The new radiology residency fourth year under the new curriculum: a survey of current residents' thoughts and suggestions about its design and purpose.

RATIONALE AND OBJECTIVES: The ABR announced changes to the board examinations for the resident class entering in 2010. These changes can allow the fourth year to be focused on subspecialization. During the restructuring process at the authors' institution, residents were queried about fourth-year design. The goal was to create a curriculum that would best meet residents' expectations while balancing clinical and educational needs. MATERIALS AND METHODS: Issues from the literature about the fourth-year curriculum were identified. An anonymous and voluntary survey based on these was developed and sent to 36 residents who made up the study group. Answers were reviewed for trends and significant unique responses before curricular development. RESULTS: Twenty-two of 36 residents (61%) responded. The most often selected electives were cardiac (91%), body MRI (77%), body interventional procedures (68%), neuroradiologic MRI (59%), musculoskeletal procedures (59%), and musculoskeletal imaging (54%). Fifty percent wanted 6 months in one area. Forty-five percent felt that the length of time in one area (most with a threshold of 9 months) would affect their decisions to pursue fellowships. The majority (73%) planned to use the fourth year to do rotations different from their planned fellowship areas. CONCLUSION: The majority of residents indicate that they would like to have at least half of their fourth year in one area, and most selected similar rotations to one another. The ability to do this extended time on one service may result in a decrease in the number of residents pursuing fellowships. However, most saw the fourth year as a way to broaden their radiologic knowledge.

Diagnostic performance of the upper gastrointestinal series in the evaluation of children with clinically suspected malrotation.

BACKGROUND: Malrotation is a congenital disorder of abnormal intestinal rotation and fixation that predisposes infants to potentially life-threatening midgut volvulus. Upper gastrointestinal tract (UGI) examination is sometimes equivocal and can lead to inaccurate diagnosis. OBJECTIVE: To determine the diagnostic performance of UGI examinations in children who subsequently underwent a Ladd procedure for suspected malrotation or volvulus. MATERIALS AND METHODS: We reviewed all children up to 21 years old who had undergone both a UGI examination and a Ladd procedure for possible malrotation across 9 years. Children were excluded if they had not undergone either a UGI examination or a Ladd procedure and if congenital abdominal wall defects were present. RESULTS: Of 229 patients identified, 166 (59% male, median age 67 days) were included. Excluded were 47 without a UGI series, 12 with omphalocele or gastroschisis, 1 without verifiable operative data, 1 who had not undergone a Ladd procedure, and 2 older than 21 years. Of the 166 patients, 40% were neonates and 73% were <12 months old, and 31% presented with bilious vomiting and 15% with abdominal distention. Of 163 patients with surgically verified malrotation, 156 had a positive UGI examination, a sensitivity of 96%. There were two patients with a false-positive UGI examination and seven with false-negative examination. Jejunal position was normal in six of the seven with a false-negative examination and abnormal in the two with a false-positive examination. Of 38 patients with surgically verified volvulus, 30 showed volvulus on the UGI series. Five required bowel resection and three died. CONCLUSION: Jejunal position can lead to inaccurate UGI series interpretation. Meticulous technique and periodic assessment of performance will help more accurately diagnose difficult or equivocal cases.

Tumor Necrosis Factor-alpha- and interleukin-1-induced cellular responses: coupling proteomic and genomic information.

The pro-inflammatory cytokines, Tumor Necrosis Factor-alpha (TNFalpha) and Interleukin-1 (IL-1) mediate the innate immune response. Dysregulation of the innate immune response contributes to the pathogenesis of cancer, arthritis, and congestive heart failure. TNFalpha- and IL-1-induced changes in gene expression are mediated by similar transcription factors; however, TNFalpha and IL-1 receptor knock-out mice differ in their sensitivities to a known initiator (lipopolysaccharide, LPS) of the innate immune response. The contrasting responses to LPS indicate that TNFalpha and IL-1 regulate different processes. A large-scale proteomic analysis of TNFalpha- and IL-1-induced responses was undertaken to identify processes uniquely regulated by TNFalpha and IL-1. When combined with genomic studies, our results indicate that TNFalpha, but not IL-1, mediates cell cycle arrest.