To evaluate the feasibility of transarterial chemoembolization (TACE) for locally advanced breast cancer (LABC). A total of 31 sequential patients with previously untreated LABC in Stages III or IV were evaluated retrospectively. Selective microcatheter insertion was performed on all branches angiographically identified to the breast tumours and axillary lymph node metastases. Angio-CT imaging was used to confirm the distribution of drugs within the tumour after the selective infusion of contrast material. The patients were treated with anti-neoplastic agents indicated for breast cancer therapy. Drugs were infused directly into the tumour-feeding arteries, and embolization was carried out with spherical embolic material, HepaSphere (50–100 µm). After the initial treatment, additional treatments were repeated as needed. The primary outcome measure was the local response of the primary tumours and lymph node metastases at 1, 3, 6, and 12 months after the initial therapy. The mean number of sessions per patient was 6.8 (range 3–23). The response rates of primary breast lesions at 1, 2, 6, and 12 months were 19
With the increasing use of minimally invasive catheter-based therapies, early identification of severe aortic stenosis (AS) has become essential. The slow upstroke waveform (Tardus) observed in carotid artery wave analysis is a known feature of AS, and quantitative assessments of Tardus can estimate the severity of AS. Prolongation of ejection time (ET) and upstroke time (UT) is a characteristic of Tardus. However, the clinical relevance of ET and UT measured during brachial–ankle pulse wave velocity (baPWV) assessment remained unclear. This study aimed to develop a predictive model for screening severe AS using baPWV-derived parameters. We enrolled 117 patients with mild to severe AS and 76 control subjects without cardiovascular disease. AS severity was classified based on peak aortic valve velocity (peak V) measured by echocardiography. We evaluated correlations between peak V and baPWV parameters, including ET, UT, and pre-ejection time (PEP), and developed a predictive model to identify severe AS. Peak V correlated significantly with ET, PEP, PEP/ET and mean UT (r = 0.52, − 0.28, − 0.44, 0.33; all p < 0.001). A model incorporating age, body mass index, corrected ET, corrected mean UT and mean percentage of mean arterial pressure (
OBJECTIVES:The impact of respiratory syncytial virus (RSV) among older adults hospitalized for acute respiratory symptoms was uncertain. We compared the prevalence and clinical outcomes of RSV with those of COVID-19 and influenza in older adults hospitalized for acute respiratory symptoms. METHODS:We conducted a multicentre prospective cohort study at three community hospitals, which enrolled emergently hospitalized adults aged ≥50 years with acute respiratory symptoms or signs from July 1, 2023, to December 31, 2024. RSV, COVID-19, and influenza A/B were measured using the FilmArray Respiratory panel 2.1 on a nasopharyngeal swab. The primary outcomes were lower respiratory tract infections (LRTIs), defined as presence of ≥2 lower respiratory symptoms/signs for at least 24 hours, including ≥1 lower respiratory sign or presence of ≥3 lower respiratory symptoms for at least 24 hours; modified LRTIs, incorporating chest radiography or computed tomography; and the 30-day all-cause mortality. RESULTS:During the 18-month study period, 3067 patients were included, with a mean age of 81 years (standard deviation: 11), and 55% of whom were male. Comorbidities included chronic pulmonary diseases (28%), chronic heart failure (32%), and diabetes (30%). The vaccination rates for RSV, COVID-19, and influenza were 0%, 62.3%, and 37.9%, respectively. The prevalence of RSV, COVID-19, and influenza A/B was 1.6%, 18.0%, and 2.3%, respectively. The rates of LRTIs were 87.8% (RSV), 82.8% (COVID-19), and 88.4% (influenza A/B). The rates of modified LRTIs exhibited a marginal increase. The 30-day mortality was highest among patients with RSV (14.3%) compared with those with COVID-19 (8.4%) and influenza A/B (2.9%) (p = 0.02). The adjusted odds ratios (95% confidence intervals) of 30-day mortality with RSV and COVID-19 relative to influenza A/B were 5.2 (1.2-36.7) and 2.9 (0.83-17.9), respectively. CONCLUSIONS:RSV should be recognized as a risk factor for mortality among older adults emergently hospitalized for acute respiratory symptoms.
OBJECTIVE:Although sodium-glucose co-transporter 2 (SGLT2) inhibitors are effective treatments, their use may be associated with increased risk of lower limb amputation. Moreover, no studies have reported on their clinical safety and efficacy in patients with chronic limb threatening ischaemia (CLTI). Therefore, this multicentre retrospective observational study evaluated their clinical efficacy in diabetic patients with CLTI who underwent endovascular therapy (EVT). METHODS:Eligible patients with diabetes and CLTI were identified retrospectively between January 2021 and December 2023 from a multicentre Japanese EVT registry. The patients were divided into two groups based on whether or not they received treatment with SGLT2 inhibitors. The clinical safety and efficacy of SGLT2 inhibitors was evaluated after propensity score matching (PSM). The primary outcome was freedom from major amputation within one year. Secondary endpoints were amputation free survival, all cause death, wound healing, cardiovascular death, and infection related death within one year. RESULTS:Among 257 patients, 51 matched pairs were analysed after PSM, with no baseline differences between groups. One year freedom from major amputation was similar (94.0% vs. 86.8%; p = .30), whereas amputation free survival was statistically significantly better in the SGLT2 inhibitor group (88.3% vs. 71.3%; p = .030). The all cause mortality rate was also lower with SGLT2 inhibitors (4.7% vs. 18.7%; p = .030). Wound healing (82.8% vs. 69.7%; p = .49), cardiovascular mortality (0.0% vs. 7.0%; p = .070), and infection related mortality (2.2% vs. 6.1%; p = .31) did not differ statistically significantly between the groups. CONCLUSION:SGLT2 inhibitors may not be associated with an increased risk of major lower limb amputation in patients with CLTI undergoing EVT. These agents may be associated with improved clinical outcomes in this population.
Introduction:Bladder cancer (BC) is rarely associated with common bile duct (CBD) obstruction. We report a case of BC with peritoneal invasion and rectal involvement complicated by bilateral ureteral and biliary obstruction. Case Presentation:A 77-year-old man presented with abdominal pain. Imaging revealed a bladder tumor with suspected muscle invasion, rectal obstruction, and bilateral hydronephrosis. Urothelial carcinoma was confirmed after transurethral resection of the bladder. Following the operation, the patient developed cholangitis with CBD obstruction, and in the absence of direct invasion or mass-like lesions suggestive of malignant retroperitoneal fibrosis, retroperitoneal extension was considered a possible mechanism. Safety concerns regarding enfortumab vedotin in the setting of biliary obstruction led us to administer pembrolizumab monotherapy. Conclusion:BC may contribute to biliary obstruction through retroperitoneal processes, underscoring the need for careful diagnostic and therapeutic assessment. Furthermore, biliary drainage enabled the initiation of systemic therapy, highlighting the importance of appropriate supportive intervention.
