{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T15:39:13Z","timestamp":1767800353987,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T00:00:00Z","timestamp":1755388800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["112\u20102314\u2010B\u2010037\u2010043"],"award-info":[{"award-number":["112\u20102314\u2010B\u2010037\u2010043"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["113\u20102314\u2010B\u2010037\u2010088\u2010MY3"],"award-info":[{"award-number":["113\u20102314\u2010B\u2010037\u2010088\u2010MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","award":["113\u20103R30"],"award-info":[{"award-number":["113\u20103R30"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Spontaneous pneumomediastinum (SPM) with pneumorrhachis is rare but generally benign and self\u2010limiting. However, the impact of environmental and seasonal factors on SPM remains unclear. This study investigated their association with SPM onset and clinical outcomes. We conducted a 12\u2010year retrospective review of SPM cases, comparing clinical characteristics and outcomes between patients with and without pneumorrhachis. A case\u2010crossover design was used to assess short\u2010term associations between environmental exposures and SPM incidence, analyzed via conditional logistic regression. A total of 70 consecutive patients were identified, with 9 classified as SPM with pneumorrhachis and 61 as SPM without pneumorrhachis. While both groups were predominantly managed with hospitalization, those with pneumorrhachis had longer hospital stays (median: 7 vs. 3\u2009days,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002) and were more often associated with severe\u2010grade SPM and identifiable triggers (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001 and\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.009, respectively). No significant environmental exposure differences were observed between groups. Seasonally, SPM incidence was significantly higher in autumn and winter (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), consistent with elevated air pollutant levels. Linear regression showed that standardized\n                    <jats:italic>\u03b2<\/jats:italic>\n                    coefficients for PM\n                    <jats:sub>2.5<\/jats:sub>\n                    were higher in autumn and winter (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u20091.15 and\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u20091.18), indicating a seasonal association between PM\n                    <jats:sub>2.5<\/jats:sub>\n                    and SPM onset. Despite experiencing more triggers and longer hospitalization, patients with pneumorrhachis had similarly favorable clinical courses. The seasonal clustering of SPM and its association with elevated PM\n                    <jats:sub>2.5<\/jats:sub>\n                    levels suggest that air pollution may be a contributing factor, warranting further investigation.\n                  <\/jats:p>","DOI":"10.1002\/kjm2.70096","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T04:31:26Z","timestamp":1755491486000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Environmental and Seasonal Factors on Spontaneous Pneumomediastinum With and Without Pneumorrhachis"],"prefix":"10.1002","volume":"42","author":[{"given":"Yu\u2010Wei","family":"Liu","sequence":"first","affiliation":[{"name":"PhD Program in Environmental and Occupational Medicine, College of Medicine Kaohsiung Medical University and National Health Research Institutes  Kaohsiung Taiwan"},{"name":"Division of Thoracic Surgery, Department of Surgery Kaohsiung Medical University, Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Surgery, School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chieh\u2010Ni","family":"Kao","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Surgery Kaohsiung Medical University, Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chi\u2010Chang","family":"Ho","sequence":"additional","affiliation":[{"name":"Institute of Environmental and Occupational Health Sciences National Taiwan University College of Public Health  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shah\u2010Hwa","family":"Chou","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Surgery Kaohsiung Medical University, Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pau\u2010Chung","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Environmental and Occupational Health Sciences National Taiwan University College of Public Health  Taipei Taiwan"},{"name":"Department of Public Health National Taiwan University College of Public Health  Taipei Taiwan"},{"name":"Department of Environmental and Occupational Medicine National Taiwan University Hospital and National Taiwan University College of Medicine  Taipei Taiwan"},{"name":"National Institute of Environmental Health Sciences National Health Research Institutes  Miaoli Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2903-1703","authenticated-orcid":false,"given":"Shu\u2010Hung","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Division of Plastic Surgery, Department of Surgery Kaohsiung Municipal Siaogang Hospital  Kaohsiung Taiwan"},{"name":"Graduate Institute of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.02.051"},{"issue":"10","key":"e_1_2_9_3_1","first-page":"1817","article-title":"Clinical Experience of Spontaneous Pneumomediastinum: Diagnosis and Treatment","volume":"7","author":"Kim K. 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