Some reports have addressed the use of three-dimensional (3-D) models in simulated clipping of cerebral aneurysms. To report on the effectiveness of these models, for this study, we developed two types of 3-D models for use in clipping simulations and for clarifying angioarchitecture and surgical approaches. The two types of model, one made of acrylic polymer and the other made of hollow silicone, were fabricated with a 3-D printer using data obtained with 3-D digital subtraction angiography (3D-DSA). The hollow silicone model was used for simulated clipping, whereas the acrylic model was used as a tool for clarifying angioarchitecture and surgical approaches. We performed simulated clipping of ce-rebral aneurysms with the two types of 3-D model for 10 patients with 11 cerebral aneurysms. In 6 of the 11 aneurysms, the first clips accorded with the clipping simulations. The remaining 4 aneu-rysms exhibited only slight variation from the simulations. In 1 of the 11 aneurysms, the lengths and shapes of the first clips did not accord with the clipping simulations. The hollow silicone model was effective at aiding in the proper selection and manipulation of the clips. The acrylic model was effective at confirming the surgical approach, aneurysm depth, and backside angioarchitecture. Moreover, the procedures were performed smoothly with a microscope without the need to use the monitor, as it was utilized in a clean field. These two types of 3-D model helped the surgeons gain a clear and intuitive understanding of aneu-rysm and angioarchitecture in three dimensions. As a result, they were highly useful for simulating clip application.

cDWI2000 appears to be more effective than mDWI1000, and at least as effective as mDWI2000 for PCa diagnosis.

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AimAs a result of the difficulty in effective prevention of gastroesophageal reflux, no standard reconstruction procedure after proximal gastrectomy (PG) has yet been established. The double‐flap technique (DFT), or Kamikawa procedure, is an antireflux reconstruction procedure in esophagogastrostomy. The efficacy of DFT has recently been reported in several studies. However, these were all single‐center studies with a limited number of cases.MethodsWe conducted a multicenter retrospective study in which patients who underwent DFT, irrespective of disease type and reconstruction approach, at each participating institution between 1996 and 2015 were registered. Primary endpoint was incidence of reflux esophagitis at 1‐year after surgery, and secondary endpoint was incidence of anastomosis‐related complications.ResultsOf 546 patients who were eligible for this study, 464 patients who had endoscopic examination at 1‐year follow up were evaluated for reflux esophagitis. Incidence of reflux esophagitis of all grades was 10.6% and that of grade B or higher was 6.0%. Male gender and anastomosis located in the mediastinum/intra‐thorax were independent risk factors for grade B or higher reflux esophagitis (odds ratio [OR]: 4.21, 95% confidence interval [CI]: 1.44‐10.9, P = 0.0109). Total incidence of anastomosis‐related complications was 7.2%, including leakage in 1.5%, strictures in 5.5% and bleeding in 0.6% of cases. Laparoscopic reconstruction was the only independent risk factor for anastomosis‐related complications (OR: 3.93, 95% CI: 1.93‐7.80, P = 0.0003).ConclusionDouble‐flap technique might be a feasible option after PG for effective prevention of reflux, although anastomotic stricture is a complication that must be well‐prepared for.

We studied the role of reactive oxygen intermediates (ROIs) in experimental liver metastasis induced in mice by the inoculation of COLON 26-M5 murine colon cancer cells, a highly metastatic variant of COLON 26 cells, and the effect of ROIs on the invasive capacity of the cells in an in vitro chemo-invasion assay model using reconstituted basement membrane matrigel. We also measured the release of ROIs from cells using electron spin resonance (ESR) spectrometry. Hydroxyl radicals (.OH) were constitutively released from the cells. This release was augmented by pre-treatment with phorbol 12-myristate 13-acetate (PMA). In experimental liver metastasis in CDF1 mice, the administration of recombinant human superoxide dismutase (r-hSOD) significantly increased the number of metastatic nodules, while administration of catalase significantly inhibited metastasis formation. In vitro pre-treatment of cells with PMA significantly increased the number of metastatic nodules. Invasive capacity of the cells was markedly augmented by pre-treatment with PMA. PMA-induced augmentation was significantly inhibited by the simultaneous addition of r-hSOD to the assay. Catalase had no significant effect. Our findings suggest that ROIs play an important role in tumor invasion and metastasis, and that hydrogen peroxide (H2O2) may contribute to the retention or extravasation of circulating tumor cells. Furthermore, the superoxide anion (O2-) released by tumor cells may play an important role in basement membrane degradation.

We developed a method that allows prenatal diagnosis of Duchenne muscular dystrophy using a single nucleated erythrocyte (NRBC) isolated from maternal blood. Maternal blood was obtained at 8 to 20 weeks of gestation. NRBCs were separated with Percoll using a discontinuous density gradient method and then collected by micromanipulator under microscopic observation. The entire genome of a single cell was amplified by primer extension preamplification (PEP). Sex was determined from a small aliquot of the PEP reaction. After an NRBC was determined to be male and confirmed to be of fetal origin, dystrophin exons 4, 8, 12, 45, 48, 50, and 51 were determined from the same PEP reaction. This diagnostic method using maternal blood is safer than amniocentesis or cordocentesis and can be applied to other X-linked diseases.

For the purpose of visualizing low-flow as well as high-flow blood vessels without using contrast agents, we propose a new technique called a hybrid of opposite-contrast MR angiography (HOP-MRA). HOP-MRA is a combination of standard time-offlight (TOF) using a full first-order velocity-compensation for white-blood (WB) and flow-sensitive black-blood (FSBB) techniques, which use motion-probing gradients to introduce intravoxel flow dephasing. A dual-echo three-dimensional gradient echo sequence was used to reduce both imaging time and misregistration. HOP-MRA images were obtained using a simple-weighted subtraction (SWS) or a frequency-weighted subtraction (FWS) applying different spatial filtering for WB and BB images. We then assessed the relationships among the contrast-to-noise ratios (CNR) of the blood-to-background signals for those three images. In both volunteer and clinical brain studies, low-flow vessels were well visualized and the background signal was well suppressed by HOP-MRA compared with standard TOF-or BB-MRA. The FWS was better than the SWS when whole-maximum intensity projection was per- To date, various MR angiography (MRA) techniques have been proposed using noncontrast enhancement (CE) for visualizing blood vessels (1,2). MRA techniques are roughly classified as white-blood (WB) (1-8) or blackblood (BB) (9 -18) techniques according to the contrast between vessels and the background tissue. The WB-and BB-MRA techniques, respectively, visualize blood vessels with higher and lower signal intensities than the background tissue. In the WB techniques, time-of-flight (TOF) (3), subtraction (4 -7), and phase contrast (PC) (8) methods have been proposed. The TOF method is a typical example of a WB-MRA and is most widely applied clinically, especially in the brain, due to its simplicity and robustness. TOF-MRA uses the inflow effect so that an artery with a high-flow velocity close to the inflow part of an imaging slab is visualized at a higher signal intensity. It is, however, difficult to visualize turbulent parts of flow, and peripheral and collateral vessels are not easily visualized. One subtraction method uses the difference of flow velocity between two cardiac phases (first introduced as an MRA method) (4), and another subtraction method is based on the difference of flow signals between the presence and absence of flow-rephasing gradients (5-7). However, as they require two different stages of imaging sequences, the acquisition time was twice that of the TOF method and misregistration artifacts often became problematic. The PC method can quantify flow velocity but is only used for special purposes as it requires 4 to 6 times the acquisition time of TOF-MRA.In contrast, the BB method can correctly visualize slowflow vessels and blood vessel walls. It is also possible with the BB method to visualize turbulent parts of flow which are difficult to visualize with the TOF method. A fast-spinecho (FSE) method was initially used in a sequence of the BB method (9,10); however, very slow or recirculati...

These results show the potential contribution of the system to microsurgical skill assessment. Quantitative and detailed analysis of surgical tasks helps surgeons better understand the key features of the required skills.