Metastasis of renal cell carcinoma to the contralateral testis is a rare occurrence, and we reported a case. The patient had previously undergone radical left nephrectomy for clear cell carcinoma of the left kidney. Six years postoperatively, he presented with enlargement of the right testis and subsequently underwent radical orchiectomy. The postoperative pathological results confirmed the diagnosis of metastasis from the left renal cell carcinoma to the right testis. Three months post-surgery, the patient initiated treatment with a combination of axitinib and pembrolizumab. At the last follow-up, the patient had completed five cycles of targeted and immunotherapy, and there was no evidence of recurrence or metastasis.

Metastasis of renal cell carcinoma to the contralateral testis is a rare occurrence, and we reported a case. The patient had previously undergone radical left nephrectomy for clear cell carcinoma of the left kidney. Six years postoperatively, he presented with enlargement of the right testis and subsequently underwent radical orchiectomy. The postoperative pathological results confirmed the diagnosis of metastasis from the left renal cell carcinoma to the right testis. Three months post-surgery, the patient initiated treatment with a combination of axitinib and pembrolizumab. At the last follow-up, the patient had completed five cycles of targeted and immunotherapy, and there was no evidence of recurrence or metastasis.

Objective:To explore the correlation between middle cerebral artery (MCA) pulsatility index (PI) and total magnetic resonance imaging (MRI) burden in elderly patients with cerebral small vessel diseases (CSVD).Methods:A total of 203 CSVD inpatients aged 60 years and above who were hospitalized in the Department of Neurology of Hebei General Hospital from March 2017 to December 2020 were enrolled. The clinical data, transcranial Doppler ultrasound parameters and brain MRI data were collected. According to the total burden score, the patients were divided into low burden group (0-1 point) and high burden group (2-4 points). Univariate and multivariate Logistic regression analysis was used to analyze the correlation between MCA PI and total MRI burden in the elderly patients with CSVD. Subsequently, the receiver operating characteristic curve was used to evaluate the value of MCA PI for predicting the high MRI burden of CSVD in the elderly.Results:Hypertension ( OR=2.569, 95% CI 1.068-6.182, P=0.035), systolic blood pressure ( OR=1.033, 95% CI 1.006-1.061, P=0.016), creatinine ( OR=1.044, 95% CI 1.009-1.079, P=0.013) and MCA PI ( OR=1.125, 95% CI 1.087-1.166, P<0.001) were independently correlated with the increasing total MRI burden in the elderly patients with CSVD. Spearman rank correlation analysis revealed that there was strong and positive correlation between MCA PI and high MRI burden in the elderly patients with CSVD ( r=0.65, P<0.001). The analysis showed that when the cut-off for MCA PI was 1.11, it could identify high MRI burden of CSVD in the elderly. The area under the curve was 0.908 (95% CI 0.864-0.953, P<0.001). The sensitivity and specificity were 0.852 and 0.880, respectively. The positive predictive value was 92.38%, and the negative predictive value was 77.70%. Conclusion:The MCA PI is positively correlated with total MRI burden in the elderly patients with CSVD, and has a higher value in predicting the total MRI burden in the elderly CSVD patients, which probably bring brighter prospects for its clinical application.

Cerebral small vessel disease (CSVD) is a group of diseases that involve the structure and function of cerebral small perforator arteries, arterioles, venules and capillaries, thus causing a series of clinical symptoms and imaging manifestation. Although the pathogenesis of CSVD is not completely clear, more and more evidence indicates that the elevated level of serum inflammatory markers plays an important role in the occurrence and development of CSVD. This article reviews the correlation between serum inflammatory markers and CSVD.