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Wubben BM, Yun HI. The Performance Characteristics of Handheld, Non-Piezoelectric Point-of-Care Ultrasound (POCUS) in the Emergency Department. Diagnostics (Basel) 2023; 14:17. [PMID: 38201326 PMCID: PMC10795712 DOI: 10.3390/diagnostics14010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
The use of handheld point-of-care ultrasound (HH-POCUS) platforms is rapidly increasing, but the diagnostic performance of HH-POCUS in the emergency department (ED) has not been well-studied. For a period of one year, only a HH-POCUS system that uses a non-piezoelectric array (Butterfly iQ+™) was available for clinical POCUS examinations in our ED. We performed a retrospective observational study of patients who underwent cardiac, thoracic, renal, biliary, or lower extremity venous (DVT) examinations from November 2021-November 2022 and calculated performance characteristics of HH-POCUS relative to radiology imaging. A total of 381 HH-POCUS studies were evaluated. Cardiac image quality was significantly lower than lung (p = 0.002). Over half of the studies (213/381) had imaging available for comparison, and HH-POCUS identified 86.5% (32/37, (95%CI) 70.4-94.9) of prespecified emergent diagnoses, including acute cholecystitis, severely reduced left ventricular ejection fraction, pericardial effusion or tamponade, moderate or larger pleural effusion, pneumothorax, moderate or larger hydronephrosis, and DVT. For less emergent diagnoses, 84.3% (43/51, (95%CI) 70.9-92.5) were identified. Overall, HH-POCUS using a non-piezoelectric array showed modest real-world performance in the ED for cardiac, thoracic, renal, biliary, and DVT examinations. HH-POCUS may be inadequate to rule out some common ED diagnoses, but had good specificity for certain conditions such as pericardial effusion.
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Affiliation(s)
- Brandon Michael Wubben
- Department of Emergency Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Hae In Yun
- Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City, IA 52242, USA;
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Merkel D, Züllich TF, Schneider C, Yousefzada M, Beer D, Ludwig M, Weimer A, Künzel J, Kloeckner R, Weimer JM. Prospective Comparison of Handheld Ultrasound Devices from Different Manufacturers with Respect to B-Scan Quality and Clinical Significance for Various Abdominal Sonography Questions. Diagnostics (Basel) 2023; 13:3622. [PMID: 38132206 PMCID: PMC10742722 DOI: 10.3390/diagnostics13243622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Handheld ultrasound (HHUS) devices have chiefly been deployed in emergency medicine, where they are considered a valid tool. The data situation is less clear in the case of internal questions in abdominal sonography. In our study, we investigate whether HHUS devices from different manufacturers differ in their B-scan quality, and whether any differences are relevant for the significance of an internal ultrasound examination. METHOD The study incorporated eight HHUS devices from different manufacturers. Ultrasound videos of seven defined sonographic questions were recorded with all of the devices. The analogue recording of the same findings with a conventional high-end ultrasound (HEUS) device served as an evaluation criterion. Then, the corresponding findings were played side by side and evaluated by fourteen ultrasound experts using a point scale (5 points = very good; 1 point = insufficient). RESULTS The HHUS devices achieved relatively good results in terms of both the B-scan quality assessment and the ability to answer the clinical question, regardless of the manufacturer. One of the tested HHUS devices even achieved a significantly (p < 0.05) higher average points score in both the evaluation of B-scan quality and in the evaluation of clinical significance than the other devices. Regardless of the manufacturer, the HHUS devices performed best when determining the status/inferior vena cava volume and in the representation of ascites/free fluid. CONCLUSION In various clinical abdominal sonography questions, HHUS systems can reliably reproduce findings, and are-while bearing their limitations in mind-an acceptable alternative to conventional HEUS systems. Irrespective of this, the present study demonstrated relevant differences in the B-scan quality of HHUS devices from different manufacturers.
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Affiliation(s)
- Daniel Merkel
- BIKUS—Brandenburg Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane (MHB), 16816 Neuruppin, Germany;
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Tim Felix Züllich
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Christoph Schneider
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Masuod Yousefzada
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Diana Beer
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Michael Ludwig
- Department of Internal Medicine I, Hospital of the German Armed Forces Berlin, 10115 Berlin, Germany;
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital Heidelberg, 69118 Heidelberg, Germany;
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Roman Kloeckner
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein—Campus Lübeck, 23538 Lübeck, Germany;
| | - Johannes Matthias Weimer
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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Hata J. Point-of-care ultrasound for acute abdomen: 5W1H (Translated version). J Med Ultrason (2001) 2022; 49:609-618. [PMID: 35355123 DOI: 10.1007/s10396-022-01203-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/24/2022] [Indexed: 12/18/2022]
Abstract
In this paper, point-of-care ultrasound (POCUS) for the initial diagnosis and the management of acute abdomen is discussed. POCUS is supposed to be executed mainly by doctors other than ultrasound specialists anytime and anywhere such as in the emergency room or the intensive care unit. Although it seems rather difficult to cover the wide spectrum of organs as well as diseases causing acute abdominal pain, the author advocates a "six approach" for the diagnosis and triage of acute abdomen, which consists of scanning at eight points in less than 5 min. With this method, the attending doctor can diagnose most of the diseases frequently encountered in patients with acute abdomen, which can help patients avoid unnecessary examinations or admissions. However, users of POCUS should be aware of its limitations, especially when they are using pocket-sized ultrasound equipment. Therefore, users should be careful when ruling out a disease even when they cannot find any pathological findings, and consider the need for further examinations such as US done by specialists with high-end equipment or CT. Since there has been no standard curriculum in Japan for POCUS training that should deal with basic physics and techniques for US, normal abdominal anatomy, typical pathological US findings, and interventional US, the establishment of a learning program for doctors and training of experts as instructors of POCUS are needed.
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Affiliation(s)
- Jiro Hata
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
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Wong TC, Tan RC, Lu JX, Cheng TH, Lin WJ, Chiu TF, Wu SH. Point-of-Care Ultrasonography as an Extension of the Physical Examination for Abdominal Pain in the Emergency Department: The Diagnosis of Small-Bowel Volvulus as a Rare Complication after Changing the Feeding Jejunostomy Tube. Diagnostics (Basel) 2022; 12:diagnostics12051153. [PMID: 35626308 PMCID: PMC9140157 DOI: 10.3390/diagnostics12051153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 02/05/2023] Open
Abstract
Point-of-care ultrasonography (POCUS) has become the most popular modality of testing for physicians in recent years and is used for improving the quality of care and increasing patient safety. However, POCUS is not always acceptable to all physicians. To address the benefits and importance of POCUS, numerous studies have examined the use of POCUS in clinical practice and even medical education. This article aims to highlight the effects of POCUS as an extension of the physical examination, and we present a case to address the reasons it should be performed. For a man experiencing abdominal pain immediately after his feeding jejunostomy tube was changed, there was high suspicion of small-bowel volvulus after a “whirlpool sign” was observed during the POCUS, whereby mesenteric vessels presented in a whirling or spiral shape. This impression was subsequently confirmed by computed tomography. Small-bowel volvulus is a rare complication of changing a feeding jejunostomy tube. The images submitted here add to the sparse evidence from the literature on the use of POCUS as an extension of the physical examination for evaluating abdominal pain. POCUS can be used after taking the patient’s history and conducting a physical examination. The observation of a whirlpool sign may indicate the presence of a volvulus that is life-threatening.
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Affiliation(s)
- Tse-Chyuan Wong
- Department of Emergency Medicine, China Medical University Hospital, Taichung 404, Taiwan; (T.-C.W.); (R.-C.T.); (W.-J.L.); (T.-F.C.)
- College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Rhu-Chia Tan
- Department of Emergency Medicine, China Medical University Hospital, Taichung 404, Taiwan; (T.-C.W.); (R.-C.T.); (W.-J.L.); (T.-F.C.)
- College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Jian-Xun Lu
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333, Taiwan; (J.-X.L.); (T.-H.C.)
| | - Tzu-Heng Cheng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333, Taiwan; (J.-X.L.); (T.-H.C.)
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Wei-Jun Lin
- Department of Emergency Medicine, China Medical University Hospital, Taichung 404, Taiwan; (T.-C.W.); (R.-C.T.); (W.-J.L.); (T.-F.C.)
- College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Te-Fa Chiu
- Department of Emergency Medicine, China Medical University Hospital, Taichung 404, Taiwan; (T.-C.W.); (R.-C.T.); (W.-J.L.); (T.-F.C.)
- College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Shih-Hao Wu
- Department of Emergency Medicine, China Medical University Hospital, Taichung 404, Taiwan; (T.-C.W.); (R.-C.T.); (W.-J.L.); (T.-F.C.)
- College of Medicine, China Medical University, Taichung 404, Taiwan
- Correspondence:
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Kang SY, Park S, Jo IJ, Jeon K, Kim S, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Cha WC, Shin TG, Yoon H. Impact of Insurance Benefits and Education on Point-of-Care Ultrasound Use in a Single Emergency Department: An Interrupted Time Series Analysis. Medicina (B Aires) 2022; 58:medicina58020217. [PMID: 35208540 PMCID: PMC8878237 DOI: 10.3390/medicina58020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Point-of-care ultrasound (POCUS) is a useful tool that helps clinicians properly treat patients in emergency department (ED). This study aimed to evaluate the impact of specific interventions on the use of POCUS in the ED. Materials and Methods: This retrospective study used an interrupted time series analysis to assess how interventions changed the use of POCUS in the emergency department of a tertiary medical institute in South Korea from October 2016 to February 2021. We chose two main interventions—expansion of benefit coverage of the National Health Insurance (NHI) for emergency ultrasound (EUS) and annual ultrasound educational workshops. The primary variable was the EUS rate, defined as the number of EUS scans per 1000 eligible patients per month. We compared the level and slope of EUS rates before and after interventions. Results: A total of 5188 scanned records were included. Before interventions, the EUS rate had increased gradually. After interventions, except for the first workshop, the EUS rate immediately increased significantly (p < 0.05). The difference in the EUS rate according to the expansion of the NHI was estimated to be the largest (p < 0.001). However, the change in slope significantly decreased after the third workshop during the coronavirus disease 2019 pandemic (p = 0.004). The EUS rate increased significantly in the presence of physicians participating in intensive POCUS training (p < 0.001). Conclusion: This study found that expansion of insurance coverage for EUS and ultrasound education led to a significant and immediate increase in the use of POCUS, suggesting that POCUS use can be increased by improving education and insurance benefits.
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Affiliation(s)
- Soo-Yeon Kang
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
- Department of Emergency Medicine, Graduate School of Kangwon National University, Chuncheon-si 24341, Korea
| | - Sookyung Park
- Samsung Medical Center, Department of Nursing, Seoul 06351, Korea;
| | - Ik-Joon Jo
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Seonwoo Kim
- Biomedical Statistics Center, Samsung Medical Center, Research Institute for Future Medicine, Seoul 06351, Korea;
| | - Guntak Lee
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Jong-Eun Park
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Taerim Kim
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Se-Uk Lee
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Sung-Yeon Hwang
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Won-Chul Cha
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Tae-Gun Shin
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Hee Yoon
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
- Correspondence:
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Alfuraih AM, Alrashed AI, Almazyad SO, Alsaadi MJ. Abdominal aorta measurements by a handheld ultrasound device compared with a conventional cart-based ultrasound machine. Ann Saudi Med 2021; 41:376-382. [PMID: 34878929 PMCID: PMC8654105 DOI: 10.5144/0256-4947.2021.376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ultraportable or pocket handheld ultrasound devices (HUD) may be useful for large-scale abdominal aortic aneurysm screening. However, the reproducibility of measurements has not been compared with conventional cart-based ultrasound machines. OBJECTIVES Investigate the intra- and inter-operator reproducibility of a HUD compared with a conventional ultrasound machine for aortic screening. DESIGN Analytical, cross-sectional. SETTING Ultrasound department at a large tertiary care hospital in Riyadh. PATIENTS AND METHODS Eligible male participants aged ≥60 years were invited to participate upon arriving for a non-vascular ultrasound appointment. Three repeated anteroposterior measurements of the transverse aorta were made at the proximal and distal locations for each machine before repeating the measurements on a subset of participants by a second blinded operator. Intraclass correlation coefficients (ICC) and the Bland-Altman method were used to analyze reproducibility. MAIN OUTCOME MEASURE Inter-system and intra- and inter-operator ICCs. SAMPLE SIZE 114 males with repeated measurements by second operator on a subset of 35 participants. RESULTS The median age (interquartile range) of participants was 68 years (62-74 years). The intra- and inter-operator ICCs were all >0.800 showing almost perfect agreement except for the inter-operator reproducibility at the proximal location using a conventional machine (ICC= 0.583, P=.007) and the Butterfly device (ICC=0.467, P=.037). The inter-system ICCs (95% CI) were 0.818 (0.736-0.874) and 0.879 (0.799-0.924) at the proximal and distal locations, respectively. The mean difference in aortic measurement between the ultrasound systems was 0.3 mm (1.7%) in the proximal location and 0.6 mm (3.6%) in the distal location. In total, >91% of the difference in measurements between the machines was <3 mm. The mean scanning time was 4:16 minutes for the conventional system and 3:53 minutes for the HUD (P=.34). CONCLUSIONS Abdominal aortic screening using a HUD was feasible and reliable compared with a conventional ultrasound machine. A pocket HUD should be considered for large-scale screening. LIMITATIONS No cases of abdominal aortic aneurysm in the sample and lack of blinding. CONFLICT OF INTEREST None.
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Affiliation(s)
- Abdulrahman M Alfuraih
- From the Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Abdulaziz I Alrashed
- From the Department of Rediodiagnostics and Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Saleh O Almazyad
- From the Department of Rediodiagnostics and Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed J Alsaadi
- From the Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
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Vegunta S, Kling JM, Patel BK. Supplemental Cancer Screening for Women With Dense Breasts: Guidance for Health Care Professionals. Mayo Clin Proc 2021; 96:2891-2904. [PMID: 34686363 DOI: 10.1016/j.mayocp.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Mammography is the standard for breast cancer screening. The sensitivity of mammography in identifying breast cancer, however, is reduced for women with dense breasts. Thirty-eight states have passed laws requiring that all women be notified of breast tissue density results in their mammogram report. The notification includes a statement that differs by state, encouraging women to discuss supplemental screening options with their health care professionals (HCPs). Several supplemental screening tests are available for women with dense breast tissue, but no established guidelines exist to direct HCPs in their recommendation of preferred supplemental screening test. Tailored screening, which takes into consideration the patient's mammographic breast density and lifetime breast cancer risk, can guide breast cancer screening strategies that are more comprehensive. This review describes the benefits and limitations of the various available supplemental screening tests to guide HCPs and patients in choosing the appropriate breast cancer screening.
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Affiliation(s)
- Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ.
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Bhavika K Patel
- Division of Breast Imaging, Mayo Clinic Hospital, Phoenix, AZ
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Feasibility and Clinical Impact of Point-of-Care Carotid Artery Examinations by Experts using Hand-Held Ultrasound Devices in Patients with Ischemic Stroke or Transitory Ischemic Attack. J Stroke Cerebrovasc Dis 2021; 30:106086. [PMID: 34537688 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/05/2021] [Accepted: 08/29/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the feasibility and clinical influence of carotid artery examinations in patients admitted with stroke or TIA with hand-held ultrasound by experts, to identify individuals not in need of further carotid artery diagnostics. MATERIALS AND METHODS Cardiologists experienced in carotid ultrasound examined 80 patients admitted to a stroke unit with suspected stroke or TIA with hand-held ultrasound devices (HUD). Grey scale and color Doppler images were stored using a GE Vscan with dual probe (phased array and linear transducer). High-end triplex ultrasound performed by a cardiologist, blinded to the details of the HUD study, was performed in all patients and used as reference. Computer tomography angiography was performed when clinically indicated. RESULTS Stroke or TIA was diagnosed in 62 (78%) patients. Age was median (range) 72 (23-93) years. A significant stenosis (> 50% diameter reduction) was ruled out in 61 (76%) of patients by the HUD examinations. Sensitivity and specificity for diagnosing a significant stenosis was 92% and 93%, respectively. One of 12 significant stenoses was missed by HUD. All four patients in need of surgery were identified by the HUD examination. Sensitivity and specificity to identify a significant stenosis by HUD was 87% and 83%, respectively, compared to CT angiography. CONCLUSION HUD examinations of the carotid arteries by experts, using hand-held ultrasound devices, were feasible and may reduce the need for high-end diagnostic imaging of the carotid vessels in patients with stroke and TIA. Thus, HUD may improve diagnostic workflow in stroke units in the future.
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Zorzi F, Ghosh S, Chiaramonte C, Lolli E, Ventura M, Onali S, De Cristofaro E, Fantini MC, Biancone L, Monteleone G, Calabrese E. Response Assessed by Ultrasonography as Target of Biological Treatment for Crohn's Disease. Clin Gastroenterol Hepatol 2020; 18:2030-2037. [PMID: 31866561 DOI: 10.1016/j.cgh.2019.10.042] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Mucosal healing, determined by ileocolonoscopy, is a goal for treatment of Crohn's disease (CD), but this is an invasive assessment procedure. We investigated whether response to tumor necrosis factor (TNF) antagonists, determined by small-intestine contrast ultrasonography, associates with long-term outcomes. METHODS We performed observational study of 80 patients with CD treated with anti-TNF agents for at least 1 year who underwent serial small intestine contrast ultrasonography (SICUS) at the University of Rome, in Italy. SICUS was used to evaluate disease site (based on bowel wall thickness), extent of lesions, and presence of complications. Inclusion criteria required pre-therapy SICUS with follow-up SICUS after 18 months. At second SICUS, patients were assigned to categories of complete or partial responder or non-responder. CD-related outcomes (corticosteroid need, hospitalization, and surgery) were assessed at 1 year from the second SICUS, using multivariate models, and were analyzed after long term follow up (5 years) using Kaplan-Meier survival analysis. RESULTS Based on SICUS, after a median of 18 months, 36 patients (51%) were complete responders, 30 were partial responders (34%), and 13 were non-responders (15%). At 1 year from the second SICUS, no patients with a complete response, based on ultrasonography, underwent surgery, in comparison to partial responders (P = .0003) or non-responders (P = .001). Complete responders used smaller amounts of corticosteroids than partial responders (P = .0001) or non-responders (P < .0001). Complete responders required fewer hospitalizations than non-responders (P = .001). Kaplan-Meier survival analysis of long-term follow up data demonstrated a lower cumulative probability of need for surgery, hospitalization, and need for steroids among SICUS-categorized complete responders (P < .0001, P = .003 and P = .0001 respectively) than SICUS-categorized non-responders. CONCLUSIONS In patients with CD, response to anti-TNF agents, determined by SICUS, is associated with better long-term outcomes than partial or no response. Ultrasonographic assessment therefore provides a relatively non-invasive method for monitoring response to treatment in patients with CD.
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Affiliation(s)
- Francesca Zorzi
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Subrata Ghosh
- NIHR Biomedical Research Centre Birmingham, University of Birmingham, Birmingham, United Kingdom
| | - Carlo Chiaramonte
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elisabetta Lolli
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Martina Ventura
- Department of Epidemiology, Lazio Regional Health Service, Rome Italy
| | - Sara Onali
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elena De Cristofaro
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimo C Fantini
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Livia Biancone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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López Zúñiga MÁ, Vallejo Palomino T, Martin Toro MA, Castillo Fernández AM, Gerez Neira D, Vílchez Parras AM, Villa García MI, Martínez Colmenero J, Padilla Moreno F, Campos Calero A, Torres Macho J. Diagnostic Capacity of Pocket-Sized Ultrasound Devices at Point of Care by a Non-radiologist Resident in Patients with Suspected Abdominal Pathology. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:263-268. [PMID: 31767453 DOI: 10.1016/j.ultrasmedbio.2019.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
Studies have reported the usefulness and tolerability in practice of abdominal ultrasound performed by non-radiologists in various clinical situations. This prospective observational single-center study included 184 patients hospitalized in an internal medicine department who underwent conventional abdominal ultrasound. A medical resident with basic training performed point-of-care clinical ultrasound using a pocket-sized device. The concordance obtained between the researcher and the radiologist was good (k >0.6) for the gallbladder, splenomegaly, longitudinal diameter of the kidney, presence of renal cysts and hydronephrosis. The specificity was >90% for all parameters assessed except normal renal size. A negative predictive value >90% was obtained for all variables studied except the presence of hepatic space-occupying lesions and gallbladder pathology, the negative predictive values for which were >80%. A positive predictive value >80% was obtained for all of these variables, except the presence of adenopathies, hepatomegaly, space-occupying lesions, echogenicity and/or enlargement of the biliary tract, left renal atrophy and right renal masses. We conclude there was a high concordance between a conventional abdominal study and that performed with a pocket-sized ultrasound device after a brief learning curve.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Juan Torres Macho
- Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
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11
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Yang JD, Hainaut P, Gores GJ, Amadou A, Plymoth A, Roberts LR. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol 2019; 16:589-604. [PMID: 31439937 PMCID: PMC6813818 DOI: 10.1038/s41575-019-0186-y] [Citation(s) in RCA: 2371] [Impact Index Per Article: 474.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. Risk factors for HCC include chronic hepatitis B and hepatitis C, alcohol addiction, metabolic liver disease (particularly nonalcoholic fatty liver disease) and exposure to dietary toxins such as aflatoxins and aristolochic acid. All these risk factors are potentially preventable, highlighting the considerable potential of risk prevention for decreasing the global burden of HCC. HCC surveillance and early detection increase the chance of potentially curative treatment; however, HCC surveillance is substantially underutilized, even in countries with sufficient medical resources. Early-stage HCC can be treated curatively by local ablation, surgical resection or liver transplantation. Treatment selection depends on tumour characteristics, the severity of underlying liver dysfunction, age, other medical comorbidities, and available medical resources and local expertise. Catheter-based locoregional treatment is used in patients with intermediate-stage cancer. Kinase and immune checkpoint inhibitors have been shown to be effective treatment options in patients with advanced-stage HCC. Together, rational deployment of prevention, attainment of global goals for viral hepatitis eradication, and improvements in HCC surveillance and therapy hold promise for achieving a substantial reduction in the worldwide HCC burden within the next few decades.
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Affiliation(s)
- Ju Dong Yang
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pierre Hainaut
- Tumor Molecular Biology and Biomarkers Group, Institute for Advanced Biosciences, Inserm U 1209 CNRS UMR5309, Université Grenoble Alpes, Grenoble, France
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Amina Amadou
- Tumor Molecular Biology and Biomarkers Group, Institute for Advanced Biosciences, Inserm U 1209 CNRS UMR5309, Université Grenoble Alpes, Grenoble, France
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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Mancusi C, Carlino MV, Sforza A. Point-of-care ultrasound with pocket-size devices in emergency department. Echocardiography 2019; 36:1755-1764. [PMID: 31393640 DOI: 10.1111/echo.14451] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/17/2022] Open
Abstract
Point-of-care ultrasound is a useful tool for clinicians in the management of patients. Particularly in emergency department, the role of point-of-care ultrasound is strongly increasing due to the need for a rapid assessment of critically ill patients and to speed up the diagnostic process. Hand-carried ultrasound devices are particularly useful in emergency setting and allow rapid assessment of patient even in prehospital setting. This article will review the role of point-of-care ultrasonography, performed with pocket-size devices, in the management of patients presenting with acute onset of undifferentiating dyspnea, chest pain, and shock in emergency department.
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Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
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13
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Rykkje A, Carlsen JF, Nielsen MB. Hand-Held Ultrasound Devices Compared with High-End Ultrasound Systems: A Systematic Review. Diagnostics (Basel) 2019; 9:diagnostics9020061. [PMID: 31208078 PMCID: PMC6628329 DOI: 10.3390/diagnostics9020061] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to review the scientific literature available on the comparison of hand-held ultrasound devices with high-end systems for abdominal and pleural applications. PubMed, Embase, Web of Science and Cochrane were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Original research describing hand-held ultrasound devices compared with high-end systems was included and assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2. The search was limited to articles published since 1 January 2012. A total of 2486 articles were found and screened by title and abstract. A total of 16 articles were chosen for final review. All of the included articles showed good overall agreement between hand-held and high-end ultrasound systems. Strong correlations were found when evaluating ascites, hydronephrosis, pleural cavities, in detection of abdominal aortic aneurysms and for use with obstetric and gynaecological patients. Other articles found good agreement for cholelithiasis and for determining the best site for paracentesis. QUADAS-2 analysis suggested few risks of bias and almost no concerns regarding applicability. For distinct clinical questions, hand-held devices may be a valuable supplement to physical examination. However, evidence is inadequate, and more research is needed on the abdominal and pleural use of hand-held ultrasound with more standardised comparisons, using only blinded reviewers.
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Affiliation(s)
- Alexander Rykkje
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
| | | | - Michael Bachmann Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
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14
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Taylor SA, Rieder F, Fletcher JG. Differences in the imaging of Crohn's disease patients between North America and Europe: are we ready to bridge the divide? Abdom Radiol (NY) 2019; 44:1637-1643. [PMID: 30580391 DOI: 10.1007/s00261-018-1872-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The emphasis of treatment in Crohn's disease has evolved from a reactive model to "treat-to-target" approaches. Cross-sectional imaging has rapidly evolved in parallel, with a growing evidence base supporting its abilities for diagnosis, monitoring and prognostication. Whilst there are differences in emphasis between Europe and North America, particularly around the type of imaging modalities and patterns of multidisciplinary care, there is increasing convergence. This perspective piece provides an overview of the evolving role of cross-sectional imaging in Crohn's disease, discusses practice differences between North America and Europe and provides suggestions on areas for future collaboration and research priorities.
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Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Lau BC, Motamedi D, Lee N. Orthopaedic Residents' Interpretation of Point-of-Care Assessment of Distal Radial Fractures with Use of Pocket-Sized Ultrasound Devices. J Bone Joint Surg Am 2019; 101:e38. [PMID: 31045677 DOI: 10.2106/jbjs.17.01098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Musculoskeletal ultrasonography is a tool that is being used increasingly. However, the interpretation of ultrasound images of fractures is not incorporated into orthopaedic training programs. This paper presents the results of an initiative to train orthopaedic surgery residents to accurately interpret images of distal radial fractures in adults and to assess their confidence levels and attitudes regarding their future use of ultrasonography. METHODS Six junior residents were given a pretest with 100 distal radial images that had been made with a pocket-sized ultrasound device; they were asked to determine fracture versus nonfracture cases (50 cases) as well as reduced fracture versus nonreduced fracture cases (50 cases). Following the pretest, residents completed a 30-minute tutorial (didactic and practical) on distal radial ultrasonography. The residents then completed a period of self-practice during 2 separate trauma rotations (a total of 14 to 16 weeks in a single academic year). Following completion of their second trauma rotation, the residents completed a posttest. Comfort level using a pocket-sized ultrasound device also was assessed during pretesting and posttesting. RESULTS The median number of days from the pretest to the posttest was 212 days (range, 175 to 225 days). Residents demonstrated an overall improvement in positive predictive value (PPV) of identifying a fracture from the pretest (86.0%; range, 77.5% to 93.1%) to the posttest (93.5%; range, 91.4% to 94.2%). The overall negative predictive value (NPV) for identifying a fracture also improved from the pretest (69.4%; range, 60.0% to 76.9%) to the posttest (81.0%; range, 76.4% to 86.7%; p = 0.04). The overall PPV for detecting a reduced fracture improved from 67.1% with the pretest (range, 54.2% to 82.4%) to 88.9% with the posttest (range, 83.3% to 94.1%; p = 0.04). The comfort level with using the ultrasound device also increased between pretesting and posttesting, and the residents felt that ultrasonography would be useful in the care of distal radial fractures. CONCLUSIONS After a focused training session and a period of self-practice, orthopaedic residents improved their interpretation of ultrasound images and their comfort level using pocket-sized ultrasound devices with adult patients with distal radial fractures. Residents felt that a pocket-sized ultrasound device was useful for fracture diagnosis and evaluation of reduction.
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Affiliation(s)
- Brian C Lau
- Departments of Orthopaedic Surgery (B.C.L. and N.L.) and Radiology and Biomedical Imaging (D.M.), University of California San Francisco Medical Center, San Francisco, California
| | - Daria Motamedi
- Departments of Orthopaedic Surgery (B.C.L. and N.L.) and Radiology and Biomedical Imaging (D.M.), University of California San Francisco Medical Center, San Francisco, California
| | - Nicolas Lee
- Departments of Orthopaedic Surgery (B.C.L. and N.L.) and Radiology and Biomedical Imaging (D.M.), University of California San Francisco Medical Center, San Francisco, California
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Del Medico M, Altieri A, Carnevale-Maffè G, Formagnana P, Casella F, Barchiesi M, Bergonzi M, Vattiato C, Casazza G, Cogliati C. Pocket-size ultrasound device in cholelithiasis: diagnostic accuracy and efficacy of short-term training. Intern Emerg Med 2018; 13:1121-1126. [PMID: 29982876 DOI: 10.1007/s11739-018-1901-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022]
Abstract
Pocket-size ultrasound devices (PSUD) are now widely available becoming a useful tool for diagnostic and therapeutic purposes. We aim to investigate the accuracy of PSUD in diagnosing cholelithiasis as compared to traditional ultrasonography. Moreover, we tested the reliability of PSUD when performed by inexperienced internal medicine residents after a short-term training. We consecutively enrolled inpatients and outpatients referred to undergo abdominal ultrasonography for signs or symptoms of gallbladder diseases in two different hospitals. Every patient underwent two independent examinations with PSUD by both expert (EXPPSUD) and nonexpert operators (N-EXPPSUD), and a conventional examination with traditional abdominal ultrasound (AUS). Every naive operator underwent a short-term training with a 2-h theoretical lesson, and a practical training focused on gallbladder under expert operator supervision. Overall, 146 patients were consecutively enrolled. Considering conventional AUS as the reference standard, sensitivity and specificity of EXPPSUD were, respectively, 93.75 and 100%. Sensitivity and specificity of N-EXPPSUD were, respectively, 75 and 91.25%. Nevertheless, when considering outpatients, PSUD has a high diagnostic accuracy even when performed by N-EXPPSUD with sensitivity of 93% and specificity of 88%. PSUD is a reliable tool for the diagnosis of cholelithiasis when used by expert operators potentially reducing the need for further diagnostic tests. It can even be successfully used by non-expert operators in outpatients setting after a short focussed training.
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Affiliation(s)
- Marta Del Medico
- Department of Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Alessandra Altieri
- Department of Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Gabriella Carnevale-Maffè
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Pietro Formagnana
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesco Casella
- Department of Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy.
| | - Marco Barchiesi
- Department of Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Manuela Bergonzi
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Claudia Vattiato
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Chiara Cogliati
- Department of Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy
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