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5. Adjuvant Chemotherapy in Patients with Locally Advanced Upper Tract Urothelial Carcinoma with or without Kidney Transplantation.

Author

Chang, Nai-Wen, Huang, Yu-Hui, Sung, Wen-Wei, and Chen, Sung-Lang

Subjects
ADJUVANT chemotherapy, TRANSITIONAL cell carcinoma, PROGRESSION-free survival, KIDNEY physiology, OVERALL survival, KIDNEY transplantation, STEM cell transplantation
Abstract

Background: The incidence of upper tract urothelial carcinoma (UTUC) is uniquely high in kidney transplant (KT) recipients in Taiwan. The evidence of adjuvant chemotherapy (AC) in UTUC is contradictory. We have sought to determine whether AC is associated with potential benefits related to locally advanced UTUC after KT. Methods: We retrospectively analyzed 134 patients with locally advanced UTUC (at least stage T2) and patients who were administrated AC after unilateral or bilateral nephroureterectomy with bladder cuff excision. Of these 134 patients, 57 patients fulfilled our inclusion criteria. We used 23 KT and 34 non-KT locally advanced UTUC patients for comparison. Results: The mean follow-up time was 52.35 ± 34.56 and 64.71 ± 42.29 months for the KT and non-KT groups, respectively. The five-year disease-free survival (DFS) and overall survival (OS) rates were 45.7% vs. 70.2% and 62.8% vs. 77.6%, for the KT and non-KT groups. The Kaplan–Meier curve and the log rank test revealed significant differences in the DFS and OS rates between the two groups, p = 0.015 and 0.036. The influence of chemotherapy on graft kidney function was mild. Only three in the KT group and two in the non-KT group developed > grade 2 nephrotoxicity. Conclusions: Our study suggested that KT patients with locally advanced UTUC who had been administered AC after surgery presented worse OS and DFS than non-KT patients. KT patients tolerated the AC course well, and their nephrotoxicity levels were mild and acceptable. [ABSTRACT FROM AUTHOR]

Published
2024
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37. Acute anal stretch inhibits NMDA-dependent pelvic-urethra reflex potentiation via spinal GABAergic inhibition in anesthetized rats

Author

Chen, Sung-Lang, Huang, Yu-Hui, Kao, Yu-Lin, Chen, Gin-Den, Cheng, Chen-Li, Peng, Hsien-Yu, Liao, Jiuan-Miaw, Huang, Pei-Chen, Tsai, Shih-Jei, and Lin, Tzer-Bin

Subjects
Reflexes -- Evaluation, Spinal cord -- Properties, Glutamate -- Health aspects, Physiological research, Biological sciences
Abstract

The impact of acute anal stretch on the pelvic-urethra reflex potentiation was examined in urethane-anesthetized rats by recording the external urethra sphincter electromyogram activity evoked by the pelvic afferent stimulation. Test stimulation (1 stimulation/30 s) evoked a baseline reflex activity with a single action potential that was abolished by gallamine (5 mg/kg iv). On the other hand, the repetitive stimulation (1 stimulation/1 s) induced spinal reflex potentiation (SRP) that was attenuated by intrathecal 6-cyano-7-nitroquinoxaline-2,4-dione (a glutamatergic [alpha]-amino-3-hydroxy-5methyl-4-isoxazoleproprionat receptor antagonist, 100 [micro]M, 10 [micro]l). and D-2-amino-5-phosphonovalerate [a glutamatergic N-methyl-D-aspartate (NMDA) antagonist, 100 [micro]M, 10 [micro]l]. Acute anal stretch using a mosquito clamp with a distance of 4 mm exhibited no effect, whereas distances of 8 mm attenuated and 12 mm abolished the repetitive stimulation-induced SRP. Intrathecal NMDA (100 [micro]M, 10 [micro]l) reversed the abolition on SRP caused by anal stretch. On the other hand, pretreated bicuculline [gamma]-aminobutyric acid (GABA) A receptor antagonist, 100 [micro]M, 10 [micro]l] but not hydroxysaclofen ([GABA.sub.B] receptor antagonist) counteracted the abolition on the repetitive stimulation-induced SRP caused by the anal stretch. All of the results suggested that anal stretch may be used as an adjunct to assist voiding dysfunction in patients with overactive urethra sphincter and that GABAergic neurotransmission is important in the neural mechanisms underlying external urethra sphincter activity inhibited by anal stretch. spinal cord: voiding dysfunction; glutamate; bicuculline; hydroxysaclofen

Published
2008

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