Non-small-cell lung cancer (NSCLC) is the most common lung cancer subtype and accounts for more than 80% of all lung cancer cases. Epidermal growth factor receptor (EGFR) phosphorylation by binding growth factors such as EGF activates downstream prooncogenic signaling pathways including KRAS-ERK, JAK-STAT, and PI3K-AKT. These pathways promote the tumor progression of NSCLC by inducing uncontrolled cell cycle, proliferation, migration, and programmed death-ligand 1 (PD-L1) expression. New cytotoxic drugs have facilitated considerable progress in NSCLC treatment, but side effects are still a significant cause of mortality. Gallic acid (3,4,5-trihydroxybenzoic acid; GA) is a phenolic natural compound, isolated from plant derivatives, that has been reported to show anticancer effects. We demonstrated the tumor-suppressive effect of GA, which induced the decrease of PD-L1 expression through binding to EGFR in NSCLC. This binding inhibited the phosphorylation of EGFR, subsequently inducing the inhibition of PI3K and AKT phosphorylation, which triggered the activation of p53. The p53-dependent upregulation of miR-34a induced PD-L1 downregulation. Further, we revealed the combination effect of GA and anti-PD-1 monoclonal antibody in an NSCLC-cell and peripheral blood mononuclear–cell coculture system. We propose a novel therapeutic application of GA for immunotherapy and chemotherapy in NSCLC.

Objectives: Hyperglycemia and hypokalemia are common problems in patients with aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study was to determine whether the plasma glucose to potassium ratio (GPR) predicts mortality due to aSAH.Methods: We prospectively recruited aSAH patients and healthy controls between March 2007 and May 2017. Clinical outcomes included mortality and poor outcome (modified Rankin scale score of 3-6) after 3 months. Multivariable analysis was used to determine the association between plasma GPR and 3-month mortality in aSAH patients.Results: A total of 553 patients were recruited, and the mortality rate was 11%. The GPR was significantly elevated in aSAH patients compared with controls, in patients with a poor outcome than with a good outcome and in non-survivals than in survivals. Multivariable analysis showed that the plasma GPR was an independent factor associated with 3-month mortality. The area under the curve of the GPR was 0.747 in predicting 3-month mortality.Conclusion: The plasma GPR on admission has potential as a predictor of 3-month mortality in patients with aSAH.

Large language models (LLMs) have been deployed in diverse fields, and the potential for their application in medicine has been explored through numerous studies. This study aimed to evaluate and compare the performance of ChatGPT-3.5, ChatGPT-4, Bing Chat, and Bard for the Emergency Medicine Board Examination question bank in the Korean language. Of the 2353 questions in the question bank, 150 questions were randomly selected, and 27 containing figures were excluded. Questions that required abilities such as analysis, creative thinking, evaluation, and synthesis were classified as higher-order questions, and those that required only recall, memory, and factual information in response were classified as lower-order questions. The answers and explanations obtained by inputting the 123 questions into the LLMs were analyzed and compared. ChatGPT-4 (75.6%) and Bing Chat (70.7%) showed higher correct response rates than ChatGPT-3.5 (56.9%) and Bard (51.2%). ChatGPT-4 showed the highest correct response rate for the higher-order questions at 76.5%, and Bard and Bing Chat showed the highest rate for the lower-order questions at 71.4%. The appropriateness of the explanation for the answer was significantly higher for ChatGPT-4 and Bing Chat than for ChatGPT-3.5 and Bard (75.6%, 68.3%, 52.8%, and 50.4%, respectively). ChatGPT-4 and Bing Chat outperformed ChatGPT-3.5 and Bard in answering a random selection of Emergency Medicine Board Examination questions in the Korean language.

This study was performed to determine whether red blood cell distribution width (RDW) is associated with 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke. RDW was measured in patients with thrombolytic therapy in emergency department. Functional outcome was assessed after 3 months and poor functional outcome was defined as modified Rankin scale 3 to 6. A total of 240 patients were enrolled, and 82 (34.2%) had a poor functional outcome. The median RDW was significantly elevated in patients with a poor functional outcome compare with those with a good outcome. RDW was independently associated with a 3-month poor functional outcome (odds ratio 3.369, 95% confidence interval 2.214–5.125). The optimal RDW cutoff for predicting 3-month poor functional outcome was 12.8%, and the area under the curve for RDW was 0.818 (95% confidence interval 0.761–0.876). The area under the curve for RDW was higher in male patients than in female patients. The RDW correlated positively with the modified Rankin scale score after 3 months and the initial National Institutes of Health Stroke Scale score. Initial higher RDW level is related to a 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke.