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Background Brain metastases frequently occur in patients with non‐small cell lung cancer (NSCLC) resulting in a poor prognosis. Here, we investigated the association between PD‐L1 expression and brain metastasis in patients with NSCLC and its clinical significance. Methods A total of 270 patients diagnosed with metastatic NSCLC who underwent PD‐L1 testing on their tumor tissue between January 2017 and March 2019 were retrospectively reviewed. The VENTANA PD‐L1 (SP263) assay was used, and positive PD‐L1 expression was defined as staining in ≥1% of tumor cells. Results Positive PD‐L1 expression was observed in 181 (67.0%) patients, and 74 (27.4%) patients had brain metastasis at diagnosis. Synchronous brain metastases were more frequently observed in PD‐L1‐positive compared with PD‐L1‐negative patients (31.5% vs. 19.1%, p = 0.045). Multiple logistic regression analysis identified positive PD‐L1 expression (odds ratio [OR]: 2.24, p = 0.012) as an independent factor associated with synchronous brain metastasis, along with the histological subtype of nonsquamous cell carcinoma (OR: 2.84, p = 0.003). However, the incidence of central nervous system (CNS) progression was not associated with PD‐L1 positivity, with a two‐year cumulative CNS progression rate of 26.3% and 28.4% in PD‐L1‐positive and PD‐L1‐negative patients, respectively (log rank p = 0.944). Furthermore, positive PD‐L1 expression did not affect CNS progression or overall survival in patients with synchronous brain metastasis (long rank p = 0.513 and 0.592, respectively). Conclusions Initial brain metastases are common in NSCLC patients with positive PD‐L1 expression. Further studies are necessary to understand the relationship between early brain metastasis and cancer immunity., We investigated the association between PD‐L1 expression and brain metastasis in patients with non‐small cell lung cancer (NSCLC) and its clinical significance. Patients with tumors exhibiting positive PD‐L1 expression (TPS ≥ 1%) were found to have a higher frequency and risk of synchronous brain metastasis when diagnosed with advanced NSCLC. No prognostic impact of PD‐L1 expression was observed on either CNS progression in the entire cohort of patients or OS in patients presenting with synchronous brain metastasis.

Study Type – Prognosis (case series) Level of Evidence 4 OBJECTIVE To investigate the rate of pathologically confirmed unfavourable prostate cancers among Korean men who fulfilled the contemporary Epstein criteria for clinically insignificant prostate cancer. PATIENTS AND METHODS This was a retrospective study of 131 Korean men who underwent radical prostatectomy (RP) for clinically insignificant prostate cancer as defined by contemporary Epstein criteria. We assessed the percentage of unfavourable prostate cancer (pathological Gleason sum ≥7 and/or extraprostatic extension [EPE]) among these men and tried to identify useful predictors for such unfavourable tumour profiles using uni- and multivariate analyses. RESULTS Among 131 men with clinically insignificant prostate cancer, 40 (30.5%) had pathological Gleason ≥7 tumours after RP. Of these 40 men, four (3.1%) also had EPE on examination of RP specimen. All those who did not have Gleason score upgrading after RP had organ-confined disease from examination of RP specimen. Overall, 40 (30.5%) of the 131 men who fulfilled the contemporary Epstein criteria for clinically insignificant prostate cancer before RP had pathologically unfavourable disease. Among our patients, no significant preoperative predictor of pathologically unfavourable disease was identified using uni- and multivariate analyses. CONCLUSION Our results showed that a significant proportion of contemporary Korean patients who meet all the conditions of the contemporary Epstein criteria for prediction of clinically insignificant prostate cancer might actually harbour prostate cancer with unfavourable pathological features. Such findings should be considered when treatment options are contemplated based upon the Epstein criteria among Asian patients.

This paper describes the development and performance evaluation of multi-nozzle virtual impactors used in concentrating aerosol particles. Four virtual impactors were designed: one single-nozzle and three multi-nozzle virtual impactors with 4, 12 and 18 nozzles, respectively. For each of the four designs, two kinds of nozzles were implemented, one that had a flat surface and the other a cut-out nozzle designed with consideration of airflow streamlines inside the impactor. Thus, a total of 8 models of virtual impactors were designed and fabricated to study the internal particle loss and concentration performance. Multi-nozzle devices were provided primarily for applications involving high-volume air sampling. Virtual impactors with cut-out nozzles yielded higher fractional collection efficiencies and lower internal losses than virtual impactors with flat nozzles. It is expected that significant flow turbulence will occur in the space between the acceleration nozzles and the collection probes. This may increase the internal losses arising from back-impaction on the acceleration nozzles and particle deposition on the collection probes with flat nozzles.

At the elbow, the ulnar nerve is compressed most commonly either in the epicondylar groove or at the cubital tunnel. While conventional electrodiagnosis may localize an ulnar neuropathy to the elbow, separating epicondylar syndrome (tardy ulnar nerve palsy) from cubital tunnel syndrome is more difficult. We describe a new method using a near-nerve needle technique for distinguishing these two types of ulnar neuropathy at the elbow. We placed three active needle electrodes across the elbow: the first was 4 cm above, and the second and third were 1.5 cm and 6 cm below the medial epicondyle, respectively. The latter two points were chosen because of the presence of the cubital tunnel in this segment. Sensory, motor, and mixed nerve conduction studies (NCS) were performed on these two segments (elbow segment and cubital tunnel segment) in 26 normal nerves and normal data were established. We also present 7 cases of epicondylar ulnar nerve palsy and 1 case of cubital tunnel syndrome in which we were able to confirm the diagnosis with the present method. In 3 cases of epicondylar ulnar nerve palsy, the present method accurately localized the lesion when other methods failed. We believe that this method will be helpful in distinguishing cubital tunnel syndrome from epicondylar ulnar nerve palsy, especially in early ulnar neuropathy in which only sensory fibers are involved.

Guanidine hydrochloride is known to be highly effective in the symptomatic treatment of the Lambert-Eaton myasthenic syndrome (LEMS). However, because of its potentially dangerous side reactions of hematologic abnormalities and renal insufficiency, 3,4-diaminopyridine, which is not readily available in the United States, is recommended as the preferred drug for LEMS. We used low-dose guanidine and pyridostigmine combination therapy in 9 patients with LEMS and analyzed its long-term safety and effectiveness. In all patients, a liberal amount of pyridostigmine was used, while daily guanidine dose was kept below 1000 mg a day, and guanidine was given between pyridostigmine dosings. This combination therapy was used for 3-102 months (mean: 34.1 months) and improved clinical status in all patients. Although guanidine had to be discontinued due to severe gastrointestinal symptoms in 3 cases, no serious side reactions such as bone marrow suppressions or signs of renal insufficiency developed in any case. Thus, we conclude that low-dose guanidine therapy is relatively safe and effective for long-term symptomatic treatment of LEMS when it is combined with pyridostigmine.

Objectives: There are many reports of experience with Goode T-tubes and Per-Lee tubes in the literature, although there are only 3 studies with Paparella II grommets. In addition to the relative lack of Paparella II studies, we believe there are 2 other areas of deficiency. The aim of the present study was to provide comprehensive 5-year follow-up data on the use of Paparella II grommets in children with refractory glue ear. Methods: Retrospective case study of all children who underwent Paparella II grommet insertions at the ENT department, Burton district general hospital between 1992 and 1997. Results: A total of 102 grommets placed in 53 children were analyzed. All children had at least 1 previous grommet treatment for glue ear. The mean functional period of the grommets was 3.73 years and 53 (52.0%) grommets remained in situ for the whole 5-year duration of follow-up. Overall infection rate was 55.9% and perforation rate was 49%. Other complications included blockage (n = 1) and dislocation into middle ear (n = 4). There was no cholesteatoma development. There was increased morbidity (infection and perforation rates) associated with increased duration of grommet in situ. This was most notable after 36 months. Conclusions: This long-term follow-up study presents data that establish the functional duration and complications associated with the Paparella II grommet, when used to treat refractory childhood OME. For grommets that have remained in situ for over 3 years, a high rate of infection and persistent tympanic membrane perforation is demonstrated.

The Calman reforms have led to a reduction in the length of all surgical training. Before the reforms, dental graduates had a shorter pathway than medical graduates to achieve maxillofacial consultant status, with exemptions from primary FRCS and 3-year medical courses. Now that 3-year dentistry courses for medical graduates have been established, medical graduates and dental graduates can complete their second degrees in the same length of time. Furthermore, medical graduates with the MRCS diploma are exempted from parts A and B of the MFDS, whereas dental graduates with MFDS have no exemptions from the MRCS examinations. Dental graduates may need more time as senior house officers to take these extra examinations. This could lead to dental graduates taking longer time than medical graduates to achieve consultant status. Traditionally, maxillofacial surgery has recruited the overwhelming majority of its trainees from dental graduates and has had close links with dental surgery. However, these recent developments in training make maxillofacial surgery far more attractive to medical graduates. Whether maxillofacial surgery continues to recruit the majority of its trainees form a dental background remains to be seen.