bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal Patient Outcomes in Chronic Dizziness: A Scoping Review
Authors: Canturk Toros , Bery Anand K. , Piccoli David , Pyche Jacob , Czikk Daniel , Osborne Jake , Pearson Alexander , Bhatt Chirayu , Shin John , Chow Linda , Azzi Jayson Lee , Tohme Angelina , Caulley Lisa , Lelli Daniel , Tse Darren 
Published: September 2023

Background
Chronic dizziness can cause significant functional impairment. Outcome measures used in this patient population have not been examined systematically. Consequently, providers lack consensus on the ideal outcome measures to assess the impact of their interventions.

Objective and Methods
We conducted a scoping review to summarize existing literature on outcomes in chronic dizziness (with a minimum of 6 mo of patient follow-up). Among other details, we extracted and analyzed patient demographics, medical condition(s), and the specific outcome measures of each study.

Results
Of 19,426 articles meeting the original search terms, 416 met final exclusion after title/abstract and full-text review. Most studies focused on Ménière's disease (75%) and recurrent benign paroxysmal positional vertigo (21%). The most common outcome measures were hearing (62%) and number of attacks by American Academy of Otolaryngology–Head & Neck Surgery criteria (60%). A minority (35%) looked formally at quality-of-life metrics (Dizziness Handicap Index or other).

Conclusions
Ménière's disease and benign paroxysmal positional vertigo are overrepresented in literature on outcome assessment in chronic dizziness. Objective clinical measures are used more frequently than quality-of-life metrics. Future work is needed to identify the optimal outcome measures that reflect new knowledge about the most common causes of chronic dizziness (including persistent postural-perceptual dizziness and vestibular migraine) and consider what is most important to patients.
Ambulatory blood pressure monitoring in pediatric patients with sickle cell anemia
Authors: Guerrero Tinoco Gustavo Adolfo , Espitaleta Vergara Zilac , Daniels García Maria José , Domínguez-Vargas Alex 
Published: September 2023

Introduction
Sickle cell anemia (SCA) is a hemoglobinopathy presenting severe endothelial damage associated with increased prevalence of hypertension (HTN). Few studies have used ambulatory blood pressure monitoring (ABPM) in pediatric patients with SCA. The aim of this study was to characterize the ABPM profile in children with SCA.

Methods
A retrospective cross-sectional study was conducted on all subjects <18 years of age with SCA who presented at a medical reference center in the city of Cartagena, Colombia. Anthropometric, clinical laboratory, treatment, and ABPM parameters, including ambulatory arterial stiffness index (AASI) were registered.

Results
The study included 79 patients, of these, 23 (29%) children had normal BP, 49 (62%) had abnormal BP and 7 (9%) had HTN. Mean age was 10.5 ± 3.6 years and 44 (56%) cases were male. Forty-eight (60%) patients had pre-HTN. Masked HTN was present in 6 (8%) patients. One (1%) had ambulatory HTN, and another one (1%) had white coat HTN. The HTA group exhibited significantly higher systolic BP and diastolic BP compared to the other groups in 24-hour BP readings, daytime BP, and night-time BP ABPM parameters (P < 0.05), except for daytime DBP (P = 0.08). Mean AASI was 0.4 ± 0.2. The HTN group had the highest AASI value compared to the other groups (P = 0.006).

Conclusion
Significant alterations in ABPM parameters are frequently observed in pediatric patients with SCA. The incorporation of ABPM, along with the assessment of AASI, is recommended for a comprehensive evaluation of cardiovascular and renal risk in SCA patients.
Virological and immunological correlates of HIV posttreatment control after temporal antiretroviral therapy during acute HIV infection
Authors: van Paassen Pien M. , van Pul Lisa , van der Straten Karlijn , Buchholtz Ninée V.J.E. , Grobben Marloes , van Nuenen Ad C. , van Dort Karel A. , Boeser-Nunnink Brigitte D. , van den Essenburg Mo D. , Burger Judith A. , van Luin Matthijs , Jurriaans Suzanne , Sanders Rogier W. , Swelsen Wendy T. , Symons Jori , Klouwens Michelle J. , Nijhuis Monique , van Gils Marit J. , Prins Jan M. , de Bree Godelieve J. , Kootstra Neeltje A. 
Published: September 2023

Objective:
People with HIV rarely control viral replication after cessation of antiretroviral therapy (ART). We present a person with HIV with extraordinary posttreatment control (PTC) for over 23 years after temporary ART during acute HIV infection (AHI) leading to a new insight in factors contributing to PTC.

Design/methods:
Viral reservoir was determined by HIV qPCR, Intact Proviral DNA Assay, and quantitative viral outgrowth assay. Viral replication kinetics were determined in autologous and donor PBMC. IgG levels directed against HIV envelope and neutralizing antibodies were measured. Immune phenotyping of T cells and HIV-specific T-cell responses were analyzed by flow cytometry.

Results:
The case presented with AHI and a plasma viral load of 2.7 million copies/ml. ART was initiated 2 weeks after diagnosis and interrupted after 26 months. Replicating virus was isolated shortly after start ART. At 18 years after treatment interruption, HIV-DNA in CD4+ T cells and low levels of HIV-RNA in plasma (<5 copies/ml) were detectable. Stable HIV envelope glycoprotein-directed IgG was present during follow-up, but lacked neutralizing activity. Strong antiviral CD8+ T-cell responses, in particular targeting HIV-gag, were detected during 25 years follow-up. Moreover, we found a P255A mutation in an HLA-B∗44 : 02 restricted gag-epitope, which was associated with decreased replication.

Conclusion:
We describe an exceptional case of PTC, which is likely associated with sustained potent gag-specific CD8+ T-cell responses in combination with a replication attenuating escape mutation in gag. Understanding the initiation and preservation of the HIV-specific T-cell responses could guide the development of strategies to induce HIV control.
Negative Pressure Wound Therapy for Patients With Complicated Mucocutaneous Separation Following Ileal Conduit Urinary Diversion
Authors: Ding Jiarong , Zhu Yiqi , Ge Huaqiang , Chen Hui , Wang Liangmei , Xie Shangxun , Zhang Shiwei , Deng Yongming , Yang Rong , Guo Hongqian 
Published: September 2023

BACKGROUND:
Mucocutaneous separation (MCS) is one of the early stomal complications of ileal conduit diversion after radical cystectomy. It can result in abdominal infection and sepsis, prolonging patient recovery. Negative pressure wound therapy (NPWT) has been widely used for abdominal wounds after orthopedic and burn surgery. This case series describes its use in complicated MCS and ostomy retraction after ileal conduit diversion.

CASES:
We describe a case series of 3 patients with moderate to severe MCS with and without infection after robot-assisted radical cystectomy with ileal conduit diversion. Our patients were treated with NPWT to avoid infection and create a satisfactory environment for healing MCS. After 2 to 4 weeks of NPWT, all 3 patients had normal micturition function with no additional peristomal wounds or complications.

CONCLUSION:
Negative pressure wound therapy may be used in the management of complicated MCS after ileal conduit diversion.
Social Vulnerability and Firearm Violence: Geospatial Analysis of 5 US Cities
Authors: Polcari Ann M , Slidell Mark B , Hoefer Lea E , Henry Marion CW , Zakrison Tanya L , Rogers Selwyn O , Benjamin Andrew J 
Published: September 2023

Background:
Firearm violence is now endemic to certain U.S. neighborhoods. Understanding factors that impact a neighborhood’s susceptibility to firearm violence is crucial for prevention. Using a nationally standardized measure to characterize community-level firearm violence risk has not been broadly studied but could enhance prevention efforts. Thus, we sought to examine the association between firearm violence and the social, structural, and geospatial determinants of health, as defined by the Social Vulnerability Index (SVI).

Study Design:
In this cross-sectional study, we merged 2018 SVI data on census tract with 2015-2021 shooting incidents from Baltimore (BAL), Chicago (CHI), Los Angeles (LA), New York City (NYC), and Philadelphia (PHL). We used negative binomial regression to associate the SVI with shooting incidents per 1,000 people in a census tract. Moran’s I statistics were used for geospatial analysis.

Results:
We evaluated 71,296 shooting incidents across 4,415 census tracts. Fifty-five percent of shootings occurred in 9.4% of census tracts. In all cities combined, a decile rise in SVI resulted in a 37% increase in shooting incidents (P<.001). A similar relationship existed in each city: 30% increase in BAL (P<.001), 50% in CHI (P<.001), 28% in LA (P<.001), 34% in NYC (P<.001), and 41% in PHL (P<.001). Shootings were highly clustered within the most vulnerable neighborhoods.

Conclusion:
In five major U.S. cities, firearm violence was concentrated in neighborhoods with high social vulnerability. A tool such as the SVI could be used to inform prevention efforts by directing resources to communities most in need and identifying factors on which to focus these programs and policies.
Rat movements reflect internal decision dynamics in an evidence accumulation task
Authors: Kane Gary A. , Senne Ryan A. , Scott Benjamin B. 
Published: September 2023

AbstractPerceptual decision-making involves multiple cognitive processes, including accumulation of sensory evidence, planning, and executing a motor action. How these processes are intertwined is unclear; some models assume that decision-related processes precede motor execution, whereas others propose that movements reflecting on-going decision processes occur before commitment to a choice. Here we develop and apply two complementary methods to study the relationship between decision processes and the movements leading up to a choice. The first is a free response pulse-based evidence accumulation task, in which stimuli continue until choice is reported. The second is a motion-based drift diffusion model (mDDM), in which movement variables from video pose estimation constrain decision parameters on a trial-by-trial basis. We find the mDDM provides a better model fit to rats’ decisions in the free response accumulation task than traditional DDM models. Interestingly, on each trial we observed a period of time, prior to choice, that was characterized by head immobility. The length of this period was positively correlated with the rats’ decision bounds and stimuli presented during this period had the greatest impact on choice. Together these results support a model in which internal decision dynamics are reflected in movements and demonstrate that inclusion of movement parameters improves the performance of diffusion-to-bound decision models.HighlightsDevelopment and validation of a free response pulse-based accumulation task for ratsResponse times are well described by drift diffusion modelsIncorporating movement data into diffusion models improves inference of latent decisions variablesRats weight sensory evidence most strongly prior to movement
Compartmentalized SARS-CoV-2 replication in upper versus lower respiratory tract after intranasal inoculation or aerosol exposure
Authors: Fischer Robert J , Bushmaker Trenton , Williamson Brandi N. , Pérez-Pérez Lizzette , Feldmann Friederike , Lovaglio Jamie , Scott Dana , Saturday Greg , Feldmann Heinz , Munster Vincent J. , de Wit Emmie , van Doremalen Neeltje 
Published: September 2023

AbstractNon-human primate models are essential for the development of vaccines and antivirals against infectious diseases. Rhesus macaques are a widely utilized infection model for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We compared cellular tropism and virus replication in rhesus macaques inoculated with SARS-CoV-2 via the intranasal route, or via exposure to aerosols. Intranasal inoculation results in replication in the upper respiratory tract and limited lower respiratory tract involvement, whereas exposure to aerosols results in infection throughout the respiratory tract. In comparison to multi-route inoculation, the intranasal and aerosol inoculation routes result in reduced SARS-CoV-2 replication in the respiratory tract.
Identification of a human hematopoietic stem cell subset that retains memory of inflammatory stress
Authors: Zeng Andy G.X. , Nagree Murtaza S. , Jakobsen Niels Asger , Shah Sayyam , Murison Alex , Cheong Jin-Gyu , Turkalj Sven , Lim Isabel N.X. , Jin Liqing , Araújo Joana , Aguilar-Navarro Alicia G. , Parris Darrien , McLeod Jessica , Kim Hyerin , Lee Ho Seok , Zhang Lin , Boulanger Mason , Wagenblast Elvin , Flores-Figueroa Eugenia , Wang Bo , Schwartz Gregory W. , Shultz Leonard D. , Josefowicz Steven Z. , Vyas Paresh , Dick John E. , Xie Stephanie Z. 
Published: September 2023

AbstractInflammation activates many blood cell types, driving aging and malignancy. Yet, hematopoietic stem cells (HSCs) survive a lifetime of infection to sustain life-long blood production. To understand HSC adaptation to inflammation, we developed xenograft inflammation-recovery models and performed single cell multiomics on isolated human HSC. Two transcriptionally and epigenetically distinct HSC subsets expressing canonical HSC programs were identified. Only one showed sustained transcriptional and epigenetic changes after recovery from inflammatory treatments. This HSC inflammatory memory (HSC-iM) program is enriched in memory T cells and HSCs from recovered COVID-19 patients. Importantly, HSC-iM accumulates with age and with clonal hematopoiesis. Overall, heritable molecular alterations in a subset of human HSCs, an adaptation to long-term inflammatory stress, may predispose to heightened age-related risk of blood cancer and infection.One-Sentence SummaryInflammation across a lifetime rewires human HSCs to produce a distinct HSC subset with both beneficial and deleterious fitness consequences.
Guidelines For Rigorous Evaluation of Clinical LLMs For Conversational Reasoning
Authors: Johri Shreya , Jeong Jaehwan , Tran Benjamin A. , Schlessinger Daniel I. , Wongvibulsin Shannon , Cai Zhuo Ran , Daneshjou Roxana , Rajpurkar Pranav 
Published: September 2023

AbstractThe integration of Large Language Models (LLMs) like GPT-4 and GPT-3.5 into clinical diagnostics has the potential to transform patient-doctor interactions. However, the readiness of these models for real-world clinical application remains inadequately tested. This paper introduces the Conversational Reasoning Assessment Framework for Testing in Medicine (CRAFT-MD), a novel approach for evaluating clinical LLMs. Unlike traditional methods that rely on structured medical exams, CRAFT-MD focuses on natural dialogues, using simulated AI agents to interact with LLMs in a controlled, ethical environment. We applied CRAFT-MD to assess the diagnostic capabilities of GPT-4 and GPT-3.5 in the context of skin diseases. Our experiments revealed critical insights into the limitations of current LLMs in terms of clinical conversational reasoning, history taking, and diagnostic accuracy. Based on these findings, we propose a comprehensive set of guidelines for future evaluations of clinical LLMs. These guidelines emphasize realistic doctor-patient conversations, comprehensive history taking, open-ended questioning, and a combination of automated and expert evaluations. The introduction of CRAFT-MD marks a significant advancement in LLM testing, aiming to ensure that these models augment medical practice effectively and ethically.
Systematic identification of disease-causing promoter and untranslated region variants in 8,040 undiagnosed individuals with rare disease
Authors: Martin-Geary Alexandra C , Blakes Alexander J M , Dawes Ruebena , Findlay Scott D , Lord Jenny , Walker Susan , Talbot-Martin Jonathan , Wieder Nechama , D’Souza Elston N , Fernandes Maria , Hilton Sarah , Lahiri Nayana , Campbell Christopher , Jenkinson Sarah , DeGoede Christian G E L , Anderson Emily R , Burge Christopher B. , Sanders Stephan J , Ellingford Jamie , Baralle Diana , Banka Siddharth , Whiffin Nicola 
Published: September 2023

AbstractBackgroundBoth promoters and untranslated regions (UTRs) have critical regulatory roles, yet variants in these regions are largely excluded from clinical genetic testing due to difficulty in interpreting pathogenicity. The extent to which these regions may harbour diagnoses for individuals with rare disease is currently unknown.MethodsWe present a framework for the identification and annotation of potentially deleterious proximal promoter and UTR variants in known dominant disease genes. We use this framework to annotatede novovariants (DNVs) in 8,040 undiagnosed individuals in the Genomics England 100,000 genomes project, which were subject to strict region-based filtering, clinical review, and validation studies where possible. In addition, we performed region and variant annotation-based burden testing in 7,862 unrelated probands against matched unaffected controls.ResultsWe prioritised eleven DNVs and identified an additional variant overlapping one of the eleven. Ten of these twelve variants (82%) are in genes that are a strong match to the individual’s phenotype and six had not previously been identified. Through burden testing, we did not observe a significant enrichment of potentially deleterious promoter and/or UTR variants in individuals with rare disease collectively across any of our region or variant annotations.ConclusionsOverall, we demonstrate the value of screening promoters and UTRs to uncover additional diagnoses for previously undiagnosed individuals with rare disease and provide a framework for doing so without dramatically increasing interpretation burden.
Multimodal structural neuroimaging data unveil data-driven subtypes of treatment-resistant depression
Authors: Colombo Federica , Calesella Federico , Bravi Beatrice , Fortaner-Uyà Lidia , Monopoli Camilla , Tassi Emma , Carminati Matteo , Zanardi Raffaella , Bollettini Irene , Poletti Sara , Brambilla Paolo , Serretti Alessandro , Maggioni Eleonora , Fabbri Chiara , Benedetti Francesco , Vai Benedetta 
Published: September 2023

AbstractBackgroundAn estimated 30% of Major Depressive Disorder (MDD) patients exhibit resistance to conventional antidepressant treatments. Identifying reliable biomarkers of treatment-resistant depression (TRD) represents a major goal of precision psychiatry, which is hampered by the clinical and biological heterogeneity underlying MDD.MethodsTo parse heterogeneity and uncover biologically-driven subtypes of MDD, we applied an unsupervised data-driven framework to stratify 102 MDD patients on their neuroimaging signature, including extracted measures of cortical thickness, grey matter volumes, and white matter fractional anisotropy. Our novel analytical pipeline integrated different machine learning algorithms to harmonize neuroimaging data, perform data dimensionality reduction, and provide a stability-based relative clustering validation. The obtained clusters were then characterized for TRD, history of childhood trauma and different profiles of depressive symptoms.ResultsOur results indicated two different clusters of patients, differentiable with 67% of accuracy: 1) one cluster (n=59) was associated with a higher proportion of TRD compared to the other, and higher scores of energy-related depressive symptoms, history of childhood abuse and emotional neglect; this cluster showed a widespread reduction in cortical thickness and volumes, along with fractional anisotropy in the right superior fronto-occipital fasciculus, stria terminalis, and corpus callosum; 2) the second cluster (n=43) was associated with cognitive and affective depressive symptoms and thicker cortices and wider volumes compared to the other.DiscussionOur stratification of MDD patients based on structural neuroimaging identified clinically-relevant subgroups of TRD with specific symptomatic and childhood trauma profiles, which are informative for tailoring personalized and more effective interventions of treatment resistance.
Effect of Higher-Dose Fluvoxamine vs Placebo on Time to Sustained Recovery in Outpatients with Mild to Moderate COVID-19: A Randomized Clinical Trial
Authors:   The Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV)-6 Study Group and Investigators, Naggie Susanna 
Published: September 2023

AbstractBackgroundThe impact of fluvoxamine in reducing symptom duration among outpatients with mild to moderate coronavirus disease 2019 (COVID-19) remains uncertain. Our objective was to assess the effectiveness of fluvoxamine 100 mg twice daily, compared with placebo, for treating mild to moderate COVID-19.MethodsThe ACTIV-6 platform randomized clinical trial aims to evaluate repurposed medications for mild to moderate COVID-19. Between August 25, 2022, and January 20, 2023, 1175 participants were enrolled at 103 US sites for evaluating fluvoxamine; participants were age ≥30 years with confirmed SARS-CoV-2 infection and ≥2 acute COVID-19 symptoms for ≤7 days. Participants were randomized to receive fluvoxamine 50 mg twice daily on day 1 followed by 100 mg twice daily for 12 additional days or to placebo. The primary outcome was time to sustained recovery (defined as at least 3 consecutive days without symptoms). Secondary outcomes included time to death; time to hospitalization or death; a composite of hospitalization, urgent care visit, emergency department visit, or death; COVID clinical progression scale; and difference in mean time unwell.ResultsAmong participants who were randomized and received study drug, the median age was 50 years (IQR 40-60), 66% were female, 45% identified as Hispanic/Latino, and 77% reported ≥2 doses of a SARS-CoV-2 vaccine. Among 589 participants who received fluvoxamine and 586 who received placebo, differences in time to sustained recovery were not observed (adjusted hazard ratio [HR], 0.99 [95% credible interval, 0.89-1.09; P(efficacy) = 0.4]). Additionally, unadjusted, median time to sustained recovery was 10 days (95% CI 10-11) in both the intervention and placebo group. No deaths were reported. Thirty-five participants reported healthcare utilization events (a prioridefined as death, hospitalization, emergency department/urgent care visit); 14 in the fluvoxamine group compared with 21 in the placebo group (HR 0.69; 95% CrI 0.27–1.21; P(efficacy)=0.86) There were 7 serious adverse events in 6 participants (2 with fluvoxamine and 4 with placebo).ConclusionsAmong outpatients with mild to moderate COVID-19, treatment with fluvoxamine does not reduce duration of COVID-19 symptoms.Trial RegistrationClinicalTrials.gov(NCT04885530).