95th Percentile Research Articles

Zero-shot image segmentation for monitoring thermal conditions of individual cage-free laying hens

Body temperature is a critical indicator of the health and productivity of egg-laying chickens and other domesticated animals. Recent advancements in thermography allow for precise surface temperature measurement without physical contact with animals, reducing animal stress from human handling. Gold standard temperature analysis via thermography requires manual selection of limited points for an object of interest, which could be time-consuming and inadequate for representing the comprehensive thermal profile of a chicken’s body. The objective of this study was to leverage and optimize a zero-shot artificial intelligence technology for the automatic segmentation of individual cage-free laying hens within thermal images, providing insights into their overall thermal conditions. A zero-shot image segmentation model (Segment Anything, “SAM”) was modified by replacing manual selections of target points with automatic selection of the initial point using pre-processing techniques (e.g., thresholding) in each thermal image. The model was also incorporated with post-processing techniques integrated with a machine learning classifier to improve segmentation accuracy. Three versions of modified SAM models (i.e., SAM, FastSAM, and MobileSAM), two common instance segmentation algorithms (i.e., YOLOv8 and Mask R-CNN), and two foundation segmentation models (i.e., U2-Net and ISNet) were comparatively evaluated to determine the optimal one for bird segmentation from thermal images. A total of 1,917 thermal images were collected from cage-free laying hens (Hy-Line W-36) at 77–80 weeks of age. The image dataset exhibited considerable variations such as feathers, bird movement, body gestures, and the specific conditions of cage-free facilities. The experimental results demonstrate that the modified SAM did not only surpass the six zero-shot models—YOLOv8, Mask R-CNN, FastSAM, MobileSAM, U2Net, and ISNet—but also outperformed other modified SAM-based models (Modified FastSAM and Modified MobileSAM) in terms of hen detection performance, achieving a success rate of 84.4 %, and in segmentation performance, with an intersection over union of 85.5 %, recall of 91.0 %, and an F1 score of 92.3 %. The optimal model, modified SAM, was pipelined to extract statistics including the averages (°C) of mean (27.03, 27.04, 28.53, 26.68), median (26.27, 26.84, 28.28, 26.78), 25th percentile (25.33, 25.61, 27.26, 25.53), and 75th percentile (28.04, 27.95, 29.22, 27.55) of surface body temperature of individual laying hens in thermal images for each week. More statistics of hen body surface temperature can be extracted based on the segmentation results. The developed pipeline is a useful tool for automatically evaluating the thermal conditions of individual birds.

Results and implications for generative AI in a large introductory biomedical and health informatics course

Generative artificial intelligence (AI) systems have performed well at many biomedical tasks, but few studies have assessed their performance directly compared to students in higher-education courses. We compared student knowledge-assessment scores with prompting of 6 large-language model (LLM) systems as they would be used by typical students in a large online introductory course in biomedical and health informatics that is taken by graduate, continuing education, and medical students. The state-of-the-art LLM systems were prompted to answer multiple-choice questions (MCQs) and final exam questions. We compared the scores for 139 students (30 graduate students, 85 continuing education students, and 24 medical students) to the LLM systems. All of the LLMs scored between the 50th and 75th percentiles of students for MCQ and final exam questions. The performance of LLMs raises questions about student assessment in higher education, especially in courses that are knowledge-based and online.

Association between temperature and occupational injuries in Spain: The role of contextual factors in workers’ adaptation

BackgroundExtensive evidence links both cold and hot temperatures to an increased incidence of occupational injuries. Contextual modifiers of the temperature-injury association have been scarcely researched. The present study addresses temporal and spatial variations to identify factors associated with (mal)adaptation to heat and cold among Spanish workers. MethodsWe assessed the association between daily mean temperature and work injuries using quasi-Poisson time-series regression models in 48 Spanish provinces over the period 1988–2019, with comparative analyses with census and economic data for the sub-periods 1989–1993, 1999–2003, 2009–2013 and 2015–2019. We explored the spatial and spatiotemporal modification of the association by demographic and socioeconomic variables via cross-sectional and longitudinal meta-regressions. Findings:We found an increased risk of work-injuries by 4 % [95 % CI: 3 %-6 %] and 12 % [95 % CI: 10 %-13 %], for the 1st and 99th percentiles of temperature, respectively, for period 1988–2019. Heat had a greater overall impact than cold, and the groups more vulnerable to heat were male workers, under 35 years, and working in agriculture, construction and hostelry. Vulnerability to heat was highest in the earliest sub-period, while vulnerability to cold rose during periods of both economic expansion and recession. High educational attainment emerged as a protective factor during the warm months in the cross-sectional meta-regressions. ConclusionsOur findings suggest an adaptation of Spanish workers to high temperatures over time. However, preventive measures are needed for traditionally exposed workers (agriculture and construction), non-traditionally vulnerable sectors (hostelry), and young, male, and less educated workers during warm months. For cold vulnerability, targeted measures should focus on women, the elderly, and tertiary service workers, especially in colder regions. Addressing temperature vulnerability would enhance worker safety, reduce injuries, and yield economic benefits.

Insulin-like growth factor-1 deficiency caused by hepatocellular adenoma leads to growth arrest, primary amenorrhea and metabolic syndrome: a case report and 4 years follow up

BackgroundHepatocellular adenoma (HCA) is a rare benign neoplasm, seldom ascribed as the cause of endocrine and metabolic derangement. We herein report a case of primary amenorrhea, growth arrest and metabolic syndrome. En bloc resection of the tumor normalized all the disturbances.Case presentationA 16-year-old girl complained of primary amenorrhea and growth arrest for the past 2 years. Her height and weight were at the 3rd percentile, whereas waist circumference was at the 90th percentile for chronological age. She was hypertensive on admission. Plasma cholesterol, triglyceride and uric acid were elevated. Evaluation of GH/IGF-1 axis showed extremely low IGF-1 concentration, which was unresponsive to hGH stimulation. Computer tomography identified a huge liver mass (18.2 cm×13.7 cm×21 cm). The patient underwent an uneventful open right hepatic lobectomy. The tumor was en bloc resected. Immunohistochemistry indicated an unclassified HCA, which was confirmed by genetic screening. IGF-1 concentration, blood pressure, lipid profile and ovarian function were all normalized after surgery, and the girl had reduction in waist circumference and gain in height during the follow up.ConclusionWe provide evidence that liver-derived IGF-1 has a direct effect on skeletal and pubertal development, blood pressure, visceral adiposity and dyslipidemia independent of insulin resistance and obesity in the circumstance of undernutrition. Though rare, we propose the need to look into HCA cases for the existence of IGF-1 deficiency and its impact on metabolic derangement.

A - 42 Exploring Emotional Regulation Difficulties and Achievement-Oriented Parental Psychological Control as the Moderators of the Association between Academic Enablers and Academic Skills in Hispanic Adolescents

Abstract Objective This study explored how emotional regulation difficulties and parental psychological control (achievement-oriented) moderate the association between academic enablers (motivation, engagement, study skills, interpersonal skills) and academic skills (reading, writing, mathematics, critical thinking). Method Responses from 157 adolescents (average age = 12, 63% Hispanic, 46% female) using the Academic Competence Evaluation Scales, the Difficulties in Emotional Regulation Scale, and the Achievement-Oriented Psychological Control measure were analyzed using the PROCESS macro conditional analysis model 3 in R (Hayes, 2013). Results Results indicated that emotional regulation moderated the association between academic enablers and academic skills and that this moderation was further moderated by psychological control, F(7, 149) = 63.5, p < 0.00. Specifically, the academic enablers-skills association was stronger for adolescents experiencing higher emotional regulation difficulties and psychological control, Tb7 = 0.0046. Probing the interaction using a modified pick-a-point approach revealed that the conditional effect of the interaction between academic enablers and emotional regulation difficulties on academic skills was significant at the 84th percentile of psychological control, θXW → Y|(Z = 3.11) = 0.0076, p = 0.0075. Alternatively, probing the interaction using the Johnson-Neyman technique revealed that the conditional effect of the interaction between academic enablers and emotional regulation difficulties on academic skills was significant when parental psychological control was greater than or equal to 2.49. Conclusions The study highlights the importance of academic enablers in skill development, especially for adolescents who experience moderate to high emotional regulation difficulties and parental pressure to succeed. Targeted interventions to improve adolescents’ emotional regulation capabilities and lessen controlling parent–child dynamics could be crucial.

First-Trimester Cell-Free DNA Fetal Fraction and Birth Weight in Twin Pregnancies.

The relationship between fetal fraction and birth weight in twin gestations is poorly understood. To investigate the relationship between first trimester cfDNA fetal fraction and birth weight < 10th percentile in twin gestations. This is a planned secondary analysis of the Twin cfDNA Study, a 17-center retrospective cohort of twin pregnancies screened for aneuploidy using cfDNA in the first trimester from 12/2011 - 2/2022, excluding those with positive screen results for chromosomal aneuploidy. CfDNA testing was performed by a single lab using massively parallel sequencing (MPSS). Baseline characteristics and birth weight of pregnancies with normal fetal fraction were compared to those with low (<5%) and high (>95%) fetal fraction using univariable analyses and multivariable regression. A total of 1041 twin pregnancies were included. Chronic hypertension, elevated BMI, and self-identified Black race were associated with fetal fraction <5th percentile. There was no difference in median fetal fraction between those with birth weight <10th percentile in at least one twin (median [IQR] fetal fraction 12.2% [9.8, 14.8] versus those with normal birth weight (10th percentile) in both twins (median [IQR] fetal fraction 12.3% [9.7, 15.2] for normal birth weight, p = 0.49). There was no association between high or low fetal fraction and birth weight <10th percentile for one (p=0.45) or both (p=0.81) twins, and there was no association between high or low fetal fraction and birth weight <5th percentile for one (p=0.44) or both (p=0.74) twins. The results were unchanged after adjustment for potential confounders. In this large cohort, there was no association between the extremes of cfDNA fetal fraction and birthweight < 10th percentile, suggesting that first trimester fetal fraction may not predict impaired fetal growth in twin gestations.

Development of a breast cancer risk prediction model integrating monogenic, polygenic, and epidemiologic risk.

Breast cancer has been associated with monogenic, polygenic, and epidemiologic (clinical, reproductive and lifestyle) risk factors, but studies evaluating the combined effects of these factors have been limited. We extended previous work in breast cancer risk modeling, incorporating pathogenic variants (PV) in six breast cancer predisposition genes and a 105-SNP polygenic risk score (PRS), to include an epidemiologic risk score (ERS) in a sample of non-Hispanic White women drawn from prospective cohorts and population-based case-control studies, with 23,518 cases and 22,832 controls, from the Cancer Risk Estimates Related to Susceptibility (CARRIERS) Consortium. The model predicts 4.4-fold higher risk of breast cancer for postmenopausal women with no predisposition PV and median PRS, but with the highest versus lowest ERS. Overall, women with CHEK2 PVs had >20% lifetime risk of breast cancer. However, 15.6% of women with CHEK2 PVs and a family history of breast cancer, and 45.1% of women with CHEK2 PVs but without a family history of breast cancer, had low (<20%) predicted lifetime risk and thus were below the threshold for MRI screening. CHEK2 PV carriers at the 10th percentile of the joint distribution of ERS and PRS, without a family history of breast cancer, had a predicted lifetime risk similar to the general population. These results illustrate that an ERS, alone and combined with the PRS, can contribute to clinically relevant risk stratification. Integrating monogenic, polygenic, and epidemiologic risk factors in breast cancer risk prediction models may inform personalized screening and prevention efforts.

A comparison of climate drivers’ impacts on silage maize yield shock in Germany

AbstractExtreme weather events have become more frequent and severe with ongoing climate change, with a huge implication for the agricultural sector and detrimental effects on crop yield. In this study, we compare several combinations of climate indices and utilized the Least Absolute Shrinkage and Selection Operator (LASSO) to explain the probabilities of substantial drops in silage maize yield (here defined as “yield shock” by using a 15th percentile as threshold) in Germany between 1999 and 2020. We compare the variable importance and the predictability skill of six combinations of climate indices using the Matthews Correlation Coefficient (MCC). Finally, we delve into year-to-year predictions by comparing them against the historical series and examining the variables contributing to high and low predicted yield shock probabilities. We find that cold conditions during April and hot and/or dry conditions during July increase the chance of silage maize yield shock. Moreover, a combination of simple variables (e.g. total precipitation) and complex variables (e.g. cumulative cold under cold nights) enhances predictive accuracy. Lastly, we find that the years with higher predicted yield shock probabilities are characterized mainly by relatively hotter and drier conditions during July compared to years with lower yield shock probabilities. Our findings enhance our understanding of how weather impacts maize crop yield shocks and underscore the importance of considering complex variables and using effective selection methods, particularly when addressing climate-related events.

Risk Factors for Natural Cause Mortality in Schizophrenia

Schizophrenia is associated with premature mortality from mostly natural causes. Decreased cognitive functioning has been identified as a determinant of mortality in the general population. However, there have been few prospective studies of this issue in persons with schizophrenia. To examine whether lower cognitive functioning is a risk factor for natural cause mortality in schizophrenia. This prospective cohort study included persons with schizophrenia or schizoaffective disorder enrolled between February 1, 1999, and December 31, 2022, at a nonprofit psychiatric system in Baltimore, Maryland. Participants were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and other clinical measures. Natural cause mortality. Associations of cognitive function, obesity, tobacco smoking, and medical conditions with natural cause mortality were evaluated using Cox proportional hazards regression models. Of the 844 participants enrolled (mean [SD] age, 39.6 [12.1] years; 533 male [63.2%]), 158 (18.7%) died of natural causes during a median follow-up of 14.4 years (range, 7.0 days to 23.9 years). The most significant factor associated with mortality was lower cognitive functioning as measured by the RBANS (Cox coefficient, -0.04; 95% CI, -0.05 to -0.03; z = -5.72; adjusted P < .001). Additional factors independently associated with mortality included the diagnosis of an autoimmune disorder (hazard ratio [HR], 2.86; 95% CI, 1.83-4.47; z = 4.62; adjusted P < .001), tobacco smoking (HR, 2.26; 95% CI, 1.55-3.30; z = 4.23; adjusted P < .001), diagnosis of chronic obstructive pulmonary disease (HR, 3.31; 95% CI, 1.69-6.49; z = 3.48; adjusted P = .006), body mass index as a continuous variable (HR, 1.06; 95% CI, 1.02-1.09; z = 3.30; adjusted P = .01), diagnosis of a cardiac rhythm disorder (HR, 2.56; 95% CI, 1.40-4.69; z = 3.06; adjusted P = .02), and being divorced or separated (HR, 1.80; 95% CI, 1.22-2.65; z = 2.97; adjusted P = .02). An RBANS score below the 50th percentile displayed a joint association with being a smoker, having an elevated body mass index, and having a diagnosis of an autoimmune or a cardiac rhythm disorder. In this prospective cohort study, lower cognitive functioning was a risk factor for natural cause mortality in schizophrenia. Efforts should be directed at methods to improve cognitive functioning, particularly among individuals with additional risk factors.

Correlation of anogenital distance from childhood to age 9 years—a prospective population-based birth cohort—the odense child cohort

Abstract STUDY QUESTION Does anogenital distance (AGD) – distance from the anus to the genitals—correlate from infancy (3 months) to the age of 9 years in boys and girls? SUMMARY ANSWER In boys, AGD correlated from infancy to 9 years of age, whereas in girls, correlations were weaker, especially between infancy and later childhood. WHAT IS KNOWN ALREADY AGD is considered a marker for prenatal androgen action. In males, reduced AGD is associated with testicular cancer, infertility and lower sperm count. In females, AGD is associated with endometriosis and PCOS. STUDY DESIGN, SIZE, DURATION In the Odense Child Cohort, a prospective population-based birth cohort, pregnant women were enrolled in early pregnancy. AGD and BMI were measured repeatedly in the children at ages 3 and 18 months, as well as at 3, 5, 7, and 9 years. PARTICIPANTS/MATERIALS, SETTING, METHODS AGD was measured from the anus to the scrotum (AGDas) and to the penis (AGDap) in 1,022 boys, and to the posterior fourchette (AGDaf) and the clitoris (AGDac) in 887 girls repeatedly between the age of 3 months to 9 years. In total 7,706 assessments were made. AGD was adjusted for body weight and SD scores (the difference between individual AGD and the mean of AGD in the population divided by standard deviation (SD) of AGD) were calculated for each child. Pearson correlation coefficient (r) of each measurement was performed to investigate whether individual AGD was stable during childhood. Short predictive values at 3 months (20th percentile) to 9 years were investigated using the AUC produced by the Receiver Operating Characteristic (ROC) curve. MAIN RESULTS AND THE ROLE OF CHANCE In boys, AGD/body size-index SD score correlated significantly between infancy and 9 years, strongest for AGDas (r = 0.540 p &amp;gt; 0.001). In girls, weaker significant correlation coefficients were found between AGD at infancy and 9 years; higher correlation coefficients were found between AGD from 3 to 9 years (p &amp;gt; 0.001). Short AGDas in infancy predicted short AGDas in boys aged 9 years (AUC: 0.767, sensitivity 0.71, specificity 0.71). The predictive values of short infant AGDap, penile width (in boys), and AGD (girls) concerning short outcomes at 9 years were low. LIMITATIONS, REASONS FOR CAUTION The AGD measurements are less precisely measurable in girls compared to boys, especially in infancy, resulting in less reproducible measurements. Additionally, because AGD is shorter in girls, the same absolute measurement error is relatively more significant, potentially contributing to greater variability and lower reproducibility in girls. This may contribute to the weaker correlations in girls compared to boys. WIDER IMPLICATIONS OF THE FINDINGS In boys, AGDas relative to body size correlated from infancy to 9 years, suggesting that AGD in infancy can be considered a non-invasive marker of later reproductive health. Further follow up studies are needed to evaluate long-term individual tracking of AGD as well as assessment of childhood AGD as early marker of adult reproductive health. STUDY FUNDING/COMPETING INTERESTS This study was supported by Odense University Hospital, Denmark, the Region of Southern Denmark, The Municipality of Odense, Denmark, The University of Southern Denmark, Odense Patient data Exploratory Network (OPEN), Denmark, The Danish Research Council (4004-00352B_FSS), Novo Nordisk Foundation, Denmark (grant no. NNF19OC0058266 and NNF17OC0029404), Sygeforsikring Danmark (journalnr. 2021-0173), The Collaborative foundation between Odense University Hospital and Rigshospitalet, Helsefonden. There is no conflict of interest of any author that could be perceived as prejudicing the impartiality of the research reported. TRIAL REGISTRATION NUMBER N/A

Neurodevelopmental imprints of sociomarkers in adolescent brain connectomes

Neural consequences of social disparities are not yet rigorously investigated. How socioeconomic conditions influence children’s connectome development remains unknown. This paper endeavors to gauge how precisely the connectome structure of the brain can predict an individual’s social environment, thereby inversely assessing how social influences are engraved in the neural development of the Adolescent brain. Utilizing Adolescent Brain and Cognition Development (ABCD) data (9099 children residing in the United States), we found that social conditions both at the household and neighborhood levels are significantly associated with specific neural connections. Solely with brain connectome data, we train a linear support vector machine (SVM) to predict socio-economic conditions of those adolescents. The classification performance generally improves when the thresholds of the advantageous and disadvantageous environments compartmentalize the extreme cases. Among the tested thresholds, the 20th and 80th percentile thresholds using the dual combination of household income and neighborhood education yielded the highest Area Under the Precision-Recall Curve (AUPRC) of 0.8224. We identified 8 significant connections that critically contribute to predicting social environments in the parietal lobe and frontal lobe. Insights into social factors that contribute to early brain connectome development is critical to mitigate the disadvantages of children growing up in unfavorable neighborhoods.

Childhood PM2.5 exposure and upward mobility in the United States

Although it is well documented that exposure to fine particulate matter (PM 2.5 ) increases the risk of several adverse health outcomes, less is known about its relationship with economic opportunity. Previous studies have relied on regression modeling, which implied strict assumptions regarding confounding adjustments and did not explore geographical heterogeneity. We obtained data for 63,165 US census tracts (86% of all census tracts in the United States) on absolute upward mobility (AUM) defined as the mean income rank in adulthood of children born to families in the 25th percentile of the national income distribution. We applied and compared several state-of-the-art confounding adjustment methods to estimate the overall and county-specific associations of childhood exposure to PM 2.5 and AUM controlling for many census tract–level confounders. We estimate that census tracts with a 1 μg/m 3 higher PM 2.5 concentrations in 1982 are associated with a statistically significant 1.146% (95% CI: 0.834, 1.458) lower AUM in 2015, on average. We also showed evidence that this relationship varies spatially between counties, exhibiting a more pronounced negative relationship in the Midwest and the South.

Development of a Nutrient Profiling Model for Processed Foods in Japan.

Numerous nutrient profiling models (NPMs) exist worldwide, but Japan lacks an official NPM. Using the Australian and New Zealand Health Star Rating (HSR) as a reference, "Processed Foods in Japan version 1.0" (NPM-PFJ (1.0)) was developed to fit Japanese food culture and policies. In total, 668 processed foods from the Standard Tables of Food Composition in Japan were analyzed, excluding seasonings/spices, fats/oils, alcoholic beverages, and infant food. The NPM-PFJ (1.0) scoring algorithm was adapted from HSR, with revised reference values for energy, saturated fat, total sugars, sodium, protein, and dietary fiber in alignment with Japanese standards. Reference values for fruits, vegetables, nuts, and legumes (fvnl) remained unchanged. Median scores were 4.5 for HSR and 5.0 for NPM-PFJ (1.0), showing high correlation (r = 0.939, p < 0.01). Thereafter, food categories familiar and meaningful in Japan were defined based on a hierarchical cluster analysis of scoring patterns, creating six categories with distinct characteristics. Finally, the rating algorithm for NPM-PFJ (1.0) was created using each group's score distribution (10th percentile). The NPM-PFJ (1.0) was developed through a fully transparent and evidence-based process and is expected to facilitate the reformulation of food products by food industries and help consumers easily access healthier processed foods. This model marks a significant step forward in developing an NPM tailored to Japanese food culture and health policies, with the potential to enhance public health.

First trimester maternal serum PAPP-A and free β-hCG levels and risk of SGA or LGA in women with and without GDM

BackgroundMaternal gestational diabetes (GDM), small (SGA) and large (LGA) for gestational age neonates are associated with increased morbidity in both mother and child. We studied how different levels of first trimester pregnancy associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotropin (fβ-hCG) were associated with SGA and LGA in GDM pregnancies and controls.MethodsAltogether 23 482 women with singleton pregnancies participated in first trimester combined screening and delivered between 2014 and 2018 in Northern Finland and were included in this retrospective case-control study. Women with GDM (n = 4697) and controls without GDM (n = 18 492) were divided into groups below 5th and 10th or above 90th and 95th percentile (pc) PAPP-A and fβ-hCG MoM levels. SGA was defined as a birthweight more than two standard deviations (SD) below and LGA more than two SDs above the sex-specific and gestational age-specific reference mean. Odds ratios were adjusted (aOR) for maternal age, BMI, ethnicity, IVF/ICSI, parity and smoking.ResultsIn pregnancies with GDM the proportion of SGA was 2.6% and LGA 4.5%, compared to 3.3% (p = 0.011) and 1.8% (p < 0.001) in the control group, respectively. In ≤ 5th and ≤ 10th pc PAPP-A groups, aORs for SGA were 2.7 (95% CI 1.5–4.7) and 2.2 (95% CI 1.4–3.5) in the GDM group and 3.8 (95% CI 3.0–4.9) and 2.8 (95% CI 2.3–3.5) in the reference group, respectively. When considering LGA, there was no difference in aORs in any high PAPP-A groups. In the low ≤ 5 percentile fβ-hCG MoM group, aORs for SGA was 2.3 (95% CI 1.8–3.1) in the control group. In fβ-hCG groups with GDM there was no association with SGA and the only significant difference was ≥ 90 percentile group, aOR 1.6 (95% CI 1.1–2.5) for LGA.ConclusionAssociation with low PAPP-A and SGA seems to be present despite GDM status. High PAPP-A levels are not associated with increased LGA risk in women with or without GDM. Low fβ-hCG levels are associated with SGA only in non-GDM pregnancies.

Prompt engineering to increase GPT3.5’s performance on the Plastic Surgery In-Service Exams

This study assesses ChatGPT's (GPT-3.5) performance on the 2021 ASPS Plastic Surgery In-Service Examination using prompt modifications and Retrieval Augmented Generation (RAG). ChatGPT was instructed to act as a "resident," "attending," or "medical student," and RAG utilized a curated vector database for context. Results showed no significant improvement, with the "resident" prompt yielding the highest accuracy at 54%, and RAG failing to enhance performance, with accuracy remaining at 54.3%. Despite appropriate reasoning when correct, ChatGPT's overall performance fell in the 10th percentile, indicating the need for fine-tuning and more sophisticated approaches to improve AI's utility in complex medical tasks.

Trends in Body Mass Index Among Individuals With Neurodevelopmental Disorders

Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are increasingly common. Individuals with NDDs have heightened obesity risks, but long-term data on body mass index (BMI) trends over time in this population are lacking. To assess secular BMI changes from 2004 to 2020 among children with NDDs compared with those without NDDs. This repeated cross-sectional study used data from the Child and Adolescent Twin Study in Sweden. Children born between January 1, 1992, and December 31, 2010, were screened for neurodevelopmental symptoms using the Autism-Tics, ADHD, and Other Comorbidities inventory between July 2004 and April 2020 when they were 9 or 12 years of age. Data analysis was conducted between September 27, 2023, and January 30, 2024. BMI percentiles (15th, 50th, and 85th) were modeled using quantile regression and compared between youths with and without NDDs. Secular changes in BMI percentiles over time spanning 2004 to 2020 were evaluated and stratified by NDD subtype. The cohort included 24 969 Swedish twins (12 681 [51%] boys) born between 1992 and 2010, with mean (SD) age of 9 (0.6) years. Of these, 1103 (4%) screened positive for 1 or more NDDs, including ADHD, ASD, and/or learning disability. Results indicated that at the 85th BMI percentile, there was a greater increase in BMI from 2004 to 2020 among youths with NDDs compared with those without NDDs (β for interaction [βint] between NDD status and time, 1.67; 95% CI, 0.39-2.90). The greatest divergence was seen for ASD (βint, 2.12; 95% CI, 1.26-3.70) and learning disability (βint, 1.92; 95% CI, 0.65-3.82). Within the latest cohort (2016-2020), the 85th BMI percentile was 1.99 (95% CI, 1.08-2.89) points higher among children with NDDs compared with those without NDDs. In this repeated cross-sectional study, at the higher end of the BMI distribution, children with NDDs had significantly greater increases in BMI compared with peers without NDDs over a 16-year period, highlighting an increasing risk of overweight over time in youths with NDDs compared with those without NDDs. Targeted obesity prevention efforts for this high-risk population are needed.

Active longevity and aging: dissecting the impacts of physical and sedentary behaviors on longevity and age acceleration.

To examine the associations of physical activity (PA) and sedentary behavior (SB) with longevity and age acceleration (AA) using observational and Mendelian randomization (MR) studies, and quantify the mediating effects of lipids. In Guangzhou Biobank Cohort Study (GBCS), PA and SB were assessed by the Chinese Version of the International Physical Activity Questionnaire. Longevity was defined as participants whose age at follow-up or at death was at or above the 90th age percentile. AA was defined as the residual resulting from a linear model that regressed phenotypic age against chronological age. Linear regression and Poisson regression with robust error variance were used to assess the associations of total and specific PA in different intensities, and SB with AA and longevity, yielding βs or relative risks (RRs) and 95% confidence intervals (CIs). Two-sample MR was conducted to examine the causal effects. Mediation analysis was used to assess the mediating effects of lipids. Of 20,924 participants aged 50 + years in GBCS, during an average follow-up of 15.0years, compared with low PA, moderate and high PA were associated with higher likelihood of longevity (RR (95% CI): 1.56 (1.16, 2.11), 1.66 (1.24, 2.21), respectively), and also cross-sectionally associated with lower AA (β (95% CI): -1.43 (-2.41, -0.45), -2.09 (-3.06, -1.11) years, respectively). Higher levels of moderate PA (MPA) were associated with higher likelihood of longevity and lower AA, whereas vigorous PA (VPA) showed opposite effects. The association of PA with longevity observed in GBCS was mediated by low-density lipoprotein cholesterol (LDL-C) by 8.23% (95% CI: 3.58-39.61%), while the association with AA was mediated through LDL-C, triglycerides and total cholesterol by 5.13% (3.94-7.30%), 7.81% (5.98-11.17%), and 3.37% (2.59-4.80%), respectively. Additionally, in two-sample MR, SB was positively associated with AA (β (95% CI): 1.02 (0.67, 1.36) years). PA showed protective effects on longevity and AA, with the effects being partly mediated through lipids. Conversely, SB had a detrimental impact on AA. MPA was associated with higher likelihood of longevity and reduced AA, whereas VPA showed adverse effects. Our findings reinforce the recommendation of "sit less and move more" to promote healthy longevity, and highlight the potential risks associated with VPA in the elderly.

Establishment of cutoff values for anti-β2 glycoprotein I antibodies in women of reproductive age in Southwest China

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by vascular thrombosis and obstetric morbidity, with accurate laboratory examination of antiphospholipid antibodies (aPLs) being crucial for diagnosis. This study focused on anti-β2 glycoprotein I (aβ2GPI) antibodies and aimed to establish the first population-based cutoff values for aβ2GPI IgA/IgM/IgG antibodies in non-pregnant women of reproductive age in Southwest China. The study cohort comprised 181 healthy women of reproductive age for study. Blood samples were collected on an early morning fast. Anti-β2GPI antibodies including IgA, IgM and IgG were measured in serum using the HOB® BioCLIA kit. According to the Clinical and Laboratory Standards Institute (CLSI) guidelines, the study used non-parametric percentile methods to calculate the 95th, 97.5th, and 99th percentiles cutoff values for aβ2GPI IgA/IgM/IgG antibodies, along with corresponding 90% confidence intervals (CI), while excluding outliers. A total of 168 independent samples were collected for verification, including 85 samples from healthy subjects and 83 samples from APS patients, in order to evaluate the analytical performance of the obtained cutoff values. The 99th percentile cutoff values were 3.36 RU/mL for aβ2GPI IgA, 27.54 RU/mL for aβ2GPI IgM and 1.81 RU/mL for aβ2GPI IgG, which indicated that the levels of aβ2GPI IgM antibodies were generally higher compared to those of IgA and IgG antibodies. Our established reference range was confirmed to be successful in validating the detected values of aβ2GPI antibodies in all healthy controls. With the 99th percentile cutoff value, the sensitivity was 14.46% for aβ2GPI IgA, 22.89% for aβ2GPI IgG, and 9.64% for aβ2GPI IgM in APS patients. This study established population-based cutoff values that are applicable to the local population for the accurate laboratory examination of aβ2GPI antibodies in non-pregnant women of reproductive age. The study also recommends paying more attention to IgM positivity in women of reproductive age.

High serum progesterone levels on the day of embryo transfer in patients undergoing artificial frozen-thawed blastocyst transfer: Is there a ceiling effect?

To evaluate the potential ceiling effect of high serum progesterone levels on the day of embryo transfer for pregnancy outcomes in patients undergoing artificial frozen-thawed blastocyst transfer (FET) cycles. This retrospective cohort study included 595 patients who underwent artificial FET cycles. We evaluated progesterone levels and found that 40.6 ng/mL corresponded to the 90th percentile and 23.9 ng/mL corresponded to the 50th percentile. Based on these findings, we categorized progesterone levels as <20 ng/mL (n=220, 37.0%), 20-40 ng/mL (n=312, 52.4%), and ≥40 ng/mL (n=63, 10.6%). The primary outcome measures were the clinical pregnancy rate (CPR) and live birth rate (LBR). Blastocyst morphology grades, including expansion, trophectoderm, and inner cell mass grades, were significantly associated with clinical pregnancy (p<0.001 for all). Progesterone levels between 20 and 40 ng/mL were associated with higher CPR (p=0.043). In the multivariate analysis, only blastocyst expansion and inner cell mass grades were independently and significantly associated with CPR [p=0.011, odds ratio (OR)=1.6, (confidence interval) CI 95%=1.13-2.39, and p=0.007, OR=1.65, CI 95%=1.14-2.39, respectively]. The progesterone level and trophectoderm grade were not statistically significant. Regarding LBR, only blastocyst expansion grades 4 and trophectoderm grades A or B were significantly associated. Based on these data, we speculate that if serum progesterone levels exceed 40 ng/mL on the day of embryo transfer in patients undergoing artificial FET cycles, there is no need to reduce the progesterone dose.

Semaphorin 3F (SEMA3F) influences patient survival in esophageal adenocarcinoma

In esophageal adenocarcinoma, the presence of lymph node metastases predicts patients' survival even after curative resection. Currently, there is no highly accurate marker for detecting the presence of lymph node metastasis. The SEMA3F/NRP2 axis was initially characterized in axon guidance and recent evidence has revealed its significant involvement in lymphangiogenesis, angiogenesis, and carcinogenesis. Hence, the objective of this study was to elucidate the roles of SEMA3F and its receptor NRP2 in esophageal adenocarcinoma. We conducted an immunohistochemical evaluation of SEMA3F and NRP2 protein expression in 776 patients with esophageal adenocarcinoma who underwent Ivor-Lewis esophagectomy at the University Hospital of Cologne. Total and positive cancer cell counts were digitally analyzed using QuPath and verified by experienced pathologists to ensure accuracy. Positive expression was determined as a cell percentage exceeding the 50th percentile threshold. In our cohort, patients exhibiting SEMA3F positive expression experience significantly lower pT- and pN-stages. In contrast, positive NRP2 expression is associated with the presence of lymph node metastases. Survival analyses showed that the expression status of NRP2 had no impact on patient survival. However, SEMA3F positivity was associated with a favorable patient survival outcome (median OS: 38.9 vs. 26.5 months). Furthermore, SEMA3F could be confirmed as an independent factor for better patient survival in patients with early tumor stage (pT1N0-3: HR = 0.505, p = 0.014, pT1-4N0: HR = 0.664, p = 0.024, pT1N0: HR = 0.483, p = 0.040). In summary, SEMA3F emerges as an independent predictor for a favorable prognosis in patients with early-stage esophageal adenocarcinoma. Additionally, NRP2 expression is linked to a higher risk of lymph node metastases occurrence. We hypothesize that low SEMA3F expression could identify patients with early-stage tumors who might benefit from more aggressive treatment options or intensified follow-up. Furthermore, SEMA3F and its associated pathways should be explored as potential tumor-suppressing agents.