Purpose: Large language models (LLMs) like ChatGPT (OpenAI) are increasingly used in healthcare, raising questions about their accuracy and reliability for medical information. This study compared 2 versions of ChatGPT in answering post-discharge follow-up questions in the area of pediatric emergency medicine (PEM). Methods: Twenty-three common post-discharge questions were posed to ChatGPT-4 and -3.5, with responses generated before and after a simplification request. Two blinded PEM physicians evaluated appropriateness and accuracy as the primary endpoint. Secondary endpoints included word count and readability. Six established reading scales were averaged, including the Automated Readability Index, Gunning Fog Index, Flesch-Kincaid Grade Level, Coleman-Liau Index, Simple Measure of Gobbledygook Grade Level, and Flesch Reading Ease. T-tests and Cohen’s kappa were used to determine differences and inter-rater agreement, respectively. Results: The physician evaluations showed high appropriateness for both defaults (ChatGPT-4, 91.3%-100% vs. ChatGPT-3.5, 91.3%) and simplified responses (both 87.0%-91.3%). The accuracy was also high for default (87.0%-95.7% vs. 87.0%-91.3%) and simplified responses (both 82.6%-91.3%). The inter-rater agreement was fair overall (κ = 0.37; P < 0.001). For default responses, ChatGPT-4 produced longer outputs than ChatGPT-3.5 (233.0 ± 97.1 vs. 199.6 ± 94.7 words; P = 0.043), with a similar readability (13.3 ± 1.9 vs. 13.5 ± 1.8; P = 0.404). After simplification, both LLMs improved word count and readability (P < 0.001), with ChatGPT-4 achieving a readability suitable for the eighth grade students in the United States (7.7 ± 1.3 vs. 8.2 ± 1.5; P = 0.027). Conclusion The responses of ChatGPT-4 and -3.5 to post-discharge questions were deemed appropriate and accurate by the PEM physicians. While ChatGPT-4 showed an edge in simplifying language, neither LLM consistently met the recommended reading level of sixth grade students. These findings suggest a potential for LLMs to communicate with guardians.

Objective: Colony-stimulating factor 1 receptor-related leukoencephalopathy (CSF1R-L) is a rare adult-onset leukoencephalopathy. Reports of CSF1R-L patients from the Indian subcontinent remain limited. We aimed to report four patients with genetically confirmed CSF1R-L from four Asian Indian families and described their clinical, molecular, and radiological features. Methods: All patients underwent clinical examination, brain magnetic resonance imaging, and whole-exome sequencing to identify causative variants in the CSF1R gene. We also reviewed published reports of Indian patients with CSF1R-L. Results: The age at enrollment ranged from 34 to 40 years. The duration of symptoms ranged from 11 months to 2 years. The chief clinical phenotype in three patients was a rapidly evolving cognitive-behavioral syndrome combined with atypical parkinsonism, and asymmetrical spastic tetraparesis was observed in one patient. We identified four different variants (three missense variants and one in-frame deletion). Radiological findings revealed white matter involvement and diffusion restriction involving the subcortical white matter and pyramidal tracts. Conclusion We expand the literature on CSF1R-L patients from India by reporting four new cases.

Inflammatory bowel disease (IBD) is a spectrum of diseases characterized by the interplay of the aberrant immune system, genetic factors, environmental factors, and intestinal microbiota, resulting in relapsing inflammation of the gastrointestinal tract. Underlying pro-inflammatory state and immune dysregulation act as a catalyst for increasing the likelihood of developing extraintestinal manifestations, including cardiovascular diseases (CVD) like atherosclerosis, pericarditis, myocarditis, venous and arterial thromboembolism, arrhythmias, despite a lower prevalence of classic CVD risk factors, like high body mass index or dyslipidemia compared to the general population. Chronic inflammation damages endothelium resulting in the recruitment of inflammatory cells, which induce cytotoxicity, lipoprotein oxidation, and matrix degradation, which increases the risk of atherosclerosis. Additionally, intestinal dysbiosis disrupts the intestinal mucosal barrier, releasing endotoxins and lipopolysaccharides into circulation, further exaggerating the atherosclerotic process. Abnormal collagen metabolism and alteration of nitric oxide-mediated vasodilation lead to blood pressure dysregulation in patients with IBD. Therefore, it is essential to make lifestyle modifications like smoking cessation, dietary changes, and increasing physical activity with adherence to medication to mitigate the risk of developing CVD in patients with IBD. This article reviews the potential links between IBD and the increased risk of CVD in such individuals.

Background: Post-liver transplant biliary strictures are a common cause of morbidity among patients who have undergone living donor liver transplantation (LDLT). Limited data are available concerning the response rates to various treatment modalities and the long-term outcomes for these individuals. Methods: This study was a retrospective analysis of a prospectively collected database, including adult patients aged 18 years or older who underwent LDLT between 2006 and 2022. Results: Between 2006 and 2022, a total of 3,550 patients underwent liver transplantation. After applying exclusion criteria, 2,956 patients were included in the analysis.During the study period, 344 patients (11.6%) developed biliary strictures. Of these, 77.0% underwent endoscopic retrograde cholangiopancreatography as the primary treatment for biliary strictures, while the remainder received percutaneous transhepatic biliary drainage. Identified risk factors for post-liver transplant biliary strictures included the presence of multiple biliary anastomoses, bile leak, and older donor and recipient ages. The overall graft and patient survival rates were comparable between patients with and without biliary strictures, at both 1 year (93.0% vs. 96.3%) and 5 years (82.3% vs. 79.2%). Conclusions Biliary strictures are observed in approximately 11% of recipients following LDLT. While the presence of biliary strictures is associated with increased morbidity, it does not significantly impact patient survival.

Emerging evidence suggests that systemic inflammation may play a critical role in neurological disorders. Recent studies have shown the connection between inflammatory bowel diseases (IBD) and neurological disorders, revealing a bidirectional relationship through the gut-brain axis.Immunotherapies, such as Treg cells infusion, have been proposed for IBD. However, the role of adaptive immune cells in IBD-induced neuroinflammation remains unclear. In this study, we established an animal model for IBD in mice with severe combined immune-deficient (SCID), an adaptive immune deficiency, to investigate the role of adaptive immune cells in IBD-induced neuroinflammation. Mice were fed 1%, 3%, or 5% dextran sulfate sodium (DSS) for 5 days. We measured body weight, colon length, disease activity index (DAI), and crypt damage. Pro-inflammatory cytokines were measured in the colon, while microglial morphology, neuronal count, and inflammatory cytokines were analyzed in the brain. In the 3% DSS group, colitis symptoms appeared at day 7, with reduced colon length and increased crypt damage showing colitis-like symptoms. By day 21, colon length and crypt damage persisted, while DAI showed recovery. Although colonic inflammation peaked at day 7, no significant increase in inflammatory cytokines or microglial hyperactivation was observed in the brain. By day 21, neuroinflammation was detected, albeit with a slight delay, in the absence of adaptive immune cells. The colitis-induced neuroinflammation model provides insights into the fundamental immune mechanisms of the gut-brain axis and may contribute to developing immune cell therapies for IBD-induced neuroinflammation.

During routine dissection, we observed a unique case of unilateral polydactyly in the left foot of a 61-year-old male cadaver. We observed the medial head of the quadratus plantae (QP) muscle, which gave off an additional tendinous slip before joining the lateral head of QP. The 4th tendon of the flexor digitorum longus (FDL) was bifurcated into two tendinous parts after receiving a thin fibrous slip from the tendinous slip of the medial head of QP. The medial division of the 4th tendon of FDL passed forward and attached to the base of the distal phalanx of the 5th toe. The extra tendinous slip from the medial head of QP was attached distally to the lateral division of the 4th tendon of FDL and formed a common anomalous tendon to the 6th toe. The knowledge of this variation would be helpful in reconstructive foot surgeries and correction of congenital deformities.