Magnetic resonance imaging brain scans (1 5 T) were obtained and

Magnetic resonance imaging brain scans (1.5 T) were obtained and images Cytoskeletal Signaling inhibitor were analyzed by using BRAINS2. The contribution of sociodemographic, cognitive and clinical characterictics was investigated.

Results. Patients showed a significant total cortical thinning (F=17.55, d=x0.62, p< 0.001) and there was a diffuse pattern of reduced thickness (encompassing frontal, temporal and parietal cortices) (all p’s< 0.001, d’s> 0.53). No significant grouprgender interactions were observed (all p’s> 0.15). There were no significant associations

between the clinical and pre-morbid variables and cortical thickness measurements (all r’s< 0.12). A weak significant negative correlation between attention and total (r=x0.24, p=0.021) and parietal cortical thickness (r=x0.27, p=0.009) was found in patients (thicker cortex was associated with lower attention). Our data revealed a similar pattern of cortical thickness changes

related to age in patients and controls.

Conclusions. Cortical thinning is independent of gender, age, age of onset and duration of the illness and does not seem to significantly influence clinical and functional symptomatology. These findings support a primary neurodevelopment disorder affecting the normal cerebral cortex development in schizophrenia.”
“Moderate caloric restriction (CR) without malnutrition increases healthspan in virtually every find more species studied, including nonhuman primates. In mice, CR exerts significant microvascular see more protective effects resulting in increased microvascular density in the heart and the brain, which likely contribute to enhanced tolerance to ischemia and improved cardiac performance and cognitive function. Yet, the underlying mechanisms by which CR confer microvascular protection remain elusive. To test the hypothesis that circulating factors triggered by CR regulate endothelial angiogenic capacity, we treated cultured human endothelial cells with sera derived from Macaca mulatta on long-term (over

10 years) CR. Cells treated with sera derived from ad-libitum-fed control monkeys served as controls. We found that factors present in CR sera upregulate vascular endothelial growth factor (VEGF) signaling and stimulate angiogenic processes, including endothelial cell proliferation and formation of capillary-like structures. Treatment with CR sera also tended to increase cellular migration (measured by a wound-healing assay using electric cellsubstrate impedance sensing [ECIS] technology) and adhesion to collagen. Collectively, we find that circulating factors induced by CR promote endothelial angiogenic processes, suggesting that increased angiogenesis may be a potential mechanism by which CR improves cardiac function and prevents vascular cognitive impairment.”
“Background. During the last decades we have seen a new focus on early treatment of psychosis.

The primary end point was death from cardiac causes, and secondar

The primary end point was death from cardiac causes, and secondary end points were death from any cause and death from arrhythmia during a mean follow-up of 30 +/- 11 years. Early repolarization was stratified according to Selinexor price the degree of J-point elevation (>= 0.1 mV or >0.2 mV) in either inferior or lateral leads.

RESULTS

The early-repolarization pattern of 0.1 mV

or more was present in 630 subjects (5.8%): 384 (3.5%) in inferior leads and 262 (2.4%) in lateral leads, with elevations in both leads in 16 subjects (0.1%). J-point elevation of at least 0.1 mV in inferior leads was associated with an increased risk of death from cardiac causes (adjusted relative risk, 1.28; 95% confidence interval [CI], 1.04 to 1.59; P=0.03); 36 subjects (0.3%) with J-point elevation of more than 0.2 mV in inferior leads had a markedly elevated risk of death from cardiac causes (adjusted relative risk, 2.98; 95% CI, 1.85 to 4.92; P<0.001) and from arrhythmia (adjusted relative risk, 2.92; 95% CI, 1.45 to 5.89; P=0.01). Other electrocardiographic risk markers, such as a prolonged QT interval corrected for heart rate (P=0.03) and left ventricular hypertrophy (P=0.004), were weaker predictors

of the primary end point.

CONCLUSIONS

An early-repolarization pattern in the inferior leads of a standard electrocardiogram is associated with an increased risk of death from cardiac causes in middle-aged subjects.”
“BACKGROUND

In most patients with stable coronary artery disease, Blebbistatin research buy plasma

cardiac troponin T levels are below the limit of detection for the conventional assay. The distribution and determinants of very low circulating troponin T levels, as well as their association with cardiovascular events, in such patients are unknown.

METHODS

We used a new, high-sensitivity assay to determine the concentration of cardiac troponin T in plasma samples from 3679 patients with stable coronary artery disease and preserved left ventricular function. Results of the assay were analyzed in relation to the incidence of cardiovascular events during a median follow-up period of 5.2 years.

RESULTS

With the highly sensitive assay, concentrations of cardiac troponin T were at or above the Z-DEVD-FMK limit of detection (0.001 mu g per liter) in 3593 patients (97.7%) and at or above the 99th percentile for apparently healthy subjects (0.0133 mu g per liter) in 407 patients (11.1%). After adjustment for other independent prognostic indicators, there was a strong and graded increase in the cumulative incidence of cardiovascular death (adjusted hazard ratio per unit increase in the natural logarithm of the troponin T level, 2.09; 95% confidence interval [CI], 1.60 to 2.74; P<0.001) and of heart failure (adjusted hazard ratio, 2.20; 95% CI, 1.66 to 2.90; P<0.001) in this study group.

Improved topical haemostatic agents and interventional radiology

Improved topical haemostatic agents and interventional radiology are becoming increasingly useful adjuncts to surgical selleck chemical control of bleeding. Better understanding of trauma-induced coagulopathy is paving the way for the replacement of blind, unguided protocols for blood component therapy with systemic treatments targeting specific deficiencies

in coagulation. Similarly, treatments targeting dysregulated inflammatory responses to severe injury are under investigation. As point-of-care diagnostics become more suited to emergency environments, timely targeted intervention for haemorrhage control will result in better patient outcomes and reduced demand for blood products. Our Series paper describes how our understanding of the roles of

the microcirculation, inflammation, and coagulation has shaped new and emerging treatment strategies.”
“The risk for developing anxiety disorders is greater in females and those individuals exhibiting a behaviorally inhibited temperament. Growth of behavioral avoidance in people is a significant predictor of symptom severity in anxiety disorders, including post-traumatic stress disorder. Using an animal model, our lab is examining how the process of learning avoidant behavior may lead certain individuals to develop anxiety. Here we examined whether the known vulnerabilities of female sex and behaviorally inhibited temperament have individual or additive effects upon the acquisition of an active-avoidance response. A discrete trial lever-press escape-avoidance protocol was used check details to examine the acquisition of behavioral avoidance in male and female Sprague-Dawley (SD) rats and behaviorally inhibited inbred Wistar-Kyoto (WKY) selleckchem rats. Overall, WKY rats of both sexes were indistinguishable

in their behavior during the acquisition of an active-avoidance response, exhibiting quicker acquisition of reinforced responses both between and within session compared to SD rats. Further WKY rats emitted more non-reinforced responses than SD rats. Sex differences were evident in SD rats in both the acquisition of the reinforced response and the emission of non-reinforced responses, with SD females acquiring the response quicker and emitting more non-reinforced responses following lever presses that led to an escape from shock. As vulnerability factors, behavioral inhibition and female sex were each associated with more prevalent reinforced and non-reinforced avoidant behavior, but an additive effect of these 2 factors was not observed. These data illustrate the importance of genetics (both strain and sex) in the assessment and modeling of anxiety vulnerability through the acquisition of active-avoidance responses and the persistence of emitting those responses in periods of non-reinforcement. Published by Elsevier Inc.”
“Background: Analysis of the distribution of reaction times (RTs) in behavioral tasks can illustrate differences attributable to changes in attention, even when no change in mean RT is observed.

Veterans with a positive screen for PTSD scored higher than Veter

Veterans with a positive screen for PTSD scored higher than Veterans without a positive screen for PTSD on measures of worry, self-punishment, social control, behavioral distraction, and avoidance coping strategies. Worry and social avoidance

coping were positively related to PTSD symptoms, and greater perceptions of understanding from others were negatively related Capmatinib cell line to these symptoms. A structural equation model revealed that scores on a measure of postdeployment social support were negatively associated with scores on measures of maladaptive cognitive coping (i.e., worry, self-punishment) and avoidance coping (social and non-social avoidance coping) strategies, which were positively associated with combat-related PTSD symptoms. These results suggest that maladaptive thought control and avoidance coping may partially mediate the relation between postdeployment social support and combat-related PTSD symptoms in treatment-seeking OEF-OIF Veterans. Consistent with cognitive therapy models,

these 4SC-202 price findings suggest that interventions that target maladaptive coping strategies such as worry, self-punishment, and social avoidance, and that bolster social support, most notably understanding from others, may help reduce combat-related PTSD symptoms in this population. Published by Elsevier Ireland Ltd.”
“Cytokine production by innate immunity is critical for shaping the adaptive immunity through regulation of T cell differentiation. In this report, we studied T cell immunoglobulin mucin domain protein 3 (Tim-3) expression on monocytes and its regulatory effect on interleukin-12 (IL-12)/IL-23 production by CD14(+) monocytes, as well as IL-17 production by CD4(+) T cells in individuals with chronic hepatitis C virus (HCV) infection. We found that Tim-3 and IL-23p19 are highly expressed and that IL-12p35 is inhibited in human CD14(+) monocytes, while IL-17 expression is upregulated in CD4(+) T cells, in chronically HCV-infected individuals compared to healthy subjects. Interestingly, Tim-3 expression is closely associated

with the differential regulation of IL-12/IL-23 expression in CD14(+) monocytes and correlated to IL-17 production by CD4(+) T cells. These Tim-3-associated IL-12/IL-23/IL-17 dysregulations in HCV-infected individuals are also recapitulated in vitro by incubating healthy monocytes or peripheral blood mononuclear cells with before Huh-7 hepatoma cells transfected with HCV RNA. Importantly, blocking Tim-3 signaling on monocytes restores the balance of IL-12/IL-23 through the intracellular STAT3 signaling, which in turn reverses the upregulated IL-17 expression both ex vivo and in vitro. Our findings suggest that Tim-3-mediated differential regulation of IL-12/IL-23 drives T(H)17 cell development, a milieu favoring viral persistence and autoimmune phenomenon during HCV infection.”
“Individuals exposed to childhood trauma are more likely to report delusional-like experiences (DLE).

The finding that red snapper did adequately respond to the fusion

The finding that red snapper did adequately respond to the fusion protein FlaA-(G4S)3-FlaB injection made it a promising candidate for vaccine treatment. To develop effective vaccine candidates against V.similar to alginolyticus, more attention should be given to these immunogenic flagellins.”
“Recent R428 purchase studies have found short-term adrenocortical

benefits of early interventions for at-risk children. The current study evaluated the effects of the Family Bereavement Program on cortisol levels six years after the program. Parentally bereaved children were randomly assigned to the 12-week preventive intervention (n = 78) or a self-study control (n = 61) condition. Six years later (mean age 17.5), salivary cortisol levels were measured before Tariquidar concentration and after a conflict discussion task conducted in late afternoon/early evening. The intervention group had significantly higher cortisol levels across the task compared to the control group, and lower cortisol was associated with higher externalizing symptoms. The group effect did not differ by age at the time of death, and the group difference remained significant after adjustment for pre-intervention mental health and current mental health symptoms. Results suggest that a family-focused intervention for parentally bereaved youth may have prevented the development of attenuated cortisol secretion suggestive of dysregulation and associated with externalizing problems.

(c) 2009 Elsevier Ltd. All rights reserved.”
“Egg-laying behavior in Aplysia is accompanied by behavioral changes such as feeding suppression. We investigated the effects of the egg-laying hormone (ELH) on food intake, the activity patterns of jaw muscles, and the activity of buccal neurons (multi-action neuron [MA1] and jaw-closing motor neuron [JC2]), which are elements of the feeding neural circuits controlling jaw movements in Aplysia kurodai. Injection of ELH

into the body cavity inhibited the intake of seaweed. After ELH application, the rhythmic activity of jaw muscles that was induced by preferred taste stimulation elicited fewer ingestion-like responses and https://www.selleck.cn/products/c646.html increased the number of rejection-like responses. ELH applied to the buccal ganglia increased the firing activity of JC2 during spontaneous rhythmic responses and during the rhythmic feeding-like responses that were evoked by electrical stimulation of the esophageal nerves. In the 2 types of rhythmic responses, the Dn (normalized value of the delay time of JC2 firing onset) decreased after ELH application as compared with the control. Furthermore, ELH decreased the size of MA1-induced inhibitory postsynaptic currents in JC2. These results suggest that ELH changes the buccal motor program from ingestion to rejection on the basis of our previous results, and may contribute to a decrease in food intake during egg laying. (c) 2013 Elsevier Ireland Ltd and the Japan Neuroscience Society.


“BACKGROUND An impaired glomerular filtration rate (GFR) l


“BACKGROUND An impaired glomerular filtration rate (GFR) leads to end-stage renal disease and increases the risks of cardiovascular disease and death. Persons with type 1 diabetes are at high risk for kidney disease, but there are no interventions that have been proved to prevent impairment of the GFR in this population.

METHODS In the Diabetes Control and Complications Trial (DCCT), 1441 persons with type 1 diabetes were randomly assigned to 6.5 years of intensive diabetes therapy aimed at achieving near-normal glucose concentrations or to conventional diabetes therapy aimed at preventing hyperglycemic

symptoms. Subsequently, 1375 participants were followed in the observational Epidemiology of Diabetes Interventions and Complications (EDIC) study. Serum creatinine levels were measured annually throughout BGJ398 nmr the course of Nepicastat the two studies. The

GFR was estimated with the use of the Chronic Kidney Disease Epidemiology Collaboration formula. We analyzed data from the two studies to determine the long-term effects of intensive diabetes therapy on the risk of impairment of the GFR, which was defined as an incident estimated GFR of less than 60 ml per minute per 1.73 m(2) of body-surface area at two consecutive study visits.

RESULTS Over a median follow-up period of 22 years in the combined studies, impairment of the GFR developed in 24 participants assigned to intensive therapy and in 46 assigned to conventional therapy (risk reduction with intensive therapy, 50%; 95% confidence interval, 18 to 69; P = 0.006). Among these participants, end-stage renal disease developed in 8 participants in the intensive-therapy group and in 16 in the conventionaltherapy

group. As compared with conventional therapy, intensive therapy was associated with a reduction in the mean estimated GFR of 1.7 ml per minute per 1.73 m(2) during the DCCT study but during the Alisertib price EDIC study was associated with a slower rate of reduction in the GFR and an increase in the mean estimated GFR of 2.5 ml per minute per 1.73 m(2) (P<0.001 for both comparisons). The beneficial effect of intensive therapy on the risk of an impaired GFR was fully attenuated after adjustment for glycated hemoglobin levels or albumin excretion rates.

CONCLUSIONS The long-term risk of an impaired GFR was significantly lower among persons treated early in the course of type 1 diabetes with intensive diabetes therapy than among those treated with conventional diabetes therapy. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; DCCT/EDIC ClinicalTrials.gov numbers, NCT00360815 and NCT00360893.)”
“Background.

We anticipate that future studies in multiple sclerosis will prov

We anticipate that future studies in multiple sclerosis will provide a new taxonomy

on the basis of mechanisms rather than clinical empiricism, and so inform strategies for improved treatment at all stages of the disease.”
“Berberine is an alkaloid derived from herb medicine Coptidis Rhizom. Although there are OSI-027 molecular weight increasing evidences that berberine exhibits neuroprotective effects against ischemic brain damage, little is known about the mechanism. In this study, we investigated the effect of berberine on ischemic injury in a middle cerebral artery occlusion (MCAO) model. We found that berberine improved neurological outcome and reduced ischemial/reperfusion (I/R)-induced cerebral infarction 48 h after MCAO. The protective effect of berberine was confirmed in in vitro study. Berberine protected PC12 cells against oxygen-glucose deprivation (OGD)-induced injury. The results showed that berberine inhibited reactive oxygen species (ROS) generation, and subsequent release of pro-apoptotic factor cytochrome c and apoptosis-inducing factors (AlFs) evoked by OGD. Findings of this study suggest that berberine protects against ischemic brain injury

by decreasing the intracellular ROS level and subsequently inhibiting mitochondrial apoptotic pathway. (c) 2008 Elsevier Ireland Ltd. All rights reserved.”
“An evolutionary birth-death process is proposed as a model of evolutionary dynamics. Agents residing in a continuous spatial environment X, play a game G, with a continuous strategy set S, against BACE inhibitor other agents in the environment. The agents’ positions and

strategies continuously change in response to other agents and to random effects. Agents spawn asexually at rates that depend on their current fitness, and agents die at rates that depend on their local population density. Agents’ individual evolutionary trajectories in X and S are governed by a system of stochastic ODEs. When the number of agents is large and distributed in a smooth density on (X,S), the collective dynamics of the entire population is governed by a certain (deterministic) PDE, which we call RO4929097 ic50 a fitness-diffusion equation. (C) 2008 Elsevier Ltd. All rights reserved.”
“Age-related changes in the effects of nitric oxide (NO) on neurons of the auditory cortex have not been determined. We therefore evaluated the anatomical changes and neurophysiological characteristics of these neurons in rats as a function of age. The numbers of cresyl violet stained cells, the numbers and areas of NADPH-d-positive neuronal cell bodies, and their optical density, were measured in Sprague-Dawley rats aged 24 months (aged group) and 4 months (control group). The modulatory effects of NO on K(+) currents of acutely isolated rat auditory cortical neurons were also assessed.

These findings raise the possibility that serum BDNF may also hav

These findings raise the possibility that serum BDNF may also have effects on neuronal activity and behavior, but the functional significance of altered serum BDNF is unknown.

To address this issue, we determined the influence of peripheral BDNF administration on depression-and anxiety-like behavior, including the forced swim test (FST), chronic unpredictable stress (CUS)/anhedonia, noveltyinduced hypophagia (NIH) test, and elevated-plus maze (EPM). Furthermore, we examined adult hippocampal neurogenesis as well as hippocampal and striatal expression of BDNF, extracellular signal-regulated kinase (ERK) and cAMP response element-binding protein (CREB), in order to determine whether peripherally administered BDNF produces antidepressant-like cellular responses in the brain. Peripheral BDNF administration increased mobility in the FST, attenuated selleck screening library the effects

of CUS on Selleck Buparlisib sucrose consumption, decreased latency in the NIH test, and increased time spent in the open arms of an EPM. Moreover, adult hippocampal neurogenesis was increased after chronic, peripheral BDNF administration. We also found that BDNF levels as well as expression of pCREB and pERK were elevated in the hippocampus of adult mice receiving peripheral BDNF. Taken together, these results indicate that peripheral/serum BDNF may not only represent a biomarker of MDD, but also have functional consequences on molecular signaling substrates, neurogenesis, and behavior. Neuropsychopharmacology (2010) 35, 2378-2391; doi: 10.1038/npp.2010.114; published online 4 August 2010″
“Soluble or membrane-anchored ligands of NKG2D and their receptor have C646 molecular weight a critical role in the elimination of tumor cells and disease progression. Plasma samples of 98 patients with B-cell chronic lymphocytic leukemia (CLL) were analyzed with specific ELISA systems for soluble major histocompatibility complex class I-related chains (sMICA and sMICB) and UL-16-binding proteins (ULBP1,

2, and 3). The flow cytometric analysis of MICA on CLL cells and natural killer group 2 member D (NKG2D) receptors on NK cells was performed after thawing of frozen peripheral blood lymphocytes of CLL patients (N = 51). Levels of sMICA, sMICB, and sULBP2 were significantly increased (P < 0.001) compared with 48 controls, whereas sULBP1 3 were not detectable in patients and controls. Levels of sMICA > 990 pg/ml (P = 0.014), sMICB > 200 pg/ml (P = 0.0001), and sULBP2 > 105 pg/ml (P < 0.0001) were associated with poor treatment-free survival (TFS). Neither MICA nor NKG2D expression could be related to clinical parameters. In multivariate analysis Binet stage (P = 0.002), sULBP2 (P = 0.002) and ZAP-70 (P = 0.002) were independent predictive factors for TFS. In patients with Binet stage A, sULBP2 levels > 105 pg/ml were strongly associated (P = 0.0025) with poor TFS.

4 ng/ml in 26%, greater than 0 75 ng/ml in 14 5% and greater than

4 ng/ml in 26%, greater than 0.75 ng/ml in 14.5% and greater than 2 ng/ml in 4.5% of men in the same sample simply by using the different assays.

Conclusions: In our prospective screening population median prostate specific antigen was 17% lower using WHO vs Hybritech based assay standardization. As such, if these assays were instead used on a serial basis in the same patient, this could lead to false acceleration or false deceleration in prostate specific antigen velocity. Thus, the assay may influence the likelihood of prostate Ispinesib biopsy and, thereby, prostate cancer detection.”
“One of the issues debated in the field of bilingualism is the question of a “”critical period”" for second language

acquisition.

Recent studies suggest an influence of age of onset of acquisition (AOA) particularly on syntactic processing; however, the processing of word order in a sentence context has not yet been examined specifically. We used functional MRI to examine word order processing in two groups of highly proficient German-French bilinguals who had either acquired French or German after the age of 10, and a third group which had acquired both languages before the age of three. Nocodazole supplier Subjects listened to French and German sentences in which the order of subject and verb was systematically varied. In both groups of late bilinguals, processing of L2 compared to L1 resulted in higher levels of activation mainly of the left inferior frontal cortex while early bilinguals showed no activation difference in any of these areas. A selective increase in activation for late bilinguals only suggests that AOA contributes to modulating overall syntactic processing in L2. In addition, Necrostatin-1 native speakers of French showed significantly higher activation for verb-subject-order than native German speakers. These data suggest that AOA effects may in particular affect those grammatical structures which are marked in the first language. (C) 2008 Elsevier Ltd. All

rights reserved.”
“Purpose: Active surveillance with selective delayed intervention is a treatment regimen used in patients with low risk prostate cancer. Decision making is based on pretreatment prostate specific antigen, clinical stage and prostate biopsy results. We reviewed our experience with immediate repeat biopsy in patients eligible for active surveillance with selective delayed intervention.

Materials and Methods: A retrospective review was done of the records of consecutive patients who underwent repeat biopsy within 3 months of a first positive biopsy from March 2002 to June 2007. Patients were considered eligible if they had prostate specific antigen less than 10 ng/ml, clinical stage T2a or less, Gleason pattern 3 or less, 3 or fewer positive cores and no single core with 50% or greater cancer involvement.

Results: A total of 104 patients met eligibility criteria.

4% vs 59 1%) (p = 0 01)

Conclusions: This randomized

4% vs 59.1%) (p = 0.01).

Conclusions: This randomized trial with median followup approaching 9 years showed that cryoablation was inferior in attaining biochemical disease-free survival in patients with locally advanced prostate cancer (cT2c-T3). Cryoablation may be more suited for less bulky prostate cancer. Longer duration neoadjuvant hormonal therapy or a multimodal approach may provide optimal biochemical disease-free survival in this patient population.”
“Glycine acts as a neuromodulator to regions

rich in glutamatergic synapses, Temsirolimus cost such as the forebrain. However, recent evidences for synaptic release of glycine in hippocampal cultured neurons and synaptosomes argue for the existence of functional glycinergic synapses in the hippocampus. It is well established that GABA and glycine act in concert at inhibitory synapses, while the existence of synapses which utilize both

glutamate and glycine is less common. The purpose of the present study was to investigate the distribution of glycine and its role in hippocampal neurotransmission. Using immunohistochemistry, we demonstrate that vesicular glycine is preferentially stored in glutamatergic, rather than GABAergic presynaptic terminals. Using the sniffer patch technique, we found that glycine could be released upon presynaptic activity. Furthermore, using whole-cell patch-clamp recordings, we show for the first time the presence of a postsynaptic strychnine-sensitive S3I-201 order Verteporfin research buy chloride current in response to presynaptic stimulation. The small amplitude of this current is likely due to the paucity of postsynaptic glycine receptors rather than a low level of glycine release. Taken together, our results suggest that glycine is stored in glutamatergic presynaptic terminals. It is likely that the major role of glycine that is released from presynaptic terminals is to modulate N-methyl-o-aspartate receptor function but may also play a role in decreasing neuronal excitability by opposing glutamatergic neurotransmission in pathological states such as epilepsy or ischemia. (C) 2013 IBRO. Published by Elsevier Ltd. All rights reserved.”
“Antibody microarrays

are a developing tool for global proteomic profiling. A protocol was established that permits robust analyses of protein extracts from mammalian tissues and cells rather than body fluids. The factors optimized were buffer composition for surface blocking, blocking duration, protein handling and processing, labeling parameters like type of dye, molar ratio of label versus protein, and dye removal, as well as incubation parameters such as duration, temperature, buffer, and sample agitation.”
“Purpose: Open inguinal lymphadenectomy has been associated with significant postoperative morbidity. Recently, small series have demonstrated the feasibility and efficacy of endoscopic groin lymphadenectomy as an alternative to open surgery.