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- Fatemi, Alimohammad, et al.
(author)
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Nailfold microvascular changes in patients with systemic lupus erythematosus and their associative factors
- 2019
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In: Microvascular Research. - : ACADEMIC PRESS INC ELSEVIER SCIENCE. - 0026-2862 .- 1095-9319. ; 126
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Journal article (peer-reviewed)abstract
- Objectives: The aim of this study was to determine capillaroscopic changes in patients with systemic lupus erythematosus (SLE) and their predictors. Methods: Fifty-nine SLE patients and 31 controls were enrolled in a cross-sectional study. Nailfold capillaroscopy examinations were performed, and qualitative semi-quantitative and quantitative parameters were evaluated in all fingers. Demographic features and lupus characteristics, such as renal involvement, medications, laboratory data, disease activity (SLEDAI) and damage, were recorded. The predictors of capillaroscopic abnormalities were obtained by backward stepwise regression analysis. Results: Capillary numbers of right hands were significantly lower in patients than in controls [8.74 (1.66) vs. 9.63 (1.80), P = 0.0001]. Capillaries were wider in patients than in controls in right [56.32 pm (16.76) vs. 50.43 mu m (10.16), P = 0.002] and left hands [54.40 (15.02) vs. 49.71 (9.77), P = 0.005]. Capillaries were shorter in SLE patients than in controls. Multivariate analysis revealed that the main associative factors of microvascular abnormalities were gender, drinking tea and hydroxychloroquine use for giant capillaries, SLEDAI and low C3 for avascularity and age, lupus nephritis and corticosteroid use for ramification. Conclusion: Most nailfold capillaroscopic abnormalities were more common in SLE patients than in controls. Hydroxychloroquine, corticosteroids, SLEDAI, low complement and lupus nephritis may be the major prognostic factors for microvascular changes in SLE patients.
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- Karbalaie, Abdolamir, 1970-, et al.
(author)
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Counting Capillaries in Nailfold Capillaroscopy:State of the Art and a Proposed Method
- 2016
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In: 2016 IEEE EMBS CONFERENCE ON BIOMEDICAL ENGINEERING AND SCIENCES (IECBES). - : IEEE. ; , s. 170-174
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Conference paper (peer-reviewed)abstract
- Capillaries play a crucial role in the microcirculatory system by exchanging metabolic substrates and waste products between blood and various tissues. The behavior of capillaries is affiliated with the number of capillaries per unit volume of tissue. Among the various noninvasive techniques available for analyzing skin microcirculation, nailfold capillaroscopyis considered to be a simple and easy-to-perform technique that allows a direct in-vivo visualization of the capillary network.Capillary density is one of the most important parameters in the studies involving capillaroscopy images. Capillary density in most of studies is defined as the number of capillaries in a one-millimeter span of the distal row in each finger or toe. This definition is silent about counting or excluding the number of the capillary with different shapes. However, there is no single standard for counting the number of capillaries in a span of one millimeter. In this paper, a novel method is proposed for determining the nailfold capillary density. This method is a modified combination of two existing techniques: the direct observation and the 90◦ method.Compared to the two existing approaches, the proposed method is more straightforward and easy to use for cases in which the capillaries have different shapes and sizes. Through different examples, we have shown how this method can be used to select the apex point of the capillary and subsequently count the number of capillaries with several papillae.
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- Karbalaie, Abdolamir, 1975-, et al.
(author)
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Image Enhancement Effect on Inter and Intra-observer Reliability of Nailfold Capillary Assessment
- 2018
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In: Microvascular Research. - : Elsevier. - 0026-2862 .- 1095-9319.
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Journal article (peer-reviewed)abstract
- Background: Nailfold capillaroscopy (NC) is a diagnostic imaging technique that is used to assess the blood capillary network in the nailfold area. NC is routinely used for patients with microcirculation problems, such as systemic sclerosis and other connective tissue diseases. Experts commonly use subjective evaluation as a reference point in images of nailfold video capillaroscopy, so it is important to reduce the inherent ambiguities in human judgment and diagnosis. Image quality is an important factor that affects measurement error and assessment time of NC images.Objective: In this study, a new image enhancement technique was introduced and evaluated subjectively.Methods: In total, 475 nailfold video capillaroscopy images from 18 healthy subjects and 41 systemic lupus erythematosus patients were used. The images were randomly divided into two sets, one each with 275 and 200. Eight independent observers who were familiar with the capillaroscopy technique participated in this study. The set of 275 images was evaluated by three observers with the forced–choice pairwise comparison method. Elliptic broken line (EBL) was used to count the number of capillaries. The intra- and inter-observer reliability of the original and enhanced images was evaluated on 200 images by five observers.Result: Except for eight images, all observers preferred the enhanced images in the visual quality comparison method. The intra-class correlation coefficient (ICC) of intra- and inter-observer reliability increased from 0.76-0.84 to 0.82-0.89, respectively, when using the enhancement method.Conclusion: By improving the image quality, more capillary details will be visible, and an observer can document more details that may not be visible in the original image and can do so more efficiently.
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- Karbalaie, Abdolamir, 1975-, et al.
(author)
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Practical issues in assessing nailfold capillaroscopic images : a summary
- 2019
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In: Clinical Rheumatology. - : Springer. - 0770-3198 .- 1434-9949. ; 38:9, s. 2343-2354
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Journal article (peer-reviewed)abstract
- Nailfold capillaroscopy (NC) is a highly sensitive, safe, and non-invasive technique to assess involvement rate of microvascularity in dermatomyositis and systemic sclerosis. A large number of studies have focused on NC pattern description, classification, and scoring system validation, but minimal information has been published on the accuracy and precision of the measurement. The objective of this review article is to identify different factors affecting the reliability and validity of the assessment in NC. Several factors can affect the reliability of the examination, e.g., physiological artifacts, the nailfold imaging instrument, human factors, and the assessment rules and standards. It is impossible to avoid all artifacts, e.g., skin transparency, physically injured fingers, and skin pigmentation. However, minimization of the impact of some of these artifacts by considering some protocols before the examination and by using specialized tools, training, guidelines, and software can help to reduce errors in the measurement and assessment of NC images. Establishing guidelines and instructions for automatic characterization and measurement based on machine learning techniques also may reduce ambiguities and the assessment time.
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