Vector flow mapping allowed visualization and measurement of several parameters defining vortex behavior inside the cardiac cycle. The differences observed in these parameters between vortices in different phases of the cardiac cycle may be related to their role in optimizing cardiac function.
The Central America Four (CA-4) region, comprising Guatemala, Honduras, El
Salvador, and Nicaragua, is the largest low- and middle-income country region in
the Western Hemisphere, with over 36 million inhabitants. The CA-4 nations share
a common geography, history, language, and development indices, and unified with
open borders in 2006. The growing CA-4 cancer burden among the noncommunicable
diseases is expected to increase 73% by 2030, which argues for a regional
approach to cancer control. This has driven efforts to establish
population-based cancer registries as a central component of the cancer control
plans. The involvement of international and academic partners in an array of
initiatives to improve cancer information and control in the CA-4 has
accelerated over the past several years. Existing data underscore that the
infectious cancers (cervical, stomach, and liver) are a particular burden. All
four countries have committed to establishing regional population-based cancer
registries and have advanced significantly in pediatric cancer registration. The
challenges common to each nation include the lack of national cancer control
plans and departments, competing health priorities, lack of trained personnel,
and sustainability strategies. General recommendations to address these
challenges are outlined. The ongoing regional, international, and academic
cooperation has proven helpful and is expected to continue to be a powerful
instrument to contribute to the design and implementation of long-term national
cancer control plans.
Cardiac surgery induces geometrical and functional changes, which are not clearly explained. Objective: to investigate the physiopathology of the heart after cardiac surgery using advanced techniques of echocardiography. Thirty patients undergoing cardiac surgery had echocardiographic study prior and after surgery. Left and right ventricular (RV) longitudinal displacement and strain were studied with speckle-tracking. Using longitudinal displacement, we defined a static longitudinal reference-point (sLRP) to which the other segments moved during systole. Transversal displacement and global function were determined by conventional-echo. Left and RV segments showed systolic longitudinal displacement towards the apex, which was the sLRP before surgery; and towards the medium segment of lateral RV-wall one week after surgery. The displacement of basal RV segment towards this sLRP was smaller, causing decreased TAPSE. Apical segments showed an inverse displacement towards the new sLRP, and septum displacement was decreased or inverted towards the lateral RV-wall, causing paradoxus septal motion. RV-wall longitudinal strain was reduced (- 23.1 ± 8.6 vs. - 14.6 ± 5.3;p < 0.001), RV transversal fractional shortening was increased (36.5 ± 10.5 vs. 41.7 ± 13; p = 0.011), and the RV fractional area change was unchanged (46.7 ± 9.5 vs. 47.8 ± 11.7; p = 0.625). The medium segment of RV lateral wall, in contact with sternotomy, remains static after surgery and acts as a new sLRP towards which the rest of segments move, explaining the reduction of TAPSE and paradoxus septal motion. The longitudinal strain of the lateral RV-wall gets impaired, but an increase of transversal motion maintains global RV function.
Summary: Myocardial dysfunction in diabetes mellitusis reversed by proper correction of metabolic changes. To assess the role of hyperglycemia on cardiac dysfunction, 50 g of dextrose were intravenously infused to 15 subjects with stable type 2 diabetes. Echocardiographic measurements were made at 0,60, 120, 180, and 240 minutes. In spite of the high levels of blood glucose reached in diabetics, left ventricular ejection fraction, fractional shortening, and stroke volume did not experience significant changes. Moreover, cardiac output significantly (p ~0 . 0 1 ) increased in diabetics secondary to an increase in heart rate. No cardiac changes were noticed in 7 healthy subjects studied in a similar fashion. However, their induced hyperglycemia was not as elevated as in the diabetic patients. These results suggest that acute induced hyperglycemia per se does not appear to impair left ventricular contractility in diabetics at resting conditions.
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