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Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 1097-1108页

作者： Hassam Ali Faisal Inayat Vishali Moond Ahtshamullah Chaudhry Arslan afzal Zauraiz Anjum Hamza Tahir muhammad Sajeel Anwar Dushyant Singh Dahiya muhammad Sohaib afzal Gul Nawaz Amir H Sohail muhammad Aziz Department of Gastroenterology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Department of Internal Medicine Saint Peter's University Hospital and Robert Wood Johnson Medical SchoolNew BrunswickNJ 08901United States Department of Internal Medicine St.Dominic's HospitalJacksonMS 39216United States Department of Internal Medicine Rochester General HospitalRochesterNY 14621United States Department of Internal Medicine Jefferson Einstein HospitalPhiladelphiaPA 19141United States Department of Internal Medicine UHS Wilson Medical CenterJohnsonNY 13790United States Division of Gastroenterology Hepatology and MotilityThe University of Kansas School of MedicineKansasKS 66160United States Department of Internal Medicine Louisiana State University HealthShreveportLA 71103United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Department of Gastroenterology and Hepatology The University of ToledoToledoOH 43606United States

BACKGROUND Roux-en-Y gastric bypass(RYGB)is a widely recognized bariatric procedure that is particularly beneficial for patients with class III obesity.It aids in significant weight loss and improves obesity-related medical conditions.Despite its effectiveness,postoperative care still has challenges.Clinical evidence shows that venous thromboembolism(VTE)is a leading cause of 30-d morbidity and mortality after RYGB.Therefore,a clear unmet need exists for a tailored risk assessment tool for VTE in RYGB candidates.AIM To develop and internally validate a scoring system determining the individualized risk of 30-d VTE in patients undergoing RYGB.METHODS Using the 2016–2021 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program,data from 6526 patients(body mass index≥40 kg/m^(2))who underwent RYGB were analyzed.A backward elimination multivariate analysis identified predictors of VTE characterized by pulmonary embolism and/or deep venous thrombosis within 30 d of RYGB.The resultant risk scores were derived from the coefficients of statistically significant variables.The performance of the model was evaluated using receiver operating curves through 5-fold cross-validation.RESULTS Of the 26 initial variables,six predictors were identified.These included a history of chronic obstructive pulmonary disease with a regression coefficient(Coef)of 2.54(P7%(Coef 1.19,P<0.001),venous stasis history(Coef 1.43,P<0.001),and preoperative anticoagulation use(Coef 1.24,P<0.001).These variables were weighted according to their regression coefficients in an algorithm that was generated for the model predicting 30-d VTE risk post-RYGB.The risk model's area under the curve(AUC)was 0.79[95%confidence interval(CI):0.63-0.81],showing good discriminatory power,achieving a sensitivity of 0.60 and a specificity of 0.91.Without training,the same model performed satisfactorily in patients with laparoscopic sleeve gastrectomy

关键词： Roux-en-Y gastric bypass Venous thromboembolism Machine learning Bariatric surgery Predictive modeling

Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis:A propensity-matched analysis

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World Journal of Experimental Medicine 2024年第2期14卷 75-88页

作者： Hassam Ali Faisal Inayat Waqas Rasheed Arslan afzal Ahtshamullah Chaudhry Pratik Patel Attiq Ur Rehman muhammad Sajeel Anwar Gul Nawaz muhammad Sohaib afzal Amir H Sohail Subanandhini Subramanium Dushyant Singh Dahiya Deepa Budh Babu P Mohan Douglas G Adler Department of Gastroenterology and Hepatology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Department of Internal Medicine Texas Tech University Health Sciences CenterLubbockTX 79430United States Department of Internal Medicine St.Dominic’s HospitalJacksonMS 39216United States Department of Gastroenterology Mather Hospital and Hofstra University Zucker School of MedicinePort JeffersonNY 11777United States Department of Hepatology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States Department of Internal Medicine UHS Wilson Medical CenterJohnson CityNY 13790United States Department of Internal Medicine Louisiana State University HealthShreveportLA 71103United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Division of Gastroenterology Hepatologyand MotilityThe University of Kansas School of MedicineKansas CityKS 64108United States Department of Internal Medicine St.Barnabas Hospital and Albert Einstein College of MedicineBronxNY 10457United States Department of Gastroenterology and Hepatology University of Utah School of MedicineSalt Lake CityUT 84132United States Center for Advanced Therapeutic Endoscopy Porter Adventist HospitalCentura HealthDenverCO 80210United States

BACKGROUND Patients with acute pancreatitis(AP)frequently experience hospital readmissions,posing a significant burden to healthcare systems.Acute peripancreatic fluid collection(APFC)may negatively impact the clinical course of AP.It could worsen symptoms and potentially lead to additional complications.However,clinical evidence regarding the specific association between APFC and early readmission in AP remains scarce.Understanding the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare costs.AIM To evaluate the association between APFC and 30-day readmission in patients with AP.METHODS This retrospective cohort study is based on the Nationwide Readmission Database for 2016-2019.Patients with a primary diagnosis of AP were identified.Participants were categorized into those with and without APFC.A 1:1 propensity score matching for age,gender,and Elixhauser comorbidities was performed.The primary outcome was early readmission rates.Secondary outcomes included the incidence of inpatient complications and healthcare utilization.Unadjusted analyses used Mann-Whitney U andχ2 tests,while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios(aHR).Kaplan-Meier curves and log-rank tests verified readmission risks.RESULTS A total of 673059 patients with the principal diagnosis of AP were included.Of these,5.1%had APFC on initial admission.After propensity score matching,each cohort consisted of 33914 patients.Those with APFC showed a higher incidence of inpatient complications,including septic shock(3.1%vs 1.3%,P<0.001),portal venous thrombosis(4.4%vs 0.8%,P<0.001),and mechanical ventilation(1.8%vs 0.9%,P<0.001).The length of stay(LOS)was longer for APFC patients[4(3-7)vs 3(2-5)days,P<0.001],as were hospital charges($29451 vs$24418,P<0.001).For 30-day readmissions,APFC patients had a higher rate(15.7%vs 6.5%,P<0.001)and a longer median readmission LOS(4 vs 3 days,P<0.001).The APFC group also had higher readmission charges($282

关键词： Acute pancreatitis Acute peripancreatic fluid collections Readmission predictors Inpatient complications Healthcare utilization and costs

Impact of COVID-19 on liver transplant recipients: A nationwide cohort study evaluating hospitalization, transplant rejection, and inpatient mortality

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World Journal of Transplantation 2024年第2期14卷 62-75页

作者： Faisal Inayat Pratik Patel Hassam Ali Arslan afzal Hamza Tahir Ahtshamullah Chaudhry Rizwan Ishtiaq Attiq Ur Rehman Kishan Darji muhammad Sohaib afzal Gul Nawaz Alexa Giammarino Sanjaya K Satapathy Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Division of Gastroenterology Mather Hospital and Zucker School of Medicine at Hofstra UniversityPort JeffersonNY 11777United States Division of Gastroenterology and Hepatology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Jefferson Einstein HospitalPhiladelphiaPA 19141United States Department of Internal Medicine St.Dominic's HospitalJacksonMS 39216United States Department of Internal Medicine Saint Francis Hospital and Medical CenterHartfordCT 06105United States Division of Hepatology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States Department of Internal Medicine Campbell University and Cape Fear Valley Medical CenterFayettevilleNC 28301United States Department of Internal Medicine North Shore University Hospital and Zucker School of Medicine at Hofstra UniversityManhassetNY 11030United States Division of Hepatology North Shore University Hospital and Zucker School of Medicine at Hofstra UniversityManhassetNY 11030United States

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has posed a major public health concern worldwide.Patients with comorbid conditions are at risk of adverse outcomes following COVID-19.Solid organ transplant recipients with concurrent immunosuppression and comorbidities are more susceptible to a severe COVID-19 infection.It could lead to higher rates of inpatient complications and mortality in this patient population.However,studies on COVID-19 outcomes in liver transplant(LT)recipients have yielded inconsistent findings.AIM To evaluate the impact of the COVID-19 pandemic on hospital-related outcomes among LT recipients in the United States.METHODS We conducted a retrospective cohort study using the 2019–2020 National Inpatient Sample database.Patients with primary LT hospitalizations and a secondary COVID-19 diagnosis were identified using the International Classi-fication of Diseases,Tenth Revision coding system.The primary outcomes included trends in LT hospitalizations before and during the COVID-19 pandemic.Secondary outcomes included comparative trends in inpatient mortality and transplant rejection in LT recipients.RESULTS A total of 15720 hospitalized LT recipients were included.Approximately 0.8%of patients had a secondary diagnosis of COVID-19 infection.In both cohorts,the median admission age was 57 years.The linear trends for LT hospitalizations did not differ significantly before and during the pandemic(P=0.84).The frequency of in-hospital mortality for LT recipients increased from 1.7%to 4.4%between January 2019 and December 2020.Compared to the pre-pandemic period,a higher association was noted between LT recipients and in-hospital mortality during the pandemic,with an odds ratio(OR)of 1.69[95%confidence interval(CI):1.55-1.84),P<0.001].The frequency of transplant rejections among hospitalized LT recipients increased from 0.2%to 3.6%between January 2019 and December 2020.LT hospitalizations during the COVID-19 pandemic had a higher association with transplant rejection than before the pande

关键词： Liver transplant recipients Solid organ transplantation COVID-19 Hospitalization Transplant rejection Mortality

Thoracic impalement injury: A survivor with large metallic object in-situ

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Chinese Journal of Traumatology 2018年第6期21卷 369-372页

作者： randhawa muhammad afzal muhammad Armughan muhammad Waqas Javed Usman Ali Rizvi Sajida Naseem Department of Surgery. Bahawal Victoria Hospital Q_uaid-E-Azam Medical College Bahawalpur Pakistan

Impalement injuries, is a severe form of trauma, which are not common in civilian life. These injuries rarely occurs in major accidents. Abdomen, chest, limbs and perineum are often involved due to their large surface area. Thoracic impalement injury is usually a fatal injury, due to location of major vessels and heart in the thoracic cavity. These injuries are horrifying to site, but the patients who are lucky enough to make it to hospital, usually survive. Chances of survival are larger in right sided impalement injuries while central injuries are always died at the scene.Our patient, 25 years old male, was brought to the emergency room (ER) with large impaled metallic bar (about 2.5 feet long) in situ, in right sided chest. The patient was immediately shifted to operation room (OR) and was operated, his recovery was uneventful without any sequelae.Such patients should be treated and resuscitated according to advanced trauma life support (ATLS) protocols and operated without any delay for further investigations. Such operations are carried out by the most experienced surgeon team available. The impaled objects should not be processed if not necessary to avoid major hemorrhage and damage to vital structures, until the patient is in operation room. Large size and unusual position of impaled objects, makes the job difficult for surgeons/anesthetists.Although horrifying at scene, patients with thoracic impalement injuries are mostly young and healthy, and those who survive the pre-hospital phase are potentially manageable with proper resuscitation. Usually these patients make recovery without any further complications.

关键词： Impalement Injury Thoracic Metallic object Traffic accident Sequela

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Multifaceted roles of extracellular RNAs in different diseases

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Military Medical Research 2023年第3期10卷 359-368页

作者： Abdullah muhammad Sohail muhammad Babar Khawar Ali afzal Ali Hassan Sara Shahzaman Ahmed Ali Molecular Medicine and Cancer Therapeutics Lab Department of ZoologyFaculty of SciencesUniversity of Central PunjabLahorePakistan Applied Molecular Biology and Biomedicine Lab Department of ZoologyUniversity of NarowalNarowalPakistan

Extracellular RNAs(exRNAs) are novel circulating factors that can be used as biomarkers in various diseases. Their unique and diverse kinds, as well as their role as biomarkers, make them significant biomarkers. There has been immense work carried out since the discovery of exRNAs in circulation and other biological fluids to catalog and determine whether exRNAs may be utilized as indicators for health and illness. In this review, we aim to understand the current state of exRNAs in relation to various diseases and their potential as biomarkers. We will also review current issues and challenges faced in using exRNAs, with clinical and lab trials, that can be used as viable markers for different diseases.

关键词： Extracellular RNAs(exRNAs) Extracellular vehicles(EVs) Cancer Biomarkers Exosomes

维普期刊数据库

Mini-organs with big impact:Organoids in liver cancer studies

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Oncology Research 2023年第5期31卷 677-688页

作者： muhammad BABAR KHAWAR YAJUN WANG ANEEQA MAJEED ALI afzal KABEER HANEEF HAIBO SUN Institute of Translational Medicine Medical CollegeYangzhou UniversityYangzhouChina Jiangsu Key Laboratory of Experimental and Translational Non-Coding RNA Research YangzhouChina Applied Molecular Biology and Biomedicine Lab Department of ZoologyUniversity of NarowalNarowalPakistan Department of Oncology Haian Hospital of Traditional Chinese MedicineHaianChina Molecular Medicine and Cancer Therapeutics Lab Department of ZoologyFaculty of Sciences TechnologyUniversity of Central PunjabLahorePakistan Chinese Institute for Brain Research(CIBR) BeijingChina

Hepatocellular carcinoma,the most common primary liver cancer and a leading cause of death,is a difficult disease to treat due to its heterogeneous nature.Traditional models,such as 2D culture and patient-derived xenografts,have not proven effective.However,the development of 3D culture techniques,such as organoids,which can mimic the tumor microenvironment(TME)and preserve heterogeneity and pathophysiological properties of tumor cells,offers new opportunities for treatment and research.Organoids also have the potential for biomarker detection and personalized medication,as well as genome editing using CRISPR/Cas9 to study the behavior of certain genes and therapeutic interventions.This review explores to-the-date development of organoids with a focus on TME modeling in 3D organoid cultures.Further,it discusses gene editing using CRISPR/Cas9 in organoids,the challenges faced,and the prospects in the field of organoids.

关键词： Heterogeneity Tumor Organoid Liver Treatment Therapy

Effects of hooked-collar on the local scour around a lenticular bridge pier

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International Journal of Sediment Research 2023年第1期38卷 1-11页

作者： Rashid Farooq Amir Hossein Azimi muhammad Atiq Ur Rehman Tariq afzal Ahmed Department of Civil Engineering International Islamic University Department of Civil Engineering Lakehead University College of Engineering and Science Victoria University Department of Civil Engineering University of Engineering and Technology James Watt School of Engineering University of Glasgow

This paper presents the results of comprehensive laboratory experiments to investigate the effects of hooked-collar on the scour development around a vertical pier with a lenticular cross section. The flow around the pier was uniform, steady, and under the clear-water condition. The axial scour profiles for cases without and with a lenticular hooked-collar were measured and the effects of hooked-collar dimensions and elevation from the bed were examined. To compute the efficiency of hooked-collar for scour prevention, the results of local scour for a bridge pier without a collar and a bridge pier with a plain collar, without a hooked wall, were used as benchmark data sets. A wide range of hooked-collar geometries such as the ratio of collar width to the pier width, Wc/Wp, ranging from 1.5 to 3.5, the ratio of hooked-collar wall height to the pier width, Hc/Wp, ranging from 0.15 to 0.6, and the ratio of collar elevation to the pier width, Ec/Wp, of-0.5, 0, and 0.5 were tested. The experimental results indicated that the equilibrium scour depth decreased with the ratio of hooked-collar to the pier width when Wcis twice the pier width, Wp. For Wc/Wp> 2, the scour depth was similar to the tests with an infinitely large pier width. In addition, the scour depth consistently reduced as the hooked-collar wall height, Hc, to the pier width, Wp, approached 0.3. The highest scour reduction efficiency was achieved when the hooked-collar being placed on the bed surface. Empirical models were developed for prediction of maximum scour depth near the lenticular bridge pier with a modified collar. The results showed that the volume of scour hole around a lenticular pier increased non-linearly with the maximum scour depth and it was independent of the hooked-collar geometry.

关键词： Local scour Erosion Collar Hooked-collar Lenticular pier Scour countermeasure Steady flow

Binary Oriented Feature Selection for Valid Product Derivation in Software Product Line

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Computers, Materials & Continua 2023年第9期76卷 3653-3670页

作者： muhammad Fezan afzal Imran Khan Javed Rashid Mubbashar Saddique Heba G.Mohamed Department of CS&SE International Islamic UniversityIslamabad44000Pakistan Information Technology Services University of OkaraOkara56300Pakistan Departmet of Computer Science MLC LabOkara56300Pakistan Department of Computer Science&Engineering University of Engineering&Technology LahoreNarowal CampusNarowal51601Pakistan Department of Electrical Engineering College of EngineeringPrincess Nourah bint Abdulrahman UniversityP.O.Box 84428Riyadh11671Saudi Arabia

Software Product Line(SPL)is a group of software-intensive systems that share common and variable resources for developing a particular system.The feature model is a tree-type structure used to manage SPL’s common and variable features with their different relations and problem of Crosstree Constraints(CTC).CTC problems exist in groups of common and variable features among the sub-tree of feature models more diverse in Internet of Things(IoT)devices because different Internet devices and protocols are communicated.Therefore,managing the CTC problem to achieve valid product configuration in IoT-based SPL is more complex,time-consuming,and hard.However,the CTC problem needs to be considered in previously proposed approaches such as Commonality VariabilityModeling of Features(COVAMOF)andGenarch+tool;therefore,invalid products are generated.This research has proposed a novel approach Binary Oriented Feature Selection Crosstree Constraints(BOFS-CTC),to find all possible valid products by selecting the features according to cardinality constraints and cross-tree constraint problems in the featuremodel of SPL.BOFS-CTC removes the invalid products at the early stage of feature selection for the product configuration.Furthermore,this research developed the BOFS-CTC algorithm and applied it to,IoT-based feature models.The findings of this research are that no relationship constraints and CTC violations occur and drive the valid feature product configurations for the application development by removing the invalid product configurations.The accuracy of BOFS-CTC is measured by the integration sampling technique,where different valid product configurations are compared with the product configurations derived by BOFS-CTC and found 100%correct.Using BOFS-CTC eliminates the testing cost and development effort of invalid SPL products.

关键词： Software product line feature model internet of things crosstree constraints variability management

Noisy ECG Signal Data Transformation to Augment Classification Accuracy

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Computers, Materials & Continua 2022年第5期71卷 2191-2207页

作者： Iqra afzal Fiaz Majeed muhammad Usman Ali Shahzada Khurram Akber Abid Gardezi Shafiq Ahmad Saad Aladyan Almetwally M.Mostafa muhammad Shafiq Department of Information Technology University of GujratGujrat50700Pakistan Department of Computer Science University of GujratGujrat50700Pakistan Faculty of Computing The Islamia University of BahawalpurBahawalpur63100Pakistan Department of Computer Science COMSATS University IslamabadIslamabadPakistan Industrial Engineering Department College of EngineeringKing Saud UniversityP.O.Box 800Riyadh 11421Saudi Arabia Department of Information Systems College of Computer and Information SciencesKing Saud UniversityP.O.Box 800Riyadh11421Saudi Arabia Department of Information and Communication Engineering Yeungnam UniversityGyeongsan38541Korea

In this era of electronic health,healthcare data is very important because it contains information about human survival.In addition,the Internet of Things(IoT)revolution has redefined modern healthcare systems and management by providing continuous monitoring.In this case,the data related to the heart is more important and requires proper analysis.For the analysis of heart data,Electrocardiogram(ECG)is used.In this work,machine learning techniques,such as adaptive boosting(AdaBoost)is used for detecting normal sinus rhythm,atrial fibrillation(AF),and noise in ECG signals to improve the classification accuracy.The proposed model uses ECG signals as input and provides results in the form of the presence or absence of disease AF,and classifies other signals as normal,other,or noise.This article derives different features from the signal using Maximal Information Coefficient(MIC)and minimum Redundancy Maximum Relevance(mRMR)technique,and then classifies them based on their attributes.Since the ECG contains some kind of noise and irregular data streams so the purpose of this study is to remove artifacts from the ECG signal by deploying the method of Second-Order-Section(SOS)(filter)and correctly classify them.Several features were extracted to improve the detection of ECG data.Compared with existing methods,this work gives promising results and can help improve the classification accuracy of the ECG signals.

关键词： ECG atrial fibrillation adaptive boosting heart rate variability