Minimally invasive mediastinal staging of non-small cell lung cancer

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure widely used for the diagnosis and staging of primary lung cancer. This review focuses on the role of EBUS-TBNA in minimally invasive mediastinal staging, restaging after induction therapy, and procedure-related issues. To better understand the role of EBUS-TBNA, one must consider issues of sedation and rapid onsite examination, sonographic features during the procedure, the number of aspirations per lymph node, and the thoroughness of the procedure. A literature review indicated that EBUS-TBNA showed equivalent or even superior performance to mediastinoscopy in the mediastinal staging of non-small cell lung cancer (NSCLC). Combining endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) or the transesophageal approach using an EBUS bronchoscope (EUS-B-FNA) with EBUS-TBNA can provide additional diagnostic benefits. A recent guideline recommended endosonography over mediastinoscopy as the initial procedure for mediastinal nodal staging in patients with NSCLC with abnormal mediastinal and/or hilar lymph nodes on chest computed tomography (CT) or positron emission tomography/CT. The diagnostic sensitivity of EBUS-TBNA for restaging after induction therapy in patients with stage IIIA-N2 NSCLC was lower than that of initial staging. It appears reasonable to perform EBUS-TBNA first for initial mediastinal staging and reserve mediastinoscopy for restaging after induction therapy

First results from the HAYSTAC axion search

The axion is a well-motivated cold dark matter (CDM) candidate first postulated to explain the absence of $CP$ violation in the strong interactions. CDM axions may be detected via their resonant conversion into photons in a "haloscope" detector: a tunable high-$Q$ microwave cavity maintained at cryogenic temperature, immersed a strong magnetic field, and coupled to a low-noise receiver. This dissertation reports on the design, commissioning, and first operation of the Haloscope at Yale Sensitive to Axion CDM (HAYSTAC), a new detector designed to search for CDM axions with masses above $20$ $\mu\mathrm{eV}$. I also describe the analysis procedure developed to derive limits on axion CDM from the first HAYSTAC data run, which excluded axion models with two-photon coupling $g_{a\gamma\gamma} \gtrsim 2\times10^{-14}$ $\mathrm{GeV}^{-1}$, a factor of 2.3 above the benchmark KSVZ model, over the mass range $23.55 < m_a < 24.0$ $\mu\mathrm{eV}$. This result represents two important achievements. First, it demonstrates cosmologically relevant sensitivity an order of magnitude higher in mass than any existing direct limits. Second, by incorporating a dilution refrigerator and Josephson parametric amplifier, HAYSTAC has demonstrated total noise approaching the standard quantum limit for the first time in a haloscope axion search.Comment: Ph.D. thesis. 346 pages, 58 figures. A few typos corrected relative to the version submitted to ProQues

The association between Korean employed workers’ on-call work and health problems, injuries

국문요약 배경 대기근무는 언제든지 근무를 해야 하는 상황이 생길 수 있기 때문에 스트레스 상황이 빈번한 근무형태이다. 하지만 대기근무에 관한 선행 연구들은 특정 직종을 대상으로 한 연구가 대부분이다. 본 연구는 특정 직종이 아닌 전체 근로자들을 대상으로 대기근무와 건강문제 및 손상의 관련성을 파악하기 위하여 수행되었다. 방법 본 연구는 2011 년 시행한 제 3차 근로환경조사 자료를 활용 하였고, 대상자는 1 년이상 근무한 임금 근로자 29,246 명으로 하였다. 대기근무와 건강문제 및 손상의 관련성을 확인하기 위해 로지스틱 회귀분석을 시행하였다. 결과 전체 대상자의 9.3%인 2723 명이 대기근무를 하고 있는 것으로, 26,524 명 (90.7%)은 대기근무를 하지 않는 것으로 나타났다. 개인적 특성과 직업적 특성, 근무환경, 직무스트레스를 보정하여 분석한 결과 대기근무를 하는 경우 그렇지 않은 경우에 비해 신체적 증상 1.33 배 (95% CI 1.22-1.44), 정신적 증상 1.31 배 (95% CI 1.08-1.60), 손상 2.76 배 (95% CI 2.26-3.37) 높게 나타났다. 세부 증상에 대해서 분석한 결과 대기근무를 하는 경우 청력문제 2.06 배 (95% CI 1.63-2.62), 피부문제 1.71 배 (95% CI 1.38-2.12), 요통 1.22 배 (95% CI 1.08-1.38), 어깨, 목, 팔 등의 근육통 1.23 배 (95% CI 1.12-1.34), 하지의 근육통 1.27 배 (95% CI 1.15-1.40), 두통 및 눈의 피로 1.46 배 (95% CI 1.32-1.60), 복통 1.37 배 (95% CI 1.02-1.85), 우울 또는 불안장애 1.43 배 (95% CI 1.07-1.93), 전신피로 1.36 배 (95% CI 1.24-1.49), 불면증 및 수면장애 1.41 배 (95% CI 1.13-1.76) 높게 나타났다. 결론 본 연구 결과, 대기근무가 건강문제 및 손상과 관련이 있다는 것을 확인 할 수 있었다. 추후 인과관계 파악을 위한 추가 연구가 진행되어야 하며 또한 다양한 직종에서도 대기근무와 관련된 연구가 필요할 것으로 보인다

Abrupt Dyskeratotic and Squamoid Cells in Poorly Differentiated Carcinoma: Case Study of Two Thoracic NUT Midline Carcinomas with Cytohistologic Correlation

Cytologic diagnosis of nuclear protein in testis (NUT) midline carcinoma (NMC) is important due to its aggressive behavior and miserable prognosis. Early diagnosis of NMC can facilitate proper management, and here we report two rare cases of thoracic NMC with cytohistologic correlation. In aspiration cytology, the tumor presented with mixed cohesive clusters and dispersed single cells, diffuse background necrosis and many neutrophils. Most of the tumor cells had scanty cytoplasm and medium-sized irregular nuclei, which had fine to granular nuclear chromatin. Interestingly, a few dyskeratotic cells or squamoid cell clusters were present in each case. Biopsy specimen histology revealed more frequent squamous differentiation, and additional immunohistochemistry tests showed nuclear expression of NUT. Because this tumor has a notorious progression and has been previously underestimated in terms of its prevalence, awareness of characteristic findings and proper ancillary tests should be considered in all suspicious cases

Is Methionyl-tRNA Synthetase Applicable as a Diagnostic Marker for Lung Cancer in Bronchial Ultrasound-Guided Brushing Cells?

Background and objective: Methionyl-tRNA synthetase (MARS) and A variant of Aminoacyl-tRNA synthetase interacting multifunctional protein 2 (AIMP2) with an exon 2 deletion (AIMP2-DX2) are known to be overexpressed in lung cancer. However, their role as diagnostic markers in lung cancer has not been well established. Thus, we evaluated their diagnostic performance in brushed cells obtained from nodular lung lesions suspected of lung cancer. Methods: Samples obtained by radial endobronchial ultrasound-guided brushing were processed for cytological examination with Papanicolaou (Pap) staining. Then, double IF staining with MARS and AIMP2-DX2 antibodies was measured in the cytology samples for peripheral lung nodules. The diagnostic performance was compared against biomarkers. Results: MARS IF staining was the only independent staining method used for the prediction of malignant cells. The area under the curve (AUC) of conventional cytology, MARS IF, and MARS IF plus cytology was 0.64, 0.68, and 0.69, respectively. The diagnostic accuracy was increased in MARS IF plus conventional cytology compared with cytology alone (71% vs. 47%). Conclusions: The combination of MARS staining with conventional cytology showed increases in the diagnostic accuracy for diagnosing lung nodules suspected of lung cancer on chest-computed tomography scans

Clinical characteristics of miliary pulmonary metastases in non‐small cell lung cancer

Abstract Background The prognosis of miliary pulmonary metastases (MPM), which are characterized as randomly disseminated, innumerable, and small metastatic nodules, has been considered as being poor. The purpose of this study was to evaluate the clinical characteristics and survival of MPM in patients with non‐small cell lung cancer (NSCLC). Methods This retrospective study included NSCLC patients with MPM and nonmiliary pulmonary metastases (NMPM) detected during staging evaluation between 2000 and 2020. MPM was defined as >50 bilaterally distributed metastatic pulmonary nodules (<1 cm in diameter), and NMPM was defined as the presence of ≤15 metastatic pulmonary nodules regardless of size. Baseline characteristics, genetic alterations and overall survival (OS) rates were compared between the two groups. Results Twenty‐six patients with MPM and 78 patients with NMPM were analyzed. The median number of patients who smoked was significantly lower in the MPM group than in the NMPM group (0 vs. 8 pack years, p = 0.030). The frequency of EGFR mutation was significantly higher in the MPM group (58%) than in the NMPM group (24%; p = 0.006). There was no significant difference in 5‐year OS between the MPM and the NMPM group by the log‐rank test (p = 0.900). Conclusion MPM in NSCLC were significantly related to EGFR mutation. The OS rate of the MPM group was not inferior to that of the NMPM group. The presence of EGFR mutations should be thoroughly evaluated for NSCLC patients with initial presentation of MPM

Are there differences among operators in false-negative rates of endosonography with needle aspiration for mediastinal nodal staging of non-small cell lung cancer?

Abstract Background Endosonography with needle aspiration (EBUS/EUS-NA) is recommended as the first choice for mediastinal nodal assessment in non-small cell lung cancer (NSCLC). It is important to maintain adequate negative predictive value of the procedure to avoid unnecessary additional surgical staging, but there are few studies on the influence of operator-related factors including competency on false negative results. This study aims to compare the false negative rate of individual operators and whether it changes according to accumulation of experience. Methods This is a retrospective study of NSCLC patients who were N0/N1 by EBUS/EUS-NA and confirmed by pathologic staging upon mediastinal lymph node dissection (n = 705). Patients were divided into a false negative group (finally confirmed as pN2/N3) and a true negative group (pN0/N1). False negative rates of six operators and whether these changed according to accumulated experience were analyzed. Results There were 111 (15.7%) false negative cases. False negative rates among six operators ranged from 8.3 to 21.4%; however, there were no statistical differences before and after adjustment for patient characteristics and procedure-related factors (P = 0.346 and P = 0.494, respectively). In addition, false negative rates did not change as each operator accumulated experience (P for trend = 0.632). Conclusions Our data suggest that there would be no difference in false negative rates regardless of which operator performs the procedure assuming that the operators have completed a certain period of observation and have performed procedures under the guidance of an expert

Correction to: Are there differences among operators in false-negative rates of endosonography with needle aspiration for mediastinal nodal staging of non-small cell lung cancer?

Following publication of the origina