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However&#44; other vascular abnormalities involved in systemic vascular physiology are gaining great clinical interest&#44; including increased carotid artery intima-media thickness&#44; reduced distensibility of arteries&#44; and increased stiffness of central and peripheral arteries&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a> Histopathological studies demonstrated the presence of aneurysm sites at other locations&#44; predominantly affecting small to medium-sized vascular territories such as brachial&#44; renal&#44; femoral&#44; and iliac arteries&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> The arterial function was investigated in several studies by various methods&#44; including evaluation of coronary flow reserve with angiography&#44; intracoronary flow velocity by transthoracic echocardiography&#44; magnetic resonance imaging&#44; and positron emission tomography&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Nailfold capillaroscopy was a non-invasive diagnostic method for microvasculature evaluation in various rheumatologic disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> Distinct morphologic patterns on nailfold capillary changes reveal specific capillaroscopic patterns&#44; possibly reflecting an underlying autoimmune inflammatory disease&#46; This technique is helpful for microvascular analysis in several diseases such as Juvenile systemic sclerosis&#44; systemic lupus erythematosus&#44; Sjogren&#39;s syndrome&#44; Beh&#231;et&#39;s disease&#44; and familial Mediterranean fever&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;12</span></a> Although capillaroscopy is considered a safe and feasible diagnostic tool&#44; little information exists regarding the application of this technique to assess microvascular function among the pediatric population diagnosed with KD&#46; Therefore&#44; the present study aimed to determine the utility of nailfold capillaroscopy in KD patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient population</span><p id="par0015" class="elsevierStylePara elsevierViewall">In this case&#8211;control study&#44; all consecutive KD patients diagnosed with KD at the Pediatric Rheumatology Department &#40;Pediatrics Center of Excellence affiliated to Tehran University of Medical Sciences&#44; Tehran&#44; Iran&#41; were included from September 2017 to November 2018&#46; According to American Heart Association guideline&#44; 31 patients were identified with KD&#46; After diagnosing KD&#44; all patients received 2<span class="elsevierStyleHsp" style=""></span>g&#47;kg of IVIG as a single dose and a high dose of aspirin &#40;80&#8211;100<span class="elsevierStyleHsp" style=""></span>mg&#41;&#46; Patients were excluded if they had a previous history of coronary artery abnormality&#44; hypertension&#44; diabetes mellitus&#44; pre-existed cardiovascular disease&#44; taking vasoactive drugs&#44; and caffeinated beverages&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The control group was selected from children under six who were referred to a growth and development clinic for routine examination and had normal growth and development without any background disorder&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The ethics committee of Tehran University of Medical Sciences approved this study&#46; All parents were asked to fill out an informed consent before all procedures&#46; The study was conducted under the Declaration of Helsinki and other applicable laws and regulations&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study protocol</span><p id="par0030" class="elsevierStylePara elsevierViewall">A careful history and physical examination were performed for all subjects&#46; All patients underwent an electrocardiogram and an echocardiogram&#46; Medical records of KD patients were retrieved and assessed for details of their acute illness&#46; The Nailfold capillary changes were analyzed by the digital nailfold videocapillaroscopy &#40;NVC&#41; &#40;optipix-optilia OP 120 021&#44; Sweden&#41; and OptiPix capillaroscopy software equipped with a &#215;200 fiber optic illumination in the sub-acute phases of Kawasaki disease after IVIG treatment&#46; The physician performing the procedure was unaware of the clinical information about the examinees&#46; Capillaroscopy was performed on eight fingers with an optical microscope &#40;at 10- and 16-time magnifications&#41; by the same observer&#46; Patients were asked to rest at a standard temperature of approximately 24<span class="elsevierStyleHsp" style=""></span>&#176;C for at least 15<span class="elsevierStyleHsp" style=""></span>min before the procedure&#46; According to modified Maricq&#39;s criteria&#44; capillary distribution and capillary morphology were evaluated by NVC&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> The increased diameter is divided into two subgroups&#58; regular dilation consists of the complete capillary dilation&#44; whereas a segment dilation of the capillary is involved in irregular dilation&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Moreover&#44; the definition of architectural capillary abnormality consisted of any disarray in the regular arrangement of capillaries&#46; The capillary density was compared with the control group according to age&#46; Morphology variations define as tortuosity&#44; branching&#44; and the other exclusive alternations of capillary loops&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Results were considered abnormal if there was a sign of local or global loss of capillaries &#40;&#62;20&#37;&#41;&#44; presence of hemorrhages in two or more areas &#40;at least two fingers&#41;&#44; or two or more dilated loops in at least two fingers&#46; The evaluation process was repeated one month after baseline data to assess the reproducibility of the findings&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Normality of the distributions of the continuous variables was examined with the Kolmogorov&#8211;Smirnov test&#46; Continuous variables are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation if normally distributed&#46; Categorical variables are reported as percentages and analyzed using the chi-squared test&#46; The correlations between the variables were used by Pearson and Spearman test&#44; as indicated&#46; The sensitivity&#44; specificity&#44; positive predictive value &#40;PPV&#41;&#44; and negative predictive value &#40;NPV&#41; of nailfold capiloroscopy for the corresponding KD were calculated&#46; Two-tailed <span class="elsevierStyleItalic">P</span> values<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 were used for significance testing&#46; All data were analyzed using Stata 12&#46;0 &#40;StataCorp&#44; College Station&#44; TX&#44; USA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Thirty-one KD patients were identified&#44; including 21 males &#40;67&#46;7&#37;&#41; and nine females &#40;32&#46;3&#37;&#41;&#46; The mean age of the patients and control group were not significantly different &#40;3&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;59 vs&#46; 4&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;91&#44; respectively&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41;&#46; The male to female ratio was 2&#46;1&#8211;1 in KD group&#46; Most KD patients &#40;71&#37;&#41; presented with typical clinical features of Kawasaki&#46; Coronary involvement was identified in 13 KD patients &#40;41&#46;9&#37;&#41;&#46; The frequency of different coronary artery abnormalities as evaluated by a transthoracic echocardiogram is summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The nailfold capillaroscopy was conducted on both the KD and control groups&#46; The abnormal capillaroscopic diameter was identified in 21 patients from KD group and four patients in the control group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The most common abnormality in the evaluation of capillaries diameter was irregular dilatation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; seen in 11 &#40;35&#46;4&#37;&#41; KD patients and 4 &#40;13&#46;3&#37;&#41; in the control group&#46; The normal capillary architecture distortions were commonly seen in KD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#46; On the other hand&#44; there were no findings of architectural capillary abnormality in the control group &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#46; About half of KD patients had a reduction in capillary density &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; while no similar abnormality was observed in the control group &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; There was no significant difference between KD patients and the control group in terms of morphology variations &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;4&#41;&#46; Moreover&#44; a positive correlation was observed between coronary involvement and abnormal capillaroscopic results &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The sensitivity&#44; specificity&#44; PPV&#44; and NPV of abnormal capillaroscopy patterns for KD were calculated&#46; The results indicate that the sensitivity and specificity of a capillaroscopy for diagnosis of KD were 84&#46;0&#37; &#40;95&#37;CI&#58; 63&#46;9&#8211;95&#46;5&#37;&#41; and 72&#46;2&#37; &#40;95&#37;CI&#58; 54&#46;8&#8211;85&#46;8&#37;&#41;&#44; respectively&#46; The PPV and NPV of capillaroscopy for KD were 67&#46;7&#37; &#40;95&#37;CI&#58; 48&#46;6&#8211;83&#46;3&#41; and 86&#46;7&#37; &#40;95&#37;CI&#58; 69&#46;3&#8211;96&#46;2&#41;&#44; respectively&#46; The positive and negative likelihood ratios were 3&#46;02 &#40;95&#37;CI&#58; 1&#46;74&#8211;5&#46;26&#41; and 0&#46;22 &#40;95&#37;CI&#58; 0&#46;09&#8211;0&#46;56&#41;&#44; respectively&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Microcirculation is highly important to normal physiological processes&#44; including tissue oxygenation&#44; hemostasis&#44; tissue repair&#44; and nutritional exchange&#46; Microcirculation assessment is vital in analyzing microvascular abnormalities in many rheumatologic disorders&#46; Recently&#44; nailfold capillaroscopy has been widely used to identify microcirculation damage since it gives precise information about capillaries&#8217; conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;14&#8211;16</span></a> However&#44; limited data exist regarding the utility of this technique among pediatric patients with KD&#46; The evaluations were done after IVIG treatment because Kawasaki disease is the acute vasculitis with the hypothesis of unstable alternations in the vasculature&#44; especially the microvascular in the acute phase&#46; The stabilization of capillaroscopy changes might be more in the sub-acute phase after IVIG treatment&#46; In the present study&#44; our findings suggest that nailfold capillaroscopy could detect morphological alterations in the microcirculation compared with the control group&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Our findings indicated that various morphological changes could be identified by using capillaroscopy among patients with KD&#44; including irregular dilatation of capillaries&#44; reduction in capillary density&#44; and architectural capillary abnormality&#46; Among our KD patients&#44; the most frequent capillaroscopic findings were decreased capillary density &#40;45&#46;2&#37;&#41; and irregular dilatation of capillaries &#40;35&#46;4&#37;&#41;&#46; In patients with systemic sclerosis&#44; the capillaroscopic patterns are characterized by a progressive capillary loss microvasculature function and have been associated with higher disease activity&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Ingegnoli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> evaluated microvascular damage among 123 cases diagnosed with systemic lupus erythematosus using nailfold capillaroscopy&#44; and their findings indicated that about 35&#46;8&#37; of cases were found to have capillary abnormalities &#40;including elongated loops&#44; dilatation of the efferent side&#44; increased tortuosity&#44; and branching&#41;&#44; while&#44; 28&#46;5&#37; of the patients had shown normal pattern&#46; The bed nails&#8217; capillary abnormalities &#40;including elongated loops&#44; dilatation of the efferent side&#44; increased tortuosity&#44; branching&#44; and loss of density&#41; are determined in connective tissue disorders such as systemic lupus erythematosus&#44;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a> Dermatomyositis&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> scleroderma&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> and the others cause of vasculitis and vasculopathy as a chronic process of vascular inflammation&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">On the contrary&#44; Kawasaki disease is an acute vasculitis accompanied by an acute inflammation process with similar abnormalities&#44; regardless of probable different mechanisms&#46; Oxidative stress has a major role in endothelial dysfunction in Kawasaki disease&#39;s acute and sub-acute phases&#46; In addition&#44; the CRP level&#44; fever duration&#44; and cytokines of inflammations lead to endothelial injuries accompanied by oxidative stress directly or indirectly&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#44;22</span></a> So&#44; the mechanisms of acute alternations in bed nail capillaries may differ from the chronic capillaroscopy in the other connective tissue disorders&#46; Although&#44; further evaluations should be involved&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This study observed a significant positive correlation between abnormal capillary changes and coronary artery involvement in sub-acute phases of Kawasaki disease after IVIG treatments&#46; Similarly&#44; Huang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> reported that coronary artery involvement significantly correlates with changes in peripheral microcirculation&#44; especially in the sub-acute phase&#46; In IVIG-resistance Kawasaki disease&#44; the IL6 and IL10 cytokines mildly decrease&#44; and IL4 and TNF&#945; cytokines increase with more coronary involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> On the other hand&#44; cytokine elevations and more inflammations accompanied by more oxidative stress lead to endothelial dysfunctions&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Indeed&#44; oxidative stress lead to RBC hemostasis dysfunctions&#44; platelet activation&#44; apoptosis inhibition&#44; and ultimately thrombocytosis causes clot formations in microvascular&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Microvascular involvements in KD such as conjunctival injections&#44; extremities edema&#44; and erythema in the acute phase of KD may be prodromal to medium-sized vascular involvement such as coronary vasculitis in the sub-acute phase&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Similarly&#44; the microvascular involvements prodromal to coronary involvements may occur in the heart muscle&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Thus&#44; early evaluations of microvascular involvements may change the treatment strategies to aggressive treatment in the early phase other than IVIG&#44; such as corticosteroids and anti-TNF&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a> Capillaroscopy may predict the early microvascular involvements&#44; consequently improving the outcome with aggressive and urgent treatments&#46; However&#44; further research should be involved&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The present study had several limitations&#46; Our study&#39;s relatively small sample size may have reduced the power to detect a significant correlation between capillaroscopic findings and other disease manifestations&#46; Moreover&#44; this study lacks a prospective follow-up to determine factors associated with alteration in capillaroscopic features&#46; Therefore&#44; the results of the present study should be interpreted in the context of its limitations&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion&#44; the findings of this study indicate that capillary alterations can be seen in KD&#44; although it is not specific to this disease&#46; So&#44; nail fold capillaroscopy can be helpful in detecting the capillary alternations in KD patients&#46; Accurate coronary artery involvement diagnosis in KD patients is the most important component in evaluating and managing this disorder&#46; Currently&#44; echocardiography is the initial step in evaluating coronary complications in KD&#46; Nailfold capillaroscopy is a feasible noninvasive diagnostic method to evaluate peripheral endothelial dysfunction that could indirectly help predict coronary arterial anomalies in KD patients&#44; along with echocardiography&#46; Nevertheless&#44; Capillaroscopy cannot replace echocardiography&#44; but it might be a complementary part of the diagnostic approach&#46; Further studies are warranted to validate this finding and provide enough evidence on using capillaroscopy to detect coronary involvement among KD patients&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Authors&#8217; contributions</span><p id="par0095" class="elsevierStylePara elsevierViewall">B&#46;S&#46; and N&#46;R&#46; performed data gathering and drafting of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">S&#46;R&#46;&#44; and F&#46;T&#46; contributed to the conception and design of the study&#44; and clinical expertise&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">R&#46;A&#46;&#44; and S&#46;N&#46; analyzed and interpreted the clinical data&#44; and clinical expertise&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">E&#46;A&#46; performed echocardiography and contributed to interpretation of the clinical data&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">V&#46;Z&#46; provided the concept the survey&#44; interpretation of the clinical data&#44; oversaw the project and critical revision of the final draft of manuscript&#44; primary responsibility for the paper&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">All authors read and approved the final version of the manuscript&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nailfold capillaroscopy has been used as a non-invasive diagnostic method for microvasculature evaluation in various rheumatological disorders&#46; The present study aimed to determine the utility of nailfold capillaroscopy in the diagnosis of Kawasaki Disease &#40;KD&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this case&#8211;control study nailfold capillaroscopy was performed in 31 patients with KD and 30 healthy controls&#46; All nailfold images were evaluated for capillary distribution and capillary morphology such as enlargement&#44; tortuosity&#44; and dilatation of the capillaries&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Result</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abnormal capillaroscopic diameter was identified in 21 patients from the KD group and 4 patients in the control group&#46; The most common abnormality in capillary diameter was irregular dilatation in 11 &#40;35&#46;4&#37;&#41; KD patients and in 4 people &#40;13&#46;3&#37;&#41; in the control group&#46; Distortions of the normal capillary architecture was commonly seen in the KD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#46; A positive correlation was observed between coronary involvement and abnormal capillaroscopic results &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;65&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;03&#41;&#46; The sensitivity and specificity of capillaroscopy for the diagnosis of KD were 84&#46;0&#37; &#40;95&#37;CI&#58; 63&#46;9&#8211;95&#46;5&#37;&#41; and 72&#46;2&#37; &#40;95&#37;CI&#58; 54&#46;8&#8211;85&#46;8&#37;&#41;&#44; respectively&#46; The PPV and NPV of capillaroscopy for KD were 67&#46;7&#37; &#40;95&#37;CI&#58; 48&#46;6&#8211;83&#46;3&#41; and 86&#46;7&#37; &#40;95&#37; CI&#58; 69&#46;3&#8211;96&#46;2&#41;&#44; respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Capillary alterations are more common in KD patients compared to control group&#46; Thus&#44; nailfold capillaroscopy can be useful in detecting these alterations&#46; Capillaroscopy is a sensitive test for detecting capillary alternations in KD patients&#46; It could be used as a feasible diagnostic modality for evaluating microvascular damage in KD&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La capilaroscopia periungueal se ha utilizado como un m&#233;todo diagn&#243;stico no-invasivo para evaluaci&#243;n de la microvasculatura en varios trastornos reumatol&#243;gicos&#46; El presente estudio pretendi&#243; determinar la utilidad de la capilaroscopia periungueal en el diagn&#243;stico de la enfermedad de Kawasaki &#40;KD&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En este estudio de casos y controles se realiz&#243; la capilaroscopia periungueal para 31 pacientes con KD y 30 controles sanos&#46; Todas las im&#225;genes de la ungueal se evaluaron para la distribuci&#243;n capilar y la morfolog&#237;a capilar&#44; como la ampliaci&#243;n&#44; la tortuosidad y la dilataci&#243;n de los capilares&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultado</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se identific&#243; un di&#225;metro capilarosc&#243;pico anormal en 21 pacientes del grupo KD y en 4 pacientes del grupo control&#46; La anomal&#237;a m&#225;s com&#250;n en el di&#225;metro de los capilares fue la dilataci&#243;n irregular en 11 &#40;35&#44;4&#37;&#41; pacientes con KD y 4 personas &#40;13&#44;3&#37;&#41; en el grupo control&#46; Las distorsiones de la arquitectura capilar normal se observaron com&#250;nmente en el grupo KD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#46; Se observ&#243; una correlaci&#243;n positiva entre la afectaci&#243;n coronaria y los resultados capilares anormales &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;65&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; La sensibilidad y la especificidad de una capilaroscopia para el diagn&#243;stico de KD fueron del 84&#44;0&#37; &#40;IC del 95&#37;&#58; 63&#44;9-95&#44;5&#37;&#41; y del 72&#44;2&#37; &#40;IC del 95&#37;&#58; 54&#44;8-85&#44;8&#37;&#41;&#44; respectivamente&#46; El VPP y el VAN de la capilaroscopia para KD fueron del 67&#44;7&#37; &#40;IC del 95&#37;&#58; 48&#44;6-83&#44;3&#41; y del 86&#44;7&#37; &#40;IC del 95&#37;&#58; 69&#44;3-96&#44;2&#41;&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las alteraciones capilares son m&#225;s frecuentes en los pacientes con KD en comparaci&#243;n con el grupo control&#46; As&#237;&#44; la capilaroscopia periungueal puede ser &#250;til en la detecci&#243;n de estas alteraciones&#46; La capilaroscopia es una prueba sensible para detectar las alteraciones capilares en pacientes con KD&#46; Podr&#237;a utilizarse como modalidad diagn&#243;stica factible para evaluaci&#243;n el da&#241;o microvascular en la KD&#46;</p></span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Coronary artery involvement features&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Patients without involvement&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;58&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Coronary artery ectasia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abnormal tapering LAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abnormal tapering LCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LAD and LMCA ectasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LCA aneurysm and abnormal tapering RCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LCA ectasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild LAD ectasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;9&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RCA ectasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Small aneurysmal dilation in LMCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;015&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">10 &#40;32&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;86&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Narrowing&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;25&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Regular dilatation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Irregular dilatation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11 &#40;35&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Increased end of the microvascular bed&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Capillary architecture</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Regular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23 &#40;74&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Irregular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The comparison of nailfold capillaroscopy findings between patients with Kawasaki disease &#40;KD&#41; and controls&#46;</p>"
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Original article
The role of nailfold capillaroscopy in pediatric patients with Kawasaki disease
El papel de la capilaroscopia periungueal pacientes pediátricos con la enfermedad de Kawasaki
Banafsheh Sedaghata,e,1, Sayed-Reza Raeeskaramia,b,c,1, Fatemeh Tahghighia,b,c, Raheleh Assaria,b,c, Ehsan Aghaei-Moghadama,b, Niloofar Razavi-Khorasania,b,c,d, Seyed-Reza Najafizadehd, Vahid Ziaeea,b,c,d,
Corresponding author
ziaee@tums.ac.ir

Corresponding author.
a Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
b Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
c Pediatric Rheumatology Society of Iran, Iran
d Rheumatology Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
e Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Kawasaki disease &#40;KD&#41; is an acute inflammatory process mainly affecting children and characterized by multi-system vascular involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> These patients experience a broad spectrum of clinical manifestations&#44; including skin lesions&#44; eyes&#44; and neurological systems&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Besides&#44; numerous studies have shown that KD patients suffer from cardiovascular complications as the major causes of morbidity and mortality among these groups of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a> The major concerns lie in determining coronary artery abnormalities&#46; However&#44; other vascular abnormalities involved in systemic vascular physiology are gaining great clinical interest&#44; including increased carotid artery intima-media thickness&#44; reduced distensibility of arteries&#44; and increased stiffness of central and peripheral arteries&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a> Histopathological studies demonstrated the presence of aneurysm sites at other locations&#44; predominantly affecting small to medium-sized vascular territories such as brachial&#44; renal&#44; femoral&#44; and iliac arteries&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> The arterial function was investigated in several studies by various methods&#44; including evaluation of coronary flow reserve with angiography&#44; intracoronary flow velocity by transthoracic echocardiography&#44; magnetic resonance imaging&#44; and positron emission tomography&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Nailfold capillaroscopy was a non-invasive diagnostic method for microvasculature evaluation in various rheumatologic disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> Distinct morphologic patterns on nailfold capillary changes reveal specific capillaroscopic patterns&#44; possibly reflecting an underlying autoimmune inflammatory disease&#46; This technique is helpful for microvascular analysis in several diseases such as Juvenile systemic sclerosis&#44; systemic lupus erythematosus&#44; Sjogren&#39;s syndrome&#44; Beh&#231;et&#39;s disease&#44; and familial Mediterranean fever&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;12</span></a> Although capillaroscopy is considered a safe and feasible diagnostic tool&#44; little information exists regarding the application of this technique to assess microvascular function among the pediatric population diagnosed with KD&#46; Therefore&#44; the present study aimed to determine the utility of nailfold capillaroscopy in KD patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient population</span><p id="par0015" class="elsevierStylePara elsevierViewall">In this case&#8211;control study&#44; all consecutive KD patients diagnosed with KD at the Pediatric Rheumatology Department &#40;Pediatrics Center of Excellence affiliated to Tehran University of Medical Sciences&#44; Tehran&#44; Iran&#41; were included from September 2017 to November 2018&#46; According to American Heart Association guideline&#44; 31 patients were identified with KD&#46; After diagnosing KD&#44; all patients received 2<span class="elsevierStyleHsp" style=""></span>g&#47;kg of IVIG as a single dose and a high dose of aspirin &#40;80&#8211;100<span class="elsevierStyleHsp" style=""></span>mg&#41;&#46; Patients were excluded if they had a previous history of coronary artery abnormality&#44; hypertension&#44; diabetes mellitus&#44; pre-existed cardiovascular disease&#44; taking vasoactive drugs&#44; and caffeinated beverages&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The control group was selected from children under six who were referred to a growth and development clinic for routine examination and had normal growth and development without any background disorder&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The ethics committee of Tehran University of Medical Sciences approved this study&#46; All parents were asked to fill out an informed consent before all procedures&#46; The study was conducted under the Declaration of Helsinki and other applicable laws and regulations&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study protocol</span><p id="par0030" class="elsevierStylePara elsevierViewall">A careful history and physical examination were performed for all subjects&#46; All patients underwent an electrocardiogram and an echocardiogram&#46; Medical records of KD patients were retrieved and assessed for details of their acute illness&#46; The Nailfold capillary changes were analyzed by the digital nailfold videocapillaroscopy &#40;NVC&#41; &#40;optipix-optilia OP 120 021&#44; Sweden&#41; and OptiPix capillaroscopy software equipped with a &#215;200 fiber optic illumination in the sub-acute phases of Kawasaki disease after IVIG treatment&#46; The physician performing the procedure was unaware of the clinical information about the examinees&#46; Capillaroscopy was performed on eight fingers with an optical microscope &#40;at 10- and 16-time magnifications&#41; by the same observer&#46; Patients were asked to rest at a standard temperature of approximately 24<span class="elsevierStyleHsp" style=""></span>&#176;C for at least 15<span class="elsevierStyleHsp" style=""></span>min before the procedure&#46; According to modified Maricq&#39;s criteria&#44; capillary distribution and capillary morphology were evaluated by NVC&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> The increased diameter is divided into two subgroups&#58; regular dilation consists of the complete capillary dilation&#44; whereas a segment dilation of the capillary is involved in irregular dilation&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Moreover&#44; the definition of architectural capillary abnormality consisted of any disarray in the regular arrangement of capillaries&#46; The capillary density was compared with the control group according to age&#46; Morphology variations define as tortuosity&#44; branching&#44; and the other exclusive alternations of capillary loops&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Results were considered abnormal if there was a sign of local or global loss of capillaries &#40;&#62;20&#37;&#41;&#44; presence of hemorrhages in two or more areas &#40;at least two fingers&#41;&#44; or two or more dilated loops in at least two fingers&#46; The evaluation process was repeated one month after baseline data to assess the reproducibility of the findings&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Normality of the distributions of the continuous variables was examined with the Kolmogorov&#8211;Smirnov test&#46; Continuous variables are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation if normally distributed&#46; Categorical variables are reported as percentages and analyzed using the chi-squared test&#46; The correlations between the variables were used by Pearson and Spearman test&#44; as indicated&#46; The sensitivity&#44; specificity&#44; positive predictive value &#40;PPV&#41;&#44; and negative predictive value &#40;NPV&#41; of nailfold capiloroscopy for the corresponding KD were calculated&#46; Two-tailed <span class="elsevierStyleItalic">P</span> values<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 were used for significance testing&#46; All data were analyzed using Stata 12&#46;0 &#40;StataCorp&#44; College Station&#44; TX&#44; USA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Thirty-one KD patients were identified&#44; including 21 males &#40;67&#46;7&#37;&#41; and nine females &#40;32&#46;3&#37;&#41;&#46; The mean age of the patients and control group were not significantly different &#40;3&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;59 vs&#46; 4&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;91&#44; respectively&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41;&#46; The male to female ratio was 2&#46;1&#8211;1 in KD group&#46; Most KD patients &#40;71&#37;&#41; presented with typical clinical features of Kawasaki&#46; Coronary involvement was identified in 13 KD patients &#40;41&#46;9&#37;&#41;&#46; The frequency of different coronary artery abnormalities as evaluated by a transthoracic echocardiogram is summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The nailfold capillaroscopy was conducted on both the KD and control groups&#46; The abnormal capillaroscopic diameter was identified in 21 patients from KD group and four patients in the control group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The most common abnormality in the evaluation of capillaries diameter was irregular dilatation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; seen in 11 &#40;35&#46;4&#37;&#41; KD patients and 4 &#40;13&#46;3&#37;&#41; in the control group&#46; The normal capillary architecture distortions were commonly seen in KD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#46; On the other hand&#44; there were no findings of architectural capillary abnormality in the control group &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#46; About half of KD patients had a reduction in capillary density &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; while no similar abnormality was observed in the control group &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; There was no significant difference between KD patients and the control group in terms of morphology variations &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;4&#41;&#46; Moreover&#44; a positive correlation was observed between coronary involvement and abnormal capillaroscopic results &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The sensitivity&#44; specificity&#44; PPV&#44; and NPV of abnormal capillaroscopy patterns for KD were calculated&#46; The results indicate that the sensitivity and specificity of a capillaroscopy for diagnosis of KD were 84&#46;0&#37; &#40;95&#37;CI&#58; 63&#46;9&#8211;95&#46;5&#37;&#41; and 72&#46;2&#37; &#40;95&#37;CI&#58; 54&#46;8&#8211;85&#46;8&#37;&#41;&#44; respectively&#46; The PPV and NPV of capillaroscopy for KD were 67&#46;7&#37; &#40;95&#37;CI&#58; 48&#46;6&#8211;83&#46;3&#41; and 86&#46;7&#37; &#40;95&#37;CI&#58; 69&#46;3&#8211;96&#46;2&#41;&#44; respectively&#46; The positive and negative likelihood ratios were 3&#46;02 &#40;95&#37;CI&#58; 1&#46;74&#8211;5&#46;26&#41; and 0&#46;22 &#40;95&#37;CI&#58; 0&#46;09&#8211;0&#46;56&#41;&#44; respectively&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Microcirculation is highly important to normal physiological processes&#44; including tissue oxygenation&#44; hemostasis&#44; tissue repair&#44; and nutritional exchange&#46; Microcirculation assessment is vital in analyzing microvascular abnormalities in many rheumatologic disorders&#46; Recently&#44; nailfold capillaroscopy has been widely used to identify microcirculation damage since it gives precise information about capillaries&#8217; conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;14&#8211;16</span></a> However&#44; limited data exist regarding the utility of this technique among pediatric patients with KD&#46; The evaluations were done after IVIG treatment because Kawasaki disease is the acute vasculitis with the hypothesis of unstable alternations in the vasculature&#44; especially the microvascular in the acute phase&#46; The stabilization of capillaroscopy changes might be more in the sub-acute phase after IVIG treatment&#46; In the present study&#44; our findings suggest that nailfold capillaroscopy could detect morphological alterations in the microcirculation compared with the control group&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Our findings indicated that various morphological changes could be identified by using capillaroscopy among patients with KD&#44; including irregular dilatation of capillaries&#44; reduction in capillary density&#44; and architectural capillary abnormality&#46; Among our KD patients&#44; the most frequent capillaroscopic findings were decreased capillary density &#40;45&#46;2&#37;&#41; and irregular dilatation of capillaries &#40;35&#46;4&#37;&#41;&#46; In patients with systemic sclerosis&#44; the capillaroscopic patterns are characterized by a progressive capillary loss microvasculature function and have been associated with higher disease activity&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Ingegnoli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> evaluated microvascular damage among 123 cases diagnosed with systemic lupus erythematosus using nailfold capillaroscopy&#44; and their findings indicated that about 35&#46;8&#37; of cases were found to have capillary abnormalities &#40;including elongated loops&#44; dilatation of the efferent side&#44; increased tortuosity&#44; and branching&#41;&#44; while&#44; 28&#46;5&#37; of the patients had shown normal pattern&#46; The bed nails&#8217; capillary abnormalities &#40;including elongated loops&#44; dilatation of the efferent side&#44; increased tortuosity&#44; branching&#44; and loss of density&#41; are determined in connective tissue disorders such as systemic lupus erythematosus&#44;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a> Dermatomyositis&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> scleroderma&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> and the others cause of vasculitis and vasculopathy as a chronic process of vascular inflammation&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">On the contrary&#44; Kawasaki disease is an acute vasculitis accompanied by an acute inflammation process with similar abnormalities&#44; regardless of probable different mechanisms&#46; Oxidative stress has a major role in endothelial dysfunction in Kawasaki disease&#39;s acute and sub-acute phases&#46; In addition&#44; the CRP level&#44; fever duration&#44; and cytokines of inflammations lead to endothelial injuries accompanied by oxidative stress directly or indirectly&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#44;22</span></a> So&#44; the mechanisms of acute alternations in bed nail capillaries may differ from the chronic capillaroscopy in the other connective tissue disorders&#46; Although&#44; further evaluations should be involved&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This study observed a significant positive correlation between abnormal capillary changes and coronary artery involvement in sub-acute phases of Kawasaki disease after IVIG treatments&#46; Similarly&#44; Huang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> reported that coronary artery involvement significantly correlates with changes in peripheral microcirculation&#44; especially in the sub-acute phase&#46; In IVIG-resistance Kawasaki disease&#44; the IL6 and IL10 cytokines mildly decrease&#44; and IL4 and TNF&#945; cytokines increase with more coronary involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> On the other hand&#44; cytokine elevations and more inflammations accompanied by more oxidative stress lead to endothelial dysfunctions&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Indeed&#44; oxidative stress lead to RBC hemostasis dysfunctions&#44; platelet activation&#44; apoptosis inhibition&#44; and ultimately thrombocytosis causes clot formations in microvascular&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Microvascular involvements in KD such as conjunctival injections&#44; extremities edema&#44; and erythema in the acute phase of KD may be prodromal to medium-sized vascular involvement such as coronary vasculitis in the sub-acute phase&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Similarly&#44; the microvascular involvements prodromal to coronary involvements may occur in the heart muscle&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Thus&#44; early evaluations of microvascular involvements may change the treatment strategies to aggressive treatment in the early phase other than IVIG&#44; such as corticosteroids and anti-TNF&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a> Capillaroscopy may predict the early microvascular involvements&#44; consequently improving the outcome with aggressive and urgent treatments&#46; However&#44; further research should be involved&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The present study had several limitations&#46; Our study&#39;s relatively small sample size may have reduced the power to detect a significant correlation between capillaroscopic findings and other disease manifestations&#46; Moreover&#44; this study lacks a prospective follow-up to determine factors associated with alteration in capillaroscopic features&#46; Therefore&#44; the results of the present study should be interpreted in the context of its limitations&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion&#44; the findings of this study indicate that capillary alterations can be seen in KD&#44; although it is not specific to this disease&#46; So&#44; nail fold capillaroscopy can be helpful in detecting the capillary alternations in KD patients&#46; Accurate coronary artery involvement diagnosis in KD patients is the most important component in evaluating and managing this disorder&#46; Currently&#44; echocardiography is the initial step in evaluating coronary complications in KD&#46; Nailfold capillaroscopy is a feasible noninvasive diagnostic method to evaluate peripheral endothelial dysfunction that could indirectly help predict coronary arterial anomalies in KD patients&#44; along with echocardiography&#46; Nevertheless&#44; Capillaroscopy cannot replace echocardiography&#44; but it might be a complementary part of the diagnostic approach&#46; Further studies are warranted to validate this finding and provide enough evidence on using capillaroscopy to detect coronary involvement among KD patients&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Authors&#8217; contributions</span><p id="par0095" class="elsevierStylePara elsevierViewall">B&#46;S&#46; and N&#46;R&#46; performed data gathering and drafting of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">S&#46;R&#46;&#44; and F&#46;T&#46; contributed to the conception and design of the study&#44; and clinical expertise&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">R&#46;A&#46;&#44; and S&#46;N&#46; analyzed and interpreted the clinical data&#44; and clinical expertise&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">E&#46;A&#46; performed echocardiography and contributed to interpretation of the clinical data&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">V&#46;Z&#46; provided the concept the survey&#44; interpretation of the clinical data&#44; oversaw the project and critical revision of the final draft of manuscript&#44; primary responsibility for the paper&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">All authors read and approved the final version of the manuscript&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nailfold capillaroscopy has been used as a non-invasive diagnostic method for microvasculature evaluation in various rheumatological disorders&#46; The present study aimed to determine the utility of nailfold capillaroscopy in the diagnosis of Kawasaki Disease &#40;KD&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this case&#8211;control study nailfold capillaroscopy was performed in 31 patients with KD and 30 healthy controls&#46; All nailfold images were evaluated for capillary distribution and capillary morphology such as enlargement&#44; tortuosity&#44; and dilatation of the capillaries&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Result</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abnormal capillaroscopic diameter was identified in 21 patients from the KD group and 4 patients in the control group&#46; The most common abnormality in capillary diameter was irregular dilatation in 11 &#40;35&#46;4&#37;&#41; KD patients and in 4 people &#40;13&#46;3&#37;&#41; in the control group&#46; Distortions of the normal capillary architecture was commonly seen in the KD group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#46; A positive correlation was observed between coronary involvement and abnormal capillaroscopic results &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;65&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;03&#41;&#46; The sensitivity and specificity of capillaroscopy for the diagnosis of KD were 84&#46;0&#37; &#40;95&#37;CI&#58; 63&#46;9&#8211;95&#46;5&#37;&#41; and 72&#46;2&#37; &#40;95&#37;CI&#58; 54&#46;8&#8211;85&#46;8&#37;&#41;&#44; respectively&#46; The PPV and NPV of capillaroscopy for KD were 67&#46;7&#37; &#40;95&#37;CI&#58; 48&#46;6&#8211;83&#46;3&#41; and 86&#46;7&#37; &#40;95&#37; CI&#58; 69&#46;3&#8211;96&#46;2&#41;&#44; respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Capillary alterations are more common in KD patients compared to control group&#46; Thus&#44; nailfold capillaroscopy can be useful in detecting these alterations&#46; Capillaroscopy is a sensitive test for detecting capillary alternations in KD patients&#46; It could be used as a feasible diagnostic modality for evaluating microvascular damage in KD&#46;</p></span>"
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            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Result"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La capilaroscopia periungueal se ha utilizado como un m&#233;todo diagn&#243;stico no-invasivo para evaluaci&#243;n de la microvasculatura en varios trastornos reumatol&#243;gicos&#46; El presente estudio pretendi&#243; determinar la utilidad de la capilaroscopia periungueal en el diagn&#243;stico de la enfermedad de Kawasaki &#40;KD&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En este estudio de casos y controles se realiz&#243; la capilaroscopia periungueal para 31 pacientes con KD y 30 controles sanos&#46; Todas las im&#225;genes de la ungueal se evaluaron para la distribuci&#243;n capilar y la morfolog&#237;a capilar&#44; como la ampliaci&#243;n&#44; la tortuosidad y la dilataci&#243;n de los capilares&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultado</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se identific&#243; un di&#225;metro capilarosc&#243;pico anormal en 21 pacientes del grupo KD y en 4 pacientes del grupo control&#46; La anomal&#237;a m&#225;s com&#250;n en el di&#225;metro de los capilares fue la dilataci&#243;n irregular en 11 &#40;35&#44;4&#37;&#41; pacientes con KD y 4 personas &#40;13&#44;3&#37;&#41; en el grupo control&#46; Las distorsiones de la arquitectura capilar normal se observaron com&#250;nmente en el grupo KD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#46; Se observ&#243; una correlaci&#243;n positiva entre la afectaci&#243;n coronaria y los resultados capilares anormales &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;65&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; La sensibilidad y la especificidad de una capilaroscopia para el diagn&#243;stico de KD fueron del 84&#44;0&#37; &#40;IC del 95&#37;&#58; 63&#44;9-95&#44;5&#37;&#41; y del 72&#44;2&#37; &#40;IC del 95&#37;&#58; 54&#44;8-85&#44;8&#37;&#41;&#44; respectivamente&#46; El VPP y el VAN de la capilaroscopia para KD fueron del 67&#44;7&#37; &#40;IC del 95&#37;&#58; 48&#44;6-83&#44;3&#41; y del 86&#44;7&#37; &#40;IC del 95&#37;&#58; 69&#44;3-96&#44;2&#41;&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las alteraciones capilares son m&#225;s frecuentes en los pacientes con KD en comparaci&#243;n con el grupo control&#46; As&#237;&#44; la capilaroscopia periungueal puede ser &#250;til en la detecci&#243;n de estas alteraciones&#46; La capilaroscopia es una prueba sensible para detectar las alteraciones capilares en pacientes con KD&#46; Podr&#237;a utilizarse como modalidad diagn&#243;stica factible para evaluaci&#243;n el da&#241;o microvascular en la KD&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Antecedentes"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultado"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:3 [
        "etiqueta" => "1"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Equal contributions&#46;</p>"
        "identificador" => "fn0005"
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    ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The increased diameter in the irregular dilatation in the nail fold capillaroscopy on a 2&#46;5 years old Kawasaki patient&#46;</p>"
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      ]
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        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Abnormal morphology and loss of density of capillary vessels in a 14 months Kawaski patient with coronary involvement&#46;</p>"
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      2 => array:8 [
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        "etiqueta" => "Table 1"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>&#58; LAD&#44; left anterior descending&#59; LCA&#44; left coronary artery&#59; LMCA&#44; left main coronary artery&#59; RCA&#44; right coronary artery&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Coronary artery involvement features&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients without involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;58&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Coronary artery ectasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abnormal tapering LAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abnormal tapering LCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LAD and LMCA ectasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LCA aneurysm and abnormal tapering RCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LCA ectasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild LAD ectasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;9&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RCA ectasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Small aneurysmal dilation in LMCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;32&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;86&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Narrowing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;25&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Regular dilatation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Irregular dilatation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;35&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Increased end of the microvascular bed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Regular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23 &#40;74&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Irregular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8 &#40;25&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Capillary density</span></td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">17 &#40;54&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Decreased&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">14 &#40;45&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Morphology</span></td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Loop&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;83&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;93&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dilatation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ramified&#44; tortuous capillaries&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The comparison of nailfold capillaroscopy findings between patients with Kawasaki disease &#40;KD&#41; and controls&#46;</p>"
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ISSN: 21735743
Original language: English
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