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Artificial intelligence and liver transplantation:Looking for the best donor-recipient pairing

Hepatobiliary & Pancreatic Diseases International 2022年第4期21卷 347-353页

作者： javier Briceno Rafael Calleja César Hervás Unit of Liver Transplantation Department of General SurgeryHospital Universitario Reina SofíaCórdobaSpain Maimónides Institute of Biomedical Research of Córdoba(IMIBIC) CórdobaSpain Department of Computer Sciences and Numerical Analysis Universidad de CórdobaCórdobaSpain

Decision-making based on artificial intelligence(AI)methodology is increasingly present in all areas of modern medicine.In recent years,models based on deep-learning have begun to be used in organ transplantation.Taking into account the huge number of factors and variables involved in donor-recipient(DR)matching,AI models may be well suited to improve organ allocation.AI-based models should provide two solutions:complement decision-making with current metrics based on logistic regression and improve their predictability.Hundreds of classifiers could be used to address this problem.However,not all of them are really useful for D-R pairing.Basically,in the decision to assign a given donor to a candidate in waiting list,a multitude of variables are handled,including donor,recipient,logistic and perioperative variables.Of these last two,some of them can be inferred indirectly from the team’s previous experience.Two groups of AI models have been used in the D-R matching:artificial neural networks(ANN)and random forest(RF).The former mimics the functional architecture of neurons,with input layers and output layers.The algorithms can be uni-or multi-objective.In general,ANNs can be used with large databases,where their generalizability is improved.However,they are models that are very sensitive to the quality of the databases and,in essence,they are black-box models in which all variables are important.Unfortunately,these models do not allow to know safely the weight of each variable.On the other hand,RF builds decision trees and works well with small cohorts.In addition,they can select top variables as with logistic regression.However,they are not useful with large databases,due to the extreme number of decision trees that they would generate,making them impractical.Both ANN and RF allow a successful donor allocation in over 80%of D-R pairing,a number much higher than that obtained with the best statistical metrics such as model for end-stage liver disease,balance of risk score,and survival outcomes following liver tra

关键词： Donor-recipient matching Artificial intelligence Deep learning Artificial neural networks Random forest Liver transplantation outcome

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Spontaneous liver rupture as first sign of polyarteritis nodosa

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World Journal of Hepatology 2016年第32期8卷 1414-1418页

作者： Irene Gómez-Luque Felipe Alconchel Rubén Ciria M Dolores Ayllón Antonio Luque Marina Sánchez Pedro López-Cillero javier Briceno General Surgery Reina Sofía University Hospital Department of Surgery Faculty of Medicine and NursingUniversity of Córdoba Unit of Hepatobiliary Surgery and Liver Transplant Reina Sofía University Hospital Department of Pathology Reina Sofía University Hospital

Polyarteritis nodosa(PAN) is one of the systemic vasculitis that affects the media wall of arteries of small and medium diameter. Diagnosis proves difficult due to the unspecific symptoms that dominate the clinical profile. Liver involvement is very diverse, ranging from the development of cirrhotic liver disease to acute abdomen presentation that requires surgery because of liver rupture. The management of these patients requires an expert multidisciplinary team. There are several cases in the literature that describe a sudden liver rupture as the first manifestation of a PAN. In this paper we present the case of a 75 years old patient without any previous disease, who is subjected to major hepatic resection for spontaneous liver rupture.

关键词： Polyarteritis nodosa Spontaneous liver rupture Liver surgery Vasculitis Rheumatology

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Gastrointestinal stromal tumors:a multidisciplinary challenge

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World Journal of Gastroenterology 2018年第18期24卷 1925-1941页

作者： Juan Manuel Sanchez-Hidalgo Manuel Duran-Martinez Rafael Molero-Payan Sebastian Rufian-Pena Alvaro Arjona-Sanchez Angela Casado-Adam Antonio Cosano-Alvarez javier Briceno-Delgado Department of General and Digestive Surgery Reina Sofia University HospitalAvda.Menéndez Pidal s/nCordoba 14004Spain Department of Intern Medicine Reina Sofia University HospitalAvda.Menéndez Pidal s/nCordoba 14004Spain Lipids and Atherosclerosis Research Unit IMIBIC/Hospital Universitario Reina Sofía/Universidad de CórdobaCordoba 14004Spain

Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs(> 95%) are positive for the KIT protein(CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis(the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvantImatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.

关键词： Gastrointestinal stromal tumors Surgery Oncology Radiology Endoscopy Nuclear medicine Pathology Disease management Tyrosine kinase inhibitors Gastroenterology

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Colorectal peritoneal metastases:Optimal management review

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World Journal of Gastroenterology 2019年第27期25卷 3484-3502页

作者： Juan Manuel Sánchez-Hidalgo Lidia Rodríguez-Ortiz Alvaro Arjona-Sánchez Sebastián Rufián-Pena Angela Casado-Adam Antonio Cosano-Alvarez javier Briceno-Delgado Department of General and Digestive Surgery Reina Sofia University HospitalCordoba 14004Spain

The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies.

关键词： Peritoneal metastases Colorectal cancer Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Peritoneal carcinomatosis

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Proteomic analysis for developing new biomarkers of hepatocellular carcinoma

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World Journal of Hepatology 2010年第3期2卷 127-135页

作者： Maria Pleguezuelo Laura M Lopez-Sanchez Antonio Rodriguez-Ariza Jose L Montero javier Briceno Ruben Ciria Jordi Muntane Manuel de la Mata Liver Research Unit and Academic Department of Surgery Reina Sofia University Hospital Research Unit Reina Sofia University Hospital Liver Research Unit and Academic Department of Surgery CIBERehd Reina Sofia University Hospital

AIM: To identify new markers of hepatocellular carcinoma (HCC) using a proteomic analysis. METHODS: Patients with liver cirrhosis of the three most frequent etiologies: hepatitis C virus, hepatitis B virus and alcoholic liver disease, were included in the study. The samples were analysed by 2D-electrophoresis in order to determine the differential protein expression. The proteins were separated according to the charge in immobilized pH 3-10 gradient strips and then by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Proteins of interest were excised, digested with trypsin and the resulting peptides were separated and identified. RESULTS: Three differentially expressed apolipoproteins (Apo) were identified based on the protein profile using proteomic techniques: Apo-A1, Apo-A4 and Apo-E. Apo-A4 levels were significantly lower in HCC than in non-HCC patients regardless of etiology (P < 0.01). Multivariate logistic regression showed that Apo-A4 and Apo-A1 were the only independent factors related to HCC diagnosis (P < 0.05). The receiver operating characteristic (ROC) curve including both Apo-A4 and Apo-A1 showed an area under the ROC of 0.944 (P < 0.001), a sensitivity of 0.89 and a specificity of 0.81 for diagnosis of HCC. CONCLUSION: Apo-A4 and Apo-A1 may be used clinically as biomarkers of HCC with a high sensibility and specificity. These findings may provide additional insights into the mechanism of HCC development and progression.

关键词： Liver cancer Apolipoproteins Serum biomarkers 2D polyacrylamide gel electrophoresis Mass spectrometry

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