Vial Technique Research Articles

Determination of specific surface area of biomass activated carbon vial headspace gas chromatography technique

This paper introduces a method for determining the specific surface area (SSA) of biomass activated carbon (BAC) using a tracer-based headspace gas chromatography (HS-GC) technique. The method relies on the adsorption equilibrium of methanol on BAC samples at elevated temperature. A mathematical model allows for the calculation of SSA from the methanol signal obtained during the headspace analysis. The results demonstrate high precision (relative standard deviation < 2.44%) and strong accuracy (correlation with the conventional BET-N2 adsorption method, R² = 0.986). This method offers several advantages over traditional techniques, including ease of operation, significant time efficiency, and the the ability to perform batch determinations of SSA, as multiple samples can be processed simultaneously during the phase equilibrium step.

Development of a flow‐cell coupled to dynamic SPME technique for automated measurement of fragrance emission from fabric

AbstractA novel automated flow‐cell coupled dynamic solid‐phase microextraction (SPME) method was developed to study the emission of volatile fragrance compounds from fabric samples in a microchamber. Calibration curves were developed with the liquid‐inner tube diffusion‐film‐emission (LIFE) vial technique to quantify the gas‐phase concentration of nine significant volatile fragrance compounds. The linearity range for the various volatile fragrance compounds ranged from 0.001 to 37.9 mg/m3. The limit of quantitation (LOQ) for each fragrance compound was determined as ~3.6–12.1 μg/m3. Using this method, we obtained comprehensive emission curves of target volatiles to quantify the volatile emission profiles of fabric samples. Compared with traditional chamber test method procedures, this work provides a novel and automated method to allow the online monitoring of the emission of various volatiles from multiple samples in one experiment. The repeatability and sensitivity of the method are comparable to or better than existing offline techniques.

Rickettsia amblyommatis isolated from Amblyomma mixtum (Acari: Ixodida) from two sites in Panama

Rickettsia amblyommatis is widely distributed in the Americas, and has been reported to infect different species of ticks within its distribution. In Panama, R. amblyommatis is the most common Rickettsia and its presence was molecularly detected in nine species of ticks and one flea species. This work described the isolation of R. amblyommatis in Vero cells by shell vial technique, from Amblyomma mixtum ticks collected from a captive tapir from Gamboa (Colon province), and a horse from El Valle de Antón (Cocle province). These represent the first isolations of R. amblyommatis in Panama.

Intravitreal Bevacizumab: Safety of multiple doses preparation from single vial in minor theater in tertiary care center

PURPOSE:&#x0D; To determine the safety of multiple doses preparation of bevacizumab from single vial in minor theatre in reducing the frequency of endophthalmitis.&#x0D; STUDY DESIGN:&#x0D; Retrospective exposure study&#x0D; PLACE AND DURATION OF STUDY:&#x0D; Department of Ophthalmology, Fauji Foundation Hospital (FFH), Rawalpindi from June 2016 to March 2018.&#x0D; MATERIAL AND METHODS:&#x0D; 1690 eyes belonging to 1001 patients was included using computer logs of patients receiving intravitreal bevacizumab (IVB). In FFH, we allocate three consecutive days every month in order to administer IVB. Approximately 50 patients were typically given IVB over three-days period.1-2 ml (depending upon the number of patients) of bevacizumab was withdrawn in a 3 cc syringe.1 cc insulin syringe with 29 G needle was taken and, 0.05 ml (1.25 mg) bevacizumab was injected from behind using the 3 cc syringe, resulting in preparation of 10-20 injections of IVB. The bevacizumab vial was then stored at 4 degrees Celsius.&#x0D; RESULTS:&#x0D; Total 1690 eyes belonging to 1001 patients were analyzed. The occurrence of endophthalmitis was 2/1690 (0.12%) corresponding to a 95% CI of 0.03%-0.43%, which does not represent an increase in cases as compared to endophthalmitis resulting from using a compounding pharmacy.&#x0D; CONCLUSION:&#x0D; Whereas, a priori, it seems reasonable to assume that aliquot preparation and storage of bevacizumab for intravitreal use particularly by a compounding pharmacy is safer. We, however, show that our preparation of IVB from single vial technique using proper sterilization is equally safe. Due to the reduced cost of our technique, we recommend it, particularly in the developing world.

Transfection of Culicoides sonorensis biting midge cell lines with Wolbachia pipientis

BackgroundBiting midges of the genus Culicoides vector multiple veterinary pathogens and are difficult to control. Endosymbionts particularly Wolbachia pipientis may offer an alternative to control populations of Culicoides and/or impact disease transmission in the form of population suppression or replacement strategies.MethodsCulicoides sonorensis cell lines were transfected with a Wolbachia infection using a modified shell vial technique. Infections were confirmed using PCR and cell localization using fluorescent in situ hybridization (FISH). The stability of Wolbachia infections and density was determined by qPCR. qPCR was also used to examine immune genes in the IMD, Toll and JACK/STAT pathways to determine if Wolbachia were associated with an immune response in infected cells.ResultsHere we have transfected two Culicoides sonorensis cell lines (W3 and W8) with a Wolbachia infection (walbB) from donor Aedes albopictus Aa23 cells. PCR and FISH showed the presence of Wolbachia infections in both C. sonorensis cell lines. Infection densities were higher in the W8 cell lines when compared to W3. In stably infected cells, genes in the immune Toll, IMD and JAK/STAT pathways were upregulated, along with Attacin and an Attacin-like anti-microbial peptides.ConclusionsThe successful introduction of Wolbachia infections in C. sonorensis cell lines and the upregulation of immune genes, suggest the utility of using Wolbachia for a population replacement and/or population suppression approach to limit the transmission of C. sonorensis vectored diseases. Results support the further investigation of Wolbachia induced pathogen inhibitory effects in Wolbachia-infected C. sonorensis cell lines and the introduction of Wolbachia into C. sonorensis adults via embryonic microinjection to examine for reproductive phenotypes and host fitness effects of a novel Wolbachia infection.

First isolation of Rickettsia monacensis from a patient in South Korea

A Rickettsia sp. was isolated from the blood of a patient with an acute febrile illness using the shell vial technique; the isolate was named CN45Kr and was identified by molecular assay as Rickettsia monacensis, which was first recognized as a pathogen in Spain. Sequencing analysis showed that the gltA sequence of the isolate was identical to that of Rickettsia sp. IRS3. The ompA-5mp fragment sequence showed 100% identity to those of R. monacensis and Rickettsia sp. In56 and ompA-3pA In56 and 100% identity to that of Rickettsia sp. IRS3. The ompB sequence was found to have 99.9% similarity to that of R. monacensis IrR/Munich. This study confirms the pathogenicity of this agent and provides additional information about its geographic distribution.

Detection of Rickettsia RaoultiI Genotypes in Southern Kazakhstan

Previously it was established that different species of genus Rickettsia were detected in Kazakhstan. Nevertheless, rickettsial species spectrum of some regions of Kazakhstan has not been studied. Dermacentor niveus ticks from Southern Kazakhstan were investigated using cell cultures by shell vial technique. The first isolates close related to genotypes Rickettsia raoultii RpA4 and DnS14 were obtained. The role of these agents in tick-borne rickettsioses morbidity in Southern Kazakhstan is discussed.

Rickettsia vini n. sp. (Rickettsiaceae) infecting the tick Ixodes arboricola (Acari: Ixodidae).

BackgroundRecently, a new rickettsia named ‘Candidatus Rickettsia vini’ belonging to the spotted fever group has been molecularly detected in Ixodes arboricola ticks in Spain, the Czech Republic, Slovakia and Turkey, with prevalence reaching up to 100 %. The aim of this study was to isolate this rickettsia in pure culture, and to describe it as a new Rickettsia species.MethodsA total of 148 ornitophilic nidicolous ticks Ixodes arboricola were collected in a forest near Breclav (Czech Republic) and examined for rickettsiae. Shell vial technique was applied to isolate rickettsiae in Vero cells. Rickettsial isolation was confirmed by optical microscopy and sequencing of partial sequences of the rickettsial genes gltA, ompA, ompB, and htrA. Laboratory guinea pigs and chickens were used for experimental infestations and infections. Animal blood sera were tested by immunofluorescence assay employing crude antigens of various rickettsiae.ResultsRickettsia vini n. sp. was successfully isolated from three males of I. arboricola. Phylogenetic analysis of fragments of 1092, 590, 800, and 497 nucleotides of the gltA, ompA, ompB, and htrA genes, respectively, showed closest proximity of R. vini n. sp. to Rickettsia japonica and Rickettsia heilongjiangensis belonging to the spotted fever group. Experimental infection of guinea pigs and chickens with R. vini led to various levels of cross-reactions of R. vini-homologous antibodies with Rickettsia rickettsii, Rickettsia parkeri, ‘Candidatus Rickettsia amblyommii’, Rickettsia rhipicephali, Rickettsia bellii, and Rickettsia felis. Laboratory infestations by R. vini-infected I. arboricola larvae on chickens led to no seroconversion to R. vini n. sp., nor cross-reactions with R. rickettsii, R. parkeri, ‘Ca. R. amblyommii’, R. rhipicephali, R. bellii or R. felis.ConclusionsOur results suggest that R. vini n. sp. is possibly a tick endosymbiont, not pathogenic for guinea pigs and chickens. Regarding specific phenotypic characters and significant differences of DNA sequences in comparison to the most closely related species (R. japonica and R. heilongjiangensis), we propose to classify the isolate as a new species, Rickettsia vini.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-016-1742-8) contains supplementary material, which is available to authorized users.

A novel spotted fever group Rickettsia infecting Amblyomma parvitarsum (Acari: Ixodidae) in highlands of Argentina and Chile

The tick Amblyomma parvitarsum (Acari: Ixodidae) has established populations in Andean and Patagonic environments of South America. For the present study, adults of A. parvitarsum were collected in highland areas (elevation >3500m) of Argentina and Chile during 2009–2013, and tested by PCR for rickettsial infection in the laboratory, and isolation of rickettsiae in Vero cell culture by the shell vial technique. Overall, 51 (62.2%) out of 82 A. parvitarsum adult ticks were infected by spotted fever group (SFG) rickettsiae, which generated DNA sequences 100% identical to each other, and when submitted to BLAST analysis, they were 99.3% identical to corresponding sequence of the ompA gene of Rickettsia sp. strain Atlantic rainforest. Rickettsiae were successfully isolated in Vero cell culture from two ticks, one from Argentina and one from Chile. DNA extracted from the third passage of the isolates of Argentina and Chile were processed by PCR, resulting in partial sequences for three rickettsial genes (gltA, ompB, ompA). These sequences were concatenated and aligned with rickettsial corresponding sequences available in GenBank. Phylogenetic analysis revealed that the A. pavitarsum rickettsial agent grouped under high bootstrap support in a clade composed by the SFG pathogens R. sibirica, R. africae, R. parkeri, Rickettsia sp. strain Atlantic rainforest, and two unnamed SFG agents of unknown pathogenicty, Rickettsia sp. strain NOD, and Rickettsia sp. strain ApPR. The pathogenic role of this A. parvitarsum rickettsia cannot be discarded, since several species of tick-borne rickettsiae that were considered nonpathogenic for decades are now associated with human infections.

Monitoring for Insecticide Resistance in Asian Citrus Psyllid (Hemiptera: Psyllidae) Populations in Florida.

The development of insecticide resistance in Asian citrus psyllid, Diaphorina citri Kuwayama, populations is a serious threat to the citrus industry. As a contribution to a resistance management strategy, we developed a glass vial technique to monitor field populations of Asian citrus psyllid for insecticide resistance. Diagnostic concentrations needed to separate susceptible genotypes from resistant individuals were determined for cypermethrin (0.5 μg per vial), malathion (1.0 μg per vial), diazinon (1.0 μg per vial), carbaryl (1.0 μg per vial), carbofuran (0.1 μg per vial), methomyl (1.0 μg per vial), propoxur (1.0 μg per vial), endosulfan (1.0 μg per vial), imidacloprid (0.5 μg per vial), acetamiprid (5.0 μg per vial), chlorfenapyr (2.5 μg per vial), and fenpyroximate (2.5 μg per vial). In 2014, resistance to two carbamate insecticides (carbaryl and carbofuran), one organophosphate (malathion), one pyrethroid (cypermethrin), and one pyrazole (fenpyroximate) was detected in field populations of Asian citrus psyllid in Immokalee, FL. There was no resistance detected to diazinon, methomyl, propoxur, endosulfan, imidacloprid, and chlorfenapyr. The levels of insecticide resistance were variable and unstable, suggesting that resistance could be successfully managed. The results validate the use of the glass vial bioassay to monitor for resistance in Asian citrus psyllid populations and provide the basis for the development of a resistance management strategy designed to extend the efficacy of all classes of insecticides used for control of the Asian citrus psyllid.

Rickettsia parkeri infecting free-living Amblyomma triste ticks in the Brazilian Pantanal

The present study evaluated the infection of rickettsiae in 151 Rhipicephalus sanguineus, 59 Amblyomma ovale, 166 Amblyomma triste, one Amblyomma dissimile and four Amblyomma dubitatum ticks collected in the municipality of Poconé, State of Mato Grosso, within the Pantanal biome of Brazil. Ticks were individually processed by the hemolymph test with Gimenez staining, isolation of rickettsia in Vero cell culture by the shell vial technique, and polymerase chain reaction (PCR) targeting the citrate synthase rickettsial gene. Through the shell vial technique, rickettsiae were successfully isolated and established in Vero cell culture from one free-living A. triste female tick, which previously showed to contain Rickettsia-like organisms by the hemolymph test. Molecular characterization of the rickettsial isolate was achieved through DNA partial sequences of three rickettsial genes (gltA, ompA, ompB), which showed to be all 100% identical to Rickettsia parkeri. After testing all ticks by PCR, the frequency of R. parkeri infection was 7.23% (12/166) in A. triste adult ticks. The remaining ticks were negative by PCR. This is the first report of in vitro isolation of R. parkeri in the Pantanal biome, confirming the occurrence of this emerging rickettsial pathogen in this natural area of South America.

Use of a vial equilibration technique to measure the change in fugacity capacity of avian food and feces samples for 1,2,3,4-tetrachlorobenzene.

A vial equilibration technique was used to estimate the fugacity capacities of food and feces samples for 1,2,3,4-tetrachlorobenzene (TCB). The method was calibrated using different volumes of n-octanol and by comparing the measured and predicted fugacity capacity (Zoct) of n-octanol for TCB. The vial equilibration technique showed linearity with increasing amounts of n-octanol added to the vial. However, the measured Zoct was on average 8.5 times lower than the literature estimate and interpreted to be influenced by co-solvent effects. The ratio of fugacity capacities of food/feces was 2.9 and was consistent with the ratio estimated using Zt calculation methods (4.3) which considers partitioning capacity of both lipids and non-lipid organic matter. These results provide experimental support to the use of lipid equivalent approaches as opposed to lipid normalization when estimating the partition capacity of biological samples containing low lipid contents.

Rickettsial infection in Amblyomma cajennense ticks and capybaras (Hydrochoerus hydrochaeris) in a Brazilian spotted fever-endemic area.

BackgroundBrazilian spotted fever (BSF), caused by the bacterium Rickettsia rickettsii, is the deadliest spotted fever of the world. In most of the BSF-endemic areas, capybaras (Hydrochoerus hydrochaeris) are the principal host for the tick Amblyomma cajennense, which is the main vector of BSF.MethodsIn 2012, a BSF case was confirmed in a child that was bitten by ticks in a residential park area inhabited by A. cajennense-infested capybaras in Itú municipality, southeastern Brazil. Host questing A. cajennense adult ticks were collected in the residential park and brought alive to the laboratory, where they were macerated and intraperitoneally inoculated into guinea pigs. A tick-inoculated guinea pig that presented high fever was euthanized and its internal organs were macerated and inoculated into additional guinea pigs (guinea pig passage). Tissue samples from guinea pig passages were also used to inoculate Vero cells through the shell vial technique. Infected cells were used for molecular characterization of the rickettsial isolate through PCR and DNA sequencing of fragments of three rickettsial genes (gltA, ompA, and ompB). Blood serum samples were collected from 172 capybaras that inhabited the residential park. Sera were tested through the immunofluorescence assay using R. rickettsii antigen.ResultsA tick-inoculated guinea pig presented high fever accompanied by scrotal reactions (edema and marked redness). These signs were reproduced by consecutive guinea pig passages. Rickettsia was successfully isolated in Vero cells that were inoculated with brain homogenate derived from a 3rd passage-febrile guinea pig. Molecular characterization of this rickettsial isolate (designated as strain ITU) yielded DNA sequences that were all 100% identical to corresponding sequences of R. rickettsii in Genbank. A total of 83 (48.3%) out of 172 capybaras were seroreactive to R. rickettsii, with endpoint titers ranging from 64 to 8192.ConclusionsA viable isolate of R. rickettsii was obtained from the tick A. cajennense, comprising the first viable R. rickettsi isolate from this tick species during the last 60 years. Nearly half of the capybara population of the residential park was seroreactive to R. rickettsii, corroborating the findings that the local A. cajennense population was infected by R. rickettsii.

Cultivation of PCV2 in swine testicle cells using the shell vial technique and monitoring of viral replication by qPCR and RT-qPCR

Porcine circovirus type 2 (PCV2) is difficult to isolate. Currently, no published articles have used the shell vial technique to isolate PCV2. In addition, the action of d-glucosamine on swine testicle cells (ST) has not been evaluated properly. Thus, the aim of this study was to determine an optimal concentration of d-glucosamine and to test the shell vial technique for PCV2 propagation in ST cells. The optimal concentration of d-glucosamine was determined to be 100mM. Because PCV2 is noncytopathic, the traditional adsorption was compared to the shell vial technique for 15 passages by qPCR, and RT-qPCR for passages 12 through 15. The quantities of viral DNA (P=0.013) and ORF1-mRNA detected with the shell vial technique were two-fold higher than the obtained with traditional adsorption. The levels of ORF2-mRNA were similar for both methods; however, by passage 15, a six-fold increase in levels was observed with the shell vial technique. Therefore, the shell vial technique was more efficient for the cultivation of PCV2, and qPCR/RT-qPCR can be used to monitor viral replication. In addition, a high viral load (>2.7×1010 DNA copies/ml) and high levels of viral mRNA expression indicated that the ST cells were persistently infected.

Coxiella burnetiiin Ticks, Argentina

<i>Coxiella burnetii</i>in Ticks, Argentina

Comparison of Real-Time Quantitative PCR and Culture for the Diagnosis of Emerging Rickettsioses

BackgroundIsolation of Rickettsia species from skin biopsies may be replaced by PCR. We evaluated culture sensitivity compared to PCR based on sampling delay and previous antibiotic treatment.Methodology/Principal FindingsSkin biopsies and ticks from patients with suspected Rickettsia infection were screened for Rickettsia spp. using qPCR, and positive results were amplified and sequenced for the gltA and ompA genes. Immunofluorescence for spotted fever group rickettsial antigens was done for 79 patients. All skin biopsies and only ticks that tested positive using qPCR were cultured in human embryonic lung (HEL) fibroblasts using the centrifugation-shell vial technique. Patients and ticks were classified as definitely having rickettsioses if there was direct evidence of infection with a Rickettsia sp. using culture or molecular assays or in patients if serology was positive. Data on previous antibiotic treatments were obtained for patients with rickettsiosis. Rickettsia spp. infection was diagnosed in 47 out of 145 patients (32%), 41 by PCR and 12 by culture, whereas 3 isolates were obtained from PCR negative biopsies. For 3 of the patients serology was positive although PCR and culture were negative. Rickettsia africae was the most common detected species (n = 25, [17.2%]) and isolated bacterium (n = 5, [3.4%]). The probability of isolating Rickettsia spp. was 12 times higher in untreated patients and 5.4 times higher in patients from our hometown. Rickettsia spp. was amplified in 24 out of 95 ticks (25%) and we isolated 7 R. slovaca and 1 R. raoultii from Dermacentor marginatus.Conclusions/SignificanceWe found a positive correlation between the bacteria copies and the isolation success in skin biopsies and ticks. Culture remains critical for strain analysis but is less sensitive than serology and PCR for the diagnosis of a Rickettsia infection.

A Formulation to Encapsulate Nootkatone for Tick Control

Nootkatone is a component of grapefruit oil that is toxic to the disease-vectoring tick, Ixodes scapularis Say, but unfortunately causes phytotoxicity to treated plants and has a short residual activity due to volatility. We prepared a lignin-encapsulated nootkatone formulation to compare with a previously used emulsifiable formulation for volatility, plant phytotoxicity, and toxicity to unfed nymphs of I. scapularis. Volatility of nootkatone was measured directly by trapping nootkatone vapor in a closed system and indirectly by measuring nootkatone residue on treated filter paper after exposure to simulated sunlight (Xenon). After 24 h in the closed system, traps collected only 15% of the nootkatone applied as the encapsulated formulation compared with 40% applied as the emulsifiable formulation. After a 1-h light exposure, the encapsulated formulation retained 92% of the nootkatone concentration compared with only 26% retained by the emulsifiable formulation. For plant phytotoxicity, cabbage, Brassica oleracea L., leaves treated with the encapsulated formulation expressed less necrosis, retaining greater leaf weight compared with leaves treated with the emusifiable formulation. The nootkatone in the emulsifiable formulation was absorbed by cabbage and oat, Avena sativa L., plants (41 and 60% recovered 2 h after application, respectively), as opposed to 100% recovery from the plants treated with encapsulated nootkatone. Using a treated vial technique, encapsulated nootkatone was significantly more toxic to I. scapularis nymphs (LC50 = 20 ng/cm2) compared with toxicity of the emulsifiable formulation (LC50 = 35 ng/cm2). Thus, the encapsulation of nootkatone improved toxicity for tick control, reduced nootkatone volatility, and reduced plant phytotoxicity.

Rickettsia monteiroi sp. nov., Infecting the Tick Amblyomma incisum in Brazil

Free-living adult Amblyomma incisum ticks were collected in an Atlantic rainforest area at Intervales State Park, State of São Paulo, Brazil. From an A. incisum specimen, rickettsiae were successfully isolated in Vero cell culture by the shell vial technique. Rickettsial isolation was confirmed by optical microscopy, transmission electron microscopy, and PCRs targeting portions of the rickettsial genes gltA, htrA, rrs, and sca1 on infected cells. Fragments of 1,089, 457, 1,362, and 443 nucleotides of the gltA, htrA, rrs, and sca1 genes, respectively, were sequenced. By BLAST analysis, the partial sequence of rrs of the A. incisum rickettsial isolate was closest to the corresponding sequence of Rickettsia bellii (99.1% similarity). The gltA partial sequence was closest to the corresponding sequences of "Candidatus Rickettsia tarasevichiae" (96.1% similarity) and Rickettsia canadensis (95.8% similarity). The htrA partial sequence was closest to the corresponding sequence of R. canadensis (89.8% similarity). The sca1 partial sequence was closest to the corresponding sequence of R. canadensis (95.2% similarity). Since our rickettsial isolate was genetically distinct from other Rickettsia species, we propose a new species designated Rickettsia monteiroi sp. nov. Phylogenetic analyses indicated that R. monteiroi belongs to the canadensis group within the genus Rickettsia, together with the species R. canadensis and "Candidatus R. tarasevichiae". Little or no antibody cross-reaction was observed between sera of R. monteiroi-inoculated guinea pigs and R. bellii-, Rickettsia rickettsii-, or R. canadensis-inoculated guinea pigs.

Contrast and Cost Savings by Implementation of a Multidose Bulk IV Contrast Delivery System

In an effort to standardize clinical operations and reduce intravenous (IV) contrast costs, the authors' department switched from 100-mL single-use IV contrast vials to a multidose IV contrast delivery system using iopromide 370. The purpose of this study was to assess IV contrast use, waste, and cost savings resulting from the implementation of this multidose system. A review was conducted of consecutive pulmonary embolism (PE) CT angiography, head and neck (HN) CT angiography, and abdomen/pelvis (AP) CT examinations performed according to standard department protocol 2 weeks before and 2 weeks after the implementation of a multidose IV contrast delivery system. The amount of contrast loaded and injected for each examination was recorded, and total contrast used and wasted were calculated. Volumes of used and wasted contrast were compared before and after implementation using Wilcoxon's rank-sum test. Associated cost savings are reported. There were 32 PE, 27 HN, and 124 AP examinations performed using the 100-mL single-use vial technique and 27 PE, 25 HN, and 175 AP examinations using the multidose technique. Use of the multidose system resulted in average reductions in used contrast volume of 15.9, 35.1, and 11.4 mL, respectively, for PE, HN, and AP examinations (Wilcoxon's P < .0001). For PE and HN examinations, this was due to reduced contrast waste, as these protocols require less than the 100-mL contents of the single-use vial. For AP examinations, savings were due to reduction in contrast volume through the use of higher iodine concentration. Associated cost savings annualize to approximately $31,800 for these 3 examination types alone at the authors' institution. The implementation of a multidose bulk IV contrast material delivery system results in significant contrast and cost savings.

Identification ofLegionella feeleiiCellulitis

Identification of<i>Legionella feeleii</i>Cellulitis