Exploring the Performance of ChatGPT Versions 3.5, 4, and 4 With Vision in the Chilean Medical Licensing Examination: Observational Study.

Background: The deployment of OpenAI's ChatGPT-3.5 and its subsequent versions, ChatGPT-4 and ChatGPT-4 With Vision (4V; also known as "GPT-4 Turbo With Vision"), has notably influenced the medical field. Having demonstrated remarkable performance in medical examinations globally, these models show potential for educational applications. However, their effectiveness in non-English contexts, particularly in Chile's medical licensing examinations-a critical step for medical practitioners in Chile-is less explored. This gap highlights the need to evaluate ChatGPT's adaptability to diverse linguistic and cultural contexts. Objective: This study aims to evaluate the performance of ChatGPT versions 3.5, 4, and 4V in the EUNACOM (Examen Único Nacional de Conocimientos de Medicina), a major medical examination in Chile. Methods: Three official practice drills (540 questions) from the University of Chile, mirroring the EUNACOM's structure and difficulty, were used to test ChatGPT versions 3.5, 4, and 4V. The 3 ChatGPT versions were provided 3 attempts for each drill. Responses to questions during each attempt were systematically categorized and analyzed to assess their accuracy rate. Results: All versions of ChatGPT passed the EUNACOM drills. Specifically, versions 4 and 4V outperformed version 3.5, achieving average accuracy rates of 79.32% and 78.83%, respectively, compared to 57.53% for version 3.5 (P<.001). Version 4V, however, did not outperform version 4 (P=.73), despite the additional visual capabilities. We also evaluated ChatGPT's performance in different medical areas of the EUNACOM and found that versions 4 and 4V consistently outperformed version 3.5. Across the different medical areas, version 3.5 displayed the highest accuracy in psychiatry (69.84%), while versions 4 and 4V achieved the highest accuracy in surgery (90.00% and 86.11%, respectively). Versions 3.5 and 4 had the lowest performance in internal medicine (52.74% and 75.62%, respectively), while version 4V had the lowest performance in public health (74.07%). Conclusions: This study reveals ChatGPT's ability to pass the EUNACOM, with distinct proficiencies across versions 3.5, 4, and 4V. Notably, advancements in artificial intelligence (AI) have not significantly led to enhancements in performance on image-based questions. The variations in proficiency across medical fields suggest the need for more nuanced AI training. Additionally, the study underscores the importance of exploring innovative approaches to using AI to augment human cognition and enhance the learning process. Such advancements have the potential to significantly influence medical education, fostering not only knowledge acquisition but also the development of critical thinking and problem-solving skills among health care professionals.

Basal Forebrain Modulation of Olfactory Coding In Vivo.

Sensory perception is one of the most fundamental brain functions, allowing individuals to properly interact and adapt to a constantly changing environment. This process requires the integration of bottom-up and topdown neuronal activity, which is centrally mediated by the basal forebrain, a brain region that has been linked to a series of cognitive processes such as attention and alertness. Here, we review the latest research using optogenetic approaches in rodents and in vivo electrophysiological recordings that are shedding light on the role of this region, in regulating olfactory processing and decisionmaking. Moreover, we summarize evidence highlighting the anatomical and physiological differences in the basal forebrain of individuals with autism spectrum disorder, which could underpin the sensory perception abnormalities they exhibit, and propose this research line as a potential opportunity to understand the neurobiological basis of this disorder.

La percepción sensorial es una de las funciones cerebrales más fundamentales, permitiendo a los individuos interactuar de manera apropiada con el entorno y adaptarse a un ambiente en constante cambio. Este proceso requiere la integración de la actividad neuronal ascendente y descendente, que es mediada por el cerebro basal (BF), una región cerebral que ha sido asociada a una serie de procesos cognitivos, como estados de atención y alerta.En este trabajo revisamos las últimas investigaciones que han utilizado optogenética y registros electrofisiológicos in vivo que han iluminado el rol del BF en el procesamiento olfatorio y la toma de decisiones. Además, resumimos la literatura que destaca las alteraciones fisiológicas y anatómicas del BF de individuos con trastornos del espectro autista, que podrían subyacer las anormalidades en la percepción que presentan, y proponemos esta línea de investigación como una posible oportunidad para entender las bases neurobiológicas de este trastorno.

State of Mental Health Research of Adolescents and Youth in Chile: An Ontological Analysis.

Knowing the state of mental health research in adolescents and youth can be an important tool for decision-making, especially in contexts of limited resources. The aim of this study is to map the scientific research on adolescent and youth mental health in Chile using an ontological framework. We have mapped the population of research articles on mental health of adolescents and youth in Chile in Scopus, Web of Science, and SciELO databases onto the ontology. The PRISMA reporting guidelines were used to screen the 1688 items based on relevance, duplication, and version. The corpus of 346 articles was coded into the ontology through an iterative process among the seven authors. This ontological mapping shows isolated research efforts that have been carried out in Chile to explain the whole state of mental health in adolescents and youth. There is a lack of coordination between the priorities established by the decision-makers and the researchers. Our results coincide with the need to strengthen mental health research in the country, and to prioritizing those topics that contribute to decision-making based on the needs of the population.

Análisis de tiroglobulina preablativa y cáncer diferenciado de tiroides preoperatorio / Analysis of pre-ablative and preoperative thyroglobulin in differentiated thyroid cancer

BACKGROUND: The measurement of plasma thyroglobulin (Tg) is widely used in the monitoring of differentiated thyroid cancer (CDT). In recent years, its value as a prognostic marker prior to ablation with radioiodine has increased, demonstrating its high negative predictive value. Recent studies indicate that a wide variety of factors could potentially influence pre-ablative Tg values, including residual tumor burden and stimulation modality. Aim: To relate the value of pre-ablative Tg with the amount of preoperative disease burden, lymph node metastases, treatment, and presence of residual disease. MATERIAL AND METHODS: Retrospective observational study of 70 patients with CDT treated between 2012 and 2018. The amount of disease burden was defined as the sum of largest diameter of individual tumors in each patient, and as the individually largest tumor per patient and number of metastatic lymph nodes. RESULTS: A smaller tumor size and absence of remnant tissue was associated with lower Tg values, although the association was not always significant. Furthermore, no significant difference was found between Tg levels measured within or more than 14 days after the surgical procedure. Thus, an early measurement of pTg after surgery would allow an initial therapeutic decision making. Conclusions: A statistical association between pre-ablative Tg levels and the amount of preoperative tumor tissue burden was found in some subgroups of patients.

Exome Sequencing Identifies Genetic Variants Associated with Extreme Manifestations of the Cardiovascular Phenotype in Marfan Syndrome.

Marfan Syndrome (MFS) is an autosomal dominant condition caused by variants in the fibrillin-1 (FBN1) gene. Cardinal features of MFS include ectopia lentis (EL), musculoskeletal features and aortic root aneurysm and dissection. Although dissection of the ascending aorta is the main cause of mortality in MFS, the clinical course differs considerably in age of onset and severity, even among individuals who share the same causative variant, suggesting the existence of additional genetic variants that modify the severity of the cardiovascular phenotype in MFS. We recruited MFS patients and classified them into severe (n = 8) or mild aortic phenotype (n = 14) according to age of presentation of the first aorta-related incident. We used Exome Sequencing to identify the genetic variants associated with the severity of aortic manifestations and we performed linkage analysis where suitable. We found five genes associated with severe aortic phenotype and three genes that could be protective for this phenotype in MFS. These genes regulate components of the extracellular matrix, TGFß pathway and other signaling pathways that are involved in the maintenance of the ECM or angiogenesis. Further studies will be required to understand the functional effect of these variants and explore novel, personalized risk management and, potentially, therapies for these patients.

Functional, Antioxidant, and Anti-Inflammatory Properties of Cricket Protein Concentrate (Gryllus assimilis).

Edible insects can represent an alternative to obtain high-quality proteins with positive biological properties for human consumption. Cricket flour (Gryllus assimilis) was used to obtain cricket protein concentrate (CPC) using pHs (10.0 and 12.0) of extraction and pHs (3.0, 4.0, 5.0, and 6.0) of isoelectric precipitation (pI). Protein content, water and oil absorption capacity, protein solubility, antioxidant, and anti-inflammatory activities were determined. In addition, the protein profile was characterized by electrophoresis and the in vitro CPC digestibility was evaluated. Cricket flour presented 45.75% of protein content and CPC 12-5.0 presented a value of 71.16% protein content using the Dumas method. All samples were more soluble at pH 9.0 and 12.0. CPC 12-3.0 presented a percentage of water-binding capacity (WBC) of 41.25%. CPC 12-6.0 presented a percentage of oil-binding capacity (OBC) of 72.93%. All samples presented a high antioxidant and anti-inflammatory activity. CPC 12-4.0 presented a value FRAP of 70,034 umol trolox equivalents (TE)/g CPC, CPC 12-6.0 presented a value ABTS of 124,300 umol TE/g CPC and CPC 10-3.0 presented a DPPH value of 68,009 umol TE/g CPC. CPC 10-6.0 and CPC 12-6.0 presented high anti-inflammatory activity, with values of 93.55% and 93.15% of protection, respectively. CPCs can be used as functional ingredients in the food industry for their excellent functional and biological properties.

[Analysis of pre-ablative and preoperative thyroglobulin in differentiated thyroid cancer]. / Análisis de tiroglobulina preablativa y cáncer diferenciado de tiroides preoperatorio.

BACKGROUND: The measurement of plasma thyroglobulin (Tg) is widely used in the monitoring of differentiated thyroid cancer (CDT). In recent years, its value as a prognostic marker prior to ablation with radioiodine has increased, demonstrating its high negative predictive value. Recent studies indicate that a wide variety of factors could potentially influence pre-ablative Tg values, including residual tumor burden and stimulation modality. AIM: To relate the value of pre-ablative Tg with the amount of preoperative disease burden, lymph node metastases, treatment, and presence of residual disease. MATERIAL AND METHODS: Retrospective observational study of 70 patients with CDT treated between 2012 and 2018. The amount of disease burden was defined as the sum of largest diameter of individual tumors in each patient, and as the individually largest tumor per patient and number of metastatic lymph nodes. RESULTS: A smaller tumor size and absence of remnant tissue was associated with lower Tg values, although the association was not always significant. Furthermore, no significant difference was found between Tg levels measured within or more than 14 days after the surgical procedure. Thus, an early measurement of pTg after surgery would allow an initial therapeutic decision making. CONCLUSIONS: A statistical association between pre-ablative Tg levels and the amount of preoperative tumor tissue burden was found in some subgroups of patients.

Behavioral biomarker of bovines of the dual purpose system / Biomarcadores conductuales de bovinos del sistema doble propósito

ABSTRACT The importance of behavioral and physiological biomarkers and their effects on the dairy production of dual purpose cattle was evaluated through the collection and analysis of the primary information. The database maintained by the University of the Amazon, the National University of Colombia, and SCIELO, was analyzed using the keywords: animal welfare, ethology and bovine behavior. It was observed that the activities to which the cows are subjected in dairy production lead to an inevitable stress for the animal due to the conditions of the system, negatively affecting the production, specifically the quantity and quality of milk produced (Total solids, fats and proteins). Greater knowledge regarding animal welfare will contribute to a better understanding of the behavior of dual purpose cattle in dairy production, subject to different management conditions. In this sense, ethology becomes a powerful tool that helps to understand how these animals perceive their environment.

RESUMEN Se evaluó a través de la recopilación y análisis de la información primaria, la importancia de los biomarcadores conductuales, fisiológicos y sus efectos en la producción lechera de bovinos doble propósito. Se analizó la base de datos que mantiene la Universidad de la Amazonia, la Universidad Nacional de Colombia, y SCIELO, usando las palabras clave: bienestar animal, etología y comportamiento bovino. Se observó que las actividades a las que son sometidas las vacas en producción lechera conllevan un estrés inevitable para el animal debido a las condiciones mismas del sistema, afectando negativamente la producción, específicamente la cantidad y calidad de leche producida (Solidos totales, grasas y proteínas). Un mayor conocimiento en lo que se refiere a bienestar animal contribuirá al mejor entendimiento de la conducta del ganado doble propósito en producción lechera, sometido a diferentes condiciones de manejo. En este sentido la etología se convierte en una herramienta poderosa que ayuda a comprender cómo perciben estos animales su entorno.

Rinofima - Auto injerto de piel total / Rhinophyma - total skin autograft

La rosácea es una dermatosis crónica de origen desconocido, principalmente localizada en la cara, caracterizada por episodios de: rubefacción, edema, enrojecimiento con aparición de pápulas, pústulas, telangiectasis y fibrosis. El rinofima representa la etapa avanzada de la rosácea, mostrando una hiperplasia e hipertrofia de las glándulas sebáceas a nivel nasal, con apariencia engrosada e irregular, lobulada de coloración rojo-púrpura con presencia de poros dilatados. Se han propuesto varios factores: genéticos, luz solar, calor, frío, esteroides, consumo de alcohol (no demostrado) presencia de Helicobacter pylori, infecciosos y seborreicos. También puede representar una reacción de hipersensibilidad al ácaro Demodex folliculorum. Para su tratamiento se utiliza: antibióticos, retinoides, crioterapia, radioterapia, escisión tangencial y escisión de espesor completo con cierre directo, con o sin injertos de piel. En los casos de rinofima con grandes tumoraciones y compromiso de las vías aéreas, la mejor elección de tratamiento es quirúrgico.

Rosacea is a chronic skin disease of unknown origin, mainly located on the face, characterized by episodes of flushing, edema, redness with papules, pustules, telangiectasia and fibrosis.The rhinophyma represents the advanced stage of rosacea, showing hyperplasia and hypertrophy of the sebaceous glands on the nose, with thickened, irregular, lobed appearance, red-purple color and dilated pores. Several factors have been proposed, like:genetic, sunlight, heat, cold, steroids, alcohol consumption (not shown), and the presence of Helicobacter pylori, infections and seborrhea factors. It may also represent a hypersensitivity reaction to Demodex folliculorum acarus. Antibiotics, retinoids, cryotherapy, radiotherapy, tangential excision and full-thickness excision with direct closure with or without skin grafts are used for it treatment. The best choice of treatment is surgical in rinophyma patients with big tumors that compromise the airways.

The laminin-induced acrosome reaction in human sperm is mediated by Src kinases and the proteasome.

The aim of this work was to determine whether laminin (Ln), an extracellular matrix protein, induces the intracellular events that may be involved in producing the acrosome reaction in human sperm. To this end, we evaluated the effect of Ln on tyrosine phosphorylation, intracellular calcium concentration, proteasome activity, and phosphorylation in human sperm. Aliquots of highly motile sperm selected with a Percoll gradient, were incubated with different concentrations of Ln (0-20 µg/ml) for different periods (0-18 h). The percentage of viable acrosome-reacted sperm was evaluated using fluorescein isothiocyanate-labeled Pisum sativum agglutinin and Hoechst 33258 DNA dye. Tyrosine phosphorylation was evaluated by Western blot analysis. The chymotrypsin-like activity of the proteasome was evaluated with a fluorogenic peptide, and intracellular calcium concentration was measured with fura-2. The results indicate that Ln stimulated the acrosome reaction of human sperm in a dose-dependent manner. This increase was drastically inhibited in the presence of herbimycin A, SU6656, and epoxomicin. In addition, Ln increased proteasome activity and phosphorylation; both events were inhibited by herbimycin A and SU6656. Finally, Ln induced an increase in intracellular calcium concentration, which was inhibited by SU6656 and epoxomicin. These results suggest that Ln is able to induce the acrosome reaction. This effect may be mediated by Src kinase and the proteasome, with the consequent induction of a calcium influx.

Subcutaneous emphysema after ultrasonic treatment: a case report / Enfisema subcutáneo posterior a la higienización con ultrasonido: reporte de un caso

Subcutaneous emphysema is a rarely disease seen in dentistry. It can be caused by the inadvertent introduction of air into the soft tissue during oral cavity procedures. In this paper, we present a case that developed asubcutaneous emphysema in genial, submandibular and eyelid area, in a middle-aged woman after treatment with ultrasonic method.

El enfisema subcutáneo es una patología vista con poca frecuencia en odontología. Puede ser causada por la introducción involuntaria de aire en los tejidos blandos durante los procedimientos efectuados en la cavidad oral. En este trabajo, se presenta un caso de enfisema subcutáneo geniano, palpebral y submandibular, en una mujer de mediana edad después de un tratamiento de higienización con un equipo de ultrasonido.

Sexual dimorphism in mesiodistal and bucolingual tooth dimensions in Chilean people / Dimorfismo sexual en las dimensiones mesiodistales y bucolinguales de las piezas dentarias en individuos chilenos

The study investigates the presence of sexual dimorphism in the size of the permanent teeth among Chilean individuals. Mesiodistal and bucolingual diameters were measured in the teeth of 150 patients between 18 and 24 years old, 67 males and 83 females (excluded were third molars and pieces with large cavities and fillings). The largest were found in males; the differences in mean bucolingual diameters with p<0.05 were observed in pieces 1.1, 1.2, 1.3, 1.6, 1.7, 2.6, 3.3, 4.1, 4.2, and 4.5; and with p <0.01, the relevant pieces were to 4.4 and 4.7. With regard to mesiodistal dimensions, the only significant difference p <0.05 was found in piece 1.2. These results show that sexual dimorphism can be found in all group teeth.

Se investiga la presencia de dimorfismo sexual en las dimensiones de las piezas dentarias permanentes, en individuos chilenos. Se midieron los diámetros mesiodistales y buco linguales de las piezas dentarias de 150 pacientes, de entre 18 y 24 años de edad, 67 hombres y 83 mujeres, se excluyeron los terceros molares y las piezas con caries y obturaciones extensas. Las mayores dimensiones se encontraron en hombres, diferencias significativas en los diámetros bucolinguales con p<0.05 resultaron en las piezas 1.1, 1.2, 1.3, 1.6, 1.7, 2.6, 3.3, 4.1,4.2 y 4.5 y con p<0.01 para las piezas 4.4 y 4.7. Con respecto a las dimensiones mesiodistales, la única diferencia significativa con p<0.05 se encontró en la pieza 1.2. Estos resultados muestran que es posible encontrar dimorfismo sexual en todos los grupos dentarios.

[Factor VIII activity among young Mexican patients with acute myocardial infarction]. / Actividad del factor VIII en jóvenes mexicanos con infarto agudo del miocardio.

BACKGROUND: Atherothrombotic disease is the leading cause of death worldwide. Most casualties are due to acute myocardial infarction (AMI). Patients younger than 45 years account for 5-10% of AMI cases. These patients generally do not display typical atherothrombotic risk factors. METHODS: Our cross-sectional study included adult patients under 45; men and women with AMI were included. A control group of healthy individuals matched for age, sex, and blood group was included to determine the role of several atherothrombotic risk factors on AMI. One hundred and sixty patients were included, the control group was comprised by 77 males (m) and 83 females (f) RESULTS: Our results indicate that 25% of patients (23 m and 18 f) had increased FVIII compared with 8.8% of control subjects. Mean FVIII activity for patients and controls was 134 mg/dl (95%CI=114) vs. 118 mg/dl (95%CI=128-140), respectively (p=0.001). Prevalence of elevated FVIII was higher than the one found for hypertension or diabetes mellitus. HDL cholesterol was higher among patients than controls. Quantitative variables associated with AMI were high FVIII activity, blood monocyte count and HDL cholesterol. CONCLUSIONS: Classical atherothrombotic risk factors do not fully explain AMI events in the young. High levels of FVIII activity is a moderate but common risk factor in young people suffering AMI.

Actividad del factor VIII en jóvenes mexicanos con infarto agudo del miocardio / Factor VIII activity among young Mexican patients with acute myocardial infarction

Antecedentes: La enfermedad aterotrombótica es la causa de muerte más frecuente y la mayoría corresponde a infarto agudo del miocardio (IAM). Los menores de 45 años representan 5 a 10% de los IAM y es común que no sean portadores de factores de riesgo aterotrombótico clásicos. Métodos: Este estudio transversal analítico incluyó pacientes menores de 45 años con IAM, de uno y otro sexo, pareados por edad, sexo y grupo sanguíneo con sus respectivos controles, para analizar el impacto de diferentes factores de riesgo aterotrombótico sobre el IAM. Incluimos 160 casos y controles, 77 hombres y 83 mujeres. Resultados: El 25% de los pacientes tuvo aumento del factor VIII de la hemostasia (FVIII) vs. 8.8% en los controles. El FVIII promedio para pacientes y controles fue 134 mg/dl (IC 95%=114) vs. 118 mg/dl (IC 95%=128-140), respectivamente (p=0.001). La prevalencia de actividad alta del FVIII fue mayor que la de diabetes mellitus o hipertensión arterial. Paradójicamente, el colesterol HDL fue mayor en los pacientes que en los controles. Las únicas variables cuantitativas asociadas a IAM fueron la actividad alta del FVIII, la cuenta de monocitos en sangre periférica y el colesterol HDL. Conclusiones: Los factores de riesgo aterotrombótico clásicos no explican totalmente el IAM en jóvenes. El aumento de FVIII es un factor de riesgo moderado pero frecuente en la población joven con IAM.

BACKGROUND: Atherothrombotic disease is the leading cause of death worldwide. Most casualties are due to acute myocardial infarction (AMI). Patients younger than 45 years account for 5-10% of AMI cases. These patients generally do not display typical atherothrombotic risk factors. METHODS: Our cross-sectional study included adult patients under 45; men and women with AMI were included. A control group of healthy individuals matched for age, sex, and blood group was included to determine the role of several atherothrombotic risk factors on AMI. One hundred and sixty patients were included, the control group was comprised by 77 males (m) and 83 females (f) RESULTS: Our results indicate that 25% of patients (23 m and 18 f) had increased FVIII compared with 8.8% of control subjects. Mean FVIII activity for patients and controls was 134 mg/dl (95%CI=114) vs. 118 mg/dl (95%CI=128-140), respectively (p=0.001). Prevalence of elevated FVIII was higher than the one found for hypertension or diabetes mellitus. HDL cholesterol was higher among patients than controls. Quantitative variables associated with AMI were high FVIII activity, blood monocyte count and HDL cholesterol. CONCLUSIONS: Classical atherothrombotic risk factors do not fully explain AMI events in the young. High levels of FVIII activity is a moderate but common risk factor in young people suffering AMI.

Iatrogenic dissection of the right coronary artery and the ascending aorta secondary to endoluminal angioplasty. A case report.

The authors present the case of a 54-year-old woman with iatrogenic dissection of the right coronary artery ostium and extension of the dissection to the ascending aorta during the intraluminal angioplasty of an obstructive lesion in the middle portion of the right coronary artery. In order to maintain coronary blood flow before surgery, the coronary dissection was treated with the implantation of three direct coronary stents that dilated the stenosis and sealed the dissection of the coronary artery. The aortic dissection needed treatment with the implantation of a Haenoshield aortic graft. During the surgery, it was decided to implant an aortocoronary bypass graft to guarantee the distal right coronary blood flow, given the possible increased risk of thrombosis of the stents because of the large thrombogenic metallic surface of the stents. On the other hand, the administration of anticoagulants and antithrombotic drugs were not indicated because of the intended surgery of the aortic dissection. The evolution of the patient was satisfactory. Causes, frequency, and treatment procedures of this iatrogeny are discussed.

La hiperhidratación endovenosa materna durante el trabajo de parto ¿aumenta la morbilidad neonatal? / The maternal endovenous hyperhydratation during labor. Increase the neonatal morbidity?

La hiperhidratación parental de la mujer embarazada en trabajo de parto es una práctica habitual en los centros perinatológicos de alta complejidad no basada en la evidencia, que lejos de conferir beneficios ha demostrado múltiples efectos adversos en el recién nacido. En recién nacidos de término produce mayor incidencia de ictericia, hiponatremia y taquipnea transitoria. No se conoce su efecto en los recién nacidos prematuros. Nuestra hipótesis de trabajo es que grandes volúmenes de soluciones libres de electrolitos (glucosa al 5 por ciento) aportados a la madre durante el trabajo de parto, provocarían una expansión del espacio extracelular en el recién nacido como consecuencia del pasaje de agua transplacentario, ocasionando un aumento en la incidencia de ductus arterioso permeable, displasia broncopulmonar y enfermedad pulmonar crónica con consecuencias a largo plazo, especialmente en aquellos niños que no logran contraer su espacio extracelular en los primeros días de vida. En este sentido hay evidencia científica que aportes hídricos excesivos en los primeros días de vida se asocian en forma estadísticamente significativa con las entidades nosológicas mencionadas.