Utility and cost evaluation of multiparametric magnetic resonance imaging for the assessment of non-alcoholic fatty liver disease.

BACKGROUND: Validated diagnostic tools that are accurate, cost effective and acceptable to patients are required for disease stratification and monitoring in NAFLD. AIMS: To investigate the performance and cost of multiparametric MRI alongside existing biomarkers in the assessment of NAFLD. METHODS: Adult patients undergoing standard of care liver biopsy for NAFLD were prospectively recruited at two UK liver centres and underwent multiparametric MRI, blood sampling and transient elastography withing 2 weeks of liver biopsy. Non-invasive markers were compared to histology as the gold standard. RESULTS: Data were obtained in 50 patients and 6 healthy volunteers. Corrected T1 (cT1) correlated with NAFLD activity score (ρ = 0.514, P < .001). cT1, enhanced liver fibrosis (ELF) test and liver stiffness differentiated patients with simple steatosis and NASH with AUROC (95% CI) of 0.69 (0.50-0.88), 0.87 (0.77-0.79) and 0.82 (0.70-0.94) respectively and healthy volunteers from patients with AUROC (95% CI) of 0.93 (0.86-1.00), 0.81 (0.69-0.92) and 0.89 (0.77-1.00) respectively. For the risk stratification of NAFLD, multiparametric MRI could save £150,218 per 1000 patients compared to biopsy. Multiparametric MRI did not discriminate between individual histological fibrosis stages in this population (P = .068). CONCLUSIONS: Multiparametric MRI accurately identified patients with steatosis, stratifies those with NASH or simple steatosis and reliably excludes clinically significant liver disease with superior negative predictive value (83.3%) to liver stiffness (42.9%) and ELF (57.1%). For the risk stratification of NAFLD, multiparametric MRI was cost effective and, combined with transient elastography, had the lowest cost per correct diagnosis.

An advocacy project to fluoridate toothpastes in Nepal.

AIMS: To describe a recent health promotion project undertaken by the United Mission to Nepal Oral Health Programme (UMN OHP) to increase the availability and consumption of affordable, fluoridated toothpaste in Nepal. METHOD: The process of advocating for the fluoridation of toothpastes in Nepal is based on Tearfund's advocacy cycle. RESULTS: The project achieved health promotion outcomes including healthy corporate and public policies and organisational practice and intermediate outcomes such as increased availability and consumption of affordable fluoridated toothpaste. Prior to implementation of the advocacy project in 1997, availability and consumption of fluoridated toothpaste was negligible. By March 2002 total market share of fluoridated toothpaste was approximately 90%. This represents an annual tonnage of 900 tons of fluoridated toothpaste. CONCLUSIONS: The health promotion activity of advocacy for the fluoridation of toothpastes in Nepal achieved measurable gains in health promotion outcomes and intermediate outcomes. Gains in health and social outcomes will take longer to evaluate but based on epidemiological evidence and the experience of other countries increased availability of affordable fluoridated toothpaste will have a significant and ongoing impact on the oral health of the people of Nepal.

In vitro infrared thermographic assessment of root surface temperatures generated by the thermafil plus system.

The purpose of this in vitro study was to investigate root surface temperatures generated by the Thermafil Plus system using infrared thermography. A total of 60 extracted human maxillary central incisors and maxillary first molars were biomechanically instrumented using ProFile 0.04 Taper Series 29 rotary instruments. The root canals were obturated using the Thermafil Plus system. An infrared thermography camera was used to measure the external root surface temperatures during and after the completion of obturation. The mean temperature rise of the external root surface from the ambient temperature was 4.26 degrees C for the mesial buccal roots, 4.58 degrees C for the distobuccal roots, 4.76 degrees C for the palatal roots, and 4.87 degrees C for the anterior roots. These temperatures were well below the critical level of 10 degrees C needed to cause damage to the attachment apparatus. From this in vitro experiment, no evidence was discovered which would indicate that the Thermafil Plus obturation system would result in damage to the periodontal ligament and the surrounding attachment apparatus as a consequence of temperature rise on the external root surface.

Use of the oxygen cost of breathing as an index of weaning ability from mechanical ventilation.

The oxygen cost of breathing (which is the difference in oxygen consumption measured during controlled ventilation and again during spontaneous ventilation) was measured in 30 patients between the ages of 17 and 96 years at the time of commencement of weaning from mechanical ventilation. There was a significant exponential correlation between the oxygen cost of breathing in ml/m2/min and the oxygen cost of breathing as a percentage of total oxygen consumption during spontaneous ventilation (OCB/VO2SV%) and the duration of weaning in days.