Bibliographic record
Abstract
A 75-year-old male with a three-month history of intermittent melena and a 40 g/L decrease in hemoglobin was referred to gastroenterology for further investigation. His surgical history was significant for an elective percutaneous endovascular aneurysm repair five years ago, complicated by a recurrent Type 2 endoleak, requiring a total of four trans-arterial and trans-lumbar embolization with copolymers, gelfoam, and endocoils. Computed tomography (CT) scan demonstrated a stable aneurysm sac diameter with no disruption of the aneurysm wall, extravasation of contrast material into the bowel, or signs of peri-graft gas (Figure 1). On esophagogastroduodenoscopy (EGD), an aortoenterc fistula secondary to a perforating endocoil was seen in the third part of the duodenum (Figure 2), which was confirmed during a subsequent duodenal diversion procedure. Computed tomography scan of the embolization material and endocoils inside the aneurysm sac. Perforating endocoil in the third part of the duodenum. Secondary aorto-enteric fistula (AEF) is a serious but rare complication of abdominal aortic aneurysm repair (1). Erosion of metallic endocoils into the aortic wall post-endoleak embolization is an extremely rare cause of AEF, with only one published case that was diagnosed at laparotomy (2). While CT is the diagnostic modality of choice in a stable patient, the high sensitivity (94%) and specificity (85%) in this case were likely affected by significant signal artifact from the embolization material (3). In summary, endoscopic examination of the 3rd and 4th portion of the duodenum is a useful diagnostic adjuvant to CT imaging in patients with previous endoleak embolization for the diagnosis of AEF. Conflict of interest statement: The authors have no conflicts to declare. Contribution: YC drafted the initial manuscript. EJC edited and provided final approval of manuscript.
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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 | 0.008 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.006 | 0.003 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.011 | 0.005 |
| Insufficient payload (model declined to judge) | 0.006 | 0.003 |
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".