Transbronchial lung biopsies are commonly performed for a variety of indications. Although generally well tolerated, complications such as bleeding do occur. Description of bleeding severity is ...crucial both clinically and in research trials; to date, there is no validated scale that is widely accepted for this purpose. Can a simple, reproducible tool for categorizing the severity of bleeding after transbronchial biopsy be created?
Using the modified Delphi method, an international group of bronchoscopists sought to create a new scale tailored to assess bleeding severity among patients undergoing flexible bronchoscopy with transbronchial lung biopsies. Cessation criteria were specified a priori and included reaching > 80% consensus among the experts or three rounds, whichever occurred first.
Thirty-six expert bronchoscopists from eight countries, both in academic and community practice settings, participated in the creation of the scale. After the live meeting, two iterations were made. The second and final scale was vetted by all 36 participants, with a weighted average of 4.47/5; 53% were satisfied, and 47% were very satisfied. The panel reached a consensus and proposes the Nashville Bleeding Scale.
The use of a simplified airway bleeding scale that can be applied at bedside is an important, necessary tool for categorizing the severity of bleeding. Uniformity in reporting clinically significant airway bleeding during bronchoscopic procedures will improve the quality of the information derived and could lead to standardization of management. In addition to transbronchial biopsies, this scale could also be applied to other bronchoscopic procedures, such as endobronchial biopsy or endobronchial ultrasound-guided needle aspiration.
Abstract
Objectives
The level of detail included when describing nailfold videocapillaroscopy (NVC) methods varies among research studies, making interpretation and comparison of results challenging. ...The overarching objective of the present study was to seek consensus on the reporting standards in NVC methodology for clinical research in rheumatic diseases and to propose a pragmatic reporting checklist.
Methods
Based on the items derived from a systematic review focused on this topic, a three-step web-based Delphi consensus on minimum reporting standards in NVC was performed among members of the European League against Rheumatism (EULAR) Study Group on Microcirculation in Rheumatic Diseases and the Scleroderma Clinical Trials Consortium.
Results
A total of 319 articles were selected by the systematic review, and 46 items were proposed in the Delphi process. This Delphi exercise was completed by 80 participants from 31 countries, including Australia and countries within Asia, Europe, North America and South America. Agreement was reached on items covering three main areas: patient preparation before NVC (15 items), device description (5 items) and examination details (13 items).
Conclusion
Based on the available evidence, the description of NVC methods was highly heterogeneous in the identified studies and differed markedly on several items. A reporting checklist of 33 items, based on practical suggestions made (using a Delphi process) by international participants, has been developed to provide guidance to improve and standardize the NVC methodology to be applied in future clinical research studies.
Transbronchial lung biopsies are commonly performed for a variety of indications. Although generally well tolerated, complications such as bleeding do occur. Description of bleeding severity is ...crucial both clinically and in research trials; to date, there is no validated scale that is widely accepted for this purpose. Can a simple, reproducible tool for categorizing the severity of bleeding after transbronchial biopsy be created?
Using the modified Delphi method, an international group of bronchoscopists sought to create a new scale tailored to assess bleeding severity among patients undergoing flexible bronchoscopy with transbronchial lung biopsies. Cessation criteria were specified a priori and included reaching > 80% consensus among the experts or three rounds, whichever occurred first.
Thirty-six expert bronchoscopists from eight countries, both in academic and community practice settings, participated in the creation of the scale. After the live meeting, two iterations were made. The second and final scale was vetted by all 36 participants, with a weighted average of 4.47/5; 53% were satisfied, and 47% were very satisfied. The panel reached a consensus and proposes the Nashville Bleeding Scale.
The use of a simplified airway bleeding scale that can be applied at bedside is an important, necessary tool for categorizing the severity of bleeding. Uniformity in reporting clinically significant airway bleeding during bronchoscopic procedures will improve the quality of the information derived and could lead to standardization of management. In addition to transbronchial biopsies, this scale could also be applied to other bronchoscopic procedures, such as endobronchial biopsy or endobronchial ultrasound-guided needle aspiration.
We report a case of broncholithiasis secondary to pulmonary actinomycosis. Broncholithiasis has occasionally been reported in association with actinomycosis, but it is unclear if actinomycosis leads ...to lymph node calcification with subsequent erosion into the airway, producing a broncholith, or if an existing generic broncholith is secondarily colonized with Actinomyces. The patient had post-obstruction pneumonia, and computed tomography showed calcified nodules obstructing the bronchus intermedius and distal necrotizing pneumonia. The nodules included sulfur granules containing Gram-positive branching filamentous organisms consistent with Actinomyces. The finding of Actinomyces throughout the broncholith is strong evidence that the etiology of the broncholithiasis was a primary pulmonary Actinomyces infection.
The genetic structures of the Iowa Corn Borer Synthetic #1 (CB) and Iowa Stiff Stalk Synthetic (SS) maize (Zea mays L.) populations are important because these populations serve as the model for ...development of modern commercial hybrids. In 1949, CB and SS were used to start a reciprocal recurrent selection (RRS) breeding program at Iowa State University. This study was conducted to analyze more thoroughly the genetic diversity within this RRS program and illustrate how the RRS program has changed over time at the molecular level. The progress of this program was measured by analyzing the variation at 86 SSR loci among 28 progenitor lines and 30 plants sampled from each of seven cycles (Cycle 0, Cycle 1, Cycle 3, Cycle 6, Cycle 9, Cycle 12, and Cycle 15) in each population. The progenitors of these populations show a high amount of variation on the basis of expected heterozygosity (0.557). As the RRS program proceeded, this variation decreased (Cycle 15, 0.245). In total, a larger amount of genetic variation was found among plants within cycles (66%) than among cycles (13%) or between populations (21%). The repartitioning of variation from within populations (96% in progenitors) to between populations (58% in Cycle 15) over time is consistent with theoretical expectations of divergence between the populations. By sampling intermediate time points, we gained a comprehensive genetic view of CB and SS permitting evaluation of the molecular-level changes occurring as a result of reciprocal recurrent selection.
ABSTRACT
Background/Objective. Our aim was to study the prevalence of counseling received by adult women with congenital heart disease to determine from whom they received such counseling and to ...describe their contraceptive and reproductive knowledge.
Methods/Design. Using a cross‐sectional survey, information was collected from 83 women, ≥19 years of age with congenital heart disease from a group of 404 women followed in our adult congenital heart disease clinic. Women were stratified into combined hormonal contraceptive and pregnancy World Health Organization risk classes 1–4 based on cardiac lesion.
Results. We hypothesized that >50% of women had not received both contraceptive and reproductive counseling that addressed their heart condition; indeed, 59% of women reported they had not received such counseling (P = .05). Women who had received heart‐specific contraceptive counseling were in higher risk combined hormonal contraceptive World Health Organization classes (P = .02). Similarly, women who reported receiving counseling regarding risks of pregnancy were also in higher pregnancy World Health Organization risk classes (P = .002). Fifty‐two of 77 women (63%) did not know if there was a contraindicated contraceptive method given their underlying heart condition; 16 of these 52 women (31%) were combined hormonal contraceptive class 3 or class 4.
Conclusions. This adult congenital heart disease survey study demonstrates an opportunity to improve individualized contraceptive and reproductive counseling with a goal toward minimizing each patient's risk of potentially avoidable adverse events. A stronger collaboration among health care professionals is needed to increase the prevalence of heart‐specific counseling and to increase the quality of counseling these women are receiving.
Cotton germplasm resources contain beneficial alleles that can be exploited to develop germplasm adapted to emerging environmental and climate conditions. Accessions and lines have traditionally been ...characterized based on phenotypes, but phenotypic profiles are limited by the cost, time, and space required to make visual observations and measurements. With advances in molecular genetic methods, genotypic profiles are increasingly able to identify differences among accessions due to the larger number of genetic markers that can be measured. A combination of both methods would greatly enhance our ability to characterize germplasm resources. Recent efforts have culminated in the identification of sufficient SNP markers to establish high-throughput genotyping systems, such as the CottonSNP63K array, which enables a researcher to efficiently analyze large numbers of SNP markers and obtain highly repeatable results. In the current investigation, we have utilized the SNP array for analyzing genetic diversity primarily among cotton cultivars, making comparisons to SSR-based phylogenetic analyses, and identifying loci associated with seed nutritional traits.
The SNP markers distinctly separated G. hirsutum from other Gossypium species and distinguished the wild from cultivated types of G. hirsutum. The markers also efficiently discerned differences among cultivars, which was the primary goal when designing the CottonSNP63K array. Population structure within the genus compared favorably with previous results obtained using SSR markers, and an association study identified loci linked to factors that affect cottonseed protein content.
Our results provide a large genome-wide variation data set for primarily cultivated cotton. Thousands of SNPs in representative cotton genotypes provide an opportunity to finely discriminate among cultivated cotton from around the world. The SNPs will be relevant as dense markers of genome variation for association mapping approaches aimed at correlating molecular polymorphisms with variation in phenotypic traits, as well as for molecular breeding approaches in cotton.
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