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Screening and follow-up of interstitial lung disease associated with rheumatoid arthritis (RA-ILD) is a challenge in clinical practice. In fact, the majority of RA-ILD patients are asymptomatic and optimal tools for early screening and regular follow-up are lacking. Furthermore, some patients may remain oligosymptomatic despite significant radiological abnormalities. In RA-ILD, usual interstitial pneumonia (UIP) is the most frequent radiological and pathological pattern, associated with a poor prognosis and a high risk to develop acute exacerbations and infections. If RA-ILD can be identified early, there may be an opportunity for an early treatment and close follow-up that might delay ILD progression and improve the long-term outcome. In connective tissue disease–associated interstitial lung disease (CTD-ILD), lung ultrasound (LUS) with the assessment of B-lines and serum Krebs von den Lungen-6 antigen (KL-6) has been recognized as sensitive biomarkers for the early detection of ILD. B-line number and serum KL-6 level were found to correlate with high-resolution computed tomography (HRCT), pulmonary function tests (PFTs), and other clinical parameters in systemic sclerosis–associated ILD (SSc-ILD). Recently, the significant correlation between B-lines and KL-6, two non-ionizing and non-invasive biomarkers, was demonstrated. Hence, the combined use of LUS and KL-6 to screen and follow up ILD in RA patients might be useful in clinical practice in addition to existing tools. Herein, we review relevant literature to support this concept, propose a preliminary screening algorithm, and present 2 cases where the algorithm was used.

Systemic autoimmune rheumatic diseases (SARDs) related pulmonary disease is highly prevalent, with variable clinical presentation and behavior, and thus is associated with poor outcomes and negatively impacts quality of life. Chest high resolution computed tomography (HRCT) is still considered a fundamental imaging tool in the screening, diagnosis, and follow-up of pulmonary disease in patients with SARDs. However, radiation exposure, economic burden, as well as lack of point-of-care CT equipment limits its application in some clinical situation. Ultrasound has found a place in numerous aspects of the rheumatic diseases, including the vasculature, skin, muscle, joints, kidneys and in screening for malignancies. Likewise it has found increasing use in the lungs. In the past two decades, lung ultrasound has started to be used for pulmonary parenchymal diseases such as pneumonia, pulmonary edema, lung fibrosis, pneumothorax, and pleural lesions, although the lung parenchymal was once considered off-limits to ultrasound. Lung ultrasound B-lines and irregularities of the pleural line are now regarded two important sonographic artefacts related to diffuse parenchymal lung disease and they could reflect the lesion extent and severity. However, its role in the management of SARDs related pulmonary involvement has not been fully investigated. This review article will focus on the potential applications of lung ultrasound in different pulmonary scenarios related with SARDs, such as interstitial lung disease, diffuse alveolar hemorrhage, diaphragmatic involvement, and pulmonary infection, in order to explore its value in clinical daily practice.

Background To investigate the diagnostic accuracy of lung ultrasound (LUS) for interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). Methods This retrospective study included patients over 18 years with RA evaluated at the Department of Rheumatology and Immunology of Shantou Central Hospital. All patients underwent chest high-resolution computed tomography (HRCT) and LUS within one month. The LUS was performed in a total of 50 scanning sites (ScS), and the number of B-lines present in each ScS was counted and summed up as B-lines score. A positive judgement was given on LUS when the B-lines score exceeded 10. The presence and patterns of ILD were defined by HRCT findings. ROC curve analysis was used to calculate the accuracy of LUS to detect ILD. Results A total of 120 RA patients (86 women, with a median age of 56.0 [50.0–64.0] years) were enrolled. Based on the HRCT, 76 patients were found to have radiographic ILD, with 63 exhibiting nonspecific interstitial pneumonia (NSIP) and 13 showing usual interstitial pneumonia (UIP). Sonographic ILD was detected in 76 patients who underwent LUS examination. The concordance rate between two modalities was 83.33% (Kappa value = 0.64, 95% CI 0.50–0.78). The diagnostic sensitivity and specificity of LUS were 86.84% and 77.27%, respectively. The positive predictive value, negative predictive value, a positive likelihood ratio and a negative likelihood ratio were 86.84%, 77.27%, 3.82, and 0.17, respectively. The number of B-lines in RA with ILD and without ILD on HRCT showed a significant difference (34.0 [15.0–96.5] vs. 6.5 [2.5–10.0], P  < 0.001). The presence of 12 B-lines on 50 ScS was the optimal cutoff value for detecting RA-ILD (AUC = 0.89, 95% CI 0.82–0.94, sensitivity of 85.53%, specificity of 81.82%, P  < 0.001). Conclusions Lung ultrasound is a valuable diagnostic tool for RA-ILD and can be used as a screening method to identify patients who require further evaluation with chest HRCT.

Acute fibrinous and organizing pneumonia (AFOP) is a new histopathological pattern of acute lung injury first described by Beasley et al. in 2002. Hallmarks of pathological findings are characterized by the presence of intra-alveolar fibrin in the form of fibrin “balls” within the alveolar spaces and organizing pneumonia with a patchy distribution. Patients with AFOP may have an acute or subacute clinical presentation. Although the pathogenesis of AFOP is not fully elucidated, it may be associated with autoimmune diseases. Reported herein is a patient diagnosed of acute AFOP associated with primary Sjögren’s syndrome. The patient’s condition promptly improved after treatment with corticosteroid.

To investigate the role of serum B-cell activating factor (BAFF) and lung ultrasound (LUS) B-lines in connective tissue disease related interstitial lung disease (CTD-ILD), and their association with different ILD patterns on high resolution computed tomography (HRCT) of chest. We measured the levels of BAFF and KL-6 by ELISA in the sera of 63 CTD-ILD patients [26 with fibrotic ILD (F-ILD), 37 with non-fibrotic ILD (NF-ILD)], 30 CTD patients without ILD, and 26 healthy controls. All patients underwent chest HRCT and LUS examination. Serum BAFF levels were significantly higher in CTD patients compared to healthy subjects (617.6 ± 288.1 pg/ml vs. 269.0 ± 60.4 pg/ml, < 0.01). BAFF concentrations were significantly different between ILD group and non-ILD group (698.3 ± 627.4 pg/ml vs. 448.3 ± 188.6 pg/ml, < 0.01). In patients with ILD, BAFF concentrations were significantly correlated with B-lines number ( = 0.37, 95% CI 0.13-0.56, < 0.01), KL-6 level ( = 0.26, 95% CI 0.01-0.48, < 0.05), and Warrick score ( = 0.33, 95% CI 0.09-0.53, < 0.01), although all correlations were only low to moderate. B-lines number correlated with Warrick score ( = 0.65, 95% CI 0.48-0.78, < 0.01), and KL-6 levels ( = 0.43, 95% CI 0.21-0.61, < 0.01). Patients with F-ILD had higher serum BAFF concentrations (957.5 ± 811.0 pg/ml vs. 516.1 ± 357.5 pg/ml, < 0.05), KL-6 levels (750.7 ± 759.0 U/ml vs. 432.5 ± 277.5 U/ml, < 0.05), B-lines numbers (174.1 ± 82 vs. 52.3 ± 57.5, < 0.01), and Warrick score (19.9 ± 4.6 vs. 13.6 ± 3.4, < 0.01) vs. NF-ILD patients. The best cut-off values to separate F-ILD from NF-ILD using ROC curves were 408 pg/ml for BAFF (AUC = 0.73, < 0.01), 367 U/ml for KL-6 (AUC = 0.72, < 0.05), 122 for B-lines number (AUC = 0.89, < 0.01), and 14 for Warrick score (AUC = 0.87, < 0.01) respectively. Serum BAFF levels and LUS B-lines number could be useful supportive biomarkers for detecting and evaluating the severity and/or subsets of CTD-ILD. If corroborated, combining imaging, serological, and sonographic biomarkers might be beneficial and comprehensive in management of CTD-ILD.

Abdominal computed tomography (CT) scanning (Figure 1A, 1C) revealed extensive gastric and small bowel wall thickening, an obvious “target” sign due to submucosal edema, a “comb” sign due to increased number of mesenteric vessels, luminal dilation, fluid accumulation, and ascites. [1] Therefore, accurate diagnosis of abdominal and urinary tract involvement in SLE necessitates a comprehensive synthesis of clinical evaluation, serological testing, and imaging findings to delineate disease extent and distinguish SLE-related pathology from alternative etiologies. Conflict of interest All authors declare no conflict of interest.

Objectives To explore the performance of multiparametric MRI-based radiomics in discriminating different human epidermal growth factor receptor 2 (HER2) expressing statuses (i.e., HER2-overexpressing, HER2-low-expressing, and HER2-zero-expressing) in breast cancer. Methods A total of 771 breast cancer patients from two institutions were retrospectively studied. Five-hundred-eighty-one patients from Institution I were divided into a training dataset ( n 1  = 407) and an independent validation dataset ( n 1  = 174); 190 patients from Institution II formed the external validation dataset. All patients were categorized into HER2-overexpressing, HER2-low-expressing, and HER2-zero-expressing groups based on pathologic examination. Multiparametric (including T2-weighted imaging with fat suppression [T2WI-FS], diffusion-weighted imaging [DWI], apparent diffusion coefficient [ADC], and dynamic contrast-enhanced [DCE]) MRI-based radiomics features were extracted and then selected from the training dataset using the least absolute shrinkage and selection operator (LASSO) regression. Three predictive models to discriminate HER2-overexpressing vs. others, HER2-low expressing vs. others, and HER2-zero-expressing vs. others were developed based on the selected features. The model performance was evaluated using the area under the receiver operating characteristic curve (AUC). Results Eleven radiomics features from DWI, ADC, and DCE; one radiomics feature from DWI; and 17 radiomics features from DWI, ADC, and DCE were selected to build three predictive models, respectively. In training, independent validation, and external validation datasets, radiomics models achieved AUCs of 0.809, 0.737, and 0.725 in differentiating HER2-overexpressing from others; 0.779, 0.778, and 0.782 in differentiating HER2-low-expressing from others; and 0.889, 0.867, and 0.813 in differentiating HER2-zero-expressing from others, respectively. Conclusions Multiparametric MRI-based radiomics model may preoperatively predict HER2 statuses in breast cancer patients. Clinical relevance statement The MRI-based radiomics models could be used to noninvasively identify the new three-classification of HER2 expressing status in breast cancer, which is helpful to the decision-making for HER2-target therapies. Key Points • Detecting HER2-overexpressing, HER2-low-expressing, and HER2-zero-expressing status in breast cancer patients is crucial for determining candidates for anti-HER2 therapy. • Radiomics features from multiparametric MRI significantly differed among HER2-overexpressing, HER2-low expressing, and HER2-zero-expressing breast cancers. • Multiparametric MRI-based radiomics could preoperatively evaluate three different HER2-expressing statuses and help to determine potential candidates for anti-HER2 therapy in breast cancer patients.

The traditional methods for testing the sleeve grouting fullness of prefabricated structures generally face the technical challenges such as high detection cost and inability to detect in real-time. In order to solve these technical challenges, the detection method and instrument based on the piezoelectric testing principle were developed. Through the electrical properties tests of grouting materials and grouting-leakage cycle tests of transparent sleeves, the effectiveness of the piezoelectric method for testing grout leakage defects was analyzed. The research results indicate that measuring the voltage changes before and after the piezoelectric sensor is wrapped in the grouting slurry can effectively evaluate the sleeve grouting fullness. The voltage measured by the piezoelectric sensor is significantly reduced after the sensor is wrapped in the grouting material (full grouting). Then the voltage increases after grouting leakage (insufficient grouting), and decreases again after supplementary grouting (full grouting). Moreover, whether the piezoelectric sensor is placed horizontally or vertically, the voltage shows obvious changes, indicating that the piezoelectric method is less affected by the sensor laying mode. Considering that the vertical embedding method is more stable for piezoelectric data, it is recommended to use the vertical laying mode in engineering projects. Furthermore, through the prefabricated model tests, the threshold for judging grouting fullness using piezoelectric method was determined. The test results show that the threshold for determining the grouting fullness using piezoelectric method can be set to 0.40. That is to say, when the voltage value is less than 0.40, it can be determined as complete grouting, otherwise it can be determined as insufficient grouting. The case studies results indicate that the piezoelectric method meets the quality control requirements during the grouting process of prefabricated structural sleeves. The research results provide a new approach and practical reference for solving the quality detection problem of sleeve grouting.

In order to calculate the fatigue deflection of prestressed concrete (PC) beams, a fatigue variable stiffness distribution (VSD) model based on crack development pattern extracted from fatigue test is presented in this study. Firstly, a linear strain distribution model along the transfer length of concrete and steel bar was established. And the stress analysis of different cross-sections along the transfer length was performed in order to calculate the average moment of inertia in the fatigue crack zone of PC beam. Then, combined with the characterization model of concrete fatigue modulus, a fatigue VSD model for PC beams was established. The model validation shows that the calculated deflections are in good agreement with the measured deflections, and the deviation does not exceed ±10%. Furthermore, the quantitative reverse deduction of fatigue damage based on stiffness index was carried out. And the multi-stage development laws of stiffness degradation and damage evolution under fatigue loading were summarized. Finally, combined with the setting of fatigue failure threshold, the critical point of the PC beam entering the failure state can be reasonably determined. which provides a reference for the assessment of structural service status. The stiffness threshold of the fatigue failure criterion is about 70%, and the damage threshold is about 0.6 for this study. The research results can provide a theoretical basis for the structural performance analysis and failure assessment for PC beams.