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Objectives Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a standard procedure, but little is known about its infectious complications. The aim of this study is to evaluate the incidence and risk factors of infectious complications of EBUS-TBNA and its clinical course, including effects on anti-cancer treatment. Methods This is a nested case-control study of patients who received EBUS-TBNA and were followed for at least 2 months at Samsung Medical Center from August 2009 to April 2019. Patients with clinical symptoms of infection and correlating chest images were defined as the infection group (n = 33). The controls were randomly selected from patients without infectious complication. Multivariate logistic regression with backward selection was used to identify the risk factors of infectious complications. Results Of the 6826 patients, 33 (0.48%) infectious complications were identified, comprising pneumonia (n = 20) and mediastinal infections (n = 13). Target lesions with necrotic features on chest computed tomography (CT) scan (adjusted odds ratio [aOR], 3.08; 95% confidence interval [CI], 1.49–6.40; P = 0.002) and procedures that were performed via the esophagus (aOR, 3.19; 95% CI, 1.47–6.88; P = 0.003) were independently associated with infectious complications. Among patients ultimately diagnosed with cancer, the infection group tended to refuse anti-cancer treatment compared to controls (32/459, 7.0% vs. 5/30, 16.7%; P = 0.066). However, among the patients who received anti-cancer treatment, there was no delay in onset of treatment. Conclusions Infectious complications of EBUS-TBNA are rare; however, attention should be paid if the target lesion appears necrotic on chest CT or if the procedure is performed via the esophagus. Although it was not conclusive due to its rarity, patients with infectious complications tended not to receive anti-cancer treatment.

This review article aims to address mysteries existing between Interstitial Lung Abnormality (ILA) and Nonspecific Interstitial Pneumonia (NSIP). The concept and definition of ILA are based upon CT scans from multiple large-scale cohort studies, whereas the concept and definition of NSIP originally derived from pathology with evolution to multi-disciplinary diagnosis. NSIP is the diagnosis as Interstitial Lung Disease (ILD) with clinical significance, whereas only a part of subjects with ILA have clinically significant ILD. Eventually, both ILA and NSIP must be understood in the context of chronic fibrosing ILD and progressive ILD, which remains to be further investigated.

Summary Background A serum galactomannan (GM) antigen test has been widely used to diagnose invasive pulmonary aspergillosis. However, there are limited data on the use of the serum GM antigen test for the serologic diagnosis of chronic pulmonary aspergillosis (CPA). Methods Data were collected from all consecutive patients with a clinical suspicion of CPA who underwent a serum GM antigen test. Results In total, 334 patients who were suspected to have CPA were eligible for this study and 168 (50%) patients were finally diagnosed with CPA. The serum GM antigen test was positive in 38 (23%) patients with CPA and in 25 (15%) patients without CPA. The sensitivity of the serum GM antigen test was 23% (95% confidence interval [CI], 17–30%), and its specificity was 85% (95% CI, 79–90%), with positive and negative predictive values of 60% (95% CI, 47–72%) and 52% (95% CI, 46–58%), respectively. The accuracy of the test was 54%. The area under the receiver operating characteristic curve was 0.538 (95% CI, 0.496–0.580). Conclusion The serum GM antigen test could not be used for the serologic diagnosis of CPA.

Lung cancer is the most common solid tumor in critically ill cancer patients admitted to intensive care units and is associated with a poor prognosis. Crizotinib is an anaplastic lymphoma kinase (ALK) inhibitor, which is active for advanced non–small cell lung cancer (NSCLC) patients harboring ALK rearrangements. We report three cases of NSCLC patients who required mechanical ventilation for respiratory failure and were successfully weaned from mechanical ventilation after treatment with ALK inhibitors. These responses were accompanied by minimal toxicities and an overt improvement in performance status. These results suggest that ALK inhibitors may be safe and effective in critically ill patients on mechanical ventilation for respiratory failure resulting from EML4-ALK translocated NSCLC progression.

In vehicular ad hoc networks, most of critical applications involved with safety rely on reliable broadcast communications with low latency. Recently, repetition-based protocols have been proposed to meet the requirements of timeliness and reliability for broadcasting. In these protocols, a sender repeatedly retransmits the broadcast message during the lifetime of the message. However, existing protocols face serious problems such as deterioration of the signal quality caused by wireless fading. In particular, since excessive repetitions might cause network congestion and waste channel resources, reliability of broadcasting should be achieved with as small a number of repetitions as possible. In this paper, we therefore propose a novel repetition-based broadcast protocol which exploits a cooperative diversity technique (called RB-CD) making a small number of repetitions robust for wireless fading. To support this cooperative diversity, neighboring nodes transmit the same message almost simultaneously (that is, using the same repetition pattern for each other) in order to form a virtual antenna array. The virtual antenna array achieves a diversity gain at the receivers. In the RB-CD protocol, the virtual antenna array consists of the source and some of its neighbors (called relays) which participate in repeating the transmission of a broadcast message. In addition, a new distributed relay selection algorithm is introduced in the RB-CD protocol. From the ns-2 simulation results, we verified that RB-CD provides a more reliable broadcasting service due to its capability of exploiting cooperative diversity.