Evaluation of a context-aware chatbot using retrieval-augmented generation for answering clinical questions on medication-related osteonecrosis of the jaw.

The potential of large language models (LLMs) in medical applications is significant, and Retrieval-augmented generation (RAG) can address the weaknesses of these models in terms of data transparency and scientific accuracy by incorporating current scientific knowledge into responses. In this study, RAG and GPT-4 by OpenAI were applied to develop GuideGPT, a context aware chatbot integrated with a knowledge database from 449 scientific publications designed to provide answers on the prevention, diagnosis, and treatment of medication-related osteonecrosis of the jaw (MRONJ). A comparison was made with a generic LLM ("PureGPT") across 30 MRONJ-related questions.

FDA-approved therapies for chronic GVHD.

Despite novel prophylactic regimens, chronic graft-versus-host disease (cGVHD) remains a challenging complication after allogeneic hematopoietic cell transplantation. Chronic GVHD can affect multiple organs and reduces quality of life, and treatment can cause serious side effects. In the last ten years, the drugs ibrutinib, ruxolitinib, belumosudil and axatilimab were FDA-approved for cGVHD.

Faster Acquisition and Improved Image Quality of T2-Weighted Dixon Breast MRI at 3T Using Deep Learning: A Prospective Study.

Objective: The aim of this study was to compare image quality features and lesion characteristics between a faster deep learning (DL) reconstructed T2-weighted (T2-w) fast spin-echo (FSE) Dixon sequence with super-resolution (T2) and a conventional T2-w FSE Dixon sequence (T2) for breast magnetic resonance imaging (MRI).

Materials And Methods: This prospective study was conducted between November 2022 and April 2023 using a 3T scanner. Both T2 and T2 sequences were acquired for each patient.

PGM3 insufficiency: a glycosylation disorder causing a notable T cell defect.

Background: Hypomorphic mutations in the () gene cause a glycosylation disorder that leads to immunodeficiency. It is often associated with recurrent infections and atopy. The exact etiology of this condition remains unclear.

Pharmacokinetics and Pharmacodynamics of an Innovative Psychedelic N,N-Dimethyltryptamine/Harmine Formulation in Healthy Participants: A Randomized Controlled Trial.

Background: Recent interest in the clinical use of psychedelics has highlighted plant-derived medicines like ayahuasca showing rapid-acting and sustainable therapeutic effects in various psychiatric conditions. This traditional Amazonian plant decoction contains N,N-dimethyltryptamine (DMT) and β-carboline alkaloids such as harmine. However, its use is often accompanied by distressing effects like nausea, vomiting, and intense hallucinations, possibly due to complex pharmacokinetic/pharmacodynamic (PK-PD) interactions and lack of dose standardization.

Gene expression comparisons between captive and wild shrew brains reveal captivity effects.

Compared with their free-ranging counterparts, wild animals in captivity experience different conditions with lasting physiological and behavioural effects. Although shifts in gene expression are expected to occur upstream of these phenotypes, we found no previous gene expression comparisons of captive versus free-ranging mammals. We assessed gene expression profiles of three brain regions (cortex, olfactory bulb and hippocampus) of wild shrews () compared with shrews kept in captivity for two months and undertook sample dropout to examine robustness given limited sample sizes.

Tumor burden with AFP improves survival prediction for TACE-treated patients with HCC: An international observational study.

Background & Aims: Current prognostic models for patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) are not extensively validated and widely accepted. We aimed to develop and validate a continuous model incorporating tumor burden and biology for individual survival prediction and risk stratification.

Methods: Overall, 4,377 treatment-naive candidates for whom TACE was recommended, from 39 centers in five countries, were enrolled and divided into training, internal validation, and two external validation datasets.

Allosteric Changes Underlie the Outside-In Transmission of Activatory Signals in the TCR.

Rather than being contained in a single polypeptide, and unlike receptor tyrosine kinases, the T cell receptor (TCR) divides its signaling functions among its subunits: TCRα/β bind the extracellular ligand, an antigenic peptide-MHC complex (pMHC), and the CD3 subunits (CD3γ, CD3δ, CD3ε, and CD3ζ) transmit this information to the cytoplasm. How information about the quality of pMHC binding outside is transmitted to the cytoplasm remains a matter of debate. In this review, we compile data generated using a wide variety of experimental systems indicating that TCR engagement by an appropriate pMHC triggers allosteric changes transmitted from the ligand-binding loops in the TCRα and TCRβ subunits to the cytoplasmic tails of the CD3 subunits.

Impact of ALDH1A1 Expression in Intrahepatic Cholangiocellular Carcinoma.

Intrahepatic cholangiocarcinoma (iCC) is a rare malignant liver tumor with limited therapeutic advancements. Despite its increasing global incidence knowledge of treatment options remains stagnant, leading to poor five-year patient survival rates and high recurrence post-surgery. ALDH1A1, a member of the ALDH superfamily, is associated with cancer stem cells and has conflicting reports regarding its prognostic role in iCC.

Cervicothoracic volumetric bone mineral density assessed by opportunistic QCT may be a reliable marker for osteoporosis in adults.

Unlabelled: This study aimed to validate the correlation between volumetric bone mineral density in the cervicothoracic and lumbar spine using measurements from opportunistic CT scans. The bone density assessment proved feasible, allowing us to propose optimal cut-off values for diagnosing osteoporosis and predicting vertebral fractures in the cervical and thoracic spine.

Objectives: To investigate the performance of cervicothoracic volumetric bone mineral density (vBMD), obtained through opportunistic quantitative computed tomography (QCT), in discriminating patients with/without osteoporosis and with/without vertebral fractures (VFs), using lumbar vBMD as the reference.

Early Albumin Administration in Veno-Arterial Extracorporeal Membrane Oxygenation.

Background: The clinical outcome and fluid balance of patients with veno-arterial extracorporeal membrane oxygenation (VA ECMO) or after extracorporeal cardiopulmonary resuscitation (eCPR) may be improved by addressing the high fluid demand with an early albumin administration.

Methods: In this prospective observational study, patients supported with VA ECMO or eCPR received early albumin administration (25 g/L) to prime the VA ECMO system. These patients were compared to patients who received a regimen based solely on balanced crystalloids (crystalloid group) or a regimen based on a 1:4 volume mixture of albumin (10 g/L) and balanced crystalloids (albumin group).

Lateral entry into general practice - an explorative analysis of general practice trainees in the competence centre for postgraduate medical education Baden-Württemberg.

Objective: To aid the shortage of general practitioners (GPs) in Germany, since 2011 medical specialists from other fields may switch specialisation by undergoing a slim-lined training programme (lateral entry) into general practice (GP). Available published qualitative and quantitative data on lateral entrants (LEs) is scarce. Aim of the study was an explorative analysis of LEs in the competence centre for postgraduate medical education Baden-Wuerttemberg (KWBW).

Length of hospital stay and readmissions after major lower extremity amputation: a Danish nationwide registry study.

Background And Purpose:  Major lower extremity amputation (MLEA) is associated with complications that may prolong length of hospital stay (LOS) and increase the risk of readmission. We primarily aimed to examine the LOS and risk of readmissions after MLEA in Denmark. Secondarily we investigated the time trends.

Prognostic value of metabolic tumor volume on [F]FDG PET/CT in addition to the TNM classification system of locally advanced non-small cell lung cancer.

Purpose: Staging of non-small cell lung cancer (NSCLC) is commonly based on [F]FDG PET/CT, in particular to exclude distant metastases and guide local therapy approaches like resection and radiotherapy. Although it is hoped that PET/CT will increase the value of primary staging compared to conventional imaging, it is generally limited to the characterization of TNM. The first aim of this study was to evaluate the PET parameter metabolic tumor volume (MTV) above liver background uptake as a prognostic marker in lung cancer.

Integrating cancer into crisis: a global vision for action from WHO and partners.

More than a billion people live in fragile, conflict-affected, and vulnerable settings requiring humanitarian support, where cancer is a substantial health issue. Despite its substantial effect on populations, cancer care remains underprioritised in emergency preparedness and response frameworks and humanitarian operational planning. This Policy Review summarises the perspectives and actionable recommendations from the First Global High-Level Technical Meeting on Non-communicable Diseases in Humanitarian Settings, with a focus on cancer.

Metastasis-directed stereotactic radiotherapy in patients with breast cancer: results of an international multicenter cohort study.

Metastasis-directed therapy (MDT) for oligometastatic breast cancer (≤ 5 metastases) has shown little effect in specific scenarios of randomized trials. Therefore, we aimed to assess outcomes after metastasis-directed stereotactic radiotherapy (SRT) in various clinical scenarios. We conducted an international retrospective cohort study in thirteen centers including breast cancer patients receiving SRT to any metastatic site.

Efficacy of CTLA-4 checkpoint therapy is dependent on IL-21 signaling to mediate cytotoxic reprogramming of PD-1CD8 T cells.

The mechanisms underlying the efficacy of anti-programmed cell death protein 1 (PD-1) and anti-cytotoxic T lymphocyte-associated protein 4 (CTLA-4) therapy are incompletely understood. Here, by immune profiling responding PD-1CD8 T (T) cell populations from patients with advanced melanoma, we identified differential programming of T cells in response to combination therapy, from an exhausted toward a more cytotoxic effector program. This effect does not occur with anti-PD-1 monotherapy.

Simulation and quantitative evaluation of three surgical techniques of endoscopic enucleation of prostate on a realistic phantom model.

Objective: To evaluate the impact of three different AEEP techniques on the training performance of novices using a realistic hydrogel prostate phantom model.

Material And Methods: The experimental setup utilized realistic prostate phantom model provided by the Max Planck Institute for Intelligent Systems, Germany. For the enucleation, we utilized a new solid-state pulsed thulium laser (Thulio®, Dornier MedTech, Weßling, Germany).

Real-world epilepsy monitoring with ultra long-term subcutaneous EEG: a 15-month prospective study.

Objective: Novel subcutaneous electroencephalography (sqEEG) systems enable prolonged, near-continuous cerebral monitoring in real-world conditions. Nevertheless, the feasibility, acceptability and overall clinical utility of these systems remains unclear. We report on the longest observational study using ultra long-term sqEEG to date.

Impaired SARS-CoV-2-Specific CD8+ T Cells After Infection or Vaccination but Robust Hybrid T Cell Immunity in Patients with Multiple Myeloma.

Background: Multiple myeloma (MM) patients are at high risk of severe infections including COVID-19 due to an immune dysregulation affecting both innate and adaptive immune responses. However, our understanding of the immune responses to infection and vaccination in MM patients is limited. To gain more detailed insights into infection- and vaccine-elicited T cell immunity in MM, we studied the CD8+ T cell response on the single-epitope level in SARS-CoV-2 convalescent and mRNA-vaccinated MM patients.

Automated tooth segmentation in magnetic resonance scans using deep learning - A pilot study.

Objectives: The main objective was to develop and evaluate an artificial intelligence model for tooth segmentation in magnetic resonance (MR) scans.

Methods: MR scans of 20 patients performed with a commercial 64-channel head coil with a T1-weighted 3D-SPACE (Sampling Perfection with Application Optimized Contrasts using different flip angle Evolution) sequence were included. Sixteen datasets were used for model training and 4 for accuracy evaluation.

Changes in isolation guidelines for CPE patients results in only mild reduction in required hospital beds.

Background: Carbapenemase-producing Enterobacterales (CPE) are an emerging public health concern globally as they are resistant to a broad spectrum of antibiotics. Colonisation with CPE typically requires patients to be managed under 'contact precautions', which creates additional physical bed demands in healthcare facilities.

Methods: This study examined the potential impact of revised isolation guidelines introduced in late 2023 in Victoria, Australia, that relaxed the requirement for indefinite isolation of CPE-colonised patients in contact precautions, based on admission of CPE-diagnosed cases prior to the guideline change.