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Development of Time-Aggregated Machine Learning Model for Relapse Prediction in Pediatric Crohn's Disease. 开发用于预测小儿克罗恩病复发的时间聚合机器学习模型
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-21 DOI: 10.14309/ctg.0000000000000794
Sooyoung Jang, JaeYong Yu, Sowon Park, Hyeji Lim, Hong Koh, Yu Rang Park

Introduction: Pediatric Crohn's disease (CD) easily progresses to an active disease compared to adult CD, making it important to predict and minimize CD relapses. However, prediction of relapse at various time points (TPs) during pediatric CD remains understudied. We aimed to develop a real-time aggregated model to predict pediatric CD relapse in different TPs and time windows (TWs).

Methods: This retrospective study was conducted on children diagnosed with CD between 2015 and 2022 at Severance Hospital. Laboratory test results and demographic data were collected starting at 3 months after diagnosis, and cohorts were formed using data from six different TPs at 1-month intervals. Relapse-defined as a pediatric CD activity index ≥30 points-was predicted, and TWs were 3-7 months with 1-month intervals. The feature importance of the variables in each setting was determined.

Results: Data from 180 patients were used to construct cohorts corresponding to the TPs. We identified the optimal TP and TW to reliably predict pediatric CD relapse with an area under the receiver operating characteristic curve score of 0.89 when predicting with a 3-month TW at a 3-month TP. Variables such as C-reactive protein levels and lymphocyte fraction were found to be important factors.

Discussion: We developed a time-aggregated model to predict pediatric CD relapse in multiple TPs and TWs. This model identified important variables that predicted relapse in pediatric CD to support real-time clinical decision making.

导言:与成人克罗恩病(CD)相比,小儿克罗恩病(CD)很容易进展为活动性疾病,因此预测并尽量减少 CD 复发非常重要。然而,对小儿克罗恩病不同时间点(TPs)的复发预测研究仍然不足。我们的目的是开发一个实时汇总模型,以预测小儿 CD 在不同时间点和时间窗 (TW) 的复发:这项回顾性研究针对2015年至2022年期间在塞弗兰医院确诊为CD的儿童。从确诊后 3 个月开始收集实验室检查结果和人口统计学数据,并以 1 个月为间隔,使用 6 个不同 TP 的数据组成队列。预测复发定义为小儿 CD 活动指数≥30 点,TW 为 3-7 个月,间隔为 1 个月。结果:结果:来自 180 名患者的数据被用于构建与 TPs 相对应的队列。我们确定了能可靠预测小儿 CD 复发的最佳 TP 和 TW,当以 3 个月的 TW 预测 3 个月的 TP 时,接收者操作特征曲线下面积得分为 0.89。C反应蛋白水平和淋巴细胞比例等变量被认为是重要因素:讨论:我们建立了一个时间聚合模型来预测小儿 CD 在多个 TP 和 TW 中的复发。该模型确定了预测小儿 CD 复发的重要变量,以支持实时临床决策。
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引用次数: 0
Diagnosing Small Intestinal Bacterial Overgrowth. 诊断小肠细菌过度生长。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-21 DOI: 10.14309/ctg.0000000000000783
Gernot Kriegshäuser
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引用次数: 0
The Effects of Testosterone Replacement Therapy in Adult Men with Metabolic Dysfunction associated Steatotic Liver Disease: A Systematic Review and Meta-analysis. 睾酮替代疗法对代谢功能障碍伴有脂肪肝的成年男性的影响:系统回顾与元分析》。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-06 DOI: 10.14309/ctg.0000000000000787
Maya Mahmoud, Hassan Kawtharany, Mohamed Awali, Nadine Mahmoud, Islam Mohamed, Wing-Kin Syn

Background: Sex steroids modulate metabolic-dysfunction associated steatotic liver disease (MASLD) pathobiology. We hypothesized that testosterone therapy (TT) modulates progression of MASLD, and performed a systematic review to evaluate the efficacy of TT on liver steatosis and fibrosis.

Methods: We searched PubMed and Embase from inception until November 2023. We screened 1489 studies and identified 9 eligible studies. We assessed risk of bias for randomized trials using RoB-2 "Cochrane risk of bias tool for randomized trials", non-randomized studies using ROBINS-I tool "Risk of Bias in Non-randomized Studies-of Interventions", and Murad's Tool for single-arm studies. We pooled estimates using RevMan 5.

Results: 3 randomized controlled trials (RCTs), 4 non-randomized studies, and 2 single-arm studies were identified. The population of interest comprised men with MASLD. TT was administered at varying doses, routes, and frequencies, with follow-up ranging 12-weeks to 8-years. Liver fibrosis and steatosis were assessed using liver biopsy in 3 studies, CT/MRI in 5, and serum scores in 2. All studies provided evidence of reduction in liver steatosis with TT compared to no TT. In addition, the LiFT (RCT) trial demonstrated a resolution of MASLD / MASH and a regression in liver fibrosis. TT led to decrease in liver enzymes. Studies were heterogenous in terms of population characteristics, treatment modalities, endpoints, and follow-up. Adverse events were comparable between the 2 groups.

Conclusion: TT is a promising treatment option for men with MASLD and low testosterone. It may improve liver steatosis and reduce liver fibrosis. Large, double-blinded randomized placebo-controlled trials are needed.

背景:性类固醇可调节代谢功能障碍相关性脂肪性肝病(MASLD)的病理生物学。我们假设睾酮疗法(TT)可调节MASLD的进展,并进行了一项系统性综述,以评估TT对肝脏脂肪变性和纤维化的疗效:我们检索了从开始到 2023 年 11 月的 PubMed 和 Embase。我们筛选了 1489 项研究,确定了 9 项符合条件的研究。我们使用RoB-2 "Cochrane随机试验偏倚风险工具 "评估了随机试验的偏倚风险,使用ROBINS-I工具 "非随机干预研究的偏倚风险 "评估了非随机研究的偏倚风险,使用Murad工具评估了单臂研究的偏倚风险。我们使用 RevMan 5.Results 对估计结果进行了汇总:结果:确定了 3 项随机对照试验 (RCT)、4 项非随机研究和 2 项单臂研究。研究对象包括患有 MASLD 的男性。TT的给药剂量、途径和频率各不相同,随访时间从12周到8年不等。有 3 项研究使用肝活检、5 项研究使用 CT/MRI、2 项研究使用血清评分对肝纤维化和脂肪变性进行了评估。此外,LiFT(RCT)试验表明,MASLD/MASH 已得到缓解,肝纤维化也有所减轻。TT 可降低肝酶。这些研究在人群特征、治疗方式、终点和随访方面存在差异。两组研究的不良事件具有可比性:TT对于患有MASLD和低睾酮的男性来说是一种很有前景的治疗选择。结论:TT 对患有 MASLD 和低睾酮症的男性来说是一种很有前景的治疗方案,它可以改善肝脏脂肪变性并减轻肝纤维化。需要进行大型双盲随机安慰剂对照试验。
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引用次数: 0
Size of Pelvic Outlet as a Potential Risk Factor for Fecal Incontinence: A Population-Based Exploratory Analysis. 作为大便失禁潜在风险因素的骨盆出口大小:基于人群的探索性分析。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-05 DOI: 10.14309/ctg.0000000000000789
Brent Hiramoto, Bryn E Falahee, Mayssan Muftah, Ryan Flanagan, Eric D Shah, Walter W Chan

Background: The impact of pelvic bone structure on fecal incontinence (FI) is unclear. We assessed the association between weight-adjusted pelvic area and FI.

Methods: This was a population-based analysis of the National Health and Nutrition Examination Survey in 2005-2006. Participants who completed the bowel health survey and dual-energy x-ray absorptiometry (DXA) were included.

Results: On multivariable analysis of 2,772 participants, the lowest pelvic area quartile predicted increased FI compared to the third (OR:2.05, CI:1.18-3.56, p=0.014) and fourth (OR:1.94, CI:1.02-3.70, p=0.045) quartiles. Sex-stratified analyses found similar association among female patients only.

Conclusion: Small pelvic area on DXA is a potential risk factor for FI.

背景:骨盆骨骼结构对大便失禁(FI)的影响尚不明确。我们评估了体重调整后骨盆面积与 FI 之间的关系:这是一项基于 2005-2006 年全国健康与营养调查的人群分析。方法:这是一项基于 2005-2006 年全国健康与营养调查的人群分析,纳入了完成肠道健康调查和双能 X 射线吸收测定(DXA)的参与者:对 2,772 名参与者进行多变量分析后发现,骨盆面积最低的四分位数与第三(OR:2.05,CI:1.18-3.56,p=0.014)和第四(OR:1.94,CI:1.02-3.70,p=0.045)个四分位数相比,预示着 FI 的增加。性别分层分析仅在女性患者中发现了类似的关联:结论:DXA显示骨盆面积小是FI的潜在风险因素。
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引用次数: 0
Association of Childhood Abuse with Incident Inflammatory Bowel Disease. 童年遭受虐待与炎症性肠病的关系
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-25 DOI: 10.14309/ctg.0000000000000718
Adjoa Anyane-Yeboa, Kevin Casey, Andrea L Roberts, Emily Lopes, Kristin Burke, Ashwin Ananthakrishnan, James Richter, Yvette C Cozier, Karenstan C Koenen, Andrew T Chan, Hamed Khalili

Introduction: A link between inflammatory bowel disease (IBD), stressful life events and psychological factors has previously been reported. Our objective was to examine the relationship between childhood emotional, physical, and sexual abuse and risk of IBD using a large cohort of female health professionals.

Methods: We included participants in the Nurses' Health Study II who completed the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire and the Sexual Maltreatment Scale of the Parent-Child Conflict Tactics Scale in 2001. Diagnosis of IBD was determined by self-report and confirmed independently by two physicians through review of medical records. We used Cox proportional hazard modeling to estimate the risk of Crohn's disease (CD) and ulcerative colitis (UC) while adjusting for covariates.

Results: Among 68,167 women followed from 1989 until 2017, there were 146 incident cases of CD and 215 incident cases of UC. Compared to women with no history of abuse, the adjusted hazard ratios of CD were 1.16 (95% CI 0.67 - 2.02) for mild, 1.58 (95% CI 0.92 - 2.69) for moderate, and 1.95 (95% CI 1.22 - 3.10) for severe abuse (Ptrend = 0.002). We did not observe an association between childhood abuse and risk of UC.

Conclusions: Women who reported early life severe abuse had an increased risk of CD. These data add to the growing body of evidence on the critical role of early life stressors in development of CD.

简介以前曾有报道称炎症性肠病(IBD)、生活压力事件和心理因素之间存在联系。我们的目的是通过一个大型女性卫生专业人员队列来研究童年情感、身体和性虐待与 IBD 风险之间的关系:我们的研究对象包括 2001 年参加护士健康研究 II 并填写了童年创伤问卷中的身体和情感虐待分量表以及亲子冲突策略量表中的性虐待量表的人员。IBD 诊断通过自我报告确定,并由两名医生通过查看病历独立确认。我们使用 Cox 比例危险模型来估算克罗恩病(CD)和溃疡性结肠炎(UC)的发病风险,同时调整协变量:从1989年到2017年,在68 167名女性中,有146例CD和215例UC病例。与无虐待史的女性相比,轻度虐待的CD调整危险比为1.16(95% CI 0.67 - 2.02),中度虐待的CD调整危险比为1.58(95% CI 0.92 - 2.69),重度虐待的CD调整危险比为1.95(95% CI 1.22 - 3.10)(Ptrend = 0.002)。我们没有观察到童年虐待与 UC 风险之间的关联:结论:报告早期遭受严重虐待的女性罹患 CD 的风险更高。这些数据为越来越多的证据增添了新的内容,这些证据表明早期生活中的压力因素对 CD 的发展起着至关重要的作用。
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引用次数: 0
Proportion and characteristics of Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: A systematic review and meta-analysis. 幽门螺杆菌阴性胃黏膜相关淋巴组织淋巴瘤的比例和特征:系统回顾与荟萃分析。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-25 DOI: 10.14309/ctg.0000000000000781
Xiu-He Lv, Qing Lu, Jia-Huan Liu, Bi-Han Xia, Zi-Jing Wang, Zhu Wang, Jin-Lin Yang

Background: While Helicobacter pylori (H. pylori) infection is common in patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma, there are still individuals who test negative for it. The proportion and characteristics of these patients remain unclear.

Methods: We conducted a systematic search of the PubMed, Embase, and Cochrane Library databases for relevant articles. Using a random effects model, we performed a meta-analysis to assess the pooled proportion of gastric MALT lymphoma patients with negative H. pylori tests. Additionally, we compared characteristics between gastric MALT lymphoma patients with and without H. pylori infection to examine clinical features in H. pylori-negative cases.

Results: A total of 50 studies involving 6033 patients were included. The overall proportion of gastric MALT lymphoma patients with negative H. pylori tests was 20.5% (95% confidence interval: 17.0%-24.6%). This rate exhibited an increasing trend over the years, particularly in non-Asian countries and in studies published after 2013, as well as in cases with sample sizes exceeding 100 participants, in male individuals, and among those with proximal or multiple lesions, non-superficial type morphology, submucosal invasion, and advanced clinical staging. Compared to H. pylori-positive patients, those who tested negative were more likely to be male, have proximal lesions, exhibit submucosal invasion, and present with an advanced clinical stage.

Conclusions: This study provides comprehensive information on the proportion and characteristics of H. pylori-negative gastric MALT lymphoma cases, highlighting the need for future clinical attention to treatment and surveillance in this patient population.

背景:幽门螺杆菌(H. pylori)感染在胃黏膜相关淋巴组织(MALT)淋巴瘤患者中很常见,但仍有检测结果为阴性的患者。这些患者的比例和特征仍不清楚:我们对 PubMed、Embase 和 Cochrane Library 数据库中的相关文章进行了系统检索。我们使用随机效应模型进行了荟萃分析,以评估幽门螺杆菌检测呈阴性的胃 MALT 淋巴瘤患者的总体比例。此外,我们还比较了有幽门螺杆菌感染和无幽门螺杆菌感染的胃MALT淋巴瘤患者的特征,以研究幽门螺杆菌阴性病例的临床特点:结果:共纳入了 50 项研究,涉及 6033 名患者。幽门螺杆菌检测阴性的胃MALT淋巴瘤患者总比例为20.5%(95%置信区间:17.0%-24.6%)。这一比例呈逐年上升趋势,尤其是在非亚洲国家和2013年以后发表的研究中,以及在样本量超过100人的病例中、男性患者中、有近端或多发病灶、非浅表型形态、粘膜下侵犯和晚期临床分期的患者中。与幽门螺杆菌阳性患者相比,检测结果为阴性的患者更有可能是男性、有近端病变、表现出粘膜下侵犯以及临床分期较晚:本研究提供了幽门螺杆菌阴性胃MALT淋巴瘤病例比例和特征的全面信息,强调了未来临床上需要关注这一患者群体的治疗和监测。
{"title":"Proportion and characteristics of Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: A systematic review and meta-analysis.","authors":"Xiu-He Lv, Qing Lu, Jia-Huan Liu, Bi-Han Xia, Zi-Jing Wang, Zhu Wang, Jin-Lin Yang","doi":"10.14309/ctg.0000000000000781","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000781","url":null,"abstract":"<p><strong>Background: </strong>While Helicobacter pylori (H. pylori) infection is common in patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma, there are still individuals who test negative for it. The proportion and characteristics of these patients remain unclear.</p><p><strong>Methods: </strong>We conducted a systematic search of the PubMed, Embase, and Cochrane Library databases for relevant articles. Using a random effects model, we performed a meta-analysis to assess the pooled proportion of gastric MALT lymphoma patients with negative H. pylori tests. Additionally, we compared characteristics between gastric MALT lymphoma patients with and without H. pylori infection to examine clinical features in H. pylori-negative cases.</p><p><strong>Results: </strong>A total of 50 studies involving 6033 patients were included. The overall proportion of gastric MALT lymphoma patients with negative H. pylori tests was 20.5% (95% confidence interval: 17.0%-24.6%). This rate exhibited an increasing trend over the years, particularly in non-Asian countries and in studies published after 2013, as well as in cases with sample sizes exceeding 100 participants, in male individuals, and among those with proximal or multiple lesions, non-superficial type morphology, submucosal invasion, and advanced clinical staging. Compared to H. pylori-positive patients, those who tested negative were more likely to be male, have proximal lesions, exhibit submucosal invasion, and present with an advanced clinical stage.</p><p><strong>Conclusions: </strong>This study provides comprehensive information on the proportion and characteristics of H. pylori-negative gastric MALT lymphoma cases, highlighting the need for future clinical attention to treatment and surveillance in this patient population.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of SCN10A Polymorphism on Abdominal Pain Perception and Visceral Hypoalgesia in Crohn's Disease and Ulcerative Colitis. SCN10A 多态性对克罗恩病和溃疡性结肠炎患者腹痛感知和内脏痛觉减退的影响
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-17 DOI: 10.14309/ctg.0000000000000778
Matthew D Coates, Vonn Walter, August Stuart, Jeffrey Small, Shannon Dalessio, Nurgul Carkaci-Salli, Ann Ouyang, Kofi Clarke, Andrew Tinsley, Emmanuelle D Williams, Piotr Janicki, Victor Ruiz-Velasco, Kent E Vrana

Introduction: Hypoalgesic inflammatory bowel disease (IBD) may provide critical insights into human abdominal pain. This condition was previously associated with homozygosity for a polymorphism (rs6795970,A1073V;1073val/val) related to Nav1.8, a voltage-gated sodium channel preferentially expressed on nociceptors. It was unclear whether this relationship existed for both Crohn's disease (CD) and ulcerative colitis (UC). This study evaluated a larger, carefully phenotyped IBD cohort to investigate this question.

Methods: Allelic and genotypic frequencies of rs6795970 were compared among study cohorts characterized by concomitant assessment of intestinal inflammatory status and abdominal pain experience. Visceral sensory perception was performed in healthy individuals using rectal balloon distension(RBD).

Results: We analyzed 416 IBD patients (261CD:155UC) and 142 healthy controls. In the IBD cohort, 84 individuals (43CD:41UC) were determined to have hypoalgesic disease. The allelic frequency of rs6795970 was significantly higher in hypoalgesic IBD patients when compared to other IBD patients and healthy controls. Hypoalgesic IBD patients were also more likely to be homozygous for this polymorphism when compared to other IBD patients and healthy controls. Hypoalgesic CD (30%vs.12%,p=0.004) and hypoalgesic UC (32%vs.15%,p=0.036) were each significantly more likely to be associated with homozygosity for the rs6795970 polymorphism. In a cohort of healthy individuals(n=50), rs6795970 homozygotes(n=11) also demonstrated reduced abdominal discomfort to RBD.

Discussion: These findings indicate that Nav1.8 plays a key role in human visceral pain perception, and could serve as a novel diagnostic target in the management of hypoalgesic CD and UC, and potential therapeutic target for conditions associated with chronic abdominal pain.

导言:低痛觉炎症性肠病(IBD)可能为人类腹痛提供重要的启示。这种疾病以前与一种多态性(rs6795970,A1073V;1073val/val)的同源性有关,这种多态性与 Nav1.8 有关,Nav1.8 是一种电压门控钠通道,在痛觉感受器上优先表达。目前还不清楚克罗恩病(CD)和溃疡性结肠炎(UC)是否都存在这种关系。本研究评估了一个规模更大、表型更仔细的 IBD 队列,以探究这一问题:在同时评估肠道炎症状态和腹痛经历的研究队列中比较了 rs6795970 的等位基因和基因型频率。在健康人中使用直肠球囊扩张(RBD)法进行内脏感知:我们分析了 416 名 IBD 患者(261CD:155UC)和 142 名健康对照者。在 IBD 队列中,有 84 人(43CD:41UC)被确定患有低痛觉疾病。与其他 IBD 患者和健康对照组相比,低痛感 IBD 患者的 rs6795970 等位基因频率明显更高。与其他 IBD 患者和健康对照组相比,低镇痛 IBD 患者也更有可能是该多态性的同卵双生者。低痛感的 CD(30%vs.12%,p=0.004)和低痛感的 UC(32%vs.15%,p=0.036)都更有可能与 rs6795970 多态性的同源性有关。在一组健康人(n=50)中,rs6795970 同源基因携带者(n=11)也表现出对 RBD 的腹部不适感减少:这些研究结果表明,Nav1.8 在人类内脏痛觉中起着关键作用,可作为治疗低痛觉 CD 和 UC 的新型诊断靶点,以及慢性腹痛相关疾病的潜在治疗靶点。
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引用次数: 0
A Multi-Institutional Study on Ultrasound Image Analysis for Staging HBV-Derived Liver Fibrosis: A Potential Noninvasive Alternative to Liver Stiffness Measurement. 一项关于超声图像分析用于分期 HBV 衍生肝纤维化的多机构研究:肝脏硬度测量的潜在无创替代方法。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-17 DOI: 10.14309/ctg.0000000000000780
Jincheng Wang, Lihua Cao, Fang Liu, Chunhui Li, Peng Zhao, Zhaoyi Li, Xiaojie Lu, Xiaohang Ye, Jianfeng Bao

Introduction: Liver stiffness measurement is principal for staging liver fibrosis but not included in routine examinations. We investigated whether comparable diagnostic performance can be achieved by mining ultrasound images and developing a novel serum index (NSI).

Methods: Texture features were extracted from ultrasound images. Spearman correlation and logistics regression selected independent variables for significant (F ≥ 2) and advanced (F ≥ 3) fibrosis. We compared the diagnostic performance of transient elastography (TE), ultrasound image biomarker, conventional serum indices (aspartate aminotransferase-to-platelet ratio index, fibrosis-4 index, gamma-glutamyl transpeptidase-to-platelet ratio), and NSI in 365 patients with chronic hepatitis B.

Results: Among patients, 52.1% had significant fibrosis and 24.2% had advanced fibrosis. PLT, gamma-glutamyl transferase, prealbumin, and globulin were incorporated into NSI. In the validation group, TE achieved the best performance (area under the curve [AUC]: 0.765 [0.690-0.849] for significant fibrosis; 0.812 [0.745-0.878] for advanced fibrosis), followed by ultrasound image biomarker (AUC: 0.712 [0.629-0.795]; 0.678 [0.595-0.763]) and NSI (AUC: 0.630 [0.534-0.725]; 0.659 [0.572-0.745]), outperforming conventional indices.

Discussion: Texture analysis enhances ultrasound's diagnostic utility, but TE remains superior. When TE is unavailable, ultrasound image analysis and NSI, incorporating prealbumin, can serve as alternative tools for fibrosis staging.

背景:肝脏硬度测量是肝纤维化分期的主要依据,但未被纳入常规检查。我们研究了是否可以通过挖掘超声图像和开发新型血清指数(NSI)来实现类似的诊断性能:方法:从超声图像中提取纹理特征。方法:从超声图像中提取纹理特征,通过斯皮尔曼相关性和物流回归选择显著纤维化(F≥2)和晚期纤维化(F≥3)的独立变量。我们比较了瞬态弹性成像(TE)、超声图像生物标志物(UIB)、传统血清指数(APRI、FIB-4、GPR)和 NSI 对 365 名慢性乙型肝炎患者的诊断效果:在患者中,52.1%有明显纤维化,24.2%为晚期纤维化。PLT、GGT、前白蛋白和球蛋白被纳入 NSI。在验证组中,TE 的性能最佳(AUC:其次是 UIB(AUC:0.712 [0.629-0.795];0.678 [0.595-0.763])和 NSI(AUC:0.630 [0.534-0.725];0.659 [0.572-0.745]),表现优于传统指数:结论:纹理分析增强了超声诊断的实用性,但TE仍然更胜一筹。结论:纹理分析增强了超声诊断的实用性,但TE仍然更胜一筹。当无法使用TE时,超声图像分析和结合前白蛋白的NSI可作为纤维化分期的替代工具。
{"title":"A Multi-Institutional Study on Ultrasound Image Analysis for Staging HBV-Derived Liver Fibrosis: A Potential Noninvasive Alternative to Liver Stiffness Measurement.","authors":"Jincheng Wang, Lihua Cao, Fang Liu, Chunhui Li, Peng Zhao, Zhaoyi Li, Xiaojie Lu, Xiaohang Ye, Jianfeng Bao","doi":"10.14309/ctg.0000000000000780","DOIUrl":"10.14309/ctg.0000000000000780","url":null,"abstract":"<p><strong>Introduction: </strong>Liver stiffness measurement is principal for staging liver fibrosis but not included in routine examinations. We investigated whether comparable diagnostic performance can be achieved by mining ultrasound images and developing a novel serum index (NSI).</p><p><strong>Methods: </strong>Texture features were extracted from ultrasound images. Spearman correlation and logistics regression selected independent variables for significant (F ≥ 2) and advanced (F ≥ 3) fibrosis. We compared the diagnostic performance of transient elastography (TE), ultrasound image biomarker, conventional serum indices (aspartate aminotransferase-to-platelet ratio index, fibrosis-4 index, gamma-glutamyl transpeptidase-to-platelet ratio), and NSI in 365 patients with chronic hepatitis B.</p><p><strong>Results: </strong>Among patients, 52.1% had significant fibrosis and 24.2% had advanced fibrosis. PLT, gamma-glutamyl transferase, prealbumin, and globulin were incorporated into NSI. In the validation group, TE achieved the best performance (area under the curve [AUC]: 0.765 [0.690-0.849] for significant fibrosis; 0.812 [0.745-0.878] for advanced fibrosis), followed by ultrasound image biomarker (AUC: 0.712 [0.629-0.795]; 0.678 [0.595-0.763]) and NSI (AUC: 0.630 [0.534-0.725]; 0.659 [0.572-0.745]), outperforming conventional indices.</p><p><strong>Discussion: </strong>Texture analysis enhances ultrasound's diagnostic utility, but TE remains superior. When TE is unavailable, ultrasound image analysis and NSI, incorporating prealbumin, can serve as alternative tools for fibrosis staging.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Serum Autotaxin Levels Predict Liver-Related Events in Primary Biliary Cholangitis Patients: A Long-term Multicenter Observational Study: Autotaxin predict liver-related events in PBC. 血清自体表皮生长因子水平可预测原发性胆汁性胆管炎患者的肝脏相关事件:一项长期多中心观察研究:自体表皮生长因子可预测原发性胆汁性胆管炎患者的肝脏相关事件
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-17 DOI: 10.14309/ctg.0000000000000779
Takanobu Iwadare, Takefumi Kimura, Yuki Yamashita, Taiki Okumura, Shun-Ichi Wakabayashi, Hiroyuki Kobayashi, Ayumi Sugiura, Tomoo Yamazaki, Satoshi Shimamoto, Koji Igarashi, Satoru Joshita, Takeji Umemura

Background: A straightforward, reliable, and noninvasive method for predicting the development of liver-related events (LRE) in primary biliary cholangitis (PBC) has not been attained thus far. The present study investigated whether serum autotaxin (ATX) could predict liver-related events (LRE) in PBC patients.

Methods: This retrospective multicenter investigation included 190 biopsy-proven untreated PBC patients. All subjects were followed for at least 1 year, during which time the prevalence of LRE, including newly developing hepatocellular carcinoma, esophagogastric varices, ascites, and hepatic encephalopathy, was investigated in relation to ATX levels at the time of liver biopsy.

Results: During the median follow-up period of 9.7 years, LRE were observed in 22 patients (11.6%). The area under the receiver operating characteristic curve and cut-off value of serum ATX for predicting LRE were 0.80 and 1.086 mg/L, respectively. Patients with serum ATX ≥ 1.086 had a significantly higher cumulative incidence of LRE compared with patients with ATX < 1.086 (33.3% vs. 3.6%, p < 0.00001). Notably, the predictive capability of ATX for LRE in PBC patients surpassed that of FIB-4, ALBI, APRI, and M2BPGi. A multivariate Cox proportional hazards model revealed ATX as an independent associated factor for LRE (hazard ratio 6.24, 95% confidence interval 1.87-20.80, p = 0.003) along with Nakanuma stage (hazard ratio 2.75, 95% confidence interval 1.52-4.99, p < 0.001). These results were closely replicated in a serologically diagnosed PBC validation cohort (n = 32).

Conclusion: Serum ATX levels may serve as a predictive marker for LRE in patients with PBC.

背景:迄今为止,还没有一种直接、可靠和无创的方法来预测原发性胆汁性胆管炎(PBC)肝脏相关事件(LRE)的发生。本研究探讨了血清自体表皮生长因子(ATX)能否预测原发性胆汁性胆管炎患者的肝脏相关事件(LRE):这项回顾性多中心调查包括190名经活检证实未经治疗的PBC患者。所有受试者都接受了至少一年的随访,在此期间,研究人员根据肝活检时的 ATX 水平调查了 LRE 的发生率,包括新发肝细胞癌、食管胃静脉曲张、腹水和肝性脑病:在中位 9.7 年的随访期间,22 名患者(11.6%)观察到 LRE。预测 LRE 的接收者操作特征曲线下面积和血清 ATX 临界值分别为 0.80 和 1.086 mg/L。与 ATX < 1.086 的患者相比,血清 ATX ≥ 1.086 的患者 LRE 累积发生率明显更高(33.3% 对 3.6%,P < 0.00001)。值得注意的是,ATX对PBC患者LRE的预测能力超过了FIB-4、ALBI、APRI和M2BPGi。多变量 Cox 比例危险模型显示,ATX 与中沼分期(危险比 2.75,95% 置信区间 1.52-4.99,p <0.001)是 LRE 的独立相关因素(危险比 6.24,95% 置信区间 1.87-20.80,p = 0.003)。这些结果在经血清学诊断的 PBC 验证队列(n = 32)中得到了紧密的重复:血清 ATX 水平可作为 PBC 患者 LRE 的预测指标。
{"title":"Serum Autotaxin Levels Predict Liver-Related Events in Primary Biliary Cholangitis Patients: A Long-term Multicenter Observational Study: Autotaxin predict liver-related events in PBC.","authors":"Takanobu Iwadare, Takefumi Kimura, Yuki Yamashita, Taiki Okumura, Shun-Ichi Wakabayashi, Hiroyuki Kobayashi, Ayumi Sugiura, Tomoo Yamazaki, Satoshi Shimamoto, Koji Igarashi, Satoru Joshita, Takeji Umemura","doi":"10.14309/ctg.0000000000000779","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000779","url":null,"abstract":"<p><strong>Background: </strong>A straightforward, reliable, and noninvasive method for predicting the development of liver-related events (LRE) in primary biliary cholangitis (PBC) has not been attained thus far. The present study investigated whether serum autotaxin (ATX) could predict liver-related events (LRE) in PBC patients.</p><p><strong>Methods: </strong>This retrospective multicenter investigation included 190 biopsy-proven untreated PBC patients. All subjects were followed for at least 1 year, during which time the prevalence of LRE, including newly developing hepatocellular carcinoma, esophagogastric varices, ascites, and hepatic encephalopathy, was investigated in relation to ATX levels at the time of liver biopsy.</p><p><strong>Results: </strong>During the median follow-up period of 9.7 years, LRE were observed in 22 patients (11.6%). The area under the receiver operating characteristic curve and cut-off value of serum ATX for predicting LRE were 0.80 and 1.086 mg/L, respectively. Patients with serum ATX ≥ 1.086 had a significantly higher cumulative incidence of LRE compared with patients with ATX < 1.086 (33.3% vs. 3.6%, p < 0.00001). Notably, the predictive capability of ATX for LRE in PBC patients surpassed that of FIB-4, ALBI, APRI, and M2BPGi. A multivariate Cox proportional hazards model revealed ATX as an independent associated factor for LRE (hazard ratio 6.24, 95% confidence interval 1.87-20.80, p = 0.003) along with Nakanuma stage (hazard ratio 2.75, 95% confidence interval 1.52-4.99, p < 0.001). These results were closely replicated in a serologically diagnosed PBC validation cohort (n = 32).</p><p><strong>Conclusion: </strong>Serum ATX levels may serve as a predictive marker for LRE in patients with PBC.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessment of Glucose and HbA1c Monitoring in a Pancreatic Cancer Surveillance Program for High-Risk Individuals. 评估胰腺癌高危人群监测计划中的葡萄糖和 HbA1c 监测。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-16 DOI: 10.14309/ctg.0000000000000777
Jihane Meziani, Jedidja G Y de Jong, Gwenny M Fuhler, Brechtje D M Koopmann, Iris J M Levink, Paul Fockens, Frank P Vleggaar, Marco J Bruno, Djuna L Cahen

Introduction: Several studies suggest that new-onset diabetes mellitus is an early manifestation of pancreatic ductal adenocarcinoma (PDAC). Therefore, the International Cancer of the Pancreas Screening Consortium recommends glucose and hemoglobin A1c (HbA1c) monitoring in high-risk individuals (HRIs) undergoing surveillance. However, evidence that such monitoring improves PDAC detection is lacking. Our aim was to investigate the association between serum glucose and HbA1c values and the development of PDAC in HRIs undergoing surveillance.

Methods: Participants were recruited from the familial pancreatic cancer surveillance cohort, which follows hereditary predisposed HRIs yearly by magnetic resonance imaging and/or endoscopic ultrasound and blood sampling. Those who underwent fasting glucose and/or HbA1c monitoring at least once were eligible candidates.

Results: Four hundred four HRIs met the inclusion criteria. During a median follow-up of 41 months (range 14-120), 9 individuals developed PDAC and 4 (without PDAC) were diagnosed with new-onset diabetes mellitus. Glucose levels ranged from 3.4 to 10.7 mmol/L (mean 5.6 ± 0.7) and HbA1c levels from 25 to 68 mmol/mol (mean 37.7 ± 4.1). The mean values did not differ significantly between PDAC cases and controls. The percentage of individuals with at least one elevated value were comparable between PDAC cases and controls for glucose (33% and 27%, P = 0.707) and HbA1c (22% and 14%, P = 0.623). No consistent glucose or HbA1c trends over time suggested a correlation with PDAC development.

Discussion: In this HRI surveillance cohort, measuring glucose and HbA1c values did not contribute to PDAC detection. Larger and longer-term studies are needed to determine the final role of glucose and HbA1c monitoring in PDAC surveillance.

简介:多项研究表明,新发糖尿病(NOD)是胰腺导管腺癌(PDAC)的早期表现。因此,国际胰腺癌筛查(CAPS)联盟建议对接受监测的高危人群(HRIs)进行血糖和 HbA1c 监测。然而,目前还缺乏证据表明这种监测能提高 PDAC 的检测率。我们的目的是调查接受监测的高危人群中血清葡萄糖和 HbA1c 值与 PDAC 发展之间的关系:方法:参与者从家族性胰腺癌(FPC)监测队列中招募,该队列每年通过 MRI 和/或 EUS 以及血液采样对有遗传倾向的 HRI 进行跟踪。至少接受过一次空腹血糖和/或 HbA1c 监测的患者为合格候选者:结果:404 例 HRI 符合纳入标准。在中位 41 个月(14-120 个月)的随访期间,9 人发展为 PDAC,4 人(无 PDAC)被诊断为 NOD。血糖水平为 3.4-10.7 mmol/L(平均值为 5.6 ± 0.7),HbA1c 水平为 25-68 mmol/mol(平均值为 37.7 ± 4.1)。PDAC 病例与对照组的平均值无明显差异。PDAC 病例和对照组之间至少有一项数值升高的百分比相当,葡萄糖(33% 和 27%,P=0.707)和 HbA1c(22% 和 14%,P=0.623)。随着时间的推移,血糖或 HbA1c 的变化趋势与 PDAC 的发展并不一致:结论:在该 HRI 监测队列中,测量血糖和 HbA1c 值无助于 PDAC 的检测。要确定血糖和 HbA1c 监测在 PDAC 监测中的最终作用,还需要进行更大规模和更长期的研究。
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Clinical and Translational Gastroenterology
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