Efficacy of endoscopic surveillance for pharyngeal mucosa during endoscopic resection for pharyngeal carcinoma: a multicenter prospective study.

INTRODUCTION: Since patients with pharyngeal squamous cell carcinoma (SCC) often have multiple pharyngeal lesions, evaluation of pharyngeal lesions before endoscopic resection (ER) is important. However, detailed endoscopic observation of the entire pharyngeal mucosa under conscious sedation is difficult. We examined the usefulness of endoscopic surveillance with narrow band imaging (NBI) and lugol staining for detection of pharyngeal sublesions during ER for pharyngeal SCC under general anesthesia (endoscopic surveillance during treatment; ESDT). METHODS: From January 2021 through June 2022, we examined 78 patients who were diagnosed with superficial pharyngeal SCC and underwent ER. They underwent the ESDT and for patients who were diagnosed with new lesions of pharyngeal SCC or high-grade dysplasia (HGD) that were not detected in the endoscopic examination before treatment, ER were performed simultaneously for new lesions and the main lesions. The primary endpoint of this study was the detection rate of new lesions of pharyngeal SCC or HGD in the ESDT. RESULTS: Fifteen of the 78 patients were diagnosed as having undetected new pharyngeal lesions in the ESDT and 10 (12.8%) (95% CI 6.9-22.2%) were histopathologically confirmed to have new lesions of pharyngeal SCC or HGD. Among the 13 lesions of SCC or HGD, 8 were found by NBI observation; however, 5 were undetectable using NBI but detectable by lugol staining. All of the 13 lesions had endoscopic findings of pink color sign on lugol staining. CONCLUSIONS: Endoscopic surveillance for pharyngeal sublesions during ER for pharyngeal SCC is feasible and useful.

Artificial Nerve Conduit for Recurrent Laryngeal Nerve Reconstruction in Thyroid Surgery.

OBJECTIVE: Oncological reconstruction of the recurrent laryngeal nerve (RLN) is sometimes necessary for RLN invaded by thyroid cancer. There have been no case reports of RLN reconstruction using artificial nerve conduits, which are often used for peripheral nerves. In this study, we retrospectively evaluate the feasibility, safety, and efficacy of a collagen conduit with collagen filaments for RLN reconstruction cases at our hospital. METHODS: Artificial nerve conduits were used in seven cases of RLN reconstruction. Two patients had preoperative unilateral vocal cord paralysis with severe vocal cord atrophy, and two had vocal cord paresis without atrophy. The remaining three patients had functional vocal cords before surgery that had to be resected via surgery due to thyroid cancer infiltration of the RLN. Reconstruction was performed using RENERVE®, which is a collagen conduit. Voice examination and laryngeal endoscopy were performed 1, 3, and 12 months after surgery. RESULTS: There was no improvement in the phonetics of the two patients with vocal cord atrophy before surgery. In the remaining five cases, three with functional vocal cords improved to preoperative values, and two with vocal cord paresis improved to greater than preoperative values. CONCLUSION: We report the first case series using an artificial nerve conduit for human RLN reconstruction. In cases of RLN resection when the patient has good voice quality pre-operatively, reconstruction of the RLN using an artificial nerve may be a favorable option in cases where direct anastomosis or ansa cervicalis to RLN anastomosis cannot be performed. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:1773-1779, 2023.

Homogeneity tests for one-way models with dependent errors under correlated groups.

We consider the problem of testing for the existence of fixed effects and random effects in one-way models, where the groups are correlated and the disturbances are dependent. The classical F-statistic in the analysis of variance is not asymptotically distribution-free in this setting. To overcome this problem, we propose a new test statistic for this problem without any distributional assumptions, so that the test statistic is asymptotically distribution-free. The proposed test statistic takes the form of a natural extension of the classical F-statistic in the sense of distribution-freeness. The new tests are shown to be asymptotically size α and consistent. The nontrivial power under local alternatives is also elucidated. The theoretical results are justified by numerical simulations for the model with disturbances from linear time series with innovations of symmetric random variables, heavy-tailed variables, and skewed variables, and furthermore from GARCH models. The proposed test is applied to log-returns for stock prices and uncovers random effects in sectors. Supplementary Information: The online version contains supplementary material available at 10.1007/s11749-022-00828-9.

Intracranial venous reflux without the central venous occlusive disease in a patient receiving hemodialysis through brachio-brachial arteriovenous fistula: A case report.

Background: Upper-limb arteriovenous fistula as a hemodialysis access among patients with end-stage renal disease (ESRD) has become a preferred type of vascular access. However, complications involving the central nervous system may occur. There have been no reported cases of internal jugular vein (IJV) regurgitation without central venous occlusive diseases (CVODs).We describe the case of a patient on HD who presented with symptomatic IJV regurgitation without CVODs. Case Description: An 83-year-old man with ESRD receiving HD through a left upper-limb AVF presented with impaired consciousness and seizures. After recovery from unconsciousness, he became alert with cognitive impairment. The left subclavian arteriography revealed early filling of the left subclavian vein due to the AVF on the left brachium, with retrograde high-flow venous reflux to the left IJV, sigmoid and transverse sinuses, with the left central veins patent. All cerebral venous drainage procedures were dependent on the right IJV. The left internal carotid arteriography showed venous congestion of the left hemisphere. The flow of the left brachial artery was measured extremely high. Under compression of the left brachial artery to reduce the flow, the regurgitation persisted. With the findings that all cerebral venous return were in the right IJV, sacrificing the left IJV was thought to be acceptable. Left IJV ligation was performed, and the patient's cognitive function improved. Conclusion: The short-term outcome after IJV ligation may be positive in the patient who was confirmed to have a normal cerebral venous return route independent of the refluxed IJV.

Evaluation of the risk of metachronous multiple squamous cell carcinoma of the head and neck after transoral surgery based on the genetic polymorphisms of alcohol dehydrogenase 1B and aldehyde dehydrogenase 2.

Patients with superficial head and neck squamous cell carcinoma (HNSCC) can be completely treated by techniques of transoral surgery (TOS). The aim of this study was to evaluate the risk of metachronous multiple HNSCC arising after TOS based on alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2). We registered patients who underwent TOS for superficial HNSCC. Buccal cell samples were obtained by using a cotton swab to examine two single nucleotide polymorphisms in ADH1B and ALDH2 genotyping. We used Cox proportional hazards models to examine the risk of metachronous HNSCC. A total of 198 patients who underwent TOS for HNSCC were evaluated. In multivariate analysis, risks for second HNSCC were ADH1B*1/*1 [hazard ratio (HR), 1.88; 95% confidence interval (CI), 1.11-3.19; P = 0.02], ALDH2*1/*2 (HR, 2.11; 95% CI, 1.00-5.16; P = 0.048) and alcohol consumption before TOS (HR, 1.17; 95% CI, 1.06-1.27; P = 0.01). The 5-year incidence rates of second primary HNSCC in the temperance group and the non-temperance group were 20.8 and 46.5%, respectively (HR, 0.54; 95% CI, 0.31-0.92; P = 0.02). Cumulative development rates of third HNSCC in the temperance group and non-temperance group at 10 years were 11.3 and 36.1%, respectively (HR, 0.19; 95% CI, 0.03-0.65; P = 0.006). ADH1B*1/*1, ALDH2*1/*2 and moderate or heavy alcohol consumption before treatment are independent risk factors of metachronous HNSCC. Since it was shown that temperance decreased the incidences of second and third metachronous HNSCC, advice to discontinue alcohol drinking is necessary.

Evaluation of Pharyngeal Background Mucosa in Patients with Superficial Hypopharyngeal Carcinoma.

OBJECTIVES/HYPOTHESIS: Transoral surgery (TOS) has become increasingly popular for patients with superficial hypopharyngeal squamous cell carcinoma (SCC). However, the number of patients in whom metachronous multiple SCC of the head and neck (HNSCC) occurs has also increased. In this study, we investigated whether multiple lugol-voiding lesions (LVLs) in the pharyngeal background mucosa observed during TOS would be a biomarker of metachronous HNSCC. STUDY DESIGN: Retrospective study. METHODS: We examined 362 patients who underwent TOS for superficial hypopharyngeal carcinoma. Endoscopic images were reviewed in a blinded fashion by two endoscopists. LVLs in the pharyngeal mucosa were graded as follows: A, no lesions; B, 1 to 4 lesions; and C, ≥5 lesions per endoscopic view. RESULTS: Cumulative incidence curves of secondary HNSCC in the groups of grades A, B, and C revealed 3-year incidence rates of 14.4%, 18.8%, and 29.3%, respectively (P = .001 for A vs. C and P = .002 for B vs. C). Cumulative incidence curves of third HNSCC in the groups of grades A, B. and C revealed 5-year incidence rates of 3.9%, 9.8%, and 19.6%, respectively (P = .001 for A vs. C and P = .006 for B vs. C). Cumulative incidence curves of fourth HNSCC in the groups of grades A, B, and C revealed 7-year incidence rates of 0%, 2.3%, and 13.2%, respectively (P = .025 for A vs. C and P = .009 for B vs. C). CONCLUSIONS: Multiple LVLs in the pharyngeal mucosa increase the risk of development of metachronous multiple HNSCC. LEVEL OF EVIDENCE: 3 (nonrandomized, controlled cohort/follow-up study) Laryngoscope, 131:2036-2040, 2021.

What factors drive the satisfaction of citizens with governments' responses to COVID-19?

OBJECTIVES: This research scrutinizes the important factors influencing the satisfaction of citizens concerning their governments' responses to the COVID-19 pandemic based on an open-sourced survey of 14 countries. METHODS: To collect information on public sentiment regarding governments' reactions to COVID-19, we consider five factors for analysis: number of confirmed cases per million population, number of deaths per million population, and governments' containment and health policies, stringency policies, and economic support policies. We examine the Kendall correlations of variables in the 14 countries and use the wild bootstrap method for regression models to find important regressors. RESULTS: Our results show that people pay stronger attention to the results of their governments' battle against COVID-19 (number of confirmed cases and deaths per million population) rather than to what policies they initiate. Health policy and economic support do influence the approval of any national response to COVID-19. We also find that public satisfaction in Japan and South Korea toward the two governments' responses to the pandemic varies greatly compared to that of other countries' citizens to their governments' responses. CONCLUSIONS: The results herein offer some suggestions to governments when initiating policies to balance public health, livelihoods, and economic support.

Larynx-preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery for cervical esophageal cancer invading pharynx.

Larynx preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery (HELPS) was created for resectable cervical esophageal cancer (CEC) invading the hypopharynx. This study aimed to verify the effectiveness and to evaluate the feasibility of the new HELPS treatment method. Between 2014 and 2018, 19 patients with CEC invading the hypopharynx were treated with HELPS. The postoperative complications and survival rates were reviewed. Postoperative recurrent laryngeal nerve paralysis occurred in four patients. All patients consumed food orally without a feeding tube at the time of the discharge. The median follow-up period was 27 months. The 2- and 3-year overall survival rates were 94.7 and 71.5%, respectively. HELPS, a new surgical treatment method that utilizes endoscopic surgery, is effective, feasible and beneficial for preserving the larynx in patients with CEC even if the tumor invaded the pharynx.

Synopsis of transoral endoscopic laryngopharyngeal surgery for superficial pharyngeal cancers.

BACKGROUND: Endoscopic laryngopharyngeal surgery (ELPS) was developed for superficial pharyngeal cancers in Japan. In this study, we present our results of ELPS for superficial pharyngeal cancers. METHODS: From November 2009 to December 2015, 258 patients with superficial pharyngeal cancers underwent ELPS. Results, including survival rates, postoperative complications, and vocal function, are reviewed. RESULTS: The median follow-up period of 258 patients was 31 months. The overall and cause-specific survival rates over 3 years were 85.7% and 100%, respectively. Only 3 patients incurred local recurrences and were successfully salvaged by re-ELPS. Regarding postoperative complications, 4 patients required reoperation because of postoperative bleeding. As for the postoperative quality of life, no patients developed vocal fold paralysis. Every patient was able to consume meals at preoperative levels. CONCLUSION: ELPS is a feasible and minimally invasive treatment for superficial pharyngeal cancers with impressive quality of life results.

Efficient, effective, safe procedure to identify nonrecurrent inferior laryngeal nerve during thyroid surgery.

BACKGROUND: The nonrecurrent inferior laryngeal nerve (NRILN) is always associated with the aberrant subclavian artery. CT images can detect this vascular anomaly, which predicts an NRILN. The purpose of this study was to report our procedure to identify the NRILN in patients with the aberrant subclavian artery. METHODS: Four of 730 patients undergoing thyroid operation in our hospital were preoperatively diagnosed with aberrant subclavian artery by CT of the neck. To avoid vocal cord paralysis, we approached the vagal nerve first before dissecting the paratracheal region to discover the separation point of the NRILN from the vagal nerve. RESULTS: The NRILN was identified without difficulty in all 4 patients. No patients showed vocal cord paralysis. CONCLUSION: Approaching the vagal nerve first before dissecting the paratracheal region is an efficient, effective, and safe procedure to identify an NRILN in patients who are preoperatively diagnosed as having the aberrant subclavian artery.

Clinical impact of iodine staining for diagnosis of carcinoma in situ in the floor of mouth, and decision of adequate surgical margin.

OBJECTIVE: The use of iodine staining has been recommended for the early detection of squamous cell carcinoma (SCC) in the upper aerodigestive tract. The purpose was to verify the effectiveness of iodine staining in detecting early squamous cell carcinoma in the floor of mouth. METHODS: Between 1995 and 2005, otolaryngological examinations including the floor of mouth were performed for 2278 esophageal cancer patients as a screening program of high-risk patient group. Iodine staining was applied to a lightly reddish and/or white patch, and/or uneven lesions in the floor of the mouth. Forceps biopsy was performed for demarcated unstained or lightly stained lesions. Three patients with the tumors in the floor of mouth, which were diagnosed as more over T2 level just by visual examination, were excluded from this study. If SCC was found in the specimen, mucosal resection was performed with a safety margin of 2mm from the unstained or lightly stained lesion. The incidence, rate of carcinoma in situ, and prognosis of cancer of the floor of mouth (CFOM) were assessed. RESULTS: Iodine staining was performed for 72 of 2278 patients (3.2%) according to the presence of suspicious reddish and/or whitish and/or uneven lesions. Of these, unstained or lightly stained areas after iodine staining were recognized in 47 patients and SCC was revealed in 28 of 47 patients. The diagnosis of other 19 patients included inflammatory mucosa (n=11), low grade dysplasia (n=6), and hyperkeratosis (n=2). Sensitivity and specificity of iodine staining for detecting SCC were 100% and 59.6%, respectively. Pathological diagnosis of the 28 patients included squamous cell carcinoma in situ (n=12), microinvasive squamous cell carcinoma (n=15) disease, and focal invasive squamous cell cancer (n=1). Twenty-four of 28 patients were treated with mucosal resection without mandible resection. The other 4 patients did not receive the treatment of CFOM due to concomitant far advanced esophageal cancer. In 24 patients undergoing mucosal resection, no patients developed local recurrence or metastasis to the cervical lymph nodes during an average of 74.2 months of follow-up period (from 7 to 156 months). The 5-year cause-specific survival of these patients was 100%. CONCLUSION: The use of iodine staining as a part of otolaryngological examinations may be beneficial for the early detection of CFOM, including carcinoma in situ and micro-invasive SCC. Moreover, it would be very useful to determine an adequate surgical margin for locally mucosal resection.

[A case of small intestinal GIST maintained as a long stable disease by imatinib mesylate 400 mg/day, alternate-day administration for 2 weeks followed by a 2 week interval].

UNLABELLED: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. The recent molecular-targeted therapies (imatinib and sunitinib) have improved the treatment of GIST remarkably. However, it would be ideal if the amount of these drugs could be adjusted according to each patient because they have various side effects and are very expensive. We experienced a case of non-curative resectable GIST maintained as a long, stable disease after operation, despite tapering down the dose of imatinib mesylate for personal reasons. CASE: A woman aged 50. She had received surgery for a lower abdominal tumor, and had been diagnosed with GIST of the small intestine and disseminations. When she suspended taking imatinib (400 mg/day) after her operation, these tumors regrew. After restarting imatinib at 400 mg/day in an alternate-day administration lasting 2 weeks followed by a 2 week interval, the disseminated tumors were in significant for 60 months after the operation.

Predictors of cervical lymph node involvement in patients with pharyngeal carcinoma undergoing endoscopic mucosal resection.

OBJECTIVE: Although detection of pharyngeal carcinoma remaining in the epithelium or subepithelial tissue layer has been difficult by routine examinations, recent advances in endoscopic technology have enabled us to detect these lesions. These patients can receive endoscopic mucosal resection (EMR) and generally have a good prognosis, but some patients have nodal involvement. The purpose was to investigate predictors of nodal involvement in patients with pharyngeal carcinoma undergoing EMR at our hospital. STUDY DESIGN: Outcomes research. METHODS: Lymph node involvement, endoscopic morphology, and tumor thickness were investigated in 152 patients treated between 2001 and 2009. RESULTS: Pathological examination revealed carcinoma in situ (CIS) for 77 patients and subepithelial invasion (SEPI) for 75 patients. There were no patients with muscular invasion. Nodal involvement was found in none of CIS but in 7 of 75 patients (9.3%) with SEPI. In patients with SEPI, the mean tumor thickness was significantly higher in patients with lymph node involvement (1311.4 ± 300.0 µm) than those without involvement (692.6 ± 495.7 µm) (p=0.002). Significant risk factors for nodal involvement included the tumor thickness over 1000 µm (p<0.001) and the presence of venous or lymphatic invasion (p<0.05). Based on analysis in relation to sensitivity and specificity, the tumor thickness over 1000 µm may serve as the most predictive factor for nodal involvement. CONCLUSION: Tumor thickness can be a simple predictor for nodal involvement in cases of SEPI. Careful follow-up including neck palpation and annual imaging diagnostics such as computed tomography or ultrasonography are recommended for these patients.

The value of narrow band imaging for early detection of laryngeal cancer.

We evaluate the value of laryngoscopy using narrow band imaging (NBI) system in the diagnosis of precancerous and cancerous laryngeal lesions. Thirty-four patients were suspected of having a total of 35 precancerous or cancerous laryngeal lesions among patients receiving conventional white-light laryngoscopy. All 34 patients underwent laryngoscopy with NBI system to determine whether those lesions were malignant before biopsy procedure. The diagnostic criteria of malignancy by NBI view was the presence of demarcated brownish area with scattered brown spots in the lesion. Histopathologic results were retrospectively compared with results of determination of malignancy made by NBI view. Of the 23 lesions histopathologically proved to be malignancies, 21 lesions were classified as malignant by NBI view. Sensitivity and specificity for the diagnosis of malignancy by means of NBI view compared with histopathologic results were 91.3% for sensitivity and 91.6% for specificity. NBI endoscopy seems to be a very promising diagnostic tool in the diagnosis of laryngeal malignant disease.

Hepatic ischemia-reperfusion increases vascular endothelial growth factor and cancer growth in rats.

BACKGROUND: In liver surgery, the hepatic pedicle often is clamped to reduce blood loss, and later unclamped, representing hepatic ischemia and reperfusion (I/R) with induction of hypoxia. Vascular endothelial growth factor (VEGF) expression reportedly is induced by hypoxia; further, some cancer cells express the VEGF receptor (flt-1, flk-1/KDR). We hypothesized that I/R-induced VEGF expression could enhance growth of microscopic tumor via VEGF receptors on tumor cells, thus promoting liver metastasis in a rat model. MATERIALS AND METHODS: Time-dependent VEGF expression in liver and plasma was determined by enzyme-linked immunosorbent assay in rats subjected to 60 min of 70% hepatic I/R (I/R group). Other rats given an intrasplenic inoculation of a rat colon adenocarcinoma cell line (RCH-H4) were divided 3 days later into three groups: group A, untreated; group B, sham operation; group C, 70% I/R for 60 min. Liver metastasis was evaluated on day 14. Expression of flt-1 and flk-1/KDR was examined in RCN-H4 cells, and effects of exogenous VEGF on RCN-H4 cell proliferation were determined by MTT assays. RESULTS: Hepatic VEGF expression increased significantly in the I/R group compared to the control group. Liver metastasis was more extensive in group C than in groups A and B. RCN-H4 cells expressed flt-1 and flk-1/KDR, while exogenous VEGF increased RCN-H4 cell proliferation. CONCLUSION: Hepatic ischemia reperfusion leads to induction of VEGF and this is associated with increased tumor burden in an animal model of colon cancer metastasis.

The value of narrow band imaging endoscope for early head and neck cancers.

OBJECTIVES: To evaluate the diagnostic value of rhinolaryngoscopy using a narrow band imaging (NBI) system in detecting squamous cell carcinoma of the head and neck (SCCHN) in patients with esophageal cancer (EC). STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: Between January 2006 and December 2006, 667 consecutive EC patients underwent rhinolaryngoscopy screening with both a white light and an NBI system. Sensitivity, specificity, accuracy, and positive/negative predictive values for detecting SCCHNs were calculated and compared. RESULTS: Forty-five patients (6.7%) of 667 patients had SCCHNs. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for detecting SCCHNs by white light were 51.1 percent, 99.7 percent, 96.4 percent, 92 percent, and 96.6 percent. In contrast, those by NBI were 97.7 percent**, 98.9 percent, 98.8 percent*, 86.3 percent, and 99.8 percent** (*P < 0.01, **P < 0.001 vs white light). CONCLUSION: An NBI endoscope significantly improves diagnostic accuracy, sensitivity, and negative predictive value in detecting SCCHN in EC patients. This endoscope would be highly beneficial in detecting superficial SCCHNs in high-risk patients.

[Early detection of recurrent hypopharyngeal cancer after radiotherapy by utilizing narrow-band imaging--report of a case].

Narrow-band Imaging (NBI) is a novel optical technique in which the diagnostic capability of endoscopes in characterizing tissue is enhanced by the use of narrow-bandwidth filters in the video endoscope system. We report a case of early recurrence of hypopharyngeal cancer after radical radiotherapy which was detected by laryngoscopy using NBI. A 66-year-old man with right pyriform sinus cancer was treated by radical radiotherapy in March 2004. Twenty months later, laryngoscopy using NBI revealed an abnormal lesion in the right pyriform sinus, visualized as scattered brownish dots, which highly suggestive of a malignant lesion. After obtaining written informed consent from the patient, endoscopic mucosal resection of the lesion was performed. Histological examination of the resected specimen revealed a squamous cell carcinoma in situ. The patient did not need any additional therapy. Laryngoscopy using NBI appears to have good potential to detect early stage local tumor recurrence after radical radiotherapy.

Head and neck cancer associated with esophageal cancer.

BACKGROUND: Multiple squamous cell carcinomas (SCCs) frequently arise in the aerodigestive tract. This study aims to clarify the incidence of squamous cell carcinoma of the head and neck (SCCHN) in esophageal cancer (EC) and clinical features of SCCHN. METHOD: We reviewed the records of 1118 EC patients treated from May 1995 to December 2001 in our institution. All patients with EC underwent otolaryngological examination and pharyngolaryngoscopy screening before and after its treatment periodically during their follow-up periods. The incidence, site and stage of SCCHNs were analyzed. RESULT: A total of 127 patients had associated SCCHNs among all patients with EC (11.4%). Of these, the index antecedent tumor was SCCHN in 49 and EC in 78 patients. One hundred and fifteen patients developed double cancers (SCCHN and EC), 9 patients developed triple cancers (2 SCCHNs and EC) and 3 patients developed fourth cancers (3 SCCHNs and EC). Of 49 patients with the index SCCHN, 30 ECs were detected metachronously after its treatment (Group A) and 20 were synchronously (Group B). Of 78 patients with index EC, 38 SCCHNs were detected synchronously (Group C) and 54 SCCHNs were metachronously (Group D). The stages of 54 SCCHNs in the Group D were 33, 14, 4, 3 (Stages I-IV, respectively), which was significantly earlier than that of 50 SCCHNs in the Groups A and B (p<0.001). CONCLUSION: The incidence of SCCHN in our EC patients was 11.4%. Periodic otolaryngological examination and pharyngoscopy screening can detect SCCHNs early in patients with primary EC.

Edaravone reduces ischemia-reperfusion injury mediators in rat liver.

BACKGROUND: In hepatic ischemia-reperfusion (I/R) injury, oxidative stress both directly injures the liver and promotes an inflammatory reaction by up-regulating various inflammatory mediators. We investigated whether edaravone, a new hydroxy radical scavenger, could reduce hepatic I/R injury including expression of inflammatory mediators such as cytokines and adhesion molecules. MATERIALS AND METHODS: Male Sprague-Dawley rats were subjected to 30 min of partial hepatic pedicle clamping (70%) followed by reperfusion. Just after initiation of reperfusion and again 1 h later, edaravone was administered intraportally. After reperfusion hepatic lipid peroxidation was measured by thiobarbituric acid assay, and hepatic injury was quantified by measuring hepatic enzymes in plasma. We serially quantified hepatic expression of mRNAs for tumor necrosis factor (TNF)-alpha and E-selectin, and histologically examined E-selectin expression and neutrophil accumulation. RESULTS: In the edaravone group, hepatic lipid peroxidation and hepatic enzyme leakage were significantly less than in the saline group. Hepatic expression of TNF-alpha and E-selectin mRNAs was significantly lower in the edaravone than the saline group, at 2 h after initiation of reperfusion. Histologically, E-selectin immunoreactivity and neutrophil accumulation were less evident in hepatic sections from the edaravone group. CONCLUSIONS: Edaravone reduced hepatic I/R injury by minimizing oxidative stress, and inhibited subsequent injurious inflammation by reducing expression of inflammatory cytokines and adhesion molecules.