Geriatrics and artificial intelligence in Spain (Ger-IA project): talking to ChatGPT, a nationwide survey.

PURPOSE: The purposes of the study was to describe the degree of agreement between geriatricians with the answers given by an AI tool (ChatGPT) in response to questions related to different areas in geriatrics, to study the differences between specialists and residents in geriatrics in terms of the degree of agreement with ChatGPT, and to analyse the mean scores obtained by areas of knowledge/domains. METHODS: An observational study was conducted involving 126 doctors from 41 geriatric medicine departments in Spain. Ten questions about geriatric medicine were posed to ChatGPT, and doctors evaluated the AI's answers using a Likert scale. Sociodemographic variables were included. Questions were categorized into five knowledge domains, and means and standard deviations were calculated for each. RESULTS: 130 doctors answered the questionnaire. 126 doctors (69.8% women, mean age 41.4 [9.8]) were included in the final analysis. The mean score obtained by ChatGPT was 3.1/5 [0.67]. Specialists rated ChatGPT lower than residents (3.0/5 vs. 3.3/5 points, respectively, P < 0.05). By domains, ChatGPT ​​scored better (M: 3.96; SD: 0.71) in general/theoretical questions rather than in complex decisions/end-of-life situations (M: 2.50; SD: 0.76) and answers related to diagnosis/performing of complementary tests obtained the lowest ones (M: 2.48; SD: 0.77). CONCLUSION: Scores presented big variability depending on the area of knowledge. Questions related to theoretical aspects of challenges/future in geriatrics obtained better scores. When it comes to complex decision-making, appropriateness of the therapeutic efforts or decisions about diagnostic tests, professionals indicated a poorer performance. AI is likely to be incorporated into some areas of medicine, but it would still present important limitations, mainly in complex medical decision-making.

Evolution of biliary complications after liver transplantation: a single European series.

BACKGROUND: The aim of this study was to analyze the evolution of biliary complications over 20 years among adult patients undergoing liver transplantation (OLT) at our institution. PATIENTS AND METHODS: Between 1985 and 2007, we performed 1000 OLT in 789 adults and 211 children. To ascertain the evolution of biliary complications among adult OLT from October 1988 to September 2007, we compared the first 100 to with the last 200 adult OLT. RESULTS: Duct-to-duct was the most common biliary anastomosis performed in both periods (1st; 89% and 2nd; 94%; P = NS). However, a T-tube was used more frequently in the first period (1st; 46% vs 2nd; 6.6%; P < .001). The remaining cases underwent a hepaticojejunostomy (1st; 11% vs 2nd; 7.6%). Biliary complications were more frequent in the first period (1st; 20% vs 2nd; 9%; P < .01). In the first period, the use of a T-tube caused 32% of complications, all of them being bile leaks; but there were none in the second period. Arterial thrombosis or strictures were related to biliary complications in 10% and 33.3% among the first and second periods, respectively. The severity of complications according to the Clavien classification was similar in both periods: IIIa, 15% versus 33.3%; IIIb, 55% versus 55.5%; and IV, 15% versus 11.1%, respectively (P = NS). CONCLUSION: The biliary complication rate among adult patients post-OLT decreased over 20 years at our institution, probably owing to the abandonment of the routine use of a T-tube as well as to advances in immunosuppressive protocols, organ preservation, and preoperative patient management.

Non-anatomical intestinal transplantation.

INTRODUCTION: Intestinal transplantation is the only long-range treatment option for patients with intestinal failure. We report an exceptional case of isolated intestinal transplantation with the implant in a non-anatomical position. CLINICAL CASE: The patient was a thirty-eight-year-old man (60 kg weight, 180 cm height, 18.3 body mass index) with intestinal failure and home parenteral nutrition due to a short-bowel syndrome for which intestinal transplantation was indicated. The patient had a vascular malformation with the cava vein located left to the aorta, and the intestine was implanted with a 180 masculine rotation around the mesenteric axis, so that the implant s superior mesenteric artery and vein matched the recipient s cava and aorta. Postoperative follow-up was excellent and the patient was discharged after six weeks with a 10-kg gain in body weight. DISCUSSION: This non-anatomical intestinal implantation of the small bowel, previously unreported, offers technical advantages over other options. Adequate intestinal function represents a unique model to prove the viability of intestinal implants in a non-anatomical position.

Trasplante intestinal en posición no anatómica / Non-anatomical intestinal transplantation

Introducción: el trasplante intestinal es el único tratamiento eficaz a largo plazo de los pacientes con fallo intestinal. Se presenta un caso clínico excepcional de trasplante intestinal aislado en posición no anatómica. Caso clínico: se trata de un varón de 38 años de edad con fallo intestinal y nutrición parenteral domiciliaria por un síndrome de intestino corto al que se le indicó un trasplante intestinal. Fue incluido en lista de espera con un peso de 60 kg, 180 cm de altura y 18,3 de índice de masa corporal. El receptor presentaba una trasposición de los grandes vasos con la vena cava situada a la izquierda de la arteria aorta por lo que el intestino se implantó con una rotación del injerto de 180º sobre su eje mesentérico, con el objetivo de que la vena y la arteria mesentérica superior del injerto coincidieran con la vena cava y la arteria aorta del receptor. El paciente presentó excelente postoperatorio y fue dado de alta a las 6 semanas con un aumento de peso de 10 kg. Discusión: esta implantación no anatómica del intestino, previamente no referida en la literatura, ofrece ventajas técnicas sobre otras alternativas. La adecuada función intestinal constituye un modelo único que prueba la viabilidad del intestino implantado en posición no anatómica(AU)

Introduction: intestinal transplantation is the only long-range treatment option for patients with intestinal failure. We report an exceptional case of isolated intestinal transplantation with the implant in a non-anatomical position. Clinical case: the patient was a thirty-eight-year-old man (60 kg weight, 180 cm height, 18.3 body mass index) with intestinal failure and home parenteral nutrition due to a short-bowel syndrome for which intestinal transplantation was indicated. The patient had a vascular malformation with the cava vein located left to the aorta, and the intestine was implanted with a 180º rotation around the mesenteric axis, so that the implant's superior mesenteric artery and vein matched the recipient's cava and aorta. Postoperative follow-up was excellent and the patient was discharged after six weeks with a 10-kg gain in body weight. Discussion: this non-anatomical intestinal implantation of the small bowel, previously unreported, offers technical advantages over other options. Adequate intestinal function represents a unique model to prove the viability of intestinal implants in a non-anatomical position(AU)

Granulomatosis sarcoidea necrosante / Necrotizing sarcoid granulomatosis

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Cytomegalovirus disease as a risk factor for graft loss and death after orthotopic liver transplantation.

To determine whether cytomegalovirus (CMV) disease is an independent risk factor for graft loss and death after orthotopic liver transplantation, we performed a 3-year follow-up study of 143 consecutive liver transplant recipients and six patients who underwent retransplantation. Thirty-seven patients (25%) had had CMV disease and were alive after treatment. Fifty-two deaths and eight graft losses occurred. The cumulative incidence of graft failure at 1 and 3 years of follow-up were 40% and 63%, respectively, for patients with CMV disease, compared with 22% and 33%, respectively, for those without CMV disease (P < .05, logrank test). Cumulative probabilities of survival for patients with and without CMV disease were 64% and 82%, respectively, at 1 year and 46% and 69%, respectively, after 3 years (P < .05, logrank test). Multivariate analysis with use of a time-dependent Cox model showed that previous CMV disease was an independent risk factor for graft loss at 1 and 3 years of follow-up (P = .04 and P = .007) and for patient survival (P = .04 and P = .01). Our results indicate that CMV disease is a significant independent risk factor for graft loss and patient survival after liver transplantation.

Risk factors for acute renal failure requiring dialysis after liver transplantation.

Acute renal failure (ARF) is a common and severe complication after liver transplantation (LT). The aim of this study was to ascertain the impact of ARF requiring dialysis in the outcome of LT and to analyze the risk factors leading to this event in the early post-operative period. From October 1988 to December 1994, 172 LT were performed in 158 patients. Postoperative ARF occurred in 88 transplants (51.1%) during the early postoperative period: mild ARF was found in 46 (serum creatinine 1.5-3 mg/dl), moderate ARF in 12 (serum creatinine > 3 mg/dl) and severe ARF in 30 (serum creatinine > 3 mg/dl with dialysis requirement). Preoperative, intraoperative, and postoperative variables were studied, comparing patients presenting severe ARF with the remaining patients. Postoperative mortality in the dialysed group was much higher than in the non-dialysis group (50% vs. 13.4%)(p < 0.001) and 1-yr actuarial graft survival was 73.4% for the non-dialysed group compared with 40.9% for the dialysed group (p < 0.05). Among 38 variables investigated, only two factors had independent prognostic value in multivariate analysis: preoperative serum creatinine > 1.5 mg/dl (OR = 4.4, p = 0.006) and graft dysfunction grades III-IV (OR = 8.9, p = 0.001). In conclusion, ARF is a severe complication post-LT; its appearance could be predicted in patients with pre-transplant renal dysfunction, severe graft dysfunction, or both. However, in many cases renal function may revert to normal if treated aggressively with early dialysis support.