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Background Our aim was to build a skill assessment system, providing objective feedback to trainees based on the motion metrics of laparoscopic surgical instruments. Methods Participants performed tissue dissection around the aorta (tissue dissection task) and renal parenchymal closure (parenchymal-suturing task), using swine organs in a box trainer under a motion capture (Mocap) system. Two experts assessed the recorded movies, according to the formula of global operative assessment of laparoscopic skills (GOALS: score range, 5–25), and the mean scores were utilized as objective variables in the regression analyses. The correlations between mean GOALS scores and Mocap metrics were evaluated, and potential Mocap metrics with a Spearman’s rank correlation coefficient value exceeding 0.4 were selected for each GOALS item estimation. Four regression algorithms, support vector regression (SVR), principal component analysis (PCA)-SVR, ridge regression, and partial least squares regression, were utilized for automatic GOALS estimation. Model validation was conducted by nested and repeated k-fold cross validation, and the mean absolute error (MAE) was calculated to evaluate the accuracy of each regression model. Results Forty-five urologic, 9 gastroenterological, and 3 gynecologic surgeons, 4 junior residents, and 9 medical students participated in the training. In both tasks, a positive correlation was observed between the speed-related parameters (e.g., velocity, velocity range, acceleration, jerk) and mean GOALS scores, with a negative correlation between the efficiency-related parameters (e.g., task time, path length, number of opening/closing operations) and mean GOALS scores. Among the 4 algorithms, SVR showed the highest accuracy in the tissue dissection task ($${\mathrm{MAE}}_{\mathrm{median}}=2.2352$$ MAE median = 2.2352 ), and PCA-SVR in the parenchymal-suturing task ($${\mathrm{MAE}}_{\mathrm{median}}=1.2714$$ MAE median = 1.2714 ), based on 100 iterations of the validation process of automatic GOALS estimation. Conclusion We developed a machine learning–based GOALS scoring system in wet lab training, with an error of approximately 1–2 points for the total score, and motion metrics that were explainable to trainees. Our future challenges are the further improvement of onsite GOALS feedback, exploring the educational benefit of our model and building an efficient training program.

A 57-year-old man visited the urology department with a painful mass on the dorsal side of the penis. Magnetic resonance imaging sagittal image showed a small nodule. Leukemia recurrence was suspected due to his history of treatment for acute myeloid leukemia treated with allogeneic hematopoietic stem cell transplantation. No recurrence was identified by bone marrow biopsy ; however, two months later, the recurrence of leukemia was strongly suspected because the tumor grew over time and blasts were found in the peripheral blood. A biopsy of the penile tumor and bone marrow was performed, leading to the diagnosis of granulocytic sarcoma. Patients with a history of leukemia may be preceded by a single recurrence to extramedullary organs, even if blood and bone marrow findings suggest remission.

Radical cystectomy (RC) is the gold standard for managing muscle-invasive and high-risknon-muscleinvasive bladder cancer, but is accompanied by non-negligible operative risk. The aim of this study is to identify preoperative variables to predict major perioperative complications after RC and to develop a nomogram using the cohort from multiple institutions in Japan. We retrospectively reviewed 668 patients who underwent open RC with ileal conduit or neobladder at Hokkaido University hospital and 20 affiliated institutions between 1997 and 2010. Complications occurring within 90 days of surgery were graded using modified Clavien classification system. We defined modified Clavien grade 3 or more as major complications and performed univariate and multivariate logistic regression analyses. Predictive accuracy of the nomogram was evaluated with the area under the receiver operating characteristics curve (AUC). A total of 528 men and 140 women were included in this study. There were a total of 160/668 patients (24%) with major perioperative complications. A multivariate model identified gender (OR : 1. 63, p=0. 04), cardiovascular comorbidity (OR : 1.48, p=0.03) and simultaneous nephroureterectomy (OR : 2.81, p=0. 01) as independent predictors. Using these 3 variables, a nomogram was developed with the AUC of 0.58. Predictive performance of our nomogram showed only fair performance ; but at least, we identified male, cardiovascular comorbidity and simultaneous nephroureterectomy as independent predictors of perioperative major complications.

Tracking decarbonization effects requires a model for the identification of spatial energy demands on city facilities. However, most developing countries lack detailed discrete time and device-specific energy demand data. In this study, we installed multiple energy demand monitoring systems that could observe electricity demands at the device level in some residences in Bogor, Indonesia. The study aimed to estimate the time-series and equipment ratio of electricity consumption by households in the entire city based on the monitoring data. However, the number of households monitored was small, and therefore unlikely to be regarded as having a representative system. Therefore, we used questionnaire data to create monitored mimic data and increased the number of samples to estimate the energy demand characteristics of the entire city via spatial interpolation. In addition, we developed a reinforcement learning system for discrete time–electricity demand estimation systems for unmonitored households using a 5-step procedure; 1) Analyzing energy demand and its patterns from monitoring data, 2) Questionnaire-based surveying of households, 3) Estimation of energy demand and its patterns based on questionnaire responses in monitored households, 4) Development of a deep learning model that extends the results from (3) to unmonitored households using data fusion, and 5) Spatial interpolation of energy demand characteristics for all households in Bogor using a spatial statistics method. The spatial electricity demand of households was interpolated from GIS and high-resolution satellite data matching procedures. Based on this analysis, we developed an hourly energy demand prediction system that could be automatically improved by adding new data from the reinforced learning framework.

Axitinib was approved for use in Japan as a salvage therapy for patients with metastatic renal cell carcinoma (RCC) in 2012. We retrospectively evaluated the cases of 32 RCC patients that were treated with Axitinib as a 2nd- or further-line therapy between November 2012 and March 2017. Overall survival (OS), progression-free survival (PFS), and adverse events were assessed. The median OS and PFS from the initiation of Axitinib were 29 and 11 months, respectively. Nineteen patients received Axitinib as a 2nd-line treatment, in whom the median OS and median PFS were 22 and 10 months, respectively, while the median OS and PFS were 29 and 15.5 months, respectively, amongthe 13 patients who received Axitinib as a 3rd- or further-line treatment, which suggested that Axitinib is effective in the 3rd-line and further-line settings. A Cox multivariate model revealed that bone metastasis was a significant adverse factor for OS. Common grade 3 or higher adverse events included hypertension (28%), diarrhea (7%), and proteinuria (7%). Although the present study demonstrated the efficacy and safety of salvage Axitinib treatment in patients who had recurrent disease after the initial systemic therapy, further large-scale studies should be warranted to make clear its clinical effectiveness in these patients.

[ABSTRACT]National Aeronautics and Space Administration (NASA) recently launched Aquarius satelliteto measure the Sea Surface Salinity (SSS) fields from space at global and regional scales. These five years ofSSS data were analyzed in the Indonesian Seas. The analysis is focused on whatpatterns of the spatial and temporal distributions of SSS in the Indonesian Seas? How does SSS change with seasons in the Indonesian Seas, particularly in the Indonesian Throughflow (ITF) channel? As a resultAquarius observations of SSS showed Indonesian Sea varied annual and seasonally. SSS propagating feature was characterized with the seasonal cycle such as Southeast monsoon and Northwest monsoon and estimated SSS concentrations during January to May give fresher (lower) thanduring June to November due to rainfall effects. The seasonal variability of SSS in the ITF channel was also estimated in the Java Sea, Makassar Strait, Celebes and Banda Seas. These results showed that SSS patterns in these seas might be influenced by El-Nino-Southern Oscillation (ENSO) phenomena and La-Nina duringNorthwest Monsoon period which indicated by remarkable freshening in the South China Sea then expand to the Java Sea, Makasar Strait and Banda Sea.

To clarify the prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients treated by systemic chemotherapy.Of the 228 metastatic urothelial carcinoma patients treated with systemic chemotherapy, 97 received radiotherapy mainly to metastatic sites. In patients for whom the purpose of radiotherapy was not specified, more than 50 Gy irradiation was considered to be for disease consolidation for survival analysis, while less than 50 Gy was categorized as palliation. According to the Kaplan-Meier method, we analysed overall survival from the initiation of treatment for metastatic urothelial carcinoma until death or the last follow-up, using the log-rank test to assess the significance of differences. The Cox model was applied for prognostic factor analysis.Overall, there was no significant difference in survival between patients with and those without radiotherapy (P = 0.1532). When analysing the patients undergoing consolidative radiotherapy separately, these 25 patients showed significantly longer survival than the 72 patients with palliative radiotherapy (P = 0.0047), with a 3-year overall survival of 43.3%. Of the present cohort, 22 underwent metastasectomy for disease consolidation, and there was no overlapping case between the metastasectomy cohort and cohort receiving consolidative radiotherapy. After controlling for four independent prognostic factors (sex, performance status, haemoglobin level and number of organs with metastasis) in our previous study, radiotherapy for disease consolidation showed a marginal value (hazard ratio = 0.666, P = 0.0966), while metastasectomy remained significant (hazard ratio = 0.358, P = 0.0006).In the selected patients, long-term disease control could be achieved after consolidative radiotherapy for metastatic urothelial carcinoma disease. Our observations suggest that local ablative therapy (surgery or radiotherapy) could facilitate long-term disease control. However, the treatment decision should be individualized because of the lack of randomized control trials.

[ABSTRACT]The center for Remote Sensing and Ocean Science (CReSOS) was established in Udayana University (UNUD) in 2003 with the aid of Japan Aerospace Exploration Agency (JAXA ) and National Institute of Aeronautics and Space of Indonesia (Lembaga Penerbangan Dan Antariksa Nasional: LAPAN). According to the objectives of CReSOS, JAXA started pilot project in 2003 and continued it until 2008. During the period, an education program on satellite remote sensing technology has been established in a master course of UNUD. At the same time, international cooperative research has also started between UNUD and Japanese research institutes. UNUD and Yamaguchi University (YU) established joint master course program in 2009 with the support of Grant from Japanese Government under the title of “International Graduate School Cooperation by Satellite Remote-Sensing”. Then UNUD and YU expanded the educational program into the double degree program in 2011. Some students in the program move to YU and study in the second academic year. After getting master degrees from both UNUD and YU, some of them go to Doctoral course and acquire PhD. Many valuable papers have been published through the program. The program is now expanded not only for Indonesian students but also for students in Southeast Asia countries.