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Primary aldosteronism (PA) has two major subtypes: unilateral (uPA) and bilateral (bPA). Although several diagnostic models for subtype classification have been reported, the optimal combination of algorithms and clinical features remains unclear. This study aimed to identify machine learning models and clinical features that contribute to PA subtype prediction. A total of 274 PA patients who underwent successful adrenal venous sampling (AVS) at a single center were analyzed. Overall, 196 endocrine features were comprehensively collected and classified into four categories: A, PA-related features; B, challenge tests; C, general biochemistry; and D, urinary steroid profile. Five machine learning algorithms were applied; predictive performance of the models as well as predictive contribution of features and categories were evaluated. Among the models, the random forest (RF) model achieved the highest predictive accuracy (91.3%). The most contributing feature in the RF model was plasma aldosterone concentration after the captopril challenge test (CCT90-PAC). Category B made the greatest contribution to RF, followed by Categories A, D, and C. Combining Categories A and B improved predictive performance. These findings indicate that machine learning models, particularly RF, are effective for PA subtype prediction, with challenge test-related features in Category B making a major contribution.

The surge in online gaming's popularity has raised concerns regarding excessive engagement particularly among younger generations. Internet gaming disorder (IGD) is increasingly recognized as a clinical concern, underscoring the necessity for early detection and intervention. Although facial expressions provide key emotional insights, their link to symptoms associated with internet gaming addiction remains largely unexplored. In this preliminary study, we investigated facial emotional expressions in response to internet gaming videos among 28 young adults who casually play online games, utilizing the automated facial expression recognition system for analysis. Participants watched internet gaming and neutral (nongaming) videos while their facial expressions were recorded. We measured the intensity of each facial expression (happy, sad, angry, surprised, scared, disgusted, and neutral) and explored their correlation with symptoms related to internet gaming addiction. Participants exhibited a higher intensity of neutral expression and a lower intensity of sad expression in internet gaming videos compared to neutral ones; however, the findings were only nominally significant and did not survive correction for multiple comparisons. Moreover, participants with higher symptoms of internet gaming addiction displayed reduced facial intensity of sadness in response to internet gaming videos. Additionally, we noted a positive correlation between the facial intensity of surprise and levels of gaming desire. Furthermore, the intensity of disgusted facial expressions showed a negative correlation with participants' familiarity levels with the online games. These preliminary and exploratory findings hold promise for deepening our understanding of individuals' emotional responses and internet gaming behavior. Future research with larger samples, including patients with IGD, will be crucial to validate these findings and to inform the development of preventive strategies and effective interventions in this field. In this preliminary study, we investigated facial emotional expressions in response to internet gaming videos among 28 young adults who casually play online games, utilizing the automated facial expression recognition system. Participants with higher symptoms of internet gaming addiction displayed reduced facial intensity of sadness in response to internet gaming videos.

Background/purpose Meconium obstruction of prematurity (MO) often occurs in extremely low-birth weight (ELBW) infants, and its treatment is quite a challenge for neonatologists. We attempted to establish a method of primary treatment for MO of prematurity in ELBW infants. Methods An iopamidol enema with 50 cm H 2 O static pressure was performed as the primary treatment. This procedure is safe and effective and we recommend this as the first treatment for MO in ELBW infants. Results The procedure was performed 50 times in 23 infants and no complications occurred. Out of 23 patients, 20 (88%) improved, but the other 3 did not. In the failure group, the procedure was performed on a significantly later date and the mortality rate was higher (12.5 vs. 67%). Conclusions This procedure is safe and effective. We recommend this as the first treatment for MO in ELBW infants.

Pulse amplitude modulation (PAM) and discrete multi-tone (DMT) technology are attractive modulation techniques for short-reach applications of the next-generation optical transmission systems. We have simulated and experimentally measured and compared the transmission characteristics of PAM and DMT by using the same simulation model and the same experimental setup. Consequently, we have confirmed that DMT has an advantage over PAM.

This chapter focuses on two of the major amplifier-based sources of interactions between channels, erbium-doped fiber amplifier (EDFA) gain dynamics, and spectral hole burning (SHB) resulting from inhomogeneous broadening. It reviews the current understanding of the underlying physics and the complex spectral structure of hole burning. Gain dynamics are important because when channel loading in the EDFAs changes, the co-propagating surviving channels are impacted. This could happen because of reconfiguration of the channels through the network or because of a fault, such as a fiber break or connector pull. In either case, the surviving channels that were co-propagating through EDFAs with the affected channels will experience changes in their gains if the amplifier is not controlled. And the longer the chain of concatenated amplifiers is and the harder these amplifiers are driven, the faster the gain dynamics can be. This chapter also presents methods of fast gain control that can be incorporated in amplifier designs to manage these dynamic effects. As a result of SHB, the gain spectrum of the EDFAs depends on the wavelengths and powers of the individual channels that are populated, even if the amplifier is maintained at the constant inversion. A numerical model of SHB is developed, and its use to predict the gain spectra for different allocations of provisioned channels is demonstrated. As the phenomenon is intrinsic to the physics of gain in EDFAs, it must be managed using the capability of the reconfigurable optical add/drop multiplexers (ROADMs) to adjust the powers of individual channels to compensate for SHB.

BackgroundSeveral well-trained expert instructors who completed the “Train-The-Trainer (TTT)” course are required to disseminate the safe use of surgical energy devices, which can be learned through the Fundamental Use of Surgical Energy (FUSE) program. This study aimed to explore whether the hybrid FUSE TTT course is feasible and effective, which can improve teaching skills of surgical energy.MethodsThe hybrid TTT course, which was designed to train FUSE-certified personnel as instructors, comprised three virtual sessions spread over 5 h in total and a 1-day in-person training, followed by a 100-min FUSE electrosurgery hands-on workshop in practice as an instructor. The participants reported on self-confidence regarding knowledge of various energy devices or adverse events before, immediately after, and 6 months after the course. Participants and experienced FUSE instructors assessed the trainees’ presentation skills at the beginning of the in-person training and after the hands-on workshop. The primary outcomes were the feasibility and completion rate of the entire course.ResultsSeventeen participants completed the entire couse; most (94%) were satisfied with the course. Self-confidence in knowledge about various contents improved significantly: the fundamentals of electrosurgery (post, p < 0.001; 6 months, p = 0.01), mechanism and prevention of adverse events (post, p = 0.001; 6 months, p = 0.04), monopolar instruments (post, p = 0.002; 6 months, p = 0.01), bipolar instruments (post, p = 0.01; 6 months, p = 0.06), and integration with other medical devices (post, p = 0.006; 6 months, p = 0.02). The presentation skill index scores of self- and peer assessments improved after the in-person training (self-assessment [pre 44 vs. post 56, p < 0.001], peer assessment [pre 39 vs. post 68, p < 0.001]).ConclusionsThe hybrid TTT course can provide FUSE-certified personnel with an improved self-confidence concerning knowledge of surgical energy and improve their presentation skills with midterm retention. This can help build trainees’ self-confidence as instructors.

Background After endoscopic submucosal dissection (ESD) of early gastric cancer (EGC), patients are at high risk for synchronous or metachronous multiple gastric cancers. Objective To elucidate the time at which multiple cancers develop and to determine whether scheduled endoscopic surveillance might control their development. Design A multicentre retrospective cohort study from 12 hospitals was conducted. Patients with EGC who underwent ESD with en bloc margin-negative curative resection were included. Synchronous cancer was classified as concomitant cancer or missed cancer. The cumulative incidence of metachronous cancers and overall survival rate were calculated using the Kaplan–Meier method. Results From April 1999 to December 2010, 1258 patients met the inclusion criteria. Synchronous or metachronous multiple cancers were detected in 175 patients (13.9%) during a mean of 26.8 months. Among the 110 synchronous cancers, 21 were missed at the time of the initial ESD. Many of the missed lesions existed in the upper third of the stomach and the miss rate was associated with the endoscopist's inexperience (<500 oesophagogastroduodenoscopy cases). The cumulative incidence of metachronous cancers increased linearly and the mean annual incidence rate was 3.5%. The incidence rate did not differ between patients with or without Helicobacter pylori eradication. Four lesions (0.32%) were detected as massively invading cancers during the follow-up. Conclusions Nineteen per cent of synchronous cancers were not detected until the initial ESD. The incidence rate of metachronous cancer after ESD was constant. Scheduled endoscopic surveillance showed that almost all recurrent lesions were treatable by endoscopic resection.

Currently, the insertions of SINEs (and other retrotransposed elements) are regarded as one of the most reliable synapomorphies in molecular systematics. The methodological mainstream of molecular systematics is the calculation of nucleotide (or amino acid) sequence divergences under a suitable substitution model. In contrast, SINE insertion analysis does not require any complex model because SINE insertions are unidirectional and irreversible. This straightforward methodology was named the “SINE method,” which resolved various taxonomic issues that could not be settled by sequence comparison alone. The SINE method has challenged several traditional hypotheses proposed based on the fossil record and anatomy, prompting constructive discussions in the Evo/Devo era. Here, we review our pioneering SINE studies on salmon, cichlids, cetaceans, Afrotherian mammals, and birds. We emphasize the power of the SINE method in detecting incomplete lineage sorting by tracing the genealogy of specific genomic loci with minimal noise. Finally, in the context of the whole-genome era, we discuss how the SINE method can be applied to further our understanding of the tree of life.