Evaluation of Electromagnetic Navigational Bronchoscopy Using Tomosynthesis-Assisted Visualization, Intraprocedural Positional Correction and Continuous Guidance for Evaluation of Peripheral Pulmonary Nodules.

BACKGROUND: Electromagnetic navigational bronchoscopy (ENB) has been shown to have variable diagnostic accuracy for the assessment of peripheral pulmonary nodules. This may be because of discrepancies between the preplanned computed tomography of chest target lesion location versus actual target location (computed tomography-to-body divergence), and the lack of a continuous navigational image. The ILLUMISITE (Medtronic, Minneapolis, MN) is a newly developed ENB platform that utilizes tomosynthesis, an imaging technology that can visualize the target location using fluoroscopy (F-ENB). This new system also allows for intraprocedural positional correction and continuous navigation guidance during sampling to overcome these limitations and improve diagnostic yield. We report our first experience in a single center, single proceduralist using this new technology. METHODS: We conducted a retrospective, single center, single operator study reviewing 72 consecutive patients (78 nodules) over a 3-month period. We investigated the overall diagnostic yield and diagnostic yield by nodule location, size, and sedation type using this new F-ENB system. RESULTS: The overall diagnostic yield was 87% and pnemothoraces occurred in 2/78 procedures. We did not find any statistically significant difference when comparing pulmonary nodule location, size or sedation method utilized ( P =0.231, 0.338, and 0.112, respectively). Sixty-nine percent of the pulmonary nodules biopsied were 2 to 3 cm in size. The average distance corrected after tomosynthesis visualization was 15.4 mm (0.4 to 29.8 mm). CONCLUSION: We report our initial experience with the ILLUMISITE system using fluoroscopic tomosynthesis-assisted visualization with continuous navigational guidance at our institution. This new technology allows the operator to correct for better target lesion alignment and real time positional correction and may improve diagnostic yields with minimal complications for evaluation of peripheral pulmonary nodules.

Risk Factors for Stunting in Children under the Age of 5 in Rural Guatemalan Highlands.

Background: Previously, a study conducted by UNICEF found that malnutrition affects approximately 80% of the indigenous children in Guatemala. Objective: Identify prevalence and risk factors for stunted growth in communities surrounding Lake Atitlán, Guatemala. Methods: Height-for-age measurements of children under the age of five, N = 84, determined stunting prevalence and presumed burden of malnutrition in this region of the Guatemalan highlands. Mothers of a subset of this sample, N = 29, were interviewed to assess factors contributing to stunting. Analysis assessed the following risk factors: inadequate nutrition, increased infectious disease risk, high rate self-report illness, inadequate breastfeeding, and inadequate utilization of prenatal care. Findings: The majority of children under the age of five were stunted (65.6%) and likely malnourished. ANOVA analysis showed significant differences in mean height-for-age Z scores (HAZs) between groups with and without adequate nutrition (F = 7.069, p = 0.013), as well has with and without high rates of self-report illness (F = 6.894, p = 0.014). Both groups with inadequate nutrition (mean HAZs = -2.9, 95% CI = [-3.58, -2.24]) and high rates of self-report illness (mean HAZs = -2.8, 95% CI = [-3.13, -2.38]) had mean HAZs that are indicative of stunting. No other risk factors were associated with stunting. Conclusion: These pilot study results offer methods by which to obtain baseline data for assessing nutritional and public health interventions to improve stunting and malnutrition status as well as the health outcomes of children in rural, indigenous communities.

The Effect of Brief Mindfulness Training on Brain Reactivity to Food Cues During Nicotine Withdrawal: A Pilot Functional Imaging Study.

OBJECTIVES: Many individuals who smoke relapse due to weight gain. Mindfulness training has been shown to help smokers quit smoking, and, in other populations, has been used to help people lose weight. This study was designed to assess the effect of one week of mindfulness practice on food cravings in smokers during 12-hour smoking abstinence. METHODS: We assessed daily smokers with a history of smoking lapse after weight gain. Participants were provided with brief training in mindfulness meditation and mindful eating and were asked to practice each skill daily for one week. Before and after this week of mindfulness practice, participants completed surveys to rate their nicotine dependence and food cravings and underwent testing via functional magnetic resonance imaging. RESULTS: Study results included pre-post intervention reduction in brain activity in dorsomedial prefrontal cortex, visual areas, and pre-motor areas, regions potentially associated with response to food images. CONCLUSIONS: The study was small; however, it suggests the possibility that mindfulness training might be used to decrease food cravings after smoking cessation.