageal Cancer and Solitary Posterior Thoracic Para-aortic Lymph Node Metastasis

We report a successful dissection of metastatic posterior thoracic para-aortic lymph node (No. 112aoP) via bilateral thoracoscopic surgery. With the anesthetized patient (a 73-year-old Japanese woman) in the prone position, two working ports were inserted for the left-side approach, and artificial pneumothorax was created. Thoracoscopic examination revealed a swollen LN posterior to the descending aorta. Fat and metastatic LNs posterior to the aorta were dissected from the aortic arch level to the diaphragm while preserving intercostal arteries. For the right-side approach, two working ports were inserted and a routine thoracoscopic esophagec-tomy was performed. Gastric conduit reconstruction was achieved laparoscopically. Operation time for the left thoracic procedure: 54 min; estimated blood loss: almost none. No recurrence was detected 24 months post-operatively. There are several surgical options for approaching No. 112aoP, including transhiatal, left thora-cotomy, and thoracoscopy. Although a wide dissection of the posterior thoracic para-aortic area has not been reported, it may be feasible and safe if the artery of Adamkiewicz and intercostal arteries are preserved. A min-imally invasive bilateral thoracoscopic approach for a thoracoscopic esophagectomy is safe and useful for esophageal cancer patients with solitary No. 112aoP metastasis

Site-specific effects of neurosteroids on GABA(A) receptor activation and desensitization

This study examines how site-specific binding to three identified neurosteroid-binding sites in the

How should tracers be injected to detect for sentinel nodes in gastric cancer – submucosally from inside or subserosally from outside of the stomach?

<p>Abstract</p> <p>Background</p> <p>In sentinel node (SN) detection for cases of early gastric cancer, the submucosal dye injection method appears to be more reasonable than the subserosal injection. To compare the two injection methods, we have focused on the rate of concordance between hot nodes (HNs) obtained from the radioisotope (RI) method and green nodes (GNs) obtained from the dye-guided method in addition to the number and distribution of GNs detected, and the sensitivity of metastatic detection.</p> <p>Methods</p> <p>The subjects of this study were 63 consecutive patients with gastric cancer (sT1–T2, sN0, tumor diameter ≦ 4 cm) in whom we attempted SN detection using a combination of RI and dye methods. ^99mTc-tin colloid was injected a day before the surgery, and indocyanine green was injected either submucosally (n = 43) with endoscopes or subserosally (n = 20) by direct vision.</p> <p>Results</p> <p>An average of hot and green nodes (H&G: 4 ± 3 vs. 4 ± 3), hot and non-green nodes (H&NG: 2 ± 3 vs. 1 ± 2), cold and green nodes (C&G: 2 ± 2 vs. 3 ± 4), and the rate of concordance (H&G/H&G + H&NG + C&G: 45 + 27% vs. 48 ± 30%) were not significantly different between the submucosal and subserosal injection methods. The spread of GNs to tier 2 stations (24% vs. 30%) and metastatic detection sensitivity (86% vs. 100%) were also not different between the submucosal and subserosal injection methods.</p> <p>Conclusion</p> <p>The tracer injection sites do not have to be limited to the submucosa.</p

Improved executive functions in 6-12-year-old children following cognitively engaging tennis lessons

The aim of this cross-sectional study was to evaluate the relationships between cognitively engaging exercise (i.e., game-based and coordination exercises), executive functions (i.e., inhibitory control and working memory), and physical fitness. Forty junior tennis players (6-12years old), who regularly participated in tennis lessons (2.55years, SD=1.61) prior to the study, were investigated. All participants completed evaluations of executive functions (inhibitory control and working memory) at rest. The duration of each lessons' instructional activities, including coordination training, game-based exercise, rallying, and non-physical activity (explanations and breaks), was recorded. Physical fitness was evaluated using the Tennis Field Test. A longer duration of game-based exercise was positively correlated with inhibitory control and physical fitness. Coordination training was associated with improved working memory. Non-physical activity was inversely correlated with inhibitory control, working memory, and physical fitness. The results suggest that game-based tennis lessons have beneficial effects on inhibitory control and physical fitness levels, and a longer duration of coordination training is associated with better working memory. The present study indicates that shortened non-physical activity time within a sports setting is associated with the development of executive functions and physical fitness

Relationship of tennis play to executive function in children and adolescents

This study evaluated the association between the frequency of tennis play and executive function in children and adolescents. One hundred and six junior tennis players (6-15 years old) participated in this study. Executive function, including inhibitory control, working memory, and cognitive flexibility were evaluated at rest. Females showed better inhibitory control and cognitive flexibility than males. In males, more frequent tennis play was associated with higher basic processing speed and inhibitory control after controlling for age, gender, body mass index (BMI), and tennis experience. More frequent tennis play was associated with better working memory in both males and females after controlling for age, gender, BMI, and tennis experience. Furthermore, longer tennis experience was related to better cognitive flexibility in males after controlling for age, gender, BMI, and frequency of tennis play. These findings suggest that tennis play is associated with the development of three foundational aspects of executive function (i.e. inhibitory control, working memory, cognitive flexibility). Especially, frequent participation in tennis play is related to better inhibitory control and working memory, while longer experience of tennis play is associated with better cognitive flexibility. Although development of inhibitory control and cognitive flexibility is slower in males than in females, the associations between tennis play and inhibitory control and cognitive flexibility appear to be larger in males than in females

The beneficial effects of game-based exercise using age-appropriate tennis lessons on the executive functions of 6-12-year-old children

This study evaluated the effects of two different types of tennis lessons-those involving a technique-based approach (TBA) and those involving a game-based approach (PLAY + STAY [P + S])-on the executive functions (EFs) of junior tennis players. Eighty-one tennis players (6-12 years old) were recruited and assigned to one of three groups: TBA, P + S, or watching TV (CONT). Subjects completed evaluations of EFs (inhibitory control, working memory, and cognitive flexibility) before and after 50 min programs. The overall score for EFs improved significantly for both the P + S and TBA groups but not for the CONT group; indeed the CONT group showed no improvement in overall EFs. Furthermore, the overall EF score improved more for P + S participants than for those in TBA. Looking at components of EFs, the pattern for inhibitory control reflected the pattern for the overall EF index: Improvement in the P + S and TBA groups but not in the CONT group. Only the P + S group improved in working memory. Thus, playing tennis and practicing isolated tennis skills both improved EFs of junior players more than did watching TV, and game-based tennis lessons seem to hold more promise for improving EFs than drills of tennis skills. (C) 2017 Elsevier B.V. All rights reserved

Complete Recovery from Blindness in Case of Compressive Optic Neuropathy due to Unruptured Anterior Cerebral Artery Aneurysm

It is not common for an isolated visual symptom to be the first indication of an aneurysm compressing the optic nerve. The compression can lead to blindness, and a recovery from the blindness is rare. We report a female with a left painless optic neuropathy caused by an unruptured anterior cerebral artery aneurysm. The patient had a temporal hemianopic visual field defect, which progressed to blindness in the left eye, while the right visual function was not affected. A coil embolization of the aneurysm completely restored her visual acuity to 20/20. These findings suggest that aneurysmal lesions should be ruled out in case of unilateral optic neuropathy with hemianopic visual field defects and progressive visual loss