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Background: The R wave in lead aVR, during the wide QRS complex tachycardia, is commonly observed in a ventricular tachycardia (VT) arising from certain locations in the ventricles. Objectives: This was a retrospective and a proof of concept study to correlate the sites of origin of VT and premature ventricular contractions (PVCs) with the occurrence of R wave in lead aVR. Methods: Patients with VT or high density of PVCs were included. Surface and intracardiac electrograms were recorded during the arrhythmia. VTs and PVCs arising from the inferior, inferolateral, or apical region of the ventricles were grouped into Zone 2. Those arising from the other areas of the ventricles were grouped into Zone 1. Results: Sixty‐four patients were included in the study. The mean age was 57 years. There were 47 males. Among 64 patients with VT or PVCs, 28 patients had an R wave in aVR (43.7%), In 26 of 28 patients with an R wave in aVR, the site of origin of the arrhythmia was in Zone 2. The R wave in aVR was absent in 36 patients, 34 of whom had the origin of arrhythmia focus in Zone 1. The presence of an R wave in aVR correctly identified Zone 2 as a site of origin of the arrhythmia with high sensitivity (93%) and specificity (94%). Conclusions: The presence of an R wave in aVR during wide QRS complex tachycardia or PVC is a valuable observation for identifying the site of origin of the arrhythmia and hence in distinguishing supraventricular tachycardia with aberrancy from VT. [ABSTRACT FROM AUTHOR]

Background As more athletes participate in youth baseball, there has been an associated increase in upper extremity injuries. Knowledge of baseball injury prevention guidelines continues to be developed and defined as throwing-related injuries rise. The purpose of this study was to evaluate how knowledgeable youth baseball caregivers were about safe pitching guidelines and secondarily determine pitching practices which may be associated with increased risk of player injury. Methods A twenty-two question survey comprised of demographic data, knowledge of overhead throwing guidelines, pitching history, presence of risk factors associated with overhead throwing and pitching habits was distributed to the caregivers of youth baseball pitchers in North Central Florida. Results Eighty-three percent (81/98) of those polled were unaware of the existence of safe pitching guidelines, regardless of the pitcher's playing experience (p > 0.05). Those who pitched more than six months out of the year were significantly more prone to experience throwing arm pain after a performance (p < 0.05). Fifty-two percent (51/98) of the caregivers recalled their child having throwing arm pain as a direct result of pitching, with twenty-six percent (25/98) of pitchers having to miss either a game or a pitching appearance. Twenty-seven percent (26/98) of all players went on to seek medical evaluation for arm discomfort due to pitching. Pitchers 13 years of age and older were more likely to throw curveballs and miss games because of throwing arm pain (p < 0.05). Conclusion Despite implementation and accessibility of safe pitching guidelines, a large portion of those surveyed were unaware or noncompliant with these established recommendations. Given the results of this study, further measures need to be taken to improve caregivers' understanding of current guidelines to help increase compliance and protect youth pitchers. [ABSTRACT FROM AUTHOR]

Background: Breast cancer treatment-related lymphedema (BCRL) arises from a mechanical insufficiency following cancer therapies. Early BCRL detection and personalized intervention require an improved understanding of the physiological processes that initiate lymphatic impairment. Here, internal magnetic resonance imaging (MRI) measures of the tissue microenvironment were paired with clinical measures of tissue structure to test fundamental hypotheses regarding structural tissue and muscle changes after the commonly used therapeutic intervention of manual lymphatic drainage (MLD). Methods and Results: Measurements to identify lymphatic dysfunction in healthy volunteers ( n = 29) and patients with BCRL ( n = 16) consisted of (1) limb volume, tissue dielectric constant, and bioelectrical impedance (i.e., non-MRI measures); (2) qualitative 3 Tesla diffusion-weighted, T1-weighted and T2-weighted MRI; and (3) quantitative multi-echo T2 MRI of the axilla. Measurements were repeated in patients immediately following MLD. Normative control and BCRL T2 values were quantified and a signed Wilcoxon Rank-Sum test was applied (significance: two-sided p < 0.05). Non-MRI measures yielded significant capacity for discriminating between arms with versus without clinical signs of BCRL, yet yielded no change in response to MLD. Alternatively, a significant increase in deep tissue T2 on the involved (pre T2 = 0.0371 ± 0.003 seconds; post T2 = 0.0389 ± 0.003; p = 0.029) and contralateral (pre T2 = 0.0365 ± 0.002; post T2 = 0.0395 ± 0.002; p < 0.01) arms was observed. Trends for larger T2 increases on the involved side after MLD in patients with stage 2 BCRL relative to earlier stages 0 and 1 BCRL were observed, consistent with tissue composition changes in later stages of BCRL manifesting as breakdown of fibrotic tissue after MLD in the involved arm. Contrast consistent with relocation of fluid to the contralateral quadrant was observed in all stages. Conclusion: Quantitative deep tissue T2 MRI values yielded significant changes following MLD treatment, whereas non-MRI measurements did not vary. These findings highlight that internal imaging measures of tissue composition may be useful for evaluating how current and emerging therapies impact tissue function. [ABSTRACT FROM AUTHOR]

This article considers the influence of the declarations and reforms announced by the Second Vatican Council (also referred to as Vatican II) on Catholics in rural parishes in the American South during the late 1960s and early 1970s. The author examines the differences between Catholicism in rural versus urban areas, including the varied impact of the changes mandated by Vatican II. He also provides an analysis of several of the declarations and documents from the council, including "Sacrosanctum Concilium," which relates to Mass, "Lumen Gentium," which relates to the laity, and "Unitatis Redintegratio," which relates to ecumenism.

The article presents the case study of 55-year-old right-handed house painter has had a constant dull ache in his right shoulder for 3 weeks. The pain worsens when he steers his car or elevates his arm, and the inability to raise his arm above his head interferes with his work. The patient has type 2 diabetes and hyperlipidemia. His medications include atorvastatin, metformin, and low-dose aspirin. Chronic progressive pain that worsens at night and with elevation of the arm is a classic presentation of rotator cuff impingement. Injecting the bursa is most helpful when a patient has too much discomfort to perform the exercises, as this man seems to.

• Macromolecular-to-free pool size ratio (PSR), derived from selective inversion recovery quantitative magnetization transfer imaging, and apparent axonal volume fraction (Vax), derived from multi-compartment diffusion MRI with the spherical mean technique, are sensitive to changes in myelin and axonal content in the normal appearing white matter surrounding chronic black holes. • The degree of axonal injury, measured by Vax, in the perilesional tissue correlates with that within chronic black hole lesions. • PSR values within chronic black holes demonstrate a moderate negative correlation with the expanded disability status scale. • Our data provide an elegant in vivo demonstration for retrograde and anterograde trans-synaptic degeneration in the perilesional area surrounding chronic black holes that can be detected using PSR and V ax. • Our findings have potential therapeutic implications advocating for chronic black hole prevention, which in turn, can help preserve axonal injury in the surrounding NAWM. Axonal injury is the primary source of irreversible neurological decline in persons with multiple sclerosis (pwMS). Identifying and quantifying myelin and axonal loss in lesional and perilesional tissue in vivo is fundamental for a better understanding of multiple sclerosis (MS) outcomes and patient impairment. Using advanced magnetic resonance imaging (MRI) methods, consisting of selective inversion recovery quantitative magnetization transfer imaging (SIR-qMT) and multi-compartment diffusion MRI with the spherical mean technique (SMT), we conducted a cross-sectional pilot study to assess myelin and axonal damage in the normal appearing white matter (NAWM) surrounding chronic black holes (cBHs) and how this pathology correlates with disability in vivo. We hypothesized that lesional axonal transection propagates tissue injury in the surrounding NAWM and that the degree of this injury is related to patient disability. Eighteen pwMS underwent a 3.0 Tesla conventional clinical MRI, inclusive of T1 and T2 weighted protocols, as well as SIR-qMT and SMT. Regions of interests (ROIs) were manually delineated in cBHs, NAWM neighboring cBHs (perilesional NAWM), distant ipsilateral NAWM and contra-lateral distant NAWM. SIR-qMT-derived macromolecular-to-free pool size ratio (PSR) and SMT-derived apparent axonal volume fraction (V ax) were extracted to infer on myelin and axonal content, respectively. Group differences were assessed using mixed-effects regression models and correlation analyses were obtained by bootstrapping 95% confidence interval. In comparison to perilesional NAWM, both PSR and V ax values were reduced in cBHs (p < 0.0001) and increased in distant contra-lateral NAWM ROIs (p < 0.001 for PSR and p < 0.0001 for V ax) but not ipsilateral NAWM (p = 0.176 for PSR and p = 0.549 for V ax). V ax values measured in cBHs correlated with those in perilesional NAWM (Pearson rho = 0.63, p < 0.001). No statistically relevant associations were seen between PSR/V ax values and clinical and/or MRI metrics of the disease with the exception of cBH PSR values, which correlated with the Expanded Disability Status Scale (Pearson rho = −0.63, p = 0.03). Our results show that myelin and axonal content, detected by PSR and V ax , are reduced in perilesional NAWM, as a function of the degree of focal cBH axonal injury. This finding is indicative of an ongoing anterograde/retrograde degeneration and suggests that treatment prevention of cBH development is a key factor for preserving NAWM integrity in surrounding tissue. It also suggests that measuring changes in perilesional areas over time may be a useful measure of outcome for proof-of-concept clinical trials on neuroprotection and repair. PSR and V ax largely failed to capture associations with clinical and MRI characteristics, likely as a result of the small sample size and cross-sectional design, however, longitudinal assessment of a larger cohort may unravel the impact of this pathology on disease progression. [ABSTRACT FROM AUTHOR]