Diagnostic accuracy of a velcro sound detector (VECTOR) for interstitial lung disease in rheumatoid arthritis patients: the InSPIRAtE validation study (INterStitial pneumonia in rheumatoid ArThritis with an electronic device).

BACKGROUND: Interstitial lung disease (ILD) is a severe systemic manifestation of rheumatoid arthritis (RA). High-resolution computed tomography (HRCT) represents the gold standard for the diagnosis of ILD, but its routine use for screening programs is not advisable because of both high cost and X-ray exposure. Velcro crackles at lung auscultation occur very early in the course of interstitial pneumonia, and their detection is an indication for HRCT. Recently, we developed an algorithm (VECTOR) to detect the presence of Velcro crackles in pulmonary sounds and showed good results in a small sample of RA patients. The aim of the present investigation was to validate the diagnostic accuracy of VECTOR in a larger population of RA patients, compared with that of the reference standard of HRCT, from a multicentre study. METHODS: To avoid X-ray exposure, we enrolled 137 consecutive RA patients who had recently undergone HRCT. Lung sounds of all patients were recorded in 4 pulmonary fields bilaterally with a commercial electronic stethoscope (ES); subsequently, all HRCT images were blindly evaluated by a radiologist, and audio data were analysed by means of VECTOR. RESULTS: Fifty-nine of 137 patients showed ILD (43.1%). VECTOR correctly classified 115/137 patients, showing a diagnostic accuracy of 83.9% and a sensitivity and specificity of 93.2 and 76.9%, respectively. CONCLUSIONS: VECTOR may represent the first validated tool for the screening of RA patients who are suspected for ILD and who should be directed to HRCT for the diagnosis. Moreover, early identification of RA-ILD could contribute to the design of prospective studies aimed at elucidating unclear aspects of the disease.

Trace Elements in Tissues of Whale Sharks (Rhincodon typus) Stranded in the Gulf of California, Mexico.

Concentration of essential (Se, Zn and Cu) and non-essential (As, Cd, Hg and Pb) trace elements were measured in selected tissues of two dead whale sharks (Rhincodon typus) stranded in the Gulf of California (GC) in 2017 and 2018. Concentrations of Cd and Pb in the skeletal muscle of the whale shark from La Paz Bay, GC were higher compared to a previous study on whale shark from China. The shark from La Paz Bay also presented higher concentration of Pb in the epidermis, compared to the same tissue of the other whale shark stranded in Punta Bufeo, GC. The Hg in all analysed tissues was lower than those documented in carnivorous sharks. Molar ratio Se:Hg shows an excess of Se over Hg in all the tissues sampled in both sharks.