Introduction: Many clinical trials have demonstrated the benefits of intraoperative systemic lidocaine administration in major abdominal surgeries. We tested the hypothesis that systemic lidocaine is associated with an enhanced early quality of recovery in patients following laparoscopic colorectal resection.
Patients and methods: We randomly allocated 126 patients scheduled for laparoscopic colorectal surgery in a 1:1 ratio to receive either lidocaine (1.5 mg kg-1 bolus over 10 min, followed by continuous infusion at 2 mg kg-1 h-1 until the end of surgery) or identical volumes and rates of saline. The primary outcome was the Quality of Recovery-15 score assessed 24 h after surgery. Secondary outcomes were areas under the pain numeric rating scale curve over time, 48-h morphine consumption, and adverse events.
Results: Compared with saline, systemic lidocaine improved the Quality of Recovery-15 score 24 h postoperatively, with a median difference of 4 (95% confidence interval: 1-6; p = 0.015). Similarly, the area under the pain numeric rating scale curve over 48 h at rest and on movement was reduced in the lidocaine group (p = 0.004 and p < 0.001, respectively). However, these differences were not clinically meaningful. Lidocaine infusion reduced the intraoperative remifentanil requirements but not postoperative 48-h morphine consumption (p < 0.001 and p = 0.34, respectively). Additionally, patients receiving lidocaine had a quicker and earlier return of bowel function, as indicated by a shorter time to first flatus (log-rank p < 0.001), yet ambulation time was similar between groups (log-rank test, p = 0.11).
Conclusions: In patients undergoing laparoscopic colorectal surgery, intraoperative systemic lidocaine resulted in statistically but not clinically significant improvements in quality of recovery (see Graphical Abstract).Trial registration: Chinese Clinical Trial Registry; ChiCTR1900027635.
导言:许多临床试验证明,在大型腹部手术中术中全身使用利多卡因有好处。我们测试了一个假设,即全身使用利多卡因与提高腹腔镜结直肠切除术患者的早期恢复质量有关:我们以 1:1 的比例随机分配了 126 名计划接受腹腔镜结直肠手术的患者,让他们接受利多卡因(10 分钟内 1.5 毫克/公斤-1 的栓剂,然后以 2 毫克/公斤-1 小时-1 的剂量持续输注,直到手术结束)或相同剂量和比例的生理盐水。主要结果是术后 24 小时的恢复质量-15 评分。次要结果是随时间变化的疼痛数字评分量表曲线下的面积、48小时吗啡消耗量和不良事件:结果:与生理盐水相比,全身用利多卡因可提高术后 24 小时的恢复质量-15 分,中位差异为 4(95% 置信区间:1-6;P = 0.015)。同样,利多卡因组患者在静息和运动时 48 小时疼痛数字评分量表曲线下的面积也有所减少(p = 0.004 和 p p = 0.34)。此外,接受利多卡因治疗的患者肠道功能恢复得更快更早,首次排便时间更短(log-rank p p = 0.11):结论:对于接受腹腔镜结直肠手术的患者,术中全身使用利多卡因对恢复质量的改善具有统计学意义,但无临床意义(见图表摘要):试验注册:中国临床试验注册中心;ChiCTR1900027635。
{"title":"Efficacy of intraoperative systemic lidocaine on quality of recovery after laparoscopic colorectal surgery: a randomized controlled trial.","authors":"Wenjun Lin, Ying Yang, Yifen Zhuo, Chunlin Qiu, Yanhua Guo, Yusheng Yao","doi":"10.1080/07853890.2024.2315229","DOIUrl":"10.1080/07853890.2024.2315229","url":null,"abstract":"<p><strong>Introduction: </strong>Many clinical trials have demonstrated the benefits of intraoperative systemic lidocaine administration in major abdominal surgeries. We tested the hypothesis that systemic lidocaine is associated with an enhanced early quality of recovery in patients following laparoscopic colorectal resection.</p><p><strong>Patients and methods: </strong>We randomly allocated 126 patients scheduled for laparoscopic colorectal surgery in a 1:1 ratio to receive either lidocaine (1.5 mg kg<sup>-1</sup> bolus over 10 min, followed by continuous infusion at 2 mg kg<sup>-1</sup> h<sup>-1</sup> until the end of surgery) or identical volumes and rates of saline. The primary outcome was the Quality of Recovery-15 score assessed 24 h after surgery. Secondary outcomes were areas under the pain numeric rating scale curve over time, 48-h morphine consumption, and adverse events.</p><p><strong>Results: </strong>Compared with saline, systemic lidocaine improved the Quality of Recovery-15 score 24 h postoperatively, with a median difference of 4 (95% confidence interval: 1-6; <i>p</i> = 0.015). Similarly, the area under the pain numeric rating scale curve over 48 h at rest and on movement was reduced in the lidocaine group (<i>p</i> = 0.004 and <i>p</i> < 0.001, respectively). However, these differences were not clinically meaningful. Lidocaine infusion reduced the intraoperative remifentanil requirements but not postoperative 48-h morphine consumption (<i>p</i> < 0.001 and <i>p</i> = 0.34, respectively). Additionally, patients receiving lidocaine had a quicker and earlier return of bowel function, as indicated by a shorter time to first flatus (log-rank <i>p</i> < 0.001), yet ambulation time was similar between groups (log-rank test, <i>p</i> = 0.11).</p><p><strong>Conclusions: </strong>In patients undergoing laparoscopic colorectal surgery, intraoperative systemic lidocaine resulted in statistically but not clinically significant improvements in quality of recovery (see Graphical Abstract).<b><i>Trial registration</i>:</b> Chinese Clinical Trial Registry; ChiCTR1900027635.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-02-12DOI: 10.1080/07853890.2024.2313676
Ali S Alyami, Yahia Madkhali, Naif A Majrashi, Bandar Alwadani, Meaad Elbashir, Sarra Ali, Wael Ageeli, Hesham S El-Bahkiry, Abdullah A Althobity, Turkey Refaee
Fibrosis is a pathological process that occurs due to chronic inflammation, leading to the proliferation of fibroblasts and the excessive deposition of extracellular matrix (ECM). The process of long-term fibrosis initiates with tissue hypofunction and progressively culminates in the ultimate manifestation of organ failure. Intestinal fibrosis is a significant complication of Crohn's disease (CD) that can result in persistent luminal narrowing and strictures, which are difficult to reverse. In recent years, there have been significant advances in our understanding of the cellular and molecular mechanisms underlying intestinal fibrosis in inflammatory bowel disease (IBD). Significant progress has been achieved in the fields of pathogenesis, diagnosis, and management of intestinal fibrosis in the last few years. A significant amount of research has also been conducted in the field of biomarkers for the prediction or detection of intestinal fibrosis, including novel cross-sectional imaging modalities such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). Molecular imaging represents a promising biomedical approach that enables the non-invasive visualization of cellular and subcellular processes. Molecular imaging has the potential to be employed for early detection, disease staging, and prognostication in addition to assessing disease activity and treatment response in IBD. Molecular imaging methods also have a potential role to enabling minimally invasive assessment of intestinal fibrosis. This review discusses the role of molecular imaging in combination of AI in detecting CD fibrosis.
纤维化是由于慢性炎症导致成纤维细胞增殖和细胞外基质(ECM)过度沉积而发生的病理过程。长期纤维化的过程始于组织功能减退,并逐渐发展到器官衰竭的最终表现。肠纤维化是克罗恩病(Crohn's disease,CD)的一个重要并发症,可导致难以逆转的持续性管腔狭窄和狭窄。近年来,我们对炎症性肠病(IBD)肠纤维化的细胞和分子机制的认识取得了重大进展。过去几年中,我们在肠纤维化的发病机制、诊断和治疗领域取得了重大进展。在预测或检测肠纤维化的生物标志物领域也开展了大量研究,包括正电子发射断层扫描(PET)和单光子发射计算机断层扫描(SPECT)等新型横断面成像模式。分子成像是一种前景广阔的生物医学方法,可实现细胞和亚细胞过程的非侵入性可视化。除了评估 IBD 的疾病活动和治疗反应外,分子成像还有可能用于早期检测、疾病分期和预后。分子成像方法还可用于肠纤维化的微创评估。本综述将讨论分子成像与人工智能相结合在检测 CD 纤维化中的作用。
{"title":"The role of molecular imaging in detecting fibrosis in Crohn's disease.","authors":"Ali S Alyami, Yahia Madkhali, Naif A Majrashi, Bandar Alwadani, Meaad Elbashir, Sarra Ali, Wael Ageeli, Hesham S El-Bahkiry, Abdullah A Althobity, Turkey Refaee","doi":"10.1080/07853890.2024.2313676","DOIUrl":"10.1080/07853890.2024.2313676","url":null,"abstract":"<p><p>Fibrosis is a pathological process that occurs due to chronic inflammation, leading to the proliferation of fibroblasts and the excessive deposition of extracellular matrix (ECM). The process of long-term fibrosis initiates with tissue hypofunction and progressively culminates in the ultimate manifestation of organ failure. Intestinal fibrosis is a significant complication of Crohn's disease (CD) that can result in persistent luminal narrowing and strictures, which are difficult to reverse. In recent years, there have been significant advances in our understanding of the cellular and molecular mechanisms underlying intestinal fibrosis in inflammatory bowel disease (IBD). Significant progress has been achieved in the fields of pathogenesis, diagnosis, and management of intestinal fibrosis in the last few years. A significant amount of research has also been conducted in the field of biomarkers for the prediction or detection of intestinal fibrosis, including novel cross-sectional imaging modalities such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). Molecular imaging represents a promising biomedical approach that enables the non-invasive visualization of cellular and subcellular processes. Molecular imaging has the potential to be employed for early detection, disease staging, and prognostication in addition to assessing disease activity and treatment response in IBD. Molecular imaging methods also have a potential role to enabling minimally invasive assessment of intestinal fibrosis. This review discusses the role of molecular imaging in combination of AI in detecting CD fibrosis.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-02-16DOI: 10.1080/07853890.2024.2317356
Maria Basagaña, Carlos Martínez-Rivera, Clara Padró, Ignasi Garcia-Olivé, Mimar Martínez-Colls, Juan Navarro, Laura Pardo, Paula Cruz, Gloria Cardona Peitx, Lídia Carabias, Albert Roger, Jorge Abad, Antoni Rosell
Background: Some patients with severe asthma may benefit from treatment with biologics, but evidence has been mostly collected from randomized controlled trials (RCTs), in which patients' characteristics are different from those encountered in asthma patients in the real-world setting. The aim of this study was to describe the clinical features of complete responders versus non-complete responders to long-term treatment with biologics in patients with severe asthma attended in routine daily practice.
Methods: Data of a cohort of 90 patients with severe asthma who were treated with biologics (omalizumab, benralizumab, and mepolizumab) for at least 12 months and were followed up to March 2022. Data recorded included clinical characteristics and effectiveness of treatment (exacerbation, Asthma Control Test [ACT] score, lung function, use of maintenance oral corticosteroids [mOCS]), FeNO, and blood eosinophils at baseline, at 12 months, and at the end of follow-up. Complete response is considered if, in addition to not presenting exacerbations or the use of mOCS, the ACT score was >20 and, the FEV1 >80% predicted.
Results: An improvement in all asthma control parameters was observed after 12 months of treatment and a mean follow-up of 55 months. After 12 months of treatment 27.2% of patients met the criteria of complete response and this percentage even increased to 35.3% at the end of follow-up. Long-term complete response was associated to better lung function with mepolizumab and omalizumab treatment and to less previous exacerbations in the benralizumab group. The main cause of not achieving a complete response was the persistence of an airflow obstructive pattern.
Conclusions: This study shows that omalizumab, benralizumab, and mepolizumab improved the clinical outcomes of patients with severe asthma in a clinic environment with similar effect sizes to RCTs in the long term follow-up. Airflow obstruction, however, was a predictor of a non-complete response to biologics.
{"title":"Clinical characteristics of complete responders versus non-complete responders to omalizumab, benralizumab and mepolizumab in patients with severe asthma: a long-term retrospective analysis.","authors":"Maria Basagaña, Carlos Martínez-Rivera, Clara Padró, Ignasi Garcia-Olivé, Mimar Martínez-Colls, Juan Navarro, Laura Pardo, Paula Cruz, Gloria Cardona Peitx, Lídia Carabias, Albert Roger, Jorge Abad, Antoni Rosell","doi":"10.1080/07853890.2024.2317356","DOIUrl":"10.1080/07853890.2024.2317356","url":null,"abstract":"<p><strong>Background: </strong>Some patients with severe asthma may benefit from treatment with biologics, but evidence has been mostly collected from randomized controlled trials (RCTs), in which patients' characteristics are different from those encountered in asthma patients in the real-world setting. The aim of this study was to describe the clinical features of complete responders versus non-complete responders to long-term treatment with biologics in patients with severe asthma attended in routine daily practice.</p><p><strong>Methods: </strong>Data of a cohort of 90 patients with severe asthma who were treated with biologics (omalizumab, benralizumab, and mepolizumab) for at least 12 months and were followed up to March 2022. Data recorded included clinical characteristics and effectiveness of treatment (exacerbation, Asthma Control Test [ACT] score, lung function, use of maintenance oral corticosteroids [mOCS]), FeNO, and blood eosinophils at baseline, at 12 months, and at the end of follow-up. Complete response is considered if, in addition to not presenting exacerbations or the use of mOCS, the ACT score was >20 and, the FEV<sub>1</sub> >80% predicted.</p><p><strong>Results: </strong>An improvement in all asthma control parameters was observed after 12 months of treatment and a mean follow-up of 55 months. After 12 months of treatment 27.2% of patients met the criteria of complete response and this percentage even increased to 35.3% at the end of follow-up. Long-term complete response was associated to better lung function with mepolizumab and omalizumab treatment and to less previous exacerbations in the benralizumab group. The main cause of not achieving a complete response was the persistence of an airflow obstructive pattern.</p><p><strong>Conclusions: </strong>This study shows that omalizumab, benralizumab, and mepolizumab improved the clinical outcomes of patients with severe asthma in a clinic environment with similar effect sizes to RCTs in the long term follow-up. Airflow obstruction, however, was a predictor of a non-complete response to biologics.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10878334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medical security support for rehabilitation therapy in China is different from that in other countries. We investigated whether the discharge plan to continue rehabilitation therapy in tertiary hospitals for patients after traumatic spinal cord injury (TSCI) was influenced by payment sources or other conditions. This was a cross-sectional, observational study. Information was collected on the general condition, caregiver, types of payment sources for continued rehabilitation, American Spinal Injury Association Impairment Scale (AIS) scores, and discharge plans. In total, 135 patients with TSCI (107 male, mean age 41.00 ± 13.73 years, mean spinal cord injury duration 238.43 ± 345.54 days) were enrolled. Medical insurance (43%) and out-of-pocket payments (27.4%) were the primary payment sources. Although most patients were beyond the acute phase, 40% continued rehabilitation therapy at other tertiary hospitals. The caregiver, payment sources, injury level, AIS level, and complete urinary tract infection (UTI) were different due to discharge plans (p > .05). Patients seemingly consider a higher AIS level and co-UTI as the requirement for tertiary hospital therapy. In non-medical insurance payment source patients, the discharge plan also differed due to the AIS level and co-UTI (p > .05). However, in medical insurance patients, the discharge plan differed only in terms of TSCI duration (p > .05). The restricted duration of medical coverage restricted the continuation of rehabilitation therapy and influenced the discharge plan of most patients with TSCI.
{"title":"The role of payment sources in the continuation of rehabilitation therapy in tertiary hospitals for patients with traumatic spinal cord injury: a study in Southwest China.","authors":"Lihua Jin, Yongqian Han, Juchuan Dong, Haonan Wang, Yifei Dong, Wenyuan Wang, Yongmei Li","doi":"10.1080/07853890.2024.2333890","DOIUrl":"10.1080/07853890.2024.2333890","url":null,"abstract":"<p><p>Medical security support for rehabilitation therapy in China is different from that in other countries. We investigated whether the discharge plan to continue rehabilitation therapy in tertiary hospitals for patients after traumatic spinal cord injury (TSCI) was influenced by payment sources or other conditions. This was a cross-sectional, observational study. Information was collected on the general condition, caregiver, types of payment sources for continued rehabilitation, American Spinal Injury Association Impairment Scale (AIS) scores, and discharge plans. In total, 135 patients with TSCI (107 male, mean age 41.00 ± 13.73 years, mean spinal cord injury duration 238.43 ± 345.54 days) were enrolled. Medical insurance (43%) and out-of-pocket payments (27.4%) were the primary payment sources. Although most patients were beyond the acute phase, 40% continued rehabilitation therapy at other tertiary hospitals. The caregiver, payment sources, injury level, AIS level, and complete urinary tract infection (UTI) were different due to discharge plans (<i>p</i> > .05). Patients seemingly consider a higher AIS level and co-UTI as the requirement for tertiary hospital therapy. In non-medical insurance payment source patients, the discharge plan also differed due to the AIS level and co-UTI (<i>p</i> > .05). However, in medical insurance patients, the discharge plan differed only in terms of TSCI duration (<i>p</i> > .05). The restricted duration of medical coverage restricted the continuation of rehabilitation therapy and influenced the discharge plan of most patients with TSCI.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10986431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-20DOI: 10.1080/07853890.2024.2353377
Sandra Öberg, Christina Sandlund, Björn Westerlind, Deborah Finkel, Lennarth Johansson
Objectives: It is widely known that sleep disorders are a common problem among older persons. Few reviews have described current knowledge about the holistic concept of sleep health of community-dwelling older people.
Aim: This study aimed to describe the current state of knowledge and identify research gaps concerning sleep health among community-dwelling older persons.
Method: We conducted a scoping review. Searches were conducted in three databases (Medline, CINAHL, and PsycINFO) to identify scientific articles including outcomes with all five sleep health dimensions (sleep duration, sleep continuity, timing, wakefulness/daytime sleepiness, and sleep quality) among community-dwelling older persons aged ≥65 years. Eight articles were included from a total of 1826 hits, with sample sizes between 1413 and 6485.
Results: The sleep health outcomes of community-dwelling older adults differed between the sexes. Older persons with at least two or more poor sleep health dimensions might have increased risk for depression, higher healthcare costs and mortality, while self-reported better sleep health might be associated with lower odds of frailty.
Conclusion: Future research is needed to confirm the findings by investigating the multidimensional concept of sleep health in a general older population. The identified knowledge gaps are how persons ≥80 years' experience their sleep health, and how sleep medicine is prescribed to treat sleep problems in persons ≥80 years in different care contexts.
{"title":"The existing state of knowledge about sleep health in community-dwelling older persons - a scoping review.","authors":"Sandra Öberg, Christina Sandlund, Björn Westerlind, Deborah Finkel, Lennarth Johansson","doi":"10.1080/07853890.2024.2353377","DOIUrl":"10.1080/07853890.2024.2353377","url":null,"abstract":"<p><strong>Objectives: </strong>It is widely known that sleep disorders are a common problem among older persons. Few reviews have described current knowledge about the holistic concept of sleep health of community-dwelling older people.</p><p><strong>Aim: </strong>This study aimed to describe the current state of knowledge and identify research gaps concerning sleep health among community-dwelling older persons.</p><p><strong>Method: </strong>We conducted a scoping review. Searches were conducted in three databases (Medline, CINAHL, and PsycINFO) to identify scientific articles including outcomes with all five sleep health dimensions (sleep duration, sleep continuity, timing, wakefulness/daytime sleepiness, and sleep quality) among community-dwelling older persons aged ≥65 years. Eight articles were included from a total of 1826 hits, with sample sizes between 1413 and 6485.</p><p><strong>Results: </strong>The sleep health outcomes of community-dwelling older adults differed between the sexes. Older persons with at least two or more poor sleep health dimensions might have increased risk for depression, higher healthcare costs and mortality, while self-reported better sleep health might be associated with lower odds of frailty.</p><p><strong>Conclusion: </strong>Future research is needed to confirm the findings by investigating the multidimensional concept of sleep health in a general older population. The identified knowledge gaps are how persons ≥80 years' experience their sleep health, and how sleep medicine is prescribed to treat sleep problems in persons ≥80 years in different care contexts.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11107849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-13DOI: 10.1080/07853890.2024.2352018
Anna-Maria Kubin, Petri Huhtinen, Pasi Ohtonen, Antti Keskitalo, Joonas Wirkkala, Nina Hautala
Background: Diabetic retinopathy (DR) is a common complication of diabetes and may lead to irreversible visual loss. Efficient screening and improved treatment of both diabetes and DR have amended visual prognosis for DR. The number of patients with diabetes is increasing and telemedicine, mobile handheld devices and automated solutions may alleviate the burden for healthcare. We compared the performance of 21 artificial intelligence (AI) algorithms for referable DR screening in datasets taken by handheld Optomed Aurora fundus camera in a real-world setting.
Patients and methods: Prospective study of 156 patients (312 eyes) attending DR screening and follow-up. Both papilla- and macula-centred 50° fundus images were taken from each eye. DR was graded by experienced ophthalmologists and 21 AI algorithms.
Results: Most eyes, 183 out of 312 (58.7%), had no DR and mild NPDR was noted in 21 (6.7%) of the eyes. Moderate NPDR was detected in 66 (21.2%) of the eyes, severe NPDR in 1 (0.3%), and PDR in 41 (13.1%) composing a group of 34.6% of eyes with referable DR. The AI algorithms achieved a mean agreement of 79.4% for referable DR, but the results varied from 49.4% to 92.3%. The mean sensitivity for referable DR was 77.5% (95% CI 69.1-85.8) and specificity 80.6% (95% CI 72.1-89.2). The rate for images ungradable by AI varied from 0% to 28.2% (mean 1.9%). Nineteen out of 21 (90.5%) AI algorithms resulted in grading for DR at least in 98% of the images.
Conclusions: Fundus images captured with Optomed Aurora were suitable for DR screening. The performance of the AI algorithms varied considerably emphasizing the need for external validation of screening algorithms in real-world settings before their clinical application.
背景:糖尿病视网膜病变(DR)是糖尿病的常见并发症,可能导致不可逆的视力丧失。对糖尿病和糖尿病视网膜病变进行有效筛查和改进治疗,可改善糖尿病视网膜病变的视觉预后。糖尿病患者人数不断增加,远程医疗、移动手持设备和自动化解决方案可减轻医疗负担。我们比较了 21 种人工智能(AI)算法在真实世界环境中通过手持式 Optomed Aurora 眼底照相机拍摄的数据集进行可转诊 DR 筛查的性能:对参加 DR 筛查和随访的 156 名患者(312 只眼睛)进行前瞻性研究。每只眼睛都拍摄了以乳头和黄斑为中心的 50° 眼底图像。由经验丰富的眼科医生和 21 种人工智能算法对 DR 进行分级:312只眼睛中有183只(58.7%)没有DR,21只(6.7%)有轻度NPDR。有 66 只眼睛(21.2%)检测出中度 NPDR,1 只眼睛(0.3%)检测出重度 NPDR,41 只眼睛(13.1%)检测出 PDR,这组眼睛中有 34.6% 患有可转诊的 DR。人工智能算法对可转诊 DR 的平均一致率为 79.4%,但结果从 49.4% 到 92.3% 不等。可转诊 DR 的平均灵敏度为 77.5%(95% CI 69.1-85.8),特异性为 80.6%(95% CI 72.1-89.2)。AI 无法分级的图像比率从 0% 到 28.2% 不等(平均为 1.9%)。21种人工智能算法中有19种(90.5%)至少对98%的图像进行了DR分级:结论:用 Optomed Aurora 采集的眼底图像适用于 DR 筛查。人工智能算法的性能差异很大,这说明筛查算法在临床应用前需要在实际环境中进行外部验证。
{"title":"Comparison of 21 artificial intelligence algorithms in automated diabetic retinopathy screening using handheld fundus camera.","authors":"Anna-Maria Kubin, Petri Huhtinen, Pasi Ohtonen, Antti Keskitalo, Joonas Wirkkala, Nina Hautala","doi":"10.1080/07853890.2024.2352018","DOIUrl":"10.1080/07853890.2024.2352018","url":null,"abstract":"<p><strong>Background: </strong>Diabetic retinopathy (DR) is a common complication of diabetes and may lead to irreversible visual loss. Efficient screening and improved treatment of both diabetes and DR have amended visual prognosis for DR. The number of patients with diabetes is increasing and telemedicine, mobile handheld devices and automated solutions may alleviate the burden for healthcare. We compared the performance of 21 artificial intelligence (AI) algorithms for referable DR screening in datasets taken by handheld Optomed Aurora fundus camera in a real-world setting.</p><p><strong>Patients and methods: </strong>Prospective study of 156 patients (312 eyes) attending DR screening and follow-up. Both papilla- and macula-centred 50° fundus images were taken from each eye. DR was graded by experienced ophthalmologists and 21 AI algorithms.</p><p><strong>Results: </strong>Most eyes, 183 out of 312 (58.7%), had no DR and mild NPDR was noted in 21 (6.7%) of the eyes. Moderate NPDR was detected in 66 (21.2%) of the eyes, severe NPDR in 1 (0.3%), and PDR in 41 (13.1%) composing a group of 34.6% of eyes with referable DR. The AI algorithms achieved a mean agreement of 79.4% for referable DR, but the results varied from 49.4% to 92.3%. The mean sensitivity for referable DR was 77.5% (95% CI 69.1-85.8) and specificity 80.6% (95% CI 72.1-89.2). The rate for images ungradable by AI varied from 0% to 28.2% (mean 1.9%). Nineteen out of 21 (90.5%) AI algorithms resulted in grading for DR at least in 98% of the images.</p><p><strong>Conclusions: </strong>Fundus images captured with Optomed Aurora were suitable for DR screening. The performance of the AI algorithms varied considerably emphasizing the need for external validation of screening algorithms in real-world settings before their clinical application.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11095279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-16DOI: 10.1080/07853890.2024.2354683
Anna Andreasson, Lars Agréus, Nikolaos Mastellos, Grzegorz Bliźniuk, Dorota Waśko-Czopnik, Agapi Angelaki, Eirini Theodosaki, Christos Lionis, Karin Hek, Robert Verheij, Ellen Wright, Stevo Durbaba, Jean Muris, Piotr Bródka, Stanislaw Saganowski, Jean-Francois Ethiér, Vasa Curcin, Brendan Delaney
Objectives: This study aimed to assess the impact of on-demand versus continuous prescribing of proton pump inhibitors (PPIs) on symptom burden and health-related quality of life in patients with gastroesophageal reflux disease (GERD) presenting to primary care.
Methods: Thirty-six primary care centres across Europe enrolled adult GERD patients from electronic health records. Participants were randomised to on-demand or continuous PPI prescriptions and were followed for 8 weeks. PPI intake, symptom burden, and quality of life were compared between the two groups using mixed-effect regression analyses. Spearman's correlation was used to assess the association between changes in PPI dose and patient-reported outcomes.
Results: A total of 488 patients (median age 51 years, 58% women) completed the initial visit, with 360 attending the follow-up visit. There was no significant difference in PPI use between the continuous and on-demand prescription groups (b=.57, 95%CI:0.40-1.53), although PPI use increased in both groups (b = 1.33, 95%CI:0.65 - 2.01). Advice on prescribing strategy did not significantly affect patient-reported outcomes. Both symptom burden (Reflux Disease Questionnaire, b=-0.61, 95%CI:-0.73 - -0.49) and quality of life (12-item Short Form Survey physical score b = 3.31, 95%CI:2.17 - 4.45) improved from baseline to follow-up in both groups. Increased PPI intake correlated with reduced reflux symptoms (n = 347, ρ=-0.12, p = 0.02) and improved quality of life (n = 217, ρ = 0.16, p = 0.02).
Conclusion: In real-world settings, both continuous and on-demand PPI prescriptions resulted in similar increases in PPI consumption with no difference in treatment effects. Achieving an adequate PPI dose to alleviate reflux symptom burden improves quality of life in GERD patients. EudraCT number 2014-001314-25.
研究目的本研究旨在评估按需处方质子泵抑制剂(PPI)与持续处方质子泵抑制剂(PPI)对初级医疗机构胃食管反流病患者的症状负担和健康相关生活质量的影响:方法:欧洲 36 个初级保健中心从电子健康记录中登记了成年胃食管反流病患者。参与者被随机分配到按需或连续PPI处方,并接受为期8周的随访。采用混合效应回归分析比较了两组患者的 PPI 摄入量、症状负担和生活质量。斯皮尔曼相关性用于评估PPI剂量变化与患者报告结果之间的关联:共有 488 名患者(中位年龄 51 岁,58% 为女性)完成了初次就诊,其中 360 人参加了随访。连续处方组和按需处方组的 PPI 使用量无明显差异(b=.57,95%CI:0.40-1.53),但两组的 PPI 使用量均有所增加(b=1.33,95%CI:0.65-2.01)。处方策略建议对患者报告的结果没有明显影响。从基线到随访,两组患者的症状负担(反流病问卷,b=-0.61,95%CI:-0.73 --0.49)和生活质量(12项简表调查物理评分,b=3.31,95%CI:2.17 --4.45)均有所改善。PPI摄入量的增加与反流症状的减少(n = 347,ρ=-0.12,p = 0.02)和生活质量的改善(n = 217,ρ=0.16,p = 0.02)相关:结论:在现实世界中,连续处方和按需处方都会导致PPI用量的增加,但治疗效果并无差异。达到足够的PPI剂量以减轻反流症状负担可提高胃食管反流病患者的生活质量。EudraCT 编号 2014-001314-25。
{"title":"Effect of on-demand vs continuous prescription of proton pump inhibitors on symptom burden and quality of life: results of a real-world randomized controlled trial in primary care patients with gastroesophageal reflux disease.","authors":"Anna Andreasson, Lars Agréus, Nikolaos Mastellos, Grzegorz Bliźniuk, Dorota Waśko-Czopnik, Agapi Angelaki, Eirini Theodosaki, Christos Lionis, Karin Hek, Robert Verheij, Ellen Wright, Stevo Durbaba, Jean Muris, Piotr Bródka, Stanislaw Saganowski, Jean-Francois Ethiér, Vasa Curcin, Brendan Delaney","doi":"10.1080/07853890.2024.2354683","DOIUrl":"https://doi.org/10.1080/07853890.2024.2354683","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the impact of on-demand versus continuous prescribing of proton pump inhibitors (PPIs) on symptom burden and health-related quality of life in patients with gastroesophageal reflux disease (GERD) presenting to primary care.</p><p><strong>Methods: </strong>Thirty-six primary care centres across Europe enrolled adult GERD patients from electronic health records. Participants were randomised to on-demand or continuous PPI prescriptions and were followed for 8 weeks. PPI intake, symptom burden, and quality of life were compared between the two groups using mixed-effect regression analyses. Spearman's correlation was used to assess the association between changes in PPI dose and patient-reported outcomes.</p><p><strong>Results: </strong>A total of 488 patients (median age 51 years, 58% women) completed the initial visit, with 360 attending the follow-up visit. There was no significant difference in PPI use between the continuous and on-demand prescription groups (<i>b</i>=.57, 95%CI:0.40-1.53), although PPI use increased in both groups (<i>b</i> = 1.33, 95%CI:0.65 - 2.01). Advice on prescribing strategy did not significantly affect patient-reported outcomes. Both symptom burden (Reflux Disease Questionnaire, b=-0.61, 95%CI:-0.73 - -0.49) and quality of life (12-item Short Form Survey physical score <i>b</i> = 3.31, 95%CI:2.17 - 4.45) improved from baseline to follow-up in both groups. Increased PPI intake correlated with reduced reflux symptoms (<i>n</i> = 347, ρ=-0.12, <i>p</i> = 0.02) and improved quality of life (<i>n</i> = 217, ρ = 0.16, <i>p</i> = 0.02).</p><p><strong>Conclusion: </strong>In real-world settings, both continuous and on-demand PPI prescriptions resulted in similar increases in PPI consumption with no difference in treatment effects. Achieving an adequate PPI dose to alleviate reflux symptom burden improves quality of life in GERD patients. EudraCT number 2014-001314-25.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11100437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-24DOI: 10.1080/07853890.2024.2356645
Sangho Lee, Doh Yoon Kim, Jihoon Han, Kyungmi Kim, Ann Hee You, Hee Yong Kang, Sung Wook Park, Mi Kyeong Kim, Jung Eun Kim, Jeong-Hyun Choi
Introduction: A change from the supine to prone position causes hemodynamic alterations. We aimed to evaluate the effect of fluid preloading in the supine position, the subsequent hemodynamic changes in the prone position and postoperative outcomes.
Patients and methods: This prospective, assessor-blind, randomized controlled trial was conducted between March and June 2023. Adults scheduled for elective orthopaedic lumbar surgery under general anaesthesia were enrolled. In total, 80 participants were randomly assigned to fluid maintenance (M) or loading (L) groups. Both groups were administered intravenous fluid at a rate of 2 ml/kg/h until surgical incision; Group L was loaded with an additional 5 ml/kg intravenous fluid for 10 min after anaesthesia induction. The primary outcome was incidence of hypotension before surgical incision. Secondary outcomes included differences in the mean blood pressure (mBP), heart rate, pleth variability index (PVi), stroke volume variation (SVV), pulse pressure variation (PPV), stroke volume index and cardiac index before surgical incision between the two groups. Additionally, postoperative complications until postoperative day 2 and postoperative hospital length of stay were investigated.
Results: Hypotension was prevalent in Group M before surgical incision and could be predicted by a baseline PVi >16. The mBP was significantly higher in Group L immediately after fluid loading. The PVi, SVV and PPV were lower in Group L after fluid loading, with continued differences at 2-3 time points for SVV and PPV. Other outcomes did not differ between the two groups.
Conclusion: Fluid loading after inducing general anaesthesia could reduce the occurrence of hypotension until surgical incision in patients scheduled for surgery in the prone position. Additionally, hypotension could be predicted in patients with a baseline PVi >16. Therefore, intravenous fluid loading is strongly recommended in patients with high baseline PVi to prevent hypotension after anaesthesia induction and in the prone position.
Trial number: KCT0008294 (date of registration: 16 March 2023).
{"title":"Hemodynamic changes in the prone position according to fluid loading after anaesthesia induction in patients undergoing lumbar spine surgery: a randomized, assessor-blind, prospective study.","authors":"Sangho Lee, Doh Yoon Kim, Jihoon Han, Kyungmi Kim, Ann Hee You, Hee Yong Kang, Sung Wook Park, Mi Kyeong Kim, Jung Eun Kim, Jeong-Hyun Choi","doi":"10.1080/07853890.2024.2356645","DOIUrl":"10.1080/07853890.2024.2356645","url":null,"abstract":"<p><strong>Introduction: </strong>A change from the supine to prone position causes hemodynamic alterations. We aimed to evaluate the effect of fluid preloading in the supine position, the subsequent hemodynamic changes in the prone position and postoperative outcomes.</p><p><strong>Patients and methods: </strong>This prospective, assessor-blind, randomized controlled trial was conducted between March and June 2023. Adults scheduled for elective orthopaedic lumbar surgery under general anaesthesia were enrolled. In total, 80 participants were randomly assigned to fluid maintenance (M) or loading (L) groups. Both groups were administered intravenous fluid at a rate of 2 ml/kg/h until surgical incision; Group L was loaded with an additional 5 ml/kg intravenous fluid for 10 min after anaesthesia induction. The primary outcome was incidence of hypotension before surgical incision. Secondary outcomes included differences in the mean blood pressure (mBP), heart rate, pleth variability index (PVi), stroke volume variation (SVV), pulse pressure variation (PPV), stroke volume index and cardiac index before surgical incision between the two groups. Additionally, postoperative complications until postoperative day 2 and postoperative hospital length of stay were investigated.</p><p><strong>Results: </strong>Hypotension was prevalent in Group M before surgical incision and could be predicted by a baseline PVi >16. The mBP was significantly higher in Group L immediately after fluid loading. The PVi, SVV and PPV were lower in Group L after fluid loading, with continued differences at 2-3 time points for SVV and PPV. Other outcomes did not differ between the two groups.</p><p><strong>Conclusion: </strong>Fluid loading after inducing general anaesthesia could reduce the occurrence of hypotension until surgical incision in patients scheduled for surgery in the prone position. Additionally, hypotension could be predicted in patients with a baseline PVi >16. Therefore, intravenous fluid loading is strongly recommended in patients with high baseline PVi to prevent hypotension after anaesthesia induction and in the prone position.</p><p><strong>Trial number: </strong>KCT0008294 (date of registration: 16 March 2023).</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11133492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-05-23DOI: 10.1080/07853890.2024.2357224
Jin Xu, Xiao Du, Shilan Zhang, Xueyan Zang, Zixi Xiao, Rongkai Su, Xiadie Huang, Ling Liu
Background: Abdominal aortic aneurysm (AAA) is highly lethal upon onset of acute aortic diseases (AAD) or rupture. Dyslipidaemia and hyperuricaemia are important risk factors for the development of AAA and AAD as well as aortic disease-related death. The aim of this study was to explore whether uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) can be used as an independent predictor of the presence of AAA or AAD.
Methods: Three hundred subjects, including 100 AAA patients (AAA group), 100 AAD patients (AAD group) and 100 controls (CON group), were recruited in this study. UHR and other serum samples were obtained upon the patients' admission before any medical treatment. The optimal cut-off points of UHR were determined using receiver operating characteristic (ROC) curve analysis.
Results: The UHR in AAA group was significantly higher than that in CON group, but there was no significant difference between AAD group and CON group. The optimal cut-off point of UHR for AAA was 7.78 (sensitivity 84.7%, specificity 62.4%, and AUC 0.811; p < 0.001), and UHR (OR: 1.122, 95%CI: 1.064-1.184; p < 0.001) was found to be an independent factor for predicting AAA after adjusting for traditional AAA risk factor.
Conclusion: UHR can be widely used in clinical practice as an auxiliary tool for screening AAA. The optimal cut-off point for UHR to AAA was determined for the first time in Chinese subjects.
{"title":"Diagnostic value of uric acid to high-density lipoprotein cholesterol ratio in abdominal aortic aneurysms.","authors":"Jin Xu, Xiao Du, Shilan Zhang, Xueyan Zang, Zixi Xiao, Rongkai Su, Xiadie Huang, Ling Liu","doi":"10.1080/07853890.2024.2357224","DOIUrl":"10.1080/07853890.2024.2357224","url":null,"abstract":"<p><strong>Background: </strong>Abdominal aortic aneurysm (AAA) is highly lethal upon onset of acute aortic diseases (AAD) or rupture. Dyslipidaemia and hyperuricaemia are important risk factors for the development of AAA and AAD as well as aortic disease-related death. The aim of this study was to explore whether uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) can be used as an independent predictor of the presence of AAA or AAD.</p><p><strong>Methods: </strong>Three hundred subjects, including 100 AAA patients (AAA group), 100 AAD patients (AAD group) and 100 controls (CON group), were recruited in this study. UHR and other serum samples were obtained upon the patients' admission before any medical treatment. The optimal cut-off points of UHR were determined using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>The UHR in AAA group was significantly higher than that in CON group, but there was no significant difference between AAD group and CON group. The optimal cut-off point of UHR for AAA was 7.78 (sensitivity 84.7%, specificity 62.4%, and AUC 0.811; <i>p</i> < 0.001), and UHR (OR: 1.122, 95%CI: 1.064-1.184; <i>p</i> < 0.001) was found to be an independent factor for predicting AAA after adjusting for traditional AAA risk factor.</p><p><strong>Conclusion: </strong>UHR can be widely used in clinical practice as an auxiliary tool for screening AAA. The optimal cut-off point for UHR to AAA was determined for the first time in Chinese subjects.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11123539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-06-07DOI: 10.1080/07853890.2024.2346546
Jia-Hui Cheng, Wen-Xin Cai, Xiao-Hong Xiang, Meng-Yan Zhou, Xing Sun, Hua Ye, Ru Li
Background: Although normal acute phase reactants (APRs) play an important role in assessing disease activity of rheumatoid arthritis (RA), some studies pointed out the discordance between disease activity and APR level. Neutrophil-to-lymphocyte ratios (NLRs), platelet-to-lymphocyte ratios (PLRs) and lymphocyte-to-monocyte ratios (LMRs) have been reported to be sensitive measures of inflammatory reaction. This study aims to explore the value of these haematological makers in assessment of APR-negative RA patients.
Methods: Out of a cohort of 418 consecutive patients with RA, we enrolled 135 patients with normal APR for this study. We performed ultrasound assessments to evaluate synovitis and bone erosion in the affected joints. Synovitis was evaluated by ultrasound grey scale (GS) and power Doppler (PD) with semi-quantitative scoring (0-3). Demographic, clinical and laboratory data were collected from the patients. Disease Activity Score-28 joints (DAS28), NLR, MLR and PLR were calculated.
Results: In RA patients with normal APR, PLR exhibited a positive correlation with ultrasound-detected synovitis and bone erosion, whereas NLR, MLR showed no significant correlation with ultrasonography parameters. The area under the ROC curve (AUC) for identifying synovitis with a GS grade ≥2 based on a PLR cutoff value of ≥159.6 was 0.7868 (sensitivity: 80.95%, specificity: 74.24%). For synovitis with a PD grade ≥2, the AUC was 0.7690, using a PLR cutoff value of ≥166.1 (sensitivity: 68.0%, specificity: 83.87%).
Conclusions: Our findings suggested that PLR might be a reliable and cost-effective marker for identifying moderate-to-severe synovitis in RA patients with normal APR.
{"title":"Platelet-to-lymphocyte ratios as a haematological marker of synovitis in rheumatoid arthritis with normal acute phase reactant level.","authors":"Jia-Hui Cheng, Wen-Xin Cai, Xiao-Hong Xiang, Meng-Yan Zhou, Xing Sun, Hua Ye, Ru Li","doi":"10.1080/07853890.2024.2346546","DOIUrl":"10.1080/07853890.2024.2346546","url":null,"abstract":"<p><strong>Background: </strong>Although normal acute phase reactants (APRs) play an important role in assessing disease activity of rheumatoid arthritis (RA), some studies pointed out the discordance between disease activity and APR level. Neutrophil-to-lymphocyte ratios (NLRs), platelet-to-lymphocyte ratios (PLRs) and lymphocyte-to-monocyte ratios (LMRs) have been reported to be sensitive measures of inflammatory reaction. This study aims to explore the value of these haematological makers in assessment of APR-negative RA patients.</p><p><strong>Methods: </strong>Out of a cohort of 418 consecutive patients with RA, we enrolled 135 patients with normal APR for this study. We performed ultrasound assessments to evaluate synovitis and bone erosion in the affected joints. Synovitis was evaluated by ultrasound grey scale (GS) and power Doppler (PD) with semi-quantitative scoring (0-3). Demographic, clinical and laboratory data were collected from the patients. Disease Activity Score-28 joints (DAS28), NLR, MLR and PLR were calculated.</p><p><strong>Results: </strong>In RA patients with normal APR, PLR exhibited a positive correlation with ultrasound-detected synovitis and bone erosion, whereas NLR, MLR showed no significant correlation with ultrasonography parameters. The area under the ROC curve (AUC) for identifying synovitis with a GS grade ≥2 based on a PLR cutoff value of ≥159.6 was 0.7868 (sensitivity: 80.95%, specificity: 74.24%). For synovitis with a PD grade ≥2, the AUC was 0.7690, using a PLR cutoff value of ≥166.1 (sensitivity: 68.0%, specificity: 83.87%).</p><p><strong>Conclusions: </strong>Our findings suggested that PLR might be a reliable and cost-effective marker for identifying moderate-to-severe synovitis in RA patients with normal APR.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11164179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}