RESUMEN

Objective: This study aimed to investigate the value of artificial intelligence (AI) for distinguishing pathological subtypes of invasive pulmonary adenocarcinomas in patients with subsolid nodules (SSNs). Materials and methods: This retrospective study included 110 consecutive patients with 120 SSNs. The qualitative and quantitative imaging characteristics of SSNs were extracted automatically using an artificially intelligent assessment system. Then, radiologists had to verify these characteristics again. We split all cases into two groups: non-IA including 11 Atypical adenomatous hyperplasia (AAH) and 25 adenocarcinoma in situ (AIS) or IA including 7 minimally invasive adenocarcinoma (MIA) and 77 invasive adenocarcinoma (IAC). Variables that exhibited statistically significant differences between the non-IA and IA in the univariate analysis were included in the multivariate logistic regression analysis. Receiver operating characteristic (ROC) analyses were conducted to determine the cut-off values and their diagnostic performances. Results: Multivariate logistic regression analysis showed that the major diameter (odds ratio [OR] = 1.38; 95 % confidence interval [CI], 1.02-1.87; P = 0.036) and entropy of three-dimensional(3D) CT value (OR = 3.73, 95 % CI, 1.13-2.33, P = 0.031) were independent risk factors for adenocarcinomas. The cut-off values of the major diameter and the entropy of 3D CT value for the diagnosis of invasive adenocarcinoma were 15.5 mm and 5.17, respectively. To improve the classification performance, we fused the major diameter and the entropy of 3D CT value as a combined model, and the (AUC） of the model was 0.868 (sensitivity = 0.845, specificity = 0.806). Conclusion: The major diameter and entropy of 3D CT value can distinguish non-IA from IA. AI can improve performance in distinguishing pathological subtypes of invasive pulmonary adenocarcinomas in patients with SSNs.

RESUMEN

PURPOSE: This study aims to evaluate the application value of the tibial tubercle-trochlear groove distance (TT-TG distance) and tibial tubercle-midepicondyle distance (TT-ME distance) on CT images in patellofemoral instability, and further investigate the association between knee joint rotation angles and patellofemoral instability. METHODS: We retrospectively analyzed CT image data of 59 patients with patellar dislocation (case group) and 39 normal knee joints (control group). We measured the TT-TG distance, TT-ME distance, and knee joint rotation angle (KJRA) of both groups, and the related indicators were analyzed using single-factor/multi-factor binary logistic stepwise regression analysis. Two senior radiologists were assigned to assess the inter-rater reliability. Interclass correlation coefficients (ICC) were calculated. Finally, we used receiver operating characteristic (ROC) curves to compare the diagnostic efficiency of these indicators in patellofemoral instability. RESULTS: The results found significant differences between both groups in terms of TT-TG distance, TT-ME distance, KJRA angle, age, location, and gender (P < 0.05). In terms of inter-rater reliability, TT-TG distance and TT-ME distance ratios showed an excellent correlation between observers (TT-TG inter-rater ICC 0.969, TT-ME inter-rater ICC 0.955). Univariate logistic regression analysis indicated that except for location and gender, all other factors significantly affected patellofemoral instability (P < 0.05). The multivariate logistic regression analysis revealed that the TT-ME distance, age, and KJRA angle were statistically significant factors related to patellofemoral instability, with TT-ME distance being a risk factor for patellofemoral instability (OR value 1.572, P value 0.000). Moreover, the ROC curve analysis demonstrated that the diagnostic capability of the TT-ME distance for detecting patellofemoral instability was higher than that of the TT-TG distance and KJRA (AUC were 0.912, 0.851, and 0.735, respectively). CONCLUSION: The TT-ME distance, age, and knee joint rotation angle are factors that affect patellofemoral instability. The TT-ME distance has better diagnostic efficiency for patellofemoral instability compared to the TT-TG distance and knee joint rotation angle.

RESUMEN

BACKGROUND: We aimed to assess the associations of vitamins intake with osteoporosis based on a national sample from US adults. METHODS: A total of 1536 participants were included in this cross-sectional study to investigate the relationship between vitamins intake and osteoporosis from National Health and Nutrition Examination Survey, including vitamin A, C, D. Logistic regression models were used to assess the associations between dietary vitamin intake and osteoporosis. RESULTS: We found that vitamins intake were negatively associated with osteoporosis. For vitamin A, compared with the first tertile, the odds ratios (ORs) and 95% confidential intervals (CIs) were 0.93 (0.81-1.04) for the second tertile and 0.85 (0.78-0.96) for the third tertile (P < 0.01). For vitamin C, compared with the first tertile, the ORs and 95% CIs were 0.89 (0.78-1.05) for the second tertile and 0.79 (0.67-0.93) for the third tertile (P < 0.01). For vitamin D, compared with the first tertile, the odds ratios (ORs) and 95% confidential intervals (CIs) were 0.94 (0.82-1.07) for the second tertile and 0.88 (0.75-0.98) for the third tertile (P < 0.01). And the negative association between vitamins intake and osteoporosis were more evident for female, aged ≥ 60, and BMI > 30, including vitamin A, C and D. CONCLUSIONS: Our findings provide evidence that vitamins intake is linked with decreased prevalence of osteoporosis, including vitamin A, C, D. Further large-scale prospective cohort studies are needed to verify our findings.

Asunto(s)

RESUMEN

OBJECTIVE: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the effects of Chinese herbal medicines (CHMs) on hematologic manifestations in patients with systemic lupus erythematosus (SLE). DATA SOURCES: PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Airiti Library were searched for the period January 2000 to February 2022. STUDY SELECTION: RCTs involving CHMs in patients with SLE with available hematologic data. DATA EXTRACTION: The primary outcomes included white blood cell (WBC) count, hemoglobin level, and platelet count. The Cochrane risk of bias tool was used to assess the quality of the included RCTs. Sensitivity analysis of RCTs with abnormal hematologic data before intervention was performed to verify the robustness of the results. Subgroup analysis was also applied for results with high heterogenicity. Core patterns of used herbal drug pairs had also been analyzed and visualized. DATA SYNTHESIS: Fifteen RCTs involving 1183 participants were included. The effects of elevating WBC count (weighted mean difference [WMD]: 0.69; 95% confidence interval [CI]: 0.33-1.06; p <0.001), hemoglobin levels (WMD: 0.64; 95% CI: 0.31-0.97; p <0.001), and platelet count (WMD: 0.61; 95% CI: 0.48-0.74; p <0.001) in the CHM group were significantly greater than those in the control group. In total, 23 single herbs and 152 herbal drug pairs were identified for core patterns network analysis. CONCLUSIONS: We demonstrated significantly superior therapeutic effects achieved with CHMs and conventional therapy regarding leukopenia, anemia, and thrombocytopenia compared to that of conventional therapy alone in patients with SLE.

Asunto(s)

RESUMEN

Antinuclear antibodies (ANAs) are essential diagnostic markers in systemic autoimmune rheumatic diseases. Among the 30 ANA patterns, homogeneous (AC-1) and dense fine speckled (AC-2) should be focused on owing to their somewhat indistinct presentation in immunofluorescence imaging and distinct correlation with clinical conditions. This study aimed to develop a flowchart to guide discrimination between AC-1 and AC-2 patterns and to re-evaluate ANA samples according to this flowchart to verify its detection ability. We re-evaluated immunofluorescence imaging of 62 ANA blood samples simultaneously subjected to solid-phase assays for autoantibodies against dsDNA, nucleosomes, histones, and DFS70. The results showed statistically significant odd ratios (ORs) of detection of anti-DFS70 using AC-2 after re-evaluation of total samples (OR 101.9, 95% CI 11.7-886.4, p-value < 0.001) and subgroup analysis of patients' samples (OR 53.8, 95% CI 5.9-493.6, p-value < 0.001). The OR of anti-nucleosome/histone/dsDNA detection using AC-1 in re-evaluated data increased to 5.43 (95% CI 1.00-29.61, p-value = 0.05). In the analysis of specific autoantibodies, more than half of the samples with an AC-2 pattern (54.2%) had specific autoantibodies other than anti-DFS70. We conclude that the flowchart for discriminating between AC-1 and AC-2 ANA patterns in this study is a viable practical guide for other laboratories when encountering equivocal ANA results.

RESUMEN

Objective: This study aimed to assess the diagnostic utility and optimal thresholds of abdominal CT plain scans in identifying various degrees of anemia. Methods: We included 40 participants in each of the mild, moderate, and severe anemia groups, totaling 120 participants, along with 40 healthy controls. We measured CT values of several abdominal structures, including the abdominal aorta (AA), inferior vena cava (IVC), liver, bilateral kidneys, spleen, and lumbar spinal cord (LSC), in both the normal and anemia groups. Additionally, we calculated the difference and ratio of CT values between AA and LSC and IVC and LSC. We analyzed the correlation between these parameters and hemoglobin (Hb) concentration. The most effective indicators and thresholds for diagnosing varying degrees of anemia using abdominal CT plain scans were identified. Results: Significant differences were observed in hemoglobin concentration, CT values of AA, CT values of IVC, liver CT values, kidney CT values, and the ratios of CT values between AA and LSC, as well as IVC and LSC, among the four groups (P < .05). However, no significant differences were found in spleen CT values and CT values of LSC between the groups (P > .05). The CT values of AA, IVC, the ratios of AA to LSC, and IVC to LSC displayed significant positive linear correlations with hemoglobin concentration. Optimal thresholds for diagnosing mild, moderate, and severe anemia in AA were found to be 35.43, 33.2, and 30.2 HU, respectively, while for IVC, they were 34.18, 31.27, and 28.1 HU, respectively. Conclusions: Among the various parameters obtained from abdominal CT plain scans, the CT value of the abdominal aorta demonstrated the highest diagnostic efficacy in distinguishing between different degrees of anemia.

Asunto(s)

RESUMEN

Background: The aim of this study was to quantitatively measure the morphology of the patellofemoral joint by magnetic resonance imaging (MRI) in young adults, to investigate the relationship between the morphology of the patellofemoral joint and chondromalacia patellae (CP), and to provide an imaging reference for early clinical diagnosis of CP. Methods: A total of 57 cases of CP and 138 cases of normal knees were retrospectively collected and assigned to the CP group and control group, respectively. The morphological parameters of the patellofemoral joint were measured systematically. The statistical software SPSS 22.0 was used in correlation analysis. Logistic regression was used for univariate analysis. A P value <0.05 was defined as statistically significant. Results: Wiberg index, patellar depth, and the lateral angle of the patella in the CP group were significantly lower than those in the control group (P=0.043, 0.001, 0.040, respectively). The width of the medial side of the trochlea, the ratio of the internal and external articular surfaces of the trochlea, the depth of the trochlea, and the inclination angle of the lateral trochlea in the CP group were significantly lower than those in the control group (P=0.003, 0.020, 0.000, 0.040, respectively), whereas the angle of the trochlea in the CP group was significantly higher than that in the control group (P=0.010). The lateral patellofemoral angle (LPA) and lateral patellofemoral contact width in the CP group were significantly lower than those in the control group (P=0.010, 0.010, respectively). In the CP group, with gender as a covariate, there were significant statistical differences between male and female in patellar depth, lateral patellar inclination angle, lateral trochlear inclination (LTI) angle, and lateral patellar contact surface width (P<0.05), whereas in the control group, there were significant differences in Wiberg index, patellar depth, medial trochlear width, and lateral patellofemoral contact surface width between male and female gender (P<0.05). Conclusions: The prevalence of CP in women was significantly higher than that in men and the reduction of trochlea width and the patella depth is an important factor for the incidence of female CP. Morphological characteristics of the patellofemoral joint are significantly correlated with the occurrence of CP in young adults.

RESUMEN

OBJECTIVE: To provide better preconceptional and prenatal counselling to patients with sjögren syndrome (SS). METHODS: In total, 2 100 143 pregnancies between 2004 and 2014 were identified in the Taiwan National Health Insurance database and birth registry. The maternal history of SS was ascertained, and data were compared between pregnant women with and without SS. We assessed the odds ratios and 95% CIs of fetal-neonatal and maternal outcomes. RESULTS: There were 449 pregnancies in women with SS and 2 099 694 pregnancies in women without SS. The risks of still birth [odds ratio (OR) = 2.14, 95% CI = 1.01, 4.55], low birth weight (<2500 g, OR = 2.53, 95% CI = 1.92, 3.33), small for gestational age (OR = 2.03, 95% CI = 1.57, 2.03) and fetal distress (OR = 1.72, 95% CI = 1.2, 2.45) as well as maternal risks of pulmonary oedema (OR = 11.64, 95% CI = 1.62, 83.48), shock (OR = 6.07, 95% CI = 1.51, 24.3) and respiratory distress (OR = 5.61, 95% CI = 1.39, 22.6) were higher in the SS group than in the non-SS group. CONCLUSION: Women with SS have significant risks of adverse fetal-neonatal and maternal outcomes and must undergo prenatal counselling to understand the risks involved before conception.

Asunto(s)

RESUMEN

Kimura disease (KD) is a rare, chronic proliferative condition presenting as a subcutaneous mass predominantly located in the head and neck region; it is characterized by eosinophilia and elevated serum IgE levels. IgG4-related disease (IgG4RD) is a fibroinflammatory condition characterized by swelling in single or multiple organs and the infiltration of IgG4 plasma cells. Herein, we presented two cases. Case 1 is a 38-year-old man with a painless mass in his right postauricular region, and Case 2 is a 36-year-old man with painless lymphadenopathy in his bilateral postauricular region. After surgical excision, they showed good recovery with no relapse. Although Cases 1 and 2 shared several overlapping pathological manifestations, there were a few differences that allowed the differentiation of KD and IgG4RD.

RESUMEN

RATIONALE: Previous treatment for macrophage activation syndrome (MAS) includes high-dose intravenous methylprednisolone along with intravenous immunoglobulin G. If MAS worsened, second-line therapy consisted of anakinra; if the disease remained refractory, third-line therapy with etoposide was considered. In addition, cyclosporine A plays a role in early MAS and in preventing recurrence. Some studies have reported the use of cytokine-targeting agents other than anakinra, such as canakinumab, tocilizumab, abatacept, and tofacitinib. PATIENT CONCERNS: The patient with systemic lupus erythematosus (SLE) had an uncommon combination of intermittent fever, hyperferritinemia, hypertriglyceridemia, jaundice, and significantly abnormal liver function test results. The patient reported a history of daily fever of 38 to 39°C, painful oral ulcer, anorexia, abdominal bloating, diarrhea, and malar rash progression for 2 weeks, and jaundice, tea-colored urine, and clay-colored stool for 1 week preceding hospital admission. DIAGNOSIS: SLE flareups in the patient were initially suspected. However, the final diagnosis was acute respiratory distress syndrome (ARDS) associated with MAS. INTERVENTIONS: The treatment included disease-modifying antirheumatic drugs (DMARDs), such as azathioprine, and titrated steroid doses of methylprednisolone (40 mg q8 h) and dexamethasone (15 mg q8 h), after the patient had ARDS and was intubated.Dose-adjusted monotherapy with dexamethasone was found to be effective; this may be attributed to some DMARDs being unsuitable for cytokine storms, that is, some DMARDs may cause complications in cytokine storms. OUTCOMES: After dexamethasone 15 mg q8 h treatment, the patient's fever subsided within 2 days, and liver function became normal within 3 weeks. The patient regularly attended scheduled outpatient follow-up visits after discharge. After 2 years, the patient reported no symptoms or signs of SLE with 2 mg/d oral dexamethasone. LESSONS: Early diagnosis of MAS and dexamethasone treatment for MAS with ARDS appear to be crucial for these patients.

Asunto(s)

RESUMEN

Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that involves multiple systems and organs. Advanced conventional treatment does not appear to markedly reduce the risk of cardiovascular disease (CVD) among patients with SLE. Chinese medicine is a complementary and alternative medicine system, and some SLE patients in Taiwan also use Chinese herbal medicines (CHMs). Thus, we aimed to investigate whether integrative therapy combining CHMs with conventional therapy reduces the risk of CVD among patients with SLE. We performed a 12-years population-based retrospective cohort study using the "Systemic Lupus Erythematosus Health Database" of the National Health Insurance Research Database (NHIRD) in Taiwan. Patients newly diagnosed with SLE between 2004 and 2013 were divided into CHM and non-CHM groups and followed up until the end of 2015. We applied 1:1 individual matching by age, gender, and year of being newly diagnosed with SLE; accordingly, 2,751 patients were included in both CHM and non-CHM groups after matching. We applied the Cox proportional hazard regression model to determine the risk of CVD in relation to CHM use. During the follow-up period, 407 patients in the CHM group and 469 patients in the non-CHM group developed CVD, with incidence rates of 337 and 422 per 10,000 person-years, respectively. The Cox proportional hazards model demonstrated a significantly decreased risk of CVD among SLE patients using CHMs (adjusted HR: 0.83; 95% CI 0.73-0.95; p = 0.008). Further analyses of different types of CVDs also showed a significantly decreased risk of ischemic stroke in the CHM group (adjusted HR: 0.74; 95% CI 0.57-0.97; p = 0.032). Among the frequently used single herbs and polyherbal formulas, Shu-Jing-Huo-Xue-Tang was associated with a significantly decreased risk of CVD (adjusted HR: 0.76; 95% CI 0.58-0.99; p = 0.041). In conclusion, CHM use reduced the risk of CVD among patients with SLE in Taiwan. Further randomized studies may be needed to determine the definite causal relationship between CHM use and its protective effects against CVD among patients with SLE.

RESUMEN

BACKGROUND: Few studies have evaluated the association between the risk of coronary artery disease (CAD) and the use of Chinese herbal products (CHP) in patients with rheumatoid arthritis (RA). This study investigated the risk of CAD among patients with RA using CHP in combination with conventional medicine. METHODS: A retrospective cohort study was conducted using the Taiwan National Insurance Research Database to assess 22,353 patients who had been newly diagnosed with RA between 1997 and 2010. Patients were assigned to the CHP group or non-CHP group according to their use or nonuse of CHP after being diagnosed with RA. The Cox proportional hazards model was used to estimate the hazard ratio (HR) of CAD for a 1:1 matched sample. RESULTS: Both the CHP and non-CHP groups comprised 4889 patients after 1:1 matching. The risk of CAD was significantly reduced in the CHP group [adjusted HR (aHR): 0.59, 95% confidence interval (CI): 0.50-0.71] compard with the non-CHP group. Those who used CHP for > 180 days had an even lower risk of CAD than users with CHP usage less than 30 days (aHR: 0.64, 95% CI: 0.43-0.95). Additionally, frequently prescribed formulae, such as Kuei-Chih-Shao-Yao-Chih-Mu-Tang, Tang-Kuei-Nien-Tung-Tang, and Shu-Ching-Huo-Hsieh-Tang, were associated with a reduced risk of CAD. CONCLUSION: The use of CHP was associated with a lower risk of CAD in patients with RA. Additional randomized controlled trials are required to assess any causal relationship between the effect of CHP usage and the risk of CAD.

Asunto(s)

RESUMEN

We report a case of acute pulmonary embolism with hemodynamic instability diagnosed by a computed tomography pulmonary angiogram. The patient developed pulseless electrical activity during systemic thrombolytic therapy with recombinant tissue plasminogen activator. Successful return of spontaneous circulation was achieved after immediate cardiopulmonary resuscitation with chest compressions for 6 min. His electrocardiogram (ECG) on arrival in the emergency department displayed sinus tachycardia, an S wave in lead I, a Q wave in lead III, incomplete right bundle branch block (RBBB), T-wave inversion (TWI) in leads V1-V3, ST elevation in leads aVR and V1, and ST depression in leads I, II, III, aVF, and V4-V6. These characteristic ECG changes might have prognostic value for clinical deterioration. He recovered after treatment. After discharge, the ECG showed resolution of TWI in leads V1-V3 and incomplete RBBB, suggesting recovery from right ventricular dysfunction, which was confirmed by an echocardiogram on follow in the outpatient department.

RESUMEN

OBJECTIVE: To study the growth aspects of orbital volume and to establish the normal value of orbital volume by computed tomography (CT). METHODS: One hundred and twenty three individuals without eye diseases (64 males, 59 females) were divided into 5 groups according to the age. Orbital volume and length of horizontal transverse axis and anterior-posterior axis of the eye were measured at different levels in original or reconstructive CT images. The relationship between orbital volume and age, gender and eyeball volume was analyzed. RESULTS: There was no difference between the left and right orbital volume in all age groups. Orbital volume grew rapidly before 20 years of old. Mean orbital volume in males aged 17 and females aged 13 was 23.54 and 21.75 ml, respectively, which reached 95% of the adult orbital volume. In normal adult, orbital volume in the male was larger than that of the female. The mean orbital volume of adult male and female was (25.04 +/- 2.37) ml and (22.89 +/- 2.67) ml, respectively. A strong linear correlation was presented between the age and orbital volume (P < 0.05). The difference of orbital volume between the male and female was statistically non-significant before 14 years old (P = 0.315). The growth of eyeball volume was consistent with that of the orbital volume, the ratio of eyeball/orbit volume was decreased with age from 0.40 to 0.26. CONCLUSIONS: There is no difference between the right and left orbital volume. Orbital volume is correlated with age and gender. Orbital volume grows rapidly before 20 years of old and still grows slowly after 40 years old.

Asunto(s)