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Impact of Artificial Intelligence-Generated Content Labels On Perceived Accuracy, Message Credibility, and Sharing Intentions for Misinformation: Web-Based, Randomized, Controlled Experiment

JMIR Form Res. 2024 Dec 24;8:e60024. doi: 10.2196/60024.

ABSTRACT

BACKGROUND: The proliferation of generative artificial intelligence (AI), such as ChatGPT, has added complexity and richness to the virtual environment by increasing the presence of AI-generated content (AIGC). Although social media platforms such as TikTok have begun labeling AIGC to facilitate the ability for users to distinguish it from human-generated content, little research has been performed to examine the effect of these AIGC labels.

OBJECTIVE: This study investigated the impact of AIGC labels on perceived accuracy, message credibility, and sharing intention for misinformation through a web-based experimental design, aiming to refine the strategic application of AIGC labels.

METHODS: The study conducted a 2×2×2 mixed experimental design, using the AIGC labels (presence vs absence) as the between-subjects factor and information type (accurate vs inaccurate) and content category (for-profit vs not-for-profit) as within-subjects factors. Participants, recruited via the Credamo platform, were randomly assigned to either an experimental group (with labels) or a control group (without labels). Each participant evaluated 4 sets of content, providing feedback on perceived accuracy, message credibility, and sharing intention for misinformation. Statistical analyses were performed using SPSS version 29 and included repeated-measures ANOVA and simple effects analysis, with significance set at P<.05.

RESULTS: As of April 2024, this study recruited a total of 957 participants, and after screening, 400 participants each were allocated to the experimental and control groups. The main effects of AIGC labels were not significant for perceived accuracy, message credibility, or sharing intention. However, the main effects of information type were significant for all 3 dependent variables (P<.001), as were the effects of content category (P<.001). There were significant differences in interaction effects among the 3 variables. For perceived accuracy, the interaction between information type and content category was significant (P=.005). For message credibility, the interaction between information type and content category was significant (P<.001). Regarding sharing intention, both the interaction between information type and content category (P<.001) and the interaction between information type and AIGC labels (P=.008) were significant.

CONCLUSIONS: This study found that AIGC labels minimally affect perceived accuracy, message credibility, or sharing intention but help distinguish AIGC from human-generated content. The labels do not negatively impact users’ perceptions of platform content, indicating their potential for fact-checking and governance. However, AIGC labeling applications should vary by information type; they can slightly enhance sharing intention and perceived accuracy for misinformation. This highlights the need for more nuanced strategies for AIGC labels, necessitating further research.

PMID:39719080 | DOI:10.2196/60024

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Large Language Models May Help Patients Understand Peer-Reviewed Scientific Articles About Ophthalmology: Development and Usability Study

J Med Internet Res. 2024 Dec 24;26:e59843. doi: 10.2196/59843.

ABSTRACT

BACKGROUND: Adequate health literacy has been shown to be important for the general health of a population. To address this, it is recommended that patient-targeted medical information is written at a sixth-grade reading level. To make well-informed decisions about their health, patients may want to interact directly with peer-reviewed open access scientific articles. However, studies have shown that such text is often written with highly complex language above the levels that can be comprehended by the general population. Previously, we have published on the use of large language models (LLMs) in easing the readability of patient-targeted health information on the internet. In this study, we continue to explore the advantages of LLMs in patient education.

OBJECTIVE: This study aimed to explore the use of LLMs, specifically ChatGPT (OpenAI), to enhance the readability of peer-reviewed scientific articles in the field of ophthalmology.

METHODS: A total of 12 open access, peer-reviewed papers published by the senior authors of this study (ET and RA) were selected. Readability was assessed using the Flesch-Kincaid Grade Level and Simple Measure of Gobbledygook tests. ChatGPT 4.0 was asked “I will give you the text of a peer-reviewed scientific paper. Considering that the recommended readability of the text is 6th grade, can you simplify the following text so that a layperson reading this text can fully comprehend it? – Insert Manuscript Text -“. Appropriateness was evaluated by the 2 uveitis-trained ophthalmologists. Statistical analysis was performed in Microsoft Excel.

RESULTS: ChatGPT significantly lowered the readability and length of the selected papers from 15th to 7th grade (P<.001) while generating responses that were deemed appropriate by expert ophthalmologists.

CONCLUSIONS: LLMs show promise in improving health literacy by enhancing the accessibility of peer-reviewed scientific articles and allowing the general population to interact directly with medical literature.

PMID:39719077 | DOI:10.2196/59843

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Characteristics and outcomes of patients with Guillain-Barré syndrome who were admitted to the intensive care unit: a retrospective observational study

J Int Med Res. 2024 Dec;52(12):3000605241306655. doi: 10.1177/03000605241306655.

ABSTRACT

OBJECTIVE: To evaluate characteristics and outcomes in critically ill patients with Guillain-Barré syndrome (GBS).

METHODS: Consecutive adults with GBS who required intensive care unit (ICU) admission at a tertiary-care hospital between 1999 and 2020 were enrolled into this retrospective cohort study. Demographics, clinical data and patient outcomes were compared between patients who did or did not receive mechanical ventilation (MV).

RESULTS: During the study period, the number of ICU admissions gradually rose from approximately 900 to 3000 annually. Forty-three patients had GBS and were included, of whom, 27 (62.8%) received MV for a median of 13 days. The MV group stayed longer in the ICU (median, 26 versus 6 days) and in the hospital (median, 120 versus 39 days) than the non-MV group. Most patients in the MV group (22 [81.5%]) required tracheostomy. At maximum follow-up, Hughes Functional Grading scores were 0 (full recovery) in 11 patients (25.5%), 1-3 in 18 (41.8%), 4-5 in 12 (27.9%), and 6 (death) in two (4.6%, both in the MV group), with higher median Hughes score in the MV group (3 versus 0.5). Complications during ICU and hospital stay included: veinous thromboembolism in five (11.6%), gastrointestinal bleeding in three (7.0%), bacteremia in five (11.6%), bedsore in one (2.3%), and GBS-treatment side effects in four (9.4%) patients; all of these complications occurred within the MV group.

CONCLUSIONS: GBS was an uncommon reason for ICU admission. The findings highlight significant morbidity with GBS, particularly among patients who need MV.

PMID:39719074 | DOI:10.1177/03000605241306655

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Exploring the epidemiological burden of RSV pre- and post-COVID-19 pandemic: A Jordanian tertiary hospital experience

J Int Med Res. 2024 Dec;52(12):3000605241306405. doi: 10.1177/03000605241306405.

ABSTRACT

OBJECTIVES: To describe changes in respiratory syncytial virus (RSV) epidemiology, its associated clinical outcomes and predictors of severe acute lower respiratory tract infection (ALRTI) pre- and post-COVID-19.

METHODS: In this retrospective cohort, we analysed data from electronic medical record of children <5 years who were hospitalized at Jordan University Hospital with RSV-associated ALRTI from 2018 to 2022.

RESULTS: 325 inpatients with respiratory infections were included. Rate of RSV infections decreased from 74% pre-pandemic to 30% post-pandemic. Patients diagnosed with ALRTI post-COVID had significantly higher SpO2, less chronic disease, lower temperature and respiratory rate at admission and fewer days in hospital compared with those diagnosed pre-COVID. Furthermore, patients diagnosed pre-pandemic were significantly more likely to have abnormal X-rays, used more antibiotics and antivirals, and had higher rates of severe disease than those with infection post-COVID.

CONCLUSION: COVID-19 and its associated social restriction measures led to changes in RSV epidemiology, characterized by a decline in rates and clinical severity in the post-pandemic period. However, further studies are needed to characterize the impact of COVID-19 on subsequent RSV seasons.

PMID:39719069 | DOI:10.1177/03000605241306405

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Gretl-variation graph evaluation TooLkit

Bioinformatics. 2024 Dec 24:btae755. doi: 10.1093/bioinformatics/btae755. Online ahead of print.

ABSTRACT

MOTIVATION: As genome graphs are powerful data structures for representing the genetic diversity within populations, they can help identify genomic variations that traditional linear references miss, but their complexity and size makes the analysis of genome graphs challenging. We sought to develop a genome graph analysis tool that helps these analyses to become more accessible by addressing the limitations of existing tools. Specifically, we improve scalability and user-friendliness, and we provide many new statistics tailored to variation graphs for graph evaluation, including sample-specific features.

RESULTS: We developed an efficient, comprehensive, and integrated tool, gretl, to analyze genome graphs and gain insights into their structure and composition by providing a wide range of statistics. gretl can be utilised to evaluate different graphs, compare the output of graph construction pipelines with different parameters, as well as perform an in-depth analysis of individual graphs, including sample-specific analysis. With the assistance of gretl, novel patterns of genetic variation and potential regions of interest can be identified, for later, more detailed inspection. We demonstrate that gretl outperforms other tools in terms of speed, particularly for larger genome graphs.

AVAILABILITY: Commented Rust source code and documentation is available under MIT license at https://github.com/MoinSebi/gretl together with Python scripts and step-by-step usage examples. The package is available at Bioconda for easy installation.

SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

PMID:39719064 | DOI:10.1093/bioinformatics/btae755

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Identification of plasma protein biomarkers for endometriosis and the development of statistical models for disease diagnosis

Hum Reprod. 2024 Dec 24:deae278. doi: 10.1093/humrep/deae278. Online ahead of print.

ABSTRACT

STUDY QUESTION: Can a panel of plasma protein biomarkers be identified to accurately and specifically diagnose endometriosis?

SUMMARY ANSWER: A novel panel of 10 plasma protein biomarkers was identified and validated, demonstrating strong predictive accuracy for the diagnosis of endometriosis.

WHAT IS KNOWN ALREADY: Endometriosis poses intricate medical challenges for affected individuals and their physicians, yet diagnosis currently takes an average of 7 years and normally requires invasive laparoscopy. Consequently, the need for a simple, accurate non-invasive diagnostic tool is paramount.

STUDY DESIGN, SIZE, DURATION: This study compared 805 participants across two independent clinical populations, with the status of all endometriosis and symptomatic control samples confirmed by laparoscopy. A proteomics workflow was used to identify and validate plasma protein biomarkers for the diagnosis of endometriosis.

PARTICIPANTS/MATERIALS, SETTING, METHODS: A proteomics discovery experiment identified candidate biomarkers before a targeted mass spectrometry assay was developed and used to compare plasma samples from 464 endometriosis cases, 153 general population controls, and 132 symptomatic controls. Three multivariate models were developed: Model 1 (logistic regression) for endometriosis cases versus general population controls, Model 2 (logistic regression) for rASRM stage II to IV (mild to severe) endometriosis cases versus symptomatic controls, and Model 3 (random forest) for stage IV (severe) endometriosis cases versus symptomatic controls.

MAIN RESULTS AND THE ROLE OF CHANCE: A panel of 10 protein biomarkers were identified across the three models which added significant value to clinical factors. Model 3 (severe endometriosis vs symptomatic controls) performed the best with an area under the receiver operating characteristic curve (AUC) of 0.997 (95% CI 0.994-1.000). This model could also accurately distinguish symptomatic controls from early-stage endometriosis when applied to the remaining dataset (AUCs ≥0.85 for stage I to III endometriosis). Model 1 also demonstrated strong predictive performance with an AUC of 0.993 (95% CI 0.988-0.998), while Model 2 achieved an AUC of 0.729 (95% CI 0.676-0.783).

LIMITATIONS, REASONS FOR CAUTION: The study participants were mostly of European ethnicity and the results may be biased from undiagnosed endometriosis in controls. Further analysis is required to enable the generalizability of the findings to other populations and settings.

WIDER IMPLICATIONS OF THE FINDINGS: In combination, these plasma protein biomarkers and resulting diagnostic models represent a potential new tool for the non-invasive diagnosis of endometriosis.

STUDY FUNDING/COMPETING INTEREST(S): Subject recruitment at The Royal Women’s Hospital, Melbourne, was supported in part by funding from the Australian National Health and Medical Research Council (NHMRC) project grants GNT1105321 and GNT1026033 and Australian Medical Research Future Fund grant no. MRF1199715 (P.A.W.R., S.H.-C., and M.H.). Proteomics International has filed patent WO 2021/184060 A1 that relates to endometriosis biomarkers described in this manuscript; S.B., R.L., and T.C. declare an interest in this patent. J.I., S.B., C.L., D.I., H.L., K.P., M.D., M.M., M.R., P.T., R.L., and T.C. are shareholders in Proteomics International. Otherwise, the authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER: N/A.

PMID:39719050 | DOI:10.1093/humrep/deae278

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Biosimilars versus the originator of follitropin alfa for ovarian stimulation in ART: a systematic review and meta-analysis

Hum Reprod. 2024 Dec 24:deae274. doi: 10.1093/humrep/deae274. Online ahead of print.

ABSTRACT

STUDY QUESTION: Is the probability of pregnancy different between women using biosimilars versus the originator of follitropin alfa for ovarian stimulation in ART?

SUMMARY ANSWER: Meta-analysis of eight randomized clinical trials (RCTs) suggests that live birth, clinical, and ongoing pregnancy rates are significantly lower with biosimilars of follitropin alfa compared to the originator.

WHAT IS KNOWN ALREADY: All biosimilars of follitropin alfa have received regulatory approval by demonstrating non-inferiority in the number of retrieved oocytes compared to the originator. Nevertheless, the most clinically relevant outcome in ART for both clinicians and patients is live birth. A meta-analysis published in 2021 suggested that biosimilars of follitropin alfa are associated with lower live birth rates compared to the originator. Since then, more relevant RCTs have been published, and thus an updated critical synthesis of the available evidence is urgently warranted.

STUDY DESIGN, SIZE, DURATION: A systematic review and meta-analysis were performed to compare biosimilars versus the originator of follitropin alfa in women undergoing ovarian stimulation for ART. A literature search was conducted until January 2024 in MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science, WHO, Clinicaltrials.gov, and others to identify eligible RCTs. The primary outcome was live birth. Secondary outcomes included clinical and ongoing pregnancy, duration of gonadotrophin administration and total FSH dose, number of oocytes retrieved, and ovarian hyperstimulation syndrome (OHSS).

PARTICIPANTS/MATERIALS, SETTING, METHODS: Data were extracted independently by two reviewers. Quality was assessed using the RoB-2 Tool by Cochrane, and a sensitivity analysis was performed by excluding studies having high risk of bias. Meta-analysis was performed using the random or fixed effects model depending on the presence or not of significant (>50%) statistical heterogeneity (I2). Results were combined using the intention-to-treat principle and are reported as risk ratio (RR) or weighted-mean-difference (WMD) with 95% CIs.

MAIN RESULTS AND THE ROLE OF CHANCE: Eight RCTs (n = 2987) (published between 2015 and 2023) were identified, assessing seven biosimilar products of follitropin alfa. The number of patients included in the eligible studies ranged from 100 to 1100. Three of the RCTs were deemed to be at high risk of bias. The duration of gonadotrophin administration was shorter in the biosimilars group (WMD: -0.19 days, 95% CI: -0.34 to -0.05; I2 = 0%, 5 studies, n = 2081), while no difference was observed in the total dose of FSH (WMD: -34.69 IUs, 95% CI: -74.54 to 5.16; I2 = 15.53%, 5 studies, n = 2081). No difference was observed in the number of oocytes retrieved (WMD: 0.27, 95% CI: -0.43 to 0.96; I2 = 10.7%, 6 studies, n = 1527) and OHSS rates (RR: 1.17, 95% CI: 0.90-1.52; I2 = 0%, 8 studies, n = 2986) between the two groups. A significantly lower live birth rate was observed using the biosimilars of follitropin alfa compared to the originator in women undergoing ovarian stimulation for ART (RR: 0.83, 95% CI: 0.72-0.96; I2 = 0%, 6 studies, n = 2335; moderate certainty of evidence). Similarly, clinical pregnancy (RR: 0.82, 95% CI: 0.73-0.92; I2 = 0%, 7 studies, n = 2876; low certainty of evidence) and ongoing pregnancy rates (RR: 0.81, 95% CI: 0.70-0.94; I2 = 0%, 7 studies, n = 1886; low certainty of evidence) were lower in the biosimilars group. These results were not materially altered in the sensitivity analyses performed where studies deemed at high risk of bias were excluded.

LIMITATIONS, REASONS FOR CAUTION: This meta-analysis included RCTs evaluating seven different biosimilars of follitropin alfa; however, pooled data appeared to be homogeneous. No data were available comparing biosimilars of follitropin alfa with the originator regarding cumulative live birth rate per aspiration or the probability of live birth in frozen thawed cycles. The population examined in the eligible RCTs includes mainly normal responders and no RCTs were identified focusing on poor or high responders.

WIDER IMPLICATIONS OF THE FINDINGS: Clinicians should be informed that although biosimilars of follitropin alfa produce similar number of oocytes with the originator, pregnancy rates after a fresh transfer are likely to be lower. Future research should focus on optimizing the production and use of biosimilars of follitropin alfa, so that they lead to pregnancy rates comparable to the originator.

STUDY FUNDING/COMPETING INTEREST(S): No external funding was used for this study. K.I.K. and A.S. have no competing interest to disclose. E.M.K. reports personal fees and non-financial support from Merck, Ferring, IBSA, and Vianex. B.W.M. has been supported by an investigator grant from NHMRC, has received consulting fees from Organon, Merck, and Norgine, research support and non-financial support from Merck KGaA, Darmstadt, Germany. B.W.M. also reports having stocks from OBsEva. C.A.V. reports grants, personal fees, and non-financial support from Merck KGaA, Darmstadt, Germany, personal fees, and non-financial support from Merck, Sharpe and Dohme, personal fees and non-financial support from Organon, grants and non-financial support from Ferring, personal fees from IBSA, and personal fees and non-financial support from Gedeon Richter and Vianex.

REGISTRATION NUMBER: Protocol for the systematic review registered in The International Prospective Register of Systematic Reviews (PROSPERO; CRD42024498237).

PMID:39719046 | DOI:10.1093/humrep/deae274

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A pilot study of transcriptomic preimplantation genetic testing (PGT-T): towards a new step in embryo selection?

Hum Reprod. 2024 Dec 24:deae265. doi: 10.1093/humrep/deae265. Online ahead of print.

ABSTRACT

STUDY QUESTION: Is it possible to predict an euploid chromosomal constitution and identify a transcriptomic profile compatible with extended embryonic development from RNA sequencing (RNA-Seq) data?

SUMMARY ANSWER: It has been possible to obtain a karyotype comparable to preimplantation genetic testing for aneuploidy (PGT-A), in addition to a transcriptomic signature of embryos which might be suggestive of improved implantation capacity.

WHAT IS KNOWN ALREADY: Conventional assessment of embryo competence, based on morphology and morphokinetic, lacks knowledge of molecular aspects and faces controversy in predicting ploidy status. Understanding the embryonic transcriptome is crucial, as gene expression influences development and implantation. PGT has improved pregnancy rates, but problems persist when high-quality euploid embryos do not reach term. In fact, only around 50-60% implant, of which 10% result in miscarriage. Comprehensive approaches, including RNA-Seq, offer the potential to discover molecular markers of reproductive competence, and could theoretically be combined with extended-embryo culture platforms up to Day 14 that can be utilized as a proxy to study embryo development at post-implantation stages.

STUDY DESIGN, SIZE, DURATION: This prospective pilot cohort study was conducted from March 2023 to August 2023. A total of 30 vitrified human blastocysts with previous PGT-A diagnosis on Day 5 (D5) or Day 6 (D6) of development were analysed: n = 15 euploid and n = 15 aneuploid. Finally, 21 embryo samples were included in the study; the rest (n = 9) were excluded due to poor quality pre-sequencing data (n = 7) or highly discordant data (n = 2).

PARTICIPANTS/MATERIALS, SETTING, METHODS: Following warming and re-expansion, embryos underwent a second trophectoderm (TE) biopsy. The embryos were then cultured until day 11 to assess their development. Biopsy analysis by RNA-Seq, studied the differential expressed genes (DEG) to compare embryos which did not or did attach to the plate: unattached embryos (n = 12) versus attached embryos (n = 9). Thus, we also obtained a specific transcriptomic signature of embryos with a “theoretical” capacity for sustained implantation, based on plate attachment on day 11.

MAIN RESULTS AND THE ROLE OF CHANCE: The digital karyotype obtained by RNA-Seq showed good concordance with the earlier PGT-A data, with a sensitivity of 0.81, a specificity of 0.83, a Cohen’s Kappa of 0.66, and an area under the ROC of 0.9. At the gene level, 76 statistically significant DEGs were found in the comparison unattached versus attached embryos (Padj < 0.05; FC > 1). To address the functional implications of these differences, significantly deregulated pathways according to GO and KEGG categories were identified. The mural trophectoderm (TE) of the unattached blastocysts showed 63 significantly deregulated terms, displaying upregulation in autophagy, apoptosis, protein kinase and ubiquitin-like protein ligase activity, and downregulation of ribosome, spliceosome, kinetochore, segregation, and chromosome condensation processes. The overall transcriptomic signature specific to embryos still attached to the plate on day 11 (with a theoretically higher implantation capacity) consists of 501 genes, including: EMP2, AURKB, FOLR1, NOTCH3, LRP2, FZD5, MDH1, APOD, GPX8, COLEC12, HSPA1A, CMTM7, BEX3, which are related to implantation and embryonic development (raw P-value < 0.05; shrunk LFC > 1.1). These findings indicate that it might be possible to identify euploid embryos with a greater capacity for implantation and development, after excluding those embryos that present chromosomal alterations.

LIMITATIONS, REASONS FOR CAUTION: This study included a small sample size, remarkable variability between samples, and low success rate of RNA amplification. Also, structural chromosomal abnormalities were not included, and it was not possible to diagnose mosaic embryos. TE biopsy does not assure the chromosomal status of the whole embryo. The maximum day for in vitro development was Day 11, and attachment to the plate on this day does not provide a clear indication of implantation capacity and viability, which was not tested in this study.

WIDER IMPLICATIONS OF THE FINDINGS: The short-term goals following on from this pilot study is to expand the sample size with embryos of more complex abnormalities, and to perform a prospective in vitro preclinical validation. In a more distant future and with optimal results, this technique could have clinical application, thus increasing clinical outcomes by assessing both chromosomal content and transcriptomic profiling.

STUDY FUNDING/COMPETING INTEREST(S): The Institut Valencià de Competitivitat Empresarial (IVACE) (IMIDCA/2022/39) and Generalitat Valenciana (CIACIF/2021/11) supported the present study. A.C. is an employee of JUNO Genetics. He has received honoraria for an IBSA lecture and a Merck lecture. He is also a minor shareholder of IVIRMA Global. The other authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER: N/A.

PMID:39719045 | DOI:10.1093/humrep/deae265

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Magnetic Resonance Imaging does not distinguish Kallmann syndrome from normosmic isolated hypogonadotropic hypogonadism

Endocr Connect. 2024 Dec 1:EC-24-0437. doi: 10.1530/EC-24-0437. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Isolated hypogonadotropic hypogonadism (IHH) may be associated with pituitary gland and olfactory system disorders. We aimed to correlate findings of Magnetic Resonance Imaging (MRI) of the pituitary gland and olfactory system in IHH patients with the patients’ olfactory phenotype.

PATIENTS AND METHODS: The present research was a single-center retrospective case-control study. MRI patterns of pituitary gland and olfactory system were studied in 46 patients, of whom 29 (63%) were classified on the basis of olfactometry as having Kallmann syndrome (KS) (16 patients with anosmia; 13 patients with hyposmia) and 17 (37%) as having normosmic IHH (nIHH). Results were compared with age- and sex-matched healthy controls. Genetic diagnosis was conducted in all IHH patients based on next-generation sequencing (NGS).

RESULTS: Almost 70% prevalence of pituitary hypoplasia was observed in IHH subjects. Olfactory Bulb (OB) abnormalities were identified in 80.4% of all patients, both the KS (82.8%) and the nIHH (76.5%) subjects. Incidence of unilaterally abnormal, hypoplastic Olfactory Sulcus (OS) was equally frequent in nIHH and KS. Statistically, piriform cortical thickness was significantly lower in all patient groups than in controls.

CONCLUSIONS: MRI cannot exclusively differentiate between KS and nIHH, as both conditions may present with OB and OS abnormalities. A surprisingly high frequency of olfactory system abnormalities was observed in nIHH patients, while anterior pituitary hypoplasia was prevalent across all IHH patients. Notably, OB abnormalities were more predominant in KS patients than in those with nIHH.

PMID:39719010 | DOI:10.1530/EC-24-0437

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All Enabling Technology Is Not Created Equal: Comparing Outcomes of Computer-Assisted Fluoroscopic Navigation Versus Robotic-Assisted Total Hip Arthroplasty

J Am Acad Orthop Surg Glob Res Rev. 2024 Dec 23;8(12). doi: 10.5435/JAAOSGlobal-D-24-00324. eCollection 2024 Dec 1.

ABSTRACT

BACKGROUND: Computer-assisted fluoroscopic navigation and robotic technologies aim to optimize implant placement and alignment in primary total hip arthroplasty (THA) to improve patient outcomes. This study uses a retrospective hospital billing database covering 1,300 hospitals to compare the clinical and economic effect of these technologies.

METHODS: The study compared patients undergoing THA with robotic versus computer-assisted fluoroscopic navigation technologies between January 1, 2016, and September 30, 2021, using the Premier Healthcare Database. Primary outcomes were operating room time and readmission rates. Secondary outcomes were length of stay, discharge status, revision rates within 90- and 365-day follow-up, and hospital costs. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. A sensitivity analysis was conducted using the nearest neighbor matching as the covariate balancing technique.

RESULTS: The cohorts included 4,378 fluoroscopically navigated THA and 10,423 robotic-assisted THA procedures with 90-day follow-up. Operating room time was markedly lower with fluoroscopic navigation compared with robotic-assisted technology (137.74 vs. 156.00 minutes; P < 0.001). Hip-related readmission rates were markedly lower (P < 0.001) for fluoroscopic navigation for both 90- and 365-day follow-up, by 43% and 40% respectively, compared with robotic-assisted technology. Results showed increased discharge ratio to home/home health, reduced length of stay, and lower hospital costs for fluoroscopic navigation compared with robotic-assisted technology. Revision rates were similar for both cohorts.

CONCLUSION: Using computer-assisted fluoroscopic navigation in THA was associated with markedly lower operating room time and readmission rates while also having improved healthcare outcomes and costs compared with robotic-assisted technology.

PMID:39719008 | DOI:10.5435/JAAOSGlobal-D-24-00324