Multimodal Deep Learning for Personalized Renal Cell Carcinoma Prognosis: Integrating CT Imaging and Clinical Data

Renal cell carcinoma represents a significant global health challenge with a low survival rate. This research aimed to devise a comprehensive deep-learning model capable of predicting survival probabilities in patients with renal cell carcinoma by integrating CT imaging and clinical data and addressing the limitations observed in prior studies. The aim is to facilitate the identification of patients requiring urgent treatment. The proposed framework comprises three modules: a 3D image feature extractor, clinical variable selection, and survival prediction. The feature extractor module, based on the 3D CNN architecture, predicts the ISUP grade of renal cell carcinoma tumors linked to mortality rates from CT images. A selection of clinical variables is systematically chosen using the Spearman score and random forest importance score as criteria. A deep learning-based network, trained with discrete LogisticHazard-based loss, performs the survival prediction. Nine distinct experiments are performed, with varying numbers of clinical variables determined by different thresholds of the Spearman and importance scores. Our findings demonstrate that the proposed strategy surpasses the current literature on renal cancer prognosis based on CT scans and clinical factors. The best-performing experiment yielded a concordance index of 0.84 and an area under the curve value of 0.8 on the test cohort, which suggests strong predictive power. The multimodal deep-learning approach developed in this study shows promising results in estimating survival probabilities for renal cell carcinoma patients using CT imaging and clinical data. This may have potential implications in identifying patients who require urgent treatment, potentially improving patient outcomes. The code created for this project is available for the public on: \href{https://github.com/Balasingham-AI-Group/Survival_CTplusClinical}{GitHub

Cerebral microembolization during off-pump coronary artery bypass surgery with the Symmetry aortic connector device

ObjectiveThe use of aortic connector systems for proximal vein grafts in off-pump coronary artery bypass grafting might minimize aortic manipulation by eliminating the need for partial aortic clamping. The objective of this study was to asses whether use of a Symmetry connector (St Jude Medical, Inc, St Paul, Minn) reduced intraoperative cerebral embolization.MethodsThirty-two consecutive patients underwent off-pump coronary artery bypass grafting. Sixteen patients received at least one mechanical proximal vein graft anastomosis with a Symmetry aortic connector system. Sixteen patients representing the control group underwent operations with standard suturing techniques using partial aortic clamping. During surgical intervention, all patients were monitored continuously with multifrequency transcranial Doppler scanning, which detected and differentiated cerebral emboli.ResultsThere were significantly more cerebral emboli in the Symmetry group (median, 36) compared with the control group (median, 11; P = .027). This was due to a higher number of gaseous emboli in the Symmetry group than in the control group (median, 27 vs 8; P = .014), whereas there was no significant difference regarding the number of solid emboli (median, 7 vs 3; P = .139).ConclusionUse of a Symmetry connector system during proximal vein graft anastomosis increased the number of emboli to the brain compared with a standard technique in coronary bypass surgery without cardiopulmonary bypass

Transit Time Flowmetry in Coronary Surgery-An Important Tool in Graft Verification

The aim of this study was to analyze the Transit time flow measurement (TTFM) experience in the first 1000 CABG operations. First 1000 patients had coronary artery bypass grafting (CABG) performed in Cardiovascular Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina, between September, 1998 and September, 2003. CABG without use of cardio-pulmonary bypass (CPB)-(OPCAB) was used as the preferential surgical method both because this method is reported to have equal or better results than CABG with use of CPB (ONCAB), and because of the significant cost savings realized. TTFM was routinely used in all grafts as a quality assurance measure. Criteria for a poor functioning graft were: low mean flow (MF), pul-satility index (PI) above 5 and a poor diastolic flow pattern. When no reversible cause of poor TTFM results were identified the graft was revised. A total of 1394 grafts in OPCAB group and 1478 in ONCAB group were performed. A total of 38 grafts (2,72%) in 37 patients (7,07%) were revised in OPCAB group, and 26 grafts (1,75%) in 26 patients (5,45%) in ONCAB group. 1 patient in OPCAB group needed 2 graft revisions. Graft revisions were more common in OPCAB, but with no significant difference (p=0,1035). The most frequently revised graft was LAD graft in both groups. Although the percentage of grafts revised are relatively low, it is still very important to record TTFM. More than 5% of patients in both groups needed graft revision. Although TTFM does not guarantee that grafts will stay open for a prolonged period of time we certainly believe that grafts that are occluded at the time of surgery will continue to stay occluded. TTFM is especially critical in OPCAB surgery where the technical challenge of grafting is higher then in ONCAB

A Comparation of Coronary Artery Bypass Grafting with and without Cardiopulmonary Bypass in Euroscore High Risk Patients

Angiotensin converting enzyme (ACE) and nitric oxide (NO) have been suggested to be in - The objective of this study is to compare outcomes of coronary artery bypass grafting (CABG) in high-risk patients performed with- (ONCAB) and without -(OPCAB) use of cardiopulmonary bypass. From October 2001 till October 2005, 210 high-risk patients classified according to European System for Cardiac Operative Risk Evaluation (EuroSCORE) (score =or> 5) underwent CABG in Cardiovascular Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina. 138 patients operated as OPCAB were compared to 72 patients operated as ONCAB. All data were entered in a patient database (DATACOR) and analyzed in SPSS. OPCAB patients received insignificantly less number of grafts than those treated by ONCAB (3,0 vs. 3,2) (p=0,071). Stroke was significantly more common in ONCAB group (2,9 vs. 11,1%) (p=0,034) while the incidence of other postoperative complications and mortality were similar. The ventilation time (4,3 vs. 6,7 hours) (p=0,007), retransfusion volume (392,7 vs. 633,7 ml) (p=0,041) and hospital stay (8,2 vs. 10,1 days) (p=0,031) was significantly less in OPCAB group. OPCAB is safe and effective in treatment of high-risk patients. Avoidance of cardiopulmonary bypass is associated with reduced incidence of neurologic complications, lower intubation time, retransfusion rate and shorter hospital stay, and in our experience the preferred operative method in such patients

Ultra wideband technology in medicine: a survey

The utilization of wireless technology in traditional medical services provides patients with enhanced mobility. This has a positive effect on the recovery speed of a person after major surgical procedures or prolonged illness. Ultrawideband (UWB) radio signals have inherent characteristics that make them highly suitable for less invasive medical applications. This paper surveys our own and related recent research on UWB technology for medical sensing and communications. Some research perspectives in the aforementioned topics are suggested too

Molecular Communication Aspects of Potassium Intracellular Signaling in Cardiomyocytes

Cardiovascular diseases continue to be a leading cause of morbidity and mortality worldwide. Cardiomyocytes, as the elementary heart components, play a crucial role in maintaining a healthy heart by coordinating contractions throughout the heart muscle that lead to a heartbeat. This study aims to characterize fine-grained ionic-level manipulation of cardiomyocytes for the controlled electrical activity that will offer new insights within the medical field. We explore the concept of Molecular Communications (MC) to analyze the propagation of potassium ions in the cardiomyocyte cytosol. By associating the number of the potassium ions in the cytosol with the membrane- and action potentials, we use metrics from the well-known Shannon's information theory to optimize the ionic injection process and manipulate cardiomyocytes electrical activity. In case ON/OFF keying modulation is adopted as the potassium ion injection method, the optimal input distribution in terms of information capacity follows the derived Bernoulli distribution. This study offers underlying concepts that can be exploited in the creation of cardiomyocyte signals either for data communication via cellular infrastructure or heart pacing. The framework presented here needs to be upgraded in the following phases and made more physiologically plausible

Strony tytułowe i spis treści / Polska Sztuka Ludowa - Konteksty 1971 t.25 z.2

Polska Sztuka Ludowa 1971 t.25, z.2; s.65-6

Contactless blood perfusion assessment of the free flap in breast reconstruction surgery

Remote photoplethysmography proved useful as anon-contact method for estimating physiological data from dif-ferent parts of the body. Recent studies have mainly focused onthe face region for extraction of blood pulsation signal. In thispaper, we have demonstrated the feasibility of non-contact remotephotoplethysmography in the monitoring of free flap tissue. Anexperimental study was conducted, where video recordings offree flaps are obtained during breast reconstruction surgery for 8patients. The hemoglobin absorption rate of the free flap is closelyrelated to signal-to-noise ratio (SNR) values extracted fromfree flap pulsation signal during surgery. Obtained results showsignificantly lower SNR values when the free flap is disconnectedfrom the blood supply compared to the SNR values when theflap is intact or after successful blood supply establishment. Thismethod shows potential as a convenient, non-invasive and reliabletool in post-operative microvascular free flap monitorin

Molecular Communication Aspects of Potassium Intracellular Signaling in Cardiomyocytes

Cardiovascular diseases continue to be a leading cause of morbidity and mortality worldwide. Cardiomyocytes, as the elementary heart components, play a crucial role in maintaining a healthy heart by coordinating contractions throughout the heart muscle that lead to a heartbeat. This study aims to characterize fine-grained ionic-level manipulation of cardiomyocytes for the controlled electrical activity that will offer new insights within the medical field. We explore the concept of Molecular Communications (MC) to analyze the propagation of potassium ions in the cardiomyocyte cytosol. By associating the number of the potassium ions in the cytosol with the membrane- and action potentials, we use metrics from the well-known Shannon's information theory to optimize the ionic injection process and manipulate cardiomyocytes electrical activity. In case ON/OFF keying modulation is adopted as the potassium ion injection method, the optimal input distribution in terms of information capacity follows the derived Bernoulli distribution. This study offers underlying concepts that can be exploited in the creation of cardiomyocyte signals either for data communication via cellular infrastructure or heart pacing. The framework presented here needs to be upgraded in the following phases and made more physiologically plausible