Dermatology Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA.
Department of Dermatology, Vanderbilt University Medical Center, Vanderbilt Dermatology Translational Research Clinic, Nashville, TN, USA.
Microcirculation. 2021 Nov;28(8):e12725. doi: 10.1111/micc.12725. Epub 2021 Sep 17.
To develop a guideline that reliably identifies cutaneous adherent and rolling leukocytes from mimicking scenarios via in vivo reflectance confocal videomicroscopy.
We used a clinical reflectance confocal microscope, the VivaScope 1500, to acquire 1522 videos of the upper dermal microcirculation from 12 healthy subjects and 60 patients after allogeneic hematopoietic cell transplantation. Blinded to clinical information, two trained raters independently counted the number of adherent and rolling leukocytes in 88 videos. Based on discrepancies in the initial assessments, we developed a guideline to identify both types of leukocyte-endothelial interactions via a modified Delphi method (without anonymity). To test the guideline's ability to improve the inter-rater reliability, the two raters assessed the remaining 1434 videos by using the guideline.
We demonstrate a guideline that consists of definitions, a step-by-step flowchart, and corresponding visuals of adherent and rolling leukocytes and mimicking scenarios. The guideline improved the inter-rater reliability of the manual assessment of both interactions. The intraclass correlation coefficient (ICC) of adherent leukocyte counts increased from 0.056 (95% confidence interval: 0-0.236, n = 88 videos, N = 10 subjects) to 0.791 (0.770-0.809, n = 1434, N = 67). The ICC of rolling leukocyte counts increased from 0.385 (0.191-0.550, n = 88, N = 10) to 0.626 (0.593-0.657, n = 1434, N = 67). Intra-rater ICC post-guideline was 0.953 (0.886-0.981, n = 20, N = 12) and 0.956 (0.894-0.983, n = 20, N = 12) for adherent and rolling, respectively.
The guideline aids in the manual identification of adherent and rolling leukocytes via in vivo reflectance confocal videomicroscopy.
通过体内反射共聚焦视频显微镜，开发一种能够可靠识别模拟场景下贴壁和滚动白细胞的指南。
我们使用临床反射共聚焦显微镜（VivaScope 1500）获取 12 名健康受试者和 60 名异基因造血细胞移植后患者上真皮微循环的 1522 个视频。两名经过培训的评估者在不了解临床信息的情况下，分别对 88 个视频中贴壁和滚动白细胞的数量进行计数。根据初步评估的差异，我们通过改良 Delphi 法（不匿名）制定了一个指南，以识别两种类型的白细胞-内皮相互作用。为了测试该指南提高观察者间一致性的能力，两名评估者使用该指南评估了其余的 1434 个视频。
我们展示了一个包含定义、逐步流程图和贴壁及滚动白细胞及模拟场景对应图像的指南。该指南提高了两种相互作用的手动评估的观察者间一致性。贴壁白细胞计数的组内相关系数（ICC）从 0.056（95%置信区间：0-0.236，n=88 个视频，N=10 个受试者）增加到 0.791（0.770-0.809，n=1434 个视频，N=67）。滚动白细胞计数的 ICC 从 0.385（0.191-0.550，n=88 个视频，N=10 个受试者）增加到 0.626（0.593-0.657，n=1434 个视频，N=67）。指南使用后评估者内 ICC 为 0.953（0.886-0.981，n=20，N=12）和 0.956（0.894-0.983，n=20，N=12），分别用于贴壁和滚动白细胞。
该指南通过体内反射共聚焦视频显微镜辅助贴壁和滚动白细胞的手动识别。
