Lorenz Fries on the defense of Avicenna, the prince of physicians: Addressed to the medics of Germany (1530).

During the 14th century CE, a pivotal shift took place in the world of medicine as its epicenter transitioned from the Middle East to Europe. The emergence of the European Renaissance sparked skepticism regarding the significance of Avicenna's contributions to the advancement of medicine. This paper explores how the rise of secularization and the Renaissance in Europe marked significant cultural transformations, fostering the spread of literacy. These societal shifts influenced the trajectory of medical thought, and Avicenna's "Canon of Medicine" received both praise and condemnation amidst the evolving intellectual landscape. In this context, Lorenz Fries composed his "Defense of Avicenna," a testament to his profound admiration for Avicenna's legacy. This paper presents an English translation of Fries' 1530 work, and introduces Fries and Avicenna's "Canon," contextualizing Fries' defense within the broader rejection of Arab-language medical texts in the 16th century. It also explores Avicenna's influence on European medicine and anatomy during the Renaissance and highlights the enduring relevance of his contributions to the annals of science. Fries' defense underscores Avicenna's methodological acumen and emphasizes the importance of a robust theoretical foundation in medical practice. Avicenna's integration of Aristotelianism with Platonism highlighted the necessity of a rigorous method informed by theory in medical analysis. Fries' defense remains relevant today, particularly in advocating for systematic medical analysis against subjective approaches. Avicenna's medical philosophy seems nested within a larger, hopeful attempt to resolve the tensions between science or naturalism and religion or spiritualism. The rejection of Avicenna reflects broader conflicts between Aristotelian and Neoplatonic traditions, suggesting a complex interplay of secularization and theological influences in shaping medical thought during the Renaissance.

What Goes In, Must Come Out: Generative Artificial Intelligence Does Not Present Algorithmic Bias Across Race and Gender in Medical Residency Specialties.

Objective Artificial Intelligence (AI) has made significant inroads into various domains, including medicine, raising concerns about algorithmic bias. This study investigates the presence of biases in generative AI programs, with a specific focus on gender and racial representations across 19 medical residency specialties. Methodology This comparative study utilized DALL-E2 to generate faces representing 19 distinct residency training specialties, as identified by the Association of American Medical Colleges (AAMC), which were then compared to the AAMC's residency specialty breakdown with respect to race and gender. Results Our findings reveal an alignment between OpenAI's DALL-E2's predictions and the current demographic landscape of medical residents, suggesting an absence of algorithmic bias in this AI model. Conclusion This revelation gives rise to important ethical considerations. While AI excels at pattern recognition, it inherits and mirrors the biases present in its training data. To combat AI bias, addressing real-world disparities is imperative. Initiatives to promote inclusivity and diversity within medicine are commendable and contribute to reshaping medical education. This study underscores the need for ongoing efforts to dismantle barriers and foster inclusivity in historically male-dominated medical fields, particularly for underrepresented populations. Ultimately, our findings underscore the crucial role of real-world data quality in mitigating AI bias. As AI continues to shape healthcare and education, the pursuit of equitable, unbiased AI applications should remain at the forefront of these transformative endeavors.

Examining Atherosclerosis Patterns in the Circle of Willis: A Case Study of Duplicated Anterior Communicating Artery.

The anterior communicating artery (ACoA) plays a pivotal role in maintaining cerebral hemodynamics, as its diameter is a major determinant of blood collateralization through the circle of Willis following internal carotid artery occlusion. While variations of this artery are not uncommon, data on their clinicopathologic relevance are limited. In this report, we present our observation from a fresh cadaver of a male individual who had succumbed to cardiac causes. The circle of Willis displayed a duplicated ACoA with atherosclerosis that predominantly affected the posterior horn while sparing the anterior horn. The anterior horn was characterized by its shorter length and larger diameter compared to the posterior horn. The paper focuses on elucidating the microsurgical anatomy of this particular ACoA variant and exploring potential mechanisms that may underlie the pattern of atherosclerotic distribution within the circle of Willis. Based on this report, while further evidence is needed for confirmation, it is plausible that the existence of a duplicated ACoA may offer a protective mechanism, ensuring uninterrupted collateral circulation in the event of a blockage in one of the horns. Further analysis of the ACoA and its pattern of involvement in intracranial atherosclerosis is warranted, as the atherosclerotic patterns in this region hold clinical and pathological significance.

Middle meningeal artery arising from the petrous internal carotid artery: Outcome of unusual stapedial artery regression.

Background: The internal and external carotid arterial systems are generally separate regarding branching patterns. However, these two systems do form collateral circulations with their terminal parts. On rare occasions, branches that belong to one arterial system may arise from the other. Case Description: We present a rare variant of a middle meningeal artery, generally derived from the external carotid artery, arising from the internal carotid artery and entering the floor of the middle cranial fossa by traveling through a small unnamed foramen. This anatomy and embryology and other variants of the middle meningeal and petrous carotid systems are discussed. Conclusion: Embryologically, this variant anatomy signifies an atypical regression of the distal stapedial artery and its connection to the external carotid artery. Surgeons who operate on the skull base, vascular interventionalists, and radiologists should be aware of this potential anatomical variation of the skull base.

Exploring Generative Artificial Intelligence-Assisted Medical Education: Assessing Case-Based Learning for Medical Students.

The recent public release of generative artificial intelligence (GenAI) has brought fresh excitement by making access to GenAI for medical education easier than ever before. It is now incumbent upon both students and faculty to determine the optimal role of GenAI within the medical school curriculum. Given the promise and limitations of GenAI, this study aims to assess the current capabilities of a GenAI (Chat Generative Pre-trained Transformer, ChatGPT), specifically within the framework of a pre-clerkship case-based active learning curriculum. The role of GenAI is explored by evaluating its performance in generating educational materials, creating medical assessment questions, answering medical queries, and engaging in clinical reasoning by prompting it to respond to a problem-based learning scenario. Our results demonstrated that GenAI addressed epidemiology, diagnosis, and treatment questions well. However, there were still instances where it failed to provide comprehensive answers. Responses from GenAI might offer essential information, hint at the need for further inquiry, or sometimes omit critical details. GenAI struggled with generating information on complex topics, raising a significant concern when using it as a 'search engine' for medical student queries. This creates uncertainty for students regarding potentially missed critical information. With the increasing integration of GenAI into medical education, it is imperative for faculty to become well-versed in both its advantages and limitations. This awareness will enable them to educate students on using GenAI effectively in medical education.

Typical brachial plexus: the legacy of a forgotten anatomist, Abram T. Kerr (1873-1938).

The brachial plexus, a complex network of nerves responsible for innervating the upper limb, exhibits remarkable anatomical variations. This editorial explores the composite drawing of a "typical" brachial plexus portrayed by Abram T. Kerr in 1918. This composite drawing of the typical brachial plexus stands as a critical contribution to the field of anatomy and surgery, and encapsulates the most prevalent patterns of formation, branching, and origins within the brachial plexus, offering a statistical map of its common variants. Kerr portrays the typical brachial plexus as a foundational resource for anatomists and medical professionals seeking to navigate the intricate landscape of this neural structure. It serves as a hypothetical model, reflecting the common arrangement of trunks, cords, and branches, shedding light on the typical composition of the plexus observed in most individuals. Beyond being a visual representation, the 'typical' brachial plexus provides a bridge between theoretical knowledge and practical applications, aiding in the identification of variations and deviations in surgical contexts. This composite drawing enhances our comprehension of the intricate and ever-evolving anatomy of the brachial plexus, reinforcing its role as a fundamental reference point for anatomical studies and clinical practice.

Compartment Syndrome Secondary to Calcium Gluconate Extravasation.

This case report highlights a rare yet severe complication of calcium gluconate extravasation, namely, compartment syndrome. We present the case of an 86-year-old female who developed compartment syndrome following an extravasation of intravenously administered calcium gluconate for the management of hyperkalemia. Initially, mild erythema and edema were observed at the site of extravasation, which eventually progressed to severe pain, a reduction in the joint range of motion due to increased compartment pressure. Despite undergoing a series of fasciotomies, the patient's condition did not improve, and extensive tissue necrosis and gangrene necessitated amputation. This case emphasizes that calcium gluconate extravasation can lead to life-threatening complications, such as compartment syndrome, underscoring the critical importance of employing proper infusion techniques.

The Emerging Role of Generative Artificial Intelligence in Medical Education, Research, and Practice.

Recent breakthroughs in generative artificial intelligence (GAI) and the emergence of transformer-based large language models such as Chat Generative Pre-trained Transformer (ChatGPT) have the potential to transform healthcare education, research, and clinical practice. This article examines the current trends in using GAI models in medicine, outlining their strengths and limitations. It is imperative to develop further consensus-based guidelines to govern the appropriate use of GAI, not only in medical education but also in research, scholarship, and clinical practice.

Circular RNAs as novel biomarkers in glomerular diseases.

Circular RNAs (circRNAs) regulate gene expression and biological procedures by controlling target genes or downstream pathways by sponging their related miRNA (s). Three types of circRNAs have been identified; exonic circRNAs (ecircRNAs), intronic RNAs (ciRNAs), and exon-intron circRNAs (ElciRNAs). It is clarified that altered levels of circRNAs have dynamic pathological and physiological functions in kidney diseases. Evidence suggests that circRNAs can be considered novel diagnostic biomarkers and therapeutic targets for renal diseases. Glomerulonephritis (GN) is a general term used to refer to a wide range of glomerular diseases. GN is an important cause of chronic kidney diseases. Here, we review the biogenesis of circRNAs, and their molecular and physiological functions in the kidney. Moreover, the dysregulated expression of circRNAs and their biological functions are discussed in primary and secondary glomerulonephritis. Moreover, diagnostic and therapeutic values of circRNAs in distinguishing or treating different types of GN are highlighted.

Antegrade Auriculotemporal-Inferior Alveolar Nerve Communication in the Infratemporal Fossa.

Communications between cranial nerves or their branches have been described previously. The exact functional significance of some of these neural communications remains to be fully understood. This paper reports a unique communication between the auriculotemporal and inferior alveolar nerves within the infratemporal fossa. The histological examination indicates an antegrade connection from the inferior alveolar nerve to the auriculotemporal nerve, which could potentially be implicated in referred pain from the anatomical territory of one nerve to the other.

Comparative Analysis of Co-Cultured Amniotic Cell-Conditioned Media with Cell-Free Amniotic Fluid Reveals Differential Effects on Epithelial-Mesenchymal Transition and Myofibroblast Activation.

Myofibroblast activation is a cellular response elicited by a variety of physiological or pathological insults whereby cells initiate a coordinated response intended to eradicate the insult and then revert back to a basal state. However, an underlying theme in various disease states is persistent myofibroblast activation that fails to resolve. Based on multiple observations, we hypothesized that the secreted factors harvested from co-culturing amniotic stem cells might mimic the anti-inflammatory state that cell-free amniotic fluid (AF) elicits. We optimized an amnion epithelial and amniotic fluid cell co-culture system, and tested this hypothesis in the context of myofibroblast activation. However, we discovered that co-cultured amniotic cell conditioned media (coACCM) and AF have opposing effects on myofibroblast activation: coACCM activates the epithelial-mesenchymal transition (EMT) and stimulates gene expression patterns associated with myofibroblast activation, while AF does the opposite. Intriguingly, extracellular vesicles (EVs) purified from AF are necessary and sufficient to activate EMT and inflammatory gene expression patterns, while the EV-depleted AF potently represses these responses. In summary, these data indicate that coACCM stimulates myofibroblast activation, while AF represses it. We interpret these findings to suggest that coACCM, AF, and fractionated AF represent unique biologics that elicit different cellular responses that are correlated with a wide variety of pathological states, and therefore could have broad utility in the clinic and the lab.

Microbiota and glomerulonephritis: An immunological point of view.

Glomerular injury is the major cause of chronic kidney diseases (CKD) worldwide and is characterized by proteinuria. Glomerulonephritis (GN) has a wide spectrum of etiologies, the intensity of glomerular damage, histopathology, and clinical outcomes that can be associated with the landscape of the nephritogenic immune response. Beyond impaired immune responses and genetic factors, recent evidence indicates that microbiota can be contributed to the pathogenesis of GN and patients' outcomes by impacting many aspects of the innate and adaptive immune systems. It is still unknown whether dysbiosis induces GN or it is a secondary effect of the disease. Several factors such as drugs and nutritional problems can lead to dysbiosis in GN patients. It has been postulated that gut dysbiosis activates immune responses, promotes a state of systemic inflammation, and produces uremic toxins contributing to kidney tissue inflammation, apoptosis, and subsequent proteinuric nephropathy. In this review, the impact of gastrointestinal tract (GI) microbiota on the pathogenesis of the primary GN will be highlighted. The application of therapeutic interventions based on the manipulation of gut microbiota with special diets and probiotic supplementation can be effective in GN.

The Role of Cytokines in Nephrotic Syndrome.

Idiopathic nephrotic syndrome (INS) is an important primary glomerular disease characterized by severe proteinuria. Evidence supports a role for T cell dysfunction in the pathogenesis of INS. Glucocorticoids are the primary therapy for INS; however, steroid-resistant NS (SRNS) patients are at a higher risk of drug-induced side effects and harbor poor prognosis. Although the exact mechanism of the resistance is unknown, the imbalances of T helper subtype 1 (Th1), Th2, and regulatory T cells (Tregs) and their cytokines may be involved in the pathogenesis of glucocorticoid responsiveness. Up to now, no confirmed biomarkers have been able to predict SRNS; however, a panel of cytokines may predict responsiveness and identify SRNS patients. Thus, the introduction of distinctive cytokines as novel biomarkers of SRNS enables both preventions of drug-related toxicity and earlier switch to more effective therapies. This review highlights the impacts of T cell population imbalances and their downstream cytokines on response to glucocorticoid responsiveness state in INS.

Mycobacterium abscessus Complex Osteomyelitis of the Wrist.

Mycobacterium abscessus (M. abscessus) is a ubiquitous, rapidly growing non-tuberculous mycobacterium, which is known to cause life-threatening lung infections in immunocompromised individuals following exposure to contaminated injectable products. We report a case of M. abscessus osteomyelitis of the right wrist in a 28-year-old patient with a history of intravenous drug use and a recent surgical repair of the right radial artery pseudoaneurysm. The patient underwent surgical debridement of the right distal radius infection. Histopathological examination and culture of the debrided tissue revealed M. abscessus complex infection. The patient was placed on intravenous amikacin, azithromycin, and cefoxitin for six weeks, followed by oral linezolid and clofazimine for six months.

The clinical significance of the glucocorticoid receptors: Genetics and epigenetics.

The impacts of glucocorticoids (GCs) are mainly mediated by a nuclear receptor (GR) existing in almost every tissue. The GR regulates a wide range of physiological functions, including inflammation, cell metabolism, and differentiation playing a major role in cellular responses to GCs and stress. Therefore, the dysregulation or disruption of GR can cause deficiencies in the adaptation to stress and the preservation of homeostasis. The number of GR polymorphisms associated with different diseases has been mounting per year. Tackling these clinical complications obliges a comprehensive understanding of the molecular network action of GCs at the level of the GR structure and its signaling pathways. Beyond genetic variation in the GR gene, epigenetic changes can enhance our understanding of causal factors involved in the development of diseases and identifying biomarkers. In this review, we highlight the relationships of GC receptor gene polymorphisms and epigenetics with different diseases.

Covid-19 and kidney injury: Pathophysiology and molecular mechanisms.

The novel coronavirus (SARS-CoV-2) has turned into a life-threatening pandemic disease (Covid-19). About 5% of patients with Covid-19 have severe symptoms including septic shock, acute respiratory distress syndrome, and the failure of several organs, while most of them have mild symptoms. Frequently, the kidneys are involved through direct or indirect mechanisms. Kidney involvement mainly manifests itself as proteinuria and acute kidney injury (AKI). The SARS-CoV-2-induced kidney damage is expected to be multifactorial; directly it can infect the kidney podocytes and proximal tubular cells and based on an angiotensin-converting enzyme 2 (ACE2) pathway it can lead to acute tubular necrosis, protein leakage in Bowman's capsule, collapsing glomerulopathy and mitochondrial impairment. The SARS-CoV-2-driven dysregulation of the immune responses including cytokine storm, macrophage activation syndrome, and lymphopenia can be other causes of the AKI. Organ interactions, endothelial dysfunction, hypercoagulability, rhabdomyolysis, and sepsis are other potential mechanisms of AKI. Moreover, lower oxygen delivery to kidney may cause an ischaemic injury. Understanding the fundamental molecular pathways and pathophysiology of kidney injury and AKI in Covid-19 is necessary to develop management strategies and design effective therapies.

Macromolecular biomarkers of chronic obstructive pulmonary disease in exhaled breath condensate.

Biomarkers provide important diagnostic and prognostic information on heterogeneous diseases such as chronic obstructive pulmonary disease (COPD). However, finding a suitable specimen for clinical analysis of biomarkers for COPD is challenging. Exhaled breath condensate (EBC) sampling is noninvasive, rapid, cost-effective and easily repeatable. EBC sampling has also provided recent progress in the identification of biological macromolecules, such as lipids, proteins and DNA in EBC samples, which has increased its utility for clinical scientists. In this article, we review applications involving EBC sampling for the analysis of COPD biomarkers and discuss its future potential.

Expression Levels of miR-30c and miR-186 in Adult Patients with Membranous Glomerulonephritis and Focal Segmental Glomerulosclerosis.

BACKGROUND: Nephrotic syndrome is a common renal problem with different histopathogenesis. MicroRNAs are reported to be involved in the pathophysiology of the syndrome. The aim of this study was to study the levels of miR-30c and miR-186 in NS patients. METHODS: Sixty patients with primary NS (membranous glomerulonephritis (MGN, N=30) and focal segmental glomerulosclerosis (FSGS, N=30)) and 24 healthy volunteers were included. Expression levels of the miR-30c and miR-186 were evaluated in plasma and peripheral blood mononuclear cell (PBMC) samples of adult patients with NS using real-time PCR. Moreover, an in-silico analysis was performed to understand the signaling pathways and biological procedures that may be regulated by these miRNAs. RESULTS: In the MGN group, significantly elevated levels of miR-30c and miR-186 were observed in PBMC (P= 0.037) and plasma (P= 0.035) samples, respectively. Moreover, there was a significant increase in miR-30c levels in PBMC samples of the FSGS group when compared to healthy controls (P= 0.004). In ROC curve analysis, combined levels of the studied miRNAs could discriminate cases from controls in plasma and blood cells (AUC≥0.72, P<0.05). CONCLUSION: A panel of miRNAs may be potential biomarkers in plasma and PBMCs samples of NS patients with different subclasses. More investigations are needed with a large sample size to validate the diagnostic values of the reported miRNAs.