Accurate information regarding oxalate levels in foods is essential for managing patients with hyperoxaluria, oxalate nephropathy, or those susceptible to calcium oxalate stones. This study aimed to assess the reliability of chatbots in categorizing foods based on their oxalate content. We assessed the accuracy of ChatGPT-3.5, ChatGPT-4, Bard AI, and Bing Chat to classify dietary oxalate content per serving into low (8 mg) oxalate content categories. A total of 539 food items were processed through each chatbot. The accuracy was compared between chatbots and stratified by dietary oxalate content categories. Bard AI had the highest accuracy of 84%, followed by Bing (60%), GPT-4 (52%), and GPT-3.5 (49%) (p < 0.001). There was a significant pairwise difference between chatbots, except between GPT-4 and GPT-3.5 (p = 0.30). The accuracy of all the chatbots decreased with a higher degree of dietary oxalate content categories but Bard remained having the highest accuracy, regardless of dietary oxalate content categories. There was considerable variation in the accuracy of AI chatbots for classifying dietary oxalate content. Bard AI consistently showed the highest accuracy, followed by Bing Chat, GPT-4, and GPT-3.5. These results underline the potential of AI in dietary management for at-risk patient groups and the need for enhancements in chatbot algorithms for clinical accuracy.

Purpose: Antibody–drug conjugates (ADC) have transformed the treatment of breast cancer. FDA-approved ADC such as trastuzumab deruxtecan (T-DXd), sacituzumab govitecan (SG), and datopotamab deruxtecan (Dato-DXd) have demonstrated clinical benefit; however, drug resistance will almost inevitably emerge in the metastatic setting, and there is no established strategy for selecting subsequent ADC after disease progression following the first exposure to the ADC. This study aimed to define mechanisms of acquired resistance and evaluate rational sequencing approaches. Experimental Design: We generated breast cancer cell lines resistant to T-DXd (TDXd-R) and SG (SG-R). We assessed antigen expression, internalization, and resistance pathways, including efflux transporter activity. To identify therapeutic strategies, we tested the efficacy of ADC carrying non–topoisomerase I (Topo1) payloads in in vitro and in vivo models. Results: Resistance in both TDXd-R and SG-R models was primarily mediated by payload-specific factors, notably upregulation of efflux transporters, rather than loss of antigen expression. Switching to ADC with mechanistically different payloads, including microtubule inhibitors, restored antitumor activity in vitro and in vivo. Conclusions: Cross-resistance to sequential ADC is primarily driven by shared payload mechanisms rather than loss of the target. Our data also suggest that the clinical benefit of sequential Topo1-based ADC may be reduced following disease progression on a Topo1-based ADC, likely due to these shared resistance pathways. Importantly, switching to ADC with non–cross-resistant payload classes may offer a more effective approach to guide ADC sequencing in patients with metastatic breast cancer, supporting payload diversification as a clinically actionable strategy.

Background: Despite the prevalence and incidence of kidney stones progressively increasing worldwide, public awareness of this condition remains unclear. Understanding trends of awareness can assist healthcare professionals and policymakers in planning and implementing targeted health interventions. This study investigated online search interest in “kidney stone” by analyzing Google Trends, focusing on stationarity of the trends and predicting future trends. Methods: We performed time series analysis on worldwide Google monthly search data from January 2004 to November 2023. The Augmented Dickey–Fuller (ADF) test was used to assess the stationarity of the data, with a p-value below 0.05 indicating stationarity. Time series forecasting was performed using the autoregressive integrated moving average to predict future trends. Results: The highest search interest for “kidney stone” (score 100) was in August 2022, while the lowest was in December 2007 (score 36). As of November 2023, search interest remained high, at 92. The ADF test was significant (p = 0.023), confirming data stationarity. The time series forecasting projected continued high public interest, likely reflecting ongoing concern and awareness. Notably, diverse regions such as Iran, the Philippines, Ecuador, the United States, and Nepal showed significant interest, suggesting widespread awareness of nephrolithiasis. Conclusion: This study highlighted that “kidney stone” is a consistently relevant health issue globally. The increase and stationarity of search trends, the forecasted sustained interest, and diverse regional interest emphasize the need for collaborative research and educational initiatives. This study’s analysis serves as a valuable tool for shaping future healthcare policies and research directions in addressing nephrolithiasis related health challenges.

Background/Objectives: The incidence and mortality of early-onset cancers have been rising in recent decades. While epidemiological studies have examined various types of cancer, updated global data on alcohol-attributable primary liver cancer (PLC) in young adults remains limited. Methods: This study utilized data from the Global Burden of Disease (GBD) study spanning 2000 to 2021 to evaluate the age-standardized incidence, mortality, and corresponding rates of alcohol-attributable PLC among young adults aged 15–49 years. Results: In 2021, there were 8290 incidence cases and 6590 deaths from alcohol-attributable PLC in young adults. The age-standardized incidence rate has increased in Europe (annual percent change [APC]: 0.44%, 95%CI 0.35 to 0.54%), Southeast Asia (APC: 0.40%, 95% CI 0.37 to 0.44%), and the Western Pacific region (APC: 0.65%, 95% CI 0.44 to 0.86%). In 2021, alcohol-attributable PLC in young adults represented 11% (+2% from 2000) of incident cases and 11% of (+2% from 2000) deaths among all PLC in young adults. About half of the countries showed an increase in the age-standardized incidence rate of alcohol-attributable PLC among young adults between 2000 and 2021. Conclusions: The incidence rate of alcohol-attributable liver cancer in young adults has shifted significantly over the past two decades, with notable increases in Europe and the Asia–Pacific region. This trend underscores the need for global strategies to address the rising prevalence of alcohol use disorder and alcohol-associated liver disease and their impact on young adults.

Background: In recent years, immunotherapy using immune checkpoint inhibitors (ICIs) has revolutionized the treatment of advanced malignancies. As such, numerous ICIs are establishing themselves as prospective therapy alternatives for individuals with head and neck cancer (HNC). Evidence suggests a potential correlation between body mass index (BMI) and the efficacy of ICIs in cancer patients. However, this association in HNC patients subjected to immunotherapy is still unclear.Aims: To investigate the effect of BMI on the survival outcomes of HNC patients treated with immunotherapy.Methods: PubMed, Web of Science, and Google Scholar databases were searched extensively for records published until January 2024. Full‐text articles aligned with the research objective were included, while records published in English, case reports, reviews, editorials, and studies reporting immunotherapy combined with other cancer therapies were excluded. The data required for review and analysis was abstracted in Excel files by two independent reviewers. Additionally, data synthesis was carried out using the Review Manager program, and evaluation of methodological quality was done with the Newcastle Ottawa scale. The statistical analyses were stratified according to the BMI values, of which patients were categorized as follows: Obese (BMI ≥ 27.5), non‐obese (BMI < 27.5), overweight (BMI: 23.5–27.5), underweight (BMI < 18.5), normal (BMI: 18.5–23.5), low (BMI < 20), and high (BMI ≥ 20).Results: Only six studies were reviewed and analyzed. A subgroup analysis of data from these studies showed that obese HNC patients on immunotherapy had significantly better overall survival (OS) rates than non‐obese patients (HR: 0.51; 95% CI: 0.29–0.93; p = 0.03). However, the progression‐free survival (PFS) was statistically similar between obese and non‐obese patients (HR: 0.72; 95% CI: 0.39–1.33; p = 0.30). In addition, when BMI was stratified as either low or high, no significant difference was observed in the OS and PFS of HNC patients (HR: 0.99; 95% CI: 0.59–1.66; p = 0.97 and HR: 0.93; 95% CI: 0.61–1.41; p = 0.42, respectively). Similarly, the statistical analyses showed that overweight patients have similar OS and PFS as patients with normal BMI (HR: 0.53; 95% CI: 0.15–1.92; p = 0.33 and HR: 0.55; 95% CI: 0.20–1.52; p = 0.25, respectively). In contrast, underweight patients demonstrated poor OS and PFS (HR: 2.56; 95% CI: 1.29–5.12; p = 0.008 and HR: 2.76; 95% CI: 1.17–6.52; p = 0.02, respectively).Discussion and Conclusion: Obese HNC patients on immunotherapy tend to have improved OS than non‐obese patients, while underweight patients have worse clinical prognoses than those with normal or above BMI.

A 63-year-old male with stage IV hepatocellular carcinoma (HCC), accompanied by lung and adrenal metastases, presented with oral bleeding. Physical examination disclosed bleeding from the tonsillar mass. A head and neck computed tomography identified a 2.4 cm enhancing lesion in the right anterior ethmoidal sinus, extending to the nasal region and medial orbit. Tonsillar mass biopsy confirmed HCC metastasis, immunopositive for Hepatocyte Paraffin 1 (HepPar1) and Arginase. He was treated with local radiotherapy (30 fractions). The unique presentation of severe bleeding from a tonsillar biopsy-proven HCC metastatic lesion underscores the rarity of head and neck involvement. Extrahepatic metastasis, particularly to the head and neck area likely due to hematogenous spread, may be a major independent predictor of poor outcomes in HCC patients. Local radiotherapy to achieve local hemostasis and reduce tumor bulk should be considered. In patients with known HCC having new oropharyngeal symptoms, HCC metastasis should be considered for a timely diagnosis. Despite its rarity, this manifestation signifies an unfavorable prognosis, reinforcing the imperative for a multidisciplinary approach to enhance therapeutic outcomes in these complex scenarios.