Shreyas Joshi

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Robotic Total Pelvic Exenteration

Journal of Minimally Invasive Gynecology, Nov 1, 2013

The purpose of this video is to present techniques and tips involved in laparoscopic total hyster... more The purpose of this video is to present techniques and tips involved in laparoscopic total hysterectomy with the Thunderbeat instrument along with the V-Care uterine manipulator. The video demonstrates that the Thunderbeat instrument can be used efficiently and safely to perform the entire laparoscopic hysterectomy with negligible blood loss and minimal thermal spread.

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3D object decomposition and super resolution

SIGGRAPH Asia 2014 Posters

A Helpful Tool in the Renal Surgery Armamentarium: Dorsal Lumbotomy nephrectomy for Tumor in Patients with End-Stage Renal Disease

Urology

OBJECTIVE To compare operative outcomes between the dorsal lumbotomy (DL) and laparoscopic (LN) a... more OBJECTIVE To compare operative outcomes between the dorsal lumbotomy (DL) and laparoscopic (LN) approaches for patients with end stage renal disease (ESRD) undergoing nephrectomy. DL operative technique is also described. MATERIALS AND METHODS We performed a retrospective review of all patients undergoing DL nephrectomy at Emory University from 2008-2020. Cases were matched with control patients with ESRD who had undergone LN. Parameters evaluated included operative time, estimated blood loss, length of stay, postoperative narcotic requirements, and complication rates. Statistical analysis performed with SPSS. RESULTS 43 DL patients and 86 LN patients were assessed. DL had shorter total OR time (173min vs 198min; p=0.001) and surgery time (101min vs 135min; p<0.001) compared to LN. There was a trend towards decreased mean length of stay among the DL group (2.65d vs 3.14d; p=0.069) as well as daily narcotic requirement measured in oral morphine equivalents (54.8mg/day vs 73.6mg/day, p=0.051). There were no differences in estimated blood loss, perioperative complication rates, ICU admissions, or 30-day readmissions. Limitations include retrospective design and small sample size. CONCLUSIONS Among patients with ESRD, DL was found to be safe and effective compared to LN, with shorter operative times, a trend towards decreased length of stay and post-operative narcotic requirements, and similar perioperative complication rates. DL should be considered as an approach for nephrectomy in this patient population.

Background

Humans spend approximately one third of their lives sleeping, but compared with other biological ... more Humans spend approximately one third of their lives sleeping, but compared with other biological processes, most of the molecular and genetic aspects of sleep have not been elucidated. A non-existent gene ontology and lack of a dedicated database containing a comprehensive list of sleep-related genes and their function presents a hurdle for sleep researchers. Materials and methods Using a two-pronged approach to solve this problem, publicly available microarray data from NCBI GEO (National Center for Biotechnology Information – Gene Expression Omnibus) database was used to develop a list of sleep-related genes for traits of interest. The data were analyzed using R Bioconductor and custom Perl scripts. The genes from this list were then matched with

Imaging-Based Scoring Systems for the Risk Stratification of Renal Tumors

Diagnosis and Surgical Management of Renal Tumors, 2018

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A Contemporary Clinicopathologic Analysis of Primary Urothelial Carcinoma of the Urethra Without Concurrent Renal Pelvic, Ureteral, or Bladder Carcinoma

International Journal of Surgical Pathology, 2021

Primary urothelial carcinoma (UCa) of the urethra is relatively uncommon, and the underlying path... more Primary urothelial carcinoma (UCa) of the urethra is relatively uncommon, and the underlying pathogenesis has not been well characterized, especially in the absence of concurrent UCa at other sites. A search for cases of primary UCa of the urethra was conducted. Patients with concurrent UCa of the renal pelvis, ureter, or bladder at the time of diagnosis of the primary tumor were excluded. Clinicopathologic and follow-up data were obtained. A total of 35 cases from 30 patients (27 male and 3 female) were included in the study. The mean patient age at the initial diagnosis was 71 years (range: 41-90 years). Cases were composed of high-grade UCa (26 of 35 = 74%), low-grade UCa (4 of 35 = 11%), and UCa in situ (5 of 35 = 14%). Invasion was present in 14 of 26 (54%) cases of high-grade UCa. Interestingly, 23 of 30 (77%) patients had a previous history of UCa including 7 (30%) cases with divergent differentiation or variant histology. Follow-up data were available in 23 patients with a m...

Pharmacological Review on Ficus Racemosalinn

Journal of Pharmaceutical Research, 2012

Ficus racemosa (Linn) is a moderate sized avenue plant, belongs to family- Moraceae. This is nati... more Ficus racemosa (Linn) is a moderate sized avenue plant, belongs to family- Moraceae. This is native to Australia, South-East Asia and the Indian subcontinent. throughout India. It is popular in Indigenous system of medicine such as Ayurveda, Siddha, Unani and also homeopathy system of medicine. The plant (Linn) in Marathi is called as 'Audumbara'. The plant can be grown by vegetative as well as sexual propagation (using seeds). The plant parts such as roots, leaves, figs (fruits), latex, and bark are used in various diseases such as dysentery, diarrhea, diabetes, stomachache, menorrhage, haemoptysis and piles.

Longitudinal impact of bladder cancer diagnosis on common psychiatric disorders

Cancer Medicine, 2021

Background: The presence of psychiatric disorders in patients with cancer is associated with incr... more Background: The presence of psychiatric disorders in patients with cancer is associated with increased morbidity and poorer outcomes. We sought to determine the impact of a new bladder cancer diagnosis on the incidence of depression and anxiety. Methods: We used a database of billing claims (MarketScan®) to identify patients newly diagnosed with bladder cancer between 2009 and 2018. Patients with preexisting psychiatric disorders or use of anxiolytics/antidepressants were excluded. We matched cases to patients without a bladder cancer or psychiatric diagnosis. Our primary outcome was a new diagnosis of depression, anxiety, or use of anxiolytics/antidepressants. Other exposures of interest included gender and treatment received. We used multivariable regression to estimate odds ratios for these exposures. Results: We identified 65,846 cases with a new diagnosis of bladder cancer (31,367 privately insured; 34,479 Medicare-eligible). Compared to controls, bladder cancer patients were more likely to develop new-onset depression/anxiety at 6 months (privately insured: 6.9% vs. 3.4%, p < 0.001; Medicare-eligible: 5.7% vs. 3.4%, p < 0.001) and 36 months (privately insured: 19.2% vs. 13.5%, p < 0.001; Medicare-eligible: 19.3% vs. 16.0%, p < 0.001). Women (vs. men, privately insured: OR 1.65, 95%CI 1.53-1.78; Medicare-eligible: OR 1.63, 95%CI 1.50-1.76) and those receiving cystectomy and chemotherapy (vs. no treatment, privately insured: OR 4.94, 95%CI 4.13-5.90; Medicare-eligible: OR 2.35, 95%CI 1.88-2.94) were more likely to develop significant depression/anxiety. Conclusion: A new diagnosis of bladder cancer was associated with increased burden of significant depression/anxiety compared with matched controls. Women and patients receiving more radical treatments had higher rates of depression and anxiety.

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Supply Chain Management During the Time of Pandemic

Data Management, Analytics and Innovation, 2021

COVID-19, an uninvited visitor, is working its way through raising a major global health issue. P... more COVID-19, an uninvited visitor, is working its way through raising a major global health issue. Public health officials suggest little or no human involvement to prevent the virus from spreading any further. This situation caused a lockdown by several nations. Such uncommon times have set the nations a daunting task of finding a balance between reopening the economy and avoiding a second wave of infections. No sectors have been left unaffected by the virus’s harsh effects. During these times, it proved difficult to meet the demand for essential commodities on time. The current supply chain management strategy failed to meet the demand. In this paper, an informal network of the ‘Decentralized Supply Chain Management’ is proposed which aims to overcome the current problems in the supply chain management. The architecture consists of four versatile layers in which data processing, automation, real-time data visibility, monitoring and quality assurance are integrated. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Minimizing opioid consumption following robotic surgery

Translational Andrology and Urology, 2021

A history of the American opioid epidemic Opioid derivatives have been utilized for centuries for... more A history of the American opioid epidemic Opioid derivatives have been utilized for centuries for their analgesic properties. During the era of the American Revolution, laudanum, an opioid based serum, was prescribed for pain control. Subsequent development of morphine led to an epidemic of addiction during the Civil War known as "Soldier's Disease" (1). By 1874, Bayer Pharmaceuticals advertised heroin as an analgesic with minimal addictive properties, leading to adoption of its use in medical practices (2). Unsurprisingly, opioid addiction became an undesirable consequence for many following heroin use, and legislators sought to address rising rates of addiction in the early 1900s by increasing taxes on opioid products and eventually banning heroin in the United States (2). Although illicit heroin use persisted for years to come, the use of legal opioid substances skyrocketed by the turn of the 21st century, creating unique and unprecedented challenges for the medical and public health communities to address rising addiction rates. Roots of a crisis: the roles of physicians, pharmaceutical companies, and government Although opioid misuse has recently gained nationwide attention, the roots of our current epidemic can be traced to a series of critical events that unfolded over the past 40 years implicating physicians, pharmaceutical companies, and federal agencies. The mainstreaming of scientific misinformation regarding opioids can be dated back

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Clinicopathologic analysis of patients undergoing repeat transurethral resection of bladder tumour following an initial diagnosis of urothelial carcinoma with lamina propria invasion and variant/divergent histology

Journal of Clinical Pathology, 2021

AimsA subset of patients with urothelial carcinoma (UCa) and lamina propria (LP) invasion in blad... more AimsA subset of patients with urothelial carcinoma (UCa) and lamina propria (LP) invasion in bladder biopsies/transurethral resections (TURs) are at significant risk for recurrence and have increased rates of progression to UCa with muscularis propria (MP) invasion. The clinicopathologic features of this patient population has not been well characterised in the Pathology literature.MethodsWe performed a search through our urologic pathology files and expert consult cases of the senior author for bladder biopsies/TURs of UCa with LP invasion and variant/divergent histology from 2014 to 2020. Patients with a prior diagnosis of UCa with MP invasion or upper tract UCa were excluded. Clinicopathologic data were obtained.ResultsNinety-five patients with at least one biopsy/TUR of UCa with LP invasion and variant/divergent histology were identified. Mean patient age was 72 years (range: 46–92 years) with a male predominance 2.3:1. Initial variant/divergent histologies identified were: glan...

Immunoreactive peptide maps of SARS-CoV-2

Communications Biology, 2021

Serodiagnosis of SARS-CoV-2 infection is impeded by immunological cross-reactivity among the huma... more Serodiagnosis of SARS-CoV-2 infection is impeded by immunological cross-reactivity among the human coronaviruses (HCoVs): SARS-CoV-2, SARS-CoV-1, MERS-CoV, OC43, 229E, HKU1, and NL63. Here we report the identification of humoral immune responses to SARS-CoV-2 peptides that may enable discrimination between exposure to SARS-CoV-2 and other HCoVs. We used a high-density peptide microarray and plasma samples collected at two time points from 50 subjects with SARS-CoV-2 infection confirmed by qPCR, samples collected in 2004–2005 from 11 subjects with IgG antibodies to SARS-CoV-1, 11 subjects with IgG antibodies to other seasonal human coronaviruses (HCoV), and 10 healthy human subjects. Through statistical modeling with linear regression and multidimensional scaling we identified specific peptides that were reassembled to identify 29 linear SARS-CoV-2 epitopes that were immunoreactive with plasma from individuals who had asymptomatic, mild or severe SARS-CoV-2 infections. Larger studies...

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Deep Learning Framework to Detect Face Masks from Video Footage

2020 12th International Conference on Computational Intelligence and Communication Networks (CICN), 2020

The use of facial masks in public spaces has become a social obligation since the wake of the COV... more The use of facial masks in public spaces has become a social obligation since the wake of the COVID-19 global pandemic and the identification of facial masks can be imperative to ensure public safety. Detection of facial masks in video footages is a challenging task primarily due to the fact that the masks themselves behave as occlusions to face detection algorithms due to the absence of facial landmarks in the masked regions. In this work, we propose an approach for detecting facial masks in videos using deep learning. The proposed framework capitalizes on the MTCNN face detection model to identify the faces and their corresponding facial landmarks present in the video frame. These facial images and cues are then processed by a neoteric classifier that utilises the MobileNetV2 architecture as an object detector for identifying masked regions. The proposed framework was tested on a dataset which is a collection of videos capturing the movement of people in public spaces while complying with COVID-19 safety protocols. The proposed methodology demonstrated its effectiveness in detecting facial masks by achieving high precision, recall, and accuracy.

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Body Composition as an Independent Predictive and Prognostic Biomarker in Advanced Urothelial Carcinoma Patients Treated with Immune Checkpoint Inhibitors

The Oncologist, 2021

Background Several immune checkpoint inhibitors (ICIs) are approved for the treatment of advanced... more Background Several immune checkpoint inhibitors (ICIs) are approved for the treatment of advanced urothelial carcinoma (UC). There are limited biomarkers for ICI-treated patients with UC. We investigated the association between body composition and clinical outcomes in ICI-treated UC patients. Materials and Methods We conducted a retrospective analysis of 70 ICI-treated patients with advanced UC at Winship Cancer Institute from 2015 to 2020. Baseline computed tomography images within 2 months of ICI initiation were collected at mid-L3 and muscle and fat compartments (subcutaneous, intermuscular, and visceral) were segmented using SliceOMatic v5.0 (TomoVision, Magog, Canada). A prognostic body composition risk score (high: 0–1, intermediate: 2–3, or low-risk: 4) was created based on the β coefficient from the multivariate Cox model (MVA) following best-subset variable selection. Our body composition risk score was skeletal muscle index (SMI) + 2 × attenuated skeletal muscle (SM) mean...

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Bacillus Calmette-Guerin (BCG) Packaged for Percutaneous Vaccination Can Be Safely Used for Intravesical Instillation in Patients With Urothelial Carcinoma of the Bladder

Urology Practice, 2020

AbstractIntroduction:Bacillus Calmette-Guerin (BCG) production is limited worldwide with stutteri... more

Correlates of Nonrandom Patterns of Serotype Switching in Pneumococcus

The Journal of Infectious Diseases, 2019

Background Pneumococcus is a diverse pathogen, with >90 serotypes, each of which has a distinc... more Background Pneumococcus is a diverse pathogen, with >90 serotypes, each of which has a distinct polysaccharide capsule. Pneumococci can switch capsules, evading vaccine pressure. Certain serotype pairs are more likely to occur on the same genetic background as a results of serotype switching, but the drivers of these patterns are not well understood. Methods We used the PubMLST and Global Pneumococcal Sequencing Project databases to quantify the number of genetic lineages on which different serotype pairs occur together. We also quantified the genetic diversity of each serotype. Regression model were used to evaluate the relationship between shared polysaccharide components and the frequency of serotype co-occurrence and diversity. Results A number of serotype pairs occurred together on the same genetic lineage more commonly than expected. Co-occurrence of between-serogroup pairs was more common when both serotypes had glucose as a component of the capsule (and, potentially, gluc...

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Long‐term consequences of the USPSTF Grade D recommendation for prostate‐specific antigen screening

Cancer, 2019

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Perioperative Statin Use and Acute Kidney Injury in Patients Undergoing Partial Nephrectomy

Kidney Cancer, 2018

Background: Statin use is widespread among the general population. Data suggest a potentially ben... more Background: Statin use is widespread among the general population. Data suggest a potentially beneficial effect of statin therapy on renal function following surgery. The impact of statins on post-partial nephrectomy (PN) renal function is unknown. We hypothesized that perioperative statin use may be associated with reduced rates of acute kidney injury (AKI) in patients undergoing PN. Objectives: To evaluate the effect of perioperative statin use on AKI rates in patients undergoing PN. Materials & Methods: 1,056 patients undergoing PN were identified from a prospectively-maintained institutional renal mass database. Exclusion criteria included lack of preoperative serum creatinine (Cr), concurrent surgeries, and those with baseline Cr <0.4. The binary outcome was AKI, defined using modified Kidney Disease Improving Global Outcomes (KDIGO) criteria. Chi-Square and Cochran-Armitage trend tests were used to evaluate the strength of associations. A multivariate logistic regression mo...

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Resistance to Systemic Therapies in Clear Cell Renal Cell Carcinoma: Mechanisms and Management Strategies

Molecular Cancer Therapeutics, 2018

Renal cell carcinoma (RCC) is the most common form of kidney cancer. It is categorized into vario... more Renal cell carcinoma (RCC) is the most common form of kidney cancer. It is categorized into various subtypes, with clear cell RCC (ccRCC) representing about 85% of all RCC tumors. The lack of sensitivity to chemotherapy and radiation therapy prompted research efforts into novel treatment options. The development of targeted therapeutics, including multi-targeted tyrosine kinase inhibitors (TKI) and mTOR inhibitors, has been a major breakthrough in ccRCC therapy. More recently, other therapeutic strategies, including immune checkpoint inhibitors, have emerged as effective treatment options against advanced ccRCC. Furthermore, recent advances in disease biology, tumor microenvironment, and mechanisms of resistance formed the basis for attempts to combine targeted therapies with newer generation immunotherapies to take advantage of possible synergy. This review focuses on the current status of basic, translational, and clinical studies on mechanisms of resistance to systemic therapies ...

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Curcumin as a permeability enhancer enhanced the antihyperlipidemic activity of dietary green tea extract

BMC Complementary and Alternative Medicine, 2019

Background: Green tea has polyphenols like flavonoids and catechins; mainly epigallocatechin-3-ga... more Background: Green tea has polyphenols like flavonoids and catechins; mainly epigallocatechin-3-gallate (EGCG), epicatechin gallate (ECG), epigallocatechin (EGC) and epicatechin (EC), out of which EGCG is of higher abundance. EGCG has shown preventive role in hypercholesterolemia. However, due to low oral bioavailability, a need arises to improve its membrane permeability and transporter-mediated intestinal efflux. Therefore, an attempt was made to enhance permeability and bioavailability of EGCG using curcumin to treat hyperlipidemia. Further, it was formulated in herbal tea bags to achieve patient compliance. Methods: EGCG extracted from green tea leaves was confirmed by High Performance Thin Layer Chromatography. Green tea extract (GTE), curcumin and their mixtures were subjected to Fourier Transform Infra-Red spectroscopy and Differential Scanning Calorimetry for compatibility studies. Powder formulation was prepared comprising GTE, curcumin, sucralose and cardamom. Results: Ex-vivo study was performed on everted goat intestine, analyzed by HPLC and demonstrated highest permeation of GTE:curcumin (220:50) (53.15%) than GTE (20.57%). Antihyperlipidemic activity was performed in rats for 15 days. Blood sample analysis of rats of test groups (formulation and GTE solution) fed on high fat diet showed (mg/dl):cholesterol 80 and 90, triglycerides 73.25 and 85.5, HDL 50.75 and 46, LDL 43.9 and 46, VLDL 14.65 and 17.1 respectively with significant lipid regulating effect. Conclusion: Curcumin enhanced permeability of EGCG. Therefore, P-glycoprotein pump inside intestine can be potential mechanism to enhance permeability of EGCG. Thus, EGCG-curcumin herbal tea bag is promising nutraceutical to treat hyperlipidemia in day-today life achieving patient compliance.

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Shreyas Joshi

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