676 Canadian Family Physician • Le Médecin de famille canadien | Vol 57: JUNE • JUIN 2011 Tools for Practice Clinical question
Bibliographic record
Abstract
In patients with multiple sclerosis (MS), is angio-plasty of obstructed extracranial venous lesions safe and does it improve MS symptoms? Evidence In a cohort study, 65 MS patients with chronic cerebrospi-nal venous insufficiency (CCSVI) underwent angioplasty for obstructed azygous or internal jugular venous lesions.1 • Participants: mean age 41 years, 46 % male, minimal to moderate disability (not in wheelchair), taking MS disease-modifying agents. • Vascular outcomes: no serious operative or immediate postoperative complications.-Restenosis at 1 year was about 50 % for internal jugular. • Neurologic outcomes at 18 months, compared with baseline (no control or placebo group):-No benefit in primary or secondary progressive subtypes.-Significant improvements in relapsing-remitting MS subtype: fewer patients relapsing during 1-year period (50 % vs 73%, P =.0014); fewer patients with lesions seen on magnetic resonance imaging (12 % vs 50%, P <.0001); and improved MS functional composite and quality-of-life scores. • All relapsing-remitting patients with patency after their procedures were relapse free. • Concerns: single study site, not randomized, no con-trol group, and unblinded.-Remission is a hallmark of relapsing-remitting MS: untreated patients can have reductions (even pro-longed) in clinical symptoms2,3 or lesions.4 A control group and long-term follow-up are essential.
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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 | 0.005 | 0.032 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.008 | 0.004 |
| Insufficient payload (model declined to judge) | 0.120 | 0.014 |
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".