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A neural-network machine learning model is developed to control a bimorph adaptive mirror to achieve and preserve aberration-free coherent X-ray wavefronts at synchrotron radiation and free electron laser beamlines. The controller is trained on a mirror actuator response directly measured at a beamline with a real-time single-shot wavefront sensor, which uses a coded mask and wavelet-transform analysis. The system has been successfully tested on a bimorph deformable mirror at the 28-ID IDEA beamline of the Advanced Photon Source at Argonne National Laboratory. It achieved a response time of a few seconds and maintained desired wavefront shapes (e.g., a spherical wavefront) with sub-wavelength accuracy at 20 keV of X-ray energy. This result is significantly better than what can be obtained using a linear model of the mirror’s response. The developed system has not been tailored to a specific mirror and can be applied, in principle, to different kinds of bending mechanisms and actuators.

Ellipsoidal and plane-elliptical surfaces are widely used as reflective, point-to-point focusing elements in many optical systems, including X-ray optics. Here the classical optical path function approach of Fermat is applied to derive a closed-form expression for these surfaces that are uniquely described by the object and image distances and the angle of incidence at a point on a mirror surface. A compact description facilitates design, modeling, fabrication, and testing to arbitrary accuracy. Congruent surfaces in two useful coordinate systems — a system centered on the ellipsoid's axes of symmetry and a mirror-centered or `vertex' system with the surface tangent to the xy plane at the mirror's center — are presented. Expressions for the local slope and radii of curvature are derived from the result, and the first several terms of the Maclauren series expansion are provided about the mirror center.

Purpose:We present final 5-year outcomes of the multicenter randomized sham-controlled trial of a water vapor therapy (Rezūm™) for treatment of moderate to severe lower urinary tract symptoms due t...

Objective To determine the incremental detection rate of clinically significant prostate cancer (csPCa) provided by sequential cores during in-bore magnetic resonance imaging (MRI)-guided prostate biopsies. Methods Single-center, retrospective interpretation of prospectively acquired data in men without previous diagnosis of csPCa who underwent in-bore MRI-guided prostate biopsy between May 2017 and December 2019. Endpoints included detection of csPCa (grade group [GG] ≥ 2) and rate of GG upgrade provided by additional cores. Descriptive statistics presented as mean and standard deviation for the continuous variables, and frequency and percentage for the categorical variables. Results Four hundred and forty-three men with 747 lesions met eligibility criteria. Clinically significant prostate cancer was detected in 43.1% (322/747) of the biopsied lesions and GG 2 PCa or greater was identified by the first core in 78.3% (252/322) of them. On a per-core basis, cores 2, 3, 4, and 5 found new csPCa in 6% (42/744), 4% (26/719), 1% (2/137), and 0% (0/11) of the cases. Core biopsy 2, 3, 4, and 5 resulted in GG upgrade in 12% (91/744), 7% (49/719), 7% (9/137), and 0% (0/11) of the lesions, respectively. Each additional core was associated with a mean increase of 5 minutes in the duration of the biopsy. Conclusions In men undergoing in-bore MRI-guided prostate biopsies, 3 targeted cores per lesion provide an optimal trade-off between detection of clinically significant tumors and biopsy duration.

Purpose This study was undertaken to determine the safety and efficacy of fexapotide triflutate (FT) 2.5 mg and 15 mg for the treatment of Grade Group 1 prostate cancer. Methods Prospective randomized transrectal intraprostatic single injection FT 2.5 mg (n = 49), FT 15 mg (n = 48) and control active surveillance (AS) (n = 49) groups were compared in 146 patients at 28 U.S. sites, with elective AS crossover (n = 18) to FT after first follow-up biopsy at 45 days. Patients were followed for 5 years including biopsies (baseline, 45 days, and 18, 36, and 54 months thereafter), and urological evaluations with PSA every 6 months. Patients with Gleason grade increase or who elected surgical or radiotherapeutic intervention exited the study and were cumulatively included in the data analysis. Percentage of normal biopsies in baseline focus quadrant, tumor grades, and volumes; and outcomes including Gleason grade in entire prostate as well as treated prostate lobe, interventions associated with Gleason grade increase and total incidence of interventions were assessed. Results Significantly improved long-term clinical outcomes were found after 4-year follow-up, with percentages of patients progressing to interventions with and without Gleason grade increase significantly reduced by FT single treatment. Results in the FT 15-mg group were superior to the FT 2.5-mg dose group. There were no drug-related serious adverse events (SAEs). Conclusions FT showed statistically significant long-term efficacy in the treatment of Grade Group 1 patients regarding clinical and pathological progression. FT 15 mg showed superior results to FT 2.5 mg. There were no drug-related SAEs; FT injection was well tolerated.

Accurate preoperative detection of prostate cancer (PCa) exhibiting "cribriform" morphology (intraductal carcinoma [IDC-P] or cribriform Gleason pattern 4 [CrP4]) is important as it is independently associated with a variety of adverse clinical outcomes. The sensitivity of multiparametric magnetic resonance imaging (mpMRI) in the detection of PCa exhibiting "cribriform" morphology remains controversial.A total of 117 eligible men with prospectively reported mpMRI who underwent in-bore MRI targeted biopsy followed by whole-mount radical prostatectomy (RP) were analyzed for lesion-level imaging-pathology correlation.Of the 206 PCa foci at RP (117 index and 89 non-index), 74% (152/206) were detected by mpMRI. Of the 54 tumors missed by mpMRI, most were non-index (98%, 53/54), grade group (GG) 1 (68%, 37/54) or GG 2 (26%, 14/54), with a median size of 1.0 cm (range, 0.7-1.5 cm), and non-cribriform morphology (96%, 52/54). Cribriform morphology was detected in 26% (53/206) of all tumors, and although targeted biopsies identified 96% (51/53) of these cancers, the cribriform component was depicted in only 45% (24/53). Of these, mpMRI detected all (100%, 44/44) index and 78% (7/9) of the non-index tumors. At univariable analysis, tumor size greater than 5 mm, % pattern 45%, cribriform morphology, zone (transition versus peripheral zone), and region (apex versus mid/base) were significantly associated with tumor visibility at mpMRI. At multivariable analysis, only tumor size, presence of any pattern 4, and peripheral zone remained significant predictors for visibility by mpMRI.At a lesion level, mpMRI offers high sensitivity for the detection of cribriform morphologies, however, the cribriform component is frequently missed by targeted biopsies. The MRI visibility is significantly associated with larger tumor size, presence of Gleason pattern 4, and peripheral zone location.

On X-ray beamlines and telescopes, glancing-incidence mirrors with parabolic profiles are used to collimate, focus, and collect light. Here, analytic descriptions for paraboloidal, plane-parabolic, and parabolic cylindrical mirrors in several congruent geometries that are commonly used in fabrication, metrology, and modeling are provided. The exact expressions are derived directly from Fermat's principle, without coordinate transformations, in several mirror-centered coordinate systems, including one with the surface tangent to the central point of intersection. Coefficients for a sixth-order polynomial series approximation are calculated for that coordinate system.

PURPOSE: To determine and compare rates of grade group (GG) discrepancies between different targeted biopsy techniques (in-bore vs fusion) after propensity score weighting using whole-mount radical prostatectomy (RP) histopathologic analysis as the reference standard. MATERIALS AND METHODS: This retrospective study evaluated men who underwent targeted (fusion or in-bore) biopsy between April 2017 and January 2019 followed by prostatectomy. The primary endpoint of the study was a change in GG from biopsy to RP at a patient level. For downgrade and upgrade analysis, men with biopsy GG1 (downgrade not possible) and GG5 (upgrade not possible) were excluded, respectively. GG upgrade, downgrade, and concordance rates of each targeting approach were compared using propensity score weighting and logistic regression with inverse probability of treatment weighting. Significance level was set at .05. Index lesion GG on RP specimen served as the reference standard. RESULTS: A total of 191 men (90 in the in-bore [mean age, 63 years ± 7 (standard deviation)] and 101 in the fusion biopsy group [mean age, 65 years ± 7]) were eligible and included. Fewer GG upgrades were noted in the in-bore biopsy group (14%; 12 of 85) compared with the fusion plus systematic biopsy group (30%; 28 of 93) (P = .012). The incidence of GG downgrade in the in-bore group (25%; 21 of 84) was higher than in the fusion group (17%; 16 of 93); however, the difference was not statistically significant (P = .2). Of the 77 men misclassified by both biopsy techniques, the majority (56%, n = 43) had a change in GG of 2 to 3 or 3 to 2. CONCLUSION: Superior sampling accuracy with MRI-guided in-bore biopsies offers a lower incidence of GG upgrades compared with MRI–transrectal US fusion biopsies upon RP. Keywords: Biopsy/Needle Aspiration, MR-Imaging, Oncology, Pathology, Prostate Supplemental material is available for this article. © RSNA, 2021

The purpose of this study was to assess the diagnostic performance of prospectively assigned mean apparent diffusion coefficient (ADC) values in multiparametric MRI (mpMRI) structured reports for discriminating clinically insignificant (International Society of Urological Pathology [ISUP] group 1) from clinically significant (ISUP groups 2-5) prostate cancer.This single-center study included men with abnormal 3-T mpMRI findings (Prostate Imaging Reporting and Data System version 2 score, ≥ 3) who subsequently underwent radical prostatectomy or targeted biopsy with positive results. One of nine radiologists prospectively reported the mean ADC for each lesion during clinical interpretation. Lesions with ADC ≤ 0.700 mmAmong the 218 eligible men, those with ISUP group 2-5 lesions had lower mean ADC values than those with ISUP 1 lesions; overall, 0.598 vs 0.803 mm/sADC values estimated prospectively in a clinical setting can help differentiate clinically insignificant from clinically significant prostate cancer, facilitating prebiopsy and pretreatment risk stratification.

Objectives To determine the implications of different prostate sampling schemes on the diagnosis of clinically significant prostate cancer (csPCA, ISUP group 2–5) and clinically insignificant prostate cancer (ciPCA, ISUP group 1) in men with abnormal multiparametric magnetic resonance imaging (mpMRI) undergoing MRI-transrectal ulrasound fusion targeted biopsies. Materials and Methods This is a retrospective analysis of a cohort including all men who had a single lesion on mpMRI of the prostate performed between January 2016 and June 2017. All men underwent an MRI-transrectal ulrasound fusion biopsy and systematic (SBx) sampling of the prostate, which combined and were considered the standard of reference. The hypothetical 3 biopsy sampling schemes were defined as follows: Targeted biopsy only (TBx), TBx + ipsilateral SBx (ipsi-SBx) and TBx + contralateral SBx (contra-SBx) and were evaluated for the detection of csPCA and ciPCA. Sensitivity and 95% intervals were calculated, McNemar test was used to compare sensitivities between the various sampling schemes. Results TBx + SBx detected csPCa in 47% (55 of 116) of the 116 men who met eligibility criteria. Sensitivity and 95% confidence intervals for csPCa detection was 85.5% (73.3%–93.5%), 96.4% (87.5%–99.6%), and 92.7 (82.4%–98%) for TBx alone, TBx + ipsi-SBx and TBx + contra-SBx, respectively. csPCa detection rates were higher for both TBx + ipsi-SBx and TBx + contra-SBx compared to TBx alone. Clinically insignificant cancers alone were detected in 7.7% (9 of 116), 10.3% (12 of 116), and 14.6% (17 of 116) of the cohort by TBx only and TBx + ipsi-SBx, and TBx + contra-SBx, respectively. Conclusions TBx + ipsi-SBx may increase the detection of csPCa while limiting overdiagnosis of indolent cancers.

INTRODUCTION AND OBJECTIVE:Positive surgical margins (PSM) in men undergoing radical prostatectomy (RP) for prostate cancer (PCa) are an adverse surgical outcome associated with increased risk of r...

These studies were undertaken to determine if fexapotide triflutate 2.5 mg transrectal injectable (FT) has significant long-term (LT) safety and efficacy for the treatment of benign prostatic hyperplasia (BPH). Two placebo controlled double-blind randomized parallel group trials with 995 BPH patients at 72 sites treated 3:2 FT:placebo, with open-label FT crossover (CO) re-injection in 2 trials n = 344 and long-term follow-up (LF) 2–6.75 years (mean 3.58 years, median 3.67 years; FT re-injection CO mean 4.27 years, median 4.42 years) were evaluated. 12 months post-treatment patients elected no further treatment, approved oral medications, FT, or interventional treatment. Primary endpoint variable was change in Symptom Score (IPSS) at 12 months and at LF. CO primary co-endpoints were 3-year incidence of (1) surgery for BPH in FT treated CO patients versus patients crossed over to oral BPH medications and (2) surgery or acute urinary retention in FT-treated CO placebo patients versus placebo patients crossed over to oral BPH medications. 28 CO secondary endpoints assessed surgical and symptomatic outcomes in FT reinjected patients versus conventional BPH medication CO and control subgroups at 2 and 3 years. FT injection had no significant safety differences from placebo. LF IPSS change from baseline was higher in FT treated patients compared to placebo (median FT group improvement − 5.2 versus placebo − 3.0, p

Convective radiofrequency water vapor thermal therapy with the Rezūm system is a relatively new treatment for benign prostatic hyperplasia (BPH). We present results from a single surgeon in an office setting. A retrospective review of 129 patients from a single surgeon who underwent the Rezūm procedure was performed. All patients were at least 4 months out from treatment. International prostate symptom scores (IPSS), maximum flow rates (Qmax), residual urine volumes, medication usage, and adverse events were monitored. Data were analyzed at baseline, 15–45 days, 46–90 days, and 91–180 days after treatment. A scripted patient questionnaire was attempted over the phone to all patients. It was administered by a resident and medical student who do not work in the provider’s office. Maximal effects were noted at the 91–180 day interval. IPSS improved from a baseline of 18.3 to 6.9 and Qmax from 10.5 to 16.8 mL/s. Improvements were independent of starting symptom score, median lobe treatment, and prostate size. There was a 17% prostate volume reduction based on TRUS and 14% based on PSA. The most common adverse events were urinary tract infections (17%) and transient urinary retention (14%). In total 90% of patients were able to come off their BPH medications and 86% of patients would recommend the procedure to a friend. Rezūm radiofrequency water vapor thermal therapy offers a minimally invasive option for BPH management with moderate improvement in symptoms and flow rate. The results appear to be independent of prostate size or presence of a median lobe, and have now been replicated in a single office setting.

INTRODUCTION AND OBJECTIVE:The direct visualization of the biopsy needle and of the MRI-visible lesion provided by in-bore MRI-guided biopsies (IBBx) may result in superior sampling accuracy of the...

INTRODUCTION AND OBJECTIVES:The standard multiparametric MRI (mpMRI) of the prostate includes dynamic contrast-enhanced (DCE), T2- and diffusion-weighted (DWI) imaging. DCE affects PI-RADS v2 score...

INTRODUCTION AND OBJECTIVES:Convective radiofrequency thermal therapy with the Rezum system is a relatively new treatment for benign prostatic hyperplasia (BPH) that has been shown to be durable th...

Introduction Most surgical treatments for male lower urinary tract symptoms and benign prostatic hyperplasia affect erectile and ejaculatory functions negatively, leading to patient dissatisfaction. Aim To determine whether water vapor thermal therapy, when conducted in a randomized controlled trial, would significantly improve lower urinary tract symptoms secondary to benign prostatic hyperplasia and urinary flow rate while preserving erectile and ejaculatory functions. Methods Men at least 50 years old with International Prostate Symptom Scores of at least 13, a peak flow rate of at least 5 to no higher than 15 mL/s, and prostate volume of 30 to 80 cm 3 were randomized 2:1 between Rezūm System thermal therapy and control. Thermal water vapor (103°C) was injected into lateral and median lobes as required for treatment of benign prostatic hyperplasia. The control procedure entailed rigid cystoscopy with simulated active treatment sounds. Main Outcome Measures Blinded group (active = 136, control = 61) comparison occurred at 3 months and the active arm was followed to 12 months for International Prostate Symptom Score, peak flow rate, and sexual function using the International Index of Erectile Function and the Male Sexual Health Questionnaire for Ejaculatory Function. The minimal clinically important difference in erectile function perceived by subjects as beneficial was determined for each erectile function severity category. Subjects not sexually active were censored from sexual function analysis. Results No treatment- or device-related de novo erectile dysfunction occurred after thermal therapy. International Index of Erectile Function and Male Sexual Health Questionnaire for Ejaculatory Function scores were not different from the control group at 3 months or from baseline at 1 year. Ejaculatory bother score improved 31% over baseline ( P = .0011). Also, 32% of subjects achieved minimal clinically important differences in erectile function scores at 3 months, and 27% at 1 year, including those with moderate to severe erectile dysfunction. International Prostate Symptom Score and peak flow rate were significantly superior to controls at 3 months and throughout 1 year ( P Conclusion Convective water vapor thermal therapy provides sustainable improvements for 12 months to lower urinary tract symptoms and urinary flow while preserving erectile and ejaculatory functions.

With the increasing adoption of targeted prostate biopsies, it becomes important to understand the strengths and shortcomings of the techniques available for targeting suspicious lesions.To compare clinically significant prostate cancer (csPCa) detection rate with magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion versus in-bore biopsy in men with abnormal multiparametric MRI (mpMRI).This single-center, retrospective analysis of prospectively generated data included all men with abnormal mpMRI and fusion or in-bore biopsy between May 2017 and April 2018. Grade group (GG) 2-5 cancers were considered csPCa.Detection of csPCa was adjusted according to patient- and lesion-related characteristics using propensity score weighting. Secondary endpoints included the detection of clinically insignificant tumors and the rate of GG upgrade from biopsy to prostatectomy specimen. Analyses were performed at patient and lesion levels.A total of 103 and 300 men were included in the in-bore and fusion cohorts, respectively. On a per-patient basis, in-bore biopsies detected a higher proportion of csPCa (61%, 63/103) than fusion plus systematic biopsies (47%, 141/300; adjusted odds ratio [OR]: 2.1, 95% confidence interval [CI]: 1.6-2.8, p0.0001). In-bore biopsies also detected fewer (11%, 11/103) clinically insignificant cancers than fusion biopsies (18%, 53/300; OR: 0.5, 95% CI: 0.3-0.8, p=0.001). Of those who had radical prostatectomy, GG upgrade after surgery was seen in 17% (4/24) of the men in the in-bore cohort and in 27% (22/82) of the men in the fusion cohort (p=0.55).MRI-guided in-bore biopsies detected more clinically significant and fewer insignificant prostate cancers than MRI-TRUS fusion targeted biopsies. Further cost-utility and patient outcome analyses are needed.In-bore biopsies (where the patient is on the magnetic resonance imaging [MRI] scanner itself) detected more aggressive cancers and fewer indolent cancers than fusion (where software blends MRI and ultrasound images) biopsies. These findings may help patients and physicians choose the best biopsy approach.

Thank you for the opportunity to respond to Dr Corona’s comments. Parsimoniously stated, lower urinary tract symptoms (LUTS) and the treatments impact sexual function. The challenge in advancing the medical and surgical care of men with LUTS is to maximize the impact on the bothersome symptoms while avoiding the undesirable effects on erectile and ejaculatory function. Excitingly, this new technology offers that possibility. Durability of the therapeutic response in men with LUTS and its impact is the next important issue and future reports will be forthcoming. We agree with Dr Corona that the need for comparative trials of the convective vapor technique with standard surgical approaches. These types of comparisons will undoubtedly be forthcoming, but clearly Dr Corona will agree that in any investigatory endeavor one must start at the beginning. This beginning was a success and lays the ground for confirmatory studies as well as those suggested above. Dr Corona wonders if the randomized controlled trial (RCT) accounted and controlled for the proper confounding variables impacting men with LUTS that we have previously published. To avoid the plague of self-citation we will not belabor these publications here. Concerning the possibility that these risk factors may confound the measurement of sexual function in this report, in our view the randomization process controls for these putative confounders unless one believes that the controls or the treatment groups are somehow unequally weighted in respective cohorts. Our analysis suggest that such bias do not exist. Contrary to cross-sectional and single cohort studies, one advantage of the blinded RCT design is the inherent protection against such unaccounted variables.

Immediate, short, and long-term functioning of an initial sample of 37 latency-aged children discharged from a residential program was examined. The results indicated significant decreases in behavior problems according to the Child Behavior Checklist (CBCL; Achenbach & Edlebrock, 1983), although at least 43% of the children were still functioning within the clinical range on ihe Aggressive, Externalizing, and Total Problem scales at discharge and followup. These findings support a long-term care model for a subgroup of this population whereby residential children with more severe symptoms and their parents require protracted supports and services within a behavioral-systems or ecological model.

We report a case of a newborn female with an unusual suprasternal simple cystic mass found to be a dermoid cyst. Dermoid cysts of the head and neck are rare lesions, but a midline location is characteristic for these congenital masses. A dermoid cyst should be high on the list of differential diagnoses given a unilocular midline cyst in a neonate even if no fat elements are demonstrated on imaging studies.

Optical systems for extreme ultraviolet (EUV) wavelengths can now reach diffraction-limited quality due to advances in optical fabrication, coating, and testing at accuracies measured in tenths of a nanometer. Driven by the demands of semiconductor photolithography, these ultrahigh-accuracy interferometric testing methods, which measure EUV optics at their operational wavelengths, produce some of the highest resolution optical systems ever made.

Diffusion-weighted imaging is useful for diagnosis of acute ischemic stroke. However, metastatic brain lesions may also demonstrate restricted diffusion on magnetic resonance imaging. We describe 4 cases (3 with metastatic neoplasms and 1 with a meningioma) with positive findings by diffusion-weighted imaging.

BACKGROUND. Racial differences exist in the management of coronary artery disease. One hypothesis is that black patients delay seeking care and that this delay may influence the management of coronary artery disease. OBJECTIVES. To assess delay in seeking care for heart disease. RESEARCH DESIGN. Cross-sectional survey. SUBJECTS. One thousand six hundred and fifty-two patients awaiting coronary angiography at three VA and one non-VA Medical Center. MEASURES. Patients were asked to retrospectively report the time between symptom onset and presentation for medical care and what if any were the reasons for delay. RESULTS. One thousand five hundred eleven patients (12% VA & 43% non-VA) answered questions regarding delay in treatment. Overall, 73% reported delaying 1 month or more and 16% reported delaying more than 6 months. Black patients and white patients were equally likely to delay as were older persons (≥65) compared with younger. Patients at the VA hospitals reported longer delays and patients with prior revascularization were less likely to report delays. We used ordinal logistic regression to predict delay using site type and prior revascularization as covariates. VA site of care independently predicted longer delays whereas prior revascularization predicted less delay. Among patients who reported at least a 1 month delay, patients at the non-VA hospital were more likely to cite ignoring symptoms as their reason for delay (72% vs. 61%; P = 0.03) as were those with at least a high school education 69% versus 50%; P = 0.003). Black patients reported that they ignored their symptom more often but this was marginally significant (77% vs. 63%; P = 0.053). CONCLUSIONS. Race was not associated with delay in seeking care among patients awaiting coronary angiography. Non-VA patients, and those with past revascularization, were less likely to delay. Ignoring symptoms was the most common reason for delays greater than 1 month. Further study of the sequence of patient and provider decisions that ultimately lead to revascularization is needed.

We report a case of transient neurologic toxicity secondary to tacrolimus. The clinical and imaging findings are reported and their subsequent regression after interruption of therapy in the patient following a bone-marrow transplant is also described. The etiology of the neurotoxicity and its analogy with other immunosuppressant agents are discussed.

The addition of long-chain polyunsaturated fatty acids (LCP: C20, and C22) to infant formula may permit fatty acid accretion rates similar to breast-fed infants, and may have long-term outcome benefits, such as improved visual acuity and cognitive development. Although fish oil may provide a source of n-3 LCP, sources of n-6 LCP have been more difficult to identify. The present study evaluates the effects of n-3 and n-6 LCP derived from single-cell oils on liver, plasma, and brain fatty acid levels in a neonatal animal model. Newborn rat pups were suckled for 14 d by dams receiving diets containing n-3 LCP alone or combinations of n-3 LCP and increasing doses of linoleic acid (18∶2n−6) or arachidonic acid (20∶4n−6). Dietary groups received 2% n−3 LCP and 1, 2, or 5% of either 18∶2n−6 or 20∶4n−6. The 20∶4n−6 source also contained modest levels of 18∶2n−6. At the termination of the study, liver, plasma, and brain were obtained from the rat pups and the phospholipid fatty acid profiles determined. The results indicate complex interactions of n−3 and n−6 fatty acids. Groups receiving dietary 20∶4n−6 incorporated higher levels of n−6 LCP into tissues than did the groups receiving 18∶2n−6. The brain was relatively resistant to changes in fatty acid composition compared with the liver and plasma. As expected, tissue n−3 LCP levels were reciprocally related to n−6 levels. The present results document that single-cell LCP oils are bioavailable in a neonatal animal model. The use of 20∶4n−6 is a more effective means of supporting n−6 status than the use of 18∶2n−6. These results may have implications for the addition of LCP to infant formula.

We carried out MRI to evaluate possible recurrent herniated nucleus pulposus (HNP) before and after i.v. infusion of 0.1 mmol/kg gadoteridol, immediately followed by an additional 0.2 mmol/kg and repeat imaging in 21 patients. In comparison with standard 0.1 mmol/ kg gadoteridol, images at a cumulative 0.3 mmol/kg demonstrated increased epidural enhancement, increased enhancement of intradural and affected S1 nerve roots. The level of certainty in MRI diagnosis of recurrent HNP at 0.3 mmol/kg was decreased in 5, increased in 1, and unchanged in 4 patients compared with standard dose. The triple dose was not advantageous for identification of recurrent HNP, owing to the increased peridiscal and S1 nerve root enhancement, which masked the displaced S1 nerve root and decreased the conspicuity of HNP.

There are several ways to combine sound theory and creative personal style, all leading to effective treatment.

Successful milieu treatment requires the creative modification of traditional theory and technique to the partial hospitalization program. The Quilt-Work Theory is a milieu approach to partial hospitalization treatment that explains why this modality is the treatment of choice for particular patients. The Quilt-Work Theory enables the trained mental health professional to operate as a professional in a generalist team, by applying traditional concepts to this nontraditional treatment forum. When used, the Quilt-Work Theory operates as the standard for making many day-to-day clinical and programmatic decisions.

We report on a new research and development program at the Advanced Light Source, Lawrence Berkeley National Lab directed to establish both at-wavelength and conventional optical metrology techniques suitable to characterize the surface profile of super-high-quality x-ray optics with sub-microradian precision.

Excerpt To the editor: We recently encountered two cases of elderly patients with hypercalcemia secondary to "one tablet per day" of vitamin D administration. The vitamin D (calciferol) was given f...