Diagnostic accuracy of deep learning in detection and prognostication of renal cell carcinoma: a systematic review and meta-analysis.

Introduction: The prevalence of Renal cell carcinoma (RCC) is increasing among adults. Histopathologic samples obtained after surgical resection or from biopsies of a renal mass require subtype classification for diagnosis, prognosis, and to determine surveillance. Deep learning in artificial intelligence (AI) and pathomics are rapidly advancing, leading to numerous applications such as histopathological diagnosis. In our meta-analysis, we assessed the pooled diagnostic performances of deep neural network (DNN) frameworks in detecting RCC subtypes and to predicting survival. Methods: A systematic search was done in PubMed, Google Scholar, Embase, and Scopus from inception to November 2023. The random effects model was used to calculate the pooled percentages, mean, and 95% confidence interval. Accuracy was defined as the number of cases identified by AI out of the total number of cases, i.e. (True Positive + True Negative)/(True Positive + True Negative + False Positive + False Negative). The heterogeneity between study-specific estimates was assessed by the I 2 statistic. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct and report the analysis. Results: The search retrieved 347 studies; 13 retrospective studies evaluating 5340 patients were included in the final analysis. The pooled performance of the DNN was as follows: accuracy 92.3% (95% CI: 85.8-95.9; I 2 = 98.3%), sensitivity 97.5% (95% CI: 83.2-99.7; I 2 = 92%), specificity 89.2% (95% CI: 29.9-99.4; I 2 = 99.6%) and area under the curve 0.91 (95% CI: 0.85-0.97.3; I 2 = 99.6%). Specifically, their accuracy in RCC subtype detection was 93.5% (95% CI: 88.7-96.3; I 2 = 92%), and the accuracy in survival analysis prediction was 81% (95% CI: 67.8-89.6; I 2 = 94.4%). Discussion: The DNN showed excellent pooled diagnostic accuracy rates to classify RCC into subtypes and grade them for prognostic purposes. Further studies are required to establish generalizability and validate these findings on a larger scale.

Outcomes of Acute Kidney Injury among Hospitalized Patients with Infective Endocarditis: A National Inpatient Sample Analysis.

Background/Objectives: Patients with infective endocarditis (IE) are more susceptible to acute kidney injury (AKI). The presence of AKI increases in-hospital complications in these patients. Methods: The 2016-2020 National Inpatient Sample (NIS) database consisting of adult admissions with IE and AKI was utilized. The primary outcome was all-cause inpatient mortality. Secondary outcomes included fluid and electrolyte disorders, stroke, septic arterial embolism, septic shock, cardiogenic shock, valve surgery, vasopressor support, mechanical ventilation, length of stay (LOS), and total hospital charges. Results: Out of a total of 63,725 adult admissions with IE, 16,295 (25.5%) admissions had AKI. Patients with AKI were more likely to be males (63% vs. 57.6%, p < 0.001) and older (55.8 vs. 50.4, p < 0.001). A higher proportion of these patients were admitted to large hospitals (60.6 vs. 55.3%, p < 0.001) and urban teaching hospitals (81.9 vs. 75%, p < 0.001). Patients with AKI had higher LOS (17 ± 16.1 vs. 11.32 ± 11.7, p < 0.001) and hospital charges (USD 239,046.8 ± 303,977.3 vs. USD 124,857.6 ± 192,883.5, p < 0.001). Multivariable analysis showed higher odds of all-cause inpatient mortality (aOR: 2.22, 95% CI: 1.81-2.73, p < 0.001). They also had higher risk for fluid and electrolyte disorder (aOR: 2.31, 95% CI: 2.10-2.53, p < 0.001), septic arterial embolism (aOR: 1.61, 95% CI: 1.42-1.84, p < 0.001), septic shock (aOR: 3.78, 95% CI: 2.97-4.82, p < 0.001), cardiogenic shock (OR: 3.37, 95% CI: 2.65-4.28, p < 0.001), valve surgery (aOR: 1.52, 95% CI: 1.35-1.71, p < 0.001), vasopressor requirement (aOR: 1.99, 95% CI: 1.52-2.60, p < 0.001), and mechanical ventilation (aOR: 2.75, 95% CI: 2.33-3.24, p < 0.001). The association with stroke was elevated but not statistically significant. Conclusions: This large retrospective analysis demonstrated that patients with AKI and infective endocarditis had increased mortality, adverse hospital outcomes, increased LOS, and hospital costs.

Acute kidney injury after robot-assisted laparoscopic prostatectomy: A meta-analysis.

BACKGROUND: We investigated the rates of acute kidney injury (AKI) post robot-assisted laparoscopic prostatectomy (RALP). METHODS: A comprehensive search was conducted to identify studies that reported the rates of AKI post-RALP. A random effects model was used, and the pooled rates of AKI were calculated. RESULTS: We identified 10 studies with 60,937 patients to be included. The mean age was 65.1 years. The mean anaesthesia time was 234.3 min (95% CI: 177.8-290.9). The mean operation time was 212.2 min (95% CI: 188.7-235.6). The mean estimated blood loss was 314.1 mL (95% CI: 153-475.3). The mean intraoperative IV fluids administered were 1985 mL (95% CI: 1516.3-2453.7). The pooled rate of AKI post RALP was 7.2% (95% CI 19-23.9). CONCLUSIONS: The rates of AKI after RALP are significant. Further studies are needed to detect the risk factors for AKI and to determine the rates of chronic kidney disease post-RALP.

Surgical Aortic Valve Replacement to Treat Prosthetic Valve Endocarditis After Valve-in-Valve Transcatheter Aortic Valve Replacement.

Prosthetic valve endocarditis (PVE) is an uncommon complication after heart valve replacement surgery that can result in increased morbidity and mortality. Current guidelines for management of PVE recommend antibiotic therapy followed by surgical valve replacement. The number of aortic valve replacements is expected to rise in the coming years with the expanded indications for use of transcatheter aortic valve replacement (TAVR) in patients with low, intermediate, and high surgical risk, as well as in patients with a failed aortic bioprosthetic valve. Current guidelines do not address the use of valve-in-valve (ViV) TAVR for management of PVE in patients who are at high risk for surgical intervention. The authors present a case of a patient with aortic valve PVE after surgical aortic valve replacement (SAVR); he was treated with valve-in-valve (ViV) TAVR due to the high surgical risk. The patient was discharged, but he returned to the hospital with PVE and valve dehiscence 14 months after ViV TAVR, after which he successfully underwent re-operative SAVR.

Reactions of Ru(III)-drugs KP1019 and KP418 with guanine, 2'-deoxyguanosine and guanosine: a DFT study.

Ruthenium (Ru)-based anticancer drugs are considered to be novel alternatives of platinum-based drugs. They exhibit potent cytotoxicity against the cancer cells and hence are useful for the treatment of cancer. Herein, the density functional theory calculations in the gas phase and aqueous media are carried out to study the reactions of two Ru(III)-based drugs such as KP1019 and KP418 with the N7 site of guanine (G), 2'-deoxyguanosine (dGua), and guanosine (Gua) to understand their reactivity against the DNA and RNA. All the reactions are found to be exothermic. The activation free energies and rate constants of these reactions indicate that KP1019 and KP418 would react with the dGua more readily than Gua. Hence, the binding of these drugs with the DNA would be more preferred as compared to RNA. It is further found that among these drugs, KP1019 would be more reactive than KP418 in agreement with the experimental observation. Thus, this study is expected to aid in the future development of potent anticancer drugs.

Ciliated respiratory epithelium encapsulating Pseudomonas brain abscess due to prior trauma.

Bacterial brain abscesses are typically spread through a haematogenous route. Open head wounds and neurosurgical interventions are uncommon aetiologies. Ectopic tissue found in the cerebral cortex is usually ascribed almost entirely from carcinomas. Here, we describe a 57-year-old gentleman who, 22 years after a fireworks related traumatic injury to the left orbit, presented with headaches and altered behaviour. Imaging revealed an abscess immediately superior to the orbit, whose bacterial aetiology was identified to be Pseudomonas aeruginosa, encapsulated by ciliated respiratory epithelium. This represents a case in which tissue was displaced during the initial trauma or craniofacial reconstructive surgery from the frontal sinus.

Successful Catheter-Directed Thrombolysis of Massive Bilateral Upper Extremity DVT Presenting as Superior Vena Cava Syndrome.

Superior vena cava syndrome (SVCS) is traditionally associated with malignancy. However, approximately one-third of SVCS cases are due to intravascular devices and pacemakers. No specific guidelines exist for managing catheter-associated SVCS. We present catheter-associated SVCS resistant to anticoagulation, angioplasty, and thrombectomy but resolved with ultrasound-assisted catheter directed thrombolysis. (Level of Difficulty: Intermediate.).

Is FapyG mutagenic?: Evidence from the DFT study.

2,6-diamino-4-oxo-5-formamidopyrimidine (FapyG) is an oxidatively damaged product of guanine (G), which is mainly formed through metabolic processes that produce OH radicals. It has been proposed that in bacterial cells, FapyG retains the coding properties of G, and is, therefore, not mutagenic. However, in mammalian cells, FapyG induces G to thymine (T) mutation more dominantly than another ubiquitous oxidative lesion, that is, 8-oxoguanine (8-oxoG). The exact reasons for these coding properties of FapyG are not properly understood. In order to rationalize the cause of FapyG-mediated mutagenesis, all of the possible base-pair interactions of FapyG with cytosine (C), adenine (A), and T, in both anti- and syn- conformations, are studied in detail by using density functional theory (DFT). The effects of solvation on the coding properties of FapyG are also evaluated. We demonstrate that the anti-FapyG:C base pair has the highest binding energy, and that the base-pair alignment is similar to that of the normal G:C base pair. Therefore, insertion of C opposite anti-FapyG is preferred over the other DNA bases. This could be the reason for the non-mutagenic behavior of FapyG in bacterial cells. However, as the binding patterns and energies of anti-FpyG:A and syn-FapyG:A base pairs are similar, and these are also similar to those of the T:A base pair, mammalian polymerases may not distinguish between FapyG and T. As a result, A would be mistakenly inserted opposite either anti-FapyG or syn-FapyG, resulting in G to T transverse mutation.

A theoretical study of some new analogues of the anti-cancer drug camptothecin.

The enzyme topoisomerase I (topo I), which is essential for cell replication, transiently causes a DNA single strand break and makes a complex with it. The anti-cancer agent camptothecin (CPT) binds to the topo I-DNA complex and stabilizes it, preventing resealing of the broken DNA strand and cell growth. Considering the structural factors of CPT that are believed to be involved in stabilizing the topo I-DNA complex via hydrogen bonding and stacking interactions, designs of two new analogues of CPT (topo I inhibitors) have been suggested. The molecular geometries of CPT, two of its analogues and certain other related molecules included in the study were fully optimized in both gas phase and aqueous media at the B3LYP/6-311++G(d,p) level of density functional theory. Solvation effects of aqueous media were treated using the polarizable continuum model (PCM). Net CHelpG charges and surface molecular electrostatic potentials (MEP) near the atomic sites of the molecules were studied. Structural analogy and surface MEP values suggests that the two new CPT analogues studied here would be potent topoisomerase I inhibitors.