Gliomas are heterogeneous tumors with increased microvasculature, hypoxia, and necrosis. The purpose of this study was to examine the distribution and relationship of the MR-derived relative cerebral ...blood volume (rCBV), lactate (Lac), and mobile lipids (Lip), which have been proposed as markers for these phenomena of gliomas in vivo.
Twenty-three patients with newly diagnosed gliomas were examined before surgical biopsy and/or resection (seven grade II, five grade III, and 11 grade IV), and 27 patients were studied after surgery but before radiation treatment and/or chemotherapy (11 grade II, two grade III, and 14 grade IV gliomas). Lac and Lip were estimated from Lac-edited three-dimensional MR spectroscopic images. Dynamic susceptibility-contrast MR imaging was applied to obtain perfusion-weighted images and rCBV maps.
Before surgical biopsy/resection, one low-grade and 12 of 16 high-grade gliomas had significantly elevated Lac. No low-grade and 10 of 16 high-grade gliomas had significantly elevated Lip. In presurgical high-grade gliomas, volumes of elevated Lip and macronecrosis were significantly correlated. rCBV was significantly increased in regions with elevated Lac. After we excluded macronecrosis, the rCBV for regions with elevated Lip but no Lac was significantly higher than rCBV in regions with elevated Lac but no Lip. After surgical biopsy/resection, more low-grade patients showed significantly elevated Lac and Lip than before.
The in vivo distribution of rCBV, Lac, and Lip, as evaluated with three-dimensional MR spectroscopic imaging, may help in the diagnosis and selection of the most appropriate therapy for patients with gliomas.
A widely used method for quantifying swarming motility is the swarm plate assay. A significant increase in the motility halo size formed by
Escherichia coli or
Azospirillum brasilense was measured on ...Tween 80-containing agar relative to untreated agar. This improvement could benefit the identification of mutants in swarming motility.
Vocabulary knowledge is of fundamental importance to reading comprehension, and many students lack the vocabulary knowledge necessary to facilitate learning to read. A study was conducted to ...determine the effects of an individualized, online vocabulary program on picture vocabulary test scores. Elementary summer school students (N = 43), entering grades 2-4, who scored poorly on a vocabulary pretest were randomly assigned to treatment or control conditions. Students in the treatment condition received computer-delivered vocabulary instruction on a stratified sample of 100 words selected from 4000 of the most common words in written English. Posttest scores on a picture vocabulary test showed that students in the treatment condition outperformed control students by more than one standard deviation. The computer-adaptive, individualized instruction provided by this vocabulary program addresses a need for efficiency in remediation of vocabulary deficits. Further study is planned to determine whether improved vocabulary performance mediated by this computer assisted language learning (CALL) program might transfer to broader measures of vocabulary knowledge or reading comprehension.
The 2013 addition of the Care Transition Measures to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey; enactment of the Patient Protection and Affordable Care Act ...(2010); and a greater focus on population health have brought a heightened awareness and need for action with patient transitions. Data are emerging from the additional Care Transition Measures and benchmarks have been developed. This article briefly describes the context of care transition. We describe the journey of Indiana University Health North Hospital to overcome patient care transition obstacles, ultimately achieving designation as a top performer. We will discuss our efforts to personalize patient outcomes and transition through activation and improve transitions for vulnerable populations, specifically in the bariatric and orthopedic patient populations. The article concludes with discussion of overcoming obstacles and future directions with continued focus on collaboration and improvement.
► The 2010 Motivational Neuronal Networks conference took place on April 24–27. ► Discussions focused on understudied brain regions involved in reward and motivation. ► Topics included subthalamic ...nucleus, subiculum, lateral habenula, and several others. ► These discussions are summarized in this review.
On April 24–27, 2010, the Motivational Neuronal Networks meeting took place in Wrightsville Beach, North Carolina. The conference was devoted to “Emerging, re-emerging, and forgotten brain areas” of the reward circuit. A central feature of the conference was four scholarly discussions of cutting-edge topics related to the conference's theme. These discussions form the basis of the present review, which summarizes areas of consensus and controversy, and serves as a roadmap for the next several years of research.
Differentiating aggressive clear cell renal cell carcinoma (ccRCC) from indolent lesions is challenging using conventional imaging. This work prospectively compared the metabolic imaging phenotype of ...renal tumors using carbon-13 MRI following injection of hyperpolarized 1-
Cpyruvate (HP-
C-MRI) and validated these findings with histopathology. Nine patients with treatment-naïve renal tumors (6 ccRCCs, 1 liposarcoma, 1 pheochromocytoma, 1 oncocytoma) underwent pre-operative HP-
C-MRI and conventional proton (
H) MRI. Multi-regional tissue samples were collected using patient-specific 3D-printed tumor molds for spatial registration between imaging and molecular analysis. The apparent exchange rate constant (
) between
C-pyruvate and
C-lactate was calculated. Immunohistochemistry for the pyruvate transporter (MCT1) from 44 multi-regional samples, as well as associations between MCT1 expression and outcome in the TCGA-KIRC dataset, were investigated. Increasing
in ccRCC was correlated with increasing overall tumor grade (ρ = 0.92,
= 0.009) and MCT1 expression (r = 0.89,
= 0.016), with similar results acquired from the multi-regional analysis. Conventional
H-MRI parameters did not discriminate tumor grades. The correlation between MCT1 and ccRCC grade was confirmed within a TCGA dataset (
< 0.001), where MCT1 expression was a predictor of overall and disease-free survival. In conclusion, metabolic imaging using HP-
C-MRI differentiates tumor aggressiveness in ccRCC and correlates with the expression of MCT1, a predictor of survival. HP-
C-MRI may non-invasively characterize metabolic phenotypes within renal cancer.
Stable multilayer thin films, assembled by a combination of layer-by-layer processing of polyelectrolytes and inorganic quantum dot monolayers prepared using the Langmuir−Schaefer deposition ...procedure, have been examined. Film formation and structure are confirmed using UV−vis absorption measurements and fluorescence spectroscopy. Growth is shown to be linear over several polyelectrolyte−quantum dot multilayers. Films consist of either (trioctylphosphine/trioctylphosphine oxide)-capped CdSe (4.1 nm ± 0.16 nm) or dodecanethiol-capped Au quantum dots (6.0 nm ± 0.9 nm) within polyelectrolyte bilayers of the well-studied (poly(allylamine hydrochloride)/poly(styrene sulfonate)) system. Electrostatic and hydrophobic interactions combine as the basis for assembly using this versatile new procedure.
The Wrist and Radius Injury Surgical Trial (WRIST) collaboration is the largest clinical trial ever conducted in hand surgery. We applied data from this study to examine the relationship between ...functional outcomes and patient satisfaction after treatment of distal radial fractures. Patients aged 60 years and older with isolated distal radial fractures were enrolled at 24 health systems. Grip strength and the arc of wrist motion were measured after treatment. The Michigan Hand Outcomes Questionnaire was used to measure patient satisfaction. Receiver operating characteristic curves were created using patient satisfaction as the reference standard and each functional measure as a predictor. At 12 months after treatment, mean grip strength was 82% of normal and mean arc of motion was 88% of normal. The optimal cut-off points to distinguish satisfaction from dissatisfaction occurred when patients recovered 59% of hand strength and 79% of wrist motion. Continuing therapy to increase functional gains beyond this point unnecessarily utilizes healthcare resources without additional patient-reported gains.
Level of evidence: IV
To investigate the relationship between magnetization transfer (MT) imaging and tissue macromolecules in high-grade serous ovarian cancer (HGSOC) and whether MT ratio (MTR) changes following ...neoadjuvant chemotherapy (NACT).
This was a prospective observational study. 12 HGSOC patients were imaged before treatment. MTR was compared to quantified tissue histology and immunohistochemistry. For a subset of patients (
= 5), MT imaging was repeated after NACT. The Shapiro-Wilk test was used to assess for normality of data and Spearman's rank-order or Pearson's correlation tests were then used to compare MTR with tissue quantifications. The Wilcoxon signed-rank test was used to assess for changes in MTR after treatment.
Treatment-naïve tumour MTR was 21.9 ± 3.1% (mean ± S.D.). MTR had a positive correlation with cellularity, rho = 0.56 (
< 0.05) and a negative correlation with tumour volume, ρ = -0.72 (
= 0.01). MTR did not correlate with the extracellular proteins, collagen IV or laminin (
= 0.40 and
= 0.90). For those patients imaged before and after NACT, an increase in MTR was observed in each case with mean MTR 20.6 ± 3.1% (median 21.1) pre-treatment and 25.6 ± 3.4% (median 26.5) post-treatment (
= 0.06).
In treatment-naïve HGSOC, MTR is associated with cellularity, possibly reflecting intracellular macromolecular concentration. MT may also detect the HGSOC response to NACT, however larger studies are required to validate this finding.
MTR in HGSOC is influenced by cellularity. This may be applied to assess for cell changes following treatment.
"88 The court used Webster's Third New International Dictionary definitions and concluded that the policy language "dwelling being constructed" was not ambiguous and held that the language meant ...bringing a dwelling into existence from the ground up, i.e., creating a complete dwelling that did not previously exist.89 The phrase did not include renovations, repairs, or refurbishments to an already-existing dwelling.90 Therefore, the U.S. District Court for the Middle District of Florida held that the vacancy exclusion applied, the exception to the exclusion did not, and entered judgment for the insurer.91 D.Dishonest Acts In Maldonado Investments, LLC v. State Farm Fire & Casualty Co.,92 the insured operated a restaurant that was destroyed by a fire set by an employee.93 The employee pleaded guilty to criminal arson.94 The insurer denied the claim, and the insured sued.95 The insurer moved for summary judgment based on the dishonesty exclusion.96 The trial court found that the dishonesty exclusion applied, but analyzed whether there was coverage under an employee dishonesty endorsement.97 That endorsement provided coverage for direct physical loss to business personal property resulting from the dishonest acts of one or more of the insured's employee(s), but required that the employee have the intent to cause the insured to sustain loss and to obtain a financial benefit for any employee or other individual or organization.98 The U.S. District Court for the Western District of Louisiana found that the endorsement did not apply because the insured did not show that the employee started the fire with the intent to obtain a financial benefit.99 In J&A Freight Systems, Inc. v. Travelers Property Casualty Co. of America.,100 the U.S. District Court for the Northern District of Illinois explained that certain endorsements that deal generally with theft do not necessarily override pre-existing endorsements that address specific types of theft and that the modification of coverage does not necessarily affect deductibles.101 The court analyzed whether an endorsement that increased the general limit for Coleman Cable shipments from $100,000 to $150,000 changed the policy's Freight Charges, Loading and Unloading "Carrier" Dishonesty Endorsement (Carrier Dishonesty Endorsement).102 The Carrier Dishonesty Endorsement modified the policy's contract's categorical carrier dishonesty exclusion by providing coverage for up to $50,000 for loss to covered property caused by or resulting from any fraudulent, dishonest, or criminal act committed by a carrier, and excluded losses in excess of $50,000 by restating word for word the categorical carrier dishonesty exclusion.103 The insured transportation broker arranged for transport of its client's load of copper wire with an individual who held himself out as a representative of a legitimate carrier.104 Unbeknown to the insured, the individual was an imposter who picked up the copper wire, but never delivered it.105 Following discovery of the subterfuge, the insured submitted a claim for $116,163.60.106 Because of the Carrier Dishonesty Endorsement, the insured determined that coverage was limited to $50,000 and paid that amount to the insured.107 The insured sued.108 The insurer moved for summary judgment, arguing that the policy provided only $50,000 coverage for the claim.109 The insured argued that the policy was ambiguous as to whether the $50,000 or $150,000 limit applied to the loss, which created a question of fact precluding summary judgment.110 The court found that the carrier dishonesty exclusion precluded coverage for losses caused by acts of carrier dishonesty and the Carrier Dishonesty Endorsement gave back coverage of only $50,000.111 The court further found that the endorsement that changed the limit for Coleman Cable shipments from $100,000 to $150,000 and provided for a $2,500 deductible for theft did not change the effect of the Carrier Dishonesty Endorsement or make it ambiguous.112 The court explained that the Coleman Cable Endorsement's reference to the $2,500 deductible for theft did not show the $150,000 limit applied to theft covered by the Carrier Dishonesty Endorsement because the deductible and exclusions are described in different portions of the policy, can be modified separately, and address different concepts.113 E.Faulty Workmanship In James McHugh Construction Co. v. Travelers Property Casualty Co. of America,114 the insured made a claim for windows scratched by a contractor while attempting to clean construction debris off the windows.115 The insurer denied the claim under the faulty workmanship exclusion.116 The insured argued that "faulty workmanship" was ambiguous because it did not specify whether it applied to processes or final products.117 The U.S. District Court for the District of Maryland found the term was unambiguous and enforceable and that the term "faulty workmanship" applies to both processes and final products.118 The court held that faulty workmanship damaged the windows.119 In Leep v. Trinity Universal Insurance Co.,120 the insured hired a contractor to replace roofing to remedy hail damage.121 After the roof replacement, the insured discovered water damage in his attic due to water vapor from disconnected furnace vent piping.122 The insurer denied the claim under the faulty workmanship exclusion, claiming that the damage occurred because the contractor disconnected the furnace vent during the roof replacement.123 The insured argued that the disconnected furnace vent piping was not faulty workmanship because work on vent piping was not within the scope of the roofing contract.124 The U.S. District Court for the District of Montana denied both parties' motions for summary judgment, rejecting the insured's claim that the faulty workmanship exclusion does not apply based on the scope of the contract, but also finding an issue of fact as to whether the contractor's workmanship was faulty.125 In National Manufacturing Co., Inc. v. Citizens Insurance Co. of America.,126 the insured made a claim for damage for metal casing stock that was damaged due to pitting caused by a faulty chemical component.127 The insurer denied the claim, claiming that coverage was barred under a faulty workmanship exclusion.128 The insurer argued that the faulty workmanship exclusion applied because the finished product was defective, the exclusion applied to both flawed product and process, the policy did not require the insured's own workmanship be faulty, and applying the exclusion would preclude the insured from obtaining coverage for its own faulty products.129 The insured contended that the cases cited by the insurer applied only to real property, that the loss was not caused by its manufacturing process, and the exclusion was ambiguous because it contained an exception for damage from covered causes of loss.130 The U.S. District Court for the District of New Jersey held that the faulty workmanship exclusion applied to both flawed product and process, but also held that an exception in the exclusion providing coverage for damages resulting from a covered cause of loss was contradictory, making the exclusion ambiguous and unenforceable.131 F. Mold and Water Damage In Morrow v. Allstate Indemnity Co.,132 the plaintiffs reported "two claims for direct physical loss to their home-one involving water damage and the other involving foundation and/or structural support damage. DAMAGES A.ACV/RCV/Holdback When calculating property damage, policies often do not provide for replacement cost coverage until the damaged property is actually repaired or replaced. ...that time, the insured is entitled to actual cash value (ACV), which is typically calculated as replacement cost less depreciation. "263 The Florida District Court of Appeal in Arko Plumbing Corp. v. Rudd264 recently held that Florida's absolute litigation privilege does not apply to an EUO.265 2.Proof of Loss Traditionally, proof of loss provisions have been considered a condition precedent to recovery under an insurance policy. ...if insureds did not comply with the proof of loss provision, they could not recover under the policy. Feb. 28, 2017), the Pennsylvania Superior Court adopted a similar approach, holding that "fjoreseeability is the lynchpin of the analysis. ...in this case, the insured's loss is excluded from coverage if it was a natural, foreseeable loss arising from deficient maintenance.
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