Where should ascitic drains be placed? Revisiting anatomical landmarks for paracentesis
Bibliographic record
Abstract
We welcome the recent publication of the BSG/BASL guidelines on the management of ascites in cirrhosis which will serve as a framework for patient management across the world.1 Following clinician feedback on Twitter,2 we wish to respectfully highlight concerns regarding their guidance on landmarks for therapeutic paracentesis. Our first concern relates to the description of the landmarks. The authors recommend this to be ‘at least 8 cm (laterally) from the midline and 5 cm above the symphysis (pubis)’.1 This was predicated on three studies (two laparoscopic; one cadaveric) on the anatomical course of the inferior epigastric artery.3–5 While this approach avoids puncturing the vessel, there remains a risk of injury to underlying solid organs which can result in haemorrhage or perforation. Of note, these studies may not be generalisable to patients with distortion of …
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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 | 0.002 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.003 | 0.006 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.014 | 0.025 |
| Insufficient payload (model declined to judge) | 0.004 | 0.004 |
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".