The Performance of ChatGPT on the American Society for Surgery of the Hand Self-Assessment Examination.

BACKGROUND: This study aims to compare the performance of ChatGPT-3.5 (GPT-3.5) and ChatGPT-4 (GPT-4) on the American Society for Surgery of the Hand (ASSH) Self-Assessment Examination (SAE) to determine their potential as educational tools. METHODS: This study assessed the proportion of correct answers to text-based questions on the 2021 and 2022 ASSH SAE between untrained ChatGPT versions. Secondary analyses assessed the performance of ChatGPT based on question difficulty and question category. The outcomes of ChatGPT were compared with the performance of actual examinees on the ASSH SAE. RESULTS: A total of 238 questions were included in the analysis. Compared with GPT-3.5, GPT-4 provided significantly more correct answers overall (58.0% versus 68.9%, respectively; P = 0.013), on the 2022 SAE (55.9% versus 72.9%; P = 0.007), and more difficult questions (48.8% versus 63.6%; P = 0.02). In a multivariable logistic regression analysis, correct answers were predicted by GPT-4 (odds ratio [OR], 1.66; P = 0.011), increased question difficulty (OR, 0.59; P = 0.009), Bone and Joint questions (OR, 0.18; P < 0.001), and Soft Tissue questions (OR, 0.30; P = 0.013). Actual examinees scored a mean of 21.6% above GPT-3.5 and 10.7% above GPT-4. The mean percentage of correct answers by actual examinees was significantly higher for correct (versus incorrect) ChatGPT answers. CONCLUSIONS: GPT-4 demonstrated improved performance over GPT-3.5 on the ASSH SAE, especially on more difficult questions. Actual examinees scored higher than both versions of ChatGPT, but the margin was cut in half by GPT-4.

Diagnosis and Management of Lunotriquetral Ligament Injuries.

PURPOSE OF REVIEW: The standard of care for lunotriquetral ligament injuries is evolving. An understanding of the mechanics of the lunotriquetral ligament and its role in carpal kinematics is critical when deciding how to treat these injuries. Treatment for these injuries varies from nonoperative to wrist arthroscopy with thermal capsulodesis and/or repair to reconstruction or limited arthrodesis. This article provides a review of the anatomy, pathomechanics, evaluation, and ultimately treatment of lunotriquetral ligament injuries. RECENT FINDINGS: Although lunotriquetral ligament injuries can occur in isolation, injuries to the lunotriquetral ligament are often viewed as a component of other injury patterns to the intrinsic and extrinsic ligaments of the wrist. Static volar intercalated segment instability typically occurs when the dorsal radiocarpal ligament is also compromised. If nonoperative treatment fails, arthroscopy is the gold standard for diagnosis even with improving imaging modalities. Recently, authors have proposed employing the technique of ulnar-shortening osteotomy in those with ulnar negative variance and the absence of an impaction lesion. Other newer techniques included bone-ligament-bone reconstruction for chronic, static instability. LT injuries rarely occur in isolation. Most injuries involving the lunotriquetral ligament can be treated nonoperatively. Those individuals with persistent pain should be treated with a diagnostic wrist arthroscopy. Primary repairs are indicated in those with an acute, complete tear. In chronic, static instability, ligament reconstruction has been shown to improve wrist function and decrease pain.

Thermodynamics of hydrophobic-polar model proteins on the face-centered cubic lattice.

The HP model, a coarse-grained protein representation with only hydrophobic (H) and polar (P) amino acids, has already been extensively studied on the simple cubic (SC) lattice. However, this geometry severely restricts possible bond angles, and a simple improvement is to instead use the face-centered cubic (fcc) lattice. In this paper, the density of states and ground state energies are calculated for several benchmark HP sequences on the fcc lattice using the replica-exchange Wang-Landau algorithm and a powerful set of Monte Carlo trial moves. Results from the fcc lattice proteins are directly compared with those obtained from a previous lattice protein folding study with a similar methodology on the SC lattice. A thermodynamic analysis shows comparable folding behavior between the two lattice geometries, but with a greater rate of hydrophobic-core formation persisting into lower temperatures on the fcc lattice.

Observed Altruism in Dental Students: An Experiment Using the Ultimatum Game.

The conventional wisdom in dental and medical education is that dental and medical students experience "ethical erosion" over the duration of dental and medical school. There is some evidence for this claim, but in the case of dental education the evidence consists entirely of survey research, which does not measure behavior. The aim of this study was to measure the altruistic behavior of dental students in order to fill the significant gap in knowledge of how students are disposed to behave, rather than how they are disposed to think. To test the altruistic behavior of dental students, the authors conducted a field experiment using the Ultimatum Game, a two-player game used in economics to observe social behavior. In the game, the "proposer" is given a pot of resources, typically money, to split with the "responder." The proposer proposes a split of the pot to the responder. If the responder accepts the proposed split, both participants keep the amounts offered. If the proposal is rejected, then neither participant receives anything. In this study, the students played the proposer, and the responder was a fictional individual although the students believed they were playing the computerized game with a real person. In fall 2015, dental students from each of the four years at one university played the game. All 160 students were invited to participate, and 136 did so, for a response rate of 85%. The results showed that the students exhibited greater levels of altruism than the general population typically does. The students' altruism was at its highest in year four and was associated with the socioeconomic status of responder. This result raises the possibility that if a decreasing ability to behave altruistically is observed during dental school, it may not be due to a general disposition of students, but rather some factor specific to the educational environment.

Early Predictors of Mortality in Geriatric Patients With Trauma.

OBJECTIVE: To identify variables that predict mortality in geriatric patients with trauma. DESIGN: Retrospective review. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: A total of 147 geriatric patients with trauma (age ≥65) with a predicted probability of survival of 10%-75% based on the Trauma Score-Injury Severity Score (TRISS). MAIN OUTCOME MEASUREMENTS: Patients were divided into 2 cohorts: survivors and nonsurvivors. The following variables available at presentation were analyzed: age, mechanism of injury, temperature, systolic blood pressure, pulse rate, shock index, respiratory rate, Glasgow Coma Scale (GCS) score, base deficit, and hematocrit (HCT). The Injury Severity Score (ISS) and TRISS were calculated for both cohorts. RESULTS: Of the 147 patients analyzed, 84 (57%) died during the index hospitalization and 63 (43%) survived. The mean age of nonsurvivors was significantly higher than that of survivors (78.6 vs. 76.1 years; P < 0.04). A greater number of nonsurvivors (72.6%) sustained injuries as a result of a low-energy mechanism compared with survivors (54%; P = 0.02). GCS, temperature, and respiratory rate were significantly lower for nonsurvivors, whereas base deficit was higher (P < 0.05). The TRISS was predictive of survival (TRISS 0.27 vs. 0.53, P < 0.001), but the distinguishing capacity of the TRISS to predict mortality was limited (area under the receiver operator curve; 0.67; 95% confidence interval 0.58-0.76; P < 0.0001). CONCLUSIONS: Older age, lower GCS, and a low-energy mechanism of injury are associated with a higher mortality rate in this at-risk geriatric trauma population. Early identification of predictors of mortality may help care providers more accurately assess injury burden in geriatric patients. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Chondroitin Sulfate is the Primary Receptor for a Peptide-Modified AAV That Targets Brain Vascular Endothelium In Vivo.

Recently, we described a peptide-modified AAV2 vector (AAV-GMN) containing a capsid-displayed peptide that directs in vivo brain vascular targeting and transduction when delivered intravenously. In this study, we sought to identify the receptor that mediates transduction by AAV-GMN. We found that AAV-GMN, but not AAV2, readily transduces the murine brain endothelial cell line bEnd.3, a result that mirrors previously observed in vivo transduction profiles of brain vasculature. Studies in vitro revealed that the glycosaminoglycan, chondroitin sulfate C, acts as the primary receptor for AAV-GMN. Unlike AAV2, chondroitin sulfate expression is required for cell transduction by AAV-GMN, and soluble chondroitin sulfate C can robustly inhibit AAV-GMN transduction of brain endothelial cells. Interestingly, AAV-GMN retains heparin-binding properties, though in contrast to AAV2, it poorly transduces cells that express heparan sulfate but not chondroitin sulfate, indicating that the peptide insertion negatively impacts heparan-mediated transduction. Lastly, when delivered directly, this modified virus can transduce multiple brain regions, indicating that the potential of AAV-GMN as a therapeutic gene delivery vector for central nervous system disorders is not restricted to brain vascular endothelium.

Evaluating the side effects of treatment for preterm labor in a center that uses "high-dose" magnesium sulfate.

OBJECTIVE: To evaluate the tolerability and safety of intravenous magnesium sulfate use for tocolysis in a center that uses a "high-dose" regimen. STUDY DESIGN: We conducted a retrospective cohort study of patients treated with magnesium sulfate for preterm labor from December 2006 to June 2010. Data were abstracted from review of individual patient electronic medical records. RESULTS: The cohort consisted of 456 women. Of these, 417 (91.4%) experienced side effects. Severe side effects (pulmonary edema, respiratory arrest, intensive care unit transfer, cardiac arrest, or death) occurred in 24 (5.3%) cases, all but one due to pulmonary edema. No cases of respiratory arrest, cardiac arrest, or death occurred. Those with severe side effects were less likely to have a singleton and more likely to have a higher order multifetal gestation (p < 0.001), received more magnesium, and more often were given multiple concurrent tocolytics (p = 0.04). CONCLUSION: "High-dose" magnesium tocolysis results in side effects for 9 of every 10 patients treated, and severe side effects occur in 1 of every 20 patients. When used for tocolysis, magnesium should be used as a single agent, for less than 48 hours, and with great caution in multifetal gestations.