Acta Informatica Medica最新文献

Background: Operating on difficult cholecystectomy with the intent to proceed with total cholecystectomy can be associated with longer postoperative time, excessive bleeding, and increased risk of intraoperative bile duct injury and other complications. Subtotal cholecystectomy is a part of bail-out procedures recommended in cases of difficult cholecystectomy. It is a convenient alternative to total cholecystectomy as it is a comparatively more manageable and safer treatment procedure.

Objective: The aim of this study was to assess the difference in outcomes between laparoscopic total cholecystectomy (LTC) and laparoscopic subtotal cholecystectomy (LSC).

Methods: This retrospective, cross-sectional study was conducted at King Fahd Hospital of the University (KFHU), Saudi Arabia, between 2010 to 2020. The study included patients over 18 years of age who underwent laparoscopic (subtotal and total) cholecystectomy at KFHU.

Results: Out of 636 cases in the study period, only 21 patients underwent laparoscopic subtotal reconstituting cholecystectomy. The laparoscopic total cholecystectomy group was more diagnosed with biliary colic (56.1%), whereas those who underwent laparoscopic subtotal cholecystectomy were mainly diagnosed with acute cholecystitis (66.7%). We found a significant association between WBC, reticulocyte count level, and the conversion to LSC. Regarding postoperative outcomes, only 7.8% had a drain in the laparoscopic total cholecystectomy group compared to the majority (71.4%) in the laparoscopic subtotal cholecystectomy group (p<0.0001). A significantly longer length of stay was reported in the subtotal cholecystectomy group (9.14±7.63 versus 4.6±3.84) and a greater rate of reoperation (9.5% versus 0.7%).

Conclusion: Laparoscopic subtotal cholecystectomy should be performed in difficult cases when total cholecystectomy is not possible, considering the possible complications of subtotal cholecystectomy. More prospective studies should take into consideration other patient-related factors that might influence postoperative outcomes and overall success rates.

Background: Gut disorders present a considerable worldwide health challenge, and increasing attention is being paid to natural substances as prospective treatment agents.

Objective: This research utilizes network pharmacology, molecular docking, and molecular dynamics simulations to examine the mechanisms of active compounds from Areca catechu in the treatment of gastrointestinal disorders.

Methods: Employing a comprehensive methodology, we evaluated active compounds from A. catechu, conducted drug-likeness and ADMET assessments, and identified principal protein targets linked to gastrointestinal diseases.

Results: Utilizing a protein-protein interaction network, gene ontology enrichment, and KEGG pathway analysis, we identified that chemicals from A. catechu are significantly associated with metabolic activities, including cholesterol metabolism, fat digestion and absorption, and the PPAR signaling pathway. Molecular docking and molecular dynamics simulations were employed to evaluate the binding affinities and stability of selected compounds with three pivotal proteins: Interleukin-6 (IL-6), Peroxisome proliferator-activated receptor gamma (PPAR-γ), and Microsomal triglyceride transfer protein large subunit (MTP). Among the compounds analyzed, catechin emerged as the most promising candidate, exhibiting the highest binding affinity and exceptional stability in inhibiting all three target proteins.

Conclusion: Our findings suggest that catechin from Areca catechu holds significant potential as a therapeutic agent for gastrointestinal disorders, acting through the modulation of critical metabolic and inflammatory pathways. This study underscores the importance of natural compounds in developing novel treatments for complex gastrointestinal conditions.

Background: Cataract surgery aims to restore clear vision by replacing the clouded crystalline lens with an intraocular lens (IOL). Accurate IOL power calculation is crucial to achieve desirable postoperative refractive outcomes.

Objective: The aim of this study was to compare the predictive accuracy of multiple intraocular lens (IOL) power calculation formulas in eyes with prior LASIK surgery using two biometric devices, LenStar 900 and IOLMaster 500, combined with immersion ultrasound (US).

Methods: This retrospective observational study included 37 eyes of 29 patients who underwent previous LASIK and subsequent cataract surgery. Biometric measurements included axial length, keratometry, anterior chamber depth, and lens thickness, which were obtained using LenStar 900 (19 eyes) or IOLMaster 500 combined with US (18 eyes). IOL power was calculated using the Shammas PL, Haigis-L, Barrett TK no history, Shammas Cooke, and EVO 2.0 (without PK1/PK2). The mean absolute error (MAE) at 3 months postoperatively was assessed for each formula within each device group.

Results: For LenStar 900, the MAE ranged from 0.389 ± 0.329 D (Barrett TK no history) to 0.574 ± 0.689 D (Shammas Cooke), with no significant differences among the formulas. For IOLMaster 500 + US, the MAE ranged from 0.423 ± 0.210 D (Barrett TK no history) to 0.601 ± 0.510 D (Shammas Cooke). Comparisons between devices revealed significantly lower MAE with LenStar 900 for Shammas PL, Shammas Cooke, and EVO 2.0, whereas differences for Haigis-L and Barrett TK showed no significant differences.

Conclusion: IOL power prediction in post-LASIK eyes varied according to the biometry device. Barrett TK had no history, and EVO performed well with LenStar 900, while Haigis-L showed consistent accuracy across devices, suggesting that it may be the most reliable formula when using non-synchronous biometry systems.

Background: Twin-to-twin transfusion syndrome (TTTS) is a severe complication in monochorionic twin pregnancies, leading to high perinatal morbidity and mortality. Fetoscopic laser photocoagulation (FLP) is the gold standard treatment; however, fetal demiseremains a concern. The soluble vascular endothelial growth factor receptors, sVEGFR-1 and sVEGFR-2, play a crucial role in regulating angiogenesis and vascular function. This study evaluates changes in sVEGFR-1 and sVEGFR-2 levels before and after FLP and explores their role in predicting fetal demise post-surgery.

Objective: Therefore, this study aims to evaluate pre- and post-surgical changes in sVEGFR-1 and sVEGFR-2 levels in TTTS cases treated with FLP and determine their predictive value for fetal demiseafter surgery. Methods: A prospective longitudinal study was done with 27 pregnant women with TTTS stage II-IV according to Quintero classification from 16 to 26 weeks of gestation undergoing FLS. Among them, 11 cases were carried out coagulation the placental vascular anastomoses, 16 cases were done ablation umbilical cord for the selective fetal reduction because of TTTS stage IV, selective intrauterine growth restriction (sIUGR) or proximate cord insertions. All the studies subject investigated the soluble levels of biomarkers. We quantified plasma levels of VEGF-R1, VEGF- R2 in twin pregnant with TTTS before and one week after surgery by ELISA. Many factors included maternal age, gestational age at surgery, stage of TTTS, placental location, level of polyhydramnios, FLS methods, sIUGR, amount of amniotic fluid drawn, duration of surgery, change of maternal circulating biomarker levels were analyzed to find out the association with fetal demise after FLS.

Results: Statistics showed that VEGF-R1 levels were significantly decreased after surgery and change in soluble VEGF-R1 levels after surgery had a difference between the group of fetal demise and non-fetal demise. ROC curve showed that degree of VEGF-R1 levels reduction after surgery were higher, the risk of fetal demise was bigger (AUC: 0.8472), in which, cut-off point of degree of VEGF-R1 levels reduction after surgery was 36.5% (sensitivity: 66.67%, specificity: 95.83%).

Conclusion: Our data suggest that change in VEGF-R1 after surgery could play a prognostic role of fetal demise after fetoscopic laser surgery.

Background: Breast cancer is a biologically heterogeneous disease with four major molecular subtypes that determine prognosis and treatment strategies. MRI-based radiomics provides a non-invasive method to predict these subtypes by quantifying tumor heterogeneity.

Objective: To develop and validate a logistic-regression model using MRI-derived radiomic features to predict four molecular subtypes of invasive breast cancer: luminal A (LA), luminal B (LB), HER2-enriched (HER2), and triple-negative breast cancer (TNBC).

Methods: A retrospective cohort of 169 patients with histologically proven invasive breast carcinoma who underwent pre-treatment dynamic contrast-enhanced MRI (DCE-MRI, 3.0 T) was analyzed. Tumors were manually segmented; radiomic texture features were extracted with LIFEx and standardized by z-score normalization. Feature selection was performed using L1-regularized logistic regression (LASSO). Four one-vs-rest logistic-regression models were trained with 5-fold cross-validation. Performance metrics included AUC, sensitivity, specificity, accuracy, and precision.

Results: The models achieved AUCs of 0.840 (TNBC), 0.788 (HER2), 0.661 (LA), and 0.635 (LB). TNBC showed the highest accuracy (0.923), whereas LB had the lowest sensitivity (0.393). Confusion matrices revealed good classification for TNBC and HER2 but frequent misclassification between LA and LB. TNBC-related features were largely intensity- and entropy-based.

Conclusion: MRI-derived radiomic signatures can non-invasively differentiate breast-cancer molecular phenotypes, with particularly strong performance for TNBC and HER2. Although LA-LB separation remains limited, the LASSO-logistic-regression framework offers moderate-to-high diagnostic accuracy and potential value as a complementary precision-oncology decision-support tool.

Background: Posterior pericardiotomy has been proposed to prevent postoperative pericardial effusion and tamponade in coronary artery bypass grafting, but its effect on pleural fluid accumulation during off-pump CABG (OPCAB) is not well defined.

Objective: To compare intraoperative metrics and early postoperative outcomes-particularly rates of pleural and pericardial effusions-between OPCAB with and without posterior pericardiotomy.

Methods: In this retrospective cohort, 68 patients underwent OPCAB from January to March 2025 and were stratified into pericardiotomy (n = 38) and control (n = 30) groups. Baseline demographics, comorbidities, left ventricular ejection fraction, operative time, and graft count were recorded. Postoperative outcomes included incidence of pericardial and pleural effusions (confirmed by echocardiography or chest radiography), new-onset atrial fibrillation (within seven days), chest-tube drainage volume, and in-hospital mortality.

Results: Groups were similar in age (mean 66.5 ± 7.1 years), sex, and major comorbidities, though peripheral artery disease and multi-vessel coronary disease were more prevalent in the pericardiotomy group (p = 0.002 and p = 0.017). Operative time and ICU stay did not differ significantly. Mediastinal drainage was higher after pericardiotomy (861 ± 551 vs. 764 ± 347 mL; p = 0.03). Pericardial effusion rates were low and comparable (10.5% vs. 13.3%; p = 0.72), and no tamponade occurred. Pleural effusions were significantly more frequent with pericardiotomy (42.1% vs. 6.6%; p = 0.001). Atrial fibrillation incidence and in-hospital mortality were similar between groups.

Conclusions: Posterior pericardiotomy in OPCAB effectively prevents clinically significant pericardial effusion and tamponade, though it redirects fluid into the pleural space, increasing pleural effusion rates. These effusions are manageable with routine drainage and do not prolong recovery. Prospective studies should further define patient selection and long-term implications.

Background: As technological advancements grow, so does its impact. Humans are seeing more and more computerization, a lot of it is being used for surgery. Their merger results in various legal problems relating to regulation, patient safety, and governance.

Objectives: The main objectives of this article are to study and join together legal rules and systems as it pertains to the use of artificial intelligence in medical situations for all main countries.

Methods: A narrative legal review was conducted to see what's been going on since 2010. Their sources were official documents like drug administration and legislation along articles written by numerous professors. Researchers in government are finding new ways to monitor themselves.

Results: Most AI health diagnosis had a regulated path if having to be approved, though one diagnostic system challenged that. The high-risk method of using robotic surgery leaves room for error between the overseeing surgeon and the manufacturer of the robot to be liable. Cross-cutting subject consist of the GDPR, HIPAA, the post-market and the surveillance, cybersecurity, and ethical considerations, which consist of the legal and privacy issue we have to take and apply into our lives every day. The progress in regulations has been noticed, but remains unclear for its implementation across different parts of the world.

Conclusion: A cohesive framework is required to balance innovative advancements with safety precautions for patients. Future governance must combine technology standards, medical testing, and safety rules to improve how artificial intelligence and robots are used in medical centers.

Background: Due to high demand and limited infrastructural capacity, the performance of the operating room at our facility was very complaisant which resulted in high waiting time for elective surgery and accumulation of cases waiting for surgery Aim: To improve the efficiency of operating room by expanding the surgical volume and thereby improve the access to elective surgical services.

Methods: We introduced an innovative OR scheduling whereby we added extra slots each for the evening and weekends. The staff working during those hours were arranged for their shifts accordingly with flexibility in their off-hour during weekdays and weekends.

Results: During full year 2024, a total of 1488 surgeries were conducted during extended OR schedule at our hospital, which comprised of about 53% cases (702/1488) conducted during evening and 64% (786/1488) during weekends. The cases conducted during extended hours contributed to 25% of overall elective routine cases performed. The highest proportion was contributed by ophthalmology (39%) followed by general surgery (28%) and orthopedic surgery (16%). While all the cases under ophthalmology were performed during weekends, majority of orthopedic cases were conducted during evening time. We noted 27% improvement in the waiting time for elective surgical admissions.

Conclusions: Redesigning the traditional working hours proved to utilize the available infrastructure and manpower in a better way, whereby we observed a huge expansion in the surgical volume.

Background: Chronic Kidney Disease (CKD) has become a significant global health issue, especially among the aging population. Renal transplantation is considered the most effective treatment for end-stage renal disease (ESRD), yet disparities exist in its accessibility and outcomes across different regions.

Objectives: This study aimed to compare the perspectives and outcomes of renal transplantation in adult and geriatric patients with CKD in Europe and Indonesia, highlighting differences in healthcare systems, patient management, and socio-cultural considerations.

Methods: A literature review was conducted using PubMed, ScienceDirect, and Google Scholar, focusing on publications from the last 10 years. Studies involving adult and elderly CKD patients undergoing renal transplantation in both Europe and Indonesia were analyzed for themes related to access, outcomes, quality of life, and post-transplant management.

Results: European countries generally demonstrated more structured transplantation programs, better post-operative care, and higher graft survival rates due to strong infrastructure and funding. In contrast, Indonesian patients faced challenges such as limited donor availability, economic constraints, and lower awareness about transplantation. Geriatric patients in both regions exhibited more complications post-transplantation compared to younger adults, but still benefited in terms of survival and quality of life.

Discussion: Disparities between Europe and Indonesia in renal transplantation stem from differences in healthcare access, government support, and patient education. Cultural and ethical issues also influence organ donation rates. Despite challenges, renal transplantation remains a viable option for geriatric patients, especially with proper selection and monitoring.

Conclusion: While renal transplantation offers improved outcomes for CKD patients globally, substantial disparities remain between regions. Efforts to enhance transplantation programs in developing countries like Indonesia are crucial, especially in addressing the needs of the aging population.

Background: Patient Education is a healthcare concept that involves educating the public with evidence-based medical information. This information surges their capabilities to promote a healthier life and better manage their conditions. LLM platforms have recently been introduced as powerful NLPs capable of producing human-sounding text and by extension patient education materials.

Objective: This study aims to conduct a scoping review to systematically map the existing literature on the use of LLMs for generating patient education materials.

Methods: The study followed JBI guidelines, searching five databases using set inclusion/exclusion criteria. A RAG-inspired framework was employed to extract the variables followed by a manual check to verify accuracy of extractions. In total, 21 variables were identified and grouped into five themes: Study Demographics, LLM Characteristics, Prompt-Related Variables, PEM Assessment, and Comparative Outcomes.

Results: Results were reported from 69 studies. The United States contributed the largest number of studies. LLM models such as ChatGPT-4, ChatGPT-3.5, and Bard were the most investigated. Most studies evaluated the accuracy of LLM responses and the readability of LLM responses. Only 3 studies implemented external knowledge bases leveraging a RAG architecture. All studies except 3 conducted prompting in English. ChatGPT-4 was found to provide the most accurate responses in comparison with other models.

Conclusion: This review examined studies comparing large language models for generating patient education materials. ChatGPT-3.5 and ChatGPT-4 were the most evaluated. Accuracy and readability of responses were the main metrics of evaluation, while few studies used assessment frameworks, retrieval-augmented methods, or explored non-English cases.