IMU-Based Energy Expenditure Estimation for Various Walking Conditions Using a Hybrid CNN-LSTM Model.

In ubiquitous healthcare systems, energy expenditure estimation based on wearable sensors such as inertial measurement units (IMUs) is important for monitoring the intensity of physical activity. Although several studies have reported data-driven methods to estimate energy expenditure during activities of daily living using wearable sensor signals, few have evaluated the performance while walking at various speeds and inclines. In this study, we present a hybrid model comprising a convolutional neural network (CNN) and long short-term memory (LSTM) to estimate the steady-state energy expenditure under various walking conditions based solely on IMU data. To implement and evaluate the model, we performed level/inclined walking and level running experiments on a treadmill. With regard to the model inputs, the performance of the proposed model based on fixed-size sequential data was compared with that of a method based on stride-segmented data under different conditions in terms of the sensor location, input sequence format, and neural network model. Based on the experimental results, the following conclusions were drawn: (i) the CNN-LSTM model using a two-second sequence from the IMU attached to the lower body yielded optimal performance, and (ii) although the stride-segmented data-based method showed superior performance, the performance difference between the two methods was not significant; therefore, the proposed model based on fixed-size sequential data may be considered more practical as it does not require heel-strike detection.

NOVEL SIMPLEXVIRUS (SIMPLEXVIRUS DOLICHOTINEALPHA1) ASSOCIATED WITH FATALITY IN FOUR PATAGONIAN MARA (DOLICHOTIS PATAGONUM).

Four of seven Patagonian maras (Dolichotis patagonum) at a zoological institution developed acute neurologic signs that progressed to tetraparesis and death. All affected were young adult females (10 mon-5 yr old) that presented over 11 d. Clinical signs were rapidly progressive and unresponsive to supportive therapies. Two of the four individuals were found deceased 4 d after hospitalization. Two individuals were euthanized due to poor prognosis and decline after 6 and 8 d, respectively. Simultaneously, an additional mara developed mild and self-resolving clinical signs, including a kyphotic gait and paraparesis. On gross examination, there were widespread petechiae and ecchymoses of the skeletal muscle, myocardium, skin, pericardium, urinary bladder mucosa, and spinal cord. On histopathology, all animals had necrotizing myelitis and rhombencephalitis, with intranuclear viral inclusions in three individuals. Electron microscopy confirmed herpesviral replication and assembly complexes in neurons and oligodendrocytes. Consensus PCR performed on spinal cord, brainstem, or cerebellum revealed a novel Simplexvirus most closely related to Simplexvirus leporidalpha 4. The virus was amplified and sequenced and is referred to as Simplexvirus dolichotinealpha1. It is unknown whether this virus is endemic in Patagonian mara or whether it represents an aberrant host species. Clinicians should be aware of this virus and its potential to cause severe, rapidly progressive, life-threatening disease in this species.

Effects of Data Augmentation on the Nine-Axis IMU-Based Orientation Estimation Accuracy of a Recurrent Neural Network.

The nine-axis inertial and measurement unit (IMU)-based three-dimensional (3D) orientation estimation is a fundamental part of inertial motion capture. Recently, owing to the successful utilization of deep learning in various applications, orientation estimation neural networks (NNs) trained on large datasets, including nine-axis IMU signals and reference orientation data, have been developed. During the training process, the limited amount of training data is a critical issue in the development of powerful networks. Data augmentation, which increases the amount of training data, is a key approach for addressing the data shortage problem and thus for improving the estimation performance. However, to the best of our knowledge, no studies have been conducted to analyze the effects of data augmentation techniques on estimation performance in orientation estimation networks using IMU sensors. This paper selects three data augmentation techniques for IMU-based orientation estimation NNs, i.e., augmentation by virtual rotation, bias addition, and noise addition (which are hereafter referred to as rotation, bias, and noise, respectively). Then, this paper analyzes the effects of these augmentation techniques on estimation accuracy in recurrent neural networks, for a total of seven combinations (i.e., rotation only, bias only, noise only, rotation and bias, rotation and noise, and rotation and bias and noise). The evaluation results show that, among a total of seven augmentation cases, four cases including 'rotation' (i.e., rotation only, rotation and bias, rotation and noise, and rotation and bias and noise) occupy the top four. Therefore, it may be concluded that the augmentation effect of rotation is overwhelming compared to those of bias and noise. By applying rotation augmentation, the performance of the NN can be significantly improved. The analysis of the effect of the data augmentation techniques presented in this paper may provide insights for developing robust IMU-based orientation estimation networks.

Inertial Motion Capture-Based Wearable Systems for Estimation of Joint Kinetics: A Systematic Review.

In biomechanics, joint kinetics has an important role in evaluating the mechanical load of the joint and understanding its motor function. Although an optical motion capture (OMC) system has mainly been used to evaluate joint kinetics in combination with force plates, inertial motion capture (IMC) systems have recently been emerging in joint kinetic analysis due to their wearability and ubiquitous measurement capability. In this regard, numerous studies have been conducted to estimate joint kinetics using IMC-based wearable systems. However, these have not been comprehensively addressed yet. Thus, the aim of this review is to explore the methodology of the current studies on estimating joint kinetic variables by means of an IMC system. From a systematic search of the literature, 48 studies were selected. This paper summarizes the content of the selected literature in terms of the (i) study characteristics, (ii) methodologies, and (iii) study results. The estimation methods of the selected studies are categorized into two types: the inverse dynamics-based method and the machine learning-based method. While these two methods presented different characteristics in estimating the kinetic variables, it was demonstrated in the literature that both methods could be applied with good performance for the kinetic analysis of joints in different daily activities.

Wearable IMMU-Based Relative Position Estimation between Body Segments via Time-Varying Segment-to-Joint Vectors.

In biomechanics, estimating the relative position between two body segments using inertial and magnetic measurement units (IMMUs) is important in that it enables the capture of human motion in unconstrained environments. The relative position can be estimated using the segment orientation and segment-to-joint center (S2J) vectors where the S2J vectors are predetermined as constants under the assumption of rigid body segments. However, human body segments are not rigid bodies because they are easily affected by soft tissue artifacts (STAs). Therefore, the use of the constant S2J vectors is one of the most critical factors for the inaccurate estimation of relative position. To deal with this issue, this paper proposes a method of determining time-varying S2J vectors to reflect the deformation of the S2J vectors and thus to increase the estimation accuracy, in IMMU-based relative position estimation. For the proposed method, first, reference S2J vectors for learning needed to be collected. A regression method derived a function outputting S2J vectors based on specific physical quantities that were highly correlated with the deformation of S2J vectors. Subsequently, time-varying S2J vectors were determined from the derived function. The validation results showed that, in terms of the averaged root mean squared errors of four tests performed by three subjects, the proposed method (15.08 mm) provided a higher estimation accuracy than the conventional method using constant vectors (31.32 mm). This indicates the proposed method may effectively compensate for the effects of STAs and ultimately estimate more accurate relative positions. By providing STA-compensated relative positions between segments, the proposed method applied in a wearable motion tracking system can be useful in rehabilitation or sports sciences.

Meningoencephalitis, Vasculitis, and Abortions Caused by Chlamydia pecorum in a Herd of Cattle.

A cow dairy (n = 2000) in close proximity to a sheep flock had third-trimester abortions and fatalities in cows and calves over a 14-month period. Eighteen of 33 aborted fetuses (55%) had multifocal random suppurative or mononuclear meningoencephalitis with vasculitis. Seventeen of these affected fetuses had intracytoplasmic bacteria in endothelial cells, and 1 fetus with pericarditis had similar bacteria within mesothelial cells or macrophages. Immunohistochemistry for Chlamydia spp. or polymerase chain reaction (PCR) for Chlamydia pecorum or both, performed on brain or pooled tissue, were positive in all 14 tested fetuses that had meningoencephalitis and in 4/4 calves and in 3/4 tested cows that had meningoencephalitis and thrombotic vasculitis. In 1 calf and 11/11 fetuses, C. pecorum PCR amplicon sequences were 100% homologous to published C. pecorum sequences. Enzootic chlamydiosis due to C. pecorum was the identified cause of the late term abortions and the vasculitis and meningoencephalitis in fetuses, calves, and cows. C. pecorum, an uncommon bovine abortogenic agent, is a differential diagnosis in late-term aborted fetuses with meningoencephalitis, vasculitis, and polyserositis.

Treadmill-to-Overground Mapping of Marker Trajectory for Treadmill-Based Continuous Gait Analysis.

A treadmill was used to perform continuous walking tests in a limited space that can be covered by marker-based optical motion capture systems. Most treadmill-based gait data are analyzed based on gait cycle percentage. However, achieving continuous walking motion trajectories over time without time normalization is often required, even if tests are performed under treadmill walking conditions. This study presents a treadmill-to-overground mapping method of optical marker trajectories for treadmill-based continuous gait analysis, by adopting a simple concept of virtual origin. The position vector from the backward moving virtual origin to a targeted marker within a limited walking volume is the same as the position vector from the fixed origin to the forward moving marker over the ground. With the proposed method, it is possible (i) to observe the change in physical quantity visually during the treadmill walking, and (ii) to obtain overground-mapped gait data for evaluating the accuracy of the inertial-measurement-unit-based trajectory estimation. The accuracy of the proposed method was verified from various treadmill walking tests, which showed that the total travel displacement error rate was 0.32% on average.

FIRST REPORT OF ADENOVIRAL HEMORRHAGIC DISEASE IN THREE MULE DEER (ODOCOILEUS HEMIONUS) IN ARIZONA.

This study presents the gross and histopathological findings of adenoviral hemorrhagic disease (AHD) in two yearling and one adult mule deer (Odocoileus hemionus). These cases represent the first known outbreak of deer adenovirus (Odocoileus adenovirus 1) in Arizona. Over the span of a month, three female captive mule deer were submitted to Midwestern University's Animal Health Institute for postmortem examination. All of these deer were from the same deer farm and historical findings were similar, consisting of acute presentation of hemorrhagic diarrhea and sudden death. Grossly and histopathologically, all cases had severe pulmonary edema and hemorrhagic enteritis. Additionally, two of the three cases had low numbers of large amphophilic intranuclear inclusions expanding endothelial cells within the small intestine and lungs. Viral PCR of pooled small intestine, lung, and spleen from each of the three cases were positive for deer adenovirus and negative for blue tongue and epizootic hemorrhagic disease.

Analysis of factors affecting re-admission after retrograde intrarenal surgery for renal stone.

PURPOSE: To investigate the factors associated with hospital readmission (HR) after retrograde intrarenal surgery (RIRS) among renal stone patients. METHODS: The study included patients who underwent RIRS from June 2011 to December 2017. Patients who were readmitted due to surgery-related complications were evaluated retrospectively. Patient demographics including age, medical comorbidity, body mass indices, ASA score, perioperative parameters and stone factors were compared with total cohorts. HR was defined as visits to the Emergency Room or unplanned admission within 30 days after discharge. The factors affecting HR rates were analyzed using uni- and multi-variate analyses. RESULTS: A total of 572 patients were enrolled into the study. The mean age was 57.6 ± 14.1 years and the mean stone diameter was 13.4 ± 6.2 mm. The mean complication rate was 6.1% and the median hospitalization time was 2.1 ± 3.4 days. HR occurred in 20 patients (3.5%). Compared to non-admission patients, readmitted patients had a higher rate of bilateral RIRS (20.0% vs 12.2%, p = 0.035), number of stones (4.65 vs 2.2, p = 0.041) and higher stone complexity score (4.15 vs 2.11, p = 0.003). Multivariate analysis showed bilateral RIRS (OR 1.091, p = 0.031) and stone complexity (OR 1.405, p = 0.003) were significant factors to predict re-admission after RIRS. CONCLUSION: Patients with complex renal stones or those who underwent bilateral RIRS were more likely to have a higher rate of re-admission. Proper perioperative management to prevent complications should be planned based on these predictive factors.

Magnetic Condition-Independent 3D Joint Angle Estimation Using Inertial Sensors and Kinematic Constraints.

In biomechanics, joint angle estimation using wearable inertial measurement units (IMUs) has been getting great popularity. However, magnetic disturbance issue is considered problematic as the disturbance can seriously degrade the accuracy of the estimated joint angles. This study proposes a magnetic condition-independent three-dimensional (3D) joint angle estimation method based on IMU signals. The proposed method is implemented in a sequential direction cosine matrix-based orientation Kalman filter (KF), which is composed of an attitude estimation KF followed by a heading estimation KF. In the heading estimation KF, an acceleration-level kinematic constraint from a spherical joint replaces the magnetometer signals for the correction procedure. Because the proposed method does not rely on the magnetometer, it is completely magnetic condition-independent and is not affected by the magnetic disturbance. For the averaged root mean squared errors of the three tests performed using a rigid two-link system, the proposed method produced 1.58°, while the conventional method with the magnetic disturbance compensation mechanism produced 5.38°, showing a higher accuracy of the proposed method in the magnetically disturbed conditions. Due to the independence of the proposed method from the magnetic condition, the proposed approach could be reliably applied in various fields that require robust 3D joint angle estimation through IMU signals in an unspecified arbitrary magnetic environment.

Robust Inertial Measurement Unit-Based Attitude Determination Kalman Filter for Kinematically Constrained Links.

The external acceleration of a fast-moving body induces uncertainty in attitude determination based on inertial measurement unit (IMU) signals and thus, frequently degrades the determination accuracy. Although previous works adopt acceleration-compensating mechanisms to deal with this problem, they cannot completely eliminate the uncertainty as they are, inherently, approaches to an underdetermined problem. This paper presents a novel constraint-augmented Kalman filter (KF) that eliminates the acceleration-induced uncertainty for a robust IMU-based attitude determination when IMU is attached to a constrained link. Particularly, this research deals with an acceleration-level kinematic constraint derived on the basis of a ball joint. Experimental results demonstrate the superiority of the proposed constrained KF over the conventional unconstrained KF: The average accuracy improved by 1.88° with a maximum of 4.18°. More importantly, whereas the accuracy of conventional KF is dependent to some extent on test acceleration conditions, that of the proposed KF is independent of these conditions. Due to the robustness of the proposed KF, it may be applied when accurate attitude estimation is needed regardless of dynamic conditions.

Amblyomma maculatum-associated rickettsiae in vector tissues and vertebrate hosts during tick feeding.

Rickettsia parkeri, a causative agent of spotted fever rickettsiosis, is transmitted by Amblyomma maculatum (Gulf Coast tick), a tick that may also carry a non-pathogenic spotted fever group Rickettsia, "Candidatus Rickettsia andeanae". Here, we evaluated R. parkeri and "Candidatus R. andeanae" in tissues from A. maculatum prior to, during, and after blood feeding on rabbits. Using colony-reared A. maculatum that were capillary-fed uninfected cells, R. parkeri, "Candidatus R. andeanae", or both rickettsiae, we detected higher levels of Rickettsia spp. in the respective treatment groups. Rickettsial levels increased during blood feeding for both R. parkeri and "Candidatus R. andeanae", with a greater increase in R. parkeri in co-infected ticks compared to singly-infected ticks. We detected transovarial transmission of "Candidatus R. andeanae" in egg and larval cohorts and confirmed vertical transmission of R. parkeri in one group of larvae. Rabbits from all Rickettsia-exposed groups seroconverted on immunofluorescent antibody testing using R. parkeri antigen. Visualization of "Candidatus R. andeanae" in tick salivary glands suggested potential transmission via tick feeding. Here, rickettsial levels in artificially infected ticks demonstrate changes during feeding and transovarial transmission that may be relevant for interpreting rickettsial levels detected in wild A. maculatum.

Rapid Soft Tissue Approximation and Repair using Laser-activated Silk Nanosealants.

Tissue approximation and repair have been conventionally performed with sutures and staples, but these means are inherently traumatic. Tissue approximation using laser-responsive nanomaterials can lead to rapid tissue sealing and repair, and is an attractive alternative to existing clinical methods. Here, we demonstrate the use of laser-activated nanosealants (LANS) with gold nanorods (GNRs) embedded in silk fibroin polypeptide matrices. The adaptability of LANS for sealing soft tissues is demonstrated using two different modalities: insoluble thin films for internal, intestinal tissue repair, and semi-soluble pastes for external repair, shown by skin repair in live mice. Laser repaired intestinal tissue held over seven times more fluid pressure than sutured intestine and also prevented bacterial leakage. Skin incisions in mice closed using LANS' showed indication of increased mechanical strength and faster repair compared to suturing. Laser-activated silk-GNR nanosealants rapidly seal soft-tissue tears and show high promise for tissue approximation and repair in trauma and routine surgery.

Quaternion-Based Local Frame Alignment between an Inertial Measurement Unit and a Motion Capture System.

Local frame alignment between an inertial measurement unit (IMU) system and an optical motion capture system (MCS) is necessary to combine the two systems for motion analysis and to validate the accuracy of IMU-based motion data by using references obtained through the MCS. In this study, we propose a new quaternion-based local frame alignment method where equations of angular velocity transformation are used to determine the frame alignment orientation in the form of quaternion. The performance of the proposed method was compared with those of three other methods by using data with different angular velocities, noises, and alignment orientations. Furthermore, the effects of the following three factors on the estimation performance were investigated for the first time: (i) transformation concept, i.e., angular velocity transformation vs. angle transformation; (ii) orientation representations, i.e., quaternion vs. direction cosine matrix (DCM); and (iii) applied solvers, i.e., nonlinear least squares method vs. least squares method through pseudoinverse. Within our limited test data, we obtained the following results: (i) the methods using angular velocity transformation were better than the method using angle transformation; (ii) the quaternion is more suitable than the DCM; and (iii) the applied solvers were not critical in general. The proposed method performed the best among the four methods. We surmise that the fewer number of components and constraints of the quaternion in the proposed method compared to the number of components and constraints of the DCM-based methods may result in better accuracy. Owing to the high accuracy and easy setup, the proposed method can be effectively used for local frame alignment between an IMU and a motion capture system.

Effect of Strapdown Integration Order and Sampling Rate on IMU-Based Attitude Estimation Accuracy.

This paper deals with the strapdown integration of attitude estimation Kalman filter (KF) based on inertial measurement unit (IMU) signals. In many low-cost wearable IMU applications, a first-order is selected for strapdown integration, which may degrade attitude estimation performance in high-speed angular motions. The purpose of this research is to provide insights into the effect of the strapdown integration order and sampling rate on the attitude estimation accuracy for low-cost IMU applications. Experimental results showed that the effect of integration order was small when the angular velocity was low and the sampling rate was large. However, as the angular velocity increased and the sampling rate decreased, the effect of integration order increased, i.e., obviously, the third-order KF resulted in better estimations than the first-order KF. When comparing the case where both transient matrix and process noise covariance matrix are applied to the corresponding order and the case where only the transient matrix is applied to the corresponding order but the process noise covariance matrix for the first-order is still used, both cases had almost equivalent estimation accuracy. However, in terms of the calculation cost, the latter case was more economical than the former, particularly for the third-order KF (i.e., the ratio of the former to the latter is 1.22 to 1).

Secondary inappropriate polycythemia with splenic hemangiosarcoma in a young adult cat.

A 20-month-old castrated male Korean shorthair cat was presented with a 3-week history of intermittent vomiting and anorexia, absolute erythrocytosis, and elevated erythropoietin levels. A diagnosis of splenic hemangiosarcoma was made by histopathology and immunohistochemical identification of factor VIII. Paraneoplastic erythrocytosis caused by a splenic hemangiosarcoma in a cat is described.

Polycythémie secondaire inappropriée et hémangiosarcome splénique chez un jeune chat adulte. Un chat commun coréen mâle castré âgé de 20 mois a été présenté avec une anamnèse de 3 semaines de vomissements intermittents et d'anorexie, d'érythrocytose absolue et des taux élevés d'érythropoïétine. Un diagnostic d'hémangiosarcome splénique a été posé par histopathologie et l'identification immunochimique du facteur VIII. L'érythrocytose paranéoplastique causée par un hémangiosarcorme splénique chez un chat est décrite.(Traduit par Isabelle Vallières).

Developmental changes in contractile responses to cholinergic stimuli: role of calcium sensitization and related pathways.

This study was performed to analyze the developmental changes in bladder response to cholinergic stimulation in detail, highlighting calcium sensitization (CS) and its related pathways. Rats were divided into three groups in accordance with reported time of developmental milestones (newborns, days 1-4; youngsters, days 5-14; and grown-ups, days 15-28). Following cholinergic stimulation (carbachol, 5 µM), the contractile response to detrusor was analyzed with respect to three phases (initial phasic, tonic, and superimposed phasic contractions). Contractile responses were analyzed by their dynamic and kinetic aspects. The responses were further compared in varying external calcium concentrations and in the presence of inhibitors of protein kinase C (PKC) and Rho kinase (ROCK), which are involved in CS. The responses of newborns contrasted with the others by their short and brisk initial phasic contractions, prominent tonic contractions, and delayed participation of irregular superimposed phasic contractions. With development, phasic contractions became prominent, and tonic contractions diminished. These developmental changes in phasic contractions were reproduced when exposed to increasing calcium concentrations. Application of specific inhibitors and molecular phasic analysis revealed that PKC was functional in tonic contractions of the newborns, whereas ROCK took over its role with development. Within a few days of birth, rats' bladders experienced drastic changes in contractile mechanisms. This included dominance of phasic contractions over tonic contractions due to increased calcium dependence and the maturational shift of the calcium sensitivity mechanism from PKC to ROCK.

Predictive Factors of Chronic Kidney Disease in Patients with Vesicoureteral Reflux Treated Surgically and Followed after Puberty.

PURPOSE: We delineated clinical features and determined predictors of chronic kidney disease during long-term postpubertal followup in patients with vesicoureteral reflux treated surgically. MATERIALS AND METHODS: We analyzed the data of 101 patients who were surgically treated for vesicoureteral reflux and had gone through puberty. Patients underwent preoperative and postoperative voiding cystourethrography to assess reflux status, and dimercaptosuccinic acid scan to assess renal cortical defects. We compared several variables preoperatively and postpubertally, including body mass index; blood urea nitrogen, creatinine and uric acid levels; estimated glomerular filtration rate; microalbuminuria; blood pressure; renal function and renal scarring. Kaplan-Meier analysis was used to predict chronic kidney disease-free survival rates throughout the followup periods. Cox regression model was adopted to identify independent predictors of chronic kidney disease. We defined chronic kidney disease as estimated glomerular filtration rate less than 60 ml/minute/1.73 m(2). RESULTS: Median followup was 100.0 months (IQR 69.0 to 136.5). Median age was 16 years at last followup (IQR 14 to 18). A total of 11 patients (10.9%) were diagnosed with de novo chronic kidney disease during postpubertal followup. It is noteworthy that serum uric acid levels (HR 1.96) and presence of high grade reflux (HR 7.40) were significant predictors of chronic kidney disease on multivariate analysis. CONCLUSIONS: In children who were treated surgically for vesicoureteral reflux preoperative uric acid levels and high grade reflux were independent predictors of de novo chronic kidney disease during postpubertal followup. Our results offer valuable information for predicting long-term renal outcomes in patients with vesicoureteral reflux treated surgically.

Phosphodiesterase Type 5 Inhibitor Use Following Radical Prostatectomy is not Associated with an Increased Risk of Biochemical Recurrence.

OBJECTIVE: Recently, conflicting findings have been reported on the effect of phosphodiesterase type 5 inhibitor (PDE5I) use on biochemical outcome following radical prostatectomy (RP). Thus, we investigated the impact of PDE5I treatment following RP, including therapeutic strategy, timing, duration, and drug type, on oncologic outcomes. METHODS: We analyzed records of 1082 patients who underwent bilateral nerve-sparing RP for clinically localized prostate cancer (PCa) between 2005 and 2014. Patients were categorized according to PDE5I use within 2 years following RP: non-user, on-demand, and rehabilitation (daily PDE5I use for ≥3 months) groups. Associations of various factors with biochemical recurrence (BCR) were analyzed using a Cox multivariate proportional hazards model. Propensity score-matched analysis was also performed. RESULTS: Among the subjects included in our study, PDE5I use was as follows: 253 (23.4 %) non-users, 475 (43.9 %) on-demand users, and 354 (32.7 %) in the rehabilitation. Multivariate analysis showed that PDE5I use was not a significant factor with regard to BCR risk [hazard ratio 1.47 (0.765-2.826); p = 0.248). Among the PDE5I users, a strategy for PDE5I use (on-demand vs. rehabilitation), timing of initiating PDE5I treatment following RP, duration of PDE5I use, and type of PDE5I used were not associated with an increased BCR risk in multivariate analyses (p = 0.304, p = 0.177, p = 0.332, and p = 0.105, respectively). In addition, PDE5I use was not associated with an increased risk of BCR among 478 matched cohorts (p = 0.672). CONCLUSIONS: PDE5I treatment following RP was not found to have any significant impact on biochemical outcome regardless of therapeutic strategy, timing, duration, and drug type. Such findings suggest that PDE5I treatment following RP is oncologically safe.

Risk of metastasis for T1a renal cell carcinoma.

INTRODUCTION: While active surveillance for small renal mass is gaining acceptance, controversy still continues on true metastatic potential of small renal cell carcinoma (RCC). Thus, we investigated the risks of synchronous/metachronous metastases and their potential predictors among T1a RCC patients who underwent surgical treatment. METHODS: We reviewed data from 2114 patients who received radical or partial nephrectomy for small renal tumor (≤ 4 cm) from 1990 to 2013. For our study, patients were stratified into four different groups according to tumor size (group 1: 0-1.0 cm, group 2: 1.1-2.0 cm, group 3: 2.1-3.0 cm, group 4: 3.1-4.0 cm). Univariate and multivariate analyses were performed to analyze metastatic potentials according to tumor size and identify useful predictors of metastases. RESULTS: Among 1913 T1a RCC patients, there were low but nonnegligible rates of metastases (group 2: 1.1 %, group 3: 3.3 %, group 4: 6.0 %, respectively). Kaplan-Meier analysis showed significant differences in metastasis-free survivals between groups (p < 0.001). A linear positive association was observed between tumor size and metastatic rate (p < 0.001). Diabetic T1a RCC patients showed significantly inferior metastasis-free survival than nondiabetic counterparts (p = 0.003). Multivariate analysis revealed that tumor size and history of diabetes mellitus were independently associated with metastasis in T1a RCC. CONCLUSIONS: As T1a RCCs present low but nonnegligible risk of metastasis, patients with small renal mass should be counseled on such risk when offered active surveillance. Larger tumor size and history of diabetes mellitus may be associated with higher risk of metastasis in T1a RCC.