Endobronchial ultrasound-guided transbronchial needle aspiration in patients with previously treated malignancies: diagnostic performance and predictive value

BACKGROUND

Endobronchial ultrasound-guided transbronchial needle aspiration is a minimally invasive and effective sampling approach for patients with mediastinal or hilar lymphadenopathy. Increased recognition of the ultrasonographic features revealed the value of its images in predicting mediastinal lymph node malignancy. However, its diagnostic validity and the predictive value of its ultrasonographic features have not been demonstrated well in patients after systemic anti-tumor therapy. This study aimed to evaluate the efficiency of endobronchial ultrasound-guided transbronchial needle aspiration in patients with suspicious lymph nodes after anti-tumor therapy.

METHODS

We retrospectively reviewed cases of endobronchial ultrasound-guided transbronchial needle aspiration performed between January 2019 and August 2021 at a single tertiary hospital center. Patients with suspected mediastinal or hilar lymph nodes within 5 years of systemic anti-tumor therapy were enrolled. Final diagnoses were determined by pathologic diagnoses of samples from transbronchial needle aspiration, surgery, or follow-up for at least 6 months. Ultrasonographic features were analyzed to assess the predictive value of malignant lymph nodes after treatment.

RESULTS

Overall, 168 lymph nodes of 138 patients were analyzed. Among 110 (65.5%) malignant lymph nodes, 75 originated from lung cancers; the other 35 were from other malignancies. No complications related to endobronchial ultrasound-guided transbronchial needle aspiration were observed. Of 58 negative results of transbronchial needle aspiration, 51 were proven to be true negatives; 7 were false. The overall sensitivity and the negative predictive value were 94.02% and 87.93%, respectively. Univariate and multivariate analysis revealed the absence of central hilar structure and short axis > 10 mm as independent predictive factors for malignancy.

CONCLUSIONS

Endobronchial ultrasound-guided transbronchial needle aspiration performs satisfactorily in diagnosing mediastinal and hilar lymphadenopathy even after anti-tumor treatment.

Rejections and membrane fouling of submerged direct contact hollow-fiber membrane distillation as post-treatment for anaerobic fluidized bed bioreactor treating domestic sewage

In this study, submerged direct contact membrane distillation (SDCMD) with a hollow-fiber membrane was applied as a post-treatment for an anaerobic fluidized bed bioreactor (AFBR) treating domestic sewage. The rejection efficiency of organic contaminants and nutrients, such as ammonia nitrogen and phosphate in SDCMD were investigated. As the transmembrane temperature difference increased, the permeate flux of SDCMD increased, while the rejection efficiency of ammonia nitrogen decreased. Regardless of the transmembrane temperature applied in this study, rejection efficiencies greater than 90% were achieved for organics and phosphate by SDCMD treatment of the AFBR effluent. A higher solution pH resulted in a lower ammonia nitrogen rejection efficiency, probably because nitrogen dominantly exists in the gaseous form and can easily pass through the hollow-fiber membrane. Long-term operation with the integrated AFBR-SDCMD process over 50 d at a transmembrane temperature of 30 °C and solution pH of 5.5 showed rejection efficiencies of 98.7%, 98.1%, and 90.5% for ammonia nitrogen, phosphate, and dissolved organic carbon (DOC), respectively. During the entire integrated process for treating domestic sewage, both DOC and nutrients present in the bulk solution of the SDCMD reactor were effectively removed to a concentrate. However, the permeate flux produced by the SDCMD membrane decreased over time, mainly because of the progressive biofouling.

Post treatment care in photodynamic therapy (PDT) of large facial port-wine stain (PWS) birthmarks

Photodynamic therapy (PDT) has been proved to be an effective and safe treatment for port-wine stain (PWS) birthmarks in China, especially for lager facial lesions. However, excessive treatment, improper nursing and human errors can cause serious adverse reactions that might result in high risks of infection, thick scabs and scar formation. The understanding and implementing of good post treatment care play a critical role in preventing and minimizing adverse reactions. This article will discuss details of good practice for the post treatment care in PDT of PWS birthmarks.

An exploratory mixed method study on the follow up status and quality of life among recurrent tuberculosis patients in South India

INTRODUCTION

After completion of treatment of Tuberculosis (TB), many patients can have long-term physical sequelae, which in some cases results in life-long impairment and further stigma.

OBJECTIVES

To determine the follow up status and quality of life of post-treatment among Category 2 TB patients under RNTCP and to explore the factors affecting the Quality of Life.

MATERIAL AND METHODS

The present study was done in urban area of Villupuram district of Tamil Nadu using Exploratory mixed methods study design. In the first phase case-control study was conducted with 100 post treatment category 2 TB patients (cases) and 100 non-TB patients (controls) matched for age and gender. The quality of life of the respondents was assessed by (WHOQOL-BREF) questionnaire (Quantitative), followed by five in-depth interviews among cases with extreme scores (Qualitative).

RESULTS

The mean scores of "perceived physical health" and "perceived psychological health" among cases after completion of treatment was significantly lower than the mean scores in controls. The determinants for perceived physical health were age, years of education and marital status. The determinants for psychological health were age, marital status and associated comorbidities. In-depth interview explored that major perspectives of cases affecting quality of life were side effects of drugs, loss of social support, loss of employment and psychological factors like anxiety, depression.

CONCLUSIONS

HR-QOL among post treatment TB patients was reduced. Efforts should be made to counsel TB patients, family members, relatives and their workplace regarding their care, support and challenges to have a reasonable QOL.

Aluminium removal and recovery from wastewater and soil using isolated indigenous bacteria

This paper elucidates the capability of isolated indigenous bacteria to remove aluminium from wastewater and soil. Two indigenous species of Brochothrix thermosphacta and Vibrio alginolyticus were isolated from an aluminium-contaminated site. These two species were used to treat aluminium-containing wastewater and contaminated soil using the bioaugmentation method. B. thermosphacta showed the highest aluminium removal of 57.87 ± 0.45% while V. alginolyticus can remove aluminium up to 59.72 ± 0.33% from wastewater. For aluminium-contaminated soil, B. thermosphacta and V. alginolyticus, showed a highest removal of only 4.58 ± 0.44% and 5.48 ± 0.58%, respectively. The bioaugmentation method is more suitable to be used to treat aluminium in wastewater compared to contaminated soil. The produced biomass separation after wastewater treatment was so much easier and applicable, compared to the produced biomass handling from contaminated soil treatment. A 48.55 ± 2.45% and 40.12 ± 4.55% of aluminium can be recovered from B. thermosphacta and V. alginolyticus biomass, respectively, with 100 mg/L initial aluminium concentration in wastewater.

Effectiveness of a home-based re-injury prevention program on motor control, return to sport and recurrence rates after anterior cruciate ligament reconstruction: study protocol for a multicenter, single-blind, randomized controlled trial (PReP)

Background

Although anterior cruciate ligament (ACL) tear-prevention programs may be effective in the (secondary) prevention of a subsequent ACL injury, little is known, yet, on their effectiveness and feasibility. This study assesses the effects and implementation capacity of a secondary preventive motor-control training (the Stop-X program) after ACL reconstruction.

Methods and design

A multicenter, single-blind, randomized controlled, prospective, superiority, two-arm design is adopted. Subsequent patients (18–35 years) with primary arthroscopic unilateral ACL reconstruction with autologous hamstring graft are enrolled. Postoperative guideline rehabilitation plus Classic follow-up treatment and guideline rehabilitation plus the Stop-X intervention will be compared. The onset of the Stop-X program as part of the postoperative follow-up treatment is individualized and function based. The participants must be released for the training components. The endpoint is the unrestricted return to sport (RTS) decision. Before (where applicable) reconstruction and after the clearance for the intervention (aimed at 4–8 months post surgery) until the unrestricted RTS decision (but at least until 12 months post surgery), all outcomes will be assessed once a month. Each participant is consequently measured at least five times to a maximum of 12 times. Twelve, 18 and 24 months after the surgery, follow-up-measurements and recurrence monitoring will follow. The primary outcome assessement (normalized knee-separation distance at the Drop Jump Screening Test (DJST)) is followed by the functional secondary outcomes assessements. The latter consist of quality assessments during simple (combined) balance side, balance front and single-leg hops for distance. All hop/jump tests are self-administered and filmed from the frontal view (3-m distance). All videos are transferred using safe big content transfer and subsequently (and blinded) expertly video-rated. Secondary outcomes are questionnaires on patient-reported knee function, kinesiophobia, RTS after ACL injury and training/therapy volume (frequency – intensity – type and time). All questionnaires are completed online using the participants’ pseudonym only.

Group allocation is executed randomly. The training intervention (Stop-X arm) consists of self-administered home-based exercises. The exercises are step-wise graduated and follow wound healing and functional restoration criteria. The training frequency for both arms is scheduled to be three times per week, each time for a 30 min duration. The program follows current (secondary) prevention guidelines.

Repeated measurements gain-score analyses using analyses of (co-)variance are performed for all outcomes.

Trial registration

German Clinical Trials Register, identification number DRKS00015313. Registered on 1 October 2018.

Biodegradation of bilge water: Batch test under anaerobic and aerobic conditions and performance of three pilot aerobic Moving Bed Biofilm Reactors (MBBRs) at different filling fractions

The bilge water that is stored at the bottom of the ships is saline and greasy wastewater with a high Chemical Oxygen Demand (COD) fluctuations (2-12 g COD L^-1). The aim of this study was to examine at a laboratory scale the biodegradation of bilge water using first anaerobic granular sludge followed by aerobic microbial consortium (consisted of 5 strains) and vice versa and then based on this to implement a pilot scale study. Batch results showed that granular sludge and aerobic consortium can remove up to 28% of COD in 13 days and 65% of COD removal in 4 days, respectively. The post treatment of anaerobic and aerobic effluent with aerobic consortium and granular sludge resulted in further 35% and 5% COD removal, respectively. The addition of glycine betaine or nitrates to the aerobic consortium did not enhance significantly its ability to remove COD from bilge water. The aerobic microbial consortium was inoculated in 3 pilot (200 L) Moving Bed Biofilm Reactors (MBBRs) under filling fractions of 10%, 20% and 40% and treated real bilge water for 165 days under 36 h HRT. The MBBR with a filling fraction of 40% resulted in the highest COD decrease (60%) compared to the operation of the MBBRs with a filling fraction of 10% and 20%. GC-MS analysis on 165 day pointed out the main organic compounds presence in the influent and in the MBBR (10% filling fraction) effluent.

Electro persulphate oxidation for polishing of biologically treated palm oil mill effluent (POME)

Malaysia alone produces more than 49 million m³ palm oil mill effluent per year. Biological treated palm oil mill effluent via ponding system often fails to fulfill the regulatory discharge standards. This is due to remaining of non-biodegradable organics in the treated effluent. Thus, the aim of this study was to resolve such issue by using electro persulphate oxidation process, for the first time, as a post treatment of palm oil mill effluent. Central composite design in response surface methodology was used to analyze and optimize the interaction of operational variables (i.e., current density, contact time, initial pH and persulphate dosage) targeted on maximum treatment efficiency. The significance of quadratic model of each response was determined by analysis of variance, where all models indicated sufficient significance with p-value < 0.0001. Optimum operational conditions with 45 mA/cm² of current density, 45 min of contact time, pH 4 and 0.892 g of S₂O₈^2- proved that 77.70% of Chemical Oxygen Demand, 97.96% of colour as well as 99.72% of Suspended Solids removal were achieved. The final pH of 5.88 of the effluent was obtained that fulfilled the limit and suitable for direct discharge to the natural environment.

HPV testing in the context of post-treatment follow up (test of cure)

BACKGROUND

Women treated for cervical lesions are at higher risk of subsequent disease compared to the general population. Consequently, post treatment surveillance strategies are required to ensure the success of treatment, so called "test of cure". The high sensitivity and negative predictive value of HPV assays can enhance post-treatment strategies.

OBJECTIVES

To provide an overview of the current data on test of cure strategies with a particular focus on HPV testing and to identify knowledge gaps and areas for further research.

RESULTS

HPV testing is sensitive for the detection of residual or recurrent disease post treatment for CIN2+ and is more sensitive than cytology alone. Co-testing increases sensitivity, marginally and there is a lack of consensus regarding the efficiency and safety to release negative women. Most test of cure studies have applied HPV DNA tests and post treatment positivity rates vary widely depending on assay and potentially, treatment type.

CONCLUSIONS

Globally, an increasing number of test of cure algorithms now incorporate HPV testing although there is heterogeneity of practice with respect to assay, number of post treatment tests, testing intervals, follow up time. While type specific persistence identified through genotyping may identify those at greater risk of disease there is no consensus as to how this may be applied, clinically. Data on HPV testing in women treated for glandular lesions would be welcome as would the performance of different HPV assays and associated biomarkers in this context.

Role of 18F-FDG PET/CT in pre and post treatment evaluation in head and neck carcinoma

Head and neck cancer (HNC) ranks as the 6^th most common cancer worldwide, with the vast majority being head and neck squamous cell carcinoma (HNSCC). The majority of patients present with complicated locally advanced disease (typically stage III and IV) requiring multidisciplinary treatment plans with combinations of surgery, radiation therapy and chemotherapy. Tumor staging is critical to decide therapeutic planning. Multiple challenges include accurate tumor localization with precise delineation of tumor volume, cervical lymph node staging, detection of distant metastasis as well as ruling out synchronous second primary tumors. Some patients present with cervical lymph node metastasis without obvious primary tumors on clinical examination or conventional cross sectional imaging. Treatment planning includes surgery, radiation, chemotherapy or combinations that could significantly alter the anatomy and physiology of this complex head and neck region, making assessment of treatment response and detection of residual/ recurrent tumor very difficult by clinical evaluation and computed tomography (CT) or magnetic resonance imaging (MRI). ¹⁸F-2-fluoro-2-deoxy-D-glucose positron emission tomography/CT (¹⁸F-FDG PET/CT) has been widely used to assess HNC for more than a decade with high diagnostic accuracy especially in detection of initial distant metastasis and evaluation of treatment response. There are some limitations that are unique to PET/CT including artifacts, lower soft tissue contrast and resolution as compared to MRI, false positivity in post-treatment phase due to inflammation and granulation tissues, etc. The aim of this article is to review the roles of PET/CT in both pre and post treatment management of HNSCC including its limitations that radiologists must know. Accurate PET/CT interpretation is the crucial initial step that leads to appropriate tumor staging and treatment planning.