A systematic review of the applications of Expert Systems (ES) and machine learning (ML) in clinical urology.

BackgroundTesting a hypothesis for 'factors-outcome effect' is a common quest, but standard statistical regression analysis tools are rendered ineffective by data contaminated with too many noisy variables. Expert Systems (ES) can provide an alternative methodology in analysing data to identify variables with the highest correlation to the outcome. By applying their effective machine learning (ML) abilities, significant research time and costs can be saved. The study aims to systematically review the applications of ES in urological research and their methodological models for effective multi-variate analysis. Their domains, development and validity will be identified.MethodsThe PRISMA methodology was applied to formulate an effective method for data gathering and analysis. This study search included seven most relevant information sources: WEB OF SCIENCE, EMBASE, BIOSIS CITATION INDEX, SCOPUS, PUBMED, Google Scholar and MEDLINE. Eligible articles were included if they applied one of the known ML models for a clear urological research question involving multivariate analysis. Only articles with pertinent research methods in ES models were included. The analysed data included the system model, applications, input/output variables, target user, validation, and outcomes. Both ML models and the variable analysis were comparatively reported for each system.ResultsThe search identified n = 1087 articles from all databases and n = 712 were eligible for examination against inclusion criteria. A total of 168 systems were finally included and systematically analysed demonstrating a recent increase in uptake of ES in academic urology in particular artificial neural networks with 31 systems. Most of the systems were applied in urological oncology (prostate cancer = 15, bladder cancer = 13) where diagnostic, prognostic and survival predictor markers were investigated. Due to the heterogeneity of models and their statistical tests, a meta-analysis was not feasible.ConclusionES utility offers an effective ML potential and their applications in research have demonstrated a valid model for multi-variate analysis. The complexity of their development can challenge their uptake in urological clinics whilst the limitation of the statistical tools in this domain has created a gap for further research studies. Integration of computer scientists in academic units has promoted the use of ES in clinical urological research

System-on-chip design of the cortical-diencephalic centre of the lower urinary tract

This article presents the design of a field programmable gate array (FPGA)-based prototype of a system on chip (SoC) capable of behaving as one of the nerve centres comprising the neuroregulatory system in humans: the cortical-diencephalic nerve centre. The neuroregulatory system is a complex nerve system consisting of a heterogeneous group of nerve centres. These centres are distributed throughout the length of the spinal cord, are autonomous, communicate via interneurons, and govern and regulate the behaviour of multiple organs and systems in the human body. As a result of years of study of the functioning and composition of the neuroregulatory system of the lower urinary tract (LUT), the centres that regulate this system have been isolated. The objective of this study is to understand the individual functioning of each centre in order to create a general model of the neuroregulatory system that is capable of operating at the level of the actual nerve centre. This model represents an advancement of the current black box models that do not allow for isolated or independent treatment of system dysfunction. In this study, we re-visit our research into the viability of the hardware design of one of these centres—the cortical-diencephalic centre. We describe this hardware because functioning of the centre is completely configurable and programmable, which validates the design for other centres that comprise the neuroregulatory system. In this document, we succinctly present the formal model of the centre, propose a hardware design and an FPGA-based prototype, construct a testing and simulation environment to evaluate it and, lastly, analyse and contrast the results using data obtained from real patients, verifying that the functional behaviour fits that observed in humans.This work has been supported by grant University of Alicante projects GRE14-02 and Smart University

The Translational Role of Animal Models for Estrogen-Related Functional Bladder Outlet Obstruction and Prostatic Inflammation

The prevalence of LUTS and prostatic diseases increases with age both in humans and companion animals, suggesting that a common underlying cause of these conditions may be age-associated alterations in the balance of sex hormones. The symptoms are present with different and variable micturition dysfunctions and can be assigned to different clinical conditions including bladder outlet obstruction (BOO). LUTS may also be linked to chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS), but the relationship between these conditions is unknown. This review summarizes the preclinical data that supports a role for excessive estrogen action in the development of obstructive voiding and nonbacterial prostatic inflammation. Preclinical studies that are emphasized in this review have unequivocally indicated that estrogens can induce functional and structural changes resembling those seen in human diseases. Recognizing excessive estrogen action as a possible hormonal basis for the effects observed at multiple sites in the LUT may inspire the development of innovative treatment options for human and animal patients with LUTS associated with functional BOO and CP/CPPS

A Descriptive study on Urodynamic Abnormalities in Stroke patients after Acute Phase.

INTRODUCTION : Cerebrovascular accident (CVA) is a serious neurologic event and, depending on the extent, a CVA can have temporary or permanent effects on survivors including deficits in speech, vision, memory, cognition, motor and sensory function, and volitional control of voiding. Stroke accounts for more than 40% of acute admissions in a neurological centre. Following a stroke, 10% of the survivors, recover completely, 80% to varying levels and 10% need institutional care due to severe disability.1 For the middle 80%, stroke rehabilitation by a rehabilitation team can significantly improve functional ability. Poor prognostic indicators of outcome are, previous stroke, older age, bladder and bowel incontinence and visuospatial deficits. AIMS AND OBJECTIVES : 1. To determine the incidence of voiding abnormalities due to bladder dysfunction in MCA stroke patients, subsequent to the acute sickness phase. 2. To describe the urodynamic abnormalities by using cystometry, in the above patients. MATERIALS AND METHODS : Patients for this study were selected from post stroke patients attending the outpatient clinics of department of Physical Medicine and Rehabilitation, and OPDs of Department of Medicine of CMC Hospital, and also from the medical OP of the Government Pentland Hospital, Vellore between January 1999 to May 2001. Study was conducted in Department of Physical Medicine and Rehabilitation, CMCH, Vellore, in collaboration with Urology Unit II. A total number of 20 patients were included in the study. This study was presented to the Research Committee for approval and ethical clearance, which were obtained. Inclusion criteria were: 1. Patients between 25-65 years of age. 2. Patients who have completed three weeks, but within three months, of onset of cerebrovascular accident in the middle cerebral arterial territory of either side. 3. Patients not having any pre-existing urinary complaint. 4. Patients who have had imaging, to confirm the site of the cerebrovascular accident. Exclusion criteria were: 1. Patients with abnormal renal function, as indicated by elevated serum creatinine. 2. Patients with history of previous strokes. 3. Patients having an unstable general condition or aphasia or poor cognition status or those who were moribund. 4. Patients with a history of epilepsy, metabolic encephalopathy or prior brain trauma or surgery of any region of the brain. 5. Patients with symptomatic, lower urinary tract infection. RESULTS : 20 patients with post stroke for 3 weeks to 3 months were selected to observe the voiding pattern and urodynamic parameters. There were 17 males and 3 females in this group and their age ranged from 34 - 65 years. Study design: Prospective descriptive study. A standardised proforma was used to enter patient data. CONCLUSION : Voiding dysfunction following cerebro vascular accident is certainly multi factorial. The symptomatology may be same for different types of dysfunctions. Proper diagnosis of the cause and appropriate management of voiding dysfunction in the post stroke patient before the patient leaves the acute care facility is desirable because urinary dysfunction may complicate patient rehabilitation. In this institution we find that the average duration of acute care admission for strokes, is about a week. Our study, although performed on a select population reveals that detrusor hyperreflexia accounts for the large percentage of urinary bladder dysfunction in post stroke patients. The incidence of incontinence, which is supposed to be a bad prognosticator, was 40%. Detrusor hyperreflexia is the major factor to cause incontinence, if not suppressed. Anti cholinergic agents for the treatment of detrusor, hyperreflexia have the potential to cause urinary retention

Detrusor ultrastructural studies in human lower urinary tract dysfunction: correlation of structural features and function.

Introduction: Lower urinary tract symptoms (LUTS), voiding dysfunction (VD) and urinary retention are common in the aging population, associated with significant morbidity.(1) LUTS can be due to overactive bladder (OAB), underactive bladder (UAB), bladder outflow obstruction (BOO), or a combination. Diagnosis is key to management, whilst avoiding harm of inappropriate therapy. Due to challenges in evaluation, there may be a role for detrusor ultrastructural analyses in diagnosis and prognosis of VD.(2,3,4) Objectives: To investigate detrusor ultrastructural changes in VD in the older population and potential clinical applications. Specifically: 1. females with bladder outflow obstruction (fBOO). 2. males with detrusor underactivity (mDU), with long term functional-structural correlation. 3. older males with coexistent overactive underactive bladders (mCOUB). Methodology and patient cohort: Patients were recruited from the Urodynamic Clinic at Concord Hospital. Patients with fBOO, mDU and mCOUB on urodynamic study who were undergoing cystoscopy as part of their clinical management were recruited. Detrusor biopsies were obtained and examined by electron microscopy. Ultrastructural analyses were performed using a standardised protocol and correlated with functional outcomes. Results Detrusor ultrastructural features of ‘myohypertrophy’ were similar in fBOO and male BOO; severity correlated with BOO duration and severity. In mDU, severe features of myohyertrophy and degeneration predicted poor long term voiding outcomes. Older mCOUB had concomitant features of myohypertrophy and dysjunctional patterns. Our standardised protocol allowed analyses of all 3 VD. Conclusions Detrusor ultrastructural features in patients with fBOO, mDU and mCOUB were described with correlations found between detrusor ultrastructure and lower urinary tract function. Detrusor ultrastructure studies not only improve understanding of VD, but may also assist in diagnosis, prognosis, and management

CHARACTERIZATION OF SMOOTH MUSCLE CELL PHENOTYPE AND FUNCTIONALITY FOR POTENTIAL TISSUE ENGINEERING APPLICATIONS

Smooth muscle cell (SMC) embedded scaffolds have possible applications in treating diseased tissues that are rich in SMCs. Stress urinary incontinence (SUI) is an example of a disease that can be caused due to SMC dysfunction within the urinary sphincter. The goal of this thesis was to create a SMC-populated tissue engineered urethral wrap (TEUW) using autologous urethral SMCs (uSMCs), to be used as a cuff around the native urethra to integrate with the host tissue for providing mechanical and functional reinforcement to the diseased urethra. uSMCs were isolated from rat urethras. SMC phenotype was verified by immunofluorescence and western blotting. Isolation purity was assessed by staining uSMCs for skeletal muscle and urothelium markers since they are also present in the urethra. TEUWs were examined for SMC phenotype, apoptosis, mechanical and histological endpoints after culture.This thesis also evaluated the functionality of differentiated SMCs (dSMCs), which were derived via mechanical stimulation of bone marrow-derived mesenchymal stem cell (BMMSCs). The long-term objective is to use BMMSCs as an autologous source for SMCs in order to create TEUW-like tubular constructs for treating SMC related dysfunctions including, but not limited to SUI. uSMCs and dSMCs were assessed and compared for intracellular Ca2+ activity (fura-2) and contractile responses (live-cell) to various stimuli.Results of isolated uSMCs revealed expression of SMC markers and absence of skeletal and urothelium markers, suggesting isolation purity. uSMC-based TEUWs showed non-linear pressure-diameter profiles like soft tissues, greater compliance than the native urethra, and burst pressures similar to stem-cell based TEUWs. Both, uSMCs and dSMCs, exhibited intracellular Ca2+ activity, with and without extracellular Ca2+, vital for full SMC function. However, their failure to show morphological changes in the presence of agonists during contractility assessment indicated absence of mature SMCs. In summary, this study demonstrates proficient uSMC isolation, which represents an important step towards TEUW development, and that uSMCs and dSMCs are not fully functional at the differentiation stage tested. Future work should focus on increasing contractile protein expression by using matrix-like culture systems and/or biochemical stimulants. Following a systematic examination, SMC-populated TEUWs could be tested in an animal model

An Investigation into the Significance and Effect of Bowel and Bladder Dysfunction on Personal Burden for People Who Have Parkinson’s Disease

The burdensomeness of bowel and bladder dysfunction, investigated among 67 people with Parkinson’s disease (PD), exploring current clinical and self-management interventions related to incontinence. Higher rates of bowel and bladder dysfunction are common among people with PD, yet knowledge of how these symptoms are differentiated and managed in the community is scarce. Using mixed method design incorporating quantitative surveys and qualitative semi-structured interviews, the study focused on dysfunctional bowel and bladder symptoms and management. The surveys and interview data, from which participant-generated burden scores were derived, supported statistical comparisons to reveal the severity and importance of participants’ perceptions of efforts to manage their diagnosis and treatment. Bowel and bladder dysfunctions were found to be directly linked to their neuro-pathophysiology rather than ageing related factors; and these symptoms caused higher levels of anxiety and distress than did other PD non-motor symptoms. Further, their own preconceptions of what constitutes a 'legitimate' health concern, affected participants' capacity to source information and assistance. Little symptom relief was obtained from medications and treatments commonly used for bowel and bladder difficulties and exacerbated the unpredictability of their bowel and bladder problems, which then prompted participants to self-impose social restrictions and report poor quality-of-life

Comparing Time Series Through Event Clusterin

The comparison of two time series and the extraction of subsequences that are common to the two is a complex data mining problem. Many existing techniques, like the Discrete Fourier Transform (DFT), offer solutions for comparing two whole time series. Often, however, the important thing is to analyse certain regions, known as events, rather than the whole times series. This applies to domains like the stock market, seismography or medicine. In this paper, we propose a method for comparing two time series by analysing the events present in the two. The proposed method is applied to time series generated by stabilometric and posture graphic systems within a branch of medicine studying balance-related functions in human beings