The Dodgers were condemned to walk-off misery in game two of Tuesday's doubleheader and the slumping MLB holders experienced the same fate midweek. The Cubs swept the Dodgers — who lost for the 13th time in 17 games following a start to the season — at Wrigley Field for the first time since Means threw the Orioles' first solo no-hitter since Jim Palmer in as Baltimore blanked the Mariners It was an almost perfect performance for Means, who retired all 27 batters he faced in Seattle but did allow a baserunner when Sam Haggerty reached on a third-strike wild pitch in the third inning.
Means is the first pitcher to throw a non-perfect no-hitter in which the team did not record a walk, hit by pitch or error. According to Stats Perform, Means is also the second pitcher in American League AL history to throw a no-hitter with plus strikeouts and 0 walks, joining Felix Fernandez — who had a perfect game in According to Stats Perform, Fulmer is the first pitcher to get a save the day after a start of less than an inning since Nolan Ryan in Marcell Ozuna hit a grand slam to lead the Atlanta Braves past the Washington Nationals , while Didi Gregorius also managed a grand slam as the Philadelphia Phillies topped the Milwaukee Brewers Stanton homered in back-to-back games for the first time since last July as the Yankees extended their winning streak to six games.
Toronto produced a five-run eighth inning to rally past the A's. Lou Trivino struggled in the eighth, allowing three hits, five runs — all earned — and two walks. Toronto won Ohtani the freak Is there anything Shohei Ohtani cannot do? The two-way Los Angeles Angels star — returning to the mound — caught his own pitch in a fine example of his fielding and agility.
Ohtani pitched five scoreless innings, giving up just one hit while striking out seven but the Angels still lost to the Tampa Bay Rays. Dodgers ace Kershaw and reigning National League NL Cy Young Award winner Bauer started in games one and two respectively, however, the Cubs were and victors to sweep the doubleheader in Chicago. The Cubs secured the day-night sweep in walk-off fashion as the Dodgers lost for the eighth time in 10 games.
Elsewhere, the Houston Astros were greeted by boos and bad words in their first visit to New York since the sign-stealing scandal. The Dodgers arrested a three-game skid and avoided a series sweep at the hands of the Brewers thanks to Sunday's onslaught.
Pollock and Matt Beaty fuelled the Dodgers with grand slams off Brewers rookie Alec Bettinger in each of the first two innings. Elsewhere, the Cincinnati Reds topped the Chicago Cubs in a wild walk-off win. Nick Castellanos — who also clubbed two home runs — hit a game-ending RBI single in the 10th inning to lead the Reds past the Cubs in an epic encounter. Heavyweight fight. Wind blowing out in Cincinnati.
And we just came up on the short end. Scherzer — who carried a shutout into the ninth inning — pitched a five-hitter, finishing with nine strikeouts, five hits and no walks before hurrying to the hospital for the birth of his third child. A two-time Cy Young Award winner, Kluber gave up two hits in eight innings, walking one and striking out 10 batters — his first strikeout game since September He became the 17th active pitcher in the majors to reach wins.
Toronto's Bo Bichette carried an historic start into the game, with a franchise record hits, 69 runs, 32 doubles, 23 homers and 56 extra-base hits through his first career games. Having never pitched above Double-A previously, debutant Bettinger gave up 11 runs against the Dodgers. He allowed 11 hits and two walks in four innings, while hitting a batter and striking out none. Tatis homer! Tatis homered for the eighth time this season as he became the first player to record plus home runs and plus stolen bases in his first career games.
Springer hits first two homers for Blue Jays in walk-off win, Brewers beat Dodgers after 11 innings May 02, George Springer hit his first home runs for the Toronto Blue Jays, who rallied to a walk-off win against the Atlanta Braves. The prized recruit — still playing as a designated hitter — fuelled the Blue Jays with a pair of homers against the Braves on Saturday. Toronto trailed and but Springer, who hit a two-run home run in the third inning and a foot shot in the seventh to level the game at , helped the Blue Jays rally.
Randal Grichuk completed the comeback against the visiting Braves with an RBI single in the 10th inning. Travis Shaw homered and hit a game-winning single for the Brewers, who scored three runs in the 11th inning to beat the Dodgers for a third consecutive game. Taillon celebrates first win in two years It was a game to remember for Jameson Taillon.
For the first time in two years, Taillon earned his first victory after the New York Yankees outlasted the Detroit Tigers Taillon allowed one run, three hits and struck out eight batters over five innings. Snell gave up one earned run and five hits across five innings, striking out six as the Padres beat the San Francisco Giants Manny Machado added a three-run homer. Tim Anderson's grand slam — second of his career — guided the Chicago White Sox to a victory over the Cleveland Indians.
Cahill's costly start While Trevor Cahill regained his composure and control, it was too late for the Pittsburgh Pirates, who were beaten by the St Louis Cardinals. Cahill gave up four runs in the opening inning and the Pirates never recovered.
Cahill allowed seven hits, five runs and a homer in just over five innings. Trout clubbed his 28th homer in Seattle — his 10th career first-inning home run away to the Mariners. The Angels star is the only Mariners opponent with more than 20 homers in Seattle. Omar Narvaez appeared to sustain a left leg injury running to first base in the win, which improves the Brewers record to , while the Dodgers are The Brewers held the Dodgers to just two hits as their offensive woes continued to haunt them, losing for the ninth time in 12 games.
Freddy Peralta was excellent on the mound for the Brewers across six innings. Milwaukee moved to a lead at the bottom of the second, thanks to Jackie Bradley Jr's two-run homer. Darvish back to his best Veteran right-hander Yu Darvish was at his brilliant best with 12 strike-outs across six innings in the San Diego Padres' triumph over the San Francisco Giants. Darvish was giving a huge reception after stepping off the mound, showing he has quickly won over his new fans after his move from the Chicago Cubs.
For the winners, Alex Kirilloff hit two home-runs, including a three-run homer to open up the lead. Left-hander Madison Bumgarner bounced back from illness to land six strike-outs and lead the Arizona Diamondbacks to a win over the Colorado Rockies. Shohei Ohtani continues to deliver home runs for the Los Angeles Angels, with his eighth of the season in their loss to the Seattle Mariners. He has scored as many in as he did across the whole season.
Alvarado gets lippy, benches cleared The benches cleared in the Philadelphia Phillies' win over the New York Mets after pitcher Jose Alvarado struck out Dominic Smith and then got chirpy. Alvarado dropped his glove and Smith did not back down so they had to be separated.
It all felt quite unnecessary. Currently, sulfur hexafluoride i. The former is a pure blood pool agent, while the latter behaves similarly at the beginning but permeates into extravascular space soon after administration, which will be discussed in Section 3. Iodinated Agents for Contrast-Enhanced CT Many iodinated agents are pure blood pool agents, which are the widest and longest used CM for X-ray-based enhancement scans i. Moreover, novel agents, like iosimenol and GE, are on the way to commercialization with the improvements made on an existing basis.
However, despite great improvements that have been made in the bone and cartilage tissue, iodinated contrast agents employed in parenchymal organs, like the liver, have not yet been largely renovated 16 , It was rapidly enhanced in the arterial phase wash-in B , started to fade wash-out in portal phase C , and was totally exhausted in the post-vascular phase D. It showed hyperintensity on T2-weighted image I. At iodine agent-enhanced CT, it has low-density before enhancement J.
It also showed wash-in and wash-out from arterial phase, portal phase, to delayed phase K—M. Finally, the gross specimen vividly reflected the morphological information of tumor N. Arrowheads indicate the margin of the HCC lesion. The blood pool agent applied to MRI is mainly established for MR angiography rather than the liver tumor, which is beyond the scope of the present review article and will not be discussed herein.
Extracellular Contrast Agents Non-Specific Agents For MRI, gadolinium-based micromolecule agents that have five or seven unpaired electrons could be stimulated to be paramagnetic under an external magnetic field. Those so-called paramagnetic contrast agents for dynamic MRI are developed and enriched These extracellular agents for non-specific liver MRI are commonly used worldwide because of the good patient tolerance and satisfying diagnostic efficacy Thus, clinical recommendations from guidelines are almost based on the Gd-chelates 8 , 9.
Reticuloendothelial System Endocytosis Ferumoxytol, a kind of iron oxide nanoparticles IONPs approved by the Food and Drug Administration FDA as medicine for iron deficiency in adults, was recently reported to be feasible for MR angiography thanks to the characteristic of longer half-life in circulation and the advantage of superparamagnetism 20 — The so-called negative contrast agents, containing iron oxide particles, darken the normal liver background on T2-weighted images to negatively enhance the target issue, in contrast with the so-called positive agents that brighten the target tissue on T1-weighted images, like Gd-chelates.
The first commercially available reticuloendothelial system RES -specific contrast agent is ferumoxides Feridex 24 , which makes lesions that contain negligible RES cells conspicuous on T2-weighted images since the normal liver background containing many RES cells can selectively take up iron oxide particulates to lower the T2 signal intensity By contrast, tumors, whether benign or malignant, primary or metastatic, that are deficient in Kupffer cells cannot exhibit SPIO uptake, shaping a relatively hyperintense area.
However, focal nodular hyperplasia FNH seems to be an exception, since SPIO particles may accumulate there and lead to a resultant isointense or even hypointense appearance 26 , Following SPIO, the derivative in terms of ultrasmall particulate iron oxides USPIO with advantages of convenient administration and striking prolonged plasma half-life that enables it also as a blood pool agent was developed thereafter 28 , 29 Table 1.
At first, Sonazoid MBs were used as the blood pool contrast agent. As early as 1 min after the intravenous administration, the MBs start to diffuse into extravascular and intercellular space where they will be phagocytosed by the Kupffer cells in the normal liver sinusoids.
Approximately 10 min later, once intravascular MBs are mostly eliminated, the remaining stable MBs endocytosed by resident macrophages in liver parenchyma will shape the so-called additional Kupffer phase or post-vascular phase, which can last to 2 h after injection 30 — 32 Table 1. Moreover, in the classical enhancement features of wash-in and wash-out, HCC theoretically appears to be perfusion defects in the Kupffer phase or post-vascular phase because of Kupffer cell shortage Figures 1 , 2.
The characteristics of the additional post-vascular phase aid much in HCC detection and diagnosis. Recently, Sonazoid has been proven to be non-inferior to SonoVue in a retrospective clinical study for focal liver lesion FLL Also, some benign lesions that lack Kupffer cells have a chance to be misdiagnosed as a false-positive sign in the Kupffer phase Therefore, the expected additional clinical benefit on diagnosis gained from the Kupffer phase has not yet been confirmed As for HCC intervention, after US brings real-time monitoring for minimally invasive operations like lesion biopsy and regional ablation, CEUS is employed for more accurate guidance and unique immediate evaluation during therapy 38 — On the other hand, three-dimensional 3D US can provide additional lateral and other viewing angles, and morphological information offers UCA another usable imaging modality i.
Moreover, contrast enhancement is also employed in fusion imaging to reveal extra small liver lesions and biopsy navigation 48 Figure 4. It was rapidly enhanced in the arterial phase wash-in B , still iso-echoic in portal phase C , and was totally exhausted in the post-vascular phase D. The contrast media CM were totally exhausted till the hepatobiliary phase J.
The gross specimen indicated the heterogeneous pathological differentiation of HCC E. The tumor was 70mm. Consecutive lateral images of the tumor remarkably illumed the irregular margin on the three-dimensional 3D US, which was obtained by auto-sweep 3D scanning in the post-vascular phase. Tomographic ultrasound images in plane A, which can be translated from front to rear, with a slice distance of 4.
The hepatobiliary phase of EOBMRI right side , as the reference, was combined with conventional grayscale US left side , displayed an 8-mm indistinctive hypointense area the triangular arrow in segment V on the same screen for the fusion imaging A. The extrasmall lesion was hypervascular in the arterial phase of Sonazoid-enhanced ultrasound US B , while the post-vascular phase indicated it to be a slightly hypoechoic area C. Pathway guidance was ready for radiofrequency ablation RFA needle manipulation on real-time US B—D , along with tracking for the metallic needle tip the curved arrow D.
And Arrowheads indicate the margin of the extrasmall HCC lesion. Hepatocyte-Specific Uptake Mangafodipir trisodium Mn-DPDP used to be a classical hepatocyte-selective contrast agent that was developed in the last century and has favorable contrast-to-noise measurements and lesion detection rate as compared to non-enhanced MRI 49 , It was high-profile at the beginning for the prolonged enhancement relative to the traditional T1 contrast agents Moreover, it is reported that the hepatocyte-selective contrast agent is correlative with the pathological differentiation degree of HCC Since the uptake of Mn-DPDP strictly occurs in hepatocytes, the extrahepatic originated metastases can be negatively illustrated However, in contrast to the question of how many normal hepatocytes are contained in a lesion, the question of whether a liver lesion is malignant or not will be the highest concern for patients.
By integrating the mechanisms of both hepatocyte-selective contrast agents and non-specific extracellular Gd-chelates, gadolinium-based hepatobiliary-specific agents were thereby developed, such as gadobenate dimeglumine Gd-BOPTA and gadoxetic acid Gd-EOB-DTPA , which are worldwide commercially available and have become a promising MRI contrast agent for FLL 56 — For HCC diagnostic imaging, the so-called hepatobiliary contrast agents achieve further detection in the early stage for primary, recurrent, and metastatic HCCs through usual dynamic imaging and additional hepatobiliary delayed phase 59 — 62 Figures 1 , 2.
Molecular Imaging Agents For the diagnostic and therapeutic purpose of molecular imaging, by means of conjugating some antibody, peptide, or ligand, molecular imaging agents are artificially designed to anchor the targeted cellular and molecular hallmarks pathologically Immune Molecular Anchoring By means of immunoreaction, gadolinium-labeled reagents for liver tumor marking and monitoring of the MR modality are commonly employed in a tumor-bearing animal model for cancer research 66 , The molecular weight of reagents mainly ranges from dozens to hundreds of kDa.
Likewise, the MBs or nanobubbles binding compounds marked with the tumor-specific immune molecule are also available for cancer research in the CEUS modality
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Reception was at the home of Ruth and Jeff Bettinger. He received a Ph. He was a marriage and family therapist. He is retired. He is the son of the late Beatrice and Abraham Bettinger. He received a doctor of law degree from Tulane University in New Orleans in Berkeley in He is the director of continuing medical education programs for the International Society for Magnetic Resonance in Medicine.
He is the son of the late Syliva and Max U. The couple met on Dec. After a honeymoon in Manhattan, the newlyweds are spending time in both of their homes in San Francisco and Great Barrington, Mass. Judge Joseph Wapner officiated. The bride graduated from the University of Washington. She is an investment counselor at Bailard, Biehl and Kaiser.
She is the aunt of Halle and Andrew Friedeberg. He is a corporate lawyer. He is the brother of Dr. Irena Vaksman of New York. Grandparents are Drs. Matron of honor was Melinda Slatt-Friedeberg. Best man was Steve Koffeld. Bridesmaids were Dr.
Halle Friedeberg was the flower girl. Ring bearers were Paul Pavolotsky and Andrew Friedeberg. Witness and signers of the ketubah were Nira Manville and Michael Zatkin. After a honeymoon in France and Switzerland, the newlyweds are living in San Francisco. He or she can often see the therapist for a long or short time, depending on the desire of the client. As a result, there are a number of client with whom I have been working for years, on and off.
For some it has been more regular, others call me every year or two for a limited amount of sessions. Repeatedly, I have heard comments from client to the effect that I am the only person that ever really knew them. One former partner never wanted to hear about certain aspects of their lives. Their parents could never deal with some other aspect. The only place they could be themselves is in the therapy office. And for gay men who have lost friends and partners to AIDS, I may be the only one left who remembers them during all those periods in their life.
In our outside life, relationships are usually mutual; you get to talk about yourself and then the other person gets to talk about him or herself. This actually inhibits some people from sharing. Many people do not have the time or desire to get to know someone else that well.
But they still want to be known. In the therapy office, it is all about them. They can be sure that at least one person in the world knows them to the extent it is possible for them to share that information. And, as a byproduct of therapy, the person often gets to know themselves better and share that information. He is correct when he states that there is very little training, and most of that training has to do more with the mechanics of sex than with human sexuality.
The record of the American mental health profession regarding understanding the nature of human sexuality is poor. As a result, teachers cannot teach what they do not know. It is even worse when you consider that they are ignorant of this disconnect for the most part. They believe they know lot about human sexuality, but as the record shows, their understanding of homosexuality, bisexuality and being transgender is extremely poor.
It has improved in recent years, but it remains poor for the most part. To make this point even further, many sexual practices that involve SM or fetishes are considered to be pathological if the individual who is attracted to that form of sexuality is feeling distressed about it.
It is almost universally negative. The American mental health profession still has a lot to learn. As a psychotherapist with a variety of clients, I agree that it's crucial for people to have a safe, open, nonjudgmental place to discuss every aspect of their lives. And therapists themselves must be willing to look at the ways they unconsciously may project negative stereotypes. Also, some started their psychotherapy practices decades ago during the age of ignorance when being queer was still formally diagnosed as a disease.
In that respect, I'm glad I trained more recently in a more accepting environment, yet I too was only required to sign up for just one class in sexuality. What a blessing that the instructor for that class didn't focus on mechanics but instead helped us students to practice talking -- yes, out loud -- about sex.
We all finished that class more sensitive to sexual matters and to issues of sexual minorities. Psychotherapists are taught to look carefully at their own countertransference. But there is one problem here. Most of the psychotherapists about whom june writes are so unaware that they are having a personal reaction that they never label it is as such. They either feel their negative reaction is "right", or they don't even recognize they are having such a reaction. For those who feel their negative reactions are "right", there is hope.
They are acknowledgng their reaction. And queer people can then avoid them. For those who are unaware they are having a countertransference reaction, the prognosis is much poorer. They can't contain their countertransference if they don't even know it exists, and thus the damage continues. The support that a client gets from such a therapist, however, may be just one manifestation of the good qualities we've already touched on in this discussion: a compatible therapist, regardless of orientation, is positive and affirming, appreciates the client's unique issues, and is willing to confront his or her own biases.
Above all, a good therapist recognizes that -- while we all feel "different" to some degree -- the shame or isolation of queer people differs markedly from that of the so-called norm. It may be compared to the experience of other groups tat experience some of the same negative prejudices, but being queer is different and unique. We also face a unique set of challenges and the queer-affirmative psychotherapist understands either through experiences or their learning the nature of the unique experience and challenges faced by those who are queer.
For instance, it's easy for the therapist to just assume that an adult client who is gay or lesbian is familiar with issues that affect sexual minorities, moves around easily in the alternative community, has decided how to handle the question of coming out, and so on.
Actually, though, many who are queer have never had an adequate opportunity to discuss feelings, resolve conflicts, confront prejudices, and develop a sense of belonging. Maybe Mom and Dad are accepting, for example, but what happens to the parents' plans if they had specific dreams about, say, weddings and grandchildren? This and many many other work, family, relationship, and discrimination questions affect queer people every day.
Therapy is one place where it's essential for them to get all the support they ask for. Just because the son or daughter is an adult and no longer living in the same household as the parents does not preclude family therapy being a tool that can help the entire family. There have been innumerable times over the years when I have been working individually with a client, and at some point, the parents are coming to visit. These times present challenges for some clients, and some of those challenges can be discussed in family therapy.
I invited the client to invite his or her parents to come to one or more sessions while they are in town to discuss the issues. It is actually more helpful if one conceives of a psychotherapist as a consultant; someone with whom an individual, couple or a family goes to for help in dealing with some problem. If one has a tax problem, one goes to an accountant.
If the problem is emotional or relational, then one goes to a psychotherapist. This takes the psychotherapist down a notch to a place of equality with the client s , and that is helpful. I wanted to confess. Have you read that, I asked the guy. Yes, he said, I have. And do you agree with it, I asked. Much of it, yes, he said. Then you can't be my therapist, I said, and walked out.
I hope that in the process of "queer-affirmative" therapy, a time comes when the counseling and guidance is not merely to counteract shame, but to teach celebration. To dive headfirst into the lifelong process of discovering what "queer" means to the individual and practicing it with joy and vigor. Myers clmyers Mon 25 Mar 02 About the training, or lack thereof, in human sexuality, I suspect my educational experience is similar to June's.
I had the obligatory one course in sexuality counseling and it did teach me everything I needed to know about how people get in and out of orgasms physiologically. But the emphasis was much heavier on learning how to communicate empathically with clients about sexual concerns and to keep our powder dry while going through some insense and specific depictions of sexual activity. My clinical experience has been that it VERY important to be able to speak frankly and comfortably about sexual issues in whatever level of detail the client will do.
I've also found it EQUALLY important not more and not less to have a strong knowledge base about sexual functioning -- harkening back to a lot of that physiological stuff we had to slog through! I really think the reason for this goes right back to the negating and invisibility we're subjected to.
It's not easy in this society to find someone frank, knowledgeable and empathic to talk about sex with. It's even harder to find that person when the kind of sex you want to talk about is not the stock heterosexual fare. Thus, I also am nodding in agreement with the point June made about not assuming that clients, just because they're queer, have everything about being queer sorted out for themselves. I would add to that the notion that just because a therapist is queer, we can't assume that homophobic or heterosexist biases will not exist with them.
One thing I appreciate so much about Michael's book is that it really is speaking to clients as CONSUMERS and encouraging people to approach their therapy experience with a sense of knowing what they want and should be able to get from a good fit with a therapist. Which leads me back to your last point, Michael. Your analogy of considering a therapist in a way similar to that with which you would consider an accountant or other professional is an interesting one.
Part of the issue here is that there is no more shame in conferring with a therapist than with a tax professional. Another issue, though, that you allude to in your last sentence: the power therapists are presumed to hold. We are sometimes believed to be people who can read minds and change personalities and perform all kinds of psychic feats through some mysterious process that only we understand.
Can you say something, Michael, about this general misconception about therapists and therapy? Also -- what should clients reasonably expect from consulting a professional therapist, as opposed to conferring with a friend or family member?
Most of us the ethical among us, at least! Michael, I thought your book was very thorough and will be helpful to a wide range of seekers. I wonder if you could speak to the idea of queer therapists over-identifying with queer clients. This concept doesn't seem to apply to straight situations and I wondered if you had any thoughts.
I'm also wondering if there's been any research on perceived outcomes of queer clients who have straight therapists versus queer clients with queer therapists. In fact, many people come to me having already done the work about lessening or eliminating the issues of shame and isolation.
While many come to me with other problems, to some degree they already have begun to celebrate who they are. About ten years ago, I was involved in a project with a number of other queer family therapist in San Francisco. We wanted to put on a conference which would deal with the issues of queer families. But midway through the meeting, I objected.
I said we already had created the diversity. My personal values, which I believe get reflected in the therapy I do not believe there is value free therapy is to celebrate life, and all that is meaningful. Being lesbian, gay, bisexual, transgender, heterosexual, polyamorous or whatever other way someone goes about loving others and creating a life for themselves is to be celebrated. We can do that in healthy or unhealthy ways, and that is where work on oneself comes in, but our nature of loving is to be accepted and celebrated.
I would also like to respond to some comments made by Cindy in post If we are consultants, we had better have something to offer our client. What we have, or should have, is a very good knowledge about human behavior, human functioning, human relationships, etc. We are selling our knowledge and expertise.
We do need to know about the mechanics of sex, as well as knowledge of human sexuality. So I tell my counseling students when I get a chance to teach that it is their job to learn about people, lots of different people, and understand what happen to people inside of them, and when they interact with other human beings, or anything else in the world. As for changing personalities, that an easy one. Psychotherapist do not change personalities.
Personalities do not change. What does change is how well, or not well a person is functioning in this world. Personalities are set at an early age. But people can grow or regress within the nature of their personalities.
If we live to be and spend the entire time in psychotherapy, we would still say we were the person we were when we began, but hopefully we would be doing a better job of functioning in this world. The therapy is not about the therapist, or what the therapist wants for the client. It is all about the client and what the client wants.
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