Summary: Deep inferior epigastric artery perforator (DIEP) flap surgery is one of the most common techniques for breast reconstruction using abdominal tissue. Although the DIEP flap reduces donor-site morbidity when compared with the conventional free transverse rectus abdominis musculocutaneous flap, violation of the anterior rectus sheath, rectus muscle, and motor nerves cannot be avoided. To further minimize tissue damage in the donor site, the use of a surgical robotic system for DIEP flap harvest with a totally extraperitoneal approach has been suggested. This totally extraperitoneal approach has a long learning curve because of the narrow preperitoneal space and the difficulty of converting a potential space to an actual space. Thus, the authors suggest a single-port robotic system optimized for narrow surgical spaces as a feasible option for DIEP flap harvest by a totally extraperitoneal approach, which has a shorter learning curve.

Krabbe disease (KD) is an autosomal recessive neurodegenerative disorder caused by defective β-galactosylceramidase (GALC), a lysosomal enzyme responsible for cleavage of several key substrates including psychosine. Accumulation of psychosine to the cytotoxic levels in KD patients is thought to cause dysfunctions in myelinating glial cells based on a comprehensive study of demyelination in KD. However, recent evidence suggests myelin-independent neuronal death in the murine model of KD, thus indicating defective GALC in neurons as an autonomous mechanism for neuronal cell death in KD. These observations prompted us to generate induced neurons (iNeurons) from two adult-onset KD patients carrying compound heterozygous mutations (p.[K563*];[L634S]) and (p.[N228_S232delinsTP];[G286D]) to determine the direct contribution of autonomous neuronal toxicity to KD. Here we report that directly converted KD iNeurons showed not only diminished GALC activity and increased psychosine levels, as expected, but also neurite fragmentation and abnormal neuritic branching. The lysosomal-associated membrane proteins 1 (LAMP1) was expressed at higher levels than controls, LAMP1-positive vesicles were significantly enlarged and fragmented, and mitochondrial morphology and its function were altered in KD iNeurons. Strikingly, we demonstrated that psychosine was sufficient to induce neurite defects, mitochondrial fragmentation, and lysosomal alterations in iNeurons derived in healthy individuals, thus establishing the causal effect of the cytotoxic GALC substrate in KD and the autonomous neuronal toxicity in KD pathology.

Globally, an increase in the transportation and expansion of the pet market is the most important cause of the invasion of non-native species. Invasion of non-native species disturbs native ecosystems and leads to socio-economic problems. The pet trade involving turtles has been globally recognized as the route through which non-native species enter ecosystems. As a result, the invasion of non-native turtles worldwide is causing problems such as competition, predation, transmission of parasites, and hybridization with native turtles. Every year, both the number of non-native turtles imported as pets in the Republic of Korea and the number of introduced species found in the wild is increasing. However, the current status of non-native turtles in the wild is not well known, posing major challenges to their management. In this study, we aimed to determine the current status of non-native turtles introduced into the wild in Korea. We analyzed the factors associated with the detection and distribution of non-native turtles. In total, 1587 of non-native turtles (three families, six genera, and 13 species including subspecies) were found in 648 sites in Korea: Chelydra serpentina, Mauremys sinensis, Chrysemys picta bellii, Graptemys ouachitensis, G. pseudogeographica pseudogeographica, G. p. kohni, Pseudemys concinna, P. nelsoni, P. peninsularis, P. rubriventris, Trachemys scripta elegans, T. s. scripta, and T. s. troostii. There was relationship between the distribution of non-native turtles and environmental factors such as precipitation and temperature. Moreover, human factors such as number of human populations and size of region were significantly related with the distribution and number of non-native turtles. In conclusion, it is likely that human factors are associated with the influx of invasive turtles to the natural habitat, while the possibility of survival and adaption for the turtles is associated mainly with environmental factors. Our result will be an essential guideline not only for understanding the current status of non-native turtles in Korea, but also for establishing strategies for management and control.

PurposeTo investigate and distinguish the computed tomography (CT) characteristics of chromophobe renal cell carcinoma (chRCC) and renal oncocytoma.Materials and MethodsFifty-one patients with renal oncocytoma and 120 patients with chRCC, diagnosed by surgery between November 2005 and June 2015, were studied retrospectively. Two observers, who were urologists and unaware of the pathological results, reviewed the preoperative CT images. The tumors were evaluated for size, laterality, tumor type (ball or bean pattern), central stellate scar, segmental enhancement inversion, and angular interface pattern and tumor complexity. To accurately analyze the mass-enhancing pattern of renal mass, we measured Hounsfield units (HUs) in each phase and analyzed the mean, maximum, and minimum HU values and standard deviations.ResultsThere were 51 renal oncocytomas and 120 chRCCs in the study cohort. No differences in clinical and demographic characteristics were observed between the two groups. A central stellate scar and segmental enhancement inversion were more likely in oncocytomas. However, there were no differences in ball-/bean-type categorization, enhancement pattern, and the shape of the interface between the groups. Higher HU values tended to be present in the corticomedullary and nephrogenic phases in oncocytomas than in chRCC. Receiver-operating characteristic curve analysis showed that the presence of a central stellate scar and higher mean HU values in the nephrogenic phase were highly predictive of renal oncocytoma (area under the curve=0.817, p<0.001).ConclusionsThe appearance of a central stellate scar and higher mean HU values in the nephrogenic phase could be useful to distinguish renal oncocytomas from chRCCs.