Performance of the Large Language Model ChatGPT on the National Nurse Examinations in Japan: Evaluation Study

[Background:] ChatGPT, a large language model, has shown good performance on physician certification examinations and medical consultations. However, its performance has not been examined in languages other than English or on nursing examinations. [Objective:] We aimed to evaluate the performance of ChatGPT on the Japanese National Nurse Examinations. [Methods:] We evaluated the percentages of correct answers provided by ChatGPT (GPT-3.5) for all questions on the Japanese National Nurse Examinations from 2019 to 2023, excluding inappropriate questions and those containing images. Inappropriate questions were pointed out by a third-party organization and announced by the government to be excluded from scoring. Specifically, these include “questions with inappropriate question difficulty” and “questions with errors in the questions or choices.” These examinations consist of 240 questions each year, divided into basic knowledge questions that test the basic issues of particular importance to nurses and general questions that test a wide range of specialized knowledge. Furthermore, the questions had 2 types of formats: simple-choice and situation-setup questions. Simple-choice questions are primarily knowledge-based and multiple-choice, whereas situation-setup questions entail the candidate reading a patient’s and family situation’s description, and selecting the nurse's action or patient's response. Hence, the questions were standardized using 2 types of prompts before requesting answers from ChatGPT. Chi-square tests were conducted to compare the percentage of correct answers for each year's examination format and specialty area related to the question. In addition, a Cochran-Armitage trend test was performed with the percentage of correct answers from 2019 to 2023. [Results:] The 5-year average percentage of correct answers for ChatGPT was 75.1% (SD 3%) for basic knowledge questions and 64.5% (SD 5%) for general questions. The highest percentage of correct answers on the 2019 examination was 80% for basic knowledge questions and 71.2% for general questions. ChatGPT met the passing criteria for the 2019 Japanese National Nurse Examination and was close to passing the 2020-2023 examinations, with only a few more correct answers required to pass. ChatGPT had a lower percentage of correct answers in some areas, such as pharmacology, social welfare, related law and regulations, endocrinology/metabolism, and dermatology, and a higher percentage of correct answers in the areas of nutrition, pathology, hematology, ophthalmology, otolaryngology, dentistry and dental surgery, and nursing integration and practice. [Conclusions:] ChatGPT only passed the 2019 Japanese National Nursing Examination during the most recent 5 years. Although it did not pass the examinations from other years, it performed very close to the passing level, even in those containing questions related to psychology, communication, and nursing

In vitro selection of tRNAs for efficient four-base decoding to incorporate non-natural amino acids into proteins in an Escherichia coli cell-free translation system

Position-specific incorporation of non-natural amino acids into proteins is a useful technique in protein engineering. In this study, we established a novel selection system to obtain tRNAs that show high decoding activity, from a tRNA library in a cell-free translation system to improve the efficiency of incorporation of non-natural amino acids into proteins. In this system, a puromycin–tRNA conjugate, in which the 3′-terminal A unit was replaced by puromycin, was used. The puromycin–tRNA conjugate was fused to a C-terminus of streptavidin through the puromycin moiety in the ribosome. The streptavidin–puromycin–tRNA fusion molecule was collected and brought to the next round after amplification of the tRNA sequence. We applied this system to select efficient frameshift suppressor tRNAs from a tRNA library with a randomly mutated anticodon loop derived from yeast [Formula: see text]. After three rounds of the selection, we obtained novel frameshift suppressor tRNAs which had high decoding activity and good orthogonality against endogenous aminoacyl-tRNA synthetases. These results demonstrate that the in vitro selection system developed here is useful to obtain highly active tRNAs for the incorporation of non-natural amino acid from a tRNA library

Sequential Evaluation of Swallowing Function During Chemoradiotherapy for Head and Neck Cancer

[Background] Many studies have addressed chronic dysphagia resulting from chemoradiotherapy for head and neck cancer (HNC) because of its severity, but changes in the swallowing function during chemoradiotherapy has been rarely reported. This study aimed to elucidate the changes in the swallowing function during chemoradiotherapy for HNC. [Methods] From April 2018 to July 2020, 20 patients who underwent definitive or postoperative chemoradiotherapy at our hospital for head and neck squamous cell carcinoma were evaluated by flexible endoscopy with the Hyodo scoring system for swallowing, the Penetration–Aspiration Scale (PAS), and the Functional Outcomes Swallowing Scale (FOSS). [Results] Assessments at the start of treatment, at 40 Gy, and at the end of treatment yielded these mean values: Hyodo score—0.39, 1.22, and 2.56; PAS—1.00, 1.05, and 1.5; FOSS—0.2, 0.55, and 1.1, respectively. The Dunn multiple comparison test was used for analysis to determine significance (P < 0.05). The Hyodo score and FOSS were significantly increased at the end of treatment versus initial evaluation; however, score was maintained at a tolerable level for oral intake. PAS did not show a significant increase. [Conclusion] In conclusion, changes in the swallowing function during chemoradiotherapy for HNC were mild, and swallowing function was maintained at a tolerable level for oral intake

The effect of Hangeshashinto on Oral Mucositis Caused by Induction Chemotherapy in Patients with Head and Neck Cancer

[Background] Oral mucositis (OM) is a side effect of chemotherapy in head and neck cancer. Severe OM often has a large impact on quality of life. Therefore, the treatment of OM during chemotherapy is very important. It was recently reported that Hangeshashinto (TJ-14), a Japanese traditional medicine (Kampo), is effective for OM caused by fluorinated pyrimidinebased agents used in colon cancer. We investigated the efficacy of TJ-14 for OM. [Methods] We enrolled patients with head and neck cancer who were treated with induction chemotherapy between September 2014 and March 2016. In this double-blind trial, patients were randomly assigned to the TJ-14 group or placebo group. Patients were instructed to dissolve 2.5 g of TJ-14 or placebo in 100 ml of drinking water, rinse their mouths with the solution for 30 s and then spit it out. They were not allowed to eat anything for 30 minutes before or after using the mouthwash. [Results] The incidence of ≥ grade 2 OM was 37.5% (three patients) in the TJ-14 group and 50.0% (four patients) in the placebo group, with no significant difference between the two groups. The mean day of onset was 9.7 in the TJ-14 group and 6.7 in the placebo group. The mean duration of ≥ grade 2 OM was 1.3 days in the TJ-14 group and 3.7 days in the placebo group. Thus TJ-14 significantly reduced the duration of ≥ grade 2 OM. [Conclusion] Treatment of OM with TJ-14 was associated with a statistically significant reduction in the duration of ≥ grade 2 OM compared to placebo. Gargling with TJ-14 is a safe and effective method of administering the drug to patients with head and neck cancer

Heterozygous Variant Fibrinogen γA289V (Kanazawa III) Was Confirmed as Hypodysfibrinogenemia by Plasma and Recombinant Fibrinogens

Introduction: Congenital fibrinogen disorders are classified as afibrinogenemia, hypofibrinogenemia, dysfibrinogenemia, and hypodysfibrinogenemia. However, difficulties are associated with discriminating between dysfibrinogenemia, hypofibrinogenemia, and hypodysfibrinogenemia using routine analyses. We previously reported a heterozygous variant fibrinogen (γA289V; Kanazawa III) as hypodysfibrinogenemia; however, the same variant had previously been described as hypofibrinogenemia. To clarify the production of γA289V fibrinogen, we expressed recombinant γA289V (r-γA289V) fibrinogen and compared it with wild-type (WT) and adjacent recombinant variant fibrinogens. Methods: Target mutations were introduced into a fibrinogen γ-chain expression vector by site-directed mutagenesis, and the vector was then transfected into Chinese hamster ovary cells to produce recombinant fibrinogen. Fibrinogen was purified from the plasma of the proposita, and culture media and fibrinogen functions were analyzed using fibrin polymerization, plasmin protection, and FXIIIa-catalyzed fibrinogen cross-linking. Results: The fibrinogen concentration ratio of the culture media to cell lysates was markedly lower for r-γA289V fibrinogen than for WT. Because the secretion of recombinant γF290L (r-γF290L) fibrinogen was similar to WT, we compared r-γF290L fibrinogen functions with WT. The fibrin polymerization of Kanazawa III plasma (K-III) fibrinogen was significantly weaker than normal plasma fibrinogen. Moreover, K-III fibrinogen showed a markedly reduced “D:D” interaction. However, all functions of r-γF290L fibrinogen were similar to WT. An in silico analysis confirmed the above results. Conclusion: The present results demonstrated that γA289 is crucial for the γ-module structure, and the γA289V substitution markedly reduced fibrinogen secretion. Moreover, K-III fibrinogen showed markedly reduced fibrin polymerization and “D:D” interactions. γA289V fibrinogen was confirmed as hypodysfibrinogenemia.ArticleINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY.42(2):190-197(2020)journal articl

Dark Quest. I. Fast and Accurate Emulation of Halo Clustering Statistics and Its Application to Galaxy Clustering

We perform an ensemble of $N$-body simulations with $2048^3$ particles for 101 flat $w$CDM cosmological models sampled based on a maximin-distance Sliced Latin Hypercube Design. By using the halo catalogs extracted at multiple redshifts in the range of $z=[0,1.48]$, we develop Dark Emulator, which enables fast and accurate computations of the halo mass function, halo-matter cross-correlation, and halo auto-correlation as a function of halo masses, redshift, separations and cosmological models, based on the Principal Component Analysis and the Gaussian Process Regression for the large-dimensional input and output data vector. We assess the performance of the emulator using a validation set of $N$-body simulations that are not used in training the emulator. We show that, for typical halos hosting CMASS galaxies in the Sloan Digital Sky Survey, the emulator predicts the halo-matter cross correlation, relevant for galaxy-galaxy weak lensing, with an accuracy better than $2\%$ and the halo auto-correlation, relevant for galaxy clustering correlation, with an accuracy better than $4\%$. We give several demonstrations of the emulator. It can be used to study properties of halo mass density profiles such as the mass-concentration relation and splashback radius for different cosmologies. The emulator outputs can be combined with an analytical prescription of halo-galaxy connection such as the halo occupation distribution at the equation level, instead of using the mock catalogs, to make accurate predictions of galaxy clustering statistics such as the galaxy-galaxy weak lensing and the projected correlation function for any model within the $w$CDM cosmologies, in a few CPU seconds.Comment: 46 pages, 47 figures; version accepted for publication in Ap

Congenital fibrinogen disorder with a compound heterozygote possessing two novel FGB mutations, one qualitative and the other quantitative

ArticleThrombosis research. 196: 152-158. (2020)journal articl

Unseiin, a Kampo medicine, Reduces the Severity and Manifestations of Skin Toxicities Induced by Cetuximab: A Case Report

Cetuximab is an effective drug used to treat patients with recurrent or metastatic head and neck squamous cell carcinoma. Skin toxicities such as paronychia and skin exsiccation are common adverse events caused by cetuximab. Skin toxicities may cause significant physical and psychosocial discomfort. The goal of managing skin toxicities is to minimize the detrimental effects on quality of life and continue the treatment. In one patient, skin toxicities became severe, up to grade 2, during treatment. The pain induced by paronychia and skin exsiccation made daily life difficult. Ten days after starting Unseiin, symptoms and finger findings resolved significantly. The patient could resume daily activities. No adverse effects induced by Unseiin were observed during treatment. Unseiin was effective on paronychia and skin exsiccation in this case and may contribute to successful treatment of skin toxicities induced by cetuximab