College reopening and community spread of COVID-19 in the United States.

OBJECTIVE: After months of lockdown due to the COVID-19 outbreak, the US postsecondary institutions implemented different instruction approaches to bring their students back for the Fall 2020 semester. Given public health concerns with reopening campuses, the study evaluated the impact of Fall 2020 college reopenings on COVID-19 transmission within the 632 US university counties. STUDY DESIGN: This was a retrospective and observational study. METHODS: Bayesian Structural Time Series (BSTS) models were conducted to investigate the county-level COVID-19 case increases during the first 21 days of Fall 2020. The case increase for each county was estimated by comparing the observed time series (actual daily cases after school reopening) to the BSTS counterfactual time series (predictive daily cases if not reopening during the same time frame). We then used multilevel models to examine the associations between opening approaches (in-person, online, and hybrid) and county-level COVID-19 case increases within 21 and 42 days after classes began. The multigroup comparison between mask and non-mask-required states for these associations were also performed, given that the statewide guidelines might moderate the effects of college opening approaches. RESULTS: More than 80% of our university county sample did not experience a significant case increase in Fall 2020. There were no significant relationships between opening approaches and community transmission in both mask-required and non-mask-required states. Only small metropolitan counties and counties with a non-community college or a higher percentage of student population showed significantly positive associations with the case number increase within the first 21-day period of Fall 2020. For the longer 42-day period, the counties with a higher percentage of the student population showed a significant case increase. CONCLUSION: The overall findings underscored the outcomes of US higher education reopening efforts when the vaccines were still under development in Fall 2020. For individual county results, we invite the college- and county-level decision-makers to interpret their results using our web application.

Assessment of angiographic vascularity of meningiomas with dynamic susceptibility contrast-enhanced perfusion-weighted imaging and diffusion tensor imaging.

BACKGROUND AND PURPOSE: The roles of DTI and dynamic susceptibility contrast-enhanced-PWI in predicting the angiographic vascularity of meningiomas have not been studied. We aimed to investigate if these 2 techniques could reflect the angiographic vascularity of meningiomas. MATERIALS AND METHODS: Thirty-two consecutive patients with meningiomas who had preoperative dynamic susceptibility contrast-enhanced-PWI, DTI, and conventional angiography were retrospectively included. The correlations between angiographic vascularity of meningiomas, classified with a 4-point grading scale, and the clinical or imaging variables-age and sex of patient, as well as size, CBV, fractional anisotropy, and ADC of meningiomas-were analyzed. The meningiomas were dichotomized into high-vascularity and low-vascularity groups. The differences in clinical and imaging variables between the 2 groups were compared. Receiver operating characteristic curve analysis was used to determine the diagnostic performance of these variables. RESULTS: In meningiomas, angiographic vascularity correlated positively with CBV but negatively with fractional anisotropy. High-vascularity meningiomas demonstrated significantly higher CBV but lower fractional anisotropy as compared with low-vascularity meningiomas. In differentiating between the 2 groups, the area under the curve values were 0.991 for CBV and 0.934 for fractional anisotropy on receiver operating characteristic curve analysis. CONCLUSIONS: CBV and fractional anisotropy correlate well with angiographic vascularity of meningiomas. They may differentiate between low-vascularity and high-vascularity meningiomas.

Differentiation of primary central nervous system lymphomas and glioblastomas: comparisons of diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MR imaging without and with contrast-leakage correction.

BACKGROUND AND PURPOSE: Contrast leakage results in underestimation of the CBV of brain tumors. Our aim was to compare the diagnostic performance of DSC perfusion MR imaging without and with mathematic contrast-leakage correction in differentiating PCNSLs and glioblastomas. MATERIALS AND METHODS: Perfusion parameters-CBV, corrected CBV, and leakage coefficient-were measured in enhancing tumor portions and contralateral NAWM of 15 PCNSLs and 20 glioblastomas, respectively. The ratios of CBV and corrected CBV were calculated by dividing the tumor values by those obtained from contralateral NAWM. A paired t test was used to compare tumor K2 and NAWM K2, as well as tumor CBV ratios without and with leakage correction. Comparisons of CBV, corrected CBV, and K2 between PCNSLs and glioblastomas were done by using a 2-sample t test. The diagnostic performance of DSC perfusion MR imaging without and with contrast-leakage correction was assessed with receiver operating characteristic curve analysis. RESULTS: PCNSLs and glioblastomas demonstrated higher K2 than those in their contralateral NAWM. Corrected CBV ratios were significantly higher than the uncorrected ones for both tumors. PCNSLs had lower CBV ratios (P < .001), lower corrected CBV ratios (P < .001), and higher K2 (P = .001) compared with glioblastomas. In differentiating between PCNSLs and glioblastomas, the area under the curve of the CBV ratio, corrected CBV ratio, and K2 were 0.984, 0.940, and 0.788, respectively. CONCLUSIONS: PCNSL can be differentiated from glioblastoma with CBV ratios, corrected CBV ratios, and K2. CBV without contrast-leakage correction seems to have the best diagnostic performance in differentiating the 2 tumors.

Differentiation of pyogenic brain abscesses from necrotic glioblastomas with use of susceptibility-weighted imaging.

BACKGROUND AND PURPOSE: A common imaging finding in brain abscess and necrotic glioblastoma is a T2 hypointense margin. The features of this hypointense rim on SWI have not been previously described, to our knowledge. We aimed to differentiate abscesses from glioblastomas by assessing the morphology of their lesion margin by using SWI. MATERIALS AND METHODS: T2WI and SWI were performed in 12 abscesses and 20 rim-enhancing glioblastomas. On T2WI and SWI, the prevalence and the border types (complete versus incomplete) of hypointense rims were qualitatively assessed. On SWI, the contour (smooth versus irregular) and the location of hypointense rims relative to the contrast-enhancing rims as well as the prevalence of the "dual rim sign," defined as 2 concentric rims at lesion margins with the outer one being hypointense and the inner one hyperintense relative to cavity contents, were also analyzed. RESULTS: Prevalence and the border types of the hypointense rims on T2WI were not different between abscesses and glioblastomas. On SWI, there were significantly more hypointense rims that were complete (P < .001) and smooth (P < .001), having the same location as the contrast-enhancing rims (P < .001) for abscesses. A dual rim sign was present in 9 of 12 abscesses but absent in all glioblastomas (P < .001). CONCLUSIONS: SWI may be helpful in differentiating pyogenic abscesses from necrotic glioblastomas. The dual rim sign is the most specific imaging feature distinguishing the 2.

Volumetric measurement for comparison of the accuracy between intraoperative CT and postoperative MR imaging in pituitary adenoma surgery.

BACKGROUND AND PURPOSE: To improve the resection rate of unexpected residual pituitary tumor under image guidance, iCT provides a less time-consuming and more convenient approach of promising the safety of the trans-sphenoidal surgery. However, iCT was thought to have worse image quality than MR imaging. This study was designed to determine the predictive concordance of iCT with standard postoperative high-strength MR imaging for the detection of residual tumors. MATERIALS AND METHODS: From February to December 2009, 33 patients with pituitary macroadenomas were enrolled in this prospective study. All patients received endoscopic trans-sphenoidal surgery for tumor removal and underwent iCT before the surgery finished. If an accessible tumor remnant was suspected and resectable, the surgery was continued. To assess the accuracy of intraoperative evaluation of tumor resection, the intraoperative findings were compared with MR imaging findings obtained 2 to 3 months after surgery by individually calculating the residual tumor volume. RESULTS: There were no statistically significant differences in the comparison between iCT and postoperative MR imaging findings (P > .05), and the predictive rates were also high (R(2) value >0.9). The GTR rate in the case of the noninvasive and fresh cases was 89% (17/19). The overall GTR rate was 58% (19/33), the second-look rate was 21% (7/33), and only one-fourth of the recurrent cases reached GTR. CONCLUSIONS: The extent of resection in trans-sphenoidal surgery can be reliably assessed by iCT. Compared with postoperative MR imaging findings, the findings in this study provided quantitative evidence that iCT not only holds significant promise for maximizing the extent of tumor resection but also eliminates the unnecessary blind surgical manipulation, thus increasing the safety of the procedure.

Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study.

This randomized, double-blind, placebo-controlled study evaluated whether lamivudine given during late pregnancy can reduce hepatitis B virus (HBV) perinatal transmission in highly viraemic mothers. Mothers were randomized to either lamivudine 100 mg or placebo from week 32 of gestation to week 4 postpartum. At birth, infants received recombinant HBV vaccine with or without HBIg and were followed until week 52. One hundred and fifty mothers, with a gestational age of 26-30 weeks and serum HBV DNA >1000 MEq/mL (bDNA assay), were treated. A total of 141 infants received immunoprophylaxis at birth. In lamivudine-treated mothers, 56 infants received vaccine + HBIg (lamivudine + vaccine + HBIg) and 26 infants received vaccine (lamivudine + vaccine). In placebo-treated mothers, 59 infants received vaccine + HBIg (placebo + vaccine + HBIg). At week 52, in the primary analyses where missing data was counted as failures, infants in the lamivudine + vaccine + HBIg group had a significant decrease in incidence of HBsAg seropositivity (10/56, 18%vs 23/59, 39%; P = 0.014) and in detectable HBV DNA (11/56, 20%vs 27/59, 46%; P = 0.003) compared to infants in the placebo + vaccine + HBIg group. Sensitivity analyses to evaluate the impact of missing data at week 52 resulting from a high dropout rate (13% in the lamivudine + vaccine + HBIg group and 31% in the placebo + vaccine + HBIg group) remained consistent with the primary analysis in that lower transmission rates were still observed in the infants of lamivudine-treated mothers, but the differences were not statistically significant. No safety concerns were noted in the lamivudine-treated mothers or their infants. Results of this study suggest that lamivudine reduced HBV transmission from highly viraemic mothers to their infants who received passive/active immunization.

Multiple extra-axial adenocarcinomas mimicking meningiomas: a case report.

We present the case of multiple meningeal tumours in the right sphenoid ridge and left parafalcine region. Magnetic resonance imaging disclosed homogenous enhancement. The histopathological examination revealed metastatic adenocarcinoma of both lesions. Metastatic adenocarcinoma should be considered in the differential diagnosis of dural-base lesions and the definitive diagnosis should only be established after the histopathological report.

Spinal epidural Rosai-Dorfman disease preceding by relapsing uveitis: a case report with literature review.

STUDY DESIGN: Case report. SETTING: Tertiary referral center hospital in Taiwan. OBJECTIVES: To report a case of spinal Rosai-Dorfman disease (RDD) presenting with paraparesis and also preceding by relapsing uveitis for 6 months. A thoracic laminectomy was performed to remove the solid mass. The pathological diagnosis reveals infiltrating histiocytes, emperipolesis and positivity for S-100. There is no recurrence 1 year later with MR imaging. CONCLUSIONS: The relapsing idiopathic uveitis may be a prodrome for this unusual disease, because RDD is associated closely to defective immunogical response. Early and accurate diagnosis of CNS RDD may reverse the neurologic deficits by early decompression.

Effects of heat, acid, and freeze-thaw challenges on survival of starved Vibrio parahaemolyticus in minimal salt medium, tryptic soy broth, and filtered oyster homogenate medium.

Vibrio parahaemolyticus is a ubiquitous gram-negative enteropathogenic bacterium. To evaluate the risk of stress-adapted V. parahaemolyticus cells in food, we investigated the survivability of starvation-adapted and starvation-low salinity-adapted cells of this pathogen in different media against different stresses. Logarithmically grown bacterial cells were starved at 25 degrees C in a minimal salt medium with 0.5 or 3.0% NaCl for 24 h. Resistances against challenges of heat, acid, and freeze-thaw treatment exhibited by the starvation-adapted cells were similar to those exhibited by the starvation-low salinity-adapted cells but substantially higher than those of the unadapted control cells. The increased stress resistance of the adapted cells against freeze-thaw challenge was lower in tryptic soy broth than in the starving medium. Resistance of the adapted bacteria against heat and freeze-thaw treatment was completely eliminated in filter-sterilized oyster homogenate medium. Practically, these results help to assess the risk of stress-adapted V. parahaemolyticus in food.

Solitary intraventricular tuberculoma in adults.

Intracranial tuberculoma is typically located in the parenchyma. Lesions limited to the ventricular system are uncommon. It is difficult to make a differential diagnosis from other lesions if no systemic tuberculosis is present. This study investigates a case of solitary intraventricular tuberculoma in a 19-year-old female patient with an initial clinical symptom of progressive headache. Cranial computed tomography revealed a strongly enhanced lesion in the lateral ventricle. Histopathology of the tumor demonstrated chronic inflammation, caseous necrosis, epithelioid cells and Langhans' giant cell. The culture study grew M. Tuberculosis. Solitary intraventricular tuberculoma in adults is extremely rare. Medical treatment is the preferred management method of this disease, and surgical intervention should be considered in certain situations.

Occupancy of glycoprotein IIb/IIIa by B-6 vitamers inhibits human platelet aggregation.

Vitamin B-6 inhibits platelet aggregation. However, the effect of the occupancy of GPIIb/IIIa, a major receptor responsible for aggregation on platelet membranes, by B-6 vitamers on platelet aggregation is unknown. This study was carried out to quantify GPIIb/IIIa occupancy in platelets treated with B-6 vitamers [pyridoxal-5-phosphate (PLP); pyridoxal (PL); pyridoxine (PN); pyridoxamine (PM)], using a monoclonal antibody-based assay, by flow cytometry. Antibody binding was compared with inhibition of platelet aggregation. PLP, PL, PN and PM occupied GPIIb/IIIa with dissociation constants of 1.83 +/- 1.15, 19.43 +/- 7.86, 3.63 +/- 1.67 and 10.89 +/- 2.93 mmol/L, respectively. Occupancy of GPIIb/IIIa by the four B-6 vitamers was negatively correlated with platelet aggregation (r = -0.90 to -0.94, P < 0.001). The concentrations of the four B-6 vitamers that inhibited maximal platelet aggregation were in the order of PLP < PN or =80% of the GPII/IIIa receptor. Platelet aggregation was inhibited by B-6 vitamers via the occupancy of GPIIb/IIIa with the potency of PLP > PN > PM > PL.

Hyperbaric oxygen treatment decreases post-ischemic neurotrophin-3 mRNA down-regulation in the rat hippocampus.

The therapeutic effect of hyperbaric oxygen (HBO) on ischemic injury was investigated using in situ hybridization to detect the mRNA expression of neurotrophin-3 (NT-3), which is thought to play a crucial role in protecting against neuronal death induced by brain ischemia. The rats under investigation were subjected to 10 min transient forebrain ischemia, and subsequently exposed to HBO (100% oxygen, 2.5 atm absolute) for 2 h. Levels of NT-3 mRNA in the CA1, CA2 and CA3 regions, and the dentate gyrus of the hippocampus were measured after various reperfusion periods. Neuronal death in the hippocampal CA1 region was also measured by Nissl staining, seven days post ischemia. The results demonstrated that HBO treatment significantly reduced the ischemia-induced down-regulation of the NT-3 mRNA level at 4 h post ischemia, and significantly increased cell survival 7 days after reperfusion. The findings suggest that an HBO treatment maintaining the NT-3 mRNA level in the hippocampus can be beneficial to the ischemic brain within a certain time frame.

Development of a real-time control strategy with artificial neural network for automatic control of a continuous-flow sequencing batch reactor.

The purpose of this study is to develop a reliable and effective real-time control strategy by integrating artificial neural network (ANN) process models to perform automatic operation of a dynamic continuous-flow SBR system. The ANN process models, including ORP/pH simulation models and water quality ([NH4(+)-N] and [NOx(-)-N]) prediction models, can assist in real-time searching the ORP and pH control points and evaluating the operation performances of aerobic nitrification and anoxic denitrification operation phases. Since the major biological nitrogen removal mechanisms were controlled at nitrification (NH4(+)-N-->NO2(-)-N) and denitritification (NO2(-)-N-->N2) stages, as well as the phosphorus uptake and release could be completely controlled during aerobic and anoxic operation phases, the system operation performances under this ANN real-time control system revealed that both the aeration time and overall hydraulic retention time could be shortened to about 1.9-2.5 and 4.8-6.2 hrs/cycle respectively. The removal efficiencies of COD, ammonia nitrogen, total nitrogen, and phosphate were 98%, 98%, 97%, and 84% respectively, which were more effective and efficient than under conventional fixed-time control approach.

Membranous obstruction of the fourth ventricle outlet. A case report.

We report the case of a 15-year-old girl with amenorrhea and a several-week history of headache. After the diagnosis of membranous obstruction of the foramen of Magendie suggested by MRI, suboccipital craniotomy for removal of the membrane was carried out. The patient made an excellent postoperative recovery, and postoperative phase-contrast MRI demonstrated patent cerebrospinal fluid (CSF) pathways at the level of the foramina of Magendie and Luschka. We believe that this case is of interest because of the unequivocal evidence on MRI studies of the occlusion of the foramen of Magendie preoperatively, and because of the dramatic postoperative MRI findings demonstrating the effectiveness of the surgical procedure both in terms of ventricular size and CSF flow characterization.

The study of Central Taiwan particles concentration variations during earthquake period.

Ambient particle concentration was taken on the traffic sampling site over the Chung-Chi Road over the bridge (CCROB) in front of Hungkuang Institute of Technology (HKIT). The sampling time was from August 1999 to December 1999. During the sampling period, Taiwan's biggest earthquake in more than a century registered 7.3 on the Richter scale (Taiwan Chi-Chi Earthquake). Besides, there are more than 20,000 aftershocks following the Taiwan Chi-Chi Earthquake within 3 months. Thus, the mass concentration of particles with aerodynamic diameters smaller than 2.5 microm (PM2.5) and PM2.5-10 was also collected then compared with the total mass concentration of suspended particles (TSP) in this study. The average TSP, PM2.5-10, and PM2.5 concentrations are 106, 24.6, and 58.0 microg/m3, respectively, after the Taiwan Chi-Chi Earthquake. The average TSP concentrations before and after Taiwan Chi-Chi Earthquake were 69.6 and 127 microg/ m3, respectively. In addition, statistical analysis of the PM10 data from this study and EPA in 1999 yielded a Tstatistic of 0.147, which is smaller than t(0.975,18) = 2.101. It is indicated that there was no significant difference. So, the PM10 concentrations measured after Taiwan Chi-Chi Earthquake in this study were also greater than those data previously obtained from Taiwan EPA in the same region of this area. The relationships between TSP, PM10, PM2.5-10, and PM2.5 particle concentrations and wind speed (R2) are .77, .59, .58, .58, respectively. And the ratios of PM2.5/PM25-10, PM2.5/PM10, and PM10/TSP are 221%, 67.2%, 58.0%, respectively. The average ratios of PM2.5/PM2.5-10 and PM2.5/PM10 increase by about 120% and 17%. It indicated that the fine-particles concentration increases compared to the coarse-particles concentration after 921 Taiwan Chi-Chi Earthquake. And the proposed reasons are that local motor vehicle emissions combined the fine particles transported from the Chi-Chi epicenter. More importantly, the wind direction was mainly blown from southeastern part. These two main factors enhance the fine-particles concentration in this area.

Breast uptake of iodine-131 mimicking lung metastases in a thyroid cancer patient with a pituitary tumour.

We report a case of a 44-year-old female thyroid cancer patient with a pituitary tumour. 131I whole body scanning showed a change of chest uptake from a unilateral crescent uptake to a bilateral full breast uptake pattern. Hyperprolactinaemia and a pituitary tumour were diagnosed as a result of observing the 131I breast uptake.

The feasible sequential control strategy of treating high strength organic nitrogen wastewater with sequencing batch biofilm reactor.

The bio-kinetics and feasible sequential control strategy of treating high strength organic carbon and nitrogen wastewater were investigated by conducting the ABS manufacturing wastewater in a series of Sequencing Batch Biofilm Reactors (SBBRs). The on-line ORP, pH, and DO monitoring parameters were applied to identify the feature-points when ammonification, nitrification, and denitrification ends. The carbonaceous matter removal kinetics in the anaerobic and aerobic reaction stages can be expressed by the Michaelis-Menten equation. High efficiency of organic carbon removal and organic nitrogen ammonification in the anaerobic stage can eliminate the substrate competition and activation inhibition to nitrifying organisms in the following aerobic stage. In the sequencing nitrogen removal processes, the producing time and system ORP values of these feature-points have good function relationships with the influent COD loading rates of SBBR, which can be integrated into a set-point (set-time and set-ORP) sequential control strategy of nitrogen removal. The automatic control operation results revealed ORP was one of the major control parameters of the sequencing nitrogen removal process in SBBR system and high overall removal efficiency were obtained.

Cerebellar metastasis from papillary serous adenocarcinoma of the ovary mimicking Ménière's disease. A case report.

BACKGROUND: In rare cases, cerebellar metastasis originating in serous papillary adenocarcinoma of the ovary can mimick Ménière's disease. CASE: A 51-year-old woman, with complete remission after optimal maximal debulking and chemotherapy for an International Federation of Gynecology and Obstetrics IIIc primary ovarian carcinoma, presented with nausea, vomiting, vertigo and headache 18 months after surgery. Investigations revealed a solitary cerebellar cystic mass, 4.6 x 4.0 x 3.2 cm. Gross total excision of the cerebellar lesion followed by brain irradiation resulted in complete resolution of her symptoms. Histology showed a metastatic tumor consistent with the primary ovarian carcinoma. CONCLUSION: In an atypical presentation in patients with metastatic ovarian carcinoma, thorough investigations should be done to rule out or confirm brain metastasis, which can be aggressively managed to prevent serious consequences and improve outcome.

Proton magnetic resonance spectroscopy of cerebral glioma after irradiation.

BACKGROUND: Conventional magnetic resonance imaging (MRI) is commonly employed to assess cerebral gliomas after radiotherapy, but it cannot always differentiate tumor regrowth from post-irradiation changes. In this study, we utilized magnetic resonance spectroscopy (MRS) to evaluate changes in cerebral metabolites in patients with a cerebral glioma after irradiation. METHODS: Over a period of 3 years, we performed MRS after MRI whenever soft tissue masses were found on magnetic resonance (MR) images. A total of 122 MR spectra of 58 patients was used for analysis. Spectral interpretations were based on integral values of the N-acetylaspartate (NAA) and choline (Cho) compounds relative to phosphocreatine/creatine (Cr). RESULTS: Our MRS study showed that higher Cho/Cr ratios occurred in regrowing gliomas than for stable diseases (range, 0.9 to 9.5 vs. 0.4 to 2.1; mean, 3.0 vs. 1.2). A greater increment in the Cho/Cr ratio between successive studies was also noted in regrowing gliomas than for stable disease (range, 41% to 87% vs. < 32%). No significant differences in NAA/Cr ratios or lactate were found between these 2 groups. None of our patients exhibited abnormal MR spectra in the mirror area of the contralateral brain. CONCLUSION: MRS provides valuable information about the metabolism of irradiated gliomas and can be used to exclude radiation encephalopathy of the contralateral brain. Cho is the most reliable indicator of a regrowing glioma. A high Cho/Cr ratio or substantial elevation in the Cho/Cr ratio between serial studies increases the likelihood of tumor regrowth. However, lower Cho/Cr ratios were inconclusive for determining if tumor regrowth or a stable process was occurring.

Lateralization and prognostic value of proton magnetic resonance spectroscopy in patients with intractable temporal lobe epilepsy.

BACKGROUND: The aims of this prospective study were to investigate the stability of hippocampal metabolite ratios obtained by proton magnetic resonance spectroscopy (MRS), to evaluate the ability of MRS to determine the pre-surgical lateralization of seizure focus, and to assess the relationship between MRS results and postoperative outcomes in patients with intractable temporal lobe epilepsy. METHODS: Within- and between-acquisition variations were evaluated in 30 control subjects, using the chemical-shift imaging technique. The most stable metabolite ratio was then applied for pre-surgical evaluation of 14 patients with intractable temporal lobe epilepsy. RESULTS: The ratio between N-acetylaspartate (NAA) and choline-containing compounds (Cho) plus creatine-phosphocreatine (Cr), i.e., NAA/(Cho+Cr), had an overall smaller percentage change between measurements (13%-28%) than did the other ratios: NAA/Cho (18%-37%), NAA/Cr (11%-60%), and Cho/Cr (19%-51%). With a mean follow-up period of 27 months (range, 12-55 months) after an anterior temporal lobectomy, 10 patients were in Engel s class I (71%), 2 were in class II (14%), and 2 were in class III (14%). Lateralization by MRS was consistent with the operation side in 11 (79%) patients, including class I in 8 patients, class II in 1 patient, and class III in 2 patients. Ranges of reduced NAA/(Cho+Cr) values were similar between patients with different post-surgical outcomes: 0.26-0.47 for class I, 0.40-0.45 for class II, and 0.34-0.40 for class III (p=0.651). CONCLUSIONS: Proton MRS may be helpful in pre-surgical lateralization of the seizure focus in patients with intractable temporal lobe epilepsy; however, it cannot provide prognostic information about postoperative seizure control.