Artificial Intelligence(AI)becomes one hotspot in the field of the medical images analysis and provides rather promising solution.Although some research has been explored in smart diagnosis for the common diseases of ...Artificial Intelligence(AI)becomes one hotspot in the field of the medical images analysis and provides rather promising solution.Although some research has been explored in smart diagnosis for the common diseases of urinary system,some problems remain unsolved completely A nine-layer Convolutional Neural Network(CNN)is proposed in this paper to classify the renal Computed Tomography(CT)images.Four group of comparative experiments prove the structure of this CNN is optimal and can achieve good performance with average accuracy about 92.07±1.67%.Although our renal CT data is not very large,we do augment the training data by affine,translating,rotating and scaling geometric transformation and gamma,noise transformation in color space.Experimental results validate the Data Augmentation(DA)on training data can improve the performance of our proposed CNN compared to without DA with the average accuracy about 0.85%.This proposed algorithm gives a promising solution to help clinical doctors automatically recognize the abnormal images faster than manual judgment and more accurately than previous methods.展开更多
AIMTo investigate the role of contrast enhanced ultrasound (CEUS) in evaluating patients with renal function impairment (RFI) showing: (1) acute renal failure (ARF) of suspicious vascular origin; or (2) suspicious ren...AIMTo investigate the role of contrast enhanced ultrasound (CEUS) in evaluating patients with renal function impairment (RFI) showing: (1) acute renal failure (ARF) of suspicious vascular origin; or (2) suspicious renal lesions.METHODSWe retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF (first group of 50 subjects) or assess previously found suspicious renal lesions (second group of 41 subjects with acute or chronic RFI). After preliminary grey-scale and color Doppler investigation, each kidney was investigated individually with CEUS, using 1.2-2.4 mL of a sulfur hexafluoride-filled microbubble contrast agent. Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS. We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second group.RESULTSIn the first group, CEUS detected renal infarction or cortical ischemia in 18/50 patients (36%; 95%CI: 23.3-50.9) and 1/50 patients (2%; 95%CI: 0.1-12), respectively. The detection rate of infarction was significantly higher (P = 0.0002; McNemar test) compared to color Doppler ultrasonography (10%). No vascular causes of ARF were identified in the remaining 31/50 patients (62%). In the second group, CEUS detected 41 lesions on 39 patients, allowing differentiation between solid lesions (21/41; 51.2%) vs complex cysts (20/41; 48.8%), and properly addressing 15/39 patients to intervention when feasible based on clinical conditions (surgery and cryoablation in 13 and 2 cases, respectively). Cysts were categorized Bosniak II, IIF, III and IV in 8, 5, 4 and 3 cases, respectively. In the remaining two patients, CEUS found 1 pseudolesion and 1 subcapsular hematoma.CONCLUSIONCEUS showed high detection rate of renal perfusion abnormalities in patients with ARF, influencing the management of patients with acute or chronic RFI and renal masses throughout their proper characterization.展开更多
Spontaneous regression of a malignant tumor is a very rare phenomenon.Renal cell carcinoma(RCC)is an aggressive malignancy with an often unpredictable behaviour.The incidence of spontaneous regression in metastatic RC...Spontaneous regression of a malignant tumor is a very rare phenomenon.Renal cell carcinoma(RCC)is an aggressive malignancy with an often unpredictable behaviour.The incidence of spontaneous regression in metastatic RCC has been estimated to lie between<1%and 7%.The spontaneous regression of a primary RCC has been reported much less commonly.Our literature review assesses the published literature concerning spontaneous regression of either primary or metastatic RCC.In order to examine this phenomenon in more detail we performed a literature search in the Pub Med Database using the Keywords"renal cell carcinoma","metastatic disease",and"spontaneous regression"and included reports from the last100 years.The incidence of spontaneous regressions in RCC has always been considered a special feature of RCC compared to other solid malignancies.The majority of case reports of spontaneously regressed RCC describe the regression of metastases after nephrectomy rather than the spontaneous regression of a primary tumor.In cases of reported regression of metastatic RCC,this mostly applied to pulmonarylesions.As possible reasons for spontaneous regressions host immune defense mechanisms against metastatic RCC tissue following nephrectomy are discussed as important factor.RCC is known to be highly immunogenic and the possible existence of cytotoxic serum factors and tumor-specific surface antigens may trigger a cell-mediated cytotoxicity as an immunological basis for regression.Histological verification of supposed regression of a primary tumor may cause diagnostic difficulties,since large central areas of necrosis and cystic lesions of the tumor can occur simultaneously.The well-known phenomenon of necrosis in a fast growing RCC at the time of nephrectomy must not be confused with true spontaneous regression.Therefore,in our opinion such reported cases of supposed partial spontaneous regressions of primary RCCs are highly questionable.Most cases of spontaneous regression of RCC metastases have been reported after nephrectomy as the only treatment.Debulking by tumor nephrectomy then gives the immune system the chance to cope effectively with the remaining much lower quantity of tumour antigens.However,the mechanisms leading to spontaneous regression of metastatic lesions after cytoreductive nephrectomy are still poorly understood.展开更多
To observe the expression of P-selectin and the localization of dendritic cells (DCs) in human kidney with IgA nephropathy, and to evaluate their function in human renal tubulointerstitial lesions and renal dysfunctio...To observe the expression of P-selectin and the localization of dendritic cells (DCs) in human kidney with IgA nephropathy, and to evaluate their function in human renal tubulointerstitial lesions and renal dysfunction, 45 biopsy specimens of patients with IgA nephropathy were divided into 3 groups according to the degree of renal tubulointerstitial lesions: i. e. mild group ( n =29), moderate group ( n =10), severe group ( n =6). Ten normal renal tissues severed as control. The expression of P-selectin was analysed by immunohistochemistry. CD1a +CD80 +DCs were investigated by double immunostaining method and the images were analyzed with Axioplan 2 microscopy. The experimental results showed that (1) P-selectin was not expressed in normal controls, but presented mainly in renal tubular epithelial cells, which was greater in severe group than mild and moderate groups. The expression of P-selectin was associated with the degree of renal tubulointerstitial lesions. (2) CD1a +CD80 +DCs were hardly observed in nomal renal tissues, but in renal tissues of patients with IgA nephropathy, CD1a +CD80 +DCs were mostly found in renal tubulointerstitium. Also the distribution area, number and density of CD1a +CD80 +DCs in severe group was much more than other groups, which was associated with the degree of renal tubulointerstitial lesions and the lever of serum creatine. The distribution of CD1a +CD80 +DCs was associated with the expression of P-selectin in patient′s renal tubulointerstitium. The present study demonstrated that P-selectin and DCs might play an important role in renal tubulointerstitial lesions of IgA nephropathy, and DCs recruited into the renal tissues with IgA nephropathy might be mediated by P-selectin.展开更多
A case of metastatic sarcomatoid renal cell carcinoma to the mandible treated with Sorafenib is reported. A 76-year-old man consulted us for hyposthesia of the right lower lip. Panorama X-ray film showed a ra-diolucen...A case of metastatic sarcomatoid renal cell carcinoma to the mandible treated with Sorafenib is reported. A 76-year-old man consulted us for hyposthesia of the right lower lip. Panorama X-ray film showed a ra-diolucent lesion in the right mandibular body. A diagnosis of metastatic tumor to the mandible from the left kidney was made after evaluation by computed tomography and positron emission tomography, which also revealed multiple bone metastases. After radiotherapy for mandibular and thoracic lesions, nephrectomy was performed. Histological diagnosis was sarcomatoid renal cell carcinoma. Interferon therapy was performed but was not effective;therefore, a molecular targeted drug, Sorafenib, was administered. Sorafenib effectively inhibited the growth of oral and other metastatic lesions for 10 months. Quality of life was relatively well maintained with tolerable adverse effects. The patient survived for as long as 2 years after appearance of the first symptom.展开更多
基金This study was supported by National Educational Science Plan Foundation“in 13th Five-Year”(DIA170375),ChinaGuangxi Key Laboratory of Trusted Software(kx201901)British Heart Foundation Accelerator Award,UK.
文摘Artificial Intelligence(AI)becomes one hotspot in the field of the medical images analysis and provides rather promising solution.Although some research has been explored in smart diagnosis for the common diseases of urinary system,some problems remain unsolved completely A nine-layer Convolutional Neural Network(CNN)is proposed in this paper to classify the renal Computed Tomography(CT)images.Four group of comparative experiments prove the structure of this CNN is optimal and can achieve good performance with average accuracy about 92.07±1.67%.Although our renal CT data is not very large,we do augment the training data by affine,translating,rotating and scaling geometric transformation and gamma,noise transformation in color space.Experimental results validate the Data Augmentation(DA)on training data can improve the performance of our proposed CNN compared to without DA with the average accuracy about 0.85%.This proposed algorithm gives a promising solution to help clinical doctors automatically recognize the abnormal images faster than manual judgment and more accurately than previous methods.
文摘AIMTo investigate the role of contrast enhanced ultrasound (CEUS) in evaluating patients with renal function impairment (RFI) showing: (1) acute renal failure (ARF) of suspicious vascular origin; or (2) suspicious renal lesions.METHODSWe retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF (first group of 50 subjects) or assess previously found suspicious renal lesions (second group of 41 subjects with acute or chronic RFI). After preliminary grey-scale and color Doppler investigation, each kidney was investigated individually with CEUS, using 1.2-2.4 mL of a sulfur hexafluoride-filled microbubble contrast agent. Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS. We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second group.RESULTSIn the first group, CEUS detected renal infarction or cortical ischemia in 18/50 patients (36%; 95%CI: 23.3-50.9) and 1/50 patients (2%; 95%CI: 0.1-12), respectively. The detection rate of infarction was significantly higher (P = 0.0002; McNemar test) compared to color Doppler ultrasonography (10%). No vascular causes of ARF were identified in the remaining 31/50 patients (62%). In the second group, CEUS detected 41 lesions on 39 patients, allowing differentiation between solid lesions (21/41; 51.2%) vs complex cysts (20/41; 48.8%), and properly addressing 15/39 patients to intervention when feasible based on clinical conditions (surgery and cryoablation in 13 and 2 cases, respectively). Cysts were categorized Bosniak II, IIF, III and IV in 8, 5, 4 and 3 cases, respectively. In the remaining two patients, CEUS found 1 pseudolesion and 1 subcapsular hematoma.CONCLUSIONCEUS showed high detection rate of renal perfusion abnormalities in patients with ARF, influencing the management of patients with acute or chronic RFI and renal masses throughout their proper characterization.
文摘Spontaneous regression of a malignant tumor is a very rare phenomenon.Renal cell carcinoma(RCC)is an aggressive malignancy with an often unpredictable behaviour.The incidence of spontaneous regression in metastatic RCC has been estimated to lie between<1%and 7%.The spontaneous regression of a primary RCC has been reported much less commonly.Our literature review assesses the published literature concerning spontaneous regression of either primary or metastatic RCC.In order to examine this phenomenon in more detail we performed a literature search in the Pub Med Database using the Keywords"renal cell carcinoma","metastatic disease",and"spontaneous regression"and included reports from the last100 years.The incidence of spontaneous regressions in RCC has always been considered a special feature of RCC compared to other solid malignancies.The majority of case reports of spontaneously regressed RCC describe the regression of metastases after nephrectomy rather than the spontaneous regression of a primary tumor.In cases of reported regression of metastatic RCC,this mostly applied to pulmonarylesions.As possible reasons for spontaneous regressions host immune defense mechanisms against metastatic RCC tissue following nephrectomy are discussed as important factor.RCC is known to be highly immunogenic and the possible existence of cytotoxic serum factors and tumor-specific surface antigens may trigger a cell-mediated cytotoxicity as an immunological basis for regression.Histological verification of supposed regression of a primary tumor may cause diagnostic difficulties,since large central areas of necrosis and cystic lesions of the tumor can occur simultaneously.The well-known phenomenon of necrosis in a fast growing RCC at the time of nephrectomy must not be confused with true spontaneous regression.Therefore,in our opinion such reported cases of supposed partial spontaneous regressions of primary RCCs are highly questionable.Most cases of spontaneous regression of RCC metastases have been reported after nephrectomy as the only treatment.Debulking by tumor nephrectomy then gives the immune system the chance to cope effectively with the remaining much lower quantity of tumour antigens.However,the mechanisms leading to spontaneous regression of metastatic lesions after cytoreductive nephrectomy are still poorly understood.
基金This study was supported by grants from the National Natural Science Foundation of China (39970340) Scientific Found of the Chinese Ministry of Health (98 2 283) and Natural Science Foundation of Shanghai (02ZB14041and 034119916)
文摘To observe the expression of P-selectin and the localization of dendritic cells (DCs) in human kidney with IgA nephropathy, and to evaluate their function in human renal tubulointerstitial lesions and renal dysfunction, 45 biopsy specimens of patients with IgA nephropathy were divided into 3 groups according to the degree of renal tubulointerstitial lesions: i. e. mild group ( n =29), moderate group ( n =10), severe group ( n =6). Ten normal renal tissues severed as control. The expression of P-selectin was analysed by immunohistochemistry. CD1a +CD80 +DCs were investigated by double immunostaining method and the images were analyzed with Axioplan 2 microscopy. The experimental results showed that (1) P-selectin was not expressed in normal controls, but presented mainly in renal tubular epithelial cells, which was greater in severe group than mild and moderate groups. The expression of P-selectin was associated with the degree of renal tubulointerstitial lesions. (2) CD1a +CD80 +DCs were hardly observed in nomal renal tissues, but in renal tissues of patients with IgA nephropathy, CD1a +CD80 +DCs were mostly found in renal tubulointerstitium. Also the distribution area, number and density of CD1a +CD80 +DCs in severe group was much more than other groups, which was associated with the degree of renal tubulointerstitial lesions and the lever of serum creatine. The distribution of CD1a +CD80 +DCs was associated with the expression of P-selectin in patient′s renal tubulointerstitium. The present study demonstrated that P-selectin and DCs might play an important role in renal tubulointerstitial lesions of IgA nephropathy, and DCs recruited into the renal tissues with IgA nephropathy might be mediated by P-selectin.
文摘A case of metastatic sarcomatoid renal cell carcinoma to the mandible treated with Sorafenib is reported. A 76-year-old man consulted us for hyposthesia of the right lower lip. Panorama X-ray film showed a ra-diolucent lesion in the right mandibular body. A diagnosis of metastatic tumor to the mandible from the left kidney was made after evaluation by computed tomography and positron emission tomography, which also revealed multiple bone metastases. After radiotherapy for mandibular and thoracic lesions, nephrectomy was performed. Histological diagnosis was sarcomatoid renal cell carcinoma. Interferon therapy was performed but was not effective;therefore, a molecular targeted drug, Sorafenib, was administered. Sorafenib effectively inhibited the growth of oral and other metastatic lesions for 10 months. Quality of life was relatively well maintained with tolerable adverse effects. The patient survived for as long as 2 years after appearance of the first symptom.
