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Urabe M, Hashiguchi Y. No-drain strategy for perforated peptic ulcer: no consensus yet. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02650-4. [PMID: 39190063 DOI: 10.1007/s00068-024-02650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Affiliation(s)
- Masayuki Urabe
- Gastrointestinal Surgery Division, Department of Surgery, Japanese Red Cross Omori Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan.
| | - Yojiro Hashiguchi
- Gastrointestinal Surgery Division, Department of Surgery, Japanese Red Cross Omori Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan
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Kim HJ, Gong EJ, Bang CS. Application of Machine Learning Based on Structured Medical Data in Gastroenterology. Biomimetics (Basel) 2023; 8:512. [PMID: 37999153 PMCID: PMC10669027 DOI: 10.3390/biomimetics8070512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
The era of big data has led to the necessity of artificial intelligence models to effectively handle the vast amount of clinical data available. These data have become indispensable resources for machine learning. Among the artificial intelligence models, deep learning has gained prominence and is widely used for analyzing unstructured data. Despite the recent advancement in deep learning, traditional machine learning models still hold significant potential for enhancing healthcare efficiency, especially for structured data. In the field of medicine, machine learning models have been applied to predict diagnoses and prognoses for various diseases. However, the adoption of machine learning models in gastroenterology has been relatively limited compared to traditional statistical models or deep learning approaches. This narrative review provides an overview of the current status of machine learning adoption in gastroenterology and discusses future directions. Additionally, it briefly summarizes recent advances in large language models.
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Affiliation(s)
- Hye-Jin Kim
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea; (H.-J.K.); (E.-J.G.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24253, Republic of Korea
- Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
| | - Eun-Jeong Gong
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea; (H.-J.K.); (E.-J.G.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24253, Republic of Korea
- Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
| | - Chang-Seok Bang
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea; (H.-J.K.); (E.-J.G.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24253, Republic of Korea
- Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea
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Konishi T, Sasabuchi Y, Matsui H, Tanabe M, Seto Y, Yasunaga H. Long-Term Risk of Being Bedridden in Elderly Patients Who Underwent Oncologic Surgery: A Retrospective Study Using a Japanese Claims Database. Ann Surg Oncol 2023; 30:4604-4612. [PMID: 37149549 PMCID: PMC10319666 DOI: 10.1245/s10434-023-13566-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Although functional outcomes are important in surgery for elderly patients, the long-term functional prognosis following oncologic surgery is unclear. We retrospectively investigated the long-term, functional and survival prognosis following major oncologic surgery according to age among elderly patients. METHODS We used a Japanese administrative database to identify 11,896 patients aged ≥ 65 years who underwent major oncological surgery between June 2014 and February 2019. We investigated the association between age at surgery and the postoperative incidence of bedridden status and mortality. Using the Fine-Gray model and restricted cubic spline functions, we conducted a multivariable, survival analysis with adjustments for patient background characteristics and treatment courses to estimate hazard ratios for the outcomes. RESULTS During a median follow-up of 588 (interquartile range, 267-997) days, 657 patients (5.5%) became bedridden and 1540 (13%) died. Patients aged ≥ 70 years had a significantly higher incidence of being bedridden than those aged 65-69 years; the subdistribution hazard ratios of the age groups of 70-74, 75-79, 80-84, and ≥ 85 years were 3.20 (95% confidence interval [CI], 1.53-6.71), 3.86 (95% CI 1.89-7.89), 6.26 (95% CI 3.06-12.8), and 8.60 (95% CI 4.19-17.7), respectively. Restricted cubic spline analysis demonstrated an increase in the incidence of bedridden status in patients aged ≥ 65 years, whereas mortality increased in patients aged ≥ 75 years. CONCLUSIONS This large-scale, observational study revealed that older age at oncological surgery was associated with poorer functional outcomes and higher mortality among patients aged ≥ 65 years.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Konishi T, Fujiogi M, Shigemi D, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Risk Factors for Postoperative Bleeding Following Breast Cancer Surgery: A Nationwide Database Study of 477,108 Cases in Japan. World J Surg 2022; 46:3062-3071. [PMID: 36155832 DOI: 10.1007/s00268-022-06746-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although postoperative bleeding is a common and serious complication in breast cancer surgery, the risk factors remain unclear. Therefore, we examined the risk factors using a Japanese nationwide database. METHODS Patients who underwent breast cancer surgery between July 2010 and March 2020 were identified from a Japanese nationwide database. Multivariable analyses for 47 candidate risk factors (4 patient characteristics, 32 comorbidities, 5 tumor characteristics, 3 preoperative drug uses, and 3 surgical procedures) were conducted to investigate risk factors associated with postoperative bleeding requiring reoperation. Two sensitivity analyses were conducted: an analysis for postoperative bleeding with or without reoperation and an analysis for patients who underwent total mastectomy without breast reconstruction. RESULTS Among the 477,108 patients included, 7048 (1.5%) developed postoperative bleeding and 2357 (0.5%) underwent reoperation for postoperative bleeding. Male sex, old age, body mass index ≥ 25.0 kg/m2, several comorbidities (deficiency anemia, cardiac arrhythmias, hypertension, liver disease, psychoses, and valvular disease), preoperative heparin use, and several procedures were identified as risk factors. Deficiency anemia showed the highest odds ratio among the risk factors (4.41 [95% confidence interval, 3.63-5.36]). High odds ratios were also observed in total mastectomy (2.32 [2.10-2.56]), flap reconstruction (1.93 [1.55-2.40]), and preoperative heparin use (1.64 [1.26-2.14]). The results corresponded with the sensitivity analyses. CONCLUSIONS This study identified several risk factors for postoperative bleeding in breast cancer surgery, such as high body mass index, anemia, cardiovascular diseases, liver diseases, psychoses, preoperative heparin use, and surgical procedures.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Division of Surgery, National Center for Child Health and Development, Japan of Emergency Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-0074, Japan
| | - Daisuke Shigemi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Chen PF, Chen L, Lin YK, Li GH, Lai F, Lu CW, Yang CY, Chen KC, Lin TY. Predicting Postoperative Mortality With Deep Neural Networks and Natural Language Processing: Model Development and Validation. JMIR Med Inform 2022; 10:e38241. [PMID: 35536634 PMCID: PMC9131148 DOI: 10.2196/38241] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Machine learning (ML) achieves better predictions of postoperative mortality than previous prediction tools. Free-text descriptions of the preoperative diagnosis and the planned procedure are available preoperatively. Because reading these descriptions helps anesthesiologists evaluate the risk of the surgery, we hypothesized that deep learning (DL) models with unstructured text could improve postoperative mortality prediction. However, it is challenging to extract meaningful concept embeddings from this unstructured clinical text. Objective This study aims to develop a fusion DL model containing structured and unstructured features to predict the in-hospital 30-day postoperative mortality before surgery. ML models for predicting postoperative mortality using preoperative data with or without free clinical text were assessed. Methods We retrospectively collected preoperative anesthesia assessments, surgical information, and discharge summaries of patients undergoing general and neuraxial anesthesia from electronic health records (EHRs) from 2016 to 2020. We first compared the deep neural network (DNN) with other models using the same input features to demonstrate effectiveness. Then, we combined the DNN model with bidirectional encoder representations from transformers (BERT) to extract information from clinical texts. The effects of adding text information on the model performance were compared using the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC). Statistical significance was evaluated using P<.05. Results The final cohort contained 121,313 patients who underwent surgeries. A total of 1562 (1.29%) patients died within 30 days of surgery. Our BERT-DNN model achieved the highest AUROC (0.964, 95% CI 0.961-0.967) and AUPRC (0.336, 95% CI 0.276-0.402). The AUROC of the BERT-DNN was significantly higher compared to logistic regression (AUROC=0.952, 95% CI 0.949-0.955) and the American Society of Anesthesiologist Physical Status (ASAPS AUROC=0.892, 95% CI 0.887-0.896) but not significantly higher compared to the DNN (AUROC=0.959, 95% CI 0.956-0.962) and the random forest (AUROC=0.961, 95% CI 0.958-0.964). The AUPRC of the BERT-DNN was significantly higher compared to the DNN (AUPRC=0.319, 95% CI 0.260-0.384), the random forest (AUPRC=0.296, 95% CI 0.239-0.360), logistic regression (AUPRC=0.276, 95% CI 0.220-0.339), and the ASAPS (AUPRC=0.149, 95% CI 0.107-0.203). Conclusions Our BERT-DNN model has an AUPRC significantly higher compared to previously proposed models using no text and an AUROC significantly higher compared to logistic regression and the ASAPS. This technique helps identify patients with higher risk from the surgical description text in EHRs.
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Affiliation(s)
- Pei-Fu Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.,Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Lichin Chen
- Research Center for Information Technology Innovation, Academia Sinica, Taipei, Taiwan
| | - Yow-Kuan Lin
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.,Department of Computer Science, Columbia University, New York, NY, United States
| | - Guo-Hung Li
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.,Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan.,Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Cheng-Wei Lu
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Mechanical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Chi-Yu Yang
- Department of Information Technology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Section of Cardiovascular Medicine, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Chih Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzu-Yu Lin
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Mechanical Engineering, Yuan Ze University, Taoyuan, Taiwan
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