Tokyo Metropolitan Hiroo Hospital (東京都立広尾病院) is located in Shibuya, Tokyo, Japan. It has 426 beds and is run by the Tokyo Metropolitan Government.The hospital focuses on emergency and disaster medical care, cardiovascular diseases, cerebrovascular diseases, and care for residents of outlying islands near Tokyo. It also specialises in providing multi-lingual care for foreign residents of Tokyo.
Although slow pathway ablation is an established curative therapy for typical atrioventricular nodal reentrant tachycardia (AVNRT), lesion delivery is constrained by the anatomical proximity to the His bundle, limiting the procedural safety margin. Peak frequency mapping (PFM) is a novel physiology-based method that highlights regions of the slow pathway-related electrograms and may enable safer ablation at more annular sites. To evaluate the reproducibility, procedural safety, and clinical efficacy of PFM-guided slow pathway ablation compared with the conventional anatomical approach. Eighty-one consecutive patients with typical AVNRT were analyzed (39 conventional, 42 PFM-guided). Procedural characteristics, acute success, safety outcomes, and mid-term recurrence were assessed. PFM consistently localized the slow pathway around the 4–5 o’clock region of the tricuspid annulus and enabled effective ablation at significantly greater distances from the His bundle (22.8 ± 5.5 vs. 11.5 ± 3.2 mm, p < 0.0001). Acute success was achieved in all PFM-guided cases and in 97.4
The oncologic outcomes of pedunculated-type T1 colorectal cancer (CRC) remain unknown. We determined the risk factors for lymph node metastasis (LNM) and recurrence and evaluated the survival according to the treatment method. In this multicenter retrospective study involving 4673 patients with T1 CRC, we analyzed 444 patients with pedunculated-type T1 CRC treated between 2009 and 2016. Treatment included local resection (LR) alone (n = 169), surgery with lymph node (LN) dissection alone (n = 83), and LR followed by additional surgery with LN dissection (n = 192). Factors associated with LNM and recurrence, relapse-free survival (RFS) and overall survival (OS) by treatment were analyzed. The median follow-up period was 64 months. LNM and recurrence were observed in 25 (5.6
To investigate whether colorectal cancer (CRC) sidedness is associated with intraoperative lavage cytology results, tumor recurrence, and prognosis. Using data from a multicenter prospective observational study conducted by the Japanese Society for Cancer of the Colon and Rectum (JSCCR), we retrospectively analyzed prognosis and recurrence patterns in pathological stage II/III right-sided and left-sided CRC, stratified by positive versus negative lavage cytology results. A total of 1500 patients met the inclusion criteria and were enrolled. Of these, 534 had right-sided CRC and 966 had left-sided CRC. Fifty-nine patients (3.9
Background Intensive care unit readmissions or in-hospital death following intensive care unit discharge are critical issues in postoperative management. However, existing predictive models have suboptimal performance and lack generalizability. We aimed to develop and internally validate a simplified risk score to identify surgical patients at high risk of adverse events (intensive care unit readmission or in-hospital death) within 7 days after intensive care unit discharge. The score was intended to be used at the time of intensive care unit discharge by bedside clinicians and intensive care unit bed managers. Methods We conducted a retrospective cohort study using inpatient claims database, enrolling adult surgical patients restricted to intensive care unit stays >48 hours between April 2018 and September 2021. Variable selection was performed using least absolute shrinkage and selection operator logistic regression, targeting adverse events within 7 days after intensive care unit discharge. We assessed discrimination by the c-statistic and calibration by intercept/slope; bootstrap internal validation quantified and corrected optimism. Results Of 9,392 patients, 99 (1.1%) had adverse events. The MV-SoLdHARP score comprises mechanical ventilation, Sequential Organ Failure Assessment score at intensive care unit discharge, lactate dehydrogenase >500 U/L, hematocrit <25%, emergency admission, renal disease, and serum potassium >4 mEq/L. The optimism-corrected c-statistic was 0.82, with calibration intercept/slope 0.20/1.04. At the moderate-or-higher risk threshold (score ≥5), sensitivity was 12.1%, specificity 99.4%, positive predictive value 18.8%, and negative predictive value 99.1%. Conclusions The risk score may help identify surgical patients at high risk of early adverse events after intensive care unit discharge. The findings may guide intensive care unit discharge decisions and resource allocation. External validation is needed to confirm stability and transportability.
