ABSTRACT Objective: To evaluate objective treatment efficacy and safety, and subjective patient-reported outcomes in patients with complex ureteral strictures (US) undergoing minimally invasive lingual mucosal graft ureteroplasty (LMGU). Materials and Methods: We prospectively enrolled patients underwent robotic or laparoscopic LMGU between May 2020 and July 2022. Clinical success was defined as symptom-free and no radiographic evidence of re-obstruction. Patient-reported outcomes, including health-related quality of life (HRQoL), mental health status and oral health-related quality of life (OHRQoL), were longitudinally evaluated before surgery, 6 and 12 months postoperatively. Results: Overall, 41 consecutive patients were included. All procedures were performed successfully with 32 patients in robotic approach and 9 in laparoscopic. Forty (97.56%) patients achieved clinical success during the median follow-up of 29 (range 15-41) months. Although patients with complex US experienced poor baseline HRQoL, there was a remarkable improvement following LMGU. Specifically, the 6-month and 12-month postoperative scores were significantly improved compared to the baseline (p < 0.05) in most domains. Twenty-eight (68.3%) and 31 (75.6%) patients had anxiety and depression symptoms before surgery, respectively. However, no significant decrease in the incidence of these symptoms was observed postoperatively. Moreover, there was no significant deterioration of OHRQoL at 6 months and 12 months postoperatively when compared to the baseline. Conclusions: LMGU is a safe and efficient procedure for complex ureteral reconstruction that significantly improves patient-reported HRQoL without compromising OHRQoL. Assessing patients’ quality of life enables us to monitor postoperative recovery and progress, which should be considered as one of the criteria for surgical success. Objective safety patientreported patient reported (US . (LMGU) Methods 202 2022 symptomfree symptom free reobstruction. reobstruction re obstruction. obstruction re-obstruction Patientreported Patient healthrelated related , (HRQoL) OHRQoL, (OHRQoL) surgery 1 Results Overall 4 included 3 97.56% 9756 97 56 (97.56% followup follow up 2 range 1541 15 15-41 Specifically 6month month 12month p 0.05 005 0 05 domains Twentyeight Twenty eight 68.3% 683 68 (68.3% 75.6% 756 75 (75.6% respectively However Moreover Conclusions progress (LMGU 20 (HRQoL (OHRQoL 97.56 975 5 (97.56 154 15-4 0.0 00 68.3 (68.3 75.6 7 (75.6 97.5 (97.5 15- 0. 68. (68. 75. (75. 97. (97. (68 (75 (97 (6 (7 (9 (

Abstract To solve the problem that the mechanical behavior of undisturbed loess in seasonally frozen soil area is affected by freeze-thaw action, triaxial shear tests of undisturbed loess under freeze-thaw condition were carried out. The results show that the mechanical properties of undisturbed loess are greatly affected by factors including freeze-thaw process, water content, natural density and confining pressure. Freeze-thaw action has a certain impact on the failure surface shape and stress-strain curve. Before and after freeze-thaw, the shape of the shear failure surface is complex, including single oblique failure surface, double oblique failure surface, vertical failure surface, X-shaped failure surface, bulging failure, etc. And under the conditions of low water content, low confining pressure and high dry density, the stress-strain curve tends to be softened. Conversely, the curve tends to harden. Freeze-thaw action can make the stress-strain curve transition from softening to hardening. In addition, the freeze-thaw action significantly weakens the failure strength, shear strength, cohesion, initial tangent modulus and failure ratio of undisturbed soil, but does not change the internal friction angle obviously. Also, the heterogeneity of natural soil is also an important factor affecting the mechanical parameters, failure surface shape and stress-strain curve of undisturbed loess. freezethaw freeze thaw out process content Freezethaw Freeze stressstrain stress strain freezethaw, thaw, complex Xshaped X shaped etc softened Conversely harden hardening addition strength cohesion obviously Also parameters

RESUMO Objetivo: A degeneração macular neovascular relacionada à idade é a principal causa de perda de visão em idosos. O objetivo deste estudo foi identificar os preditores iniciais que afetam o prognóstico visual após a injeção intravítrea de combercepte para degeneração macular neovascular relacionada à idade. Métodos: Esta é uma revisão retrospectiva de 58 pacientes com degeneração macular neovascular relacionada à idade que foram tratados com injeções intravítreas de 0,5 mg de combercepte na prática clínica de rotina. Foram coletadas informações básicas, tais como idade, sexo, pressão intraocular e evolução da doença. A melhor acuidade visual corrigida, as sensibilidades retinianas médias e varreduras de tomografia de coerência óptica foram registradas no início do estudo e 6 meses após o tratamento. Foi efetuada uma análise de regressão logística para determinar os preditores independentes da melhor acuidade visual corrigida 6 meses após o tratamento. Resultados: Após 6 meses de tratamento, a média da acuidade visual melhor corrigida melhorou de 1,10 ± 0,42 para 0,41 ± 0,18 logMAR; as sensibilidades retinianas médias aumentaram de 5,13 ± 0,86 para 7,32 ± 1,21 dB; a espessura retiniana central média diminuiu de 440,38 ± 61,05 para 260,01 ± 24,86 μm; e os pontos hiper-reflexivos, tanto em números totais quanto em cada camada de retina, foram significativamente reduzidos em comparação com os valores de antes do tratamento (todos com p<0,05). Houve 22 pacientes com visão melhorada e 36 pacientes com visão não melhorada. As análises multivariadas mostraram que o número de pontos hiper-reflexivos sub-retinianos, o estado da membrana limitante externa, a melhor acuidade visual corrigida inicial e a idade foram preditores independentes para a melhor acuidade visual corrigida (todos com p<0,05). Conclusão: A má recuperação de pacientes após a injeção de combercepte intravítreo pode estar relacionada ao número de pontos hiper-reflexivos sub-retinianos, ao estado da membrana limitante externa, à acuidade visual corrigida inicial e à idade, parâmetros que podem ser usados como preditores de resultados visuais de curto prazo e devem ser totalmente avaliados antes da cirurgia. Objetivo idosos Métodos 5 05 0 0, rotina básicas sexo doença Resultados 110 1 10 1,1 042 42 0,4 041 41 018 18 0,1 logMAR 513 13 5,1 086 86 0,8 732 7 32 7,3 121 21 1,2 dB 44038 440 38 440,3 6105 61 61,0 26001 260 01 260,0 2486 24 24,8 μm hiperreflexivos, hiperreflexivos hiper reflexivos, reflexivos retina todos p<0,05. p005 p p<0,05 . p<0,05) 2 3 subretinianos, subretinianos sub retinianos, retinianos sub-retinianos externa Conclusão cirurgia 11 1, 04 4 51 5, 08 8 73 7, 12 4403 44 440, 610 61, 2600 26 260, 248 24, p00 p<0,0 p0 p<0, p<0 p<

ABSTRACT Purpose: Neovascular age-related macular degeneration is the leading cause of vision loss in the elderly. We aimed to identify baseline predictors of visual prognosis after intravitreal conbercept injection for neovascular age-related macular degeneration. Methods: We conducted a retrospective review of 58 patients with neovascular age-related macular degeneration who were treated with intravitreal injections of conbercept 0.5 mg in routine clinical practice. Basic information such as age, sex, intraocular pressure, and disease course was collected. Best-corrected visual acuity, mean retinal sensitivity, and optical coherence tomography findings were recorded at baseline and 6 months after treatment. Logistic regression analysis was used to identify independent predictors of best-corrected visual acuity at 6 months after treatment. Results: After the 6-month treatment, the mean best-corrected visual acuity improved from 1.10 ± 0.42 logarithm of the minimum angle of resolution (logMAR) to 0.41 ± 0.18 logMAR, the mean retinal sensitivity increased from 5.13 ± 0.86 dB to 7.32 ± 1.21 dB, the mean central retinal thickness decreased from 440.38 ± 61.05 μm to 260.01 ± 24.86 μm, and the total number of hyperreflective dots and the number of hyperreflective dots in each retina layer were significantly reduced as compared with those before treatment (all p<0.05). Twenty-two patients showed improved vision, and 36 had unimproved vision. Multivariate analyses revealed that the number of subretinal hyperreflective dots, the state of external limiting membrane, baseline best-corrected visual acuity, and age were independent predictors of best-corrected visual acuity (all p<0.05). Conclusion: Poor recovery of patients after intravitreal conbercept injection may be related to the number of subretinal hyperreflective dots, the state of external limiting membrane, baseline best-corrected visual acuity, and age, which may be used as predictors of short-term visual outcomes and should be fully evaluated before operation. Purpose agerelated elderly Methods 5 05 0 0. practice sex pressure collected Bestcorrected Best corrected bestcorrected best Results 6month month 110 1 10 1.1 042 42 0.4 logMAR (logMAR 041 41 018 18 0.1 513 13 5.1 086 86 0.8 732 7 32 7.3 121 21 1.2 44038 440 38 440.3 6105 61 61.0 26001 260 01 260.0 2486 24 24.8 all p<0.05. p005 p p<0.05 . p<0.05) Twentytwo Twenty two 3 membrane Conclusion shortterm short term operation 11 1. 04 4 51 5. 08 8 73 7. 12 2 4403 44 440. 610 61. 2600 26 260. 248 24. p00 p<0.0 p0 p<0. p<0 p<

RESUMEN Introducción: La investigación sobre el entrenamiento con vibraciones ha experimentado un periodo de desarrollo aplicándose en muchos proyectos como el bádminton, el balonmano, el salto de longitud y el voleibol. Sin embargo, todavía no hay una evaluación cuantitativa de la investigación sobre sus efectos en el hombro, el codo y en el desarrollo de la fuerza muscular en las extremidades superiores de los atletas de voleibol. Se cree que un protocolo de entrenamiento específico con vibración puede aportar beneficios al rendimiento sensomotor y a la implementación de la fuerza muscular en los atletas de voleibol. Objetivo: Estudiar los efectos del entrenamiento con vibraciones sobre la función de las extremidades superiores en jugadores de voleibol. Métodos: Se utilizaron métodos de investigación literarios, experimentales y estadísticos matemáticos para explorar la relación entre el entrenamiento con vibración bajo la fuerza muscular de los miembros superiores y sus articulaciones. Resultados: El entrenamiento vibratorio con amplitud de 2mm, en una frecuencia de vibración entre 30Hz y 45Hz, la frecuencia del entrenamiento vibratorio se presentó inversamente proporcional al efecto del entrenamiento vibratorio. Conclusión: El entrenamiento con vibraciones mostró beneficios de coordinación motora y aumento de la fuerza muscular en jugadores de voleibol. Una estrategia adecuada de entrenamiento con vibraciones puede maximizar las habilidades de los atletas, como la coordinación corporal, la flexibilidad y la capacidad de salto. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento. Introducción bádminton balonmano voleibol embargo hombro Objetivo Métodos literarios articulaciones Resultados 2mm mm Hz 45Hz Conclusión corporal II tratamiento

RESUMO Introdução: A pesquisa sobre o treinamento por vibração experimentou um período de desenvolvimento sendo aplicada em muitos projetos como badminton, handebol, salto em distância e voleibol. Entretanto, ainda não há uma avaliação quantitativa da pesquisa sobre seus efeitos em ombro, cotovelo e sobre o desenvolvimento de força muscular nos membros superiores dos atletas de voleibol. Acredita-se que um protocolo de treino específico com vibração possa trazer benefícios ao desempenho sensório-motor e implementação de força muscular nos atletas de voleibol. Objetivo: Estudar os efeitos do treinamento por vibração sobre a função dos membros superiores dos jogadores de vôlei. Métodos: Utilizou-se métodos de pesquisa bibliográfica, experimental e estatística matemática para explorar a relação entre o treinamento vibratório sob a força muscular dos membros superiores e suas articulações. Resultados: O treinamento vibratório com amplitude de 2mm, numa frequência de vibração entre 30Hz e 45Hz, a frequência do treinamento vibratório apresentou-se inversamente proporcional ao efeito do treinamento vibratório. Conclusão: O treinamento vibratório mostrou benefícios de coordenação motora e aumento de força muscular nos jogadores de voleibol. Uma estratégia adequada de treinamento por vibração pode maximizar as habilidades dos atletas, tais como coordenação corporal, flexibilidade e habilidade de salto. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento. Introdução badminton handebol voleibol Entretanto ombro Acreditase Acredita se sensóriomotor sensório motor Objetivo vôlei Métodos Utilizouse Utilizou bibliográfica articulações Resultados 2mm mm Hz 45Hz apresentouse apresentou Conclusão corporal II tratamento

ABSTRACT Introduction: The research on vibration training has experienced a period of development in many projects, such as badminton, handball, long jump, and volleyball. However, there is still no quantitative research evaluation of its effects on the development of shoulder, elbow, and upper limb muscle strength in volleyball athletes. It is believed that a specific training protocol with vibration may bring benefits to sensory-motor performance and muscle strength implementation in volleyball athletes. Objective: To study the effects of vibration training on upper limb function in volleyball players. Methods: Literature, experimental, and mathematical-statistical research methods were used to explore the relationship between vibration training under the muscle strength of the upper limbs and their joints. Results: The vibration training with an amplitude of 2mm, at a vibration frequency between 30Hz and 45Hz, the frequency of vibration training presented inversely proportional to the effect of vibration training. Conclusion: Vibration training showed the benefits of motor coordination and increased muscle strength in volleyball players. An appropriate vibration training strategy can maximize athletes’ skills, such as body coordination, flexibility, and jumping ability. Level of evidence II; Therapeutic studies - investigation of treatment outcomes. Introduction projects badminton handball jump However shoulder elbow athletes sensorymotor sensory Objective players Methods Literature experimental mathematicalstatistical mathematical statistical joints Results 2mm mm Hz 45Hz Conclusion skills flexibility ability II outcomes

Abstract The effects of 1-methylcyclopropene (1-MCP) treatment and controlled-atmosphere (CA) storage and their combination on quality and antioxidant capacity of postharvest blueberries were evaluated here. To investigate the most appropriate approach for maintaining fruit quality, blueberries were subjected to four different treatments, a control (CK), 1-MCP, 3% O2 + 10% CO2 (CA), and 1-MCP combined with 3% O2+10% CO2 (1-MCP + CA), then stored for 80 days at 0 °C. It was found that the applications of 1-MCP, CA and 1-MCP + CA were effective at delaying the increase in weight loss and inhibiting the decrease in firmness, total soluble solids (TSS) contents and titratable acidity (TA) contents. In addition, 1-MCP, CA and 1-MCP + CA treatment could significantly suppress MDA accumulation and relative electrolytic leakage promotion. Moreover, the production of reactive oxygen species (ROS), such as O2- and H2O2, was reduced by all the treatment, which was associated with increased activities of antioxidant enzymes including superoxide dismutase (SOD), catalase (CAT), and ascorbate peroxidase (APX). Taken together, our findings indicate 1-MCP, CA and 1-MCP + CA have potential applications in maintaining the quality and improving the antioxidant capacity of harvested blueberries, and 1-MCP + CA is the most effective treatment.

Abstract The lithology and thickness of the rock beam affect its mechanical properties and acoustic emission characteristics when it is fractured. In this study, three-point bending tests of rock beams were carried out. Then, we proposed to utilize the percentage of peak energy to characterize the intensity of energy release during fracture. Finally, the energy release mechanism of coal roof fracture was discussed. The evolution process of acoustic emission includes five stages. The acoustic emission amplitude distribution of rock beams has three typical patterns. Most of the cracks after fracture are tensile cracks, the proportion of tensile cracks is positively correlated with the elastic modulus. The percentage of peak energy is positively correlated with thickness and elastic modulus. More energy is released when thick and hard roof fractures. When necessary, measures such as reducing the thickness or the strength of the roof could be taken to improve the safety of mining.

α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors are the predominant mediators of glutamate-induced excitatory neurotransmission. It is widely accepted that AMPA receptors are critical for the generation and spread of epileptic seizure activity. Dysfunction of AMPA receptors as a causal factor in patients with intractable epilepsy results in neurotransmission failure. Brain-specific serine/threonine-protein kinase 1 (SAD-B), a serine-threonine kinase specifically expressed in the brain, has been shown to regulate AMPA receptor-mediated neurotransmission through a presynaptic mechanism. In cultured rat hippocampal neurons, the overexpression of SAD-B significantly increases the frequency of miniature excitatory postsynaptic currents (mEPSCs). Here, we showed that SAD-B downregulation exerted antiepileptic activity by regulating AMPA receptors in patients with temporal lobe epilepsy (TLE) and in the pentylenetetrazol (PTZ)-induced epileptic model. We first used immunoblotting and immunohistochemistry analysis to demonstrate that SAD-B expression was increased in the epileptic rat brain. Subsequently, to explore the function of SAD-B in epilepsy, we used siRNA to knock down SAD-B protein and observed behavior after PTZ-induced seizures. We found that SAD-B downregulation attenuated seizure severity and susceptibility in the PTZ-induced epileptic model. Furthermore, we showed that the antiepileptic effect of SAD-B downregulation on PTZ-induced seizure was abolished by CNQX (an AMPA receptor inhibitor), suggesting that SAD-B modulated epileptic seizure by regulating AMPA receptors in the brain. Taken together, these findings suggest that SAD-B may be a potential and novel therapeutic target to limit epileptic seizures.

ABSTRACT Objective Type 2 diabetes (T2DM) is characterized by the progressive deterioration of pancreatic islet β-cell function over time and insulin resistance. Knowing more about the differences in pancreatic islet function in T2DM patients who have had diabetes for different lengths of time can help improve therapy for T2DM. Subjects and methods We conducted a cross-sectional study to compare islet β-cell function and insulin resistance in T2DM patients (n = 3,254) who had had diabetes for different lengths of time and those in normal controls (n = 794) using ANOVA and LSD analysis. Results We found that compared with that in normal controls, HOMA-β in T2DM patients with a history of diabetes of less than 1 year was lower (approximately 52% of that of normal controls, p = 0.003), while HOMA-IR in these patients was higher (approximately 50% of that of normal controls, p = 0.007). Compared with that in other diabetic patients, HOMA-β in patients with a history of diabetes of more than 30 years was the lowest. HOMA-IR in patients with a history of diabetes of between 20 and 30 years was lower than that in other diabetic patients (p < 0.05). Conclusions There were obvious decreases in HOMA-β and increases in HOMA-IR in T2DM patients with a history of diabetes of less than 1 year compared with those in normal controls. Therefore, early screening and intervention for T2DM might help improve islet function and delay the progression of diabetes.

Abstract Engyodontium album is a widespread pathogen that causes different kinds of dermatoses and respiratory tract diseases in humans and animals. In spite of its perniciousness, the basic genetic and molecular background of this species remains poorly understood. In this study, the mitochondrial genome sequence of E. album was determined using a high-throughput sequencing platform. The circular mitogenome was found to be 28,081 nucleotides in length and comprised of 17 protein-coding genes, 24 tRNA genes, and 2 rRNA genes. The nucleotide composition of the genome was A+T-biased (74.13%). Group-II introns were found in the nad1, nad5, and cob genes. The most frequently used codon of protein-coding genes was UAU. Isoleucine was identified as the most common amino acid, while proline was the least common amino acid in protein-coding genes. The gene-arrangement order is nearly the same when compared with other Ascomycota mitogenomes. Phylogenetic relationships based on the shared protein-coding genes revealed that E. album is closely related to the Cordycipitaceae family, with a high-confidence support value (100%). The availability of the mitogenome of E. album will shed light on the molecular systematic and genetic differentiation of this species.

Effects of yucca extract (YE) on feed efficiency, immune and antioxidative function in Arbor Acres broilers were studied. One hundred and twenty-eight fourteen-day-old broiler chickens were randomly divided into four treatments with four replicates of 8 birds each. These four diets were formulated by adding 0, 100, 200 and 300 mg/kg YE to the basal diet. The results showed that: diets supplemented with 100 and 200 mg/kg YE increased average body weight gain, feed efficiency, IgG, IgM, T-AOC, CAT and SOD levels, and have positive effects on inducing immune organs' maturation. In addition, 100 mg treatment mainly improved the feed efficiency whereas 200 mg treatment mainly acted on immunity and anti-oxidation. In conclusion, YE can be used as a feed additive due to its capability to improve feed efficiency, immune and antioxidative function in broilers.

Background Accompanying its rapid economic development and population growth, China is the world's third largest acid rain region, following Europe and North America. The effects of acid rain on forest ecosystem were widely researched, including the growth, the nutrient of the leaf and soil, and so on. However, there are few reports about the effects of acid rain on the soil microbial diversity. This study investigated the effects of acid rain on soil microbial community function under potted Masson pine seedlings (Pinus massoniana Lamb). Results After 7 months of treatment with simulated acid rain, the low acid load treatment (pH 5.5) stimulated soil microbial activity, and increased soil microbial diversity and richness, while the higher levels of acid application (pH 4.5, pH 3.5) resulted in lower soil microbial activity and had no significant effects on soil microbial diversity and richness. Principal component analysis showed that there was clear discrimination in the metabolic capability of the soil microbial community among the simulated acid rain and control treatments. Conclusion The results obtained indicated that the higher acid load decreased the soil microbial activity and no effects on soil microbial diversity assessed by Biolog of potted Masson pine seedlings. Simulated acid rain also changed the metabolic capability of the soil microbial community.

Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology. A number of questions regarding its etiology are unclear. CD4+CD25+ regulatory T cells (Tregs) play a critical role in self-tolerance and, for unknown reasons, their relative number is reduced in PBC patients. B-cell-activating factor (BAFF) is a key survival factor during B-cell maturation and its concentration is increased in peripheral blood of PBC patients. It has been reported that activated B cells inhibit Treg cell proliferation and there are no BAFF receptors on Tregs. Therefore, we speculated that excessive BAFF may result in Treg reduction via B cells. To prove our hypothesis, we isolated Tregs and B cells from PBC and healthy donors. BAFF and IgM concentrations were then analyzed by ELISA and CD40, CD80, CD86, IL-10, and TGF-β expression in B cells and Tregs were measured by flow cytometry. BAFF up-regulated CD40, CD80, CD86, and IgM expression in B cells. However, BAFF had no direct effect on Treg cell apoptosis and cytokine secretion. Nonetheless, we observed that BAFF-activated B cells could induce Treg cell apoptosis and reduce IL-10 and TGF-β expression. We also showed that BAFF-activated CD4+ T cells had no effect on Treg apoptosis. Furthermore, we verified that bezafibrate, a hypolipidemic drug, can inhibit BAFF-induced Treg cell apoptosis. In conclusion, BAFF promotes Treg cell apoptosis and inhibits cytokine production by activating B cells in PBC patients. The results of this study suggest that inhibition of BAFF activation is a strategy for PBC treatment.

OBJETIVO: A cirurgia torácica vídeo-assistida (CTVA) tem sido uma intervenção de escolha para o tratamento de pneumotórax espontâneo (PS) com bolha pulmonar. Nosso objetivo foi apresentar uma abordagem de CTVA uniportal unilateral para bulectomia bilateral e avaliar sua eficácia terapêutica. MÉTODOS: Entre maio de 2011 e janeiro de 2012, cinco pacientes foram submetidos a bulectomia bilateral por essa abordagem. Todos apresentavam PS bilateral. A TCAR pré-operatória mostrou que todos os pacientes tinham bolhas bilaterais no pulmão apical. As indicações cirúrgicas, os procedimentos de operação e os desfechos foram revisados. RESULTADOS: Todos os pacientes foram submetidos com sucesso a essa abordagem para bulectomia bilateral, sem complicações intraoperatórias. A mediana de tempo para a retirada do dreno torácico foi de 4,2 dias, e a mediana do tempo de hospitalização no pós-operatório foi de 5,2 dias. A mediana de seguimento pós-operatório foi de 11,2 meses. Um paciente teve recidiva de PE do lado esquerdo três semanas após a cirurgia e foi submetido a abrasão pleural. CONCLUSÕES: A bulectomia bilateral utilizando CTVA uniportal combinada com acesso contralateral ao mediastino anterior é tecnicamente confiável e promove desfechos favoráveis para pacientes com PS que desenvolvem bolhas bilaterais no pulmão apical. Entretanto, para a realização desse procedimento cirúrgico, são necessários cirurgiões com experiência em CTVA, instrumentos toracoscópicos longos, entre outras exigências.

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) has been a surgical intervention of choice for the treatment of spontaneous pneumothorax (SP) with lung bulla. Our objective was to introduce a uniportal VATS approach for simultaneous bilateral bullectomy and to evaluate its therapeutic efficacy. METHODS: Between May of 2011 and January of 2012, five patients underwent bilateral bullectomy conducted using this approach. All of the patients presented with bilateral SP. Preoperative HRCT revealed that all of the patients had bilateral apical bullae. We reviewed the surgical indications, surgical procedures, and outcomes. RESULTS: All of the patients were successfully submitted to this approach for bilateral bullectomy, and there were no intraoperative complications. The median time to chest tube removal was 4.2 days, and the median length of the postoperative hospital stay was 5.2 days. The median postoperative follow-up period was 11.2 months. One patient experienced recurrence of left SP three weeks after the surgery and underwent pleural abrasion. CONCLUSIONS: Bilateral bullectomy through uniportal VATS combined with contralateral access to the anterior mediastinum is technically reliable and provides favorable surgical outcomes for patients with bilateral SP who develop bilateral apical bullae. However, among other requirements, this surgical procedure demands that surgeons be experienced in VATS and that the appropriate thoracoscopic instruments are available.