The Application of Kidney Injury Molecule-1 to Determine the Duration Between Shockwave Lithotripsy Sessions

ERTNet: an interpretable transformer-based framework for EEG emotion recognition

Background

Emotion recognition using EEG signals enables clinicians to assess patients' emotional states with precision and immediacy. However, the complexity of EEG signal data poses challenges for traditional recognition methods. Deep learning techniques effectively capture the nuanced emotional cues within these signals by leveraging extensive data. Nonetheless, most deep learning techniques lack interpretability while maintaining accuracy.

Methods

We developed an interpretable end-to-end EEG emotion recognition framework rooted in the hybrid CNN and transformer architecture. Specifically, temporal convolution isolates salient information from EEG signals while filtering out potential high-frequency noise. Spatial convolution discerns the topological connections between channels. Subsequently, the transformer module processes the feature maps to integrate high-level spatiotemporal features, enabling the identification of the prevailing emotional state.

Results

Experiments' results demonstrated that our model excels in diverse emotion classification, achieving an accuracy of 74.23% ± 2.59% on the dimensional model (DEAP) and 67.17% ± 1.70% on the discrete model (SEED-V). These results surpass the performances of both CNN and LSTM-based counterparts. Through interpretive analysis, we ascertained that the beta and gamma bands in the EEG signals exert the most significant impact on emotion recognition performance. Notably, our model can independently tailor a Gaussian-like convolution kernel, effectively filtering high-frequency noise from the input EEG data.

Discussion

Given its robust performance and interpretative capabilities, our proposed framework is a promising tool for EEG-driven emotion brain-computer interface.

The Ideal Interval Between Repeated Shockwaves Lithotripsy Sessions for Renal Stones: A Randomized Controlled Trial

Objectives: To assess the ideal interval between repeated extracorporeal shockwave lithotripsy (SWL) for renal stones. Patient and Methods: Eligible patients with a single renal stone ≤20 mm who required SWL were randomly assigned to one of three groups based on intervals between first and second sessions. Patients underwent the second session after 3, 7, and 14 days in Groups 1, 2, and 3, respectively. Tubular functions were assessed through comparisons of urinary execration of kidney injury molecule-1 (KIM-1), neutrophil gelatinase associated lipocalin (NGAL), and interleukin-18 (IL-18) with pre-SWL values, whereas glomerular function was assessed by comparisons of protein/creatinine ratio with pre-SWL and changes in ipsilateral renal function on isotope scans. Treatment success was assessed by noncontrast CT after 3 months. Results: All demographics of the 166 patients included in the study were comparable between the three groups. There were significant elevations of tubular biomarkers and protein/creatinine ratio after first and second SWL sessions compared with pre-SWL values (p < 0.0001). All tubular biomarkers returned to pre-SWL values at 7 and 14 days after second session, whereas they remained significantly elevated 3 days after second session (p = 0.027, < 0.001 and <0.001 for KIM-1, NGAL, and IL-18, respectively). SWL success was 73.6% in Group 1, 83.7% in Group 2, and 81% in Group 3. A significant decrease in ipsilateral renal split function was observed in Group 1 at the 3-month follow-up. Conclusions: An interval of 7 days is required between SWL sessions when treating renal stones to allow for complete recovery of kidney functions. Clinical Trial Registration: ID: NCT04575480.

The effect of piezoelectric shockwave lithotripsy with 2- and 8-mm focus sizes on stone disintegration and renal injury

OBJECTIVES

To compare the efficacy and safety of shockwave lithotripsy (SWL) using a narrow focus or wide focus for renal stones.

PATIENTS AND METHODS

A double-blind randomised trial included adult patients with a solitary radio-opaque renal pelvic stone of 1-2 cm. Patients were randomised into two groups: narrow-focus (2 mm) SWL and wide-focus (8 mm) SWL. The stone-free rate (SFR) and presence of complications such as haematuria, fever, pain, and peri-renal haematoma were evaluated. Pre- and postoperative urinary markers (neutrophil gelatinase-associated lipocalin [NGAL] and kidney injury molecule 1 [KIM-1]) concentrations were compared to assess renal injury.

RESULTS

A total of 135 patients were recruited for this study. The SFR after the first SWL session was 79.2% and 69.1% in narrow- and wide-focus groups, respectively. There was a comparable rise in the median 2-h NGAL concentration in both groups (P = 0.62). However, the rise in the median (interquartile range [IQR]) 2-h KIM-1 concentration was significantly higher in the narrow-focus group at 4.9 (4.6, 5.8) ng/mL compared with the wide-focus group at 4.4 (3.2, 5.7) ng/mL (P = 0.02). Nevertheless, the 3-day NGAL and KIM-1 urinary marker concentrations were significantly improved (P = 0.263 and P = 0.963, respectively). The overall SFR after three sessions was 86.6% and 86.8% in the narrow- and wide-focus groups, respectively (P = 0.77). Both groups were comparable for complications, apart from the median pain score and the percentage of high-grade haematuria, which were significantly higher in the narrow-focus group (P < 0.001 and P = 0.03, respectively).

CONCLUSION

Narrow- and wide-focus SWL were associated with comparable outcomes and re-treatment rates. However, narrow-focus SWL was associated with significantly higher morbidity in terms of pain and haematuria.

Evaluation of the urinary podocalyxin and nephrin excretion levels to determine a safe time interval between two sessions of SWL for renal stones: a non randomized exploratory study

OBJECTIVES

We aimed to evaluate the role of nephrin and podocalyxin in determining the intervals between shock wave lithotripsy (SWL) sessions and how soon the kidney damage was recovered.

METHODS

This work was a prospective study that included 30 patients with unilateral kidney stones. The patients' midflow urine samples were collected before SWL and 1 h, 1 day and 1 week after the procedure. Nephrin and podocalyxin levels in the urine samples were measured by the enzyme-linked immunosorbent assay method.

RESULTS

Among the 30 patients who underwent SWL, 19 were males and 11 were females. The mean age of the SWL group was 34.7 ± 13.2. Both biomarkers did not correlate with age, creatinine values, body mass index, stone side, stone size, energy, frequency and shock numbers. Nephrin and podocalyxin levels were significantly higher at the pre-SWL point (p < 0.05). After the procedure, a significant decrease was observed in both biomarker levels (p < 0.05). At the end of first day, these levels started to increase progressively up to the end of the first week (p  > 0.05).

CONCLUSIONS

Nephrin and podocalyxin may help to determine early period kidney damage associated with SWL. Post-SWL podocalyxin and nephrin values may be used to determine the interval between SWL sessions.

Autophagy activation protects shock wave induced renal tubular epithelial cell apoptosis may through modulation of Akt/ GSK-3β pathway

Purpose: Extracorporeal shock wave lithotripsy (ESWL) is well documented to exert destructive effect to renal cells and its mechanism is not clear. Autophagy is one of cell basic response for stressful conditions and it is important to determine cell's fate. The aim of this study is to elucidate the role of autophagy in the process of shock wave-induced renal cells injury.

Methods: NRK-52E cell, a rat renal tubular epithelial cell, was exposed to shock wave at the voltage of 14KV. GFP-LC3 puncta was used to monitor Autophagy flux in the process of shock wave injury. Autophagic relative proteins, such as light chain 3 (LC3), beclin-1 and p62, were also examined. Cell variability and apoptosis were detected when inhibition autophagy with 3-methyladenine (3MA) or stimulating its activity with rapamycin during the process of shock wave injury. The role of Akt/ GSK-3β and its connection with autophagy in the process of shock wave injury were also investigated.

Results: Shock wave was confirmed to activate autophagy in renal cells, which was manifested in LC3-II turnover, beclin-1 induction and degradation of p62. Inhibition autophagy enhanced cell damage or apoptosis, whereas its stimulating was able to exert protection from shock wave injury. Akt/ GSK-3β, a cell-survival signaling pathway, can also be activated during the process. And its activation could be suppressed by blockade autophagy.

Conclusion: Autophagy is a self-protective response for renal cells from shock wave injury. The cyto-protection of autophagy may be connected with modulation Akt/ GSK-3β pathway.