ge-adjusted mortality rates of pulmonary embolism (PE) increased significantly between 1951 and 2000, and the rate of successful treatment of acute PE has been increasing in Japan. 1 Three clinical surveys have been performed by Tohoku University and the calculated number of new patients with pulmonary thromboembolism in Japan has been increasing, the most recent total being 4,108 (3.22 per 100,000). 2 Mutidetector-row computed tomography (MDCT) is now widely available, making it possible to directly visualize thrombus and enabling alternative diagnoses. The clinical validity of using MDCT and D-dimer to rule out PE has been reported, 3 and recently, the results of the largest study (PIOPED II study) using either MDCT pulmonary angiography (MDCTA) or MDCTA combined with indirect venography (MDCTA-CTV) were reported, 4 showing that MDCTA-CTV had a higher sensitivity than MDCTA alone, with similar specificity. However, MDCTA-CTV was inconclusive in 10.6% of patients because of poor image quality of either CTA or CTV. 4 Several reports have suggested that right ventricular (RV) dysfunction assessed by MDCT helped predict mortality during follow-up, 5-7 and it is possible to evaluate RV dysfunction indicating submassive PE without echocardiography.Kucher et al reported a reduction in mortality from the use of inferior vena cava (IVC) filters in massive PE, 8 and Sakuma et al reported that several patients died of recurrence with submassive PE and even with non-massive PE. 9 Since 2003, we have routinely placed IVC filters in patients with massive or submassive PE with extensive deep venous thrombosis (DVT) on MDCTA-CTV. Echocardiography is used to assess RV dysfunction at that time. In the present study, the RV to left ventricular (LV) short-axis diameter (RVD/LVD) was also calculated by MDCT, and the patients were reclassified: RVD/LVD >1.0 was regarded as RV dysfunction (submassive PE) according to van der Meer et al. 5 The purpose of this study was to evaluate the usefulness and safety of MDCTA-CTV-oriented management of acute PE, including IVC filter indication. Methods PatientsBetween January 2003 and December 2005, 71 consecutive inpatients and outpatients (26 males, 45 females; mean age 58±17 years, range 17-86) suspected of having acute PE and who had not undergone diagnostic testing for PE were enrolled. Exclusion criteria were contraindication to the use of iodine contrast material (eg, history of allergy to contrast medium, renal insufficiency, pregnancy). All patients underwent MDCTA and indirect venography within 1 week from onset. 1948 -1954)

INTRODUCTION AND OBJECTIVES:The UCiTrainer is a low cost, portable laparoscopic trainer that utilizes an electronic tablet for video and optics; it can be printed with a consumer-level three-dimensional (3D) printer. We report our initial experience on the feasibility of using 3D printing technology as a novel method of manufacturing and distribution for low cost, surgical education tools on a global on demand basis.METHODS: We created computer-aided designs (CAD) using Solidworks Software (Dassault Systemes Solidworks Corp., Velizy-Villacoublay, France) for nine separate components which could then be assembled into a laparoscopic training device including an instrument port mold. These files were provided to two remote institutions to 3D print and assemble the trainer. The CAD files were uploaded to Makerware software (MakerBot Industries, New York City, NY) to be sliced into layers and prepared for printing. All pieces were printed using a Flashforge Creator 3D printer (Flashforge, Jinhua, China) in five separate prints. The following printer settings were used: raft layer, 15% infill, 2 shells, 0.10 mm layer height, 230 ? C extruder, 110 ? C build plate, 90 mm/s extrusion and 150 mm/s travel. In this process, successive layers of a heated, acrylonitrile butadiene styrene filament were extruded and laid on top of one another in both the horizontal and vertical axis. The printed mold was used to create two instrument ports using a liquid silicone rubber. Both remote institutions were provided oral and written instructions for assembly of the components.RESULTS: Initial attempts of 3D printing of the larger pieces (Figure 1b) were not successful due to deformation of the plastic. Additionally, initial calibration and leveling of the 3D printer were challenging to novices. Accordingly, the build plate was increased to 120 ? C and a full enclosure was made for the 3D printer to retain heat during the printing process. With these adjustments, successful printing of the components was accomplished. Both institutions were subsequently able to completely assemble and use the training device using only the oral and written instructions provided.CONCLUSIONS: 3D printing technology can be used successfully to disseminate a training device for use in surgical education. The device is inexpensive and can be made on an as-needed basis.

boys, who were compared with 126 boys without CH. This study was approved by the institutional review board of our hospital (no. 60180016).RESULTS: The mean age of patients with (Hypo-T group) and without (Normal-T group) CH at surgery was 23.3AE14.5 and 34.8AE30.4 months, respectively (p[0.45). The mean testicular volume was 0.54AE0.27 cm 3 (Normal-T group) and 0.62AE0.36 cm 3 (Hypo-T group) (p[0.30). The number of SSCs per tubule was 0.62AE0.59 in the Normal-T group and 2.14AE0.69 in the Hypo-T group (p<0.01).CONCLUSIONS: In patients with CH, the number of SSCs per tubule was significantly increased, and differentiation to SSCs occurred at a greater degree than in those without CH. We suspected that this was caused by the high thyroid-stimulating hormone (TSH) levels during mini-puberty. TSH is similar in structure to follicle-stimulating hormone, and their respective receptors are located in Sertoli cells. A previous study revealed that TSH promotes the proliferation of Sertoli cells, suggesting that Sertoli cells are involved in the SSC differentiation process. It provides a novel therapeutic method for preserving fertility potential in cryptorchid boys through stimulation of Sertoli cell function via thyroid hormones.

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