Performance of GPT-3.5 and GPT-4 on standardized urology knowledge assessment items in the United States: a descriptive study.

PURPOSE: This study aimed to evaluate the performance of Chat Generative Pre-Trained Transformer (ChatGPT) with respect to standardized urology multiple-choice items in the United States. METHODS: In total, 700 multiple-choice urology board exam-style items were submitted to GPT-3.5 and GPT-4, and responses were recorded. Items were categorized based on topic and question complexity (recall, interpretation, and problem-solving). The accuracy of GPT-3.5 and GPT-4 was compared across item types in February 2024. RESULTS: GPT-4 answered 44.4% of items correctly compared to 30.9% for GPT-3.5 (P>0.0001). GPT-4 (vs. GPT-3.5) had higher accuracy with urologic oncology (43.8% vs. 33.9%, P=0.03), sexual medicine (44.3% vs. 27.8%, P=0.046), and pediatric urology (47.1% vs. 27.1%, P=0.012) items. Endourology (38.0% vs. 25.7%, P=0.15), reconstruction and trauma (29.0% vs. 21.0%, P=0.41), and neurourology (49.0% vs. 33.3%, P=0.11) items did not show significant differences in performance across versions. GPT-4 also outperformed GPT-3.5 with respect to recall (45.9% vs. 27.4%, P<0.00001), interpretation (45.6% vs. 31.5%, P=0.0005), and problem-solving (41.8% vs. 34.5%, P=0.56) type items. This difference was not significant for the higher-complexity items. Conclusion: s: ChatGPT performs relatively poorly on standardized multiple-choice urology board exam-style items, with GPT-4 outperforming GPT-3.5. The accuracy was below the proposed minimum passing standards for the American Board of Urology's Continuing Urologic Certification knowledge reinforcement activity (60%). As artificial intelligence progresses in complexity, ChatGPT may become more capable and accurate with respect to board examination items. For now, its responses should be scrutinized.

Vaccination coverage in children with juvenile idiopathic arthritis, inflammatory bowel diseases, and healthy peers: Cross-sectional electronic survey data.

BACKGROUND: Patients with immune-mediated diseases, such as juvenile idiopathic arthritis (JIA) and inflammatory bowel disease (IBD) are at increased risk of developing infections, due to disease-related immune dysfunction and applying of immunosuppressive drugs. AIM: To evaluate vaccine coverage in patients with IBD and JIA, and compare it with healthy children. METHODS: In the cross-sectional study we included the data from a questionnaire survey of 190 Legal representatives of children with JIA (n = 81), IBD (n = 51), and healthy children (HC, n = 58). An electronic online questionnaire was created for the survey. RESULTS: There were female predominance in JIA patients and younger onset age. Parents of JIA had higher education levels. Employment level and family status were similar in the three studied groups. Patients with JIA and IBD had lower vaccine coverage, without parental rejection of vaccinations in IBD, compare to JIA and healthy controls. The main reason for incomplete vaccination was medical conditions in IBD and JIA. IBD patients had a lower rate of normal vaccine-associated reactions compared to JIA and HC. The encouraging role of physicians for vaccinations was the lowest in JIA patients. IBD patients had more possibilities to check antibodies before immune-suppressive therapy and had more supplementary vaccinations compared to JIA and HC. CONCLUSION: JIA and IBD patients had lower vaccine coverage compared to HC. Physicians' encouragement of vaccination and the impossibility of discus about future vaccinations and their outcomes seemed the main factors for patients with immune-mediated diseases, influencing vaccine coverage. Further investigations are required to understand the reasons for incomplete vaccinations and improve vaccine coverage in both groups, especially in rheumatic disease patients. The approaches that stimulate vaccination in healthy children are not always optimal in children with immune-mediated diseases. It is necessary to provide personalized vaccine-encouraging strategies for parents of chronically ill children with the following validation of these technics.

A Case of Congenital Hypotonia and Developmental Delay in an Individual with a De Novo Variant Outside of the Canonical HX-Motif of ATN1.

We present a case of a 4-year-old female with a de novo heterozygous variant in the ATN1 gene. The whole exome sequencing was performed on the patient and her parents, and a likely pathogenic, de novo variant was identified in exon 5 of the ATN1 gene. There are two well-documented conditions associated with the ATN1 gene: congenital hypotonia, epilepsy, developmental delay, and digital anomalies (CHEDDA) syndrome and dentatorubral-pallidoluysian atrophy (DRPLA). Unlike DRPLA which is caused by an expanded trinucleotide repeat, CHEDDA syndrome is caused by variants in the histidine-rich (HX) motif at exon 7 of ATN1 similar to the de novo variant found in exon 5 of the presented individual. CHEDDA syndrome is a neurodevelopmental disorder previously documented in over 17 unrelated individuals. Compared to other documented CHEDDA syndrome cases, this individual shares similarities in respect to hypotonia, hearing impairment, impaired gross and fine motor ability, gastrointestinal abnormalities, hyperextensible joints, and frontal bossing. However, the individual presented here has only a moderate developmental delay and has acquired more developmental milestones such as higher-level language skills and more developed fine motor skills, than previously described individuals. The authors of this paper believe the patient's milder phenotype may be due to the variant's location outside of the canonic HX motif.

A Novel Technique to Minimize Contamination for Cervical Cancer Surgery Patients.

The Laparoscopic Approach to Cervical Cancer (LACC) trial changed the surgical management of cervical cancer worldwide. It was a multinational phase III clinical trial that reported lower survival and higher rate of abdominopelvic recurrences in minimally invasive surgery (MIS) than those of open surgery after hysterectomy. It is possible that tumor exposure to the peritoneal cavity in the MIS arm may account for these differences. We propose a novel technique to minimize peritoneal contamination of malignant cells present at the cervical os by placing a vaginal cerclage abdominally to create a seal at the apex of the vagina during MIS radical hysterectomy. The 2 patients in this work remain healthy and disease-free more than 18 months after surgery using this novel technique. We intend this work to serve as a platform both for offering a safe alternative to the open approach supported by the LACC trial and, most importantly, for promoting discussion of the results of the LACC trial and further research on surgical techniques in the treatment of cervical cancer. MIS has repeatedly been shown to have lower rates of infection, fewer complications, and shorter hospital stays while providing oncologic care that is noninferior to open approach.