The characteristics of myelomatous pleural effusion（MPE） as a rare complication：a case and review of the literature.

We reported a patient with multiple myeloma who developed myelomatous pleural effusion （MPE）. This patient had nine courses of chemotherapy, and pleural effusion developed after the fourth course. Although administration of several chemotherapeutic agents and intrapleural administration of OK432 were performed, the patient died 4 months after the development of MPE. We analyzed the previous reports to clarify the characteristics of patients who developed MPE

Long-term persistent fetomaternal hemorrhage

Key Clinical Message: It is not clear that how long the affected fetuses can tolerate fetomaternal hemorrhage (FMH). Incidental serial measurements of the fetal peak systolic velocity of the middle cerebral artery and the retrospective analysis of stocked blood available incidentally indicated that our patient had suffered from FMH for at least 2 weeks prior to delivery

Right ventricular basal inflow and outflow tract diameters overestimate right ventricular size in subjects with sigmoid-shaped interventricular septum: a study using three-dimensional echocardiography

Sigmoid-shaped ventricular septum (SS), a frequently encountered minor abnormality in echocardiographic examinations of the elderly, may have some influence on RV shape. We aimed to determine the influence of SS on the accuracy of the 6 RV linear diameter measurements in the light of three-dimensional echocardiographic (3DE) RV volume. The aorto-septal angle (ASA) was measured in the parasternal long-axis view using two-dimensional echocardiography (2DE) as an index of SS in 70 patients without major cardiac abnormalities who were subdivided into 35 with SS (ASA ≤ 120°) and 35 without SS (NSS). We measured RV end-diastolic volume (RVEDV) using 3DE; in addition, using 2DE, we measured basal RV diameter, mid-cavity diameter, longitudinal diameter and end-diastolic area in the apical four-chamber view; proximal RV outflow tract (RVOT) diameter in the parasternal long-axis view; and proximal and distal RVOT diameters in the parasternal short-axis view. RVEDV did not differ between the SS and NSS groups. The SS group had greater basal RV diameter and proximal and distal RVOT diameters than the NSS group. RV mid-cavity diameter, longitudinal diameter, and end-diastolic area did not differ between the groups. Among the 2DE parameters of RV size, RV end-diastolic area was most strongly correlated with RVEDV (r = 0.67), followed by RV mid-cavity diameter (r = 0.58). When SS is present, the echocardiographic basal RV diameter and RVOT diameters overestimate RV size, and the measurement of RV end-diastolic area and mid-cavity diameter more correctly reflect 3D RV volume

Deep Learning-Based Nuclear Lobe Count Method for Differential Count of Neutrophils

Differentiating neutrophils based on the count of nuclear lobulation is useful for diagnosing various hematological disorders, including megaloblastic anemia, myelodysplastic syndrome, and sepsis. It has been reported that one-fifth of sepsis-infected patients worldwide died between 1990 and 2017. Notably, fewer nuclear-lobed and stab-formed neutrophils develop in the peripheral blood during sepsis. This abnormality can serve as an early diagnostic criterion. However, testing this feature is a complex and time-consuming task that is rife with human error. For this reason, we apply deep learning to automatically differentiate neutrophil and nuclear lobulation counts and report the world's first small-scale pilot. Blood films are prepared using venous peripheral blood taken from four healthy volunteers and are stained with May Grunwald Giemsa stain. Six-hundred 360 x 363-pixel images of neutrophils having five different nuclear lobulations are automatically captured by Cellavision DM-96, an automatic digital microscope camera. Images are input to an original architecture with five convolutional layers built on a deep learning neural-network platform by Sony, Neural Network Console. The deep learning system distinguishes the four groups (i.e., band-formed, two-, three-, and four- and five-segmented) of neutrophils with up to 99% accuracy, suggesting that neutrophils can be automatically differentiated based on their count of segmented nuclei using deep learning

Left ventricular global longitudinal strain calculated from manually traced endocardial border lengths utilizing the images for routine ejection fraction measurement by biplane method of disks

Purpose The purpose of this study was to test whether the fractional change in the endocardial border length between end-diastole and end-systole as manually traced in left ventricular ejection fraction (LVEF) measurement using the biplane method of disks (MOD) was consistent with the global longitudinal strain derived from speckle-tracking echocardiography. Methods For 105 patients who underwent echocardiography, two- and four-chamber images with manually traced endocardial lines for LVEF measurement by MOD were stored. LV endocardial lengths at end-diastole and at end-systole were measured on both images to calculate the fractional length changes, which were averaged (GLS(MOD)). Speckle-tracking analysis was performed to measure global longitudinal strains in the apical two- and four-chamber and long-axis images, and the three values were averaged (GLS(STE)) according to the ASE and EACVI guidelines. Results There was no significant difference between GLS(MOD) and GLS(STE). GLS(MOD) correlated well with GLS(STE) (r = 0.81, p < 0.001), and there was no fixed bias in the Bland-Altman analysis. The intraclass correlations for the intra- and inter-observer comparisons for GLS(STE) were excellent, and those for GLS(MOD) were adequate. Conclusion The fractional LV endocardial border length change, GLS(MOD), showed sufficient agreement with GLS(STE) to justify its use as a substitute for the STE-derived global longitudinal strain

Altered oscillation of Doppler-derived renal and renal interlobar venous flow velocities in hypertensive and diabetic patients

Background and purpose Flow velocity oscillation rate (FVOR) of the renal interlobar vein has been reported to be decreased in patients with urinary obstruction or diabetic nephropathy, and increased in those with hypertension during pregnancy. To clarify the clinical role of the renal interlobar venous FVOR, we investigated the flow velocity patterns of the renal vessels in patients with hypertension (HT) and/or diabetes (DM). Methods and results Pulsed-wave Doppler sonography was performed in 34 patients: 15 with HT, 10 with DM, and nine with both HT and DM (HT-DM). Each FVOR of the right and left interlobar veins was closely and positively correlated with the ipsilateral interlobar arterial resistive index (RI), especially in the HT group, but not with the estimated glomerular filtration rate. The right interlobar venous FVOR was decreased in the DM and HT-DM groups compared to the HT group. Conclusion The renal interlobar venous FVOR is strongly influenced by the arterial RI in HT patients, and is reduced in DM patients without an obvious relationship with diabetic nephropathy. These findings should be noted for the clinical application of renal interlobar venous flow analysis