Diagnostic Algorithm Research Articles

Clinical, Functional, Sports Participation, and Osteoarthritis Outcomes After ACL Injury: Ten-Year Follow-up Study of the Delaware-Oslo ACL Cohort Treatment Algorithm.

Anterior cruciate ligament reconstruction (ACLR) is often recommended for treatment of an ACL injury; however, the literature reports similar outcomes for those undergoing rehabilitation alone. We assessed the clinical, functional, sports participation, and osteoarthritis outcomes following our treatment algorithm, and compared 10-year outcomes among participants who chose progressive rehabilitation alone, early ACLR, or delayed ACLR. We included 276 participants who had a unilateral ACL injury without substantial concomitant knee injuries in a prospective cohort study. Treatment choice was based on shared decision-making after a 5-week progressive rehabilitation program. At the 10-year follow-up, we assessed patient-reported outcomes (International Knee Documentation Committee Subjective Knee Form [IKDC-SKF], Knee injury and Osteoarthritis Outcome Score [KOOS], and patient acceptable symptom state [PASS] achievement), quadriceps strength, hop performance, sports participation, and weight-bearing radiographs. Sixty-nine percent of the participants (191 participants; 99 male and 92 female; 6 African American, 7 Asian, 59 Caucasian, 119 unknown) attended the 10-year follow-up, including 98% (53) of 54 participants who had rehabilitation alone, 68% (114) of 167 with early ACLR, and 69% (24) of 35 with delayed ACLR. Among the entire cohort, 78% (126 of 162) reported having a PASS, 72% (109 of 151) had symmetrical quadriceps strength, ≥85% (≥116 of ≤137) had a symmetrical hop performance, 93% (162 of 174) were still engaged in some kind of sports, only 1% (1 of 139) had symptomatic osteoarthritis, and 12% (17 of 139) had radiographic evidence of osteoarthritis. We found similar outcomes after rehabilitation alone and early ACLR. The participants who underwent delayed ACLR had similar outcomes to the other 2 groups except for significantly lower KOOS Sports scores, KOOS Quality of Life scores, and hop performance (p ≤ 0.03). Participants who had rehabilitation alone were older, less active, and more likely to have concomitant lateral meniscal injuries than those who underwent ACLR. Participants who followed our treatment algorithm after ACL injury had high percentages of satisfaction and of symmetrical quadriceps strength and hop performance, high sports participation rates, and low prevalences of osteoarthritis. Participants who chose progressive rehabilitation alone, despite being older and less active, had similar clinical, functional, sports participation, and osteoarthritis outcomes compared with those who chose early ACLR. Participants who underwent delayed ACLR scored lower on KOOS Sports, KOOS Quality of Life, and hop performance compared with both other groups. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Assessing ChatGPT Responses to Frequently Asked Questions Regarding Pediatric Supracondylar Humerus Fractures.

The internet and standard search engines are commonly used resources for patients seeking medical information online. With the advancement and increasing usage of artificial intelligence (AI) in health information, online AI chatbots such as ChatGPT may surpass traditional web search engines as the next go-to online resource for medical information. This study aims to assess the ability of ChatGPT to answer frequently asked questions regarding pediatric supracondylar humerus (SCH) fractures. Seven (7) frequently asked questions (FAQs) regarding SCH fractures were presented to ChatGPT. Initial responses were recorded and rated as either "excellent requiring no clarification (0 items need clarification)," "satisfactory requiring minimal clarification (1 to 2 items need clarification)," "satisfactory requiring moderate clarification (3 to 4 items need clarification)," or "unsatisfactory requiring substantial clarification (>4 items need clarification or response contains false information)." While 4 responses met satisfactory ratings with either moderate (2 responses) or minimal (2 responses) clarification, 3 of the 7 FAQs yielded a response from ChatGPT that were unsatisfactory. There were no responses that required no further clarification. ChatGPT provided some satisfactory responses to FAQs regarding pediatric SCH fractures, but required substantial clarification about treatment algorithms, casting and return to sport timelines, and the utility of physical therapy. Therefore, ChatGPT is an unreliable resource for information on treating SCH fractures. Parents of children who experience SCH fractures should continue to communicate with their doctors for the most accurate medical information. Level V-expert opinion on ChatGPT responses.

Prevalence and diagnostic accuracy of different diagnostic tests for Chagas disease in an indigenous community of the Paraguayan Chaco.

Chagas disease (CD), caused by the protozoan Trypanosoma cruzi (T. cruzi), poses a major health challenge in Paraguay, especially in the resource-limited Chaco region. Rapid diagnostic tests (RDTs) are valuable tools to enhance diagnostic access. This study evaluates CD prevalence and risk factors in an indigenous community in the Paraguayan Chaco and validates the national RDT-based diagnostic algorithm for resource-limited settings against the recommended standard algorithm, which relies solely on conventional serological tests. A descriptive cross-sectional study was conducted in Casanillo, Presidente Hayes, Paraguay. In July 2023, a two-week field campaign was executed using a non-probability convenience sampling method targeting individuals aged over 9 months. Screening involved a single RDT, with positives confirmed via enzyme-linked immunosorbent assay (ELISA). Algorithm accuracy was validated externally at the National Reference Laboratory of Paraguay against the standard algorithm, which, in this study, included an ELISA and Hemagglutination test. Discordant cases were resolved with a second ELISA or Immunofluorescence. The study involved 999 participants, with a median age of 26 years (IQR 12-45), and 51.1% were female. The RDT-based diagnostic algorithm showed 97.1% agreement (κ = 0.94, 95%CI: 0.90-0.98) with the standard algorithm. The RDT alone had 96.0% agreement (κ = 0.91, 95%CI: 0.87-0.96), while the confirmatory ELISA had 94.3% agreement (κ = 0.88, 95%CI: 0.83-0.93). The algorithm's sensitivity/specificity (95%CI) were 94.6% (89.2-97.8)/98.6% (96.1-99.7), with the RDT at 94.6% (89.2-97.8)/96.8% (93.6-98.7) and the ELISA at 96.9% (92.3-99.2)/92.7% (88.5-95.8). T.cruzi infection seroprevalence was 12.6% (95%CI: 9.56-16.52). Age, Sanapaná ethnicity, and awareness of CD vectors were significantly associated with infection odds. No significant associations were found with other typical CD risk factors, clinical history, or health habits. The study underscores the high burden of T. cruzi infection in indigenous communities in the Paraguayan Chaco, urging immediate interventions for improved diagnosis and treatment. The combination of RDTs with conventional serology for diagnostic screening in resource-constrained settings proved useful, and its further use is encouraged.

БИОХИМИЧЕСКИЕ МАРКЕРЫ ДИСФУНКЦИИ ГЕПАТОБИЛИАРНОЙ СИСТЕМЫ У НОВОТЕЛЬНЫХ КОРОВ

The purpose of research is to study the biochemical parameters of the blood of cows to search for informative biomarkers for assessing hepatobiliary disorders in the early lactation period. Objectives: a comprehensive biochemical study of the blood of cows in the early lactation period and determination of the activity of liver and skeletal muscle enzymes as indicators characterizing liver cell damage. Experimental studies were carried out in 7 farms of the Altai Region. A total of 87 blood samples were collected from animals during the study period. The material for research was the blood serum of cows during the period up to 45 days of lactation. As a result of research, it was found that in cows with fatty liver degeneration there is a significant increase in the concentration of bilirubin in the blood - up to 13.72 µmol/l, a decrease in the concentration of albumin beyond the standard ranges to 26.4 g/l cholesterol to 1.74 mmol/l, compared to healthy animals. The level of triglycerides in the blood of sick cows decreases to 0.33 mmol/l, compared to healthy animals (0.47 mmol/l), however, these changes are within standard intervals (0.22–0.55 mmol/l). A study of circulating liver enzymes showed that in cows with fatty degeneration there is a significant increase in the enzymatic activity of aspartate aminotransferase (AST) to 148.3 U/l, glutamyltransferase (GGT) to 30.0 U/l and creatine kinase (CK) to 667.8 U /l, which is 1.95, 1.55 and 6.71 times more than in healthy animals, respectively. Thus, changes in the concentrations of bilirubin, cholesterol, albumin, AST and GGT can be used as a diagnostic algorithm that is highly informative when testing disorders of the functional state of the liver, which will allow for timely correction.

Treatment algorithm: thirst management for critically ill people without artificial airway

Treatment algorithm: thirst management for critically ill people without artificial airway

Hypercalcemia: A Practice Overview of its Diagnosis and Causes

Hypercalcemia is defined as a serum calcium concentration higher than 10.5 mg/gL or 2.6 mmol/L. Only 50% of serum calcium is active, presented as ionized calcium. The remaining half is bound to albumin, phosphate, and other serum anions, and their changes can affect the serum calcium concentration. Thus, to discriminate true hypercalcemia from pseudo hypercalcemia, an ionized calcium concentration higher than 1.3 mmol/L might be more appropriate. Many variables can lead to hypercalcemia, and managing them is necessary to treat this ion disorder. Indeed, it can be caused by malignancies, hematologic disorders, or genetic diseases such as familial hypocalciuric hypercalcemia, or it can be related to hormone disorders involving parathormone or vitamin D. For this condition, the correct diagnostic algorithm should be followed. In this review, we summarize the diagnostic steps to follow and detail each clinical pathway is involved in hypercalcemia.

Clustering of Urinary Biomarkers to Identify Interstitial Cystitis Subtypes and Different Clinical Characteristics and Treatment Outcomes

Purpose: Interstitial cystitis/bladder pain syndrome (IC/BPS) is mysterious and difficult to diagnose without cystoscopic hydrodistention. This study aimed to explore non-invasive and highly reliable urine biomarkers to identify Hunner’s IC (HIC) and different non-Hunner’s IC (NHIC) subtypes. Methods: In total, 422 women with and without clinically diagnosed IC/BPS (n = 376 and 46, respectively) were retrospectively enrolled. Patients were diagnosed with HIC or NHIC by cystoscopic hydrodistention under anesthesia. Then, the maximal bladder capacity (MBC) and glomerulation grade were determined. Thirteen urine inflammatory cytokines, chemokines, and oxidative stress biomarkers based on the previously reported predictors of IC/BPS were assayed using commercial microsphere kits. The dataset was randomly divided into training (70%) and test (30%) sets for model construction and validation using logistic regression and stepwise variable selection techniques. To construct the predictive models, univariate analysis was performed to evaluate the discriminative power of each urinary biomarker, measured by the area under the curve (AUC). Biomarkers with AUC values < 0.6 were excluded from further modeling. Multivariate logistic regression was then employed, with variables selected through stepwise forward selection based on log-likelihood criteria. For dichotomization, cutoff values were determined using quartile ranges from the control group. The final model’s performance was assessed using AUC, accuracy, sensitivity, and specificity in both training and test sets. Results: By setting the screening criterion to AUC ≥ 0.60, the potential urinary biomarkers for identifying IC/BPS cases were eotaxin, monocyte chemoattractant protein-1, tumor necrosis factor-alpha (TNF-α), 8-hydroxy-2′-deoxyguanosine (8-OHdG), and 8-isoprostane. Those for identifying HIC from the IC/BPS cohort were interleukin (IL)-6, IL-8, interferon γ-inducible protein 10 (IP-10), and regulated on activation, normal T-cell expressed and secreted (RANTES). A diagnostic algorithm using a cluster of urinary biomarkers included TNF-α ≥ 0.95 pg/mL or 8-OHDG ≥ 22.34 pg/mL and 8-isoprastane ≥ 22.34 pg/mL for identifying IC/BPS from the overall cohort; for identifying HIC from the IC/BPS cohort, the urinary IP-10 ≥ 3.74 pg/mL or IP-10 ≥ 19.94 pg/mL was added. Conclusions: Using a cluster of urinary biomarkers such as TNF-α or 8-OHdG and 8-isoprostane can identify IC/BPS from a study cohort, and adding the urinary IP-10 can distinguish HIC from IC/BPS cases.

Insights in non-CAH pediatric primary adrenal insufficiency: a single-center experience from India.

Pediatric primary adrenal insufficiency (PAI) etiologies beyond congenital adrenal hyperplasia (CAH) show regional variations. Given limited data from India, this study aims to describe the etiological profile, phenotype, and genotype of pediatric PAI in an Indian cohort. We conducted a retrospective review of patients with PAI onset before 20 years of age from 1998 to 2023 at a single center. After excluding patients with inadequate data (n=20), CAH (n=218), and bilateral adrenalectomy (n=19), we analyzed demographic, clinical, biochemical, and genetic data of the remaining patients. Among 54 patients (45 probands), the median age at presentation was 6 years (range 0.1-19). Common clinical features included hyperpigmentation (90.7 %), adrenal crisis (33.3 %), and seizures (29.6 %). Mineralocorticoid deficiency was present in two-third patients including one patient each with AAAS, MRAP, and NNT mutation. Adrenoleukodystrophy (ALD) was the most common cause (40 %), followed by ACTH resistance states (20 %), early steroidogenic defects (13.3 %), congenital adrenal hypoplasia (11.1 %), autoimmune causes (8.9 %), and tuberculosis (4.5 %). Genetics diagnosed 14/15 patients without phenotypic clues and confirmed diagnoses in 21 tested of 30 with phenotypic pointers (alacrimia in AAAS, hypoparathyroidism/candidiasis in autoimmune polyendocrine syndrome-1 and neurodeficit in ALD). Genetics differentiated CYP11A1 mutation from suspected ALD in two siblings with neurological deficits. We identified seven novel gene variants. We report the first case of NNT associated with 46,XY gonadal dysgenesis. Adrenal tuberculosis was a unique cause of pediatric PAI. This study reveals diverse non-CAH pediatric PAI etiologies in India, emphasizing genetic testing's importance for precise diagnoses and suggests region-specific diagnostic algorithm.

Vitiligo-update on pathogenesis, diagnostics and therapy

Vitiligo is acommon skin disease leading to depigmentation that is associated with progressive destruction of melanocytes. The main subtype, nonsegmental vitiligo (NSV), is considered achronic autoimmune disease leading to activation of melanocyte-specific CD8+ lymphocytes and development of acutaneous immune memory. Vitiligo can result in significant impairment of quality of life and is associated with anumber of comorbidities. Despite the existence of national guidelines and international treatment recommendations, there is astrong need for improved health care for patients with vitiligo. The options in the treatment algorithm for vitiligo are similar and consisted until recently of only topical and systemic corticosteroids, topical calcineurin inhibitors, phototherapy, and surgical interventions. New insights into the pathobiological role of the interferon signature in vitiligo have most recently contributed to the approval of the first vitiligo-specific therapy with the topical Janus kinase1/2 inhibitor ruxolitinib for patients with NSV.

Propensity score-matched real-world comparative treatment outcomes of Janus kinase inhibitors for ulcerative colitis in patients with and without prior exposure to anti-tumor necrosis factor α antibody.

Tofacitinib (TFB), filgotinib (FIL), and upadacitinib (UPA) are Janus kinase (JAK) inhibitors approved for moderate-to-severe ulcerative colitis (UC). The appropriate positioning of each JAK inhibitor in the treatment algorithm, however, is unclear. Furthermore, real-world efficacy of JAK inhibitors for patients with UC and prior anti-tumor necrosis factor α antibody (aTNF) treatment are not fully investigated. We compared the efficacy and safety of 3 JAK inhibitors in patients with UC, considering their prior aTNF exposure. A retrospective study was conducted in patients with UC who started TFB, FIL, or UPA at 2 academic centers. This propensity score-matched cohort study assessed the effectiveness of the 3 JAK inhibitors for UC in patients with and without prior aTNF exposure, comparing steroid-free clinical remission and response rates after 8 weeks. Among 274 patients who met the inclusion criteria, 145 experienced aTNF exposure (TFB: 59.2%, 100/169; FIL: 34.5%, 20/58; UPA: 53.2%, 25/47). Based on propensity score-matching, UPA led to a higher steroid-free clinical remission rates than TFB (adjusted odds ratio [aOR], 5.57; 95% confidence interval [CI], 1.42-21.90) or FIL (aOR, 9.00; 95% CI, 1.42-57.10) in patients exposed to aTNF. Steroid-free clinical remission and clinical response rates did not differ significantly between each group in patients non-exposed to aTNF. The incidence of adverse events was slightly higher with UPA than TFB or FIL. UPA may be more effective for UC than TFB or FIL, especially in patients with previous aTNF exposure, although consideration should be given to adverse events.

The Role of IVUS in Coronary Complications.

Intravascular ultrasound (IVUS) is an essential tool in the diagnostic and therapeutic management of coronary artery disease. In daily practice, IVUS is particularly useful for plaque characterization, optimizing stent implantation, and identifying the cause of in-stent restenosis. In acute coronary syndromes, it helps to detect culprit lesions that are not clearly visible on angiography and plays a key role in the diagnostic algorithm for myocardial infarction with non-obstructive coronary arteries (MINOCA). Additionally, IVUS is frequently used in complex and calcified lesions to guide optimal plaque modification strategies and improve procedural and long term outcomes. Beyond these common applications, IVUS is crucial in managing coronary complications, such as coronary dissection, perforation, intramural hematoma, and side-branch occlusion. In these challenging cases, IVUS allows us to overcome some of the limitations of angiography. This review explores the role of IVUS in bail out situations, offering practical tips and techniques for navigating coronary complications and improving procedural success in a safer and more refined manner.

Treatment Interval Progression and Adherence to Observe-and-Plan Regimen for Neovascular Age-Related Macular Degeneration Treated with Aflibercept 2mg.

Treatment burden of anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (AMD) can be reduced with the Observe-and-Plan (O&P) regimen, which allows for an individualized treatment while reducing the number of injections and assessment visits. In this study, we evaluate detailed characteristics of treatment interval adjustment through individual follow-ups and evaluate adherence to the O&P regimen in a real-world setting in one of the largest centers in Europe. This was a retrospective cohort study of treatment-naïve eyes with neovascular AMD that were treated with intravitreal aflibercept 2mg in an O&P regimen who had persisting exudation after completion of loading dose. We evaluated decisions on adjustment of treatment intervals and adherence to the O&P regimen from a total of 5 follow-up visits. Data from visits and decision on treatment intervals were extracted from a treatment database. A total of 561 eyes were eligible for this study. Treatment intervals gradually increased from a 4-weeks interval (loading dose) to a wide distribution of intervals from 4-weeks to 12-weeks, and at the 5th follow-up 24.9% were followed without any treatment. In total, 209 eyes (49.5%) at the 5th follow-up (of 422 eyes present at the 5th follow-up) adhered to the treatment algorithm. Aflibercept 2mg in an O&P treatment regimen leads to a variety of treatment intervals, and some eyes may be overtreated. An important proportion of eyes deviate from the intended O&P treatment regimen. Our study contributes to understanding real-world implications of personalized treatment regimens.

Personalized metronomic radiopharmaceutical therapy through injection profile optimization via physiologically based pharmacokinetic (PBPK) modeling

Each treatment cycle of radiopharmaceutical therapy (RPT) is administered as a single dose. We aimed to investigate a personalized metronomic RPT paradigm, employing multiple lower-dose administrations, to evaluate its effect on delivering radiopharmaceuticals to tumors. We developed a physiologically-based pharmacokinetic (PBPK) model applied to metastatic castration-resistant prostate cancer patients to analyze the impact of metronomic framework and various infusion durations (1–4 h) on absorbed doses (ADs) in tumors and organ-at-risk (OAR). We designed a treatment algorithm to select optimal regimens with high AD, while investigating what we term radiopharmaceutical delivery payload (RDP). This metric evaluates the efficiency of radiopharmaceutical delivery by quantifying the proportion of the administered dose that successfully reaches the target tissue. The goal is to optimize trade-offs between RDP and tumors-AD among injection profiles, amongst varying radioactivity (1-22GBq), total radiopharmaceutical mass (25-210nmol), number of injections (2–6), and time intervals (12–36 h) between injections. Our framework applied to five patients led to increased AD between 2 and 358 Gy (between 2 and 146%) higher than normally administered to patients, safeguarding OARs. Using single-dose scenarios to match ADs in metronomic approach, led to significant increase in injected activities, requiring injection of 0 to 9GBq additional activity (reducing RDP by 3–75%). Maintaining total administered radioactivity within clinically therapeutic levels, increasing frequency, time interval, and infusion duration increases tumors and OARs AD by 0.05-73%, while it decreased tumors-to-OARs AD ratios by 0.1–30%. Based on the PBPK modeling approach, metronomic RPT appears to improve efficacy (RDP) in delivered doses to tumors for a given total injected radioactivity.

Vibration dataset of main journal bearings in internal combustion engines under diverse climatic and varying operating conditions.

The dataset includes vibration signatures from both healthy and faulty main journal bearings of an internal combustion engine, captured with a tri-axial accelerometer mounted on the bearings' housing. The engine was exposed to various climatic and operating conditions, including variations in temperature and humidity, and tested at different engine rotation speeds, following a standard, MIL-STD-810G. The data was collected in a state-of-the-art climatic and vibration chamber to simulate real-world environmental conditions. The dataset comprises more than 500 files, each recorded under a range of climatic and operational conditions, with root mean square (RMS) values included. This dataset provides a valuable and reliable benchmark for researchers and practitioners to validate their diagnostic algorithms and models against real engine conditions, as no such dataset is publicly available.

'à la carte' treatment algorithm for patellofemoral instability.

Patellar instability is a complex and multifactorial problem that poses difficulties in treatment decision-making. The treatment algorithm proposed by the 'Lyon School of Knee Surgery' aims to guide surgeons in identifying imaging risk factors for failure and proposing a therapeutic plan focused on correcting major risk factors present in specific case.

Managing Mandibular Osteoradionecrosis.

Mandibular osteoradionecrosis (MORN) is a morbid complication of head and neck radiation therapy. Recent advances in surgical and medical therapies underscore the need for a shift in traditional treatment paradigms and a disease grading system that can guide appropriate management. Pubmed/MEDLINE. We conducted a detailed review of publications related to MORN, specifically focusing on its staging and management techniques. Articles meeting inclusion criteria were synthesized into a final narrative review. There has been a paradigm shift away from hyperbaric oxygen therapy in the management of MORN. Growing evidence for the efficacy of pentoxifylline and tocopherol in early-stage disease and novel surgical techniques to manage moderate and late-stage disease warrant an updated staging stratification which is proposed. This review summarizes the clinical efficacy of established and novel therapeutic modalities currently available in treating MORN, emphasizing the significant advances achieved over the last decade. It introduces a contemporary staging and treatment algorithm which incorporates traditional, evidence-supported surgical and medical management with effective early intervention strategies.

Treatment of radial artery occlusion after transradial coronary catheterization: a review of the literature and proposed treatment algorithm.

Transradial artery access (TRA) has been established as the default access site for most coronary catheterization procedures with fewer access-related and bleeding complications, rapid hemostasis, early ambulation of the patient and reduction in all-cause mortality compared with transfemoral access. However, radial artery occlusion (RAO) remains the most frequent complication of TRA coronary catheterization procedures. The purpose of our review was to conduct detailed literature research and summarize all the available treatment strategies for RAO, given the lack of a standardized treatment protocol in the literature. Pharmacological treatment with low-molecular-weight-heparin (LMWH) or other anticoagulant, invasive strategies and pharmaco-invasive methods available in the literature were included in our review. Data was derived from case series, case reports, clinical trials and observational studies. Eight studies regarding pharmacological treatment with LMWH or any other anticoagulant and 7 studies of invasive treatment were included in our review. There are only two randomized studies one with LMWH (tinzaparin) and one with apixaban. Furthermore, taking into consideration data derived from the above-mentioned studies a treatment algorithm for RAO was proposed. RAO remains the most frequent complication of coronary procedures with transradial access. Application of preventive strategies and good knowledge of the risk factors remain the key factor for reduction of the incidence of this clinical entity. Therapeutic options include anticoagulation regimens and interventional techniques through the distal radial artery. Large, randomized, multicenter studies should be conducted to evaluate the efficacy of the available treatment methods and define a standardized treatment protocol for RAO.

Wound, Pressure Ulcer, and Burn Guidelines-5: Guidelines for the management of lower leg ulcers and varicose veins, second edition.

"Wound, Pressure Ulcer, and Burn Guidelines-5: Guidelines for the management of lower leg ulcers and varicose veins, second edition" is revised from the first edition, which was published in the Japanese Journal of Dermatology in 2011. The guidelines were drafted by the Wound, Pressure Ulcer, and Burn Guidelines Drafting Committee delegated by the Japanese Dermatological Association and intend to facilitate physicians' clinical decisions in preventing, diagnosing and management of lower leg ulcers and varicose veins. We updated all sections by collecting documents published since the publication of the first edition. In particular, we added clinical question 8 (CQ8), which addresses endovenous laser ablation for varicose veins, a procedure that became covered by the Japanese national health insurance after the writing of the first edition, and endovenous radiofrequency ablation, which became covered by national health insurance in 2014. We also rearranged the subsequent clinical question (CQs) for easier reading. While the addition of these new techniques has increased the number of options available within the treatment algorithm, differences have arisen in the indication for surgery depending on the facility performing the treatment. Therefore, these have been abbreviated.

IncARMAG: A convolutional neural network with multi-level autoregressive moving average graph convolutional processing framework for medical image classification

IncARMAG: A convolutional neural network with multi-level autoregressive moving average graph convolutional processing framework for medical image classification

Advanced genetic algorithm-based signal processing for multi-degradation detection in steam turbines

Advanced genetic algorithm-based signal processing for multi-degradation detection in steam turbines