Burnout and the role of mentorship for radiology trainees and early career radiologists.

Burnout is a widespread issue among physicians, including radiologists and radiology trainees. Long hours, isolation, and substantial stress levels contribute to healthcare workers experiencing a substantially higher rate of burnout compared with other professionals. Resident physicians, continuously exposed to stressors such as new clinical situations and performance feedback, are particularly susceptible. Mentorship has proven to be an effective strategy in mitigating burnout. Various mentorship delivery models exist, all aiming to have mentors serve as role models to mentees, thereby alleviating stress and anxiety. Physician groups and healthcare enterprises have actively implemented these programs, recognizing them as both successful and cost-effective. This article explores different mentorship models, their implementation processes, and the effectiveness of these programs as a standard component of academic departments.

Imaging Features of Primary Intracranial Sarcoma with DICER1 Mutation: A Multicenter Case Series.

Primary intracranial sarcoma, DICER1-mutant, is a rare, recently described entity in the fifth edition of the WHO Classification of CNS Tumors. Given the entity's rarity and recent description, imaging data on primary intracranial sarcoma, DICER1-mutant, remains scarce. In this multicenter case series, we present detailed multimodality imaging features of primary intracranial sarcoma, DICER1-mutant, with emphasis on the appearance of the entity on MR imaging. In total, 8 patients were included. In all 8 patients, the lesion demonstrated blood products on T1WI. In 7 patients, susceptibility-weighted imaging was obtained and demonstrated blood products. Primary intracranial sarcoma, DICER1-mutant, is a CNS neoplasm that primarily affects pediatric and young adult patients. In the present case series, we explore potential imaging findings that are helpful in suggesting this diagnosis. In younger patients, the presence of a cortical lesion with intralesional blood products on SWI and T1-weighted MR imaging, with or without extra-axial blood products, should prompt the inclusion of this entity in the differential diagnosis.

Perirenal lymphatics: anatomy, pathophysiology, and imaging spectrum of diseases.

Despite being rarely discussed, perinephric lymphatics are involved in many pathological and benign processes. The lymphatic system in the kidneys has a harmonious dynamic with ureteral and venous outflow, which can result in pathology when this dynamic is disturbed. Although limited by the small size of lymphatics, multiple established and emerging imaging techniques are available to visualize perinephric lymphatics. Manifestations of perirenal pathology may be in the form of dilation of perirenal lymphatics, as with peripelvic cysts and lymphangiectasia. Lymphatic collections may also occur, either congenital or as a sequela of renal surgery or transplantation. The perirenal lymphatics are also intimately involved in lymphoproliferative disorders, such as lymphoma as well as the malignant spread of disease. Although these pathologic entities often have overlapping imaging features, some have distinguishing characteristics that can suggest the diagnosis when paired with the clinical history.

The Lack of Standardization of Allopathic and Osteopathic Medical School Grading Systems and Transcripts.

OBJECTIVE: The purpose of this study is to assess the variability in grading systems used by US allopathic and osteopathic medical schools across all 4 years of medical school coursework. DESIGN: Transcripts were reviewed from all participating allopathic and osteopathic medical schools for all 4 years of coursework for grading system type, the presence or absence of a key or guide, the inclusion of grade distribution within class year, inclusion of a class rank, and summary statements or evaluation systems used by the institution within the Medical Student Performance Evaluation to evaluate overall performance. SETTING: Loyola University Medical Center. Maywood, IL. PARTICIPANTS: Transcripts were reviewed for 144 out of existing 147 allopathic medical schools (97.9%) and 37 out of 39 existing osteopathic medical schools (94.8%). RESULTS: For allopathic schools, grading system distribution for preclinical years was-41.6% Pass/Fail, 40.3% Honors, 13.2% Letter; while grading system distribution for clinical years was-78.5% Honors, 15.9% Letter. Only 35.4% of allopathic medical schools used the same system for all 4 years, while the remaining schools used a different system for preclinical and clinical years. For osteopathic medical schools, grading system distribution for preclinical years was-45.9% Letter, 32.4% Honors, and 13.5% Pass/Fail; while grading system distribution for clinical years was-59.5% Honors and 29.7% Letter (Table 4). Overall, 56.7% of osteopathic programs used the same system for all 4 years, while the remaining schools used a different system for the preclinical years than the clinical years. Variability also existed within each of these broader grading system categories (Table 1, Table 3). CONCLUSIONS: Our results highlight the variability in grading systems used by medical schools both among programs and between preclinical and clinical years. From the residency program perspective, the lack of consistent, objective comparisons between school transcripts makes comparing applicants from different institutions difficult.

COMPASS Ascending: Emerging clues regarding the roles of MLL3/KMT2C and MLL2/KMT2D proteins in cancer.

The KMT2 (lysine methyltransferase) family of histone modifying proteins play essential roles in regulating developmental pathways, and mutations in the genes encoding these proteins have been strongly linked to many blood and solid tumor cancers. The KMT2A-D proteins are histone 3 lysine 4 (H3K4) methyltransferases embedded in large COMPASS-like complexes important for RNA Polymerase II-dependent transcription. KMT2 mutations were initially associated with pediatric Mixed Lineage Leukemias (MLL) and found to be the result of rearrangements of the MLL1/KMT2A gene at 11q23. Over the past several years, large-scale tumor DNA sequencing studies have revealed the potential involvement of other KMT2 family genes, including heterozygous somatic mutations in the paralogous MLL3/KMT2C and MLL2(4)/KMT2D genes that are now among the most frequently associated with human cancer. Recent studies have provided a better understanding of the potential roles of disrupted KMT2C and KMT2D family proteins in cell growth aberrancy. These findings, together with an examination of cancer genomics databases provide new insights into the contribution of KMT2C/D proteins in epigenetic gene regulation and links to carcinogenesis.

Vitamin D and vitamin B12 deficiencies in patients with small intestinal carcinoid tumour: is opioid use disorder a confounding factor in the diagnosis?

Carcinoid tumours have the ability to secrete various peptides and bioamines that lead to carcinoid syndrome manifested as cutaneous flushing, diarrhoea, bronchial constriction and cardiac involvement. The deficiencies of vitamins D and B12 have previously been reported in patients with carcinoid tumours presumably due to chronic diarrhoea associated with the carcinoid syndrome. Herein, we chronicle the case of a patient with opioid use disorder who presented with small bowel obstruction that was found to be caused by a midgut carcinoid tumour. Laboratory studies revealed deficiencies of vitamins D and B12 even though he denied diarrhoea and had no other aetiology of deficiencies of these vitamins. Additionally, this paper presents a review of the published medical literature pertaining to clinical features, diagnostic investigations and treatment of intestinal carcinoid tumours and explores possible explanations for the observed deficiencies in these patients.

Use of large osteochondral allografts in reconstruction of traumatic uncontained distal femoral defects.

UNLABELLED: Large osteoarticular injuries with subchondral bone loss involving the knee in young active patients often result in significant morbidity and loss of normal joint function. A review of the current literature reveals that multiple surgical management options are currently employed, however there is no consensus on standard of care. Osteochondral allografting provides an attractive alternative treatment option for the repair of large articular defects of the knee. METHODS: In this article we present the case of a young male who suffered traumatic intraarticular bone loss secondary to a grade IIIA distal femoral fracture and subsequently underwent reconstruction of his medial femoral condyle using a fresh-frozen osteochondral allograft. RESULTS: We present the radiographic and functional outcome of this patient at two years post-operative. The range of motion of the knee was 0-130° and the patient's post-operative functional outcome was evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS), which was 76%. CONCLUSIONS: While further research is required, the results of our case study concur with the current body of literature supporting the use of fresh-frozen osteochondral allograft as a reconstructive option for treating large traumatic intraarticular lesions involving the distal femur.

Fungi and animals may share a common ancestor to nuclear receptors.

Nuclear receptors (NRs) are a large family of transcription factors. One hallmark of this family is the ligand-binding domain (LBD), for its primary sequence, structure, and regulatory function. To date, NRs have been found exclusively in animals and sponges, which has led to the generally accepted notion that they arose with them. We have overcome the limitations of primary sequence searches by combining sequence profile searches with structural predictions at a genomic scale, and have discovered that the heterodimeric transcription factors Oaf1/Pip2 of the budding yeast Saccharomyces cerevisiae contain putative LBDs resembling those of animal NRs. Although the Oaf1/Pip2 LBDs are embedded in an entirely different architecture, the regulation and function of these transcription factors are strikingly similar to those of the mammalian NR heterodimer peroxisome proliferator-activated receptor alpha/retinoid X receptor (PPAR alpha/RXR). We demonstrate that the induction of Oaf1/Pip2 activity by the fatty acid oleate depends on oleate's direct binding to the Oaf1 LBD. The alteration of two amino acids in the predicted ligand-binding pocket of Oaf1 abolishes both ligand binding and the transcriptional response. Hence, LBDs may have arisen as allosteric switches, for example, to respond to nutritional and metabolic ligands, before the animal and fungal lineages diverged.

Bioinformatic approaches to assigning protein function from novel sequence data.

The current pace of functional genomic initiatives and genome sequencing projects has provided researchers with a bewildering array of sequence and biological data to analyze. The disease system-driven approach to identifying key genes frequently identifies nucleotide and protein sequences for which the gene and protein function are not known in sufficient detail to allow informed follow-up. Using a range of bioinformatic tools and sequence-based clues, most of unassigned sequences can now be annotated. This chapter takes as an example an unannotated expressed sequence tag, describing how to identify its related gene, and how to annotate the encoded protein using sequence, profile, and structure-based annotation methodologies.

The human plasma proteome: a nonredundant list developed by combination of four separate sources.

We have merged four different views of the human plasma proteome, based on different methodologies, into a single nonredundant list of 1175 distinct gene products. The methodologies used were 1) literature search for proteins reported to occur in plasma or serum; 2) multidimensional chromatography of proteins followed by two-dimensional electrophoresis and mass spectroscopy (MS) identification of resolved proteins; 3) tryptic digestion and multidimensional chromatography of peptides followed by MS identification; and 4) tryptic digestion and multidimensional chromatography of peptides from low-molecular-mass plasma components followed by MS identification. Of 1,175 nonredundant gene products, 195 were included in more than one of the four input datasets. Only 46 appeared in all four. Predictions of signal sequence and transmembrane domain occurrence, as well as Genome Ontology annotation assignments, allowed characterization of the nonredundant list and comparison of the data sources. The "nonproteomic" literature (468 input proteins) is strongly biased toward signal sequence-containing extracellular proteins, while the three proteomics methods showed a much higher representation of cellular proteins, including nuclear, cytoplasmic, and kinesin complex proteins. Cytokines and protein hormones were almost completely absent from the proteomics data (presumably due to low abundance), while categories like DNA-binding proteins were almost entirely absent from the literature data (perhaps unexpected and therefore not sought). Most major categories of proteins in the human proteome are represented in plasma, with the distribution at successively deeper layers shifting from mostly extracellular to a distribution more like the whole (primarily cellular) proteome. The resulting nonredundant list confirms the presence of a number of interesting candidate marker proteins in plasma and serum.

Protein sequence analysis in silico: application of structure-based bioinformatics to genomic initiatives.

The current pace of high-throughput genome sequencing programs coupled with high-throughput functional genomic screens has provided researchers with a bewildering array of sequence and biological data to contend with. Identification of proteins of interest from a particular biological study requires the application of bioinformatic tools to process and prioritise the data. From a protein function standpoint, transfer of annotation from known proteins to a novel target is currently the only practical way to convert vast quantities of raw sequence data into meaningful information. New bioinformatics tools now provide more sophisticated methods to transfer functional annotation, integrating sequence, family profile and structural search methodology. The importance of these approaches to medical research is increasing as we move to annotate the proteome through functional and structural genomic efforts.