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Objectives To assess the quality and alignment of ChatGPT's cancer treatment recommendations (RECs) with National Comprehensive Cancer Network (NCCN) guidelines and expert opinions. Methods Three urologists performed quantitative and qualitative assessments in October 2023 analyzing responses from ChatGPT-4 and ChatGPT-3.5 to 108 prostate, kidney, and bladder cancer prompts using two zero-shot prompt templates. Performance evaluation involved calculating five ratios: expert-approved/expert-disagreed and NCCN-aligned RECs against total ChatGPT RECs plus coverage and adherence rates to NCCN. Experts rated the response's quality on a 1-5 scale considering correctness, comprehensiveness, specificity, and appropriateness. Results ChatGPT-4 outperformed ChatGPT-3.5 in prostate cancer inquiries, with an average word count of 317.3 versus 124.4 ( p

Objective: We aimed to determine the reliability of using the Fibrosis-4 (FIB-4) index in COVID-19 patients without underlying liver illness. Method: We employed multivariate logistic regression to identify variables that exhibited statistically significant influence on the ultimate outcome. Multilayer perceptron analysis was employed to develop a prediction model for the FIB-4 index concerning ICU admission and intubation rates. However, the scarcity of cases rendered the assessment of the mortality rate unfeasible. We plotted ROC curves to analyze the predictive strength of the FIB-4 index across various age groups. Result: In univariate logistic regression, only the FIB-4 index and respiratory rate demonstrated statistical significance on all poor outcomes. The FIB-4 index for mortality prediction had an ROC and AUC of 0.863 (95% CI: 0.781–0.9444). It demonstrates predictive power across age groups, particularly for age ≥65 (AUC: 0.812, 95% CI: 0.6571–0.9673) and age

Abstract Background Both nonoperative and operative treatments for spinal metastasis are expensive interventions. Patients' expected 3‐month survival is believed to be a key factor to determine the most suitable treatment. However, to the best of our knowledge, no previous study lends support to the hypothesis. We sought to determine the cost‐effectiveness of operative and nonoperative interventions, stratified by patients' predicted probability of 3‐month survival. Methods A Markov model with four defined health states was used to estimate the quality‐adjusted life years (QALYs) and costs for operative intervention with postoperative radiotherapy and radiotherapy alone (palliative low‐dose external beam radiotherapy) of spine metastases. Transition probabilities for the model, including the risks of mortality and functional deterioration, were obtained from secondary and our institutional data. Willingness to pay thresholds were prespecified at $100,000 and $150,000. The analyses were censored after 5‐year simulation from a health system perspective and discounted outcomes at 3% per year. Sensitivity analyses were conducted to test the robustness of the study design. Results The incremental cost‐effectiveness ratios were $140,907 per QALY for patients with a 3‐month survival probability >50%, $3,178,510 per QALY for patients with a 3‐month survival probability 50%. Conclusions This study emphasizes the need to choose patients carefully and estimate preoperative survival for those with spinal metastases. In addition to reaffirming previous research regarding the influence of ambulatory status on cost‐effectiveness, our study goes a step further by highlighting that operative intervention with postoperative radiotherapy could be more cost‐effective than radiotherapy alone for patients with a better survival outlook. Accurate survival prediction tools and larger future studies could offer more detailed insights for clinical decisions.

Extracellular vesicles (EVs) are an important regulatory factor for natural killer cell activity (NKA) in the tumor microenvironment. The relationship between circulating EVs in the peripheral blood and natural killer (NK) cells in prostate cancer (PCa) is unclear. This study aimed at investigating the key regulators in the interaction between circulating EVs and NK cells in PCa patients before and after tumor removal. NK‐cell characteristics were prospectively assessed in 79 patients treated with robot‐assisted laparoscopic radical prostatectomy preoperatively and postoperatively. Compared with healthy donors, the existence of prostate tumors increased the number of circulating EVs and altered ligand expression of EVs. Circulating EVs extracted from cancer patients significantly decreased NKA of NK cells compared with those extracted from healthy donors. Upon treatment with an inhibiting antibody or small interfering RNA, natural killer cell protein group 2A (NKG2A) was identified as the main NKA regulator in cancer patients for accepting the signal from circulating EVs. After surgery, NKA was increased and NKG2A expression on NK cells was significantly reduced. The expression of ligands for natural killer cell protein group 2D (NKG2D) on EVs and the level of circulation EVs both significantly increased. With the decrease in NKG2A levels on NK cells and the increase in total NKG2D ligands on circulating EVs, which was increased postoperatively, both NKG2A on NK cells and NKG2D ligands on circulating exosomes are main regulators of NKA restoration after prostatectomy.

Abstract The determination of lumbopelvic alignment is essential for planning adult spinal deformity surgery and for ensuring favorable surgical outcomes. This prospective study investigated the correlation between the lumbar section of lumbar spine lordosis and increasing pelvic incidence in 324 Asian adults with a mean age of 55 ± 13 years (range: 20–80 years), comprising 115 male and 209 female volunteers. Participants were divided into three groups based on pelvic incidence (G1, G2, and G3 had pelvic incidence of

Abstract To compare clinical outcomes between the use of robotic-assisted laparoscopic radical prostatectomy (RP) and radiotherapy (RT) with long-term androgen deprivation therapy (ADT) in locally advanced prostate cancer (PC), 315 patients with locally advanced PC (clinical T-stage 3/4) were considered for analysis retrospectively. Propensity score-matching at a 1:1 ratio was performed. The median follow-up period was 59.2 months (IQR 39.8–87.4). There were 117 (37.1%) patients in the RP group and 198 (62.9%) patients in the RT group. RT patients were older and had higher PSA at diagnosis, higher Gleason score grade group and more advanced T-stage (all p

Individuals with brachial plexus injury (BPI) require upper limb function restoration, but the treatment remains controversial. Vitamin B12 may aid in pain control and nerve regeneration. We present the technical aspects of ultrasound-guided perineural vitamin B12 injection for BPI. The demonstrative case is a 50-year-old man with BPI resulting from a traffic accident. Under ultrasound guidance, vitamin B12 was injected precisely into the brachial plexus compartment around the swollen neuroma of the C6 root. Motor and sensory functions of the left upper extremity improved over 6 months. Ultrasound-guided perineural vitamin B12 injection may be an efficient and personalized intervention in cases of post-ganglionic BPI that failed to improve in the first 3 months.

Abstract Background Although patients with lumbar spinal stenosis (LSS) may have impaired postural control, current diagnosis of LSS depends mainly on clinical manifestation and radiological assessment, while functional assessment of postural balance remains less investigated. This study thus correlated radiological assessment via MR imaging with functional assessment using foam posturography in LSS patients. Methods Forty-seven LSS patients aged 50–85 years were enrolled. All patients received subjective outcome measures first, followed by plain radiography of whole spine and lumbosacral spine, MR imaging, and foam posturography under four conditions. Then, these results were analyzed using stepwise multiple regression analysis. Another 47 age- and sex-matched healthy controls also underwent foam posturography for comparison. Results The LSS group revealed significant increases in the sway area of foam posturography than the control group regardless of various conditions. Advanced age, poor walking endurance, and neural compression at the L2/3 level on MR images were significantly correlated with the characteristic parameters of foam posturography (p 0.05). Conclusions Patients with LSS who exhibit less severe symptoms do not ensure normal postural balance. Functional assessment (foam posturography) on postural balance significantly correlated with radiological assessment (MR imaging) in LSS patients. The use of foam posturography may help assess postural control in LSS patients. It takes a short time and costs less, and would be practical to make this a routine examination in LSS patients.

Background/Purpose: This study measured the acceleration magnitude using a dummy model filled with various air-material ratios to elucidate the mechanism of resonance effect on ocular vestibular-evoked myogenic potential (oVEMP). Methods: With the percentages of air volume altered by filling various materials (water, glycerol, or ethanol) in an acrylic-made hollow spherical model, a minishaker was utilized to deliver vibration stimuli to the model. Then, acceleration magnitude of each model was measured. Results: Since the air was most occupied at the upper part of the model (z-axis), acceleration magnitude along the z-axis was selected for comparison. An increasing trend of the z-axis acceleration magnitude ranging 0.110–0.759 g was identified in air–water model with air volume percentage ranged 40–100%. On the other hand, a significant increasing trend of acceleration magnitude along the z-axis (0.157–0.759 g) was noted in air-glycerol model with 80–100% of air volume. While in air-ethanol model, a significant increasing trend in acceleration magnitude along the z-axis ranged 0.121–0.759 g correlating with 40–100% of air volume. Conclusion: The mechanism for eliciting oVEMP is via the first-order bone vibration coupled with the second-order resonance effect. Both percentage of air volume (i.e. frontal sinus) and density of filling media (i.e. skull property) may contribute to the resonance effect, which then increases the acceleration magnitude so as to enhance the elicitation of oVEMP.

Background: Minimally invasive carpal tunnel release has recently emerged as the primary surgical approach for recalcitrant carpal tunnel syndrome. A major concern related to surgical failure with this technique is the incomplete release of the flexor retinaculum. Case presentation: We developed a technique using dynamic ultrasound for evaluating the adequacy of median nerve decompression following minimally invasive carpal tunnel release. This novel imaging method was applied to two patients who showed significant symptom relief after the intervention. This case study also provides details of the dynamic ultrasound protocol and highlights the advantages of this technique. Conclusion: Dynamic ultrasound imaging can be used to confirm the completeness of carpal tunnel decompression. A large-scale prospective trial should be conducted to validate whether additional dynamic ultrasound examination can improve the outcome of minimally invasive carpal tunnel release.

BackgroundPercutaneous cervical nucleoplasty (PCN) is a simple, safe, and effective treatment for contained cervical herniated intervertebral disc (CHIVD). However, few studies have compared the actual benefits of PCN against conservative treatment (CT), either clinically or radiographically.PurposeThe present study sought to analyze and to compare the outcomes of symptomatic contained CHIVD treated with PCN or CT.MethodsThe present study was designed as a case-control comparative study. Patients who indicated for PCN after a failed CT for more than 6 months were recruited. After the exclusion of some patients who did not meet the selection criteria of the study, we finally enrolled 71 patients treated with PCN. In addition, another 21 patients who indicated for PCN but finally chose to receive CT continuously were also enrolled and categorized as the control group. All patients completed the 6-month follow-up. Pain levels and functional outcomes were evaluated pre- and post-operatively by assessing the visual analog scale (VAS), Oswestry Disability Index (ODI), and Neck Disability Index (NDI). Radiographic images of 72 of 104 intervened segments were collected to measure disc height and other cervical spinal alignments, such as range of motion, C2-7 Cobb's angle, and C2-7 sagittal vertical axis.ResultsCompared with the CT group, the PCN group showed significantly better outcomes on VAS, ODI, and NDI at the 1-month post-operative follow-up, which continued through at least the 6-month follow-up (P < 0.01 for VAS and P < 0.05 for ODI and NDI). The mean disc height significantly decreased, from 6.04 ± 0.85 mm to 5.76 ± 1.02 mm, 3 months after PCN treatment (P = 0.003). However, the degree of disc height decrease did not correlate with the changes of the substantial VAS improvement.ConclusionsTo provide therapeutic benefits for symptomatic contained CHIVD patients after an invalid CT for 6 months, PCN seems to be a better option than CT. The reduced disc heights did not alter the clinical outcomes of PCN.

Rapid eye movement (REM) sleep behavior disorder (RBD) is associated with Parkinson’s disease (PD). In this study, a smartwatch-based sensor is utilized as a convenient tool to detect the abnormal RBD phenomenon in PD patients. Instead, a questionnaire with sleep quality assessment and sleep physiological indices, such as sleep stage, activity level, and heart rate, were measured in the smartwatch sensors. Therefore, this device can record comprehensive sleep physiological data, offering several advantages such as ubiquity, long-term monitoring, and wearable convenience. In addition, it can provide the clinical doctor with sufficient information on the patient’s sleeping patterns with individualized treatment. In this study, a three-stage sleep staging method (i.e., comprising sleep/awake detection, sleep-stage detection, and REM-stage detection) based on an accelerometer and heart-rate data is implemented using machine learning (ML) techniques. The ML-based algorithms used here for sleep/awake detection, sleep-stage detection, and REM-stage detection were a Cole–Kripke algorithm, a stepwise clustering algorithm, and a k-means clustering algorithm with predefined criteria, respectively. The sleep staging method was validated in a clinical trial. The results showed a statistically significant difference in the percentage of abnormal REM between the control group (1.6 ± 1.3; n = 18) and the PD group (3.8 ± 5.0; n = 20) (p = 0.04). The percentage of deep sleep stage in our results presented a significant difference between the control group (38.1 ± 24.3; n = 18) and PD group (22.0 ± 15.0, n = 20) (p = 0.011) as well. Further, our results suggested that the smartwatch-based sensor was able to detect the difference of an abnormal REM percentage in the control group (1.6 ± 1.3; n = 18), PD patient with clonazepam (2.0 ± 1.7; n = 10), and without clonazepam (5.7 ± 7.1; n = 10) (p = 0.007). Our results confirmed the effectiveness of our sensor in investigating the sleep stage in PD patients. The sensor also successfully determined the effect of clonazepam on reducing abnormal REM in PD patients. In conclusion, our smartwatch sensor is a convenient and effective tool for sleep quantification analysis in PD patients.