Hydroxychloroquine had neutral effect on long-term risk of malignancy in rheumatoid arthritis patients: A population-based retrospective cohort study.

BACKGROUND: The cancer risk in rheumatoid arthritis (RA) patients has been discussed. Hydroxychloroquine (HCQ) may exert protective effects against malignancy. The study investigated the association between HCQ use and the risk of subsequent malignancy in RA patients. METHODS: Catastrophic illness certificated RA patients were extracted from the National Health Insurance Research Database. The index date was set 180 days after the RA diagnosis date to avoid immortal time bias. Two groups were matched in a 1-to-1 ratio by propensity score regarding age, gender, index date, relevant comorbidities, and comedication. HCQ users prior to the diagnosis of RA were exempted to ensure compliance with the new-user design. Cancers diagnosed before or less than 180 days after the index date were excluded to mitigate protopathic bias. The study adopted the Kaplan-Meier curve and Cox proportional hazards model to examine the association between HCQ use and cancer risk. The assumption of proportional hazard was also tested. RESULTS: Based on strict criteria, we included 492 eligible RA patients and divided them into study and control groups (N = 246 in each group). HCQ users exhibited a neutral risk of cancer relative to the controls (adjusted hazard ratio, 0.99; 95% CI, 0.44-2.21, p > .05). The assumption of proportional hazard was not violated. CONCLUSION: This study does not observe the effect of using HCQ as a primary regimen to prevent cancer in RA patients. We are assured that HCQ is not associated with an increased risk of subsequent malignancy in RA patients. Further mechanistic research is needed.

Diagnostic performance of endorectal ultrasound combined with shear wave elastography for rectal tumors staging.

OBJECTIVE: This study aims to analyze the performance of endorectal ultrasound (ERUS) combined with shear wave elastography (SWE) for rectal tumor staging. METHODS: Forty patients with rectal tumors who had surgery were enrolled. They underwent ERUS and SWE examinations before surgery. Pathological results were used as the gold standard for tumor staging. The stiffness values of the rectal tumor, peritumoral fat, distal normal intestinal wall, and distal perirectal fat were analyzed. The diagnostic accuracy of ERUS stage, tumor SWE stage, ERUS combined with tumor SWE stage, and ERUS combined with peritumoral fat SWE stage were compared and evaluated by receiver operating characteristic (ROC) curve to select the best staging index. RESULTS: From T1 to T3 stage, the maximum elasticity (Emax) of the rectal tumor increased gradually (p < 0.05). The cut-off values of adenoma/T1 and T2, T2 and T3 tumors were 36.75 and 85.15kPa, respectively. The diagnostic coincidence rate of tumor SWE stage was higher than that of ERUS stage. Overall diagnostic accuracy of ERUS combined with peritumoral fat SWE Emax restaging was significantly higher than that of ERUS. CONCLUSIONS: ERUS combined with peritumoral fat SWE Emax for tumor restaging can effectively distinguish between stage T2 and T3 rectal tumors, which provides an effective imaging basis for clinical decisions.

China rheumatoid arthritis registry of patients with Chinese medicine (CERTAIN): Rationale, design, and baseline characteristics of the first 11,764 enrollees.

BACKGROUND: Chinese medicine (CM) has become a popular interventional treatment for rheumatoid arthritis (RA). However, limited knowledge about general characteristics and long-term clinical outcomes hampers the development of CM for RA. PURPOSE: The main objectives of the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) were to describe the population of RA patients receiving CM treatment in multiple centers in China using different variables and compare these findings with internationally reported data. STUDY DESIGN: The CERTAIN is a prospective, multicenter, observational disease registry. METHODS: Adult RA patients who fulfilled the 2010 American College of Rheumatology/ European League Against Rheumatism classification criteria for RA and received CM treatment were recruited into the CERTAIN by rheumatologists from 145 hospitals across 30 provinces in China. Data on demographics, disease characteristics, comorbidities, treatments, and adverse events, with a 2-year follow-up, were collected and documented using a predefined protocol. RESULTS: In the 2 years since the study began in September 2019, 11,764 patients have been enrolled (enrolment is ongoing), and 13.10% of participants have completed the 6-month follow-up. We present the baseline characteristics of the first 11,764 enrollees. CONCLUSIONS: The CERTAIN is the first nationwide registry to document comprehensive data on CM treatment in patients with RA. The development of the CERTAIN resource is a significant step forward for Chinese RA patients, herbal medicine users, and research communities and will deepen our understanding of CM for RA. REGISTRATION: The study was registered at ClinicalTrials.gov (NCT05219214).

Strain Imaging in the Evaluation of Thyroid Nodules: The Associated Factors Leading to Misdiagnosis.

This study analyzed which imaging characteristics may contribute to misdiagnosis of benign and malignant thyroid nodules (TNs) through strain imaging (SI). We analyzed SI parameters and conventional ultrasound (CUS) characteristics of 264 nodules with histopathology results and we applied binary logistic regression analysis to select independent variables for incorrect SI results. The elastography imaging (EI) score and the virtual touch tissue imaging (VTI) score of malignant TNs were remarkably higher than that in benign TNs. VTI, of which the false-positive rate (FPR), the false-negative rate (FNR), and the cutoff value were 47.6% (39/82), 17.6% (32/182) and 3.5, presented higher diagnostic performance than EI. Aspect ratio (odd ratio [OR]: 14.208) and intra-nodular calcification (OR: 20.384) were significantly associated with false-positive VTI findings, while posterior acoustic feature (OR: 30.424) was significantly associated with false-negative VTI findings. Sex (OR: 0.221) and aspect ratio (OR: 0.268) were negatively associated with false-negative EI findings. In conclusion, sex and aspect ratio significantly affect the accuracy of EI results, while aspect ratio, intra-nodular calcification and posterior acoustic features notably affect the accuracy of VTI results. These CUS features of TNs should not be ignored before explaining SI examination results.

Evaluation of thyroid nodules with coexistent Hashimoto's thyroiditis according to various ultrasound-based risk stratification systems：A retrospective research.

PURPOSES: To investigate the efficiency of Thyroid Imaging Reporting and Data System (TI-RADS) proposed by KWAK, the American College of Radiology, and the 2015 American Thyroid Association (ATA) guidelines for thyroid nodules with Hashimoto's thyroiditis (HT) and to determine whether HT influence the diagnostic performance of these risk-stratification systems. METHODS: A total of 101 nodules with HT and 101 nodules with non-HT were retrospectively analyzed by ultrasound-based diagnostic classifications and compared with histopathological results. The areas under the receiver operating characteristic curve (AUCs) were calculated for comparative analysis. RESULTS: In the HT group, KWAK TI-RADS has the best sensitivity (91.67%), while ACR TI-RADS has the highest specificity (82.93%) and accuracy (81.19%). The AUCs of ACR TI-RADS, ATA guidelines, and KWAK TI-RADS were 0.844, 0.782, and 0.830, respectively. In the non-HT group, the sensitivity and specificity of three risk-stratification systems had no significant difference. The AUCs of ACR TI-RADS, ATA guidelines, and KWAK TI-RADS were 0.872, 0.839, and 0.874, respectively. No significant difference was found in diagnostic effectiveness of the same systems with both contexts. CONCLUSIONS: ACR TI-RADS performed the most effective for thyroid nodules in HT, whereas KWAK TI-RADS was the best for those in non-HT. Both of TI-RADS (ACR and KWAK) provided higher diagnostic effectiveness than ATA guidelines in HT or in non-HT. Moreover, HT could not affect the diagnostic performance of these risk-stratification systems.

Virtual Touch Tissue Imaging and Quantification (VTIQ) combined with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) for malignancy risk stratification of thyroid nodules.

OBJECTIVE: This study was conducted to investigate the diagnostic performance of Virtual Touch Tissue Imaging and Quantification (VTIQ), combined with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) in differentiating malignant and benign thyroid nodules. METHODS: A total of 130 thyroid nodules in 128 patients were included. The diagnostic performance of conventional ultrasound (US), VTIQ, and the combination of these two techniques was calculated and compared according to the area under the receiver operating characteristic curve (AUROC), for sensitivity, specificity, and accuracy. RESULTS: The sensitivity and specificity for the ACR TI-RADS were 98.6% (72/73) and 24.6% (14/57), respectively. There was a strong agreement with ACR TI-RADS categories of thyroid nodules (all ICCs > 0.60). With an optimal cutoff value of 2.46 m/s, the sensitivity and specificity of the minimal shear wave velocity (SWVmin) were 87.7% (64/73) and 70.2% (40/57). By applying this value to downgrade or upgrade ACR TI-RADS, the specificity significantly increased from 24.6% (14/57) to 47.4% (27/57; P < 0.05) and the sensitivity remained at 98.6% (72/73). CONCLUSIONS: VTIQ combined with ACR TI-RADS could improve the specificity of the differential diagnosis of thyroid nodules without a loss of sensitivity.

Shear Wave Velocity: A New Quantitative Index to Estimate the Status of Thyroid in Diffuse Thyroid Disease.

Objective. The purpose of the study was to assess the application value of VTQ in DTD. Research Design and Methods. Thirty healthy subjects and 74 DTD patients were involved. The thyroid stiffness, which was expressed by SWV, was measured by VTQ and compared between the patients and healthy people. The relationship between SWV and thyroid serological indexes was also analyzed. Results. The thyroid SWVs of DTD patients were higher than those of the healthy (2.56 ± 1.33 m/s versus 1.74 ± 0.16 m/s, P = 0.011). There was no significant difference between the thyroid SWVs in GD and HT patients (P = 0.168). The SWVs in patients with GD and HT were both higher than those of the healthy (P < 0.05). The area under the ROC curve was 0.938 for SWV to distinguish between DTD and healthy thyroid. With a cutoff value of 2.02 m/s, the sensitivity and specificity were 81.12% and 100.00%, respectively. Additionally, we found a positive liner correlation between thyroid SWV and TSH in DTD patients (P < 0.001). Conclusion. SWV is a good indicator of the thyroid tissue stiffness, which might be considered helpful in screening DTD. What is more, SWV might have a potential in assessing the thyroid function.

The application of Virtual Touch tissue quantification (VTQ) in diagnosis of thyroid lesions: a preliminary study.

OBJECTIVES: Virtual Touch tissue quantification (VTQ) is a quantified ultrasound (US) acoustic radiation force impulse (ARFI) imaging method that provides numerical measurements (wave-velocity values) of tissue stiffness. The purpose of this study was to detect whether VTQ could be applied to differentiate between benign and malignant thyroid lesions. METHODS: Healthy subjects' thyroid tissue and thyroid lesions were examined by VTQ to analyze their elasticity after conventional ultrasound. All the thyroid lesions were analyzed pathologically after surgery and correlated the VTQ values with the pathological results. RESULTS: The VTQ value of healthy thyroid tissue, the benign lesions, and the malignant lesions were 1.69 ± 0.41 m/s, 2.03 ± 0.42 m/s, and 3.10 ± 1.08 m/s, respectively. The VTQ value of the malignant lesions was higher than that of the healthy thyroid tissue and the benign lesions (both p<0.001). The VTQ value of the benign lesions was higher than that of the healthy thyroid tissue (p<0.001). With a cutoff value of 2.42 m/s, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for differentiating between the benign and the malignancy lesions were 80.00%, 89.23%, 87.05%, 69.56%, and 93.54%, respectively. CONCLUSIONS: VTQ could provide quantitative elasticity measurements, which might play an important role in differentiating between benign and malignant thyroid lesions.

[Study on the prevalence of snoring and obstructive sleep apnea-hypopnea syndrome in Guangxi, China].

OBJECTIVE: To study the prevalence of snoring and obstructive sleep apnea-hypopnea syndrome (OSAHS) and its high risk factors in Guangxi Zhuang Autonomous Region. METHODS: From January 2003 to March 2005, a total number of 11,163 persons aged > or =14 years Zhuang minority living in Guangxi (from Guinan, Guizhong and Guibei) were surveyed. Questionnaire was administered to draw information. Polysomnography(PSG) and in-home polygraphy were performed on participants being studied and who had reported snoring. RESULTS: Among all the surveyed people, 2940reported snoring with a prevalence of 27.3%. 448 (320 males and 128 females) people reported OSAHS with prevalence as 4.3% (5.9% in males and 2.5% in females). From 14 to 60 year olds, the prevalence of snoring and OSAHS increased with age. Among those above 60 years of age, both the prevalencerates ofsnoring and OSAHS werereduced with age. Among all the study population, 260 (21.6%) had habitual OSAHS a nd 188 (10.8%) hadoccasional OSAHS. The high risk factors of OSAHS were: position during sleep, disease of nose, drinking alcohol, smoking, gender, body mass index (BMI) and age. CONCLUSION: The prevalence rates of snoring and OSAHS were 27.3% and 4.3% respectively. From 14 to 60 years of age, the prevalence rates of snoring and OSAHS were increasing with age while from 60 years of age on, the prevalence of snoring and OSAHS reduced with age. The prevalence rates of snoring and OSAHS in males were higher than females. The high risk factors of OSAHS were position during sleep,disease of nose, drinking, smoking,gender, BMI and age.

[A statistical study of the blood pressure in snoring population of Guangxi].

OBJECTIVE: To study the prevalence of snoring, the blood pressure in the snoring population and the correlating between hypertension and snoring in Guangxi. METHODS: From January 2003 to March 2005, people older than 14 from the south, central and north Guangxi were studied for the prevalence of snoring. A questionnaire was administered, and the blood pressure, height and weight of the participants were measured. RESULTS: A total of 2862 families, 11 163 persons (aged 14 - 99 years, mean, 39.6 +/- 17.5 years) were surveyed. The prevalence of snoring was 27.3% (2940/10 758). The systolic blood pressure and the diastolic blood pressure of the non-snoring were 122.73 +/- 21.71 mm Hg and 75.68 +/- 13.17 mm Hg respectively. The systolic blood pressure and the diastolic blood pressure of the snoring were 128.23 +/- 30.85 mm Hg and 79.27 +/- 12.42 mm Hg respectively. The prevalence of hypertension of the two groups was 19.9% and 32.1% respectively. With the increase of age, there was an increasing tendency of snoring rate (tendency chi(2) = 592.613, P = 0.000) and hypertension rate (tendency chi(2) = 1868.277, P = 0.000). The hypertension incidence of the occasional snorers, habitual snorers, mild snorers, moderate snorers, and severe snorers and persons who suffered from sleep apnea was 27.6%, 37.4%, 27.5%, 31.1%, 37.4% and 44.1% respectively. Multiple logistic regression models showed that the risk factors for hypertension were snoring, age, body mass index (BMI), nationality and alcohol consumption. The partial correlation analysis showed that snoring was positively correlated to the diastolic blood pressure but not correlated to the systolic blood pressure. The severity of snoring was positively correlated to both the diastolic and the systolic blood pressures. CONCLUSIONS: The prevalence of snoring was 27.3% in Guangxi. The systolic blood pressure, the diastolic blood pressure and the prevalence of hypertension in snoring subjects were higher than those in non-snoring subjects. The prevalence of hypertension increased with increased severity of snoring. The severity of snoring was positively correlated to the diastolic and the systolic blood pressures. Snoring, age, BMI and alcohol consumption were the risk factors for hypertension.