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Aim: The aim of the study was to develop machine learning algorithms (MLA) for diagnosing acute graft dysfunction (AGD) in kidney transplant recipients based on contrast-enhanced ultrasound (CEUS) analysis of the graft.Materials and methods: This prospective study involved 71 patients with kidney transplant undergoing CEUS during follow-up. AGD wasdefined as an increase in serum creatinine levels of at least 25% compared to the baseline of the last three months. The control group consisted of patients with stable kidney graft function (SGF). The top five CEUS parameters that achieved the best discrimination between the AGD and SGF groups were selected based on ANOVA testing and then employed as input for training MLA (naïve Bayes (NB), k-nearest neighbors (k-NN), and logistic regression (LR)). The models were validated by leave-one-out cross-validation., Results: Among the 111 CEUS analyses, 21 corresponded to the AGD group and 90 to the SGF group. CEUS analyses yielded 44 parameters, from which five were selected: the wash out rate in segmental arteries,time to peak in segmental arteries, medullary mean transit time, renal mean transit time, and medullary time to fall. These five parameters were employed as input for MLA, yielding an AUROC of 0.68 for NB and k-NN and 0.72 for LR. The inclusion of graft survival in the MLA significantly improved discrimination accuracy, yielding an AUROC of 0.79 for NB, 0.76 for k-NN,and 0.81 for LR., Conclusions: The use of MLA represents a promising strategy for analyzing CEUS-derived parameters in the setting AGD.

Introduction and Importance: Gallbladder lymphangiomas are very-rare, yet benign tumors that start developing in early life. Those tumors often go unnoticed until adulthood as they grow into a larger size or a complication happens. Despite its rarity, suspicion for the diagnosis should be maintained by the physicians., Case Presentation: A 14-year-old female patient presented to the hospital complaining of right upper quadrant abdominal pain of one month duration. Physical examination showed mild upper quadrant tenderness. Serology testing for the patient only showed eosinophilia. Computed tomography showed a large non-enhancing cystic lesion attached to the gallbladder. Presumptive diagnosis of hydatid cyst was made, and the patient was treated accordingly. Histological analysis of mass showed dilated lymphatic vessels, hence the shift in diagnosis towards a lymphangioma was made., Clinical Discussion: Gallbladder lymphangioma are usually asymptomatic, but they can present with pain, nausea and vomiting. Multiple complications had been reported including compression of the nearby structures, intra-abdominal infection, rupture, torsion or hemorrhagic transformation. Surgical removal of the mass is the treatment of choice., Conclusions: Right upper quadrant pain can be the presenting symptom of liver pathology. Histological assessment is needed to confirm the diagnosis which will show dilated lymphatic vessels., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: Our study aimed to assess the usefulness of contrast-enhanced ultrasound (CEUS) in the initial evaluation of the graft function., Materials and Method: A cross-sectional study was conducted in the early postoperative period on patients with kidney transplantation, between September 2017 to November 2018. Two groups of patients were investigated; delayed graft function (DGF) and early graft function (EGF). All patients were examined by grey scale, Doppler ultrasound and CEUS., Results: Nineteen patients, aged from 23 to 64 years (mean age 50 years), 7 in the DGF group and 12 in the EGF group were evaluated. The resistive index (RI) show significantly higher values in the DGF group at the level of upper interlobar artery (p=0.025) and medium interlobar artery (p=0.02). The CEUS investigation shows a greater region of interest (ROI) area (p=0.02) and lower values for wash-out area under the curve (WoAUC) (p=0.047) and respectively wash-in and wash-out area under the curve (WiWoAUC) (p=0.031) for the DGF group. The quality of fit (QoF) proved lower in the DGF group either for evaluation of global graft (p=0.012), cortex (p=0.025), or medulla (p=0.009).A significant relationship among all patients was found between the glomerular filtration rate (GFR) [ml/min] and the renal artery fall time (FT) [s] (p=0.012), WoAUC [a.u.] (p=0.03), and WiWoAUC [a.u.] (p=0.024). The arterial QoF [%] was associated with the arterial ROI area (p=0.048)., Conclusions: Intensity CEUS parameters WoAUC and WiWoAUC may be useful to diagnose and follow-up grafts with delayed function. Additional studies on larger cohorts are required for the recommendation of CEUS as a routine evaluation of the transplanted kidney.

Shear-wave elastography (SWE) showed the absence or presence of significant differences among stable kidney allograft function and allograft dysfunction. We evaluated the variability of kidney allograft stiffness in relation to allograft dysfunction, respectively, in terms of a correlation of stiffness with patients' characteristics. A single-center prospective study on patients who had undergone renal transplantation was conducted between October 2017 and November 2018. Patients were clinically classified as having a stable allograft function or allograft dysfunction. SWE examinations performed by the same radiologist with a LOGIQ E9 were evaluated. Ten measurements were done for Young's modulus (kPa) at the level of allograft cortex and another ten at the level of medulla. Eighty-three SWE examinations from 63 patients, 69 stable allografts, and 14 allografts with dysfunction were included in the analysis. The intra-examinations stiffness showed high variability, with the quantile covariation coefficient ranging from 2.21% to 45.04%. The inter-examinations stiffness showed heterogeneity (from 28.66% to 42.38%). The kidney allograft cortex stiffness showed significantly higher values in cases with dysfunction (median = 28.70 kPa, interquartile range (IQR) = (25.68-31.98) kPa) as compared to those with stable function (median = 20.99 kPa, interquartile range = (16.08-27.68) kPa; p -value = 0.0142). Allograft tissue stiffness (both cortex and medulla) was significantly negatively correlated with body mass index (-0.44, p -value < 0.0001 for allograft cortex and -0.42, p -value = 0.0001 for allograft medulla), and positively correlated with Proteinuria/Creatinuria ratio (0.33, p -value = 0.0021 for allograft cortex and 0.28, p -value = 0.0105 for allograft medulla) but remained statistically significant only in cases with stable function. The cortical tissue stiffness proved significantly higher values for patients with allograft dysfunction as compared to patients with stable function, but to evolve as an additional tool for the evaluation of patients with a kidney transplant and to change the clinical practice, more extensive studies are needed., Competing Interests: The authors declare no conflict of interest.

High flow priapism caused by perineal trauma is a relatively rare disorder. Early diagnosis represents a mandatory condition for the therapeutic resolution. Ultrasound examination is affordable and a within reach method for diagnosis also in an emergency context. We present the case of a 56-year-old male patient with traumatic priapism which was subsequently investigated by contrast-enhanced ultrasound and shear wave elastography. This may be one of the first cases presented in the literature.

Aim: To identify the mean values of Shear Wave Elastography (SWE) in pancreatic neoplasms., Material and Method: This pilot case-control study was conducted in a tertiary care setting and data were collected in a prospective manner. Thirty-three subjects were included and divided into two groups: 18 healthy subjects and 15 patients with pancreatic neoplasm, from which 14 patients were diagnosed with adenocarcinoma and one with intraductal papillary mucinous neoplasia. Inclusion criteria for patients with pancreatic neoplasia were histopathological confirmation obtained by endoscopic ultrasonography (EUS) with fine needle aspiration or surgically and imaging confirmation by computed tomography with contrast enhancement. A number of minimum 5 shear wave velocity (SWV) measurements regarding each segment respectively at the tumoral level was obtained among a series of elastograms., Results: The mean SWV of the pancreas in the control group was 1.21±0.27 m/s. Data regarding the pathological parenchyma indicated an increase of the SWV at the tumoral (cephalic) level corresponding to 1.54±0.32 m/s, with significant statistical difference between the control batch and tumoral group, p=0.02., Conclusions: Transabdominal SWE represents a surrogate but feasible method for differentiation cancer from the normal pancreatic tissue. In a clinical setting, data regarding the stiffness complementary to an ultrasound evaluation could guide high-risk patients for a close-up pancreatic monitoring.

Aim: The purpose of this study is to evaluate pancreatic stiffness by ARFI abdominal elastography. In the current literature, there are relatively few studies that have assessed the clinical utility of this technique., Material and Method: A number of 37 healthy subjects were included. The data were collected in a prospective manner and afterwards included in an observational, analytical and longitudinal study. Subsequently viewing the pancreatic parenchyma in bidimensional mode (2D-US) mode, 10 shear wave velocity (SWV) measurements for each segment: head, body and tail were performed. Statistical analysis by regression models targeted also the possible influence of other factors in assessing SWV. A comparative analysis was performed regarding the statistical significance of 5 versus 10 SWV measurements for each segment., Results: The pancreas was entirely evaluated in all subjects. The mean SWV from the entire parenchyma was 1.216 m/s±0.36 and between the three segments SWV were similar (head: 1.224 m/s, body: 1.227 m/s and tail: 1.191 m/s). A ratio of the IQR/Median >0.4 was interpreted as statistically invalid, relevant data being highlighted in the percentage of 83.78% for the head of the pancreas, 78.37% for the body, and 67.56% at the caudal level. Significant correlations were observed between the data (mean and median SWV) provided by the group with 5 measurements of the SWV versus the standard group: 93.9% for the head, 96.6% for the body, and 98.7% accordingly to the tail., Conclusions: SWV determination by percutaneous approach represents a useful imaging method for evaluating pancreatic stiffness, of course within these limitations. Because we did not observe statistically significant differences between the results obtained by 5 or 10 measurements, we suggest that it would be sufficient to perform only five measurements of the SWV per pancreatic segment. The data obtained in the normal pancreas could be used in future comparative assessments regarding the inflammatory or tumoral pathology of the pancreas.

Ultrasonography is generally accepted and performed as a first choice imaging technique in patients with jaundice. The method allows the discrimination between cholestatic and mechanical jaundice. The existing procedures are multiple: gray scale, Doppler, i.v. contrast enhancement, elastography, tridimensional ultrasonography, each of these with different contribution to the positive and differential diagnosis regarding the nature of the jaundice. The final diagnosis is a multimodal one and the efficiency is dependent on the level of the available technology, the examiner's experience, the degree and modality of integration of the data within the clinical context, as well as on the portfolio of available imaging procedures. This review shows the main ultrasonographic methods consecrated in the evaluation of the biliary tree. It also underlines the integrated character of the procedures, as well as the necessity to correlate with other imaging methods and the clinical situation.

Ultrasonography (US) is the essential imaging method in gallbladder examination being the most widespread and inexpensive technique. The method is indicated both in congenital and acquired disorders, inflammatory, tumoral, or degenerative pathology. Besides the basic technique (grey scale US), new sophisticated techniques exist: Doppler US, i.v. contrast enhanced harmonic examination, tridimensional US, elastography. Each technique provides specific information, while their combination helps, in most cases, to establish the accurate non-invasive diagnosis. However, the US findings should be correlated with the patient's clinical exam and other imaging methods. This paper is a synthesis of literature combined with our own experience, aiming to present the US features of gallbladder pathology and the correlations within the clinical picture and other imaging methods. Relevant images for this integrative approach are presented. The final conclusion is the necessity for a correlation of all clinical and imaging data in order to obtain an accurate diagnosis.

Type I diabetes is an autoimmune and a polygenic disease, in which MHC-class II genes contribute to 48% of the disease. The aim of the present study, is to provide a guideline to understanding the molecular association of these genes, through the immunogenetic analysis of 3 Latin american mestizo populations. We included 606 individuals, 349 patients with DMDI and 257 healthy controls coming from 3 geographical areas: Mexico City, Mexico; Caracas, Venezuela and Medellin, Colombia. The results clearly indicate that in mestizo groups, the diabetogenic haplotypes are from mediterranean ancestry, while protection is due to Amerindian genes. It was demonstrated that the relevant sequences for IDDM expression are located to DRB1 and DQB1 loci with a minimal contribution of DQA1 residues. The sequences determining peptide recognition and the induction of TH1 cells mediating the cellular autoimmune response are in positions DRB1-57 and 74 (an aspartic acid and a glutamic acid respectively, confer protection), modulated by D-57 in the DQ, 8 chain. These data show that DRB1-DQB1 haplotypes are central for IDDM expression and open new pathways for the disease management.

HLA-DRB1, DQA1 and DQB1 alleles have been determined in 42 families with one IDDM proband and 64 healthy controls, by oligotyping (PCR-SSO) using primers and probes from the XI International Histocompatibility Workshop. A positive DRB1*03 and DRB1*04 association with the disease was observed, whereas DRB1*11 and DRB1*07 showed negative association but 19% of patients carried DRB1 alleles different to DRB1*03 or *04. When single alleles were considered, DQA1*03 showed the strongest association with susceptibility to the disease (RR = 8.2, Pc = 0.00001) but this association was outgrown by 2 and 3 allele combinations, with genotype DRB1*04-DQA1*03-DQB1*0302/DRB1*03- DQA1*0501- DQB1*0201 showing the strongest association (RR = 28, Pc = 0.002). Application of the relative predispositional effect (RPE) method to our data, revealed a further susceptibility risk provided by the DRB1*13-DQA1*0102-DQB1*0604 haplotype once DR3 and DR4 haplotypes were removed. When DQA1-DQB1 genotypes were analysed for presence of Arg 52 (DQ alpha) and absence of Asp 57 (DQ beta), genotypes SS/SS were found significantly increased in diabetics. Interestingly, one of the strongest associations with the disease was observed with the DQA1*03-DQB1*0201 combination encoded mainly by genes in trans (RR = 11.7 Pc = 0.00004). These observations and their comparison with DR-DQ haplotypes in more homogeneous ethnic groups support the stronger influence of the DQ molecule rather than the individual DR or DQ alleles in the susceptibility to IDDM. They also emphasize the need for detailed HLA haplotype studies in non-Caucasian and ethnically mixed populations to gain further insight into the nature of genetic and environmental factors contribution to autoimmunity.