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Page 1 of 85

Risk of encephalitis and meningitis after COVID-19 vaccination in South Korea: a self-controlled case series analysis

Several neurological manifestations shortly after a receipt of coronavirus infectious disease 2019 (COVID-19) vaccine have been described in the recent case reports. Among those, we sought to evaluate the risk...

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Autotaxin inhibition attenuates the aortic valve calcification by suppressing inflammation-driven fibro-calcific remodeling of valvular interstitial cells

Patients with fibro-calcific aortic valve disease (FCAVD) have lipid depositions in their aortic valve that engender a proinflammatory impetus toward fibrosis and calcification and ultimately valve leaflet ste...

Improved emotion differentiation under reduced acoustic variability of speech in autism

Socio-emotional impairments are among the diagnostic criteria for autism spectrum disorder (ASD), but the actual knowledge has substantiated both altered and intact emotional prosodies recognition. Here, a Bay...

Polygenic risk score-based phenome-wide association study of head and neck cancer across two large biobanks

Numerous observational studies have highlighted associations of genetic predisposition of head and neck squamous cell carcinoma (HNSCC) with diverse risk factors, but these findings are constrained by design l...

Safety and efficacy of sirolimus in recurrent intravenous leiomyomatosis, pulmonary benign metastatic leiomyomatosis, and leiomyomatosis peritonealis disseminata: a pilot study

Intravenous leiomyomatosis (IVL), pulmonary benign metastatic leiomyomatosis (PBML), and leiomyomatosis peritonealis disseminata (LPD) are leiomyomas with special growth patterns and high postoperative recurre...

The medication-based Rx-Risk Comorbidity Index and risk of hip fracture - a nationwide NOREPOS cohort study

Few previous studies have assessed overall morbidity at the individual level with respect to future risk of hip fracture. The aim of this register-based cohort study was to examine the association between morb...

Paxlovid use is associated with lower risk of cardiovascular diseases in COVID-19 patients with autoimmune rheumatic diseases: a retrospective cohort study

Paxlovid has been shown to be effective in reducing mortality and hospitalization rates in patients with coronavirus disease 2019 (COVID-19). It is not known whether Paxlovid can reduce the risk of cardiovascu...

Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review

Experiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one’s lifetime. This underscores the importanc...

Investigating the nexus of metabolic syndrome, serum uric acid, and dementia risk: a prospective cohort study

The global dementia prevalence is surging, necessitating research into contributing factors. We aimed to investigate the association between metabolic syndrome (MetS), its components, serum uric acid (SUA) lev...

Assessing the impact of type 2 diabetes on mortality and life expectancy according to the number of risk factor targets achieved: an observational study

Type 2 diabetes (T2D) is associated with an increased risk of premature death. Whether multifactorial risk factor modification could attenuate T2D-related excess risk of death is unclear. We aimed to examine t...

The optimal antithrombotic strategy for post-stroke patients with atrial fibrillation and extracranial artery stenosis—a nationwide cohort study

In post-stroke atrial fibrillation (AF) patients who have indications for both oral anticoagulant (OAC) and antiplatelet agent (AP), e.g., those with carotid artery stenosis, there is debate over the best anti...

Low awareness of the transitivity assumption in complex networks of interventions: a systematic survey from 721 network meta-analyses

The transitivity assumption is the cornerstone of network meta-analysis (NMA). Violating transitivity compromises the credibility of the indirect estimates and, by extent, the estimated treatment effects of th...

Malaria vaccination: hurdles to reach high-risk children

Ensuring that malaria vaccines deliver maximum public health impact is non-trivial. Drawing on current research, this article examines hurdles that malaria immunization may face to reach high-risk children and...

Efficacy and safety of gut microbiota-based therapies in autoimmune and rheumatic diseases: a systematic review and meta-analysis of 80 randomized controlled trials

Previous randomized controlled trials (RCTs) suggested that gut microbiota-based therapies may be effective in treating autoimmune diseases, but a systematic summary is lacking.

The influence of n-3 polyunsaturated fatty acids on cognitive function in individuals without dementia: a systematic review and dose–response meta-analysis

Omega-3 polyunsaturated fatty acids (n-3 PUFA) have been suggested as a cognitive enhancing agent, though their effect is doubtful. We aimed to examine the effect of n-3 PUFA on the cognitive function of middl...

Correlates of protection and determinants of SARS-CoV-2 breakthrough infections 1 year after third dose vaccination

The emergence of new SARS-CoV-2 variants and the waning of immunity raise concerns about vaccine effectiveness and protection against COVID-19. While antibody response has been shown to correlate with the risk...

Degree of joint risk factor control and hazard of mortality in diabetes patients: a matched cohort study in UK Biobank

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Characterization and trajectories of hematological parameters prior to severe COVID-19 based on a large-scale prospective health checkup cohort in western China: a longitudinal study of 13-year follow-up

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Gut microbiome features and metabolites in non-alcoholic fatty liver disease among community-dwelling middle-aged and older adults

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Influence of lack of blinding on the estimation of medication-related harms: a retrospective cohort study of randomized controlled trials

Empirical evidence suggests that lack of blinding may be associated with biased estimates of treatment benefit in randomized controlled trials, but the influence on medication-related harms is not well-recogni...

Medication adherence in patients with type 2 diabetes after disability onset: a difference-in-differences analysis using nationwide data

Effectively managing the coexistence of both diabetes and disability necessitates substantial effort. Whether disability onset affects adherence to type 2 diabetes medication remains unclear. This study invest...

Global epidemiology of type 2 diabetes in patients with NAFLD or MAFLD: a systematic review and meta-analysis

Non-alcoholic fatty liver disease (NAFLD) and metabolic-associated fatty liver disease (MAFLD) shares common pathophysiological mechanisms with type 2 diabetes, making them significant risk factors for type 2 ...

A self-controlled case series study to measure the risk of SARS-CoV-2 infection associated with attendance at sporting and cultural events: the UK Events Research Programme events

In 2021, whilst societies were emerging from major social restrictions during the SARS-CoV-2 pandemic, the UK government instigated an Events Research Programme to examine the risk of COVID-19 transmission fro...

Subsidized gestational diabetes mellitus screening and management program in rural China: a pragmatic multicenter, randomized controlled trial

The increasing prevalence of gestational diabetes mellitus (GDM) is a major challenge, particularly in rural areas of China where control rates are suboptimal. This study aimed to evaluate the effectiveness of...

Carbohydrate quality, not quantity, linked to reduced colorectal cancer incidence and mortality in US populations: evidence from a prospective study

Carbohydrates have been implicated in colorectal cancer (CRC) risk, but the specific impact of carbohydrate quality and quantity on CRC susceptibility in US populations remains unclear.

TBK1, a prioritized drug repurposing target for amyotrophic lateral sclerosis: evidence from druggable genome Mendelian randomization and pharmacological verification in vitro

There is a lack of effective therapeutic strategies for amyotrophic lateral sclerosis (ALS); therefore, drug repurposing might provide a rapid approach to meet the urgent need for treatment.

Thrombospondin 1 enhances systemic inflammation and disease severity in acute-on-chronic liver failure

The key role of thrombospondin 1 (THBS1) in the pathogenesis of acute-on-chronic liver failure (ACLF) is unclear. Here, we present a transcriptome approach to evaluate THBS1 as a potential biomarker in ACLF di...

Autoimmune diseases and adverse pregnancy outcomes: an umbrella review

There is a high prevalence of autoimmune conditions in women specially in the reproductive years; thus, the association with adverse pregnancy outcomes has been widely studied. However, few autoimmune conditio...

The role of lifestyle in the association between long-term ambient air pollution exposure and cardiovascular disease: a national cohort study in China

Cardiovascular disease (CVD) caused by air pollution poses a considerable burden on public health. We aim to examine whether lifestyle factors mediate the associations of air pollutant exposure with the risk o...

Common and distinct cortical thickness alterations in youth with autism spectrum disorder and attention-deficit/hyperactivity disorder

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders with overlapping behavioral features and genetic etiology. While brain cortical thickness (CT...

Exploring the Smoking-Epilepsy Nexus: a systematic review and meta-analysis of observational studies

Epilepsy, characterized by recurrent unprovoked seizures, poses significant challenges to affected individuals globally. While several established risk factors for epilepsy exist, the association with cigarett...

Plasma metabolites and risk of seven cancers: a two-sample Mendelian randomization study among European descendants

While circulating metabolites have been increasingly linked to cancer risk, the causality underlying these associations remains largely uninterrogated.

Association between patient ethnicity and prostate cancer diagnosis following a prostate-specific antigen test: a cohort study of 730,000 men in primary care in the UK

Black men have higher prostate-specific antigen (PSA) levels and higher prostate cancer incidence and mortality than White men, while Asian men tend to have lower prostate cancer incidence and mortality than W...

Specific dairy foods and risk of frailty in older women: a prospective cohort study

Dairy contains a complex mixture of lipids, proteins, and micronutrients. Whether habitual dairy consumption is associated with health benefits is not well established. Since dairy is high in nutrients that ar...

The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review

Peer support for mental health is recommended across international policy guidance and provision. Our systematic umbrella review summarises evidence on the effectiveness, implementation, and experiences of pai...

Mid- and long-term risk of atrial fibrillation among breast cancer surgery survivors

The risk of incident atrial fibrillation (AF) among breast cancer survivors, especially for younger women, and cancer treatment effects on the association remain unclear. This study aimed to investigate the ri...

Supermarket interventions to improve dietary and lifestyle behaviours: what is the key to success?

The original article was published in BMC Medicine 2024 22 :52

Myocardial bridging in obstructive hypertrophic cardiomyopathy: a risk factor for myocardial fibrosis

Myocardial bridging (MB) is common in patients with hypertrophic cardiomyopathy (HCM). There are sparse data on the impact of MB on myocardial fibrosis in HCM. This study was designed to evaluate the relations...

Mesenchymal stromal cells plus basiliximab improve the response of steroid-refractory acute graft-versus-host disease as a second-line therapy: a multicentre, randomized, controlled trial

For patients with steroid-refractory acute graft-versus-host disease (SR-aGVHD), effective second-line regimens are urgently needed. Mesenchymal stromal cells (MSCs) have been used as salvage regimens for SR-a...

Estrogen-modulating treatment among mid-life women and COVID-19 morbidity and mortality: a multiregister nationwide matched cohort study in Sweden

It has been repeatedly shown that men infected by SARS-CoV-2 face a twofold higher likelihood of dying, being hospitalized or admitted to the intensive care unit compared to women, despite taking into account ...

Genetic investigation into the broad health implications of caffeine: evidence from phenome-wide, proteome-wide and metabolome-wide Mendelian randomization

Caffeine is one of the most utilized drugs in the world, yet its clinical effects are not fully understood. Circulating caffeine levels are influenced by the interplay between consumption behaviour and metabol...

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Novel insights from our special issue on maternal factors during pregnancy that influence maternal, fetal and childhood outcomes

Immunogenicity and safety of razi recombinant spike protein vaccine (rcp) as a booster dose after priming with bbibp-corv: a parallel two groups, randomized, double blind trial.

The immunity induced by primary vaccination is effective against COVID-19; however, booster vaccines are needed to maintain vaccine-induced immunity and improve protection against emerging variants. Heterologo...

Characteristics and clinical treatment outcomes of chronic hepatitis B children with coexistence of hepatitis B surface antigen (HBsAg) and antibodies to HBsAg

The coexistence of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb) represents an uncommon serological pattern observed in patients with hepatitis B virus (HBV) infection, and its u...

Efficacy of interventions targeted at physician prescribers of opioids for chronic non-cancer pain: an overview of systematic reviews

To combat the opioid crisis, interventions targeting the opioid prescribing behaviour of physicians involved in the management of patients with chronic non-cancer pain (CNCP) have been introduced in clinical s...

Comparison of immune checkpoint inhibitors related to pulmonary adverse events: a retrospective analysis of clinical studies and network meta-analysis

Immune checkpoint inhibitors (ICIs) have transformed tumor treatment. However, the risk of pulmonary adverse events (PAEs) associated with ICI combination therapy is still unclear. We aimed to provide a PAE ov...

Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study

Annual screening through low-dose computed tomography (LDCT) is recommended for heavy smokers. However, it is questionable whether all individuals require annual screening given the potential harms of LDCT scr...

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Physician associates: Doctors express anger over RCP extraordinary general meeting

Doctors have expressed concerns over the way a meeting at the Royal College of Physicians to discuss issues related to physician associates was conducted

Doctors’ industrial action: in search of an endgame

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Increasing numbers of doctors going less than full time for their wellbeing

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25 year trends in cancer incidence and mortality among adults in the UK

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Haiti: Hospitals burn to ground as violence rages

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Assessing robustness to worst case publication bias using a simple subset meta-analysis

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When tackling racism is everyone’s problem, it becomes no one’s

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Even short periods of diabetes remission are linked to lower risk of heart attack and stroke

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Why learning to swallow pills is good for patients, parents, and the planet

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Patient and planetary harms from high anticholinergic burden medication

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Multimorbidity research: where one size does not fit all

This editorial reviews research on multimoridity by Beaney and colleagues, and explains why timeframes and frequency are important considerations when defining chronic conditions for multimorbidity research

Effectiveness and cost effectiveness of pharmacological thromboprophylaxis for medical inpatients

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Same day GP hubs: How will they affect access and continuity of care?

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Covid-19: Researcher blows the whistle on data integrity issues in Pfizer’s vaccine trial

Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis

Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study

The illusion of evidence based medicine

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A noninvasive treatment for “chemo brain”

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Patients undergoing chemotherapy often experience cognitive effects such as memory impairment and difficulty concentrating — a condition commonly known as “chemo brain.”

MIT researchers have now shown that a noninvasive treatment that stimulates gamma frequency brain waves may hold promise for treating chemo brain. In a study of mice, they found that daily exposure to light and sound with a frequency of 40 hertz protected brain cells from chemotherapy-induced damage. The treatment also helped to prevent memory loss and impairment of other cognitive functions.

This treatment, which was originally developed as a way to treat Alzheimer’s disease, appears to have widespread effects that could help with a variety of neurological disorders, the researchers say.

“The treatment can reduce DNA damage, reduce inflammation, and increase the number of oligodendrocytes, which are the cells that produce myelin surrounding the axons,” says Li-Huei Tsai, director of MIT’s Picower Institute for Learning and Memory and the Picower Professor in the MIT Department of Brain and Cognitive Sciences. “We also found that this treatment improved learning and memory, and enhanced executive function in the animals.”

Tsai is the senior author of the new study, which appears today in Science Translational Medicine . The paper’s lead author is TaeHyun Kim, an MIT postdoc.

Protective brain waves

Several years ago, Tsai and her colleagues began exploring the use of light flickering at 40 hertz (cycles per second) as a way to improve the cognitive symptoms of Alzheimer’s disease. Previous work had suggested that Alzheimer’s patients have impaired gamma oscillations — brain waves that range from 25 to 80 hertz (cycles per second) and are believed to contribute to brain functions such as attention, perception, and memory.

Tsai’s studies in mice have found that exposure to light flickering at 40 hertz or sounds with a pitch of 40 hertz can stimulate gamma waves in the brain, which has many protective effects, including preventing the formation of amyloid beta plaques. Using light and sound together provides even more significant protection. The treatment also appears promising in humans: Phase 1 clinical trials in people with early-stage Alzheimer’s disease have found the treatment is safe and does offer some neurological and behavioral benefits.

In the new study, the researchers set out to see whether this treatment could also counteract the cognitive effects of chemotherapy treatment. Research has shown that these drugs can induce inflammation in the brain, as well as other detrimental effects such as loss of white matter — the networks of nerve fibers that help different parts of the brain communicate with each other. Chemotherapy drugs also promote loss of myelin, the protective fatty coating that allows neurons to propagate electrical signals. Many of these effects are also seen in the brains of people with Alzheimer’s.

“Chemo brain caught our attention because it is extremely common, and there is quite a lot of research on what the brain is like following chemotherapy treatment,” Tsai says. “From our previous work, we know that this gamma sensory stimulation has anti-inflammatory effects, so we decided to use the chemo brain model to test whether sensory gamma stimulation can be beneficial.”

As an experimental model, the researchers used mice that were given cisplatin, a chemotherapy drug often used to treat testicular, ovarian, and other cancers. The mice were given cisplatin for five days, then taken off of it for five days, then on again for five days. One group received chemotherapy only, while another group was also given 40-hertz light and sound therapy every day.

After three weeks, mice that received cisplatin but not gamma therapy showed many of the expected effects of chemotherapy: brain volume shrinkage, DNA damage, demyelination, and inflammation. These mice also had reduced populations of oligodendrocytes, the brain cells responsible for producing myelin.

However, mice that received gamma therapy along with cisplatin treatment showed significant reductions in all of those symptoms. The gamma therapy also had beneficial effects on behavior: Mice that received the therapy performed much better on tests designed to measure memory and executive function.

“A fundamental mechanism”

Using single-cell RNA sequencing, the researchers analyzed the gene expression changes that occurred in mice that received the gamma treatment. They found that in those mice, inflammation-linked genes and genes that trigger cell death were suppressed, especially in oligodendrocytes, the cells responsible for producing myelin.

In mice that received gamma treatment along with cisplatin, some of the beneficial effects could still be seen up to four months later. However, the gamma treatment was much less effective if it was started three months after the chemotherapy ended.

The researchers also showed that the gamma treatment improved the signs of chemo brain in mice that received a different chemotherapy drug, methotrexate, which is used to treat breast, lung, and other types of cancer.

“I think this is a very fundamental mechanism to improve myelination and to promote the integrity of oligodendrocytes. It seems that it’s not specific to the agent that induces demyelination, be it chemotherapy or another source of demyelination,” Tsai says.

Because of its widespread effects, Tsai’s lab is also testing gamma treatment in mouse models of other neurological diseases, including Parkinson’s disease and multiple sclerosis. Cognito Therapeutics, a company founded by Tsai and MIT Professor Edward Boyden, has finished a phase 2 trial of gamma therapy in Alzheimer’s patients, and plans to begin a phase 3 trial this year.

“My lab’s major focus now, in terms of clinical application, is Alzheimer’s; but hopefully we can test this approach for a few other indications, too,” Tsai says.

The research was funded by the JPB Foundation, the Ko Hahn Seed Fund, and the National Institutes of Health.

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MIT scientists have found that a potential treatment for Alzheimer’s disease involving flickering lights and low-pitched sound could also help prevent cognitive problems after cancer treatment, reports Clare Wilson for  New Scientist . The treatment is aimed at stimulating 40 Hz brainwaves, which are linked to memory processing. The results suggest targeting such “brainwaves may result in broader benefits for the brain, including increasing the activity of immune cells and, most recently, boosting its drainage system, which could help clear a toxic protein called beta-amyloid.”  

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Fungi could be the key to major cancer research breakthroughs

Scientists' intrigue with fungi is twofold: the fungus in our bodies could hold crucial answers about the behavior of cancer cells, and the benefits of medicinal mushrooms are promising.

Two years ago, medical researchers taking a close look at cancer cells announced they had found a strange and surprising neighbor: fungi. But these fungi didn’t just live near tumors—they offered clues about how deadly the cancer might be. Candida yeasts associated with colon cancer were predictive of metastatic growth, while with gastrointestinal cancer, they correlated with poor survival rates.

It’s still too early to know if the fungi fuel the disease or if the disease is somehow incubating the fungi. But at the very least, these discoveries hint that there may be a new way to diagnose people earlier and better understand their prognosis.

“Initially, we were astounded,” says Iliyan Iliev, an immunologist at Weill Cornell Medicine in New York and one of the researchers who made the fungi-cancer connection. In addition to Candida, his team found several other fungal species that were associated with the disease, such as Blastomyces in lung cancer and Malassezia, a variety of yeast, tied to breast cancer.

( Here's the guidance on lung cancer and breast cancer screenings . )

Part of that surprise, for many, might be because of another link between fungi and our health. Medicinal mushrooms are sold throughout the world in various forms, from tinctures and capsules to powders and teas. They sustain a $30 billion business that’s expected to double by 2032, in part because of their cancer-fighting association.

Even so, researchers are still at an early stage of understanding the true benefits of medicinal mushrooms. In 2022, scientists in India and Belgium published a comprehensive survey of peer-reviewed literature on the topic. While at least 32 species showed promise, according to the report, only around a dozen had been clinically tested for their potentially therapeutic properties.

“Mushrooms produce a wide range of chemicals not readily found in other organisms,” says Walter Luyten, a professor emeritus at the Belgian university KU Leuven who contributed to the report. Some of these naturally derived compounds interact with the immune system to, as the report notes, “exhibit potent antitumor activity,” meaning they might slow the growth of certain cancers or even keep them from forming. Species such as reishi (Ganoderma lucidum) and maitake (Grifola frondosa), to name just two, have shown promise in clinical studies.

( Cancer vaccines are showing promise. Here’s how they work. )

Though mushrooms are vastly understudied, Luyten and his team called them “one of the best gifts of nature for new ... pharmaceuticals,” if we can better understand them.

This is the paradox of medicinal fungi: It’s a mysterious realm that could help or hurt us. Understanding this difference, and how best to harness what we’re learning, hinges on exploring a broader frontier called the mycobiome.

Your body is   certainly no stranger to good or bad fungi. The yeast in your stomach that helps regulate digestion? That’s a good thing. The fungal infection on your skin that causes athlete’s foot? Not so much. Among the trillions of tiny microbes that live on or inside each of us in a delicate balance, there are bacteria, viruses, and single-celled protozoans, all of which are part of what’s known as your microbiome. Fungi are also included in that universe, but in recent years researchers have assigned them a separate designation— the mycobiome—in recognition that these organisms work quite differently.

( Humans are not prepared for a pandemic caused by fungal infections. )

Siew Ng, director of the Microbiota I-Center at the Chinese University of Hong Kong, says our body’s fungal community is a “small but crucial component” of the gastrointestinal microbiome in particular. But while gut fungi such as Candida, Saccharomyces, and Cladosporium are all fundamental to our health, they have also been linked to diseases. Candida, for instance, can overpopulate and cause dysbiosis, a disorder associated with many health issues, including colorectal cancer. In other words, good fungi can become too successful and run amok, and turn into bad fungi.

For Deepak Saxena, a microbiologist at New York University, the life-altering question is simple: Why do some fungi inhabit tumors? Saxena’s research group was the first to identify fungi in pancreatic cancer, finding in 2019 that a Malassezia yeast can migrate from the small intestine to the pancreas and inhabit cancer cells. Saxena hypothesizes that the fungi’s presence in the pancreas might be because of either immunosuppression or some other kind of altered environment that tumors help create. In lab experiments with mice, Saxena has seen the use of antifungal treatments arrest tumor progression, although plenty of research has shown that what works in mice often isn’t directly transferable to humans.

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For mushroom experts, it’s not as simple as using one thing to treat another either. Ng says that traditional varietals like reishi and turkey tail ( Trametes versicolor ) have immune-boosting properties that have been shown to enhance the efficacy of chemotherapy. Numerous studies also indicate that many mushroom species do, in fact, contain anticancer compounds, including biologically active carbohydrates and terpenes that stimulate the immune system. Still, there are questions about what dose is most effective and whether any of these would work as a stand-alone treatment.

( The fungus in 'The Last of Us' is a real medicine—and it's very, very expensive. )

In the meantime, there are no mushroom-based cancer drugs or immunity boosters on the market today that have been approved by the U.S. Food and Drug Administration. That makes any mushroom-related remedy sold over the counter with health claims essentially “try at your own risk.”

For some people, however, that seemingly untapped potential has led them to seek another kind of guidance.

On an overcast day this past October near Port Angeles, Washington, Robert Rogers tromped through a shady, wooded area followed by a dozen intrepid foragers who had signed up for his specially guided tour as part of the annual Olympic Peninsula Fungi Festival. He pointed to a fan-shaped fungus the size of a half-dollar growing on a decayed nurse log. Its earthen-hued bands resembled the plumage of a game bird. This is what turkey tail looks like in the wild, he told the crowd.

( Want to try foraging food? Here’s how to do it safely. )

Rogers isn’t a doctor. He’s a self-described clinical herbalist and the author of The Fungal Pharmacy, a field guide to identifying mushrooms and lichens with purported health benefits. And he’s one of many ad hoc enthusiasts who have compiled research about incorporating fungi into everyday health routines, often as a preventive measure. Most commonly consumed mushrooms—even the ubiquitous grocery store button—have phytonutrients beneficial to our health. When it comes to cancer, however, medicinal fungi such as turkey tail are not exactly assassins. “They don’t kill cancer cells on sight,” he explains. “They encourage the immune system to do the job.”

More specifically, Ng says, turkey tail has been shown to increase the production of cytokines, which aid the body’s cellular response to fighting a foreign pathogen or tumor. Used traditionally for centuries, a chemical from the mushroom has been the focus of more than four dozen clinical trials to date.

( Turkey tail. Chaga. Lion’s mane. Do these mushroom supplements really help you? )

As for the connection between fungi and cancer cells, Iliev concedes that he initially considered it to be “biologically improbable,” but he’s since shifted toward “cautious optimism” about unraveling more mysteries of the mycobiome. In another recent study, researchers at NYU, including Saxena, found that there are 20 distinct types of fungi that may someday be useful in distinguishing between people with cancer and those without, pushing forward the idea that early testing of fungi might pave the way for better diagnoses and treatment.

Compare the potential advances of medicinal fungi to the advent of penicillin. One of the great fungi-based infection fighters of the modern age, it was discovered accidentally nearly a century ago, after a physician let mold grow in a petri dish of Staphylococcus bacteria. Who knows what other connections we might find now that we’ve started looking?

( A psychedelic surprise may be thriving in your local garden. )

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This paper is in the following e-collection/theme issue:

Published on 14.3.2024 in Vol 26 (2024)

Quality and Dependability of ChatGPT and DingXiangYuan Forums for Remote Orthopedic Consultations: Comparative Analysis

Authors of this article:

Original Paper

• Zhaowen Xue * , PhD   ; 
• Yiming Zhang * , PhD   ; 
• Wenyi Gan * , PhD   ; 
• Huajun Wang * , PhD   ; 
• Guorong She * , PhD   ; 
• Xiaofei Zheng, PhD  

Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University, Guangzhou, China

*these authors contributed equally

Corresponding Author:

Xiaofei Zheng, PhD

Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, The First Affiliated Hospital of Jinan University

No. 613, Huangpu Avenue West

Tianhe District

Guangzhou, 510630

Phone: 86 13076855735

Email: [email protected]

Background: The widespread use of artificial intelligence, such as ChatGPT (OpenAI), is transforming sectors, including health care, while separate advancements of the internet have enabled platforms such as China’s DingXiangYuan to offer remote medical services.

Objective: This study evaluates ChatGPT-4’s responses against those of professional health care providers in telemedicine, assessing artificial intelligence’s capability to support the surge in remote medical consultations and its impact on health care delivery.

Methods: We sourced remote orthopedic consultations from “Doctor DingXiang,” with responses from its certified physicians as the control and ChatGPT’s responses as the experimental group. In all, 3 blindfolded, experienced orthopedic surgeons assessed responses against 7 criteria: “logical reasoning,” “internal information,” “external information,” “guiding function,” “therapeutic effect,” “medical knowledge popularization education,” and “overall satisfaction.” We used Fleiss κ to measure agreement among multiple raters.

Results: Initially, consultation records for a cumulative count of 8 maladies (equivalent to 800 cases) were gathered. We ultimately included 73 consultation records by May 2023, following primary and rescreening, in which no communication records containing private information, images, or voice messages were transmitted. After statistical scoring, we discovered that ChatGPT’s “internal information” score (mean 4.61, SD 0.52 points vs mean 4.66, SD 0.49 points; P =.43) and “therapeutic effect” score (mean 4.43, SD 0.75 points vs mean 4.55, SD 0.62 points; P =.32) were lower than those of the control group, but the differences were not statistically significant. ChatGPT showed better performance with a higher “logical reasoning” score (mean 4.81, SD 0.36 points vs mean 4.75, SD 0.39 points; P =.38), “external information” score (mean 4.06, SD 0.72 points vs mean 3.92, SD 0.77 points; P =.25), and “guiding function” score (mean 4.73, SD 0.51 points vs mean 4.72, SD 0.54 points; P =.96), although the differences were not statistically significant. Meanwhile, the “medical knowledge popularization education” score of ChatGPT was better than that of the control group (mean 4.49, SD 0.67 points vs mean 3.87, SD 1.01 points; P <.001), and the difference was statistically significant. In terms of “overall satisfaction,” the difference was not statistically significant between the groups (mean 8.35, SD 1.38 points vs mean 8.37, SD 1.24 points; P =.92). According to how Fleiss κ values were interpreted, 6 of the control group’s score points were classified as displaying “fair agreement” ( P <.001), and 1 was classified as showing “substantial agreement” ( P <.001). In the experimental group, 3 points were classified as indicating “fair agreement,” while 4 suggested “moderate agreement” ( P <.001).

Conclusions: ChatGPT-4 matches the expertise found in DingXiangYuan forums’ paid consultations, excelling particularly in scientific education. It presents a promising alternative for remote health advice. For health care professionals, it could act as an aid in patient education, while patients may use it as a convenient tool for health inquiries.

Introduction

The fast growth of artificial intelligence (AI) in recent years has brought tremendous changes to different professions and businesses, altering the way people live and work. The application of AI in medicine is expanding in several areas, including medical image analysis, medication-interaction detection, the identification of high-risk patients, and medical record coding [ 1 , 2 ]. As technology advances, OpenAI introduced ChatGPT on November 30, 2022, as a new kind of natural language model capable of communicating with people through text-to-text, human-like dialogues [ 3 , 4 ]. The more powerful GPT-4 subsequently became accessible through a paid ChatGPT Plus membership on March 13, 2023. It has attracted a lot of interest since its release and has the potential to be widely used in the health care system [ 5 , 6 ]. Most medical AI research has targeted medical workers as software users, which requires medical knowledge reserves [ 7 ]. ChatGPT and other conversation question-and-answer AI software programs do not establish a user threshold, and their strong function makes them an essential auxiliary tool to increase finance and management job efficiency [ 8 ]. Health is a natural component of humans and should be explored and used in ChatGPT, particularly in the context of situational conversations between patients and physicians.

As human civilization advances, the quest for more convenient, professional, and precise medical services intensifies, with patients expecting increasingly high standards of care. The internet era has spurred hospitals to offer remote diagnostic and treatment services, facilitating doctor-patient interactions beyond physical boundaries and enhancing an understanding of medical issues through remote health care, particularly for those far from medical centers [ 1 ]. The recent COVID-19 pandemic has accelerated this digital shift in medicine [ 2 , 9 , 10 ]. However, the complexity of medical information can reduce physician efficiency and patient comprehension, highlighting the need for patient navigation services, especially in countries with evolving medical systems such as China [ 11 - 13 ]. Amid this backdrop, the rapid advancement of AI technologies such as ChatGPT offers promising support in navigating medical systems, aiding patients in understanding their disease, and selecting a health care facility [ 14 ].

“DingXiangYuan” is a leading digital health technology enterprise in China that seeks to unite physicians, researchers, patients, and hospitals through expert and authoritative knowledge exchange, extensive and thorough medical data collection, and top-notch digital medical services [ 15 ]. Its remote diagnosis and treatment application has been widely used in China. In the application forums, users may seek the assistance of physicians who are qualified and accredited by the site. At the same time, the information provided by doctors is public, and supervision by the platform leads to a high level of quality for the questions and answers listed in these forums. However, consultations on DingXiangYuan are costly and restrict the number of conversations patients can have with their physicians. In addition, websites offering remote consultations, such as DingXiangYuan, still require physicians to respond on the web, which does not reduce the burden on clinicians.

Nevertheless, a comparative analysis of the quality of responses obtained from paid remote health consultations and ChatGPT-4 has yet to occur. This analysis was based on 82 orthopedic surgery–related consultations sourced from the Doctor DingXiang section of the DingXiangYuan platform. Responses from physicians on the web served as the control group, while those from ChatGPT-4 made up the experimental group. To determine the efficacy of ChatGPT-4 as a reliable remote health consultation resource, we conducted a comparative analysis of its logical response structure, diagnostic accuracy, the viability of its treatment recommendations, and the ability to effectively disseminate medical knowledge pertaining to various conditions. The goal is to provide a workable foundation for the development of ChatGPT-4 in the medical domain.

Data Set of Orthopedic-Related Remote Consultation

The “Doctor DingXiang” website is a remote network that houses a collection of orthopedic-related medical dialogues and is one of China’s largest remote-paid consultation platforms ( Figure 1 A and Figure 2 ). To protect patients, the website blocks access to all content that may compromise their privacy, including the patient’s username, images provided in the question, imaging data, and biochemical examination results, from all other website visitors, allowing only the questioner and the target doctor to access it. In addition, there are categories of diseases on the site, and only about 100 consultation results are displayed for each type of disease. Each doctor’s response can be either spoken or written; however, since the spoken answers are not as accurate as the written answers and contain many spoken words, only the written answers were adopted ( Multimedia Appendix 1 ). From May 20, 2023, to May 30, 2023, a total of 8 types of illness (with a total of 800 cases) were identified, namely gout, osteoarthritis, plantar fasciitis, fracture, osteoporosis, lumbar disc herniation, tendon sheath cyst, and osteoporosis. Of these, 82 patients originally met the screening criteria according to the above requirements. The 82 issues ( Figure 1 ) we collected from this website are compliant with the HIPAA (Health Insurance Portability and Accountability Act) of 1996, given the information provided above [ 16 ]. “Doctor answers” refers to the website’s collection of responses from board-certified physicians ( Figure 2 A). Multimedia Appendix 2 contains all queries obtained from the Doctor DingXiang website, as well as the doctors’ responses.

ChatGPT’s Answers

ChatGPT exhibits robust learning capabilities within the same dialogue window, enhancing responses to subsequent questions based on previous answers. However, this ability also introduces the potential for systematic error. To elaborate, this interconnectedness of responses does not allow for the maintenance of independence in ChatGPT-4’s answers to each question. Therefore, when 73 patients’ questions from the included consultations were entered into ChatGPT as questions ( Figure 1 B), a “new chat” was created for each question-and-answer set to minimize systematic errors. This process took place from June 1, 2023, to June 10, 2023. The use of a “new chat” for each inquiry ensured the independence of each response by preventing the AI from using context from previous interactions, thereby eliminating any learning or bias that may have been carried over from earlier questions. In addition, no plug-ins were used with ChatGPT-4, and the “chat history and training” option was deactivated to preserve the objectivity of each response. All ChatGPT-4 answers can be found in Multimedia Appendix 4 .

Response Qualification

The “data set of orthopedic-related remote consultation” was compiled by a professional orthopedic doctor on the Doctor DingXiang website, and 3 professional orthopedic physicians evaluated the ChatGPT and doctor response quality scores. To reduce systematic error resulting from human factors, the orthopedic surgeon who assessed the answers did not know how the answers were grouped. Specific scoring criteria were separated into “properties of natural coherence,” “clinical effect,” and “overall satisfaction” ( Multimedia Appendix 5 ). The 3 orthopedic physicians convened initially to calibrate their scoring criteria using 2 examples provided by the author ( Multimedia Appendix 6 ). After individual scoring, the Fleiss κ method was used to test the interrater consistency among the 3 physicians’ scores. The final statistical data were derived from the mean value of the scores given by the 3 physicians.

Dependability of Comparative Analysis of Responses

When discussing the dependability of comparative analysis of responses, it is essential to consider 3 critical aspects: logical reasoning, internal information, and external information. These components collectively form the foundation for assessing the dependability of answers.

• Logical reasoning: The answer uses logic and stepwise thinking to produce a response with the given information in the question stem.
• Internal information: The answer uses information present within the question stem to procure a response.
• External information: The answer uses external information to produce a response.

Usability of Comparative Analysis of Responses

When assessing the usability of comparative analysis of responses in the medical field, it is crucial to focus on how effectively these analyses can guide diagnosis and treatment, provide therapeutic insights, and educate patients on their conditions.

• Guiding function: To evaluate the accuracy of the provided diagnosis and differential diagnosis as well as the accuracy of the clinical treatment direction judgement and guidance.
• Therapeutic effect: To determine whether the treatment suggestions provided in response to the consultation are accurate and if they can alleviate or treat the diseases proposed by the patients.
• Medical knowledge popularization education: To evaluate whether the response introduces the cause and course of the disease and whether it can enhance patients’ understanding of the illness.

Overall Satisfaction

On a scale of 1-10 points, the rater assigned a general rating to the replies. A score of 1-3 points indicated that the responses are biased and that they do not include contents that could call for differential diagnosis and certain auxiliary exams that need to be improved. A score of 4-6 points suggests that there is a possible danger of misdiagnosis or a delay in treatment. Scores of 7-9 points indicate consultation services that can practically replace licensed medical professionals. Finally, a score of 10 points indicates a full replacement for a licensed medical professional’s consultation service.

For statistical analysis, SPSS (version 26.0; IBM Corporation) was used. Chi-square analysis was used to analyze scoring differences between different groups. The Kolmogorov-Smirnov technique was used to determine whether the data exhibited a normal distribution; ultimately, it indicated that none of the data in this investigation were normally distributed. Consequently, the Mann-Whitney U test of independent samples was used to assess the disparity in scoring performance between the experimental and control groups [ 17 ]. When P <.05, the difference was considered statistically significant. Scott π statistic is a statistical measure of interrater reliability. Fleiss κ is a generalization of this statistic. SPSS was used to examine the consistency of the 3 raters for each item. Finally, GraphPad Prism 8 (GraphPad Software) was used to construct bar charts to display the comparison of dependability and usability between 2 types of responses, as well as the overall satisfaction outcomes.

Orthopedic Case Selection and Comparative Assessment

We selected 8 orthopedic diseases from the Doctor DingXiang website and consulted 800 cases in total, namely fracture, osteoarthritis, cervical spondylosis, lumbar disc herniation, tendon sheath cyst, plantar fasciitis, osteoporosis, and gout. In the initial screening, we excluded 717 cases in which patients provided information that visitors could not view or where doctors used voice responses. The second screening process excluded patients who provided information that the visitor could not view in the follow-up questions (a total of 9 cases). Finally, 73 eligible cases were included. Without being aware of the replies’ origin, 3 orthopedic physicians in practice assessed the responses. The authors concluded by summarizing the statistical findings and designating the response assessment of Doctor DingXiang as the control group and the response evaluation of ChatGPT-4 as the experimental group.

Evaluation Results for Dependability and Usability

After statistical scoring, we discovered that ChatGPT’s “internal information” score (mean 4.61, SD 0.52 points vs mean 4.66, SD 0.49 points; P =.43) and “therapeutic effect” score (mean 4.43, SD 0.75 points vs mean 4.55, SD 0.62 points, P =.32) were lower than those of the control group, but the differences were not statistically significant ( P >.05; Figures 3 E and 4E). ChatGPT showed better performance in the “logical reasoning” score (mean 4.81, SD 0.36 points vs mean 4.75, SD 0.39 points; P =.38), “external information” score (mean 4.06, SD 0.72 points vs mean 3.92, SD 0.77 points; P =.25), and “guiding function” score (mean 4.73, SD 0.51 points vs mean 4.72, SD 0.54 points; P =.96), although the changes were not statistically significant ( Figures 3 D, 3F, and 4D). However, we were glad to see that, in terms of remote diagnosis and treatment, ChatGPT’s “medical knowledge popularization education” scores were better than those of the control group (mean 4.49, SD 0.67 points vs mean 3.87, SD 1.01 points; P <.001), and the difference was statistically significant ( Figure 4 F). Figure 3 A depicts the score distribution of ChatGPT and the control group in terms of “logical reasoning.”

The figures show the distributions of “logical reasoning” ( Figure 3 A), “internal information” ( Figure 3 B), “external information” ( Figure 3 C), “guiding function” ( Figure 4 A), “therapeutic effect” ( Figure 4 B), and “medical knowledge popularization education” ( Figure 4 C). Other than that for “medical knowledge popularization education,” the score distribution for the remaining elements was roughly comparable.

In terms of “overall satisfaction,” we see that ChatGPT had slightly higher overall satisfaction scores of <5 points compared with the control group ( Figures 5 A and 5B), but the difference was not statistically significant (mean 8.35, SD 1.38 points vs mean 8.37, SD 1.24 points; P =.92; Figure 5 C).

Consistency Testing Among the 3 Orthopedic Physicians’ Evaluations

Using Fleiss κ, the consistency of the ratings among 3 physicians was determined ( Multimedia Appendix 5 ). The Fleiss κ evaluations for “logical reasoning,” “internal information,” “external information,” “therapeutic effect,” “medical knowledge popularization education,” and “overall satisfaction” were rated as showing “fair agreement” for the control group, while “guiding function” was rated as showing “substantial agreement” ( Multimedia Appendix 5 ; P <.001). According to Fleiss κ values, “internal information,” “external information,” and “overall satisfaction” were rated as displaying “fair agreement” in the ChatGPT responses, whereas “logical reasoning,” “guiding function,” “therapeutic effect,” and “medical knowledge popularization education” were rated as showing “moderate agreement” ( Multimedia Appendix 5 ; P <.001).

Main Findings of This Study

This cross-sectional research gathered 73 frequently asked clinical questions from patients and excellent responses given by licensed, qualified physicians on a reputable remote medical service website. After using ChatGPT to get the answers to these queries and seeking the evaluation of professional doctors, we discovered that, when compared with the responses of qualified clinicians, ChatGPT’s answers also showed strong logic and the capacity to extract and analyze key information, and they could help physicians respond to patients’ questions in a manner that reflects professionalism. Overall, ChatGPT’s responses received generally positive feedback from doctors. Professional responses from ChatGPT were able to assess and address queries in light of a large database, and the service even suggested literature on diseases for interested customers. With the help of ChatGPT, this method may unleash latent productivity, allowing health care personnel to use the time saved on more difficult duties. However, ChatGPT still has a lot of drawbacks. Although ChatGPT can analyze photographs, the procedure to do so is very complicated: medical images must be submitted to a public site to establish links for analysis, and the success rate of analysis is not very high. In addition, ChatGPT is not yet able to accurately diagnose a patient’s illness; this task must be left to expert physicians, whose assessment and oversight are crucial to the process [ 18 ]. Therefore, we believe that ChatGPT may successfully help doctors with remote diagnosis and treatment services, significantly increase clinicians’ job efficiency, and save more time, but it still cannot take over from the doctor entirely.

Comparison With Previous Research

As the internet has grown, many hospitals have established remote medical services. Doctor-patient contact is no longer hampered by distance thanks to the internet, which makes it easier for both parties to interact. Remote medical services have expanded quickly over the last 3 years as a result of the COVID-19 pandemic, and, to some degree, they have even altered the conventional medical model. Remote diagnosis and therapy, nevertheless, are not yet flawless. Patients must pay additional costs for remote diagnostic and therapy services, and their communications may be ignored or they may receive pointless answers [ 2 ]. More crucially, in certain fields, including orthopedics, textual communication alone may be unable to provide clinicians with a whole picture of the patient’s condition. There is still no replacement for a physical examination, imaging examination, or biochemical test. In addition, physicians must expend a great deal of additional time and effort to decide how to respond to patients, which adds significantly to their burden and may not have the intended outcome [ 19 ].

Previous studies have indicated that ChatGPT-3.5 demonstrated strong performance in addressing public health inquiries on Reddit’s r/AskDocs, showcasing its considerable promise for offering remote medical consultation services [ 20 ]. This is noteworthy given the hesitancy of some patients to discuss their health issues publicly, coupled with the challenge of ensuring the reliability of unpaid responses on such platforms [ 20 ]. Contrasting with this, this study compares ChatGPT-4 with paid professional responses on the Doctor DingXiang forums, revealing that ChatGPT-4’s overall performance is comparable to that of paid medical professionals, with the added benefit of more effective dissemination of medical knowledge. In addition, ChatGPT’s low barrier to entry means this real-time, AI-driven, question-and-answer software better addresses the immediate health consultation needs of users, making it more significant for widespread application.

Interactive AI software that offers immediate feedback has an advantage over traditional AI analytical output software in that it allows users to inquire not only about the answers to “what” but also about the underlying “why” [ 21 ]. In the context of clinical scenarios, users have the ability to request critical information and foundations for diagnosis and treatment through ChatGPT. This functionality aids in the clarification of the operational logic behind their decisions, fostering greater transparency in the use of ChatGPT software and the comprehension of users. In relation to personal privacy, users have the ability to configure ChatGPT’s personal settings to “chat history and training” and enable a personalized input mode to proactively minimize the exposure of sensitive data.

Significance for Hierarchical Diagnosis and Treatment as Well as Triage

A major worldwide problem is the scarcity and unequal distribution of medical resources. The issue is made worse in certain nations with high population densities, such as China, by the abundance of people who require medical treatment [ 22 ]. In addition, China is unable to guarantee the effectiveness of medical resource allocation, as other high-income countries can, due to ineffective rules and legislation and a lack of rigorously educated general practitioners [ 23 ]. To address this issue, the hierarchical medical system was created, and it has steadily replaced other medical systems to provide basic health care in the majority of high-income countries [ 24 ]. According to the severity and urgency of their sickness, patients must be sent to medical facilities of the appropriate level, such as primary medical institutions or specialized medical institutions [ 25 ]. This is a perfect medical paradigm, but patients’ treatment decisions are significantly influenced by their self-rated health state, chronic illnesses, socioeconomic situation, and educational level, particularly since the majority of patients lack an objective grasp of their ailment and pertinent medical expertise [ 26 , 27 ]. The hierarchical medical system has not had the desired impact in China as a consequence of its deployment. Some medical facilities are suffering from severe work pressure overload due to a lack of medical resources and patients’ unrealistic treatment preferences [ 23 ]. To enhance patients’ medical behavior and help them choose the best medical facilities, high-quality guiding services are thus necessary to assist patients in understanding their disease-related information before treatment [ 28 ]. This may somewhat mitigate the issues brought on by a lack of medical resources and assist patients in receiving more focused and appropriate medical care.

Patient navigation services, a patient-centered intervention, are becoming more and more popular. These services use trained personnel to identify patient-level barriers to care, such as cultural, logistical, and educational ones, and then remove them to encourage full and prompt access to care [ 29 , 30 ]. A growing body of research demonstrates the beneficial effects that patient guide services have on illness prevention, the spread of health information, medical decision-making, and communication promotion. Patient navigation can help remove barriers brought on by language, cultural differences, a lack of relevant medical knowledge, and other factors, especially for some patients with a lack of medical knowledge or a relatively low level of education, in the face of a more complex but hierarchical medical center or sociomedical system. This will lead to a more effective patient path and fewer delays in diagnosis and treatment [ 31 ]. More crucially, research has demonstrated that patient guiding services have benefited people with chronic illnesses such as diabetes and cardiovascular disease and have somewhat decreased the likelihood of rehospitalization [ 32 ]. Patient guidance services may not only aid in the patient’s healing process but also assist them with developing a more thorough and expert understanding of the causes, symptoms, and other facets of associated diseases, enabling them to treat, care for, and monitor their disease more skillfully and effectively [ 33 ]. However, previous research discovered that some issues remain with the present patient guidance service, such as navigators’ potential lack of expertise. In addition, some patient navigators, although trained on how to perform their job, lack a history of medical education, making it difficult for them to respond to the patient’s consultation [ 11 ]. Even if it may be a little harsh to demand that patient navigators be all-knowing, finding practical and trustworthy approaches to boost the effectiveness and caliber of patient navigation services is still necessary.

The Challenges of Promoting ChatGPT in the Medical Field

While using AI is the general trend in science and technology development, individuals must also understand that the tool can only work optimally in the ideal regulatory environment, which often has some lag. To ensure the rational use of ChatGPT in the medical field, hospitals need to organize training on the use of ChatGPT and uniformly manage the accounts used by doctors during working hours. Doctors must also take responsibility for assessing the quality of ChatGPT’s responses and ensuring that the patient’s right to be informed of the use of ChatGPT is met. Specifically, physicians are required to assign a unique account when using ChatGPT in clinical practice, and they must also have the corresponding patient present. The physician has the authority not only to assess the quality of ChatGPT’s responses before presenting them to the patient but also to provide the patient with the final interpretation of said responses. Conversely, individuals who use ChatGPT but do not identify as medical professionals should refrain from relying exclusively on it for health-related information.

ChatGPT can assist clinicians in better organizing clinical data, analyzing imaging results, and providing personalized support for clinical decision-making regarding cancer patients, according to recent studies [ 34 - 36 ]. As previously stated, physicians, in their capacity as users of ChatGPT, are additionally obligated to oversee its use. In this regard, ChatGPT functions as a supplementary tool. Should ChatGPT outputs be incorporated into the physician-patient communication and clinical decision-making process, the physician must disclose the information source to the patients to guarantee that they are well-informed. Simultaneously, the hospital must oversee the ChatGPT accounts used by physicians and coordinate training courses on ChatGPT usage to guarantee that physicians who use ChatGPT in their clinical practice possess a certain level of proficiency in its operation. By implementing these management tasks, certain potential hazards and medical disputes can be circumvented, and the application of AI software in the medical field can be promoted more effectively.

Although this study establishes a sound theoretical foundation for the clinical implementation of ChatGPT, there are numerous areas still requiring further refinement. As one example, there is a need for further refinement of cross-sectional experiments in the future to compare the following: the quality of answers provided by AI software in various clinical disciplines, variations in the quality of answers generated by different AI software programs (ChatGPT, Google Board, Claude, and so forth), and disparities between different language inputs used by AI software. Alternatively, a randomized controlled trial could assess the efficacy of ChatGPT as a supplementary tool for clinicians to use while interacting with patients. Further development is required to ensure the full functionality, safety, and dependability of ChatGPT as a medical AI.

Limitations

Initially, we intended to investigate the viability of using the ChatGPT app for medical guidance. This study solely included orthopedic cases as the research object and did not gather multidisciplinary clinical cases to rule out variations in the difficulty levels of working in other clinical specialties, which may produce different findings. In the future, it will be possible to aggregate challenges from many disciplines and examine how AI performance differs between fields in solving difficulties. Furthermore, neither machine translation nor manual translation can preserve the flaws and precision of the original sentence content. Users are unable to ascertain the processing logic of AI when using ChatGPT as a research tool across different language types. Consequently, they are limited to inputting ChatGPT data in accordance with the language type used in the control content and assessing the output quality of ChatGPT content in the same language. Medical personnel are required to use ChatGPT under a special number with a real-name system for supervision purposes. As an auxiliary tool, ChatGPT users are not only tasked with assessing the quality of responses but also possess the authority to make the ultimate interpretation of the content. Ultimately, further randomized controlled trials are required in the future to validate the use of AI in medicine while controlling for confounding variables, as this study was cross-sectional in nature.

This study demonstrates that ChatGPT-4 responses match the expertise found among health care practitioners on DingXiangYuan, a leading remote medical consultation platform in China, across various metrics such as logical reasoning and diagnostic accuracy. Notably, it excels at providing scientific education. ChatGPT-4 is thus recommended as an alternative to traditional remote health consultations. It can assist physicians in educating patients, thereby enhancing medical knowledge dissemination. For patients, it offers accessible, reliable health advice, improving information accessibility and decision-making support. These findings suggest a transformative potential for ChatGPT-4 in health care, notably in enhancing access to medical advice and patient education. It implies the need for advancing medical AI with a focus on ethical and transparent applications, highlighting its role in improving health care delivery and patient empowerment.

Acknowledgments

The authors would like to thank DingXiangYuan and the Doctor DingXiang website’s public display of orthopedic-related remote consultation cases. We thank the LetPub website for its linguistic assistance during the preparation of this manuscript.

Authors' Contributions

ZX was responsible for conceptualization, investigation, visualization, and writing of the original draft, as well as writing, reviewing, and editing. YZ was responsible for data curation, formal analysis, and writing the original draft. WG was responsible for data curation and formal analysis. HW, GS, and XZ were responsible for grading the responses, writing—reviewing and editing, and supervising the entire study. All authors read and approved the final manuscript.

Conflicts of Interest

None declared.

Select inclusion criteria and exclusion criteria for website consultation dialogue information.

The 82 patient questions and online responses from doctors on the Doctor DingXiang website (translated from Chinese to English using ChatGPT-3.5).

High-resolution version Figure 1.

ChatGPT-4 responses after asking questions from 82 patients in Chinese (translated from Chinese to English using ChatGPT-3.5).

Consistent evaluation of Fleiss κ among the 3 raters.

Orthopaedic physicians’ initial criteria calibration.

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Abbreviations

Edited by A Castonguay; submitted 15.07.23; peer-reviewed by M Chatzimina, F Tang, J Li; comments to author 27.10.23; revised version received 04.11.23; accepted 30.01.24; published 14.03.24.

©Zhaowen Xue, Yiming Zhang, Wenyi Gan, Huajun Wang, Guorong She, Xiaofei Zheng. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 14.03.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

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President Biden spoke of his major priorities last night during the State of the Union. Among his essential calls to Congress was to fund $12 billion into women’s health research. During his speech, President Biden remarked, “To state the obvious, women are more than half our population, but research on women’s health has always been underfunded…Pass my plan for $12 billion to transform women’s health and benefit millions of lives across America.”

In November, President Biden together with First Lady Dr. Jill Biden launched the White House Initiative on Women’s Health Research . Chaired by Carolyn M. Mazure, PhD, the Initiative fundamentally changes how our nation approaches and funds women’s health research.

“This call for investment, on the heels of $100 million in federal dollars committed to women’s health research from the Advanced Research Projects Agency for Health, or ARPA-H, is critical to transform research on women’s health,” said Mazure, the director of Women’s Health Research at Yale and Norma Weinberg Spungen and Joan Lebson Bildner Professor in Women's Health Research, and professor of psychiatry and of psychology.

According to the White House Fact Sheet , the investments will support a new fund at the National Institutes of Health and catalyze private and philanthropic commitments to increase funding for women’s health research. “These new resources will make investments that maximize our ability to prevent, diagnose, and treat health conditions in women and ensure women get the answers they need when it comes to their health.”

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To address the chronic-pain crisis, digital health technologies must break out of their silos and become integrative and holistic.

• Benjamin Lipp

Spotlight | 28 February 2024

Stealthy stem cells to treat disease

Gene-editing strategies that allow stem cells to evade the immune system offer hope for universal cell-replacement therapies.

• Elie Dolgin

News | 26 February 2024

The surprising link between gut bacteria and devastating eye diseases

Finding raises hopes that antibiotics could treat some genetic diseases that can cause blindness — but also prompts doubts.

• Saima Sidik

News Explainer | 26 February 2024

‘Breakthrough’ allergy drug: injection protects against severe food reactions

A study suggests that the asthma treatment omalizumab can reduce the risk of dangerous allergic reactions to peanuts and other foods.

News | 22 February 2024

CAR-T therapy for multiple sclerosis enters US trials for first time

Hopes are high that engineered immune cells, which are already in use to treat blood cancer, will halt the progression of a degenerative autoimmune disorder.

• Asher Mullard

Obituary | 21 February 2024

Judith Campisi (1948–2024), cell biologist who explored how cells age

Researcher who established the role of cellular senescence in cancer and ageing.

•  &  Jan Hoeijmakers

Article | 21 February 2024

Monolithic silicon for high spatiotemporal translational photostimulation

A silicon-based electrode system is described that allows tunable spatiotemporal photostimulation of cardiac systems, with the optoelectronic capabilities of these devices being demonstrated in mouse, rat and pig heart models.

• , Jing Zhang
•  &  Bozhi Tian

Article 21 February 2024 | Open Access

Prevalence of persistent SARS-CoV-2 in a large community surveillance study

Using viral sequence data, individuals with persistent SARS-CoV-2 infections were identified, and had higher odds of self-reporting long COVID, in a large community surveillance study.

• Mahan Ghafari
• , Matthew Hall
•  &  Katrina Lythgoe

News Feature | 20 February 2024

Mind-reading devices are revealing the brain’s secrets

Implants and other technologies that decode neural activity can restore people’s abilities to move and speak — and help researchers to understand how the brain works.

• Miryam Naddaf

News | 16 February 2024

Move over, CRISPR: RNA-editing therapies pick up steam

Two RNA-editing therapies for genetic diseases have in the past few months gained approval for clinical trials, raising hopes for safer treatments.

News & Views | 14 February 2024

Smoking’s lasting effect on the immune system

It emerges from a study of human cells that smoking can influence certain immune responses to the same extent as can age or genetics. Smoking can alter the immune system in ways that persist long after quitting the habit.

•  &  Simon Stent

News Feature | 14 February 2024

The future of precision cancer therapy might be to try everything

Researchers are blasting patients’ cancer cells with dozens of drugs in the hope of finding the right treatment.

Career Q&A | 12 February 2024

A researcher-exchange programme made me a better doctor at home and abroad

Caleb Skipper describes how global health collaborations bring valuable transfers of knowledge to both sides of the Atlantic.

• Christopher Bendana

News | 07 February 2024

Turbocharged CAR-T cells melt tumours in mice — using a trick from cancer cells

Immune cells armed with a mutation first identified in cancer cells gain potency but don’t turn cancerous themselves.

News | 02 February 2024

Crackdown on skin-colour bias by fingertip oxygen sensors is coming, hints FDA

Devices can overestimate blood oxygen levels in people with dark skin, affecting medical care.

News | 01 February 2024

Why autoimmune disease is more common in women: X chromosome holds clues

Rogue antibodies are drawn to the protein–RNA coating on half of the X chromosomes in an XX cell.

Comment | 31 January 2024

Forget lung, breast or prostate cancer: why tumour naming needs to change

The conventional way of classifying metastatic cancers according to their organ of origin is denying people access to drugs that could help them.

• Fabrice André
• , Elie Rassy
•  &  Benjamin Besse

News Feature | 23 January 2024

Can autoimmune diseases be cured? Scientists see hope at last

After decades of frustration and failed attempts, scientists might finally be on the cusp of developing therapies to restore immune ‘tolerance’ in conditions such as diabetes, lupus and multiple sclerosis.

• Cassandra Willyard

News | 18 January 2024

Fingertip oxygen sensors can fail on dark skin — now a physician is suing

A community health centre in California led by the researcher files the first lawsuit against pulse oximeter manufacturers.

News | 17 January 2024

Potent new pill provides COVID relief for the masses

The drug simnotrelvir shortens symptoms for those with mild infections and is sold at a lower price in China than its main rival.

News Q&A | 15 January 2024

New NIH chief opens up about risky pathogens, postdoc salaries and the year ahead

Nature talks to Monica Bertagnolli about hot-button issues and her top priorities for 2024.

News | 12 January 2024

Google AI has better bedside manner than human doctors — and makes better diagnoses

Researchers say their artificial-intelligence system could help to democratize medicine.

News Feature | 08 January 2024

Antibiotic resistance is a growing threat — is climate change making it worse?

Researchers are studying how extreme weather and rising temperatures can encourage the spread of drug-resistant infections.

• Carissa Wong

News | 05 January 2024

Potent psychedelic drug banishes PTSD, small study finds

Military veterans with cognitive and psychological problems saw drastic improvements after a dose of ibogaine.

Research Highlight | 04 January 2024

A record-setting transplant heals a baby’s broken heart

Partial-heart transplant from a living donor allows an infant's heart valves to grow as he does.

Editorial | 03 January 2024

A new class of antibiotics is cause for cautious celebration — but the economics must be fixed

The threat of antimicrobial resistance means that new antibiotics need to be used sparingly. Governments must support their development with a long-term funding plan.

News Feature | 03 January 2024

Long COVID is a double curse in low-income nations — here’s why

Not only is the prevalence of the condition poorly understood, but it’s also often ignored by physicians and the wider public.

News | 20 December 2023

Cancer-fighting CAR T cells could be made inside body with viral injection

Scientists are devising ways to edit the genomes of immune cells without having to extract them from the people being treated.

Scientists question cancer tests that use microscopic nematode worms

Some doctors say a troublingly high number of cancer-free people have tested positive on the tests sold by a Japanese start-up.

• David McNeill
•  &  Momoko Suda

News & Views | 13 December 2023

A next-generation inhalable dry powder COVID vaccine

Current injectable COVID-19 vaccines are unable to induce robust immunity in the mucosal tissues lining the airways. A protein-based vaccine delivered to the lungs in the form of an inhaled dry powder shows promise as a way forward.

•  &  Mangalakumari Jeyanathan

News | 13 December 2023

Extreme morning sickness? Scientists finally pinpoint a possible cause

A protein released by fetal cells in the placenta influences the risk of experiencing severe nausea and vomiting during pregnancy.

News Feature | 13 December 2023

The cancer physician who helped to deliver a life-extending treatment

Thomas Powles’s breakthrough success in treating a deadly bladder cancer could herald the next wave of powerful immunotherapeutic drugs.

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• v.48(1); 2020 Jan

The increasing importance of sports science and medicine

The notion that exercise has a multitude of benefits, especially for health, has been around for millennia. 1 Physicians’ traditional focus on the prevention of disease and the maintenance of health requires them to find interventions that will help patients, with as few adverse effects and reactions as possible. Only lately has the focus shifted towards acute illnesses and treating patients according to their complaints. 1 In any case, diet and exercise have almost always been part of the regimen emphasised by physicians. 1 Even ancient physicians recognised the importance of these two aspects of care in the formulation of their treatments. 2 This understanding suggests that maintaining health in a preventative manner may be a more appropriate medical approach than treating patients at the doorway of disease.

Most modern diseases can be said to be preventable. 2 Almost half of the mortality rate in the United States can be traced to behavioural causes. 2 The main causes of early death in the country are smoking and diseases attributable to physical inactivity linked to obesity. 2 Physicians should consider returning to an approach of prescribing lifestyle changes before prescribing medication. Prescribing exercise can indeed maximise the health of patients. 1 Clearly, exercise is relatively inexpensive yet massively effective for multiple bodily systems. Exercise can be considered a medication, and physicians should be encouraged to start treating physical activity as a prescription that they can recommend to their patients. As more people are beginning to recognise, the benefits of exercise will usually outweigh the risks, and each person should be able to perform at least a minimum amount of exercise. 2

There is a growing opinion that, in the near future, lack of exercise may be the most important public health problem. 2 Physicians should consider it their duty to modify patients’ lifestyles in ways that lead to the health benefits that science has now confirmed are clear and undeniable. Many conditions, such as depression, osteoarthritis, hypertension, obesity, cancer, and diabetes mellitus have outcomes that are obviously ameliorated by increased physical activity. 3

The United States is in love with sports, with 60% of Americans describing themselves as sports fans. 4 Billions of dollars are generated every year by various US-based sports leagues, such as the National Hockey League, the National Basketball Association, Major League Baseball, and the National Football League. 4 Collegiate sports are a multimillion-dollar business as well. 4 As the earnings increase, so do the investments that these leagues make in the best players. Because of the financial impact of these various sports, it has become a priority for the leagues to keep their players healthy. As such, optimising performance, improving the best players’ availability, and decreasing the risk of injury have become the main thrusts of sports science and sports medicine when tied to high-performance teams. 5

Sports science research can help lead to evidence-based approaches that will allow athletes and active individuals to exercise in optimal ways. There is a continuing gap between current practices in athletics and the latest scientific evidence, compounded by an era of anti-intellectualism and ‘fake news’, as well as a burgeoning disbelief in fact and science. 4 Non-peer-reviewed articles are proliferating, as are so-called ‘predatory’ journals and conferences, which can contribute to the dilution of good science that could be used for the benefit of athletes, active individuals, and indeed, all patients who are trying to exercise more.

Coaches and athletes need to listen more carefully and more often to sports scientists, whose findings can be supported and dispersed by sports medicine physicians. Widespread support for the use of unproven supplements in sports, or wearing specific bracelets or anklets to supposedly improve athletic ability, are but a few of the pseudoscientific practices that coaches and athletes need to discuss further with scientists and physicians. Conversely, those engaged in the science of sports medicine and the provision of health care need to improve their ability to translate terms and ideas that may not be easily understood by those engaged or about to engage in sports and exercise activities.

Knowledge transfer is key, and sports communities all over the world should be able to engage with sports scientists and medical providers more directly. We now have the ability to leverage social media, application software, and other forms of technology to achieve this. Our use of these evolving tools should focus on sports physicians and athletes being proactive, using exercise as prevention, rather than reactive, treating maladies as needed. The idea that ‘exercise is medicine’ should become second nature in the world of primary care and sports medicine. 1

Declaration of conflicting interest

The authors declare that there is no conflict of interest.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

George G.A. Pujalte https://orcid.org/0000-0002-7537-7457

Scientists found tiny nanoplastics in people’s arteries. Their presence was tied to a higher risk of heart disease.

People with microplastics and nanoplastics in plaque lining a major blood vessel in their neck may have a higher risk of heart attack, stroke or death, new research suggests. 

The findings, published Wednesday in The New England Journal of Medicine , are the first time scientists have linked these tiny plastic particles, the result of degraded plastic pollution, to cardiovascular disease . 

Microplastics are defined as particles smaller than 5 millimeters, and nanoplastics are far smaller — so tiny that they can be seen only with specialized microscopes. In recent years, their ubiquity has become undeniable: They have been found in fresh snowfall in Antarctica and at the depths of the Marianas Trench , as well as in human blood; breast milk; urine; and placental, lung and liver tissue .

Dr. Raffaele Marfella — a cardiology researcher in the University of Campania Luigi Vanvitelli’s department of advanced medical and surgical sciences in Naples, Italy, and the lead author of the new study — said that he and his colleagues initiated the study to look for new risk factors for cardiovascular disease . 

They knew of the enormous amount of degraded plastic pollution contaminating the planet and wondered “whether plastic, in the form of micro- or nanoplastics, could also degrade our arteries,” Marfella said in an email. People can inhale and ingest the plastic particles. The plastic can also enter the body through skin.

To study the effects, they turned to a group of patients already scheduled to undergo surgery for a condition called carotid artery stenosis, in which plaque , or fatty deposits, blocks normal blood flow. The body’s two carotid arteries supply blood to the brain, face and neck. The researchers looked at plaque removed from 257 patients and tracked the patients’ health for an average of 34 months following the surgery. 

They found plastic particles — mostly nanoplastics — in the plaque of 150 patients. At follow-up, nonfatal heart attack, nonfatal stroke or death from any cause occurred in 20% of those patients and in 7.5% of the patients without detectable plastic particles.

After adjusting for age, sex, body mass index and health conditions such as diabetes and abnormal cholesterol, the patients with detectable levels of plastics had “nearly a five times greater risk of a cardiovascular event” than the other patients, Marfella said.  

Numerous experimental studies on cells and in animals have shown that the presence of these plastic particles increases diseases. One study published online in February in the Journal of Hazardous Materials found microplastics, for the first time, in human arteries. 

Previous studies finding the tiny particles in human tissue were “pioneering,” said Dick Vethaak, a biologist and toxicologist at Utrecht University’s Institute for Risk Assessment Sciences and coordinator of the Dutch Microplastics and Human Health Consortium, but this study “is the first of its kind.” 

“It is the first one that looked at a large number of donors in so much detail” and the first to follow patients for years to track their health, said Vethaak, who wasn’t involved with the new study. 

However, this kind of observational study can show only an association between the plastic particles and heart attack, stroke or death. It cannot show that they caused these cardiovascular events. For that, researchers would need to conduct a randomized, controlled trial, but it would be unethical to intentionally expose people to potential toxins.

Nevertheless, the study offers some hints about the relationship between the presence of micro- and nanoplastics and heart disease, said Dr. Martha Gulati, director of preventive cardiology in the Smidt Heart Institute at Cedars-Sinai in Los Angeles.

“We know that cardiovascular disease, particularly myocardial infarction, is usually triggered by an inflammatory response ,” Gulati said, using another term for heart attack. The Italian researchers measured markers for inflammation in patients and found that those markers increased as the level of plastics in the plaque rose. 

Still, “is the inflammation due to the nanoplastics or something else?” Gulati asked.

Because the study was carried out in a very specific group of patients, the results cannot be applied to the broader population. But it could pave the way for future studies. 

“This paper might provoke people to figure out if we can measure micro- and nanoplastics in the general population and then examine who goes on to develop cardiac events,” Gulati said. 

Vethaak said similar studies are in the pipeline for other kinds of human tissue.

The researchers also noted the possibility that the plaque samples could have been  contaminated in the lab. 

“Future studies performed with the use of clean rooms, where there is no plastic in any form except the material under study, might corroborate our observations,” they wrote in the paper.

“I hope that this study, and more work that it triggers, helps us address our environment and cardiovascular health because I feel like this is something that really needs to be discussed,” Gulati said. “It gets very little attention.”

Barbara Mantel is an NBC News contributor. She is also the topic leader for freelancing at the Association of Health Care Journalists, writing blog posts, tip sheets and market guides, as well as producing and hosting webinars. Barbara’s work has appeared in CQ Researcher, AARP, Undark, Next Avenue, Medical Economics, Healthline, Today.com, NPR and The New York Times.