Evaluation of Large language model performance on the Multi-Specialty Recruitment Assessment (MSRA) exam.

INTRODUCTION: AI-powered platforms have gained prominence in medical education and training, offering diverse applications from surgical performance assessment to exam preparation. This research paper examines the capabilities of Large Language Models (LLMs), including Llama 2, Google Bard, Bing Chat, and ChatGPT-3.5, in answering multiple-choice questions of the Clinical Problem Solving (CPS) paper of the Multi-Specialty Recruitment Assessment (MSRA) exam. METHODS: Using a dataset of 100 CPS questions from ten subject categories, we assessed the LLMs' performance against medical doctors preparing for the exam. RESULTS: Results showed that Bing Chat outperformed all other LLMs and even surpassed human users from the Qbank question bank. Conversely, Llama 2's performance was inferior to human users. Google Bard and ChatGPT 3.5 did not exhibit statistically significant differences in correct response rates compared to human candidates. Pairwise comparisons demonstrated Bing Chat's significant superiority over Llama 2, Google Bard, and ChatGPT 3.5. However, no significant differences were found between Llama 2 and Google Bard, Llama 2, and ChatGPT-3.5, and Google Bard and ChatGPT-3.5. DISCUSSION: Freely available LLMs have already demonstrated that they can perform as well or even outperform human users in answering MSRA exam questions. Bing Chat emerged as a particularly strong performer. The study also highlights the potential for enhancing LLMs' medical knowledge acquisition through tailored fine-tuning. Medical knowledge tailored LLMs such as Med-PaLM, have already shown promising results. CONCLUSION: We provided valuable insights into LLMs' competence in answering medical MCQs and their potential integration into medical education and assessment processes.

Anterior migration of Ozurdex implant: a review on risk factors, complications, and management.

PURPOSE: To describe the common risk factors, complications, and management options for anterior migration of Ozurdex implant. METHODS: A comprehensive review of the literature was performed. RESULTS: Amongst the most common risk factors predisposing to implant anterior migration we found a history of pseudophakia or aphakia or previous vitrectomy. The most common complication is that of corneal edema. CONCLUSIONS: A variety of management options to treat migration of the dexamethasone implant are utilized by different specialists around the world. These depend on the doctor's preference, presence of corneal damage and history of previous migrations after repositioning the implant. The most common approaches are operative or non-operative implant repositioning and surgical implant removal.

Emergency General Surgery: Predicting Morbidity and Mortality in the Geriatric Population.

Introduction Numerous scoring systems have been created to predict the risk of morbidity and mortality in patients undergoing emergency general surgery (EGS). In this article, we compared the different scoring systems utilized at Humanitas Research Hospital and analyzed which one performed the best when assessing geriatric patients (>65 years of age). The scoring systems that were utilized were the APACHE II (Acute Physiology and Chronic Health Evaluation II), ASA (American Society of Anesthesiologists), ACS-NSQIP (American College of Surgeons-National Surgical Quality Improvement Program), Clinical Frailty Score, and the Clavien-Dindo classification as control. Materials and Methods We compiled a database consisting of all patients over the age of 65 who underwent EGS in a consecutive 24-month period between January 1, 2017 and December 31, 2018. We used the biostatistical program "Stata Version 15" to analyze our results. Results We found 213 patients who matched our inclusion criteria. Regarding death, we found that the ACS-NSQIP death calculator performed the best with an area under the curve of 0.9017 (odds ratio: 1.09; 95% confidence interval: 1.06-1.12). The APACHE II score had the lowest discriminator when predicting death. Considering short-term complications, the Clavien-Dindo classification scored highly, while both the APACHE II score and Clinical Frailty Score produced the lowest results. Conclusion The results obtained from our research showed that scoring systems and classifications produced different results depending on whether they were used to predict deaths or short-term complications among geriatric patients undergoing EGS.

Where Are We with RPE Replacement Therapy? A Translational Review from the Ophthalmologist Perspective.

The retinal pigmented epithelium (RPE) plays a pivotal role in retinal homeostasis. It is therefore an interesting target to fill the unmet medical need of different retinal diseases, including age-related macular degeneration and Stargardt disease. RPE replacement therapy may use different cellular sources: induced pluripotent stem cells or embryonic stem cells. Cells can be transferred as suspension on a patch with different surgical approaches. Results are promising although based on very limited samples. In this review, we summarize the current progress of RPE replacement and provide a comparative assessment of different published approaches which may become standard of care in the future.

Erratum: Addendum: Emergency General Surgery: Predicting Morbidity and Mortality in the Geriatric Population.

[This corrects the article DOI: 10.1055/s-0042-1756461.].

Congenital orbital teratoma: a case report with preservation of the globe and 18 years of follow-up.

BACKGROUND: Congenital orbital teratomas are extremely rare, usually benign neoplasms, comprised of cells originating from all three germ cell layers. Clinically the tumor appears solid, most of the times is intraconal and presents as a rapidly growing mass leading to a massive unilateral axial proptosis, chemosis, exposure keratopathy, markedly distended eyelids and often, loss of vision. To prevent these complications, tumor excision usually involves enucleation or even orbital exenteration. CASE PRESENTATION: We report a case of a 1-day old infant who presented with dramatic proptosis at birth due to a true congenital orbital teratoma. We describe the clinical findings, the preoperative neuroimaging, the surgical management which included complete tumor resection with preservation of the globe to allow for optimal orbital growth, the histopathological evaluation, and the clinical course during 18 years of follow up. CONCLUSION: Every effort to salvage the globe should be made to achieve the best possible orbito-facial development. Furthermore, the value of prompt surgical management with a less invasive transconjunctival globe sparing procedure can be appreciated in our case.

Short-Term Outcomes After COVID-19-Related Treatment Interruption Among Patients with Neovascular Age-Related Macular Degeneration Receiving Intravitreal Bevacizumab.

PURPOSE: To assess outcomes and recovery strategy of patients undergoing intravitreal injections for exudative age-related macular degeneration who experienced COVID-19 related interruption in treatment during complete lockdown. METHODS: This was a retrospective, observational case study. We used a mixed effect model with random intercepts to evaluate best corrected visual acuity (BCVA) accounting for measured central macular thickness (CMT) and individual variability of each eye. Furthermore, we analysed measures of the pigmented epithelium detachment as well as presence of subretinal fluid and intraretinal cysts. RESULTS: We included 39 patients and we found a significant reduction in the BCVA between the pre- and post-lockdown controlling for CMT. There was no significant difference in pigmented epithelium detachment and in presence of subretinal fluid and intraretinal cysts. CONCLUSION: We detected a significant loss in visual function. The magnitude of the average loss was, however, limited suggesting good efficacy of the recovery strategy.

Large eddy simulation of dispersion of hazardous materials released from a fire accident around a cubical building.

The turbulent smoke dispersion from a pool fire around a cubical building is studied using large eddy simulation at a high Reynolds number, corresponding to existing experimental measurements both in laboratory and field test scales. Emphasis of this work is on the smoke dispersion due to two different fuel pool fire accident scenarios, initiated behind the building. For the setup of fire in the first case, crude oil was used with a heat release rate of 7.8 MW, and in the second, diesel oil with a heat release rate of 13.5 MW. It is found that in both fire scenarios, the downstream extent of the toxic zone is approximately the same. This is explained in terms of the fact that the smoke concentration and dispersion are influenced mainly by the convective buoyant forces and the strong turbulence mixing processes within the wake zone of the building. It is suggested that wind is the dominating factor in these accident scenarios, which represent the conditions resulting in the highest toxicity levels.

A novel quantitative analysis method for idiopathic epiretinal membrane.

PURPOSE: To introduce a novel method to quantitively analyse in three dimensions traction forces in a vast area of the ocular posterior pole. METHODS: Retrospective analysis of 14 eyes who underwent peeling surgery for idiopathic, symptomatic and progressive epiretinal membrane. The technique measures the shift in position of vascular crossings after surgery from a fixed point, which is the retinal pigmented epithelium. This shift is defined as the relaxation index (RI) and represents a measure of the postoperative movement of the retina due to released traction after surgery. RESULTS: Best-corrected visual acuity was significantly better than baseline at all follow ups while the RI had its maximum value at baseline. Moreover, we found a significant correlation between best-corrected visual acuity at 6 months and RI at baseline. CONCLUSION: While all previous published methods focused on bi-dimensional changes observed in a small region, this study introduces a three-dimensional assessment of tractional forces. Future integration of RI into built-in processing software will allow systematic three-dimensional measurement of intraretinal traction.

Assessment of air flow distribution and hazardous release dispersion around a single obstacle using Reynolds-averaged Navier-Stokes equations.

The flow around a cubical building, with a pollution source at the central point of the top of the cube, is studied. The Reynolds-averaged Navier-Stokes and species concentration equations are solved for Reynolds number, Re = 40,000, is based on the height of the cube. The predictions obtained with the standard, the Kato-Launder, and the low-Reynolds number k-epsilon models are examined with various wall functions for the near wall treatment of the flow. Results are compared against Martinuzzi and Tropea measurements (J. of Fluids Eng., 115, 85-92, 1993) for the flow field and against Li and Meroney (J. of Wind Eng. and Industrial Aerodynamics, 81, 333-345, 1983) experiments and Gaussian models for the concentration distribution. It is found that the present unstructured mesh model performs similarly to the structured mesh models. Results from the Kato-Launder model are closer to the experimental data for the flow patterns and contaminant distribution on the cube's roof. However, the Kato-Launder model has an over-prediction for the recirculation zone and the contaminant distribution windward of the cube. The standard k-epsilon and the low-Reynolds number k-epsilon models predict similar flow patterns and are closer to the experimental data of the cube's windward and side face.