Gastroenterology Meets Machine Learning: Status Quo and Quo Vadis.

Background:Arteriovenous malformations (AVMs) of the corpus callosum (CC) are rare entities. We performed a systematic review of the available literature to better define the natural history, patient characteristics, and treatment options for these lesions.Methods:A MEDLINE, Google Scholar, and The Cochrane Library search were performed for studies published through June 2015. Data from all eligible studies were used to examine epidemiology, natural history, clinical features, treatment strategies, and outcomes of patients with CC-AVMs. A systematic review and pooled analysis of the literature were performed.Results:Our search yielded 37 reports and 230 patients. Mean age at presentation was 26.8 years (±13.12 years). AVMs were most commonly located in the splenium (43%), followed by the body (31%), and then the genu (23%) of the CC. A Spetzler-Martin grade of III was the most common (37%). One hundred eighty-seven (81.3%) patients presented with hemorrhage, 91 (40%) underwent microsurgical excision, and 87 (38%) underwent endovascular embolization. Radiosurgery was performed on 57 (25%) patients. Complete obliteration of the AVM was achieved in 102 (48.1%) patients and approximately twice as often when microsurgery was performed alone or in combination with other treatment modalities (94% vs. 49%; P < 0.001). Mean modified Rankin Scale (mRS) at presentation was 1.54 and mean mRS at last follow-up was 1.31. This difference was not statistically significant (P = 0.35).Conclusion:We present an analysis of the pooled data in the form of a systematic review focusing on management of CC-AVMs. This review aims to provide a valuable tool to aid in decision making when dealing with this particular subtype of AVM.

Current Resources for Evidence‐Based Practice January/February 2013

Recurrence after primary treatment of prostate cancer is one of the major challenges facing urologists. Biochemical recurrence is not rare and occurs in up to one third of the patients undergoing radical prostatectomy. Management of biochemical recurrence is tailored according to the site and the burden of recurrence. Therefore, developing an imaging technique to early detect recurrent lesions represents an urgent need. Positron emission tomography (PET) of 68Ga-labelled prostate-specific membrane antigen (68Ga-PSMA) is an emerging imaging modality that seems to be a promising tool with capability to localize recurrent prostate cancer. A systematic review of literature was done to evaluate the role of 68Ga-PSMA PET/CT scan in patients with recurrent prostate cancer after primary radical treatment. A systematic and comprehensive review of literature was performed in September 2017 analyzing the MEDLINE and Cochrane Library following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The following key terms were used for the search "PSMA," "prostate-specific membrane antigen," "positron emission tomography," "PET," "recurrent," "prostate cancer," "prostate neoplasm," "prostate malignancy," and "68Ga." Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Thirty-seven articles met our inclusion criteria and were included in the analysis of this systematic review. Of the 37 articles selected for analysis only four studies were prospective. The overall detection rate of 68Ga-PSMA PET scan ranged from 47% up to 96.6%. The main advantage of this imaging technique is its relatively high detection rates at low serum PSA levels below 0.5 ng/mL (ranging from 11.1% to 75%). Higher serum PSA level was strongly associated with increased positivity on 68Ga-PSMA PET scan. 68Ga-PSMA PET scan was found superior to conventional imaging techniques (CT and MRI) in this setting of patients and even it seems to outperform choline-based PET scan. This technique provided significant changes in the therapeutic management of 28.6-87.1% of patients. After biochemical recurrence, the primary goal is to locate the recurrent lesions' site. 68Ga-PSMA PET/CT seems to be effective in identifying recurrence localization also for very low levels of PSA (<0.5 ng/mL) thus permitting to choose the best therapeutic strategy as early as possible. However, data available cannot be considered exhaustive and prospective randomized trials are needed.

The objective of this study is to explore the use of ChatGPT(Chat-Generative Pre-Trained Transformer) in neurosurgery and its potential impact on the field. The authors aim to discuss, through a systematic review of current literature, how this rising new artificial intelligence (AI) technology may prove to be a useful tool in the future, weighing its potential benefits and limitations.The authors conducted a comprehensive and systematic literature review of the use of ChatGPT and its applications in healthcare and different neurosurgery topics. Through a systematic review of the literature, with a search strategy using the databases such as PubMed, Google Scholar, and Embase, we analyzed the advantages and limitations of using ChatGPT in neurosurgery and evaluated its potential impact.ChatGPT has demonstrated promising results in various applications, such as natural language processing, language translation, and text summarization. In neurosurgery, ChatGPT can assist in different areas such as surgical planning, image recognition, medical diagnosis, patient care, and scientific production. A total of 128 articles were retrieved from databases, where the final 22 articles were included for thorough analysis. The studies reviewed demonstrate the potential of AI and deep learning (DL), through language models such as ChatGPT, to improve the accuracy and efficiency of neurosurgical procedures, as well as diagnosis, treatment, and patient outcomes across various medical specialties, including neurosurgery. There are, however, limitations to its use, including the need for large datasets and the potential for errors in the output, which most authors concur will need human verification for the final application.Our search demonstrated the potential that ChatGPT holds for the present and future, in accordance with the studies'authors' findings herein analyzed and expert opinions. Further research and development are required to fully understand its capabilities and limitations. AI technology can serve as a useful tool to augment human intelligence; however, it is essential to use it in a responsible and ethical manner.

ABSTRACTBackgroundLittle attention in the literature appears to have been paid to the issue of postoperative weight-bearing protocols for different injury patterns after pelvic fracture surgery. The primary aim of this study is to review the currently available literature to define the level of available evidence used to inform surgical decisions on weight-bearing after pelvic fracture surgery. Secondary aims are to assess the published methods of fracture classification, surgical management, and assessment or reporting of patient outcomes.MethodsA systematic review of the English language literature from 1990 to 2016 was undertaken. Eligible papers were all papers reporting minimum 6-month outcomes following surgery for pelvic fractures in adults. Exclusion criteria included pathological fractures or those resulting from penetrating injury, solely osteoporotic fractures, or series with less than 6 months of follow-up data.ResultsThere is very little published scientific data to inform the treating surgeon on postoperative weight-bearing protocols after pelvic fracture surgery, with no randomized trials and only 1 paper out of 122 stating this as a primary aim. More than half of the papers published did not state what postoperative protocol was employed. There is no standardization of outcome measures, with less than 20% of papers using the most common validated outcome scoring system; in contrast, there is good agreement on the use of either the Tile (75%) or Burgess and Young (20%) classification.LimitationsDue to the lack of published studies looking at the topic of postoperative weight-bearing after pelvic fractures, no specific recommendations are possible. As large numbers of papers were included, they were not individually assessed for bias.ConclusionA review of postoperative weight-bearing regimes reveals a nonexistent scientific evidence base from which to make recommendations, although a consensus strategy has been identified. Future research needs to be directed at this topic, as has already been the case in numerous other fracture areas, since the advantages of early mobility are potentially significant. The reported methodology for assessing and reporting patient outcomes after pelvic fracture surgery reveals no consistent standards, and the majority of papers use no specific outcome scoring system.How to cite this articleRickman M, Link B-C, Solomon LB. Patient Weight-bearing after Pelvic Fracture Surgery—A Systematic Review of the Literature: What is the Modern Evidence Base? Strategies Trauma Limb Reconstr 2019;14(1):45–52.

PurposeBiodegradable implants are of major interest in orthopaedics, especially in the skeletally immature population. Magnesium (Mg) implants are promising for selected surgical procedure in adults, but evidence is lacking. Thus, the aim of this study is to analyze the safety and efficacy of resorbable Mg screw in different orthopaedic procedures in skeletally immature patients. In addition, we present a systematic review of the current literature on the clinical use of Mg implants.MethodsFrom 2018 until the writing of this manuscript, consecutive orthopaedic surgical procedures involving the use of Mg screws performed at our centre in patients < 15 years of age were retrospectively reviewed. In addition, a systematic review of the literature was performed in the main databases. We included clinical studies conducted on humans, using Mg-alloy implants for orthopaedic procedures.ResultsA total of 14 patients were included in this retrospective analysis. Mean age at surgery was 10.8 years (sd 2.4), mean follow-up was 13.8 months (sd 7.5). Healing was achieved in all the procedures, with no implant-related adverse reaction. No patients required any second surgical procedure. The systematic review evidenced 20 clinical studies, 19 of which conducted on an adult and one including paediatric patients.ConclusionEvidence on resorbable Mg implants is low but promising in adults and nearly absent in children. Our series included apophyseal avulsion, epiphyseal fractures, osteochondritis dissecans, displaced osteochondral fragment and tendon-to-bone fixation. Mg screws guaranteed stable fixation, without implant failure, with good clinical and radiological results and no adverse events.Level of evidenceIV – Single cohort retrospective analysis with systematic review

An imbalance of iron metabolism with consecutive aggregation of α-synuclein and axonal degeneration of neurons has been postulated as the main pathological feature in the development of Parkinson’s disease (PD). Quantitative susceptibility mapping (QSM) is a new imaging technique, which enables to measure structural changes caused by defective iron deposition in parkinsonian brains. Due to its novelty, its potential as a new imaging technique remains elusive for disease-specific characterization of motor and non-motor symptoms (characterizing the individual parkinsonian phenotype). Functional network changes associated with these symptoms are however frequently described for both magnetoencephalography (MEG) and resting state functional magnetic imaging (rs-fMRI). Here, we performed a systematic review of the current literature about QSM imaging, MEG and rs-fMRI in order to collect existing data about structural and functional changes caused by motor and non-motor symptoms in PD. Whereas all three techniques provide an effect in the motor domain, the understanding of network changes caused by non-motor symptoms is much more lacking for MEG and rs-fMRI, and does not yet really exist for QSM imaging. In order to better understand the influence of pathological iron distribution onto the functional outcome, whole-brain QSM analyses should be integrated in functional analyses (especially for the non-motor domain), to enable a proper pathophysiological interpretation of MEG and rs-fMRI network changes in PD. Herewith, a better understanding of the relationship between neuropathological changes, functional network changes and clinical phenotype might become possible.

CR Climate Research Contact the journal Facebook Twitter RSS Mailing List Subscribe to our mailing list via Mailchimp HomeLatest VolumeAbout the JournalEditorsSpecials CR 73:247-264 (2017) - DOI: https://doi.org/10.3354/cr01475 REVIEW Public perceptions of climate geoengineering: a systematic review of the literature Christopher L. Cummings1,*, Sapphire H. Lin1, Benjamin D. Trump2 1Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore 637718 2Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109, USA *Corresponding author: ccummings@ntu.edu.sg ABSTRACT: Geoengineering is a set of proposed large-scale technological fixes designed to curb anthropogenic climate change mostly through the reduction or neutralization of greenhouse gas emissions. While this set of technologies may provide significant benefit to future society, it may also be controversial for a variety of reasons including values-based objections and uncertainties regarding the manageability and potential irreversibility of the technologies. Studies of public perceptions of geoengineering have begun to elicit responses to these proposed technologies, yet the findings of such work are scattered across many publications, and represent the work of a variety of scholars using many methods to collect data. This work provides a systematic review of empirical literature regarding the methods and results of public perception studies of 2 distinct geoengineering approaches: carbon dioxide removal and solar radiation management. Reviewing public opinion data regarding these sets of technologies can provide a stronger basis of understanding that can empower anticipatory governance initiatives, future decision-making, and risk communication. We do not analyze public opinion studies regarding carbon dioxide capture and storage, as other reviews have been recently published elsewhere. Four key themes are identified and reviewed across studies: (1) support for research and use of geoengineering, (2) risk and benefit perceptions, (3) familiarity with geoengineering, and (4) trust in governing bodies. This review also discusses methodological issues pertaining to participant sampling and framing of geoengineering technologies within the reviewed studies. KEY WORDS: Public perception · Geoengineering · Risk and benefit perception · Familiarity · Trust Full text in pdf format PreviousCite this article as: Cummings CL, Lin SH, Trump BD (2017) Public perceptions of climate geoengineering: a systematic review of the literature. Clim Res 73:247-264. https://doi.org/10.3354/cr01475 Export citation RSS - Facebook - Tweet - linkedIn Cited by Published in CR Vol. 73, No. 3. Online publication date: September 13, 2017 Print ISSN: 0936-577X; Online ISSN: 1616-1572 Copyright © 2017 Inter-Research.

Organizations have long struggled with appropriate interventions to mitigate knowledge worker turnover. Because of their unique skills, knowledge workers have a considerably higher rate of turnover than traditional workers, and they are expensive to replace. Organizations use performance appraisal systems to identify and retain critical employees. Knowledge workers enable organizations to remain creative and innovative as well as maintain their competitive edge. The purpose of this study was to use systematic review of extant literature to show how organizations can effectively use performance appraisal systems to improve the retention of knowledge workers. This was done by gathering evidence on performance appraisal systems and knowledge workers from various databases and conducting a rigorous synthesis of available evidence. The efficacy of appraisal systems in mitigating knowledge worker churn was viewed through the lens of expectancy theory and a conceptual framework was developed. Expectancy theory focuses on an individual’s belief that they can obtain desired outcomes if they exert certain effort. Knowledge workers want to be challenged and evaluated based on objective criteria. A thematic analysis of the evidence revealed important themes for management practice: identify and segment knowledge workers, ensure a positive perception of the appraisal system via ‘voice’ inclusion, and deploy competent job evaluators for accurate performance evaluation. This is the first known systematic review of the literature which focuses on the competence of the appraiser as an important influence on knowledge workers’ reaction to appraisal outcome and how this impacts intention to quit.

Occipital neuralgia (ON) is a primary headache disorder characterized by severe, paroxysmal, shooting or stabbing pain in the distribution of the greater occipital, lesser occipital, and/or third occipital nerves. Both medical and surgical options exist for treating headaches related to ON. The purposes of this study are to summarize the current state of surgical ON management through a systematic review of the literature and, in doing so, objectively identify future directions of investigation. We performed a systematic review of primary literature on surgical management for ON of at least level IV evidence. Included studies were analyzed for level of evidence, therapeutic intervention, study design, sample size, follow-up duration, outcomes measured, results, and risk of bias. Twenty-two studies met the inclusion criteria. All 22 studies used patient-reported pain scores as an outcome metric. Other outcome metrics included complication rates (7 studies; 32%), patient satisfaction (7 studies; 32%), quality of life (7 studies; 18%), and analgesic usage (3 studies; 14%). Using the ROBINS-I tool for risk of bias in nonrandomized studies, 7 studies (32%) were found to be at critical risk of bias, whereas the remaining 15 studies (68%) were found to be at serious risk of bias. Greater occipital nerve decompression seems to be a useful treatment modality for medically refractory ON, but further prospective, randomized data are required.

Objective: Tumor-associated proptosis comprises a frequent phenomenon that negatively impacts quality of life in patients suffering from spheno-orbital meningioma (SOM). Therefore, proptosis outcome represents an important measure in meningioma surgery. In the current study, we analyzed our institutional database in order to evaluate the recovery of tumor-associated proptosis in patients with SOM.Methods: Between 2009 and 2019, 32 patients with SOM underwent surgical treatment at the authors' institution. The exophthalmos index (EI) was calculated by means of preoperative and postoperative tumor-associated proptosis. Patients with preoperative EI ≥ 1.1 were included in further analysis. Further, we performed a systematic review of the contemporary literature. Favorable proptosis outcome was defined as postoperative decreased EI compared with preoperative EI.Results: Overall, 25 of 32 patients with SOM (78%) suffered from preoperative proptosis in the present series. Preoperative mean EI of 1.37 ± 0.18 decreased after surgical treatment to a postoperative mean EI of 1.15 ± 0.1 during follow-up (p < 0.0001). Systematic review of the literature revealed three studies with individual data on preoperative and postoperative EI measurements leading to a total of 103 patients; 100 of 103 patients (97%) with SOM and preoperative proptosis achieved favorable outcome.Conclusions: The EI provides a comparable standard in evaluation of surgical outcome in patients with tumor-associated proptosis due to SOMs. The large dataset consisting of pooled individual patient data from the systematic review of the literature and the present case series support the assumption that surgical treatment is highly effective in the treatment of tumor-associated proptosis in SOM.

Systematic review of the literature was done to determine (1) the frequency and type of associated injuries, (2) frequency of concomitant Osgood-Schlatter disease, (3) methods of treatment, (4) functional and radiologic outcomes according to fracture type, and (5) complications of tibial tubercle fractures in pediatric patients. A systematic review of the English literature from 1970 to 2013 included 23 eligible articles reporting 336 fractures with a mean follow-up of 33.56 months (range, 5.7 to 115 mo). Fractures were classified by a comprehensive system that included characteristics of previous systems. Clinical outcomes were assessed by a qualitative scale (excellent/fair/poor), the rate of return to preinjury activity, and knee range of motion. Rate of fracture healing, associated injuries (patellar/quadriceps tendon avulsion and meniscal tears), compartment syndrome, and complications were also recorded. Mean age at surgery was 14.6 years and the most common fracture reported was type III (50.6%). The overall associated injury rate was 4.1%, most common in type III fractures (4.7%). Compartment syndrome was present in 3.57% of cases. Open reduction and internal fixation were done in 98% of surgical cases. Rates of return to preinjury activity and knee range of motion were 98%, regardless of the type of fracture. Fracture consolidation was achieved in 99.4% of cases. Overall complication rate was 28.3%; removal of an implant because of bursitis (55.8%) was most common. Tenderness/prominence (17.9%) and refracture (6.3%) were also common. Treatment of tibial tubercle fractures in adolescents produced good clinical and radiologic results regardless of fracture type, which was more related to potential complications. Fractures with intra-articular involvement tended to present with more associated injuries and to have fair functional outcomes, suggesting that advanced imaging may be justified with these fractures. Complications could be more common than expected without a significant effect on final outcome. Finally, there is a need for longer follow-up to determine long-term outcomes. Level III-systematic review of level III/IV studies.

Pharmacists have a valuable role in the management of allergic rhinitis (AR) at the community pharmacy level. This role has been reported extensively in numerous papers. However, a systematic review of the available literature and a comprehensive analysis of the outcomes has not been published. This systematic review aimed to evaluate the impact of interventions developed by pharmacists on clinical AR outcomes. A thorough search was performed in three electronic databases, including studies published between January 2000 and June 2019. After the selection process, only three articles met the inclusion criteria and were further analysed. Despite the scarcity of the available studies, in all of them was clear that the pharmacist plays a pivotal role in the management of AR, significantly improving the patients’ quality of life and symptom control. This systematic review also stresses the utmost importance to investigate and report practices and interventions developed by pharmacists using measurable outcomes.

Numerous techniques have been described to correct brow aesthetics in facial rejuvenation. We report the senior author's (A.M.) current approach for eyebrow elevation utilizing a lateral subcutaneous brow lift and, when indicated, a medial subgaleal brow lift. Furthermore, a systematic review of the literature was performed comparing the different surgical approaches and techniques. A systematic review of the literature was performed using the MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials databases. Studies were included if the content was original, provided outcome data, and complications. The senior author (A.M.) has performed over 500 lateral temporal subcutaneous brow lifts for lateral brow ptosis. The vast majority was highly satisfied with the outcome and there were minimal complications. This represents the largest series of patients utilizing this technique. Twenty-six articles were reviewed and 5 met our screening criteria and were analyzed critically for inclusion and further objective review. All of the studies were retrospective in nature and report high patient satisfaction with an acceptable risk profile. In this study, we described the largest series of patients undergoing lateral subcutaneous brow lifts (n > 500), as well as a systematic review of the current literature. The current literature described an overall high degree of patient satisfaction with low complication rates, similar to the senior author's (A.M.) experience. This technique has emerged as a reliable technique for lateral brow elevation with a very low and acceptable risk profile.

Background: Spinal cord injury (SCI) imposes a heavy burden on patients and health systems. Magnetic resonance imaging (MRI) provides a detailed evaluation of the spinal cord and associated soft tissues in a non-invasive manner. Objectives: We aimed to adopt and adapt suitable recommendations and guidelines in Iran for the utilization of MRI in the management of acute SCI patients based on available international guidelines and through a systematic review of literature, followed by guideline development based on the Delphi technique. Methods: After the primary systematic search and review of the literature and guidelines on the use of MRI in the management of acute SCI, all relevant recommendations were retrieved. Desired recommendations were then extracted and presented to our expert panel through the Delphi technique. The final decision for the inclusion or adaptation of recommendations to improve SCI care in the Iranian population was made through expert panel meetings. Results: Our literature search resulted in 769 records. Only three records provided recommendations on the role of MRI in the management of acute SCI, from which a total of six recommendations were extracted. Of these, the two final recommendations were extracted: (I) “Use MRI in adult patients with acute SCI prior to surgical interventions, when feasible, to facilitate clinical decision making,” and (II) “Use MRI in adult patients in the acute period following SCI and before or after surgical interventions (only when fixation is not used) to improve the prediction of neurologic outcomes following acute SCI.” Conclusions: The final recommendations help appropriately use MRI in patients with acute SCI, facilitating the management of these patients and improving their outcomes. This study shows that it is possible for developing countries to indigenize international guidelines, and with minor changes, an appropriate therapeutic framework can be created to improve service delivery.