askMUSIC: Leveraging a Clinical Registry to Develop a New Machine Learning Model to Inform Patients of Prostate Cancer Treatments Chosen by Similar Men

BackgroundClinical registries provide physicians with a means for making data-driven decisions but few opportunities exist for patients to interact with registry data to help make decisions.ObjectiveWe sought to develop a web-based system that uses a prostate cancer (CaP) registry to provide newly diagnosed men with a platform to view predicted treatment decisions based on patients with similar characteristics.Design, setting, and participantsThe Michigan Urological Surgery Improvement Collaborative (MUSIC) is a quality improvement consortium of urology practices that maintains a prospective registry of men with CaP. We used registry data from 45 MUSIC urology practices from 2015 to 2017 to develop and validate a random forest machine learning model. After fitting the random forest model to a derivation cohort consisting of a random two-thirds sample of patients after stratifying by practice location, we evaluated the model performance in a validation cohort consisting of the remaining one-third of patients using a multiclass area under the curve (AUC) measure and calibration plots.Results and limitationsWe identified 7543 men diagnosed with CaP, of whom 45% underwent radical prostatectomy, 30% surveillance, 17% radiation therapy, 5.6% androgen deprivation, and 1.8% watchful waiting. The personalized prediction for patients in the validation cohort was highly accurate (AUC 0.81).ConclusionsUsing clinical registry data and machine learning methods, we created a web-based platform for patients that generates accurate predictions for most CaP treatments.Patient summaryWe have developed and tested a tool to help men newly diagnosed with prostate cancer to view predicted treatment decisions based on similar patients from our registry. We have made this tool available online for patients to use.     

Turning cigarette butt waste into an alternative control tool against an insecticide-resistant mosquito vector

Annually, 4.5 trillion cigarette butts (CBs) are flicked into our environment. Evidence exists that CB waste is deadly to aquatic life, but their lethality to the aquatic life of the main dengue vector is unknown. CBs are full of toxicants that occur naturally, during planting and manufacturing, which may act as larvicidal agents. We assessed Aedes aegypti vulnerability to Marlboro butts during its development. Overall, CBs showed insecticidal activities against larvae. At early phases of development, mortality rates were much higher in two CBs solution (2CBSol) and 3CBSol microcosms (MICRs). Larval survival gradually decreased with development in 1CBSol-MICRs. However, in great presence of CBs, mortality was high even for the late developmental stages. These results suggest that A. aegypti larvae are vulnerable to CB presence in their habitats, but this effect was seen most during the early developmental phases and in the presence of increased amounts of cigarette remnants. CB filters are being used as raw material in many sectors, i.e., brick, art, fashion, plastic industries, as a practical solution to the pollution problem, the observed butt waste toxicity to mosquito larvae open new avenues for the identification of novel insecticide products.     

Effect of some curing methods on acrylic maxillary denture base fit

The aim of this study was to investigate the fit of acrylic maxillary denture bases processed by the methods of microwave, quick-wet-heat, slow-wet-heat, and self curing. Forty stone-casts were obtained using a mould of an undercut-free acrylic resin master cast of an edentulous maxilla. Standard acrylic replicas patterns sealed on casts and randomized to four groups (10 in each) were used to make denture bases using different processing methods for each of the four groups. The resultant discrepancy of fit between the denture base and the casts were measured using a silicone wafer. Varying fit discrepancies both within and between denture base groups was observed. The proportional fit-loss in the palatal region was significantly greater than the sulcular areas for all materials tested (p < 0.05). The fit-loss observed was greater in microwave-cured bases than for other materials examined. Careful selection of appropriate denture base materials and processing technique is important when providing complete dentures for edentulous patients.     

Sodium‐glucose co‐transporter (SGLT) and glucose transporter (GLUT) expression in the kidney of type 2 diabetic subjects

The sodium‐glucose co‐transporters (SGLTs) are responsible for the tubular reabsorption of filtered glucose from the kidney into the bloodstream. The inhibition of SGLT2‐mediated glucose reabsorption is a novel and highly effective strategy to alleviate hyperglycaemia in patients with type 2 diabetes mellitus (T2DM). However, the effectiveness of SGLT2 inhibitor therapy is diminished due, in part, to a compensatory increase in the maximum reabsorptive capacity (Tm) for glucose in patients with T2DM. We hypothesized that this increase in Tm could be explained by an increase in the tubular expression of SGLT and glucose transporters (GLUT) in these patients. To examine this, we obtained human kidney biopsy specimens from patients with or without T2DM and examined the mRNA expression of SGLTs and GLUTs. The expression of SGLT1 is markedly increased in the kidney of patients with T2DM, and SGLT1 mRNA is highly and significantly correlated with fasting and postprandial plasma glucose and HbA1c. In contrast, our data demonstrate that the levels of SGLT2 and GLUT2 mRNA are downregulated in diabetic patients, but not to a statistically significant level. These important findings are clinically significant and may have implications for the treatment of T2DM using strategies that target SGLT transporters in the kidney.