Tissue diagnosis of peripheral pulmonary lesions (PPLs) can be challenging. In the past, flexible bronchoscopy was commonly performed for this purpose but its diagnostic yield is suboptimal. This has led to the development of new bronchoscopic modalities such as radial endobronchial ultrasound (R-EBUS), electromagnetic navigation bronchoscopy (ENB) and virtual bronchoscopy (VB). We performed this meta-analysis using data from previously published R-EBUS studies, to determine its diagnostic yield and other performance characteristics. Ovid MEDLINE and PubMed databases were searched for R-EBUS studies in September 2016. Diagnostic yield was calculated by dividing the number of successful diagnoses by the total number of lesions. Meta-analysis was performed using MedCalc (Version 16.8). Inverse variance weighting was used to aggregate diagnostic yield proportions across studies. Publication bias was assessed using funnel plot and Duval and Tweedie's test. 57 studies with a total of 7872 lesions were included in the meta-analysis. These were published between October 2002 and August 2016. Overall weighted diagnostic yield for R-EBUS was 70.6% (95% CI: 68–73.1%). The diagnostic yield was significantly higher for lesions >2 cm in size, malignant in nature and those associated with a bronchus sign on computerized tomography (CT) scan. Diagnostic yield was also higher when R-EBUS probe was within the lesion as opposed to being adjacent to it. Overall complication rate was 2.8%. This is the largest meta-analysis performed to date, assessing the performance of R-EBUS for diagnosing PPLs. R-EBUS has a high diagnostic yield (70.6%) with a very low complication rate.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/resp.12980

Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis

Introduction: Uptake of HIV tests is a challenging issue in vulnerable populations including immigrants, normally using standard diagnostic tools. Objectives of this study were to evaluate the acceptability of HIV rapid test; estimate the percentage of newly HIV diagnoses and evaluate knowledge, attitudes and perception (KAP) about HIV/AIDS and other STIs in a specific set of immigrants and vulnerable population in Rome (Italy). Methods: All immigrant and Italian people, aged 16–70 years, attending the infectious disease outpatient clinic of the National Institute for Health, Migration and Poverty (INMP) in Rome (Italy), during the period December 2012 to December 2013 were enrolled. HIV rapid testing was provided for free and patients were asked to fill in a questionnaire evaluating KAP about HIV/STIs. All patients with risky sexual behaviours or with a recent diagnosis of STIs were invited to come back after 3–6 months and a post-counselling questionnaire was offered. Results: Out of the total s...

HIV rapid testing in the framework of an STI prevention project on a cohort of vulnerable Italians and immigrants.

Left ventricular (LV) myocardial longitudinal diastolic strain rate measured by two-dimensional speckle tracking imaging (2D-STI) was proved to have a better correlation with the LV diastolic function. We aimed to use this sensitive tool to predict LV myocardial diastolic dysfunction in young peritoneal dialysis (PD) patients with preserved LV ejection fraction (LVEF). We enrolled 30 PD patients aged ≤60 with LVEF ≥54% and classified as normal LV diastolic function by conventional echocardiography, and 30 age- and sex-matched healthy people as the control group. The left atrial maximum volume index (LAVI), LV mass index (LVMI), LVEF, LV posterior wall thickness (LVPWT), interventricular septal thickness (IVST), peak velocity of tricuspid regurgitation (TR), peak early diastolic velocity/late diastolic velocity (by Pulsed Doppler) (E/A) and E/peak velocity of the early diastolic wave (by Pulsed-wave tissue Doppler) (E/e’) were recorded by conventional echocardiographic. Next, the average LV global longitudinal systolic strain (GLS avg) and the average LV global longitudinal diastolic strain rate (DSr avg) during early diastole (DSrE avg), late diastole (DSrA avg) and isovolumic relaxation period (DSrIVR avg) were obtained from 2D-STI. Combined them with E, the new noninvasive indexes (E/DSrE avg., E/DSrA avg. and E/DSrIVR avg) were derived. The PD group ‘s LVEF, E/e′, TR and LAVI were in the normal range compared with the controls, and only e′ (p < 0.001) was decreased. The LVMI (p < 0.001), LVPWT (p < 0.001), IVST (p < 0.001) increased while E/A (p < 0.001) decreased. The GLS avg. (p = 0.008) was significantly decreased in PD patients compared with the controls. DSrA avg. (p = 0.006) and E/DSrE avg. (p = 0.006) were increased, while DSrE avg. (p < 0.001), DSrIVR avg. (p = 0.017) and E/DSrA avg. (p < 0.001) decreased. After the multivariable regression analysis, the correlation between DSrE and the conventional parameters including LVPWT (p < 0.001), E/A (p < 0.001) still remained significant. Young PD patients with preserved LVEF already exhibited myocardial diastolic dysfunction. Global diastolic strain rate indexes were valuable parameters to evaluate diastolic dysfunction. Additionally, LVPWT was highly correlated with DSrE, such parameter should be taken into account for predicting the early LV diastolic dysfunction in clinical practice.

/pdf/global-diastolic-strain-rate-for-the-assessment-of-left-1h64s3c6ez.pdf

Global diastolic strain rate for the assessment of left ventricular diastolic dysfunction in young peritoneal dialysis patients: a case control study.

Currently, interventions for HIV/AIDS control in Sri Lanka are only carried out among the most-at-risk populations. This study was conducted to identify the level of awareness and stigma-related attitudes among the general population of Sri Lanka. A cross-sectional study was carried out among 869 residents of 18-64 years of age in Kandy, Sri Lanka. A self-administered questionnaire was utilised to obtain information about stigma, discrimination and HIV/AIDS-related knowledge. Chi-square test and multivariate analysis were applied to find possible associations between HIV-related variables and socio-demographic indicators. Response rate was 82.0%. Overall, 93.5% of the participants have heard of HIV/AIDS but the knowledge on HIV/AIDS was low with an average score of 51.7%, no statistically significant difference between genders (p = 0.352). Only 58.1% were aware that a condom was an effective tool for its prevention. There were many misconceptions related to epidemiology of HIV/AIDS. The participants showed more positive attitudes towards HIV/AIDS and people living with HIV/AIDS (PLHIV) for all questionnaire items except for those listed under shame and blame. Positive attitudes towards PLHIV were observed to be greater among those with a better HIV/AIDS-related knowledge score. There was no significant association between the attitudes towards PLHIV and socio-demographic characteristics such as ethnicity and religion. There is a greater need of making attempts towards educating the public regarding HIV/AIDS to eliminate misconceptions prevalent in the society. Stigma-related attitudes are mainly due to shame and blame associated with the disease. As the attitudes towards PLHIV were more positive among those with a better HIV/AIDS-related knowledge score, targeted HIV/AIDS-related health education interventions maybe recommended in this regard.

/pdf/awareness-and-attitudes-towards-hiv-aids-among-residents-of-2tv4b55ce7.pdf

Awareness and attitudes towards HIV/AIDS among residents of Kandy, Sri Lanka

Background and Purpose Recently, the score for the targeting of atrial fibrillation (STAF) was introduced to identify the risk of atrial fibrillation (AF) in stroke patients. In this study, we aim to evaluate the usefulness of the STAF score for AF screening in acute stroke patients. Methods Patients with acute ischemic stroke who were admitted to our stroke unit were prospectively enrolled from March 2011 to March 2013. Baseline National Institutes of Health Stroke Scale (NIHSS), left atrial dilatation, and vascular etiology were assessed to calculate the STAF score. Logistic regression analysis was used to examine the relationship between AF and STAF factors. Univariate analysis of AF and age, history of coronary heart disease and rheumatic heart disease, NIHSS, left atrial dilatation, and vascular etiology was performed. Results A total of 472 patients were enrolled in our analysis. AF was documented in 78 (16.53%) patients, of which 50% were paroxysmal. Multivariable analysis demonstrated that age, NIHSS, left atrial dilatation, and the absence of vascular etiology can each function as independent predictors for AF. In addition, all AF patients with a STAF ≥5 show a sensitivity of 76.92% and a specificity of 78.68%. The area under the receiver operating characteristic for all AF patients was .842 versus .763 for the paroxysmal AF (pAF) patients. In addition, a sensitivity of 81% (95% CI 73-92) and a ROC of .829 were for new-AF. Conclusions The value of the STAF system for predicting the risk of pAF and new-AF in stroke patients is relatively limited.

The Value of the Score for the Targeting of Atrial Fibrillation (STAF) Screening in Acute Stroke Patients

BACKGROUND Atrial fibrillation is the most common significant cardiac arrhythmia in clinical practice, but its risk factors remain to be clarified. We have hypothesized that left ventricular posterior wall thickness is an independent risk factor for paroxysmal atrial fibrillation (PAF). METHODS A total of 166 consecutive patients with paroxysmal atrial fibrillation were included in this study. Another 166 healthy check-up people, strictly age and sex-matched, were enrolled as controls in the same period. Univariable analysis and multivariable conditional logistic stepwise regression analysis were conducted. Receiver operating characteristic (ROC) curve analysis was performed on those significant indices obtained from the multivariable logistic regression analysis. RESULTS The multivariable stepwise analysis identified left ventricular posterior wall thickness, left atrial diameter tricuspid insufficiency and residence (countryside) as independent predictors for paroxysmal atrial fibrillation. Receiver operating characteristic curve analysis demonstrated the cutoff values of those risk factors aforementioned. CONCLUSIONS In this strictly age and sex-matched population-based sample, left ventricular posterior wall thickness, left atrial diameter, tricuspid insufficiency and residence were predictive risks for paroxysmal atrial fibrillation. This study offers novel information therapeutically beyond that provided by traditional clinical atrial fibrillation risk factors.

Left ventricular posterior wall thickness is an independent risk factor for paroxysmal atrial fibrillation

Objectives : To explore HIV/AIDS related knowledge, attitude and behaviour among migrant peasant workers in Changsha, which is a inland city in central China, and to provide evidence that educating this population may help to prevent the spread of HIV/AIDS in China . Methods : A total of 1782 migrant peasant workers participated in the study. A questionnaire was used to determine their knowledge of HIV/AIDS and related attitude and behaviour items. Results : The majority of the respondents had a rather low level of overall HIV/AIDS knowledge and its prevention, had what constituted risky behaviour in this regard and a generally low acceptance of HIVinfected persons. Furthermore , their behaviour and attitude were analysed with respect to their educational level, occupational class and score of HIV/AIDS related knowledge. Conclusions : The results of this investigation will help healthcare professionals develop a sensitive and specific educational programme for migrant peasant workers. Educating this population will be a very important aspect of HIV/AIDS prevention in China.

The survey of HIV/AIDS related knowledge, attitude and behaviour among migrant peasant workers in middle city in China.

Objective: To evaluate the efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of thoracic sarcoidosis. Methods: A retrospective dataset of 35 patients who received EBUS-TBNA was analyse d. These patients underwent EBUS-TBNA due to suspected sarcoidosis (radiographic stages I and II) with enlarged hilar or mediastinal lymph nodes (≥ 1.0 cm) revealed by computed tomography. When EBUS-TBNA was considered to be nondiagnostic, surgical biopsy and clinical and radiological follow-up was performed. Results: Twenty-eight of 35 (80%) patients had a final diagnosis of sarcoidosis. Among them, 25 (89.3%) were diagnosed by EBUS-TBNA. Conclusion: Endobronchial ultrasound-guided transbronchial needle aspiration is a safe and effective procedure for the diagnosis of stages I and II of thoracic sarcoidosis.

/pdf/efficacy-of-endobronchial-ultrasound-guided-transbronchial-2k24m0e4j4.pdf

Efficacy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis of Thoracic Sarcoidosis.

Objective\nWe aimed to investigate whether Yi Fu Kang oral liquid (YFK) could reduce the gastrointestinal side effects caused by chemotherapy.\n\n\nMethods\nWe randomized 40 animals into four groups for treatment: Control (0.8 mL 0.9% saline solution /100 g body weight/day), Ou Li shu (0.8 mL/100 g body weight/day), YFK (1 mL/100 g body weight/day) and YFK groups [2 mL/100 g body weight/day] (n = 10 in each group). The latency time to first emesis and the total number of emetic behaviours were recorded. The gastrointestinal function of YFK was assessed by observing gastric remnant rate of methyl orange and charcoal powder propelling test of small intestine. Gross mucosal damage was assessed in a blind manner by calculation of a lesion index.\n\n\nResults\nDifferent dosages of Yi Fu Kang oral liquid can obviously promote the gastric emptying ( p< 0.01) and the promotion of small intestine function ( p< 0.01). Yi Fu Kang oral liquid can also protect the gastric mucosa and reduce the emetic response.\n\n\nConclusion\nYi Fu Kang oral liquid can enhance the function of gastrointestinal of animals by reducing the number of emetic responses, protecting the gastric mucosa and propelling movement of small intestine.

/pdf/effect-of-yi-fu-kang-oral-liquid-on-gastrointestinal-side-53jtqyyjqb.pdf

Effect of Yi Fu Kang Oral Liquid on Gastrointestinal Side Effects Caused by Chemotherapy

<h3>Purpose/Objective(s)</h3> Unparallel evolution between clinical radiation therapy (RT) paradigms and preclinical RT techniques, especially in biologically guided RT, has posed a challenge to completely validate the benefits and pitfalls of novel RT techniques prior to their translation to bedside practices. In this study, we firstly investigated the feasibility of biologically guided RT implemented within a small animal radiation therapy (SART) platform, with quad-modal on-board positron emission tomography (PET), single-photon emission computed tomography (SPECT), spectral CT, and cone-beam computed tomography (CBCT) imaging integrated, in a Monte Carlo model as a proof-of-concept. <h3>Materials/Methods</h3> The SART platform with quad-modal imaging guidance was modeled by using a planning tool. A preclinical biologically guided RT workflow with quad-modal imaging guidance was designed, in which image-guided RT and emission-guided radiation therapy (EGRT) can be implemented. To demonstrate the potential of contrast-enhanced spectral CT used in biologically guided RT for simultaneously guiding dose prescription based on tracer uptakes and dose calculation based on underlying tissue electron densities in the platform, iodine uptake fractions and virtual non-contrast electron densities in the Kidney1 inserts within a simulated phantom, mixed with an iodine contrast agent at electron fractions of 0.02 and 0.03, were decomposed quantitatively by using the Bayesian eigen tissue decomposition method and the maximum a posterior (MAP) estimation. To demonstrate EGRT implemented in the platform, the preliminary algorithm of EGRT was illustrated by introducing a 2-mm setup error to a target in the simulated phantom. The dose calculation was implemented after the set of binary micro-multileaf collimator (bmMLC) configurations was determined. The dose distributions delivered by EGRT were compared to that delivered by the conventional RT method with three treatment beams with and without setup error. <h3>Results</h3> For the Kidney1 insert with an iodine contrast agent fraction of 0.02, the average relative errors in the iodine contrast agent fraction and the underlying electron density estimated were 0.64% and 0.95%, respectively. In EGRT, the simulations resulted in 4339 and 5197 beamlet responses in an exemplary dose slice delivery with and without the 2-mm setup error, respectively. Compared to the conventional RT method, EGRT scheme introduced into the SART platform was validated to be more robust to setup errors while providing improved tumor targeting and a lesser dose burden on normal tissues during the treatment beam delivery in preclinical RT setting. <h3>Conclusion</h3> The results demonstrated the successful implementation of biologically guided RT within the SART platform with quad-model imaging guidance. With the comprehensive image- and emission-guided RT schemes integrated, this novel SART platform affords one-stop preclinical RT studies. 

The Feasibility of Biologically Guided Radiation Therapy Implemented in a Small-Animal Radiation Therapy Platform Integrated with Quad-Modal On-Board Imaging

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