Background and Objective
Robotic bronchoscopy has demonstrated high navigational success in small peripheral lung nodules but the diagnostic yield is discrepantly lower. Needle based confocal laser ...endomicroscopy (nCLE) enables real‐time microscopic imaging at the needle tip. We aim to assess feasibility, safety and needle repositioning based on real‐time nCLE‐guidance during robotic bronchoscopy in small peripheral lung nodules.
Methods
Patients with suspected peripheral lung cancer underwent fluoroscopy and radial EBUS assisted robotic bronchoscopy. After radial EBUS nodule identification, nCLE‐imaging of the target area was performed. nCLE‐malignancy and airway/lung parenchyma criteria were used to identify the optimal sampling location. In case airway was visualized, repositioning of the biopsy needle was performed. After nCLE tool‐in‐nodule confirmation, needle passes and biopsies were performed at the same location.
Measurements and Main Results
Twenty patients were included (final diagnosis n = 17 (lung) cancer) with a median lung nodule size of 14.5 mm (range 8–28 mm). No complications occurred. In 19/20 patients, good quality nCLE‐videos were obtained. In 9 patients (45%), real‐time nCLE‐imaging revealed inadequate positioning of the needle and repositioning was performed. After repositioning, nCLE‐imaging provided tool‐in‐nodule‐confirmation in 19/20 patients. Subsequent ROSE demonstrated representative material in 9/20 patients (45%) and overall diagnostic yield was 80% (16/20). Of the three patients with malignant nCLE‐imaging but inadequate pathology, two were diagnosed with malignancy during follow‐up.
Conclusion
Robotic bronchoscopic nCLE‐imaging is feasible and safe. nCLE‐imaging in small, difficult‐to‐access lung nodules provided additional real‐time feedback on the correct needle positioning with the potential to optimize the sampling location and diagnostic yield.
Robotic bronchoscopic nCLE‐imaging is feasible, safe and enables real‐time visualization of tumour cells at the needle tip. Based on nCLE‐guidance, the robotic bronchoscope was repositioned in almost half of patients. Our data show the potential of robotic bronchoscopic nCLE‐imaging as a safe, improved strategy to diagnose small difficult‐to‐access lung nodules.
The Robotic Endoscopic System (Auris Health, Inc., Redwood City, CA) has the potential to overcome several limitations of contemporary guided-bronchoscopic technologies for the diagnosis of lung ...lesions. Our objective is to report on the initial post-marketing feasibility, safety and diagnostic yield of this technology.
We retrospectively reviewed data on consecutive cases in which robot-assisted bronchoscopy was used to sample lung lesions at four centers in the US (academic and community) from June 15th, 2018 to December 15th, 2018.
One hundred and sixty-seven lesions in 165 patients were included in the analysis, with an average follow-up of 185 ± 55 days. The average size of target lesions was 25.0 ± 15.0 mm. Seventy-one percent were located in the peripheral third of the lung. Pneumothorax and airway bleeding occurred in 3.6 and 2.4% cases, respectively. Navigation was successful in 88.6% of cases. Tissue samples were successfully obtained in 98.8%. The diagnostic yield estimates ranged from 69.1 to 77% assuming the cases of biopsy-proven inflammation without any follow-up information (N = 13) were non-diagnostic and diagnostic, respectively. The yield was 81.5, 71.7 and 26.9% for concentric, eccentric and absent r-EBUS views, respectively. Diagnostic yield was not affected by lesion size, density, lobar location or centrality.
RAB implementation in community and academic centers is safe and feasible, with an initial diagnostic yield of 69.1-77% in patients with lung lesions that require diagnostic bronchoscopy. Comparative trials with the existing bronchoscopic technologies are needed to determine cost-effectiveness of this technology.
Thoracentesis is a fundamental procedure in interventional pulmonology, providing both diagnostic and therapeutic value. This review article offers a comprehensive analysis of thoracentesis, delving ...into pleural anatomy, procedural techniques, indications, and recent advancements. The article details the evolution of thoracentesis, including the crucial role of ultrasound guidance and emerging approaches that enhance precision and minimize complications. It addresses the wide range of indications for thoracentesis in diverse clinical scenarios, from the diagnosis of pleural effusions to therapeutic drainage of pleural collections. Furthermore, this review explores the management of coagulopathy and anticoagulation pertaining to thoracentesis. It will also provide strategies for preventing and managing complications, ensuring that thoracentesis remains a well-tolerated procedure with minimal risks. This article concludes by examining future directions in thoracentesis, including potential innovations and trends that will shape the landscape of interventional pulmonary medicine. This review serves as an essential resource for pulmonologists, interventional radiologists, and healthcare professionals, offering a comprehensive update on thoracentesis.
The inability to assess ASM in vivo is a significant hurdle in advancing our understanding of airway diseases such as asthma, as well as evaluating potential treatments and therapies. In this study, ...we demonstrate that endoscopic OR-OCT can be used to accurately measure changes to ASM structure following BT. Our results demonstrate how this technology could occupy an important role in asthma treatments targeting ASM.
The inability to assess and measure changes to the airway smooth muscle (ASM) in vivo is a major challenge to evaluating asthma and its clinical outcomes. Bronchial thermoplasty (BT) is a therapy for asthma that aims to reduce the severity of excessive bronchoconstriction by ablating ASM. Although multiple long-term clinical studies of BT have produced encouraging results, the outcomes of BT treatment in practice have been variable, and questions remain regarding the selection of patients. Previously, we have demonstrated an imaging platform called orientation-resolved optical coherence tomography that can assess ASM endoscopically using an imaging catheter compatible with bronchoscopy. In this work, we present results obtained from a longitudinal BT study performed using a canine model ( n = 8) and with the goal of investigating the use of orientation-resolved optical coherence tomography (OR-OCT) for measuring the effects of BT on ASM. We demonstrate that we are capable of accurately assessing ASM both before and in the weeks following the BT procedure using blinded matching to histological samples stained with Masson’s trichrome ( P < 0.0001, r
2
= 0.79). Analysis of volumetric ASM distributions revealed significant decreases in ASM in treated airways (average cross-sectional ASM area: 0.245 ± 0.145 mm
2
pre-BT and 0.166 ± 0.112 mm
2
6 wk following BT). These results demonstrate that OR-OCT can provide clinicians with the feedback necessary to better evaluate ASM and its response to BT, and may potentially play an important role in phenotyping asthma and predicting which patients are most likely to respond to BT treatment.
NEW & NOTEWORTHY The inability to assess ASM in vivo is a significant hurdle in advancing our understanding of airway diseases such as asthma, as well as evaluating potential treatments and therapies. In this study, we demonstrate that endoscopic OR-OCT can be used to accurately measure changes to ASM structure following BT. Our results demonstrate how this technology could occupy an important role in asthma treatments targeting ASM.
Cannibalism and aggression are major sources of mortality in the larviculture of the spotted seatrout, Cynoscion nebulosus. High stocking density can either increase cannibalism by increasing the ...likelihood of encounters between aggressors and prey or decrease cannibalism by interfering with normal territorial or aggressive behaviors. The goal of this study was to assess the effect of stocking density on cannibalism and aggressive behaviors in hatchery-reared spotted seatrout. Seven-day-old larvae were stocked randomly into three replicates of three different densities (15 (233 total fish), 30 (465 total fish), and 60 (930 total fish) L−1) in 15.5-L aquaria. Feeding was conducted every 8h based on residual rotifer or Artemia counts. Growth was determined 6days poststocking at the conclusion of the experiment. To quantify cannibalism and aggressive behaviors, three cameras filmed three tanks for 9h each day. Recorded behaviors were quantified for three selected 30-minute segments per tank per day: 1h, 4h, and 7h post-feeding. Aggressive acts were scored as: nip (aggressor strikes prey causing prey to dart), chase (aggressor moves more than one body length toward prey), and capture (predator captures and holds prey but unable to consume). In all stocking densities there was a significant increase in aggression and cannibalism with time since feeding. Growth was significantly higher in the lower density treatment. An observed density threshold existed at a stocking density of 30fishL−1, beyond which the intensity of aggressive behaviors did not increase. Based on the results of this study, aggression in early stage hatchery-reared spotted seatrout might be alleviated with increased feeding frequency. Further, spotted seatrout could possibly be cultured at densities higher than the current protocol allows.
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspirate (TBNA) is a widely used method of minimally invasive lymph node sampling. The benefit of processing samples by cytologic methods ...versus “core biopsy” is unclear. It is unknown if safety or diagnostic yield varies by needle gauge.
Between June 2018 and July 2019, 40 patients (56 lesions) undergoing EBUS TBNA lymph node evaluation were enrolled in this single-center prospective trial. Patients were chosen by permuted block randomization to undergo EBUS TBNA starting with 22-gauge (22g) or 19-gauge (19g) needles. Separate samples were sent for processing by cytologic methods and histopathology. Surgical pathologists and cytopathologists were blinded to needle size. The primary endpoint was diagnostic yield. Secondary endpoints compared specimen adequacy by rapid onsite evaluation (ROSE), sample adequacy for molecular testing, sample quality, and safety.
Diagnostic yield for histopathologic examination was 87.5% and 83.9% for 19g and 22g respectively (P = 0.625). There was no significant difference in diagnostic yield by cytologic examination based on needle size. There was no significant difference in slide quality. Molecular adequacy for core-biopsy was 77% and 80% for 22g and 19g needles, respectively. Molecular adequacy for cytology cell block was 77% and 80% for 22g and 19g needles, respectively. There were no significant procedural complications.
Both the 22g and 19g EBUS TBNA needles provided a similar diagnostic yield and clinical utility for ancillary testing. Processing techniques by cytologic methods or “core biopsy” showed no significant impact in diagnostic yield or utility of molecular testing.
Cannibalism is a major cause of mortality in the intensive culture of the spotted seatrout, Cynoscion nebulosus. Increased feeding frequency may reduce attacks on conspecifics and enhance growth due ...to less energy spent on aggression, or more efficient digestion of smaller ration parcels. The goal of this study was to examine the effects of feeding frequency on aggressive and cannibalistic behaviors in larval hatchery-reared spotted seatrout. Ten-day-old reared larvae stocked at 30fishl−1 were subjected to one of four feeding frequencies (every 1, 2, 4, or 8h) for eight days by subdividing the total ration of enriched Artemia accordingly. Blocks of three replicate tanks per treatment were monitored from 2-h before feeding until 1-h after feeding via four video cameras. For each tank, two pre-selected 30min segments starting 30min before and 30min after each feeding event were scored for the number of nips, chases, and captures (Type 1 cannibalism). Three main factors, Frequency, Day, and Time were significant for all three behaviors. Significant Frequency×Time interactions along with follow-up tests of interaction means indicated that the numbers of nips and chases were lower after feeding than before feeding for all but the most frequent (1-h) feeding frequency. The 2-h frequency treatment elicited the fewest aggressive and cannibalistic acts, likely reflecting the best balance between the opposing effects of ration size on satiation and feeding frequency on gut evacuation time. Specific growth rate (SGR) was relatively high and did not differ between the 2-h and conventional 8-h frequencies; but size heterogeneity was significantly higher for the 8-h frequency treatment.
•The effects of feeding frequency on aggression and cannibalism were examined in larval hatchery-reared spotted seatrout.•Ten-day-old larvae were subjected to one of four feeding-frequencies for eight days by subdividing the total ration.•Aggression was mediated by a trade-off between the opposing effects of ration size and feeding frequency.•Spotted seatrout larvae from the 2-h frequency treatment exhibited low aggression, high growth and low size heterogeneity.•Aggression can be reduced by attaining adequate satiation while precluding complete gut evacuation between feedings.
A simple protocol for the synthesis of Weinreb benzamides and α,β-unsaturated Weinreb amides through a palladium-catalyzed cross-coupling reaction between organoboronic acids and ...N-methoxy-N-methylcarbamoyl chloride has been developed. The method is also applicable to the use of potassium organotrifluoroborates.
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