ate without symptom information (κ = 0.42-0.56) (all p less then .001). Diagnostic certainty levels were highest for radiologists performing injections (mean [± SD], 90.0 ± 9.9) and were significantly higher for MRI review with symptom information versus without symptom information (means for reading 1, 84.6 ± 13.1 vs 62.9 ± 20.7; p less then .001). CONCLUSION. In lumbar spine MRI, presumptive pain generators diagnosed using symptom information from electronic questionnaires showed almost perfect agreement with pain generators diagnosed using symptom information from direct patient interviews. CLINICAL IMPACT. Patient-reported symptom information from a brief questionnaire can be correlated with MRI findings to distinguish presumptive pain generators from incidental abnormalities.BACKGROUND. Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children in certain regions and is rising in prevalence with increasing obesity. Accurate noninvasive imaging methods for diagnosing and quantifying liver fat are needed to guide NAFLD management. OBJECTIVE. The purpose of this article is to evaluate four ultrasound technologies for quantitative assessment of liver fat content in children using MRI proton density fat fraction (PDFF) as a reference standard. METHODS. This prospective study enrolled children who underwent clinical abdominal MRI without general anesthesia between November 2018 and July 2019. Ciforadenant Patients underwent investigational liver ultrasound within a day of 1.5-T or 3-T MRI. Acquired ultrasound radiofrequency data were processed offline to compute the acoustic attenuation coefficient, hepatorenal index (HRI), Nakagami parameter, and shear-wave elastography (SWE) parameters (elasticity, viscosity, and dispersion). Ultrasound parameters were of 98% for moderate steatosis. For HRI, the threshold of 1.48 achieved sensitivity of 90% and specificity of 76% for steatosis, and 2.11 achieved sensitivity of 100% and specificity of 100% for moderate steatosis. The interobserver concordance coefficient was 0.92 for attenuation coefficient and 0.91 for HRI. CONCLUSION. Attenuation coefficient and HRI accurately detected and quantified liver fat in this small sample of children. CLINICAL IMPACT. Quantitative ultrasound parameters may guide NAFLD diagnosis and management in children.Contemporary imaging methods provide detailed visualization of carotid athero-sclerotic plaque, enabling a major evolution of in vivo carotid plaque imaging evaluation. The degree of luminal stenosis in the carotid artery bifurcation, as assessed by ultrasound, has historically served as the primary imaging feature for determining ischemic stroke risk and the potential need for surgery. However, stroke risk may be more strongly driven by the presence of specific characteristics of vulnerable plaque, as visualized on CT and MRI, than by traditional ultrasound-based assessment of luminal narrowing. This review highlights six promising imaging-based plaque characteristics that harbor unique information regarding plaque vulnerability maximum plaque thickness and volume, calcification, ulceration, intraplaque hemorrhage, lipid-rich necrotic core, and thin or ruptured fibrous cap. Increasing evidence supports the association of these plaque characteristics with risk of ischemic stroke, although these characteristics have varying suitability for clinical implementation. Key aspects of CT and MRI protocols for carotid plaque imaging are also considered. Practical next steps and hurdles are explored for implementing routine imaging assessment of these plaque characteristics in addition to, or even as replacement for, traditional assessment of the degree of vascular stenosis on ultrasound, in the identification of individuals at high risk of ischemic stroke.Infertility risk and fertility preservation (FP) are often salient quality-of-life concerns for young adults (YAs; i.e., 18-39 years old) who have experienced a cancer diagnosis. However, we know little about how members of this population communicate with close loved ones when faced with choices about FP before beginning cancer treatment. In this study, we apply the Family Determinants of Clinical Decisions (DECIDE) Typology to explore how YA cancer patients and their romantic partners negotiate unique and complex decisions about fertility with one another, their parents, and other family members. Through individual semi-structured interviews with 12 YA patient-romantic partner dyads, we found that most (n = 8) YA couples were collaborative in their decision-making communication, but that they varied in the extent to which they valued family involvement (i.e., open-, filtered-, and closed-collaborative). Other YA patients were independent and did not involve any partners or family members in decision-making, or they exemplified incongruent decision-making styles between the involved parties. Our findings have multiple implications for decision-making theory and practice in both cancer and FP communication.
To examine feeding skills of infants with cleft palate with or without cleft lip (CP±L) using infant-driven feeding systems compared to healthy controls on standard bottles.
Cross-sectional cohort.
Large pediatric academic medical center in the Midwestern United States.
Infants with CP±L (n = 15) using the Dr. Brown's Specialty Feeding System and typically developing infants without CP±L (n = 15) using the Dr. Brown's Natural Flow Original or Options bottles.
Bottle-feeding proficiency, duration, milk transfer, and signs of feeding difficulty.
Five-minute feeding proficiency differed significantly between groups with the control group taking 44% of the feed compared to 15% for the CP±L group on level 1 (
< .001) and 21% on level 2 (
< .001) nipples. Proportion of milk transfer was 96% ± 7% for controls and 75% ± 24% for the CP±L group (
= .013). Feeding duration (minutes) differed between the control group (13 ± 3) and the CP±L groups on each nipple level (level 1 29 ± 16;
= .003; level 2 32 ± 11;
= .001). Milk transfer rate (mL/min) was 9 ± 3 for control infants compared to 3 ± 1 for infants with CP±L on level 1 (
< .001) and 5 ± 1 on level 2 (
= .007). Coughing occurred in 40% of infants with CP±L and 27% of controls.
Even when using specialty bottles, infants with CP±L differ from noncleft infants in feeding proficiency, duration, and overall intake.
Even when using specialty bottles, infants with CP±L differ from noncleft infants in feeding proficiency, duration, and overall intake.Ciforadenant
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