Increasing Confident Thoughts in an Adolescent With Autism: A Pilot Study.

Private events such as thoughts and feelings occur within the individual and are inaccessible to outside observers. Creating interventions for troublesome private events, therefore, is challenging. Precision teaching has a number of studies where participants self-count targeted private events and intervene by engaging in 1-min timings of positive thoughts. The present pilot study extended the 1-min timing procedure to a 15-year-old girl with autism spectrum disorder. After the intervention, the participant's level of despondent thoughts dropped by ÷4.55 in level, with lower levels of anxiety and depression as measured by the Beck Anxiety Inventory and the Beck Depression Inventory.

A 10-year restrospective evaluation of ultrasound in pregnant abdominal trauma patients.

The pregnant abdominal trauma patient presents a unique diagnostic challenge. This study aimed to evaluate the accuracy of abdominal sonography for the detection of clinically important injuries in pregnant abdominal trauma patients. A retrospective review was performed of a trauma center database from 2001 to 2011. Medical records were reviewed to determine initial abdominal imaging test results and clinical course. Sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detection of traumatic injury were calculated. Of 19,128 patients with suspected abdominal trauma, 385 (2 %) were pregnant. Of these, 372 (97 %) received ultrasound as the initial abdominal imaging test. All 13 pregnant patients who did not receive ultrasound received abdominal CT. Seven pregnant patients underwent both ultrasound and CT. Seven ultrasound examinations were positive, leading to one therapeutic Cesarean section and one laparotomy. One ultrasound was considered false positive (no injury was seen on subsequent CT). There were 365 negative ultrasound examinations. Of these, 364 were true negative (no abdominal injury subsequently found). One ultrasound was considered false negative (a large fetal subchorionic hemorrhage seen on subsequent dedicated obstetrical ultrasound). Sensitivity and positive predictive value were 85.7 %. Specificity and negative predictive value were 99.7 %. Abdominal sonography is an effective and sufficient imaging examination in pregnant abdominal trauma patients. When performed as part of the initial assessment using an abbreviated trauma protocol with brief modifications for pregnancy, ultrasound minimizes diagnostic delay, obviates radiation risk, and provides high sensitivity for injury in the pregnant population.

Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study.

OBJECTIVE: The purpose of this study was to determine the diagnostic performance of magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis during pregnancy in a multiinstitutional study. STUDY DESIGN: In this multicenter retrospective study, the cases of pregnant women who underwent MRI evaluation of abdominal or pelvic pain and who had clinical suspicion of acute appendicitis between June 1, 2009, and July 31, 2014, were reviewed. All MRI examinations with positive findings for acute appendicitis were confirmed with surgical pathologic information. Sensitivity, specificity, negative predictive values, and positive predictive values were calculated. Receiver operating characteristic curves were generated, and area under the curve analysis was performed for each participating institution. RESULTS: Of the cases that were evaluated, 9.3% (66/709) had MRI findings of acute appendicitis. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive values were 96.8%, 99.2%, 99.0%, 92.4%, and 99.7%, respectively. There was no statistically significant difference between centers that were included in the study (pair-wise probability values ranged from 0.12-0.99). CONCLUSION: MRI is useful and reproducible in the diagnosis of suspected acute appendicitis during pregnancy.

Ovarian imaging by magnetic resonance in adolescent girls with polycystic ovary syndrome and age-matched controls.

PURPOSE: To compare ovarian morphology in adolescent girls with and without polycystic ovary syndrome (PCOS) using magnetic resonance imaging (MRI). MATERIALS AND METHODS: In 21 adolescent girls (age 12-18 years) without and 19 adolescents with PCOS (diagnosis based on excessive hair growth and irregular menstrual cycles) ovarian volume, antral follicle count (AFC) per ovary, and follicle size were evaluated. MRI was performed at 1.5 T or 3 T and axial or angled-axial single-shot echo-train spin echo images of 6 mm slice thickness were acquired. In a subset of subjects, 2-mm images were also obtained. PCOS and non-PCOS groups were compared using mixed affects regression. RESULTS: Mean AFC per ovary and ovarian volume were substantially greater in PCOS subjects compared to non-PCOS subjects. Mean follicle size was similar between groups. Follicles exceeding 10 mm were seen in 2/19 PCOS subjects versus 9/21 non-PCOS subjects. Consistently higher follicle counts were detected in images obtained at 2 mm compared to 6-mm slice thickness. CONCLUSION: In adolescence, MRI of the ovary reveals distinct differences between girls with and without PCOS. MRI may help evaluate young patients in whom transvaginal ultrasound is contraindicated.

Therapy of relapsed leukemia after allogeneic hematopoietic cell transplantation with T cells specific for minor histocompatibility antigens.

The adoptive transfer of donor T cells that recognize recipient minor histocompatibility antigens (mHAgs) is a potential strategy for preventing or treating leukemic relapse after allogeneic hematopoietic cell transplantation (HCT). A total of 7 patients with recurrent leukemia after major histocompatibility complex (MHC)-matched allogeneic HCT were treated with infusions of donor-derived, ex vivo-expanded CD8(+) cytotoxic T lymphocyte (CTL) clones specific for tissue-restricted recipient mHAgs. The safety of T-cell therapy, in vivo persistence of transferred CTLs, and disease response were assessed. Molecular characterization of the mHAgs recognized by CTL clones administered to 3 patients was performed to provide insight into the antileukemic activity and safety of T-cell therapy. Pulmonary toxicity of CTL infusion was seen in 3 patients, was severe in 1 patient, and correlated with the level of expression of the mHAg-encoding genes in lung tissue. Adoptively transferred CTLs persisted in the blood up to 21 days after infusion, and 5 patients achieved complete but transient remissions after therapy. The results of these studies illustrate the potential to selectively enhance graft-versus-leukemia activity by the adoptive transfer of mHAg-specific T-cell clones and the challenges for the broad application of this approach in allogeneic HCT. This study has been registered at http://clinicaltrials.gov as NCT00107354.

Multifocal intravascular papillary endothelial hyperplasia in the retroperitoneum and spine: a case report and review of the literature.

The authors present a unique case of intravascular papillary endothelial hyperplasia (IPEH) localized in the renal hilum, retroperitoneum, and spine in a patient with Wegener granulomatosis. IPEH rarely occurs in the abdomen or spine with few cases reported in the literature. No case has been reported of IPEH involving both the retroperitoneum and spine. In our case, MR imaging revealed enhancing masses in the right renal hilum and retroperitoneum as well as multiple focal enhancing lesions throughout the spine with lower thoracic ventral thecal sac compression. The diagnosis was established by resection of the renal hilum mass, and interval follow-up is deemed necessary for the remaining lesions because the long-term evolution of IPEH with conservative treatment alone is not well established.

"No-shows": who fails to follow up with initial behavioral health treatment?

OBJECTIVE: We sought to determine what demographic and clinical factors are associated with receipt of initial mental health treatment. STUDY DESIGN AND METHODS: A total of 1177 patients completed structured clinical interviews (Michigan Screening for Treatment and Research Triage) when they called to authorize mental health benefits. Measures included age, sex, alcohol use, drug use, anxiety, depression, medical history, behavioral health treatment history, psychosocial stressors, functioning, and suicidality. Multivariate analyses determined the association between these variables and a behavioral health claim within 90 days of the interview. RESULTS: Among those completing interviews, 85% attended initial mental health treatment. Factors significantly associated with increased odds of treatment initiation were good self-rated health (odds ratio [OR] = 1.70; 95% confidence interval [CI] = 1.15, 2.50), support of family or friends (OR = 1.71; 95% CI = 1.11, 2.65), previous outpatient mental health visits (OR = 1.56; 95% CI = 1.11, 2.19), and recent alcohol use (OR = 1.41; 95% CI = 1.00, 1.97). Factors associated with decreased odds of treatment initiation were recent period of total disability (OR = 0.62; 95% CI = 0.45, 0.87), any previous suicide attempt (OR = 0.56; 95% CI = 0.36, 0.87), 6 or more physician visits for medical reasons this year (OR = 0.64; 95% CI = 0.44, 0.92), and legal problems (OR = 0.31; 95% CI = 0.16, 0.61). In multivariate analyses, family support, history of medical visits, and recent alcohol use were no longer significant predictors. CONCLUSIONS: Most individuals in this insured population who completed an initial telephone assessment had an initial behavioral health claim. However, patients with greater health or social service needs were at higher risk for not obtaining treatment, suggesting the need for greater outreach and attention by providers and insurers.

Imaging acute appendicitis.

Acute appendicitis is the most common entity requiring emergent abdominal surgery. Early diagnosis is critical to proper management. Patients often present with a classic clinical picture and may not require imaging, although many patients have nonspecific signs and symptoms. It is in these cases that imaging plays a large role. Imaging options include computed tomography, ultrasound, and magnetic resonance. The following discussion addresses the different imaging modality options with regard to diagnostic performance, indications, and interpretation in patients with suspected acute appendicitis.

Comparison of split double and triple twists in pair figure skating.

In this study, we compared the kinematic variables of the split triple twist with those of the split double twist to help coaches and scientists understand these landmark pair skating skills. High-speed video was taken during the pair short and free programmes at the 2002 Salt Lake City Winter Olympics and the 2003 International Skating Union Grand Prix Finals. Three-dimensional analyses of 14 split double twists and 15 split triple twists from eleven pairs were completed. In spite of considerable variability in the performance variables among the pairs, the main difference between the split double twists and split triple twists was an increase in rotational rate. While eight of the eleven pairs relied primarily on an increased rotational rate to complete the split triple twist, three pairs employed a combined strategy of increased rotational rate and increased flight time due predominantly to delayed or lower catches. These results were similar to observations of jumps in singles skating for which the extra rotation is typically due to an increase in rotational velocity; increases in flight time come primarily from delayed landings as opposed to additional height during flight. Combining an increase in flight time and rotational rate may be a good strategy for completing the split triple twist in pair skating.

Polycystic ovary syndrome: clinical and imaging features.

Polycystic ovary syndrome is the most common endocrine disorder occurring in reproductive-age women. The syndrome is complex, multifactorial, and not always easily defined. Diagnosis is based upon a combination of clinical and biochemical criteria and ovarian morphology. The following review describes the clinical features, pathophysiology, diagnosis, and the role of imaging. Diagnostic imaging techniques are discussed, with emphasis on ultrasound as the main modality used worldwide. Contributions of 3-dimensional and Doppler ultrasound are addressed in addition to potential indications for magnetic resonance imaging in the evaluation of patients with suspected polycystic ovary syndrome.

Cross-sectional imaging of extranodal involvement in abdominopelvic lymphoproliferative malignancies.

Extranodal lymphoproliferative diseases are common, and their prevalence is increasing. Non-Hodgkin lymphomas and Hodgkin disease, in particular, frequently involve extranodal structures in the abdomen and pelvis, including both the solid organs (liver, spleen, kidneys, and pancreas) and the hollow organs of the gastrointestinal tract. Because virtually any abdominopelvic tissue may be involved, many different imaging manifestations are possible, and lymphoproliferative diseases may mimic other disorders. Familiarity with the imaging manifestations that are diagnostically specific for extranodal lymphoproliferative diseases is important because imaging plays an important role in the noninvasive management of disease. However, a definitive diagnosis requires a biopsy (of bone marrow, a lymph node, or a mass), a peripheral blood analysis, and other laboratory tests. In patients with known disease, the goals of imaging are staging, evaluation of response to therapy, and identification of new or recurrent disease or of complications of therapy. In patients without known disease, imaging permits a provisional diagnosis.

Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings.

The purposes of this study were to determine the (1) frequency with which nonenhanced computed tomography (CT) (NECT) permits conclusive diagnosis of acute appendicitis, (2) accuracy of NECT when findings are conclusive, and (3) overall accuracy of a CT protocol consisting of NECT with selective use of contrast. Five hundred and thirty-six patients underwent a NECT protocol with selective use of contrast. Diagnostic accuracy was then determined separately for (1) patients with conclusive initial NECT, (2) patients with inconclusive initial NECT, and (3) all patients. NECT was conclusive on initial interpretation in 404/536 patients and inconclusive in 132/536. Of 132 inconclusive studies, 126 were repeated with contrast (intravenous, oral or rectal). Sensitivity, specificity, and positive and negative predictive value for diagnosis of acute appendicitis were (1) 90%, 96.0%, 84.8%, and 97.4% in patients with conclusive NECT (n = 404); (2) 95.6%, 92.3%, 73%, and 99% in patients with inconclusive NECT followed by repeat CT with contrast; and (3) 91.3%, 95%, 82%, and 98% in all patients. The initial diagnosis of appendicitis may be made by NECT in 75% of patients, with contrast administration reserved for inconclusive NECT studies.

MR contrast agents for liver imaging: what, when, how.

The major classes of contrast agents currently used for magnetic resonance (MR) imaging of the liver include extracellular agents (eg, low-molecular-weight gadolinium chelates), reticuloendothelial agents (eg, ferumoxides), hepatobiliary agents (eg, mangafodipir), blood pool agents, and combined agents. Mechanisms of action, dosage, elimination, toxic effects, indications for use, and MR imaging technical considerations vary according to class. Gadolinium chelates are the most widely used. Ferumoxides are a useful adjunct for detection of hepatocellular carcinoma, particularly when used in combination with gadolinium to achieve improved lesion-to-liver contrast over that achievable with gadolinium alone. Mangafodipir is a prototype hepatobiliary agent that is taken up by lesions with functioning hepatocytes. It may be used for MR cholangiography as well as liver imaging. Although mangafodipir is no longer commercially available in the United States, it is currently marketed and used in Europe. Blood pool agents have not yet been approved for human use in the United States. However, a new combined MR contrast agent, gadobenate dimeglumine, recently was approved, and other agents are in various stages of development.

Future directions in MR imaging of the female pelvis.

New technology continues to change the field of MR imaging. This article describes select areas of technical development that are likely to have an increasing clinical impact on MR imaging of the female pelvis, including high-field imaging, parallel imaging, contrast agents, diffusion-weighted imaging and spectroscopy, and MR-guided intervention.

MR imaging of benign uterine disease.

MR provides excellent depiction of the female pelvic anatomy and has become the imaging modality of choice for the accurate diagnosis of numerous benign gynecologic conditions. Detection and characterization of leiomyomata and adenomyosis is performed routinely at many centers, and MR plays an important role in stratifying patients into appropriate treatment options. MR imaging is also uniquely well suited to the evaluation of gynecologic conditions that occur during pregnancy and in the postpartum period. This article describes MR protocols and the typical findings of various benign conditions of the uterine corpus and cervix, including congenital anomalies, leiomyomas, adenomyosis, and complications related to pregnancy.

MR imaging of malignant uterine disease.

The role of MR imaging in the diagnosis and management of patients who have uterine malignancy continues to evolve. MR imaging has been shown to be effective for preoperative characterization and staging of endometrial and cervical carcinoma, and for the evaluation of posttreatment changes and recurrent disease. Because of its potential to provide detailed information about local extent and metastatic disease, MR imaging has enormous potential to help triage patients to appropriate treatment groups and provide imaging surveillance after therapy. This article reviews the MR imaging technique and the imaging characteristics of malignant disease of the uterine corpus and cervix.

MR imaging evaluation of the adnexa.

MR imaging has become an important tool in the evaluation of patients with adnexal disease, and its role continues to evolve. Some benign entities can be diagnosed by MR imaging with a high grade of confidence, such as teratomas, endometriomas, simple and hemorrhagic cysts, fibromas, and hydrosalpinx. In cases of malignant lesions, MR imaging may be more accurate than other modalities for lesion characterization, staging, and follow-up.

MRI of the female pelvis using vaginal gel.

OBJECTIVE: Vaginal distention with aqueous gel optimizes MRI evaluation of the vaginal walls and outer contours of the cervix. The objective of this pictorial essay is to illustrate the use of vaginal gel for MRI of the female pelvis. CONCLUSION: Distention of the vagina with gel is an inexpensive, well-tolerated procedure that may improve MRI evaluation of a variety of gynecologic conditions.

Magnetic resonance evaluation of pregnant patients with acute abdominal pain.

Acute abdominal pain in a pregnant patient is associated with a long differential diagnosis, and diagnostic imaging is often required to guide management. Ultrasound is safe and widely available; however, maternal structures may be difficult to evaluate during pregnancy due to anatomic changes. Computed tomography is accurate but exposes the fetus to ionizing radiation. Magnetic resonance (MR) imaging provides excellent anatomic resolution and tissue characterization without ionizing radiation, and MR diagnosis frequently requires no contrast administration. Using an appropriate combination of sequences, MR imaging can reliably demonstrate many causes of acute abdominal pain during pregnancy.