Pharmacologic Activation of Angiotensin-Converting Enzyme II Alleviates Diabetic Cardiomyopathy in db/db Mice by Reducing Reactive Oxidative Stress

Background@#Diabetes mellitus is one of the most common chronic diseases worldwide, and cardiovascular disease is the leading cause of morbidity and mortality in diabetic patients. Diabetic cardiomyopathy (DCM) is a phenomenon characterized by a deterioration in cardiac function and structure, independent of vascular complications. Among many possible causes, the renin-angiotensin-aldosterone system and angiotensin II have been proposed as major drivers of DCM development. In the current study, we aimed to investigate the effects of pharmacological activation of angiotensin-converting enzyme 2 (ACE2) on DCM. @*Methods@#The ACE2 activator diminazene aceturate (DIZE) was administered intraperitoneally to male db/db mice (8 weeks old) for 8 weeks. Transthoracic echocardiography was used to assess cardiac mass and function in mice. Cardiac structure and fibrotic changes were examined using histology and immunohistochemistry. Gene and protein expression levels were examined using quantitative reverse transcription polymerase chain reaction and Western blotting, respectively. Additionally, RNA sequencing was performed to investigate the underlying mechanisms of the effects of DIZE and identify novel potential therapeutic targets for DCM. @*Results@#Echocardiography revealed that in DCM, the administration of DIZE significantly improved cardiac function as well as reduced cardiac hypertrophy and fibrosis. Transcriptome analysis revealed that DIZE treatment suppresses oxidative stress and several pathways related to cardiac hypertrophy. @*Conclusion@#DIZE prevented the diabetes mellitus-mediated structural and functional deterioration of mouse hearts. Our findings suggest that the pharmacological activation of ACE2 could be a novel treatment strategy for DCM.

Serotonergic Regulation of Hepatic Energy Metabolism

The liver is a vital organ that regulates systemic energy metabolism and many physiological functions. Nonalcoholic fatty liver disease (NAFLD) is the commonest cause of chronic liver disease and end-stage liver failure. NAFLD is primarily caused by metabolic disruption of lipid and glucose homeostasis. Serotonin (5-hydroxytryptamine [5-HT]) is a biogenic amine with several functions in both the central and peripheral systems. 5-HT functions as a neurotransmitter in the brain and a hormone in peripheral tissues to regulate systemic energy homeostasis. Several recent studies have proposed various roles of 5-HT in hepatic metabolism and inflammation using tissue-specific knockout mice and 5-HT-receptor agonists/antagonists. This review compiles the most recent research on the relationship between 5-HT and hepatic metabolism, and the role of 5-HT signaling as a potential therapeutic target in NAFLD.

Iliac Vein Injury Due to a Damaged Hot Shearstrade mark Tip Cover During Robot Assisted Radical Prostatectomy

We report a rare case of vascular injury secondary to a damaged Hot Shearstrade mark tip cover. Two 1 mm holes in the tip cover resulted in perforations in the obturator and external iliac veins during pelvic node dissection. Bleeding was controlled with bipolar coagulation and a 5 mm metal clip in the obturator and iliac vein, respectively. The rest of the procedure was completed uneventfully. Frequent integrity assessment of this accessory is necessary. Its function is important in order to carry out safe dissection in proximity to delicate structures. When injuries arise from areas not directly involved in the dissection, immediate inspection of the instruments should be mandatory.

A Unique Instrumental Malfunction during Robotic Prostatectomy

Over the past decade, the introduction of robotics in the field of medicine has provided a new approach to patients requiring surgery, and both its advantages and disadvantages are currently under study by many groups worldwide. The use of robotics has especially been considered by the urological community as a treatment option in radical prostatectomy. The current case report is one in which the da Vinci Surgical Systemtrade mark, with fourth arm use was employed in radical prostatectomy. This case presents a unique occurrence in which a bolt of the Prograsper forcep became loose during an operation, leading to diminished device functionality and later impedance of its removal. A circumstance such as this has not previously been reported, so we introduce for other robotic surgeons our unique instrumental malfunction case during a robotic prostatectomy.

Embryonic-Natural Orifice Transluminal Endoscopic Surgery Nephrectomy

We describe our initial experience with embryonic-natural orifice transluminal endoscopic surgery (E-NOTES) nephrectomy in a nonfunctioning kidney. E-NOTES was performed with modified single port access by using a surgical glove and wound retractor. We used several laparoscopic instruments, such as articulating laparoscopic instruments, clips, conventional laparoscopic graspers, and dissectors. The operative time was 80 minutes. There were no intraoperative complications.

Hybrid Transvaginal Gastro-Endoscopic Nephrectomy in a Porcine Model

This animal experimental study reports one case of hybrid transvaginal natural orifice transluminal endoscopic surgery (NOTES) for nephrectomy. We performed a nephrectomy through a transvaginal access and 2 additional 5 mm trocars in the abdomen by using the keyhole technique. The specimen was removed through the vaginal tract. The total procedure time was 102 minutes. There were no intraoperative complications.

Initial Clinical Experience with Robot-Assisted Laparoscopic Partial Nephrectomy for Complex Renal Tumors

PURPOSE: Robot-assisted laparoscopic partial nephrectomy (RLPN) is gaining acceptance as an alternative to open partial nephrectomy and laparoscopic partial nephrectomy for small renal masses. However, it still remains a technically challenging procedure even for experienced laparoscopists. Endophytic tumors or renal hilar tumors pose an additional challenge. MATERIALS AND METHODS: We reviewed the medical records of 11 patients (mean age: 49.3 years; range: 31-67 years) who underwent RLPN for small, complex renal masses including hilar tumors and endophytic tumors. RLPN was performed with the Da Vinci(R) surgical system (Intuitive Surgical, Sunnyvale, USA) with three robot arms and intraoperative ultrasonography (Tile-pro(R) System). RESULTS: RLPN was performed successfully without complications in all cases. The mean tumor size was 3.2 cm (range, 1.1-8.0 cm). The mean operative time was 177 minutes (range, 150-260 minutes), and the mean warm ischemia time was 32 minutes (range, 25-41 minutes). The mean estimated blood loss was 177 ml (range, 50-350 ml), and the mean hospital stay was 4 days (range, 3-7 days). Pathology found four patients with clear cell type renal cell carcinoma, one with multilocular multicystic renal cell carcinoma, two with papillary type, one with chromophobe type, and three with angiomyolipoma. CONCLUSIONS: RLPN is a feasible and safe surgery for complex renal tumors. In our experiences, RLPN could be a nephron-sparing surgical option for patients with compromised renal function and it could be an alternative to open partial nephrectomy and laparoscopic partial nephrectomy for a select group of patients.

Yonsei Experience in Robotic Urologic Surgery-Application in Various Urological Procedures

PURPOSE: The da Vinci(R) robot system has been used to perform complex reconstructive procedures in a minimally invasive fashion. Robot-assisted laparoscopic radical prostatectomy has recently established as one of the standard cares. Based on experience with the robotic prostatectomy, its use is naturally expanding into other urologic surgeries. We examine our practical pattern and application of da Vinci(R) robot system in urologic field. PATIENTS AND METHODS: Robotic urologic surgery has been performed during a period from July 2005 to August 2008 in a total of 708 cases. Surgery was performed by 7 operators. In our series, radical prostatectomy was performed in 623 cases, partial nephrectomy in 43 cases, radical cystectomy in 11 cases, nephroureterectomy in 18 cases and other surgeries in 15 cases. RESULTS: In the first year, robotic urologic surgery was performed in 43 cases. However, in the second year, it was performed in 164 cases, and it was performed in 407 cases in the third year. In the first year, only prostatectomy was performed. In the second year, partial nephrectomy (2 cases), nephroureterectomy (3 cases) and cystectomy (1 case) were performed. In the third year, other urologic surgeries than prostatectomy were performed in 64 cases. The first robotic surgery was performed with long operative time. For instance, the operative time of prostatectomy, partial nephrectomy, cystectomy and nephroureterectomy was 418, 222, 340 and 320 minutes, respectively. Overall, the mean operative time of prostatectomy, partial nephrectomy, cystectomy and nephrourectectomy was 179, 173, 309, and 206 minutes, respectively. CONCLUSION: Based on our experience at a single-institution, robot system can be used both safely and efficiently in many areas of urologic surgeries including prostatectomy. Once this system is familiar to surgeons, it will be used in a wide range of urologic surgery.