Björn-Erik Erlandsson

Nailfold Capillaroscopy in Rheumatic Diseases: Which Parameters Should Be Evaluated?

Video nailfold capillaroscopy (NFC), considered as an extension of the widefield technique, allows a more accurate measuring and storing of capillary data and a better defining, analyzing, and quantifying of capillary abnormalities. Capillaroscopic study is often performed on the patients suspected of having microcirculation problems such as Raynauds phenomenon as the main indication for nailfold capillaroscopy. Capillaroscopic findings based on microcirculation studies can provide useful information in the fields of pathophysiology, differential diagnosis, and monitoring therapy. Nailfold capillaroscopy provides a vital assessment in clinical practices and research; for example, its reputation in the early diagnosis of systemic sclerosis is well established and it is also used as a classification criterion in this regard. This review focuses on the manner of performing video nailfold capillaroscopy and on a common approach for measuring capillary dimensions in fingers and toes.

A Novel Data-Mining Approach Leveraging Social Media to Monitor Consumer Opinion of Sitagliptin

A novel data mining method was developed to gauge the experience of the drug Sitagliptin (trade name Januvia) by patients with diabetes mellitus type 2. To this goal, we devised a two-step analysis framework. Initial exploratory analysis using self-organizing maps was performed to determine structures based on user opinions among the forum posts. The results were a compilation of users clusters and their correlated (positive or negative) opinion of the drug. Subsequent modeling using network analysis methods was used to determine influential users among the forum members. These findings can open new avenues of research into rapid data collection, feedback, and analysis that can enable improved outcomes and solutions for public health and important feedback for the manufacturer.

Capillary density : An important parameter in nailfold capillaroscopy

Nailfold capillaroscopy is one of the various noninvasive bioengineering methods used to investigate skin microcirculation. It is an effective examination for assessing microvascular changes in the peripheral circulation; hence it has a significant role for the diagnosis of Systemic sclerosis with the classic changes of giant capillaries as well as the decline in capillary density with capillary dropout. The decline in capillary density is one of microangiopathic features existing in connective tissue disease. It is detectable with nailfold capillaroscopy. This parameter is assessed by applying quantitative measurement. In this article, we reviewed a common method for calculating the capillary density and the relation between the number of capillaries as well as the existence of digital ulcers, pulmonary arterial hypertension, autoantibodies, scleroderma patterns and different scoring system.

A novel data-mining approach leveraging social media to monitor and respond to outcomes of diabetes drugs and treatment

A novel data-mining method was developed to gauge the experiences of medical devices and drugs by patients with diabetes mellitus. Self-organizing maps were used to analyze forum posts numerically to better understand user opinion of medical devices and drugs. The end-result is a word list compilation that correlates certain positive and negative word cluster groups with medical drugs and devices. The implication of this novel data-mining method could open new avenues of research into rapid data collection, feedback, and analysis that would enable improved outcomes and solutions for public health.

Using Homo-Separation of Variables for Solving Systems of Nonlinear Fractional Partial Differential Equations

A new method proposed and coined by the authors as the homo-separation of variables method is utilized to solve systems of linear and nonlinear fractional partial differential equations (FPDEs). The new method is a combination of two well-established mathematical methods, namely, the homotopy perturbation method (HPM) and the separation of variables method. When compared to existing analytical and numerical methods, the method resulting from our approach shows that it is capable of simplifying the target problem at hand and reducing the computational load that is required to solve it, considerably. The efficiency and usefulness of this new general-purpose method is verified by several examples, where different systems of linear and nonlinear FPDEs are solved.

Elliptical broken line method for calculating capillary density in nailfold capillaroscopy: Proposal and evaluation

Nailfold capillaroscopy is a practical method for identifying and obtaining morphological changes in capillaries which might reveal relevant information about diseases and health. Capillaroscopy is harmless, and seems simple and repeatable. However, there is lack of established guidelines and instructions for acquisition as well as the interpretation of the obtained images; which might lead to various ambiguities. In addition, assessment and interpretation of the acquired images are very subjective. In an attempt to overcome some of these problems, in this study a new modified technique for assessment of nailfold capillary density is introduced. The new method is named elliptic broken line (EBL) which is an extension of the two previously known methods by defining clear criteria for finding the apex of capillaries in different scenarios by using a fitted elliptic. A graphical user interface (GUI) is developed for pre-processing, manual assessment of capillary apexes and automatic correction of selected apexes based on 90° rule. Intra- and inter-observer reliability of EBL and corrected EBL is evaluated in this study. Four independent observers familiar with capillaroscopy performed the assessment for 200 nailfold videocapillaroscopy images, form healthy subject and systemic lupus erythematosus patients, in two different sessions. The results show elevation from moderate (ICC=0.691) and good (ICC=0.753) agreements to good (ICC=0.750) and good (ICC=0.801) for intra- and inter-observer reliability after automatic correction of EBL. This clearly shows the potential of this method to improve the reliability and repeatability of assessment which motivates us for further development of automatic tool for EBL method.

Counting capillaries in nailfold capillaroscopy: State of the art and a proposed method

Capillaries play a crucial role in the microcircu-latory 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 capillaroscopy is 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 one millimeter span of the distal row in each finger or toe. This definition is silent about counting or excluding the number of 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 capillary and subsequently count the number of capillaries with several papillae.

A novel data-mining platform leveraging social media to monitor outcomes of Januvia

A novel data-mining method was developed to gauge the experiences of the diabetes mellitus drug Januvia. Self-organizing maps were used to analyze forum posts numerically to infer user opinion of drug Januvia. Graph theory was used to discover influential users. The result is a word list compilation correlating positive and negative word cluster groups and a web of influential users on Januvia. The implications could open new research avenues into rapid data collection, feedback, and analysis that would enable improved solutions for public health.

Image enhancement effect on inter and intra-observer reliability of nailfold capillary assessment

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.

A Novel Data-Mining Platform to Monitor the Outcomes of Erlontinib (Tarceva) Using Social Media

A novel data-mining method was developed to gauge the experiences of the oncology drug Tarceva. Self-organizing maps were used to analyze forum posts numerically to infer user opinion of drug Tarceva. The result is a word list compilation correlating positive and negative word cluster groups and a web of influential users on Tarceva. The implica-tions could open new research avenues into rapid data collec-tion, feedback, and analysis that would enable improved solu-tions for public health.