Purpose: We evaluated the surgical outcomes of non-renorrhaphy, mini-incision partial nephrectomy using a soft-coagulation system.
Methods: Non-renorrhaphy mini-incision, partial nephrectomy was performed in 33 consecutive patients with small renal tumors between April 2016 and March 2019. After tumor resection, the soft-coagulation system was used to achieve hemostasis. A TachoSil^Ⓡ or BOLHEAL^Ⓡ was used on the resection bed. The urinary collecting system was only sutured if it was opened. The surgical outcomes of each patient were retrospectively evaluated.
Results: The patients’ mean age was 66.8 (36–83) years. The mean tumor size, operative time, and amount of intraoperative blood loss were 25.7 mm, 230 (140–357) min, and 292.2 (0–1332) mL, respectively. In 8 patients, the renal artery was clamped during the operation (mean warm ischemia time: 7.4 [2–18] min). The urinary collecting system was sutured in 18 patients. Two complications of Clavien-Dindo grade III or worse occurred: postoperative bleeding, which required a blood transfusion, and complete atrioventricular block (A-V block), which required temporary cardiac pacing. The A-V block spontaneously resolved a few days after the operation, and cardiac pacing was not required thereafter. The surgical margins were negative in all cases, and no tumor recurrence was observed during the observational period (681.8 [16–1126] days). The mean (range) rate of change in the estimated glomerular filtration rate at one year after surgery was −9.0% (−21.8–14.3%).
Conclusion: Non-renorrhaphy partial nephrectomy using a soft-coagulation system is safe and produces acceptable oncological outcomes.

The transplantation of cultured epithelium is useful in the treatment of large-area skin defects, but such epithelium can also be cultured simultaneously with melanocytes in the culture process. By using this technique, therapy can be performed to adjust pigmentation although free adjustment of the color tone is not possible.
In this study, the authors attempted to develop a culture technique for coloring cultured epithelium that allows color matching by controlling the number and function of melanocytes in the cultured keratinocytes.
Cocultivation of keratinocytes and melanocytes was possible by the method of Rheinwald and Green.
However, endothelin-1, which promotes melanocyte proliferation, did not enhance the proliferation of these cells in this culture condition.
Dinoprost, a promotor of melanin synthesis, did not affect proliferation but did enhance melanin synthesis.
During keratinocyte culture, melanocytes specifically cocultured by another technique, were added at the time of passaging of the cultured keratinocytes, thus allowing simultaneous culture of keratinocytes and melanocytes.
In addition, the melanocytes coexisted at a uniform density on the surface of the cultured keratinocytes.
Depending on the concentration of the applied melanocyte cells, the dopa response of the cultured keratinocytes was enhanced. From the above, it was possible to culture melanocytes under different specific conditions in advance during keratinocytes culture, and the color tone of the cultured keratinocytes could be freely changed by application of the coexisting cultured melanocytes during preparation of cultured epithelium for transplantation.
Pharmaceutical control was also possible by adding a melanin synthesis promoter such as dinoprost.
Depigmentation and pigmentation can be a major esthetic afflictions in patients. This technology may be applicable to color matching of transplantion sites such as in vitiligo.

Background: Electrocardiographic (ECG) strain pattern has been reported as a poor prognostic factor in patients with aortic stenosis (AS). However, there is no evidence regarding the prevalence of changes in ECG strain and its clinical impact following aortic valve replacement (AVR). This study aimed to investigate the prevalence and prognostic impact of changes in ECG strain pattern after surgical and transcatheter AVR (TAVR).
Methods: Data on 129 patients who underwent AVR (TAVR: 84 cases, 65%) were retrospectively evaluated. The ECG and echocardiographic findings of all included patients were evaluated before and 1 year after AVR. We also assessed freedom from all-cause death and hospitalization for heart failure as clinical outcomes.
Results: Of the 129 patients, 53 (41.1%) had ECG strain before undergoing AVR, and in 32 of these patients (60.4%), ECG strain had normalized one year after undergoing AVR. The Sokolow-Lyon voltage at baseline, AS severity, and AVR type did not differ significantly with or without ECG normalization. Multivariate analysis showed that AVR was not associated with ECG normalization. There was no difference in the clinical outcomes between patients with and without ECG strain or between patients with and without ECG normalization. Cox proportional hazard analysis revealed that increased AS severity, prolonged QT interval, and AVR type were associated with clinical outcomes.
Conclusion: In approximately 60% of the patients, ECG strain normalized regardless of the AVR type. Although ECG strain and normalization after AVR did not affect prognosis, further prospective studies in larger populations are required.

Background: Serum laminin-γ2 monomer (Ln-γ2m) is a potentially useful novel biomarker for the surveillance of hepatocellular carcinoma (HCC). We measured the serum Ln-γ2m levels before and after transarterial chemoembolization (TACE) as treatment for HCC and evaluated its diagnostic value in predicting HCC treatment efficacy.
Methods: HCC patients treated with TACE at the St. Marianna University School of Medicine Hospital were enrolled between January 2013 and February 2018 (n=28; 19 men and 9 women; mean age: 70 years). Treatment effects were evaluated by dynamic contrast-enhanced computed tomography (CECT) a median 7 (range: 4–25) days after TACE using the modified Response Evaluation Criteria in Solid Tumors. Serum Ln-γ2m levels were measured by chemiluminescent immunoassay before and 7 days after TACE.
Results: According to the CECT results, 5 patients had a complete response (CR), 11 a partial response (PR), 5 stable disease (SD), and 7 progressive disease (PD). In the effective therapeutic group (patients with CR or PR), serum Ln-γ2m levels were significantly decreased after TACE, by 60% with CR (3/5) and 36% with PR (4/11). Conversely, in PR cases in which therapy was ineffective, serum Ln-γ2m levels increased after TACE. In these cases, tumor progression was observed in CT images within 3 months. In the ineffective therapeutic group (patients with SD or PD), serum Ln-γ2m levels were significantly increased, by 100% with SD (5/5) and 86% with PD (6/7).
Conclusion: The serum Ln-γ2m response may predict the treatment efficacy of TACE for advanced HCC.

Aim: Although the serum hepatitis B virus (HBV) DNA level is an important biomarker for the management of chronic HBV infection and a known independent predictor of hepatocellular carcinoma (HCC), HBV DNA is no longer useful as nucleos(t)ide analogue (NA) suppresses the serum HBV DNA titer. Because the viral markers HB surface antigen (HBsAg) and HB core-related antigen (HBcrAg) can reflect intrahepatic HBV replication activity and constitute important biomarkers for HCC, the value of using these two markers in combination to assess HCC risk was investigated in a patient cohort.
Methods: Included in this study were consecutive patients with chronic HBV infection in whom the association of HBsAg and HBcrAg with HCC risk was investigated cross-sectionally, and longitudinally.
Results: When the high-value cut-offs of HBsAg and HBcrAg were defined as 3.5 log IU/mL and 4.9 log U/mL among the HBe-negative patients, respectively, those with a history of HCC were found frequently in the low HBsAg group (p=0.017) and high HBcrAg group (p=0.040). When HBsAg and HBcrAg were combined, an HCC history was most frequent in the subset with low HBsAg and high HBcrAg (odds ratio [OR], 5.40; p<0.001), irrespective of NA therapy (OR, 5.71; p=0.012). These results were almost the same in the HBe-positive patients. In a longitudinal analysis of the subsequent development of HCC carried out on 374 patients without a history of HCC at enrollment, HCC developed significantly more frequently in the low HBsAg/high HBcrAg group (OR, 3.55; p=0.006).
Conclusions: This cross-sectional and longitudinal analysis showed that the patients with low HBsAg/high HBcrAg values were at high risk of developing HBV-related HCC, indicating that the combination of HBsAg and HBcrAg values may be an excellent biomarker for assessing HCC risk, especially in patients receiving NA treatment.

A 44-year-old Japanese woman had a fever 3 days before visiting our hospital. Two days later, she visited a nearby clinic and received antibiotics for a suspected urinary tract infection. On the following day, because her symptoms worsened with a fever of 40ºC, systemic muscle pain, diarrhea, and vital signs indicating shock, she visited the clinic again and was referred to our hospital. She presented with conjunctival congestion, disuse erythema on her face, limbs, and trunk, and elevated inflammatory markers (white blood cells 17,700 /μL; C-reactive protein 34 mg/dL). Systemic contrast-enhanced computed tomography provided no useful information about the source of the fever. Because she was menstruating and had a history of tampon use, we suspected Toxic Shock Syndrome (TSS), hospitalized her, and began administration of replacement fluid, hypertensive agents, and combination antibiotic therapy. The blood culture was negative, but the vaginal culture showed methicillin-sensitive Staphylococcus aureus . On the 7th hospital day, the diagnosis of TSS was confirmed with the appearance of desquamation on her palms and soles in addition to other findings. Among the disease that result in septic shock, although TSS is likely to lead to death due to multiple organ failure, diagnosis may be difficult if an appropriate medical history is not obtained to clarify the diagnosis of TSS. In recent years, the rate of tampon use has increased in Japan. Menstrual TSS, as a differential diagnosis of febrile diseases with shock, is expected to become important.