Impact of surgery and radiation therapy on spinal high-grade gliomas: a population-based study

Cerebral radiation necrosis (CRN) is a known complication of radiation therapy. Treatment options are limited and include steroids, bevacizumab, and surgery. This study seeks to determine the safety of laser interstitial thermal therapy (LITT) for CRN and identify the pattern of post-ablation volume change over time. Patients undergoing LITT for tumor treatment at Henry Ford Hospital between November 2013 and January 2016 with biopsy-confirmed CRN were prospectively collected and retrospectively reviewed with attention to ablation volume, survival, demographic data, steroid dose, and complications. Imaging occurred at set intervals beginning pre-ablation. Ten patients with 11 ablations were evaluated. Four patients had a primary diagnosis of high-grade glioma, while six had metastatic lesions. An average of 86% of CRN volume was ablated. Ablation volume increased to 430% of initial CRN volume at 1–2 weeks before decreasing to 69% after 6 months. No patient had a decline in baseline neurological examination while in the hospital. Four patients developed delayed neurological deficits likely due to post-operative edema, of which three improved back to baseline. The 6-month survival was 77.8% and the 1-year survival was 64.8% based on Kaplan–Meier curve estimates. In this study, LITT was a relatively safe treatment for CRN, providing both a diagnostic and therapeutic solution for refractory patients. Significant increase in ablation volume was noted at 1–2 months, gradually decreasing in size to less than the original volume by 6 months. Further studies are needed to better define the role of LITT in the treatment of CRN.     

Exploring the Role of Peer Advice in Self-Regulated Learning: Metacognitive,Social, and Environmental Factors

This Conversation Starters article presents a selected research abstract from the 2016 Association of American Medical Colleges Northeast Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the pilot study. These thoughts explore the metacognitive, social, and environmental mechanisms whereby advice plays a role in self-regulated learning.     

Angioleiomyoma in a Rare Location: A Case Report

A case report of a 38-year-old man with a 10 year history of left buttock mass associated with pain and numbness. A computed tomography scan showed a subcutaneous enhancing 1cm lesion that was not communicating with surrounding structures to include neurovascular structures. The mass was removed without complication and sent to pathology for extensive review. This case report signifies the importance of maintaining a broad differential with a subcutaneous mass presentation and includes thorough histology and pathology for angioleiomyoma.     

Exergame Use as a Gateway to the Adoption of and Adherence to Sport‐Specific and General Physical Activity

To explore methods of promoting physical activity, research was conducted to determine whether exergame use could serve as a gateway to future physical activity and to test its efficacy as an intervention. Undergraduates (n = 103) received introductory training during weeks 0–4 through a racquetball videogame (exergame), traditional training, or no‐exposure (control group). All groups then participated in the same, traditional training for weeks 5–8. No differences existed between the exergame and traditional training groups for most outcomes. Both groups increased over time in most outcomes and showed greater skills test performance at post‐intervention assessments than the control group. However, baseline physical activity moderated these outcomes. These results provide partial support for a gateway mechanism and guidelines for future research.     

Disclosing incidental findings in brain research: The rights of minors in decision‐making

MRI is used routinely in research with children to generate new knowledge about brain development. The detection of unexpected brain abnormalities (incidental findings; IFs) in these studies presents unique challenges. While key issues surrounding incidence and significance, duty of care, and burden of disclosure have been addressed substantially for adults, less empirical data and normative analyses exist for minors who participate in minimal risk research. To identify ethical concerns and fill existing gaps, we conducted a comprehensive review of papers that focused explicitly on the discovery of IFs in minors. The discourse in the 21 papers retrieved for this analysis amply covered practical issues such as informed consent and screening, difficulties in ascertaining clinical significance, the economic costs and burden of responsibility on researchers, and risks (physical or psychological). However, we found little discussion about the involvement of minors in decisions about disclosure of IFs in the brain, especially for IFs of low clinical significance. In response, we propose a framework for managing IFs that integrates practical considerations with explicit appreciation of rights along the continuum of maturity. This capacity‐adjusted framework emphasizes the importance of involving competent minors and respecting their right to make decisions about disclosure. J. Magn. Reson. Imaging 2013;38:1009–1013. © 2013 Wiley Periodicals, Inc.