Medical students' perceptions of the impact of artificial intelligence in radiology.

OBJECTIVES: To analyse medical students' perceptions of the impact of artificial intelligence in radiology. MATERIAL AND METHODS: A structured questionnaire comprising 28 items organised into six sections was distributed to students of medicine in Spain in December 2019. RESULTS: A total of 341 students responded. Of these, 27 (7.9%) included radiology among their three main choices for specialization, and 51.9% considered that they clearly understood what artificial intelligence is. The overall rate of correct answers to the objective true-or-false questions about artificial intelligence was 70.7%. Whereas 75.9% expressed their disagreement with the hypothesis that artificial intelligence would replace radiologists, only 41.9% disagreed with the hypothesis that the demand for radiologists would decrease in the future. Only 36.7% expressed concerns about the role of artificial intelligence related to choosing radiology as a specialty. A greater proportion of students in the early years of medical school agreed with statements that radiologists accept artificial-intelligence-related technological changes and work with the industry to apply them as well as with statements about the need to include basic training about artificial intelligence in the medical school curriculum. CONCLUSIONS: The students surveyed are aware of the impact of artificial intelligence in daily life, but not of the current debate about its potential applications in radiology. In general, they think that artificial intelligence will revolutionise radiology without having an alarming effect on the employability of radiologists. The students surveyed think that it is necessary to provide basic training about artificial intelligence in undergraduate medical school programs.

Medical students' perceptions of the impact of artificial intelligence in radiology. / Percepciones de estudiantes de Medicina sobre el impacto de la inteligencia artificial en radiología.

OBJECTIVES: To analyze medical students' perceptions of the impact of artificial intelligence in radiology. MATERIAL AND METHODS: A structured questionnaire comprising 28 items organized into six sections was distributed to students of medicine in Spain in December 2019. RESULTS: A total of 341 students responded. Of these, 27 (7.9%) included radiology among their three main choices for specialization, and 51.9% considered that they clearly understood what artificial intelligence is. The overall rate of correct answers to the objective true-or-false questions about artificial intelligence was 70.7%. Whereas 75.9% expressed their disagreement with the hypothesis that artificial intelligence would replace radiologists, only 41.9% disagreed with the hypothesis that the demand for radiologists would decrease in the future. Only 36.7% expressed concerns about the role of artificial intelligence related to choosing radiology as a specialty. A greater proportion of students in the early years of medical school agreed with statements that radiologists accept artificial-intelligence-related technological changes and work with the industry to apply them as well as with statements about the need to include basic training about artificial intelligence in the medical school curriculum. CONCLUSIONS: The students surveyed are aware of the impact of artificial intelligence in daily life, but not of the current debate about its potential applications in radiology. In general, they think that artificial intelligence will revolutionize radiology without having an alarming effect on the employability of radiologists. The students surveyed think that it is necessary to provide basic training about artificial intelligence in undergraduate medical school programs.

Fluctuation electron microscopy study of crystal nucleation in TiO2-SiO2 glass with heat treatment.

We have used fluctuation electron microscopy (FEM) to investigate the nucleation stage of TiO2 crystal formation in binary TiO2-SiO2 glasses with heat treatment. It was found that spatial fluctuations of electron scattering in the glass with 13 wt% TiO2 increases with heat treatment above 800 °C but before any crystals precipitate, i.e. before crystals are detectable by electron diffraction. We have attributed this to TiO2 clustering and increasing medium-range order due to gradual ordering of TiO2 phase. Moreover, we have found that FEM is sensitive to structural changes at temperatures as low as 400 °C but the nature of the changes yet to be determined. This demonstrates that FEM can be sensitive to structural changes in oxide glasses occurring during thermal treatment but preceding detection of the first crystals.

[Telemedicine, prison and illness associated with HIV]. / Telemedicina, centros penitenciarios y enfermedad por VIH.

OBJECTIVE: Communicate the activity of telemedicine, from its opening, between a hospital consultation of infectious diseases and a penitentiary center. METHODS: Descriptive study of the tele-consultation of infectious diseases of the Alcorcón Foundation University Hospital with the Navalcarnero penitentiary center from 2013 to 2017, which is carried out by videoconference. The reason and number of consultations, diagnosis of HIV, antiretroviral treatment (ART), immunovirological situation, diagnosis of hepatitis C virus (HCV= and intervention performed by the infectious expert were analyzed. RESULTS: A total of 75 patients were evaluated in a total of 168 consultations (in the first year 11 consultations and in the fifth year 62). The index of successive / new consultations was 1.24 and 85% of the patients required less than 1 year of follow-up. 84% of patients did not move to the hospital. 99% of patients accepted this modality. 96% were HIV positive, 94% of them took ART and 85% had undetectable viral load with 532 CD4/mL of medium. 90% had positive serology for HCV. 72% of the consultations were for the assessment of HCV treatment, which was sofosbuvir/ledipasvir by 63%. 40% changed their ART (70% to avoid interactions). CONCLUSIONS: Most of the evaluated patients have HIV infection. This type of consultation has a growing demand, is efficient (avoids transfers and is decisive) and has high acceptance. The most frequent reason for consultation was the treatment of HCV and more than a third of patients required ART change.

Comparison of two dosage regimens of albuterol in acute asthma.

BACKGROUND: The standard therapy for acute episodes of asthma in the United States consists of three 2.5-mg doses of aerosolized albuterol given every 20 minutes. Whether this approach represents optimum therapy has never been tested. METHODS: This study employed a prospective, sequential design in which the effects of two doses of 5.0 mg of aerosolized albuterol administered during 40 minutes (high dose) were contrasted with the standard dose (three 2.5-mg doses). Improvements in pulmonary function, clinical resolution of the asthma attacks, and admission rates were used as primary endpoints. Both regimens were part of an overall care plan that involved objective, pretested decision algorithms. RESULTS: In an emergency department, 160 patients who presented with acute exacerbations of asthma received either standard (n = 80) or high-dose (n = 80) albuterol treatment. There were no significant baseline differences in gender, racial composition, clinical signs and symptoms, medication use, or peak expiratory flow (PEF) between the groups. Both treatment schedules were effective, but the high-dose regimen increased lung function more rapidly and to a greater extent than standard-dose therapy. It also resulted in lower charges to third party payers. More subjects attained the discharge criteria quicker and left the emergency department with peak expiratory flows closer to normal. Fewer patients in the high-dose group were admitted, but this trend did not quite reach statistical significance. CONCLUSIONS: Two 5.0-mg treatments of aerosolized albuterol at a 40-minute interval provide effective therapy for acute exacerbations of asthma. This combination of dose and frequency promotes maximum bronchodilatation, increases efficiency, and reduces the risks of undertreatment.

The influence of parasympatholytics on the resolution of acute attacks of asthma.

PURPOSE: To evaluate the role of parasympatholytics in the resolution of acute attacks of asthma. METHODS: This study employed a prospective sequential design in which the influence of 0.5 and 1.0 mg of ipratropium bromide on peak expiratory flow rates (PEFR), hospital admissions, and length of stay (LOS) in the emergency department (ED) was evaluated. The parasympatholytic was added to a well-investigated standard therapeutic regimen that was anchored by the use of repetitive doses of albuterol, and employed pretested decision algorithms. RESULTS: One hundred and thirty-one patients received ipratropium (l) and 123 who did not (NI) served as controls. There were no significant pretreatment between group differences in gender, racial composition clinical signs and symptoms, or PEFR. The presence of ipratropium in the regimen did not influence discharge/admission patterns, LOS, the rate of improvement of the patients, or the level of PEFR achieved. CONCLUSION: Anticholinergic agents such as ipratropium are not first-line treatments for acute asthma. They do not add any therapeutic benefit to the effects of albuterol given in divided doses over 1 hour, nor do they facilitate recovery in patients whose immediate response to sympathomimetics is impaired.

Tracheoplasty in a large tracheoesophageal fistula.

Postintubation tracheoesophageal fistulas (TEFs) are severe lesions that can be associated with tracheal stenosis and therapeutic difficulties. A case is reported of a woman with TEF and postintubation tracheal stenosis with 6.5 cm of affected trachea, and total esophageal exclusion. A tracheoplasty method is described patching the loss of the tracheal membranous wall with the posterior esophageal wall. In a final step, a self-expanded tracheal stent and esophagocolic bypass were added.

Effects of phorbol 12,13-diacetate on human isolated bronchus.

Protein kinase C appears to be involved in the regulation of airway contractility. Phorbol 12,13-diacetate (PDA; 0.01-10 microM), a protein kinase C activator, produced a transient relaxation followed by a sustained contraction of human isolated bronchus. Different protein kinase C inhibitors (calphostin C, staurosporine and 1-(5-isoquinolinesulfonyl)-2-methylpiperazine) (H-7), nifedipine (NIF; 1 microM) or incubation with Ca(2+)-free medium, inhibited the spasmogenic response to phorbol, while ouabain (10 microM) suppressed only the initial relaxation. These results indicate that the initial relaxation, in response to PDA, is related to the activation of Na(+)/K(+)-ATPase, while the ensuing contraction depends on extracellular Ca(2+) entry.Incubation with PDA (1-5 microM) depressed the maximal relaxation to theophylline and caffeine obtained at 37 degrees C but augmented the spasmogenic responses to methylxanthines (10 mM) obtained in cooled preparations. These effects do not result apparently from increased extracellular entry of Ca(2+), but instead, from facilitation of the release of Ca(2+) from intracellular stores.

Surgical treatment of lung carcinoma involving the chest wall.

From 1969 to 1986, 97 patients with chest wall invasion by lung carcinoma (excluding superior sulcus tumours) underwent surgical resection in two hospitals, La Paz (Madrid) and La Fé (Valencia). The same surgical policy was used in both thoracic surgical units: extrapleural pulmonary resection when tumour involved only the parietal pleura (N = 36), and en bloc chest wall resection when the carcinoma extended into the ribs and intercostal muscles (N = 61). The tumour histology was classified according the WHO criteria. Lobectomy or bilobectomy was carried out in 72%, pneumonectomy in 18% and segmentectomy or wedge resection in 10% of the patients. The perioperative mortality was higher in the en bloc resection group 9/61 (15%) versus 2/36 (6%) for extrapleural dissection. The node staging was NO in 58/97 (60%), N1 in 16/97 (16%) and N2 in 23/97 (24%). The probability of survival was calculated by the Kaplan-Meier method collecting data from the perioperative survivors only. The overall 5-year survival was 23% with no significant differences between the en bloc resection and the extrapleural lung resection groups. The most important predictor of survival was the node stage. The 5-year survival for N1 and N2 were 8% and 6%, respectively. These percentages increased to 34% when N0 patients were considered. Other predictors of survival were not significant. The authors conclude that either extrapleural or en bloc chest wall resection are both valid procedures which may be used depending on the depth of local invasion.

Successful revascularization of large isolated tracheal segments.

The omentum has been shown to be of use in clinical and experimental revascularization of tracheobronchial anastomoses. We have evaluated the possibility of revascularizing large and completely isolated tracheal segments while preserving the main tracheal characteristics. Ten experiments were performed in dogs, introducing 10-14 cartilage ring tracheal segments enveloped in omentum into the abdomen. Revascularization resulted in all cases with preservation of tracheal consistency. In only two cases were small mucosal necrotic zones observed. The experimental model thus appears to be of use in the revascularization of large tracheal segments, with excellent preservation of both cartilage and mucosa.

Management of non-tumoral tracheal stenosis in 112 patients.

From January 1973 to August 1989, 112 patients with non-tumoral tracheal strictures were treated in our unit. In 102 patients, the stenosis followed respiratory support. Eighty-one patients were treated surgically; the rest required only endoscopic therapy. In 28 patients, surgical treatment followed failure of endoscopic management. Of the patients submitted to surgery an isolated tracheal stenosis was present in 54 cases while a laryngotracheal stricture was the lesion in the other 27. Tracheal resection and end-to-end anastomosis was performed in the former group. Rethi, Pearson and Couraud procedures, respectively, were carried out in the latter. We emphasize the difference in the results achieved in the first 5 years and those obtained in the last 10 years. In the former period, 7 reoperations were needed. On the other hand, although the overall mortality of both series was 9%, it decreased to 2% during the last 10 years. Excellent or good ultimate results were achieved in 92% of survivors. Finally, we stress the differences in the proportion of reinterventions and definitive failures in the surgical treatment of isolated tracheal stenosis compared to laryngotracheal strictures.

Blunt chest injuries in 1696 patients.

We review 1696 patients with blunt chest trauma. Road traffic accidents were the main cause of injury followed by domestic falls and labour accidents. Outdoor falls and sport accidents accounted for a small number of injuries. For clinical evaluation, Stoddart's score was used. The injuries were considered as minor in 710 patients, intermediate in 740 and severe in 246. Global in-hospital mortality was low (5%) but increased to 37% when only patients with multiple severe injuries were considered. Thoracic wall fractures were present in 1419 patients. Flail chest was diagnosed in 140 patients and pulmonary contusion in 275. Diaphragmatic rupture was present in 40 patients and tracheobronchial injury in 6. Cardiovascular injuries occurred in 55 patients. Associated extrathoracic injuries were seen in 611 patients: 923 patients were clinically observed and/or medically treated. An intercostal tube was inserted in 638 patients. Thoracotomy was undertaken in 105 patients. Surgical fixation for flail chest was carried out in 29 patients. The results were generally good: 9 patients did not need any mechanical ventilation and 11 were ventilated for a short period. No deaths were due to the surgical procedure. The authors maintain that a selective attitude restricting, but not ignoring, surgical stabilization is the best policy.

The colon as oesophageal substitute in non-malignant disease. Long-term clinical results and functional studies.

Between 1974 and 1987, we performed 18 left colonic interpositions for benign oesophageal disease: caustic lesions in 6 patients, undilatable reflux stenosis in 5, reoperative peptic strictures in 5, penetrating wound in 1 and iatrogenic stricture following oesophagogastric transection for bleeding in 1. Four patients were women. The mean age was 40 +/- 19 years. In 10 patients a left thoracotomy was used; in the other 8 a cervico-abdominal approach was employed. One patient died postoperatively from liver failure. The mean follow-up was 11 +/- 4 years. Clinical results were excellent or good in 12 of the remaining 17 patients (71%). These results varied according to the length of colon interposition; in patients with long colonic interposition, poorer results were achieved. The motor activity of the colonic transplant was evaluated by manometric studies. After intraluminal injection of 30 ml of liquid, the colon responded uniformly with sequential peristaltic waves. Transmission of the oesophageal waves through the oesophagocolic anastomosis was studied in 2 patients. After wet swallows, the oesophageal contractile waves were followed by colonic waves. Solid radionuclide colonic transit studies were carried out in 18 control subjects and in 18 patients with colon interposition. In subjects with a normal oesophagus, the general pattern was rapid emptying of the bolus through the oesophagus. Findings in patients with a short transplant were similar to those observed in normal oesophagi. In most patients with long transplants the transit was abnormal.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluorimetric determination of gallium in a nickel alloy and aluminium with N-oxalylamine(salicylaldehyde hydrazone).

A fluorimetric determination of gallium, based on the formation of the fluorescent chelate with N-oxalylamine(salicylaldehyde hydrazone) (OSH)-Ga(III), is proposed. The complex has excitation and emission maxima at 395 and 475 nm, respectively. The detection limit is 3 ng/ml and Ga can be determined up to 277 ng/ml. The method has been applied to the determination of gallium in a nickel alloy and aluminium. Extraction with n-butyl acetate from 6M hydrochloric acid medium has been used to separate Ga from the interfering elements in the alloys.

Spectrophotometric determination of bismuth in pharmaceutical preparations using 1-[di(2-pyridyl)--methylene]-5-salicylidene-thiocarbonohydrazide.

A simple and fast spectrophotometric method for the determination of bismuth in pharmaceutical preparations is described. The used chromatic reactive is 1-[di(2-pyridyl)methylene]-5-salicilydene-thiocarbonohydrazide+ ++ forming a yellow complex with bismuth. In a solution containing 40% v/v of dimethylformamide molar absorption is 5.7 x 10(4) l.mol-1.cm-1 at 421 nm and at pH 4.3. The optimal conditions for the color development and the possible interferences are studied.

[Application of selection criteria in sequential double lung transplantation]. / Ampliación de los criterios de selección en el trasplante bipulmonar secuencial. Grupo de Trasplante Pulmonar de Valencia.

Since the first sequential double lung transplant was performed in 1986, such procedures have been increasing in number and the criteria used as indications for this type of surgery have broadened. Our aim was to reflect on the application of selection criteria and to describe the anesthetic and surgical techniques and postoperative follow-up of 72 patients who underwent this type of transplant surgery between March 1993 and December 1998. Actuarial survival five years after surgery was 74.4%. Among patients requiring transplantation after septic disease, actuarial survival was 90.8% for cystic fibrosis and 88.2% for bronchiectasis. Of the preoperative risk factors analyzed (prior surgery, pachypleuritis, multiresistant germs, poor nutrition, mechanical ventilation and corticoid therapy), only prior treatment with high doses of corticoids proved significant. Eleven patients have been diagnosed of bronchiolitis obliterans, four have died and only two continue to experience difficulties in daily living. The high survival rate and the restriction-free life after recovery lead us to consider sequential double lung transplantation to be the treatment of choice for all pulmonary diseases.

[Respiratory failure caused by megaesophagus and tracheomalacia]. / Détresse respiratoire par mégaoesophage et trachéomalacie.

We report a case of acute respiratory failure in an 83-year-old woman suffering from a megaoesophagus compressing the posterior tracheal wall. Naso-oesophageal aspiration did not allow tracheal extubation because of associated tracheomalacia. Treatment included tracheostomy and decrease of cardial tonus by administration of botulinic toxin, after weaning from mechanical ventilation.

[Extremely prolonged neuromuscular block after a single dose of rocuronium]. / Bloc neuromusculaire extrêmement prolongé après une dose unique de rocuronium.

Postoperative curarization in patients has been established. Nevertheless, extremely prolonged neuromuscular blockades are rare. We report the case of a prolonged neuromuscular blockade (lasting 10 hours) following a single dose of rocuronium, in an elderly patient with severe renal failure. We have studied the possible causes of prolonged curarization, and discussed the interest of the use of sugammadex in such cases.

Caracterización de la enfermedad respiratoria baja en pacientes menores de 5 años, hospitalizados en un centro de 3º nivel / Characterization of low respiratory disease in patients under 5 years old, hospitalized in a center of 3º level / Caracterização da doença respiratória baixa em pacientes menores de 5 anos, hospitalizados em centro de 3 níveis

Introducción: Caracterizar la enfermedad respiratoria baja en pacientes hospitalizados basados en el panel viral, como parte del programa de vigilancia epidemiológica en Bogotá, Colombia. Población y métodos: Trabajo retrospectivo transversal entre enero de 2010 y junio de 2011 en un hospital de tercer nivel, involucrando menores de 5 años, mediante inmunofluorescencia indirecta en aspirado nasofaríngeo para virus sincitial respiratorio (VSR), parainfluenza 1, 2, 3, influenza A, B y adenovirus. Resultados: Se obtuvieron 1063 casos, encontrándose un mayor número en el primer semestre del segundo año (145%). Los meses de mayor afectación fueron abril y mayo, siendo los hombres los más afectados. El promedio de edad fue de 8,18 meses; los menores de 1 año representaron el 75% de los casos y los menores de 2 años el 93%. En el 67% de los eventos no se aisló ninguno de los virus estudiados y en el 28% el VSR. El promedio de estancia hospitalaria fue de 7,11 días, siendo mayor para el VSR que para los otros virus o resultado negativo. El 51% recibió antibióticos. Conclusiones: Resultados similares a los descritos en la literatura pero analizados a la altura de Bogotá y en una comunidad de condición socioeconómica baja.

Introduction: Characterization of lower respiratory disease in hospitalized patients based on the viral panel as part of epidemiological surveillance program in Bogota, Colombia. Population and methods: Transversal retrospective study between January 2010 and June 2011 from a tertiary level hospital was developed with children younger than 5 years old. Indirect immunofluorescence in nasopharyngeal aspirate for respiratory syncytial virus (RSV), parainfluenza 1, 2, 3; influenza A, B and adenoviruses were analyzed. Results: 1063 cases were obtained, finding a greater number of cases in the first half of year (145%). The months with higher affectation were April and May, men being the most affected. The average age was 8.18 months; children under 1 year old accounted for 75% of cases and children under 2 years old 93%. In 67% of the events none of the studied virus was isolated and in 28% RSV. The average hospital stay was 7.11 days, being greater for RSV than for other viruses or negative. 51% received antibiotics. Conclusion: The results were similar to those described in the literature but analyzed at the height of Bogota and in a community of low socio-economic status.

Introdução: Caracterização da doença respiratória inferior em pacientes hospitalizados com base no painel viral como parte do programa de vigilância epidemiológica em Bogotá, Colômbia. População e métodos: Estudo transversal retrospectivo entre jeiro de 2010 e junho de 2011 de um hospital de nível terciário foi desenvolvido com crianças menores de 5 anos. Imunofluorescência indireta em aspirado nasofaríngeo para o vírus respiratório sincitial (VSR), parainfluenza 1, 2, 3; Influenza A, B e adenovírus foram analisados. Resultados: Foram obtidos 1063 casos, encontrando-se um maior número de casos na primeira metade do ano (145%). Os meses com maior afetação foram abril e maio, sendo os homens os mais afetados. A média de idade foi de 8,18 meses; Crianças menores de 1 ano representaram 75% dos casos e crianças menores de 2 anos 93%. Em 67% dos eventos nenhum dos vírus estudados foi isolado e em 28% RSV. A média de internação hospitalar foi de 7,11 dias, sendo maior para RSV do que para outros vírus ou negativos. 51% receberam antibióticos. Conclusão: Os resultados foram semelhantes aos descritos na literatura, mas analisados na altura de Bogotá e em uma comunidade de baixo status socioeconômico.