Notice bibliographique
Résumé
A 56-year-old female presented with a week history of abdominal distension and jaundice. She was known for metastatic breast cancer on fifth-line chemotherapy and had completed her fourth cycle of paclitaxel/carboplatin one month prior to presentation. She had also experienced recurrent pulmonary embolisms and was currently on tinzaparin. On arrival, the patient was tachycardic but otherwise vitally stable, afebrile and had a normal mental status. Her physical examination revealed a systolic ejection murmur, mild crackles at both lung bases, visible jaundice, ascites, and peripheral edema. She only complained of new fluid retention and increased pressure-like chronic abdominal pain. On investigation, she was found to have an acute kidney injury and an acutely elevated cholestatic transaminitis, with evidence of liver dysfunction (increased INR, reduced albumin, mild thrombocytopenia and low glucose). Her tumor markers were increasing. Her CT and US showed stable metastatic disease in the liver and no evidence of biliary dilatation or vascular thrombosis. However, there was significant interval increase in ascites. She underwent a paracentesis, which removed 4 liters of peritoneal fluid. Analysis was compatible with portal hypertension without evidence of spontaneous bacterial peritonitis Identify and treat a reversible cause of liver failure with high mortality Diagnosis made by autopsy. Supportive treatment was initiated with IV albumin, and the patient was admitted with a diagnosis of drug induced liver injury. However, her laboratory results showed rapid deterioration in all liver enzymes as well as liver function tests. Her mental status remained normal. She was empirically started on N-acetylcysteine, but liver biopsy and steroids were deemed unlikely to change management. Given the poor prognosis and ineligibility to a liver transplant, the patient changed her goals of care. Her liver failure unfortunately progressed, and she died within 3 days of presentation. In the end, all biochemical and microbiologic workup were negative. In fact, the autopsy surprisingly revealed the cause of death to be multiorgan failure secondary to disseminated Clostridium perfringens infection, from either the gallbladder or the necrotic tumor as the primary site, leaving the medical team to wonder how the diagnosis was missed despite negative blood cultures. Although it is the most frequent cause of liver failure, drug-induced liver injury remains a diagnosis of exclusion. Clostridium perfringens bacteremia is rare and rapidly lethal, with mortality rates greater than 60%, but it is also a treatable cause of acute liver failure. Prompt recognition and aggressive treatment are mandatory for any chances of survival. Laboratory findings of hemolysis may raise suspicion of the diagnosis. Hence, early suspicion of infectious causes for hemodynamic or clinical deterioration warrants empirical broad-spectrum antibiotics. None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,189 | 0,053 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».