Assessment of left ventricular diastolic function in children after successful repair of aortic coarctation

The purpose of the study was an assessment of left ventricular diastolic function in children after the successful repair of aortic coarctation (CoA). The prospective study concerned 32 pediatric patients after the CoA surgery. Tissue Doppler imaging parameters including strain and strain rate and the conventional echocardiographic indexes were analyzed in patients and healthy controls. Analysis of mitral annulus velocities, E–E′ ratio, strain, and strain rate of left ventricular mid-cavity segments and conventional indexes of mitral inflow showed the worsening of left ventricular diastolic mechanics in the study group compared to healthy controls. The E/E′ ratio was significantly higher in the study group compared to the control group (8.30 ± 3.24 vs. 6.95 ± 1.36; p < 0.05). The early diastolic strain rate to late diastolic strain rate ratio as well as early to late diastolic strain ratio of the left ventricular mid-cavity segments were significantly lower in the study group compared to healthy controls (1.81 ± 0.63 vs. 3.74 ± 1.53; p < 0.001 and 1.20 ± 0.49 vs. 3.41 ± 1.26; p < 0.001). No differences of the pulmonary venous flow parameters between those two groups were observed. The left ventricular diastolic mechanics in hypertensive patients after CoA repair did not differ from normotensive subjects. Hypertensive and normotensive children after surgical repair of CoA are found to have worsening of the left ventricular diastolic mechanics suggesting the impairment of the active myocardial relaxation

A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity

Non-steroidal anti-inflammatory drugs (NSAIDs) represent a diverse class of drugs and are among the most commonly used analgesics for arthritic pain worldwide, though long-term use is associated with a spectrum of adverse effects. The introduction of cyclooxygenase-2-selective NSAIDs early in the last decade offered an alternative to traditional NSAIDs with similar efficacy and improved gastrointestinal tolerability; however, emerging concerns about cardiovascular safety resulted in the withdrawal of two agents (rofecoxib and valdecoxib) in the mid-2000s and, subsequently, in an overall reduction in NSAID use. It is now understood that all NSAIDs are associated with some varying degree of gastrointestinal and cardiovascular risk. Guidelines still recommend their use, but little is known of how patients use these agents. While strategies and guidelines aimed at reducing NSAID-associated complications exist, there is a need for evidence-based algorithms combining cardiovascular and gastrointestinal factors that can be used to aid treatment decisions at an individual patient level

Mitigating risk in ecommerce transactions: perceptions of information credibility and the role of user-generated ratings in product quality and purchase intention

Although extremely popular, electronic commerce environments often lack information that has traditionally served to ensure trust among exchange partners. Digital technologies, however, have created new forms of "electronic word-of-mouth," which offer new potential for gathering credible information that guides consumer behaviors. We conducted a nationally representative survey and a focused experiment to assess how individuals perceive the credibility of online commercial information, particularly as compared to information available through more traditional channels, and to evaluate the specific aspects of ratings information that affect people's attitudes toward ecommerce. Survey results show that consumers rely heavily on web-based information as compared to other channels, and that ratings information is critical in the evaluation of the credibility of online commercial information. Experimental results indicate that ratings are positively associated with perceptions of product quality and purchase intention, but that people attend to average product ratings, but not to the number of ratings or to the combination of the average and the number of ratings together. Thus suggests that in spite of valuing the web and ratings as sources of commercial information, people use ratings information suboptimally by potentially privileging small numbers of ratings that could be idiosyncratic. In addition, product quality is shown to mediate the relationship between user ratings and purchase intention. The practical and theoretical implications of these findings are considered for ecommerce scholars, consumers, and vendors. © 2014 Springer Science+Business Media New York