Recurrence-Free Survival after Postoperative Hormone Therapy for Catamenial Pneumothorax.

Background: Catamenial pneumothorax (CP) is a rare form of spontaneous pneumothorax that is linked to endometriosis; thus, it predominantly manifests in women of reproductive age. Considerable research has explored the potential benefits of postoperative hormone therapy following various surgical interventions. This study was performed to examine the clinical implications of postoperative hormone treatment in patients with CP. Methods: The study included patients who underwent surgical intervention for CP between November 2009 and February 2023. These procedures included wedge resection, diaphragm resection, and total pleural coverage. Recurrence-free survival was analyzed using the Kaplan-Meier log-rank test to assess the impact of hormone therapy. Additionally, Cox proportional hazards analysis was employed to identify risk factors associated with postoperative CP recurrence. Results: The study included 41 patients, with a median age of 38.4 years. Among them, 27 individuals received hormone therapy, 8 of whom experienced recurrence during a median follow-up period of 1 year. Patients who received hormone therapy exhibited a lower rate of recurrence than those who did not; however, the difference was not statistically significant, likely due to the small sample size. Side effects of hormone therapy included depression (6.8%), excessive sweating (3.4%), and headache (3.4%). In the analysis of risk factors for postoperative recurrence, diaphragm resection emerged as a protective factor (hazard ratio, 0.16; 95% confidence interval, 0.03-0.77; p=0.022). Conclusion: Hormone treatment combined with surgery did not significantly impact recurrence in patients with CP. The application of diaphragm resection was the sole factor that displayed significance in preventing CP recurrence.

Double-bar technique for the correction of asymmetric pectus excavatum.

Background: Minimally invasive repair of pectus excavatum (MIRPE) improves clinical outcomes and chest wall morphology. However, asymmetry in patients with pectus excavatum (PE) remains as an important issue, even after surgery. Here, we evaluated the benefit of double-bar technique in achieving a symmetric chest wall. Methods: This retrospective study included 79 patients with PE who underwent MIRPE between 2017 and 2021. The patients were divided into the double- or non-double-bar groups. Asymmetric degree (AD) and sternal rotation angle (SRA) were used to assess the severity of asymmetry based on computed tomography (CT) images. The primary outcome was the change in radiologic parameters. Secondary outcomes were clinical results, including hospital stay, pain scores, and complication rates. Subgroup analysis of patients with preoperative asymmetric PE was performed. Results: Patients in the double-bar group (n=23) were younger than those in the non-double-bar group (n=56). Additionally, the double-bar group exhibited lower pain scores and shorter hospital stay. Based on radiological assessments, the double-bar group demonstrated a greater decrease in AD without compromising improvement in the Haller index (HI). The benefit of the double-bar technique was more obvious among patients with asymmetry with a preoperative AD >5%, resulting in a significant reduction in AD. In this subgroup, a better correction of sternal rotation was observed. Conclusions: The double-bar technique may be a promising option for correcting asymmetry in patients with PE. Simplified AD and SRA radiologic assessments can be used to evaluate improvements in chest wall configuration.

Left Upper Division Segmentectomy Compared with Lobectomy for Lung Expansion and Bronchus Tortuosity.

BACKGROUND: For patients with left upper lobe lesions, the functional benefit of left upper division segmentectomy over left upper lobectomy remains controversial. This study evaluated the clinical and functional outcomes after these two procedures. METHODS: This retrospective study included 135 patients with left upper lobe lesions (left upper lobectomy, 110; left upper division segmentectomy, 25). Propensity score matching was used to compare the two groups. Spirometry and computed tomography volume assessments were performed to evaluate bronchus angle and tortuosity. Short-term clinical respiratory symptoms were assessed via medical record reviews. RESULTS: Patients in both groups had similar preoperative characteristics, apart from tumor size (left upper division segmentectomy, 1.6 ± 0.9 cm; left upper lobectomy, 2.8 ± 1.7 cm; p = 0.002). After propensity score matching, both groups had similar preoperative spirometry and pathological results. The postoperative spirometry results were similar; however, the left upper division segmentectomy group had a significantly smaller decrease in left-side computed tomography lung volume compared with that in the left upper lobectomy group (left upper division segmentectomy, 323.6 ± 521.4 mL; left upper lobectomy, 690.7 ± 332.8 mL; p = 0.004). The left main bronchus-curvature index was higher in the left upper lobectomy group (left upper division segmentectomy, 1.074 ± 0.035; left upper lobectomy, 1.097 ± 0.036; p = 0.013), and more patients had persistent cough in the left upper lobectomy group (p = 0.001). CONCLUSIONS: Left upper division segmentectomy may be a promising option for preventing marked bronchial angulation and decreasing postoperative persistent cough in patients with left upper lobe lung cancer.

Predictive Scoring System for Spontaneous Closure of Infant Ventricular Septal Defect: The P-VSD Score.

Ventricular septal defect (VSD) is a common congenital heart disease. However, consensus on the utility of echocardiography in predicting spontaneous closure (SC) of VSD remains lacking. This study aimed to identify and validate significant predictors of SC through a predictive scoring system. This retrospective study included medical records of 712 echocardiography instances performed on 304 patients diagnosed with VSD from 2016 to 2020 in their first year of life. A novel scoring system for predicting the SC of VSD was developed and validated using another dataset from different hospitals. Of the 304 patients, 215 (70.7%) had perimembranous (PM) VSDs and 89 had muscular (29.3%) VSDs. The median follow-up periods were 36.2 (interquartile range [IQR], 13-59) months and 13.7 9 (IQR, 5-37.4) days for PM and muscular VSDs, respectively. The overall SC rate during follow-up was 29.3%. Pulmonary hypertension (HTN), concomitant left ventricle (LV)-right atrium (RA) shunt, VSD size to aortic valve (AV) annulus size ratio, and left ventricular end-diastolic dimension (LVEDD) z-score were significant risk factors affecting SC of VSD. The "P-VSD" score, a new scoring system, demonstrated an area under the curve for predictability of 0.769. Pulmonary HTN, concomitant LV-RA shunt, LVEDD z-score, and VSD size-to-AV annulus size ratio at diagnosis were significantly associated with non-SC VSD after infancy. The P-VSD score can predict the SC of VSD in clinical settings and simplify the identification and appropriate management of high-risk patients.

Histopathologic fate of resected pulmonary pure ground glass nodule: a systematic review and meta-analysis.

Background: Pure ground glass nodules (GGNs) have been increasingly detected through lung cancer screening programs. However, there were limited reports about pathologic characteristics of pure GGN. Here we presented a meta-analysis of the histologic outcome and proportion analysis of pure GGN. Methods: This study included previous pathological reports of pure GGN published until June 14, 2022 following a systematic search. A meta-analysis estimated the summary effects and between-study heterogeneity for pathologic diagnosis of invasive adenocarcinoma (IA), minimally invasive adenocarcinoma (MIA), adenocarcinoma in situ (AIS), and atypical adenomatous hyperplasia (AAH). Results: This study incorporated 24 studies with 3,845 cases of pure GGN that underwent surgery. Among them, sublobar resection was undertaken in 60% of the patients [95% confidence interval (CI): 38-78%, I2=95%]. The proportion of IA in cases of resected pure GGN was 27% (95% CI: 18-37%, I2=95%), and 50% of IA had non-lepidic predominant patterns (95% CI: 35-65%, I2=91%). The pooled proportions of MIA, AIS, and AAH were 24%, 36%, and 11%, respectively. Among nine studies with available clinical outcomes, no recurrences or metastases was observed other than one study. Conclusions: The portion of IA in cases of pure GGN is significantly larger that expected. More than half of them owned invasiveness components if MIA and IA were combined. Furthermore, there were quite number of lesions with aggressive histologic patterns other than the lepidic subtype. Therefore, further attempts are necessary to differentiate advanced histologic subtype among radiologically favorable pure GGN.

Segmentectomy quality remains important in ground-glass-dominant stage I lung cancer.

BACKGROUND: Segmentectomy for early-stage lung cancer has benefits for survival and parenchymal preservation. However, segmentectomies are technically challenging, thereby resulting in considerable variability in the quality of resection. In this study, we aimed to review the quality of segmentectomies and analyze their clinical impact. METHODS: This retrospective study reviewed patients diagnosed with stage I lung cancer after segmentectomies between 2013 and 2021. Segmentectomies were classified as anatomical or nonanatomical; anatomical resection included segmental bronchus and vessel (artery and/or vein) divisions; others were classified as nonanatomical. The primary outcome was recurrence-free and overall survival, and the secondary outcome was postoperative spirometry and lung plication, which is seen as a fibrotic line along the stapling site. RESULTS: Of the 132 segmental resections included in this study, 101 (76.5%) were anatomical segmentectomies. The median consolidation-tumor ratio was 0.40, and 83.3% (110/132) had ground-glass opacities (GGOs). Compared to nonanatomical resections, more N1 and total lymph node stations were retrieved after anatomical segmentectomies. Regarding clinical outcomes, recurrence-free survival was better after anatomical segmentectomy (p = 0.049); however, overall survival was not significantly different (p = 0.064). Furthermore, at 3-6 months postoperatively, thicker lung plication at the stapling site was observed in nonanatomical resections (p < 0.001). Subgroup analysis for complex segmentectomies revealed a larger decrease in forced-expiration volume in 1 s after nonanatomical resection. CONCLUSION: Anatomical segmentectomy resulted in better survival and a lower incidence of thick lung plication, even in GGO-dominant tumors. Therefore, further standardization and quality management of segmentectomy procedures will improve the clinical outcomes.

Impact of extended mediastinal lymph node dissection for stage I ground-glass opacity lesions.

Background: Mediastinal lymph node dissection (MLND) is a critical component in lung cancer surgery. With the increasing number of patients with ground-glass opacity (GGO) lesions, the clinical impact of MLND has not been sufficiently assessed, particularly for part-solid lesions. This study aimed to evaluate the impact of extended N2 MLND in patients with GGO lesions with a consolidation tumor ratio (CTR) of 0.3-0.7. Methods: Among patients diagnosed with stage I adenocarcinoma between 2013 and 2019, we retrospectively reviewed 138 patients with a CTR of 0.3-0.7. They were divided into the following two groups by MLND: limited N2 MLND (<3 N2 stations; n=100) and extended N2 MLND (≥3 N2 stations; n=38). Kaplan-Meier curves were used to compare oncologic outcomes and logistic regression was used to identify the predictive factors for postoperative complications (PoCs). Propensity-score matching regarding tumor characteristics and surgical extent were also performed to compare these two MLND assessments in clinical outcome. Results: The extended N2 MLND group had larger solid components (9.5 vs. 7.0 mm, P=0.002) and more patients underwent lobectomy (P=0.008). Kaplan-Meier survival curves revealed no significant difference in clinical outcomes. After propensity score matching, the difference between two MLND strategies was also non-significant in clinical outcome. However, extended N2 MLND was found to be a significant factor in the development of PoC [odds ratio (OR), 4.57; 95% confidence interval (CI): 1.26-16.6; P=0.021]. Conclusions: For GGO lesions with a CTR of 0.3-0.7, the extended MLND strategy may not be optimal in terms of clinical outcome. It could lead to more frequent early complications with no oncologic benefits. Due to the limited number of cases in this study, further prospective research on MLND for part-solid lesions is required.

Optimal Management of Patients with Phlegmonous Esophagitis: A Systematic Review and Meta-Analysis.

GOALS: To assess the characteristics and prognosis-influencing factors of phlegmonous esophagitis, a rare condition marked by suppurative inflammation of the esophageal submucosa and muscular layers. BACKGROUND: Effective management strategies for phlegmonous esophagitis are lacking. This study aims to systematically review cases to better understand the disease's features and prognostic determinants. METHOD: A systematic search was performed using PubMed/MEDLINE and Google Scholar from inception to 20 April 2023. Phlegmonous esophagitis case reports and studies with patient information were included; clinical manifestations, laboratory results, imaging findings, other diagnostic findings, and outcomes were analyzed. A pooled analysis was performed to investigate mortality-related risk factors. RESULTS: A total of 35 cases of phlegmonous esophagitis were selected from 31 case reports and 2 case series (median age, 57.0 years; male, 54.3%). The patients presented various clinical symptoms, with neck-to-epigastric pain and dysphagia being the most common. Comorbid diabetes mellitus was a major predisposing factor; one-third of the patients had no previous medical history. Computed tomography (CT) and endoscopic examinations were predominantly used for phlegmonous esophagitis diagnosis. Radiological findings showed that the upper and middle esophagus were most frequently involved. Treatments included administration of broad-spectrum antibiotics and drainage via endoscopy or surgery. There were three cases of mortality, and non-survivors tended to have shorter hospital stays, indicating rapid disease progression. In logistic regression, thoracic surgery was a significant mortality-related risk factor (odds ratio, 19.30; 95% confidence interval, 1.33-282.00, p = 0.03). CONCLUSION: Advancements in CT and endoscopy have led to less-invasive diagnostic and treatment methods for phlegmonous esophagitis. Endoscopic localized abscess treatment is associated with positive outcomes.

Oxidized Regenerated Cellulose versus Polyglycolic Acid for Pleural Coverage in Pneumothorax Surgery.

Objectives: Although surgical intervention for spontaneous pneumothorax (SP) reduces the recurrence rate, thoracoscopic surgery is associated with greater postoperative recurrence rates than open thoracotomy. A polyglycolic acid (PGA) sheet or oxidized regenerated cellulose (ORC) mesh can therefore be used for additional coverage after thoracoscopic surgery, and this study compared the clinical impacts of these two materials. Methods: From 2018 to 2020, 262 thoracoscopic surgeries for primary SP were performed, of which 125 patients were enrolled in this study, and 48 and 77 patients received ORC and PGA coverage, respectively. The clinical characteristics and surgical procedures were reviewed, and the recurrence rates were compared. To obtain more comprehensive evidence, we performed a literature review and meta-analysis comparing ORC and PGA coverage. Results: There were no significant differences in patient characteristics between the two groups. Operating time was slightly shorter in the ORC group than in the PGA group (p = 0.008). The pneumothorax recurrence rate was similar in both groups (PGA: 10.4%, ORC: 6.2%, p = 0.529), but the recurrence-free interval was significantly longer (p = 0.036) in the ORC (262 days) than in the PGA (48.5 days) group. The literature review identified three relevant studies, and the meta-analysis revealed no difference in pneumothorax recurrence rate between the two coverage materials. Conclusions: The two visceral pleural coverage materials, PGA and ORC, did not show significant differences in postoperative pneumothorax recurrence. Therefore, if applied appropriately, the choice of material between ORC and PGA for thoracoscopic pneumothorax surgery does not have a significant impact on the clinical outcome.

The Uncomfortable Truth: Open Thoracotomy versus Minimally Invasive Surgery in Lung Cancer: A Systematic Review and Meta-Analysis.

For decades, lung surgery in thoracic cancer has evolved in two ways: saving more parenchyma and being minimally invasive. Saving parenchyma is a fundamental principle of surgery. However, minimally invasive surgery (MIS) is a matter of approach, so it has to do with advances in surgical techniques and tools. For example, MIS has become possible with the introduction of VATS (video-assisted thoracic surgery), and the development of tools has extended the indication of MIS. Especially, RATS (robot-assisted thoracic surgery) improved the quality of life for patients and the ergonomics of doctors. However, the dichotomous idea that the MIS is new and right but the open thoracotomy is old and useless may be inappropriate. In fact, MIS is exactly the same as a classic thoracotomy in that it removes the mass/parenchyma containing cancer and mediastinal lymph nodes. Therefore, in this study, we compare randomized-controlled trials about open thoracotomy and MIS to find out which surgical method is more helpful.

Clinical Benefits of Lobe-Specific Lymph Node Dissection in Surgery for NSCLC: A Systematic Review and Meta-Analysis.

Introduction: The impact of lobe-specific lymph node dissection (LS-LND) in surgery for NSCLC remains controversial compared with that of systematic lymph node dissection (S-LND). This study aimed to compare clinical outcomes between the two strategies, including postoperative complications, and to explain the advantages of LS-LND. Methods: We searched for studies comparing LS-LND and S-LND up to April 14, 2022, using PubMed, EMBASE, and Web of Science. The primary outcomes were overall survival and recurrence-free survival. Secondary outcomes included postoperative complications, such as arrhythmia, chylothorax, and pneumonia. We evaluated the risk of bias and assessed the evidence quality using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Results: A total of 13 studies, including one randomized controlled trial and 12 retrospective studies with 11,522 patients who underwent curative resections for lung cancer, were included. The results indicated that LS-LND had favorable overall survival (hazard ratio [HR] = 0.80, 95% confidence interval [CI]: 0.73-0.87) but no difference in recurrence-free survival (HR = 0.96, 95% CI: 0.84-1.09) on comparison with S-LND. In terms of postoperative complications, patients undergoing LS-LND had a lower rate of chylothorax (risk ratio [RR] = 0.54, 95% CI: 0.35-0.85) and arrhythmia (RR = 0.74, 95% CI: 0.57-0.97) than patients undergoing S-LND, but the risk of postoperative pneumonia was not different. The overall quality of evidence was low to moderate owing to the risk of bias related to heterogeneous study populations. Conclusions: Patients undergoing LS-LND had a comparable and favorable long-term prognosis and a lower rate of postoperative complications. Nevertheless, further standardized studies are necessary to improve the quality of evidence.

Predictive scoring of high-grade histology among early-stage lung cancer patients: The MOSS score.

BACKGROUND: Poor prognosis associated with adenocarcinoma of International Association for the Study of Lung Cancer (IASLC) grade 3 has been recognized. In this study we aimed to develop a scoring system for predicting IASLC grade 3 based before surgery. METHODS: Two retrospective datasets with significant heterogeneity were used to develop and evaluate a scoring system. The development set was comprised of patients with pathological stage I nonmucinous adenocarcinoma and they were randomly divided into training (n = 375) and validation (n = 125) datasets. Using multivariate logistic regression, a scoring system was developed and internally validated. Later, this new score was further tested in the testing set which was comprised of patients with clinical stage 0-I non-small cell lung cancer (NSCLC) (n = 281). RESULTS: Four factors that were related to IASLC grade 3 were used to develop the new scoring system the MOSS score; male (M, point 1), overweight (O, point 1), size>10 mm (S, point 1), and solid lesions (S, point 3). Predictability of IASLC grade 3 increased from 0.4% to 75.2% with scores from 0 to 6. The area under the curve (AUC) of the MOSS was 0.889 and 0.765 for the training and validation datasets, respectively. The MOSS score exhibited similar predictability in the testing set (AUC: 0.820). CONCLUSION: The MOSS score, which combines preoperative variables, can be used to identify high-risk early-stage NSCLC patients with aggressive histological features. It can support clinicians in determining a treatment plan and surgical extent. Further refinement of this scoring system with prospective validation is needed.

Prevalence and Mortality Risk of Neurological Disorders during the COVID-19 Pandemic: An Umbrella Review of the Current Evidence.

INTRODUCTION: Coronavirus disease 2019 (COVID-19), a global pandemic, has infected approximately 10% of the world's population. This comprehensive review aimed to determine the prevalence of various neurological disorders in COVID-19 without overlapping meta-analysis errors. METHODS: We searched for meta-analyses on neurological disorders following COVID-19 published up to March 14, 2023. We obtained 1,184 studies, of which 44 meta-analyses involving 9,228,588 COVID-19 patients were finally included. After confirming the forest plot of each study and removing overlapping individual studies, a re-meta-analysis was performed using the random-effects model. RESULTS: The summarized combined prevalence of each neurological disorder is as follows: stroke 3.39% (95% confidence interval, 1.50-5.27), dementia 6.41% (1.36-11.46), multiple sclerosis 4.00% (2.50-5.00), epilepsy 5.36% (-0.60-11.32), Parkinson's disease 0.67% (-1.11-2.45), encephalitis 0.66% (-0.44-1.77), and Guillain-Barré syndrome 3.83% (-0.13-7.80). In addition, the mortality risk of patients with comorbidities of COVID-19 is as follows: stroke OR 1.63 (1.23-2.03), epilepsy OR 1.71 (1.00-2.42), dementia OR 1.90 (1.31-2.48), Parkinson's disease OR 3.94 (-2.12-10.01). CONCLUSION: Our results show that the prevalence and mortality risk may increase in some neurological diseases during the COVID-19 pandemic. Future studies should elucidate the precise mechanisms for the link between COVID-19 and neurological diseases, determine which patient characteristics predispose them to neurological diseases, and consider potential global patient management.

Global, Regional, and National Burden of Mesothelioma 1990-2019: A Systematic Analysis of the Global Burden of Disease Study 2019.

Rationale: Mesothelioma has become a major health burden since World War II because of the use of asbestos. Although many countries have imposed bans on asbestos, there remain significant mortality and morbidity from mesothelioma because of its long latent period and aggressiveness. Also, the use of asbestos is increasing in low-income countries, potentiating risk of mesothelioma in the coming decades. Assessment of the global burden of mesothelioma is required to take proper measures against the disease. Objectives: To assess the burden of mesothelioma from 1990 to 2019 at the global, regional, and national levels and to investigate patterns according to sex, age, sociodemographic index, and risk factors. Methods: The numbers, rates, and age-standardized rates of incidence, death, and disability-adjusted life years (DALYs) of mesothelioma in 204 countries and territories from 1990 to 2019 were estimated using vital registration and cancer registry data. The relationship between sociodemographic index and age-standardized DALY rate was determined, and DALYs attributable to occupational exposure to asbestos were calculated. Results: In 2019, there were 34,511 (95% uncertainty interval [UI], 31,199 to 37,771) incident cases of mesothelioma globally, with an age-standardized rate of 0.43 per 100,000 persons (95% UI, 0.38 to 0.47), which decreased between 1990 and 2019 by -12.6% (95% UI, -21.8% to -2.3%). Mesothelioma was responsible for 29,251 (95% UI, 26,668 to 31,006) deaths in 2019, with an age-standardized rate of 0.36 deaths per 100,000 persons (95% UI, 0.33 to 0.39), which decreased between 1990 and 2019 by -9.6% (95% UI, -17.8% to -1.1%). The age-standardized incidence rate increased in central Europe between 1990 and 2019 by 46.1% (95% UI, 16.6% to 72.4%). The Netherlands, Australia, and the United Kingdom had the highest age-standardized incidence rates. Incidence rates were higher in men than in women ages 45-49 to 90-94 years, peaking at 85-89 years. Occupational exposure to asbestos contributed to 85.2% (95% UI, 82.1% to 88.1%) of DALYs. Conclusions: The global burden of mesothelioma is decreasing in terms of age-standardized incidence and mortality rates. Mesothelioma remains a substantial public health challenge in many parts of the world.

Effects of physical rehabilitation interventions in COVID-19 patients following discharge from hospital: A systematic review.

BACKGROUND: Hospitalized patients recovering from coronavirus disease 2019 (COVID-19) may experience disability and suffer from significant physical and mental impairment requiring physical rehabilitation following their discharge. However, to date, no attempt has been made to collate and synthesize literature in this area. OBJECTIVE: This systematic review examines the outcomes of different physical rehabilitation interventions tested in COVID-19 patients who were discharged from hospital. SEARCH STRATEGY: A systematic search of MEDLINE/PubMed, CINAHL, Scopus and medRxiv was conducted to identify articles published up to March 2022. INCLUSION CRITERIA: This systematic review included studies of outpatient rehabilitation programs for people recovering from COVID-19 who received physical activity, exercise, or breathing training to enhance or restore functional capacity, pulmonary function, quality of life, and mental health or function. DATA EXTRACTION AND ANALYSIS: Selection of included articles, data extraction, and methodological quality assessments were conducted by two review authors respectively, and consensus was reached through discussion and consultation with a third reviewer. Finally, we review the outcomes of studies based on four categories including: (1) functional capacity, (2) pulmonary function, (3) quality of life, and (4) mental health status. RESULTS: A total of 7534 titles and abstracts were screened; 10 cohort studies, 4 randomized controlled trials and 13 other prospective studies involving 1583 patients were included in our review. Early physical rehabilitation interventions applied in COVID-19 patients who were discharged from the hospital improved multiple parameters related to functional capacity, pulmonary function, quality of life and mental health status. CONCLUSION: Physical rehabilitation interventions may be safe, feasible and effective in COVID-19 patients discharged from the hospital, and can improve a variety of clinically relevant outcomes. Further studies are warranted to determine the underlying mechanisms. Please cite this article as: Rahmati M, Molanouri Shamsi M, Woo W, Koyanagi A, Won Lee SW, Keon Yon DK, Shin JI, Smith L. Effects of physical rehabilitation interventions in COVID-19 patients following discharge from hospital: A systematic review. J Integr Med. 2022; 21(2): 149-158.

Proposal of a revised International Association for the Study of Lung Cancer grading system in pulmonary non-mucinous adenocarcinoma: The importance of the lepidic proportion.

OBJECTIVES: We aimed to measure the validity of the International Association for the Study of Lung Cancer (IASLC) grading system in Korean patients and propose a modification for an increase of its predictability, especially in grade 2 patients. MATERIALS AND METHODS: From 2012 to 2017, histopathologic characteristics of 1358 patients with invasive pulmonary adenocarcinoma (stage I-III) from two institutions were retrospectively reviewed and re-classified according to the IASLC grading system. Considering the amount of the lepidic proportion, the validity of the revised model (Lepidic-10), derived from the training cohort (hospital A), was measured using the validation cohort (hospital B). Its predictability was compared to that of the IASLC system. RESULTS: Of the 1358 patients, 259 had a recurrence, and 189 died during follow-up. The Harrell's concordance index and area under the curve of the IASLC system were 0.685 and 0.699 for recurrence-free survival (RFS) and 0.669 and 0.679 for death, respectively. From the training cohort, the IASLC grade 2 patients were divided into grades 2a and 2b (Lepidic-10 model) with a 10 % lepidic pattern. This new model further distinguished patients in both institutions that had better performance than the IASLC grading (Hospital A, p < 0.001 for RFS and death; Hospital B, p = 0.0215 for RFS, p = 0.0429 for death). CONCLUSION: The IASLC grading system was easily applicable; its clinical use in predicting the prognosis of Korean patients with pulmonary adenocarcinoma was validated. Furthermore, the introduction of the lepidic proportion as an additional criterion to differentiate grade 2 patients improved its predictability.

Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score.

Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (±pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusions: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.

Combined Intrathoracic and Abdominal Splenosis.

BACKGROUND Splenosis refers to autotransplantation of splenic tissue after splenic injury or splenectomy, most frequently occurring in the abdominal and pelvic cavities. Thoracic splenosis is a rare condition associated with a history of simultaneous rupture of the spleen and diaphragm resulting from trauma. To the best of our knowledge, only a limited number of cases have been reported for combined intrathoracic and abdominal splenosis. CASE REPORT We present a case of a 50-year-old man with a history of splenectomy and left nephrectomy 15 years ago due to an accident, who had experienced chest pain for the past month. A 1-cm focal pleural thickening in the left posterior pleura was revealed on the chest computed tomography (CT) scan. We found this to be suspicious for a solitary fibrous tumor. Based on this information, surgery was performed for tumor removal, and the pathologic examination confirmed splenic tissues. The patient was then discharged without any complications. Further abdominopelvic CT showed several contrast-enhanced lesions, suggestive of intraperitoneal splenosis. CONCLUSIONS We would like to emphasize the importance of thorough history-taking to avoid misdiagnosis and unnecessary procedures with respect to the rarity of splenosis. Moreover, appropriate use of diagnostic tools, including radionuclide imaging studies, is recommended to establish an accurate diagnosis of thoracic splenosis.

Prognosis of resected invasive mucinous adenocarcinoma compared with the IASLC histologic grading system for invasive nonmucinous adenocarcinoma: Surgical database study in the TKIs era in Korea.

BACKGROUND: The prognosis of invasive mucinous adenocarcinoma (IMA) remains controversial and should be clarified by comparison with the International Association for the Study of Lung Cancer (IASLC) histologic grading system for invasive nonmucinous adenocarcinoma (INMA). METHODS: This study included patients with IMA who underwent curative resection. Their clinicopathological outcomes were compared with those of patients with INMA. Propensity score matching was performed to compare the prognosis of IMA with IASLC grade 2 or 3. Kaplan-Meier survival curves and log-rank tests were used to analyze recurrence-free survival (RFS) and overall survival (OS). RESULTS: The prognoses of IMA and IASLC grade 2 were similar in terms of RFS and OS. Although patients with IMA had better RFS than patients with IASLC grade 3, the OS was not significantly different. After propensity score matching, IMA demonstrated similar RFS to IASLC grade 2 but superior to IASLC grade 3; there was no difference in the OS compared with grades 2/3. Multivariate analysis revealed that tumor size (hazard ratio [HR] = 1.20, p = 0.028), lymphovascular invasion (HR = 127.5, p = 0.003), and maximum standardized uptake value (HR = 1.24, p = 0.005) were poor prognostic predictors for RFS. Patients with IMA demonstrated RFS similar to and significantly better than that of patients with IASLC grades 2 and 3, respectively. For OS, IMA prognosis was between that of IASLC grades 2 and 3. CONCLUSIONS: Since the prognosis of IMA among lung adenocarcinomas appears to be relatively worse, further clinical studies investigating IMA-specific treatment and follow-up plans are necessary to draw more inferences.