Can Artificial Intelligence Accurately Detect Urinary Stones? A Systematic Review.

Objectives: To perform a systematic review on artificial intelligence (AI) performances to detect urinary stones. Methods: A PROSPERO-registered (CRD473152) systematic search of Scopus, Web of Science, Embase, and PubMed databases was performed to identify original research articles pertaining to AI stone detection or measurement, using search terms ("automatic" OR "machine learning" OR "convolutional neural network" OR "artificial intelligence" OR "detection" AND "stone volume"). Risk-of-bias (RoB) assessment was performed according to the Cochrane RoB tool, the Joanna Briggs Institute Checklist for nonrandomized studies, and the Checklist for Artificial Intelligence in Medical Imaging (CLAIM). Results: Twelve studies were selected for the final review, including three multicenter and nine single-center retrospective studies. Eleven studies completed at least 50% of the CLAIM checkpoints and only one presented a high RoB. All included studies aimed to detect kidney (5/12, 42%), ureter (2/12, 16%), or urinary (5/12, 42%) stones on noncontrast computed tomography (NCCT), but 42% intended to automate measurement. Stone distinction from vascular calcification interested two studies. All studies used AI machine learning network training and internal validation, but a single one provided an external validation. Trained networks achieved stone detection, with sensitivity, specificity, and accuracy rates ranging from 58.7% to 100%, 68.5% to 100%, and 63% to 99.95%, respectively. Detection Dice score ranged from 83% to 97%. A high correlation between manual and automated stone volume (r = 0.95) was noted. Differentiate distal ureteral stones and phleboliths seemed feasible. Conclusions: AI processes can achieve automated urinary stone detection from NCCT. Further studies should provide urinary stone detection coupled with phlebolith distinction and an external validation, and include anatomical abnormalities and urologic foreign bodies (ureteral stent and nephrostomy tubes) cases.

Towards an objective measurement of sleep quality in non-human animals: using the horse as a model species for the creation of sleep quality indices.

Sleep disturbance is observed across species, resulting in neurocognitive dysfunction, poor impulse control and poor regulation of negative emotion. Understanding animal sleep disturbance is thus important to understand how environmental factors influence animal sleep and day-to-day welfare. Self-reporting tools for sleep disturbance commonly used in human research to determine sleep quality cannot be transferred to non-verbal animal species research. Human research has, however, successfully used frequency of awakenings to create an objective measurement of sleep quality. The aim of this study was to use a novel sleep-quality scoring system for a non-human mammalian species. Five separate sleep quality indices calculations were developed, using frequency of awakenings, total sleep time and total time spent in different sleep states. These indices were applied to a pre-existing data set of equine sleep behaviour taken from a study investigating the effects of environmental change (lighting and bedding) on the duration of time in different sleep states. Significant treatment effects for index scores both differed and aligned with the original sleep quantity results, thus sleep quality may be a useful alternative measurement of sleep disturbance that could be used to investigate impactful (emotional, cognitive) effects on the animal.

Long-term Outcomes of Minimally Invasive Rendezvous Procedures to Treat Complex Ureteric Strictures and Injuries.

Background: Complex ureteric strictures and injuries occurring during major abdominal and pelvic operations may cause significant morbidity and distress to patients. A rendezvous procedure is an endoscopic technique used in case of such injuries. Objective: To evaluate perioperative and long-term outcomes of rendezvous procedures to treat complex ureteric strictures and injuries. Design setting and participants: We retrospectively reviewed patients undergoing a rendezvous procedure for ureteric discontinuity including strictures and injuries, treated between 2003 and 2017 at our Institution and completing at least 12 mo of follow-up. We divided patients into two groups: early postsurgical obstruction, leakage, or detachment (group A) and late strictures (oncological/postsurgical; group B). Outcome measurements and statistical analysis: If appropriate, we performed a retrograde study ± rigid ureteroscopy to assess the stricture 3 mo after the rendezvous procedure, followed by a MAG3 renogram at 6 wk, 6 mo, and 12 mo, and annually thereafter for 5 yr. Results and limitations: Forty-three patients underwent a rendezvous procedure, 17 in group A (median age 50 yr, range 30-78) and 26 in group B (median age 60 yr, range: 28-83). Ureteric strictures and ureteric discontinuities were stented successfully in 15 out of 17 patients in group A (88.2%) and 22 out of 26 patients (84.6%) in group B. For both groups, the median follow-up was 6 yr. In group A, of 17 patients, 11 (64.7%) were stent free with no further interventions, two (11.7%) had a subsequent Memokath stent insertion (38%), and two (11.7%) required reconstruction. Of 26 patients in group B, eight (30.7%) required no further interventions and were stent free, ten (38.4%) were maintained with long-term stenting, and one was managed with a Memokath stent (3.8%). Of the 26 patients, only three (11.5%) required major reconstruction, while four patients with malignancy (15%) died during follow-up. Conclusions: With a combined antegrade and retrograde approach, the majority of complex ureteric strictures/injuries can be bridged and stented with an overall immediate technical success rate of above 80%, avoiding major surgery in unfavourable circumstances and allowing time for stabilisation and recovery of the patient. Additionally, in case of technical success, further interventions may be unnecessary in up to 64% of patients with acute injury and about 31% of patients with late stricture. Patient summary: The majority of complex ureteric strictures and injuries can be resolved using a rendezvous approach, avoiding major surgery in unfavourable circumstances. Moreover, this approach can help avoid further interventions in 64% of such patients.

Does relative renal function improve after intervention for chronic ureteric obstruction?

INTRODUCTION: Unilateral renal function often deteriorates with chronic ureteric obstruction. Our objectives were to determine the change in relative renal function (RRF) by MAG3 renography after intervention for ureteric obstruction, and to identify clinical/epidemiological factors which influence long-term outcomes. MATERIAL AND METHODS: We identified 228 patients from 2006 to 2017 who underwent MAG3 renography before and after intervention for unilateral ureteric obstruction. Patients were grouped into categories preoperatively - with normal RRF (43-57%) through mild (29-42%), moderate (15-28%) and severe (<15%) impairment of RRF. Patient demographics, types of obstructive uropathy and intervention employed were analysed. Each group was assessed for the absolute change in RRF and change in RRF category postoperatively. RESULTS: The mean patient age was 50.4 years (SD 16.7), and 62.3% were female. Overall, the mean pre- and post-intervention RRF of the obstructed kidney did not differ significantly (32.30% vs. 32.20%, P = 0.835). Most patients remained in their preoperative RRF group: 85.9% of normal, 67.4% of mild, 64.4% of moderate and 73.3% of patients with severe RRF impairment did not change category.Patients with mildly impaired preoperative RRF showed a significant worsening postoperatively (36.37% vs. 34.58%, P = 0.024). The other three groups showed no significant change in RRF following intervention.Multivariate logistic regression analysis showed no statistically significant association between type of intervention, age, gender or diagnosis and improvement in postoperative RRF category. CONCLUSIONS: Our results show that RRF does not improve significantly after intervention for ureteric obstruction. The aim should therefore be to maintain existing renal function and relieve symptoms.

Anaerobic Speed Reserve: A Key Component of Elite Male 800-m Running.

PURPOSE: In recent years (2011-2016), men's 800-m championship running performances have required greater speed than previous eras (2000-2009). The "anaerobic speed reserve" (ASR) may be a key differentiator of this performance, but profiles of elite 800-m runners and their relationship to performance time have yet to be determined. METHODS: The ASR-determined as the difference between maximal sprint speed (MSS) and predicted maximal aerobic speed (MAS)-of 19 elite 800- and 1500-m runners was assessed using 50-m sprint and 1500-m race performance times. Profiles of 3 athlete subgroups were examined using cluster analysis and the speed reserve ratio (SRR), defined as MSS/MAS. RESULTS: For the same MAS, MSS and ASR showed very large negative (both r = -.74 ± .30, ±90% confidence limits; very likely) relationships with 800-m performance time. In contrast, for the same MSS, ASR and MAS had small negative relationships (both r = -.16 ± .54; possibly) with 800-m performance. ASR, 800-m personal best, and SRR best defined the 3 subgroups along a continuum of 800-m runners, with SRR values as follows: 400-800 m ≥ 1.58, 800 m ≤ 1.57 to ≥ 1.48, and 800-1500 m ≤ 1.47 to ≥ 1.36. CONCLUSION: MSS had the strongest relationship with 800-m performance, whereby for the same MSS, MAS and ASR showed only small relationships to differences in 800-m time. Furthermore, the findings support the coaching observation of three 800-m subgroups, with the SRR potentially representing a useful and practical tool for identifying an athlete's 800-m profile. Future investigations should consider the SRR framework and its application for individualized training approaches in this event.

Tactical Behaviors in Men's 800-m Olympic and World-Championship Medalists: A Changing of the Guard.

PURPOSE: To assess the longitudinal evolution of tactical behaviors used to medal in men's 800-m Olympic Games (OG) or world-championship (WC) events in the recent competition era (2000-2016). METHODS: Thirteen OG and WC events were characterized for 1st- and 2nd-lap splits using available footage from YouTube. Positive pacing strategies were defined as a faster 1st lap. Season's best 800-m time and world ranking, reflective of an athlete's "peak condition," were obtained to determine relationships between adopted tactics and physical condition prior to the championships. Seven championship events provided coverage of all medalists to enable determination of average 100-m speed and sector pacing of medalists. RESULTS: From 2011 onward, 800-m OG and WC medalists showed a faster 1st lap by 2.2 ± 1.1 s (mean, ±90% confidence limits; large difference, very likely), contrasting a possibly faster 2nd lap from 2000 to 2009 (0.5, ±0.4 s; moderate difference). A positive pacing strategy was related to a higher world ranking prior to the championships (r = .94, .84-.98; extremely large, most likely). After 2011, the fastest 100-m sector from 800-m OG and WC medalists was faster than before 2009 by 0.5, ±0.2 m/s (large difference, most likely). CONCLUSIONS: A secular change in tactical racing behavior appears evident in 800-m championships; since 2011, medalists have largely run faster 1st laps and have faster 100-m sector-speed requirements. This finding may be pertinent for training, tactical preparation, and talent identification of athletes preparing for 800-m running at OGs and WCs.

Schistosomiasis-A Disobedient Ureter, a Disobedient Diagnosis.

Background: Schistosomiasis is rare in western countries, but remains a potentially serious disease. It is known to result in severe urogenital complications; prompt diagnosis can therefore significantly affect outcomes. Case Presentation: We report the case of a 41-year-old male with pleuritic chest pain and visible hematuria who had emigrated from Zimbabwe to the United Kingdom 20 years previously. CT imaging revealed a hydronephrotic right pelvicaliceal system, with a dilated ureter to its distal portion. Preliminary tests for schistosomiasis, including terminal urine microscopy and serology, were negative. An initial ureteroscopy was challenging owing to a tight ureteral stricture such that a retrograde stent insertion and not ureteroscopic visualization or biopsy was carried out. A relook ureteroscopy after 6 weeks revealed a dense distal ureteral stricture, biopsies were taken, the stricture was ablated with LASER, and a retrograde stent was placed. Microscopic examination of the biopsies confirmed Schistosomiasis haematobium. Treatment consisted of a divided dose of praziquantel and a reducing dose of steroids. At a third look ureteroscopy the stricture was ablated with LASER again, and the stent was removed. Subsequent renograms indicated recurrent obstruction despite LASER treatment and a retrograde ureteral stent was replaced. The patient ultimately had a Boari flap ureteral reimplant with good results. Conclusion: This case illustrates the clinical challenges of diagnosing and treating ureteral schistosomiasis. It shows that all the initial tests can be negative, but where the clinical picture points toward schistosomiasis it is worth persevering and a good tissue biopsy may be the only way to verify an otherwise elusive diagnosis.

The Relationship Between Training Load and Injury in Men's Professional Basketball.

PURPOSE: To establish the relationship between the acute:chronic workload ratio and lower-extremity overuse injuries in professional basketball players over the course of a competitive season. METHODS: The acute:chronic workload ratio was determined by calculating the sum of the current week's session rating of perceived exertion of training load (acute load) and dividing it by the average weekly training load over the previous 4 wk (chronic load). All injuries were recorded weekly using a self-report injury questionnaire (Oslo Sports Trauma Research Center Injury Questionnaire20). Workload ratios were modeled against injury data using a logistic-regression model with unique intercepts for each player. RESULTS: Substantially fewer team members were injured after workload ratios of 1 to 1.49 (36%) than with very low (≤0.5; 54%), low (0.5-0.99; 51%), or high (≥1.5; 59%) workload ratios. The regression model provided unique workload-injury trends for each player, but all mean differences in likelihood of being injured between workload ratios were unclear. CONCLUSIONS: Maintaining workload ratios of 1 to 1.5 may be optimal for athlete preparation in professional basketball. An individualized approach to modeling and monitoring the training load-injury relationship, along with a symptom-based injury-surveillance method, should help coaches and performance staff with individualized training-load planning and prescription and with developing athlete-specific recovery and rehabilitation strategies.

Modeling parameters that characterize pacing of elite female 800-m freestyle swimmers.

Pacing offers a potential avenue for enhancement of endurance performance. We report here a novel method for characterizing pacing in 800-m freestyle swimming. Websites provided 50-m lap and race times for 192 swims of 20 elite female swimmers between 2000 and 2013. Pacing for each swim was characterized with five parameters derived from a linear model: linear and quadratic coefficients for effect of lap number, reductions from predicted time for first and last laps, and lap-time variability (standard error of the estimate). Race-to-race consistency of the parameters was expressed as intraclass correlation coefficients (ICCs). The average swim was a shallow negative quadratic with slowest time in the eleventh lap. First and last laps were faster by 6.4% and 3.6%, and lap-time variability was ±0.64%. Consistency between swimmers ranged from low-moderate for the linear and quadratic parameters (ICC = 0.29 and 0.36) to high for the last-lap parameter (ICC = 0.62), while consistency for race time was very high (ICC = 0.80). Only ~15% of swimmers had enough swims (~15 or more) to provide reasonable evidence of optimum parameter values in plots of race time vs. each parameter. The modest consistency of most of the pacing parameters and lack of relationships between parameters and performance suggest that swimmers usually compensated for changes in one parameter with changes in another. In conclusion, pacing in 800-m elite female swimmers can be characterized with five parameters, but identifying an optimal pacing profile is generally impractical.

Relationships Between Pacing Parameters and Performance of Elite Male 1500-m Swimmers.

PURPOSE: Pacing has a substantial effect on endurance performance. The authors characterize pacing and identify its parameters for optimal performance in 1500-m freestyle swimming. METHODS: Web sites provided 50-m lap and 1500-m race times for 330 swims of 24 elite male swimmers. Pacing for each swim was characterized with 7 parameters derived from a general linear model: linear and quadratic coefficients for the effect of lap number; reductions from predicted time for first, second, penultimate, and last laps; and lap-time variability. Scatter plots of race time vs each parameter for each swimmer were used to identify optimum values of parameters. RESULTS: Most scatterplots showed only weak relationships between the parameter and performance, but one-third to one-half of swimmers had an optimum value of the parameter that was substantially different from their mean value. A large improvement in performance time (1.4% ± 0.9%, mean ± SD) could be achieved generally by reversing the sign of the linear parameter to make the slowest lap occur earlier in the race. Small to moderate improvements might also accrue by changing the quadratic parameter, by making the first and second laps slower and the penultimate and last laps faster, and reducing lap-time variability. CONCLUSIONS: This approach to analysis of pacing may help improve performance in swimmers and other endurance athletes in sports with multiple laps, but data from many competitions are required.

Age of Peak Competitive Performance of Elite Athletes: A Systematic Review.

BACKGROUND: Knowledge of the age at which elite athletes achieve peak performance could provide important information for long-term athlete development programmes, event selection and strategic decisions regarding resource allocation. OBJECTIVES: The objective of this study was to systematically review published estimates of age of peak performance of elite athletes in the twenty-first century. METHODS: We searched SPORTDiscus, PubMed and Google Scholar for studies providing estimates of age of peak performance. Here we report estimates as means only for top (international senior) athletes. Estimates were assigned to three event-type categories on the basis of the predominant attributes required for success in the given event (explosive power/sprint, endurance, mixed/skill) and then plotted by event duration for analysis of trends. RESULTS: For both sexes, linear trends reasonably approximated the relationships between event duration and estimates of age of peak performance for explosive power/sprint events and for endurance events. In explosive power/sprint events, estimates decreased with increasing event duration, ranging from ~27 years (athletics throws, ~1-5 s) to ~20 years (swimming, ~21-245 s). Conversely, estimates for endurance events increased with increasing event duration, ranging from ~20 years (swimming, ~2-15 min) to ~39 years (ultra-distance cycling, ~27-29 h). There was little difference in estimates of peak age for these event types between men and women. Estimations of the age of peak performance for athletes specialising in specific events and of event durations that may best suit talent identification of athletes can be obtained from the equations of the linear trends. There were insufficient data to investigate trends for mixed/skill events. CONCLUSION: Differences in the attributes required for success in different sporting events likely contribute to the wide range of peak-performance ages of elite athletes. Understanding the relationships between age of peak competitive performance and event duration should be useful for tracking athlete progression and talent identification.

Predicting a nation's olympic-qualifying swimmers.

UNLABELLED: Talent identification and development typically involve allocation of resources toward athletes selected on the basis of early-career performance. PURPOSE: To compare 4 methods for early-career selection of Australia's 2012 Olympic-qualifying swimmers. METHODS: Performance times from 5738 Australian swimmers in individual Olympic events at 101 competitions from 2000 to 2012 were analyzed as percentages of world-record times using 4 methods that retrospectively simulated early selection of swimmers into a talent-development squad. For all methods, squad-selection thresholds were set to include 90% of Olympic qualifiers. One method used each swimmer's given-year performance for selection, while the others predicted each swimmer's 2012 performance. The predictive methods were regression and neural-network modeling using given-year performance and age and quadratic trajectories derived using mixed modeling of each swimmer's annual best career performances up to the given year. All methods were applied to swimmers in 2007 and repeated for each subsequent year through 2011. RESULTS: The regression model produced squad sizes of 562, 552, 188, 140, and 93 for the years 2007 through 2011. Corresponding proportions of the squads consisting of Olympic qualifiers were 11%, 11%, 32%, 43%, and 66%. Neural-network modeling produced similar outcomes, but the other methods were less effective. Swimming Australia's actual squads ranged from 91 to 67 swimmers but included only 50-74% of Olympic qualifiers. CONCLUSIONS: Large talent-development squads are required to include most eventual Olympic qualifiers. Criteria additional to age and performance are needed to improve early selection of swimmers to talent-development squads.

The performance effect of centralizing a nation's elite swim program.

UNLABELLED: Many national sporting organizations recruit talented athletes to well-resourced centralized training squads to improve their performance. PURPOSE: To develop a method to monitor performance progression of swimming squads and to use this method to assess the progression of New Zealand's centralized elite swimming squad. METHODS: Best annual long-course competition times of all New Zealand swimmers with at least 3 y of performances in an event between 2002 and 2013 were downloaded from takeyourmarks.com (~281,000 times from ~8500 swimmers). A mixed linear model accounting for event, age, club, year, and elite-squad membership produced estimates of mean annual performance for 175 swim clubs and mean estimates of the deviation of swimmers' performances from their individual quadratic trajectories after they joined the elite squad. Effects were evaluated using magnitude-based inferences, with a smallest important improvement in swim time of -0.24%. RESULTS: Before 2009, effects of elite-squad membership were mostly unclear and trivial to small in magnitude. Thereafter, both sexes showed clear additional performance enhancements, increasing from large in 2009 (males -1.4%±0.8%, females -1.5%±0.8%; mean±90% confidence limits) to extremely large in 2013 (males -6.8%±1.7%, females -9.8%±2.9%). Some clubs also showed clear performance trends during the 11-y period. CONCLUSIONS: Our method of quantifying deviations from individual trends in competition performance with a mixed model showed that Swimming New Zealand's centralization strategy took several years to produce substantial performance effects. The method may also be useful for evaluating performance-enhancement strategies introduced at national or club level in other sports.

Career performance trajectories of Olympic swimmers: benchmarks for talent development.

The age-related progression of elite athletes to their career-best performances can provide benchmarks for talent development. The purpose of this study was to model career performance trajectories of Olympic swimmers to develop these benchmarks. We searched the Web for annual best times of swimmers who were top 16 in pool events at the 2008 or 2012 Olympics, from each swimmer's earliest available competitive performance through to 2012. There were 6959 times in the 13 events for each sex, for 683 swimmers, with 10 ± 3 performances per swimmer (mean ± s). Progression to peak performance was tracked with individual quadratic trajectories derived using a mixed linear model that included adjustments for better performance in Olympic years and for the use of full-body polyurethane swimsuits in 2009. Analysis of residuals revealed appropriate fit of quadratic trends to the data. The trajectories provided estimates of age of peak performance and the duration of the age window of trivial improvement and decline around the peak. Men achieved peak performance later than women (24.2 ± 2.1 vs. 22.5 ± 2.4 years), while peak performance occurred at later ages for the shorter distances for both sexes (∼1.5-2.0 years between sprint and distance-event groups). Men and women had a similar duration in the peak-performance window (2.6 ± 1.5 years) and similar progressions to peak performance over four years (2.4 ± 1.2%) and eight years (9.5 ± 4.8%). These data provide performance targets for swimmers aiming to achieve elite-level performance.

Page kidney phenomenon presenting as acute renal failure after partial nephrectomy: a case report and review of the literature.

BACKGROUND: The Page kidney phenomenon, whilst a known condition, is in itself a rare entity. This report illustrates a case following partial nephrectomy which presented as post-operative renal failure. CASE PRESENTATION: The authors present a case of renal cell carcinoma in a solitary kidney that after partial nephrectomy resulted in a subcapsular haematoma formation and acute renal failure. CONCLUSION: The condition of Page kidneys are typically described in young patients after trauma. However, with the increasing usage of surgical interventions, post-operative bleeding can result in a compression-induced necrosis.

The increased risk of urinary stone disease in betel quid chewers.

The chewing of betel quid is a common practice in many countries of the world, particularly in Southeast Asia. The quid consists of a preparation of areca nut, betel leaf and calcium hydroxide "lime" paste ("chuna"). For the first time, we present a study that links its use to urinary stone disease. Eight patients (seven male and one female) who presented to our Stone Unit with recurrent urinary stones were included in the study. All were from the Indian subcontinent and were found to regularly chew betel. The patients underwent metabolic screening including blood, random urine and 24-h urine tests, quantitative chemical analysis of their calculi (where possible) and each completed a 7-day Diet Diary on his/her free, home diet. The study demonstrated a high incidence of hypercalciuria, a tendency to pass an alkaline urine and low urinary citrate excretion among the patients. Together these urinary risk factors increase the probability of developing both calcium phosphate-containing and calcium oxalate-containing stones. In support of this hypothesis, the patients were found to form stones consisting mainly of calcium phosphate but mixed with calcium oxalate. It is concluded that the use of calcium hydroxide "chuna" in the betel quid is the major contributor to the cause of urinary stones in its users. Moreover, the development of urinary lithiasis in such patients may be a precursor to milk-alkali syndrome in those individuals whose chewing habit is more extensive than in the patients in this study and who do not seek to decrease their habit over the long term.

Testicular seminoma presenting 22 years after treatment for extra-gonadal germ-cell tumour.

We report an interesting case of testicular seminoma in a 57-year-old man who had received treatment for a pulmonary extra-gonadal seminoma 22 years previously. This case indicates that patients with extra-gonadal germ-cell tumours should either be followed up for life or, if discharged, should be informed of the potential risk of developing testicular tumour in the future and advised of the need for regular self-testicular examination.

Influence of a nurse practitioner on non-attendance rate for barium enema.

Non-attendance for barium enema investigation wastes resources, prolongs waiting times and delays diagnosis of colorectal carcinoma. In an inner-city hospital with a previous non-attendance rate of over 20% for barium enema we investigated the value of systematic personal contact with a nurse practitioner at the time of booking. We compared two groups of patients, all of whom received an explanation of the procedure from the referring clinician. Patients referred from the colorectal clinic were accompanied by the colorectal nurse practitioner to the radiology department for booking, an appointment being sent later by mail. The nurse practitioner reiterated the details of the procedure, provided supplementary information, confirmed the patient's contact details and provided a telephone number in case further information or assistance was needed. Patients referred from the gastroenterology clinic were managed as previously, making their own way to the radiology department and receiving supplementary information only on request. The patients referred from the two clinics were closely similar; however, the non-attendance rate for the intervention (colorectal) clinic was 4/157 (2.5%) compared with 17/110 (15.5%) for the comparison clinic (P<0.001). A year previously the non-attendance rates in these clinics had been 23% and 20%, respectively. These results indicate that personal contact, with supplementary information, can substantially reduce the non-attendance rate for barium enema.