Comparison of disposable digital single-operator cholangioscopy versus direct peroral cholangioscopy for the diagnosis of intraductal superficial lesions of the bile duct.

BACKGROUND AND AIMS: Disposable digital single-operator cholangioscopy (D-SOC) and direct peroral cholangioscopy (D-POC) using an ultraslim endoscope are established POC modalities for the diagnosis and treatment of various biliary diseases. We compared the usefulness of D-SOC and D-POC for the diagnosis of intraductal superficial lesions of the bile duct (ISL-Bs). METHODS: In total, 38 consecutive patients with suspected biliary diseases who underwent both D-SOC and D-POC were enrolled. The primary outcome was the detection rate of the ISL-Bs, and the secondary outcomes were the technical success of POC and POC-guided forceps biopsy sampling (POC-FB), procedure time, visualization quality, and tissue adequacy. RESULTS: D-SOC had a higher technical success rate than D-POC but without a statistically significant difference (100% vs. 92.1%, P = 0.248). D-POC had a marginally higher ISL-B detection rate (34.2% vs. 28.9%, P = 0.683) and significantly higher visualization quality (P = 0.033). The mean procedure time was significantly shorter with D-SOC (11.00 ± 1.34 vs. 19.03 ± 2.95 min, P < 0.001). The technical success rate of POC-FB and tissue adequacy did not differ between the two techniques (D-SOC vs. D-POC: 81.8% vs. 84.6%, P = 0.693 and 77.8% vs. 90.9%, P = 0.566). CONCLUSIONS: Our results demonstrate that both POC systems are safe and useful for the detection, characterization, and diagnosis of minute ISL-Bs. While D-SOC displayed a shorter procedure time and a tendency for higher technical success rate, D-POC provided superior visualization quality, allowing detailed observation of the surface structure and microvascular patterns.

Feasibility of intraoperative pathologic examination for sentinel lymph nodes during sentinel node navigation surgery in early gastric cancer: results of pathologic protocol for SENORITA trial.

BACKGROUND: During sentinel node navigation surgery in patients with gastric cancer, intraoperative pathologic examination of sentinel nodes is crucial in determining the extent of surgery. In this study, we evaluated the feasibility and accuracy of intraoperative pathologic protocols using data from a prospective, multicenter, randomized trial. METHODS: A retrospective analysis was conducted using data from the SEntinel Node ORIented Tailored Approach trials from 2013 to 2016. All sentinel lymph nodes were evaluated during surgery with hematoxylin-eosin (HE) staining using a representative section at the largest plane for lymph nodes. For permanent histologic evaluation, sentinel basin nodes were stained with HE and cytokeratin immunohistochemistry in formalin-fixed, paraffin-embedded (FFPE) sections and examined with HE for three deeper-step sections at 200-µm intervals. The failure rate of identification by frozen section and the metastasis rate in non-sentinel basins were investigated. RESULTS: Of the 237 patients who underwent sentinel node basin dissection, 30 had lymph node metastases on permanent pathology. Thirteen patients had macrometastasis confirmed in frozen sections as well as FFPE sections (failure rate: 0%). Patients with negative sentinel nodes in frozen sections but micrometastasis in FFPE sections had no lymph node recurrence during the follow-up period (0%, 0/6). However, in cases with tumor-positive nodes in frozen sections, metastases in non-sentinel basins were detected in the paraffin blocks (8.3%, 2/24). CONCLUSIONS: The single-section HE staining method is sufficient for detecting macrometastasis via intraoperative pathological examination. If a negative frozen-section result is confirmed, sentinel basin dissection can be performed safely. Otherwise, standard surgery is required.

Prognostic Roles of Inflammatory Biomarkers in Radioiodine-Refractory Thyroid Cancer Treated with Lenvatinib.

BACKGRUOUND: Inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR), serve as valuable prognostic indicators in various cancers. This multicenter, retrospective cohort study assessed the treatment outcomes of lenvatinib in 71 patients with radioactive iodine (RAI)-refractory thyroid cancer, considering the baseline inflammatory biomarkers. METHODS: This study retrospectively included patients from five tertiary hospitals in Korea whose complete blood counts were available before lenvatinib treatment. Progression-free survival (PFS) and overall survival (OS) were evaluated based on the median value of inflammatory biomarkers. RESULTS: No significant differences in baseline characteristics were observed among patients grouped according to the inflammatory biomarkers, except for older patients with a higher-than-median NLR (≥2) compared to their counterparts with a lower NLR (P= 0.01). Patients with a higher-than-median NLR had significantly shorter PFS (P=0.02) and OS (P=0.017) than those with a lower NLR. In multivariate analysis, a higher-than-median NLR was significantly associated with poor OS (hazard ratio, 3.0; 95% confidence interval, 1.24 to 7.29; P=0.015). However, neither the LMR nor the PLR was associated with PFS. A higher-than-median LMR (≥3.9) was significantly associated with prolonged OS compared to a lower LMR (P=0.036). In contrast, a higher-than-median PLR (≥142.1) was associated with shorter OS compared to a lower PLR (P=0.039). CONCLUSION: Baseline inflammatory biomarkers can serve as predictive indicators of PFS and OS in patients with RAI-refractory thyroid cancer treated with lenvatinib.

Retinestatin, a Polyol Polyketide from a Termite Nest-Derived Streptomyces sp.

A new polyol polyketide, named retinestatin (1), was obtained and characterized from the culture of a Streptomyces strain, which was isolated from a subterranean nest of the termite Reticulitermes speratus kyushuensis Morimoto. The planar structure of 1 was elucidated on the basis of the cumulative analysis of ultraviolet, infrared, mass spectrometry, and nuclear magnetic resonance spectroscopic data. The absolute configuration of 1 at 12 chiral centers was successfully assigned by employing a J-based configuration analysis in combination with ROESY correlations, a quantum mechanics-based computational approach to calculate NMR chemical shifts, and a 3 min flash esterification by Mosher's reagents followed by NMR analysis. Biological evaluation of retinestatin (1) using an in vitro model of Parkinson's disease revealed that 1 protected SH-SY5Y dopaminergic cells from MPP+-induced cytotoxicity, indicating its neuroprotective effects.

Usefulness of Direct Peroral Cholangioscopy Using a Multibending Ultraslim Endoscope for the Management of Intrahepatic Bile Duct Lesions (with Videos).

Background/Aims: : Peroral cholangioscopy (POC) has been used to assess intrahepatic duct (IHD) lesions but with a limited role. A new multibending (MB) ultraslim endoscope has been designed to improve POC performance. We evaluated the usefulness of POC using the MB ultraslim endoscope for the management of IHD lesions. Methods: : Between March 2017 and March 2020, 22 patients underwent direct POC using the MB ultraslim endoscope for IHD lesions documented by previous imaging or cholangiopancreatography. The primary outcome was technical success of POC, and secondary outcomes were technical success of POC-guided interventions, median procedure time, and POC-related adverse events. Results: : The technical success rate for POC using the MB ultraslim endoscope for IHD lesions was 95.5% (21/22). Free-hand insertion was successful in 95.2% (20/21). The overall technical success rate for POC-guided intervention was 100% (21/21), including nine diagnostic and 12 therapeutic procedures (eight direct stone removal and four intraductal lithotripsies). The median procedure time was 29 minutes (range, 9 to 79 minutes). There were no procedure-related adverse events. Conclusions: : Direct POC using the MB ultraslim endoscope allows direct visualization of IHD lesions and may be useful for diagnosis and therapeutic management in selected patients.

Active Surveillance for Low-Risk Papillary Thyroid Carcinoma as an Acceptable Management Option with Additional Benefits: A Comprehensive Systematic Review.

BACKGRUOUND: Active surveillance (AS) has been introduced as a management strategy for low-risk papillary thyroid carcinoma (PTC) due to its typically indolent nature. Despite this, the widespread adoption of AS has encountered several challenges. The aim of this systematic review was to evaluate the safety of AS related to disease progression and its benefits compared with immediate surgery (IS). METHODS: Studies related to AS in patients with low-risk PTC were searched through the Ovid MEDLINE, Embase, Cochrane Library, and KoreaMed databases. Studies on disease progression, surgical complication, quality of life (QoL), and cost-effectiveness were separately analyzed and narratively synthesized. RESULTS: In the evaluation of disease progression, the proportions of cases with tumor growth ≥3 mm and a volume increase >50% were 2.2%-10.8% and 16.0%-25.5%, respectively. Newly detected lymph node metastasis was identified in 0.0%-1.4% of patients. No significant difference was found between IS and delayed surgery in surgical complications, including vocal cord paralysis and postoperative hypoparathyroidism. AS was associated with better QoL than IS. Studies on the cost-effectiveness of AS reported inconsistent data, but AS was more cost-effective when quality-adjusted life years were considered. CONCLUSION: AS is an acceptable management option for patients with low-risk PTC based on the low rate of disease progression and the absence of an increased mortality risk. AS has additional benefits, including improved QoL and greater QoL-based cost-effectiveness.

Association between Weight Change and Incidence of Dyslipidemia in Young Adults: A Retrospective Cohort Study of Korean Male Soldiers.

Background: Recent lifestyle changes have increased the prevalence of dyslipidemia in Korea. Young men are known to have a low awareness of dyslipidemia and a lack of motivation to maintain their weight. However, the association between weight change and dyslipidemia in young adults has not been thoroughly examined. Methods: Data from the Armed Forces Medical Command Defense Medical Information System database were used. In this study, 15,068 soldiers who underwent private and corporal health examinations between May 2020 and April 2022 were included. The difference in weights between the two different health examinations was used to quantify weight change. Four components of the lipid profile were used to assess dyslipidemia during the corporal health examination. Results: After adjusting for relevant covariates, weight gain was associated with increased risk of dyslipidemia (adjusted odds ratio [OR], 1.38 [95% confidence interval, CI, 1.15 to 1.64] for the 5% to 10% weight gain group; and OR, 2.02 [95% CI, 1.59 to 2.55] for the ≥10% weight gain group), whereas weight loss was associated with decreased risk (adjusted OR, 0.82 [95% CI, 0.68 to 0.98] for the 5% to 10% weight loss group; and OR, 0.38 [95% CI, 0.27 to 0.53] for the ≥10% weight loss group). In subgroup analysis based on the participants' baseline body mass index, smoking status, regular exercise habits, and hypertension status, there were no significant differences between the subgroups. Conclusion: Weight change was associated with dyslipidemia in Korean male soldiers. The findings suggest that limiting weight gain in young adults by encouraging a healthy lifestyle may help prevent dyslipidemia.

FLI-1 is expressed in a wide variety of hematolymphoid neoplasms: a special concern in the differential diagnosis.

Friend Leukemia Virus Integration 1 (FLI-1) is a member of E26 transformation-specific family of transcription factors that participates in hematopoietic and vascular endothelial cell development. Immunohistochemical detection of FLI-1 has been widely used to diagnose vascular tumors or, more evidently, Ewing's sarcoma. However, the expression pattern of FLI-1 in hematolymphoid neoplasms remains unclear. Therefore, in this study, we aimed to investigate the expression of FLI-1 in these tumors, focusing on high-grade lesions, which presents a diagnostic challenge by mimicking Ewing's sarcoma. We evaluated the expression FLI-1 in various types of lymphoid and plasmacytic tumors, including 27 plasmablastic lymphomas, 229 diffuse large B-cell lymphomas, 22 precursor T- or B-lymphoblastic lymphomas, 24 angioimmunoblastic-type nodal T-follicular helper cell lymphomas, 52 peripheral T-cell lymphomas, NOS, 18 Burkitt lymphomas, 18 non-gastric lymphomas of mucosa-associated lymphoid tissue, 38 chronic lymphocytic leukemia/small lymphocytic lymphomas, 15 mantle cell lymphomas, 23 gastric MALT lymphomas, 50 plasma cell myelomas, and 38 follicular lymphomas. We calculated the H-scores of FLI-1 immunostaining, ranging from 0 to 200, and used the scores to analyze the clinicopathological significance of FLI-1 statistically. FLI-1 was expressed to varying degrees in all types of hematological tumors. FLI-1 expression was detected in 84.1% of patients (466/554). FLI-1 was highly expressed in precursor T- or B-lymphoblastic lymphomas. Follicular lymphomas exhibited low FLI-1 expression. In plasmablastic lymphoma, 85.2% of the patients were focally positive for FLI-1. FLI-1 expression did not correlate with clinicopathological variables, such as demographic data or disease stage, in patients with plasmablastic lymphoma and diffuse large B-cell lymphoma. However, FLI-1 overexpression was associated with poorer overall survival in patients with plasmablastic lymphoma. This study demonstrates that FLI-1 is expressed in various hematolymphoid neoplasms. FLI-1 expression can lead to diagnostic confusion, especially in small blue round cell tumors, such as lymphoblastic lymphoma, plasmablastic lymphoma, and plasma cell myeloma, when distinguishing tumors positive for CD99 and CD56 without CD3, CD20, or CD45. Our findings also suggested the possibility of FLI-1 as a potential prognostic biomarker for plasmablastic lymphoma.

Histiocytic sarcoma mimicking localized tenosynovial giant cell tumor in the pediatric foot: A rare case report with MRI Findings.

We present a rare case of histiocytic sarcoma (HS) occurring in the foot of a 12-year-old male, initially misdiagnosed as localized tenosynovial giant cell tumor (TSGCT). HS is an exceptionally uncommon hematologic malignant neoplasm, with its occurrence in children and extranodal sites being even rarer. To our knowledge, this is the first reported case of extranodal HS in the foot, emphasizing comprehensive MRI findings. Initially, the patient was diagnosed with TSGCT based on histological results following surgical resection. However, after recurrence and subsequent surgical resection, histological and immunochemical analyses led to a revised diagnosis of HS. This report focuses on the MRI findings of HS, highlighting the distinctions from localized TSGCT. While both conditions share histopathological similarities, immunohistochemical tests are crucial for accurate diagnosis. The report underscores the importance of differentiating HS for appropriate treatment.

Effect of thyroid-stimulating hormone suppression on quality of life in thyroid lobectomy patients: interim analysis of a multicenter, randomized controlled trial in low- to intermediate-risk thyroid cancer patients (MASTER study).

Purpose: Current clinical practices favor less or no thyroid-stimulating hormone (TSH) suppression for low- to intermediate-risk thyroid cancer patients who receive thyroid lobectomy. The association of TSH suppression on health-related quality of life (HR-QoL) in patients after thyroid lobectomy is not well studied. This study aimed to evaluate the effect of TSH suppression on patient HR-QoL after thyroid lobectomy. Methods: This study included patients enrolled in an ongoing, multicenter, randomized controlled study investigating the effects of TSH suppression. Patients were randomized to either the low-TSH group (TSH target range, 0.3-1.99 µIU/mL) or the high-TSH group (TSH target range, 2.0-7.99 µIU/mL). The HR-QoL, hyperthyroidism symptom, and depression symptom questionnaires performed preoperatively and 2 weeks and 3 months postoperatively were evaluated. Results: Total of 669 patients (low-TSH group, 340; high-TSH group, 329) were included. Although total HR-QoL score changes were not different between the 2 groups, the high-TSH group had a significantly higher score in the physical domain at postoperative 3 months (P = 0.046). The 2 groups did not have significant differences in hyperthyroidism and depression scores. Conclusion: In the short-term postoperative period, the physical HR-QoL scores in thyroid lobectomy patients were better when they did not receive TSH suppression. This study suggests the importance of considering HR-QoL when setting TSH suppression targets in thyroid lobectomy patients.

Age and Post-Lobectomy Recurrence after Endoscopic or Robotic Thyroid Surgery: A Retrospective Cohort Study of 2348 Papillary Thyroid Carcinoma Patients.

The biology of papillary thyroid carcinoma (PTC) in young patients is poorly understood, and there are conflicting data regarding the recurrence for younger patients compared to older patients. We retrospectively analyzed 2348 clinically node-negative (cN0) PTC patients who underwent a thyroid lobectomy between 2008 and 2017. Young age was defined as less than 35 years old. The clinicopathological characteristics and oncologic outcomes of the young age group were compared to those of the older age group. The number of young age cN0 PTC patients accounted for 20.7% of the enrolled patients, and 24.2% were upstaged into pathologic N1a. The young age group had a significantly larger proportion of females, endoscopic/robotic thyroid lobectomies, stage N1a, and larger tumor sizes. Post-lobectomy recurrences were significantly higher in the young age group. In the Cox analysis, young age, large tumor size, and stage N1a were significant risk factors. The multivariate analysis reveals that young age and stage N1a are significant risk factors. Conversely, minimally invasive or robot-endoscopic thyroidectomies were not risk factors for post-lobectomy recurrence compared to conventional thyroidectomies. While young patients with a stage N1a had a significant risk factor for post-lobectomy recurrence, endoscopic/robotic thyroidectomy was as feasible and safe as conventional thyroidectomies in the median seven-year oncologic follow-up. Further high-quality studies are needed to elucidate the relationship between age and the risk of post-lobectomy recurrence.

Extremely Rare CT and MRI Findings of Peritoneal Leiomyoma Mimicking Hepatic Mass: A Case Report.

Leiomyoma is a common benign tumor from smooth muscle cells, mostly in the uterus. Peritoneal leiomyomas (PLs) are extremely rare and mostly reported as disseminated peritoneal leiomyomatosis. However, to the best of out knowledge, radiologic findings of isolated PL are not reported in English literature. Herein, we introduce the radiologic findings of PL mimicking hepatic mass in a 34-year-old female. CT showed a mass with curvilinear heterogeneous enhancement at the liver's peripheral area. On MRI, the mass showed gradual and heterogeneous enhancement on gadoxetic acid-enhanced MRI and diffusion restriction. The radiologic diagnosis was a benign hepatic tumor, such as degenerated hemangioma, adenoma, and inflammatory myofibroblastic tumor; however, the mass was diagnosed as PL pathologically.

MicroRNA miR-274-5p Suppresses Found-in-Neurons Associated with Melanotic Mass Formation and Developmental Growth in Drosophila.

The hematopoietic system plays a crucial role in immune defense response and normal development, and it is regulated by various factors from other tissues. The dysregulation of hematopoiesis is associated with melanotic mass formation; however, the molecular mechanisms underlying this process are poorly understood. Here, we observed that the overexpression of miR-274 in the fat body resulted in the formation of melanotic masses. Moreover, abnormal activation of the JNK and JAK/STAT signaling pathways was linked to these consequences. In addition to this defect, miR-274 overexpression in the larval fat body decreased the total tissue size, leading to a reduction in body weight. miR-274-5p was found to directly suppress the expression of found-in-neurons (fne), which encodes an RNA-binding protein. Similar to the effects of miR-274 overexpression, fne depletion led to melanotic mass formation and growth reduction. Collectively, miR-274 plays a regulatory role in the fne-JNK signaling axis in melanotic mass formation and growth control.

A Randomized Controlled Trial of Cryoanalgesia for Pain Management following Pectus Excavatum Repair: A Single-Center, Single-Blind, Parallel Design Study.

INTRODUCTION: Conventional postoperative pain management, with an intravenous patient-controlled approach or thoracic epidural analgesia, has proved suboptimal following a minimally invasive repair of pectus excavatum. Considering its postulated mechanism of action, we encouraged cryoanalgesia as an effective method for postrepair pain management and a possibly superior alternative. METHODS: A randomized, single-blind clinical trial was tested on patients undergoing pectus excavatum (PE) repair in March and December 2022. Among 101 patients, consenting study participants were randomly assigned to one of two groups: cryoanalgesia (group C, n = 24) or noncryoanalgesia (group N, n = 24). Group N received conventional pain management. Comparing the results, pain levels were measured using the visual analog scale (VAS-R for resting and VAS-D for dynamic) and the total rescue analgesic consumption was determined. Intrathoracic cryoablation was performed bilaterally on the fourth and seventh intercostal nerves using a cryoprobe at -80°C for 2 minutes. RESULTS: The two groups had similar baseline-patient characteristics; however, group C had a longer mean operative time (159 vs. 125 minutes, p < 0.01) and experienced significantly less pain throughout the postoperative course, with VAS at 6 hours (5.38 vs. 7.04, p < 0.01) and 48 hours (3.17 vs. 5.67, p < 0.01). CONCLUSION: Cryoanalgesia improved postoperative pain control at rest and during movement following PE repair. However, the outcome was less favorable than expected because the VAS was greater than 4 (moderate pain), although after a day or two, it decreased to lower levels (VAS < 4) in the cyro group. Considering its extra invasiveness and instrumentation, a routine cryoanalgesia procedure for pectus surgery is yet to be determined.

Unilateral Multifocality Is Not a Risk Factor for Recurrence After Thyroid Lobectomy: A Study of 1,684 Patients With Differentiated Thyroid Cancer.

BACKGROUND/AIM: Many studies indicate that multifocality is associated with high-risk features of differentiated thyroid cancer (DTC). Herein, we evaluated the impact of the unilateral multifocality on post-lobectomy recurrence in patients with DTC. PATIENTS AND METHODS: We retrospectively analyzed 1,684 patients with DTC who underwent thyroid lobectomy from 2008 to 2015 using logistic regression models to calculate the relative risk on post-lobectomy recurrence. RESULTS: Tumor diameter increased from 4.9 mm to 8.1 mm and the proportion of extrathyroidal extension (ETE) and unilateral multifocality progressively increased from 2008 to 2015 (2.1% to 24.3% and 4.2% to 22.8%, respectively). During the 88.6-month follow-up period, 67 (3.98%) recurrences and 2 (0.12%) deaths were observed. There were 269 (16.0%) multifocal DTC cases. There was no significant difference between the multifocal and unifocal groups in terms of the proportion of recurrences (5.2% vs. 3.7%) and distant metastasis (0.4% vs. 0.1%). Logistic regression analysis revealed age <42.5 years (OR=1.83), tumor diameter greater than 7.5 mm (OR=1.89), and N1a (OR=2.04) were potent risk factors for post-lobectomy recurrence. Conversely, male sex (OR=0.77; p=0.407), ETE (OR=1.16; p=0.698) and multifocality (OR=1.23; p=0.526) were not risk factors for recurrence after thyroid lobectomy. A positive node ratio (PNR) ≥42.0%, N1a stage, a tumor diameter ≥7.5mm and age <42.5 years were significant risk factors for recurrence (Log-rank p=0.001, p=0.001, p=0.004 and p=0.009, respectively). Contrariwise, multifocality and ETE were proven to not be risk factors for DTC recurrence after thyroid lobectomy (Log-rank p=0.099 and p=0.126, respectively). CONCLUSION: Unilateral multifocality was not a risk factor for DTC recurrence after thyroid lobectomy and could not be considered an indication for immediate completion or total thyroidectomy.

Effects of Uncertainty, Appraisal of Uncertainty, and Self-Efficacy on the Quality of Life of Elderly Patients with Lung Cancer Receiving Chemotherapy: Based on Mishel's Theory of Uncertainty.

Background and Objectives: The purpose of this study is to enhance the quality of life in elderly patients with lung cancer by understanding relations of uncertainty, appraisal of uncertainty, self-efficacy, and quality of life targeting elderly patients with lung cancer receiving anticancer therapy, and also analyzing the factors affecting the quality of life based on Mishel's theory. Materials and Methods: The subjects were a total of 112 lung cancer patients aged 65 or older receiving anticancer therapy. The data was collected by using self-report questionnaires targeting patients in hemato-oncology at Chungbuk National University Hospital. The data were analyzed using descriptive statistics, a t-test, an analysis of variance, Pearson's correlational coefficients, and hierarchical regression analysis. Results: In stage 1, anticancer therapy (chemotherapy) (ß = -0.34, p < 0.001), economic condition (low) (ß = -0.30, p < 0.001), the number of anticancer therapies (three times or more) (ß = -0.29, p < 0.001), and education (graduation from high school or higher) (ß = 0.18, p = 0.033) were influencing factors (F = 0.52, p < 0.001). In stage 2, self-efficacy (ß = 0.41, p < 0.001), appraisal of uncertainty: danger (ß = -0.29, p < 0.001), appraisal of uncertainty: opportunity (ß = 0.18, p = 0.018), the number of anticancer therapies (three times or more) (ß = -0.17, p = 0.006), and anticancer therapy (chemotherapy) (ß = -0.14, p = 0.031) were influencing factors, which showed 74.2% explanatory power (F = 26.17, p < 0.001). Conclusions: In order to improve the quality of life of subjects, it would be necessary to develop interventions for raising their self-efficacy by considering their degree of education, economic condition, the types and numbers of anticancer therapies, and understanding of the appraisal of uncertainty about the disease is assessed as an opportunity factor or a danger factor.

Toxicity and Biodistribution of Fragmented Polypropylene Microplastics in ICR Mice.

Currently, polypropylene (PP) is used in various products, thus leading to high daily exposure in humans. Thus, it is necessary to evaluate the toxicological effects, biodistribution, and accumulation of PP microplastics in the human body. In this study, administration of two particle sizes of PP microplastics (approximately 5 and 10-50 µm) did not lead to any significant changes in several toxicological evaluation parameters, including body weight and pathological examination, compared with the control group in ICR mice. Therefore, the approximate lethal dose and no-observed-adverse-effect level of PP microplastics in ICR mice were established as ≥2000 mg/kg. Furthermore, we manufactured cyanine 5.5 carboxylic acid (Cy5.5-COOH)-labeled fragmented PP microplastics to monitor real-time in vivo biodistribution. After oral administration of the Cy5.5-COOH-labeled microplastics to the mice, most of the PP microplastics were detected in the gastrointestinal tract and observed to be out of the body after 24 h in IVIS Spectrum CT. Therefore, this study provides a new insight into the short-term toxicity, distribution, and accumulation of PP microplastics in mammals.

Huge Primary Pleural Cyst Mimicking an Exophytic Echinococcal Cyst: A Case Report.

A 58-year-old woman presented with an incidental asymptomatic mass occupying the entire right lower thorax. A radiologic study demonstrated a huge cystic mass, initially suggestive of an exophytic echinococcal cyst. After unsuccessful catheter drainage, the patient was referred for surgery, and curative resection of the lung-, heart-, and diaphragm-compressing mass was performed under video-assisted thoracoscopic surgery. Culture studies revealed no growth of parasitic, bacterial, or fungal infections, and the final pathological result confirmed a primary pleural cyst. Thoracic cystic masses mostly manifest as bronchogenic or pericardial cysts, while primary pleural cysts have rarely been reported. We present a rare case of a huge pleural cyst that initially mimicked an echinococcal cyst.

A Comprehensive Assessment of the Harms of Fine-Needle Aspiration Biopsy for Thyroid Nodules: A Systematic Review.

BACKGRUOUND: There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of FNAB. METHODS: Studies related with the harms of FNAB were searched on MEDLINE, Embase, Cochrane library, and KoreaMed from 2012 to 2022. Also, studies reviewed in the previous systematic reviews were evaluated. Included clinical complications were postprocedural pain, bleeding events, neurological symptoms, tracheal puncture, infections, post-FNAB thyrotoxicosis, and needle tract implantation of thyroid cancers. RESULTS: Twenty-three cohort studies were included in this review. Nine studies which were related with FNAB-related pain showed that most of the subjects had no or mild discomfort. The 0% to 6.4% of the patients had hematoma or hemorrhage after FNAB, according to 15 studies. Vasovagal reaction, vocal cord palsy, and tracheal puncture have rarely described in the included studies. Needle tract implantation of thyroid malignancies was described in three studies reporting 0.02% to 0.19% of the incidence rate. CONCLUSION: FNAB is considered to be a safe diagnostic procedure with rare complications, which are mainly minor events. Thorough assessement of the patients' medical condition when deciding to perform FNABs would be advisable to lower potential complications.

Successful Endoscopic Vacuum Therapy for Extensive Gastric Tubing Necrosis after Ivor-Lewis Esophagectomy: A Case Report.

The stomach has become the most commonly used site for grafts to replace the esophagus in esophageal cancer surgery because of its good blood supply and ability to enable single-reconstruction anastomosis. However, anastomotic failure is a serious complication after esophageal cancer surgery. Unlike anastomotic leakage due to local ischemia, gastric tube necrosis is a life-threatening condition with a high mortality rate. Gastric tube necrosis involves extensive ischemia due to a decreased blood supply, and an urgent operation is mandatory in most cases. Endoscopic vacuum therapy (EVT) has been used for anastomotic leakage after esophageal surgery. In recent years, it has been successfully used for more extensive disease, including large esophageal perforation as an indication for reoperation. Hence, we report a case of extensive gastric tube necrosis treated by EVT after an Ivor Lewis operation.