Patients with inflammatory bowel disease (IBD) are at increased risk of vitamin D deficiency and vitamin D levels have been found to be lower in active disease. This is associated with low bone mineral density resulting in 35–40% of patients with IBD suffering from osteopenia and 15% from osteoporosis. As such the British Society of Gastroenterology (BSG) guidelines on the management of IBD recommend that vitamin D should be measured and supplemented if deficient. In addition, patients who are prescribed steroids should receive concomitant vitamin D replacement. We sought to assess whether IBD patients at a busy London district general hospital were being screened for vitamin D deficiency and treated accordingly.
Methods
We performed a retrospective cohort study of patients seen in the IBD clinic during August 2021. Unique patient identification numbers were cross referenced with electronic records including those from Primary Care. Data collection included patient demographics, IBD diagnosis, drug history, vitamin D level and vitamin D treatment (if <50nmol/L). Levels were defined as insufficiency (25-hydroxy vitamin D <25nmol/L) and deficiency (25-50nmol/L).
Results
121 patients were identified of which 61 (50.4%) were male with an average age of 48 years. Patients were of mixed ethnicity: 53 (43.8%) white, 36 Asian, 2 Black, 11 other and 21 not stated. 66 (54.5%) patients had a diagnosis of ulcerative colitis, 46 crohns disease and 9 IBD-unclassified. The cohort was varied in terms of severity of disease with 30 (24.8%) patients on biologic treatment. 48 (39.7%) patients had a vitamin D level checked in the year preceding the clinic appointment and levels ranged from 10-122.2nmol/L (median of 62.3nmol/L). 17 (35.4%) of these patients were vitamin D deficient (n=8) or insufficient (n=9); however, only 7 (43.8%) were prescribed vitamin D therapy. A further 24 patients were taking vitamin D, but had not had a level checked within the past year. 11.6% (14) were being treated with prednisolone; 85% (12) of these had Vitamin D prescribed.
Conclusions
More than 60% of patients in our cohort did not have vitamin D levels checked and just under half of those that would have benefited from treatment were not given it. However, 85% of patients being treated with Prednisolone were appropriately prescribed vitamin D. Vitamin D deficiency in IBD is important due to the risk of low bone mineral density. Clinical studies have also pointed to the potential for vitamin D to improve IBD outcomes. As such it is important that we are identifying and managing low vitamin D levels appropriately. We plan to provide guidance to clinicians within the department and primary care regarding the BSG recommendations and appropriate vitamin D replacement.
Purpose This study aimed to compare the performance of ChatGPT, a large language model (LLM), with human neurosurgical applicants in a neurosurgical national selection interview, to assess the potential of artificial intelligence (AI) and LLMs in healthcare and provide insights into their integration into the field.
Abstract Objective Despite advances in skull-base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a common complication following retrosigmoid (RS) vestibular schwannoma (VS) surgery. We aimed to review and classify the available strategies used to prevent CSF leaks following RS VS surgery. Methods A systematic review, including studies of adults undergoing RS VS surgery since 2000, was conducted. Repair protocols were synthesized into a narrative summary, and a taxonomic classification of techniques and materials was produced. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were described. Results All 42 studies were case series, of which 34 were retrospective, and eight were prospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A repair taxonomy was produced considering seven distinct stages to CSF leak prevention, including intraoperative approaches to the dura, internal auditory canal (IAC), air cells, RS bony defect, extracranial soft tissue, postoperative dressings, and CSF diversion. Notably, there was significant heterogeneity among institutions, particularly in the dural and IAC stages. The median postoperative incidence of CSF leaks was 6.3% (IQR: 1.3–8.44%). Conclusions The intraoperative strategies used to prevent CSF leaks during RS VS surgery vary between and within institutions. As a result of this heterogeneity and inconsistent reporting of CSF leak predictive factors, a meaningful comparative analysis of repair protocols was not feasible. Instead, we propose the development of a prospective multicenter observational evaluation designed to accurately capture a comprehensive dataset of potential CSF risk factors, including all stages of the operative repair protocol.
Abstract Objectives Despite advances in skull base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a relatively common complication after translabyrinthine (TL) vestibular schwannoma (VS) surgery. We conducted a systematic review to synthesize the repair techniques and materials used in TL VS surgery to prevent CSF leaks. Design A systematic review of studies published since 2000 reporting techniques to prevent CSF leaks during adult TL VS surgery was conducted. A narrative synthesis of primary repair protocols was produced, and a taxonomy was established. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were extracted. Results All 43 studies were case series, and 39 were retrospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A taxonomy was produced, classifying repairs into seven distinct stages, including approaches to the dura, middle ear cleft, air cells, TL bony defect, extra-cranial soft tissue, postoperative dressings, and CSF diversion. The median postoperative incidence of CSF leaks was 6% (interquartile range: 0–10%). Conclusions This systematic review reveals substantial inter-institutional heterogeneity in intraoperative strategies to prevent CSF leaks following TL VS surgery. However, comparing these techniques is challenging due to the multiple predictive factors for CSF leaks and their inconsistent reporting. We propose a taxonomy of seven stages to classify operative techniques and materials aimed at preventing CSF leaks. We recommend that future evaluations should adopt a prospective approach encompassing data collection strategies that considers all operative stages described by our taxonomy.
Purpose Despite advances in technology, stereotactic brain tumour biopsy remains challenging due to the risk of injury to critical structures. Indeed, choosing the correct trajectory remains essential to patient safety. Artificial intelligence can be used to perform automated trajectory planning. We present a systematic review of automated trajectory planning algorithms for stereotactic brain tumour biopsies.Methods A PRISMA adherent systematic review was conducted. Databases were searched using keyword combinations of 'artificial intelligence', 'trajectory planning' and 'brain tumours'. Studies reporting applications of artificial intelligence (AI) to trajectory planning for brain tumour biopsy were included.Results All eight studies were in the earliest stage of the IDEAL-D development framework. Trajectory plans were compared through a variety of surrogate markers of safety, of which the minimum distance to blood vessels was the most common. Five studies compared manual to automated planning strategies and favoured automation in all cases. However, this comes with a significant risk of bias.Conclusions This systematic review reveals the need for IDEAL-D Stage 1 research into automated trajectory planning for brain tumour biopsy. Future studies should establish the congruence between expected risk of algorithms and the ground truth through comparisons to real world outcomes.
Relatively little evidence exists on predictive factors for the spontaneous regression of lumbar disc herniation (LDH), although it is a well-documented phenomenon. Therefore, current care is not optimized to identify those who would benefit from early surgery versus those who could avoid surgical risks and pursue nonsurgical therapy. In this study, the authors aimed to analyze and summarize all literature to date on predictive factors for spontaneous LDH regression as well as suggest future research strategies to aid in the decision-making for this cohort.A literature search was conducted of the Cochrane, Embase, and MEDLINE databases for articles that described LDH in terms of the North American Spine Society task force definitions: bulging, protruded, extruded, and sequestered disc morphologies. All articles described a nonsurgical primary symptomatic LDH cohort with at least two MR images to assess regression. Those with concomitant spinal disease were excluded. The primary outcome was to assess the probability of disc regression for each disc morphology, with a secondary analysis for any other predictive factors identified. The authors synthesized their results with the only previous review (examining articles published before March 2014) to comprehensively describe the literature. A qualitative analysis of the wider literature was also performed for those studies with differing definitions of LDH but meeting all remaining inclusion criteria.Sixteen articles describing 360 cases of LDH were identified. Participants tended to be younger and male and presented with radiculopathy and L4-5 or L5-S1 LDH. The mean time to follow-up imaging was 11.5 months. The probabilities of spontaneous regression with bulging, protruded, extruded, and sequestered discs were 13.3%, 52.5%, 70.4%, and 93.0%, respectively (χ2 = 126.01, p < 0.001). Extruded and sequestered discs were also significantly more likely to completely regress than smaller morphologies. Other predictors of regression were larger baseline herniation volume (1260.16 vs 1006.71 mm3, p < 0.002), transligamentous herniation (χ2 = 13.321, p < 0.001), and higher Komori types (χ2 = 14.5132, p < 0.001). The authors also found similar trends in qualitative data as well as confirmed that symptom improvement was associated with disc regression.This study shows further evidence of the influence of disc morphology on predicting LDH regression as well as provides the first meta-analysis of data indicating additional predictive factors. Further investigation of predictive factors for early (< 6 months) LDH regression is suggested to optimize clinical use.
Introduction: Endoscopic skull base surgery aims to reduce surgical morbidity by minimizing tissue manipulation and exposure. However, the anatomical constraints posed by the narrow surgical corridors and constrained operative workspace present technical challenges due to reduced dexterity. Previously, we evaluated a novel handheld robotic instrument in the context of endonasal skull base surgery. This study assesses the broader applicability, feasibility, and potential usefulness of this robotic technology for 360-degree skull base approaches.
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