Prediction and Staging of Hepatic Fibrosis in Children with Hepatitis C Virus: A Machine Learning Approach / 대한의료정보학회지

OBJECTIVES: The aim of this study is to develop an intelligent diagnostic system utilizing machine learning for data cleansing, then build an intelligent model and obtain new cutoff values for APRI (aspartate aminotransferase-to-platelet ratio) and FIB-4 (fibrosis score) for the prediction and staging of fibrosis in children with chronic hepatitis C (CHC). METHODS: Random forest (RF) was utilized in this study for data cleansing; then, prediction and staging of fibrosis, APRI and FIB-4 scores and their areas under the ROC curve (AUC) have been obtained on the cleaned dataset. A cohort of 166 Egyptian children with CHC was studied. RESULTS: RF, APRI, and FIB-4 achieved high AUCs; where APRI had AUCs of 0.78, 0.816, and 0.77; FIB-4 had AUCs of 0.74, 0.828, and 0.78; and RF had AUCs of 0.903, 0.894, and 0.822, for the prediction of any type of fibrosis, advanced fibrosis, and differentiating between mild and advanced fibrosis, respectively. CONCLUSIONS: Machine learning is a valuable addition to non-invasive methods of liver fibrosis prediction and staging in pediatrics. Furthermore, the obtained cutoff values for APRI and FIB-4 showed good performance and are consistent with some previously obtained cutoff values. There was some agreement between the predictions of RF, APRI and FIB-4 for the prediction and staging of fibrosis.

Oxidative stress and neonatal jaundice: an etiological study

This study aimed at investigating the role of oxidative stress in the development of neonatal jaundice. The enzyme activities of erythrocyte glucose-6-phosphate dehydrogenase [G6PD], plasma glutathione peroxidase [GSHPx] and glutathione-S-transferase [GST] were measured by quantitative determination of enzyme activity in 40 jaundiced full term newborns with different peak bilirubin levels [12.5 - 20 mg/dl] [not attributable to any known etiology] and 20 control newborns. The level of plasma advanced oxidation protein products [AOPP], an index of oxidative stress was also measured in these newborns. None of the jaundiced newborns needed phototherapy or exchange blood transfusion before the study. Plasma GSHPx activity was significantly lower in infants with hyperbilirubinaemia compared to control group. However, the enzyme activities of both plasma GST and erythrocyte G6PD as well as plasma AOPP concentrations were significantly higher in jaundiced newborn infants than in the control group. Plasma GSHPx activity demonstrated a significant negative correlation with GST activity, bilirubin concentration and AOPP levels. A significant positive correlation was also evident between serum bilirubin and plasma AOPP concentrations. The results of this study suggest that low GSHPx activity in jaundiced newborn infants might predispose these infants to oxidative stress. This may result in the development of mild oxidative hemolysis and jaundice

Leukotrienes and essential fatty acids patterns in children with severe protein energy malnutrition

The objective of this study is to investigate the roles of leukotrienes [LTs] and essential fatty acids [EFA] in the pathophysiology of severe protein energy malnutrition [PEM]. Plasma cysteinyl LTs [LTC[4], LTD[4], LTE[4]] and plasma EFA levels were measured by ELISA and gas liquid chromatography after plasma extraction respectively, in 40 severely malnourished children with kwashiorkor [n=20] and marasmus [n=20]. Ten well nourished children of matching age served as control. The cysteinyl LTs level was significantly higher in kwashiorkor group than in marasmic or control groups [p<0.05]. The plasma fatty acid patterns in malnourished children indicated changes characteristic of EFA deficiency, with lower linoleic acid [LA], alpha-linolenic acid [alpha LNA], arachidonic acid [AA] and docosahexaenoic acid [DHA] levels, accompanied by significantly higher oleic acid levels in both malnourished groups. The lowest values of LA and alpha-LNA were detected in marasmic group and the lowest levels of AA and DHA were in kwashiorkor group [p<0.05]. There was an inverse correlation between AA and LTs levels in children with kwashiorkor. Clinical problems associated with kwashiorkor such as hair and skin changes, edema, psychomotor alteration and hepatomegaly were significantly correlated directly with LTs and in versely with AA levels. The findings of this study suggest that cysteinyl LTs and EFA deficiency are involved in the pathophysiology of PEM particularly kwashiorkor and that severe PEM is associated with impaired FA desaturation and elongation pathways