Bibliographic record
Abstract
A previously well 52-year-old gentleman presented with a 2-week history of itch, jaundice, lethargy, pale stools and dark urine. He had no risk factors for liver disease. On systematic questioning, the only new addition to his diet was an acai berry supplement drink to promote weight loss. Blood tests revealed markedly raised bilirubin and ALP, and slightly raised AST and ALT. Ferritin was also raised but was felt to represent an acute phase reactant. The remaining liver screen was unremarkable. Imaging showed a 12 mm hemangioma in segment VII of the liver but was otherwise normal, with no ductal dilatation noted. ERCP revealed normal ducts. Liver biopsy was performed and this revealed hepatocellular and canalicular cholestasis with minimal parenchymal inflammation. Portal tracts were inflamed with lymphocytes. Findings were felt to be consistent with ductal obstruction or drug reaction. Overall findings were felt to be in keeping with a drug reaction secondary to the acai berry supplement. He had been commenced on prednisolone, ursodeoxycholic acid, cholestyramine, lansoprazole and chlorphenamine in a district general hospital prior to transfer to the Liver Unit. On arrival, naltrexone was added to the regimen. His bilirubin peaked at 284 µmol/L but soon decreased, and returned to normal levels within 2 months. High levels of D-aspartate are found in these berries, and this amino acid is involved in a pituitary pathway involved in stimulation of testosterone production. Alongside anabolic steroids, androgenic steroids have also been shown to be involved in development of cholestatic jaundice. Beta-sitosterol is also found in the berries and is a precursor of boldenone which is an anabolic steroid. These steroid pathways are among the hypotheses for development of cholestatic jaundice in this gentleman. J Med Cases. 2014;5(6):373-375 doi: https://doi.org/10.14740/jmc1794w
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".