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Proper collimator selection is critical to obtaining high-quality, interpretable nuclear medicine images. Collimators help eliminate scatter, which leads to poor spatial resolution and blurry images. We present the case of a posttherapy 177 Lu-DOTATATE (Lutathera) patient who was initially imaged with a low-energy, high-resolution collimator routinely used in 99m Tc imaging. On image review, the patient was reimaged with the appropriate medium-energy, high-resolution collimator, which resulted in improved image quality. When reviewing the quality of images, it is important to understand modifications to the imaging that can significantly improve image quality and interpretation., (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)

A 63-y-old woman with a history of breast cancer presented with concerns of osseous metastasis. Initial whole-body planar bone scintigraphy revealed a focus of concern overlying the sternum. SPECT/CT images revealed the anomaly-localized activity in the needleless hub attached to the chemotherapy port. If not for the precision of SPECT/CT, such a rare artifact could have led to a false-positive diagnosis, particularly impactful in breast cancer patients. This case emphasizes the critical role of SPECT/CT in accurate diagnoses., (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)

Chronic functional gallbladder disorder, characterized by biliary pain in the absence of structural pathology, poses a diagnostic challenge necessitating reliable cholecystagogues for accurate evaluation. However, recurrent shortages of synthetic cholecystokinin analogs have prompted the exploration of alternative agents. This paper describes the efficacy of Ensure Plus as a viable fatty meal substitute for hepatobiliary scintigraphy in assessing chronic functional gallbladder disorder. Through comparative studies, Ensure Plus demonstrates comparable diagnostic accuracy to cholecystokinin in similar patient populations. Furthermore, Ensure Plus demonstrates significant symptom improvement after cholecystectomy in patients with anomalous gallbladder ejection fractions. This paper offers a detailed protocol for the seamless integration of Ensure Plus into hepatobiliary scintigraphy, providing clinicians with a valuable tool to navigate cholecystokinin shortages while maintaining diagnostic precision in cases of chronic functional gallbladder disorder. The use of Ensure Plus not only addresses practical supply challenges but also underscores its potential as a cost-effective and clinically sound alternative in biliary diagnostics., (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)

Dual-energy x-ray absorptiometry (DXA) is an accurate means to assess bone mineral density, determine the risk of a fragility fracture, and monitor response to therapy. Despite its seemingly straightforward nature-the review of 2-to-3 nondiagnostic images and a few automatically generated numbers-the proper performance and interpretation of DXA can often be complex. It is complex because it is highly dependent on many factors, such as image acquisition, processing, analysis, and subsequent examination interpretation. Each step is subject to potential errors, artifacts, and diagnostic pitfalls; hence, meticulous attention must be paid to the technique by both the technologist and the interpreting physician to provide high-quality results and, in turn, maximize the examination's clinical utility. This article is part 1 of a 2-part series. Part 1 will begin with a review of bone physiology and osteoporosis etiology, followed by a discussion of the principles underlying DXA and the technical procedure. Part 2 will focus on DXA interpretation and discuss scanning pitfalls and clues to recognizing issues and improving scan quality., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

Diuretic renal scintigraphy plays a critical diagnostic role by providing a physiologic means for differentiating between obstructive and nonobstructive hydronephrosis as well as assessing the function of the affected kidney. The exam accuracy is highly dependent upon and benefits from close attention to the protocol. This article reviews kidney anatomy and physiology, patient preparation, available radiopharmaceuticals, diuretic administration, acquisition, processing, quantification, and interpretation criteria., (Copyright © 2022 by the Society of Nuclear Medicine and Molecular Imaging, Inc.)

Abnormally increased 18 F-FDG avidity of axillary lymph nodes has become a frequent diagnostic dilemma on PET/CT in the current climate of global vaccinations directed against severe acute respiratory syndrome coronavirus 2. This avidity is due to the inflammatory response evoked by vaccines and the nonspecific nature of 18 F-FDG uptake, which is increased in both malignant and inflammatory processes. Similarly, 18 F-fluciclovine, an amino acid analog indicated for the assessment of biochemical recurrence of prostate cancer, may also demonstrate nonspecific inflammatory uptake. We report a case of 18 F-fluciclovine PET/CT obtained for concern about prostate cancer. In this case, isolated avid lymph nodes were seen in the left axilla. A screening questionnaire revealed that the patient had recently received the second dose of the Pfizer-BioNTech coronavirus disease 2019 vaccine in his left shoulder, and hence, the uptake was determined to be reactive., (© 2022 by the Society of Nuclear Medicine and Molecular Imaging.)

Abstract: A 71-year-old man with a history of carcinoid and prostate adenocarcinoma underwent 68Ga-DOTATATE PET/CT to evaluate new mediastinal lymphadenopathy. The scan revealed new carcinoid metastases, but the mediastinal nodes were not avid. 18F-FDG PET/CT was performed to evaluate for cardiac and mediastinal sarcoidosis, revealing a lack of cardiac sarcoidosis, but probable mediastinal sarcoidosis. 18F-Fluciclovine PET/CT was then performed for possible prostate metastases, revealing the patient's known prostate cancer. Three different PET radiopharmaceuticals revealed 3 different processes in a single patient within a 195-day period, demonstrating the power of nuclear medicine diagnostics., Competing Interests: Conflicts of interest and sources of funding: none declared. Conflicts of interest and sources of funding: none declared., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Recommended 177 Lu-DOTATATE treatment regimens involve prophylaxis with antiemetics to counteract the emetogenic properties of the nephroprotective amino acid solution infusion. We describe a 58-y-old woman treated with 177 Lu-DOTATATE for metastatic small-bowel carcinoid, who was allergic to many classes of antiemetics. Therefore, she was treated with 177 Lu-DOTATATE without antiemetic prophylaxis. She tolerated the compounded amino acid infusion of lysine and arginine, followed by 177 Lu-DOTATATE, without significant nausea or any vomiting. We hypothesize that aggressive antiemetic prophylaxis may not be necessary if a 177 Lu-DOTATATE patient receives compounded lysine/arginine amino acid solutions. The omission would decrease overall health-care costs and limit possible medication side effects., (© 2021 by the Society of Nuclear Medicine and Molecular Imaging.)

Objective: The aim of this study was to assess variation in diuretic renal scintigraphy (DRS) practice patterns and quantify compliance with the national guidance in a large cohort of laboratories from different institutions and practice settings across the United States., Methods: By means of an institutional review board-approved protocol, we extracted 107 facility-specific, adult DRS protocols and associated 174 reports from the Intersocietal Accreditation Commission database, representing all laboratories applying for genitourinary scintigraphy certification during the 2016 to 2018 accreditation cycle. From these, we assessed 40 variables regarding facilities and staffing, patient preparation, examination technique and acquisition, image processing, and reporting., Results: Review of protocols and reports demonstrates a very high degree of variability in DRS practice across the United States and suboptimal compliance with societal guidelines and practice parameters. Some of the more variable or underreported parameters include the use of patient hydration, type and dosage of radiopharmaceutical, dosage and timing of diuretic administration, quantitative parameters assessed, and report content., Conclusion: There is high variability in the performance and reporting of DRS among laboratories applying for accreditation, similar to that seen in studies of other nuclear medicine examinations. The wide degree of practice variance may have a significant impact on diagnostic accuracy and patient management, with inaccurate or incomplete results. This survey impresses the need for standardization and improved quality of this important nuclear medicine examination., (Published by Elsevier Inc.)

The goal of this work was to determine U.S. diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for adult renal scintigraphy. Methods: Under an Institutional Review Board-approved protocol, data were collected from the Intersocietal Accreditation Commission during one 3-y accreditation cycle encompassing 110 facilities. Elements included radiopharmaceutical, administered activity, practice type, and examination volume. DRLs and AAAs were calculated and compared with non-U.S. values and societal recommendations as available. Results: Ninety-three facilities provided data on 99m Tc-mercaptoacetyltriglycine ( 99m Tc-MAG3), and 15 provided data on 99m Tc-diethylenetriaminepentaacetic acid ( 99m Tc-DTPA) for adult renal scintigraphy exams. Analysis demonstrated a DRL of 392.2 MBq (10.6 mCi) for 99m Tc-MAG3 and 531.7 MBq (14.4 mCi) for 99m Tc-DTPA, with an AAA of 370 MBq (10 mCi) for 99m Tc-MAG3 and 445.9 MBq (12.1 mCi) for 99m Tc-DTPA. Conclusion: The resultant calculated novel U.S. DRLs and AAAs may serve as benchmarks that nuclear medicine facilities may use to refine renal scintigraphy protocols, reduce patient doses, and potentially guide future societal guideline recommendations., (© 2021 by the Society of Nuclear Medicine and Molecular Imaging.)

A pilot study was performed to determine whether the raw data from routinely obtained upright and supine myocardial perfusion scan (MPS) imaging could be used as an opportunity to screen for obstructive sleep apnea (OSA). We hypothesized that abnormal respiratory motion seen only on supine imaging (not upright imaging) corresponds with OSA. MPS supine-only respiratory motion was compared with known OSA diagnoses and with risk factors known to be associated with OSA. Methods: We reviewed 154 consecutive MPS studies from patients at our institution, including both exercise and chemical stress testing. All examinations were obtained because there was clinical suspicion of myocardial ischemia. We used the MPS panogram to assess for respiratory motion on supine stress or upright rest or stress imaging. We obtained the age, sex, body mass index, hypertensive history, and continuous positive airway pressure or OSA diagnosis history. Results: We compared the patients who had supine, stress-only respiratory motion with the remaining patients, assessing their OSA risk factors and known OSA diagnoses. In total, 65 patients (42.2%) had 3 or more OSA risk factors and 26 patients (16.9%) had a known OSA diagnosis. A similar percentage of patients with abnormal supine-only respiratory motion and patients with 3 or more OSA risk factors had a known OSA diagnosis, 9 (16.7%) and 14 (21.5%), respectively. Conclusion: We found a similar prevalence of known OSA diagnoses in patients with abnormal supine-only respiratory motion on MPS studies and patients with 3 or more OSA risk factors. The pilot study suggests that assessment of motion on MPS studies may provide an opportunity to also screen for OSA., (© 2020 by the Society of Nuclear Medicine and Molecular Imaging.)

OBJECTIVE. FDG PET/CT has emerged as an effective tool for the timely accurate assessment of how tumors respond to therapy. To standardize interpretation and reporting, numerous response criteria have been developed. This article will review the evolution of these criteria along with their strengths and weaknesses. CONCLUSION. Several qualitative assessments applicable to common malignancies have been developed in recent years that solve many of the challenges faced by their quantitative predecessors. These are reviewed, and information is provided regarding individual treatment efficacy and prognosis.

Radiology by its nature is intricately connected to the Internet and is at the forefront of technology in medicine. The past few years have seen a dramatic rise in Internet-based technology in healthcare, with imaging as a core application. Numerous Internet-based applications and technologies have made forays into medicine, and for radiology it is more seamless than in other clinical specialties. Many applications in the practice of radiology are Internet based and more applications are being added every day. Introduction of mobile devices and their integration into imaging workflow has reinforced the role played by the Internet in radiology. Due to the rapid proliferation of wearable devices and smartphones, IoT-enabled technology is evolving healthcare from conventional hub-based systems to more personalized healthcare systems. This article briefly discusses how the IoT plays a useful role in daily imaging workflow and current and potential future applications, how mobile devices can be integrated into radiology workflows, and the impact of the IoT on resident and medical student education, research, and patient engagement in radiology.

Objective: To determine if use of the oral cholecystagogue, Ensure Plus (EP), in hepatobiliary scintigraphy (HBS) leads to a similar distribution of normal and abnormal gallbladder ejection fractions (GBEFs) versus other historical secondary findings of chronic biliary disease in a similar patient population compared with the conventional cholecystokinin analog, sincalide. The HBS findings analyzed included the GBEF, small bowel transit time, gallbladder fill time, and reversal of the normal gallbladder versus small bowel transit. The secondary objectives were to determine whether patient outcomes were significantly different for EP and sincalide HBS study patients following cholecystectomy, namely, the surgical pathology and patient-reported biliary-type pain., Methods: We reviewed all HBS examinations over a retrospective 34-month period. Data from 446 patients who underwent sincalide or EP HBS with GBEF determination for evaluation of chronic symptoms concerning for biliary etiology met the inclusion criteria. The aforementioned HBS findings and postsurgical patient outcomes were obtained for each patient group., Results: Comparing HBS examinations performed with sincalide or EP, no significant differences were noted in the major HBS findings of similar patient populations. Outcomes for the sincalide and EP groups status post cholecystectomy were assessed to determine their sensitivity, specificity, positive predictive value, and negative predictive value. The outcomes assessed were the histopathology and patient-reported amelioration of biliary-type pain. No significant differences were noted., Conclusions: The sincalide and EP cholecystagogues did not lead to significantly different HBS findings for similar patient populations or postcholecystectomy outcomes.

Tumor response assessments are essential to evaluate cancer treatment efficacy and prognosticate survival in patients with cancer. Response criteria have evolved over multiple decades, including many imaging modalities and measurement schema. Advances in FDG-PET/CT have led to tumor response criteria that harness the power of metabolic imaging. Qualitative PET/CT assessment schema are easy to apply clinically, are reproducible, and yield good prognostic results. We present 3 such criteria, namely, the Lugano classification for lymphoma, the Hopkins criteria, and the Neck Imaging Reporting and Data Systems criteria for head and neck cancers. When comparing baseline PET/CTs with interim or end-of-treatment PET/CTs, radiologists can classify the tumor response as complete metabolic response, partial metabolic response, no metabolic response, or progressive disease, which has important implications in directing further cancer management and long-term patient prognosis. The purpose of this article is to review the progression of tumor response assessments from CT- and PET/CT-based quantitative and semi-quantitative systems to PET/CT-based qualitative systems; introduce the classification schema for these systems; and describe how to use these rapid, powerful, and qualitative PET/CT-based systems in daily practice through illustrative cases., (© 2019 by American Journal of Neuroradiology.)

OBJECTIVE. The purpose of this article is to provide a review of 123 I-ioflupane SPECT in the evaluation of suspected parkinsonian syndromes (PSs). This collection of diseases presents frequent diagnostic challenges, even by movement disorder and dementia specialists. CONCLUSION. The 123 I-ioflupane scan serves as an imaging biomarker of the status of presynaptic dopamine transporters (DATs) in the striatum. As a result of neuronal death, DATs are greatly reduced in patients with PS neurodegenerative disorders, whereas clinical mimics generally do not show striatal DAT loss. This provides a tremendous opportunity for 123 I-ioflupane to aid in the accurate and timely diagnosis of these patients and optimize their management.

Purpose: Describe a unique case of achiasma in a patient with Kapur-Toriello syndrome., Observations: We provide a brief review of achiasma with common findings on examination and imaging studies, and a published classification system. In addition, consistent with the rare Kapur-Toriello syndrome, he had a right unilateral cleft lip and palate, neurologic abnormality in his achiasma, anal atresia, vesicoureteral reflux, hypospadias, and growth deficiency., Conclusions: and Importance: Achiasma is an incredibly rare neurological deficit and we present the first case of achiasma in Kapur-Toriello syndrome.

Fluorine 18 ( 18 F) fluciclovine (anti-1-amino-3- 18 F-fluorocyclobutane-1-carboxylic acid [FACBC]) is a radiolabeled amino acid analog that takes advantage of the amino acid transport upregulation in several types of cancer cells. FACBC is taken up to a greater extent in prostate cancer cells than in surrounding normal tissue, providing an opportunity for its use in cases of this common cancer. In 2016, the U.S. Food and Drug Administration found the accuracy of FACBC PET to be superior to that of other molecular imaging techniques and subsequently granted approval for its use in PET of recurrent prostate cancer. As FACBC is an 18 F radiotracer, an on-site cyclotron is not required for its production. This feature enables the widespread clinical availability of this agent and, in turn, an opportunity for improved patient care. The clinical pharmacology and imaging features of FACBC are reviewed, and the role of this agent in the imaging of recurrent prostate cancer, within the context of research that supports its effectiveness, is discussed. The administration of and image acquisition facilitated by using FACBC, as compared with 18 F fluorodeoxyglucose, which is more widely used, are described. In addition, the criteria for interpreting FACBC imaging findings are outlined, with emphasis on common causes of false-positive and false-negative findings. © RSNA, 2019.

A 48-y-old man with a history of colon cancer presented with recurrent hepatic metastasis along a prior microwave ablation bed. Split-bolus, intraprocedural 18 F-FDG PET was performed to guide repeat microwave ablation and immediately confirm complete treatment. PET-guided ablation is highly accurate for targeting and treating malignant hepatic lesions and feasible for nonspecialized tertiary care hospitals without an onsite cyclotron., (© 2019 by the Society of Nuclear Medicine and Molecular Imaging.)

Objective: To determine if classically reported findings associated with chronic cholecystitis on hepatobiliary scintigraphy (HBS), such as delayed small bowel (SB) transit, slow gallbladder (GB) filling, and reversal of the normal GB and SB transit, are associated with a depressed GB ejection fraction (GBEF). The secondary objectives were to determine whether GBEF is correlated with the time of GB filling, time of SB transit, or reversal of normal GB/SB filling sequence. We hypothesize that an association between a depressed GBEF and these classical HBS findings could validate them as surrogate markers for chronic GB disease., Patients and Methods: We reviewed all HBS exams over a retrospective 16-month period. Data from 221 patients (mean age, 45.3 ± 15.2 years; 152 female and 69 male subjects) who underwent HBS with GBEF determination for evaluation of chronic symptoms concerning for biliary etiology met inclusion criteria. Classically reported findings for cholecystitis were recorded for each patient. Comparisons were made using t test and Fisher test analysis., Results: Comparing exams with normal and abnormal GBEF values, there were no significant differences based on age, sex, GB fill time, normal versus delayed SB transit, and reversal of normal GB/SB filling sequence. Additionally, we did not see a correlation between the measured GBEF and GB fill time, SB transit time, or reversal of normal GB/SB filling sequence., Conclusions: Delayed SB transit, slow GB filling time, and reversal of the normal GB and SB filling sequence on HBS imaging are not associated with the measured GBEF and not predictive of chronic GB disease.

Background: Prior research on the efficacy of vertebroplasty has focused primarily on subjective, patient-reported outcomes., Objective: To apply an armband activity monitor (SenseWear by BodyMedia Inc, USA) to patients presenting for consideration for vertebroplasty and to determine the correlation between patient-reported outcomes and quantitative activity metrics at baseline and 30 days after presentation., Materials and Methods: Nineteen patients were enrolled (15 receiving vertebroplasty, 4 not receiving vertebroplasty). Patients reported their average pain over the past 24 hours and completed the Roland-Morris disability questionnaire at baseline and 30 days. Patients wore the SenseWear Armband activity monitor for a median of 4 days at baseline and at the 30-day time period to assess steps, metabolic equivalents expended, sedentary activity time, moderate activity time, sleep efficiency, and total sleep time. Pain and disability scores were correlated with activity monitor metrics using linear regression analysis., Results: Changes in reported average pain in the past 24 hours and disability scores were not significantly different between vertebroplasty and non-vertebroplasty groups (p>0.05). Changes in activity monitor data were not significantly different between the vertebroplasty and non-vertebroplasty groups (p>0.05). None of the correlations between the reported pain or disability scores and the activity monitor data were significant., Conclusions: Activity monitors can be used to objectively record changes in activity following vertebroplasty procedures. Patient-reported pain or disability scores do not correlate with activity monitor-measured activity or sleep metrics., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective  To determine both the rate of delayed cervical lymph node metastasis in patients with esthesioneuroblastoma (ENB) and a clinically N0 untreated neck and the effectiveness of salvage treatment. Design  Retrospective review. Setting  Tertiary academic medical center. Participants  All patients from January 1, 1965, to December 31, 2010, who received definitive treatment for ENB. Main Outcome Measures  The study involved 52 patients: 27 (52%) patients underwent surgery and adjuvant radiotherapy (SART) to the primary site only and 25 (48%) underwent surgery alone (SA) as treatment of the primary site, without elective neck dissection. Results  Median follow-up for the SART group was 10 years versus 15.7 years for the SA group. The 10-year delayed cervical lymph node metastasis estimate is 41%. With median follow-up of 47 months after salvage treatment, the 4-year cervical lymph node recurrence-free survival estimate is 70%; the 5-year overall survival estimate is 39%. Conclusions  Delayed cervical lymph node metastases are common, indolent, and salvaged effectively in most patients. We propose that patients with ENB and clinically N0 cervical lymph nodes may choose to forego elective neck dissection or elective neck radiotherapy in favor of neck observation within their initial treatment.

Background and Purpose: Cauda equina syndrome typically requires emergent MR imaging to detect compressive lesions on the cauda equina, which may require surgical decompression. While CT is sometimes performed as a complementary imaging technique to evaluate osseous integrity in patients with cauda equina syndrome, the accuracy of CT in detecting significant spinal stenosis and cauda equina impingement is not well-defined in the literature. We hypothesized that percentage thecal sac effacement on CT of the lumbar spine would have high sensitivity and high negative predictive value in evaluating significant spinal stenosis and cauda equina impingement., Materials and Methods: We analyzed imaging studies for 151 consecutive patients with clinically suspected cauda equina syndrome. The percentage thecal sac effacement (<50%, ≥50%) was determined on CT and MR imaging. The presence or absence of cauda equina impingement was determined on MR imaging. Using MR imaging as the reference standard, we performed statistical analysis to determine the accuracy of CT in predicting significant spinal stenosis (percentage thecal sac effacement, ≥50%) and cauda equina impingement., Results: Forty of 151 patients had a percentage thecal sac effacement of ≥50% on MR imaging. Nineteen of 40 had cauda equina impingement. Readers determined that there was a CT percentage thecal sac effacement of <50% in 97/151 cases, and CT percentage thecal sac effacement of ≥50% in 54/151 cases. Reader sensitivity for the detection of significant spinal stenosis (MR percentage thecal sac effacement of ≥50%) was 0.98; specificity, 0.86; positive predictive value, 0.72; and negative predictive value, 0.99. No cases read as CT percentage thecal sac effacement of <50% were found to have cauda equina impingement., Conclusions: CT percentage thecal sac effacement of ≥50% predicts significant spinal stenosis on MR imaging in patients with clinically suspected cauda equina syndrome. CT percentage thecal sac effacement of <50% appears to reliably rule out cauda equina impingement. This imaging marker may serve as an additional tool for the clinician in deciding whether MR imaging can be deferred., (© 2017 by American Journal of Neuroradiology.)

Purpose: The authors presented their results in effectively using a free and widely-accessible online app platform to manage and teach a first-year pathology course at Mayo Medical School., Methods Used: The authors utilized the Google "Blogger", "Forms", "Flubaroo", "Sheets", "Docs", and "Slides" apps to effectively build a collaborative classroom teaching and management system. Students were surveyed on the use of the app platform in the classroom, and 44 (94%) students responded., Results: Thirty-two (73%) of the students reported that "Blogger" was an effective place for online discussion of pathology topics and questions. 43 (98%) of the students reported that the "Forms/Flubaroo" grade-reporting system was helpful. 40 (91%) of the students used the remote, collaborative features of "Slides" to create team-based learning presentations, and 39 (89%) of the students found those collaborative features helpful. "Docs" helped teaching assistants to collaboratively create study guides or grading rubrics. Overall, 41 (93%) of the students found that the app platform was helpful in establishing a collaborative, online classroom environment., Conclusions: The online app platform allowed faculty to build an efficient and effective classroom teaching and management system. The ease of accessibility and opportunity for collaboration allowed for collaborative learning, grading, and teaching.

In 2006, small blocks of flexible curriculum time, termed selectives, were implemented in the Mayo Medical School preclinical curriculum. Selectives permitted students to pursue professional endeavors, such as research, service, and career exploration, in the preclinical years. The purpose of this study was to survey current and former Mayo medical students regarding the impact of selectives on their research interest and productivity. The authors surveyed 377 current and former Mayo Medical School students from the 2004 to 2014 graduating classes, 154 participants (41% response rate) responded to the survey. The classes were grouped into pre- and postselective groups for the comparison studies. Postselective students published significantly more (p = 0.003) and gave significantly more presentations (p = 0.0007) during medical school than preselective students. Thirty-four (72% of the postselective respondents) indicated that selectives had a strong or very strong impact on their current research interest. Respondents spent an average of 4.0 [3.0-5.0] weeks of Selective time on research, resulting in 1.8 [1.4-2.2] publications and 1.8 [1.4-2.2] presentations, which represented 52.5% [40.0-65.0%] and 47.3% [37.1-57.4%] of the students' total medical school publications and presentations, respectively. Flexible selective time during the preclinical years results in significantly more medical student academic productivity., (© 2015 The International Union of Biochemistry and Molecular Biology.)

Purpose. The authors proposed that introducing real patients into a pathology classroom early in medical education would help integrate fundamental principles and disease pathology with clinical presentation and medical history. Methods. Three patients with different pathologies described their history and presentation without revealing their diagnosis. Students were required to submit a differential diagnosis in writing, and then were able to ask questions to arrive at the correct diagnosis. Students were surveyed on the efficacy of patient-based learning. Results. Average student scores on the differential diagnosis assignments significantly improved 32% during the course. From the survey, 72% of students felt that patient encounters should be included in the pathology course next year. Seventy-four percent felt that the differential diagnosis assignments helped them develop clinical decision-making skills. Seventy-three percent felt that the experience helped them know what questions to ask patients. Eighty-six percent felt that they obtained a better understanding of patients' social and emotional challenges. Discussion. Having students work through the process of differential diagnosis formulation when encountering a real patient and their clinical presentation improved clinical decision-making skills and integrated fundamental concepts with disease pathology during a basic science pathology course.

Directed cell migration requires precise spatial control of F-actin-based leading edge protrusion, focal adhesion (FA) dynamics, and actomyosin contractility. In spreading fibroblasts, the Abl family kinases, Abl and Arg, primarily localize to the nucleus and cell periphery, respectively. Here we provide evidence that Abl and Arg exert different spatial regulation on cellular contractile and adhesive structures. Loss of Abl function reduces FA, F-actin, and phosphorylated myosin light chain (pMLC) staining at the cell periphery, shifting the distribution of these elements more to the center of the cell than in wild-type (WT) and arg(-/-) cells. Conversely, loss of Arg function shifts the distribution of these contractile and adhesion elements more to the cell periphery relative to WT and abl(-/-) cells. Abl/Arg-dependent phosphorylation of p190RhoGAP (p190) promotes its binding to p120RasGAP (p120) to form a functional RhoA GTPase inhibitory complex, which attenuates RhoA activity and downstream pMLC and FA formation. p120 and p190 colocalize both in the central region and at the cell periphery in WT cells. This p120:p190 colocalization redistributes to a more peripheral distribution in abl(-/-) cells and to a more centralized distribution in arg(-/-) cells, and these altered distributions can be restored to WT patterns via re-expression of Abl or Arg, respectively. Thus, the altered p120:p190 distribution in the mutant cells correlates inversely with the redistribution in adhesions, actin, and pMLC staining in these cells. Our studies suggest that Abl and Arg exert different spatial regulation on actomyosin contractility and focal adhesions within cells., (© 2010 Wiley-Liss, Inc.)

In migrating cells, actin polymerization promotes protrusion of the leading edge, whereas actomyosin contractility powers net cell body translocation. Although they promote F-actin-dependent protrusions of the cell periphery upon adhesion to fibronectin (FN), Abl family kinases inhibit cell migration on FN. We provide evidence here that the Abl-related gene (Arg/Abl2) kinase inhibits fibroblast migration by attenuating actomyosin contractility and regulating focal adhesion dynamics. arg-/- fibroblasts migrate at faster average speeds than wild-type (wt) cells, whereas Arg re-expression in these cells slows migration. Surprisingly, the faster migrating arg-/- fibroblasts have more prominent F-actin stress fibers and focal adhesions and exhibit increased actomyosin contractility relative to wt cells. Interestingly, Arg requires distinct functional domains to inhibit focal adhesions and actomyosin contractility. The kinase domain-containing Arg N-terminal half can act through the RhoA inhibitor p190RhoGAP to attenuate stress fiber formation and cell contractility. However, Arg requires both its kinase activity and its cytoskeleton-binding C-terminal half to fully inhibit focal adhesions. Although focal adhesions do not turn over efficiently in the trailing edge of arg-/- cells, the increased contractility of arg-/- cells tears the adhesions from the substrate, allowing for the faster migration observed in these cells. Together, our data strongly suggest that Arg inhibits cell migration by restricting actomyosin contractility and regulating its coupling to the substrate through focal adhesions.