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Esteban Y, Rodriguez-Smith J, Tominna M, Cassedy A, Meyers AB, Henrickson M, Ting TV, Vega-Fernandez P. Dissemination of a Pediatric Musculoskeletal POCUS Scoring System via Virtual Education: A Proof-of-Concept Study. POCUS J 2023; 8:146-152. [PMID: 38099160 PMCID: PMC10721286 DOI: 10.24908/pocus.v8i2.16229] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Point of care pediatric musculoskeletal POCUS scanning and scoring protocols for childhood arthritis have emerged in recent years. However, pediatric musculoskeletal POCUS curricula in rheumatology fellowship programs are limited due to availability of trained faculty and resources. This proof-of-concept study investigated the effectiveness of educational methods for a pediatric musculoskeletal POCUS scoring protocol among fellows and physicians of differing subspecialties. Educational methods assessed included recorded videos and virtual review sessions. Effectiveness was assessed by calculating interrater reliability for the musculoskeletal POCUS scoring systems using the intra-class correlation coefficient (ICC). Following training sessions, participants then underwent scoring exercise(s) until the goal of an excellent ICC ≥ 0.75 was reached. Four participants completed two rounds of virtual education, review, and scoring sessions. Excellent interrater reliability was achieved for most views. This proof-of-concept study demonstrated virtual education covering advanced concepts of pediatric musculoskeletal POCUS provides a knowledge base for physicians from different subspecialties and various experience.
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Affiliation(s)
- Ysabella Esteban
- Division of Rheumatology, Nationwide Children's HospitalColumbus, OHUSA
| | - Jackeline Rodriguez-Smith
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | | | - Amy Cassedy
- Department of Pediatrics, Division of Biostatistics and Epidemiology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Arthur B Meyers
- Department of Radiology, Division of Radiology and Medical Imaging, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Michael Henrickson
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Tracy V Ting
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Patricia Vega-Fernandez
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
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Vega-Fernandez P, Esteban Y, Oberle E, Proulx-Gauthier JP, Clark M, Shenoi S, Thatayatikom A, Benham H, Brunner EJ, Woolnough L, Henrickson M, Pratt LR, De Ranieri D, Hoffmann S, Janow G, Bukulmez H, Altaye M, Cassedy A, Ting TV, Roth J. Reliability of the Pediatric Specific Musculoskeletal Ultrasound Scoring Systems for the Elbow, Wrist, and Finger Joints. J Rheumatol 2023; 50:236-239. [PMID: 36182106 PMCID: PMC9898106 DOI: 10.3899/jrheum.220382] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Musculoskeletal ultrasound (MSUS) is increasingly being used in the evaluation of pediatric musculoskeletal diseases. In order to provide objective assessments of arthritis, reliable MSUS scoring systems are needed. Recently, joint-specific scoring systems for arthritis of the pediatric elbow, wrist, and finger joints were proposed by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) MSUS workgroup. This study aimed to assess the reliability of these scoring systems when used by sonographers with different levels of expertise. METHODS Members of the CARRA MSUS workgroup attended training sessions for scoring the elbow, wrist, and finger. Subsequently, scoring exercises of B mode and power Doppler (PD) mode still images for each joint were performed. Interreader reliability was determined using 2-way single-score intraclass correlation coefficients (ICCs) for synovitis and Cohen [Formula: see text] for tenosynovitis. RESULTS Seventeen pediatric rheumatologists with different levels of MSUS expertise (1-15 yrs) completed a 2-hour training session and calibration exercise for each joint. Excellent reliability (ICC > 0.75) was found after the first scoring exercise for all the finger and elbow views evaluated on B mode and PD mode, and for all of the wrist views on B mode. After a second training session and a scoring exercise, the wrist PD mode views reached excellent reliability as well. CONCLUSION The preliminary CARRA MSUS scoring systems for assessing arthritis of the pediatric elbow, wrist, and finger joints demonstrate excellent reliability among pediatric MSUS sonographers with different levels of expertise. With further validation, this reliable joint-specific scoring system could serve as a clinical tool and scientific outcome measure.
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Affiliation(s)
- Patricia Vega-Fernandez
- P. Vega-Fernandez, MD, MSc, Y. Esteban, MD, M. Henrickson, MD, MPH, T.V. Ting, MD, MSc, Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA;
| | - Ysabella Esteban
- P. Vega-Fernandez, MD, MSc, Y. Esteban, MD, M. Henrickson, MD, MPH, T.V. Ting, MD, MSc, Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Edward Oberle
- E. Oberle, MD, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jean-Philippe Proulx-Gauthier
- J.P. Proulx-Gauthier, MD, FRCPC, Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Matthew Clark
- M. Clark, MD, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan Shenoi
- S. Shenoi, MBBS, MS, Seattle Children's Hospital and Research Center University of Washington, Seattle, Washington, USA
| | | | - Heather Benham
- H. Benham, DNP, APRN, Scottish Rite for Children Dallas, Dallas, Texas, USA
| | - Emily J Brunner
- E.J. Brunner, DO, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Leandra Woolnough
- L. Woolnough, MD, MSCS, Department of Pediatrics, UFHealth, Gainesville, Florida, USA
| | - Michael Henrickson
- P. Vega-Fernandez, MD, MSc, Y. Esteban, MD, M. Henrickson, MD, MPH, T.V. Ting, MD, MSc, Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Laura R Pratt
- L.R. Pratt, MD, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Deirdre De Ranieri
- D. De Ranieri, MD, Department of Pediatrics, Northwestern Feinberg School of Medicine, Division of Rheumatology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Sarah Hoffmann
- S. Hoffmann, MD, Children's Hospital of Richmond, Virginia, USA
| | - Ginger Janow
- G. Janow, MD, MPH, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey, USA
| | - Hulya Bukulmez
- H. Bukulmez, MD, Department of Pediatrics, Division of Pediatric Rheumatology, Metro Health Medical System, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mekibib Altaye
- M. Altaye, PhD, A. Cassedy, PhD, Department of Pediatrics, University of Cincinnati, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Amy Cassedy
- M. Altaye, PhD, A. Cassedy, PhD, Department of Pediatrics, University of Cincinnati, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tracy V Ting
- P. Vega-Fernandez, MD, MSc, Y. Esteban, MD, M. Henrickson, MD, MPH, T.V. Ting, MD, MSc, Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Erkens R, Esteban Y, Towe C, Schulert G, Vastert S. Pathogenesis and Treatment of Refractory Disease Courses in Systemic Juvenile Idiopathic Arthritis: Refractory Arthritis, Recurrent Macrophage Activation Syndrome and Chronic Lung Disease. Rheum Dis Clin North Am 2021; 47:585-606. [PMID: 34635293 DOI: 10.1016/j.rdc.2021.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Systemic juvenile idiopathic arthritis is a distinct and heterogeneous disease presently classified under the umbrella of juvenile idiopathic arthritis, with some patients following a monophasic remitting course, whereas others have persistent disease with chronic organ- and life-threatening complications. Although biologic therapies have revolutionized treatment, recent follow-up studies report significant numbers of children with persistently active disease on long term follow-up. This review focuses on refractory disease courses, specifically refractory arthritis, systemic juvenile idiopathic arthritis with recurrent, or longstanding signs of macrophage activation syndrome, and systemic juvenile idiopathic arthritis associated with suspected, probable, or definite lung disease.
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Affiliation(s)
- Remco Erkens
- Division of Pediatric Rheumatology & Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands; Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, the Netherlands
| | - Ysabella Esteban
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Christopher Towe
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Grant Schulert
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sebastiaan Vastert
- Division of Pediatric Rheumatology & Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands; Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, the Netherlands.
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Nahar-Gohad P, Sultan H, Esteban Y, Stabile A, Ko JL. RACK1 identified as the PCBP1-interacting protein with a novel functional role on the regulation of human MOR gene expression. J Neurochem 2012; 124:466-77. [PMID: 23173782 DOI: 10.1111/jnc.12100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 11/10/2012] [Accepted: 11/14/2012] [Indexed: 12/23/2022]
Abstract
Poly C binding protein 1 (PCBP1) is an expressional regulator of the mu-opioid receptor (MOR) gene. We hypothesized the existence of a PCBP1 co-regulator modifying human MOR gene expression by protein-protein interaction with PCBP1. A human brain cDNA library was screened using the two-hybrid system with PCBP1 as the bait. Receptor for activated protein kinase C (RACK1) protein, containing seven WD domains, was identified. PCBP1-RACK1 interaction was confirmed via in vivo validation using the two-hybrid system, and by co-immunoprecipitation with anti-PCBP1 antibody and human neuronal NMB cell lysate, endogenously expressing PCBP1 and RACK1. Further co-immunoprecipitation suggested that RACK1-PCBP1 interaction occurred in cytosol alone. Single and serial WD domain deletion analyses demonstrated that WD7 of RACK1 is the key domain interacting with PCBP1. RACK1 over-expression resulted in a dose-dependent decrease of MOR promoter activity using p357 plasmid containing human MOR promoter and luciferase reporter gene. Knock-down analysis showed that RACK1 siRNA decreased the endogenous RACK1 mRNA level in NMB, and elevated MOR mRNA level as indicated by RT-PCR. Likewise, a decrease of RACK1 resulted in an increase of MOR proteins, verified by (3) H-diprenorphine binding assay. Collectively, this study reports a novel role of RACK1, physically interacting with PCBP1 and participating in the regulation of human MOR gene expression in neuronal NMB cells.
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Affiliation(s)
- Pranjal Nahar-Gohad
- Department of Biological Sciences, Seton Hall University, South Orange, NJ 07079, USA
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