Tri-Service General Hospital Songshan Branch

Artificial intelligence (AI) technologies are increasingly integrated into healthcare, yet their economic value remains uncertain. Traditional economic evaluation methods may not adequately capture the unique features of AI, including dynamic model evolution, scalability, and broader societal impacts. This systematic review synthesized existing evidence on the cost-effectiveness of AI-based healthcare interventions and assessed the methodological rigor of published studies. A comprehensive search identified health economic evaluations of AI applications published between September 2019 and March 2025, following PRISMA and SWiM guidelines and registered in PROSPERO (CRD42025641230). Eligible studies were full economic evaluations comparing AI-based interventions with non-AI alternatives, and data were extracted on study characteristics, analytical methods, decision-analytic models, perspectives, outcomes, and AI-specific costs. Methodological quality was evaluated using the CHEERS checklist. A total of 52 studies from 15 countries were included, most published after 2020, focusing on diabetic retinopathy screening, cancer detection, and cardiovascular disease applications. Cost-utility analysis was the predominant method (79%), followed by cost-effectiveness analysis (15%). Nearly all studies (98%) concluded that AI-based strategies were cost-effective, cost-beneficial, or cost-saving. However, reporting of AI-specific costs was inconsistent, while over 90% of studies detailed expenses such as software licensing, per-test charges, or maintenance fees, some omitted cost information entirely, limiting comparability. Overall, AI-based healthcare interventions are generally reported as cost-effective, but methodological heterogeneity, incomplete cost reporting, and potential publication bias constrain the reliability and comparability of current evidence. Standardized economic evaluation frameworks that incorporate comprehensive cost structures and account for the evolving nature of AI are urgently needed.

IntroductionProton pump inhibitors (PPIs) used for gastrointestinal-related disorders are associated with increased insulin resistance, a risk factor for worsening hyperuricemia. However, lansoprazole has shown potential in reducing insulin resistance by increasing the expression of peroxisome proliferator-activated receptor gamma and CCAAT/enhancer-binding protein alpha mRNA in adipogenesis. This study aims to investigate the effects of lansoprazole compared to other PPIs in reducing the risk of gout.MethodWe conducted a retrospective cohort study on patients using lansoprazole from 2000 to 2005, based on the Taiwan National Health Insurance Database, with follow-up until 2013. A comparison cohort on other PPIs was selected through propensity score matching for age, sex, comorbidities, and concomitant medications. Gout risk was analyzed using survival analysis and a Cox proportional hazards model.ResultsAmong 1816 lansoprazole users, 139 developed gout (7.7%), compared to 968 (13.3%) out of 7264 in the other PPIs group. The average age was 53.33 (± 14.79) in the lansoprazole group and 52.71 (± 14.81) in the other PPIs group. The cumulative incidence of gout was lower in the lansoprazole cohort, with a significantly reduced gout risk (adjusted hazard ratio, 0.64; 95% CI, 0.56–0.73). This lower risk remained after stratification by gender and among individuals over 30 years old.ConclusionsAmong PPI users, lansoprazole is associated with a significantly lower risk of gout. For patients at risk of gout who require PPI therapy, lansoprazole may be considered the treatment of choice.Key Points• The cumulative incidence of gout is lower in lansoprazole users than in other PPI users• Lansoprazole users had a significant lower risk of developing gout compared to other PPI users• Lansoprazole may be considered for patients at risk of gout

Evidence on the safety of antidiabetic agents in end-stage renal disease (ESRD) patients requiring dialysis, a group often excluded from randomized controlled trials, is scant. Dipeptidyl peptidase-4 inhibitors (DPP-4i), widely used for type 2 diabetes mellitus (T2DM) management in this group, have raised concerns regarding the risk of heart failure (HF). However, real-world evidence on HF risk with DPP-4i in dialysis-dependent diabetic patients is limited. We aimed to assess HF safety of DPP-4i compared with sulfonylureas (SU)/meglitinides in a nationwide T2DM population with ESRD requiring dialysis. A new user, active comparator cohort study employing propensity score-inverse probability of treatment weighting was conducted utilizing Taiwan's nationwide healthcare claims database (2012-2020). Evaluated outcomes included hospitalizations for HF or cardiovascular death as the primary outcome, with major adverse cardiovascular events (MACEs), all-cause mortality, and severe hypoglycemia as secondary outcomes, using weighted Cox proportional hazards models. The study included 6882 patients initiating DPP-4i and 6174 starting SU/meglitinides, with a mean age of 66.4 years and 53.1% male. Initiation of DPP-4i versus SU/meglitinide was not associated with increased risks of HF hospitalizations, cardiovascular death, MACEs, or all-cause mortality, but was significantly tied to a 44% reduced risk of severe hypoglycemia. This study's findings indicate that in T2DM patients with ESRD requiring dialysis, DPP-4i do not elevate the risk of hospitalizations for HF, cardiovascular death, or all-cause mortality, but significantly lower the risk of severe hypoglycemia compared with SUs/meglitinides. This supports the preference for DPP-4i over SUs or meglitinides for managing T2DM in dialysis patients.

The rapid urease test (RUT) is a reliable method for diagnosing Helicobacter pylori infections in endoscopy suites; however, there is a need for tests with enhanced sensitivity and faster results. This study aimed to evaluate the diagnostic performance of the new dry detection device test compared to the gel detection device and Pronto Dry RUT in detecting Helicobacter pylori infection among middle-aged and elderly Taiwanese individuals. A total of 100 participants with suspected Helicobacter pylori infection undergoing upper gastroscopy were prospectively enrolled. The dry detection device demonstrated a 99% concordance rate with the Pronto Dry RUT, with seven participants testing positive for Helicobacter pylori using both tests. In contrast, the gel detection device detected only six positive cases, highlighting the superior diagnostic sensitivity of the dry detection device. Additionally, the dry detection device produced significantly faster results than the gel detection device. These findings suggest that the dry detection device is a suitable and efficient RUT for diagnosing Helicobacter pylori in middle-aged and elderly patients. Further studies are warranted to explore its application in broader populations and clinical settings.

AimMost previous research on AI‐based image diagnosis of acute cholecystitis (AC) has utilized ultrasound images. While these studies have shown promising outcomes, the results were based on still images captured by physicians, introducing inevitable selection bias. This study aims to develop a fully automated system for precise gallbladder detection among various abdominal structures, aiding clinicians in the rapid assessment of AC requiring cholecystectomy.MethodsThe dataset comprised images from 250 AC patients and 270 control participants. The VGG‐16 architecture was employed for gallbladder recognition. Post‐processing techniques such as the flood fill algorithm and centroid calculation were integrated into the model. U‐Net was utilized for segmentation and features extraction. All models were combined to develop a fully automated AC detection system.ResultsThe gallbladder identification accuracy among various abdominal organs was 95.3%, with the model effectively filtering out CT images lacking a gallbladder. In diagnosing AC, the model was tested on 120 cases, achieving an accuracy of 92.5%, sensitivity of 90.4%, and specificity of 94.1%. After integrating all components, the ensemble model achieved an overall accuracy of 86.7%. The automated process required 0.029 seconds of computation time per CT slice and 3.59 seconds per complete CT set.ConclusionsThe proposed system achieves promising performance in the automatic detection and diagnosis of gallbladder conditions in patients requiring cholecystectomy, with robust accuracy and computational efficiency. With further clinical validation, this computer‐assisted system could serve as an auxiliary tool in identifying patients requiring emergency surgery.

ABSTRACT This study attempted to understand the biomechanics of using 3D-printed anatomical assembly thin bone plate (AATBP) and anterior star-shaped plating (ASP) under different patellar fractures. The transverse (C1), transverse plus second fragment (C2) and complex (C3) patella fractures were defined for performing the dynamic cyclic load test and finite element (FE) analysis. The AATBP was fixed onto the patella after adjusting the total fixation height using a ratchet mechanism and providing holding power hooks. The ASP contoured the plate/distal legs based on the patella surface curvature and generated an additional drill guide to avoid screw interference. The average ASP fixation fracture gaps were significantly larger than the AATBP fixation. FE analysis showed that the AATBP biomechanical performance was better than the ASP fixation for different patella fractures. The 3D-printed AATBP can be used effectively for different patella fractures without screw interference and demonstrated greater stability for comminuted patellar fractures.

Introduction We report a case of an underage girl whose main complaint was ”repeated episodes of tachycardia for five years, recurring and deteriorated for one day”. The patient was treated with drugs in the pediatric ward of Songshan General Hospital, but the effect was [undesirab](javascript:;)le. Then, she was transferred to cardiovascular department for secondary electrophysiological examination and radiofrequency ablation. Electrophysiological examination showed that the left wall concealed accessory pathway was accompanied by paroxysmal atrioventricular reentrant tachycardia and right atrial appendage tachycardia. The occult accessory pathway was cured after radiofrequency ablation, but the right atrial appendage tachycardia still remained. Finally the right atrial appendage ligation combined with radiofrequency ablation was adopted and satisfactory results were obtained. Combined with relevant document literature, this paper analyzes the ECG characteristics of right atrial appendage tachycardia, so as to provide a reference for clinical practice. Methods The concealed atrioventricular accessory pathway was cured after catheter ablation, but the right atrial appendage tachycardia could not be terminated by catheter ablation. The patient was transferred to cardiovascular surgery for right atrial appendage ligation and radiofrequency ablation. Results Over a month after the cardiac surgery, there was no any recurrence of tachycardia. Also, the symptoms like fatigue and shortness of breath improved. The echocardiography showed a significant improvement in the size of each chamber of the heart, an increase in EF(ejection fraction) and the improvement in valve regurgitation. Pericardial effusion disappeared after more than half a year of cardiac surgery. Conclusions Atrial appendage tachycardia is a common form of atrial tachycardia in children and can easily lead to tachycardia cardiomyopathy[1](#ref-0001). The efficacy of antiarrhythmic drug treatment is limited[2](#ref-0002). Complete healing through catheter ablation is challenging because of the integrated requirement of the interventional and surgical interventions.[3](#ref-0003)

To evaluate the effectiveness and safety of respiratory syncytial virus (RSV) vaccination during pregnancy in preventing lower respiratory tract infection (LRTI) in infants and neonates, we conducted a systematic search of randomized controlled trials (RCTs) in five databases (PubMed, Embase and Cochrane Library, Web of Science, Cochrane Center Register of Controlled trial) until 1 May 2023. We performed a meta-analysis of the eligible trials using RevMan5.4.1 software. Our analysis included six articles and five RCTs. The meta-analysis revealed significant differences in the incidences of LRTI [risk ratio (RR): 0.64; 95% confidence interval (CI): 0.43, 0.96; p = 0.03)] and severe LRTI (RR: 0.37; 95% CI: 0.18, 0.79; p = 0.01) between the vaccine group and the placebo group for newborns and infants. These differences were observed at 90, 120, and 150 days after birth (p = 0.003, p = 0.05, p = 0.02, p = 0.03, p = 0.009, p = 0.05). At 180 days after birth, there was a significant difference observed in the incidence of LRTI between the two groups (RR: 0.43; 95% CI: 0.21, 0.90; p = 0.02). The safety results showed a significant difference in the incidence of common adverse events between the two groups (RR: 1.08; 95% CI: 1.04, 1.12; p < 0.0001). However, there was no significant difference observed in the incidence of serious adverse events (RR: 1.05; 95% CI: 0.97, 1.15; p = 0.23), common and serious adverse events (RR: 1.02; 95% CI: 0.96, 1.10; p = 0.23), or common and serious adverse events among pregnant women and newborns and infants (RR: 0.98; 95% CI: 0.93, 1.04; p = 0.52). In conclusion, maternal RSV vaccination is an effective and safe immunization strategy for preventing LRTI in postpartum infants, with greater efficacy observed within the first 150 days after birth.