Abstract Background Kidney function is associated with kidney volume. This study aims to explore automated segmentation for measuring total kidney volume (TKV) and to analyse the association between (changes in) TKV and acute kidney injury (AKI) incidence and/or severity in Intensive Care Unit (ICU) patients. Methods Patients were included in this retrospective pilot cohort study when at least two abdominal Computed Tomography (CT) scans were performed during ICU admission. If available, CT scans made before the ICU admission were included as a baseline scan. TKV was measured by automated segmentation of both kidneys using Data Analysis Facilitation Suite (DAFS, Voronoi Analytics Incorporated). All segmentations were visually checked and manually adjusted when necessary. ΔTKV was calculated between baseline CT and CT1 (ΔTKVCT1–baseline) and CT1 and CT2 (ΔTKVCT2–CT1). Primary outcomes were differences in kidney volume before and after manual correction and AKI incidence and severity, per the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, on the day of scanning. Results Twenty-six patients were included, of whom eighteen developed AKI during ICU admission. Analysis showed no significant differences in volumes before and after manual correction of the automated segmentations. TKV was not associated with AKI incidence or severity. Longitudinal intraindividual changes in TKV were observed. Median ΔTKVCT1–baseline was statistically significantly different for AKI versus non-AKI patients (−22 cm3 (−49–9) versus 42 cm3 (23–43), p = 0.03) and for different KDIGO stages. Conclusion This study demonstrates the possibility of measuring TKV on CT in ICU patients using automated segmentation. Longitudinal intraindividual changes in TKV were observed, however, no clear association between TKV and AKI was found. Clinical trial number Not applicable.
Abstract Introduction Follow-up for hematuria, often found incidentally on urinalysis, is critical as it may be an early sign of glomerular disease or malignancy. We evaluated nephrology and urology referral patterns for outpatients with hematuria, and factors associated with nephrology and urology referrals. Methods This retrospective, observational cohort study leveraged electronic health record data from a large, regional health care system in Pennsylvania, USA. Outpatients with hematuria (≥1+ blood) on dipstick urinalysis from January 1, 2022, to September 30, 2022, without nephrology/urology appointments in the prior 10 years or prior genitourinary cancer were enrolled. The primary objective evaluated the proportion of outpatients with hematuria who had nephrology or urology referrals or appointments within 6 months following initial presentation. Secondary objectives evaluated concurrent proteinuria and follow-up testing patterns. Results The mean (standard deviation) age of the 5,475 outpatients with hematuria on urinalysis was 60.5 (20.8) years, and most were female (78.0%). Overall, 774/5,475 (14.1%) patients with hematuria had a nephrology or urology referral/appointment within 6 months following presentation. Urine microscopy was performed at the time of hematuria detection for 3,324/5,475 (60.7%) patients, of whom 2,388 (71.8%) had ≥3 red blood cells (RBCs) per high-power field (HPF). Repeat urinalysis was performed for 1,582/5,475 (28.9%) patients. Increased referral likelihood was associated with male sex (odds ratio: 2.3; 95% confidence interval [CI]: 1.9–2.7) and ≥30 RBCs/HPF on microscopy (odds ratio: 1.7; 95% CI: 1.3–2.1). Of 4,952 patients with proteinuria data, 2,375 (48.0%) had hematuria and ≥1+ protein on urinalysis, and 373/2,375 (15.7%) had nephrology (n = 58; 2.4%) and/or urology (n = 332; 14.0%) referrals within 6 months. Conclusion This study provides insight into current outpatient hematuria management patterns. The low referral rates, particularly with concurrent hematuria and proteinuria, highlight opportunities to improve management moving forward.
Vidya Venkatesan, Aomawa L. Shields, Russell Deitrick
et al.
Eccentric planets may spend a significant portion of their orbits at large distances from their host stars, where low temperatures can cause atmospheric CO2 to condense out onto the surface, similar to the polar ice caps on Mars. The radiative effects on the climates of these planets throughout their orbits would depend on the wavelength-dependent albedo of surface CO2 ice that may accumulate at or near apoastron and vary according to the spectral energy distribution of the host star. To explore these possible effects, we incorporated a CO2 ice-albedo parameterization into a one-dimensional energy balance climate model. With the inclusion of this parameterization, our simulations demonstrated that F-dwarf planets require 29% more orbit-averaged flux to thaw out of global water ice cover compared with simulations that solely use a traditional pure water ice-albedo parameterization. When no eccentricity is assumed, and host stars are varied, F-dwarf planets with higher bond albedos relative to their M-dwarf planet counterparts require 30% more orbit-averaged flux to exit a water snowball state. Additionally, the intense heat experienced at periastron aids eccentric planets in exiting a snowball state with a smaller increase in instellation compared with planets on circular orbits; this enables eccentric planets to exhibit warmer conditions along a broad range of instellation. This study emphasizes the significance of incorporating an albedo parameterization for the formation of CO2 ice into climate models to accurately assess the habitability of eccentric planets, as we show that, even at moderate eccentricities, planets with Earth-like atmospheres can reach surface temperatures cold enough for the condensation of CO2 onto their surfaces, as can planets receiving low amounts of instellation on circular orbits.
Choon Chiat Oh, Boon Yee Lim, Elizabeth Chun Yong Lee
et al.
ABSTRACT Background Cutaneous squamous cell carcinoma (cSCC) remains poorly understood at the molecular level, both in the immunocompetent and immunosuppressed population with skin of colour. Data on the diversity of viruses found in cSCC is also lacking. Objectives We aimed to characterise the immunological and molecular profiles of cSCC in organ transplant recipients (OTR) and non‐transplant recipients in an Asian cohort (n = 53) and explore the diversity of viruses detected. Methods Gene expression analysis was performed on snap‐frozen cSCC tissues using the NanoString PanCancer IO360 panel. Viral detection was performed using the Twist Comprehensive Viral Research Panel. Results cSCC presented dysregulation of immune response pathways and tumour microenvironment remodelling compared to adjacent normal skin tissue. Cell‐type profiling based on gene expression profiles showed higher levels of exhausted CD8 cells, neutrophils, and cytotoxic cells in tumour cells. Furthermore, three distinct clusters of cSCC gene signatures could be observed, where Cluster 3 with the highest Tumour inflammation signature (TIS) scores displayed distinct upregulation of most pathways suggesting a more inflamed or “hot” tumour phenotype. cSCC of OTR exhibited greater expression of tumour markers (AQP9, SERPINA1) and reduced expression of T‐cell cytokines (CXCL10, CXCL11). Viruses were particularly enriched in tumour tissue, as compared with normal skin. In addition, there was an enrichment of detectable viruses in transplant‐associated cSCC, with several tumours harbouring multiple viruses (HPV, EBV, MCV, and TTV). Conclusions cSCC is marked by a pro‐tumorigenic immune environment with altered immune cell populations. These findings support the potential for stratified, immune‐tailored treatment approaches for cSCC, especially in OTR who have a higher disease burden. Future studies on the possible oncogenic role of the detected viruses can be undertaken.
Dermatology, Diseases of the genitourinary system. Urology
Introduction. COVID-19 has been associated with both acute and chronic extrapulmonary complications, including renal dysfunction. Understanding the long-term effects of COVID-19 on renal function is essential for managing recovery in affected individuals.Objective. This study aimed to evaluate the long-term renal outcomes in patients who recovered from COVID-19, focusing on changes in glomerular filtration rate (GFR), blood urea nitrogen (BUN), and serum creatinine levels in Iran.Materials & methods. A retrospective cohort study was conducted using data from the Mashhad University of Medical Sciences cohort. The study included patients who had confirmed COVID-19 and a minimum follow-up period of six months post-recovery. Renal function was assessed by measuring the Glomerular Filtration Rate (GFR), Blood Urea Nitrogen (BUN), and serum creatinine levels both at baseline (when COVID-19 was initially diagnosed) and at follow-up. Statistical analysis was performed to explore the associations between renal outcomes and various factors, including gender, the severity of COVID-19, and blood pressure status.Results. In the study, 55.3% were male, and the mean age of 51.38 ± 13.41. Among the patients, 55.3% were male and 44.7% were female. The difference in mean creatinine level between baseline and follow-up was significant (p < 0.001). The difference in mean GFR between baseline and follow-up was significant (p < 0.001). In men, the mean blood urea nitrogen at the first visit and at the follow-up difference was not statistically significant (p = 0.241). In women, the mean blood urea nitrogen was a statistically significant decrease (p = 0.003). Other parameters, including creatinine and GFR, did not differ significantly in both male and female groups at the time of hospitalization and follow-up.Conclusion. Overall, the results of this study suggest that COVID-19 can affect kidney function, especially in association with underlying factors such as hypertension and diabetes, and female gender, which may be risk factors for more severe renal complications in patients with COVID-19. The decrease in GFR in patients with hypertension and diabetes highlights the importance of controlling these diseases in patients with COVID-19. Overall, this study showed that COVID-19 can have lasting effects on patients' kidney function.
OBJECTIVE To present the management of retained foreign bodies in the genitourinary system resulting from warfare, bomb blasts, and firearm-related injuries. STUDY DESIGN Descriptive case series. Place and Duration of the Study: Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Pakistan, from June 2017 to December 2023. METHODOLOGY Patients with retained foreign bodies in the genitourinary tract, resulting from previous exposure to bomb blasts, mines, and firearm-related injuries, were included in this study. All patients underwent surgical management. Descriptive statistics were determined for location, duration of retention, type of foreign body, outcome, length of hospital stay, and postoperative complications. RESULTS All 14 patients included in the study were male, with a mean age of 30.85 ± 13.38 years. The average indwelling time of these foreign bodies was 33.50 ± 16.34 months, ranging from 10 to 61 months. These foreign bodies were retained in the kidney (n = 5), urinary bladder (n = 4), and testes and ureter (n = 2; each); penis was involved in one case. The extracted foreign bodies were metal pellets (n = 12) and bullets (n = 2). The successful removal of pellets and bullets from kidneys and bladder was achieved endoscopically in nine cases. The mean length of hospital stays for open and endourological procedures was 4.0 ± 1.41 days and 3.5 ± 2.13 days, respectively (p = 0.630). Postoperative complications were reported in one case only, which required a blood transfusion; it was labelled as Clavien-Dindo Grade II. CONCLUSION Retained foreign bodies in the genitourinary tract in warfare injuries are uncommon and can be managed effectively with endourological as well as open surgery. KEY WORDS Retained foreign bodies, Genitourinary tract, Bomb blasts, Warfare.
Moez Dawood, Ben Heavner, Marsha M. Wheeler
et al.
Rare diseases are collectively common, affecting approximately one in twenty individuals worldwide. In recent years, rapid progress has been made in rare disease diagnostics due to advances in DNA sequencing, development of new computational and experimental approaches to prioritize genes and genetic variants, and increased global exchange of clinical and genetic data. However, more than half of individuals suspected to have a rare disease lack a genetic diagnosis. The Genomics Research to Elucidate the Genetics of Rare Diseases (GREGoR) Consortium was initiated to study thousands of challenging rare disease cases and families and apply, standardize, and evaluate emerging genomics technologies and analytics to accelerate their adoption in clinical practice. Further, all data generated, currently representing ~7500 individuals from ~3000 families, is rapidly made available to researchers worldwide via the Genomic Data Science Analysis, Visualization, and Informatics Lab-space (AnVIL) to catalyze global efforts to develop approaches for genetic diagnoses in rare diseases (https://gregorconsortium.org/data). The majority of these families have undergone prior clinical genetic testing but remained unsolved, with most being exome-negative. Here, we describe the collaborative research framework, datasets, and discoveries comprising GREGoR that will provide foundational resources and substrates for the future of rare disease genomics.
Snehasis Banerjee, Sayan Paul, Ruddradev Roychoudhury
et al.
This article presents Teledrive, a telepresence robotic system with embodied AI features that empowers an operator to navigate the telerobot in any unknown remote place with minimal human intervention. We conceive Teledrive in the context of democratizing remote care-giving for elderly citizens as well as for isolated patients, affected by contagious diseases. In particular, this paper focuses on the problem of navigating to a rough target area (like bedroom or kitchen) rather than pre-specified point destinations. This ushers in a unique AreaGoal based navigation feature, which has not been explored in depth in the contemporary solutions. Further, we describe an edge computing-based software system built on a WebRTC-based communication framework to realize the aforementioned scheme through an easy-to-use speech-based human-robot interaction. Moreover, to enhance the ease of operation for the remote caregiver, we incorporate a person following feature, whereby a robot follows a person on the move in its premises as directed by the operator. Moreover, the system presented is loosely coupled with specific robot hardware, unlike the existing solutions. We have evaluated the efficacy of the proposed system through baseline experiments, user study, and real-life deployment.
Martin J. Hetz, Nicolas Carl, Sarah Haggenmüller
et al.
Large Language Models (LLMs) are revolutionizing medical Question-Answering (medQA) through extensive use of medical literature. However, their performance is often hampered by outdated training data and a lack of explainability, which limits clinical applicability. This study aimed to create and assess UroBot, a urology-specialized chatbot, by comparing it with state-of-the-art models and the performance of urologists on urological board questions, ensuring full clinician-verifiability. UroBot was developed using OpenAI's GPT-3.5, GPT-4, and GPT-4o models, employing retrieval-augmented generation (RAG) and the latest 2023 guidelines from the European Association of Urology (EAU). The evaluation included ten runs of 200 European Board of Urology (EBU) In-Service Assessment (ISA) questions, with performance assessed by the mean Rate of Correct Answers (RoCA). UroBot-4o achieved an average RoCA of 88.4%, surpassing GPT-4o by 10.8%, with a score of 77.6%. It was also clinician-verifiable and exhibited the highest run agreement as indicated by Fleiss' Kappa (k = 0.979). By comparison, the average performance of urologists on board questions, as reported in the literature, is 68.7%. UroBot's clinician-verifiable nature and superior accuracy compared to both existing models and urologists on board questions highlight its potential for clinical integration. The study also provides the necessary code and instructions for further development of UroBot.
Yuhao Wu, Franziska Roesner, Tadayoshi Kohno
et al.
Large language models (LLMs) extended as systems, such as ChatGPT, have begun supporting third-party applications. These LLM apps leverage the de facto natural language-based automated execution paradigm of LLMs: that is, apps and their interactions are defined in natural language, provided access to user data, and allowed to freely interact with each other and the system. These LLM app ecosystems resemble the settings of earlier computing platforms, where there was insufficient isolation between apps and the system. Because third-party apps may not be trustworthy, and exacerbated by the imprecision of natural language interfaces, the current designs pose security and privacy risks for users. In this paper, we evaluate whether these issues can be addressed through execution isolation and what that isolation might look like in the context of LLM-based systems, where there are arbitrary natural language-based interactions between system components, between LLM and apps, and between apps. To that end, we propose IsolateGPT, a design architecture that demonstrates the feasibility of execution isolation and provides a blueprint for implementing isolation, in LLM-based systems. We evaluate IsolateGPT against a number of attacks and demonstrate that it protects against many security, privacy, and safety issues that exist in non-isolated LLM-based systems, without any loss of functionality. The performance overhead incurred by IsolateGPT to improve security is under 30% for three-quarters of tested queries.
The re-energization of electrical distribution systems in a post-disaster scenario is of grave importance as most modern infrastructure systems rely heavily on the presence of electricity. This paper introduces a method to coordinate the field teams for the optimal energization of an electrical distribution system after an earthquake-induced blackout. The proposed method utilizes a Markov Decision Process (MDP) to create an optimal energization strategy, which aims to minimize the expected time to energize each distribution system component. The travel duration of each team and the possible outcomes of the energization attempts are considered in the state transitions. The failure probabilities of the system components are computed using the fragility curves of structures and the Peak Ground Acceleration (PGA) values which are encoded to the MDP model via transition probabilities. Furthermore, the proposed solution offers several methods to determine the non-optimal actions during the construction of the MDP and eliminate them in order to improve the run-time performance without sacrificing the optimality of the solution.
Anukul Ghimire, Samveg Shah, Utkarsh Chauhan
et al.
Abstract Background There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions. Methods Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN. Results Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters). Conclusions High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.
Introduction. Currently, stents are used in the treatment of various benign and malignant diseases of the upper urinary tract and urethra. Modern stents made of a superelastic alloy, coated with a polymer, regardless of location, are characterized by higher and longer-lasting patency in terms of decompression and relief of obstruction, fewer irritative symptoms of the genitourinary system and no need for frequent replacement, which leads to improved quality of life in addition to cost savings. Despite promising results, there are few studies in the literature regarding their use, and these tend to be peer-to-peer, retrospective, involving small numbers of patients, and based on the surgeon's personal experience. Materials and methods. In literature review used data about using minimally invasive methods for treatment of ureteral strictures, published in PubMed’s base (https://www.ncbi.nlm.nih.gov/pubmed/), scientific electronic library of RF – Elibrary.ru (https://elibrary.ru/) and also professional endourological association websites. The databases were searched using the following keywords: «ureteral stent», «urethral stent», «allium», «uventa» and «memokath». At the first stage, 93 sources no older than 5 years were found that were relevant to the topic of the review. Conference abstracts, short communications, and duplicate publications were excluded. Then, based on the relevance of the data, the reliability of the sources, the impact factors of the journals and the sequence of presentation of the material in the manuscript, 43 articles in scientific international peer-reviewed journals, practical guidelines and clinical recommendations were selected directly for citation in the review. Results. The stent is one of the most common urological prostheses used in the treatment of obstructive uropathy. The main causes of obstruction of the ureter and urethra include benign and malignant factors. Active introduction of minimally invasive technologies into everyday urological practice using ureteral or urethral stents are effective and safe methods of urine diversion (especially in comorbid patients), however, unfortunately, side effects from the use of these prosthetic systems continue to reduce the quality of life of patients. The use of polymer materials in urology has made it possible to introduce a huge number of non-metallic stents used by urologists, however, due to the occurrence of various kinds of complications, an attempt has been made to introduce a new generation of stents – made of a superelastic alloy, coated with polymer. Stents made of superelastic alloy coated with polymer have been used in the treatment of various pathologies of the ureter and urethra for more than two decades. The need for reliable long-term urinary tract drainage has led to the development of improved urinary tract stent designs such as Memokath, Allium, and Uventa. The main advantages of the latter are a convenient delivery system, a self-expanding mechanism, low adhesive properties, no tissue ingrowth, ease of removal, and no need for frequent replacement. Despite the evolution of ureteral and urethral stent designs, complications continue to arise that limit their use and the search for «ideal» drainage systems continues. Conclusion. Today it is difficult to overestimate the role of drainage systems in the treatment of obstructive urological and oncological diseases. However, despite significant success in their use, prostheses are constantly subject to constant modifications and developments aimed at increasing their suitability, durability, ease of implantation and functionality, while reducing the complications associated with them. Future developments in the field of urogenital prosthetic surgery and urology in general continue to attract interest, and ongoing research into new biomaterials, stem cells and tissue engineering is expanding the boundaries of possible interventions in the human genitourinary tract.
Andrii Voshchepynets, Oleksiy Agapitov, Lynn Wilson
et al.
We present the results of processing the effects of the powerful Gamma Ray Burst GRB221009A captured by the charged particle detectors (electrostatic analyzers and solid-state detectors) onboard spacecraft at different points in the heliosphere on October 9, 2022. To follow the GRB221009A propagation through the heliosphere we used the electron and proton flux measurements from solar missions Solar Orbiter and STEREO-A; Earth magnetosphere and the solar wind missions THEMIS and Wind; meteorological satellites POES15, POES19, MetOp3; and MAVEN - a NASA mission orbiting Mars. GRB221009A had a structure of four bursts: less intense Pulse 1 - the triggering impulse - was detected by gamma-ray observatories at 131659 UT (near the Earth); the most intense Pulses 2 and 3 were detected on board all the spacecraft from the list, and Pulse 4 detected in more than 500 s after Pulse 1. Due to their different scientific objectives, the spacecraft, which data was used in this study, were separated by more than 1 AU (Solar Orbiter and MAVEN). This enabled tracking GRB221009A as it was propagating across the heliosphere. STEREO-A was the first to register Pulse 2 and 3 of the GRB, almost 100 seconds before their detection by spacecraft in the vicinity of Earth. MAVEN detected GRB221009A Pulses 2, 3, and 4 at the orbit of Mars about 237 seconds after their detection near Earth. By processing the time delays observed we show that the source location of the GRB221009A was at RA 288.5 degrees, Dec 18.5 degrees (J2000) with an error cone of 2 degrees
We introduce RJUA-QA, a novel medical dataset for question answering (QA) and reasoning with clinical evidence, contributing to bridge the gap between general large language models (LLMs) and medical-specific LLM applications. RJUA-QA is derived from realistic clinical scenarios and aims to facilitate LLMs in generating reliable diagnostic and advice. The dataset contains 2,132 curated Question-Context-Answer pairs, corresponding about 25,000 diagnostic records and clinical cases. The dataset covers 67 common urological disease categories, where the disease coverage exceeds 97.6\% of the population seeking medical services in urology. Each data instance in RJUA-QA comprises: (1) a question mirroring real patient to inquiry about clinical symptoms and medical conditions, (2) a context including comprehensive expert knowledge, serving as a reference for medical examination and diagnosis, (3) a doctor response offering the diagnostic conclusion and suggested examination guidance, (4) a diagnosed clinical disease as the recommended diagnostic outcome, and (5) clinical advice providing recommendations for medical examination. RJUA-QA is the first medical QA dataset for clinical reasoning over the patient inquiries, where expert-level knowledge and experience are required for yielding diagnostic conclusions and medical examination advice. A comprehensive evaluation is conducted to evaluate the performance of both medical-specific and general LLMs on the RJUA-QA dataset. Our data is are publicly available at \url{https://github.com/alipay/RJU_Ant_QA}.