An international survey to assess use of oral and rectal contrast in CT protocols for penetrating torso trauma.

PURPOSE: There is controversy regarding the administration of oral and rectal contrast for CT performed to detect bowel injury in the context of penetrating torso trauma. Given the lack of published societal guidelines, our goal was to survey radiologists from the American Society of Emergency Radiology membership database to determine consensus on CT protocols for penetrating trauma. METHODS: With ethics board approval, an anonymous ten-question online survey was distributed via email to 589 radiologists in the American Society of Emergency Radiology (ASER) member database. The survey was open for a 4-week period in February 2018. A commercially available website that allows subscribers to create and analyze survey results was used for analysis. RESULTS: We received 124 responses (21% response rate) with a majority from U.S. institutions (82%). Seventy-four percent of respondents indicated they do not routinely administer oral contrast in penetrating trauma, 68% do not administer rectal contrast, and 90% do not use commercially available software to assess penetrating injury trajectory. Results from U.S. and non-U.S. practices were comparable. The decision to administer intraluminal contrast is made by the referring physician at 52% of institutions. There is in-house attending level radiology coverage at 54% of institutions and when asked if trauma scans are reviewed before removing the patient from the table, 41% of respondents answered "No." CONCLUSION: Enteric contrast is used in a minority of respondents' centers for penetrating trauma cases, which is likely driven by a perceived lack of added benefit and delays in patient care.

Multiplexed paper test strip for quantitative bacterial detection.

Rapid, sensitive, on-site detection of bacteria without a need for sophisticated equipment or skilled personnel is extremely important in clinical settings and rapid response scenarios, as well as in resource-limited settings. Here, we report a novel approach for selective and ultra-sensitive multiplexed detection of Escherichia coli (non-pathogenic or pathogenic) using a lab-on-paper test strip (bioactive paper) based on intracellular enzyme (ß-galactosidase (B-GAL) or ß-glucuronidase (GUS)) activity. The test strip is composed of a paper support (0.5 × 8 cm), onto which either 5-bromo-4-chloro-3-indolyl-ß-D: -glucuronide sodium salt (XG), chlorophenol red ß-galactopyranoside (CPRG) or both and FeCl(3) were entrapped using sol-gel-derived silica inks in different zones via an ink-jet printing technique. The sample was lysed and assayed via lateral flow through the FeCl(3) zone to the substrate area to initiate rapid enzyme hydrolysis of the substrate, causing a change from colorless-to-blue (XG hydrolyzed by GUS, indication of nonpathogenic E. coli) and/or yellow to red-magenta (CPRG hydrolyzed by B-GAL, indication of total coliforms). Using immunomagnetic nanoparticles for selective preconcentration, the limit of detection was ~5 colony-forming units (cfu) per milliliter for E. coli O157:H7 and ~20 cfu/mL for E. coli BL21, within 30 min without cell culturing. Thus, these paper test strips could be suitable for detection of viable total coliforms and pathogens in bathing water samples. Moreover, inclusion of a culturing step allows detection of less than 1 cfu in 100 mL within 8 h, making the paper tests strips relevant for detection of multiple pathogens and total coliform bacteria in beverage and food samples.

Emphasizing the Diagnostic Value of Digital Tomosynthesis in Detecting Hip Fractures.

Our institution recently implemented the use of digital tomosynthesis (DTS) to workup emergency room patients with suspected hip fractures after initial negative or indeterminate radiographs. Our purpose is to evaluate the diagnostic accuracy of DTS for hip fracture detection. We performed a retrospective review of all DTS studies over a 17-month period (July 2017 to November 2018). The results of the radiographs and DTS were recorded as either positive or negative for fracture based on the radiology report. Our reference standard for a fracture was either confirmation on subsequent CT or MRI from the same visit or documentation of clinical findings supportive of a fracture in the patient's electronic medical record. For patients with negative DTS who did not undergo subsequent cross-sectional imaging, a missed fracture was excluded if they did not return within 30 days with a confirmed fracture. Among 91 patients, there were 34 confirmed fractures-sites including, 7 femoral necks, 10 pubic rami, and 7 greater trochanters. DTS was positive for fracture in 29 patients; 28 of these fractures were true positives, 6 confirmed on cross-sectional imaging, and 22 confirmed clinically. One false positive was observed in a patient with no clinical evidence of a fracture. Six fractures were not detected by tomosynthesis but confirmed on CT/MRI. The sensitivity and specificity of DTS are 82% and 98%, respectively, compared to that of radiographs alone at 47% and 96%, respectively. DTS is a promising adjunct to radiographs for hip fracture detection in an emergency department.

Hysterectomy with Fetus In Situ for Uterine Rupture at 21-Week Gestation due to a Morbidly Adherent Placenta.

BACKGROUND: Uterine rupture due to a morbidly adherent placenta is a rare obstetrical cause of acute abdominal pain in the pregnant patient. We present a case to add to the small body of published literature describing this diagnosis. CASE: A 32-year-old G5T2P1A1L2 with multiple prior cesarean sections presented at 21+3 weeks' gestation with abdominal pain and presyncope. Ultrasound showed a large volume of complex intraabdominal free fluid and a heterogenous placenta with irregular lacunae and increased vascularity extending to the posterior bladder wall. Exploratory laparotomy identified a uterine defect and a hysterectomy was performed due to significant bleeding. Pathology confirmed a diagnosis of placenta percreta. CONCLUSION: Early recognition and management of uterine rupture due to a morbidly adherent placenta are essential to prevent catastrophic hemorrhage.

Efficacy and Accessibility of a Novel Liver Fibrosis Evaluation Program: Limited Abdominal Ultrasound with Concurrent Transient Elastography.

RATIONALE AND OBJECTIVES: To review sustainability and fair access related to setting up a centralized transient elastography (TE) program in the radiology department and to perform a quality assessment of a novel liver fibrosis evaluation program that combines TE with limited abdominal ultrasound (US). MATERIAL AND METHODS: As part of a quality assessment, a retrospective chart review was performed on 758 patients who underwent TE immediately after limited abdominal US of the liver over a 12-month period. The elastography results and sonographic findings were documented, including the number and type of lesions identified. In terms of fair access evaluation, the indication for TE and referring service was reviewed for each case. RESULTS: Most referrals were initiated by infectious disease (52.2% [396 of 758]) or gastroenterology (46.3% [351 of 758]) for patients with viral hepatitis (29.8% [226 of 758] for HBV and 52.2% [396 of 758] for HCV) and nonalcoholic steatohepatitis (11.9% [90 of 758]). Only 3.2% (24 of 758) of indications were outside the usual indications for which standardized values of TE were available. Most studies demonstrated minimal fibrosis (66.6% [510 of 766] ≤F1) or more advanced fibrosis (21.1% [162 of 766] ≥F3). Liver nodularity was observed in 63 cases, correlating to F2 fibrosis and above in 81.0% (51 of 63). US screening detected five new cases of hepatocellular carcinoma (HCC). CONCLUSIONS: This unique program allows fair access and ensures that referrals are requested for appropriate indications. Concurrent US confers many advantages including proper TE probe placement to optimize measurement success, characterization of sonographic features that correlate with advanced fibrosis, and provides an opportunity to screen for HCC, in a population which may not otherwise have access to standardized screening.

Chemical perturbation of secondary metabolism demonstrates important links to primary metabolism.

Bacterially produced secondary metabolites are used as antibiotics, anticancer drugs, and for many other medicinal applications. The mechanisms that limit the production of these molecules in the laboratory are not well understood, and this has impeded the discovery of many important compounds. We have identified small molecules that remodel the yields of secondary metabolites in many actinomycetes and show that one set of these molecules does so by inhibiting fatty acid biosynthesis. This demonstrates a particularly intimate relationship between this primary metabolic pathway and secondary metabolism and suggests an approach to enhance the yields of metabolites for discovery and biochemical characterization.

Synthesis of substituted isoquinolines via Pd-catalyzed cross-coupling approaches.

Palladium complexes incorporating ligands based on a 1,3,5,7-tetramethyl-2,4,8-trioxa-6-phosphaadamantanyl scaffold were used to catalyze the arylation of ethyl cyanoacetate, malononitrile, and various ketones. The products from these reactions can be elaborated to substituted ß-arylethylamines and used in microwave-assisted Pictet-Spengler reactions. The protocol developed is suitable for the synthesis of libraries of substituted isoquinolines.