Search

Background: About half of myasthenia gravis (MG) patients with purely ocular symptoms at onset progress to generalized myasthenia gravis (gMG). Objectives: To develop and validate a model to predict the generalization of MG at 6months after disease onset in patients with ocular-onset myasthenia gravis (OoMG). Methods: Data of patients with OoMG were retrospectively collected from two tertiary hospitals in Germany and China. An accelerated failure time model was developed using the backward elimination method based on the German cohort to predict the generalization of OoMG. The model was then externally validated in the Chinese cohort, and its performance was assessed using Harrell’s C-index and calibration plots. Results: Four hundred and seventy-seven patients (275 from Germany and 202 from China) were eligible for inclusion. One hundred and three (37.5%) patients in the German cohort progressed from OoMG to gMG with a median follow-up time of 69 (32–116) months. The median time to generalization was 29 (16–71) months. The estimated cumulative probability of generalization was 30.5% [95% CI (confidence interval), 24.3–36.2%) at 5years after disease onset. The final model, which was represented as a nomogram, included five clinical variables: sex, titer of anti-AChR antibody, status of anti-MuSK antibody, age at disease onset and the presence of other autoimmune disease. External validation of the model using the bootstrap showed a C-index of 0.670 (95% CI, 0.602–0.738). Calibration curves revealed moderate agreement of predicted and observed outcomes. Conclusion: The nomogram is a good predictor for generalization in patients with OoMG that can be used to inform of the individual generalization risk, which might improve the clinical decision-making. [ABSTRACT FROM AUTHOR]

Myasthenia gravis, Thymectomy, Generalization, Complete stable remission. [Extracted from the article]

PURPOSE: Telerobotic surgery is a developing and promising modality that highly improves the laparoscopic dexterity. We have performed more than 100 laparoscopic and thoracoscopic procedures since December 2002 with the aid of the Da Vinci® robotic system. This study was designed to assess the value of robots in colonic laparoscopic surgery. We present our first cases of robotic-assisted colectomies. METHODS: Two patients underwent a telerobotic-assisted sigmoidectomy for sigmadiverticulitis. One of these cases was complicated with a sigmoid-bladder fistula. Three other patients were submitted to a colon resection for cancer: sigmoidectomy (n = 2), and right colectomy (n = 1). A four-trocar technique was used for all operations. Tissue dissection of colonic adhesions, mobilization of the colon, management of the fistula, mesenteric dissection and division, and bowel resection were fully performed with the telerobotic system. RESULTS: Three operations were completed using the Da Vinci® system without any problems in acceptable times. In two patients, the operation had to be converted to laparotomy because of severe adhesions and locally extended tumor growth. Postoperative courses of all patients were uneventful. Patients were discharged between postoperative Days 9 and 20, and were well six months later. CONCLUSIONS: Colonic telerobotic surgery can be performed safely. Benefits were seen during dissection of the rectum in the small pelvis. A major limitation is a lack of a large operation field especially if there is the need to dissect a colonic flexure in the upper abdomen. The enormous costs and the lack of appropriate instruments can be a major problem in the further expansion of the telerobotic surgery. [ABSTRACT FROM AUTHOR]

Background: Pleural invasion (PI) is considered to be an adverse prognostic factor in non-small cell lung cancer (NSCLC). However, the prognostic roles of PI in pathologic (p)T3-4N0M0 NSCLC remain controversial. Therefore, this study aimed to evaluate the predictive value of PI in patients with pT3-4N0M0 NSCLC., Methods: This study selected 9,185 patients with resected pT3-4N0M0 NSCLC from 2010 to 2019 from the Surveillance, Epidemiology, and End Results (SEER) database. PL0 was defined as lack of PI; PL1 and PL2 as invasion of the elastic layer and of the surface of the visceral pleural invasion (VPI), respectively; and PL3 as the parietal pleura invasion (PPI). Patients were divided into six groups according to PI status and T categories. This study used propensity score matching (PSM) to reduce baseline differences. The risk factors were statistically analyzed using the Cox proportional hazard model. Overall survival (OS) was assessed with the Kaplan-Meier method and log-rank test., Results: Kaplan-Meier analysis stratified by T category showed worse OS in patients with PI (P<0.001). In multivariable Cox analysis of OS, patients with T3 and VPI had a significantly worse prognosis than did those with T3 but not PI (after PSM: P=0.001). There was no difference between those with T3 and VPI and those with T3 and PPI (after PSM: P=0.12) or between those with T3 PI and those with T4 but not PI (after PSM: P=0.30)., Conclusions: PI is a factor of poor prognosis in patients with pT3-4N0M0 NSCLC. Our results recommend future studies exploring the prognostic value of various T3-4 subcategories to allow PI to be separated from other T descriptors and confounders., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-24-860/coif). W.Z. receives financial support from China Scholarship Council during his studies in Germany. H.B. is from Charité Research Organisation GmbH (CRO), Berlin, Germany. The other authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Background: Pneumonectomy is one of the important surgical methods for non-small cell lung cancer (NSCLC). This study evaluated the effects of laterality on the short- and long-term survival of NSCLC patients undergoing pneumonectomy., Methods: We reviewed the Surveillance, Epidemiology, and End Results database to retrieve the data of patients who underwent pneumonectomy for stage I-III NSCLC from 2004 to 2015. Propensity score matching (PSM) was used to reduce the selection bias. Logistic regression was used to analyze the correlation between laterality and mortality at 3, 6, and 9 months. The Kaplan-Meier curve was used to further assess the effect of laterality on overall survival (OS)., Results: A total of 4,763 patients met the enrollment criteria [right-sided, 1,988 (41.7%); left-sided, 2,775 (58.3%)]. After PSM, 1,911 patients for each side were included in the further analysis. The first 6 months following pneumonectomy was the main period of death, with 32.0% (428/1,336) and 19.9% (250/1,258) of right- and left-sided deaths occurring during this period. The logistic regression analysis showed that right-sided pneumonectomy was an independent risk factor for 3- (P<0.001) and 6-month (P<0.001) mortality. However, laterality had no significant effect on postoperative death at 7-9 months (P=0.82). In the total cohort, right-sided patients had worse OS (P<0.001), but the subgroup survival analysis of patients with a follow-up period >6 months revealed that laterality had no statistically significant effect on OS (P=0.75)., Conclusions: Right-sided pneumonectomy was associated with a higher perioperative mortality risk that lasted about 6 months. After that period, laterality was not observed to have a significant prognostic effect on the OS of patients undergoing pneumonectomy., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-24-700/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)