Objective To report the experience in managing complex posterior urethral obliteration with dartos island skin flap. Methods 32 patients with complex posterior urethral obliteration were treated with dartos island skin flap substitution urethroplasty.Partial resection of the inferior pubic synphysis was needed to facilitate high proximal placement of the flap. Results The outcome was excellent in 31 (97%).Including subsequent procedures,the over all 3 months～7 years fllowup investigations were carried out in 27 patients.Urinary flow rates of more than 15 ml/s (for adults) and 8 ml (for children) could be achieved in 25 of 27 patients.Two patients with urinary flow decreased required further reconstruction.The hairy pouch formed within scrotal skin flap was noted in two patients. Conclusions Dartos island skin flap urethroplasty is a highly effective 1-stage method of reconstructing complex posterior urethral obliteration.

Objective To investigate the security and result of operation of one side polycystic kidney removal and homonymy kidney transplantation simultaneously for giga-polycystic kidney di-sease of terminal stage. Methods Forty-five patients with polycystic kidney of transplantation were retrospectively analyzed. The patients were divided into 2 groups. Patients of group A (n=23) under-went resection of the cystic kidney by extraperitoneum and the other 22 patients(group B) didn't re-move the cystic kidney. The data including average length of hospital stay, variance of blood pressure, lessen of abdominal circumference, lung capacity, total lung capacity, FEV1.0/FVC, incidence rate of delayed graft function (DGF) and 1 year patient/kidney survival rate of the 2 groups were compared. Results The average length of post-operative hospital stay of group A was (14.5±2.6)d,lessen of blood pressure was (30.0±0.7/13.34±8.4)mm Hg, lessen of abdominal circumference was (11.0+ 6. 3) cm, lung capacity increased (1.4±0.3)L, total lung capacity increased (2.0±1.0)L, FEV1.0/ FVC increased (5.3±1.0) %, the incidence rate of DGF was 8.7% (2/23), 1 year patient/ kidney survival rate was 100.0%/95.7%. The average length of post-operative hospital stay of group B was (28.45±7.9)d,lessen of blood pressure was (3.9±11.2/2.9±12. 0)ram Hg, lessen of abdominal circumference was (3.3±2.2)cm, lung capacity increased (0.44±0.3)L, total lung capacity increased (0.8±0.2) L, FEV1.0/FVC increased (2.0±0.9)%, the incidence rate of DGF was 9.1%(2/22), 1 year patient/kidney survival rate was 100.0%/95.5%. There were no significant differences of the incidence rate of DGF and 1 year patient/kidney survival rate between the 2 groups. While there were significant differences of the other data between the 2 groups(P＜0.05). Conclusions It is safe and convenient for one side polycystic kidney removal and homonyrny kidney transplantation simultaneous-ly for giga-polycystic kidney disease of terminal stage. The procedure could be applied to the patients of graveness complication or giga-polycystie kidney hampering operation of transplantation.

OBJECTIVE: Complication incidence of urinary fistula which frequently occurs following renal transplantation is 3%-10%. Thus, poor processing may cause loss of transplanted kidney. This study was designed to retrospectively analyze urinary fistula following renal transplantation and to summarize the processing experience. METHODS: A total of 27 out of 1 203 patients with urinary fistula following renal transplantation (16 males and female 11 and mean age of 43 years) were collected from Guangzhou General Hospital of Guangzhou Military Command of Chinese PLA from December 2000 to March 2009. Totally, 26 patients accepted donor kidney from corpse, and 1 from living body. All patients were treated with expectant treatment (n=17) including inserting 18Fr Foley catheter alone and draining from the native drainage channel of operative site (n=12) and inserting a ureteral stent (single-J) by cystoscope retrograde approach and inserting 18Fr Foley catheter into the bladder (n=5); exploring operation (n=10) including anastomosing ureter and bladder and placing ureteral stent (n=5) and anastomosing ureter and ureter of recipient and placing ureteral stent (n=5); pedicled omentum grafts to cover and surround stoma after suturing (n=6). RESULTS: Only 1 case was failed because kidney vain was injured in the second operation and the kidney was resected. Another 26 cases were cured. Within the 3 month to 7 years follow-up, the urinary fistulas did not relapse, no stegnosis or hydronephrosis, no urinary tract infection and renal function were normal. CONCLUSION: Rapid diagnosis and treatment for urinary fistulas after renal transplantation is imperative. First mostly patients may be cured by expectant treatment. If not then perform exploratory operation. Using peclicled omentum grafts to cover and surround stoma after suturing for complex urinary fistulas can raise achievement ratio of operation.

Objective To assess the effect of alprostadil on accelerating early recovery of renal transplant patients with delayed graft function.Methods A randomized control clinical trial was designed in renal recipients with delayed graft function(DGF)who were administered with 50μg alprostadil each day after the operation.The effects of alprostadil were compared with the control group which included 14 recipients with DGF to determine the influences of alprostadil on urine,serum creatinine(SCr).Under Doppler ultrasound,the renal blood flow resistance-indexes(RI)were measured.The rates of acute renal graft rejection(AR)were also calculated in both groups,and the 1year patient/graft survival rates were compared between the two groups.Results Urine was significantly higher in alprostadil-treated group than in control group(P ＜ 0.05).On the contrary,SCr and RI were significantly lower in alprostadil-treated group than in control group(P ＜ 0.05).No significant differences were found between the two groups in AR rate(6.25％ vs 7.14％)and the 1-year patient/graft survival rates(P ＞ 0.05).Conclusion The application of alprostadil in renal recipients with DGF had beneficial effects on accelerating recovery of renal graft function.

Objective:Bioinformatics was used to analyze the gene expression profile of renal chromophobe cell carcinoma (RCCC) to find out the key genes of RCCC.Methods:Chromophobe renal cell carcinoma gene chip data GSE15641 and GSE11151 were downloaded from the GEO database. Using R software packages such as " Affy" and " limma" in R software to screen differentially expressed genes, combining with David and STRING online bioinformatics tools to analyze the regulatory network of differentially expressed genes and construct protein-protein interaction (PPI) network, the Hub gene was screened through the Cytohubba plug-in of Cytoscape software.Results:A total of 261 differentially expressed genes were screened, including 194 down-regulated genes and 67 up-regulated genes. Gene enrichment (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed to explore their biological functions. In GO enrichment analysis, biological processes were mainly enriched in cell secretion, gluconeogenesis and cell proliferation regulation; in cell composition, they were mainly enriched in exosomes, plasma membranes and their components; in molecular function, they were mainly enriched in heparin binding; in KEGG pathway analysis, they were mainly enriched in metabolic pathway, antibody biosynthesis pathway and renin angiotensin system pathway. PPI network was constructed by using online bioinformatics tools. The top 10 Hub genes were screened by using cytohubba plug-in in Cytoscape software, which were pipecolic acid and sarcosine oxidase (PIPOX), hydroxyacid oxidase 2 (HAO2), kynurenine 3-monooxygenase (KMO), solute carrier family 2 member 2 (SLC2A2), formimidoyltransferase cyclodeaminase (FTCD), angiogenin (ANG), APOBEC1 complementation factor (A1CF), aldehyde dehydrogenase 8 family member A1 (ALDH8A1), vitamin D binding protein (GC), histidine rich glycoprotein (HRG).Conclusions:Bioinformatics analysis of differentially expressed genes in renal chromophobe cell carcinoma can effectively explore the interaction information of these differentially expressed genes, and provide new ideas for the treatment of renal chromophobe cell carcinoma.

A s an im portant part of epigenetic m arker, D N A m ethylation involves in the gene regulation and attracts a w ide spread attention in biological auxology, geratology and oncology fields. In forensic science, because of the relative stable, heritable, abundant, and age-related characteristics, D N A m ethyla-tion is considered to be a useful com plem ent to the classic genetic m arkers for age-prediction, tissue-identification, and m onozygotic tw ins' discrim ination. V arious m ethods for D N A m ethylation detection have been validated based on m ethylation sensitive restriction endonuclease, bisulfite m odification and m ethylation-C pG binding protein. In recent years, it is reported that the third generation sequencing m ethod can be used to detect D N A m ethylation. T his paper aim s to m ake a review on the detection m ethod of D N A m ethylation and its applications in forensic science.

Objective To discuss the treatment of urethral stricture after hypospadias reDair.Methods Thirty-seven cases of urethral stricture after hypospadias repair from 1999 to 2006 were ret-rospectively analyzed. Of 37 patients,the stricture was located at the distal end of urethra in 7 cases.There were 3 1 cases with anastomotic stricture.There was 1 case with distal urethral stricture and anastomotic structure.There were 1 3 patients with the simple urethral stricture and the complicated 24 cases.Of 13 simple urethral stricture patients,4 patients were repaired with urethro-meatomy,6 patients with shelf operation and 3 patients with transurethral holmium laser urethrotomy.Eight Pa-tients with complicated urethral fistula,6 patients with urethral diverticula,4 patients with phallo-campsis and 6 patients with many times of postoperative urethral stricture were repaired with shelf op-eration or penis skin flap or septum of scrotum skin flaps urethroplasty. Results The simple stric-tures of 1 2 patients were cured by stage 1 operation,the other one cured after second surgery.Of 8 patients with fistula,7 were cured at stage 1,the other one was cured at the stage 2.Of 6 patients with diverticulum,all were cured at stage 1.Of 4 patients with phallocampsis,3 cases were cured at stage 1,the other one was cured at the stage 2.Of 6 patients with recurrent strictures,all were cured at stage 1.A1l patients were followed up 1 2 to 24 months.The micturition was without difficuItv at stand position. Conclusions Urethral stricture is one of the most common complications after hypos-padias repair.The simple urethral stricture could be repaired with urethro-meatomy or sheIf operation or transurethral holmium laser urethrotomy.The complicated urethral stricture could be reDaired with shelf operation or penis skin flaps or septum of scrotum skin flaps urethroplasty and overjetted with dortos of scrotum flaps.

Objective To summarize the success of congenital penile curvature. Methods 401 cases of con-genital penile curvature,whose average age is 2. 5 years ,ranging from 1 year to 26 years old. Of all cases ,383 patients who have both hypespadias and penile cun, ature, only 18 patients are congenital penile curvatures. 295 paitents are slight curvature,85 patients are moderate curvature and 21 patients are severe curvature. Curvature correction was per-formed on a case-by-case basis by solution fibric trabs of ventrial urethra and surrounding,skin de-gloving, ff necessa-ry,dorsal plication,and confirmed by Gittes test. Results . Curvature correction was possible by mobilization of ure-thra after penile degloviag,only a few need dorsal plieation. Followup for 6 months to 2 years,396 patients are success at once. The others after a second surgery had 100% success. Conclusions Solution fibrie trabs of ventrial urethra and surrounding, skin de-gloving, if necessary,dorsal plication ,is the first choice to repair of the congenital penile cur-vature and have good results.

Objective To improve the success of the urethral stricture repair in males. Methods Chose 101 males of urethral stricture,their median age was 9 years old (range 3 to 57 years old). Of the patients,61 patients had anterior urethral stricture and the posterior urethral stricture occurred in 40 patients. The length of the stricture varied from 0.5 to 2.0 cm. All patients were repaired with the only genital flap suturing the strictural urethra. Results All repairs were completed in 1 stage, follow-up was from 12 to 18 months, excepted for patients with 3 fistula and 3 urethral stricture, 95 patients were voiding a straight stream, the other 6 patients need another surgery. Conclusion It is a good technique to treat urethral stricture with genital flap ff there is short urethral stricture with sufficient genital skin.

OBJECTIVETo evaluate safety and efficacy of conversion of calcineurin inhibitors (CNI) to sirolimus (SRL) therapy for treatment of new-onset diabetes after kidney transplantation (NODAT).

METHODSOf 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.

RESULTSThe 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.

CONCLUSIONConversion from CNI to SLR therapy can significantly the metabolism of patients with NODAT without increasing the risk of acute graft rejection.

Blood Glucose ; Calcineurin Inhibitors ; therapeutic use ; Diabetes Mellitus ; Graft Rejection ; prevention & control ; Humans ; Hypoglycemic Agents ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; Sirolimus ; therapeutic use