Search

Background: Radiofrequency Ablation (RFA) and Microwave Ablation (MWA) are alternative treatments for colorectal liver metastasis (CRLM) patients that are unsuitable for resection. However, consensus is lacking regarding selection criteria, tumour characteristics, ablation technique delivery, and device settings. This study aims to summarise current evidence to inform future prospective studies., Methods: A systematic review was conducted following PRISMA guidelines. Studies assessing RFA and MWA treatment of CRLM were identified in Medline, Embase, Web of Science and the Cochrane database of systematic reviews, from inception until 31 st August 2024., Results: Fifty-two studies were included (retrospective cohort n = 45, prospective cohort n = 5, non-randomized comparative studies n = 2). Fifty-four inclusion criteria were used across 45 studies and were not stated in 7 studies. Tumours varied in mean number [1-8] and diameter (1.54-4.35 cm). Neoadjuvant chemotherapy use (10-100 % of patients), ablation delivery approach (open n = 4, laparoscopic n = 11, percutaneous n = 26, mixed n = 5), anaesthetic mode (GA n = 18, LA n = 11, mixed n = 2) and delivering clinician (radiologist n = 11, surgeon n = 16, both n = 1) all varied. Thirty-two studies lacked complete ablation device settings. Six studies followed a standardized ablation algorithm and 14 studies had specific settings. Five-year survival ranged from 0 to 69.7 % for ablation., Conclusions: There is significant heterogeneity in the reporting of study design, patient selection, and ablation techniques for CRLM. The lack of standardized approaches and inconsistent reporting of methodology and outcomes make it challenging to determine the optimal ablative treatment for CRLM. We recommend that future research should focus on clearly defining selection and treatment criteria, as well as treatment delivery., Competing Interests: Conflict of interest All authors of the manuscript “Ablative techniques in Colorectal Liver Metastases: A Systematic Review, Descriptive Summary of Practice, and recommendations for optimal data reporting” declare no conflicting interests., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Most recent studies on the coronavirus disease 2019 (COVID-19) pandemic and cutaneous melanoma (CM) focused more on delayed diagnosis or advanced presentation. We aimed to ascertain mortality trends of CM between 2012 and 2022, focusing on the effects of the COVID-19 pandemic. In this serial population-based study, the National Vital Statistics System dataset was queried for mortality data. Excess CM-related mortality rates were estimated by calculating the difference between observed and projected mortality rates during the pandemic. Totally there were 108,853 CM-associated deaths in 2012-2022. CM-associated mortality saw a declining trend from 2012 to 2019 overall. However, it increased sharply in 2020 (ASMR 3.73 per 100,000 persons, 5.95% excess mortality), and remained high in 2021 and 2022, with the ASMRs of 3.82 and 3.81, corresponding to 11.17% and 13.20% excess mortality, respectively. The nonmetro areas had the most pronounced rise in mortality with 12.20% excess death in 2020, 15.33% in 2021 and 20.52% in 2022, corresponding to a 4-6 times excess mortality risk compared to large metro areas during the pandemic. The elderly had the most pronounced rise in mortality, but the mortality in the younger population was reduced., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To develop a novel endoscopic system that reduces trauma to the patient and declutters the surgical field for the surgeon in minimally invasive heart valve surgery., Methods: We designed and developed a retractor-camera combination for minimally invasive heart surgery; the cable and camera were connected to the underbelly of the left atrial retractor blade to provide an illuminated, wide-angle view of the mitral valve. We conducted ex vivo, in vivo, and, ultimately, a first-in-man randomized, nonanonymized clinical trial on 20 patients who required minimally invasive mitral valve surgery. Data from the preoperative period and the immediate postoperative period were gathered, and patients were followed for 3 months., Results: Our camera-retractor combo demonstrated safe and efficient exposure and vision in all detailed studies. The total operation time for the intervention group (316.5 ± 65.1 min) was slightly shorter than for the control group (317.5 ± 50.8 min). There was no significant difference in the ability to provide exposure of the mitral valve and surrounding left atrial tissue for both control and test articles. The novel camera-retractor reduced clutter in the operation field substantially and eliminated chest penetration for the camera. We also observed that the camera did not fog, did not stain with blood, and did not require frequent corrections to its position., Conclusions: We launch a novel atrial retraction-imaging platform that is less invasive for the patient and eliminates clutter and redundant movements for the surgeon., Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare no conflicts of interest. The Endopsis technology has undergone a thorough review, including an extensive prior art search, prior to the final submission of its PCT application and subsequent National Phase entries. It has successfully navigated all assessments and does not present any conflicts of interest or infringe upon existing patents in the market.

Background: Drug overdose is an escalating public health crisis in the United States (U.S.). This study evaluated the temporal trend of drug overdose-related deaths in the U.S., with an emphasis on identifying disparities across subpopulations and the contributing drugs., Methods: Using the nationwide death dataset from the National Vital Statistics System (NVSS), we estimated the drug overdose-related age-standardized mortality rate (ASMR) and temporal trends for individuals aged 12 and older from 2012 to 2022. Excess mortality during the Coronavirus disease 2019 (COVID-19) pandemic was evaluated based on the pre-pandemic trends using predictive modeling analysis., Findings: Among 809,967 overdose-related deaths during 2012-2022, ASMR increased by 8.9% [95% confidence interval (CI): 6.0%-11.9%] per year from 2012 to 2019 and increased to 12.9% (95% CI: 2.1%-24.8%) from 2019 to 2022, with the excess ASMR of 16.9% in 2020, increased to 26.4% in 2021 and then decreased to 19.3% in 2022. Significant age, sex, racial/ethnic and geographic disparities were demonstrated, with adolescents (annual percentage change [APC]:21.6%) and males (APC:13.6%) having the most pronounced increase during the pandemic. Ethnic minorities especially the non-Hispanic American Indian/Alaska Native experienced the highest excess ASMR (33.1% in 2020). Illicit fentanyl and synthetics starting with the lowest ASMR in 2012 (1.0 per 100,000), marked the most dramatic increase and became the leading cause of overdose-related death since 2016 (7.5 per 100,000), leading to the highest ASMR by 2022 (27.4 per 100,000). All drug types except heroin experienced varying degrees of excess ASMRs, with prescription opioid pain relievers (23.5%-55.1%), benzodiazepines (27.4%-40.9%) and antidepressants (10.4%-17.8%) exhibiting consistent increases from 2020 to 2022, while the excess ASMRs for illicit fentanyl and synthetics (25.3%-10.0%), psychostimulants (32.8%-14.6%) and methadone (35.0%-33.3%) decreased between 2021 and 2022., Interpretation: Overdose-related mortality is increasing at an alarming rate, and the stark differences point to the need for targeted interventions to reduce the burden of drug overdose deaths., Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., Competing Interests: Professor Ji has received speaker fees from Gilead Sciences, MSD, and Ascletis, in addition to consulting or advisory board fees from Gilead and MSD. All other authors report no potential conflicts., (© 2024 The Author(s).)

Background and Study Aims: Cirrhosis is a chronic progressive disease which requires complex care. Its incidence is rising in the Arab countries making it the 7th leading cause of death in the Arab League in 2010. ChatGPT is a large language model with a growing body of literature demonstrating its ability to answer clinical questions. We examined ChatGPT's accuracy in responding to cirrhosis related questions in Arabic and compared its performance to English., Materials and Methods: ChatGPTs responses to 91 questions in Arabic and English were graded by a transplant hepatologist fluent in both languages. Accuracy of responses was assessed using the scale: 1. Comprehensive, 2. Correct but inadequate, 3. Mixed with correct and incorrect/outdated data, and 4. Completely incorrect.Accuracy of Arabic compared to English responses was assessed using the scale: 1. Arabic response is more accurate, 2. Similar accuracy, 3. Arabic response is less accurate., Results: The model provided 22 (24.2%) comprehensive, 44 (48.4%) correct but inadequate, 13 (14.3%) mixed with correct and incorrect/outdated data and 12 (13.2%) completely incorrect Arabic responses. When comparing the accuracy of Arabic and English responses, 9 (9.9%) of the Arabic responses were graded as more accurate, 52 (57.1%) similar in accuracy and 30 (33.0%) as less accurate compared to English., Conclusion: ChatGPT has the potential to serve as an adjunct source of information for Arabic speaking patients with cirrhosis. The model provided correct responses in Arabic to 72.5% of questions, although its performance in Arabic was less accurate than in English. The model produced completely incorrect responses to 13.2% of questions, reinforcing its potential role as an adjunct and not replacement of care by licensed healthcare professionals. Future studies to refine this technology are needed to help Arabic speaking patients with cirrhosis across the globe understand their disease and improve their outcomes., Competing Interests: Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.)

Background/aims: Patients with cirrhosis and hepatocellular carcinoma (HCC) require extensive and personalized care to improve outcomes. ChatGPT (Generative Pre-trained Transformer), a large language model, holds the potential to provide professional yet patient-friendly support. We aimed to examine the accuracy and reproducibility of ChatGPT in answering questions regarding knowledge, management, and emotional support for cirrhosis and HCC., Methods: ChatGPT's responses to 164 questions were independently graded by two transplant hepatologists and resolved by a third reviewer. The performance of ChatGPT was also assessed using two published questionnaires and 26 questions formulated from the quality measures of cirrhosis management. Finally, its emotional support capacity was tested., Results: We showed that ChatGPT regurgitated extensive knowledge of cirrhosis (79.1% correct) and HCC (74.0% correct), but only small proportions (47.3% in cirrhosis, 41.1% in HCC) were labeled as comprehensive. The performance was better in basic knowledge, lifestyle, and treatment than in the domains of diagnosis and preventive medicine. For the quality measures, the model answered 76.9% of questions correctly but failed to specify decision-making cut-offs and treatment durations. ChatGPT lacked knowledge of regional guidelines variations, such as HCC screening criteria. However, it provided practical and multifaceted advice to patients and caregivers regarding the next steps and adjusting to a new diagnosis., Conclusion: We analyzed the areas of robustness and limitations of ChatGPT's responses on the management of cirrhosis and HCC and relevant emotional support. ChatGPT may have a role as an adjunct informational tool for patients and physicians to improve outcomes.

Background: Little is known about mortality trends among patients with psoriasis (PsO) and psoriatic arthritis (PsA) in the United States., Objectives: To ascertain mortality trends of PsO and PsA between 2010 and 2021, focusing on the effects of the COVID-19 pandemic., Methods: We collected data from the National Vital Statistic System and calculated age-standardized mortality rates (ASMR) and cause-specific mortality for PsO/PsA. We evaluated observed versus predicted mortality for 2020-2021 based on trends from 2010 to 2019 with joinpoint and prediction modelling analysis., Results: Among 5810 and 2150 PsO- and PsA-related deaths between 2010 and 2021, ASMR for PsO dramatically increased between 2010-2019 and 2020-2021 (annual percentage change [APC] 2.07% vs. 15.26%; p < 0.01), leading to a higher observed ASMR (per 100,000 persons) than predicted for 2020 (0.27 vs. 0.22) and 2021 (0.31 vs. 0.23). The excess mortality of PsO was 22.7% and 34.8% higher than that in the general population in 2020 (16.4%, 95% CI: 14.9%-17.9%) and 2021 (19.8%, 95% CI: 18.0%-21.6%) respectively. Notably, the ASMR rise for PsO was most pronounced in the female (APC: 26.86% vs. 12.19% in males) and the middle-aged group (APC: 17.67% vs. 12.47% in the old-age group). ASMR, APC and excess mortality for PsA were similar to PsO. SARS-CoV-2 infection contributed to more than 60% of the excess mortality for PsO and PsA., Conclusions: Individuals living with PsO and PsA were disproportionately affected during the COVID-19 pandemic. Both ASMRs increased at an alarming rate, with the most pronounced disparities among the female and middle-aged groups., (© 2023 European Academy of Dermatology and Venereology.)

Purpose: ChatGPT is a large language model trained on a large dataset covering a broad range of topics, including the medical literature. We aim to examine its accuracy and reproducibility in answering patient questions regarding bariatric surgery., Materials and Methods: Questions were gathered from nationally regarded professional societies and health institutions as well as Facebook support groups. Board-certified bariatric surgeons graded the accuracy and reproducibility of responses. The grading scale included the following: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Reproducibility was determined by asking the model each question twice and examining difference in grading category between the two responses., Results: In total, 151 questions related to bariatric surgery were included. The model provided "comprehensive" responses to 131/151 (86.8%) of questions. When examined by category, the model provided "comprehensive" responses to 93.8% of questions related to "efficacy, eligibility and procedure options"; 93.3% related to "preoperative preparation"; 85.3% related to "recovery, risks, and complications"; 88.2% related to "lifestyle changes"; and 66.7% related to "other". The model provided reproducible answers to 137 (90.7%) of questions., Conclusion: The large language model ChatGPT often provided accurate and reproducible responses to common questions related to bariatric surgery. ChatGPT may serve as a helpful adjunct information resource for patients regarding bariatric surgery in addition to standard of care provided by licensed healthcare professionals. We encourage future studies to examine how to leverage this disruptive technology to improve patient outcomes and quality of life., (© 2023. The Author(s).)