This study aimed to evaluate the impact of sample volume position on fetal cardiac output (CO) measurements. Fetuses with normal hearts were enrolled. Fetal CO was calculated using the pulsed Doppler method, with the velocity time integral (VTI) recorded at two distinct positions: the valve hinge level (Valve: V group) and just distal to the valve (Supra-valve: S group). Additionally, we acquired electronic spatio-temporal image correlation (eSTIC) volume data. Left-ventricular CO was calculated as the product of stroke volume and heart rate, with stroke volume derived from left-ventricular volume measurements using the virtual organ computer-aided analysis (VOCAL) technique on the three-dimensional eSTIC data (eSTIC group). We then compared the left-ventricular CO levels among the V, S, and eSTIC groups to assess their correlation. The S group showed significantly larger VTI of the aortic valve (8.5 ± 2.3 vs. 9.3 ± 2.5 cm, V vs. S group). Similarly, the S group also had significantly larger VTI of the pulmonary valve (7.0 ± 1.9 vs. 8.2 ± 2.2 cm). Combined cardiac output (CCO) in the V group was 396 ± 136 mL/min/kg, and that in the S group was 450 ± 154 mL/kg/min, which also showed that the S group had a significantly larger CCO. Focusing on left ventricle CO, the V group was 140 ± 73 mL/kg/min, the S group was 157 ± 77 mL/kg/min, and the eSTIC group was 133 ± 69 mL/kg/min. This suggested that the V group's results were more similar to the eSTIC group's. This study suggests that CO measurements are significantly influenced by the sample volume position. Furthermore, placing the VTI sample volume on the valve hinge level appears to reflect CO more accurately.
A 73-year-old man developed drug-induced lung disease (DILD) during treatment with ampicillin and ceftriaxone for Enterococcus faecalis infective endocarditis. He had a history of pneumoconiosis and developed postoperative fever; however, chest radiography showed no new abnormalities, and drug fever was initially suspected, leading to continuation of antibiotics. Several days later, he exhibited decreased SpO2 and fine crackles, and chest CT revealed new bilateral interstitial opacities. Other etiologies were excluded, and DILD was suspected. Discontinuation of the suspected drugs and administration of corticosteroids led to rapid clinical improvement. In this case, preexisting pneumoconiosis masked newly developed pulmonary lesions, resulting in premature diagnostic closure. Known lesions may distort clinical perception and induce cognitive bias. This case underscores the importance of considering the possibility of “Masking” in patients with chronic pulmonary disease and highlights the need for early CT imaging and additional investigations when new symptoms emerge.
Background: Endoscopic resection has become a standard curative treatment for superficial esophageal cancer. However, limited data are available regarding long-term outcomes and causes of death after curative endoscopic treatment, particularly deaths unrelated to the primary esophageal cancer. This study aimed to clarify post-treatment prognosis and to identify factors associated with mortality in patients with superficial esophageal cancer who underwent curative endoscopic resection. Methods: We conducted a multicenter cohort study in Japan to evaluate survival outcomes, causes of death, and prognostic factors in patients with superficial esophageal cancer who achieved curative resection by endoscopic treatment. Patients were stratified according to endoscopic treatment indication categories (absolute, relative, and beyond indication). Five-year overall survival and disease-specific survival were analyzed, along with risk factors for all-cause and cause-specific mortality. Results: No disease-specific deaths were observed in patients with absolute or relative indication lesions, whereas the disease-specific 5-year survival rate was 81% in patients with beyond-indication lesions. When overall mortality, including deaths from other diseases and other malignancies, was evaluated, the 5-year survival rates were 92% for absolute indication cases, 85% for relative indication cases, and 69% for beyond-indication cases. Multivariate analysis identified low body mass index (BMI) and advanced age as independent risk factors for mortality. Notably, low BMI was significantly associated with non-cancer-related death. Conclusions: Even among patients who achieve curative endoscopic treatment for superficial esophageal cancer, long-term survival is limited by deaths from other malignancies and non-cancer-related causes. Low BMI represents a clinically important prognostic factor, underscoring the need for comprehensive post-treatment surveillance and supportive care beyond cancer control.
The availability of high-concentration 20
Background Accurate preoperative staging of upper tract urothelial carcinoma (UTUC) remains challenging. This study aimed to develop site-specific scoring systems for predicting muscle-invasive UTUC without ureteroscopic findings. Methods This retrospective multicenter study initially included 386 patients who underwent radical nephroureterectomy for UTUC at Tottori University Hospital and affiliated hospitals between January 2015 and December 2021. Patients with clinically node-positive disease or those who received neoadjuvant chemotherapy were excluded. Preoperative variables included age, sex, body mass index, hydronephrosis, urinary cytology, clinical T stage, tumor size, and multifocality. Univariable and multivariable logistic regression analyses were performed separately for ureteral and renal pelvic tumors to identify the predictors of muscle-invasive disease. Results Among 356 eligible patients, 157 (44.1%) had muscle-invasive UTUC. Multivariable analysis identified positive urinary cytology and clinical T stage as independent predictors of muscle-invasive disease in both ureteral and renal pelvic tumors, whereas hydronephrosis was an additional independent predictor in ureteral tumors. Scoring systems incorporating these variables achieved areas under the curve of 0.865 for ureteral cancer and 0.745 for renal pelvic cancer. Optimal cutoff scores based on the Youden index were ≥ 3 for ureteral tumors and ≥ 2 for renal pelvic tumors, with sensitivity rates of 85.4% and 68.0% and specificity rates of 77.4% and 73.6%, respectively. Conclusion Site-specific scoring systems based on routinely available preoperative variables accurately predicted muscle-invasive UTUC without requiring ureteroscopic findings. These models may facilitate preoperative risk stratification, although external validation is required.
