A scientometric analysis of fairness in health AI literature.

Artificial intelligence (AI) and machine learning are central components of today's medical environment. The fairness of AI, i.e. the ability of AI to be free from bias, has repeatedly come into question. This study investigates the diversity of members of academia whose scholarship poses questions about the fairness of AI. The articles that combine the topics of fairness, artificial intelligence, and medicine were selected from Pubmed, Google Scholar, and Embase using keywords. Eligibility and data extraction from the articles were done manually and cross-checked by another author for accuracy. Articles were selected for further analysis, cleaned, and organized in Microsoft Excel; spatial diagrams were generated using Public Tableau. Additional graphs were generated using Matplotlib and Seaborn. Linear and logistic regressions were conducted using Python to measure the relationship between funding status, number of citations, and the gender demographics of the authorship team. We identified 375 eligible publications, including research and review articles concerning AI and fairness in healthcare. Analysis of the bibliographic data revealed that there is an overrepresentation of authors that are white, male, and are from high-income countries, especially in the roles of first and last author. Additionally, analysis showed that papers whose authors are based in higher-income countries were more likely to be cited more often and published in higher impact journals. These findings highlight the lack of diversity among the authors in the AI fairness community whose work gains the largest readership, potentially compromising the very impartiality that the AI fairness community is working towards.

Telehealth and digital health innovations: A mixed landscape of access.

In the wake of emergent natural and anthropogenic disasters, telehealth presents opportunities to improve access to healthcare when physical access is not possible. Yet, since the beginning of the COVID pandemic, lessons learned reveal that various populations in the United States do not or cannot adopt telehealth due to inequitable access. We explored the Digital Determinants of Health (DDoHs) for telehealth, characterizing the role of accessibility, broadband connectivity and electrical grids, and patient intersectionality. In addition to its role as an existing Social Determinant of Health, Policies and Laws directly and indirectly affect these DDoHs, making access more complex for marginalized populations. Digital systems lack the flexibility, accessibility, and usability to inclusively provide the essential services patients need in telehealth. We propose the following recommendations: (1) design technology and systems using accessibility and value sensitive design principles; (2) support a range of technologies and settings; (3) support multiple and diverse users; and (4) support clear paths for repair when technical systems fail to meet users' needs. Addressing these requires change not only from providers but also from the institutions providing these systems.

Treatment of hypothermic circulatory arrest with thoracotomy and pleural lavage.

We describe a successful case of severe hypothermia due to coldwater immersion. An eight-year-old boy was saved from cold water (4 degrees C) after forty minutes. Open rewarming and resuscitation was performed by thoracotomy and pleural lavage for cardiac arrest due to the low core temperature (25 degrees C). The patient recovered primarily well without any postoperative complications. The follow-up of two years shows good state of physical health but some neuropsychological defects disturbing normal progress in school work.

[A case of acute subdural hematoma associated with convexity meningioma].

A 61-year-old normotensive woman was admitted to our hospital with complaints of severe headache and nausea. She has had a limp due to the poliomyelitis in her childhood. Three days before admission, she had a headache without unconsciousness. On admission, she was almost alert. Her vital signs were normal. A mild monoparesis of the atrophic right lower extremity was evident. This impairment was due to her past poliomyelitis. There were no other motor palsy, sensory loss, nuchal rigidity, and papilledema. A plain CT scan showed a crescent high density zone adjacent to a round high density mass in the left convexity. A cerebral angiogram showed a vascular left temporoparietal mass supplied by a middle meningeal artery. A craniotomy was then immediately performed. The well encapsulated tumor was totally resected, and the adjacent subdural hematoma was also evacuated. Histologically, the tumor was transitional meningioma with areas containing thin-walled vessels and focal necrosis. Postoperative course was uneventful. The origin of hemorrhage in this case would seem to be the thin-walled blood vessel with loss of vessel support. The clinical significance and the mechanism of the hemorrhage from the meningioma were discussed.

[A case of ophthalmoplegic migraine with cerebral aneurysm].

A case of ophthalmoplegic migraine with cerebral aneurysm is reported. A 47-year-old female with a 17-year history of migraine was admitted. She had three attacks of severe migrainous headache accompanied with nausea and vomiting within three weeks. Soon after the third attack, she noticed diplopia and left blepharoptosis. Lumbar puncture revealed no hemorrhage but the cerebral angiogram demonstrated an aneurysm at the junction of the left internal carotid artery and the posterior communicating artery. Operation revealed that the oculomotor nerve was not compressed by the aneurysm. But the oculomotor nerve had an indentation produced by the posterior communicating artery at 1-2 mm distal to the midbrain. A piece of sponge was then inserted between the nerve and the responsible artery. After the operation, her oculomotor nerve palsy was gradually improved and she discharged with mild anisocoria. The exact pathogenesis of ophthalmoplegia in ophthalmoplegic migraine is still unknown. In our case, cross compression of the oculomotor nerve with dilated posterior communicating artery seemed to be the cause of ophthalmoplegia.

[Postoperative tension pneumocephalus--report of 3 cases].

Three cases of tension pneumocephalus are reported and pathogenesis, clinical features and management of this complication is discussed. Case 1: A 12-year-old female underwent a craniotomy for a suprasellar tumor following V-P shunting. At that time, Mayfield's pin fixing head holder was used and a CSF leak from a puncture wound caused by the head holder was noted postoperatively. Although she showed uneventful recovery from the anesthesia, several hours after surgery, she developed general convulsions and deteriorated. CT scan revealed a huge bifrontal accumulation of air compressing the entire brain postero-caudally. No active measures were taken to treat the intracranial air and a follow-up CT scan revealed a hemorrhagic infarction in the right occipital lobe possibly caused by transtentorial herniation. The patient remained in a vegetative state until her death three years later. Case 2: A 55-year-old man had a pansinectomy for sinusitis. Seven days later he developed CSF rhinorrhea and a severe headache. A CT scan revealed air in the subarachnoid space as well as in the ventricles. After repeated spinal taps, he became stuporous. An emergency repair of the CSF leak was performed. Intraoperatively, the accumulation of air was noted in the subarachnoid space under extreme tension. He made a full recovery. Case 3: A 69-year-old woman underwent a neck clipping for a ruptured anterior communicating aneurysm 2 days after the onset. Shortly before the craniotomy, a continuous spinal drainage system was installed. Postoperatively she did not recover from the anesthesia and a CT scan showed an accumulation of air in the bifrontal subdural space compressing the brain posteriorly.(ABSTRACT TRUNCATED AT 250 WORDS)

[Results of the surgical treatment of metastatic brain tumors].

Results of surgical treatment in 85 cases with metastatic brain tumors are reviewed. The lung was the most frequent site of primary lesion and the following sites were GI tract and the breast. Adequate treatment consisted of total removal of tumor, irradiation and/or chemotherapy were carried out in 51 cases. The remaining 34 cases had an unsuccessful treatment because of their poor physical condition. Mean survival time after adequate treatment was 8.75 months in the former group and 3.06 months in the latter group. Of 51 patients (86.3%) in the former group, 44 showed improvement of the neurological signs after treatment. In the latter group, only 14 patients (41.2%) revealed neurological improvement. Total removal of tumor was carried out in 55 of 85 cases. The one-month operative mortality for all patients was 19.2%. Postoperative one-year survival rate was 12.5% in 16 cases with multiple metastases and in 36 cases with single metastasis was 25.6%. Follow-up study of 77 cases showed 31.2% of survival rate in 6 months, 18.2% in one-year and 5.2% in two-years. Only four patients survived more than 3 years after treatment. The direct causes of death in cases of total removal were attributed in recurrence of primary lesion or remote metastases to other organs. This study revealed that the prognosis of the patient with metastatic brain tumor was influenced by existence of intracranial hypertension due to brain edema or metastatic tumor itself and metastases to other organs.(ABSTRACT TRUNCATED AT 250 WORDS)

[3 operated cases of congenital deficiency of Factor XIII associated with intracranial hematomas].

Three operated cases of congenital deficiency of factor XIII (fibrin-stabilizing factor) associated with intracranial hematomas were described and the diagnosis, replacement therapy of the factor were discussed. Congenital deficiency of factor XIII is quite rare coagulation disorder and only 100 patients were reported in the literatures in which we could find only one case who had craniotomy for associated intracranial hemorrhage. Case 1: A 41-year-old female with the history of unknown hemorrhagic diathesis complained of headache and right hemiparesis on August 2, 1980. CT scan showed left parietal intracerebral hematoma caused by unknown hemorrhagic diathesis and operated on under fresh blood transfusion. Postoperative state was uneventful but bleeding from the operated wound and rebleeding in the operated hematoma cavity were found on 5th postoperative day. The screening test for factor XIII was abnormal but replacement therapy with fresh plasma and factor XIII failed to control hemorrhagic diathesis. The patients died of GI bleeding and recurrent intracerebral hematoma on 21st postoperative day. Case 2: A 1.4-year-old boy with the history of umbilical bleeding on delivery and diagnosed as congenital deficiency of factor XIII in the other hospital fall down and struck his occiput on September 20, 1980. He vomited and became stuporous two days after injury, and was transferred to Ryukyu University Hospital. CT can revealed epidural hematoma at the left posterior fossa which extended to the supratentorium. The hematoma was successfully evacuated under infusion of fresh plasma and he showed uneventful recovery without rebleeding by postoperative appropriate replacement therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Brain metastasis of hepatoblastoma--a case report and review of literature].

Hepatoblastoma is a rare abdominal tumor which affects infant, especially two or three year old boy. The authors experienced a rare case of cerebral metastasis of hepatoblastoma. The patient was a 1 and one thirds year old boy who was admitted because of left hemiparesis, somnolent consciousness, and abdominal tumor in September 21, 1982. At admission physical examination showed massive epigastric tumor with emaciated and dehydrated condition. Neurological evaluation indicated left spastic hemiparesis, somnolent consciousness and bilateral choked disc. Laboratory data were leukocytosis, marked thrombocytosis and slight abnormality of the liver function test. Alpha-fetoprotein level was 61 X 10(4) ng/ml and human chronic gonadotropin 20 IU/l. Chest X-P was suspected to be multiple metastatic lesions. Celiac angiogram showed a giant malignant tumor of the liver. Cranial CT scan revealed an intracerebral mass in the right frontal lobe which was visualized an enhanced high density area by contrast enhancement with a cystic component. The patient was diagnosed metastatic tumors of the brain and the lung with primary hepatoblastoma. En bloc tumor removal with right frontotemporal craniotomy was performed. Histological diagnosis of the removed tumor was a well differentiated type of the hepatoblastoma. Postoperative course was fine as for consciousness and hemiparesis. With recent development of chemotherapy and medical treatment for infantile malignancy, the prognosis of hepatoblastoma has been improved. This report is believed to be the first operative case for metastatic brain tumor of hepatoblastoma.

Renin-angiotensin system in an infant with malignant renovascular hypertension.

A one-year-old girl with malignant renovascular hypertension had increased levels of plasma renin activity and angiotensin II concentration in peripheral blood and in blood from the affected kidneys as compared with that from the contralateral kidney. Unilateral nephrectomy was followed by resolution of the hypertension and normalization of the activity of the renin-angiotensin system.