Diagnostic performances of GPT-4o, Claude 3 Opus, and Gemini 1.5 Pro in "Diagnosis Please" cases.

PURPOSE: Large language models (LLMs) are rapidly advancing and demonstrating high performance in understanding textual information, suggesting potential applications in interpreting patient histories and documented imaging findings. As LLMs continue to improve, their diagnostic abilities are expected to be enhanced further. However, there is a lack of comprehensive comparisons between LLMs from different manufacturers. In this study, we aimed to test the diagnostic performance of the three latest major LLMs (GPT-4o, Claude 3 Opus, and Gemini 1.5 Pro) using Radiology Diagnosis Please Cases, a monthly diagnostic quiz series for radiology experts. MATERIALS AND METHODS: Clinical history and imaging findings, provided textually by the case submitters, were extracted from 324 quiz questions originating from Radiology Diagnosis Please cases published between 1998 and 2023. The top three differential diagnoses were generated by GPT-4o, Claude 3 Opus, and Gemini 1.5 Pro, using their respective application programming interfaces. A comparative analysis of diagnostic performance among these three LLMs was conducted using Cochrane's Q and post hoc McNemar's tests. RESULTS: The respective diagnostic accuracies of GPT-4o, Claude 3 Opus, and Gemini 1.5 Pro for primary diagnosis were 41.0%, 54.0%, and 33.9%, which further improved to 49.4%, 62.0%, and 41.0%, when considering the accuracy of any of the top three differential diagnoses. Significant differences in the diagnostic performance were observed among all pairs of models. CONCLUSION: Claude 3 Opus outperformed GPT-4o and Gemini 1.5 Pro in solving radiology quiz cases. These models appear capable of assisting radiologists when supplied with accurate evaluations and worded descriptions of imaging findings.

Fenestration of the superior cerebellar artery diagnosed by magnetic resonance angiography.

We herein report a case of fenestration of the superior cerebellar artery (SCA), which was incidentally diagnosed by magnetic resonance (MR) angiography. A 65-year-old woman was referred to our hospital for unruptured cerebral aneurysms. MR angiography revealed 2 unruptured aneurysms. It also showed fenestration of the left SCA near its origin from the basilar artery, as well as several other vascular variations: a left common carotid artery arising from the brachiocephalic trunk, and a right vertebral artery terminating to the right posterior inferior cerebellar artery. Yearly observation was chosen as a treatment strategy due to the small size of the cerebral aneurysms. According to previous reports, SCA fenestration is an extremely rare variation. This is the second case of SCA fenestration diagnosed by MR angiography in the relevant English-language literature.

COVID-19 Vaccination in a Former Fukushima Nuclear Accident Evacuation Area: COVID-19 Vaccination for Former Evacuees.

After the Fukushima accident in 2011, approximately 160000 residents were forced to evacuate the site. The evacuation order has since been lifted and the Japanese government is now advancing a return strategy. As the return proceeds, deterioration of health indicators and measures in the municipalities around the nuclear power plant remains unchanged. This affected the local governments' coronavirus disease (COVID-19) vaccination drive during the COVID-19 pandemic. In Japan, municipalities keep track of residents' information and implement health-related measures. However, many residents evacuated the town, thus leaving their registered residence. With long-term evacuation and few returnees, it was difficult for government officials to constantly monitor the residents' health. Therefore, there is an urgent need to maintain residents' records and ensure that they receive health services without any gap. This report aimed to provide implications for post-disaster community health services and support as observed during the COVID-19 vaccination program at a disaster site.

Occurrence and Quantitative Microbial Risk Assessment of Methicillin-Resistant Staphylococcus aureus (MRSA) in a Sub-Catchment of the Yodo River Basin, Japan.

The occurrence of Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA) in a sub-catchment of the Yodo River Basin, a representative water system of a drinking water source in Japan, was investigated. The chromogenic enzyme-substrate medium method was used for the detection of S. aureus and MRSA by the presence or absence of antimicrobials in the medium for viable bacteria in a culture-based setting. The contributions of S. aureus and MRSA from wastewater to the rivers were estimated based on mass flux-based analysis, and quantitative microbial risk assessment (QMRA) was further conducted for S. aureus and MRSA in river environments. The mean abundance of S. aureus and MRSA was 31 and 29 CFU/mL in hospital effluent, 124 and 117 CFU/mL in sewage treatment plant (STP) influent, 16 and 13 CFU/mL in STP effluent, and 8 and 9 CFU/mL in river water, respectively. Contribution of the pollution load derived from the target STP effluent to river water ranged from 2% to 25%. The QMRA showed that to achieve the established health benchmarks, the drinking water treatment process would need to yield 1.7 log10 and 2.9 log10 inactivation in terms of infection risk and disability-adjusted life year (DALY) indexes, respectively. These findings highlight the link between medical environment and the importance of environmental risk management for antimicrobial-resistant bacteria in aquatic environments.

Applications of cell resealing to reconstitute microRNA loading to extracellular vesicles.

MicroRNAs (miRNAs) are cargo carried by extracellular vesicles (EVs) and are associated with cell-cell interactions. The response to the cellular environment, such as disease states, genetic/metabolic changes, or differences in cell type, highly regulates cargo sorting to EVs. However, morphological features during EV formation and secretion involving miRNA loading are unknown. This study developed a new method of EV loading using cell resealing and reconstituted the elementary miRNA-loading processes. Morphology, secretory response, and cellular uptake ability of EVs obtained from intact and resealed HeLa cells were comparable. Exogenously added soluble factors were introduced into multivesicular endosomes (MVEs) and their subsequent secretion to the extracellular region occurred in resealed HeLa cells. In addition, miRNA transport to MVEs and miRNA encapsulation to EVs followed a distinct pathway regulated by RNA-binding proteins, such as Argonaute and Y-box binding protein 1, depending on miRNA types. Our cell-resealing system can analyze disease-specific EVs derived from disease model cells, where pathological cytosol is introduced into cells. Thus, EV formation in resealed cells can be used not only to create a reconstitution system to give mechanistic insight into EV encapsulation but also for applications such as loading various molecules into EVs and identifying disease-specific EV markers.

VMAT2 Safeguards ß-Cells Against Dopamine Cytotoxicity Under High-Fat Diet-Induced Stress.

Vesicular monoamine transporter 2 (VMAT2) uptakes cytoplasmic monoamines into vesicles for storage. VMAT2 plays a role in modulating insulin release by regulating dopamine levels in the pancreas, although the exact mechanism remains elusive. We found that VMAT2 expression in ß-cells specifically increases under high blood glucose conditions. The islets isolated from ß-cell-specific Vmat2 knockout (ßVmat2KO) mice show elevated insulin secretion levels in response to glucose stimulation. Under prolonged high-fat diet feedings, the ßVmat2KO mice exhibit impaired glucose and insulin tolerance and progressive ß-cell dysfunction. Here we demonstrate VMAT2 uptake of dopamine to protect dopamine from degradation by monoamine oxidase, thereby safeguarding ß-cells from excess reactive oxygen species (ROS) exposure. In the context of high demand for insulin secretion, the absence of VMAT2 leads to elevated ROS in ß-cells, which accelerates ß-cell dedifferentiation and ß-cell loss. Therefore, VMAT2 controls the amount of dopamine in ß-cells, thereby protecting pancreatic ß-cells from excessive oxidative stress.

Reduced Tumorigenicity of Mouse ES Cells and the Augmented Anti-Tumor Therapeutic Effects under Parg Deficiency.

PolyADP-ribosylation is a post-translational modification of proteins, and poly(ADP-ribose) (PAR) polymerase (PARP) family proteins synthesize PAR using NAD as a substrate. Poly(ADP-ribose) glycohydrolase (PARG) functions as the main enzyme for the degradation of PAR. In this study, we investigated the effects of Parg deficiency on tumorigenesis and therapeutic efficacy of DNA damaging agents, using mouse ES cell-derived tumor models. To examine the effects of Parg deficiency on tumorigenesis, Parg+/+ and Parg-/- ES cells were subcutaneously injected into nude mice. The results showed that Parg deficiency delays early onset of tumorigenesis from ES cells. All the tumors were phenotypically similar to teratocarcinoma and microscopic findings indicated that differentiation spectrum was similar between the Parg genotypes. The augmented anti-tumor therapeutic effects of X-irradiation were observed under Parg deficiency. These results suggest that Parg deficiency suppresses early stages of tumorigenesis and that Parg inhibition, in combination with DNA damaging agents, may efficiently control tumor growth in particular types of germ cell tumors.

Premature Death of a Schizophrenic Patient due to Evacuation after a Nuclear Disaster in Fukushima.

Although psychiatric patients are likely to be adversely impacted by disasters, information regarding the processes involved in adverse impacts is limited. In March 2011, Japan experienced an earthquake, tsunami, and the Fukushima Daiichi Nuclear Power Plant accident. In its aftermath, Takano Hospital, 22 km south of the power plant, underwent forced patient evacuation. A 54-year-old Japanese male with schizophrenia, who had been hospitalized in the psychiatric ward for over 20 years, was transferred and experienced a series of hospital relocations. Although his physical status was intact when he left Takano Hospital, his condition gradually worsened, presumably due to incomplete exchange of patient information between institutions and changes in the treatment environment. Having developed ileus a few days prior, he was bedridden when he returned to Takano Hospital in May 2011. Over the course of treatment, he developed aspiration pneumonia and died in August 2011. A review of medical records revealed that all his purgative medicines had been stopped after his evacuation, possibly contributing to the development of ileus. This case highlights the necessity of establishing systems enabling patient information sharing between institutions in disaster settings and the importance of recognizing that long-term evacuation may have fatal impacts for psychiatric patients.

A Comparative Survival Analysis Between Evacuees and Nonevacuees Among Dialysis Patients in Fukushima Prefecture After Japan's 2011 Fukushima Nuclear Incident.

OBJECTIVE: There has been little research on the health consequences of evacuation in the disaster context. A comparative analysis of survival between evacuated and nonevacuated hospital dialysis patients was conducted following Japan's Fukushima Dai-ichi nuclear power plant incident, which occurred on March 11, 2011. METHODS: The study included 554 patients (mean age: 70.9) receiving dialysis therapy at one of the Tokiwakai Group hospitals-all of which are located in and around Iwaki City, approximately 50 km from the Fukushima nuclear plant-as of the incident date. The patients' survival after the incident was tracked until March 3, 2017. Significant differences in mortality rates between postincident evacuees and nonevacuees were tested using the Bayesian survival analysis with Weibull multivariate regression. RESULTS: Out of 554 dialysis patients, 418 (75.5%) were evacuated after the incident. The postincident mortality rate (adjusted for covariates) of evacuees was not statistically significantly different from that of nonevacuees. The hazard ratio was 1.17 (95% credible intervals: 0.77-1.74). CONCLUSIONS: If performed in a well-planned manner with satisfactory arrangements for appropriate selection of evacuees and their transportation, evacuation could be a reasonable option, which might save more lives of vulnerable people.

Balancing the risk of the evacuation and sheltering-in-place options: a survival study following Japan's 2011 Fukushima nuclear incident.

OBJECTIVE: The decision to evacuate or shelter-in-place is fundamental to emergency response, especially for a vulnerable population. While an elevated risk of mortality due to a hasty, unplanned evacuation has been well documented, there is little research on and knowledge about the health consequences of sheltering-in-place in disaster contexts. We compared hospital mortality in patients who sheltered-in-place (non-evacuees) after the incident with the baseline preincident mortality and articulated postincident circumstances of the hospital while sheltering-in-place. PARTICIPANTS: We considered all 484 patients admitted to Takano Hospital (located 22 km South of the Fukushima Daiichi nuclear power plant) from 1 January 2008 to 31 December 2016. METHODS: Significant differences in mortality rates between preincident baseline and three postincident groups (evacuees, non-evacuees (our major interest) and new admittees) were tested using the Bayesian survival analysis with Weibull multivariate regression and survival probability using the Kaplan-Meier product limit method. All the analyses were separately performed by the internal and psychiatry department. RESULTS: After adjusting for covariates, non-evacuees in the internal department had a significantly higher mortality risk with an HR of 1.57 (95% credible intervals 1.11 to 2.18) than the baseline preincident. Of them, most deaths occurred within the first 100 days of the incident. No significant increase in mortality risk was identified in evacuees and new admittees postincident in the department, which were adjusted for covariates. In contrast, for the psychiatry department, statistical difference in mortality risk was not identified in any groups. CONCLUSIONS: The mortality risk of sheltering-in-place in a harsh environment might be comparable to those in an unplanned evacuation. If sheltering-in-place with sufficient resources is not guaranteed, evacuation could be a reasonable option, which might save more lives of vulnerable people if performed in a well-planned manner with satisfactory arrangements for appropriate transportation and places to safely evacuate.

Intense photoluminescence from ceria-based nanoscale lamellar hybrid.

Nanosheets, which are ultrathin inorganic crystals, have the potential to exhibit unique surface states and quantum effects. These nanosheets can be further manipulated to form lamellar structures for the fabrication of advanced hybrid nanomaterials. Here we report that conventionally nonluminescent ceria yields intense UV photoluminescence with an internal quantum yield (QY) of 59% when self-organized into a nanosheet lamellar architecture with dodecyl sulfate (DS) bilayers. The origin of luminescence exist at the organic/inorganic interfaces, where surface Ce(3+) ions of ceria nanosheet layers graft with DS anions to activate radiative 5d → 4f transition.

Drastic changes in photoluminescence properties of multilayer films composed of europium hydroxide and titanium oxide nanosheets.

Multilayer films consisting of Eu(OH)(3-x) and titanium oxide nanosheets showed strong Eu(3+) emission under UV-light irradiation, in which the titanium oxide nanosheet works as an antenna collecting UV-light, and then the Eu(OH)(3-x) nanosheet acts as an emitting layer receiving the absorbed energy.