Improved closure techniques for laparoscopic partial nephrectomy in moderately complex renal cell carcinoma

Laparoscopic partial nephrectomy(LPN)as a minimally invasive nephron-sparing surgery is gradually becoming the preferred surgical treatment for T1a renal carcinoma since it yields faster post-operative recovery and equivalent oncological outcomes to radical nephrectomy.[1]However,it is difficult to perform LPN for complex renal tumors,resulting in a longer warm ischemic time(WIT),which consequently affects the recovery of post-operative renal function.[2]With the development of laparoscopic instruments and techniques and the accumulating experience of surgeons,the WIT during LPN may be shortened using anatomy-based early unclamping(EUC)[1]after the placement of one or two running sutures on the tumor bed.In this study,we improved the closure techniques for LPN using EUC in patients with complex renal tumors and assessed their effectiveness.

Conditional Knockout of Src Homology 2 Domain-containing Protein Tyrosine Phosphatase-2 in Myeloid Cells Attenuates Renal Fibrosis after Unilateral Ureter Obstruction

Background：Src homology 2 domain-containing protein tyrosine phosphatase-2 （SHP-2） is a kind of intracellular protein tyrosine phosphatase.Studies have revealed its roles in various disease,however,whether SHP-2 involves in renal fibrosis remains unclear.The aim of this study was to explore the roles of myeloid cells SHP-2 in renal interstitial fibrosis.Methods：Myeloid cells SHP-2 gene was conditionally knocked-out （CKO） in mice using loxP-Cre system,and renal interstitial fibrosis was induced by unilateral ureter obstruction （UUO）.The total collagen deposition in the renal interstitium was assessed using picrosirius red stain.F4/80 immunostaing was used to evaluate macrophage infiltration in renal tubular interstitium.Quantitative real-time polymerase chain reaction and enzyme linked immunosorbent assay were used to analyze the production of cytokines in the kidney.Transferase-mediated dUTP nick-end labeling stain was used to assess the apoptotic renal tubular epithelial cells.Results：Src homology 2 domain-containing protein tyrosine phosphatase-2 gene CKO in myeloid cells significantly reduced collagen deposition in the renal interstitium after UUO.Macrophage infiltration was evidently decreased in renal tubular interstitium of SHP-2 CKO mice.Meanwhile,the production of pro-inflammatory cytokines was significantly suppressed in SHP-2 CKO mice.However,no significant difference was observed in the number of apoptotic renal tubular epithelial cells between wild-type and SHP-2 CKO mice.Conclusions：Our observations suggested that SHP-2 in myeloid cells plays a pivotal role in the pathogenesis of renal fibrosis,and that silencing of SHP-2 gene in myeloid cells may protect renal from inflammatory damage and prevent renal fibrosis after renal injury.