Search

Diagnosis of diffuse parenchymal lung diseases (DPLD) on high resolution CT (HRCT) is difficult for non-expert radiologists due to varied presentation for any single disease and overlap in presentation between diseases.To evaluate whether a pattern-based training algorithm can improve the ability of non-experts to diagnosis of DPLD.Five experts (cardiothoracic-trained radiologists), and 25 non-experts (non-cardiothoracic-trained radiologists, radiology residents, and pulmonologists) were each assigned a semi-random subset of cases from a compiled database of DPLD HRCTs. Each reader was asked to create a top three differential for each case. The non-experts were then given a pattern-based training algorithm for identifying DPLDs. Following training, the non-experts were again asked to create a top three differential for each case that they had previously evaluated. Accuracy between groups was compared using Chi-Square analysis.A total of 400 and 1450 studies were read by experts and non-experts, respectively. Experts correctly placed the diagnosis as the first item on the differential versus having the correct diagnosis as one of their top three diagnoses at an overall rate of 48 and 64.3%, respectively. Pre-training, non-experts achieved a correct diagnosis/top three of 32.5 and 49.7%, respectively. Post-training, non-experts demonstrated a correct diagnosis/top three of 41.2 and 65%, a statistically significant increase (p0.0001). In addition, post training, there was no difference between non-experts and experts in placing the correct diagnosis within their top three differential.The diagnosis of DPLDs by HRCT imaging alone is relatively poor. However, use of a pattern-based teaching algorithm can improve non-expert interpretation and enable non-experts to include the correct diagnosis within their differential diagnoses at a rate comparable to expert cardiothoracic trained radiologists.

Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI.\ud \ud An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow‐up was 90 days. The primary outcome was the incidence of groin wound SSI.\ud \ud 1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 versus 5 days, P = .005), a significantly higher rate of post‐operative acute kidney injury (19.6% versus 11.7%, P = .018), with no significant difference in 90‐day mortality. Female sex, Body mass index≥30 kg/m2, ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft, or prosthetic), and increased operative time were independent predictors of SSI.\ud \ud Groin infections, which are clinically apparent to the treating vascular unit, are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non‐modifiable variables.

Coronavirus(CoV) and human metaneumovirus(hMPV) are worldwide causes of lower respiratory tract infection(LRTI) in adults Chest CT is increasingly used in the diagnosis and management of LRTI Our aims were to compare chest CT features for LRTI due to sporadic CoV with hMPV and correlate chest CT findings with clinical outcomes We retrospectively reviewed records of 61 adults with nucleic acid amplification(NAA) assay positive for CoV and 104 adults positive for hMPV over 33 months at 4 community hospitals in the northeast US A thoracic radiologist reviewed all chest CT images Inclusion criteria included:1 symptoms of acute LRTI, 2 chest CT within 7 days of positive NAA assay, 3 no other pulmonary infection/lung disease that might interfere with chest CT interpretation Ground-glass opacities(GGO) were more frequent (p< 05) with hMPV(47/104,45%) than with sporadic CoV(15/61,25%) Multifocal consolidation was more common (p< 05) with hMPV(31/104,30%) than with sporadic CoV(8/61,13%) LRTI without chest CT findings was more common (p< 05) with sporadic CoV (28/61,46%) than with hMPV (16/104,15%) For hMPV, multifocal consolidation was associated(p< 05) with treatment with assisted ventilation(9/30,30%) For hMPV, no other chest CT finding correlated with any studied outcome(new supplementary oxygen at discharge, discharge to skilled facility, hospital re-admission within 30 days) No chest CT finding correlated with any studied outcome for sporadic CoV With hMPV, healthcare providers should be aware that multifocal consolidation on chest CT often portends treatment with invasive/non-invasive ventilatory support

Our understanding of how genotype controls phenotype is limited by the scale at which we can precisely alter the genome and assess the phenotypic consequences of each perturbation. Here we describe a CRISPR-Cas9-based method for multiplexed accurate genome editing with short, trackable, integrated cellular barcodes (MAGESTIC) in Saccharomyces cerevisiae. MAGESTIC uses array-synthesized guide-donor oligos for plasmid-based high-throughput editing and features genomic barcode integration to prevent plasmid barcode loss and to enable robust phenotyping. We demonstrate that editing efficiency can be increased more than fivefold by recruiting donor DNA to the site of breaks using the LexA-Fkh1p fusion protein. We performed saturation editing of the essential gene SEC14 and identified amino acids critical for chemical inhibition of lipid signaling. We also constructed thousands of natural genetic variants, characterized guide mismatch tolerance at the genome scale, and ascertained that cryptic Pol III termination elements substantially reduce guide efficacy. MAGESTIC will be broadly useful to uncover the genetic basis of phenotypes in yeast.