U-Net Modelling-Based Imaging MAP Score for Tl Stage Nephrectomy: An Exploratory Study

We evaluate the stability of the clinical application of the MAP scoring system based on anatomical features of renal tumour images, explore the relevance of this scoring system to the choice of surgical procedure for patients with limited renal tumours, and investigate the effectiveness of automated segmentation and reconstruction 3D models of renal tumour images based on U-net for interpretative cognitive navigation during laparoscopy Tl stage radical renal tumour cancer surgery. A total of 5 000 kidney tumour images containing manual annotations were applied to the training set, and a stable and efficient full CNN algorithm model oriented to clinical needs was constructed to regionalism and multistructure and to finely automate segmentation of kidney tumour images, output modelling information in STL format, and apply a tablet computer to intraoperatively display the Tl stage kidney tumour model for cognitive navigation. Based on a training sample of MR images from 201 patients with stage Tl renal tumour cancer, an adaptation of the classical U-net allows individual segmentation of important structures such as renal tumours and 3D visualisation to visualise the structural relationships and the extent of tumour invasion at key surgical sites. The preoperative CT and clinical data of 225 patients with limited renal tumours treated surgically at our hospital from August 2011 to August 2012 were retrospectively analysed by three imaging physicians using the MAP scoring system for the total score and the variables R (maximum diameter), E (exogenous/endogenous), N (distance from the renal sinus), A (ventral/dorsal), L (relationship along the longitudinal axis of the kidney), and h (whether in contact with the renal hilum). The score for each variable (contact with the renal hilum) was statistically compared with each other for the three observers. Patients were divided into three groups according to the total score—low, medium, and high—and according to the surgical procedure—radical and partial resection. The correlation between the total score and the score of each variable and the choice of surgical procedure was analysed. The agreement rate of the total score and the score of each variable for all three observers was over 90% ( P ≤ 0.001). The map scoring system based on the anatomical features of renal tumour imaging was well stabilized, and the scores were significantly correlated with the surgical approach.

POCUS Evaluation in Acute Kidney Injury

Acute kidney injury is a common clinical problem encountered in general internal medicine. The evaluation of acute kidney injury is mainly driven by the patient’s clinical history, physical exam and basic urinary/laboratory investigation. Point of care ultrasound (POCUS) may be a useful tool to help clinicians to narrow and/or prioritize differential diagnosis in patients presenting with acute kidney injury. Here we present a case of a 67-year old male presenting with dysuria, fevers, and flank pain along with elevation in serum creatinine who was admitted for acute kidney injury secondary to complicated urinary tract infection. Subsequent renal POCUS showed bilateral anechoic fluid collection within the renal sinus with dilated calyces suggestive of bilateral hydronephrosis most likely due to a new diagnosis of benign prostatic hyperplasia. This case demonstrates the use of POCUS added valuable diagnostic information and therapeutic management for this patient presenting with acute kidney injury.

Erdheim-Chester Disease - Multisystemic Radiological Manifestations

Erdheim-Chester disease (ECD) is a rare, multisystem disorder with a constellation of clinical and radiological findings. We present a case of ECD who came with acute obstructive uropathy and chronic bone pain. Radiological work up in this patient led to a host of findings in various systems, the correlation of which led to narrowing of the differential diagnoses. A 44-year-old male presented with right loin pain and nausea for 1-day duration. A provisional diagnosis of right ureteric colic was made. Routine lab investigations revealed normal total counts and urine analysis. Additional laboratory investigations revealed a raised erythrocyte sedimentation rate (ESR) and Creactive protein (CRP). Radiological Investigations 1. Patient was referred for ultrasound of abdomen which revealed mild to moderate right hydronephrosis with a suspicious hypoechoic area (~ 0.7 x 1.2 cm) in the renal pelvis region raising possibility of a lesion. 2. Contrast computed tomography (CT) study of abdomen was performed which revealed enhancing soft tissue infiltration (+30 to +45 HU) around bilateral kidneys (giving ‘hairy kidney appearance’) (Figures 1, 2 & 3) and adrenal glands with infiltration to renal sinus and constriction of bilateral renal pelves resulting in moderate right and mild left hydronephrosis. Thin streak of excreted contrast was traversing the narrowed segment of renal pelves (Figures 4 & 5). 3. Soft tissue infiltration covering the visualized thoracic and abdominal aorta (giving ‘coated aorta appearance’) (Figures 6 & 7), extending below renal arteries to aortic bifurcation and proximal bilateral common iliac arteries. 4. The adrenal glands were not separately visualized from the above mentioned perinephric soft tissue. 5. Both ureters were normal in course and caliber. No evidence of ureteric calculus. 6. No significant retroperitoneal lymphadenopathy. 7. Few tiny centriacinar nodules with patchy ground glass opacities in postero basal segment of both lungs (left > right) (Figure 8).

Effect of Dietary Strategies on Respiratory Quotient and Its Association with Clinical Parameters and Organ Fat Loss: A Randomized Controlled Trial

The relation between changes in respiratory quotient (RQ) following dietary interventions and clinical parameters and body fat pools remains unknown. In this randomized controlled trial, participants with moderate abdominal obesity or/and dyslipidemia (n = 159) were randomly assigned to a Mediterranean/low carbohydrate (MED/LC, n = 80) or a low fat (LF, n = 79) isocaloric weight loss diet and completed a metabolic assessment. Changes in RQ (measured by indirect calorimeter), adipose-tissue pools (MRI), and clinical measurements were assessed at baseline and after 6 months of intervention. An elevated RQ at baseline was significantly associated with increased visceral adipose tissue, hepatic fat, higher levels of insulin and homeostatic insulin resistance. After 6 months, body weight had decreased similarly between the diet groups (−6 ± 6 kg). However, the MED/LC diet, which greatly improved metabolic health, decreased RQ significantly more than the LF diet (−0.022 ± 0.007 vs. −0.002 ± 0.008, p = 0.005). Total cholesterol and diastolic blood pressure were independently associated with RQ changes (p = 0.045). RQ was positively associated with increased superficial subcutaneous-adipose-tissue but decreased renal sinus, pancreatic, and intramuscular fats after adjusting for confounders. Fasting RQ may reflect differences in metabolic characteristics between subjects affecting their potential individual response to the diet.

PROGNOSTIC FACTORS OF RENAL TUMOR RECURRENCE AFTER RADICAL NEPHRECTOMY

INTRODUCTION Renal cell carcinoma (RCC) represents 3% of overall malignant neoplasms in adults. However, its aetiology has not been clearly established. Although surgery represents the cornerstone in treatment, recurrence postoperative rates are around 20-30%, what implies prognostic factors search must be mandatory in order to help to plan de follow-up and the different adjuvant therapy possibilities available in case they were necessary. MATERIAL AND METHODS A retrospective observational study was carried out in 110 patients who underwent radical nephrectomy between 2004 and 2018, with the aim of identifying possible prognostic factors of recurrence of RCC after these surgeries. Preoperative data (epidemiological, comorbidities and laboratory tests), surgical, pathological and variables related to follow-up were taken into account. A univariate and multivariate analysis were performed, using chi-square test and logistic regression, respectively. RESULTS The median follow-up time was 53.5 months (SD = 35.8), time in which 19 patients had a recurrence of RCC after radical nephrectomy (17.2%). Histopathological items such as the surgical piece size, the nodal and microvascular invasion, the renal sinus invasion and the presence of necrosis in the surgical piece were associated with RCC recurrence in the univariate analysis, while only the presence of necrosis in the surgical piece showed a significant result in the multivariate analysis (p = 0.004). CONCLUSIONS Histopathological analysis, highlighting the presence of necrosis in the histological sample, was proved to be the main risk factor of RCC recurrence.

Differences in clinical and computed tomography imaging features between two types of mixed epithelial and stromal tumor of the kidney: Suggestions for patient management

Background To analyze the differences in clinical features and computed tomography characteristics in the two types of mixed epithelial and stromal tumor of the kidney (MESTK) and to establish a treatment plan for the MESTK types.Methods 17 patients underwent multidetector computed tomography (MDCT) before surgery and had a pathological diagnosis of MESTK were enrolled. Their clinical information (R.E.N.A.L.Nephrometry Score (R.E.N.A.L.－NS), radical nephrectomy (RN), partial nephrectomy (PN), etc.) were collected. The radiological features included renal sinus fat invagination (SFI), maximal diameter (MD), capsule and septa of the tumor, etc. were also analyzed. They were divided into two types according to the MDsolid/MDtumor ratio (type A with > 63%; type B with ≤ 63%). An independent-sample t-test and Fisher exact test were used to assess the differences between the two groups. Results MESTKs demonstrated a variable multi-septate cystic and solid components with a delayed enhancement. There were 9 patients for type A and 8 subjects for type B. Compared with type A, the lesions in type B have larger MD (79.13±39.06 vs. 41.22±24.19, p = 0.028), higher R.E.N.A.L.－NS (10.03±0.50 vs. 8.95±1.26, P＜0.001), higher RN (75.00% vs.22.22%, p =0.015), larger SFI (87.5% vs.33.3%, p=0.05), more septa (100% vs. 0%, p <0.001) and more capsule (100% vs. 11.1%, p < 0.001).Conclusion Type B MESTK has more hazardous features compared with type A, suggesting that RN is more suitable for type B and PN for type A.

RENAL LYMPHANGIECTASIA IN A PATIENT AFFECTED BY COVID-19

SUMMARY: In December 2019, a new subspecies of coronavirus was identied in China, which they called SARS-CoV-2, responsible for the subsequent disease that the WHO called COVID-19. The disease has spread rapidly causing a global pandemic. Much is still unknown about SARS-CoV-2, but early research supports the hypothesis that the severity of Covid-19 is conditioned by the hyperinammatory response that occurs in our body when in contact with SARS-CoV-2. The severity of the condition is related to the respiratory failure it causes, however, there are studies that do not limit pulmonary involvement. Research indicates that the access mechanism of SARS-CoV-2 to the body is closely related to the ACE2 enzyme. An enzyme that, among other tissues, can be found in the epithelium of renal tubular cells. This is the reason why there are data from patients with Covid-19 that have a great effect on kidney function. It is for this reason that this clinical case of renal lymphagectasia is presented. Renal lymphagectasia is a rare entity of renal lymphatics that occurs in both children and adults, it can be unilateral or bilateral and has no sex predilection. It is characterized because there is dilation of the lymphatic ducts, generating cavities occupied by a liquid content corresponding to lymph. Its most frequent locations are the neck (70%) and the armpit (20%). Renal lymphangiectasia (RFL) is of very low frequency and can be confused with other cystic pathologies of the kidney. RFL has been described by various names such as: renal lymphangioma, peri-pelvic lymphangiectasia, polycystic renal sinus disease, renal hygroma, and multicystic perippelvic renal lymphangiectasia. It is believed to occur due to an alteration in the communication between the renal lymphatic ducts and the retroperitoneal lymphatics. We report the case of an elderly patient with Covid-19 infection, and LFR, in which this alteration was discovered incidentally in the study of abdominal pain associated with microscopic hematuria. OBJECTIVE: Describe bilateral renal lymphangiectasia associated with covid-19 infection. DESIGN: Prospective, observational in a single center. METHODOLOGY: This is a systematic review of bilateral renal lymphangiectasia in a patient affected by the new coronavirus (Covid-19); emphasizing its clinical characteristics and its short-term complications. The information and images obtained belong to the medical staff in charge of the case, whose reinforcements are provided by the Excel, Word and JPG statistical package.