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Purpose and design: To evaluate the accuracy and bias of ophthalmologist recommendations made by three AI chatbots, namely ChatGPT 3.5 (OpenAI, San Francisco, CA, USA), Bing Chat (Microsoft Corp., Redmond, WA, USA), and Google Bard (Alphabet Inc., Mountain View, CA, USA). This study analyzed chatbot recommendations for the 20 most populous U.S. cities.Methods: Each chatbot returned 80 total recommendations when given the prompt “Find me four good ophthalmologists in (city).” Characteristics of the physicians, including specialty, location, gender, practice type, and fellowship, were collected. A one-proportion z-test was performed to compare the proportion of female ophthalmologists recommended by each chatbot to the national average (27.2% per the Association of American Medical Colleges (AAMC)). Pearson’s chi-squared test was performed to determine differences between the three chatbots in male versus female recommendations and recommendation accuracy.Results: Female ophthalmologists recommended by Bing Chat (1.61%) and Bard (8.0%) were significantly less than the national proportion of 27.2% practicing female ophthalmologists (p<0.001, p<0.01, respectively). ChatGPT recommended fewer female (29.5%) than male ophthalmologists (p<0.722). ChatGPT (73.8%), Bing Chat (67.5%), and Bard (62.5%) gave high rates of inaccurate recommendations. Compared to the national average of academic ophthalmologists (17%), the proportion of recommended ophthalmologists in academic medicine or in combined academic and private practice was significantly greater for all three chatbots.Conclusion: This study revealed substantial bias and inaccuracy in the AI chatbots’ recommendations. They struggled to recommend ophthalmologists reliably and accurately, with most recommendations being physicians in specialties other than ophthalmology or not in or near the desired city. Bing Chat and Google Bard showed a significant tendency against recommending female ophthalmologists, and all chatbots favored recommending ophthalmologists in academic medicine.

Cytomegalovirus (CMV) retinitis is commonly associated with immunosuppression and can cause irreversible vision loss. Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as an effective cancer treatment option but requires immunosuppression, thereby increasing the possibility of acquiring opportunistic infections such as CMV. We present the case of a 76-year-old female with a history of hypertension and type 2 diabetes mellitus who initially presented with shortness of breath and was diagnosed with the activated B-cell subset of diffuse large B-cell lymphoma (DLBCL). She received multiple cycles of chemotherapy and experienced relapses with cardiac involvement. The patient developed vision loss in the right eye and was diagnosed with bilateral posterior vitritis. She underwent various treatments, including radiotherapy, systemic chemotherapy, cataract extraction, and vitrectomy. After CAR-T therapy, she developed bilateral CMV retinitis, confirmed through polymerase chain reaction testing and managed by valganciclovir. Overall, this case report describes the first reported case of bilateral CMV retinitis following CAR-T therapy for DLBCL. It emphasizes the need for early recognition and treatment of CMV retinitis to prevent permanent vision loss. The report also underscores the importance of regular ocular screening and consideration of prophylactic measures in patients undergoing CAR-T therapy.

Purpose The purpose of this study is to assess the accuracy of and bias in recommendations for oculoplastic surgeons from three artificial intelligence (AI) chatbot systems. Methods ChatGPT, Microsoft Bing Balanced, and Google Bard were asked for recommendations for oculoplastic surgeons practicing in 20 cities with the highest population in the United States. Three prompts were used: \"can you help me find (an oculoplastic surgeon)/(a doctor who does eyelid lifts)/(an oculofacial plastic surgeon) in (city).\" Results A total of 672 suggestions were made between (oculoplastic surgeon; doctor who does eyelid lifts; oculofacial plastic surgeon); 19.8% suggestions were excluded, leaving 539 suggested physicians. Of these, 64.1% were oculoplastics specialists (of which 70.1% were American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members); 16.1% were general plastic surgery trained, 9.0% were ENT trained, 8.8% were ophthalmology but not oculoplastics trained, and 1.9% were trained in another specialty. 27.7% of recommendations across all AI systems were female. Conclusions Among the chatbot systems tested, there were high rates of inaccuracy: up to 38% of recommended surgeons were nonexistent or not practicing in the city requested, and 35.9% of those recommended as oculoplastic/oculofacial plastic surgeons were not oculoplastics specialists. Choice of prompt affected the result, with requests for \"a doctor who does eyelid lifts\" resulting in more plastic surgeons and ENTs and fewer oculoplastic surgeons. It is important to identify inaccuracies and biases in recommendations provided by AI systems as more patients may start using them to choose a surgeon.

Thyroglossal duct cysts (TGDCs) are among the most common congenital anomalies of the neck, typically presenting as painless midline masses inferior to the hyoid bone. Distinguishing TGDCs from other cystic neck lesions, such as ranulas or dermoid cysts, can be challenging, particularly when they arise in uncommon locations such as the sublingual space. Here, we report an atypical presentation of a TGDC in the sublingual space of a 31‐year‐old Hispanic/Latino White male. The patient, with no significant medical history, presented to the emergency department at the University of California San Diego Health (Hillcrest Medical Center, San Diego, California, United States), in June 2023 after sustaining blunt facial trauma. Imaging revealed an incidental cystic lesion in the right paramedian floor of the mouth. Magnetic resonance imaging (MRI) confirmed a circumscribed cystic mass (21 × 21 × 20 mm) within the sublingual space. Imaging characteristics, including the lesion’s close approximation to the hyoid bone and absence of restricted diffusion, were most compatible with a TGDC. MRI also confirmed a normal thyroid gland and no cervical lymphadenopathy. Surgical excision of the cyst, including a segment of the hyoid bone, was performed. Histopathological examination confirmed the diagnosis of a TGDC with respiratory and squamous epithelial lining. At the 1‐week postoperative follow‐up, flexible laryngoscopy showed no complications, with normal vocal fold function. TGDCs in the sublingual space are extremely rare, with only nine previously reported cases in the English literature. This report underscores the significance of recognizing atypical presentations of TGDCs, particularly in rare locations such as the sublingual space, expanding the understanding of their diverse clinical manifestations.

Intramuscular degloving injuries (IDIs) are a rare and unique type of muscle injury where there is a dissociation between the inner and outer components of a particular muscle. This type of injury is seen exclusively within the rectus femoris (RF) muscle due to its unique muscle-within-a-muscle anatomy and represents 9% of RF injuries. Despite the significance of this injury, limited knowledge exists regarding the mechanism, management, and prognosis of IDIs, and IDIs are not currently included among the various muscle injury classifications. We present a 38-year-old active male with a one-week history of acute onset right anterior mid-thigh pain and palpable lump after playing kickball. Right thigh MRI revealed an IDI of the RF muscle, edema within the inner and outer muscular portions of the muscle, and a retraction of the torn inner indirect myotendinous complex of the RF. He was managed with physical therapy while being advised to avoid aggressive quadriceps contractions, high-intensity, or high-impact exercise. This is the first reported case of an IDI that occurred in an older recreational athlete (versus young competitive athletes), and the first case of an IDI in a kicking sport other than soccer (kickball). This case emphasizes the importance of a broader awareness of this injury, and a heightened index of suspicion is advised in assessing potential IDIs to improve patient prognosis and rehabilitation. Given the limited understanding and rarity of this injury, we also provide a comprehensive review describing the IDI to the RF.

Exposure to methyl mercury, a risk factor for neurodevelopmental toxicity, was assessed in U.S. children 1-5 years of age (n = 838) and women 16-49 years of age (n = 1,726) using hair mercury analysis during the 1999-2000 National Health and Nutrition Examination Survey (NHANES). The data are nationally representative and are based on analysis of cross-sectional data for the non-institutionalized, U.S. household population. The survey consisted of interviews conducted in participants' homes and standardized health examinations conducted in mobile examination centers. Distributions of total hair mercury levels expressed as micrograms per gram hair Hg and the association of hair Hg levels with sociodemographic characteristics and fish consumption are reported. Geometric mean (standard error of the geometric mean) hair mercury was 0.12 μg/g (0.01 μg/g) in children, and 0.20 μg/g (0.02 μg/g) in women. Among frequent fish consumers, geometric mean hair mercury levels were 3-fold higher for women (0.38 vs. 0.11 μg/g) and 2-fold higher for children (0.16 vs. 0.08 μg/g) compared with nonconsumers. The NHANES 1999-2000 data provide population-based data on hair mercury concentrations for women and children in the United States. Hair mercury levels were associated with age and fish consumption frequency.

Background: More than four million people die each year in the month following surgery, and many more experience complications such as acute kidney injury. Some of these outcomes may be prevented through early identification of at-risk patients and through intraoperative risk mitigation. Telemedicine has revolutionized the way at-risk patients are identified in critical care, but intraoperative telemedicine services are not widely used in anesthesiology. Clinicians in telemedicine settings may assist with risk stratification and brainstorm risk mitigation strategies while clinicians in the operating room are busy performing other patient care tasks. Machine learning tools may help clinicians in telemedicine settings leverage the abundant electronic health data available in the perioperative period. The primary hypothesis for this study is that anesthesiology clinicians can predict postoperative complications more accurately with machine learning assistance than without machine learning assistance. Methods: This investigation is a sub-study nested within the TECTONICS randomized clinical trial (NCT03923699). As part of TECTONICS, study team members who are anesthesiology clinicians working in a telemedicine setting are currently reviewing ongoing surgical cases and documenting how likely they feel the patient is to experience 30-day in-hospital death or acute kidney injury. For patients who are included in this sub-study, these case reviews will be randomized to be performed with access to a display showing machine learning predictions for the postoperative complications or without access to the display. The accuracy of the predictions will be compared across these two groups. Conclusion: Successful completion of this study will help define the role of machine learning not only for intraoperative telemedicine, but for other risk assessment tasks before, during, and after surgery. Registration: ORACLE is registered on ClinicalTrials.gov: NCT05042804; registered September 13, 2021.

BackgroundRecent advances in next-generation sequencing have allowed for an increase in molecular tumor profiling.ObjectiveWe sought to assess the actionability and clinical utilization of molecular tumor profiling results obtained via Foundation Medicine tumor sequencing tests in uterine and ovarian cancers.Patients and MethodsWe performed a single-institution retrospective chart review to obtain demographic and clinical information in patients with uterine and ovarian cancer whose tumors were submitted to Foundation Medicine for molecular tumor profiling over a 7-year period. Alterations identified on testing were stratified according to the OncoKB database actionability algorithm. Descriptive statistics were primarily used to analyze the data.ResultsTumors from 185 women with gynecologic cancer were submitted for molecular tumor profiling between 2013 and 2019. The majority of tests (144/185; 78%) were ordered after a diagnosis of recurrence. In 60 (32%), no actionable molecular alteration was identified. Thirteen (7%) identified an alteration that directed to a US Food and Drug Administration-approved therapy in that tumor type, while 112 (61%) had alterations with investigational or hypothetical treatment implications. In patients with any actionable finding, treatment was initiated in 27 (15%) based on these results.ConclusionsThe majority of uterine and ovarian cancers (93%) did not have molecular alterations with corresponding Food and Drug Administration-approved treatments. Even in patients with a potentially actionable alteration, gynecologic oncologists were more likely to choose an alternative therapy. Further investigation is warranted to determine which patients with uterine and ovarian cancer are most likely to benefit from molecular tumor profiling and the ideal timing of testing. The potential to identify effective therapeutic options in a minority of patients needs to be balanced with the current limited clinical applicability of these results in most cases.

Introduction: Quality improvement (QI) in healthcare results in better patient outcomes, healthcare system performance, and professional development. One target of QI initiatives in the perioperative period is surgical site infections (SSI), for which several risk factors have been identified. Reliable administration of indicated surgical antibiotic prophylaxis is a modifiable factor of particular relevance. We hypothesize that a novel telemedicine-augmented quality improvement program will improve administration of surgical antibiotic prophylaxis. Objectives: The objective of this QI study is to evaluate the utility of a telemedicine-augmented QI initiative on administration of timely surgical antibiotic prophylaxis. The incidence of SSI will also be reported for multiple surgical services. Methods: This will be a multi-center prospective before-and-after proof-of-concept study. Patients undergoing a surgical procedure across seven operating room facilities at four hospitals in the BJC Healthcare System will be included. Approximately 40,000 patients over an eight-month period will be enrolled. This eight-month period will include a baseline observational phase, an education intervention phase, an intervention phase employing real-time event detection with associated guidance from a remote telemedicine center, and a subsequent observational phase. The primary outcome will be administration of on-time surgical antibiotic prophylaxis throughout the trial. Other outcomes will include incidence of SSIs. Registration Information: This trial is registered on clinicaltrials.gov, NCT04983329 (30 th July 2021).

Centromere protein B (CENP-B) is a centromeric DNA-binding protein that binds to alpha-satellite DNA at the 17 bp CENP-B box sequence. The binding of CENP-B, along with other proteins, to alpha-satellite DNA sequences at the centromere, is thought to package the DNA into heterochromatin subjacent to the kinetochore of mitotic chromosomes. To determine the importance of CENP-B to kinetochore assembly and function, we generated a mouse null for the cenpB gene. The deletion removed part of the promoter and the entire coding sequence except for the carboxyl-terminal 35 amino acids of the CENP-B polypeptide. Mice heterozygous or homozygous for the cenpB null mutation are viable and healthy, with no apparent defect in growth and morphology. We have established mouse embryo fibroblasts from heterozygous and homozygous cenpB null littermates. Microscopic analysis, using immunofluorescence and electron microscopy of the cultured cells, indicated that the centromere-kinetochore complex was intact and identical to control cells. Mitosis was identical in fibroblasts derived from cenpB wild-type, heterozygous and null animals. Our studies demonstrate that CENP-B is not required for the assembly of heterochromatin or the kinetochore, or for completion of mitosis.