Application of N Descriptors Proposed by the International Association for the Study of Lung Cancer in Clinical Staging.

Background Patients with N1 or N2 non-small cell lung cancer exhibit prognostic heterogeneity. To refine the current N staging system, new N stages were proposed by the International Association for the Study of Lung Cancer. However, those proposed new N stages have not been validated. Purpose To evaluate the prognostic performance of the proposed N descriptors for clinical staging. Materials and Methods Participants with non-small cell lung cancer without distant metastasis from January 2010 to December 2014 were retrospectively included. Each patient's clinical N (cN) stage was assigned to one of seven categories (cN0, cN1a, cN1b, cN2a1, cN2a2, cN2b, cN3). The 5-year overall survival rates were estimated with the Kaplan-Meier method. The adjusted hazard ratios (HRs) and their 95% CIs were estimated by using a multivariable Cox proportional hazard model. Ad hoc analyses according to lymph node (LN) size were performed. Results A total of 1271 patients (median age, 66 years; interquartile range, 59-73 years; 812 men) were included. The 5-year overall survival rates were 77.3%, 53.7%, 36.0%, 29.2%, 34.4%, 18.0%, and 12.4% for stages cN0, cN1a, cN1b, cN2a1, cN2a2, cN2b, and cN3, respectively. Patients with cN2b disease had a worse prognosis than patients with cN2a disease (HR, 1.53; 95% CI: 1.06, 2.22; P = .02). There was no prognostic difference between cN1b and cN1a (HR, 1.13; 95% CI: 0.61, 2.09; P = .71); however, there was a difference between cN1 subgroups when stratified by LN size (≥2 cm; HR, 2.26; 95% CI: 1.16, 4.44; P = .02). Within cN2a disease, there were no differences between cN2a1 and cN2a2 (HR, 0.98; 95% CI: 0.61, 1.56; P = .93) or between subgroups according to LN size (HR, 0.74; 95% CI: 0.40, 1.37; P = .34). Conclusion A survival difference was observed between single- and multistation involvement among cN2 disease. The number of involved lymph node stations in patients with cN1 disease and the presence of skip metastasis in patients with cN2 disease were not associated with survival differences. © RSNA, 2021 Online supplemental material is available for this article.

Accuracy and complications of percutaneous transthoracic needle lung biopsy for the diagnosis of malignancy in patients with idiopathic pulmonary fibrosis.

OBJECTIVES: To determine the accuracy of CT-guided percutaneous transthoracic needle lung biopsy (PTNB) for the diagnosis of malignancy and the associated complication rates in patients with idiopathic pulmonary fibrosis (IPF). METHODS: This retrospective study included 91 CT-guided PTNBs performed in 80 patients with IPF from April 2003 through December 2016. Data regarding patients, target lesions, procedures, complications, and pathological reports were collected, and the final diagnosis was made. The diagnostic accuracy, sensitivity, specificity, percentage of nondiagnostic results, and complication rates were determined. Multivariable logistic regression analyses were performed to identify risk factors for nondiagnostic results and major complications. RESULTS: Three biopsies (technical failure [n = 2] and undetermined final diagnosis [n = 1]) were excluded from the diagnostic accuracy calculation. The diagnostic accuracy, sensitivity, and specificity were 89% (78/88), 90% (62/69), and 84% (16/19), respectively. The percentage of nondiagnostic results was 34% (30/88). Lesion size ≤ 3 cm (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.5-31.2; p = 0.001) and needle tip placement outside the target lesion (OR, 13.7; 95% CI, 1.4-132.2; p = 0.02) were risk factors for nondiagnostic results. The overall and major complication rates were 51% (46/91) and 12% (11/91), respectively. The presence of honeycombing along the path of the needle (OR, 11.2; 95% CI, 1.4-89.1; p = 0.02) was an independent risk factor for major complications. CONCLUSIONS: CT-guided PTNB shows a relatively reasonable accuracy in diagnosing malignancy in patients with IPF. The complication rate may be high, especially when the needle passes through honeycomb lesions. KEY POINTS: • In patients with idiopathic pulmonary fibrosis (IPF), CT-guided percutaneous transthoracic needle lung biopsy (PTNB) showed a relatively reasonable accuracy for the diagnosis of malignancy. • Target lesion size ≤ 3 cm and biopsy needle tip placement outside the target lesion were risk factors for nondiagnostic results of CT-guided PTNB. • The complication rate may be high, especially in cases where the biopsy needle passes through honeycomb lesions.

Erratum to: Impacts of whey protein on starch digestion in rumen and small intestine of steers.

[This corrects the article DOI: 10.5187/jast.2019.61.2.98.].

Impacts of whey protein on starch digestion in rumen and small intestine of steers.

Four Korean native steers (511 ± 17.2 kg; 2 × 2 replicated crossover design) fitted with duodenal cannulas were used to investigate the influence of oral administration of soluble whey protein (WP; 82.29% crude protein) on ruminal fermentation, gastrointestinal (GI) hormone secretion in the blood, pancreatic α-amylase activity in the duodenum, and disappearance rate in each segment of the GI tract. Steers were orally fed the basal diet (control; TMR [total mixed ration] 9 kg/d) or the basal diet with enriched WP (400 g/d) for 14 days. The apparent crude protein disappearance rate in the rumen of the WP was higher than in control (p < 0.05). However, no difference between groups was observed in the apparent crude protein disappearance rate in the intestine and the apparent starch disappearance rates in the rumen, GI tract. The level of cholecystokinin, secretin, and ghrelin in serum and pancreatic α-amylase activity in the duodenum of the WP also did not change. The changes in the level of blood urea nitrogen related to protein metabolism were higher in the WP than in the control (p < 0.05). However, the levels of total protein, lipid, carbohydrate and mineral metabolites did not change. Consequently, we suggest that the oral administration of WP in steers assisted in ruminal fermentation due to the population increase of microbes in the rumen but did not improve the starch digestion rate in the small intestine because GI hormone secretion in the blood and pancreatic α-amylase activity did not change.

Community socioeconomic status and public access defibrillators: A multilevel analysis.

BACKGROUND: Although current guidelines recommend that distribution of public-access defibrillators (PADs) should take into account area-level risk of out-of-hospital cardiac arrest (OHCA), community socioeconomic status (SES) can unduly influence policy implementation in positioning PADs. Using recent, complete data from Seoul Metropolitan City, Korea, this study aims to examine whether community SES is associated with distribution of PADs, in terms of per capita count and risk-grid coverage. METHODS: A cross-sectional, observational study was conducted using three sources of administrative data: (1) PAD registry data (2007-2015), (2) OHCA database (2010-2014), and (3) community socioeconomic characteristics of two sub-city levels (neighborhoods nested in districts). We examined the relationship between neighborhood per capita tax, an SES proxy, with each of the two outcome variables. After examining per capita number of PADs and risk-grid coverage by neighborhood tax quartile, multilevel linear regression analysis was conducted to account for the nested nature of data and also to control for OHCA risk in the model. RESULTS: A total of 6609 PADs in 405 neighborhoods were included in the analysis. The average number of positioned PADs per 10,000 persons was 7.45, showing a gradient by neighborhood SES (4.92 in the lowest SES quartile vs 12.66 in the highest). Risk-grid coverage was around 10% across all neighborhood SES quartiles. These findings remained valid in the multilevel analysis: per capita number of PADs was still positively associated with neighborhood SES, while risk-grid coverage of PADs was not. CONCLUSIONS: More affluent neighborhoods in Seoul exhibit higher per capita PADs, even accounting for OHCA risk, while risk-grid coverage is generally low regardless of community SES. Seoul's ongoing program aimed to increase PAD coverage should also pay attention to improving community-level inequality as well as distributional efficiency.

Shaofu Zhuyu decoction ameliorates obesity-mediated hepatic steatosis and systemic inflammation by regulating metabolic pathways.

Shaofu Zhuyu decoction (SFZYD, also known as Sobokchugeo-tang), a classical prescription drug in traditional East Asian medicine, has been used to treat blood stasis syndrome (BSS). Hepatic steatosis is the result of excess caloric intake, and its pathogenesis involves internal retention of phlegm and dampness, blood stasis, and liver Qi stagnation. To evaluate the effects of treatment with SFZYD on obesity-induced inflammation and hepatic steatosis, we fed male C57BL/6N mice a high fat diet (HFD) for 8 weeks and then treated them with SFZYD by oral gavage for an additional 4 weeks. The results of histological and biochemical examinations indicated that SFZYD treatment ameliorates systemic inflammation and hepatic steatosis. A partial least squares-discriminant analysis (PLS-DA) scores plot of serum metabolites showed that HFD mice began to produce metabolites similar to those of normal chow (NC) mice after SFZYD administration. We noted significant alterations in the levels of twenty-seven metabolites, alterations indicating that SFZYD regulates the TCA cycle, the pentose phosphate pathway and aromatic amino acid metabolism. Increases in the levels of TCA cycle intermediate metabolites, such as 2-oxoglutaric acid, isocitric acid, and malic acid, in the serum of obese mice were significantly reversed after SFZYD treatment. In addition to inducing changes in the above metabolites, treatment with SFZYD also recovered the expression of genes related to hepatic mitochondrial dysfunction, including Ucp2, Cpt1α, and Ppargc1α, as well as the expression of genes involved in lipid metabolism and inflammation, without affecting glucose uptake or insulin signaling. Taken together, these findings suggest that treatment with SFZYD ameliorated obesity-induced systemic inflammation and hepatic steatosis by regulating inflammatory cytokine and adipokine levels in the circulation and various tissues. Moreover, treatment with SFZYD also reversed alterations in the levels of metabolites of the TCA cycle, the pentose phosphate pathway and aromatic amino acid metabolism.

Factors associated with radiologic progression of non-cystic fibrosis bronchiectasis during long-term follow-up.

BACKGROUND AND OBJECTIVE: Non-cystic fibrosis (CF) bronchiectasis is a chronic airway inflammatory disease, exhibiting a diverse array of clinical courses. The purpose of this study was to determine the factors that predict radiologic progression of non-CF bronchiectasis during a long-term follow-up. METHODS: We reviewed the electronic medical records that included pulmonary function test data from non-CF bronchiectasis patients, who were older than 18 years of age with a follow-up of computerized tomography for more than 5 years. The original Bhalla score was used to determine the radiologic severity of non-CF bronchiectasis. RESULTS: A total of 155 patients (mean age, 59.6 years; male, 45.2%) were included for the final analysis. The mean follow up time was 7.11 ± 1.42 (5-10) years. The baseline Bhalla score was 9.52 ± 3.14 (4-19), and the change of Bhalla score was 0.55 ± 1.14 (-2 to 5). The Bhalla score was increased in 56 patients (36.1%) but not in 99 patients (63.9%). The Bhalla score change was significantly associated with the age at diagnosis (p = 0.037), body mass index (BMI, p = 0.012), chronic infection of Pseudomonas aeruginosa (p = 0.005) or isolation of nontuberculous mycobacterium (p = 0.042) in respiratory specimens. In a multivariate analysis, BMI and isolation of P. aeruginosa were significantly related with the Bhalla score change. CONCLUSION: The radiologic progression of non-CF bronchiectasis was associated with lower BMI and isolation of P. aeruginosa in respiratory specimens.

Test-Retest Reliability of Word Recognition Score Using Korean Standard Monosyllabic Word Lists for Adults as a Function of the Number of Test Words.

BACKGROUND AND OBJECTIVES: The purpose was to establish the test-retest reliability of word recognition score (WRS) using Korean standard monosyllabic word lists for adults (KS-MWL-A) recently developed based on the international standard for speech audiometry (ISO 8253-3:2012). SUBJECTS AND METHODS: Subjects consisted of 159 adults aged to 18 to 25 years with normal hearing sensitivity. WRSs were obtained in 2 dB steps from the level of speech recognition thresholds to the level of 86% correct responses or greater. After one or two weeks, retest was performed. Correlation, confidence interval (CI) and prediction interval (PI) were calculated for the reliability. RESULTS: Correlation coefficients were 0.88 for 50 test words, 0.76 for 25 and 0.61 for 10 words. Results also showed that 95% CIs and PIs were narrower for 25 and 50 test words than those for 10 test words. CONCLUSIONS: Korean WRS using the KS-MWL-A has high reliability for 25 and 50 test words, but relatively low for 10 words. It suggested that 95% CIs for each test words would be criteria for significant differences in WRS for groups and 95% PIs at each score of WRS could be utilized for a considerable difference for each individual at retest.