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We sought to evaluate the behavior of cardiac mechanical synchrony as measured by phase SD (PSD) derived from gated MPI SPECT (gSPECT) in patients with super-response after CRT and to evaluate the clinical and imaging characteristics associated with super-response. 158 subjects were evaluated with gSPECT before and 6 months after CRT. Patients with an improvement of LVEF > 15% and NYHA class I/II or reduction in LV end-systolic volume > 30% and NYHA class I/II were labeled as super-responders (SR). 34 patients were classified as super-responders (22%) and had lower PSD (32° ± 17°) at 6 months after CRT compared to responders (45° ± 24°) and non-responders 46° ± 28° (P = .02 for both comparisons). Regression analysis identified predictors independently associated with super-response to CRT: absence of previous history of CAD (odds ratio 18.7; P = .002), absence of diabetes mellitus (odds ratio 13; P = .03), and history of hypertension (odds ratio .2; P = .01). LV dyssynchrony after CRT implantation, but not at baseline, was significantly better among super-responders compared to non-super-responders. The absence of diabetes, absence of CAD, and history of hypertension were independently associated with super-response after CRT.

Gated myocardial perfusion scintigraphy (GMPS) phase analysis is an important tool to investigate the physiology of left ventricular (LV) dyssynchrony. We aimed to test the performance of GMPS LV function and phase analysis in different clinical settings and on a diverse population. This is a post hoc analysis of a prospective, non-randomized, multinational, multicenter cohort study. Clinical evaluation and GMPS prior to cardiac resynchronization therapy (CRT)(baseline) and 6-month post CRT (follow-up) were done. LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), LV ejection fraction (LVEF), LV phase standard deviation (LVPSD), and percentage of left ventricle non-viable (PLVNV) were obtained by 10 centers and compared to the core lab. 276 GMPS studies had all data available from individual sites and from core lab. There were no statistically significant differences between all variables except for LVPSD. When subjects with no mechanical dyssynchrony were excluded, LVPSD difference became non-significant. LVESV, LVEF, LVPSD and PLVNV had strong correlation in site against core lab comparison. Bland–Altman plots demonstrated good agreement. The presented correlation and agreement of LV function and dyssynchrony analysis over different sites with a diverse sample corroborate the strength of GMPS in the management of heart failure in clinical practice.

The endometrium is derived from the mucosal lining of the fused Mullerian ducts. It is essential for reproduction and may be one of the most complex tissues in the human body [1].

It is estimated that two of every five Indians are infected with TB bacillus, and there is strong chance that at least 10% of them will develop tuberculosis during their lifetime [1, 2].

Background Placing the left ventricular (LV) lead in a viable segment with the latest mechanical activation (vSOLA) may be associated with optimal cardiac resynchronization therapy (CRT) response. We assessed the role of gated SPECT myocardial perfusion imaging (gSPECT MPI) in predicting clinical outcomes at 6 months in patients submitted to CRT. Methods Ten centers from 8 countries enrolled 195 consecutive patients. All underwent gSPECT MPI before and 6 months after CRT. The procedure was performed as per current guidelines, the operators being unaware of gSPECT MPI results. Regional LV dyssynchrony (Phase SD) and vSOLA were automatically determined using a 17 segment model. The lead was considered on-target if placed in vSOLA. The primary outcome was improvement in ≥1 of the following: ≥1 NYHA class, left ventricular ejection fraction (LVEF) by ≥5%, reduction in end-systolic volume by ≥15%, and ≥5 points in Minnesota Living With Heart Failure Questionnaire (MLHFQ). Results Sixteen patients died before the follow-up gSPECT MPI. The primary outcome occurred in 152 out of 179 (84.9%) cases. Mean change in LV phase standard deviation (PSD) at 6 months was 10.5°. Baseline dyssynchrony was not associated with the primary outcome. However, change in LV PSD from baseline was associated with the primary outcome (OR 1.04, 95% CI 1.01-1.07, P = .007). Change in LV PSD had an AUC of 0.78 (0.66-0.90) for the primary outcome. Improvement in LV PSD of 4° resulted in the highest positive likelihood ratio of 7.4 for a favorable outcome. In 23% of the patients, the CRT lead was placed in the vSOLA, and in 42% in either this segment or in a segment within 10° of it. On-target lead placement was not significantly associated with the primary outcome (OR 1.53, 95% CI 0.71-3.28). Conclusion LV dyssynchrony improvement by gSPECT MPI, but not on-target lead placement, predicts clinical outcomes in patients undergoing CRT.

In the last years a growing scientific interest has been focused on chronic endometritis and on the consequences of this pathology on reproduction [1].

Left ventricular diastolic dyssynchrony (LVDD) can be assessed by gated myocardial perfusion single-photon emission computed tomography (GMP-SPECT). LVDD is an area of interest in subjects who underwent cardiac resynchronization therapy (CRT). The aim of this post hoc analysis was to assess the role of LVDD in subjects with CRT who were followed up at 6-month period. Left ventricular diastolic dyssynchrony was assessed by GMP-SPECT at baseline and after CRT procedure in 160 subjects from 10 different cardiological centers. CRT procedure was performed as per current guidelines. Outcomes were defined as improvement in ≥1 New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF) by 5%, and reduction in end-systolic volume (ESV) by 15% and 5% points in Minnesota Living with Heart Failure Questionnaire. LVDD was defined as diastolic phase standard deviation ≥40 ± 14°. Improvement in NYHA functional class occurred in 105 (65.6%), LVEF in 74 (46.3%), decrease in ESV in 86 (53.8%), and Minnesota score in 85 (53.1%) cases. Baseline LV diastolic standard deviation was 53.53° ± 20.85 and at follow-up 40.44° ± 26.1283; (P

Repeated implantation failure is a major clinical challenge and is the cause of considerable stress to patients and clinicians in assisted reproductive technology (ART). Hysteroscopy enables the clinician evaluate the uterine abnormalities such as endometrial polyps, submucous myomas, adhesions, septa, tubal ostia, and inflammatory endometrial pathologies like endometrial tuberculosis and chronic endometritis. Hysteroscopy also allows the diagnosis as well as the treatment of the intrauterine pathology in the same setting, thereby increasing the pregnancy rate in subfertility.

Objective: To develop a consensus on the diagnostic criteria for chronic endometritis (CE) at hysteroscopy (HSC), and to evaluate these proposed criteria in a randomized-controlled observer study. Design: Systematic review of studies evaluating the diagnostic accuracy of HSC in CE diagnosis; Delphi consensus on hysteroscopic diagnostic criteria for CE; randomized-controlled observer study to evaluate the reproducibility of the proposed diagnostic criteria. Setting: Not applicable. Participant(s): Experts from different countries were involved in the systematic review and contributed to the Delphi consensus. Physicians from different countries were involved in the observer study. Intervention(s): After reaching consensus on the diagnostic criteria, the Delphi poll created a questionnaire including 100 hysteroscopic pictures (50 from women with CE [domain 1] and 50 from women without CE [domain 2]), with a single question per picture (Answer_A: suggestive of CE; answer B: not suggestive of CE). A total of 200 physicians were invited to take part in the observer study. Before completing the questionnaire, physicians were randomized to receive a description of the diagnostic criteria (group A) or no such information (group B). Main Outcome Measure(s): The primary outcome was to compare the questionnaire scores for the two groups of observers. The secondary outcome was to assess the interobserver agreement in the diagnosis of CE in each group. Result(s): A total of 126 physicians completed the questionnaire (62 in group A and 64 in group B). Observers in group A obtained higher total scores compared with those in group B (P

This article describes the benefit of monitoring the intravasation rate in addition to the conventional measurement of fluid deficit in hysteroscopic surgical procedures. The intravasation rate is the rate, in milliliters per minute, at which fluid enters the systemic circulation, whereas fluid deficit is the amount of irrigation fluid, in milliliters, already absorbed by the patient. To determine the intravasation rate, a manually operated intravasation monitoring pump was constructed, with which one of us (Dr. Atul Kumar) performed 966 hysteroscopic procedures from May 1993 to February 2010. Because the intravasation rate had to be manually calculated by an assistant, it was decided to replace the assistant with a controller to monitor intravasation rate. The surgical experience gathered from the manually operated pump was used to develop algorithms for the controller. The controller-operated intravasation monitoring pump was constructed, with which 41 hysteroscopic procedures were performed from March 2010 to August 2011. In hysteroscopic procedures, this pump simultaneously displays the real-time intravasation rate and the fluid deficit on an LCD screen.

gled cutting loop. A 22-year-old woman underwent suction curettage of a missed abortion at 6 weeks of gestation. The tip of the Karman cannula, a 6-mm flexible plastic cannula, broke during the procedure. After multiple unsuccessful attempts to remove the cannula tip via mechanical means under ultrasound guidance, the patient was ultimately referred to us for hysteroscopic intervention. Hysteroscopic view from

Recurrent respiratory papillomatosis is a chronic disease of children and young adults associated with various complications, one of which is malignant change. We report CT findings of malignant change in a case of recurrent respiratory papillomatosis.

Genocide is one of the most challenging problems of our age. In her book, “A Problem from Hell:” America and the Age of Genocide, Samantha Power (2002) argues that the United States, while in a position to intervene in genocide, has lacked the will to do so, and therefore it is incumbent on the U.S. citizenry to pressure their government to act. This article reviews how the topic of genocide raises questions along the fault lines of the field of Peace and Conflict Studies (PACS). In this article, a framework is provided to examine genocide and responses to it. This includes a review of a multiplicity of factors that (a) facilitate genocide, (b) constrain action in the face of it, and (c) facilitate intervention. In this analysis, further consideration is given to the location of the actor either within the region of the conflict or external to it. Our goal is to situate the study of genocide in the PACS field and promote to the articulation of possibilities for intervention by individuals, organizations, and policymakers. Author Bio(s) Paul Cormier is a member of Lake Helen First Nations Red Rock Indian Band in Northern Ontario, Canada. He is a member of the Wolf Clan and his traditional spirit name is Ma'iingan or Wolf in Ojibway. He has a Master's Degree in Conflict Analysis and Management. Currently, he is a doctoral student in Peace and Conflict Studies at the University of Manitoba. His research interests are in Traditional Indigenous Peacebuilding, land disputes relating to Indigenous Peoples and identity-based conflicts, and Indigenous land rights, with the long-term objective of bringing peace to the Indigenous Peoples of the world by a reconnection to traditional lands. Email: pncormier@hotmail.com Peter Karari is a doctoral student in Peace and Conflict Studies at the Mauro Centre, University of Manitoba. His doctorate research focuses on ethno-political violence and peace-building in Kenya. He has worked as a Programme Coordinator with Compassion International–Kenya and as the Chief Executive Officer with Oxfam GB–Kenya. He holds a B.A. in Social Work from the University of Nairobi in Kenya and an M.A. in Peace and Conflict Research from Otto-von Guericke University in Germany. Email: karari_mp@yahoo.com Alka Kumar is an Associate Professor of English at University of Delhi, India. She now lives in Winnipeg and is currently a doctoral student in Peace and Conflict Studies at the University of Manitoba. Her interests lie in the fields of development, religious conflict and human rights. Email: alkakr@yahoo.com Robin Neustaeter is a peace activist, educator, and mother. She has been teaching courses and conducting workshops in the areas of education and conflict resolution for ten years. Currently, she is a doctoral student in Peace and Conflict Studies at the University of Manitoba. Email: robin_neu@yahoo.ca Jodi Read is a doctoral student in Peace and Conflict Studies at the University of Manitoba. She was a designer of the Mennonite Central Committee U.S. Immigration Listening Project, and facilitated focus groups in ten churches on the West Coast of the U.S. At Eastern Mennonite University, she conducted interviewed with documented and undocumented immigrant Mexican workers in the region. For seven years, she served with Mennonite Central Committee in Bolivia and Chile. She worked toward diverse project goals such as income generation, peace-building, and domestic violence. Email: read.jodi@gmail.com This article is available in Peace and Conflict Studies: http://nsuworks.nova.edu/pcs/vol17/iss1/2 Jessica Senehi is Assistant Professor in Peace and Conflict Studies at the University of Manitoba, and Associate Director of the Arthur V. Mauro Centre for Peace and Justice at St. Paul’s College. At the University of Manitoba, in 2007, she established the award-winning graduate-level Summer Institute for Peace and Renewing Community. In 2006, she established the Winnipeg International Storytelling Festival: Storytelling on the Path to Peace, presented by the Mauro Centre for Peace and Justice. Her research focuses on the role of storytelling in peacebuilding, cultural conflict, and gender. Email: Jessica_Senehi@umanitoba.ca Authors Paul Cormier, Peter Karari, Alka Kumar, Robin Neustaeter, Jodi Read, and Jessica Senehi This article is available in Peace and Conflict Studies: http://nsuworks.nova.edu/pcs/vol17/iss1/2 “The Problem from Hell” “The Problem from Hell”: Examining the Role of Peace and Conflict Studies for Genocide Intervention and Prevention Paul Cormier, Peter Karari, Alka Kumar, Robin Neustaeter, Jodi Read, and Jessica Senehi

A 50-year-old woman with menometrorrhagia was referred for hysteroscopy. A 20-mm polyp was seen arising from the anterior uterine wall. The polyp was unremarkable except that its external surface appeared bright red (Fig. 1). However, an area over the posterior uterine cavity wall, which was in apposition with the polyp, appeared bright red in a well-circumscribed area (Fig. 2), and for the sake of illustration this area is termed as ‘‘mirror lesion.’’ ‘‘Mirror lesion’’ was rounded, confirming to the shape of the polyp, it had well-defined sharp margins, and its bright red texture differentiated it from the surrounding endometrium. The entire polyp

Eighty patients with primary carcinoma of the gallbladder were studied by ultrasonography. Two broad groups were defined. In group I (72.5%), the gallbladder lumen was identified along with a mass lesion, and in group II (27.5%), a large mass totally replacing the gallbladder was seen. Group I was further categorized into three subtypes according to the morphology of the lesion: type 1--a mass almost filling the lumen; type 2--a polypoidal mass projecting into the lumen; and type 3--an infiltrating mass. Associated findings of infiltration of the liver, presence of calculi, biliary tree obstruction, liver metastasis, and lymphadenopathy further supported the diagnosis. Ultrasonography was found to be highly reliable in the diagnosis of carcinoma of the gallbladder. In addition, it provided guidance for biopsy/aspiration of nonpalpable tumors. Its shortcomings appear to be its inability to assess peritoneal and bowel involvement, as well as that of the omentum and posterior rectus sheath.

Hysteroscopic visualization of the endometrium after 6 months of antitubercular therapy showed an improvement in the mucosal morphology. A closer visualization at increased magnification was helpful in demonstrating the remnants of a healing tubercular pathology after antitubercular therapy.

Intraluminal adhesions in the interstitial part of the fallopian tube were viewed at hysteroscopy by placing the microhysteroscope tip very close to the tubal orifice and viewing with a source magnification of 25×.