Knowledge and Perceptions of Hepatitis B and Hepatocellular Carcinoma Screening Guidelines Among Trainees: A Tale of Three Centers.

BACKGROUND: Hepatitis B (HBV), the leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the USA. Undiagnosed HBV precludes HCC screening and contributes to late-stage cancer presentation and decreased survival. Barriers to HBV and HCC screening include lack of insurance and limited diffusion of guidelines. We aimed to assess knowledge about HBV and HCC screening indications and explore barriers to screening. METHODS: We surveyed trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We assessed knowledge using clinical vignettes. We performed bivariate and Chi-squared analyses. RESULTS: There were 183 respondents; median age was 31 and 52% were male. The sample was 35% Hispanic, 29% White, 18% Asian, and 9% Black. Training department was Internal Medicine, 71%; Family Medicine, 11%; Infectious Diseases, 6%; or Gastroenterology, 7%. Only 59% correctly estimated national HBV prevalence; 25% correctly estimated global prevalence. In vignettes with behavioral risk factors, trainees correctly advised screening, 63-96%. However, when the risk factor was the birthplace, correct responses ranged from 33 to 53%. Overall, 45% chose an incorrect combination of HBV screening tests. Perceived barriers to screening included limited expertise in screening of immigrants and limited patient education. Respondents were more likely to recommend HCC screening in cirrhotic patients versus non-cirrhotic HBV patients. Key barriers to HCC screening included uncertainty about HCC guidelines and patient financial barriers. CONCLUSIONS: Knowledge of HBV and HCC screening recommendations is suboptimal among trainees. Efforts to broadly disseminate HBV and HCC guidelines through targeted educational interventions are needed.

A Venous Malformation in the Vastus Lateralis: Our Experience with Cryotherapy.

The present report describes a case of cryotherapy ablation in a 35-year-old woman with a 1.5 cm painful venous malformation (VM) in the right vastus lateralis muscle. After the patient had failed sclerotherapy, a single session of cryotherapy was performed that resulted in both technical and clinical success. At 8-month follow-up, there was no residual pain. The use of cryotherapy ablation for the treatment of an intramuscular VM has only been previously described on 1 occasion. Based on our results, cryotherapy is a promising therapy for fast and safe treatment for patients with venous vascular malformations.

Monostotic Scapular Caffey Disease: A Case Report With MRI Correlate.

Caffey disease, also referred to as infantile cortical hyperostosis, is a self-limiting inflammatory disease of bone, typically diagnosed in infancy (ages less than five months). This disease is characterized by asymmetric, often polyostotic bony hyperostosis and expansion, with a predilection for the mandible (70-90%). We present a unique case of a two-month-old boy with monostotic scapular hyperostosis. The disease is primarily diagnosed on plain film and further evaluated with bone scintigraphy or skeletal survey to identify the extent of osseous involvement. Accompanying MR imaging is not usually obtained due to lack of specificity and diagnostic utility, and when pursued, can potentially confound the diagnosis. MR findings of this case are presented to re-iterate the benignity of this disease process and obviate the need for further invasive procedures.

Skeletal Fluorosis.

ABSTRACT: A 27-year-old man with polysubstance abuse including methamphetamine, fentanyl, and 1.5 years of electronics compressed gas duster inhalation presented following an assault. Radiologic imaging performed for suspected fractures revealed periosteal reaction, cortical thickening with increased bone density, and ligament and tendon ossification, which were not present on imaging obtained 3 years before presentation. A bone scan was subsequently performed revealing a metabolic superscan with cortical irregularity. Further investigation revealed skeletal fluorosis from electronics compressed gas duster inhalation. Skeletal fluorosis may be considered when these osseous findings are encountered.

Simulation-based Training for Interventional Radiology and Opportunities for Improving the Educational Paradigm.

The current model for medical education is based on the Master-Apprentice model which was adopted into practice over a century ago. Since then, there have been many changes in healthcare and the environment in which trainees learn, practice and become proficient in procedural and critical thinking skills. The current model for medical education has however, not changed considerably in this time frame, resulting in significant limitations to trainee education. Simulator-based training is a technique which can minimize the limitations of the apprenticeship model by mitigating the effect of time constraints, increased emphasis on patient safety and satisfaction and nonstandardization of Interventional Radiology (IR) curricula. Currently, simulators are utilized in some IR programs, however robust research into simulators must be performed to prove the educational validity of simulators and support formalization and widespread integration of simulation based training into a new, improved and standardized IR curriculum.

Decoupling translational and rotational effects on the phase synchronization of rotating helices.

The locomotion of swimming microorganisms often relies on synchronized motions; examples include the bundling of flagella and metachronal coordination of cilia. It is now generally accepted that such behavior can result from hydrodynamic interactions alone. In this paper we consider the interactions between two side-by-side rigid helices driven by constant torques. We use the method of regularized Stokeslets to simulate an end-pinned model, in which restoring forces and torques are applied at one end of each helix. This allows us to decouple the respective effects of translation and rotation on phase synchronization. We find that while translational freedom leads to synchrony, rotational freedom can result in either synchrony or antisynchrony, depending on the stiffness of the system. In addition, we characterize the nature of the physical mechanisms driving these behaviors, focusing on the individual effects of each applied force and torque. For translational freedom, there is a single underlying mechanism in which the interaction forces indirectly influence the helix rotation rates. Multiple mechanisms are at play for rotational freedom: the interaction torques may exert either direct or indirect influence depending on stiffness. These characterizations are important to the future development of reduced-order models, which should capture not only the expected end behaviors (synchrony or antisynchrony), but also the nature of the driving mechanisms.