Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve

Objectives: The aim of the study was to compare the effects of uterine size and surgeon experience on the surgical out­comes of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign gynecological conditions. Material and methods: This was a retrospective analysis of 184 LAVH cases. All hysterectomies were performed by the same surgeon and divided into two groups, with uterine weight of < 280 g (group 1) and uterine weight of > 280 g (group 2). The groups were compared in terms of the effects of the uterine size and surgeon experience vs. the operative outcomes (operative time, change in hemoglobin levels, hospital stay, and perioperative complications). Results: No significant differences in mean age, parity, history of chronic systemic diseases and previous surgery history were observed between the two groups. However, operative time was significantly greater in group 2 as compared to group 1 (132.1 ± 42.7 minutes vs. 111.5 ± 30.4 minutes, p < 0.05). There were no differences in the hospital stay and perioperative complications between the two groups. One case of bladder injury occurred in each group and one patient underwent a second laparoscopic surgery for postoperative bleeding in group 2. Greater surgeon experience was demonstrated to be associated with decreased operative bleeding and, consequently, smaller differences between preoperative and postop­erative hemoglobin levels. Operative time was also reduced as the surgeon was getting more experienced but the effect did not reach statistical significance. Conclusions: Our study supports the thesis that LAVH is a safe and effective procedure for managing benign gynecologi­cal conditions. Despite increased operative time, LAVH can be safely performed for enlarged uterus in conjunction with increased surgeon experience

Evaluation of congenital rib anomalies with multi-detector computed tomography in the Turkish population

Background: This study aimed to evaluate the congenital anomalies of ribs in the Turkish population using multi-detector computed tomography (CT) and to reveal the prevalence and distribution of these anomalies according to genders and directions. Materials and methods: This study included 1120 individuals (592 male, 528 female) over 18 who applied to our hospital with a suspicion of Covid-19 and who had thoracic CT. Anomalies such as a bifid rib, cervical rib, fused rib, SRB anomaly, foramen rib, hypoplastic rib, absent rib, supernumerary rib, pectus carinatum, and pectus excavatum, which were previously defined in the literature, were examined. Descriptive statistics were performed with the distribution of anomalies. Comparisons were made between the genders and the directions. Results: A prevalence of 18.57% rib variation was observed. Women had 1.3 times more variation than men. Although there was a significant difference in the distribution of anomalies by gender (p=0.000), there was no difference in terms of anomaly direction (p>0.05). The most common anomaly was the hypoplastic rib, followed by the absence rib. While the incidence of the hypoplastic rib was close in women and men, 79.07% of the absence rib was seen in women (p<0.05). The study also includes a rare case of bilateral first rib foramen. At the same time, this study includes a rare case of rib spurs extending from the left 11th rib to the 11th intercostal space. Conclusions: This study demonstrates detailed information about congenital rib anomalies in the Turkish population, which may vary between people. Knowing these anomalies is essential for anatomy, radiology, anthropology, and forensic sciences

Evaluation of e148q and concomitant aa amyloidosis in patients with familial mediterranean fever

The aim of the study was to compare the clinical phenotype of patients with familial Mediterranean fever (FMF)-related AA amyloidosis, according to the age of FMF diagnosis and E148Q genotype. Patients with biopsy-confirmed FMF-related AA amyloidosis were included in the study. Tel-Hashomer criteria were applied in the diagnosis of FMF. All patients had detailed baseline assessment of clinical features, renal functions, genetic testing, histopathological diagnosis of amyloidosis, and treatment received. Multiple comparisons were performed according to the age of diagnosis, disease phenotype, mutation, and mortality. Our study included 169 patients with a diagnosis of AA amyloidosis. There were 101 patients diagnosed with FMF \u3c 18 years of age and 68 patients diagnosed who were ≥18 years of age. The three most common clinical manifestations were fever (84.6%), abdominal pain (71.6%), and arthritis (66.9%). The most common allele among FMF patients was M694V (60.6%), followed by E148Q (21.4%), and M680I (10.3%). The most frequent genotypes were M694V/M694V (45.0%), M694V/E148Q (14.8%), and E148Q/E148Q (11.2%) among 169 patients in our cohort. During the follow-up period, 15 patients (10 male, 5 female) died, of whom 14 had M694V homozygous genotype and one was homozygous for E148Q. Clinicians should be aware of patients with homozygous E148Q genotype for close monitoring and further evaluation. The possible relationship between E148Q and AA amyloidosis needs to be confirmed in other ethnicities

Relationship between psychosocial status, diabetes mellitus, and left ventricular systolic function in patients with stable multivessel coronary artery disease

Background: Negative emotional conditions contribute to the development of coronary artery disease (CAD). Depression and anxiety are prognostic factors in patients with CAD. The aim of our study was to investigate the association between emotional conditions and left ventricular (LV) systolic functions in CAD. Methods: 168 patients (102 men, 66 women, mean age 66.3 &#177; 9.9 years) with stable angina and multivessel disease (MVD) were included in the study. According to the LV ejection fraction (LVEF) in echocardiography, patients were divided into two groups, the preserved group (LVEF > 50%), and the impaired group (LVEF < 50%). The preserved group consisted of 94 patients and the impaired group consisted of 74 patients. Emotional status was evaluated using the Hamilton Depression (HAM-D), Hamilton Anxiety (HAM-A), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores. Results: The prevalence of diabetes mellitus (DM) was significantly higher in the impaired group than in the preserved group (29.8% vs 56.8%, p < 0.01). The HAM-D, HAM-A, BAI and BDI scores were higher in the impaired group compared to the preserved group (HAM-D: 12.1 &#177; 3.3 vs 14.5 &#177; 2.3, p = 0.03; HAM-A: 12.7 &#177; 3.4 vs 14.3 &#177; 2.2, p = 0.01; BAI: 18.6 &#177; &#177; 6.4 vs 22.1 &#177; 6.6, p = 0.01 and BDI: 13.9 &#177; 2.5 vs 17.2 &#177; 2.0, p = 0.002, respectively). In multivariate analysis, BDI scores (odds ratio [OR]: 2.197, < 95% confidence interval [CI] 1.101&#8211;4.387; p = 0.026), HAM-A scores (OR: 1.912, < 95% Cl 1.092&#8211;2.974; p = 0.041) and DM (OR: 2.610, < 95% Cl 1.313&#8211;5.183; p = 0.006) were important risk factors for LV dysfunction in stable patients with MVD. Conclusions: This study demonstrated that emotional status and DM are factors associated with impaired LV systolic function in patients with stable CAD

Evaluating ChatGPT-4’s performance as a digital health advisor for otosclerosis surgery

PurposeThis study aims to evaluate the effectiveness of ChatGPT-4, an artificial intelligence (AI) chatbot, in providing accurate and comprehensible information to patients regarding otosclerosis surgery.MethodsOn October 20, 2023, 15 hypothetical questions were posed to ChatGPT-4 to simulate physician-patient interactions about otosclerosis surgery. Responses were evaluated by three independent ENT specialists using the DISCERN scoring system. The readability was evaluated using multiple indices: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (Gunning FOG), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), and Automated Readability Index (ARI).ResultsThe responses from ChatGPT-4 received DISCERN scores ranging from poor to excellent, with an overall score of 50.7 ± 8.2. The readability analysis indicated that the texts were above the 6th-grade level, suggesting they may not be easily comprehensible to the average reader. There was a significant positive correlation between the referees’ scores. Despite providing correct information in over 90% of the cases, the study highlights concerns regarding the potential for incomplete or misleading answers and the high readability level of the responses.ConclusionWhile ChatGPT-4 shows potential in delivering health information accurately, its utility is limited by the level of readability of its responses. The study underscores the need for continuous improvement in AI systems to ensure the delivery of information that is both accurate and accessible to patients with varying levels of health literacy. Healthcare professionals should supervise the use of such technologies to enhance patient education and care

Patient classification considering the risk of restenosis after coronary stent placement

Aging and some lifestyle habits cause plaque accumulation in the blood vessels of the heart and this causes narrowing of the arteries. Stents are tiny wire mesh tubes which are used in balloon angioplasty to keep the vessels open. However, the stented vessel has a risk of re-narrowing due to the recovery response of the stented vessel segment and this is called in-stent-restenosis. The objective of this study is classifying patients according to their risks of restenosis. For this purpose, first a utilites additives discriminates model called parametrized classification model is developed, then to improve the classification performance of this model, a non-dominated sorting based multi-objective evolutionary algorithm (NSGA-II) is implemented. Finally, computational experiments are conducted with real life data to demonstrate the efficiency of proposed methods