The higher prevalence of truncal obesity and diabetes in American than Chinese patients with chronic hepatitis C might contribute to more rapid progression to advanced liver disease

Diabetes mellitus early warning and factor analysis using ensemble Bayesian networks with SMOTE-ENN and Boruta

Diabetes mellitus (DM) has become the third chronic non-infectious disease affecting patients after tumor, cardiovascular and cerebrovascular diseases, becoming one of the major public health issues worldwide. Detection of early warning risk factors for DM is key to the prevention of DM, which has been the focus of some previous studies. Therefore, from the perspective of residents' self-management and prevention, this study constructed Bayesian networks (BNs) combining feature screening and multiple resampling techniques for DM monitoring data with a class imbalance in Shanxi Province, China, to detect risk factors in chronic disease monitoring programs and predict the risk of DM. First, univariate analysis and Boruta feature selection algorithm were employed to conduct the preliminary screening of all included risk factors. Then, three resampling techniques, SMOTE, Borderline-SMOTE (BL-SMOTE) and SMOTE-ENN, were adopted to deal with data imbalance. Finally, BNs developed by three algorithms (Tabu, Hill-climbing and MMHC) were constructed using the processed data to find the warning factors that strongly correlate with DM. The results showed that the accuracy of DM classification is significantly improved by the BNs constructed by processed data. In particular, the BNs combined with the SMOTE-ENN resampling improved the most, and the BNs constructed by the Tabu algorithm obtained the best classification performance compared with the hill-climbing and MMHC algorithms. The best-performing joint Boruta-SMOTE-ENN-Tabu model showed that the risk factors of DM included family history, age, central obesity, hyperlipidemia, salt reduction, occupation, heart rate, and BMI.

Alpha fetoprotein promotes polarization of macrophages towards M2-like phenotype and inhibits macrophages to phagocytize hepatoma cells

Alpha-fetoprotein(AFP) is a cancer biomarker for the diagnosis of hepatocellular carcinoma(HCC); however, its role in macrophage polarization and phagocytosis remains unclear. In the present study, we explored the correlation between AFP regulation of macrophage function and the possible regulatory mechanisms. Human mononuclear leukemia cells (THP-1) and monocytes from healthy donors were used to analyze the effect of AFP on the macrophages' phenotype and phagocytosis. THP-1 cells and healthy human donor-derived monocytes were polarized into M0 macrophages induced by phorbol ester (PMA), and M0 macrophages were polarized into M1 macrophages induced by lipopolysaccharide(LPS) and interferon-γ(IFN-γ). Interleukin-4(IL-4) and interleukin-13(IL-13) were used to induce M0 macrophage polarization into M2 macrophages. Tumor-derived AFP(tAFP) stimulated M0 macrophage polarization into M2 macrophages and inhibited M1 macrophages to phagocytize HCC cells. The role of AFP in promoting macrophage polarization into M2 macrophages and inhibiting the M1 macrophages to phagocytize HCC cells may be involved in activating the PI3K/Akt signaling pathway. AFP could also enhanced the migration ability of macrophages and inhibited the apoptosis of HCC cells when co-cultured with M1-like macrophages. AFP is a pivotal cytokine that inhibits macrophages to phagocytize HCC cells.

Risk factors for liver-related mortality of patients with hepatitis C virus after sustained virologic response to direct-acting antiviral agents

BACKGROUND AND AIM

The aim of this study was to identify the factors associated with liver-related and non-liver-related mortality of patients with hepatitis C virus (HCV) after sustained virologic response (SVR) to direct-acting antiviral agents (DAAs).

METHODS

We conducted a retrospective, single-center cohort study of HCV patients cured by DAAs.

RESULTS

A total of 330 patients with SVR to DAAs were eligible. The median follow-up period was 3.38 years (inter-quartile range: 2.03-4.58). The cumulative liver-related or non-liver-related mortality rates at 1, 3, and 5 years were 0.00 or 1.29%, 2.87 or 3.60%, and 5.10 or 9.46, respectively. Among the liver-related deaths, 9 of the 10 were from liver cancer. Among the non-liver-related deaths, the most common cause was malignancy. Through multivariate analysis using the Cox proportional hazard model, diabetes mellitus (DM, hazard ratio 13.1, 95% confidence interval 2.81-61.3) and a history of hepatocellular carcinoma (HCC, 12.8, 2.76-59.2), independently predicted liver-related death. No variables were associated with non-liver-related death.

CONCLUSION

Our findings suggest that DM and a history of HCC are risk factors for liver-related mortality of HCV patients cured by DAAs. These results indicate that early management of HCV and HCC surveillance of diabetic patients after SVR are important to increase the chance of survival. Further studies are needed to confirm the association of DM and HCC history with survival.

Hepatitis C virus: A critical approach to who really needs treatment

Introduction of effective drugs in the treatment of hepatitis C virus (HCV) infection has prompted the World Health Organization to declare a global eradication target by 2030. Propositions have been made to screen the general population and treat all HCV carriers irrespective of the disease status. A year ago the new severe acute respiratory syndrome coronavirus 2 virus appeared causing a worldwide pandemic of coronavirus disease 2019 disease. Huge financial resources were redirected, and the pandemic became the first priority in every country. In this review, we examined the feasibility of the World Health Organization elimination program and the actual natural course of HCV infection. We also identified and analyzed certain comorbidity factors that may aggravate the progress of HCV and some marginalized subpopulations with characteristics favoring HCV dissemination. Alcohol consumption, HIV coinfection and the presence of components of metabolic syndrome including obesity, hyperuricemia and overt diabetes were comorbidities mostly responsible for increased liver-related morbidity and mortality of HCV. We also examined the significance of special subpopulations like people who inject drugs and males having sex with males. Finally, we proposed a different micro-elimination screening and treatment program that can be implemented in all countries irrespective of income. We suggest that screening and treatment of HCV carriers should be limited only in these particular groups.

Exploratory study on classification of diabetes mellitus through a combined Random Forest Classifier

BACKGROUND

Diabetes Mellitus (DM) has become the third chronic non-communicable disease that hits patients after tumors, cardiovascular and cerebrovascular diseases, and has become one of the major public health problems in the world. Therefore, it is of great importance to identify individuals at high risk for DM in order to establish prevention strategies for DM.

METHODS

Aiming at the problem of high-dimensional feature space and high feature redundancy of medical data, as well as the problem of data imbalance often faced. This study explored different supervised classifiers, combined with SVM-SMOTE and two feature dimensionality reduction methods (Logistic stepwise regression and LAASO) to classify the diabetes survey sample data with unbalanced categories and complex related factors. Analysis and discussion of the classification results of 4 supervised classifiers based on 4 data processing methods. Five indicators including Accuracy, Precision, Recall, F1-Score and AUC are selected as the key indicators to evaluate the performance of the classification model.

RESULTS

According to the result, Random Forest Classifier combining SVM-SMOTE resampling technology and LASSO feature screening method (Accuracy = 0.890, Precision = 0.869, Recall = 0.919, F1-Score = 0.893, AUC = 0.948) proved the best way to tell those at high risk of DM. Besides, the combined algorithm helps enhance the classification performance for prediction of high-risk people of DM. Also, age, region, heart rate, hypertension, hyperlipidemia and BMI are the top six most critical characteristic variables affecting diabetes.

CONCLUSIONS

The Random Forest Classifier combining with SVM-SMOTE and LASSO feature reduction method perform best in identifying high-risk people of DM from individuals. And the combined method proposed in the study would be a good tool for early screening of DM.

Potential therapeutic targets in the tumor microenvironment of hepatocellular carcinoma: reversing the protumor effect of tumor-associated macrophages

In hepatocellular carcinoma patients, due to the microenvironmental specificity of liver, the tumor microenvironment exhibits high immunosuppression and drug resistance, resulting in excessive or insufficient responses to immunotherapy. The dynamic interactions between tumor cells and immune modulators in the TME significantly impact the occurrence and development of tumors, efficacy, and drug resistance, which can create a much more positive response to immunotherapy. Moreover, with the wide application of single-cell sequencing technology in the TME, increasing evidence shows an interaction network among cells. Sequencing results suggest that specific tumor-associated macrophages are a hub node, connecting different cell populations in the cell interaction network, and can could regulate tumor generation and antitumor immunity. This review focused on therapeutic targets that could be targeted to remodel the tumor microenvironment and reprogram the tumor-associated macrophage phenotype in hepatocellular carcinoma patients, thereby improving immunotherapeutic efficacy.

Incidence and risk factors of hepatocellular carcinoma in patients with hepatitis C in China and the United States

Hepatitis C virus (HCV) infection is the main cause of hepatocellular carcinoma (HCC) in the United States (US) and an increasingly common cause of HCC in China. We aimed to evaluate the incidence and risk factors of HCC in HCV patients in the US and China. 795 HCV RNA + patients without HCC from University of Michigan Health System (UMHS) in the US and 854 from Peking University Health Sciences Center (PUHSC) in China were prospectively followed for a median of 3.2 and 4.0 years, respectively. 45.4% UMHS and 16.2% PUHSC patients had cirrhosis. 57.6% UMHS and 52.0% PUHSC patients achieved SVR. 45 UMHS and 13 PUHSC patients developed HCC. Cumulative incidence of HCC at 5 years was 7.6% in UMHS and 1.8% in PUHSC cohort (P < 0.001). Ten patients not diagnosed with cirrhosis at enrollment but median APRI ≥ 2.0 developed HCC. Multivariate analysis showed age, gender, cirrhosis and APRI were predictors of HCC while study site and SVR were not. In this study of HCV patients, HCC incidence in the PUHSC cohort was lower than in the UMHS cohort, due to lower proportion of PUHSC patients with cirrhosis. APRI can identify risk of HCC among patients not diagnosed to have cirrhosis.

Comparison of clinical outcomes and impact of SVR in American and Chinese patients with chronic hepatitis C

Background & Aims

Chronic HCV infection is an important cause of hepatocellular carcinoma (HCC) and liver failure in the US but limited data are available in China. We compared the incidence of clinical outcomes among adults with chronic HCV infection in the US and China and examined factors associated with outcomes.

Methods

A parallel prospective study of 2 cohorts of patients with HCV RNA+ recruited in 1 site in the US (UMHS) and 3 sites (PUHSC) in China between September 2011 and July 2015 was carried out. Composite liver outcomes (liver-related deaths, HCC, liver transplantation or liver decompensation), were analysed using competing-risk Cox proportional hazards model to determine incidence and associated factors.

Results

A total of 795 UMHS and 854 PUHSC patients were followed for a median of 3.06 and 3.99 years, respectively. At enrolment, a significantly higher percentage of UMHS patients had cirrhosis (45.4% vs. 16.2%). The 5-year cumulative incidence of composite liver outcomes was significantly higher in UMHS than in PUHSC patients (25.3% vs. 6.6%, p <0.0001). Stratification by stage of liver disease at enrolment showed this difference persisted only in the subgroup without cirrhosis due to higher aspartate aminotransferase to platelet ratio index (APRI) in the UMHS cohort. A total of 493 UMHS and 502 PUHSC patients received HCV treatment, and sustained virologic response (SVR) was achieved in 88.0% UMHS and 86.8% PUHSC treated-patients. SVR as time-dependent variable was associated with 80% lower risk of composite liver outcomes among patients with decompensated cirrhosis but not the overall cohorts.

Conclusions

When accounting for disease severity at entry, the incidence of composite liver outcomes was similar in patients with HCV in the US and China. Achievement of SVR had the greatest short-term impact on patients with decompensated cirrhosis.

Lay summary

Patients with chronic hepatitis C virus infection were recruited from centres in the United States and China. During follow-up, a higher percentage of the American patients had clinical outcomes: liver failure, liver cancer, liver transplant or liver-related deaths than the Chinese patients, mainly because more American patients had cirrhosis at enrolment. Older age and more advanced liver disease were associated with higher incidence of outcomes overall and viral clearance after hepatitis C treatment was associated with a lower incidence of outcomes in patients with advanced cirrhosis. Our findings highlight the importance of improving diagnosis and treatment of hepatitis C before advanced liver disease develops.

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The incidence of clinical outcomes in US and Chinese patients with chronic HCV infection was compared.

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Outcome rates were higher in the US cohort, in which cirrhosis was more common.

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SVR rates were similar in the 2 cohorts.

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SVR decreased the incidence of clinical outcomes in patients with decompensated cirrhosis over a median 3-year follow-up.

Hepatocellular Carcinoma Mechanisms Associated with Chronic HCV Infection and the Impact of Direct-Acting Antiviral Treatment

Hepatitis C virus (HCV) infection is the major risk factor for liver cirrhosis and hepatocellular carcinoma (HCC). The mechanisms of HCC initiation, growth, and metastasis appear to be highly complex due to the decade-long interactions between the virus, immune system, and overlapping bystander effects of host metabolic liver disease. The lack of a readily accessible animal model system for HCV is a significant obstacle to understand the mechanisms of viral carcinogenesis. Traditionally, the primary prevention strategy of HCC has been to eliminate infection by antiviral therapy. The success of virus elimination by antiviral treatment is determined by the SVR when the HCV is no longer detectable in serum. Interferon-alpha (IFN-α) and its analogs, pegylated IFN-α (PEG-IFN-α) alone with ribavirin (RBV), have been the primary antiviral treatment of HCV for many years with a low cure rate. The cloning and sequencing of HCV have allowed the development of cell culture models, which accelerated antiviral drug discovery. It resulted in the selection of highly effective direct-acting antiviral (DAA)-based combination therapy that now offers incredible success in curing HCV infection in more than 95% of all patients, including those with cirrhosis. However, several emerging recent publications claim that patients who have liver cirrhosis at the time of DAAs treatment face the risk of HCC occurrence and recurrence after viral cure. This remains a substantial challenge while addressing the long-term benefit of antiviral medicine. The host-related mechanisms that drive the risk of HCC in the absence of the virus are unknown. This review describes the multifaceted mechanisms that create a tumorigenic environment during chronic HCV infection. In addition to the potential oncogenic programming that drives HCC after viral clearance by DAAs, the current status of a biomarker development for early prediction of cirrhosis regression and HCC detection post viral treatment is discussed. Since DAAs treatment does not provide full protection against reinfection or viral transmission to other individuals, the recent studies for a vaccine development are also reviewed.

Application of tabu search-based Bayesian networks in exploring related factors of liver cirrhosis complicated with hepatic encephalopathy and disease identification

This study aimed to explore the related factors and strengths of hepatic cirrhosis complicated with hepatic encephalopathy (HE) by multivariate logistic regression analysis and tabu search-based Bayesian networks (BNs), and to deduce the probability of HE in patients with cirrhosis under different conditions through BN reasoning. Multivariate logistic regression analysis indicated that electrolyte disorders, infections, poor spirits, hepatorenal syndrome, hepatic diabetes, prothrombin time, and total bilirubin are associated with HE. Inferences by BNs found that infection, electrolyte disorder and hepatorenal syndrome are closely related to HE. Those three variables are also related to each other, indicating that the occurrence of any of those three complications may induce the other two complications. When those three complications occur simultaneously, the probability of HE may reach 0.90 or more. The BN constructed by the tabu search algorithm can analyze not only how the correlative factors affect HE but also their interrelationships. Reasoning using BNs can describe how HE is induced on the basis of the order in which doctors acquire patient information, which is consistent with the sequential process of clinical diagnosis and treatment.

Association between Take-Out Food Consumption and Obesity among Chinese University Students: A Cross-Sectional Study

Background: The frequency of take-out food consumption has increased rapidly among Chinese college students, which has contributed to high obesity prevalence. However, the relationships between take-out food consumption, body mass index (BMI), and other individual factors influencing eating behavior among college students are still unclear. This study explored the association of take-out food consumption with gender, BMI, physical activity, preference for high-fat and high-sugar (HFHS) food, major category, and degree level among Chinese college students. Methods: Cross-sectional data were collected from 1220 college students in Beijing, China, regarding information about take-out food consumption, physical activity, and preference for HFHS food using a self-reported questionnaire. The logistic linear regression model was used to analyze the association between take-out food consumption and personal and lifestyle characteristics. Results: Out of 1220 college students, 11.6% of college students were overweight or obese. Among the personal and lifestyle characteristics, high frequency of take-out food consumption was significantly associated with a non-medical major, high preference for HFHS food, degree level, and higher BMI, but not physical activity. Conclusion: Among Chinese college students, consumption of take-out food may be affected by major category, preference for HFHS food, degree level, and BMI. This could provide guidance on restrictions of high take-out food consumption, which contributes to high obesity prevalence and high risk for metabolic diseases.

Sustained virological response to hepatitis C treatment decreases the incidence of complications associated with type 2 diabetes

BACKGROUND

The role of hepatitis C (HCV) eradication on the long-term complications of type 2 diabetes mellitus remains incompletely studied.

AIM

To investigate whether antiviral treatment impacted risk of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy among diabetic patients from the four US health systems comprising the Chronic Hepatitis Cohort Study (CHeCS).

METHODS

We included CHeCS HCV patients with diagnosis codes for type 2 diabetes who were on antidiabetic medications. Patients were followed until an outcome of interest, death, or last health system encounter. The effect of treatment on outcomes was estimated using the competing risk analysis (Fine-Gray subdistribution hazard ratio [sHR]), with death as a competing event.

RESULTS

Among 1395 HCV-infected patients with type 2 diabetes, 723 (52%) were treated with either interferon-based or direct-acting antivirals (DAAs); 539 (75% of treated) achieved sustained virological response (SVR). After propensity score adjustment to address treatment selection bias, patients with SVR demonstrated significantly decreased risk of acute coronary syndrome (sHR = 0.36; P < 0.001), end-stage renal disease (sHR = 0.46; P < 0.001), stroke (sHR = 0.34; P < 0.001), and retinopathy (sHR = 0.24; P < 0.001) compared to untreated patients. Results were consistent in subgroup analyses of DAA-treated patients and interferon-treated patients, an analysis of cirrhotic patients, as well as in sensitivity analyses considering cause-specific hazards, exclusion of patients with on-treatment retinopathy, and treatment status as a time-varying covariate.

CONCLUSION

Successful HCV treatment among patients with type 2 diabetes significantly reduces incidence of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy, regardless of cirrhosis. Our findings support the importance of HCV antiviral therapy among patients with type 2 diabetes to reduce the risk of these extrahepatic outcomes.

Sustained virological response and metabolic risk factors are associated with mortality in patients with chronic hepatitis C

BACKGROUND AND AIM

Previous studies have reported that sustained virological response (SVR) to interferon-based treatment reduces the risk of mortality in chronic hepatitis C (CHC) patients, mainly in cirrhotic patients. A population-based study reported that metabolic risk factors increase the risk of mortality in CHC patients. We aim to investigate the association between SVR, metabolic risk factors and mortality in CHC patients with and without advanced fibrosis.

METHODS

We collected data from 1452 CHC patients who underwent interferon-based therapy. All patients underwent liver biopsy prior to therapy. Mild fibrosis was defined as a modified Knodell score of 0-2, while advanced fibrosis was defined as a score of 3-4.

RESULTS

1452 patients were followed up for a median (IQR) of 6.6 (4.2-9.4) years, 1124 patients (77.4%) achieved SVR, 619 patients (42.6%) were advanced fibrosis. 14 patients with mild fibrosis and 55 patients with advanced fibrosis died during follow-up period. According to multivariate Cox regression analyses, SVR reduced the risks of all-cause mortality (HR, 0.21; 95% CI, 0.12-0.37; P<0.001), liver-related mortality (HR, 0.19; 95% CI, 0.10-0.38; P < .001), and non-liver-related mortality (HR, 0.26; 95% CI, 0.10-0.71; P = 0.009) in the patients with advanced fibrosis. SVR also reduced the risk of liver-related mortality (HR, 0.09; 95% CI, 0.01-0.60; P = 0.013) in the patients with mild fibrosis. Anti-hypertensive treatment increased the risks of all-cause mortality (HR, 6.1; 95% CI: 1.66-22.54; P = 0.006) and liver-related mortality (HR, 12.3; 95% CI: 1.4-108.5; P = 0.02) in the patients with mild fibrosis.

CONCLUSION

SVR and metabolic risk factors are associated with mortality in CHC patients given interferon-based treatment.

Diabetes is associated with advanced fibrosis and fibrosis progression in non-genotype 3 chronic hepatitis C patients

BACKGROUND

Diabetes is a risk factor of fibrosis progression in chronic hepatitis C (CHC). However, only one longitudinal study exploring whether diabetes is associated with progression from non-cirrhotic liver to cirrhosis in CHC patients has been conducted.

AIMS

We investigated whether diabetes is associated with progression from non-cirrhotic liver to cirrhosis in non-genotype 3 CHC patients.

METHODS

A cohort consisting of 976 non-genotype 3 patients histologically proven to have CHC was studied. After excluding patients with biopsy-proven or ultrasound-identified cirrhosis, there were 684 patients without cirrhosis. All 684 patients underwent hepatocellular carcinoma surveillance using ultrasound every 6 months, with a median duration of follow-up evaluation of 102.4 months. During the follow-up period, 60 patients developed cirrhosis according to ultrasound findings.

RESULTS

For the subgroup of 684 patients without cirrhosis, Kaplan-Meier survival analyses showed no significantly different cumulative incidences of cirrhosis (log-rank test; P = 0.71) among the patients with diabetes as compared to those without. However, after making adjustments for age, gender, fibrosis, steatosis, sustained virological response status, and obesity using Cox's proportional hazard model, diabetes was found to be an independent predictor for cirrhosis (HR = 1.9; 95% CI = 1.05-3.43, P = 0.03).

CONCLUSIONS

Diabetes is associated with progression from non-cirrhotic liver to cirrhosis in non-genotype 3 CHC patients.

Hepatitis C Virus and Hepatocellular Carcinoma: A Narrative Review

Hepatocellular carcinoma (HCC) is a leading cause of liver-related death worldwide. Hepatitis C virus (HCV) infection is a major cause of advanced hepatic fibrosis and cirrhosis, with significantly increased risk for development of HCC. The morbidity and mortality of HCV-related HCC remains high, as rates of HCV cirrhosis continue to increase. The long-term goal of antiviral therapy for chronic HCV is to reduce complications from cirrhosis, including HCC. The advent of new direct-acting antivirals with high rates of virological clearance has revolutionized cure of HCV infection. While the development of HCC in HCV patients who achieve disease sustained virologic response is reduced, these patients remain at risk for HCC, particularly those patients with advanced fibrosis and cirrhosis. This review outlines the epidemiology of HCC in chronic HCV, various mechanisms, risk factors and pathophysiology that contribute to this disease process, screening recommendations, and the available data on the impact of new direct-acting antiviral treatment on the development on HCC.

Prevalence of hyperlipidemia in Shanxi Province, China and application of Bayesian networks to analyse its related factors

This study aimed to obtain the prevalence of hyperlipidemia and its related factors in Shanxi Province, China using multivariate logistic regression analysis and tabu search-based Bayesian networks (BNs). A multi-stage stratified random sampling method was adopted to obtain samples among the general population aged 18 years or above. The prevalence of hyperlipidemia in Shanxi Province was 42.6%. Multivariate logistic regression analysis indicated that gender, age, region, occupation, vegetable intake level, physical activity, body mass index, central obesity, hypertension, and diabetes mellitus are associated with hyperlipidemia. BNs were used to find connections between those related factors and hyperlipidemia, which were established by a complex network structure. The results showed that BNs can not only be used to find out the correlative factors of hyperlipidemia but also to analyse how these factors affect hyperlipidemia and their interrelationships, which is consistent with practical theory, is superior to logistic regression and has better application prospects.