Faculty Bibliography

Clinical evaluations of large language models (LLMs) have rapidly expanded since 2022, yet their evidence base remains opaque. The overwhelming volume of studies creates challenges for manual curation and review. However, LLMs themselves offer the scalability and capability to evaluate the ever-growing evidence base. This LLM-assisted review identified 4,609 peer-reviewed studies in clinical medicine between January 2022 and September 2025, equating to roughly 3.2 papers per day. Only 1,048 studies used real-world patient data and of these only 19 were prospective randomized trials; most addressed simulated scenarios (n = 1,857) or exam-style tasks (n = 1,704). ChatGPT and related OpenAI models constitute 65.7% of evaluated models, with Gemini/Bard a distant second constituting 13.1% of evaluated models. Patient-facing communication and education comprised 17% of tasks, followed by knowledge retrieval, and education and assessment simulation. Across 1,046 head-to-head comparisons, LLMs outperformed humans in 33% of comparisons, with a strong dependency on task realism and level of training. At least 25% of studies had sample sizes less than 30. Despite the growth of LLMs in medicine, rigorous, patient-centered evidence remains scarce, underscoring the need for larger prospective trials before clinical adoption.

INTRODUCTION/UNASSIGNED:Effective clinical research training is crucial for advancing medical science and improving patient care. However, current evaluation systems in China often focus on theoretical knowledge, neglecting practical skills and innovation. This study aimed to develop a comprehensive evaluation framework for clinical research training programs using the Delphi consensus method. METHOD/UNASSIGNED:A 2-round Delphi method was employed, involving healthcare professionals and educators from top tertiary hospitals and leading academic institutions in China. The first round included 15 participants, and the second round included 19 participants. The evaluation framework was based on the Kirkpatrick model, covering Reaction, Learning, Behavior, and Results dimensions. Indicators were evaluated using a 5-point Likert scale, with consensus defined as a mean significance score ≥3.50 and a coefficient of variation ≤0.25. RESULTS/UNASSIGNED:In the first round, 9 indicators were excluded and 5 added. In the second round, 26 indicators met consensus criteria. Key indicators included "Relevance of training content" (mean = 4.89, CoV = 0.06), "Degree of knowledge mastery" (mean = 4.58, CoV = 0.13), and "Impact on career development" (mean = 4.53, CoV = 0.15). Other significant indicators were "Timeliness of training information" (mean = 4.84, CoV = 0.08) and "Success rate of applying for scientific research funds" (mean = 4.05, CoV = 0.21). DISCUSSION/UNASSIGNED:This study developed a comprehensive evaluation framework for clinical research training in China, emphasizing the importance of relevant training content, strong learning outcomes, and long-term professional impact. This framework provides a robust tool to assess and enhance clinical research training programs, ultimately contributing to improved healthcare and medical research. Future work should focus on validating this framework through empirical studies and refining it based on ongoing feedback.

Childhood adversity is increasingly recognized as a critical modifier of neurologic disorder development and disease severity, including in the neuroimmune disorder multiple sclerosis (MS). While previous studies have linked early-life adversity to increased MS susceptibility and more severe disease, the underlying biological mechanisms remain poorly understood. This study investigated associations between childhood adversity and MS clinical features, with a focus on two potential pathogenic mechanisms: allostatic load and epigenetic modifications. We evaluated 60 consecutively enrolled young adults with MS; 30 with paediatric-onset MS (POMS) and 30 with adult-onset MS (AOMS). At time of enrolment in this cross-sectional study, participants had MS disease duration of 6 years on average. POMS participants were mean 22.09 (2.66) years and AOMS participants were mean 32.41 (2.19) years old. 62% of participants were female. Childhood adversity was defined using a composite index of individual, family and socioeconomic measures captured by the adverse childhood experiences questionnaire, parental education level and estimated household income during childhood. Clinical outcomes included patient-reported SymptoMScreen questionnaire regarding MS symptom burden and MS neurologist-assessed disability using the Expanded Disability Status Scale (EDSS) of the participant's neurologic exam at the time of enrolment. Circulating biomarkers of allostatic load and genome-wide epigenetic profiles (DNA methylation via RRBS; reduced representation bisulfite sequencing) were also assessed. A history of high childhood adversity was associated with significantly greater patient-reported MS symptom burden (P = 0.001) and higher neurologist-reported EDSS disability scores (P = 0.028), independent of disease duration or timing of treatment initiation. There were no differences between childhood adversity and circulating biomarkers of allostatic load. While childhood adversity was not associated with global epigenetic changes across the entire cohort, stratified analysis revealed divergent methylation patterns by age of MS onset: POMS participants with childhood adversity had increased DNA methylation, whereas AOMS participants with childhood adversity showed decreased methylation compared to individuals without childhood adversity. None of the observed clinical and biologic differences were explained by differences in disease duration or the interval between symptom onset and treatment initiation. Our findings suggest that childhood adversity is associated with increased MS symptom burden and neurologic disability in young adults with MS. Childhood adversity may differentially shape the epigenome, depending on the age of MS onset, with potential implications for disease trajectory and therapeutic vulnerability. These results support the biological embedding of childhood adversity in MS and highlight the need for age- and exposure-sensitive approaches to understanding MS pathogenesis across the lifespan.

Knee injuries are one of the most common complaints in sports medicine. Magnetic resonance imaging is an essential adjunct to clinical evaluation for many traumatic injuries and overuse conditions. Given the heavy use of knee magnetic resonance imaging, developing faster magnetic resonance imaging acquisition methods and deployment in clinical practice would be valuable. In this article, we illustrate a spectrum of knee abnormalities from our clinical practice, utilizing a recently developed, publicly available sub-5-minute knee magnetic resonance imaging protocol with super-resolution image reconstruction based on deep learning. We review common traumatic injuries and overuse conditions of the knee and illustrate cases with this novel fast knee magnetic resonance imaging protocol.

RATIONALE/BACKGROUND:The discoveries of neutrophilic inflammation and Pseudomonas-dominant pulmonary dysbiosis have helped pave the way for host-directed therapy in bronchiectasis. Substantial knowledge gaps still remain about the interplay between neutrophilic signatures and microbes in non-tuberculous mycobacterial lung disease (NTM-LD), a phenotypically diverse lung infection that is increasingly prevalent in the United States and other parts of the world. OBJECTIVES/OBJECTIVE:Evaluate the lower airway microbiota and neutrophilic traits in NTM- and NTM+ bronchiectasis. METHODS:16S rRNA gene sequencing, cell counts, and neutrophil extracellular trap (NET) immunoassays were performed on bronchoscopic lower airway samples in 200 bronchiectasis subjects (108 NTM-, 92 NTM+). A preclinical model of oral commensal micro-aspiration and NTM infection was used to profile the murine lower airways with flow cytometry and a NET assay. MEASUREMENTS AND MAIN RESULTS/RESULTS:Lower airways of NTM+ bronchiectasis patients were enriched with Mycobacterium and oral commensals (e.g., Veillonella, Prevotella and Streptococcus). NET levels were higher in NTM+ BAL. Mycobacterium and oral commensals co-occurred with NET and neutrophils in network studies. Distinct oral commensal taxa were associated with severe disease phenotypes such as cavitary disease and exacerbators. In a murine micro-aspiration model, the combination of oral commensals and Mycobacterium led to a sustained pro-inflammatory immune response marked by an increase in Th17, γδT cells, PD-1+ T lymphocytes as well as higher NET levels. CONCLUSIONS:Our analyses showed that distinct microbiome features beyond the primary pathogen can contribute to neutrophilic inflammation and severe disease phenotypes in bronchiectasis/ NTM-LD.

Respiratory viruses-including SARS-CoV-2 (COVID-19), Respiratory Syncytial Virus (RSV), and Influenza-pose significant risks to immunocompromised patients, who experience attenuated vaccine responses and higher morbidity. To address evolving vaccine recommendations for the 2025-2026 season, the Infectious Diseases Society of America (IDSA), in collaboration with the Vaccine Integrity Project (VIP) and partner organizations, developed rapid guidelines for U.S.-licensed vaccines targeting these viruses. The guideline applies to adults and children with compromised immunity due to hematologic malignancy, solid organ or hematopoietic cell transplantation, autoimmune disease on immunosuppressants, HIV with severe immunosuppression, and similar conditions. Strong recommendations, supported by moderate-certainty evidence, endorse timely administration of age-appropriate COVID-19, RSV, and Influenza vaccines, with guidance on optimal timing relative to immunosuppressive therapy and transplantation. Co-administration of these vaccines is considered appropriate. Research gaps remain in immunogenicity, durability, and clinical effectiveness, particularly for patients receiving B-cell-depleting therapies or early post-transplant. Priority areas include defining correlates of protection, optimizing vaccine schedules, evaluating high-dose or adjuvanted formulations, and improving real-world effectiveness and safety data. Equity and access strategies are essential to ensure uptake among vulnerable populations. These guidelines aim to support evidence-based decision-making and highlight the need for harmonized, multi-virus research to inform tailored vaccination strategies for immunocompromised individuals.

The American Venous Forum has formulated evidence-based clinical practice guidelines to provide recommendations on the care of patients with upper extremity deep vein thrombosis. All recommendations follow a systematic review of workup and therapy options for patients with upper extremity deep vein thrombosis. Potential limitations of these guidelines are due to the lack of evidence on some specific sub-areas such as risk stratification and long-term outcomes.