A Case of Prosthetic Infective Endocarditis with Acute Myocardial Infarction due to Septic Embolism
Bibliographic record
Abstract
症例は68歳，男性．2017年1月に大動脈弁狭窄症に対して大動脈弁置換術（CEP MAGNA 25 mm Edwards Lifescience Corporation，Irvine，USA）および無症候性心筋虚血に対して大伏在静脈（saphenous vein graft；以下SVG）を用いた冠動脈バイパス術2枝（SVG-#7，SVG-4PD）を施行した．2017年11月近医外来に1週間以上続く，微熱を主訴に来院した．微熱以外の自覚症状は特に認めなかった．心臓超音波検査で人工弁感染性心内膜炎（Prosthetic Valve Endocarditis；以下PVE）を疑われ，当院へ紹介となった．入院翌日に胸部不快感を自覚し，緊急心臓カテーテル検査を施行したところ，左冠動脈主幹部に血栓によると思われる病変が認められ，血栓吸引を行った．しかし，血流の改善が得られず，冠動脈バイパス術を施行されていない回旋枝の血流改善目的に経皮的古典的バルーン血管形成を追加し，血流の改善が認められた．この際に吸引した血栓を培養に提出したところ，入院時に提出した血液培養と同様のStreptococcus pasteurianusが検出された．経食道心臓超音波検査で左冠尖に相当する弁尖に感染性疣腫を疑う所見を指摘された．以上よりPVEおよび疣贅に伴う冠動脈閉塞再発予防を目的とし，再大動脈弁置換術（Crown PRT 23 mm Sorin Group，Burnaby，Canada）を施行した．術後29日目に抗菌薬による加療継続目的に近医へ転院となった．
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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 | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.010 | 0.005 |
| 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".