Objectives: Sepsis is a leading global cause of mortality, and predicting its outcomes is vital for improving patient care. This study explored the capabilities of ChatGPT, a state-of-the-art natural language processing model, in predicting in-hospital mortality for sepsis patients. Methods: This study utilized data from the Korean Sepsis Alliance (KSA) database, collected between 2019 and 2021, focusing on adult intensive care unit (ICU) patients and aiming to determine whether ChatGPT could predict all-cause mortality after ICU admission at 7 and 30 days. Structured prompts enabled ChatGPT to engage in in-context learning, with the number of patient examples varying from zero to six. The predictive capabilities of ChatGPT-3.5-turbo and ChatGPT-4 were then compared against a gradient boosting model (GBM) using various performance metrics. Results: From the KSA database, 4,786 patients formed the 7-day mortality prediction dataset, of whom 718 died, and 4,025 patients formed the 30-day dataset, with 1,368 deaths. Age and clinical markers (e.g., Sequential Organ Failure Assessment score and lactic acid levels) showed significant differences between survivors and non-survivors in both datasets. For 7-day mortality predictions, the area under the receiver operating characteristic curve (AUROC) was 0.70–0.83 for GPT-4, 0.51–0.70 for GPT-3.5, and 0.79 for GBM. The AUROC for 30-day mortality was 0.51–0.59 for GPT-4, 0.47–0.57 for GPT-3.5, and 0.76 for GBM. Zero-shot predictions using GPT-4 for mortality from ICU admission to day 30 showed AUROCs from the mid-0.60s to 0.75 for GPT-4 and mainly from 0.47 to 0.63 for GPT-3.5. Conclusions GPT-4 demonstrated potential in predicting short-term in-hospital mortality, although its performance varied across different evaluation metrics.

Viral load and the duration of viral shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are important determinants of the transmission of coronavirus disease 2019.In this study, we examined the effects of viral doses on the lung and spleen of K18-hACE2 transgenic mice by temporal histological and transcriptional analyses. Approximately, 1×105 plaque-forming units (PFU) of SARS-CoV-2 induced strong host responses in the lungs from 2 days post inoculation (dpi) which did not recover until the mice died, whereas responses to the virus were obvious at 5 days, recovering to the basal state by 14 dpi at 1×102 PFU. Further, flow cytometry showed that number of CD8+ T cells continuously increased in 1×102 PFU-virusinfected lungs from 2 dpi, but not in 1×105 PFU-virus-infected lungs. In spleens, responses to the virus were prominent from 2 dpi, and number of B cells was significantly decreased at 1×105PFU; however, 1×102 PFU of virus induced very weak responses from 2 dpi which recovered by 10 dpi. Although the defense responses returned to normal and the mice survived, lung histology showed evidence of fibrosis, suggesting sequelae of SARS-CoV-2 infection. Our findings indicate that specific effectors of the immune response in the lung and spleen were either increased or depleted in response to doses of SARS-CoV-2. This study demonstrated that the response of local and systemic immune effectors to a viral infection varies with viral dose, which either exacerbates the severity of the infection or accelerates its elimination.

Background: As the number of large-scale studies involving multiple organizations producing data has steadily increased, an integrated system for a common interoperable format is needed. In response to the coronavirus disease 2019 (COVID-19) pandemic, a number of global efforts are underway to develop vaccines and therapeutics. We are therefore observing an explosion in the proliferation of COVID-19 data, and interoperability is highly requested in multiple institutions participating simultaneously in COVID-19 pandemic research. Results: In this study, a laboratory information management system (LIMS) approach has been adopted to systemically manage various COVID-19 non-clinical trial data, including mortality, clinical signs, body weight, body temperature, organ weights, viral titer (viral replication and viral RNA), and multiorgan histopathology, from multiple institutions based on a web interface. The main aim of the implemented system is to integrate, standardize, and organize data collected from laboratories in multiple institutes for COVID-19 non-clinical efficacy testings. Six animal biosafety level 3 institutions proved the feasibility of our system. Substantial benefits were shown by maximizing collaborative high-quality non-clinical research. Conclusions This LIMS platform can be used for future outbreaks, leading to accelerated medical product development through the systematic management of extensive data from non-clinical animal studies.

Clay-shoveler’s fractures are rare stress-type avulsion fractures of the spinous processes especially in sports. There have been two case reports that discussed clay-shoveler’s fractures in golf. A 36-year-old beginner golfer presented with a pain in the back after practicing golf swing. No fractures were detected using cervical radiography; however, computed tomography (CT) and magnetic resonance imaging (MRI) revealed T2∼T3 spinous process fractures. The patient was treated conservatively and his pain subsided. The mechanism of injury is speculated to that of clay-shoveler’s fractures. Therefore, if a golfer suffers persistent pain in the cervicothoracic region, clay-shoveler’s fracture is one possibility to consider.

Clay-shoveler’s fractures are rare stress-type avulsion fractures of the spinous processes especially in sports. There have been two case reports that discussed clay-shoveler’s fractures in golf. A 36-year-old beginner golfer presented with a pain in the back after practicing golf swing. No fractures were detected using cervical radiography; however, computed tomography (CT) and magnetic resonance imaging (MRI) revealed T2∼T3 spinous process fractures. The patient was treated conservatively and his pain subsided. The mechanism of injury is speculated to that of clay-shoveler’s fractures. Therefore, if a golfer suffers persistent pain in the cervicothoracic region, clay-shoveler’s fracture is one possibility to consider.

Assessing antigen concentration of vaccine is essential step in determining the quality of the vaccine prior to vaccination. After vaccination, vaccine-induced antibody titer should also be measured to verify the vaccine efficacy. Since conventional assay used for vaccine concentrations and induced Ab-titers is antibody-based enzyme-linked immunosorbent assay, the assay inevitably brings drawbacks of antibody such as high cost for production, limited stability, and inconsistent quality between lot-to-lots. Aptamer is single-stranded nucleic acid having three-dimensional structure and has features overcoming limitations of antibody. This review will briefly introduce the features of aptamer and potential of aptamer-based system for evaluation of vaccine efficacy.
Antibodies ; Enzyme-Linked Immunosorbent Assay ; Vaccination ; Vaccines

Anatomic variations in the biliary tree may not be detected until adulthood and they can cause unexplained jaundice and biliary pain. Recognition of these anatomic variations is important to avoid an incorrect diagnosis and significant ductal injury during biliary surgery. Although there are numerous anatomic bile duct variations, an accessory cystic duct draining into the right hepatic duct is rare. We report a case of an accessory cystic duct draining into the right hepatic duct with cholelithiasis, in which the abnormality was identified by endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography and confirmed by laparoscopic cholecystectomy.
Bile Ducts ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Choledocholithiasis ; Cholelithiasis ; Cystic Duct* ; Diagnosis ; Hepatic Duct, Common ; Jaundice

Invasive aspergillosis is a serious threat and a leading cause of death in immunocompromised patients. Aspergillus tracheobronchitis is an infrequent but severe form of invasive pulmonary aspergillos in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We report an extraordinary case of acute airway obstruction and respiratory failure due to Aspergillus tracheobronchitis in an immunocompromised patient. Fiberoptic bronchoscopy revealed extensive obstruction of both the main and lobar bronchus with yellowish nodules strongly adhered to the bronchial wall; both histologic examination and culture of these nodules revealed Aspergillus fumigatus. Even with early detection of an intraluminal growth of Aspergillus and prompt institution of antifungal therapy, the patient died of refractory hypoxemia a few days later. This report shows that Aspergillus tracheobronchitis should be considered in immunocompromised patients with suspected lung infection even when the main radiographic finding is atelectasis.
Airway Obstruction ; Anoxia ; Aspergillosis ; Aspergillus ; Aspergillus fumigatus ; Bronchi ; Bronchoscopy ; Cause of Death ; Humans ; Immunocompromised Host ; Lung ; Pulmonary Atelectasis ; Respiratory Insufficiency

A fenestrated middle cerebral artery (MCA) is a rare congenital anomaly, and is related to interference in the normal embryonic development of the MCA. Fenestrated MCA has been regarded to have no clinical significance other than a rare event of hemorrhage from associated aneurysm. However, the fenestration within the arterial trunk can be an obstacle against thrombus migration and may be associated with a major cerebral infarction. Moreover, the presence of this anomaly can be hardly detected prior to thrombolytic procedures, and emergent treatments are proceeded without any information of anatomical configurations. Therefore, the recanalization procedures would carry a high risk of intraprocedural complications. We report a rare case of MCA territory infarction from occlusion of fenestrated M1 segment, and also introduce a safe method of mechanical thrombolysis using coil.
Aneurysm ; Cerebral Infarction ; Embryonic Development ; Female ; Hemorrhage ; Infarction ; Mechanical Thrombolysis ; Middle Cerebral Artery ; Pregnancy ; Thrombosis

PURPOSE: Fibrous hamartoma (FH) of infancy is a distinctive fibrous growth that most frequently occurs at birth and during the postnatal period. It is important for clinicians and pathologists to recognize this entity to avoid an aggressive approach. METHODS: We herein describe the clinicopathologic features of 9 FHs diagnosed at a single institution between 1997 and 2010. RESULTS: There were 7 boys and 2 girls, and the mean age of presentation was 14.7 months. The common locations were the lower back and gluteal region (n = 3) and scrotum (n = 2). They were solitary lesions, and measured 1.0 to 7.0 cm in maximum diameter (mean, 4.9 cm). The excised masses tended to be poorly circumscribed, and consisted of an intimate mixture of firm, gray-white tissue with fat. Histologically, these lesions were composed of 3 components forming a vague, irregular, organoid pattern: well-defined intersecting trabeculae of fibrocollagenous tissue; loosely textured areas of small, rounded, primitive mesenchymal cells; and mature fat. Over a median follow-up of 72 months, no patient showed recurrence. CONCLUSION: FH should be distinguished from other forms of fibromatosis and malignant tumors because it is benign and usually cured by local excision.
Buttocks ; Diagnosis, Differential ; Fibroma ; Follow-Up Studies ; Hamartoma ; Humans ; Infant ; Organoids ; Parturition ; Scrotum ; Soft Tissue Neoplasms