Comparison of a new methodology for the assessment of 3D myocardial strain from volumetric ultrasound with 2D speckle tracking

An alternative approach to extract 3D myocardial strain based on elastic registration of the ultrasound images (3DSE) was developed by our lab. The aim of the present study was to test its clinical performance by comparing strain values obtained by 3DSE with the ones obtained with 2D speckle tracking (2DST). Standard 2D B-mode and volumetric datasets were acquired in 12 patients with coronary heart disease (CHD) and in 12 control subjects. Longitudinal (ε(LL)), circumferential (ε(CC)) and radial (ε(RR)) strain values were obtained from 2D datasets using commercially available 2DST software and from volumetric datasets using the 3DSE approach. 3DSE provided lower strain values than 2DST. With both approaches global ε(LL) and ε(CC) were significantly lower in patients with CHD than in controls. Global ε(LL) and ε(CC) correlated well between both methods (R = 0.83, R = 0.86, respectively), while segmental correlations were moderate [R = 0.63 (ε(LL)), R = 0.41 (ε(CC))]. The highest differences in ε(LL) values obtained by the two methods and the highest number of erroneous ε(LL) with 3DSE were observed in the basal LV segments. This study shows that in real-life datasets our 3DSE method provides global and regional ε(LL) and ε(CC) values that are comparable with the ones obtained from 2DST, even though they are not interchangeable with each other. As only a single acquisition is required, 3D methods may offer advantages over the current 2D techniques. However, the accuracy of the 3DSE can still be improved by solving the problems that appear with deformation estimation in the basal segments.     

Non-allergic cutaneous reactions in airborne chemical sensitivity--a population based study

Multiple chemical sensitivity (MCS) is characterised by adverse effects due to exposure to low levels of chemical substances. The aetiology is unknown, but chemical related respiratory symptoms have been found associated with positive patch test. The purpose of this study was to investigate the relationship between cutaneous reactions from patch testing and self-reported severity of chemical sensitivity to common airborne chemicals. A total of 3460 individuals participating in a general health examination, Health 2006, were patch tested with allergens from the European standard series and screened for chemical sensitivity with a standardised questionnaire dividing the participants into four severity groups of chemical sensitivity. Both allergic and non-allergic cutaneous reactions--defined as irritative, follicular, or doubtful allergic reactions--were analysed in relationship with severity of chemical sensitivity. Associations were controlled for the possible confounding effects of sex, age, asthma, eczema, atopic dermatitis, psychological and social factors, and smoking habits. In unadjusted analyses we found associations between allergic and non-allergic cutaneous reactions on patch testing and the two most severe groups of self-reported sensitivity to airborne chemicals. When adjusting for confounding, associations were weakened, and only non-allergic cutaneous reactions were significantly associated with individuals most severely affected by inhalation of airborne chemicals (odds ratio = 2.5, p = 0.006). Our results suggest that individuals with self-reported chemical sensitivity show increased non-allergic cutaneous reactions based on day 2 readings of patch tests.     

Metformin‐associated risk of acute dialysis in patients with type 2 diabetes: A nationwide cohort study

Recent guidelines governing anti‐diabetic medications increasingly advocate metformin as first‐line therapy in all patients with type 2 diabetes. However, metformin could be associated with increased risk of acute kidney injury (AKI), acute dialysis and lactate acidosis in marginal patients. In a retrospective nationwide cohort study, a total of 168 443 drug‐naïve patients with type 2 diabetes ≥50 years, initiating treatment with either metformin or sulphonyl in Denmark between 2000 and 2012 were included in this study (70.7% initiated treatment with metformin); calculation of 1‐year risk of acute dialysis was based on g‐standardization of cause‐specific Cox regression models for acute dialysis, end‐stage renal disease and death. One‐year risks of acute dialysis were 92.4 per 100 000 (95% CI, 67.1‐121.3) and 142.7 per 100 000 (95% CI, 118.3‐168.0) for sulphonylurea and metformin, respectively. The metformin‐associated 1‐year risk of acute dialysis was increased by 50.3 per 100 000 (95% CI, 7.9‐88.6), corresponding to a risk ratio of 1.53 (95% CI, 1.06‐2.23), and a number needed to harm of 1988, thus providing evidence of potential concerns pertaining to the increasing use of metformin.     

How women experience and cope with daily hassles after sexual abuse – a retrospective qualitative study

The impact of stress on health can depend on factors such as frequency, heightening of stress during a given period or the presence of one or a few repeated hassles of psychological importance. The aim of this study was to gain a deeper understanding of how adult women experience and cope with daily hassles after sexual abuse. Ten interviews were analysed using the grounded theory method. The theoretical model of ‘protecting armor in daily life’ emerged. The aftermath of sexual abuse related coping with daily stress can be understood as a three‐phase process: (1) avoiding and escaping—coping after experiencing sexual abuse; (2) accepting and disclosing—starting a process of recovery; and (3) reconciling and repossessing—living with the experience in the present. The model contributes to a deeper understanding of the everyday life of women who have experienced sexual abuse. Increased knowledge of coping behaviours that can be used to deal with daily hassles may also serve as a tool for health professionals, other helpers and family to help these women rebuild a good life.     

Simulation-Based Training for Colonoscopy: Establishing Criteria for Competency

The aim of this study was to create simulation-based tests with credible pass/fail standards for 2 different fidelities of colonoscopy models.Only competent practitioners should perform colonoscopy. Reliable and valid simulation-based tests could be used to establish basic competency in colonoscopy before practicing on patients.Twenty-five physicians (10 consultants with endoscopic experience and 15 fellows with very little endoscopic experience) were tested on 2 different simulator models: a virtual-reality simulator and a physical model. Tests were repeated twice on each simulator model. Metrics with discriminatory ability were identified for both modalities and reliability was determined. The contrasting-groups method was used to create pass/fail standards and the consequences of these were explored.The consultants significantly performed faster and scored higher than the fellows on both the models (P < 0.001). Reliability analysis showed Cronbach α = 0.80 and 0.87 for the virtual-reality and the physical model, respectively. The established pass/fail standards failed one of the consultants (virtual-reality simulator) and allowed one fellow to pass (physical model).The 2 tested simulations-based modalities provided reliable and valid assessments of competence in colonoscopy and credible pass/fail standards were established for both the tests. We propose to use these standards in simulation-based training programs before proceeding to supervised training on patients.     

Consolidative Radiotherapy to Residual Masses After Chemotherapy Is Associated With Improved Outcome in Diffuse Large B-Cell Lymphoma. A Retrospective,Population-Based Study

Background

The role of consolidative radiotherapy (RT) in advanced diffuse large B-cell lymphoma (DLBCL) is not established.