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Australasian Psychiatry : Bulletin of... Jun 2024To determine whether a brief educational intervention for Junior Medical Officers (JMOs), using teaching methods aimed at achieving higher outcomes on Bloom's Taxonomy,...
OBJECTIVE
To determine whether a brief educational intervention for Junior Medical Officers (JMOs), using teaching methods aimed at achieving higher outcomes on Bloom's Taxonomy, significantly improved participant confidence and knowledge in decision making about restrictive care.
METHOD
JMOs received a teaching session on restrictive medical and mental health care. Groups were randomly assigned to either sessions including a component of modern pedagogical interventions (Think-Pair-Share and SNAPPS), or sessions including a control period focusing on reviewing a condensed summary of relevant information. Pre- and post-intervention measures were recorded for subjective self-ratings of confidence and scores on standardized clinically relevant extended matching questions (EMQs).
RESULTS
There was no difference in subjective confidence improvement between groups; however, the group receiving the modern pedagogical intervention demonstrated significantly greater objective performance on knowledge-based EMQs.
CONCLUSIONS
A brief modern pedagogical intervention using interactive teaching methods shows promise for improving knowledge of restrictive care and the Mental Health and Guardianship Acts. In the control group, similarly increased confidence in knowledge did not equate to increased competence on a knowledge assessment. Refurbishing educational interventions presents opportunities for improving clinical outcomes and engaging junior doctors in psychiatry.
PubMed: 38876497
DOI: 10.1177/10398562241260170 -
JMIR Mental Health Jun 2024Due to recent advances in artificial intelligence (AI), large language models (LLMs) have emerged as a powerful tool for a variety of language related tasks, including...
BACKGROUND
Due to recent advances in artificial intelligence (AI), large language models (LLMs) have emerged as a powerful tool for a variety of language related tasks, including sentiment analysis, and summarization of provider-patient interactions. However, there is limited research on these models in the area of crisis prediction.
OBJECTIVE
This study aimed to evaluate the performance of LLMs, specifically OpenAI's GPT-4, in predicting current and future mental health crisis episodes using patient provided information at intake among users of a national telemental health platform.
METHODS
De-identified patient provided data was pulled from specific intake questions of the Brightside telehealth platform, including the chief complaint, for 140 patients who indicated suicidal ideation (SI), and another 120 patients who later indicated SI with a plan during the course of treatment. Similar data was pulled for 200 randomly selected patients treated during the same time period who never endorsed SI. Six senior Brightside clinicians (three psychologists and three psychiatrists) were shown patients' self-reported chief complaint and self-reported suicide attempt history but were blinded to the future course of treatment and other reported symptoms including SI. They were asked a simple yes/no question regarding their prediction of endorsement of SI with plan along with their confidence level about the prediction. GPT-4 was provided similar information and asked to answer the same questions, enabling us to directly compare the performance of AI and clinicians.
RESULTS
Overall, clinicians' average precision (0.698) was higher than GPT-4 (0.596) in identifying SI with plan at intake (n=140) vs. no SI (n=200) when using chief complaint alone, while sensitivity was higher for GPT-4 (0.621) than clinicians' average (0.529). The addition of suicide attempt history increased clinicians' average sensitivity (0.590) and precision (0.765), while increasing GPT-4 sensitivity (0.590) but decreasing GPT-4 precision (0.544). Performance decreased comparatively when predicting future SI with plan (n=120) vs no SI (n=200) with chief complaint only for clinicians (average sensitivity=0.399; average precision=0.594) and GPT-4 (sensitivity=0.458; precision=0.482). The addition of suicide attempt history increased performance comparatively for clinicians (average sensitivity=0.457; average precision=0.687) and GPT-4 (sensitivity=0.742; precision=0.476).
CONCLUSIONS
GPT-4 with a simple prompt design produced results on some metrics that approached that of a trained clinician. Additional work must be done before such a model could be piloted in a clinical setting. The model should undergo safety checks for bias given evidence that LLMs can perpetuate the biases of the underlying data they are trained upon. We believe that LLMs hold promise to augment identification of higher risk patients at intake and potentially deliver more timely care to patients.
PubMed: 38876484
DOI: 10.2196/58129 -
The Journal of Biological Chemistry Jun 2024Theta-mediated end-joining (TMEJ) is critical for survival of cancer cells when other DNA double-stranded break repair pathways are impaired. Human DNA polymerase theta...
Theta-mediated end-joining (TMEJ) is critical for survival of cancer cells when other DNA double-stranded break repair pathways are impaired. Human DNA polymerase theta (Pol θ) can extend single-stranded DNA oligonucleotides, but little is known about preferred substrates and mechanism. We show that Pol θ can extend both single-stranded DNA and RNA substrates by unimolecular stem loop synthesis initiated by only two 3' terminal base-pairs. Given sufficient time, Pol θ uses alternative pairing configurations that greatly expand the repertoire of sequence outcomes. Further primer-template adjustments yield low-fidelity outcomes when the nucleotide pool is imbalanced. Unimolecular stem loop synthesis competes with bimolecular end-joining, even when a longer terminal microhomology for end-joining is available. Both reactions are partially suppressed by the ssDNA binding protein RPA. Protein-primer grasp residues that are specific to Pol θ are needed for rapid stem-loop synthesis. The ability to perform stem-loop synthesis from a minimally paired primer is rare amongst human DNA polymerases but we show that human DNA polymerases Pol η and Pol λ can catalyze related reactions. Using purified human Pol θ, we reconstituted in vitro TMEJ incorporating an insertion arising from a stem loop extension. These activities may help explain TMEJ repair events that include inverted repeat sequences.
PubMed: 38876299
DOI: 10.1016/j.jbc.2024.107461 -
EBioMedicine Jun 2024The need for new therapeutics for attention deficit hyperactivity disorder (ADHD) is evident. Brain, cerebrospinal fluid (CSF), and plasma protein biomarkers with causal...
BACKGROUND
The need for new therapeutics for attention deficit hyperactivity disorder (ADHD) is evident. Brain, cerebrospinal fluid (CSF), and plasma protein biomarkers with causal genetic evidence could represent potential drug targets. However, a comprehensive screen of the proteome has not yet been conducted.
METHODS
We employed a three-pronged approach using Mendelian Randomization (MR) and Bayesian colocalization analysis. Firstly, we studied 608 brains, 214 CSF, and 612 plasma proteins as potential causal mediators of ADHD using MR analysis. Secondly, we analysed the consistency of the discovered biomarkers across three distinct subtypes of ADHD: childhood, persistent, and late-diagnosed ADHD. Finally, we extended our analysis to examine the correlation between identified biomarkers and Tourette syndrome and pervasive autism spectrum disorder (ASD), conditions often linked with ADHD. To validate the MR findings, we conducted sensitivity analysis. Additionally, we performed cell type analysis on the human brain to identify risk genes that are notably enriched in various brain cell types.
FINDINGS
After applying Bonferroni correction, we found that the risk of ADHD was increased by brain proteins GMPPB, NAA80, HYI, CISD2, and HYI, TIE1 in CSF and plasma. Proteins GMPPB, NAA80, ICA1L, CISD2, TIE1, and RMDN1 showed overlapped loci with ADHD risk through Bayesian colocalization. Overexpression of GMPPB protein was linked to an increase in the risk for all three ADHD subtypes. While ICA1L provided protection against both ASD and ADHD, CISD2 increased the probability of both disorders. Cell-specific studies revealed that GMPPB, NAA80, ICA1L, and CISD2 were predominantly present on the surface of excitatory-inhibitory neurons.
INTERPRETATION
Our comprehensive MR investigation of the brain, CSF, and plasma proteomes revealed seven proteins with causal connections to ADHD. Particularly, GMPPB and TIE1 emerged as intriguing targets for potential ADHD therapy.
FUNDING
This work was partly funded by the Key R & D Program of Zhejiang (T.L. 2022C03096); the National Natural Science Foundation of China Project (C.Z. 82001413); Postdoctoral Foundation of West China Hospital (C.Z. 2020HXBH163).
PubMed: 38876042
DOI: 10.1016/j.ebiom.2024.105197 -
Translational Oncology Jun 2024For pediatric patients with solid abdominal tumors, early diagnosis can guide clinical treatment decisions, and comprehensive preoperative evaluation is essential to...
BACKGROUND
For pediatric patients with solid abdominal tumors, early diagnosis can guide clinical treatment decisions, and comprehensive preoperative evaluation is essential to reduce surgical risk. The aim of this study was to explore the feasibility of multiphase enhanced CT-based transformer in the early diagnosis of tumors and prediction of surgical risk events (SRE).
METHODS
A total of 496 pediatric patients with solid abdominal tumors were enrolled in the study. With Swin transformer, we constructed and trained two Swin-T models based on preoperative multiphase enhanced CT for personalized prediction of tumor type and SRE status. Subsequently, we comprehensively evaluated the performance of each model and constructed four benchmark models for performance comparison.
RESULTS
There was no significant difference in SRE status between tumor types. In the diagnostic task, areas under the receiver operating characteristic curves (AUC) of the Swin-T model were 0.987 (95 % CI, 0.973-0.997) and 0.844 (95 % CI, 0.730-0.940) in the training and validation cohorts, respectively. In predicting SRE, AUCs of the Swin-T model were 0.920 (95 % CI, 0.885-0.948) and 0.741 (95 % CI, 0.632-0.838) in the training and test cohorts, respectively. The Swin-T model achieved the best performance in both classification tasks compared to benchmark models.
CONCLUSION
The Swin-T model is a promising tool to assist pediatricians in the differential diagnosis of abdominal tumors and in comprehensive preoperative evaluation.
PubMed: 38875936
DOI: 10.1016/j.tranon.2024.102034 -
International Journal of Surgery Case... Jun 2024Embolization of an arteriovenous malformation (AVM) via the anterior inferior cerebellar artery (AICA) is difficult. The "pressure cooker" technique in the AICA via a...
INTRODUCTION AND IMPORTANCE
Embolization of an arteriovenous malformation (AVM) via the anterior inferior cerebellar artery (AICA) is difficult. The "pressure cooker" technique in the AICA via a marathon microcatheter can be effective.
CASE STUDY
A 43-year-old man with a cerebellar hematoma involving the brainstem. Angiography revealed an AVM supplied by the right AICA. Embolizing the AVM by casting an Onyx-18 liquid embolic system assisted by the "pressure cooker" technique was planned. An Apollo microcatheter was used for Onyx casting, and a Marathon microcatheter was used to establish a coiling plug to prevent Onyx reflux. The AVM was obliterated. Postoperatively, burr hole drainage of the cerebellar hematoma was performed. Postoperative computed tomography showed that the cerebellar hematoma and hydrocephalus had resolved. Magnetic resonance imaging revealed that there was no new serious infarction from damage to the cerebellum or brainstem. The patient recovered well.
CLINICAL DISCUSSION
During Onyx casting, the drawback is that reflux can occlude normal vessels. The "pressure cooker" technique was useful for preventing Onyx reflux and for driving the Onyx to penetrate the AVM. However, it was difficult to use this technique in slim AICA; the Marathon microcatheter had a thinner tip than other microcatheters, and it can be used to establish the "pressure cooker" technique. This technique provides more solutions for AVMs in transarterial embolization through small feeding arteries.
CONCLUSION
In a selective case, it was feasible to use the "pressure cooker" technique in the AICA via a Marathon microcatheter to embolize the AVM.
PubMed: 38875831
DOI: 10.1016/j.ijscr.2024.109905 -
International Journal of Surgery Case... Jun 2024Percutaneous endoscopic lumbar discectomy (PELD) is increasingly being utilized to treat patients with lumbar disc herniation. PELD is unique in that it uses a single...
Contrast enhancing epidural fluid accumulation after percutaneous endoscopic lumbar discectomy: A case report of recurrent disc herniation within pseudocyst secondary to irrigation fluid.
INTRODUCTION
Percutaneous endoscopic lumbar discectomy (PELD) is increasingly being utilized to treat patients with lumbar disc herniation. PELD is unique in that it uses a single working port endoscope with constant irrigation of the surgical field to visualize pathology. The current report is of a case of postoperative epidural irrigation fluid accumulation presenting as peripherally enhancing epidural lesions, masking an underlying re-herniation.
PRESENTATION OF CASE
A patient with a Lumbar 5-Sacral 1 level disc herniation presenting with radiculopathy was treated using PELD. Following the operation, the patient experienced recurrent pain, prompting a repeat MRI of the lumbar spine. Multiple ring-enhancing lesions within the epidural space were observed, creating diagnostic dilemmas. The differential diagnoses included epidural abscess, pseudomeningocele from unintended durotomy, epidural hematoma, or trapped epidural fluid collection presenting as a pseudocyst with or without recurrent disc herniation. A repeat endoscopic discectomy was performed to confirm the diagnosis of pseudocyst, revealing a recurrent disc herniation.
DISCUSSION
Pseudocysts are not an uncommon complication of PELD, typically believed to be due to an inflammatory response to disc fragments. However, in this case, the epidural fluid collection was likely the result of trapped irrigation fluid from continuous irrigation during the procedure, which masked an underlying re-herniation on imaging.
CONCLUSION
With the increasing utilization of PELD, it is important to acknowledge unique complications such as fluid accumulation from irrigation within the epidural space. Fluid accumulation can lead to contrast-enhancing pseudocyst formation, which can theoretically lead to mass effect or increased intracranial and intraspinal pressure and may mask additional underlying pathology.
PubMed: 38875830
DOI: 10.1016/j.ijscr.2024.109884 -
International Journal of Surgery Case... Jun 2024Standard treatment for renal cell carcinomas (RCCs) is radical/partial nephrectomy and unlike upper urothelial carcinoma, complete ureteral removal is not necessary nor...
INTRODUCTION
Standard treatment for renal cell carcinomas (RCCs) is radical/partial nephrectomy and unlike upper urothelial carcinoma, complete ureteral removal is not necessary nor is advised in RCCs as tumor recurrence in ureteral remnant has scarcely been reported. Here, we present a rare case of chromophobe RCC (ChRCC) metastasis in remnant ureter following radical nephrectomy and perform a literature review in this regard.
CASE PRESENTATION
A 66-year-old man presented with a CT scan-as a surveillance protocol imaging- showing a mass in ipsilateral remnant ureter 9 months after radical nephrectomy due to ChRCC while being completely asymptomatic. Cystoscopy revealed a polypoid mass protruding from right ureterovesical junction and transurethral resection of tumor revealed it to be a ChRCC. Distal ureterectomy was performed confirming pathology without any lymph node involvement. 12 months after ureterectomy, he remained asymptomatic with no sign of metastasis or recurrence in his follow up CT scan.
DISCUSSION
RCC metastasis to distal ureter after radical nephrectomy has been rarely reported and only 2 cases of them were ChRCC. Gross hematuria has been the main presentation of such disease. However, our case was completely asymptomatic, highlighting necessity of surveillance imaging. No specific treatment guideline exists for such presentation but tumor resection has been the most common treatment modality.
CONCLUSION
Metachronous RCC metastasis may occur in remnant ureter which can be completely asymptomatic, highlighting necessity of surveillance imaging and reviewing them meticulously. Surgical resection of the metastasis by distal ureterectomy seems to be the best treatment option.
PubMed: 38875827
DOI: 10.1016/j.ijscr.2024.109907 -
Challenges and outcomes of upper cervical spinal tuberculosis surgery in pandemic-Case series study.International Journal of Surgery Case... Jun 2024Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs. Conversely, the incidence of spinal tuberculosis (TB) was...
INTRODUCTION AND IMPORTANCE
Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs. Conversely, the incidence of spinal tuberculosis (TB) was limited to a mere 6 % of cases of extrapulmonary tuberculosis. Upper cervical spinal TB is an exceptionally uncommon condition, with an incidence rate of approximately 0.3-1 % among all cases of spinal tuberculosis.
CASE DESCRIPTION
Three patients diagnosed with upper cervical spinal tuberculosis who underwent Anterior Cervical Corpectomy Fusion (ACCF) or Occipitocervical fusion surgery were reviewed retrospectively. The data was obtained during the pandemic period in Indonesia. The patients were evaluated using pre-operative and post-operative Cobb's angles, Visual Analog Scale (VAS), Frankel scale, and Neck Pain and Disability (NPAD) scale.
CLINICAL DISCUSSION
The ACCF surgery was more favourable when the compression was extended to the vertebral body; it showed good clinical and radiological outcomes. Multilevel ACCF and pathologies affecting bone quality seemed to be risk factors for material subsidence and instability. In this case, all the patients had performed ACCF surgery. The mean Cobb's angle pre-operative was 15.30, and Cobb's angle post-operative was 6.50. The mean pre-operative VAS value was 6.3, and the post-operative VAS value was 3. Compared to the post-operative scale, the pre-operative Frankel scale experienced an average increase of 2 levels. In contrast, the mean value of good post-operative NPAD is 29.3.
CONCLUSION
Operative procedures on upper cervical spinal tuberculosis cases can improve patient's quality of life significantly, clinically and radiologically.
PubMed: 38875826
DOI: 10.1016/j.ijscr.2024.109858 -
International Journal of Surgery Case... Jun 2024Tumours of salivary glands are rare and have various histo-pathological subtypes. Myoepitheliomas were first classified by Sheldon et al. and the criterion to classify...
INTRODUCTION
Tumours of salivary glands are rare and have various histo-pathological subtypes. Myoepitheliomas were first classified by Sheldon et al. and the criterion to classify or diagnose it was first defined by Barnes et al. and Sciubba and Brannon. Myoepithelioma accounts for less than 1 % of all salivary gland tumours, 40 % of these tumours occur in the parotid gland while 21 % occur in the minor salivary glands. A case of myoepithelioma of a minor salivary gland of the cheek is described, emphasizing the problems of the differential diagnosis.
PRESENTATION OF THE CASE
A 40-year-old female reported to the department with a complaint of a cheek bite on her right side for a few months. The physical examination showed a presence of lobulated whitish mucosa on the right buccal mucosa at the level of the occlusal plane, on palpation it revealed a non-painful mass approximately 1.5 cm in radius, mobile to bimanual palpation. An excisional biopsy was performed under local anaesthesia. Microscopic and immunohistochemistry confirmed the tumour to be a myoepithelioma of a minor salivary gland with the absence of definitive features of malignancy.
DISCUSSION
Due to their infrequency and multiplicity of histopathology, myoepitheliomas present difficulties in diagnosis. Cellular varieties can be misdiagnosed as malignancies. A key to determining diagnostic criteria for myoepitheliomas is to study cellular morphology, cytoplasmic filament expression, and ultrastructural features of the tumour and apply this information to defining myoepitheliomas.
CONCLUSION
Myoepitheliomas are rare tumours, utilization of immunohistochemical staining and electron microscopy are useful tools for the diagnosis of myoepitheliomas to ensure proper treatment and follow-up.
PubMed: 38875824
DOI: 10.1016/j.ijscr.2024.109849