Predictive Value of Endobronchial Ultrasound Strain Elastography in Mediastinal Lymph Node Staging: The E-Predict Multicenter Study Results

Background: Systematic assessment of lymph node status by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is indicated in (suspected) lung cancer. Sampling is herein guided by nodal size and FDG-PET characteristics. Ultrasound strain elastography (SE) might further improve risk stratification. By imaging tissue deformation over time, SE computes relative tissue strain. In several tissues, a lower strain (deformation) has been associated with a higher likelihood of malignancy. Objectives: To assess if EBUS-SE can independently help predict malignancy, and when combined with size and FDG uptake information. Methods: This multicenter (n = 5 centers) prospective trial included patients with suspected or proven lung cancer using a standardized measurement protocol. Cytopathology combined with surgery or follow-up imaging (>6 months) were used as reference standard. Results: Between June 2016 and July 2018, 327 patients and 525 lymph nodes were included (mean size 12.3 mm, malignancy prevalence 0.48). EBUS-SE had an overall AUC of 0.77. A mean strain <115 (range 0-255) showed 90% sensitivity, 43% specificity, 60% positive predictive value, and 82% negative predictive value. Combining EBUS-SE (<115) with size (<8 mm) and FDG-PET information into a risk stratification algorithm increased the accuracy. Combining size and SE showed that the 48% a priori chance of malignancy changed to 11 and 70% in double negative or positive nodes, respectively. In the subset where FDG-PET was available (n = 370), triple negative and positive nodes went from a 42% a priori chance of malignancy to 9 and 73%, respectively. Conclusions: EBUS-SE can help predict lymph node malignancy and may be useful for risk stratification when combined with size and PET information. (c) 2020 The Author(s) Published by S. Karger AG, Base

Concentrations of free radicals and beta-endorphins in repeat breeder cows

Repeat breeding (RB) is one of the major problems that affect the reproductive efficiency and economy of milk production in dairy animals. So far, the etiopathogenesis of this pathology has not been defined completely. Stress has been hypothesized to be a cause of impaired reproductive efficiency. Stress may cause an overproduction of beta-endorphins and free radicals; in particular, reactive oxygen species (ROS). The aim of this work is to determine the concentrations of these substances in RB cows and to evaluate the correlation with the serum level of progesterone. The study was performed on 60 dairy cows: 26 RB and 34 control cows. Blood samples were collected on day 12 and day 16, after artificial insemination (AI) in all subjects, in order to assess the concentrations of progesterone, free radicals and beta-endorphins. The stressors, free radicals and beta-endorphins, that we considered, were higher in repeat breeders (day 12, 93.32(±1.91) UCarr and 0.50(±0.03) ng/ml; day 16, 94.42(±1.91) UCarr and 0.61(±0.03) ng/ml), with a lower level of progesterone, which probably is responsible for failure to conceive. The stress factors (free radicals and beta-endorphins) may actually enhance each other and induce an inhibition of progesterone synthesis in repeat breeders

Longstanding Endobronchial Foreign Body

There are many circumstances in which the diagnosis of endobronchial inhalation of a foreign body (FB) can be missed. Generally, in such cases, within weeks or at most months from the event, clinical bronchopulmonary symptoms develop which allow a correct diagnosis to be made and significant complications to be avoided. We report the case of a patient in whom an endobronchial FB remained undiagnosed, because of lack of symptoms, for almost three years, and then caused signifiicant complications before being identified and removed. Problems related to diagnosis and therapy are discussed

Acute exacerbation of idiopathic pulmonary fibrosis: report of a series

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Granular cell tumor of the trachea as a rare cause of dyspnea in a young woman

Tracheal granular cell tumors are rare neurogenic neoplasms characterized by an indolent behavior. We report the case of a young woman affected by this tumor with non-specific clinical presentation. We performed a literature search in order to identify all the cases of tracheal granular cell tumor and to summarize the current state of knowledge about this rare disease