No abstract

The purpose of this study was to investigate the feasibility of using a new three-dimensional ultrasound system to perform fetal echocardiographic examination in real time. The device consisted of a Philips Sonos 7500 (Andover, MA) ultrasound system and a 4 MHz, 4X matrix transducer. The study was approved by the Institutional Review Board and was performed with the informed consent of the mother. The study population consisted of 12 singleton fetuses with gestational ages of 16-37 weeks. Of these, ten fetuses had normal cardiac anatomy, one had complete atrioventricular septal defect, and the other a thickened tricuspid valve. The system allowed comprehensive visualization of fetal cardiac anatomy and color Doppler flow unattainable by two-dimensional approaches. This preliminary investigation suggests that live three-dimensional fetal echocardiography could be a significant tool for prenatal diagnosis and assessment of congenital heart disease in the human fetus.

Aortic valve stenosis (AS) severity can be estimated by various modalities. Due to some of the limitations of the currently available methods, the usefulness of live three-dimensional transthoracic echocardiography (3D TTE) in the assessment of AS was explored. Live 3D TTE was able to visualize the aortic valve orifice in all 11 patients studied. Live 3D TTE correctly estimated the severity of AS in all 10 patients in whom AS severity could be evaluated at surgery. These included eight patients with severe AS and two with moderate AS. Two of these 10 patients with AS had associated hypertrophic cardiomyopathy and underwent myectomy at the time of aortic valve replacement. Aortic valve orifice area measurements by live 3D TTE correlated well with intraoperative three-dimensional transesophageal echocardiographic reconstruction measurements (r=0.85) but not as well with two-dimensional transesophageal echocardiography measurements (r=0.64). Live 3D TTE measurements of the aortic valve orifice area also did not correlate well with two-dimensional transthoracic echocardiography measurements (r=0.46) but the number of patients studied with two-dimensional transthoracic echocardiography was smaller (only seven) and four of these did not undergo two-dimensional transthoracic echocardiography at the authors' institution. Altogether, four patients with severe AS by live 3D TTE, and subsequently confirmed at surgery, were misdiagnosed as having moderate AS by two-dimensional transthoracic echocardiography. Because it is completely noninvasive and views the aortic valve in three dimensions, 3D TTE could be a useful complement to the existing modalities in the evaluation of AS severity.

We report the usefulness of live three-dimensional transthoracic echocardiography in the accurate assessment of the morphology and efficacy of Amplatzer transcatheter devices used for closure of atrial septal defect and patent foramen ovale.

Objectives The primary outcome measures evaluated the financial toxicity and mental well‐being of the oral cancer survivors. Methods A cross‐sectional study of oral cancer survivors who were disease‐free for more than 6 months after treatment and visited the hospital for a routine follow‐up is included in the study. Mental well‐being and financial toxicity were evaluated using the Depression, Anxiety, and Stress Scale ‐ 21 (DASS 21) and Comprehensive Score for financial Toxicity (COST‐ Functional Assessment of Chronic Illness Therapy) questionnaires. A literature review was done to compare the results with financial toxicity and mental health in cancer patients from the pre‐pandemic era. Results A total of 79 oral cancer survivors were included in the study, predominantly males (M: F = 10:1). The age ranged from 26 to 75 years (The median age is 49). The full‐time employment dropped from 83.5% in the pre‐treatment period to 21.5% post‐treatment. Depression was observed in 58.2% and anxiety in 72.2%. Unemployed survivors were observed to have more depression (OR = 1.3, 95% confidence interval (CI) = 0.3–5.4, p = 0.6), anxiety (OR = 3.5, 95% CI = 0.3–21.2, p = 0.1) and stress (OR = 1.6, 95% CI = 0.3–6.6, p = 0.5) than rest of the cohort. On univariate analysis, unemployed survivors ( M = 11.8 ± 3.8, p = 0.01) had significantly poorer financial toxicity scores. Survivors with depression ( M = 16.4 ± 7.1, p = 0.06) and stress ( M = 14.4 ± 6.8, p = 0.002) had poor financial toxicity scores. On multifactorial analysis of variance, current employment ( p = 0.04) and treatment modality ( p = 0.05) were significant factors impacting the financial toxicity. Conclusion There is a trend towards increased incidence of depression, anxiety, and stress among oral cancer survivors compared to the literature from the pre‐COVID era. There is significant financial toxicity among either unemployed or part‐time workers. This calls for urgent public/government intervention to prevent the long‐term impact of financial toxicity on survival and quality of life.