Effect of Ajwa date seed powder on visceral fat depots and inflammatory response in high fat fed Sprague Dawley female rats.

ABSTRACT Background: Central obesity a worldwide metabolic and cosmetic problem poses significant health risk. Ajwa date seed has antioxidant property and its high fiber content may prevent fat absorption and reduce fat deposition. Objective: To evaluate the effect of Ajwa date seed powder on visceral fat depots and inflammatory response in high fat fed Sprague Dawley female rats. Methodology: Thirty-six healthy rats of four weeks age were divided into three groups and followed for 12 weeks. Group A (normal control) received regular diet. Group B (HFD control) received high fat diet, while group C (HFD+Ajwa group) received high fat diet along with 2% Ajwa date seed powder. Body weight was measured weekly. Blood sample was drawn for the estimation of serum IL-6 and leptin levels by ELISA method at 12th week. After which rats were euthanized; perinephric fat was removed and weighed in grams. Results: HFD+Ajwa group gained less body weight as compared to HFD control group (p value = 0.012). There was a remarkable reduction in perinephric fat weight (p value ≤ 0.001) and level of IL-6 in HFD+Ajwa group (p value ≤ 0.001) as compared to HFD control. There was no significant difference in serum leptin level of the rats of all groups (p value = 0.567). Conclusion: Ajwa date seed can prevent visceral adiposity and gain in body weight. Moreover, it has anti-inflammatory effect; but no significant effect on satiety hormone. Key Words: Obesity, Visceral fat, P. dactylifera L (Ajwa date) seed, IL-6, Leptin.

Analysis of Clinical Characteristics, Radiological Predictors, Pathological Features, and Perioperative Outcomes Associated with Perinephric Fat Adhesion Degree

Background. To assess the clinical characteristics, radiological predictors, and pathological features of perinephric fat adhesion degree (PFAD) graded based on fixed criteria and to determine the impact of adherent perinephric fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN) outcomes. Methods. 84 patients undergoing RLPN were included and graded into 4 groups based on PFAD. Univariate and multivariate analyses were performed for clinical characteristics and radiological predictors of PFAD. Perioperative data were compared between APF groups and non-APF groups. Masson staining determined collagen fibers. Immunohistochemistry detected CD45 immune cells and CD34 vessels. Results. 20, 28, 18, and 18 patients were graded as normal perinephric fat (NPF), mild adherent perinephric fat (MiPF), moderate adherent perinephric fat (MoPF), and severe adherent perinephric fat (SPF), respectively. Multivariate analysis revealed that gender ( p < 0.001), age ( p = 0.003), and hypertension ( p = 0.006) were significant clinical risk factors of PFAD, while radiological predictors included perinephric stranding ( p = 0.001), posterior perinephric fat thickness ( p = 0.009), and perinephric fat density ( p = 0.02). APF was associated with drain output ( p = 0.012) and accompanied by immune cells gathering in renal cortex near thickened renal capsule with many vessels. Conclusions. Clinical characteristics and radiological predictors can evaluate PFAD and may assist to guide preoperative surgical option. Pathological features of APF reflect decapsulation and bleeding during kidney mobilization at RLPN.

Value of Radiomics of Perinephric Fat for Prediction of Intraoperative Complexity in Renal Tumor Surgery

<b><i>Introduction:</i></b> The aim of this study was to assess the value of computed tomography (CT)-based radiomics of perinephric fat (PNF) for prediction of surgical complexity. <b><i>Methods:</i></b> Fifty-six patients who underwent renal tumor surgery were included. Radiomic features were extracted from contrast-enhanced CT. Machine learning models using radiomic features, the Mayo Adhesive Probability (MAP) score, and/or clinical variables (age, sex, and body mass index) were compared for the prediction of adherent PNF (APF), the occurrence of postoperative complications (Clavien-Dindo Classification ≥2), and surgery duration. Discrimination performance was assessed by the area under the receiver operating characteristic curve (AUC). In addition, the root mean square error (RMSE) and <i>R</i>² (fraction of explained variance) were used as additional evaluation metrics. <b><i>Results:</i></b> A single feature logit model containing “Wavelet-LHH-transformed GLCM Correlation” achieved the best discrimination (AUC 0.90, 95% confidence interval [CI]: 0.75–1.00) and lowest error (RMSE 0.32, 95% CI: 0.20–0.42) at prediction of APF. This model was superior to all other models containing all radiomic features, clinical variables, and/or the MAP score. The performance of uninformative benchmark models for prediction of postoperative complications and surgery duration were not improved by machine learning models. <b><i>Conclusion:</i></b> Radiomic features derived from PNF may provide valuable information for preoperative risk stratification of patients undergoing renal tumor surgery.

Study on the correlation between preoperative inflammatory indexes and adhesional perinephric fat before laparoscopic partial nephrectomy

Objective This study was aimed to evaluate the effect of preoperative composite inflammatory index on adhesional perinephric fat (APF), providing a help for preoperative risk assessment of laparoscopic partial nephrectomy (LPN) in patients with renal cell carcinoma. Materials and methods A retrospective study was conducted on 231 patients with renal cell carcinoma, who underwent laparoscopic partial nephrectomy. They were divided into two groups according to whether there was APF during operation. Relevant clinical data, laboratory parameters and imaging examination were obtained before operation to calculate the composite inflammatory index and MAP score. The composite inflammatory index was divided into high value group and low value group by ROC curve method. The related predictive factors of APF were analyzed by logistic regression method. Results The APF was found in 105 patients (45.5%). In multivariate analysis, systemic immune inflammation index (SII) (high/low), MAP score, tumor size and perirenal fat thickness were independent predictors of APF. The operation time of patients with APF was longer, and the difference of blood loss was not statistically significant. Conclusion SII is an independent predictor of APF before laparoscopic partial nephrectomy. Trial registration ChiCTR, ChiCTR2100045944. Registered 30 April 2021—Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=125703.

Analysis of predictors of adherent perinephric fat and its impact on perioperative outcomes in laparoscopic partial nephrectomy: a retrospective case–control study

Background Adherent perinephric fat (APF), characterized by inflammatory fat surrounding the kidney, can limit the isolation of renal tumors and increase the operative difficulty in laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the predictors of APF and its impact on perioperative outcomes during LPN. Methods A total of 215 consecutive patients undergoing LPN for renal cell carcinoma (RCC) from January 2017 to June 2019 at our institute were included. We divided these patients into two groups according to the presence of APF. Radiographic data were retrospectively collected from preoperative cross-sectional imaging. The perioperative clinical parameters were compared between the two groups. Univariate and multivariate analyses were performed to evaluate the predictive factors of APF. Results APF was identified in 41 patients (19.1%) at the time of LPN. Univariate analysis demonstrated that APF was significantly correlated with the male gender (P = 0.001), higher body mass index (P = 0.002), lower preoperative estimated glomerular filtration rate (P = 0.004), greater posterior perinephric fat thickness (P< 0.001), greater perinephric stranding (P< 0.001), and higher Mayo Adhesive Probability (MAP) score (P< 0.001). The MAP score (P< 0.001) was the only variable that remained an independent predictor for APF in multivariate analysis. We found that patients with APF had longer operative times (P< 0.001), warm ischemia times (P = 0.001), and greater estimated blood loss (P = 0.003) than those without APF. However, there were no significant differences in surgical approach, transfusion rate, length of postoperative stay, complication rate, or surgical margin between the two groups. Conclusions Several specific clinical and radiographic factors including the MAP score can predict APF. The presence of APF is associated with an increased operative time, warm ischemia time, and greater estimated blood loss but has no impact on other perioperative outcomes in LPN.

1324 Open Partial Nephrectomy for Renal Cell Carcinoma

Open partial nephrectomy, or nephron-sparing surgery (NSS), is now considered as the standard for small renal tumors treatment. The oncologic efficacy and safety of NSS for the treatment of stage-T1a renal tumors have been repeatedly demonstrated to be equivalent to radical nephrectomy. A 66-year-old gentleman chronic smoker was incidentally found to have a small mid pole lesion in the left kidney on routine ultrasound scan, CT finding was 2x2 cm mid pole tumor, no involvement or metastasis, the patient given the option of partial nephrectomy. In surgery, the left kidney was explored, and the tumor mass was seen to occupy the mid pole. The mid pole branch of the renal artery was clamped after cooling the kidney with ice slush following 300cc of 20% mannitol infusion. In-situ nephron-sparing left nephrectomy was done with a margin of 1cm minor upper calyceal injury repaired. The patient was discharged five days postoperative. Gross examination of the specimen revealed a wedge biopsy of the mid pole with attached perinephric fat with swelling part at the outer surface, pushing the capsule. Microscopic sections show a well-defined tumor mass in the renal parenchyma, surrounded by a fibrous capsule, composed of a multilocular cystic area lined by malignant cells. NSS initially was reserved for patients with solitary kidneys, tumors, and those with significant comorbidities predisposing to future renal failure; indications have expanded recently to allow elective partial nephrectomy in the setting of a normal contralateral kidney.

Analysis of Clinical Characteristics, Radiological Predictors, Pathological Features and Perioperative Outcomes Associated with Perinephric Fat Adhesion Degree

Background To assess the clinical characteristics, radiological predictors and pathological features of perinephric fat adhesion degree (PFAD) graded based on fixed criteria and to determine the impact of adherent perinephric fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN) outcomes. Methods 84 patients undergoing RLPN were included and graded into 4 groups based on PFAD. Univariate and multivariate analysis were performed for clinical characteristics and radiological predictors of PFAD. Perioperative data was compared between APF groups and non-APF groups. Masson staining determined collagen fibers. Immunohistochemistry detected CD45 immune cells and CD34 vessels. Results: 20, 28, 18 and 18 patients were graded as normal perinephric fat (NPF), mild adherent perinephric fat (MiPF), moderate adherent perinephric fat (MoPF) and severe adherent perinephric fat (SPF), respectively. Multivariate analysis revealed that gender (p < 0.001), age (p = 0.003) and hypertension (p = 0.006) were significant clinical risk factors of PFAD, while radiological predictors included perinephric stranding (p = 0.001), posterior perinephric fat thickness (p = 0.009) and perinephric fat density (p = 0.02). APF was associated with drain output (P = 0.012) and accompanied by immune cells gathering in renal cortex near thickened renal capsule with many vessels. Conclusions Clinical characteristics and radiological predictors can evaluate PFAD and may assist guide preoperative surgical option. Pathological features of APF reflect decapsulation and bleeding during kidney mobilization at RLPN.

Analysis of Clinical Characteristics, Radiological Predictors, Pathological Features and Perioperative Outcomes Associated With Perinephric Fat Adhesion Degree

Background: To assess the clinical characteristics, radiological predictors and pathological features of perinephric fat adhesion degree (PFAD) graded based on fixed criteria and to determine the impact of adherent perinephric fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN) outcomes. Methods: 84 patients undergoing RLPN were included and graded into 4 groups based on PFAD. Univariate and multivariate analysis were performed for clinical characteristics and radiological predictors of PFAD. Perioperative data was compared between APF groups and non-APF groups. Masson staining determined collagen fibers. Immunohistochemistry detected CD45 immune cells and CD34 vessels.Results: 20, 28, 18 and 18 patients were graded as normal perinephric fat (NPF), mild adherent perinephric fat (MiPF), moderate adherent perinephric fat (MoPF) and severe adherent perinephric fat (SPF), respectively. Multivariate analysis revealed that gender (p<0.001), age (p=0.003) and hypertension (p=0.006) were significant clinical risk factors of PFAD, while radiological predictors included perinephric stranding (p=0.001), posterior perinephric fat thickness (p=0.009) and perinephric fat density (p=0.02). APF was associated with drain output (P = 0.012) and accompanied by immune cells gathering in renal cortex near thickened renal capsule with many vessels.Conclusions: Clinical characteristics and radiological predictors can evaluate PFAD and may assist guide preoperative surgical option. Pathological features of APF reflect decapsulation and bleeding during kidney mobilization at RLPN.