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Purpose: This study aims to investigate the effects of language selection and translation quality on Generative Pre-trained Transformer-4 (GPT-4)'s response accuracy to expert-level diagnostic radiology questions., Materials and Methods: We analyzed 146 diagnostic radiology questions from the Japan Radiology Board Examination (2020-2022), with consensus answers provided by two board-certified radiologists. The questions, originally in Japanese, were translated into English by GPT-4 and DeepL and into German and Chinese by GPT-4. Responses were generated by GPT-4 five times per question set per language. Response accuracy was compared between languages using one-way ANOVA with Bonferroni correction or the Mann-Whitney U test. Scores on selected English questions translated by a professional service and GPT-4 were also compared. The impact of translation quality on GPT-4's performance was assessed by linear regression analysis., Results: The median scores (interquartile range) for the 146 questions were 70 (68-72) (Japanese), 89 (84.5-95.5) (GPT-4 English), 64 (55.5-67) (Chinese), and 56 (46.5-67.5) (German). Significant differences were found between Japanese and English (p = 0.002) and between Japanese and German (p = 0.022). The counts of correct responses across five attempts for each question were significantly associated with the quality of translation into English (GPT-4, DeepL) and German (GPT-4). In a subset of 31 questions where English translations yielded fewer correct responses than Japanese originals, professionally translated questions yielded better scores than those translated by GPT-4 (13 versus 8 points, p = 0.0079)., Conclusion: GPT-4 exhibits higher accuracy when responding to English-translated questions compared to original Japanese questions, a trend not observed with German or Chinese translations. Accuracy improves with higher-quality English translations, underscoring the importance of high-quality translations in improving GPT-4's response accuracy to diagnostic radiology questions in non-English languages and aiding non-native English speakers in obtaining accurate answers from large language models., (© 2024. The Author(s).)

Background: Previous research on the changes in resting-state functional connectivity (rsFC) in anorexia nervosa (AN) has been limited by an insufficient sample size, which reduced the reliability of the results and made it difficult to set the whole brain as regions of interest (ROIs)., Methods: We analyzed functional magnetic resonance imaging data from 114 female AN patients and 135 healthy controls (HC) and obtained self-reported psychological scales, including eating disorder examination questionnaire 6.0. One hundred sixty-four cortical, subcortical, cerebellar, and network parcellation regions were considered as ROIs. We calculated the ROI-to-ROI rsFCs and performed group comparisons., Results: Compared to HC, AN patients showed 12 stronger rsFCs mainly in regions containing dorsolateral prefrontal cortex (DLPFC), and 33 weaker rsFCs primarily in regions containing cerebellum, within temporal lobe, between posterior fusiform cortex and lateral part of visual network, and between anterior cingulate cortex (ACC) and thalamus ( p < 0.01, false discovery rate [FDR] correction). Comparisons between AN subtypes showed that there were stronger rsFCs between right lingual gyrus and right supracalcarine cortex and between left temporal occipital fusiform cortex and medial part of visual network in the restricting type compared to the binge/purging type ( p < 0.01, FDR correction)., Conclusion: Stronger rsFCs in regions containing mainly DLPFC, and weaker rsFCs in regions containing primarily cerebellum, within temporal lobe, between posterior fusiform cortex and lateral part of visual network, and between ACC and thalamus, may represent categorical diagnostic markers discriminating AN patients from HC.

Aim: Atezolizumab and bevacizumab (Atezo/Bev) combination immunotherapy regimens and direct oral anticoagulants (DOACs) are both associated with bleeding. Therefore, combining Atezo/Bev regimens with DOACs may exacerbate the bleeding risk. This study investigated the feasibility of the Atezo/Bev regimen in patients taking DOACs., Methods: This retrospective study included 141 patients with unresectable hepatocellular carcinoma (HCC) or advanced lung cancer (LC) treated with Atezo/Bev regimens. Patients who used antithrombotic agents other than DOACs were excluded. Bleeding events during the Atezo/Bev regimen were analyzed., Results: The incidence rates of bleeding of any grade in the DOAC (n = 11) and no antithrombotic agent (NAA) (n = 130) groups were 9.1% and 10.8%, respectively, with no significant differences. Moreover, no significant difference was found in the frequency of bleeding of grade ≥3 between the DOAC and NAA groups. No patients in the DOAC group discontinued the Atezo/Bev regimen because of severe bleeding. Although serum albumin levels, with a hazard ratio (HR) of 0.298 (95% confidence interval [CI]: 0.105-0.847), independently contributed to bleeding events (p = 0.023), DOAC administration did not (HR: 1.357; 95% CI: 0.157-10.54; p = 0.770). Among only patients with HCC (n = 59), none of the five patients taking DOACs experienced bleeding events. A high albumin-bilirubin score (HR: 9.083, 95% CI: 1.118-73.76) was associated with bleeding events (p = 0.039)., Conclusions: DOACs did not have a considerable effect on bleeding events in the Atezo/Bev regimens for HCC or LC. Under careful surveillance for bleeding, Atezo/Bev regimens may be feasible in patients receiving DOACs., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Background: The Kerlan-Jobe Orthopedic Clinic (KJOC) questionnaire is a self-reported performance and functional assessment tool with good reliability and validity for overhead athletes with shoulder and elbow injuries. This study aimed to develop a Japanese version of the KJOC (J-KJOC) to clarify its reproducibility and validity for use by Japanese university baseball players., Methods: The J-KJOC was translated according to the guidelines for cross-cultural adaptation. A total of 88 university baseball players completed the J-KJOC and the Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaires. Thirty players completed the J-KJOC two times after a median interval of two weeks. We assessed the absolute reliability, construct validity, internal consistency, and test-retest reliability., Results: Cronbach's alpha coefficients ranged from 0.88 and the intraclass correlation coefficient for the total score was 0.91. A fixed bias was absent in the J-KJOC scores (mean difference: -2.2, 95% CI: -4.8 to 0.5). Furthermore, the J-KJOC score was correlated with the Q-DASH-disability/symptom (r = -0.60, p<0.01) and Q-DASH-sports/music (r = -0.63, p<0.01) scores but not correlated with the Q-DASH-work score (r = -0.11, p = 0.316)., Conclusions: The J-KJOC questionnaire demonstrated good reproducibility and validity for assessing upper arm performance in Japanese university baseball players. The results of this study support the use of the J-KJOC for Japanese-speaking baseball players. Further research using this instrument on other types of overhead athletes is needed to determine its wider utility in sports medicine applications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Sasagawa et al.)

Background: The Square Stepping Exercise (SSE) is an exercise training program that integrates physical exercise and cognitive elements and can be conducted in a group setting. The potential of SSE in delaying cognitive decline in older adults is promising. However, the coronavirus pandemic has made it more difficult for older adults worldwide to exercise together in person. To address this issue, this study conducted a wholistic evaluation of the effects of a center-based hybrid SSE trial on cognitive, physical, psychological, and group functioning in sedentary older adults., Methods: A total of 93 older adults (19 men, 74 women) participated in the study. Fifty-eight participants (9 men, 49 women) completed center-based hybrid SSE sessions over 12 weeks under coronavirus pandemic circumstances, whereas other 35 participants in the control group maintained their current level of daily activities. Cognitive functions focused on executive functions assessed by the Stroop Color-Word Test (inhibition) and the Trail Marking Test (TMT) (set-shifting). Psychological and group functioning were assessed by the Subjective Vitality Scale and the Physical Activity Group Environment Questionnaire. Physical function was evaluated by measuring gait speeds. A repeated ANOVA was conducted on the measured variables separately for the intervention and control groups to focus on the change of participant's performance over data collection points., Results: Outcomes of the Stroop Color-Word Test and the TMT revealed that the hybrid SSE was highly effective in improving executive function. Stroop performance (correct trials) was significantly improved in the incongruent condition, as well as both TMT-A and -B over the intervention period in the intervention group. The hybrid SSE was also beneficial to improve physical (gait speed at usual pace and at the maximum pace) as well as psychological functioning (subjective vitality). Furthermore, SSE participants reported increased engagement with the SSE task, social communication, and increased bonding and closeness with their group members through the hybrid SSE., Conclusions: In this study, hybrid SSE was found to be effective in enhancing cognitive, physical, psychological, and group functioning in sedentary older adults. The findings of this study are crucial to provide older adults with a safer and efficient option to exercise., (© 2024. The Author(s).)

Although brain morphological abnormalities have been reported in anorexia nervosa (AN), the reliability and reproducibility of previous studies were limited due to insufficient sample sizes, which prevented exploratory analysis of the whole brain as opposed to regions of interest (ROIs). Objective was to identify brain morphological abnormalities in AN and the association with severity of AN by brain structural magnetic resonance imaging (MRI) in a multicenter study, and to conduct exploratory analysis of the whole brain. Here, we conducted a cross-sectional multicenter study using T1-weighted imaging (T1WI) data collected between May 2014 and February 2019 in Japan. We analyzed MRI data from 103 female AN patients (58 anorexia nervosa restricting type [ANR] and 45 anorexia nervosa binge-purging type [ANBP]) and 102 age-matched female healthy controls (HC). MRI data from five centers were preprocessed using the latest harmonization method to correct for intercenter differences. Gray matter volume (GMV) was calculated from T1WI data of all participants. Of the 205 participants, we obtained severity of eating disorder symptom scores from 179 participants, including 87 in the AN group (51 ANR, 36 ANBP) and 92 HC using the Eating Disorder Examination Questionnaire (EDE-Q) 6.0. GMV reduction were observed in the AN brain, including the bilateral cerebellum, middle and posterior cingulate gyrus, supplementary motor cortex, precentral gyrus medial segment, and thalamus. In addition, the orbitofrontal cortex (OFC), ventromedial prefrontal cortex (vmPFC), rostral anterior cingulate cortex (ACC), and posterior insula volumes showed positive correlations with severity of symptoms. This multicenter study was conducted with a large sample size to identify brain morphological abnormalities in AN. The findings provide a better understanding of the pathogenesis of AN and have potential for the development of brain imaging biomarkers of AN. Trial Registration: UMIN000017456. https://center6.umin.ac.jp/cgi-open-bin/icdr/ctr&#95;view.cgi?recptno=R000019303 ., (© 2023. The Author(s).)

Validation of biomarker assays is crucial for effective drug development and clinical applications. Interlaboratory reproducibility is vital for reliable comparison and combination of data from different centers. This review summarizes interlaboratory studies of quantitative LC-MS-based biomarker assays using reference standards for calibration curves. The following points are discussed: trends in reports, reference and internal standards, evaluation of analytical validation parameters, study sample analysis and normalization of biomarker assay data. Full evaluation of these parameters in interlaboratory studies is limited, necessitating further research. Some reports suggest methods to address variations in biomarker assay data among laboratories, facilitating organized studies and data combination. Method validation across laboratories is crucial for reducing interlaboratory differences and reflecting target biomarker responses.

Background: Good nutrition, regular physical activity, and adequate sleep are important for promoting health. However, it is not well characterized how these lifestyle behaviours are associated with mood at the start of school days., Aim: To identify the weekday health-related behaviours (breakfast intake, physical activity, and sleep) of Singaporean adolescents and explore their associations with mood at the beginning of the school morning., Methods: 365 adolescents (52.3% boys, 47.7% girls) aged 14-19 years ( M  = 16.9, SD  = 1.3 years) completed a survey set on breakfast habits, physical activity participation, sleep duration, and mood., Results: More than one-third (38.6%) of participants never (15.0%) or irregularly (23.6%) consumed breakfast on weekdays. Adolescents consuming breakfast irregularly reported significantly higher negative mood scores than regular breakfast consumers ( p  = .002; d  = .404). Almost two-thirds (64.1%) of adolescents did <60 min of moderate-to-vigorous physical activity (MVPA) on weekdays and reported lower positive morning mood scores than those who ≥60 min of MVPA ( p  = .014; d  = .284). Although most (88.3%) adolescents slept <8 h each night, sleep duration was not related to either positive mood or negative mood., Conclusion: The present study suggests that eating breakfast on a regular basis and completing for ≥60 min of weekday MVPA are useful behaviours to start school days in a better mood. Parents and health educators should recognise the importance of establishing these habits and support students by instigating practical approaches so they can achieve a regular breakfast intake and physical activity engagement., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ciguatoxins (CTXs) are neurotoxins responsible for ciguatera poisoning (CP), which affects more than 50,000 people worldwide annually. The development of analytical methods to prevent CP is a pressing global issue, and the N2a assay is one of the most promising methods for detecting CTXs. CTXs are highly toxic, and an action level of 0.01 μg CTX1B equivalent (eq)/kg in fish has been proposed. It is desirable to further increase the detection sensitivity of CTXs in the N2a assay to detect such low concentrations reliably. The opening of voltage-gated sodium channels (Na V channels) and blocking of voltage-gated potassium channels (K V channels) are thought to be involved in the toxicity of CTXs. Therefore, in this study, we developed an assay that could detect CTXs with higher sensitivity than conventional N2a assays, using K V channel inhibitors as sensitizing reagents for N2a cells. The addition of the K V channel inhibitors 4-aminopyridine and tetraethylammonium chloride to N2a cells, in addition to the traditional sensitizing reagents ouabain and veratridine, increased the sensitivity of N2a cells to CTXs by up to approximately 4-fold. This is also the first study to demonstrate the influence of K V channels on the toxicity of CTXs in a cell-based assay.

Background: Prevention of pitching-related elbow pain in youth baseball players is important. Overhead pitching involves a whole-body motion, including head-neck rotation. A limited range of motion of head-neck rotation may cause inefficient pitching motion; however, this association is unclear., Purpose: To determine whether the range of motion of head-neck rotation is associated with the history of pitching-related elbow pain in youth baseball players., Study Design: Cross-sectional study; Level of evidence, 3., Methods: A total of 311 youth baseball players were selected and asked to complete a questionnaire survey about their age, weight, height, sex, baseball experience, main position, pitching side, and previous/current elbow pain during pitching. The range of motion of the upper and lower limb joints, head-neck rotation, and thoracic kyphosis angle were measured. Binomial logistic regression analysis was used to identify factors associated with the history of elbow pain related to pitching., Results: There were 101 players with a history of pitching-related elbow pain (history group) and 142 players with no pitching-related elbow pain (no-history group). The history group had significantly lower values than the no-history group regarding the range of motion of head-neck rotation on the nondominant side (74.9°± 9° vs 77.7°± 9.6°; P = .02) and overall head-neck rotation (150.6°± 14.7° vs 154.9°± 18.4°; P = .04). Binomial logistic regression analysis identified head-neck rotation on the nondominant side (odds ratio [OR], 0.97 [95% CI, 0.94-1.00]), shoulder horizontal adduction on the dominant side (OR, 0.98 [95% CI, 0.96-1.00]), height (OR, 1.04 [95% CI, 1.00-1.08]), and playing position (pitcher) (OR, 0.40 [95% CI, 0.21-0.76]) as factors associated with a history of pitching-related elbow pain., Conclusion: Our cross-sectional analysis demonstrated that youth baseball players with a history of pitching-related elbow pain had limited head-neck rotation range of motion on the nondominant side, and this was a significant factor associated with the history of pitching-related elbow pain., (© The Author(s) 2024.)

Objective: A phosphorylcholine (PC)-derivative with high binding ability (PCDB) was intranasally administered to mice with ovalbumin (OVA), and immune responses were investigated to determine whether PCDB has antigenicity and adjuvanticity., Methods: BALB/c mice were intranasally immunized with PCDB coupled with OVA, unbound PCDB plus OVA, cholera toxin (CT) plus OVA, OVA alone, and PCDB alone. Then, the production of OVA- and PC-specific antibodies in external secretions and serum, and the secretion of cytokines such as IL-4 and IFN-γ from splenic mononuclear cells by stimulation with PCDB and OVA were examined. Furthermore, the secretion of IL-12p40 from CD11c + cells following stimulation with PCDB was observed to clarify the adjuvant effect of PCDB through TLR4., Results: Intranasal immunization with PCDB plus OVA increased OVA- and PC-specific IgA in external secretions and OVA- and PC-specific antibodies in the serum. The analysis of IgG subclasses specific to OVA and PC showed a higher production of IgG1 than IgG2, and the secretion of both IL-4 and IFN-γ was enhanced. However, IL-12p40 secretion from CD11c + cells was increased and OVA-specific IgE production was not promoted by PCDB stimulation., Conclusion: Intranasal administration of the protein antigen with PCDB enhanced immune responses specific to the mixed antigen and PC. Although PCDB acted to bias the immune response toward the Th2-type, antigen-specific IgE production did not increase. These findings suggest that PCDB has the potential to be a mucosal vaccine with both adjuvanticity and antigenicity without causing side effects due to type I allergy., (Copyright © 2023. Published by Elsevier B.V.)

Purpose: Herein, we assessed the accuracy of large language models (LLMs) in generating responses to questions in clinical radiology practice. We compared the performance of ChatGPT, GPT-4, and Google Bard using questions from the Japan Radiology Board Examination (JRBE)., Materials and Methods: In total, 103 questions from the JRBE 2022 were used with permission from the Japan Radiological Society. These questions were categorized by pattern, required level of thinking, and topic. McNemar's test was used to compare the proportion of correct responses between the LLMs. Fisher's exact test was used to assess the performance of GPT-4 for each topic category., Results: ChatGPT, GPT-4, and Google Bard correctly answered 40.8% (42 of 103), 65.0% (67 of 103), and 38.8% (40 of 103) of the questions, respectively. GPT-4 significantly outperformed ChatGPT by 24.2% (p < 0.001) and Google Bard by 26.2% (p < 0.001). In the categorical analysis by level of thinking, GPT-4 correctly answered 79.7% of the lower-order questions, which was significantly higher than ChatGPT or Google Bard (p < 0.001). The categorical analysis by question pattern revealed GPT-4's superiority over ChatGPT (67.4% vs. 46.5%, p = 0.004) and Google Bard (39.5%, p < 0.001) in the single-answer questions. The categorical analysis by topic revealed that GPT-4 outperformed ChatGPT (40%, p = 0.013) and Google Bard (26.7%, p = 0.004). No significant differences were observed between the LLMs in the categories not mentioned above. The performance of GPT-4 was significantly better in nuclear medicine (93.3%) than in diagnostic radiology (55.8%; p < 0.001). GPT-4 also performed better on lower-order questions than on higher-order questions (79.7% vs. 45.5%, p < 0.001)., Conclusion: ChatGPTplus based on GPT-4 scored 65% when answering Japanese questions from the JRBE, outperforming ChatGPT and Google Bard. This highlights the potential of using LLMs to address advanced clinical questions in the field of radiology in Japan., (© 2023. The Author(s).)

This study investigated the effects of the timing of caffeine (3 mg/kg body mass) ingestion on three-point shooting accuracy and other performance parameters during a basketball exercise simulation test (BEST). Eighteen college basketball players (mean ± SD: age = 24.4 ± 1.5 years, height = 181.7 ± 9.5 cm, body mass = 80.9 ± 13.2 kg) underwent one familiarization trial and three main conditions in a randomized order: (a) placebo (maltodextrin) and placebo, (b) caffeine and placebo, and (c) placebo and caffeine. Participants ingested either the placebo or caffeine pill 75 and 15 min before performing four quarters of the BEST and a three-point shooting protocol. During each quarter, participants completed 16 rounds of the BEST and ten three-point shots. Vertical jump height, 6 m sprint timing, BEST completion timing, three-point shooting accuracy, heart rate, rate of perceived exertion, blood glucose, blood lactate, and psychological measures pertaining to performance were measured. The BEST completion timing differed among conditions (placebo and placebo = 26.4 ± 2.0 s, caffeine and placebo = 25.8 ± 2.0 s, placebo and caffeine = 25.9 ± 2.1 s; p = .031) but not three-point shooting accuracy (placebo and placebo = 12.33 ± 4.10; caffeine and placebo = 12.61 ± 2.81; placebo and caffeine = 11.67 ± 3.77; p = .648), vertical jump height, or sprint times. Manipulating ingestion timing of caffeine did not improve three-point shooting accuracy, vertical jump height, or 6 m sprint timings, but caffeine can improve performance times during simulated basketball exercise irrespective of ingestion timing.

Background: Although several reports have examined the association between preoperative function and postoperative outcomes in patients undergoing total hip arthroplasty (THA), it is unclear whether the ability of the affected or non-affected side particularly impacts on outcomes. We aimed to investigate the association between affected and non-affected side ability and walking independence., Methods: We prospectively enrolled 721 consecutive patients who underwent THA. Preoperatively, quadriceps isometric strength (QIS) and one-leg standing time (OLST) were measured. The endpoints were walking independence within 3, 5, 7, 10, and 14 days postoperatively. The associations between preoperative abilities and outcomes were examined using multivariate Cox hazard model, and the area under the curves (AUCs) for outcomes were compared., Results: We analysed 540 patients after excluding patients who met the exclusion criteria. Both affected and non-affected QIS predicted walking independence within 3 ( p   =  0.006 and 0.001, respectively), 5, 7, 10, and 14 (both p   <  0.001) days postoperatively. For OLST, only the affected side did not predict walking independence within 3 days postoperatively ( p   =  0.154 and 0.012, respectively), and both sides did at days 5 ( p   =  0.019 and <0.001, respectively), 7, 10, and 14 (both p   <  0.001). The AUCs of the non-affected side ability for walking independence were significantly greater than those of the affected side on postoperative days 3 (0.66 vs. 0.73; p   =  0.021) and 5 (0.67 vs. 0.71; p   =  0.040), with no significant difference after day 7., Conclusions: Both sides abilities were associated with walking independence after THA, but non-affected side was found to be particularly crucial for early walking independence., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.