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A 12-year retrospective review analyzed associations between environmental exposures and SPM onset using a case-crossover design with conditional logistic regression, comparing patients with and without pneumorrhachis. Among 70 consecutive cases, pneumorrhachis showed longer hospitalization and more severe disease and triggers, while overall environmental exposures did not differ; seasonality increased incidence in autumn and winter with higher PM2.5 effects.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/impact-of-environmental-and-seasonal-factors-on-spontaneous-pneumomediastinum-with-and-without-pneumorrhachis/459396/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/impact-of-environmental-and-seasonal-factors-on-spontaneous-pneumomediastinum-with-and-without-pneumorrhachis/459396.png","ImageObject",300,407,{"name":92,"@type":93},"Riley","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the study aim regarding spontaneous pneumomediastinum?","Question",{"text":112,"@type":113},"To investigate how environmental and seasonal factors relate to the onset of SPM and its clinical outcomes, comparing patients with and without pneumorrhachis.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How many patients were included, and how were they classified?",{"text":117,"@type":113},"Seventy consecutive SPM patients were identified, with 9 classified as SPM with pneumorrhachis and 61 as SPM without pneumorrhachis.",{"name":119,"@type":110,"acceptedAnswer":120},"What seasonal pattern did the study observe for SPM incidence?",{"text":121,"@type":113},"SPM incidence was significantly higher in autumn and winter, consistent with elevated air pollutant levels.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},459396,1792165601,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},1374391975076,"https://ap-avatar.wpscdn.com/avatar/14000253ca4ec9f6853?x-image-process=image/resize,m_fixed,w_180,h_180&k=1783305029341752051","The Kaohsiung Journal of Medical Sciences  \nORIGINAL ARTICLE  OPEN ACCESS   \nImpact of Environmental and Seasonal Factors on Spontaneous Pneumomediastinum With and Without Pneumorrhachis  \nYu-Wei Liu1,2,3 | Chieh-Ni Kao2 | Chi-Chang Ho4 | Shah-Hwa Chou2 | Pau-Chung Chen4,5,6,7 | Shu-Hung Huang3,8,9   \n1PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan | 2Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University, Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan | 3Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan | 4Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan | 5Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan | 6Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan | 7National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan | 8Division of Plastic Surgery, Department of Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung,  \nTaiwan | 9Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Correspondence: Pau-Chung Chen ([pchen@ntu.edu.tw](pchen@ntu.edu.tw)) | Shu-Hung Huang ([huangsh63@gmail.com](huangsh63@gmail.com))  \nReceived: 15 March 2025 | Revised: 16 July 2025 | Accepted: 31 July 2025  \nFunding: This work was supported by National Science and Technology Council, 112-2314-B-037-043, 113-2314-B-037-088-MY3; Kaohsiung Medical University Hospital, 113-3R30 .  \nKeywords: air pollution | environmental factors | pneumorrhachis | seasonal variations | spontaneous pneumomediastinum  \nABSTRACT  \nSpontaneous pneumomediastinum (SPM) with pneumorrhachis is rare but generally benign and self-limiting. 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-year retrospective review of SPM cases, comparing clinical characteristics and outcomes between patients with and without pneumorrhachis. A case-crossover design was used to assess short-term 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 days, p = 0.002) and were more often associated with severe-grade SPM and identifiable triggers (p \u003C 0.001 and p = 0.009, respectively) . No significant environmental exposure differences were observed between groups. Seasonally, SPM incidence was significantly higher in autumn and winter (p \u003C 0.001), consistent with elevated air pollutant levels. Linear regression showed that standardized β coefficients for PM2.5 were higher in autumn and winter (β = 1.15 and β = 1.18), indicating a seasonal association between PM2.5 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 PM2.5 levels suggest that air pollution may be a contributing factor, warranting further investigation.  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2025 The Author(s) . The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia, Ltd on behalf of Kaohsiung ","cbCaimh292UTPIDf","https://ap.wps.com/l/cbCaimh292UTPIDf","pdf",815356,13,"English","# Abstract\n# Introduction\n## Definition and triggers of SPM\n## Diagnostic and clinical course considerations\n## Role of pneumorrhachis and severity\n## Seasonality and environmental exposure rationale","[{\"question\":\"What was the study aim regarding spontaneous pneumomediastinum?\",\"answer\":\"To investigate how environmental and seasonal factors relate to the onset of SPM and its clinical outcomes, comparing patients with and without pneumorrhachis.\"},{\"question\":\"How many patients were included, and how were they classified?\",\"answer\":\"Seventy consecutive SPM patients were identified, with 9 classified as SPM with pneumorrhachis and 61 as SPM without pneumorrhachis.\"},{\"question\":\"What seasonal pattern did the study observe for SPM incidence?\",\"answer\":\"SPM incidence was significantly higher in autumn and winter, consistent with elevated air pollutant levels.\"}]","Impact of Environmental and Seasonal Factors on Spontaneous Pneumomediastinum With and Without Pneumorrhachis | PDF",1790755847,33]