GPT-based chatbot tools are still unreliable in the management of prosthetic joint infections.

BACKGROUND: Artificial intelligence chatbot tools responses might discern patterns and correlations that may elude human observation, leading to more accurate and timely interventions. However, their reliability to answer healthcare-related questions is still debated. This study aimed to assess the performance of the three versions of GPT-based chatbots about prosthetic joint infections (PJI). METHODS: Thirty questions concerning the diagnosis and treatment of hip and knee PJIs, stratified by a priori established difficulty, were generated by a team of experts, and administered to ChatGPT 3.5, BingChat, and ChatGPT 4.0. Responses were rated by three orthopedic surgeons and two infectious diseases physicians using a five-point Likert-like scale with numerical values to quantify the quality of responses. Inter-rater reliability was assessed by interclass correlation statistics. RESULTS: Responses averaged "good-to-very good" for all chatbots examined, both in diagnosis and treatment, with no significant differences according to the difficulty of the questions. However, BingChat ratings were significantly lower in the treatment setting (p = 0.025), particularly in terms of accuracy (p = 0.02) and completeness (p = 0.004). Agreement in ratings among examiners appeared to be very poor. CONCLUSIONS: On average, the quality of responses is rated positively by experts, but with ratings that frequently may vary widely. This currently suggests that AI chatbot tools are still unreliable in the management of PJI.

The Avantage ® dual mobility cup in primary total hip arthroplasty: A registry study.

Background: Avantage Cup has been widely used in dual mobility implants. However, in Swedish Registry, the outcome of the Avantage Cup is reported with higher implants revision compared to control. The aim of our study was to verify if the same results are present in the Registry of Prosthetic Orthopedic Implants (RIPO) of Emilia Romagna (ER, Italy), as the Avantage cup was the most implanted dual mobility cup for a long follow-up reported in this Registry (2000-2012). Furthermore, we assessed the survival rate of the implant over the time. Methods: We included all patients that underwent a primary THA using the Avantage cup during the period 2000-2020 in RIPO Registry. The survivorship of the primary THA implants was calculated and plotted according to Kaplan-Meier method. Results: 886 Avantage cups were included in the analysis. During the observational period 44 hips were revised. The most common reasons for revision were: periprosthetic fractures (PPF) (n = 7, 0.8 %), deep infection (n = 7, 0.8 %), and cup aseptic loosening (n = 13, 1.5 %).The survival rate of the implant was 96.8 % (95.3-97.8) at 5 years, 95.7 at 10 years (94.0-97.0) and 92.1 at 15 years (88.5-94.6). Conclusion: In conclusion, this study has demonstrated that the Avantage cup in primary hip arthroplasty implanted with a "friendly" femoral stem granted satisfactory long-term survival. Therefore, in the Swedish Registry, the cause of the poor results presented for Avantage Cup could be the thick, rough neck stem of the widely used Lubinus stem.

Typical values of z-resolution for different Digital Breast Tomosynthesis systems evaluated in a multicenter study.

PURPOSE: The aim of the present study, conducted by a working group of the Italian Association of Medical Physics (AIFM), was to define typical z-resolution values for different digital breast tomosynthesis (DBT) models to be used as a reference for quality control (QC). Currently, there are no typical values published in internationally agreed QC protocols. METHODS: To characterize the z-resolution of the DBT models, the full width at half maximum (FWHM) of the artifact spread function (ASF), a technical parameter that quantifies the signal intensity of a detail along reconstructed planes, was analyzed. Five different commercial phantoms, CIRS Model 011, CIRS Model 015, Modular DBT phantom, Pixmam 3-D, and Tomophan, were evaluated on reconstructed DBT images and 82 DBT systems (6 vendors, 9 models) in use at 39 centers in Italy were involved. RESULTS: The ASF was found to be dependent on the detail size, the DBT angular acquisition range, the reconstruction algorithm and applied image processing. In particular, a progressively greater signal spread was observed as the detail size increased and the acquisition angle decreased. However, a clear correlation between signal spread and angular range width was not observed due to the different signal reconstruction and image processing strategies implemented in the algorithms developed by the vendors studied. CONCLUSIONS: The analysis led to the identification of typical z-resolution values for different DBT model-phantom configurations that could be used as a reference during a QC program.

End-to-end test for lung SBRT: An Italian multicentric pilot experience.

PURPOSE: Set up a lung SBRT end-to-end (e2e) test and perform a multicentre validation. MATERIAL AND METHODS: A group of medical physicists from four hospitals and the Italian Institute of Ionizing Radiation Metrology designed the present e2e test. One sub-group set up the test, while another tested its feasibility and ease of use. A satisfaction questionnaire was used to collect user feedback. Each participating centre (PC) received the ADAM breathing phantom, a microDiamond detector and radiochromic films. Following the e2e protocol, each PC performed its standard internal procedure for simulating, planning, and irradiating the phantom. Each PC uploaded its planning and treatment delivery data in a shared Google Drive. A single centre analyzed all the data. RESULTS: The e2e test was successfully performed by all PCs. Participants' comments indicated that ADAM was well suited to the purpose and the protocol well described. All PCs performed the test in static and dynamic modes. The ratio between measured and planned point dose obtained by PC1, PC2, PC3, PC4 was: 0.99, 0.96, 1.01 and 1.01 (static track) and 0.99, 1.02, 1.01 and 0.94 (dynamic track). The gamma passing rates (3 % global, 3 mm) between planned and measured dose maps were 98.5 %, 94.0 %, 99.1 % and 94.0 % (static track) and 99.5 %, 96.5 %, 86.0 % and 94.5 % (dynamic track) for PC1, PC2, PC3 and PC4, respectively. CONCLUSIONS: An e2e test for lung SBRT has been proposed and tested in a multicentre framework. The results and user feedback prove the validity of the proposed e2e test.

How the detector resolution affects the clinical significance of SBRT pre-treatment quality assurance results.

PURPOSE: Aim of this work was to study how the detector resolution can affect the clinical significance of SBRT pre-treatment volumetric modulated arc therapy (VMAT) verification results. METHODS: Three detectors (PTW OCTAVIUS 4D 729, 1500 and 100 SRS) used in five configurations with different resolution were compared: 729, 729 merged, 1500, 1500 merged and 1000 SRS. Absolute local gamma passing rates of 3D pre-treatment quality assurance (QA) were evaluated for 150 dose distributions in 30 plans. Five different kinds of error were introduced in order to establish the detection sensitivity of the three devices. Percentage dosimetric differences were evaluated between planned dosevolume histogram (DVH) and patients' predicted DVH calculated by PTW DVH 4D® software. RESULTS: The mean gamma passing rates and the standard deviations were 92.4% ±â€¯3.7%, 94.6% ±â€¯1.8%, 95.3% ±â€¯4.2%, 97.4% ±â€¯2.5% and 97.6% ±â€¯1.4 respectively for 729, 729 merged, 1500, 1500 merged and 1000 SRS with 2% local dose/2mm criterion. The same trend was found on the sensitivity analysis: using a tight gamma analysis criterion (2%L/1mm) only the 1000 SRS detected every kind of error, while 729 and 1500 merged detected three and four kinds of error respectively. Regarding dose metrics extracted from DVH curves, D50% was within the tolerance level in more than 90% of cases only for the 1000 SRS. CONCLUSIONS: The detector resolution can significantly affect the clinical significance of SBRT pre-treatment verification results. The choice of a detector with resolution suitable to the investigated field size is of main importance to avoid getting false positive.

CT image quality assessment by a Channelized Hotelling Observer (CHO): Application to protocol optimization.

In this work we investigate the feasibility of employing a Channelized Hotelling model Observer (CHO) in a CT protocol optimization program with the aim at assuring that the scanners are working at their own best with regard to the quality of images and patient exposure. Although the benefit of using model observers in the clinical protocol optimization is evident, in the practice it is still to be investigated what are the pitfalls associated with this method. With this concern we focused on a clinical protocol for oncology of the abdomen. For the implementation of CHO, we designed a new phantom with the aim of minimizing the number of acquired images. After tuning the model according to a restricted data set, we applied it to the evaluation of a large data set of images obtained with different reconstruction algorithms and acquired on different scanners. Results were very encouraging about the usefulness of CHO for the mentioned purposes. For the first time, at our knowledge, the applicability of CHO was demonstrated for images reconstructed with both filtered back projection (FBP) and iterative (IR) algorithms on the same scanner as well as for images from different scanners, though produced by the same manufacturer. Instead it turned out that CHO was not applicable for the same purposes over images from another manufacturer.

Advances in the FTU collective Thomson scattering system.

The new collective Thomson scattering diagnostic installed on the Frascati Tokamak Upgrade device started its first operations in 2014. The ongoing experiments investigate the presence of signals synchronous with rotating tearing mode islands, possibly due to parametric decay processes, and phenomena affecting electron cyclotron beam absorption or scattering measurements. The radiometric system, diagnostic layout, and data acquisition system were improved accordingly. The present status and near-term developments of the diagnostic are presented.

[Affective temperaments and psychopathological dimensions of personality in Bipolar Disorder]. / Temperamenti affettivi e dimensioni psicopatologiche di personalità nel Disturbo Bipolare.

OBJECTIVES: The first objective of our study is the evaluation of correlation between affective temperaments and psychopathological dimensions in a clinical sample of patients with Bipolar Disorder and the individualization of possible differences within the three diagnostic subtypes (bipolar I, II and cyclothymia). The second one is to observe whether any specific temperament may influence the number of hospitalizations or the age of the bipolar depression onset. MATERIALS AND METHODS: At the Bipolar Disorder Unit of Policlinico Gemelli (Rome, Italy) a group of 60 patients with Bipolar Disorder (BD) has been enrolled. All patients have been submitted to the TEMPS-A for the evaluation of affective temperament and TCI-R for the evaluation of psychopathological dimensions of personality. RESULTS: BD I group showed 5 significant correlations from moderate (r=0.40) to high degree (r=0.60). SD dimension of TCI shows 3 significant correlations with TEMPS-A dimensions: it is inversely correlated with Cyclothymia (r= -0.57; p<0.01), Irritability (r=0.60; p<0.01) and Anxiety (r=-.45; p<0.05). BDII group showed 5 significant correlations. Irritability dimension of TEMPS-A presented the highest number of correlations with TCI dimensions: it was inversely correlated to SD (r= -.65; p<0.01) and directly correlated with HA (r=0.48; p<0.05) and ST (r=-0.49; p<0.05). In the comparison of diagnostic groups with regards to temperamental dimensions, only Hyperthymia and Irritability dimensions were significative. CONCLUSIONS: Many works have evaluated temperament through the use of these two tools (TEMPS-A and TCI-R) but few have analysed correlation between them and none has focused attention on patients with bipolar disorder diagnosis only.

[Diagnosis of deficit and attention/hyperactivity disorders (ADHD) in patients with bipolar or unipolar depression: an experimental study]. / Diagnosi pregressa di Disturbo da Defi cit d'Attenzione/Iperattività (ADHD) in pazienti con Depressione Bipolare e Unipolare: uno studio sperimentale.

INTRODUCTION: The present research study starts up from the current scientific and academic interest concerning Deficit and Attention/Hyperactivity Disorders, which in this period seems to have an "epidemic" diffusion. Some authors have proved how the Deficit and Attention/Hyperactivity Disorder may predispose to the development of other psychopathological attitude in adulthood. A recent study has underlined a common comorbidity between ADHD in childhood and Bipolar Disorder. The aim of the present was to verify the existence of an ADHD diagnosis in patients with depression (Unipolar and Bipolar) and to verify if such syndrome overstays in the present psychopathological picture. Moreover there has been even the intention to investigate on a difference in ADHD symptomatology in patients with Bipolar and Unipolar Depression. MATERIALS AND METHODS: The study has been conducted on a sample of 67 patients with depression diagnosis (35 patients with bipolar depression diagnosis, 32 patients with depression unipolar diagnosis) enrolled at the Bipolar Disorders Unit of the Clinical Psychiatry and Drug Dependence Institute of the Policlinico Universitario A. Gemelli in Rome. The evaluation has been performed through the supply of the following psychometric tests: Neo Personality Inventory (Mole-pi-R), Brown Attention Deficit Disorder Scale (Brown ADD-Scale), Adult ADHD Self-Report Staircases (ASRS-v1.1), Criteria of the Deficit and Attention / Hyperactivity Disorder for childhood according to the DSM-IV-Tr. RESULTS: The achieved results point out that 42% of the sample has satisfied the ADHD Criterions during their childhood according to the DSM-IV-Tr and that symptomatology seems to remain in the present psychopathological picture. As to polarity of depression it has emerged that patients with Bipolar Depression diagnosis have satisfied with a greater frequency the ADHD criteria during their childhood than patients with Unipolar Depression. CONCLUSIONS: Our results seem to confirm the hypothesis that patients with bipolar depression diagnosis have more Deficit and Attention / Hyperactivity Disorders comorbidity diagnosis than others.

[Atypical jobs: current facts, health surveillance and monitoring]. / I lavori atipici: rilievi di attualità, sorveglianza sanitaria, vigilanza.

Based on the analysis of data collected during scientific studies and on the knowledge gained from the investigations on flexible or new forms of jobs it can be observed that the increasing amount of industrial accidents reporting and the existence of bad frame of mind are to be charged to the lack of training, to the uncertainty related to these type of jobs, to the short duration of the employment timeframe, to the difficulty of being in line with the company security standards, to risky activities, to immigrants who hardly get socially integrated, to workers with a low level of education and to their limited work experience. Since lots of studies have demonstrated that workers are fully unsatisfied when they recognize the uncertainty of their job situation it is mandatory to intervene on the real implementation of training, health control, emergency management and monitoring, thus avoiding any kind of marginalization. Given the complexity of these new forms of jobs, it will be up to the supervising institutions to look for new and adequate models and tools to monitor and control all the different situations, always keeping in mind all the relevant rules and laws.

Synergy of electron-cyclotron and lower-hybrid current drive in steady-state plasmas.

Improvement (up to a factor of approximately 4) of the electron-cyclotron (EC) current drive efficiency in plasmas sustained by lower-hybrid (LH) current drive has been demonstrated in stationary conditions on the Tore Supra tokamak. This was made possible by feedback controlled discharges at zero loop voltage, constant plasma current, and constant density. This effect, predicted by kinetic theory, results from a favorable interplay of the velocity space diffusions induced by the two waves: the EC wave pulling low-energy electrons out of the Maxwellian bulk, and the LH wave driving them to high parallel velocities.

Incidence of, and risk factors for, nosocomial infections among hematopoietic stem cell transplantation recipients, with impact on procedure-related mortality.

OBJECTIVES: To determine the incidence of, and risk factors for, nosocomial infections (NIs) occurring among hematopoietic stem cell transplantation (HSCT) recipients during hospitalization and to evaluate the impact of these NIs on patient outcome. DESIGN: A two-year prospective observational study in two HSCT units. PATIENTS: All patients admitted to the HSCT units between February 1997 and March 1999. SETTING: A teaching hospital. METHODS: After admission to the HSCT units, the patients were followed prospectively on a daily basis to collect all pertinent variables for the development of NIs. RESULTS: 49 NIs were identified in 34 of the 143 patients screened. The incidence of NIs and infected patients was 34.2% and 23.7%, respectively. The incidence density of NI was 8.96 per 1,000 patient-days. The most frequent NIs were bloodstream infections ([BSIs], 42.8%) and respiratory tract infections (28.6%). Other sites involved were as follows: eye (8.2%), urinary tract (6.1%), gastrointestinal tract (6.1%), skin (4.1%), ear (2%), and central venous catheter ([CVC], 2%). Because of the predominance and clinical relevance of BSIs, we examined both intrinsic and extrinsic risk factors associated with these infections. Independent risk factors for BSIs were allograft from matched unrelated or partially matched family donor, graft-versus-host disease (GVHD) prophylaxis without methotrexate (MTX), type of CVC, and duration of total parenteral nutrition. Four variables were independently associated with mortality occurring during hospitalization: culture-proven BSIs, advanced disease phase at transplant, type of transplant, and absence of MTX for GVHD prophylaxis. CONCLUSIONS: The study identified several factors associated with increased risk of BSIs among HSCT patients. Because BSIs are life-threatening complications for HSCT recipients, preventive measures aimed at reducing the incidence of these infections among patients given HSCT should be adopted.

Restorative and orthodontic treatment of maxillary peg incisors: a clinical report.

This clinical report describes a combination treatment approach to an esthetic defect that resulted from diastemata and peg-shaped lateral incisors. Minor tooth movement was achieved through the use of a removable orthodontic appliance and orthodontic rubber band, and full-coverage PFM crowns were placed on the lateral incisors. These complementary orthodontic and restorative procedures successfully corrected the defect.

Dynamics of tearing modes during strong electron cyclotron heating on the FTU tokamak.

The localized electron cyclotron resonance heating power that can suppress sawteeth reconnection often drives m = 2 tearing modes in a tokamak operating at constant current. The dynamics of mode onset and coupled mode evolution is described in detail and compared with a nonlinear theoretical model that identifies the effects of mode coupling, finite inertia of the rotating islands, and wall braking.

The contruction and replication properties of hybrid plasmids composed of the r-determinant of R100.1 and the plasmids pCRI and pSC201.

We have cloned the entire r-determinant of the antibiotic resistance plasmid R100.1 on the plasmic vectors pCR1 and pSC201. We find that the hybrid plasmids segregate from cultures in which replication of the vector is blocked. This suggests that the r-det is not capable of autonomous replication.

Self-annealing of Sendai virus RNA.

Both complementary strands are found in 50S Sendai virion RNA. 50S Sendai virion RNA has been shown to consist of unequal amounts of a single population of plus and minus strands by annealing studies.

Molecular weight determination of Sendai RNA by dimethyl sulfoxide gradient sedimentation.

The molecular weight of the large RNA of Sendai virus has been determined by sedimentation analysis in sucrose gradients containing 99% dimethyl sulfoxide (DMSO) to be 2.3 x 10(6). Sendai RNA recovered from 99% DMSO was found to cosediment with nondenatured Sendai RNA at 46 to 48s in ordinary sucrose gradients. The molecular weight value of 2.3 x 10(6) is considerably smaller than the estimates of 6 x 10(6) to 7 x 10(6) determined under nondenaturing conditions, suggesting a unique structure for Sendai RNA.