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Machine learning applications in stroke medicine:advancements,challenges,and future prospectives

Neural Regeneration Research 2024年第4期19卷 769-773页

作者： Mario Daidone Sergio Ferrantelli Antonino Tuttolomondo internal medicine and Stroke Care Ward Department of Health PromotionMother and Child CareInternal Medicine and Medical SpecialtiesUniversity of Palermo Molecular and Clinical medicine PhD Program University of Palermo

Stroke is a leading cause of disability and mortality worldwide,necessitating the development of advanced technologies to improve its diagnosis,treatment,and patient *** recent years,machine learning techniques have emerged as promising tools in stroke medicine,enabling efficient analysis of large-scale datasets and facilitating personalized and precision medicine *** abstract provides a comprehensive overview of machine learning’s applications,challenges,and future directions in stroke *** introduced machine learning algorithms have been extensively employed in all the fields of stroke *** learning models have demonstrated remarkable accuracy in imaging analysis,diagnosing stroke subtypes,risk stratifications,guiding medical treatment,and predicting patient *** the tremendous potential of machine learning in stroke medicine,several challenges must be *** include the need for standardized and interoperable data collection,robust model validation and generalization,and the ethical considerations surrounding privacy and *** addition,integrating machine learning models into clinical workflows and establishing regulatory frameworks are critical for ensuring their widespread adoption and impact in routine stroke *** learning promises to revolutionize stroke medicine by enabling precise diagnosis,tailored treatment selection,and improved *** research and collaboration among clinicians,researchers,and technologists are essential for overcoming challenges and realizing the full potential of machine learning in stroke care,ultimately leading to enhanced patient outcomes and quality of *** review aims to summarize all the current implications of machine learning in stroke diagnosis,treatment,and prognostic *** the same time,another purpose of this paper is to explore all the future perspectives these techniques can provide in combating this disabling dis

关键词： cerebrovascular disease deep learning machine learning reinforcement learning stroke stroke therapy supervised learning unsupervised learning

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Prevalence of nonalcoholic fatty liver disease in pediatrics and adolescents:a systematic review and meta-analysis

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World Journal of Pediatrics 2024年第6期20卷 569-580页

作者： Eun Joo Lee Miyoung Choi Sang Bong Ahn Jeong-Ju Yoo Seong Hee Kang Yuri Cho Do Seon Song Hong Koh Dae Won Jeon Hye Won Lee department of Pediatrics Yonsei University College of MedicineSeoulKorea Clinical Evidence Research National Evidence-Based Healthcare Collaborating Agency(NECA)SeoulKorea department of internal medicine Nowon Eulji Medical CenterEulji University College of MedicineSeoulKorea department of internal medicine Soonchunhyang University Bucheon HospitalBucheonKorea department of internal medicine Sangkye Paek HospitalInje University College of MedicineSeoulKorea Center for Liver and Pancreatobiliary Cancer National Cancer CenterGoyangKorea department of internal medicine College of MedicineSt.Vincent's HospitalThe Catholic University of KoreaSuwonKorea department of internal medicine Hanyang University College of MedicineSeoulKorea department of internal medicine Yonsei University College of MedicineSeoulKorea

Background As childhood obesity escalates worldwide,the prevalence of nonalcoholic fatty liver disease(NAFLD)in pediatric and adolescent populations is also ***,systematic studies and meta-analyses evaluating the prevalence of pediatric NAFLD remain *** The MEDLINE,Korean medical Database(KMBASE),Embase,Global Health,and Cochrane Library databases were searched from January 1997 to April *** terms included NAFLD or steatosis;nonalcoholic or steatohepatitis;child(ren),adolescent,or teenager;and prevalence,incidence,or epidemiology.A random-effects meta-analysis model was used to estimate the prevalence of pediatric *** A total of 2116 publications were found,of which 62 were included in the *** them,27 reported the prevalence in the general population and 39 in the obese *** worldwide pooled prevalence of pediatric NAFLD was 13%[95%confidence interval(CI)9-18%]in the general population and 47%(95%CI 41%–53%)in the obese *** 16 studies in the general population and 18 in the obese population,NAFLD prevalence varied by *** the general population,the prevalence of NAFLD was 15%(95%CI 8%–23%)in males and 10%(95%CI 6%–15%)in *** the obese population,it was 54%(95%CI 46%–61%)in males and 39%(95%CI 30%–49%)in *** The global prevalence of pediatric NAFLD is rising in both the general and obese *** the increasing rates of childhood obesity,epidemiological studies on the prevalence and incidence of NAFLD are needed.

关键词： Meta-analysis Nonalcoholic fatty liver disease Pediatric Prevalence

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RNA modifications in the progression of liver diseases: from fatty liver to cancer

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Science China Life Sciences 2024年第10期67卷 2105-2119页

作者： Simiao Li Wajahat Z Mehal Xinshou Ouyang department of internal medicine Section of Digestive DiseasesYale University School of Medicine

Non-alcoholic fatty liver disease（NAFLD） has emerged as a prominent global health concern associated with high risk of metabolic syndrome, and has impacted a substantial segment of the population. The disease spectrum ranges from simple fatty liver to non-alcoholic steatohepatitis（NASH）, which can progress to cirrhosis and hepatocellular carcinoma（HCC） and is increasingly becoming a prevalent indication for liver transplantation. The existing therapeutic options for NAFLD, NASH, and HCC are limited, underscoring the urgent need for innovative treatment strategies. Insights into gene expression, particularly RNA modifications such as N6methyladenosine（m6A）, hold promising avenues for interventions. These modifications play integral roles in RNA metabolism and cellular functions, encompassing the entire NAFLD-NASH-HCC progression. This review will encompass recent insights on diverse RNA modifications, including m6A, pseudouridine（Ψ）, N1-methyladenosine（m1A）, and 5-methylcytidine（m5C） across various RNA species. It will uncover their significance in crucial aspects such as steatosis, inflammation, fibrosis, and tumorigenesis. Furthermore, prospective research directions and therapeutic implications will be explored, advancing our comprehensive understanding of the intricate interconnected nature of these pathological conditions.

关键词： m6A RNA modification NASH NAFLD HCC fatty liver

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Endoscopic hemostasis using self-expandable metal stent combinedwith PuraStat® for patient with high risk of post-endoscopicsphincterotomy bleeding (with video)

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 94-96页

作者： Takeshi Ogura Yuki Uba Masahiro Yamamura Nobu Nishioka Hiroki Nishikawa 2nd department of internal medicine Osaka Medical and Pharmaceutical UniversityOsakaJapan

To the Editor:Endoscopic sphincterotomy(EST)is an established technique for removal of bile duct stones and self-expandable metal stent(SEMS)***,bleeding can be considered an adverse event after EST,particularly for patients with high risk of bleeding such as those on *** the various techniques reported for obtaining endoscopic hemostasis[1-3].

关键词： bleeding stasis endoscopic

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Metabolic dysfunction-associated steatotic liver disease:Navigating terminological evolution,diagnostic frontiers and therapeutic horizon-an editorial exploration

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World Journal of Gastroenterology 2024年第18期30卷 2387-2390页

作者： Aleksandra Boldys Lukasz Buldak department of internal medicine and Clinical Pharmacology School of Medicine in KatowiceMedical University of SilesiaKatowice 40-752Poland

Metabolic dysfunction-associated steatotic liver disease(MASLD),once known as non-alcoholic fatty liver disease(NAFLD),represents a spectrum of liver disorders characterized by lipid accumulation within *** redefinition of NAFLD in 2023 marked a significant reposition in terminology,emphasizing a broader understanding of liver steatosis and its associated *** is now recognized as a major risk factor for liver cirrhosis,hepatocellular carcinoma,and systemic complications such as cardiovascular diseases or systemic *** challenges arise,particularly in identifying MASLD in lean individuals,necessitating updated diagnostic protocols and investing in non-invasive diagnostic ***,there is an urgent need for effective treatments targeting MASLD,with emerging pharmacological options focusing on,among others,carbohydrate and lipid ***,understanding the roles of bile acid metabolism,the microbiome,and dietary interventions in MASLD pathogenesis and management holds promise for innovative therapeutic *** is a strong need to emphasize the importance of collaborative efforts in understanding,diagnosing,and managing MASLD to improve physicians’approaches and patient outcomes.

关键词： Metabolic dysfunction-associated steatotic liver disease Diagnostics Pathophysiology of metabolic dysfunction-associated steatotic liver disease Therapy of metabolic dysfunction-associated steatotic liver disease Therapeutic innovations

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Propensity score matching analysis for clinical impact of braided-type versus laser-cut-type covered self-expandable metal stents for endoscopic ultrasound-guided hepaticogastrostomy

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 181-185页

作者： Mitsuki Tomita Takeshi Ogura Akitoshi Hakoda Saori Ueno Atsushi Okuda Nobu Nishioka Yoshitaro Yamamoto Hiroki Nishikawa 2nd department of internal medicine Osaka Medical and Pharmaceutical UniversityOsakaJapan Endoscopy Center Osaka Medical and Pharmaceutical UniversityOsakaJapan

Background:To prevent stent migration during endoscopic ultrasound-guided hepaticogastrostomy(EUS-HGS),intra-scope channel release technique is important,but is unfamiliar to non-expert *** self-expandable metal stent(SEMS)is an additional factor to prevent stent ***,no compara-tive studies of laser-cut-type and braided-type during EUS-HGS have been *** aim of this study was to compare the distance between the intrahepatic bile duct and stomach wall after EUS-HGS among laser-cut-type and braided-type ***:To evaluate stent anchoring function,we measured the distance between the hepatic parenchyma and stomach wall before EUS-HGS,one day after EUS-HGS,and 7 days after ***,propensity score matching was performed to create a propensity score for using laser-cut-type group and braided-type ***:A total of 142 patients were enrolled in this *** them,24 patients underwent EUS-HGS using a laser-cut-type SEMS,and 118 patients underwent EUS-HGS using a braided-type ***-HGS using the laser-cut-type SEMS was mainly performed by non-expert endoscopists(n=21);EUS-HGS using braided-type SEMS was mainly performed by expert endoscopists(n=98).The distance after 1 day was significantly shorter in the laser-cut-type group than that in the braided-type group[2.00(1.70-3.75)vs.6.90(3.72-11.70)mm,P<0.001].In addition,this distance remained significantly shorter in the laser-cut-type group after 7 *** these results were similar after propensity score matching analysis,the distance between hepatic parenchyma and stomach after 7 days was increased by 4 mm compared with the distance after 1 day in the braided-type *** the other hand,in the laser-cut-type group,the distance after 1 day and 7 days was almost the ***:EUS-HGS using a laser-cut-type SEMS may be safe to prevent stent migration,even in non-expert hands.

关键词： Endoscopic ultrasound-guided hepaticogastrostomy Endoscopic ultrasound-guided biliary drainage Endoscopic retrograde cholangiopancreatography

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Advancements in hemostatic strategies for managing upper gastrointestinal bleeding: A comprehensive review

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World Journal of Gastroenterology 2024年第15期30卷 2087-2090页

作者： Ah Young Lee Joo Young Cho Division of Gastroenterology Department of Internal MedicineCha Gangnam Medical CenterCha University College of MedicineSeoul 06135Korea

Upper gastrointestinal(GI)hemorrhage presents a substantial clinical *** management typically involves resuscitation and endoscopy within 24 h,although the benefit of very early endoscopy(<12 h)for high-risk patients is *** goals include stopping acute bleeding,preventing rebleeding,and using a multimodal approach encompassing endoscopic,pharmacological,angiographic,and surgical *** agents such as vasopressin,prostaglandins,and proton pump inhibitors are effective,but the increase in antithrombotic use has increased GI bleeding *** hemostasis,particularly for nonvariceal bleeding,employs techniques such as electrocoagu-lation and heater probes,with concerns over tissue injury from monopolar *** methods such as Hemospray and Endoclot show promise in creating mechanical tamponades but have ***,the first-line therapy includes thermal probes and hemoclips,with over-the-scope clips emerging for larger ulcer *** gold probe,combining bipolar electrocoagulation and injection,offers targeted coagulation but has faced device-related *** advancements involve combining techniques and improving endoscopic imaging,with studies exploring combined approaches showing *** research is crucial for developing standardized and effective hemorrhage management strategies.

关键词： Upper gastrointestinal bleeding Hemostasis Endoscopy Probe Spray Clip

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Trends in colorectal cancer incidence according to an increase in the number of colonoscopy cases in Korea

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World Journal of Gastrointestinal Oncology 2024年第1期16卷 51-60页

作者： Ga Hee Kim Yeong Chan Lee Tae Jun Kim Sung Noh Hong Dong Kyung Chang Young-Ho Kim Dong-Hoon Yang Chang Mo Moon Kyunga Kim Hyun Gun Kim Eun-Ran Kim Division of Gastroenterology Department of Internal MedicineAsan Medical CenterUniversity of Ulsan College of MedicineSeoul 05505South Korea department of Digital Health Samsung Advanced Institute for Health Science and TechnologySungkyunkwan University School of MedicineSeoul 06351South Korea Division of Gastroenterology Department of Internal MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351South Korea Division of Gastroenterology Department of Internal MedicineEwha Womans UniversitySeoul 07985South Korea Biomedical Statistics Center Samsung Medical CenterSeoul 06351South Korea Division of Gastroenterology Department of Internal MedicineSoonchunhyang University College of MedicineSeoul 04401South Korea

BACKGROUND The incidence of colorectal cancer(CRC)and preinvasive CRC(e.g.,early colon cancer and advanced adenoma)is gradually increasing in several *** To evaluate the trend in incidence of CRC and preinvasive CRC according to the increase in the number of colonoscopies performed in *** This retrospective cohort study enrolled Korean patients from 2002 to 2020 to evaluate the incidence of CRC and preinvasive CRC,and assess the numbers of diagnostic colonoscopies and colonoscopic ***-related complications by age group were also *** The incidence of CRC showed a rapid increase,then decreased after 2012 in the 50-75 year-age *** the study period,the rate of incidence of preinvasive CRC increased at a similar level in patients under 50 and 50-75 years of *** 2009,the increase has been rapid,showing a pattern similar to the increase in *** rate of colonoscopic polypectomy in patients aged under 50 was similar to the rate in patients over 75 years of age after *** rate of complications after colonoscopy and related deaths within 3 mo was high for those over 75 years of *** The diagnosis of preinvasive CRC increased with the increase in the number of colonoscopies *** the risk of colonoscopy-related hospitalization and death is high in the elderly,if early lesions at risk of developing CRC are diagnosed and treated under or at the age of 75,colonoscopy-related complications can be reduced for those aged 76 years or over.

关键词： Colorectal cancer Preinvasive colorectal cancer Colorectal polypectomy Colonoscopy

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Reporting quality evaluation of clinical practice guidelines for pulmonary nodules with the RIGHT checklist

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Chinese medical Journal 2024年第5期137卷 625-627页

作者： Xuan Wu Wenqiang Wang Quncheng Zhang Ya Sun Nan Wei Li Yang Yuanjian Yang Huizhen Yang Haiyang Liu Xiaoju Zhang department of Respiratory and Critical Care medicine Zhengzhou University People’s HospitalHenan Provincial People’s HospitalZhengzhouHenan 450003China department of internal medicine Academy of Medical ScienceZhengzhou UniversityZhengzhouHenan 450001China department of internal medicine Xinxiang Medical UniversityXinxiangHenan 453003China

To the Editor:Pulmonary nodules are defined as localized opacities of up to 30 mm in diameter,surrounded by pulmonary parenchyma or located adjacent to the pleura.^([1])The ideal management for pulmonary nodules is to diagnose and treat malignant nodules as early as possible and minimize radiation exposures,based on the general *** practice guidelines(CPGs)always provide efficient recommendations based on systematic reviews of high-quality evidence and reporting to optimize patient care.^([2])Accumulating evidence shows that adherence to the guidelines improves patient outcomes.^([3])However,the reporting quality of CPGs seems poor.^([4])Several instruments have been generated to evaluate the quality of CPGs.

关键词： pulmonary Clinical clinical

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Yield of alarm features in predicting significant endoscopic findings among hospitalized patients with dyspepsia

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World Journal of Gastroenterology 2024年第26期30卷 3210-3220页

作者： Lama Ibrahim Maamoun Basheer Tawfik Khoury Wisam Sbeit department of internal medicine Galilee Medical CenterNahariya 22001Israel department of Gastroenterology Galilee Medical CenterNahariya 22001Israel Azrieli Faculty of medicine Bar-Ilan UniversitySafed 1311502Israel

BACKGROUND Dyspepsia is a very prevalent upper gastrointestinal tract symptoms *** of these symptoms might arise from serious underlying diseases,so the promotion of evidence-based guidelines could potentially better align evaluation and *** To determine the value of alarm features as a predictive factor for significant endoscopic findings(SEFs)among hospitalized patients presenting with *** We conducted a retrospective case-control study including information about 6208 endoscopic procedures performed for hospitalized *** were divided into two groups,with and without SEFs,and compared to elucidate the ability of the different alarm features to predict *** During the study,605 patients fulfilled the inclusion *** the demographics and clinical characteristics of the two groups were compared,tachycardia(P<0.05),normocytic anemia,(P<0.05),leukocytosis(P<0.05),and hypoalbuminemia(P<0.05)documented on admission prior to endoscopy were strong predictors of *** the alarm features,upper gastrointestinal bleeding,persistent vomiting,odynophagia[odds ratio(OR)=3.81,P<0.05;OR=1.75,P=0.03;and OR=7.81,P=0.07,respectively]were associated with *** weight loss was strongly associated with malignancy as an endoscopic finding(OR=2.05;P<0.05).In addition,long-term use of anti-aggregate medications other than aspirin(P<0.05)was correlated to *** Novel predictors of SEFs were elucidated in this *** parameters could be used as an adjunctive in decision making regarding performing upper endoscopy in hospitalized patients with dyspepsia.

关键词： Dyspepsia Endoscopy Weight loss Anti-aggregate medications Persistent vomiting Odynophagia

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