Postoperative Pain Intensity After Single-port, Double-port, and Triple-port Video-assisted Lung Lobectomy: A Three-arm Parallel Randomized Clinical Trial

OBJECTIVE

Video-assisted thoracic surgery (VATS) has evolved from a multiport approach to a one-port approach to reduce the degree of surgical trauma. However, there is no consensus on the number of incisions leading to less postoperative pain. Early postoperative pain was compared after three technical variants of VATS lobectomy under multimodal analgesia, including thoracic epidural analgesia.

DESIGN

This study was designed as a prospective, randomized, controlled clinical trial with three parallel arms.

SETTING

Single-center study.

PARTICIPANTS

A total of 112 adult patients with ASA statuses I to III who were scheduled to undergo elective VATS lobectomy for early-stage non-small cell lung cancer were enrolled.

INTERVENTIONS

Patients were randomly assigned to one of three groups: single-port, double-port, and triple-port VATS lobectomy. The same postoperative analgesia protocol was used in each group.

MEASUREMENTS AND MAIN RESULTS

The primary outcome was postoperative pain intensity at rest and when coughing within the first 72 hours after surgery. The secondary outcomes were cumulative opioid consumption and the composite rate of postoperative complications. A total of 112 patients were enrolled in the study, 91 of whom completed the study protocol. There were no significant differences between the study groups in terms of pain intensity either at rest (p = 0.319) or when coughing (p = 0.202). There was no difference in the incidence of postoperative complications.

CONCLUSIONS

This study revealed no differences in pain intensity in the early postoperative period between three different technical variants of VATS lobectomy when an analgesia protocol based on thoracic epidural anesthesia was used.

Effectiveness of Artificial Intelligence Models in Predicting Lung Cancer Recurrence: A Gene Biomarker-Driven Review

BACKGROUND/OBJECTIVES

Lung cancer recurrence, particularly in NSCLC, remains a major challenge, with 30-70% of patients relapsing post-treatment. Traditional predictors like TNM staging and histopathology fail to account for tumor heterogeneity and immune dynamics. This review evaluates AI models integrating gene biomarkers (TP53, KRAS, FOXP3, PD-L1, and CD8) to enhance the recurrence prediction and improve the personalized risk stratification.

METHODS

Following the PRISMA guidelines, we systematically reviewed AI-driven recurrence prediction models for lung cancer, focusing on genomic biomarkers. Studies were selected based on predefined criteria, emphasizing AI/ML approaches integrating gene expression, radiomics, and clinical data. Data extraction covered the study design, AI algorithms (e.g., neural networks, SVM, and gradient boosting), performance metrics (AUC and sensitivity), and clinical applicability. Two reviewers independently screened and assessed studies to ensure accuracy and minimize bias.

RESULTS

A literature analysis of 18 studies (2019-2024) from 14 countries, covering 4861 NSCLC and small cell lung cancer patients, showed that AI models outperformed conventional methods. AI achieved AUCs of 0.73-0.92 compared to 0.61 for TNM staging. Multi-modal approaches integrating gene expression (PDIA3 and MYH11), radiomics, and clinical data improved accuracy, with SVM-based models reaching a 92% AUC. Key predictors included immune-related signatures (e.g., tumor-infiltrating NK cells and PD-L1 expression) and pathway alterations (NF-κB and JAK-STAT). However, small cohorts (41-1348 patients), data heterogeneity, and limited external validation remained challenges.

CONCLUSIONS

AI-driven models hold potential for recurrence prediction and guiding adjuvant therapies in high-risk NSCLC patients. Expanding multi-institutional datasets, standardizing validation, and improving clinical integration are crucial for real-world adoption. Optimizing biomarker panels and using AI trustworthily and ethically could enhance precision oncology, enabling early, tailored interventions to reduce mortality.

Bilateral Spontaneous Hemothorax: A Rare Case of Primary Pleural Angiosarcoma and Literature Review

Introduction and case report: Angiosarcomas, rare soft tissue malignancies originating from endothelial cells, represent only 1-2% of all soft tissue sarcomas. Primary pleural angiosarcoma (PPA) is exceptionally rare, with only 43 reported cases since 1943. There are many diagnostic and therapeutic challenges due to the rarity of these tumors. We present the case of a 72-year-old man presenting with back pain, dyspnea and anemia. Conventional imaging revealed bilateral pleural effusion and a thickened parietal pleura, while contrast chest MR was able to identify pleural sites of contrast enhancement. Left chest tube placement evidenced a hemothorax, and the cytology result was negative. A thoracoscopic approach was chosen, allowing us to perform different parietal pleural biopsies. Radiological and pathological features led to the diagnosis of epithelioid PPA. Despite pleural drainage and blood transfusions, the patient died only 4 days after diagnosis. Objectives: To present a literature review, evaluating the disease epidemiology and the clinical, diagnostic and therapeutic features of PPA. Methods: We reviewed cases of PPA in the literature (1954-2024) by searching the PubMed database for the terms "pleural angiosarcoma" and "pleura + angiosarcoma". Results: We found a total of 47 cases that were described between 1987 and 2024 with sufficient data to be included in our review. PPA was found to be a challenging diagnosis, found mostly in older Caucasian males. The cytology is mostly indeterminant, and an endoscopic approach is usually needed. Radical surgery is the most common treatment option, and chemotherapy and radiation therapy are also often used. However, the prognosis is poor. Conclusions: PPA is very rare, and complex cases such as this one showcase the importance of innovative approaches like MRI and emphasize the significance of multidisciplinary collaboration for optimal patient management. Bilateral spontaneous hemothorax, as seen in this case, is uncommon and poses additional challenges in disease management. Further research to advance the diagnostic capabilities and treatment efficacy is needed.

The effect of continuous infusion chemotherapy through femoral artery catheterization on GP73, AFP-L3, and safety efficacy in liver cancer patients

This study examines the impact of continuous infusion chemotherapy via femoral artery catheterization on Golgi protein 73 (GP73) and alpha fetoprotein heterogeneity (AFP-L3) in liver cancer patients. A retrospective analysis was conducted on 108 liver cancer patients treated from January 2020 to December 2022, divided into two groups: transarterial chemoembolization (TACE) and continuous infusion regional arterial chemotherapy via femoral artery catheterization (CIFAC), with 54 patients in each group. Serum tumor markers, liver function, adverse reactions, quality of life, and 1-year survival rate were analyzed and compared between the two groups of patients. Prior to treatment, no significant differences were observed in tumor markers, liver function, and quality of life between groups (P > 0.05). After 60 and 90 days, the CIFAC group exhibited significantly lower levels of GP73, AFP, and AFP-L3 compared to TACE (P < 0.05). Additionally, CIFAC patients had lower levels of alanine aminotransferase (ALT), aspartate transaminase (AST), indocyanine green (ICG15) (P < 0.05), reduced adverse reactions (nausea, vomiting, etc.), and higher Karnofsky scores (P < 0.05). The one-year survival rate of the CIFAC group was significantly higher than that of the TACE group (P < 0.05). Continuous infusion chemotherapy through femoral artery catheterization can help reduce serum tumor marker levels, improve liver function, and reduce adverse reactions in liver cancer patients.

Patients with coronavirus disease 2019 and spontaneous pneumothorax: a propensity-matched, multicentre case-control study

OBJECTIVES

Pneumothorax and pneumomediastinum have been frequently reported in coronavirus disease-19 (COVID-19), thus complicating the patient's overall health-care management and survival rate. The goal of this study was to evaluate the outcomes of patients with COVID-19 who developed spontaneous pneumothorax (SPN) or spontaneous pneumomediastinum (SPM).

METHODS

In this Italian multicentre retrospective cohort study, medical records of non-vaccinated COVID-19 patients, from March 2020 to May 2021, were analysed. To reduce the risk of bias due to unbalanced groups, a propensity score matching approach was applied using logistic regression to estimate propensity scores. Separate multivariable generalized linear models were then used to assess the risk of in-hospital death and other outcomes.

RESULTS

A total of 474 patients were assessed, 72 of whom developed SPN or SPM. In separate multivariable generalized linear model regression analyses of the unmatched cohort, SPN [odds ratio (OR) 2.44, 95% confidence interval (CI) 1.7-5.55; P = 0.031] was associated with an increase in the in-hospital death rate, results confirmed even after matching the 2 cohorts. SPM (OR 1.21, 95% CI 1.13-1.30, P < 0.001) and SPN (OR 1.34, 95% CI 1.26-1.43, P < 0.001) were associated with an increase in the length of hospital stay. The risk of in-hospital death also increased with age, comorbidities (classified by the Charlson comorbidity index) and smoking habits.

CONCLUSIONS

SPN in hospitalized COVID-19 patients may be associated with an increased risk of in-hospital death and prolonged hospitalization.

Pulmonary Metastasectomy in Renal Cell Carcinoma

Recent advances in immunotherapy and targeted therapy have resulted in survival rates as high as 90% at 1 year in metastatic renal cell carcinoma patients; however, sustained response and ultimate cure is rarely achieved with systemic therapy alone (complete response rates remain <5%), and progression of disease at distant sites is common. Pulmonary metastasectomy is recommended as a component of multimodal management in patients with favorable-risk or intermediate-risk classification and can be associated with excellent survival if complete resection is obtained.

Practice Advisory for Postoperative Pain Management of Thoracic Surgical Patients: A Report from the Society of Cardiovascular Anesthesiologists

Pain after thoracic surgery is often significant, which can disrupt normal respiratory mechanics and impair the clearance of secretions, thus increasing the risk of postoperative respiratory complications. Poorly controlled acute pain can lead to persistent post-thoracotomy pain and continued opioid use that can affect quality of life. With the increased awareness of opioid-associated adverse effects and recent emphasis on enhanced recovery, opioid-sparing multimodal analgesia has been used widely for acute pain management after thoracic surgery. This practice advisory reviews, evaluates, and summarizes the recent literature related to pharmacological therapies and non-pharmacological therapies used for postoperative pain management after thoracic surgery and offers guidance to providers in making appropriate pain management decisions for their patients.

The value of the CRP-albumin-lymphocyte index (CALLY index) as a prognostic biomarker in acute ischemic stroke

This study aims to evaluate the predictive capability of CRP-albumin-lymphocyte (CALLY) index in relation to hemorrhagic transformation (HT) and functional outcome in acute ischemic stroke (AIS). A total of 439 AIS patients were included in this analysis. Multivariate logistic regression was conducted to examine the relationship between the CALLY index, HT, and functional outcomes. To address its non-linear association, a restricted cubic spline (RCS) model identified an optimal threshold for the CALLY index. Subgroup analyses further explored the association between the CALLY index and HT. The receiver operating characteristic (ROC) curve, the net reclassification index (NRI), and the integrated discrimination index (IDI) were used to assess and compare the predictive performance of the CALLY index with established models for HT. Furthermore, mediation analysis was performed to elucidate the causal pathways linking the CALLY index, HT, and functional outcomes. Among the participants, 9.79% (43/439) experienced HT, and 49.32% (182/369) encountered adverse outcomes. A higher CALLY index was associated with a lower risk of developing HT (OR 0.449, 95% CI 0.283-0.713) and poor outcome (OR 0.691, 95% CI 0.558-0.855). RCS curves demonstrated an increased risk of HT when the CALLY index fell below 1.188. Compared to existing HT prediction models, the CALLY index demonstrates superior predictive performance, with an AUC of 0.746. Furthermore, the CALLY index exhibits improved reclassification ability, as indicated by enhanced NRI and IDI values. The CALLY index independently predicts HT and adverse outcomes in AIS, demonstrating superior accuracy to existing risk scores and offering a practical biomarker for clinical prognosis.

Triiodothyronine protects infarcted myocardium by reducing apoptosis and preserving mitochondria

Myocardial infarction (MI) is a leading cause of heart failure, with thyroid hormone (TH) signaling playing a key role in heart function and postinfarct recovery. Despite evidence of TH administration's safety in cardiac patients, inconsistent therapeutic outcomes and limited understanding of its mechanisms hinder clinical translation. This study aims to investigate the long-term effect of acute triiodothyronine (T3) administration following MI and to elucidate the mechanisms of its cardioprotective actions. To this end, two doses (40 μg/kg) of T3 were administered immediately after injury and 24 h later in a cryoinjury mouse model of left ventricle (LV) infarction. Remarkably T3 administration significantly reduced scar expansion. Echocardiographic analysis conducted 28 days post-injury revealed that T3 administration improved LV remodeling and prevented LV hypertrophy. At molecular level, T3 administration strongly reduced apoptosis in the peri-infarcted area, without inducing cardiac cell proliferation. Furthermore, T3 prevented the accumulation of long-chain acylcarnitines and the subsequent mitochondrial damage. These findings demonstrate that acute T3 treatment following MI improves long-term LV function and reduces LV remodeling by limiting apoptosis in the peri-infarct region and by preserving mitochondrial function and structural integrity.

Implementing value-based healthcare: a scoping review of key elements, outcomes, and challenges for sustainable healthcare systems

Introduction

Value-Based Health Care (VBHC) is an increasingly important healthcare paradigm that focuses on maximizing health outcomes relative to the cost of care delivered. Various healthcare organizations have adopted VBHC principles, but significant barriers remain in adapting care models, engaging stakeholders, and measuring outcomes. Moreover, the lack of standardized methods for measuring outcomes and financial sustainability further complicates the transition to VBHC. Understanding the factors that facilitate or hinder VBHC adoption is crucial to informing policy and practice for broader implementation. The objective is to map the literature addressing VBHC concerning population, study characteristics, funding models, outcome measures, and barriers and facilitators.

Methods

Following the JBI methodology and the PRISMA-ScR reporting guidance, a scoping review was undertaken to include primary and secondary research on VBHC across various healthcare settings. Searches were undertaken in nine relevant databases. Peer-reviewed quantitative and qualitative studies published in English were included and analyzed. A total of 145 studies were included after screening 2,725 studies.

Results

The findings show that the United States leads VBHC research, contributing 65% of the studies, followed by European countries. Cohort and cross-sectional studies were predominant, focusing on various populations, including hospitals, surgical patients, and cancer patients. Key findings highlight that Value-Based Purchasing and Time-Driven Activity-Based Costing models were the most frequently reported funding models. Traditional in-hospital care remains the dominant delivery model, with increasing interest in telemedicine. Outcome measure were diverse, ranging from patient-reported outcomes to cost savings for both patients and providers. Barriers to VBHC implementation include insufficient funding, fee-for-service model persistence, and resistance from healthcare professionals. Facilitators included strong leadership, multidisciplinary collaboration, and the use of digital tools.

Conclusion

The review highlights the need for consistent outcome measurements, financial incentives, and improved data transparency to ensure the successful and scalable implementation of VBHC across healthcare systems. While VBHC shows promise in improving healthcare efficiency and quality, challenges remain in aligning financial and operational structures to fully support this paradigm shift.

Analysis of the safety and feasibility of sleeve resection under UniVATS after neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type non-small cell lung cancer

OBJECTIVE

To investigate the safety and feasibility of sleeve resection under Uni-VATS following neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type non-small cell lung cancer(NSCLC).

METHODS

We analyzed 10 cIIB-IIIB NSCLC patients who underwent sleeve lung resection under single-port thoracoscopy from December 2022 to August 2023 after receiving platinum-based chemotherapy combined with albumin paclitaxel and programmed cell death protein-1 (PD-1) inhibitor drugs. Perioperative clinical data, side effects during neoadjuvant therapy, operation time, intraoperative blood loss, conversion rate to open thoracotomy, postoperative duration of chest tube placement, postoperative drainage volume, postoperative complications, and tumor outcomes were recorded.

RESULTS

This study included 10 patients. The preoperative clinical staging distribution was as follows: Stage IIB, 1 case; Stage IIIA, 5 cases; and Stage IIIB, 4 cases. Imaging evaluation after neoadjuvant therapy revealed that none of the patients achieved complete remission, whereas partial remission and stable disease were observed in 7 cases and 3 cases, respectively. All patients successfully underwent surgery, of which 2 patients required conversion to open thoracotomy (conversion rate, 20%) and 8 patients underwent single-port thoracoscopic minimally invasive surgery. Notably, 2 patients underwent sleeve resection of the right upper lobe, 2 patients underwent sleeve resection of the right middle and lower lobes, 2 patients underwent sleeve resection of the left upper lobe, and 4 patients underwent sleeve resection of the left lower lobe. The average operation time was 236 ± 87.7 min, the average intraoperative blood loss was 168 ± 62.5 mL, the average duration of chest tube placement was 5 days, the average total drainage volume was 1012 ± 464 mL, and the average hospitalization duration was 7 days. One patient developed encapsulated pleural effusion after surgery and underwent computed tomography (CT)-guided puncture drainage. At the 3-month and 6-month follow-up visits, no patient reported any particular discomfort, and chest radiography and CT revealed no abnormalities or signs of tumor recurrence.

CONCLUSION

Sleeve resection after neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type NSCLC under single-port thoracoscopy is safe and feasible and provides short-term postoperative benefits for patients.

Cardiac herniation identified without any symptoms following extrapleural pneumonectomy: a case report

BACKGROUND

Cardiac herniation, especially right-sided herniation, is a fatal complication which causes sudden hypotension due to obstruction of the vena cava. Here, we describe a case of cardiac herniation identified without any symptoms after right extrapleural pneumonectomy performed for diffuse pleural mesothelioma.

CASE PRESENTATION

A 72-year-old man with diffuse pleural mesothelioma underwent a right extrapleural pneumonectomy after chemotherapy. The tumor had widely invaded the pericardium, necessitating pericardial resection. The pericardial defect was approximately 10 × 6 cm and was reconstructed with a 0.1-mm polytetrafluoroethylene sheet. Routine chest radiographs taken just after the operation were normal. A chest radiograph on postoperative day one revealed cardiac herniation but he remained hemodynamically stable. An urgent re-thoracotomy was performed for pericardial reconstruction. Severe hypotension occurred immediately before the operation, but was improved upon placing the patient in the left lateral decubitus position. Postoperatively, he developed postoperative complications including chylothorax and empyema, and was discharged 118 days after surgery.

CONCLUSIONS

Cardiac herniation can occur without any symptoms following right pneumonectomy with pericardiectomy. Urgent reoperation is warranted due to the high risk of impending shock, even in hemodynamically stable patients.

PMILACG Model: A Predictive Model for Identifying Invasiveness of Lung Adenocarcinoma Based on High-Resolution CT-Determined Ground Glass Nodule Features

The morphology of ground-glass nodule (GGN) under high-resolution computed tomography (HRCT) has been suggested to indicate different histological subtypes of lung adenocarcinoma (LUAD); however, existing studies only include the limited number of GGN characteristics, which lacks a systematic model for predicting invasive LUAD. This study aimed to construct a predictive model based on GGN features under HRCT for LUAD. A total of 1,189 surgical LUAD patients were enrolled, and their GGN-related features were assessed by 2 individual radiologists. The pathological diagnosis of the invasive LUAD was established by pathologic examination following surgery (including 1,073 invasive and 526 non-invasive LUAD). After adjustment by multivariate logistic regression, GGN diameter (OR = 1.382, 95% CI: 1.300-1.469), mean CT attenuation (OR = 1.007, 95% CI: 1.006-1.009), heterogeneous uniformity of density (OR = 2.151, 95% CI: 1.587-2.915), not defined nodule-lung interface (OR = 1.915, 95% CI: 1.384-2.651), GGN with spiculation (OR = 2.097, 95% CI: 1.519-2.896), type I (OR = 1.678, 95% CI: 1.216-2.371), and type II (OR = 3.577, 95% CI: 1.153-11.097) vessel changes were independent risk factors for invasive LUAD. In addition, a predictive model integrating these six independent GGN features was established (named as invasion of lung adenocarcinoma by GGN features (ILAG)), and receiver-operating characteristic curve illustrated that the ILAG model presented good predictive value for invasive LUAD (AUC: 0.905, 95% CI: 0.890-0.919). In conclusion, The ILAG predictive model, which integrates imaging features of GGN via HRCT, including diameter, mean CT attenuation, heterogeneous uniformity of density, not defined nodule-lung interface, GGN with spiculation, type I, and type II vessel changes, shows great potential for early estimation of LUAD invasiveness.

Techniques for Local Anesthesia in Transperineal and Transrectal Prostate Biopsy: An Image-based Step-by-Step Guide With Dedication to Anatomy

Prostate biopsy is the cornerstone in the diagnostic pathway of prostate cancer. It's normally performed using local or general anesthesia. The prostate's high sensitivity to mechanical stimuli and irritation is due to its complex nerve supply, mainly from the pelvic plexus. It originates from the sacral plexus, with both parasympathetic and sympathetic nerves having a role in prostatic innervation. As the procedure involves needle penetration into sensitive tissues, it is essential to ensure effective peribioptic pain management, as patients may experience considerable discomfort during the process. Local anesthesia has proven to be one of the safest, most reliable, and most effective approaches to managing this pain, as it provides targeted relief with minimal side effects. This report describes in detail the current anesthesia techniques applied during both transrectal and transperineal prostate biopsy procedures, delving into their mechanisms of action, as well as reviewing recent research findings on their efficacy. We describe an image-based step-by-step technique with dedication to pelvic anatomy for a comprehensive understanding of how local anesthesia can be administered and therefore enhance the overall experience of patients undergoing prostate biopsy.

Impact of microwave ablation on survival rates and recurrence in hepatic malignant tumors

PURPOSE

This study aimed to evaluate the efficacy of percutaneous microwave ablation (MWA) for treating hepatic malignant tumors and to identify factors influencing tumor recurrence post-treatment.

METHODS

A total of 249 patients with hepatic malignant tumors treated at the Shandong Cancer Hospital and Institute were included, and 101 patients were analyzed. Disease-free and overall survival rates were assessed at 1, 2, and 3 years post-MWA. Correlations between tumor recurrence and factors such as Child-Pugh B classification and lesion count were examined, and a meta-analysis was conducted to identify independent risk factors for recurrence.

RESULTS

The study found disease-free survival rates of 80.2%, 72.3%, and 70.3% at 1, 2, and 3 years post-MWA, with overall survival rates at 99%, 97%, and 96%. Significant correlations were observed between tumor recurrence, Child-Pugh B classification, and the number of lesions. Meta-analysis confirmed lesion count and Child-Pugh B classification as independent risk factors for recurrence following MWA treatment.

CONCLUSION

The study underscores the importance of considering Child-Pugh B classification and lesion count in predicting tumor recurrence after MWA for hepatic malignant tumors. These findings offer valuable insights for clinicians in decision-making and post-treatment monitoring.

Comparison of Early Functional Recovery Following Triportal Robot-Assisted and Uniportal Video-Assisted Segmentectomy in Patients With Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matched Analysis

BACKGROUND

Robot-assisted thoracoscopic surgery (RATS) is more precise and flexible than video-assisted thoracoscopic surgery (VATS) for early-stage non-small cell lung cancer (NSCLC) treatment. This study compared the early postoperative functional recovery of patients who underwent triportal RATS with that of patients who underwent uniportal video-assisted thoracic surgery (UVATS) for segmentectomy.

METHODS

This observational, prospective study included 172 patients with clinical stage I or II peripheral NSCLC who underwent RATS or UVATS segmentectomy. Propensity score matching (PSM) was used to balance differences between groups. The functional recovery data were collected during the first 4 weeks after discharge via portable devices and questionnaires (EORTC QLQ-C30, Christensen Fatigue Scale, MD Anderson Symptom Inventory, and Leicester Cough Questionnaire).

RESULTS

After PSM, the baseline characteristics were consistent between the groups. RATS was associated with shorter operation time and lower total drainage volume compared to UVATS. However, RATS was associated with more cases of severe postoperative pain. Despite this, patients who underwent RATS recovered well, showed good short-term outcomes in fatigue and physical function, and experienced few postoperative adverse events. The differences in average daily step count and sleep duration were not significant. In terms of global health status (GHS), RATS was slightly but nonsignificantly advantageous.

CONCLUSIONS

In the enhanced recovery after surgery (ERAS) pathway, triportal RATS has potential benefits in terms of perioperative and early postoperative functional recovery after segmentectomy.

TRIAL REGISTRATION

Biomedical Research Ethics Committee of Shandong Province: 2022-580; Chinese Clinical Trial Registry: ChiCTR2300067977.

Evolving Paradigms in Lung Cancer: Latest Trends in Diagnosis, Management, and Radiopharmaceuticals

Lung cancer is one of the most common and deadliest forms of cancer worldwide. Over the past two decades, significant changes have occurred in the classification of lung cancer, involving multidisciplinary input and emphasizing the growing contribution of immunohistochemistry and molecular techniques to morphology in the classification scheme. This comprehensive review will cover the background and epidemiology of lung cancer as well as advancements in its staging and management, including discussions of new surgical techniques, targeted therapies, and immunotherapy. The review will detail the role of 18F-FDG-PET-CT in lung cancer, highlighting its importance in staging, treatment response assessment, and recurrence detection. While immunotherapy has transformed lung cancer management and improved patient outcomes, it presents major challenges and opportunities for optimal assessment of treatment response in lung cancer patients using 18F-FDG-PET-CT. This review will also explore future directions, including a discussion of promising new targeted diagnostic radiopharmaceuticals for PET/CT imaging. Additionally, there will be a brief discussion of evolving and exciting treatment options for lung cancer using targeted therapeutic radiopharmaceuticals. Several case-based illustrations are included to exemplify the role of 18F-FDG-PET-CT in various clinical scenarios.

Predictive value of the neutrophil-to-lymphocyte ratio for epidural labor analgesia-associated intrapartum fever: a retrospective single-center study

BACKGROUND

Studies have indicated that epidural analgesia increases the risk of maternal fever during labor, possibly due to non-infectious inflammation. The neutrophil-to-lymphocyte ratio (NLR) is a crucial indicator of inflammation, with a higher NLR potentially signaling worse patient adverse outcomes. The present study explores whether NLR has clinical predictive value for epidural analgesia-related maternal fever (ERMF).

METHODS

A retrospective analysis was performed for 1602 women who voluntarily requested analgesia for epidural labor from January 2023 to June 2024. Univariate and multivariate logistic regression analyses were applied to identify the factors influencing intrapartum fever, and the association between NLR and ERMF was explored. The receiver operating characteristic (ROC) curve was used to assess the area under the curve (AUC) of NLR for intrapartum fever, and the nearest ascending index was utilized to determine the cut-off value.

RESULTS

A total of 1602 parturients were included, of which 160 (10%) had intrapartum fever. Body mass index (BMI) (OR = 1.132, 95% CI: 1.027-1.246, P = 0.012), the duration of the first stage of labor (OR = 1.002, 95% CI: 1.001-1.003, P < 0.001), percentage of lymphocytes (OR = 1.205, 95%CI: 1.073-1.354, P = 0.012) and NLR (OR = 1.964, 95% CI: 1.462-2.639, P < 0.001) were independent risk factors for intrapartum fever. High NLR levels were associated with a higher incidence of ERMF at subgroups of ages < 35 years (OR = 1.343, 95%CI: 1.215-1.486, P < 0.001), ages ≥ 35 years (OR = 1.274, 95%CI: 1.105-1.468, P = 0.01), BMI < 24 kg/m2 (OR = 1.326, 95% CI: 1.176-1.495, P < 0.001), BMI ≥ 24 kg/m2 (OR = 1.515, 95%CI: 1.147-2.000, P = 0.003), first stage of labor < 600 min (OR = 1.466, 95%CI: 1.241-1.733, P < 0.001), and first stage of labor ≥ 600 min (OR = 1.257, 95%CI: 1.109-1.424, P < 0.001). Maternal NLR levels greater than 6.305 (AUC = 0.702, 95%CI: 0.634-0.768, P < 0.001) were good predicators of intrapartum fever.

CONCLUSIONS

High NLR is associated with EMRF, and NLR is a viable predictor of early identification of the occurrence of EMRF, which may be beneficial for pregnancy outcomes.

Transanal minimally invasive (TAMIS) mucosal resection with muscular plication for patients with obstructed defecation syndrome-A prospective pilot study

BACKGROUND

Rectocele and intussusception are frequently observed during defecography as potential contributors to obstructed defecation syndrome (ODS). We aimed to describe our initial experience with transanal minimally invasive surgery (TAMIS) mucosectomy with muscular plication, as a novel surgical approach to treat patients with ODS.

METHODS

Conducted between August 2021 and October 2023 at the Medical University of Vienna, 11 patients (8 female) were prospectively enrolled and underwent TAMIS mucosectomy with circular mucosectomy and longitudinal muscular plication (internal Delorme's procedure). Functional outcome and quality of life were assessed by using standardized questionnaires pre- and postoperatively. The median follow up time was 16 months.

RESULTS

In defecography rectal intussusception could be observed in all patients and rectocele was found in nine patients (81.8%). The median age at the time of surgical procedure was 56 years (range 28-76 years). Neither intraoperative nor postoperative complications occurred. The median ODS score decreased from 16 to 11 points (p = 0.171), and four out of five patients (80%) with preexistent fecal incontinence reported improvement of their symptoms postoperatively (80%), though one patient had new onset of fecal incontinence symptoms. No significant changes could be demonstrated in terms of quality life by using the Short-Form Health Survey 12 (SF-12) survey.

CONCLUSIONS

Our initial results showed that TAMIS mucosectomy is a safe technique, offering a viable alternative transanal approach for treating symptomatic ODS. Future studies with a larger sample size and a longer follow-up period should enhance the robustness of our preliminary findings.

Assessment of Tumor Burden Score as a Feasible and Reliable Tool for Prognosis Prediction for Hepatocellular Carcinoma Undergoing Hepatectomy: A Multicenter, Retrospective Study

Background

Maximum diameter and number are the main parameters of tumor burden in hepatocellular carcinoma (HCC). Tumor burden score (TBS) shows its distinguished ability to stratify patients with HCC undergoing transcatheter arterial chemoembolization (TACE). However, the prognostic accuracy of TBS in HCC undergoing liver resection and its association with the BCLC stage has not been well evaluated.

Methods

A total of 3044 treatment-naïve HCC patients from six independent medical centers undergoing liver resection were retrospectively analyzed. Survival analyses were conducted by plotting Kaplan-Meier curves and the Log rank test. We further investigated whether the tumor burden score was a feasible subclassification criterion across the BCLC stage. Then, we also used TBS to identify HCC patients beyond BCLC criteria who could benefit most from surgical resection. Finally, univariate and multivariate cox analysis was used to determine independent prognostic predictors.

Results

About 44.2% (n=1343) of patients had low TBS, 38.8% (n=1182) had intermediate TBS and 17% (n=519) had high TBS. Overall survival (OS) and recurrence-free survival deteriorated incrementally with increasing TBS (P<0.0001). Subgroup analysis indicated that there was a significant survival difference among the three TBS groups across the BCLC stage (P<0.0001). Low TBS group of patients beyond BCLC criteria reported acceptable outcomes compared to intermediate TBS group patients within BCLC criteria, even better than high TBS group (5-year OS: 64.3%, 69.8%, and 56.3%). Finally, low TBS was identified as an independent protective prognostic factor.

Conclusion

Tumor burden score is a feasible and reliable prognostic tool for prognosis prediction and clinical decisions.

NSCLC: Current Evidence on Its Pathogenesis, Integrated Treatment, and Future Perspectives

Non-small cell lung carcinoma (NSCLC) comprises the majority of lung cancer cases, characterized by a complex interplay of genetic alterations, environmental factors, and molecular pathways contributing to its pathogenesis. This article highlights the multifaceted pathogenesis of NSCLC and discusses screening and integrated strategies for current treatment options. NSCLC is an evolving field with various aspects including the underlying molecular alterations, oncogenic driver mutations, and immune microenvironment interactions that influence tumor progression and response to therapy. Surgical treatment remains the most applicable curative option, especially in the early stages of the disease, adjuvant chemotherapy may add benefits to previously resected patients. Combined Radio-chemotherapy can also be used for palliative purposes. There are various future perspectives and advancing horizons in NSCLC management, encompassing novel therapeutic modalities and their applications, such as CAR-T cell therapy, antibody-drug conjugates, and gene therapies. On the other hand, it's crucial to highlight the efficacy of innovative modalities of Immunotherapy and immune checkpoint inhibitors that are nowadays widely used in treatment of NSCLC. Moreover, the latest advancements in molecular profiling techniques and the development of targeted therapies designed for specific molecular alterations in NSCLC play a significant role in its treatment. In conclusion, personalized approaches are a cornerstone of successful treatment, and they are based on a patient's unique molecular profile, tumor characteristics, and host factors. Entitling the concept of individualized treatment strategies requires proper patient selection, taking into consideration mechanisms of resistance, and investigating potential combination therapies, to achieve the optimal impact on long-term survival.

Comparing survival outcomes of localized tumor destruction, sublobar resection, and pulmonary lobectomy in stage IA non-small cell lung cancer: a study from the SEER database

PURPOSE

A large-scale comparative analysis was performed with the aim of comparing local tumor destruction (LTD), sublobar resection (SR), and pulmonary lobectomy (PL) for cancer-specific survival (CSS) and overall survival (OS) in stage IA non-small cell lung cancer (NSCLC).

METHODS

In the Surveillance, Epidemiology, and End Results (SEER) database (2000-2021), we included patients with pathologically confirmed stage IA non-small cell lung cancer who were treated with LTD, SR, or PL. Comparison between groups was performed separately after 1:1 proportional propensity score matching (PSM) with a caliper value of 0.1. Kaplan-Meier analysis was performed to compare survival outcomes between groups.

RESULTS

In the total cohort of 4437 LTD patients, 2425 SR patients, and 6386 PL patients, 84.18% of LTD-treated patients were older than 65 years, whereas 68.95% of SR-treated patients and 62.82% of PL-treated patients were older than 65 years. The CSS (HR = 0.756, 95% CI 0.398 ~ 1.436, P = 0.393) and OS (HR = 0.46, 95% CI 0.553 ~ 1.295, P = 0.442) of LTD were consistent with SR. Whereas LTD demonstrated lower CSS (HR = 0.603, 95% CI 0.378 ~ 0.940, P = 0.024) and OS (HR = 0.590, 95% CI 0.432 ~ 0.805, P < 0.001) than PL, but were consistent when the tumor size was ≤ 1 cm. The CSS (HR = 1.215, 95% CI 0.872 ~ 1.693, P = 0.249) of SR was consistent with PL, but OS (HR = 1.347, 95% CI 1.079 ~ 1.681, P = 0.008) was higher than PL, but were consistent when the tumor size was 1.1-3 cm.

CONCLUSIONS

In patients with stage IA non-small cell lung cancer, the CSS and OS of LTD were no worse than those of SR. Compared with PL, the CSS and OS of LTD were lower, but when the tumor size was ≤ 1 cm, the CSS and OS of LTD were no worse than those of PL.

Artificial intelligence for diagnosis and predictive biomarkers in Non-Small cell lung cancer Patients: New promises but also new hurdles for the pathologist

The rapid development of artificial intelligence (AI) based tools in pathology laboratories has brought forward unlimited opportunities for pathologists. Promising AI applications used for accomplishing diagnostic, prognostic and predictive tasks are being developed at a high pace. This is notably true in thoracic oncology, given the significant and rapid therapeutic progress made recently for lung cancer patients. Advances have been based on drugs targeting molecular alterations, immunotherapies, and, more recently antibody-drug conjugates which are soon to be introduced. For over a decade, many proof-of-concept studies have explored the use of AI algorithms in thoracic oncology to improve lung cancer patient care. However, despite the enthusiasm in this domain, the set-up and use of AI algorithms in daily practice of thoracic pathologists has not been operative until now, due to several constraints. The purpose of this review is to describe the potential but also the current barriers of AI applications in routine thoracic pathology for non-small cell lung cancer patient care and to suggest practical solutions for rapid future implementation.

A Holistic Approach to Implementing Artificial Intelligence in Lung Cancer

The application of artificial intelligence (AI) in lung cancer, particularly in surgical approaches, has significantly transformed the healthcare landscape. AI has demonstrated remarkable advancements in early lung cancer detection, precise medical image analysis, and personalized treatment planning, all of which are crucial for surgical interventions. By analyzing extensive datasets, AI algorithms can identify patterns and anomalies in lung scans, facilitating timely diagnoses and enhancing surgical outcomes. Furthermore, AI can detect subtle indicators that may be overlooked by human practitioners, leading to quicker intervention and more effective treatment strategies. The technology can also predict patient responses to surgical treatments, enabling tailored care plans that improve recovery rates. In addition to surgical applications, AI streamlines administrative tasks such as record management and appointment scheduling, allowing healthcare providers to concentrate on delivering high-quality care. The integration of AI with genomics and precision medicine holds the potential to further refine surgical approaches in lung cancer treatment by developing targeted strategies that enhance effectiveness and minimize side effects. Despite challenges related to data privacy and regulatory concerns, the ongoing advancements in AI, coupled with collaboration between healthcare professionals and AI experts, suggest a promising future for lung cancer care. This article explores how AI addresses the challenges of lung cancer treatment, focusing on current advancements, obstacles, and the future potential of surgical applications.

Intrathymic Hemagioma: A Challenging Case Report with Special Focus on the Importance of Its Multidisciplinary Approach

Mediastinal hemangiomas, particularly those of thymic origin, are rare phenomena. Due to its rarity, this pathologic condition is not characterized as related to the angiogenic profile of hemangioma endothelial cells. The diagnosis is challenging clinically and radiologically, and biopsies may not yield a definitive answer. Surgical resection offers the material for histologic diagnosis, relieves symptoms, and has a favorable long-term prognosis for such benign tumors. Sometimes, such benign tumors may have aggressive behavior and repeated recurrences but the causes responsible for this unpredictable evolution are not actually known. A case of intrathymic hemangioma diagnosed in a 16-year-old girl is presented here. We focused equally on a multidisciplinary approach to this challenging diagnosis but also on the characterization of the hemangioma endothelial cells profile not previously performed for such type of vascular anomalies. To define an antibodies panel for the evaluation of intrathymic hemangiomas may help in the full characterization of this rare vascular lesion, and subsequently focus on the new therapeutic targets which may be applied for cases with aggressive behavior.

Resection and Reconstruction for Lung and Airway Tumors Invading the Carina

Tumors located at the tracheal bifurcation constitute a heterogeneous group of neoplasms whose treatment poses significant challenges due to their anatomical location, the requirement for radical resection, the need to restore local anatomy, and the necessity of maintaining adequate oxygenation throughout the entire procedure. Advances in airway reconstruction surgical techniques, anesthesia, and complementary therapies have progressively expanded indications for radical treatment of these neoplasms, resulting in significant improvements in both short- and long-term outcomes in recent years.

Association between preoperative serum albumin levels and length of stay in elderly patients with hip fractures: A nonlinear relationship

Previous studies have provided relatively limited evidence in examining the impact of preoperative serum albumin levels on the length of hospital stay (LOS) in patients with hip fractures. This study aimed to elucidate the association between preoperative serum albumin levels and LOS in elderly patients with hip fractures. This retrospective cohort study included 1444 elderly patients undergoing surgical treatment for hip fractures at the Second People's Hospital of Shenzhen from January 2012 to December 2021. The main exposure variable was serum albumin level, and the outcome variable was LOS. A generalized additive model was used to identify the nonlinear relationship between serum albumin levels and LOS, and saturation effects were calculated using a two-piecewise linear regression model. Subgroup analysis was conducted using stratified logistic regression. The median LOS was 10 (8-15) days among all included patients. After adjusting for potential confounding factors (age, sex, comorbidities, hypertension, coronary heart disease, stroke, diabetes, duration of surgery, surgical method, intraoperative blood loss, red cell distribution width, estimated glomerular filtration rate, blood urea nitrogen, postoperative pneumonia, and transfer to ICU), a nonlinear relationship was found between serum albumin levels and LOS, with a turning point at 3.06. On the left side of the turning point, the effect size was not statistically significant (β = 1.84, 95% CI -1.00 to 4.68, P = .2042), while on the right side of the turning point, for every 1 g/dL increase in albumin, LOS decreased by 1.05 days (β = -1.05, 95% CI -1.90 to -0.20, P = .0162). A nonlinear relationship was observed between preoperative serum albumin levels and LOS in elderly patients with hip fractures. When albumin levels were >3.06 g/dL, they were negatively correlated with LOS. This has important implications for clinicians in the development of nutritional improvement strategies.

Primary pulmonary meningioma: a case report and literature review

INTRODUCTION

Primary pulmonary meningioma is a rare disease. There have been only a little over 50 cases of primary pulmonary meningioma (PPM) reported in previous literature. The pathogenesis of PPM is still unclear. We report a case of PPM cured by thoracoscopic right middle lobe wedge resection and systematically review previously reported cases in previous literature.

CASE REPORT

A 57-year-old male patient was found to have a nodule in the right middle lobe of about 1.8 cm in diameter on a chest-enhanced CT scan performed more than 7 years ago. A re-examination in 2023 found the subpleural nodule in the right middle lobe had grown larger than before. Considering surgical treatment, the patient underwent a thoracoscopic right middle lobe wedge resection after a thorough examination. The final pathological diagnosis was primary pulmonary meningioma. Regular follow-up CT scans showed no recurrence.

CONCLUSION

Primary pulmonary meningioma is a rare tumor that occurs in sites similar to lung cancer. Most cases are solitary, presenting as ground-glass nodules (GGO), and can occur in multiple lobes, involving the mediastinum and pleura with multiple nodules. Clinical and radiological diagnoses are often challenging, especially distinguishing from primary lung cancer. Surgery remains the optimal choice for the diagnosis and treatment of PPM. Most cases are benign with a good prognosis, and wedge resection is usually the preferred surgical approach. A small proportion of malignant cases may require lobectomy and adjuvant radiotherapy and chemotherapy due to tumor invasiveness.

Hematogenous metastasis to the colon from hepatocellular carcinoma: A case report

Introduction and importance: Most extrahepatic metastases of hepatocellular carcinoma (HCC) are to the lungs and bones, metastases to the colon are rare. In the present study, we experienced a case of metastasis to the ascending colon during repeated treatment for HCC. Case Presentation: A 63-year-old man was diagnosed with multiple HCCs (T4N0M0 stage IIIB) associated with portal vein invasion. Transcatheter arterial chemoembolization (TACE), transarterial infusion (TAI) and radiofrequency ablation (RFA) were performed, and partial response was achieved, but the main nodule at S6 lesion subsequently recurred to protrude outside of the liver. A partial hepatic S6 resection was performed for local control 1.5 years after the initial treatment. IVR was then performed again, but approximately 8 months after hepatic resection, an abdominal computed toography (CT) showed a mass lesion in the ascending colon. After a total colonoscopy and biopsy, a diagnosis of colorectal metastasis of HCC was made. A right hemicolectomy was performed for local control. The patient had a good post-operative course, but developed liver failure due to rapid growth of the tumor thrombus of the main portal vein and died of primary disease approximately 3.5 months after the colon resection. Clinical Discussion: The metastasis of HCC to the colon is an extremely rare occurrence. Conclusion: One possible reason for this rarity is that portal vein tumor thrombosis (PVTT) results in colorectal metastasis via trans-portal retrograde metastasis.

Intrauterine Contraceptive Device Translocation Leading to Right Anteromedial Ovarian Surface Impingement and Laparoscopic Retrieval: A Case Report and Literature Review

We report a rare case of a 29-year old woman presenting with abdominal pain, whose initial examination failed to identify intrauterine contraceptive device (IUCD) threads. IUCD migration was confirmed by CT scan and subsequent single-port laparoscopic retrieval alleviated her symptoms.

Imaging Features of the Mesenchymal Tumors of the Breast according to WHO Classification: A Pictorial Essay

Mesenchymal tumors of the breast, which originate from the mammary stroma, are rare accounting for only approximately 0.5%-1% of all breast tumors. Pathologically, they can exist on a spectrum, ranging from benign to malignant. Such tumors may present with nonspecific findings on breast imaging, including mammography, ultrasound, and MRI, which can lead to diagnostic challenges. In the 2019 revised 5th edition of the World Health Organization classification, breast mesenchymal tumors are categorized into six groups. The current pictorial essay aimed to explore the clinical, pathological, and imaging characteristics of representative lesions in each category according to this six-group classification, with the ultimate goal of enhancing awareness for early diagnosis.

Gestational gigantomastia with pseudoangiomatous stromal hyperplasia - a case report of rare entities

Gestational gigantomastia (GG) is a rare and severe clinical complication of pregnancy. It is characterized by dramatic and uncontrolled growth of the breasts, often leading to physical discomfort, psychological distress and significant surgical complications. Its pathophysiology is poorly understood; management options include conservative pharmacological and surgical interventions. Pseudoangiomatous stromal hyperplasia of the breast is a very rare, incidental, and histological diagnosis seen predominantly in women aged 30-40 years old, with the management generally involving surgical excision. The authors herein discuss an unusual case of bilateral GG complicated by pseudoangiomatous stromal hyperplasia in a premenopausal Caribbean woman, which is the second reported case in this population, with the first reported by one of our authors.

The effect of stored autologous blood transfusion on IL-1, IL-6, TNF-α and liver function recovery in patients undergoing liver cancer surgery

PURPOSE

This study aim is to evaluate the application of stored autologous blood transfusion in liver cancer surgery and explore its impact on postoperative changes in inflammatory factors and liver function recovery.

METHOD

The study used a control group (CG) design and included 150 patients who underwent liver cancer surgery. While the observation group (OG) got autologous blood that had been preserved, the CG had a standard allogeneic blood transfusion. Examine the variations between the CG and the OG using the following measures: prior to, during, and following surgery contrast MELD score, blood routine indicators, pro-inflammatory cytokine levels.

RESULT

MELD ratings, IL-1, IL-6, TNF-α levels, and preoperative blood routine indicators did not differ between the observation and CGs (p > 0.05). However, the blood routine indicators in the OG were lower than those in the CG on the first day following surgery (p < 0.05); seven days following surgery, there was no significant difference among the experiment participants (p > 0.05). In the meanwhile, the postoperative OG's levels of IL-1, IL-6, TNF-α, and HAF were lower than those of the CG (p < 0.05). The PVF of the OG was lower than the CG on the first day following surgery (p < 0.05), but on the seventh day following surgery, there was no discernible difference between the experiment's participants (p > 0.05).

CONCLUSION

The research outcomes showcase that stored autologous blood transfusion can reduce the levels of inflammatory factors after surgery and promote the recovery of liver function;Research suggests important references for further understanding the application and mechanism of stored autologous blood transfusion, and provide a basis for personalized treatment and recovery of liver cancer patients undergoing surgery.

Comparison between stapled hemorrhoidopexy and harmonic scalpel hemorrhoidectomy in the management of third- and fourth-degree piles: a randomized clinical trial

BACKGROUND

This study compared the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grade III and grade IV piles regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year.

PATIENTS AND METHODS

This was a single-blind, prospective, randomized, controlled, single-center trial conducted from January to December 2022 that included 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles.

RESULTS

The patients were divided into two groups of 35 patients each. Group I underwent SH and group II underwent HSH. The mean age of group I was 42.94 years and of group II, 42.20 years. The mean time of the procedure was 24.42 min ± 2.367 for SH and 31.48 min ± 2.21 for HSH. Postoperative pain in group I was lower than in group II during the first 2 weeks, but there was persistent mild pain in most patients in group I at the 2‑week follow-up. In group II there was significant improvement in pain after 2 weeks, with higher patient satisfaction. Wound infection was detected in 3 (5%) patients in group I and no patients in group II (p = 0.077). Postoperative bleeding occurred in 4 (11.4%) patients in group I in the form of spotting after defecation only during the first postoperative month; no bleeding was detected in group II (p = 0.039). There were 3 (15%) cases of flatus incontinence but after taking a detailed history these were found to be cases of urgency to defecate rather than incontinence. There were 7 (20%) cases of recurrence at the 1‑year follow-up in group I and 1 (2.9%) case in group II (p = 0.024).

CONCLUSION

Compared with SH, HSH was safer, easier, and associated with a lower incidence of recurrence after 1 year and with higher patient satisfaction.

Artificial Intelligence in Surgery: A Systematic Review of Use and Validation

Background: Artificial Intelligence (AI) holds promise for transforming healthcare, with AI models gaining increasing clinical use in surgery. However, new AI models are developed without established standards for their validation and use. Before AI can be widely adopted, it is crucial to ensure these models are both accurate and safe for patients. Without proper validation, there is a risk of integrating AI models into practice without sufficient evidence of their safety and accuracy, potentially leading to suboptimal patient outcomes. In this work, we review the current use and validation methods of AI models in clinical surgical settings and propose a novel classification system. Methods: A systematic review was conducted in PubMed and Cochrane using the keywords "validation", "artificial intelligence", and "surgery", following PRISMA guidelines. Results: The search yielded a total of 7627 articles, of which 102 were included for data extraction, encompassing 2,837,211 patients. A validation classification system named Surgical Validation Score (SURVAS) was developed. The primary applications of models were risk assessment and decision-making in the preoperative setting. Validation methods were ranked as high evidence in only 45% of studies, and only 14% of the studies provided publicly available datasets. Conclusions: AI has significant applications in surgery, but validation quality remains suboptimal, and public data availability is limited. Current AI applications are mainly focused on preoperative risk assessment and are suggested to improve decision-making. Classification systems such as SURVAS can help clinicians confirm the degree of validity of AI models before their application in practice.

Association of Serum Uric Acid to Lymphocyte Ratio with Clinical Outcomes in Cerebral Venous Sinus Thrombosis

Purpose

The serum uric acid to lymphocyte ratio (ULR) is a systemic marker of inflammation, and it has been studied as an indicator of prognosis in cardiovascular disease. This study investigates the relationship between ULR and clinical outcomes in patients with cerebral venous sinus thrombosis (CVST).

Patients and Methods

A total of 636 patients with CVST were included in the study and randomly divided into a training set (n = 445) and a testing set (n = 119) in a ratio of 7:3.Logistic regression analysis was employed to analyze the risk factors for poor outcomes. The nomogram was established using the training dataset, and its predictive performance was assessed with the testing dataset.

Results

ULR accurately predicted poor outcomes in CVST and was linked to a higher likelihood of poor outcomes (OR=1.015, 95% CI: 1.003-1.026, P = 0.013). Age, infection, intracranial hypertension, coma, and intracerebral hemorrhage were independent predictors of poor outcomes in CVST. Additionally, a new nomogram incorporating ULR was constructed to predict the risk of poor outcomes in CVST patients. The nomogram demonstrated good accuracy and reliability, as shown by the receiver operating characteristic curve, calibration curve, and decision curve analysis.

Conclusion

ULR independently forecasted poor outcomes in patients with CVST. The novel nomogram incorporating ULR could provide CVST patients with personalized risk assessment and treatment plans, leading to improved patient prognosis.

Serum Extracellular Matrix Molecules and Their Fragments as Biomarkers of Inflammation and Fibrosis in Inflammatory Bowel Diseases: A Systematic Review

BACKGROUND AND AIM

Contemporary techniques to assess disease activity or bowel damage in patients with inflammatory bowel disease [IBD], such as endoscopy and imaging, are either invasive or lack accuracy. Non-invasive biomarkers for this purpose remain an unmet medical need. Herein, we provide a comprehensive systematic review of studies evaluating blood extracellular matrix [ECM] biomarkers and their relevance in IBD.

METHODS

We conducted a systematic review of PubMed, EMBASE, Web of Science, and Scopus to identify citations pertaining to ECM biomarkers of IBD up to March 1, 2024. Studies were categorized based on marker subtype and clinical use.

RESULTS

Thirty-one ECM markers were identified, 28 of which demonstrated the ability to differentiate IBD disease activity. Collagen III emerged as the most extensively investigated [1212 IBD patients], with the degradation marker C3M and deposition marker PRO-C3 being associated with IBD and subtypes. Collagen V markers C5M and PRO-C5 emerged as the most accurate single markers for diagnosis of IBD, with an area under the curve of 0.91 and 0.93, respectively. Overall, studies were characterized by variable endpoints. None of the studies included histological grading of intestinal damage, repair, or fibrosis formation as the primary outcome in relation to the ECM blood markers.

CONCLUSIONS

Multiple ECM markers are linked with IBD and its phenotypes. However, more rigorous study designs and clearly defined endpoints are needed to ensure reproducibility and develop reliable and accurate biomarkers. ECM markers hold promise as they provide a 'window' into transmural tissue remodelling and fibrosis burden, warranting further investigation.

TTF-1 is a highly sensitive but not fully specific marker for pulmonary and thyroidal cancer: a tissue microarray study evaluating more than 17,000 tumors from 152 different tumor entities

Thyroid transcription factor 1 (TTF-1) immunohistochemistry (IHC) is routinely used for the distinction of primary pulmonary adenocarcinomas. However, TTF-1 can also occur in other malignancies. A tissue microarray containing 17,772 samples from 152 different tumor types was analyzed. Napsin-A, CK20, SATB2, FABP1, and Villin-1 IHC data were available from previous studies. TTF-1 staining was seen in 82 of 152 tumor categories including thyroidal cancers (19-100%), adenocarcinomas (94%), neuroendocrine tumors (67%) of the lung, small cell neuroendocrine carcinomas (71-80%), mesenchymal tumors (up to 42%), and thymomas (39%). Comparative analysis of TTF-1 and Napsin-A revealed a sensitivity/specificity of 94%/86% (TTF-1), 87%/98% (Napsin-A), and 85%/99.1% (TTF-1 and Napsin-A) for the distinction of pulmonary adenocarcinomas. Combined analysis of TTF-1 and enteric markers revealed a positivity for TTF-1 and at least one enteric marker in 22% of pulmonary adenocarcinomas but also a TTF-1 positivity in 6% of colorectal, 2% of pancreatic, and 3% of gastric adenocarcinomas. TTF-1 is a marker of high sensitivity but insufficient specificity for pulmonary adenocarcinomas. A small fraction of TTF-1-positive gastrointestinal adenocarcinomas represents a pitfall mimicking enteric-type pulmonary adenocarcinoma. Combined analysis of TTF-1 and Napsin-A improves the specificity of pulmonary adenocarcinoma diagnosis.

New perspectives on tracheal resection for COVID-19-related stenosis: A propensity score matching analysis

OBJECTIVE

The large number of patients with COVID-19 subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase in tracheal stenosis in the next years. The aim of this study was to evaluate and compare postoperative outcomes of patients who survived COVID-19 critical illness and underwent tracheal resection for postintubation/posttracheostomy tracheal stenosis with those of non-COVID-19 patients.

METHODS

It was single-center, retrospective study. All consecutive patients with post-intubation/posttracheostomy tracheal stenosis who underwent tracheal resection from February 2020 to March 2022 were enrolled. A total of 147 tracheal resections were performed: 24 were in post-COVID-19 patients and 123 were in non-COVID-19 patients. A 1:1 propensity score matching analysis was performed, considering age, gender, body mass index, and length of stenosis. After matching, 2 groups of 24 patients each were identified: a post-COVID-19 group and a non-COVID group.

RESULTS

No mortality after surgery was registered. Posttracheostomy etiology of stenosis resulted more frequently in post-COVID-19 patients (n = 20 in the post-COVID-19 group vs n = 11 in the non-COVID-19 group; P = .03), as well as intensive care unit admissions during the postoperative period (16 vs 9 patients; P = .04). Need for postoperative reintubation for glottic edema and respiratory failure was higher in the post-COVID-19 group (7 vs 2 postoperative reintubation procedures; P = .04). Postoperative dysphonia was observed in 11 (46%) patients in the post-COVID-19 group versus 4 (16%) patients in the non-COVID-19 group (P = .03).

CONCLUSIONS

Tracheal resection continues to be safe and effective in COVID-19-related tracheal stenosis scenarios. Intensive care unit admission rates and postoperative complications seem to be higher in post-COVID-19 patients who underwent tracheal resection compared with non-COVID-19 patients.

Pleural mesothelioma in situ : a comprehensive review

Pleural mesothelioma is a rare and aggressive cancer that affects the pleura. In recent years, there has been increasing interest and attention in detecting and diagnosing early-stage or precancerous forms of mesothelioma because of its severe prognosis and short life expectancy at the time of diagnosis. Mesothelioma in situ represents a clear opportunity to improve and innovate the diagnostic approach and the multimodality treatment of mesothelioma: the diagnosis of pleural mesothelioma at the 'in-situ phase' means early disease detection and thus paves the way to new possible curable strategies. Since 2021, when mesothelioma in situ was finally identified and described as a new histological entity, its diagnosis and management became a challenge and the subject of ongoing research; several aspects remain open and still outstanding as regards diagnostic techniques, time and probability of progression, need for and methods of follow up, aggressive and early surgery. This narrative review aims to provide a comprehensive overview of mesothelioma in situ covering its definition, risk factors, diagnostic criteria, and tricky aspects of early detection. It also highlights its clinical significance, new perspectives, and potential future indications in the context of pleural mesothelioma multidisciplinary management.

Severe tracheal tear due to endotracheal intubation: a case report

Background

Tracheobronchial injury is a life-threatening condition with a considerable missed diagnosis rate. The larger the tracheal lesion the more difficult it is to heal. Both conservative and non-conservative treatments are used to treat tracheal injury. This article reports a clinical scenario in which conservative treatment was successfully used to manage a severe tracheal tear.

Case Description

We present the case of a 63-year-old male with a cough for over a year who suffered from a 4-cm tracheobronchial injury (level IIIA, Cardillo classification) after endotracheal intubation for right lower bilobectomy. This injury showed full-layer tissue tearing of the tracheal wall, without esophageal injury or mediastinitis. The tracheal tear was discovered during the bronchoscopy examination on postoperative day one. The patient's vital signs were almost stable, including body temperature, blood pressure, heart rate, and oxygen saturation. We adopted a conservative treatment approach, including oxygen administration, painkillers, broad-spectrum antibiotics therapy, and nutritional support. Using this treatment, the 4-cm long tracheal rupture healed within four weeks. No tracheal tear was found in the bronchoscopy re-examination. The computed tomography scan showed that the mediastinal and subcutaneous emphysema had disappeared entirely. The patient fully recovered well without any complaints of discomfort.

Conclusions

Conservative treatment provides a valuable strategy for treating patients with massive tracheal lesions, representing an effective approach, especially in older patients with underlying diseases whose conditions are not suitable for operative treatments.

Pulmonary Endometriosis: A Systematic Review

Background/Objectives: Endometriosis is characterized by the presence of ectopic endometrial-like glands and stroma outside the endometrial cavity, which mainly occurs in the pelvic cavity. Pulmonary endometriosis, or thoracic endometriosis syndrome (TES), describes the rare presence of endometrial-like cells in the thoracic cavity and includes catamenial pneumothorax, catamenial hemothorax, hemoptysis, and lung nodules. Our aim is to summarize the results of all reported cases of TES. Methods: Extensive research was conducted through MEDLINE/PUBMED using the keywords "thoracic endometriosis", "thoracic endometriosis syndrome", "catamenial pneumothorax", "catamenial hemoptysis", and "TES". Following PRISMA guidelines, all published cases of TES between January 1950 and March 2024 were included. A systematic review of 202 studies in English, including 592 patients, was performed. Results: The median age of women with TES is 33.8 years old. The most common clinical presentation is catamenial pneumothorax (68.4%), while lesions are mainly found in the right lung unilaterally (79.9%). Chest computed tomography (CT) was used alone or after an X-ray to determine the pathological findings. Ground-glass opacity nodules and cystic lesions represent the most common finding in CT, while pneumothorax is the most common finding in X-rays. Video-assisted thoracoscopic surgery (VATS) is the main therapeutic approach, usually in combination with hormonal therapy, including GnRH analogues, progestins, androgens, or combined oral contraceptives. Hormonal therapy was also administered as monotherapy. Symptom recurrence was reported in 10.1% of all cases after the treatment. Conclusions: High clinical awareness and a multidisciplinary approach are necessary for the best clinical outcome for TES patients. More studies are required to extract safer conclusions.

Cost-effectiveness and postoperative outcomes of spontaneous vs. mechanical ventilation during video-assisted thoracoscopic surgery: a retrospective study

Background

Video-assisted thoracoscopic surgery (VATS) is known to have the advantages of being minimally invasive, reducing complications, and shortening hospitalization time. However, related cost surveys have been inconsistent. In recent years, a new concept of tubeless anesthesia has been introduced, but its impact on the cost-effectiveness of VATS is unclear. This study compared the hospitalization costs and postoperative outcomes in patients undergoing spontaneous ventilation VATS (SV-VATS) and mechanical ventilation VATS (MV-VATS).

Methods

We retrospectively analyzed data on the VATS procedures performed at the Shaoxing People's Hospital from June 2022 to July 2023. Overall, 386 patients who met the inclusion criteria were treated with SV-VATS (n=57) or MV-VATS (n=329). Comprehensive cost comparisons were performed between the groups.

Results

The two groups shared comparable clinical characteristics, such as age (P=0.64), sex (P=0.72), body mass index (BMI) (P=0.68), and type of procedure (P=0.43). All costs are expressed in U.S. dollars ($). The overall, diagnostic, operation, and material costs of SV-VATS and MV-VATS were $3,858.71±$746.32 vs. $3,870.26±$990.69 (P=0.94), $911.83 vs. $908.73 (P=0.51), $875.58 vs. $875.58 (P=0.51), and $1,560.5 vs. $1,596.91±$727.18 (P=0.31), respectively. In addition, the median costs of anesthesia materials and total medications were $233.51 vs. $324.02 and $290.63 vs. $364.14, respectively (P<0.001). Among medications, the cost of anesthesia medicine was $179.6±$45.48 vs. $224.12±$54.67, respectively (P<0.001). Postoperative complications, including sore throat, hoarseness, and expectoration, did not occur in the SV-VATS group, whereas 13, 11, and 10 cases were noted, respectively, in the MV-VATS group (13.5%, 11.5%, and 10.4%, respectively; P=0.01, P=0.03, P=0.041). The time to extubation in the SV-VATS and MV-VATS groups was 4 and 10 min, respectively (P<0.001). No intermediate surgery was performed in either group.

Conclusions

Compared with SV-VATS, MV-VATS can reduce patients' anesthesia and medicine costs and has similar postoperative adverse event rates in VATS patients, which is conducive to accelerating patient recovery. Therefore, tubeless anesthesia is recommended for future VATS.

The optimal stereotactic body radiotherapy dose with immunotherapy for pulmonary oligometastases: a retrospective cohort study

Background

Stereotactic body radiotherapy (SBRT) is a precise and effective treatment for pulmonary oligometastases, offering high local control (LC) rates. However, the optimal SBRT dose when combined with immunotherapy remains unclear, and there is a lack of comprehensive studies focusing on dose optimization in this setting. This study addresses this knowledge gap by exploring different SBRT dose regimens and their impact on progression-free survival (PFS), overall survival (OS), and LC in patients receiving concurrent immunotherapy, offering novel insights into the synergistic effects of these treatments.

Methods

A retrospective cohort study was conducted of 101 patients with 141 pulmonary oligometastases treated from April 2018 to April 2022. Inclusion criteria included patients with a maximum of five lung metastases and an Eastern Cooperative Oncology Group performance status of ≤2. Patients received SBRT with doses ranging from 50-70 Gy in 5-10 fractions. Follow-up was performed quarterly, and the best dose was determined by comparing survival outcomes across different dose groups. The patients received SBRT with doses ranging from 50-70 Gy in 5-10 fractions. Patient demographics, tumor characteristics, treatment details, and outcomes were collected. The Kaplan-Meier method was used for the survival analysis, and Cox regression models were used to identify prognostic factors for LC, PFS, and OS.

Results

The median follow-up for the 101 patients was 22.4 months (range, 1-58 months). The cohort comprised 82.2% male patients with a median age of 64 years (range, 36-81 years). The majority of the patients (64.4%) had primary tumors originating from non-lung sites, with adenocarcinoma being the predominant histological subtype (47.5%). The median tumor size was 13.5 mm. Across the entire cohort, the median OS was 39 months, and the median PFS was 11 months. Pre-treatment with immunotherapy significantly improved outcomes: the PFS increased to 13 months compared to 7 months for those who did not receive immunotherapy [P=0.02, hazard ratio (HR) = 0.523, 95% confidence interval (CI): 0.302-0.906], and the OS was also significantly improved (P=0.008, HR =0.411, 95% CI: 0.214-0.792). The SBRT regimen of 60 Gy in 10 fractions provided the best outcomes, with a median OS of 39 months, a median PFS of 10 months, and a LC rate of 92.4%, with relatively low toxicity compared to other regimens.

Conclusions

SBRT is a potent, minimally invasive option for managing pulmonary oligometastases, especially when preceded by immunotherapy. The 60 Gy in 10 fractions regimen demonstrated significant efficacy in terms of OS and LC, while maintaining manageable toxicity. Although the retrospective nature of the study introduces some selection bias, this dose regimen appears to offer a promising therapeutic option for pulmonary oligometastases. Further validation through well-designed prospective studies would help confirm the optimal SBRT dose and clarify the role of immunotherapy in this setting.