Focused Abbreviated Survey MRI Protocols for Brain and Spine Imaging.

There has been extensive growth in both the technical development and the clinical applications of MRI, establishing this modality as one of the most powerful diagnostic imaging tools. However, long examination and image interpretation times still limit the application of MRI, especially in emergent clinical settings. Rapid and abbreviated MRI protocols have been developed as alternatives to standard MRI, with reduced imaging times, and in some cases limited numbers of sequences, to more efficiently answer specific clinical questions. A group of rapid MRI protocols used at the authors' institution, referred to as FAST (focused abbreviated survey techniques), are designed to include or exclude emergent or urgent conditions or screen for specific entities. These FAST protocols provide adequate diagnostic image quality with use of accelerated approaches to produce imaging studies faster than traditional methods. FAST protocols have become critical diagnostic screening tools at the authors' institution, allowing confident and efficient confirmation or exclusion of actionable findings. The techniques commonly used to reduce imaging times, the imaging protocols used at the authors' institution, and future directions in FAST imaging are reviewed to provide a practical and comprehensive overview of FAST MRI for practicing neuroradiologists. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Metabolomic Profiling for Diagnosis and Prognostication in Surgery: A Scoping Review.

OBJECTIVE: This review assimilates and critically evaluates available literature regarding the use of metabolomic profiling in surgical decision-making. BACKGROUND: Metabolomic profiling is performed by nuclear magnetic resonance spectroscopy or mass spectrometry of biofluids and tissues to quantify biomarkers (ie, sugars, amino acids, and lipids), producing diagnostic and prognostic information that has been applied among patients with cardiovascular disease, inflammatory bowel disease, cancer, and solid organ transplants. METHODS: PubMed was searched from 1995 to 2019 to identify studies investigating metabolomic profiling of surgical patients. Articles were included and assimilated into relevant categories per PRISMA-ScR guidelines. Results were summarized with descriptive analytical methods. RESULTS: Forty-seven studies were included, most of which were retrospective studies with small sample sizes using various combinations of analytic techniques and types of biofluids and tissues. Results suggest that metabolomic profiling has the potential to effectively screen for surgical diseases, suggest diagnoses, and predict outcomes such as postoperative complications and disease recurrence. Major barriers to clinical adoption include a lack of high-level evidence from prospective studies, heterogeneity in study design regarding tissue and biofluid procurement and analytical methods, and the absence of large, multicenter metabolome databases to facilitate systematic investigation of the efficacy, reproducibility, and generalizability of metabolomic profiling diagnoses and prognoses. CONCLUSIONS: Metabolomic profiling research would benefit from standardization of study design and analytic approaches. As technologies improve and knowledge garnered from research accumulates, metabolomic profiling has the potential to provide personalized diagnostic and prognostic information to support surgical decision-making from preoperative to postdischarge phases of care.

Impact of Autoantibodies to Complement Components on the Disease Activity in SLE.

INTRODUCTION: Systemic Lupus Erythematosus (SLE) is a chronic multi-system autoimmune disease with varied clinical presentations. Complement components are the major players in disease pathogenesis. This retrospective cross-sectional study was aimed at assessing the role of autoantibodies to these complement components and their association disease activity in newly diagnosed SLE patients from India. METHOD: Clinically diagnosed SLE patients (n=57) classified as per 2015 ACR/SLICC revised criteria were enrolled between November 2016 to April 2017. Patients' sera were tested for C3 and C4 by nephelometry, while serum levels of factor H, factor P (properdin) as well as autoantibodies to C3, C4, factor H and factor P were detected by ELISA. GraphPad Prism Version 6.01 was used for statistical analysis. Mean, SD, SEM were calculated. Mann Whittney U-test, ANOVA, Chi-square test, Odd's Ratio were calculated. Pearson's correlation was used to study relativeness of the study parameters. RESULTS: Among the 57 SLE patients, low C3 were seen in 51% patients, low C4 in 49%, low factor H in 19% and low factor P in 49% patients. Positivity for autoantibodies against complement components, anti-C3 were seen in 42% patients, anti-C4 in 7%, anti-factor H in 19% and anti-factor P in 28% patients. Serum levels of C3 (p=0.0009), C4 (p=0.0031) and anti-C3 autoantibodies (p=0.0029) were significantly associated with ACR/SLICC 2015 scores. CONCLUSION: Hypocomplementemia was found to be associated with higher disease damage score in newly diagnosed SLE patients. This study adds novel arguments for the importance of the anti-C3 autoantibodies as a marker of SLE.

Multisystem Imaging Findings of Cystic Fibrosis in Adults: Recognizing Typical and Atypical Patterns of Disease.

OBJECTIVE: There is an expanding and increasingly heterogeneous population of adult patients with cystic fibrosis (CF). Although CF is usually diagnosed in children with progressive multisystem involvement, up to 7% of CF cases are currently diagnosed de novo in adults with subtle manifestations distinct from the typical features of classic CF. The purpose of this article is to present the wide spectrum of CF in adults, including both classic and nonclassic variants, with an emphasis on the nonclassic imaging findings. CONCLUSION: Recurrent pancreatitis, chronic sinusitis, and congenital bilateral absence of the vas deferens (CBAVD) are several of the ways in which CF is identified in adult patients with relatively rare mutations and with overall milder manifestations. It is important for radiologists to recognize the wide spectrum of CF to optimally monitor disease progression and response to therapeutic interventions in distinct adult patient populations.

Clinical and Imaging Features of Noncutaneous Melanoma.

OBJECTIVE: The purpose of this article is to summarize the epidemiologic characteristics, clinical aspects, and radiologic appearance of as well as the management considerations and differential diagnoses for noncutaneous primary melanomas occurring at specific anatomic sites. Primary ocular, sinonasal, meningeal, biliary, adrenal, alimentary tract, and genitourinary melanomas are highlighted. CONCLUSION: Noncutaneous primary melanomas are a complex group of malignancies with biologic findings that are unique when compared with findings for cutaneous melanomas. Each noncutaneous primary melanoma has its own specific diagnostic and management challenges, depending on the anatomic location where they arise.

Bone regeneration in critical-sized bone defect enhanced by introducing osteoinductivity to biphasic calcium phosphate granules.

OBJECTIVES: Biphasic calcium phosphate (BCP) is frequently used as bone substitute and often needs to be combined with autologous bone to gain an osteoinductive property for guided bone regeneration in implant dentistry. Given the limitations of using autologous bone, bone morphogenetic protein-2 (BMP2)-coprecipitated, layer-by-layer assembled biomimetic calcium phosphate particles (BMP2-cop.BioCaP) have been developed as a potential osteoinducer. In this study, we hypothesized that BMP2-cop.BioCaP could introduce osteoinductivity to BCP and so could function as effectively as autologous bone for the repair of a critical-sized bone defect. MATERIALS AND METHODS: We prepared BMP2-cop.BioCaP and monitored the loading and release kinetics of BMP2 from it in vitro. Seven groups (n = 6 animals/group) were established: (i) Empty defect; (ii) BCP; (iii) BCP mixed with biomimetic calcium phosphate particles (BioCaP); (iv) BCP mixed with BMP2-cop.BioCaP; (v) BioCaP; (vi) BMP2-cop.BioCaP; (vii) BCP mixed with autologous bone. They were implanted into 8-mm-diameter rat cranial critical-sized bone defects for an in vivo evaluation. Autologous bone served as a positive control. The osteoinductive efficacy and degradability of materials were evaluated using micro-CT, histology and histomorphometry. RESULTS: The combined application of BCP and BMP2-cop.BioCaP resulted in significantly more new bone formation than BCP alone. The osteoinductive efficacy of BMP2-cop.BioCaP was comparable to the golden standard use of autologous bone. Compared with BCP alone, significantly more BCP degradation was found when mixed with BMP2-cop.BioCaP. CONCLUSION: The combination of BCP and BMP2-cop.BioCaP showed a promising potential for guided bone regeneration clinically in the future.

Traumatic orbital encephalocele: Presentation and imaging.

OBJECTIVE: Traumatic orbital encephalocele is a rare but severe complication of orbital roof fractures. We describe 3 cases of orbital encephalocele due to trauma in children. METHODS: Retrospective case series from the University of Wisconsin - Madison and Medical College of Wisconsin. RESULTS: Three cases of traumatic orbital encephalocele in pediatric patients were found. The mechanism of injury was motor vehicle accident in 2 patients and accidental self-inflicted gunshot wound in 1 patient. All 3 patients sustained orbital roof fractures (4 mm to 19 mm in width) and frontal lobe contusions with high intracranial pressure. A key finding in all 3 cases was progression of proptosis and globe displacement 4 to 11 days after initial injury. On initial CT, all were diagnosed with extraconal hemorrhage adjacent to the roof fractures, with subsequent enlargement of the mass and eventual diagnosis of encephalocele. CONCLUSION: Orbital encephalocele is a severe and sight-threatening complication of orbital roof fractures. Post-traumatic orbital encephalocele can be challenging to diagnose on CT as patients with this condition often have associated orbital and intracranial hematoma, which can be difficult to distinguish from herniated brain tissue. When there is a high index of suspicion for encephalocele, an MRI of the orbits and brain with contrast should be obtained for additional characterization. Imaging signs that should raise suspicion for traumatic orbital encephalocele include an enlarging heterogeneous orbital mass in conjunction with a roof fracture and/or widening fracture segments.

Workflow interruptions in an era of instant messaging: A detailed analysis.

INTRODUCTION: The complex practice environment and responsibilities incumbent on diagnostic radiologists creates a workflow susceptible to disruption. While interruptions have been shown to contribute to medical errors in the healthcare delivery environment, the exact impact on highly subspecialized services such as diagnostic radiology is less certain. One potential source of workflow disruption is the use of a departmental instant messaging system (Webex), to facilitate communications between radiology faculty, residents, fellows, and technologists. A retrospective review was conducted to quantify the frequency of interruption experienced by our neuroradiology fellows. MATERIALS AND METHODS: Data logs were gathered comprising all instant messages sent and received within the designated group chats from July 5-December 31, 2021, during weekday shifts staffed by neuroradiology fellows. Interruptions per shift were calculated based on month, week, and day of the week. RESULTS: 14,424 messages were sent across 289 total shifts. The 6 fellows assigned to the main neuroradiology reading room sent 3258 messages and received 10,260 messages from technologists and other staff. There was an average of 50 interruptions per shift when examined by month (range 48-53), and 52 interruptions per shift when examined by day of the week (range 40-60). CONCLUSION: Neuroradiology fellows experience frequent interruptions from the departmental instant messaging system. These disruptions, when considered in conjunction with other non-interpretative tasks, may have negative implications for workflow efficiency, requiring iterative process improvements when incorporating new technology into the practice environment of diagnostic radiology.

Training the New Radiologists: Approaches for Education.

The field of Radiology is continually changing, requiring corresponding evolution in both medical student and resident training to adequately prepare the next generation of radiologists. With advancements in adult education theory and a deeper understanding of perception in imaging interpretation, expert educators are reshaping the training landscape by introducing innovative teaching methods to align with increased workload demands and emerging technologies. These include the use of peer and interdisciplinary teaching, gamification, case repositories, flipped-classroom models, social media, and drawing and comics. This publication aims to investigate these novel approaches and offer persuasive evidence supporting their incorporation into the updated Radiology curriculum.

Energy storage and water splitting applications of self-grown Na2O-NiCl2 upright standing nanoplates: a process of 3D nickel surface modification using seawater.

The recent trend in research fosters the use of abundant seawater for modifying metal surfaces as electrode materials for energy generation, storage, transport, and water-splitting technologies. Economic and ecofriendly seawater is used as a solvent for modifying the surface of 3D nickel-foam (NiF) to Na2O-NiCl2@NiF as an electrode material in electrochemical supercapacitors and water-splitting electrocatalysis applications. The phase of the as-obtained Na2O-NiCl2 is confirmed from the proposed reaction mechanism, followed various physical measurement tests such as X-ray photoelectron spectroscopy and Fourier transform infrared analysis. The formation of Na2O-NiCl2 is caused by a high operation temperature and pressure of seawater solvent, the presence of lone pair electrons on oxygen, and more reactivity of Na for combining with dissolved oxygen than the lone-pair free Cl (towards Ni). In addition to exceptional HER and OER electrocatalytic activities, i.e., 146.3 mV cm-2 and 217 mV cm-2 at a scan rate of 5 mV s-1 to attain the 10 mA cm-2 current density, the Na2O-NiCl2 has demonstrated moderate energy storage ability with considerable durability, i.e., 2533 F g-1 specific capacitance at 3 A g-1 current density even after 2000 redox cycles. The as-assembled Na2O-NiCl2//Na2O-NiCl2 symmetric electrochemical supercapacitor device has ignited a "CNED" panel consisting of nearly forty LEDs with full brightness, offering applied importance in home appliances. In nutshell, seawater-modified metal surfaces can be used for energy storage and water-splitting applications.

Bilateral duplicated internal carotid arteries presenting as middle ear masses: a case report and review of the literature.

OBJECTIVES: We seek to describe an individual with bilateral duplicated internal carotid arteries (ICAs) presenting as middle ear masses, to discuss the anatomy and characteristic imaging findings associated with this condition, and to familiarize clinicians with effective methods to prevent and manage complications related to this entity. METHODS: The clinical presentation of an individual with this unusual vascular anomaly was reviewed. A literature search was then performed to identify previously reported studies describing aberrant ICAs in order to characterize the presentation, anatomy, imaging findings, and management of this condition. RESULTS: An aberrant ICA presenting as a middle ear mass is uncommon; there are only approximately 45 reported cases to date. The majority of these cases presented as a unilateral anomaly without a duplication, were associated with pulsatile tinnitus and hearing loss, and were diagnosed during middle ear procedures. Bilateral aberrant ICAs are exceedingly rare, with only 14 existing reports. Only 1 of these cases presented with duplicated ICAs. Our report demonstrates an unusual presentation of aberrant ICAs, as pulsatile tinnitus was absent and previous middle ear surgery had been performed without establishing this diagnosis and without any resulting complications. Furthermore, this case represents the first known instance of a bilateral duplicated ICA system without persistent stapedial arteries. Although vascular middle ear anomalies are unusual, complications of surgical manipulation have been documented. CONCLUSIONS: The clinician must have a high index of suspicion for vascular lesions in patients presenting with a retrotympanic mass. Appropriate diagnostic imaging studies should be performed to exclude this diagnosis before middle ear exploration. Should injury to the carotid artery occur, surgeons should follow specific guidelines to avoid potentially serious complications.

Environmental sustainability assessment of softwood and hardwood seedlings production in forest nurseries: A case study from Pakistan.

This article describes the environmental impacts of producing a single seedling in forest nurseries of selected districts (i.e., Haripur, Abbottabad, and Mansehra) of Hazara Division of Khyber Pakhtunkhwa, Pakistan using the life cycle assessment (LCA) approach. This study was based on the cradle-to-gate approach which begins with the pre-nursery stage and progresses toward the main nursery before transplanting seedlings into the plantation site. Data or life cycle inventory (LCI) of seedling production were collected through questionnaire surveys and personal meetings with forest nurseries managers and workers regarding consumption of different inputs such as electricity, diesel, fertilizers, herbicides, and polyethylene bags, organic manure, and water consumption. The SimaPro software version 8.5 and the CML2000 v2.05 environmental model was applied to perform life cycle impact assessment (LCIA) for a single seedling production in forest nurseries in the study area. In line with the objectives of the study, primary data regarding inputs and outputs of the nurseries were collected from 35 nurseries in the study area by using a random questionnaire method. In addition, secondary data were taken from online databases such as Eco-invent v.3.2 CORRIM and peer-reviewed published literature. For this study, a functional unit of a single seedling was considered. Production weighted average data were modeled in the latest environmental modeling software i.e., SimaPro v.8.5 for ten US-EPA most wanted environmental impacts, such as global warming potential (GWP), abiotic depletion (AD), eutrophication potential (EP), acidification potential (AP), freshwater aquatic eco-toxicity (FAE), marine water eco-toxicity (MWE), terrestrial eco-toxicity (TE), ozone layer depletion (OLD), photochemical oxidation (PO), and human toxicity (HT). The results showed that the highest environmental impact posed by a single seedling was marine aquatic eco-toxicity (11.31360 kg 1,4-DB eq), followed by global warming potential (0.02945 kg CO2 eq) and (0.01227 kg 1,4-DB eq) human toxicity. The primary reason for these environmental burdens was the use of synthetic fertilizers in forest nurseries and the consumption of fossil fuels in nursery mechanization and transportation activities. The total cumulative energy demand for a single seedling was (0.800 MJ) with more than 90% contribution from fossil fuel energy resources such as petrol and diesel. It is therefore highly recommended to use renewable energy resources and organic fertilizers instead of chemical fertilizers in forest nurseries to avoid and minimize greenhouse gas emissions (GHS) and other toxic emissions in the study area.

Assessment of particulate matter (PM) in ambient air of different settings and its associated health risk in Haripur city, Pakistan.

Particulate matter (PM) is a major air pollutant causing serious health problems. The aim of the present study was to find out concentration of PM in ambient air and its associated health risk in Haripur city, Pakistan. Twenty-three samples were taken at various educational institutes, hospitals, recreational areas and industries in Haripur city. Concentration of PM2.5 (µg/m3) and PM10 (µg/m3) was measured with Youngteng YT-HPC 3000A portable PM counter. The results revealed that values of both PM2.5 and PM10 were above the permissible limits (35 µg/m3 for PM2.5 and 150 µg/m3 for PM10) set by Environmental Protection Agency Pakistan (Pak-EPA) in all the educational institutes, hospitals, recreational areas and industries investigated. Furthermore, significant (p<0.05) variation was found in the concentration of both PM2.5 and PM10 in all the educational institutes, hospitals, recreational areas, and industries studied. The concentration of PM2.5 was positively correlated with the concentration of PM10 in all the sampling sites. Therefore, from 1-14 scale standard of health index, the values of PM2.5 and PM10 exhibited that the ambient air quality of Haripur city Pakistan is under high risk. If the regulatory authorities such as Environmental Protection Agency, Health Department and Local Government monitor PM pollution in different settings of Haripur city, then a decrease can be possible in the pollution level. The remedies that can be taken to overcome the problem of ambient air pollution such as PM are plantation of trees at the sites where there are higher levels of air pollutants and use of masks on personal protection basis along with implementation of pollution control system in industries of Hattar Industrial Estate Haripur city, Pakistan.

Economic valuation of selected ecosystem services in Islamabad Capital Territory (ICT), Pakistan.

Payment for ecosystem services (PES) is a mechanism where a consumer is able and ready to pay for the protection of the precise ecosystem service and there must be a provider such as local societies receiving an economic resource, who in return, must have the ability to maintain that ecosystem service. Economic valuation provides basis for payment for ecosystem services. Therefore, objective of this study was to evaluate tourism and carbon stock services of the Islamabad Capital Territory (ICT), Pakistan. Two forest zones (Chirpine and Scrub) of Islamabad capital territory (ICT) were selected for estimation of carbon stock and their carbon credits and carbon worth, a questionnaire-based survey was conducted for tourism as a payment for ecosystem services. The method for carbon stock assessment was systematic sampling for Chirpine forest whereas random sampling was done for scrub forest. The size of sampling plot was 17.84 m radius, and a total of 93 plots (49 Scrub zone and 44 Chirpine zone) was taken in the study area. The carbon stock of both zones (Chirpine and Scrub zone) is 22556.75 ton/ha (Chirpine 20105.79, Scrub 2450.96) and total carbon dioxide sequestered by both zone is 82557.72 ton/ha (Chirpine 73587.2, Scrub 8970.52), total carbon credits of both zone is 302160.87 (Chirpine 269328.97, Scrub 32831.9) and the carbon worth of both Chirpine and scrub zone is 4532418.92 $ (Chirpine 4039937.09$, Scrub 492481.83$). Similarly, from tourism point of view, in Shakar Parian, 94% tourists were agreed for PES whereas 6% were disagreed for the PES (the 6% tourist were disagreed to contribute for PES, 40% were agreed for Rs.5 contribution and 54% for Rs.10.). moreover, in Lake view Park, 97% tourists were agreed and 3% are disagreed (In Lake View Park 5% tourists were disagreed for the PES contribution whereas 32% were agreed for Rs.5 and 63% were for Rs.10). In Damen e Koh, around 87% tourist were agreed and 13% were disagreed, (24% were agreed for the contribution of Rs.5 and 63% tourists were agreed for the contribution of Rs.10). In Marghazar Zoo, 93% tourists were agreed (22% were agreed for contribution of Rs.5 and 71% tourist were agreed for contribution of Rs.10) and 7% are disagreed for PES whereas 7% tourists were not agreed for contribution. PES may implement to compensate forest and parks manager to ensure better management of the forests and parks. Due to prime location and scenic beauty of the ICT, it has huge potential for implementation of PES mechanism for sustainable forest management and conservation. Therefore, it is recommended that Capital Development Authority (CDA) Islamabad should devise a plan for implementation of PES in forests and parks of ICT for its sustainable management of recreational and forest resources.

Bridging the gap: interactive, case-based learning in radiology education.

Traditional teaching methods in radiology education have not kept pace with advances in technology that foster successful transition into independent practice. This deficit has been exacerbated by the COVID-19 pandemic, as the need for social distancing and the introduction of hybrid staffing models have decreased the critical educational interactions at the reading room workstations between staff and trainees. By leveraging interactive, case-based learning, educators have the opportunity to bridge the substantial gap between basic pattern recognition and successfully making a diagnosis in independent practice. For the educator, this signals a shift away from perfect case selection and presenter authority, and toward the role of a guide facilitating an active case-based learning experience. This form of learning is best accompanied by guided interpretation and iterative feedback with the goal of developing similar levels of mastery and autonomy among graduating trainees. In this article, we present the tools and methods for incorporating interactive cases into existing and novel teaching materials to meet the unique challenges educators are facing today.

Remodeling, Reintervention, and Survival After Endovascular Repair of Chronic Type B Dissection.

BACKGROUND: The efficacy of thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection (cTBAD) is controversial. Only limited evidence describes temporal anatomic changes after TEVAR for cTBAD and their relationship to outcomes. We sought to investigate early aortic remodeling events after TEVAR for cTBAD with thoracic aneurysm and determine the association with reintervention and survival. METHODS: Records from 95 cTBAD patients undergoing TEVAR from 2005 to 2017 were reviewed. Using 3-dimensional centerline analysis, anatomic phenotyping of the thoracoabdominal aorta was performed. Reverse aortic remodeling (RAR) was defined by a ≥5-mm reduction in maximal thoracic aortic diameter. Kaplan-Meier analysis estimated freedom from reintervention and survival. RESULTS: Visceral segment dissection involvement was present in 89% of patients (n = 85), and the mean preoperative thoracic diameter was 63 mm (SD, 10). Complete thoracic false lumen thrombosis occurred in 71% of patients (n = 67), whereas abdominal false lumen thrombosis was documented in 60% (n = 57) by 6 months. RAR occurred in 41%. Aortic reintervention rate was 39% (n = 37). The 1- and 3-year freedom from reintervention was significantly higher in subjects experiencing early RAR (log-rank P = .02), but reintervention did not impact overall survival (log-rank P = .9). Similarly, overall survival was similar between patients with or without RAR (log-rank P = .4). CONCLUSIONS: Early RAR is associated with decreased rates of reintervention; however, overall survival is not impacted by these changes. TEVAR for cTBAD results in a high rate of reintervention, which mandates vigilant surveillance protocols.

Factors Influential in the Selection of Radiology Residents in the Post-Step 1 World: A Discrete Choice Experiment.

OBJECTIVES: Reporting of United States Medical Licensing Examination Step 1 results will transition from a numerical score to a pass or fail result. We sought an objective analysis to determine changes in the relative importance of resident application attributes when numerical Step 1 results are replaced. METHODS: A discrete choice experiment was designed to model radiology resident selection and determine the relative weights of various application factors when paired with a numerical or pass or fail Step 1 result. Faculty involved in resident selection at 14 US radiology programs chose between hypothetical pairs of applicant profiles between August and November 2020. A conditional logistic regression model assessed the relative weights of the attributes, and odds ratios (ORs) were calculated. RESULTS: There were 212 participants. When a numerical Step 1 score was provided, the most influential attributes were medical school (OR: 2.35, 95% confidence interval [CI]: 2.07-2.67), Black or Hispanic race or ethnicity (OR: 2.04, 95% CI: 1.79-2.38), and Step 1 score (OR: 1.8, 95% CI: 1.69-1.95). When Step 1 was reported as pass, the applicant's medical school grew in influence (OR: 2.78, 95% CI: 2.42-3.18), and there was a significant increase in influence of Step 2 scores (OR: 1.31, 95% CI: 1.23-1.40 versus OR 1.57, 95% CI: 1.46-1.69). There was little change in the relative influence of race or ethnicity, gender, class rank, or clerkship honors. DISCUSSION: When Step 1 reporting transitions to pass or fail, medical school prestige gains outsized influence and Step 2 scores partly fill the gap left by Step 1 examination as a single metric of decisive importance in application decisions.

Nontraumatic Vascular Emergencies of the Neck.

Nontraumatic vascular emergencies of the head and neck are uncommon, but can occur in patients with central venous catheters, head and neck infections, and in patients with head and neck cancer. Recognizing the imaging findings of vascular complications in these patient populations is critically important to ensure expeditious treatment to avoid significant morbidity and mortality.