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Abstract：
OBJECTIVE: To develop a guideline that reliably identifies cutaneous adherent and rolling leukocytes from mimicking scenarios via in vivo reflectance confocal videomicroscopy.
METHODS: We used a clinical reflectance confocal microscope, the VivaScope 1500, to acquire 1522 videos of the upper dermal microcirculation from 12 healthy subjects and 60 patients after allogeneic hematopoietic cell transplantation. Blinded to clinical information, two trained raters independently counted the number of adherent and rolling leukocytes in 88 videos. Based on discrepancies in the initial assessments, we developed a guideline to identify both types of leukocyte-endothelial interactions via a modified Delphi method (without anonymity). To test the guideline\'s ability to improve the inter-rater reliability, the two raters assessed the remaining 1434 videos by using the guideline.
RESULTS: We demonstrate a guideline that consists of definitions, a step-by-step flowchart, and corresponding visuals of adherent and rolling leukocytes and mimicking scenarios. The guideline improved the inter-rater reliability of the manual assessment of both interactions. The intraclass correlation coefficient (ICC) of adherent leukocyte counts increased from 0.056 (95% confidence interval: 0-0.236, n = 88 videos, N = 10 subjects) to 0.791 (0.770-0.809, n = 1434, N = 67). The ICC of rolling leukocyte counts increased from 0.385 (0.191-0.550, n = 88, N = 10) to 0.626 (0.593-0.657, n = 1434, N = 67). Intra-rater ICC post-guideline was 0.953 (0.886-0.981, n = 20, N = 12) and 0.956 (0.894-0.983, n = 20, N = 12) for adherent and rolling, respectively.
CONCLUSIONS: The guideline aids in the manual identification of adherent and rolling leukocytes via in vivo reflectance confocal videomicroscopy.
METHODS: We used a clinical reflectance confocal microscope, the VivaScope 1500, to acquire 1522 videos of the upper dermal microcirculation from 12 healthy subjects and 60 patients after allogeneic hematopoietic cell transplantation. Blinded to clinical information, two trained raters independently counted the number of adherent and rolling leukocytes in 88 videos. Based on discrepancies in the initial assessments, we developed a guideline to identify both types of leukocyte-endothelial interactions via a modified Delphi method (without anonymity). To test the guideline\'s ability to improve the inter-rater reliability, the two raters assessed the remaining 1434 videos by using the guideline.
RESULTS: We demonstrate a guideline that consists of definitions, a step-by-step flowchart, and corresponding visuals of adherent and rolling leukocytes and mimicking scenarios. The guideline improved the inter-rater reliability of the manual assessment of both interactions. The intraclass correlation coefficient (ICC) of adherent leukocyte counts increased from 0.056 (95% confidence interval: 0-0.236, n = 88 videos, N = 10 subjects) to 0.791 (0.770-0.809, n = 1434, N = 67). The ICC of rolling leukocyte counts increased from 0.385 (0.191-0.550, n = 88, N = 10) to 0.626 (0.593-0.657, n = 1434, N = 67). Intra-rater ICC post-guideline was 0.953 (0.886-0.981, n = 20, N = 12) and 0.956 (0.894-0.983, n = 20, N = 12) for adherent and rolling, respectively.
CONCLUSIONS: The guideline aids in the manual identification of adherent and rolling leukocytes via in vivo reflectance confocal videomicroscopy.
摘要：
目的：制定一项指南，通过体内反射共聚焦视频显微镜可靠地识别皮肤粘附和滚动白细胞的模拟情景。
方法：我们使用临床反射共聚焦显微镜，VivaScope1500，从12名健康受试者和60名异基因造血细胞移植后的患者中获取1522个上真皮微循环视频。对临床信息视而不见，两名受过训练的评估者独立计算了88个视频中粘附和滚动白细胞的数量。根据初步评估的差异，我们制定了一项指南,通过改良的Delphi方法(不匿名)鉴定两种类型的白细胞-内皮细胞相互作用.为了测试准则提高评分者间可靠性的能力，两位评价者使用该指南评估了剩余的1434个视频。
结果：我们展示了一个由定义组成的指南，一步一步的流程图，以及粘附和滚动白细胞和模仿场景的相应视觉效果。该指南提高了手动评估两种相互作用的评估者之间的可靠性。粘附白细胞计数的组内相关系数（ICC）从0.056增加（95％置信区间：0-0.236，n=88个视频，N=10名受试者）至0.791（0.770-0.809，n=1434，N=67）。滚动白细胞计数的ICC从0.385（0.191-0.550，n=88，N=10）增加到0.626（0.593-0.657，n=1434，N=67）。指南后评分者ICC为0.953（0.886-0.981，n=20，N=12）和0.956（0.894-0.983，n=20，N=12），分别。
结论：该指南有助于通过体内反射共聚焦视频显微镜手动识别粘附和滚动的白细胞。
方法：我们使用临床反射共聚焦显微镜，VivaScope1500，从12名健康受试者和60名异基因造血细胞移植后的患者中获取1522个上真皮微循环视频。对临床信息视而不见，两名受过训练的评估者独立计算了88个视频中粘附和滚动白细胞的数量。根据初步评估的差异，我们制定了一项指南,通过改良的Delphi方法(不匿名)鉴定两种类型的白细胞-内皮细胞相互作用.为了测试准则提高评分者间可靠性的能力，两位评价者使用该指南评估了剩余的1434个视频。
结果：我们展示了一个由定义组成的指南，一步一步的流程图，以及粘附和滚动白细胞和模仿场景的相应视觉效果。该指南提高了手动评估两种相互作用的评估者之间的可靠性。粘附白细胞计数的组内相关系数（ICC）从0.056增加（95％置信区间：0-0.236，n=88个视频，N=10名受试者）至0.791（0.770-0.809，n=1434，N=67）。滚动白细胞计数的ICC从0.385（0.191-0.550，n=88，N=10）增加到0.626（0.593-0.657，n=1434，N=67）。指南后评分者ICC为0.953（0.886-0.981，n=20，N=12）和0.956（0.894-0.983，n=20，N=12），分别。
结论：该指南有助于通过体内反射共聚焦视频显微镜手动识别粘附和滚动的白细胞。
