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Objective: In spite of the recognized benefits of ultrasound, many physicians have little experience with using ultrasound to perform procedures. Many medical schools and residency programs lack a formal ultrasound training curriculum. We describe an affordable ultrasound training curriculum and versatile, inexpensive practice model., Design: Participants underwent a didactic session to teach the theory required to perform ultrasound-guided procedures. Motor skills were taught using a practice model incorporating analogs of common anatomic and pathologic structures into an opacified gelatin substrate., Setting: The Marcia and Eugene Applebaum Simulation Learning Institute, Beaumont Hospital, Royal Oak, MI; a private nonprofit tertiary care hospital associated with the OUWB School of Medicine, Rochester, MI., Participants: The model was tested in a cohort of 50 medical students and general surgery residents., Results: The gelatin model can be constructed for $1.03 per learner. The solid, cystic, and vascular structural analogs were readily identifiable on ultrasound and easily differentiated based on their echotextures. Eighty-four percent of participants successfully aspirated the cystic structure, 88% successfully biopsied a portion of the solid structure, and 76% successfully cannulated the tubular structure. Overall, 82% of participants achieved a passing score for the exercise based on a validated Objective Structured Assessment of Technical Skill instrument. There were no significant differences between the medical students and residents., Conclusion: This model can be used to teach basic ultrasound skills such as aspiration, biopsy, and vessel cannulation, providing a foundation for the use of ultrasound in a broad range of clinical procedures, as well as providing practice opportunities for medical students and residents to gain increased ultrasound competency and confidence., (Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Unlabelled: September 11, 2001 saw the dawn of the US-led global war on terror, a combined diplomatic, military, social, and cultural war on terrorist activities. Chemical, biological, radiological, nuclear, and high-yield explosives (CBRNE), as a group of tactics, are often the preferred weapons of terrorists across the globe. We undertook a survey of US medical schools to determine what their self-reported level of training for terrorist events encompasses during the four years of undergraduate medical education., Methods: We surveyed 170 medical schools in the US and Puerto Rico using a five-question, internet-based survey, followed by telephone calls to curriculum offices for initial nonresponders. We used simple descriptive statistics to analyze the data., Results: A majority of US medical schools that completed the survey (79 schools or 65.3%) have no required lecture or course on CBRNE or terrorist activities during the first or second year (preclinical years). Ninety-eight out of the 121 respondents (81.0%), however, believed that CBRNE training was either very important or somewhat important, as reflected in survey answers., Conclusions: Most physician educators believe that training in CBRNE is important; however this belief has not resulted in widespread acceptance of a CBRNE curriculum in US medical schools.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, and some of its forms are progressive. This study describes the profiling of hepatic gene expression and serum protein content in patients with different subtypes of NAFLD. Liver biopsy specimens from 98 bariatric surgery patients were classified as normal, steatosis alone, steatosis with nonspecific inflammation, and nonalcoholic steatohepatitis (NASH). Microarray hybridizations were performed in triplicate and the microarray expression levels of a selected group of genes were confirmed using real-time quantitative reverse-transcriptase polymerase chain reaction. Serum protein profiles of the same patients were determined by SELDI-TOF mass spectrometry. Of 98 obese patients, 91 were diagnosed with NAFLD (12 steatosis alone, 52 steatosis with nonspecific inflammation, and 27 NASH), and 7 patients without NAFLD served as obese controls. Each group of NAFLD patients was compared with the obese controls, and 22 genes with more than twofold differences in expression levels were revealed. Proteomics analyses were performed for the same group comparisons and revealed twelve significantly different protein peaks. In conclusion, this genomic/proteomic analysis suggests differential expression of several genes and protein peaks in patients within and across the forms of NAFLD. These findings may help clarify the pathogenesis of NAFLD and identify potential targets for therapeutic intervention.