Parsonage-Turner Syndrome Following COVID-19 Vaccination: MR Neurography.

Vaccination is one of the several known triggers of Parsonage-Turner syndrome (PTS). This case series describes two individuals with clinical presentations of PTS whose symptoms began 13 hours and 18 days following receipt of the Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273 COVID-19 vaccine, respectively. The diagnosis of PTS was confirmed by using both electrodiagnostic testing and 3.0-T MR neurography. Although research is needed to understand the association between PTS and COVID-19 vaccination, MR neurography may be used to help confirm suspected cases of PTS as COVID-19 vaccines continue to be distributed worldwide.

Quantitative T2 -mapping magnetic resonance imaging for assessment of muscle motor unit recruitment patterns.

INTRODUCTION: In this study, we aimed to determine whether muscle transverse relaxation time (T2 ) magnetic resonance (MR) mapping results correlate with motor unit loss, as defined by motor unit recruitment patterns on electromyography (EMG). METHODS: EMG and 3-Tesla MRI exams were acquired no more than 31 days apart in subjects referred for peripheral nerve MRI. Two musculoskeletal radiologists qualitatively graded T2 -weighted, fat-suppressed sequences for severity of muscle edema-like patterns and manually placed regions of interest within muscles to obtain T2 values from T2 -mapping sequences. Concordance was calculated between qualitative and quantitative MR grades and EMG recruitment categories (none, discrete, decreased) as well as interobserver agreement for both MR grades. RESULTS: Thirty-four muscles (21 abnormal, 13 control) were assessed in 13 subjects (5 females and 8 males; mean age, 46 years) with 14 EMG-MRI pairs. T2 -relaxation times were significantly (P < .001) increased in all EMG recruitment categories compared with control muscles. T2 differences were not significant between EMG grades of motor unit recruitment (P = .151-.702). T2 and EMG score concordance was acceptable (Harrell's concordance index [c index]: rater A, 0.71; 95% confidence interval [CI], 0.51-0.87; rater B, 0.77; 95% CI, 0.57-0.91). Qualitative MRI and EMG score concordance was poor to acceptable (c index: rater A, 0.60; 95% CI, 0.50-0.79; rater B, 0.72; 95% CI, 0.55-0.89). T2 values had moderate-to-substantial ability to distinguish between absent vs incomplete (ie, decreased or discrete) motor unit recruitment (c index: rater A, 0.78; 95% CI, 0.50-1.00; rater B, 0.86; 95% CI, 0.57-1.00). DISCUSSION: Quantitative T2 MR muscle mapping is a promising tool for noninvasive evaluation of the degree of motor unit recruitment loss.

The influence of tethering and gravity on the stability of compliant liquid-lined airways.

This study revolves around two simple questions: 1) how does pulmonary airway recruitment/de-recruitment (RecDer) depend on the tethering support provided by surrounding airways and alveoli, and 2) does airway angle of inclination (θ) influence airway stability? These two questions are critical to understanding the existence and prevention of atelectrauma, which may contribute to ventilator-induced lung injury (VILI). To address these questions, we develop PDMS 2mm ID compliant tubes that mimic pulmonary airways. Airway obstruction is modeled using silicone oil, and recruitment occurs through insufflation with a constant flow of air at Q=0.25ml/s. Parenchymal tethering is modeled through the use of a pressure chamber through which we independently establish the external pressure (Pext). Repetitive RecDer oscillation is observed as a function of Pext and θ. We find that airway collapse significantly increases the rate of instability, and this rate correlates strongly with the dimensionless film thickness (ε=h/R), where h is the film thickness and R is the transumural pressure dependent vessel radius. Furthermore, the angle of orientation influences RecDer oscillation, with stability decreased when airflow is directed in the upward direction. These results may provide insight into protective mechanical ventilation processes that can reduce the existence or severity of VILI.

Node-pore sensing enables label-free surface-marker profiling of single cells.

Flow cytometry is a ubiquitous, multiparametric method for characterizing cellular populations. However, this method can grow increasingly complex with the number of proteins that need to be screened simultaneously: spectral emission overlap of fluorophores and the subsequent need for compensation, lengthy sample preparation, and multiple control tests that need to be performed separately must all be considered. These factors lead to increased costs, and consequently, flow cytometry is performed in core facilities with a dedicated technician operating the instrument. Here, we describe a low-cost, label-free microfluidic method that can determine the phenotypic profiles of single cells. Our method employs Node-Pore Sensing to measure the transit times of cells as they interact with a series of different antibodies, each corresponding to a specific cell-surface antigen, that have been functionalized in a single microfluidic channel. We demonstrate the capabilities of our method not only by screening two acute promyelocytic leukemia human cells lines (NB4 and AP-1060) for myeloid antigens, CD13, CD14, CD15, and CD33, simultaneously, but also by distinguishing a mixture of cells of similar size­AP-1060 and NALM-1­based on surface markers CD13 and HLA-DR. Furthermore, we show that our method can screen complex subpopulations in clinical samples: we successfully identified the blast population in primary human bone marrow samples from patients with acute myeloid leukemia and screened these cells for CD13, CD34, and HLA-DR. We show that our label-free method is an affordable, highly sensitive, and user-friendly technology that has the potential to transform cellular screening at the benchside.

Non-spinal musculoskeletal malpractice suits against radiologists in the USA--rates, anatomic locations, and payments in a survey of 8,265 radiologists.

The objective of this study was to present the characteristics of non-spinal musculoskeletal malpractice suits with attention to rates, anatomic location, and payments in a survey of 8,265 radiologists. The malpractice histories of 8,265 radiologists from 36 states were evaluated from credentialing data required of all radiologists participating in the network of One Call Medical, Inc., a broker for imaging tests in workmen's compensation cases. Twenty six hundred of the 8,265 radiologists (31.5 %) had at least one suit. Of the 4,741 total claims, 627 (13.2 %) were related to the bones and soft tissues. Four hundred seventeen (66.1 %) of them involved the musculoskeletal system other than the spine. A cause was known for 400. Of these, 91.8 % (367/400) resulted from an alleged failure to diagnose. The foot was the most common site with a rate 6.00 cases/1,000 radiologist's person years (95 % confidence interval (CI), 4.68-7.68), and the hip was second with a rate of 5.30 cases/1,000 person years (95 % CI, 4.15-6.76). The highest median payment related to ankle injuries with a median settlement of $72,500 (interquartile range (IQR), $40,000-$161,250). The state in which the highest median settlement occurred was Maryland ($125,000; IQR, $95,000-$230,000)) whereas Utah had the highest rate of suits (5.24 cases per 1,000 person years; CI, 3.03-9.04). Claims regarding foot and hip injury were the most common, but ankle settlements incurred the highest awards.

Spinal-related malpractice suits against radiologists in the USA-rates, anatomic location, percent of adverse judgments, and average payments.

To present overall rates, anatomic location, percent of adverse settlements to the radiologists, and average payments to the plaintiff in spinal-related malpractice suits in a survey of 8,265 radiologists. The malpractice histories of 8,265 radiologists from 36 states were evaluated from credentialing data required of all radiologists participating in the network of One Call Medical Incorporated, a broker for CT/MR in workmen's compensation cases. Two hundred twenty-six of the 8,265 radiologists (31.5 %) had at least one suit. Of the 4,741 total claims, 627 (13.2 %) were related to the bones and adjacent soft tissue. Two hundred and ten (32.9 %) involved the spine. Of these, 70.2 % (134/191) were settled in favor of the plaintiff. One hundred and sixteen (68.2 %) involved the cervical spine with an average settlement of $483,156. Lumbar cases accounted for 28 (16.5 %) of spinal suits, with an average settlement of $119,272. Thoracic cases (26) accounted for only 15.3 % of spinal cases and had an average settlement of $481,608. An allegation of spinal malpractice resulting in a settlement or judgment against the radiologist occurred at a rate of 29.5 cases per 1,000 radiologists' person years. Of the three spinal regions, the cervical spine was the most frequent anatomic site of a malpractice suit and among all those cases settled incurred the highest payment in judgment to the plaintiff.

The causes of medical malpractice suits against radiologists in the United States.

PURPOSE: To determine the most frequent causes of malpractice suits as derived from credentialing data of 8401 radiologists. MATERIALS AND METHODS: This study was approved by the Institutional Review Board of New Jersey Medical School. A total of 8401 radiologists in 47 states participating in the network of One-Call Medical, a broker for computed tomographic/magnetic resonance studies in workers' compensation cases, were required to provide their malpractice history as part of their credentialing application. Of these, 2624 (31%) radiologists had at least one claim in their career. In each enrollee's credentialing file, if there was a claim against the enrollee there was a narrative regarding each malpractice case from which, in most instances, a primary allegation could be discerned. Among the 4793 cases, an alleged cause could be derived from the narrative in 4043 (84%). Statistical analysis was performed with Stata 12 (2011; Stata, College Station, Tex) software. RESULTS: The most common general cause was error in diagnosis (14.83 claims per 1000 person-years [95% confidence interval {CI}: 14.19, 15.51]). In this category, breast cancer was the most frequently missed diagnosis (3.57 claims per 1000 person-years [95% CI: 3.26, 3.91]), followed by nonspinal fractures (2.49 claims per 1000 person-years [95% CI: 2.28, 2.72]), spinal fractures (1.32 claims per 1000 person-years [95% CI: 1.16, 1.49]), lung cancer (1.26 claims per 1000 person-years [95% CI: 1.11, 1.42]), and vascular disease (1.08 claims per 1000 person-years [95% CI: 0.93, 1.24]). The category next in frequency was procedural complications (1.76 claims per 1000 person-years [95% CI: 1.58, 1.96]), followed by inadequate communication with either patient (0.40 claim per 1000 person-years [95% CI: 0.32, 0.50]) or referrer (0.71 claim per 1000 person-years [95% CI: 0.60, 0.84]). Radiologists had only a peripheral role in 0.92 claim per 1000 person-years (95% CI: 0.77, 1.10). Failure to recommend additional testing was a rare cause (0.41 claim per 1000 person-years [95% CI: 0.34, 0.50]). CONCLUSION: Errors in diagnosis are, by far, the most common generic cause of malpractice suits against radiologists. In this category, breast cancer was the most frequently missed diagnosis, followed by nonvertebral fractures and spinal fractures. Failure to communicate and failure to recommend additional testing are both uncommon reasons for initiating a suit.

The demography of medical malpractice suits against radiologists.

PURPOSE: To delimit demographic characteristics of malpractice claims against radiologists in the United States by sex and location and to note the varying percentages of favorable outcomes and award amounts to plaintiffs by state. MATERIALS AND METHODS: This HIPAA-compliant study was institutional review board-approved. All radiologists enrolled in One-Call Medical, a specialized preferred provider organization, go through an initial and recurrent credentialing process, which records state of residence, age, sex, and malpractice history. For each radiologist, a record of unfavorable outcomes and payment awards is derived from narratives provided by the National Practitioner's Data Bank. All other suits are self-reported. Rates of malpractice claims per state were calculated with a zero-inflated negative binomial regression model allowing for differences in years at risk. Poisson regression was used to calculate the incidence rate ratio (IRR) for any payment as a result of a malpractice claim compared with the average of all 36 states, adjusted for sex. To determine the association of age, sex, and state with amount of payment, we used a general linear model assuming a gamma family distribution. RESULTS: In August 2010, 8401 radiologists from 47 states composed One-Call Medical's panel. During their careers, 30.9% (2600 of 8401) had been the subject of at least one malpractice claim. Median payment awards varied by 14-fold from Maine ($350 000) to Colorado ($24 105), while mean payments varied ninefold from Oregon ($715 707) to Nebraska ($74 373). Adjusted for age and state, radiologists in Alabama had the lowest rate of malpractice suits per 100 practice-years for men (0.95; 95% confidence interval [CI]; 0.73, 1.28) and women (0.70; 95% CI: 0.52, 0.96) compared with those in New York, who had the highest rate of suits for men (5.65; 95% CI: 5.09, 6.26) and women (4.13; 95% CI: 3.54, 4.80). Overall, male radiologists had a higher rate of being sued than did their female counterparts (IRR = 1.37; 95% CI: 1.20, 1.56). CONCLUSION: The likelihood of a radiologist being the defendant in at least one suit is 50% by age 60, yet the difference in frequency and average number of suits accrued varies widely by state of residence and sex. Among resolved suits, the percentage of cases in which payment was made to the plaintiff differs markedly by state, as do median and mean award amount. Men are more likely than women to be sued during the course of their careers.