Chih-Yi Chen

Background/Objectives: Ground-glass pulmonary nodules are often nonpalpable and not visible during thoracoscopic surgery, making accurate localization important for achieving adequate pathological margins. However, no clinically validated localization-error threshold has been established. We evaluated the association between Dmn and pathological margin adequacy after image-guided thoracoscopic pulmonary nodule resection and sought to identify a clinically relevant localization-accuracy threshold. Methods: We retrospectively reviewed 169 patients in a predefined peripheral-lesion cohort who underwent cone-beam computed tomography-guided pulmonary nodule localization using hook-wire placement or dye marking in a hybrid operating room, followed by thoracoscopic wedge resection. Dmn was defined as the shortest three-dimensional Euclidean distance from the localization needle tip to the tumor margin. Pathological margin adequacy was defined as a resection margin equal to or greater than the maximum tumor diameter. Logistic regression was used to identify predictors of pathological margin inadequacy, and receiver operating characteristic analysis was performed to determine the optimal Dmn cutoff. Results: Dmn was independently associated with pathological margin inadequacy (odds ratio, 1.617; 95% confidence interval, 1.356–1.928; p < 0.001). Receiver operating characteristic analysis yielded an area under the curve of 0.827 and an optimal Dmn cutoff of 4.90 mm, with a sensitivity of 71.0% and specificity of 94.2%. Pathological margin inadequacy occurred more frequently in patients with Dmn ≥ 4.9 mm than in those with Dmn < 4.9 mm (73.3% vs. 6.5%, p < 0.001). Conclusions: In this single-center cohort, a Dmn of approximately 4.9 mm was associated with pathological margin inadequacy after cone-beam computed tomography-guided pulmonary nodule localization and thoracoscopic wedge resection. This value may serve as a candidate intraoperative warning threshold for margin reassessment; however, prospective external validation is required before routine clinical implementation.

Background: Pulmonary nodule localization in a hybrid operating room (OR) followed by thoracoscopic operation presents a viable alternative for early lung cancer treatment, potentially supplanting conventional two-stage preoperative computed tomography-guided localization. This hybrid OR technique enables lesion localization under positive ventilation, contrasting with the traditional method requiring concurrent respiratory motion. This study aimed to evaluate our experience with different ventilator settings and the accuracy of pulmonary nodule localization. Methods: We retrospectively analyzed 176 patients with multiple pulmonary nodules who had localization procedures in our hybrid operating room. Ninety-five patients were assigned to the traditional ventilator setting group (tidal volume 8–10 mL/kg) and 81 to the lung-protective strategy group (tidal volume < 8 mL/kg). Localization accuracy was assessed via hybrid computed tomography imaging, ensuring that the needle-to-lesion distance was ≤5 mm. Between-group differences were assessed using the chi-squared test, Fisher’s exact test, and the Mann–Whitney U test, as appropriate. Results: Pathological findings revealed primary lung malignancy in 150 patients, inclusive of invasive adenocarcinoma, adenocarcinoma in situ, and minimally invasive adenocarcinoma. Multivariate regression analysis identified tidal volume, nodule count, and localization depth as significant predictors of localization accuracy. Conclusions: This study demonstrated that ventilator settings with a tidal volume of 8–10 mL/kg significantly enhanced localization accuracy and slightly improved patient oxygenation. However, additional randomized controlled trials are warranted to validate these findings and establish definitive guidelines for future interventions.

Background: Cigarette smoking and particulate matter (PM) with aerodynamic diameter < 2.5 μm (PM_2.5) are major preventable cardiovascular mortality and morbidity promoters. Their joint role in metabolic syndrome (MS) pathogenesis is unknown. We determined the risk of MS based on PM_2.5 and cigarette smoking in Taiwanese adults.Methods: The study included 126,366 Taiwanese between 30 and 70 years old with no personal history of cancer. The Taiwan Biobank (TWB) contained information on MS, cigarette smoking, and covariates, while the Environmental Protection Administration (EPA), Taiwan, contained the PM_2.5 information. Individuals were categorized as current, former, and nonsmokers. PM_2.5 levels were categorized into quartiles: PM_2.5 ≤ Q1, Q1 < PM_2.5 ≤ Q2, Q2 < PM_2.5 ≤ Q3, and PM_2.5 > Q3, corresponding to PM_2.5 ≤ 27.137, 27.137 < PM_2.5 ≤ 32.589, 32.589 < PM_2.5 ≤ 38.205, and PM_2.5 > 38.205 μg/m³.Results: The prevalence of MS was significantly different according to PM_2.5 exposure (p-value = 0.0280) and cigarette smoking (p-value < 0.0001). Higher PM_2.5 levels were significantly associated with a higher risk of MS: odds ratio (OR); 95% confidence interval (CI) = 1.058; 1.014–1.104, 1.185; 1.134–1.238, and 1.149; 1.101–1.200 for 27.137 < PM_2.5 ≤ 32.589, 32.589 < PM_2.5 ≤ 38.205, and PM_2.5 > 38.205 μg/m³, respectively. The risk of MS was significantly higher among former and current smokers with OR; 95% CI = 1.062; 1.008–1.118 and 1.531; 1.450–1.616, respectively, and a dose-dependent p-value < 0.0001. The interaction between both exposures regarding MS was significant (p-value = 0.0157). Stratification by cigarette smoking revealed a significant risk of MS due to PM_2.5 exposure among nonsmokers: OR (95% CI) = 1.074 (1.022–1.128), 1.226 (1.166–1.290), and 1.187 (1.129–1.247) for 27.137 < PM_2.5 ≤ 32.589, 32.589 < PM_2.5 ≤ 38.205, and PM_2.5 > 38.205 μg/m³, respectively. According to PM_2.5 quartiles, current smokers had a higher risk of MS, regardless of PM_2.5 levels (OR); 95% CI = 1.605; 1.444–1.785, 1.561; 1.409–1.728, 1.359; 1.211–1.524, and 1.585; 1.418–1.772 for PM_2.5 ≤ 27.137, 27.137 < PM_2.5 ≤ 32.589, 32.589 < PM_2.5 ≤ 38.205, and PM_2.5 > 38.205 μg/m³, respectively. After combining both exposures, the group, current smokers; PM_2.5 > 38.205 μg/m³ had the highest odds (1.801; 95% CI =1.625–1.995).Conclusion: PM_2.5 and cigarette smoking were independently and jointly associated with a higher risk of MS. Stratified analyses revealed that cigarette smoking might have a much higher effect on MS than PM_2.5. Nonetheless, exposure to both PM_2.5 and cigarette smoking could compound the risk of MS.

Background Family history of gout and sex are independently associated with gout. However, there is a paucity of research regarding the joint role of both factors in gout pathogenesis. Therefore, we assessed the independent and combined association of family history of gout and sex with gout. Methods Our analysis included 132,311 Taiwan Biobank (TWB)-enrolled individuals comprising 21,159 gout cases and 111,152 controls. We subcategorized the family history of gout as (1) both siblings and parents had gout), (2) only parents had gout, and (3) only siblings had gout. Results Generally, sex (men compared to women) and family history of gout were independently associated with a higher risk of gout. The odds ratio (OR); 95% confidence interval (CI) was 9.175; 8.801–9.566 for sex, and 2.306; 2.206–2.410 for family history. For the subcategories ‘both siblings and had gout,’ ‘only parents had gout,’ and ‘only siblings had gout,’ the odds ratios (ORs); 95% confidence intervals (CIs) were 4.944; 4.414–5.538, 2.041; 1.927–2.161, and 2.162; 2.012–2.323, respectively. The interaction between sex and family history was significant (p value = 0.0001). After stratification by sex, family history of gout remained significantly associated with a higher risk of gout in both sexes, even though the odds ratios were higher in men. For the subcategories ‘both siblings and parents had gout,’ ‘only parent had gout,’ and ‘only siblings had gout,’ the corresponding ORs; 95% CIs were 6.279; 5.243–7.520, 2.211; 2.062–2.371, and 2.148; 1.955–2.361 in men and 4.199; 3.566–4.945, 1.827; 1.640–2.035, and 2.093; 1.876–2.336 in women. After integrating sex and family history (reference: women with no family history), the highest risk of gout was observed in men who had at least one parent and sibling with a history of gout (OR; 95% CI 55.774; 46.360–67.101). Conclusion Sex and family history of gout were independently and interactively associated with gout. Sex-wise, men had a higher risk of gout than women. Family history was associated with a higher risk of gout in both sexes, but men had a higher risk. Notably, men having both siblings and parents with gout had the highest risk of gout.

The standard treatment for early-stage lung cancer is complete tumor excision by limited resection of the lung. Preoperative localization is used before video-assisted thoracoscopic surgery (VATS) to improve the accuracy of pulmonary nodule excision. However, lung atelectasis and hypoxia resulting from controlling apnea during the localization procedure may affect the localization accuracy. Pre-procedural pulmonary recruitment may improve the respiratory mechanics and oxygenation during localization. In this study, we investigated the potential benefits of pre-localization pulmonary recruitment prior to pulmonary ground-glass nodule localization in a hybrid operating room. We hypothesized that pre-localization pulmonary recruitment would increase the localization accuracy, improve oxygenation, and prevent the need for re-inflation during the localization procedure. We retrospectively enrolled patients with multiple pulmonary nodule localizations before surgical intervention in our hybrid operating room. We compared the localization accuracy between patients who had undergone pre-procedure pulmonary recruitment and patients who had not. Saturation, re-inflation rate, apnea time, procedure-related pneumothorax, and procedure time were also recorded as secondary outcomes. The patients who had undergone pre-procedure recruitment had better saturation, shorter procedure time, and higher localization accuracy. The pre-procedure pulmonary recruitment maneuver was effective in increasing regional lung ventilation, leading to improved oxygenation and localization accuracy.

Background: Total thyroidectomy is the treatment of choice for multinodular goiter (MNG). In some of these cases, incidental thyroid cancer (ITC) is detected postoperatively. Papillary thyroid microcarcinoma (PTMC), the most common type of ITC, has clinical factors and pathologic similarities with ITC that have not been well clarified previously. We investigated the incidence and characteristics of ITC and PTMC in euthyroid patients undergoing total thyroidectomy for MNG. Methods: We retrospectively investigated the data of 151 euthyroid patients who underwent total thyroidectomy for MNG between January 2016 and December 2020. Patients with PTMC were then selected from among those with ITC for further data analysis. Results: The incidence rates of ITC and PTMC were 31.1% (47/151) and 21.1% (32/151), respectively. The mean age of patients with ITC was 52.8 ± 11.7 years, which was younger than that of patients with benign MNG (57.2 ± 12.5 years, p < 0.05). Bilateral cancer was observed in 17 patients with ITC (17/47, 36.2%) and nine with PTMC (9/32, 28.1%). The numbers of patients in the ITC and PTMC groups whose cancer was not on the side comprising the dominant tumor were 15 (15/47, 31.9%) and 13 (13/32, 40.6%), respectively. The multivariate analysis demonstrated that younger age was a clinical factor associated with ITC and PTMC. Conclusion: Younger age is a clinical factor for ITC and PTMC. We recommend taking considering clinical factors and pathologic characteristics of ITC and PTC when considering total thyroidectomy in euthyroid patients with MNG.

Chemotherapy is the treatment of choice for gastric cancer, but the currently available therapeutic drugs have limited efficacy. Studies have suggested that gastric cancer stem cells may play a key role in drug resistance in chemotherapy. Therefore, new agents that selectively target gastric cancer stem cells in gastric tumors are urgently required. Sirtuin-3 (SIRT3) is a deacetylase that regulates mitochondrial metabolic homeostasis to maintain stemness in glioma stem cells. Targeting the mitochondrial protein SIRT3 may provide a novel therapeutic option for gastric cancer treatment. However, the mechanism by which stemness is regulated through SIRT3 inhibition in gastric cancer remains unknown. We evaluated the stemness inhibition ability of the SIRT3 inhibitor 4′-bromo-resveratrol (4-BR), an analog of resveratrol in human gastric cancer cells. Our results suggested that 4-BR inhibited gastric cancer cell stemness through the SIRT3-c-Jun N-terminal kinase pathway and may aid in gastric cancer stem-cell–targeted therapy.

Different approaches to endoscopic thyroidectomy utilize incisions that result in inevitable physical trauma to patients since postoperative tissue fibrosis and scars will influence their quality of life for a lifetime. Over the past few years, most studies have discussed the safety concerns of different kinds of endoscopic thyroidectomy; conversely, there has been less discussion on postoperative quality of life. Because most patients undergoing thyroidectomy for cancer or benign diseases are likely to have long-term survival, it is essential to study the cosmetic outcome of patients’ scars from minimally invasive video-assisted thyroidectomy (MIVAT) and bilateral axillo-breast approach (BABA) robotic thyroidectomy on quality of life. From July 2015 to December 2017, 95 patients—60 who underwent MIVAT and 35 who underwent BABA robotic thyroidectomy—were retrospectively studied. Patient demographics, operative indications, pathologic findings, pain scores after surgery, complications, perception of scars, and overall satisfaction were compared between the two groups. The cosmetic outcome and overall satisfaction were evaluated at least 2 years after the operation using the patient scar assessment questionnaire and the 36-item short form health survey (SF-36). There was no statistically significant difference in scar perception between the two groups. However, in the SF-36, the MIVAT group had better satisfaction than the BABA robotic group regarding general health, vitality, mental health, and health change. MIVAT and BABA robotic thyroidectomy can be safely performed in selected patients, and patients who underwent MIVAT had better postoperative qualities of life than those who underwent the BABA robotic approach.

The eighth edition of the American Joint Committee on Cancer (AJCC) staging system for lung cancer was introduced in 2017 and included major revisions, especially of stage III. For the subgroup stage IIIA-N2 non-small-cell lung cancer (NSCLC), surgical resection remains controversial due to heterogeneous disease entity. The aim of this study was to evaluate the clinicopathologic features and prognostic factors of patients with completely resected stage IIIA-N2 NSCLC. We retrospectively evaluated 77 consecutive patients with pathologic stage IIIA-N2 NSCLC (AJCC eighth edition) who underwent surgical resection with curative intent in China Medical University Hospital between 2006 and 2014. Survival analysis was conducted, using the Kaplan–Meier method. Prognostic factors predicting overall survival (OS) and disease-free survival (DFS) were analyzed, using log-rank tests and multivariate Cox proportional hazards models. Of the 77 patients with pathologic stage IIIA-N2 NSCLC examined, 35 (45.5%) were diagnosed before surgery and 42 (54.5%) were diagnosed unexpectedly during surgery. The mean age of patients was 59 years, and the mean length of follow-up was 38.1 months. The overall one-, three-, and five-year OS rates were 91.9%, 61.3%, and 33.5%, respectively. Multivariate analysis showed that tumor size p = 0.003) and video-assisted thoracoscopic surgery (VATS) approach (HR: 0.383, p = 0.014) were significant predictors for improved OS. For patients with surgically treated, pathologic stage IIIA-N2 NSCLC, tumor size <3 cm and the VATS approach seemed to be associated with better prognosis.

The nasopharyngeal tract traps mainly coarse particles in inhaled air. Soluble carcinogenic compounds, endotoxins, and trace metals contained in these particles are potential causes of inflammation and oxidative stress which could enhance carcinogenesis. The aim of this study was to determine the association between coarse particulate matter (PM_10-2.5) and nasopharyngeal cancer (NPC). A total of 521,098 men (355 cases and 520,743 non-cases), aged ≥40 years were included in this study. Data were retrieved from the Taiwan Cancer Registry, the Adult Preventive Medical Services Database, and the Air Quality Monitoring Database. PM_10-2.5 was significantly associated with a higher risk of NPC after adjusting for SO₂, NOx, O₃, age, body mass index, smoking, alcohol drinking, betel nut chewing, exercise, hypertension, diabetes, and hyperlipidemia. With PM_10-2.53 as the reference, the ORs and 95% CIs were 1.47; 1.03–2.11, 1.34; 0.94–1.91, and 1.68; 1.16–2.44 for 20.44≤PM_10-2.510-2.510-2.5≥29.27 μg/m³, respectively. PM_10-2.5 remained significantly associated with a higher risk of NPC after further adjustments were made for the aforementioned covariates and PM_2.5. The ORs; 95% CIs were 1.42; 0.96 to 2.12, 1.41; 0.94 to 2.10, and 1.71; 1.10 to 2.66 for 20.44≤PM_10-2.510-2.510-2.5≥29.27 μg/m³, respectively. In conclusion, PM_10-2.5 was significantly associated with a higher risk of NPC in Taiwanese men.