By virtue of its ability to regulate the composition of cerebrospinal fluid (CSF), the choroid plexus (CP) is ideally suited to instigate a rapid response to traumatic brain injury (TBI) by producing growth regulatory proteins. For example, Esophageal Cancer Related Gene-4 (Ecrg4) is a tumor suppressor gene that encodes a hormone-like peptide called augurin that is present in large concentrations in CP epithelia (CPe). Because augurin is thought to regulate senescence, neuroprogenitor cell growth and differentiation in the CNS, we evaluated the kinetics of Ecrg4 expression and augurin immunoreactivity in CPe after CNS injury. Adult rats were injured with a penetrating cortical lesion and alterations in augurin immunoreactivity were examined by immunohistochemistry. Ecrg4 gene expression was characterized by in situ hybridization. Cell surface augurin was identified histologically by confocal microscopy and biochemically by sub-cellular fractionation. Both Ecrg4 gene expression and augurin protein levels were decreased 24–72 hrs post-injury but restored to uninjured levels by day 7 post-injury. Protein staining in the supraoptic nucleus of the hypothalamus, used as a control brain region, did not show a decrease of auguin immunoreactivity. Ecrg4 gene expression localized to CPe cells, and augurin protein to the CPe ventricular face. Extracellular cell surface tethering of 14 kDa augurin was confirmed by cell surface fractionation of primary human CPe cells in vitro while a 6–8 kDa fragment of augurin was detected in conditioned media, indicating release from the cell surface by proteolytic processing. In rat CSF however, 14 kDa augurin was detected. We hypothesize the initial release and proteolytic processing of augurin participates in the activation phase of injury while sustained Ecrg4 down-regulation is dysinhibitory during the proliferative phase. Accordingly, augurin would play a constitutive inhibitory function in normal CNS while down regulation of Ecrg4 gene expression in injury, like in cancer, dysinhibits proliferation.

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There are concerns regarding the anatomy knowledge amongst medical school graduates and foundation doctors. Clinical procedures performed without relevant anatomical knowledge could result in serious harm to patients. The aim of this quantitative study was to assess education provision in the domains of anatomy, radiology and practical procedures for foundation year doctors during their first two years of training (FY1, FY2). A national survey of acute hospital trusts in England was conducted. Each trust completed a proforma relating to education provision for foundation year doctors between 6/8/2014 and 4/8/2015. A total of 95/161 (59%) acute hospital trusts in England responded. The mean number of teaching hours/year was 55.6±19.0 for FY1 and 57.3±30.4 hours/year for FY2. Anatomy education was provided in eight trusts with a mean of 2.3±1.0 hours/year for FY1 and 2.7±2.0 hours/year for FY2. The mean provision of practical procedure education was 2.2±1.3 hours/year for FY1 and 2.7±4.4 hours/year for FY2. The mean provision of radiology education was 10.5±18.7 hours/year for FY1 and 7.8±14.2 hours/year for FY2. Reasons for the lack of teaching included: lack of time, facilities, teaching staff, financial resources and absence of specific educational domains in the foundation curriculum. Medical education provision for foundation doctors is highly variable. There are wide discrepancies in postgraduate anatomy education, procedural skill training and radiology education between hospital trusts. Clin. Anat. 29:982-990, 2016. © 2016 Wiley Periodicals, Inc.