Journal of investigative medicine : the official publication of the American Federation for Clinical Research
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Immunotherapy with checkpoint inhibitors has improved the outcomes of patients with metastatic lung cancer in recent years. Despite improved prognosis, not all patients respond to treatment. Therapeutic interventions to build on the success of immune checkpoint inhibitors are needed. ⋯ Palliative radiation therapy administered in proximity with immune checkpoint inhibitors immunotherapy had no effect on the OS of metastatic lung cancer patients. However, patients receiving palliative radiotherapy with fractions above 700 cGy showed better OS. Further studies are needed to optimize a combination strategy.
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After completing medical school in the United States, most students apply to residency programs in order to progress in their training. The residency application process contains numerous writing sections, including the personal statement, curriculum vitae, and "impactful experiences" section. This study's purpose is to investigate the perception of third and fourth year medical students on generative artificial intelligence (GenAI) and its influence on the residency application process. ⋯ More than half of survey participants believe that in the future, GenAI may alter the significance program directors place on letters of recommendation (LORs) in their selection criteria for deciding who to interview and select. Our survey results indicate that a number of students are either using or are receptive to the idea of using GenAI to draft or refine certain components of their residency application, such as the personal statement and impactful experiences section. As the application of GenAI expands, in-person interactions in the evaluation of candidates may become increasingly critical, and although personal statements and LORs are currently significant components of the residency application, their future roles remain a question.
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This study examined inflammatory bowel disease (IBD) trends over the last 10 years, including their nationwide patterns, and the outcomes of the utilization of total parental nutrition (TPN). Nationwide inpatient sample (NIS) database from 2010 to 2020, was used to identify IBD hospitalization and discharges and investigate outcomes, including in-hospital mortality and hospital resource utilization. The hospitalizations for IBD combining both Crohn's disease (CD) and ulcerative colitis (UC) initially noted a rising trend until 2016 followed by a decreasing trend with statistical significance (p < 0.001). ⋯ The combined use of TPN in IBD showed a decreased trend from 5.9 to 4.3% with statistical significance (p < 0.001). There is a decline in the trend in TPN usage in both CD and UC. The hospital costs and malnutrition trend has increased, while the inpatient mortality, length of stay, and TPN use decreased over the year.
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Comparative Study
Normal saline vs balanced intravenous fluids in acute ischemic stroke: A retrospective study.
While some studies have suggested better outcomes for critically ill patients with balanced solutions over normal saline, the best type of intravenous fluid to use for stroke patients remains unknown. Using a retrospective chart review of 2015-2019 Get with the Guidelines® data at a single academic medical center, this study sought to determine whether balanced solutions or normal saline are associated with risk of hemorrhagic transformation or 90-day disability in patients with acute ischemic stroke treated with intravenous thrombolysis. Exposure was the type of intravenous fluid and outcomes were modified Rankin scale (mRS) ≤2 at 90 days and hemorrhagic transformation. ⋯ In multivariate analysis, exposure to a balanced solution at any time was associated with increased 90-day disability (OR 6.3, 95% CI 2.4-17.0, p < 0.01), but not hemorrhagic transformation. Thus, this observational trial demonstrated that exposure to balanced solutions is associated with an increased risk of disability at 90 days and possibly hemorrhagic transformation in patients with acute ischemic stroke treated with intravenous thrombolysis. This data would suggest that normal saline is a preferred solution in these patients, though larger future trials are needed.
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Endocrine disruptive chemicals (EDCs) are considered as the potential attributes for the increasing trend in obesity and metabolic syndrome (MS) through disruption of sex hormones, particularly in women. We evaluated the association of understudied EDC compounds with total testosterone (TT), sex hormone-binding globulin (SHBG), obesity, and MS. A population-based cross-sectional study was conducted using the National Health and Nutrition Examination Survey datasets collected during the years 2013-2016. ⋯ In addition, high exposure to triclosan was also inversely associated with SHBG concentrations (regression coefficient = -0.09; 95% CI: -0.15, -0.02, p = 0.013). However, these EDCs were found to be associated with SHBG, obesity, and MS according to menopausal status. High exposure to certain nonpersistent EDCs was associated with low SHBG, obesity, and MS according to menopausal status.