The House that Jack Built

The House That Jack Built is a contemporary novel, set on the mythical Caribbean island of St. Anne, that explores enduring themes of American literature such as independence, selfdetermination, and the effects of greed on the independent spirit

A reminder of peristalsis as a useful tool in the prenatal differential diagnosis of abdominal cystic masses

With routine antenatal ultrasound and recent advances in ultrasound technology, fetal intraabdominal cystic masses are recognized more often and are better characterized than in the past. They may be classified as solid and cystic, and may originate from multiple structures. When considering the extensive differential diagnosis of cystic masses, the observation of peristalsis narrows the possibilities to the gastrointestinal tract. To find this feature on ultrasound, the examiner must expressly think and look for it, otherwise it may be missed. Our case report illustrates one of those cases

Deciphering the Multifactorial Nature of Acinetobacter baumannii Pathogenicity

Background: Acinetobacter baumannii is an emerging bacterial pathogen that causes a broad array of infections, particularly in hospitalized patients. Many studies have focused on the epidemiology and antibiotic resistance of A. baumannii, but little is currently known with respect to its virulence potential. Methodology/Principal Findings: The aim of this work was to analyze a number of virulence-related traits of four A. baumannii strains of different origin and clinical impact for which complete genome sequences were available, in order to tentatively identify novel determinants of A. baumannii pathogenicity. Clinical strains showed comparable virulence in the Galleria mellonella model of infection, irrespective of their status as outbreak or sporadic strains, whereas a non-human isolate was avirulent. A combined approach of genomic and phenotypic analyses led to the identification of several virulence factors, including exoproducts with hemolytic, phospholipase, protease and iron-chelating activities, as well as a number of multifactorial phenotypes, such as biofilm formation, surface motility and stress resistance, which were differentially expressed and could play a role in A. baumannii pathogenicity. Conclusion/Significance: This work provides evidence of the multifactorial nature of A. baumannii virulence. While A. baumannii clinical isolates could represent a selected population of strains adapted to infect the human host, subpopulations of highly genotypically and phenotypically diverse A. baumannii strains may exist outside the hospita

Automated Radiology Report Summarization Using an Open-Source Natural Language Processing Pipeline

Diagnostic radiologists are expected to review and assimilate findings from prior studies when constructing their overall assessment of the current study. Radiology information systems facilitate this process by presenting the radiologist with a subset of prior studies that are more likely to be relevant to the current study, usually by comparing anatomic coverage of both the current and prior studies. It is incumbent on the radiologist to review the full text report and/or images from those prior studies, a process that is time-consuming and confers substantial risk of overlooking a relevant prior study or finding. This risk is compounded when patients have dozens or even hundreds of prior imaging studies. Our goal is to assess the feasibility of natural language processing techniques to automatically extract asserted and negated disease entities from free-text radiology reports as a step towards automated report summarization. We compared automatically extracted disease mentions to a gold-standard set of manual annotations for 50 radiology reports from CT abdomen and pelvis examinations. The automated report summarization pipeline found perfect or overlapping partial matches for 86% of the manually annotated disease mentions (sensitivity 0.86, precision 0.66, accuracy 0.59, F1 score 0.74). The performance of the automated pipeline was good, and the overall accuracy was similar to the interobserver agreement between the two manual annotators

Cholangioscopy in primary sclerosing cholangitis: a case series of benign features.

Background and aimsCholangioscopy is useful in establishing a visual diagnosis of cholangiocarcinoma (CCA), but this is harder to achieve in primary sclerosing cholangitis (PSC) because of the stricture-forming nature of the disease. Furthermore, it can be harder to differentiate malignant from benign features of the underlying inflammation. This case series demonstrates the varied features of nonmalignant inflammatory findings in PSC.MethodsA single experienced endoscopist performed cholangioscopy for PSC cases referred for ERCP.ResultsCholangioscopy in these 5 cases without CCA demonstrated the features of acute and chronic inflammation, acute inflammatory mass, dominant stricture, acute cholangitis in a duct with features of chronic inflammation with a large pigmented stone, and fibrostenotic disease. Cholangioscopic maneuvers such as advancement across strictures after balloon dilation, targeted mucosal biopsy, and electrohydraulic lithotripsy (EHL) of impacted stones are demonstrated. The relevant radiographic and histopathologic features of the disease accompany each case description. Regarding long-term prognosis, 1 case of acute inflammatory mass and a case of worsening liver function required a liver transplant evaluation, whereas the other 3 cases remain stable.ConclusionsCholangioscopic features of benign disease in PSC are varied. Knowledge of these features is essential in differentiating between benign and malignant findings. These features, combined with biopsy and cytology evaluation, can help in tailoring management in patients with benign PSC

Cholangioscopy in primary sclerosing cholangitis: a case series of dominant strictures and cholangiocarcinoma

Background and aimsPrompt and accurate differentiation of benign and malignant strictures in primary sclerosing cholangitis (PSC) is crucial. ERCP with brush cytology, the most common modality to achieve this, is hindered by a low diagnostic yield. Cholangioscopy can overcome this limitation by establishing a visual diagnosis based on the characteristic morphologic features of cholangiocarcinoma (CCA) and can aid in targeted biopsies of suspicious lesions. However, its role in PSC remains unclear. This case series demonstrates the performance of the latest generation of single-operator cholangioscope for this indication.MethodsA single experienced endoscopist performed cholangioscopy for PSC cases referred for ERCP.ResultsCholangioscopies of patients 1 to 3 demonstrate the features of extrahepatic duct dominant strictures (DS) and the cholangioscopic maneuvers undertaken in these cases, including advancement across the DS after balloon dilation, biopsy of the DS, and electrohydraulic lithotripsy of impacted stones. Cholangioscopies of patients 4 to 6 demonstrate the varied features of CCA ranging from focal stricture with tumor vessels, papillary frond-like projections, and features of an intraductal papillary biliary neoplasm. Also shown are the radiographic and histopathologic features of the disease.ConclusionsCholangioscopy allowed us to identify morphologic features of both malignancy and benign disease in PSC in the setting of extrahepatic duct strictures, and we were able to obtain adequate targeted tissue samples for histopathologic confirmation

Fetal ultrasound: Early diagnosis and natural evolution of proximal femoral focal deficiency.

Proximal femoral focal deficiency is an extremely rare congenital anomaly with only a few case reports in the literature. This case illustrates one diagnosed by prenatal ultrasound. The diagnosis may be isolated or associated with other abnormalities and syndromes. This report describes the early obstetrical ultrasound diagnosis, its evolution and associated findings throughout pregnancy. To the best of our knowledge, it is the first report associating this diagnosis with sickle cell trait. Another finding in our patient was a concomitant intrauterine growth restriction that we attribute to placental infarctions and a retro placental hemorrhage, also on the basis of sickle cell trait. At birth, placental weight was under the 10th percentile for gestational age. Obstetrical ultrasound in the prenatal diagnosis of proximal femoral focal deficiency is important, because early recognition of this malformation could provide useful information to parents and physicians regarding newborn management and therapeutic planning

Identification and Characterization of an Acinetobacter baumannii Biofilm-Associated Protein▿

We have identified a homologue to the staphylococcal biofilm-associated protein (Bap) in a bloodstream isolate of Acinetobacter baumannii. The fully sequenced open reading frame is 25,863 bp and encodes a protein with a predicted molecular mass of 854 kDa. Analysis of the nucleotide sequence reveals a repetitive structure consistent with bacterial cell surface adhesins. Bap-specific monoclonal antibody (MAb) 6E3 was generated to an epitope conserved among 41% of A. baumannii strains isolated during a recent outbreak in the U.S. military health care system. Flow cytometry confirms that the MAb 6E3 epitope is surface exposed. Random transposon mutagenesis was used to generate A. baumannii bap1302::EZ-Tn5, a mutant negative for surface reactivity to MAb 6E3 in which the transposon disrupts the coding sequence of bap. Time course confocal laser scanning microscopy and three-dimensional image analysis of actively growing biofilms demonstrates that this mutant is unable to sustain biofilm thickness and volume, suggesting a role for Bap in supporting the development of the mature biofilm structure. This is the first identification of a specific cell surface protein directly involved in biofilm formation by A. baumannii and suggests that Bap is involved in intercellular adhesion within the mature biofilm