Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Computers in biology and medicine
Imaging and machine learning reveal pigment ring spatial characteristics in vitiligo progression
BACKGROUND: Vitiligo is a chronic autoimmune disorder causing skin depigmentation due to melanocyte loss, with pigment ring dynamics being key to understanding and managing the disease. METHODS: Data from 105 vitiligo patients were collected using reflectance confocal microscopy (RCM) imaging to analyze pigment ring patterns across progressive and stable stages. A multi-task self-supervised learning framework was used to identify and classify pigment ring types (complete, depressed, incomplete, and absent). Graph-based structural analysis was applied to characterize the spatial and network dynamics of pigment rings, incorporating metrics such as clustering coefficients, centrality measures, and Ripley's statistics. RESULTS: Progressive-stage patients exhibited denser clustering and spatial propagation of absent and depressed pigment rings, which played dominant roles in the network. Stable-stage patients showed higher clustering coefficients for complete rings, indicating restored structural stability. The learning framework demonstrated high accuracy in identifying pigment ring types, with an AUC of 0.99 and PR score of 0.95. Ripley's K-function analysis highlighted significant clustering of absent and depressed rings in the progression stage, correlating with active disease. CONCLUSION: Integrating imaging, machine learning, and graph-based analysis offers key insights into vitiligo progression, enabling better staging and personalized treatments, with future research needed for broader validation and model refinement.
16 May 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
The burden of autoimmune pulmonary alveolar proteinosis: a systematic review
BACKGROUND: Autoimmune pulmonary alveolar proteinosis (aPAP) is characterised by abnormal alveolar surfactant accumulation and reduced pulmonary gas transfer. Disease severity and progression depend on pulmonary surfactant accumulation, the rate of which varies widely among patients. Currently, whole-lung lavage (WLL) is the most widely accepted therapy. This review addresses the burden of aPAP on patients, caregivers and society. METHODS: MEDLINE and Embase databases were systematically searched for reports on the manifestations, treatment burden, caregiver impact and healthcare costs of aPAP published after 2000. RESULTS: Out of 1023 publications identified, 50 reported relevant data (for 2855 aPAP patients), including 43 observational studies and seven phase 2/3 trials. Commonly reported symptoms included dyspnoea, cough and sputum production. Clinical manifestations included progressive hypoxaemia, reduced exercise capacity, reduced quality of life, and an increased rate of serious infections. Low prevalence and nonspecific signs and symptoms contributed to delayed diagnosis of aPAP, frequent misdiagnoses, use of multiple tests with nondiagnostic results, and therapies that were inappropriate or exacerbated the disease. WLL was the most frequently administered therapy, and many patients required repeat procedures. Medical care costs were higher for PAP patients than for non-PAP control patients. CONCLUSIONS: The results highlight the multifactorial and substantial burden of aPAP on patients. Significant unmet needs remain, particularly in achieving timely and accurate diagnosis and in providing effective, well-tolerated therapies that address the underlying pathophysiology of the disease.
10 Apr 2026
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