bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the Classification of Defect Levels in Main Electrical Equipment Through Advanced Prompting on a Large Language Model
Authors: Zhou Yan , Chen Long , Wei Qiang , Su Yan , Qiao Binrui , Guo Ying , Geng Wei
Published: November 2024

The stable operation of the power system is closely related to the national economy and people’s livelihoods. Therefore, the timely detection, qualitative assessment, and handling of major equipment defects are crucial. The classification of defect levels in main electrical equipment is a fundamental task in this process, which is often manually completed, supplemented by knowledge bases or expert systems. However, this approach is time-consuming, labor-intensive, involves challenging human–machine interaction, and relies on expert experience. Conversational large language models, such as ChatGPT, ERNIE Bot, ChatGLM, have garnered widespread recognition in various domains. However, these models may have errors in the reasoning process, resulting in biased or even erroneous outputs, which is referred to as the “hallucinations”. The hallucinations’ problem of large language models poses challenges in specific fields. To mitigate the hallucinations in large language models, researchers often seek to incorporate domain-specific knowledge into these models through methods like fine-tuning or prompt learning. In order to enhance model performance while minimizing computational costs, this study adopts the prompt learning approach. Specifically, we propose a large language model prompt learning framework based on knowledge graphs, aiming to provide the large language model with reasoning support by leveraging specific information stored within the knowledge graph and receive explainable reasoning result. Experimental results demonstrate that our module achieved superior results on the power defect dataset compared to the non-prompt method.
A Comprehensive Review of Water Quality Analysis
Authors: Nayak Bhaktishree , Panda Prafulla Kumar
Published: November 2024

The effluent discharge of domestic wastewater and industrial effluents into watercourses has necessitated the development of monitoring systems with the purpose of characterizing levels of pollution. Substantial levels of pollution in emerging nations have been exacerbated by rapidly growing populations and inefficient enforcement of sustainable management initiatives. The Water Quality Index (WQI) can help fill the gap between water quality reporting and monitoring by offering a simple and effective way to assimilate and communicate results from a large amount of data. WQIs are the kind of communication tools that can facilitate knowledge sharing between scholars and the general public. The degradation of natural water resources, such as lakes, streams, and estuaries, is the most significant problem facing humanity. Water that is not clean has far-reaching effects on all aspects of life. Water resource management is therefore essential if it is to maximize water quality. If data are analyzed and water quality can be predicted in advance, water pollution may be efficiently addressed. Although this subject has been the subject of numerous earlier studies, additional research is still required to fully understand the effectiveness, reliability, accuracy, and application of the present approaches to water quality management. In this research work, a comprehensive review has been conducted on water quality assessment using artificial techniques. It reviews 75 research works on water quality analysis. The data collected in each research work have been analyzed. Moreover, the type of water resource surface water, groundwater, drinking water as well has been analyzed. The parameters considered in each work are “Dissolved Oxygen (DO), Potential of Hydrogen (pH), Biochemical Oxygen Demand (BOD), Total Dissolved Solids (TDS), and Chemical Oxygen Demand (COD), chloride, hardness, alkalinity, nitrate–nitrite”. In addition, the Artificial Intelligence technique utilized for water quality analysis is also assessed. Finally, the research gaps identified in water quality detection are exhibited.
Fast BET Based on Pre-Processing Evolution Using Global Mean Inter-Vertex Distance of Deformable Surface for MRI Brain Extraction
Authors: Son ChangIl , Ma JongSu , Bong IlRyong , Yu NamChol
Published: November 2024

As a method based on the deformable surface evolution, brain extraction tools (BET) is widely used for brain extraction on cranial 3D magnetic resonance (MR) images. BET iteratively applies an evolution model depending on local parameters to the deformable surface until it reaches the brain border. In this paper, we propose a modified BET based on the fast model introducing a global parameter, the global mean inter-vertex distance of deformable surface. The surface evolution consists of two steps driven by two models: pre-processing step by the fast model and major step by the original model. We demonstrated our method in the experiments with T1-weighted and diffusion weighted MR images of 19 normal subjects. The modified BET converged within 300 iterations less than half of about 1000 iterations in the original BET, while reducing substantially the false negative regions and self-intersections. The proposed method may be efficient for high resolution images and large-scale studies.
Impact of Honest Signal, Cues, Prey’s Experience Rate and Environmental Toxicity in a Predator–Prey Interaction Model
Authors: Sardar Purnendu , Pada Das Krishna , Biswas Santosh , Rana Sourav
Published: November 2024

Biological signaling plays a crucial role in predator–prey interaction systems, serving both intraspecific and interspecific communication purposes. Prey populations utilize signaling internally, employing honest signals among themselves to enhance their defense capabilities. Conversely, they also use signaling for interspecific communication, emitting cues to predators to increase their own chances of survival. Recently, Al-Salman et al. [Appl. Math. Modell. 89, 1405 (2021)] proposed a two-species interaction model incorporating Holling Type II predation along with honest signals and cues. In this paper, we extend and modify their study by incorporating factors such as prey’s experience rate and environmental toxicity in prey populations. We conduct a comprehensive mathematical and numerical analysis of the model. We investigate the positive invariance and dissipativeness of the model, discuss the existence of equilibrium points and analyze the behavior of the system around all equilibrium points. Particularly, we determine conditions for local stability and Hopf bifurcation of the system. Furthermore, we perform a detailed numerical analysis to study periodic solutions through Hopf bifurcations in the proposed system. We plot two-parameter bifurcation diagrams to examine changes in the system with combined effects, identifying critical values for stability switching. There is no chaotic dynamics seen in our investigation. Numerical results indicate that the system tends to stabilize when the experience rate is high, and the rate of error-prone honest signals regulates system stability. Additionally, we analyze how environmental toxicity affects the stability of the system.
Recent Developments of USG Score for GCA
Authors: Keen Helen
Published: November 2024

The 2022 European League Against Rheumatism (EULAR) guidelines have introduced a significant advancement in the diagnostic approach to Giant Cell Arteritis (GCA). According to these updated guidelines, Ultrasound (US) examinations of the cranial and axillary arteries should be considered the primary imaging method for evaluating patients who are suspected to have GCA, provided that the examinations are performed by adequately trained specialists using high-quality equipment. This recommendation marks a notable shift in the traditional management practices for GCA, as it acknowledges the effectiveness of ultrasound as a non-invasive, efficient, and reliable point-of-care test for individuals with suspected GCA. As a result, this development has paved the way for the establishment of fast-track clinics dedicated to GCA diagnosis and treatment across various parts of the globe.

However, it is important to note that the use of ultrasound for diagnosing GCA comes with certain challenges. The highly technical nature of the ultrasound procedure, combined with its dependence on the expertise of the operator, often leads to criticism regarding its reliability as a clinical tool. This can create confusion among clinicians when they attempt to interpret formal ultrasound reports, especially if they are not trained in sonography themselves.

In this presentation, we will thoroughly examine the evidence supporting the use of ultrasonography in the diagnosis of Giant Cell Arteritis. The discussion will encompass several key concepts, including:

1. The validity of ultrasonography as a diagnostic tool for GCA.

2. The diagnostic performance of ultrasound in identifying the condition.

3. The practical utility of ultrasound in an Australian Fast Track Clinic setting.

4. The assessment of treatment response and sensitivity to change, as measured by ultrasound findings.

5. The various scoring tools utilized in ultrasound evaluations, such as the Halo Count, the Halo Score, and the OMERACT GCA Ultrasound Score.

6. A review of the EULAR guidelines and how they have evolved over time.

7. Critical information that clinicians who are not trained in sonography need to understand regarding the use of ultrasound in GCA.

Through this comprehensive review, we aim to clarify the role of ultrasonography in the diagnosis and management of Giant Cell Arteritis, empowering clinicians with the knowledge they need to effectively utilize this diagnostic tool in their practice.
Current Challenges in Managing SpA
Authors: Schett Georg
Published: November 2024

Managing spondyloarthritis (SpA) presents several complex challenges that impact patient outcomes. One of the foremost issues is the delay in diagnosis, often due to overlapping symptoms with other conditions and insufficient awareness among clinicians. This delay can lead to significant joint damage and increased disability.

Differentiating between axial psoriatic arthritis (axial PsA) and ankylosing spondylitis (AS) is crucial for effective management. While both conditions share inflammatory features, axial PsA and AS may exhibit distinct clinical manifestations and imaging findings. An emphasis on comprehensive clinical assessment, including patient history and physical examination, can aid in accurate differentiation.

Non-radiographic axial spondyloarthritis (nr-axSpA) poses additional challenges, as conventional imaging may not reveal significant changes. Current strategies focus on early intervention and utilizing MRI for detecting inflammatory changes, thereby facilitating timely treatment initiation.

Treating early PsA before irreversible bone damage occurs is essential. Evidence suggests that aggressive management with disease-modifying antirheumatic drugs (DMARDs) and biologics may prevent long-term joint impairment.

In summary, addressing these multifaceted challenges, requires a comprehensive approach. By focusing on these areas, healthcare professionals can significantly improve the quality of care and long-term outcomes for patients with spondyloarthritis.
Ten Rules for the Management of Antiphospholipid Syndrome
Authors: Zhao Jiuliang
Published: November 2024

2023 ACR/EULAR APS classification criteria started a new era for doctors to comprehensively understand this disease. According to current research evidence and clinical practice experiences, we summarize 10 rules for management of APS as followed:

Rule 1: APS is a systemic autoimmune disease with multi-systemic involvement and heterogeneity of clinical phenotypes.

Rule 2: Each APS related thrombotic event requires a comprehensive assessment of “risk factors”.

Rule 3: APS arterial n venous events w/ different mechanisms require separate predict models of recurrency.

Rule 4: APS-related arterial thrombosis are not only “thromboembolic” but also “vasculopathic”.

Rule 5: Microangiopathy is an unawareness and underestimated but pivotal phenotype of APS.

Rule 6: Effective screening & timely diagnosis of APS-valvular heart diseases are crucial for prevention and prognosis improvement.

Rule 7: APS-related hematological involvement includes thrombocytopenia & autoimmune hemolytic anemia.

Rule 8: Significant heterogeneity of OAPS indicates different mechanisms and the necessity of stratification before Treatment.

Rule 9: APLs is one of major contributing factors related irreversible organ damage in SLE

Rule 10: Treatment of APS requires individualized precision stratification strategies including immunomodulators.
A Systematic Review of the Effectiveness of Self-symptoms Monitoring with Patient Reported Outcome Measures in Patients with Rheumatic Diseases Patients
Authors: Kwan Yu Heng , Oh Livia , Ang Pui Kim , Xiong Zhonghui , Chong Pei Xin , Ng Chin Teck , Yoon Sungwon , Ong Pei Shi , Choo Silvana X. , Leung Ying Ying , Thumboo Julian , Fong Warren
Published: November 2024

Objective:

We aimed to provide an up-to-date synthesis of the effectiveness of patient reported outcome measures (PROMs) use to self-monitor symptoms compared to conventional follow-up care in patients with rheumatic diseases. We also compared the effect of providing feedback via PROMs to a control group in which PROMs feedback was not provided.

Methods:

This review was guided by the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. Articles published before October 2023 were retrieved from PubMed[Formula: see text], Cochrane Library[Formula: see text], Embase[Formula: see text], and PsycINFO[Formula: see text](Ovid). Studies were included if (1) they compared PROMs use compared against not using PROMs, (2) used PROMs as an intervention with feedback provided to healthcare professionals/patients to compare against PROMs use but no feedback was provided. Methodological quality and level of evidence were evaluated according to the Risk of Bias tool and the Risk of Bias in Non-randomized Studies of Interventions tool.

Results:

A total of 15, 571 articles were screened, 5 articles met the inclusion criteria, and 3 additional articles were identified from handsearching. Most studies reported positive results on symptom control, health-related quality of life, patient perception, shared decision making, and a reduction in clinic visits. No studies reported on survival/mortality. In general, we found conflicting evidence regarding whether feedback from physicians improved patient satisfaction in clinical care.

Conclusion:

We identified 8 articles through a systematic review and synthesised evidence on their effectiveness. There is a lack of studies comparing PROMs use to conventional care in rheumatic diseases. Future studies should explore the implications of using PROMs in clinical care.
GPX4 Downregulation Induces Platelet Ferroptosis in Systemic Lupus Erythematosus
Authors: Zhou Zhirui , Yang Fangyuan , Huang Ying , Zhuang Jian , Yuan Yuxuan , Wei Jinli , He Yi
Published: November 2024

Background:

Ferroptosis is a recently discovered type of regulated necrosis and glutathione peroxidase 4 (GPX4) has been recognized as a key enzyme that protects against ferroptosis. However, the role of platelet GPX4 in systemic lupus erythematosus (SLE) has not been explored. In this study, GPX4 levels in platelets were measured and the correlation with clinical features were analyzed.

Methods:

Platelet GPX4 protein expression was detected by Western blot and immunofluorescence in 37 SLE patients and 23 healthy controls. Clinical data were recorded at time points of blood sampling. Platelet activation was analyzed by flow cytometry, LDH release by LDH release assay and plasma oxidized DNA levels by a general 8-OHdG ELISA kit.

Results:

Patients with SLE had significantly decreased expression of platelet GPX4 and increased percentage of platelet activation as compared with healthy controls. Furthermore, levels of platelet GPX4 were negatively correlated with SLEDAI-2K score, 24-hour urine protein and oxidized DNA. Low GPX4 expression were associated with skin and joint involvements of SLE patients. Interestingly, deferoxamine (DFO), a ferroptosis inhibitor, could protect SLE platelets from death.

Conclusions:

These findings confirmed that downregulated GPX4 protein in platelets of SLE patients negatively correlated with plasma oxidized DNA, SLE disease activity and 24-hour urine protein, suggesting the potential role of platelet ferroptosis in oxidized DNA release and the pathogenesis of SLE.
Taking “Gout” as an Example, a New Model of Disease Science Popularisation in the Era of Integrated Media
Authors: Ai Meichen , Wei Jinli , Li Wanfen , Zhuang Jian , Yang Fangyuan , Li Jie , He Yi
Published: November 2024

Background:

Statistics indicate that there are approximately 200 million individuals with hyperuricemia and 20 million people suffering from gout within my country. The general public is lack of awareness of the risks associated with gout. Many primary hospitals lack the capacity to correctly diagnose and treat gout, resulting in the inefficient use of national medical resources and significant distress and economic hardship for patients. Consequently, the expeditious and efficacious dissemination of gout science knowledge to the general public is of considerable social and economic consequence.

Methods:

The project team employs a rational integration of online platforms, newspapers, and other resources, in both online and offline modes, and promotes gout medical science knowledge through the utilization of new integrated media science popularisation models.

Results:

The project leader created the personal IP of “Dr. He Yi” with a cumulative fan base of over 2 million across the entire network. He was awarded one science popularisation project of the Guangdong Province Science and Technology Plan and two science popularisation projects of the Guangzhou City Science and Technology Plan. As the editor-in-chief, he published the popular science book “Dr. Tiantian Talks about Rheumatism-Gout”. As of May 2022, more than 600 popular science articles have been published, more than 200 popular science videos have been released, and 3 training and teaching videos have been recorded; the cumulative number of visits has exceeded 200 million times. Nearly 100 free clinics, science popularisation lectures, and grassroots doctor training have been conducted. The project leader was awarded several honours, including the “2023 Sohu Video Top Ten Broadcasters of the Year” accolade, the “2020 Chinese Medical Doctor Association Health Communication Working Committee n Kwai, Comprehensive Doctors and Science popularisation Contribution Award”, and the “2020 Baidu Health Live Broadcast Top Ten”. Additionally, the project was recognised with the “Guangdong Provincial Medical Science and Technology Award, Popular Science Award”.

Conclusion:

The project team proposed a novel model of “integrated media” for the popularisation of medical science. This model is not merely the integration of newspapers and online media, nor is it simply the integration of popular science articles, videos, and books. It also encompasses the integration of free clinics, popular science lectures, grassroots doctor training, MDT diagnosis and treatment teams, and new “three habitats” medical talent training. This model improves patients’ quality of life, reduces patients’ economic burden, conserves health care resources, and contributes to national health.
Performance of Low-dose Computed Tomography, Magnetic Resonance Imaging and Conventional Radiography in Differentiating Axial Involvement in Patients with Psoriatic Arthritis
Authors: Yan Xianfeng , Cheng Isaac T. , So Jacqueline , So Ho , Lee Ryan Ka Lok , Griffith James Francis , Tam Lai-Shan
Published: November 2024

Background:

Sacroiliac joints (SIJ) radiography has lower sensitivity and specificity compared to magnetic resonance imaging (MRI) and low-dose CT (ldCT) of the SIJ for detecting axial spondyloarthritis. Whether this is also true for axial psoriatic arthritis (axPsA) remains uncertain. This study aimed to evaluate the performance of ldCT, MRI, and conventional radiography of SIJ and spine in distinguishing axial involvement in PsA patients.

Methods:

Fifty-one consecutive PsA patients (70.6% male, age 41 ± 13 years) meeting the CASPAR classification criteria, regardless of back pain, were included. All patients underwent SIJ and whole-spine radiography, SIJ MRI as well as SIJ ldCT, while 25 (49%) of 51 patients also underwent whole-spine MRI and ldCT. One rheumatologist with expertise in imaging and one trained reader evaluated images. The final diagnosis of axPsA was ascertained by two experienced rheumatologists. The sensitivity, specificity, and diagnostic accuracy of the three modalities for discriminating axPsA were compared.

Results:

AxPsA was diagnosed in 33.3% (17) of 51 patients. In discerning axial involvement in PsA patients, MRI exhibited superior sensitivity (92.9%) compared with ldCT (83.3%) and radiography (67.9%), while ldCT demonstrated higher specificity (97.1%) than MRI (86.4%) and radiography (72.7%). LdCT achieved the highest diagnostic accuracy (92%) among the three modalities, surpassing radiography (71%) and being comparable to MRI (89%). In the subgroup of patients with whole spine imaging, the combination of MRI and ldCT SIJ had the best diagnostic accuracy, reaching 93%. Including SIJ ldCT in addition to SIJ MRI further improved specificity (86.7% vs. 73.3%) with unchanged sensitivity (100%), while incorporating SIJ MRI alongside SIJ ldCT further improved sensitivity from 83% to 100%, with a modest decrease in specificity (86.7% vs. 93.3%). However, incorporating spine MRI/ldCT alongside SIJ MRI/ldCT did not further improve sensitivity or specificity in discriminating axial involvement in PsA patients.

Conclusion:

LdCT demonstrated superior diagnostic performance in distinguishing axial involvement in PsA patients compared to MRI or radiography, although MRI was more sensitive for detecting active sacroiliitis. The highest diagnostic performance was achieved with both MRI and ldCT of the SIJ. Additional spine imaging did not further increase diagnostic performance.
Retention Rate and Predisposing Factors for Secukinumab in Patients with Axial Spondyloarthritis: Retrospective Data from Two Tertiary Hospitals in China
Authors: Fu Zhong-Chao , Wen Lin , Cheng Xiao-Gui , Liu Xiao-Yu , Zhang Li-Jun , Shi Ran-Geng , Huang Jin-Xian
Published: November 2024

Background

Data from open label follow-up were merely 5 years for secukinumab as second line treatment. Real world evidence from European and Korean cohort revealed retention rate up to 4 years. No data from China has been published. We aim to evauate the longterm retention rate of secukinumab in axial spondyloarthritis (axSpA) and its predisposing factors in Chinese patients.

Methods

Patients were recruited from retrospective medical records of two tertiary hospitals in China from January 2020 and March 2024. Patients were diagnosed with 2009 ASAS classification criteria. The retention rate of secukinumab was estimated using the Kaplan-Meier method, and the log-rank test was used to compare the retention curves of the two cohorts.

Results

In total, medical records of prescription for secukinumab and relevant clinical information from 445 patients were identified. The mean age was 34 (29[Formula: see text]41) years with male gender of 77.30% and HLA-B27 posititivy of 88.54% in our cohort. Mean disease duration was 8 (5[Formula: see text]13) years with relatively shorter duration in biologics naive compared with biologics experienced patients (7 (3[Formula: see text]12) vs. 9 (6[Formula: see text]14) years, p¡0.05). The secukinumab treatment period was 3-42 months, with majority of 150mg dosage. 16 patients (3.60%) initiated with 300mg loading dose. Smoking status and other clinical characteristics including concomitant treatment and comorbility were not significant between the two groups. Overall retention rate of our cohort during follow-up at 12-month, 24-month and 36-month was 0.750, 0.686 and 0.641, respectively. In subgroup analysis, biologics experience contributed to lower retention rate (Figure 1) and higher dose (300mg) treatment resulted in better retention rate (Figure 2). Discontinuation occurred in 35 patients mainly due to fertility demand. Switching because of inefficient response occurred in 58 patients. Adalimumab (n=24) was the preferred choice, followed by etanercept (n=16)., other DMARDs or NSAIDs (n=13) and JAKi (n=5).

Conclusion

Secukinumab had a good performance of retention in patients with axSpA from China, especially in those with higher dosage and without biologics experience.
Differential Immunogenicity of mRNA-based and Inactivated Virus COVID-19 Vaccines in Patients with Inflammatory Rheumatic Disease - A Prospective Study up to 12 Months Post-3rd Dose
Authors: Wong Nga Sze , Cheng Isaac T , Yu Tracey , Chan Vivien , Li Tena , Tam Lai-Shan , Chan Paul KS , So Ho
Published: November 2024

Background

During the COVID-19 pandemic, 2 types of COVID-19 vaccines were made available in Hong Kong - the mRNA-based vaccine and the inactivated virus vaccine. All residents were required to complete 3 vaccinations. There is concern that immunogenicity acquired from COVID-19 vaccinations could be unsustainable in patients with inflammatory rheumatic disease (IRD) due to the underlying condition and immunosuppressive medication used. Therefore, this study aims to investigate the immunogenicity of COVID-19 vaccines and its sustainability in IRD patients.

Methods

This single-centre cohort was assembled prospectively from 8/2021 - 2/2022 in Hong Kong. Peripheral blood samples were collected from the patients before, 28 (± 3) days and 12 months after the third dose of COVID-19 vaccination. The neutralising antibody titre against the SARS-CoV-2 virus was quantified by ELISA.

Results

A total of 83 patients (age: 51.4± 11.7 years; 72.3% female; 17 rheumatoid arthritis, 17 psoriatic arthritis, 12 axial spondylarthritis, 37 systematic lupus erythematosus) attended all 3 visits. The vaccine distribution is summarized in Fig. 1A. Majority (96.4%) of patients had positive neutralising antibodies before the 3rd vaccine dose despite a low mean titre of 38.2± 29.7%. The antibody titre improved significantly after the 3rd dose (85.9± 23.8%) and was maintained at the 12-month visit (87.5± 22.6%). The mean antibody levels pre- and post-3rd dose were higher in patients who took mRNA-based vaccine (Fig. 1B). The presence of COVID-19 infection during the follow-up period led to significantly higher antibody titre at the 12-month visit (Table 1). There were no significant associations between immunogenicity and age, type of IRD, biologic/targeted Disease Modifying Anti-Rheumatic Drugs usage as well as additional booster doses.

Conclusion

3 doses of COVID-19 vaccine produced sustained humoral response in IRD patients. The immunogenicity appeared to be dependent on the type of vaccines received in the short term and breakthrough infection in longer term.
Infection Risk Profiles of Upadacitinib in Patient with Rheumatoid Arthritis: A Meta-Analysis of Randomized Clinical Trials
Authors: Mohd Yusof Mohd Haidir , Jinih Marcel
Published: November 2024

Background There is a increasing suggestion that upadacitinib may elevate the risk of infections in patients with rheumatoid arthritis (RA). To better understand this potential infection risk, we conducted a meta-analysis using data from randomized clinical trials (RCTs) to evaluate the overall risk of infections in these patients.

Methods We conducted a comprehensive systematic search in EMBASE, MEDLINE, and CENTRAL from their inception until 31st December 2023 to identify relevant RCTs reporting the occurrence of infections in patients with RA who were treated with monotherapy upadacitinib (15mg once daily orally) regardless of the background RA therapy used in these patients. The primary outcomes were the incidence of total infections, serious infections, non-serious infections, and opportunistic infections (including herpes zoster and tuberculosis). The secondary outcomes were the incidence of various sites of infections, including the upper respiratory tract, lower respiratory tract, gastrointestinal tract and others. In anticipation of study heterogeneity, the effect estimate was pooled with a random-effects model, to obtain the risk ratios (RR) and 95% confidence intervals (CI), using Mantel-Haenszel statistical method.

Results Nine RCTs were included, involving a total of 4,575 RA patients. Compared to the control group (placebo and other active treatments), patients treated with upadacitinib exhibited a significant increase in the risk of total infections (RR, 1.18; 95% CI, 1.02-1.36; I2, 49%), and non-serious infections (RR, 1.16; 95% CI, 1.01-1.34; I2, 46%). Patients who were on upadacitinib were significantly at an increased risk of gastrointestinal infections (RR, 3.10; 95% CI, 1.47-6.56; I2, 0%) but not on other types of infections.

Conclusion Compared with placebo and other active treatments, upadacitinib signi?cantly increased the overall risk of infections (total infections and non-serious infections), particularly gastrointestinal infections. These ?ndings may assist clinicians to weigh the benefit-risk balance of upadacitinib prior to their administration to patients with RA.
The Optimal Criteria for Patients with Systemic Lupus Erythematosus Should Meet Before Pregnancy: A Large-scale China Multicenter Study
Authors: Zhang Xueyang , Liu Lingshan , Lin Shudian , Duan Xinwang , Luo Hui , Wang Yongfu , Wu Zhenbiao , Huang Can , Long Yin , Cui Yixin , Shi Xiaohua , Song Yijun , Liu Juntao , Zeng Xiaofeng , Zhao Jiuliang , Li Mengtao , Tian Xinping
Published: November 2024

Systemic lupus erythematosus (SLE) is often related to a lower rate of live birth and a higher incidence of adverse pregnancy outcomes (APOs), and pregnancy can lead to an increased risk of SLE flares. Comprehensive preconception assessment is crucial, but global consensus regarding the criteria the patients should meet before pregnancy has not been formed yet. This study, conducted retrospectively based on data from Chinese SLE Treatment and Research group (CSTAR) registry, a multicenter Chinese SLE cohort, aimed to investigate the optimal criteria. Analysis included 347 singleton pregnancies from 333 patients with SLE in total. The criteria that patients with SLE should meet before pregnancy were identified by univariate logistic regression analysis, which were: 1) disease stable for at least 6 months; 2) absent of vital organ damage; 3) on nonfluorinated corticosteroids no more than the dose equivalent to prednisone 7.5mg per day; 4) on hydroxychloroquine. The proportion of live birth was significantly higher in the group meeting the criteria (86.1% vs 73.7%, p=0.004). Furthermore, the gestational week at delivery (38.4 vs 37.6, p<0.001) and the birthweight (2956.7g vs 2810.2g, p=0.004) were significantly larger. Then, APOs occurred less frequently in the group meeting the criteria (29.4% vs 52.1%, p<0.001). For each type of APOs, the incidences of therapeutic abortion (5.0% vs 12.0%, p=0.019), preterm delivery (14.2% vs 33.3%, p<0.001), and preeclampsia (1.1% vs 5.4%, p=0.023) were remarkably lower. When it comes to disease flares, patients in group meeting the criteria experienced flares during pregnancy less frequently (14.7% vs 28.1%, p=0.005), as well as for severe flares (5.8% vs 15.6%, p=0.006). Results were similar when taking both gestation period and one year postpartum into consideration. The results of this study stress the importance of comprehensive preconception assessment and warrant the implementation of such criteria among patients with SLE in clinical practice.
Effects of Secukinumab on Enthesiophyte and Erosion Progression in Psoriatic Arthritis-A One-year Double-blind, Randomized, Placebo-controlled Trial Utilizing High-resolution Peripheral Quantitative Computed Tomography
Authors: Jin Yingzhao , Cheng Isaac T , So Ho , Lai Billy T , Ying Shirley K , Kwok Kitty Y , Griffith James , Hung Vivian , Szeto Cheuk-Chun , Lee Jack Jock-Wai , Qin Ling , Tam Lai-shan
Published: November 2024

Background

This study aimed to ascertain the effect of secukinumab on erosion and enthesiophyte progression in psoriatic arthritis (PsA) by high-resolution peripheral quantitative computed tomography (HR-pQCT).

Methods

This was a one-year double-blind, randomized, placebo-controlled trial (NCT0362386740). Patients with erosion in the metacarpophalangeal joints (MCPJ) 2-4 were randomised in a 1:1 ratio to either the secukinumab or placebo group. HR-pQCT of the MCPJ 2-4 were performed at baseline, week-24 and 1-year. Progression of enthesiophyte were defined as changes in enthesiophyte volume exceeding smallest detectable change (SDC) (0.12mm3) or the identification of any new enthesiophyte. Partial repair of erosion was defined as a reduction in erosion volume greater than SDC (0.1mm3).

Results

Forty patients (age: 51.9± 13.4 years, 20 [50%] male) were recruited. Thirty-four patients who completed study treatment were included in the per-protocol analysis. The erosion volume at baseline, week-24 and week-48 revealed significant reduction in the secukinumab group while no differences in the placebo group (Figure-3A). There was a trend suggesting that fewer patients developed new-erosions in the secukinumab group (one-erosion in one-patient) compared to the placebo group (six-erosions in five-patients) (p=0.078) (Figure-3B). A significantly higher proportion of erosions with partial healing was observed in the secukinumab group compared with the placebo group [51%vs30%, p=0.029] (Figure-3C). Regarding enthesiophyte, a total of 25-enthesiophytes were identified in both the secukinumab and placebo groups at baseline. The enthesiophyte volume at baseline, week-24 and week-48 revealed significant differences in the secukinumab group while no differences in the placebo group (Figure-3D). While one (one-enthesiophyte in one-patient) and four-enthesiophytes (four-enthesiophytes in three-patients) were newly identified in the secukinumab group and placebo group respectively (Figure-3E), the proportion of enthesiophyte progression was numerically higher in the placebo group than the secukinumab group [40%vs16%, p=0.114] at week 48 (Figure-3F). GEE results showed that the odds ratio (OR) for enthesiophyte progression in the secukinumab group was 0.264 (95% CI: 0.080-0.878, p=0.030), while the OR for partial erosion healing in the secukinumab group was 2.816 (95% CI: 1.109 to 7.153, p=0.029), adjusting for tender-joint-counts.

Conclusions

Secukinumab demonstrates a potential benefit in facilitating partial erosion repair and preventing enthesiophyte progression in PsA.
Eosinophilic Granulomatosis with Polyangiitis (EGPA): A Case Report Presenting with Peripheral Polyneuropathy
Authors: Thi Phuong Nguyen , Anh Ngoc Nguyen Thi , Hong Hoa Dang
Published: November 2024

Background: Eosinophilic granulomatosis with polyangiitis is a rare clinical condition with multiple organ involvement. We report a case of a 64-year-old male patient who presented with symptoms of chronic rhinosinusitis, numbness, and pain in both lower limbs, weight loss of 6 kg/3 months, and subcutaneous vasculitis lesions along the forearms and legs on both sides. The patient had peripheral eosinophilia with an eosinophil count of 11.6%, eosinophil count of 1.56G/l, positive pANCA test, and electromyography results showing damage to the left calf nerve, bilateral superficial peroneal nerve, and left deep peroneal nerve with axonal loss. Biopsy results of calf muscle showed chronic granulomatous vasculitis. The patient was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA) according to the ACR/EULAR 2022 criteria. The patient was given intravenous Methylprednisolone, followed by maintenance treatment with reduced doses of Corticosteroids and Methotrexate. The patient’s leg pain was significantly reduced, numbness in both lower limbs was reduced, and the patient’s quality of life was improved. Methods: clinical case report. Results: The patient’s peripheral polyneuropathy and subcutaneous vasculitis were significantly reduced after treatment with Corticosteroids and Methotrexate. Conclusion: Eosinophilic granulomatosis with polyangiitis is a rare clinical condition with manifestations of multiple organ damage. Timely detection and diagnosis help increase treatment effectiveness and improve clinical symptoms for patients.
Comparison of Ultrasonographic Findings with Plain Radiography in Patients with Knee Osteoarthritis
Authors: Shrestha Swikriti , Vaidya Binit , Nakarmi Shweta
Published: November 2024

Background

Knee osteoarthritis is one of the most commonly encountered joint disease with prevalence ranging upto 7.9%. There are various radiologic instruments to measure the disease severity of knee osteoarthritis. Kellgren Lawrence (KL grading) classification is commonly used radiographic tool to assess severity. High frequency musculoskeletal ultrasound is being used now-a-days as a reliable tool for assessment of osteoarthritis

Objective

To compare musculoskeletal findings with X-ray findings in knee osteoarthritis

Method

A prospective crosssectional study was conducted in patients with knee osteoarthritis in national centre for rheumatologic disease. An AP view standing X-ray was done for the involved knee and K-L grading was done. High frequency musculoskeletal ultrasound was done for the same knee. Synovial hypertrophy, Doppler activity, cartilage thickness (medial, lateral, intercondylar), osteophytes were noted. Pearson’s coefficient of correlation was calculated to compare the correlation between musculoskeletal ultrasound and radiographic findings

Result

A total of 138 patients with knee osteoarthritis were enrolled in the study with female predominance of 83% and mean age of 56.87± 10.61 years. A negative correlation was observed between cartilage thickness (medial) with joint space narrowing (KL grading)

Conclusion

Musculoskeletal ultrasound may be used in clinical practice to diagnose and monitor cases of knee osteoarthritis. It is potential imaging technique which might help in therapeutic interventions as well as disease monitoring.
Treatment of Juvenile Psoriatic Arthritis with Anti-interlukin-17 – A Case Report
Authors: Ng Daniel Yu Hin , AU Ka-Nam , Tse Kei-Chiu Nico
Published: November 2024

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory joint disease in children and adolescents. Historically, moderate to severe psoriatic arthritis were treated with disease-modifying anti-rheumatic drugs, such as methotrexate. Since the 2000s, biologics such as TNF-inhibitors had been used for severe or refractory disease. More recently, Secukinumab, an anti-IL-17 monoclonal antibody, was approved in the US for treatment of psoriatic JIA since 2021.

Methods

We describe a case of psoriatic JIA, who was to our knowledge the first paediatric patient to be treated with Secukinumab in Hong Kong.

Results

A 12-years-old Chinese girl presented with 6-months history of plaque psoriasis associated with left hip pain. (Figure 1) Her JADAS10 score was 16.5 and her PASI score was 10.4. Naproxen, topical steroids and oral methotrexate were used but did not significantly improve her symptoms. An MRI scan continued to show evidence of active sacroiliitis. The patient was treated with Secukinumab at a loading dose of 150mg weekly SC for five weeks, followed by a maintenance dose of 150mg monthly. After one month, her inflammatory markers normalised and her JADAS10 score was 0, indicating inactive arthritis. After 3 months, her PASI score was 0.6. Follow-up of her skin condition showed complete solution of psoriasis at 6 months. (Figure 2)

Conclusion

Secukinumab induced rapid disease remission in a Chinese paediatric patient with PsJIA. It helped prevent progressive joint damage and greatly improved her skin’s cosmetic appearance. Our case demonstrated the remarkable efficacy of Secukinumab in the treatment of PsJIA.
Knee Tuberculosis Masquerading as Pigmented Villonodular Synovitis: A Challenging Diagnostic Case Report
Authors: Islam Asif , Nisar Hajira , Khurshid Fatima , Iqbal Nasir
Published: November 2024

Background:

Tuberculous arthritis presents a diagnostic difficulty due to its modest clinical indications and vague imaging data, frequently resulting in a delayed or wrong diagnosis. Pigmented villonodular synovitis (PVNS), which might seem like tuberculous arthritis, complicates the diagnosis.

Case Report:

This case study features a young child whose knee arthritis was first misdiagnosed as PVNS. Magnetic resonance imaging (MRI) revealed nodular masses and hemosiderin deposits around the knee joint, indicating widespread PVNS. This error caused a delay in accurate diagnosis and treatment.

Conclusion:

These findings underscore the relevance of investigating TB in patients who appear with PVNS-like characteristics, emphasizing the necessity for a high index of suspicion and quick examination to achieve fast and correct diagnosis for successful care.
Prevalence of Sexual Dysfunction in Ankylosing Spondylitis and Its Correlation with Disease Activity
Authors: Jain Piyush , Giri Avdesh
Published: November 2024

Background:

Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and pelvis. While studies have extensively explored the physical manifestations of AS, the prevalence of sexual dysfunction in male patients and its association with disease activity remains under-explored.

The study aims to determine the prevalence of sexual dysfunction in AS and its association with the disease activity.

Methods:

This comparative cross-sectional observational study was conducted with sexually active male patients diagnosed with AS. Disease activity was quantified using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP). Functional limitations and the extent of spinal and pelvic involvement were assessed through the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Metrology Index (BASMI), respectively. Sexual function was evaluated using the International Index of Erectile Function-15 (IIEF-15), and psychological status was measured via the Hospital Anxiety and Depression Scale (HADS).

Results:

The study reveals a significantly higher prevalence of sexual dysfunction among male patients with AS compared to control subjects, with p-values of < 0.0001 across all five domains of IIEF-15 (Fig.1). Notably, domains such as erectile function, orgasmic function, and overall sexual satisfaction were markedly impaired and exhibited a strong negative correlation with increased disease activity, as measured by BASDAI and the ASDAS-CRP. The erectile function scores demonstrated a pronounced negative correlation with disease activity indices, with correlation coefficients of -0.9840 for BASDAI and -0.9669 for ASDAS-CRP (Fig.2).

Conclusion:

AS is associated with a high prevalence of sexual dysfunction and correlates with disease severity. The results underscore the importance of integrating sexual health assessments into routine clinical evaluations of AS patients and addressing sexual dysfunction as a critical component of comprehensive disease management.
Gastrointestinal Involvement in Systemic Sclerosis - Review of 250 Patients’ Clinical, Radiological and Serological Profile - A Retrospective Study
Authors: Jacob Manna , Mathew Ashish , Nithin Koshy , Goel Ruchika , Mathew John
Published: November 2024

Background:

Gastrointestinal manifestations are common in Systemic Sclerosis, but studies in the Indian population are sparse.

Methods:

This is a retrospective study of 100 patients who presented to the Department of Clinical Immunology and Rheumatology between 2014 to 2019. The charts and investigations were reviewed for clinical and serological profile, and the investigations done were recorded.

Results:

100 patients diagnosed with systemic sclerosis (SSc) who fulfilled the ACR/EULAR 2013 criteria were included in the study-81 patients were classified as diffuse SSc, 15 as limited SSc and 4 as Sine Scleroderma. In total, 72 out of 100 patients reported reflux symptoms and 4 reported chronic diarrhoea. The imaging studies done for the patients and the findings are summarised in Table 1; the indications for endoscopy and the findings are summarised in Table 2. 2 patients were diagnosed with Chronic liver disease. 90 out of 100 patients were treated with a combination of proton pump inhibitors (PPIs) and prokinetics and 10 patients with PPIs alone. H Pylori eradication and antifungal therapy as per scopy findings were administered. 3 patients with chronic diarrhoea were empirically treated with Rifaximin for probable SIBO with symptomatic improvement.

Conclusions:

GI involvement is common in Scleroderma patients (93%- symptomatic and subclinical combined); however, the symptoms are under reported. Complications of GERD are less common in our popular, probably due to early initiation of PPIs and prokinetics. HRCT identified esophageal dilatation in 79% of the patients. Patients with refractory symptoms need to undergo scopies to rule out infections and malignancies. Further studies are required for better assessment and management of GI symptoms.
Effect of Achieving Sustained SDAI Remission on Erosion Healing in Early Rheumatoid Arthritis - A One-year Prospective HR-pQCT Study
Authors: Wu Qihan , So Ho , Cheng Tsz-Ho , Jin Yingzhao , Lau Sze-Lok , Tam Lai-shan
Published: November 2024

Background

Rheumatoid arthritis (RA) is a chronic inflammatory disease with progressive joint destruction. High-resolution peripheral quantitative CT (HR-pQCT) is a novel technique for detailed bone microstructure analysis allowing volumetric assessment of bone erosions. While most patients demonstrating little baseline joint damage on radiography in the early stage of RA, whether achieving simple disease activity index (SDAI) remission can lead to better structural outcome is to be confirmed.

Methods

Patients with ERA were recruited and treated to the target of simple disease activity index (SDAI) remission using a standardized algorithm. One hundred patients who received the one-year tight-control treatment were grouped by achieving SDAI sustained LDA [SDAI [Formula: see text] at 6, 9 and 12 months (sLDA group) or not (non-sLDA group). HR-pQCT of the second to fourth metacarpophalangeal joints were performed at baseline, month 6 and one-year. Erosion volume and marginal bone mineral density (BMD) were measured. On an individual patient basis, erosion progression was defined as at least one erosion showing (1) an increase in erosion volume exceeding the smallest detectable change [SDC] (0.08 mm 3) AND (2) a decrease in marginal BMD exceeding SDC (7.8 mmHA/cm 3). Erosion healing was defined as at least one erosion showing (1) a reduction in erosion volume greater than SDC AND an increase in BMD exceeding SDC OR complete disappearance of the lesion AND (2) the absence of any erosion progression.

Results

Fourteen patients (12.8%) achieved sustained SDAI remission from 6-12 months (SDI group). After 12 months, a significant reduction in erosion volume and marginal osteosclerosis was observed in both groups. The SDI group showed a lower incidence of erosion progression (increase in volume [Formula: see text]0.08mm 3 and decrease in marginal osteosclerosis [Formula: see text]7.8mg HA/cm 3 : 0% vs 16%, p=0.135) and exhibited a higher rate of erosion healing (56% vs 29%, p=0.083) compared with the non-SDI group. In the GEE model, patients in the SDI group showed a higher likelihood of erosion healing (OR: 2.976, 95% CI: 1.0 - 8.9, p=0.050). The changes in erosion depth and width were similar between two groups.

Conclusion

Achieving sustained SDAI remission could improve erosion healing and limit erosion progression in patients with ERA.