Editorial Comment: Yesterday's future: the gap between where we are now and where we were supposed to be
Bibliographic record
Abstract
Had my dear mentor and friend, the Canadian surgeon Pierre Grondin, been alive today he would have been surprised—or even shocked—to realize that, 45 years after he placed the tricuspid valve in the surgical arena, we heart surgeons are still debating which is the best repair technique [1]. In spite of all the known limitations of a retrospective analysis, the paper by Thomas Guenther et al.exemplifies one more good effort to clarify this issue [2]. In any case it is remarkable to see how the suture technique has withstood the pressure from the mighty medical industry in trying to sell prosthetic rings (more than 20 types are currently on the market). Now, more than ever, we have to be conscious of the interface between authorship, industry and science in order to avoid what has been defined as ‘business adopting the appearance of science’. Although our practice has clearly evolved during this long period of time, from leaving the tricuspid valve untouched to the point of repairing any grade of tricuspid regurgitation (TR) we have unfortunately failed to find a clear answer to four important questions: Does the tricuspid valve behave the same way in cases of rheumatic mitral disease, as in cases of degenerative mitral disease? Why do so many rheumatic mitral or mitral and aortic patients, who had no TR at the time of surgery, develop severe TR in the long-term, despite a normally-functioning left side valve repair or replacement? Could preventive fixation of the tricuspid annulus at the time of the first operation be the answer to this problem? and When is the best time to re-operate those high-risk surgical cases? If we want to help our patients, we will need to focus on those four issues, as surgeons at the Mayo Clinic have recently done in relation to the first question [3]. PS: I have some tips for those surgeons who, for various reasons, prefer a suture repair: With the patient under cardiac arrest and before doing the mitral repair or replacement, carefully place the two lines of sutures and, after releasing the aortic clamp, tie them at the end while testing the valve by flushing the right ventricle with saline. Try to keep the sutures buried into the annulus as much as possible by stitching back into it as close as possible to the previous exit point, and make sure that the first and last stitches clearly overlap both the anteroseptal and posteroseptal commissures. Always use a braided, synthetic 00 suture.
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 | 0.007 | 0.028 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.026 | 0.028 |
| Insufficient payload (model declined to judge) | 0.011 | 0.013 |
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".