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Machine learning models for predicting non-alcoholic fatty liver disease in the general United States population:NHANES database

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World Journal of Hepatology 2021年第10期13卷 1417-1427页

作者： Amporn Atsawarungruangkit Passisd Laoveeravat Kittichai Promrat Division of gastroenterology Warren Alpert Medical SchoolBrown UniversityProvidenceRI 02903United States Division of Digestive Diseases and Nutrition University of Kentucky College of MedicineLexingtonKY 40536United States Division of gastroenterology and Hepatology Providence VA Medical CenterProvidenceRI 02908United States

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common chronic liver disease,affecting over 30% of the United States *** patient identification using a simple method is highly *** To create machine learning models for predicting NAFLD in the general United States *** Using the NHANES *** NAFLD-related factors were *** dataset was divided into the training(70%)and testing(30%)*** machine learning algorithms were applied to the training *** bestperforming models and another interpretable model(i.e.,coarse trees)were tested using the testing *** There were 3235 participants(n=3235)that met the inclusion *** the training phase,the ensemble of random undersampling(RUS)boosted trees had the highest F1(0.53).In the testing phase,we compared selective machine learning models and NAFLD *** on F1,the ensemble of RUS boosted trees remained the top performer(accuracy 71.1%and F10.56)followed by the fatty liver index(accuracy 68.8% and F10.52).A simple model(coarse trees)had an accuracy of 74.9% and an F1 of *** Not every machine learning model is *** a simpler model such as coarse trees,we can create an interpretable model for predicting NAFLD with only two predictors:fasting C-peptide and waist *** the simpler model does not have the best performance,its simplicity is useful in clinical practice.

关键词： Artificial intelligence Machine learning Non-alcoholic fatty liver disease Fatty liver United States population NHANES

Prevalence and risk factors of steatosis and advanced fibrosis using transient elastography in the United States’ adolescent population

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World Journal of Hepatology 2021年第7期13卷 790-803页

作者： Amporn Atsawarungruangkit Yousef Elfanagely Jason Pan Kelsey Anderson James Scharfen Kittichai Promrat Division of gastroenterology Warren Alpert Medical School of Brown UniversityProvidenceRI 02903United States Department of Internal Medicine Warren Alpert Medical School of Brown UniversityProvidenceRI 02903United States

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the leading cause of chronic liver disease in children and *** To determine the prevalence and risk factors of steatosis and advanced fibrosis using transient elastography(TE)in the United States’adolescent *** Using the National Health and Nutrition Examination Survey 2017-2018,adolescent participants aged 13 to 17 years who underwent TE and controlled attenuation parameter(CAP)were included in this ***-one factors associated with liver steatosis and fibrosis were *** and multivariate linear regression analysis were used to identify statistically significant *** Seven hundred and forty participants met inclusion ***(S1-S3),based on CAP,and advanced fibrosis(F3-F4),based on TE,were present in 27%and 2.84%of the study population,*** predictors of steatosis grade included log of alanine aminotransferase,insulin resistance,waistto-height ratio,and body mass *** predictors of fibrosis grade included steatosis grade,non-Hispanic black race,smoking history,and systolic blood *** This study demonstrated a high prevalence of steatosis in the United States’adolescent *** 3%of United States’adolescents had advanced *** findings are concerning because a younger age of onset of NAFLD can lead to an earlier development of severe disease,including steatohepatitis,cirrhosis,and liver decompensation.

关键词： Non-alcoholic fatty liver disease Fatty liver Metabolic syndrome Cirrhosis,national health and nutrition examination survey Pediatric Adolescents

Identification of Nonalcoholic Fatty Liver Disease following Pancreatic Surgery in a Western Cohort Using a Novel Radiographic Technique

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Journal of Clinical and Translational Hepatology 2015年第4期3卷 246-253页

作者： Sidney Olefson Melissa Jackson David J.Grand Kevin P.Charpentier Nirav Makwana Kittichai Promrat Department of Internal Medicine Warren Alpert Medical School of Brown UniversityProvidenceRIUSA Department of Diagnostic Imaging Warren Alpert Medical School of Brown UniversityProvidenceRIUSA Department of Surgery Warren Alpert Medical School of Brown UniversityProvidenceRIUSA Division of gastroenterology and Hepatology Warren Alpert Medical School of Brown UniversityProvidenceRIUSA

Background and Aims:While traditional risk factors for the development of nonalcoholic fatty liver disease(NAFLD)relate to metabolic syndrome,several Asian studies have suggested a high rate of de novo NAFLD following pancreaticoduodenectomy(PD).The aim of this study is to identify de novo NAFLD after pancreatic surgery and its associated risk ***:A retrospective cohort of patients at a single center that underwent PD or distal pancreatectomy(DP)over 7 years was ***-and postoperative contrast-enhanced computed tomography scans of the abdomen were reviewed,including attenuation measurements of the liver,spleen,and *** outcomes included hepatic attenuation,liver to muscle ratio(LMR),and liver to spleen ratio(LSR).Results:Of the 96 patients(mean age 64.3)included,70%underwent PD,and 30%underwent *** mean LMR decreased significantly from 1.81 to 1.66(p=0.02),noted only in *** interaction effect with LMR was observed with surgical type,chemotherapy,blood loss,pancreatic enzyme replacement,or *** decreased In 55%of ***:Increased fatty infiltration,as evidence by decreased LMR,was found among men that underwent PD and DP within a year of *** may be related to weight loss and malabsorption and deserves further investigation.

关键词： Retrospective cohort NAFLD Whipple Distal pancreatectomy

The metabolite, alpha-ketoglutarate inhibits non-alcoholic fatty liver disease progression by targeting lipid metabolism

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Liver Research 2020年第2期4卷 94-100页

作者： Katsuya Nagaoka Joud Mulla Kevin Cao Zhixiang Cheng Dan Liu William Mueller Amalia Bay Grace Hildebrand Shaolei Lu Chiung-Kuei Huang Liver Research Center Division of Gastroenterology&Liver Research CenterWarren Alpert Medical School of Brown University and Rhode Island HospitalProvidenceRIUSA Department of Pathology and Laboratory Medicine Warren Alpert Medical School of Brown UniversityRhode Island HospitalProvidenceRIUSA

Background:Non-alcoholic liver disease is of increased concern and contributing to economic burdens not only in developing countries but in developed countries as *** the biomarker of early diagnosis and early intervention approaches for non-alcoholic liver disease is unmet and required further *** the alpha-ketoglutarate(a-KG)is recently proposed to be a potential biomarker in differentiating patients with obesity from those with non-alcoholic liver disease,how a-ketoglutatate is involved in the fatty liver progression is not ***:A high-fat diet(HFD)feeding animal model,liver functional assays,and molecular approaches were adopted to clarify the impact of a-KG in fatty liver ***:In the current study,it was found that dietary a-KG would inhibit weight gain in male and female mice fed with a normal chew or *** feeding caused fatty liver in male mice,but a-KG treatment could substantially inhibit hepatic steatosis *** studies revealed the possible linkage of a-KG protective functions to lipid *** analysis identified the important role of peroxisome proliferator-activated receptors in beneficial a-KG-mediated effects on fatty liver ***:The current study demonstrates the therapeutic potential of a-KG and how it may be used,via dietary supplementation,as a preventive intervention for non-alcoholic liver disease in obese patients.

关键词： Peroxisome proliferator-activated receptor gamma(PPARγ) Steatosis Non-alcoholic fatty liver disease(NAFLD) Non-alcoholic steatohepatitis(NASH) Alpha-ketoglutarate(a-KG) Gender difference C57BL/6 mouse

Giant duodenal ulcers

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World Journal of gastroenterology 2008年第32期14卷 4995-4999页

作者： Eric Benjamin Newton Mark R Versland Thomas E Sepe Department of Medicine Division of Gastroenterology-Hepatology University of Connecticut Health Center Warren Alpert School of Medicine Brown University Providence

Giant duodenal ulcers （GDUs） are a subset of duodenal ulcers that have historically resulted in greater morbidity than usual duodenal ulcers. Until recently, few cases had been successfully treated with medical therapy. However, the widespread use of endoscopy, the introduction of H-2 receptor blockers and proton p^Jmp inhibitors, and the improvement in surgical techniques all have revolutionized the diagnosis, treatment and outcome of this condition. Nevertheless, GDUs are still associated with high rates of morbidity, mortality and complications. Thus, surgical evaluation of a patient with a GDU should remain an integral part of patient care. These giant variants, while usually benign, can frequently harbor malignancy. A careful review of the literature highlights the important differences when comparing GDUs to classical peptic ulcers and why they must be thought of differently than their more common counterpart.

关键词： Giant duodenal ulcer Hel/cobacter py/ori Nonsteroidal anti-inflammatory drugs Malignancy Endoscopy

Artificial intelligence and cholangiocarcinoma:Updates and prospects

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World Journal of Clinical Oncology 2022年第2期13卷 125-134页

作者： Hossein Haghbin Muhammad Aziz Department of gastroenterology Ascension Providence SouthfieldSouthfieldMI 48075United States Department of gastroenterology University of Toledo Medical CenterToledoOH 43614United States

Artificial intelligence(AI)is the timeliest field of computer science and attempts to mimic cognitive function of humans to solve *** the era of“Big data”,there is an ever-increasing need for AI in all aspects of ***(CCA)is the second most common primary malignancy of liver that has shown an increase in incidence in the last *** has high mortality as it is diagnosed in later stages that decreases effect of surgery,chemotherapy,and other *** technological advancement there is an immense amount of clinicopathologic,genetic,serologic,histologic,and radiologic data that can be assimilated together by modern AI tools for diagnosis,treatment,and prognosis of *** literature shows that in almost all cases AI models have the capacity to increase accuracy in diagnosis,treatment,and prognosis of *** studies however are retrospective,and one study failed to show AI benefit in *** is immense potential for AI in diagnosis,treatment,and prognosis of CCA however limitations such as relative lack of studies in use by human operators in improvement of survival remains to be seen.

关键词： Artificial intelligence Machine learning Cholangiocarcinoma Diagnosis Treatment Prognosis

Molecular profiling reveals potential targets in cholangiocarcinoma

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World Journal of gastroenterology 2023年第25期29卷 4053-4071页

作者： Dan Liu Yang Shi Hongze Chen Muhammad Azhar Nisar Nicholas Jabara Noah Langwinski Sophia Mattson Katsuya Nagaoka Xuewei Bai Shaolei Lu Chiung-Kuei Huang Department of gastroenterology The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052Henan ProvinceChina Pathology and Laboratory Medicine Tulane University School of MedicineNew OrleansLA 70112United States Department of Medicine Rhode Island Hospital and the Alpert Medical School of Brown UniversityProvidenceRI 02903United States Department of Pathology Alpert Medical School of Brown UniversityProvidenceRI 02903United States

BACKGROUND Cholangiocarcinoma(CCA)is a devastating malignancy and has a very poor prognosis if tumors spread outside the *** the molecular mechanisms underlying the CCA progression will likely yield therapeutic approaches toward treating this deadly *** To determine the molecular pathogenesis in CCA *** In silico analysis,in vitro cell culture,CCA transgenic animals,histological,and molecular assays were adopted to determine the molecular *** The transcriptomic data of human CCA samples were retrieved from The Cancer Genome Atlas(TGCA,CHOL),European Bioinformatics Institute(EBI,GAD-00001001076),and Gene Expression Omnibus(GEO,GSE107943)*** Gene set enrichment analysis,the cell cycle and Notch related pathways were demonstrated to be significantly activated in CCA in TCGA and GEO ***,through differentially expressed genes,found several cell cycle and notch associated genes were significantly up-regulated in cancer tissues when compared with the non-cancerous control *** associated genes,via quantitative real-time PCR and western blotting assays,were further examined in normal human cholangiocytes,CCA cell lines,mouse normal bile ducts,and mouse CCA tumors established by specifically depleting P53 and expressing KrasG12D mutation in the ***,we validated that the cell cycle and Notch pathways are up-regulated in CCA cell lines and mouse CCA ***,targeting cell cycle and notch pathways using small molecules also exhibited significant beneficial effects in controlling tumor *** importantly,we demonstrated that several cell cycle and Notch associated genes are significantly associated with poor overall survival and disease-free survival using the Log-Rank *** In summary,our study comprehensively analyzed the gene expression pattern of CCA samples using publicly available datasets and identified the cell cycle and Notch pathways are po

关键词： Bile duct cancer Notch Cell cycle Liver cancer Therapeutic target

Truth lies below: A case report and literature review of typical appearing polyps yet with an atypical diagnosis

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World Journal of Gastrointestinal Endoscopy 2019年第1期11卷 54-59页

作者： Aaron Fisher Edward Yousif Marc Piper Department of Internal Medicine University of Michigan Medical School Department of Internal Medicine Division of GastroenterologyProvidence-Providence Park Hospital Michigan State University College of Human Medicine

BACKGROUND Enteropathy associated T-cell lymphoma(EATL) is a rare form of peripheral Tcell lymphoma and makes up less than 5% of gastrointestinal lymphomas. EATL can be divided into type 1 which is associated with celiac disease, and monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL), formally type 2, which is not associated with celiac *** SUMMARY We present a 60-year-old African American female, without celiac disease, who presented with abdominal pain, diarrhea, and 30 lb. weight loss over a 3 month period. She was subsequently diagnosed with EATL throughout her entire gastrointestinal tract. She is currently undergoing chemotherapy with EOCH(Etoposide, Oncovin, Cyclophosphamide, and Hydroxydaunorubicin). EATL is most common in the Asian and Hispanic population yet the incidence in African Americans is uncertain and emphasizes the rarity of this case. A literature review was included to further emphasize similarities and differences between our case and previously reported cases of *** The patient was diagnosed with EATL, immunochemical testing was not conclusive for MEITL however was suggestive of the disease.

关键词： Enteropathy associated T-cell lymphoma Monomorphic epitheliotropic intestinal T-cell lymphoma Peripheral T-cell lymphoma Gastrointestinal lymphoma Endoscopy Case report Literature review

Gut microbiome in non-alcoholic fatty liver disease associated hepatocellular carcinoma:Current knowledge and potential for therapeutics

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World Journal of Gastrointestinal Oncology 2022年第5期14卷 947-958页

作者： Imaad Said Hassan Ahad Adnan Said Brown University ProvidenceRI 02912United States Kansas University LawrenceKS 66045United States Division of gastroenterology and Hepatology Department of MedicineWilliam S.Middleton VAMCUniversity of Wisconsin School of Medicine and Public HealthMadisonWI 53705United States

Metabolic diseases such as nonalcoholic fatty liver disease(NAFLD)are rising in incidence and are an increasingly common cause of cirrhosis and hepatocellular carcinoma(HCC).The gut microbiome is closely connected to the liver via the portal vein,and has recently been identified as a predictor of liver disease *** in NAFLD,cirrhosis and HCC have identified certain microbial signatures associated with these diseases,with the disease-associated microbiome changes collectively referred to as *** pathophysiologic underpinnings of these observations are an area of ongoing investigation,with current evidence demonstrating that the gut microbiome can influence liver disease and carcinogenesis via effects on intestinal permeability(leaky gut)and activation of the innate immune *** the innate immune system,pathogen recognition receptors(Toll like receptors)on resident liver cells and macrophages cause liver inflammation,fibrosis,hepatocyte proliferation and reduced antitumor immunity,leading to chronic liver disease and ***-associated changes include increase in secondary bile acids and reduced expression of FXR(nuclear receptor),which have also been associated with deleterious effects on lipid and carbohydrate metabolism associated with progressive liver *** experimental and clinical studies are needed in different populations to examine these questions *** role of therapeutics that modulate the microbiome is an emerging field with experimental studies showing the potential of diet,probiotics,fecal microbiota transplantation and prebiotics in improving liver disease in experimental *** studies are ongoing with preliminary evidence showing improvement in liver enzymes and *** microbial profile is different in responders to cancer immunotherapy including liver cancer,but whether or not manipulation of the microbiome can be utilized to affect response is being investigated.

关键词： Microbiome Gut microbiome Hepatocellular carcinoma Nonalcoholic fatty liver disease Pathophysiology Treatment