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Beijing Da Xue Xue Bao. Yi Xue Ban =... Jun 2021To construct a preoperative evaluation system for partial nephrectomy using CT three-dimensional visualization technology and to explore its practical value.
OBJECTIVE
To construct a preoperative evaluation system for partial nephrectomy using CT three-dimensional visualization technology and to explore its practical value.
METHODS
The clinical data of the patients who underwent partial nephrectomy for renal tumors in Department of Urology, Peking University First Hospital were collected retrospectively. At the same time, the homogenized standard data of patients who underwent partial nephrectomy for renal tumors were collected in 16 clinical centers in China. The CT three-dimensional visualization system was applied (IPS system, Yorktal) to evaluate tumor anatomy, blood supply, perirenal fat and other information. The parameters were summarized to build a three-dimensional nephrometry system, on the basis of which virtual surgery design and intraoperative navigation were completed.
RESULTS
A three-dimensional visualization image was established based on the enhanced CT urography. The nephrometry system included the longest diameter and volume of the tumor, proportion volume of tumor invading the parenchyma, maximum depth of the tumor invading the parenchyma, contact surface area, flatness of the tumor surface, renal segment where the tumor was located, vascular variation, and perirenal fat. The average two-dimensional diameter of the tumor was (2.78±1.43) cm, the average three-dimensional maximum diameter was (3.09±1.35) cm, and the average postoperative pathological size was (3.01±1.38) cm. The maximum tumor diameter in the three-dimensional image was significantly related to the prolonged renal artery clamping time and intra-operative blood loss (=0.502, =0.020; =0.403, =0.046). The three-dimensional and pathological tumor volume were (25.7±48.4) cm and (33.0±36.4) cm, respectively (=0.229). The tumor volume was significantly related to the intraoperative blood loss (=0.660, < 0.001). The proportion volume of the tumor invading into renal parenchyma was significantly related to the prolongation of renal artery clamping and the occurrence of postoperative complications (=0.410, =0.041; =0.587, =0.005). The tumor contact surface area and the presence of vascular variation did not show correlation with the perioperative data and postoperative complications. While the preoperative evaluation was completed, the reconstructed three-dimensional image could be zoomed, rotated, combined display, color adjustment, transparency, and simulated cutting on the Touch Viewer system. The process generally consisted of showing or hiding the tissue, adjusting the transparency of the interested area, rotating and zooming the image to match the position of the surgical patient. Together, these functions met the requirements of preoperative virtual surgery plan and intraoperative auxiliary navigation.
CONCLUSION
Three-dimensional images can provide a more intuitive anatomical structure. The CT three-dimensional visua-lization system clearly displays tumor anatomical parameters, blood supply and perirenal fat. The three-dimensional nephrometry system for renal tumors can help predict the difficulty of partial nephrectomy and perioperative complications. Importing the reconstructed three-dimensional visualization image into the specified program or robot operating system can complete virtual surgery and intraoperative navigation, helping the surgeon to better grasp the surgical process. The indexes included in the nephrometry system and the score weights of each index need to be confirmed and perfected by multi-center study with large samples.
Topics: China; Humans; Kidney; Kidney Neoplasms; Laparoscopy; Nephrectomy; Retrospective Studies
PubMed: 34145871
DOI: 10.19723/j.issn.1671-167X.2021.03.030 -
Journal of Nutritional Science 2022Excess body weight and hyperlipidaemia cause severe health problems and have social implications. Amycenone is an active substance extracted from Yamabushitake mushrooms...
Amycenone reduces excess body weight and attenuates hyperlipidaemia by inhibiting lipogenesis and promoting lipolysis and fatty acid β-oxidation in KK- obese diabetic mice.
Excess body weight and hyperlipidaemia cause severe health problems and have social implications. Amycenone is an active substance extracted from Yamabushitake mushrooms with no reports of its activity against excess body weight and hyperlipidaemia. This research clarifies the effects and mechanisms of action of amycenone on the inhibition of body weight excess and hyperlipidaemia attenuation using KK- mice. Amycenone or water was administered to 8-week-old male KK- mice by gavage for 8 weeks. Their body weight and food intake were recorded during the experiment. At the end of the experimental period, the mice were dissected, and blood samples, lipid metabolism-related organs and tissues were collected and stored for further analysis. Amycenone treatment suppressed body weight gain and improved serum levels of fasting blood glucose and non-esterified fatty acids. Additionally, serum and hepatic cholesterol and triacylglycerol levels were reduced after this treatment, whereas the phosphorylation levels of AMPK, PKA and HSL increased and the expression level of FAS decreased. The protein level of C/EBPβ and gene expression level of were higher in the perirenal adipose tissue of amycenone-treated KK- mice. Furthermore, amycenone phosphorylated AMPK, PKA and ACC, and PPARγ expression was lower in the mesenteric adipose tissue. The phosphorylation levels of AMPK, LKB1, PKA and ACC were also induced, and FAS expression level was reduced in the liver of the amycenone-treated group. Amycenone could reduce excess body weight and attenuate hyperlipidaemia in KK- mice by inhibiting lipogenesis and promoting lipolysis through lipid metabolism pathway stimulation and fatty acid β-oxidation acceleration.
Topics: AMP-Activated Protein Kinases; Animals; Body Weight; Diabetes Mellitus, Experimental; Fatty Acids; Hyperlipidemias; Lipogenesis; Lipolysis; Male; Mice; Mice, Obese; Obesity; Plant Extracts
PubMed: 35836693
DOI: 10.1017/jns.2022.43 -
Medicine Sep 2022Hematomas after percutaneous angiography often occur in the thigh, retroperitoneal, intraperitoneal, or abdominal wall. Renal hematoma after percutaneous angiography is...
RATIONALE
Hematomas after percutaneous angiography often occur in the thigh, retroperitoneal, intraperitoneal, or abdominal wall. Renal hematoma after percutaneous angiography is very rare.
DIAGNOSES
Herein, we present a case of perirenal hematoma and delayed contrast metabolism after cerebral angiograph, which may be caused by improper operation.
INTERVENTIONS
Conservative treatments which development by multi-disciplinary collaboration.
OUTCOMES
After treatment, the clinical symptoms of the patients gradually disappeared and the imaging results became negative.
CONCLUSION
Though the patient missed timely diagnosis and treatment, fortunately no catastrophic events occurred. Meanwhile, the potential causes, diagnosis, and therapeutic management were all discussed.
Topics: Angiography; Gastrointestinal Hemorrhage; Hematoma; Humans; Kidney Diseases; Retroperitoneal Space
PubMed: 36181057
DOI: 10.1097/MD.0000000000030807 -
Nutrition & Diabetes Jun 2024Vitamin D was shown to directly exert a protective effect on diabetic kidney disease (DKD) in our previous study. However, whether it has an effect on perirenal adipose...
BACKGROUND
Vitamin D was shown to directly exert a protective effect on diabetic kidney disease (DKD) in our previous study. However, whether it has an effect on perirenal adipose tissue (PRAT) or the intestinal flora and its metabolites (trimethylamine N-oxide, TMAO) is unclear.
METHODS
DKD mice were received different concentrations of 1,25-(OH)D for 2 weeks. Serum TNF-α levels and TMAO levels were detected. 16S rRNA sequencing was used to analyze gut microbiota. qPCR was used to detect the expression of TLR4, NF-Κb, PGC1α, and UCP-1 in kidney and adipose tissue. Histological changes in kidney and perirenal adipose tissue were observed using HE, PAS, Masson and oil red staining. Immunofluorescence and immunohistochemistry were used to detect the expression of VDR, PGC1α, podocin, and UCP-1 in kidney and adipose tissue. Electron microscopy was used to observe the pathological changes in the kidney. VDR knockout mice were constructed to observe the changes in the gut and adipose tissue, and immunofluorescence and immunohistochemistry were used to detect the expression of UCP-1 and collagen IV in the kidney.
RESULTS
1,25-(OH)D could improve the dysbiosis of the intestinal flora of mice with DKD, increase the abundance of beneficial bacteria, decrease the abundance of harmful bacteria, reduce the pathological changes in the kidney, reduce fat infiltration, and downregulate the expression of TLR4 and NF-κB in kidneys. The serum TMAO concentration in mice with DKD was significantly higher than that of the control group, and was significantly positively correlated with the urine ACR. In addition, vitamin D stimulated the expression of the surface markers PGC1α, UCP-1 and VDR in the PRAT in DKD mice, and TMAO downregulated the expression of PRAT and renal VDR.
CONCLUSIONS
The protective effect of 1,25-(OH)D in DKD mice may affect the intestinal flora and its related metabolite TMAO on perirenal fat and kidneys.
Topics: Animals; Gastrointestinal Microbiome; Mice; Kidney; Methylamines; Male; Receptors, Calcitriol; Mice, Knockout; Diabetic Nephropathies; Adipose Tissue; Mice, Inbred C57BL; Vitamin D; Calcitriol
PubMed: 38858392
DOI: 10.1038/s41387-024-00297-z -
Cureus Oct 2023Subcapsular hematoma (SRH) or perirenal hematoma (PRH) can be seen after trauma, interventional radiological procedures, urological procedures, anticoagulant...
Subcapsular hematoma (SRH) or perirenal hematoma (PRH) can be seen after trauma, interventional radiological procedures, urological procedures, anticoagulant medications, coagulation disorders, infections, and spontaneously in some patients. Within the urological procedures, PRH can occur after percutaneous nephrolithotomy and extracorporeal shortwave lithotripsy but has only been reported a few times after cystoscopy/ureteroscopy. Here, we present the case of PRH as a complication from cystoscopy with retrograde pyelography in a patient with underlying chronic kidney disease (CKD) and an extensive surgical history for nephrolithiasis. In addition to this, our patient had a further complication of sepsis by , of which the source is proven to be urinary, and it appears that the fungemia was triggered during the procedure as well. The diagnosis was confirmed by abdominal computed tomography (CT), and PRH was proven to resolve with conservative management on repeat imaging months later.
PubMed: 37933348
DOI: 10.7759/cureus.46602 -
Communications Biology Oct 2021Reindeer (Rangifer tarandus) are semi-domesticated animals adapted to the challenging conditions of northern Eurasia. Adipose tissues play a crucial role in northern...
Reindeer (Rangifer tarandus) are semi-domesticated animals adapted to the challenging conditions of northern Eurasia. Adipose tissues play a crucial role in northern animals by altering gene expression in their tissues to regulate energy homoeostasis and thermogenic activity. Here, we perform transcriptome profiling by RNA sequencing of adipose tissues from three different anatomical depots: metacarpal (bone marrow), perirenal, and prescapular fat in Finnish and Even reindeer (in Sakha) during spring and winter. A total of 16,212 genes are expressed in our data. Gene expression profiles in metacarpal tissue are distinct from perirenal and prescapular adipose tissues. Notably, metacarpal adipose tissue appears to have a significant role in the regulation of the energy metabolism of reindeer in spring when their nutritional condition is poor after winter. During spring, genes associated with the immune system are upregulated in the perirenal and prescapular adipose tissue. Blood and tissue parameters reflecting general physiological and metabolic status show less seasonal variation in Even reindeer than in Finnish reindeer. This study identifies candidate genes potentially involved in immune response, fat deposition, and energy metabolism and provides new information on the mechanisms by which reindeer adapt to harsh arctic conditions.
Topics: Adaptation, Biological; Adipose Tissue; Animals; Arctic Regions; Finland; Reindeer; Seasons; Siberia; Transcriptome
PubMed: 34620965
DOI: 10.1038/s42003-021-02703-z -
BioMed Research International 2021Percutaneous tumor ablation is usually performed using computed tomography (CT) or ultrasound (US) guidance, although reliable visualization of the target tumor could be...
OBJECTIVE
Percutaneous tumor ablation is usually performed using computed tomography (CT) or ultrasound (US) guidance, although reliable visualization of the target tumor could be challenging. Magnetic resonance- (MR-) guided ablation provides more reliable visualization of the target tumors and allows multiplanar imaging of the treatment process, making it the modality of choice, in particular if lesions are small.
METHODS
From March 2016 to January 2018, 32 patients scheduled for percutaneous treatment of T1 RCC underwent MR-guided MWA. Complications were classified according to the Clavien grade. Kaplan-Meier survival estimates were calculated to evaluate progression-free survival (PFS).
RESULTS
Technical success was achieved in all lesions. The mean energy and procedure duration were 61.6 ± 8.7 kJ and 118.2 ± 26.7 min, respectively. The glomerular filtration rate (GFR) dropped rapidly after 1 month of treatment and slowly recovered within three months ( < 0.05). Postoperative pain and fever were the most common adverse events after treatment. Perirenal hematoma, thermal injury of the psoas muscle, and abdominal distension were common complications after MWA, and the incidence rates were 9.4% (3/32), 6.3% (2/32), and 6.3% (2/32), respectively. According to the Clavien grade classification, serious complications include hydrothorax, bowel injury, and renal failure, all of which have a probability of 3.1%. Of note, the three serious complications occurred in one patient. The 1-, 2-, and 3-year PFS rates were 96.9%, 93.8%, and 83.9%, respectively. The mean PFS rates were 33.972 months (95% CI: 33.045, 35.900).
CONCLUSION
Microwave ablation is feasible under MR guidance and provides effective treatment of RCC in one session.
Topics: Adult; Aged; Carcinoma, Renal Cell; Female; Glomerular Filtration Rate; Hematoma; Humans; Hydrothorax; Kidney Neoplasms; Male; Microwaves; Middle Aged; Psoas Muscles; Radiofrequency Ablation; Renal Insufficiency; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography
PubMed: 34055980
DOI: 10.1155/2021/5537192 -
Prognostic impact of perirenal fat stranding on oncologic outcomes in ureteral urothelial carcinoma.Investigative and Clinical Urology Jan 2021Perirenal fat stranding (PRFS) is defined as linear areas of soft-tissue attenuation in the perirenal space that can result from ureteral obstruction. We analyzed the...
PURPOSE
Perirenal fat stranding (PRFS) is defined as linear areas of soft-tissue attenuation in the perirenal space that can result from ureteral obstruction. We analyzed the prognostic impact of PRFS on outcomes in patients with ureteral urothelial carcinoma (UC).
MATERIALS AND METHODS
Overall, 126 patients evaluated preoperatively by computerized tomography (CT) scan and diagnosed with ureteral UC following nephroureterectomy between January 2001 and May 2018 were included. We analyzed associations between oncologic outcomes and secondary signs such as hydronephrosis and PRFS.
RESULTS
Overall, 68 patients (54.0%) showed PRFS on preoperative CT scans. The patients' mean age was 66.33±9.49 years. A high pT stage (≥T3) was seen in 47 patients (37.3%) and high-grade tumors were seen in 90 patients (71.4%). Lymphovascular invasion (LVI) was seen in 15 patients (11.9%), and 5 (4.0%) were at the pN1 stage. Multivariate Cox analysis showed that cT stage≥3, PRFS, pT stage≥3, tumor grade, LVI, and pN1 stage were independent prognostic factors of recurrence-free survival (RFS) and cancer-specific survival (CSS) (all p<0.05).
CONCLUSIONS
PRFS was found to be an independent prognostic factor for RFS and CSS. PRFS is easily detectable in preoperative CT imaging and may be useful for improving the prediction of oncologic outcomes of ureteral UC. Therefore, PRFS along with other important preoperative CT findings can help urologists give preoperative advice to patients with ureteral UC before surgical management.
Topics: Aged; Blood Vessels; Carcinoma, Transitional Cell; Female; Humans; Intra-Abdominal Fat; Kidney; Lymphatic Vessels; Male; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Staging; Nephrectomy; Prognosis; Survival Rate; Tomography, X-Ray Computed; Ureteral Neoplasms; Ureteral Obstruction
PubMed: 33314805
DOI: 10.4111/icu.20200125 -
Oncology Letters Sep 2022Primary retroperitoneal perirenal CIC rearrangement sarcoma is rare. The current case report presents a 69-year-old male patient with this pathology, including the...
Primary retroperitoneal perirenal CIC rearrangement sarcoma is rare. The current case report presents a 69-year-old male patient with this pathology, including the clinical features, pathomorphology and immunohistochemistry, and CIC gene rupture detected by fluorescence hybridization (FISH). Furthermore, the relevant literature was reviewed. Histologically, the tumor was composed of diffuse nests of small- to medium-sized juvenile round blue cells with hyperchromatic nuclei, prominent nucleoli and occasional mitotic signs. The tumor involved adipose tissue with no obvious hemorrhagic necrotic foci. Immunohistochemistry indicated scattered expression of CD99 in tumor cells. FISH examination suggested that the CIC gene was fragmented and translocated.
PubMed: 35949589
DOI: 10.3892/ol.2022.13442 -
International Journal of Surgery Case... Oct 2021Emphysematous pyelonephritis (EPN) is an uncommon suppurative infection of renal parenchyma and perirenal tissue characterized by production of gas within renal...
INTRODUCTION
Emphysematous pyelonephritis (EPN) is an uncommon suppurative infection of renal parenchyma and perirenal tissue characterized by production of gas within renal parenchyma, collecting system or perinephric tissue.
CASE PRESENTATION
We report a case of young non diabetic female with past history of extracorporeal shock wave lithotripsy (ESWL) who presented with intermittent lower abdominal pain, dysuria and left lower limb swelling. Abdomen examination was notable for tenderness at left iliac fossa and fullness at left renal angle. Blood investigation showed leukocytosis and deranged creatinine levels. Urine analysis showed pyuria. Transabdominal ultrasound revealed left nephrolithiasis with moderate hydronephrosis, vesical calculus and double J (DJ) stent in situ. Patient was diagnosed as acute pyelonephritis and started on intravenous antibiotics. Despite on medical management, the condition deteriorated and progressed to septic shock. Computed tomography of kidneys, ureters and bladder (CT KUB) showed air fluid level in calyceal system with perinephric collection and confirmed diagnosis as emphysematous pyelonephritis. Patient underwent surgical drainage to control the sepsis. Few days later after control of sepsis and optimization, left nephrectomy and removal of retained DJ stent was done.
CLINICAL DISCUSSION
This case report highlights the need to consider emphysematous pyelonephritis as a possible diagnosis in patients harbouring DJ stents even in young non diabetics. Early aggressive medical management coupled with urological intervention is a valuable alternative to upfront emergent nephrectomy. However, surgery should not be delayed in patient with fulminant infection at presentation or who failed on conservative management.
CONCLUSION
Emphysematous pyelonephritis warrants high index of suspicion for timely diagnosis and can be fatal if not recognized early and promptly treated.
PubMed: 34534814
DOI: 10.1016/j.ijscr.2021.106405