1
|
Liu JY, Zhu L, Gao X, Li J, Sun ZY, Jin ZY, Xue HD. Autoimmune Pancreatitis Surveillance: A Simplified MRI Protocol Versus a Comprehensive Pancreatic MRI Protocol. Acad Radiol 2024; 31:1906-1917. [PMID: 38040626 DOI: 10.1016/j.acra.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 12/03/2023]
Abstract
RATIONALE AND OBJECTIVES Magnetic resonance imaging (MRI) has good diagnostic performance and causes no radiation damage, making it an ideal tool for the autoimmune pancreatitis (AIP) surveillance. However, its time cost is high. This study aimed to evaluate (1) whether a simplified protocol (SP) of MRI for AIP surveillance provides information equivalent to the comprehensive protocol (CP) and (2) the time cost reductions associated with using an SP. MATERIALS AND METHODS This retrospective single-institutional study included 40 patients with AIP with at least two contrast-enhanced MRI/magnetic resonance cholangiopancreatography studies. Two radiologists evaluated two imaging sets (CP/SP) per patient, independently. Intra- and inter-observer agreement in the evaluation of the pancreas and extrapancreatic organs involvement using the SP/CP in addition to the time cost differences between the SP and CP were assessed. Intra- and inter-rater reliability were assessed using Cohen's kappa test, intraclass correlations, or the weighted kappa test. The differences in time costs between the CP and SP were compared using the Mann-Whitney U test or Wilcoxon signed-rank test. RESULTS The SP had strong intra- and inter-observer agreement with the CP in evaluating MRI parameters (κ > 0.60, moderate to excellent) and disease activity status (κ > 0.80, all excellent). The overall image acquisition time cost for the SP was 49.2% of the CP. For the two radiologists, the image interpretation time cost of the SP was reduced by approximately 35% and 27% compared to the CP. CONCLUSION For AIP surveillance, SP MRI provides information consistent with the CP and is less time-consuming.
Collapse
Affiliation(s)
- Jing-Yi Liu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Liang Zhu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Xin Gao
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Juan Li
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Zhao-Yong Sun
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| |
Collapse
|
2
|
Kangas ST, Ouédraogo CT, Tounkara M, Ouoluoguem B, Coulibaly IN, Haidara A, Diarra NH, Diassana K, Tausanovitch Z, Ritz C, Wells JC, Briend A, Myatt M, Radin E, Bailey J. Nutritional treatment of children 6-59 months with severely low weight-for-age z-score: a study protocol for a 3-arm randomized controlled trial. Trials 2024; 25:30. [PMID: 38191436 PMCID: PMC10773065 DOI: 10.1186/s13063-023-07890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Admission criteria that treat children with low mid-upper-arm circumference (MUAC), and low weight-for-height z-score (WHZ) are not aligned with the evidence on which children are at risk of mortality. An analysis of community-based cohort data from Senegal found that a combination of weight-for-age (WAZ) and MUAC criteria identified all children at risk of near-term death associated with severe anthropometric deficits. This study will address whether children with WAZ <-3 but MUAC ≥125 mm benefit from therapeutic feeding with ready-to-use therapeutic foods (RUTF) and whether a simplified protocol is non-inferior to the weight-based standard protocol. METHODS This is a prospective individually randomized controlled 3-arm trial conducted in the Nara health district in Mali. Children aged 6-59 months presenting with MUAC ≥125 mm and WAZ <-3 will be randomized to (1) control group receiving no treatment, (2) simplified treatment receiving 1 sachet of RUTF daily until WAZ ≥-3 for 2 visits, (3) standard treatment receiving RUTF according to WHZ category: (a) WHZ <-3 receive 200 kcal/kg/day until WHZ ≥-2 for 2 visits, (b) WHZ ≥-3 but <-2 receive 1 sachet daily until WHZ ≥-2 for 2 visits or (c) WHZ ≥-2 receive no treatment. All children will be followed up first fortnightly for 12 weeks and then monthly until 6 months post-enrolment. The primary endpoint will be measured at 2 months with the primary outcome being WAZ as a continuous measure. Other outcomes include other anthropometric measurements and a secondary endpoint will be observed at 6 months. A total of 1397 children will be recruited including 209 in the control and 594 in both the simplified and standard arms. The sample size should enable us to conclude on the superiority of the simplified treatment compared to no treatment and on the non-inferiority of the simplified treatment versus standard treatment with a margin of non-inferiority of 0.2 WAZ. DISCUSSION This trial aims to generate new evidence on the benefit of treating children with WAZ <-3 but MUAC ≥125 mm in order to guide the choice of admission criteria to malnutrition treatment and build evidence on the most efficient treatment protocol. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov: NCT05248516 on February 21, 2022.
Collapse
Affiliation(s)
| | | | - Moctar Tounkara
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Technics and Technologies of Bamako, Bamako, Mali
| | | | | | | | | | | | | | - Christian Ritz
- National Institute of Public Health, Copenhagen, Denmark
| | - Jonathan C Wells
- Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - André Briend
- Department of International Health, University of Tampere School of Medicine, Tampere, Finland
- Department of Nutrition, Exercise and Sports, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark Myatt
- Brixton Health, Brixton, UK
- Emergency Nutrition Network, Kidlington, Oxforshire, UK
| | | | | |
Collapse
|
3
|
Royse AG, Lui E, Gai D, Cid X, Canty D, Wang A, Bridgford L, Royse CF. Three Zone Scanning Protocol For Lung Ultrasound: An Anatomical Basis. Heart Lung Circ 2023; 32:247-251. [PMID: 36400698 PMCID: PMC9673129 DOI: 10.1016/j.hlc.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/24/2022] [Accepted: 09/03/2022] [Indexed: 11/17/2022]
Abstract
Lung ultrasound is rapidly gaining popularity based on point of care ease of use, diagnostic fidelity and lack of ionising radiation. This was particularly notable at the beginning of the COVID-19 pandemic, where concerns of contamination of the x-ray department led to a reluctance to order frequent chest x-rays. Early COVID-19 lung involvement is of a bronchopneumonia, and patches of consolidation adjacent to the chest wall were easily detectable by ultrasound. A large number of proposed scanning protocols were advocated and are often complex and largely based on traditional stethoscope examination or access points on the chest wall rather than the underlying lung anatomy. A surgical understanding of lung anatomy and related surface anatomy has led us to develop a simplified three zone scanning protocol in 2013. The anterior zone corresponds to the upper lobe, and the posterior zone is divided between upper lobe and lower lobe. The relationship between lung lobes and the surface of the chest wall provides the anatomical basis for a simple three scanning zone lung ultrasound protocol.
Collapse
Affiliation(s)
- Alistair G Royse
- Department of Surgery, The University of Melbourne, Melbourne, Vic, Australia; Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Vic, Australia.
| | - Elaine Lui
- Department of Radiology, The University of Melbourne, Melbourne, Vic, Australia; Department of Radiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Dayu Gai
- Department of Radiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Ximena Cid
- Department of Surgery, The University of Melbourne, Melbourne, Vic, Australia; Department of Medicine, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - David Canty
- Department of Surgery, The University of Melbourne, Melbourne, Vic, Australia; Department of Anaesthesia, Monash Medical Centre, Melbourne, Vic, Australia
| | - Andrew Wang
- Department of Surgery, The University of Melbourne, Melbourne, Vic, Australia
| | - Lindsay Bridgford
- Department of Surgery, The University of Melbourne, Melbourne, Vic, Australia; Emergency Department, Maroondah Hospital, Melbourne, Vic, Australia
| | - Colin F Royse
- Department of Surgery, The University of Melbourne, Melbourne, Vic, Australia; Department of Anaesthesia, The Royal Melbourne Hospital, Melbourne, Vic, Australia; Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|