To Örebro University

INTRODUCTION: Large language models (LLMs) are increasingly used in clinical communication, but their accuracy and readability in patient education remain unclear. This study compared three LLMs for preoperative counseling before a DIEP breast reconstruction.

METHODS: A total of 40 frequently asked preoperative questions regarding DIEP breast reconstruction were collected and categorized using the BREAST-Q framework. These were submitted in English to three LLMs: ChatGPT, Gemini and Copilot (anonymized as Model A-C). Each question was submitted to all three models and the responses were anonymized. An expert panel of eight board-certified plastic surgeons from both Europe and USA. Ratings were made of a 5-point Likert scale for accuracy, informativeness and readability. Together with a general evaluation (easiness, problematic content, incorrectness) and information-material specific evaluation (relevance and lowest reading level).

RESULTS: Significant differences were found between models across all domains. ChatGPT achieved the highest accuracy (p = 0.019), Copilot was the most informative (p = 0.041), and both ChatGPT and Copilot produced more readable responses than Gemini (p < 0.001). Copilot had fewer problematic statements, while Gemini generated text at the simplest reading level but with lower accuracy. Agreement among raters was strong for accuracy (κ = 0.96) but weak for qualitative domains.

CONCLUSION: Each LLM showed distinct strength ChatGPT produced the most accurate answers, Copilot the most informative, and Gemini the simplest language. No model was uniformly superior. These findings support supervised, task-specific use of LLMs in patient education for breast reconstruction.

INTRODUCTION: The free fibula flap is a workhorse flap for bony reconstruction of the craniofacial skeleton. The aim of the study was to conduct a systematic review to investigate the postoperative donor site complications and functional outcomes, specifically ankle instability (AI) and gait disturbances (GD), for patients who have received a free fibula flap (FFF) for head and neck cancer reconstruction.

METHODS: We designed a PRISMA-compliant systematic review, which was registered prospectively in PROSPERO. Searches were designed with a health science librarian and included MEDLINE, EMBASE, CINAHL and PEDro. Risk of bias assessment was conducted for each included study, with an assessment of quality using GRADE.

RESULTS: Following exclusion of duplicate entries, a total of 1940 abstracts were identified. After parallel blinded eligibility assessment, 32 studies were included in the analysis. The total number of included participants was 1163, with the total number of FFF being 955. The mean time for functional assessment was 35 months postoperatively (range 8-81 months). The subjective and objective assessment modalities varied considerably. The primary result for AI were 3.3 % and 5.5 % for GD. The results demonstrate heterogeneity in the literature regarding the reporting of AI and GD following FFF.

CONCLUSION: According to this review, the risk of developing these complications appears to be limited but underreporting may be a limitation. Consensus on methods for standardized outcomes assessment of FFF-reconstruction is needed to establish the impact of free fibula flap on AS and GD.

Areolar sebaceous hyperplasia (ASH), also known as Montgomery hyperplasia, is an uncommon benign neoplasm. Despite nearly 40 years since the first case was described, this condition remains rare, with only 20 reported cases. We present a case of ASH in a 44-year-old female and review the existing literature.

Generative artificial intelligence (AI) large language models are an emerging technology, with ChatGPT and Gemini being 2 well-known examples. The current literature discusses clinical applications and limitations of AI, but its role in research has not yet been extensively evaluated. This study aimed to assess the role of ChatGPT and Gemini in developing novel and clinically relevant research ideas (RIs) for systematic reviews (SRs) in head and neck reconstruction. ChatGPT and Gemini were prompted to provide 10 novel and clinically relevant RIs for SRs in the following domains: head and neck reconstruction in general, microsurgery, and complications in reconstructive head and neck procedures. A comprehensive search was then performed for SRs in MEDLINE, Cochrane Library, and Embase to determine the novelty of the RIs generated. A total of 60 RIs were generated, with half created by ChatGPT and the other half by Gemini. Overall, 3613 entries were found through the literature search. After deduplication and screening, a total of 50 studies that partially addressed the AI-generated RIs were identified and were included in the present review. Out of the 60 AI-generated RIs, 42 had not been previously studied and were therefore considered novel. No statistically significant differences were found between the outputs generated by Gemini and ChatGPT. Both ChatGPT and Gemini were able to effectively generate novel and clinically relevant RIs for SRs, although their suggestions were generally broad. This study demonstrated that AI could potentially aid in the process of conducting novel SRs.

Nitrous oxide has a wide range of medical applications, such as being used as an analgesic in general anesthesia, dental procedures, childbirth and sedation. Lately, it has also been employed as an inhalant recreational drug to induce brief euphoria. Recent studies indicate a worldwide rise in the incidence of skin frostbites associated with nitrous oxide use. A scoping review was conducted to synthesize and summarize the existing literature published in English regarding frostbite injuries associated with the recreational use of nitrous oxide. The literature search was carried out in July 2024 using databases such as Embase, Web of Science and PubMed®. From an initial pool of 83 publications, 8 studies were ultimately selected for full-text review as they met our inclusion criteria for analysis. Additionally, we provide a representative clinical case involving a 21-year-old male who experienced frostbite following skin exposure to nitrous oxide. Most publications on nitrous oxide induced frostbites are from recent years, primarily between 2022 and 2024, with the first case documented in 1996. These injuries are mostly observed in young adults, with a female dominance, and are typically localized to the inner thighs. According to the existing literature, the predominant treatment approach is conservative management, with excision and split-thickness skin grafting (STSG) in the second place. This study represents the first literature review summarizing frostbite injuries to the skin from nitrous oxide misuse. There is a need for enhanced preventive measures to raise public awareness and reduce the incidence of frostbite injuries associated with the recreational use of nitrous oxide.

Introduction: Nicotine consumption is linked to higher perioperative complications. The cellular damage secondary to smoking is due to cellular dysfunction and thrombogenesis following free radical release, tissue hypoxia, microvascular injury, and inhibition of immune cell function by oxidative stress. This has an impact on wound healing as a whole, while increasing risk of infection and wound dehiscence.

Method: A review of the literature was conducted to summarize all studies focusing nicotine-complications in Plastic and Hand surgery. Of 2,186 articles, retrieved from PubMed, Embase and Web of Science databases, 364 publications were included following a blinded parallel screening as per PRISMA.

Result: Numerous peri-operative complications have been attributed to smoking, from undesirable aesthetic outcomes to life threatening sepsis. Some previous studies have illustrated a few of nicotine’s physiological effects as reversible, through a smoking cessation ranging from 3 to 8 weeks, or even longer, while others seem persistent. Available literature has found a correspondence between the amount of nicotine consumption and complication rates. Both pre- and postoperative nicotine cessation has been proven to have favourable outcome.

Discussion: Nicotine abuse is linked to higher complication rates following Plastic and Hand Surgery, according to the published literature. Nicotine consumers are a high-risk patient group that needt o be stratified, evaluated for peri-operative morbidities, and provided risk-specific care and follow-up.

It is important to understand the pathophysiological mechanisms behind the negative effects of nicotine on postoperative recovery. A standardized pre- and postoperative nicotine detox routine should be established to minimize the rate of postoperative complications.

Introduction: In Sweden, approximately 1700 patients are diagnosed with head and neck cancer (HNC) every year. HNC is relatively rare (2,6 % of all cancers). Risk factors for HNC are smoking, high consumption of alcohol, human papilloma virus (HPV) infection and inflammation 1. The Örebro head and neck cancer registry (ÖHNCR) was founded 1988 to register amount of HNC patients, treatment, reconstruction and overall survival.

Method: We performed a retrospective review of all microvascular and local/regional reconstructions in ÖHNCR from 1988 to 2023. It includes in total 4111 patients in the registry to present day.

Result: The majority, approximately 71.8% of the patients, were judged to be tumour-free at the last check-up. The five-year survival rate for all HNC patients has increased from 49.8% in 1988 to 55.1% in 2023, an increase of 5.3%. Overall survival varies between types of cancer within HNC. The number of both free and local/regional flaps has increased over the past two decades. Of all reported patients in ÖHHCR, approximately 44 patients (34%) have been reconstructed each year. The most common free flap for soft tissue reconstruction were, radial free flap (n=331, 49%) and osteocutaneous reconstruction was the fibula free flap (n=210, 31%). The most common local/regional flap were pectoralis major flap (n=242, 33%).

Discussion: The registry data trends correspond with the current literature, with increased incidence of number of cases with HNC and following reconstruction. We speculate that the increased number of reconstructions, permits an increased number of radical HNC resections followed by improved oncological- and functional outcomes.

RATIONALE: Availability of the dopamine and noradrenaline precursor tyrosine is critical for normal functioning, and deficit in tyrosine transport across cell membrane and the blood-brain barrier has been reported in bipolar disorder and schizophrenia. Clozapine and lithium are two psychoactive agents used to treat psychosis, mood disorders and suicidal behavior, but their mechanism of action remains largely unknown.

OBJECTIVE: To characterize immediate and delayed differences in tyrosine uptake between healthy controls (HC) and bipolar patients (BP) and see if these differences could be normalized by either clozapine, lithium or both. A second objective was to see if clozapine and lithium have additive, antagonistic or synergistic effects in this.

METHOD: Fibroblasts from five HC and five BP were incubated for 5 min or 6 h with clozapine, lithium, or combination of both. Radioactive labelled tyrosine was used to quantify tyrosine membrane transport.

RESULTS: There was significantly reduced tyrosine uptake at baseline in BP compared to HC, a deficit that grew with increasing incubation time. Clozapine selectively increased tyrosine uptake in BP and abolished the deficit seen under baseline conditions, while lithium had no such effect. Combination treatment with clozapine and lithium was less effective than when clozapine was used alone.

CONCLUSIONS: There was significant deficit in tyrosine transport in BP compared to HC that was reversed by clozapine but not lithium. Clozapine was more effective when used alone than when added together with lithium. Potential clinical implications of this will be discussed.