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BACKGROUND This research integrates a comparative analysis of the performance of human researchers and OpenAI's ChatGPT in systematic review tasks and an assessment of the application of Natural Language Processing (NLP) models in clinical practice through a review of five studies. OBJECTIVE The objective of this study is dual: to evaluate the reliability between ChatGPT and human researchers in extracting key information from clinical articles, and to investigate the practical use of NLP in clinical settings as evidenced by selected studies. METHODS The study design comprised a systematic review of clinical articles executed independently by human researchers and ChatGPT. The level of agreement between and within raters for parameter extraction was assessed using Fleiss' and Cohen's kappa statistics. RESULTS The comparative analysis revealed a high degree of concordance between ChatGPT and human researchers for most parameters, with less agreement for study design, clinical task, and clinical implementation. The review identified five significant studies that demonstrated the diverse applications of NLP in clinical settings. The findings from these studies highlighted the potential of NLP to improve clinical efficiency and patient outcomes in various contexts, from enhancing allergy detection and classification to improving quality metrics in psychotherapy treatments for veterans with PTSD. CONCLUSIONS The results underscore the potential of NLP models, including ChatGPT, in performing systematic reviews and other clinical tasks. Despite certain limitations, NLP presents a promising avenue for enhancing healthcare efficiency and accuracy. Future research should concentrate on broadening the range of clinical applications and exploring the ethical considerations of using NLP in healthcare settings. CLINICALTRIAL PROSPERO: CRD42023401683

Zusammenfassung Hintergrund Die interdisziplinäre Versorgung von polytraumatisierten PatientInnen ist personal- und ressourcenaufwendig. Seit der Einführung des G‑DRG-Systems 2003 in Deutschland wurde in den meisten Untersuchungen ein finanzielles Defizit in der Schwerstverletztenversorgung festgestellt. Ziel dieser Studie war es, Auswirkungen des 2020 neu eingeführten aG-DRG-Systems auf die Kostendeckung in der Schwerverletztenbehandlung zu analysieren. Erstmals wurden auch die Kosten für Organisation, Zertifizierung und Dokumentation sowie die Kosten für nicht schwer verletzte SchockraumpatientInnen betrachtet. Methodik Eingeschlossen wurden alle PatientInnen, die im Jahr 2017 im chirurgischen Schockraum der Zentralen Notaufnahme des Universitätsklinikums Leipzig behandelt wurden. Für die Analyse wurden das Kostenmodell nach Pape et al. um die Module Organisation, Dokumentation und Zertifizierung ergänzt sowie die Kosten für „übertriagierte“ PatientInnen betrachtet. Es erfolgte die Berechnung der Kosten in den Jahren 2017–2020 im Vergleich der jeweiligen Erlöse. Ergebnisse Es wurden 834 PatientInnen im Schockraum behandelt. Die 258 schwer verletzten PatientInnen wurden in 3 Gruppen untergliedert: „ISS 9–15 + ITS“ (n 72; ∅ ISS 11,9; Kosten/PatientIn 14.715 €), „ISS ≥ 16“ (n 186; ∅ ISS 27,7; Kosten/PatientIn 30.718 €) und „DRG-Polytrauma“ (n 59; ∅ ISS 32,4; Kosten/PatientIn 26.102 €). Schlussfolgerung Die Polytraumaversorgung im aG-DRG 2020 ist defizitär. Insgesamt entstand im Jahr 2020 ein Defizit von 5858 € pro schwer verletztem/verletzter PatientIn.

Despite various treatment attempts, the heterogenous group of soft tissue sarcomata (STS) with more than 100 subtypes still shows poor outcomes. Therefore, effective biomarkers for prognosis prediction and personalized treatment are of high importance. The Procollagen-Lysine, 2-Oxoglutarate 5-Dioxygenase (PLOD) gene family, which is related to multiple cancer entities, consists of three members which encode important enzymes for the formation of connective tissue. The relation to STS, however, has not yet been explored. In this study, data from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases were used to analyze the role of PLOD1–3 in STS. It was found that an overexpression of PLOD family members correlates with poor prognosis, which might be due to an increased infiltration of immune-related cells in the tumor microenvironment. In STS, the expression of PLOD genes could be a novel biomarker for prognosis and a personalized, more aggressive treatment in these patients.

Simple Summary Soft tissue sarcomas (STS) are a group of rare malignant tumors with high tissue heterogeneity and poor prognosis, and which are still without effective individualized immunotherapy approaches. In this study, four potential tumor antigens, six STS immune subtypes, and six functional gene modules were identified. The different immune subtypes have different molecular, cellular, and clinical characteristics. The superiority of mRNA vaccine therapies has been demonstrated during the current pandemic as well as in tumor vaccine studies, and the present study provides guidance for future mRNA vaccine development. Furthermore, in future individualized immunotherapies for STS, it is possible to select different immunotherapies based on the different immune subtypes identified in this study. In fact, the immune subtypes identified in this study explain, to some extent, the failure of immunotherapy for certain STS subtypes in previous clinical trials, and facilitate further understanding of strategy selection for the immunotherapy of STS. To our knowledge, this is the first study to address STS mRNA vaccine development and immunophenotyping. This study provides a theoretical framework for STS mRNA vaccine development and the selection of patients for vaccination and provides a reference for promoting individualized immunotherapy. Abstract Soft tissue sarcomas (STS) are a rare disease with high recurrence rates and poor prognosis. Missing therapy options together with the high heterogeneity of this tumor type gives impetus to the development of individualized treatment approaches. This study identifies potential tumor antigens for the development of mRNA tumor vaccines for STS and explores potential immune subtypes, stratifying patients for immunotherapy. RNA-sequencing data and clinical information were extracted from 189 STS samples from The Cancer Genome Atlas (TCGA) and microarray data were extracted from 103 STS samples from the Gene Expression Omnibus (GEO). Potential tumor antigens were identified using cBioportal, the Oncomine database, and prognostic analyses. Consensus clustering was used to define immune subtypes and immune gene modules, and graph learning-based dimensionality reduction analysis was used to depict the immune landscape. Finally, four potential tumor antigens were identified, each related to prognosis and antigen-presenting cell infiltration in STS: HLTF, ITGA10, PLCG1, and TTC3. Six immune subtypes and six gene modules were defined and validated in an independent cohort. The different immune subtypes have different molecular, cellular, and clinical characteristics. The immune landscape of STS reveals the immunity-related distribution of patients and intra-cluster heterogeneity of immune subtypes. This study provides a theoretical framework for STS mRNA vaccine development and the selection of patients for vaccination, and provides a reference for promoting individualized immunotherapy.

The overexpression of the enzymes involved in the degradation of procollagen lysine is correlated with various tumor entities. Procollagen-lysine, 2-oxoglutarate 5-dioxygenase 3 (PLOD3) expression was found to be correlated to the progression and migration of cancer cells in gastric, lung and prostate cancer. Here, we analyzed the gene expression, protein expression, and the clinical parameters of survival across 33 cancers based on the Clinical Proteomic Tumor Analysis Consortium (CPTAC), function annotation of the mammalian genome 5 (FANTOM5), Gene Expression Omnibus (GEO), Genotype-Tissue Expression (GTEx), Human Protein Atlas (HPA) and The Cancer Genome Atlas (TCGA) databases. Genetic alteration, immune infiltration and relevant cellular pathways were analyzed in detail. PLOD3 expression negatively correlated with survival periods and the infiltration level of CD8+ T cells, but positively correlated to the infiltration of cancer associated fibroblasts in diverse cancers. Immunohistochemistry in colon carcinomas, glioblastomas, and soft tissue sarcomas further confirm PLOD 3 expression in human cancer tissue. Moreover, amplification and mutation accounted for the largest proportion in esophageal adenocarcinoma and uterine corpus endometrial carcinoma, respectively, the copy number alteration of PLOD3 appeared in all cancers from TCGA, and molecular mechanisms further proved the effect of PLOD3 on tumorigenesis. In particular, PLOD3 expression appears to have a tumor immunological effect, and is related to multiple immune cells. Furthermore, it is also associated with tumor mutation burden and microsatellite instability in various tumors. PLOD3 acts as an inducer of various cancers, and it could be a potential biomarker for prognosis and targeted treatment.

BACKGROUND During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCCs) have been established at several hospitals across Germany with the intention to assist local health care professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals and therefore to prevent the collapse of local health system structures. In addition, these centers coordinate interhospital transfers of patients with COVID-19 and provide or arrange specialized telemedical consultations. OBJECTIVE This study describes the establishment and management of a CCCC at a German university hospital. METHODS We performed economic analyses (cost, cost-effectiveness, use, and utility) according to the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria. Additionally, we conducted a systematic review to identify publications on similar institutions worldwide. The 2 months with the highest local incidence of COVID-19 cases (December 2020 and January 2021) were considered. RESULTS During this time, 17.3 requests per day were made to the CCCC regarding admission or transfer of patients with COVID-19. The majority of requests were made by emergency medical services (601/1068, 56.3%), patients with an average age of 71.8 (SD 17.2) years were involved, and for 737 of 1068 cases (69%), SARS-CoV-2 had already been detected by a positive polymerase chain reaction test. In 59.8% (639/1068) of the concerned patients, further treatment by a general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% (291/1068) of patients were admitted to normal wards, and 12.9% (138/1068) were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than €52,000 (US $60,031) per month. Of the 334 patients with detected SARS-CoV-2 who were referred via EMS or outpatient physicians, 302 (90.4%) were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found. CONCLUSIONS Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefits of the CCCC are that it prevents hospitals from being overrun by patients and that it avoids situations in which physicians must weigh one patient’s life against another’s.

Background and objectives Texture analysis derived from morphological magnetic resonance (MR) images might be associated with histopathology in tumors. The present study sought to elucidate possible associations between texture features derived from T1-and T2-weighted images with proliferation index Ki67 in soft tissue sarcomas. Methods Overall, 29 patients (n = 13, 44.8% female) with a median age of 52 years were included into this retrospective study. Several soft tissue sarcomas were investigated. Texture analysis was performed on pre-contrast T1-weighted and T2-weighted images using the free available Mazda software. Results The best correlation coefficients with Ki67 index were identified for the following parameters: T1-weighted images “45dgr_RLNonUni (p = 0.50, P = 0.006), T2-weighted images “S (4,0)SumAverg” (p = −0.45, P = 0.02). A ROC analysis was performed for Ki67-index with a threshold of 10%. The highest area under the curve (AUC) was found for the parameter “T1_WavEnHL_s-7” with an AUC of 0.90. For the threshold of Ki67 = 20% the highest AUC was identified for the parameter „T2_S (1,1)Entropy” with an AUC of 0.77. Conclusion Several texture features derived from T1-and T2-weighted images correlated with proliferation index Ki67 and might be used as valuable novel biomarkers in soft tissue sarcomas.

The interdisciplinary care of severely injured patients is staff and resource intensive. Since the introduction of the G‑DRG system in Germany in 2003, most studies have identified a financial deficit in the care of severely injured patients. The aim of this study was to analyze the effects of the new aG-DRG system introduced in 2020 on cost recovery in the treatment of severely injured patients. For the first time, the costs for organization, certification and documentation as well as the costs for non-seriously injured shock room patients were included.All patients who were treated in the surgical shock room of the emergency department of the Leipzig University Hospital in 2017 were included. For the analysis, the cost model according to Pape et al. was extended by the module organization, documentation and certification and for the first time the costs for overtriaged patients were considered. A cost calculation was performed for the years 2017-2020 as well a comparison with the respective earnings.A total of 834 patients were treated in the shock room and 258 severely injured patients were divided into 3 groups: ISS 9-15 + ICU (n 72; ∅ ISS 11.9; costs per patient 14,715 €),ISS ≥ 16 (n 186; ∅ ISS 27.7; costs per patient 30,718 €) and DRG polytrauma (n 59; ∅ ISS 32.4; costs per patient 26,102 €).Polytrauma care under the aG-DRG 2020 is in deficit. Overall, in 2020 a deficit of 5858 € per severely injured patient resulted.HINTERGRUND: Die interdisziplinäre Versorgung von polytraumatisierten PatientInnen ist personal- und ressourcenaufwendig. Seit der Einführung des G‑DRG-Systems 2003 in Deutschland wurde in den meisten Untersuchungen ein finanzielles Defizit in der Schwerstverletztenversorgung festgestellt. Ziel dieser Studie war es, Auswirkungen des 2020 neu eingeführten aG-DRG-Systems auf die Kostendeckung in der Schwerverletztenbehandlung zu analysieren. Erstmals wurden auch die Kosten für Organisation, Zertifizierung und Dokumentation sowie die Kosten für nicht schwer verletzte SchockraumpatientInnen betrachtet.Eingeschlossen wurden alle PatientInnen, die im Jahr 2017 im chirurgischen Schockraum der Zentralen Notaufnahme des Universitätsklinikums Leipzig behandelt wurden. Für die Analyse wurden das Kostenmodell nach Pape et al. um die Module Organisation, Dokumentation und Zertifizierung ergänzt sowie die Kosten für „übertriagierte“ PatientInnen betrachtet. Es erfolgte die Berechnung der Kosten in den Jahren 2017–2020 im Vergleich der jeweiligen Erlöse.Es wurden 834 PatientInnen im Schockraum behandelt. Die 258 schwer verletzten PatientInnen wurden in 3 Gruppen untergliedert: „ISS 9–15 + ITS“ (n 72; ∅ ISS 11,9; Kosten/PatientIn 14.715 €), „ISS ≥ 16“ (n 186; ∅ ISS 27,7; Kosten/PatientIn 30.718 €) und „DRG-Polytrauma“ (n 59; ∅ ISS 32,4; Kosten/PatientIn 26.102 €).Die Polytraumaversorgung im aG-DRG 2020 ist defizitär. Insgesamt entstand im Jahr 2020 ein Defizit von 5858 € pro schwer verletztem/verletzter PatientIn.

Gastric and esophagogastric junction cancers are heterogeneous and aggressive tumors with an unpredictable response to cytotoxic treatment. New methods allowing for the analysis of drug resistance are needed. Here, we describe a novel technique by which human tumor specimens can be cultured ex vivo, preserving parts of the natural cancer microenvironment. Using a tissue chopper, fresh surgical tissue samples were cut in 400 μm slices and cultivated in 6‐well plates for up to 6 days. The slices were processed for routine histopathology and immunohistochemistry. Cytokeratin stains (CK8, AE1/3) were applied for determining tumor cellularity, Ki‐67 for proliferation, and cleaved caspase‐3 staining for apoptosis. The slices were analyzed under naive conditions and following 2–4 days in vitro exposure to 5‐FU and cisplatin. The slice culture technology allowed for a good preservation of tissue morphology and tumor cell integrity during the culture period. After chemotherapy exposure, a loss of tumor cellularity and an increase in apoptosis were observed. Drug sensitivity of the tumors could be assessed. Organotypic slice cultures of gastric and esophagogastric junction cancers were successfully established. Cytotoxic drug effects could be monitored. They may be used to examine mechanisms of drug resistance in human tissue and may provide a unique and powerful ex vivo platform for the prediction of treatment response.

Adipose tissue plays a pivotal role, both in the regulation of energy homeostasis and as an endocrine organ. Consequently, adipose tissue dysfunction is closely related to insulin resistance, morbid obesity, and metabolic syndrome. To study molecular mechanisms and to develop novel therapeutic strategies, techniques are required to genetically modify mature adipocytes. Here, we report on adeno-associated viral (AAV) vectors as a versatile tool to transduce human mature adipocytes in organotypic three-dimensional tissue cultures.