Objective To investigate the immunological function variation of peripheral dendritic cell(DC)from bladder cancer patients after blocking PD-L1 pathway.Methods DC from normal control and patient with bladder cancer were cultured with rhGM-CSF,rhIL-4 in vitro and treated with PD-L1 monoclonal antibody.The expression of CD1a,HLA and CD83 were examined by flow cell meter.The effect of DC induced lymphatic cellular proliferation and its capability of secreting IL-10,IL-12 were determined by MTT and ELISA.Results Blocking PD-LI pathway did not infuluence the maturation of DC.But the DCs from bladder cancer patient signifcantly boosted the lymphatic cellular proliferating(4.00 ± 1.28 versus 1.49 ±0.45)and IL-12 secretion capability(108.30 ± 21.89 versus 37.17 ± 14.89 ng/L),and yet it also decreased the secretion of IL-10(108.90 ± 21.77 versus 14.99 ± 54.99 ng/L)after blocking PD-L1 pathway (P ＜ 0.05).Conclusion Blocking PD-LI pathway on the DC from bladder cancer patient may improve its anticancer immunological function.

Objective To evaluate the feasibility,safety and efficacy of tubeless percutaneous nephrolithotomy ( PCNL).Methods Patients who underwent PCNL were randomized into 2 groups by extracting a random number generated from random number table,tubeless PCNL group and traditional PCNL group when the stones were cleared.Each patient in tubeless PCNL group was treated with insertion of a F5 ureteral double pigtail stent without placement of nephrostomy tube,while both double pigtail stent and F16 nephrostomy tube were placed in patients in traditional PCNL group.Exclusion criteria were severe bleeding requiring blood transfusion,stone residual requring a second PCNL,severe hydronephrosis with the thickness of renal parenchyma less than 5 mm,pyonephrosis,stricture of ureter or ureteropelvic junction,and severe perforation of the collecting system.A total of 50 patients were enrolled in this study.Tubeless PCNL and traditional PNCL were performed in 25 patients,including 27 kidney units,respectively.The two groups had comparable demographic data.All the operations were performed by the same surgeon.Evaluation factors included postoperative pain,decreased hemoglobin,blood transfusion rate,incidence of fever and perirenal hematoma,and duration of hospitalization.Results The average visual analogue scale (VAS) score on postoperative day 1 in tubeless PCNL group was 2.24 compared with 5.04 in traditional PCNL group (P ＜ 0.01 ).The average hospital stay in tubeless PC NL group (3.04 d) was significantly shorter than that in traditioal PCNL group (6.88 d) (P ＜0.01 ).The differences in average hemoglobin drop and stone clearance in the 2 groups were not significant.The differences between the 2 groups in blood transfusion ( 1/25 in tubeless PCNL group vs 3/25 in traditional PCNL group,P ＞0.05),renal hematomas rate (6/27 in tubeless PCNL group vs 7/27 in traditional PCNL group,P ＞ 0.05) and fever rate (3/25 in tubeless PCNL group vs 4/25 in traditional PCNL group,P ＞0.05 ) were not significant.There was no incidence of urinary leakage from the nephrostomy site in the 2 groups.Conclusions Tubeless PCNL can significantly decrease postoperative pain and discomfort and shorten the duration of hospitalization without increase of complications.Tubeless PCNL is safe,effective and performable,but the contraindications such as massive haemorrhage,pyonephrosis,ureteral obstruction,severe perforation of the collecting system,residual stone requring a second PCNL,should be kept in mind.

Objective To evaluate the feasibility and efficacy of laparoscopic single-port transumbilical renal pedicle lymphatic disconnection (TRPLD) for treatment of chyluria. Methods Nine cases of chyluria underwent laparoscopic single-port TRPLD. In all cases a 2-3 cm single inverted Ushaped supraumbilical incision was made, two 5-mm and one 12-mm trocars were inserted, and a medical rubber glove was sutured surrounding the three trocars and incision was made for gas proofing.Conventional straight and flexible instruments were used for dissection. Results All laparoscopic operations were successfully completed without conversion to open surgery. The mean operative time was 135 (96-178) minutes, and the mean estimated blood loss was 126 (50-250) ml. Chyluria disappeared in all patients after operation and did not reoccur during the follow-up (1 - 6 months).Conclusions Laparoscopic single-port transumbilical TRPLD represents a feasible and novel mini-invasive option for patients with chyluria.

Objective To evaluate the effectiveness and safety of terazosin in the treatment of Chinese benign prostatic hyperplasia (BPH) patients. Methods A multicenter prospective postmarketing observational study was conducted from June 2007 to March 2008 in 32 urologic centers.Patients were given terazosin for 4 weeks according to the routine medical care procedures following instructions. Effectiveness evaluation included the primary endpoint focusing on the changes in IPSS total score at the end of 2nd and 4th week compared with the baseline. The secondary endpoints were the changes in Qmax and QOL at the end of 4th week, diastolic and systolic blood pressures at the end of 2nd and 4th week compared with the baseline and the discontinuation rate of terazosin within the four weeks. Safety was assessed by adverse events. Results There were 1006 patients included in this study (FAS) and 992 patients (PP) completed the study. Among them, there were 344 patients having hypertension. The total IPSS score reduced from 22.32±6. 13 at baseline to 16. 98±5.92 at the end of the 2nd week and to 14.00±5. 52 at the end of the 4th week in FAS population (P＜0. 01).The total IPSS score changed from 22.32±6.15 at baseline to 16. 96±5.93 at the end of the 2nd week and to 13. 95±5.52 at the end of the 4th week in the PP population (P＜0.01). The efficacy rate was 26.54% at the 2-week treatment and 60.64% at the 4-week treatment, which was defined as obtaining improvement by 30% compared with the baseline. Patient's IPSS in different age groups with different prostatic hyperplasia levels and patients combined with or without 5-α reductase inhibitors were all decreased significantly(P＜0.01). With 4-week treatment of terazosin, Qmax and QOL were improved significantly by 32% and 45% (P＜0.01). Terazosin decreased BPH patient blood pressure with untreated or uncontrolled hypertension (P＜0.05), but had little influence on normal blood pressure of those under control. The incidence of adverse reactions was low. The most common adverse event was dizziness (3.68%). At the end of the study, 960 subjects (95%) were taking drug continuously.Conclasions Terazosin can significantly improve the symptoms and quality of life in Chinese BPH patients with good safety and compliance.

Objective To present the initial experience and results of laparoscopic transvaginal radical cystectomy (LATRC) with orthotopic ileal neobladder. Methods Six female patients with muscle invasive bladder carcinoma underwent LATRC with orthotopic ileal neobladder. The mean age was 61 years (range 55 to 73 years) . The LATRC with orthotopic ileal neobladder consisted of 4 major steps, namely laparoscopic cystectomy, operation on vagina, extracorporeal formation of ileal pouch and laparoscopic urethral pouch anastomosis. With 5 trocars, the bilateral pelvic lymphadenectomy was performed first The ureters were dissected just outside the bladder. Assisted by the uterine manipulator and the LigaSure system, total bladder, uterus and appendage were dissected by the laparoscopic approach. In the transvaginal step, the specimen was removed through the incision of the anterior and posterior vaginal fornix apex and the neovagina was created by the visualized suture. A 30-40 cm ileal loop was taken from the abdominal cavity, isolated, de-tubularized and reconfigured into W shaped pouch with running suture. The anti-refluxing ureter implantation was performed by inserting the 1 cm ureter into the pouch and suturing in place. The urethra neobaldder anastomosis was done under the laparoscope. Results The mean duration of surgery was 6.2 h(range from 4 to 8 h). The estimated blood loss was 665 ml (range from 400 to 1200 ml). All patients achieved urine control and had neither obstruction nor reflux proved by the intravenous pyelography 1-3 months after surgery. The mean value of neobladdermaximum capacity was 427 ml. No vesicovaginal fistula or other serious complication occurred The mean follow-up was 16 months (9-30 months). During the follow-up, there was no mortality. One patient with lymph node involvement developed liver metastasis 8 months post-operatively. Conclusions The LATRC is feasible and effective for the female patients with invasive bladder cancer. Using uterine manipulator and the transvaginal procedure makes the laparoscopic manipulation easier and simpler. The visualized incision and suture on vagina is good for recovery and reducing postoperative vesicovaginal fistula.

BACKGROUND: Urological complication is one of common surgical complications following transplantation and severely threatens renal function, even patient's lives. Urological complications following renal transplantation mainly contain urinary fistula,ureteral obstruction and ureter backflow.OBJECTIVE: To retrospectively analyze the incidence and management of urological complications following kidney transplantation.METHODS: A total of 1 223 patient times following kidney transplants were selected at the Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University of Chinese PLA from December 1993 to April 2007.According to ureter of donor kidney and the urinary tract of recipients, ureteroneocystostomy was used for urinary tract reconstitution in 948 patient times, and end-to-end ureteroureterostomy in 275 patient times. Urological complications such as urinary fistula, ureteral obstruction and vesicoureteral reflux (VUR) were treated by the different methods on the basis of the different causes, mainly by surgical procedures. Reason of urological complications, surgical management of urologicalcomplications and its clinical outcome, the 3-year survival rate of grafted kidney were measured.RESULTS AND CONCLUSION: In a total of 1 223 patients, urological complications were encountered in 92 cases (7.5%), including 43 cases of urinary fistula (3.5%), 35 ureteral obstruction (2.9%), 14 VUR (1.1%). 35 cases of urinary fistula, 29 ureteral obstruction, 6 VUR were cured by surgical procedures including ureteroureterostomy in 35 patients (50%), revision of ureteroneocystostomy in 18 (25.7%), endourology in 11 (15.7%) and other operation in 6 (9.6%). All recipients with urological complications regained normal graft function except one undoing transplanted nephrectomy due to the pelvis and urteral necrosis. There was no grafted kidney and recipient loss secondary to these complications in the present series. The 3-year survival rate of graft with urological complications and without urological complications did not show significant difference (P > 0.05). These indicated that most of urological complications following kidney transplantation request surgical management, and ureteroureterostomy are frequently used. The long-term graft survival is not affected by a correctly treated urological complication.

BACKGROUND: Urinary kidney injury molecule-1 (KIM-1) has been proved to be a novel kidney-specific injury molecule as a marker for the diagnosis of acute renal ischemia injury, and KIM-1 participated in the progress of renal injury repair. However, no one reported the significance of its dynamic expression during the functional rehabilitation of renal graft.OBJECTIVE: To investigate the relations between urinary KIM-1 level and the early renal graft function in order to provide rational approaches for evaluating or predicting early renal graft function.METHODS: The 46 patients were divided into 3 groups, including 22 cases of immediate graft function (IGF), 14 cases of slow graft function (SGF) and 10 cases of delayed graft function (DGF). The 24-hour urine specimen was collected every day for 2 weeks since the operation. The urinary KIM-1 content was detected by enzyme linked immunosorbent assay (ELISA), and at the same time the urinary and serum creatinine levels were detected. The diversity of urinary KIM-1 level was observed during the recovery of the graft function, and the clinical significance was evaluated by analyzing the correlation of urinary KIM-1 level and serum creatinine.RESULTS AND CONCLUSION: At the first 2 days after kidney transplantation, the urinary KIM-1 levels were high and no significant difference was observed between the three groups (P < 0.05). Two days later, the urinary KIM-1 level descended quickly along with the descent of the serum creatinine in IGF and SGF groups; the urinary KIM-1 maintained high levels until the serum creatinine reached normally. In DGF group, the urinary KIM-1 decreased quickly to a low level after 2 days from operation, but it increased promptly 1 to 2 days before the recovery of graft function and kept a high level until the serum creatinine reached normally. This suggested that consecutive detection of urinary KIM-1 is useful for monitoring the early graft function after kidney transplantation, and high urinary KIM-1 may suggest the recovery of graft function.

BACKGROUND:In vitro screening and amplification are important links to harvest muscle-derived stem cells that are satisfactory to clinical requirement.OBJECTIVE:To probe into the method of isolation,culture and purification of skeletal muscle-derived stem cells from adult rats in vitro.METHODS:The skeletal muscle was obtained sterilely following adult Sprague Dawley rats were anesthetized.Muscle-derived stem cells were harvested using enzyme digestion with Ⅺ collagenase,Dispese and trypsogen,and then purified by Percoll density gradient centrifugation and differential adhesion method.Growth curves were recorded and MTT colorimetric technique was used to describe the effects of various kinds of inoculum density on cell growth.Cells were identified by immunocytochemistry.RESULTS AND CONCLUSION:Primary muscle-derived stem cells were less in volume,lower adherence and well refraction,appearing as globular or fusiform or spindle and slowly multiplication.Following subculture,complete medium containing 20%serum was added.Cell number was greatest when cell density was 1×109/L,which was the optimal density.Cells at passages 1-4 grew well.Cells showed desmin(+),CD34(+),CD45(-)and Sca-1(+)by immunocytochemistry.Results verified that high-purity muscle-derived stem cells can be obtained in vitro and amplified successfully following primary culture.

BACKGROUND: Urethral fistula following renal transplantation accounts for 40%-70% of urinary complications, owing to surgical and medical factors. OBJECTIVE: To effectively decrease and avoid attack of urethral fistula after renal transplantation, and prolong the survival of kidney. METHODS: Clinical data from 68 cases following renal transplantation were retrospectively analyzed at the levels of pathogeny, diagnosis and treatment. There were 47 males and 21 females, aging 20 58 years. Urethral fistula occurred at 3 31 days after renal transplantation, and the amount was 60-2 000 mL per day. Based on the principle of the urethral injury classification method, urethral fistula was divided into simple and complex categories, while according to the fistula site, etiology and extent, urethral fistula was divided into low, high and multiple fistula. Attack rate of simple urethral fistula and complex urethral fistula was detected following renal transplantation so as to analyze the pathogeny of urethral fistula. RESULTS AND CONCLUSION: Of 68 cases with urethral fistula following renal transplantation, 47 cases (69.1%) were simple urethral fistula, including 42 cases with ureteral end necrosis, 4 cases with lax anastomotic suture of ureter bladder, and 1 case with ureteral anastomotic badness caused by wound infection, and 21 cases (30.9%) were complex urethral fistula, including 2 cases with renal pelvis fistula, 2 cases with ureter, 11 cases with ureterovesical anastomosis region, 6 cases with ureteral necrosis longer than 2 cm. A lot of causes may induce urethral fistula following renal transplantation. The blood stream, edema, size of fistula, length of the ureter, and operative procedures are selected to ensure free of strain. Urethral fistula can be treated on time on the basis of different situations.

BACKGROUND: Present existed procedure protocol for urinary fistula has some limitations, which can not reflect diseased region, pathological change, or severe condition of patients, OBJECTIVE: To establish the procedure protocol for urinary fistula diagnosis and treatment following renal transplantation, in addition, to investigate its significance in clinical practice. METHODS: A total of 102 cases with urinary fistula, including 67 male and 35 female, range in age from 21 to 57 years. According to the business management mode, we have designed the "five-step procedure protocol" for the diagnosis and treatment of urinary fistula after renal transplantation. Four diagnosis steps consisting of qualitative, located, quantitative and classified, as well as one treatment step. Among 102 cases of urinary fistula, 34 were adopted conservative treatment, including 24 cases with drainage tube and retention type catheter, 10 cases with indwelling ureteric stents at tubal bladder. Other 68 cases received surgical treatment. In 47 cases with simple fistula, 36 cases received ureter/bladder replantation, 11 cases with ureteral anastomosis. Twenty-one cases with complex fistula were treated with surgical prosthesis using omentum majus after repairing. RESULTS AND CONCLUSION: Among the 34 cases receiving conservative treatment, 2 got urinary tract infection repeatedly, and 5 got the stenosis of ureterovesical anastomotic stoma. Among the 68 cases receiving surgical treatment, 2 had ureteral stoma stricture, 1 ureterovesical anastomotic stoma stricture, and 1 ureteral countercurrent. In the surgical treatment series, 3 cases died from severe pulmonary infection elicited by urinary fistula. 77 cases were available for long-term follow-up, 22 were dropped out. In the 57 cases with simple fistula were followed up for 1-10 years, the transplanted renal function was normal in 40 cases, and 17 cases suffered from chronic rejection. 20 cases with complex fistula treated with surgical prosthesis using omentum majus were followed up for 1-7 years, 19 cases were normal, 1 patient had increased creatinine, which was returned to normal after intravenous glucocorticoid therapy. The design of "qualitative, located, quantitative and classified" standard for urinary fistula diagnosis following renal transplantation, and the establishment of "five-step procedure protocol", make urinary fistula diagnosis and treatment more ordered and standard, which is more feasible for selecting optimal therapeutic scheme.