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Background：Surgical resection is generally considered the main curative treatment for intrahepatic biliary cystadenocarcinoma （IBCA） or suspected IBCAs,but controversy exists regarding the prognosis for IBCAs.This study aimed to describe the clinicopathological characteristics of IBCA and identify prognostic factors that may influence the survival of patients treated with surgical procedures.Methods：Thirty-four patients with histologically confirmed IBCA treated between January 2000 and June 2014 were included.The clinical characteristics of patients with IBCA were compared with those of 41 patients with intrahepatic biliary cystadenoma （IBC）;factors that significant difference were analyzed for prognosis analysis of IBCA using multivariate/univariate Cox proportional hazards regression models.Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank test.Results：IBCAs had a strong female predominance,and the most common presenting symptoms were abdominal pain or discomfort.Compared with IBCs,IBCAs occurred in older patients,in more male patients,and were associated statistically significant abnormal increase in alanine aminotransferase （P =0.01） and total bilirubin （P =0.04）.Mural nodules were more frequently seen with IBCAs and may associate with malignancy.It was difficult to differentiate between IBC and IBCA based on laboratory examination and imaging findings.Although complete resection is recommended,enucleation with negative margins also achieved good outcomes.Median overall patient survival was 76.2 months;survival at 1,3,and 5 years was 88.0％,68.7％,and 45.8％,respectively.Radical resection and noninvasive tumor type were independent prognostic factors for overall survival.Conclusions：It remains difficult to distinguish between cystadenomas and cystadenocarcinomas based on laboratory examination and image findings.Complete resection is recommended for curative treatment,and patients should be closely followed postoperatively,particularly those with invasive tumors.

Background Lophomonas blattarum is an emerging protozoan that mostly infects the lower respiratory tract and causes pulmonary lophomoniasis. Radiologic findings in patients with pulmonary lophomoniasis have yet to be studied. Thus, we conducted a registry-based clinical investigation to evaluate the radiologic findings of lophomoniasis. Methods In this cross-sectional study, 34 Lophomonas positive patients were enrolled. Demographic data, relevant characteristics, and radiologic findings of the patients were recorded and analyzed. Results Thirty-four (male = 18, female = 16) patients with an average age of 52.21 ± 20.48 years old were examined. Radiological findings such as Alveolar consolidation (26.5%), Ground glass opacity (5.9%), Centrilobular nodules (23.5%), Tree -in- bud (38.2%), Cavitation (23.5%), Pleural effusion (23.5%), Interstitial opacity (8.8%), Lymphadenopathy (23.5%), Bronchocele (5.9%), Bronchiectasis (29.4%), Nodules (8.8%) and Mass (11.8%) were obtained, that the frequency of all radiological findings was less than 50%. Conclusion In this study, the most common radiological findings in patients with lophomoniasis were tree-in-bud nodules, alveolar consolidation, bronchiectasis, and centrilobular nodules which were mostly seen in the right lung and its middle and lower lobes. Given that the radiologic findings of this disease are unknown, it can be considered in differential diagnosis.

Background Basidiobolomycosis is a fungal infection exhibiting a wide spectrum of clinical manifestations that frequently resemble abdominal malignancies or inflammatory conditions. This study elucidates the characteristic imaging features that can help make an accurate diagnosis. Methods We examined pretreatment imaging studies (CT, MRI, ultrasound) of 32 histopathologically proven cases of basidiobolomycosis at a tertiary referral center between 2015 and 2021. Two radiologists, blind to the pathology results, scrutinized the lesions for localization, morphology, enhancement pattern, and ancillary findings. Results The cohort (mean age 9.8 ± 13.8 years and 53% male) demonstrated three basic imaging patterns: (1) hepatic lesions (21.9%) appearing as heterogeneously enhancing masses with necrotic cores; (2) gastrointestinal involvement (18.8%) showing circumferential wall thickening chiefly affecting the ileocecal region; and (3) mesenteric masses (15.6%) with peripheral enhancement and central necrosis. Other findings included regional lymphadenopathy (31.3%) and obstructive uropathy. At first, the misdiagnosis rate was 78%, most frequently as malignancy (37.5%) or appendicitis (31.2%). The follow-up indicated that 90.6% were responsive to treatment. Conclusion Basidiobolomycosis shows distinct imaging characteristics, especially necrotic hepatic masses, and segmental bowel wall thickening, which could help differentiate the condition from neoplasms or inflammatory diseases. These findings act as a compelling argument to always include fungal etiologies within the differential diagnosis in patients with pertinent imaging findings in endemic regions.

Background Interstitial lung diseases (ILD) are relatively rare fibrotic lung diseases that can cause significant morbidity and mortality. Early diagnosis of ILDs is crucial to improve patient survival. Incidental radiologic findings of interstitial lung disease may provide an opportunity for early diagnosis. We sought to estimate the incidence of incidental interstitial lung disease findings on CT scans ordered for other reasons and quantify the time to pulmonary function test or pulmonary referral. Methods In this retrospective cohort study performed at a large metropolitan health system, radiology reports from CT scans of the neck, chest, abdomen/pelvis, and coronary arteries of adult patients were reviewed for documentation of ILD findings based on the pre-defined search terms. We also descriptively examined time from CT scan to pulmonary function testing or pulmonology referral. The main outcomes were incidence of ILD findings on CT scans and frequency of follow up testing. Results Of the 239,535 scans that were included, there were 25,219 initial scans with ILD findings (10.8%). Of those patients, only 16.1% had pulmonary function testing or pulmonary referral at one year, and 23.9% at 5 years. Follow up testing was more common if interstitial lung disease findings were present on CT chest compared to other scan types. The median time to PFT for all scan types was 59 days and the median time to pulmonary referral was 112 days. Conclusion In conclusion, incidental findings of interstitial lung disease are common on many different types of CT scans but infrequently lead to follow up pulmonary function testing or referral to a pulmonary specialist. Significant delays in time were noted for pulmonary referrals. This study raises awareness of delay in diagnosing ILD.

Aim This study aimed to assess the performance of OpenAI’s ChatGPT in generating diagnosis based on chief complaint and cone beam computed tomography (CBCT) radiologic findings. Materials and methods 102 CBCT reports (48 with dental diseases (DD) and 54 with neoplastic/cystic diseases (N/CD)) were collected. ChatGPT was provided with chief complaint and CBCT radiologic findings. Diagnostic outputs from ChatGPT were scored based on five-point Likert scale. For diagnosis accuracy, the scoring was based on the accuracy of chief complaint related diagnosis and chief complaint unrelated diagnoses (1–5 points); for diagnosis completeness, the scoring was based on how many accurate diagnoses included in ChatGPT’s output for one case (1–5 points); for text quality, the scoring was based on how many text errors included in ChatGPT’s output for one case (1–5 points). For 54 N/CD cases, the consistence of the diagnosis generated by ChatGPT with pathological diagnosis was also calculated. The constitution of text errors in ChatGPT’s outputs was evaluated. Results After subjective ratings by expert reviewers on a five-point Likert scale, the final score of diagnosis accuracy, diagnosis completeness and text quality of ChatGPT was 3.7, 4.5 and 4.6 for the 102 cases. For diagnostic accuracy, it performed significantly better on N/CD (3.8/5) compared to DD (3.6/5). For 54 N/CD cases, 21(38.9%) cases have first diagnosis completely consistent with pathological diagnosis. No text errors were observed in 88.7% of all the 390 text items. Conclusion ChatGPT showed potential in generating radiographic diagnosis based on chief complaint and radiologic findings. However, the performance of ChatGPT varied with task complexity, necessitating professional oversight due to a certain error rate.

Objective The purpose of our study was to perform a meta-analysis and systematic review to compare differences in clinical manifestations and chest computed tomography (CT) findings between immunocompetent and immunocompromised pulmonary cryptococcosis (PC) patients. Methods An extensive search for relevant studies was performed using the PubMed, EMBASE, Cochrane Library, and Web of Sciences databases from inception to September 30, 2021. We included studies that compared the clinical manifestations and chest CT findings between immunocompetent and immunocompromised PC patients. Study bias and quality assessment were performed using the Newcastle–Ottawa Scale (NOS). Results Nine studies involving 248 immunocompromised and 276 immunocompetent PC patients were included in our analysis. The NOS score of each eligible study was above 5, indicating moderate bias. The proportion of elderly patients (> = 60 years old) in the immunosuppressed group was significantly higher than that in the immunocompetent group (OR = 2.90, 95% CI (1.31–6.43), Z = 2.63, p  = 0.01). Fever (OR = 7.10, 95% CI (3.84–13.12), Z = 6.25, p  < 0.000) and headache (OR = 6.92, 95% CI (2.95–16.26), Z = 4.44, p < 0.000) were more common in immunosuppressed patients. According to thin-section CT findings, lesions were more frequently distributed in the upper lobe (OR = 1.90, 95% CI (1.07–3.37), Z = 2.2, p  = 0.028) in immunocompromised individuals. The proportions of patients with cavity sign (OR = 5.11, 95% CI (2.96–8.83), Z = 5.86, p  = 0.00), ground-glass attenuation (OR = 5.27, 95% CI (1.60–17.35), Z = 2.73, p  = 0.01), and mediastinal lymph node enlargement (OR = 2.41, 95% CI (1.12–5.20), Z = 2.24, p  = 0.03) were significantly higher in immunocompromised patients. Conclusion No significant differences in nonspecific respiratory symptoms were found between immunocompromised and immunocompetent PC patients. Nevertheless, fever and headache were more common in immunocompromised patients. Among the CT findings, cavity, ground-glass attenuation, and mediastinal lymph node enlargement were more common in immunocompromised individuals.

Background With the emergence of macrolide resistance, concerns about the efficacy of macrolides for the treatment of Mycoplasma pneumoniae (MP) pneumonia in children have been raised. This study aimed to determine the effect of macrolide resistance on the outcome of children who were hospitalized with MP pneumonia. Methods Between 2010 and 2015, we performed culture of MP from nasopharyngeal samples obtained from children who were hospitalized with pneumonia at five hospitals in Korea. Macrolide resistance was determined by the analysis of 23S rRNA gene transition and the minimal inhibitory concentrations of four macrolides. Medical records were reviewed to analyze the clinical response to treatment with macrolides. Results MP was detected in 116 (4.8%) of the 2436 children with pneumonia. MP pneumonia was prevalent in 2011 and 2015. Of the 116 patients with MP pneumonia, 82 (70.7%) were macrolide-resistant. There were no differences in the age distribution, total duration of fever, and chest x-ray patterns between the macrolide-susceptible and macrolide-resistant groups. After macrolide initiation, mean days to defervescence were longer in the macrolide-resistant group than in macrolide-susceptible group (5.7 days vs. 4.1 days, P  = 0.021). However, logistic regression analysis revealed that the presence of extrapulmonary signs ( P  = 0.039), homogeneous lobar consolidation ( P  = 0.004), or parapneumonic effusion ( P <  0.001) were associated with fever duration of ≥7 days after the initiation of macrolides, regardless of macrolide resistance. Conclusions This study demonstrated that fever duration in MP pneumonia was determined by the radiologic findings of chest x-ray, not by the presence of macrolide resistance. The results highlight the need for future studies to assess therapeutic benefit from macrolides in the treatment of children with MP pneumonia.

The prognostic significance of the presence of cystic features in patients with newly diagnosed glioblastoma (GB) is highly controversial. The purpose of this study was to determine whether cystic GB patients have a more favorable prognosis compared to non-cystic GB patients. The records of all GB patients diagnosed between August 2008 and December 2020 at Seoul St. Mary’s Hospital were reviewed retrospectively. Out of 254 GB patients, we excluded patients with a confirmed isocitrate dehydrogenase (IDH) mutation or an unknown IDH mutation status. A total of 145 patients met our eligibility criteria. Of the 145 patients we analyzed, 16 patients were classified as the cystic group, and 129 patients were classified into the non-cystic group. As there was a significant difference in the extent of resection between the two groups, 32 patients were matched according to propensity score matching. A Kaplan-Meier survival curve of the two groups indicated that the cystic group had better survival than the non-cystic group (28.6 months versus 18.8 months, respectively; p = 0.055). On multivariate analysis, the presence of cystic features (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.17–0.91, p = 0.029) was significantly related with a longer OS. Longer OS was also related with well-known prognostic factors, such as grossly total resection (HR: 0.05, CI: 0.01–0.31, respectively; p = 0.001) and lower European Cooperative Oncology Group (ECOG) score (HR: 3.67, CI: 1.56–9.02, respectively; p = 0.003). Our results suggest that the presence of cystic features could be an independent prognostic factor suggesting better survival in GB patients. Further larger and prospective studies to validate our findings are needed. •Cystic features in newly diagnosed glioblastoma (GB) patients have highly controversial prognostic significance.•Presence of cystic features could be related to a larger extent of resection in GB patients.•It also could be an independent prognostic factor suggesting better survival in IDH-wildtype GB patients.

Nosocomial pneumonia, or hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) are important health problems worldwide, with both being associated with substantial morbidity and mortality. HAP is currently the main cause of death from nosocomial infection in critically ill patients. Although guidelines for the approach to this infection model are widely implemented in international health systems and clinical teams, information continually emerges that generates debate or requires updating in its management. This scientific manuscript, written by a multidisciplinary team of specialists, reviews the most important issues in the approach to this important infectious respiratory syndrome, and it updates various topics, such as a renewed etiological perspective for updating the use of new molecular platforms or imaging techniques, including the microbiological diagnostic stewardship in different clinical settings and using appropriate rapid techniques on invasive respiratory specimens. It also reviews both Intensive Care Unit admission criteria and those of clinical stability to discharge, as well as those of therapeutic failure and rescue treatment options. An update on antibiotic therapy in the context of bacterial multiresistance, in aerosol inhaled treatment options, oxygen therapy, or ventilatory support, is presented. It also analyzes the out-of-hospital management of nosocomial pneumonia requiring complete antibiotic therapy externally on an outpatient basis, as well as the main factors for readmission and an approach to management in the emergency department. Finally, the main strategies for prevention and prophylactic measures, many of them still controversial, on fragile and vulnerable hosts are reviewed.

Community-acquired pneumonia represents the third-highest cause of mortality in industrialized countries and the first due to infection. Although guidelines for the approach to this infection model are widely implemented in international health schemes, information continually emerges that generates controversy or requires updating its management. This paper reviews the most important issues in the approach to this process, such as an aetiologic update using new molecular platforms or imaging techniques, including the diagnostic stewardship in different clinical settings. It also reviews both the Intensive Care Unit admission criteria and those of clinical stability to discharge. An update in antibiotic, in oxygen, or steroidal therapy is presented. It also analyzes the management out-of-hospital in CAP requiring hospitalization, the main factors for readmission, and an approach to therapeutic failure or rescue. Finally, the main strategies for prevention and vaccination in both immunocompetent and immunocompromised hosts are reviewed.