A National Medical Student Diagnostic Radiology Competition Initiative: Survey and Outcomes of the RadiOlympics.

RATIONALE AND OBJECTIVES: Diagnostic radiology residents may participate in an annual diagnostic imaging tournament that enables residents to engage in friendly competition, network with peers, and practice for board examinations. Medical students would likely enjoy a similar activity, which could increase their interest and knowledge in radiology. Given the lack of initiatives designed to promote competition and learning in medical school radiology education, we designed and implemented the RadiOlympics, the first known national medical student radiology competition in the United States. MATERIAL AND METHODS: A draft version of the competition was emailed to many medical schools in the United States. Medical students interested in assisting with implementation of the competition were invited to a meeting to refine the layout. Ultimately, the format of seven rounds of five questions each and a final round of ten questions all over four months was decided. Questions were written by students and approved by faculty. At the conclusion of the competition, surveys were sent out to gather feedback and gauge how this competition has influenced their interest in radiology. RESULTS: Out of 89 schools that were successfully contacted, 16 schools' radiology clubs agreed to participate, which made up 187 medical students on average per round. At the conclusion of the competition, feedback from students was very positive. Students' confidence in interpreting imaging studies increased after the competition (p < 0.001), although there was not an increased interest in radiology as a career (p = 0.77). CONCLUSION: The RadiOlympics is a national competition that can be successfully organized by medical students for medical students and is an engaging opportunity for medical students to be exposed to radiology.

Comparing Symmetric Dimethylarginine and Amyloid-ß42 as Predictors of Alzheimer's Disease Development.

Background: Physicians may soon be able to diagnose Alzheimer's disease (AD) in its early stages using fluid biomarkers like amyloid. However, it is acknowledged that additional biomarkers need to be characterized which would facilitate earlier monitoring of AD pathogenesis. Objective: To determine if a potential novel inflammation biomarker for AD, symmetric dimethylarginine, has utility as a baseline serum biomarker for discriminating prodromal AD from cognitively unimpaired controls in comparison to cerebrospinal fluid amyloid-ß42 (Aß42). Methods: Data including demographics, magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography scans, Mini-Mental State Examination and Functional Activities Questionnaire scores, and biomarker concentrations were obtained from the Alzheimer's Disease Neuroimaging Initiative for a total of 146 prodromal AD participants and 108 cognitively unimpaired controls. Results: Aß42 (p = 0.65) and symmetric dimethylarginine (p = 0.45) were unable to predict age-matched cognitively unimpaired controls and prodromal AD participants. Aß42 was negatively associated with regional brain atrophy and hypometabolism as well as cognitive and functional decline in cognitively unimpaired control participants (p < 0.05) that generally decreased in time. There were no significant associations between Aß42 and symmetric dimethylarginine with imaging or neurocognitive biomarkers in prodromal AD patients. Conclusions: Correlations were smaller between Aß42 and neuropathological biomarkers over time and were absent in prodromal AD participants, suggesting a plateau effect dependent on age and disease stage. Evidence supporting symmetric dimethylarginine as a novel biomarker for AD as a single measurement was not found.

Risk factors for intradialytic decline in cerebral perfusion and impaired cerebral autoregulation in adults on hemodialysis.

INTRODUCTION: Hemodialysis (HD) patients have significant burden of cerebral ischemic pathology noted on brain imaging. These ischemic type lesions maybe due to cerebral hypoperfusion that may be occurring during blood pressure (BP) fluctuations commonly noted during HD sessions. We evaluated changes in cerebral perfusion and measured an index of cerebral autoregulation (CA index) during HD to identify potential risk factors for intradialytic decline in cerebral perfusion and impaired cerebral autoregulation. METHODS: In this cross-sectional study, we included HD patients age 50 years or older receiving conventional in-center HD. We measured cerebral perfusion during HD, using cerebral oximetry, and calculated the correlation between cerebral perfusion and BP during HD as an index of CA. We measured the association between potential risk factors for intradialytic decline in cerebral perfusion and CA index. FINDINGS: We included 32 participants and 118 HD sessions in our analysis. The mean ± SD decline in cerebral oxygen saturation during HD was 6.5% ± 2.9% with a relative decline from baseline values of 9.2% ± 4.4%. Greater drop in systolic BP (SBP) during HD was associated with decline in cerebral oxygen saturation, p = 0.02. Impaired CA index was noted in 37.3% of HD sessions. Having diabetes and >20 mmHg drop in SBP during HD were associated with increased (worse) CA index with an increase of 0.24 95%CI [0.06, 0.41] for diabetes and increase of 0.43 95%CI [0.27, 0.56] for a >20 mmHg drop in SBP during HD. DISCUSSION: Cerebral perfusion can decline during HD and is associated with changes in systemic BP. This may be due to impaired cerebral autoregulation in HD patients. Risk factors for worse CA index include diabetes and >20 mmHg drop in SBP during HD. This study highlights the risk of intradialytic decline in cerebral perfusion and impaired cerebral autoregulation in HD patients.