1,720,976 research outputs found
Assessing ChatGPT-4 as a clinical decision support tool in neuro-oncology radiotherapy: a prospective comparative study
No full textBackground and purpose: Large language models (LLMs) such as ChatGPT-4 have shown potential for medical decision support, but their reliability in specialized fields remains uncertain. This study aimed to evaluate ChatGPT-4’s performance as a clinical decision support tool in neuro-oncology radiotherapy by comparing its treatment recommendations for patients with central nervous system tumors against a multidisciplinary tumor board’s decisions, an independent specialist’s opinion, and published guidelines. Materials and methods: We prospectively collected 101 neuro-oncology cases (May 2024–May 2025) presented at a tertiary-care tumor board. Key case details were entered into ChatGPT-4 with a standardized query asking whether to recommend radiotherapy and, if so, the target volumes and dose. The AI’s recommendations were recorded and compared to the tumor board’s consensus, a blinded radiation oncologist’s recommendation, and ESMO guideline indications when applicable. Concordance rates (percentage agreement) and Cohen’s kappa were calculated. Sensitivity and specificity were assessed using the reference decisions as ground truth. McNemar’s test was used to evaluate any bias in discordant recommendations. Results: ChatGPT-4 matched the tumor board’s radiotherapy recommendations in 76% of cases (κ = 0.61). Agreement with the independent specialist was 79% (κ = 0.58). In 61 low-complexity cases with clear guidelines, ChatGPT-4 concurred with guideline-based indications in 76.7% of cases, missing some recommended treatments (sensitivity 73%, specificity 100%). In intermediate-complexity scenarios, concordance with the tumor board was 70.8%, with most discrepancies due to the AI recommending treatment that experts did not (sensitivity 85.7%, specificity 64.7%). In high-complexity cases, agreement was 90.9% (sensitivity 100%, specificity 83.3%). Overall, ChatGPT-4 showed an overtreatment bias, more often recommending radiotherapy when the human experts chose observation (p < 0.05 for AI vs. tumor board discordances). Its overall agreement (76%) was lower than that of the human specialist (90%). Conclusion: ChatGPT-4 can reproduce many expert radiotherapy decisions in neuro-oncology, reflecting substantial absorption of standard clinical practice. However, it cannot substitute for human judgment: the AI omitted some indicated treatments in straightforward cases and suggested unnecessary therapy in some borderline cases, indicating a lack of nuanced clinical reasoning. Careful human oversight is essential if such models are to be used for clinical decision support
Loss of skeletal muscle mass during treatment is associated with reduced overall survival in gastric cancer patients undergoing conversion surgery
No full textBackground: The recent introduction of multimodal approach in the setting of conversion surgery (CS) significantly improved survival of stage IV gastric cancer (GC) patients. The prognosis has been related to several tumor and patient factors. Abnormal body composition, specifically the depletion of the lean mass compound, have been associated with impaired short- and long-term outcomes in GC. Aim was to analyze potential variation of body composition during systemic treatment and to evaluate aftermath on further resection and survival. Methods: In this retrospective monocenter analysis, we assessed pre-treatment and preoperative body composition of stage IV GC patients who underwent surgical exploration following systemic treatment in the setting of CS, over a 12-year period. A radiologist blinded to the patient outcomes assessed the areas of skeletal muscle, and adipose tissue by a dedicated software through standardized protocols. Demographics and clinical data were obtained from prospectively maintained databases and patient records. Results: We included 42 GC patients. Median age was 59 years, 27, 64.3 % were male, and 22/42 were Yoshida category 3 and 4. Surgical interventions included curative resection (23/42 cases), or palliation (19/42). We observed difference in the distribution of body components according to gender, at diagnosis, with more subcutaneous adipose tissue in males (p < 0.001) vs. more visceral adipose tissue in females (p = 0.039). During systemic treatment, a significant increase in total muscle area was observed, but nor in males (median delta TMA -7cm2 in males and delta TMA +4.8 cm2 in females, p = 0.048). Increased TMA during chemotherapy was associated with improved overall survival, with median OS 63 months, vs. 27 months for patients who lost lean mass (p = 0.042). The protective effect of increased TMA was also confirmed at a multivariate analysis after normalization for age and type of surgical procedure (HR 0.98, 95%CI 0.97–0.99; p = 0.035). Conclusion: As increased skeletal muscular mass during systemic treatment independently improved the overall survival, longitudinal evaluation of body composition must be part of routinary work-up of gastric cancer patients in the setting of conversion surgery. Potential effects of nutritional interventions must be evaluated
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Improved detection and quantification of peritoneal metastases using delayed contrast-enhanced dual-energy CT scans
No full textBackground: Computed tomography (CT) is widely used to diagnose peritoneal metastases (PM), with debated accuracy. Dual-energy CT (DECT) may improve accuracy, yet its diagnostic performance is still unknown. We explored the potential of DECT for PM detection and quantification. Materials and methods: We retrospectively included patients undergoing staging DECT for cancers with a high risk of peritoneal involvement, followed by staging laparoscopy/laparotomy, which served as the reference standard. Nine readers with varying experience levels (three expert, three intermediate, and three inexpert) reviewed two sets of images, separated by ≥ 60 days, considering the presence/absence of PM, abdominal region(s) involved, and calculated the radiological peritoneal cancer index (PCI). The first set included contrast-enhanced delayed-DECT scans reconstructed as virtual 120-kVp images; the second set also included virtual monoenergetic, 40-keV images and iodine maps. Performance metrics, receiver operating characteristic (ROC) analysis, McNemar, DeLong, and Wilcoxon tests were applied. Results: Twenty patients (mean age 64.2 years; 12 females) were included, 10 with PM. At per-patient analysis, the addition of monoenergetic 40-keV images and iodine maps slightly increased the performance and improved inter-reader agreement, with significant benefit for inexperienced readers only (p = 0.010). Per-region analysis demonstrated a significant advantage with an area under the ROC curve ranging from 0.709 to 0.766 (p < 0.001), confirmed for each reader group; in addition, the inter-reader agreement significantly improved. Quantitative analysis showed a reduction in the differences between CT results and surgical PCI by DECT (4 ± 12 versus 2 ± 9, p < 0.001). Conclusion: DECT-derived reconstructions in the delayed-phase enhanced PM detection and quantification. Relevance statement: Delayed-phase DECT reconstruction showed superior accuracy over conventional CT in detecting and quantifying peritoneal metastases. These findings could help establish a new standard CT protocol for malignancies with peritoneal tropism. Key Points: CT is the most widely used technique for assessing peritoneal metastases. The accuracy of CT for peritoneal metastases is debated; dual-energy CT shows promise. In our study, delayed-phase dual-energy CT provided significant advantages for all readers. © The Author(s) 2025
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Weighing the benefits: Exploring the differential effects of light-weight and heavy-weight polypropylene meshes in inguinal hernia repair in a retrospective cohort study
Get PDFBackground: Inguinal hernia repair is a common surgical procedure, with more than 20 million cases yearly. Choice between mesh types varies in clinical practice. To compare light-weight polypropylene (LW-PP, 34-36 g/ m2) and heavy-weight polypropylene (HW-PP, 95 g/m2) meshes. Methods: Data from patients who underwent open inguinal hernia repair between 2020 and 2022. Selection criteria ensured homogeneity. Endpoints were to assess the impact of different mesh weights on overall healthrelated quality of life (HRQoL), using Short Form 36 (SF-36), and to monitor postoperative complications. Results: Two hundred patients were included in both groups. Lateral and direct hernias occurred in 60.5 % and 39.5 %. According to EHS, 31.5 %, 22.3 % and 46.2 % were classified as size 1, 2, 3. Follow-up showed similar HRQoL at 30-days, with a favorable trend towards LW-PP mesh offering fewer limitations, better comfort, and improved general health after 12-months. No difference in postoperative paresthesia, wound hematoma, and interference with daily activities. Conclusion: 1-year after surgery HRQoL evaluation highlights the non-inferiority of LW-PP. Mesh selection should be tailored, aiming at improving outcomes and postoperative comfort
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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