["Double Grooves-Double Rings" technique of transurethral Thulium laser enucleation of the prostate: learning curve of single surgeon]

Objective: To evaluate the learning curve of the "Double Grooves-Double Rings" (DGDR) technique of transurethral Thulium laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH) by a single surgeon. From June 2021 to July 2022, 84 patients mean age (69.0±8.0) years,preoperative prostate volume (90.9±40.3)ml with BPH underwent ThuLEP in the Department of Urology, Peking University First Hospital.Performed by a single surgeon who had no experience of transurethral resection of prostate (TURP) and any laser surgeries. The case scatter plots with the best fitting line were drawn to analyze the learning curve. According to the date of the surgeries, the patients were equally divided into three learning stages (28 patients for each group). The T-PSA,prostate volume,operative time,enucleation time, enucleation efficiency,catheter indwelling time, hemoglobin drop and perioperative complications (including re-TURP, blood transfusion, stress incontinence≥3 months and urethral stricture) were compared among the groups. The learning curve was divided into three stages, and the cutting point was shown on the 14^th case. Except the prostate volume [stage1 (75.7±30.7) ml, stage2 (93.40±39.6)ml, stage3 (103.5±46.2) ml, P<0.05], there was no significant difference of the baseline data between three groups (P>0.05). Compared with those of stage 1(100.6±24.7) min,(0.55±0.22) g/min, a statistically significant improvement was observed in both of the operative time and the enucleation efficiency among stage 2[(84.5±36.6) min, (0.87±0.33) g/min and stage 3 (71.2±26.3) min, (1.27±0.45) g/min, P<0.05]. The learning curve of the DGDR technique for ThuLEP can be divided into three stages. A ThuLEP beginner can preliminarily master this technique after completing 14 cases.

[Whole-course management strategies for gastroesophageal reflux disease: an evidence mapping study based on clinical practice guidelines]

Gastroesophageal reflux disease (GERD) is one of the most common digestive diseases with high incidence, complicated clinical symptoms, difficulties in standard treatment, and heavy medical burden. At present, some GERD-relevant clinical practice guidelines (CPGs) have been issued by different countries and academic organizations, but some recommendations were inconsistent, which has caused some problems for the current clinical whole-course management of GERD. To summarize the relevant evidence among the CPGs on GERD and formulate the whole- course management strategies, we included GERD-relevant CPGs published or updated after 2010 by searching websites of guidelines, relevant professional societies, and electronic databases. We extracted the recommendations and summarized the evidence from the aspects of symptoms, epidemiology, diagnosis and treatment, which was presented in the form of evidence mapping. We included 24 CPGs, including three in Chinese and 21 in English. The clinical practice management strategies of GERD were formulated based on the evidence from the aspects of clinical symptoms, diagnostic methods, medical treatment, anti-reflux surgery and endoscopic treatment, psychological treatment, and traditional Chinese medicine treatment.

Cine magnetic resonance urography for postoperative evaluation of reconstructive urinary tract after ileal ureter substitution: initial experience

AIM

To report the initial experiences with functional cine magnetic resonance urography (cine MRU) and assess its usefulness as a novel postoperative evaluation method of ileal ureter substitution.

MATERIALS AND METHODS

The medical records of 17 patients from who underwent cine MRU during June 2010 to December 2019 during their follow-up after ileal ureter substitution were collected. The cine MRU videos of reconstructive urinary tract were observed, and the luminal diameter, contraction ratio, peristaltic waves, and ureteral jets were measured.

RESULTS

Seventeen patients underwent cine MRU after ileal ureter substitution during their follow-up. Based on their cine MRU videos assessing the morphology and the peristaltic motility of the reconstructive urinary tract, there was resolution of preoperative hydronephrosis, which matched their ameliorative renal function. Clearly, peristaltic motility of the ileal graft was observed in 14 patients with obvious peristaltic waves and ureteral jets.

CONCLUSION

This study is the first to assess the clinical utility of functional cine MRU during the patient follow-up after ileal ureter substitution. Cine MRU is a radiation-free, non-invasive imaging method that can clearly show the morphology and the peristaltic motility of the ileal graft. Therefore, cine MRU, as a novel technique, will be extremely useful in the postoperative evaluation of patients after ileal ureter substitution.

[Application of totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis in upper urinary tract urothelial carcinomas treatment]

OBJECTIVE

To evaluate the feasibility and effectiveness of the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis in the treatment of upper urinary tract urothelial carcinoma (UTUC), and to review the experience of renal autotransplantation for UTUC treatment.

METHODS

One case of applying the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis to the UTUC treatment was reported, and related literature was reviewed. The patient was a sixty-four-year old man who received right radical nephroureterectomy for right ureteral carcinoma 1 year before and diagnosed as left ureteral carcinoma(G2, high grade) this time. In order to preserve his renal function and avoid the shortness of common kidney-sparing surgery, a totally extraperitoneal procedure, including retroperitoneoscopic nephrectomy, ureterectomy, renal autotransplantation and Boari flap-pelvis anastomosis, was performed to the patient.

RESULTS

The operation was completed successfully without perioperative complications. The renal function recovered to preoperative level within 1 week. No deterioration of renal function during the follow-up and no tumor recurrence was observed under cystoscopy at the 3-month postoperative consult.

CONCLUSION

The totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis is a feasible and effective treatment for UTUC. The innovative procedure has several advantages compared to the former ones. The extraperitoneal procedure results in significantly less pain, shorter hospital stay, decreased overall time to recovery and lower bowel complications risk without warm ischemia time extension. Meanwhile, the Boari flap-pelvis anastomosis simplifies the follow -up protocols and creates an easy route for cystoscopy and topical therapy. From the systematic clinical analysis, as well as the related literature review, it's been concluded that the renal autotransplantation can be a reasonable option for the patients who have UTUC in solitary kidney or have bilateral UTUC. This type of treatment possesses advantages of preservation of renal function and total resection of malignant lesions. But long-term data and large cohort study on renal function or tumor recurrence are still absent which will be necessary to confirm the advantages of this approach.

[Advances in surgical repair of ureteral injury]

Ureteral injury can be classified as iatrogenic or traumatic, which represents a rare but challenging field of reconstructive urology. Due to their close proximity to vital abdominal and pelvic organs, the ureters are highly susceptible to iatrogenic injury, while ureteral injury caused by external trauma is relatively rare. The signs of ureteric injury are difficult to identify initially and often present after a delay. The treatment of ureteral injury, which is depended on the type, location, and degree of injury, the time of diagnosis and the patient's overall clinical condition, ranges from simple endoscopic management to complex surgical reconstruction. And long defect of the ureter presents much greater challenges to urologists. Ureterotomy under endoscopy using laser or cold-knife is available for the treatment of 2-3 cm benign ureteral injuries or strictures. Pyeloplasty is an effective treatment for ureteropelvic junction obstruction and some improved methods showed the possibility of repairing long-segment (10-15 cm) stenosis. Proximal and mid-ureteral injuries or strictures of 2-3 cm long can often be managed by primary ureteroureterostomy. When not feasible due to ureteral defects of longer segment, mobilization of the kidney should be considered, and transureteroureterostomy is alternative if the proximal ureter is of sufficient length. And autotransplantation or nephrectomy is regarded as the last resorts. Most of the injuries or strictures are observed in the distal ureter, below the pelvic brim, and are usually treated with ureteroneocystostomy. A non-refluxing technique together with a ureteral nipple or submucosal tunnel method, is preferable as it minimizes vesico-ureteral reflux and the risk of infection. In order to cover a longer distance, ureteroneocystostomy in combination with a psoas hitch (covering 6-10 cm of defect) or a Boari flap (covering 12-15 cm) is often adopted. Among various ureteral replacement procedures, only intestinal ureteral substitution, which includes ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance when urothelial tissue is insufficient. Ileal ureter can be used to replace the ureter of >15 cm defect and even to replace the entire unbilateral ureter or bilateral ureter. Laparoscopic and robotic-assisted techniques are increasingly being employed for ureteral reconstruction and adopted with encouraging results.

Detection of a novel HLA-A*11 variant, A*11:292, in a Taiwanese individual

One nucleotide substitution at residue 860 of HLA-A*11:01:01:01 results in a novel allele, HLA-A*11:292.

Detection of an HLA-C*03 variant, HLA-C*03:258, in a Taiwanese individual

One nucleotide substitution at residue 506 of HLA-C*03:02:01 results in a novel allele, HLA-C*03:258.

HLA-B*40:400, a novel HLA-B*40 variant, identified in a Taiwanese individual

One nucleotide substitution at residue 314 of HLA-B*40:01:01 results in a novel allele, HLA-B*40:400.

HLA-A*26:160, a novel variant of HLA-A*26, discovered in a Taiwanese individual

One nucleotide replacement at residue 755 of HLA-A*26:01:01:01 results in a novel allele, HLA-A*26:160.

Discovery of a novel HLA-B*27 variant, B*27:168, by sequence-based typing in a Taiwanese blood donor

Nucleotide substitutions at residues 409 and 412 of HLA-B*27:06 result in a novel allele, HLA-B*27:168.

A possible association of HLA-C*07:18:01:01 and HLA-B*58:01

HLA-C*07:18:01:01 is possibly in association on the same haplotype as HLA-B*58:01.

Detection of an HLA-B*58 variant, HLA-B*58:19, by sequence-based typing in a Taiwanese individual

One nucleotide substitution at codon 152 of HLA-B*58:01:01:01 results in a novel allele, HLA-B*58:19.

The novel HLA-DRB1*15:158 allele discovered in a Taiwanese individual

Three nucleotide substitutions in HLA-DRB1*15:01:01:01 result in a new allele, HLA-DRB1*15:158.

HLA-A*24:386, a novel variant of HLA-A*24, discovered in a Taiwanese blood donor

One nucleotide replacement at residue 181 of HLA-A*24:02:01:01 results in a novel allele, HLA-A*24:386.

Detection of an HLA-C*03 variant, HLA-C*03:187, in a Taiwanese individual

One nucleotide substitution at residue 527 of HLA-C*03:03:01:01 results in a novel allele, HLA-C*03:187.

HLA-B*15:436, a novel variant of HLA-B*15, discovered in a Taiwanese individual

Nucleotide substitutions in codons 43 and 45 of HLA-B*15:18:01:01 result in a new allele, HLA-B*15:436.

HLA-DQB1*03:01:40, an HLA-DQB1*03:01 variant, identified in a Taiwanese individual

One nucleotide substitution at codon 106 of HLA-DQB1*03:01:01:01 results in a new allele, HLA-DQB1*03:01:40.

HLA-C*15:29, an HLA-C*15 variant, identified in a Taiwanese individual

One nucleotide substitution at codon 116 of HLA-C*15:02:01:01 results in a new allele, HLA-C*15:29.

HLA-B*40:55, an HLA-B*40 variant, identified in Taiwanese individuals

One nucleotide substitution at codon 248 of HLA-B*40:01:01 results in a new allele, HLA-B*40:55.

Detection of an HLA-B*15 variant, HLA-B*15:192, in a Taiwanese individual

One nucleotide replacement at codon 145 of HLA-B*15:01:01:01 results in a new allele, HLA-B*15:192.

Detection of a novel HLA-DRB1*12 variant, HLA-DRB1*12:67, in a Taiwanese individual

One nucleotide substitution at residue 266 of HLA-DRB1*12:02:01:01 results in a new allele, HLA-DRB1*12:67.

Discovery of a novel HLA-A*02 variant, HLA-A*02:684, in a Taiwanese individual

One nucleotide replacement at residue 728 of HLA-A*02:03:01 results in a new allele, HLA-A*02:684.

HLA-B*40:01:45, a novel variant of HLA-B*40:01, discovered in a Taiwanese hematopoitic stem cell donor

Two nucleotide replacements within HLA-B*40:01:01 result in the novel allele, HLA-B*40:01:45.

Identification of a novel HLA-B*27 variant, B*27:112, by sequence-based typing in a Taiwanese donor

One nucleotide substitution at residue 74 of HLA-B*27:04:01 results in a novel allele, HLA-B*27:112.

Detection of a novel HLA-A*30 variant, A*30:109, in a Taiwanese individual

One nucleotide substitution at residue 488 of HLA-A*30:01:02 results in a novel allele, HLA-A*30:109.

A novel HLA allele, HLA-C*15:02:01:04, identified in a Taiwanese individual

One nucleotide substitution at residue 1924 of HLA-C*15:02:01:01 results in a novel allele, HLA-C*15:02:01:04.

Influence of dairy by-product waste milk on the microbiomes of different gastrointestinal tract components in pre-weaned dairy calves

The community structure of colonised bacteria in the gastrointestinal tracts (GITs) of pre-weaned calves is affected by extrinsic factors, such as the genetics and diet of the calves; however, the dietary impact is not fully understood and warrants further research. Our study revealed that a total of 6, 5, 2 and 10 bacterial genera showed biologically significant differences in the GITs of pre-weaned calves fed four waste-milk diets: acidified waste milk, pasteurised waste milk, untreated bulk milk, and untreated waste milk, respectively. Specifically, generic biomarkers were observed in the rumen (e.g., Bifidobacterium, Parabacteroides, Fibrobacter, Clostridium, etc.), caecum (e.g., Faecalibacterium, Oxalobacter, Odoribacter, etc.) and colon (e.g., Megamonas, Comamonas, Stenotrophomonas, etc.) but not in the faeces. In addition, the predicted metabolic pathways showed that the expression of genes related to metabolic diseases was increased in the calves fed untreated waste milk, which indicated that untreated waste milk is not a suitable liquid diet for pre-weaned calves. This is the first study to demonstrate how different types of waste milk fed to pre-weaned calves affect the community structure of colonised bacteria, and the results may provide insights for the intentional adjustment of diets and gastrointestinal bacterial communities.

Identification of a novel HLA-A*02:01:01 variant, HLA-A*02:01:01:09, in a Taiwanese bone marrow donor

An intronic mutation in intron 3 of A*02:01:01:01 leads to the formation of A*02:01:01:09.

HLA-A*11:256Q, a novel HLA-A*11 variant, detected in a Taiwanese individual

Nucleotide deletions from residues 409 to 417 of HLA-A*11:02:01 results in a novel allele, HLA-A*11:256Q.

Detection of a novel HLA-C*03 variant, HLA-C*03:227, in a Taiwanese individual

One nucleotide substitution at residue 19 of HLA-C*03:03:01:01 results in a novel allele, HLA-C*03:227.

The novel HLA-DRB1*15:140 allele discovered in a Taiwanese unrelated hematopoietic stem cell donor

One nucleotide substitution at residue 91 of HLA-DRB1*15:02:01:01 results in a new allele, HLA-DRB1*15:140.

Identification of a novel HLA-C allele, HLA-C*15:134, in a Taiwanese hematopoietic stem cell donor

One nucleotide substitution in codon 17 of HLA-C*15:02:01:01 results in a novel allele, HLA-C*15:134.

Detection of a novel HLA-A*11 variant, A*11:255, in a Taiwanese individual

One nucleotide substitution at residue 532 of HLA-A*11:02:01 results in a novel allele, HLA-A*11:255.

HLA-B*15:414, a novel variant of HLA-B*15, discovered in a Taiwanese individual

One nucleotide replacement at residue 221 of HLA-B*15:18:01:01 results in a new allele, HLA-B*15:414.

HLA-C*07:544, a novel HLA-C*07 variant, detected in a Taiwanese bone marrow donor

One nucleotide exchange at residue 768 of the HLA-C*07:02:01:01 results in a novel allele, HLA-C*07:544.

Identification of a novel HLA-B*07 variant, B*07:269, by sequence-based typing in a Taiwanese bone marrow stem cell donor

One nucleotide replacement at residue 559 of HLA-B*07:05:01:01 or B*07:06:01 results in a novel allele, HLA-B*07:269.

HLA-B*15:388, a novel variant of HLA-B*15, discovered in a Taiwanese individual

One nucleotide replacement at residue 47 of HLA-B*15:18:01:01 results in a new allele, HLA-B*15:388.

Detection of a novel HLA-B*46:01 variant, HLA-B*46:01:22, in a Taiwanese individual

One nucleotide replacement at residue 606 of HLA-B*46:01:01 results in a new allele, HLA-B*46:01:22.

Identification of a novel HLA-A*02 variant, HLA-A*02:621, in a Taiwanese bone marrow donor

One nucleotide replacement at residue 169 of HLA-A*02:01:01:01 results in a new allele, HLA-A*02:621.