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Objectives To investigate the role of PET in predicting the prognosis of resected stage IA non-small cell lung cancer (NSCLC) and planning individualized therapeutic strategies. Methods We retrospectively reviewed the data of patients who underwent surgical resection for lung cancer between January 2004 and December 2014. The clinical data, imaging characteristics of nodules, surgical approaches, and outcomes were analyzed. Results We evaluated 998 cases; 637 patients with pathological stage I disease were categorized as follows: stage IA1 (251 cases), stage IA2 (250 cases), and stage IA3 (136 cases). The mean follow-up period was 109 months. Significant differences were observed in sex, tumor differentiation, epidermal growth factor receptor mutation, smoking habits, lymphovascular space invasion, tumor size, maximum standard uptake value (SUVmax), and carcinoembryonic antigen level among the groups. Multivariable Cox regression revealed that ground-glass opacity ratio (hazard ratio (HR) = 0.001) and tumor SUVmax independently predicted the postoperative risk of relapse for stage IA3 NSCLC. The HR for SUVmax > 4 was 8.986 ( p < 0.001). The 5-year overall survival (OS) rates were 87.2%, 92.9%, and 82.7%, and the 5-year disease-free survival (DFS) rates were 93.2%, 84.2%, and 70.51% for stage IA1, IA2, and IA3 NSCLC, respectively (both p < 0.001). OS and DFS rates were poor in stage IA3 NSCLC patients with an SUVmax uptake > 4 (OS, 71.0% and 92.2%; DFS, 50.2% and 87.3%, for SUVmax > 4 and ≤ 4, respectively; both p = 0.001). Conclusions SUVmax was a prognostic factor for resected stage IA NSCLC. Postoperative treatment may be considered for IA3 NSCLC with SUVmax > 4. Key Points • PET helps surgeons to assess patients with early-stage lung cancer. • This retrospective study revealed that PET plays an influential role in predicting the prognosis of resected lung cancer. • Better prognostication aids better planning of therapeutic strategies with diversification.

The beneficial application of three-dimensional (3D) printing for surgical stabilization of rib fractures (SSRF) has never been proposed in the literature before. The aim of this study was to verify patients' surgical outcomes when utilizing preoperative three-dimensional printing for SSRF. We retrospectively reviewed the records of all consecutive patients who were treated at our hospital for SSRF from July 2015 to December 2017. The patients were divided into two groups according to whether or not 3D printing was utilized. Forty-eight patients who underwent SSRF at our hospital were enrolled. Of them, three patients underwent bilateral surgeries. The patients with application of preoperative 3D printing for SSRF had statistically significant associations with shorter operation time per fixed plate (p < 0.001), and a smaller incision length (p < 0.001). We present an useful technique involving 3D printing for promoting SSRF significantly with shorter operation time and an appropriate incision length.

Background and Objective This study aimed to investigate the relationship between bleb formation, primary spontaneous pneumothorax (PSP) and pectus excavatum (PE). Methods From July 2005 to December 2016, the records of 514 patients with PE who underwent the Nuss procedure were obtained from a prospectively collected database and reviewed. Clinical features, images and treatments were analyzed retrospectively. Results The incidence rate of bleb formation was 26.5% in PE patients. The bleb group had a greater body height (174.4 cm vs. 170.4 cm, p  < 0.001), a higher Haller index (HI; 4.2 vs. 3.43, p  < 0.001) and a higher risk of developing PSP than the non-bleb group (risk ratio 9.8, p  = 0.002). HI values larger than 3.615 had good discriminatory power for predicting bleb formation in patients with PE. With each increase in the HI, PE patients had a 2.2-fold greater odds ratio of bleb formation (odds ratio 2.221, CI 1.481–3.330, p  < 0.001). Conclusion We discovered that a high percentage of PE patients have bleb formation and a higher risk of PSP, especially those with an HI >3.615. High-resolution computed tomography of the chest may be useful for evaluating both the HI and the presence of blebs in the lungs before performing a corrective surgical procedure.

Serious blunt chest trauma usually induces hemothorax, pneumothorax, and rib fractures. More studies have claimed that early video-assisted thoracoscopic surgery with surgical stabilization of rib fractures (SSRF) results in a good prognosis in patients with major trauma. This study aimed to verify the outcomes in patients with chest trauma whether SSRF was performed. Consecutive patients who were treated in a medical center in Taiwan, for traumatic events between January 2015 and June 2020, were retrospectively reviewed. This study focused on patients with major trauma and thoracic injuries, and they were divided into groups based on whether they received SSRF. We used electrical impedance tomography (EIT) to evaluate the change of ventilation conditions. Different scores used for the evaluation of trauma severity were also compared in this study. Among the 8396 patients who were included, 1529 (18.21%) had major trauma with injury severity score > 16 and were admitted to the intensive care unit initially. A total of 596 patients with chest trauma were admitted, of whom 519 (87%) survived. Younger age and a lower trauma score (including injury severity scale, new injury severity score, trauma and injury severity score, and revised trauma score) account for better survival rates. Moreover, 74 patients received SSRF. They had a shorter intensive care unit (ICU) stay (5.24, p  = 0.045) and better performance in electrical impedance tomography (23.46, p  < 0.001). In patients with major thoracic injury, older age and higher injury survival scale account for higher mortality rate. Effective surgical stabilization of rib fractures shortened the ICU stay and helped achieve better performance in EIT. Thoracoscope-assisted rib fixation is suggested in severe trauma cases.

Introduction This report presents the first case of a patient with high cervical spinal cord injury who underwent successful laparoscopic implantation of a diaphragm pacing system in Taiwan. It also compares the pros and cons of laparoscopic and thoracoscopic implantation and discusses postoperative care. Background The diaphragm pacing system (DPS) represents a substantial advancement in respiratory support technology, particularly for patients with chronic respiratory insufficiency. It electrically stimulates the phrenic nerve, which in turn activates the diaphragm—the primary muscle involved in respiration [ 1 ]. This stimulation mimics the natural neural impulses that drive diaphragmatic contractions, thereby promoting inhalation and a more efficient lung ventilation. The DPS typically consists of implanted electrodes, an external pulse generator, and connecting leads [ 2 ]. It is mainly used in patients with high spinal cord injuries, amyotrophic lateral sclerosis, and central hypoventilation syndrome. These conditions often result in compromised neural control of the diaphragm, leading to severe respiratory insufficiency. By restoring diaphragm function, DPS can enhance the patients’ quality of life, reduce dependence on mechanical ventilators, and lower the risk of ventilator-associated complications [ 3 ]. Despite its benefits, DPS is not without challenges. Patient selection and the surgical approach are critical to perform successful DPS implantation for the restoration of diaphragm function [ 4 ]. This report presents the first case of a patient with cervical spine injury who underwent successful laparoscopic implantation of DPS in Taiwan. Furthermore, it discusses postoperative ICU care and reviews the pros and cons of different surgical approaches to performing DPS implantation.

Objectives Tyrosine kinase inhibitors (TKIs) are the primary therapeutic option for patients with advanced-stage epidermal growth factor receptor-mutant (EGFR-m) lung adenocarcinoma. However, the role of EGFR-TKIs in advanced-stage lung cancer is uncertain regardless of therapeutic methods. This study investigated the outcome of the impact of epidermal growth factor receptor (EGFR)-TKI in patients with advanced lung adenocarcinoma treated with various therapeutic strategies. Methods This retrospective analysis used cancer registry data from 1159 patients with lung cancer treated between January 2015 and December 2017 at Tri-Service General Hospital. Only patients with lung adenocarcinoma stages 3B and four were selected for the study. All lung adenocarcinoma patients with ever TKI treatment had an EGFR mutation. Results Three-hundred sixty-two patients with advanced lung adenocarcinoma with complete medical records were enrolled. According to personalized therapeutic processes, they were divided into nine groups: only TKI treatment, only chemotherapy (CT), TKI with lung cancer salvage surgery, TKI with CT, TKI with radiotherapy (RT), CT with lung cancer salvage surgery, CT with RT, TKI with CT, and lung cancer salvage surgery. A multivariate Cox regression analysis showed TKI with lung cancer salvage surgery (HR: 4.675, p  = 0.005) is the only good prognostic treatment. The poor predictors for overall survival were only CT (HR: 0.336, p  = 0.048) and TKI with CT (HR: 0.359, p  = 0.023). Kaplan–Meier survival analysis showed a statistical significance in an average overall survival (OS) of ever TKI treatment and never TKI treatment (33.24 vs. 17.64 months, p  < 0.001). Furthermore, TKI usage duration was statistically increased in TKI with lung cancer salvage surgery (40.4 ± 20.7 vs 14.96 ± 13.13 months, p  < 0.001). The survival rate ( p  = 0.033) and OS ( p  < 0.001) in lung cancer salvage surgery were statistically better than the group of TKI without surgery. Conclusion The best therapeutic strategy for advanced lung adenocarcinoma is TKI with lung cancer salvage surgery, according to significantly longer OS and better survival. It also prolonged TKI usage. Mutated EGFR lung adenocarcinoma patients with ever TKI treatment had significantly better survival than with other treatments. Regardless of the combination of other treatments, EGFR mutation with TKI therapy is recommended as a positive prognostic factor for patients with lung adenocarcinoma.

Classifying cancer genetic variants based on clinical actionability is crucial yet challenging in precision oncology. Large language models (LLMs) offer potential solutions, but their performance remains underexplored. This study evaluates GPT-4o, Llama 3.1, and Qwen 2.5 in classifying genetic variants from the OncoKB and CIViC databases, as well as a real-world dataset derived from FoundationOne CDx reports. GPT-4o achieved the highest accuracy (0.7318) in distinguishing clinically relevant variants from variants of unknown clinical significance (VUS), outperforming Qwen 2.5 (0.5731) and Llama 3.1 (0.4976). LLMs demonstrated better concordance with expert annotations for variants with strong clinical evidence but exhibited greater inconsistencies for those with weaker evidence. All three models showed a tendency to assign variants to higher evidence levels, suggesting a propensity for overclassification. Prompt engineering significantly improved accuracy, while retrieval-augmented generation (RAG) further enhanced performance. Stability analysis across 100 iterations revealed greater consistency with the CIViC system than with OncoKB. These findings highlight the promise of LLMs in cancer genetic variant classification while underscoring the need for further optimization to improve accuracy, consistency, and clinical applicability.

Background Otitis media remains a significant global health concern, particularly in resource-limited settings where timely diagnosis is challenging. Artificial intelligence (AI) offers promising solutions to enhance diagnostic accuracy in mobile health applications. Objective This study introduces a hybrid AI framework that integrates convolutional neural networks (CNNs) for image classification with large language models (LLMs) for clinical reasoning, enabling real-time otoscopic diagnosis. Methods We developed a dual-path system combining CNN-based feature extraction with LLM-supported interpretation. The framework was optimized for mobile deployment, with lightweight models operating on-device and advanced reasoning performed via secure cloud APIs. A dataset of 10,465 otoendoscopic images (expanded from 2820 original clinical images through data augmentation) across 10 middle-ear conditions was used for training and validation. Diagnostic performance was benchmarked against clinicians of varying expertise. Results The hybrid CNN–LLM system achieved an overall diagnostic accuracy of 97.6%, demonstrating the synergistic benefit of combining CNN-driven visual analysis with LLM-based clinical reasoning. The system delivered sub-200 ms feedback and achieved specialist-level performance in identifying common ear pathologies. Conclusions This hybrid AI framework substantially improves diagnostic precision and responsiveness in otoscopic evaluation. Its mobile-friendly design supports scalable deployment in telemedicine and primary care, offering a practical solution to enhance ear disease diagnosis in underserved regions.

Navigation bronchoscopy is an emerging technique used to evaluate pulmonary lesions. Using Veran’s SPiN electromagnetic navigation bronchoscopy (ENB) and Archimedes virtual bronchoscopy navigation (VBN), this study aimed to compare the accuracy and safety of these procedures for lung lesions and to identify potentially relevant knowledge for the application of artificial intelligence in interventional pulmonology in a single institute. This single-center, retrospective study compared the ENB and VBN results in patients with pulmonary lesions unsuitable for biopsy via percutaneous transthoracic needle biopsy methods. A total of 35 patients who underwent navigation bronchoscopy for pulmonary lesion diagnosis were enrolled. Nineteen patients were stratified in the ENB group, and sixteen were in the VBN group. The mean age of this cohort was 67.6 ± 9.9 years. The mean distance of the lesion from the pleural surface was 16.1 ± 11.7 mm (range: 1.0–41.0 mm), and most lesions were a solid pattern (n = 33, 94.4%). There were 32 cases (91.4%) of pulmonary lesions with an air-bronchus sign. A statistically significant difference was found between pulmonary size and transparenchymal nodule access (p = 0.049 and 0.037, respectively). The navigation success rate was significantly higher in the VBN group (93.8% vs. 78.9%). Moreover, no procedure-related complications or mortality were noted. The radiographic characteristics, such as size or solid component, can affect the selection of the biopsy procedure, either ENB or VBN. Navigation bronchoscopy-guided biopsy demonstrated acceptable accuracy and a good safety profile in evaluating pulmonary lesions when the percutaneous approach was challenging or life threatening.

Intestinal intussusception is relatively rare in adults and accounts for approximately 5% of intestinal obstruction. Intussusception is classified into subtypes according to the location, including ileoileal, ileocolic, ileo-ileocolic, colo-colic, jejuno-ileal, or jejuno-jejunal; the ileocolic type being the most common. However, intussusception of a combination of different subtypes has rarely been reported in the available literature. Abdominal computed tomography (CT) is the most accurate tool to evaluate intestinal intussusception. The pathological lead point in the intestine typically results in adult intussusception. Surgical intervention is usually adopted in cases of adult intussusception due to a high incidence of underlying bowel malignancy. An inflammatory fibroid polyp (IFP) is one of the uncommon benign neoplasms of the gastrointestinal (GI) system, which can result in intestinal intussusception. Herein, we present a case of a 50-year-old female with combined ileoileal and ileocolic intussusception, which was initially diagnosed by abdominal CT. Therefore, laparoscopic right hemicolectomy surgery was performed, confirming the final diagnosis as ileoileal and ileocolic intussusception secondary to IFP.