Accuracy and Readability of Kidney Stone Patient Information Materials Generated by a Large Language Model Compared to Official Urologic Organizations.

OBJECTIVE: To compare the readability and accuracy of large language model generated patient information materials (PIMs) to those supplied by the American Urological Association (AUA), Canadian Urological Association (CUA), and European Association of Urology (EAU) for kidney stones. METHODS: PIMs from AUA, CUA, and EAU related to nephrolithiasis were obtained and categorized. The most frequent patient questions related to kidney stones were identified from an internet query and input into GPT-3.5 and GPT-4. PIMs and ChatGPT outputs were assessed for accuracy and readability using previously published indexes. We also assessed changes in ChatGPT outputs when a reading level was specified (grade 6). RESULTS: Readability scores were better for PIMs from the CUA (grade level 10-12), AUA (8-10), or EAU (9-11) compared to the chatbot. GPT-3.5 had the worst readability scores at grade 13-14 and GPT-4 was likewise less readable than urologic organization PIMs with scores of 11-13. While organizational PIMs were deemed to be accurate, the chatbot had high accuracy with minor details omitted. GPT-4 was more accurate in general stone information, dietary and medical management of kidney stones topics in comparison to GPT-3.5, while both models had the same accuracy in the surgical management of nephrolithiasis topics. CONCLUSION: Current PIMs from major urologic organizations for kidney stones remain more readable than publicly available GPT outputs, but they are still higher than the reading ability of the general population. Of the available PIMs for kidney stones, those from the AUA are the most readable. Although Chatbot outputs for common kidney stone patient queries have a high degree of accuracy with minor omitted details, it is important for clinicians to understand their strengths and limitations.

Syndrome of Inappropriate Antidiuretic Hormone Release Secondary to Ectopic Olfactory Neuroblastoma: Case Report and Review of Literature.

Ectopic olfactory neuroblastoma (ONB) is a rare neuroendocrine sinonasal malignancy which arises from sinonasal regions where olfactory neuroepithelium does not exist. Presentation of syndrome of inappropriate antidiuretic hormone release (SIADH) in patients with ectopic ONB is extremely rare. We report a case of a 22-year-old patient with ectopic ONB and paraneoplastic SIADH that was managed at our center. The ONB was arising from the left lamina papyracea and extending into the maxillary and ethmoid sinuses and filling the nasal cavity. Correction of sodium levels occurred within 24 hours of endoscopic resection via a combined trans-nasal transorbital approach. To avoid negative sequela secondary to rapid sodium correction, the patient was managed by desmopressin to obtain gradual sodium correction, which was achieved on the fourth postoperative day. Ectopic presentation of ONB with paraneoplastic SIADH is extremely rare with only 7 cases reported in the literature to date. Management via surgical resection and/or radiotherapy for these patients requires the managing clinician to be vigilant of serum sodium levels. A multidisciplinary approach is essential for optimal outcomes.

Assessing tophaceous spinal gout treatment response using dual-energy CT as a point-of-care imaging modality: case report.

We describe a case of chronic tophaceous gout affecting the spine, hands, elbows, feet, and knees in a 67-year-old man with serum urate levels at 549 µmol/L whose response to treatment was successfully mapped using dual-energy computed tomography (DECT). The patient presented with exacerbation of acute-on-chronic lumbar back pain. He had received a diagnosis of gout 3 years prior to this presentation yet was not on any urate-lowering therapy. The patient received febuxostat 80 mg and colchicine 0.3 mg once daily and underwent DECT to assess baseline monosodium urate (MSU) burden. At baseline, MSU deposits were seen in the hands, elbows, feet, knees, and lumbar spine including the left L5-S1 facet joint encroaching onto the neural foramen. After 2.5 years of treatment, serum urate level was within the target range (< 360 µmol/L), and the patient underwent a follow-up DECT that revealed almost full resolution of MSU deposition in the spine, including the MSU-burdened facet joint and neural foramen in the lumbar spine, in addition to all the affected peripheral joints. This case is the first report of radiological evidence of nearly complete resolution of MSU deposits in spinal gout on DECT after urate-lowering therapy treatment, which demonstrates the utility of this imaging modality as a non-invasive investigational point-of-care imaging modality for mapping treatment response and identifying the etiology of back pain in a patient with chronic tophaceous spinal gout.

Functional mapping of androgen receptor enhancer activity.

BACKGROUND: Androgen receptor (AR) is critical to the initiation, growth, and progression of prostate cancer. Once activated, the AR binds to cis-regulatory enhancer elements on DNA that drive gene expression. Yet, there are 10-100× more binding sites than differentially expressed genes. It is unclear how or if these excess binding sites impact gene transcription. RESULTS: To characterize the regulatory logic of AR-mediated transcription, we generated a locus-specific map of enhancer activity by functionally testing all common clinical AR binding sites with Self-Transcribing Active Regulatory Regions sequencing (STARRseq). Only 7% of AR binding sites displayed androgen-dependent enhancer activity. Instead, the vast majority of AR binding sites were either inactive or constitutively active enhancers. These annotations strongly correlated with enhancer-associated features of both in vitro cell lines and clinical prostate cancer samples. Evaluating the effect of each enhancer class on transcription, we found that AR-regulated enhancers frequently interact with promoters and form central chromosomal loops that are required for transcription. Somatic mutations of these critical AR-regulated enhancers often impact enhancer activity. CONCLUSIONS: Using a functional map of AR enhancer activity, we demonstrated that AR-regulated enhancers act as a regulatory hub that increases interactions with other AR binding sites and gene promoters.

Recalcitrant Anaphylaxis Associated with Fibrin Sealant: Treatment with "TISSEEL-ectomy".

Here, we present the case of an adolescent male who developed a severe allergic reaction 10 minutes after application of TISSEEL fibrin sealant to control bleeding during a gynecomastia revision surgery. Conventional treatments of acute hypersensitivity were ineffective. After a "tisseel-ectomy," the patient's condition improved and symptoms resolved. Besides oral tranexamic acid, and topical and local anaesthesia, no other medications besides TISSEEL were administered preceding the allergic reaction. After TISSEEL was identified as the allergen upon its removal, his clinical status improved. The patient had been exposed to TISEEL 15 months before the anaphylactic episode. This case can aid in decision-making for surgical re-exposure to fibrin sealants in the setting of acute anaphylaxis.