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PANCE study help - Physician Assistant National Certifying Updated: 2023

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PANCE Physician Assistant National Certifying

The material on NCCPA's certification and recertification exams can be organized in two dimensions: Organ systems and the diseases, disorders and medical assessments physician assistants encounter within those systems; and The knowledge and skills physician assistants should exhibit when confronted with those diseases, disorders and assessments.

Please note that while the subject matter covered on the certification and recertification exams is the same, there is some difference in the nature of the questions on those exams. Generally, the questions on the initial certification test are more specific, while questions on the recertification test tend to address broader clinical issues. This difference is most apparent in the questions related to applying basic science concepts and reflects the different functions of the two exams.

Note: Because of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) publication, NCCPA will adapt its content blueprints, disease and disorder lists, and psychiatry-related terminology within test questions to conform to DSM-5 classifications and diagnostic criteria for all of our examinations.
In NCCPA examinations, psychiatry-related terminology within test questions will include the DSM-5 terminology followed by the DSM-IV-TR terminology in parentheses. Example: illness anxiety disorder (hypochondriasis)

Based on delays in implementation of DSM-5 guidelines within the field of psychiatry, NCCPA will continue to present psychiatry-related terminology within test questions in the manner outlined above until further notice.

Beginning in 2019, there was a new content blueprint released for the Physician Assistant National Certifying Examination (PANCE). The content blueprint provides guidance on the information assessed on the Physician Assistant National Certifying Examination (PANCE). The examination is categorized in two dimensions:
Knowledge of the diseases and disorders physician assistants encounter; and Knowledge and skills related to tasks physician assistants perform when treating patients.
The detailed listings provided under each of these two categories represent examples of the material that may be covered on PANCE. It is not possible to include all courses on a single exam, and it may be possible that some questions on the test cover content that is not listed in the examples.

The content blueprint for PANCE is based on information provided from certified physician assistants who participate in profession-wide practice analysis studies. Certified PAs are involved throughout the test development process, including: reviewing results of the practice analysis, writing questions that appear on PANCE, reviewing exams before they are administered, reviewing performance data for test questions, and developing recommendations for the passing standard. Certified PAs work with NCCPA to continuously review the content included on PANCE to ensure it is relevant and current, as the practice of medicine changes and treatment guidelines are revised or new ones introduced.

Cardiovascular System 13%
Dermatologic System 5%
Endocrine System 7%
Eyes, Ears, Nose, and Throat 7%
Gastrointestinal System/Nutrition 9%
Genitourinary System (Male and Female) 5%
Hematologic System 5%
Infectious Diseases 6%
Musculoskeletal System 8%
Neurologic System 7%
Psychiatry/Behavioral Science 6%
Pulmonary System 10%
Renal System 5%
Reproductive System (Male and Female) 7%
History Taking and Performing Physical Examination 17%
Using Diagnostic and Laboratory Studies 12%
Formulating Most Likely Diagnosis 18%
Managing Patients
Health Maintenance, Patient Education, and Preventive Measures 10%
Clinical Intervention 14%
Pharmaceutical Therapeutics 14%
Applying Basic Scientific Concepts 10%
Professional Practice 5%
Physician Assistant National Certifying
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Physician Assistant National Certifying
Question: 375
Which of the following syndromes corresponds to: chromosomal deficit of #13?
A. Dubin-Johnson syndrome
B. Patau's syndrome
C. Edward's syndrome
D. Down syndrome
Answer: B
Section 19: Sec Nineteen (376 to 400)
Details: Urinary System Practice Exam
Question: 376
The renal medulla is composed of tissue called ______.
A. Renal pyramids
B. Nephrons
C. Renal sinus
D. Renal pelvis
Answer: A
Question: 377
Juxtaglomerular cells combine with _______ cells to form the juxtagomerular apparatus in
the kidney.
A. Macula densa
B. Renal pelvis
C. Nephron
D. Renal sinus
Answer: A
Question: 378
Which of the following is not in the sequence of proper kidney blood flow? The starting
point is the renal artery and the finishing point is the renal vein.
A. Arciform artery
B. Afferent arteriole
C. Interlobar vein
D. Arciform vein
Answer: C
Question: 379
Which is found in the highest concentration in the urine?
A. Uric acid
B. Urea
C. Glucose
D. Creatinine
Answer: B
Question: 380
The primary function of the ascending loop of Henle in the kidney is?
A. The active re-absorption of sodium
B. The active re-absorption of chloride ions
C. The passive re-absorption of potassium
D. The passive re-absorption of urea
Answer: B
Question: 381
The middle layer of the urinary bladder is identified as ___________.
A. Mucous coat
B. Submucous coat
C. Muscular Coat
D. Sphincter Coat
Answer: B
Question: 382
The micturition reflex center is located in the _____.
A. Pons
B. Midbrain
C. Lumbar plexus
D. Sacral plexus
Answer: D
Question: 383
Which of the following match with the definition: a poor output of urine?
A. Oliguria
B. Pyruia
C. Enuresis
D. Diuresis
Answer: A
Question: 384
Capillary loops located in the medulla are also known as _________.
A. Vasa recta
B. Urea collectors
C. Trigone
D. Macula densa
Answer: A
Question: 385
The primary function of the descending loop of Henle in the kidney is?
A. Reabsorption of sodium ions
B. Reabsoption of water by osmosis
C. Secretion of hydrogen ions
D. Secretion of potassium ions
Answer: B
Question: 386
Which of the following is not considered a part of the male urethra?
A. Prostatic
B. Membranous
C. Vasapore
D. Penile
Answer: C
Question: 387
When glucose if found in urine it is called _____.
A. Glucosuria
B. Uremia
C. Ureteritis
D. Glucose intolerance
Answer: A
Question: 388
The one of the functions occurring at the distal convoluted tubule in the kidney is?
A. Passive secretion of hydrogen ions
B. Passive secretion of potassium ions
C. Limited re-absorption of water
D. No re-absorption of sodium
Answer: B
Question: 389
ADH has which of the following effects on the distal convoluted tubule?
A. Decrease water re-absorption
B. Increase water re-absorption
C. Decrease the concentration of urine
D. Increase the urine volume
Answer: B
Question: 390
Which of the following is not associated with the role of the kidneys?
A. Release of erythropoietin (hormone)
B. Release of renin (enzyme)
C. Release of Vitamin E
D. Activate Vitamin D
Answer: C
Question: 391
Each kidney contains approximately ______ nephrons.
A. 10 million
B. 1 million
C. 100,000
D. 10,000
Answer: B
Question: 392
The release of Angiotension II
causes which of the following to occur?
A. Increased filtration rate
B. Decreased glomerular hydrostatic pressure
C. Increase synthesis of Vitamin E
D. Increased release of erythropoietin
Answer: A
Question: 393
Which of the following is an effect of a diuretic?
A. Decreased Cardiac Output
B. Increased fluid volume
C. Increased sodium re-absorption
D. Increased chloride ion re-absorption
Answer: A
Question: 394
Which of the following is not considered a loop diuretic?
A. Bumetadine (BUMEX)
B. Furosemide (LASIX)
C. Chlorthiazide (DIURIL)
D. Ethacrynic Acid (EDECRIN)
Answer: C
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Medical Certifying study help - BingNews Search results Medical Certifying study help - BingNews Almost half of children on the weight-loss drug semaglutide are no longer clinically obese, landmark study finds Getty Images © Provided by INSIDER Getty Images
  • 134 children with clinical obesity were given weight-loss drug semaglutide. 
  • Almost half of them lost enough weight to no longer be considered clinically obese.
  • Semaglutide, a medically-prescribed drug, is changing the face of obesity treatment, experts have said. 

Almost half of children given weight-loss jab semaglutide lost enough weight to no longer be considered clinically obese, a study found. 

The study, presented at the European Congress on Obesity in Dublin, is the latest in a series of trials showing the jab offers life-saving treatment to people with obesity. 

Two hundred and one adolescents with clinical obesity between 12 and 18 were entered in a trial to test the effect of the weight-loss drug semaglutide, marketed under the name Ozempic when it is prescribed for diabetes and Wegovy when prescribed for weight loss.

One hundred and thirty-four of these children received a weekly dose of 2.4 milligrams of semaglutide for more than a year, alongside healthy lifestyle counseling, The Guardian reported. The rest received the same lifestyle counseling and a placebo jab. 

The study found that at the end of 68 weeks of treatment, almost 45% of children who got semaglutide dropped enough weight to no longer be considered clinically obese, compared to just 12% of adolescents who received the placebo, per The Guardian. 

The results are "historically unprecedented with treatments other than bariatric surgery," Aaron Kelly, a study lead and the co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota said at a press conference about the findings, per The Guardian. 

"These results underscore the high degree of clinical effectiveness of semaglutide in adolescents with obesity," the report stated per The Guardian. 

Semaglutide has changed the face of obesity treatment 

A man checking his weight in a doctor's office. Jose Luis Pelaez Inc/Getty Images © Jose Luis Pelaez Inc/Getty Images A man checking his weight in a doctor's office. Jose Luis Pelaez Inc/Getty Images

The FDA approved semaglutide, a drug initially designed to treat type 2 diabetes, for the treatment of obesity in 2021. 

The drug has changed the face of obesity treatment. Obesity is a poorly understood disease, but what is clear is that for those who have it, lifestyle interventions and diets alone are usually not effective.

"The biggest misconception about obesity is that people have just let themselves go," Fatima Cody Stanford, associate professor at Harvard Medical School, previously told Insider

"But research actually shows us that obesity is a disease caused by one's biology," she said. 

However, a landmark study showed that semaglutide could help people who are dangerously overweight reduce their risk substantially, to the point where their weight was no longer a health issue.

The study was a breakthrough for the field, which previously could only offer invasive bariatric surgery as a last resort. 

Since then, a series of papers have shown the drug can help people shed the pounds linked with obesity.

Semaglutide is safe but should only be used under clinical advice

A stock image of a doctor and patient. The Good Brigade/Getty Images © The Good Brigade/Getty Images A stock image of a doctor and patient. The Good Brigade/Getty Images

The drug has taken over social media, prompting some to take it without a medical need for weight loss.

These posts, however, have prompted widespread false claims such as exaggerated side effects and misleading success stories, Christopher McGowan, a board-certified physician in internal medicine, gastroenterology, and obesity medicine, previously told Insider

"Semaglutide is a legitimately effective medication. It provides health-altering weight loss," he told Insider. "It has an overall excellent safety profile and is generally well tolerated," he said. 

But, he cautioned, "people are seeing on social media it's a quick fix or a way to lose a few pounds. That's not how they're studied or intended to be used." 

While weight loss is generally a good thing, medical intervention is only deemed as necessary when your weight puts you at risk of serious health issues such as diabetes and cancer, Francesco Rubino, chair of metabolic surgery at King's College London, previously told Insider.

Those who aren't in that category could seek other interventions, such as improving their diet and exercise, he said.

"The question is, do you actually need to lose weight?" he said. 

Semaglutide is also a lifelong commitment, as those who stop the drug can see their weight rebound, said Rubino. 

"You would have to commit to a lifelong taking of this drug, which is something you would contemplate only if the benefits outweigh the risks, as low as this risk could be," Rubino said. 

Wed, 17 May 2023 23:14:22 -0500 en-US text/html
UAE: New foundation programme to help medical students get into top-ranked US, UK, European universities © Provided by Khaleej Times

Ajman-based Thumbay Group, which operates Gulf Medical University and also provides healthcare services in the UAE, has tied up the education management group Gems Middle East to offer the University of London International Foundation Programme with a specialised focus on medicine in its Thumbay Medicity campus.

The nine-month programme will offer students a pathway into various undergraduate degree programmes, encompassing fields such as medicine, dentistry, veterinary sciences, physiotherapy, nursing, midwifery, pharmacy, and nutrition.

Priced at $6,800 (Dh25,000) per term, the programme will serve as a stepping stone towards admission into renowned universities in Europe, Asia, and America.

It will offer preparation for the BMAT and UCAT exams, crucial prerequisites for medical and dental programmes in the UK and other countries. Upon completion of the programme, students will receive a certificate of completion from the University of London and an International A-Level Certification from LRN-UK. Moreover, extensive guidance and support for the UCAT and BMAT exams will be provided.

The Medical Foundation Programme is scheduled to commence in September 2023, with applications set to open in June 2023. The programme welcomes applications from students who currently hold A-levels, International Baccalaureate (IB), or equivalent Grade 12 qualifications.

Lynne Roberts, director of the International Foundation Programme, University of London Worldwide, said the programme assists students to achieve high academic standards and gain both the skills and intellectual curiosity necessary to succeed at university.

"This not only expands our global presence but also provides students with a remarkable opportunity to gain seamless access to the programs offered by Gulf Medical University,” said Prof. Hossam Hamdy, chancellor of Gulf Medical University.

Amir Saadati, executive director of Gems Middle East, said that they are currently in talks with several UK-based universities.

“These discussions aim to provide students with the chance to study graduate entry medicine after completing the UoL Foundation program and Higher Diploma in Pre-Clinical Sciences (HDPCS) at Gulf Medical University. This initiative aims to broaden the academic opportunities available to students and enhance their educational journey even further,” he said.

Mon, 05 Jun 2023 01:01:09 -0500 en-AE text/html
Medical professionals encourage CPR certification during CPR and AED Awareness Week

(AP) - June 1-7 is known as National CPR and AED Awareness Week! 

Medical professionals from Purdue Global report that over 350,000 people die from cardiac arrest each year. These incidents often happen outside of doctor's offices or hospitals.  

That makes the use of CPR and AED's crucial in saving someone from cardiac arrest. Melissa Burdi is the VP and Dean of the Purdue Global School of Nursing. She urges people to get CPR and AED certified.

"The key message is that you don't have to be a healthcare provider to take CPR courses and to become certified. Anyone can learn CPR," said Burdi.

Burdi says that you can get certified at local fire departments, hospitals, or schools.

Sun, 04 Jun 2023 14:43:00 -0500 en text/html
Latest version of ChatGPT passes radiology board-style exam, highlights AI's ‘growing potential,' study finds

How ChatGPT could replace textbooks and rewrite higher education



The latest version of ChatGPT, the artificial intelligence chatbot from OpenAI, is smart enough to pass a radiology board-style exam, a new study from the University of Toronto found.

GPT-4, which launched officially on March 13, 2023, correctly answered 81% of the 150 multiple-choice questions on the exam.

Despite the chatbot’s high accuracy, the study — published in Radiology, a journal of the Radiological Society of North America (RSNA) — also detected some concerning inaccuracies.


"A radiologist is doing three things when interpreting medical images: looking for findings, using advanced reasoning to understand the meaning of the findings, and then communicating those findings to patients and other physicians," explained lead author Rajesh Bhayana, M.D., an abdominal radiologist and technology lead at University Medical Imaging Toronto, Toronto General Hospital in Toronto, Canada, in a statement to Fox News Digital.

The latest version of ChatGPT, the artificial intelligence chatbot from OpenAI, is smart enough to pass a radiology board-style exam, a new study from the University of Toronto has found. iStock © iStock The latest version of ChatGPT, the artificial intelligence chatbot from OpenAI, is smart enough to pass a radiology board-style exam, a new study from the University of Toronto has found. iStock

"Most AI research in radiology has focused on computer vision, but language models like ChatGPT are essentially performing steps two and three (the advanced reasoning and language tasks)," she went on.


"Our research provides insight into ChatGPT’s performance in a radiology context, highlighting the incredible potential of large language models, along with the current limitations that make it unreliable."


The researchers created the questions in a way that mirrored the style, content and difficulty of the Canadian Royal College and American Board of Radiology exams, according to a discussion of the study in the medical journal.

(Because ChatGPT doesn’t yet accept images, the researchers were limited to text-based questions.)

The questions were then posed to two different versions of ChatGPT: GPT-3.5 and the newer GPT-4.

The GPT-3.5 version of ChatGPT answered 69% of questions correctly (104 of 150), near the passing grade of 70% used by the Royal College in Canada, according to the study findings. 

It struggled the most with questions involving "higher-order thinking," such as describing imaging findings.

"A radiologist is doing three things when interpreting medical images: looking for findings, using advanced reasoning to understand the meaning of the findings, and then communicating those findings to patients and other physicians," said the lead author of a new study (not pictured). iStock © iStock "A radiologist is doing three things when interpreting medical images: looking for findings, using advanced reasoning to understand the meaning of the findings, and then communicating those findings to patients and other physicians," said the lead author of a new study (not pictured). iStock

As for GPT-4, it answered 81% (121 of 150) of the same questions correctly — exceeding the passing threshold of 70%.

The newer version did much better at answering the higher-order thinking questions.

"The purpose of the study was to see how ChatGPT performed in the context of radiology — both in advanced reasoning and basic knowledge," Bhayana said. 

"GPT-4 performed very well in both areas, and demonstrated improved understanding of the context of radiology-specific language — which is critical to enable the more advanced tools that radiology physicians can use to be more efficient and effective," she added.

The researchers were surprised by GPT-4's "marked improvement" in advanced reasoning capabilities over GPT-3.5.

"Our findings highlight the growing potential of these models in radiology, but also in other areas of medicine," said Bhayana.

"Our findings highlight the growing potential of these models in radiology, but also in other areas of medicine," said the lead author of a new study. NELSON ALMEIDA/AFP via Getty Images © NELSON ALMEIDA/AFP via Getty Images "Our findings highlight the growing potential of these models in radiology, but also in other areas of medicine," said the lead author of a new study. NELSON ALMEIDA/AFP via Getty Images

Dr. Harvey Castro, a Dallas, Texas-based board-certified emergency medicine physician and national speaker on artificial intelligence in health care, was not involved in the study but reviewed the findings.

"The leap in performance from GPT-3.5 to GPT-4 can be attributed to a more extensive training dataset and an increased emphasis on human reinforcement learning," he told Fox News Digital.

"This expanded training enables GPT-4 to interpret, understand and utilize embedded knowledge more effectively," he added.


Getting a higher score on a standardized test, however, doesn't necessarily equate to a more profound understanding of a medical subject such as radiology, Castro pointed out. 

"It shows that GPT-4 is better at pattern recognition based on the vast amount of information it has been trained on," he said.

Many health technology experts, including Bhayana, believe that large language models (LLMs) like GPT-4 will change the way people interact with technology in general — and more specifically in medicine.

"They are already being incorporated into search engines like Google, electronic medical records like Epic, and medical dictation software like Nuance," she told Fox News Digital. 

"But there are many more advanced applications of these tools that will transform health care even further."

"The leap in performance from GPT-3.5 to GPT-4 can be attributed to a more extensive training dataset and an increased emphasis on human reinforcement learning," Dr. Harvey Castro, a board-certified emergency physician and national speaker on AI in health care, told Fox News Digital. Jakub Porzycki/NurPhoto © (Photo by Jakub Porzycki/NurPhoto) "The leap in performance from GPT-3.5 to GPT-4 can be attributed to a more extensive training dataset and an increased emphasis on human reinforcement learning," Dr. Harvey Castro, a board-certified emergency physician and national speaker on AI in health care, told Fox News Digital. Jakub Porzycki/NurPhoto

In the future, Bhayana believes these models could answer patient questions accurately, help physicians make diagnoses and guide treatment decisions. 

Honing in on radiology, she predicted that LLMs could help augment radiologists’ abilities and make them more efficient and effective.

"We are not yet quite there yet — the models are not yet reliable enough to use for clinical practice — but we are quickly moving in the right direction," she added.

Perhaps the biggest limitation of LLMs in radiology is their inability to interpret visual data, which is a critical aspect of radiology, Castro said.

Large language models (LLMs) like ChatGPT are also known for their tendency to "hallucinate," which is when they provide inaccurate information in a confident-sounding way, Bhayana pointed out.

"These hallucinations decreased in GPT-4 compared to 3.5, but it still occurs too frequently to be relied on in clinical practice," she said.

"Physicians and patients should be aware of the strengths and limitations of these models, including knowing that they cannot be relied on as a sole source of information at present," Bhayana added.

"Physicians and patients should be aware of the strengths and limitations of these models, including knowing that they cannot be relied on as a sole source of information at present." Frank Rumpenhorst/picture alliance via Getty Images © Frank Rumpenhorst/picture alliance via Getty Images "Physicians and patients should be aware of the strengths and limitations of these models, including knowing that they cannot be relied on as a sole source of information at present." Frank Rumpenhorst/picture alliance via Getty Images

Castro agreed that while LLMs may have enough knowledge to pass tests, they can’t rival human physicians when it comes to determining patients’ diagnoses and creating treatment plans.

"Standardized exams, including those in radiology, often focus on 'textbook' cases," he said. 

"But in clinical practice, patients rarely present with textbook symptoms."

Every patient has unique symptoms, histories and personal factors that may diverge from "standard" cases, said Castro. 

"This complexity often requires nuanced judgment and decision-making, a capacity that AI — including advanced models like GPT-4 — currently lacks."


While the improved scores of GPT-4 are promising, Castro said, "much work must be done to ensure that AI tools are accurate, safe and valuable in a real-world clinical setting."

Wed, 24 May 2023 18:00:57 -0500 en-US text/html
Study examines safety and efficacy of made-to-fade tattoos for medical markings

Researchers at Henry Ford Health -; one of the nation's leading integrated academic medical institutions -; in collaboration with Ephemeral Tattoo, have conducted a study on the safety and efficacy of made-to-fade tattoos for medical markings.

Fifty to 60 percent of cancer patients receive radiation therapy during their course of treatment. Patients have traditionally been required to receive small, permanent tattoos on their skin to ensure therapy is delivered accurately to the same place each time while minimizing healthy tissue exposure to radiation. On the heels of this study, Ephemeral will offer its innovative made-to-fade tattoo ink -; which meets all required medical standards -; as a replacement for the small, permanent tattoos patients receive on their skin to help position them for radiation treatment.

As part of the study, 15 patients who were scheduled to undergo radiation therapy were given a total of 44 tattoos using Ephemeral's made-to-fade ink, which is specifically formulated to last throughout the four-to-eight-week course of treatment, but disappear after. Ephemeral Tattoo ink is applied like a traditional tattoo – by a needle into the dermis -; but due to the degradation of the bioabsorbable polymers, the ink breaks down over time into small enough sizes for the body's immune system to remove it. The study was created by Henry Ford Health radiation oncology resident Eric Schaff, M.D., with the help of principal investigator Farzan Siddiqui, M.D., Ph.D., and research engineer Marissa Gilbert.

The initial safety data we've seen from this study is promising. Study participants were questioned weekly as to whether they experienced any adverse effects at the site of the tattoo, such as pain, itchiness, rashes or other issues. To date, there have been no adverse effects reported by participants."

Eric Schaff, M.D., Henry Ford Health radiation oncology resident

The biodegradable ink used in the study was developed by Ph.D. chemical engineers, Vandan Shah and Brennal Pierre at Ephemeral Tattoo. Dr. Dhaval Bhanusali, board certified dermatologist and Michigan State University alum, was instrumental in advising Ephemeral and lending his resources on making ink improvements. According to Brennal Pierre, co-founder and chief technology officer of Ephemeral Tattoo, the ink is made up of FDA-approved ingredients, similar to dissolvable stitches.

"Ephemeral Tattoo's ink is made from medical-grade polymers, which are chains of smaller molecules and natural and synthetic color additives routinely used in food, medical devices, drugs and cosmetics," said Pierre, who is also a chemical and biomolecular engineer. "The polymers in Ephemeral Tattoo ink are biodegradable and bioabsorbable, so after they enter the body, they will gradually break apart until the particles are small enough for the body to remove."

Made-to-fade tattoos for radiation therapy could potentially provide a range of benefits for patients, Dr. Schaff explained.

"One of the potential benefits is providing an alternative to permanent tattoos for individuals with religious, cultural or other considerations that prohibit them from receiving a permanent tattoo," said Dr. Schaff. "For some patients, permanent tattoos also serve as a daily reminder of prior radiation therapy, which may have a negative psychological impact on their quality of life. We believe semi-permanent tattoos could offer patients an alternative to permanent tattoos, which has long been the standard of care for radiation therapy alignment."

Over the years, there have been attempts in the medical community to use non-permanent tattoo options, such as henna, for radiation therapy alignment. Because henna and other temporary tattoos start to fade quickly and do not last the six to eight weeks required for longer radiation courses, the tattoos must be reapplied over the course of treatment, which can introduce inaccuracies and prolong treatment time.

Tue, 16 May 2023 12:00:00 -0500 en text/html
‘A picture worth a thousand words’: Art meets medicine at CHOP’s in-house studio of medical illustrators

The walls of Eo Trueblood’s office are covered in images of body parts, medical devices, and surgical procedures.

He pointed to a black and white graphite sketch of a human heart, exposed in the chest cavity, ready for a coronary artery bypass. It’s an image he captured while being embedded with a medical team in the operating room.

“So, the number one rule of sketching in the O.R. — no erasers,” Trueblood said with a laugh. “You don’t want to be putting sprinkles everywhere.”

Trueblood, a certified medical illustrator at Children’s Hospital of Philadelphia, has another rule for himself.

“If a person looks at the illustration and has no idea what’s going on, I’ve completely failed,” he said. “A few words or a couple of labels can add to what they’re understanding, but ultimately, you should be able to look at it and say, ‘Two [conjoined] twins, they’re separated right down the middle and there’s some vascular anatomy,’ and that’s it.”

In a digital age where most people have thousands of images of human hearts or lungs right at their fingertips, it may come as a surprise that hospitals like the Children’s Hospital of Philadelphia employ an in-house team of medical illustrators.

But Trueblood said their work often goes far beyond the static images found online.

“You have to be able to tell a story and understand how to tell a story visually,” Trueblood said, “simplifying really complex concepts and procedures and diagnoses and distilling them into a visual that anyone can look at and understand.”

As lead medical illustrator at Stream Studios, Eo Trueblood creates anatomical learning aids for students, doctors and patients, like his illustration of the spine and bladder that hangs on his office wall. (Kimberly Paynter/WHYY)

Trueblood, co-founder of CHOP’s Stream Studios, said medical illustration is a small, but unique field that has a lot of offer.

There are only an estimated 2,000 certified professionals worldwide, according to the Association of Medical Illustrators. Unlike other kinds of artists, they study anatomy, physiology, and other biomedical subjects in addition to taking courses on drawing, graphics, and design.

They assist with cadaver dissections, learn how to translate very detailed scientific research, and sit in on medical procedures in order to create illustrations with accuracy and specificity.

Sometimes that involves capturing what’s known as a “surgical moment,” which can later be used as a teaching tool.

“It’s the moment that is most didactic. It teaches a technique,” Trueblood said. “It’ll inform the surgeon who’s looking at that illustration about tissue reaction, how things are being moved and stretched, what instrumentation is being used.”

Other times, Trueblood and his colleagues are there to document history being made. One of his most well-known illustrations depicts the world’s first bilateral hand transplant in a child at CHOP in 2015.

Another notable one is the 2017 “lamb in a bag” experiment, when scientists were able to keep alive premature lamb fetuses in an artificial womb, which raised hope that something similar could one day be created to help very premature human fetuses survive.

“I always joke that I get to illustrate science fiction sometimes,” Trueblood said, “because it is amazing what people are able to figure out and kind of the care that they’re able to provide.”

The studio’s illustrations are used in scientific journals, manuscripts, for hospital websites, and pamphlets. They’re also used to help patients and their families understand what’s happening.

“The families have no idea what’s on the inside and they don’t understand the gibberish that we’re talking,” said Dr. Brian Dunham, a pediatric ear surgeon at CHOP. “So, the picture is worth a thousand words every time.”

Dunham and Trueblood co-founded Stream Studios in 2013. Since then, they’ve added a third illustrator to the team, Brittany C. Bennett, and have taken on more 3D and animation work. They have plans to expand their portfolio even more by partnering with medical school programs.

These days, Dunham is just as comfortable with a stylus pen or sketching pencil in his hand as he is with a scalpel.

“The act of surgery is, you’re trying to cognitively build a map of the anatomy you’re traveling through,” Dunham said. “It’s the same process that you do when you’re making a drawing. You’re trying to discover the form and understand it.”

The content of the work can be quite serious and scientific, but the illustrators find ways to have fun with it.

For example, when choosing a likeness for an illustration, they often use family members and friends for inspiration.

In Dunham’s office, various medical illustrations displayed on the wall have familiar faces. A young girl with a mark on her neck closely resembles his youngest daughter. Another image of a child’s head showing a transparent view of a cochlear implant was modeled after a partner’s daughter.

“My kids have crawled all over me in my studio at home,” Dunham said. “They’ve seen all of this stuff as it comes off the production line.”

Trueblood has his own collection of illustrations modeled after his cousin’s two children, a close friend, his dad, his real-life partner, and even himself.

Stream Studios lead medical illustrator Eo Trueblood demonstrates how he creates visual renderings at CHOP. (Kimberly Paynter/WHYY)

“Most people are tickled,” he said. “They get to see a version of themselves in a cool situation.”

Neither of the studio’s co-founders initially envisioned careers as medical illustrators, or imagined that this could be a way to make a creative living. Both said they are grateful to have found this niche where art, science, and medicine meet.

“I get paid to draw every day,” Trueblood said. “It’s incredible science and incredible medicine. And ultimately, I feel like there are times where I’m able to deliver back to the community, which feels great.”

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Tue, 23 May 2023 01:30:00 -0500 en-US text/html
Multivitamins may help slow memory loss in older adults, study shows

A daily multivitamin — an inexpensive, over-the-counter nutritional supplement — may help slow memory loss in people ages 60 and older, a large nationwide clinical trial suggests.

The research, a collaboration between scientists at Brigham and Women’s Hospital and Columbia University, appeared in the American Journal of Clinical Nutrition on Wednesday.

It was the second such multivitamin clinical study within the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) — a larger body of research examining the health effects of certain dietary supplements — to reach the same conclusion.

The most latest study found that those taking multivitamins showed an estimated 3.1 fewer years of memory loss compared with a control group who took a placebo. Put another way, the multivitamin group was an estimated 3.1 years “younger” in terms of their memory function than the placebo group.

“Older adults are very concerned about preserving cognition and memory, so this is a very important finding,” said JoAnn Manson, chief of Brigham’s division of preventive medicine and co-leader of the study with Howard Sesso, associate director of the division. “They are looking for safe and effective prevention strategies. The fact that two separate studies came to similar conclusions is remarkable.”

Manson, also a professor of medicine at Harvard Medical School, described the effect of the supplements as “substantial.”

She stressed, however, that a dietary supplement “will never be a substitute for a healthy diet and a healthy lifestyle.”

The study used a commonly available multivitamin — Centrum Silver — but “we think any high-quality multivitamin is likely to convey similar results,” Manson said. Centrum Silver contains vitamins D, A and B12, thiamine, riboflavin and manganese, among other substances.

Manson and Sesso reported grants to their institution from Mars Edge, which is a unit of the food company, Mars, and which focuses on nutrition research and produces the dietary supplement CocoaVia. Several of the 10 authors of the research also reported financial support from the National Institutes of Health.

Mars Edge and Pfizer Consumer Healthcare (now Haleon), maker of Centrum Silver, donated the multivitamins and placebo tablets and packaging. COSMOS is also supported by NIH grants.

Sesso also reported grants from supplements company, Pure Encapsulations, and biopharmaceuticals company, Pfizer; and honoraria or travel support for lectures from the trade group for the dietary supplement industry, Council for Responsible Nutrition; chemical company, BASF; NIH; and a group that focuses on nutrition research, American Society for Nutrition.

Multivitamins already are popular with older Americans; 39 percent of adults ages 60 and older take multivitamins, according to the Centers for Disease Control and Prevention. U.S. sales of multivitamins and multivitamins with minerals totaled about $8 billion in 2020, according to NIH.

Memory benefit of multivitamins lasted three years

The latest trial included more than 3,500 participants ages 60 and older who completed web-based assessments of memory and cognition annually over three years. The tasks were recalling words and recognizing novel objects, and a measure of executive control.

Compared with the placebo group, participants randomized to multivitamin supplementation did significantly better on immediate recall of words after one year and sustained that benefit for an additional two years of follow-up, according to the study.

Multivitamin use, however, “did not significantly affect memory retention, executive function, or novel object recognition” when compared with placebo use, the study showed.

The findings that multivitamin use may help with memory and cognition are especially important because the brain, as all other organs in the body, requires nutrients for optimal functioning and can suffer cognitively without them, brain-health experts said.

“This study is groundbreaking,” said Andrew Budson, professor of neurology at Boston University and chief of cognitive behavioral neurology at VA Boston Healthcare System, who was not involved in the research.

Low levels of vitamins B1 — also known as thiamine — B12 and D are associated with cognitive decline, he said. “That a simple multivitamin can slow cognitive decline while they are aging normally is quite exciting, as it is something that almost everyone can do,” Budson said.

Paul E. Schulz, professor of neurology and director of the Neurocognitive Disorders Center at the McGovern Medical School at UTHealth Houston, said the brain requires a lot of vitamins and minerals to function properly. “Think of a complicated engine that requires lots of specialty parts and needs them all,” said Schulz, who also was not part of the study. “We regularly see people who are deficient in them who come in with cognitive impairment.”

Slowing of cognitive aging

The previous study, conducted by Brigham and Women’s Hospital and scientists at Wake Forest University School of Medicine, appeared in the fall in the journal Alzheimer’s & Dementia. It found a 60 percent slowing of cognitive aging among those who took multivitamins compared with the placebo group.

The two studies were independent of each other and had different designs. But, significantly, both were randomized placebo-controlled clinical trials, the “gold standard” of research in determining the efficacy of a drug or medical treatment — directly linking cause and effect.

“This is probably the best evidence there is for taking a multivitamin,” said Donald Hensrud, a specialist in nutrition at the Mayo Clinic, who was not involved in the research. “A randomized, controlled trial — good study.”

Curiously, both studies suggest that participants who derived the greatest benefits may have been those with a history of cardiovascular disease, the researchers said.

“It’s most intriguing because this same finding was replicated in two studies, with different designs, and with no overlapping participants,” Manson said, speculating that those with heart disease may have had a lower nutrient status at the start of the study. “They may have started from a lower threshold, so the improvements may have been more easily detectable,” she said.

In the overall COSMOS trial, which includes different studies, there were lower rates of stomach pain, diarrhea, skin rash and bruising as side effects with multivitamin use compared with the placebo, but an increased rate of gastrointestinal bleeding.

Future research on multivitamins

The study population included people of different races, ethnicities, educational levels, socioeconomic status and household income. “However, as is the case for volunteers in any randomized clinical trials, the participants tended to be slightly more educated, had slightly higher socioeconomic status, and had less diversity than a cross-section of U.S. adults in these age groups,” Manson said.

The researchers said that future studies should explore whether the findings would be applicable to even more diverse participants, including those with lower education levels and social economic status, because the “benefits may turn out to be even greater in populations with lower incomes and poorer quality diets,” Manson said.

Additional studies also should try to identify the nutrients that provide the most benefits, as well as the specific mechanisms involved, the researchers said.


Wed, 24 May 2023 08:15:00 -0500 en text/html
Study: Omega-3 may help develop baby's gut

Pregnant women may already be taking prenatal vitamins, but some may want to consider adding omega-3 fatty acids, too, according to new research. A woman's body doesn't make omega-3s, so she has to get them elsewhere, like in a supplement or through diet. Salmon is a highly recommended healthy omega-3 food for pregnant women. Mercy Medical Center pediatrician Dr. Ashanti Woods said new research shows omega-3s may benefit a developing baby's brain, heart, eyes, and now, even gut health.

Mon, 29 May 2023 15:24:00 -0500 en-US text/html
Could inhaling menthol help Improve memory in Alzheimer's disease?
  • A new study shows that inhaling menthol improves cognitive function in animal models of Alzheimer’s disease.
  • Researchers found that menthol inhalation decreased the level of interleukin-1-beta, a protein that causes inflammation.
  • Lower IL-1-beta levels were linked to better cognitive function in healthy mice and mice with Alzheimer’s.
  • The findings suggest the possibility for some inhaled substances to help treat Alzheimer’s disease.

According to a latest study in mouse models, published in Frontiers in Immunology, repetitive brief exposure to methanol can impact the immune system and prevent the cognitive decline that occurs among individuals with Alzheimer’s disease.

Researchers found that when mice smelled this substance, the level of interleukin-1-beta decreased. This protein is associated with the inflammatory response.

Additionally, by blocking this protein with a drug used to treat autoimmune conditions, researchers were able to boost cognitive ability in the mice with Alzheimer’s-like symptoms.

These findings illustrate the ability of odors and immune modulators to potentially treat this neurodegenerative disease.

“The study is interesting in that it brings to light the fact that, through the olfactory (smell) pathways, we can modulate the brain,” Dr. Brett Osborn, a board-certified neurosurgeon, chief of neurosurgery at St. Mary’s Medical Center in West Palm Beach, FL, not involved in this research, told Medical News Today. “We can effect a positive change on the brain through smell and smell alone.”

Furthermore, this does not require the implantation of a deep brain stimulator electrode or a vagal nerve stimulator system. The study demonstrates that the rodent Alzheimer’s brain can not only be “accessed” but positively affected at the cellular level — in the form of a disease-modifying therapy — through the nasal passages, Dr. Obsorn added.

“The findings that smelling menthol is sufficient to mitigate genetic predisposition to Alzheimer’s disease progression to cognitive dysfunction are provocative,” said Dr. Mikhail Kolonin, professor and director of the Center for Metabolic and Degenerative Diseases with the Institute of Molecular Medicine at UTHealth Houston, TX, who was not involved with this study. “Loss of smell has been previously linked to cognitive impairment and biomarkers of Alzheimer’s disease in patients.”

The study identifies the clear role of regulatory T cells (T-regs), immune cells with immunosuppressive activity, in mediating cognitive function in mice modeled to develop Alzheimer’s disease.

This is an important finding, which currently does not have a mechanistic explanation, Dr. Kolonin noted.

“It is striking that menthol inhalation and T-reg blockade had comparable potency in mitigating cognitive impairment,” said Dr. Kolonin. He explained:

“Because [the] authors conclude that T-reg blockade and olfaction appear to be mediated by the same cytokines, the details of their signaling could explain the underlying mechanisms. It is known that under proinflammatory conditions T-regs produce IL-17, a cytokine that triggers the onset of cognitive and synaptic deficits in early stages of Alzheimer’s disease. It is surprising that IL-17 was not pursued in the study as a potential mechanistic link.”

Menthol lowers inflammation in the part of the brain associated with memory.

“There appears to be an immunomodulatory effect of menthol in the prefrontal cortex, an area related to memory input, and one that is dysfunctional in the Alzheimer’s patient,” explained Dr. Osborn.

“More specifically, menthol inhalation reduced the cytokine (inflammatory chemicals) load in this region in the rodent Alzheimer’s model relative to the control group. The result? A less inflamed brain,“ he added.

“This effect is theorized to be at least one of the mechanisms by which the [Alzheimer’s disease] mice in the menthol-exposed group exhibited improved cognitive function,“ Dr. Osborn continued.

Inflammation and Alzheimer’s are closely intertwined, and therapies such as menthol inhalation may be beneficial in treating this disease.

“The study reinforces the fact that Alzheimer’s disease is underpinned by inflammation and that if therapies can be engineered to address this pathogenic component, the onset of [Alzheimer’s] may be delayed, and its progression thwarted,” Dr. Osborn stated.

“Potentially, this therapy could be administered via an inhaled agent, menthol, for example, that would be directly delivered to the limbic system of the brain — responsible for our emotions and memory — via the olfactory nerves, as there are neuronal connections between the olfactory and limbic systems,” he pointed out.

“There is a direct connection between the olfactory nerves/ tracts and the limbic system,” said Dr. Osborn. “The limbic system is associated with memory processing, emotional responses, fight-or-flight responses, aggression, and sexual response.”

It is also important to note the connectivity of the limbic system to the olfactory system is responsible for the intimate association of memory and smell.

While emphasizing that the study did not employ aromatherapy, “[o]dors often stimulate memory,” Dr. Osborn further explained. “They also may conjure up emotions, good or bad. In the context of the latter, this may confer a survival benefit: A toxic odor may cause us to run away or flee for fear of a chemical/ toxin exposure, as the flight-or-flight centers are activated by the smell alone.”

Since this study was only conducted on animals, there is no way of knowing how a human would be affected.

“This is a rodent model,” said Dr. Osborn. “It is often the case that such studies do not map to a human. There are a variety of interspecies genetic, anatomic, metabolic and physiologic differences that account for this phenomenon.”

In addition, only menthol was tested as an olfactory stimulant in the study.

“It was not assessed if the effect is specific for cold-sensing neuron activation and the likely role of TRPM8 signaling was not addressed,” Dr. Kolonin cautioned. “It would be interesting to determine if heat sensing stimulation would have similar or opposite effects.”

Another limitation of this study is that immune cells implicated in the process along with T-regs were not characterized.

“It is not clear what T-cells are reduced by menthol in the brain and determining whether those are effector, killer, or other T-cells would be insightful,” said Dr. Kolonin. “Brain microglia and astrocytes, the cells likely responsible for the secretion of IL-1-beta and IL-6, the cytokines modulated by menthol and T-regs, have also not been analyzed.”

“While the authors conclude that inhibition of T-regs reduced both IL-1-beta and IL-6, their data consistently show that IL-6 expression is in fact upregulated. IL-6 is a cytokine that can play distinct context-dependent and time-dependent roles. It would be interesting to determine if/ how intermittent/ transient modulation of IL-6 may be beneficial for disease intervention.”

– Dr. Mikhail Kolonin

“In this study, cognitive function tests were limited to measuring mouse freezing upon fear conditioning,” continued Dr. Kolonin.

“However, this test has a stress behavior component, which complicates data interpretation. It would be advantageous to use water maze or novel object recognition tests, better fit for Alzheimer’s symptoms assessment,” he added.

Thu, 18 May 2023 12:00:00 -0500 en text/html
AI study by Google researchers reveals incredible jump in Med-PaLM 2's answering accuracy

Artificial intelligence has permeated every technology field today. Among them, one field which is particularly resilient to emerging technologies is the medical field. Due to dealing in extremely sensitive areas that can lead to life-and-death scenarios, the medical field has been apprehensive about deploying new medtech tools into general practice. However, AI has been knocking at its door for some time, and if a new study conducted by Google researchers is to be believed, Google's in-house Med-PaLM 2 is getting really high accuracy scores in medical question-answering (MedQA) and is in prime position to enable medical professionals in offering faster medical care to patients.

In effect, Med-PaLM 2, is a medical large language model (LLM) that is being trained to synthesise information from medical images. In fact, not just Google, other players too are working on generative AI in the healthcare industry, and among them is Sam Altman-led OpenAI's ChatGPT. And the competition is stiff. A study published in JAMA Internal Medicine said that ChatGPT delivered higher quality answers to questions than written responses from genuine practitioners.

Now, on Wednesday, Google Health UK research lead Alan Karthikesalingam posted on Twitter, highlighting the accomplishment. He said, ?So happy to share #MedPaLM2 - our team's evolution of Med-PaLM. A new state of art for medical question-answering! Med-PaLM 2 scores 86.5% on MedQA-USMLE, exceeding Med-PaLM's score by >19%, & 81.8% on PubMedQA?.

It should be noted that the MedQA-USMLE dataset is a multiple-choice questionnaire based on the USA's Medical License Exams. So, getting a high score essentially means that the AI could, in theory, get certified to practice medicine in the USA. PubMedQA is also a similar dataset. In the dataset test, Med-PaLM 2 has scored a high 86.5% as per the study conducted by the group. The study is currently available in a pre-print stage on arXiv. It should also be noted that the study has not been peer-reviewed or published in a journal so far.

Karthikesalingam stated in a series of tweets the high level of scrutiny taken in order to ensure that the results of the test were not a fluke or a misrepresentation of the AI platform's abilities. He said, ?We believe in rigorous, careful evaluation. Physicians even preferred #MedPaLM2's long-form answers to answers from other real physicians along 8/9 axes of quality including medical accuracy (consensus w/medical opinion) and reasoning, with less likelihood of harm?.

?To highlight the real-world importance of nuanced evaluation we introduce a new dataset of "adversarial" questions designed specifically to probe LLM weaknesses including #HealthEquity,? he added.

It is unclear at the moment how much of an impact this new AI technology can have in the medical field but Google seems optimistic about the results. However, the study is just the beginning. In order for this technology to be adopted and used in real-life situations, it will have to undergo much stricter scrutiny to understand whether the AI can consistently and reliably help patients in their health care.

As it is, even Google chief Sundar Pichai, while speaking at the recently held Google I/O had highlighted how the company was working on this technology in a careful and responsible manner to ensure it did not go wrong.

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Thu, 18 May 2023 06:22:00 -0500 en-IN text/html

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