1,721,083 research outputs found
Current Artificial Intelligence Based Chatbots May Produce Inaccurate and Potentially Harmful Information for Patients With Aortic Disease
No full textThe world has witnessed the diffusion of artificial intelligence (AI) based chatbots, computer programs designed to simulate a conversation with a human being. AI chatbots are rapidly evolving thanks to significant in- vestments in the digital world.1 This technology is here to stay and must be acknowledged for the good and the bad. Many individuals already trust it for accurate information in various fields, including health, where reliability is crucial. However, the same innovative and revolutionary tool can be deleterious if used improperly, and users must be aware of the possibility of encountering inaccurate information.2e4
A web based community of people with an interest in aortic disease (Think Tank Aorta), led by a former aortic patient (T.S.), is pursuing the project of interrogating two commonly used, free of charge chatbots, namely ChatGPT 3.0 (OpenAI, San Francisco, CA, USA) and Bing (Microsoft, Redmond, WA, USA), to evaluate the accuracy of replies to common questions that an aortic patient might ask (cha- tAortaAI).5 The chatAortaAI project is on a completely voluntary basis and includes patients, former patients, family members, healthcare professionals as well as any other individual with an interest in aortic disease. The team is composed of 22 individuals from 11 countries who guarantee their continued interest in the project. The team members are fluent in a total of 10 languages.
In the pilot study, April 1 e May 31 2023, each team member interrogated the chatbots with questions that an aortic patient, seeking information on the disease, might ask. It should be noted that the same question was asked more than once with identical or similar wording, in the same or different session, and also in different languages. Three sets of questions were asked: non-medical (BASIC), aortic (AORTA), and complex aortic disease (ADVANCED). The total number of questions in the three different levels was 42, including seven test questions for AI and 35 ques- tions to evaluate the accuracy of AI responses.
The form BASIC included questions 1 e 17 (https://docs. google.com/forms/d/e/1FAIpQLSeRBZrU97p71CT_KIx5vj FqrRPgUclMpU7s4sDS5kN7nY0CXg/viewform?pli1⁄41),the form AORTA included questions 18 e 29 (https://docs. google.com/forms/d/e/1FAIpQLSfENIb9n_Tao9Ox59xjnKdjs DshBWy0O7Wsuj9lA0Ec_cqtIw/viewform), and the form ADVANCED included questions 30 e 42 (https://docs. google.com/forms/d/e/1FAIpQLScSoG-GaOT7M1cSJLPrAwb s11oF4NFGZOgnnO2hfVgsJmFhqQ /viewform).
The form BASIC was completed by 22 team members, the form AORTA was completed by 20 team members, and the form ADVANCED was completed by 19 team members.
The first item analysed was the accuracy of replies to questions asked in English as evaluated by two experienced academic vascular surgeons (G.M. and G.T.). Based on their medical expertise and current guidelines,6 the team member rated the accuracy of answers on a two point Likert scale as accurate (addresses all aspects of the question and provides additional information or context beyond what was expected) or inaccurate (addresses some aspects of the question but significant parts are missing or incomplete). The second item analysed was the consistency of the replies to questions asked in the same language. Quite surprisingly, the exact same question led to an array of different replies. Finally, the accu- racy of the replies dropped when the questions were asked in a language other than English, with several erratic replies.
The overall analysis showed that 111/279 (39.8%) of the English questions and 178/308 (57.8%) of questions in the other tested languages were inaccurate. ChatGPT’s analysis of the results from all the tests showed that responses were inaccurate in 44.4% (63/142) of the English questions and 65.2% (103/158) of the other tested languages. Bing Chat responses were inaccurate in 35.0% (48/137) of English questions and 50.0% (75/150) of questions in the case of other tested languages (Fig. 1). This pilot study showed that the English language in chatbots provides more accurate responses compared with other test languages.
The functionality of AI chatbots may cause harm by pro- ducing misleading or inaccurate content, thereby eliciting concerns around medical misinformation. Thus, the applica- tion of AI chatbots should be carried out ethically and responsibly, considering its potential risks and concerns. The language algorithms interrogated are undergoing rapid development, and it is the mission of this team to continue monitoring these in the future for changes and improve- ments and to come up with more structured studies. For the time being, the present findings should be shared both with the medical community and the lay public so that they can be warned against the potential risks of looking for medical in- formation in the aortic field through this source
Endovascular reconstruction of the aortic arch with new-generation dual-branch and triple-branch endograft: design, applicability, indications, outcomes, and future directions
No full textIntroduction: Repair of aortic arch pathologies such as degenerative aneurysms and dissections still represents a significant challenge for vascular and cardiac surgeons. We focused on the design, evolution, implementation, and prospects of endovascular dual branch technology for treatment of pathologies in the aortic arch. Areas covered: The literature search was conducted in a non-systematic fashion through the PubMed and Scopus databases; articles deemed relevant to the scope of the work and fully published in English language from January 12,000 until December 2023 were considered for inclusion. Two companies so far have developed and launched in market a dedicated arch dual branch platform: Terumo Aortic and Cook Medical. Expert opinion: A common limitation to the available technology is represented by the fact that urgent cases (i.e. large or rapidly growing aneurysms, symptomatic patients) cannot be treated because the customization process generally takes between 6 and 8 weeks, and there is an inherent risk for aorta-related adverse events to happen during the waiting time. While the future holds much promise, several technical hurdles still exist and further developments (in device design, operators' skills, patients' selection, and outcomes assessment) are needed to establish the safety and effectiveness of treatment particularly over the long-run
Laterally Extended Pelvic Resection for Gynaecological Malignancies: A Multicentric Experience with Out-of-the-Box Surgery
No full textPurpose: To evaluate morbidity and oncological outcome in a multicentre series of women with gynaecological malignancies infiltrating pelvic side wall (PSW) that received laterally extended pelvic resection (LEPR). Methods: Patients operated between 2007 and 2017 at three institutions were included. LEPR was defined as an en bloc lateral resection of a pelvic tumour involving sidewall muscle, and/or bone, and/or major nerve, and/or major vascular structure. Postsurgical complications and survivals were evaluated. Results: Sixty-three women with gynaecological tumours involving PSW were treated with LEPR. Five women underwent primary LEPR, whereas 58 (92%) patients needed LEPR because of recurrence. Twenty-four women (38%) received previous radiation therapy before the surgery. R0 resection was achieved in 54 patients (85.7%), whereas the pathologic margins were microscopically and macroscopically positive in 8 (12.7%) patients and 1 (1.6%) patient, respectively. There was one perioperative death, whereas major postoperative complications occurred in 17 patients (27.7%). Thirty (47.5%) women experienced recurrences: 24/54 (44.4%) were in the R0 group, and 6/9 (66.6%) were in the R1 group, with a median PFS of 15 months and 7 months, respectively (p = 0.024). In total, 11 of 54 (20.3%) patients died of disease in the R0 group and 5 of 9 (55.5%) in the R1 group; a median OS was not reached and was 32 months for R0 and R1 groups, respectively (p = 0.033). Conclusions: Involvement of the PSW should not prevent obtaining R0 resection. Although the LEPR is associated with considerable morbidity (≈ 30%), a long-term survival seems to be achieved in those women with complete resection
TAA 8. Hybrid Repair Techniques for Kommerell Diverticulum, New Aortic Arch Classification, Early and Late Results
No full textObjective: The aim of this study was to evaluate early and late results of hybrid repair techniques for Kommerell diverticulum (KD).
Methods: All patients undergoing hybrid repair (thoracic endovascular aortic repair + supra-aortic debranching) for KD between 2009 and 2018 were included in this retrospective multicenter study (three Italian cen- ters). A proximal landing zone (PLZ) of at least 2 cm of healthy aorta was considered adequate for the deployment of a standard thoracic
stent graft. The early end points were technical success, in-hospital mor- tality, and cerebrovascular events. Late outcomes included survival, rein- tervention, and patency of supra-aortic debranching. We proposed an embryogenetic anomaly-based aortic arch classification for PLZ evalua- tion to choose the most appropriate hybrid adjunct (Fig).
Results: Sixteen patients with KD were included. According to the aforementioned classification, six patients (37.5%) required stent graft deployment in PLZ 0, nine (56.3%) in PLZ 1, and one (6.3%) in PLZ 2. Tech- nical success was achieved in all patients. One patient (6.3%) died in the hospital of posterior cerebral hemorrhage after a total debranching (PLZ 0). No other cerebrovascular event was registered. One patient (6.3%) re- ported an asymptomatic right subclavian artery-left subclavian artery bypass occlusion and required an early reintervention. The 30-day pri- mary assisted patency of supra-aortic debranching was 100% (Table I). Two type II endoleaks (12.5%) were detected at 1-month computed to- mography angiography. Further transient complications were registered in three cases: hemidiaphragm paralysis in one patient and recurrent laryngeal nerve paralysis in two patients. At a mean follow-up of 48 months, four patients died of non-aorta-related reasons and one right common carotid artery-right subclavian artery bypass lost its patency. Ten patients (62.5%) presented with aneurysmal sac shrinkage of at least 5 mm (Table II).
Conclusions: Hybrid repair has been confirmed to be a safe and effec- tive approach for KD. Operative risk is mostly related to the invasiveness of the hybrid adjunct
Parametric Color Coding of Digital Subtraction Angiography in the Evaluation of the Type B Chronic Aortic Dissection During Tevar: A Preliminary Study
No full textAngiographic assessment of type B chronic aortic dissection (TBCAD) can be complex in TEVAR procedures, due to the presence of true and false lumen.
Quantitative digital subtraction angiography (Q-DSA) with a parametric color-coding provides a novel approach for encoding temporal information and enabling quantitative measurements.
The potential value of the use of color in the display of these parametric images was recognized, particularly useful in situations in which there is a complex flow pattern.
The aim of this study was to evaluate whether the use of parametric color-coding in the post-processing of DSA series is advantageous in the evaluation of TBCAD during TEVAR procedures
Wound care during COVID-19 pandemic
No full textThe spread of the coronavirus COVID-19 has profoundly affected the way we conduct our medical practices, resulting in a decrease in necessary medical care, including the wound healing specialty. The actual period of COVID-19 pandemic limits the ability to practice wound healing in normal conditions. Patients with vascular leg ulcers represent an extremely vulnerable population, with poor quality of life caused by the pain directly related to both ulcer duration and ulcer area. These patients must not be overlooked due to the irreversible consequences that we will observe. If ischemic and venous wounds are not treated or managed, the results could be drastic, such as infections, sepsis, amputations, or even fatalities
Complete aortic thrombosis in SARS-CoV-2 infection
No full textA 74-year-old man with a history of diabetes mellitus, coronary artery disease, and previous myocardial infarction presents to the emergency department with cardiogenic shock.
Three-dimensional computed tomographic (CT) angiography revealed the complete thrombotic occlusion of the aorta, arising from the descending aorta and including all the visceral arteries.
Multifocal ground-glass opacities were visualized in the bilateral lungs (Panels B and C). Diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed by reverse transcriptase-polymerase chain reaction analysis. The patient died immediately after the CT scan
Multiorgan and vena cava perforation by an inferior vena cava filter: surgical approach and bovine pericardial patch reconstruction
No full textN/
Open conversion following Nellix Endovascular Aneurysm Sealing (EVAS)
Get PDFThe Nellix Endovascular Aneurysm Sealing (EVAS) System (Endologix, Irvine, California, USA) was presented as a novel concept in the treatment of abdominal aortic aneurysm (AAA). After numerous adverse events, the device has been voluntarily withdrawn from the market by the manufacturer. The purpose of this video is to describe the technical approach of a successful explantation of the Nellix endograft in a patient who underwent EVAS for AAA. The patient’s consent for publication was obtained
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