Applicability of Endobronchial Ultrasound and Virtual Bronchoscopic Navigation Combined with Rapid On-Site Evaluation in Diagnosing Peripheral Lung Lesions

Background To investigate the value of endobronchial ultrasound (EBUS) and virtual bronchoscopic navigation (VBN) combined with rapid on-site evaluation (ROSE) in diagnosing peripheral pulmonary lesions (PPLs). Methods Between January 1st 2019 to September 1st 2021, EBUS and VBN examination were performed in 250 consecutive patients with PPLs who were admitted to Zhangzhou Affiliated Hospital of Fujian Medical University (Fujian, China). Finally, 198 eligible patients were randomly divided into ROSE group (100 cases) and non-ROSE group (98 cases). The diagnostic yield of brushing and biopsy, the complications, the procedure time, the diagnosis time and expense during diagnosis were analyzed. Results In the ROSE group, the positive rate of EBUS brushing and biopsy were 68%, 84%, repectively. The average procedure time and diagnosis time were 18.6 ± 6.8 min, 3.84 ± 4.28 days, repectively, and the average expense was 4093.15 ± 4494.67 yuan. In the controls, the positive rate of brushing and biopsy were 44%, 74%, repectively. The average procedure time and diagnosis time were 15.4 ± 5.7 min, 6.46 ± 3.66 days, repectively. And the average expense during diagnosis was 6420.28 ± 4541.33 yuan. There was significant difference in the positive rate of EBUS brushing and biopsy, diagnosis time and expense during diagnosis between both groups. And no significant difference was observed in the complications and the procedure time. Additionally, the impact of ROSE on diagnostic yield in right upper lobe and the size of lesion ≤2 cm in diameter was significant. Conclusion In combination with ROSE, EBUS could significantly improve the positive rate of diagnosing PPLs, shorten diagnosis time and reduce expense during diagnosis. ROSE will be of great importance in the diagnosis of PPLs and medical resource.

Merger Control in Hungary

The present study presents the findings of the most comprehensive research that has ever been conducted in relation to the 30-year-old Hungarian merger authorisation process that has been in place since the political transition in Hungary. The aim of the research is, in particular, to present to the wider professional public the development of the authorisation process for mergers (or concentrations) in Hungary, which started in the last decade, and the resulting public value returns that have been achieved. The most important results to emerge from the research are that – compared to 2010 data – the average procedure time for full-scale merger proceedings in 2020 was reduced by 62%, and the administrative time limit for simplified cases decreased by 82.5%. Furthermore, the research revealed that today one-third of the Hungarian Competition Authority’s market interventions in connection with mergers take a verbal/informal form. This study was conducted using the methodology of data processing and analysing that are at the disposal of the Hungarian Competition Authority.

Non-bronchoscopic Bronchoalveolar Lavage as a Refinement for Safely Obtaining High-quality Samples from Macaques

Nonbronchoscopic bronchoalveolar lavage (NB-BAL) is a minimally invasive diagnostic and research tool used to sample the cells of lower airways and alveoli without using a bronchoscope. Our study compared NB-BAL and bronchoscopic bronchoalveolar lavage (B-BAL) in terms of costs, cell yields, and the number of post-procedural complications in macaques. We also analyzed procedure times, BAL fluid volume yields, and vital signs in a subset of animals that underwent NB-BAL. Compared with the B-BAL technique, NB-BAL was less expensive to perform, with fewer complications, fewer animals requiring temporary or permanent cessation of BALs, and higher cell yields per mL of recovered saline. The average procedure time for NB-BAL was 6.8 ± 1.6 min, and the average NB-BAL lavage volume yield was 76 ± 9%. We found no significant differences in respiration rate before, during, or after NB-BAL but did find significant differences in heart rate and oxygen saturation (SpO2). This study demonstrates that NB-BAL is a simple, cost-effective, and safe alternative to B-BAL that results in higher cell yields per mL, improved animal welfare, and fewer missed time points, and thus constitutes a refinement over the B-BAL in macaques.

Three-Dimensional Printed Targeting Device for Scaphoid Fracture Fixation

Background: Percutaneous guide wire insertion for scaphoid screw fixation can be challenging and often requires multiple attempts with significant radiation exposure to the surgical team. A 3-dimensional (3D) printed targeting device has the potential to reduce procedure time and intraoperative radiation exposure. Methods: Our targeting device protocol included a preprocedure computed tomography (CT) scan of a casted cadaver wrist, followed by 3D printing of a customized targeting guide. In a comparison trial, seven orthopedic surgery residents performed percutaneous scaphoid guide wire insertion on different cadaver specimens by both freehand technique and using our targeting device. Radiation exposure and procedure times were compared. All specimens underwent postprocedure CT to assess Kirschner wire (K-wire) accuracy, determined by central third placement. Pre- and postprocedure CT scans from the targeting device group were co-registered to compare planned and actual K-wire trajectories. Results: Using the freehand technique, mean fluoroscopy time was 120 seconds (standard deviation: ±53 seconds) generating 2.45 milligray of radiation. Average procedure time was 21 minutes with a mean of 6.4 (range: 3-9) insertion attempts. A single insertion attempt was made using the targeting device with an average procedure time of 30 seconds and no fluoroscopy exposure. Four K-wires were placed within the central scaphoid in both groups. Using the targeting device, average linear deviation from the planned trajectory was 2.1 mm, while the maximum linear deviation was 3.75 mm. Conclusion: When compared to freehand scaphoid guide wire insertion, our targeting device provides similar accuracy while significantly reducing intraoperative radiation exposure and procedure time.

Warm Season Temperature-Mortality Relationships in Chisinau (Moldova)

Results of the epidemiological study of relationships between air temperature and daily mortality in Chisinau (Moldova) are presented. The research’s main task included description of mortality dependence on different temperature variables and identification of thermal optimum (minimal mortality temperature, MMT). Total daily deaths were used to characterize the mortality of urban and rural populations in April–September of 2000–2008, excluding the extremely warm season of 2007. The simple moving average procedure and 2nd-order polynomials were used for daily mean (Tmean), maximum (Tmax), and minimum (Tmin) temperatures and mortality approximation. Thermal optimum for mortality in Chisinau (15.2 deaths) was observed at Tmean, Tmax, and Tmin about 22°C, 27-28°C, and 17-18°C, respectively. Considering these values as certain cut-points, the correlations between temperature and mortality were estimated below and above MMTs. With air temperatures below its optimal value, each additional 1°C increase of Tmean (Tmax, Tmin) was accompanied by 1.40% (1.35%, 1.52%) decrease in daily mortality. The increase of Tmean and Tmax above optimal values was associated with ~2.8% and 3.5% increase of mortality; results for Tmin were not statistically significant. The dependency of mortality on apparent temperature was somewhat weaker below MMT; a significant relationship above MMT was not identified.

Identification Method for Structural Parameters

A hybrid method for identifying structural parameters is presented in this paper. All the measured and integrated responses are analysed using the identification method with a shift-average procedure to identify the stiffness and damping parameters as well as to reconstruct the unknown seismic input. To evaluate the reliability of the method, the identified structural stiffness is compared with the theoretical value computed from given material and geometric properties.