1
|
Shelly S, Soontrapa P, Madigan NN, Polzin MJ, Singh TD, Sista SRS, Paul P, Braksick SA, Liao B, Windebank AJ, Boon AJ, Litchy WJ, Milone M, Liewluck T. Compound Muscle Action Potential and Myosin-Loss Pathology in Patients With Critical Illness Myopathy: Correlation and Prognostication. Neurology 2024; 103:e209496. [PMID: 38870464 DOI: 10.1212/wnl.0000000000209496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Prolonged compound muscle action potential (CMAP) duration and preferential loss of myosin are considered the diagnostic hallmarks of critical illness myopathy (CIM); however, their correlation and prognostic values have not been studied. We aimed to investigate the correlation between CMAP duration and myosin loss and their effect on mortality by comparing between patients with CIM with and without myosin loss. METHODS We searched the Mayo Clinic Electromyography Laboratory databases (1986-2021) for patients diagnosed with CIM on the basis of prolonged distal CMAP durations (>15 msec in fibular motor nerve studies recording over the tibialis anterior or >8 msec in other motor nerves) and needle EMG findings compatible with myopathy. Electrodiagnostic studies were generally performed within 24 hours after weakness became noticeable. We included only patients who underwent muscle biopsy. Clinical, electrophysiologic, and myopathologic data were reviewed. We conducted myosin/actin ratio analysis when muscle tissue was available. We used the Fisher exact test for categorical data comparisons and the Mann-Whitney 2-tailed test for continuous data. We applied the Kaplan-Meier technique to analyze survival rates. RESULTS Twenty patients (13 female patients) were identified [median age at diagnosis of 62.5 years (range: 19-80 years)]. The median onset of weakness was 24 days (range: 1-128) from the first day of intensive care unit admission. Muscle biopsy showed myosin loss in 14 patients, 9 of whom had >50% of myofibers affected (high grade). Type 2 fiber atrophy was observed in 19 patients, 13 of whom also had myosin loss. Patients with myosin loss had higher frequency of steroid exposure (14 vs 3; p = 0.004); higher median number of necrotic fibers per low-power field (2.5 vs 1, p = 0.04); and longer median CMAP duration (msec) of fibular (13.4 vs 8.75, p = 0.02), tibial (10 vs 7.8, p = 0.01), and ulnar (11.1 vs 7.95, p = 0.002) nerves compared with those without. Only patients with high-grade myosin loss had reduced myosin/actin ratios (<1.7). Ten patients died during median follow-up of 3 months. The mortality rate was similar between patients with and without myosin loss. Patients with high-grade myosin loss had a lower overall survival rate than those with low-grade or no myosin loss, but this was not statistically significant (p = 0.05). DISCUSSION Myosin loss occurred in 70% of the patients with CIM with prolonged CMAP duration. Longer CMAP duration predicts myosin-loss pathology. The extent of myosin loss marginally correlates with the mortality rate. Our findings highlight the potential prognostic values of CMAP duration and myosin loss severity in predicting disease outcome.
Collapse
Affiliation(s)
- Shahar Shelly
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Pannathat Soontrapa
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Nicolas N Madigan
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Michael J Polzin
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Tarun D Singh
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Sri Raghav S Sista
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Pritikanta Paul
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Sherri A Braksick
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Bing Liao
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Anthony J Windebank
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Andrea J Boon
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - William J Litchy
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Margherita Milone
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Teerin Liewluck
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| |
Collapse
|
6
|
Guillen-Grima F, Guillen-Aguinaga S, Guillen-Aguinaga L, Alas-Brun R, Onambele L, Ortega W, Montejo R, Aguinaga-Ontoso E, Barach P, Aguinaga-Ontoso I. Evaluating the Efficacy of ChatGPT in Navigating the Spanish Medical Residency Entrance Examination (MIR): Promising Horizons for AI in Clinical Medicine. Clin Pract 2023; 13:1460-1487. [PMID: 37987431 PMCID: PMC10660543 DOI: 10.3390/clinpract13060130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023] Open
Abstract
The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model's overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. MATERIAL AND METHODS We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4's new image analysis capability. RESULTS GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p < 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as "error requiring intervention to sustain life" and "error resulting in death", had a 0% rate. CONCLUSIONS GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model's high success rate is commendable, understanding the error severity is critical, especially when considering AI's potential role in real-world medical practice and its implications for patient safety.
Collapse
Affiliation(s)
- Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Healthcare Research Institute of Navarra (IdiSNA), 31008 Pamplona, Spain
- Department of Preventive Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain
| | - Sara Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | - Laura Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Department of Nursing, Kystad Helse-og Velferdssenter, 7026 Trondheim, Norway
| | - Rosa Alas-Brun
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | - Luc Onambele
- School of Health Sciences, Catholic University of Central Africa, Yaoundé 1100, Cameroon;
| | - Wilfrido Ortega
- Department of Surgery, Medical and Social Sciences, University of Alcala de Henares, 28871 Alcalá de Henares, Spain;
| | - Rocio Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 413 46 Gothenburg, Sweden;
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden
| | | | - Paul Barach
- Jefferson College of Population Health, Philadelphia, PA 19107, USA;
- School of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, 1020 Vienna, Austria
- Department of Surgery, Imperial College, London SW7 2AZ, UK
| | - Ines Aguinaga-Ontoso
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Healthcare Research Institute of Navarra (IdiSNA), 31008 Pamplona, Spain
| |
Collapse
|