RESUMO
BACKGROUND: Pouchitis is one of the major postoperative complications of ulcerative colitis (UC), and it is still difficult to predict the development of pouchitis after ileal pouch-anal anastomosis (IPAA) in UC patients. In this study, we examined whether a deep learning (DL) model could predict the development of pouchitis. METHODS: UC patients who underwent two-stage restorative proctocolectomy with IPAA at Keio University Hospital were included in this retrospective analysis. The modified pouchitis disease activity index (mPDAI) was evaluated by the clinical and endoscopic findings. Pouchitis was defined as an mPDAI ≥ 5.860; endoscopic pouch images before ileostomy closure were collected. A convolutional neural network was used as the DL model, and the prediction rates of pouchitis after ileostomy closure were evaluated by fivefold cross-validation. RESULTS: A total of 43 patients were included (24 males and 19 females, mean age 39.2 ± 13.2 years). Pouchitis occurred in 14 (33%) patients after ileostomy closure. In less than half of the patients, mPDAI scores matched before and after ileostomy closure. Most of patients whose mPDAI scores did not match before and after ileostomy closure had worse mPDAI scores after than before. The prediction rate of pouchitis calculated by the area under the curve using the DL model was 84%. Conversely, the prediction rate of pouchitis using mPDAI before ileostomy closure was 62%. CONCLUSION: The prediction rate of pouchitis using the DL model was more than 20% higher than that using mPDAI, suggesting the utility of the DL model as a prediction model for the development of pouchitis. It could also be used to determine early interventions for pouchitis.
Assuntos
Colite Ulcerativa , Bolsas Cólicas , Aprendizado Profundo , Pouchite , Proctocolectomia Restauradora , Adulto , Anastomose Cirúrgica/efeitos adversos , Inteligência Artificial , Colite Ulcerativa/complicações , Colite Ulcerativa/cirurgia , Bolsas Cólicas/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Pouchite/etiologia , Proctocolectomia Restauradora/efeitos adversos , Estudos RetrospectivosRESUMO
New dammarane-type triterpene oligoglycosides, jujubosides A1 and C and acetyljujuboside B1 were isolated from Zizyphi Spinosi Semen, the seeds of Zizyphus jujuba MILL. var. spinosa Hu, together-with three known saponins. The structures of jujubosides A1 and C and acetyljujuboside B were determined on the basis of chemical and physicochemical evidence. Jujubosides A1 and C and acetyljujuboside B were found to inhibit the histamine release from rat peritoneal exudate cells induced by antigen-antibody-reaction.
Assuntos
Glicosídeos/síntese química , Glicosídeos/farmacologia , Antagonistas dos Receptores Histamínicos/química , Antagonistas dos Receptores Histamínicos/farmacologia , Extratos Vegetais/farmacologia , Plantas Medicinais/química , Saponinas/química , Saponinas/farmacologia , Animais , Líquido Ascítico/citologia , Sequência de Carboidratos , Glicosídeos/isolamento & purificação , Liberação de Histamina/efeitos dos fármacos , Masculino , Conformação Molecular , Dados de Sequência Molecular , Extratos Vegetais/isolamento & purificação , Ratos , Ratos Wistar , Sementes/química , Relação Estrutura-AtividadeRESUMO
Following the elucidation of jujubosides A1 and C and acetyljujuboside B, novel protojujubogenin type triterpene bisdesmosides, protojujubosides A, B, and B1, were isolated from Zizyphi Spinosi Semen, the seeds of Zizyphus jujuba Mill. var. spinosa Hu. The structures of protojujubosides A, B, and B1 were determined on the basis of chemical and physicochemical evidence, which included the conversion of protojujubosides to known jujubosides using enzymatic hydrolysis. Protojujubosides A and jujubosides A, B, and C were found to show potent immunological adjuvant activity.