Intrapulmonary shunting and hepatopulmonary syndrome
Bibliographic record
Abstract
A57-year-old woman was referred for assessment of progressive dyspnoea, decreasing exercise tolerance and worsening bluish facial discolouration. She had congenital cirrhosis complicated by portal hypertension aged 4 years, for which she underwent a portacaval shunt. She was an exsmoker of 30 years. On examination, she was centrally cyanosed and clubbed. Her jugular venous pressure was not elevated, cardiac examination was normal and there were no focal chest signs. Spider naevi were noted, but no palpable organomegaly or ascites. Her oxygen saturation, however, was 88% breathing room air, which did not alter when recumbent or supine. A chest radiograph showed normal lung fields and vasculature, and no effusions. Renal and liver profile blood tests and international normalized ratio were normal. Arterial blood gas analysis revealed: pH 7.43 (normal 7.35–7.45), Pa∘ 2 7.21 kPa (normal >10.6 kPa), PaC∘ 2 3.96 kPa (normal 4.6–6.0 kPa) breathing room air. Her AaPa∘ 2 was 7.8 kPa (predicted agecorrected AaPa∘ 2 2.10 kPa). Pa∘ 2 increased to 69.8 kPa breathing 100% inspired oxygen delivered using continuous positive airway pressure. Her calculated intrapulmonary shunt fraction was 7% (normal <5%). Pulmonary function tests showed normal spirometry and preserved lung volumes, however, carbon monoxide diffusing capacity was only 38% predicted, adjusted for haemoglobin 17.8 g/dl. Transthoracic echocardiography demonstrated normal structure and function of all cardiac chambers. Contrast echocardiography established the presence of intrapulmonary shunting (Figure 1) and confirmed the diagnosis of hepatopulmonary syndrome. She was established on long-term oxygen therapy and is currently under consideration for a liver transplant.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".