Evaluation of the Sensitivity and Specificity of the New Clinical Diagnostic and Classification Criteria for Kashin-Beck Disease,an Endemic Osteoarthritis,in China

This study aimed to evaluate the sensitivity and specificity of the new clinical diagnostic and classification criteria for Kashin-Beck disease （KBD） using six clinical markers： flexion of the distal part of fingers, deformed fingers, enlarged finger joints, shortened fingers, squat down, and dwarfism. One-third of the total population in Linyou County was sampled by stratified random sampling.

Classification Criteria of Narrow/Wide Ice-ResistantConical Structures Based on Direct Measurements

Ice-induced structural vibration generally decreases with an increase in structural width at the waterline. Definitions of wide/narrow ice-resistant conical structures, according to ice-induced vibration, are directly related to structure width, sea ice parameters, and clearing modes of broken ice. This paper proposes three clearing modes for broken ice acting on conical structures: complete clearing, temporary ice pile up, and ice pile up. In this paper, sea ice clearing modes and the formation requirements of dynamic ice force are analyzed to explore criteria determining wide/narrow ice-resistant conical structures. According to the direct measurement data of typical prototype structures, quantitative criteria of the ratio of a cone width at waterline(D) to sea ice thickness(h) is proposed. If the ratio is less than 30(narrow conical structure), broken ice is completely cleared and a dynamic ice force is produced; however, if the ratio is larger than 50(wide conical structure), the front stacking of broken ice or dynamic ice force will not occur.

Human Brucellosis Mimicking Axial Spondyloarthritis: a Challenge for Rheumatologists when Applying the 2009 ASAS Criteria

Although the development of the 2009 Sp A classification criteria by Assessment of Spondylo Arthritis international Society（ASAS） represents an important step towards a better definition of the early disease stage particularly in axial spondyloarthritis（ax Sp A）, the specificity of the criteria has been criticized these days. As the commonest zoonotic infection worldwide, human brucellosis can mimic a large number of diseases, including Sp A. This study was performed to determine the frequency of rheumatologic manifestations in patients with brucellosis and the chance of misdiagnosing them as having ax Sp A in central China. The results showed that clinical manifestations of ax Sp A could be observed in brucellosis. Over half of patients had back pain, and one fifth of the patients with back pain were less than 45 years old at onset and had the symptom for more than 3 months. Two young males were falsely classified as suffering from ax Sp A according to the ASAS criteria, and one with MRI proved sacroiliitis was once given Etanercept for treatment. Therefore, differential diagnosis including human brucellosis should always be kept in mind when applying the ASAS criteria, even in traditionally non-endemic areas.

Immunosuppressant treatment for IgG4-related sclerosing cholangitis: A case report

BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a multi-system fibroinflammatory disorder that can involve any organ,including the salivary glands,pancreas,and biliary tree.Treatment of immunoglobulin G4-related sclerosing cholangitis(IgG4-SC)is similar to that for IgG4-RD,but progression is irreversible in some cases.We present a case of IgG4-SC in which an immuno-suppressant induced marked clinical and radiologic improvement.CASE SUMMARY A 63-year-old male presented with a prominent itching sensation and wholebody jaundice.He showed obstructive-pattern jaundice,an elevated IgG4 level,and infiltration of a large number of IgG4-positive cells in the ampulla of Vater.The imaging findings of intrahepatic duct(IHD)and common bile duct dilation,an elevated serum IgG4 level,and characteristic histological findings led to diagnosis of IgG4-SC that compatible with the 2019 ACR/EULAR classification criteria.We planned to treat the patient with high-dose glucocorticoid(GC),followed by cyclophosphamide pulse therapy.After treatment with high-dose GC and an immunosuppressant,imaging studies showed that IHD dilatation had completely resolved.CONCLUSION Prompt diagnosis and appropriate treatment of IgG4-SC are important.Because there is a risk of relapse of IgG4-SC,the GC dose should be gradually reduced,and a maintenance immunosuppressant should be given.

NATIONAL FIELD TRIAL OF THE CHINESE CLASSIFICATION AND DIAGNOSTIC CRITERIA OF MENTAL DISORDERS: COMPREHENSIBILITY, ACCEPTABILITY AND APPLICABILITY

The Chinese Neurology and Psychiatry Association conducted a national field trial of its Chinese Classification and Diagnostic Criteria of Mental Disorders (CCMD-2) involov-ing 26 provinces and municipalities, 80 psychiatric institutes, and 224 professionals. The results were as follows: (1)95.2% of researchers considered the comprehensibility of the CCMD-2 diagnstic criteria good. Within the ten major categories, comprehensibility ranged from 85.7% to 100%. (2) Of those surveyed concerning the acceptibility of the CCCMD-2 diagnostic criteria, 85.9% considered them acceptable. In individual classifications, the rate ranged from 74.1% to 95.2%. (3) 1498 cases were tested. The overall applicability rate which indicated the consistency between the CCMD-2 result and the actual clinical diagnoses was found to be 87.6%, (averaging Kappa = 0.82,P<0.01), better than those obtained from non-Chinese systems of diagnosis.