Bibliographic record
Abstract
To the Editor: Hyperviscosity syndrome (HVS) is a life-threatening condition often occurring as a complication of Waldenström macroglobulinemia (WM) but rarely in the context of rheumatic disease. Given its rarity, diagnosis can be delayed, leading to greater morbidity. Our interest was sparked by a recent experience with a patient with rheumatoid arthritis (RA) who developed epistaxis with progressively worsening dyspnea, confusion, and visual deficits culminating in hospitalization due to HVS1. As HVS is uncommon in the era of biologic medications, we conducted a systematic review (Supplementary Figure 1, available from the authors on request) to define factors that predispose to HVS and describe outcomes of previous treatment approaches. We identified 25 cases of hyperviscosity attributed to RA. The most common presenting features for HVS included bleeding diathesis (e.g., epistaxis, gastrointestinal hemorrhage, gingival bleeding), heart failure (dyspnea and/or pedal edema), neurologic symptoms (dizziness, syncope, confusion), and constitutional symptoms (Table 1). RA developed years before HVS (7.9 ± 7.4 yrs) but was the presenting manifestation in 3 cases. Synovitis was often active … Address correspondence to Dr. J.B. Miller, Instructor of Medicine, 5200 Eastern Ave., Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD 21224, USA. Email: JMill237{at}jhmi.edu.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.026 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.006 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".