Speckle tracking echocardiography in the critically ill: enticing research with minimal clinical practicality or the answer to non-invasive cardiac assessment?

Echocardiography is developing rapidly. Speckle tracking echocardiography is the latest semi-automatic tool that has potential to quantitatively describe cardiac dysfunction that may be unrecognised by conventional echocardiography. It is a non-Doppler, angle-independent, feasible and reproducible method to evaluate myocardial function in both non-critically ill and critically ill populations. Increasingly it has become a standard measure of both left and right ventricle function in specific patient groups, e.g. chemotherapy-induced cardiomyopathy or pulmonary hypertension. To date there are few studies in the critically ill, predominantly in sepsis, yet all describe dysfunction beyond standard measures. Other areas of interest include heart-lung interactions, right ventricle function and twist and torsion of the heart. A word of caution is required, however, in that speckle tracking echocardiography is far from perfect and is more challenging, particularly in the critically ill, than implied by many published studies. It takes time to learn and perform and most values are not validated, particularly in the critically ill. We should be cautious in accepting that the latest software used in cardiology cohorts will automatically be the answer in the critically ill. Even with these limitations the technology is enticing and results fascinating. We are uncovering previously undescribed dysfunction and although it currently is essentially a research-based activity, there is great promise as a clinical tool as echocardiography analysis becomes more automated, and potentially speckle tracking echocardiography could help describe cardiac function in critical illness more accurately than is possible with current techniques.

Workplace smoking related absenteeism and productivity costs in Taiwan.

OBJECTIVE: To estimate productivity losses and financial costs to employers caused by cigarette smoking in the Taiwan workplace. METHODS: The human capital approach was used to calculate lost productivity. Assuming the value of lost productivity was equal to the wage/salary rate and basing the calculations on smoking rate in the workforce, average days of absenteeism, average wage/salary rate, and increased risk and absenteeism among smokers obtained from earlier research, costs due to smoker absenteeism were estimated. Financial losses caused by passive smoking, smoking breaks, and occupational injuries were calculated. RESULTS: Using a conservative estimate of excess absenteeism from work, male smokers took off an average of 4.36 sick days and male non-smokers took off an average of 3.30 sick days. Female smokers took off an average of 4.96 sick days and non-smoking females took off an average of 3.75 sick days. Excess absenteeism caused by employee smoking was estimated to cost USD 178 million per annum for males and USD 6 million for females at a total cost of USD 184 million per annum. The time men and women spent taking smoking breaks amounted to nine days per year and six days per year, respectively, resulting in reduced output productivity losses of USD 733 million. Increased sick leave costs due to passive smoking were approximately USD 81 million. Potential costs incurred from occupational injuries among smoking employees were estimated to be USD 34 million. CONCLUSIONS: Financial costs caused by increased absenteeism and reduced productivity from employees who smoke are significant in Taiwan. Based on conservative estimates, total costs attributed to smoking in the workforce were approximately USD 1032 million.

Immunohistochemical estrogen receptor assessment in hyperplastic, neoplastic, and physiologic endometria.

Endometrial hyperplasias and some endometrial carcinomas arise in a setting of estrogen excess. Steroid hormones interact with cells via specific receptors; assessing receptor levels may indicate a tissue's potential for interaction with that hormone. To examine estrogen receptor (ER) levels in endometrial hyperplasia, endometrial carcinoma, and physiologically cycling endometrium, an immunohistochemical technique utilizing a monoclonal anti-estrophilin (estrogen receptor) antibody was applied to formalin-fixed, paraffin-embedded tissue. In complex hyperplasia and grade I adenocarcinoma, the mean percentages of epithelial cells demonstrating nuclear staining for ER was mildly decreased compared to proliferative endometrium. A trend was noted toward less ER staining in atypical hyperplasia compared to non-atypical complex hyperplasia. ER varied with physiologic cycling of the endometrium. ER was also present in atrophic endometrium, myometrium, adenomyosis, and leiomyomata. Immunohistochemistry permits localization of ER and is a useful technique in ER assessment of endometrial hyperplasias and carcinomas.