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Introduction: The objective of this study was to determine if use of an automated irrigation pump (AIP) during ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) affects circulating nurse labor, irrigation-related issues, and surgeon and nurse satisfaction when compared to manual hand pump (HP) irrigation. Methods: Eighty consecutive adult patients undergoing unilateral URS or PCNL were prospectively randomized to irrigation with the HP or AIP. Preoperative pump setup time, intraoperative pump maintenance time, total pump time (setup+maintenance), and the number of irrigation-related concerns verbalized by the surgeon intraoperatively were recorded; postoperatively, surgeons and nurses rated their satisfaction with the irrigation system (1 = highly dissatisfied to 10 = highly satisfied). Results: Eighty patients were enrolled (39 AIP and 41 HP); 51 patients underwent URS and 29 patients underwent PCNL. On univariate analysis, the AIP resulted in a significantly reduced total pump time for URS (2.9 vs 5.9 minutes) and PCNL (4.6 vs 33.9 minutes; p

Societal impact statement Sour cherry (Prunus cerasus L.) is an agriculturally valuable tree that produces fruits used in a range of culinary dishes, beverages, and other products. The progenitor species and number of origins of sour cherry remain unresolved. Here, we performed phylogenetic analyses of plastid genomes and nuclear genes from nine wild species and three historically important sour cherry cultivars. Our analyses identified Prunus fruticosa and Prunus avium as the closest extant relatives of the progenitor species of tetraploid sour cherry. Furthermore, our analyses revealed P. fruticosa as the likely maternal contributor. These findings and transcriptomic datasets should serve as valuable new resources to guide future breeding efforts in sour cherry.

Purpose: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for the management of complex or large renal stones. A major challenge for the surgeon, however, is the need to assimilate the nearly 2000 static images from a CT scan into a functional mental image to enable surgical planning. Accordingly, we investigated the potential of immersive virtual reality (iVR) to enhance surgical planning and its impact on the outcomes among patients undergoing PCNL. Materials and Methods: Between 2019 and 2023, 175 patients undergoing PCNL were preoperatively randomized into a CT-only group (N = 89) or a CT+iVR group (N = 86). CT scans were rendered into iVR models that allowed the surgeon not only to visualize and manipulate each patient's relevant anatomy, but also to simulate the percutaneous approach to the proposed calyx. Postoperative CT scans were defined as absolute stone free, < 2 mm remnants, or 2.1 to 4 mm remnants. Results: Preoperative visualization of the iVR model resulted in a changed calyx of entry in 30% of cases. The CT+iVR group had a significant improvement in absolute stone-free rate (33.70% vs 20.22%, P =.043) and overall < 4 mm remnant rate (62.79% vs 48.20%, P =.044). Clavien-Dindo II+IIIa complications were less in the iVR group (3.48% vs 12.30%, P =.03). The results were independent of the surgeon's years of PCNL experience. Conclusions: Preoperative iVR model visualization benefited surgeons and patients alike. From a surgical standpoint, viewing the iVR model resulted in a safer, more effective percutaneous stone removal procedure. [ABSTRACT FROM AUTHOR]

The Rubik’s cube is a prototypical combinatorial puzzle that has a large state space with a single goal state. The goal state is unlikely to be retrieved using orders of randomly generated moves, posing unique challenges for machine learning. The proposed work is above to solve the Rubik’s cube with recursion and DeepCubeA, a deep reinforcement learning approach that learns how to solve increasingly difficult states in reverse from the goal state without any specific domain knowledge. DeepCubeA solves 100% of all test patterns, finding a shortest path to the goal state 60.3% of the time. Deep Cube A generalizes to other combinatorial puzzles andis able to solve the 15 puzzle, 24 puzzle, 35 puzzle, 48 puzzle, Lights Out and Sokoban, finding a shortest path in the majority of verifiable cases. These models were trained with 1 4 GPUs and 20 30 CPUs. This varies throughout training as the training is often stopped and started again to make room for other processes. Further our experimentation compares the results of Rubik’s cube solving among both recursion and DeepCubeA and also with the state of art models. Later, we intend to develop a new deep learning model with an application.

Background: A minority of urologists performing percutaneous nephrolithotomy (PCNL) achieve their own nephrostomy access. In an effort to simplify the access part of PCNL, we herein describe our initial experience with endoscopic-guided retrograde percutaneous access in the prone split-leg position. Case Presentation(s): After informed consent, a confirmed negative urine culture, and 1 week pretreatment with tamsulosin, four carefully selected PCNL patients underwent endoscopic-guided retrograde access in a prone split-leg position using the Lawson catheter. In all the four patients, we achieved endoscopic-guided retrograde upper pole access in the prone split-leg position. A single Clavien 3B complication occurred. Total fluoroscopy time for the PCNL averaged 162 seconds (51-283). Complete stone-free rate at 1 week based on CT scan was 25%, and a stone-free rate defined as

ObjectiveTo compare the performance of 3 contemporary ureteroscopic biopsy devices for the histopathologic diagnosis of upper tract urothelial carcinoma (UTUC).MethodsWe retrospectively reviewed 145 patients who underwent 182 urothelial biopsies using 2.4F backloaded cup biopsy forceps, a nitinol basket, or 3F standard cup biopsy forceps at 3 tertiary academic centers between 2011 and 2016. Experienced genitourinary pathologists provided an assessment of each specimen without knowledge of the device used for biopsy. For patients who underwent nephroureterectomy without neoadjuvant chemotherapy within 3 months of biopsy-proven UTUC diagnosis, the biopsy grade was compared with both the grade and stage of the surgical specimen.ResultsBiopsy utilization varied among the 3 institutions (P .05) and was favored over standard cup forceps specimens. Grade concordance was not affected by specimen size (P >.05), morphology (P >.1), or location (P >.5). No difference existed among the devices in the rate of acquiring a grade concordant biopsy; however, the backloaded cup forceps provided concordant biopsies that could be distinguished as low- and high-grade (P = .02).ConclusionThe backloaded cup forceps and nitinol basket obtained a higher quality urothelial specimen compared with standard cup forceps. Ureteroscopic biopsy device selection did not significantly impact the accuracy of the histologic diagnosis of UTUC.

Background: The ureteral stent provides a conduit for urinary drainage from the kidney to the bladder and is integral to contemporary urologic practice. A ureteral stent is often utilized in acute conditions to prevent or overcome obstruction; however, in nonsurgical patients, because of disease or preference, a ureteral stent may be used as a last resort for long-term management of a stricture in lieu of a nephrostomy tube. This case highlights a patient whose chronic ureteral obstruction has been managed with an indwelling ureteral stent for 25 years; remarkably, stent exchanges are currently required only every 2 years. Case Presentation: A 33-year-old man initially presented with a solitary left kidney and a ureteropelvic junction obstruction. The patient's right kidney was nonfunctioning since childhood because of a presumed ureteropelvic junction obstruction with grade IV hydronephrosis. The patient underwent two failed open repairs of the left kidney in the 1980s, resulting in a totally intrarenal, constricted renal pelvis; an endopyelotomy in 1992 also failed and required angioembolizaton of a segmental renal vessel. The patient refused any further surgical procedures and thus has been managed exclusively with a 7/14F × 28 cm endopyelotomy stent (Boston Scientific®) for 25 years; the interval between stent changes was slowly expanded until they are now being done at 2-year intervals. The patient has not developed recurrent urinary tract infections, stent colic, or stent encrustation. Conclusion: Patients who require chronic indwelling ureteral stents are rare. In this situation, with careful monitoring, the interval between stent exchanges was extended to 2 years, thereby precluding a chronic nephrostomy tube.

PurposeCoconut water has long been touted for its medicinal qualities including natural hydration. We sought to determine whether its consumption would induce changes to urinary lithogenic factors beyond changes in urine volume.Materials and methodsAfter Institutional Review Board approval, volunteers with no prior history of nephrolithiasis were recruited. Each participant was randomized initially to either the coconut water or the water phase of the study. Participants kept meticulous food and fluid intake logs during the first phase of the study and were asked to replicate that diet for the second phase. For each phase the participant consumed 2L of either Taste of Nirvana® pure coconut water or tap water daily for four days. Participants were not restricted to consume additional fluid of their choice during their assigned study phase. During days 3 and 4 of each phase the participant collected a 24-hour urine specimen. Coconut water citrate and malate content were measured and were used along with the beverage pH to calculate the total alkali content of the coconut water. Supersaturation levels were calculated using Equil2. Nonparametric paired analysis using the Wilcoxon test was performed for statistical analysis.ResultsThere were 4 adult male and 4 adult female participants. Each individual's 24-hour urine collection had a creatinine excretion within 20% of the mean for each subject's four samples corroborating that all samples were collected properly. The two samples from each phase for each individual were averaged. The coconut water itself was also analyzed and it was calculated to have a total alkali content of 13.8 mEq/L. Consumption of coconut water significantly increased urinary citrate (29%, p=0.02), urinary potassium (130%, p=0.01), and urinary chloride (37%, p=0.03), without affecting urine pH (p=0.16) or volume beyond that of tap water (p=1.00).ConclusionsCoconut water consumption increases urinary potassium, chloride, and citrate in nonstone forming individuals.

ObjectiveThe summer surgery program (SSP) was founded in 2012 as an educational program for students at the critical juncture between high school and college to engender interest in medicine, science, and innovation. This program has a distinct emphasis on innovation and problem solving based on real-life operative challenges identified by students during surgical observation in the operating room. The effect of the SSP regarding postsecondary education and career goals was evaluated by participants using a follow-up questionnaire.DesignRetrospective cohort study using web-based survey administered to students at least 1 year after participation in the SSP. Associations between demographics and survey responses were made using Fisher's exact test and a Bonferonni correction was used to account for multiple comparisons.ParticipantsBetween July 2012 and August 2015, 119 students enrolled in the SSP. We sent a web-based questionnaire link to all participants who completed the program. The questionnaire contained 80 questions assessing the participant's interest in studying medicine or science in college, knowledge of health care, and their appreciation and understanding of innovation.SettingUC Irvine Medical Center, Orange, CA; Institutional tertiary care center.ResultsIn total, 77 (64.7%) of 119 students who matriculated in the SSP completed the follow-up survey; the mean number of years after the program was 2.09 years. Nearly all students reported the program increased their interest in studying medicine or science in college (97.4%), led them to a better understanding of their own career goals (93.5%) and made them more confident in their ability to succeed in a career in health care (88.3%). The majority indicated the program led them to better understand the training and schooling required of doctors and surgeons (94.8%), and led them to better appreciate the roles of different medical specialties (96.1%). Overall 96% of students reported that the program led them to better understand the importance of innovation and 86% of the respondents noted they better understood the process of innovation. Participants in the SSP were confident they would be able to become a health professional (p < 0.0001). Of note, there was no drop off in the ratings for the program when comparing classes that were 1, 2, 3, or 4 years after their SSP experience.ConclusionsThe follow-up survey revealed that the 2 week SSP had a markedly, long lasting positive effect on participants in areas of academic, career, and innovation-related variables.

Time resolved phase-contrast magnetic resonance imaging 4D-PCMR (also called 4D Flow MRI) data while capable of non-invasively measuring blood velocities, can be affected by acquisition noise, flow artifacts, and resolution limits. In this paper, we present a novel method for merging 4D Flow MRI with computational fluid dynamics (CFD) to address these limitations and to reconstruct de-noised, divergence-free high-resolution flow-fields. Proper orthogonal decomposition (POD) is used to construct the orthonormal basis of the local sampling of the space of all possible solutions to the flow equations both at the low-resolution level of the 4D Flow MRI grid and the high-level resolution of the CFD mesh. Low-resolution, de-noised flow is obtained by projecting in vivo 4D Flow MRI data onto the low-resolution basis vectors. Ridge regression is then used to reconstruct high-resolution de-noised divergence-free solution. The effects of 4D Flow MRI grid resolution, and noise levels on the resulting velocity fields are further investigated. A numerical phantom of the flow through a cerebral aneurysm was used to compare the results obtained using the POD method with those obtained with the state-of-the-art de-noising methods. At the 4D Flow MRI grid resolution, the POD method was shown to preserve the small flow structures better than the other methods, while eliminating noise. Furthermore, the method was shown to successfully reconstruct details at the CFD mesh resolution not discernible at the 4D Flow MRI grid resolution. This method will improve the accuracy of the clinically relevant flow-derived parameters, such as pressure gradients and wall shear stresses, computed from in vivo 4D Flow MRI data.

Cryoablation (CA) is a minimally invasive modality for the management of small renal cortical neoplasms (RCN). Effective ablation is dependent on achieving target temperatures during CA that result in tumor cell death. We investigated long-term oncologic outcomes following CA using multipoint thermal sensors (MTS), which allow precise temperature determination at four points along the needle.We performed a retrospective review of 20 patients with

Introduction: Pediatric Relapsing Polychondritis (RP) is a rare autoimmune disorder that causes inflammation and damage to cartilage in children. Common symptoms include pain, swelling and deformities in the ears, nose, trachea, joints, and eyes. The lack of research on the pediatric population necessitates further evaluation of the literature on pediatric RP to summarize existing patterns in presentation, management, and treatment. Methods: A systematic review was conducted on PubMed and Embase from 1947 to April 2023 on RP in patients under 21 years old abiding by the 2020 PRISMA checklist. Only patient presentations meeting McAdam criteria for RP and including information on management were included. Results: From the 304 initial studies, 54 studies were included for final analysis with a total of 68 patients, who were predominantly female (65%). With a median diagnostic delay of 1 year, the mean age of onset was 12 years old. The most common symptoms on presentation included bilateral auricular chondritis (69%), nasal cartilage inflammation (62%), and respiratory tract chondritis (63%). The most commonly reported information in the literature for the initial workup usually included CT/MRI (72%), bronchoscopy (57%), biopsy (51%), and labs (88%), which most commonly displayed elevated ESR (59%). The most common medications were corticosteroids (91%) and methotrexate (35%) and the most common procedural treatment was tracheostomy (38%). The most efficacious treatment options were monoclonal antibodies (87%, n = 15) and corticosteroids (66%, n = 62) used in 22% and 91% of patients, respectively. The most commonly used monoclonal antibody therapy was infliximab (13%, n = 9). Conclusion: The most common presentation for pediatric RP includes chondritis of the ear, nose, and respiratory tract. The most effective treatment options include corticosteroids and monoclonal antibody therapy, such as infliximab. Our findings highlight increasing remission achieved with anti-rheumatic drugs and monoclonal antibody treatment, especially alongside corticosteroids. [ABSTRACT FROM AUTHOR]

Experimental blood flow measurement techniques are invaluable for a better understanding of cardiovascular disease formation, progression, and treatment. One of the emerging methods is time‐resolved three‐dimensional phase‐contrast magnetic resonance imaging (4D flow MRI), which enables noninvasive time‐dependent velocity measurements within large vessels. However, several limitations hinder the usability of 4D flow MRI and other experimental methods for quantitative hemodynamics analysis. These mainly include measurement noise, corrupt or missing data, low spatiotemporal resolution, and other artifacts. Traditional filtering is routinely applied for denoising experimental blood flow data without any detailed discussion on why it is preferred over other methods. In this study, filtering is compared to different singular value decomposition (SVD)‐based machine learning and autoencoder‐type deep learning methods for denoising and filling in missing data (imputation). An artificially corrupted and voxelized computational fluid dynamics (CFD) simulation as well as in vitro 4D flow MRI data are used to test the methods. SVD‐based algorithms achieve excellent results for the idealized case but severely struggle when applied to in vitro data. The autoencoders are shown to be versatile and applicable to all investigated cases. For denoising, the in vitro 4D flow MRI data, the denoising autoencoder (DAE), and the Noise2Noise (N2N) autoencoder produced better reconstructions than filtering both qualitatively and quantitatively. Deep learning methods such as N2N can result in noise‐free velocity fields even though they did not use clean data during training. This work presents one of the first comprehensive assessments and comparisons of various classical and modern machine‐learning methods for enhancing corrupt cardiovascular flow data in diseased arteries for both synthetic and experimental test cases. [ABSTRACT FROM AUTHOR]

Purpose: Retrograde intrarenal surgery is the gold-standard treatment for most kidney stones. During ureteroscopy, ureteral access sheath insertion at forces greater than 8.0 Newtons (N) risks high-grade ureteral injury. To monitor force, our institution utilizes a unique, Bluetooth-equipped device (i.e., the University of California—Irvine Force Sensor). Given the unique nature of the force sensor, we sought to develop an inexpensive and accessible force sensor based on Boyle's law and the specific amount of force required to compress an occluded 1.0 mL syringe. Materials and Methods: We evaluated three brands of 1.0 mL syringes. After setting the plunger at 1.0 mL, the syringe was occluded, and the syringe plunger was compressed. The syringe volume was recorded when the applied force on the plunger reached 4.0 N, 6.0 N, and 8.0 N. Multiple trials were performed to assess reliability and reproducibility. A method for applying this clinically was also developed. Results: The precise force thresholds identified for a 1.0 mL Luer-Lok™ Syringe (Becton Dickinson, Franklin Lakes, NJ) were 0.30 mL for 4.00 N, 0.20 mL for 6.00 N, and 0.15 mL for 8.00 N. The 1.0 mL Tuberculin Syringe and 1.0 mL Luer Slip Syringe were less precise, but compression from 1.0 to 0.40 mL, 0.25 mL, and 0.20 mL corresponded to force sensor readings that did not exceed 4.00 N, 6.00 N, and 8.00 N, respectively. Conclusions: Based on volume changes, 4.00 N, 6.00 N, and 8.00 N of force can be reliably and reproducibly achieved using an occluded 1.0 mL syringe. [ABSTRACT FROM AUTHOR]

Transient chaos is a characteristic behavior observed in nonlinear systems, where trajectories within a specific region of phase space exhibit chaotic dynamics for a finite duration before transitioning to an external attractor. In many nonlinear systems, transient and chaotic behaviors are closely associated with variations in the system's energy. In this paper, we introduce the concept of an energy variable and establish its connection with the Melnikov integral. We explore the influence of energy variation in an amplitude‐modulated (AM) force‐driven Ueda oscillator through numerical simulations. Our investigation reveals the emergence of transient chaos, chaotic dynamics, and regular behaviors, underscoring the significant role played by the energy variable, denoted as ϵ$$ \epsilon $$, in the system. We employ various analytical tools, including phase diagrams, Poincaré maps, time series plots, and bifurcation diagrams, to characterize and visualize transient chaos, regular, and chaotic motions within the system. [ABSTRACT FROM AUTHOR]

Purpose: We sought to evaluate the technical feasibility of performing a combined robotically assisted mini-percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (URS) procedure by a single urologist using the MONARCH Platform, Urology (Johnson & Johnson MedTech, Redwood City, California). Material and Methods: In this prospective, first-in-human clinical trial, 13 patients underwent robotically-assisted PCNL for renal calculi at the University of California-Irvine, Department of Urology. Successful completion of the procedure was assessed as the primary endpoint. Postoperative adverse events were monitored for 30 days following the completion of the procedure. Stone ablation efficiency was evaluated on postoperative day 30 with low-dose 2-3 mm slice CT scans. Patients were classified according to the maximum length of their residual stone fragments as either absolute stone-free (Grade A), < 2 mm remnants (Grade B), or 2.1-4.0 mm remnants (Grade C). Results: The combined robotic mini-PCNL and URS procedure was successfully completed in 12 of 13 procedures. No robotic device–related adverse events occurred. Preoperative stone burden was quantified by both maximum linear measurement (median 32.8 mm) as well as by CT-based volume (median 1645.9 mm3). Using the unique robotically assisted targeting system, percutaneous access was gained directly through the center of the renal papilla in a single pass in all cases. Median operative time was 187 minutes (range: 83-383 minutes). On postoperative day 30, a 98.7% (range: 72.9%-100.0%) volume reduction was achieved, with 5 Grade A (38.5%), 1 Grade B (7.7%), and 2 Grade C (15.4%). Three patients experienced complications (2 grade 1 and one grade 2 Clavien-Dindo). Conclusions: Our preliminary investigation demonstrates the safety, efficacy, and feasibility of a unique robotic-assisted combined mini-PCNL and URS platform. [ABSTRACT FROM AUTHOR]

Per-and polyfluoroalkyl substances (PFAS) are synthetic chemicals that are known for their environmental persistence and adverse health effects. This study comprehensively assessed PFAS contamination in the Kamrup region of Assam, India, focusing on its presence in groundwater and associated health risks. The analysis detected 12 PFAS in groundwater samples from both the Kamrup Metro and Rural regions. In Kamrup Rural, Perfluorohexanoic acid (PFHxA), perfluorononanoic acid (PFNA), and perfluorooctanesulfonic acid (PFOS) were prevalent, whereas in Kamrup Metro, PFNA and PFOS were dominant, based on detection frequencies. These findings are noteworthy, as they demonstrate the widespread presence of PFAS in groundwater, a vital source of drinking water in the region. The assessment of PFAS health risks in India involved hazard quotient calculations for different age groups. Perfluorobutanesulfonic acid (PFBS) posed the highest risk, ranking children > boys > men > girls > women. Overall, ∑PFAS had low hazard (HQ: 0.27–0.41). Further, this study assessed PFBS and PFOS toxicity in human kidney epithelial cell lines (HEK293T) cells, revealing that PFBS was more cytotoxic than PFOS. The study examined the metabolomics of HEK293T cells after PFBS exposure, revealing significant alterations in lipid metabolism, particularly glycerophospholipids, potentially affecting cellular function and health. These findings underscore the importance of monitoring PFAS contamination in drinking water sources, especially in regions such as Kamrup, where groundwater is a primary source. Our metabolomics results show significant health effects at the cellular level, raising concerns about the impact of PFAS exposure on human health. This study highlights PFAS contamination in Kamrup, Assam's groundwater and its health risks, providing valuable insights for policymakers and public health management. [ABSTRACT FROM AUTHOR]

Introduction: Knowledge of transverse dentofacial dimensions is crucial for accurate diagnosis and treatment planning. Periodontitis can alter the widths of the arches by causing pathological migration of teeth and the concurrent bone loss can affect the transverse width of the arches. Aim: To compare the transverse dentofacial widths in adults with skeletal class I and class II malocclusions with horizontal growth pattern and with mild to moderate periodontitis using Cone Beam Computed Tomography (CBCT). Materials and Methods: This retrospective observational study was conducted in Department of Orthodontics, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India, from January 2019 to January 2021. Total 96 CBCT samples (48 skeletal Class I, 48 skeletal Class II) of patients between age group of 25-35 years, patients having mild to moderate periodontitis based on bone loss seen on CBCT and patients having a horizontal growth pattern with the angle between sella-nasion and mandibular plane less than 32° were included in the study. Transverse dentofacial measurements were made on the coronal plane of the CBCT scans. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20. Chi-square test and Student’s t-test were used to compare age, linear measurements and angular measurements between the skeletal class I and skeletal Class II groups. A p-value of