Bibliographic record
Abstract
Elkargy et al.1 from Egypt evaluated lubiprostone in a randomized controlled trial (RCT) and found that it improved constipation in 91% children. This is in stark contrast to the previous multicentre (United States, Canada, Europe) RCT by Beninga et al.2 in which only 18.5% children responded. The authors hypothesized that milder disease of a shorter duration and absence of faecal impaction could have translated to better outcomes. But are they enough to explain why their patients did so resoundingly well—especially as 62% of these had failed a previous laxative? The dosing of lubiprostone is conventionally BD and in this study authors used TDS dosing for those <50 kg with almost 80% patients receiving TDS dosing. Peak plasma levels of the active metabolite of lubiprostone called M3 occurs 1 h after administration, and the t½ is approximately 3 h.3 With such a rapid washout, possibly TDS dosing lead to a more sustained effect and better outcome. The authors have not reported separate results for those who received TDS versus BD dosing and it would be interesting to see what it showed. Secondly, for unexplained reasons it has been observed that a dose of 24 mcg/day (as compared to a higher dose) is associated with more sustained response.4 In this study by Elkargy a much higher proportion (80% vs. 60%) received 24 mcg as compared to the previous one by Benninga. Also apart from its effect on chloride channel-2, lubiprostone improves intestinal permeability.5 Patients with constipation have increased intestinal permeability and dybiosis.6, 7 This phenomena is likely exaggerated in residents of tropical countries.8 Could the effect of lubiprostone on gut permeability and the microbiome be the main driver of sustained constipation resolution in this population? The author declares no conflict of interest. None The study was approved by the hospital's research ethics board.
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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 | 0.074 | 0.180 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.003 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.006 |
| Scholarly communication | 0.003 | 0.009 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.009 | 0.012 |
| Insufficient payload (model declined to judge) | 0.008 | 0.003 |
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".