Virtual patients using large language models: Scalable, contextualized simulation of clinician-patient dialog with feedback.

Background: Virtual patients (VPs) are computer screen-based simulations of patient-clinician encounters. VP use is limited by cost and low scalability.

Objective: Show proof-of-concept that VPs powered by large language models (LLMs) generate authentic dialogs, accurate representations of patient preferences, and personalized feedback on clinical performance; and explore LLMs for rating dialog and feedback quality.

Mathematical assessment of the role of temperature on desert locust population dynamics.

This study presents a novel non-autonomous mathematical model to explore the intricate relationship between temperature and desert locust population dynamics, considering the influence of both solitarious and gregarious phases across all life stages. The model incorporates temperature-dependent parameters for key biological processes, including egg development, hopper growth, adult maturation, and reproduction. Theoretical analysis reveals the model's capacity for complex dynamical behaviors, such as multiple stable states and backward bifurcations, suggesting the potential for sudden and unpredictable population shifts.

Treatment With Avacopan in Patients With Respiratory Tract Manifestations of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.

Objective: The ADVOCATE trial demonstrated that treatment of active granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) with avacopan was noninferior in achieving remission at week 26 and superior for sustained remission at week 52 compared with a prednisone taper. This analysis of ADVOCATE evaluated the efficacy and safety of avacopan in patients with ear, nose, throat (ENT), or lung manifestations.

Methods: This post hoc analysis included patients enrolled in ADVOCATE with ENT or lung manifestations at baseline.

COVID-19 Pandemic and Racial and Ethnic Disparities in Long-Term Nursing Home Stay or Death Following Hospital Discharge.

Importance: Long-term nursing home stay or death (long-term NH stay or death), defined as new long-term residence in a nursing home or death following hospital discharge, is an important patient-centered outcome.

Objective: To examine whether the COVID-19 pandemic was associated with changes in long-term NH stay or death among older adults with sepsis, and whether these changes were greater in individuals from racial and ethnic minoritized groups.

Design, Setting, And Participants: This cross-sectional study used patient-level data from the Medicare Provider Analysis and Review File, the Master Beneficiary Summary File, and the Minimum Data Set.

Nanomaterials-Induced Pyroptosis: Advancing Novel Therapeutic Pathways in Nanomedicine.

Pyroptosis, a form of programmed cell death characterized by cell lysis and inflammation, has significant implications for disease treatment. Nanomaterials (NMs), with their unique physicochemical properties, can precisely modulate pyroptosis, offering novel and intelligent therapeutic strategies for cancer, infectious diseases, and chronic inflammatory conditions with targeted activation and reduced systemic toxicity. This review explores the mechanisms by which NMs regulate pyroptosis, comparing molecular and NM inducers, and examines the role of intrinsic properties such as size, shape, surface charge, and chemical composition in these processes.

Sample Size Adjustment in Sequential Multiple Assignment Randomized Trials.

Clinical trials are often designed based on limited information about effect sizes and precision parameters with risks of underpowered studies. This is more problematic for SMARTs where strategy effects are based on sequences of treatments. Sample size adjustment offers flexibility through re-estimating sample size during the trial to ensure adequate power at the final analysis.

Prophylactic Use of Cardiac Medications and Survival in Duchenne Muscular Dystrophy.

Introduction/aims: Prophylactic treatment of left ventricular dysfunction (LVD) in Duchenne muscular dystrophy (DMD) delays onset of LVD, but there is limited data showing impact on survival. Our aim was to describe survival among treated and untreated individuals with DMD.

Methods: Retrospective, population-based surveillance data from the Muscular Dystrophy Surveillance, Tracking and Research Network (MD STARnet) were used.

International Validation of a Novel PEACE Scale to Improve the Quality of Upper Gastrointestinal Mucosal Inspection During Endoscopy.

Introduction: The performance of a high quality esophagogastroduodenoscopy (EGD) is dependent on the mucosal cleanliness. Recently, the Polprep: Effective Assessment of Cleanliness in EGD (PEACE) scale was created to assess the degree of mucosal cleanliness during EGD. The aim of this study was to validate this scoring system in a cohort of international endoscopists.

Survival, Tumor Control, and Safety Outcomes of Proton Therapy in Sinonasal Cancer Population: A Systematic Review and Meta-Analysis.

Background: In sinonasal cancer (SNC), treatment with proton therapy (PT) provides excellent local control, especially after gross total resection. Because of the heterogeneity and rarity of this disease site, a comprehensive assessment of toxicity, survival, and control rates is lacking. Our primary objective was to assess the toxicity outcomes of PT in SNC patients, with a secondary aim of assessing survival and tumor control after PT.

Temporal Tendencies: Exploring the Impact of Chronotype Timing on Youth Depression Risk.

Developmental changes in youth sleep preferences (chronotype) and pubertal development are consequential for youth risk for depression. Previous research has identified individual differences in chronotype in risk for psychopathology. However, little is known regarding how the timing of chronotype may confer risk in youth.

Optimizing Electroconvulsive Therapy With E-Field Modeling: A Narrative Review.

Electroconvulsive therapy (ECT) is an effective treatment for severe depression, especially in treatment-resistant cases. However, its potential cognitive side effects necessitate careful dosing to balance therapeutic benefits and cognitive stability. Recent advances in electric field (E-field) modeling offer promising avenues to optimize ECT dosing.

Circulating and Magnetic Resonance Imaging Biomarkers of Intestinal Fibrosis in Small Bowel Crohn's Disease.

Background: We previously identified circulating and MRI biomarkers associated with the surgical management of Crohn's disease (CD). Here we tested associations between these biomarkers and ileal resection inflammation and collagen content.

Methods: Fifty CD patients undergoing ileal resection were prospectively enrolled at 4 centers.

Unraveling the Invisible: Topological Data Analysis as the New Frontier in Radiology's Diagnostic Arsenal.

This commentary examines Topological Data Analysis (TDA) in radiology imaging, highlighting its revolutionary potential in medical image interpretation. TDA, which is grounded in mathematical topology, provides novel insights into complex, high-dimensional radiological data through persistent homology and topological features. We explore TDA's applications across medical imaging domains, including tumor characterization, cardiovascular imaging, and COVID-19 detection, where it demonstrates 15-20% improvements over traditional methods.

Lipidomics of Huntington's Disease: A Comprehensive Review of Current Status and Future Directions.

Background: Huntington's disease (HD) is a multifaceted neurological disorder characterized by the progressive deterioration of motor, cognitive, and psychiatric functions. Despite a limited understanding of its pathogenesis, research has implicated abnormal trinucleotide cytosine-adenine-guanine CAG repeat expansion in the huntingtin gene (HTT) as a critical factor. The development of innovative strategies is imperative for the early detection of predictive biomarkers, enabling timely intervention and mitigating irreversible cellular damage.

The impact of virtual reality on patient experience during wide-awake surgery: a randomized controlled trial.

This study aimed to establish whether virtual reality can reduce patient anxiety and improve surgical satisfaction during wide-awake local anaesthetic no tourniquet hand procedures. Previously validated questionnaires were used to assess subjective anxiety and patient satisfaction. Objective anxiety was determined using patient blood pressure and heart rate measured four times during the procedure.

Characterization and Machine Learning-Driven Property Prediction of a Novel Hybrid Hydrogel Bioink Considering Extrusion-Based 3D Bioprinting.

The field of tissue engineering has made significant advancements with extrusion-based bioprinting, which uses shear forces to create intricate tissue structures. However, the success of this method heavily relies on the rheological properties of bioinks. Most bioinks use shear-thinning.

Addressing the Triple Trauma of Factors Leading to Perinatal Health and Mental Health Consequences in Two Upstate New York Communities.

This article focuses on the impact of trauma experienced by individuals, families and groups, and neighborhoods in Rochester and Syracuse, New York. Using the levels of analysis put forward in Bronfenbrenner's ecological systems theory (i.e.

Risk factors affecting polygenic score performance across diverse cohorts.

Apart from ancestry, personal or environmental covariates may contribute to differences in polygenic score (PGS) performance. We analyzed the effects of covariate stratification and interaction on body mass index (BMI) PGS (PGS) across four cohorts of European (N = 491,111) and African (N = 21,612) ancestry. Stratifying on binary covariates and quintiles for continuous covariates, 18/62 covariates had significant and replicable R differences among strata.

Long term outcomes associated with the use of perioperative systemic chemotherapy on low grade appendiceal mucinous neoplasms with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Introduction: Low grade appendiceal mucinous neoplasms (LAMN) are indolent tumors that lack invasive potential but may present as pseudomyxoma peritonei. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) significantly improves both overall and recurrence free survival. While systemic chemotherapy is generally considered ineffective for LAMN, little literature is available to support this notion.

Post-burns persistent inflammation leads to kidney PANoptosis with Caspases pathway activation.

Background: There is higher prevalence of chronic kidney disease (CKD) in burn patients after hospital discharge; however, the cause remains unclear. This study aimed to investigate the lasting impacts of severe burns on the kidneys and to explore potential treatments.

Methods: The study examined the effects of burning on healthy mice and adenine-induced CKD mice.

Utility of Noninvasive Testing Before Invasive Coronary Angiography in the Assessment for Revascularization.

Objective: To examine the role of noninvasive testing (NIT) before invasive coronary angiography (ICA) by evaluating the association between a positive myocardial perfusion imaging (MPI) or computed tomography angiography (CTA) result and the decision to perform coronary revascularization.

Patients And Methods: We screened all patients who received ICA between August 1, 2015, and July 31, 2019, and identified those who received MPI or CTA within the preceding 12 months. We considered MPI to be a positive result if it found moderate or severe ischemia in a specific coronary territory and CTA to be a positive result if it identified a stenosis greater than 50% in any major coronary artery.

Characteristics and Associated Risk Factors of Broad Ligament Hernia: A Systematic Review.

The broad ligament, a double-layered peritoneum attaching the lateral uterus to the pelvic sidewall, plays a vital role in pelvic anatomy. Small bowel herniation through a defect in the broad ligament, known as broad ligament herniation, involving protrusion of viscera through defects in this ligament, is rare but can lead to severe complications. This systematic review aims to evaluate the presentation, diagnosis, management, and factors associated with broad ligament herniation.