- MeSH
- posudkové řízení MeSH
- psaní * MeSH
- umělá inteligence * MeSH
- Publikační typ
- časopisecké články MeSH
- komentáře MeSH
V posledních letech se v ČR stává využívání koloběžek stále populárnějším způsobem dopravy, zejména ve velkých městech. S nárůstem popularity však přichází i alarmující nárůst počtu úrazů, které jsou s tímto typem dopravy spojeny. Tento článek prezentuje výsledky retrospektivní studie, která hodnotila klinické a demografické charakteristiky pacientů s těmito úrazy, vč. diagnóz, výsledků a komplikací. Z analýzy bylo zjištěno, že v Ústřední vojenské nemocnici bylo v letech 2010–2022 ošetřeno 21 pacientů s úrazy hlavy a krku spojenými s jízdou na koloběžkách. Hlavní diagnózy zahrnovaly akutní subdurální hematom (5; 24 %), intracerebrální hematom (1; 5 %), kontuze mozku (5; 24 %), frakturu lbi (2; 10 %) a poranění obličejového skeletu (8; 38 %). Ze závažných komplikujících diagnóz nesouvisejících s kraniofaciálním poraněním se vyskytlo postižení axiálního skeletu (2; 10 %) a tenzní pneumotorax (1; 5 %). Hospitalizace byla nutná u 71 % pacientů a neurochirurgická intervence byla provedena u 4 pacientů. Závažným problémem je jízda na koloběžkách v ebrietě a pod vlivem omamných látek, která byla zjištěna v 29 % případů. Tyto výsledky poukazují na potřebu zvýšené opatrnosti a bezpečnosti při používání koloběžek.
In recent years, the use of scooters has become an increasingly popular mode of transport in the Czech Republic, especially in large cities. However, with the increase in popularity comes an alarming increase in the number of accidents associated with this type of transport. This article presents the results of a retrospective study that evaluated the clinical and demographic characteristics of patients with these injuries, including diagnoses, outcomes, and complications. The analysis found that 21 patients with head and neck injuries associated with riding scooters were treated at the Central Military Hospital between 2010 and 2022. Major diagnoses included acute subdural hematoma (5; 24%), intracerebral hematoma (1; 5%), brain contusion (5; 24%), skull fracture (2; 10%) and facial skeletal injury (8; 38%). Of the serious complicating diagnoses not related to craniofacial injury, involvement of axial skeletal injury (2; 10%) and tension pneumothorax (1; 5%) occurred. Hospitalization was required in 71% of patients and neurosurgical intervention was performed in 4 patients. A serious problem is riding scooters while under the influence of alcohol and narcotics, which was found in 29% of cases. These results point to the need for increased caution and safety when using scooters.
- Klíčová slova
- bezpečnost silničního provozu, koloběžka,
- MeSH
- akutní subdurální hematom etiologie MeSH
- dopravní nehody * MeSH
- kontuze mozku etiologie MeSH
- kraniocerebrální traumata * etiologie MeSH
- lidé MeSH
- poranění obličeje etiologie MeSH
- retrospektivní studie MeSH
- traumatické intracerebrální krvácení etiologie MeSH
- úrazy a nehody MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Artificial intelligence (AI) has advanced substantially in recent years, transforming many industries and improving the way people live and work. In scientific research, AI can enhance the quality and efficiency of data analysis and publication. However, AI has also opened up the possibility of generating high-quality fraudulent papers that are difficult to detect, raising important questions about the integrity of scientific research and the trustworthiness of published papers. OBJECTIVE: The aim of this study was to investigate the capabilities of current AI language models in generating high-quality fraudulent medical articles. We hypothesized that modern AI models can create highly convincing fraudulent papers that can easily deceive readers and even experienced researchers. METHODS: This proof-of-concept study used ChatGPT (Chat Generative Pre-trained Transformer) powered by the GPT-3 (Generative Pre-trained Transformer 3) language model to generate a fraudulent scientific article related to neurosurgery. GPT-3 is a large language model developed by OpenAI that uses deep learning algorithms to generate human-like text in response to prompts given by users. The model was trained on a massive corpus of text from the internet and is capable of generating high-quality text in a variety of languages and on various topics. The authors posed questions and prompts to the model and refined them iteratively as the model generated the responses. The goal was to create a completely fabricated article including the abstract, introduction, material and methods, discussion, references, charts, etc. Once the article was generated, it was reviewed for accuracy and coherence by experts in the fields of neurosurgery, psychiatry, and statistics and compared to existing similar articles. RESULTS: The study found that the AI language model can create a highly convincing fraudulent article that resembled a genuine scientific paper in terms of word usage, sentence structure, and overall composition. The AI-generated article included standard sections such as introduction, material and methods, results, and discussion, as well a data sheet. It consisted of 1992 words and 17 citations, and the whole process of article creation took approximately 1 hour without any special training of the human user. However, there were some concerns and specific mistakes identified in the generated article, specifically in the references. CONCLUSIONS: The study demonstrates the potential of current AI language models to generate completely fabricated scientific articles. Although the papers look sophisticated and seemingly flawless, expert readers may identify semantic inaccuracies and errors upon closer inspection. We highlight the need for increased vigilance and better detection methods to combat the potential misuse of AI in scientific research. At the same time, it is important to recognize the potential benefits of using AI language models in genuine scientific writing and research, such as manuscript preparation and language editing.
- MeSH
- algoritmy * MeSH
- analýza dat MeSH
- jazyk (prostředek komunikace) MeSH
- lidé MeSH
- sémantika MeSH
- umělá inteligence * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
This study aims to develop a fully automated imaging protocol independent system for pituitary adenoma segmentation from magnetic resonance imaging (MRI) scans that can work without user interaction and evaluate its accuracy and utility for clinical applications. We trained two independent artificial neural networks on MRI scans of 394 patients. The scans were acquired according to various imaging protocols over the course of 11 years on 1.5T and 3T MRI systems. The segmentation model assigned a class label to each input pixel (pituitary adenoma, internal carotid artery, normal pituitary gland, background). The slice segmentation model classified slices as clinically relevant (structures of interest in slice) or irrelevant (anterior or posterior to sella turcica). We used MRI data of another 99 patients to evaluate the performance of the model during training. We validated the model on a prospective cohort of 28 patients, Dice coefficients of 0.910, 0.719, and 0.240 for tumour, internal carotid artery, and normal gland labels, respectively, were achieved. The slice selection model achieved 82.5% accuracy, 88.7% sensitivity, 76.7% specificity, and an AUC of 0.904. A human expert rated 71.4% of the segmentation results as accurate, 21.4% as slightly inaccurate, and 7.1% as coarsely inaccurate. Our model achieved good results comparable with recent works of other authors on the largest dataset to date and generalized well for various imaging protocols. We discussed future clinical applications, and their considerations. Models and frameworks for clinical use have yet to be developed and evaluated.
- MeSH
- adenom * diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- nádory hypofýzy * diagnostické zobrazování chirurgie MeSH
- neuronové sítě (počítačové) MeSH
- počítačové zpracování obrazu metody MeSH
- prospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: To examine published data and assess evidence relating to safety and efficacy of surgical management of symptomatic pineal cysts without hydrocephalus (nhSPC), we performed a systematic review of the literature and meta-analysis. METHODS: Following the PRISMA guidelines, we searched Pubmed and SCOPUS for all reports with the query 'Pineal Cyst' AND 'Surgery' as of March 2021, without constraints on study design, publication year or status (PROSPERO_CRD:42,021,242,517). Assessment of 1537 hits identified 26 reports that met inclusion and exclusion criteria. RESULTS: All 26 input studies were either case reports or single-centre retrospective cohorts. The majority of outcome data were derived from routine physician-recorded notes. A total of 294 patients with surgically managed nhSPC were identified. Demographics: Mean age was 29 (range: 4-63) with 77% females. Mean cyst size was 15 mm (5-35). Supracerebellar-infratentorial approach was adopted in 90% of cases, occipital-transtentorial in 9%, and was not reported in 1%. Most patients were managed by cyst resection (96%), and the remainder by fenestration. Mean post-operative follow-up was 35 months (0-228). PRESENTATION: Headache was the commonest symptom (87%), followed by visual (54%), nausea/vomit (34%) and vertigo/dizziness (31%). Other symptoms included focal neurology (25%), sleep disturbance (17%), cognitive impairment (16%), loss of consciousness (11%), gait disturbance (11%), fatigue (10%), 'psychiatric' (2%) and seizures (1%). Mean number of symptoms reported at presentation was 3 (0-9). OUTCOMES: Improvement rate was 93% (to minimise reporting bias only consecutive cases from cohort studies were considered, N = 280) and was independent of presentation. Predictors of better outcomes were large cyst size (OR = 5.76; 95% CI: 1.74-19.02) and resection over fenestration (OR = 12.64; 3.07-52.01). Age predicted worse outcomes (OR = 0.95; 0.91-0.99). Overall complication rate was 17% and this was independent of any patient characteristics. Complications with long-term consequences occurred in 10 cases (3.6%): visual disturbance (3), chronic incisional pain (2), sensory disturbance (1), fatigue (1), cervicalgia (1), cerebellar stroke (1) and mortality due to myocardial infarction (1). CONCLUSIONS: Although the results support the role of surgery in the management of nhSPCs, they have to be interpreted with a great deal of caution as the current evidence is limited, consisting only of case reports and retrospective surgical series. Inherent to such studies are inhomogeneity and incompleteness of data, selection bias and bias related to assessment of outcome carried out by the treating surgeon in the majority of cases. Prospective studies with patient-reported and objective outcome assessment are needed to provide higher level of evidence.
- MeSH
- cysty * chirurgie MeSH
- dospělí MeSH
- epifýza mozková * chirurgie MeSH
- hydrocefalus * etiologie chirurgie MeSH
- lidé MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- přehledy MeSH
- systematický přehled MeSH
Pituitary adenoma surgery has evolved rapidly in recent decades, changing clinical practice markedly and raising new challenges. There is no current consensus or guidelines for perioperative care that includes possible complication management. This study aims to determine current practice across European neurosurgical centres. We created a list of eligible departments performing pituitary adenoma surgery based on cooperation with EANS, national neurosurgical societies, and personal communication with local neurosurgeons. We contacted the chairpersons from each department and asked them (or another responsible neurosurgeon) to fill out the survey. The survey consisted of 58 questions. For further analysis, departments were divided into subgroups: "academic"/ "non-academic centre", "high-volume"/"low-volume", "mainly endoscopic"/ "mainly microscopic"/ "mixed practise", and by geographical regions. Data from 254 departments from 34 countries were obtained. The average time to complete the survey was 18 min. Notably, the endoscopic approach is the predominant surgical approach in Europe, used in 56.8% of the centres. In routine cases without intraoperative cerebrospinal fluid leak, high-volume centres are less pedantic with sellar closure when compared with low-volume centres (p < 0.001). On the other hand, when a postoperative cerebrospinal fluid leak occurs, high-volume centres are more active and indicate early reoperation (p = 0.013). Less than 15% of the participating centres perform early postoperative MRI scans. Marked variation was noted among different groups of respondents and some contentious issues are discussed. Such information can encourage useful debate about the reasons for the variations seen and perhaps help develop standardised protocols to improve patient outcomes. A future research focus is to compare European results with other regions.
- MeSH
- adenom * chirurgie MeSH
- endoskopie MeSH
- lidé MeSH
- nádory hypofýzy * chirurgie MeSH
- průzkumy a dotazníky MeSH
- retrospektivní studie MeSH
- únik mozkomíšního moku MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Pineal apoplexy is a rare condition, with unknown incidence and clinical significance. To elucidate this clinical condition, we analyzed our own case series and performed a review of the literature. METHODS: We enrolled all patients with a hemorrhagic pineal apoplexy who were referred to our department between January 2000 and January 2020. Hemorrhagic pineal apoplexy was defined as the presence of fluid-fluid levels inside the pineal cyst (PC) on an axial or sagittal magnetic resonance scan. In one patient, after PC apoplexy, we performed a circadian melatonin sampling from peripheral blood to determine the function of the pineal gland. The PubMed database was searched for publications using the terms "pineal" and "apoplexy." RESULTS: Eight patients were enrolled, of which three patients underwent surgical treatment and five patients were managed conservatively. One patient was tested for circadian melatonin secretion. Results confirmed melatonin secretion with preserved physiologic circadian rhythm.Our search of the literature led us to 31 studies that comprised 30 patients with apoplectic PC, 9 with apoplectic pineal tumor, and 1 with bleeding into the normal pineal gland. Most patients presented with headache, nausea, and vomiting, less frequently with acute hydrocephalus and gaze palsy. Twenty patients with a PC underwent resection or aspiration. Two patients underwent shunt placement as the only procedure and five received both shunt and surgical removal. Six patients with a PC were observed without surgical treatment. All the nine patients with a pineal tumor were operated on. In indicated cases, four patients received radiation therapy and one received chemotherapy. CONCLUSION: Clinical significance of hemorrhagic pineal apoplexy ranges from an asymptomatic course to rapid deterioration and death. In patients with mild symptoms, observation is indicated, whereas surgical treatment is reserved for severe cases presenting with obstructive hydrocephalus and includes cerebrospinal fluid diversion, resection of apoplectic pineal lesions, or both.
Hormone-secreting adenomas are treated in many neurosurgical centers within Europe. The goal of the survey is to understand variance in practice management of pituitary tumors amongst neurosurgical centers. A list of departments performing pituitary surgery was created. The survey consisted of 58 questions. This study focuses on neurosurgical care of hormone-secreting adenomas. For analysis, the departments were divided into four subgroups: academic/non-academic, high-volume/low-volume, "mainly endoscopic/mainly microscopic practice" and geographical regions. Data from 254 departments from 34 countries were obtained. Most centers surgically treat 1-5 hormone-secreting adenomas per year. In prolactinomas this is the case in 194 centers, (76.4%), in GH-secreting adenomas: 133 centers, (52.4%), ACTH-secreting adenomas: 172 centers, (69.8%). Surgery as a primary treatment of prolactinomas is considered in 64 centers (25.2%). In 47 centers (18.8%), GH-secreting microadenomas are often treated pharmacologically first. Debulking surgery for an invasive GH-secreting adenoma in which hormonal remission is not a realistic goal of the surgery and the patient has no visual deficit surgery is always or mostly indicated in 156 centers (62.9%). Routine postoperative hydrocortisone replacement therapy is administered in 147 centers (58.6%). Our survey shows that in most centers, few hormone-secreting adenomas are treated per year. In about 25% of the centers, prolactinoma surgery may be regarded as first-line treatment; in about 20% of the centers, medical treatment is the first-line treatment for GH-secreting adenomas. Pretreatment for ACTH-secreting adenomas is routinely used in 21% of centers. This survey may serve as plea for neurosurgical care centralization of hormone-secreting adenomas.
