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Medical students have limited exposure to oncologic specialties, leading to inadequate information or misconceptions that can limit recruitment. Mentorship and involvement in oncology research can be challenging as these fields require fellowship training and/or are not part of core clerkships. A multidisciplinary symposium was implemented to introduce oncologic specialties, connect students with mentors, and facilitate research. Symposium implementation required recruitment of key stakeholders, partnership with administrative staff, and institutional support. Promotion was aided by advanced registration, social media teams, and sharing via email groups, calendars, and newsletters. Date selection, clear expectations for speakers, and day-of logistics were considered. Sessions were evaluated with pre- and post-surveys. The agenda is shown in Table 1. 21 and 31 students, 11 and 12 leaders, 1 and 2 administrators, and 2 and 6 staff members attended the first and second annual symposia, respectively. 7 students responded to the feedback survey for each symposium. Breakdown was 28% M1, 42% M2, 28% M3 students for the first, and 42% M1, 28% M2, 14% M3, and 14% graduate students for the second symposium. Symposia were rated 4.5/5 and 4.8/5 stars. 23% of respondents reported they were able to connect with faculty of interest after the event, 30% were exposed to new and interesting ideas, and 23% had new opportunities available after meeting with mentors. A third of speakers reported having at least one student follow up for research. Surveys suggested interest but limited knowledge of clinical oncology prior to the event, with enhanced knowledge and mentorship/research opportunities post-symposia. Multidisciplinary, multi-institutional symposia were implemented with favorable results. Key considerations for setting up a symposium are provided to facilitate implementation of this innovative education opportunity at other institutions. This approach could also be adapted to multi-disciplinary fields outside of oncology. [ABSTRACT FROM AUTHOR]

Centronuclear myopathies (CNMs) are a group of rare inherited congenital myopathies for which there is currently no cure. The most common form is X-linked myotubular myopathy (XL-MTM) with an estimated incidence of 1 in 50,000 male births and a typically severe clinical phenotype. The international Myotubular and Centronuclear Myopathy Patient Registry collects demographic, genetic and clinical data for affected individuals (living and deceased) and female carriers of XL-MTM. In the past few years two clinical trials have taken place, ASPIRO & Unite-CNM, both of which were halted prematurely because of liver-related serious adverse events, ranging from reversible liver function abnormalities to fatal cholestatic liver failure. These events have led to an increasing awareness of liver-related pathology, including pre-existing liver dysfunction in XL-MTM and CNM which may predispose patients to treatment-related adverse events, as highlighted in a recent publication on the ASPIRO gene therapy trial for XL-MTM. Driven by two patient organisations (MTM-CNM Family Connection and Myotubular Trust UK), a group of international experts was assembled to create the 'Liver Collaborative' to better understand liver challenges experienced in the community from both a natural history perspective and in the context of emerging clinical trials. Working with the MTM & CNM Patient Registry, a liver health questionnaire was developed and implemented into the registry platform in April 2023, with 168 questionnaires completed. The Collaborative is responsive to emerging new research which is advancing the understanding of potential liver dysfunction in XLMTM and CNM. The liver health questionnaire will be updated to capture additional data on nutritional diet and patient liver testing results. Findings from the current and expanded questionnaire will be presented. The registry has been a key instrument for the longitudinal collection of this data. [ABSTRACT FROM AUTHOR]

Foot and mouth disease (FMD) remains endemic in many areas of continental Southeast Asia (SEA). It is responsible for substantial economic losses in the smallholder sector and threatens livelihoods. In recent years, novel diagnostic tests have been developed which reportedly detect FMD virus more effectively and efficiently. This critically appraised topic (CAT) aimed to evaluate the feasibility of these diagnostic tests for FMD in SEA compared to conventional tests. Relevant studies that evaluate diagnostic tests are identified and critically assessed, and recommendations are made on suitable potential diagnostic tests for use in the smallholder sector in SEA. A systematic search of electronic databases (CABI: CAB Abstracts, Web of Science Core Collections) was carried out to identify relevant studies that compared novel and conventional diagnostic tests. The search strategy initially identified 12 papers, of which six fulfilled all the inclusion criteria and were selected for this review. Most of the selected studies had limitations in design and comparability, making it difficult to validly compare the effectiveness and efficiency of the relevant diagnostic tests. These limitations include variation in sample characteristics, methodology, measurable outcomes and the different aspects of the diagnostic tests that each study focused on. Most studies concluded that novel diagnostic tests were more effective and efficient than conventional tests: had greater analytical sensitivity and specificity, were more robust, had a wider range of processable sample types and serotypes, could detect various diseases, had faster testing speeds and provided greater value for money. However, strong recommendations on which specific diagnostic test to rely on could not be made, since there was conflicting evidence and multiple confounding factors. Overall, the evidence found did not entirely apply to the target scenario, being SEA smallholder farms. Recommendations for the target scenario were also made based on the study findings., (© 2024 The Author(s). Australian Veterinary Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Veterinary Association.)

Coronary artery blood flow is influenced by various factors including vessel geometry, hemodynamic conditions, timing in the cardiac cycle, and rheological conditions. Multiple patterns of disturbed coronary flow may occur when blood flow separates from the laminar plane, associated with inefficient blood transit, and pathological processes modulated by the vascular endothelium in response to abnormal wall shear stress. Current simulation techniques, including computational fluid dynamics and fluid-structure interaction, can provide substantial detail on disturbed coronary flow and have advanced the contemporary understanding of the natural history of coronary disease. However, the clinical application of these techniques has been limited to hemodynamic assessment of coronary disease severity, with the potential to refine the assessment and management of coronary disease. Improved computational efficiency and large clinical trials are required to provide an incremental clinical benefit of these techniques beyond existing tools. This contemporary review is a clinically relevant overview of the disturbed coronary flow and its associated pathological consequences. The contemporary methods to assess disturbed flow are reviewed, including clinical applications of these techniques. Current limitations and future opportunities in the field are also discussed.

Introduction: ChatGPT is a natural language processing chatbot with a significant prevalence in modern media with a clear application in the medical triage workflow. ChatGPT has shown significant capacity for understanding clinical vignettes, radiology reports, and even passing the American Board of Neurological Surgery board exam. There has never been an evaluation of the chatbot in triage and diagnosing spinal vignettes common to primary and urgent care practice., Methods: Fifteen clinical scenarios were created to mimic spinal complaints common to primary and urgent care scenarios. GPT4 was instructed to assess the situation as if it was in a primary care office, and determine diagnosis, imaging recommendations, and if emergency room (ER) or operative referral was necessary. Answers were recorded and the results compared to those of attending and resident respondents., Results: GPT4 provided the most likely diagnosis in each scenario. Additionally, it recommended reasonable clinical management of each scenario which would fall within standard practice guidelines. ChatGPT tended towards over-referral to the ER, though this was not significant. GPT4 was non-inferior in all categories when compared to respondents., Conclusion: ChatGPT is a powerful tool for primary triage of spinal issues. It can rapidly and accurately evaluate clinical scenarios and provide clear diagnostic reasoning. GPT4 is not designed for medical use and will provide a disclaimer as such. It did tend towards over-referring patients to the ER. With specific training, it is likely that artificial intelligence and natural language processing chatbots will become widely used in primary triage of spinal issues., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: A primary barrier to curing HIV is the HIV reservoir. The leading infectious cause of death worldwide for people living with HIV is tuberculosis (TB), but we do not know how TB impacts the HIV reservoir., Methods: Participants in identification and validation cohorts were selected from previously enrolled studies at Groupe Haïtien d'Étude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) in Port au Prince, Haiti. Intact and non-intact proviral DNA were quantified using droplet digital PCR of peripheral blood mononuclear cell (PBMC)-derived CD4+ T cells. Kruskal-Wallis tests were used to compare medians with tobit regression for censoring., Results: In the identification cohort, we found that people living with HIV with a history of active pulmonary TB (n=19) had higher levels of intact provirus than people living with HIV without a history of active TB (n=47) (median 762; IQR, 183-1173 vs 117; IQR, 24-279 intact provirus per million CD4, respectively; P =0.0001). This difference also was seen in the validation cohort (n=31), (median 102; IQR, 0-737 vs 0; IQR, 0-24.5 intact provirus per million CD4, P =0.03) for TB vs no-TB history groups, respectively. The frequencies of CD4+ T cells with any detectable proviral fragment was directly proportional to the levels of interleukin-1 beta (r=0.524, P = 0.0025) and interleukin-2 (r=0.622, P =0.0002)., Conclusions: People living with HIV with a history of active pulmonary TB have more HIV pro-virus in their circulating CD4+ T cells, even years after TB cure. We need to characterize which CD4+ T cells are harboring intact provirus to consider the impact of T cell-targeting HIV cure interventions for people living in TB-endemic areas., Competing Interests: The authors report no competing financial interests., (Copyright © 2024 Pathogens and Immunity.)

Folate, vitamin B 12 , vitamin B 6 and riboflavin interact by functioning as cofactors within one-carbon metabolism (OCM), a network of interrelated cellular pathways essential for numerous biological processes, including the biosynthesis of DNA, amino acid interconversions and methylation reactions. The pathways of OCM are influenced by endocrine signals and genetic polymorphisms and are particularly responsive to relevant B-vitamin intakes. Physiological changes in healthy pregnancy, leading to a steady decline in B-vitamin status, add another layer of complexity to the regulation of OCM. Although significant advances have been made to improve our understanding of these pregnancy-related changes, no specific reference ranges yet exist for B-vitamin biomarkers in pregnancy to support normal fetal growth without depleting maternal stores. The lack of pregnancy-related criteria for adequacy of B-vitamin status is in turn a major limitation in identifying pregnant women most at risk of B-vitamin deficiency. Another challenge is that the evidence is very limited to provide a basis for establishing pregnancy-specific dietary recommendations for B-vitamins to support successful pregnancy outcomes. In terms of preventing adverse outcomes, periconceptional folic acid supplementation has a proven role, established more than 30 years ago, in protecting against neural tube defect-affected pregnancies and this has been the major focus of public health policy worldwide. This review evaluates the emerging evidence for the less well recognised role of B-vitamins in preventing hypertensive disorders in pregnancy and the intergenerational effects of B-vitamins on offspring neurodevelopment and cognitive performance during childhood. We also consider the underlying biological mechanisms.

Background and Objective: The Yorkshire Kidney Screening Trial (YKST) assessed the feasibility of adding abdominal noncontrast computed tomography (NCCT) to lung cancer screening to screen for kidney cancer and other abdominal pathology., Methods: A prospective diagnostic study offered abdominal NCCT to 55-80-yr-old ever-smokers attending a UK randomised lung cancer screening trial (May 2021 to October 2022). The exclusion criteria were dementia, frailty, previous kidney/lung cancer, and computed tomography (CT) of the abdomen and thorax within previous 6 and 12 mo, respectively. Six-month follow-up was undertaken., Key Findings and Limitations: A total of 4438 people attended lung screening, of whom 4309 (97%) were eligible for and 4019 (93%) accepted abdominal NCCT. Only 3.9% respondents regretted participating. The additional time to conduct the YKST processes was 13.3 min. Of the participants, 2586 (64%) had a normal abdominal NCCT, whilst 787 (20%) required an abdominal NCCT imaging review but no further action and 611 (15%) required further evaluation (investigations and/or clinic). Of the participants, 211 (5.3%) had a new serious finding, including 25 (0.62%) with a renal mass/complex cyst, of whom ten (0.25%) had histologically proven kidney cancer; ten (0.25%) with other cancers; and 60 (1.5%) with abdominal aortic aneurysms (AAAs). Twenty-five (0.62%) participants had treatment with curative intent. Of the participants, 1017 (25%) had nonserious findings, most commonly benign renal cysts (727 [18%]), whereas only 259 (6.4%) had nonserious findings requiring further tests. The number needed to screen to detect one serious abdominal finding was 18; it was 93 to detect one suspicious renal lesion and 402 to detect one histologically confirmed renal cancer. Limitations of the cohort were fixed age range and being prior lung cancer screening attendees., Conclusions and Clinical Implications: In this first prospective risk-stratified screening study of abdominal NCCT offered alongside CT thorax, uptake and participant satisfaction were high. The prevalence of serious findings, cancers, and AAAs, is in the range of established screening programmes such as bowel cancer. Longer-term outcomes and cost effectiveness should now be evaluated., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: To develop a method of consistently identifying interfacility transfers (IFTs) in Medicare Claims using patients with ST-Elevation Myocardial Infarction (STEMI) as an example., Data Sources/study Setting: 100% Medicare inpatient and outpatient Standard Analytic Files and 5% Carrier Files, 2011-2020., Study Design: Observational, cross-sectional comparison of patient characteristics between proposed and existing methods., Data Collection/extraction Methods: We limited to patients aged 65+ with STEMI diagnosis using both proposed and existing methods., Principal Findings: We identified 62,668 more IFTs using the proposed method (86,128 versus 23,460). A separately billable interfacility ambulance trip was found for more IFTs using the proposed than existing method (86% vs. 79%). Compared with the existing method, transferred patients under the proposed method were more likely to live in rural (p < 0.001) and lower income (p < 0.001) counties and were located farther away from emergency departments, trauma centers, and intensive care units (p < 0.001)., Conclusions: Identifying transferred patients based on two consecutive inpatient claims results in an undercount of IFTs and under-represents rural and low-income patients., (© 2024 The Author(s). Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)

Introduction: Health research bodies recommend patient involvement and engagement in research and healthcare planning, although their implementation is not yet widespread. This deficiency extends to progressive pulmonary fibrosis (PPF), where crucial aspects remain unknown, including causal mechanisms, curative treatments and optimal symptom management. This study addresses these gaps by seeking stakeholders' perspectives to guide research and treatment directions., Method: A priority-setting partnership was established to explore stakeholders' priorities in the diagnosis, treatment, management and care of PPF, including idiopathic pulmonary fibrosis which is the archetypal PPF. Stakeholders included people living with PPF, their carers, relatives and healthcare professionals involved in their management., Results: Through an online open-ended survey, 2542 responses were collected from 638 stakeholders. Thematic analysis identified 48 specific research questions, which were then cross-referenced with academic literature to pinpoint research gaps. Following the evidence check, 44 unanswered questions were shortlisted by 834 stakeholders in a second online survey. Ultimately, a top 10 priority list was established through consensus.The prioritised research questions include (1) improved diagnosis accuracy and timing, (2) development of new treatments, (3) enhanced accuracy in primary care, (4) optimal timing for drug and non-drug interventions, (5) effective cough treatment, (6) early intervention for PPF, (7) improved survival rates, (8) symptom reduction, (9) impact of interventions on life expectancy and (10) new treatments with reduced side effects., Conclusion: Stakeholders' priorities can be summarised into five areas: early diagnosis, drug and non-drug treatments, survival and symptom management. Ideally, these topics should guide funding bodies and health policies., Competing Interests: Competing interests: AMR discloses payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Boehringer Ingelheim, Hoffman La Roche, Irish Lung Fibrosis Association, Aerogen. Support for attending meetings and travel from Boehringer Ingelheim, Hoffman La Roche, Interstitial Lung Disease Interdisciplinary Network. GJ discloses grants or contracts from any entity from AstraZeneca, Biogen, Galecto, GlaxoSmithKline, Nordic Biosciences, RedX, Pliant; consulting fees from Apollo Therapeutics, AstraZeneca, Brainomix. Bristol Myers Squibb, Chiesi, Cohbar, Daewoong, GlaxoSmithKline, Veracyte, Resolution Therapeutics, Pliant; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Boehringer Ingelheim, Chiesi, Roche, PatientMPower, AstraZeneca; payment for expert testimony from Pinsent Masons; participation on a Data Safety Monitoring Board or Advisory Board with Boehringer Ingelheim, Galapagos, Vicore; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid with NuMedii and Action for Pulmonary Fibrosis., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

The pharmacokinetic profile of selected NSAIDs in southern black rhinoceros ( Diceros bicornis minor ) were studied. Phenylbutazone (PBZ), meloxicam (MEL), and firocoxib (FIR) were administered orally to five captive, black rhinoceros, and blood was collected at predetermined time points for NSAID quantification and noncompartmental pharmacokinetic (PK) analysis. Phenylbutazone 4.0 mg/kg PO q12h for three doses, MEL 0.3 mg/kg PO q24h administered twice, and a single oral dose of FIR 0.1 mg/kg, were tested with a minimum washout time of 2 wk. PBZ reached a median (range) peak concentration (C max ) of 9.42 (2.74-11.5) g/ml at a mean (range) time (T max ) of 6.00 (4.00 to >12.00) h, and the median (range) elimination half-life (T 1/2 ) was 6.07 (3.95-6.49) h. Phenylbutazone pharmacokinetic parameters for black rhinoceros in this study were similar to domestic horses. Meloxicam reached a median (range) C max of 0.576 (0.357-0.655) µg/ml at a median (range) time (T max ) of 6.00 (4.00-12.00) h; the median (range) T 1/2 of MEL was 14.0 (12.4-17.9) h. These results demonstrate that once-daily administration of MEL at 0.3 mg/kg resulted in a serum concentration of greater than 0.200 µg/ml from 2 to 24 h in four animals, which is within the analgesic range (0.200-0.400 µg/ml) for this drug in other species postulated by other studies. A single dose of firocoxib (0.1 mg/kg) reached a median (range) peak concentration (C max ) of 15.7 (9.65-17.3) ng/ml at a median (range) T max of 4.00 (4.00-6.00) h. The median (range) elimination T 1/2 of FIR was 4.96 (4.47-6.51) h, which is faster than in the horse. The data suggest that extrapolation from equine FIR dosage recommendations is inappropriate for black rhinoceros.

Background: While the cognitive hallmark of typical Alzheimer disease (AD) is impaired memory consolidation, increasing evidence suggests that the frontal lobes and associated executive functions are also impacted., Objective: We examined two neurobehavioral executive function tasks and associations with cortical thickness in patients diagnosed with mild cognitive impairment (MCI), suspected AD dementia, and a healthy control group., Methods: First, we compared group performances on a go/no-go (GNG) task and on Luria's Fist-Edge-Palm (FEP) motor sequencing task. We then examined correlations between neurobehavioral task performance and the thickness of frontal cortical regions, AD signature regions, broader unbiased brain regions, and white matter hyperintensities (WMH)., Results: Participants with MCI performed worse than healthy controls, but better than participants with suspected AD dementia on both tasks. Both GNG and FEP (to a slightly greater extent) tasks showed diffuse associations with most AD signature regions and multiple additional regions within the temporal, parietal, and occipital cortices. Similarly, both tasks showed significant associations with all other cognitive tasks examined. Of the frontal regions examined, only the middle frontal gyrus and pars opercularis were associated with performance on these tasks. Interactions between the precuneus and transtemporal gyri were most predictive of GNG task performance, while the interaction between superior temporal and lingual gyri was most predictive of FEP task performance., Conclusion: This study replicates difficulties with both GNG and FEP tasks in participants with MCI and AD dementia. Both tasks showed widespread associations with the cortical thickness of various brain structures rather than localizing to frontal regions, consistent with the diffuse nature of AD., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Medical students are increasingly seeking out research opportunities to build their skills and network with future colleagues. Medical student-led conferences are an excellent endeavor to achieve this goal., Methods: The American Association of Neurological Surgeons student chapter at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell designed an in-person medical student research symposium alongside the Northwell Health Department of Neurosurgery. Postconference feedback forms were sent out digitally to student attendees to evaluate event planning and execution and responses were given on a scale of 1-5 (5 being the highest score)., Results: In December 2023, the Northeast Medical Student Research Symposium was held with over 80 participants and 52 medical student presenters. Keynote speakers delivered lectures geared toward students interested in neurosurgery and neuroscience research, followed by an interactive poster board session and resident/attending networking dinner. After the conference, students affirmed that they learned more about neuroscience research after the event (mean: 4.3), were more inclined to attend other neuroscience research events in the future (mean: 4.7), and would attend this event if held next year (mean: 4.8). The poster sessions (mean: 4.75) and keynote lectures (mean: 5) were the highest rated events, while the resident/attending networking dinner (mean: 3.6) was a potential area for improvement., Conclusions: Regional in-person conferences are an excellent way to foster interest in neurosurgery and neuroscience research, network with like-minded peers, and prepare students for presentations at national meetings., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: The rapidly increasing adoption of large language models in medicine has drawn attention to potential applications within the field of neurosurgery. This study evaluates the effects of various contextualization methods on ChatGPT's ability to provide expert-consensus aligned recommendations on the diagnosis and management of Chiari Malformation and Syringomyelia., Methods: Native GPT4 and GPT4 models contextualized using various strategies were asked questions revised from the 2022 Chiari and Syringomyelia Consortium International Consensus Document. ChatGPT-provided responses were then compared to consensus statements using reviewer assessments of 1) responding to the prompt, 2) agreement of ChatGPT response with consensus statements, 3) recommendation to consult with a medical professional, and 4) presence of supplementary information. Flesch-Kincaid, SMOG, word count, and Gunning-Fog readability scores were calculated for each model using the quanteda package in R., Results: Relative to GPT4, all contextualized GPTs demonstrated increased agreement with consensus statements. PDF+Prompting and Prompting models provided the most elevated agreement scores of 19 of 24 and 23 of 24, respectively, versus 9 of 24 for GPT4 (p=.021, p=.001). A trend toward improved readability was observed when comparing contextualized models at large to ChatGPT4, with significant decreases in average word count (180.7 vs 382.3, p<.001) and Flesch-Kincaid Reading Ease score (11.7 vs 17.2, p=.033)., Conclusions: The enhanced performance observed in response to ChatGPT4 contextualization suggests broader applications of large language models in neurosurgery than what the current literature indicates. This study provides proof of concept for the use of contextualized GPT models in neurosurgical contexts and showcases the easy accessibility of improved model performance., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: ChatGPT has been increasingly investigated for its ability to provide clinical decision support in the management of neurosurgical pathologies. However, concerns exist regarding the validity of its responses. To assess the reliability of ChatGPT, we compared its responses against the 2023 Congress of Neurological Surgeons (CNS) guidelines for patients with Chiari I Malformation (CIM)., Methods: ChatGPT-3.5 and ChatGPT-4 were prompted with revised questions from the 2023 CNS guidelines for patients with CIM. ChatGPT provided responses were compared to CNS guideline recommendations using cosine similarity scores and reviewer assessments of 1) contradiction with guidelines, 2) recommendations not contained in guidelines, and 3) failure to include guideline recommendations. Scoping review was conducted to investigate reviewer-identified discrepancies between CNS recommendations and GPT-4 responses., Results: A majority of ChatGPT responses were coherent with CNS recommendations. However, moderate contradiction was observed between responses and guidelines (15.3% ChatGPT-3.5 responses, 38.5% ChatGPT-4 responses). Additionally, a tendency toward over-recommendation (30.8% ChatGPT-3.5 responses, 46.1% ChatGPT-4 responses) rather than under-recommendation (15.4% ChatGPT-3.5 responses, 7.7% ChatGPT-4 responses) was observed. Cosine similarity scores revealed moderate similarity between CNS and ChatGPT recommendations (0.553 ChatGPT-3.5, 0.549 ChatGPT-4). Scoping review revealed 19 studies relevant to CNS-ChatGPT substantive contradictions, with mixed support for recommendations contradicting official guidelines., Conclusions: Moderate incoherence was observed between ChatGPT responses and CNS guidelines on the diagnosis and management of CIM. The recency of the CNS guidelines and mixed support for contradictory ChatGPT responses highlights a need for further refinement of large language models prior to their application as clinical decision support tools., (Copyright © 2024 Elsevier Inc. All rights reserved.)