Improving the outcomes of patients with Hirschsprung Disease through greater understanding of the histopathology
Bibliographic record
Abstract
Hirschsprung Disease (HD) is a congenital disorder marked by absent neural innervation in the distal intestine, leading to obstructive symptoms. Diagnosis involves rectal suction biopsy (RSB), followed by surgery at about three months of age. Transition zone pull-through (TZPT) arises from incomplete surgery, possibly causing complications. Chapter 1 introduces HD's etiology, pathology, diagnosis, and treatment. Chapter 2 compares healthy and HD bowels, identifying HD's histopathophysiology. The results highlight the need for circumferential bowel examination to detect TZPT. Predicting diseased bowel length based on patient traits proves challenging. Chapter 3 explores RSB complications and HD risk factors. RSB is generally safe (0.8% minor complications). Predictors of HD include male gender, syndromes, delayed meconium passage, abdominal distension, bilious vomiting, and failure to thrive. Chapter 4 evaluates calretinin vs. acetylcholinesterase staining for RSB, favoring calretinin. Chapter 5 delves into complications during the wait for surgery, affecting 17% of patients. Risk exists for patients with total aganglionic colon (TCA), suggesting the need to limit waiting time. Chapter 6 assesses resection level determination. Current methods (contrast enema, intraoperative judgment, and full-thickness biopsy) suffice for patients with short segment disease. For patients with longer segment disease, intraoperative pathological examination is advised. Chapter 7 examines surgical complications, affecting 21% of patients. Postoperative rectal irrigation is a potential cause of anastomotic leakage, warranting transanastomotic drainage tube use. Chapter 8 studies long-term outcomes after successful primary surgery vs. TZPT with redo surgery or conservative treatment, showing comparable results. Thus, standard surgical treatment isn't required in TZPT cases.
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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) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".