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Accurate identification of prostate cancer Gleason grade group remains an important component of the initial management of clinically localized disease. However, Gleason score upgrading (GSU) from biopsy to radical prostatectomy can occur in up to a third of patients treated with surgery. Concern for disease undergrading remains a source of diagnostic uncertainty, contributing to both over-treatment of low-risk disease as well as under-treatment of higher-risk prostate cancer. This review examines the published literature concerning risk factors for GSU from time of biopsy to prostatectomy final pathology. Risk factors identified for Gleason upgrading include patient demographic and clinical factors including age, body mass index, race, prostate volume, and biomarker based assays, including prostate-specific antigen (PSA) density, and testosterone values. In addition, prostate magnetic resonance imaging (MRI) findings have also been associated with GSU. Biopsy-specific characteristics associated with GSU include lower number of biopsy cores and lack of targeted methodology, and possibly increasing percent biopsy core positivity. Recognition of risk factors for disease undergrading may prompt confirmatory testing including repeat sampling or imaging. Continued refinements in imaging guided biopsy techniques may also reduce sampling error contributing to undergrading.

Background: Transarterial chemoembolisation (TACE) and radioembolisation (TARE) can lead to the deterioration of liver function, especially in cases of a high tumour burden, potentially lessening the benefits of subsequent systemic treatments. We aimed to verify whether a high number of previous transarterial treatments modified the outcomes of patients who received sorafenib as a frontline systemic treatment. Methods: A retrospective analysis of a large multicenter dataset containing prospectively collected data of sorafenib-treated patients was conducted. Results: Data from 696 patients were analysed, with 139 patients having received >two transarterial procedures before starting sorafenib. A propensity score matched 139 identified pairs of patients. Having received >two locoregional treatments was independently associated with a shorter survival (hazard ratio 1.325, 95% confidence interval 1.018–1.725, p = 0.039). This pattern was confirmed amongst responders to sorafenib, but not in progressors. A trend toward a higher rate of the permanent discontinuation of sorafenib due to liver failure (18.7 vs. 10.8%, p = 0.089) and a lower rate of eligibility for second-line treatments (24.5 vs. 17.3%, p = 0.184) was observed in patients who had received >two transarterial procedures. Conclusions: Repeated endovascular treatments negatively impacted the survival of HCC patients, especially sorafenib-responders. An early switch to systemic therapies should be considered in cases that are unlikely to respond.

Introduction: Although the clinical benefits of pelvic lymph node dissection (PLND) at the time of radical prostatectomy for prostate cancer remain uncertain, major guidelines recommend PLND based on risk profile. Thus, the objective of this study was to examine the association between PLND and survival among patients undergoing RP stratified by Gleason grade group (GG) with the aim of allowing patients and physicians to make more informed care decisions about the potential risks and benefits of PLND. Materials and methods: From the SEER-17 database, we examined overall (OS) and prostate cancer-specific (PCSS) survival of prostate cancer patients who underwent RP from 2010 to 2015 stratified by GG. We applied propensity score matching to balance pre-operative characteristics including race, age, PSA, household income, and housing status (urban/rural) between patients who did and did not undergo PLND for each GG. Statistical analyses included log-rank test and Kaplan-Meier curves. Results: We extracted a matched cohort from 80,287 patients with GG1-5 who underwent RP. The median PSA value was 6.0 ng/mL, and the median age was 62-years-old. 49,453 patients underwent PLND (61.60%), while 30,834 (38.40%) did not. There was no difference in OS and PCSS between patients who received PLND and those who did not for all Gleason GG (OS–GG1: P = 0.20, GG2: P = 0.34, GG3: P > 0.05, GG4: P = 0.55, GG5: P = 0.47; PCSS–GG1: P = 0.11, GG2: P = 0.96, GG3: P = 0.81, GG4: P = 0.22, GG5: P = 0.14). Conclusions: In this observational study, PLND at the time of RP was not associated with improved OS or PCSS among patients with cGS of 3 + 3, 3 + 4, 4 + 3, 4 + 4, 4 + 5, and 5 + 4. These findings suggest that until definitive clinical trials are completed, prostate cancer patients who have elected RP should be appropriately counseled on the potential risks and lack of proven survival benefit of PLND.

Joseph S. Renzulli believes the purpose of gifted education is to increase the reservoir of creative and productive young people who will make innovative contributions to the arts, sciences, and all other areas of human knowledge and productivity and that these contributions will be guided toward making the world a better place for all people. He makes a distinction between what he calls lesson-learning giftedness and creative productive giftedness. While lesson-learning giftedness is all about learning the prescribed material, be able to demonstrate your learning by taking a test or through oral, written, artistic, dramatic, or some other form of expression; creative-productive giftedness is defined as those aspects of human activity and involvement where a premium is placed on the development of original ideas, material, and products that are purposefully designed to have an impact on one or more target audiences. The pedagogy discussed in the article is based on the role that knowledge plays in developing an investigative mindset, high levels of creative productivity, and how the integrated use of three levels of knowledge contribute to the major goal of gifted education.

International students have been a growing presence in U.S. higher education institutions for over a decade. Feelings of belonging play a crucial role in the adjustment of these students to campus life in American universities, and their conationals play a significant role in facilitating this adjustment process. However, the role of belonging and co-national communities in facilitating the persistence of international students toward and beyond degree attainment remains understudied. In our examination of the aspirations of 642 international students across 9 U.S. universities, we establish that stronger feelings of academic and social belonging are associated with a higher likelihood of aspiring to stay in the United States after graduation. In particular, we demonstrate the presence of an academic enclave effect wherein larger communities of co-nationals have a stronger influence on the aspirations of international students with low social belonging but does not affect the aspirations of socially well-integrated international students.

Providing challenging and engaging learning opportunities is one way to motivate students to learn. In this article, we discuss the contributions of the gifted education field to the development of enrichment pedagogy and identify several different types of these engaging instructional strategies, including interest-based learning pedagogy, differentiation and curriculum compacting, project-based learning, open-ended choice, and the application of creative productivity to students learning. We identify this specialized pedagogy and give examples of how these exciting pedagogical strategies can be implemented in classrooms and by enrichment specialists and school counselors, both for academically talented and for all students. We conclude with a brief overview of research that demonstrates longitudinal benefits for students who are exposed to this type of teaching, suggesting positive outcomes.

Abstract Background Fermented soy products have shown to possess inhibitory effects on prostate cancer (PCa). We evaluated the effect of a fermented soy beverage (Q-Can®), containing medium-chain triglycerides, ketones and soy isoflavones, among men with localized PCa prior to radical prostatectomy. Methods We conducted a placebo-controlled, double-blind randomized trial of Q-Can®. Stratified randomization (Cancer of the Prostate Risk Assessment (CAPRA) score at diagnosis) was used to assign patients to receive Q-Can® or placebo for 2–5 weeks before RP. Primary endpoint was change in serum PSA from baseline to end-of-study. We assessed changes in other clinical and pathologic endpoints. The primary ITT analysis compared PSA at end-of-study between randomization arms using repeated measures linear mixed model incorporating baseline CAPRA risk strata. Results We randomized 19 patients, 16 were eligible for analysis of the primary outcome. Mean age at enrollment was 61, 9(56.2%) were classified as low and intermediate risk, and 7(43.8%) high CAPRA risk. Among patients who received Q-Can®, mean PSA at baseline and end-of-study was 8.98(standard deviation, SD 4.07) and 8.02ng/mL(SD 3.99) compared with 8.66(SD 2.71) to 9.53ng/mL(SD 3.03), respectively, (Difference baseline – end-of-study, p = 0.36). There were no significant differences in Gleason score, clinical stage, surgical margin status, or CAPRA score between treatment arms (p > 0.05), and no significant differences between treatment arms in end-of-study or change in lipids, testosterone and FACT-P scores (p > 0.05). Conclusions Short exposure to Q-Can® among patients with localized PCa was not associated with changes in PSA levels, PCa characteristics including grade and stage or serum testosterone. Due to early termination from inability to recruit, study power, was not achieved.

Hamdan Intelligence Scale (HIS) is the first intelligence scale that has been developed and normed in the United Arab Emirates (UAE). This study aimed to examine the refinement, validity, and reliability of HIS in upper elementary grades using the Rasch model. A total of 4,301 students (34.3% Male; 65.7% Female) from grade 4 to 6 (32.1% grade 4; 33.7% grade 5; 34.2% grade 6) were administered to the HIS. The confirmatory factor analysis was first conducted to verify the fitness of the one-factor model of the HIS. The results of validity showed strong correlation coefficients between the HIS and the Aurora-g battery (0.83) and the Raven’s Standard Progressive Matrices (RSPM; 0.86). Moreover, the results of the developmental trends demonstrated that raw scores of the HIS increase with age and grade relatively constantly across composite scores. Unidimensionality was confirmed through the Confirmatory Factor Analysis and Principal Component Analysis of Residuals (PCAR). The low eigenvalues of the first contrast were below 2, and additionally, the infit and outfit mean squares ranged from 0.88 to 1.14 and 0.84 to 1.14. Rasch’s person reliability result of 0.62 was acceptable reliability. The results provided strong support for the validity and reliability of using the Hamdan Intelligence Scale in the UAE environment.

Background & Aims: Sarcopenia is associated with increased morbidity and mortality in patients with cirrhosis, but its definition in current literature is very heterogeneous. We performed a systematic review and meta-analysis to assess the association between mortality and sarcopenia evaluated by computed tomography (CT) in patients with cirrhosis, both overall and stratified for the criteria used to define sarcopenia. Methods: Medline, Embase, Scopus, and Cochrane Library were searched up to January 2023. We included studies assessing sarcopenia presence with CT scans and providing data on the risk of mortality. Adjusted hazard ratios (HRs) and 95% CIs were pooled using a random-effects model. Results: Thirty-nine studies comprising 12,827 patients were included in the meta-analysis. The summary prevalence of sarcopenia was 44% (95% CI 38-50%). The presence of sarcopenia (any definition) was an independent predictor of mortality with an adjusted HR of 2.07 (95% CI 1.81-2.36), and the result was consistent in all subgroup analyses. The prognostic role of the EASL/AASLD criteria was confirmed for the first time with an HR of 1.86 (95% CI 1.53-2.26) (n = 14 studies). The cut-offs used to define sarcopenia based on psoas muscle parameters varied among studies, thus, a subgroup analysis was not feasible. There was no substantial heterogeneity for the main estimates and no significant risk of publication bias. Conclusions: Sarcopenia on CT is associated with a 2-fold higher risk of mortality in patients with cirrhosis. The cut-offs proposed by EASL/AASLD are prognostically relevant and should be the recommended criteria used to define sarcopenia in clinical practice. Impact and implications:: Sarcopenia assessed by the reference standard (computed tomography scan) is an independent predictor of mortality in patients with cirrhosis, with a 2-fold increase in the risk of death in all sensitivity analyses. This finding is particularly valid in patients from Europe and North America, and in transplant candidates. Stratifying for the parameters and cut-offs used, we confirmed for the first time the prognostic impact of the definition proposed by EASL/AASLD, supporting their use in clinical practice. Psoas muscle assessment is promising, but data are still limited and too heterogeneous to recommend its routine use at present.

Abstract Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most people infected with the virus experience mild to moderate respiratory illness. However, some might become seriously ill and may develop acute respiratory distress syndrome (ARDS), thus requiring non-invasive or invasive mechanical ventilation. Furthermore, COVID-19 disease can involve also other organs and systems, causing several extra-pulmonary manifestations and, thus, negatively influencing the patient’s outcome. Imaging studies play a pivotal role in the monitoring of severely ill patients, especially those admitted to the intensive care unit (ICU), who can develop several potentially life-threatening complications, both from the infection itself and the mechanical supporting system. This widespread utility of imaging modalities calls for a deeper understanding of potential radiologic findings in this disease and the need for multidisciplinary collaboration between radiologists and anesthesiologists to provide actionable guidance to appropriate interventions under such conditions.

In this article, I describe a series of Five Core Competencies that gifted education specialists should consider integrating into their teaching to respond to the many changes that are taking place in technology, work, and career preparation. Although the focus of this theory is on high- level jobs usually pursued by college graduates and advanced degree students, this work also has relevance for the general-education community because future employment at all levels will require various degrees of proficiency in the Core Competencies discussed below. Students who will pursue college degrees and professional level jobs will need to attain advanced levels of these skills, have the opportunity to explore a wide range of skills, and be able to learn them more rapidly. Students should be placed in learning situations that require the adaptability that is the theme of this article so that they will learn to apply the skills in ways that will lead to success in job-transformational situations. Leadership and advanced-level positions require high levels of both performance and flexibility in the competencies that will be discussed below. The Catch-A-Wave Theory of Adaptability will be introduced with the presentation of background information and a rationale for the theory. The theory itself along with the five Core Competencies included in the theory will follow and then be supplemented with a section that provides strategies and resources for developing those competencies.

Abstract Background Polycystic ovary syndrome (PCOS) is the most prevalent, chronic endocrine-metabolic disorder of adolescents and young women (AYAs), affecting 5–10% of AYAs worldwide. There is no approved pharmacological therapy for PCOS. Standard off-label treatment with oral contraceptives (OCs) reverts neither the underlying pathophysiology nor the associated co-morbidities. Pilot studies have generated new insights into the pathogenesis of PCOS, leading to the development of a new treatment consisting of a fixed, low-dose combination of two so-called insulin sensitisers [pioglitazone (PIO), metformin (MET)] and one mixed anti-androgen and anti-mineralocorticoid also acting as an activator of brown adipose tissue [spironolactone (SPI)], within a single tablet (SPIOMET). The present trial will evaluate the efficacy, tolerability and safety of SPIOMET, on top of lifestyle measures, for the treatment of PCOS in AYAs. Methods In this multicentre, randomised, double-blind, placebo-controlled, four-arm, parallel-group, phase II clinical trial, AYAs with PCOS will be recruited from 7 clinical centres across Europe. Intention is to randomise a total of 364 eligible patients into four arms (1:1:1:1): Placebo, PIO, SPI + PIO (SPIO) and SPI + PIO + MET (SPIOMET). Active treatment over 12 months will consist of lifestyle guidance plus the ingestion of one tablet daily (at dinner time); post-treatment follow-up will span 6 months. Primary endpoint is on- and post-treatment ovulation rate. Secondary endpoints are clinical features (hirsutism, menstrual regularity); endocrine-metabolic variables (androgens, lipids, insulin, inflammatory markers); epigenetic markers; imaging data (carotid intima-media thickness, body composition, abdominal fat partitioning, hepatic fat); safety profile; adherence, tolerability and acceptability of the medication; and quality of life in the study participants. Superiority (in this order) of SPIOMET, SPIO and PIO will be tested over placebo, and if present, subsequently the superiority of SPIOMET versus PIO, and if still present, finally versus SPIO. Discussion The present study will be the first to evaluate—in a randomised, double-blind, placebo-controlled way—the efficacy, tolerability and safety of SPIOMET treatment for early PCOS, on top of a lifestyle intervention. Trial registration EudraCT 2021–003177-58. Registered on 22 December 2021. https://www.clinicaltrialsregister.eu/ctr-search/search?query=%092021-003177-58 .

This article describes current attempts and steps to expand both services and research about gifted education and talent development programs and educational opportunities for academically talented students in Italy. The laws, procedures, and policies that have been essential to this process are described, as is the outcome, which is the implementation and use of the Schoolwide Enrichment Model as one viable method for developing students' talents and gifts in Italian schools.

The aim of the present study was to test a new oral contrast medium composed of natural components for the magnetic resonance (MR) imaging of small bowel diseases. Between January 2018 and June 2019, 35 patients affected by ileocolic Crohn’s disease (CD) were enrolled in the present study. Each patient underwent two sequential MR enterographies, first with the standard polyethylene glycol (PEG) water solution and, after 3 weeks, with the new natural beverage designed by our team. At the end of the administration of each oral contrast, a satisfaction survey was given to the patients to assess the palatability of both beverages. The intestinal distention and the quality of images were evaluated by two expert radiologists for both studies and the interreader agreement was calculated. According to the satisfaction questionnaire, 97.1% of patients expressed positive judgments regarding the natural beverage (71.4% very good and 25.7% good) whereas only 8.6% of them appreciated the PEG water solution (8.6% good) (p = 0.0001). The degree of intestinal distention was excellent and good in 97.1% of patients after the administration of PEG and in 94.3% of the patients after the administration of the natural beverage, without significant differences between the two products and with almost perfect (k = 0.821) and substantial (k = 0.754) inter-observer variability, respectively. No statistical differences were observed between the two expert radiologists regarding the evaluation of the imaging quality; in particular, they were considered good and excellent in 100% of patients after the administration of PEG water solution and in 97.2% of those who took the natural beverage, with substantial (k = 0.618) and almost perfect (k = 0.858) inter-observer variability, respectively. The new natural beverage demonstrated the same intestinal distension and excellent image quality compared to the synthetic standard oral contrast administered during MRE for small bowel diseases, proving to be a valid alternative with better palatability.

Celem niniejszego artykułu jest przegląd badań naukowych dotyczących problematyki dobrostanu (well-being) uzdolnionych dzieci i młodzieży. Przyjęto procedurę przeglądu systematycznego w oparciu o protokół Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al. 2021). Analizie poddano 15 artykułów opublikowanych w latach 2005–2022 w recenzowanych czasopismach naukowych. Analizy pokazały, że nie można jednoznacznie stwierdzić, czy uzdolnienia są czynnikiem ryzyka, czy też czynnikiem chroniącym dla subiektywnego poczucia dobrostanu dzieci i młodzieży uzdolnionej. Jednocześnie wyniki badań publikowane w większości analizowanych tekstów nie wskazały istotnych statystycznie różnic między poczuciem dobrostanu subiektywnego, jak i psychicznego uczniów uzdolnionych w porównaniu do uczniów o przeciętnych zdolnościach. W badaniach subiektywnego poczucia dobrostanu uzdolnionych dzieci i młodzieży wykorzystuje się szereg skal odnoszących się do różnych obszarów psychofizycznego funkcjonowania człowieka, np. nastroju, stresu, poczucia własnej skuteczności, zainteresowań, poczucia samotności, poczucia humoru, klimatu szkolnego, co pozwala na holistyczne spojrzenie na analizowane zjawisko.

Background: Traumatic pelvic injuries are associated with high injury severity scores and significant morbidity and mortality. Active bleeding is the most common cause of death among those patients. Due to limitations of surgery for pelvic hematomas, angiographic treatment is at the forefront of pelvic trauma management. Objective: The present article aims to discuss the available endovascular treatment modalities, and common angiographic treatment strategies and techniques. Conclusion: Interventional radiologists plays a key role in the management of patients with pelvic trauma. New standardized protocols are needed to minimize the time spent on deciding the correct treatment for each patient.

Objective: Multiple endocrine neoplasia type 4 (MEN4) is caused by a CDKN1B germline mutation first described in 2006. Its estimated prevalence is le ss than one per million. The aim of this study was to define the disease characteristics. Methods: A systematic review was performed according to the PRISMA 2020 criteria. A literature search from January 2006 to August 2022 was done using MEDLINE® and Web of ScienceTM. Results: Forty-eight symptomatic patients fulfilled the pre-defined eligi bility criteria. Twenty-eight different CDKN1B variants, mostly missense (21/48, 44%) and frameshift mutations (17/48, 35%), were reported. The majority of patients were women (36/48, 75%). Men became symptomatic at a median age of 32.5 years (ran ge 10–68, mean 33.7 ± 23), whereas the same event was recorded for women at a media n age of 49.5 years (range 5–76, mean 44.8 ± 19.9) (P = 0.25). The most frequently affected endocrine organ was the parathyroid gland (36/48, 75%; uniglandular disease 31/36, 86%), followed by the pituitary gland (21/48, 44%; hormone-secreting 16/21, 76%), the endocrine pancreas (7/48, 15%), and the thyroid gland (4/48, 8%). Tumors of the ad renal glands and thymus were found in three and two patients, respectively. The present ing first endocrine pathology concerned the parathyroid (27/48, 56%) and the pituit ary gland (11/48, 23%). There were one (27/48, 56%), two (13/48, 27%), three (3/48, 6%), or four (5/48, 10%) syn-or metachronously affected endocrine organs in a single patient, respectively. Conclusion: MEN4 is an extremely rare disease, which most frequently affect s women around 50 years of age. Primary hyperparathyroidism as a unigla ndular disease is the leading pathology.

A man in his 40s presented to our Hospital with abdominal pain, jaundice, and pruritus. He had a history of Alagille Syndrome treated with cholecystojejunostomy in the neonatal period because of initial misdiagnosis of biliary atresia. Laboratory investigations showed hyperbilirubinemia (total bilirubin 1.76 mg/dL [

This study is addressed at the cultural heritage of the UNESCO historical centre of Urbino (Italy) through the focus on a very peculiar building and ornamental carbonate porous (spongy) stone also found in the opus quadratum Roman dry walls. For these rocks, the mathematician and historian Bernardino Baldi (16th century AD) and the mineralogist Francesco Rodolico (middle of the 20th century AD) introduced, respectively, the popular terms of Tufo spugnoso or Pietra Spugna. Physical observations and stable isotope data (δ13C and δ18O) of these rocks allowed, for the first time, their classification as calcareous tufas, thus contributing to the valorization of the stone heritage of the city. This carbonate lithotype was formed by the chemical precipitation of CaCO3, driven by the CO2 degassing of supersaturated calcium-bicarbonate-rich waters, coupled with the passive encrustations of organic material in continental environments. Radiocarbon analyses dated these stones mostly between 9100 and 4700 yr. BP when a maximum growth of these carbonate continental deposits occurred in Mediterranean regions and northern Europe, i.e., during the Holocene Atlantic climatic optimum. Work is still in progress on a perched springline of calcareous tufas found along the Metauro Valley (a few km from Urbino), being good candidates for provenance, at least for those blocks exploited by the Romans and successively reused in the architectural framework of Urbino.

Abstract Volcanic rocks were among the most sought-after materials to produce grinding tools in antiquity because lavas lithologies, either mafic or felsic, ensured good wear resistance and grinding capacity with respect to many other kinds of rocks. The interest in findings made of vesciculated lavas, referable to parts of querns, mortars, and/or pestles of the Final Bronze Age site of Monte Croce Guardia (Arcevia) lies in the fact that this settlement was built upon limestones belonging to the sedimentary sequence of the Marche-Umbria Apennines (central Italy) and far away from potential raw materials of volcanic rocks. A petrologic study of 23 grinding tool fragments clearly indicates a provenance from the volcanic provinces of central Italy: Latium and Tuscany Regions. Few leucite tephrites (5) and one leucite phonolite lavas have a clear magmatic affinity with the high-K series of the Roman Volcanic Province (Latium) whereas the most abundant volcanic lithotype (17 samples) is represented by shoshonites (K-series) whose thin section texture, modal mineralogy and major-trace elements contents closely match with the shoshonite lavas from the Radicofani volcanic centre in the Tuscan Magmatic Province. At Radicofani (a volcanic neck in the eastern sector of Tuscany) a Final Bronze Age site coeval to that of Arcevia is present and a potential pathway corridor from that site towards Arcevia (air-line distance of ca. 115 km) is dotted with many settlements of the same age. Through analytical algorithms based on the slope and the different human-dependent cost-functions which can be applied to determine non-isotropic accumulated cost surface, least-cost paths and least-cost corridors, the best route from Radicofani to Monte Croce Guardia, approximately 140 km long, was simulated, with a walking time of 25–30 h, possibly using pack animals and wheel chariots. Three thousand years ago the Apennine Mountains did not thus constitute a barrier for human movements. This study also shed light on some other possible patterns of interactions between Final Bronze Age communities of central Italy through the present-day regions of Tuscany, Umbria and Marche, aimed towards the best performance of strategic economic activities at that time such as that of the transformation of cereals, and accompanied to cultural and social reasons.

One of the biggest challenges facing gifted education is how to balance the need to provide students with enrichment opportunities within the context of an overly prescribed or required curriculum. The emergence of standards in individual states and the new Common Core State Standards coupled with the almost overpowering influence of standardized testing has had the effect of squeezing highly engaging enrichment activities out of the curriculum. Many teachers have become so accustomed to requirements for "teaching-the-text" and overusing worksheets to grind up standardized test scores that they no longer have the opportunity or, in some cases, the know-how to deviate from prescribed material. Few would argue that standards-driven curriculum is not important; however, research has clearly and unequivocally shown that high engagement enrichment experiences do in fact, contribute to higher achievement scores "and" they also make school more meaningful and enjoyable for students (Dotterer & Lowe, 2011; Greenwood, 1991; Reyes et al., 2012, & Wang & Holcombe, 2010). In this article we present a strategy that teachers can use for achieving some balance between the required curriculum and a way of infusing enrichment activities into standards driven material. Teachers who have used this technique have commented about how it has made them feel more creative about their teaching and more like professionals rather than mere purveyors of other people's material. Some examples of exciting ideas developed by teachers are provided to illustrate how the technique has been used.

The diversity of skills, talents, and interests of students that we serve in our schools requires a remarkable range of teachers' skills, time, and resources. This brief article focuses on differentiation and the ways that teachers can adapt and differentiate the regular curriculum to meet the academic needs of all of their students. Challenges and solutions about how differentiation can be implemented will be discussed, as will a variety of strategies that can be used to differentiate, challenge, and engage all students. Defined simply, differentiation is matching a required curriculum with the learning styles, expression styles, interests and abilities of students. It is predicated on the simple belief that engaged and motivated students score higher, are easier to manage, and enjoy learning more. Both research and current practice illustrate the importance of differentiated instruction for meeting every child's needs as well as raising achievement-- and some of that research is summarized in this article.

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy and its incidence is rising in Western countries. Although surgical resection is considered the only curative treatment, up to 70% of patients are diagnosed at an advanced stage, which precludes surgical intervention. Those who are inoperable become candidates for systemic treatment. Currently, the combination of gemcitabine and cisplatin is the first-line chemotherapy, with a median overall survival (OS) of about one year. Recently, there has been a notable increase in evidence regarding chemotherapy for biliary tract cancer; however, the effectiveness of the new chemotherapy drugs still needs to be evaluated. Today, intra-arterial therapies (IAT), especially trans-arterial chemoembolization (TACE) and trans-arterial radioembolization (TARE), are widely used. Both TACE and TARE have demonstrated good efficacy in controlling localized disease and in improving survival. However, current literature does not conclusively show whether TACE is superior to TARE or vice versa. As recent meta-analyses have indicated, both TACE and TARE offer suboptimal objective response rates but yield similar positive outcomes. It’s important to note that these findings are based on single-center studies, which often include a small number of patients and lack a comparative design. Therefore, when comparing such studies, there’s an inevitable selection bias among the treatment groups (TACE or TARE) and significant heterogeneity. This review outlines the current evidence on the use of interventional IAT in managing ICC.

ABSTRACT: Hydatid disease (HD) is a zoonotic parasitic disease caused by the larvae of Echinococcus. Bone echinococcosis is rare, accounting for 0.5% to 4% of all echinococcosis. We describe a particular case of pelvic echinoccosis. A 29-year-old man initially presents with pain in his left hip for several years. After an accidental fall from a tree, he suffered a fracture of the left acetabulum. X-rays and CT scans showed an osteolytic area of the acetabulum with bony cortical interruption. MR imaging demonstrated extensive area of osteostructural alteration of the iliac wing and the left acetabulum due to multiple cysts with enhancement of the walls after administration of Gadolinium-based contrast agents. A CT-guided biopsy of an osteolytic area was performed with diagnosis of echinococcus cyst. He underwent albendazole therapy and subsequently echinococcus cyst exeresis, bone curettage, and left hip arthroplasty. Twenty-two months after surgery, CT scan showed recurrence of disease. After 4 years and 6 months of chronic therapy CT scan showed an increase in size of the cyst at the site of the disease recurrence. Five years and 4 months after the first operation, a new cyst exeresis and pelvic bone curettage with implant retention was performed. This case report demonstrates that hydatid cysts should be considered as a possible cause for non-specific pelvic pain, especially in endemic locations.

Changing demographics in schools around the world have raised questions about the nature and role of gifted education programs. An intense interest in the underrepresentation of students from low-income families and minority groups in gifted education programs has caused the field to re-examine both identification and services. In this article, the authors discuss the larger issues related to identification and programming, including data about the extent of the problem in American schools. We review the recommendations and suggested practices made by other researchers and writers in the field for improving the representation of diverse students in gifted programs and provide examples of efforts taking place in schools that are dealing with this challenge. The authors conclude by describing how a specific approach developed over decades shows promise in addressing the problem of under-representation.

A critical need exists in engineering education to draw on the non-traditional divergent thinking and risk-taking necessary for making radical technological breakthroughs. Literature suggests that individuals with Attention Deficit Hyperactivity Disorder (ADHD) characteristics demonstrate unparalleled creativity and risk-taking potential. While this group of students may offer significant benefits to the advancement of the nation, they are currently significantly underrepresented in engineering programs because of the major academic and emotional challenges that the rigidly structured engineering programs impose on them. Funded by the Division of Engineering Education and Centers of the National Science Foundation, this study is aimed at understanding creative potential and challenges of engineering students with ADHD characteristics. A cohort of 18 female and 36 male undergraduate students were recruited from the School of Engineering at the University of Connecticut (n=54). To quantify the level of ADHD-related characteristics and the creative potential of the participants, the investigators administered Brown ADD Scales for Adults and Torrance Test of Creative Thinking (TTCT) Figural Form A, respectively. A 40-question instrument was designed and administered to understand the learning styles, the perception of current engineering programs in terms of rewarding creativity and risk-taking, and the difficulties of the participants in engineering programs. It was found that there is a statistically significant positive correlation between the Brown total score and the Creativity Index (r=.45, p=.001). Among Brown subscale scores, attention was found to have the largest correlation with the Creativity Index. There were positive significant correlations with the Creativity Index and all of the Brown subscales except for memory. The Brown scores were found to have positive significant correlations with three of the TTCT sub-categories: fluency, originality, and resistance to premature closure. A negative correlation exists between the GPA and total Brown score, suggesting weaker academic accomplishments of students with ADHD characteristics. GPA showed no correlation with the Creativity Index, suggesting a lack of creativity appreciation in current engineering programs. The Mann-Whitney test on survey questions revealed that students with a higher Brown t-score are significantly more willing to take a chance in which they may fail in order to pursue innovation. This study found that only three of the eighteen students who are formally diagnosed with ADHD are receiving services from the Center of Students with Disabilities CSD. It is expected that the outcomes of this study lead to a paradigm shift in how these individuals are perceived by both our society and our engineering educational system. The knowledge generated through this study will help to identify the academic struggles of this group of students and facilitate development of specialized education programs that foster largely unrecognized talents and unique potential of this underrepresented population.

Background & Aims: Alcohol abuse and metabolic disorders are leading causes of hepatocellular carcinoma (HCC) worldwide. Alcohol-related aetiology is associated with a worse prognosis compared with viral agents, because of the lower percentage of patients diagnosed with HCC under routine surveillance and a higher burden of comorbidity in alcohol abusers. This study aimed to describe the evolving clinical scenario of alcohol-related HCC over 15 years (2006–2020) in Italy. Methods: Data from the Italian Liver Cancer (ITA.LI.CA) registry were used: 1,391 patients were allocated to three groups based on the year of HCC diagnosis (2006–2010; 2011–2015; 2016–2020). Patient characteristics, HCC treatment, and overall survival were compared among groups. Survival predictors were also investigated. Results: Approximately 80% of alcohol-related HCCs were classified as cases of metabolic dysfunction-associated fatty liver disease. Throughout the quinquennia,

The work illustrated in this paper is part of a project of a multisector business group aimed at defining and quantifying the environmental profile of the production activities carried out by the companies of the group during the period 2020–2021. The approach used is that of an Organisational Life Cycle Assessment (ISO 14072). The paper describes the methodological approaches and the main results. Since some of the companies of the group operate in the material recovery and self-production of electricity from renewable sources sector, thus giving rise to avoided impacts, particular attention was paid to the allocation of end-of-life situations and the separate treatment of any credits. The results highlighted environmental hotspots and enabled the companies of the organisation to undertake actions which improved the overall environmental profile.

Background: The aim of the present study was to evaluate the presence and the prognostic value of the radiological signs of microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). Methods: Between January 2015 and December 2017, all patients (91 patients) with de novo HCC or HCC recurrence occurring at least 2 years after the last treatment in NAFLD (36 patients) or with hepatitis C virus (HCV) liver disease (55 patients) were included. Each HCC was treated with liver resection and transplantation to obtain the anatomopathological confirmation of MVI. All patients had at least one available computed tomography (CT) scan or magnetic resonance imaging (MRI) performed no more than one month prior to the treatment. The clinical data of each patient, tumor burden (diameter, margins, two-trait predictor of venous invasion (TTPVI), and peritumoral enhancement), the recurrence rate (RR) after a 1-year follow-up, and the time to recurrence (TTR) were collected. Results: The NAFLD–HCC nodules were larger as compared to HCV–HCC (51 mm vs. 36 mm, p = 0.004) and showed a higher prevalence of TTPVI (38.9 vs. 20.0%, p = 0.058). At multivariate analysis, nodule diameter >50 mm was found to be the only independent prognostic factor of TTPVI (hazard ratio: 21.3, 95% confidence interval: 4.2–107.7, p < 0.001), and the presence of TTPVI was confirmed to be the only independent prognostic factors of recurrence (hazard ratio: 2.349, 95% confidence interval: 1.369–4.032, p = 0.002). No correlations were found between TTR and irregular tumor margins or peritumoral enhancement. Conclusion: The NAFLD–HCC patients had larger tumors at diagnosis and showed a more frequent presence of radiological signs of MVI as compared to the HCV–HCC patients. The MVI was related to a more rapid recurrence after curative treatments, demonstrating the prognostic value of this radiological diagnosis.

Abstract A petrographic and geochemical study of several volcanic millstones, representative of 119 artifacts found in the ancient Greek colony of Megara Hyblaea (Sicily Island) and recording the grinding device evolution from the Archaic to the Hellenistic period, unravelled the volcanoes involved as quarrying and production areas. This was possible also through the comparison with available petrographic and geochemical literature data of ancient volcanic millstones found in the whole Mediterranean. Saddle querns, hopper-rubber, rotary Morgantina- and Delian-type millstones of Megara Hyblaea consist of lithotypes belonging to five magmatic series: Tholeiitic, Na-Alkaline, Tholeiitic Transitional, Calcalkaline and High-K Alkaline. A provenance from the Eastern Sicily, i.e. mugearites from Etna and basalts and basaltic andesites from the Hyblaean Mountains were recognized for all the four investigated grinding devices. By contrast, a sea-trade is involved for several saddle querns made of calcalkaline basaltic andesites and andesites lavas (Aegean Islands) and two Morgantina-type millstones consisting of a calcalkaline rhyodacite ignimbrite from the quarrying site of Mulargia (Sardinia). A wide millstone trade, both local (Eastern Sicily) or maritime (Central-Eastern Mediterranean) was thus constrained through six centuries, from the foundation of the Greek colony up to the destruction of the settlement at the end of third century BCE. Finally, Vulture Volcano (southern Italian peninsula) is the most probable candidate for the only leucite- and haüyne-bearing phonolite of the High-K Alkaline Series.

To determine which method of radiotherapy proves more effective after prostatectomy: Adjuvant (ART) or early salvage (ESRT), we observed the pathologic and adverse risk factors of patients and their results from both treatments, looking specifically at biochemical-free survival rates, metastasis-free survival rates, and overall survival rates. Peer review articles containing their own data collected between 1986 and 2022 were reviewed. We reviewed 67 peer review articles and included 33 that met criteria. Studies focused on the adverse risk factors and the results of patients either before/after receiving adjuvant or early salvage/salvage radiotherapy were included in the analysis. Patient characteristics had an effect on what treatment a patient would receive; if a patient had more than one adverse risk factor such as a high Gleason score, prostate-specific antigen (PSA) level, T-stage, or positive margins, they would receive immediate radiation after prostatectomy, which would classify as ART. If the patient had no adverse risk factors after surgery, they would be placed in an observation period to follow their PSA and overall health, and only if necessary, undergo ESRT. Of the 33 studies, ART was proven to be only slightly more beneficial when relating to biochemical recurrence-free survival while ART and ESRT results were similar in metastasis-free survival and overall survival. ART and ESRT are overall comparable in their patient outcomes, despite their own unique pros and cons. The use of ESRT reduces overtreatment in men who may not experience biochemical recurrence. However, in those with very high-risk pathologic features, a multi-disciplinary approach should be utilized to best determine which mode of radiation therapy after surgery is recommended.

Background Intrahepatic cholangiocarcinoma (ICC) is the second most common primitive liver cancer and is rising in incidence worldwide. Given its low survival and resectability rates, locoregional therapies such as Yttrium-90 transarterial radioembolization (Y-TARE) are increasingly being employed. This retrospective study aim was to confirm and update our previous results about overall survival (OR), safety, and efficacy of Y-TARE in patients with unresectable/recurrent ICC. Materials and Methods OS was evaluated as primary endpoint while radiological tumor response at 3 months, based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, was considered as secondary endpoint. Results Over a total of 49 patients, the overall median survival was 16 months (27-41 months, 95% confidence interval [CI]) from Y-TARE procedure. A significantly longer survival was recorded in naive patients compared to patients previously submitted to any type of liver-directed treatment and radical surgery (18 vs 14 months, P =.015 and 28 vs 14 months, P =.001, respectively). Target lesion and overall objective response for RECIST 1.1 criteria were 64.6% and 52.1%, respectively. Low rates of postprocedural and late complications were recorded. Conclusions In unresectable and recurrent ICC, Y-TARE confirms its safety and its potential in increasing OS, especially in naive patients.

ObjectiveIn this study, we investigate whether a Convolutional Neural Network (CNN) can generate informative parametric maps from the pre-processed CT perfusion data in patients with acute ischemic stroke in a clinical setting.MethodsThe CNN training was performed on a subset of 100 pre-processed perfusion CT dataset, while 15 samples were kept for testing. All the data used for the training/testing of the network and for generating ground truth (GT) maps, using a state-of-the-art deconvolution algorithm, were previously pre-processed using a pipeline for motion correction and filtering. Threefold cross validation had been used to estimate the performance of the model on unseen data, reporting Mean Squared Error (MSE). Maps accuracy had been checked through manual segmentation of infarct core and total hypo-perfused regions on both CNN-derived and GT maps. Concordance among segmented lesions was assessed using the Dice Similarity Coefficient (DSC). Correlation and agreement among different perfusion analysis methods were evaluated using mean absolute volume differences, Pearson correlation coefficients, Bland-Altman analysis, and coefficient of repeatability across lesion volumes.ResultsThe MSE was very low for two out of three maps, and low in the remaining map, showing good generalizability. Mean Dice scores from two different raters and the GT maps ranged from 0.80 to 0.87. Inter-rater concordance was high, and a strong correlation was found between lesion volumes of CNN maps and GT maps (0.99, 0.98, respectively).ConclusionThe agreement between our CNN-based perfusion maps and the state-of-the-art deconvolution-algorithm perfusion analysis maps, highlights the potential of machine learning methods applied to perfusion analysis. CNN approaches can reduce the volume of data required by deconvolution algorithms to estimate the ischemic core, and thus might allow the development of novel perfusion protocols with lower radiation dose deployed to the patient.

Our history and culture can be charted to a large extent by the creative contributions of the world's most gifted and talented individuals. What causes some people to use their intellectual, motivational, and creative assets in such a way that it leads to outstanding manifestations of creative productivity, while others with similar or perhaps even greater assets fail to achieve at expected levels of accomplishment? The sheer amount of folk wisdom, portrayals in popular media, and biographical and anecdotal accounts about creativity and giftedness are nothing short of mindboggling. Some clarity, however, can be found by carefully examining the creativity literature. Creativity researchers, for instance, tend to agree that creativity is the combination of originality and task appropriateness as defined in a particular context (Plucker, Beghetto, & Dow, 2004). Moreover, researchers have differentiated among different levels of creativity, ranging from the more subjective (mini-c) to the everyday (little-c) experiences of creativity to professional (Pro-c) and finally, eminent (Big-C) levels of creativity (Beghetto & Kaufman, 2007; Kaufman & Beghetto, 2009). Along these same lines, creativity researchers have also argued that although creativity can be experienced across multiple domains at lower levels of performance, high levels of creative production tend to be domain specific (Kaufman, Beghetto, Baer, & Ivcevic, 2010).

Why and how should a society devote special resources to the development of giftedness in young people for the twenty-first century? If we agree that the goals of gifted education and talent development are to maximize young people's opportunities for self-fulfillment and increase society's reservoir of creative problem solvers and producers of knowledge, then it would seem wise that programming and services enhance students' capacity for creative productivity, not just content acquisition. This general theory for the development of human potential is discussed through an exploration of four research-based subtheories: the Three-Ring Conception of Giftedness, the Enrichment Triad Model, Operation Houndstooth, and Executive Functions. In this article, a reexamination of current gifted and talented programming is intended to generate future research, extend dialogue among scholars, and inspire continued support for programming based on theory and related research.

Abstract To evaluate the potential variability of Manganese (Mn2+) in commercial pineapple juice (PJ) produced in different years and to identify the optimal Mn2+ concentration in the correct amount of PJ to be administered prior to Magnetic Resonance Cholangiopancreatography (MRCP) in order to suppress the gastroduodenal (GD) liquid signal. The Mn2+ concentration in PJ produced in different years was defined using Atomic Absorption Spectrometry. The optimal Mn2+ concentration and the amount of PJ, were estimated in an in-vitro analysis, and were then prospectively tested in a population of patients who underwent MRCP. The results were compared with those achieved with the previous standard amount of PJ used in a similar population. The concentrations of Mn2+ in commercial PJ produced in different years did not differ. A total amount of 150 ml (one glass) of PJ having a high Mn2+ content (2.37 mg/dl) was sufficient for the suppression of the GD liquid signal, despite the additional dilution caused by GD liquids since it led to a final concentration of Mn2+ of 0.5–1.00 mg/dl. The optimized single-dose oral administration of 150 ml (approximately one glass) of PJ having a high Mn2+ concentration prior to MRCP was adequate to guarantee the correct amount of Mn2+ to suppress the GD signal.