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Analysis of response to 20 generations of selection for body composition in mice: fit to infinitesimal model assumptions.

Data were analysed from a divergent selection experiment for an indicator of body composition in the mouse, the ratio of gonadal fat pad to body weight (GFPR). Lines were selected for 20 generations for fat (F), lean (L) or were unselected (C), with three replicates of each. Selection was within full-sib families, 16 families per replicate for the first seven generations, eight subsequently. At generation 20, GFPR in the F lines was twice and in the L lines half that of C. A log transformation removed both asymmetry of response and heterogeneity of variance among lines, and so was used throughout. Estimates of genetic variance and heritability (approximately 50% ) obtained using REML with an animal model were very similar, whether estimated from the first few generations of selection, or from all 20 generations, or from late generations having fitted pedigree. The estimates were also similar when estimated from selected or control lines. Estimates from REML also agreed with estimates of realised heritability. The results all accord with expectations under the infinitesimal model, despite the four-fold changes in mean. Relaxed selection lines, derived from generation 20, showed little regression in fatness after 40 generations without selection.

Journal Article↗

Health and literacy in first- and second-generation Moroccan Berber women in the Netherlands: Ill literacy?

AIM: The present study was aimed at investigating the role of literacy and generation in the self-reported general health status of Moroccan Berber speaking women in the Netherlands. METHOD: Fifty women in our sample (N = 75) were first generation women, from which group 25 were literates and 25 illiterates. Another group of 25 literate women belonged to the second generation. The three groups were matched for demographic characteristics. Questionnaires were administered reflecting all concepts under study. We hypothesized that, within the first generation, illiterates compared with literates would report worse health. Our second hypothesis was that literates of the first generation compared with those of the second generation would have a similar health condition. RESULTS: After controlling for age, having a job, and having an employed partner, the first generation literates compared with the illiterates of the first generation indeed reported significantly better health. Additionally, we did not find any differences in health condition between both literate groups, even after controlling for age, number of children, and marital status. Health complaints that were most frequently reported by both groups, concerned pain in shoulders, back and head. CONCLUSIONS: Our results underline the importance of offering immigrants optimal access to opportunities and facilities that can improve their literacy and reading ability.

Journal Article↗

Towards a standardization of thrombin generation assessment: the influence of tissue factor, platelets and phospholipids concentration on the normal values of Thrombogram-Thrombinoscope assay.

BACKGROUND: Thrombin generation assay was developed several years ago to mimic physiological coagulation mechanisms but it had important limitations. Thrombogram-Thrombinoscope assay using a fluorogenic substrate, allows obtaining thrombin generation curves in non-defibrinated platelet rich plasma (PRP) in a fully automated manner. METHODS: We standardised the methodology of Thrombogram-Thrombinoscope and we evaluated the precision of thrombin generation parameters (lag-time, maximum concentration of thrombin [Cmax], time required to reach Cmax [Tmax] and endogenous thrombin potential ETP) using different concentrations of recombinant human tissue factor, platelets or phospholipids. Normal values of thrombin generation assay were established in optimal experimental conditions. RESULTS: In the presence of low TF concentrations (final dilution of thromboplastin in plasma: 1/1000-1/2000) the Thrombogram assay showed intra-assay and inter-assay coefficients of variation lower than 9%. Thrombin generation parameters showed an important inter-individual variability and the coefficients of variation ranged from 18% to 50%. In PRP the lag-time, Cmax and Tmax but not the ETP, were influenced by TF concentration. Thrombin generation parameters were not influenced by variations of platelet concentration from 50 x 10(9)/l to 400 x 10(9)/l. The addition of synthetic procoagulant phospholipids in PPP strongly influenced all the parameters of thrombogram. For all the parameters of thrombogram a threshold effect was observed in the presence of phospholipid concentrations equal or higher to 4 microM. In frozen-thawed PRP the lag-time and the Tmax were significantly reduced and the Cmax was increased compared to the fresh PRP, but the ETP, the intra assay and the inter-assay coefficients of variation were similar in both test-systems. CONCLUSION: Thrombogram-Thrombinoscope assay performed in fresh or in frozen-thawed PRP has an acceptable precision, with low inter-assay and intra-assay coefficient of variations. The concentration of TF is determinant for the normal values of the studied parameters of thrombin generation. When the assay is performed in PPP, thrombin generation parameters are influenced by the concentration of procoagulant synthetic phospholipids. The optimal experimental conditions were obtained in the presence of 1/1000 final dilution of thromboplastin, a platelet count higher than 50 x 10(9)/l and a synthetic phospholipid concentration higher than 4 microM.

Journal Article↗

Structure-function of airway generations 0 to 4 in the preterm lamb.

Five generations of airways from 15 preterm lambs of 130-137 d (90% term) gestation were studied to investigate the effect of generation on structure-function of preterm airways. Airway rings were measured to determine the internal radius (r), and wall thickness (t). The ratio r/t was then calculated as a morphometric index used in the determination of wall stress. Airway rings from each generation were placed in tissue baths to compare passive, active, and total force development. Contraction via membrane depolarization (KCl) and muscarinic receptor stimulation (acetylcholine) were evaluated. As r and t decreased, r/t declined by a factor of 3.48 down the generations. At the optimal length for active force development, the passive, active, and total stresses decreased significantly as a function of generation. The receptor-mediated response to acetylcholine was significantly less in generations 0, 1, and 2 than in generations 3 and 4. No differences were found among the various generations in contractility as measured by the response to KCl. These data suggest that based on the interrelationship between airway morphometry and force development the trachea is exposed to greater wall stress than the lower airways during continuous positive airway pressure. Taken together, these data may help to explain the structural changes, such as tracheomegaly, as well as the physiologic changes in airway reactivity seen in the premature infant after mechanical ventilation.

Acetylcholine↗

A possible role of neuropeptide Y as a mediator of undernutrition to the hypothalamic gonadotropin-releasing hormone pulse generator in goats.

To understand central mechanisms for nutritional infertility, the activity of the GnRH pulse generator was directly assessed in ovariectomized (OVX) goats under several experimental conditions by recording characteristic increases in the multiple-unit activity (volleys). When estradiol (E(2))-treated animals were fasted for 4-5 days, the activity of the GnRH pulse generator was gradually suppressed, and the volley interval at the end of fasting was significantly prolonged, compared with that during the feeding period (67.4 vs. 49.3 min, n = 5, P < 0.01). On the other hand, such a significant effect on the pulse generator was not observed in OVX goats. In the second experiment, the animals received a bolus intracerebroventricular injection of several doses (0, 2, 5, and 20 microg/400 microl) of neuropeptide Y (NPY). Exogenous NPY dose-dependently inhibited the pulse generator activity. At the highest dosage, the 1st posttreatment volley interval was significantly longer than that of the pretreatment (112.4 vs. 32.6 min, n = 5, P < 0.01) in OVX goats. The suppressive effect of NPY was similarly observed in OVX+E(2) goats. Further, when NPY was infused (10 microg/200 microl.h for 6 h) into OVX goats, the activity of the GnRH pulse generator was almost completely inhibited during the infusion period. Hypothalamic sites responding to fasting were immunohistochemically evaluated using an antibody for Fos in castrated goats. Fos-immunoreactive neurons were found in areas adjacent to the third ventricle. Double-labeling immunohistochemistry revealed that a subpopulation of NPY neurons in the arcuate nucleus was activated in response to fasting. These results demonstrate that: 1) the activity of the GnRH pulse generator is suppressed by fasting in the presence of E(2); 2) exogenous NPY inhibits the activity of the GnRH pulse generator regardless of the presence of E(2); and 3) several hypothalamic neurons or regions, including those containing NPY in the arcuate nucleus, are activated by fasting. Collectively, these observations suggest that NPY acts as a mediator of undernutrition to the GnRH pulse generator.

Animal Nutritional Physiological Phenomena↗

CORRELATION OF SOUND GENERATION AND METABOLIC HEAT FLUX IN THE BUMBLEBEE BOMBUS LAPIDARIUS

Flying insects produce extreme amounts of heat as a by-product during the contractions of their thoracic flight muscles (Heinrich, 1989). Before flight, metabolic heat may serve to warm up the thoracic muscles until the minimum lift-off temperature is reached (Heinrich, 1974b; Stone and Willmer, 1989; Esch and Goller, 1991). Social bees and wasps are also able to use the heat produced in their flight muscles for brood incubation and for active regulation of nest temperatures (Heinrich, 1974a; Seeley and Heinrich, 1981; Schultze-Motel, 1991). In this study, we report simultaneous measurements of heat flux and sound generation by wing buzzing in individual bumblebee workers (Bombus lapidarius L.). Bumblebees used in the experiments were taken from colonies in observation nest boxes (Schultze-Motel, 1991) and placed into the cylindrical 100 ml stainless-steel vessel of a Calvet-type microcalorimeter (MS 70, Setaram, Lyon; Wadso, 1987). A small microphone had been installed below the screw cap of the calorimeter vessel. The sensitivity of the calorimeter under these conditions was 41.7 mV W-1. Both the calorimeter and the microphone signals were amplified and recorded on a dual-channel chart recorder. In 32 out of a total of 36 measurements, the bumblebees showed prolonged periods of sound generation, most frequently at the beginning of experiments. We assume that the sound was not produced in an alarm reaction, but by flight movements of the wings when the animals attempted to lift off inside the calorimeter vessel. The buzzing sounds produced by bumblebees are caused by oscillations of the flight muscles inside the metathorax (Schneider, 1975). Previous endoscopic observations of bumblebees sitting on the bottom of our calorimeter vessel had shown that there was a one-to-one correlation between episodes of wing movements and sound production. The microphone recordings thus allowed an easy way of measuring locomotor activity inside the calorimeter. The simultaneous recordings of calorimeter and microphone signals showed a very good agreement between periods of sound generation and increased metabolic heat flux from the animals. This was most conspicuous in some experiments without continuous wing buzzing activity but with distinct episodes of intense sound generation that were always coupled to a simultaneous increase of heat flux (Fig. 1). Between episodes of sound generation, heat flux typically returned from maxima exceeding 200 W kg-1 to basal values around 10 W kg-1. During one experiment, we recorded a deviation from the usually observed synchronism between metabolic heat flux and sound generation (Fig. 2). The acoustic activity of the animal started about 45 min after the beginning of the experiment. Remarkably, the heat flux signal showed a steep increase as early as 5 min before the first sound generation was observed. During the period of continuous wing buzzing, heat fluxes of more than 350 W kg-1 were measured. These fluxes correspond to metabolic rates during free flight in other Hymenoptera: about 300 W kg-1 in the carpenter bee Xylocopa capitata (Nicolson and Louw, 1982), 300-500 W kg-1 in honeybees, Apis mellifera (Nachtigall et al. 1989) and about 350 W kg-1 in the bumblebees Bombus lucorum and B. pascuorum flying in a wind tunnel (Ellington et al. 1990). We suggest that the sharp increase in heat flux before the beginning of sound generation represents a preflight endothermic warm-up event. Apparently, the warm-up of flight muscles proceeded without any wing buzzing.

Journal Article↗

Generation of alloxan radical in rat islet cells: participation of NADPH: cytochrome P-450 reductase.

Cytotoxic actions of alloxan are thought to be caused by the hydroxyl radical (HO+) generated in a cyclic reaction involving alloxan and its reduction product, alloxan radical (HA+). The generation of HA+ and the oxidation of reduced nicotinamide adenine dinucleotide phosphate (NADPH) were observed in the reaction system of alloxan with NADPH in the presence of purified NADPH: cytochrome P-450 reductase [EC 1.6.2.4] (fp2) from rat liver microsomes. Both the generation of HA+ and the oxidation of NADPH were increased with increasing the concentrations of alloxan or fp2. These results indicate that NADPH-linked HA+ generation was catalyzed by fp2. The HA+ was generated in the reaction of alloxan with a homogenate of rat islet cells. The generation of HA+ in the reaction of alloxan with the homogenate of rat islet cells was markedly diminished by an immunogloblin fraction (Ig) of anti-fp2 serum, but not by control-Ig. The anti-fp2-Ig also inhibited the generation of HA+ in the reaction system of alloxan with NADPH in the presence of fp2. When the homogenate of islet cells from phenobarbital-treated rats was used, the generation of HA+ was significantly increased in comparison with that from the control rats. However, the homogenate of islet cells from 3-methylcholanthrene-treated rats did not have such a stimulative effect. These results suggest that the reduction of alloxan to HA+ was catalyzed by fp2 presented in islet cells.

Alloxan↗

Active oxygens generation by flavonoids.

The hydrogen peroxide (H2O2)-generating effects of 14 flavonoids were investigated. Seven out of 14 flavonoids tested were found to generate H2O2 in an acetate buffer of pH 7.4. The H2O2-generating abilities of flavonoids decrease in the order of myricetin > baicalein > quercetin > (-)-epicatechin > (+)-catechin > fisetin = 7,8-dihydroxy flavone. This ability was observed in flavonoids with either a pyrogallol or catechol structure, and the pyrogallol-type flavonoids generated more H2O2 than the catechol-types. The amount of H2O2 generated by myricetin (pyrogallol-type flavonoid) was proportional to its concentration and to the reaction time until about 4 h. In addition, H2O2 generation by myricetin was dependent on the amount of dissolved oxygen in the buffer, and it was inhibited by the addition of superoxide dismutase. These results suggest that the flavonoids generate H2O2 by donating a hydrogen from their pyrogallol or catechol structure to oxygen, through a superoxide anion radical. It was also found that flavonoids which generated more H2O2 were more powerful antioxidants in the NADPH-dependent lipid peroxidation of rat microsomes.

Animals↗

Entrance doses during lateral lumbar spine and antero-posterior abdomen examinations: generator waveform dependence.

In North Trent, UK, an entrance dose survey of lateral lumbar spine and antero-posterior (AP) abdomen examinations has been carried out in 17 radiology departments. The survey comprised 294 lateral lumbar spine and 322 AP abdomen entrance dose measurements. The mean entrance doses were found to be approximately half of the relevant national reference entrance dose levels of 30 mGy and 10 mGy, respectively. The effect of generator waveform on entrance dose was studied by separating the generators into two types: "pulsating potential" (PP) generators and "constant potential" (CP) generators for each examination. PP generators comprised 23% of the total number of examinations. The mean entrance dose and radiographic exposure factors from CP generators were found to be significantly lower than those from PP generators. The use of CP type generators, together with low attenuation components can significantly reduce patient entrance doses for these examinations.

Body Weight↗

Enhancing effect of the endocrine disruptor para-nonylphenol on the generation of reactive oxygen species in human blood neutrophils.

Although para-nonylphenol (NP) is known as an endocrine disruptor, the immunologic effect of NP has been poorly analyzed. We found that NP from 5 to 50 microM caused a dose-dependent stimulatory effect on the generation of reactive oxygen species (ROS) in human blood neutrophils, which was measured by using a chemiluminescence reagent, luminol. Furthermore, ROS-scavenging enzymes such as catalase and superoxide dismutase and antioxidative agents alpha-tocopherol and beta-carotene showed strong preventive effects on NP-induced ROS generation. To analyze the biochemical mechanism of NP-induced ROS generation in human neutrophils, we investigated the effects of different types of metabolic inhibitor for the activation pathways of ROS generation in the cells. Reduced nicotinamide adenine dinucleotide phosphate (NADPH)-dependent oxidase inhibitor, diphenyl iodonium chloride and the myeloperoxidase inhibitor sodium azide (NaN3) showed remarkable inhibitory effects on ROS generation induced by NP, but an inhibitor against mitochondrial respiratory function, potassium cyanide (KCN), did not exhibit significant effect. Furthermore, the phosphatidylinositol-3 (PI3) kinase inhibitor wortmannin and the tyrosine kinase inhibitor protein phosphorylation inhibitor 1 (PP1) caused strong suppression against NP-induced ROS generation. The selective protein kinase C inhibitor Ro-32-0432, p38 MAP kinase inhibitor SB 203580, and ERK MAP kinase inhibitor PD 98059 also showed significant suppressive effects on NP-induced ROS generation. These results suggest that NP causes an enhancing effect on ROS generation in human blood neutrophils through the activation of signal transduction pathways associated with the respiratory burst function in these cells. Additionally, to examine in vivo effects of NP, we also analyzed the effects of NP itself and the synergistic effects of NP and a typical inflammatory agent, opsonized zymosan, on human whole blood including neutrophils.

Endocrine System↗

The DrosDel collection: a set of P-element insertions for generating custom chromosomal aberrations in Drosophila melanogaster.

We describe a collection of P-element insertions that have considerable utility for generating custom chromosomal aberrations in Drosophila melanogaster. We have mobilized a pair of engineered P elements, p[RS3] and p[RS5], to collect 3243 lines unambiguously mapped to the Drosophila genome sequence. The collection contains, on average, an element every 35 kb. We demonstrate the utility of the collection for generating custom chromosomal deletions that have their end points mapped, with base-pair resolution, to the genome sequence. The collection was generated in an isogenic strain, thus affording a uniform background for screens where sensitivity to genetic background is high. The entire collection, along with a computational and genetic toolbox for designing and generating custom deletions, is publicly available. Using the collection it is theoretically possible to generate >12,000 deletions between 1 bp and 1 Mb in size by simple eye color selection. In addition, a further 37,000 deletions, selectable by molecular screening, may be generated. We are now using the collection to generate a second-generation deficiency kit that is precisely mapped to the genome sequence.

Animals↗

Automated signal generation in prescription-event monitoring.

Signal generation is a method of highlighting potential safety issues in a drug that then need to be investigated further. Previously automated signal generation has mainly been applied to spontaneous reporting systems. The Drug Safety Research Unit (DSRU) performs observational postmarketing studies on selected newly marketed medicines in England using a method known as prescription-event monitoring (PEM). The DSRU has investigated automated procedures for the generation of signals using the event data from PEM studies. Proportional reporting ratios (PRRs) and incidence rate ratios (IRRs) were studied as possible tools for signal generation in PEM data. The PEM database contains 78 completed studies of drugs prescribed in primary care from a variety of therapeutic classes. Retrospective studies were carried out to identify the implications of changing the comparator group of drugs, along with analysing the results at different levels in the DSRU's hierarchical dictionary and performing signal generation after 30 and 180 days of observation since starting the drug. Automated signal generation is a useful hypothesis generating method that is likely to prove to be useful both in clinical trials and postmarketing studies. PRRs are simple to apply and do not require a denominator. IRRs take into account the time subjects were exposed to the drug prior to the event of interest, and offers a useful, and more in depth look into the data. However, with both methods it is important to perform signal generation at multiple levels in the dictionary and with careful selection of the comparator group.

Adverse Drug Reaction Reporting Systems↗

Also with a restrictive transfusion policy, screening with second-generation anti-hepatitis C virus enzyme-linked immunosorbent assay would have reduced post-transfusion hepatitis C after open-heart surgery.

The incidence of post-transfusion hepatitis non-A, non-B (PTH-NANB) was prospectively assessed among open-heart surgery patients from the southeast region of Sweden before the introduction of antihepatitis C virus (HCV) blood donor screening. Blood samples for alanine aminotransferase analysis were drawn before and 2, 3, and 4 months after transfusion. Surgery was performed in four centres. Of 190 transfused and followed-up patients 2 (1.1%) contracted PTH-NANB, both operated on at the centre with significantly fewer transfusions than the other centres. One patient had antibodies to HCV detected by first-generation (C100-3) and later by second-generation anti-HCV enzyme-linked immunosorbent assay (ELISA-2) and by positive second-generation recombinant immunoblot assay (4-RIBA). The other patient, although negative by first-generation anti-HCV ELISA, was positive by second-generation ELISA and by 4-RIBA. Both patients were hepatitis C-viremic by polymerase chain reaction (PCR). All the six donors implicated in the two hepatitis cases were first-generation anti-HCV-negative, but two, one for each patient, were positive by second-generation anti-HCV ELISA. This finding was confirmed by positive 4-RIBA in only 1 donor, the other being 'indeterminate'. However, in both donors hepatitis C viremia was found by PCR. This study shows that the second-generation anti-HCV ELISA will further reduce the risk for PTH-NANB/C and draws attention to the problem of evaluation of confirmatory tests.

Adolescent↗

Seroconversion to hepatitis C virus antibodies in patients with acute posttransfusion non-A, non-B hepatitis in Sweden with a second generation test.

28 patients with posttransfusion non-A, non-B (NANB) hepatitis in Stockholm, Sweden, were studied for seroconversion to hepatitis C virus antibodies (anti-HCV) and time lag to seroconversion by first and second generation tests. 15/28 patients (54%) seroconverted to anti-HCV with a first generation anti-HCV ELISA using C100-3 from the nonstructural (NS) region 4 of the HCV genome and 23 (82%) with a second generation anti-HCV ELISA including also antigens from the core and NS3 regions of the HCV genome. The mean time from onset of hepatitis to seroconversion was 6.1 weeks (0-18 weeks) with the first generation test and 2.3 weeks (0-7 weeks) with the second generation test. Development of chronic hepatitis was noticed in 14/23 (61%) patients who seroconverted to anti-HCV with the second generation ELISA and in none of 5 patients with posttransfusion NANB hepatitis who did not seroconvert. The inclusion of antigens from the core and NS3 regions of the HCV genome has increased the sensitivity of the second generation anti-HCV ELISA as compared to the first generation ELISA and also shortened the time lag to seroconversion in patients with posttransfusion hepatitis C. Patients with posttransfusion NANB hepatitis seroconverting seem more prone to develop chronic disease than patients not seroconverting.

Enzyme-Linked Immunosorbent Assay↗

Divergent selection for body weight and yolk precursor in Coturnix coturnix japonica. 10. Response to selection over thirty generations.

Japanese quail lines were divergently selected for 30 generations for 4-wk BW (HW, LW) or plasma yolk precursor (HP, LP) as measured by total plasma phosphorus (TPP) at the beginning of lay. The HW, LW, HP, and LP lines were initiated from a randombred control line (R1). In the ninth generation of selection in the HW line, sublines were developed by continuing to select males for increased 4-wk BW whereas females were selected for increased (HW-HP line) or decreased (HW-LP) TPP. Individual selection was used in the HW, LW, HW-HP, and HW-LP lines. In the HP and LP lines, females were individually selected whereas males were selected on their full-sisters' performance. Realized heritabilities (h2), based on the linear regression of selection responses (corrected for environmental changes) on accumulated selection differentials (weighted for the number of offspring produced) over generations, declined with selection in the HW, LW, HP, and LP lines. The h2 of 4-wk BW in the HW line was 0.42 during the first 10 generations of selection and then declined to 0.30 during the next 2 generations of selection. In the LW line, realized h2 of 4-wk BW was 0.40, 0.16, and -0.12 in Generations 1 through 10, 11 through 20, and 21 through 30, respectively. The respective h2 for TPP in the HP line were 0.29, 0.17, and 0.14. The h2 of TPP in the LP line was 0.35 during the first 10 generations and essentially zero during the next 20 generations. Four-week BW and TPP were negatively associated in the HW, HP, and LP lines. There was no significant relationship between these two traits in the LW line.

Animals↗

Positive and negative generation effects, hypermnesia, and total recall time.

Self-generated information is typically remembered better than perceived information (the generation effect). Experimental design produces an important limiting condition for this effect: Generation enhances recall in within-subjects designs, but typically not in between-subjects designs. However, Mulligan (2001) found that the generation effect emerged over repeated recall tests in a between-subjects design, calling into question the generality of this limiting condition. Two experiments further delineated the emergent generation effect Experiment 1 demonstrated that this effect does not require multiple discrete recall tests but may emerge on a single recall test of long duration. Experiment 2 demonstrated that the negative generation effect (a reversal of the typical generation effect produced under certain conditions) is abolished by multiple recall tests. In both experiments, the generate condition produced greater hypemnesia (increased recall over tests) than did the read condition.

Affect↗

Persistence of dengue-3 virus through transovarial transmission passage in successive generations of Aedes aegypti mosquitoes.

Progeny of Aedes aegypti mosquitoes infected intrathoracically with dengue-3 virus was reared to subsequent generations. In each generation, blood-fed females were confined individually and the eggs obtained from the transovarially infected females were pooled. The seventh generation obtained from the infected parental mosquitoes showed that virus could persist in mosquitoes in successive generations through transovarial passage. The rate of vertical transmission initially increased in the few generations (F1-F2), but in subsequent generations it was found to be steady. Parental mosquitoes inoculated with virus showed higher mortality than the diluent-inoculated controls. There was an increase in the larval duration of transovarially infected batches at the seventh generation when compared with uninfected control mosquitoes. The fecundity and fertility of the transovarially infected batches of mosquitoes was also affected when compared with the controls. This is the first report demonstrating persistence of dengue virus in the successive generations of mosquitoes infected through vertical transmission. These observations, which have great epidemiologic importance, suggest that vector mosquitoes may play an important role in the maintenance of virus in nature, and that mosquitoes may act as reservoirs of these viruses.

Aedes↗

Pedagogical Efficacy of LLM-Generated Synthetic Data Versus Real-World Clinical Records: A Randomized Controlled Non-Inferiority Trial.

BACKGROUND: Expert-reviewed clinical cases generated by large language models (LLMs) may supplement case resources in medical education, but their short-term educational performance relative to real-case-derived teaching materials remains uncertain. We compared immediate post-training test performance after teaching with the two types of case materials and assessed non-inferiority against a prespecified margin. METHODS: We conducted a prospective, parallel-group, randomized non-inferiority trial. Through the Wenjuanxing online platform, participants were randomized 1:1 to learn with either real-case-derived teaching cases compiled by clinicians and reviewed by experts or AI-generated clinical cases produced by Gemini 3.0 Pro from fully de-identified matched real cases and reviewed by three senior general surgery specialists with full-professor rank. The primary outcome was the total score on an independent 10-item immediate post-training test (0-10 points), with a prespecified non-inferiority margin of -0.5 points. Secondary outcomes included the training-phase performance score, learning efficiency index, single-item mental effort rating, case realism, and case-source judgment. RESULTS: A total of 403 participants were randomized, of whom 386 were included in the modified intention-to-treat analysis: 192 in the real-case group and 194 in the AI-generated case group. The mean post-training test score was 4.95 (SD, 3.35) in the real-case group and 4.61 (SD, 3.35) in the AI-generated case group. The mean difference (AI-generated minus real-case group) was -0.335 points (95% CI, -1.006 to 0.337). Because the lower bound of the confidence interval was below the prespecified non-inferiority margin of -0.5 points, non-inferiority was not demonstrated (one-sided P = 0.314). No significant between-group differences were observed in the training-phase performance score, learning efficiency index, or single-item mental effort rating. AI-generated cases received lower realism ratings for Level 3 cases. The proportion of participants with at least one high-confidence completely incorrect response was 1.6% in the real-case group and 2.1% in the AI-generated case group. CONCLUSIONS: In this short-term, text-based online case-learning setting, no statistically significant between-group difference was observed in immediate post-training test performance; however, non-inferiority of AI-generated clinical cases relative to real-case-derived teaching materials was not demonstrated.

Humans↗