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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 and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 241-248页

作者： Chao Sun George Boon-Bee Goh Wan-Cheng Chow Wah-Kheong Chan Grace Lai-Hung Wong Wai-Kay Seto Yi-Hsiang Huang Han-Chieh Lin I-Cheng Lee Hye Won Lee Seung Up Kim Vincent Wai-Sun Wong Jian-Gao Fan Center for Fatty Liver Disease Department of GastroenterologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai Key Lab of Pediatric Gastroenterology and NutritionShanghai 200092China Department of gastroenterology&Hepatology Singapore General HospitalSingaporeSingapore gastroenterology and Hepatology Unit Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia Department of medicine and Therapeutics and State Key Laboratory of Digestive Disease The Chinese University of Hong KongHong KongChina Department of medicine The University of Hong KongHong KongChina Institute of Clinical medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina Division of gastroenterology and Hepatology Taipei Veterans General HospitalTaipeiTaiwanChina Faculty of medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina Department of internal medicine Yonsei University College of MedicineSeoulKorea

Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic ***,the prevalence and risk factors for impaired renal function in patients with NAFLD remain *** objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD ***:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective *** fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 *** renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)***:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,*** multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of *** glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.

关键词： Nonalcoholic fatty liver disease Impaired renal function Agile 3+ Agile 4 Metabolic syndrome

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Managing end-stage carcinoid heart disease:A case report and literature review

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 1076-1083页

作者： Nikola Bulj Vedran Tomasic Maja Cigrovski Berkovic Department of Cardiology University Hospital Centre“Sestre Milosrdnice“Zagreb 10000Croatia Division of gastroenterology Department of Internal MedicineUniversity Hospital Centre“Sestre Milosrdnice”Zagreb 10000Croatia Department for Sport and Exercise medicine University of Zagreb Faculty of KinesiologyZagreb 10000Croatia

BACKGROUND Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs)are rare tumors,often diagnosed in an advanced stage when curative treatment is impossible and grueling symptoms related to vasoactive substance release by tumor cells affect patients’quality of *** complications of GEP-NENs,primarily tricuspid and pulmonary valve disease,and right-sided heart failure,are the leading cause of death,even compared to metastatic *** SUMMARY We present a case of a 35-year-old patient with progressive dyspnea,back pain,polyneuropathic leg pain,and nocturnal diarrhea lasting for a decade before the diagnosis of neuroendocrine carcinoma of unknown primary with extensive liver *** the initial presentation,serum biomarkers were not evaluated,and the patient received five cycles of doxorubicin,which he did not tolerate well,so he refused further therapy and was lost to *** 10 years,he presented to the emergency room with signs and symptoms of right-sided heart *** markers,serum chromogranin A,and urinary 5-hydroxyindoleacetic acid were extremely elevated(900 ng/mL and 2178µmol/L),and transabdominal ultrasound confirmed hepatic *** tomo-graphy(CT)showed liver metastases up to 6 cm in diameter and metastases in mesenteric lymph nodes and ***,an Octreoscan showed lesions in the heart,thoracic spine,duodenum,and ascendent colon.A standard trans-thoracic echocardiogram confirmed findings of carcinoid heart *** patient was not a candidate for valve *** started octreotide acetate treatment,and the dose escalated to 80 mg IM *** biochemical CONCLUSION Carcinoid heart disease occurs with carcinoid syndrome related to advanced neuroendocrine tumors,usually with liver metastases,which manifests as right-sided heart valve dysfunction leading to right-sided heart *** heart disease and tumor burden are major prognostic factors of poor surviva

关键词： Gastroenteropancreatic neuroendocrine neoplasms Carcinoid syndrome Carcinoid heart disease Diagnosis Treatment Case report

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Outcomes of endoscopic submucosal dissection in cirrhotic patients: First American cohort

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World Journal of Hepatology 2024年第5期16卷 784-790页

作者： Robert Luke Pecha Fares Ayoub Ankur Patel Abdullah Muftah Michael W Wright Mai A Khalaf Mohamed O Othman Department of gastroenterology and Hepatology UC DavisSacramentoCA 95817United States Department of gastroenterology and Hepatology Baylor College of MedicineHoustonTX 77030United States internal medicine Baylor College of MedicineHoustonTX 77030United States Department of gastroenterology and Hepatology University of Texas Medical Branch at GalvestonGalvestonTX 77550United States Medical School Baylor College of MedicineHoustonTX 77030United States Department of Tropical medicine Tanta UniversityTanta 31527Egypt

BACKGROUND Among patients with cirrhosis and pre-malignant or early malignant mucosal lesions,surgical intervention carries a much higher bleeding *** such lesions are discovered,endoscopic submucosal dissection(ESD)may offer curative therapy with lower risks than surgery and improved outcomes compared to traditional endoscopic *** To evaluate the outcomes of ESD in patients with *** Patients with cirrhosis undergoing ESD between July 2015 and August 2022 were retrospectively matched in 1:2 fashion to controls based on lesion location,size,and anticoagulation *** outcomes were compared between *** A total of 64 Lesions from 59 patients were included(16 cirrhosis,43 control).There were no differences in patient or lesion characteristics between *** bloc and curative resection was achieved in 84.21%,78.94%of the cirrhosis group and 88.89%,68.89%of controls,respectively,with no significant *** patients had significantly higher rates of intra-procedural coagulation grasper use for control of bleeding(47.37%vs 20%;P=0.02).There were otherwise no significant differences in adverse event *** the 29 patients with follow up,we found higher rates of recurrence in the cirrhosis group compared to controls(40%vs 5.26%;P=0.019),however this effect did not persist on multivariable analysis controlling for known *** ESD may be safe and effective in patients with *** procedure related outcomes were not significantly different between ***-procedural bleeding requiring use of the coagulation grasper use was expectedly higher in the cirrhosis group given the known effects of liver disease on hemostasis.

关键词： Endoscopic aubmucosal dissection Cirrhosis Advanced polypectomy Intraprocedural bleeding Colon cancer

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Navigating the autophagic landscape:Epigenetic modulation in gastrointestinal cancer

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World Journal of gastroenterology 2024年第31期30卷 3628-3634页

作者： Davide Ramoni Federico Carbone Fabrizio Montecucco Department of internal medicine University of GenoaGenoa 16132Italy Department of internal medicine University of Genoa and IRCSS Policlinico San MartinoGenoa 16132Italy

This editorial comments on the manuscript by Chang et al,focusing on the still elusive interplay between epigenetic regulation and autophagy in gastrointestinal diseases,particularly ***,essential for cellular homeostasis,exhibits diverse functions ranging from cell survival to death,and is particularly implicated in physiological gastrointestinal cell ***,its role in pathological backgrounds remains intricate and *** underscore the dual nature of autophagy in cancer,where its early suppressive effects in early stages are juxtaposed with its later promotion,contributing to *** discrepancy is attributed to the dysregulation of autophagy-related genes and their intricate involvement in cellular *** modifications and regulations of gene expression,including non-coding RNAs(ncRNAs),emerge as critical players in exerting regulatory control over autophagy flux,influencing treatment responses and tumor *** epigenetic mechanisms and improving strategies involving the inhibition or induction of autophagy through pharmacological or genetic means present potential avenues to sensitize tumor cells to ***,nanocarrier-based delivery of ncRNAs offers innovative therapeutic *** the intricate interaction between autophagy and ncRNA regula-tion opens avenues for the development of targeted therapies,thereby improving the prognosis of gastrointestinal malignancies with poor outcomes.

关键词： Epigenetic regulation Autophagy Gastrointestinal cancer Non-coding RNAs Target therapies

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Risk of hepatitis B virus reactivation in oncological patients treated with tyrosine kinase inhibitors:A case report and literature analysis

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World Journal of gastroenterology 2024年第9期30卷 1253-1256页

作者： Francesca Colapietro Nicola Pugliese Antonio Voza Alessio Aghemo Stella De Nicola Department of Biomedical Sciences Humanitas UniversityMilan 20072Italy Division of internal medicine and Hepatology Department of GastroenterologyHumanitas Research HospitalMilan 20089Italy Department of Emergency Humanitas Research HospitalMilan 20089Italy

Hepatitis B virus(HBV)reactivation(HBVr)represents a severe and potentially life-threatening condition,and preventive measures are available through blood test screening or prophylactic therapy *** assessment of HBVr traditionally considers factors such as HBV profile,including hepatitis B surface antigen(HBsAg)and antibody to hepatitis B core antigen,along with type of medication(chemotherapy;immunomodulants).Nevertheless,consideration of possible patient’s underlying tumor and the specific malignancy type(solid or hematologic)plays a crucial role and needs to be assessed for decision-making process.

关键词： Chronic hepatitis B Reactivation Nucleoside analogue Tyrosine kinase inhibitors Onco-hematology

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Low skeletal muscle mass and high visceral adiposity are associated with recurrence of acute cholecystitis after conservative management:A propensity score-matched cohort study

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 64-70页

作者： Yudai Koya Michihiko Shibata Yuki Maruno Yoshitaka Sakamoto Shinji Oe Koichiro Miyagawa Yuichi Honma Masaru Harada Department of gastroenterology Kyushu Rosai HospitalMoji Medical Center3-1 HigashiminatomachiMoji-kuKitakyushu 801-8502Japan Third Department of internal medicine School of MedicineUniversity of Occupational and Environmental HealthKitakyushu 807-8555Japan Department of Surgery Kyushu Rosai Hospital Moji Medical CenterKitakyushu 801-8502Japan

Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of *** skeletal muscle mass or adiposity have various effects in several *** aimed to clarify the relationship between RAC and body ***:Patients with AC who were treated at our hospital between January 2011 and March 2022 were *** psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of *** areas were divided by height to obtain the psoas muscle mass index(PMI)and subcutaneous/visceral adipose tissue index(SATI/VATI).According to median VATI,SATI and PMI values by sex,patients were divided into the high and low PMI *** performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of ***:The entire cohort was divided into the high PMI(n=81)and low PMI(n=80)*** the propensity score-matched cohort there were 57 patients in each *** Kaplan-Meier analysis,the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts(log-rank P=0.001 and 0.015,respectively).In a multivariate Cox regression analysis,the hazard ratios of low PMI and low VATI for RAC were 5.250(95%confidence interval 1.083-25.450,P=0.039)and 0.158(95%confidence interval:0.026-0.937,P=0.042),***:Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.

关键词： Acute cholecystitis Low skeletal muscle mass Recurrent acute cholecystitis Sarcopenia Visceral adiposity

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Solid pancreatic masses:What’s hidden beneath?Insights into rare pancreatic lesions

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World Journal of Clinical Cases 2024年第29期12卷 6255-6257页

作者： Daniel Vasile Balaban Department of internal medicine and gastroenterology Carol Davila University of Medicine and PharmacyBucharest 020021Romania

The diagnostic approach to solid pancreatic masses has significantly evolved from the era when a focal pancreatic mass was almost synonymous to pancreatic ductal adenocarcinoma,to a wide spectrum of pancreatic lesions,some of which have good *** the advent of advanced diagnostic tools,particularly refined imaging and tissue acquisition techniques,a broader spectrum of differential diagnoses has been recognized,encompassing conditions ranging from neuroendocrine tumors or inflammatory masses,to rare entities like metastatic clear cell sarcoma or solitary fibrous *** herein discuss case reports of some rare pancreatic lesions,which were diagnosed by combining clinical and imaging features and endoscopic ultrasound-guided tissue sampling and confirmed on surgical *** reports on these rare pancreatic tumors will contribute to a better understanding of their pathogenesis and effective management.

关键词： Pancreatic mass Pancreas Metastasis Diagnosis Endoscopic ultrasound

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Gastroesophageal reflux following peroral endoscopic myotomy for achalasia:Bumps in the road to success

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World Journal of gastroenterology 2024年第29期30卷 3461-3464页

作者： David Itskoviz Stephen David Howard Malnick Kaplan Medical Center Institute of Gastroenterology and HepatologyHebrew University Medical School of JerusalemRehovot 76100Israel Kaplan Medical Center Department of Internal Medicine CHebrew University Medical School of JerusalemRehovot 76100Israel

Achalasia can significantly impair the quality of *** clinical presentation typically includes dysphagia to both solids and liquids,chest pain,and *** can be delayed in patients with atypical presentations,and they might receive a wrong diagnosis,such as gastroesophageal reflux disease(GERD),owing to overlapping symptoms of both *** the cause of achalasia is poorly understood,its impact on the motility of the esophagus and gastroesophageal junction is well *** treatment modalities have been utilized,with the most common being surgical Heller myotomy with concomitant fundoplication and pneumatic balloon ***,peroral endoscopic myotomy(POEM)has gained popularity as an effective treatment for achalasia,despite a relatively high incidence of GERD occurring after treatment compared to other *** magnitude of post-POEM GERD depends on its definition and is influenced by patient and procedure-related *** longterm sequelae of post-POEM GERD are yet to be determined,but it appears to have a benign course and is usually manageable with clinically available *** risk factors for post-POEM GERD and modifying the POEM procedure in selected patients may improve the overall success of this technique.

关键词： Achalasia Per-oral endoscopic myotomy Gastroesophageal reflux Pneumatic dilatation Heller myotomy Proton pump inhibitor Acidic fermentation

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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 *** peripancreatic fluid collection(APFC)may negatively impact the clinical course of *** could worsen symptoms and potentially lead to additional ***,clinical evidence regarding the specific association between APFC and early readmission in AP remains *** the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare *** To evaluate the association between APFC and 30-day readmission in patients with *** This retrospective cohort study is based on the Nationwide Readmission Database for *** with a primary diagnosis of AP were *** were categorized into those with and without APFC.A 1:1 propensity score matching for age,gender,and Elixhauser comorbidities was *** primary outcome was early readmission *** outcomes included the incidence of inpatient complications and healthcare *** 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 *** A total of 673059 patients with the principal diagnosis of AP were *** these,5.1%had APFC on initial *** propensity score matching,each cohort consisted of 33914 *** 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 APF

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

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