Comparison of Two Rapid Urease Tests for Detection of Helicobacter pylori Infection

Rapid urease tests are widely used at endoscopyto determine the presence of Helicobacter pyloriinfection. In this prospective study, we compared theaccuracy of two rapid urease tests, CLOtest andPyloriTek, using histology as the gold standard.Histologic staining was performed using both H&E andGiemsa, and all slides were reviewed by a singlepathologist who was blinded to the results of the rapidurease tests and endoscopic findings. One hundred twopatients were enrolled; their mean age was 59 years(range 16 to 95 years), and there were 45 males and 57females. Histology confirmed the presence of H. pylori infection in 39% of patients. Theproportions of false positives for CLOtest (8.0%) andPyloriTek measured at 1 hr (29.0%) were significantlydifferent (Z = 2.90, P = 0.0038). No significantdifference was seen between the proportions of falsenegatives. We conclude that the clinical usefulness ofPyloriTek urease test is limited by its lack ofspecificity.     

Measurement properties of instruments assessing psoriatic arthritis symptoms for psoriasis clinical trials: a systematic literature review

ABSTRACT

Introduction: The International Dermatology Outcome Measures (IDEOM) identified ‘Psoriatic Arthritis (PsA) Symptoms’ as a core domain to be measured in psoriasis clinical trials. This domain includes the measurement of pain, patient global and physical function. Herein, we evaluated the quality (i.e. measurement properties) of five candidate ‘PsA Symptoms’ measures: Patient Global Assessment (PGA) for Joints, PGA for PsA, the Routine Assessment Patient Index 3 (RAPID3), the PsA Impact of Disease 9 (PsAID9) and PsAID12.

Areas covered: We searched MEDLINE and EMBASE (inception-to-March 2018) for studies assessing the measurement properties of candidate instruments. Two reviewers independently assessed the risk of bias of 12 eligible articles using the COSMIN checklist. For each measurement property, we rated the quality of the evidence as ‘high,’ ‘moderate,’ ‘low,’ or ‘very low’ (GRADE approach) and classified the results as ‘sufficient,’ ‘insufficient,’ or ‘inconsistent.’ Finally, we provided recommendations.

Expert opinion: In PsA, RAPID3 had ‘very low’ quality evidence for ‘sufficient’ content validity and no evidence of internal structure. Global assessment instruments had ‘very low’ quality evidence for ‘inconsistent’ content validity. PsAID9 and PsAID12 had ‘low’ evidence for ‘sufficient’ content validity and were recommended to measure ‘PsA Symptoms.’ Further validation studies will improve the level of evidence of this recommendation.     

病情活动性指标ASDAS、RAPID3和BASDAI在判断强直性脊柱炎患者疾病活动度中的比较

目的 研究ASDAS和RAPID3对强直性脊柱炎(ankylosing spondylitis,AS)患者疾病活动度的判断价值。 方法 对82例AS患者进行问卷调查,统计其一般情况、病情活动度指标,抽取静脉血测定红细胞沉降率(erythrocyte sedimentation rate,ESR)和C反应蛋白(C-reactive protein,CRP)水平。通过相关性分析、kappa一致性检验比较传统方法Bath强直性脊柱炎病情活动性指数(BASDAI)与新型方法ASDAS、RAPID3对疾病活动度的评估价值。 结果 ASDAS-CRP与RAPID3具有较好的一致性(kappa值: 0.788),而这两者与BASDAI的一致性检验结果不理想(kappa值: 0.342, 0.367)。BASDAI、ASDAS、RAPID3与医生总体评价(DOCGL)、患者自身评价(PATGL)均具有良好的相关性,其中ASDAS、RAPID3与DOCGL、PATGL的相关性明显强于BASDAI与DOCGL、PATGL的相关性(ASDAS-CRP、ASDAS-ESR、RAPID3、BASDAI与DOCGL的相关性分析r值分别为0.684、0.720、0.642及0.576;与PATGL的相关性分析r值分别为0.822、0.816、0.851及0.725)。 结论 ASDAS对AS疾病活动的评估能力优于BASDAI,是理想的评价疾病活动度的新指标,值得推广应用;RAPID3具有方便、简洁、不受实验室检查结果限制的特点,在评价AS活动度时同样具有良好的可靠性及有效性。     

Touch Cytology (A Reliable and Cost-Effective Method for Diagnosis of Helicobacter pylori Infection)

A variety of reliable methods are available fordetecting Helicobacter pylori (Hp) during uppergastrointestinal endoscopy. We evaluated the clinicalutility and cost-effectiveness of rapid urease test (RUT), touch cytology (TC), and histology (H).Two hundred thirty-eight consecutive patients (178without previous medical treatment and 60 formerlytreated with anti-Hp therapy) were tested for Hpinfection by RUT, TC, and H (H&E stain). Theinfection status for each patient was established by aconcordance of two test results. The time to carry outthe three tests and their cost were also calculated. Sensitivity of TC (100%) was significantlyhigher than that of RUT (86.8%; P < 0.001), but notthan that of H (94.9%). RUT was significantly morespecific than H (100% vs 95.6%; P < 0.05), but not than TC (96.4%). Hp infection was more frequentin the patients with chronic active gastritis than inthose with chronic nonactive gastritis (P < 0.001).No Hp infection was detected in absence of chronic antral inflammation. RUT resulted the cheapestmethod and H the most expensive; TC is faster andcheaper than H. When additional information about theseverity of mucosal damage or the presence of cell atypias is not necessary, histologicexamination can be omitted, and a cost-effectivestrategy for assessing Hp status might consist in takingtwo antral biopsies, the former for performing RUT andthe latter for preparing a slide by TC, whichshould be stained and examined only when the RUT resultis negative.     

Validation of RAPID3 using a Japanese version of Multidimensional Health Assessment Questionnaire with Japanese rheumatoid arthritis patients: Characteristics of RAPID3 compared to DAS28 and CDAI

Abstract

Objectives. To validate Routine Assessment of Patient Index Data 3 (RAPID3) using a Japanese version of Multidimensional Health Assessment Questionnaire (MDHAQ) with Japanese rheumatoid arthritis (RA) patients and to describe the characteristics of RAPID3 by comparison with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI).

Methods. The original MDHAQ was translated into Japanese with minor cultural modifications and was translated back in English. Test–retest reliability was evaluated in 50 Japanese RA patients and further validation was performed in 350 Japanese RA patients recruited by seven rheumatologists. RAPID3, CDAI, and DAS28 were assessed on two consecutive visits.

Results. The test–retest reliability and the internal reliability of RAPID3 were excellent. Spearman's correlation coefficients between RAPID3 score versus CDAI score and DAS28 score were 0.761and 0.555. However, the agreement measured by kappa (weighted) for RAPID3 category versus CDAI category and for RAPID3 category versus DA28 category were 0.225 (0.382) and 0.187 (0.336). The sensitivity and specificity of “RAPID3 ≤ 3 and swollen joint ≤ 1” for predicting Boolean remission were 90.0% and 93.4%, respectively.

Conclusions. RAPID3 obtained by Japanese MDHAQ was validated with Japanese RA patients and the remission criteria were found to have excellent clinical utility in usual care.     

基于RAPID软件CT灌注参数评估急性缺血性脑卒中患者侧支循环

目的 观察RAPID软件的CT灌注（CTP）参数评估急性缺血性脑卒中（AIS）患者侧支循环的价值。方法 回顾性分析94例接受一站式脑卒中CT检查的前循环血管闭塞AIS患者，基于多期相CT血管造影（mCTA）侧支循环评分法评估其侧支循环为良好（mCTA评分≥ 4分）或不良（mCTA评分≤ 3分）。以RAPID软件处理CTP数据，获得脑血流峰值时间（Tmax>4 s、>6 s、>8 s、>10 s）对应的低灌注区体积（V_{Tmax>4 s}、V_{Tmax>6 s}、V_{Tmax>8 s}、V_{Tmax>10 s}）、梗死核心区体积（V_CBF<30%）及缺血半暗带体积和低灌注强度比值（HIR）；比较侧支循环良好（良好组）与不良患者（不良组）年龄、入院时美国国立卫生研究院卒中量表（NIHSS）评分、血糖等一般资料及CTP参数的差异。应用二元logistic回归分析建立联合回归模型，以mCTA侧支循环评分结果为标准，采用受试者工作特征（ROC）曲线评估CTP参数及联合回归模型评估AIS侧支循环状态的效能，分析CTP参数与mCTA侧支循环评分的相关性。结果 良好组51例，不良组43例。良好组年龄、入院时NIHSS评分及CTP参数V_{Tmax>4 s}、V_{Tmax>6 s}、V_{Tmax>8 s}、V_{Tmax>10 s}、V_CBF<30%、HIR均小于不良组（P均<0.05），其余各项差异均无统计学意义（P均>0.05）。mCTA侧支循环评分与V_{Tmax>6 s}、V_{Tmax>8 s}、V_{Tmax>10 s}、V_CBF<30%及HIR均呈负相关（r=-0.523、-0.615、-0.699、-0.786、-0.730，P均<0.05），与V_{Tmax>4 s}无明显相关性（P>0.05）。以CTP参数V_{Tmax>4 s}、V_{Tmax>6 s}、V_{Tmax>8 s}、V_{Tmax>10 s}、V_CBF<30%及HIR评估AIS侧支循环良好的曲线下面积（AUC）分别为0.643、0.756、0.793、0.834、0.892及0.851，联合回归模型[Logit （P）=6.82-0.051×V_CBF<30%-4.435×HIR-0.053×年龄]的AUC为0.911。结论 以RAPID软件所获CTP参数V_CBF<30%及HIR可有效评估AIS患者侧支循环。