Quantitative MRCP as Part of Primary Sclerosing Cholangitis Standard of Care in the National Health Service in England: A Feasibility Assessment Among Hepatologists

Background: Primary sclerosing cholangitis (PSC) is a rare chronic liver disease characterised by bile duct strictures. Magnetic resonance cholangiopancreatography (MRCP) is the principal imaging modality for diagnosis; however, its interpretation is subjective. Quantitative MRCP (MRCP+) provides quantitative assessment of the biliary anatomy and can support objective disease assessment. We evaluated the potential impact, feasibility, and perceived usefulness that MRCP+ would have on PSC patient management. Methods: Alongside systematic evaluation of UK and European clinical guidelines on PSC management, semi-structured interviews with 16 stakeholders were conducted. The Lean Assessment Process methodology was used to assess potential impact and feasibility of adopting MRCP+ for the PSC care pathway within the NHS. Price as a barrier to adoption was investigated to evaluate perceptions between technology cost and adoption. Perceived ease of use and perceived trust were calculated and used to evaluate perceived usefulness (PU). Results: For PSC management, MRCP (81%) scored higher than liver biopsy (68%) and ERCP (50%) due to its non-invasive nature. There was good internal consistency between responders on the relationship between price point and the use of MRCP+ to support diagnosis (CA:0.836) and monitoring (CA:0.904). A price point of up to GBP 500 was unlikely to be a barrier for adoption. The overall perceived usefulness for MRCP+ for patient management was 74%. Conclusions: There is strong interest in using MRCP+ to support PSC management. MRCP+ has the potential to address unmet needs including reducing subjectivity, measurement of the whole biliary tree and objectively measuring biliary disease progression

Do lower antenatal blood pressure cut-offs in pregnant women with obesity identify those at greater risk of adverse maternal and perinatal outcomes? A secondary analysis of data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT)

\ua9 The Author(s) 2025. Background: Obesity is a major risk-factor for adverse pregnancy outcomes. While the 2017 American College of Cardiology/American Heart Association (ACC/AHA) classification of normal and abnormal blood pressure (BP) outside pregnancy has been suggested for use in pregnancy, the impact on adverse outcomes has not been examined specifically in women with obesity. Methods: The UK Pregnancies Better Eating and Activity Trial (UPBEAT) enroled women with a body mass index (BMI) ≥ 30 kg/m2. In secondary analyses, maximal antenatal BP was categorised by 2017 ACC/AHA criteria: ‘Normal’ BP (systolic [sBP] <120 mmHg and diastolic [dBP] <80 mmHg), ‘Elevated’ BP (sBP 120–129 mmHg and dBP <80 mmHg), ‘Stage 1 hypertension’ (sBP 130–139 mmHg and/or dBP 80-89 mmHg), and ‘Stage 2 hypertension’ (sBP ≥140 mmHg and/or dBP ≥90 mmHg, non-severe [sBP 140-159 mmHg and/or dBP 90–109 mmHg] and severe (sBP ≥160 mmHg and/or dBP ≥110 mmHg). Main outcomes were preterm birth, postpartum haemorrhage (PPH), birthweight <10th centile (small-for-gestational age, SGA), and neonatal intensive care unit (NICU) admission. Associations with adverse outcomes were adjusted for UPBEAT intervention, maternal age, booking BMI, ethnicity, parity, smoking, alcohol, and previous pre-eclampsia or gestational diabetes. Diagnostic test properties (positive and negative likelihood ratios, -LR and +LR) were assessed as individual categories (vs. ‘Normal’ BP), and as threshold values. Results: Severe ‘Stage 2 hypertension’ (vs. BP < 160/110 mmHg) was associated with PPH (RR 2.57 (1.35, 4.86)) and SGA (RR 2.52 (1.05, 6.07)) only in unadjusted analyses. No outcomes were associated with ‘Stage 1 hypertension’ or ‘Elevated BP’. All +LR were <5.0 and -LR ≥ 0.20, indicating that no BP threshold was useful as a diagnostic test to detect preterm birth, PPH, SGA, or NICU admission. Conclusions: Among pregnant women with obesity, we found no evidence that lowering the antenatal BP considered to be abnormal (from 140/90 mmHg) would assist in identifying women and babies at risk

Comparison of Saccular Function in Nonmusicians and Violinists Using cVEMP: A Pilot Study

Abstract Introduction Human auditory and vestibular systems change due to noise exposure. Professional musicians are often subjected to loud music and longer durations as part of their practice. Although the effects of music have been explored extensively on the auditory system, it is important to understand changes in the vestibular system also. The current study is aimed to compare cervical vestibular evoked myogenic potential (cVEMP) findings in nonmusicians and violinists to understand if there are any changes in the P1 and N1 latencies and absolute amplitudes in the violinists’ groups because of their exposure to violin music. Materials and Methods Twelve participants (6 nonmusicians and 6 violinists) of both genders were included in the study. Pure tone audiometry and distortion product otoacoustic emissions (DPOAEs) were performed on all the participants. cVEMP P1 and N1 latencies and absolute amplitudes were obtained, and overall mean differences were compared within and between groups. Results Pure tone average and DPOAE were within the normal range between and within the groups. Results indicate that P1 and N1 absolute amplitudes and latencies were slightly prolonged in the violinists’ group; however, the mean difference was not statistically significant. Comparison of mean absolute amplitudes and latencies between the ears in the violinists’ group showed longer latencies and greater absolute amplitudes in the left ear of violinists as compared with the right ear. In the study, the violinists’ group consisted of participants who had an average daily exposure of about one-and-a-half hours and had an experience of playing the instrument for more than 5 years. Conclusion cVEMP is useful in detecting early changes in the saccule that may occur due to noise exposure. It can be concluded that, even before a clinically detectable hearing loss or vestibular damage, changes in saccule are observed with the help of cVEMP and should be included in the audiovestibular test for early identification.</jats:p