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Liu XF, Li Y, Ju S, Zhou YL, Qiang JW. Network Analysis and Nomogram in the Novel Classification and Prognosis Prediction of Advanced Schistosomiasis Japonica. Am J Trop Med Hyg 2023; 108:569-577. [PMID: 36689944 PMCID: PMC9978554 DOI: 10.4269/ajtmh.22-0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Clinical classification of advanced schistosomiasis japonica is important for treatment options and prognosis prediction. Network analysis was used to solve the problem of complexity and co-occurrence complications in classification of advanced schistosomiasis. A total of 4,125 retrospective patients were enrolled and divided randomly into a training cohort (n = 2,888) and a validation cohort (n = 1,237). Network analysis was used to cluster the isolated complications of advanced schistosomiasis. The accuracy of the network was evaluated. Nomograms based on the clustered complications were built to predict 1- to 5-year survival rates in advanced schistosomiasis. The predictive performance of the nomogram was also evaluated and validated. Fifteen isolated complications were identified: metabolic syndromes, minimal hepatic encephalopathy, hepatic encephalopathy, chronic obstructive pulmonary disease, pulmonary hypertension, respiratory failure, right heart failure, gastroesophageal variceal bleeding, gastrointestinal ulcer bleeding, splenomegaly, fibrosis, chronic kidney disease, ascites, colorectal polyp, and colorectal cancer. Through network analysis, three major clustered complications were achieved-namely, schistosomal abnormal metabolic syndromes (related to chronic metabolic abnormalities), schistosomal abnormal hemodynamics syndromes (related to severe portal hypertension and portosystemic shunting), and schistosomal inflammatory granulomatous syndromes (related to granulomatous inflammation). The nomograms showed a good performance in prognosis prediction of advanced schistosomiasis. The novel classification-based nomogram was useful in predicting the survival rate in advanced schistosomiasis japonica.
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Affiliation(s)
- Xue-Fei Liu
- Department of Radiology, Jinshan Hospital, Fudan University, 201508, Shanghai, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, 201508, Shanghai, China
- Address correspondence to Ying Li, Longhang road 1508#, Shanghai, China (Ying Li), or Jin-Wei Qiang, Longhang road 1508#, Shanghai, China (Jin-Wei Qiang). E-mails: or
| | - Shuai Ju
- Department of Interventional Radiology, Jinshan Hospital, Fudan University, 201508, Shanghai, China
| | - Yan-Li Zhou
- Department of Nuclear Medicine, Jinshan Hospital, Fudan University, 201508, Shanghai, China
| | - Jin-Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, 201508, Shanghai, China
- Address correspondence to Ying Li, Longhang road 1508#, Shanghai, China (Ying Li), or Jin-Wei Qiang, Longhang road 1508#, Shanghai, China (Jin-Wei Qiang). E-mails: or
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Pham K, Mertelsmann A, Mages K, Kingery JR, Mazigo HD, Jaka H, Kalokola F, Changalucha JM, Kapiga S, Peck RN, Downs JA. Effects of helminths and anthelmintic treatment on cardiometabolic diseases and risk factors: A systematic review. PLoS Negl Trop Dis 2023; 17:e0011022. [PMID: 36827239 PMCID: PMC9956023 DOI: 10.1371/journal.pntd.0011022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/12/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Globally, helminth infections and cardiometabolic diseases often overlap in populations and individuals. Neither the causal relationship between helminth infections and cardiometabolic diseases nor the effect of helminth eradication on cardiometabolic risk have been reviewed systematically in a large number of human and animal studies. METHODS We conducted a systematic review assessing the reported effects of helminth infections and anthelmintic treatment on the development and/or severity of cardiometabolic diseases and risk factors. The search was limited to the most prevalent human helminths worldwide. This study followed PRISMA guidelines and was registered prospectively in PROSPERO (CRD42021228610). Searches were performed on December 10, 2020 and rerun on March 2, 2022 using Ovid MEDLINE ALL (1946 to March 2, 2022), Web of Science, Cochrane Library, Global Index Medicus, and Ovid Embase (1974 to March 2, 2022). Randomized clinical trials, cohort, cross-sectional, case-control, and animal studies were included. Two reviewers performed screening independently. RESULTS Eighty-four animal and human studies were included in the final analysis. Most studies reported on lipids (45), metabolic syndrome (38), and diabetes (30), with fewer on blood pressure (18), atherosclerotic cardiovascular disease (11), high-sensitivity C-reactive protein (hsCRP, 5), and non-atherosclerotic cardiovascular disease (4). Fifteen different helminth infections were represented. On average, helminth-infected participants had less dyslipidemia, metabolic syndrome, diabetes, and atherosclerotic cardiovascular disease. Eleven studies examined anthelmintic treatment, of which 9 (82%) reported post-treatment increases in dyslipidemia, metabolic syndrome, and diabetes or glucose levels. Results from animal and human studies were generally consistent. No consistent effects of helminth infections on blood pressure, hsCRP, or cardiac function were reported except some trends towards association of schistosome infection with lower blood pressure. The vast majority of evidence linking helminth infections to lower cardiometabolic diseases was reported in those with schistosome infections. CONCLUSIONS Helminth infections may offer protection against dyslipidemia, metabolic syndrome, diabetes, and atherosclerotic cardiovascular disease. This protection may lessen after anthelmintic treatment. Our findings highlight the need for mechanistic trials to determine the pathways linking helminth infections with cardiometabolic diseases. Such studies could have implications for helminth eradication campaigns and could generate new strategies to address the global challenge of cardiometabolic diseases.
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Affiliation(s)
- Khanh Pham
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, United States of America
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
| | - Anna Mertelsmann
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, United States of America
| | - Keith Mages
- Samuel J. Wood Library, Weill Cornell Medicine, New York, New York, United States of America
| | - Justin R. Kingery
- Department of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Humphrey D. Mazigo
- Department of Parasitology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Hyasinta Jaka
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Mwanza College of Health and Allied Sciences, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | | | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Robert N. Peck
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Jennifer A. Downs
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
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Li Y, Ju S, Li X, Zhou YL, Qiang JW. Prediction of minimal hepatic encephalopathy by using an radiomics nomogram in chronic hepatic schistosomiasis patients. PLoS Negl Trop Dis 2021; 15:e0009834. [PMID: 34653175 PMCID: PMC8550421 DOI: 10.1371/journal.pntd.0009834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/27/2021] [Accepted: 09/23/2021] [Indexed: 01/04/2023] Open
Abstract
Objective To construct an MR-radiomics nomogram to predict minimal hepatic encephalopathy (MHE) in patients with chronic hepatic schistosomiasis (CHS). Methods From July 2017 to July 2020, 236 CHS patients with non-HE (n = 140) and MHE (n = 96) were retrospective collected and randomly divided into training group and testing group. Radiomics features were extracted from substantia nigra-striatum system of a brain diffusion weighted images (DWI) and combined with clinical predictors to build a radiomics nomogram for predicting MHE in CHS patients. The ROC curve was used to evaluate the predicting performance in training group and testing group. The clinical decisive curve (CDC) was used to assess the clinical net benefit of using radiomics nomogram in predicting MHE. Results Low seralbumin (P < 0.05), low platelet count (P < 0.05) and high plasma ammonia (P < 0.05) was the significant clinical predictors for MHE in CHS patients. The AUC, specificity and sensitivity of the radiomics nomogram were 0.89, 0.90 and 0.86 in the training group, and were 0.83, 0.85 and 0.75 in the training group. The CDC analysis showed clinical net benefits for the radiomics nomogram in predicting MHE. Conclusions The radiomics nomogram combining DWI radiomics features and clinical predictors could be useful tool to predict MHE in CHS patients. Minimal hepatic encephalopathy (MHE) is usually neglected clinically in chronic hepatic schistosomiasis (CHS) patients. The diffusion change in substantia nigra-striatum system of MHE patients has been reported. We hypothesized that the change could be better detected by DWI-based radiomics. A radiomics nomogram combining radiomics and clinical predictors of MHE was built to predict MHE in CHS patients. The results demonstrate that the radiomics nomogram would be useful for predicting MHE in CHS patients.
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Affiliation(s)
- Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Shuai Ju
- Department of Intervention Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xin Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yan Li Zhou
- Department of Nuclear medicine, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
- * E-mail:
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Li Y, Cai BS, Li X, Ju S, Yang XY, Qiang JW. Treatment of Upper Gastrointestinal Bleeding by Percutaneous Transsplenic Varices Embolization in Chronic Hepatic Schistosomiasis Japonicum Patients. Am J Trop Med Hyg 2021; 105:1109-1113. [PMID: 34280135 DOI: 10.4269/ajtmh.21-0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/13/2021] [Indexed: 11/07/2022] Open
Abstract
To evaluate percutaneous transsplenic varices embolization (PTSVE) in the treatment of upper gastrointestinal bleeding (UGIB) in patients with chronic hepatic schistosomiasis japonicum (CHS), 29 CHS patients (20 males and 9 females) complicated with UGIB were selected as the investigation subjects. The patients were treated by PTSVE under the guidance of X-ray fluoroscopy. The success rate of PTSVE and the rate of complications were observed. In addition, the degrees of varices before and after PTSVE were evaluated by abdominal computed tomography (CT). Results showed that 26 CHS patients (89.6%) were successfully treated with PTSVE. Three cases (10.3%) failed, and two experienced intraperitoneal bleeding within 1 week after PTSVE. The abdominal CT showed a significant decrease of the varices stage in coronary (P < 0.001), esophageal (P = 0.006), and paraesophageal (P = 0.013) varices, but slightly increased perisplenic varices within 1 month of the intervention (P = 0.014). PTSVE may be a safe and effective procedure for the treatment of UGIB in CHS patients, particularly suitable for those with a widened hepatic fissure and exposed hepatic portal vein trunk and an enlarged spleen.
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Affiliation(s)
- Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Ban Sheng Cai
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xin Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Shuai Ju
- Department of Intervention Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xiu Ying Yang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
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Akbari M, Tabrizi R, Lankarani KB, Heydari ST, Karamali M, Keneshlou F, Niknam K, Kolahdooz F, Asemi Z. The Effects of Folate Supplementation on Diabetes Biomarkers Among Patients with Metabolic Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Horm Metab Res 2018; 50:93-105. [PMID: 29342488 DOI: 10.1055/s-0043-125148] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although several studies have evaluated the effect of folate supplementation on diabetes biomarkers among patients with metabolic diseases, findings are inconsistent. This review of randomized controlled trials (RCTs) was performed to summarize the evidence on the effects of folate supplementation on diabetes biomarkers among patients with metabolic diseases. Randomized-controlled trials (RCTs) published in PubMed, EMBASE, Web of Science and Cochrane Library databases up to 1 September 2017 were searched. Two review authors independently assessed study eligibility, extracted data, and evaluated risk of bias of included studies. Heterogeneity was measured with a Q-test and with I2 statistics. Data were pooled by using the fix or random-effect model based on the heterogeneity test results and expressed as standardized mean difference (SMD) with 95% confidence interval (CI). A total of sixteen randomized controlled trials involving 763 participants were included in the final analysis. The current meta-analysis showed folate supplementation among patients with metabolic diseases significantly decreased insulin (SMD -1.28; 95% CI, -1.99, -0.56) and homeostasis model assessment of insulin resistance (HOMA-IR) (SMD -1.28; 95% CI, -1.99, -0.56). However, folate supplementation did not affect fasting plasma glucose (FPG) (SMD -0.30; 95% CI, -0.63, 0.02) and hemoglobin A1C (HbA1c) (SMD -0.29; 95% CI, -0.61, 0.03). The results of this meta-analysis study demonstrated that folate supplementation may result in significant decreases in insulin levels and HOMA-IR score, but does not affect FPG and HbA1c levels among patients with metabolic diseases.
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Affiliation(s)
- Maryam Akbari
- Health Policy Research Center, Institute of Health, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Tabrizi
- Health Policy Research Center, Institute of Health, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran B Lankarani
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Karamali
- Department of Gynecology and Obstetrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Keneshlou
- Department of Urology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Kayvan Niknam
- Department of Anesthesiology and Pain Medicine, Rasoul Akram Medical Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Kolahdooz
- Indigenous and Global Health Research, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
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Magnetic Resonance Spectroscopy for Evaluating Portal-Systemic Encephalopathy in Patients with Chronic Hepatic Schistosomiasis Japonicum. PLoS Negl Trop Dis 2016; 10:e0005232. [PMID: 27977668 PMCID: PMC5199111 DOI: 10.1371/journal.pntd.0005232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/29/2016] [Accepted: 12/05/2016] [Indexed: 12/02/2022] Open
Abstract
Portal-systemic encephalopathy (PSE) is classified as type B hepatic encephalopathy. Portal-systemic shunting rather than liver dysfunction is the main cause of PSE in chronic hepatic schistosomiasis japonicum (HSJ) patients. Owing to lack of detectable evidence of intrinsic liver disease, chronic HSJ patients with PSE are frequently clinically undetected or misdiagnosed, especially chronic HSJ patients with covert PSE (subclinical encephalopathy). In this study, we investigated whether magnetic resonance spectroscopy (MRS) could be a useful tool for diagnosing PSE in chronic HSJ patients. Magnetic resonance (MR) T1-weighted imaging, diffusion-weighted imaging, and MRS were performed in 41 chronic HSJ patients with suspected PSE and in 21 age-matched controls. The T1 signal intensity index (T1SI) and apparent diffusion coefficient (ADC) value were obtained in the Globus pallidus. Liver function was also investigated via serum ammonia and liver function tests. Higher T1SI and ADC values, increased lactate and glutamine levels, and decreased myo-inositol were found in the bilateral Globus pallidus in chronic HSJ patients with PSE. No significantly abnormal serum ammonia or liver function tests were observed in chronic HSJ patients with PSE. On the basis of these findings, we propose a diagnostic procedure for PSE in chronic HSJ patients. This study reveals that MRS can be useful for diagnosing PSE in chronic HSJ patients. Portal-systemic encephalopathy (PSE) is classified as type B hepatic encephalopathy. Portal-systemic shunting rather than liver dysfunction is the main cause of PSE in chronic hepatic schistosomiasis japonicum (HSJ) patients. Chronic HSJ patients with PSE are frequently misdiagnosed as suffering from dementia, depression, and other psychiatric disorders. However, there are few studies of this type of encephalopathy. In this study, magnetic resonance spectroscopy (MRS) was used as a noninvasive tool to detect abnormalities in brain metabolism in chronic HSJ patient with PSE. The results demonstrate that MRS would be useful for the diagnosis of PSE in chronic HSJ patients. Based on the results, a diagnostic procedure for PSE has also been proposed.
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