Nevin Manimala

J Med Internet Res. 2021 Mar 5;23(3):e26646. doi: 10.2196/26646.

ABSTRACT

BACKGROUND: The increasing development of artificial intelligence (AI) systems in medicine driven by researchers and entrepreneurs goes along with enormous expectations for medical care advancement. AI might change the clinical practice of physicians from almost all medical disciplines and in most areas of health care. While expectations for AI in medicine are high, practical implementations of AI for clinical practice are still scarce in Germany. Moreover, physicians’ requirements and expectations of AI in medicine and their opinion on the usage of anonymized patient data for clinical and biomedical research have not been investigated widely in German university hospitals.

OBJECTIVE: This study aimed to evaluate physicians’ requirements and expectations of AI in medicine and their opinion on the secondary usage of patient data for (bio)medical research (eg, for the development of machine learning algorithms) in university hospitals in Germany.

METHODS: A web-based survey was conducted addressing physicians of all medical disciplines in 8 German university hospitals. Answers were given using Likert scales and general demographic responses. Physicians were asked to participate locally via email in the respective hospitals.

RESULTS: The online survey was completed by 303 physicians (female: 121/303, 39.9%; male: 173/303, 57.1%; no response: 9/303, 3.0%) from a wide range of medical disciplines and work experience levels. Most respondents either had a positive (130/303, 42.9%) or a very positive attitude (82/303, 27.1%) towards AI in medicine. There was a significant association between the personal rating of AI in medicine and the self-reported technical affinity level (H₄=48.3, P<.001). A vast majority of physicians expected the future of medicine to be a mix of human and artificial intelligence (273/303, 90.1%) but also requested a scientific evaluation before the routine implementation of AI-based systems (276/303, 91.1%). Physicians were most optimistic that AI applications would identify drug interactions (280/303, 92.4%) to improve patient care substantially but were quite reserved regarding AI-supported diagnosis of psychiatric diseases (62/303, 20.5%). Of the respondents, 82.5% (250/303) agreed that there should be open access to anonymized patient databases for medical and biomedical research.

CONCLUSIONS: Physicians in stationary patient care in German university hospitals show a generally positive attitude towards using most AI applications in medicine. Along with this optimism comes several expectations and hopes that AI will assist physicians in clinical decision making. Especially in fields of medicine where huge amounts of data are processed (eg, imaging procedures in radiology and pathology) or data are collected continuously (eg, cardiology and intensive care medicine), physicians’ expectations of AI to substantially improve future patient care are high. In the study, the greatest potential was seen in the application of AI for the identification of drug interactions, assumedly due to the rising complexity of drug administration to polymorbid, polypharmacy patients. However, for the practical usage of AI in health care, regulatory and organizational challenges still have to be mastered.

PMID:33666563 | DOI:10.2196/26646

SICOT J. 2021;7:7. doi: 10.1051/sicotj/2021002. Epub 2021 Mar 5.

ABSTRACT

BACKGROUND: Identifying the risk factors for the neurological deficit in spine tuberculosis would help surgeons in deciding on early surgery, thus reducing the morbidity related to neurological deficit. The main objective of our study was to predict the risk of neurological deficit in patients with spinal tuberculosis (TB).

METHODS: The demographic, clinical, radiological (X-ray and MRI) data of 105 patients with active spine TB were retrospectively analyzed. Patients were divided into two groups – with a neurological deficit (n = 52) as Group A and those without deficit (n = 53) as Group B. Univariate and multivariate logistic regression analysis was used to predict the risk factors for the neurological deficit.

RESULTS: The mean age of the patients was 38.1 years. The most common location of disease was dorsal region (35.2%). Paradiscal (77%) was the most common type of involvement. A statistically significant difference (p < 0.05) was noted in the location of disease, presence of cord compression, kyphosis, cord oedema, loss of CSF anterior to the cord, and degree of canal compromise or canal encroachment between two groups. Multivariate analysis revealed kyphosis > 30° (OR – 3.92, CI – 1.21-12.7, p – 0.023), canal encroachment > 50% (OR – 7.34, CI – 2.32-23.17, p – 0.001), and cord oedema (OR – 11.93, CI – 1.24-114.05, p – 0.03) as independent risk factors for predicting the risk of neurological deficit.

CONCLUSION: Kyphosis > 30°, cord oedema, and canal encroachment (>50%) significantly predicted neurological deficit in patients with spine TB. Early surgery should be considered with all these risk factors to prevent a neurological deficit.

PMID:33666548 | DOI:10.1051/sicotj/2021002

Expert Rev Med Devices. 2021 Mar 5. doi: 10.1080/17434440.2021.1899805. Online ahead of print.

ABSTRACT

INTRODUCTION: Energy-based devices are widely used in thyroid surgery in order to achieve optimal hemostasis, while their role in the incidence of hypocalcemia and hypoparathyroidism comprises a topic evaluated in numerous studies.

AREAS COVERED: The aim of this systematic review is to investigate the potential benefit of Ultrasonic Shears and Electrothermal Bipolar (Radiofrequency) System in thyroid surgery regarding the incidence of post-operative hypocalcemia and hypoparathyroidism. A systematic review of the literature in PubMed/Medline and Scopus databases was conducted. 49 studies met the inclusion criteria and were analyzed. A statistically decreased rate of transient hypocalcemia and hypoparathyroidism were reported in 15 studies and 4 studies respectively, when using energy-based devices. However, 18 and 13 surveys examined transient hypocalcemia and hypoparathyroidism respectively and demonstrated no statistical difference between energy-based devices and conventional hemostasis. No difference was observed between the groups concerning permanent hypocalcemia. Out of 13 studies, only 2 showed a significant reduction in the occurrence of permanent hypoparathyroidism in the energy-based device group.

EXPERT OPINION: Energy-based devices reduced the rate of transient hypocalcemia and hypoparathyroidism after thyroid surgeries in 42.8% and 23.5% of the included studies respectively. Further studies are needed to evaluate their impact on permanent post-operative hypocalcemia and hypoparathyroidism.

PMID:33666537 | DOI:10.1080/17434440.2021.1899805

J Laparoendosc Adv Surg Tech A. 2021 Mar 5. doi: 10.1089/lap.2021.0016. Online ahead of print.

ABSTRACT

Purpose: To compare and analyze the incidence of postoperative reflux esophagitis (RE) in patients with early- and intermediate-stage proximal gastric cancer after proximal gastrectomy plus esophagus-remnant stomach anterior wall anastomosis with proper spacing between the reserved anastomotic stoma and the stump of the remnant stomach versus total gastrectomy plus Roux-en-Y anastomosis and to analyze the advantages and disadvantages of these anastomosis approaches. Methods: Hospitalization data of 23 patients with early- and intermediate-stage proximal gastric cancer were retrospectively analyzed. They were divided into an observation group who underwent proximal gastrectomy plus esophagus-remnant stomach anterior wall anastomosis with proper spacing between the reserved anastomotic stoma and the stump of the remnant stomach and a control group who underwent total gastrectomy plus Roux-en-Y anastomosis. Quality observation indicators were compared between the two groups. Results: There was no statistically significant difference between the groups in the number of lymph nodes cleared or the recurrence rate at 12 months postoperatively. The incidence of postoperative RE was significantly lower in the observation group (25%) than in the control group (80%). The operation time, postoperative length of hospital stay, appetite change, body mass index, and hemoglobin level at 6 months postoperatively were significantly better in the observation group than in the control group (P < .05). Conclusion: Proximal gastrectomy plus esophagus-remnant stomach anterior wall anastomosis with proper spacing between the reserved anastomotic stoma and the stump of the remnant stomach can be used as a preferred surgical procedure for early- and mid-stage proximal gastric cancer.

PMID:33666512 | DOI:10.1089/lap.2021.0016

J Palliat Med. 2021 Mar 5. doi: 10.1089/jpm.2020.0358. Online ahead of print.

ABSTRACT

Background: Health professionals who care for patients and their families at the end of life (EOL) may experience gratitude, and enhanced spirituality and meaning in life, yet they are also at increased risk of psychological distress, compassion fatigue, and occupational burnout given the stressors they encounter in their work. Objectives: This research evaluated the feasibility and acceptability of a novel six-week mindfulness-based compassion training intervention, which was tailored to health professionals involved in EOL care (“MBCT4HP”), and explored its impact on levels of psychological distress, compassion fatigue, compassion satisfaction, occupational burnout, self-compassion, and mindfulness. Design: We adopted an observational, repeated measures pilot study. Setting/Subjects: Thirty-one health professionals participated. The intervention comprised six, weekly sessions (totaling seven hours) designed to foster compassion for self and others, including formal and informal compassion and mindfulness practices, daily home practice, and a reflective experiential pedagogy. Measurements: Validated outcome measures for anxiety, depression, and stress; compassion satisfaction, compassion fatigue (burnout, secondary traumatic stress); occupational burnout (emotional exhaustion, personal accomplishment, and depersonalization), self-compassion, and mindfulness were administered at baseline, end of intervention, and eight weeks postintervention. The feasibility and acceptability of the intervention was assessed using attendance records, home practice logs, and self-report satisfaction items. Descriptive statistics and Generalized Linear Mixed Models were used to analyze the data. Results: Participants reported that the sessions were useful, relevant, easy to understand, and that they gave them sufficient knowledge to implement the strategies learned. Levels of anxiety, compassion fatigue (burnout only), and emotional exhaustion decreased over time with some decay in effects at follow up, and levels of compassion satisfaction and self-compassion increased with time. Conclusions: The intervention was feasible and acceptable to health professionals involved in EOL care and had a positive impact on levels of anxiety, compassion fatigue (burnout), emotional exhaustion, compassion satisfaction, and self-compassion.

PMID:33666500 | DOI:10.1089/jpm.2020.0358

Phys Rev Lett. 2021 Feb 19;126(7):079901. doi: 10.1103/PhysRevLett.126.079901.

ABSTRACT

This corrects the article DOI: 10.1103/PhysRevLett.125.048102.

PMID:33666493 | DOI:10.1103/PhysRevLett.126.079901

J Phys Chem Lett. 2021 Mar 5:2489-2495. doi: 10.1021/acs.jpclett.1c00085. Online ahead of print.

ABSTRACT

The phosphinidenesilylene (HPSi; X¹A’) molecule was prepared via a directed gas-phase synthesis in the bimolecular reaction of ground-state atomic silicon (Si; ³P) with phosphine (PH₃; X¹A₁) under single-collision conditions. The chemical dynamics are initiated on the triplet surface via addition of a silicon atom to the non-bonding electron pair of phosphine, followed by non-adiabatic dynamics and surface hopping to the singlet manifold, accompanied by isomerization via atomic hydrogen shift and decomposition to phosphinidenesilylene (HPSi, X¹A’) along with molecular hydrogen. Statistical calculations predict that silylidynephosphine (HSiP, X¹Σ⁺) is also formed, albeit with lower yields. The barrier-less route to phosphinidenesilylene opens up a multipurpose mechanism to access the hitherto obscure class of phosphasilenylidenes through silicon-phosphorus coupling via reactions of atomic silicon with alkylphosphines under single-collision conditions in the absence of successive reactions of the reaction products, which are not feasible to prepare by traditional synthetic routes.

PMID:33666441 | DOI:10.1021/acs.jpclett.1c00085

Anal Chem. 2021 Mar 5. doi: 10.1021/acs.analchem.0c05206. Online ahead of print.

ABSTRACT

Plasmonic nanostructure-enabled label-free surface-enhanced Raman spectroscopy (SERS) emerges as a rapid nondestructive molecular fingerprint characterization technique for complex biological samples. However, label-free SERS bioanalysis faces challenges in reliability and reproducibility due to SERS signals’ high susceptibility to local optical field variations at plasmonic hotspots, which can bias correlations between the measured spectroscopic features and the actual molecular concentration profiles of complex biochemical matrices. Herein, we report that plasmonically enhanced electronic Raman scattering (ERS) signals from metal nanostructures can serve as a SERS calibration internal standard to improve multivariate analysis of living biological systems. Through side-by-side comparisons with noncalibrated SERS datasets, we demonstrate that the ERS-based SERS calibration can enhance supervised learning classification of label-free living cell SERS spectra in (1) subtyping breast cancer cells with different degrees of malignancy and (2) assessing cancer cells’ drug responses at different dosages. Notably, the ERS-based SERS calibration has the advantages of excellent photostability under laser excitation, no spectral interference with biomolecule Raman signatures, and no occupation competition with biomolecules at hotspots. Therefore, we envision that the ERS-based SERS calibration can significantly boost the multivariate analysis performance in label-free SERS measurements of living biological systems and other complex biochemical matrices.

PMID:33666427 | DOI:10.1021/acs.analchem.0c05206

Brain Behav. 2021 Mar 5:e02038. doi: 10.1002/brb3.2038. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to identify the determinants of cognitive dysfunction and compare the effect of CPZ and LTC on cognition in WWE.

METHODS: An observational study involving 87 consenting adult WWE aged between 16 and 40 years on LTC or CZP monotherapy. At enrollment, an interviewer-based questionnaire was used to obtain demographic and clinical information from participants. The diagnosis of epilepsy was mainly clinical and supported by electroencephalographic (EEG) features and classified based on recommendation by the 2017 International League Against Epilepsy (ILAE). Zung Self-Reporting Depression Scale (ZSRDS) was used to assess the mood of participants. The Community Screening Interview for Dementia (CSID) was used to assess various cognition domains. The National Hospital Seizure Severity Scale (NHS-3) was used to assess disease severity.

RESULTS: There were statistical differences between the CZP and LTC groups in all domains of cognition assessed except for orientation. The total CSID scores of the LTC group were 59.2 (4.9) as opposed to CZP group, 57.2 (5.0); p: .005. Those with focal onset seizures had lower median total CSID score (58; IQR: 54-62) when compared to those with generalized onset seizures (62; IQR: 58-62), p: .012. There was a significant correlation between ZSRD score and NHS-3 score; rho: 0.30, p: .007. Bivariate analysis shows statistically significant correlation between total CSID score and ZSRDS (rho: -0.65), BMI (rho: 0.22), and NHSS-3 score (rho: -0.36), respectively. However, the effect of AED on CSID scores was lost after multivariate quantile regression with only ZSRDS retaining significance.

CONCLUSION: Depression, seizure severity, type and structural etiology were associated with cognitive impairment among WWE. However, on regression model, only depression was statistically significant. The presence of more risks for cognitive impairment in the CZP group limits possible conclusion of LTC superiority.

PMID:33666367 | DOI:10.1002/brb3.2038

Pediatr Pulmonol. 2021 Mar 5. doi: 10.1002/ppul.25359. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess if intrauterine growth retardation (IUGR) was associated with reduced lung function at 16 to 19 years WORKING HYPOTHESIS: Very prematurely born young people who had IUGR would have reduced lung function post-puberty.

STUDY DESIGN: Prospective follow-up study.

PATIENT-SUBJECT SELECTION: One hundred and fifty-nine 16-19 year olds born prior to 29 weeks of gestation; 37 had IUGR.

METHODOLOGY: Lung function tests were performed: spirometry was used to assess forced expiratory volume in one second (FEV₁ ), forced expiratory flow at 75%, 50% and 25% of expired vital capacity (FEF₇₅ , FEF₅₀ and FEF₂₅ ), peak expiratory flow (PEF) and forced vital capacity (FVC). Functional residual capacity (FRC_pleth ) total lung capacity (TLC_pleth ) and residual volume (RV_pleth ) were measured. Alveolar function was assessed by diffusion capacity within the lungs of carbon monoxide (D_L CO). Impulse oscillometry was used to assess respiratory resistance and lung clearance index to assess ventilation homogeneity. Exercise capacity was assessed using a shuttle sprint test.

RESULTS: After adjustment for BMI, the mean FEV₁ /FVC, FEF₇₅ , FEF_25-75 , FRC_pleth and RV_pleth were poorer in those who had had IUGR, with differences between 0.56 and 0.75 z-scores. After further adjustment for BPD and postnatal corticosteroid use, only the difference in RV_pleth z-scores remained statistically significant, adjusted difference (95% CI): 0.66 (0.18,1.13). Exercise capacity was lower in those with IUGR and this was more pronounced in males (p=0.04).

CONCLUSIONS: At 16 to 19 years of age, those who had IUGR had poorer lung function and exercise capacity compared with those with adequate intrauterine growth. This article is protected by copyright. All rights reserved.

PMID:33666356 | DOI:10.1002/ppul.25359