Performance of Artificial Intelligence (AI)-Powered Chatbots in the Assessment of Medical Case Reports: Qualitative Insights From Simulated Scenarios.

Introduction With the expanding awareness and use of AI-powered chatbots, it seems possible that an increasing number of people could use them to assess and evaluate their medical symptoms. If chatbots are used for this purpose, that have not previously undergone a thorough medical evaluation for this specific use, various risks might arise. The aim of this study is to analyze and compare the performance of popular chatbots in differentiating between severe and less critical medical symptoms described from a patient's perspective and to examine the variations in substantive medical assessment accuracy and empathetic communication style among the chatbots' responses. Materials and methods Our study compared three different AI-supported chatbots - OpenAI's ChatGPT 3.5, Microsoft's Bing Chat, and Inflection's Pi AI. Three exemplary case reports for medical emergencies as well as three cases without an urgent reason for an emergency medical admission were constructed and analyzed. Each case report was accompanied by identical questions concerning the most likely suspected diagnosis and the urgency of an immediate medical evaluation. The respective answers of the chatbots were qualitatively compared with each other regarding the medical accuracy of the differential diagnoses mentioned and the conclusions drawn, as well as regarding patient-oriented and empathetic language. Results All examined chatbots were capable of providing medically plausible and probable diagnoses and classifying situations as acute or less critical. However, their responses varied slightly in the level of their urgency assessment. Clear differences could be seen in the level of detail of the differential diagnoses, the overall length of the answers, and how the chatbot dealt with the challenge of being confronted with medical issues. All given answers were comparable in terms of empathy level and comprehensibility. Conclusion Even AI chatbots that are not designed for medical applications already offer substantial guidance in assessing typical medical emergency indications but should always be provided with a disclaimer. In responding to medical queries, characteristic differences emerge among chatbots in the extent and style of their respective answers. Given the lack of medical supervision of many established chatbots, subsequent studies, and experiences are essential to clarify whether a more extensive use of these chatbots for medical concerns will have a positive impact on healthcare or rather pose major medical risks.

Long-Term effects of COVID-19: a review of current perspectives and mechanistic insights.

Although SARS-CoV-2, responsible for COVID-19, is primarily a respiratory infection, a broad spectrum of cardiac, pulmonary, neurologic, and metabolic complications can occur. More than 50 long-term symptoms of COVID-19 have been described, and as many as 80% of patients may develop ≥1 long-term symptom. To summarize current perspectives of long-term sequelae of COVID-19, we conducted a PubMed search describing the long-term cardiovascular, pulmonary, gastrointestinal, and neurologic effects post-SARS-CoV-2 infection and mechanistic insights and risk factors for the above-mentioned sequelae. Emerging risk factors of long-term sequelae include older age (≥65 years), female sex, Black or Asian race, Hispanic ethnicity, and presence of comorbidities. There is an urgent need to better understand ongoing effects of COVID-19. Prospective studies evaluating long-term effects of COVID-19 in all body systems and patient groups will facilitate appropriate management and assess burden of care. Clinicians should ensure patients are followed up and managed appropriately, especially those in at-risk groups. Healthcare systems worldwide need to develop approaches to follow-up and support patients recovering from COVID-19. Surveillance programs can enhance prevention and treatment efforts for those most vulnerable.

Interrelation between Tween and the membrane properties and high pressure tolerance of Lactobacillus plantarum.

Tween® 80 is a frequently used supplement of media for the cultivation of lactic acid bacteria. We investigated its effect on the cell physiology and stress tolerance of Lactobacillus (L.) plantarum. Data on the transcriptomic response to Tween 80 supplementation and its effects on cellular fatty acid profiles and growth characteristics are compared with data characterizing the effect of Tween 80, other Tween types and free fatty acids on the high hydrostatic pressure (HHP) tolerance of L. plantarum strain TMW 1.708. These include effects on cell viability, sub-lethal injury, metabolic activity, protein release and propidium iodide uptake. Tween 80 caused the downregulation of fatty acid biosynthesis and an increase in oleic acid and cyclopropane fatty acid levels in the cell membrane. Tween 20, Tween 80 and free oleic acid, but not Tween 40, Tween 60 and other free fatty acids, conferred resistance against HHP. Tween 80 diminished pressure-induced loss of metabolic activity, protein release and uptake of propidium iodide. However, loss of cell viability exceeded by far membrane permeabilization, suggesting that membrane permeabilization, which has frequently been postulated as a major factor in HHP inactivation of microbes, is not necessarily required for HHP-induced cell death of Lactobacillus plantarum.

Inactivation of non-proteolytic Clostridium botulinum type E in low-acid foods and phosphate buffer by heat and pressure.

The effect of high pressure thermal (HPT) treatments on the inactivation of spores of non-proteolytic type E Clostridium botulinum TMW 2.990 was investigated at high pressures (300 to 600 MPa) and elevated temperatures (80 to 100 °C) in four low-acid foods (steamed sole, green peas with ham, vegetable soup, braised veal) and imidazole phosphate buffer (IPB). In addition, corresponding conventional thermal treatments at ambient pressure were performed to expose possible synergisms of pressure and temperature on spore inactivation. In general, spore count reduction was more efficient by combining pressure and temperatures < 100 °C and the overall process duration could be shortened due to accelerated heating rates (adiabatic effect). Processing at 90 °C and 600 MPa resulted in inactivation below the detection limit after 5 min in all foods except steamed sole. Traditional thermal processing of spores at 90 °C for 10 min, on the other hand, did not result in an estimated 6-log reduction. Additional HPT treatments in steamed sole and IPB did not reveal pronounced food matrix dependent protective effects. Here, varying pressure levels did not appear to be the driving force for spore count reduction in steamed sole at any temperature. By applying a Weibull distribution on destruction kinetics of isobaric/isothermal holding times, 6D-values were calculated. Compression and decompression phase (1 s pressure holding time) had a considerable impact on spore count reduction (max. -2.9 log units) in both, foods and buffer. Hence, compression and decompression phases should directly be included into the total lethal effect of HPT treatments to avoid prolonged holding times and overprocessing.

The preservation of Listeria-critical foods by a combination of endolysin and high hydrostatic pressure.

The aim of this work was to examine the combination of endolysin PlyP825 and high hydrostatic pressure (HHP) processing against a cocktail of stationary phase Listeria monocytogenes cells in several Listeria-critical food products (i.e. milk, mozzarella and smoked salmon). In order to determine the efficacy of the combined application, both challenge-lethality tests and storage tests were performed. In milk and mozzarella, we could demonstrate that the application of PlyP825 prior to HHP processing allowed for a synergistic inactivation of cells, a reduction in the pressure level with equal antimicrobial efficacy and an enhanced eradication of L. monocytogenes during storage at abuse temperatures. For smoked salmon, no such effects were detected. Although the efficacy of the method was highly dependent on the food vehicle and parameters applied, we hereby demonstrated the potential of the combined endolysin-HHP application for complete eradication of L. monocytogenes from foods at milder processing conditions.

Non-linear pressure/temperature-dependence of high pressure thermal inactivation of proteolytic Clostridium botulinum type B in foods.

The effect of high pressure thermal (HPT) processing on the inactivation of spores of proteolytic type B Clostridium botulinum TMW 2.357 in four differently composed low-acid foods (green peas with ham, steamed sole, vegetable soup, braised veal) was studied in an industrially feasible pressure range and temperatures between 100 and 120°C. Inactivation curves exhibited rapid inactivation during compression and decompression followed by strong tailing effects. The highest inactivation (approx. 6-log cycle reduction) was obtained in braised veal at 600 MPa and 110°C after 300 s pressure-holding time. In general, inactivation curves exhibited similar negative exponential shapes, but maximum achievable inactivation levels were lower in foods with higher fat contents. At high treatment temperatures, spore inactivation was more effective at lower pressure levels (300 vs. 600 MPa), which indicates a non-linear pressure/temperature-dependence of the HPT spore inactivation efficiency. A comparison of spore inactivation levels achievable using HPT treatments versus a conventional heat sterilization treatment (121.1°C, 3 min) illustrates the potential of combining high pressures and temperatures to replace conventional retorting with the possibility to reduce the process temperature or shorten the processing time. Finally, experiments using varying spore inoculation levels suggested the presence of a resistant fraction comprising approximately 0.01% of a spore population as reason for the pronounced tailing effects in survivor curves. The loss of the high resistance properties upon cultivation indicates that those differences develop during sporulation and are not linked to permanent modifications at the genetic level.

Combination of endolysins and high pressure to inactivate Listeria monocytogenes.

Outbreaks of listeriosis are often related to the consumption of low-processed ready-to-eat food products (e.g. soft cheeses or smoked fish) contaminated with Listeria monocytogenes. Traditional preservation techniques, such as heat treatment, cannot eliminate Listeria from these products without strongly affecting the quality of the foods. We therefore investigated the use of endolysin (PlyP40, Ply511, or PlyP825) in combination with high hydrostatic pressure processing to kill L. monocytogenes in buffer. The results demonstrated a more than additive effect when both treatments were combined. For example, whereas 0.16 µg/mL PlyP825 or 300 MPa (1 min, 30 °C) applied individually reduced the cell count by 0.2 and 0.3 log cfu, respectively, a combined treatment resulted in a reduction of 5.5 log cfu. Similar results were obtained for the other endolysins combined with high pressure processing. We also showed that the synergistic inactivation of cells by endolysin and HHP is possible at a pressure level of only 200 MPa (2 min, 30 °C). Thus, the application of endolysins did not only substantially increase the bactericidal effect of high pressure, but it also enabled the inactivation of bacterial cells at much lower pressure levels. This shows the potential of using such combined processes for the inactivation of L. monocytogenes and food preservation.

High pressure thermal inactivation of Clostridium botulinum type E endospores - kinetic modeling and mechanistic insights.

Cold-tolerant, neurotoxigenic, endospore forming Clostridium (C.) botulinum type E belongs to the non-proteolytic physiological C. botulinum group II, is primarily associated with aquatic environments, and presents a safety risk for seafood. High pressure thermal (HPT) processing exploiting the synergistic effect of pressure and temperature can be used to inactivate bacterial endospores. We investigated the inactivation of C. botulinum type E spores by (near) isothermal HPT treatments at 300-1200 MPa at 30-75°C for 1 s to 10 min. The occurrence of heat and lysozyme susceptible spore fractions after such treatments was determined. The experimental data were modeled to obtain kinetic parameters and represented graphically by isoeffect lines. In contrast to findings for spores of other species and within the range of treatment parameters applied, zones of spore stabilization (lower inactivation than heat treatments alone), large heat susceptible (HPT-induced germinated) or lysozyme-dependently germinable (damaged coat layer) spore fractions were not detected. Inactivation followed first order kinetics. Dipicolinic acid release kinetics allowed for insights into possible inactivation mechanisms suggesting a (poorly effective) physiologic-like (similar to nutrient-induced) germination at ≤450 MPa/≤45°C and non-physiological germination at >500 MPa/>60-70°C. Results of this study support the existence of some commonalities in the HPT inactivation mechanism of C. botulinum type E spores and Bacillus spores although both organisms have significantly different HPT resistance properties. The information presented here contributes to closing the gap in knowledge regarding the HPT inactivation of spore formers relevant to food safety and may help industrial implementation of HPT processing. The markedly lower HPT resistance of C. botulinum type E spores compared with the resistance of spores from other C. botulinum types could allow for the implementation of milder processes without endangering food safety.

Pressure-Based Strategy for the Inactivation of Spores.

Since the first application of high hydrostatic pressure (HHP) for food preservation more than 100 years ago, a wealth of knowledge has been gained on molecular mechanisms underlying the HHP-mediated destruction of microorganisms. However, one observation made back then is still valid, i.e. that HHP alone is not sufficient for the complete inactivation of bacterial endospores. To achieve "commercial sterility" of low-acid foods, i.e. inactivation of spores capable of growing in a specific product under typical storage conditions, a combination of HHP with other hurdles is required (most effectively with heat (HPT)). Although HPT processes are not yet industrially applied, continuous technical progress and increasing consumer demand for minimally processed, additive-free food with long shelf life, makes HPT sterilization a promising alternative to thermal processing.In recent years, considerable progress has been made in understanding the response of spores of the model organism B. subtilis to HPT treatments and detailed insights into some basic mechanisms in Clostridium species shed new light on differences in the HPT-mediated inactivation of Bacillus and Clostridium spores. In this chapter, current knowledge on sporulation and germination processes, which presents the basis for understanding development and loss of the extreme resistance properties of spores, is summarized highlighting commonalities and differences between Bacillus and Clostridium species. In this context, the effect of HPT treatments on spores, inactivation mechanism and kinetics, the role of population heterogeneity, and influence factors on the results of inactivation studies are discussed.

Differential effects of sporulation temperature on the high pressure resistance of Clostridium botulinum type E spores and the interconnection with sporulation medium cation contents.

High pressure thermal (HPT) processing can be used to improve traditional preservation methods and increase food safety and durability, whereas quality related characteristics can be largely maintained. Clostridium (C.) botulinum type E is a non-proteolytic, psychrotrophic, toxin-producing spore former, commonly associated with aquatic environments in temperate regions of the northern hemisphere. Sporulation in nature is likely to occur under varying conditions including temperature and nutrient availability, which might affect resistance properties of resulting spores. In our study, we determined the effect of sporulation temperature (13-38 °C) on the resistance of three Clostridium botulinum type E strains to differently intense HPT treatments (200 MPa at 40 and 80 °C, and 800 MPa at 40 and 80 °C). Furthermore, the effect of cations on sporulation temperature-mediated alterations in HHP resistance was investigated. Results indicate that low and high sporulation temperatures can increase and decrease sporal HPT resistance, respectively, in a treatment-dependent (pressure level, treatment temperature) manner, whereas the trends observed are largely unaffected by pressure dwells (1 s-10 min). Furthermore, results show that the cation content of the sporulation medium (Ca(2+), Mg(2+), Mn(2+)) marginally influences and partially counteracts effects on the HPT resistance of spores grown at low and elevated temperatures, respectively. This suggests that sporulation temperature and medium cations provoke changes in some common spore resistance structures. Sporulation conditions can markedly affect spore resistance properties and, thus, should be considered for the experimental setup of worst case studies aiming to evaluate the effectiveness of food processes in terms of the inactivation of C. botulinum type E spores.

Effect of sporulation medium and its divalent cation content on the heat and high pressure resistance of Clostridium botulinum type E spores.

Clostridium (C.) botulinum type E belongs to the non-proteolytic physiological C. botulinum group II and produces the highly potent Botulinum neurotoxin E (BoNT/E) even at refrigerated temperatures. As C. botulinum type E spores are highly prevalent in aquatic environments, seafood and fishery products are commonly associated with this organism. Hydrostatic high pressure (HHP) treatments, or treatments combining HHP with elevated temperatures (HHPT), can be used to improve traditional preservation methods and increase food safety, quality and durability. In this study, we assessed the effect of different sporulation media and cation concentration on the heat resistance, HHP resistance, and HHPT resistance of spores from three C. botulinum type E strains. SFE (sediment fish extract) sporulation media yielded the most resistant spores, whereas, in M140 media, the least resistant spores were produced. Furthermore our results indicate that the divalent cation content (Ca(2+), Mg(2+) and Mn(2+)) plays a role in the differential development of C. botulinum type E spore resistance to heat, HHP and HHPT in different media. Calcium cations confer heat and HPPT resistance to spores, while high amounts of magnesium cations appear to have a negative effect. Manganese cations in low concentrations are important for the development resistance to HPP and HPPT treatments, but not heat alone. This study provides valuable information on the nature of non-proteolytic C. botulinum type E spores grown in different media. The data provided here can be useful to the food industry and to researchers when considering spore properties in food safety risk assessment and the experimental design of future inactivation studies.

Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia.

BACKGROUND: This paper describes a randomized prospective study conducted in 308 patients undergoing caesarean section in spinal anaesthesia at a single hospital between 2010 and 2012 to find a suitable anti-emetic strategy for these patients. MATERIAL AND METHODS: Spinal anesthesia was performed in left prone position, at L3/L4 with hyperbaric 0.5% Bupivacaine according to a cc/cm body height ratio. There were no opioids given peri-operatively. The patients received either no prophylaxis (Group I) or tropisetron and metoclopramide (Group II) or dimenhydrinate and dexamethasone (Group III), or tropisetron as a single medication (Group IV). The primary outcome was nausea and/or vomiting (NV) in the intraoperative, early (0-2 h) or late (2-24 h) postoperative period. Multivariate statistical analysis was conducted with a regression analysis and a backward elimination of factors without significant correlation. RESULTS: All prophylactic agents significantly reduced NV incidence intraoperatively. Relative risk reduction for NV by prophylaxis was most effective (59.5%) in Group II (tropisetron and metoclopramide). In Group III (dimenhydrinate and dexamethasone), NV risk was reduced by 29.9% and by 28.7% in Group IV (tropisetron mono-therapy). The incidence of NV in the early (0?2 h) and the late (2?24 h) postoperative period was low all over (7.8%), but the relative risk reduction of NV in the early postoperative period was 54.1% (Group IV), 45.1% (Group III), and 34.8% (Group II), respectively. In the late postoperative period, there was no significant difference between the 4 groups. CONCLUSIONS: We recommend a prophylactic medication with tropisetron 2 mg and metoclopramide 20 mg for patients during caesarean section. These agents are safe, reasonably priced, and highly efficient in preventing nausea and vomiting.

Technological evolution of diagnostic testing in oncology.

Diagnostic testing has been improving the quality of cancer care. The dynamics of this field can be grasped through the application of innovation lifecycle models. Single testing, parallel testing and whole-genome sequencing are major technological evolutions. Given the increasing availability of biomarkers, the performance of single testing will be limited in the future, favoring the further implementation of parallel testing technologies. Whole-genome sequencing will lead to a further performance increase by introducing the era of genomic medicine. A broad adoption of presently available diagnostic technologies sets up the infrastructure for future technologies. The speed at which these technologies are introduced depends heavily on the regulatory and reimbursement environment, while their final diffusion is subject to pragmatic criteria such as user friendliness, perceived risk and perceived value added.

Prophylaxis of postoperative nausea and vomiting in elective breast surgery.

STUDY OBJECTIVE: To evaluate strategies to treat postoperative nausea and vomiting (PONV) in patients undergoing elective breast surgery. DESIGN: Prospective, randomized, double-blinded, placebo-controlled trial. SETTING: University-affiliated hospital. PATIENTS: 480 patients with risk factors for PONV. INTERVENTIONS: Patients were randomized to three groups to receive an antiemetic prophylactic combination of haloperidol and tropisetron (Group HT), dimenhydrinate and dexamethasone (Group DD), or no prophylaxis (Group P). Anesthesia was maintained with volatile anesthesia (desflurane or sevoflurane) and fentanyl or total intravenous anesthesia (TIVA). MEASUREMENTS: Incidence of nausea, emesis, or both in the early (0 - 2 hrs) and late (2 - 24 hrs) postoperative periods were recorded, as were the number of episodes and the time of each occurrence; and patient assessment of the PONV experience on a scale comparable to a numeric rating scale (NRS). MAIN RESULTS: Both antiemetic combinations significantly reduced PONV incidence. In patients who received no prophylaxis, PONV incidence was 48.2% in patients given volatile anesthetics and 43.8% in those who received TIVA. PONV incidence was 17.5% in the Group HT patients who received volatile anesthetics, and 25% in the Group HT patients who received TIVA. PONV incidence was 11.4% in Group DD patients given volatile anesthetics, and 15% in Group DD patients receiving TIVA. TIVA reduced the incidence of PONV in the early postoperative period (0-2 hrs), but increased PONV incidence in the late period (2-24 hrs). Patients given TIVA with propofol and remifentanil intraoperatively required more opioids postoperatively than patients given volatile anesthetics. CONCLUSION: The frequency of PONV was reduced significantly with both antiemetic combinations.

Sub-lethal stress effects on virulence gene expression in Enterococcus faecalis.

Enterococci are ubiquitous lactic acid bacteria commonly associated with the human digestive tract as commensal organisms. Additionally, these organisms have a long history of use in foods improving flavor as well as providing protective mechanisms as either a probiotic or antimicrobial additive. However, Enterococcus faecalis accounts for up to 10% of all nosocomial infections of the bloodstream, wounds, urinary tract and heart. Knowledge about the regulation of virulence factors is limited and the involvement of environmental signals contributing to E. faecalis pathogenicity is poorly documented. In this study, two clinical E. faecalis isolates, TMW 2.63 and OG1RF, as well as one food isolate, TMW 2.629, were subjected to six sub-lethal food- and host-related stresses including 6.8% NaCl, 200 ppm nitrite, 51 degrees C, 80 MPa, pH 4.1 and 0.08% bile salts (cholic acid:chenodeoxycholic acid 1:1), respectively, reducing their growth rate to 10%. Relative gene expression of 15 stress and virulence-associated genes including dnaK, groEL, ctsR, clpPBCEX, gls24, efaAfs, ace, fsrB, gelE, sprE and cylB, was quantified by using real time PCR and Lightcycler((R)) technology (reference conditions: BHI broth, 37 degrees C, pH = 7.4). Apart from strain-dependent differences, sub-lethal environmental stress was capable of provoking significant alterations in the expression of virulence-associated genes in E. faecalis from clinical as well as food origins of isolation. These results help to avoid preconditioning enterococci in food production processes and to understand the complex mechanisms in E. faecalis' switch to pathogenicity.

Increased arterial oxygen content by artificial haemoglobin induces a decrease in regional cerebral blood flow and decreased regional cerebral oxygen delivery.

BACKGROUND AND OBJECTIVE: Under physiological conditions, cerebral oxygen delivery is kept constant by adaptation of the regional cerebral blood flow (CBF) in relation to the oxygen content. So far, decreases of the regional CBF induced by a higher arterial oxygen content have been produced under hyperbaric or hyperviscous conditions. We tested whether local CBF is also reduced by a high haemoglobin (Hb) concentration at a normal haematocrit (Hct). METHODS: Compared with controls (n=8), Hb content was increased to 19 g dl(-1) in conscious rats by isovolaemic replacement of the plasma fraction with an artificially high Hb solution (Hb-based oxygen carriers; HH group, n=8). In another group (n=8), Hct was decreased by isovolaemic exchange with an Hb-based oxygen carrier resulting in a normal Hb content (NH group). Mean and regional CBF was measured by iodo-[(14)C]-antipyrine autoradiography. Oxygen delivery was calculated from arterial oxygen content and CBF. RESULTS: Compared with the controls (Hb 15.3 g dl(-1), Hct 0.44), mean CBF was lower in the HH (Hb 20.3 g dl(-1), Hct 0.44) group by 23% (P < or = 0.05), but remained unchanged in the NH group (Hb 15.0 g dl(-1), Hct 0.29). On a local level, hyperoxygenation reduced CBF in 22 out of 39 brain regions. In the NH group mean CBF was unchanged, whereas local CBF was higher in 10 areas. In both groups, overall cerebral oxygen delivery was unchanged compared with the control group. Locally though, high arterial Hb content decreased oxygen delivery in one-third of the brain structures. CONCLUSION: Whereas the overall cerebral oxygen delivery in the brain is maintained during hyperoxygenation and haemodilution, local oxygen delivery is decreased by high arterial Hb content in some brain regions.

Regional heterogeneity of cerebral blood flow response to graded pressure-controlled hemorrhage.

BACKGROUND: Little is known about the regional distribution of cerebral blood flow (CBF) in nonanesthetized animals during periods of lowered blood pressure. The present investigation addresses the specific reaction patterns of local cerebral blood flow (LCBF) in comparison with mean CBF during graded pressure-controlled hemorrhagic shock in conscious rats. METHODS: Conscious rats were subjected to graded pressure-controlled hemorrhage (to 85, 70, 55, or 40 mm Hg) by arterial blood withdrawal. After a period of 30 minutes, blood pressure was stabilized by withdrawal or reinfusion of blood. LCBF was determined autoradiographically by the iodo(14C)antipyrine method in 34 brain structures, and mean CBF was calculated and compared with the values of nonhemorrhaged control animals. RESULTS: Mean CBF remained unchanged except for the group with the lowest blood pressure of 40 mm Hg (decrease in CBF of 28%). Otherwise, LCBF was increased in some brain structures at an unchanged mean CBF. Congruently, at 40 mm Hg, the decrease in mean CBF did not show up in all brain structures, the local pattern of CBF varying between an unchanged and a profoundly decreased CBF. The mean coefficient of variation of CBF was increased with the severity of hemorrhagic shock, which indicates an enhanced heterogeneity of CBF. CONCLUSION: Because of the substantial heterogeneity in the responses of LCBF to pressure-controlled hemorrhage, autoregulation of CBF during pressure-controlled hemorrhagic shock has to be reconsidered on a regional basis.