Search

Particle-hole symmetry breaking in the fractional quantum Hall effect has recently been studied both theoretically and experimentally with most works focusing on non-Abelian states in the second electronic Landau level. In this work, we theoretically investigate particle-hole symmetry breaking of incompressible fractional quantum Hall states in the lowest Landau level under the influence of the realistic effect of a finite magnetic field strength. A finite magnetic field induces Landau level and sub-band mixing which are known to break particle-hole symmetry at the level of the Hamiltonian. We analyze the Haldane pseudopotentials, energy spectra and energy gaps, and the wave functions themselves, under realistic conditions. We find that particle-hole symmetry is broken, as determined by energy gaps, between states related via particle-hole conjugation, however, we find that particle-hole symmetry is largely maintained as determined by the effective mass of composite fermions. Finally, we comment and make connection to recent experimental observations regarding particle-hole symmetry in the lowest Landau level fractional quantum Hall effect [Pan et al. Phys. Rev. Lett. 124, 156801 (2020)], 9 pages, 8 figures, 4 tables

Research at Shin-yvslh-sri (CADNO-14), a pre-contact Tolowa village and shell midden site on the north coast of California, involves an innovative collaborative historical ecology approach—an expli...

The fractional quantum Hall effect (FQHE) observed at half filling of the second Landau level is believed to be caused by a pairing of composite fermions captured by the Moore-Read Pfaffian wave function. The generating Hamiltonian for the Moore-Read Pfaffian is a purely three-body model that breaks particle-hole symmetry and lacks other properties, such as dominate two-body repulsive interactions, expected from a physical model of the FQHE. We use exact diagonalization to study the low energy states of a more physical two-body generator model derived from the three-body model. We find that the two-body model exhibits the essential features expected from the Moore-Read Pfaffian: pairing, non-Abelian anyon excitations, and a neutral fermion mode. The model also satisfies constraints expected for a physical model of the FQHE at half-filling because it is: short range, spatially decaying, particle-hole symmetric, and supports a roton mode with a robust spectral gap in the thermodynamic limit. Hence, this two-body model offers a bridge between artificial three-body generator models for paired states and the physical Coulomb interaction and can be used to further explore properties of non-Abelian physics in the FQHE., 11 pages, 11 figures, 3 appendices; Version 3 corrects a mislabeled Grant number in the Acknowledgments

INTRODUCTION: Military sexual trauma (MST) includes sexual harassment or sexual assault that occurs during military service and is of increasing public health concern. The population prevalence of MST among female and male veterans who served during Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) has not been estimated to our knowledge. The purpose of this study is to assess the population prevalence and identify military correlates of MST, sexual harassment, and sexual assault among OEF/OIF veterans. METHODS: MST was assessed in the 2009-2011 National Health Study for a New Generation of U.S. Veterans, a survey of 60,000 veterans who served during the OEF/OIF eras (response rate, 34%, n=20,563). Weighted prevalence estimates and AORs of MST, sexual harassment, and sexual assault among women and men were calculated. Gender-stratified logistic regression models controlled for military and demographic characteristics. Data analyses were conducted in 2013-2014. RESULTS: Approximately 41% of women and 4% of men reported experiencing MST. Deployed men had lower risk for MST compared with non-deployed men, though no difference was found among women. However, veterans reporting combat exposure during deployment had increased risk for MST compared with those without, while controlling for OEF/OIF deployment. Among women, Marines and Navy veterans had increased risk for MST compared with Air Force veterans. MST was significantly higher among veterans who reported using Veterans Affairs healthcare services. CONCLUSIONS: These prevalence estimates underscore the importance of public awareness and continued investigation of the public health impact of MST. Language: en

To determine per-lesion sensitivity and positive predictive value (PPV) of gadoxetic acid-enhanced 3-T magnetic resonance (MR) imaging for the diagnosis of malignant lesions by using matched (spatially correlated) hepatectomy pathologic findings as the reference standard. Materials andIn this prospective, institutional review board-approved, HIPAA-compliant study, 20 patients (nine men, 11 women; mean age, 59 years) with malignant liver lesions who gave written informed consent underwent preoperative gadoxetic acid-enhanced 3-T MR imaging for surgical planning. Two image sets were independently analyzed by three readers to detect liver lesions (set 1 without and set 2 with hepatobiliary phase [HBP] images). Hepatectomy specimen ex vivo MR imaging assisted in matching gadoxetic acid-enhanced 3-T MR imaging findings with pathologic findings. Interreader agreement was assessed by using the Cohen κ coefficient. Per-lesion sensitivity and PPV were calculated.Cohen κ values were 0.64-0.76 and 0.57-0.84, and overall per-lesion sensitivity was 45% (42 of 94 lesions) to 56% (53 of 94 lesions) and 58% (55 of 94 lesions) to 64% (60 of 94 lesions) for sets 1 and 2, respectively. The addition of HBP imaging did not affect interreader agreement but significantly improved overall sensitivity for one reader (P.05) and almost for another (P = .05). Sensitivity for 0.2-0.5-cm lesions was 0% (0 of 26 lesions) to 8% (two of 26 lesions) for set 1 and 4% (one of 26 lesions) to 12% (three of 26 lesions) for set 2. Sensitivity for 0.6-1.0-cm lesions was 28% (nine of 32 lesions) to 59% (19 of 32 lesions) for set 1 and 66% (21 of 32 lesions) to 69% (22 of 32 lesions) for set 2. Sensitivity for lesions at least 1.0 cm in diameter was at least 81% (13 of 16 lesions) for set 1 and was not improved for set 2. PPV was 98% (56 of 57 lesions) to 100% (60 of 60 lesions) for all readers without differences between image sets or lesion size.Gadoxetic acid-enhanced 3-T MR imaging provides high per-lesion sensitivity and PPV for preoperative malignant liver lesion detection overall, although sensitivity for 0.2-0.5-cm malignant lesions is poor.

Previous assessments of Afghanistan/Iraq Veterans have lacked a systematic overview of all injury and illness experiences captured by the Veterans Health Administration (VHA) health care services. In this initial study, we quantify the health care utilization behavior of eligible Veterans and describe the level and type of usage among them.A roster of service members who have served in Afghanistan/Iraq and became eligible for VHA care between 2002 and 2010 and their corresponding administrative VA medical encounter data were abstracted from the VHA Office of Public Health Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Health Surveillance System.Between 2002 and 2010, approximately 55% of eligible Veterans accessed VHA health care. Higher utilization was observed among Veterans 50 years of age and older compared to younger Veterans. Higher utilization was also observed among Veterans with increasing cumulative deployment time. Mental disorder diagnostic codes accounted for the greatest number of visits per Veteran.Veterans with mental health diagnoses may need a different level of care than other VHA users. Other service factors associated with utilization require further research to better understand the underlying relationship. Current observed results may be reflective of future expected utilization patterns and may assist in resource planning and research.

The link between autoimmune diseases and primary immunodeficiency syndromes has been increasingly appreciated. Immunologic evaluation of a young man with autoimmune enterocolopathy and unexplained infections revealed evidence of immunodeficiency, including IgG subclass deficiency, impaired Ag-induced lymphocyte proliferation, reduced cytokine production by CD8+ T lymphocytes, and decreased numbers of NK cells. Genetic evaluation identified haploinsufficiency of NFAT5, a transcription factor regulating immune cell function and cellular adaptation to hyperosmotic stress, as a possible cause of this syndrome. Inhibition or deletion of NFAT5 in normal human and murine cells recapitulated several of the immune deficits identified in the patient. These results provide evidence of a primary immunodeficiency disorder associated with organ-specific autoimmunity linked to NFAT5 deficiency.

Objective Histopathology is potentially an important outcome measure in UC. Multiple histological disease activity (HA) indices, including the Geboes score (GS) and modified Riley score (MRS), have been developed; however, the operating properties of these instruments are not clearly defined. We assessed the reproducibility of existing measures of HA. Design Five experienced pathologists with GI pathology fellowship training and expertise in IBD evaluated, on three separate occasions at least two weeks apart, 49 UC colon biopsies and scored the GS, MRS and a global rating of histological severity using a 100 mm visual analogue scale (VAS). The reproducibility of each grading system and for individual instrument items was quantified by estimates of intraclass correlation coefficients (ICCs) based on two-way random effects models. Uncertainty of estimates was quantified by 95% two-sided CIs obtained using the non-parametric cluster bootstrap method. Biopsies responsible for the greatest disagreement based on the ICC estimates were identified. A consensus process was used to determine the most common sources of measurement disagreement. Recommendations for minimising disagreement were subsequently generated. Results Intrarater ICCs (95% CIs) for the total GS, MRS and VAS scores were 0.82 (0.73 to 0.88), 0.71 (0.63 to 0.80) and 0.79 (0.72 to 0.85), respectively. Corresponding inter-rater ICCs were substantially lower: 0.56 (0.39 to 0.67), 0.48 (0.35 to 0.66) and 0.61 (0.47 to 0.72). Correlation between the GS and VAS was 0.62 and between the MRS and VAS was 0.61. Conclusions Although ‘substantial’ to ‘almost perfect’ ICCs for intrarater agreement were found in the assessment of HA in UC, ICCs for inter-rater agreement were considerably lower. According to the consensus process results, standardisation of item definitions and modification of the existing indices is required to create an optimal UC histological instrument.

Nonalcoholic fatty liver disease (NAFLD) is an increasingly common metabolic disorder in adults and children in developed countries (1–3). It is defined by the deposition of lipids within hepatocytes in the absence of substantial alcohol intake. Approximately 20% of patients with NAFLD have a progressive form of the condition known as nonalcoholic steatohepatitis (NASH), which is characterized by the presence of inflammation and hepatocellular injury in addition to steatosis. Patients with NASH may develop fibrosis and can progress to cirrhosis (1). NAFLD is now among the most common causes of cirrhosis in the United States and Europe (3). Clinical management and future therapeutic investigations may benefit from a wider array of tools for quantitative evaluation of the fatty liver disease spectrum. Currently, histology and imaging are both used for evaluating NAFLD (4). In the NASH Clinical Research Network (CRN) Scoring System, liver biopsy specimens are scored for multiple histologic features including steatosis, inflammation, hepatocellular ballooning, and fibrosis (5). The diagnosis of NASH requires a specific pattern of histologic abnormalities that includes, in addition to steatosis, inflammatory cellular infiltrates and hepatocellular ballooning centered around the lobular central vein, with or without fibrosis (6,7). Since liver biopsy is an invasive procedure that samples only a small part of the liver, noninvasive imaging methods are under investigation to fill roles that are complementary or surrogate to histology (4,7). Diffusion-weighted imaging (DWI) is an magnetic resonance imaging (MRI) method under investigation in liver disease. It is sensitive to the microscopic motion of spins as they diffuse and perfuse through tissue (8). Diffusion and perfusion are affected by several tissue characteristics, including the presence of restrictive barriers within tissue, the viscosity of the fluid in which the spins are diffusing, and the velocity and fractional volume of perfusing spins. These tissue characteristics may be altered in chronic liver diseases such as NAFLD, and several recent animal and human studies have reported that steatosis (9–15), inflammation (9,10,16), and fibrosis (16–19) may affect DWI measurements. However, these prior studies appear not to have examined the independent effects of the various histologic features of NAFLD on DWI measurements (ie, with multiple linear regression) in human subjects to determine whether the observed effects are confounded by or attributable to other histologic features. Also, we sought to investigate the effects of inflammation in NAFLD in human subjects. Furthermore, knowledge of the physics and artifacts of liver DWI has progressed since these prior studies. More detailed models of intravoxel incoherent motion (IVIM) have superseded the apparent diffusion coefficient (ADC) for DWI quantification (20,21), and methods to mitigate the bulk motion artifacts that are prominent in liver have been developed (22,23). The purpose of this study was to evaluate the associations between histologic features of NAFLD and quantitative DWI parameters in a cross-sectional clinical study in adults, incorporating recent advances in DWI methodology.

Background and study aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of lymph nodes is used for staging of gastrointestinal malignancies. False-positive rates of 5 % – 7 % are not well understood. Elements of EUS examinations that contribute to false-positive cytological findings were investigated. Patients and methods: 13 patients undergoing EUS staging of gastrointestinal luminal malignancy were consecutively enrolled together with 3 patients with extraluminal tumors (pancreas, lung) defined as controls. After EUS, cellular debris and fluid were collected from the FNA needle catheter, instrument channel, and endoscope tip for cytologic and histologic investigation. Results: 6 of 13 patients (46 %) had malignant cells contaminating the FNA needle catheter, instrument channel, or endoscope tip. Malignant cells were present in the instrument channel in 5 cases (38 %), exterior tip of echoendoscope in 4 (31 %) and needle catheter in 2 (15 %). Conclusions: Echoendoscopes used for FNA in patients with luminal tumors are at risk for malignant cell contamination of the instrument channel, FNA needle catheter, and echoendoscope tip. FNA needle contamination can contribute to false-positive findings.

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated serum aminotransferase levels in the United States.1–3 It has been estimated that approximately 80 million Americans have NAFLD, and the prevalence of this condition is expected to rise with the continuing epidemic of obesity.4,5 Nonalcoholic steatohepatitis (NASH), which is the progressive form of NAFLD, is typically associated with inflammation and cellular injury in addition to steatosis with or without perisinusoidal fibrosis on liver histology.6 Liver biopsy is the gold standard for diagnosing NAFLD and confirming the presence of NASH.7–9 However, liver biopsy is an invasive procedure and is not routinely favored by general practitioners and patients because of potential risks, which include abdominal pain, bleeding, and, very rarely, death.10 It is not practical to subject all patients with NAFLD to a liver biopsy assessment; therefore, noninvasive biomarkers are needed.11–13 Imaging studies are being increasingly used for noninvasive assessments of NAFLD and have shown promise in detecting hepatic steatosis, but they are limited in their assessment of the presence of NASH. Among the imaging modalities, ultrasound and computed tomography are routinely available and are commonly used, but they lack sensitivity and accuracy in quantifying liver fat.14–16 Magnetic resonance (MR)—especially magnetic resonance spectroscopy (MRS)—has emerged as an accurate technique for quantifying liver fat. However, MRS is limited because it measures a small volume of the sampled tissue and is technically difficult to perform, and it is largely used as a research tool with limited clinical availability and application in routine clinical practice.17,18 Conventional magnetic resonance imaging (MRI) techniques are limited by T1 bias, T(2)* decay, and multifrequency signal-interference effects of protons in fat and eddy currents and, therefore, may not be accurate in the quantification of liver fat.18 Advanced MRI techniques eliminate the biases seen with conventional MRI techniques and can provide the magnetic resonance imaging–estimated proton density fat fraction (MRI-PDFF), a novel biomarker that has shown a robust correlation and equivalency with the magnetic resonance spectroscopy–measured proton density fat fraction (MRS-PDFF).19–22 In addition, MRI-PDFF allows fat mapping of the entire liver and can be applied on any clinical MRI platform, whereas MRS measures fat biochemically in small regions of interest (ROIs). Using a randomized, double-blinded, placebo-controlled clinical trial, we recently showed that MRI-PDFF could detect small amounts of changes in liver fat.23 In the present study, we hypothesized that MRI-PDFF is equivalent to MRS-PDFF in quantifying liver fat cross-sectionally and longitudinally and that the two techniques would correlate with each other over a 24-week time period in patients with biopsy-proven NAFLD. Therefore, we aimed to validate MRI-PDFF by a three-way comparison of the liver MRI-PDFF, MRS-PDFF, and liver histology–determined steatosis grade at two time points (24 weeks apart) and also to assess whether small changes in the liver fat content appreciated by MRI-PDFF have any clinical or biochemical significance.

Molecular studies are part of standard care for cancer patients. Bone, a common and sometimes sole site of metastasis, requires decalcification for morphological examination. Many commonly used decalcification agents contain strong acids that degrade nucleic acids. The paradigm shift in oncology, with biomarker targeted therapy and gene expression profiling analysis, requires sufficient nucleic acid recovery from bone biopsy specimens. We systematically studied the effects of a spectrum of decalcification agents on the quantity and quality of RNA and DNA recovered from bone biopsies. Multiple bone biopsies of similar size and cellularity were fixed in 10% neutral-buffered formalin, randomized to various decalcification agents for 2 hours then processed, and embedded. Tissue lysates were obtained from unstained sections and nucleic acid isolated. DNA and RNA were quantified. Assessment of DNA and RNA integrity was accomplished by comparison of the average cycle threshold by polymerase chain reaction of selected housekeeping genes for each agent. Results were then analyzed by 2-sample t test. There was a significant decrease in both DNA and RNA yield and integrity with strong acids (hydrochloric, nitric) vs 14% EDTA and formic acid. DNA yield was (mean nanograms) 6.15 vs 68.68 (P.001) and RNA was (mean nanograms) 121.53 vs 288.89 (P=.003), respectively. DNA integrity (mean cycle threshold) was 35.79 vs 30.16 (P.001), and RNA was 33.03 vs 26.5 (P.001), respectively. Decalcification of bone biopsies with EDTA or formic acid agents was associated with a significant improvement in recovered nucleic acid quantity and quality.

PurposeThis case study was undertaken as a process consultation in a non‐profit Christian church which has experienced a general decline in attendance in addition to a particular problem characterized as a habit of late arrival at the primary Sunday worship service. The paper aims to discuss these issues.Design/methodology/approachThis case study was designed as an action research project using appreciative inquiry and institutional theory in the structuralist tradition. This combined methodological approach was effectively used to identify core values and norms inherent in the organization and functioning of the church.FindingsResults confirmed the premise of a habit of late arrival and indicated that there was little focus or support by congregants on the traditions and practices that occur early in the church service. Great value was placed on the overall environment, teaching and messaging that occurred from the sermons which begin approximately 45 minutes after the start of the service. Validation and review of the possibility propositions resulted in a reorganization of the primary Sunday worship service resulting in increased attendance and on time performance.Originality/valueThis case study finds that methods inherent in institutional analysis and appreciative inquiry can be effectively combined to identify gaps in organizational goals and performance which are direct results of encapsulated organizational traditions. It is anticipated that the methodological approach in this study is generally applicable to organizations of various types.

To demonstrate the feasibility of an innovative technique for the surgical management of rectal cancer, we performed transanal minimally invasive surgery assisted low anterior resection with total mesorectal excision (TAMIS-assisted LAR with TME) in a cadaver model. Transanal LAR via natural orifice transluminal endoscopic surgery has been reported in cadaveric series using rigid transanal platforms. This procedure has not been described using a combination of a single incision laparoscopy and TAMIS transanal endoscopic platform. We describe the first cadaveric series of TAMIS-assisted LAR with TME.TAMIS-assisted LAR with TME was successfully performed in five fresh human cadavers. The procedure was performed using the mini-Gelpoint single incision platform and the Gelpoint Path TAMIS platform (Applied Medical, Rancho Santa Margarita, CA). The variables recorded were age, body mass index (BMI), operative time, complications, and specimen length. The grade of the TME was determined by evaluation of the specimen by photo documentation by a gastrointestinal pathologist.All cadavers were male with a mean age of 71 ± 8 years and mean BMI of 28 ± 3 kg/m(2). The mean operative time was 200 ± 55 min (range 128-249 min). The quality of the TME was grade I (complete) with intact mesorectum in all five cases. The mean specimen length was 36.8 ± 3.4 cm.TAMIS-assisted LAR with TME was feasible. A high-quality TME can be achieved using this innovative technique. Transanal endoscopic total mesorectal dissection may revolutionize the surgical management of rectal cancer. However, multicenter clinical trials are needed to further evaluate the oncologic safety and surgical outcomes of transanal endoscopic TME using various platforms before widespread application of this new technique.

We numerically study the fractional quantum Hall effect at filling factors $\nu=12/5$ and 13/5 (the particle-hole conjugate of 12/5) in high-quality two-dimensional GaAs heterostructures via exact diagonalization including finite well width and Landau level mixing. We find that Landau level mixing suppresses $\nu=13/5$ fractional quantum Hall effect relative to $\nu=12/5$. By contrast, we find both $\nu=2/5$ and (its particle-hole conjugate) $\nu=3/5$ fractional quantum Hall effects in the lowest Landau level to be robust under Landau level mixing and finite well-width corrections. Our results provide a possible explanation for the experimental absence of the 13/5 fractional quantum Hall state as caused by Landau level mixing effects., Comment: 7 pages, 8 figures; v2 is published version

Splenic lymphangioma is a rare, benign lesion of the spleen that is characterized microscopically by a proliferation of thin-walled vascular channels filled by proteinacious material. Based on microscopic features, three types of lymphangiomas are described as simple capillary, cavernous, and cystic; however, the distinction between these types is not uniformly accepted. The cystic type is the most common type and has well described imaging characteristics. However, little is known about the less common cavernous and capillary forms of lymphangioma. Herein, we present a case of a patient with two synchronous colon cancers that presented with a concomitant splenic mass that was initially suspected to be metastatic disease. Despite the use of multiple imaging modalities including computed tomography (CT), magnetic resonance imaging (MRI), nuclear imaging, and contrast-enhanced ultrasound, the final diagnosis of cavernous lymphangioma was made following core needle biopsy of the lesion. A thorough review of literature and this case now demonstrate the difficulty in differentiating atypical forms of splenic lymphangiomas from other benign lesions such as hemangioma.

The prognostic and predictive value of Her2/neu and the hormone receptors in patient with primary or metastatic breast cancer is essential for a favorable outcome of treatment. We have been experiencing increasing requests to test cytologic specimens for these markers in patients with metastatic breast carcinoma. A recent study threw some doubts on the validity of such testing using cell blocks. In this study we compared our immunohistochemical Her2/neu, ER and PR testing performed on 42 formalin-fixed, paraffin-embedded cell blocks from 27 fine needle aspirations (FNA) and 15 serous effusions of 42 patients with metastatic (n = 38) and primary (n = 4) breast carcinoma to the test results obtained on tissue sections. In seven cases the Her2/neu immunohistochemistry (IHC) results on cell blocks were also compared with Her2/neu fluorescence in situ hybridization (FISH) on tissue or cell block. The study revealed 100% correlation for positive and negative Her2/neu results. For ER testing the results showed 85.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 85.7% negative predictive value (NPV). For PR testing the results showed 80% sensitivity, 100% specificity, 100% PPV, and 88.8% NPV respectively. In conclusion, IHC for Her2/neu, ER and PR performed on formalin-fixed, paraffin-embedded cell blocks prepared from fresh FNA and serous fluid is reliable in predicting the expression of these markers when correlated with IHC and FISH performed on the corresponding tumor tissue.

Background Although pancreatic rests have characteristic endoscopic features, confirming a histological diagnosis may be desirable to exclude other significant pathology. Aims The aim of this study was to assess the efficacy and safety of endoscopic band ligation snare polypectomy (EBLSP) for removal of suspected pancreatic rests and to compare the diagnostic yield to other endoscopic tissue sampling methods. Methods An electronic endoscopic report database was searched for patients referred for evaluation of incidentally found gastric antral subepithelial lesions. Tissue sampling technique, pathology, and complications were recorded. Results Removal of suspected pancreatic rests with EBLSP was successful in all 21 cases without complications. Nineteen of 21 (90%) who underwent EBLSP had a histological diagnosis of heterotopic pancreas compared with 5 of 14 (36%) who underwent tissue sampling with biopsy and/or snare (P = 0.001). The endoscopic characteristics of the histology proven pancreatic rests were an antral subepithelial mass with central umbilication measuring 6–10 mm in diameter and located 2–6 cm from the pylorus in the 3–7 o’clock position. Conclusions Endoscopic band ligation snare polypectomy resection of gastric antral lesions suspected to be pancreatic rests had a diagnostic yield superior to standard biopsy forceps and snare polypectomy techniques. However, because all pathologically confirmed pancreatic rests had typical endoscopic appearances of pancreatic rests, it may not be necessary to obtain histologic diagnosis for every suspected gastric antral heterotopic pancreas.

Carotid plaque calcification normally appears as a signal void with clinical MR sequences. Here, we describe the use of an adiabatic inversion recovery prepared two-dimensional ultrashort echo time sequence to image and characterize carotid plaque calcification using a clinical 3-T scanner. T1, T, and free water content were measured for seven carotid samples, and the results were compared with micro-CT imaging. Conventional gradient echo and fast spin echo images were also acquired for comparison. Correlations between T1, T, free water concentration, and mineral density were performed. There was a close correspondence between inversion recovery prepared two-dimensional ultrashort echo time morphologic and micro-CT appearances. Carotid plaque calcification varied significantly from sample to sample, with T1s ranging from 94 ± 19 to 328 ± 21 msec, Ts ranging from 0.31 ± 0.12 to 2.15 ± 0.25 msec, and free water concentration ranging from 5.7 ± 2.3% to 16.8 ± 3.4%. There was a significant positive correlation between T1 (R = 0.709; P < 0.074), T (R = 0.816; P < 0.025), and free water concentration, a negative correlation between T1 (R = 0.773; P < 0.042), T (R = 0.948; P < 0.001) and CT measured mineral density, and a negative correlation between free water concentration (R = 0.936; P < 0.002) and mineral density. Magn Reson Med, 2010. © 2010 Wiley-Liss, Inc.

An 11-year-old boy presented with exercise intolerance due to chronic hypoxemia. Work-up revealed a diagnosis of hepatopulmonary syndrome (HPS) secondary to a congenital extrahepatic portal-venous shunt (Abernethy malformation). Plasticity in the developing liver was exploited as a strategy for the treatment of HPS. With use of a staged endovascular approach, the portosystemic vascular circuitry was modified in a manner that facilitated progressive growth and development of the severely hypoplastic and underdeveloped intrahepatic portal venous system. After completion of the final procedure, the patient's intrahepatic portal veins were normal in appearance; 2 months later, signs and symptoms of HPS completely resolved. The patient remains free of HPS stigmata after 2 years.

Capsular retraction is an infrequent but characteristic feature of malignant liver lesions such as hepatic metastases and intrahepatic cholangiocarcinoma. Rarely, this finding may be observed in association with benign lesions, such as atypical haemangiomas. Capsular retraction has not previously been reported in association with hepatic inflammatory pseudotumour (IPT). Hepatic IPT is an uncommon benign hepatic lesion with a good clinical prognosis. In this report, we discuss the case of a 48-year-old woman with capsular retraction secondary to multifocal hepatic inflammatory IPTs.

Chronic liver disease is a major public health problem worldwide. Liver fibrosis, a common feature of almost all causes of chronic liver disease, involves the accumulation of collagen, proteoglycans, and other macromolecules within the extracellular matrix. Fibrosis tends to progress, leading to hepatic dysfunction, portal hypertension, and ultimately cirrhosis. Liver biopsy, the standard of reference for diagnosing liver fibrosis, is invasive, costly, and subject to complications and sampling variability. These limitations make it unsuitable for diagnosis and longitudinal monitoring in the general population. Thus, development of a noninvasive, accurate, and reproducible test for diagnosis and monitoring of liver fibrosis would be of great value. Conventional cross-sectional imaging techniques have limited capability to demonstrate liver fibrosis. In clinical practice, imaging studies are usually reserved for evaluation of the presence of portal hypertension or hepatocellular carcinoma in cases that have progressed to cirrhosis. In response to the rising prevalence of chronic liver diseases in Western nations, a number of imaging-based methods including ultrasonography-based transient elastography, computed tomography–based texture analysis, and diverse magnetic resonance (MR) imaging–based techniques have been proposed for noninvasive diagnosis and grading of hepatic fibrosis across its entire spectrum of severity. State-of-the-art MR imaging–based techniques in current practice and in development for noninvasive assessment of liver fibrosis include conventional contrast material–enhanced MR imaging, double contrast-enhanced MR imaging, MR elastography, diffusion-weighted imaging, and MR perfusion imaging. © RSNA, 2009

inhibitor (PPI) esomeprazole in the third copayment tier on the TRICARE formulary on July 17, 2005. The change to nonpreferred formulary status for esomeprazole included a $13 copayment increase (from $9.00 to $22.00) for either a 30-day supply purchased from a community pharmacy or a 90-day supply purchased from the mail-order pharmacy and a $0 copayment if obtained from a military pharmacy but with a prior authorization (PA) requirement. The change to nonpreferred formulary status was designed to encourage the use of PPIs other than esomeprazole and to increase the use of the mail-order pharmacy for esomeprazole purchases.To quantify changes in (a) the TRICARE beneficiary utilization of esomeprazole relative to other PPIs and (b) the pharmacy settings used for filling esomeprazole prescriptions following implementation of a copayment increase and nonpreferred formulary status for esomeprazole.A census of outpatient pharmacy fill records for prescription acid-reducing medications (PPIs, histamine-2 blockers, misoprostol, and sucralfate) obtained by beneficiaries aged 18 years or older from January 1, 2005, through December 31, 2006, was examined. Interrupted time series regression analyses without a control group were used to compare the utilization of esomeprazole relative to other PPIs, as well as the pharmacy setting used to obtain esomeprazole, in the months before and after the formulary change. The rates of continued esomeprazole use, switching to other prescription PPIs (lansoprazole, omeprazole, pantoprazole, and rabeprazole), switching to non-PPI prescription acid-reducing drugs, and discontinued prescription acid-reducing medication use among existing esomeprazole users (i.e., beneficiaries who obtained esomeprazole as the last PPI fill before the formulary change) were calculated overall and for each pharmacy setting used prior to the formulary change.Over the 24-month study period from January 1, 2005, through December 31, 2006, the total numbers of PPI fills and PPI users increased by 8.5% and 9.0%, respectively, and the number of esomeprazole users decreased by 4.6%. Of esomeprazole users, the percentages of individuals obtaining esomeprazole from military pharmacies and community pharmacies, respectively, decreased from 1.7% to 1.1% and from 89.7% to 81.7%, while the percentage of individuals obtaining esomeprazole from the mail-order pharmacy increased from 8.8% to 17.6%. Time series analysis yielded a positive, statistically significant growth in esomeprazole fills (beta1=0.114; P=0.012) during the 6-month pre-intervention period (January through June 2005) and a significant reduction in August 2005 (beta2=-5.0%; P0.001), the month immediately following the formulary change. During the 17-month post-intervention period (August 2005 through December 2006), no statistically significant change in trend for esomeprazole fills (beta3=-0.0265; P=0.534) was observed, although a small increase in the raw number of esomeprazole fills was noted. Among the 117,801 existing esomeprazole users, 86,386 (73.3%) continued using esomeprazole, 17,676 (15.0%) switched to other prescription PPIs, 679 (0.6%) used only non- PPI prescription therapy, and 13,060 (11.1%) discontinued all prescription acid-reducing pharmacotherapy after the formulary change. Significantly higher PPI switching and acid-reducing therapy discontinuation rates were observed among men aged 18-44 years and in TRICARE enrollees relative to women, those over 45 years of age, and those who used other health insurance (P0.001). Individuals who used military pharmacies, where a PA requirement was implemented, were more likely to change pharmacy settings to obtain esomeprazole (43.8%) than were users of community pharmacies (11.9%) or the mail-order pharmacy (22.8%). Mail-order pharmacy users were less likely to discontinue acid-reducing pharmacotherapy (4.9%) than were community (11.9%) or military (12.9%) pharmacy users (P0.05).After adjustment for serial correlation, the formulary change was associated with a migration of approximately 5% of all PPI fills and 25% of esomeprazole fills to the preferred PPIs in the first post-intervention month. Over the 17-month post-intervention period, the trend toward increased esomeprazole use was slowed and use of the mail-order pharmacy for esomeprazole fills nearly doubled. Our observed PPI switch rate of 15.0% resembled the rate observed for another insured population that experienced a similar formulary restructuring, but was substantially lower than the rates reported for more sizeable formulary changes. Thus, the present study's copayment differentials for third-tier medications ($19 compared with tier 1 and $13 compared with tier 2 copayments) may be less than the threshold amount required to optimize switching to preferred PPIs.