Nature Medicine最新文献

{"title":"Prioritizing infant mental health: a research-driven pathway for action","authors":"Anusha Lachman, Berna Gerber, Marlette Burger, Fiona Ross, Juan Bornman, Tracey Smythe, on behalf of the Early Intervention and Child Mental Health ‘public square’","doi":"10.1038/s41591-024-03338-3","DOIUrl":"10.1038/s41591-024-03338-3","url":null,"abstract":"A comprehensive research agenda is needed to identify gaps and actionable steps to prioritize infant and early life mental health care globally.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"31 1","pages":"28-30"},"PeriodicalIF":58.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An evaluation framework for clinical use of large language models in patient interaction tasks","authors":"Shreya Johri, Jaehwan Jeong, Benjamin A. Tran, Daniel I. Schlessinger, Shannon Wongvibulsin, Leandra A. Barnes, Hong-Yu Zhou, Zhuo Ran Cai, Eliezer M. Van Allen, David Kim, Roxana Daneshjou, Pranav Rajpurkar","doi":"10.1038/s41591-024-03328-5","DOIUrl":"10.1038/s41591-024-03328-5","url":null,"abstract":"The integration of large language models (LLMs) into clinical diagnostics has the potential to transform doctor–patient 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) approach for evaluating clinical LLMs. Unlike traditional methods that rely on structured medical examinations, CRAFT-MD focuses on natural dialogues, using simulated artificial intelligence agents to interact with LLMs in a controlled environment. We applied CRAFT-MD to assess the diagnostic capabilities of GPT-4, GPT-3.5, Mistral and LLaMA-2-7b across 12 medical specialties. Our experiments revealed critical insights into the limitations of current LLMs in terms of clinical conversational reasoning, history-taking and diagnostic accuracy. These limitations also persisted when analyzing multimodal conversational and visual assessment capabilities of GPT-4V. We propose a comprehensive set of recommendations for future evaluations of clinical LLMs based on our empirical findings. These recommendations emphasize realistic doctor–patient conversations, comprehensive history-taking, open-ended questioning and using a combination of automated and expert evaluations. The introduction of CRAFT-MD marks an advancement in testing of clinical LLMs, aiming to ensure that these models augment medical practice effectively and ethically. By simulating realistic doctor–patient conversations, a framework can be applied to large language models to investigate shortcomings and bias in patient interactions, providing insight before actual clinical deployment.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"31 1","pages":"77-86"},"PeriodicalIF":58.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empagliflozin in nondiabetic individuals with calcium and uric acid kidney stones: a randomized phase 2 trial","authors":"Manuel A. Anderegg, Simeon Schietzel, Matteo Bargagli, Lia Bally, Nicolas Faller, Matthias B. Moor, Grazia M. Cereghetti, Marie Roumet, Sven Trelle, Daniel G. Fuster","doi":"10.1038/s41591-024-03330-x","DOIUrl":"10.1038/s41591-024-03330-x","url":null,"abstract":"Efficacy of sodium-glucose cotransporter 2 inhibitors for kidney stone prevention in nondiabetic patients is unknown. In a double-blind, placebo-controlled, single-center, crossover phase 2 trial, 53 adults (≥18 and <75 years) with calcium (n = 28) or uric acid (UA; n = 25) kidney stones (at least one previous kidney stone event) without diabetes (HbA1c < 6.5%, no diabetes treatment) were randomized to once daily empagliflozin 25 mg followed by placebo or reverse (2 weeks per treatment). Randomization and analysis were performed separately for both stone types. Primary analyses were conducted in the per protocol set. Primary outcomes were urine relative supersaturation ratios (RSRs) for calcium oxalate (CaOx), calcium phosphate (CaP) and UA—validated surrogates for stone recurrence. Prespecified RSR reductions (≥15%) were met in both groups of stone formers. In patients with calcium stones, empagliflozin reduced RSR CaP (relative difference to placebo, −36%; 95% confidence interval, −48% to −21%; P < 0.001), but not RSRs CaOx and UA. In patients with UA stones, empagliflozin reduced RSR UA (−30%; 95% confidence interval, −44% to −12%; P = 0.002) but not RSRs CaOx and CaP. No serious or prespecified adverse events occurred. Thus, empagliflozin substantially reduced RSRs in nondiabetic adults with calcium and UA kidney stones. ClinicalTrials.gov registration: NCT04911660 . As part of the SWEETSTONE trial, the authors report the ability of the sodium-glucose cotransporter 2 inhibitor empagliflozin to reduce the likelihood of kidney stone formation in individuals without diabetes.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"31 1","pages":"286-293"},"PeriodicalIF":58.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41591-024-03330-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-omic profiling a defined bacterial consortium for treatment of recurrent Clostridioides difficile infection","authors":"Rajita Menon, Shakti K. Bhattarai, Emily Crossette, Amanda L. Prince, Bernat Olle, Jeffrey L. Silber, Vanni Bucci, Jeremiah Faith, Jason M. Norman","doi":"10.1038/s41591-024-03337-4","DOIUrl":"10.1038/s41591-024-03337-4","url":null,"abstract":"Donor-derived fecal microbiota treatments are efficacious in preventing recurrent Clostridioides difficile infection (rCDI), but they have inherently variable quality attributes, are difficult to scale and harbor the risk of pathogen transfer. In contrast, VE303 is a defined consortium of eight purified, clonal bacterial strains developed for prevention of rCDI. In the phase 2 CONSORTIUM study, high-dose VE303 was well tolerated and reduced the odds of rCDI by more than 80% compared to placebo. VE303 organisms robustly colonized the gut in the high-dose group and were among the top taxa associated with non-recurrence. Multi-omic modeling identified antibiotic history, baseline stool metabolites and serum cytokines as predictors of both on-study CDI recurrence and VE303 colonization. VE303 potentiated early recovery of the host microbiome and metabolites with increases in short-chain fatty acids, secondary bile acids and bile salt hydrolase genes after antibiotic treatment for CDI, which is considered important to prevent CDI recurrences. These results support the idea that VE303 promotes efficacy in rCDI through multiple mechanisms. Results of multi-omic profiling of the microbiome and host immunity of individuals treated with VE303 to prevent recurrent Clostridioides difficile infection in the context of a phase 2 trial show robust colonization of VE303 and indicate potential biomarkers of response.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"31 1","pages":"223-234"},"PeriodicalIF":58.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic and transmission dynamics of the 2024 Marburg Virus Outbreak in Rwanda","authors":"Yvan Butera, Leon Mutesa, Edyth Parker, Raissa Muvunyi, Esperance Umumararungu, Alisen Ayitewala, Jean Pierre Musabyimana, Alhaji Olono, Placide Sesonga, Olusola Ogunsanya, Emmanuel Kabalisa, Oluwatobi Adedokun, Nelson Gahima, Laetitia Irankunda, Chantal Mutezemariya, Richard Niyonkuru, Arlene Uwituze, Ithiel Uwizera, James Kagame, Arlette Umugwaneza, John Rwabuhihi, Fidele Umwanankabandi, Valens Mbonitegeka, Edouard Ntagwabira, Etienne Kayigi, Gerard Izuwayo, Herve Murenzi, Therese Mukankwiro, Nasson Tuyiringire, Jean Marie Vianney Uwimana, Agnes Gasengayire, Reuben Sindayiheba, Glory-Ugochi Onyeugo, Merawi Aragaw, Lenny Gitundu, Radjabu Bigirimana, Mosoka Fallah, Adaora Ejikeme, Senga Sembuche, Alice Kabanda, Jean Claude Mugisha, Emmanuel Edwar Siddig Francis, Pierre Gashema, Jerome Ndayisenga, Alexis Rugamba, Faustin Kanyabwisha, Gad Murenzi, Anise Happi, Jean Claude Semuto Ngabonziza, Misbah Gashegu, Ayman Ahmed, Noella Bigirimana, Edson Rwagasore, Muhammed Semakula, Jean Paul Rwabihama, Clarisse Musanabaganwa, Eric Seruyange, Menelas Nkeshimana, Theogene Twagirumugabe, David Turatsinze, Eric Remera, Noel Gahamanyi, Sofonias Kifle Tessema, Isabelle Mukagatare, Sabin Nsanzimana, Christian Happi, Claude Mambo Muvunyi","doi":"10.1038/s41591-024-03459-9","DOIUrl":"https://doi.org/10.1038/s41591-024-03459-9","url":null,"abstract":"<p>The ongoing outbreak of Marburg virus disease (MVD) in Rwanda marks the third largest historically, though it has exhibited the lowest fatality rate. Genomic analysis of samples from 18 cases identified a lineage with limited internal diversity, closely related to a 2014 Ugandan case. Our findings suggest that the Rwandan lineage diverged decades ago from a common ancestor shared with diversity sampled from bats in Uganda. Our genomic data reveals limited genetic variation, consistent with single zoonotic transmission event and limited human-to-human transmission. Investigations including contact tracing, clinical assessments, sequencing and serology, linked the index case to a mining cave inhabited by <i>Rousettus aegyptiacus</i>. Serology tests identified three individuals seropositive for IgG and IgM, further supporting the zoonotic origin of the outbreak through human-animal interactions.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"75 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AlphaFold gets an upgrade (and a Nobel)","authors":"Karen O’Leary","doi":"10.1038/s41591-024-03392-x","DOIUrl":"10.1038/s41591-024-03392-x","url":null,"abstract":"","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"30 12","pages":"3393-3393"},"PeriodicalIF":58.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From clinical to biological definitions of neurological diseases","authors":"Karen O’Leary","doi":"10.1038/s41591-024-03387-8","DOIUrl":"10.1038/s41591-024-03387-8","url":null,"abstract":"","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"30 12","pages":"3392-3392"},"PeriodicalIF":58.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prime time for gene editing","authors":"Karen O’Leary","doi":"10.1038/s41591-024-03390-z","DOIUrl":"10.1038/s41591-024-03390-z","url":null,"abstract":"","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"30 12","pages":"3392-3393"},"PeriodicalIF":58.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health impacts of microplastic exposure","authors":"Karen O’Leary","doi":"10.1038/s41591-024-03388-7","DOIUrl":"10.1038/s41591-024-03388-7","url":null,"abstract":"","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"30 12","pages":"3392-3392"},"PeriodicalIF":58.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-acting PrEP prevents HIV in women","authors":"Karen O’Leary","doi":"10.1038/s41591-024-03393-w","DOIUrl":"10.1038/s41591-024-03393-w","url":null,"abstract":"","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"30 12","pages":"3393-3393"},"PeriodicalIF":58.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}