BACKGROUND As survival has been prolonged owing to surgical and medical improvements,liver failure has become a prognostic determinant in patients with congestive heart diseases.Congestive hepatopathy,an abnormal stat...BACKGROUND As survival has been prolonged owing to surgical and medical improvements,liver failure has become a prognostic determinant in patients with congestive heart diseases.Congestive hepatopathy,an abnormal state of the liver as a result of congestion,insidiously proceed toward end-stage liver disease without effective biomarkers evaluating pathological progression.Regular measurements of shear wave elastography cannot qualify liver fibrosis,which is a prognosticator in any type of chronic liver disease,in cases of congestion because congestion makes the liver stiff without fibrosis.We hypothesized that the effects of congestion and fibrosis on liver stiffness can be dissociated by inducing architectural deformation of the liver to expose structural rigidity.To establish a strategy measuring liver stiffness as a reflection of architectural rigidity under congestion.METHODS Two-dimensional shear wave elastography(2dSWE)was measured in the supine(Sp)and left decubitus(Ld)positions in 298 consecutive cases as they were subjected to an ultrasound study for various liver diseases.Regions of interest were placed at twelve sites,and the median and robust coefficient of variation were calculated.Numerical data were compared using the Mann-Whitney U or Kruskal-Wallis test followed by Dunn's post-hoc multiple comparisons.The inferior vena cava(IVC)diameters at different body positions were compared using the Wilcoxon matched pairs signed rank test.The number of cases with cardiothoracic ratios greater than or not greater than 50%was compared using Fisher’s exact test.A correlation of 2dSWE between different body positions was evaluated by calculating Spearman correlation coefficients.RESULTS The IVC diameter was significantly reduced in Ld in subjects with higher 2dSWE values in Ld(LdSWE)than in Sp(SpSWE)(P=0.007,(average±SD)13.9±3.6 vs 13.1±3.4 mm)but not in those with lower LdSWE values(P=0.32,13.3±3.5 vs 13.0±3.5 mm).In 81 subjects,SpSWE was increased or decreased in Ld beyond the magnitude of robust coefficient of variation,which suggests that body postural changes induced an alteration of liver stiffness significantly larger than the technical dispersion.Among these subjects,all 37 with normal SpSWE had a higher LdSWE than SpSWE(Normal-to-Hard,SpSWE-LdSWE(Δ2dSWE):(minimum-maximum)-0.74--0.08 m/sec),whereas in 44 residual subjects with abnormal SpSWE,LdSWE was higher in 27 subjects(Hard-to-Hard,-0.74--0.05 m/sec)and lower in 17 subjects(Hard-to-Soft,0.04-0.52 m/sec)than SpSWE.SpSWE was significantly correlated withΔ2dSWE only in Hard-to-Soft(P<0.0001).Δ2dSWE was larger in each lobe than in the entire liver.When Hard-to-Hard and Hard-to-Soft values were examined for each lobe,fibrosis-4 or platelet counts were significantly higher or lower only for Hard-to-Soft vs Normal-to-Hard cases.CONCLUSION Gravity alters the hepatic architecture during body postural changes,causing outflow blockage in hepatic veins.A rigid liver is resistant to structural deformation.Stiff-liver softening in the Ld position suggests a fibrous liver.展开更多
Velopharyngeal closure function following modified unified velopharyngeal plasty performed by a single surgeon was evaluated pre- and postoperatively in 14 children with cleft palate after cleft palate closure and no ...Velopharyngeal closure function following modified unified velopharyngeal plasty performed by a single surgeon was evaluated pre- and postoperatively in 14 children with cleft palate after cleft palate closure and no improvement by speech training. Subjects were evaluated for velopharyngeal closure function before and after surgery at 1 (short-term evaluation) and 3 (mid-term evaluation) years. Degree of hypernasality and degree of air leakage through the nose in the soft blowing test were each classified into three grades and each grade was given scores. Velopharyngeal closure function was classified according to the total score into four grades: “good”, 'fair”, 'slightly poor” and “poor”. At the short-term evaluation, 11 patients (78.6%) achieved an improvement to “good” or “fair” on the overall evaluation. More satisfactory results were obtained at the mid-term evaluation, with 14 patients (100%) graded as “good” or “fair”. Our results indicate that this modified unified velopharyngeal plasty effectively improves velopharyngeal insufficiency when performed as a secondary surgery for cleft palate in children.展开更多
Background: Generally, clinicians do not accurately estimate life expec-tancy in terminally ill patients with cancer. Aim: To evaluate the value of the Prognostic Nutritional Index (PNI) for accurately estimating the ...Background: Generally, clinicians do not accurately estimate life expec-tancy in terminally ill patients with cancer. Aim: To evaluate the value of the Prognostic Nutritional Index (PNI) for accurately estimating the life expectancy of patients with end-stage oral cancer. Design: A longitudinal section study. Setting/participants: Fifteen patients (12 men;mean age: 71.7 years) who died of oral cancer between 2005 and 2014 (the terminal group) were included. The mean PNI values at the initial visit and at 3, 2, and 1 months before the deaths were comparatively analyzed. Results: The mean follow-up period was 133 days. At the initial examination, the PNI values were 49.1 ± 4.5 (p = 0.6723). The PNI value of the terminal group was 35.6 ± 5.1 at 2 months before death and 28.6 ± 3.0 at 1 month before death. The PNI values at 3, 2, and 1 months before death in the terminal group significantly differed from each other and from that at the initial visit and steadily decreased until death. Conclusions: Our findings suggest the utility of PNI as a prognostic index in patients with end-stage oral cancer patients. Furthermore, the PNI should be routinely considered in the nutritional management of patients with oral cancer nearing death.展开更多
文摘BACKGROUND As survival has been prolonged owing to surgical and medical improvements,liver failure has become a prognostic determinant in patients with congestive heart diseases.Congestive hepatopathy,an abnormal state of the liver as a result of congestion,insidiously proceed toward end-stage liver disease without effective biomarkers evaluating pathological progression.Regular measurements of shear wave elastography cannot qualify liver fibrosis,which is a prognosticator in any type of chronic liver disease,in cases of congestion because congestion makes the liver stiff without fibrosis.We hypothesized that the effects of congestion and fibrosis on liver stiffness can be dissociated by inducing architectural deformation of the liver to expose structural rigidity.To establish a strategy measuring liver stiffness as a reflection of architectural rigidity under congestion.METHODS Two-dimensional shear wave elastography(2dSWE)was measured in the supine(Sp)and left decubitus(Ld)positions in 298 consecutive cases as they were subjected to an ultrasound study for various liver diseases.Regions of interest were placed at twelve sites,and the median and robust coefficient of variation were calculated.Numerical data were compared using the Mann-Whitney U or Kruskal-Wallis test followed by Dunn's post-hoc multiple comparisons.The inferior vena cava(IVC)diameters at different body positions were compared using the Wilcoxon matched pairs signed rank test.The number of cases with cardiothoracic ratios greater than or not greater than 50%was compared using Fisher’s exact test.A correlation of 2dSWE between different body positions was evaluated by calculating Spearman correlation coefficients.RESULTS The IVC diameter was significantly reduced in Ld in subjects with higher 2dSWE values in Ld(LdSWE)than in Sp(SpSWE)(P=0.007,(average±SD)13.9±3.6 vs 13.1±3.4 mm)but not in those with lower LdSWE values(P=0.32,13.3±3.5 vs 13.0±3.5 mm).In 81 subjects,SpSWE was increased or decreased in Ld beyond the magnitude of robust coefficient of variation,which suggests that body postural changes induced an alteration of liver stiffness significantly larger than the technical dispersion.Among these subjects,all 37 with normal SpSWE had a higher LdSWE than SpSWE(Normal-to-Hard,SpSWE-LdSWE(Δ2dSWE):(minimum-maximum)-0.74--0.08 m/sec),whereas in 44 residual subjects with abnormal SpSWE,LdSWE was higher in 27 subjects(Hard-to-Hard,-0.74--0.05 m/sec)and lower in 17 subjects(Hard-to-Soft,0.04-0.52 m/sec)than SpSWE.SpSWE was significantly correlated withΔ2dSWE only in Hard-to-Soft(P<0.0001).Δ2dSWE was larger in each lobe than in the entire liver.When Hard-to-Hard and Hard-to-Soft values were examined for each lobe,fibrosis-4 or platelet counts were significantly higher or lower only for Hard-to-Soft vs Normal-to-Hard cases.CONCLUSION Gravity alters the hepatic architecture during body postural changes,causing outflow blockage in hepatic veins.A rigid liver is resistant to structural deformation.Stiff-liver softening in the Ld position suggests a fibrous liver.
文摘Velopharyngeal closure function following modified unified velopharyngeal plasty performed by a single surgeon was evaluated pre- and postoperatively in 14 children with cleft palate after cleft palate closure and no improvement by speech training. Subjects were evaluated for velopharyngeal closure function before and after surgery at 1 (short-term evaluation) and 3 (mid-term evaluation) years. Degree of hypernasality and degree of air leakage through the nose in the soft blowing test were each classified into three grades and each grade was given scores. Velopharyngeal closure function was classified according to the total score into four grades: “good”, 'fair”, 'slightly poor” and “poor”. At the short-term evaluation, 11 patients (78.6%) achieved an improvement to “good” or “fair” on the overall evaluation. More satisfactory results were obtained at the mid-term evaluation, with 14 patients (100%) graded as “good” or “fair”. Our results indicate that this modified unified velopharyngeal plasty effectively improves velopharyngeal insufficiency when performed as a secondary surgery for cleft palate in children.
文摘Background: Generally, clinicians do not accurately estimate life expec-tancy in terminally ill patients with cancer. Aim: To evaluate the value of the Prognostic Nutritional Index (PNI) for accurately estimating the life expectancy of patients with end-stage oral cancer. Design: A longitudinal section study. Setting/participants: Fifteen patients (12 men;mean age: 71.7 years) who died of oral cancer between 2005 and 2014 (the terminal group) were included. The mean PNI values at the initial visit and at 3, 2, and 1 months before the deaths were comparatively analyzed. Results: The mean follow-up period was 133 days. At the initial examination, the PNI values were 49.1 ± 4.5 (p = 0.6723). The PNI value of the terminal group was 35.6 ± 5.1 at 2 months before death and 28.6 ± 3.0 at 1 month before death. The PNI values at 3, 2, and 1 months before death in the terminal group significantly differed from each other and from that at the initial visit and steadily decreased until death. Conclusions: Our findings suggest the utility of PNI as a prognostic index in patients with end-stage oral cancer patients. Furthermore, the PNI should be routinely considered in the nutritional management of patients with oral cancer nearing death.
