To clarify the nature of power Doppler (PD) signals in rheumatoid synovium and to establish the connection between PD signals and active inflammation using synovial histopathology. Ten adult patients (median age 57.0 years, 9 women and one man) with rheumatoid arthritis (RA) were enrolled and received ultrasound (US) examinations. US-guided synovial biopsies using core needle were performed in 7 knees, 2 wrists and one elbow. Each patient had one joint biopsied. In total, 11 synovial specimens were obtained for hematoxylin and eosin staining and histopathologic examinations. The US examinations revealed prominent synovial hypertrophy in all biopsied joints. Six synovial specimens were PD-positive (from 3 knees, 2 wrists and 1 elbow) while 5 synovial specimens were PD-negative (from 5 knees). In comparison with the PD-negative synovial specimens, the PD-positive synovial specimens had significantly more lymphocyte infiltration, vessel proliferation and lining hyperplasia on histologic examination. There was no significant difference in fibrin exudate and stromal fibrosis between the PD-positive and the PD-negative synovial specimens. PD signals in rheumatoid synovium indicate active inflammation and vascularization supported by synovial histopathology. Our study establishes the connection between synovial PD signals and active synovitis in RA.

N-terminal pro b-type natriuretic peptide (NT-proBNP) was considered a prognostic factor for mortality in hemodialysis patients in previous studies. However, NT-proBNP has not been fully explored in terms of predicting other clinical outcomes in hemodialysis patients. This study aimed to investigate if NT-proBNP could predict emergency department (ED) visits, hospitalization, admission to intensive-care unit (ICU), and cardiovascular incidents in hemodialysis patients. Serum NT-proBNP and other indicators were collected in 232 hemodialysis patients. Patients were followed up for three years or until mortality. Outcomes included mortality, number of ED visits, hospitalizations, admissions to ICU, and cardiovascular events. NT-proBNP was found to predict recurrent ER visits, hospitalization, admission to ICU, cardiovascular events, and mortality, after adjusting for covariates. Time-dependent area under the curve (AUC) was used to evaluate the NT-proBNP predicting ability. Using time-dependent AUC, NT-proBNP has good predictive ability for mortality, ED visit, hospitalization, ICU admission, and cardiovascular events with the best predictive ability occurring at approximately 1 year, and 5th, 62nd, 63rd, and 63rd days respectively. AUC values for predicting mortality, hospitalization, and ICU admission decreased significantly after one year. NT-proBNP can be applied in predicting ED visits but is only suitable for the short-term. NT-proBNP may be used for predicting mortality in the long term.

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