AIM:Currently, global rheumatology training programs lack structured frameworks to address the digital literacy and governance of large language models (LLMs) use. This study aimed to assess the use and educational gap related to LLMs in rheumatology. METHODS:The Asia-Pacific League of Associations for Rheumatology (APLAR) Young Rheumatologists (AYR) conducted an international cross-sectional survey to assess the familiarity, usage patterns, perceptions, and educational unmet needs regarding LLMs among rheumatologists and trainees. RESULTS:A total of 767 participants completed the survey, with 89.6% reporting prior use of LLMs. ChatGPT was the most adopted tool (68.7%), followed by DeepSeek (37.2%) and Google Gemini (21.9%), with a subset of respondents integrating multiple LLMs platforms. While usage is widespread, only 9.9% reported established institutional policies on LLMs use. LLMs users were significantly younger and expressed higher confidence in verifying LLMs-generated information compared to nonusers. Although both groups shared concerns regarding the potential loss of traditional clinical skills (81.1%), active users significantly favored the integration of mandatory LLMs training into core rheumatology curricula. CONCLUSION:There is a significant disparity between the high prevalence of LLMs adoption in rheumatology and the absence of formal educational guidelines or institutional governance. These findings underscore an urgent need for the development of competency frameworks to ensure the safe, critical, and effective application of LLMs in clinical practice.
Haemangiomas are benign vascular tumours characterized by proliferating blood vessels and are commonly encountered in the head and neck region; however, their occurrence at the tongue base is exceptionally rare. Owing to the tongue’s complex mobility and functional importance, such lesions may lead to significant clinical challenges. This report describes a large capillary haemangioma of the tongue base in a young adult. A 26-year-old male presented with an incidentally detected tongue-base mass following an episode of oral bleeding. Progressive dysphagia developed over time, although speech and tongue mobility remained normal. MRI revealed a heterogeneous exophytic vascular lesion, and FNAC confirmed haemangioma. The mass, approximately 4 × 3 cm, was completely excised via a trans-oral approach. Histopathological evaluation established the diagnosis of capillary haemangioma. The postoperative course was uneventful, and no recurrence was noted after 12 months of follow-up. Tongue-base haemangiomas may mimic other benign lesions, making accurate diagnosis essential. Given the risk of bleeding, airway compromise, and functional impairment, prompt evaluation and appropriate surgical management are crucial to achieving optimal patient outcomes.
Cut-throat injuries are incised wounds to the neck, commonly associated with homicide, less commonly with suicides or, rarely, as accidents. Distinguishing between homicidal cut-throat wounds mimics those of suicidal origin, is a challenging situation when either a unique weapon is used or the body is recovered after a prolonged period, often without reliable history or witnesses. We report four cases of cut throat wound with different manner of death, and unique weapon of offence. These cases highlights the challenges faced by forensic pathologists and underscores the need for meticulous forensic autopsy examination.
Background The posterior approach to the proximal tibia provides direct access to posterior knee and tibial pathologies, allowing controlled identification and protection of neurovascular structures within the popliteal fossa. Despite these advantages, concerns regarding prone positioning, potential neurovascular injury, wound complications, and limited surgeon familiarity have restricted its widespread use. This study aimed to evaluate indications, perioperative complications, and functional outcomes of the posterior approach to the proximal tibia, highlighting practical pearls and pitfalls. Methods A retrospective review was conducted of 21 patients who underwent surgery using a posterior approach to the proximal tibia between March 2021 and December 2024 at Shri Balaji Institute of Medical Sciences, Raipur, a tertiary care center in Central India. Indications included posterior tibial condyle open reduction and internal fixation or posterior cruciate ligament avulsion fixation in nine of 21 patients (42.9%), popliteal cyst excision in five (23.8%), posterior tibial exostosis with impingement in four (19.0%), and excision or curettage of proximal tibial lesions in three (14.3%). All procedures were performed in the prone position using either a direct posterior or posteromedial approach based on lesion location. Operative duration, complications (graded according to the Clavien-Dindo classification), and functional outcomes were assessed using the Lysholm score. Results The cohort comprised 21 patients (13 males (61.9%) and eight females (38.1%)) with a mean age of 37.4 years (range, 19-62 years). Two of 21 patients (9.5%) developed Clavien-Dindo grade II complications, including one superficial surgical site infection and one transient tibial nerve neuropraxia, both managed conservatively. No vascular injuries, deep infections, anesthesia-related events, or permanent neurological deficits were observed. At a mean follow-up of 12.6 months, three of 21 patients (14.3%) were lost to follow-up. Among the remaining 18 patients, 17 (94.4%) achieved satisfactory functional outcomes, with a mean Lysholm score of 88.4 ± 5.7, and most returned to their preoperative activity levels. Conclusions The posterior approach to the proximal tibia was safe and effective in this cohort, with a low complication rate and favourable functional outcomes. Careful patient selection, meticulous dissection, approach customization based on lesion location, gentle neurovascular handling, maintenance of knee flexion in the prone position, thorough preoperative imaging, and appropriate anesthetic optimization are essential to minimize complications.
e16396 Background: Outcomes in first-line metastatic pancreatic ductal adenocarcinoma (mPDAC) remain poor, with gemcitabine plus nab-paclitaxel (GnP) yielding median overall survival (OS) < 11 months in contemporary trials. ARC-8, a phase I/Ib randomized study, evaluated the CD73 inhibitor quemliclustat combined with GnP ± the PD-1 inhibitor zimberelimab and demonstrated encouraging survival outcomes. We conducted a trial-in-context benchmark analysis to assess whether the ARC-8 OS signal exceeds contemporary first-line expectations after accounting for cross-trial differences. Methods: Published ARC-8 efficacy data were synthesized for treatment-naïve mPDAC patients receiving 100-mg quemliclustat-based regimens (quemliclustat + GnP or quemliclustat + zimberelimab + GnP). As ARC-8 lacked a control arm, a matched synthetic control arm (SCA) was derived from historical GnP-treated patients using key baseline characteristics. Contemporary phase III GnP benchmarks from MPACT and NAPOLI-3 control arms were included. Cross-trial differences in OS, progression-free survival (PFS), and overall response rate (ORR) were qualitatively assessed for potential directional bias. Results: Across benchmarking approaches, pooled ARC-8 quemliclustat-based regimens were associated with a median OS of 15.7 months, exceeding contemporary first-line GnP benchmarks. In the matched SCA comparison, OS remained improved (HR for death 0.63), despite baseline characteristics expected to bias against ARC-8. PFS and ORR were broadly similar to GnP benchmarks. No new safety signals or toxicity were observed. Conclusions: In a trial-in-context benchmark analysis, quemliclustat-based regimens in ARC-8 were associated with a consistent OS advantage compared with contemporary GnP benchmarks despite similar PFS and ORR, suggesting a clinically meaningful survival signal and supporting the clinical and biologic rationale for the ongoing phase III PRISM-1 trial. OS, PFS and ORR for ARC-8 Quemliclustat regimens v/s GnP benchmarks. Population/ comparator Median OS, months (95% CI) 12-moOS (%) Median PFS, months ORR (%) ARC-8 Q100 ± Z + GnP (n=122) 15.7 (12.7 63 6.3 (5.4-7.7) 39 Synthetic control GnP (matched, n=515) 9.5 (8.8-10.5) 39.7 5.6 37.3 Contemporary phase III GnP benchmarks 9.2 (8.3-10.6) 40 5.6 (5.3-5.8) 36 Q=quemliclustat; Z=zimberelimab; GnP=gemcitabine+nab-paclitaxel.
