Endobronchial Ultrasound in Mediastinal Lymphadenopathy

Currently, endobronchial ultrasound dramatically changed diagnostic approaches for mediastinal lesions, both benign and malignant. Still there is a lack of data regarding the optimal anaesthesia, route of intubation, needle type, and specific clinical situations concerning EBUS in real clinical practice. A short, but clinically oriented, description of EBUS-TBNA and EUS-b-FNA techniques for mediastinal lesions is provided

Small Noncoding RNAs MTS0997 and MTS1338 Affect the Adaptation and Virulence of Mycobacterium tuberculosis

Tuberculosis (TB) is currently the leading cause of death among bacterial infectious diseases. The spectrum of disease manifestations depends on both host immune responses and the ability of Mycobacterium tuberculosis to resist it. Small non-coding RNAs are known to regulate gene expression; however, their functional role in the relationship of M. tuberculosis with the host is poorly understood. Here, we investigated the effect of small non-coding sRNAs MTS1338 and MTS0997 on M. tuberculosis properties by creating knockout strains. We also assessed the effect of small non-coding RNAs on the survival of wild type and mutant mycobacteria in primary cultures of human alveolar macrophages and the virulence of these strains in a mouse infection model. Wild-type and mutants survived differentially in human alveolar macrophages. Infection of I/St mice with KO M. tuberculosis H37RV strains provided beneficial effects onto major TB phenotypes. We observed attenuated tuberculosis-specific inflammatory responses, including reduced cellular infiltration and decreased granuloma formation in the lungs. Infections caused by KO strains were characterized by significantly lower inflammation of mouse lung tissue and increased survival time of infected animals. Thus, the deletion of MTS0997 and MTS1338 lead to a significant decrease in the virulence of M. tuberculosis

Сравнительная эффективность виртуальной бронхоскопии и эндобронхиальной ультрасонографии в малоинвазивной диагностике периферических образований легких: первый опыт

Data regarding the efficacy of virtual bronchoscopy (VB) compared to radial endobronchial ultrasound (rEBUS) for minimally invasive diagnostics of peripheral pulmonary lesions (PPLs) are still controversial.Aim. To assess the comparative efficacy of VB versus VB plus rEBUS in patients with PPLs.Methods. The study enrolled 36 subjects with PPLs detected by chest high resolution computed tomography (HRCT). All patients had bronchoscopy with various biopsy methods (based on navigation) alone or in combination with each other, followed by cytological, histological (if the biopsy sample was available), and microbiological analysis of the specimens. The subjects were randomized into two groups depending on the navigation technique: VB + rEBUS group (I) and VB group (II). VB (Osirix) was done as a planning procedure before real bronchoscopy with rEBUS navigation (Olympus UM-S20-17S) in group I. In group II VB was the only navigation technique.Results. Overall diagnostic yield (d. y.) reached 60% and 56% for groups I and II, respectively. In group I, the d.y. reached 86% for malignancy and 42% for other benign diseases. In group II, the d.y. reached 100% for malignancy and 36% for other benign diseases. The navigation efficacy was higher in the presence of a draining bronchus sign according to chest HRCT, lesion size more than 20 mm, upper lobe peripheral lesion. In group I, detecting the lesion with the ultrasound radial mini probe was also a predictor of efficacy. In group II, abnormal intraluminal bronchial anatomy according to VB as a sign of central lung cancer was also a predictor of efficacy.Conclusion. Both rEBUS and VB are safe and effective navigation techniques that provide for highly effective minimally invasive diagnosis of PPLs. VB could be a sound alternative when rEBUS is unavailable.На сегодняшний день нет единого мнения о месте виртуальной бронхоскопии (ВБ) в качестве навигационной методики при малоинвазивной диагностике периферических образований легких (ПОЛ), в т. ч. при сочетании с радиальной эндобронхиальной ультрасонографией (рЭБУС).Целью исследования явилась сравнительная оценка эффективности ВБ и комбинации ВБ с рЭБУС в дифференциальной диагностике ПОЛ.Материалы и методы. В исследование включены пациенты (п = 36) с ПОЛ, выявленными по данным компьютерной томографии высокого разрешения (КТВР) органов грудной клетки (ОГК). У всех пациентов выполнена бронхоскопия с различными модальностями биопсий (с учетом навигации) в комбинациях или моновариантах с последующим цитологическим, гистологическим (при наличии биоптата) и микробиологическим исследованием полученного материала. В зависимости от используемой навигационной методики пациенты рандомизированы в 2 группы. Больным 1-й группы (п = 20) выполнялась ВБ в комбинации с рЭБУС с помощью мини-зоцда, 2-й (п = 16) — только ВБ.Результаты. Суммарная диагностическая эффективность биопсий составила 60 и 56 % для 1-й и 2-й групп соответственно, при этом злокачественные ПОЛ верифицировались почти в 2 раза чаще доброкачественных — 86 % гх 42 % в 1-й группе и 100 % те 36 % — во 2-й. Отмечена более высокая эффективность биопсий у пациентов обеих групп при наличии симптома дренирующего бронха по данным КТВР ОГК, размере ПОЛ > 20 мм, верхнедолевой локализации ПОЛ. У больных 1-й группы предиктором эффективности также являлась визуализация ПОЛ при ультразвуковом сканировании при помощи радиальнго минизонда, а у пациентов 2-й группы — измененная внутрипросветная анатомия по данным ВБ как признак централизации периферического рака.Заключение. ВБ и рЭБУС являются эффективными и безопасными навигационными методиками, позволяющими обеспечить высокоэффективную малоинвазивную диагностику при ПОЛ. В случаях, когда рЭБУС недоступна, альтернативой может выступать ВБ

Tuberculosis: integrated studies for a complex disease 2050

Tuberculosis (TB) has been a disease for centuries with various challenges [1]. Like other places where challenges and opportunities come together, TB challenges were the inspiration for the scientific community to mobilize different groups for the purpose of interest. For example, with the emergence of drug resistance, there has been a huge volume of research on the discovery of new medicines and drug delivery methods and the repurposing of old drugs [2, 3]. Moreover, to enhance the capacity to detect TB cases, studies have sought diagnostics and biomarkers, with much hope recently expressed in the direction of point-of-care tests [4]. Despite all such efforts as being highlighted in 50 Chapters of this volume, we are still writing about TB and thinking about how to fight this old disease–implying that the problem of TB might be complex, so calling the need for an integrated science to deal with multiple dimensions in a simultaneous and effective manner. We are not the first one; there have been proposed integrated platform for TB research, integrated prevention services, integrated models for drug screening, integrated imaging protocol, integrated understanding of the disease pathogenesis, integrated control models, integrated mapping of the genome of the pathogen, etc. [5–12], to name some. These integrated jobs date back decades ago. So, a question arises: why is there a disease named TB yet? It might be due to the fact that this integration has happened to a scale that is not global, and so TB remains to be a problem, especially in resource-limited settings. Hope Tuberculosis: Integrated Studies for a Complex Disease helps to globalize the integrated science of TB.info:eu-repo/semantics/publishedVersio