P22 viral capsids and ferritin protein cages are utilized as templating macromolecules to conjugate Gd(III)-chelating agent complexes, and we systematically investigates the effects of the macromolecules' size and the conjugation positions of Gd(III)-chelating agents on the magnetic resonance (MR) relaxivities and the resulting image contrasts. The relaxivity values of the Gd(III)-chelating agent-conjugated P22 viral capsids (outer diameter: 64 nm) are dramatically increased as compared to both free Gd(III)-chelating agents and Gd(III)-chelating agent-conjugated ferritins (outer diameter: 12 nm), suggesting that the large sized P22 viral capsids exhibit a much slower tumbling rate, which results in a faster T1 relaxation rate. Gd(III)-chelating agents are attached to either the interior or exterior surface of P22 viral capsids and the conjugation positions of Gd(III)-chelating agents, however, do not have a significant effect on the relaxivity values of the macromolecular conjugates. The contrast enhancement of Gd(III)-chelating agent-conjugated P22 viral capsids is confirmed by in vitro phantom imaging at a short repetition times (TR) and the potential usage of Gd(III)-chelating agent-conjugated P22 viral capsids for in vivo MR imaging is validated by visualizing a mouse's intravascular system, including the carotid, mammary arteries, the jugular vein, and the superficial vessels of the head at an isotropic resolution of 250 μm.

The study aims to report the operative outcomes of robot-assisted thoracoscopic esophagectomy (RATE) with extensive mediastinal lymphadenectomy (ML) for intrathoracic esophageal cancer. We analyzed a prospective database of 114 consecutive patients who underwent RATE with lymph node dissection along recurrent laryngeal nerve (RLN) followed by cervical esophagogastrostomy. The study included 104 men with a mean age of 63.1 ± 0.8 years. Of these, 110 (96.5%) had squamous cell carcinoma, and the location of the tumor was upper esophagus in 7 (6.1%), middle in 62 (54.4%), and lower in 45 (39.5%). Preoperative concurrent chemoradiation was performed in 15 patients (13.2%). All but one patient underwent successful RATE, and R0 resection was achieved in 111 patients (97.4%). Extended ML and total ML were performed in 24 (21.1%) and 90 (78.9%) patients, respectively. Total operation time was 419.6 ± 7.9 minutes, and robot console time was 206.6 ± 5.2 minutes. The mean number of total, mediastinal, and RLN nodes was 43.5 ± 1.4, 24.5 ± 1.0, and 9.7 ± 0.7, respectively. The most common complication was RLN palsy (30, 26.3%), followed by anastomotic leakage (17, 14.9%) and pulmonary complications (11, 9.6%). Median hospital stay was 16 days, and 90-day mortality was observed in three patients (2.5%). On multivariate analysis, preoperative concurrent chemoradiation was a risk factor for pulmonary complications (odds ratio 7.42, 95% confidence interval 1.91-28.8, P = 0.004). RATE with extensive ML could be performed safely with acceptable postoperative outcomes. Long-term survival data should be followed in the future to verify the oncological outcome of the procedure.

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Background: In lung transplantation (LTx), patients with thoracic muscle sarcopenia may have to require longer to recovery. We measured thoracic muscle volume by using the cross sectional area (CSA) and assessed its effect on early outcomes after LTx.Methods: A retrospective analysis was conducted to evaluate the effect of thoracic sarcopenia in patients undergoing LTx between January 2010 and July 2015. The lowest CSA quartile (Q1) was defined as sarcopenia.Results: In total, 109 patients were enrolled. 50.8±37.2 days, P= ns) tended to be longer in Q1 than Q4, but the difference was not significant. However, the 1-year survival rate was better in Q1 compared with Q4 (66.6% vs. 46.0%, P=0.04).Conclusions: Although patients with thoracic sarcopenia seem to require a longer post-operative recovery time after LTx, this does not compromise their early outcomes. By contrast, patients with larger thoracic muscle volume (Q4) showed poorer survival times.Keywords: Lung transplantation (LTx); sarcopenia; thoracic muscles; cross sectional area (CSA) Computed tomography (CT) (10), magnetic resonance imaging (MRI) (11), bioelectrical impedance (BIA) (12), anthropometry (13), and dual-energy X-ray absorptiometry (DXA) (14) have been used to assess muscle mass, while handheld and computerized dynamometry have been used to measure hand grip and quadriceps strength (3,15). Short Physical Performance Battery and usual gait speed can assess functional status (16-18). The 6-minute walk test is the most commonly used modality to assess functional status but it cannot index isolated muscle function as part of the sarcopenia definition (5).SubmittedSome studies of LTx patients have focused on low muscle mass and the importance of rehabilitation after LTx (3,4), but the clinical effect of sarcopenia on LTx outcome has not been studied until now. In this study, we hypothesized that thoracic skeletal muscle mass measured by analyzing the CSA from a chest CT image could be a predictor of early outcomes and survival after LTx, and can also be used to assess the suitability of lung transplant candidates. Methods PatientsThis study was approved by the Severance Hospital Institutional Review Board (4-2016-0129). We retrospectively reviewed the medical records of 111 patients who underwent LTx at our institution between January 2010 and July 2015. Age, sex, underlying diseases, height and weight at the time of the operation, post-operative course and mortality data were collected for all patients; data on thoracic muscle CSA were available in 109 of the patients. Measurement of thoracic skeletal muscle CSAThe thoracic muscle CSA at the level of the carina was determined based on a study performed by Rozenberg et al. (19). The first single slice identifying at carina level on each patient's chest CT scan was selected. We then outlined the borders of the thoracic skeletal muscle (pectoralis, intercostal and paraspinal muscles) in the CSA, and the area was measured (Figure 1). These steps were completed semiautomatically using Aquarius iNtuition...