Cytogenetic analysis of 2959 couples with spontaneous abortion and detailed analysis of rare karyotypes.

Chromosome abnormality is one of the important causes of spontaneous abortion. However, due to regional and ethnic differences, the reported rates of chromosomal abnormalities in patients with spontaneous abortion vary greatly. At present, there is no large sample statistics of chromosome abnormality in patients with spontaneous abortion in Yantai, Shandong province, China and hence 2959 couples (5918 individuals) with spontaneous abortion were recruited for this study. G banding was used to examine the karyotype of patients. The results showed that chromosomal abnormalities were present in 173 of 2959 couples with the rate of 5.85%. Female carriers were significantly higher than male. Chromosomal abnormality rate was positively correlated with the number of spontaneous abortions. Structural aberrations were significantly greater than numerical aberrations, with a prevalence of 92.49% and 7.51%, respectively. Balanced translocation, Robertson translocation and inversion were the most common types of chromosomal structural abnormalities. Among them, the proportion of balanced translocation was the highest (63.13%, 101/160). In addition, three cases of rare complex abnormal karyotype were detected. In summary, chromosome abnormality could be one of the important causes of spontaneous abortion in Yantai, Shandong province, China. The sex of patients with chromosomal abnormalities and the number of spontaneous abortions should be considered in genetic counselling. When one of the partners have chromosome abnormality, preimplantation genetic diagnosis and prenatal diagnosis could play a great significance for preventing the birth of children with chromosomal diseases and reducing birth defects.

A novel nomogram provides improved accuracy for predicting biochemical recurrence after radical prostatectomy.

BACKGROUND: Various prediction tools have been developed to predict biochemical recurrence (BCR) after radical prostatectomy (RP); however, few of the previous prediction tools used serum prostate-specific antigen (PSA) nadir after RP and maximum tumor diameter (MTD) at the same time. In this study, a nomogram incorporating MTD and PSA nadir was developed to predict BCR-free survival (BCRFS). METHODS: A total of 337 patients who underwent RP between January 2010 and March 2017 were retrospectively enrolled in this study. The maximum diameter of the index lesion was measured on magnetic resonance imaging (MRI). Cox regression analysis was performed to evaluate independent predictors of BCR. A nomogram was subsequently developed for the prediction of BCRFS at 3 and 5 years after RP. Time-dependent receiver operating characteristic (ROC) curve and decision curve analyses were performed to identify the advantage of the new nomogram in comparison with the cancer of the prostate risk assessment post-surgical (CAPRA-S) score. RESULTS: A novel nomogram was developed to predict BCR by including PSA nadir, MTD, Gleason score, surgical margin (SM), and seminal vesicle invasion (SVI), considering these variables were significantly associated with BCR in both univariate and multivariate analyses (P < 0.05). In addition, a basic model including Gleason score, SM, and SVI was developed and used as a control to assess the incremental predictive power of the new model. The concordance index of our model was slightly higher than CAPRA-S model (0.76 vs. 0.70, P = 0.02) and it was significantly higher than that of the basic model (0.76 vs. 0.66, P = 0.001). Time-dependent ROC curve and decision curve analyses also demonstrated the advantages of the new nomogram. CONCLUSIONS: PSA nadir after RP and MTD based on MRI before surgery are independent predictors of BCR. By incorporating PSA nadir and MTD into the conventional predictive model, our newly developed nomogram significantly improved the accuracy in predicting BCRFS after RP.

Molecular cytogenetic characterization of mosaicism for a small supernumerary marker chromosome derived from chromosome 8 associated with congenital hypoplasia of the tongue and review of the literature.

OBJECTIVE: To present molecular cytogenetic characterization of mosaic supernumerary ring chromosome 8 which has trisomy of a region of chromosome 8p12-q21.13 associated with congenital hypoplasia of the tongue and review of the literature. CASE REPORT: A 27 year-old woman presented with congenital hypoplasia of the tongue. The chromosome karyotype of peripheral blood lymphocytes was detected by conventional cytogenetic analysis. The genome copy number variations were detected by SNP array. Conventional cytogenetic analysis of the peripheral blood revealed a karyotype of 47,XX,+mar[60]/46,XX[40]. SNP array revealed that there was a duplication of 45.2 Mb at arr[hg19] 8p12q21.13(36,013,636-81,263,140) × 2-3. CONCLUSION: With this study a patient involving mosaic trisomy 8p12-q21.13 along with clinical properties, is described and compared to previously reported cases involving a small supernumerary marker chromosome (sSMC) derived from chromosome 8.

[The origin, development and mechanisms of special acupuncture needle tools for cutaneous region].

In this paper, we expound the origin and development of special acupuncture needle tools for cutaneous region, and discuss its mechanisms from modern medical theory. By consulting related acupuncture books and literature and in combination with needles used in clinical practice, we conclude that acupuncture needle tools can be divided into skin massage needle (digital pressing, spoon needle, etc.), cutaneous pricking blood needle (shear needle, three-edged needle, plum blossom needle, etc.), subcutaneous shallow puncture needle (intradermal needle, superficial needle, subcutaneous in-dwelling needle), etc. The skin-brain axis is the core of skin stimulation therapy. Mechanical pressure exerted on the skin surface induced by acupuncture stimulation or pressing, microcirculation changes and drug superposition are probably the underlying mechanisms of special skin acupuncture needle tools for treatment of various clinical disorders.

[Summary and core technique on the origin and evolution of reinforcing-reducing manipulation achieved by lifting and thrusting the needle].

By analyzing the evolution of reinforcing-reducing manipulation achieved by lifting and thrusting the needle recorded in ancient literature of traditional Chinese medicine, it is found that the main contents of reinforcing-reducing manipulation by lifting and thrusting the needle include manipulating speed change, manual amplitude, insertion layer, gender, the direction to the acupuncture receiver, forenoon and afternoon and relevant quantity. Among them, gender, the direction to the acupuncture receiver, forenoon and afternoon and relevant quantity are the unnecessary parameters, while the manipulating speed change, manual amplitude and insertion layer are the indispensable parameters. The manipulating speed change is the core of the necessary parameters for the reinforcing-reducing manipulation achieved by lifting and thrusting the needle. Combined with the manual amplitude, the manipulating speed of needle determines the volume of needling stimulation. The insertion layer is decided on the base of the clinical demand. In the core technique of reinforcing-reducing manipulation by lifting and thrusting the needle, the reinforcing is achieved by thrusting the needle forcefully and quickly and then lifting the needle body slowly and evenly back to the original layer. The reducing is achieved by lifting the needle forcefully and quickly and then thrusting the needle body slowly and evenly back to the original layer. The manipulating speed and manual amplitude of needling are the parameters to quantize acupuncture manipulation. In association with the acupuncture effects in human body, these parameters contribute to the interpretation of the dose-effect relationship of acupuncture and the improvement of clinical effects.

[Efficacy and outcome of palliative TURP in patients with bladder outlet obstruction induced by advanced prostate cancer].

OBJECTIVE: To evaluate the efficacy and outcome of palliative transurethral resection of the prostate (pTURP) in patients with server bladder outlet obstruction (BOO) due to prostatic obstruction induced by advanced prostate cancer. METHODS: All the 16 patients who had a pTURP between November 2007 and January 2015 due to BOO (high residual urine volume combined with hydronephrosis or urinary retention refractory to medical treatment) at our institution were retrospectively assessed. All the patients were diagnosed with advanced prostate cancer (III stage or IV stage). The clinical data, functional and oncological follow-up results were evaluated. The cancer specific survivals were estimated by Kaplan-Meier analysis. RESULTS: The mean age of the patients was 73.8 years (63-81 years). Five cases were graded in stage III of prostate cancer and 11 in stage IV. The indications for pTURP were refractory urinary retention in 12 cases, and high residual urine volume with hydronephrosis in 4 cases. The mean prostate volume at pTURP was 43.2 mL (28-78 mL) and the mean PSA (prostate specific antigen) level before pTURP was 48.2 µg/L (2-107 µg/L). The patients had mean residual urine volume 166.4 mL (50-450 mL) and mean urinary flow rate 3.6 mL/s (0-6 mL/s, n=7) before pTURP. It took mean 62.9 min (35-94 min) in pTURP with mean estimated blood loss 126.9 mL (30-263 mL) and mean resected tissue 14.1 g (10-22 g). There were no transfusion cases. Postoperative mean serum PSA 20.5 µg/L (1-41 µg/L), residual urine volume 43.4 mL (0-400 mL) and urinary flow rate 10.1 mL/s (7-16 mL/s, n=7) were shown in these cases. A patient encountered persistent hematuria needing irrigation. Compared with preoperation, the patients had significantly lower serum PSA level (P<0.001), less residual urine volume (P<0.001) and more urinary flow rate (P=0.001) after pTURP. The mean follow-up after pTURP was 36 months (1-86 months). In addition, 2 patients received repeated pTURP. At the time of the latest analysis, 3 patients died from prostate cancer progression. As estimated by Kaplan-Meier analysis, the 2-, 3- and 5-year cancer specific survival rates after pTURP were 91%, 78% and 58%, respectively. CONCLUSION: Despite less resected tissue, greater delay in urination and reoperation rates, pTURP is a fairly effective procedure in patients with server BOO. Although a potential negative impact of pTURP on survival cannot be excluded, the estimated 3- and 5-year cancer specific survival rates in this series seem to justify this intervention.

[Prognostic factors for intravesical recurrence after surgery for upper tract urothelial carcinoma in renal transplant recipients].

OBJECTIVE: To elucidate clinicopathological independent prognostic factors for intravesical recurrence after nephroureterectomy for native upper tract urothelial carcinoma (UTUC) in renal transplant recipients. METHODS: In this study, 38 patients clinically diagnosed as localized UTUC after renal transplantation were included, and treated by retroperitoneal laparoscopic nephroureterectomy between April 2006 and March 2013, after exclusion of those with a previous and/or concurrent history of bladder cancer. The clinicopathologic features, risk factors, and intravesical recurrence free survival were analyzed using the Kaplan-Meier method. Univariate and multivariate analyses by Cox's proportional hazards regression model were used to identify independent risk factors for intravesical tumor recurrence. RESULTS: Of all the patients, 16/38 (42.1%) developed subsequent intravesical recurrence during a median follow-up period of 38 months (range 12 to 104 months), of whom, 12/16 (75.0%) developed recurrent bladder cancer within 2 years after nephroureterectomy, and the median interval between surgery and intravesical recurrence was 15.5 months (range 6 to 48 months). Multifocal tumors, native aristolochic acid nephropathy (AAN) and distal ureter involvement were determined as risk factors for intravesical recurrence by univariate analysis. The intravesical recurrence rate was 62.5% (5/8) in the group of native AAN, and 46.2% (12/26) in the group of multifocality. By multivariate analyses, multifocality (HR=2.603, 95% CI=1.529-8.906, P=0.019) and native AAN (HR=2.179, 95% CI=1.085-8.093, P=0.038) were identified as independent predictors for the development of recurrent bladder cancer after surgery for UTUC in renal transplant recipients. CONCLUSION: The incidence of intravesical recurrence after laparoscopic nephroureterectomy for UTUC in renal transplant recipients is high, and most subsequent bladder cancers recur within 2 years after surgery. Tumor multifocality and native AAN are significant independent risk factors in developing initial intravesical recurrence after laparoscopic surgery for primary UTUC after renal transplantation.

[Ureteral stricture following renal transplantation: risk factors and surgical management].

OBJECTIVE: To evaluate the prevalence and the risk factors of the ureteral stricture following renal transplantation and outcomes of surgical managements. METHODS: By a retrospective analysis, we assessed 1 293 patients who underwent renal transplantation between January 2001 and December 2013 at our center. The patients with ureteral stricture had undergone surgical management which included neoureterocystostomy, ureteral anastomosis with the native ureter and endoscopic therapy. RESULTS: Ureteral stricture following renal transplantation was diagnosed in 17 cases (1.3%) including 6 males and 11 females. The mean age of the patients at the time of surgery was 44 (29 to 64) years. The median interval between ureteral stricture obstruction and kidney transplantation was 4 (1 to 120) months. The ureteral stricture was significantly correlated with multiple renal arteries, donor age and delayed graft function. The effective rate of surgical management was 65.75%. CONCLUSION: The incidence of ureteral stricture as a urologic complication after renal transplantation is low. The advanced techniques that preserve the ureteric blood supply should be applied. The surgical managements have respective advantages and disadvantages. The neoureterocystostomy shows best outcome, while ureteral anastomosis with the native ureter has poor outcome.

Recombinant human bone morphogenetic protein-2-induced ossification of the ligamentum flavum in rats and the associated global modification of histone H3.

OBJECT: The primary object of this investigation was to study recombinant human bone morphogenetic protein-2 (rhBMP-2)-induced ossification of the ligamentum flavum and associated histone H3 modification in a rat model. In an additional set of studies the authors investigated spinal cord and behavioral changes in the same model. METHODS: The authors report on 2 separate sets of studies. A total of 90 rats were used for the 2 sets of studies (45 each); in each study, a lyophilized rhBMP-2 and collagen mixture (20 µg rhBMP-2 and 200 µl collagen) was implanted in the lumbar extradural space in 18 rats; another 18 animals were used for a sham-operation control group and underwent implantation of lyophilized collagen without rhBMP-2 at the same level; an additional 9 animals were used as untreated controls. Lumbar spinal samples were harvested from the rhBMP-2 groups and the shamoperation control groups at 1 week, 3 weeks, and 9 weeks after the operation. Samples were also obtained from untreated controls at the same time points. All samples were scanned using micro-CT and then made into paraffinembedded sections. The sections from the first set of 45 rats were stained using elastica van Gieson and toluidine blue, and the expression of histone modifications (H3K9ac, H3K18ac, H3K4me3, and H3K36me3) and osteogenic transcription factors (osterix, Runx2) was detected by immunohistochemistry. In the second set of studies, hindlimb motor function was assessed at 1 week, 3 weeks, and 9 weeks after surgery. After behavioral evaluation, samples were harvested, scanned using micro-CT, and then made into paraffin-embedded sections. The sections were stained using Luxol fast blue. The expression of NeuN was also detected using immunohistochemistry. RESULTS: Ossification was seen in the rhBMP-2 group from 1 week after insertion, and the volume of ossified mass increased at 3 and 9 weeks. There was no ossification seen in the sham-surgery and normal controls. The pathological changes of ossification involved ligament degeneration, cartilage formation, and, finally, bone replacement. Spinal cord evaluation showed a significant decrease in white matter content and number of neurons at 9 weeks after operation in the rhBMP-2-treated group (compared with findings in the sham-surgery and control groups as well as findings at the earlier time points in the rhBMP-2 group). Using immunohistochemical staining, histone modifications (H3K9ac, H3K18ac, H3K4me3, and H3K36me3) and osteogenic transcription factors (osterix, Runx2) all were found to be expressed in the fibrocartilage area of the rat ossified ligamentum flavum samples (rhBMP2 group). CONCLUSIONS: This rhBMP-2-induced OLF is a typical endochondral ossification, which is similar to clinical OLF. The compressed spinal cord around the ossification site showed signs of a chronic degenerative process. Histone H3 modifications (H3K9ac, H3K18ac, H3K4me3, and H3K36me3) may play an important role in OLF.

Marginal living donor in kidney transplantation: experience in a Chinese single center.

BACKGROUND: Living donor kidney transplantation is becoming popular in China, whereas, in clinical situations, some kidney donors may be sub-optimal, namely marginal living donor. The present study aimed to evaluate the safety and efficacy of marginal living donor kidney transplantation in a Chinese single center. METHODS: Between January 2001 and December 2009, 888 kidney transplantations were performed in our center; 149 were living donor kidney transplantations. The living donors and recipients were followed up regularly after the operation. Of the living donors, 30 donors were marginal, who were older than 60 years or suffered from kidney anomaly or some benign diseases. Among the non-marginal living kidney transplantations, 58 donors and recipients had complete perioperative and follow-up data. We compared the marginal and non-marginal living donor kidney transplantations with regard to donor age, follow-up period, donor's serum creatinine at the last follow-up, recipient's serum creatinine at the last follow-up, and graft survival at the last follow-up. RESULTS: The mean age of donors in the marginal and non-marginal living donors were (55 ± 9) (37-66) and (43 ± 12) (30-59) years. The mean follow-up times of the marginal and non-marginal groups were (26.4 ± 13.4) months and (28.8 ± 14.8) months. The donor and recipient serum creatinine levels at the last follow-up were (1.16 ± 0.20) mg/dl and (1.30 ± 0.24) mg/dl in the marginal group, and (1.12 ± 0.32) mg/dl and (1.34 ± 0.32) mg/dl in the non-marginal group. Three recipients in the marginal group and five recipients in the non-marginal group had acute rejection episodes during the first year. Actuarial 3-year graft survival was 96.7% in the marginal group and 100% in the non-marginal group. No significant differences were detected between the two groups with regard to these data. CONCLUSION: Utilization of highly selective marginal living donors can be a safe, feasible, and effective way for the treatment of patients with end stage renal disease.

[Endoscopic therapy combined antegrade percutaneous approach and retrograde transurethral approach for ureteral obstruction after kidney transplantation].

OBJECTIVE: To evaluate the method and efficacy of endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach for ureteral obstruction after kidney transplantation. METHODS: Eight cases were analyzed retrospectively who received endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach when they had been diagnosed with ureteral obstruction in the transplant kidney from February 2007 to March 2013 in Department of Urology, Peking University Third Hospital. The cases included three males and five females, with the average age being 44 years (30-64 years). The interval between ureteral obstruction and kidney transplantation ranged from one month to 12 months. Four cases presented with increased serum creatine, two with anuria and two with urinary leakage. The stricture site was located in ureter terminal part in seven cases, and middle part in 1 case. In three cases, percutaneous nephrostomy were carried out immediately while endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach were carried out later. The remaining five cases were treated simultaneously. RESULTS: The average serum creatine decreased from (237±43) µmol/L to (121±29) µmol/L (P<0.05) after the therapy. No perioperative complications occurred. Two urinary fistula healed. Six cases were treated successfully with two cases that failed followed by percutaneous nephrostomy. The ureteral obstruction recurred in one case after six months with recurrence rate of 17% (1/6). CONCLUSION: Endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach is an effective therapeutic approach to treat ureteral obstruction in transplant kidney which shows good clinical results.

Total endoscopic nephroureterectomy for native kidney ipsilateral to transplanted kidney.

BACKGROUND: From limited exposure with management of the native distal ureter ipsilateral to the transplanted kidney, we usually choose open nephroureterectomy (NU) or laparoscopic NU combined with an open approach in renal transplant (RTx) recipients. We herein describe our preliminary experience with total endoscopic NU with bladder cuff (BC) excision and evaluate its feasibility for RTx recipients. METHODS: From August 2008 to June 2011, eight RTx recipients underwent total endoscopic NU with BC excision for clinically presumed native upper urinary tract urothelial carcinoma (UUT-UC) ipsilateral to the transplanted kidney. Cystoscopic circumferential excision of the ipsilateral ureteral orifice with BC was followed by retroperitoneal laparoscopic NU using early ureteral ligation without primary BC closure. The intact specimen was removed through a 3-cm flank incision (an enlarged trocar site). Perioperative and pathological data and oncological outcomes were collected and analyzed. RESULTS: All endoscopic procedures were completed successfully without major complications and with open conversion. The mean estimated blood loss was 100 ml with no blood transfusion. The mean operating room time was 234.8 minutes, mean time to ambulation was 2.6 days, and mean hospital stay was 9.0 days. Pathological findings confirmed UUT-UC in seven recipients, two with bladder UC. During the mean 25.2-month follow-up, none of the recipients developed recurrence, while two developed contralateral UUT-UC after the first NU. CONCLUSION: Total endoscopic NU with BC excision is technically feasible and safe for RTx recipients.

[Expression of kidney injury molecule-1 in renal ischemic postconditioning and its protective effect against renal ischemia-reperfusion injury in rats].

OBJECTIVE: To investigate whether the protective mechanism of ischemic postconditioning (IPO) against renal ischemia reperfusion injury (IRI) is related to the expression of kidney injury molecule-1 (Kim-1), and whether Kim-1 can reflect the protective effect of ischemic postconditioning as a sensitive biomarker in rats so as to find early and effective indicators to use IPO in clinical research of urology in future. METHODS: Eighty-five male SD rats (240-300 g) were randomly divided into three groups (IRI: n=30; IPO: n=30; sham operation group: n=25). After the right nephrectomy through median abdominal incision to make the solitary kidney model, the left renal artery was separated from the renal pedicle. In IRI group, the left renal artery was blocked for 45 min before reperfusion. In IPO group, six cycles of 10 s reperfusion-10 s reocclusion of the left kidney were performed after 45 min ischemia. The blood samples and the kidney cortex tissues were taken at the time points of 6 h, 12 h, 24 h, 48 h and 72 h after reperfusion, with 5 rats for each time point. The plasma samples were obtained for urea and creatinine detection. A modified quantitative RT-PCR was used to quantitate the Kim-1 mRNA expression of renal tissue. Five rats were chosen from groups IRI and IPO respectively to obtain the urine samples of each rat, 0 h, 6 h, 12 h, 24 h, 48 h, and 72 h after reperfusion. The Kim-1 levels of urine were detected by ELISA. Pathological examinations were performed to check the differences between the three groups. RESULTS: Urine tests and RT-PCR showed that, in IRI and IPO groups, Kim-1 and its mRNA levels began to rise after 6 h of reperfusion and reached the peak at 24 h synchronously. Urine Kim-1 levels in IRI group were significantly higher than those of the IPO group at 6 h, 12 h, 24 h, 72 h (P<0.05). The Kim-1 mRNAs in IPO group were lower than those in IRI group at the time points of 6 h, 12 h, 24 h, and 48 h (P<0.05), and the levels decreased more rapidly after 24 h. BUN and Cr significantly increased at 12 h, which were later than the Kim-1 and Kim-1 mRNA. The BUN and Cr levels in IRI group were higher than those in IPO group after 24 h (P<0.05). The pathological examination showed that there was less epithelial injury in IPO group. CONCLUSION: Ischemic postconditioning can attenuate the renal ischemia reperfusion injury and downregulate the expression of Kim-1 and Kim-1 mRNA. Kim-1, as a biomarker and protective factor of acute kidney injury (AKI), can sensitively reflect the renal protective effect by ischemic postconditioning.

[Postoperative urinary continence and learning curve after laparoscopic radical prostatectomy].

OBJECTIVE: To evaluate urinary continence outcomes after laparoscopic radical prostatectomy (LRP), and explore the learning curve for continence. METHODS: Between May 2006 and May 2011, 200 consecutive patients with clinically localized prostate cancer underwent LRP in Peking University Third Hospital, of whom 160 were performed by a single surgeon and followed up successfully. The average age was (71.9±5.5) years (their age range: 56 to 85 years). All the patients were continent before operation. Of these patients, 11 had undergone previous transurethral resection of the prostate (TURP) and the other 149 were diagnosed by transrectal prostate biopsy. No metastasis was found before surgery. The data about the patients and the operations were recorded. The time from operation till urinary continence was obtained and accessed by interviews. Continence was defined as the use of no pad and no urinary leakage or loss of a few drops occasionally. The patients were divided into 4 equal groups in the 40 consecutive series to determine whether continence was statistically different in group A (1-40) as compared with the other groups. RESULTS: All the operations were performed laparoscopically without any conversion to open surgery. The mean operative duration was (230±57) min (ranging from 110 to 493 min), the median estimated blood loss was 200 mL (ranging from 30 to 1 200 mL), 12 patients (7.5%) received blood transfusions intraoperatively, and the average hospital stay after surgery was (11.8±7.9) d (ranging from 5 to 60 days). The distribution of pathologic stages was as follows: T2a 20%, T2b 16.9%, T2c 40%, T3a 15%, T3b 5.6% and T4 2.5%. The overall positive surgical margin (PSM) rate was 32.5%. The overall continence rates (no pad) were 14.4% after 1 month, 48.8% after 3 months, 77.5% after 6 months and 86.3% after 12 months. At the end of the follow-up, 21 patients (13.1%) were still incontinent . There was a significant difference in continence between the early (Group A) and later groups (P<0.05). CONCLUSION: Continence results after LRP were encouraging, which were comparable to the results in previously published open series. Continence could be improved with increasing surgical experience, and it takes 40-50 cases to reach a plateau for surgeons who have some experiences of laparoscopic operations.

[Retrospective study of dysfunction transplant nephrectomy from a single-center within 10 years].

OBJECTIVE: To find the reasons for dysfunction in renal graft. METHODS: A total of 27 patients with failed allografted kidneys underwent transplant nephrectomy from 2001 to 2010. The patients' data were collected separately. The pathologic diagnosis was made according to the Banff 2009 standard. RESULTS: All the operations were successful. The pathologic reports showed that 15 cases were acute rejection complicated with other factors (1 case was infected by Bacillus tuberculosis, 2 by mold, and 1 with IgA, 6 were found thrombus in operation), 6 cases were chronic rejection complicated with other factors [2 cases were acute rejection, and 2 cases were posttransplantation lymphoproliferative disorders (PTLD)], 4 cases were end-stage renal graft, and 2 PTLD alone. A total of 13 cases were human leukocyte antigen (HLA) mismatch, of which, 11 were confirmed as rejection. CONCLUSION: Rejection complicated with other factors is the most important reason for dysfunction in renal graft, such as thrombus and infection. HLA mismatch may cause the rejection. End-stage renal graft or PTLD also has an important position in the reason for nephrograft dysfunction.

[Joint therapy of native upper tract transitional cell carcinoma ipsilateral to a transplanted kidney by retroperitoneoscopic nephroureterectomy combined with a midline lower abdominal transperitoneal excision].

OBJECTIVE: To present the preliminary experience of the operative procedure and clinical outcomes of retroperitoneal laparoscopic nephroureterectomy (RPLNU) with a midline lower abdominal transperitoneal incision for native upper urinary tract transitional cell carcinoma (UUT-TCC) ipsilateral to a transplanted kidney. METHODS: In the study, 15 renal recipients with native UUT-TCC ipsilateral to a transplanted kidney were operated on with RPLNU via a midline lower abdominal transperitoneal incision between November 2005 and January 2009. Retroperitoneal laparoscopic nephrectomy was performed first and followed by cystoscopic excision of ipsilateral ureteral orifice with bladder cuff. A 6-8 cm midline lower abdominal incision was made. The distal ureter was dissected transperitoneally into the intramural segment and extracted completely. The intact specimen was removed manually via the same incision. The cystostomy was generally sutured. RESULTS: The mean operation time was 253 minutes. The mean estimated blood loss was 245 mL. Three patients needed blood transfusion. No open conversion was required during the retroperitoneoscopic nephrectomy. Two of the patients suffered from minor complications. The pathological findings confirmed UUT-TCC in all the patients with 9 of the pelvises and 9 of the ureters. Five of the patients were involved with bladder TCC. With the mean follow-up of 35 months, none of them had retroperitoneal recurrence or distant metastasis, 2 of the 5 patients with bladder TCC had recurrence in bladder and 4 had contralateral native UUT-TCC after the first unilateral nephroureterectomy. CONCLUSION: RPLNU with a midline lower abdominal transperitoneal incision may be a safe and feasible alternative for native UUT-TCC ipsilateral to a transplanted kidney with satisfactory oncologic outcomes.

Laparoendoscopic single-site radical cystectomy and urinary diversion: initial experience in China using a homemade single-port device.

PURPOSE: We report our initial experience with the first series of laparoendoscopic single-site (LESS) radical cystectomy and urinary diversion performed by a single surgeon using a homemade single-port device at a single institution in China. PATIENTS AND METHODS: Between December 2010 and February 2011, we performed five LESS radical cystectomis using a homemade single-port device composed of an inverted cone device of polycarbonate and a powder-free surgical glove. The port was placed into a 5-cm periumbilical incision. The conventional laparoscope and laparoscopic instruments were inserted through the single-port. No additional ports were needed for radical cystoprostatectomy and bilateral standard pelvic lymphadenectomy. Cutaneous ureterostomy and ileal conduit urinary diversion were used for our patients, respectively. Perioperatively, oncologic data and complications were collected and analyzed. RESULTS: All the procedures were completed successfully. The mean extirpative operative time was 208.2 (168-280) minutes, estimated blood loss was 270 (100-500) mL, bowel recovering time was 9.75 (6-12) days, and postoperative hospital stay was 19.5 (14-28) days. One patient needed a transfusion of 400 mL of red blood cells. The pathologic evaluation revealed negative margins and negative lymph node involvement. After the operations, one patient had a bowel obstruction, while another patient died from cardiac disease. Mean follow-up time was 143 (110-173) days. CONCLUSIONS: In our experience, LESS radical cystectomy is clinically feasible and safe for selected patients, but requires a learning curve. Our homemade single-port device is a cost-effective and convenient device. Although the initial outcomes have been promising, the long-term oncologic evaluation of these patients awaits.

[Protective effect of heat shock protein 70 and magnesium sulfate supplementation on renal ischemia reperfusion injury].

OBJECTIVE: To investigate whether there is a protective mechanism in exogenous magnesium ions supplement in renal ischemia reperfusion injury(IRI ), and to study the expression of heat shock protein 70 (HSP70) and HSP70-mRNA in the reperfusion injury. METHODS: A total of 90 male Japanese white rabbits (1.8-2.0 kg) were divided into three groups: ischemia reperfusion group (I-R), MgSO4 pretreatment group and sham operation group. The right kidney was cut through median abdominal incision to make solitary kidney model. The left renal artery was blocked for 1 h in I-R group and MgSO4 group. 2.5% MgSO4 1 mL/(kg×h) was given through ear vein before the artery was blocked and during the blockeage in the MgSO4 group. the kidney cortex tissue was taken 1, 2, 4, 24, 48 and 72 h after reperfusion. Immunohistochemical examination was used to determine the HSP70 expression. A modified quantitative Real time-PCR was used to quantitate HSP70-mRNA in the three groups. Pathological examination was also used to confirm the results. RESULTS: Real time-PCR showed that HSP70-mRNA began to increase at the end of 1 h, and reached the peak at the end of 2 h in both I-R and MgSO4 groups, but expression in I-R group which was remarkably higher than that in the MgSO4 group at the end of 2 h and 4 h ( P<0.05). HSP70-mRNA levels decreased rapidly at the end of 24 h. In I-R group, moderate HSP70 expression could be seen in the proximal tubules during immunohistochemical examination after reperfusion for 24 h and 48 h. By contrast, there was weak HSP70 expression in the MgSO4 group 24 h and negative 48 h after reperfusion. Epithelial shedding, border brush, inflammatory cell infiltration and protein casts were serious after 24 to 48 h reperfusion, while only slight tubular cell shedding and necrosis could be found in the MgSO4 group at the matched time. CONCLUSION: Magnesium supplement can significantly relieve the renal ischemia reperfusion injury. It can inhibit the upregulated expression of HSP70 and HSP70-mRNA in vivo, which demonstrates that the expression of HSP70 is not necessary in the protective mechanism.

[Analysis of perioperative complications of laparoscopic radical cystectomy for bladder cancer].

OBJECTIVE: To evaluate operation process and perioperative complications of patients who underwent laparoscopic radical cystectomy (LRC). METHODS: The clinical data of 49 cases of LRC from October 2004 to June 2010 were reviewed retrospectively. Perioperative complications and mortality were analyzed, and so were the operative time, blood loss and postoperative hospital stay. Perioperative complications were defined as any adverse event within 30 days of surgery. All complications were graded according to an established five-grade modification of the original Clavien system. RESULTS: The mean operation time was 418 minutes, the mean blood loss was 514 mL, the transfusion rate was 36.7%, the mean transfusion volume was 578 mL, and the average postoperative hospital stay was 20 d. For urinary diversion, ileal conduits were constructed in 27 patients (55.1%), ileal neobladders in 16 patients (32.7%), and ureterocutaneostomies in 6 patients (12.2%). A total of 17 patients (34.7%) developed at least one perioperative complication. Complications of grades 1-2 occurred in 12 patients (24.5%), which included subileus, urinary tract infections, deep venous thrombosis of the lower limbs, pneumonia, etc. Complications of grades 3-5 occurred in 5 patients(10.2%), and one patient died of pulmonary embolism. Ileal neobladders and ileal conduits were similar at the operation time, blood loss, transfusion rates, postoperative hospital stay and morbidity of perioperative complications. CONCLUSION: Morbidity of perioperative complications following LRC was still high. The most frequent complications were subileus and urinary tract infections. The surgery should be performed on selected patients, and measures need to be taken to prevent these complications. Compared with ileal conduits, ileal neobladders did not increase the operation time, blood loss and morbidity.