Publications

BACKGROUND: YouTube is an open-access platform increasingly used for both medical and patient education, but its user-generated content is not subject to peer review and shows wide variability in accuracy and quality. Celiac plexus blocks are technically complex procedures that are presented on YouTube, yet the educational quality of these instructional videos has not yet been systematically evaluated.

OBJECTIVE: To evaluate the educational quality of YouTube videos on celiac plexus blocks and to explore the utility of ChatGPT-4o as a secondary, adjunctive tool for assessing video quality.

METHODS: YouTube was searched on June 2nd, 2025 using the keywords "celiac plexus neurolysis," "celiac block for cancer pain," "celiac plexus block," and "celiac plexus injection." The 17 most-viewed videos were independently evaluated by two board-certified chronic pain physicians and by ChatGPT-4o using a modified DISCERN scale (mDISCERN), the Global Quality Scale (GQS), and a usefulness classification.

RESULTS: Based on human expert ratings, only 18 % of videos contained highly reliable information as assessed by the mDISCERN scale, and 24 % demonstrated moderate to excellent information quality on the Global Quality Scale. Overall, 65 % of videos were classified as useful. Inter-rater reliability between human experts ranged from poor to moderate across the three scales of evaluation, while agreement between human expert and ChatGPT-4o assessment was poor.

CONCLUSIONS: The educational quality of YouTube videos on celiac plexus blocks was generally poor. Unlike similar studies investigating other procedures, the quality of videos produced by physician and hospital sources was not better than that of videos by nonacademic sources. These findings highlight the need to improve the quality of educational content produced by physicians, hospitals, and professional societies.

UNLABELLED: Children with cerebral palsy (CP) undergoing orthopaedic surgery require thorough preoperative evaluation to enhance outcomes and minimize risks. This comprehensive review covers various considerations. Each part of the preoperative assessment is explained, emphasizing the importance of a tailored approach to address the specific needs and complexities of children with CP. Anesthesia considerations include the pulmonary, cardiovascular, and gastrointestinal systems to reduce perioperative complications. Neurological issues, such as seizure management and medication interactions, are detailed, along with respiratory problems like aspiration and poor airway clearance, gastrointestinal concerns, nutritional status, and bowel management. Vascular considerations focus on planning access and volume resuscitation before major orthopaedic procedures. Skin-related issues, including pressure ulcers and wound healing, require preventive strategies and careful postoperative care. Other factors addressed include urinary tract problems, deep vein thrombosis risks, blood loss management, pain control, anesthesia challenges, and psychological effects. This review highlights the importance of teamwork, patient-centered care, and thorough planning to ensure the best possible outcomes for children with CP undergoing orthopaedic surgery.

KEY CONCEPTS: (1)Children with cerebral palsy (CP) who are preparing for orthopaedic surgery need a thorough preoperative assessment.(2)A thorough preoperative assessment is crucial to make sure that any surgical procedure is customized to the child's specific functional needs and that the risks and benefits are thoughtfully evaluated.(3)Multidisciplinary care and focusing on patient-centered outcomes are crucial when deciding to pursue orthopaedic surgery in this high-risk population.(4)Effective communication with the child's caregivers and health care team is vital to ensure coordinated care and a clear plan for both preoperative and postoperative management.

BACKGROUND: Traumatic arthrotomies are rare, urgent injuries that carry high presumed risks for joint contamination and septic arthritis (SA). Most of these injuries occur in the knee. Like open fractures, treatment typically involves prompt antibiotic administration followed by surgical irrigation, debridement, and closure. Unlike open fractures, there is sparse evidence guiding pediatric arthrotomy management. This study aimed to characterize the demographics, clinical management, and outcomes of pediatric traumatic arthrotomies of the knee and other joints.

METHODS: Children with confirmed traumatic arthrotomy diagnoses admitted to the emergency department at a level 1 pediatric trauma center between 2013 and 2023 were retrospectively reviewed. Patient demographics, clinical characteristics, and outcomes were summarized using descriptive statistics. Postoperative complications were analyzed, along with 95% confidence intervals calculated using the Clopper-Pearson method.

RESULTS: Our cohort consisted of 36 patients (75% male, 68% White, average age 10 years, 58% privately insured). Traumatic arthrotomies most frequently resulted from falls (44%) and occurred in the knee joint (89%). The median time from admission to the operating room was 9 h (r, 2-45), with antibiotics initiated after a median of 4 h (r, 0-16) and continued for a median of 6 d (r, 0-24). Most patients (92%) underwent open irrigation and debridement with a median irrigation volume of 6 L (r, 1-9 L), and drain placement was used in 8 patients (22%). Forty-four percent of patients with a knee arthrotomy had an associated deep structure injury requiring repair. Four patients (11%) required reoperation for complex soft-tissue management, and three (8%) experienced noninfectious complications. Two patients developed superficial infections (5%); no cases of deep infection/SA were observed. Median duration of joint immobilization was 14 d (r, 0-59), and median time to return to full range of motion was 45 d (r, 6-93). Median time to clearance for full activity was 40 d (r, 12-153).

CONCLUSIONS: Following a traumatic arthrotomy, most children achieve complete, uncomplicated recoveries. We report an absence of deep infection and a low superficial infection rate, none of which occurred in the knee. However, surgeons should remain vigilant in assessing for associated soft-tissue injuries.

KEY CONCEPTS: (1)In this investigation, we found that there is a very low risk of deep infection or septic arthritis in children with traumatic arthrotomies (0% in our series) when applying the standard of care of timely antibiotic administration and surgical irrigation and debridement of the joint.(2)There was a high rate of structural soft-tissue injury that required repair (i.e., patellar/quadriceps tendon laceration) in traumatic arthrotomies of the knee.(3)Most children experience full recovery and return to sport around 6 weeks after traumatic arthrotomy.

LEVEL OF EVIDENCE: Level IV, case series.

COVID-19 has affected millions of individuals worldwide, yet the neuro-ophthalmic consequences among survivors remain incompletely characterized. In this case report, we describe a case of unilateral optic neuritis identified in the emergency department using ultrasound in a previously healthy young woman shortly after confirmed SARS-CoV-2 infection. This case highlights the importance of recognizing neuro-ophthalmic sequelae of COVID-19, outlines the diagnostic evaluation, and demonstrates clinical improvement with corticosteroid therapy.

Background and objective Large language models (LLMs) are increasingly being explored as adjuncts to medical education; however, comparative data on the performance and error patterns of newer models on standardized licensing-style questions remain limited. This study evaluated two advanced large language models (LLMs) - Gemini-Pro and GPT-4 Turbo - on the National Board of Medical Examiners (NBME) Step 1-style multiple-choice questions to assess accuracy, reasoning quality, and common failure modes relevant to exam preparation and clinical reasoning training. Methods A total of 112 NBME Step 1 questions were collected; seven image- or table-dependent items were excluded, yielding 105 text-only questions. Prompts were standardized to include the clinical stem, query, and answer choices and were submitted via Python API to Gemini-Pro and GPT-4 Turbo. Outputs were independently adjudicated by two third-year medical students and one board-certified physician using binary accuracy scoring and structured evaluation of reasoning features (logical reasoning, internal information use, and external knowledge application). Incorrect responses were categorized as logical, informational, or statistical errors. Comparative analyses included raw accuracy calculations and chi-square testing of reasoning-feature distributions. Results GPT-4 Turbo achieved 90.99% accuracy on the January 2024 NBME Step 1 question set, substantially outperforming Gemini-Pro (54.46%). GPT-4 Turbo demonstrated fewer errors overall, with lower logical (16%), informational (4%), and statistical (4%) error rates compared with older baselines reported in the study (e.g., GPT-3.5 logical errors 42%). GPT-4 Turbo incorporated external information in 76% of correct responses versus 25% for Gemini-Pro, and differences in performance metrics between GPT-4 Turbo and Gemini-Pro were statistically significant (p < 0.05). Conclusions GPT-4 Turbo markedly outperformed Gemini-Pro on text-based NBME Step 1 questions, showing higher accuracy, stronger reasoning consistency, and fewer logical/informational failures. These findings support GPT-4 Turbo's potential role as a high-yield supplementary tool for Step 1-style learning and feedback, while underscoring the need for continued refinement and cautious, supervised integration of LLMs into medical education, given persistent (though reduced) error rates.

PURPOSE: To report on the presentation, treatment, and visual outcome of stromal keratitis (SK) in the Zoster Eye Disease Study (ZEDS).

DESIGN: Secondary analysis of SK end point of randomized clinical trial.

SUBJECTS: Patients with herpes zoster ophthalmicus (HZO) were randomized in a double-masked clinical trial of oral valacyclovir 1 g daily or placebo for 1 year. They were followed prospectively every 3 months for 18 months for end points of SK, iritis (IR), endothelial keratitis (EK), or dendritiform epithelial keratitis (DEK).

METHODS: Presentation of recurrent, new, or worsening SK was evaluated retrospectively by treatment assignment, randomization strata, and use of topical steroids. Investigators had been allowed discretionary treatment of end points including open-label valacyclovir and topical steroids. Visual outcome and treatment with open-label oral valacyclovir and topical steroids were evaluated.

MAIN OUTCOME MEASURES: Use of open-label valacyclovir and topical steroid treatment of recurrent, new, or worsening SK, and visual acuity at 12 months.

RESULTS: Recurrent, new, or worsening SK occurred in 105 of 527 participants (20%). The randomization group was not associated with this complication. Mean best-corrected visual acuity at enrollment was logMAR 0.10 ± 0.14 with no difference at 1 year, logMAR 0.13 ± 0.2, and no difference between valacyclovir and placebo groups at enrollment or at 1 year. Among the 105 instances of SK, 79 (75%) were recognized at scheduled study visits rather than at episodic visits. In only 11 of 105 (10%) of recurrent, new, or worsening SK did masked investigators opt to treat with open-label oral antiviral. At the time of SK complication, 52 of 105 participants (50%) were receiving topical steroids, but 47 of 52 participants (90%) receiving topical steroids were using 1× daily or less, 21 of 47 participants (45%) were using high potency, and 26 of 47 participants (55%) were using low potency (P = .47). Of 48 of 105 participants (47%) receiving no topical steroids at recurrent, new, or worsening SK, 18 of 48 (38%) had discontinued steroids in the prior 3 months. A total of 38 of 48 participants (75%) receiving no topical steroids at complication SK were subsequently treated with high-potency steroids 2× daily or more. Of 26 of 52 participants (50%) receiving low-potency steroids at SK complication, 23 of 26 (88%) were treated with increase in frequency only.

CONCLUSIONS: Individuals with ocular complications of HZO who develop SK generally maintain very good vision without the use of oral antiviral therapy when monitored closely and SK is recognized and treated. Low-potency topical steroids should be considered for treatment and ongoing suppression of SK in HZO.

Obstructive sleep apnea (OSA) and insomnia could accelerate biological aging through pathways including oxidative stress and systemic inflammation. This systematic review aimed to determine the association of sleep disorders with circulating markers of biological aging. We searched MEDLINE, Embase, CINAHL, Cochrane, PsycINFO from inception to October 2024. Eligibility criteria included full manuscript English studies on adult humans examining OSA or insomnia and circulating markers of aging. Of the 1839 deduplicated records screened, 49 full-text studies were eligible for inclusion. Included studies ranged from poor to good quality and assessed telomere length (TL), DNA methylation clocks (epigenetics), mitochondrial alterations, sirtuin levels and activity, autophagy protein levels, and klotho gene expression. Telomeres were the most extensively studied marker, with our findings showing a significant association between TL and OSA, based on both unadjusted and adjusted values (SMD = -0.451, 95% CI: 0.688 to -0.215, p = 0.0026 and SMD = -3.01, 95% CI: 4.98 to -1.04, p = 0.033, respectively). Most studies linked insomnia and poor sleep quality to shorter TL. Although evidence for other aging biomarkers was more limited, the published literature supports the role of OSA and insomnia in accelerating biological aging, especially for telomere length.

BACKGROUND: Spironolactone is widely used in dermatology. While routine potassium monitoring is no longer recommended in young, healthy females taking spironolactone for acne, hyperkalemia incidence, risk factors, and monitoring necessity in older females is unclear.

OBJECTIVE: To determine hyperkalemia incidence in females aged ≥45 taking spironolactone for dermatologic conditions.

METHODS: In this retrospective cohort study, 1197 Mass General Brigham medical records from January 1, 2015 through February 25, 2025 were reviewed; 398 cases were analyzed.

RESULTS: Hyperkalemia incidence was 10.1% (40/398) and more commonly observed in older patients (age ≥65: 22.4% versus ages 45-64: 7.9%) and those with ≥1 predisposing comorbidity (medically complex: 14.7% versus healthy: 7.3%). Healthy females aged 45-64 were least affected (6.3%). Patients age ≥65 with ≥1 predisposing comorbidity had the highest incidence (28.1%). Hyperkalemia was generally mild (97.5%), asymptomatic (85%), and did not impact clinical management (62.5%).

LIMITATIONS: Limitations include retrospective design and lack of comparator group.

CONCLUSION: Overall hyperkalemia risk in females aged ≥45 is higher than in younger patients and increased further in specific subpopulations. Hyperkalemia is generally mild and prescription modification is uncommon. While spironolactone use is safe for most patients, monitoring guidelines should be clarified to ensure optimal management in this population.

BACKGROUND: Borderline personality disorder (BPD) is often accompanied by interpersonal dysfunction. Psychotherapy can improve interpersonal functioning, but individual characteristics may moderate outcomes. This systematic review used individual participant data meta-analysis (IPD-MA) to examine such moderators.

METHOD: A literature search up to 26 November 2025 across 10 databases (including PubMed, Medline, Embase, PsychINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) investigating the effects of psychotherapy on interpersonal functioning in individuals with BPD compared to treatment as usual (TAU) or clinical management control interventions (CM). Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects on interpersonal functioning and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688).

RESULTS: Out of 23,735 identified records, 32 RCTs (2762 participants) met inclusion criteria. Individual participant data (IPD) were available for 17 trials (1431 participants). All trials were rated as having either high risk of bias or some concerns. Missing data were common, with 321 out of 1431 participants (23%) lost to follow-up. Meta-analyses of both aggregate data and IPD yielded comparable effect estimates, though statistical significance differed (IPD-MA: β = -0.21, CI: -0.45 to -0.02, SE = 0.12, p = 0.0778; 17 trials, 1071 participants). In unadjusted analyses, the presence of co-occurring anxiety disorder(s) (β = -0.40, 95% CI: -0.73 to -0.08) and a higher number of co-occurring disorders (β = -0.08, 95% CI: -0.15 to -0.01) were associated with larger treatment effects (not significant after alpha correction).

CONCLUSION: Psychotherapy appears to be effective for individuals with BPD. Although moderator effects did not remain statistically significant after alpha correction, unadjusted analyses suggested larger treatment effects in individuals with co-occurring anxiety and greater clinical complexity. Importantly, these findings indicate that such comorbidities may not be a contraindication for psychotherapy for BPD.

BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) offer cardiorenal benefits in patients with type 2 diabetes mellitus (T2DM).

OBJECTIVE: To evaluate safety and effectiveness of SGLT2i in improving clinical outcomes in patients with psoriasis and comorbid T2DM, compared with dipeptidyl peptidase-4 inhibitors (DPP4i) and glucagon-like peptide-1 receptor agonists (GLP1RA).

METHODS: This emulated target trial included adults with psoriasis and T2DM initiating SGLT2i, DPP4i, or GLP1RA between 2013 and 2025. SGLT2i initiators were propensity score-matched to DPP4i initiators and GLP1RA initiators, respectively. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of the outcomes.

RESULTS: A total of 8799 SGLT2i initiators and 8799 matched DPP4i initiators with psoriasis and comorbid T2DM, and 11,550 SGLT2i initiators and 11,550 matched GLP1RA initiators, were included. Compared with DPP4i, treatment with SGLT2i was associated with significantly lower all-cause mortality (HR = 0.633, 95% CI = 0.564-0.711) and reduced risks of emergency visits (HR = 0.915, 95% CI = 0.871-0.961), acute kidney injury (HR = 0.834, 95% CI = 0.759-0.916), chronic kidney disease (HR = 0.866, CI = 0.791-0.949), end-stage renal disease (HR = 0.555, 95% CI = 0.438-0.703), and severe sepsis (HR = 0.689, CI = 0.594-0.799). Compared with GLP1RA, treatment with SGLT2i was associated with reduced risks of asthma (HR = 0.822, 95% CI = 0.713-0.946), depression (HR = 0.887, CI = 0.801-0.983), sleep disorders (HR = 0.856, CI = 0.783-0.936), and malignancies (HR = 0.852, 95% CI = 0.764-0.951).

LIMITATIONS: Retrospective design.

CONCLUSION: Treatment with SGLT2i was associated with favorable clinical outcomes in patients with psoriasis and comorbid T2DM. These findings support investigation of SGLT2i as an adjunct therapy in this population.