OpenMed/multicare-articles huggingface dataset:
Benchmarking ChatGPT-4 on a radiation oncology in-training exam and Red Journal Gray Zone cases: potentials and challenges for ai-assisted medical education and decision making in radiation oncology
Authors: Yixing Huang, Ahmed Gomaa, Sabine Semrau, Marlen Haderlein, Sebastian Lettmaier, Thomas Weissmann, Johanna Grigo, Hassen Ben Tkhayat, Benjamin Frey, Udo Gaipl, Luitpold Distel, Andreas Maier, Rainer Fietkau, Christoph Bert, Florian Putz
Journal: Front Oncol (2023)
Keywords: gray zone, artificial intelligence, clinical decision support (cds), large language model, natural language processing, radiotherapy

Purpose:
The potential of large language models in medicine for education and decision-making purposes has been demonstrated as they have achieved decent scores on medical exams such as the United States Medical Licensing Exam (USMLE) and the MedQA exam. This work aims to evaluate the performance of ChatGPT-4 in the specialized field of radiation oncology.
Methods:
The 38th American College of Radiology (ACR) radiation oncology in-training (TXIT) exam and the 2022 Red Journal Gray Zone cases are used to benchmark the performance of ChatGPT-4. The TXIT exam contains 300 questions covering various topics of radiation oncology. The 2022 Gray Zone collection contains 15 complex clinical cases.
Results:
For the TXIT exam, ChatGPT-3.5 and ChatGPT-4 have achieved the scores of 62.05% and 78.77%, respectively, highlighting the advantage of the latest ChatGPT-4 model. Based on the TXIT exam, ChatGPT-4's strong and weak areas in radiation oncology are identified to some extent. Specifically, ChatGPT-4 demonstrates better knowledge of statistics, CNS & eye, pediatrics, biology, and physics than knowledge of bone & soft tissue and gynecology, as per the ACR knowledge domain. Regarding clinical care paths, ChatGPT-4 performs better in diagnosis, prognosis, and toxicity than brachytherapy and dosimetry. It lacks proficiency in in-depth details of clinical trials. For the Gray Zone cases, ChatGPT-4 is able to suggest a personalized treatment approach to each case with high correctness and comprehensiveness. Importantly, it provides novel treatment aspects for many cases, which are not suggested by any human experts.
Conclusion:
Both evaluations demonstrate the potential of ChatGPT-4 in medical education for the general public and cancer patients, as well as the potential to aid clinical decision-making, while acknowledging its limitations in certain domains. Owing to the risk of hallucinations, it is essential to verify the content generated by models such as ChatGPT for accuracy.
Hemorrhagic Shock from a Duodenal Ulcer Eroding into an Ectopic Varix
Authors: Harjit Singh, Alexandra Kimchy, Camille Boustani, Mfoniso Umoren, Amol Rangnekar, Coleman Smith
Journal: Case Reports Hepatol (2023)
MeSH terms: Case Reports

Ectopic varices are an infrequent yet fatal complication resulting from the progression of liver cirrhosis. Duodenal varices pose a significant challenge to clinicians as they are not easily visualized on endoscopy due to their submucosal location and lack of red color signs. Identification of duodenal varices is important given the risk of massive and life-threatening bleeding that is difficult to control. Patients may present in hemorrhagic shock requiring immediate resuscitation; however, confirmation of the bleeding source as variceal or non-variceal is critical in determining the optimal therapeutic intervention. Here, we report an unusual case of a duodenal ulcer that eroded into an ectopic varix resulting in hemorrhagic shock.
Case report: Successful therapy with azacitidine for acute myeloid leukemia with NUP98::RARG resembling acute promyelocytic leukemia
Authors: Zhichen Wei, Linlin Shao, Shuqian Xu, Xiaolin Zhang, Lin Wang, Ping Qin, Qiang Song, Ming Hou, Yan Shi
Journal: Front Oncol (2024)
Keywords: acute myeloid leukemia, acute promyelocytic leukemia, all-trans retinoic acid, azacitidine, nucleoporin 98-retinoic acid receptor gamma
MeSH terms: Case Reports

We report a case of acute myeloid leukemia (AML) with retinoic acid receptor gamma (RARG) rearrangement, exhibiting clinical, morphological, and immunophenotypic features similar to classic acute promyelocytic leukemia (APL). RNA sequencing analysis of the patient's bone marrow samples revealed the presence of nucleoporin 98 (NUP98)-RARG caused by translocation. AML with RARG rearrangement is insensitive to all-trans retinoic acid (ATRA) and arsenic trioxide. The patient received azacitidine therapy after failing ATRA and standard 3 + 7 therapy (idarubicin and cytarabine) and achieved complete remission. Conclusively, this acute myeloid leukemia subtype may benefit from azacitidine.
Case report: Occult Listeria monocytogenes invasion leading to prosthetic hip joint infection in a patient with rheumatoid arthritis taking tofacitinib
Authors: Chaowen Deng, Kelvin Hei-Yeung Chiu, Nan Lou, Fanfan Xing
Journal: Front Med (Lausanne) (2024)
Keywords: listeria monocytogenes, case report, prosthetic joint infection, rheumatoid arthritis, tofacitinib
MeSH terms: Case Reports

It has been suggested that targeted therapy may potentially increase the risk of listeriosis. However, no reported cases of Listeria monocytogenes prosthetic joint infection have been documented during Janus Kinase (JAK) pathway inhibitor use. Herein, we present a 70-year-old female with rheumatoid arthritis who had undergone bilateral hip joint replacement and subsequently developed Listeria monocytogenes prosthetic joint infection following tofacitinib therapy. We suggest that the use of tofacitinib may potentially heighten susceptibility to listeriosis in patients afflicted with rheumatoid arthritis.
A rare LMNA missense mutation causing a severe phenotype of mandibuloacral dysplasia type A: a case report
Authors: Adriana Amaral Carvalho, Renato Assis Machado, Célia Márcia Fernandes Maia, Luis Antônio Nogueira Dos Santos, Daniella Reis Barbosa Martelli, Ricardo Della Coletta, Hercílio Martelli Júnior
Journal: Rev Paul Pediatr (2024)
MeSH terms: Lamin Type A / genetics, Mutation, Missense, Phenotype, Case Reports, Acro-Osteolysis, Child, Female, Humans, Lipodystrophy, Mandible / abnormalities, Mandible / diagnostic imaging, Lamin Type A, LMNA protein, human, Mandibuloacral dysplasia with type A lipodystrophy

Objective:
To report the case of a girl presenting a severe phenotype of mandibuloacral dysplasia type A (MADA) characterized by prominent osteolytic changes and ectodermal defects, associated with a rare homozygous LMNA missense mutation (c.1579C>T).
Case description:
A 6-year-old girl was evaluated during hospitalization exhibiting the following dysmorphic signs: subtotal alopecia, dysmorphic facies with prominent eyes, marked micrognathia and retrognathia, small beaked nose, teeth crowding and thin lips, generalized lipodystrophy, narrow and sloping shoulders, generalized joint stiffness and bone reabsorption in the terminal phalanges. In dermatological examination, atrophic skin, loss of cutaneous elasticity, hyperkeratosis, dermal calcinosis, and hyperpigmented and hypochromic patches were observed. Radiology exams performed showed bilateral absence of the mandibular condyles, clavicle resorption with local amorphous bone mass confluence with the scapulae, shoulder joints with subluxation and severe bone dysplasia, hip dysplasia, osteopenia and subcutaneous calcifications.
Comments:
MADA is a rare autosomal recessive disease caused by mutations in LMNA gene. It is characterized by craniofacial deformities, skeletal anomalies, skin alterations, lipodystrophy in certain regions of the body and premature ageing. Typical MADA is caused by the p.R527H mutation in the LMNA gene. However, molecular analysis performed from oral epithelial cells obtained from the patient showed the rare mutation c.1579C>T, p. R527C in the exon 9 of LMNA. This is the sixth family identified with this mutation described in the literature.
Stiff-person syndrome in association with Hashimoto's thyroiditis: a case report
Authors: Mingzhu Chen, Zhou Hong, Haicun Shi, Chunmei Wen, Yuan Shen
Journal: Front Neurol (2024)
Keywords: hashimoto’s thyroiditis, anti-gad antibodies, autoimmune diseases, paraneoplastic syndromes, stiff-person syndrome
MeSH terms: Case Reports

Stiff-person syndrome (SPS) is a rare neurological disorder characterized by chronic and progressive axial muscle rigidity and paroxysmal painful muscle spasms. The present case study described an SPS patient (increased anti-GAD65 antibody in serum and cerebrospinal fluid) with co-occurring Hashimoto's thyroiditis and decreased C3 complement levels. The clinical presentation, diagnostic approach, and treatment employed for this unique case were comprehensively described in detail. In this case, we comprehensively presented a case of SPS with co-occurring Hashimoto's thyroiditis and an associated decrease in serum C3 complement, as well as a discussion on the current data on this topic.
Cardiac tamponade, a rare complication of gastric cardia cancer resection after neoadjuvant chemotherapy combined with immunotherapy: a case report and literature review
Authors: Wei Du, Hemei Wang, Junmei Shen, Xi Qiao, Jifang Yao, Chao Li
Journal: Front Oncol (2023)
Keywords: cardiac tamponade, gastric cardia cancer, immunotherapy, neoadjuvant chemotherapy, transthoracic gastric resection
MeSH terms: Case Reports

Transthoracic cardia resection is a technically well-established surgical procedure. However, acute cardiac tamponade in the early postoperative period is extremely rare. The occurrence is life-threatening to the patient. It also poses a great clinical challenge for perioperative management. To date, few cases of pericardial tamponade have been reported in gastric cancer resection performed after neoadjuvant chemotherapy combined with immunotherapy. We present the case of a 62-year-old woman who received neoadjuvant chemotherapy combined with immunotherapy before surgery, followed by transthoracic surgery. A life-threatening complication, pericardial tamponade, occurred in the early postoperative period. The successful outcome was achieved in through multidisciplinary collaboration.
Effects of Low-Frequency Deep Brain Stimulation in Bilateral Zona Incerta for a Patient With Tremor and Cerebellar Ataxia
Authors: Ami Kumar, Kristen L Matulis, Zena A Fadel, Alexander S Fanning, Christian J Amlang, Sheng-Han Kuo
Journal: Tremor Other Hyperkinet Mov (N Y) (2024)
Keywords: dbs, caudal zona incerta, cerebellar ataxia, low-frequency stimulation
MeSH terms: Cerebellar Ataxia / physiopathology, Cerebellar Ataxia / therapy, Deep Brain Stimulation / methods, Essential Tremor / physiopathology, Essential Tremor / therapy, Zona Incerta / physiopathology, Case Reports, Aged, Humans, Male, Tremor / etiology, Tremor / physiopathology, Tremor / therapy

Background:
Whether low-frequency deep brain stimulation (DBS) in the caudal zona incerta (cZi) can improve cerebellar ataxia symptoms remains unexplored.
Case report:
We report a 66-year-old man initially diagnosed with essential tremor and subsequently developed cerebellar ataxia after bilateral cZi DBS implantation. We tested the effects of low-frequency DBS stimulations (sham, 10 Hz, 15 Hz, 30 Hz) on ataxia severity.
Discussion:
Low-frequency cZi DBS improves ataxic speech at 30 Hz, but not at 10 Hz or 15 Hz in this patient. Low-frequency DBS did not improve gait or stance. Therefore, low-frequency stimulation may play a role in treating ataxic speech.
Highlights:
The finding of this case study suggests that bilateral low-frequency DBS at 30 Hz in the caudal zona incerta has the potential to improve ataxic speech but has limited impact on gait and stance. The involvement of zona incerta in speech warrants further investigation.
A criteria-based progressive rehabilitation program for rectus femoris strain in a recreational soccer player: a case report
Authors: Ángel González-de-la-Flor, Guillermo García-Pérez-de-Sevilla
Journal: Front Bioeng Biotechnol (2024)
Keywords: muscle, rectus femoris, rehabilitation, soccer, strain
MeSH terms: Case Reports

Introduction: The purpose of this study was to describe the criteria-based progressive rehabilitation program implemented on a recreational soccer player diagnosed with a grade 1 rectus femoris strain. Methods: A 33-year-old male injured the rectus femoris muscle. At the first physical examination, the patient showed significant physical impairment due to important limitations to the active range of motion of the knee flexion and the hip flexor strength. The rehabilitation program consisted of specific training of the rectus femoris, lumbopelvic stabilization, mobility exercises, and running technique exercises, for 6 weeks, which was divided into three phases. Each week, the patient performed four rehabilitation sessions, combined with cross-training (swimming), to maintain his cardiorespiratory capacity. Results: The patient improved functionally and returned to play soccer 6 weeks after the injury without pain. Moreover, the patient passed the criteria of each phase at week 2 for phase 1, at week 4 for phase 2 and at week 6 for phase 3. Conclusion: This case study demonstrates that criteria of progression may control the return to sport timetable for recreational soccer players according to the functional and clinical limitations throughout the entire treatment.
Case report: Blotchy skin in a puffy neonate: is there a new association?
Authors: Chacko J Joseph, Arijit Lodha, Soumya R Thomas, Essa Al Awad, Nicola A M Wright, Cora Constantinescu, Doan Le, Majeeda Kamaluddeen
Journal: Front Pediatr (2023)
Keywords: chylothorax, congenital, newborn, pleural effusion, purpura fulminans
MeSH terms: Case Reports

Introduction:
Purpura fulminans in the neonatal population is a rare but potentially life-threatening condition complicated by thrombosis, resultant vital organ necrosis, and gangrene of the extremities. Considering the rapid evolution of the pathogenetic mechanism, an index of suspicion, early identification, and prompt intervention are imperative for improved outcomes. The majority of purpura fulminans cases have an infectious etiology, but it is essential to consider other congenital and acquired causes.
Case description:
We present a clinical case of a female neonate to emphasize the correlation between purpura fulminans, congenital chylothorax, involvement of the PAK2 gene, and the occurrence of retinal detachment in both eyes. After draining the congenital chylothorax, the neonate developed purpura fulminans due to a loss of protein C, S, and antithrombin factors, previously not reported in the literature. The purpuric lesions resolved after the administration of fresh frozen plasma. Subsequently, no recurring purpura fulminans lesions were noted following the normalization of the antithrombotic factor levels in the serum. Subsequently, the child also developed retinal detachment in both eyes.
Salvage Aneurysmorrhaphy as an Adaptable and Still Pertinent Technique in the Management of Challenging True Aneurysms of Arteriovenous Fistulas: A Case Series of Different Variations, With Illustrative Surgical Pictures
Authors: Homa Pourriyahi, Homayoun Pourriahi, Hossein Najd Sepas
Journal: EJVES Vasc Forum (2024)
Keywords: aneurysm, aneurysmoplasty, aneurysmorrhaphy, arteriovenous fistula, megafistula, partial aneurysmectomy

Introduction:
Aneurysmorrhaphy, described as reduction aneurysmoplasty, partial aneurysmectomy, or vessel wall recalibration, can be considered a suitable surgical plan for true aneurysms of arteriovenous fistulas (AVFs), allowing for a dynamic approach to reconstruction of aneurysmal AVFs of different severities, ensuring salvage of the native access.
Report:
Six challenging cases of AVF aneurysms are presented, some with extremely dilated and tortuous megafistulas, for which three surgical technique variations were performed. The patients had a mean age of 59.2 years, 50% were female, with brachiocephalic (n = 5, 83.3%) or brachiobasilic (n = 1, 16.7%) AVFs. The fistulas were created an average of 4.67 years previously, and the aneurysms had an average maximum diameter of 37.5 mm (range 25-60 mm). Surgical indications were rupture risk, thrombosis, or outflow stenosis compromising haemodialysis, infections, and concerns for quality of life (affected by post-puncture bleedings, disfiguring aesthetics, pain, and discomfort). The surgical techniques were simple aneurysmorrhaphy (n = 3, 50%), aneurysmorrhaphy with partial excision of aneurysmal segment with end to end anastomosis of venous ends (n = 2, 33.3%), and aneurysmorrhaphy with establishment of new venous outflow (n = 1, 16.7%). All AVFs were patent post-operatively and at follow up (mean 5.6 months, median one month). Haemodialysis was resumed through the AVFs at a mean of 2.17 weeks post-operatively, with placement of an alternative route for haemodialysis in the meantime. No patients experienced post-operative complications.
Discussion:
Experience with the more challenging cases shows that aneurysmorrhaphy can still be considered an acceptable, flexible, and pertinent method for salvage of megafistulas, giving the surgeon the much needed versatility to adapt to anatomical and pathological variations, with high patency rates and minimal complications, especially when other treatment options are not possible in complicated cases. AVF salvage through aneurysmorrhaphy allows for a dynamic approach to the reconstruction of severely tortuous, dilated veins, ensuring patency of the native AVF.
Treatment of Progressive Cherubism during the Second Dental Transitional Phase with Calcitonin
Authors: Ethan Meijer, Henk van den Berg, Arjen H G Cleven, Esther Edelenbos, Willem H Schreuder
Journal: Case Rep Dent (2023)
MeSH terms: Case Reports

Cherubism is an autosomal dominant disease with variable expression. Aggressive forms of untreated cherubism may lead to severe malformation of the maxillofacial skeleton, developing tooth germs and teeth. Scarcely described and empirically applied interventional therapies during active stages of the disease try to limit the damage and deformation caused by progression of expanding intraosseous lesions. The final goal is to minimize the need for corrective surgeries once progressive growth has halted and disease enters its quiescent phase. New insights into the pathophysiology of cherubism hypothesize a potential role for dental development and jaw growth in the (hyper)activation of the disease. Theoretically, this could guide the ideal moment of pharmacological interventions. In this case report, the off-label use of systemic calcitonin treatment is described, stressing particularly the potential importance of its appropriate timing and duration of treatment.
Subacute hemorrhagic pericardial tamponade after COVID-19 infection mimicking carcinomatous pericarditis: a case report
Authors: Hiroyuki Yamamoto, Nao Kume, Katsuya Hashimoto, Jun Isogai, Takuya Kuwabara, Masayuki Noguchi, Hiroyuki Murayama, Toru Hashimoto, Hidemitsu Ogino
Journal: Front Cardiovasc Med (2024)
Keywords: covid-19, acute pericarditis, cytology, hemorrhagic pericardial tamponade, sarcoid-like reaction
MeSH terms: Case Reports

Background:
Coronavirus disease (COVID-19)-associated acute pericarditis has recently received much attention owing to its high frequency associated with pericardial tamponade (PT), showing unfavorable prognosis. However, early diagnosis and treatment remain challenging in cases of non-specific signs and symptoms.
Case presentation:
A 64-year-old man was admitted to our hospital for acute osteomyelitis of the toes and was properly treated with antimicrobial agents. Three days after admission, the patient developed mild COVID-19 without pneumonia, for which early anti-COVID-19 agents were initiated. Nevertheless, the patient developed hemorrhagic PT due to acute pericarditis 2 weeks later, which was confirmed by cardiac magnetic resonance, requiring an urgent pericardiocentesis. Although cytological analysis of the hemorrhagic pericardial fluid strongly suggested adenocarcinoma, the atypical cells were eventually proven to be mesothelial cells with reactive atypia. Furthermore, lymph nodes swelling with abnormal 2-[18F]-fluoro-2-deoxy-D-glucose accumulation on imaging were suggestive of malignancy. However, biopsy examination revealed multiple non-caseating granulomas in the lymph node, unlikely due to malignancy. Eventually, the temporal association of the preceding COVID-19 with the occurrence of subacute PT without other identifiable cause led to a final diagnosis of COVID-19-associated acute pericarditis. With anti-inflammatory and corticosteroids treatment, the patient's symptoms involving the pericardial structure and function were completely resolved along with improvements in size of the affected lymphadenopathies.
Conclusions:
We encountered a unique case of COVID-19-associated acute pericarditis exhibiting hemorrhagic PT. This case underscores the residual risk of delayed pericardial involvement even in patients with mild COVID-19 who receive early treatment, and the recognition that COVID-19 may cause various cytomorphological and histological features. Additionally, the importance of considering this rare entity as a cause of hemorrhagic pericardial effusions should be highlighted.
Case report: Microsatellite instability determination is not always black and white in Lynch syndrome diagnosis
Authors: Julieta E Rodriguez, Damien Vasseur, Mohamed Amine Bani, Odile Cabaret, Sophie Cotteret, Martine Muleris, Veronica Golbarg, David Malka, Thomas Pudlarz, Olivier Caron, Cristina Smolenschi
Journal: Front Oncol (2024)
Keywords: case report, circulating dna, colorectal cancer, discordant msi, next-generation sequencing
MeSH terms: Case Reports

Introduction:
Microsatellite instability (MSI) is a genetic marker that is useful in the detection and treatment of Lynch syndrome (Sd). Although conventional techniques such as immunohistochemistry (IHC) and polymerase chain reaction (PCR) are the standards for MSI detection, the advent of next-generation sequencing (NGS) has offered new possibilities, especially with circulating DNA.
Case report:
We present the case of a 26-year-old patient with Lynch Sd and a BRAF-mutated metastatic colon cancer. The discordant MSI results between the conventional methods and NGS posed challenges in making treatment decisions. Subsequent NGS analysis revealed a high MSI status, leading to participation in an immunotherapy trial, with remarkable clinical response.
Conclusion:
This case emphasizes the importance of comprehensive molecular profiling and strong interdisciplinary collaborations, especially in cases with ambiguous MSI results.
Full Mouth Rehabilitation for a Patient With Generalized Attrition: The Hobo Technique in Action
Authors: Lisa Debbarma, Vineet Sharma
Journal: Cureus (2024)
Keywords: attrition, hobo twin-stage, patient-centered, pfm crowns, vertical dimension
MeSH terms: Case Reports

This case report addresses the critical issue of severe tooth wear and its impact on the vertical dimension of occlusion in a 75-year-old patient. The patient presented with worn-down teeth, chewing difficulties, and aesthetic concerns, prompting a comprehensive treatment plan utilizing the Hobo twin-stage technique. The approach involved careful diagnosis, root canal therapy, and the creation of provisional restorations, monitored through an occlusal splint. The prosthetic phase incorporated strategically designed porcelain-fused-to-metal crowns, aiming for optimal tooth alignment and balanced movement. The successful outcome not only restored function and aesthetics but also enhanced the patient's confidence. This case underscores the effectiveness of a systematic approach in managing severe tooth wear, emphasizing the importance of regular follow-ups and good oral hygiene for long-term success.