Citations

Abstract Objectives To comprehensively evaluate the validity of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for both prevalent diagnoses and less common diseases, and to assess the performance of a large language model (LLM)-based system in validating these codes. Materials and Methods This retrospective study analyzed hospital admissions from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We developed a validated LLM-based system using GPT-4o, refined through iterative prompt engineering, to assess ICD-10-CM code validity. We measured the positive predictive value (PPV) of ICD-10-CM codes, PPV of principal and secondary diagnoses, and the performance of an LLM-based system in code validation. Results Among 865 079 assigned codes, the PPV was 84.6% (95% CI, 84.5%-84.6%). Principal diagnoses had a PPV of 93.9% (95% CI, 93.7%-94.1%), while secondary diagnoses had a PPV of 83.8% (95% CI, 83.7%-83.9%). The LLM system demonstrated high performance in validating ICD codes, achieving 93.6% accuracy, 95.4% sensitivity, and 85.2% specificity. Among correctly assigned secondary diagnoses, the majority (67.9%) represented historical or baseline conditions, while 32.1% reflected active conditions that deviated from baseline status; 22.3% of these emerged after hospital admission. PPV decreases with later diagnosis positions, with the largest decline occurring between principal and secondary diagnoses. Discussion and Conclusion In this large-scale evaluation, ICD-10-CM codes exhibited generally high accuracy, though variability existed by position and condition type. A validated LLM system performed comparably to physician review and offers a scalable means to improve coding accuracy. These findings support the potential for integrating LLM-based auditing into routine workflows to strengthen the quality of administrative and research data.

851 Background: Diffuse idiopathic skeletal hyperostosis (DISH) has been associated with increased risk of vertebral fractures in elderly men with prostate cancer. However, its potential role in the development of malignancies is poorly defined. In particular, the relationship between DISH and gastrointestinal (GI) cancers—including esophageal, gastric, colorectal, liver, biliary system, and pancreatic cancers—has not been examined. This study aimed to explore the risk of GI cancers among patients with DISH compared to those without DISH. We also assessed survival and incidence of vertebral fractures in these groups. Methods: Using the Mayo Clinic Platform (Full AMC1 dataset), we identified patients with and without a documented history of DISH. Outcomes included (1) prevalence and risk of GI cancers, (2) survival among GI cancer patients, and (3) vertebral fracture incidence. Relative risks (RRs) and hazard ratios (HRs) were calculated using SPSS20.0 and platform-based statistical tools, respectively. Kaplan–Meier survival analyses were performed to evaluate cancer survival outcomes. Results: A total of 6,189,860 patients were included, of whom 2,802 (0.05%) had DISH and 6,187,058 (99.95%) did not. Patients with DISH had a significantly higher prevalence of GI cancers compared with those without (RR = 1.63, 95% CI: 1.377–1.930). Survival analysis suggested worse outcomes among GI cancer patients without DISH (HR = 1.72, 95% CI: 1.25–2.35). Vertebral fracture incidence appeared lower among DISH patients, although low event numbers limit the reliability of this observation. Conclusions: DISH is associated with increased risk of GI cancers, while GI cancer patients without DISH may experience poorer survival. The observed trend toward lower vertebral fracture incidence among DISH patients should be interpreted cautiously due to limited event numbers. These findings highlight the importance of integrating musculoskeletal and oncologic perspectives in patient management and warrant further mechanistic and interventional studies. Survival analysis. Statistic Without DISH With DISH Patient Count 214,180 109 1 Month Survival 95.3% 98.2% 5 Month Survival 82.2% 87.9% 10 Month Survival 72.4% 85.1% 30 Month Survival 54.3% 74.1% 60 Month Survival 44.9% 60.6% Log-Rank 11.90 P-Value 0.00056 Hazard Ratio 1.72 (95% CI: 1.25 - 2.35)

331 Background: The relationship between plant-based dietary patterns and upper gastrointestinal (GI) cancers remains unclear. The Healthful Plant-Based Diet Index (hPDI) is a tool that measures adherence to plant-based diet and generates “scores” for clinical comparison. We conducted a systematic review and meta-analysis to examine the association between hPDI and the risk of esophageal and gastric cancers. Methods: A PubMed search identified relevant studies reporting on the association between hPDI and upper GI cancers. Reference lists were manually searched for additional studies. Study selection followed PRISMA guidelines, and quality was assessed using the Newcastle–Ottawa Scale (NOS). Pooled risk estimates were calculated using inverse-variance fixed-effects models, with subgroup analyses by cancer type. Sensitivity analyses were conducted using leave-one-out approach and by switching between fixed- and random-effects models. Forest plots and funnel plots were generated with RevMan 5.4, while Begg’s and Egger’s tests for publication bias were performed using Stata 15. Results: A total of four studies were included, all with high NOS scores. Overall, higher hPDI scores were associated with a significantly lower risk of upper GI cancers (RR = 0.64, 95% CI: 0.56–0.75). In subgroup analyses, the inverse association was consistent for both esophageal cancer (RR = 0.66, 95% CI: 0.54–0.79) and gastric cancer (RR = 0.63, 95% CI: 0.50–0.79). Between-study heterogeneity was low (I² = 35%, P = 0.16). Publication bias assessment indicated no evidence of small-study effects, as Begg’s test was non-significant (P = 0.88) and Egger’s test showed no significant bias (P = 0.76). Sensitivity analyses confirmed the robustness of the findings, with consistent results after sequential exclusion of individual studies and when using random-effects models. Conclusions: Higher hPDI scores were associated with a significantly reduced risk of esophageal and gastric cancers, indicating that adherence to a healthy plant-based diet may reduce upper GI cancer risk. These findings highlight the potential role of dietary modification in upper GI cancer prevention.

ABSTRACT Objective To comprehensively evaluate the validity of ICD-10-CM codes for both prevalent diagnoses and less common diseases, and to assess the performance of a large language model (LLM)-based system in validating these codes. Materials and Methods This retrospective study analyzed hospital admissions from the Medical Information Mart for Intensive Care (MIMIC-IV) database. We developed a validated LLM-based system using GPT-4o, refined through iterative prompt engineering, to assess ICD-10-CM code validity. We measured the PPV of ICD-10-CM codes, PPV of principal and secondary diagnoses, and the performance of an LLM-based system in code validation. Results Among 865,079 assigned codes, the PPV was 84.6% (95% CI, 84.5%-84.6%). Principal diagnoses had a PPV of 93.9% (95% CI, 93.7%-94.1%), while secondary diagnoses had a PPV of 83.8% (95% CI, 83.7%-83.9%). The LLM system demonstrated high performance in validating ICD codes, achieving 93.6% accuracy, 95.4% sensitivity and 85.2% specificity. Among correctly assigned secondary diagnoses, the majority (67.9%) represented historical or baseline conditions, while 32.1% reflected active conditions that deviated from baseline status; 22.3% of these emerged after hospital admission. PPV decreases with later diagnosis positions, with the largest decline occurring between principal and secondary diagnoses. Discussion and Conclusion In this large-scale evaluation, ICD-10-CM codes exhibited generally high accuracy, though variability existed by position and condition type. A validated LLM system performed comparably to physician review and offers a scalable means to improve coding accuracy. These findings support the potential for integrating LLM-based auditing into routine workflows to strengthen the quality of administrative and research data.

Abstract Background Standardizing beam modeling in the treatment planning system is challenging due to machine‐specific configuration variations. Because of the proton therapy system (PTS) complexity and continuous development, there is no vendor's representative (“golden”) beam data like in LINACs at this stage. Purpose The primary goal of this study is to create a PTS‐specific repository of source model parameters and beam commissioning data for scanning proton therapy treatment planning systems and establish a set of reference values with associated bands of variations for this data. Methods We conducted a survey of 31 PTSs at 27 proton therapy centers to gather beam commissioning source model parameters used in their treatment planning system, ensuring a diverse selection of PTSs from major vendors: Hitachi, IBA, Varian, and Mevion. For each proton therapy center, we collected (i) beam meterset calibration in protons per MU, (ii) in‐air spot size at isocenter in terms of standard deviation in x‐ (crossline, σ x ) and y‐ (inline, σ y ) directions, (iii) in‐air angular spread at isocenter in x‐direction (θ x ) and y‐direction (θ y ) and (iv) distal falloff. For each PTS, we plotted each parameter as a function of nominal energy and performed polynomial regression analysis with optimal model selection based on Akaike Information Criterion. We calculated intraclass correlation coefficients (ICC) to quantify inter‐PTS variability and generated uncertainty bands representing standard deviations across PTSs for each parameter. Additionally, we computed percentage deviations of each individual PTS from the overall multi‐vendor mean to identify systematic vendor‐specific patterns and outliers across the 31 total PTSs analyzed. Results Multi‐vendor beam parameter analysis across 31 PTSs revealed systematic vendor‐specific patterns in inter‐PTS consistency and energy dependencies. Beam meterset calibration demonstrated excellent inter‐PTS consistency across most vendors (ICC: Varian ProBeam ≈ 0, IBA Proteus ONE = 0.006, Mevion S250i with HYPERSCAN = 0.015), with IBA Proteus PLUS systems showing moderate variation (ICC = 0.156 for the dedicated nozzle, ICC = 0.248, for the universal nozzle). Spot size and angular spread variability were highly vendor‐dependent, ranging from excellent consistency in IBA Proteus ONE to substantial variation in IBA Proteus PLUS with the universal nozzle (angular spread ICC = 0.566). Distal falloff maintained excellent consistency across all vendors (ICC < 0.023), indicating reliable energy spread characteristics. Uncertainty band analysis revealed characteristic energy‐dependent patterns, with most systems showing larger uncertainties at lower energies for spot size and angular spread, while IBA Proteus PLUS with the universal nozzle exhibited the largest uncertainty bands overall. Percentage deviation analysis demonstrated vendor‐specific clustering patterns, with some systems showing systematic positive or negative deviations from the multi‐vendor mean. Conclusions The reference data provided in this work will help to cross‐check the beam model during treatment planning system commissioning. Furthermore, this information is useful for Monte Carlo applications and research, where beam characteristics are required to set up phase space parameters, thereby avoiding the need to model the entire PTS. Finally, the results of this study will have indispensable educational value by providing valuable insights into the characteristics and capabilities of different PTSs.

Abstract The progression of osteoarthritis (OA) is fundamentally characterized by the aberrant transformation of chondrocytes into a fibrotic phenotype, although the precise molecular mechanisms involved remain inadequately understood. In this study, the interplay between epigenetic modifications and metabolic reprogramming during the activation of fibrocartilage cells in osteoarthritis was investigated. The findings demonstrate that FSTL1 markedly upregulates key glycolytic enzymes, including LDHA, HK2, and PKM, in chondrocytes, triggering a “glycolytic burst” that results in elevated intracellular lactate levels. This accumulated lactate acts as a precursor for epigenetic modifications, specifically promoting the lactylation of histone H3 lysine 18 (H3K18la) in fibrocartilage cells, thereby facilitating the transcriptional activation of critical fibrosis‐related genes such as Itga6, Cxcl10, and Parp16. Notably, pharmacological inhibition of the PI3K/mTOR pathway or lactate dehydrogenase significantly diminishes H3K18la levels and markers of chondrocyte fibrosis, while exogenous lactate supplementation can counteract this effect. In summary, this study unveils the core mechanism by which FSTL1 reshapes the epigenetic landscape of chondrocytes and drives the fibrotic process through the activation of the “glycolysis‐lactate‐H3K18la” cascade axis, offering a dual‐target intervention strategy for OA involving metabolic reprogramming and epigenetic modification.

Purpose of review The rising prevalence of obesity, now affecting over 40% of U.S. adults, poses critical implications for colorectal cancer screening, as obesity increases the risk of both colorectal adenomas and cancer. Despite these elevated risks, patients with obesity have lower colonoscopy screening participation and face unique barriers that compromise procedural quality. This review aims to highlight the challenges encountered during colonoscopy in obese patients and examine emerging solutions that may enhance screening effectiveness and patient outcomes. Recent findings Obesity is associated with suboptimal bowel preparation, prolonged cecal intubation times, lower adenoma detection rates, and increased sedation-related complications. These challenges stem from altered gastrointestinal physiology, body habitus, and comorbid conditions. Recent innovations in bowel preparation strategies, sedation protocols, and endoscopic technologies—such as robotic-assisted colonoscopy and artificial intelligence-enhanced visualization—have demonstrated promise in addressing these limitations. Institutional initiatives, including tailored protocols and endoscopy team training, are also contributing to improved outcomes. Summary As obesity rates climb, adapting colonoscopy practices to meet the needs of this population is essential. Incorporating evidence-based strategies and emerging technologies can help overcome procedural barriers, improve detection rates, and reduce disparities in colorectal cancer screening. Continued research and guideline refinement are needed to optimize care delivery for patients with obesity.

Abstract Background Patients with inflammatory bowel disease (IBD) are at increased risk of herpes zoster (HZ) infection due to innate immune abnormalities and use of immunosuppressive therapy. The recombinant zoster vaccine (RZV) is recommended, but its efficacy in preventing recurrent HZ among patients with IBD is not well established. Methods Using data from the TriNetX Linked Network, we conducted a retrospective cohort study of adults (≥18 years) with IBD and a prior uncomplicated HZ episode. Patients with IBD who received RZV were propensity score-matched 1:1 with those who did not. The primary outcome was subsequent HZ complications. Secondary outcomes included subtypes of HZ complications and recurrent uncomplicated HZ. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated via Cox proportional hazards models. Results After matching, 1260 vaccinated and 1260 unvaccinated patients with IBD were included. Compared to the unvaccinated cohort, patients receiving RZV had a significantly reduced incidence of HZ complications (7.4% vs. 14.5%; HR, 0.75; 95% CI, 0.58–0.97; P = .028). Postherpetic neuralgia was notably decreased (5.8% vs. 12.5%; HR, 0.66; P = .010), and no central nervous system involvement occurred among vaccinated patients. Protective effects were more pronounced in patients with ulcerative colitis, females, and those not receiving immunosuppressive therapy. Conclusions RZV substantially lowers the risk of HZ complications in patients with IBD, offering significant clinical benefits to those at high risk due to immunosuppression. These findings underscore the importance of RZV as part of preventive care strategies in patients with IBD.