Risk Stratification and Radiologic Evaluation of Central Venous Port Malfunction

Background Appropriate indications for radiologic evaluation of central venous ports are not fully understood. We aimed to quantitatively assess the utility of clinical history and imaging in the evaluation of malfunctioning central venous ports. Methods Clinical history, plain radiographs, and line injections intended to evaluate central venous port malfunction in 153 consecutive cases over a nearly 4-year period were retrospectively reviewed by 2 radiologists. Radiographs and line injections were separately categorized as normal or abnormal, and a consensus was reached on the final imaging diagnosis. The likelihood of a port-related abnormality necessitating immediate intervention was determined for all represented combinations of clinical history, radiographic findings, and line injection results. Results A radiologic diagnosis was made in 96.1% of cases; 19.7% of these diagnoses were classified as critical, requiring prompt intervention. Very low risk histories had a 0.0% incidence of critical port abnormalities in our cohort, regardless of imaging findings. Low risk histories had a 10.5% incidence of a critical abnormality and were best evaluated either by line injection, either directly or following an abnormal chest radiograph. Intermediate and high risk histories were associated with a 30.5% and 61.1% incidence of critical port abnormalities, respectively, and were best evaluated by line injection without preceding chest radiograph. Conclusions There are several scenarios in which imaging does not meaningfully affect management of malfunctioning central venous ports. Recognizing these inefficiencies may allow for more appropriate and cost-effective use of radiographs and line injections to evaluate the cause of port malfunction. © 2014, ASSOCIATION FOR VASCULAR ACCESS. Published by Elsevier Inc. All rights reserved

Virtual microfluidics for digital quantification and single-cell sequencing

We have developed hydrogel-based virtual microfluidics as a simple and robust alternative to complex engineered microfluidic systems for the compartmentalization of nucleic acid amplification reactions. We applied in-gel digital multiple displacement amplification (dMDA) to purified DNA templates, cultured bacterial cells and human microbiome samples in the virtual microfluidics system, and demonstrated whole-genome sequencing of single-cell MDA products with excellent coverage uniformity and markedly reduced chimerism compared with products of liquid MDA reactions.Broad Institute of MIT and Harvard (Lawrence Summers Fellowship)Burroughs Wellcome Fund (Career Award)Massachusetts Institute of Technology. Center for Microbiome Informatics and TherapeuticsNational Human Genome Research Institute (U.S.) (Broad Institute of MIT and Harvard. Grant U54HG003067)Massachusetts Institute of Technology. Center for Environmental Health SciencesFiji. Ministry of Healt