Annals of Medicine and Surgery最新文献

Introduction: Recent advancements in generative AI, exemplified by ChatGPT, hold promise for healthcare applications such as decision-making support, education, and patient engagement. However, rigorous evaluation is crucial to ensure reliability and safety in clinical contexts. This scoping review explores ChatGPT's role in clinical inquiry, focusing on its characteristics, applications, challenges, and evaluation.

Methods: This review, conducted in 2023, followed PRISMA-ScR guidelines (Supplemental Digital Content 1, http://links.lww.com/MS9/A636). Searches were performed across PubMed, Scopus, IEEE, Web of Science, Cochrane, and Google Scholar using relevant keywords. The review explored ChatGPT's effectiveness in various medical domains, evaluation methods, target users, and comparisons with other AI models. Data synthesis and analysis incorporated both quantitative and qualitative approaches.

Results: Analysis of 41 academic studies highlights ChatGPT's potential in medical education, patient care, and decision support, though performance varies by medical specialty and linguistic context. GPT-3.5, frequently referenced in 26 studies, demonstrated adaptability across diverse scenarios. Challenges include limited access to official answer keys and inconsistent performance, underscoring the need for ongoing refinement. Evaluation methods, including expert comparisons and statistical analyses, provided significant insights into ChatGPT's efficacy. The identification of target users, such as medical educators and nonexpert clinicians, illustrates its broad applicability.

Conclusion: ChatGPT shows significant potential in enhancing clinical practice and medical education. Nevertheless, continuous refinement is essential for its successful integration into healthcare, aiming to improve patient care outcomes, and address the evolving needs of the medical community.

Introduction and importance: Osteosarcoma is an exceptionally serious, uncommon disease in children with morbidity, mortality, and psychological burdens.

Case presentation: In this report, the authors present the case of a previously healthy 7-year-old girl who exhibited continuous, painful limping. Plain imaging and a MRI scan revealed the presence of a lytic lesion in the femur on the left side. The diagnosis of osteosarcoma was confirmed. There was no significant familial history of cancer. The girl and her family underwent the operation and chemotherapy, received follow-up and support for a year, and both the patient and the medical team expressed a lot of satisfaction.

Clinical discussion: The survival and prognosis from osteosarcoma in the literature was 59% for all patients at a median follow-up up 54 months, current treatment of osteosarcoma involves chemotherapy and limb surgery, with (60-80)% of patients in remission after 5 years.

Conclusion: This case emphasizes the importance of promptly considering osteosarcoma in a child when the clinical presentation and medical imaging align with the diagnosis.

Objectives: Methadone is a long-acting synthetic agonist of opioid receptors, which is used as an analgesic and as an alternative treatment in opioid-dependent patients. Clinical manifestations of methadone poisoning include miotic pupils, low levels of consciousness (LOC), respiratory depression or apnea, and coma and death. Considering the high consumption of methadone in society and the prevalent instances of overdose and poisoning, whether accidental or intentional, the authors decided to investigate the clinico-epidemiological, diagnostic, and therapeutic characteristics of methadone poisoning in the Mazandaran province, northern Iran, from 2020 to 2022.

Methods: This study was a retrospective and descriptive cross-sectional registry-based study, wherein data was collected from the Mazandaran Registry Center of Opioids Poisoning (MRCOP), on patients with methadone poisoning. Data based on various parameters such as individual characteristics, ingestion motivation, and clinical outcomes were collected in a checklist.

Results: Of the 385 patients, who entered the study, 264 were men and 121 were women. The mean age of the patients was 29.02 years. Two hundred forty-four patients had intentionally consumed methadone. The most common symptoms observed among individuals with methadone poisoning were decreased arterial blood oxygen (225 patients) and decreased LOC (173 patients). The length of hospitalization for most patients was less than 1 week. Except for seven of them who died, most of them were discharged in good general condition.

Conclusion: The study identified sex, age, marital and employment status, and suicidal intent as the most significant factors influencing methadone poisoning, which should be considered in the design and implementation of public education and prevention programs.

Introduction and importance: Cystic fibrosis (CF) is a widespread life-shortening recessive genetic disease and can present with sinus mucocele. Sinus mucocele is a rare condition, with limited prevalence data on unilateral proptosis.

Case presentation: The authors present a case of a 19-month-old boy with CF who experienced worsening proptosis and exotropia in his right eye. A brain and orbit MRI revealed diffuse polypoid mucosal thickening, possible dense fungal deposit, deformity of the mid face, especially on the right side, with more prominent bulging of medical and inferior walls of the right lobe, a right ethmoidal mucocele causing ocular globe displacement, medial rectus compression, and optic nerve. An examination of the eye fundus showed disc edema and vascular congestion. Endoscopic sinus surgery successfully drained the mucocele, and treatment with antibiotics and corticosteroids led to symptom improvement and resolution of proptosis within 3 weeks.

Clinical discussion: Mucoceles represent an uncommon complication associated with CF in pediatric patients. Consequently, any child presenting with this issue should undergo evaluation for CF. Investigating this infrequent condition's underlying mechanisms and consequences may improve treatment approaches and outcomes for those impacted.

Conclusion: Sinus mucocele with unilateral proptosis in CF patients is uncommon, and endoscopic sinus surgery appears to be an effective cure for this complication, even in the pediatric population at high risk, like CF patients.

Introduction: Dandy-Walker syndrome (DWS), a complex neurodevelopmental disorder, has intrigued clinicians and researchers since its description by physicians Walter Dandy and Arthur Walker. Despite its recognition for nearly a century, understanding its etiology, pathogenesis, and clinical manifestations remains elusive. This bibliometric analysis aims to elucidate influential academic works on DWS.

Methods: In January 2024, the authors conducted a Scopus search for articles on DWS and identified the top 100 referenced publications. The Harzing Publish or Perish search engine was utilized with relevant terms, including 'Dandy-Walker', 'Dandy-Walker Syndrome', and 'Dandy-Walker Malformation'. Data from Scopus, including publication details and citation counts, were compiled and organized using Microsoft Excel. Statistical analysis and data visualization were performed using Python, with Pandas, Matplotlib, Seaborn, and NetworkX libraries employed for this purpose.

Results: The bibliometric analysis of DWS research revealed key insights. Significant research output was noted in the 2000-2009 and 1990-1999 decades. The cumulative citations totaled 6059, with an average of 2.60 citations per year per article. Leading authors included W B Dobyns, Kathleen J Millen, and G Pilu. Institutions such as the University of California and Harvard Medical School were prominent, with the United States being the predominant contributor. Major journals like the American Journal of Medical Genetics played significant roles.

Conclusion: This bibliometric study summarizes the most-cited articles on DWS, providing light on the field and its seminal works that have shaped both present-day clinical treatment and the trajectory of future research.

[This retracts the article DOI: 10.1097/MS9.0000000000002452.].

[This retracts the article DOI: 10.1097/MS9.0000000000002643.].

Nonsmall cell lung cancer (NSCLC) is the major cause of cancer-related mortality worldwide, accounting for 84% of lung cancer cases. The newly FDA-approved kinase inhibitor, repotrectinib (AUGTYRO), offers a promising option for treating advanced or metastatic NTRK/ROS1-positive Nonsmall cell lung cancer. Repotrectinib has demonstrated significant efficacy in clinical trials. Notably, the phase 1/2 TRIDENT-1 study showed impressive progression-free survival and intracranial activity in both TKI-naïve and pretreated patients. With its high response rates and manageable side effects, repotrectinib is set to play a significant role in treating ROS1+ and NTRK+advanced solid tumors, highlighting the ongoing need for research and clinical application.

Background: Hypotension is an independent predictor of long-term patient morbidity and duration of hospital stay. Multiple factors contribute to the development of intraoperative hypotension. Prevention and treatment of these factors may reduce patients' hypotension and its associated morbidity and mortality. This study aimed to assess the prevalence and associated factors of intraoperative hypotension in patients undergoing elective thoracic surgery.

Methods: This institution-based cross-sectional study was conducted among 174 adult patients who underwent elective thoracic surgery. A systematic random sampling technique was used, and quantitative data were collected through interviews and data retrieval from charts via a pretested questionnaire. Both bivariable and multivariable logistic regression analyses were performed to evaluate the associations between independent and dependent variables. The level of statistical significance was defined as a P-value less than 0.05. The data were entered into Info 7.2.1 and analyzed via SPSS version 26 software, which was used to calculate descriptive statistics, and bivariate and multivariate logistic regression were performed.

Results: In general, information was collected from 174 patients during the study period. The results of the present study revealed that 65 (41%) patients developed intraoperative hypotension (95% CI: 36.43-48%). Intraoperative blood loss was significantly associated with intraoperative hypotension [AOR=9.58, 95% CI (2.57-35.8)] (P=0.001).

Conclusion and recommendation: The findings of this study revealed high rates of intraoperative hypotension episodes, which were 41%, in patients who underwent elective thoracic surgery. Age, ASA class, type of intraoperative blood loss, type of procedure pre-existence comorbidity, and duration of surgery were predictors of intraoperative hypotension in patients who underwent elective thoracic surgery. The anaesthetist's, surgeon, and PACU staff's understanding of these factors is very crucial for close follow-up of this group of patients.

Introduction: K wire is one of the most common implants used for fixation of acromioclavicular joint dislocation. The migration of K wire from the AC joint to the spinal canal is a rare occurrence. In this report, the authors present a case of a young adult who presented with weakness of the left upper limb secondary to migration of the K wire from the AC joint to the spinal canal.

Case presentation: A 46-year-old male farmer presented with complaints of pain in the neck, tingling sensation in the left upper limb, and a tender palpable swelling on the left side of his neck with weakness of finger flexors and abductors. He had had an open reduction and fixation with K wire for Acromioclavicular dislocation three months back. CT confirmed the K wire is passing through the neural foramen between C5 and C6 vertebra and extending across the entire diameter of the spinal canal. Under intravenous anesthesia, a transverse skin incision was made over the prominent swelling on the neck, and the wire was gently removed. Minimal seepage of spinal fluid was observed, which stopped on its own after a few days.

Discussion: Although AC joint stabilization by K wire fixation provides a safe and easy fixation with low morbidity, complications such as a loss of fixation or loosening can occur. Migration of K wire into a spinal canal is a well-known but infrequent complication. Resorption of bone, muscle action, and negative intrathoracic pressures associated with respiration and heat necrosis causes progressive loosening and dislodgement. Spinal migration is very dangerous because it can cause serious damage to the dura mater, spinal cord, and vertebral artery.

Conclusion: Early identification and removal of the K wire, once it has migrated from the site of use, is mandatory to prevent its grievous complications.