Accuracy of Right and Left Ventricular Functional Assessment by Short-Axis vs Axial Cine Steady-State Free-Precession Magnetic Resonance Imaging: Intrapatient Correlation With Main Pulmonary Artery and Ascending Aorta Phase-Contrast Flow Measurements

Objective

The left ventricle (LV) is routinely assessed with cardiac magnetic resonance imaging (MRI) by using short-axis orientation; it remains unclear whether the right ventricle (RV) can also be adequately assessed in this orientation or whether dedicated axial orientation is required. We used phase-contrast (PC) flow measurements in the main pulmonary artery (MPA) and the ascending aorta (Aorta) as nonvolumetric standard of reference and compared RV and LV volumes in short-axis and axial orientations.

Methods

A retrospective analysis identified 30 patients with cardiac MRI data sets. Patients underwent MRI (1.5 T or 3 T), with retrospectively gated cine steady-state free-precession in axial and short-axis orientations. PC flow analyses of MPA and Aorta were used as the reference measure of RV and LV output.

Results

There was a high linear correlation between MPA-PC flow and RV–stroke volume (SV) short axis (r = 0.9) and RV-SV axial (r = 0.9). Bland-Altman analysis revealed a mean offset of 1.4 mL for RV axial and –2.3 mL for RV–short-axis vs MPA-PC flow. There was a high linear correlation between Aorta-PC flow and LV-SV short-axis (r = 0.9) and LV-SV axial (r = 0.9). Bland-Altman analysis revealed a mean offset of 4.8 m for LV short axis and 7.0 mL for LV axial vs Aorta-PC flow. There was no significant difference (P = .6) between short-axis–LV SV and short-axis–RV SV.

Conclusion

No significant impact of the slice acquisition orientation for determination of RV and LV stroke volumes was found. Therefore, cardiac magnetic resonance workflow does not need to be extended by an axial data set for patients without complex cardiac disease for assessment of biventricular function and volumes.     

A Qualitative Study of Gestational Weight Gain Counseling and Tracking

Excessive gestational weight gain (GWG) predicts adverse pregnancy outcomes and later obesity risk for both mother and child. Women who receive GWG advice from their obstetric clinicians are more likely to gain the recommended amount, but many clinicians do not counsel their patients on GWG, pointing to the need for new strategies. Electronic medical records (EMRs) are a useful tool for tracking weight and supporting guideline-concordant care, but their use for care related to GWG has not been evaluated. We performed in-depth interviews with 16 obstetric clinicians from a multi-site group practice in Massachusetts that uses an EMR. We recorded, transcribed, coded, and analyzed the interviews using immersion-crystallization. Many respondents believed that GWG had “a lot” of influence on pregnancy and child health outcomes but that their patients did not consider it important. Most indicated that excessive GWG was a big or moderate problem in their practice, and that inadequate GWG was rarely a problem. All used an EMR feature that calculates total GWG at each visit. Many were enthusiastic about additional EMR-based supports, such as a reference for recommended GWG for each patient based on pre-pregnancy body mass index, a “growth chart” to plot actual and recommended GWG, and an alert to identify out-of-range gains, features which many felt would remind them to counsel patients about excessive weight gain. Additional decision support tools within EMRs would be well received by many clinicians and may help improve the frequency and accuracy of GWG tracking and counseling.     

Reliability and validity of the Sexual Pressure Scale for Women-Revised

Sexual pressure among young urban women represents adherence to gender stereotypical expectations to engage in sex. Revision of the original five-factor Sexual Pressure Scale was undertaken in two studies to improve reliabilities in two of the five factors. In Study 1 the reliability of the Sexual Pressure Scale for Women-Revised (SPSW-R) was tested, and principal components analysis was performed in a sample of 325 young, urban women. A parsimonious 18-item, four-factor model explained 61% of the variance. In Study 2 the theory underlying sexual pressure was supported by confirmatory factor analysis using structural equation modeling in a sample of 181 women. Reliabilities of the SPSW-R total and subscales were very satisfactory, suggesting it may be used in intervention research.     

Balance during obstacle crossing following stroke

Difficulty negotiating obstacles may contribute to the high falls rate following stroke. This study examined the impact of stroke on balance during obstacle crossing. Centre of mass (COM) and centre of pressure (COP) were measured as 12 stroke subjects and 12 unimpaired subjects stepped over a 4 cm high obstacle at self-selected speed. Unimpaired subjects also walked at speeds matched to their yoked stroke subject. Compared with unimpaired subjects at matched speed, at unaffected lead toe clearance, anterior-posterior (AP) separation between COM and COP increased in stroke subjects, which might indicate instability. Step lengths before and after the obstacle tended to be reduced which could increase the risk of losing balance forwards. The COM AP velocity was reduced at affected lead toe off following stroke, which may minimise instability. Following stroke the COM and COP were positioned more posteriorly during affected lead toe clearance, which might also assist stability.     

Evaluating Child Protection Referrals from Southern Education & Library Board Schools

This research project set out to evaluate the experiences of staff in schools within the Southern Education & Library Board when making referrals to Social Services about child protection concerns during 1999/2000. In June 2001 data were gathered from questionnaires and interviews conducted with those who had made referrals. The pre-referral consultation process with the senior social worker was seen as a necessary and important provision in supporting staff when considering a referral. The report concluded that staff believed the process mostly protected the children and young people about whom they had concerns. However, some stated that they did not receive sufficient information and feedback from Social Services about the investigation and ongoing work, which they viewed as necessary in helping them support these young people appropriately during this traumatic and disruptive time.     

Tierexperimentelle Untersuchungen zur Effektivitat der transarteriellen Chemoembolisation （TACE） unter Einsatz von Bletilla striata

Zusammenfassung Evaluierung der Effektivit?t von Bletilla striata bei transerteriellen Chemoembolisation (TACE) im Kleintiermodell. Nach subkapsul?rer Implantation (Tag 0) eines soliden Morris Hepatoms (2 mm³) bei ACI-Ratten (n=30) wurden am 13. Tag die Tumorvolumina (V1) magnettomographisch bestimmt. Im Anschlu erfolgten nach Laparatomie die retrograde Katheterisierung der Arteria gastroduodenalis und die Anwendung folgender Therapieprotokolle: (A) TACE (0.1 mg Mitomycin C+0,1 mL Lipiodol)+Bletilla striata (1,0 mg) (n=10); (B) TACE (Bletilla striata (1,0 mg)+Ligatur (n=10); (C) TACE allein (Kontrollgruppe,n=10). Zur Effektivit?tsbeurteilung der unterschiedlichen Therapieprotokolle erfolgte am 28. Tag eine erneute magnettomographische Bestimmung der Tumorvolumina (V2). Das durschschnittliche Tumorvolumen der Gruppen A, B und C vor und nach interventioneller Therapie betrug 0,0355 cm³ und 0, 2248 cm³, 0,0374 cm³ und 0,0573 cm³ sowie 0,0380 cm³ und 0,3674 cm³. Das errechnete durchschnittliche Verh?ltnis (V2/V1) betrug 6,28, 1,53 sowie 9,14. Im Vergleich zur Kontrollgruppe C konnte somit für Therapiegruppe B eine signifikant (P<0,01) geringere Tumorvolumenzunahme im Beobachtungszeitraum ermittelt werden, w?hrend zwischen Gruppe A und Gruppe C keine statistisch signifikanten (P>0,05) Unterschiede im Tumorwachstum festgestellt werden konnten. Das Wachstum der induzierten Lebertumoren konnte unter Behandlung mittels TACE+Bletilla striata +Ligatur im Tiermodell statistisch signifikant im Vergleich zur Kontrollgruppe gehemmt werden.

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QIAN Jun, male, born in 1967, M. D., Associated Professor