Clinical and Translational Gastroenterology最新文献

{"title":"Patients With Inflammatory Bowel Disease Are at Increased Risk of Respiratory Syncytial Virus Infections After Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Propensity-Matched Cohort Analysis.","authors":"Saqr Alsakarneh, Oscar Ramirez Ramirez, Mary S Hayney, Jana G Hashash, Francis A Farraye, Freddy Caldera","doi":"10.14309/ctg.0000000000000840","DOIUrl":"10.14309/ctg.0000000000000840","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with inflammatory bowel disease (IBD) are at an increased risk of infections. Before the COVID-19 pandemic, respiratory syncytial virus (RSV) followed predictable seasonal patterns, which have been recently disrupted. This study aimed to investigate whether severe acute respiratory syndrome (SARS) coronavirus 2 (CoV-2) infection is associated with an increased risk of RSV infection in patients with IBD compared with those without a history of SARS-CoV-2 infection.</p><p><strong>Methods: </strong>This retrospective cohort study used the TriNetX database to identify patients aged 18 years and older with IBD and SARS-CoV-2 infection (IBD-SARS-CoV-2 cohort) during the 2022 and 2023 RSV seasons. A 1:1 propensity score matching was used to compare patients with IBD but no history of SARS-CoV-2 infection (IBD non-SARS-CoV-2 cohort).</p><p><strong>Results: </strong>In the 2022 IBD-SARS-CoV-2 cohort (mean age: 53.7 ± 17.6 years; 59% female; 77% White), the RSV infection risk was 0.47%, higher than 0.19% in the matched IBD non-SARS-CoV-2 cohort (adjusted odds ratio [aOR]: 2.4; 95% CI: 1.5-3.6). The risk was highest 30-60 days after SARS-CoV-2 infection (aOR: 2.9; 95% CI: 1.7-4.9), particularly in those aged 60 years and older (aOR: 2.5; 95% CI: 1.3-4.5). The use of systemic corticosteroids (aOR: 2.3; 95% CI: 1.1-4.6) or immune-modifying therapies (aOR: 3.9; 95% CI: 2-7.1) was associated with higher RSV infection risk. Similar trends were observed during the 2023 RSV season, with no significant differences in RSV-related hospitalizations.</p><p><strong>Discussion: </strong>Adults with IBD have a higher risk of RSV infection after SARS-CoV-2 infection, particularly those receiving steroids or immune therapies. SARS-CoV-2 infection may have contributed to the recent RSV infection surge in this population, warranting further research.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00840"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucin 5AC as a Biomarker for Sessile Serrated Lesions: Results From a Systematic Review and Meta-Analysis.","authors":"Kevin Liu, Moniyka Sachar, Violeta Popov, Ziheng Pei, Giulio Quarta","doi":"10.14309/ctg.0000000000000831","DOIUrl":"10.14309/ctg.0000000000000831","url":null,"abstract":"<p><strong>Introduction: </strong>Sessile serrated lesions (SSLs) are a class of colon polyps challenging to detect through current screening methods but highly associated with colon cancer. To improve detection, we sought a biomarker sensitive for SSLs. Recent endoscopic and histopathologic studies suggest that SSLs are associated with alterations in intestinal mucin expression, but the frequency with which this occurs is not known.</p><p><strong>Methods: </strong>We performed a meta-analysis of available pathologic studies comparing mucin expression on SSLs to normal colonic mucosa, tubular adenomas, villous adenomas, traditional serrated adenomas (TSAs), and hyperplastic polyps (HPs). We searched Medline, Pubmed, and Embase and found 440 publications in this topic, and 18 total studies met inclusion.</p><p><strong>Results: </strong>We found that MUC5AC expression was more common in SSLs compared to normal colonic mucosa (OR = 82.9, P < 0.01), tubular adenoma (OR = 11, P < 0.01), and TSAs (OR = 3.6, P = 0.04). We found no difference in MUC5AC expression between SSLs versus HPs (OR = 2.1, P = 0.09) and no difference in MUC5AC expression between left colon and right colon HPs, with an OR = 1.8, P = 0.23.</p><p><strong>Discussion: </strong>We found that MUC5AC expression was found commonly on villous adenoma, SSLs, and TSAs while the frequency on colon cancers declined. MUC5AC is also upregulated in inflammatory bowel disease and in response to intestinal infections. MUC5AC expression highlights the potential of mucins as useful biomarkers, though not specific to SSLs. Further research into the clinical utility of MUC5AC as a pathologic or fecal biomarker could enhance SSL detection.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00831"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Spontaneous Bacterial Peritonitis Prophylaxis Is Associated With a Higher Rate of Infections other than Spontaneous Bacterial Peritonitis in 2 US-Based National Cirrhosis Cohorts.","authors":"Scott Silvey, Nilang Patel, Jacqueline G O'Leary, Sofia S Jakab, Heather Patton, Shari Rogal, John D Markley, Ramsey Cheung, Arpan Patel, Timothy R Morgan, Jasmohan S Bajaj","doi":"10.14309/ctg.0000000000000837","DOIUrl":"10.14309/ctg.0000000000000837","url":null,"abstract":"<p><strong>Introduction: </strong>Antibiotic overuse and subsequent antibiotic resistance lead to worse infection outcomes in cirrhosis. Secondary spontaneous bacterial peritonitis prophylaxis (SecSBBPr) is associated with higher SBP recurrence, but impact on non-SBP infections is unclear.</p><p><strong>Methods: </strong>We studied patients with cirrhosis and SBP who were given SecSBPPr or not between 2009 and 2019 in 2 complementary national cohorts (Veterans Affairs Corporate Data Warehouse [VA-CDW] and non-VA TriNetX). Development of total non-SBP infections and specifically urinary tract infections (UTIs), bacteremia, pneumonia, and C. difficile using validated codes over 2 years was compared between those on SecSBPPr vs not. Multivariable regression for non-SBP infections was performed.</p><p><strong>Results: </strong>VA-CDW: Of 4,673 veterans with index SBP, 2,539 (54.3%) were started on SecSBPPr. In total, 1,406 (30.1%) developed non-SBP infections (13.5% UTI, 12.4% pneumonia, 8.5% bacteremia, and 6.8% C. difficile ). On multivariable regression, SecSBPPr was significantly associated with any non-SBP infection (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.10-1.44, P < 0.0001) and UTI (OR 1.21, 95% CI 1.01-1.45, P = 0.036). TriNetX: Of 6,708 patients with index SBP, 3,261 (48.6%) were started on SecSBPPr. In total, 1,932 (28.8%) patients developed non-SBP infections (13.4% UTI, 12.9% pneumonia, 8.6% bacteremia, and 5.9% C. difficile ). On multivariable regression, SecSBPPr was significantly associated with any non-SBP infection (OR 1.33, 95% CI 1.12-1.59, P < 0.0001), UTI (OR 1.35, 95% CI 1.07-1.71, P = 0.010), pneumonia (OR 1.35, 95% CI 1.06-1.72, P = 0.017), and bacteremia (OR 1.47, 95% CI 1.10-1.97, P = 0.009).</p><p><strong>Discussion: </strong>In 2 diverse US-based national cohorts of patients with cirrhosis and SBP, use of SecSBPPr was associated with a higher risk of non-SBP infections, especially urinary tract infections.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00837"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pruritus and Fatigue in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Study of Turkish Patients From the Global NASH/MASH Registry.","authors":"Yusuf Yilmaz, Caglayan Keklikkiran, Andrei Racila, Maria Stepanova, Zobair M Younossi","doi":"10.14309/ctg.0000000000000844","DOIUrl":"10.14309/ctg.0000000000000844","url":null,"abstract":"<p><strong>Introduction: </strong>Despite being underappreciated, pruritus and fatigue are not uncommon in metabolic dysfunction-associated steatotic liver disease (MASLD). In this prospective registry-based study, we sought to evaluate the prevalence, predictors, and impact of these symptoms on patient-reported outcomes (PROs) in patients with MASLD from Türkiye, a country with one of the highest burdens of MASLD globally.</p><p><strong>Methods: </strong>A total of 1,874 Turkish patients from the Global Liver Registry were included. Significant pruritus and fatigue were defined using the Chronic Liver Disease Questionnaire-nonalcoholic steatohepatitis and the Functional Assessment of Chronic Illness Therapy-Fatigue, respectively. PROs were assessed using the Chronic Liver Disease Questionnaire-nonalcoholic steatohepatitis, Functional Assessment of Chronic Illness Therapy-Fatigue, and the Work Productivity and Activity Impairment: Specific Health Problem questionnaire.</p><p><strong>Results: </strong>The prevalence of significant pruritus and fatigue was 37% and 33%, respectively. Both symptoms were significantly associated with female sex, type 2 diabetes, depression, abdominal pain, and lack of regular exercise. Patients with these symptoms had significantly worse PROs, with impairments up to 31% (all P < 0.0001). Over 1-2 years, symptoms persisted in 47%-52% of patients with baseline pruritus and 33%-39% with baseline fatigue. Independent predictors of a higher likelihood of resolution of pruritus included the absence of fatigue at baseline and the lack of abdominal pain, with odds ratios of 0.36 (95% confidence interval: 0.22-0.59) and 0.60 (95% confidence interval: 0.39-0.91), respectively (both P < 0.05).</p><p><strong>Discussion: </strong>Pruritus and fatigue are common in MASLD, significantly impairing PROs and often persisting over time. Regular assessment and management are essential to improve patients' well-being and functioning.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00844"},"PeriodicalIF":3.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of CFTR Pathogenic Variants in Pancreatitis: A Systematic Review and Meta-Analysis.","authors":"Joanna Jiang, Gavisha Waidyaratne, Shiab Mussad, Spencer Harris, Maegan E Roberts, Yevgeniya Gokun, A Jay Freeman, Samuel Han, Phil A Hart, Luis F Lara, Peter J Lee, Somashekar G Krishna, Georgios I Papachristou, Peter P Stanich, Mitchell L Ramsey","doi":"10.14309/ctg.0000000000000846","DOIUrl":"10.14309/ctg.0000000000000846","url":null,"abstract":"<p><strong>Introduction: </strong>Pathogenic variants (PVs) in the cystic fibrosis transmembrane conductance regulator ( CFTR ) gene are commonly reported across the spectrum of pancreatitis, including acute (AP), recurrent acute (RAP), and chronic pancreatitis (CP). We aimed to define the pooled prevalence of CFTR PVs according to pancreatitis phenotype.</p><p><strong>Methods: </strong>A systematic search using synonyms for CFTR and pancreatitis was performed in Embase and Pubmed databases. The primary outcome was the frequency of subjects with at least one CFTR PV among those who underwent germline CFTR testing. Subgroup analyses included age, pancreatitis etiology, and genetic testing strategy. Confidence intervals (CIs) were obtained using the exact binomial method (Clopper-Pearson), and a Sidik-Jonkman random-effects model was used to calculate pooled prevalence.</p><p><strong>Results: </strong>In total, 138 studies were included in the final analysis; 17 (n = 1,873) reported populations with AP, 21 (n = 1,172) with RAP, 86 (n = 13,428) with CP, and 36 (n = 4,521) with unspecified pancreatitis type. The pooled prevalence of at least one CFTR PV was 8.0% (95% CI: 4.3%-14.4%) of AP, 16.4% (95% CI: 10.2%-25.4%) of RAP, 15.3% (95% CI: 12.2%-19.0%) of CP, and 25.0% (95% CI: 17.5%-34.3%) of unspecified pancreatitis. Heterogeneity was high in each phenotype (I 2 value range 88.3%-96.7%).</p><p><strong>Discussion: </strong>These findings underscore the complex landscape of CFTR PVs in pancreatitis, emphasizing the importance of tailored approaches in addressing this genetic component across diverse patient groups and phenotypic presentations. In addition, these data are useful for pretest genetic counseling and provide a justification for developing CFTR -directed interventions.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00846"},"PeriodicalIF":3.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Model for Predicting Biliary Complications After Liver Transplantation.","authors":"Feng Hu, Yuancheng Li, Hongfei Zeng, Renhua Ju, Di Jiang, Leida Zhang, Jun Li, Xingchao Liu, Guangyi Liu, Chengcheng Zhang","doi":"10.14309/ctg.0000000000000843","DOIUrl":"10.14309/ctg.0000000000000843","url":null,"abstract":"<p><strong>Introduction: </strong>The risk factors of biliary complications (BCs) after liver transplantation are not comprehensively determined. BCs also vary in times of onset. Machine learning (ML) can reveal regularities based on large-scale data to make predictions and have demonstrated good performance in liver transplantation. However, whether ML can be an efficient tool for BC prediction was not determined.</p><p><strong>Methods: </strong>Five hundred seventeen patients from 2 centers were enrolled. Patients were randomly divided into training and validation sets at 3:1 ratio. K-fold cross-validation and the synthetic minority oversampling technique were used to debug the models, which were evaluated by receiver operating characteristic curves. SHapley Additive exPlanation values and Sankey diagrams were applied to visualize the results. Seven ML algorithms were administrated to build models for BCs prediction at 3, 6, and 12 months.</p><p><strong>Results: </strong>Among all the models, support vector machine produced the highest area under curve values in predicting BCs (3-month = 0.916; 6-month = 0.892; 12-month = 0.885). According to the analysis of support vector machine, the 3-month risk factors of BCs and corresponding SHapley Additive exPlanation value ranges were donor age (-0.13, 0.21), Model for End-Stage Liver Disease score (-0.15, 0.18), neoplastic disease (-0.14, 0.28), diabetes (-0.12, 0.27), hypertension (-0.13, 0.21), and intraoperative blood transfusion (-0.09, 0.25), whereas 6-month factors were recipient age (-0.14, 0.16), donor body mass index (-0.10, 0.13), recipient body mass index (-0.13, 0.23), and diabetes (-0.12, 0.43). The 12-month risk factors were recipient age (-0.14, 0.19), diabetes (-0.13, 0.25), and basiliximab (-0.16, 0.24). The Sankey diagram enabled clear visualization of the contribution of individual risk factors to the model in different times of BCs onset.</p><p><strong>Discussion: </strong>The ML algorithm was able to identify risk factors of BCs in all postoperative periods and this supplied insights in patient management.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00843"},"PeriodicalIF":3.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival Outcomes of Preoperative Serum Biomarkers in Patients With Surgically Treated Intrahepatic Cholangiocarcinoma.","authors":"Di Zeng, Shaofeng Wang, Nansheng Cheng, Geng Liu, Bei Li","doi":"10.14309/ctg.0000000000000845","DOIUrl":"10.14309/ctg.0000000000000845","url":null,"abstract":"<p><strong>Introduction: </strong>Intrahepatic cholangiocarcinoma (ICC) is a highly malignant tumor, often diagnosed at advanced stages, with recurrence and metastasis significantly affecting survival. The combined prognostic value of biomarkers such as the Systemic Immune-Inflammation Index (SII), Fibrosis-4 (FIB-4), and Prognostic Nutritional Index (PNI) remains underexplored.</p><p><strong>Methods: </strong>A retrospective analysis of 280 patients with ICC who underwent curative resection was performed. The prognostic significance of FIB-4, SII, and PNI for overall survival (OS) and disease-free survival (DFS) was assessed using clinical, pathological, and follow-up data. Statistical analysis included Cox regression and Kaplan-Meier survival curves.</p><p><strong>Results: </strong>High PNI was significantly associated with better OS ( P = 0.014) and DFS ( P = 0.025). High FIB-4 levels correlated with worse OS ( P = 0.0076) and DFS ( P = 0.023). High SII was strongly associated with poor OS ( P < 0.0001) and DFS ( P = 0.00041). The combination of high SII, low PNI, and high FIB-4 was linked to significantly worse OS (hazard ratios = 2.633, P = 0.002) and DFS (hazard ratios = 2.475, P = 0.004).</p><p><strong>Discussion: </strong>Preoperative serum biomarkers, including PNI, FIB-4, and SII, are significant independent prognostic factors for patients with ICC. Their combined use may help refine prognostic assessment and guide personalized treatment strategies.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00845"},"PeriodicalIF":3.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expression Patterns of Immune Checkpoint Molecules and Their Clinical Values in Gastric Neuroendocrine Neoplasms.","authors":"Mengjie Liang, Junren Lu, Xingzhou Wang, Peng Song, Shichao Ai, Daming Cai, Feng Sun, Xiaofeng Lu, Meng Wang, Shuang Fu, Heng Yu, Wenxian Guan, Xiaofei Shen","doi":"10.14309/ctg.0000000000000842","DOIUrl":"10.14309/ctg.0000000000000842","url":null,"abstract":"<p><strong>Introduction: </strong>Gastric neuroendocrine neoplasms (g-NENs) are a rare type of stomach tumor. However, limited data exist about the expression and clinical significance of B7 family ligands/receptors in patients with g-NENs. Thus, we conducted this study to address this issue in a cohort of 112 patients with g-NENs.</p><p><strong>Methods: </strong>Using immunohistochemistry, we mapped and quantified the expression of the B7 family ligands/receptors in 112 g-NEN samples: programmed cell death ligand 1 and 2 (PD-L1 and PD-L2), B7-H3, B7-H4, recombinant human galectin-9 (LGALS9), and CD155. Associations between the marker levels, clinicopathological variables, and survival were evaluated.</p><p><strong>Results: </strong>The percentages of high expression of PD-L1, PD-L2, B7-H3, B7-H4, LGALS9, and CD155 in the cohort of 112 g-NEN cases were 37.5%, 55.4%, 46.4%, 37.5%, 46.4%, and 51.8%, respectively. Elevated expression of PD-L1, PD-L2, B7-H3, B7-H4, LGALS9, and CD155 was significantly associated with several clinicopathological characteristics. K-M analysis indicated that high expression levels of CD155, B7-H3, PD-L2, and LGALS9 were correlated with poor overall survival (OS) ( P < 0.0001, P = 0.0002, P = 0.0319 and P = 0.0120, respectively). Multivariate Cox regression analysis indicated that high CD155 expression, vasculature invasion, and worse World Health Organization pathological grade were independent prognostic factors for OS ( P = 0.007, P = 0.030, and P = 0.019, respectively).</p><p><strong>Discussion: </strong>We detected variable expression of the PD-L1, PD-L2, B7-H3, B7-H4, LGALS9, and CD155 proteins in g-NENs. These results suggest that the expression level of CD155 may be a vital indicator of OS in patients with g-NENs. B7 family ligands/receptors could be potential immunotherapeutic targets for g-NENs.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00842"},"PeriodicalIF":3.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-Guided Fluid Resuscitation for Acute Pancreatitis Improves Outcomes.","authors":"Niwen Kong, Patrick Chang, Ira A Shulman, Ubayd Haq, Maziar Amini, Denis Nguyen, Farhaad Khan, Rachan Narala, Nisha Sharma, Daniel Wang, Tiana Thompson, Jonathan Sadik, Cameron Breze, David C Whitcomb, James L Buxbaum","doi":"10.14309/ctg.0000000000000825","DOIUrl":"10.14309/ctg.0000000000000825","url":null,"abstract":"<p><strong>Introduction: </strong>Ariel Dynamic Acute Pancreatitis Tracker (ADAPT) is an artificial intelligence tool using mathematical algorithms to predict severity and manage fluid resuscitation needs based on the physiologic parameters of individual patients. Our aim was to assess whether adherence to ADAPT fluid recommendations vs standard management impacted clinical outcomes in a large prospective cohort.</p><p><strong>Methods: </strong>We analyzed patients consecutively admitted to the Los Angeles General Medical Center between June 2015 and November 2022 whose course was richly characterized by capturing more than 100 clinical variables. We inputted these data into the ADAPT system to generate resuscitation fluid recommendations and compared with the actual fluid resuscitation within the first 24 hours from presentation. The primary outcome was the difference in organ failure in those who were over-resuscitated (>500 mL) vs adequately resuscitated (within 500 mL) with respect to the ADAPT fluid recommendation. Additional outcomes included intensive care unit admission, systemic inflammatory response syndrome (SIRS) at 48 hours, local complications, and pancreatitis severity.</p><p><strong>Results: </strong>Among the 1,083 patients evaluated using ADAPT, 700 were over-resuscitated, 196 were adequately resuscitated, and 187 were under-resuscitated. Adjusting for pancreatitis etiology, gender, and SIRS at admission, over-resuscitation was associated with increased respiratory failure (odd ratio [OR] 2.73, 95% confidence interval [CI] 1.06-7.03) as well as intensive care unit admission (OR 2.40, 1.41-4.11), more than 48 hours of hospital length of stay (OR 1.87, 95% CI 1.19-2.94), SIRS at 48 hours (OR 1.73, 95% CI 1.08-2.77), and local pancreatitis complications (OR 2.93, 95% CI 1.23-6.96).</p><p><strong>Discussion: </strong>Adherence to ADAPT fluid recommendations reduces respiratory failure and other adverse outcomes compared with conventional fluid resuscitation strategies for acute pancreatitis. This validation study demonstrates the potential role of dynamic machine learning tools in acute pancreatitis management.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00825"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fact or Myth? Black Patients Do Not Want to Participate in Clinical Trials.","authors":"Krystal Mills, Francisco Figueroa, RaKetra Knight, Emem Ekpo, Lilian C Lee, Lance Baldo, Chuanbo Xu, Siqi Wang, Robert M Adelman, Priscilla Pemu, Theodore Levin, Aasma Shaukat, Julia J Liu","doi":"10.14309/ctg.0000000000000826","DOIUrl":"10.14309/ctg.0000000000000826","url":null,"abstract":"<p><strong>Introduction: </strong>To assess strategies for optimizing participation of underserved minorities in a blood-based early colorectal cancer detection test study (PREEMPT CRC; NCT04369053) at a hospital serving primarily Black individuals.</p><p><strong>Methods: </strong>Culturally sensitive, racially congruent research staff approached individuals undergoing average-risk screening colonoscopy. Consent/study procedures were synchronized with clinical appointments. Enrolled and not-enrolled patient characteristics were compared. Recruitment was compared with other study sites.</p><p><strong>Results: </strong>In total, 247 of 509 eligible individuals were enrolled; most were identified as Black (88.7%). No baseline characteristics were associated with participation. Recruitment was high compared with other sites (11th centile).</p><p><strong>Discussion: </strong>Recruitment barriers for Black individuals can be overcome when easy, culturally sensitive access is facilitated.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00826"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}