Time intervals from the first symptom to surgery of ovarian malignancies in a tertiary government hospital

@#<p style="text-align: justify;"><strong>Objective.</strong> This is a cross-sectional study aimed to determine the time intervals from the first symptom to surgery of 37 patients with ovarian malignancies who underwent surgery at a tertiary government hospital from June to October 2019.</p><p style="text-align: justify;"><strong>Methods.</strong> Structured interviews of patients and chart reviews were conducted to identify the intervals and the reasons behind such. The data were analyzed using Stata/SE 14.1, with the time intervals presented as medians and the reasons as frequencies. Multinomial logistic regression analysis established the association of time intervals with the extent of surgery and final stage of ovarian malignancies.</p><p style="text-align: justify;"><strong>Results.</strong> The median Total Time Interval from the first symptom to surgery was 214 days. The longest delay was the Total System Interval (from the first visit at the tertiary hospital to surgery) with a median of 70 days. This was followed closely by Patient Interval (from the first symptom to consult with the initial physician) with a median of 64 days. A distant third was the Initial Physician Interval (from the consult with the initial physician to the first visit at the tertiary hospital) with a median of 29 days. Most common reasons for the delays were the patients not acknowledging the gravity of their condition for the Patient Interval; choice to go to other hospitals, distance and laboratory works or diagnostics for the Initial Physician Interval; waiting for laboratory work-ups for the First System Interval; and waiting for other departments' clearance for the Second System Interval. The most common first symptom was abdominal enlargement. The length of interval and the final stage (p=0.056 for Stage III and p=0.162 for Stage IV)) as well as extent of surgery (p=0.093) did not show significant association.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The time interval from first symptom to surgery showed a median of 214 days. The greatest delay is contributed by Total System Interval followed by Patient Interval due to varying reasons. Length of time intervals, however, was not found to be significantly associated with the extent of surgery and final stage</p>

Efficacy comparision of lumbar disc herniation treated with acupuncture at different time intervals / 中国针灸

OBJECTIVE@#To observe the effect of lumbar disc herniation treated with acupuncture at different time intervals.@*METHODS@#A total of 180 patients of lumbar disc herniation were randomized into an observation group 1, an observation group 2 and an observation group 3, 60 cases in each one. All patients were treated with acupuncture at Jiaji L-L (EX-B 2), Huantiao (GB 30), Weizhong (BL 40), etc. And then KWD-808 electroacupuncture instrument was connected, time intervals of acupuncture were once every day, once every 2 days and once every 3 days, 3 weeks were provided. At 1-week, 2-week and 3-week treatment, the visual analogous scale (VAS) and Japanese Orthopedics Association (JOA) scale were observated, and the effects were evaluated.@*RESULTS@#The effective rates in the observation group 1 and the observation group 2 were 96.7% (58/60) and 95.0% (57/60), there was no significant different between the two groups (>0.05), which were superior to 88.3% (53/60) in the observation group 3 (both 0.05) at 1-week, 2-week and 3-week treatment, however, they were significantly reduced compared with the observation group 3 (all 0.05) at 1-week, 2-week and 3-week treatment, however, they were significantly increased compared with the observation group 3 at 3-week treatment (both <0.05).@*CONCLUSION@#Acupuncture once every day and once every 2 days in the treatment of lumbar disc herniation is equally effective, better than once every 3 days.

Oncological outcomes in extended time intervals between preoperative chemoradiotherapy with capecitabine and surgery in operable rectal adenocarcinoma / Resultados oncológicos en intervalos extendidos de tiempo entre quimioradioterapia preoperatoria con capecitabina y cirugía en adenocarcinoma rectal operable

Objective: To assess whether extended time intervals (8-12, 13-20 and >20 weeks) between the end of neoadjuvant chemoradiotherapy and surgery affect overall survival, disease-free survival. Materials and methods: Retrospective study in 120 patients with rectal adenocarcinoma without evidence of metastasis (T1-4/N0-2/M0) at the time of diagnosis that underwent surgery with curative intent after neoadjuvant chemoradiotherapy with capecitabine and obtained R0 or R1 resection between January 2010 to December 2014 at the National Cancer Institute of Peru. Dates were evaluated by Kaplan-Meier method, log- rank test and Cox regression analysis. Results: Of the 120 patients, 70 were women (58%). The median age was 63(26-85) years. All received neoadjuvant chemoradiotherapy. No significant difference was found between the association of the median radial (0.6, 0.7 and 0.8 cm; p=0.826) and distal edge (3.0, 3.5 and 4.0 cm; p=0.606) with time interval groups and similarly the mean resected (18.8, 19.1 and 16.0; p=0.239) and infiltrated nodules (1.05, 1.29 and 0.41); p=0.585). The median follow-up time of overall survival and desease free survival was 40 and 37 months, respectively. No significant differences were observed in overall survival (79.0%, 74.6% and 71.1%; p=0.66) and disease-free survival (73.7%, 68.1% and 73.6%; p=0.922) according to the three groups studied at the 3-year of follow-up. Conclusions: We found that widening the time intervals between the end of neoadjuvant chemoradiotherapy and surgery at 24 weeks does not affect the overall survival, disease-free survival and pathological outcomes. It allows to extend the intervals of time for future studies that finally will define the best time interval for the surgery

Objetivo: Evaluar si los intervalos de tiempo extendidos (8-12, 13-20 y >20 semanas) entre el fin de la quimioradioterapia neoadyuvante y la cirugía afectan la sobrevida global, y la sobrevida libre de enfermedad. Material y métodos: Estudio retrospectivo de 120 pacientes con adenocarcinoma rectal sin evidencia de metástasis (T1-4/N0-2/M0) al momento del diagnóstico que se sometieron a cirugía con intención curativa luego de quimioradioterapia neoadyuvante con capecitabina y tuvieron resección R0 o R1 entre enero 2010 y diciembre 2014 en el Instituto Nacioanal de Enfermedades Neoplásicas de Perú. El análisis se hizo con el método de Kaplan-Meier, la prueba log-rank y la regresión de Cox. Resultados: De 120 pacientes, 70 fueron mujeres (58%). La mediana de la edad fue 63 años (26-85 años). Todos recibieron quimioradioterapia neoadyuvante. No hubo diferencia significativa entre la asociación de las medianas de los bordes radial (0,6, 0.7 y 0,8 cm; p=0,826) y distal (3,0, 3,5 y 4,0 cm; p=0,606) con los intervalos de tiempo de los grupos y similarmente con la media de los ganglios resecados (18,8, 19,1 y 16,0; p=0,239) e infiltrados (1,05, 1,29 y 0,41; p=0,585). No se observaron diferencias significativas en sobrevida global (79,0%, 74,6% y 71,1%; p=0,66) y sobrevida libre de enfermedad (73,7%, 68,1% y 73,6%; p=0,922), en los tres grupos estudiados a 3 años de seguimiento. Conclusiones: Encontramos que aumentar los intervalos de tiempo entre el fin de la quimioradioterapia neoadyuvante y la cirugía hasta 24 semanas no afecta la sobrevida global, sobrevida libre de enfermedad ni los desenlaces patológicos. Esto permitiría extender los intervalos de tiempo en estudios futuros para definir el mejor intervalo de tiempo para la cirugía

Evaluation of left ventricular performance in menopausal women.

The incidence of ischemic heart disease is well documented in the literature in post menopausal women but the degree of deterioration of left ventricular performance in estrogen deficient state in women is not very clear. The present study was conducted to find the left ventricular performance by recording systolic time intervals (STIs) in 50 post menopausal women having either natural or surgical menopause and that was compared with 25 premenopausal controls. There was significant (P<0.01) increase in QS2-I, PEP-I and PEP/LVET ratio but significant (P<0.01) decrease in LVETI in surgical menopause group whereas the natural menopause group showed less increase in QS2-I (P<0.05), PEP/LVET ratio (P<0.01) and decrease (P<0.01) in LVET-1. Thus, the performance of left ventricle is more affected in surgical menopause group as compared to natural menopause group. The ventricular dysfunction was observed by STIs prior to the appearance of clinical signs and symptoms.

Quantitative study of fetal heart conduction time intervals by tissue Doppler imaging and pulse Doppler echocardiography / 中华超声影像学杂志

Objective To establish reference values of normal fetal heart conduction time intervals by tissue Doppler imaging(TDI)and pulsed Doppler(PD)echocardiography,and to assess their correlation with gestational-age and fetal heart rate.Methods One hundred and eighty-nine pregnant women underwent detailed echocardiographic examinations.Atrio-ventricular conduction time interval(AV)and the time interval from onset of ventricular contraction to the onset of atrial contraction of next cardiac cycle(VA)were measured by TDI and PD echocardiography.Results TDI-AV was(126.56±15.33)ms(95% CI 124.10～129.03 ms),TDI-VA was(285.22±24.53)ms(95% CI 281.27～289.16 ms),PD-AV was(127.42±12.88)ms(95% CI 125.35～129.49 ms),PD-VA was(287.42±25.19)ms(95% CI 283.37～291.47 ms).A paired t test revealed no systematic difference between the two approaches used to measure AV and VA.AV and VA were significantly positively correlated with gestational age,and significantly negatively correlated with fetal heart rate.Heart conduction time intervals were altered in fetus with paroxysmal arrhythmia.Conclusions This study established the normal values of fetal heart conduction time intervals.Prenatal determination of fetal heart conductional time intervals has important potential clinical utility in assessing fetal arrhythmia.

Assessment of Time Interval Between Onset of Ventricular Inflow and Onset of Early Diastolic Velocity by Tissue Doppler in Normal Infants

PURPOSE: Recently, time interval between onset of transmitral early inflow (E) and onset of early diastolic (Ea) velocity of the mitral annulus (TE-Ea) has been used to identify diastolic dysfunction in adults, but to date, no studies have been done in infants. The purpose of our study was to evaluate the normal values of TE-Ea in infants under 1 year of age, and to assess the influence of age, heart rate and cardiac growth on this index. METHODS: Thirty healthy children (mean+/-SD, age; 5.4+/-2.3 months) underwent echocardiography. Mitral and tricuspid inflow and tissue Doppler velocities were obtained from the leaflet tips and lateral site of the annulus, respectively, in the apical four-chamber view. The time intervals between the peak of R wave and onset of mitral and tricuspid E velocity (T(E)) and between peak of R wave and onset of Ea velocity (T(Ea)) were measured. The differences between these time intervals were calculated as T(E-Ea), which were compared with demographic and echocardiographic variables. RESULTS: Mean heart rate was 125.27+/-10.78 (bpm). Mitral T(E-Ea) was shorter than tricuspid T(E-Ea) (mean+/-SD, 24.89+/-10.33 msec versus 32.43+/-12.72 msec, P=0.016). Both mitral and tricuspid T(Ea) were significantly greater than T(E) (both: P<0.01). Age and heart rate did not show correlation with T(Ea-E). When correlated with echocardiographic variables, mitral T(E-Ea) tended to decrease as mitral ring area increased. CONCLUSION: In normal infants, T(E-Ea) values differ between both ventricles, which suggest differences in ventricular adaptation in the first year of life.

Tissue Doppler Image-Derived Myocardial Performance(Tei Index) as a Simple Assessment of Global Cardiac Function in Adults

BACKGROUND AND OBJECTIVES: A new Doppler time index of myocardial performance (the Tei index) has been studied as a useful predictor of global cardiac function. It is defined as (a-b)/b, where a is the interval between the end and onset of the mitral inflow, and b is the ejection time of the left ventricular outflow. However, the Doppler time intervals are not measured on the same cardiac cycle. SUBJECTS AND METHODS: We compared the tissue Doppler imaging (TDI)-derived Tei index, which can be measured on the same cardiac cycle, with the conventional Tei index as measured by pulsed wave Doppler method, in healthy persons (n=44), in patients having diastolic dysfunction with an E/E' ratio >10 (DD, n=56), and in patients having systolic dysfunction with an ejection fraction<50% (SD, n=10). At the septal and lateral mitral annulus from the apical 4-chamber view, the time interval between the end and onset of the mitral annular velocities during diastole (a') minus the duration of the systolic wave (b') divided by b', which is (a'-b')/b', is defined as the TDI-tei index. RESULTS: The TDI-Tei index and the conventional Tei index were significantly higher in the SD group than in the DD group, and they were also higher in the DD group than in the healthy controls. The TDI-Tei index at the septal and lateral annulus correlated well with the Tei index (r=0.71, r=0.65, respectively, p<0.001) and this showed a good correlation with other echocardiographic parameters of diastolic function. CONCLUSION: We demonstrated that the TDI-Tei index correlates well with the conventional Tei index along with having the advantage of simultaneous recording of the systolic and diastolic velocities in adults.

Effects of breath holding in air on cardiac responses in man / 体力科学

Healthy male subjects were asked to hold their breath in air at the tidal inspiratory level, and time-dependent changes in mean values of several parameters of cardiovascular function were studied. The heart rate increased abruptly after the beginning of breath-holding and then decreased slightly with time. The stroke volume (SV) remained significantly low until the end of breath-holding, so that the cardiac output was decreased in parallel. With regard to the systolic time interval, the totai eiectromechanical systole and the left-ventricular systolic time (LVET) were not significantly changed, whereas the pre-ejection period (PEP) was markedly prolonged. Therefore, ratios of PEP/LVET and SV/LVET were increased and decreased with time, respectively. As the systolic, and in particular the diastolic blood pressures were elevated, the pulse pressure was reduced. Ratios of the diastolic and systolic times in relation to the heart rate at rest, during breath-holding and during recovery after breath-holding were all proved to be described by a single regression curve. However, the ratios obtained for cycling exercise at various heart rates showed a marked shift above the curve. These results clearly indicate that cardiac performance is lowered during breath-holding in air.

Circulatory responses to sudden strenuous exercise. A study by mechanocardiographic method / 体力科学

A study was conducted for further investigation of the mechanism of notch formation of heart rate (HR) in sudden strenuous exercise (SSE), and rapid increase in stroke volume (SV) right after SSE which were the questions arised in the prior experiment.<BR>Six healthy male students volunteered for the study. A bicycle ergometer was prepared for SSE. The intensity and duration of SSE were 100%VO<SUB>2</SUB>max and 1 min, respectively. Warming-up consisting of 80%VO<SUB>2</SUB>max for 5 min, preceeded SSE. The interval between SSE and warming-up varied from 5 to 30 min. A control experiment was also conducted without warming-up.<BR>The main results obtained were as follows :<BR>1) Diastolic time (DT) temporarily elongated when a notch of HR was formed at the early stage of SSE. Warming-up prevented this formation. No notch was observed throughout total electromechanical systolic time (QS<SUB>2</SUB>), left ventricular ejection time (LVET) or preejection time (PEP) .<BR>2) DT was prolonged immediately after SSE, while LVET, PEPi (PEP index, Weissler's equation) were shortened. PEP/LVET did not change in the initial stage of the recovery period, while electrical systolic time (QT) and QS<SUB>2</SUB> shortend and QT/QS<SUB>2</SUB> increased temporarily.<BR>These results suggest the following conclusions :<BR>1) Notch formation observed in heart rate is due to the temporary extension of DT at the early stage of SSE.<BR>2) Decrease in afterload may be the main cause for the rapid increase in stroke volume after SSE, though other factors such as increase in preload, myocardial contractility and sympathetic tone should also be considered.

Comparisons of left ventricular systolic and diastolic times in exercise between trained and untrained men / 体力科学

The systolic time intervals (STI's) and the diastolic time (DT) as functions of the RR interval during exercise were proved to be described by cubic regression equations that converge to the origin of the coordinates. Using the equations, we compared I) the systolic time and DT of trained and untrained men, and II) examined the relations between parameters of STI's. I) Forty healthy male subjects aged 19-22 years old were divided into three groups, i, e., 8 long distance runners (group LD), 16 men with relatively high fitness (group A) and 16 men with relatively low fitness (group B) . They performed submaximal exercise test using a cycle ergometer for measuring the time of electromechanical systole (QS<SUB>2</SUB>) and DT. After test, maximal exercise test was conducted to determine the maximal heart rate (HRmax) in each subject. Means±SD of the minimum QS<SUB>2</SUB> and the minimum DT of the 40 subjects predicted from the regression equations at the HRmax were 209.7±12.5 and 108.2±15.6 ms, their ratio being about 2: 1. The QS<SUB>2</SUB> was significantly shorter, whereas DT was longer in the group LD than in the groups A and B at the HR of more than 120 bpm. II) Ten healthy male subjects aged 19-22 years old performed submaximal exercise to clarify the relations between any two of QS<SUB>2</SUB>, the left ventricular ejection time (LVET) and the preejection period (PEP) at the same HR: there were positive and negative significant correlations between QS<SUB>2</SUB> and LVET, and between LVET and PEP, respectively, at the HR of more than 100 bpm. These results reveal that, when the HR is increased in exercise, the left ventricular systolic time (QS<SUB>2</SUB>) is shortened while the diastolic time is lengthened for the subjects trained as long distance runners. The shortening of the systolic time is mainly caused by shortening of LVET. The changes in the systolic and diastolic times suggest that contractility of cardiac muscle is enhanced during exercise of above moderate intensity after an extensive period of the aerobic training.

Changes in systolic and diastolic time intervals during prolonged exercise. (Part 3) / 体力科学

A study was undertaken to elucidate the mechanism responsible for the specific changes in systolic time intervals (STIs), diastolic time (DT) and the ratio of total electromechanical systole to DT (QS<SUB>2</SUB>/DT), which were observed during prolonged exercise<SUP>17, 19)</SUP> Sixteen healthy male students performed short-term incremental maximal exercise and 40-min submaximal exercise with a work load requiring 65% of maximal oxygen consumption on a bicycle ergo-meter, Heart rate (HR), stroke volume (SV), blood pressure (BP), STIs and DT were calculated from electrocardiogram, phonocardiogram, derivative of ear densitogram, impedance cardiogram and finger arterial pressure wave.<BR>1) During the short-term exercise, STIs, DT and QS<SUB>2</SUB>/DT changed rectilinearly in accordance with increased HR, whereas they changed in a specific zigzag pattern during the prolonged exercise.<BR>2) During the prolonged exercise, SV and BP were lower than those during the short-term exercise, except for SV between 1 and 2 min after the start of the exercise. From 2 min onwards, left ventricular ejection time (LVET), QS<SUB>2</SUB> and QS<SUB>2</SUB>/DT became smaller than those during the short-term exercise.<BR>3) Differences between the measured values of LVET, pre-ejection period (PEP) and PEP/LVET and those predicted by multiple regression equations during the prolonged exercise were smaller than those during the short-term exercise.<BR>From these findings, it was concluded that the specific changes observed in STIs, DT and QS<SUB>2</SUB>/DT during prolonged exercise are produced by decrease of SV and BP in the early stage, and probably influenced by a decrease in myocardial contractility in the late stage.

Changes in systolic and diastolic time intervals during prolonged exercise. (Part 2) / 体力科学

A study was undertaken to determine whether the specific change in the ratio of systolic to diastolic time (QS<SUB>2</SUB>/DT) observed during prolonged exercise<SUP>17)</SUP> is dependent on HR or elapsed time, and also to elucidate the possible relationship between change in QS<SUB>2</SUB>/DT and distance-running performance. Twelve male distance runners were divided into two groups, a high- (HP Group) and a low-performance (LP Group) group, according to their 10, 000-meter running performance. They performed 60-min exercise on a bicycle ergometer at a work load controlled so as to keep the HR at 150 bpm. HR, systolic time intervals (STIs) and DT were calculated from electrocardiogram, phonocardiogram and the derivative of ear densitogram.<BR>In the time course of QS<SUB>2</SUB>/DT, two crests were formed at 2 and 15 min after the start of exercise, and also two troughs were formed at 10 and 20 min. Some of these troughs and crests formed even when HR was kept constant. Patterns of change in QS<SUB>2</SUB>, DT, QS<SUB>2</SUB>/DT and other parameters were similar in the two groups. However, the absolute values of the parameters differed. QS<SUB>2</SUB>, left ventricular ejection time (LVET) and QS<SUB>2</SUB>/DT in the HP Group were lower than those in the LP Group, whereas DT in the HP Group was longer than that in the LP Group.<BR>From these findings, it was concluded that the specific change seen in QS<SUB>2</SUB>/DT during prolonged exercise is dependent not on the HR level but on elapsed time. The changes in STIs and DT during prolonged exercise are thus influenced by the distance-running performance of the subjects.

Determination of Pulmonary to Systemic Flow Ratio and Prediction of Pulmonary Arterial Pressure in Children by Pulsed Doppler Echocardiography

The purpose of this study is to evaluate pulsed Doppler echocardiographic method (PD) for the measurement of pulmonary to systemic flow ratio (QP/Qs) and pulmonary arterial pressure in children. We studied 32 children with left to right shunt who had undergone cardiac catheterization, 11 children who had heart diseases without shunt and 14 normal children. Velocity time intergral (VTI) was calculated by triangulated meansurement [1/2(maximum blood velocityxejection time)]. Doppler blood flow was calculated from the equation : Doppler blood flow=VTIxcross sectional areaxheart rate. The following Doppler time intervals and ratio of intervals were also measured : preejection period(PEP), acceleration time(AT), ejection time (ET), PEP/AT, PEP/ET and AT/ET. Qp/Qs measured by PD was 1.09+/-0.15 (mean+/-SD) in children with no shunt and normal children. A high correlation was found between Fick and Doppler-derived Qp/Qs in children with left to right shunt (r=0.87). All the children with Qp/Qs less than 1.5 showed no significant discrepancy between two methods. The best correlation with pulmonary arterial pressure was achieved by the PEP/AT (r=0.84 vs systolic pressure). Sensitivity and specificity of PEP/AT for predicting pulmonary arterial hypertension were 79% and 95%, respecitively. In conclusion, it is thought that determination of Qp/Qs and prediction of pulmonary arterial pressure in children by PD is a useful, noninvasive method and triangulated measurement may be used as a simple and easy method for the measurement of Qp/Qs.