Radiology resident selection factors predict resident performance.

PURPOSE: To determine selection factors that predict radiology resident performance. METHODS: 59 consecutive radiology residents from 2002 to 2015 were ranked on performance during residency. Correlations and multiple regression analyses were performed to predict resident performance from the following selection factors: United States Medical Licensing Exam (USMLE) Step 1 score, medical school rank, Alpha Omega Alpha (AOA) membership, honors in clinical rotations, Medical Student Performance Evaluation (MSPE), and interview score. Results were compared against predictions from Match rank position. RESULTS: Five selection factors showed significant or marginally significant correlations with resident performance (r = 0.2 to 0.3). The interview score was not significantly correlated. A multiple regression model comprised of the USMLE Step 1 score, medical school rank, AOA membership, and interview score predicted resident performance, with an adjusted R2 of 0.19. The interview score was included in the model but did not achieve statistical significance. Match rank did not predict resident performance, with an R2 of 0.01. CONCLUSIONS: A multiple regression model comprised of the USMLE Step 1 score, medical school rank, and AOA membership predicted radiology resident performance and may assist with resident selection.

SH3YL1 protein as a novel biomarker for diabetic nephropathy in type 2 diabetes mellitus.

BACKGROUND AND AIMS: Oxidative stress contributes to development of diabetic nephropathy. We implicated SH3YL1 in oxidative stress-induced inflammation and examined whether SH3YL1 could be used as a new biomarker of diabetic nephropathy. METHODS AND RESULTS: In this study, we investigated the relationship between plasma level of SH3YL1 and diabetic nephropathy in patients with type 2 diabetes. In addition, we examined the physiological role of SH3YL1 in db/db mice and cultured podocytes. Plasma SH3YL1 concentration was significantly higher in patients with diabetes than in controls, even in normoalbuminuric patients, and was markedly increased in the macroalbuminuria group. Plasma SH3YL1 level was positively correlated with systolic blood pressure, HOMA-IR, postprandial blood glucose, plasma level of retinol binding protein 4 (RBP 4), and urinary albumin excretion (UAE) and was inversely correlated with BMI. Regression analysis showed that plasma level of RBP 4, UAE, and BMI were the only independent determinants of plasma SH3YL1 concentration. In db/db mice, plasma and renal SH3YL1 levels were significantly increased in mice with diabetes compared with control mice. In cultured podocytes, high glucose and angiotensin II stimuli markedly increased SH3YL1 synthesis. CONCLUSION: These findings suggest that plasma level of SH3YL1 offers a promising new biomarker for diabetic nephropathy.

Improved Radiologists' Efficiency and Accuracy with the Application of Scripting Software for the Automated Reporting of Comparison Studies.

RATIONALE AND OBJECTIVES: The American College of Radiology reporting guidelines state that "comparison with relevant examinations and reports should be part of the radiologic consultation and report when appropriate and available." MATERIALS AND METHODS: We evaluated the use of open-source Windows scripting software for the automated retrieval of the date and time of prior studies. RESULTS AND CONCLUSION: The date and time of the comparative study are transferred automatically to the present report in a structured voice recognition dictation system with a "regular expression substitution pattern" construct.

Effects of chlorine-based and quaternary ammonium-based disinfectants on the wettability of a polyvinyl siloxane impression material.

STATEMENT OF PROBLEM: Polyvinyl siloxane (PVS) impression materials must be cold disinfected before cast pouring to prevent cross-contamination among personnel and patients. However, disinfection may affect the ability of PVS impression materials to provide bubble-free stone surfaces because of the removal of surfactants. PURPOSE: The purpose of this in vitro study was to compare the water contact angles of a PVS impression material treated with either a quaternary ammonium-based (QAB) (DisCide Ultra) or a chlorine-based (CLB) (Dispatch) disinfectant for various exposure times. No disinfection and acetone-immersed (total surfactant removal) specimens were used as positive and negative controls. An additional purpose was to measure changes in the contact angles of the disinfected PVS impression material after applying a topical wetting agent. MATERIAL AND METHODS: Flat and disk-shaped PVS specimens (n=5/test condition) were fabricated and subsequently exposed to disinfectants for different times (1 minute, 5 minutes, 30 minutes, 6 hours, and 24 hours). After disinfection, the contact angle with distilled water was determined over a 3-minute period using dynamic contact analysis. The same contact angle measurements were repeated after a wetting agent was applied to the previously disinfected specimens. Contact angles were statistically compared using 2-way ANOVA. The Sidak post hoc test was used to perform pairwise simple contrast and effect comparisons (α=.05). RESULTS: The contact angle increased directly with disinfectant contact time. For the CLB product, the contact angle after 30-minute disinfection was not significantly different from that of 1 minute disinfection (P>.05). For the QAB product, exceeding 5-minutes of disinfection resulted in a significantly greater contact angle (P<.001). The application of a wetting agent made the disinfected PVS specimens less hydrophobic. CONCLUSIONS: A QAB disinfectant product is more effective at removing surfactant than a CLB disinfectant product. Therefore, a CLB disinfectant provides more working time and control. A wetting agent can reduce the hydrophobicity of a disinfected impression material if the duration of cold disinfection is less than 6 hours.

Gastric infarction following gastric bypass surgery.

Gastric infarction is an extremely rare occurrence owing to the stomach's extensive vascular supply. We report an unusual case of gastric infarction following gastric bypass surgery. We describe the imaging findings and discuss possible causes of this condition.

Perihepatic abscess caused by dropped appendicoliths following laparoscopic appendectomy: sonographic findings.

We report the case of a 6-year-old girl presenting with acute appendicitis complicated by perforated appendix, followed by perihepatic abscess associated with ectopic appendicoliths. CT findings were initially suspicious for an intrahepatic abscess with internal calcifications. However, on sonography the abscess appeared to be in a perihepatic location. Perihepatic abscess associated with a dropped or retained appendicolith has been rarely reported. Awareness of the possibility of a perihepatic abscess as a complication of laparoscopic appendectomy and use of sonography should result in optimal management of this rare complication.

Impact of a more restrictive approach to urinary tract imaging after febrile urinary tract infection.

OBJECTIVES: To determine the impact of using an algorithm requiring selective rather than routine urinary tract imaging following a first febrile urinary tract infection (UTI) on imaging use, detection of vesicoureteral reflux (VUR), prophylactic antibiotic use, and UTI recurrence within 6 months. DESIGN: Retrospective review comparing outcomes during periods before algorithm use (September 1, 2006, to August 31, 2007) and after algorithm use (September 1, 2008, to August 31, 2009). The new algorithm, which adapted recommendations from the United Kingdom's National Institute for Health and Clinical Excellence 2007 guidelines, was implemented in 2008. The algorithm calls for renal ultrasonography in most cases and restricts voiding cystourethrography for use in patients with certain risk factors. SETTING: County health system. PARTICIPANTS: Children younger than 2 years with a first febrile UTI. INTERVENTION: Selective algorithm for urinary tract imaging. MAIN OUTCOME MEASURES: Urinary tract imaging use, detection of VUR, prophylactic antibiotic use, and UTI recurrence within 6 months. RESULTS: After introduction of the new algorithm, voiding cystourethrography and prophylactic antibiotic use decreased markedly. Rates of UTI recurrence within 6 months and detection of grades 4 and 5 VUR did not change, but detection of grades 1 to 3 VUR decreased substantially. Patients in the prealgorithm group with grades 1 to 3 VUR who would have been missed with selective screening underwent no interventions other than successive urinary tract imaging and prophylactic antibiotic use. CONCLUSIONS: By restricting urinary tract imaging after an initial febrile UTI, rates of voiding cystourethrography and prophylactic antibiotic use decreased substantially without increasing the risk of UTI recurrence within 6 months and without an apparent decrease in detection of high-grade VUR. Clinicians can be more judicious in their use of urinary tract imaging.

Informatics in radiology: use of a macro scripting editor to facilitate transfer of dual-energy X-ray absorptiometry reports into an existing departmental voice recognition dictation system.

The process of verbally reporting or manually retyping numeric data generated at dual-energy x-ray absorptiometry (DXA) involves numerous pitfalls. With use of a macro scripting editor, a customized macro was created to automate the transfer of data generated by a DXA scanner into a structured voice recognition dictation system without requiring radiologists to type in a medical record number or accession number to identify the study. A preliminary report is generated with use of software for a DXA unit and a customized template that includes numeric and qualitative assessments of osteoporosis as well as data from prior studies if available. A customized macro is then invoked by the macro scripting editor, which selectively transfers the report from the draft document into the voice recognition dictation system, thereby producing a final structured diagnostic report. All of the radiologists surveyed to evaluate this automated method reported ease of software use and greater efficiency in report production. In addition, a random audit of the 800 DXA scans that have been reported with this technique demonstrated no reports generated under an incorrect accession number and no incorrect transfer of data. Automated DXA reporting is now the preferred method of dictation at the authors' institution and represents an inexpensive, accurate, and customizable means of DXA reporting.

Acute traumatic gonadal vein rupture in a pregnant patient involved in a major motor vehicle collision.

We present a case of a 29-year-old female in her second trimester of pregnancy with twin gestations who was involved in a major motor vehicle collision and subsequently diagnosed by multidetector computed tomography with retroperitoneal hemorrhage from a traumatic ruptured right ovarian vein. Gonadal vein rupture should be considered as a rare cause of hemorrhage when evaluating a pregnant patient who has sustained blunt abdominal trauma.

Health information system based on EHR for workplace health promotion.

The multifactoral origins of occupational health, must take into consideration of all factors simultaneously, including the working environment,lifestyle habits and medical examinations. We defined the concepts and requirements of the 'workplace electronic health records' (WEHR). Hereby, we present the architecture and function of health information system (HIS) based on WEHR for workplace health promotion (WHP).

Angiotensin receptor blockers improve insulin resistance in type 2 diabetic rats by modulating adipose tissue.

Adipose tissue is recognized as a pivotal organ in the development of insulin resistance. This study seeks to determine the effect of angiotensin receptor blockade (ARB) on insulin resistance of adipocytes in culture and in a rat model of type 2 diabetes. Treatment of Otsuka Long-Evans Tokushima Fatty rats with the ARB L158809 for six months significantly lowered fasting plasma glucose, cholesterol and triglyceride levels but led to higher plasma adiponectin levels. Insulin resistance, measured by an intraperitoneal glucose tolerance test, of the treated rats was significantly improved along with an increase in the number of small differentiated adipocytes; however, epididymal fat mass decreased. Treatment significantly lowered lipid peroxidation and MCP-1 expression while increasing adiponectin production by the adipose tissue. ARB treatment significantly improved insulin sensitivity and markedly suppressed AT2-induced oxidative stress, PAI-1 and MCP-1 levels and NF-kappaB activation of adipocytes in culture. Treatment increased adiponectin and PPARgamma expression along with intracellular triglyceride levels reflecting differentiation of the cultured adipocytes. Our study suggests that ARB treatment improves insulin resistance by modification of adipose tissue thereby blunting the development of diabetes.

Acute aortoiliac and femoral artery thrombosis complicating diabetic ketoacidosis.

Acute abdominal aortic occlusion is a devastating event with high associated rates of morbidity and mortality even with surgical intervention. This report describes a case of acute aortoiliac and femoral artery occlusion likely resulting from a hypercoagulable state caused by diabetic ketoacidosis (DKA). Vascular thrombosis is a little-known but potentially devastating complication of DKA that should be considered in every patient treated for DKA and should be added to the differential diagnoses when attempting to determine the etiology of a thrombosed vessel.

Temporary spontaneous thrombosis of a splenic artery pseudoaneurysm in chronic pancreatitis during intravenous octreotide administration.

Splenic artery pseudoaneurysm is a well-known and potentially life-threatening complication of pancreatitis for which immediate endovascular or surgical treatment is indicated. An unusual case of spontaneous thrombosis of a splenic artery pseudoaneurysm with associated partial splenic infarction was encountered in the setting of chronic pancreatitis during intravenous octreotide administration, with recanalization 9 months later.