Diagnostic Concepts Research Articles

Observational Diagnostics: The Building Block of AI-Powered Visual Aid for Dental Practitioners

Artificial intelligence (AI) has gained significant traction in medical image analysis, including dentistry, aiding clinicians in making timely and accurate diagnoses. Radiographs, such as orthopantomograms (OPGs) and intraoral radiographs, along with clinical photographs, are the primary imaging modalities employed for AI-powered analysis in the dental field. In this review, we discuss the most recent research and product developments concerning the clinical application of AI as a visual aid in dentistry and introduce the concept of Observational Diagnostics (ODs) as a structured method to standardise image analysis. ODs serve as foundational elements for AI-driven diagnostic aids and have the potential to improve the consistency and reliability of diagnostic data used in treatment planning. We provide illustrative examples to demonstrate how ODs not only represent a significant advancement towards more precise diagnostic aids but also provide the basis for the generation of evidence-based treatment recommendations. These OD-based algorithms have been integrated into chairside AI applications to streamline clinical workflows to improve consistency, accuracy, and efficiency.

One unified hypothesis of neuropsychiatric disorders: Transdiagnostic common staging models

Much like physicists perpetually seek a grand unified theory capable of making predictions for particles within the same theoretical framework, the idea that diverse clinical presentations of psychiatric disorders might be explained by common biological mechanisms is of interest to those in the field of biopsychiatry. Despite the attempts made by the Research Domain Criteria (RDoC) to develop a more physiologically oriented diagnostic concept, departing from phenotype-driven diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), the complexity of the RDoC matrix has made it challenging for those accustomed to conventional approaches. In this paper, I endeavor to integrate the diathesis-stress model, the allostatic load model, and the kindling model into what I term “transdiagnostic common staging models.” From this model, shared aspects among different traditional diagnostic categories become apparent, encompassing concepts such as excitatory-inhibitory imbalance, inflammation, inflexibility, and sensitization. While it is possible that different traditional categories may lean towards different neurocircuits or neurotransmitters, I also propose the potential for cross-system interactions. This approach may offer a promising avenue for understanding the complex interplay of biological mechanisms underlying psychiatric disorders, shedding light on their commonalities and differences.

Improved radiological imaging of congenital aural atresia using flat-panel volume CT.

Precise preoperative radiological evaluation of aural atresia is of utmost importance for surgical planning. Until now, multislice computed tomography (MSCT) has been used but it cannot adequately visualize small structures such as the stapes. Flat-panel volume CT (fpVCT) with its secondary reconstructions (fpVCTSECO) offers ahigh-resolution visualization of the middle ear. New otosurgical planning software also enables detailed 3D reconstruction of the middle ear anatomy. Evaluation of the use of fpVCTSECO in combination with an otosurgical planning software for amore accurate diagnosis and treatment of congenital aural atresia. Sevenpatients with congenital aural atresia underwent preoperative MSCT (600 µm slice thickness) and corresponding fpVCT (466 µm slice thickness). In addition, fpVCTSECO (99 µm slice thickness) were reconstructed. The Jahrsdoerfer and Siegert grading scores were determined and their applicability in the abovementioned imaging modalities was evaluated. In addition, the malleus incus complex was analyzed in 3D rendering. Imaging with fpVCTSECO enabled reliable visualization of the abnormalities, in particular the ossicular chain. Asignificant difference in the Siegert grading score was found. In addition, the malleus-incus complex could be visualized better in 3D. The introduction of new imaging techniques and surgical planning techniques into the diagnostic concept of aural atresia facilitates the identification of malformed anatomy and enables systematic analysis. This combination can also help to more accurately classify the pathology and thus increase the safety and success of the surgical procedure.

The basic statistical concepts and their interrelationships in diagnostic research.

Many medical postgraduate students exhibit a lack of clarity in their understanding of relevant statistical concepts during the conduct of diagnostic studies. This article, grounded in research practice, delves into the role of understanding statistical concepts in diagnostic research. It includes an exploration of sensitivity, specificity, types of statistical errors, and their interrelationships, as well as a discussion on statistical power-an often-overlooked but crucial concept in research. The article elucidates these important concepts with specific examples and illustrations, and addresses an issue of inconsistency related to the receiver operating characteristic curve in research practice. By drawing analogies between basic concepts in diagnostic tests and concepts in statistics, this article helps to enhance researchers' abilities in designing and interpreting clinical diagnostic studies, thereby improving the quality of clinical diagnostic research.

Research progress of antiviral treatment for patients with chronic hepatitis B combined with metabolic fatty liver disease

Chronic hepatitis B (CHB) mainly causes cirrhosis and hepatocellular carcinoma (HCC). Metabolic fatty liver disease (MAFLD) has become the most common chronic liver disease worldwide with the continuous changes in lifestyle and dietary patterns and the increase in the number of obese individuals. Consequently, the incidence rate of CHB combined with MAFLD is rapidly increasing. However, the pathogenesis, treatment, and clinical prognosis remain unclear due to the interaction between CHB and MAFLD. Notably, in the academic community, there are still controversies as to whether patients with CHB and MAFLD should immediately start antiviral treatment, whether MAFLD affects the antiviral efficacy in CHB patients, and whether nucleos(t)ide analogues (NAs) affect the body's metabolism. This article reviews the epidemiology, clinical prognosis, treatment management strategies (especially the antiviral efficacy of NAs drugs), and NAs drug effects on the body's metabolism in patients with CHB combined with MAFLD so as to provide diagnostic and therapeutic concept for clinicians.

New clinicopathological concept of endometrial carcinoma with integration of histological features and molecular profiles.

The dual-stratified pathway of endometrial carcinomas (ECs) has long been dominant. However, in 2013, The Cancer Genome Atlas (TCGA) defined four EC subgroups with distinctive prognoses. Inspired by TCGA, in 2018, the Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) provided four pragmatic molecular classifiers to apply surrogate immunohistochemical markers to TCGA subgroup categorization. These trends prompted the revision of 2020 WHO Classification of Female Genital Tumors, 5th edition (2020 WHO classification), in which four molecular subtypes are recognized: POLE-ultramutated; mismatch repair-deficient; p53-mutant; and no specific molecular profile. In the 2020 WHO classification, the diagnostic algorithm is characterized by prioritizing POLEmut over other molecular abnormalities. Following the 2020 WHO classification, Federation of International Gynecology and Obstetrics (FIGO) proposed a new staging system in 2023. The updated system focuses on diagnostic parameters, such as histological type and grade, lymphovascular space invasion, and molecular alterations. These new histomolecular diagnostic concepts of ECs are being accordingly introduced into the routine pathology practice. For the first time, the 2020 WHO classification includes mesonephric-like adenocarcinoma (MLA) as a novel histological entity, mimicking the conventional mesonephric adenocarcinoma, but is considered of Müllerian ductal origin.

Stress fractures of the growth plates in the fingers of adolescent rock climbers

Primary periphyseal stress injuries (PPSI) of the hand and fingers are arare condition overall but are most commonly seen in adolescent rock climbers and is the most common sport-specific injury in young climbers. Early diagnosis and treatment are crucial for agood treatment outcome and to avoid chronic sport-related injury. The aim of the study is to introduce the injury to awider audience. Based on an analysis of the current literature, the pathophysiology is demonstrated and the diagnostic and treatment standards are analyzed. Prophylactic measures are also reported. Based on asystematic multiple database analysis, the current literature on PPSI of the hand and fingers in climbers were collected and further analyzed in anarrative review. The pathophysiology, diagnostic and treatment concepts are presented. Most cases of PPSI to the hand and fingers are in young rock climbers; however, afew cases have been reported in gymnasts, baseball players and piano players. Overall, there are over 200 documented cases in the literature. Most are Salter-Harris III/Aitken IIfractures but gradeI, II and IV fractures have also been reported. Patients are mostly 13-15years of age and within the main pubertal growth spurt. After diagnosis, usually by magnetic resonance imaging (MRI), treatment is often conservative, with an increasing number of cases requiring surgical revision. Surgery usually involves spot drilling of the growth plate to induce fusion. Early diagnosis and treatment are critical for a good outcome. This includes specific education and information for athletes, coaches, parents and treating physicians. Also, the frequent use of the crimp position has also been shown to increase the risk of PPSI. Preventive aspects should target this as well as overall load management.

Improved radiological imaging of congenital aural atresia using flat-panel volume CT. German version

Precise preoperative radiological evaluation of aural atresia is of utmost importance for surgical planning. Until now, multislice computed tomography (MSCT) has been used but it cannot adequately visualize small structures such as the stapes. Flat-panel volume CT (fpVCT) with its secondary reconstructions (fpVCTSECO) offers ahigh-resolution visualization of the middle ear. New otosurgical planning software also enables detailed 3D reconstruction of the middle ear anatomy. Evaluation of the use of fpVCTSECO in combination with an otosurgical planning software for amore accurate diagnosis and treatment of congenital aural atresia. Sevenpatients with congenital aural atresia underwent preoperative MSCT (600 µm slice thickness) and corresponding fpVCT (466 µm slice thickness). In addition, fpVCTSECO (99 µm slice thickness) were reconstructed. The Jahrsdoerfer and Siegert grading scores were determined and their applicability in the abovementioned imaging modalities was evaluated. In addition, the malleus incus complex was analyzed in 3D rendering. Imaging with fpVCTSECO enabled reliable visualization of the abnormalities, in particular the ossicular chain. Asignificant difference in the Siegert grading score was found. In addition, the malleus-incus complex could be visualized better in 3D. The introduction of new imaging techniques and surgical planning techniques into the diagnostic concept of aural atresia facilitates the identification of malformed anatomy and enables systematic analysis. This combination can also help to more accurately classify the pathology and thus increase the safety and success of the surgical procedure.

Advancement of a diagnostic prediction model for spatiotemporal calibration of earth observation data: a case study on projecting forest net primary production in the mid-latitude region

ABSTRACT Developing a precise and interpretable spatiotemporal model is need for establishing evidence-based adaptation strategies on climate change-driven disasters. This study introduced a diagnostic prediction concept as a generalized modeling framework for enhancing modeling precision and interpretability and demonstrate a case study of estimating forest net primary production (NPP) in a mid-latitude region (MLR) by developing a diagnostic NPP diagnostic prediction model (DNPM). The diagnostic prediction concept starts with modeling meteorology and static environmental data, referred as a prognostic prediction part. Then, its outcome is refined with spatiotemporal residual calibration in the diagnostic prediction part, of which result undergo spatial, temporal, and spatiotemporally explicit validation methods. For the case of DNPM, a prognostic NPP prediction model (PNPM) was set, using a multilinear regression on SPEI 3, temperature, and static environmental features extracted from topography and soil by a random forest. Subsequently, during the diagnostic process of DNPM, we calibrated the primary outcome based on the temporal pattern captured at the time-series residual of PNPM. The results highlighted the superiority of the DNPM over the PNPM. Spatiotemporal validation showed that the DNPM achieved higher accuracy, with Pearson correlation coefficients ( r ) ranging from 0.975 to 0.992 and root mean squared error (RMSE) between 38.99 and 70.23 gC/m2/year across all climate zones. Similarly, temporal validation indicated that DNPM outperformed the PNPM, with r values of 0.233 to 0.494 and RMSE of 46.01 to 70.75 gC/m2/year, compared to the PNPM’s r values of 0.192 to 0.406 and RMSE of 55.23 to 89.31 gC/m2/year. This study showed enhanced diagnostic prediction concept can be applied to diverse environmental modeling approaches, offering valuable insights for climate adaptation and forest policy formulation. By accurately predicting various environmental targets, including drought and forest NPP, this approach aids in making informed policy decisions across different scales.

Thinking and Unthinking the Present: Philosophy after Foucault

What might a contemporary philosophical practice after and following Foucault look like? After briefly analyzing Foucault’s rather ambiguous stance towards academic philosophy in his posthumously published Le discours philosophique, we argue for continuing his historico-philosophical practice of diagnosing the present. This means taking up his analytic heuristic (with its three dimensions of power, knowledge and subjectivity) rather than his more concrete diagnostic concepts and the specific historical results they yield. We argue that the common methodological operation on each of the three axis is to shift the perspective from the given legitimacies, norms, identities and selves to their historical, conflict-ridden emergence. Practicing philosophy in this way allows developing Foucauldian contributions in two contemporary philosophical debates: critical ontology and political epistemology. While ontology and epistemology might seem surprising fields to work in for philosophers inspired by and critically loyal to Foucault, we attempt to dispel these reservations and illustrate the stakes in both debates, pointing to the urgent issues of ecological questions and of the problematization of untruths in politics respectively.

Effects of diagnostic labels on perceptions of marginal cases of mental ill-health

Two experimental studies (Ns = 261, 684) investigated how diagnostic labels affect perceptions of people experiencing marginal levels of mental ill-health. These effects offer insight into the consequences of diagnostic “concept creep”, in which concepts of mental illness broaden to include less severe phenomena. The studies found consistent evidence that diagnostic labeling increases the perception that people experiencing marginal problems require professional treatment, and some evidence that it increases empathy towards them and support for affording them special allowances at work, school, and home. The studies also indicated that labels may reduce the control people are perceived to have over their problems and their likelihood of recovering from them. These findings point to the potential mixed blessings of broad diagnostic concepts and the cultural trends responsible for them. Expansive concepts may promote help-seeking, empathy, and support, but also undermine perceived agency and expectations that problems can be overcome.

NO-CONTACT DIAGNOSTICS IN THE FUNCTION OF RISK-BASED MAINTENANCE ON A WIND GENERATOR MODEL

When it comes to risk-based maintenance of technical systems, selecting a diagnostic procedure is the weakest link in the chain of steps that guarantee the system's availability, sustainability, and safe operation while utilizing its working characteristics.The model of a wind generator, which by virtue of its technological structure represents an increasingly widespread system in the geographical and topographical sense, was used to examine diagnostics based on non-contact, remote collection of pertinent information, which is essential for assessing the state of the technical system. In addition, the fact that the system is not physically accessible to the maintenance teams emphasizes the necessity of taking prompt action to rectify work in order to preserve production capacity and the security of the exploitation process.When applied to the wind generator model, proactive maintenance based on risk allows for enhanced interconnected machine efficiency, optimal maintenance process planning, and real-time production process control. These factors contribute to the advancement and refinement of the contemporary 4K industry philosophy.The concept of remote diagnostics in complex technological structures is of interest to the authors. The goal is to process information about the condition through the lens of risk, paying particular attention to the diagnostic method's reliability and improving prediction accuracy in the maintenance of industrial plant machinery.

The role of administrative categories in the globalisation of a psychiatric concept: Case studies of autism in Japan

This paper explores how what I call ‘administrative categories’ have been adopted by the Japanese government and experts in autism support and what roles these categories have played in local settings. Since support practices for children and adults with autism began in the 1950s in Japan, the Japanese government and people engaging in autism support have used Japanese-specific administrative categories, instead of relying on a medical concept of autism, such as ‘severe moving disabilities’ (SMD), ‘emotional disturbance’, and ‘extremely disruptive behavioural disorders’ (EDBD).To understand the emergence of these three autism-related administrative categories in Japan, historical materials published from the 1950s to the 1990s by Japanese authors (doctors, psychologists, teachers, educationalists, welfare workers, government officials, and parents) and interview data with 19 leading experts of autism in Japan were collected and analysed thematically.The analysis revealed that the governmental ministries aimed to focus on establishing administrative support by avoiding engaging in aetiological debates among doctors, and to describe the political agenda more vividly. Administrative categories filled the gap between local interests and international medical concepts, enabling the concept of autism to be rooted in Japan's administrative systems. Three roles of administrative categories were identified: i) separation from medicine, ii) describing local problems, and iii) claimsmaking to wider actors and the public.I concluded that looking purely at medical and specifically diagnostic concepts limits our understanding of the formation of practices regarding disabilities, and thus more focus should be placed on categorisation practices outside of medicine. In addition, to the literature on the globalisation of Euro-American psychiatric concepts, this study contributes to our knowledge of a form of locality that has not been central in the exploration of the influence of globalisation on local settings and the relationships between the local and the global.

Next-generation phenotyping integrated in a national framework for patients with ultrarare disorders improves genetic diagnostics and yields new molecular findings

Individuals with ultrarare disorders pose a structural challenge for healthcare systems since expert clinical knowledge is required to establish diagnoses. In TRANSLATE NAMSE, a 3-year prospective study, we evaluated a novel diagnostic concept based on multidisciplinary expertise in Germany. Here we present the systematic investigation of the phenotypic and molecular genetic data of 1,577 patients who had undergone exome sequencing and were partially analyzed with next-generation phenotyping approaches. Molecular genetic diagnoses were established in 32% of the patients totaling 370 distinct molecular genetic causes, most with prevalence below 1:50,000. During the diagnostic process, 34 novel and 23 candidate genotype–phenotype associations were identified, mainly in individuals with neurodevelopmental disorders. Sequencing data of the subcohort that consented to computer-assisted analysis of their facial images with GestaltMatcher could be prioritized more efficiently compared with approaches based solely on clinical features and molecular scores. Our study demonstrates the synergy of using next-generation sequencing and phenotyping for diagnosing ultrarare diseases in routine healthcare and discovering novel etiologies by multidisciplinary teams.

Nuclear medicine approaches in the diagnosis and treatment of neuroendocrine neoplasms

Despite, or perhaps because of the rarity of neuroendocrine neoplasms, the diagnosis and treatment of these malignancies is of particular importance. Nuclear medicine can make an important contribution to this challenge. It offers the most sensitive and specific imaging of these tumor entities and can be helpful in treatment due to the radiotherapeutic drugs that have recently been approved. This theragnostic (fusion of therapeutic and diagnostic) concept is based on the frequent overexpression of somatostatin receptors on neuroendocrine tumor cells.Using diagnostic and therapeutic pharmaceuticals based on analogues from somatostatin, most applications from the nuclear medicine are successful, an additional therapeutic method is SIRT, also known as TARE, in which the hypervascularization of NEN-metastases is used as a therapeutic target.

Preliminary application of real-time shear wave elastography to evaluate endometrial receptivity and predict pregnancy outcome.

Endometrial receptivity is crucial for the establishment of a healthy pregnancy outcome. Previous research on endometrial receptivity primarily examined endometrial thickness, endometrial echo types, and endometrial blood supply. To explore the differences in the elastic modulus of the endometrium in women with various pregnancy outcomes by real-time shear wave elastography (SWE) and to investigate its application value in evaluation of endometrial receptivity. A total of 205 pregnant women who were admitted at Wenzhou People's Hospital between January 2021 and December 2022 were selected. Three-dimensional transvaginal sonography and real-time shear wave elastography were performed in the proliferative phase and receptive phase of the endometrium, and the average elastic modulus of the endometrium in the two phases was obtained and compared. According to whether the pregnancy was successful or not, the participants were divided into the pregnancy group (n= 72) and non-pregnancy group (n= 133), and the differences in intimal thickness, 3D blood flow parameters, and average elastic modulus of intima were compared between the two groups. The average elastic modulus of the endometrium in the proliferative phase and receptive phase was (23.92 ± 2.31) kPa and (11.82 ± 2.24) kPa, respectively, and the difference was statistically significant P< 0.05. The average elastic modulus of the endometrium in the pregnancy group and non-pregnancy group was (9.97 ± 1.08) kPa and (12.82 ± 2.06) kPa, respectively, and the difference was statistically significant P< 0.05. The area under the curve of predicting pregnancy by the average elastic modulus of the endometrium in the receptive phase was 0.888 (0.841∼0.934), with corresponding P value < 0.05. The critical value was 11.15, with a corresponding sensitivity of 81.7% and specificity of 78.2%. Real-time shear wave elastography can quantitatively evaluate endometrial elasticity, indirectly reflect the endometrial phase, and provide a new diagnostic concept for evaluating endometrial receptivity and predicting pregnancy outcome in infertile patients.

Diagnostic Concepts for Condition Monitoring and Fallback Mechanisms in Vehicle Electrical Systems

Diagnostic Concepts for Condition Monitoring and Fallback Mechanisms in Vehicle Electrical Systems

Ineffective coping (00069): A Walker and Avant conceptual analysis.

To analyze the diagnostic concept of "ineffective coping" (00069) proposed by NANDA-I, using Walker and Avant's framework. The theoretical framework of Walker and Avant was used for the concept analysis. A search was performed in the Virtual Health Library portal using the keywords "ineffective coping" and "enfrentamento ineficaz." According to the literature, ineffective coping is defined as an adoption of inadequate psychosocial and behavioral strategies in response to a set of contextual stressors that negatively affect well-being and lifestyle. The concept created for ineffective coping has the potential to address the psychosocial elements associated with life experiences in the face of coping mechanisms. This analysis may contribute to the improvement of nursing care for patients experiencing difficult situations in their lives, as well as the challenges of nursing interventions that promote positive adaptation.

Specialized Concepts for the Management of Severe Neurotrauma

Neurotrauma results from violence on structures of the central or peripheral nervous system and is a clinically common disease entity with high relevance for patients' long-term outcome. The application of evidence-based diagnostic and therapeutic concepts aims to minimize secondary injury and thus to improve treatment outcome. This article describes the current management of the two main injury patterns of neurotrauma - traumatic brain and spinal cord injury.

Reframing acute kidney injury as a pathophysiological continuum of disrupted renal excretory function.

Surrogate measures of glomerular filtration rate (GFR) continue to serve as pivotal determinants of the incidence, severity, and management of acute kidney injury (AKI), as well as the primary reference point underpinning knowledge of its pathophysiology. However, several clinically important deficits in aspects of renal excretory function during AKI other than GFR decline, including acid-base regulation, electrolyte and water balance, and urinary concentrating capacity, can evade detection when diagnostic criteria are built around purely GFR-based assessments. The use of putative markers of tubular injury to detect "sub-clinical" AKI has been proposed to expand the definition and diagnostic criteria for AKI, but their diagnostic performance is curtailed by ambiguity with respect to their biological meaning and context specificity. Efforts to devise new holistic assessments of overall renal functional compromise in AKI would foster the capacity to better personalize patient care by replacing biomarker threshold-based diagnostic criteria with a shift to assessment of compromise along a pathophysiological continuum. The term AKI refers to a syndrome of sudden renal deterioration, the severity of which is classified by precise diagnostic criteria that have unquestionable utility in patient management as well as blatant limitations. Particularly, the absence of an explicit pathophysiological definition of AKI curtails further scientific development and clinical handling, entrapping the field within its present narrow GFR-based view. A refreshed approach based on a more holistic consideration of renal functional impairment in AKI as the basis for a new diagnostic concept that reaches beyond the boundaries imposed by the current GFR threshold-based classification of AKI, capturing broader aspects of pathogenesis, could enhance AKI prevention strategies and improve AKI patient outcome and prognosis.