Koto Hospital

<h3>Background</h3> Human epidermal growth factor receptor 2 (HER2) is overexpressed in ∼20% of advanced gastroesophageal adenocarcinomas (GEAs). Trastuzumab (T-mab) is the standard first-line treatment for HER2-positive GEA, and trastuzumab deruxtecan (T-DXd) has demonstrated clinical efficacy in later-line settings. However, the potential loss of HER2 expression following T-mab treatment raises concerns about the subsequent effectiveness of T-DXd. The temporal dynamics of HER2 expression across treatment lines are not well understood. <h3>Design</h3> We designed a prospective, single-arm, multicenter study to investigate the association between the efficacy of third-line T-DXd and changes in HER2 status in tumor tissue and blood after first-line T-mab treatment in patients with HER2-positive GEA. The aim is to inform the optimal clinical use of T-DXd. Serial tumor and/or blood re-biopsies will be carried out at each line of treatment following first-line therapy. The study consists of two parts. In part 1, we will evaluate biomarker dynamics—specifically HER2 status and circulating tumor DNA alterations—during second-line therapy. In part 2, we will assess the efficacy and safety of third-line T-DXd in relation to these biomarker changes. Approximately 120 patients will be enrolled in part 1 and 50 in part 2.

Background and study aimsAlthough the endoscopic pressure study integrated system (EPSIS) is useful to evaluate competency of lower esophageal sphincter as a major part of the anti-reflux barrier, its availability is limited. This study aimed to assess whether gastric fold stretching during insufflation can predict intragastric pressure (IGP) without special equipment.Patients and methodsA retrospective analysis included 33 patients who underwent esophagogastroduodenoscopy and EPSIS between June and July 2024. Gastric fold stretching along the greater curvature at the level of the cardia, observed in a retroflex view during insufflation, was compared with EPSIS results by reviewing recorded videos. Time ranges were defined as follows, and IGP was measured at the end of each range: Time range 1, until the ratio of longitudinal fold thickness to the groove width between folds reached 1:2; Time range 2, until the ratio reached 1:4; and Time range 3, until the folds or mucosal ridges were almost flattened. Variability was assessed using the coefficient of variation (CV), calculated as the standard deviation divided by the mean.ResultsTime ranges 1, 2, and 3 were fully observed in 100%, 97%, and 70% of patients, respectively. Mean IGPs at the end of Time ranges 1, 2, and 3 were 8.9, 11.1, and 17.7 mmHg, with CVs of 0.32, 0.28, and 0.08, respectively.ConclusionsFlattening of gastric folds or mucosal ridges during insufflation is a reliable predictor of IGP. This finding may help identify patients with anti-reflux barrier dysfunction during regular endoscopic examination.

Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, yet the role of nerve conduction studies (NCS) in its diagnosis remains debated. This study aimed to evaluate the diagnostic yield of NCS and its correlation with clinical features in patients with suspected CTS. Materials &amp; Methods: A retrospective cross-sectional study was conducted on 201 patients referred for NCS with symptoms suggestive of CTS. Demographic characteristics, symptom profiles, physical examination findings (Tinel’s sign, Phalen’s maneuver), and NCS results were reviewed. Diagnostic accuracy measures were calculated, and associations between clinical features and NCS-confirmed CTS were assessed using chi-square tests.Results: NCS confirmed CTS in 65.2% (n=131) of patients. Bilateral symptoms p=0.007), nocturnal exacerbation ( p&lt;0.001), and a positive Phalen’s maneuver (100 vs. 28; p&lt;0.001) were significantly associated with NCS-confirmed CTS. Severe numbness (p&lt;0.001) and pain (p&lt;0.001) also correlated with positive findings, whereas comorbidities showed no significant association (p=0.396).Conclusions: NCS demonstrates higher diagnostic value in patients presenting with bilateral symptoms, nocturnal pain, and positive provocative tests, supporting a selective rather than routine approach to its use. However, its limited sensitivity in early-stage disease underscores the importance of combining clinical and electrophysiological assessments. Future longitudinal studies are warranted to determine the predictive role of NCS in treatment outcomes.

There is a paucity of data on safety of calcium channel blockers (CCB) in patients with severe aortic stenosis (AS) and hypertension. Among 2,460 patients with severe AS and hypertension receiving antihypertensive therapy in the CURRENT AS registry-2, we compared the clinical outcomes between patients taking antihypertensive therapy with CCB (CCB group) and without CCB (no CCB group). In the entire study population, CCB was prescribed in 1,763 patients (71.7%), which was the most commonly prescribed antihypertensive agents. The prescription rates of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and thiazides were 61.9%, 25.6%, and 7.3% in the CCB group, and 75.8%, 54.4%, and 6.0% in the no CCB group. In the propensity score matched cohort, the cumulative 3-year incidence of all-cause death or hospitalization for heart failure was not different between the CCB and no CCB groups (38.3% vs. 38.7%, log-rank P=0.65; HR, 0.94; 95%CI, 0.77-1.15; P=0.56). The cumulative 3-year incidence of syncope was low regardless of CCB prescription (1.1% vs. 1.0%, P=0.74). Among patients with severe AS and hypertension, CCB was the most commonly prescribed antihypertensive agents, and antihypertensive therapy with CCB was associated with comparable clinical outcomes to antihypertensive therapy without CCB. Syncope was rarely seen in patients with severe AS and hypertension receiving antihypertensive therapy regardless of CCB prescription.

In atmospheric correction, it is difficult to remove the contribution of aerosol absorption and scattering. satellite-based atmospheric products and global reanalysis data have often been used as input parameters of atmospheric correction processing. In recent years, there have been some researches using the aerosol parameter (Aerosol Optical Depth) in the CAMS global reanalysis (EAC4), therefore we evaluated the accuracy using ground-based measurements and satellite products. As a result, it can be said that it is sufficient to use the CAMS global reanalysis (EAC4) as a parameter for atmospheric correction processing.

To evaluate surgical outcomes and patient-reported outcomes of one-sided dorsal onlay urethroplasty with penile invagination, so-called Kulkarni urethroplasty, in male patients with complex anterior urethral strictures, including pan-anterior and peno-bulbar urethral strictures. We retrospectively reviewed 39 consecutive male patients who underwent Kulkarni urethroplasty between 2016 and 2024. Through a perineal approach, one-sided urethral mobilization was performed with penile invagination to access the entire anterior urethra. Oral mucosa graft (OMG) or penile skin graft (PSG) was used as the urethral substitute. Success was defined as passing flexible cystoscopy without resistance and voiding without additional interventions. Patient-reported outcomes were assessed using the urethral stricture surgery patient-reported outcome measure (USS-PROM), Sexual Health Inventory for Men (SHIM), and EuroQol-5 dimensions (EQ-5D) questionnaires. Follow-up evaluations were conducted at 3, 6, and 12 months postoperatively and then annually. The median stricture length was 44 mm (IQR 27-84). At a median follow-up of 12 months (IQR 6-34), the overall success rate was 89.7% (80.0% for OMG and 95.8% for PSG). Significant improvements were observed in maximum flow rate, post-void residual volume, lower urinary tract symptoms (LUTS) score, LUTS-related quality of life, EQ-5D score, and EQ-visual analog scale (all p < 0.001). SHIM scores remained unchanged, indicating preserved erectile function. Two (5.2%) experienced grade 2 donor-site complications. Kulkarni urethroplasty demonstrates excellent surgical outcomes and significant improvements in patient-reported outcomes for complex anterior urethral strictures while preserving erectile function. Both OMG and PSG appear to be viable options for this procedure.

Rescue of a biliary extraction basket impaction using argon plasma coagulation

Limited data exist on surgical outcomes following artificial urinary sphincter (AUS) implantation in patients with a history of urethroplasty for urethral stricture. This study aimed to evaluate the surgical outcomes of AUS implantation in such patients, focusing on the risk of urethral erosion. We retrospectively reviewed 14 male patients who developed severe urinary incontinence following urethroplasty for urethral stricture and subsequently underwent AUS implantation at our center between March 2012 and January 2024. Patients underwent either excision and primary anastomosis (EPA) or non-transecting anastomotic urethroplasty (NTAU), followed by AUS implantation using either the standard or transcorporeal approach, depending on periurethral adhesions and corpus spongiosum condition. Outcomes were assessed regularly after AUS implantation, focusing on complications, especially urethral erosion. The median follow-up period after AUS implantation was 46 months. Erosion occurred in 4 of 14 patients (28.6%), all of whom had undergone EPA, while no cases of erosion were observed in patients treated with NTAU. The 12-, 36-, and 60-month AUS survival rates were 100.0%, 90.9%, and 71.6%, respectively. Patients who underwent the transcorporeal approach had comparable erosion rates to those who received the standard approach (p = 0.60). Patients with a history of urethroplasty face a high risk of AUS erosion. Whether urethral transection during urethroplasty influences urethral erosion following AUS implantation requires further accumulation of cases.

Pembelajaran yang perlu dikembangkan guru dan diminati siswa pada saat ini adalah pembelajaran yang kreatif dan inovatif. Sehingga perlu diupayakan suatu model pembelajaran inovatif yang dapat menumbuhkan daya nalar dan kreativitas siswa serta pembelajaran yang menyenangkan. Untuk itu penulis melakukan penelitian tindakan kelas yang berjudul “ Meningkatkan hasil belajar siswa kelas IV UPTD SDN 05 Koto Tuo pada pokok bahasan penjumlahan dan pengurangan bilangan bulat menggunakan peraga garis bilangan”. Permasalahan adalah apakah hasil belajar dapat ditingkatkan melalui pembelajaran dengan memanfaatkan alat peraga garis bilangan. Tujuan penelitian ini untuk mengetahui peningkatan hasil belajar siswa pada pokok bahasan penjumlahan dan pengurangan bilangan bulat melalui pemanfaatkan alat peraga garis bilangan. Dalam penelitian ini, metode yang digunakan adalah penggunaan peraga garis bilangan yang akan dapat menumbuhkan kreativitas siswa dalam pemecahan masalah dan tidak membosankan serta hasilnya akan lebih terkesan pada diri siswa. Penelitian ini dilaksanakan melalui 2 siklus, masing - masing siklus 2 pertemuan. Siklus I tentang penjumlahan dan pengurangan bilangan bulat yang dilaksanakan pada tanggal 19 Sepetember dan tanggal 22 September 2023.Hasil analisis tes akhir siklus I nilai rata – rata kelas mencapai 63,33. Didapat siswa (67%) belum tuntas dan 3 siswa (33%) sudah tuntas. Kendala siswa yang belum tuntas adalah siswa kurang aktif bertanya serta kurang memperhatikan penjelasan guru. Siklus 2 dilaksanakan pada tanggal 9 Oktober 2023 dan tanggal 12 Oktober 2023 hasil tes akhir siklus II rata-ratanya adalah 81,55 dan siswa seluruh siswa tuntas (89%) dalam mengerjakan tes. Karena nilai rata – rata kelas yang dicapai dan ketuntasan belajar sudah melebihi tolak ukur yang ditentukan yaitu, nilai rata – rata kelas 7,0 dan ketuntasan belajar 75% maka pelaksanaan siklus I dan siklus II sudah cukup dan penelitian tindakan kelas ini dinyatakan berhasil.