Hasil untuk "Diseases of the genitourinary system. Urology"

Wenshen Pu, Yong Xu, Jiali Liu et al.

Arteriovenous grafts remain crucial for hemodialysis access despite the risk of perigraft seromas (PSs)—sterile fluid collections causing graft compression, thrombosis, and dysfunction. Current treatments (surgical drainage and compression therapy) show high recurrence rates. We describe a novel occlusion-reopening technique for refractory PSs in 5 patients receiving hemodialysis (mean age, 62.6 years) with expanded polytetrafluoroethylene AVGs. All seromas developed at arterial anastomoses (1-43 days after placement) and recurred after conventional therapies. Our protocol involved (1) intentional graft occlusion via manual compression to induce thrombosis, (2) complete surgical seroma evacuation with pseudocapsule preservation, and (3) percutaneous transluminal angioplasty using 6-mm balloons for graft reopening (see Fig 1 for details). Technical success was achieved in all cases, with immediate restoration of thrill/bruit and mean post–percutaneous transluminal angioplasty flow of 1320 mL/min. No seroma recurrences occurred during follow-up, and all AVGs remained functional. The occlusion-reopening technique addresses PS pathophysiology by eliminating fluid production through temporary thrombosis while preserving graft architecture. This approach demonstrates 100% efficacy in our series for recurrent PSs unresponsive to standard therapies, offering a reproducible solution with durable outcomes.

Hyunmin Kim, Yukun Zhou, Rahul A. Jonas et al.

Oculomics - the concept of predicting systemic diseases, such as cardiovascular disease and dementia, through retinal imaging - has advanced rapidly due to the data efficiency of transformer-based foundation models like RETFound. Image-level mixed sample data augmentations, such as CutMix and MixUp, are frequently used for training transformers, yet these techniques perturb patient-specific attributes, such as medical comorbidity and clinical factors, since they only account for images and labels. To address this limitation, we propose a hierarchical sampling strategy, Oculomix, for mixed sample augmentations. Our method is based on two clinical priors. First (exam level), images acquired from the same patient at the same time point share the same attributes. Second (patient level), images acquired from the same patient at different time points have a soft temporal trend, as morbidity generally increases over time. Guided by these priors, our method constrains the mixing space to the patient and exam levels to better preserve patient-specific characteristics and leverages their hierarchical relationships. The proposed method is validated using ViT models on a five-year prediction of major adverse cardiovascular events (MACE) in a large ethnically diverse population (Alzeye). We show that Oculomix consistently outperforms image-level CutMix and MixUp by up to 3% in AUROC, demonstrating the necessity and value of the proposed method in oculomics.

Chalachew Tenna Alemu, Yohannes Kifle Tessema, Messay Mekonen Molla et al.

Abstract Myxofibrosarcoma of the spermatic cord is a rare form of para-testicular tumor that usually presents with painless scrotal or inguinal swelling. Ultrasonography revealed a solid mass in the scrotum, suggesting a para-testicular tumor, and exploration via a high inguinal incision revealed a large para-testicular mass. Finally, a pathologic examination revealed a low-grade sarcoma favoring myxoid fibrosarcoma. Here, we present the first reported case of myxofibrosarcoma of the spermatic cord in Ethiopia in a 54-year-old male patient and reviewed the available literature on the topic.

Xiaoxi Wang, Wang Jin, Xuan Li et al.

Abstract Background Peritoneal dialysis (PD) is one of the relatively safe and effective renal replacement therapies for patients with end-stage renal disease (ESRD). There are three main types of PD catheter insertion procedures: open surgery, laparoscopic surgery, and percutaneous insertion. Currently, open surgery is most commonly used in clinical practice, although some hospitals have adopted laparoscopic and percutaneous insertion methods. However, there is still a lack of large-scale studies comparing percutaneous and laparoscopic catheter placement. This study aims to collect and synthesize existing literature data, analyze complications related to PD catheter insertion, and determine the optimal catheter placement method. Methods This Meta-analysis has been registered on the PROSPERO platform (CRD42024509930). Articles published in EMBASE, PubMed, Web of Science, and CNKI were retrieved, statistically analyzed, and reviewed. The statistical software Review Manager version 5.4.1 was used for data analysis. Results A total of nine studies on surgical outcomes and complications were included. The article types included one randomized controlled trial (RCT), one prospective study, and seven retrospective studies. The methodological quality of the 8 included non-randomized studies was assessed using the Newcastle-Ottawa Scale (NOS). The average score was 7.4 points (range: 6 to 8), indicating an overall high study quality. According to existing literature, laparoscopic PD catheter insertion may reduce postoperative bleeding risk but is associated with a longer surgical duration. Additionally, there were no statistically significant differences between laparoscopic and percutaneous catheter insertion methods in terms of the length of hospital stays, early and late complications—including peritonitis, exit-site infections, catheter malfunction and failure, hernia, and dialysate leakage. Conclusion Data analysis indicates that the clinical outcomes of laparoscopic and percutaneous PD catheter insertion are similar. However, large-scale, multicenter studies are still needed to further validate these findings. Clinical trial number Not applicable.

Fahud Ahmmed, Md. Zaheer Raihan, Kamnur Nahar et al.

Skin diseases can arise from infections, allergies, genetic factors, autoimmune disorders, hormonal imbalances, or environmental triggers such as sun damage and pollution. Some skin diseases, such as Actinic Keratosis and Psoriasis, can be fatal if not treated in time. Early identification is crucial, but the diagnostic methods for these conditions are often expensive and not widely accessible. In this study, we propose a novel and efficient method for diagnosing skin diseases using deep learning techniques. This approach employs a modified VGG16 Convolutional Neural Network (CNN) model. The model includes several convolutional layers and utilizes ImageNet weights with modified top layers. The top layer is updated with fully connected layers and a final softmax activation layer to classify skin diseases. The dataset used, titled "Skin Disease Dataset," is publicly available. While the VGG16 architecture does not include data augmentation by default, preprocessing techniques such as rotation, shifting, and zooming were applied to augment the data prior to model training. The proposed methodology achieved 90.67% accuracy using the modified VGG16 model, demonstrating its reliability in classifying skin diseases. The promising results highlight the potential of this approach for real-world applications.

Takashi Nishibayashi, Seiji Kanazawa, Kumpei Yamada

Symptom Checkers (SCs) provide medical information tailored to user symptoms. A critical challenge in SC development is preventing unexpected performance degradation for individual diseases, especially rare diseases, when updating algorithms. This risk stems from the lack of practical pre-deployment evaluation methods. For rare diseases, obtaining sufficient evaluation data from user feedback is difficult. To evaluate the impact of algorithm updates on the diagnostic performance for individual rare diseases before deployment, this study proposes and validates a novel Synthetic Vignette Simulation Approach. This approach aims to enable this essential evaluation efficiently and at a low cost. To estimate the impact of algorithm updates, we generated synthetic vignettes from disease-phenotype annotations in the Human Phenotype Ontology (HPO), a publicly available knowledge base for rare diseases curated by experts. Using these vignettes, we simulated SC interviews to predict changes in diagnostic performance. The effectiveness of this approach was validated retrospectively by comparing the predicted changes with actual performance metrics using the R-squared ($R^2$) coefficient. Our experiment, covering eight past algorithm updates for rare diseases, showed that the proposed method accurately predicted performance changes for diseases with phenotype frequency information in HPO (n=5). For these updates, we found a strong correlation for both Recall@8 change ($R^2$ = 0.83,$p$ = 0.031) and Precision@8 change ($R^2$ = 0.78,$p$ = 0.047). Our proposed method enables the pre-deployment evaluation of SC algorithm changes for individual rare diseases. This evaluation is based on a publicly available medical knowledge database created by experts, ensuring transparency and explainability for stakeholders. Additionally, SC developers can efficiently improve diagnostic performance at a low cost.

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Tarunveer S. Ahluwalia, Teemu K.E. Rönkkö, Mie K. Eickhoff et al.

Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as novel therapeutics to treat diabetic kidney disease (DKD). Although the beneficial effects of SGLT2i have been demonstrated, their target mechanisms on kidney function are unknown. The current study aimed to elucidate these mechanisms by studying SGLT2i-induced changes in the urinary proteome of persons with type 2 diabetes (T2D) and DKD. Methods: A total of 40 participants with T2D were enrolled in a double-blinded randomized cross-over trial at the Steno Diabetes Center Copenhagen, Denmark. They were treated with 10 mg of dapagliflozin for 12 weeks. Thirty-two participants with complete urinary proteomics measures before and after the trial were included. All participants received renin-angiotensin system blockade and had albuminuria, (urine albumin-to-creatinine ratio [UACR] ≥30 mg/g). A type 1 diabetes (T1D) cohort consisting of healthy controls and persons with DKD was included for validation. Urinary proteome changes were analyzed using Wilcoxon signed-rank test. Functional enrichment analysis was conducted to discover affected biological processes. Results: Dapagliflozin treatment significantly (Padjusted < 0.05) affected 36 urinary peptide fragments derived from 19 proteins. Eighteen proteins were correspondingly reflected in the validation cohort. A multifold change in peptide abundance was observed in many proteins (A1BG, urinary albumin [ALB], Caldesmon 1, COLCRNN, heat shock protein 90-β [HSP90AB1], IGLL5, peptidase inhibitor 16 [PI16], prostaglandin-H2-D-isomerase [PTGDS], SERPINA1). These also included urinary biomarkers of kidney fibrosis and function (type I and III collagens and albumin). Biological processes relating to inflammation, wound healing, and kidney fibrosis were enriched. Conclusion: The current study discovers the urinary proteome impacted by the SGLT2i, thereby providing new potential target sites and pathways, especially relating to wound healing and inflammation.

Nao Asai, Yasuhiro Suzuki, Akimasa Asai et al.

Abstract Background Japanese peritoneal dialysis (PD) guidelines do not suggest applying mupirocin/gentamicin ointment to the exit sites of PD patients to prevent exit-site infection (ESI). The guidelines do not mention topical antimicrobials as a treatment for ESI. Methods We retrospectively investigated the additional use of topical antibiotic ointments on patients receiving oral or intravenous antibiotics for recurrent and/or refractory ESI at Aichi Medical University and Nagoya University Hospitals between 2017 and 2022. Results A total of 13 patients (11 men, 2 women) were included in this study. Median age was 69.0 years, median duration of PD was 26.0 months, two patients had diabetes as a complication, and ESI incidence was 2.7 episodes per patient-year. Systemic antibacterial treatment had been administered for a median of 27.0 days before application therapy. Mupirocin was used in eight cases and gentamicin in five cases, with complete resolution in all cases. No adverse effects such as skin symptoms, antibiotic resistance, or non-tuberculous mycobacterial infections were observed. Cases were divided into two groups based on the duration of topical antibiotic use: short-term group < 90 days and long-term group ≥ 90 days. All patients in both groups achieved complete resolution, with no significant differences in time to resolution, number of recurrent ESIs, or occurrence of ESIs after discontinuation of application therapy. Conclusion Additional use of topical antibiotic for recurrent and/or refractory ESI appears safe and effective. This study suggests that future randomized controlled trials are warranted.

V. A. Oganyan, N. A. Karelskaya, D. M. Monakov et al.

The paper presents the results of surgical treatment of 14 patients with renal masses undergone partial nephrectomy on the Da Vinci Si and Da Vinci Xi robotic systems using ‘drug &amp; cold’ ischemia. The advantages of the original technique, such as long-term safe renal ischemia, nephron sparing, minimal blood loss with no hemotransfusions and short length of hospital stay were presented.

Darlyn Buenaño Vera, Byron Oviedo, Washington Chiriboga Casanova et al.

The early identification of diseases in cocoa pods is an important task to guarantee the production of high-quality cocoa. The use of artificial intelligence techniques such as machine learning, computer vision and deep learning are promising solutions to help identify and classify diseases in cocoa pods. In this paper we introduce the development and evaluation of a deep learning computational model applied to the identification of diseases in cocoa pods, focusing on "monilia" and "black pod" diseases. An exhaustive review of state-of-the-art of computational models was carried out, based on scientific articles related to the identification of plant diseases using computer vision and deep learning techniques. As a result of the search, EfficientDet-Lite4, an efficient and lightweight model for object detection, was selected. A dataset, including images of both healthy and diseased cocoa pods, has been utilized to train the model to detect and pinpoint disease manifestations with considerable accuracy. Significant enhancements in the model training and evaluation demonstrate the capability of recognizing and classifying diseases through image analysis. Furthermore, the functionalities of the model were integrated into an Android native mobile with an user-friendly interface, allowing to younger or inexperienced farmers a fast and accuracy identification of health status of cocoa pods

Yingjing Xu, Xueyan Cai, Zihong Zhou et al.

Hypomimia is a non-motor symptom of Parkinson's disease that manifests as delayed facial movements and expressions, along with challenges in articulation and emotion. Currently, subjective evaluation by neurologists is the primary method for hypomimia detection, and conventional rehabilitation approaches heavily rely on verbal prompts from rehabilitation physicians. There remains a deficiency in accessible, user-friendly and scientifically rigorous assistive tools for hypomimia treatments. To investigate this, we developed HypomimaCoach, an Action Unit (AU)-based digital therapy system for hypomimia detection and rehabilitation in Parkinson's disease. The HypomimaCoach system was designed to facilitate engagement through the incorporation of both relaxed and controlled rehabilitation exercises, while also stimulating initiative through the integration of digital therapies that incorporated traditional face training methods. We extract action unit(AU) features and their relationship for hypomimia detection. In order to facilitate rehabilitation, a series of training programmes have been devised based on the Action Units (AUs) and patients are provided with real-time feedback through an additional AU recognition model, which guides them through their training routines. A pilot study was conducted with seven participants in China, all of whom exhibited symptoms of Parkinson's disease hypomimia. The results of the pilot study demonstrated a positive impact on participants' self-efficacy, with favourable feedback received. Furthermore, physician evaluations validated the system's applicability in a therapeutic setting for patients with Parkinson's disease, as well as its potential value in clinical applications.

Branko Mitic, Philipp Seeböck, Jennifer Straub et al.

Fast detection of emerging diseases is important for containing their spread and treating patients effectively. Local anomalies are relevant, but often novel diseases involve familiar disease patterns in new spatial distributions. Therefore, established local anomaly detection approaches may fail to identify them as new. Here, we present a novel approach to detect the emergence of new disease phenotypes exhibiting distinct patterns of the spatial distribution of lesions. We first identify anomalies in lung CT data, and then compare their distribution in a continually acquired new patient cohorts with historic patient population observed over a long prior period. We evaluate how accumulated evidence collected in the stream of patients is able to detect the onset of an emerging disease. In a gram-matrix based representation derived from the intermediate layers of a three-dimensional convolutional neural network, newly emerging clusters indicate emerging diseases.

Jeziel Basso, Juliana Beust de Lima, Marina Bessel et al.

Abstract Background Prostate cancer exhibits a very diverse behaviour, with some patients dying from the disease and others never needing treatment. Active surveillance (AS) consists of periodic PSA assessment (prostate-specific antigen), DRE (digital rectal examination) and periodic prostate biopsies. According to the main guidelines, AS is the preferred strategy for low-risk patients, to avoid or delay definitive treatment. However, concerns remain regarding its applicability in certain patient subgroups, such as African American men, who were underrepresented in the main cohorts. Brazil has a very racially diverse population, with 56.1% self-reporting as brown or black. The aim of this study is to evaluate and validate the AS strategy in low-risk prostate cancer patients following an AS protocol in the Brazilian public health system. Methods This is a multicentre AS prospective cohort study that will include 200 patients from all regions of Brazil in the public health system. Patients with prostate adenocarcinoma and low-risk criteria, defined as clinical staging T1–T2a, Gleason score ≤ 6, and PSA < 10 ng/ml, will be enrolled. Archival prostate cancer tissue will be centrally reviewed. Patients enrolled in the study will follow the AS strategy, which involves PSA and physical examination every 6 months as well as multiparametric MRI (mpMRI) every two years and prostate biopsy at month 12 and then every two years. The primary objective is to evaluate the reclassification rate at 12 months, and secondary objectives include determining the treatment-free survival rate, metastasis-free survival, and specific and overall survival. Exploratory objectives include the evaluation of quality of life and anxiety, the impact of PTEN loss and the economic impact of AS on the Brazilian public health system. Discussion This is the first Brazilian prospective study of patients with low-risk prostate cancer under AS. To our knowledge, this is one of the largest AS study cohort with a majority of nonwhite patients. We believe that this study is an opportunity to better understand the outcomes of AS in populations underrepresented in studies. Based on these data, an AS national clinical guideline will be developed, which may have a beneficial impact on the quality of life of patients and on public health. Trial registration Clinicaltrials registration is NCT05343936.

Han Yu, Yanqing Chi, Baoxing Wang

Abstract Background To access the efficacy of percutaneous transluminal angioplasty and arteriovenous fistula reconstruction for immature arteriovenous fistula, compare the long-term patency and post-operative complications between them. Materials and methods The medical records and Hemodialysis record sheets from 44 patients between May 2020 and January 2022 who underwent percutaneous transluminal angioplasty or arteriovenous fistula reconstruction treatment for immature autogenous arteriovenous fistula (AVF) were retrospectively reviewed. The patients were divided into two groups according to the type of surgery they received, including 25 patients in the PTA group and 19 patients in the AVF reconstruction group. Clinical outcomes were included, such as the primary and secondary patency rates following the procedure, maturation time, peak systolic velocity (PSV) of brachial artery, maximum pump-controlled blood flow at initial dialysis, and post-operative complications rates in the two groups. Results Technical and clinical success was achieved in 100% of the 44 cases. For patients who underwent percutaneous transluminal angioplasty, the primary patency rate at 3, 6, and 9 months was 84.0%, 68.0%, 60.0%, and the secondary patency rate was 92.0%, 84.0%, 80.0%, respectively. And for patients who underwent arteriovenous fistula reconstruction, the primary patency rate at 3, 6, and 9 months was 89.5%, 73.7%, 68.4%, and the secondary patency rate was 100.0%, 94.7%, 94.7%, respectively. There were no significant differences between the two groups in terms of patency rates (p > .050). In patients whose maturation was successful, the average maturation time of fistula after the PTA procedure was 19.36 ± 13.94 days, and 58.63 ± 18.95 days for the reconstruction procedure (p < .010). The PSV of brachial artery before and after the procedure was 87.64 ± 23.87 cm/s and 153.20 ± 21.69 cm/s in PTA group, for reconstruction group, the number was 86.26 ± 20.59 cm/s and 151.26 ± 29.94 cm/s, respectively. No statistically significant differences (p > .050). The maximum pump-controlled blood flow at initial dialysis was 232.60 ± 16.72 ml/min in PTA group, which was significantly higher than 197.11 ± 10.45 ml/min in reconstruction group (p < .010). Subcutaneous hematoma, restenosis, thrombus formation, and pseudoaneurysm were major complications in PTA group. Restenosis, thrombus formation, and pseudoaneurysm were major complications in reconstruction group, with no statistically significant differences between the two groups (p > .050). Conclusion When immature AVFs require reconstruction surgery, the patency outcomes are comparable to AVFs that undergo successful management by PTA. While, when AVFs are successfully managed by PTA, they have significantly less maturation times and higher maximum pump-controlled blood flow rates at initial dialysis AVF use.

Manisha Ghate, Pallavi Shidhaye, Shraddha Gurav et al.

Background : We aimed to determine the anti-SARS-CoV-2 IgG antibodies among people living with HIV (PLHIV) in Pune, India. Methods : This cross-sectional study was conducted between March 2021 and June 2021. Demographic and clinical information related to coronavirus disease 2019 (COVID-19) were recorded on structured questionnaires. Blood samples were collected and tested for anti-SARS-CoV-2 IgG antibodies using commercial ELISA. Results : Of the 405 HIV infected individuals enrolled in the study, 223(55.1%) were females. Mean age and CD4 count of participants were 42 years (SD: 10) and 626 cells/mm 3 (SD: 284) respectively. A total of 382 (95%) PLHIV were virologically suppressed. The seropositivity against SARS-CoV-2 was found in 221 PLHIV (54.6%, 95% CI: 49.7-59.4). No significant association was found between demographic or clinical factors and seropositivity. Conclusion : A high prevalence of anti-SARS-CoV-2 IgG antibodies was found among PLHIV attending ART centre indicating an exposure to the virus among them.

Tuo Wu, Cunhua Pan, Yijin Pan et al.

In this paper, we propose a comprehensive framework to jointly analyze the angle estimation error and design the three-dimensional (3D) positioning algorithm for a millimeter wave (mmWave) positioning system. First, we estimate the angles of arrival (AoAs) at the anchors by applying the two-dimensional discrete Fourier transform (2D-DFT) algorithm. Based on the property of the 2D-DFT algorithm, the angle estimation error is analyzed in terms of probability density functions (PDF). The analysis shows that the derived angle estimation error is non-Gaussian, which is different from the existing work. Second, the intricate expression of the PDF of the AoA estimation error is simplified by employing the first-order linear approximation of triangle functions. Then, we derive a complex expression for the variance based on the derived PDF. Specifically, for the azimuth estimation error, the variance is separately integrated according to the different non-zero intervals of the PDF. Finally, we apply the weighted least square (WLS) algorithm to estimate the 3D position of the MU by using the estimated AoAs and the obtained non-Gaussian variance. Extensive simulation results confirm that the derived angle estimation error is non-Gaussian, and also demonstrate the superiority of the proposed framework.

Fakrul Islam Tushar, Vincent M. D'Anniballe, Geoffrey D. Rubin et al.

Despite the potential of weakly supervised learning to automatically annotate massive amounts of data, little is known about its limitations for use in computer-aided diagnosis (CAD). For CT specifically, interpreting the performance of CAD algorithms can be challenging given the large number of co-occurring diseases. This paper examines the effect of co-occurring diseases when training classification models by weakly supervised learning, specifically by comparing multi-label and multiple binary classifiers using the same training data. Our results demonstrated that the binary model outperformed the multi-label classification in every disease category in terms of AUC. However, this performance was heavily influenced by co-occurring diseases in the binary model, suggesting it did not always learn the correct appearance of the specific disease. For example, binary classification of lung nodules resulted in an AUC of < 0.65 when there were no other co-occurring diseases, but when lung nodules co-occurred with emphysema, the performance reached AUC > 0.80. We hope this paper revealed the complexity of interpreting disease classification performance in weakly supervised models and will encourage researchers to examine the effect of co-occurring diseases on classification performance in the future.

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Somendra Bansal, Ketankumar G Rupala, Prasun Ghosh et al.

Introduction: The end-stage renal disease (ESRD) population is increasing worldwide and organ shortage is an important issue. The disparity between the availability of organs and waitlisted patients for transplants has forced many transplant centers across the world to use marginal kidney donors. We assess and compare postoperative estimated glomerular filtration rate (eGFR) in patients who received a graft from marginal renal donor (MRD) versus those who received a graft from standard renal donor (SRD). Methods: A total of 214 patients with ESRD underwent open live donor renal allografting from September 2015 to September 2017. Out of 214 donors, 165 (77.1%) were SRD and 49 (22.9%) were MRD. Post-transplant eGFR was calculated at 2 months for donors and at days 1, 3, 5, and 7 and month 1, 3, 6, and 12 for recipients. Results: There was no statistically significant difference in eGFR of recipients at preoperative and postoperative period between SRD and MRD groups. Although at 12 months of follow–up eGFR was relatively high in SRD group, it did not show any statistically significant difference. The recipient survival rate at 1-year follow-up was 98.2% in SRD and 100% in MRD group. Conclusions: Renal transplant recipients using MRDs have a comparable glomerular filtration rate to SRDs at the end of 1 year. Short-term outcomes in recipients receiving marginal renal grafts were similar when compared to the allograft from standard donors.