Are the ACR 2010 diagnostic criteria for fibromyalgia better than the 1990 criteria?

Fibromyalgia (FM) is difficult to diagnose and manage chronic pain condition whose symptoms have no clear pathophysiological cause, although it is thought that patient hypersensitivity to a range of stimuli may give rise to mechanical hyperalgesia as a result of altered central nociceptive processing. The 1990 American College of Rheumatology (ACR) classification criteria, which have been widely used in clinical practice, require the existence of chronic widespread pain (CWP) for > 3 months, and the presence of at least 11 out of 18 specified tender points upon digital palpation, although this latter criterion has long been criticised. The newer 2010 ACR diagnostic criteria state that FM can be defined as CWP associated with somatic symptoms, and recommend the use of a widespread pain index and a scale to rate symptom severity. A modified version of the 2010 criteria removed the physician assessment of the extent of somatic symptoms and replaced it by a summary score of three self-reported symptoms, thus making it easier to use while maintaining its sensitivity. This review discusses the advantages and limitations of all of these criteria.     

Associations between ocular and extra-ocular assessment in primary Sjögren's syndrome*

ObjectivesTo assess associations between ophthalmological features and the main systemic biomarkers of primary Sjögren's Syndrome (pSS), and to identify systemic biomarkers associated with severe keratoconjunctivitis sicca (KCS) in pSS patients.MethodsIn this cross-sectional study, data was retrospectively extracted from the monocentric cohort of the French reference centre for pSS. We analysed data from the initial visit of patients admitted for suspicion of pSS and included patients validating pSS ACR/EULAR classification criteria. Ophthalmological assessment included Schirmer's test, tear break-up time, ocular staining score (OSS), and visual analogue scale (DED-VAS) for dry eye disease (DED) symptoms. Results of minor salivary gland biopsy, unstimulated whole salivary flow rate, anti-SSA/Ro antibodies, anti-SSB/La antibodies, and rheumatoid factor (RF) were collected.ResultsA total of 253 patients (245 females) with confirmed pSS, aged 56.6 ± 13.0 years, were included, among which 37% had severe KCS. Multivariate analysis showed that the presence of anti-SSA/Ro antibodies, anti-SSB/La antibodies and RF were associated with conjunctival OSS (odds ratio–OR– = 1.25 per OSS unit increase; confidence interval–CI–95% = 1.05–1.49; P = 0.01; OR = 1.31 per OSS unit increase; CI95% = 1.09–1.58, P = 0.002, and OR = 1.34 per OSS unit increase; CI95% = 1.12–1.59; P = 0.001, respectively). Both anti-SSB/La antibodies and DED-VAS ≥ 5 were significantly associated with severe KCS (OR = 2.03; CI95% = 1.03–4.00; P < 0.05 and OR = 2.52, CI95% = 1.31–4.90; P < 0.01, respectively).ConclusionAssociation between conjunctival OSS and systemic biomarkers of pSS indicate the crucial importance of conjunctival staining when pSS is suspected as a cause of DED. Conversely, patients with anti-SSB and DED-VAS ≥ 5 features should be prioritized for extensive evaluation by an ophthalmologist due to their association with severe KCS.     

Reengineering the Radiology Enterprise: A Summary of the 2014 Intersociety Committee Summer Conference

The current initiative to reform health care from both a quality and a cost perspective has already had a profound impact on the radiology enterprise. We have seen a decrease in the utilization of imaging studies, a reduction in reimbursement, a declining payer mix, shrinking incomes, a proliferation of performance indices, creation of radiology mega-groups, growth of national radiology companies, and increasing turf incursions. Our cheese is clearly on the move, and we must take action to reengineer the radiology enterprise. In keeping with general health care reform, we must be patient-centric, data driven, and outcome based. We must create a radiology enterprise that adheres to the value equation of providing the highest quality health care, for the lowest possible cost, for all citizens.     

A web-based Delphi study on the indications of chest radiographs for patients in ICUs

BACKGROUND: Strategies for ordering bedside chest radiographs (CXRs) have substantial logistic and financial consequences in the ICU. Many of the indications for CXRs in the ICU are controversial, such as the ordering of daily routine CXRs for intubated patients. The opinions of intensivists about ordering CXRs have not been reported. Comparing these opinions to established guidelines and identifying situations where opinions diverge in the absence of guidelines are of considerable interest. METHODS: We asked 190 intensivists from 34 ICUs in the area of Paris, France, to anonymously complete a 29-item questionnaire about their opinions regarding the ordering of CXRs; each item described a clinical scenario. Of the 29 scenarios, 10 dealt with the placement of medical devices, 8 with the presence of medical devices, and 11 with other clinical situations. The study was based on a Delphi process deployed over the Internet through an original software application. Three Delphi rounds were run between January and March 2006, using the same questionnaire. Detailed feedback for the answers given during the previous round was supplied to each intensivist solicited for updating his answers. RESULTS: Eighty-two intensivists from 32 ICUs completed the study. A consensus emerged that routine CXRs were necessary for eight scenarios and unnecessary for two scenarios. The study also shed light on items without a consensus. In particular, 75% of intensivists (58% on the first round) did not support obtaining daily routine CXRs in intubated patients. CONCLUSION: The study underlines situations in which intensivists do not support the guidelines and outlines recommendations likely to be followed in clinical practice.     

An Efficient Fractal Method for Detection and Diagnosis of Breast Masses in Mammograms

In this paper, we present an efficient fractal method for detection and diagnosis of mass lesion in mammogram which is one of the abnormalities in mammographic images. We used 110 images that were carefully selected by a radiologist, and their abnormalities were also confirmed by biopsy. These images included circumscribed benign, ill-defined, and spiculated malignant masses. Firstly, we discriminated lesions automatically using new fractal dimensions. The results which were examined by different types of breast density showed that the proposed method was able to yield quite satisfactory detection results. Secondly, noting that contours of masses playing the most important role in diagnosis of different mass types, we defined new fractal features based on information extraction from the contours. This information is able to identify the roughness in mass contours and determines the extent of spiculation or smoothness of the masses. In this manner, in classification of the spiculated malignant masses from the circumscribed benign tumors, we achieved highly satisfactory results, i.e., 0.98 measured in terms of area under ROC curve (AUC). In this paper, it is also shown that the roughness in contours is a suitable characteristic feature for diagnosis of ill-defined malignant tumors with AUC equal to 0.94 in their classification. The extracted information was also found to be useful in the classification of early malignancies whereas in the classification of spiculated and ill-defined malignant masses in their early stage from those of benign tumors, we achieved high accuracy of 0.99 and 0.90 for AUC, respectively.     

Incidence and Mortality of Physician-Diagnosed Primary Sjögren Syndrome: Time Trends Over a 40-Year Period in a Population-Based US Cohort

Objective

To estimate the incidence and mortality rates, and their evolution over time, of physician-diagnosed primary Sjögren syndrome (pSS) in residents of Olmsted County, Minnesota.

2017EULAR/ACR系统性红斑狼疮分类标准与既往标准诊断价值的比较

目的比较2017EULAR/ACR系统性红斑狼疮分类标准和既往标准诊断的价值。方法从近10年门诊及住院最终确诊为SLE患者及非SLE结缔组织病患者中分别随机抽取60例,分为SLE疾病组和非SLE疾病组。对所有患者临床表现及实验室数据按照ACR1997、SLICC2012和2017EULAR/ACR三种不同的SLE分类标准要求进行填表;统计三种分类标准诊断SLE的情况;确诊的SLE患者,按照符合的分类标准数进行统计分析。结果ACR1997分类标准中SLE组与非SLE组比较,抗磷脂抗体和Coombs试验相差不大,差异无统计学意义(P> 0. 05),其他临床表现差异均十分显著,有统计学意义(P <0. 05); SLICC2012中关节炎、抗磷脂抗体和Coombs试验,差异无统计学意义(P> 0. 05),其他临床表现差异均十分显著,有统计学意义(P <0. 05); 2017EULAR/ACR中关节炎、抗磷脂抗体和Coombs试验差异无统计学意义(P> 0. 05),其余各项差异均有统计学意义(P <0. 05)。3种分类方法的敏感性分别为0. 64、0. 86和0. 92,特异性分别为0. 81、0. 67和0. 61。确诊SLE患者中,只符合1个分类标准的有9例,符合2个分类标准的有31例,符合3个分类标准的有20例,差异有统计学意义(P <0. 05)。结论 2017EULAR/ACR SLE分类标准对SLE患者的诊断要优于ACR1997和SLICC2012,具有较高的敏感性,有利于患者的早期诊断,虽然特异性略低前2种标准,但同样值得临床推广。