Faculty Bibliography

BACKGROUND/UNASSIGNED:Point-of-care ultrasound (POCUS) is endorsed by multiple national societies as an important skill in internal medicine (IM). Despite its growing importance, current evaluation methods for POCUS competence focus primarily on image acquisition and interpretation, overlooking clinical decision-making. OBJECTIVES/UNASSIGNED:We developed and evaluated an objective structured clinical examination (OSCE) that assesses IM residents' ability to select appropriate ultrasound examinations, interpret pathological images, and integrate these findings into clinical decision-making. METHODS/UNASSIGNED:Over both the 2022 and 2023 academic years, 110 postgraduate year-2 IM residents participated in a longitudinal POCUS curriculum. Eighty-one of these residents participated in a 40-min OSCE case 9 months later. In the OSCE, residents encountered a clinical case involving a patient with systemic lupus erythematosus and respiratory distress, requiring both lung and cardiac ultrasounds. Residents' performance was evaluated using a 50-question rubric that assessed image quality, interpretation, and clinical reasoning. This is a cross-sectional study. RESULTS/UNASSIGNED:Most residents successfully identified the appropriate examinations and interpreted pathological images, with 91% performing a lung ultrasound and 96% performing a cardiac ultrasound. However, many residents did not conduct a comprehensive lung exam, and many faced challenges obtaining certain cardiac views. Despite these gaps, most residents articulated appropriate differential diagnoses and management plans. CONCLUSIONS/UNASSIGNED:Our OSCE was able to evaluate the scanning patterns of the residents and test their ability to apply abnormal findings to a case, despite variability in the residents' scanning skills. This OSCE highlights opportunities to improve our POCUS curriculum in emphasizing comprehensive examination techniques and integration of clinical reasoning.

Corticosteroid management for patients with sarcoidosis requires the need for close monitoring to detect and manage any complications that may arise during treatment.

Genome-wide association studies (GWAS) have highlighted a large number of genetic variants with potential disease association, but functional analysis remains a challenge. Here we describe an approach to functionally validate identified variants through differentiation of induced pluripotent stem cells (iPSCs) to study cellular pathophysiology. We collected peripheral blood cells from Framingham Heart Study participants and reprogrammed them to iPSCs. We then differentiated 68 iPSC lines into hepatocytes and adipocytes to investigate the effect of the 1p13 rs12740374 variant on cardiometabolic disease phenotypes via transcriptomics and metabolomic signatures. We observed a clear association between rs12740374 and lipid accumulation and gene expression in differentiated hepatocytes, in particular, expression of SORT1, CELSR2, and PSRC1, consistent with previous analyses of this variant using other approaches. Initial investigation of additional SNPs also highlighted correlations with gene expression. These findings suggest that iPSC-based population studies hold promise as tools for the functional validation of GWAS variants.

Serous epithelial ovarian cancer (EOC) patients often succumb to aggressive metastatic disease, yet little is known about the behavior and genetics of ovarian cancer metastasis. Here, we aim to understand how omental metastases differ from primary tumors and how these differences may influence chemotherapy. We analyzed the miRNA expression profiles of primary EOC tumors and their respective omental metastases from 9 patients using miRNA Taqman qPCR arrays. We find 17 miRNAs with differential expression in omental lesions compared to primary tumors. miR-21, miR-150, and miR-146a have low expression in most primary tumors with significantly increased expression in omental lesions, with concomitant decreased expression of predicted mRNA targets based on mRNA expression. We find that miR-150 and miR-146a mediate spheroid size. Both miR-146a and miR-150 increase the number of residual surviving cells by 2-4 fold when challenged with lethal cisplatin concentrations. These observations suggest that at least two of the miRNAs, miR-146a and miR-150, up-regulated in omental lesions, stimulate survival and increase drug tolerance. Our observations suggest that cancer cells in omental tumors express key miRNAs differently than primary tumors, and that at least some of these microRNAs may be critical regulators of the emergence of drug resistant disease.