The purpose of this study was to investigate associations between right ventricular (RV) function and left ventricular (LV) diastolic function in patients with reduced LV ejection fraction (LVEF) and preserved LVEF.
Methods
A total of 139 patients who had undergone echocardiography were recruited. LV diastolic function was determined as the ratio of mitral inflow E to mitral e′ lateral annular velocities (E/e′). RV function was determined as the RV index of myocardial performance (RIMP). Patients were divided into two groups: the preserved LVEF group (n = 100, LVEF ≥ 50%) and the reduced LVEF group (n = 39, LVEF < 50%).
Results
Associations between RV function and LV diastolic function in patients with reduced LVEF and preserved LVEF differed significantly. RIMP correlated significantly with E/e′ in patients with reduced LVEF (r = 0.47, p = 0.003), but not in those with preserved LVEF (r = 0.04, p = 0.68). An important finding of the multivariate regression analysis showed that RIMP was the only independent determinant of E/e′ in patients with reduced LVEF, whereas age and gender (not RIMP) was the independent determinant of E/e′ in patients with preserved LVEF.
Conclusions
Associations between RV function and LV diastolic function in patients with reduced LVEF and preserved LVEF differed significantly, and RV function showed a close correlation with LV diastolic function in patients with reduced LVEF, but not in those with preserved LVEF. Thus, these findings may well have clinical implications for better management of patients with reduced LVEF.
Posterior myocardial infarction (MI) can induce LV remodeling and ischemic mitral regurgitation (IMR). The protective effects of a cardiac support device (CSD) against LV remodeling and IMR after posterior MI have been poorly documented.
Methods
Posterior MI was induced by ligation of the left circumflex coronary artery in beagle dogs. After 7 days, the dogs were randomized to a CSD placement (CSD group, n = 8) or no treatment (CTL group, n = 8).
Results
At 3 months after MI, the LV remodeling was less marked and the LV and RV systolic functions were better in the CSD group than in the CTL group. Neither the RV nor LV diastolic function (min dP/dt, Tau and EDPVR) was disturbed by the CSD. IMR was consistently prevented in our canine model.
Conclusion
Early application of a CSD after posterior MI can attenuate LV remodeling without causing any deterioration of the biventricular diastolic function.
In end-stage renal disease patients with preserved LV ejection fraction undergoing chronic hemodialysis, we investigated the relationship of left atrial deformational parameters evaluated by two-dimensional speckle tracking imaging (2D-STI) with conventional echocardiographic diastolic dysfunction parameters and brain natriuretic peptide level.
Methods
The study group enrolled 30 patients treated with chronic hemodialysis three times weekly. Two-dimensional transthoracic echocardiography and Doppler studies were performed 44.93 (13.46) immediately before and after HD. All patients had preserved left ventricular ejection fraction.
Results
The mean age of patients was 44.93 ± 13.46 years. The mean brain natriuretic peptide (BNP) value after HD was 221.56 ± 197.79 pg/ml. BNP values were significantly higher before HD (p = 0.004), the anteroposterior diameter, area, and the volumes of the LA decreased significantly after HD. On the other hand, the left atrial ejection fraction (LAEF) and the peak LA strain during LV systole (LAGS) were found to be higher. Before HD, there were significant inverse correlations between LAGS and BNP levels (r = ?0.482, p = 0.007), E/E′ (r = ?0.33, p = 0.049), LAVmax (r = ?0.366, p = 0.047), and LAVmin (r = –0.579, p = 0.001). LAGS had a significant correlation with E′ velocity (r = 0.557, p = 0.001) (Table 5) and LAEF (r = 0.58, p = 0.001). After HD, there were also significant correlations between LAGS and echocardiographic parameters of systolic and diastolic LV function.
Conclusions
We observed that left atrium global peak systolic strain values decreased consistently with deteriorating systolic and diastolic function. Our results suggest that LAGS measurements may be helpful as a complimentary method to evaluate diastolic function.
We examined the impact of advanced age on left ventricular mass regression and the change in the diastolic function after aortic valve replacement in patients with aortic stenosis.
Methods
The present study included 129 patients who underwent either surgical or transcatheter aortic valve replacement and 1-year postoperative echocardiography. The patient characteristics and echocardiographic findings were compared between patients who were <80 years of age (group Y: n = 69) and those who were ≥80 years of age (group O: n = 60).
Results
Preoperative echocardiography revealed that although the left ventricular mass was similar between the groups, the patients in group O had more severe diastolic dysfunction in comparison to those in group Y. Postoperatively, left ventricular mass regression was significantly greater (p = 0.02) and diastolic dysfunction was less prevalent in group Y (p = 0.02) in comparison to group O. The change in E/e′ was significantly correlated with the left ventricular mass regression in group Y (p = 0.02), but not in Group O (p = 0.21).
Conclusions
The patients in group O were less susceptible to improvements in myocardial remodeling and the diastolic function in comparison to those in group Y. The altered physiological response to aortic valve replacement might help to determine the appropriate timing of surgery in elderly patients.
It has been reported that carotid intima-media thickness (IMT) correlates with the risk of stroke or cardiovascular disease. The purpose of this study was to analyze the relationships between echocardiographic findings and carotid atherosclerosis.
Methods
A total of 234 patients (62 ± 15 years) were referred for echocardiography to evaluate the left ventricular (LV) function. The LV ejection fraction, the ratio of the peak velocity of early rapid filling and the peak velocity of atrial filling (E/A), and the peak early diastolic mitral annular velocity (e′) were obtained by echocardiography. The maximum IMT (Max-IMT) and plaque score (PS) were measured by carotid ultrasonography within 1 month of the echocardiographic examination.
Results
The mean values of Max-IMT and carotid PS were 2.41 ± 1.23 mm and 8.5 ± 6.3, respectively. The decreased mean E/A (0.94 ± 0.39) and mitral e′ (5.5 ± 1.9 cm/s) indicated LV diastolic dysfunction. A good correlation was observed between Max-IMT and PS (r = 0.83, p < 0.0001). It was shown that 2.8 mm of Max-IMT was equivalent to 10.1 of carotid PS, which indicated severe carotid atherosclerosis. In multiple logistic stepwise regression analysis, among the echocardiographic parameters, only e′ was independently associated with severe carotid atherosclerosis (Max-IMT ≥ 2.8 mm or PS ≥ 10.1).
Conclusions
The present study demonstrated that decreased early diastolic mitral annular velocity relates to the parameter reflecting carotid atherosclerosis. Therefore, the presence of severe carotid atherosclerosis may affect LV diastolic dysfunction.
To investigate differences in functional intervertebral disk (IVD) characteristics between low back pain (LBP) patients and controls using T2-mapping with axial loading during MRI (alMRI).
Methods
In total, 120 IVDs in 24 LBP patients (mean age 39 years, range 25–69) were examined with T2-mapping without loading of the spine (uMRI) and with alMRI (DynaWell® loading device) and compared with 60 IVDs in 12 controls (mean age 38 years, range 25–63). The IVD T2-value was acquired after 20-min loading in five regions of interests (ROI), ROI1-5 from anterior to posterior. T2-values were compared between loading states and cohorts with adjustment for Pfirrmann grade.
Results
In LBP patients, mean T2-value of the entire IVD was 64 ms for uMRI and 66 ms for alMRI (p?=?0.03) and, in controls, 65 ms and 65 ms (p?=?0.5). Load-induced T2-differences (alMRI–uMRI) were seen in all ROIs in both patients (0.001?>?p?<?0.005) and controls (0.0001?>?p?<?0.03). In patients, alMRI induced an increase in T2-value for ROI1-3 (23%, 18% and 5%) and a decrease for ROI4 (3%) and ROI5 (24%). More pronounced load-induced decrease was detected in ROI4 in controls (9%/p?=?0.03), while a higher absolute T2-value was found for ROI5 during alMRI in patients (38 ms) compared to controls (33 ms) (p?=?0.04).
Conclusion
The alMRI-induced differences in T2-value in ROI4 and ROI5 between patients and controls most probably indicate biomechanical impairment in the posterior IVD regions. Hence, alMRI combined with T2-mapping offers an objective and clinical feasible tool for biomechanical IVD characterization that may deepen the knowledge regarding how LBP is related to altered IVD matrix composition.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
The diastolic wall strain (DWS) of the left ventricle has been proposed as an indicator of left ventricular (LV) wall stiffness. The DWS is calculated as follows using M-mode echocardiography:
$${\text{DWS}} = \left[ {\left( {\text{LV posterior wall thickness at end-systole}} \right) - \left( {\text{LV posterior wall thickness at end-diastole}} \right)} \right]/\left( {\text{LV posterior wall thickness at end-systole}} \right)$$
Although this index is simple and clinically useful, normal values for children, including neonates, have not been reported.
Methods
The DWS was measured in 235 healthy people, ranging from neonates to adults. They were classified into 8 subgroups according to their age. The DWS was compared with conventional echocardiographic parameters for left ventricle function, including shortening fraction of the left ventricle, the Tei index, E/A of mitral flow, mitral annular tissue Doppler velocity during systole (s′) and during early diastole (e′), and the E/e′ ratio.
Results
The DWS in the just after birth group was 0.28 ± 0.11, which was significantly lower than that of the remaining groups (p < 0.05), except for the neonate group at 5–10 days after birth. The DWS was highest in the 1–9 years of age group, and then gradually decreased with age. Stepwise regression of various echocardiographic parameters showed that e′ was the most relevant parameter for the DWS (β = 0.64).
Conclusions
Normal values for the DWS of the left ventricle change with age. The data reported in this study can be used as normal values for the DWS of the left ventricle determined by M-mode echocardiography.
Amputation for localized extremity sarcoma (ES), once the primary therapy, is now rarely performed. We reviewed our experience to determine why patients with sarcoma still undergo immediate or delayed amputation, identify differences based on amputation timing, and evaluate outcomes.
Methods
Records of patients with primary, nonmetastatic ES who underwent amputation at our institution from 2001 to 2011 were reviewed. Univariate analysis was performed, and survival outcomes were calculated.
Results
We categorized 54 patients into three cohorts: primary amputation (A1, n = 18, 33%), secondary amputation after prior limb-sparing surgery (A2, n = 22, 41%), and hand and foot sarcomas (HF, n = 14, 26%). Median age at amputation was 54 years (range 18–88 years). Common indications for amputation (> 40%) were loss of function, bone involvement, multiple compartment involvement, and large tumor size (A1); proximal location, joint involvement, neurovascular compromise, multiple compartment involvement, multifocal or fungating tumor, loss of function, and large tumor size (A2); and joint involvement and prior unplanned surgery (HF). There was no difference in disease-specific survival (DSS) (p = 0.19) or metastasis-free survival (MFS) (p = 0.31) between early (A1) and delayed (A2) amputation. Compared with cohorts A1/A2, HF patients had longer overall survival (OS) (p = 0.04).
Conclusions
Indications for amputation for extremity sarcoma vary between those who undergo primary amputation, delayed amputation, and amputation for hand or foot sarcoma. Amputations chosen judiciously are associated with excellent disease control and survival. For patients who ultimately need amputation, timing (early vs. delayed) does not affect survival.
Speckle tracking echocardiography (STE) is an echocardiography modality that is able to measure left ventricular (LV) characteristics, including rotation, strain and strain rate. Strain measures myocardial fibre contraction and relaxation. This study aims to assess the effect of renal sympathetic denervation (RDN) on functional myocardial parameters, including STE, and to identify potential differences between responders and non-responders.
Methods
The study population consisted of 31 consecutive patients undergoing RDN in the context of treatment for resistant hypertension. Patients were included between December 2012 and June 2014. Transthoracic echocardiography and speckle tracking analysis was performed at baseline and at 6 months follow-up.
Results
The study population consisted of 31 patients with treatment-resistant hypertension treated with RDN (mean age 64 ± 10 years, 15 men). The total study population could be divided into responders (n = 19) and non-responders (n = 12) following RDN. RDN reduced office blood pressure by 18.9 ± 26.8/8.5 ± 13.5 mmHg (p < 0.001). A significant decrease was seen in LV posterior wall thickness (LVPWd) (0.47 ± 1.0 mm; p = 0.020), without a significant change in the LV mass index (LVMI). In the total cohort, only peak late diastolic filling velocity (A-wave velocity) decreased significantly by 5.3 ± 13.2 cm/s (p = 0.044) and peak untwisting velocity decreased significantly by 14.5 ± 28.9°/s (p = 0.025).
Conclusion
RDN reduced blood pressure and significantly improved functional myocardial parameters such as A-wave velocity and peak untwisting velocity in patients with treatment-resistant hypertension, suggesting a potential beneficial effect of RDN on myocardial mechanics.
To investigate the epidemiology of radiographic degenerative lumbar scoliosis (DLS) and symptomatic DLS and clarify the impact of radiographic spinopelvic parameters on the presence of symptoms and quality of life (QOL) in DLS subjects.
Methods
We obtained the age, gender, screening for chronic low back pain (CLBP) and lumbar spinal stenosis (LSS), QOL assessments and X-rays of the thoracolumbar spine from 254 patients from the general population for this study. The prevalence of DLS and symptomatic DLS were estimated and factors associated with symptoms, and the QOL in the DLS subjects was analysed.
Results
The prevalence of radiographic and symptomatic DLS was 19.2 and 7.8 %, respectively. A female gender (p = 0.018) and decreased sacral slope (p = 0.025) were associated with the presence of CLBP in the DLS subjects. A higher age was also associated with the presence of LSS in these subjects (p = 0.007), whereas the Cobb angle was found to be close the limit for significance (p = 0.063). The sacro-femoral-pubic angle and Cobb angle correlated with the EuroQol-5 dimensions utility score (r = 0.314, p = 0.014) and EuroQol-visual analogue scale score (r = ?0.291, p = 0.043), respectively. Lumbar lordosis and body mass index correlated with the lumbar function (r = 0.285, p = 0.047) and visual analogue scale for leg pain (r = 0.328, p = 0.022) on the Japanese Orthopaedic Association Back Pain Questionnaire, respectively.
Conclusions
The prevalence of radiographic DLS in this study was approximately 20 % and roughly 40 % of the DLS subjects had symptoms. Some spinopelvic parameters may impact the occurrence of symptoms and the QOL in DLS subjects.
The purpose of this study was to evaluate the role of medial opening wedge high tibial osteotomy (HTO) in medial unicompartmental osteoarthritis (MCOA) of knee and to compare between the two methods of osteotomy using either dynamic axial fixator (DAF) or locking compression plate (LCP).
Methods
A total of 20 patients with medial osteoarthritis of knee were enrolled in this prospective study who were divided into two groups of 10 each. First group comprising of two males and eight females were treated by HTO using DAF. Second group comprising of five males and five females were treated by HTO using LCP. We assessed various radiological parameters including hip knee ankle angle (HKA), tibiofemoral angle (TFA), weight-bearing line on tibia, Insall Salvati index and tibial slope. Functional outcome of knee at final follow-up was assessed by Oxford knee score (OKS) and visual analogue scale.
Results
In first group, mean HKA angle changed from 187° to 178.30° (p = 0.006), mean TFA from 182.40° to 172° (p = 0.003), average position of weight-bearing line from 11.24 to 59.54 % (p = 0.004), and mean OKS 43.3–16.9 (p = 0.004). In second group, mean HKA angle changed from 186° to 178.80° (p = 0.004), mean TFA from 180.90° to 173.60° (p = 0.004), average position of weight-bearing line from 14 to 61.3 % (p = 0.004), and mean OKS 43.2–16.5 (p = 0.002).
Conclusion
HTO is an established treatment for patients with symptomatic MCOA knee with significant improvement in the clinical and radiographic parameters. There is no significant difference between the two methods; however, external fixator has the complication of pin tract infections.
To investigate the outcomes of patients with colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated using the liver-first approach in the era of modern chemotherapy in Japan.
Methods
We analyzed and compared data retrospectively on patients with asymptomatic resectable colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated either using the liver-first approach (n = 12, LF group) or the primary-first approach (n = 13, PF group).
Results
Both groups of patients completed their therapeutic plan and there was no mortality. Postoperative morbidity rates after primary resection and hepatectomy, and post-hepatectomy liver failure rate were comparable between the groups (p = 1.00, p = 0.91, and p = 0.55, respectively). Recurrence rates, median recurrence-free survival since the last operation, and 3-year overall survival rates from diagnosis were also comparable between the LF and PF groups (58.3 vs. 61.5 %, p = 0.87; 10.5 vs. 18.6 months, p = 0.57; and 87.5 vs. 82.5 %, p = 0.46, respectively).
Conclusions
The liver-first approach may be an appropriate treatment sequence without adversely affecting perioperative or survival outcomes for selected patients.
The relation between systolic pulmonary pressure (sPAP) and left atrium in patients with heart failure (HF) is unclear. Diastolic dysfunction, expressed as restrictive mitral filling pattern (RMP), and functional mitral regurgitation (FMR) are associated with both LA enlargement and increased sPAP. We aimed to evaluate whether atrial dilation might modulate the consequences of RMP and FMR on the pulmonary circulation of patients with HF with reduced ejection fraction (HFrEF).
Methods
1256 HFrEF patients were retrospectively recruited in four Italian centers. Left ventricular (LVD) and atrial (LAD) diameters were measure by m-mode, and EF were measured. RMP was defined as E-wave deceleration time lower than 140 ms. FMR was quantitatively measured. sPAP was evaluated based on maximal tricuspid regurgitant velocity and estimated right atrial pressure.
Results
Final study population was formed by 1005 patients because of unavailability of sPAP in 252 patients. Mean EF was 33 ± 3, 35% had RMP, 67% had mild, and 26% moderate-to-severe FMR. 69% of patients had increased sPAP. A significant association was observed between sPAP and EF, RMP, FMR, and LAD (p < 0.0001 for all). At multivariate analysis, LAD was positively associated with sPAP (p < 0.0001) independently of EF, RMP, and FMR. Analogously, LAD (p < 0.05) was associated with more severe symptoms and worse prognosis after adjustment for LV function and FMR.
Conclusion
LA dilation was positively associated with sPAP independently of EF, RMP, and FMR. This highlights that LA size should be considered a marker of the severity of the disease.
Two-dimensional (2D) speckle tracking imaging (STI) is a non-invasive method used to assess subtle changes in left ventricular (LV) function such as strain and rotational dynamics. However, 2D methodology is complicated by issues such as the out-of-plane problem inherent in short-axis imaging. In addition, circumferential rotation contributes to three-dimensional (3D) wall deformations and affects tracking accuracy. By using 3D-STI technique, we evaluated LV global longitudinal strain (GLS) and apical rotation in severe aortic stenosis (AS) patients with preserved LV ejection fraction (EF).
Methods
LV GLS and apical rotation were evaluated using 3D-STI in 20 severe AS patients (79 ± 8 years old; aortic valve area 0.7 ± 0.2 cm2) with preserved LVEF (68 ± 7%). Data were compared with those of 11 hypertensive LV hypertrophy (LVH) patients (75 ± 10 years old, EF = 66 ± 4%) and 12 controls (healthy individuals: 30 ± 14 years old, EF = 63 ± 6%).
Results
Compared with LVH patients, severe AS patients had significantly decreased values of GLS (?13.0 ± 2.4 vs. ?10.4 ± 2.0%, p = 0.008). In contrast, LV rotation was significantly higher in AS than LVH patients (13.9 ± 3.0° vs. 10.8 ± 2.5°, p = 0.007). There was no significant difference in stroke volume index among three groups. In these three groups, severe AS patients had significantly decreased values of GLS [analysis of variance (ANOVA), p < 0.001] and increased LV rotation (ANOVA, p < 0.001).
Conclusions
In severe AS patients, impaired GLS existed although LVEF was preserved. However, LV rotation was increased in patients with severe AS probably to maintain the LV stroke volume.
To identify risk factors that may lead to the development of dysphagia after combined anterior and posterior (360°) cervical fusion surgery.
Methods
A single center, retrospective analysis of patients who had same-day, 360° fusion at Henry Ford Hospital between 2008 and 2012 was performed. Variables analyzed included demographics, medical co-morbidities, levels fused, and degree of dysphagia.
Results
The overall dysphagia rate was 37.7 %. Patients with dysphagia had a longer mean length of stay (p < 0.001), longer mean operative time (p < 0.001), greater intraoperative blood loss (p = 0.002), and fusion above the fourth cervical vertebra, C4, (p = 0.007). There were no differences in the rates of dysphagia when comparing patients undergoing primary or revision surgery (p = 0.554).
Conclusion
Prolonged surgery and fusion above C4 lead to higher rates of dysphagia after 360° fusions. Prior anterior cervical fusion does not increase the risk of dysphagia development.
To compare the perioperative outcomes of thulium vapoenucleation of the prostate (ThuVEP) with holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic benign prostatic obstruction (BPO).
Methods
Forty-eight and 46 patients were prospectively randomized to ThuVEP and HoLEP. All patients were assessed preoperatively and 4-week postoperatively. The complications were noted and classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%).
Results
Median age at surgery was 73 (67–76) years and median prostate volume was 80 (46.75–100) cc and not different between the groups (p = 0.207). The median operative time was 60 (41–79) minutes without significant differences between both groups (p = 0.275). There were no significant differences between the groups regarding catheterization time [2 (2–2) days, p = 0.966] and postoperative stay [2 (2–3) days, p = 0.80]). Clavien 1 (13.8%), Clavien 2 (3.2%), Clavien 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. However, the occurrence of acute postoperative urinary retention was higher after HoLEP compared to ThuVEP (15.2 vs. 2.1%, p ≤ 0.022). At 1-month follow-up, peak urinary flow rates (10.7 vs. 22 ml/s), post-void residual volumes (100 vs. 20 ml), International Prostate Symptom Score (20 vs. 10) and Quality of Life (4 vs. 3) had improved significantly (p ≤ 0.005) without significant differences between the groups.
Conclusions
ThuVEP and HoLEP are safe and effective procedures for the treatment of symptomatic BPO. Both procedures give equivalent and satisfactory immediate micturition improvement with low perioperative morbidity.
There is increasing evidence that Glasgow Prognostic Score (GPS), based on systemic inflammatory response and albumin level, is a useful predictor of overall survival in patients with various types of cancer.
Methods
Patients with lung metastasis from colorectal carcinoma who underwent a lung metastasectomy from 2000 to 2015 were retrospectively investigated. Routine laboratory measurements including serum C-reactive protein (CRP), albumin, and the tumor marker carcinoembryonic antigen were performed before the metastasectomy.
Results
Ninety-nine patients underwent 132 lung metastasectomy procedures during the study period. Kaplan–Meier analysis revealed that GPS (p = 0.017), number of metastases (p = 0.004), and the presence of liver metastasis (p = 0.010) were associated with overall survival, while univariate analysis selected GPS (p = 0.028), number of metastases (p = 0.005), and liver metastasis (p = 0.014) as predictive factors associated with overall survival. Multivariate analysis also indicated GPS (p = 0.004), number of metastases (p = 0.004), and liver metastasis (p = 0.013) as predictive factors associated with overall survival.
Conclusion
In addition to number of metastases and liver metastasis, GPS is an important predictor of overall survival in colorectal cancer patients who undergo a lung metastasectomy.
To clarify the risk factors for complications after diverting ileostomy closure in patients who have undergone rectal cancer surgery.
Methods
The study group comprised 240 patients who underwent a diverting ileostomy at the time of lower anterior resection or internal anal sphincter resection, in our department, between 2004 and 2015. Univariate and multivariate analyses of 18 variables were performed to establish which of these are risk factors for postoperative complications.
Results
The most common complications were intestinal obstruction and wound infection. Univariate analysis showed that an age of 72 years or older (p?=?0.0028), an interval between surgery and closure of 6 months or longer (p?=?0.0049), and an operation time of 145 min or longer (p?=?0.0293) were significant risk factors for postoperative complications. Multivariate analysis showed that age (odds ratio, 3.4236; p?=?0.0025), the interval between surgery and closure (odds ratio, 3.4780; p?=?0.0039), and operation time (odds 2.5179; p?=?0.0260) were independent risk factors.
Conclusions
Age, interval between surgery and closure, and operation time were independent risk factors for postoperative complications after diverting ileostomy closure. Thus, temporary ileostomy closure should be performed within 6 months after surgery for rectal cancer.
Cervical and back pains are important clinical problems affecting human populations globally. It is suggested that Propionibacterium acnes (P. acnes) is associated with disc herniation. The aim of this study is to evaluate the distribution of P. acnes infection in the cervical and lumbar disc material obtained from patients with disc herniation.
Methods and material
A total of 145 patients with mean age of 45.21 ± 11.24 years who underwent micro-discectomy in cervical and lumbar regions were enrolled into the study. The samples were excited during the operation and then cultured in the anaerobic incubations. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction.
Results
In this study, 145 patients including 25 cases with cervical and 120 cases with lumbar disc herniation were enrolled to the study. There was no significant difference in the age of male and female patients (p = 0.123). P. acnes infection was detected in nine patients (36%) with cervical disc herniation and 46 patients (38.3%) with lumbar disc herniation and no significant differences were reported in P. acnes presence according to the disc regions (p = 0.508.). Moreover, there was a significant difference in the presence of P. acnes infection according to the level of lumbar disc herniation (p = 0.028).
Conclusion
According to the results, the presence of P. acnes is equal in patients with cervical and lumbar disc herniation. There was a significant difference in the distribution of P. acnes infection according to level of lumbar disc herniation.
We evaluated the ability of transthoracic echocardiography (TTE) to correctly identify abnormal left ventricular (LV) size, function, and mass when compared to cardiac magnetic resonance (CMR). Whilst numerous studies have compared TTE and CMR with respect to correlation between measurements and study reproducibility, few have employed categorical analysis relevant to clinical practice.
Methods
Two hundred and fifteen consecutive patients who underwent both TTE and CMR were evaluated for the presence of abnormal LV size, systolic function, and mass. Abnormal LV systolic function was further categorized into grades (mild, moderate, and severe). Quantification of LV morphology and function was performed on TTE and CMR according to published guidelines. The level of agreement between TTE and CMR was compared across binary and categorical variables using Cohen’s kappa.
Results
Compared to CMR, TTE demonstrated excellent agreement in identification of abnormal versus normal function (κ = 0.87). However, agreement across grades of LV function was less strong (κ = 0.63). Whilst agreement for identification of severe LV dysfunction was good (κ = 0.68), this would still lead to misclassification of severe dysfunction in approximately one in seven cases. Agreement between TTE and CMR was moderate to good for identification of LV dilation (κ = 0.43–0.63), but poor for identification of increased mass (κ = 0.04).
Conclusions
Whilst in clinical practice TTE performs well in identification of normal versus abnormal systolic function, it has substantial limitations across grades of dysfunction and in the assessment of LV size and mass. These limitations have important implications when considering management decisions for patients based on thresholds of LV morphology or function.
