Ischemic necrosis of the breast following septic shock: A case report.

Fat necrosis of the breast is a common and benign entity, often secondary to trauma, surgery, radiation therapy, or unknown etiologies. Critically ill patients with septic shock may experience end-organ hypoperfusion and tissue infarction and necrosis, which may result in breast fat necrosis, however, to the best of our knowledge this has not been previously described. We report a case of biopsy-proven breast fat necrosis secondary to septic shock following an emergency surgery in a postmenopausal female.

Development of RAD-Score: A Tool to Assess the Procedural Competence of Diagnostic Radiology Residents.

OBJECTIVE: The purpose of this study is to develop a tool to assess the procedural competence of radiology trainees, with sources of evidence gathered from five categories to support the construct validity of tool: content, response process, internal structure, relations to other variables, and consequences. SUBJECTS AND METHODS: A pilot form for assessing procedural competence among radiology residents, known as the RAD-Score tool, was developed by evaluating published literature and using a modified Delphi procedure involving a group of local content experts. The pilot version of the tool was tested by seven radiology department faculty members who evaluated procedures performed by 25 residents at one institution between October 2014 and June 2015. Residents were evaluated while performing multiple procedures in both clinical and simulation settings. The main outcome measure was the percentage of residents who were considered ready to perform procedures independently, with testing conducted to determine differences between levels of training. RESULTS: A total of 105 forms (for 52 procedures performed in a clinical setting and 53 procedures performed in a simulation setting) were collected for a variety of procedures (eight vascular or interventional, 42 body, 12 musculoskeletal, 23 chest, and 20 breast procedures). A statistically significant difference was noted in the percentage of trainees who were rated as being ready to perform a procedure independently (in postgraduate year [PGY] 2, 12% of residents; in PGY3, 61%; in PGY4, 85%; and in PGY5, 88%; p < 0.05); this difference persisted in the clinical and simulation settings. User feedback and psychometric analysis were used to create a final version of the form. CONCLUSION: This prospective study describes the successful development of a tool for assessing the procedural competence of radiology trainees with high levels of construct validity in multiple domains. Implementation of the tool in the radiology residency curriculum is planned and can play an instrumental role in the transition to competency-based radiology training.

Practical applications of balanced steady-state free-precession (bSSFP) imaging in the abdomen and pelvis.

Balanced steady-state free-precession (bSSFP) is an important pulse sequence that may be underutilized in abdominal and pelvic magnetic resonance imaging (MRI). bSSFP offers several advantages for abdominal and pelvic MRI that include: bright blood effects, a relative insensitivity to the dephasing effects which occur in structures with linear movement, low specific absorption rate (SAR), high signal-to-noise ratio (SNR), high spatial resolution, and rapid acquisition times. Bright blood effects can be exploited to diagnose or confirm vascular pathologies when gadolinium-enhanced imaging cannot be performed, is indeterminate, or is degraded by artifact. The relative insensitivity to dephasing artifact in areas of linear movement is useful when imaging the biliary, urinary, and gastrointestinal tracts where dephasing artifacts may mimic filling defects such as calculi or polyps. Low SAR imaging is important in pediatric and pregnant patients and may be useful in patients with medical devices that restrict SAR levels. Rapid acquisition times and high SNR are extremely valuable assets in abdominal and pelvic MRI and bSSFP (which can be performed as static or cine acquisitions) and can be added to most existing abdominal and pelvic protocols when deemed suitable without significantly prolonging examination times. This article reviews the fundamentals of bSSFP imaging, presents vascular and nonvascular applications of bSSFP in abdominal and pelvic MRI, and discusses potential limitations (including imaging artifacts) of bSSFP. LEVEL OF EVIDENCE: 5 J. Magn. Reson. Imaging 2017;45:11-20.

Design, expression, and purification of de novo transmembrane "hairpin" peptides.

While our understanding of the folding and structure of water-soluble proteins has progressed to the point where they can be artificially designed and produced from first principles, there has been only limited work toward the de novo design of membrane proteins. Such studies have been hindered in large part due to the practical challenges in the production and characterization of multispanning transmembrane (TM) proteins that arise from their highly hydrophobic character. In this work, we used molecular biology cloning techniques to produce a library of partially randomized Ala- and Ile-rich de novo helix-loop-helix (hairpin) TM constructs as models for tertiary TM-TM folding. From this plasmid DNA library, we selected sequences corresponding to hairpins with 0, 1, or 2 putative TM segments. While purification protocols could be adapted for application with a broad range of designed protein hairpins, bacterial expression of constructs with multiple predicted TM segments was limited as it is with native membrane proteins. Examples of the peptide hairpins obtained were characterized by circular dichroism spectroscopy, tryptophan fluorescence, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). We found that hairpins composed of two TM segments display characteristic behavior on detergent solubilization, such as an increase in helical structure (vs. that in aqueous buffer), and sequence-dependent migration rates in SDS-PAGE analysis-features that may serve as structural hallmarks to verify dual TM topology in hairpin sequences.