Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance.

The assessment of post-myocardial infarction (MI) left ventricular (LV) remodeling by cardiovascular magnetic resonance (CMR) currently uses criteria defined by echocardiography. Our aim was to provide CMR criteria for assessing LV remodeling following acute MI.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site

Induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as neoadjuvant treatment for locally recurrent rectal cancer: study protocol of a multicentre, open-label, parallel-arms, randomized controlled study (PelvEx II)

Background A resection with clear margins (R0 resection) is the most important prognostic factor in patients with locally recurrent rectal cancer (LRRC). However, this is achieved in only 60 per cent of patients. The aim of this study is to investigate whether the addition of induction chemotherapy to neoadjuvant chemo(re)irradiation improves the R0 resection rate in LRRC. Methods This multicentre, international, open-label, phase III, parallel-arms study will enrol 364 patients with resectable LRRC after previous partial or total mesorectal resection without synchronous distant metastases or recent chemo- and/or radiotherapy treatment. Patients will be randomized to receive either induction chemotherapy (three 3-week cycles of CAPOX (capecitabine, oxaliplatin), four 2-week cycles of FOLFOX (5-fluorouracil, leucovorin, oxaliplatin) or FOLFORI (5-fluorouracil, leucovorin, irinotecan)) followed by neoadjuvant chemoradiotherapy and surgery (experimental arm) or neoadjuvant chemoradiotherapy and surgery alone (control arm). Tumours will be restaged using MRI and, in the experimental arm, a further cycle of CAPOX or two cycles of FOLFOX/FOLFIRI will be administered before chemoradiotherapy in case of stable or responsive disease. The radiotherapy dose will be 25 × 2.0 Gy or 28 × 1.8 Gy in radiotherapy-naive patients, and 15 × 2.0 Gy in previously irradiated patients. The concomitant chemotherapy agent will be capecitabine administered twice daily at a dose of 825 mg/m2 on radiotherapy days. The primary endpoint of the study is the R0 resection rate. Secondary endpoints are long-term oncological outcomes, radiological and pathological response, toxicity, postoperative complications, costs, and quality of life. Discussion This trial protocol describes the PelvEx II study. PelvEx II, designed as a multicentre, open-label, phase III, parallel-arms study, is the first randomized study to compare induction chemotherapy followed by neoadjuvant chemo(re)irradiation and surgery with neoadjuvant chemo(re)irradiation and surgery alone in patients with locally recurrent rectal cancer, with the aim of improving the number of R0 resections

Special Education: from disability to exceptionality

[Extract:] Special education is influenced by changes in philosophical understandings of disability and the role of disabled people within society and shaped by social, economic, cultural, and political reforms over time. The early beginnings of special education emerge in care settings through charity, religion, and institutions and combine with work settings to then transform into formal public education systems. Reforms to the disability sector and special education are argued on the basis of morality, values, social justice, and human rights and challenged through advocacy, legislation, policy, research, and practice. Key debates in special education include conceptual understandings of disability, language and labeling, placement, inclusion/exclusion, cost and funding, assessment, curriculum instruction, and behavior management

Trophic ecology of coral reef gobies: Interspecific, ontogenetic, and seasonal comparison of diet and feeding intensity

In fishes, a small body size may facilitate cost-effective exploitation of various primary and secondary food resources, but may pose difficulties associated with digestion of plant material and finding sufficient food in a foraging area potentially restricted by a high risk of predation. We examined the trophic ecology of five common, small-bodied coral reef fish from the family Gobiidae. For each species, we determined diet composition, feeding bite rate, foraging substrate, and feeding behaviour, and examined whether diet composition and feeding bite rate changed ontogenetically and seasonally. The five species showed a diverse range of trophic modes: Amblygobius bynoensis and Amblygobius phalaena were herbivores, Valenciennea muralis was a carnivore, Asterropteryx semipunctatus a detritivore, and Istigobius goldmanni an omnivore. Both the herbivores and detritivore supplemented their diet with animal material. The consumption of a wide range of dietary resources by the two smallest species with the most restricted mobility (A. semipunctatus and I. goldmanni) may ensure energy requirements are met within a restricted foraging area. There was a significant difference in mean feeding bite rate among species, with carnivore > herbivore > omnivore > detritivore. None of the species exhibited an ontogenetic shift in diet composition or increase in feeding bite rate, indicating that (1) postmaturation growth is not facilitated by a higher quality diet or increased feeding intensity following maturation, and (2) their small body size does not preclude herbivory. The herbivores had the highest gut:fish length ratio, which may facilitate plant digestion. While diet did not change seasonally, the mean feeding bite rate was significantly lower in winter than summer for four of the study species