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Objectives The established benefits of point-of-care ultrasound have given rise to multiple new and innovative curriculums to incorporate ultrasound teaching into medical education. This study sought to measure the educational success of a comprehensive and integrated 4-year point-of-care ultrasound curriculum. Methods We integrated a curriculum consisting of traditional didactics combined with asynchronous learning modules and hands-on practice on live models with skilled sonographers into all 4 years of education at a Liaison Committee on Medical Education–accredited US Medical School. Each graduating student was administered an exit examination with 48 questions that corresponded to ultrasound milestones. Results Ninety-five percent (n = 84) of fourth-year medical students completed the exit examination. The mean score was 79.5% (SD, 10.2%), with mean scores on the ultrasound physics and anatomy subsections being 77.1% (SD, 11.0%) and 85.9% (SD, 21.0%), respectively. Conclusions A comprehensive 4-year point-of-care ultrasound curriculum integrated into medical school may successfully equip graduating medical students with a fundamental understanding of ultrasound physics, anatomy, and disease recognition.

HPI: A 22 year-old male presented to the emergency department with a chief complaint of retrosternal chest pain that started yesterday. He described the pain as a constant, sharp and pleuritic. The pain was worsened by lying flat, and improves with leaning forward. He reported having a sore throat and other cold symptoms earlier in the week. The patient’s exam was notable for a faint pericardial friction rub. A bedside echocardiogram demonstrated normal cardiac function without pericardial effusion. The patient’s ECG is shown. Significant findings: The ECG shows diffuse ST- elevation. The patient also has mild PR-depression, most notably in the inferior and lateral leads. The patient also has minimal PR elevation in lead aVR. The patient was diagnosed with acute pericarditis (ECG stage 1). Discussion: Pericarditis is inflammation or infection of the pericardial sac. There most common etiologies are viral or idiopathic1,2. While it is rarely fatal, acute pericarditis can cause severe, disabling pain2. Furthermore, concomitant myocarditis can cause significant morbidity and mortality. Classic ECG findings include diffuse ST-elevations and PR- segment depression, without reciprocal ST-segment depression (as shown in this image). The ECG of pericarditis may move through various stages when followed over time1,2. These include stage 1: diffuse ST-elevations with concave-upwards contour, PR- depressions (most common in II, aVF, V4-6); stage 2: ST segments become isoelectric and T waves flatten; stage 3: symmetric T wave inversion throughout ECG; and stage 4: ECG normalization2. These ECG changes have variable sensitivity and specificity depending on the stage, with less than 50% of patients progressing through the classic stages2.

Background Juxtafacet cysts (JFCs) are a cause of back and radicular pain that can be treated conservatively and operatively. Such strategies include lumbosacral brace, epidural injection, open surgery, and minimally invasive surgery; although surgical treatment is usually reserved for unsuccessful conservative treatment. The role of minimally invasive surgery in athletic youth with JFCs has yet to be determined. Patients/Material and Methods The patient is a 16-year-old basketball player with a JFC. We performed endoscope-assisted cystectomy. Results Endoscope-assisted JFC excision immediately and completely resolved the patient's lower back and leg pain with no recurrence of symptoms 4 years after surgery. Conclusion We suggest that JFCs of the lumbar spine be a part of the differential diagnosis in young patients with back and radicular pain. Furthermore, we recommend that endoscope-assisted surgery be employed in the treatment of JFCs in young athletes.

Synovial sarcomas (SS) are soft tissue sarcomas with poor prognosis, displaying a lack of response to conventional cytotoxic chemotherapy. Although SS cell lines have moderate chemosensitivity to isofamide and doxorubicin therapy, the clinical prognosis is still poor. In this article, we showed that flavokawain B (FKB), a novel chalcone from kava extract, potently inhibits the growth of SS cell lines SYO-I and HS-SY-II through induction of apoptosis. Treatment with FKB increased caspase 8, 9, and 3/7 activity compared to vehicle-treated controls, indicating that both extrinsic and intrinsic apoptotic pathways were activated. Furthermore, FKB treatment of both cell lines resulted in increased mRNA and protein expression of death receptor-5 and the mitochondrial pro-apoptotic proteins Bim and Puma, while down-regulating the expression of an inhibitor of apoptosis, survivin in a dose-dependent manner. Our results suggest the natural compound FKB has a pro-apoptotic effect on SS cell lines. FKB may be a new chemotherapeutic strategy for patients with SS and deserves further investigation as a potential agent in the treatment of this malignancy.

Low back pain (LBP) is the most prevalent musculoskeletal complaint among professional and amateur golfers; however, associated radiological changes in golf-related LBP have not been examined in the literature. We suspect that Modic Type 1 changes in the lumbar spine are linked to golf-related LBP. In this retrospective case series, four middle-aged golfers (one professional and three high-level amateurs) presented to our clinic with LBP. Inflammation of the right side of endplates in the lumbar spine was suspected based on Modic Type 1 changes detected by magnetic resonance imaging (MRI) in each patient. All four cases were diagnosed with right-sided endplate inflammation and administered intradiscal steroid injections with a non-steroidal anti-inflammatory drug (NSAID). Treatment swiftly alleviated LBP and diminished Modic Type 1 changes on follow-up MRI 3-6 months later in all four patients. We suggest that Modic Type 1 changes play a significant role in the diagnosis and treatment of golf-related LBP. © 2010 The Author(s).

Synovial sarcomas (SS) are soft tissue sarcomas with poor prognosis, displaying a lack of response to conventional cytotoxic chemotherapy. Although SS cell lines have moderate chemosensitivity to isofamide and doxorubicin therapy, the clinical prognosis is still poor. In this article, we showed that flavokawain B (FKB), a novel chalcone from kava extract, potently inhibits the growth of SS cell lines SYO-I and HS-SY-II through induction of apoptosis. Treatment with FKB increased caspase 8, 9, and 3/7 activity compared to vehicle-treated controls, indicating that both extrinsic and intrinsic apoptotic pathways were activated. Furthermore, FKB treatment of both cell lines resulted in increased mRNA and protein expression of death receptor-5 and the mitochondrial pro-apoptotic proteins Bim and Puma, while down-regulating the expression of an inhibitor of apoptosis, survivin in a dose-dependent manner. Our results suggest the natural compound FKB has a pro-apoptotic effect on SS cell lines. FKB may be a new chemotherapeutic strategy for patients with SS and deserves further investigation as a potential agent in the treatment of this malignancy.

Synovial sarcoma (SS) is a soft tissue sarcoma with poor prognosis and lack of response to conventional cytotoxic chemotherapy. The regulatory mechanisms for the rapid proliferation of synovial sarcoma poorly understood. Surgical resection with/without adjuvant radiotherapy and chemotherapy are the mainstay of treatment. Although the sarcoma cell lines have moderate chemosensitivity to isofamide and doxorubicin therapy, the overall prognosis is still poor. Therefore, further development of the treatment for SS is required. Kava is an ancient crop of the western Pacific. The root extract of kava has been served as a traditional beverage for Pacific Islanders. Consumption of this traditional beverage has been thought to be correlated with low and uncustomary sex ratios of cancer incidence in 3 kava-drinking countrites: Fiji, Vanuatu and Western Samoa. We have already reported that a kind of fravokawains from kava extracts (FKA: flavokawein A) induced apoptosis against bladder cancer cells, and flavokawein B (FKB) was also significant effective in inhibiting the growth of prostate cancer cells. In this study, we examined the inhibitory proliferation effects of the FKB in synovial sarcoma growth and whether FKB modulates tumor apoptosis cascades in human synovial sarcoma cell lines. We treated 2 cell lines of synovial sarcoma (SYO-I, HS-SY-II) by different concentrations of FKB (0, 2.5, 5.0, 7.5 μg/μl) for 24 hours. From the results of real time PCR, depending on the concentrations of FKB in both cell lines, the expression of Survivin was found to be decreased, while those of DR5, Puma, and Bim were increased. These results indicated that FKB effectively induces apoptosis of the two cell lines depending on the concentration. In conclusion, our findings demonstrate that FKB is effective for growth inhibition of synovial sarcoma cell lines in vitro and suggest that FKB may be a new therapeutic option for patients with synovial sarcoma. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4241. doi:10.1158/1538-7445.AM2011-4241