ABSTRACT
Biopsy site changes in mediastinal lymph nodes (LNs) attributable to prior endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) have not been studied in a systematic manner. Twenty-four contributors from 14 institutions in 5 countries collaborated via social media (Twitter) to retrospectively review consecutive cases of resected mediastinal LNs from patients with prior EBUS-TBNA. Resected LNs were reexamined by submitting pathologists for changes attributable to EBUS-TBNA. Patients who received neoadjuvant therapy were excluded. Cases with suspected biopsy site changes underwent central review by 5 pathologists. A total of 297 mediastinal LN resection specimens from 297 patients (183 male/114 female, mean age: 65 y, range: 23 to 87) were reviewed. Biopsy site changes were most common in station 7 (10 cases) followed by 11R, 4R, and 10R, and were found in 34/297 (11.4%) cases, including displacement of tiny cartilage fragments into LN parenchyma in 26, intranodal or perinodal scars in 7, and hemosiderin in 1. Cartilage fragments ranged from 0.26 to 1.03 mm in length and 0.18 to 0.62 mm in width. The mean interval between EBUS-TBNA and LN resection was 38 days (range: 10 to 112) in cases with biopsy site changes. A control group of 40 cases without prior EBUS-TBNA, including 193 mediastinal LN stations, showed no evidence of biopsy site changes. Biopsy site changes are identified in a subset of resected mediastinal LNs previously sampled by EBUS-TBNA. The location of the abnormalities, temporal association with prior EBUS-TBNA, and the absence of such findings in cases without prior EBUS-TBNA support the contention that they are caused by EBUS-TBNA.
Subject(s)
Cartilage/pathology , Image-Guided Biopsy/adverse effects , Lymph Node Excision/adverse effects , Lymph Nodes/pathology , Adult , Aged , Aged, 80 and over , Biopsy, Fine-Needle/adverse effects , Biopsy, Fine-Needle/methods , Endosonography/adverse effects , Endosonography/methods , Female , Humans , Image-Guided Biopsy/methods , Lymph Node Excision/methods , Male , Mediastinum , Middle Aged , Retrospective Studies , Ultrasonography, Interventional/adverse effects , Ultrasonography, Interventional/methods , Young AdultABSTRACT
Caffeine and taurine are two major neuromodulators present in large quantities in many popular energy drinks. We investigated their effects on sleep-wake control in constant darkness using the fruit fly Drosophila as a model system. It has been shown that caffeine, as the most widely used psychostimulant, can boost arousal through the dopamine pathway in the mushroom bodies of flies. Taurine is a GABA receptor agonist, which is inhibitory to neuronal firing. We show here that flies receiving a low dose of caffeine (0.01%) increase locomotor activity by 25%, and decrease total sleep by 15%. Treatment with taurine at 0.1% to 1.5% reduces locomotor activity by 28% to 86%, and shifts it from diurnal to nocturnal. At 0.75%, taurine also increases total sleep by 50%. Our results show that taurine increases sleep, while caffeine, as previously reported, attenuates sleep. Flies treated with both caffeine and taurine exhibit two differential effects which depend upon the ratio of taurine to caffeine. A high taurine:caffeine ratio promotes sleep, while a low ratio of taurine:caffeine inhibits sleep to a greater extent than the equivalent amount of caffeine alone. This intriguing enhancement of caffeine action by low doses of taurine may account for the presence of both compounds in energy-promoting drinks such as Red Bull® and Monster®.
