Aim. Evaluation of the diagnostic and clinical effectiveness of the HepatoScan AI system, integrating neural network– based computed tomography (CT) analysis and interactive three-dimensional (3D) preoperative modeling in realworld clinical practice.

Materials and methods. A single-center comparative study was conducted, including a prospective cohort with artificial intelligence-assisted (AI) preoperative planning (n = 104) and a purposefully matched retrospective cohort undergoing standard preoperative planning (n = 100). In the AI-assisted group, automated liver and lesion segmentation, 3D volumetry, and stratification of anatomical complexity using the TROPH-L (Tumor – Regional capsule – Outflow veins – Portal vein – Hepatic bile – Localization) classification were applied. Diagnostic performance was assessed at the patient level using sensitivity, specificity, and AUROC (area under the receiver operating characteristic curve), with histopathological confirmation for malignant tumors and expert interpretation of multiphasic CT for benign lesions. Clinical effectiveness was analyzed in patients classified as TROPH-L II–III.

Results. The compared groups were well balanced in terms of demographic and clinical characteristics, lesion parameters, and distribution of TROPH-L categories. In the overall cohort, the use of HepatoScan AI was associated with a higher sensitivity of preoperative diagnosis compared with the standard approach (93.3% vs. 84.2%; p = 0.008), while maintaining high specificity. The AUROC was higher in the AI group (0.954 vs. 0.892), although the difference was not statistically significant; a similar trend was observed across nosological subgroups. Among patients classified as TROPH-L II–III (n = 54 in the AI group and n = 55 in the standard planning group), AI-assisted planning was associated with a shorter operative time (160 vs. 180 minutes; p = 0.01) and reduced intraoperative blood loss (280 vs. 400 mL; p = 0.004). In addition, a higher rate of R0 resections (100% vs. 91.3%) and lower rates of postoperative complications and in-hospital mortality were observed in the AI group, although these differences were not statistically significant.

Conclusion. Integration of the HepatoScan AI system with interactive 3D preoperative planning is associated with improved diagnostic performance and favorable intraoperative metrics in patients with liver tumors, particularly in anatomically complex cases (TROPH-L II–III). These findings highlight the strong potential of the proposed digital technologies to optimize preoperative planning and warrant further prospective multicenter validation.

Aim. To develop and validate a test setup for measuring the load under compression elements (CE) of multilayer bandages composed of materials with different stiffness.

Materials and methods. Prototypes of multilayer bandages were fabricated in the laboratory by combining three types of CEs (foam polymer and dense nonwoven viscose material) with three types of fixing fabrics (FF) based on polyester and viscose/polyester. The test setup consisted of an upper-limb model made of rigid plastic covered with artificial skin and a block with two strain‑gauge sensors that recorded the load in gram-force (gf) under the CE area and in a control zone without a CE at an external pressure of 40 mmHg. For each CE–FF combination, 10 repeated measurements were performed in two regions of the sample (60 values per sensor per group), and the data were analysed using nonparametric statistical tests.

Results. The load under the CE differed significantly between groups (p < 0.001) and depended on the type and stiffness of the material: the median load under type 3 CE with the highest stiffness was 259.4 (252.6; 263.3) gf, whereas under type 1 CE with the lowest stiffness it was 149.9 (145.1; 171.9) gf. Type 2 CE produced intermediate values of 241.7 (206.4; 259.3) gf. Testing of the FFs also showed statistically significant differences in pressure in the absence of a CE (p < 0.001): the highest load was recorded under type 2 FF (viscose/polyester) at 141.0 (140.2; 142.1) gf, and the lowest under type 1 FF made of polyester with higher surface density at 14.5 (14.3; 15.6) gf; type 3 FF provided an intermediate level of 65.7 (64.9; 69.3) gf.

Conclusion. The developed in vitro setup shows high sensitivity to differences in CE stiffness and FF properties and can be used as a screening tool for quantitative comparative assessment of multilayer bandage prototypes with locally differentiated compression areas prior to in vivo studies.

Aim. To develop a multimodal environmental modification protocol for the intensive care unit (ICU) and evaluate its feasibility and preliminary associations with sleep quality and pain intensity in patients.

Materials and methods. A quasi-experimental, single-arm study involving 152 adult patients was conducted from June to August 2025 in the ICU of a Type B hospital in Central Java, Indonesia. Environmental modifications included six interventions: earplugs, eye masks, music therapy, lavender aromatherapy, lighting adjustments, and noise reduction measures, which were applied daily for three consecutive nights (content validity = 0.94). Sleep quality was measured using the Richards-Campbell Sleep Questionnaire (RCSQ), and pain intensity was measured using the numeric rating scale (NRS). Paired t-tests, 95% confidence intervals (CI), and Cohen's d were used to describe intervention effectiveness. Normality of distribution was tested using the Shapiro–Wilk test.

Results. All 152 ICU participants completed the three-day protocol, with overall adherence being 94%. Mean RCSQ scores improved from 34.6 with 11.3 to 51.8 with 10.6 (95% CI: 15.46–18.94; paired t-test, p < 0.001; Cohen's d = 1.57). Mean NRS scores decreased from 4.7 with 1.8 to 2.8 with 1.3 (95% CI: −2.15 to −1.65; paired t-test, p < 0.001; Cohen's d = 1.21). No adverse events were noted. Objective environmental monitoring (subsample n = 40) showed a mean reduction in noise and lighting levels at the patient's bedside during the intervention.

Conclusion. The protocol for creating a positive environment in the ICU was feasible, acceptable, and resulted in subjective improvements in sleep quality and pain intensity in patients.

Adenomatous goiter is a common benign thyroid condition that can become surgically challenging when it extends into the mediastinum, including in patients with a history of partial thyroid surgery. Retrosternal goiter is often diagnosed at a late stage, and its management is frequently complex due to distorted mediastinal anatomy.

Case report. A 58-year-old woman with a history of left isthmolobectomy performed in 2006 presented with a rapidly enlarging right-sided neck mass accompanied by dysphagia. Although the cervical findings initially suggested right thyroid lobe involvement, contrast-enhanced computed tomography revealed a massive retrosternal goiter originating from residual left thyroid tissue. The lesion extended retrosternally into the anterior mediastinum, resulting in significant tracheal narrowing, displacement of the esophagus, and close anatomical relationships with major mediastinal vessels. Management was undertaken by a multidisciplinary team, and the patient underwent complete thyroidectomy using a combined transcervical approach and median sternotomy, achieving complete resection of the retrosternal component.

Discussion. This case highlights delayed retrosternal progression of adenomatous goiter after partial thyroid surgery. Cross-sectional imaging guided surgical planning, and median sternotomy enabled safe complete resection, underscoring the importance of long-term follow-up and multidisciplinary management.

Alport syndrome (AS) is a hereditary nephropathy caused by mutations in the COL4A3, COL4A4, and COL4A5 genes. Rare contiguous COL4A5–COL4A6 alterations cause AS with diffuse leiomyomatosis (AS-DL).

Case report. A 16-year-old male had mild proteinuria, hematuria, hearing loss and myopia since childhood. Estimated glomerular filtration rate was 82.8 mL/min/1.73 m². Kidney biopsy showed segmental mesangial sclerosis; immunofluorescence was negative. Electron microscopy demonstrated diffuse glomerular basement membrane thinning and podocyte foot-process effacement. Two deceased brothers had end stage kidney disease; the mother had hematuria, uterine myoma, and a benign bladder tumor. A diagnosis of X-linked AS was established according to the Flinter criteria and nephroprotective treatment was initiated. Since 2024, the patient had complained of epigastric symptoms. An endoscopy revealed a 2-cm gastric submucosal lesion. A whole-exome sequencing identified a hemizygous missense variant in COL4A5 and a COL4A6 exon 1–2 deletion, confirming AS-DL.

Discussion. This case demonstrates the co-occurrence of AS-DL and shows that early pedigree assessment, combined with integrated clinicopathologic-genetic evaluation in a multidisciplinary framework, enables a timely diagnosis of atypical familial AS-DL and improves clinical management.