Am I Ready to Be an Independent Neuroradiologist? Objective Trends in Neuroradiology Fellows' Performance during the Fellowship Year.

BACKGROUND AND PURPOSE: Aside from basic Accreditation Council for Graduate Medical Education guidelines, few metrics are in place to monitor fellows' progress. The purpose of this study was to determine objective trends in neuroradiology fellowship training on-call performance during an academic year. MATERIALS AND METHODS: We retrospectively reviewed the number of cross-sectional neuroimaging studies dictated with complete reports by neuroradiology fellows during independent call. Monthly trends in total call cases, report turnaround times, relationships between volume and report turnaround times, and words addended to preliminary reports by attending neuroradiologists were evaluated with regression models. Monthly variation in frequencies of call-discrepancy macros were assessed via χ2 tests. Changes in frequencies of specific macro use between fellowship semesters were assessed via serial 2-sample tests of proportions. RESULTS: From 2012 to 2017, for 29 fellows, monthly median report turnaround times significantly decreased during the academic year: July (first month) = 79 minutes (95% CI, 71-86 minutes) and June (12th month) = 55 minutes (95% CI, 52-60 minutes; P value = .023). Monthly report turnaround times were inversely correlated with total volumes for CT (r = -0.70, F = 9.639, P value = .011) but not MR imaging. Words addended to preliminary reports, a surrogate measurement of report clarity, slightly improved and discrepancy rates decreased during the last 6 months of fellowship. A nadir for report turnaround times, discrepancy errors, and words addended to reports was seen in December and January. CONCLUSIONS: Progress through fellowship correlates with a decline in report turnaround times and discrepancy rates for cross-sectional neuroimaging call studies and slight improvement in indirect quantitative measurement of report clarity. These metrics can be tracked throughout the academic year, and the midyear would be a logical time point for programs to assess objective progress of fellows and address any deficiencies.

A Double-Edged Sword: Neurologic Complications and Mortality in Extracorporeal Membrane Oxygenation Therapy for COVID-19-Related Severe Acute Respiratory Distress Syndrome at a Tertiary Care Center.

In this clinical case series, we report our experience to date with neurologic complications of extracorporeal membrane oxygenation therapy for COVID-19 Acute Respiratory Distress Syndrome. We have found an unexpectedly increased rate of complications as demonstrated by neuroimaging compared with meta-analysis data in extracorporeal membrane oxygenation therapy for all Acute Respiratory Distress Syndrome etiologies over the past few decades and compared with the most recent baseline data describing the incidence of neurologic complication in all patients with COVID-19. For our 12-patient cohort, there was a rate of intracranial hemorrhage of 41.7%. Representative cases and images of devastating intracranial hemorrhage are presented. We hypothesize that the interplay between hematologic changes inherent to extracorporeal membrane oxygenation and inflammatory and coagulopathic changes that have begun to be elucidated as part of the COVID-19 disease process are responsible. Continued analysis of extracorporeal membrane oxygenation therapy in this disease paradigm is warranted.

Reversal of abnormal dexamethasone suppression test in alcoholics abstinent for four weeks.

Fourteen of 64 alcoholic inpatients (22%) showed a nonsuppression postdexamethasone response when tested between the second and fifth days of admission. No association with alterations of hepatic enzymes (GGT, SGOT, SGPT) was observed. At retest (in the fourth week of abstinence), no abnormal response to the Dexamethasone Suppression Test (DST) was detected. The nonsuppressor alcoholics did not meet the criteria for major depression according to the Research Diagnostic Criteria (RDC). The data indicate a lack of specificity of the DST for the diagnosis of depression in alcoholics during the first days of withdrawal.

Response variability of ethanol-induced locomotor activation in mice.

Mice from a randomly bred strain were divided into two groups according to their locomotor responses to ethanol (0.8-3.0 g/kg): in two thirds of the tested animals ethanol increased locomotor activity (ethanol activated-EA), whereas in the remaining one third it did not (ethanol non-activated-ENA). Both groups did not differ in their locomotor activity after saline administration. Furthermore, EA and ENA mice presented a similar increase in locomotor activity after challenge with 1.0 and 2.0 mg/kg d-amphetamine. Chronic exposure to ethanol increased the ethanol-induced locomotor activation in both EA and ENA groups. The possibility that the lack of responsiveness of ENA mice to ethanol's acute activating effect could be due to a higher sensitivity to the depressant effect of ethanol is discussed.

Development and reacquisition of tolerance to ethanol administered pre- and post trial to rats.

The development of tolerance to the disruptive effects of ethanol on bar-pressing behavior was studied in rats by exposing them to four cycles of drug administration intercalated by 34-day drug-free periods. A negative correlation was obtained between the successive cycles and the number of sessions required for the rats to reach the criterion of tolerance. Also studied was the possible difference in the rate of development of tolerance in the four cycles when ethanol was administered before or after the task. One group of rats was required to perform the response under the influence of ethanol, while other group received the drug 90 min after the bar-pressing sessions. At the first cycle the group which performed under drug action developed tolerance more rapidly than the group which received ethanol after the task.

An attempt to improve the identification of alcohol-dependent patients in a teaching general hospital.

The information on drinking habits contained in medical records with that obtained through the CAGE alcoholism screening test was compared for 124 inpatients of a teaching general hospital. This survey was followed by testing the possibility of introducing the CAGE test into the routine clinical interview. A second analysis of 110 medical records performed 2 months later indicated the failure of this attempt, as the general pattern of information on drinking habits remained unaltered and characterized by either no information at all or information that was too ambiguous to be of clinical value. Among the different hypotheses that could account for the negative results is the possibility that physicians are not sufficiently informed on the wide spectrum of clinical disorders associated to alcohol abuse. Another important factor is the lack of motivation shown by attending physicians to detect less obvious cases of alcohol dependence as they feel pessimistic about dealing with this condition.

Diagnostic of alcoholism: how useful is the combination of gamma glutamyl transferase with different biochemical markers?

The present paper analyses the alterations in sensitivity, specificity and in the positive predictive value (PPV) of GGT as a state marker of alcohol abuse when used either alone or in combination with glutamate pyruvate transaminases (SGPT), glutamate oxalacetate (SGOT) and mean corpuscular volume (MCV). The results obtained with an alcoholic (n = 70) and non-alcoholic sample (n = 63) showed that the best combination considering sensitivity was obtained when GGT was combined with MCV (80%). However, this combination produced the largest decrease in PPV. The relevance of taking into account not only sensitivity but also PPV when the markers are to be used as screening tests in unselected populations is discussed.

Lack of agreement between two questionnaires that evaluate the severity of the alcohol dependence syndrome.

The Short-Alcohol Dependence Data (SADD) and the Alcohol Dependence Scale (ADS) questionnaires, both designed to evaluate the degree of severity of alcohol dependence, were compared in a sample of 201 known alcoholics. Although a significant correlation was found between the scores obtained on the two scales (r = 0.61; P less than 0.01), respondents were classified differently by the two questionnaires (Kappa = 0.20). Subjects were generally considered less dependent by the ADS than by the SADD. Different possibilities that could explain the differential classification are discussed.

Alcohol use among adolescents in São Paulo, Brazil.

Drinking habits was studied in a sample of 3114 students from a low socioeconomic level and aging from 9 to 18 years. Males and females were equally represented in the sample. The survey showed that 27% were non-drinkers, 54% experimental drinkers, 14% moderate regular drinkers and 5% excessive regular drinkers. The excessive regular drinkers reported a higher proportion of heavy alcohol consumption among close relatives, mainly fathers. Sex and age-related differences were found in the drinking pattern. Males as well as oldest students were over represented among the drinkers excepted for excessive regular drinkers where no age difference was detected. This finding (same proportion of excessive regular drinkers in all age groups) was discussed taking into account the possibility that the high drop out rates in Brazilian schools could be introducing a bias in the figures found for the oldest adolescent groups. Beliefs about drinking consequences and location where most drinking occurs were also studied.

Reversible effects of acute and long-term administration of delta-9-tetrahydrocannabinol (THC) on memory in the rat.

A study was designed to develop a measure of both acute and chronic effects of THC administration on memory in the rat. Errors in an 8-arm radial maze, before and after two delay intervals (5 s and 1 h, introduced between the fourth and the fifth arm choice), constituted the principal dependent measures. The first experiment involved testing the animals shortly after administration of 1.25 mg/kg THC. The drug did not affect performance in the pre-delay tests, although a significant effect was observed after the 5-s delay but not after 1-h delay. In the second experiment, 5 mg/kg THC or saline were administered 6 days/week for 90 days. Testing was conducted 18 h after each drug administration. During chronic administration the pre-delay performance did not differ between groups but the post-delay performance of the THC group deteriorated in a gradual manner, relative to their controls, in both the 5-s and 1-h delay conditions. After discontinuation of drug administration, the differences between groups reversed only after 30 days. The results provided evidence that both acute and chronic administration of THC affected working-memory in the radial arm maze test, although it did not interfere with the general cues of the task (reference memory). Chronic drug effects on memory were reversible after prolonged abstinence. Thus, the 8-arm radial maze task proved to be a useful measure of THC effects on memory and could be further used to investigate more thoroughly the mechanisms involved in such drug effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Amygdaloid kindling and kindled seizures in rats receiving chronic ethanol administration.

The effects of chronic ethanol administration were studied in rats receiving amygdaloid kindling. Daily ethanol administration 10 min prior to kindling stimulation delayed acquisition of kindling without affecting the electrical afterdischarge. For the lowest tested dose of ethanol (0.5 g/kg), this delay was restricted to kindling stages 1 and 2. For the higher doses of ethanol (1.0 and 1.5 g/kg) this delay became more severe and stages 3 and 4 were blocked. Ethanol produced a clear dose-related anticonvulsant effect upon kindled seizures. After repeated exposure to kindling stimulation and ethanol this anticonvulsant effect vanished. After a 15-day interval without stimulation or ethanol application kindled animals were insensitive to ethanol's anticonvulsant effect. In conclusion, it is suggested that the anticonvulsant effects of low ethanol doses are restricted to kindling stages 1 and 2 and that anticonvulsant effects of high ethanol doses are limited by tolerance and by the level of consolidation of the kindled seizure. Finally, we suggest that the anticonvulsant properties of ethanol are not due to its general depressant effect but to some rather specific action.

Evaluation of AIDS prevention among homosexual and bisexual men in Switzerland.

Attitudinal and behavioural change among gay men in Switzerland was measured between 1987 and 1990 to evaluate the effectiveness of AIDS prevention activities. The methodology used included a self-administered questionnaire published in Swiss gay magazines and distributed by gay organizations (N = 795 in 1987, N = 720 in 1990) and in-depth interviews with men recruited through advertisements and through the questionnaire (N = 42 in 1987, N = 24 in 1990). The two independent sampling procedures yielded similar samples with regard to socio-demographic characteristics, allowing comparisons to be made between the 1987 and 1990 data. Personal confrontation with AIDS (knowing someone who is HIV-positive, or who is ill or dead from AIDS) increased significantly during the period but more adequate ways of coping developed. Behavioural change towards safer sex began well before the first study. The majority of responding homosexuals have adapted their sexual behaviour to the new situation created by AIDS and generally maintain a protective behaviour. However, "exceptions" (condom rupture or episodes of non-protection) are not infrequent and should deserve more attention. Three indicators of sexual behaviour (number of sexual partners, anal sex and use of condom and oral sex with ejaculation), reported for the last 3 months before each study, exhibit few changes between 1987 and 1990: number of partners remained stable, unprotected oral sex decreased. Anal sex slightly increased, the use of condoms remaining stable. Sixty-seven percent of the sample knew their serostatus in 1990 (57% in 1987), and 13% of these stated that they were HIV+ (14% in 1987).

The excitatory component of ethanol in mice: a chronic study.

The effects of chronic administration of initially depressant, ineffective and excitatory doses of ethanol on the locomotor activity of mice was studied. The results showed that (1) an excitatory effect of ethanol is observed after tolerance develops to its depressant action; (2) the effect induced by an initially excitatory dose of ethanol became more pronounced with chronic exposure to the drug; and (3) tolerance to the excitatory effect was not reached after 60 days of ethanol treatment.

Ethanol induces hyper and hypoglycemia in both fasted and nonfasted rats dependent on the ambient temperature.

An experiment was undertaken to characterize the influence of ambient temperature on ethanol-induced glycemic alterations in rats. Animals under two different feeding conditions (nonfasted or 48-hr fasted) were IP injected with 4.0 g/kg of ethanol. Blood glucose and body temperature were measured before, 90 and 180 min after drug administration. The rats were tested under ambient temperatures of 16, 21 and 32 degrees C. Fed animals with a mean pre-drug glycemia of near 105 mg/100 ml presented a variation of blood glucose ranging from 50 mg/100 ml at 16 degrees C to 140 mg/100 ml at 32 degrees C. The glycemia from fasted rats, with a starting value of 70 mg/100 ml ranged from 20 to 115 mg/100 ml at 16 and 32 degrees C, respectively. It was concluded that the administration of ethanol can render nonfasted as well as fasted rats hypo or hyperglycemic, depending upon the environmental temperature.

Does hypothermia play a relevant role in the glycemic alterations induced by ethanol?

The potential of ethanol-induced hypothermia on the glycemic alterations induced by this drug were evaluated. In Experiment 1 ambient temperature was manipulated. After 4.0 g/kg of ethanol blood glucose levels and body temperature were assessed in fed or 48 hr starved rats at either 21 degrees C or 28 degrees C room temperature. Hyper or hypoglycemia was observed depending on both the feeding condition and the environmental temperature. In Experiment 2, this hypothesis was tested by determining if rats tolerant to the thermic effects of ethanol would show a decreased glycemic response. The results support this assumption.

Blood glucose and body temperature alterations induced by ethanol in rats submitted to different levels of food deprivation.

The effects of 1.0, 3.0 and 5.0 g/kg of ethanol on blood glucose levels and body temperature were examined in rats submitted to either acute food deprivation (24 or 48 hr), chronic starvation, or to both chronic plus acute food deprivation. The results show that: (a) 3.0 and 5.0 g/kg produced either an increase or a decrease of glucose levels depending on the state of fasting; (b) rats not deprived of food presented hyperglycemia while being hypothermic; (c) a marked hypothermia was present when no substantial alterations in glycemia were observed; and (d) in cases where hypoglycemia and hypothermia occurred, the fall in body temperature paralleled or preceded the decrease in glucose levels.

Interference by a nonpharmacological factor on the action of psychoactive drugs in rats. A comparative study.

The interaction of 5 psychoactive drugs (ethanol, chlorpromazine, diazepam, pentobarbital and THC) with a nonpharmacological factor was studied in rats. The nonpharmacological variable studied was the level of motivation to overcome the depressant action of the drugs administered. Rats highly motivated to perform a learned escape response (high intensity footshocks during training) required significantly higher doses of ethanol to become impaired when compared to low motivated animals (low intensity footshocks during training). However, the level of motivation did not interact with the action of the other 4 drugs, as the doses required to impair the escape response were the same in the low and high motivated rats. The greater susceptibility of ethanol to a nonpharmacological factor when compared to the other psychoactive drugs is discussed.

Hypoglycemia and hypothermia induced by ethanol: antagonism by indomethacin.

The influence of pretreatment with 5.0 or 10.0 mg/kg of indomethacin, a prostaglandin synthetase inhibitor, on the alterations in body temperature produced by 3.0 and 4.0 g/kg of ethanol, was studied in food-deprived and free-feeding rats. A partial antagonism of ethanol's hypothermic effect resulted from indomethacin pretreatments and this effect was found to be ethanol dose-dependent. This result could account for the conflicting reports in the literature on the effectiveness of indomethacin in antagonizing ethanol-induced hypothermia. Indomethacin (5.0 mg/kg) also antagonized ethanol-induced hypoglycemia in 48 hr starved rats. The relationship between two effects of ethanol, hypothermia and hypoglycemia, is discussed.

The excitatory effect of ethanol: absence in rats, no tolerance and increased sensitivity in mice.

Three questions related to ethanol's stimulating effect (ESE) were studied. The first referred to the reported absence of tolerance to ESE in mice. It was determined whether tolerance would develop if the period of ethanol treatment were extended significantly beyond those normally found in the literature. No evidence of tolerance to ESE was found over a 5-month period of treatment. The second issue related to the possibility that mice not only do not develop tolerance but actually become more responsive to ESE after chronic exposure. A dose of ethanol that acutely did not produce a significant activating effect did induce a marked excitation after the animals were chronically treated with ethanol. Finally, the issue was addressed of whether the absence of ESE in some strains of rats could in part be due to a masking effect by the depressant component of this drug. To test this possibility rats were treated with ethanol for a 4-month period. Tolerance to the depressant effect was observed but no ESE was detected.

Correlation between biological state markers of alcohol abuse and severity of alcohol dependence syndrome.

Data on the correlation between the degree of severity of the alcohol dependence syndrome, as evaluated through the Short Alcohol Dependence Data (SADD) questionnaire, and alterations of four biological state markers of alcohol abuse, namely gamma-glutamyltransferase (GGT), glutamate pyruvate transaminase (SGPT), glutamate oxalacetate transaminase (SGOT) and mean corpuscular volume (MCV), in a sample of 137 alcoholics, are presented. A significant increase in the proportion of altered GGT and SGOT results was found in those patients with higher scores in the SADD. The analysis of the correlation (Spearman coefficient) between the values of each biological test and the SADD scores showed only a significant, though low, positive correlation for SGOT (r = 0.29).