Spinal cord injury in the emergency context: Review of program outcomes of a spinal cord injury rehabilitation program in Sri Lanka

Background: The final months of the conflict in Sri Lanka in 2009 resulted in massive displacement of the civilian population and a high volume of orthopedic trauma including spinal cord injury. In response to this need, Médecins Sans Frontières implemented a multidisciplinary rehabilitation program. Methods. Patients were admitted to the program if they had a spinal cord injury

The Open Anchoring Quest Dataset: Anchored Estimates from 96 Studies on Anchoring Effects

People’s estimates are biased toward previously considered numbers (anchoring). We have aggregated all available data from anchoring studies that included at least two anchors into one large dataset. Data were standardized to comprise one estimate per row, coded according to a wide range of variables, and are available for download and analyses online (https://metaanalyses.shinyapps.io/OpAQ/). Because the dataset includes both original and meta-data it allows for fine-grained analyses (e.g., correlations of estimates for different tasks) but also for meta-analyses (e.g., effect sizes for anchoring effects)

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Impact of Clinical and Echocardiographic Response to Cardiac Resynchronization Therapy On Long-Term Survival

Ventricular Dysfunction & Heart Failur

Left ventricular rotational mechanics in patients with coronary artery disease: differences in subendocardial and subepicardial layers

Objective Subendocardial and subepicardial layers have opposite orientation of the myofibres and they are differently affected by coronary artery disease. This study investigated the differences in subendocardial and subepicardial left ventricular (LV) twist in patients with coronary artery disease. Methods 214 patients were included in the study: 60 with first ST elevation myocardial infarction (STEMI), 111 with chronic ischaemic heart failure (HF) and 43 normal subjects. Real-time three-dimensional echocardiography provided LV volumes and function. Two-dimensional speckle tracking echocardiography differentiating the subendocardial and subepicardial layers was used for the assessment of LV twist. Patients with STEMI were divided into two groups (small and large STEMI). Results Compared with normal subjects, peak subendocardial LV twist was significantly impaired in patients with STEMI (11.2 +/- 6.0 degrees vs 15.3 +/- 2.7 degrees, p<0.001). In patients with chronic HF, peak subendocardial LV twist was even more impaired (4.6 +/- 3.4 degrees, p<0.001 vs normal subjects and patients with STEMI). Conversely, peak subepicardial LV twist was not statistically different between normal subjects and patients with STEMI (8.9 +/- 1.9 degrees vs 8.4 +/- 4.4 degrees, p=0.98), whereas it was significantly impaired in patients with chronic HF (2.6 +/- 2.5 degrees, p<0.001 vs normal subjects and patients with STEMI). Peak subendocardial LV twist was not statistically different between large and small STEMI, whereas peak subepicardial LV twist was significantly lower in large STEMI than in small STEMI (7.1 +/- 4.8 degrees vs 9.6 +/- 3.6 degrees, p=0.025). Conclusions Subendocardial LV twist is reduced in patients with STEMI and chronic ischaemic HF whereas subepicardial LV twist is reduced only in chronic ischaemic HF. When STEMI are divided into large and small infarctions, it becomes evident that subepicardial LV twist is only reduced in large infarctions

Incremental Prognostic Value of Novel Left Ventricular Diastolic Indexes for Prediction of Clinical Outcome in Patients With ST-Elevation Myocardial Infarction

This study examined the prognostic value of novel diastolic indexes in ST-elevation acute myocardial infarction (AMI), derived from strain and strain rate analysis using 2-dimensional speckle tracking imaging. Echocardiograms were obtained within 48 hours of admission in 371 consecutive patients with first ST-elevation AMI (59.7 +/- 11.6 years old). Indexes of diastolic function including mean strain rate during isovolumic relaxation (SRIVR), mean early diastolic strain rate (SRE) and mean diastolic strain at peak transmitral E wave (E) were obtained from 3 apical views. Mean early diastolic velocity from 4 basal segments by color-coded tissue Doppler imaging was measured. Indexes of diastolic filling including E/SRIVR, E/SRE, E/diastolic strain at E, and E/early diastolic velocity were calculated. The primary end point (composite of death, hospitalization for heart failure, repeat MI, and repeat revascularization) occurred in 84 patients (22.6%) during a mean follow-up of 17.3 +/- 12.2 months. Mean SRIVR (p < 0.001), multivessel disease (p < 0.001), Thrombolysis In Myocardial Infarction grade 0 to 1 flow after percutaneous coronary intervention (p = 0.004), and left ventricular ejection fraction (p = 0.008) were independent predictors of the combined end point on Cox regression analysis. Mean SRIVR showed incremental prognostic value over baseline clinical and echocardiographic variables (global chi-square increase from 41.0 to 51.6, p < 0.001). After dividing patient population based on median SRIVR, patients with SRIVR <= 0.24/second had significantly higher event rates than others (hazard ratio 2.74, 95% confidence interval 1.61 to 4.67, p < 0.001). In conclusion, SRIVR was incremental to left ventricular ejection fraction, Thrombolysis In Myocardial Infarction grade 0 to 1 flow after percutaneous coronary intervention, and multivessel disease and superior to other diastolic indexes in predicting future cardiovascular events after AMI. SRIVR may be useful in identifying high-risk patients soon after AMI. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:592-597)Cardiac Dysfunction and Arrhythmia

The effect of cardiac resynchronization therapy on left ventricular diastolic function assessed with speckle-tracking echocardiography

Aims: Changes in left ventricular (LV) diastolic function after cardiac resynchronization therapy (CRT) in relation to LV reverse remodelling and heart failure aetiology have not been extensively characterized. The aims of the study were to evaluate changes in LV diastolic function with speckle-tracking echocardiography in relation to: (i) cardiac resynchronization therapy response (LV remodelling) and (ii) heart failure aetiology. Methods and results: A total of 192 heart failure patients undergoing CRT implantation were evaluated. Speckle-tracking echocardiography was performed before and 6 months after implantation and reliable analysis was obtained in 188 patients. Left ventricular diastolic function was assessed by measuring diastolic strain rate during the isovolumic relaxation period (SR ) and by calculating the ratio of peak transmitral E-wave to SR (E/SR ). Changes in LV diastolic parameters were evaluated in responders and non-responders and in patients with ischaemic and non-ischaemic cardiomyopathy. Response to CRT was defined a

Quantitative assessment of mitral regurgitation comparison between three-dimensional Transesophageal Echocardiography and Magnetic Resonance Imaging

Background-Quantification of mitral regurgitation severity with 2-dimensional (2D) imaging techniques remains challenging. The present study compared the accuracy of 2D transesophageal echocardiography (TEE) and 3-dimensional (3D) TEE for quantification of mitral regurgitation, using MRI as the reference method. Methods and Results-Two-dimensional and 3D TEE and cardiac MRI were performed in 30 patients with mitral regurgitation. Mitral effective regurgitant orifice area (EROA) and regurgitant volume (Rvol) were estimated with 2D and 3D TEE. With 3D TEE, EROA was calculated using planimetry of the color Doppler flow from en face views and Rvol was derived by multiplying the EROA by the velocity time integral of the regurgitant jet. Finally, using MRI, mitral Rvol was quantified by subtracting the aortic flow volume from left ventricular stroke volume. Compared with 3D TEE, 2D TEE underestimated the EROA by a mean of 0.13 cm(2). In addition, 2D TEE underestimated the Rvol by 21.6% when compared with 3D TEE and by 21.3% when compared with MRI. In contrast, 3D TEE underestimated the Rvol by only 1.2% when compared with MRI. Finally, one third of the patients in grade 1 and >= 50% of the patients in grade 2 and 3, as assessed with 2D TEE, would have been upgraded to a more severe grade, based on the 3D TEE and MRI measurements. Conclusions-Quantification of mitral EROA and Rvol with 3D TEE is feasible and accurate as compared with MRI and results in less underestimation of the Rvol as compared with 2D TEE. (Circ Cardiovasc Imaging. 2010; 3: 694-700.)Cardiovascular Aspects of Radiolog