Purpose: To evaluate the quality indicators（QIs）of palliative radiotherapy at St. Marianna University Hospital.

Materials and Methods: Patients who received radiotherapy for bone or brain metastases between January and December 2023 were included in this analysis. We reviewed the chart records of patients and calculated 4 QIs for bone metastases and 3 QIs for brain metastases.

Results: QIs for bone metastases were: 1.0（49/49）for “adequate fractionations for bone metastases,” 0.98（48/49）for “assessment of pain before radiotherapy,” 1.0（5/5）for “prompt initiation of radiotherapy for metastatic spinal cord compression,”1.0（5/5）for “concurrent use of steroids with radiotherapy for metastatic spinal cord compression.” QIs for brain metastases were: 0.86（49/57）for “assessment of performance status before radiotherapy,” 0.88（23/26）for “completion of planned whole brain radiotherapy,” and 1.0（26/26）for “initiation of whole brain radiotherapy without delay.”

Conclusion: QIs for bone metastases were high. Efforts for improvement are warranted for “assessment of performance status before radiotherapy” and “completion of planned whole brain radiotherapy.”

BACKGROUND: Cardiogenic shock exhibits a heterogeneous pathogenesis, and its prognosis differs widely among cases. Critically ill patients are managed with mechanical circulatory support, but the prognostic factors in cardiogenic shock patients requiring veno-arterial extracorporeal membrane oxygenation（V-A ECMO）are still unclear. This study was performed to evaluate the clinical characteristics of patients with cardiogenic shock requiring V-A ECMO in our hospital and investigate their prognosis and prognostic factors.

METHODS: We retrospectively investigated patients with cardiogenic shock requiring V-A ECMO at St. Marianna University Hospital between January 1, 2017, and December 31, 2022. Clinical characteristics were compared between the in-hospital death and live discharge groups, and potential predictive factors for in-hospital mortality were evaluated.

RESULTS: Eighty-seven patients were included in this study. Median age was 62 years, 76% were male, median lactate level before V-A ECMO introduction was 8 mmol/L, median high-sensitive（hs）troponin T was 0.238 ng/mL, and 37.9% of patients had cardiopulmonary arrest on arrival at hospital. In-hospital deaths occurred in 60%（n＝52）of cases. Multivariate logistic regression analysis showed that hs troponin T level and fulminant myocarditis were independent predictors of in-hospital mortality.

CONCLUSION: Hs troponin T and lactate assays may be useful for predicting in-hospital mortality in patients with cardiogenic shock requiring V-A ECMO. Further multicenter case series are required to improve the accuracy of these indicators.

Background: Myocardial calcification with myocarditis is a clinically rare condition, and its etiology, clinical significance, and management remain unclear.

Case Summary: We report a case of fulminant myocarditis with marked myocardial calcifications. The patient was in cardiogenic shock upon arrival, and various examinations led to the diagnosis of lymphocytic myocarditis. We managed the patient with mechanical circulatory support（MCS）and waited for recovery of cardiac function. Computed tomography（CT）on day 10 showed the diffuse extensive left ventricular myocardial calcifications. Cardiac function did not recover, and the patient died of sepsis.

Discussion: Myocardial calcifications is suggestive of severe myocardial damage. The cardiac function of affected patients does not recover in a short term, and long-term MCS is required. A heart transplant should also be considered, if applicable.