Implementing EBUS TBNA: first experience and review of literature.

Lung cancer has a very dismal prognosis and careful diagnosis and staging is of outmost importance. EBUS has become a cornerstone investigation for diagnosis and staging and current guidelines stress that there is a steep learning curve when introducing this tech- nique in practice (only 30 procedures are considered necessary). Over a period of 10 months a total of 21 patients have been addressed to our unit for an EBUS TBNA procedure. Only three were referred for staging purposes (for lung, digestive and cervix cancers) the others being primary diagnostic approaches where simpler procedures had previously failed. Procedures were initially performed under local anesthesia (3 cases) then under general anesthesia and jet ventilation using a laryngeal mask approach. Mediastinal lymph node group 7 was the most frequent target (9 cases) followed by group 4R (8 cases) and peribronchial tumoral processes (7 cases); one case did not required any needle-aspiration. On average each examination resulted in the sampling of 1.4 targets. There were no significant procedure related severe adverse events. Although 21 G cytology needles were used, adequate histological samples were obtained for 11 cases and cytology was the examination of choice for 9 cases. The pathology/cytology results were retrospectively assessed as satisfactory for 15 cases (confirmed neoplastic or other disease) and inconclusive for 5 cases. Non neoplastic disorders were represented by sarcoidosis, tuberculosis and bronchogenic cyst (3 cases). The procedure can be considered fast and safe; trained pathology personnel play an extremely important role: presently referrals are rare for staging purposes.

EGFR MUTATIONS IN NON-SMALL CELL LUNG CANCER: LOCAL EPIDEMIOLOGY AND CLINICAL IMPORTANCE.

INTRODUCTION: Lung cancer's dismal prognosis led to new therapeutic approaches among which TKIs being among most promising; MATERIAL AND METHOD: Retrospective study at the Regional Institute of Oncology Iasi of non small cell lung cancer patients which underwent molecular investigations between November 2013 - September 2014. EGFR mutation status (positive, negative, undetermined) was assessed with an Entrogen EGFR kit using DNA extracted from paraffin embedded samples (surgical or endobronchial biopsies) with the Macherey-Nagel "NucleoSpin FFPE DNAkit" and then amplified on a Applied Biosystem 7500 Real Time PCR System. RESULTS: There were 63 adenocarcinoma samples (17 females, mean age 60,9 +/- 9 years): 49 primary lung tumors and 14 secondary lesions (brain, lymph nodes, pleural). There was insufficient bioptic material for three cases. TTF1 status was determined for 46 patients--six were negative. There were twelve mutations identified (7 female subjects, 5 male)--six L858R, five Del 19 and one G719X; ten were TTF1 positive for the remaining two TTF1 status was unknown. Female sex predominance was statistically significant (p = 0.02, chi squared). Mean age for mutation positive patients was 64 +/- 10 years; there were three never smokers, three active smokers and no data on smoking status was available for six subjects. CONCLUSION: Although small dimension of the study group precludes statistical significance EGFR mutations seem to correlate with TTF1 status.

Rad52 protein function study by fluorescence tagging.

Rad52 protein plays a significant role in DNA lesions repair by homologous recombination in eukariotic cells. Human Rad52 function somewhat overlaps with BRCA2 and has a role in cell survival in the absence of BRCA1-BRCA2 mediated recombination. Additional Rad52 function analysis and intracellular localization studies are probably necessary. We present a method for Rad22 protein tagging, a Schizosaccharomyces pombe Rad52 homologue, by Crerecombinase-mediated cassette exchange (RMCE) using the versatile pAW8 plasmid. Rad22 protein was C-termini yEGFP tagged; the resulting strain was analyzed by fluorescence microscopy. The yEGFP signal was observed (Rad22 foci) for 7.5 microM camptothecin, 0.005% methyl methanesulfonate, and 4 mM hydroxyurea treated cells. The RMCE method was efficient, and the presence of tagged Rad22 protein was confirmed by Western-Blot and fluorescence microscopy.

Obstructive sleep apnea patients voice analysis.

UNLABELLED: It is generally considered that obstructive sleep apnea may associate larynx abnormalities--either anatomic or functional in nature; considering the vocal tract as a series of uniform loss cylindrical pipes the idea of non-invasively exploring this by means of spectral analysis emerged. The aim of our study is to evaluate potential changes in acoustic features of voice in sleep apnea patients as compared to matched controls in order to develop a potential screening test. MATERIAL AND METHOD: Sleep apnea subjects and controls were asked to produce sustained vowels such as "a" and "i" which were recorded and analyzed. Some parameters were estimated--average of fundamental frequency, peak amplitude variation and compared and others are still to be developed.

[Pulse pressure, arterial compliance and Buckberg index in hypertensive patients treated with nebivolol and nitrates]. / Presiunea pulsului, complianta arterelor de conductanta si irigatia subendocardica la hipertensivii tratati cu nebivolol si nitrati.

OBJECTIVE: To evaluate the effect of nebivolol and nitrate administration on the arterial compliance--an essential factor for left ventricular hypertrophy regression. MATERIAL AND METHOD: The arterial compliance was assessed in 32 hypertensive patients (mean age 52.3 years +/- 11, M/F ratio = 26/6) before drug administration, three hour post oral intake of nebivolol 5 mg and five minutes after sublingual 0.5 mg nitroglycerin. PARAMETERS: mean aortic blood pressure (PAom), pulse pressure (PP), augmentation index (AGIx) and Buckberg index (diastolic pressure-time index/systolic pressure-time index). The statistical significance of the results was determined by means of t-Student test. RESULTS: After nebivolol: PAom decreased from 131.2 +/- 15 mmHg to 118 +/- 15.3 mmHg; PP decreased from 72.5 +/- 12 mmHg to 52.3 +/- 11.3 mmHg; AG decreased from 17 to 10.2 mmHg, AGIx decreased from 26.4% to 22.3%, Buckberg index increased from 145.4 +/- 25% to 161.4 +/- 30%. After nitroglycerin: PAom decreased to 108.5 +/- 12 mmHg; PP decreased to 41.2 +/- 9.3 mmHg; AG decreased to 2.3 mmHg, AGIx decreased to 3.6%, Buckberg index increased to 171.2 +/- 32%. CONCLUSIONS: Nebivolol and nitrates determined a significant lowering of mean aortic pressure and an increase of the arterial compliance suggesting a beneficial effect that could promote the regression of left ventricular hypertrophy.

[The influence of nCPAP therapy on the autonomic nervous system dysfunction in OSA patients]. / Influenta terapiei nCPAP asupra sistemului nervos autonom la pacientii cu SAOS.

UNLABELLED: Obstructive sleep (OSA) can induce severe arrhythmias, including prolonged periods of asystole and heart block. Heart rate variability (HRV) has gained importance as a technique employed to explore the autonomic nervous system (ANS) which plays an important role in arrythmogenesis. AIMS: Our aim was to investigate nocturnal HRV by spectral analysis of RR intervals before and after continuous positive airway pressure (nCPAP) therapy. METHODS: To confirm the relation between OSA and ANS dysfunction, we prospectively investigated ANS function in 24 patients (18 males, mean age 53 years) with moderate or severe OSA. Overnight polysomnography was performed before and after nCPAP therapy. We analyzed apnea/hypopnea index (AHI), desaturation index, mean arterial oxygen saturation, mean and standard deviation (SD) for nocturnal HRV triangular index and pNN50 before and after initiating CPAP treatment. RESULTS: AHI decreased markedly from 51 to 3 events/h, desaturation index decreased from 45.9 to 3.62 events/h, and mean arterial oxygen saturation improved from 92.15% to 94.8%. Nocturnal HRV triangular index decreased from 18.3 to 12.85 as well as nocturnal pNN50 in all patients after initiating nCPAP therapy, suggesting that efficient nCPAP therapy may restore nocturnal autonomic defects, characteristic of severe and moderate OSA, as proven in previous studies. CONCLUSIONS: Abnormalities in cardiovascular variability may be implicated in the subsequent development of cardiovascular diseases in patients with OSA. These results suggest that impaired ANS function is present in patients with OSA and can be improved by successful nCPAP therapy.