Performance of Loop-Mediated Isothermal Amplification (LAMP)-Lateral Flow Detection and Xpert MTB/RIF Ultra for Diagnosis of Pulmonary Tuberculosis

Background: Due to the limitations of diagnosis by Xpert MTB/RIF assay, WHO suggests Loop—Mediated Isothermal Amplification (TB-LAMP) instead of sputum-smear microscopy for pulmonary TB diagnosis in patients. Dr. Thongchai Kaewphinit et al. invented a fast TB detection kit called TB d-tect (LAMP-LFD assay). There was no clinical trial to estimate the performance of TB d-tect. Objective: This study was aimed to find the performance of LFD assay and Xpert MTB/RIF ultra for pulmonary TB. Material and methods: A cross-sectional study was conducted. Suggestive pulmonary TB patients were enrolled from June 2020-28 February 2021. Respiratory specimens were collected from each patient and sent for AFB smear, LAMP-LFD assay, Xpert MTB/RIF ultra and culture TB. Result: 139 patients with suspected pulmonary TB were enrolled. 51% of patients were diagnosed with pulmonary tuberculosis. Based on culture TB as a gold standard, the sensitivity and specificity of LAMP-LFD assay were 85.4% (95% CI: 70.8% - 94.4%) and 87.8% (95% CI: 79.6 - 93.5), respectively. The sensitivity and specificity of Xpert MTB/RIF ultra were 95.1% (95% CI: 83.5% - 99.4%) and 74.5% (95% CI: 64.7 - 82.8), respectively. According to ROC curve, it was found that the areas under the curve of LAMP-LFD assay and Xpert MTB/RIF ultra were 0.866 and 0.848, respectively (p = 0.546). Conclusion: The diagnostic sensitivity and specificity of LAMP-LFD assay appeared to be comparable to those of Xpert MTB/RIF ultra. LAMP-LFD assay could be used in resource limiting laboratory.

快速现场评估在经支气管针吸活检中的应用进展及存在的问题

对脏器或病变针吸组织行快速现场评估（rapid on-site evaluation,ROSE）,已有多年临床应用历史,尤其近些年在TBNA中应用也日益广泛,然而学者们关于ROSE在TBNA中应用价值等方面认识尚不一致.有研究认为ROSE提高了TBNA的诊断率,具有减少TBNA穿刺数、简便可行的优点[1-2],但也有人提出相反的意见[3-4].本文就ROSE在TBNA中的应用进展和存在的一些问题做简要阐述.

Bronchial thermoplasty

Asthma is a chronic inflammatory disease that affects 300 million people worldwide. Its prevalence rangesfrom 1% to 18% of the population in different countries. The World Health Organization has estimated that 15 million disability-adjusted life years are lost annually due to asthma. Worldwide deaths from asthma are estimated at 250 000 per year. Furthermore, asthma is a major cause of absence from work in many countries, including United States .

Failures in emergency management of pediatric airway foreign bodies by rigid bronchoscopy:we have yet to complete our learning

Background Several children are affected by airway foreign body aspiration(FBA)resulting from life-threatening conditions.Choking has been considered the major symptom and is defined as airway blockage by a foreign body(FB),leading to marked morbidity or mortality.This retrospective study indicates the possibility of misdiagnosis or rigid bronchoscope(RB)failure,which is the standard gold method for extracting FB in the airway.Methods Six children with airway FBA who failed treatment using RB between 2018 and 2019 were retrospectively studied.The inclusion criterion was a history of failure to extract FB using RB followed by flexible fiberoptic bronchoscopy(FFB).Results In the present study,among 63 patients who had undergone rigid bronchoscopy,airway FBs were successfully removed in 57(90.48%).Rigid bronchoscopy failed in 6(9.52%)patients.The age of cases at the time of bronchoscopy ranged from 11 months to 13 years.FFB was performed to extract missing or remaining FBs and was done successfully in all patients.The patients made an uneventful recovery following FB extraction using the FFB method.Conclusions It is not easy to diagnose and treat airway FB in children.Rigid bronchoscopy has been approved as a method to manage airway FB,but a negative bronchoscopy result must usually be interpreted carefully.FFB is applicable as a proper and relatively safe diagnostic and therapeutic tool in managing airway FBs among the pediatric population,especially in cases where rigid bronchoscopy was performed but missed or failed to extract the FB.

Alternatives to surgery in children with mild OSA

Precision medicine requires coordinated and integrated evidence-based combinatorial approaches so that diagnosis and treatment can be tailored to the individual patient.In this context,the treatment approach to mild obstructive sleep apnea(OSA)is fraught with substantial debate as to what is mild OSA,and as to what constitutes appropriate treatment.As such,it is necessary to first establish a proposed consensus of what criteria need to be employed to reach the diagnosis of mild OSA,and then examine the circumstances under which treatment is indicated,and if so,whether and when anti-inflammatory therapy(AIT),rapid maxillary expansion(RME),and/or myofunctional therapy(MFT)may be indicated.