Ting-Shuo Huang

Pancreaticoduodenectomy (PD) is the gold standard treatment for localized pancreatic head tumors and has a high surgical morbidity rate. In recent years, m

Background: Metabolic dysfunction–associated fatty liver disease (MAFLD) is a leading cause of chronic disease and can progress to liver fibrosis or hepatocellular carcinoma. Its subtypes—obese, diabetic, and lean—are associated with varying degrees of fibrotic burden and different complications, yet the existing analytics methods often overlook its multisystem nature, intraphenotype variability, and disease dynamics. These limitations hinder accurate risk stratification and restrict personalized intervention planning. Objective: This study developed a novel, 2-stage, contrastive learning–based method to predict the phenotype of MAFLD among adults. This method leverages multiview contrastive learning; it models individual heterogeneities and important relationships in clinical and survey-based data to predict phenotypes among adults, thus supporting clinical decision-making and personalized care. Methods: Demographic, clinical, lifestyle, and genetic family history data of 4408 adults revealed how capturing essential relationships in patient data from different sources can transform individual-level representations into multiple, complementary views. Evaluation of the predictive efficacy of the proposed method in comparison with 8 prevalent methods relied on recall, precision, F ₁ -score, and area under the curve values. Moreover, a Shapley additive explanation analysis was performed for interpretability. Results: The proposed method consistently and significantly outperformed all benchmark methods. It attained the highest F ₁ -score, showing a 32.8% improvement for nondiabetic MAFLD (0.531 vs 0.400) and 30.4% improvement for diabetic MAFLD (0.519 vs 0.398) over the respective best-performing benchmark. The results underscore the clinical value and utility of integrating clinical and survey-based data in the prediction of MAFLD phenotypes among adults. Conclusions: The proposed method is a viable approach for MAFLD phenotype prediction. It is more effective in identifying at-risk adults than many prevalent data-driven analytics methods and thereby can enhance clinical decision-making and support patient-centric care and management.

Negative pressure wound therapy (NPWT) is widely recognized for its efficacy in treating diabetic wounds, but the mechanisms involved in the wound healing process remain unclear. By examining changes in blood cytokine levels as molecular signaling precursors, we aim to provide a comprehensive cytokine profile to support adjunctive therapy research and clinical applications. A diabetic mouse wound model was established to compare cytokine profiles between NPWT-treated and standard dressing groups, identifying key signaling candidates that may facilitate wound healing. By integrating normal mouse data with large-scale cytokine analysis, we developed a time-stratified NPWT approach to track acute-phase cytokine fluctuations in diabetic conditions. NPWT did not significantly enhance coagulation-related cytokine expression but effectively reduced inflammation, albeit with a delayed regulatory effect compared to wild-type mice. A one-sided binomial test revealed that NPWT advanced the cytokine expression peak from 16 to 2 h, partially restoring the early healing pattern seen in normal mice and suggesting its potential role in modulating early-stage wound repair. These findings provide novel insights into early cytokine regulation during wound healing and highlight the potential of NPWT to inform therapeutic strategies. This refined monitoring approach may contribute to improved clinical decision-making and support enhanced wound management in diabetic patients.

Hip fractures have profound impacts on patients’ conditions and quality of life, even when they receive therapeutic treatments. Many patients face the risk of poor prognosis, physical impairment, and even mortality, especially older patients. Accurate patient outcome estimates after an initial fracture are critical to physicians’ decision-making and patient management. Effective predictions might benefit from analyses of patients’ multimorbidity trajectories and medication usages. If adequately modeled and analyzed, then they could help identify patients at higher risk of recurrent fractures or mortality. Most analytics methods overlook the onset, co-occurrence, and temporal sequence of distinct chronic diseases in the trajectory, and they also seldom consider the combined effects of different medications. To support effective predictions, we develop a novel deep learning–based method that uses a cross-attention mechanism to model patient progression by obtaining “contextual information” from multimorbidity trajectories. This method also incorporates a nested self-attention network that captures the combined effects of distinct medications by learning the interactions among medications and how dosages might influence post-fracture outcomes. A real-world patient dataset is used to evaluate the proposed method, relative to six benchmark methods. The comparative results indicate that our method consistently outperforms all the benchmarks in precision, recall, F-measures, and area under the curve. The proposed method is generalizable and can be implemented as a decision support system to identify patients at greater risk of recurrent hip fractures or mortality, which should help clinical decision-making and patient management.

Negative Pressure Wound Therapy (NPWT) is a commonly employed clinical strategy for wound healing, yet its early-stage mechanisms remain poorly understood. To address this knowledge gap and overcome the limitations of human trials, we establish an NPWT C57BL/6JNarl mouse model to investigate the molecular mechanisms involved in NPWT. In this study, we investigate the intricate molecular mechanisms through which NPWT expedites wound healing. Our focus is on NPWT’s modulation of inflammatory immune responses and the concurrent orchestration of multiple signal transduction pathways, resulting in shortened coagulation time and reduced inflammation. Notably, we observe a significant rise in dickkopf-related protein 1 (DKK-1) concentration during NPWT, promoting the differentiation of Hair Follicle Stem Cells (HFSCs) into epidermal cells, expediting wound closure. Under negative pressure, macrophages express and release DKK-1 cytokines, crucial for stimulating HFSC differentiation, as validated in animal experiments and in vitro studies. Our findings illuminate the inflammatory dynamics under NPWT, revealing potential signal transduction pathways. The proposed framework, involving early hemostasis, balanced inflammation, and macrophage-mediated DKK-1 induction, provides a novel perspective on enhancing wound healing during NPWT. Furthermore, these insights lay the groundwork for future pharmacological advancements in managing extensive wounds, opening avenues for targeted therapeutic interventions in wound care.

Objective Estimating the deterioration paths of chronic hepatitis B (CHB) patients is critical for physicians' decisions and patient management. A novel, hierarchical multilabel graph attention-based method aims to predict patient deterioration paths more effectively. Applied to a CHB patient data set, it offers strong predictive utilities and clinical value. Materials and Methods The proposed method incorporates patients' responses to medications, diagnosis event sequences, and outcome dependencies to estimate deterioration paths. From the electronic health records maintained by a major healthcare organization in Taiwan, we collect clinical data about 177 959 patients diagnosed with hepatitis B virus infection. We use this sample to evaluate the proposed method's predictive efficacy relative to 9 existing methods, as measured by precision, recall, F-measure, and area under the curve (AUC). Results We use 20% of the sample as holdouts to test each method's prediction performance. The results indicate that our method consistently and significantly outperforms all benchmark methods. It attains the highest AUC, with a 4.8% improvement over the best-performing benchmark, as well as 20.9% and 11.4% improvements in precision and F-measures, respectively. The comparative results demonstrate that our method is more effective for predicting CHB patients' deterioration paths than existing predictive methods. Discussion and Conclusion The proposed method underscores the value of patient-medication interactions, temporal sequential patterns of distinct diagnosis, and patient outcome dependencies for capturing dynamics that underpin patient deterioration over time. Its efficacious estimates grant physicians a more holistic view of patient progressions and can enhance their clinical decision-making and patient management.

Background Feeding jejunostomy is a solid way for patients to maintain enteral nutrition. However, debate over the superiority of the laparoscopic vs. laparotomic method has raised concerns in recent years. This systemic review and meta-analysis aimed to compare the postoperative outcomes between these two approaches. Methods We searched PubMed, Embase, and Scopus from the date of inception to April 2022 for studies comparing laparoscopic and open feeding jejunostomy. Study characteristics and outcomes were extracted from the included articles. The primary outcome was the relative risk (RR) of postoperative complications in each group. We also analyzed the major/minor complication rates and operations, excluding major concomitant procedures. The risk of bias of included studies were assessed using the ROBINS-I tool. The certainty of evidence was rated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results A total of seven retrospective studies with 1195 patients in total were included in this systemic review and meta-analysis. Laparoscopic feeding jejunostomy carried a significantly lower postoperative complication rate (RR: 0.62; 95% CI, 0.42–0.91, p = 0.02, low certainty of evidence) compared with laparotomy, and the heterogeneity was moderate (I² = 34%, p = 0.18). After excluding major concomitant procedures, the RR between the laparoscopic and open group was 0.48 (95% CI, 0.33–0.70, p < 0.001, low certainty of evidence), suggesting that the laparoscopic approach was superior in terms of postoperative complications. Conclusions Our results indicate that laparoscopic feeding jejunostomy might reduce the postoperative overall complication rate compared with open feeding jejunostomy.

Background: Reduced-port laparoscopic gastrectomy can potentially reduce postoperative pain and improve recovery time. However, the inherent difficulty caused by the narrow manipulation angle makes this operation difficult, especially during lymph node dissection. The intrinsic advantage of the da Vinci^® robotic system might offset this difficulty, maintaining adequate surgical quality with risks of surgical complications equal to those by the conventional four-port robotic approach. The aim of this study was to compare the reduced-port robotic approach and the conventional four-port approach in terms of postoperative pain and short-term surgical outcomes. Methods: All patients who underwent radical gastrectomy with D2 lymph node dissection using the da Vinci Xi robotic system, including reduced-port or conventional four-port approach, were analyzed retrospectively. The primary outcome was postoperative pain assessed using the numerical rating scale (NRS). The secondary outcomes were the number of harvested lymph nodes, operation time, length of hospital stay, and postoperative 30-day complications. Results: Forty-eight patients were enrolled in the study, 10 cases in the reduced-port and 38 in the conventional four-port group. Postoperative NRS revealed no significant difference between the reduced-port and conventional four-port groups [postoperative day (POD) 1: 4.5 vs. 3, p = 0.047, POD 3: 4 vs. 3, p = 0.178]. After propensity score matching, there were no significant differences in the median number of harvested lymph nodes, operation time, and length of hospital stay between the groups. The postoperative 30-day complications were more frequent in the conventional four-port group, but there was no significant difference compared with the reduced-port group after propensity score matching. Conclusions: Reduced-port robotic gastrectomy with D2 lymph node dissection might be comparable to the conventional four-port robotic operation in terms of postoperative pain, surgical quality, and short-term outcomes. However, further studies are required to confirm our results and clarify the advantages of the robotic reduced-port approach.