Ultrasound Versus Contrast-Enhanced Magnetic Resonance Imaging for Subclinical Synovitis and Tenosynovitis: A Diagnostic Performance Study

OBJECTIVES: Radiographic manifestations of synovitis (e.g., erosions) can be observed only in the late stage of rheumatoid arthritis. Ultrasound is a noninvasive, cheap, and widely available technique that enables the evaluation of inflammatory changes in the peripheral joint. In the same way, dynamic contrast-enhanced magnetic resonance imaging (MRI) enables qualitative and quantitative measurements. The objectives of the study were to compare the sensitivity and accuracy of ultrasound in detecting subclinical synovitis and tenosynovitis with those of contrast-enhanced MRI. METHODS: The ultrasonography and contrast-enhanced MRI findings of the wrist, metacarpophalangeal, and proximal interphalangeal joints (n=450) of 75 patients with a history of joint pain and morning stiffness between 6 weeks and 2 years were reviewed. The benefits score was evaluated for each modality. RESULTS: The ultrasonic findings showed inflammation in 346 (77%) joints, while contrast-enhanced MRI found signs of early rheumatoid arthritis in 372 (83%) joints. The sensitivities of ultrasound and contrast-enhanced MRI were 0.795 and 0.855, respectively, and the accuracies were 0.769 and 0.823, respectively. Contrast-enhanced MRI had a likelihood of 0–0.83 and ultrasound had a likelihood of 0–0.77 for detecting synovitis and tenosynovitis at one time. The two imaging modalities were equally competitive for detecting synovitis and tenosynovitis (p=0.055). CONCLUSION: Ultrasound could be as sensitive and specific as contrast-enhanced MRI for the diagnosis of subclinical synovitis and tenosynovitis

Managing collecting or remarketing channels: different choice for cannibalisation in remanufacturing outsourcing

Cannibalisation is still a concern for original equipment manufacturers (OEMs) when they outsource remanufacturing operations to the authorised remanufacturers (ARs). In dealing with the cannibalisation in remanufacturing outsourcing, many OEMs (such as Sun, Apple, Hewlett Packard, Bosch Tools, and Gateway) use core collecting or remanufactured product remarketing. Motivated by examples from industry, we develop two models in which an OEM produces new products but outsources remanufacturing operations to a AR. The two potential strategies for dealing with the cannibalisation from remanufacturing outsourcing are: (1) collecting used cores from consumers, or (2) remarketing all remanufactured products to consumers. Among other results, we find that minimising cannibalisation problems does not equate with maximising profits. In particular, if the collection cost coefficient is not pronounced, the aggressive response by the OEM can effectively minimise the cannibalisation problems, but will reduce the profitability for the OEM on the other hand. Further, as the collection cost coefficient is moderate, remarketing remanufactured products can secure Pareto improvements. As such, we suggest that, practising managers should combine the cannibalisation problems of remanufacturing with the costs of collecting used cores

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field