Leading Article Current views on aetiology and management of haemolytic uraemic syndrome
Bibliographic record
Abstract
The haemolytic uraemic syndromes (HUS) are a heterogeneous group of disorders characterized by haemolytic anaemia, thrombocytopaenia and renal failure occurring predominantly in infants and young children. The disorder, which is acknow-ledged as the commonest cause of acute renal failure in children in Britain, is increasingly recog-nized in adults.23 Two broad subtypes are now recognized: the first is common in children and is associated with a diarrhoeal prodrome (D +), whereas the second is rare in childhood and not associated with antecedent diarrhoea (D-).4 D + HUS is synonymous with typical, prototypic, epidemic or enteropathic HUS and D- with atypical or sporadic disease. Many causes of D + HUS, mainly infectious agents,5`8 have been proposed but a strong associa-tion has now been found between D + HUS and enteric infection with verocytotoxin-producing Escherichia coli (VTEC).9'0 These organisms are associated with clinical conditions ranging from mild diarrhoea to haemorrhagic colitis and HUS.8"l ' VTEC strains of several serotypes have been isolated from patients with HUS, but the majority of such isolates belong to the serotype 01 57: H7. 2 VTEC produce 2 types ofverocytotoxin (VT1 and VT2),'3 which resemble Shiga toxin in structure and mode of action; linking D + cases to the HUS which may complicate Shigella dysen-teriae infections.'4 The toxins consist of a biologically active subunit A, linked to B subunits,'5"16 which bind to a specific cell surface glycoprotein GB3.'7 Once attached to the cell surface subunit A enters the cell and inhibits protein synthesis by inactivating 60s ribosomal subunits, which leads to cell death.'8 Karmali et al. found evidence ofVTEC infection in an estimated 75 % of Canadian children with D + HUS using a combination of laboratory methods, involving recovery of VTEC or neut-ralizable free verocytotoxin in faeces, and a rise in antibody titre to verocytotoxin.'0 A collaborative study by the British Association for Paediatric Nephrology, the Communicable Disease Surveil-lance Centre, and the Division of Enteric
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.085 | 0.024 |
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".