Is generative pre-trained transformer artificial intelligence (Chat-GPT) a reliable tool for guidelines synthesis? A preliminary evaluation for biologic CRSwNP therapy.

INTRODUCTION: Biologic therapies for Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) have emerged as an auspicious treatment alternative. However, the ideal patient population, dosage, and treatment duration are yet to be well-defined. Moreover, biologic therapy has disadvantages, such as high costs and limited access. The proposal of a novel Artificial Intelligence (AI) algorithm offers an intriguing solution for optimizing decision-making protocols. METHODS: The AI algorithm was initially programmed to conduct a systematic literature review searching for the current primary guidelines on biologics' clinical efficacy and safety in treating CRSwNP. The review included a total of 12 studies: 6 systematic reviews, 4 expert consensus guidelines, and 2 surveys. Simultaneously, two independent human researchers conducted a literature search to compare the results. Subsequently, the AI was tasked to critically analyze the identified papers, highlighting strengths and weaknesses, thereby creating a decision-making algorithm and pyramid flow chart. RESULTS: The studies evaluated various biologics, including monoclonal antibodies targeting Interleukin-5 (IL-5), IL-4, IL-13, and Immunoglobulin E (IgE), assessing their effectiveness in different patient populations, such as those with comorbid asthma or refractory CRSwNP. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha subunit, demonstrated significant improvement in nasal symptoms and quality of life in patients with CRSwNP in several randomized controlled trials and systematic reviews. Similarly, mepolizumab and reslizumab, which target IL-5, have also shown efficacy in reducing nasal polyp burden and improving symptoms in patients with CRSwNP, particularly those with comorbid asthma. However, additional studies are required to confirm the long-term efficacy and safety of these biologics in treating CRSwNP. CONCLUSIONS: Biologic therapies have surfaced as a promising treatment option for patients with severe or refractory CRSwNP; however, the optimal patient population, dosage, and treatment duration are yet to be defined. The application of AI in decision-making protocols and the creation of therapeutic algorithms for biologic drug selection, could offer fascinating future prospects in the management of CRSwNP.

Endoscopic Extended Sinus Surgery for Patients with Severe Chronic Rhinosinusitis with Nasal Polyps, the Choice of Mucoplasty: A Systematic Review.

PURPOSE OF REVIEW: The advances in the knowledge of the molecular basis of the inflammatory response in chronic rhinosinusitis with nasal polyps (CRSwNP) have led the management of these patients towards personalized and precision medicine. Surgery has been positioned as a suitable alternative in patients who do not achieve control with appropriate medical treatment, but polypoid recurrences remain a constraint. The emergence of new surgical approaches based on patient phenotyping and the poor disease control associated with type 2 inflammatory phenotype makes it necessary to review the role of personalized and precision surgery in managing the disease. RECENT FINDINGS: Surgical approaches based on wide resection of bony sinus structures and the treatment of mucosa lining the sinonasal cavity have been analyzed and compared with other techniques and seem to offer more favorable surgical outcomes and improved quality of life (QoL), in addition to lower relapse rates. The innovations with new complementary surgical techniques, such as reboot surgery adding an extended autologous mucosal graft from the nasal floor (mucoplasty), may benefit endoscopic and QoL outcomes in the most severe CRSwNP patients with type 2 phenotype. Using bilateral endonasal mucoplasty as a complementary technique to reboot surgery is a suitable technical choice that has improved short- and medium-term QoL and endoscopic outcomes for patients with severe CRSwNP. These results are likely due to a combination of the extension of reboot and the inherent inflammatory and healing properties of mucoplasty. We propose this technique as a valuable surgical resource, although more robust clinical studies are needed to evaluate its long-term benefits comprehensively.

Omalizumab Treatment in Uncontrolled Asthma and CRSwNP Patients, with Previous Endoscopic Sinus Surgery, to Improve Quality of Life and Endoscopic Outcomes: a Two-Year Real-Life Study.

PURPOSE OF REVIEW: Despite molecular underlying advances, limited and divergent data on monoclonal antibodies (mAb) therapy in chronic rhinosinusitis with nasal polyps (CRSwNP) make further analysis necessary. The objective of this study is to evaluate the effect of omalizumab as an adjunct to endoscopic sinus surgery (ESS) on the treatment of CRSwNP under real-life conditions. RECENT FINDINGS: Since the introduction of omalizumab, as the first biologic agent for the treatment of diseases such as severe allergic asthma, different studies have demonstrated an effect of omalizumab on CRSwNP, with significant improvements in sinonasal symptoms and endoscopic scores. The high efficacy derived from mAb therapy and the need for ESS prior to mAb recommended by guidelines, has led to compare both therapeutic alternatives, finding discrepancies in their effect on quality of life (QoL) and complementary tests outcomes. Patients with moderate-to-severe asthma with clinical criteria for omalizumab indication, and coexistent CRSwNP disease, were selected for a non-randomized interventional retrospective study into four treatment subgroups. Measures were analyzed and compared between groups and over time at the baseline, 16 weeks and 1 and 2 years after treatment. Omalizumab treatment in patients with previous ESS exhibited an earlier and more pronounced improvement in QoL, symptoms scale and endoscopic findings (nasal polyp score and the bilateral modified Lund-Kennedy) as early from week 16, which improvement persisted for 2 years. A greater mean improvement of 33.4 ± 6.5 (95% CI: 20.3-46.4; p < 0.001) points in sinonasal outcome test 22 (SNOT-22) was associated with ESS at week 16, against omalizumab effect (17.8 ± 7.6 [95% CI: 2.6-33.0]; p = 0.023). At year 2, an improvement in SNOT-22 of 62.6 ± 8.9 (95% CI: 48.4-84.1; p < 0.001) points was exclusively associated with omalizumab. Clinical evidence of the effect of omalizumab added to ESS treatment is provided in this study in the short- and long-term.

Impact of mobilization of residents in otolaryngology-head-neck surgery in COVID-19 units on mental health status.

BACKGROUND: To investigate mental health, sleep, and addiction features of young otolaryngologists (YO) according to the mobilization in COVID-19 units at the end of the third European wave of infections. METHODS: A cross-sectional survey was sent to 220 YO of 6 European University hospitals. The following outcomes were evaluated: postgraduate year; age; management of COVID-19 patients; workload; nights on call; stress; Beck depression inventory; Insomnia severity index; sleep and mental health status evolutions throughout pandemic; consumption of alcohol, tobacco, and drugs before and during pandemic. RESULTS: A total of 128 YO completed the evaluations (58.2%). Twenty responders (15.6%) did not manage COVID-19 patients, while 65 (50.8%), 20 (15.6%), and 23 (18%) managed rarely, frequently or daily COVID-19 patients during the pandemic, respectively. The management of COVID-19 patients was associated with increases of workload (p = 0.023) and number of nights on-call (p < 0.001). At the end of the third wave, the depression rates were 34% (N = 31/68) and 57% (N = 34/60) in YO who worked less and more than 50 h weekly, respectively. Sleep disturbance concerned 39% (N = 26/66) and 55% (N = 27/60) of YO who worked less and more than 50 h weekly, respectively. Mobilized YO reported a significant increase of alcohol consumption compared with control group (p = 0.002). Tobacco and drugs consumptions did not evolve. The consumption of alcohol was positively correlated with the number of nights on-call (p = 0.036) and the total hours of work (p = 0.009). CONCLUSIONS: Young otolaryngologists (YO) mobilized in COVID-19 units reported higher hours worked, nights on call, and alcohol consumption compared with others. Future large cohort-studies are needed to confirm our observations.

Chronic rhinosinusitis with nasal polyps management in the biologic therapy era: an international YO-IFOS survey.

PURPOSE: To investigate the consistency between the international guidelines recommendations and worldwide standard practices regarding diagnostic work-up and follow-up strategies for managing patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the era of monoclonal antibodies. METHODS: A questionnaire developed by the Rhinology section of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (Yo-IFOS) included items regarding the management of CRSwNP patients, monoclonal prescription, surgical and follow-up procedures, awareness of biologicals availability, and other relevant clinical practices. The online survey was directed to otolaryngologists and distributed in Europe, North America, South America, and the Middle East through otolaryngological and/or rhinological societies. RESULTS: A total of 202 responses were analyzed; the mean participants' age was 45 ± 11 (73% men and 27% women), and 31% were from the United States, Canada 19%, Europe 45%, Middle East and South America 5%. Only 60% of the respondents declared using validated symptoms and endoscopic score systems in their clinical practice. Several practice discrepancies emerged in our cohort, including preferred surgical approach, prescription of preoperative oral steroids, and perioperative antibiotics (59% and 58%, respectively), as well as divergent awareness levels of available biologics for CRSwNP worldwide. CONCLUSIONS: CRSwNP needs a complex and time-consuming assessment, according to the latest guidelines. There seems to be a gap between these recommendations and the real-world data, which should draw more attention to bringing them into uniform clinical practice in the near future.

AI-IoT Low-Cost Pollution-Monitoring Sensor Network to Assist Citizens with Respiratory Problems.

The proliferation and great variety of low-cost air quality (AQ) sensors, combined with their flexibility and energy efficiency, gives an opportunity to integrate them into Wireless Sensor Networks (WSN). However, with these sensors, AQ monitoring poses a significant challenge, as the data collection and analysis process is complex and prone to errors. Although these sensors do not meet the performance requirements for reference regulatory-equivalent monitoring, they can provide informative measurements and more if we can adjust and add further processing to their raw measurements. Therefore, the integration of these sensors aims to facilitate real-time monitoring and achieve a higher spatial and temporal sampling density, particularly in urban areas, where there is a strong interest in providing AQ surveillance services since there is an increase in respiratory/allergic issues among the population. Leveraging a network of low-cost sensors, supported by 5G communications in combination with Artificial Intelligence (AI) techniques (using Convolutional and Deep Neural Networks (CNN and DNN)) to predict 24-h-ahead readings is the goal of this article in order to be able to provide early warnings to the populations of hazards areas. We have evaluated four different neural network architectures: Multi-Linear prediction (with a dense Multi-Linear Neural Network (NN)), Multi-Dense network prediction, Multi-Convolutional network prediction, and Multi-Long Short-Term Memory (LSTM) network prediction. To perform the training of the prediction of the readings, we have prepared a significant dataset that is analyzed and processed for training and testing, achieving an estimation error for most of the predicted parameters of around 7.2% on average, with the best option being the Multi-LSTM network in the forthcoming 24 h. It is worth mentioning that some pollutants achieved lower estimation errors, such as CO2 with 0.1%, PM10 with 2.4% (as well as PM2.5 and PM1.0), and NO2 with 6.7%.

Fluid Viscoelasticity Triggers Fast Transitions of a Brownian Particle in a Double Well Optical Potential.

Thermally activated transitions are ubiquitous in nature, occurring in complex environments which are typically conceived as ideal viscous fluids. We report the first direct observations of a Brownian bead transiting between the wells of a bistable optical potential in a viscoelastic fluid with a single long relaxation time. We precisely characterize both the potential and the fluid, thus enabling a neat comparison between our experimental results and a theoretical model based on the generalized Langevin equation. Our findings reveal a drastic amplification of the transition rates compared to those in a Newtonian fluid, stemming from the relaxation of the fluid during the particle crossing events.

Active particles sense micromechanical properties of glasses.

Understanding the mechanical properties of glasses is a great scientific challenge. A powerful technique to study the material response on a microscopic scale is microrheology, in which one analyses the translational dynamics of an externally driven probe particle. Here we show that the translational and rotational dynamics of a self-propelled probe particle with an unconstrained orientational motion can be used to gather information about the mechanical properties of a colloidal glassy system. We find that its rotational diffusion coefficient continuously increases towards the glass transition and drops down in the glassy state. Such unexpected behaviour demonstrates a strong coupling mechanism between the orientation of the active probe particle and the glassy structure, which can be well described by a simple rheological model. Our results suggest that active probe particles may be useful for the micromechanical characterization of complex materials.

Correction: Transient coarsening and the motility of optically heated Janus colloids in a binary liquid mixture.

Correction for 'Transient coarsening and the motility of optically heated Janus colloids in a binary liquid mixture' by Juan Ruben Gomez-Solano et al., Soft Matter, 2020, DOI: 10.1039/d0sm00964d.

Transient coarsening and the motility of optically heated Janus colloids in a binary liquid mixture.

A gold-capped Janus particle suspended in a near-critical binary liquid mixture can self-propel under illumination. We have immobilized such a particle in a narrow channel and carried out a combined experimental and theoretical study of the non-equilibrium dynamics of a binary solvent around it - lasting from the very moment of switching illumination on until the steady state is reached. In the theoretical study we use both a purely diffusive and a hydrodynamic model, which we solve numerically. Our results demonstrate a remarkable complexity of the time evolution of the concentration field around the colloid. This evolution is governed by the combined effects of the temperature gradient and the wettability, and crucially depends on whether the colloid is free to move or is trapped. For the trapped colloid, all approaches indicate that the early time dynamics is purely diffusive and characterized by composition layers travelling with constant speed from the surface of the colloid into the bulk of the solvent. Subsequently, hydrodynamic effects set in. Anomalously large nonequilibrium fluctuations, which result from the temperature gradient and the vicinity of the critical point of the binary liquid mixture, give rise to strong concentration fluctuations in the solvent and to permanently changing coarsening patterns not observed for a mobile particle. The early time dynamics around initially still Janus colloids produces a force which is able to set the Janus colloid into motion. The propulsion due to this transient dynamics is in the direction opposite to that observed after the steady state is attained.

Application of Radio Environment Map Reconstruction Techniques to Platoon-based Cellular V2X Communications.

Vehicle platoons involve groups of vehicles travelling together at a constant inter-vehicle distance, with different common benefits such as increasing road efficiency and fuel saving. Vehicle platooning requires highly reliable wireless communications to keep the group structure and carry out coordinated maneuvers in a safe manner. Focusing on infrastructure-assisted cellular vehicle to anything (V2X) communications, the amount of control information to be exchanged between each platoon vehicle and the base station is a critical factor affecting the communication latency. This paper exploits the particular structure and characteristics of platooning to decrease the control information exchange necessary for the channel acquisition stage. More precisely, a scheme based on radio environment map (REM) reconstruction is proposed, where geo-localized received power values are available at only a subset of platoon vehicles, while large-scale channel parameters estimates for the rest of platoon members are provided through the application of spatial Ordinary Kriging (OK) interpolation. Distinctive features of the vehicle platooning use case are explored, such as the optimal patterns of vehicles within the platoon with available REM values for improving the quality of the reconstruction, the need for an accurate semivariogram modeling in OK, or the communication cost when establishing a centralized or a distributed architecture for achieving REM reconstruction. The evaluation results show that OK is able to reconstruct the REM in the platoon with acceptable mean squared estimation error, while reducing the control information for REM acquisition in up to 64% in the best-case scenario.

Porphyria-induced posterior reversible encephalopathy syndrome and central nervous system dysfunction.

BACKGROUND AND AIM: An association between neuropsychiatric manifestations and neuroimaging suggestive of posterior reversible encephalopathy syndrome (PRES) during porphyric attacks has been described in numerous case reports. We aimed to systematically review clinical-radiological features and likely pathogenic mechanisms of PRES in patients with acute hepatic porphyrias (AHP) and porphyric attacks. METHODS: PubMed, Scopus, Ovid MEDLINE, and Google Scholar were searched (July 30, 2019). We included articles describing patients with convincing evidence of an AHP, confirmed porphyric attacks, and PRES in neuroimaging. RESULTS: Forty-three out of 269 articles were included, which reported on 46 patients. Thirty-nine (84.8%) patients were women. The median age was 24 ±â€¯13.8 years. 52.2% had unspecified AHP, 41.3% acute intermittent porphyria, 4.3% hereditary coproporphyria, and 2.2% variegate porphyria. 70.2% had systemic arterial hypertension. Seizures, mental changes, arterial hypertension, and hyponatremia occurred more frequently than expected for porphyric attacks (p < .001). Seizures and hyponatremia were also more frequent than expected for PRES. The most common distributions of brain lesions were occipital (81.4%), parietal (65.1%), frontal (60.5%), subcortical (40%), and cortical (32.5%). Cerebral vasoconstriction was demonstrated in 41.7% of the patients who underwent angiography. 19.6% of the patients had ischemic lesions, and 4.3% developed long-term sequelae (cognitive decline and focal neurological deficits). CONCLUSIONS: Brain edema, vasoconstriction, and ischemia in the context of PRES likely account for central nervous symptoms in some porphyric attacks.

Outcomes of traumatic brain injury: the prognostic accuracy of various scores and models.

INTRODUCTION: Traumatic Brain Injury (TBI) is a worldwide health problem, and is a pathology that causes significant mortality and disability in Latin America. Different scores and prognostic models have been developed in order to predict the neurological outcomes of patients. We aimed to test the prognostic accuracy of the Marshall CT classification system, the Rotterdam CT scoring system, and the IMPACT and CRASH models, in predicting 6-month mortality and 6-month unfavourable outcomes in a cohort of trauma patients with TBI in a university hospital in Colombia. METHODS: We analysed 309 patients with significant TBI who were treated in a regional trauma centre in Colombia over a two year period. Bivariate and multivariate analyses were undertaken. The discriminatory power of each model, as well as its accuracy and precision, were assessed by logistic regression and AUC. Shapiro Wilks, chi2 and Wilcoxon test were used to compare the actual outcomes in the cohort against the predicted outcomes. RESULTS: The median age was 32 years, and 77.67% were male. All four prognostic models showed good accuracy in predicting outcomes. The IMPACT model had the greatest accuracy in predicting an unfavourable outcome (AUC 0.864; 95% CI 0.819 - 0.909) and in predicting mortality (AUC 0.902; 95% CI 0.862 - 0.943) in patients with TBI. CONCLUSION: All four prognostic models are applicable to eligible TBI patients in Colombia. The IMPACT model was shown to be more accurate than the other prognostic models, and had a higher sensitivity in predicting 6-month mortality and 6-month unfavourable outcomes in patients with TBI in a university hospital in Colombia.

Memory-Induced Transition from a Persistent Random Walk to Circular Motion for Achiral Microswimmers.

We experimentally study the motion of light-activated colloidal microswimmers in a viscoelastic fluid. We find that, in such a non-Newtonian environment, the active colloids undergo an unexpected transition from enhanced angular diffusion to persistent rotational motion above a critical propulsion speed, despite their spherical shape and stiffness. We observe that, in contrast to chiral asymmetric microswimmers, the resulting circular orbits can spontaneously reverse their sense of rotation and exhibit an angular velocity and a radius of curvature that nonlinearly depend on the propulsion speed. By means of a minimal non-Markovian Langevin model for active Brownian motion, we show that these nonequilibrium effects emerge from the delayed response of the fluid with respect to the self-propulsion of the particle without counterpart in Newtonian fluids.

Spatio-Temporal Analysis of Urban Acoustic Environments with Binaural Psycho-Acoustical Considerations for IoT-Based Applications.

Sound pleasantness or annoyance perceived in urban soundscapes is a major concern in environmental acoustics. Binaural psychoacoustic parameters are helpful to describe generic acoustic environments, as it is stated within the ISO 12913 framework. In this paper, the application of a Wireless Acoustic Sensor Network (WASN) to evaluate the spatial distribution and the evolution of urban acoustic environments is described. Two experiments are presented using an indoor and an outdoor deployment of a WASN with several nodes using an Internet of Things (IoT) environment to collect audio data and calculate meaningful parameters such as the sound pressure level, binaural loudness and binaural sharpness. A chunk of audio is recorded in each node periodically with a microphone array and the binaural rendering is conducted by exploiting the estimated directional characteristics of the incoming sound by means of DOA estimation. Each node computes the parameters in a different location and sends the values to a cloud-based broker structure that allows spatial statistical analysis through Kriging techniques. A cross-validation analysis is also performed to confirm the usefulness of the proposed system.

Optimizing the MAC Protocol in Localization Systems Based on IEEE 802.15.4 Networks.

Radio frequency signals are commonly used in the development of indoor localization systems. The infrastructure of these systems includes some beacons placed at known positions that exchange radio packets with users to be located. When the system is implemented using wireless sensor networks, the wireless transceivers integrated in the network motes are usually based on the IEEE 802.15.4 standard. But, the CSMA-CA, which is the basis for the medium access protocols in this category of communication systems, is not suitable when several users want to exchange bursts of radio packets with the same beacon to acquire the radio signal strength indicator (RSSI) values needed in the location process. Therefore, new protocols are necessary to avoid the packet collisions that appear when multiple users try to communicate with the same beacons. On the other hand, the RSSI sampling process should be carried out very quickly because some systems cannot tolerate a large delay in the location process. This is even more important when the RSSI sampling process includes measures with different signal power levels or frequency channels. The principal objective of this work is to speed up the RSSI sampling process in indoor localization systems. To achieve this objective, the main contribution is the proposal of a new MAC protocol that eliminates the medium access contention periods and decreases the number of packet collisions to accelerate the RSSI collection process. Moreover, the protocol increases the overall network throughput taking advantage of the frequency channel diversity. The presented results show the suitability of this protocol for reducing the RSSI gathering delay and increasing the network throughput in simulated and real environments.

Practical Considerations in the Implementation of Collaborative Beamforming on Wireless Sensor Networks.

Wireless Sensor Networks (WSNs) are composed of spatially distributed autonomous sensor devices, named motes. These motes have their own power supply, processing unit, sensors and wireless communications However with many constraints, such as limited energy, bandwidth and computational capabilities. In these networks, at least one mote called a sink, acts as a gateway to connect with other networks. These sensor networks run monitoring applications and then the data gathered by these motes needs to be retrieved by the sink. When this sink is located in the far field, there have been many proposals in the literature based on Collaborative Beamforming (CB), also known as Distributed or Cooperative Beamforming, for these long range communications to reach the sink. In this paper, we conduct a thorough study of the related work and analyze the requirements to do CB. In order to implement these communications in real scenarios, we will consider if these requirements and the assumptions made are feasible from the point of view of commercial motes and their constraints. In addition, we will go a step further and will consider different alternatives, by relaxing these requirements, trying to find feasible assumptions to carry out these types of communications with commercial motes. This research considers the nonavailability of a central clock that synchronizes all motes in the WSN, and all motes have identical hardware. This is a feasibility study to do CB on WSN, using a simulated scenario with randomized delays obtained from experimental data from commercial motes.

Dynamics of Self-Propelled Janus Particles in Viscoelastic Fluids.

We experimentally investigate active motion of spherical Janus colloidal particles in a viscoelastic fluid. Self-propulsion is achieved by a local concentration gradient of a critical polymer mixture which is imposed by laser illumination. Even in the regime where the fluid's viscosity is independent of the deformation rate induced by the particle, we find a remarkable increase of up to 2 orders of magnitude of the rotational diffusion with increasing particle velocity, which can be phenomenologically described by an effective rotational diffusion coefficient dependent on the Weissenberg number. We show that this effect gives rise to a highly anisotropic response of microswimmers in viscoelastic media to external forces, depending on its orientation.

Melatonin reduces endoplasmic reticulum stress and autophagy in liver of leptin-deficient mice.

The sedentary lifestyle of modern society along with the high intake of energetic food has made obesity a current worldwide health problem. Despite great efforts to study the obesity and its related diseases, the mechanisms underlying the development of these diseases are not well understood. Therefore, identifying novel strategies to slow the progression of these diseases is urgently needed. Experimental observations indicate that melatonin has an important role in energy metabolism and cell signalling; thus, the use of this molecule may counteract the pathologies of obesity. In this study, wild-type and obese (ob/ob) mice received daily intraperitoneal injections of melatonin at a dose of 500 µg/kg body weight for 4 weeks, and the livers of these mice were used to evaluate the oxidative stress status, proteolytic (autophagy and proteasome) activity, unfolded protein response, inflammation and insulin signalling. Our results show, for the first time, that melatonin could significantly reduce endoplasmic reticulum stress in leptin-deficient obese animals and ameliorate several symptoms that characterize this disease. Our study supports the potential of melatonin as a therapeutic treatment for the most common type of obesity and its liver-associated disorders.