Classification of Tomato Fruit Using Yolov5 and Convolutional Neural Network Models.

Four deep learning frameworks consisting of Yolov5m and Yolov5m combined with ResNet50, ResNet-101, and EfficientNet-B0, respectively, are proposed for classifying tomato fruit on the vine into three categories: ripe, immature, and damaged. For a training dataset consisting of 4500 images and a training process with 200 epochs, a batch size of 128, and an image size of 224 × 224 pixels, the prediction accuracy for ripe and immature tomatoes is found to be 100% when combining Yolo5m with ResNet-101. Meanwhile, the prediction accuracy for damaged tomatoes is 94% when using Yolo5m with the Efficient-B0 model. The ResNet-50, EfficientNet-B0, Yolov5m, and ResNet-101 networks have testing accuracies of 98%, 98%, 97%, and 97%, respectively. Thus, all four frameworks have the potential for tomato fruit classification in automated tomato fruit harvesting applications in agriculture.

Combined Mueller matrix imaging and artificial intelligence classification framework for Hepatitis B detection.

Significance: The combination of polarized imaging with artificial intelligence (AI) technology has provided a powerful tool for performing an objective and precise diagnosis in medicine. Aim: An approach is proposed for the detection of hepatitis B (HB) virus using a combined Mueller matrix imaging technique and deep learning method. Approach: In the proposed approach, Mueller matrix imaging polarimetry is applied to obtain 4 × 4 Mueller matrix images of 138 HBsAg-containing (positive) serum samples and 136 HBsAg-free (negative) serum samples. The kernel estimation density results show that, of the 16 Mueller matrix elements, elements M 22 and M 33 provide the best discriminatory power between the positive and negative samples. Results: As a result, M 22 and M 33 are taken as the inputs to five different deep learning models: Xception, VGG16, VGG19, ResNet 50, and ResNet150. It is shown that the optimal classification accuracy (94.5%) is obtained using the VGG19 model with element M 22 as the input. Conclusions: Overall, the results confirm that the proposed hybrid Mueller matrix imaging and AI framework provides a simple and effective approach for HB virus detection.

Utilization of surgical procedures and racial disparity in the treatment of urinary incontinence after prostatectomy.

AIMS: To analyze the rates of incontinence procedures after radical prostatectomy, and define the variables associated with them. METHODS: We conducted an IRB approved retrospective review of patients with prostate cancer who underwent radical prostatectomy at a single institute from January 1998 to December 2012. Logistic regression and time to event analyses were performed to ascertain variables associated with receipt of incontinence procedure after prostatectomy. RESULTS: Four thousand four hundred one men underwent radical prostatectomy (69.8% open, 30.1% laparoscopic or robotic) of whom 74.3% were white Caucasian and 22.1% were African-American. Overall, 165 (3.7%) patients underwent a total of 191 procedures for male urethral sling or artificial urinary sphincter placement. African-American men received fewer incontinence procedures than white Caucasian men (2.1% versus 4.3%, P = 0.001); and with a longer delay after prostatectomy than white Caucasian men (28.3 months versus 19.9 months, P = 0.029). Men who had a laparoscopic or robotic prostatectomy received an incontinence procedure earlier than men who had an open prostatectomy (17.6 months versus 24.4 months, P = 0.0001). On multivariate analysis, age at prostatectomy, diagnosis of incontinence, and race were independently associated with receiving an incontinence procedure. CONCLUSIONS: The overall rate of incontinence surgery after radical prostatectomy is low at 3.7%. African-American men receive incontinence procedures at a lower rate and with a longer delay after prostatectomy than white Caucasian men. Further studies are needed to define the reasons for this racial disparity in urinary incontinence surgery in the prostate cancer survivor. Neurourol. Urodynam. 35:733-737, 2016. © 2015 Wiley Periodicals, Inc.

The Ohmmeter Identifies the Site of Fluid Leakage during Artificial Urinary Sphincter Revision Surgery.

PURPOSE: While the AMS 800 artificial urinary sphincter improves continence in up to 90% of patients, revision surgery may be needed in up to 50%. We determined whether an ohmmeter could accurately assess the site of fluid leak from individual components of the artificial urinary sphincter at the time of revision surgery. MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent artificial urinary sphincter revision surgery between 1996 and 2013. Patients in whom fluid loss was identified preoperatively by plain film radiography and who subsequently underwent revision surgery using the ohmmeter were assessed for outcomes. RESULTS: The ohmmeter was used intraoperatively in a total of 20 surgeries in 19 patients and it correctly identified the location of fluid loss in 18 of 20 (90%). Fluid leakage was found from the pressure regulating balloon in 13 cases, from the cuff in 4 and from the tubing to the pressure regulating balloon in 1. None had fluid loss from the pump. In the 17 cases in which only the malfunctioning component was replaced a satisfactory postoperative outcome with a fully functional device was documented in all. Repeat surgery was performed in 5 of 17 cases (29.4%) at a median of 17 months (range 2 to 39). No patient underwent repeat surgery due to failure to accurately diagnose a component leak. CONCLUSIONS: In cases of suspected fluid loss as a cause of artificial urinary sphincter malfunction an ohmmeter can identify the site of fluid loss during component revision surgery.

Surgical options for apical prolapse repair.

Pelvic organ prolapse is a common medical condition that affects the quality of life of many women. Approximately 50% of parous women have pelvic organ prolapse and the lifetime risk for surgical intervention is 6.7% at the age of 80 years. In the USA, the number of women at risk for symptomatic prolapse is increasing, which is consistent with the recent increase in the overall number of prolapse and incontinence procedures being performed. Although prolapse is usually multicompartmental and isolated defects are rare, the apical compartment deserves special attention because apical support is integral to a durable prolapse repair. Since many women may initially present to their primary care physicians, all members of the medical community should have a basic understanding of the diagnosis and treatment for apical prolapse.

Long-term durability of the distal urethral polypropylene sling for the treatment of stress urinary incontinence: minimum 11-year followup.

PURPOSE: We report on the long-term outcomes of the distal urethral polypropylene sling for stress urinary incontinence in a patient cohort that was closely followed and whose outcomes were reported at 1 and 5 years after surgery. MATERIALS AND METHODS: We performed a prospective study of all consecutive patients who underwent a distal urethral polypropylene sling procedure between November 1999 and April 2000. The 1 and 5-year outcomes for this particular patient cohort were previously reported. At the minimum 11-year followup, outcome was determined by patient self-assessment including validated questionnaires. RESULTS: A total of 69 patients were followed prospectively and followup was obtained for 30. Of those lost to followup 10 were deceased and 5 were cognitively impaired. Mean patient age at followup was 73 years (range 40 to 97). More than 11 years after surgery 48% of patients reported no stress urinary incontinence symptoms and 63% were never bothered by stress urinary incontinence. Patients reported a mean overall symptom improvement of 64% compared to 81% at 5 years. Overall 82% of patients met the criteria for treatment success by symptom scores and 80% met the criteria by bother scores. CONCLUSIONS: The distal urethral polypropylene sling procedure has excellent long-term durability in the treatment of stress urinary incontinence, in addition to low morbidity and low cost as previously described. Eleven years after the procedure the majority of patients report symptom improvement. Nevertheless, many older patients are unable to participate in followup. When choosing an anti-incontinence procedure, durability should be considered in light of patient age given that the theoretical advantages of long-term durability are limited by cognitive decline and mortality.

Foreign body in the bladder 11 years after intravaginal pessary.

Vaginal pessaries used for symptomatic pelvic organ prolapse (POP) rarely develop complications when regularly monitored. However, many reports of complications of neglected pessaries have been described. Patients presenting with pessary complications report a variety of symptoms ranging from malodorous discharge or recurrent infections to more severe symptoms such as vaginal bleeding, complete urinary incontinence, or defecatory obstruction. Complete pessary encapsulation within the bladder is rare. We present the case of a 79-year-old postmenopausal woman referred to a tertiary care center for treatment of a large intravesical foreign body 11 years after pessary placement. The patient successfully underwent minimally invasive surgery to remove the foreign body and repair the bladder defect. Physicians should have a low threshold for diagnostic imaging in patients presenting with unclear history. Large intravesical foreign bodies can be removed by a vaginal approach with good outcomes.

Missed diagnosis of complete urethral transection after sling: the case for translabial ultrasound.

Patients with complications of urethral sling placement for stress urinary incontinence are often treated for recurrent symptoms for years after initial reassuring evaluation. Translabial ultrasound is a noninvasive modality with minimal risks that can clearly diagnose urethral mesh complications. We present a 47-year-old premenopausal woman referred for treatment of urethral stricture and diverticulum 8 years after mesh sling placement. The diagnosis was made at an outside institution by voiding cystourethrogram and cystoscopy. However, translabial ultrasound confirmed the diagnosis of complete urethral transection, and the patient underwent a complex urethral reconstruction. Ultrasound should be used to evaluate patients with a history of urethral sling and persistent lower urinary tract symptoms. Referral to a center with advanced pelvic reconstruction services may be required.

Expanding the Role of Neuromodulation for Overactive Bladder: New Indications and Alternatives to Delivery.

From the time that it was granted US Food and Drug Administration approval, neuromodulation has secured a firm position in the treatment algorithm for overactive bladder. With neuromodulation, physicians were able to bridge the gap between the two ends of the treatment spectrum (medical therapy and open surgery). Sacral nerve stimulation has been the most widely used form of neuromodulation. Recent modifications to its design, namely the development of the tined lead and the launching of the refined InterStim II (Medtronic, Minneapolis, MN), have made sacral nerve simulation even less invasive and more effective. While InterStim is maintaining a level of success with these advancements, peripheral means of neuromodulation are being explored. The current literature takes a closer look at posterior tibial and pudendal nerve stimulation as alternatives to sacral nerve stimulation. The field of neuromodulation is also expanding in terms of the target patient population, as it is being used to treat children, patients with neurological disease, and others. As the role of neuromodulation increases, we must continue to assess its efficacy, safety, and cost-effectiveness in comparison to other therapeutic options.

Inertial effects on flow rate spectrum of diffuser micropumps.

This study develops a diffuser micropump and characterizes its output flow rates, such as the parabola shape on the frequency domain and the affecting factors. First, an equivalent circuit using electronic-hydraulic analogies was constructed. Flow rate analysis results were then compared to experimental results to verify the applicability of the circuit simulation. The operational frequency was 800 Hz for both cases and maximum flow rates were 0.078 and 0.075 mul/s for simulation and experimental results, respectively. Maximum flow rate difference between simulation and experiment was 3.7%. The circuit was then utilized to analyze inertial effects of transferred fluid and system components on output flow rates. This work also explained why the flow rate spectrum has a parabolic shape. Analysis results demonstrated that without inertial effects, micropump flow rates are linearly proportional to operational frequency; otherwise flow rate spectrum has parabolic shape. The natural frequency of the actuator-membrane structure was identified using the finite element method to verify whether this parameter affects flow rate characteristics. Experimental and simulation results demonstrated that the frequency of the maximum pumping flow rate was 800 Hz and the first mode natural frequency of actuator-membrane structure was 91.4 kHz, suggesting that the structure natural frequencies of the actuator-membrane structure do not play any role in micropump operations.

Effect of pulse width on object movement in vitro using holmium:YAG laser.

BACKGROUND AND PURPOSE: The holmium:YAG laser is an effective modality for intracorporeal lithotripsy. The fiber tip needs to be in contact with the calculus for maximal effect. Laser energy can cause stone retropulsion, necessitating cumbersome repositioning of the fiber. We examined the effect of varying the laser pulse width on object movement in vitro. MATERIALS AND METHODS: Two experiments were conducted using a holmium:YAG laser at the 350-microsec and 700-microsec pulse-width settings. In the first experiment, one pulse was delivered to a non-fragmentable ball bearing at increasing energy settings, and object displacement was measured. In the second experiment, a train of pulses was delivered to a fragmentable soda lime phantom at increasing energy settings, and the total energy delivered before movement from the tip of the fiber was determined. RESULTS: The mean ball bearing movement was significantly greater at the 350-microsec setting with a 200-microm fiber (P < 0.0001), as well as a 400-microm fiber (P < 0.0069). More disparity in movement was noted at higher energy settings. The total energy delivered to the soda lime phantom before migration was significantly greater using the 700-microsec setting (P < 0.0018). CONCLUSIONS: Pressure waves from Ho:YAG lithotripsy are less than with other modalities, yet some retropulsion occurs. The duration of the laser pulse can influence shockwave generation and object migration. Longer pulse width results in less object movement after one shock and more energy delivery during repetitive shocks. Clinically, this regimen may reduce the need for fiber readjustment and lead to more efficient stone fragmentation.