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From prediction to prevention:machine learning revolutionizes hepatocellular carcinoma recurrence monitoring

World Journal of Gastroenterology 2024年第7期30卷 631-635页

作者： mariana michelle Ramírez-mejía nahum méndez-sánchez Plan of Combined studies in medicine Faculty of MedicineNational Autonomous University of MexicoDistrito Federal 04510Mexico Liver Research Unit Medica Sur Clinic&FoundationDistrito Federal 14050Mexico Faculty of medicine National Autonomous University of MexicoDistrito Federal 04510Mexico

In this editorial,we comment on the article by Zhang et al entitled Development of a machine learning-based model for predicting the risk of early postoperative recurrence of hepatocellular *** carcinoma(HCC),which is characterized by high incidence and mortality rates,remains a major global health challenge primarily due to the critical issue of postoperative *** recurrence,defined as recurrence that occurs within 2 years posttreatment,is linked to the hidden spread of the primary tumor and significantly impacts patient *** predictive factors,including both patient-and treatment-related factors,have limited predictive ability with respect to HCC *** integration of machine learning algorithms is fueled by the exponential growth of computational power and has revolutionized HCC *** study by Zhang et al demonstrated the use of a groundbreaking preoperative prediction model for early postoperative HCC *** persist,including sample size constraints,issues with handling data,and the need for further validation and *** study emphasizes the need for collaborative efforts,multicenter studies and comparative analyses to validate and refine the *** these challenges and exploring innovative approaches,such as multi-omics integration,will enhance personalized oncology *** study marks a significant stride toward precise,efficient,and personalized oncology practices,thus offering hope for improved patient outcomes in the field of HCC treatment.

关键词： Hepatocellular carcinoma Early recurrence machine learning XGBoost model Predictive precision medicine Clinical utility Personalized interventions

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Insulin resistance and adipose tissue interactions as the cornerstone of metabolic(dysfunction)-associated fatty liver disease pathogenesis

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World Journal of Gastroenterology 2023年第25期29卷 3999-4008页

作者： shreya C Pal nahum méndez-sánchez Faculty of medicine National Autonomous University of MexicoMexico City 04510Mexico Liver Research Unit Medica Sur Clinic&FoundationMexico City 04510Mexico

The relationship between metabolic derangements and fatty liver development are undeniable,since more than 75% of patients with type 2 diabetes mellitus present with fatty *** is also significant epidemiological association between insulin resistance(IR)and metabolic(dysfunction)-associated fatty liver disease(mAFLD).For little more than 2 years,the nomenclature of fatty liver of non-alcoholic origin has been intended to change to mAFLD by multiple *** a myriad of reasons for which mAFLD is thought to be of metabolic origin could be exposed,the bottom line relies on the role of IR as an initiator and perpetuator of this *** is a reciprocal role in mAFLD development and IR as well as serum glucose concentrations,where increased circulating glucose and insulin result in increased de novo lipogenesis by sterol regulatory elementbinding protein-1c induced lipogenic enzyme stimulation;therefore,increased endogenous production of *** same effect is achieved through impaired suppression of adipose tissue(AT)lipolysis in insulin-resistant states,increasing fatty acid influx into the *** complementary reciprocal situation occurs when liver steatosis alters hepatokine secretion,modifying fatty acid metabolism as well as IR in a variety of tissues,including skeletal muscle,AT,and the *** aim of this review is to discuss the importance of IR and AT interactions in metabolic altered states as perhaps the most important factor in mAFLD pathogenesis.

关键词： metabolic(dysfunction)-associated fatty liver disease Insulin resistance Adipose tissue Fatty liver metabolic syndrome Adipokine

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Gastroenteritis in an adult female revealing hemolytic uremic syndrome: case report

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World Journal of Gastroenterology 2018年第6期24卷 763-766页

作者： Paulina Chinchilla-López Vania Cruz-Ramón Oscar Ramírez-Pérez nahum méndez-sánchez Liver Research Unit Medica Sur Clinic and Foundation

Nowadays acute gastroenteritis infection caused by Escherichia coli(E. coli) O157:H7 is frequently associated with hemolytic uremic syndrome(HUs), which usually developed after prodromal diarrhea that is often bloody. The abdominal pain accompanied by failure kidney is a suspicious symptom to develop this disorder. Their pathological characteristic is vascular damage which manifested as arteriolar and capillary thrombosis with abnormalities in the endothelium and vessel walls. The major etiological agent of HUs is enterohemorragic(E coli) strain belonging to serotype O157:H7. The lack of papers about HUs associated to gastroenteritis lead us to report this case for explain the symptoms that are uncommon. Furthermore, this report provides some strategies to suspect and make an early diagnosis, besides treatment approach to improving outcomes and prognosis for patients with this disorder.

关键词： Gastroenteritis Gastrointestinal hemorrhage Hemolytic-uremic syndrome Escherichia coli O157 shiga-toxigenic Escherichia coli

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Adiponectin as a protective factor in hepatic steatosis

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World Journal of Gastroenterology 2005年第12期11卷 1737-1741页

作者： nahum méndez-sánchez Norberto C.Chávez-Tapia Antonio R.Villa Karla sánchez-Lara Daniel Zamora-Valdés martha H.Ramos misael Uribe Liver Research Unit Clinical Epidemiology Unit

AIm: Obesity and insulin resistance (IR) are closely related to hepatic steatosis (Hs), and adiponectin is a hepatic insulin sensitizer that has important effects in liver function. This study aims at investigating the relationship between serum adiponectin concentration and the presence of Hs. mETHODs: We carried out a cross-sectional study in a check-up unit of a University Hospital in mexico City. We enrolled 196 subjects, comprising 98 subjects with Hs (27 women, 71 men) and 98 controls (37 women and 61 men). Anthropometric, metabolic and biochemical variables were measured in the two groups. serum adiponectin and leptin concentrations were determined, their association with grade of Hs tested, and concentrations, according to quartiles, compared between cases and controls. X2 analysis for linear trends was used to test for a dose-response relationship and logistic regression analysis was conducted to test for a protective effect of adiponectin. REsULTs: The Hs subjects were older and more obese than controls, with a central obesity pattern. In the fourth quartile of adiponectin concentrations, Hs was less common and severe. In a multivariate model of the fourth quartile of the adiponectin concentrations, we observed a protective effect (OR = 0.17, 95%CI: 0.04-0.67, P= 0.01). In subjects with more severe Hs, we observed higher leptin concentrations, and caloric intakes, total fat and iron consumption were higher than in controls. CONCLUsION: The results of the present study suggest that a high serum concentration of adiponectin is associated with a protective effect against Hs.

关键词： Adiponectin Hepatic steatosis Leptin Diet

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metabolic syndrome as a risk factor for gallstone disease

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World Journal of Gastroenterology 2005年第11期11卷 1653-1657页

作者： nahum méndez-sánchez Norberto C. Chavez-Tapia Daniel motola-Kuba Karla sanchez-Lara Guadalupe Ponciano-Rodríguez Héctor Baptista martha H. Ramos misael Uribe Departments of Biomedical Research and Gastroenterology and Liver Unit

AIm: To establish an association between the presence of metabolic syndrome and the development of gallstone disease. mETHODs: We carried out a cross-sectional study in a check-up unit in a university hospital in mexico City. We enrolled 245 subjects, comprising 65 subjects with gallstones (36 women, 29 men) and 180 controls (79 women and 101 men without gallstones). Body mass index, waist circumference, blood pressure, plasma insulin, and serum lipids and lipoproteins levels were measured. Insulin resistance was calculated by homeostasis model assessment. Unconditional logistic regression analysis (univariate and multivariate) was used to calculate the risk of gallstone disease associated with the presence of at least three of the criteria (Adult Treatment Panel Ⅲ). Analyses were adjusted for age and sex. REsULTs: Among 245 subjects, metabolic syndrome was present in 40% of gallstone disease subjects, compared with 17.2% of the controls, adjusted by age and gender (odds ratio (OR) = 2.79; 95%CI, 1.46-5.33; P= 0.002), a dose-dependent effect was observed with each component of metabolic syndrome (OR=2.36, 95%CI, 0.72-7.71; P= 0.16 with one component and OR = 5.54, 95%CI, 1.35-22.74; P = 0.02 with four components of metabolic syndrome). Homeostasis model assessment was significantly associated with gallstone disease (adjusted OR = 2.25; 95%CI, 1.08-4.69; P= 0.03). CONCLUsION: We conclude that as for cardiovascular disease and diabetes mellitus, gallstone disease appears to be strongly associated with metabolic syndrome.

关键词： Obesity metabolic syndrome Gallstones Insulin resistance

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serum leptin levels and insulin resistance are associated with gallstone disease in overweight subjects

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World Journal of Gastroenterology 2005年第39期11卷 6182-6187页

作者： nahum méndez-sánchez Luisa B Bermejo-martínez Yolanda Vi(n|~)als Norberto C Chavez-Tapia Irina Vander Graff Guadalupe Ponciano-Rodríguez martha H Ramos misael Uribe Departments of Biomedical Research and Gastroenterology and Liver Unit medica sur Clinic and Foundation Mexico CityMexico Clinical Research Center National Institute of Perinatology.mexico City Mexico Departments of Biomedical Research and Gastroenterology and Livei Unit medica sur Clinic and Foundation Mexico CityMexico Faculty of medicine National Autonomous University of mexico (UNAm).mexico City Mexico

AIm: To establish an association between the serum leptin levels and the development of gallstone disease (GD).mETHODs: We carried out a non-matched case-controlled study in a university hospital in mexico City. Two hundred and eighty-seven subjects were included: 97 cases with gallstones and 190 controls. Body mass index (BmI), fasting plasma leptin, insulin, serum lipid, and lipoprotein levels were measured. Insulin resistance was calculated by homeostasis model assessment (HOmA-IR). Unconditional logistic regression analysis (univariate and multivariate)stratified by BmI was used to calculate the risk of ***: The multivariate conditional regression analysis revealed a model for those patients with BmI ＜30. The selected variables in the model were HOmA-IR index with OR = 1.31, P= 0.02 and leptin higher than median with OR = 2.11, P= 0.05. In the stratum of BmI ≥30, we did not find a useful ***: We concluded that insulin resistance and the development of GD appears to be associated with serum leptin levels in subjects with overweight, but not in obese subjects with similar metabolic profiles.

关键词： Obesity Leptin Gallstones, Cholesterol Insulin resistance

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mitochondrial DNA from hepatocytes as a ligand for TLR9: Drivers of nonalcoholic steatohepatitis?

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World Journal of Gastroenterology 2016年第31期22卷 6965-6971页

作者： Priya Handa Akhila Vemulakonda Kris V Kowdley misael Uribe nahum méndez-sánchez senior Research scientist Organ Care Research and Liver Care Network Swedish Medical Center Liver Research Unit Medica Sur Clinic and Foundation

Nonalcoholic fatty liver disease(NAFLD) is the most common liver disease worldwide, affecting approximately one third of the Western world. It consists of a wide spectrum of liver disorders, ranging from fatty liver to nonalcoholic steatohepatitis(NAsH), which consists of steatosis, ballooning injury and inflammation. Despite an alarming growth in the statistics surrounding NAFLD, there are as yet no effective therapies for its treatment. Innate immune signaling has been thought to play a significant role in initiating and augmenting hepatic inflammation, contributing to the transition from nonalcoholic fatty liver to NAsH. An immune response is triggered by countless signals called damage-associated molecular patterns(DAmPs) elicited by lipid-laden and damaged hepatocytes, which are recognized by pattern recognition receptors(PRRs) on hepatic immune cells to initiate inflammatory signaling. In this editorial, in addition to summarizing innate immune signaling in NAFLD and discussing potential therapies that target innate immune pathways, we have described a recent study that demonstrated that mitochondrial DNA serves as a DAmP activating a hepatic PRR, TLR9, in mice and in the plasma of NAsH patients. In addition to identifying a new ligand for TLR9 during NAsH progression, the study shows that blocking TLR9 reverses NAsH, paving the way for the development of future NAsH therapy.

关键词： TLR9 Damage-associated molecular patterns Products of microbial metabolism produced by pathogens mitochondrial DNA Hepatocytes Nonalcoholic steatohepatitis Nonalcoholic fatty liver disease Inflammation Innate immune signaling Kupffer cells Therapy

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Low serum levels of ghrelin are associated with gallstone disease

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World Journal of Gastroenterology 2006年第19期12卷 3096-3100页

作者： nahum méndez-sánchez Guadalupe Ponciano-Rodríguez Luisa Bermejo-martínez Antonio R Villa Norberto C Chávez-Tapia Daniel Zamora-Valdés Raúl Pichardo-Bahena Blanca Barredo-Prieto martha H Uribe-Ramos martha H Ramos Héctor A Baptista-González misael Uribe Liver Unit Biomedical Research Department Medica Sur Clinic and FoundationMexico CityMexico Faculty of medicine National Autonomous University of mexico (UNAm) Mexico CityMexico Clinical Research Department National Institute of Perinatology Mexico CityMexico Clinical Epidemiology Unit National Institute of medical sciences and Nutrition Mexico CityMexico

AIm： To explore the role of ghrelin in gallstone disease. mETHODs： We carried out a cross-sectional study in 150 subjects, 38 with gallstones （cases） and 112 controls. We also did a real-time PCR-RT study in twenty gallbladder samples each. Body mass index （BNI）, serum insulin, ghrelin, and serum lipids were measured. Logistic regression analyses （univariate and multivariate） were conducted to estimate the probability of gallstone disease associated with serum ghrelin concentrations. REsULTs： Cases were statistically different from controls in gender distribution （P = 0.01）, age （53 vs 44 yr, P = 0.002）, BNI （28 vs 25; P = 0.004）, and glucose （5.26 vs 4.98 mmol/L; P = 0.05）. The prevalence of ghrelin serum levels above the third tercile was lower in subjects without metabolic syndrome （P 〈 0.05）. In a multivariate model, we found a protective effect, when ghrelin values were higher than the median value （OR = 0.27, 95%CI 0.09-0.82, P = 0.02）. Twenty （20%） gallbladder specimens expressed ghrelin mRNA. CONCLUsION： serum ghrelin concentrations are associated with a protective effect of GD.

关键词： Gallstones Obesity Ghrelin Gallbladder Gastrointestinal hormones

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Current trends of liver cirrhosis in mexico: similitudes and differences with other world regions

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World Journal of Clinical Cases 2018年第15期6卷 922-930页

作者： nahum méndez-sánchez Felipe Zamarripa-Dorsey Arturo Panduro Emma Purón-González Edgar Ulises Coronado-Alejandro Carlos Alejandro Cortez-Hernández Fátima Higuera de la Tijera José Luis Pérez-Hernández Eira Cerda-Reyes Heriberto Rodríguez-Hernández Vania César Cruz-Ramón Oscar Lenin Ramírez-Pérez Nancy Edith Aguilar-Olivos Olga Fabiola Rodríguez-martínez samantha Cabrera-Palma Guillermo Cabrera-álvarez Liver Research Unit Medica Sur Clinic and Foundation Department of Gastroenterology Hospital "Juárez" of México Department of molecular Biology in me-dicine Civil Hospital of Guadalajara "Fray Antonio Alcalde" Department of Internal medicine "Christus Muguerza "Super Specialty" Hospital" Monterrey Department of Gas-troenterology "University Hospital "Jose Eleuterio González" Monterrey Department of Gastroenterology "General Hospital of Mexico "Dr.Eduardo Liceaga" Department of Gastroenterology "Central Military Hospital" Faculty of medicine and Nutrition Juárez University of the State of Durango Liver Clinic Regional General Hospital IMSS 1

AIm To investigate the main current etiologies of cirrhosis in *** We performed a cross-sectional retrospective multicenter study that included eight hospitals in different areas of mexico. These hospitals provide health care to people of diverse social classes. The inclusion criteria were a histological, clinical, biochemical, endoscopic, or imaging diagnosis of liver cirrhosis. Data were obtained during a 5-year period(January 2012-December 2017). REsULTs A total of 1210 patients were included. The mean age was 62.5 years(sD = 12.1), and the percentages of men and women were similar(52.0% vs 48.0%). The most frequent causes of liver cirrhosis were hepatitis C virus(HCV)(36.2%), alcoholic liver disease(ALD)(31.2%), and nonalcoholic steatohepatitis(23.2%), and the least frequent were hepatitis B virus(1.1%), autoimmune disorders(7.3%), and other conditions(1.0%).CONCLUsION HCV and ALD are the most frequent causes of cirrhosis in mexico. However, we note that non-alcoholic fatty liver disease(NAFLD) as an etiology of cirrhosis increased by 100% compared with the rate noted previously. We conclude that NAFLD will soon become one of the most frequent etiologies of liver cirrhosis in mexico.

关键词： Alcoholic liver disease Hepatitis C virus Nonalcoholic steatohepatitis Liver cirrhosis

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The mechanism of dysbiosis in alcoholic liver disease leading to liver cancer

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Hepatoma Research 2020年第2期6卷 20-32页

作者： nahum méndez-sánchez Alejandro Valencia-Rodríguez Alfonso Vera-Barajas Ludovico Abenavoli Emidio scarpellini Guadalupe Ponciano-Rodríguez David Q.-H.Wang Liver Research Unit Medica Sur Clinic&FoundationMexico City 14050Mexico Faculty of medicine National Autonomous University of MexicoMexico City 04510Mexico Department of Health sciences University“Magna Graecia”Viale EuropaCatanzaro 88100Italy Clinical Nutrition Unit and Internal Medicine Unit“Madonna del Soccorso”General HospitalVia Luciano Manara 7San Benedetto del Tronto(AP)63074Italy Public Health Department Faculty of MedicineNational Autonomous University of MexicoMexico City 04510Mexico Department of medicine and Genetics Division of Gastroenterology and Liver DiseasesMarion Bessin Liver Research CenterEinstein-Mount Sinai Diabetes Research CenterAlbert Einstein College of MedicineBronxNY 10461USA

Currently, alcoholic liver disease (ALD) is one of the most prevalent chronic liver diseases worldwide, representing one of the main etiologies of cirrhosis and hepatocellular carcinoma (HCC). Although we do not know the exact mechanisms by which only a selected group of patients with ALD progress to the final stage of HCC, the role of the gut microbiota within the progression to HCC has been intensively studied in recent years. To date, we know that alcohol-induced gut dysbiosis is an important feature of ALD with important repercussions on the severity of this disease. In essence, an increased metabolism of ethanol in the gut induced by an excessive alcohol consumption promotes gut dysfunction and bacterial overgrowth, setting a leaky gut. This causes the translocation of bacteria, endotoxins, and ethanol metabolites across the enterohepatic circulation reaching the liver, where the recognition of the pathogen-associated molecular patterns via specific Toll-like receptors of liver cells will induce the activation of the nuclear factor kappa-B pathway, which releases pro-inflammatory cytokines and chemokines. In addition, the mitogenic activity of hepatocytes will be promoted and cellular apoptosis will be inhibited, resulting in the development of HCC. In this context, it is not surprising that microbiota-regulating drugs have proven effectiveness in prolonging the overall survival of patients with HCC, making attractive the implementation of these drugs as co-adjuvant for HCC treatment.

关键词： Alcoholic liver disease gut microbiota dysbiosis hepatocellular carcinoma

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