Endoscopic aspergilloma management for non-surgical patients
Bibliographic record
Abstract
Background: Pulmonary aspergilloma is a chronic fungal infection and, without therapy, is often fatal. Death can occur from massive hemoptysis, cachexia, or secondary infection. Standard therapy is surgical resection, but unfortunately, many patients are not candidates due to poor lung function and comorbidities. Objectives:Aspergilloma removal via bronchoscopy may be an important, less invasive, and viable alternative therapy to the gold standard of surgical resection. Important considerations include patient selection, the use of antifungal treatment peri-procedure, optimization of procedure time, and the minimization of the risk of bleeding. We assessed whether this multi-modal approach to therapy may lead to overall benefits and reduced risk of recurrence. Methods: We describe a single-centre case series of 15 patients deemed non-surgical candidates selected for endoscopic procedure. All patients received a minimum of 3 months of appropriate antifungal therapy with no improvement in the size of the aspergilloma by radiographic measurements. The procedure was performed by an interventional pulmonologist. Blunt instruments were used to remove the fungus ball. Antifungal treatment was given for 1 to 3 months afterwards. Results: Across all patients (n=15), subjective symptomatic improvements occurred with no complications observed, including death or bleeding. Follow up time ranged from 6 months to 10 years. Only one patient severely immunocompromised post lung transplant had recurrence of the disease at 3 years. Conclusion: While further study is required to determine the optimal protocol, our proposed multi-modal approach to aspergilloma removal was viable, safe and effective.
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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 | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".