What ' s known on the subject? and What does the study add?Radical cystectomy remains associated with comparatively high perioperative morbidity and mortality, despite improvements in surgical techniques and perioperative care. At present, most studies on the complications associated with open radical cystectomy were derived from Western academic high-volume centres, and data from Japan and other Asian countries were very limited.Using the modifi ed Clavien grading system and 11 category grouping reported from MSKCC, we observed that 68% of patients experienced at least one complication within 90 days of surgery, and 17% of patients experienced major complications (90-day mortality rate = 2%), which were compatible with reports from Western high-volume centres. As far as we know, our report is the largest one regarding perioperative morbidity and mortality in Asian patients who underwent radical cystectomy. OBJECTIVE• To determine the type, incidence and severity of 90-day morbidity after radical cystectomy in our institution and our affi liated hospitals in accordance with a standard reporting methodology. A t present, most studies on complications associated with open radical cystectomy are derived from W estern academic high-volume centres and data from J apan and other A sian countries remain very limited. PATIENTS AND METHODS• The study comprised a retrospective multi-institutional study.• The records were reviewed of 928 patients who underwent open radical cystectomy between 1997 and 2010.• All complications within 90 days of surgery were categorized into 11 specifi c categories and graded in accordance with the modifi ed C lavien system.• Multivariate regression models were used to determine predictors of complications. RESULTS• A t least one complication was observed in 635 (68%) patients and a major (grade 3-5) complication was observed in 156 (17%) patients.• The most common complication categories were infectious (30%), gastrointestinal (26%), wound-related (21%) and genitourinary (15%).• The 30-day mortality rate was 0.8% and the 90-day mortality rate was 2%.• A multivariate regression model showed that previous cardiovascular comorbidity and type of urinary diversion (i.e. ileal conduit or neobladder) were signifi cant factors for any and major complications. CONCLUSIONS• Surgical complication-related radical cystectomy is signifi cant and both previous cardiovascular comorbidity and the type of urinary diversion were found to be signifi cant factors for any and major complications.• The 90-day mortality rate was 2%, which is compatible with reports from Western high-volume centres.

attacks and urolithiasis from the age of 27 years, along pathy; platelet aggregation; polycythaemia vera with mild proteinuria and haematuria and mild polycythaemia 5 years before admission, blood values were haematocrit (Htc) 52%, white blood cell count 13 000/ml, red blood cell (RBC) count 5 600 000/ml, Case report On admission, he presented with a reddish face, injected conjunctivae, and moderate hepatosplenome-Patient 1 a 35-year-old Japanese male, was referred to galy. Neurological signs and the findings on head CT our hospital in June 1994 because of a hypertensive scan were consistent with cranial nerves VIII and IX crisis (224/140 mmHg) with headache, visual disturbdamage due to cerebral infarction. Repeated and freance, and dark urine. He had been normotensive until quent blood pressure measurements were within March 1994 when he developed an upper respiratory normal limits. infection. His past history included recurrent gout Urinalysis in both cases demonstrated intense proteinuria (patient 1, 4.0 g/day; patient 2, 2.8 g/day) and Correspondence and offprint requests to: Eri Muso MD, Third haematuria (20-40 RBCs; 30-40 RBCs per high-power Division, Department of Internal Medicine, Faculty of Medicine, field in the sediments respectively) with numerous RBC

Summary Dendritic cells (DCs) polarize naive CD4+ T cells to either T helper 1 (Th1) or Th2 cells. We examined the role of glycogen synthase kinase 3 (GSK3) activity during DC development from murine bone marrow (BM) cells. DCs were generated by culturing lineage‐marker‐negative BM cells with granulocyte–macrophage colony‐stimulating factor in the presence or absence of a specific inhibitor of GSK3 (Gi), SB415286, for 6 days. DCs generated in the presence (GiDC) or absence (control DC) of SB415286 similarly exhibited a conventional DC phenotype (CD11b+ B220– CD8–). These DCs were mixed with allogeneic CD4+ T cells and the ability to polarize Th1 or Th2 cells was evaluated. The GiDCs exhibited markedly impaired function to induce Th2 polarization compared to control DCs. In contrast, the ability of GiDCs to generate Th1 cells was slightly higher than that of control DCs. CD86 expression and CD40‐mediated interleukin‐6 production were completely diminished in GiDCs, which might be associated with the impaired ability of the GiDCs to induce Th2 differentiation. These results suggest that the GSK3 activity during DC development is essential for the establishment of the DC function to induce Th2, but not Th1, differentiation.

:  The impact of post‐transplant donor‐specific antibody (DSA) on the development of chronic rejection has been focused recently. The aim of this study was to evaluate the significance of DSA, graft function and pathological factors of chronic rejection. Seventy‐three kidney recipients who underwent protocol biopsy were included in the study. The median follow‐up period after transplant was 40 months. The presence of anti‐HLA antibody (aHLAAb) and DSA was tested using flow beads analysis (FlowPRA®). The patients were divided into a group with DSA, a group with non‐donor‐specific aHLAAb and a group without aHLAAb. Protocol biopsy specimen were compared for transplant glomerulopathy (cg), vasculopathy (cv), C4d deposition at peritubular capillary (PTC), peritubular capillaritis (ptc score 0–3) and thickening of PTC basement membrane (ptcbm score 0–3) as recently proposed. The presence of DSA was significantly associated with the presence of cg, ptcbm. The group with non‐donor‐specific aHLAAb had ptcbm but did not have cg. The group without aHLAAb rarely showed ptcbm. The presence of DSA was associated with impaired graft function. C4d was not specific for the patients with DSA. These histopathological markers are useful in the detection of immunological chronic rejection. Early detection by screening tests will be important for treatment before irreversible change occurs.

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