Boolean Algebra for Laboratory Diagnostics in Medicine

Research Article | DOI: https://doi.org/10.31579/2690-1919/381

Boolean Algebra for Laboratory Diagnostics in Medicine

  • Gerhard Zugmaier *

Department of Haematology, Oncology and Immunology, Philipps University Marburg, Marburg, Germany.

*Corresponding Author: Gerhard Zugmaier, MD, Department of Haematology, Oncology and Immunology, Philipps University Marburg, Marburg, Germany.

Citation: Gerhard Zugmaier, (2024), Boolean Algebra for Laboratory Diagnostics in Medicine, J Clinical Research and Reports, 16(2); DOI:10.31579/2690-1919/381

Copyright: © 2024, Gerhard Zugmaier. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 10 June 2024 | Accepted: 25 June 2024 | Published: 03 July 2024

Keywords: boolean algebra; linear equations; medicine; diagnostics

Abstract

Background: Medical diagnostic tools have become increasingly complex in the last decade. Numerous permutations are necessary to come to the correct decision on how to treat a patient. 

Aim: This study used Boolean algebra to define laboratory parameters by disease entity. We assigned each parameter to a group of disease entities. Since we did not want to give the impression that the respective list of diseases strictly determined the laboratory parameters, we used the mathematical symbol ≈ for approximation in the equations. 

Results: A system of linear Boolean equations permitted assignment of each laboratory parameter to a set of disease entities. Addition of the linear equations by use of the axioms of Boolean algebra resulted in assignment of a disease entities to laboratory parameters. 

Conclusion: Linear Boolean equations may have the potential to become part of diagnostics in medicine.

Introduction

Precision medicine is a crucial condition for patient-tailored treatment decisions. It enables exact definition of disease and risk-stratified treatment guidelines.  This is especially important for life-threatening diseases, such as myocardial infarction or acute leukemia, which require swift action. The international statistical classification of diseases and related health problems (ICD) from the World Health Organization (WHO) has been beneficial in developing a standardized approach to disease management; the latest version is ID 11 (Cazzola and Sehn 2022). In addition to the classical approach of anamnesis and physical examination, numerous technical tools have become available for decision-making on treating patients (Swerdlow et al. 2008, 2017, Alaggio 2022, Cazzola and Sehn 2022).  Boolean algebra is useful for the definition of hematologic malignancies In this study, we have developed a system of linear Boolean equations to (Zugmaier et al. 2019, 2021, 2023) enable assignment of laboratory parameters to disease entities and vice versa.

Materials and Methods

The binary system, including 2 integers, is used. It can be easily transferred from the decimal system (Hoffmann 2016): 

0=0, 1=1, 2=10, 3=11, 4=100, etc. 

The following axioms are used as defined by Shannon (1940) 

  • The rules of arithmetic for addition and multiplication apply. 
  • The symbols of addition multiplication and equations are worldwide accepted and known; therefore, they are not explained in the list of abbreviations and symbols.
  • The result of an addition or multiplication can only be 1 or 0. No other numbers are permitted.
  • Addition:
    • 1 + 1 +1 …+ 1 = 1
    • 1 + 0 + 0…+ 0 = 1
    • 0 + 1 + 1…+ 1 = 1
    • 0 + 0 + 0 …+ 0 = 0
    • 1 + 0 = 0 …+ 1
  • Multiplication
    • 1 x 1 x 1….x 1 = 1
    • 1 x 0 x 0 …x 0 = 0
    • 0 x 1 x 1 …x 1 = 0
    • 0 x 0 x 0….x 0 = 0
    • 1 x 0 = 0 x 1
  • instead of = for “equal” ≈ for “approximately” equal is used, for reasons of practicality we still use the term “equation” Instead of the term “approximation”

Abbreviations and Symbols

AA aplastic anemia

ACE angiotensin converting enzyme

ACTH adrenocorticotropic hormone

AG anion gap

ALL acute lymphocytic leukemia ALT alanine aminotransferase

AML acute myeloid leukemia

AP alkaline phosphatase

Approximate ≈

AST aspartate aminotransferase

Ca2+ calcium

Cl-chloride

CLL chronic lymphocytic leukemia

CML chronic myeloid leukemia 

Decreased ↓

Ig immune globulin

Increased ↑

K+ Potassium

LDH lactate dehydrogenase

MDS myelodysplastic syndrome

Mg2+magnesium

MM multiple myeloma

Na+Sodium

NHL non-Hodgkin lymphoma

PV polycythemia vera

RA rheumatoid arthritis

SIDADH syndrome of inappropriate antidiuretic hormone secretion

SLE systemic lupus erythematosus

Results

AP↑ ≈ hyperparathyroidism + acromegaly + hyperthyroidism + Paget  + hepatitis + sarcoidosis + cholestasis + mononucleosis + osteomyelitis + malignant bone tumor + metastasis osteomalacia + albumin injection + vitamin B12↓ ↓ + phosphate↑ + weight↓ + dehydration + infarction + osteomyelitis + cirrhosis + chlorpropamide + ergosterol + 

AP↓ ≈ hypothyroidism + osteoporosis + celiac disease + vitamin D↑+ vitamin C↓+ milk – alkali syndrome + vitamin B12↓

AG = Na+ - (Cl­- + HCO3-)

AG↑≈ ketoacidosis + salicylates + methanol + ethylene glycol + propylene glycol + lactic acidosis + renal failure

AG↓ ≈ MM + lithium

ALT↑ ≈ hepatitis + mononucleosis + liver abscess + cholestasis + alcohol + malignant tumor

AST↑ ≈ diabetes mellitus + muscular dystrophy + Paget + cholecystits + hepatitis + pneumonia + hemolysis + polymyositis + pancreatitis + ileitis + exercise + tonic and clonic seizures + rhabdomyolysis + peptic ulcer + uremia + vitamin B12↓ + myoglobulinemia + salicylates + alcohol + dehydration + malignant tumor + infarction + ulcerative colitis + muscle necrosis + intramuscular injections + hepatic necrosis + cholestasis + uremia

Bicarbonate↑ ≈ aldosterone↑ + Cushing + hypothyroidism + metabolic alkalosis 

Bicarbonate↓ ≈ Addison + ventilation↑ + metabolic acidosis

Ca2+↑ ≈ hyperparathyroidism + hyperthyroidism + hypothyroidism + Cushing + Addison + osteoporosis + Paget + sarcoidosis + immobilization + vitamin D↑ + milk-alkali syndrome + thiazide diuretics + berylliosis + malignant tumor

Ca2+↓ ≈ hypoparathyroidism + pregnancy + pancreatitis + renal insufficiency + fluids↑ + malabsorption + corticosteroids + vitamin D↓+ corticosteroids

CL↑ ≈ hyperparathyroidism + diabetes mellitus + diabetes insipidus + respiratory alkalosis + metabolic acidosis 

Cl-  ↓ ≈ ketoacidosis + Addison + aldosterone↑ + cardiac failure + pyloric obstruction + metabolic acidosis + metabolic alkalosis + emphysema + diuretics 

LDH↑ ≈ muscle disease + hypothyroidism + hepatitis + mononucleosis + hemolysis + cholestasis + intestinal obstruction + celiac disease + vitamin B12↓ + folic acid↓ + alcohol + NHL + Hodgkin + ALL + AML + CLL + CML + infarction + polymyositis + dermatomyositis + muscle necrosis

Phosphate↑ ≈ Fanconi + acromegaly + hyperparathyroidism + Paget + sepsis + sarcoidosis + fracture + intestinal obstruction + renal failure + vitamin D↓ + muscle necrosis + milk – alkali syndrome + respiratory alkalosis + vitamin D↑ + MM + osteolysis + AML + CML

Phosphate↓ ≈ hypoparathyroidism + diabetes mellitus + Fanconi + vitamin D↓ + diarrhea + vomiting + gout + ketoacidosis + respiratory alkalosis + K+↓ + Mg2+↓ + androgens + epinephrine + glucagon + insulin + salicylates + antacids + alcohol + intravenous glucose + anabolic steroids

K+↑ ≈ aldosterone↓ + Addison + rhabdomyolysis + hemolysis + urinary obstruction + renal failure + acidosis + muscle necrosis + amiloride + spironolacatone + triamterene + ACE inhibitors + food + status epilepticus + hemorrhage + fruit juice + soft drinks + oranges + peaches + bananas + tomatoes + protein diet↑

K+↓ ≈ diabetes mellitus + Cushing + aldosterone↑ + ileus + vomiting + metabolic acidosis + pyelonephritis + diuretics + estrogens + salicylates + corticosteroids + aldosteronoma + villous adenoma + colonic cancer + Zollinger-Ellison syndrome + metabolic alkalosis 

Albumin↓ ≈ an albuminemia + diabetes mellitus + hepatitis + ulcerative colitis + protein - losing enteropathy + glomerulonephritis + SLE + polyarteritis + RA + rheumatic fever + peptic ulcer + congestive heart failure + cirrhosis + nephrotic syndrome + estrogens + MM + Hodgkin + ALL + CLL + macroglobulinemia 

IgG↑ ≈ tuberculosis + hepatitis + osteomyelitis + SLE + RA + vasculitis + vasculitis + cirrhosis + MM

IgG↓ ≈ agammaglobulinemia + lymphoid aplasia + common variable immune deficiency + nephrotic syndrome + MM + CLL

IgA↑ ≈ Wiscott Aldrich + SLE + RA + sarcoidosis + cirrhosis + MM

IgA↓ ≈ absent in 3 per 100,000 + hereditary telangiectasia + lymphoid aplasia + nephrotic syndrome + Still + SLE + common variable immune deficiency + agammaglobulinemia + cirrhosis + ALL AML + CLL + CML

Na+↑ ≈ diabetes insipidus + diabetes mellitus + hyperparathyroidism + aldosterone↑ + corticosteroids + diuretics + thalamic lesion

Na+↓ ≈ Addison + pneumonia + brain abscess + SIADH + congestive heart failure + cirrhosis + lung cancer + meningitis

Pancytopenia ≈ AA + PNH + tuberculosis + hepatitis + SLE + irradiation + vitamin B12↓ + folate↓+ chemotherapy + benzene + MM + MDS + AML + ALL + myelofibrosis + Hodgkin + non-Hodgkin 

Reticulocytes↑ ≈ hemorrhage + hemolysis + response to treatment

Reticulocytes↓ ≈ deprivation + anemia of chronic disease + bone marrow failure + Fe↓ + vitamin B12↓ + folate↓

Uric acid ↑ ≈ polycystic kidney + sickle cell anemia + Wilson + Fanconi + von Gierke + Down + Indians + Filipinos + Maoris + hypothyroidism + hypoparathyroidism + hyperparathyroidism + psoriasis + hemolysis + sarcoidosis + renal failure + diuretic + salicylate + lead + berylliosis + hypertension + metabolic syndrome + ALL + AML + CLL + CML + MM + PV + NHL + Hodgkin

Uric acid↓ ≈ xanthinuria + Fanconi + Wilson + Dalmatian dog mutation + acromegaly + celiac disease + allopurinol + ACTH + contrast media + carcinoma + Hodgkin

Diseases can easily be assigned to laboratory parameters. The laboratory parameters of each row, in which the disease entity is listed, are added. This is shown here by using SLE as example.

SLE ≈ albumin↓ + IgA↓ + IgA↑ + pancytopenia. This example shows an increased as well as a decreased IgA level can point to an SLE. 

Discussion:

Boolean algebra is a mathematical basis of computer science. It uses a binary system restricted to the integers 0 and 1. Permutations of various inputs of binary numbers can only result in an output of either 1 or 0, not both. Any other integer is not permitted. The gates in computer science are defined by the mathematical operators of Boolean algebra. In this study we used the AND gate and the OR gate. The AND gate is identical to multiplication. The OR gate is identical to addition with one exception, 1 + 1 =1 (Shannon 1940). In regular binary arithmetic 1 + 1 = 10 would account. This is not possible in Boolean arithmetic, since it can have only 1 or 0 as result of computations. This approach has the advantage of simplifying arithmetic operations and enabling the calculation of complex permutations. Since the equations do not claim a strict relation, the mathematical symbol ≈ for approximation has been used. 

In this study, we used linear Boolean equations to standardize the relationship between laboratory parameters and disease entities. Linear equations in Boolean algebra have been investigated over decades (Melter and Rudeanu 1984). To our knowledge, this system of linear Boolean algebra study is used for the first time in medicine and has never been applied before.

Mathematics in medicine. Become a crucial component of all exact sciences, including medicine, physics, and chemistry. Clinical research would not be possible without biostatistics and mathematical modeling (Matthäus and Matthäus 2020).

Boolean algebra has successfully been used in various areas of medicine. This application includes laboratory and clinical research (Albert and Robeva 2015, He et al. 2015, Lin and Khatri 2014, Macauley and Young 2020, Varadan and Anastassiou 2005, DiAndreth 2022, Riede et al. 2008, Palma et al. 2021, Zugmaier and Locatelli 2019, 2021 and 2022). 

The term “mathematical logic” sometimes used instead of “Boolean algebra” is misleading and should be abandoned. Logic is crucial for any rational endeavor also for mathematics, but logic is not a mathematical subdiscipline (Grattan-Guiness, 2000). 

The definition of logic as part of mathematics leads to circular statements. Misleading notions such as “truth values” should be avoided.  We have used numbers as done in arithmetic operations (Steffens et al. 2020). Our approach is purely mathematical. 

The mathematical symbols in new mathematical areas are difficult to understand since they lack standardization and standardization is often not accepted, by part of the mathematical community (Vivaldi 2014). This is especially true for Boolean algebra. There is no consensus on the symbols to be used, resulting in the use of different symbols for the same mathematical operations (Hoffman 2016). On the other hand, the same symbols are used for various mathematical operations. In this study we have only used symbols of ordinary arithmetic and algebra, which have been accepted and used worldwide.

This study has limitations. The linear equations can provoke an unjustified impression of certainty, which can rarely be achieved in medicine. The linear equations used in this study are rather approximations and not equations in the strict sense (see Materials and Methods). The physician will always have the last word on how to apply such a system. This holds true for any tool of diagnostics in medicine.

In conclusion, linear Boolean equations have been shown to be a useful part of diagnostics in medicine. This is the first application of linear Boolean equations in medicine.

References

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

img

Virginia E. Koenig

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

img

Delcio G Silva Junior

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

img

Ziemlé Clément Méda

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

img

Mina Sherif Soliman Georgy

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

img

Layla Shojaie

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

img

Sing-yung Wu

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

img

Orlando Villarreal

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

img

Katarzyna Byczkowska

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

img

Anthony Kodzo-Grey Venyo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

img

Pedro Marques Gomes

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

img

Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

img

Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

img

Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

img

Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

img

Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

img

Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

img

Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

img

Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

img

Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

img

Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

img

Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

img

Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

img

Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

img

Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

img

S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

img

Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

img

George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

img

Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

img

Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

img

Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

img

Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

img

Maria Dolores Gomez Barriga