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BACKGROUND: The purpose of this study was to determine the prevalence of high disease activity as measured using the Ankylosing Spondylitis Disease Activity Score (ASDAS) in ankylosing spondylitis (AS) patients who nonetheless have low Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores after anti-tumor necrosis factor (TNF) treatment. Its clinical impact on anti-TNF survival was also investigated. METHODS: We conducted a single-centre retrospective cohort study of AS patients having low BASDAI scores (< 4) and available ASDAS-C-reactive protein (CRP) data after 3 months of first-line anti-TNF treatment. Patients were grouped into high-ASDAS (≥ 2.1) and low-ASDAS (< 2.1) groups according to the ASDAS-CRP after 3 months of anti-TNF treatment. Their characteristics were compared. And survival analyses were carried out using Kaplan-Meier curves and log-rank test with the event being discontinuation of anti-TNF treatment due to lack/loss of efficacy. RESULTS: Among 116 AS patients with low BASDAI scores after 3 months of anti-TNF treatment, 38.8% were grouped into the high-ASDAS group. The high-ASDAS group tended to have greater disease activity after 9 months of treatment (BASDAI 2.9 ± 1.1 vs. 2.3 ± 1.4, p=0.007; ASDAS-CRP 1.8 ± 0.6 vs. 1.5 ± 0.7, p=0.079; proportion of high ASDAS-CRP 27.8% vs. 13.8%, p=0.094) and greater risk of discontinuing anti-TNF treatment due to lack/loss of efficacy than the low-ASDAS group (p=0.011). CONCLUSIONS: A relatively high proportion of AS patients with low BASDAI scores had high ASDAS-CRP. These low-BASDAI/high-ASDAS-CRP patients also had a greater risk for discontinuation of anti-TNF treatment due to low/lack of efficacy than the low-ASDAS group. The use of the ASDAS-CRP alone or in addition to the BASDAI may improve the assessment of AS patients treated with anti-TNF agents.
Subject(s)
Spondylitis, Ankylosing , Tumor Necrosis Factor-alpha , C-Reactive Protein/analysis , Humans , Retrospective Studies , Severity of Illness Index , Spondylitis, Ankylosing/diagnosis , Spondylitis, Ankylosing/drug therapy , Spondylitis, Ankylosing/epidemiology , Treatment OutcomeABSTRACT
Age estimation is important in forensics, and numerous techniques have been investigated to estimate age based on various parts of the body. Among them, dental tissue is considered reliable for estimating age as it is less influenced by external factors. The advancement in deep learning has led to the development of automatic estimation of age using dental panoramic images. Typically, most of the medical datasets used for model learning are non-uniform in the feature space. This causes the model to be highly influenced by dense feature areas, resulting in adequate estimations; however, relatively poor estimations are observed in other areas. An effective solution to address this issue can be pre-dividing the data by age feature and training each regressor to estimate the age for individual features. In this study, we divide the data based on feature clusters obtained from unsupervised learning. The developed model comprises a classification head and multi-regression head, wherein the former predicts the cluster to which the data belong and the latter estimates the age within the predicted cluster. The visualization results show that the model can focus on a clinically meaningful area in each cluster for estimating age. The proposed model outperforms the models without feature clusters by focusing on the differences within the area. The performance improvement is particularly noticeable in the growth and aging periods. Furthermore, the model can adequately estimate the age even for samples with a high probability of classification error as they are located at the border of two feature clusters.
Subject(s)
Age Determination by Teeth , Deep Learning , Humans , AnthropometryABSTRACT
A fully automated point-of-care testing (POCT) system with a surface acoustic wave (SAW) immunosensor was developed for rapid and sensitive detection of cardiac troponin I (cTnI) in body fluid (plasma and whole blood). The assay, based on gold nanoparticle sandwich immunoassay and subsequent gold staining, was performed on the SAW immunosensor packaged inside a disposable microfluidic cartridge. The entire fluidic process, including plasma separation, reagent transport, metering, and mixing, was carried out by controlling the centrifugal force acting on the rotating cartridge and laser-irradiated ferrowax microvalves. On investigation of sensor response to various cTnI concentrations, the system exhibited a high performance with a detection limit of 6.7 pg mL(-1), and the coefficient of variation was less than 10% over the entire test range (10 pg mL(-1) to 25 ng mL(-1)). On comparing this POCT system with a clinically utilized system in a physical laboratory (Centaur® XP; Siemens), a correlation coefficient of 0.998 was found, validating the diagnostic capability of the SAW immunosensor.
Subject(s)
Immunoassay/instrumentation , Microfluidic Analytical Techniques/instrumentation , Point-of-Care Systems , Troponin I/blood , Equipment Design , Gold/chemistry , Humans , Limit of Detection , Nanoparticles/chemistry , SoundABSTRACT
This study suggests a hybrid method based on ResNet50 and vision transformer (ViT) in an age estimation model. To this end, panoramic radiographs are used for learning by considering both local features and global information, which is important in estimating age. Transverse and longitudinal panoramic images of 9663 patients were selected (4774 males and 4889 females with a mean age of 39 years and 3 months). To compare ResNet50, ViT, and the hybrid model, the mean absolute error, mean square error, root mean square error, and coefficient of determination (R2) were used as metrics. The results confirmed that the age estimation model designed using the hybrid method performed better than those using only ResNet50 or ViT. The estimation is highly accurate for young people at an age with distinct growth characteristics. When examining the basis for age estimation in the hybrid model through attention rollout, the proposed model used logical and important factors rather than relying on unclear elements as the basis for age estimation.
Subject(s)
Age Determination by Teeth , Tooth , Adult , Female , Humans , Male , Age Determination by Teeth/methods , Radiography, Panoramic , Republic of Korea , East Asian PeopleABSTRACT
BACKGROUND: The inability to assess structural changes in facet joints is a limitation of established radiographic scoring systems for ankylosing spondylitis (AS). We compared radiographic evidence of ankylosis in cervical facet joints and cervical vertebral bodies in patients with AS. METHODS: We analysed longitudinal data collected from 1106 AS patients and assessed 4984 spinal radiographs obtained up to 16 years of follow-up. Comparisons between cervical facet joints and cervical vertebral bodies focused on the presence of ankylosis, which was defined by at least one facet joint exhibiting complete ankylosis (according to the method of de Vlam) or at least one vertebral body with a bridging syndesmophyte (according to the modified Stoke Ankylosing Spondylitis Spinal Score [mSASSS]). Ankylosis was assessed over time using spinal radiographs collected during follow-up periods stratified in 4-year increments. RESULTS: Patients with cervical facet joint ankylosis had higher cervical mSASSS, sacroiliitis grades, and inflammatory markers, with more prevalent hip involvement and uveitis. Overall, the numbers of spinal radiographs indicating ankylosis were comparable between cervical facet joints (17.8%) and cervical vertebral bodies (16.8%), and they usually presented together (13.5%). We observed similar proportions of radiographs with ankylosis only in cervical facet joints (4.3%) and cervical vertebral bodies (3.3%). As damage progressed, configurations with both cervical facet joint ankylosis and bridging syndesmophytes became more predominant with longer follow-up times, while configurations with cervical facet joint ankylosis only or bridging syndesmophytes only were less frequently observed. CONCLUSIONS: Evidence of cervical facet joint ankylosis appears as often as bridging syndesmophytes on routine AS spinal radiographs. Presence of cervical facet joint ankylosis should be considered because it may have a higher disease burden.
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Objective: This study aimed to identify trajectories of radiographic progression of the spine over time and use them, along with associated clinical factors, to develop a prediction model for patients with ankylosing spondylitis (AS). Methods: Data from the medical records of patients diagnosed with AS in a single center were extracted between 2001 and 2018. Modified Stoke Ankylosing Spondylitis Spinal Scores (mSASSS) were estimated from cervical and lumbar radiographs. Group-based trajectory modeling classified patients into trajectory subgroups using longitudinal mSASSS data. In multivariate analysis, significant clinical factors associated with trajectories were selected and used to develop a decision tree for prediction of radiographic progression. The most appropriate group for each patient was then predicted using decision tree analysis. Results: We identified three trajectory classes: class 1 had a uniformly increasing slope of mSASSS, class 2 showed sustained low mSASSS, and class 3 showed little change in the slope of mSASSS but highest mSASSS from time of diagnosis to after progression. In multivariate analysis for predictive factors, female sex, younger age at diagnosis, lack of eye involvement, presence of peripheral joint involvement, and low baseline erythrocyte sedimentation rate (log) were significantly associated with class 2. Class 3 was significantly associated with male sex, older age at diagnosis, presence of ocular involvement, and lack of peripheral joint involvement when compared with class 1. Six clinical factors from multivariate analysis were used for the decision tree for classifying patients into three trajectories of radiographic progression. Conclusion: We identified three patterns of radiographic progression over time and developed a decision tree based on clinical factors to classify patients according to their trajectories of radiographic progression. Clinically, this model holds promise for predicting prognosis in patients with AS.
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Objective: The objective of this study was to investigate spinal radiographic progression in specific age ranges of ankylosing spondylitis (AS) patients. Methods: Longitudinal data for 1125 AS patients at a single hospital from 2000 to 2018 were retrospectively reviewed. Radiographic intervals were obtained from patients with consecutive spinal radiographs. The radiographic progression rate was defined as the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) change per year within each interval. Using generalized estimating equations (GEEs), estimated marginal means were calculated for the mSASSS progression rate across age groups after adjusting for potential confounders. Results: We obtained 4016 radiographic intervals and stratified them into five groups based on patient age at the interval start: <20 (n = 122); 20-29 (n = 1124); 30-39 (n = 1690); 40-49 (n = 794); and ⩾50 years (n = 286). The mean (SD) mSASSS progression rate for all the intervals was 0.8 (1.9). The GEE-estimated mean mSASSS progression rate increased with age, peaking in the 30-39 age group with a value of 1.15 [95% confidence interval (CI) 1.03, 1.27], and decreased slightly thereafter. In the presence of risk factors, rapid progression occurred at earlier ages: the GEE-estimated mean mSASSS progression rate in those with elevated C-reactive protein levels and preexisting syndesmophytes was 2.82 (95% CI 1.93, 3.71) in the 20-29 age group. Conclusion: Spinal structural damage in AS seems to progress most rapidly when patients are age 30-39 years. An awareness of the trends in radiographic progression with advancing age could improve understanding of the natural course of AS.
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Magnetic resonance imaging (MRI) plays an important role in diagnosing and classifying axial spondyloarthritis (SpA) and is also useful for appropriate evaluation of disease status owing to its ability to detect inflammation early and reveal structural changes. However, dedicated MRI for the anterior chest wall (ACW) is not routinely considered despite relatively frequent presence of ACW lesions. To date, no study has investigated the imaging findings and clinical features of ACW involvement in Korean SpA patients. Thus, we aimed to show ACW involvement in SpA patients using ACW lesions found by MRI. We describe 20 cases of ACW involvement in which MRI-detected manubriosternal joint lesions. The lesion types included subchondral bone marrow edema, marginal or central bone erosions, subchondral fat infiltration or deposition, and ankylosis, with erosions being the most prevalent finding. We also provide the literature review results describing MRI findings of ACW lesions in SpA patients.
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Capacitive pressure sensors based on porous structures have been extensively explored for various applications because their sensing performance is superior to that of conventional polymer sensors. However, it is challenging to develop sufficiently sensitive pressure sensors with linearity over a wide pressure range owing to the trade-off between linearity and sensitivity. This study demonstrates a novel strategy for the fabrication of a pressure sensor consisting of stacked carbon nanotubes (CNTs) and polydimethylsiloxane. With the addition of carbon nanotubes, the structure is linearly compressed due to the reinforced mechanical properties, thereby resulting in high linearity. Additionally, the percolation effect is boosted by the CNTs having a high dielectric constant, thus improving the sensitivity. The pressure sensor exhibits linear sensitivity (R2 = 0.991) in the medium-pressure range (10-100 kPa). Furthermore, it delivers excellent performance with a fast response time (â¼60 ms), in conjunction with high repeatability, reproducibility, and reliability (5 and 50 kPa/1000 cycles). The fabricated sensors are applied in wearable devices to monitor finger bending and detect finger motions in real time with high precision. The large-area sensor is integrated with a neural network to accurately recognize the sitting posture on a plane, thereby demonstrating the wide-range detection performance.
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OBJECTIVES: To investigate the causes and risk of death in a large cohort of Korean patients with rheumatoid arthritis (RA). METHODS: Patients in the Hanyang BAE (Bae registry of Autoimmune diseases for Epidemiology) RA cohort who fulfilled the American College of Rheumatology criteria were analyzed. A total of 2355 patients were enrolled from October 2001 to December 2015. Mortality data were derived by linking with data from the Korean National Statistical Office. Standardized mortality ratio was estimated by dividing observed deaths by expected number of deaths in the general population. RESULTS: Over the observation period, 225 deaths were reported. Total age- and sex-adjusted standardized mortality ratio was 1.65 (95% confidence interval 1.44-1.87). The most common cause of death was malignancy (40 cases; 17.8%), followed by respiratory disease (38 cases; 16.9%) and cardiovascular disease (32 cases; 14.2%). Mortality rate and causes of death differed according to year and age of RA onset. Compared with survivors, individuals who died were more likely to be male, smokers, diagnosed with RA at an older age, and to have long disease duration, higher erythrocyte sedimentation rate and C-reactive protein, higher rheumatoid factor positivity rate, more severe radiographic damage, and more comorbidities. CONCLUSION: The mortality rate of patients with RA remains higher than that of the general population. Therefore, to improve the survival of patients with RA, attention should be paid to the management of comorbidities as well as to the RA itself.
Subject(s)
Arthritis, Rheumatoid/mortality , Adult , Cause of Death/trends , Comorbidity , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Republic of Korea/epidemiology , Survival Rate/trendsABSTRACT
Objective: To elucidate whether clinical features and the weighted genetic risk score (wGRS) were associated with the presence of lupus nephritis (LN). Methods: We retrospectively divided patients with systemic lupus erythematosus (SLE, n=1,078) into biopsy-proven LN (n=507) and non-LN groups (non-LN, n=571) Baseline clinical features, serologic markers, and the wGRS were collected The wGRS was calculated from 112 non-human leukocyte antigen (non-HLA) loci and HLA-DRß1 amino acid haplotypes for SLE Associations among clinical features, wGRS, and the presence of LN were identified. Results: In the multivariate analysis, patients with LN were younger at diagnosis (odds ratio [OR]=0.97, p<0.001), had more pleuritis (OR=2.44, p<0.001) and pericarditis (OR=1.62, p=0.029), had a higher detection rate of anti-double stranded deoxyribonucleic acid (anti-dsDNA antibodies, OR=2.22, p<0.001), anti-Smith antibodies (anti-Sm antibodies, OR=1.70, p=0.002), low level of complement (OR=1.37, p=0.043) and absence of antiphospholipid antibodies (aPL antibodies, OR=1.60, p=0.002), and had higher wGRS (OR=1.16, p=0.012) Mediation analysis suggested that anti-Sm antibodies and low complement could be mediators in the relationship between high wGRS and the presence of LN. Conclusion: Onset age, pleuritis, pericarditis, several serologic markers, and wGRS were associated with the presence of LN Anti-Sm antibodies and low complement appeared to mediate the indirect relationship between wGRS and the presence of LN.
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An enzymatic reaction was employed as a means to enhance the sensitivity of an immunosensor based on localized surface plasmon resonance (LSPR). The reaction occurs after intermolecular binding between an antigen and an antibody on gold nano-island (NI) surfaces. For LSPR sensing, the gold NI surface was fabricated on glass substrates using vacuum evaporation and heat treatment. The interferon-γ (IFN-γ) capture antibody was immobilized on the gold NIs, followed by binding of IFN-γ to the antibody. Subsequently, a biotinylated antibody and a horseradish peroxidase (HRP) conjugated with avidin were simultaneously introduced. A solution of 4-chloro-1-naphthol (4-CN) was then used for precipitation; precipitation was the result of the enzymatic reaction catalyzed the HRP on gold NIs. The LSPR spectra were obtained after each binding process. Using this method, the enzyme-catalyzed precipitation reaction on the gold NI surface was found to effectively amplify the change in the signal of the LSPR immunosensor after intermolecular binding.
Subject(s)
Immunoenzyme Techniques/instrumentation , Nanostructures/chemistry , Nanotechnology/instrumentation , Surface Plasmon Resonance/instrumentation , Antibodies, Immobilized/chemistry , Antibodies, Immobilized/metabolism , Gold/chemistry , Humans , Interferon-gamma/analysis , Interferon-gamma/metabolism , Surface Plasmon Resonance/methodsABSTRACT
BACKGROUND: In this study, we aimed to evaluate and compare the treatment indication for patients with glucocorticoid-induced osteoporosis (GIOP) in various clinical practice guidelines. METHODS: We searched for potentially relevant studies conducted from January 2000 to March 2020 using online databases, including PubMed, Ovid-EMBASE, Guidelines International Network, National Institute for Health and Clinical Excellence, KoreaMed, KMbase, and KoMGI. We reviewed and analyzed the guidelines that included recommendations on GIOP and fulfilled the inclusion criteria. RESULTS: A total of 94 articles were selected based on review of the title and abstract; 14 guidelines were assessed upon reviewing the full text. The bone mineral density score for therapeutic intervention of GIOP in postmenopausal women was presented in 7 guidelines, among which 3 guidelines set a T-score of -2.5 or lower and the other 4 guidelines proposed a less stringent cut-off point of -1.5 or lower. Among the 10 guidelines published since 2012 after the emergence of the fracture risk assessment tool (FRAX), 6 guidelines included FRAX in their criteria for defining intervention thresholds. However, they were further divided into fixed-probability (n=3) and age-dependent (n=3) thresholds based on the country. CONCLUSIONS: Recently developed guidelines use FRAX as the criterion for establishing the treatment of patients with GIOP. However, these intervention thresholds need to be adapted for each country.
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OBJECTIVES: The clinical benefit of conventional disease-modifying antirheumatic drugs (cDMARDs) for treating ankylosing spondylitis (AS) is generally limited to improvements in peripheral arthritis. However, cDMARDs could be conditionally considered as alternatives to established drugs for improving axial manifestations in exceptional circumstances. However, there are few studies of the impact of cDMARDs on radiographic progression outcomes. Therefore, we investigated the effectiveness of cDMARDs on radiographic progression in AS. METHODS: Among 1280 AS patients at a single hospital from 2000 to 2018, 301 who had been treated with sulfasalazine (SSZ) or methotrexate (MTX) were enrolled. For each patient, the entire follow-up period was split into 1-year intervals. Each interval was classified as either an "on-cDMARD" interval, which was a period of treatment with SSZ alone, MTX alone, or a combination of SSZ and MTX, or an "off-cDMARD" interval, which was a period without cDMARD treatment. Radiographic progression was scored using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). The relationship between cDMARD use and radiographic progression within the intervals, defined as the rate of mSASSS progression, was investigated using linear models with adjustment for potential confounding covariates and for clustering among observations from the same patient. RESULTS: The 732 on-cDMARD intervals and 1027 off-cDMARD intervals were obtained from enrolled patients. In multivariable regression analysis, there was no significant association between cDMARDs and the rate of mSASSS progression (ß = -0.081, p = 0.418). The mean adjusted mSASSS change per year was 0.610 from on-cDMARD intervals and 0.691 from off-cDMARD intervals. CONCLUSION: Treatment with cDMARDs may not reduce radiographic progression in AS patients.
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BACKGROUND: Structural variations such as copy number variations (CNVs) have a functional impact on various human traits. This study profiled genome-wide CNVs in Korean patients with rheumatoid arthritis (RA) to investigate the efficacy of treatment with TNF-α blockers. METHODS: A total of 357 Korean patients with RA were examined for the efficacy of TNF-α blocker treatment. Disease activity indexes were measured at baseline and 6 months after the treatment. The patients were classified as responders and non-responders based on the change in disease activity indexes according to the EULAR response criteria. CNVs in the same patients were profiled using fluorescence signal intensity data generated by a genome-wide SNP array. The association of CNVs with response to TNF-α blockers was analyzed by multivariate logistic regression accounting for genetic background and clinical factors including body mass index, gender, baseline disease activity, TNF-α blocker used, and methotrexate treatment. RESULTS: The study subjects varied in their responses to TNF-α blockers and had 286 common CNVs in autosomes. We identified that the 3.8-kb deletion at 2q14.3 in 5% of the subjects was associated with response to TNF-α blockers (1.37 × 10- 5 ≤ P ≤ 4.07 × 10- 4) at a false discovery rate threshold of 5%. The deletion in the identified CNV was significantly more frequent in the non-responders than in the responders, indicating worse response to TNF-α blockers in the deletion carriers. The 3.8-kb deletion at 2q14.3 is located in an intergenic region with the binding sites of two transcription factors, MAFF and MAFK. CONCLUSIONS: This study obtained the CNV landscape of Korean patients with RA and identified the common regional deletion associated with poor response to treatment with TNF-α blockers.
Subject(s)
Arthritis, Rheumatoid/drug therapy , Etanercept/pharmacology , Infliximab/pharmacology , Methotrexate/pharmacology , Polymorphism, Single Nucleotide , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Antirheumatic Agents/pharmacology , Arthritis, Rheumatoid/genetics , Arthritis, Rheumatoid/metabolism , Genotype , Humans , Immunosuppressive Agents/pharmacology , Treatment Outcome , Tumor Necrosis Factor-alpha/metabolismABSTRACT
Background/Aims: Anti-C-reactive protein (CRP) antibody has been introduced as a potential biologic marker in Systemic lupus erythematosus (SLE). The aim of study is to evaluate the level of anti-CRP antibody in patients with SLE. METHODS: This study investigated the relationship between levels of anti-CRP antibodies and disease activity markers, such as complement, anti-double-stranded DNA antibody, and SLE disease activity index in 34 patients with SLE. RESULTS: The serum anti-CRP antibody levels of the patients with SLE were significantly higher than those of the healthy controls (11.3 ± 5.6 µg/mL vs. 9.1 ± 2.8 µg/mL). The percentages of the positive anti-CRP antibody were 52.9% in SLE and 27.8% in controls. Disease duration of SLE showed significant correlation with the anti-CRP antibody (r = 0.234, p = 0.026). However no significant relationship was observed between the levels of anti-CRP antibodies and disease activity markers. Conclusions: These data show that the anti-CRP antibody levels of the patients with SLE were significantly higher than those of healthy controls. We observed that the presence of the anti-CRP anti-CRP antibody was not associated with disease activity of SLE.
Subject(s)
Biomarkers , C-Reactive Protein , Lupus Erythematosus, Systemic , Adult , Biomarkers/blood , C-Reactive Protein/analysis , Disease Progression , Female , Humans , Lupus Erythematosus, Systemic/blood , Lupus Nephritis , Male , Middle AgedABSTRACT
BACKGROUND/AIMS: The aim of this study was to compare the sleep quality between rheumatoid arthritis (RA) patients and healthy controls; and to evaluate the relationship between RA disease activity and sleep quality in Korea. METHODS: A total of 130 RA patients and 67 age- and sex-matched healthy controls were enrolled in a comparative study of sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Age, gender, concomitant medication, erythrocyte sedimentation rate, serum C-reactive protein, Beck Depression Inventory second edition (BDI-II), 28 joints disease activity score (DAS28), pain visual analog scale (VAS), and PSQI were analyzed as covariates. We also analyzed the sleep quality of RA patients according to the disease activity (DAS28 ≤ 3.2, 3.2 < DAS28 < 5.1, and DAS28 ≥ 5.1, respectively). RESULTS: The total PSQI score and the frequency of poor sleep quality, were higher in the RA patients (5.62 ± 4.19, 38.5%) than in the control subjects (3.57 ± 2.17, 13.4%). The patients with poor sleep quality (PSQI > 5) were older and had a higher BDI-II and VAS score than the patients without sleep disturbance (PSQI ≤ 5). The score in subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, daytime dysfunction, total PSQI, and frequency of poor sleep quality were increased when RA activity was high. CONCLUSIONS: Sleep disturbance was observed in RA patients (38.5%), and high RA disease activity was associated with poor sleep quality in Korea.