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ABSTRACT: Cobas TaqMan MTB assay is a real-time polymerase chain reaction (qPCR) kit in rapid detection of Mycobacterium tuberculosis (MTB) from clinical specimens. There are, however, limited studies validating its performance. We performed a prospective study in two hospitals in Taiwan including 586 respiratory specimens. By using culture as the reference method, the sensitivity and specificity of Cobas TaqMan MTB assay were 82.7 % and 96.5 %, respectively. The sensitivity of Cobas TaqMan MTB assay in acid-fast stain negative respiratory specimens was only 34.9 %. Five specimens from five patients were positive for MTB by the Cobas TaqMan MTB assay but were negative for MTB by conventional culture methods. A diagnosis of pulmonary tuberculosis was made based on clinical and radiological findings as well as response to anti-tuberculosis treatment in all these five patients. Addition of data from these five specimens with discrepant results (PCR vs. culture) from patients with symptoms clinically compatible with tuberculosis increased the sensitivity of Cobas TaqMan MTB assay to 83.1 %. The Cobas TaqMan MTB assay is a rapid identification tool with a high degree of specificity for the direct detection of MTB in respiratory specimens. The sensitivity for detecting acid-fast smear-negative respiratory specimens, however, was low.
Journal of Medical Microbiology 05/2013; · 2.50 Impact Factor
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ABSTRACT: BACKGROUND AND OBJECTIVE: Correct and early risk stratification for critically ill pneumonia patients remains an unmet medical need. This study aimed to test whether N-terminal pro B-type natriuretic peptide (NT-proBNP) can serve as a prognostic marker in this setting. METHODS: This prospective study enrolled 216 pneumonia patients admitted to intensive care unit. Plasma NT-proBNP samples were obtained upon intensive care unit admission and primary outcome was all-cause mortality at 30 days. Patient demographics, comorbidities, x-ray findings, need for ventilatory support, presence of shock, antibiotic regimens, APACHE II, and Infectious Diseases Society of America/American Thoracic Society(IDSA/ATS) 2007 minor criteria were assessed. RESULTS: Overall 30-day mortality was 30%. NT-proBNP levels were significantly higher in nonsurvivors compared to survivors (11938±13121 vs. 5658±9240 pg/ml, p=0.001). Area under receiver operating characteristic curves of NT-proBNP, APACHE II, and IDSA/ATS 2007 minor criteria were not significantly different regarding prediction of mortality (0.715, 0.754 vs. 0.654, p=0.085). Adding NT-proBNP to APACHE II significantly increased the area under receiver operating characteristic curve from 0.754 to 0.794(p=0.048). Receiver operating characteristic analysis revealed optimal NT-proBNP and APACHE II cutoffs of 2177.5 pg/ml and 25.5, respectively. In multivariate analysis, both NT-proBNP and APACHE II values above cutoffs had a significantly higher probability of death than those below cutoffs. A categorical approach combining NT-proBNP and APACHE II cutoffs provides additional risk stratification over a single marker approach. CONCLUSIONS: For pneumonia patients admitted to intensive care unit, NT-proBNP strongly and independently predicts mortality, and its prognostic accuracy is comparable to APACHE II and IDSA/ATS 2007 minor criteria.
Respirology 04/2013; · 2.42 Impact Factor
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ABSTRACT: OBJECTIVES: To investigate the impact of the directly observed therapy, short course (DOTS) and DOTS-Plus strategies on changes in resistance profiles among Mycobacterium tuberculosis (MTB). METHODS: We performed a retrospective analysis of resistance profiles among isolates of MTB obtained from 2160 consecutive patients with culture-confirmed pulmonary tuberculosis (TB) between 2005 and 2011 at a referral centre in southern Taiwan. RESULTS: Of the 2160 patients, 70 (3.2%) had primary multidrug-resistant (MDR)-TB, 178 (8.2%) had acquired MDR-TB, 10 (0.5%) had primary extensively drug-resistant (XDR)-TB, 23 (1.1%) had acquired XDR-TB and 5 (0.2%) had totally drug-resistant (TDR)-TB. Trend analysis revealed that the rates of acquired MDR-TB were significantly lower after implementation of the DOTS and DOTS-Plus programmes (P < 0.01). There was a significant negative correlation between the coverage rates of the DOTS and DOTS-Plus programmes and the rates of acquired MDR-TB (r = -0.84, P = 0.02 and r = -0.92, P = 0.03, respectively). The rates of resistance to rifampicin, isoniazid, ofloxacin, moxifloxacin, levofloxacin and para-aminosalicylic acid also decreased significantly during the study period. However, the rates of primary MDR-TB remained stable (P = 0.11). Multivariate logistic regression analysis showed that age ranging from 45 to 64 years, positive acid-fast stain results at the initiation of treatment and treatment without DOTS were independent risk factors associated with acquired MDR-TB. In addition, previous treatment for TB (100% versus 19% for TDR-TB and non-TDR-TB, P < 0.01) and treatment without DOTS (80% versus 44% for TDR-TB and non-TDR-TB, P = 0.18) were risk factors for TDR-TB. CONCLUSIONS: DOTS and DOTS-Plus are both effective at preventing the acquisition of MDR-TB in Taiwan.
Journal of Antimicrobial Chemotherapy 04/2013; · 5.07 Impact Factor
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The Journal of thoracic and cardiovascular surgery 03/2013; · 3.41 Impact Factor
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ABSTRACT: BACKGROUND: Apoptosis-associated biomarkers are rarely studied, especially their role in predicting the development of tuberculosis (TB) from latent TB infection and in prognostication. METHODS: Patients with TB and interferon-gamma release assay (IGRA)-positive and IGRA-negative family contacts were evaluated to analyze changes in apoptosis-associated serum biomarkers, which included decoy receptor 3 (DcR3), prostaglandin 2 (PGE2), and lipoxin. The prognostic implications of these serum biomarkers were also analyzed. RESULTS: One hundred TB patients and 92 IGRA-negative and 91 IGRA-positive family contacts were recruited. The DcR3 and PGE2 levels decreased from the IGRA-negative group to the IGRA-positive group, and peaked in the TB group. Lipoxin decreased to trough in the TB group. The three apoptosis serum markers and age were independent factors discriminating active TB from latent TB infection. In active TB, older age, co-morbidity, and higher serum DcR3 and monocyte chemotactic protein (MCP)-1 were independently associated with poorer six-month survival. CONCLUSION: Apoptosis-associated serum biomarkers change along with the status of Mycobacterium tuberculosis infection. In close contacts with positive IGRA, high DcR3 and PGE2 and low lipoxin may increase the probability of active TB. Older age, co-morbidity, and high DcR3 and MCP-1 levels might be important prognostic factors that warrant further investigation.
BMC Infectious Diseases 01/2013; 13(1):45. · 3.12 Impact Factor
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ABSTRACT: Background:Approaches to respiratory care of patients needing prolonged mechanical ventilation (PMV) might be varied. In this study, we assessed the predictive value of usual variables for extubation outcome in PMV patients.Methods:From 2005 to 2007, intubated patients who were admitted to the intermediate respiratory care unit, had been placed on mechanical ventilation for ≧21 days at the time of admission, and underwent extubation after successful spontaneous breathing trials were included. Comparisons between patients with successful extubation and failed extubation in terms of weaning parameters and clinical predictors of extubation outcome were performed. Also, one-year survival of patients with regard to extubation outcome was analyzed.Results:Twenty seven (23.7%) of 119 PMV patients required reintubation within 7 days. Multivariate logistic regression analysis demonstrated the only variable associated with extubation failure was ineffective cough (p <0.001). Possessing two or more acceptable weaning parameters was not helpful in predicting extubation outcome. Patients with failed extubation had worse one-year survival (HR, 0.491; 95% CI, 0.277-0.871; p =0.015) compared with those with successful extubation.Conclusions:In PMV patients who tolerated spontaneous breathing trials and were ready to extubate, ineffective cough was the best predictor of extubation failure. Furthermore, extubation failure was associated with future mortality; thus, different management strategies need to be developed for improving patient outcome.
Respiratory care 01/2013; · 2.01 Impact Factor
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ABSTRACT: INTRODUCTION: To assess the efficacy and potential prognostic factors of patients with stage III N2 non-small-cell lung cancer (NSCLC) treated with neoadjuvant docetaxel-cisplatin (DP) chemotherapy followed by surgical resection. METHODS: Sixty-two patients with NSCLC treated with DP as neoadjuvant chemotherapy between November 2003 and December 2009 were identified and reviewed in this study. Tumor response, survival, and clinicopathologic data were collected retrospectively. The time to event was analyzed by fitting Cox proportional hazards models. RESULTS: Fifty-eight (94%) of 62 patients eventually underwent surgical resection after DP. The overall clinical response rate to induction DP chemotherapy was 42%. Patients with squamous cell carcinoma (SCC) histology were more likely to response to the DP regimen than those with adenocarcinoma histology (68% vs. 33%, P = .006). With a median follow-up of 82.4 months among the 58 patients, there were 41 (71%) tumor relapses and 27 (47%) deaths. The median event-free survival was 27.5 months (95% CI, 22.3-32.7 months), and the median overall survival was 66.7 months (95% CI, 35.1-98.3 months). In multivariate analysis, when fitting the Cox proportional hazards model, SCC histology (hazard ratio [HR] 0.234 [95% CI, 0.098-0.560]; P = .001) and mediastinal downstaging to N0 (HR 0.451 [95% CI, 0.226-0.898]; P = .024) were independent predictors of better event-free survival. CONCLUSIONS: Neoadjuvant chemotherapy with the DP regimen is both active and well tolerated in patients with stage III N2 NSCLC. SCC histology predicted a better treatment response and survival outcome than adenocarcinoma histology in this patient group. Further investigation of combined-modality treatment is warranted to improve survival in the adenocarcinoma subset of stage III N2 NSCLC.
Clinical Lung Cancer 01/2013; · 2.94 Impact Factor
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ABSTRACT: ABSTRACT BACKGROUND: Sputum samples from patients with non-multidrug-resistant (non-MDR) pulmonary tuberculosis (TB) may remain smear-positive for acid-fast bacilli (AFB) on the 5th month of anti-TB treatment. However, its significance remains unknown. METHODS: From January 2004 to April 2009, there were 5403 patients with culture-confirmed pulmonary TB from in four hospitals in Taiwan. Among them, 116 (2.2%) non-MDR-TB patients whose sputum samples were smear-positive by concentration smear method on the 5th month of treatment were evaluated. RESULTS: Sputum culture yielded Mycobacterium tuberculosis in 10 patients (8.6%, MTB group), non-tuberculous mycobacteria in 23 (19.8%, NTM group), and no-growth in the remaining 83 (71.6%, no-growth group). The relapse rate (22%) was higher in the MTB group (p=0.01). Four predictors, smear grading ≥3+ on the 5th month ["S"] (OR:10.73, 2.67-43.17), no sputum culture conversion on the 2nd month ["C"] (OR:7.16, 1.45-35.44), lack of Directly Observed Therapy ["O"] (OR:6.40, 1.54-26.56), and no radiographic improvement on the 5th month ["R"] (OR:4.18, 1.02-17.10), were associated with viable M. tuberculosis (MTB group). An integrated "SCOR" index of 1 point for each positive factor had the best discriminatory power for predicting culture results on the 5th month. If the "SCOR" index was 0, all smear-positive sputum was culture-negative for M. tuberculosis. CONCLUSIONS: Positive sputum smears by a concentrated smear method on the 5th month of treatment in non-MDR TB patients, especially those with a low "SCOR" index, may be due to non-viable bacilli and NTM. Careful review of the quality of patient supervision, bacteriologic data, and chest radiography is crucial.
Chest 01/2013; · 5.25 Impact Factor
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Chieh-Liang Wu,
Shih-Chi Ku,
Kuang-Yao Yang,
Wen-Feng Fang,
Chih-Yen Tu,
Chang-Wen Chen,
Kuo-Hsuan Hsu,
Wen-Chien Fan,
Meng-Chih Lin,
Wei Chen,
Chih-Ying Ou, Chong-Jen Yu
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ABSTRACT: BACKGROUND/PURPOSE: Community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) may be caused by potential antimicrobial drug-resistant (PADR) microbes. The aims of this study were to evaluate the incidences and risk factors associated with PADR microbes observed in patients with pneumonia occurring outside the hospital setting in Taiwan. METHODS: We conducted a retrospective study of patients with CAP or HCAP admitted to six medical centers in the northern, central, and southern regions of Taiwan in 2007. The pathogens were evaluated by microbiological specimens within 72 hours after admission. The patients' comorbidities, pathogens, and outcomes were evaluated. The risk factors of PADR microbes were identified by logistic regression analysis. RESULTS: The enrolled patients exhibited HCAP (n=713) and CAP (n=933). The pathogens associated with HCAP (n=383) and CAP (n=441) included Pseudomonas spp. (29%vs. 10%, p<0.001), Klebsiella spp. (24% vs. 25%, p=0.250), Escherichia coli (6% vs. 8%, p=0.369), Haemophilus influnezae (3% vs. 7%, p=0.041), Streptococcus pneumoniae (2% vs. 6%, p=0.003) and methicillin-resistant Staphylococcus aureus (MRSA) (8% vs. 4%, p=0.008). The core pathogens of CAP and HCAP differed among the three regions of Taiwan. PADR microbes, including Pseudomonas spp. (n=191), Acinetobacter spp. (n=41), MRSA (n=49) and cefotaxime- or ceftazidime-resistant Enterbacteriaceae (n=25), were isolated from 13% of patients with CAP and 23% of patients with HCAP. Previous hospitalization, and neoplastic and neurological diseases were significant risk factors for acquiring PADR microbes. CONCLUSION: PADR microbes were common in patients with HCAP and CAP in Taiwan. Broad-spectrum antibiotics targeting PADR microbes should be administered to patients who have undergone previous hospitalization and who exhibit neurological disorders and/or malignancies.
Journal of the Formosan Medical Association 01/2013; 112(1):31-40. · 1.13 Impact Factor
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ABSTRACT: There is paucity of risk factors on lung function decline among patients with non-tuberculous mycobacteria (NTM) pulmonary disease in literature.
Patients with NTM pulmonary disease between January 2000 and April 2011 were retrospectively selected. Sixty-eight patients had at least two pulmonary function tests within a mean follow-up period of 47 months.
Sixty-eight patients were included. They had a median age of 65 years and 65% had impaired lung function (Forced expiratory volume in 1 second [FEV1] <80% of predicted value). The mean FEV1 decline was 48 ml/year. By linear regression, younger age (beta: 0.472, p<0.001), initial FEV1>50% of predicted value (beta: 0.349, p = 0.002), male sex (beta: 0.295, p = 0.018), bronchiectasis pattern (beta: 0.232, p = 0.035), and radiographic score >3 (beta: 0.217, p = 0.049) were associated with greater FEV1 decline. Initial FEV1>50% of predicted value (beta: 0.263, p = 0.032) was also associated with greater FVC annual decline, whereas M. kansasii pulmonary disease was marginally associated with greater annual FVC decline (beta: 0.227, p = 0.062).
NTM pulmonary disease is associated with greater decline in lung function in patients who are young, male, with bronchiectasis, and with a high radiographic score. Special attention should be given to patients with these risk factors.
PLoS ONE 01/2013; 8(3):e58214. · 4.09 Impact Factor
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ABSTRACT: The up-regulation of fucosyltransferase 8 (FUT8), the only enzyme catalyzing α1,6-fucosylation in mammals, has been observed in several malignant cancers including liver, ovarian, thyroid, and colorectal cancers. However, the pathological role and the regulatory mechanism of FUT8 in cancers remain largely unknown. In the current study, we report that the expression of FUT8 is up-regulated in nonsmall cell lung cancer (NSCLC) and correlates with tumor metastasis, disease recurrence, and poor survival in patients with NSCLC. Knocking down FUT8 in aggressive lung cancer cell lines significantly inhibits their malignant behaviors including in vitro invasion and cell proliferation, as well as in vivo metastasis and tumor growth. The results of glycoproteomic and microarray analyses show that FUT8 globally modifies surface antigens, receptors, and adhesion molecules and is involved in the regulation of dozens of genes associated with malignancy, suggesting that FUT8 contributes to tumor progression through multiple mechanisms. Moreover, we show that FUT8 is up-regulated during epithelial-mesenchymal transition (EMT), a critical process for malignant transformation of tumor, via the transactivation of β-catenin/lymphoid enhancer-binding factor-1 (LEF-1). These results provide a model to illustrate the relation between FUT8 expression and lung cancer progression and point to a promising direction for the prognosis and therapy of lung cancer.
Proceedings of the National Academy of Sciences 12/2012; · 9.68 Impact Factor
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Clinical Infectious Diseases 11/2012; · 9.15 Impact Factor
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Qing Lan,
Chao A Hsiung,
Keitaro Matsuo,
Yun-Chul Hong,
Adeline Seow,
Zhaoming Wang,
H Dean Hosgood,
Kexin Chen,
Jiu-Cun Wang,
Nilanjan Chatterjee, [......],
Hsien-Chih Lin,
Tangchun Wu,
Yi-Long Wu,
Pan-Chyr Yang,
Baosen Zhou,
Min-Ho Shin,
Joseph F Fraumeni,
Dongxin Lin,
Stephen J Chanock,
Nathaniel Rothman
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ABSTRACT: To identify common genetic variants that contribute to lung cancer susceptibility, we conducted a multistage genome-wide association study of lung cancer in Asian women who never smoked. We scanned 5,510 never-smoking female lung cancer cases and 4,544 controls drawn from 14 studies from mainland China, South Korea, Japan, Singapore, Taiwan and Hong Kong. We genotyped the most promising variants (associated at P < 5 × 10(-6)) in an additional 1,099 cases and 2,913 controls. We identified three new susceptibility loci at 10q25.2 (rs7086803, P = 3.54 × 10(-18)), 6q22.2 (rs9387478, P = 4.14 × 10(-10)) and 6p21.32 (rs2395185, P = 9.51 × 10(-9)). We also confirmed associations reported for loci at 5p15.33 and 3q28 and a recently reported finding at 17q24.3. We observed no evidence of association for lung cancer at 15q25 in never-smoking women in Asia, providing strong evidence that this locus is not associated with lung cancer independent of smoking.
Nature Genetics 11/2012; · 35.53 Impact Factor
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ABSTRACT: Protocolized hemodynamic resuscitation in severe sepsis or septic shock is not universally applied in all emergency departments and general hospital wards around the world. It is unknown whether ScvO2 levels are associated with the clinical outcome of severe sepsis or septic shock under non-protocolized resuscitation. In this prospective study, we enrolled 124 non-cirrhotic patients who were admitted to intensive care units for severe sepsis or septic shock. The average Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 25.3±7.6. According to ScvO2 levels after initial resuscitation before ICU admission, patients were divided into high (ScvO2 ≥ 70%, n=63) and low (ScvO2 < 70%, n=61) ScvO2 groups. Compared to high ScvO2 groups, low ScvO2 groups showed no significant differences in 28-day mortality (25.4% vs. 24.6%; P = 0.943) or hospital mortality (30.2% vs. 31.1%; P = 0.794). Multivariate logistic regression models showed low mean arterial pressure (MAP) (hazard ratio 0.967, 95% CI 0.94~0.994, P=0.019) and high central venous pressure (CVP) (hazard ratio 1.150, 95% CI 1.057~1.251, P=0.001) after initial resuscitation were associated with higher 28-day mortality. On the contrary, ScvO2 levels after resuscitation were not related to 28-day or hospital mortality. In conclusion, our results showed MAP and CVP were still the most important hemodynamic variables in initial hemodynamic resuscitation. Low postresuscitation ScvO2 was not associated with a worse outcome. It is possible that ScvO2 less than 70% might not necessarily be associated with tissue hypoxia, and critical ScvO2 levels require to be determined by further studies.
Shock (Augusta, Ga.) 11/2012; · 2.87 Impact Factor
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ABSTRACT: In the era of targeted therapy, the association between lung adenocarcinoma patient survival and malignant pleural effusion (MPE) remains unclear. This study investigated the clinical characteristics, survival, and epidermal growth factor receptor (EGFR) mutation status of lung adenocarcinoma patients with MPE.During June 2005 to December 2010, consecutive pleural effusions were collected prospectively. Patient clinical characteristics, EGFR mutation status, and overall survival (OS) were analysed.We collected MPEs from 448 patients in stage IV lung adenocarcinoma at initial diagnosis. Median OS for patients with MPEs at initial diagnosis and following disease progression were 14.3 months and 21.4 months, respectively (p=0.001). There were 296 (66.1%) patient harbouring EGFR mutations; mutation rate among patients with MPEs at initial diagnosis and following disease progression were 68.2% and 56.6%, respectively (p=0.044); L858R mutation rate was also higher among the former (32.6% vs. 18.1%; p=0.009). Multivariate analysis revealed that patients who developed MPEs following disease progression, harboured EGFR mutations, and received EGFR-TKI therapy had longer OS. Patients in stage IV lung adenocarcinoma with MPEs at initial diagnosis have shorter overall survival and higher EGFR mutation rate, especially for L858R, than patients who develop MPEs following disease progression.
European Respiratory Journal 09/2012; · 5.89 Impact Factor
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Chih-Cheng Lai,
Cheng-Yi Wang,
Hsin-Ming Lu,
Likwang Chen,
Nai-Chi Teng,
Yuan-Horng Yan,
Jen-Yu Wang,
Yen-Teh Chang,
Ting-Ting Chao,
Hen-I Lin,
Cheng-Ren Chen, Chong-Jen Yu,
Jung-Der Wang
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ABSTRACT: This study took advantage of a large population-based database of the Taiwan National Health Insurance (NHI) to investigate the epidemiology of idiopathic pulmonary fibrosis (IPF) in Taiwan.
This is a retrospective cohort study based on secondary analysis of prospectively collected data in the NHI system and governmental data on death registry in Taiwan during 1997-2007. By using the broad and narrow definitions for IPF, we estimated incidence and prevalence rates of IPF, and its associated clinical outcomes.
The estimates of annual IPF incidence rates became more stable after 2000, ranging between 0.9 and 1.6 cases per 100,000 persons. The prevalence rates became more than twofold from 2000 to 2007 (from 2.8 to 6.4 cases per 100,000 persons for the broad definition, and from 2.0 to 4.9 cases per 100,000 persons for the narrow definition). Men of age older than 75 years had markedly higher incidence and prevalence rates than other groups. Around 40% of all incidences and about 30% of prevalent cases occurred in this population group. The median survival time after IPF diagnosis was 0.9 year (interquartile range (IQR), 0.2-2.5 years) and 0.7 year (IQR, 0.1-2.3 years) for the broad and narrow definitions, respectively. Progression of IPF was the leading cause of death, followed by cancer.
In Taiwan, elderly men were the major group suffering from IPF. Survival time was short after IPF diagnosis, and the poor survival was largely attributable to quick IPF progression after diagnosis.
Respiratory medicine 09/2012; 106(11):1566-74. · 2.33 Impact Factor
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ABSTRACT: We evaluated the performance of the DR. TBDR/NTM IVD kit, which was designed to detect Mycobacterium tuberculosis, rifampin-resistant M. tuberculosis, and nontuberculous mycobacteria, for detecting 110 positive and 50 negative cultures in Mycobacterium Growth Indicator Tubes. The accuracy rate of this kit for identification of Mycobacterium species was 95.5% (105/110).
Journal of clinical microbiology 08/2012; 50(10):3398-401. · 4.16 Impact Factor
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ABSTRACT: Although endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) has been shown to increase the diagnostic yield over conventional bronchoscopic techniques, an important issue regarding the optimal number of biopsy specimens required has not been thoroughly investigated.
We sought to examine whether the number of biopsy specimens taken was associated with the diagnostic yield of EBUS-guided TBB and, if this was the case, to determine the optimal number of specimens required for the maximum diagnostic yield in peripheral pulmonary lesions.
The medical records of patients undergoing EBUS-guided TBB for the diagnosis of peripheral pulmonary lesions from 2008 to 2010 were retrospectively reviewed. The association of clinical and radiological features, including the number of biopsy specimens, with the diagnostic yield was analysed.
A total of 384 patients were included for analysis. The overall diagnostic yield of EBUS-guided TBB was 73%, and the only factor influencing the diagnostic yield was the position of the probe. Patients in which the EBUS probe was placed within the lesions had a significantly higher yield (85%) than those in which the probe was adjacent to or outside the lesions (38%; p < 0.001). When the number of biopsy specimens was determined based on their adequacy, it was an insignificant factor in predicting the diagnostic yield.
Probe position independently predicts the diagnostic yield of EBUS-guided TBB. In real-world practice, the optimal number of biopsy specimens should be decided on a case-by-case basis.
Respiration 07/2012; 84(2):128-34. · 2.26 Impact Factor
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ABSTRACT: BACKGROUND: Abnormal thoraco-abdominal motion may contribute to exercise limitation in patients with chronic pulmonary obstructive disease (COPD). The current study aimed to assess how the thoraco-abdominal asynchrony in COPD patients correlates with exercise performance during the six-minute walk test (6MWT). METHODS: Eighty-eight COPD patients (40 moderate and 48 severe) and 14 healthy controls were evaluated at rest and during the 6MWT for the magnitude of rib cage and abdominal motion and asynchrony between the two (phase angle) with a respiratory inductive plethysmography. RESULTS: Compared to healthy control subjects, patients with COPD had similar magnitude of rib cage and abdominal motionbut greater asynchrony at rest. During the 6MWT, patients with COPD showed decreased rib cage motion and increased asynchrony. Rib cage excursion at 3 min after the beginning of 6MWT (RC3min) was an independent predictor for the 6MWT distance (p <0.0001), in addition to age, forced expiratory volume in one second (FEV₁, % predicted) and residual volume/total lung capacity ratio. There was no correlation between RC3min and St George's Respiratory Questionnaire scores. CONCLUSIONS: Thoraco-abdominal asynchrony worsens early during 6MWT in patients with moderate and severe COPD and RC3min predicts poor walking capability. A pulmonary rehabilitation strategy devised to improve rib cage excursion may help improve exercise tolerance.
Respiratory care 07/2012; · 2.01 Impact Factor
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ABSTRACT: This study was aimed to investigate the ability of potential indices from epidemiologic surveillance to detect false-positive cultures of Mycobacterium tuberculosis (MTB). All clinical specimens for mycobacterial culture from April 1 to August 31, 2010, were reviewed. Single-positive cultures without relevant clinical and pathologic information were categorized as suspected false-positive cultures. Genotyping methods were used to confirm false-positive cultures. The performance of epidemiologic surveillance indices to detect potential false-positive cultures was evaluated. A total of 14,462 specimens were sent to the laboratory and 214 batches were processed in 107 work days (average 67.6 specimens per batch, ranging from 21 to 130 specimens per batch). Seventy-one single-positive cultures were identified, among which 5 cultures of multidrug-resistant MTB in 1 batch were false-positive, confirmed by genotyping methods. Epidemiologic surveillance with statistical process control charts for single-positive cultures per day showed good performance in epidemiologic surveillance. The false-positive rate was 38.5% in the 13 potential false-positive cultures according to the statistical process control chart for single-positive cultures per day. Although the incidence of tuberculous disease is high in Taiwan, clustering of multidrug-resistant MTB in 1 batch or clustering of single-positive cultures still suggested the occurrence of false-positive MTB cultures. Therefore, epidemiologic surveillance for the clustering of single-positive cultures with the statistical process control chart could be used to monitor the occurrence of false-positive results.
Diagnostic microbiology and infectious disease 06/2012; 73(4):343-9. · 2.45 Impact Factor
