Bibliographic record
Abstract
A 76-year-old Asian male with HBeAg-negative chronic hepatitis B infection, not on antiviral therapy, was referred to the hepatology clinic for investigation of recurrent liver lesions. His past medical history was notable for hypertension, polycystic kidney disease, chronic kidney disease, treated prostate adenocarcinoma and recently exenterated malignant melanoma of the right eyelid. The latter was followed by negative clinical and radiological surveillance confirming the absence of metastases. There was no personal or family history of colorectal or hepatocellular carcinoma. He also reported no gastrointestinal symptoms, including RUQ abdominal pain, weight loss, gastrointestinal bleeding episodes and symptoms of decompensated liver disease. Blood work at the time of presentation shown a normocytic anemia but normal liver enzyme level and function. Hepatitis B serology is reported in Table 1. Hepatitis B serology results *Hepatitis B Surface Antigen. †Hepatitis B Surface Antibody. ‡Hepatitis B e Antigen. §Hepatitis B e Antibody. ‖Hepatitis B virus DNA. Hepatitis B serology results *Hepatitis B Surface Antigen. †Hepatitis B Surface Antibody. ‡Hepatitis B e Antigen. §Hepatitis B e Antibody. ‖Hepatitis B virus DNA. Computed tomography of the abdomen was concerning for new liver lesions but radiographic characteristics were not diagnostic for hepatocellular carcinoma. In view of patient’s age and the possibility of a gastrointestinal primary tumour, endoscopic examination was warranted in order to exclude primary colorectal malignancy (Figure 1A). (A) Cross-sectional image of the liver with demonstrated hepatic lesion suggestive of malignancy. (B) Raised pigmented nodule noted in the large bowel. (C) Flat, freckle-like nodule at the right colon. (D) Multiple ulcerated pigmented lesion in the stomach body. (E) Large ulcer with pigmented base at the duodenum. (F) Histological sample demonstrating infiltration of pigment secreting neoplastic cells. Colonoscopy demonstrated multiple nodular and flat lesions with central pigmentation in the ascending colon and throughout the transverse colon (Figure 1B and C). Similarly, upper gastrointestinal endoscopy revealed numerous pigmented gastric and duodenal nodular lesions (Figure 1D and E). Microscopically, the lamina propria of the stomach, duodenum and colon (Figure 1F) were in infiltrated by neoplastic atypical cells containing cytoplasmic pigment which spared the glands. Immunohistochemistry for S100 highlighted the neoplastic cells, consistent with metastatic melanoma. Following endoscopy, the patient was started on tenofovir disoproxil fumarate 300 mg daily to suppress chronic HBV infection. He was promptly referred to the Melanoma Clinic and is scheduled to start double immunotherapy (checkpoint inhibition) for metastatic melanoma.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".