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Background: Liver transplantation (LT) activities during the COVID-19 pandemic have been curtailed in many countries. The impact of various policies restricting LT on outcomes of potential LT candidates is unclear. Methods: We studied all patients on the nationwide LT waitlists in Hong Kong and Singapore between January 2016 and May 2020. We used continuous time Markov chains to model the effects of different scenarios and varying durations of disruption on LT candidates. Findings: With complete cessation of LT, the projected 1-year overall survival (OS) decreased by 3•6%, 10•51% and 19•21% for a 1-, 3- and 6-month disruption respectively versus no limitation to LT, while 2-year OS decreased by 4•1%, 12•55%, and 23•43% respectively. When only urgent (acute-on-chronic liver failure [ACLF] or acute liver failure) LT was allowed, the projected 1-year OS decreased by a similar proportion: 3•1%, 8•41% and 15•20% respectively. When deceased donor LT (DDLT) and urgent living donor LT (LDLT) were allowed, 1-year projected OS decreased by 1•2%, 5•1% and 8•85% for a 1-, 3- and 6-month disruption respectively. OS was similar when only DDLT was allowed. Complete cessation of LT activities for 3-months resulted in an increased projected incidence of ACLF and hepatocellular carcinoma (HCC) dropout at 1-year by 49•1% and 107•96% respectively. When only urgent LT was allowed, HCC dropout and ACLF incidence were comparable to the rates seen in the scenario of complete LT cessation. Interpretation: A short and wide-ranging disruption to LT results in better outcomes compared with a longer duration of partial restrictions. Funding: None to disclose.

More than 80% of people in the United States who are older than 65 years have 1 or more chronic medical problems, and 50% have 2 or more. The cost of care for the elderly is at least 3 to 4 times that of younger populations and is rapidly growing, mostly because of a lack of preventive approaches and overly medicalized and fragmented care. This article summarizes the most up-to-date evidence for specific integrative modalities for common geriatric conditions, including falls, frailty, osteoporosis, and end-of-life palliative care.

PURPOSE The aim of the study was to assess the ability of chest digital tomosynthesis (DTS) for detection of interstitial lung disease (ILD) compared with conventional chest radiography. MATERIALS AND METHODS We retrospectively reviewed 78 patients (60 males, 18 females, mean age = 53.05 years, range, 19-83 years) who underwent chest DTS for a 5-year interval (January 1, 2009-December 31, 2014). Of the 78 patients, 33 (42.3%) carried a diagnosis of ILD and 45 (57.7%) were not ILD. All computed tomography reports and medical records were reviewed. The conventional chest radiography and DTS were separately reviewed by 2 radiologists for the presence of ILD and the confidence in diagnosis. RESULTS The diagnostic accuracy of DTS for the detection of ILD was better than conventional chest radiography (P < 0.05). Digital tomosynthesis had a sensitivity of 83.3% and negative predictive value of 89.0% that were statistically significantly better than conventional chest radiography (43.9% and 70.9%, respectively). Confidence in diagnosing ILD at DTS was higher than conventional chest radiography (P < 0.001) and had higher interobserver agreement than conventional chest radiography (P < 0.01). CONCLUSIONS Digital tomosynthesis improves diagnostic performance and confidence in diagnosing ILD compared with conventional chest radiography. Digital tomosynthesis can be suggested as the initial diagnostic technique for patients with suspected ILD.

Themaincauses of smoking-related deaths are lung cancer, chronicobstructive pulmonary disease (COPD), and ischemic heartdisease.Smokinghasalsobeenstronglyassociatedwithseveralinterstitiallungdiseases(ILDs),namelypulmonaryLangerhanscell histiocytosis (PLCH), respiratory bronchiolitis (RB), RB-associated ILD (RB-ILD), and desquamative interstitialpneumonia (DIP).This article reviews the major diffuse pulmonary diseasesaffectingsmokers,includingemphysemaandsmoking-relatedILDs. We describe the histologic and radiologic features of thedifferent forms of emphysema (centrilobular, panlobular, andparaseptal). Finally, we then discuss the clinical, histopatho-logic, and radiologic characteristics of smoking-related ILDs,including PLCH, RB, RB-ILD, and DIP. Bronchogenic carci-noma is not covered in this article.

Background: There have been several reports in the literature of dermatofibromas with granular cells. Here we report a granular cell tumor with the architecture of a dermatofibroma. This is the first report of this histological variant of granular cell tumor. The lesion was a 2.5-cm oval, hyperpigmented plaque present for “years” on the back of a 60-year-old African-American woman. Methods: The specimen was processed using formalin fixation and paraffin embedding. Tissue sections were stained with hematoxylin and eosin. Immunohistochemical studies were performed with antibodies directed against S-100 protein, neuron-specific enolase, and factor XIIIa. Results: Histopathologic examination revealed granular cells, some of which were spindle shaped, distributed singly and in small groups between collagen bundles resembling a dermatofibroma. Immunohistochemical studies showed the tumor cells to be positive for S-100 and neuron-specific enolase and negative for factor XIIIa. Conclusion: The immunohistochemical findings support the diagnosis of a granular cell tumor with a dermatofibroma-like pattern.

The lungs are a common site for metastatic spread of malignancy. Approximately 20%-54% of patients with extrathoracic malignancy have pulmonary metastases at autopsy. The most common primary neoplasms with pulmonary metastases at autopsy include breast, colon, kidney, uterus, and head and neck. Less common primary malignancies including choriocarcinoma, osteosarcoma, testicular tumors, melanoma, and thyroid carcinoma also metastasize to the lungs. The detection of pulmonary metastases, as with other distant metastases, indicates a poor prognosis and directly affects treatment planning. For example, in a large retrospective study of patients with melanoma, median survival was only 7.3 months after development of pulmonary metastases. Evaluation is primarily performed with chest radiography and computerized tomography (CT), although other modalities such as fluorodeoxyglucose-positron emission tomography (FDG-PET) may also play a role. Pulmonary metastases can have a wide spectrum of appearances on imaging, reflecting the route of spread as well as the local behavior of the neoplastic cells.