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Wong KA, Hatef A, Ryu JL, Nguyen XV, Makary MS, Prevedello LM. An Artificial Intelligence Tool for Clinical Decision Support and Protocol Selection for Brain MRI. AJNR Am J Neuroradiol 2023; 44:11-16. [PMID: 36521960 PMCID: PMC9835923 DOI: 10.3174/ajnr.a7736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Protocolling, the process of determining the most appropriate acquisition parameters for an imaging study, is time-consuming and produces variable results depending on the performing physician. The purpose of this study was to assess the potential of an artificial intelligence-based semiautomated tool in reducing the workload and decreasing unwarranted variation in the protocolling process. MATERIALS AND METHODS We collected 19,721 MR imaging brain examinations at a large academic medical center. Criterion standard labels were created using physician consensus. A model based on the Long Short-Term Memory network was trained to predict the most appropriate protocol for any imaging request. The model was modified into a clinical decision support tool in which high-confidence predictions, determined by the values the model assigns to each possible choice, produced the best protocol automatically and low confidence predictions provided a shortened list of protocol choices for review. RESULTS The model achieved 90.5% accuracy in predicting the criterion standard labels and demonstrated higher agreement than the original protocol assignments, which achieved 85.9% accuracy (κ = 0.84 versus 0.72, P value < .001). As a clinical decision support tool, the model automatically assigned 70% of protocols with 97.3% accuracy and, for the remaining 30% of examinations, achieved 94.7% accuracy when providing the top 2 protocols. CONCLUSIONS Our model achieved high accuracy on a standard based on physician consensus. It showed promise as a clinical decision support tool to reduce the workload by automating the protocolling of a sizeable portion of examinations while maintaining high accuracy for the remaining examinations.
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Affiliation(s)
- K A Wong
- From the Department of Radiology (K.A.W., A.H., J.L.R., X.V.N., M.S.M., L.M.P.), The Ohio State University College of Medicine, Columbus, Ohio
| | - A Hatef
- From the Department of Radiology (K.A.W., A.H., J.L.R., X.V.N., M.S.M., L.M.P.), The Ohio State University College of Medicine, Columbus, Ohio
- Tri-County Radiologists (A.H.), Newark, Ohio
| | - J L Ryu
- From the Department of Radiology (K.A.W., A.H., J.L.R., X.V.N., M.S.M., L.M.P.), The Ohio State University College of Medicine, Columbus, Ohio
- ProScan Imaging (J.L.R.), Columbus, Ohio
| | - X V Nguyen
- From the Department of Radiology (K.A.W., A.H., J.L.R., X.V.N., M.S.M., L.M.P.), The Ohio State University College of Medicine, Columbus, Ohio
| | - M S Makary
- From the Department of Radiology (K.A.W., A.H., J.L.R., X.V.N., M.S.M., L.M.P.), The Ohio State University College of Medicine, Columbus, Ohio
| | - L M Prevedello
- From the Department of Radiology (K.A.W., A.H., J.L.R., X.V.N., M.S.M., L.M.P.), The Ohio State University College of Medicine, Columbus, Ohio
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Tripathi M, Singh BK, Zhou J, Tikno K, Widjaja A, Sandireddy R, Arul K, Abdul Ghani SAB, Bee GGB, Wong KA, Pei HJ, Shekeran SG, Sinha RA, Singh MK, Cook SA, Suzuki A, Lim TR, Cheah CC, Wang J, Xiao RP, Zhang X, Chow PKH, Yen PM. Vitamin B 12 and folate decrease inflammation and fibrosis in NASH by preventing syntaxin 17 homocysteinylation. J Hepatol 2022; 77:1246-1255. [PMID: 35820507 DOI: 10.1016/j.jhep.2022.06.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND & AIMS Several recent clinical studies have shown that serum homocysteine (Hcy) levels are positively correlated, while vitamin B12 (B12) and folate levels are negative correlated, with non-alcoholic steatohepatitis (NASH) severity. However, it is not known whether hyperhomocysteinemia (HHcy) plays a pathogenic role in NASH. METHODS We examined the effects of HHcy on NASH progression, metabolism, and autophagy in dietary and genetic mouse models, patients, and primates. We employed vitamin B12 (B12) and folate (Fol) to reverse NASH features in mice and cell culture. RESULTS Serum Hcy correlated with hepatic inflammation and fibrosis in NASH. Elevated hepatic Hcy induced and exacerbated NASH. Gene expression of hepatic Hcy-metabolizing enzymes was downregulated in NASH. Surprisingly, we found increased homocysteinylation (Hcy-lation) and ubiquitination of multiple hepatic proteins in NASH including the key autophagosome/lysosome fusion protein, Syntaxin 17 (Stx17). This protein was Hcy-lated and ubiquitinated, and its degradation led to a block in autophagy. Genetic manipulation of Stx17 revealed its critical role in regulating autophagy, inflammation and fibrosis during HHcy. Remarkably, dietary B12/Fol, which promotes enzymatic conversion of Hcy to methionine, decreased HHcy and hepatic Hcy-lated protein levels, restored Stx17 expression and autophagy, stimulated β -oxidation of fatty acids, and improved hepatic histology in mice with pre-established NASH. CONCLUSIONS HHcy plays a key role in the pathogenesis of NASH via Stx17 homocysteinylation. B12/folate also may represent a novel first-line therapy for NASH. LAY SUMMARY The incidence of non-alcoholic steatohepatitis, for which there are no approved pharmacological therapies, is increasing, posing a significant healthcare challenge. Herein, based on studies in mice, primates and humans, we found that dietary supplementation with vitamin B12 and folate could have therapeutic potential for the prevention or treatment of non-alcoholic steatohepatitis.
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Affiliation(s)
- Madhulika Tripathi
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857.
| | - Brijesh Kumar Singh
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857
| | - Jin Zhou
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857
| | - Keziah Tikno
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857
| | - Anissa Widjaja
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857
| | - Reddemma Sandireddy
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857
| | - Kabilesh Arul
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857
| | - Siti Aishah Binte Abdul Ghani
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857
| | - George Goh Boon Bee
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169608
| | - Kiraely Adam Wong
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857
| | - Ho Jia Pei
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857
| | | | - Rohit Anthony Sinha
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh 226014, Lucknow, India
| | - Manvendra K Singh
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857
| | - Stuart Alexander Cook
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857; Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh 226014, Lucknow, India
| | - Ayako Suzuki
- Duke Gastroenterology Clinic, 40 Duke Medicine Circle, Suite 03107, DUMC 3913 Durham, NC 27710, USA
| | - Teegan Reina Lim
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169608
| | - Chang-Chuen Cheah
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169608
| | - Jue Wang
- Institute of Molecular Medicine, Peking University, 5 Yiheyuan Road, Beijing, China 100871
| | - Rui-Ping Xiao
- Institute of Molecular Medicine, Peking University, 5 Yiheyuan Road, Beijing, China 100871
| | - Xiuqing Zhang
- Institute of Molecular Medicine, Peking University, 5 Yiheyuan Road, Beijing, China 100871
| | - Pierce Kah Hoe Chow
- Department of Surgery, Singapore General Hospital and Dept. of Surgical Oncology, National Cancer Centre, Singapore 169608
| | - Paul Michael Yen
- Laboratory of Hormonal Regulation, Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore 169857; Duke Molecular Physiology Institute, 300 N Duke St, Durham, NC 27701, USA; Endocrinology, Metabolism, and Nutrition, 30 Duke Medicine Circle Clinic 1A, Durham, NC 27710, USA.
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Sun SCC, Bae A, Qi X, Harris J, Wong KA, Miller MD, Mo H. Natural variation in drug susceptibility to HCV polymerase inhibitors in treatment-naïve HCV patient isolates. J Viral Hepat 2011; 18:861-70. [PMID: 21108698 DOI: 10.1111/j.1365-2893.2010.01396.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Summary. To assess the natural variation in drug susceptibility among treatment-naïve hepatitis C virus (HCV) patient isolates, the susceptibilities of chimeric replicons carrying the HCV NS5B polymerase from up to 51 patient isolates against a panel of diverse HCV nonnucleoside polymerase inhibitors were evaluated using a replicon-based transient replication assay. Some patient to patient variation in susceptibility to the panel of three HCV nonnucleoside polymerase inhibitors was observed. Linear regression and correlation analyses revealed no correlations among the susceptibilities to the polymerase inhibitors tested. Our results suggest that variable antiviral responses to HCV nonnucleoside polymerase inhibitors may be observed because of the natural variation in baseline susceptibility. In addition, the lack of correlation among the susceptibilities to three classes of HCV polymerase inhibitors evaluated here supports their possible combined use in a combination therapy strategy.
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Affiliation(s)
- S-C C Sun
- Department of Clinical Virology, Gilead Sciences, Inc., Foster City, CA 94404, USA
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Abstract
Individuals in malaria endemic regions do not develop fully protective immune responses against Plasmodium liver stage infections. In high transmission areas, individuals can be exposed to more than two infective mosquito bites daily. Their exposure to Plasmodium sporozoites, therefore, is in the form of small and frequent doses. This is very different from individuals studied in controlled immunization trials where the delivery of large numbers of radiation-attenuated sporozoites in a limited number of doses can induce sterile protective immunity. Using irradiated mosquitoes infected with Plasmodium yoelii 17XNL, we tested whether daily bites from a few mosquitoes can induce a protective immune response in mice. This immunization strategy successfully induced a protective response, preventing the development of liver stages when mice were challenged with nonirradiated sporozoites. These results provide further support for the development of liver stage vaccines. They are also a call for further study into why fully protective responses against the liver stage are not seen in individuals from endemic regions.
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Affiliation(s)
- K A Wong
- Department of Medical Parasitology, New York University School of Medicine, New York, NY 10010, USA
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Wong KA, Bano A, Rigaux A, Wang B, Bharadwaj B, Schürch S, Green F, Remmers JE, Hasan SU. Pulmonary vagal innervation is required to establish adequate alveolar ventilation in the newborn lamb. J Appl Physiol (1985) 1998; 85:849-59. [PMID: 9729557 DOI: 10.1152/jappl.1998.85.3.849] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To investigate the effects of bilateral intrathoracic vagotomy on the establishment of continuous breathing and effective gas exchange at birth, we studied 8 chronically instrumented, unanesthetized, sham-operated and 14 vagotomized newborn lambs after a spontaneous, unassisted vaginal delivery. Fetal lambs were instrumented in utero to record sleep states, diaphragmatic electromyogram, blood pressure, arterial pH, and blood-gas tensions. Six of eight sham-operated lambs established effective gas exchange within 10 min of birth, whereas 12 of 14 vagotomized animals developed respiratory acidosis and hypoxemia (P = 0.008). Breathing frequency in vagotomized newborns was significantly lower during the entire postnatal period compared with sham-operated newborns. Vagotomized subjects also remained hypothermic during the entire postnatal period (P < 0.05). Bronchoalveolar lavage indicated an increased minimum surface tension, whereas lung histology showed perivascular edema and partial atelectasis in the vagotomized group. We conclude that stimulation of breathing and effective gas exchange are critically dependent on intact vagal nerves during the transition from fetal to neonatal life.
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Affiliation(s)
- K A Wong
- Department of Pediatrics, The University of Calgary, Calgary, Alberta, Canada T2N 4N1
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Lidgett AJ, Moran M, Wong KA, Furze J, Rhodes MJ, Hamill JD. Isolation and expression pattern of a cDNA encoding a cathepsin B-like protease from Nicotiana rustica. Plant Mol Biol 1995; 29:379-84. [PMID: 7579187 DOI: 10.1007/bf00043660] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Sequence analysis of a 1.33 kb clone from a root cDNA library of Nicotiana rustica revealed an open reading frame encoding a protein of 356 amino acids. The deduced protein has high levels of homology to human cathepsin B protease and a cathepsin B-like cysteine protease from wheat but much lower levels of homology with other plant cysteine proteinases. Southern blotting experiments suggest a limited number of cathepsin B-like genes are present in the genome of N. rustica and also that of N. tabacum. RNA analysis involving a range of tissues, harvested from both Nicotiana species 4-5 h after the beginning of a 16 h photoperiod, revealed the cathepsin B-like gene was being expressed strongly in roots, stem and developing flowers but weakly in mature leaves. Further analysis of RNA extracted from leaf tissue of N. tabacum revealed the gene showed rhythmic expression and also that its expression increased in response to wounding. Analysis of leaf tissues harvested during the latter part of a 16 h photoperiod (11 and 16 h after illumination commenced) showed that transcript levels were two three times higher than in leaf tissue harvested either towards the end of the dark period or 5 h after illumination commenced. When leaf tissue was wounded at 11:00 (5 h after plants were illuminated), and harvested for RNA extraction 6 h later, the level of cathepsin B-like transcript in mesophyll tissue was found to be increased ca. 2-fold relative to the level detected in unwounded controls.
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Affiliation(s)
- A J Lidgett
- Department of Genetics and Developmental Biology, Monash University, Melbourne, Victoria, Australia
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