Potential and role of artificial intelligence in current medical healthcare

Artificial intelligence(AI)is defined as the digital computer or computer-controlled robot's ability to mimic intelligent conduct and crucial thinking commonly associated with intelligent beings.The application of AI technology and machine learning in medicine have allowed medical practitioners to provide patients with better quality of services;and current advancements have led to a dramatic change in the healthcare system.However,many efficient applications are still in their initial stages,which need further evaluations to improve and develop these applications.Clinicians must recognize and acclimate themselves with the developments in AI technology to improve their delivery of healthcare services;but for this to be possible,a significant revision of medical education is needed to provide future leaders with the required competencies.This article reviews the potential and limitations of AI in healthcare,as well as the current medical application trends including healthcare administration,clinical decision assistance,patient health monitoring,healthcare resource allocation,medical research,and public health policy development.Also,future possibilities for further clinical and scientific practice were also summarized.

Polymorphism of genes encoding drug-metabolizing and inflammation-related enzymes for susceptibility to cholangiocarcinoma in Thailand

BACKGROUND Cholangiocarcinoma(CCA)is an intractable cancer,and its incidence in north eastern Thailand is the highest worldwide.Infection with the liver fluke Opisthorchis viverrini(OV)has been associated with CCA risk.However,animal experiments have suggested that OV alone does not induce CCA,but its combination with a chemical carcinogen like nitrosamine can cause experimentally induced CCA in hamsters.Therefore,in humans,other environmental and genetic factors may also be involved.AIM To examine relations between risk for CCA and genetic polymorphisms in carcinogenmetabolizing and inflammation-related genes.METHODS This hospital-based case-control study enrolled 95 case-control pairs matched by age(±5 years)and sex.We examined relations between risk for CCA and genetic polymorphisms in carcinogenmetabolizing and inflammation-related genes,serum anti-OV,alcohol consumption,and smoking.Polymorphisms of CYP2E1,IL-6(-174 and-634),IL-10(-819),and NF-κB(-94)and their cooccurrence with polymorphisms in the drug-metabolizing enzyme gene GSTT1 or GSTM1 were also analyzed.RESULTS Although CCA risk was not significantly associated with any single polymorphism,persons with the GSTT1 wild-type and CYP2E1 c1/c2+c2/c2 genotype had an increased risk(OR=3.33,95%CI:1.23-9.00)as compared with persons having the GSTT1 wild-type and CYP2E1 c1/c1 wild genotype.The presence of anti-OV in serum was associated with a 7-to 11-fold increased risk,and smoking level was related to an OR of 1.5-1.8 in multivariable analyses adjusted for each of the seven genetic polymorphisms.CONCLUSION In addition to infection with OV,gene-gene interactions may be considered as one of the risk factors for CCA development.

Medium-term surgical outcomes and health-related quality of life after laparoscopic vs open colorectal cancer resection: SF-36 health survey questionnaire

BACKGROUND Previous studies that compared the postoperative health-related quality of life(HRQoL)outcomes after receiving laparoscopic resection(LR)or open resection(OR)in patients with colorectal cancer(CRC)have different conclusions.AIM To explore the medium-term effect of postoperative HRQoL in such patients.METHODS This study randomized 567 patients undergoing non-metastatic CRC surgery managed by one surgeon to the LR or OR groups.HRQoL was assessed during the preoperative period and 3,6,and 12 mo postoperative using a modified version of the 36-Item Short Form(SF-36)Health Survey questionnaire,emphasizing eight specific items.RESULTS This cohort randomly assigned 541 patients to receive LR(n=296)or OR(n=245)surgical procedures.More episodes of postoperative urinary tract infection(P<0.001),wound infection(P<0.001),and pneumonia(P=0.048)were encountered in the OR group.The results demonstrated that the LR group subjectively gained mildly better general health(P=0.045),moderately better physical activity(P=0.006),and significantly better social function recovery(P=0.0001)3 mo postoperatively.Only the aspect of social function recovery was claimed at 6 mo,with a significant advantage in the LR group(P=0.001).No clinical difference was found in HRQoL during the 12 mo.CONCLUSION Our results demonstrated that LR resulted in better outcomes,including intra-operative blood loss,surgery-related complications,course of recovery,and especially some health domains of HRQoL at least within 6 mo postoperatively.Patients should undergo LR if there is no contraindication.

Statin use and the risk of colorectal cancer: A population-based case-control study

AIM: To investigate whether the use of statins is associated with colorectal cancer risk. METHODS: We conducted a population-based case-control study in Taiwan. Data were retrospectively collected from the Taiwan National Health Insurance Research Database. Cases consisted of all patients who were aged 50 years and older and had a first-time diagnosis of colorectal cancer between the period 2005 and 2008. The controls were matched to cases by age, sex, and index date. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multiple logistic regression. RESULTS: We examined 1156 colorectal cancer cases and 4624 controls. The unadjusted ORs for any statin prescription was 1.10 (95% CI = 0.94-1.30) and the adjusted OR was 1.09 (95% CI = 0.91-1.30). When statin use was categorized by cumulative dose, the adjusted ORs were 0.99 (95% CI = 0.78-1.27) for the group with cumulative statin use below 105 defined daily doses (DDDs); 1.07 (95% CI = 0.78-1.49) for the group with cumulative statin use between 106 and 298.66 DDDs; and 1.30 (95% CI = 0.96-1.75) for the group with cumulative statin use of 298.66 DDDs or more compared with nonusers. CONCLUSION: This study does not provide support for a protective effect of statins against colorectal cancer.

An updated review of long-term outcomes from randomized controlled trials in approved pharmaceuticals for diabetic macular edema

Diabetic macular edema(DME) is a major sight-threatening cause in diabetic patients. We review the long-term outcome of four approved pharmacotherapy for treating DME, including intravitreal injections of corticosteroids(dexamethasone implants and fluocinolone acetonide inserts) and anti-vascular endothelial growth factor(VEGF)(ranibizumab and aflibercept). They all show superior ability to improve vision and reduce macular thickness, comparing with sham injections or macular focal/grid laser treatment. Anti-VEGF agents result in low incidence of severe ocular or systemic adverse effects, but glaucoma and cataract should be aware after intravitreal corticosteroids. Prompt treatment with these agents can lead to a better outcome.

Media: A Double-Edged Sword in the Disease Control. Content Analysis of News Report on SARS Event in Taiwan

Objective: This study was conducted to explore what media exactly do when disease is emerging and furthermore, to infer the role and the responsibility that media should play. Method: A content analysis with 0.81 inter-rater reliability was adopted to categorize SARS-related events shown on the three major newspapers in 117 days, dated from March 13th (the date before the first probable case of SARS in Taiwan was identified) to July 7th (the date after Taiwan was removed from the list of SARS-affected countries by the bulletin of World Health Organization), 2003. Results: There were totally 8923 SARS events related news found in the observed newspapers during the study period. When the epidemic situation is more serious, the media will also lay out more coverage on reporting the related contents. In the reporting contents, the three most influential newspapers in Taiwan mainly emphasized the impact dimension (34.27%). Only 2.16% of the coverage was on the topic of health communication and prevention education. Overall, the opinions of general public are the primary sources of news (46.57%). Health authority was not the main and typical sources information of the press (9.42%). Conclusion: Media is a double-edged sword in the communicable disease control. We suggest that the health authority should take advantage of media to transmit message rapidly to convey related information to public.

Approved pharmacotherapy for myopic choroidal neovascularization:a review of randomized controlled trials in ranibizumab and aflibercept

Myopic choroidal neovascularization(mCNV) can cause severe visual impairment in highly myopic patients. We review the randomized trials of two approved pharmacotherapy for treating mCNV, including intravitreal injections of ranibizumab and aflibercept. These two vascular endothelial growth factor(VEGF) antagonists show superior ability to improve vision and reduce macular thickness, comparing with sham injections or verteporfin photodynamic therapy(vPDT). There is no severe ocular or systemic adverse reaction reported in studies associated with ranibizumab and aflibercept for mCNV. Prompt treatment with these agents can lead to a better outcome.

Investigation on the Benefits and Satisfaction Degree of the Electronic Official Document On-line Submission and Approval System-A Case Study of a Medical Center in Southern Taiwan

Purpose:The aim of the study was to investigate the actual benefits of the electronic official document online submission and approval system and the satisfaction of hospital staff in a medical center in southern Taiwan,and to find out whether there are any differences between medical institutions and general government personnel.Methods:A cross-sectional study was conducted to investigate satisfactory outcome with questionnaires.The subjects were administrators,healthcare professionals and medical personnel of a medical center in the southern part of Taiwan who had signed electronic documents online.A total of 395 questionnaires were sent out,147 of which were valid,and the rate of collecting data survey was 37%.We analyzed with SPSS version 20.Results:The official document approval system was mainly used by administrative units and contractors,accounting for more than 50%of users.Besides,the frequency of use was at least more than once a week.As for the user’s perception of operating system,most people thought that it is easier to choose the format of official document and to set up the duty agent on leave,but in the part of the signing and approval process setting or modifying,it was considered more difficult,accounting for 38.1%.In terms of perceptual usefulness,the average value was 3.81,which showed that the user agreed that the system has met the needs of daily official documents.When some users of service area encountered problems with their use,the clerical staff were able to provide services immediately and have the professional ability to resolve problems,in order to agree to the majority,accounting for 53.7%.In addition,nearly 60%of users rated the official document system positively,with an average of 3.84 satisfaction,which was higher than the certified value of 3,conforming to the standards for satisfaction with the use of official documents.In addition,the role authorization,perceptual easy-to-use and service area were significant(p<0.05).The perceptual usefulness of Subordinate units was also significant(p=0.016).The frequency of use,perceptual easy-to-use,perceptual usefulness,service area and satisfaction were significantly different(p<0.05).The correlation coefficient between perceptual usefulness and user satisfaction was 0.833,indicating that there was a high correlation.The daily usage frequency of contractors was higher than supervisors.However,supervisors had the highest frequency of use every quarter(p=0.135).There was no significant difference between contractors and supervisors in the frequency of use.Conclusion:It is suggested that education and training on the operation of the electronic official document on-line submission and approval system should be conducted,which can enhance the education and training of supervisors and medical personnel.Continually,invite supervisors and medical personnel to provide advices on the official document system as a reference for future improvements of the system.

Comparison of structural outcome between intravitreal bevacizumab and laser treatment for type 1 retinopathy of prematurity after long-term follow-up

Background:To compare the structural outcome of intravitreal bevacizumab(IVB)and laser treatment for type 1 retinopathy of prematurity(ROP).Methods:This is a retrospective comparative study.From December 2002 to April 2009,patients with type 1ROP according to criteria of Early Treatment of Retinopathy of Prematurity(ETROP)study were treated by peripheral retinal diode laser photocoagulation in nearly confluent pattern.From May 2009 to January 2015,we performed IVB for patients with type 1 ROP.The patients were closely followed until disappearance of retinal neovascularization in the laser group and regression of avascular zone in the bevacizumab group.The demographical data,postmenstrual age(PMA)for treatment,and fundus findings were recorded by chart review.The difference between laser and bevacizumab groups was compared by Student t-test and Fisher exact test.Results:We collected 43 patients(86 eyes)with type 1 ROP,including 30 male and 13 female infants.Their mean gestation age and birth body weight(BBW)were 27.5 weeks and 1,034 gm.Zone I and zone II disease were found in 8 and 35 patients.The mean PMA for treatment was 37.3 weeks.The mean follow-up period was54.4 months.Laser treatment was administered in 26 patients,and bevacizumab injection for 17 infants.Single session of laser was performed in all patients of laser group without recurrence of retinal neovascularization.Complete regression of ROP was found in 15 infants of bevacizumab group following the first IVB.Four eyes in two patients(2/17,11.7%)had recurrence of ROP and received additional injections and adjuvant laser treatment.There was no unfavorable anatomical results such as retinal detachment or macular ectopia or complications such as cataract or endophthalmitis in either bevacizumab or laser management.Conclusions:Laser therapy and IVB were both effective treatments for type 1 ROP to cause favorable anatomical outcomes.Single session of laser ablation in nearly confluent pattern was sufficient for complete regression of ROP in laser group.Single IVB was appropriate for managing most of cases with ROP in bevacizumab group,but a small proportion(nearly one tenth)of them had recurrent episodes requiring adjuvant therapies.

Approved pharmacotherapy for macular edema secondary to branch retinal vein occlusion:A review of randomized controlled trials in dexamethasone implants,ranibizumab,and aflibercept

There are three approved pharmacotherapies for treating macular edema secondary to branch retinal vein occlusion(BRVO), including corticosteroids(dexamethasone implants) and anti-vascular endothelial growth factor(VEGF)(ranibizumab and aflibercept). They all show superior ability to improve vision and reduce macular thickness, comparing with sham injections or macular grid laser treatment. There is no severe ocular or systemic adverse reaction reported in studies associated with anti-VEGF for macular edema after BRVO. Intraocular pressure elevation and cataract aggravation should be addressed after intravitreal dexamethasone implants. Single intravitreal dexamethasone implant had effective duration as long as four to six months. Intravitreal anti-VEGF requires six monthly injections as loading doses, and then PRN regimen needed according to functional and anatomical changes. Ozurdex and ranibizumab reduce not only macular edema, but also the probability of retinal ischemia and neovascularization in patient s with BRVO. Prompt treatment with these agents can lead to a better outcome.

The use of aflibercept in ophthalmology:a review of randomized controlled trials

We reviewed randomized controlled trials associated with the intravitreal use of aflibercept for this article. These studies proved that aflibercept is an effective anti-vascular endothelial growth factor agent for the treatment of neovascular age-related macular degeneration (nAMD), myopic choroidal neovascularization (mCNV), diabetic macular edema (DME), and macular edema associated with retinal vein occlusion. The incidence of severe ocular or systemic complications after intravitreal administration of aflibercept was low.

H1-antihistamine use and head and neck cancer risk in type 2 diabetes mellitus

This study aimed to examine the association between the use of H1-antihistamines(AHs)and head and neck cancer(HNC)risk in patients with type 2 diabetes mellitus(T2DM).Data from the National Health Insurance Research Database of Taiwan were analyzed for the period from 2008 to 2018.A propensity-score-matched cohort of 54,384 patients each in the AH user and nonuser groups was created and analyzed using Kaplan-Meier method and Cox proportional hazards regression.The results showed that the risk of HNC was significantly lower in AH users(adjusted hazard ratio:0.55,95%CI:0.48 to 0.64)and the incidence rate was also lower(5.16 vs.8.10 per 100,000 person-years).The lower HNC incidence rate in AH users(95%CI:0.63;0.55 to 0.73)suggests that AH use may reduce the risk of HNC in T2DM patients.

The gut microbiome:implications for neurogenesis and neurological diseases

There is an increasing recognition of the strong links between the gut microbiome and the brain,and there is persuasive evidence that the gut microbiome plays a role in a variety of physiological processes in the central nervous system.This review summarizes findings that gut microbial composition alterations are linked to hippocampal neurogenesis,as well as the possible mechanisms of action;the existing literature suggests that microbiota influence neurogenic processes,which can result in neurological disorders.We consider this evidence from the perspectives of neuroinflammation,microbial-derived metabolites,neurotrophins,and neurotransmitters.Based on the existing research,we propose that the administration of probiotics can normalize the gut microbiome.This could therefore also represent a promising treatment strategy to counteract neurological impairment.

Predictive model for 5.year mortality after breast cancer surgery in Taiwan residents

Background:Few studies of breast cancer surgery outcomes have used longitudinal data for more than 2 years.This study aimed to validate the use of the artificial neural network(ANN)model to predict the 5?year mortality of breast cancer patients after surgery and compare predictive accuracy between the ANN model,multiple logistic regression(MLR)model,and Cox regression model.Methods:This study compared the MLR,Cox,and ANN models based on clinical data of 3632 breast cancer patients who underwent surgery between 1996 and 2010.An estimation dataset was used to train the model,and a validation dataset was used to evaluate model performance.The sensitivity analysis was also used to assess the relative signifi?cance of input variables in the prediction model.Results:The ANN model significantly outperformed the MLR and Cox models in predicting 5?year mortality,with higher overall performance indices.The results indicated that the 5?year postoperative mortality of breast cancer patients was significantly associated with age,Charlson comorbidity index(CCI),chemotherapy,radiotherapy,hormone therapy,and breast cancer surgery volumes of hospital and surgeon(all P<0.05).Breast cancer surgery volume of surgeon was the most influential(sensitive)variable affecting 5?year mortality,followed by breast cancer surgery volume of hospital,age,and CCI.Conclusions:Compared with the conventional MLR and Cox models,the ANN model was more accurate in predict?ing 5?year mortality of breast cancer patients who underwent surgery.The mortality predictors identified in this study can also be used to educate candidates for breast cancer surgery with respect to the course of recovery and health outcomes.

Compressive Optic Neuropathy Caused by Cholesterol Granuloma in the PosteriorEthmoid Sinus

Purpose:.Cholesterol granuloma is usually associated with chronic middle ear disease..Involvement of the ethmoid sinus by cholesterol granuloma is rare..We describe a case with cholesterol granuloma of the posterior ethmoid sinus causing optic nerve compression..No previous reports were found in our review of the literature.Case report:.A 48-year-old man had impaired visual acuity and a relative afferent pupillary defect in the right eye. Fundus fluorescein angiography showed a swollen optic nerve head and optic disc leakage. Automated perimetry revealed a severe peripheral visual field defect with tunnel vision. Computerized tomography demonstrated an expansile,.isodense mass in the right posterior ethmoid sinus, remodeling of the bony walls of the right sphenoid sinus, and lateral displacement of the optic nerve in the right orbit..Compressive optic neuropathy caused by posterior ethmoid sinus lesion was diagnosed..A transnasal endoscopic exploration of the right ethmoid sinuses demonstrated a soft expansile cystic lesion with a thick yellow cap sule that filled the inside of the posterior ethmoid sinus.Brownish fluid with shiny crystals was drained by fine needle aspiration. The capsule was removed completely, and the mucociliary clearance of the sinus was reestablished..The pathologic pictures confirmed the diagnosis of cholesterol granuloma, which included typical cholesterol clefts surrounded by inflammatory cells with focal multi-nucleated giant cells. Visual function fully recovered without recurrent lesions after a three-year follow-up.Conclusion:.Compressive optic neuropathy can be rarely caused by cholesterol granuloma in the posterior ethmoid sinus. The visual prognosis may be good after transnasal endoscopic decompression in such patients.

Intravitreal Aflibercept for Macular Edema Secondary to Branch Retinal Vein Occlusion in Chinese Patients

Purpose: To investigate the short-term efficacy and safety of intravitreal aflibercept in a case series of patients from Taiwan, China, with macular edema secondary to branch retinal vein occlusion(BRVO).Methods: A total of 32 patients with macular edema associated with BRVO,.without prior macular laser or other intervention, were enrolled consecutively from September 2013 to February 2015..The cases received single 2 mg injections of intravitreal aflibercept..Primary outcome measures included changes in central foveal thickness.(CFT;.1 mm increments by spectral-domain optic coherence tomography).and best corrected visual acuity.(BCVA),.determined at 1,.2,.and 3months after the injection. Complications after injections were recorded. The changes in CFT and BCVA were compared with Wilcoxon sign-rank tests.Results:.The CFT was significantly reduced and the BCVA was significantly improved at 1, 2, and 3 months after injection(all P < 0.05). Tomography findings revealed no recurrence within 3 months. No systemic thromboembolic events,elevated intraocular pressure, retinal detachment, or infectious endophthalmitis occurred following injection.Conclusion:.Single intravitreal aflibercept may be useful in treating macular edema associated with BRVO within 3months. No adverse systemic or ocular effects were found in this case series.

中国台湾省居民乳腺癌术后5年死亡率预测模型的研究

背景与目的目前少有采用2年以上的数据分析乳腺癌手术效果的研究。本文旨在研究人工神经网络(artificial neural network, ANN)模型在预测乳腺癌患者术后5年死亡率中的应用,比较ANN模型、多元逻辑回归(multiple logistic regression, MLR)模型和Cox回归模型的预测准确度。方法本研究根据1996–2010年接受手术治疗的3632例乳腺癌患者的临床资料,对MLR、Cox和ANN模型进行比较。应用估算数据集测试模型,应用验证数据集评估模型性能,应用灵敏度分析法对预测模型中输入变量的相对显著性进行评价。结果在预测5年死亡率方面ANN模型明显优于MLR和Cox模型,并且综合性能指标更高。研究结果显示,乳腺癌患者术后5年死亡率与年龄、Charlson并发症指数(Charlson comorbidity index, CCI)、化疗、放疗、激素治疗、医院和外科医生的乳腺癌手术量均显著相关(均为P <0.05)。外科医生的乳腺癌手术量是对5年死亡率影响最大(敏感)的变量,其次是医院的乳腺癌手术量、患者年龄和CCI。结论与传统的MLR和Cox模型相比,ANN模型在预测乳腺癌患者术后5年死亡率方面更为准确。本研究中确定的死亡率预测因子也可用于对乳腺癌手术患者进行康复和健康方面的教育。

Factors Affecting Corneal Hysteresis in Taiwan Residents Adults

Purpose: To investigate the correlation of various corneal hysteresis(CH) factors in Chinese adults.Methods: From January 2009 to November 2011, the healthy right eyes of a total of 292 adults were recruited into the study. Goldmann-correlated intraocular pressure(IOPG) and CH were measured using an ocular response analyzer(ORA).Central corneal thickness was measured using the ORA's integrated handheld ultrasonic pachymeter. The IOLMaster was used to obtain the ocular biometric measurements including axial length, anterior chamber depth, and keratometric values.The Pearson correlation coefficient was used to test correlations between CH and quantitative factors. The chi-square test was used to detect differences in categorical values.Results: Longer axial length(P =0.0001), lower IOPG(P =0.03), older age(P=0.003),and thinner central corneal thickness(P=0.0001) were significantly associated with lower CH.The anterior chamber depth(P=0.34), gender(P =0.23), and corneal curvature(P=0.18) had no relationship to CH.Conclusion: Various factors including axial length, intraocular pressure, age, and central corneal thickness can affect measurement of corneal biomechanical properties in Chinese adults.But the anterior chamber depth, gender, and corneal curvature were irrelevant to CH.

Simultaneous bilateral floating knee:A case report

BACKGROUND The phrase “floating knee is a flail knee joint,” referring to ipsilateral femoral and tibial fractures,was first used by Blake and Mc Bryde in 1975.This condition is often caused by a high-energy trauma with often extensive injury to the soft tissues,and is accompanied by life-threatening systemic complications,including head,chest or abdominal injuries and a high incidence of fat embolism.Floating knee is a severe and uncommon injury pattern.CASE SUMMARY A 27-year-old man sustained multiple injuries when the electric motorcycle he was riding was hit by a van.His injuries included traumatic hypovolemic shock,comminuted and open type II fractures of the left femoral shaft,fracture of the right femoral shaft,comminuted fracture of the bilateral tibial and fibular shaft,and multiple lacerations and abrasions on his forehead,lower lip,neck and limbs.The diagnosis was simultaneous bilateral floating knee complicated with soft tissue injuries.After emergency treatment and the exclusion of life-threating complications,open reduction and internal fixation were successfully performed using plates and screws in the bilateral femoral and tibial shafts.CONCLUSION Simultaneous bilateral floating knee is a rare and severe injury pattern.The treatment is challenging,and complications.We present a case report of a young adult who suffered from bilateral floating knees during road traffic accident.We also offer our treatment experience of this complex injury and review past literature.

Intravitreal aflibercept for rubeosis iridis secondary to proliferative diabetic retinopathy

The purpose of this article is to report a case with rubeosis iridis treated by intravitreal aflibercept. A 61-year-old man had iris neovascularization and scanty vitreous hemorrhage secondary to proliferative diabetic retinopathy in the right eye. Neither neovascularization of angle nor elevation of intraocular pressure was found. Single intravitreal al ibercept 2 mg injection was performed. Rubeosis iridis disappeared on the next day. Scattered retinal laser photocoagulation was added 1 week later. There was no recurrence after 3-month follow-up. Aflibercept may serve as another anti-vascular endothelial growth factor(anti-VEGF) for treating rubeosis iridis.