[Evaluation of the value of EBUS-TBNA in diagnosis of mediastinal lesions].

OBJECTIVE: To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosis of mediastinal lesions and to discuss its optimal indication. METHODS: One hundred and twenty three patients with mediastinal lesions who underwent EBUS-TBNA were included in this study. The accuracy, sensitivity, specificity, positive and negative predictive value of EBUS-TBNA in diagnosis of mediastinal lesions were analyzed according to the final diagnosis and evaluate its value and the optimal indication. RESULTS: In the 123 patients, EBUS-TBNA was successfully performed to obtain samples from 286 stations of lymph nodes (2.33 stations/per patient). The puncture success rate was 100%. The procedure was uneventful without complications. Final diagnosis indicated that there were 83 positive and 40 negative patients. EBUS-TBNA had a sensitivity of 95.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 90.0%, and overall accuracy of 96.8%. For diagnosis of the epithelial cancer, EBUS-TBNA had an accuracy of 98.8%, sensitivity of 98.8%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 100%. EBUS-TBNA failed to reveal three lymphomas. For diagnosis of benign mediastinal diseases, EBUS-TBNA had a diagnosis rate of 47.2% which had a confirmed clinical application value. CONCLUSIONS: EBUS-TBNA may be expected to replace the mediastinoscopy as a superior choice for diagnosis of mediastinal epithelial cancers. EBUS-TBNA can not replace mediastinoscopy but being a promising tool for diagnosis of benign mediastinal lesions including granulomas. For certain special diseases such as lymphoma, mediastinoscopy cannot be replaced. However, EBUS-TBNA can be a potentially favorite choice for early stage screening.

[CT-guided hookwire localization of small solitary pulmonary nodules in video-assisted thoracoscopic surgery].

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. METHODS: Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. RESULTS: All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 +/- 3.08 mm in diameter, and the mean distance from lesion to parietal pleura was 10.09 +/- 2.62 mm. The mean localization time was 20.18 +/- 7.16 min, and then the nodules were removed by VATS within 18 +/- 6.65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. CONCLUSION: The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.

Association of Diabetes With Central Corneal Thickness Among a Multiethnic Asian Population.

Importance: Thicker or thinner central corneas may lead to either overestimation or underestimation of intraocular pressure, which is the most important causal and treatable risk factor for glaucoma. However, the findings on the associations between diabetes, random glucose, and glycated hemoglobin A1c (HbA1c) with central corneal thickness (CCT) are conflicting. Objective: To evaluate the associations between diabetes, random glucose, and HbA1c with CCT in a multiethnic Asian population. Design, Setting, and Participants: Cross-sectional analysis of the Singapore Epidemiology of Eye Diseases (SEED) Study conducted from 2004 to 2011. A total of 10 033 Chinese, Malay, and Indian individuals 40 years or older residing in Singapore were recruited. Participants with incomplete information on diabetes status (448 participants), prior refractive or cataract surgery (1940 eyes), and corneal edema or dystrophy (29 eyes) were excluded. A meta-analysis was conducted to estimate the overall association of diabetes with CCT. Exposures: Standardized clinical examinations and interviewer-administered questionnaire to collect information about demographic, systemic, and ocular factors. Main Outcomes and Measures: Measurement of CCT using ultrasound pachymetry. Results: A total of 8846 adults (mean [SD] age, 57.9 [9.9] years; 4447 women [50.3%]) (17 201 eyes) were included in the final analyses. The CCT profile was similar among participants with and without diabetes (mean [SD] CCT, 545.3 [33.7] µm vs 544.8 [33.9] µm; P = .39). Following adjustments of age, sex, ethnicity, corneal curvature, axial length, and body mass index, CCT was a mean (SD) of 4.9 (0.8) µm (95% CI, 3.3-6.5 µm) thicker in patients with diabetes than those without diabetes. Multivariable analyses also showed that thicker CCT was associated with higher random glucose (per 10 mg/dL [to convert to mmol/L, multiply by 0.0555], ß = 0.3; 95% CI, 0.2-0.4) and higher HbA1c (per percentage, ß = 1.5; 95% CI, 1.0-2.1) (all P < .001). These associations were significant in the subgroup with diabetes but not in the subgroup without diabetes. A meta-analysis including 12 previous population- and clinical-based studies showed that CCT was 12.8 µm (95% CI, 8.2-17.5 µm) thicker in eyes of patients with diabetes. Conclusions and Relevance: These findings suggest that diabetes and hyperglycemia were associated with thicker CCT. This study provides useful information on the interpretation of intraocular pressure in patients with diabetes.

Direct and Indirect Associations Between Diabetes and Intraocular Pressure: The Singapore Epidemiology of Eye Diseases Study.

Purpose: The association between diabetes and IOP is controversial; diabetes is associated with thicker central corneal thickness (CCT), and thicker CCT is associated with higher IOP. We therefore aimed to clarify the diabetes-IOP association, considering CCT as a potential mediator. Methods: We included 8636 participants from the Singapore Epidemiology of Eye Diseases (SEED) Study. Associations of diabetes, serum glucose, or HbA1c with IOP were assessed using regressions models, with adjustments for potential confounding factors. Regression-based mediation (path) analyses were further performed to evaluate the indirect effects of diabetes on IOP through the mediator (CCT), in addition to the direct effect of diabetes on IOP. Results: Of the 8636 participants, 2524 (29.23%) had diabetes. Diabetes, higher serum glucose, or HbA1c levels were all associated with higher IOP (all P < 0.01). The effect of diabetes on IOP was partially and minimally mediated through CCT; the proportion of mediating effect of CCT was 11.09% of the total effect of diabetes on IOP. Axial length and spherical equivalent were not mediating variables in the diabetes-IOP association. Findings were consistent across three ethnicity groups. Conclusions: Diabetes or higher long-term hyperglycemia was associated with higher IOP. CCT contributed a small proportion of mediating effect to the total effect of diabetes on IOP. We conclude that high IOP observed in diabetes is mainly due to the direct association of diabetes and IOP, and this finding may have pathophysiologic significance with respect to the risk of glaucoma among persons with diabetes.

[Serum proteomic patterns may assist the diagnosis of solitary pulmonary nodules].

OBJECTIVE: To screen relatively specific biomarkers in serum from lung adenocarcinoma patients by surface-enhanced laser desorption and ionization time of flight mass spectrometry (SELDI-TOFMS), and to investigate the clinical value of SELDI-TOF-MS in differentiation of benign from malignant solitary pulmonary nodules (SPN). METHODS: Serum samples from 71 lung adenocarcinoma patients and 71 healthy volunteers with matched gender, age and history of smoking were analyzed using WCX2 ProteinChip to screen potential biomarkers. 28 patients received surgical treatment among total 53 patients with SPN. The clinical value of SELDI-TOF-MS in differentiation of benign from malignant solitary pulmonary nodules was evaluated by pathological diagnosis. RESULTS: Five highly expressed potential biomarkers were identified with the relative molecular weights of 4047.79 Da, 4203.99 Da, 4959. 81 Da, 5329. 30 Da and 7760.12 Da. The postoperative pathologic diagnosis was lung adenocarcinoma in 24 patients with SPN, validating the clinical value of the 5 potential biomarkers. CONCLUSION: SELDI-TOF-MS technology is a quick, easy, convenient, and high-throughput analyzing method capable of screening several relatively specific potential biomarkers from the serum of lung adenocarcinoma patients and may have attractive clinic value in differentiation of solitary pulmonary nodules.

[Dry eye in graft-versus-host disease].

OBJECTIVE: To investigate patients who had ocular presentations after allogeneic hematopoietic stem cell transplantation. METHODS: The eyes of 20 patients of leukemia who had undergone allogeneic hematopoietic stem cell transplantation were examined. The ocular surface of these patients was examined by slit-lamp. The eye examination also included evaluation of tear break-up time, Schirmer tests with and without nasal stimulation, and fluorescein staining, rose bengal staining, etc. Conjunctival impression cytology and pathological examination of surgical specimens from 3 patients were performed. RESULTS: Fourteen of 20 patients developed chronic graft-versus-host disease (cGVHD). Eight patients suffered from dry eye accompanied by GVHD simultaneously. The incidence of dry eye in GVHD was 57%. Among them, 4 cases were severe dry eye associated with significant decrease of visual acuity and even development of corneal ulcer. Ophthalmic pathology findings were as follows: loss of conjunctival goblet cells or significant reduction in amount; conjunctival and corneal epithelial keratinization and squamous metaplasia; and dominance of T cell in conjunctival inflammatory infiltration cells. CONCLUSION: Dry eye is the major ocular complication after allogeneic hematopoietic stem cell transplantation. It affected the patients' life quality severely. The high incidence and potentially severe ocular problems in these patients suggest that close ophthalmic monitoring is important in allogeneic hematopoietic stem cell transplantation.

Comparative proteomic analysis of non-small-cell lung cancer and normal controls using serum label-free quantitative shotgun technology.

The aim of this study was to distinguish non-small-cell lung cancer from normal controls and explore the new potential biomarkers of lung cancer by serum proteomics technology. Label-free quantitative liquid chromatography tandem mass spectrometry (1D-LC/MS/MS) analysis was performed on eight non-small-cell lung cancer (NSCLC) serum samples and eight normal controls. The proteomic data we obtained was analyzed by normalized, randomly paired t test and integrated bioinformatic methods, including hierarchical clustering analysis, principal-component analysis, and support vector machine. We obtained 931 proteins with at least two peptides identified from the 16 serum samples, and 62 proteins were differentially expressed between non-small-cell lung cancer patients and normal controls. There were 16 proteins expressed much higher in the lung cancer group than in the controls. Two hundred eight proteins were shared in all 16 serum samples. Through hierarchical clustering analysis and principal-component analysis based on the 62 differentially expressed proteins, we could distinguish non-small-cell lung cancer from the normal controls. The prediction accuracy of non-small-cell lung cancer analyzed by the support vector machine algorithm based on 208 proteins which were shared in all serum samples is 93.75%. Protein expression patterns have changed in the serum of non-small-cell lung cancer patients. Label-free quantitative LC/MS/MS may be a good method to improve the diagnostic accuracy for lung cancer and it can help in discovering the new biomarkers.

[Effects of anti-CD25 monoclonal antibody on the level of cytokines in aqueous humour after rat penetrating keratoplasty].

OBJECTIVE: To investigate the toxicity of anti-CD25 monoclonal antibody (mAb) to rat cornea and its effects on the cytokines in the aqueous humour after penetrating keratoplasty (PKP), thereby evaluating the effect of anti-CD25 mAb in preventing corneal allograft rejection. METHODS: The corneal toxicity of anti-CD25 mAb at 50, 100 and 200 microg administered via subconjunctival injection was evaluated in 12 SD rats by histological examination and transmission electron microscopy. Another 93 SD rats were randomized into 5 groups, and transplantation of corneal allograft from Wistar rats was performed in 4 groups with the other group as the normal control. The 4 allograft groups were treated with saline, 100 microg anti-CD25 mAb, 100 microg anti-CD25 mAb with 50 microg dexamethasone, and 50 microg dexamethasone, respectively. The graft rejection was observed, the aqueous humour levels of IFN-gamma and IL-4 were measured with ELISA, and IFN-gamma mRNA expressions in the grafts detected with RT-PCR. RESULTS: anti-CD25 mAb at 50 or 100 microg did not show significant toxicity on the cornea, but at 200 microg, the mAb caused swelling of the corneal stromal cells and endothelial cells. After corneal allograft transplantation, a significant delay in allograft rejection was observed in the 3 groups with mAb or dexamethasone treatment as compared with that in saline group (P<0.05). IFN-gamma mRNA expression in the allograft on days 11 after PKP and in the aqueous humour on days 6 and 11 was markedly increased in saline group compared with that in the 3 treatment groups (P<0.05). The mean IL-4 level in the aqueous humour was significantly higher in the mAb group than in saline group (P<0.05), but markedly lower in anti-CD25 mAb+dexamethasone and dexamethasone groups than in anti-CD25 mAb group (P<0.05). CONCLUSIONS: Anti-CD25 mAb at 20 and 100 microg does not obviously affect the rat corneas. Anti-CD25 mAb inhibits IFN-gamma expression and promotes IL-4 the expression to reduce corneal allograft rejection, whereas anti-CD25 mAb with low-dose dexamethasone inhibits both IFN-gamma and IL-4 expressions to more effectively promote the graft survival.