Current Use and Barriers to Point-of-Care Ultrasound in Rheumatology: A National Survey of VA Medical Centers.

INTRODUCTION: Point-of-care ultrasound (POCUS) can assist rheumatologists in monitoring disease activity, establishing diagnoses, and guiding procedural interventions. POCUS use has been increasing, but little is known about current use and barriers among rheumatologists. The purpose of this study was to characterize current POCUS use, training needs, and barriers to use among rheumatologists in practice. METHODS: A prospective observational study of all Veterans Affairs (VA) medical centers was conducted using a web-based survey sent to all chiefs of staff and rheumatology chiefs about current POCUS use, training needs, barriers, and policies. RESULTS: All chiefs of staff (n = 130) and rheumatology chiefs at VA medical centers (n = 95) were surveyed with 100% and 84% response rates, respectively. The most common diagnostic POCUS applications were evaluation of synovitis, joint effusion, tendinopathies, bursitis, and rotator cuff. The most common procedural applications were arthrocentesis and joint, bursa, and tendon injection. Most rheumatology chiefs (69%) expressed interest in training for their group. The most common barriers to POCUS use were lack of trained providers (68%), funding for training (54%), training opportunities (38%), funding for travel (38%), and ultrasound equipment (31%). Lack of POCUS infrastructure was common, and few facilities had POCUS policies (20%), image archiving (25%), or quality assurance processes (6%). CONCLUSION: Currently, half of rheumatology groups use diagnostic and procedural ultrasound applications. Most rheumatology groups desire training, and lack of training and equipment were the most common barriers to ultrasound use. Deliberate investment is needed in ultrasound training and infrastructure for systematic adoption of POCUS in rheumatology. Graphical Abstract available for this article. TRIAL REGISTRATION: NCT03296280.

Clinical Characteristics and Classification Criteria Performance in a Single-Center Cohort of 114 Patients With Immunoglobulin G4-Related Disease.

INTRODUCTION/OBJECTIVES: Immunoglobulin G4-related disease (IgG4-RD) is a heterogeneous fibroinflammatory condition. The 2019 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Classification Criteria for IgG4-RD were published to provide unified classification criteria in clinical research. The purpose of this study was to characterize demographics, disease manifestations, and treatments of patients with IgG4-RD and assess performance of the Classification Criteria in a heterogeneous cohort with a large population of Black patients. METHODS: This was a medical records review of all patients referred to a specialized IgG4-RD clinic. Demographics, serology, histopathology, disease manifestations, and treatment information were collected and analyzed. An ACR/EULAR Classification Criteria score for IgG4-RD was calculated to compare performance in definite diagnosis, probable diagnosis, and mimicker groups. RESULTS: A total of 198 patients were evaluated. Eighty-five (43%) were mimickers. Of the remaining 114, 58 (51%) were classified as definite, and 56 (49%) as probable cases by treating clinicians. Pancreatitis was the most common presentation (37%) among 28 different organ manifestations of IgG4-RD. In patients with definite clinical diagnosis of IgG4-RD, 84% met the IgG4-RD Classification Criteria (i.e., score ≥20) with mean score of 29. Only 9% of the probable cases met this threshold with an average score of 8. None of the mimickers met the Classification Criteria. CONCLUSIONS: This study highlights the broad spectrum of IgG4-RD and validates the use of the ACR/EULAR Classification Criteria for IgG4-RD, including a large proportion of Black patients. As shown in this study, IgG4-RD is a heterogeneous disease and continues to represent a diagnostic challenge to clinicians.

Enhancing the efficacy of fluocinolone acetonide by encapsulating with PLGA nanoparticles and conjugating with linear PEG polymer.

Fluocinolone acetonide (FA), a glucocorticoid is used to treat inflammation in the posterior segment of the eye. Due to short half-life and body clearance, it will not be able to give therapeutic effect for long time with a single injection. Formulating FA nanoparticles (NPs) or PEG conjugates can be an effective way to overcome these disadvantages. We prepared two formulations, FA loaded in PLGA nanoparticles (NPs-FA) and FA conjugated to linear PEG (PEG-FA). The NPs-FA were characterised for size and zeta potential using particle size analyser and shape and morphology by using scanning electron microscope (SEM). The amount of drug loaded per mg of NPs and in-vitro release of FA from NPs were calculated using reverse phase high pressure liquid chromatography (RP-HPLC). NPs synthesis was optimized with factorial and Response Surface Methodology (RSM). Chemically synthesized PEG-FA conjugates were characterized using H-NMR and purity of the conjugate was analysed using RP-HPLC. Visualization of cellular uptake of NPs was done by coumarin-6 loaded NPs under fluorescent microscope. RAW 264.7 macrophages were treated with NPs-FA and PEG-FA conjugates to study their effectiveness in inhibiting TNF-α levels compared to free FA treatment. Stability test confirmed that FA is more stable within NPs than in free form. Particle size and zeta potential were found to be 183.6 ± 12.47nm and -25.6 ± 4.4mV, respectively. 149.58 ± 11.3µg of FA was encapsulated per mg of NPs and 61 µg of FA was present per mg of PEG-FA conjugate. In vitro drug release study showed a sustained release of FA from the NPs for a period of 30 days. Fluorescent microscope images showed uptake of NPs by RAW 264.7 cells. TNF-α assay confirmed that substantial inhibition of TNF-α levels from both formulations compared to free FA. From the results, we conclude that new formulations will greatly reduce drug dosage and frequency of administration for long term treatment of inflammation in posterior part of the eye.

Analytical framework for value added utilization of glass waste in concrete: Mechanical and environmental performance.

This work was designed to incorporate glass waste as partial replacement of coarse aggregate in concrete through optimization of its amount by assessment of mechanical and environmental performances. Fresh and hardened properties of glass waste concrete were evaluated and compared with the conventional concrete. Moreover, compressive strength was evaluated experimentally as well as analytically at different ages. While, environmental performance was evaluated with an assessment of CO2 footprint and volume utilization of raw materials for both types of concrete; conventional and glass waste concrete. Consequently, a sustainable concrete was selected that possesses high workability and mechanical performance, minimum CO2 footprint and least utilization of conventional natural raw materials. For optimization, corresponding values of designed parameters were translated into a framework for glass waste management by application of analytical hierarchy process (AHP) and technique for order preference by similarity to ideal solution (TOPSIS). Similar prioritization for all types of mixtures was achieved through proposed framework by applying such multi criteria decision making techniques. Proposed framework may further be used for adjusting the priority weights for each criterion according to the requirement as well as for extended evaluation of additional criteria.

Severe ocular trauma in the emergency room.

UNLABELLED: To assess the nature, severity, and mechanisms of ocular trauma in the emergency room at an academic teaching hospital. METHODS: Individual review of patients' records involving ocular trauma in the emergency room. Severe intraocular trauma was defined as any injury that required intraocular surgery, any traumatic optic neuropathy, or total destruction of the eye. RESULTS: Of 519 patients in 2010 seen in the emergency room for ocular trauma, 52 patients (10%) had severe ocular trauma. Contusions (17) were the most common injury, followed closely by penetrating lacerations (16) and ruptures (16). In addition, 33 of these 52 patients (63.5%) had a full-thickness open globe injury, with physical assault as the most common etiology. CONCLUSION: The most common severe ocular traumas seen in the emergency room were contusions, penetrating lacerations, and ruptures. Penetrating lacerations and ruptures were the most common causes of open eye wall injuries.