A Novel Dorsal Slit Approached Non-Ischemic Partial Nephrectomy Method for a Renal Tissue Regeneration in a Mouse Model.

BACKGROUND: Kidney ischemia-reperfusion (IR) via laparotomy is a conventional method for kidney surgery in a mouse model. However, IR, an invasive procedure, can cause serious acute and chronic complications through apoptotic and inflammatory pathways. To avoid these adverse responses, a Non-IR and dorsal slit approach was designed for kidney surgery. METHODS: Animals were divided into three groups, 1) sham-operated control; 2) IR, Kidney IR via laparotomy; and 3) Non-IR, Non-IR and dorsal slit. The effects of Non-IR method on renal surgery outcomes were verified with respect to animal viability, renal function, apoptosis, inflammation, fibrosis, renal regeneration, and systemic response using histology, immunohistochemistry, real-time polymerase chain reaction, serum chemistry, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining, and Masson's trichrome staining. RESULTS: The Non-IR group showed 100% viability with mild elevation of serum blood urea nitrogen and creatinine values at day 1 after surgery, whereas the IR group showed 20% viability and lethal functional abnormality. Histologically, renal tubule epithelial cell injury was evident on day 1 in the IR group, and cellular apoptosis enhanced TUNEL-positive cell number and Fas/caspase-3 and KIM-1/NGAL expression. Inflammation and fibrosis were high in the IR group, with enhanced CD4/CD8-positive T cell infiltration, inflammatory cytokine secretion, and Masson's trichrome stain-positive cell numbers. The Non-IR group showed a suitable microenvironment for renal regeneration with enhanced host cell migration, reduced immune cell influx, and increased expression of renal differentiation-related genes and anti-inflammatory cytokines. The local renal IR influenced distal organ apoptosis and inflammation by releasing circulating pro-inflammatory cytokines. CONCLUSION: The Non-IR and dorsal slit method for kidney surgery in a mouse model can be an alternative surgical approach for researchers without adverse reactions such as apoptosis, inflammation, fibrosis, functional impairment, and systemic reactions.

Long-Term Outcome After Endoscopic Submucosal Dissection for Early Gastric Cancer in Non-neoplastic Pathology Results.

BACKGROUND: After endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), negative pathological findings cause concern about the adequacy of the procedure and local recurrence after ESD. AIM: To investigate the incidence of local recurrence in cases with negative pathological findings after ESD for EGC and pathologically complete resection (CR) during long-term follow-up. METHODS: We reviewed 453 patients who underwent ESD for ECG from January 2007 to December 2010, respectively. Of these patients, in 17 cases the pathology results confirmed no residual tumor (NRT), and in 421 cases they showed CR in the ESD specimen. Finally, 17 NRT and 358 CR cases were followed up during surveillance. Patient characteristics, endoscopic and pathological data were analyzed for risk factors of local recurrence. We also re-evaluated the pathology of the NRT group to identify hidden malignant cells in the previous ESD specimens. RESULTS: There was no difference between the two groups in terms of recurrence during follow-up surveillance (median 55.7 months). Late local recurrence of EGC was found in two cases (11.8%) in the NRT group, and three early local recurrences (5.6%) were found in the CR group. A review of the pathology in the NRT group revealed hidden malignant cells in five patients (29.4%). CONCLUSIONS: Even when the pathological report indicates NRT after ESD, it might be necessary to re-evaluate ESD specimens with a width <2 mm, and long-term endoscopic surveillance should be routinely used for detecting local EGC recurrence after ESD.

Successful video-assisted thoracoscopic lobectomy in a pregnant woman with lung cancer.

A 38-year-old non-smoking female patient was evaluated at our hospital for an increasing mass in the right lower lung field at 24 weeks of gestation. Computed tomography revealed an approximately 7.5-cm diameter mass in the right lower lung lobe. After assessing the benefits to the patient and risks to the fetus, we performed a lobectomy with mediastinal lymph node dissection using video-assisted thoracoscopy. Three months postoperatively, the patient delivered a healthy male baby. The patient is alive 10 months following the lobectomy, and no evidence of recurrence and distant metastasis is noted. The 6-month-old infant is also doing well postpartum.