To improve upon prior attempts to predict which patients will pass their obstructing ureteral stones, we developed a machine learning algorithm to predict the passage of obstructing ureteral stones ...using only the CT scan at a patient's initial presentation.
We obtained Institutional Review Board approval to conduct a retrospective study by extracting data from all patients with an obstructing 3-10 mm ureteral stone. We included patients with sufficient data to be categorized as having either passed or failed to pass an obstructing ureteral stone. We developed a 3D-convolutional neural network (CNN) model using a dynamic learning rate, the Adam optimizer, and early stopping with 10-fold cross-validation. Using this model, we calculated the area under the curve (AUC) and developed a model confusion matrix, which we compared with a model based only on the largest dimension of the stone.
A total of 138 patients met inclusion criteria and had adequate images that could be preprocessed and included in the study. Seventy patients failed to pass their ureteral stones, and 68 patients passed their stones. For the 3D-CNN model, the mean AUC was 0.95 with an overall mean sensitivity of 95% and mean specificity of 77%, which outperformed the model based on stone-size.
The 3D-CNN model predicts which patients will pass their obstructing ureteral stones based on CT scan alone and does not require any further measurements. This can provide useful clinical information which may help obviate the need for a delay in care for patients who inevitably require surgical intervention.
Abstract Introduction Obesity has been correlated with high grades of prostate cancer. Body mass index and waist circumference are not good surrogates for obesity. Objective To evaluate whether ...periprostatic fat volume and periprostatic fat ratio as determined by multi-parametric magnetic resonance imaging correlates with the presence of high-grade prostate cancer. Materials and Methods A total of 295 consecutive patients (Median age 64, range 38-84) underwent mpMRI of the prostate gland between August 2013 and February 2015. All patients underwent a 3 Tesla multi-parametric MRI. Using DynaCAD (Invivo, Gainesville Florida, USA), we calculated the prostate volume and volume of the periprostatic fat seen on mpMRI. The peri-prostatic fat ratio was calculated using the formula peri-prostatic fat volume / prostate volume). Results A higher periprostatic fat volume ( p <0.001) and a higher periprostatic fat ratio ( p <0.001) were significantly associated with a higher Gleason Score. Periprostatic fat ratio is a better predictor of higher Gleason Score compare to periprostatic fat volume (p<0.001). There was no correlation observed between periprostatic fat ratio and PSA (Median 7.34, range 0.36-59.7, p=0.274), age (Median 64, range 38-84, p=0.665) or BMI (Median 28.33, range 17.99-45.44, p=0.310). Patients with a higher periprostatic fat ratio were more likely to undergo intervention for prostate cancer. Conclusion A higher periprostatic fat ratio is significantly associated with a higher Gleason Score. Periprostatic fat ratio is a better predictor of higher Gleason Score compare to periprostatic fat volume and may be an important risk factor in diagnosing patients higher grade prostate cancer.
To describe the steps and technique of a robotic pyelolithotomy for complete removal of a left staghorn stone after a previous open pyelolithotomy.
The patient is placed in a left modified flank ...position with 4 laparoscopic ports placed: 12mm port for camera paramedian to the left of the midline, 8mm robotic port left lower quadrant at the level of the umbilicus, 8mm robotic port midclavicular line 2 finger breaths below the costal margin, 12mm Airseal assistant port paramedian infraumbilical. The white line of Toldt was incised and the colon was mobilized medially. Anterior Gerota's fascia was opened and tacked to the lateral abdominal wall exposing renal pelvis and parenchyma. An intraoperative ultrasound confirmed the underlying stone. A V-shaped Gil-Vernet pyelolithotomy incision was made and Prograsp forceps were used to manipulate the stone out of the renal pelvis. The collecting system was inspected and irrigated using the robotic lens. The pyelotomy was closed with 4-0 Monocryl suture on a TF needle in 2 lengths of suture, superiorly and inferiorly. Gerota's fascia was closed over the renal pelvis and the kidney was re-retroperitonealized by tacking the colon to the white line of Toldt. The specimen was retrieved through a mini-Pfannenstiel incision via a specimen bag. The patient was discharged on postoperative day 1 and seen in clinic 5 weeks later for stent removal.
Robotic pyelolithotomy is a minimally invasive alternative that can be offered to patients with complete staghorn stones even after major open stone surgery. However case selection for this approach relies on the stone burden primarily in a dilated renal pelvis with limited calyceal projections. It is imperative to review preoperative imaging to understand the calyceal anatomy and the rotation required to free the stone from the collecting system.
Vitamin D deficiency is more common among African Americans (AAs) than among European Americans (EAs), and epidemiologic evidence links vitamin D status to many health outcomes. Two genome-wide ...association studies (GWAS) in European populations identified vitamin D pathway gene single-nucleotide polymorphisms (SNPs) associated with serum vitamin D 25(OH)D levels, but a few of these SNPs have been replicated in AAs. Here, we investigated the associations of 39 SNPs in vitamin D pathway genes, including 19 GWAS-identified SNPs, with serum 25(OH)D concentrations in 652 AAs and 405 EAs. Linear and logistic regression analyses were performed adjusting for relevant environmental and biological factors. The pattern of SNP associations was distinct between AAs and EAs. In AAs, six GWAS-identified SNPs in
GC
,
CYP2R1
, and
DHCR7/NADSYN1
were replicated, while nine GWAS SNPs in
GC
and
CYP2R1
were replicated in EAs. A
CYP2R1
SNP, rs12794714, exhibited the strongest signal of association in AAs. In EAs, however, a different
CYP2R1
SNP, rs1993116, was the most strongly associated. Our models, which take into account genetic and environmental variables, accounted for 20 and 28 % of the variance in serum vitamin D levels in AAs and EAs, respectively.
Introduction
In 2006, the Association of American Medical Colleges (AAMC) recommended to increase medical school enrollment to address an anticipated physician shortage in the future. To accommodate ...this increase, medical schools not only increased students enrolled at existing medical schools, but also opened new regional medical campuses (RMCs). However, the Liaison Committee on Medical Education (LCME) has standards for medical schools with more than one geographically separate campus; specifically, the curriculum should have comparable educational experiences, equivalent methods of assessment, and uniform graduation standards across all locations. Thus, RMCs have the unique task of maintaining an autonomous identity with their own strengths and resources, all the while remaining consistent and comparable to the central campus. Indiana University School of Medicine has eight RMCs and a main campus in Indianapolis. The first‐year Human Structure course integrates gross anatomy, histology, and embryology and utilizes identical learning objectives, assessment, and state‐wide pre‐recorded lectures. This instructional design leaves the local educational team, cohort of students (75% fewer students at RMCs), and the campus climate among the differences in learning environment. The goal of this study is to explore the differences in medical students’ perceptions of the anatomy environment at RMCs versus the central campus despite comparability in formal curriculum.
Methods
This IRB‐approved study used a modified version of the Dundee Ready Educational Environment Measure, that included a 40‐item Likert survey and six free response questions to gather more information about the medical education environment. First‐year medical students were recruited from three RMCs and main academic campus. A Mann Whitney U test was used to compare survey responses of participants at RMCs and main campus (α ≤ .05) and free responses comments were analyzed using thematic analysis.
Results
A total of 15 RMC (21%) and 12 main campus students (9%) completed the survey. Students at the main campus reported significantly lower scores on 10 items compared to RMC participants (p ≤ 0.035). These items related to stimulating learning, providing student‐centered instruction, offering constructive feedback, and having a relaxed laboratory learning environment. Thematic analysis of free responses was consistent with survey results and demonstrated that students at RMCs appreciate the smaller number of students which provides more opportunity for one‐on‐one instruction, support, and camaraderie among peers.
Discussion
In considering the learning experience of students, the contributions of factors beyond the formal curriculum need to be explored. Thus, the interaction of instructor and student, through empathy, support, communication, and the learning environment as a whole need to be considered and developed. Allowing the unique qualities and identities of the RMC and central campus to flourish can improve the learning environment while maintaining comparable curriculum standards.
Abstract
Racial disparities in prostate cancer have not been well characterized on a genomic level. Here we show the results of a multi-institutional retrospective analysis of 1,152 patients (596 ...African-American men (AAM) and 556 European-American men (EAM)) who underwent radical prostatectomy. Comparative analyses between the race groups were conducted at the clinical, genomic, pathway, molecular subtype, and prognostic levels. The EAM group had increased
ERG
(
P
< 0.001) and
ETS
(
P
= 0.02) expression, decreased SPINK1 expression (
P
< 0.001), and basal-like (
P
< 0.001) molecular subtypes. After adjusting for confounders, the AAM group was associated with higher expression of
CRYBB2, GSTM3
, and inflammation genes (
IL33, IFNG, CCL4, CD3, ICOSLG
), and lower expression of mismatch repair genes (
MSH2
,
MSH6
) (p < 0.001 for all). At the pathway level, the AAM group had higher expression of genes sets related to the immune response, apoptosis, hypoxia, and reactive oxygen species. EAM group was associated with higher levels of fatty acid metabolism, DNA repair, and WNT/beta-catenin signaling. Based on cell lines data, AAM were predicted to have higher potential response to DNA damage. In conclusion, biological characteristics of prostate tumor were substantially different in AAM when compared to EAM.
PDF
