Utilization of the Revised American College of Rheumatology (rACR) Scoring to Avoid Unnecessary Temporal Artery Biopsies-A Case Series.

Introduction: The American College of Rheumatology (ACR) criteria, and more recently the revised ACR criteria (rACR), are a scoring system developed to aid in the diagnosis of giant cell arteritis (GCA). Our aim was to investigate the value of the non-biopsy criteria of the original ACR criteria and rACR criteria to predict GCA, and investigate the utilization of such scores to avoid biopsy when a very high or very low likelihood of a positive temporal artery biopsy TAB was predicted. Method: We conducted a retrospective cohort study of 59 patients undergoing TAB from 2013 to 2017 in Beaumont Hospital, a tertiary referral centre in Dublin, Ireland. Demographic data, biochemical results, presenting features, and histology results were collected and collated. Results: Data were analysed from 53 patients and ACR scores were compiled. Seventeen scored < 3 and thirty-six scored 3−5. All 11 positive biopsies were in the 3−5 score range. Forty-five patients were analysed with rACR scores. Eight were excluded due to not meeting the inclusion criteria. Of the 11 positive biopsies, 2 were in the 3−4 score range, and 9 were in the ≥5 score range. In the ACR method, 36% of all biopsies scored as low-risk pre-biopsy. In the rACR method, 84.4% of all biopsies scored in the low- and intermediate-risk group pre-biopsy and 15.6% of all biopsies scored in the high-risk group pre-biopsy. Conclusions: This study illustrates the potential value of the rACR scoring system as a useful tool to categorize patients according to risk with a view to avoiding unnecessary TAB. The data suggest that a TAB has a helpful role in low- and intermediate-risk groups but is of minimal benefit in the high-risk group.

Multipoint near-infrared spectrometry for real-time monitoring of protein conformational stability in powdered infant formula.

Powdered infant formula (PIF) can be the sole source of nutrition for babies and infants. Monitoring conformational changes in protein during manufacture of PIF is critical in order to maintain its nutritional value. This study presents the development of a calibration model for monitoring conformational changes in PIF protein by applying a novel multipoint near-infrared (NIR) spectrometry. NIR spectra were collected for PIF and PIF proteins, casein and whey protein isolate, before and after heat treatment. Results show that principal component analysis showed discrimination between native protein at room temperature and protein conformational changes caused at elevated temperature. Partial least squares regression analysis showed good calibration models with correlation coefficients ranging between 87% and 99% for the prediction of protein quality. This novel multipoint NIR spectrometry could serve as a simple in-line tool to rapidly monitor protein quality during processing stages, contributing to product nutritional value.