Cancer-associated fibroblasts promote malignant phenotypes of prostate cancer cells via autophagy : Cancer-associated fibroblasts promote prostate cancer development.

Dysregulation of autophagy in cancer-associated fibroblasts (CAFs) has been demonstrated to play a role in malignant phenotypes of human tumors. We intended to investigate the function of CAFs autophagy in prostate cancer (PCa). Firstly, CAFs and normal fibroblasts (NFs) were isolated from cancerous and adjacent normal tissues of PCa patients, for the following experimental preparation. In comparison with NFs, CAFs expressed higher levels of the myofibroblast marker ?-smooth muscle actin (?-SMA) and the mesenchymal marker Vimentin. Besides, CAFs possessed a higher autophagic level than NFs. As for malignant phenotypes, PCa cells co-cultured with CAFs-CM showed greater proliferation, migration and invasion capabilities, while these outcomes were obviously abolished by autophagy inhibition with 3-Methyladenine (3-MA). Moreover, silencing of ATG5 in CAFs inhibited fibroblasts autophagic level and suppressed malignant phenotypes of PCa cells, while ATG5 overexpression in NFs exerted opposite effects. Depletion of ATG5 in CAFs inhibited the xenograft tumor growth and lung metastasis of PCa cells. Taken together, our data demonstrated the promotive effect of CAFs on PCa malignant phenotypes through ATG5-dependent autophagy, suggesting a novel mechanism for PCa progression.

Use of endoscopic tissue morcellator in removing retroperitoneal fat in retroperitoneoscopic radical nephrectomy.

BACKGROUND: Evaluate the safety and effectiveness of using an endoscopic tissue morcellator (ETM) to remove the retroperitoneal fat during retroperitoneoscopic radical nephrectomy (RRN). METHODS: The use of ETM in the removal of retroperitoneal fat was retrospectively analyzed in patients who underwent RRN for localized renal cancer in our hospital from January 2010 to January 2018. We accrued the appropriate patients and divided them into two groups. The first group included patients of RRN where ETM was used to remove the retroperitoneal fat, while the second group was comprised of patients of RRN where ETM was not performed, which served as the control group. Each group was further divided into two subgroups, including obese patients (BMI ≥ 28) and patients suffering from high-volume renal cancer (Stage T2a). The differences between the two groups as well as their subgroups were analyzed and statistically compared. RESULTS: All 222 nephrectomies were completed under retroperitoneoscopy, ETM was used in 105 of these 222 patients. Among them, 31 cases were of obese patients, and 26 cases were of high-volume renal cancer patients. The other 117 patients had undergone RRN without the use of ETM. Among them, 36 cases were of obese patients, and 28 cases were of high-volume renal cancer patients. The differences in age, BMI, tumor position, and tumor size between the two groups were not statistically significant, P > 0.05. Both the surgical time and the blood loss for the ETM group were significantly lower than the control group, p < 0.05. In the subgroup analysis, the obese patients and patients with high tumor volume also showed a significantly lower surgical time and less blood loss, p < 0.05. The postoperative hospitalization time, the total survival rate, and the disease-free survival rate were not statistically significant, p > 0.05. CONCLUSIONS: The use of ETM in removing the retroperitoneal fat during the RRN can potentially reduce the surgical time and lessen the blood loss. This technique is especially advantageous for obese and large-volume tumor patients.

LIMK2 acts as an oncogene in bladder cancer and its functional SNP in the microRNA-135a binding site affects bladder cancer risk.

LIM kinases modulate multiple aspects of cancer development, including cell proliferation and survival. As the mechanisms of LIMK-associated tumorigenesis are still unclear, we analyzed the tumorigenic functions of LIM kinase 2 (LIMK2) in human bladder cancer (BC) and explored whether the newly identified LIMK2 3´-UTR SNP rs2073859 (G-to-A allele) is correlated with clinical features. Expression levels of LIMK2 in 38 human BC tissues and eight cell lines were examined using quantitative real-time PCR and immunohistochemistry. LIMK2 was overexpressed in most BC tissues (27/38, 71%) and BC-derived cell lines (6/8), and was more frequently overexpessed in high-grade than low-grade BC (80% vs. 47%). The effects of LIMK2 on BC cell proliferation, survival and migration, were studied by overexpression and RNA interference approaches in vitro and in vivo. LIMK2 overexpression promoted proliferation, migration and invasion of BC cells, while LIMK2 depletion inhibited cell invasion and viability and induced growth arrest in vitro and in vivo. PCR-Restriction Fragment Length Polymorphism (RFLP) was used to genotype LIMK2 SNP rs2073859 and multivariate logistic regression applied to assess the relationship between allele frequency and clinical features in 139 BC patients. Functional analyses localized SNP rs2073859 within the microRNA-135a seed-binding region and revealed significantly lower LIMK2 G allele expression. The frequency of A genotypes (AG + AA) was higher in the BC group than normal controls and correlated with risks of high-grade and high-stage BC. In conclusion, LIMK2 may function as an oncogene in human BC, while allele-specific regulation by microRNA-135a may influence disease risk.

[Ejaculatory duct dilation combined with seminal vesicle clysis for refractory hematospermia: A report of 32 cases].

OBJECTIVE: To evaluate the effect of ejaculatory duct dilation combined with seminal vesicle clysis in the treatment of refractory hematospermia. METHODS: Using ureteroscopy, we treated 32 patients with refractory hematospermia by transurethral dilation of the ejaculatory duct combined with clysis of the seminal vesicle with diluent gentamicin. RESULTS: The operation was successfully accomplished in 31 cases, with the mean operation time of 32 (26－47) minutes. The patients were followed up for 6－39 (mean 23.6) months. No complications, such as urinary incontinence and retrograde ejaculation, were found after operation. Hematospermia completely disappeared in 27 cases, was relieved in 1, and recurred in 3 after 3 months postoperatively. Those with erectile dysfunction or mental anxiety symptoms showed significantly decreased scores of IIEF-Erectile Function (IIEF-EF) and Self-Rating Anxiety Scale (SAS). CONCLUSIONS: Ejaculatory duct dilation combined with seminal vesicle clysis under the ureteroscope, with its the advantages of high effectiveness and safety, minimal invasiveness, few complications, and easy operation, deserves general clinical application in the treatment of refractory hematospermia.

Application of Allogeneic Human Acellular Dermal Matrix Reduces the Incidence of Fistula in Hypospadias Repair.

Background: Urethrocutaneous fistula is one of the most common complications arising from hypospadias surgery. The purpose of our study was to investigate the effectiveness and safety of allogeneic human acellular dermal matrix (HADM) application as a means of preventing the occurrence of urethrocutaneous fistula following hypospadias surgery. Methods: This is a non-randomized study of 219 cases (out of 270 patients with hypospadias) which satisfied inclusion and exclusion criteria. These patients were divided into two groups: 101 HADM patients, and 118 control patients (who did not receive HADM). In the control group, 77 boys were treated by single-stage urethroplasty (TIP) and 41 underwent staged urethroplasty (Thiersch-Duplay). In the HADM group, 59 boys underwent the TIP and 42 underwent the Thiersch-Duplay. In the postoperative period, we recorded the incidence of infection, urethrocutaneous fistula, and urethral stricture complications in these two groups of patients. The effectiveness and safety of HADM in preventing urethrocutaneous fistula following hypospadias surgery were evaluated according to these indicators. Results: In the control group, following the operation there were 16 cases of infection, 38 cases of urethrocutaneous fistula after extubating, and 5 cases of urethral stricture. In the HADM group, there were 19 cases of postoperative infection, 12 cases of urethrocutaneous fistula after extubating, and 5 children with urethral stricture. In comparing the two groups, it was found that the postoperative infection rate (13.6 vs. 18.8%) and the incidence of urethral stricture (4.2 vs. 5.0%) were not statistically significant (P > 0.05), while the postoperative urethrocutaneous fistula rate (32.2 vs. 11.9%) was statistically significant (P < 0.001). Conclusion: It is found that HADM application can significantly reduce the incidence of urethrocutaneous fistula complications, without increasing the risk of infection and urethral stricture.

Prognostic Signature Development on the Basis of Macrophage Phagocytosis-Mediated Oxidative Phosphorylation in Bladder Cancer.

Background: Macrophages are correlated with the occurrence and progression of bladder cancer (BCa). However, few research has focused on the predictive relevance of macrophage phagocytosis-mediated oxidative phosphorylation (MPOP) with BCa overall survival. Herein, we aimed to propose the targeted macrophage control based on MPOP as a treatment method for BCa immunotherapy. Methods: The mRNA expression data sets and clinical data of bladder cancer originated from Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) data set. A systematic study of several GEO data sets found differentially expressed macrophage phagocytosis regulators (DE-MPR) between BCa and normal tissues. To discover overall survival-associated DE-MPR and develop prognostic gene signature with performance validated based on receiver operating curves and Kaplan-Meier curves, researchers used univariate and Lasso Cox regression analysis (ROC). External validation was done with GSE13057 and GSE69795. To clarify its molecular mechanism and immune relevance, GO/KEGG enrichment analysis and tumor immune analysis were used. To find independent bladder cancer prognostic variables, researchers employed multivariate Cox regression analysis. Finally, using TCGA data set, a predictive nomogram was built. Results: In BCa, a four-gene signature of oxidative phosphorylation composed of PTPN6, IKZF3, HDLBP, and EMC1 was found to predict overall survival. With the MPOP feature, the ROC curve showed that TCGA data set and the external validation data set performed better in predicting overall survival than the traditional AJCC stage. The four-gene signature can identify cancers from normal tissue and separate patients into the high-risk and low-risk groups with different overall survival rates. The four MPOP-gene signature was an independent predictive factor for BCa. In predicting overall survival, a nomogram integrating genetic and clinical prognostic variables outperformed AJCC staging. Multiple oncological features and invasion-associated pathways were identified in the high-risk group, which were also correlated with significantly lower levels of immune cell infiltration. Conclusion: This paper found the MPOP-feature gene and developed a predictive nomogram capable of accurately predicting bladder cancer overall survival. The above discoveries can contribute to the development of personalized treatments and medical decisions.

A Necroptosis-Related lncRNA to Develop a Signature to Predict the Outcome, Immune Landscape, and Chemotherapeutic Responses in Bladder Urothelial Carcinoma.

Objective: Many studies have drawn their attention to the immunotherapy of bladder urothelial carcinoma in terms of immunologic mechanisms of human body. These include immunogenicity of the tumor cells and involvement of long non-coding RNA (lncRNA). We constructed a necroptosis-related long noncoding RNA (nrlncRNA) risk factor model to predict BLCA outcomes and calculate correlations with chemosensitivity and immune infiltration. Methods: Transcriptomic data from BLCA specimens were accessed from The Cancer Genome Atlas, and nrlncRNAs were identified by performing co-expression analysis. Univariate analysis was performed to identify differentially expressed nrlncRNA pairs. We constructed least absolute contraction and selector operation regression models and drew receiver operating characteristic curves for 1-, 3-, and 5-year survival rates. Akaike information criterion (AIC) values for survival over 1 year were determined as cutoff values in high- and low-risk subgroups. We reassessed the differences between subgroups in terms of survival, clinicopathological characteristics, chemotherapy efficacy, tumor-infiltrating immune cells, and markers of immunosuppression. Results: We identified a total of 260 necroptosis-related lncRNA pairs, of which we incorporated 13 into the prognostic model. Areas under the curve of 1-, 3-, and 5- year survival time were 0.763, 0.836, and 0.842, respectively. We confirmed the excellent predictive performance of the risk model. Based on AIC values, we confirmed that the high-risk group was susceptible to unfavorable outcomes. The risk scores correlated with survival were age, clinical stage, grade, and tumor node metastases. The risk model was an independent predictor and demonstrated higher predictive power. The risk model can also be utilized to determine immune cell infiltration status, expression levels of immune checkpoint genes, and the sensitivity to cisplatin, doxorubicin, and methotrexate. Conclusion: We constructed a novel necroptosis-related signature that predicts BLCA outcomes and performs satisfactorily in the immune landscape and chemotherapeutic responses.

Diagnosis of male posterior urethral stricture: comparison of 64-MDCT urethrography vs. standard urethrography.

BACKGROUND: There are no reports regarding voiding/retrograde urethrography with 64-row multidetector CT (64-MDCT).To compare the clinical relevance of conventional voiding/retrograde urethrography and 64-MDCT urethrography for the evaluation of male posterior urethral stricture. METHODS: From January to October 2009, 21 men were referred to our institution for the management of posterior urethral stricture. The patients were evaluated with conventional voiding and retrograde urethrography and 64-MDCT urethrography. The patients were examined by open operative intervention which was required in all patients. The radiologic data were compared using the operative findings. RESULTS: 64 MDCT urethrography provided extra clinical data in ten patients. It was superior to conventional urethrography for judging the urethral stricture length in three patients, characterizing the site of urethra-rectal fistula in four patients, and accurately delineating the proximal urethra in six patients. CONCLUSIONS: 64-MDCT urethrography is a promising tool as an alternative to traditional radiographic methods for defining male urethral strictures. It has the advantage of examining patients only in one position, without distortion, and by generating three-dimensional images; it can accurately measure the stricture length, aid in the diagnosis of some associated pathological conditions, such as urethrorectal fistula, and does not expose the physician to radiation.

[Superiority of modified method in urine drainage for hypospadias repair: a 20 years' experience with 864 cases].

OBJECTIVE: To explore an ideal urine drainage method and new urethral secretions of hypospadias repair. METHODS: The authors retrospectively analyzed 864 cases of hypospadias undergoing hypospadias repair and different post-operative urine drainages. The patients were divided into 5 groups based on the methods of urine drainage. RESULTS: The rates of such complications as cystospasm, infection of incisional wound and urinary fistula were as follows: modified method group: 2.86%, 3.33%, 1.90%; 3-tube method group: 10.77%, 11.54%, 8.46%; He's method group: 20.89%, 15.04%, 9.75%; traditional method group: 36.25%, 41.25%, 37.50%; 1-tube method group: 56.47%, 58.82%, 48.23%. The modified method was significantly better than all the other four methods (P < 0.05). CONCLUSION: As an ideal drainage method of urine and new urethral secretions of hypospadias repair, the modified method boosts the success ratio of hypospadias repair.

New-Onset Diabetes After Renal Transplantation (NODAT): Is It a Risk Factor for Renal Cell Carcinoma or Renal Failure?

BACKGROUND Diabetes mellitus (DM) is a risk factor for renal failure and possibly for renal cell carcinoma (RCC). Post-transplantation DM occurs frequently after solid organ transplantation. We investigated whether new-onset diabetes after renal transplantation (NODAT) is a risk factor for RCC or renal failure. MATERIAL AND METHODS Data of 96,699 discharged patients with and without NODAT were extracted from the 2005-2014 Nationwide Inpatient Sample (NIS) database, after excluding patients with DM diagnosed at least 1 year prior to renal transplantation. Main outcomes were RCC diagnosis less than 1-year post-transplantation, RCC stage, and renal failure. Univariate and multivariate regression analyses were performed to identify demographic and clinical factors associated with post-transplantation RCC or renal failure. RESULTS Significant differences were found in age and race between patients with and without NODAT (both P<0.001). The renal failure rate was 0.8% (n=1) in NODAT patients and 0.3% (n=314) in those without NODAT. Older age (OR, 1.030; 95% CI: 1.023 to 1.036), male (OR, 1.872; 95% CI: 1.409 to 2.486), Black (OR, 2.199; 95% CI: 1.574 to 3.071) and hospitalization in urban teaching hospitals were associated with increased risk of RCC. CONCLUSIONS Analysis of over 90,000 NIS hospitalizations with diagnosis-coded kidney transplantation suggested that NODAT may not be an independent risk factor for RCC and renal failure.

Complications of retrograde intrarenal surgery classified by the modified Clavien grading system.

The increase in the retrograde intrarenal surgery (RIRS) has been accompanied by the increase in complications. This study identified the factors that affected the severity of the complications using the modified Clavien classification system (MCCS). Three hundred and twenty-two consecutive RIRS performed by a single surgeon were analyzed. Data collection included demographics, clinical parameters, and perioperative and postoperative complications. The rate of adverse events for each of the Clavien grades was calculated, and statistical comparisons were made. The impact of each of the factors on the severity of the complications, based on the MCCS, was investigated using the univariate and multivariate analyses. The total complication rate was 26.1% (MCCS: I = 67.7%, II = 22.7%, IIIb = 7.2%, IVb = 2.4%). On the univariate analyses, the following factors affected complication: positive preoperative urine culture, operative time, irrigation rate, and stone burden. Multivariate logistic regression analysis demonstrated that positive preoperative urine culture, irrigation rate, and operative time were the significant factors affecting the complications. Most of the RIRS complications were in the lower Clavien grades and major complications were uncommon. Positive preoperative urine culture, irrigation rate, and operative time were the factors that affected complications.

[Management of urinary obstruction following renal transplantation: report of 16 cases].

OBJECTIVE: To explore the diagnosis and treatment of urinary obstruction involving the transplanted kidney. METHODS: A retrospective analysis was performed in 16 cases of urinary obstruction involving the transplanted kidney, including 5 cases of ureteral calculi, 6 vesicoureteral anastomotic stricture, 2 pyeloureteral junction stricture after transplantation, 1 ureter necrosis due to graft rejection, and 2 infection surrounding the renal graft and ureter end necrosis. RESULTS: Only one patient had the renal graft removed due to massive hemorrhage in an open surgery for correction of urinary obstruction, and the renal function of the graft was preserved in all the other cases after endoscopic or open surgeries. In the follow-up for 0.5 to 3 years after the second surgery, serum creatinine of the patients were maintained within the range of 90-150 micromol/L, without further renal enlargement or exacerbation of renal retention shown by B-mode ultrasonography. CONCLUSION: Urinary obstruction after renal transplantation is a difficult surgical complication, which can be managed by endoscopic or open surgeries depending on the causes of the obstruction.

Interventional therapy for stenosis and aneurysm in renal graft artery: report of 9 cases.

OBJECTIVE: To study the interventional therapy for renal graft artery stenosis and aneurysm patients with renal transplantation to further improve the survival rate of the graft. METHOD: Seven patients with of renal graft artery stenosis received balloon dilatation of the stenotic artery, followed by stent implantation. For renal graft artery aneurysm in another 2 patients, thrombin infusion and stent implantation were respectively performed. RESULTS: The condition was successfully managed in 6 of the 7 patients with renal artery stenosis, whose serum Cr levels dropped to below 106 micromol/L 3 d after the operation. Thrombin infusion in one of the 2 patients with renal artery aneurysm caused thrombus in the renal graft and then aneurysm rupture, resulting in final graft loss. The other aneurysm case was successfully managed with stent implantation. CONCLUSIONS: Interventional therapy as balloon dilatation combined with stent implantation is ideal for treating renal graft artery stenosis, and stent implantation constitutes an important management for artery aneurysm in the renal graft.

[Diagnosis and treatment of adrenal medullary hyperplasia (with report of 8 cases)].

OBJECTIVE: To study the diagnosis and treatment of adrenal medullary hyperplasia (AMH). METHODS: An retrospective analysis of the clinical data of 8 patients with AMH admitted in our hospital from May 1998 to May 2002 were conducted with a review of the follow-up study. RESULTS: CT scanning of the adrenal gland showed unilateral abnormal appearance in all 8 cases. Diagnoses of AMH in 4 patients and pheochromocytoma in the other 4 patients were established before surgery. All the patients underwent unilateral adrenalectomy, among whom 7 were cured and 1 suffered recurrence 1 month after operation because of medullar hyperplasia in the contralateral adrenal gland. CONCLUSIONS: AMH should be differentiated from pheochromocytoma, especially from adrenal nodules shown by catecholamin assay. Definite diagnosis depends on pathological examination and surgical removal through abdominal approach is the best choice of treatment, in which both sides of the adrenal glands should be explored.

[Comparative anatomical study of three surgical approaches for treating complex posterior urethral stricture].

OBJECTIVE: To evaluate the advantages and disadvantages of 3 surgical approaches via superior intermedial margin of the pubis, inferior medial margin of the pubis, and the perineum, respectively, in the treatment of posterior urethral stricture. METHODS: Thirty-five adult male corpses were dissected in which the distances from the bulbo-membranous urethra conjunction (D), the apex of prostate (E), and the bladder neck (F) to the superior medial margin of the pubis (A), the inferior medial margin of the pubis (B) and the midpoint of linear distance between the two ischial tuberosities on the perineum (C) were respectively measured and compared. Another 20 adult male corpses were subjected to the 3 surgical approaches as described above and the urethra was exposed to identify the tissues and organs with possible injuries resulted from the surgery, which were evaluated by scoring. RESULTS: The distances measured were as follows: AD=6.5+/-0.5 cm, BD=2.2+/-0.5 cm, CD =3.4+/-0.6 cm, and BD0.05, t=0.13). The angles FAE (beta(1)) =(22.7+/-2.6)(degrees), FBE (beta(2))=(32.9+/-6.4)(degrees), FCE (beta(3))=(15.0+/-3.2)(degrees), and beta(2) beta(1) beta(3) (P=0.05, SNK means). The score for tissue and organ injuries for the approach of the superior medial margin of the pubis was 13, 20 for the approach of inferior medial margin of the pubis, and 15 for perineum approach. CONCLUSIONS: In terms of operative field exposure, the best operation approach is via the inferior pubis, followed by superior pubis approach and perineum approach; while in view of the injuries, superior pubis approach is better than the perineum and inferior pubis approaches. The inferior pubis approach should be the primary choice in the treatment of posterior urethral stricture.

[Misdiagnosis of corticomedullary mixed pathological changes in adrenals: report of 4 cases].

Pathological changes usually occur independently in the adrenal cortex and medulla because of their distinct embryonic origins, and changes involving both the cortex and medulla are rare. We report 4 cases of corticomedullary mixed pathological changes adrenal glands. CT scanning of the adrenal glands showed unilateral abnormalities in all the 4 cases, 3 of which were diagnosed as aldosteronism and the other pheochromocytoma before surgery. Unilateral adrenalectomy was performed in the 4 patients 3 being cured and discharged. The other 1 had recurrence 18 months postoperatively with suspected pathological changes on the other side. Subsequent pathological examination confirmed the suspicion in both the cortex and medulla of the other adrenal gland. In cases with clinical presentations as simultaneous onset of aldosteronism and catecholamine responses, pathological changes in both the cortex and medulla of the adrenal glands should be considered. Perioperative management of such cases should be the same as that in cases of catecholamine responses, and the diagnosis relies on histopathological examination.

[Application of multihole U-shaped drainage stent in complex posterior urethra surgery].

OBJECTIVE: To study a method for using a new drainage stent following complex posterior urethral operation. METHODS: Fifty-five patients,15 of whom had complex posterior urethrorectal fistula, 35 had complex posterior stricture or atresia, and 5 had bladder exstrophy, received surgical treatment, after which multihole U-shaped drainage stent was applied. RESULTS: All the patients were normal in micturition and no complications occurred during the follow-up period lasting for 1 to 10 years. CONCLUSION: Multihole U-shaped drainage stent performs the functions of both stenting and drainage, and is applicable in complex posterior urethral surgery.

[Modified Madigan prostatectomy].

OBJECTIVE: To improve Madigan prostatectomy (MPC) for a much satisfactory effect in open surgery. METHODS: A total of 52 patients with benign prostatic hyperplasia (BPH) were treated using MPC. The MPC procedure was modified by exposing anterior prostatic urethra near the bladder neck and conjunction with cystotomy. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time. RESULTS: The intact of prostatic urethra was kept completely or almost for 48 cases. The hemorrhage amount during modified procedure was a less. The mean operative time was 120 minutes. The 35 patients had been followed up for 1 - 12 months. The average Qmax was 18.9 ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 8 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC. CONCLUSIONS: The modified MPC can reduce the urethra injury and enlarge the MPC indications. The modified technique is easy to perform with little complications and much more satisfactory clinical result. The modified MPC is highly recommended.

[Surgical techniques for the ureterointestinal anastomosis in continent urinary diversion].

OBJECTIVE: To compare the complications of direct and antirefluxing techniques of ureterointestinal anastomosis in continent urinary diversion. METHODS: Sixty-three patients underwent continent urinary diversion. Twenty-four patients were treated by the direct ureteroenteric anastomosis and the others treated by the antirefluxing technique. The follow up studies included following-up the information of ureteric stricture, ureteric reflux, renal function and acute urinary infection. It was assessed for 3 months to 6 years with a mean follow up of 26 months after operation. RESULTS: Of 78 ureters reimplanted using antirefluxing technique. A total of 12 ureters had anastomotic stricture formation postoperatively. Only one of 48 ureters reimplanted using direct anastomoses had anastomotic stricture. The difference between the direct and antirefluxing technique groups was remarkable (chi2 = 4.375, P < 0.05). Furthermore, there was no significant difference between the direct and antirefluxing technique groups in regard to ureteric reflux, renal function and acute urinary infection. CONCLUSIONS: Antirefluxing anastomoses resulted in obviously higher rate of ureterointestinal anastomotic stricture in comparison with the direct anastomosis. The direct ureteroenteric anastomosis may be the suitable choice for patients undergoing continent urinary diversion.

[Outcomes of conversion to sirolimus therapy for new-onset diabetes mellitus after kidney transplantation].

OBJECTIVE: To evaluate safety and efficacy of conversion of calcineurin inhibitors (CNI) to sirolimus (SRL) therapy for treatment of new-onset diabetes after kidney transplantation (NODAT). METHODS: Of 321 kidney transplant recipients, 34 patients who developed NODAT (10.59%) were divided into 3 groups to receive continued CNI therapy at a reduced dose (group A, 14 cases), sirolimus conversion therapy (group B, 12 cases), or oral hypoglycemic drugs (group C, 12 cases). All the patients had dietary and exercise therapies, and insulin injections were given in patients with postprandial (2 h) blood glucose over 14.0 mmol/L. The patients were followed up regularly for 5 years. RESULTS: The mean blood glucose level was 13.02∓1.74 mol/L upon the diagnosis of NODAT in the 34 patients without significant differences between the 3 groups. At 6 months of therapy, fasting plasma glucose levels in the 3 groups decreased to 8.05 ∓2.45, 7.45∓2.44, and 9.30∓3.89 mmol/L, repsectively; at 12 months, blood glucose became normal in both groups A and B, but the patients in group A needed a greater daily insulin dose (P<0.05). In group B, the mean serum creatinine level was 165.1∓61.82 mmol/L at the conversion and lowered to 150∓53.05 mmol/L at 5 years (P<0.05), which were similar to those in group A at the two time points (152∓43.05 and 145.88∓53.05 mmol/L, respectively; P>0.05). In group C, creatinine level further increased after medication with oral hypoglycemic drugs. At 5 years, the patient and graft survival rates were 100% and 75% in group A, respectively, similar to those in group B (83.4% and 68%, respectively; P>0.05); group C showed lower patient and graft survival rates than groups B and C. CONCLUSION: Conversion from CNI to SLR therapy can significantly the metabolism of patients with NODAT without increasing the risk of acute graft rejection.