Differentiation between acute and chronic cor pulmonales with midventricular systolic strain of the right ventricle in the emergency department

Cor pulmonale (CP) is defined as the structural and functional alternation of the right ventricle (RV) caused by primary disorders of the respiratory system. We aimed to differentiate acute CP complicated with massive pulmonary thromboembolism (PTE) from the chronic form due to severe chronic obstructive pulmonary disease (COPD) with strain analysis of RV in the emergency department. We included patients showing echocardiographic features of pulmonary hypertension in the emergency department. From March 2005 to July 2006, a total of 52 patients, 24 consecutive patients with acute CP (ten males, mean 69 ± 10 years) and 28 consecutive patients with chronic CP associated with severe COPD (22 males, mean 63 ± 14 years), were included. Echocardiographic data and strain analyses were obtained with GE Vivid 7. There was no statistical difference in age, fractional area change of RV, TR Vmax, and Tei index in both groups. However, more males were included in the chronic group. Midventricular systolic strain of RV was significantly increased in patients with acute CP. Regarding the midventricular systolic strain in the detection of acute CP by the receiver operating curve analysis, the best sensitivity and specificity were obtained when −12.2% was applied as the criterion (more than −12.2% for predicting an acute CP, the sensitivity, specificity, and accuracy were 83.3, 78.6, and 80.8%, respectively). Midventricular systolic strain of RV can be used in the differentiation between acute and chronic CPs in the emergency department.     

HIV-negative gay men's accounts of using context-dependent sero-adaptive strategies

We enrolled 166 gay and bisexual men who tested HIV-negative at a community sexual health clinic in Vancouver, British Columbia, into a year-long mixed-methods study. A subsample of participants who reported recent condomless anal sex (n = 33) were purposively recruited into an embedded qualitative study and completed two in-depth qualitative interviews. Analysis of baseline interviews elicited three narratives relevant to men's use of context- or relationally-dependent HIV-risk management strategies: (1) seroadaptive behaviours such as partner testing and negotiated safety agreements used with primary sexual partners, (2) serosorting and seroguessing when having sex with new partners and first-time hookups and (3) seroadaptive behaviours, including one or more of seropositioning/strategic positioning, condom serosorting and viral load sorting, used by participants who knowingly had sex with a serodiscordant partner. Within men's talk about sex, we found complex and frequently biomedically-informed rationale for seroadaptation in men's decisions to have what they understood to be various forms of safe or protected condomless anal sex. Our findings support the need for gay men's research and health promotion to meaningfully account for the multiple rationalities and seroadaptive strategies used for having condomless sex in order to be relevant to gay men's everyday sexual decision-making.     

<Emphasis Type="Bold">Discrepancies between coronary CT angiography and invasive coronary angiography with focus on culprit lesions which cause future cardiac events</Emphasis>

Objectives

To evaluate the clinical significance of discrepant lesions between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) in a longitudinal study.

Methods

In 220 patients with suspected coronary artery disease (CAD) who underwent both 256-row CCTA and ICA, the obstructive CAD (≥ 50% stenosis) on CCTA was compared with that on ICA as the reference standard. We analysed the causes of the discrepancy between CCTA and ICA. During a 40-month follow-up period, major adverse cardiac events (MACE) were assessed.

Results

Discordance between CCTA and ICA was observed in 121 of the 3166 coronary artery segments (3.8%). Common causes were calcification (45.9%) and positive remodelling (PR) (29.6%) in 83 false positive lesions, and noise (40.0%) and motion artefact (37.8%) in 38 false negative lesions. MACE occurred in seven lesions among the discrepant lesions; six among the 29 PR lesions (20.7%) and one among the 53 calcified lesions (1.9%). With respect to the prediction power of MACE in an intermediate stenosis, the CCTA-related value including PR was higher than the ICA-related value.

Conclusions

PR was a frequent cause of MACE among the false positive lesions on CCTA. Therefore, the presence of PR on CCTA may suggest clinical significance, although it can be missed by ICA.

Key Points

? Compared to ICA, PR in CCTA may be cause of false positive lesion. ? CCTA-related value including PR shows higher prediction power of MACE than ICA-related value. ? PR reflects atherosclerotic burden that can be related to cardiac events. ? PR in CCTA should be observed carefully, even if it is false positive.

     

Tumor-Suppressing Effect of Silencing of Annexin A3 Expression in Breast Cancer

Introduction

Annexin A3 (ANXA3) participates in various tumor-associated biological processes, including tumor initiation, progression, and metastasis. The present study was designed to investigate the expression and function of ANXA3 in breast cancer cells.

Central positional nystagmus in inferior cerebellar peduncle lesions: a case series

Journal of Neurology - We aimed to characterize the central positional nystagmus (CPN) observed in lesions involving the inferior cerebellar peduncle (ICP). We analyzed the clinical and...     

Difficulties faced by Korean disaster relief workers while providing humanitarian aid: A descriptive study

The aim of the present study was to identify difficulties experienced by Korean disaster relief workers during humanitarian aid deployment. A convenience sample of disaster relief workers aged > 18 years, who had been dispatched to an overseas disaster site, were recruited; 107 relief workers completed the Humanitarian Aid Difficulty Scale that consists of 23 items comprising five factors. The average difficulty rating was 2.64 on a five point scale. By item, participants gave the highest scores for bathroom use and the lowest scores for cooperation among team members. By factor, infrastructure was rated as the greatest difficulty, followed by health conditions, goods and equipment, culture and customs, and cooperation. Considering sociodemographic characteristics, there were significant age differences in the culture and customs factor, as well as significant occupation differences in the cooperation, culture and customs, and goods and equipment factors. These findings highlight the need to improve the welfare of workers. It is recommended that further research be conducted according to occupation and with repeated measurement prior to, in the middle of, and after deployment of relief workers.     

Vestibular impairments in episodic ataxia type 2

Journal of Neurology - Episodic ataxia type 2 (EA2) can present diverse ocular motor abnormalities, but few studies have systematically evaluated vestibular function during the interictal periods....     

Effect of metalworking fluid mist exposure on cross-shift decrement in peak expiratory flow

Exposure to metalworking fluids (MWF) mist and cross-shift decrements in peak expiratory flow (PEF) were evaluated and their relationship was analyzed using several statistical methods. The objective of this study was to assess workers, exposure to MWF mineral mist and to find the MWF mist level for predicting cross-shift decrements in PEF. A total of 158 workers handling water-soluble MWF had MWF mist exposures with an arithmetic mean (AM) of 0.4 mg/m(3) (range: LOD-13.5 mg/m(3)), and 9.2% of workers (219) showed a cross-shift decline greater than 10% in PEF. MWF mist exposure and cross-shift decrements in PEF that were matched (n=113) were linearly significantly associated (R(2)=0.036, p=0.045) although the correlation was quite weak (r=0.189). We found a slight increase in cross-shift decrements in PEF with increased exposure to MWF aerosol mass concentration. The MWF mist exposure level was categorized into two or three groups by the cutoffs of either the National Institute for Occupational Safety and Health's Recommended Exposure Level (NIOSH REL: 0.5 mg/m(3)) or the American Conference of Governmental Industrial Hygienists Notice of Intended Change (ACGIH NIC: 0.2 mg/m(3)). The cross-shift decrement in PEF observed from workers exposed to > or =0.2 mg/m(3) was slightly higher than that of the exposure level of < or =0.2 mg/m(3) at p=0.207 while significant differences among categorized exposure groups (2 categories, <0.5 and > or =0.5 mg/m(3), or 3 categories, <0.2, 0.2-0.5 and > or =0.5 mg/m(3)) were not detected. In order to find out whether there is a specific level that allows us to predict cross-shift decrements in PEF, several statistical models were constructed. Logistic regression showed that the MWF concentration, whether treated as a continuous variable or a categorical variable, was not significantly associated with cross-shift decrements dichotomized by a cutoff of either 10% or 15% in PEF. We couldn't find evidence of a significant PEF decrement increase with increasing exposure category. Thus, we concluded that PEF decrements measured in workers exposed to MWF mist concentrations greater than either 0.2 mg/m(3) or 0.5 mg/m(3) was not significantly different from those found in workers exposed to lower MWF mist concentrations. Further study is needed to establish the level of MWF mineral mist predicting non-malignant respiratory health effects.     

Comparison of laser ablation using multidirectional and forward-firing fibers in breast cancer

Background: The aim of this study was to compare the therapeutic effect of laser ablation using the forward-firing fiber and the multidirectional-firing fiber for breast cancer treatment with pathologic results.

Material and methods: An ex vivo study of laser ablation was conducted using normal breast and breast cancer tissue. Each ablated area was demarcated into three zones, and the temperature was measured. Laser ablations using multidirectional and forward-firing types of fiber were compared regarding the shape, diameter and aspect ratio of the ablated lesions.

Results: The ablated lesions were classified into three zones: a carbonized zone with complete tissue loss; a coagulated zone with no viable cells; and a non-damaged zone. The shape of the ablated lesion was elliptical using the forward-firing fiber and round using the multidirectional-firing fiber. Compared with normal breast tissue, breast cancer tissue required a more powerful setting for laser ablation to achieve necrosis, and the aspect ratio of the thermal lesion was higher for laser ablation using the multidirectional-firing fiber.

Conclusions: The experimental results on breast tissue have shown that multidirectional-firing fiber is more effective than using forward-firing fibers and that this may prove to be another feasible therapeutic option for management of breast cancer.