Power Doppler ultrasonographic assessment of the ankle in patients with inflammatory rheumatic diseases

Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the last decade, ultrasound(US) has become a practical imaging tool for the assessment of articular and periarticular pathologies, including joint synovitis, tenosynovitis, and enthesitis in rheumatic diseases. Progress in power Doppler(PD) technology has enabled evaluation of the strength of ongoing inflammation. PDUS is very useful for identifying the location and kind of pathologies in rheumatic ankles as well as for distinguishing between inflammatory processes and degenerative changes or between active inflammation and residual damage. The aim of this paper is to illustrate the US assessment of ankle lesions in patients with inflammatory rheumatic diseases, including rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus, focusing on the utility of PDUS.

Clinical prediction of complicated appendicitis:A case-control study utilizing logistic regression

BACKGROUND Since high-quality evidence on conservative treatment of acute appendicitis using antibiotics has increased,differentiation of patients with complicated appendicitis(CA)from those with simple appendicitis(SA)has become increasingly important.Previous studies have revealed that male gender,advanced age,comorbid conditions,prehospital delay,fever,and anorexia are risk factors of perforated appendicitis.Elevated serum C-reactive protein(CRP)level and hyponatremia have also been reported as predictive biomarkers of CA.However,confounding between various factors is problematic because most previous studies were limited to univariate analysis.AIM To evaluate non-laboratory and laboratory predictive factors of CA using logistic regression analyses.METHODS We performed an exploratory,single-center,retrospective case-control study that evaluated 198 patients(83.9%)with SA and 38 patients(16.1%)with CA.Diagnoses were confirmed by computed tomography images for all cases.We compared age,sex,onset-to-visit interval,epigastric/periumbilical pain,right lower quadrant pain,nausea/vomiting,diarrhea,anorexia,medical history(of previous non-surgically treated appendicitis,diabetes,hypertension,dyslipidemia,liver cirrhosis,hemodialysis,chronic lung diseases,malignant tumors,immunosuppressant use,and antiplatelet use),vital signs,physical findings,and laboratory data to select the explanatory variates for logistic regression.Based on the univariate comparisons,we performed logistic regression for clinical differentiation between CA and SA using only nonlaboratory factors and also including both non-laboratory and laboratory factors.RESULTS The 236 eligible patients consisted of 198 patients(83.9%)with SA and 38 patients(16.1%)with CA.The median ages were 34 years old[interquartile ranges(IR),24-45 years]in the SA group and 49 years old(IR,35-63 years)in the CA group(P<0.001).The median onset-to-visit interval was 1 d(IR,0-1)and 1 d(IR,1-2)in the SA and CA groups,respectively(P<0.001).Heart rate,body temperature,and serum CRP level in the CA group were significantly higher than in the SA group;glomerular filtration rate and serum sodium were significantly lower in the CA group.Anorexia was significantly more prevalent in the CA group.The regression model including age,onset-to-visit interval,anorexia,tachycardia,and fever as non-laboratory predictive factors of CA(Model 1)showed that age≥65 years old,longer onset-to-visit interval,and anorexia had significantly high odds ratios.The logistic regression for prediction of CA including age,onset-to-visit interval,anorexia,serum CRP level,hyponatremia(serum sodium<135 mEq/L),and glomerular filtration rate<60 mL/min/1.73 m2(Model 2)showed that only elevated CRP levels had significantly high odds ratios.Under the curve values of receiver operating characteristics curves of each regression model were 0.74 for Model 1 and 0.87 for Model 2.CONCLUSION Our logistic regression analysis on differentiating factors of CA from SA showed that high CRP level was a strong dose-dependent predictor of CA.

Serum squamous cell carcinoma antigen is a predictive factor of outcomes in patients with locally advanced unresectable esophageal squamous cell carcinoma treated by definitive chemoradiotherapy

Aim:Definitive chemoradiotherapy(dCRT)is the standard treatment for locally advanced unresectable esophageal squamous cell carcinoma(LU-ESCC).This study aimed to describe the results of dCRT for T4 ESCC and evaluate the pretherapeutic predictive factors of the outcomes.Methods:A total of 133 patients with T4 ESCC who received dCRT were grouped into those who achieved a complete response(CR)or those who had residual disease(RD).The clinicopathologic variables were compared between the groups and the overall survival(OS)was evaluated.The predictive factor of RD was assessed and the prognostic factor for OS was identified.Results:Among the 133 patients,31(23%)achieved CR.The CR group had a significantly better OS than the RD group(89.9 months vs.10.7 months;hazard ratio=0.096;95%confidence interval:0.05-0.19;P<0.001).Multivariate analysis showed that a supracarinal tumor(OR=3.21;P=0.016),higher pretherapeutic serum SCC-Ag level(>1.6 ng/mL)(OR=2.86;P=0.018),and metastatic node invasion(OR=3.19;P=0.048)were independent predictors of RD.The increased level of pretherapeutic serum squamous cell carcinoma antigen(>1.6 ng/mL)(OR=1.61;P=0.022)was an independent predictor of poor survival.Conclusions:Among the patients who underwent dCRT for LU-ESCC,23%achieved CR,and the long-term outcome of these patients was favorable.Increased levels of pretherapeutic serum squamous cell carcinoma antigen were also found to be predictive of treatment failure.