The endovascular filament perforation model to mimic subarachnoid hemorrhage (SAH) is a commonly used model - however, the technique can cause a high mortality rate as well as an uncontrollable ...volume of SAH and other intracranial complications such as stroke or intracranial hemorrhage. In this protocol, a standardized SAH mouse model is presented, induced by endovascular filament perforation, combined with magnetic resonance imaging (MRI) 24 h after operation to ensure the correct bleeding site and exclude other relevant intracranial pathologies. Briefly, C57BL/6J mice are anesthetized with an intraperitoneal ketamine/xylazine (70 mg/16 mg/kg body weight) injection and placed in a supine position. After midline neck incision, the common carotid artery (CCA) and carotid bifurcation are exposed, and a 5-0 non-absorbable monofilament polypropylene suture is inserted in a retrograde fashion into the external carotid artery (ECA) and advanced into the common carotid artery. Then, the filament is invaginated into the internal carotid artery (ICA) and pushed forward to perforate the anterior cerebral artery (ACA). After recovery from surgery, mice undergo a 7.0 T MRI 24 h later. The volume of bleeding can be quantified and graded via postoperative MRI, enabling a robust experimental SAH group with the option to perform further subgroup analyses based on blood quantity.
The utilization of epidural electrodes in the preoperative evaluation of intractable epilepsy is a valuable but underrepresented tool. In recent years, we have adapted the use of cylindrical epidural ...1-contact electrodes (1-CE) instead of Peg electrodes. 1-CEs are more versatile since their explantation is a possible bedside procedure. Here we report our experience with 1-CEs as well as associated technical nuances. This retrospective analysis included 56 patients with intractable epilepsy who underwent epidural electrode placement for presurgical evaluation at the Department of Neurosurgery at the Charité University Hospital from September 2011 to July 2021. The median age at surgery was 36.3 years (range: 18-87), with 30 (53.6%) female and 26 (46.4%) male patients. Overall, 507 electrodes were implanted: 93 Fo electrodes, 33 depth electrodes, and 381 epidural electrodes, with a mean total surgical time of 100.5 ± 38 min and 11.8 ± 5 min per electrode. There was a total number of 24 complications in 21 patients (8 Fo electrode dislocations, 6 CSF leaks, 6 epidural electrode dislocations or malfunction, 3 wound infections, and 2 hemorrhages); 11 of these required revision surgery. The relative electrode complication rates were 3/222 (1.4%) in Peg electrodes and 3/159 (1.9%) in 1-CE. In summary, epidural recording via 1-CE is technically feasible, harbours an acceptable complication rate, and adequately replaces Peg electrodes.
Introduction
Perioperative opioid use has been associated with adverse clinical outcomes. Additionally, opioid disposal carries significant costs, due to the waste of pharmaceutical products and the ...time needed by skilled labor to report the waste. In this study, we aimed to estimate costs and predict factors of opioid-associated intraoperative product waste, as well as to evaluate whether higher intraoperative opioid doses are associated with increased risk of adverse postoperative outcomes.
Methods
We included 170,607 patients undergoing general anesthesia and receiving intraoperative fentanyl, hydromorphone, or morphine at Beth Israel Deaconess Medical Center, Boston, MA, USA, between January 2010 and June 2020. We estimated product waste-associated costs based on various opioid syringe sizes and determined predictors of opioid waste. Further, we evaluated whether higher opioid doses were associated with postoperative adverse events according to the severity-indexed, incident report-based medication error-reporting program classification. The primary outcome included post-extubation desaturation, postoperative nausea or vomiting, or postoperative somnolence or sedation.
Results
The use of the smallest syringe sizes (50 mcg for fentanyl, 0.2 mg for hydromorphone, and 2 mg for morphine) resulted in the lowest product waste-associated costs. The main predictor of opioid waste was the administration of more than one intraoperative opioid (adjusted odds ratio aOR = 7.64, 95% CI 7.40–7.89,
P
< 0.001). Intraoperative doses of fentanyl > 50–100 mcg (aOR = 1.17 1.10–1.25,
P
< 0.001, adjusted risk difference ARD 2%) and > 100 mcg (aOR = 1.24 1.16–1.33,
P
< 0.001, ARD 3%), hydromorphone > 1 mg (aOR = 1.13 1.06–1.20,
P
< 0.001, ARD 2%), and morphine > 2–4 mg (aOR = 1.26 1.02–1.56,
P
= 0.04, ARD 3%) and > 4 mg (aOR = 1.45 1.18–1.77,
P
< 0.001, ARD 5%) were associated with higher risk of the primary outcome.
Conclusion
Smaller syringe sizes of intraoperative opioids may help to reduce product waste and associated costs, as well postoperative adverse events through utilization of lower intraoperative opioid doses.
Affiliation Bias in Peer Review of Abstracts/Reply Gallo, Robert J; Savage, Thomas; Chen, Jonathan H ...
JAMA : the journal of the American Medical Association,
04/2024, Volume:
331, Issue:
14
Journal Article
Peer reviewed
Shay et al thank Gallo et al for their interest in their study and for raising awareness about the statistical considerations when investigating large language model (LLM). The response acknowledges ...the importance of accounting for randomness in LLM outputs and suggests the development of statistical standards for LLM studies. The response also clarifies the methodology used in the original study and addresses concerns raised by Gallo et al.
Affiliation Bias in Peer Review of Abstracts—Reply von Wedel, Dario; Shay, Denys; Schaefer, Maximilian S
JAMA : the journal of the American Medical Association,
04/2024, Volume:
331, Issue:
14
Journal Article
Background Acetaminophen and 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are administered as standard prophylaxes for postoperative pain, nausea, and vomiting. Preclinical studies, ...however, suggest that 5-HT3 antagonists may compromise acetaminophen’s analgesic effect. This hospital registry study investigates whether 5-HT3 antagonists mitigate the analgesic effect of prophylactic acetaminophen in a perioperative setting. Methods This study included 55,016 adult patients undergoing general anesthesia for ambulatory procedures at a tertiary healthcare center in Massachusetts from 2015 to 2022. Using binary exposure variables and a comprehensive selection of preplanned patient- and procedure-related covariates for confounder control, the authors investigated whether intraoperative 5-HT3 antagonists affected the association between pre- or intraoperative acetaminophen and postoperative opioid consumption, gauged by opioid dose in milligram oral morphine equivalents (OME) administered in the postanesthesia care unit. A multivariable, zero-inflated negative binomial regression model was applied. Results A total of 3,166 patients (5.8%) received only acetaminophen, 15,438 (28.1%) only 5-HT3 antagonists, 31,850 (57.9%) both drugs, and 4,562 (8.3%) neither drug. The median postanesthesia care unit opioid dose was 7.5 mg OME (interquartile range, 7.5 to 14.3 mg OME) among 16,640 of 55,016 (30.2%) patients who received opioids, and the mean opioid dose was 3.2 mg OME across all patients (maximum cumulative dose, 20.4 mg OME). Acetaminophen administration was associated with a –5.5% (95% CI, –9.6 to –1.4%; P = 0.009; adjusted absolute difference, –0.19 mg OME; 95% CI, –0.33 to –0.05; P = 0.009) reduction in opioid consumption among patients who did not receive a 5-HT3 antagonist, while there was no effect in patients who received a 5-HT3 antagonist (adjusted absolute difference, 0.00 mg OME; 95% CI, –0.06 to 0.05; P = 0.93; P for interaction = 0.013). Conclusions A dose-dependent association of pre- or intraoperative acetaminophen with decreased postoperative opioid consumption was not observed when 5-HT3 antagonists were coadministered, suggesting that physicians might consider reserving 5-HT3 antagonists as rescue medication for postoperative nausea or vomiting when acetaminophen is administered for pain prophylaxis. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
Purpose
Latent class analysis (LCA) has identified hyper- and non-hyper-inflammatory subphenotypes in patients with acute respiratory distress syndrome (ARDS). It is unknown how early inflammatory ...subphenotypes can be identified in patients at risk of ARDS. We aimed to test for inflammatory subphenotypes upon presentation to the emergency department.
Methods
LIPS-A was a trial of aspirin to prevent ARDS in at-risk patients presenting to the emergency department. In this secondary analysis, we performed LCA using clinical, blood test, and biomarker variables.
Results
Among 376 (96.4%) patients from the LIPS-A trial, two classes were identified upon presentation to the emergency department (day 0): 72 (19.1%) patients demonstrated characteristics of a hyper-inflammatory and 304 (80.9%) of a non-hyper-inflammatory subphenotype. 15.3% of patients in the hyper- and 8.2% in the non-hyper-inflammatory class developed ARDS (p = 0.07). Patients in the hyper-inflammatory class had fewer ventilator-free days (median interquartile range, IQR 2823–28 versus 2827–28; p = 0.010), longer intensive care unit (32–6 versus 00–3 days; p < 0.001) and hospital (96–18 versus 53–9 days; p < 0.001) length of stay, and higher 1-year mortality (34.7% versus 20%; p = 0.008). Subphenotypes were identified on day 1 and 4 in a subgroup with available data (n = 244). 77.9% of patients remained in their baseline class throughout day 4. Patients with a hyper-inflammatory subphenotype throughout the study period (n = 22) were at higher risk of ARDS (36.4% versus 10.4%; p = 0.003).
Conclusion
Hyper- and non-hyper-inflammatory subphenotypes may precede ARDS development, remain identifiable over time, and can be identified upon presentation to the emergency department. A hyper-inflammatory subphenotype predicts worse outcomes.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Lung-protective mechanical ventilation strategies have been proven beneficial in the operating room (OR) and the ICU. However, differential practices in ventilator management persist, often resulting ...in adjustments of ventilator parameters when transitioning patients from the OR to the ICU.
To characterize patterns of ventilator adjustments during the transition of mechanically ventilated surgical patients from the OR to the ICU and assess their impact on 28-day mortality.
Hospital registry study including patients undergoing general anesthesia with continued, controlled mechanical ventilation in the ICU between 2008 and 2022. Ventilator parameters were assessed 1 hour before and 6 hours after the transition.
Of 2,103 patients, 212 (10.1%) died within 28 days. Upon OR-to-ICU transition, V
and driving pressure decreased (-1.1 ml/kg predicted body weight IQR, -2.0 to -0.2;
< 0.001; and -4.3 cm H
O -8.2 to -1.2;
< 0.001). Concomitantly, respiratory rates increased (+5.0 breaths/min 2.0 to 7.5;
< 0.001), resulting overall in slightly higher mechanical power (MP) in the ICU (+0.7 J/min -1.9 to 3.0;
< 0.001). In adjusted analysis, increases in MP were associated with a higher 28-day mortality rate (adjusted odds ratio, 1.10; 95% confidence interval, 1.06-1.14;
< 0.001; adjusted risk difference, 0.7%; 95% confidence interval, 0.4-1.0, both per 1 J/min).
During transition of mechanically ventilated patients from the OR to the ICU, ventilator adjustments resulting in higher MP were associated with a greater risk of 28-day mortality.
•ChatGPT aims to replicate human behavior in scientific research but its ability to emulate real-world human reviewers is yet to be discovered.•This study presents the first methodological ...qualitative assessment of ChatGPT's capability to imitate real human reviewers in scientific research.•Analysis of 720 comments by human reviewers, independently reviewed by researchers showing strong consensus, revealed that the majority of human reviewers’ comments (78.5 %) lacked equivalents in ChatGPT's comments.•Comments on context and methodology exhibited lower levels of complete and partial agreement compared to general comments.•ChatGPT version GPT-4 has a limited ability to emulate human reviewers within the peer review process of scientific research.
ChatGPT is an AI platform whose relevance in the peer review of scientific articles is steadily growing. Nonetheless, it has sparked debates over its potential biases and inaccuracies. This study aims to assess ChatGPT's ability to qualitatively emulate human reviewers in scientific research.
We included the first submitted version of the latest twenty original research articles published by the 3rd of July 2023, in a high-profile medical journal. Each article underwent evaluation by a minimum of three human reviewers during the initial review stage. Subsequently, three researchers with medical backgrounds and expertise in manuscript revision, independently and qualitatively assessed the agreement between the peer reviews generated by ChatGPT version GPT-4 and the comments provided by human reviewers for these articles. The level of agreement was categorized into complete, partial, none, or contradictory.
720 human reviewers’ comments were assessed. There was a good agreement between the three assessors (Overall kappa >0.6). ChatGPT's comments demonstrated complete agreement in terms of quality and substance with 48 (6.7 %) human reviewers’ comments, partially agreed with 92 (12.8 %), identifying issues necessitating further elaboration or recommending supplementary steps to address concerns, had no agreement with a significant 565 (78.5 %), and contradicted 15 (2.1 %). ChatGPT comments on methods had the lowest proportion of complete agreement (13 comments, 3.6 %), while general comments on the manuscript displayed the highest proportion of complete agreement (17 comments, 22.1 %).
ChatGPT version GPT-4 has a limited ability to emulate human reviewers within the peer review process of scientific research.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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